Consider the lowly worm. For some, it’s just a garden pest. But for more than a billion people in the developing world, parasitic worms can be a pernicious threat, causing disease, disability and sometimes death.

In a newly published perspective in the medical journal The Lancet, Stanford researchers, including Stanford Health Policy's Eran Bendavid and a host of distinguished colleagues, urge the World Health Organization to develop sweeping new guidelines to help end parasitic worm diseases, one of the world’s most prevalent health problems. They call for greatly expanded treatment of these diseases, which could save years of human suffering and an estimated $3 billion in lost productivity — similar to the impact of the Ebola and Zika epidemics of recent years, they say.

“Now everyone is coming together to say, ‘Now is the time, after more than a decade of new experience and data, to update the way we do things,’ said Nathan Lo, a Stanford MD/PhD candidate who is the first author of the commentary. “There is so much opportunity, whether it’s expanding treatment from children to the entire community or bringing in other strategies, such as sanitation, to strengthen the way we approach these diseases.”

The perspective is published today in Lancet Infectious Diseases and coincides with a WHO meeting in Geneva where officials, including many of the authors, are gathering to consider new treatment guidelines.

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In this new article, Megan Palmer, a senior research scholar at the Center for International Security and Cooperation, talks about the different ways that the FBI is collaborating with the biotech community in order to be prepared to respond to an emerging biological threat. One of them is by reaching out to student bioengineers at programs like the International Genetically Engineered Machine (iGEM) Competition. The purpose of that event is to demonstrate how synthetic biology can be used to address pressing global issues.

As the article states, whether it’s an accidental outbreak or a biological attack, the FBI seeks to create a culture of trust and transparency with the biotech community. Palmer discussed this topic recently at the Biofabricate conference for synthetic biology and design in New York City.

As Palmer noted, biological attacks are a historical reality. In 1984, cult members poisoned patrons of 10 salad bars in Oregon with salmonella, sickening more than 750 people. And in 2001 shortly after the 9/11 attacks, anthrax spores that were mailed to newsrooms and government offices killed five people. While other incidents may have simply failed, it seems prudent to prepare for future attacks that could be even more deadlier.

Enter the FBI's foreay into the biotech community. Collaboartion between the public and private sectors is increasing in this area. As Palmer said, examples exist of iGEM students acting as "white hat biohackers" to help biotech companies detect weaknesses in their systems that  all in collaboration with the FBI, Palmer says. 

“There’s the overall sense that the government has acknowledged that it is not necessarily the center of influence in technological development,” Palmer told the publication. “We’re going to start seeing many more examples of partnerships between the government and the private sector where you wouldn't have necessarily expected them before. People should be willing to give them a chance.” 

To Palmer, the key to the collaboration is open communication. She reports progress with the FBI and biotech community on this front. Palmer herself asks the FBI questions about its involvement and interest in biotech dangers. So far, they have “been willing to have more of those conversations,” she said. The true test will come when the relationship is finally tested by what Palmer describes as a “triggering event,” either a situation where there is reason to believe a biotech has occurred or one in which the FBI is prying a bit too much into the lives of biologists. Palmer said that if the relationship doesn’t withstand this type of challenge, the trust between the FBI and the community would weaken, and communication would break down.

Follow CISAC on Twitter at @StanfordCISAC and on Facebook at www.facebook.com/StanfordCISAC.

Amy Zegart, co-director of CISAC, wrote the following op-ed for the San Francisco Chronicle:

Donald Trump’s stunning win has made many wonder: Just how dangerous could a Trump foreign policy be? There are plenty of reasons to be afraid, very afraid.

Stanford students are applying lean start-up techniques to some of the world’s most difficult foreign policy issues.

The fall 2016 quarter class, Hacking for Diplomacy: Tackling Foreign Policy Challenges with the Lean Launchpad, is a first-of-its-kind course for studying statecraft, created as a reflection of the best that Stanford and Silicon Valley offers in the way of pioneering paradigms. Hacking for Diplomacy is co-taught by Joe Felter, a senior researcher at Stanford’s Center for International Security and Cooperation (CISAC). It is based on the Lean LaunchPad methodology, created by course designer Steve Blank, a Stanford lecturer and entrepreneur.

