Thursday, July 31, 2014

Why Many Girls From Troubled Lands (incl: Indonesia) Don't Want A One-Way Ticket To America


The words of Alina, a young women who is living on the front lines of global climate in Nepal, are stuck in my head. At the end of the trailer for An Inconvenient Youth, a documentary that tells the truth about climate change, Alina says, “I love this place. I love the mountains. I love the rivers. I love my earth.” She isn’t looking for a way out of Nepal – she wants to fix the home she loves.


Alina isn’t alone. Over the past five years, I’ve heard her message echoed by many girls, especially the delegates of the G(irls)20 Summit that brings together girls from each G20 country (plus the European & African Unions, Afghanistan, Pakistan and the MENA region) to design solutions that will economically advance girls around the world. Like Alina, these girls want to stop the brain drain. That doesn’t mean they don’t want to explore, learn and have an impact on the world. What it means is that they aren’t looking for a one-way ticket to America. I asked four G(irls)20 delegates to tell me what needs to be fixed in their countries and why they must be a part of the solution:

Ayendha Kukuh Pangesti, Age 20, Indonesia

When Ayendha went to college, she saw things she didn’t see at home: people who are unemployed, faced with poverty and have limited access to education, information and technology. She asked a sixth-grade village girl what college she wants to attend and the little girl’s response made her sad. The girl told her that she will not go to college because her education will end when she graduates from elementary school, when she (and her friends) will begin working and waiting to get married.

Ayendha says that although Indonesia has a gender equality program, there is a gap between men and women, especially in the rural areas. The biggest gaps are in education, labor force and health. She explains, “These three aspects are like a never-ending loop and stem. But my biggest concern is relations between the labor force and education. Low income impacts education because those families prefer to employ their children rather than educate them. Girls become victims and marry at a young age to survive.” The solution isn’t easy and it’s a repeat of what we’ve been hearing for years: Women and girls need to be educated so they can get jobs and be paid fairly for their work. That’s when girls will begin to dream, their confidence will rise and women will no longer be second-class.

As an educated woman, Ayendha believes that helping other women have the same rights as she does is not an option, but an obligation. “Especially as a delegate representing Indonesia at the G(irls)20 Summit, I have the duty to take an active role to assist the government in its goals to empower Indonesian women,” she says. “This opportunity is also a good tool to socialize and promote awareness of gender equality in the media so this issue is not only a burden on the government, but also the society.”

Ayendha talks about what she’s doing to fix the problem, “Considering that Indonesia is rich in agriculture and almost all regions have an unique agricultural potential, I have a big project named ‘Women Agripreneurship’.” The core of this project is to empower women in agriculture and create value to their local community. One of the Agripreneurship programs she’s working on is called “Talas Day” (talas is a vegetable, also known as taro, that is grown in Southern India and Southeast Asia). Starting in the village of Situgede where they grow and sell taro as low priced raw material, the Agripreneurship program will educate women to cultivate taro into high value products that will help their families, their region and the nation’s economy. Through this program volunteers will provide training, facilitate access to capital and government donors, help market the products and socialize the program so more villages are inspired. “I hope this Women Agripreneurship program can be applied to other areas with their local commodities in agriculture,” says Ayendha. “In this way, step by step, many women in Indonesia can become entrepreneurs and pillars for their families and the country.”

Misato Oi, Age 19, Japan

Born and raised in Kyoto, one of the most historical cities in Japan, and witnessing Japanese traditions die, Misato Oi, wants to revive the importance of the Japanese culture because she believes it will have a ripple effect. Misato says, “Our lives will be more sustainable as Japanese culture is very sustainable with a spirit of reusing things. And it will help the Tokyo Olympics be more successful as cultural promotion should be one of the keys in attracting more tourists.” She adds to that thought, “Our culture has been handed down from generation to generation. In some cases people took great risks to hand down the culture. I feel a strong responsibility to hand down our ancestors’ wisdom to the next generation, with a pride of being Japanese. Another reason is related to my future dream to set up a cultural business that can help protect and promote Japanese traditions.”

But Misato isn’t waiting, she’s taking action now. “As a member of the Kyoto University International Business Studying Society (KUIBSS), I work to protect Japan’s traditional agriculture, specifically the sericulture industry (production of raw silk by raising silkworms),” she says. “KUIBSS supports old men and women who are protecting traditional sericulture in the Fukushima Prefecture, one of the most affected areas from the earthquake that hit Japan in 2011. At one time, Japan was a ‘silk power’ that exported 80% of the world’s supply. Most of the silk was from Fukushima and an area called Oshu (includes Fukushima). The fact that Fukushima supported Japan’s prosperity as the number one silk supplier was a sense of pride for Fukushima, a sense of pride that could be a mental support to Fukushima’s earthquake disaster reconstruction. However, [as a result of the earthquake] Fukushima’s sericulture is endangered.”

After working with farmers to learn the process of sericulture, KUIBSS and Misato started producing 100% Fukushima stems. Then they negotiated a deal with cotton mills to make kimono fabric with Fukushima stems and even created new kimono products that are being sold in a traditional kimono shop. They succeeded in making 100% Fukushima silk kimonos and found a way to sell them. Misato says, “This is how we are making a difference locally at the same time spreading the awareness globally.”

