September 18 London Event – ‘Imagining the next crisis’

Tuesday, September 18. 6pm. Juju’s Bar and Stage, Truman Brewery, Brick Lane. 

Ten years after the collapse of Lehman Brothers sparked global financial turmoil and 17 since 9/11, PS21 looks where the next major crisis threatening humanity might come from. Bringing together experts in finance, security, cyberspace, public health and more, we’ll be looking at what we should be worrying about and how it might be managed. After the long summer, a great chance to network, question the experts and talk about what the rest of the year – and century – might have iin store.

Peter Apps [Moderator] – Reuters Global Affairs Columnist

Heather Williams – Lecturer in Defence Studies, Kings College London

Mike Dolan – Investment Editor, Thomson Reuters

Angela Chatzidimitriou – Global Blockchain Stakeholder Engagement Manager, Hewlett-Packard

John Bassett – Former senior official, GCHQ and member of the PS21 International Advisory Group

Dr Colin Brown – Consultant in Infectious Diseases, Public Health England

Doors will open at six p.m., with the discussion beginning at seven p.m. After brief presentations from each speaker, we will break for interval followed by a Q and A/panel discussion. The bar will remain open throughout.

Sign up here

Why Zika may be as tough to beat as Ebola

baby-feet-619533_960_720A printer-friendly version is available here.

Peter Apps is Reuters global defence correspondent. He is currently on sabbatical as executive director of the Project for Study of the 21st Century (PS21).

Taraneh Shirazian, obstetrician and gynecologist at New York University Langone medical center has been seeing some very worried women — those with pregnancies who have traveled through Latin America and the Caribbean in the last few months. As the scale of Zika virus outbreak becomes apparent, they are terrified that their unborn children may have been affected.

She struggles to know what to tell them about the risk they may face. The data is simply not available. What is clear, however, is that the Americas appear to be facing a health crisis on a scale and potential complexity that could be compared to West Africa’s 2014 Ebola outbreak.

So far, thousands of children have been born in Latin America in recent months suffering from microcephaly — smaller-than-normal heads with resulting brain damage and associated problems. Scientists believe the cases are almost certainly linked to the mosquito-borne virus. The World Health Organization warned this week that the Zika virus might well spread across the Americas, including much of the United States.

Just like Ebola in 2014, this Zika outbreak represents a sea change and step up from previous, much more limited, occurrences of the disease. Zika was first identified in 1947 but has only been seen in significant numbers in humans since 2007, with cases skyrocketing in the last year. As a result, it is outstripping both the capabilities of already stretched local health systems and much wider global scientific knowledge.

The differences with Ebola, though, are equally stark and may make it even harder for countries, individuals and families to handle.

For most of its sufferers, of course, Zika is a much less serious disease than Ebola. Symptoms are usually limited to a mild fever and rash with up to 80 percent of sufferers showing no external signs of the disease at all. On that level, it hardly bears comparison to Ebola, which is believed to have killed more than 11,000 people in 2014, almost all of them in Sierra Leone, Liberia and Guinea. Symptoms were singularly horrific, massive hemorrhaging that left victims covered in highly infectious sweat and blood that carried the disease to those closest to them.

Breaking the cycle of infection for a disease like Ebola is a relatively simple, but psychologically brutal process. Populations have to be educated to avoid direct physical contact with the sick or dying, interacting with them only through masks and gloves and making sure those suffering most were kept on isolation wards — provided enough are even available.

As a 23-year-old journalist, I covered the 2005 outbreak of the Ebola-like Marburg virus in the northern Angola. One anecdote in particular stands out — a story that told the infectious disease specialists they were finally winning the battle for hearts and minds.

In a remote village near the town of Uige, a pregnant woman began vomiting blood. Had this happened earlier in the outbreak, her husband would almost certainly have looked after her, infecting himself and the rest of the family. Instead, he took no chances, removing the other children from the house and locking his wife inside. It took several days for medics to reach the village — she died inside the house. The rest of the family lived — but the man, unsurprisingly, was apparently psychologically destroyed.

Zika, though, is a different kind of cruel. The only significant worry, it seems, is over unborn children. The problem is, because the symptoms are so mild, women living in affected areas — now spanning some 20 countries across an entire continent — simply do not know until far too late whether they have been infected.

Even when ultrasonic scans are available — and in most places they are not — microcephaly is not usually detectable until relatively late in the pregnancy, often the last three months. Even in countries where abortion is legal at all, it is often illegal at that late stage. In some cases, microcephaly can only be diagnosed at birth or even in the weeks and months following.

