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Factors predicting metastatic disease in 68Ga-PSMA-11 PET positive osseous lesions in prostate cancer

Bone is the most common site of distant metastatic spread in prostate adenocarcinoma. Prostate-specific membrane antigen uptake has been described in both benign and malignant bone lesions, which can lead to false-positive findings on 68Ga-prostate-specific membrane antigen-11 positron emission tomography (68Ga-PSMA-11 PET). The purpose of this study was to evaluate the diagnostic accuracy of 68Ga-PSMA-11 PET for osseous prostate cancer metastases and improve bone uptake interpretation using semi-quantitative metrics. METHODS: 56 prostate cancer patients (18 pre-prostatectomy, 38 biochemical recurrence) who underwent 68Ga-PSMA-11 PET/MRI or PET/CT examinations with osseous PSMA-ligand uptake were included in the study. Medical records were reviewed retrospectively by board-certified nuclear radiologists to determine true or false positivity based on a composite endpoint. For each avid osseous lesion, biological volume, size, PSMA-RADS rating, maximum standardized uptake value (SUVmax), and ratio of lesion SUVmax to liver, blood pool, and background bone SUVmax were measured. Differences between benign and malignant lesions were evaluated for statistical significance, and cut-off values for these parameters were determined to maximize diagnostic accuracy. RESULTS: Among 56 participants, 13 patients (22.8%) had false-positive osseous 68Ga-PSMA-11 findings and 43 patients (76.8%) had true-positive osseous 68Ga-PSMA-11 findings. Twenty-two patients (39%) had 1 osseous lesion, 18 (32%) had 2-4 lesions, and 16 (29%) had 5 or more lesions. Cut-off values resulting in statistically significant (p<0.005) differences between benign and malignant lesions were: PSMA-RADS ≥4, SUVmax ≥4.1, SUVmax ratio of lesion to blood pool ≥2.11, to liver ≥0.55, and to bone ≥4.4. These measurements corresponded to lesion-based 68Ga-PSMA-11 PET lesion detection rate for malignancy of 80%, 93%, 89%, 21%, 89%, and a specificity of 73%, 73%, 73%, 93%, 60%, respectively. CONCLUSION: PSMA-RADS rating, SUVmax, and SUVmax ratio of lesion to blood pool can help differentiate benign from malignant lesions on 68Ga-PSMA-11 PET. SUVmax ratio to blood pool above 2.2 is a reasonable parameter to support image interpretation and presented superior lesion detection rate and specificity when compared to visual interpretation by PSMA RADS. These parameters hold clinical value by improving diagnostic accuracy for metastatic prostate cancer on 68Ga-PSMA-11 PET/MRI and PET/CT.




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The role of Nuclear Medicine for COVID-19 - Time to act now.




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Letter to the Editor: Who was the first doctor to report the Covid-19 outbreak in Wuhan, China?




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MITIGATE-NeoBOMB1, a Phase I/IIa Study to Evaluate Safety, Pharmacokinetics and Preliminary Imaging of 68Ga-NeoBOMB1, a Gastrin-releasing Peptide Receptor Antagonist, in GIST Patients

Introduction: Gastrin Releasing peptide receptors (GRPRs) are potential molecular imaging targets in a variety of tumors. Recently, a 68Ga-labelled antagonist to GRPRs, NeoBOMB1, was developed for PET. We report on the outcome of a Phase I/IIa clinical trial (EudraCT 2016-002053-38) within the EU-FP7 project Closed-loop Molecular Environment for Minimally Invasive Treatment of Patients with Metastatic Gastrointestinal Stromal Tumours (‘MITIGATE’) (grant agreement number 602306) in patients with oligometastatic gastrointestinal stromal tumors (GIST). Materials and Methods: The main objectives were evaluation of safety, biodistribution, dosimetry and preliminary tumor targeting of 68Ga-NeoBOMB1 in patients with advanced TKI-treated GIST using PET/CT. Six patients with histologically confirmed GIST and unresectable primary or metastases undergoing an extended protocol for detailed pharmacokinetic analysis were included. 68Ga-NeoBOMB1 was prepared using a kit procedure with a licensed 68Ge/68Ga generator. 3 MBq/kg body-weight were injected intravenously and safety parameters were assessed. PET/CT included dynamic imaging at 5 min, 11 min and 19 min as well as static imaging at 1, 2 and 3-4 h p.i. for dosimetry calculations. Venous blood samples and urine were collected for pharmacokinetics. Tumor targeting was assessed on a per-lesion and per-patient basis. Results: 68Ga-NeoBOMB1 (50 µg) was prepared with high radiochemical purity (yield >97%). Patients received 174 ± 28 MBq of the radiotracer, which was well tolerated in all patients over a follow-up period of 4 weeks. Dosimetry calculations revealed a mean adsorbed effective dose of 0.029 ± 0.06 mSv/MBq with highest organ dose to the pancreas (0.274 ± 0.099 mSv/MBq). Mean plasma half-life was 27.3 min with primarily renal clearance (mean 25.7 ± 5.4% of injected dose 4h p.i.). Plasma metabolite analyses revealed high stability, metabolites were only detected in the urine. In three patients a significant uptake with increasing maximum standard uptake values (SUVmax at 2h p.i.: 4.3 to 25.9) over time was found in tumor lesions. Conclusion: This Phase I/IIa study provides safety data for 68Ga-NeoBOMB1, a promising radiopharmaceutical for targeting GRPR-expressing tumors. Safety profiles and pharmacokinetics are suitable for PET imaging and absorbed dose estimates are comparable to other 68Ga-labelled radiopharmaceuticals used in clinical routine.




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CXCR4-targeted positron emission tomography imaging of central nervous system B-cell lymphoma

C-X-C chemokine receptor 4 is a transmembrane chemokine receptor involved in growth, survival, and dissemination of cancer, including aggressive B-cell lymphoma. Magnetic resonance imaging (MRI) is the standard imaging technology for central nervous system involvement of B-cell lymphoma and provides high sensitivity but moderate specificity. Therefore, novel molecular and functional imaging strategies are urgently required. Methods: In this proof-of-concept study, 11 patients with lymphoma of the CNS (CNSL, n = 8 primary and n = 3 secondary involvement) were imaged with the CXCR4-directed positron emission tomography (PET) tracer 68Ga-Pentixafor. To evaluate the predictive value of this imaging modality, treatment response, as determined by MRI, was correlated with quantification of CXCR4 expression by 68Ga-Pentixafor PET in vivo before initiation of treatment in 7 of 11 patients. Results: 68Ga-Pentixafor-PET showed excellent contrast characteristics to the surrounding brain parenchyma in all patients with active disease. Furthermore, initial CXCR4 uptake determined by PET correlated with subsequent treatment response as assessed by MRI. Conclusion: 68Ga-Pentixafor-PET represents a novel diagnostic tool for central nervous system lymphoma with potential implications for theranostic approaches as well as response and risk assessment.




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Targeting Fibroblast Activation Protein:Radiosynthesis and Preclinical Evaluation of an 18F-labeled FAP Inhibitor

Fibroblast activation protein (FAP) has emerged as an interesting molecular target used in the imaging and therapy of various types of cancers. Gallium-68–labeled chelator-linked FAP inhibitors (FAPIs) have been successfully applied to positron emission tomography (PET) imaging of various tumor types. To broaden the spectrum of applicable PET tracers for extended imaging studies of FAP-dependent diseases, we herein report the radiosynthesis and preclinical evaluation of an 18F–labeled glycosylated FAP inhibitor ([18F]FGlc-FAPI). Methods: An alkyne-bearing precursor was synthesized and subjected to click chemistry–based radiosynthesis of [18F]FGlc-FAPI by two-step 18F-fluoroglycosylation. FAP-expressing HT1080hFAP cells were used to study competitive binding to FAP, cellular uptake, internalization, and efflux of [18F]FGlc-FAPI in vitro. Biodistribution studies and in vivo small animal PET studies of [18F]FGlc-FAPI compared to [68Ga]Ga-FAPI-04 were conducted in nude mice bearing HT1080hFAP tumors or U87MG xenografts. Results: [18F]FGlc-FAPI was synthesized with a 15% radioactivity yield and a high radiochemical purity of >99%. In HT1080hFAP cells, [18F]FGlc-FAPI showed specific uptake, a high internalized fraction, and low cellular efflux. Compared to FAPI-04 (IC50 = 32 nM), the glycoconjugate, FGlc-FAPI (IC50 = 167 nM), showed slightly lower affinity for FAP in vitro, while plasma protein binding was higher for [18F]FGlc-FAPI. Biodistribution studies revealed significant hepatobiliary excretion of [18F]FGlc-FAPI; however, small animal PET studies in HT1080hFAP xenografts showed higher specific tumor uptake of [18F]FGlc-FAPI (4.5 % injected dose per gram of tissue [ID/g]) compared to [68Ga]Ga-FAPI-04 (2 %ID/g). In U87MG tumor–bearing mice, both tracers showed similar tumor uptake, but [18F]FGlc-FAPI showed a higher tumor retention. Interestingly, [18F]FGlc-FAPI demonstrated high specific uptake in bone structures and joints. Conclusion: [18F]FGlc-FAPI is an interesting candidate for translation to the clinic, taking advantage of the longer half-life and physical imaging properties of F-18. The availability of [18F]FGlc-FAPI may allow extended PET studies of FAP-related diseases, such as cancer, but also arthritis, heart diseases, or pulmonary fibrosis.




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Semi-automatically quantified tumor volume using Ga-68-PSMA-11-PET as biomarker for survival in patients with advanced prostate cancer

Prostate specific membrane antigen (PSMA) targeting Positron Emission Tomography (PET) imaging is becoming the reference standard for prostate cancer (PC) staging, especially in advanced disease. Yet, the implications of PSMA-PET derived whole-body tumor volume for overall survival are poorly elucidated to date. This might be due to the fact that (semi-) automated quantification of whole-body tumor volume as PSMA-PET biomarker is an unmet clinical challenge. Therefore, a novel semi-automated software is proposed and evaluated by the present study, which enables the semi-automated quantification of PSMA-PET biomarkers such as whole-body tumor volume. Methods: The proposed quantification is implemented as a research prototype (MI Whole Body Analysis Suite, v1.0, Siemens Medical Solutions USA, Inc., Knoxville, TN). PSMA accumulating foci were automatically segmented by a percental threshold (50% of local SUVmax). Neural networks were trained to segment organs in PET-CT acquisitions (training CTs: 8,632, validation CTs: 53). Thereby, PSMA foci within organs of physiologic PSMA uptake were semi-automatically excluded from the analysis. Pretherapeutic PSMA-PET-CTs of 40 consecutive patients treated with 177Lu-PSMA-617 therapy were evaluated in this analysis. The volumetric whole-body tumor volume (PSMATV50), SUVmax, SUVmean and other whole-body imaging biomarkers were calculated for each patient. Semi-automatically derived results were compared with manual readings in a sub-cohort (by one nuclear medicine physician using syngo.MM Oncology software, Siemens Healthineers, Knoxville, TN). Additionally, an inter-observer evaluation of the semi-automated approach was performed in a sub-cohort (by two nuclear medicine physicians). Results: Manually and semi automatically derived PSMA metrics were highly correlated (PSMATV50: R2=1.000; p<0.001; SUVmax: R2=0.988; p<0.001). The inter-observer agreement of the semi-automated workflow was also high (PSMATV50: R2=1.000; p<0.001; ICC=1.000; SUVmax: R2=0.988; p<0.001; ICC=0.997). PSMATV50 [ml] was a significant predictor of overall survival (HR: 1.004; 95%CI: 1.001-1.006, P = 0.002) and remained so in a multivariate regression including other biomarkers (HR: 1.004; 95%CI: 1.001-1.006 P = 0.004). Conclusion: PSMATV50 is a promising PSMA-PET biomarker that is reproducible and easily quantified by the proposed semi-automated software. Moreover, PSMATV50 is a significant predictor of overall survival in patients with advanced prostate cancer that receive 177Lu-PSMA-617 therapy.