The teaching team also includes Jeremy Weinstein, a political science professor at the Freeman Spogli Institute; Zvika Krieger, the U.S. Department of State's Representative to Silicon Valley; and Steve Weinstein, the CEO of MovieLabs.

'Breaking free'

The class is based on cultivating ideas and imagination, breaking free of the traditional “business plan” approach to rolling out new products and solutions. In the case of diplomacy, the lean start-up method is fast and flexible above all. It has three key principles based on concepts such as "mission model canvas," "beneficiary development," and "agile engineering,” according to Felter, also a research fellow at the Hoover Institution.

“The first principle is accepting that any proposed solution to a problem whether in the commercial world or public sector is initially just a set of untested hypotheses – at best informed guesses – as to what may solve the needs of a customer or beneficiary,” said Felter.

Regarding beneficiary development, he said, experiential learning is central.

“There are no answers to complex challenges ‘inside the building,’ if you will, and students must ‘get out of the building’ to find out –in as intimate detail as possible – the various pains and gains experienced by the various beneficiaries, stakeholders and end users that must be addressed to find viable and deployable solutions to their problems,” Felter said.

The last principle, “agile development,” is based on the view that proposed solutions are generated and constantly updated through a collecting of data and feedback. This in turn, Felter explained, is rapidly tested and new solutions are designed based this iterative process.

Overall, he noted, the core idea is that entrepreneurs are everywhere, and that lean startup principles favor experimentation over elaborate planning, offering a faster way to get a desired product or solution to market.

Real-world instruction

In the class, student teams analyze real-world foreign policy challenges. They then use lean startup principles to find new approaches to seemingly intractable or very complex problems that have bedeviled the foreign policy world. The teams actually work with mentors and officials in the U.S. State Department and other civilian agencies and private companies.

Each week, the teams present their findings (“product”) to a panel of faculty and mentors, who will critique their solutions. The outcomes will range, as they vary from problem to problem. Examples include human rights, food security, refuges and labor recruitment, and mosquito disease threats, among others.

On Oct. 10, U.S. Secretary of State John Kerry visited the class. “Brilliant minds are applying technology to world’s toughest problems. Their perspective will inform,” Kerry tweeted after the class.

Kerry’s State Department gave the students seven challenges to address – human trafficking, avoiding space collisions, tracking nuclear devices, and countering violent extremism. The students will explore and analyze these issues through the rest of the quarter.

One student, Kaya Tilev, later asked Kerry what the students should be striving for to make their “solutions” a reality for national policymakers.

Kerry said, “Well, you’re doing it. You’re in it. You’re in the program. And I have absolute confidence if you come up with a viable solution it is going to be implemented, adopted, and institutionalized.”

Zvika Krieger, the state department official, told the students that Kerry was impressed with them and the class.

“He (Kerry) brought up our class in all of his meetings that day, including at a lunch with the CEOs/founders of Google, Airbnb, and Lyft; in a podcast interview with Wired magazine, and in remarks at the Internet Association's conference,” Krieger wrote in an email to them.

Global flashpoints are proliferating around the globe – the Syrian War, conflict and civil wars across the Middle East and in parts of Africa; the pursuit of weapons of mass destruction by states and non-state groups; the most significant flow of refugees since World War II; North Korea nuclear testing; Russian adventurism on its borders; China’s forays into the South China Sea; and a changing climate.

In other words, there is no shortage of thorny problems for young minds to solve as they embark on their careers.

‘Hungry to apply their energy’

Jeremy Weinstein, the political science professor, described the students as “hungry to apply their energy and talents to real-world problems, and to use hands-on experiences as a way of accelerating their learning.”

The class taps into that motivation by bringing together data scientists, engineers, and social scientist, he noted. In the end, the idea is for students to learn how to “innovate inside government.”

Weinstein is optimistic that this class – and a stronger connection between the State Department and Stanford’s technical and policy expertise – can drive more innovation inside government.

“Technology can play a critical role in addressing many of today’s foreign policy challenges, and this class is one new way for senior U.S. officials to tap into the passion, creativity and talent of Silicon Valley,” he said.