María del Rosario Margarita Liuzzi (Maggie Liuzzi), Age 21, Argentina (Ambassador, 2013 Delegate)

“In Argentina we are tackling many inequality issues by giving transfers of money called ‘social plans’ to many poor people, making this one of the main expenses of the state,” says Maggie. “Those expenses are covered by debt or monetary emissions, principally the latter, which usually lead to high inflation rates. The problem is that those plans, although necessary and helpful in the short-term, do not give the right incentives, as they are given to the unemployed (which often goes against the will to find a job), or women with more than a certain amount of children (which often makes them have more kids in order to receive the plan, as sad as this may sound) and create a strong dependence, among other consequences.”

Maggie believes that microcredit could be an extremely impactful tool if correctly implemented: “It consists of small credits, mainly with productive and entrepreneurial purposes. These allow households to start their own small business, often related to clothing, food and services which otherwise would be unachievable because of a lack of credit access from banks, as they do not have enough traditional warranties or savings to offer. Without them, the only viable alternative is to approach a local informal lender, who often charges ridiculous interest rates and sometimes provokes abusive pressuring situations in the communities.”

Maggie will graduate as an economist this year and is writing her thesis on microcredit. She knows that social problems require solutions beyond money: “This year I participated in microcredit programs from different organizations in Buenos Aires, such as “TECHO,” as a credit assessor. Women play an essential role in the field, as they shape the vast majority of microcredit recipients and have an increasing responsibility towards the household economy. However, I think there is still a lot of improvement to struggle for in terms of sustainability of the microfinance organizations and of the businesses started by the micro-entrepreneurs. We must put more effort in helping them throughout the formalization processes, which is the only way for them to start thinking about it as a future asset and not only as a current source of income. The role of the organizations is not only to give a credit but also to provide entrepreneurial training.”

Maggie is very interested in information and communication technologies and is considering doing a Master’s in that area. She says, “It would be a totally new world for me, but it thrills me how impactful it can get in various spheres of life. For now, the link between IT and development has not been sufficiently explored and the idea of doing it myself captivates me.”

Fernanda Gabrielle Lagoeiro, Age 20, Brazil

Fernanda lives in Campinas, a countryside city in São Paulo, Brazil. She is studying Journalism at PUC-Campinas University and her goal is to become an international correspondent.

“Brazil’s main problems are education, health, violence, unemployment, corruption and poverty,” says Fernanda. “But I believe that education is the highest deficit we have because it can turn everything on a cycle. We need to create a “new model” of mentality, entrepreneurship, management, education, health and politics. A model that includes corporate social responsibility, a model that helps people understand that we live in an ordinary world and social problems are unfortunately a part of our lives, and we are responsible for changing them.”

That model begins with formal and informal education. Fernanda adds, “Non-formal education includes a variety of educational programs and activities outside the classrooms. It promotes, amongst others, the concept of lifelong learning and provides wide access to information. It can also empower vulnerable groups, specially in cases where access to the formal education system is limited.”

It’s a problem that Fernanda says needs to be attacked locally and globally. She says, “If you want to change the world, start by cleaning your bedroom.” And she’s starting with what she loves, writing combined with the power of social media: “Social networks can help me share information and improve education and health through the power of writing, mixing my hability with my wish to solve a big problem.” She’ll start with a blog that focuses on education and health.

Going back to her own bedroom, Fernanda is a Lupus carrier (auto immune disease) and she wants to help others. She says, “I have been working on a project, seeking partnerships to create an online platform to support Lupus carriers, who are mostly young women, in order to work on their self-respect, knowledge about the disease and treatment options, and to help them conquer their fears and lead a normal life. I also intend for it to become a book in the future.”

And she’s counting on youth to help change Brazil because she believes her generation has the power to push the government to make better decisions. She uses the word “awake.” But first youth must be educated and put their knowledge into practice. She says, “The future I want is one in which all people have the opportunity of high equality education and health, and understand the importance of inalienable human rights. I want people to be engaged on putting in practice what they learned, and to be able to ask and search about what was once ignored. That’s an action that would make Brazil grownup in a developed way… I believe we can make significant changes with simple words or actions.”

About the G(irls)20 Summit: “The 2014 goal is to see action from G20 leaders that backs up their verbal commitment to engaging women in the economy,” says Farah Mohamed, President & CEO G(irls)20. With a focus on entrepreneurship, youth unemployment, agriculture and technology, the summit will be held in Australia on August 25-26.


Forbes by Denise Restauri

CHINA’s Xi’s anti-corruption campaign still leaves rule of law by the wayside



Members of the Politburo Standing Committee of the Chinese Communist Party collectively rule a nation of 1.3 billion people, making them China's most powerful group of political leaders.

The party has decided to open a formal corruption investigation into Zhou Yongkang, one of the nine members of the paramount policymaking body of the previous administration of President Hu Jintao. The party’s anti-graft watchdog announced it is investigating Zhou for “serious violations of party discipline.”

The 71-year-old Zhou is said to have been implicated in a large web of corruption. He is the highest-ranking Communist Party figure to face a formal criminal investigation since the country embarked on economic reform in the late 1970s.

