On the eve of the Lunar New Year, Beijing is bright and bustling. Keeping a promise made to a friend 2000 km away, a reporter walks along Zhongguancun Boulevard in search of a medicine called the "baota lozenge." However, more than twenty-some pharmacies of all sizes have all given the same answer: this once familiar anthelmintic drug has been off the counters of pharmacies for over 10 years!

In Sichuan and Guizhou, some 2000 km away, the final report from the Chinese Academy of Sciences Rural Policy Research Center and the Rural Education Action Project (REAP) on the current infection status of intestinal worms in children is fresh off the press. In the more than twenty years since the baota lozenge came off the market, prevention efforts against soil-borne worm infections in rural children have weakened and these parasitic infections traditionally affecting rural children have re-emerged!

According to results from a survey of 6 randomly selected nationally designated poor counties and 95 villages, in which 817 three to five year-old preschool-aged children and 890 eight to ten-year old school-aged children in Sichuan and Guizhou were screened for intestinal worms, REAP found that infection rates for intestinal worms (Ascaris, hookworm and whipworm) reached 22%: 21% for preschool-aged children and 23% for school-aged children.

In a country like China that has been experiencing an economic boom for the past 30 years, why do poor rural children today still have such a high infection rate of intestinal worms?

Delisting the baota lozenge and its effects on children's health

Among 817 three to five year-old preschool-aged children and 890 eight to ten-year old school-aged children randomly selected from 6 poor counties, the overall intestinal worm infection rate was high at 22%, mainly with Ascaris. Of the infected children, ~80% had roundworms, and 15% had multiple infections. This result overturns the presumption that intestinal worms infection decreases when standard of living increases.

A WHO report in 1999 explained that in tropical and subtropical regions, the loss from soil-borne parasitic diseases and schistosomiasis accounts for over 40% of the total disease burden. Those affected are mainly children; the diseases increase the risk of malnutrition, anemia, stunting, impaired cognition, and other diseases.   

Actually, even before this report was published, China had already prioritized prevention of soil-borne parasitic diseases and schistosomiasis in public health measures. In the 50 years from the founding of new China to the early 1990s, the Chinese government had been devoted to increasing awareness of parasitic worm infections and systematic use of anti-parasite drugs as part of its prevention efforts to drastically reduce intestinal worm infection rates in children. However, in the last 20 years, not only have intestinal worms not been considered a priority in national infectious disease control, but the baota lozenge used consecutively for 10 years has also retreated from the market.

With the baota lozenge off the market and intestinal worm prevention at a low, what is the current health status of the vast number of rural children?

With this question in mind, CCAP and REAP's team, with the help of the Chinese CDC's Parasitic Diseases Control and Prevention Institute, conducted a field work investigation from April 2010 to June 2010 in Sichuan and Guizhou.

To ensure representativeness and the scientific nature of the survey, 6 nationally designated poor counties were randomly selected across the two provinces. After sampling areas were confirmed, the townships in each county were divided into 42 groups according to per capita net income and 12 townships were randomly selected from each group. Four sample townships were selected from each sample county. In every sample township, 2 sample schools were randomly selected; in every sample school, 2 sample villages served by the school were randomly selected; in each sample village, 11 eight to ten-year olds were selected for parasitic worm infection screening. At the same time, in every village, using child vaccination records (provided by township health center), the research team acquired the name list of all three to five-year old children in the two sample villages within that township. Eleven three to five-year old preschool-aged children were randomly selected from each sample village for screening for intestinal worms.

In this way, with collaborations with international parasitic worm expert consultants and recommendations from the Chinese CDC Parasitic Disease Control and Prevention Institute, 46 schools, 95 villages served by the schools, and a total of 1707 children were randomly selected to form the sample. Of these, 817 were three to five years old and considered preschool-aged and 890 were eight to ten years old and considered school-aged.

The investigation and screening of children for parasitic worms consisted of three main parts: anthropomorphic measures, basic socioeconomic information and children's fecal samples. A team of nurses from Xi'an Jiaotong University was responsible for measuring children's height and weight; REAP team members collected information on sample children's age, gender, parental education levels, hygiene and family characteristics, as well as whether children had received anthelmintics in the past year and a half. Chinese CDC Parasitic Disease Control and Prevention Institute analyzed fecal samples.    

Over the course of a few months of data analysis, results indicate: sample areas have high infection rates of intestinal worms, but discrepancies exist across different age groups, areas and types of parasitic worm infection. Twenty-one percent of preschool-aged and 23% of school-aged children in sample areas were infected with Ascaris, hookworm or whipworm or a combination thereof. Infection rates meet WHO's criteria for mass treatment. In one province, 34% of preschool-aged and 40% of school-aged children have one or more of the three types of worms. In the other province, although infection rates are lower among preschool and school-aged children, they are still 10% and 7%, respectively. Among the types of worm infection, Ascaris is most severe, with infection rates reaching 17%, followed by whipworm (7%), pinworm (5%), and hookworm (4%).