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Radioiodine Ablation of Remaining Thyroid Lobe in Patients with Differentiated Thyroid Cancer Treated by Lobectomy. A systematic review and meta-analysis.

Purpose: We aimed to conduct a systematic review and meta-analysis of studies reporting the performance of radioactive iodine therapy (131-I therapy) in differentiating thyroid cancer (DTC) patients requiring a completion treatment following lobectomy. We also evaluated the response to 131-I therapy according to 2015ATA guidelines and the adverse events. Methods: A specific search strategy was designed to find articles evaluating the use of I-131 in patients with evidence of DTC after lobectomy. PubMed, CENTRAL, Scopus and Web of Science were searched. The search was updated until January 2020, without language restriction. Data were cross-checked and any discrepancy discussed. A proportion meta-analysis (with 95%CI) was performed using the random-effects model. Meta-regressions on I-131 success were attempted. Results: The pooled success ablation rate was 69% with better results in patients receiving a single administration of about 3.7 GBq; high heterogeneity was found (I2 85%), and publication bias was absent (Egger test: P = 0.57). Incomplete structural responses were recorded in only 14 of 695 (2%) patients enrolled in our analysis. Incomplete biochemical responses were observed in 8 to 24% of patients, with higher rates (24%) in patients receiving low radioiodine activities (~1.1 GBq) and lower rates (from 8 to 18%) in patients receiving higher activities of radioiodine (~3.7 Gbq). Neck pain due to thyroiditis was reported in up to 18% of patients but, in most cases, symptoms resolved after oral paracetamol or a short course of prednisone. Conclusion: Lobar ablation with 131-I is effective especially when high 131I activities are used. However, the rate of incomplete biochemical response to initial treatment appears to be slightly higher than the classical scheme of initial treatment of DTC. "Radioisotopic lobectomy" should be considered for patients with low-to-intermediate risk DTC requiring completion treatment after lobectomy due to specific individual risk factors and/or patient’s preferences.




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Yttrium-90 Radioembolization: Telemedicine during COVID-19 outbreak, opportunity for prime time.




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PET imaging quantifying 68Ga-PSMA-11 uptake in metastatic colorectal cancer

At diagnosis 22% of colorectal cancer (CRC) patients have metastases and 50% later develop metastasis. Peptide receptor radionuclide therapy (PRRT) with lutetium-177 (177Lu)-PSMA-617 is employed to treat metastatic prostate cancer (PC). 177Lu-PSMA-617 targets Prostate Specific Membrane Antigen (PSMA) a cell surface protein enriched in PC and the neovasculature of other solid tumors including CRC. We performed gallium-68 (68Ga)-PSMA-11 PET-CT imaging of ten metastatic CRC patients to assess metastasis avidity. Eight patients had lesions lacking avidity and two had solitary metastases exhibiting very low avidity. Despite expression of PSMA in CRC neovasculature, none of the patients exhibited tumor avidity sufficient to be considered for 177Lu-PSMA-617 PRRT.




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The Impact of Radiobiologically-Informed Dose Prescription on the Clinical Benefit of Yttrium-90 SIRT in Colorectal Cancer Patients

The purpose of this study was to establish the dose-response relationship of selective internal radiation therapy (SIRT) in patients with metastatic colorectal cancer (mCRC), when informed by radiobiological sensitivity parameters derived from mCRC cell lines exposed to yttrium-90 (90Y). Methods: 23 mCRC patients with liver metastases refractory to chemotherapy were included. 90Y bremsstrahlung SPECT images were transformed into dose maps assuming the local dose deposition method. Baseline and follow-up CT scans were segmented to derive liver and tumor volumes. Mean, median, and D70 (minimum dose to 70% of tumor volume) values determined from dose maps were correlated with change in tumor volume and vRECIST response using linear and logistic regression, respectively. Radiosensitivity parameters determined by clonogenic assays of mCRC cell lines HT-29 and DLD-1 after exposure to 90Y or external beam radiotherapy (EBRT; 6MV photons) were used in biological effective dose (BED) calculations. Results: Mean administered radioactivity was 1469±428 MBq (847-2185 MBq), achieving a mean radiation absorbed tumor dose of 35.5±9.4 Gy and mean normal liver dose of 26.4±6.8 Gy. A 1.0 Gy increase in mean, median, and D70 absorbed dose was associated with reduction in tumor volume of 1.8%, 1.8%, and 1.5%, respectively, and increased probability of vRECIST response (odds ratio: 1.09, 1.09, and 1.10 respectively). Threshold mean, median and D70 doses for response were 48.3, 48.8, and 41.8 Gy respectively. EBRT-equivalent BEDs for 90Y are up to 50% smaller than those calculated by applying protraction-corrected radiobiological parameters derived from EBRT alone. Conclusion: Dosimetric studies have assumed equivalence between 90Y SIRT and EBRT, leading to inflation of BED for SIRT and possible under-treatment. Radiobiological parameters for 90Y were applied to a BED model, providing a calculation method that has the potential to improve assessment of tumor control.




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Integrity of neurocognitive networks in dementing disorders as measured with simultaneous PET/fMRI

Background: Functional magnetic resonance imaging (fMRI) studies have reported altered integrity of large-scale neurocognitive networks (NCNs) in dementing disorders. However, findings on specificity of these alterations in patients with Alzheimer’s disease (AD) and behavioral variant frontotemporal dementia (bvFTD) are still very limited. Recently, NCNs have been successfully captured using positron emission tomography (PET) with F18-fluordesoxyglucose (FDG). Methods: Network integrity was measured in 72 individuals (38 male) with mild AD, bvFTD, and healthy controls using a simultaneous resting state fMRI and FDG-PET. Indices of network integrity were calculated for each subject, network, and imaging modality. Results: In either modality, independent component analysis revealed four major NCNs: anterior default mode network (DMN), posterior DMN, salience network, and right central executive network (CEN). In fMRI data, integrity of posterior DMN was found to be significantly reduced in both patient groups relative to controls. In the AD group anterior DMN and CEN appeared to be additionally affected. In PET data, only integrity of posterior DMN in patients with AD was reduced, while three remaining networks appeared to be affected only in patients with bvFTD. In a logistic regression analysis, integrity of anterior DMN as measured with PET alone accurately differentiated between the patient groups. A correlation between indices of two imaging modalities was overall low. Conclusion: FMRI and FDG-PET capture partly different aspects of network integrity. A higher disease specificity of NCNs as derived from PET data supports metabolic connectivity imaging as a promising diagnostic tool.




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Reshaping the amyloid buildup curve in Alzheimer's disease? - Partial volume effect correction of longitudinal amyloid PET data

It was hypothesized that the brain β-amyloid buildup curve plateaus at an early symptomatic Alzheimer's disease (AD) stage. Atrophy-related partial volume effects (PVEs) degrade signal in hot-spot imaging techniques, such as amyloid positron emission tomography (PET). This longitudinal analysis of amyloid-sensitive PET data investigated the shape of the β-amyloid curve in AD applying PVE correction (PVEC). We analyzed baseline and 2-year follow-up data of 216 symptomatic individuals on the AD continuum (positive amyloid status) enrolled in Alzheimer's Disease Neuroimaging Initiative (17 AD dementia, 199 mild cognitive impairment), including 18F-florbetapir PET, magnetic resonance imaging and mini mental state examination (MMSE) scores. For PVEC, the modified Müller-Gärtner method was performed. Compared to non-PVE-corrected data, PVE-corrected data yielded significantly higher regional and composite standardized uptake value ratio (SUVR) changes over time (P=0.0002 for composite SUVRs). Longitudinal SUVR changes in relation to MMSE decreases showed a significantly higher slope of the regression line in the PVE-corrected as compared to the non-PVE-corrected PET data (F=7.1, P=0.008). These PVEC results indicate that the β-amyloid buildup curve does not plateau at an early symptomatic disease stage. A further evaluation of the impact of PVEC on the in-vivo characterization of time-dependent AD pathology, including the reliable assessment and comparison of other amyloid tracers, is warranted.




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Molecular imaging of PD-L1 expression and dynamics with the adnectin-based PET tracer 18F-BMS-986192

18F-BMS-986192, an adnectin-based human programmed cell death ligand 1 (PD-L1) tracer, was developed to non-invasively determine whole-body PD-L1 expression by positron emission tomography (PET). We evaluated usability of 18F-BMS-986192 PET to detect different PD-L1 expression levels and therapy-induced changes of PD-L1 expression in tumors. Methods: In vitro binding assays with 18F-BMS-986192 were performed in human tumor cell lines with different total cellular and membrane PD-L1 protein expression levels. Subsequently, PET imaging was executed in immunodeficient mice xenografted with these cell lines. Mice were treated with interferon gamma (IFN) intraperitoneally for 3 days or with the mitogen-activated protein kinase kinase (MEK1/2) inhibitor selumetinib by oral gavage for 24 hours. Thereafter 18F-BMS-986192 was administered intravenously, followed by a 60-minute dynamic PET scan. Tracer uptake was expressed as percentage injected dose per gram tissue (%ID/g). Tissues were collected to evaluate ex vivo tracer biodistribution and to perform flow cytometric, Western blot, and immunohistochemical tumor analyses. Results: 18F-BMS-986192 uptake reflected PD-L1 membrane levels in tumor cell lines, and tumor tracer uptake in mice was associated with PD-L1 expression measured immunohistochemically. In vitro IFN treatment increased PD-L1 expression in the tumor cell lines and caused up to 12-fold increase in tracer binding. In vivo, IFN did neither affect PD-L1 tumor expression measured immunohistochemically nor 18F-BMS-986192 tumor uptake. In vitro, selumetinib downregulated cellular and membrane levels of PD-L1 of tumor cells by 50% as measured by Western blotting and flow cytometry. In mice, selumetinib lowered cellular, but not membrane PD-L1 levels of tumors and consequently no treatment-induced change in 18F-BMS-986192 tumor uptake was observed. Conclusion: 18F-BMS-986192 PET imaging allows detection of membrane-expressed PD-L1, as soon as 60 minutes after tracer injection. The tracer can discriminate a range of tumor cell PD-L1 membrane expression levels.




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177Lu-EB-PSMA radioligand therapy with escalating doses in patients with metastatic castration-resistant prostate cancer

Purpose: This study is designed to assess the safety and therapeutic response to 177Lu-EB-PSMA treatment with escalating doses in patients with metastatic castration-resistant prostate cancer (mCRPC). Methods: With institutional review board approval and informed consent, patients were randomly divided into three groups: Group A (n = 10) were treated with 1.18 ± 0.09 GBq/dose of 177Lu-EB-PSMA. Group B (n = 10) were treated with 2.12 ± 0.19 GBq/dose of 177Lu-EB-PSMA. Group C (n = 8) were treated with 3.52 ± 0.58 GBq/dose of 177Lu-EB-PSMA. Eligible patients received up to three cycles of 177Lu-EB-PSMA therapy, at eight-week intervals. Results: Due to disease progression or bone marrow suppression, 4 out of 10, 5 out of 10, and 5 out of 10 patients completed three cycles therapy as planned in Groups A, B, and C, respectively. The prostate-specific antigen (PSA) response was correlated with treatment dose, with PSA disease control rates in Group B (70%) and C (75%) being higher than that in Group A (10%) (P = 0.007), but no correlation between Group B and Group C was found. 68Ga-PSMA PET/CT showed response in all the treatment groups, however, there was no significant difference between the three groups. Hematologic toxicity study found that platelets in Group B and Group C decreased more than those in Group A, and that Grade 4 thrombocytopenia occurred in 2 (25.0%) patients in Group C. No serious nephritic or hepatic side effects were observed. Conclusion: This study demonstrates that 2.12 GBq/dose of 177Lu-EB-PSMA seems to be safe and adequate in tumor treatment. Further investigations with increased number of patients are warranted.




