Probably one of the scarier and generally under-reported global health stories of the past few years has been the emergence of new strains of Tuberculosis that are resistant to regular treatment regimens.  According to a World Health Organization report out today, in some areas of the world one fourth of all new cases of TB is of the hard-to-treat (and easy to spread) multi-drug resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB) variety. 

The report estimates that 440,000 people around the world had MDR-TB and about one third of those people succumbed to the disease in 2008.  Almost 50% of the MDR-TB cases occurred in China and India.  In Africa, there were an estimated 69,000 cases of MDR-TB in 2008. 

How bad is this disease?  Three years ago, the acclaimed photojournalist James Natchwey turned his lense on this disease -- which, incidentally, is how I came to learn of it. The images are chilling.

The WHO report says MDR and XDR TB can be effectively contained with the right amount of focus and funding.  Unfortunately, many of the 27 countries in which M/XDR-TB is most prevelant countries lack both.

The WHO estimates that there will be 1.3 million new cases of M/XDR-TB in these countries between now and 2015. The Stop TB Partnership's goal is to diagnose and treat 80% of new M/XDR-TB cases. To do so will cost an estimated $16 billion over six years. Currently, only $280 million is available to fight M/XDR TB worldwide. This funding gap is problematic, to say the least.  Unless we direct more funding toward fighting this disease it may proliferate -- perhaps even reaching donor countries. 

Image: James Natchway
 

Last week, a group of investigators dispatched by the Security Council to Somalia released an exhaustive, 100 plus page report on arms trafficking, aid diversion, and other criminal activities in Somalia.  So far, much of the press around the report has focused on allegations that World Food Program aid had been diverted to suspected militants.  The report also provides evidence that Eritrea has been supporting Somali militants, raising the prospect that Eritrea will once again come under international condemnation. 

I'll have much more to write about this report soon. In the meantime, I found this short explanation of the pirates' business model, tucked away in the report's annex, to be fascinating.

A basic piracy operation requires a minimum eight to twelve militia prepared to stay at sea for extended periods of time, in the hopes of hijacking a passing vessel. Each team requires a minimum of two attack skiffs, weapons, equipment, provisions, fuel and preferably a supply boat. The costs of the operation are usually borne by investors, some of whom may also be pirates.

To be eligible for employment as a pirate, a volunteer should already possess a firearm for use in the operation. For this ‘contribution’, he receives a ‘class A’ share of any profit. Pirates who provide a skiff or a heavier firearm, like an RPG or a general purpose machine gun, may be entitled to an additional A-share. The first pirate to board a vessel may also be entitled to an extra A-share.

At least 12 other volunteers are recruited as militiamen to provide protection on land of a ship is hijacked, In addition, each member of the pirate team may bring a partner or relative to be part of this land-based force. Militiamen must possess their own weapon, and receive a ‘class B’ share — usually a fixed amount equivalent to approximately US$15,000.

If a ship is successfully hijacked and brought to anchor, the pirates and the militiamen require food, drink, qaad, fresh clothes, cell phones, air time, etc. The captured crew must also be cared for. In most cases, these services are provided by one or more suppliers, who advance the costs in anticipation of reimbursement, with a significant margin of profit, when ransom is eventually paid.

When ransom is received, fixed costs are the first to be paid out. These are typically:

• Reimbursement of supplier(s)

• Financier(s) and/or investor(s): 30% of the ransom

• Local elders: 5 to 10 %of the ransom (anchoring rights)

• Class B shares (approx. $15,000 each): militiamen, interpreters etc.

The remaining sum — the profit — is divided between class-A shareholders.

Wonder if they teach that at Wharton? 

Image: Report of the Somalia Monitoring Group: "Two skiffs (Arabian model) used by pirates to carry provisions and fuel"

This video is a few days old, but I thought folks might be interested in watching Secretary of State Clinton's address to the Commission in the Status of Women at the United Nations last week. 

Full text of her remarks here.

On October 26, 1971, California Governor Ronald Reagan phoned President Nixon to offer some foreign policy advice: get the United States out of the United Nations. The day before, you see, the General Assembly had voted to give mainland China (The People’s Republic of China) the Chinese “seat” at the UN. This was held previously by United States’ anti-communist ally, Taiwan.

The US Ambassador the UN at the time, one George H.W. Bush, tried to rally support against the General Assembly vote. He was unsuccessful, in part because the Nixon administration was simultaneously was preparing a rapprochment with the PRC.  (Nixon would visit China six months later.) Reagan, of course, would have had no way of knowing this so he called up Nixon to vent. 

The audio of that conversation is now available.  What is so striking to me is the extent to which it parallels contemporary debates about the UN.  One side sticks to emotional pleas and sloganeering to argue that the United States should withdraw from the UN. The other side offers coolly rational explanations about why sticking it out at the United Nations serves American security interests.

Reagan was clearly pursued by the former. He called the UN “morally bankrupt” and argued that pulling out of the UN would make for good domestic politics ahead of the 1972 elections. Reagan was so dedicated to this idea that he even said he would unsign a Gubernatorial proclamation for “UN Week.”

Nixon saw the bigger picture. To a certain extent he tried to placate Reagan (who, by then, was a rising star), but suggested that the United Nations was still an important entity to advance American foreign policy interests. In particular, he cited India-Pakistan. Said Nixon:

“Let me give some thought to the whole thing. It’s a tough one, as you are aware. We got some fish to fry on India-Pakistan --- we are trying to avoid a war there, and the UN may have to play some damn role there, because we don’t want to get involved in that miserable place."

The audio of this exchange, which I discovered via Dave Noon, is well worth 12 minutes of your time.

Relatedly, Gallup has been gauging Americans' opinion about the United Nations since the early 1950s.  You can see that the UN's favoribility ratings remained fairly steady until a slump during the Reagan years. It then peaked when his VP and former UN Ambassador became president in 1988. Americans' perception of the UN, it would seem, can be influenced by the tone set by the president. 

H/t to Attackerman and Rick Pearlstein for the title.