At the same time, regional differences are quite distinct. In one of the provinces, 7 villages out of 48 sample villages and 2 schools out of the 23 sample schools had prevalence rates above 20%. About half of the sample villages and schools suggest evidence of parasitic worm infection. In the other province, one quarter of the sample villages and one third of the sample schools had infection rates above 50%. Evidently, intestinal worms prevention is an important public health concern that needs to be emphasized by local disease control centers.

Besides high infection rates of parasitic worms, the intensity of infection should not be ignored. Among preschool-aged children in the two sample areas, each gram of fecal matter contains 23,568 and 17,064 roundworm eggs, respectively. According to WHO standards, this level of roundworm infection is considered a "moderate" infection level. Hookworm and whipworm infection intensities are lower; only hookworm infection among school-aged children in Sichuan reached "moderate intensity," while other infection levels could be considered "low intensity".

 What causes parasitic worm infection in these children?

The investigation shows that infection in preschool-aged children correlates with maternal education and family health conditions, while infection in school-aged children correlates with school health education and hygiene conditions. Of particular importance is that even though eliminating worms costs only 4 RMB per person per year, prevention efforts have not been included in local medical services in less accessible rural areas with high infection rates.

In the third grade class of Longshan elementary school in Machang township, Pingba county, Anshun city, Guizhou province, one question continues to haunt head teacher Li: "Why does our class have students calling in sick and missing school every day?"

On the surface, Teacher Li's third grade class is no different from schools in other rural areas in China. The students are typical rural schoolchildren filled with curiosity, who have bright eyes, dirty hands, and colorful backpacks.

However, if you pay close attention, you will notice they are very different from same-aged children in other areas. These students are mostly on the small side, and look one to two years younger than their actual age. At recess, there is none of the typical pent-up energy kids usually have after sitting in a classroom all morning. No excited children chasing one another, no shouts from the hubbub of play, no lively rhythm of skipping rope. It is as if a blanket of weariness has descended on these children.  

The culprit is no other than intestinal worms. According to the introduction provided by researchers Drs. Xiaobing Wang and Chengfang Liu, Longshan elementary school has one of the highest infection rates of all sampled schools, reaching 70%. One of the two sample villages covered by Longshan elementary schools had parasitic worm infection rates as high as 80%.

What effect does parasitic worm infection have on children's growth and development? REAP's results indicate that worms lead to anemia in 22.7% of the rural school-aged children, and delayed physical development in 30%, which is a 400% higher risk than non-infected children. Compared with non-infected children, affected children have below-average weights, shorter stature, weaker body constitution, and general underdevelopment, just to name a few characteristics.

The project research team, Chinese CDC Parasitic Disease Control and Prevention Institute's Guofei Wang and Xibei University's Professor Yaojiang Shi believe that worms not only cause discomfort and nausea, but also lead to significant learning (memory) and cognitive impairments.

Renfu Luo, an assistant researcher at CCAP, believes that the underlying reason is that high infection rates have long been neglected, and so have caused low school attendance rates and limited attention spans, which ultimately lead to infected children falling behind their healthy counterparts.

In fact, according to the WHO's parasitic worms prevention guidelines, for schools like Longshan elementary school that are rural and inaccessible, two mass administrations of albendazole or mebendazole (both available on the market) are needed per year. However, the reality is, even though the medicine costs only 4 RMB per person per year for kids from Longshan elementary school and other nearby rural villages, the public health infrastructure required to combat the disease has not been incorporated into the scope of medical services.

If the Longshan elementary school sample is an example of the typical conditions in western villages, what are the implications on a larger scale? CCAP researcher Linxiu Zhang believes that in the long run, if parasitic worm infections in children continue to be neglected in national infectious disease control, the future efficiency and productivity of the rural labor force will be affected. From an education perspective, and in light of an increasingly competitive skill-based socioeconomic environment, intestinal worms may very well be the primary driver for perpetuating the vicious intergenerational cycle of poverty.

From the 6 sample counties investigated over the course of 3 months, the researchers were able to see with their own eyes the health situation of Longshan elementary school and other sample schools. The researchers could not resist asking, how did these kids become infected with intestinal worms? Living in more or less the same environment, why do some kids become infected while others escape that fate?