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NEMESIS: Non-inferiority, Individual Patient Meta-analysis of Selective Internal Radiation Therapy with Yttrium-90 Resin Microspheres versus Sorafenib in Advanced Hepatocellular Carcinoma

In randomized clinical trials (RCTs), no survival benefit has been observed for selective internal radiotherapy (SIRT) over sorafenib in patients with advanced hepatocellular carcinoma (aHCC). This study aimed to assess by means of a meta-analysis whether overall survival (OS) with SIRT, as monotherapy or followed by sorafenib, is non-inferior to sorafenib, and compare safety profiles for patients with aHCC. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library up to February 2019 to identify RCTs comparing SIRT as monotherapy, or followed by sorafenib, to sorafenib monotherapy among patients with aHCC. The main outcomes were OS and frequency of treatment-related severe adverse events (AEs grade ≥3). The per-protocol population was the primary analysis population. A non-inferiority margin of 1.08 in terms of hazard ratio (HR) was pre-specified for the upper boundary of 95% confidence interval (CI) for OS. Pre-specified subgroup analyses were performed. Results: Three RCTs, involving 1,243 patients, comparing sorafenib with SIRT (SIRveNIB and SARAH) or SIRT followed by sorafenib (SORAMIC), were included. After randomization, 411/635 (64.7%) patients allocated to SIRT and 522/608 (85.8%) allocated to sorafenib completed the studies without major protocol deviations. Median OS with SIRT, whether or not followed by sorafenib, was non-inferior to sorafenib (10.2 and 9.2 months, [HR 0.91, 95% CI 0.78–1.05]). Treatment-related severe adverse events were reported in 149/515 patients (28.9%) who received SIRT and 249/575 (43.3%) who received sorafenib only (p<0.01). Conclusion: SIRT as initial therapy for aHCC is non-inferior to sorafenib in terms of OS, and offers a better safety profile.




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Impact of 68Ga-PSMA-11 PET on the Management of recurrent Prostate Cancer in a Prospective Single-Arm Clinical Trial

Introduction: Prostate-specific membrane antigen ligand positron emission tomography (PSMA PET) induces management changes in patients with prostate cancer. We aim to better characterize the impact of PSMA PET on management of recurrent prostate cancer in a large prospective cohort. Methods: We report management changes following PSMA PET, a secondary endpoint of a prospective multicenter trial in men with prostate cancer biochemical recurrence. Pre-PET (Q1), Post-PET (Q2) and Post-Treatment (Q3) questionnaires were sent to referring physicians recording site of recurrence, intended (Q1 to Q2 change) and implemented (Q3) therapeutic and diagnostic management. Results: Q1/Q2 response was collected for 382/635 (60%, intended cohort), Q1/Q2/Q3 for 206 patients (32%, implemented cohort). Intended management change (Q1/2) occurred in 260/382 (68%) patients. Intended change (Q1/2) was considered major in 176/382 (46%) patients. Major changes occurred most often for patients with PSA of 0.5 to <2.0 ng/mL (81/147, 55%). By analysis of stage-groups, management change was consistent with PET disease location, i.e. majority of major changes towards active surveillance (47%) for unknown disease site (103/382, 27%), towards local/focal therapy (56%) for locoregional disease (126/382, 33%), and towards systemic therapy (69% M1a; 43% M1b/c) for metastatic disease (153/382, 40%). According to Q3 responses, intended management was implemented in 160/206 (78%) patients. A total of 150 intended diagnostic tests, mostly CT (n = 43, 29%) and bone Scans/NaF-PET (n = 52, 35%), were prevented by PSMA PET; 73 tests, mostly biopsies (n = 44, 60%) as requested by the study protocol, were triggered (Q1/2). Conclusion: According to referring physicians, sites of recurrence were clarified by PSMA PET and disease localization translated into management changes in more than half of patients with biochemical recurrence of prostate cancer.




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Unexplained Hyperthyroglobulinemia in Differentiated Thyroid Cancer Patients Indicates Radioiodine Adjuvant Therapy: A Prospective Multicenter Study

Background: The management for totally thyroidectomized differentiated thyroid cancer (TT-DTC) patients with unexplained hyperthyroglobulinemia remains indeterminate due to evidence scarcity. This multicenter study aimed at prospectively evaluating the response to radioiodine (131I) adjuvant therapy (RAT) and its potential role in risk stratification and causal clarification. Methods: TT-DTC patients with stimulated serum thyroglobulin (Tgoff) levels > 10 ng/mL but no structurally evident disease were consecutively enrolled in five tertiary care institutions. After the administration of 5.55 GBq of 131I, the risk of presence of persistent/recurrent/metastatic DTC (prmDTC) was compared to that before RAT. The causes of hyperthyroglobulinemia were explored and the response to RAT was assessed 6-12 months post RAT. The change in suppressed thyroglobulin (Tgon) level was reported. Results: A cohort of 254 subjects with a median Tgoff of 27.1 ng/mL was enrolled for the analyses. Immediately after RAT, low-, intermediate-, and high-risk were identified in 5.9%, 88.6%, and 5.5% patients, respectively, with no significant difference in risk stratification compared with that before RAT (P = 0.952). During the follow-up (median, 10.6 months), hyperthyroglobulinemia was ultimately attributed to thyroid remnant, biochemical disease, and structural/functional disease in 17.3%, 54.3%, and 28.3% of subjects, respectively. In addition, excellent, indeterminate, biochemical incomplete, and structural/functional incomplete responses were achieved in 18.1%, 27.2%, 36.2%, and 18.5% of patients, respectively. Notably, distribution for either cause of hyperthyroglobulinemia or response to RAT was comparable among the three postoperative risk groups. Tgon levels in patients who merely received RAT declined significantly over time. Conclusion: Our study demonstrated that over 90% of TT-DTC patients with unexplained hyperthyroglobulinemia are stratified as intermediate-high risk, and RAT using 5.55 GBq of 131I reveals biochemical/functional/structural disease and yields non-structural/functional incomplete response in more than 80% patients, suggesting TT-DTC patients with unexplained hyperthyroglobulinemia as explicit candidates for RAT.




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Reported differences between Digital and Analog PET/CT studies




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Editor's Page: Unacceptable Denials




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Receptor-targeted photodynamic therapy of glucagon-like peptide 1 receptor positive lesions

Treatment of hyperinsulinemic hypoglycemia is challenging. Surgical treatment of insulinomas and focal lesions in congenital hyperinsulinism (CHI) is invasive and carries major risks of morbidity. Medication to treat nesidioblastosis and diffuse CHI has varying efficacy and causes significant side effects. Here, we describe a novel method for therapy of hyperinsulinemic hyperglycemia, highly selectively killing beta cells by targeted photodynamic therapy (tPDT) with exendin-4-IRDye700DX, targeting the glucagon-like peptide 1 receptor (GLP-1R). A competitive binding assay was performed using Chinese hamster lung (CHL) cells transfected with the GLP-1R. The efficacy and specificity of tPDT with exendin-4-IRDye700DX was examined in vitro in cells with different levels of GLP-1R expression. Tracer biodistribution was determined in BALB/c nude mice bearing subcutaneous CHL-GLP-1R xenografts. Induction of cellular damage and the effect on tumor growth were analyzed to determine treatment efficacy. Exendin-4-IRDye700DX has a high affinity for the GLP-1R with an IC50 value of 6.3 nM. TPDT caused significant specific phototoxicity in GLP-1R positive cells (2.3 ± 0.8 % and 2.7 ± 0.3 % remaining cell viability in CHL-GLP-1R and INS-1 cells resp.). The tracer accumulates dose-dependently in GLP-1R positive tumors. In vivo tPDT induces cellular damage in tumors, shown by strong expression of cleaved-caspase-3 and leads to a prolonged median survival of the mice (36.5 vs. 22.5 days resp. p<0.05). These data show in vitro as well as in vivo evidence for the potency of tPDT using exendin-4-IRDye700DX. This could in the future provide a new, minimally invasive and highly specific treatment method for hyperinsulinemic hypoglycemia.




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Confirmation of 123I-FP-CIT-SPECT (ioflupane) quantification methods in dementia with Lewy body and other neurodegenerative disorders

Rationale: To conduct a retrospective study comparing three 123I-FP-CIT-SPECT quantitative methods in patients with neurodegenerative syndromes as referenced to neuropathological findings. Methods: 123I-FP-CIT-SPECT and neuropathological findings among patients with neurodegenerative syndromes from the Mayo Alzheimer's Disease Research Center and Mayo Clinic Study of Aging were examined. Three 123I-FP-CIT-SPECT quantitative assessment Methods: MIMneuro (MIM Software Inc.), DaTQUANT (GE Healthcare), and manual region of interest (ROI) creation on an Advantage Workstation (GE Healthcare) were compared to neuropathological findings describing the presence or absence of Lewy body disease (LBD). Striatum to background ratios (SBRs) generated by DaTQUANT were compared to the calculated SBRs of the manual method and MIMneuro. The left and right SBRs for caudate, putamen and striatum were evaluated with the manual method. For DaTQUANT and MIMneuro the left, right, total and average SBRs and z-scores for whole striatum, caudate, putamen, anterior putamen, and posterior putamen were calculated. Results: The cohort included 24 patients [20 (83%) male, aged 75.4 +/- 10.0 at death]. The antemortem clinical diagnoses were Alzheimer’s disease dementia (ADem, N = 6), probable dementia with Lewy bodies (pDLB, N = 12), mixed ADem/pDLB (N = 1), Parkinson’s disease with mild cognitive impairment (N = 2), corticobasal syndrome (N = 1), idiopathic rapid eye movement sleep behavior disorder (iRBD) (N = 1) and behavioral variant frontotemporal dementia (N = 1). Seventeen (71%) had LBD pathology. All three 123I-FP-CIT-SPECT quantitative methods had area under the receiver operating characteristics (AUROC) values above 0.93 and up to 1.000 (p<0.001) and showed excellent discrimination between LBD and non-LBD patients in each region assessed, p<.001. There was no significant difference between the accuracy of the regions in discriminating the two groups, with good discrimination for both caudate and putamen. Conclusion: All three 123I-FP-CIT-SPECT quantitative methods showed excellent discrimination between LBD and non-LBD patients in each region assessed, using both SBRs and z-scores.




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Amyloid PET in Dementia Syndromes: A Chinese Multicenter Study

Cerebral β-amyloid deposits and regional glucose metabolism assessed by positron emission tomography (PET) are used to distinguish between Alzheimer's disease (AD) and other dementia syndromes. In the present multicenter study, we estimated the prevalence of β-amyloid deposits on PET imaging in a wide variety of dementia syndromes and mild cognitive impairment (MCI) within a memory clinic population. Methods: Of the 1193 consecutive patients with cognitive impairment (CI) who received combined 18F-AV45 and/or 11C-PIB PET, 960 were diagnosed with AD, 36 with frontotemporal dementia (FTD), 5 with dementia with Lewy bodies (DLB), 144 with MCI, 29with vascular dementia (VaD), 4 with corticobasal syndrome (CBS) and 15 with unclassifiable dementia. Baseline clinical diagnoses were independently established without access to PET imaging results. ApoE genotype analysis was performed in CI patients and 231 gender- and age-matched controls. Results: Of the 1193 CI patients, 860 (72.1%) were amyloid-positive. The prevalence of amyloid positivity in AD and MCI patients was 86.8% (833/960) and 9.7% (14/144), respectively. In FTD patients, the prevalence of β-amyloid deposits was 5.6% (2/36). In the 4 CBS patients, two were amyloid-positive. Three of the 5 DLB patients showed amyloid positivity, as did 6 of the 29 VaD (20.7%) patients. The ApoE4 allele frequency was significantly increased in amyloid-positive CI patients (30.5%) as compared with other amyloid-negative CI patients (14%) or controls (7.3%). Conclusion: Amyloid imaging may potentially be the most helpful parameter for differential diagnosis in dementia, particularly to distinguish between AD and FTD. Amyloid PET can be used in conjunction with the ApoE4 allele genetic risk test for amyloid deposits.