Taking on endemic corruption within the party is the right thing to do.

But it needs to be pointed out that the unusual move to bring criminal charges against such a powerful politician is part of the political battle waged by the current administration of President Xi Jinping to solidify its power base.

Zhou was head of a state-owned oil company. It is believed that he used money he had earned illicitly from the oil business to build up a corrupt network of people cemented by interests.

China’s leadership may appear to be monolithic, but in fact the innermost circles of the party and the state include people with widely different agendas and motives. Each section of the government tends to become an interest group. The Xi administration recently launched a series of campaigns against such corrupt interest groups.

After the top official of the Ministry of Railways was charged with corruption, the ministry was dismantled and its functions were taken over by three separate organizations at the time the Xi administration was inaugurated.

Gen. Xu Caihou, who was once one of the country’s most senior military officials, was expelled from the party after being accused of accepting bribes.

Now, the administration is targeting the oil sector’s entrenched interests in its campaign to purge the party of corruption.

Zhou is said to have close ties with former President Jiang Zemin. There must have been fierce resistance within the party to the move against Zhou.

Immediately after Zhou retired from the Politburo Standing Committee in 2012, the government started detaining people around him, including high-ranking officials and business big shots.

The Xi administration then began to make efforts to prepare public opinion for actions against influential politicians by stressing that even high-level officials would not be exempted from its anti-graft campaign.

The investigation into Zhou came after careful and meticulous efforts to corner the former security chief.

It can safely be assumed now that Xi has built a solid power base for his leadership.

The Communist Party Central Committee’s plenary session last year called for judicial reform, and the rule of law is expected to be high on the agenda during this year’s session, to be convened in October.

There are some fundamental questions, however, about whether the action against Zhou will contribute to the efforts to establish the rule of law in China.

The decision to investigate the former member of the Politburo Standing Committee was made by the party leadership, not by the judiciary.

Once the party’s inquiry discovers his violations, he will be stripped of party membership and subjected to the legal process of criminal justice.

The whole system is based on the assumption that the Communist Party’s power is superior to judicial power. The party leadership is considered infallible.

Stamping out corruption to build a fair society is a worthy policy goal. If this goal is merely a political tool used by the powers that be to buttress the party’s monopoly on power, however, there will be limits to what this undertaking can achieve.

As for the rule of law, China has a Constitution that enumerates the people’s rights.

But the party has been cracking down on many legal and academic experts campaigning for the realization of constitutional government. The reality of China’s government is a far cry from the rule of law.

What China really needs is an effective system for the rule of law that can expose and punish the crimes of even top party leaders. Establishing such a system is the proper way to root out systemic corruption.

--The Asahi Shimbun

 

The Haqqani Threat to the US-Pakistan Détente


America and Pakistan have seen relations improve in recent months. Unfortunately, the Haqqani network could derail this.

The Haqqani network — a family-run syndicate that happens to be one of South Asia’s most fearsome militant groups — has long been a source of tension for the volatile U.S.-Pakistan relationship. And it’s easy to understand why.

U.S. military officials often describe the Haqqani network as one of its biggest threats in Afghanistan. John Allen, who commanded U.S. and NATO forces in Afghanistan from July 2011 to February 2013, says the group wounded or killed more than 500 of his troops. It’s been blamed for an attack on the U.S. embassy in Kabul. It held Bowe Bergdahl, the only U.S. POW in Afghanistan, in captivity. It has close associations with Al-Qaeda, and the State Department has formally designated it as a terrorist organization (this status does not apply to the Afghan Taliban, with which the Haqqani network is affiliated).


The Haqqani network also has links to Pakistan’s security establishment, which views the group as a strategic asset that limits the influence of archrival India in Afghanistan (it frequently assaults Indian targets in Afghanistan). In 2011, Mike Mullen, then the Chairman of the Joint Chiefs of Staff, infamously described it as a “veritable arm” of Pakistan’s main intelligence agency. An angry Pakistan rejected the accusation and threatened to cut off ties with Washington.

Last year, unknown gunmen assassinated Nasiruddin Haqqani, one of the group’s top leaders. Tellingly, he was not gunned down in an isolated, mountainous, tribal-area redoubt — but rather as he strolled into a bakery in the suburbs of Islamabad, Pakistan’s capital (Rawalpindi, the city that houses military headquarters, is nearby).

For years, Haqqani fighters enjoyed a sanctuary in Pakistan’s North Waziristan tribal agency. Washington (to the irritation of Islamabad) pressured Pakistan relentlessly to target this safe haven, but to no avail.

Then, in recent weeks, Pakistan changed course and launched a military offensive in North Waziristan. Islamabad insists that its offensive is targeting all militant groups, including the Haqqani network. Pakistani officials report that the offensive has driven the group into Afghanistan, and they are asking U.S. forces to go after it there. In effect, Pakistan wants the United States, and its Afghan allies, to serve as the anvil to Pakistan’s hammer.

This should all be music to Washington’s ears. Unfortunately, it is not. That’s because the offensive is happening several years too late, and because there’s little reason to believe Pakistan’s claims about targeting the Haqqani network are actually true. As a result, U.S.-Pakistan relations face a new crisis rooted in an old problem.