The effects, though, can be awful — intellectual and physical disability, shortened lifespan, huge requirements for ongoing care as long as they survive. For poor families and countries this will be incredibly difficult to manage.

For now, there remains a huge amount we do not know — what the incidence rate is likely to be, how severe the arising disabilities, how wide the geographic scope of spread. Hardly surprisingly, even before President Barack Obama’s call for increased research, estimates were already ramping up. But they will take time. And the statistics that are most crucial will only come in as the number of cases rise.

Under such circumstances, warnings for potentially pregnant women to avoid huge swathes of Latin America and the Caribbean make perfect sense. But that does little good for the millions living in those countries.

Earlier this week, El Salvador took the unprecedented step of advising its own population to put off pregnancy for two years, presumably in the hope that by then the situation might be somewhat resolved. How achievable that is in a country with high illiteracy rates, extremely limited sex education and access to contraception is another matter. It might prove impossible in any country. For one thing, women in their late 30s or older are unlikely to want to wait.

For now, researchers in Texas working on a vaccine say it could be 10 years away — although the more scientists who join the battle, the shorter that process might be. In the meantime, the brunt of the effort against the virus will have to be an industrial fight against the mosquitoes that carry Zika and their habitats.

Already, Brazil has mobilized several thousand troops for that effort. As in West Africa, it’s not hard to imagine the United States and other major powers also joining the effort.

Ultimately, as with Ebola, the worse the outbreak is — and the richer the countries actually and potentially affected — the more resources will be plowed into it. If the worst comes to the worst, the United States would probably spend almost whatever it took to make sure Americans could safely procreate.

If the World Health Organization is right in its predictions of the spread of the virus, it could yet come to that. In the meantime, however — just as with Ebola — we look set for another spell of almost impossible medical policy challenges and countless personal tragedies and traumas.

This article first appeared in Reuters on January 28, 2016. 

Project for Study of the 21st Century is a non-national, non-ideological, non-partisan organization. All views expressed are the author’s own.

Balancing the books: Is it time for a revolution in healthcare?


David Murrin is the author of Breaking the Code of Historythe culmination of decades of personal research across a wide range of disciplines. David compellingly argues that human behaviour is not random, but determined by specific, quantifiable and predictable patterns fuelled by our need to survive and prosper. He has called this cycle The Five Stages of Empire, which due to its fractal nature is applicable to empires, all the way down to the cycle of the individual. According to David, to resolve the issues confronting us today we cannot merely study the past. The human race will need to understand this precise algorithm of behaviour that has caused us to re-enact the same destructive cycles in ever-greater magnitudes, in order to change our future. He is also a Global Fellow at PS21.

Since man developed increasingly sophisticated societies, the burden of the state has been steadily and systematically increasing. As empires in the past have found to their cost that if the burden becomes too great to bear and the state goes into debt, the typical solution has been to raise taxes which at some point stifle productivity and are perceived as unjust. At this point the empire loses moral imperative, individual freedoms become restricted and decline sets in. For a system to survive and maintain stability there has to be a dynamic balance between the burden and revenue generation.

Looking at the burdens of state and their development over history, defence was always primary to establish security. Then there was the cost of governance which typically increased with the age and size of an Empire. Subsequently, as we mastered our environment, there was the cost of infrastructure; initially walls and burial buildings and later all manner of structures that helped us master our world. Next came education and much more recently the welfare state and National Health programmes. The National Health burden of the Western world comes at a time when life expectancy has increased and our revenue degeneration has slowed down resulting in a fiscal crisis.

Take Britain as a prime example of a Western nation in the pie chart of UK central government expenditure in 2009-10. Debt interest is shown in purple. Social protection includes pensions and welfare.

With some 18% of national expenditure going on health via the NHS, which is more than 3 times what is spent on defence at a time when the world has become a very dangerous place, is it not time that we looked at some radical changes to the spending pattern that are more efficient? Healthcare seems a good place to start.

Without a doubt, the introduction of the NHS at the end of the war was a moral imperative that moved Britain away from the Victorian era into the modern age in the way it supported and looked after its population. Notably, America and Obamacare have taken place at the same stage of the empire cycle as it did in Britain i.e. whilst the system went into decline.

In particular, it is strange that politicians are quick to dictate to admirals and generals as to how they might defend the nation with fewer resources, but never seem to question the mindset and way our doctors are trained and their very thought process. From my personal experience, I would have to say that, on the whole, the UK medical system seems to be stuck in a Newtonian world, and doctors are not trained in evidence based scientific medicine that is practiced in America. Some key points to start would be:

1. The first place to start the revolution is by reviewing other health care systems and how they train their doctors and import new best practices from abroad.