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Interim PET evaluation in diffuse large B-cell lymphoma employing published recommendations: Comparison of the Deauville 5-point scale and the {Delta}SUVmax method

The value of interim 18F-fluorodeoxyglucose positron emission tomography (iPET) guided treatment decisions in patients with diffuse large B-cell lymphoma (DLBCL) has been the subject of much debate. This investigation focuses on a comparison of the Deauville score and the deltaSUVmax (SUVmax) approach – two methods to assess early metabolic response to standard chemotherapy in DLBCL. Methods: Of 609 DLBCL patients participating in the Positron Emission Tomography-guided Therapy of Aggressive non-Hodgkin Lymphomas (PETAL) trial, iPET scans of 596 patients originally evaluated using the SUVmax method were available for post-hoc assessment of the Deauville score. A commonly used definition of an unfavorable iPET result according to the Deauville score is an uptake greater than that of the liver, whereas an unfavorable iPET scan with regard to the SUVmax approach is characterized as a relative reduction of the maximum standardized uptake value between baseline and iPET staging of less than or equal to 66%. We investigated the two methods’ correlation and concordance by Spearman’s rank correlation coefficient and the agreement in classification, respectively. We further used Kaplan-Meier curves and Cox regression to assess differences in survival between patient subgroups defined by the pre-specified cut-offs. Time-dependent receiver operating curve analysis provided information on the methods’ respective discrimination performance. Results: Deauville score and SUVmax approach differed in their iPET-based prognosis. The SUVmax approach outperformed the Deauville score in terms of discrimination performance – most likely due to a high number of false-positive decisions by the Deauville score. Cut-off-independent discrimination performance remained low for both methods, but cut-off-related analyses showed promising results. Both favored the SUVmax approach, e.g. for the segregation by iPET response, where the event-free survival hazard ratio was 3.14 (95% confidence interval (CI): 2.22 – 4.46) for SUVmax and 1.70 (95% CI: 1.29 – 2.24) for the Deauville score. Conclusion: When considering treatment intensification, the currently used Deauville score cut-off of an uptake above that of the liver seems to be inappropriate and associated with potential harm for DLBCL patients. The SUVmax criterion of a relative reduction of the maximum standardized uptake value of less than or equal to 66% should be considered as an alternative.




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The effects of monosodium glutamate on PSMA radiotracer uptake in men with recurrent prostate cancer: a prospective, randomized, double-blind, placebo-controlled intra-individual imaging study.

The prostate-specific membrane antigen (PSMA) is an excellent target for theranostic applications in prostate cancer (PCa). However, PSMA-targeted radioligand therapy can cause undesirable effects due to high accumulation of PSMA radiotracers in salivary glands and kidneys. This study assessed orally administered monosodium glutamate (MSG) as a potential means of reducing kidney and salivary gland radiation exposure using a PSMA targeting radiotracer. Methods: This prospective, double-blind, placebo-controlled study enrolled 10 biochemically recurrent PCa patients. Each subject served as his own control. [18F]DCFPyl PET/CT imaging sessions were performed 3 – 7 days apart, following oral administration of either 12.7 g of MSG or placebo. Data from the two sets of images were analyzed by placing regions of interest on lacrimal, parotid and submandibular glands, left ventricle, liver, spleen, kidneys, bowel, urinary bladder, gluteus muscle and malignant lesions. The results from MSG and placebo scans were compared by paired analysis of the ROI data. Results: A total of 142 pathological lesions along with normal tissues were analyzed. As hypothesized a priori, there was a significant decrease in maximal standardized uptake values corrected for lean body mass (SULmax) on images obtained following MSG administration in the parotids (24 ± 14%, P = 0.001), submandibular glands (35 ± 11%, P<0.001) and kidneys (23 ± 26%, P = 0.014). Significant decreases were also observed in lacrimal glands (49 ± 13%, P<0.001), liver (15 ± 6%, P<0.001), spleen (28 ± 13%, P = 0.001) and bowel (44 ± 13%, P<0.001). Mildly lower blood pool SULmean was observed after MSG administration (decrease of 11 ± 13%, P = 0.021). However, significantly lower radiotracer uptake in terms of SULmean, SULpeak, and SULmax was observed in malignant lesions on scans performed after MSG administration compared to the placebo studies (SULmax median decrease 33%, range -1 to 75%, P<0.001). No significant adverse events occurred and vital signs were stable following placebo or MSG administration. Conclusion: Orally administered MSG significantly decreased salivary gland, kidney and other normal organ PSMA radiotracer uptake in human subjects, using [18F]DCFPyL as an exemplar. However, MSG caused a corresponding reduction in tumor uptake, which may limit the benefits of this approach for diagnostic and therapeutic applications.




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Discussions with Leaders: A Conversation Between Johnese Spisso and Johannes Czernin




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Time for a Next-Generation Nuclear Medicine Gamma Camera? [NEWSLINE]




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Inclusive Growth and Job Creation in Africa: The Outlook for 2019 and Beyond

Invitation Only Research Event

30 September 2019 - 1:30pm to 2:30pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Abebe Aemro Selassie, Director, African Department, International Monetary Fund
Chair: Elizabeth Donnelly, Deputy Head and Research Fellow, Africa Programme, Chatham House

The IMF projects real GDP growth of 3.3 per cent in 2019 for sub-Saharan Africa but there is a mixed picture across the continent with growth in Mauritania, Senegal, Ethiopia and Rwanda outstripping projected growth rates for South Africa and Nigeria, for example, while a handful of economies seek to emerge from crisis. Yet, as is increasingly well documented, even strong growth has not delivered lasting socio-economic transformation in many contexts. And that most pressing of needs – job creation including to accommodate, in the next 15 years, an increase in the working age population greater than that in the rest of the world combined – remains a pressing concern for governments and societies. With populations continuing to grow at faster rates than economic growth, and a significant proportion of jobs outside agriculture being in the informal sector, investment in formal labour markets is crucial to creating inclusive economic growth.
 
At this event, the International Monetary Fund’s Africa Director, Abebe Aemro Selassie will discuss the outlook for sub-Saharan African economies in 2019 and progress towards achieving inclusive economic growth to accommodate future demographic change.
 
Attendance at this event is by invitation only. 

Yusuf Hassan

Parliamentary and Media Outreach Assistant, Africa Programme
+44 (0) 20 7314 3645




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Violent Extremist Groups in Africa: Local and Global Factors

Research Event

10 October 2019 - 5:00pm to 6:00pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Professor Stig Jarle Hansen, Professor, Norwegian University of Life Sciences; Author, Horn, Sahel and Rift: Fault-lines of the African Jihad
Bulama Bukarti, PhD Candidate, SOAS, University of London; Analyst, Tony Blair Institute for Global Change
Chair: Aoife McCullough, PhD Candidate, LSE

Islamist-inspired radical organizations in Africa have had a historical presence that extends well beyond the more recent emergence of groups including Al Shabaab, Boko Haram, Ansar Dine and Al-Qaeda in the Islamic Maghreb.
  
Despite more than three decades of international efforts to immobilize these organizations, they have proven to be adaptable and resilient, continuing to engage in insurgent campaigns against the state and employing terrorist violence against civilians. As they operate within and across different states and regions, the key to understanding this persistence – as well as the challenges of responding to it – often lies in the interaction between global dynamics and frequently underappreciated local factors.
 
At this event, which will launch the book Horn, Sahel and Rift: Fault-lines of the African Jihad, speakers will discuss key factors leading to the emergence of radical Islamist violence in Africa, its impact and the outlook ahead for African and other actors in addressing these issues.
 
THIS EVENT IS NOW FULL AND REGISTRATION HAS CLOSED. 

Yusuf Hassan

Parliamentary and Media Outreach Assistant, Africa Programme
+44 (0) 20 7314 3645




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Sudan Stakeholder Dialogues: Options for Economic Stabilization, Recovery and Inclusive Growth

3 October 2019

The Chatham House Africa Programme designed the Sudan Stakeholder Dialogues series to help identify the factors that have led to the current economic crisis, the immediate steps that need to be taken to avert collapse and stabilize the economy, and the longer-term structural reforms required to set Sudan on the path to recovery. The project is funded by Humanity United.

Ahmed Soliman

Research Fellow, Horn of Africa, Africa Programme

2019-10-03-Sudan.jpg

An employee removes bread from the oven at a bakery in the Sudanese capital, Khartoum, on 24 May 2019. Photo: Getty Images.

Three private roundtable meetings were convened in the first quarter of 2019, with the aim of generating informed and constructive new thinking on policy options and reforms that could help Sudan build a more economically prosperous, stable and inclusive nation. The roundtables were held under the Chatham House Rule.

The project sought to offer a neutral space for discussion to policymakers and influencers from a broad range of backgrounds: Sudanese government officials, opposition figures, economists, experts on Sudan’s political economy and governance, civil society figures, representatives of international financial institutions, and other international policymakers.

This paper draws together the key themes and findings from each of the three roundtables, ranging from broad structural economic issues to sector-specific priority interventions. It presents options and recommendations for Sudanese leaders, including the transitional government, in support of building a more economically prosperous, peaceful and inclusive nation.




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Forging Inclusive Economic Growth in Zimbabwe: Insights from the Zimbabwe Futures 2030 Roundtable Series

10 October 2019

This briefing note is the result of a collaborative research process with the Zimbabwean private sector, government representatives, industry organizations and experts, drawing on best practice and senior-level insights to identify policy options for long-term economic revival and expansion in Zimbabwe, and pathways for inclusive development.

Dr Knox Chitiyo

Associate Fellow, Africa Programme

Christopher Vandome

Research Fellow, Africa Programme

Caleb Dengu

Development Banking and Finance Specialist

David Mbae

Konrad-Adenauer-Stiftung Resident Representative for Zimbabwe

Central to the research process was the Zimbabwe Futures 2030 roundtable series, complemented by additional interviews and research. Participants at the three roundtables, held in Harare and Bulawayo in the first half of 2019, discussed the necessary policies and business strategies to enable and support the effective implementation of the Mnangagwa administration’s Transitional Stabilisation Programme, Vision 2030, and other longer-term national development plans.

This process was conducted by the Chatham House Africa Programme, the Zimbabwe Business Club and the Konrad-Adenauer-Stiftung (KAS); and in partnership with the Confederation of Zimbabwe Industries for a roundtable in Bulawayo. The project was supported by KAS and the Dulverton Trust.




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Mobilizing Multinational Military Operations in Africa: Quick Fixes or Sustainable Solutions?

Research Event

25 October 2019 - 9:30am to 11:15am

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Professor Tony Chafer, University of Portsmouth
Professor Gordon Cumming, Cardiff University
Dr Roel van der Velde, Cardiff University
Ahmed Soliman, Research Fellow, Horn of Africa, Chatham House
Dr Elisa Lopez Lucia, Université Libre de Bruxelles; University of Portsmouth
Chair: Janet Adama Mohammed, West Africa Programme Director, Conciliation Resources

Peacekeeping missions which have sought to address evolving forms of conflict and instability on the African continent – led by the United Nations, African Union and European Union – have frequently been overstretched.

Across regions including the Sahel, the Horn and West Africa, the issues of violent extremism and criminality – often set against a backdrop of collapsing or severely weakened central states – have led to the mobilisation of a diverse set of new collective responses.

These include notable African-led efforts such as AMISOM in Somalia or more recently the G5 Sahel, where France have played a pivotal role in initiating new and more ad hoc approaches to coalition-building.

As existing multinational missions in Africa continue to evolve on the ground and while new collective opportunities increasingly present themselves, it is critical for policymakers to understand how far such efforts reflect meaningful long-term solutions to the challenges of conflict and insecurity.