After repeated comparison and analysis of the data, researchers found that these poor rural village children's infection rates are correlated with mother's education level, children's unsanitary hygiene habits (such as not washing hands before meals and after bathroom use), and family health conditions (such as access to potable, clean water, toilet sanitation, and livestock/poultry breeding habits). At the same time, children's habit of wearing split pants for convenient urination/defecation also exacerbates the risk for worm infection. Because mothers are usually responsible for their children's eating and health habits at home, mothers with lower education levels often lack knowledge about health and nutrition improvement and intestinal worm disease severity. Thus, the higher the mother's education level, the lower the child's chance of infection. Interestingly though, father's education level has no visible effect on the child's risk of infection.

For school-aged children, the main reason for intestinal worm infection is that poor rural village schools lack safe drinking water services and facilities. In these sample schools, researchers found that the schools' water quality is a far cry from the national standards for safe, potable water. However, because these schools cannot provide boiled water, many students have no choice but to drink unprocessed, unboiled water.

Drinking unboiled water is a main cause for infection in children. According to calculations made by the research team, consuming unboiled water increases infection by 11%, while washing hands before meals can decrease infection by about 4.6%.

Poor school sanitation conditions are also a main driver for infection. Research findings indicate that two-thirds of the sampled schools did not have sinks for washing hands; even though a few schools have constructed sinks, because there is no running water or soap, they are really just for display. Also, none of the sampled school treated their bathroom waste using appropriate and safe chemical methods, which not only affects sanitation in and around the school, but also facilitates parasitic worm cross-infection.

Insufficient knowledge or poor public health measures?

Prevention of intestinal worm infection for poor, rural village children is unstructured, unsystematic, and combined with school sanitation and health education deficiencies, has triggered high infection rates in remote rural areas. However, the primary reason for this phenomenon is the lack of basic public health measures in rural settings.

The analysis of the data begs the following question: Why, in the midst of rapid economic progress, are there still elevated levels of infection among children in certain regions? We know from China's past successes in infectious disease control that basic public health services are all that is needed to effectively prevent parasitic worm infection. And cheap, effective, safe, and reliable anthelmintics are easily acquirable. Yet high levels of infection persist. Why?

As early as 1960, many international experts in global development praised China for its ability, despite its developing status and low average income, to effectively provide public health services for rural citizens and children. Turning back to that page in long forgotten history, China was actually able to prevent parasitic worm disease at impressive proportions in a short span of 50 years. The success can be attributed to strong adherence to prevention and the hard work of medical and public health personnel.

Data indicate that in the 1970s, the parasitic worm infection rate among China's children reached about 80%. The 1990 seminal nation-wide human parasites survey found that overall parasitic prevalence remained high at 63%, with the intestinal worm infection rate at 59%. Even though China's population infected with Ascaris, whipworm and hookworm at that time reached 140 million people, due to administration of anthelmintics in rural villages combined with health education and waste management as part of a concerted prevention effort, the parasitic infection rate ultimately plummeted at the beginning of this century. Soil-borne worm infection rates decreased to about 20%. 

This was an accomplishment during a time of massive prevention and treatment by the infectious disease control unit. This period marked a golden era for public health measures in rural villages. Almost everyone over 35 years of age born in rural areas can still vividly remember the many "barefoot" and village doctors who performed regular check-ups for various villages, treated common diseases for free, and educated people about basic disease prevention and health practices. One of the most commonly seen services was providing free "baota" lozenges or albendazole to children, in the form of a pink or blue, mildly sweet anthelmintic pill.

However, this "free lunch" period did not last long. After conducting field work studies on the sample villages, researchers discovered that entering into the 1980s, with decreasing investment in rural public health and medical services, the rural health system sustained by "barefoot" doctors crumbled, and villagers have since rarely enjoyed basic public health protection. With severe financial shortages and lack of coordination, education and public health collaboration efforts also descended into stagnation. School-aged children's health surveillance and vaccination measures reached a nearly historic low. In recent years, the Chinese government has begun to redirect attention to rural public health. However, the prolonged 20-year disappearance of basic rural public health services from the national radar has initiated the revival of many once eliminated diseases in these areas. Some villages actually exist in zones of concentrated outbreaks.

With an impressive record of success just twenty years ago, why is the prevention of parasitic worms in children still so difficult in an economically blossoming and increasingly health conscious society? Is it due to insufficient monetary funding, gaps in knowledge, or some other reason?

Researchers believe that even with the disappearance of the high quality and inexpensive "baota" lozenge, other drug treatments for parasitic worm infections in children exist today, requiring just two administrations per year and a low cost of less than 4 RMB. However, the critical problem is that health and education administration in various areas currently lack substantive, effective coordination in their anthelmintic efforts. Small investments that maximize benefit to many people's livelihoods are slow to be made.