2. The Next step is the realisation that there are many conditions that are just not currently healed quickly and effectively enough, so we need to look at health from a new holistic perspective.

3. Democracy is about giving the population self-responsibility and yet the arrival of the NHS has for some reason created a mindset of ‘when I get ill I will be looked after’, rather than of ‘I must take responsibility for my health and only when that fails, I will be looked after by the NHS’.

4. The fast food revolution and the widespread consumption of sugar is a fine example of a self-created lifestyle health problem that the UK government is now trying to reverse, to ease the burden on the NHS and give the population more productive lifestyles.

5. In that regard changing the population’s attitude towards health collectively has to be a vital component of change. Much as it is tough to accept lessons from the Germany of the 1930s which had a culture that encouraged everyone to be fit. Whilst its purpose should not be emulated, it is an example of a society with collective values around health.

6. The antibiotic crisis is a hallmark of overused medicine that has potentially crated a serious problem. Whilst I am sure science will soon fill the gap with effective substitutes, the lesson is clear; without respecting the natural balance of our bodies and the environment we risk new threats, so we must not misuse our medical technology.

Is there a silver bullet? I believe that there is an area of study that is so far reaching in its effect on the human well-being that if refined and applied to a population, it could not only change productivity, but also lift the burden on health systems. That area is the understanding of the gut flora and balance. Once one realises that 90% of all our immunological responses take place in our guts, the importance of a well-balanced gut is obvious. The widespread use of antibiotics is immediately in contravention to this balance, and without corrective action has enormous consequences.

With aging populations placing an even bigger burden on the health care system it is time for a revolution in the sector, both on our collective values and self-responsibility and also in the way that our medical profession perceives the very nature of our living being.

This article was originally published on on July 14, 2015.

PS21 is a non-national, non-governmental, non-ideological organization. All views expressed are the author’s own.

PS21 Global Fellow battles Ebola in Sierra Leone

A Freetown street
A Freetown street

Felicity Fitzgerald, a British paediatrician working with the charity Save the Children, has recently returned to Sierra Leone for the fight against the Ebola virus outbreak.

In this piece for Britain’s Daily Telegraph, she finds herself splitting her time between research and patient care.
I’m going to be splitting my time between paediatric clinical work and some desperately needed research. At the peak of the epidemic, all I could think about was changing sheets, cleaning floors, moving patients in and out of the isolation unit and trying to give pain relief and dioralytes to our patients. Data gathering came a long way down the priority list.

This is an upsetting reality of outbreak work. When facilities are filled to the brim with needy patients, making detailed notes about what is actually happening to those patients is a rare luxury.

However if we don’t gather data we will remain in the same evidence vacuum that confronted us with this epidemic…

Epidemiologists and clinicians alike are slightly slack-jawed at the drop-off.

The most logical explanation is that sufficient community mobilization (no touching, safe burials, take sick people to hospital and DON’T look after them at home) occurred at a point when we finally achieved sufficient bed and laboratory capacity. That meant we could rapidly move patients out of the community and into Ebola Treatment Centres.

But it didn’t really feel like that. It felt like one week we were full every day with queues of people needing to be admitted, and the next we had empty beds.

You can donate to support Save the Children’s work in Sierra Leone here.

EBook: Before Ebola: Dispatches from a Deadly Outbreak

Published in October 2014, “Before Ebola” was the first of what should be be a series of 10-30,000 word Kindles Singles to be published with Some will be — like this — powerful personal narratives on major issues and trends. Others will be reportage and analysis. All well, my first, aim to tell some of the greatest and most important stories of the 21st century in readable and accessible ways.

Content people read. Discussions they remember…

The haunting firsthand account of the deadliest Marburg outbreak in history. The year is 2005. A highly infectious, unidentified Ebola-like virus is sweeping through the slums and villages of northern Angola. Within months, more than 200 people have died, medical services have collapsed and aid workers are on the brink of exhaustion. At 23, Peter Apps was just starting out as a foreign correspondent when Reuters sent him into the heart of the outbreak to get the story. In “Before Ebola: Dispatches from a Deadly Outbreak” Apps recalls in vivid, unflinching detail the horrors of life in a hot zone, the compassion of those trying to contain it, and how a terrified young journalist came of age in a time of almost unbearable crisis.

Peter Apps is a global defense correspondent for Reuters news, currently dividing his time between London and Washington, D.C. In September 2006, Apps broke his neck in a minibus crash while covering the Sri Lankan civil war, leaving him largely paralyzed from the shoulders down.

Cover design by Kristen Radtke.