At this roundtable event, participants will reflect on how such missions become mobilised and legitimised, the extent to which they can be defined as ‘new’, and whether they represent a truly sustainable means to tackle the issue of conflict in Africa.

This roundtable is held in partnership with Cardiff University and the University of Portsmouth and is supported by the Leverhulme Trust.

Fergus Kell

Projects Assistant, Africa Programme
+ 44 (0) 20 7314 3671




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The Relevance of Intergovernmental Organizations to African States: The International Organization of La Francophonie

Research Event

6 November 2019 - 10:00am to 11:15am

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Louise Mushikiwabo, Secretary General, Organisation Internationale de la Francophonie (OIF)
Chair: Bob Dewar CMG, Associate Fellow, Africa Programme, Chatham House

African states are well represented in intergovernmental organizations linked by official language and colonial history such as the Organisation Internationale de la Francophonie (OIF), the Comunidade dos Países de Língua Portuguesa (CPLP) and the Commonwealth. These organizations aim to provide support in addressing matters of mutual interest – in addition to responding to significant policy challenges such as improving sustainable growth prospects and opportunities to young populations – and citizens are increasingly vocal on key issues such as democracy, human rights and the rule of law. This event series examines the importance of these intergovernmental organizations in working with their members to responsibly and sustainably respond to policy challenges in Africa.

At this event, Louise Mushikiwabo, secretary general of the Organisation Internationale de la Francophonie (OIF), will discuss the organisation’s relevance to African states and the future of the organization on the continent.

THIS EVENT IS NOW FULL AND REGISTRATION HAS NOW CLOSED.

Sahar Eljack

Programme Administrator, Africa Programme
+ 44 (0) 20 7314 3660




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Prospects for Peace and Stability in South Sudan

Research Event

11 November 2019 - 5:00pm to 6:15pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Alan Boswell, Senior Analyst for South Sudan, International Crisis Group
Miklos Gosztonyi, Conflict Analyst, South Sudan, Norwegian Refugee Council
Naomi Pendle, Research Fellow, Firoz Lalji Centre for Africa, London School of Economics
Golda Abbé, Founding Member, Ghidam (Via Skype)
Chair: Teohna Williams, CEO, Business Plan for Peace

South Sudan’s prolonged peace process is approaching a critical juncture. There is uncertainty about whether the country’s political leaders will meet the 12 November 2019 deadline to form a transitional government of national unity – a process already delayed after a revitalized power-sharing deal was signed in September 2018. A political impasse has been caused by a lack of progress on outstanding issues such as deciding on the number of states and reunifying the security forces. The latter issue is seen as critical to preventing the reoccurrence of large-scale violence which would exacerbate already considerable humanitarian needs. Continued mediation by regional and international partners remains important to finding a way forward and preventing a return to widespread conflict.

At this event, a panel of speakers will examine the status of the peace deal, the issue of federalism and subdivision, measures needed to prevent the humanitarian crisis from worsening and opportunities to foster greater security and unity in the country.

THIS EVENT IS NOW FULL AND REGISTRATION HAS CLOSED.

Sahar Eljack

Programme Administrator, Africa Programme
+ 44 (0) 20 7314 3660




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Central and Eastern Europe and Sub-Saharan Africa: The Potential of Investment Partnerships for Mutual Benefit

31 October 2019

Trade between Central and Eastern Europe and sub-Saharan Africa has increased significantly in the last decade and a half. There is a strong case to be made for greater economic re-engagement, especially in terms of investment, that has the potential to support inclusive growth in both regions.

Damir Kurtagic

Former Academy Robert Bosch Fellow, Africa Programme

recycled-containerboard-warehouse_mondi_poland.jpg

Recycled containerboard warehouse, Mondi Group, Poland. Photo: Mondi Group.

Summary

  • There are growing economic links between the economies of Central and Eastern Europe and sub-Saharan Africa in terms of both trade and investment. However, while trade has picked up significantly from pre-EU accession levels, investment has not increased to the same extent.
  • Contrary to common assumption, investment flows are not solely from Central and Eastern Europe to sub-Saharan Africa. In reality, the largest investment flow between the two blocs occurs in the opposite direction – from South Africa into Central and Eastern Europe.
  • Sub-Saharan Africa can benefit from a greater commercial relationship focused on attracting sustainable investment from Central and Eastern Europe. For this to happen, commercial strategies towards Central and Eastern European countries need to be put in place before strategy can be reinforced by greater diplomatic and informational support.
  • For many sub-Saharan African governments, there is no overall targeted approach to attracting Central and Eastern European investors. A notable exception is South Africa, where departments have been established at provincial government level to specifically target investment from Central and Eastern Europe.
  • Sub-Saharan African governments expect Central and Eastern European private-sector investment to result not only in job creation, but also to bring spillover benefits such as the transfer of skills and knowledge to domestic industries.
  • Each sub-Saharan African country, in accordance with its individual circumstances, will need to adopt a discrete mix of administrative reform (particularly aimed at cutting red tape), as well as infrastructural and other policies that improve the business environment and generate investor confidence.
  • Much of the private sector in Central and Eastern Europe is somewhat hesitant to invest in sub-Saharan Africa on a greater scale. Many companies are most comfortable operating within their domestic environment; when they invest abroad, it tends to be in the ‘neighbourhood’ with which they are already familiar. Perceptions of risk are often compounded by popular misperceptions and generalizations about sub-Saharan Africa.
  • Central and Eastern European countries stand to gain from a deeper investment relationship. While greater engagement with sub-Saharan Africa has already been pursued by some countries, most of them focus on trade. Institutional support to companies from Central and Eastern Europe (both public and private) has evolved to a degree, but is still not comprehensive. Information for companies interested in investing is either lacking or not shared in an efficient way. And the greatest challenge is ensuring top-level political engagement.
  • EU membership offers clear opportunities for Central and Eastern European countries to invest sustainably and responsibly in sub-Saharan Africa. Not only is financial support forthcoming, through innovative EU financial instruments, but the availability of information relevant to business and the EU’s extensive diplomatic presence in Africa should help to alleviate some of the concerns of Central and Eastern European investors.




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Côte d'Ivoire’s 2020 Elections: Contestation and Change

Invitation Only Research Event

8 November 2019 - 12:00pm to 1:00pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Hon Guillaume Soro, Chairman, Rassemblement Pour la Côte d’Ivoire (RACI)
Chair: Paul Melly, Consulting Fellow, Africa Programme, Chatham House

As Côte d'Ivoire enters a critical final 12 months before presidential elections scheduled for October 2020, the political atmosphere remains highly uncertain, stoked by the fracturing of the RDR-PDCI alliance and the potential candidacy of a range of high-profile political names. While President Ouattara’s two terms in office have ushered in an improved business environment, with annual economic growth averaging 8 per cent since 2012, political instability over the next 12 months may pose a threat to recent progress and raises wider security concerns in light of the major post-election violence witnessed a decade previously.

At this event, Ivorian presidential contender, and former prime minister and parliamentary speaker, Guillaume Soro, will assess the prime-election context in Côte d'Ivoire and the policies required to deliver inclusive growth and future stability for its citizens.

Attendance at this event is by invitation only. 

Sahar Eljack

Programme Administrator, Africa Programme
+ 44 (0) 20 7314 3660




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Understanding South Africa's Political Landscape

Members Event

14 November 2019 - 6:00pm to 7:00pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Carien du Plessis, Journalist; Co-Author, Understanding South Africa

James Hamill, Associate Fellow, International Institute for Strategic Studies; Author, Africa's Lost Leader: South Africa's Continental Role Since Apartheid

Martin Plaut, Senior Researcher, Institute of Commonwealth Studies; Co-Author, Understanding South Africa

Chair: Pumela Salela, UK Country Head, Brand South Africa 

President Cyril Ramaphosa led the African National Congress (ANC) to electoral victory in South Africa in May 2019. His promise of rooting out corruption and generating job-creating growth resonated with an electorate scarred by corruption scandals and structural economic and racial inequality.

However, divisions within the ruling party have meant that the delivery of these promises has been slow. Complex and often divisive racial dynamics continue to dominate political discourse especially around land reform and economic transformation.

The country’s main opposition party, the Democratic Alliance (DA), faces its own political crisis following the resignation of former leader Mmusi Maimane, bringing into question the role of opposition parties in the young democracy. 

At this event, South African journalists, Martin Plaut and Carien du Plessis, discuss their new book, Understanding South Africa, providing insights into the current and historical trends that define the political fault lines of modern South Africa. Is Ramaphosa shying away from the difficult political decisions necessary to encourage meaningful change in South Africa’s political environment? And how should the international community understand the trends and dynamics that dominate South African politics?

Members Events Team




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Secrecy, spies and the global South: intelligence studies beyond the 'Five Eyes' alliance

6 November 2019 , Volume 95, Number 6

Zakia Shiraz and Richard J. Aldrich

The study of secrecy and spies remain subjects dominated by Anglo-American experiences. In recent years there has been some effort to refocus the lens of research upon ‘intelligence elsewhere’, including the global South. This is partly because of intense interest in the Arab Spring and ‘managed democracy’, placing a wider range of secret services under the spotlight. However, the approach to research is still dominated by concepts and methods derived from studying the English-speaking states of the ‘Five Eyes’ alliance and their European outriders. This article calls for a re-examination of research strategies for Intelligence Studies and for those theorizing surveillance, suggesting that both fields have much to learn from area studies and development studies, especially in the realm of research practice and ethics. If the growing number of academics specializing in intelligence genuinely wish to move forward and examine the global South they will need to rethink their tool-kit and learn from other disciplines. We suggest there is a rich tradition to draw upon.




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Rebel diplomacy and digital communication: public diplomacy in the Sahel

6 November 2019 , Volume 95, Number 6

Michèle Bos and Jan Melissen

Most research on social media as a tool for public diplomacy focuses on its use by recognized international actors to advance their national interest and reputation, deliver foreign policy objectives or promote their global interests. This article highlights the need for paying more attention to non-state diplomacy in conflict situations outside the western world. We examine how rebel groups use new media to enhance their communications, and what the motivations behind this are. Our public diplomacy perspective helps convey the scope of rebel communications with external actors and provides insights for policy-makers seeking to ascertain the nature, intentions and capacities of myriad rebel groups. Our focus is on the Sahel region, where numerous such groups vying for international attention and support make use of multiple social media channels. We analyse two groups in Mali: the MNLA, a Tuareg secessionist group; and Ansar Dine, a Salafist insurgency with ties to Al-Qaeda in the Islamic Maghreb. Our qualitative analysis of Ansar Dine and MNLA communications on several digital platforms helps identify these African rebel groups' international and local framing activities. Rebel groups use public diplomacy nimbly and pragmatically. The digital age has fundamentally changed which stakeholders such groups can reach, and we suggest that social media increase the power they are able to carve out for themselves on the international stage.




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China's ivory bans: enhancing soft power through wildlife conservation

6 November 2019 , Volume 95, Number 6

Jonas Gamso

China has been a major market for elephant ivory for centuries. However, the Chinese government recently enacted bans on imports and exports of ivory (2015) and on the domestic ivory trade (2017). These bans appear to have come in response to intensive influence campaigns and public shaming from domestic and foreign activists, who cited declining elephant populations and highlighted China's role. However, this shaming-narrative is at odds with conventional wisdom regarding Chinese policy-making: China typically resists international pressures and its authoritarian government is thought to be largely insulated from domestic efforts by civil society groups. This article reconciles Beijing's ivory policy with these conventional beliefs about policy-making in China. I argue that the Chinese government saw unique benefits to banning the ivory trade, under growing international scrutiny, as doing so enhanced Chinese soft power while having very little impact on its sovereignty or development. Non-government organizations (NGOs) operating both inside and outside of China played a role as well: NGOs in China helped to shift Chinese public opinion towards favouring the bans, while those operating abroad led public relations efforts to publicize Chinese demand for ivory to foreign audiences. Efforts by the latter group of NGOs intensified pressure on the Chinese government to rein in the ivory market, while increasing the soft power benefits that banning ivory would bring to Beijing.