According to field interviews, when the "baota" lozenge retreated from center stage, local health and education departments debated about who should take responsibility for children's health, and teachers and principals also shunned the problem. In discussions with some teachers from sampled schools, researchers found that teachers scratched their heads over poor parental care in addressing the issue. Despite all schools establishing relevant health education curricula, due to limited manpower and financial resources, most schools do not have full-time health education teachers and do not distribute unified teaching materials to students, so the curriculum can hardly be implemented.

Actually though, cross-department cooperation has occurred in the past. At the end of the last century, the Ministries of Health and Education used to collaborate on formulating and implementing effective anthelmintic interventions for children through stratified school-based efforts that provided anthelmintics for free to children in severe infection areas. At that time, treatment of parasitic worms in children was highly successful.

However, the reality is that in the sampled areas, a relatively large portion of medical institutions lack funding support and the necessary facilities. Thus, they have no capacity to freely provide parasitic worm prevention services to children, resulting in 55% of sampled rural children being infected with intestinal worms. These children have never been administered any anthelmintics, and even for those who have been treated, they did not undergo any examination of the distribution of intestinal worm infection beforehand. Parents often solely look for changes to their children's appetite or compare their children's weight with that of other same-aged peers. They rarely seek medical help or follow a doctor's advice, and many freely allow their kids to take the medications on their own. Due to limited knowledge about parasitic worm infections and prevention, parents never followed-up to make sure the medication worked and are unclear about reinfection risks. The vast majority of parents wrongly assume that using anthelmintics just once will prevent infection in the long run.

By investigating children who have used anthelmintics in the past 18 months (47% of the sample), researchers found that even after treatment, intestinal worms reinfection rates in children remained at a high 20%. In one sampled province, intestinal worms reinfection rates in children were at a startling 33% after treatment. These results indicate that across sampled areas, one-third of preventive medication efforts produced no effect. What is needed is integration into rural public health services system with long-term follow-up, surveillance, and medical intervention when appropriate.

An indisputable reality is that the worm burden reduction is different from other types of infectious disease control because specialized equipment and knowledge are needed for detection of intestinal worm infection in children, and the disease often strikes poor, remote rural areas. Thus, even though rural public health services have received more attention today, it remains difficult to attract the focus of relevant departments.

Recommendations from experts in multiple fields: Increase the level of parasitic worm prevention and improve health facilities in poor rural schools

The situation of intestinal worm infection is one parameter by which to measure the economic development and social civilization level of a country. However, some poor areas in China today still have high rates of infection, which is inconsistent with the rapid socioeconomic development in the country, sounding a loud warning bell for the Ministries of Health and Education. 

International research indicates that for every 1 RMB spent on health education, 6 RMB is saved in medical treatment fees. For the reemergence of intestinal worms affecting children in some rural areas, are there other better solutions?

Renfu Luo, an assistant researcher at CCAP, suggests that the pressing matter at the moment is to mobilize parasitic worms prevention efforts in poor rural areas, renew inclusion of such efforts in the government's infectious disease control focus, develop and implement a long-term health education curriculum in schools that covers parasitic worm prevention, as well as launch health promotion campaigns in rural communities. With this foundation, the government needs to organize relevant experts to go deep into the vast number of poverty-stricken villages. Talks, newspapers, bulletins, and slogans, among other methods that address intestinal worms prevention; disseminating information on individual and public health; motivating schools, children, and families; urging poor rural communities to change unsanitary habits and thereby eliminate or reduce external factors affecting health are among the basic interventions that can lower the infection rates in impoverished children.

Yaojiang Shi, Director of the Xibei (Northwest) Research Center for Economic and Social Development and Professor of Xibei University, believes that the education administrative departments must intensify improvements to public health and drinking water facilities in poor rural schools while simultaneously nurturing and teaching children about good health habits. On the supply side, schools should provide students with safe drinking water and improve toilets and hand-washing areas; these improvements in external conditions can facilitate decreases in parasitic worm infection rates.

CCAP deputy director Linxiu Zhang recommends that the central government should augment investment efforts to manage environmental sanitation in poor rural villages, improve water source environmental protection and water quality, promote context-specific domestic pollution control, strengthen livestock pollution measures, reduce livestock waste, recycle, and process waste through non-hazardous treatment. At the same time, the government should consider including parasitic worm prevention services in the Rural Cooperative Medical System in poverty-stricken areas, allowing children to truly enjoy the benefits of national public health services for intestinal worms detection and treatment, experience effective decreases in infection rates, and develop healthily to reach their potential. (Article correspondent: Jin Ke)

Relevant background information

The past and present of the "baota" lozenge

"Baota" lozenge targets a common type of parasitic worm, the intestinal roundworm. At the beginning of the liberation period, roundworm infection was prevalent throughout China's cities and countryside.