Had Pakistan’s North Waziristan operation been launched several years earlier, at the height of the U.S. military surge in Afghanistan, then U.S. forces would have been in a strong position to handle an influx of fighters from Pakistan. Yet today, U.S. forces are headed for the exits.

Afghan troops aren’t in much of a position to help either. They have their hands full with a resurgent Taliban, which is staging stepped-up assaults. These have produced offensives in Helmand and Kandahar provinces and actual takeovers of territory in areas outside the cities of Kabul and Jalalabad. Some might argue that Pakistan’s North Waziristan offensive, by unloading Haqqani network fighters into Afghanistan, is contributing to this increased unrest in Afghanistan. The Afghan government, for its part, has blamed the Haqqani network for two recent major attacks — a mass-casualty market bombing and an assault on Kabul’s airport.

In effect, at the very moment U.S. forces are seeking some semblance of a smooth withdrawal from Afghanistan, a Pakistani military offensive is flushing some of the most ruthless anti-Afghan militants into that nation amid an intensified insurgency.

And it could get even worse.

Many Pakistani Taliban (TTP) fighters are based in eastern Afghanistan. The TTP (which mainly attacks the Pakistani state) and Haqqani network may focus on different targets, but they each share the same hardline ideology and loyalty to Afghan Taliban leader Mullah Omar. This all suggests that Haqqani fighters could conceivably cooperate operationally with TTP (and Afghan Taliban) forces in Afghanistan. Incidentally, one of the TTP’s founding leaders, the late Baitullah Mehsud, was once a Haqqani network commander.

At the same time, there’s little reason to believe Pakistan’s security establishment truly wants to take on its long-time trusted asset. Why would it want to sever ties now, given the uncertainties of Afghanistan’s future amid the U.S. withdrawal, and given that reconciliation with India remains a distant dream?

There’s also little reason to believe Pakistan wants the Haqqani network to stay out of Pakistan. The latter derives leverage over the Haqqani network by hosting it on its soil. By denying it a sanctuary, Pakistan would lose this leverage — and risk having the organization turn on the Pakistani state. Consider that some Afghan Taliban members have expressed deep unhappiness about Pakistan, and that when Baitullah Mehsud was a Haqqani commander, the group launched several attacks on the Pakistani military.

Little wonder, then, that a range of sources — from U.S. officials to North Waziristan locals — believe the Haqqani network was tipped off about the offensive by the Pakistani military and fled in advance. Pakistan’s own ambassador to Washington admits that many Haqqani fighters left North Waziristan before the offensive (in his view, this is simply because the operation was pre-announced).

So, despite all the spin about taking definitive action against militants of all stripes, Pakistan may have more nefarious objectives in North Waziristan: Smash the sanctuaries of anti-state militants such as the TTP, but shield the Haqqani network by sending it to Afghanistan (and to other Pakistan tribal areas), where the group can exploit rising political instability (stemming from an ongoing election crisis) and aid an increasingly emboldened Afghan Taliban. Then, when the offensive in North Waziristan has ceased, the organization can return to its Pakistani sanctuary and resume its cross-border strikes on Afghanistan.

This all has troubling implications for U.S.-Pakistan relations. Washington can’t be happy that Pakistan is merely displacing, rather than destroying, the Haqqani network — and especially into Afghanistan at such a delicate time. If the Haqqani network returns to its North Waziristan sanctuary and resumes attacks on Afghanistan, threats will likely intensify on Capitol Hill to reduce military aid to Pakistan. After all, a recent U.S. defense spending bill calls for $300 million in military aid to be withheld from Pakistan if the country has not “significantly disrupted” the Haqqani network’s “safe haven and freedom of movement.”

Such warnings won’t be received well in Islamabad, where officials often (and justifiably) note that Pakistan’s military has lost scores of soldiers fighting militant groups in the tribal belt, and complain that U.S. forces have failed to disrupt Pakistani Taliban safe havens in Afghanistan, which are used to mount attacks on Pakistan. Indeed, some of the TTP’s most vicious and hardline leaders — including supreme leader Mullah Fazlullah, who orchestrated the brief takeover of the Swat region in 2009, and TTP Mohmand tribal agency chief Omar Khalid Khorasani, who earlier this year ordered the execution of 23 Pakistani soldiers held in captivity — are reportedly based in Afghanistan.

The upshot? The current period of preternaturally placid U.S.-Pakistan relations could soon be shattered, thanks to the militant organization that so often bedevils them.

Michael Kugelman is the senior program associate for South Asia at the Woodrow Wilson International Center for Scholars in Washington, DC.

 

The Ruinous Pitfalls of a Divided Indonesia

Prabowo Subianto’s, left, next move in challenging President-Elect Joko Widodo’s right to the nation’s highest office.

President-Elect Joko Widodo faces a barrage of potentially damaging problems even before he officially enters office ‘United We Stand’:

Jakarta Governor Joko Widodo has been officially declared the winner of Indonesia’s hard-fought presidential election on July 9, and in his victory speech he called for the country to unite after a deeply divisive election that has seen his rival, Prabowo Subianto, challenge the decision.