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Somalia's Electoral Road-Map and Federal Relations

Research Event

15 November 2019 - 10:30am to 11:30am

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Abdirahman Abdishakur Warsame, Leader, Wadajir Party, Federal Republic of Somalia
Chair: Ahmed Soliman, Research Fellow, Africa Programme, Chatham House

As Somalia heads into an electoral cycle, its political landscape and federal picture appear unstable. The federal government is seeking to implement a feasible electoral model that will further the country’s democratic transition ahead of elections set for late 2020 and early 2021. An expanded and more inclusive process will require an agreement on election modalities and approved electoral law, the completion of the constitutional review and improved security provision.
 
Reconciliation and dialogue between the federal government and federal member states will be critical to making further progress on political, security and economic reforms. Recent contestations in the regions of Jubaland, Galmudug and Puntland do not bode well. Somalia’s political leaders are readying themselves for a tough contest with several opposition parties recently merging to form the Forum for National Parties (FNP), led by former President Sharif Sheikh Ahmed.
 
At this event, the Abdirahman Warsame, leader of the Wadajir Party, will analyse the political and federal transition in Somalia and give his perspective on how to improve the often-fractious relationship between the centre and the regions.
 
THIS EVENT IS NOW FULL AND REGISTRATION HAS CLOSED.

Sahar Eljack

Programme Administrator, Africa Programme
+ 44 (0) 20 7314 3660




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POSTPONED: Connecting Infrastructure Development and Inclusive Economic Growth in Côte d'Ivoire

Research Event

13 March 2020 - 4:00pm to 5:00pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Hon Bruno Nabagné Kone, Minister of Construction, Housing and Urban Planning, Republic of Côte d'Ivoire

Strong economic growth in Côte d'Ivoire – with annual GDP growth averaging eight per cent since 2012 – is interlinked with an increase in spending on national infrastructure. In 2018, the government announced a $7 billion injection for the sector over five years, for projects including a new 7.5km bridge spanning two districts of Abidjan and a highway extending to Burkina Faso. A public-private partnership to build a new $1.5 billion metropolitan railway system in the capital received formal approval in October 2019.

But the government of Côte d'Ivoire has struggled to make the country’s impressive growth inclusive: Côte d’Ivoire ranked 165th out of 189 on the 2019 United Nations Human Development Index, and the poverty rate is around 46%. Translating significant infrastructural investment into benefit for ordinary and vulnerable Ivorian citizens, including through how project development is managed with communities, will be a critical issue in the lead up to elections scheduled for October 2020 and beyond.

PLEASE NOTE THIS EVENT IS POSTPONED UNTIL FURTHER NOTICE.

 

Sahar Eljack

Programme Administrator, Africa Programme
+ 44 (0) 20 7314 3660




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Diversity and Unity: African Agency in International Affairs

22 November 2019

Professor Carlos Lopes

Associate Fellow, Africa Programme
More and more, African countries are able to act in concert to stand up for the interests of the continent.

2019-11-22-AU.jpg

Delegates leave the plenary hall of the Africa Union headquarters in Addis Ababa in January 2018. Photo: Getty Images.

The conventional wisdom is that Africa is at the periphery of international affairs, and the perpetual subject – or victim – of decisions by powerful political or economic actors from outside the continent. The argument then goes on that the diversity of African countries, their atomization and fragmentation, further weakens the ability of the continent to act as a unified whole. As with much cliché about Africa, it does not tell the whole story. 

Soft vs hard power

There is no denying that the structure of international affairs, built on foundations which preceded the independence of the vast majority of African states, places limits on the continent’s ability to independently shape the course of its development and its international engagements. African countries lack the hard power that would typically allow them to be bolder in the global scene.

But Africa has long found softer approaches to exercise its agency, through international institutions and diplomatic arrangements. The collective mobilization at the level of the UN, leading up to the successful 1969 declaration by the General Assembly of apartheid as a crime against humanity, is a good example of early post-independence collective influence.

The last two decades have further empowered African countries, as economic development has been translated into increased diplomatic capacity, and socioeconomic potential has given weight to a more assertive leadership.

There are many examples, including: the successful integration of African priorities in the Sustainable Development Goals, notably financing for development; the push to include a substantial climate financing component for developing countries in the Paris Agreement; enhanced coordination between African non-permanent members of the UN Security Council; the condemnation of the International Criminal Court; or the solid resistance to reversals of the Doha Round at the World Trade Organization.

A fragmented unity?

It is also correct to note that individual African countries are quite diverse. Today, there are 55 member states of the African Union (AU); 30 are middle income economies with the rest towards the bottom of various indexes measuring progress and wellbeing. Socioeconomic and political divergences undeniably exist within the continent. But these factors have not prevented the continent from demonstrating some impressive feats of collective agency.

The internal processes put in place by the AU have created a level of continental diplomacy which is more coordinated than any other continental block bar the EU. African countries have also proved adept at using other diplomatic alliances to exercise collective agency, for instance as the most powerful voice within the G77, a coalition of developing nations.

Africa’s Future in a Changing Global Order: Agency in International Relations

HE Jakaya Kikwete, former president of the Republic of Tanzania, addresses a Chatham House conference on the role that African states and citizens play in international relations.

This has allowed Africa to build tactical alliances with countries and blocs from across the globe, resisting being drawn into any one sphere of influence. It has thus retained ultimate control of decision-making, even on issues of traditional ‘hard’ politics, notably the establishment of the African Peace and Security Architecture and the subsequent building of African capacity to collectively manage its peace and security efforts.

Among other things, this collective political will has powered African opposition to a formal permanent presence of US Africa Command (AFRICOM) and helped resolve conflicts from West Africa to Zimbabwe and Lesotho.

Another extraordinary example of collective political resistance can be observed in the trade discussions taking place between Africa and Europe. The EU is Africa's number-one trading partner. It designed and aggressively promoted new bilateral economic partnership agreements (EPAs) at a time when Africans were busy putting together a continental free-trade area. The apparent imbalance between the collective weight of the EU and the weakness of African states seemed likely to end African aspirations to continental integration.

But, to the surprise of many, the majority of African countries were able to resist pressure to sign the EPAs. Almost 20 years into the negotiations, only 15 countries have signed them, with 5 of these being interim agreements. Comparatively, 54 African countries signed the African Continental Free Trade Area agreement in 2018, and 28 have so far ratified.

The ongoing debate between Europe and Africa on migration is an equally useful illustration of how the continent has become more protective of its interests. Despite pressure, the continent has collectively resisted attempts to externalize the EU’s internal migration management challenges to Africa. Rather, it has emphasized finding solutions that would also benefit its nationals through a mobility framework that privileges the management of intra-Africa migration.   

Diversity and unity

There are of course different levels of agency at work. The power of African countries is uneven both vis-à-vis the international community and within the continent itself, where development pathways are increasingly divergent. Achieving collective positions and joint action demands the careful balancing of regional and bilateral objectives and assuaging multiple – and sometimes contradictory – concerns. It is not easy in Africa, like for any other region.

However, there is no denying that Africans have realized the need for bolder action in the international arena, and the importance of unity in achieving their goals. The call by Africa’s leaders for the reform of their continental organization, the AU, demonstrates their recognition of its current limitations. This must now go beyond good intentions.

This article is the first of a series on African agency in international affairs.




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The Horn of Africa and the Gulf States: Strategic Engagements and Red Sea Geopolitics

Invitation Only Research Event

16 December 2019 - 9:00am to 12:15pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Ambassador Mohamed Ali Guyo, IGAD Special Envoy for the Red Sea, Gulf of Aden and Somalia
Julian Reilly, UK Special Envoy for the Red Sea and Horn of Africa
Parfait Onanga-Anyanga, United Nations Special Envoy for the Horn of Africa
Alexander Rondos, EU Special Representative for the Horn of Africa
Chair: Susan Stigant, Director of Africa Programs, United States Institute of Peace

Over the last five years, the prevailing order in the Horn of Africa has been influenced by increasing engagement from the Gulf states across the Red Sea. Their growing presence has presented governments in the region with significant policy challenges, as they seek to leverage interest and competition to further their own objectives with Gulf players and their allies, while simultaneously navigating the multiple overlapping tensions and disputes that have long marked the Horn region.

Balancing regional and global dynamics will continue to be a considerable challenge for states in the Horn that already have to deal with complex internal development and political and conflict challenges. Interventions by the Gulf states have heightened tensions around internal and cross-border relationships but they have also contributed to reconciliation and have the potential to fuel long-term regional economic integration. Developing a collective action plan and coordinated strategies for engagement on common issues with the Gulf states and along the shared Red Sea arena will enable countries in the Horn of Africa to better meet the challenges and benefits from external interest.

This high-level invitation-only roundtable will bring together the special envoys and representatives for the Horn of Africa and Red Sea, along with expert participants, to analyse regional dynamics and explore options to boost collaboration and burden-sharing towards greater integration, development and more durable peace and security on both sides of the Red Sea.

Event attributes

Chatham House Rule

Sahar Eljack

Programme Administrator, Africa Programme
+ 44 (0) 20 7314 3660




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Economic Recovery and Anticorruption in South Africa: Assessing Progress on the Reform Agenda

Invitation Only Research Event

4 December 2019 - 3:00pm to 4:00pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Professor Nick Binedell, Founding Director and Sasol Chair of Strategic Management, Gordon Institute of Business Science (GIBS), University of Pretoria

South Africa has significant economic potential based on its resource endowment, quality human capital and well-developed infrastructure compared to the region. However, the country’s economic growth rate has not topped 2 per cent since 2013, and in 2018, was below 1 per cent. This has put a strain on citizens and communities in a country that still suffers from structural inequality, poverty and high unemployment. Economic recovery and anti-corruption were the central pillars of President Cyril Ramaphosa’s 2019 electoral campaign and he has set an investment target of $100 billion. However, voters and investors alike are demanding faster and more visible progress from the country’s enigmatic leader who has a reputation for caution and calculation.

At this event, Professor Nick Binedell will discuss the progress of and opposition to the president’s economic reform agenda and the opportunities for international investment to support long term inclusive and sustainable growth in South Africa.

Attendance at this event is by invitation only. 

Event attributes

Chatham House Rule

Sahar Eljack

Programme Administrator, Africa Programme
+ 44 (0) 20 7314 3660




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Can the New European Commission Deliver on Its Promises to Africa?

4 December 2019

Fergus Kell

Projects Assistant, Africa Programme

Damir Kurtagic

Former Academy Robert Bosch Fellow, Africa Programme
Familiar promises of equal partnership must be backed by bolder action, including an expanded budget, internal reform and a rethink of its approach to trade negotiations.

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Jutta Urpilainen, new EU commissioner for international partnerships, at the European Parliament in Brussels in October. Photo: Getty Images.

The new European Commission, headed by Ursula von der Leyen, assumed office on 1 December, and there are early signs that Africa will begin near the top of their foreign policy priorities. Policy towards Africa under the new EU administration is yet to be fully defined, but its contours are already visible in the selection of commissioners and assignment of portfolios.  

Although rumours of a dedicated commissioner for Africa were unfounded, the appointment of Jutta Urpilainen to the new role of commissioner for international partnerships – replacing the former post of development commissioner – is a strong signal of ongoing change in EU development thinking, away from bilateral aid towards trade and investment, including by the private sector. 

This may have significant consequences for the EU’s relationship with Africa. In her mission letter to Urpilainen in September, von der Leyen listed the first objective as a new ‘comprehensive strategy for Africa’. Urpilainen, Finland’s finance minister before being posted to Ethiopia as special representative on mediation, has also described her appointment as an opportunity to move on from traditional measures of aid delivery. 

Ambition or incoherence? 