As part of the former Soviet Union's aid projects in China, China imported wormseed seeds to test plant from the Soviet Union. The 20 g of seeds (can imagine the value of the seeds) imported were divided into 4 portions and under the protection of public security personnel, were transported to 4 state-owned farms in cities given the task of test planting: Hohhot, Datong, Xian and Weifang. Only one trial in Weifang announced success. In order to keep the information secret, Weifang publicized the successful test plant as "Pyrethrum No. 1" to the outside.

This roundworm-specific anthelmintic is derived from wormseed in the Chenopodiaceae family of herbs. It was initially administered in pure tablet form, but in order to expedite administration to children, a certain proportion of sugar was added, and the medicine was transformed into a light yellow and pink cone-shaped pill that resembled a pagoda ("baota"). People thus named this medication the "baota" lozenge.

The anthelmintic encountered many hardships including the Great Leap Forward, which through mistaken industrial techniques led to 3500 kg of raw materials going to waste. Then, the rebels from the "Ten Years of Turmoil" took the promising manufacturing of wormseed medication and left it in a terrible mess. In 1979, the Ministry of Health and State Food and Drug Administration promoted universal administration of "baota" lozenge. But in September 1982, all dosage forms and raw materials were eliminated. By the early 1990s, "baota" lozenge had disappeared from China.

The dangers of a few important types of intestinal worms

Intestinal worms mainly infect children, and due to competition with the host for nutrients, often lead to malnutrition and anemia in infected children, compromised physical and cognitive development, and even death from complications.

Ascaris larvae migration can lead to larvae-induced pneumonia and allergic reactions, while adult roundworms residing in the small intestine can destroy gastrointestinal function, generating abdominal pain, loss of appetite, nausea, diarrhea or constipation and even severe complications such as intestinal obstruction, biliary duct ascariasis, and appendicitis.

Hookworm resides in the duodenum and small intestine, sucking up nutrients and blood in children, leading to anemia, poor appetite, nausea and vomiting, pale nails and facial complexion, dizziness, feebleness, shortness of breath, palpitation etc. Chronic infection can affect children's growth and development and severe infection can cause anemia-induced congestive heart failure.  

Whipworm resides in children's cecum and appendix and consumes tissue fluid and blood for sustenance. Infected individuals can experience appetite loss, nausea, vomiting, bloody stool and other symptoms.

Pinworm's unique feature is that it stimulates itchy sensations in the anus and genitals at night, affecting sleep with associated symptoms of poor appetite, emaciation, irritability, night terror etc and can induce ectopic complications such as appendicitis.  

North Korea conducted its first nuclear weapons test in October 2006, prompting the UN Security Council to establish military and economic sanctions in an effort to block further development of the country's nuclear program. After North Korea conducted another test in May 2009—a move that U.S. President Barack Obama described as "directly and recklessly challenging the international community"—the UN Secretary General, at the request of the Security Council, convened a Panel of Experts to advise and assist the UN committee that enforces the sanctions (the "1718 Committee," after the UN Security Council Resolution that brought it into being).

John Everard, 2010-2011 Pantech Fellow with the Stanford Korean Studies Program at the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) and former UK Ambassador to North Korea, left Stanford at the end of March to take up a position with the panel.

The seven-member panel comprises independent experts from the Security Council's five permanent member countries—China, France, the Russian Federation, the United Kingdom, and the United States—and from South Korea and Japan. Some experts come from academic institutions while others have been lent to the panel by national governments. As part of its efforts to advise the 1718 Committee, the panel often travels to inspect banned goods—such as materials that could be used for nuclear purposes—in intercepted cargo shipping to or from North Korea. 

During his diplomatic service in North Korea from 2006 to 2008, Everard closely observed and took photographs of the details of everyday life, discovering that the mindset of ordinary people frequently does not match official government ideology. "There is an openness toward warm relations with Americans if political relations improve," he says. Everard is currently working on completing a book describing his observations of the everyday life of non-elite North Koreans, as well as his experience as a foreigner living in North Korea. It also addresses how North Korea as a country has evolved over the past sixty years and provides suggestions for how better to deal with its government.

Although Everard looks forward to his new position with the Panel of Experts, he will not soon forget his time at Shorenstein APARC. "It has been a great experience," he emphasizes. "It has been a real delight to be surrounded not just by this beautiful architecture and the wonderful facilities that Stanford has, but also by the very friendly, very intelligent people here."

February 10th marked the launch of the Program on Food Security and the Environment's Global Food Policy and Food Security Symposium Series. Setting the stage for the two-year series were Jeff Raikes, CEO of the Bill & Melinda Gates Foundation, and Greg Page, CEO and Chairman of Cargill Inc. As CEOs from the largest foundation and the largest agricultural firm in the world they provided important perspectives on global food security in these particularly volatile times. Full video and clips of the event are now available - Improving Food Security in the 21st Century: What are the Roles for Firms and Foundations.