Joko knows exactly how divided Indonesian society became over the people’s decision to choose the best political figure to lead the country for the next five years. Joko also knows that the different political choices of the members of his opposing camp seemed to be what caused a rift in the archipelago.

It is normal, then, for Joko to ask the Indonesian people to unite and start with a new and cooperative political life. To Joko, a united Indonesia will have to be based on the continued nurturing of democracy in the country.

This would perhaps be the most important domestic challenge Joko may face during his presidency.

As president-elect, Joko has begun to realize that if he moves alone in leading the country for the next five years, he can face many of the common dangers that may jeopardize the real fabric of the country in the long term. He may experience a “bumping over crisis and change.”

When calling the Indonesian people to unite, and to demonstrate his serious intention of uniting the country, Joko should have cited the story of two men trying break a bundle of sticks: however hard they tried, neither of them could break the bundle. But when they untied it, they had no trouble breaking the individual sticks.

The message derived from this story is crystal clear: that a harmonious, national political life needs to be worked out together, regardless of political orientation and background.

If Joko can really show his new prescriptions for reuniting Indonesia, and if his leadership can bring the people to build mutual trust and understanding, then the country can achieve what it wants, at least for the next five years.

What cannot be achieved by a single soul can be achieved by the combine efforts of the masses.

Joko’s call for unity sounds like a bright idea to start making a much better and stronger Indonesia, but it will be difficult to achieve. His road to the State Palace will not automatically see the disappearance of the myriad of problems the country currently faces, from poverty and conflict over land rights to labor unrest and religious violence and flashpoints in Papua and Aceh — not to mention the residual problems from the presidential election.

The country’s post-election political condition will still be in a vulnerable state as Prabowo’s camp continues to challenge the General Elections Commission (KPU) decision. And it’s not impossible that people will align themselves to Prabowo’s cause suggesting a more severe, if not deadly, conflict among society.

Perhaps, what one fears is that the post-presidential era will witness the dawn of a tug-of-war — a continuation of an open political, if not physical, clash between supporters of the two opposing political camps. This may, in turn, cause an erosion of trust and further disarray within the system.

Now that Joko has done enough to secure Indonesia’s highest office, he must start thinking of the best political, economic and perhaps security formulas to ensure that the country does not fall apart. His job as leader is to convince the people that what he will do what is best not just for the political parties that he represents, but for the Indonesian people at large.

The public policies Joko may initiate in the next five years will certainly be scrutinized by the people, if not by the opposition coalition.

Joko must realize the relatively small size of his coalition, which will control only 37 percent of legislative seats when the new House of Representatives goes into session on Oct. 1 — provided that the coalition led by Prabowo holds together.

This suggests the vulnerability of his presidential position if his basic national policies fail to garner political support from the House. The “Gus Dur fiasco” may then repeat itself.

Whether Joko’s call for unity is effective and whether people from all walks of life can clearly hear his call, Joko must realize from the very beginning that a critical weakness within Indonesian society is that its people are not strongly motivated to achieve unity as a nation. Sometimes the public mood is far too defensive — if not conservative — and disinclined to truly move forward.

This may lead one to conclude the problems Indonesia faces will not disappear even if Joko is perceived to able to maintain unity, if not a transition toward a full-fledged democracy. The fractures within society may have already run too deep.

Joko spoke of his aspiration for Indonesia to be an axis of global maritime trade as one of the key policies of his economic plan for a more self-reliant and sovereign Indonesia. But such a doctrine will certainly provide no strategic gains for the nation if Joko fails to eventually prevent Indonesia from falling deeper into a well of more acute problems. His call for the country to reunite would, instead, turn into a fractured society.

If this is the case, the expression “united we stand, divided we fall” comes to mind, suggesting the dangerous scenario: unless the Indonesian people are united, they will fall into pieces. In the end, one could then ask what kind of knowledge will contribute the most to understanding Joko’s prescription for Indonesia’s various problems in the next five years.

Bantarto Bandoro is a senior lecturer at the School of Defense Strategy at the Indonesian Defense University, and founder of the Institute for Defense and Strategic Research (IDSR) in Jakarta. (Reuters Photos) 

 

Viral hepatitis – the silent killer


Viral hepatitis kills approximately half a million people every year in the 11 member states of WHO’s Southeast Asia region. An estimated 100 million people are currently infected with hepatitis B and another 30 million with chronic hepatitis C.

Since these infections can go undetected for years, many people do not know they are infected until much later, when treatment may be too late.

There are several different viruses that cause viral hepatitis. The most common cause is infection with one of four viruses — hepatitis A, B, C, or E. Possible symptoms include yellowing of the skin and eyes (known as jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Acute hepatitis infections can take weeks to months to fully subside. In rare cases, they can progress to liver failure, which can be deadly. Complications of chronic hepatitis, which can be caused by hepatitis B or C infections, include scarring of the liver (known as cirrhosis), liver cancer, and even death. Most of these deaths however, are preventable.

Viral hepatitis B and C are the most common causes of liver cirrhosis and cancer worldwide. They are spread most commonly through contact with contaminated blood. Hepatitis A and E are endemic to Southeast Asia, where most people are infected during childhood.

They are spread through the fecal-oral route, most commonly when food or drinking water is contaminated by the fecal matter of an infected person.