However, this ambition may be at odds with other EU priorities and practices, notably managing migration and institutions and instruments for governing EU–Africa relations that remain rooted in a ‘traditional’ model of North–South development cooperation rather than equitable partnership.

Another newly created post will see Margaritis Schinas assume the role of vice-president for promoting the European way of life – formerly ‘protecting our European way of life’ before a backlash saw it changed – a reminder that migration will remain high on the EU’s foreign policy agenda. The new high representative for foreign and security policy and chief EU diplomat, Josep Borrell, has highlighted the need for bilateral partnership with countries of origin and transit, mainly in Africa. 

Negotiations also continue to stall on a replacement to the Cotonou Agreement, the 20-year partnership framework between the EU and the African, Caribbean and Pacific (ACP) group of states, which now looks certain to be extended for at least 12 months beyond its expiry in February 2020.

Ambiguities in the EU’s negotiating approach have certainly contributed to the delay: having pushed initially for a separate regional pillar for Africa that would be opened to the North African countries (who are not ACP members) and include a loosely defined role for the African Union, this would later be abandoned in favour of a dual-track process on separate new agreements with the AU and ACP respectively.

The EU also continues to pursue controversial economic partnership agreements under the aegis of Cotonou, despite their increasing appearance of incompatibility with the pathbreaking African Continental Free Trade Area (AfCFTA) – one of the clearest expressions to date of African agency.

The EU has so far attempted to gloss over this incoherence, claiming that EPAs can somehow act as the ‘building blocks’ for Africa-wide economic integration. But tensions are appearing between EU departments and within the commission, with the European External Action Service inclined to prioritize a more strategic continental relationship with the AU, while the Directorate-General for International Cooperation and Development remains committed to the ACP as the conduit for financial support and aid delivery.

And it is unlikely to get away with such incoherence for much longer. Change is now urgent, as numerous countries in sub-Saharan Africa continue to attract the strategic and commercial interests of the EU’s competitors: from established players such as China and potentially in future the UK, which is intent on remodelling its Africa ties post-Brexit, to emerging actors such as Turkey or Russia, which held its first Africa summit in October. 

The need for delivery

If the EU is serious about its rhetoric on equal partnership, it must therefore move beyond convoluted hybrid proposals. Delivering on the Juncker administration’s proposal to increase funding for external action by 30 per cent for 2021–27 would mark an important first step, particularly as this involves streamlining that would see the European Development Fund – the financial instrument for EU-ACP relations – incorporated into the main EU budget.

The new commission should therefore continue to exert pressure on the European Council and European Parliament to adopt this proposal, as negotiations on this financial framework have been repeatedly subject to delay and may not be resolved before the end of the year. 

Beyond this, proactive support for the AfCFTA and for structural transformation more broadly must be prioritized ahead of vague promises for a continent-to-continent free trade agreement, as held out by Juncker in his final State of the Union address in 2018. 

The significance of internal EU reforms for Africa should also not be discounted. The EU’s Common Agricultural Policy, for instance, has placed the African sector at a particular disadvantage and has made it harder to compete even in domestic markets, let alone in the distant EU export markets. EU efforts to stimulate inflows of private investments into the African agricultural sector, abolish import tariffs and offer technical support for African producers to satisfy EU health and safety regulations will be of little use if they are undermined by heavy subsidies across Europe.

Ultimately, changes to job titles alone will be insufficient. The new commission’s rhetoric, while ambitious, differs little from that of the previous decade – Africa has heard the promise of a ‘partnership of equals’ and of ‘shared ownership’ since before the advent of the Joint Africa–EU Strategy in 2007. Now is the time for truly bold steps to implement this vision.




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The African Continental Free Trade Area Could Boost African Agency in International Trade

10 December 2019

Tighisti Amare

Assistant Director, Africa Programme

Treasure Thembisile Maphanga

Director, Trade and Industry, African Union Commission (2012–19)
The agreement, which entered into force in May, could be a major step for Africa’s role in international trade, if the continent can overcome barriers to implementation.

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Delegates arrive at the closing ceremony of the African Union summit in Niger in July. Photo: Getty Images.

The entry into force of the African Continental Free Trade Area (AfCFTA) on 30 May, after only three years of negotiations, is an economic, political and diplomatic milestone for the African Union (AU) and its member states, crucial for economic growth, job creation, and making Africa a meaningful player in international trade. But the continent will have to work together to ensure that the potential benefits are fully realized.

A necessary innovation

With its advances in maintaining peace and security, abundant natural resources, high growth rates, improved linkages to global supply chains and a youthful population, Africa is emerging as a new global centre of economic growth, increasingly sought after as a partner by the world’s biggest economies. Governments from across Africa have been taking a more assertive role in international markets, including through proactive diversification of trading partners, and the continent remains a strong advocate for the multilateral trading system.

However, this is not yet reflected in outcomes. The African Union does not have observer status at the World Trade Organization, despite diplomatic efforts in the past decade. Africa has less than a three per cent share of global trade, and the growing trend towards protectionism across the global economy may only increase the vulnerability of a disunited Africa. Its fractured internal market means that trade within Africa is lower than for any other region on the globe, with intra-African trade just 18 per cent of overall exports, as compared to 70 per cent in Europe.

The AfCFTA is the continent’s tool to address the disparity between Africa’s growing economic significance and its peripheral place in the global trade system, to build a bridge between present fragmentation and future prosperity. It is an ambitious, comprehensive agreement covering trade in goods, services, investment, intellectual property rights and competition policy. It has been signed by all of Africa’s states with the exception of Eritrea.

It is the AU's Agenda 2063 flagship project, brought about by the decisions taken at the January 2012 African Union Summit to boost intra-African trade and to fast track the establishment of the Continental Free Trade Area. It builds upon ambitions enshrined in successive agreements including the Lagos Plan of Action and the Abuja Treaty. Access to new regional markets and reduced non-tariff barriers are intended to help companies scale up, driving job creation and poverty reduction, as well as attracting inward investment to even Africa’s smaller economies.

The signing in 2018 of the instruments governing the Single Air Transport Market and the Protocol on Free Movement of Persons, Right of Residence and Right of Establishment provided another step towards the gradual elimination of barriers to the movement of goods, services and people within the continent.

Tests to come

However, while progress is being made towards the ratification of the AfCFTA, much remains to be done before African countries can fully trade under its terms. The framework for implementation is still under development, and the creation of enabling infrastructure that is critical for connectivity will take time to develop and requires extensive investment.

Africa’s Future in a Changing Global Order: Africa’s Economic Diplomacy

Treasure Thembisile Maphanga talks about the international implications of the African Continental Free Trade Agreement (AfCFTA).

So, the first test for the AfCFTA will be the level to which Africa’s leaders make it a domestic priority, and whether a consensus can be maintained across the AU’s member states as the costs of implementation become clear.

There is no guarantee that the gains of free trade will be evenly distributed. They will mainly depend on the extent to which countries embrace industrialization, liberalization of their markets and opening of their borders for free movement of goods and people – policies that some incumbent leaders may be reluctant to implement. Political will to maintain a unified negotiating position with diverse stakeholders, including the private sector, will come under increasing stress.  

A second challenge is how the AfCFTA relates to already existing trade arrangements, notably with the EU.  The AU has long preferred to pursue a continent-to-continent trading arrangement instead of the bilateral Economic Partnership Agreements being sought by the EU under the African, Caribbean and Pacific (ACP) framework to which, with the exception of Algeria, Egypt, Libya, Morocco, Tunisia and South Africa, all African states belong. The signing of the AfCFTA is one important step towards making this possible.

But there are currently negotiations under the ACP to replace the Cotonou Accord (the framework governing trade between ACP members and the EU, including Economic Partnership Agreements [EPAs], that is due to expire in 2020). Negotiations on the African pillar of the accord are due to take place after the AfCFTA has entered into force. So African states and the AU will face the challenge of balancing their commitment to the ACP bloc with pursuing their own interests.

And though the AfCFTA should supersede any other agreements, the EPAs or their successors, will continue to govern day-to-day trading, in parallel to the new pan-African market. It is not yet clear how these contradictions will be reconciled.

A new role for the AU?

The AU will need to play an active role as the main interlocutor with Africa´s international trading partners, with the AfCFTA secretariat being the arbiter of internal tensions and trade disputes. The AU´s engagement at continental level has to date revolved mainly around headline political diplomacy, security and peacekeeping. With the continental free market becoming a reality, an effective pivot to economic diplomacy will be critical for growth and development.

With the AfCFTA, the AU has endeavoured to address Africa’s unsustainable position in global trade, to stimulate growth, economic diversification and jobs for its growing population. Much will depend on the commitment of African leaders to maintaining a unified negotiating position to implement the agreement and the AU’s capacity to effectively move from political to economic diplomacy.




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Can Liberation Movements Really Rid Southern Africa of Corruption?

17 December 2019

Christopher Vandome

Research Fellow, Africa Programme
Southern Africa’s national liberation movements have survived ‘end of decade’ elections across the region. Combating corruption has been at the heart of many of the campaigns, but the question is can they succeed?

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Supporters of the Namibian incumbent president and ruling party South West Africa People's Organisation (SWAPO) presidential candidate Hage Geingob cheer and dance. Photo by GIANLUIGI GUERCIA/AFP via Getty Images.

Swapo’s victory in Namibia two weeks ago was the last in a series of recent ‘end of decade’ elections that have returned dominant parties to power across Southern Africa. However, the “enduring appeal of liberation” is wearing thin.

Experiences across the region show that if governments are to deliver on their electoral promises, they must empower institutions, actively promote a culture of accountability and transparency within their party ranks and pursue economic reforms that untangle the web of party-state-business alliances. Such actions are critical for the survival of national liberation movements as the dominant force in the politics of Southern Africa – but will be difficult to implement.

Avoid political factionalism

South Africa, Botswana, Angola and Zimbabwe all saw new presidents take over just before elections. All used the rhetoric of anti-corruption to distance themselves from the tainted image of their predecessors. But acting on this requires a shift in mind-set in parties that have always preferred to deal with their problems behind closed doors. High profile adversaries from past regimes make tempting targets but could also drive party divisions.

In Angola, the transition of power was safeguarded by an agreement that former president José Eduardo dos Santos would be immune from prosecution. But this week his son faced corruption charges before the country’s supreme court, a high-profile example of a wave of anti-corruption cases across Southern Africa, driven by dominant parties wary of their future.

The allegations against José Filemino De Sousa Dos Santos, nickname ‘Zenu’, include a $500-million fraud involving the country’s central bank. Pressure is also mounting on Zenu’s sister Isabel — once prominent in Angola, she is now absent from public life.

Other leaders have had to tread more carefully. Immunity was a luxury Cyril Ramaphosa was neither willing nor politically able to grant Jacob Zuma in South Africa. Reliant on a few close allies at the top of the party, Ramaphosa lacks foot soldiers at the grassroots level, and his campaign against corruption within the ANC has faced persistent opposition.

Rebuilding institutions and empowering authorities takes time, and with few high-profile cases to point to, people are getting restless. This is also the case in Zimbabwe, where a worsening economic situation has left policy reformers politically isolated.

Party, state, and business

Long term incumbency has blurred the distinction between the party and the state. Liberation movements have created vast party-linked business empires. Political allegiance grants access to economic resources through appointments to lucrative positions in state-owned enterprises, preferential bids for tenders and licenses, and direct access to decision makers.

In Angola, this was fuelled by oil revenues. In South Africa, state capture flourished in an environment where the ANC and its constituent elements had significant power on the panels that chose leaders for state-owned enterprises (SOEs). In Namibia, an Icelandic fishing company paid backhanders to officials for fishing rights in what has become known as the ‘Fishrot’ scandal. Zanu-PF officials’ access to preferential foreign exchange rates present them with lucrative opportunities in Zimbabwe.