Jeff Raikes: A Perspective from the Bill & Melinda Gates Foundation

Catalytic philanthropy

The Gates Foundation, through its Agricultural Development Initiative, has been a leader in addressing global food security issues. The Foundation allocates 25% of its resources to global development and to addressing the needs of the 1 billion people who live in extreme poverty ($1/day). 70-75% of those people live in rural areas and are dependent on subsistence agriculture for their livelihoods.

The Gates Foundation is driven by the principle: how can it invest its resources in ways that can leverage performance and address market failures? Its approach embodies a novel concept driven by both private sector motives and public responsibilities. Raikes describes this as catalytic philanthropy.

"The Foundation identifies where its investments can create an innovation, a new intervention that can really raise the quality of lives for people," said Raikes. "If successful, it can be scaled up and sustained by the private sector if we can show that there is a profit opportunity or the public sector if we can show that this is a better way to improve the overall quality of society through investment in public dollars."

Image Photo credit: Michael Prince

In the realm of agriculture, allocating resources across the agricultural value chain has proven to be the most effective approach. As an example of this strategy, Raikes talked about a farmer-owned, Gates-supported dairy chilling plant in Kenya. The cooling facility provided the storage necessary to provide a predictable price at which to sell farmers' milk. This price knowledge and market access gave farmers the confidence to invest in better technology and better dairy cattle. The plant also provided artificial insemination services and extension services to teach farmers how to get greater amounts of milk from the cattle.

"I love the concept. I also love the numbers," said Raikes. "In just two or three years there were now 3,000 farmers in a 25 kilometer radius that were able to access this dairy chilling plant and able to sell their milk."

In addition to improving incomes, Raikes remarked that very consistently what he hears is when farmers are able to improve their incomes the first thing they do with the money is invest in the education of their children.

Upcoming challenges to food security

During the next 40 years or so, global food production must double to accommodate a growing and richer population. Climate change and water scarcity contribute to this challenge. The places that will suffer the most severe weather are also the places where the poorest farmers live. 95% of sub-Saharan agriculture is rain fed with very little irrigation.

"If we are going to be able to feed the world we are going to have to figure out how to achieve more crop per drop," cautioned Raikes. "This includes trying to breed crop varieties that will better withstand water shortages. Early results show that you can get as much as a 20% increase in yield or more under stressed conditions when you have varieties that are bred for that need."

These challenges are compounded by the current economic crisis that is putting pressure on budgets in both donor and developing countries. In 2009, the G20 committed 22 billion dollars to agricultural development in recognition of the importance of agricultural development to food security. However, of the 22 billion promised, 224 million dollars went to five countries in the first round of grants in June. By November, when 21 additional countries submitted their proposals, just 97 million dollars were available to be dispersed and 17 countries were turned away empty handed.

High- and low-tech solutions

In an effort to alleviate some of this deficit, the Gates Foundation has committed 300 million dollars in six grants that span the value chain. These include investments in science and technology, farm management practices, farmer productivity, and market access as well as the data and policy environment to support the Foundation's work. The grants are intended to support about 5 ½ million farm families in sub-Saharan Africa and South Asia.

"We believe innovative solutions can come from both high-tech and low-tech," said Raikes. "On the high-tech end, submergent genes are allowing rice crops to survive periods of flooding up to 15 days. In areas of rice farming prone to flooding, this can save entire crops traditionally wiped out by such weather disasters."

Image Photo credit IRRI/Ariel Javellana

The sub1gene seeds are now being used by 400,000 farmers and are on track to be used by 20 million rice farmers by 2017. On the low-tech end, the Gates Foundation is providing $2 triple layer bags to farmers to reduce crop loss from pests; an affordable solution that has increased average income per farmer by $150/year.

"We primarily support conventional breeding, but we also support biotechnology breeding. In some cases we think that breeders in Africa and South Asia will want to take advantage of the modern tools we use here in our country to provide better choices for their farmers," explained Raikes.

Reasons for optimism

After years of diminished support, US Agricultural Development assistance to sub-Saharan Africa has gone from about 650 million in 2005 to about 1.5 billion in 2009. In developing countries, the Comprehensive Agricultural Development Program (CADP) in Africa has challenged countries to dedicate 10% of their national budgets to agriculture with the goal of improving annual agricultural growth by 6%. 20 countries have signed on to the CADP compacts, and 10 countries are exceeding the 6% growth target. Finally, since 1990, 1.3 billion people worldwide have lifted themselves out of poverty primarily through improvements in agricultural productivity.