Lack of proper sanitation contributes greatly to this problem. Children, who tend to present with only mild symptoms, carry the infection and can spread it to others.

The most important thing we can do to prevent the spread of hepatitis is arm the public with information to protect themselves and their families. Since each virus is unique and transmitted in a different way, prevention approaches must be multidimensional. To prevent the spread of hepatitis A and E, proper hygiene is essential.

At the cornerstone of prevention are vaccines. Though a vaccine against hepatitis A is available, it is not yet widely used in the region. All countries of the region, however, have included hepatitis B vaccines in their immunization programmes for children. Indonesia and Thailand use the tetravalent form, and other countries use the pentavalent form of the vaccine.

An additional dose at birth is administered in Bhutan, the Democratic People’s Republic of Korea, India, Indonesia, Myanmar, Maldives and Thailand. More than 24 million doses of the hepatitis vaccine are being administered in the region annually.

This year on 22 May, the World Health Assembly adopted a resolution to improve the prevention, diagnosis and treatment of viral hepatitis. The resolution highlights the importance of expanding hepatitis A and B vaccination programmes and considers a range of measures to strengthen infection control and improve access to quality and affordable hepatitis medicines and diagnostics.

There are several challenges to translating this resolution into action. In most countries in the region, surveillance systems for viral hepatitis are inadequate and do not enable evidence-based policy decisions. Preventive measures are not universally implemented.

Treatment for hepatitis is not widely available. While there are new medicines that bring the promise of a cure, such treatments come at a significant cost. A combination of approaches is essential to make these new hepatitis medications accessible in low-and middle-income countries.

The provision and integration of viral hepatitis services into settings that serve high-risk populations are also challenging. Administration of treatment on a larger scale would require an expansion of the role of primary health care and training of primary health care personnel, which is a huge undertaking.

Because hepatitis viruses differ in their distribution and routes of transmission, coordinated national strategies based on the local epidemiological context must be adopted. Special attention must be paid to the transmission of hepatitis B from mother to fetus during pregnancy, by encouraging mothers to get tested for hepatitis B while pregnant and promoting the hepatitis B vaccine for all newborns at birth.

National blood donation systems must develop quality-assured screening of all donated blood, tissues and organs for prevention of hepatitis B and hepatitis C. Healthcare workers must be counseled on the importance of needle safety and glove use when working with blood products.

Emphasis must be placed on adequate sanitation, to improve food and drinking water safety, and control the spread of hepatitis A and E. National policies need to provide equitable access to the prevention, diagnosis and treatment of viral hepatitis.

None of this can be achieved by ministries of health alone. These national strategies must have the support of other sectors, both public and private. To win the battle against this silent killer, a coordinated, multisectoral effort is urgently needed.

____________________

The writer is WHO regional director for Southeast Asia.

 

Fear that Malaria Parasite is Mutating


Currently-effective treatment programs could be endangered across the world

As was probably inevitable, the parasites carried by mosquitos in Southeast Asia are mutating genetically to become resistant to the most popular drug used to combat malaria, according to a study in the New England Journal of Medicine, causing deep concern that heretofore-effective malaria treatment programs could be endangered, both in Asia and Africa.

The World Health Organization reported in 2010 that 219 million documented cases of malaria were recorded across the world, killing 660,000 to 1.2 million people, many of them children in Africa. The actual number is not known given that many cases in rural areas are undocumented.

Resistance to artemisinin, the main drug used to treat malaria, is now widespread throughout Southeast Asia, particularly in areas of Cambodia, Myanmar, Thailand and Vietnam, according to the study, conducted by an international team of scientists including those from the National Institute of Allergy and Infectious Diseases in the United States. It now takes a six-day course to combat malaria instead of the standard three-day course, according to the study,

Although that is likely to be a temporary solution. The history of mutation of parasites is grim. Poor drug compliance during treatment can lead to failure to fully clear a malaria attack, allowing the remaining parasites, which were less susceptible to the drug, to survive and reproduce. As the infected persons are bitten by new generations of mosquitoes, the hardier disease spreads. As parasites’ life cycles are short, with successive generations natural selection leads to the evolution of strains of new, resistant parasites. Mass drug administration programs in areas where malaria is endemic may also give people doses of the drug that are too low to kill the parasite. If treatment of ill patients fails for some reason, they retain parasites in their blood which can carry on reproducing.

Quinine was the first effective western treatment for malaria, remaining the drug of choice and leading to the famed gin and tonic highball. It was introduced by the army of the British East India Company after it was discovered in the 1700s that quinine could be used to prevent and treat the disease, although the bitter taste was unpleasant. British officers in India took to adding a mixture of water, sugar, lime and gin to the quinine. In the 1940s other drugs such as chloroquine, with fewer unpleasant side effects, replaced it.

Chloroquine was replaced by sulphadoxine-pyrimethamine (SP), but resistance to SP also emerged in Western Cambodia and spread to Africa. SP was replaced by ACTs, and now there are concerns that history will repeat itself for a third time.