Hacking for defense

Last year, Felter and Blank also led a Hacking for Defense class based on the same lean start-up principles. Hacking for Diplomacy is co-listed as both an International Policy Studies and a Management Science and Engineering course – it counts for international relations and political science majors as well.

Blank, a consulting associate professor in engineering, told the Stanford News Service in a recent story that he seeks to cultivate in students a passion for giving back to society and their world.

“We’re going to create a network of entrepreneurial students who understand the diplomatic, policy and national security problems facing the country and get them engaged in partnership with islands of innovation in the Department of State,” said Blank, who also wrote about the new hacking for Diplomacy course in the Huffington Post.

“Teams must take these products out to the real world and ask potential users for feedback,” he noted.

Stanford researchers have determined that more than 15 million children are living in high-mortality hotspots across 28 Sub-Saharan African countries, where death rates remain stubbornly high despite progress elsewhere within those countries.

The study, published online Oct. 25 in The Lancet Global Health, is the first to record and analyze local-level mortality variations across a large swath of Sub-Saharan Africa.

These hotspots may remain hidden even as many countries are on track to achieve one of the U.N. Sustainable Development Goals: reducing the mortality rate of children under 5 to 25 per 1,000 by 2030. National averages are typically used for tracking child mortality trends, allowing left-behind regions within countries to remain out of sight — until now.

The senior author of the study is Eran Bendavid, MD, MS, an assistant professor of medicine and core faculty member at Stanford Health Policy. The lead author is Marshall Burke, PhD, an assistant professor of Earth System Science and a fellow at the Freeman Spogli Institute’s Center on Food Security and the Environment.

Decline in under-5 mortality rate

The authors note that the ongoing decline in under-5 mortality worldwide ranks among the most significant public and population health successes of the past 30 years. Deaths of children under the age of 5 years have fallen from nearly 13 million a year in 1990 to fewer than 6 million a year in 2015, even as the world’s under-5 population grew by nearly 100 million children, according to the Institute for Health Metrics and Evaluation.

“However, the amount of variability underlying this broad global progress is substantial,” the authors wrote.

“Mortality numbers are typically tracked at the national level, with the assumption that national differences between countries, such as government spending on health, are what determine progress against mortality,” Bendavid said. “The goal of our work was to understand whether national-level mortality statistics were hiding important variation at the more local level — and then to use this information to shed light on broader mortality trends.”

The authors used data from 82 U.S. Agency for International Development surveys in 28 Sub-Saharan African countries, including information on the location and timing of 3.24 million births and 393,685 deaths of children under 5, to develop high-resolution spatial maps of under-5 mortality from the 1980s through the 2000s.

Using this database, the authors found that local-level factors, such as climate and malaria exposure, were predictive of overall patterns, while national-level factors were relatively poor predictors of child mortality.

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Temperature, malaria exposure, civil conflict

“We didn’t see jumps in mortality at country borders, which is what you’d expect if national differences really determined mortality,” said co-author Sam Heft-Neal, PhD, a postdoctoral scholar in Earth System Science. “But we saw a strong relationship between local-level factors and mortality.”

For example, he said, one standard deviation increase in temperature above the local average was related to a 16-percent higher child mortality rate. Local malaria exposure and recent civil conflict were also predictive of mortality.

The authors found that 23 percent of the children in their study countries live in mortality hotspots — places where mortality rates are not declining fast enough to meet the targets of the U.N. Sustainable Development Goals. The majority of these live in just two countries: Nigeria and the Democratic Republic of Congo. In only three countries do fewer than 5 percent of children live in hotspots: Benin, Namibia and Tanzania.

As part of the research, the authors have established a high-resolution mortality database with local-level mortality data spanning the last three decades to provide “new opportunities for a deeper understanding of the role that environmental, economic, or political conditions play in shaping mortality outcomes.”  The database, available at http://fsedata.stanford.edu, is an open-source tool for health and environmental researchers, child-health experts and policymakers.

“Our hope is that the creation of a high-resolution mortality database will provide other researchers new opportunities for deeper understanding of the role that environmental, economic or political conditions play in shaping mortality outcomes,” said Bendavid.  “These data could also improve the targeting of aid to areas where it is most needed.”

The research was supported by a grant from the Stanford Woods Institute for the Environment.