Raikes pointed to Ghana as a success story. Since 1990, casaba production, an important staple food for poor smallholder farmers, has increased fivefold. Tomato production increased six fold. The cocoa sector has been revived and hunger has been cut by 75%.

"The key to success in Ghana was a combination of getting the right developing country policy with the right macroeconomic reform, the right institutional reform, smart public investment, and an overall good policy environment," said Raikes.

Supporting good policy is an important part of the Foundation's food security strategy, and was a strong motivation behind its funding of FSE's Global Food Policy and Food Security Symposium series.

"We see this symposium series as an opportunity to gather policy leaders who will bring new ideas of what will be effective policy approaches and effective economic environments in the countries we care a lot about, in particular sub-Saharan Africa and South Asia," said Raikes.

Raikes concluded his remarks by reminding everyone that the key to improving food security globally is making sure women, who make up at least 70% of the farm labor population, are included in the equation.

Greg Page: Balancing the race to caloric sufficiency with rural sociology

As the largest global agricultural firm, Cargill has an influential role to play in the world of food and agriculture. Cargill is a major supplier of food and crops and a provider of farmer services, inputs, and market access.

Image Photo credit: Olaf Hammelburg

Together with the Gates Foundation, Cargill has reached out and trained 200,000 cocoa farmers in the Ivory Coast, Ghana, and Cameroon. One tribe and one small village at a time the company has helped improve food safety, quality maintenance, and storage; benefiting the farmers, Cargill, and customers further down the supply chain. Cargill has also assisted, through financing and product purchasing, 265,000 farmers in Benin, Burkina Faso, the Ivory Coast, Malawi, Uganda, Zambia, and Zimbabwe.

Can the world feed itself?

A billion people lack sufficient caloric intake on a daily basis. In sub-Saharan Africa, 38% of all children are chronically malnourished, largely the result of inadequate agricultural productivity. While nine of the ten countries that have the highest prevalence of malnourishment are in sub-Saharan Africa, the two countries with the largest absolute number of malnourished people are India and China.

"This points to the difficulty of this problem," said Page. "India exports corn and soybean protein and China has 2.5 trillion dollars of hard currency reserves. These issues aren't necessarily of ability to feed people, but a willingness and commitment to do so."

Can the world feed itself? Yes, said Page.

When you break down the number of calories needed per malnourished person per day and convert that to tons of whole grains required to extinguish that hunger you get 30 million tons; 1/6 the amount of grain we converted to fuel globally last year. In the U.S. alone, 40% of our corn goes to ethanol.

"It isn't an issue of caloric famine-it is an issue of economic famine," stated Page. "In other words, this is not a food supply problem, but rather the lack of purchasing power to pay for a diet. An adequate price must be assured to reward the farmer for his efforts and to provide enough money that she can do it again the following year."

Rural sociology premium

What we face is the need to keep smallholders on the farm-despite the fact that they may not be the low-cost producer of foodstuffs-in order to avoid a rural population migration that would be unsustainable. As a result, the challenge the world faces is who is going to pay that rural sociology premium? If it costs more to raise crops on small farms is that burden going to be borne by the urban poor or is there going to be an alternative funding mechanism that allows smallholders to succeed?

Image Photo credit: Cargill

What is the survival price for a smallholder farmer? Page explained that if you wanted a family of four on a farm in sub-Saharan Africa to receive an income commensurate with the average per capita income of the urban population, you would come up with a price near $400 a ton.

"To put this in context, the highest price for maize that has ever been reached here in the United States is about $275 a ton," said Page. "This rural sociology premium to sustain smallholders is not an insignificant amount of money. How do we achieve fairness between the revenue received by the rural smallholder and the price borne by the urban consumer?"

State of disequilibrium - complacency to crisis

Today we are experiencing incredible price volatility where commodity prices are in a continuous state of disequilibrium. Very small changes in production have outsized impacts on price. This is in contrast to the last two and a half decades when the world operated with fairly robust stocks due to crop subsidies in the United States and Western Europe.

"This period of subsidization was when the western world probably did more harm to sub-Saharan Africa and South Asia than any other period in history," said Page. "We refused to allow price to signal to western farmers to produce less. As a result, the world price of grains fell far below the ability of any smallholder to compete. We then shipped those surpluses to developing countries, which then failed to invest in their agriculture for decades."

Today we are lurching from complacency to crisis. The ability of information and market speculation to be transmitted rapidly is affecting purchasing decisions of thousands to millions of consumers. Rising fuel prices, export restrictions, increasing demand for crops for biofuels, and unpredictable weather have all contributed to higher prices. Some of the drivers of price, however, are good things, such as the increase in per capita income and the capacity of more people to have a more dense and nutritious diet.