According to a report by the National Institutes of Health, artemisinin was regarded as something of a wonder drug. It was used by Chinese herbalists for the treatment of skin diseases as well as malaria going back to 200 BC. In the 1960s, the People’s Liberation Army established a screening research program to attempt to find a malaria treatment program that would rid its soldiers of the debilitating disease, Of a list of nearly 5,000 traditional Chinese medicines, scientists discovered that artemisinin, found in the leaves of wormwood trees, could be extracted and subjected to purification. A number of other products were found by Chinese scientists to be used in combination with artemisinin.

The drug was widely distributed and was considered to be an effective treatment. However, the parasite, Plasmodium falciparum, appears to have mutated genetically, according to the New England Journal of Medicine study, threatening treatment programs. The study, which analyzed blood samples from more than 1,000 malaria patients in 10 countries across Asia and Africa, found that artemisinin resistance in P.falciparum - the most deadly form of malaria-causing parasites – is now firmly established in western and northern Cambodia, Thailand, Vietnam and eastern Myanmar. There are also signs of emerging resistance in central Myanmar, southern Laos and northeastern Cambodia, the study said.

“It may still be possible to prevent the spread of artemisinin-resistant malaria parasites across Asia and then to Africa by eliminating them, but that window of opportunity is closing fast,” Nicholas White, senior author of the study and Chairman of Mahidol Oxford Tropical Medicine Research Unit (MORU), told reporters. “Conventional malaria control approaches won’t be enough – we will need to take more radical action and make this a global public health priority, without delay."

“Frontline ACTs are still very effective at curing the majority of patients. But we need to be vigilant as cure rates have fallen in areas where artemisinin resistance is established,” said Elizabeth Ashley, lead scientist of the TRAC study and a clinical researcher at MORU. “Action is needed to prevent the spread of resistance from Myanmar into neighboring Bangladesh and India.”

“If resistance spreads out of Asia and into Africa much of the great progress in reducing deaths from malaria will be reversed,” said Jeremy Farrar, Director of the Wellcome Trust in a prepared news release. “Our ability to respond to these rapidly emerging health problems depends on swift gathering of evidence, which can be quickly translated into public health and clinical interventions that are then implemented. Antimicrobial resistance is happening now. This is not just a threat for the future, it is today's reality.”

While new antimalarial medicines are in development, and another paper published in the New England Journal of Medicine has shown some promising trial results for a potential new antimalarial drug in development at Novartis, they are unlikely to be available for widespread distribution for several years, according to the group. “The artemisinin drugs are arguably the best antimalarials we have ever had. We need to conserve them in areas where they are still working well,” Ashley concluded. Asia Sentinel

 

Why Asia Won’t Sanction Russia for MH17


The U.S. is trying to pressure Asia into imposing sanctions on Russia. This effort is almost certainly futile.


The U.S. is pushing Asian nations to join it and the European Union in sanctioning Russia for the shooting down of MH17. It’s unlikely to have much success.

A senior State Department official– which, although unnamed in the reports is almost certainly Peter Harrell, deputy secretary of state for counter threat finance and sanctions– briefed reporters about the renewed effort on Wednesday during a one-day stop in Singapore. The American diplomat traveled to China and South Korea before landing in Singapore, and he intends to spend Thursday and Friday in Japan in an effort to get the region on board with sanctions against Russia. According to the Wall Street Journal, the diplomat was meeting with government officials and private-sector leaders in each country he visited.



“It’s certainly our hope that countries in this region—which includes many significant financial and commercial centers—would join us in putting pressure [on Russia],” the State Department official said, according to WSJ. He also said the meetings were aimed at explaining what the U.S. has already done, what it might do in the future and answering any questions.

The U.S. and EU on Tuesday announced new sanctions this week against Russia’s banking, energy and defense industries in the wake of the downing of Malaysian Airlines Flight 17 earlier this month.



To date, Asia has not shown much appetite for sanctioning Russia over events in the Ukraine. Only Japan and Australia have imposed sanctions on Russia for its annexation of Crimea and interference in eastern Ukraine. Australia didn’t impose any sanctions until June. Japan acted more quickly and slightly more forcefully. In March it suspended visa talks with Russia following its annexation of Crimea. Then, in April it imposed visa bans on 23 Russian individuals. More notably, as Ankit reported, earlier this week Japan announced it was imposing additional sanctions against individuals and groups involved with the annexation of Crimea. It also said it would curtail imports from the Crimea and freeze funds intended for new projects in Russia. Although these latest sanctions have slightly more substance, they are relatively minor compared with the sectoral sanctions the West has adopted.



Despite Asia’s reluctance to sanction Russia thus far, the American diplomat in Asia this week expressed optimism that the shooting down of MH17 will spur the region into action. “MH17 being shot down brought home to the world that this is a global problem,” the diplomat was quoted as saying.

Don’t bet on it. At most, a few Asian nations will adopt largely symbolic sanctions against Russia– but even this is far from guaranteed.

China is in many ways the least likely to impose sanctions on Russia for the MH17 incident. To begin with, President Xi Jinping has made strengthening ties with Russia a top priority of his foreign policy. Moreover, as noted last week, China has been more critical of the West’s response to MH17 than Russia’s involvement. In any case, Beijing has strong economic interests in Russia and it almost always puts its narrow self-interests above solving “global problems.”