Ending this bureaucratic rent seeking goes beyond appointing ‘clean’ officials, which has been central to the anti-corruption campaigns in Angola and South Africa. Governments must also allow scrutiny of the state and empower those institutions designed for that role, such as the National Prosecuting Authority and the Public Protector in South Africa. Zimbabwe’s auditor general has published an in-depth report of the state of corruption in the country’s SOEs.

Companies must also be held to account for their role in aiding, and at worst directly benefitting, from state graft. International businesses have actively sought to benefit from corruption. They are now starting to face the consequences. A former Credit Suisse banker has pleaded guilty in the US over handling alleged kickbacks in Mozambique’s $2-billion “tuna bond” scandal. Global banks and consultancies continue to feel the squeeze for their complicity in state capture in South Africa.

Competition and pluralism

National liberation movements may only have a limited window within which to act. Across the region civil society campaigns and investigative journalists have shed light on some of the worst abuses of power. Anti-corruption campaigns are starting to bite. The state will continue to play a central role in Southern African economies, an important arbiter of economic transformation able to balance the region’s highly unequal and resource-dependent economies.

But opposition, civil society and the media are also critical for the progression towards democratic competition and pluralism in Southern Africa. Parliaments remain vital for holding rulers to account. Long used to unchallenged dominance, liberation movements have significant adjustments to make to rise to the challenge of a new era.

This article was originally published in the Mail and Guardian.




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African Agency Holds Power to Account in a Social Media Age

18 December 2019

Yusuf Hassan

Parliamentary and Media Outreach Assistant, Africa Programme

Waihiga Mwaura

News Anchor, Citizen TV Kenya
Structures to support more in-depth investigative journalism are vital in Africa because that seems to be the only thing those in power still truly fear.

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Broadcast technicians work in a control room during the official launch of the Digital Terrestrial Television (TNT) in February 2019 near Abidjan, Ivory Coast. Photo by ISSOUF SANOGO/AFP via Getty Images.

Africa’s media landscape has undergone a significant change over the last decade as digitalization and new forms of media consumption have weakened state control of information. Social media has provided an opportunity for African citizens and journalists to take agency over how the continent is presented to the wider world, and many emerging African voices bring clarity to this digitally disrupted marketplace. But significant external support is required to make these efforts sustainable.  

There is no one ‘African’ story. African media remains as diverse as the 55 states in the African Union, with each national media ecosystem dependent on patterns of culture and governance - most importantly the power gap between those in leadership and their voters.

Journalists from Egypt, Eritrea and Cameroon - states in the 2019 global top 10 for putting their colleagues in prison - have different perspectives from those in other more liberal African countries.

This is most visible in traditional media where a business model based on advertising revenue has allowed African media houses to grow. But it is susceptible to manipulation from state and business actors holding outlets to ransom in exchange for editorial influence or control – a particularly acute problem in states where business and political elites are closely intertwined, and a middle-class consumer base to fund market-driven advertising has yet to develop.

Those African countries with relatively open borders, stronger passports and a more vibrant civil society also tend to have a more diverse and vibrant media environment. Open borders allow for easier movement, granting journalists the opportunity to travel, benchmark and participate in exchange programs.

The power of online networking

The advent of the social media age has begun to disrupt the links between governance and media health, as the large operations required by ‘serious’ media organizations have been replaced by mobile phone cameras and social media timelines.

Many African journalists are at the forefront of this innovation, unrestricted by historical perceptions of how journalism should be presented, and free to disrupt and change the established narratives to better engage with their ever-growing audiences.

And, far from replacing journalism, social media has actively empowered African journalists and media professionals. Instead of acting as sources for international media outlets as in the past, African journalists can publish their work on their own platforms, enabling greater ownership of how issues in their localities are globally framed. This local voice is often the key to avoiding the endemic oversimplifications and generalisations that have coloured much external coverage of the continent.

Obviously, these changes bring risks. Individual uploaders are largely free to publish what they like, and misinformation can - and often has - lead to devastating consequences, evident in recent violence across central Mali, South Africa and the middle belt of Nigeria.

But journalists on the African continent have an increasingly important role in preventing the spread of misinformation, not only as purveyors of news but also as fact-checkers, able to discern the difference between valid opinion and dubious rhetoric on social media, while new pan-African digital networks and discussion groups enable journalists to share knowledge, expertise, and story ideas, or quickly verify information from across the continent.

It is now possible to quickly find authentic voices for TV, radio or online commentary through digital platforms, present on the ground and able to speak with real authority. Many online networks also include Africa-focused journalists from outside the continent, and any biased or incorrect coverage of the African continent can be ‘called out’ and heavily critiqued, with challenges shared and solutions generated. While journalists remain independent, their working practices and professional standards are being shaped by the discourse in the groups like never before.

Online networking has also exposed the existence of lingering cultural differences between journalists of different national backgrounds, such as a hesitancy to discuss sensitive issues – the health of leaders for instance – for fear of being targeted by the authorities, or the level to which government statements are uncritically accepted.

While journalists search for truth, how they go about it is still very dependent on the state of democracy in their country. Though the cross-fertilisation of best practices and critical scrutiny can only improve the quality of journalism on the continent, in many places there remains a long way to go.

Drive for better resources

Across the world, digital media has struggled to create models which can provide news free at the point of access while also successfully monetizing content. This is even more palpable on the African continent, as the subscription-based models employed as a remedy elsewhere are not feasible on such a large scale in countries without a well-established middle-class.

African media needs resources to keep operating at a time when revenue is dwindling, and talented journalists are decamping to join the marketing, communication and sales sectors in search of better wages. Structures to support more in-depth investigative journalism are vital in Africa because that seems to be the only thing those in power still truly fear.

This means more training opportunities, fellowships, and exchange programs to allow the exchange of ideas and expertise. And, as social media has given a platform to talented local voices from across Africa, then an international community which truly wants to understand the nuances of the continent must hire them.   




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Africa’s Long-standing Leaders Are Disappearing

3 January 2020

Dr Alex Vines OBE

Managing Director, Ethics, Risk & Resilience; Director, Africa Programme
Leaders who cling to power are being pushed out across the continent, and the trend looks set to continue in 2020.

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A man holds a portrait of Robert Mugabe during his official funeral ceremony. Photo: Getty Images.

Africa’s dinosaur leaders are members of an increasingly small and unstable club. Popular protests last year forced Algeria’s president, Abdelaziz Bouteflika, out of office after almost 20 years in power, as well as Sudan’s president, Omar al-Bashir, who ruled for 30 years. In 2017, Robert Mugabe was deposed in a military coup (although this was denied) after 40 years. 
And in 2011, mass protests led to the downfall of Tunisia’s president, Zine el-Abidine Ben Ali, after he had been in power for 23 years.

Somewhat smoother are the political transitions in Angola and the Democratic Republic of the Congo (DRC). José Eduardo dos Santos, after almost 38 years in power, stepped down from office in 2017 as his term ended. So did his younger neighbour, Joseph Kabila, in January 2019, after 18 years in the presidency.

What the six former leaders had in common was that they wanted to remain heads of state and considered succession planning or stepping down only as a last resort. This year will be crucial for the six countries in political transition particularly as the reform-window period is short.

From A to Z 

Algeria: Tens of thousands of protesters have rallied in the capital Algiers and other cities against the December 2019 elections, rejecting what they see as sham transitional politics. A soft landing for Algeria in 2020 is unlikely, and what happens in the year has significant regional implications.

Angola: A transition is under way, led by President João Lourenço. This shift is smoother than many others, but 2020 will be the watershed year. The country has been in economic recession for four years but is predicted to see gross domestic product growth in 2020. Investment and job creation will determine the pace of change. The honeymoon period has ended and there are signs of increasing frustration among the urban youth and the middle class.

DRC: Despite his constitutionally mandated term expiring in December 2016, Joseph Kabila continued his presidency by continuously postponing elections until 30 December 2018. This election saw a three-way contest between the Union for Democracy and Social Progress (UDSP), the Engagement for Citizenship and Development party and the People’s Party for Reconstruction and Democracy (PPRD). Fèlix Tshisekedi of the UDSP was declared the winner by the Independent National Electoral Commission on January 10 last year with 38.6% votes. He was followed by Martin Fayulu of the Engagement for Citizenship and Development party, with 34.8%. He denounced the election results. In third place was Emmanuel Ramazani Shadary, of the PPRD, a key ally of Kabila.

Although this was the first peaceful transition of power in DRC, there were widespread electoral inconsistencies and some observers believed that Fayulu was the legitimate winner. In 2020 it will become clearer whether a genuine transition from Kabila’s influence is taking place.

Sudan: More promising than the DRC or Algeria, a 39-month transitional administration led by a technocratic prime minister, Abdalla Hamdok, has been established and enjoys domestic and international goodwill. This honeymoon is likely to be short, and the transitional administration needs to show results. The United States can help by removing Sudan from its terror list, thereby lifting the de facto ban on Sudan’s access to the dollar-based international financial system.

Tunisia: A low-profile, conservative law professor beat a charismatic media magnate released from prison in the presidential election runoff in October 2019. Kais Saied won 70% of the vote and his victory and the putting together of a new governing coalition is another step forward in an open-ended democratic transition that started in 2011 after Ben Ali fell.

Zimbabwe: This is a deeply troubled transition with an acute foreign exchange liquidity crisis, a deteriorating economy, hyperinflation and underperforming government. The state’s clinics and hospitals are closed or turn away patients as medical supplies run out and the doctors’ strike over decimated wages continues. There are power outages and almost half of the people face hunger and starvation as a result of drought and the economic crisis.

Zimbabwe’s 2020 looks bleak, a far cry from the euphoria of two years ago when a “military assisted transition” removed Mugabe and replaced him with Emmerson Mnangagwa.

More changes coming

So what do these political developments in 2019 tell us more broadly?

Long-standing leaders have been persistent in Africa, despite the end of single-party rule in favour of a multiparty system. About a fifth of all African heads of state since independence can be classed as long-standing leaders — in power for more than a decade — and only five countries have never experienced one. But the trend is in decline.

It remains most resilient in central Africa and in the Great Lakes regions. Cracks are appearing in their citadels in Malabo and Kampala, but in 2019 Equatorial Guinea’s President Teodoro Obiang Mbasogo celebrated 40 years in power and Uganda’s Yoweri Museveni 33 years.

Will there be any more departures from the dinosaurs club in 2020?

One of the shortest serving members of this club, President Pierre Nkurunziza (14 years in power) has said he will not stand for the 2020 elections in Burundi, although this is uncertain given that a 2018 constitutional referendum could allow him to stay in power until 2034. Togo’s Faure Gnassingbé (14 years in power) will stand for re-election to the presidency again after Parliament in 2019 approved a constitutional change permitting him to potentially stay in office until 2030.

Amending constitutions to change term limits so that incumbent leaders can run for office is a favoured tactic. Rwanda’s Paul Kagame (19 years in office) and the Republic of Congo’s Denis Sassou Nguesso (25 years in power) have done this. But Eritrea’s Isaias Afwerki has never held an election during his 16 years in power.

Attempts at dynasties have been less successful, such as with Grace Mugabe in Zimbabwe or Gamal Mubarak in Egypt, but Obiang is grooming his playboy son Teodorin to succeed him and Gabon’s Ali Bongo and Togo’s Gnassingbé both succeeded their fathers.

The year is a reminder that more of these long-standing leaders will, in 2020 and beyond, step down or die. Most long-standing leaders in Africa are over the age of 70, with Paul Biya, aged 86, having served 37 years as Cameroon’s president.

Some former leaders capitulated under internal pressure: in Algeria, Sudan, Tunisia and Zimbabwe. Only in Angola and the DRC was a transition process organized as part of an elite bargain.

What the political transitions have in common is that honeymoons are short and that, whether they are led by interim administrations or elected leaders, they need to deliver political and socioeconomic improvements to succeed, but have inherited shambolic economies. Their success depends on accountable political leadership and domestic and international support.

This article was originally published by the Mail & Guardian.