India is nearly as unlikely as China to impose sanctions. Russia and India have longstanding ties based on each side sticking by the other during times of need. Indeed, India was the only major country to (more or less) openly support Russia’s annexation of Crimea back in March. It also remains highly reliant on Russia arms, and won’t risk pushing Moscow closer to Beijing over “global problems” that have little to do with India itself.

Singapore typically only supports sanctions endorsed by the UN Security Council, which are unlikely to happen given Moscow’s veto power in that body. Moreover, as a financial hub– along with Hong Kong– it is likely to benefit from any Western financial sanctions that restricts Russia’s access to London financial markets.

South Korea also seems unlikely to adopt sanctions against Russia. Just last week South Korean Ambassador to Russia Wi Sung-lac said that South Korea had no plans to follow America and Europe’s lead in adopting sanctions. Then, after the meeting with the U.S. official this week, a spokeswoman for South Korea’s Foreign Ministry reaffirmed it hasn’t committed to sanctions. If it didn’t do so over Russia’s annexation of Crimea, it is unlikely to do so because of MH17. Like Crimea, it lacks a direct connection to the shooting down of MH17. Unlike Crimea, Russia can maintain some plausible deniability in the downing of MH17.

Furthermore, South Korea has economic and political interests in maintaining strong ties to Russia. Indeed, President Park Geun-hye has sought to deepen ties with Russia during her tenure, with Vladimir Putin even visiting Seoul briefly last fall. Already, two way trade between the countries is around $17.5 billion annually, and Seoul and Moscow are looking to triple direct investment flows over a two year period. South Korea is also trying to capitalize on Russia’s growing isolation with the West. Just last week, South Korean debt investors met with officials from Russia’s third largest bank to discuss investing in the company. Russia also holds vast amounts of energy reserves, which South Korea would like to tap into in the future. Finally, South Korea knows that Russia could use its ties with North Korea to retaliate against Seoul for any action it takes against Moscow. Maintaining Russia’s support on North Korea is far more important to South Korea than the Ukraine.

In many ways, Australia seems like a strong candidate to impose stronger sanctions against Russia. As noted above, it has already sanctioned Russia over the Ukraine. More importantly, 36-38 Australians died on MH17 (news sources differ on the exact number), and Prime Minister Tony Abbott has been as vocal as any other world leader in condemning Russia for its role in the plane’s downing.

“Russian-controlled territory, Russian-backed rebels, quite likely a Russian-supplied weapon. Russia can’t wash its hands of this,” was how Abbott put it on Australian national television earlier this month.

Rhetoric aside, however, Abbott has pursued an engagement strategy towards Russia and President Putin since MH17 in an attempt to get Moscow to force the Ukrainian rebels to allow for the victims’ bodies to be taken out of the country. Abbott also seeks Russia’s help in ensuring a full investigation takes place.

In order to achieve this, Abbott has all but ruled out more sanctions against Russia. Indeed, when asked if Australia would follow the EU and America’s lead in imposing new sanctions on Russia this week, Abbott said, “I know that various things are happening in Europe and elsewhere. That is a matter for the Europeans and others. We are just focused on getting onto the site as quickly as we can. We want to get in, we want to get cracking and we want to get out.”

He added: “We already have some sanctions on Russia. I’m not saying that we might not at some point in the future move further. But at the moment, our focus is not on sanctions.” As more time passes, and the victims’ remains are returned home, any impetus to punish Russia for the incident is likely to fade.

Which leaves Japan. Tokyo is the Asian nation most likely to impose additional sanctions on Russia for MH17. As noted above, Japan has already taken the lead in imposing sanctions against Russia for events in the Ukraine. This is a reflection of its need to retain the support of its G7 allies, and particularly the United States.

Nonetheless, as Ankit and I noted on a recent podcast, and Clint also discussed on Tokyo report, Japan’s response to MH17 will be tempered by Prime Minister Shinzo Abe’s desire to achieve a rapprochement with Russia. Even after Russia’s annexation of Crimea– which for Japan was far more worrisome than MH17 given the potential for China to replicate the model in Asia– Abe confirmed that he still wants Putin to visit Tokyo this fall, and even suggested that Japan will take the lead in bringing Russia back into the G8.

As such, Japan’s sanctions to date have been crafted with an eye towards not scuttling the potential rapprochement with Moscow. Furthermore, Russia is well aware of Tokyo’s desire to improve bilateral ties, and has sought to play on Japan’s fears that imposing sanctions will scuttle that possibility. After Japan announced its most recent sanctions this week, for instance, Russia’s Foreign Ministry issued a statement warning, “The imposition by Tokyo of new sanctions on Russia … inevitably threaten a whole range of bilateral relations, and set them back.”

At most, then, Japan will only adopt whatever sanctions are necessary to appease Washington. This may be no sanctions at all. The Japanese government is trying to skirt the issue by insisting that it needs to focus on implementing the new sanctions it imposed on Monday. It can also try to play the Iran sanctions card with the U.S. to avoid having to adopt new sanctions on Russia. If Japan is ultimately forced to adopt some sanctions against Russia over MH17, they are likely to be entirely symbolic and not felt much in Moscow.


The Diplomat
by Zachary Keck