"Interestingly, the upside of the ethanol and biofuels program is that it brought prices back to a sufficiency that reinvigorated investment in agriculture," noted Page. "On one level I think a very good argument could be made that the biofuels program brought the world further from famine than it ever had been because of the price."

Critical food security factors

Page concluded by summarizing the elements that Cargill believes are critically important to increase food security. The first is the ability to understand the tradeoffs between a fast path to caloric sufficiency and the needs of rural sociology. Second, that crops be grown in the right soil, with the right technology, and relying on free trade so we can harvest competitive advantage to its fullest.

Another critical factor is rural property rights. Smallholders must have the ability to own the land, have access to it, and transfer it to future generations if you want a farmer to reinvest in his farm, said Page.

"Smallholders in developing countries need some degree of revenue certainty and access to a reliable market if we expect them to do what their countries really need them to do, which is raise productivity," explained Page. "Today they are often forced to sell at harvest, often below the cost of production, and lack the storage capabilities and capital to provide crops sufficiently and continuously."

Open, trust-based markets also play a key role in ensuring food security. Governments need to support trade. When Russia, Ukraine, and Argentina turned to embargos as a way to protect domestic food prices open markets were jeopardized and price volatility increased. Finally, there are very important roles for the world's governments in the creation of infrastructure that is vital to provide access to markets.

"I believe fully and completely in the world's capacity to harvest photosynthesis to feed every single person and to do it at prices that can be borne by all," concluded Page.

Sooner or later, I believe, there will be major change in North Korea. The system may be very strong, but it is also very brittle. Without democratic electoral processes and free speech, smooth and gradual adjustments cannot be made to meet changing circumstances and the needs of the people.

-David Straub
Korean Studies Program
In the mid-1990s, after the death of Kim Il Sung, I heard many top U.S. officials, speaking privately, predict that the North Korean regime would collapse in a matter of just a few years, if not months. I was younger then and assumed they knew what they were talking about. They didn't. They didn't know much about North Korea. They simply compared it to the situation in the Soviet Union and Eastern Europe, where communist regimes had just collapsed, and thought the same thing would happen in the very different circumstances of North Korea. Everyone was saying it would happen, so it must true, people assumed. Americans don't like the North Korean regime, so wishful thinking also contributed to this consensus among Americans.

These days, as another leadership succession is underway in North Korea, many people again are speculating about the "collapse" of the Pyongyang regime. The fact of the matter is that no one, not even in Pyongyang, really knows what is going to happen there. I believe there could be dramatic change in the regime in North Korea even as you are reading this, but I also believe it is possible that the regime could last many decades more.

A former colleague, Bill Newcomb, recently compared the situation in North Korea to the buildup of pressure along a fault zone. No one, he noted, can predict when a particular earthquake will occur and how large it will be, but scientists today can say with confidence that a major earthquake will inevitably occur in a certain area eventually. Pyongyang is indeed like that.

Sooner or later, I believe, there will be major change in North Korea. The system may be very strong, but it is also very brittle. Without democratic electoral processes and free speech, smooth and gradual adjustments cannot be made to meet changing circumstances and the needs of the people.

Whether the political earthquake in Pyongyang occurs sooner or later, it is only prudent to prepare thoroughly. The United States and other countries will help the Republic of Korea when dramatic change occurs in North Korea, but it will be the Republic of Korea and the people of North and South Korea who, inevitably, will bear the most risk and stand to gain the most.

Since we cannot predict exactly when or how change will come to North Korea or what its nature will be, South Koreans and their allies and friends abroad need to begin to prepare now for many possibilities. I understand that some South Koreans are concerned that such a discussion will offend and anger Pyongyang and may cause its own problems. But the consequences of not preparing could be far worse. This should not be a matter of pushing for collapse, much less risking war, but for preparing prudently to meet real dangers and real opportunities.

South Koreans need to pool their wisdom and their resources, so that they will be able to respond quickly and effectively no matter what eventually happens in North Korea. There needs to be much more thorough study and debate, both within the government and among the citizenry, about how to deal with various possible crises on the Korean Peninsula, including unification.

I worked on German affairs in the U.S. State Department shortly after German unification, and observed as the government in Bonn, while making heroic efforts, made many serious mistakes. Policies regarding currency unification, wages and pensions, property claims and many other issues caused human suffering and national problems that linger today, twenty years later. How great is the understanding in South Korea among government officials and the public about these issues?

One of the things that many South Koreans seem to have concluded from German unification is that unification will be too risky and too costly. There certainly will be risks and the costs will be great when unification occurs. But unification may occur whether all South Koreans want it or not, and whether they are ready or not. And most costs, if carefully planned, will actually be investments. Moreover, there will not only be risks; there will be opportunities for enormous gain. Unified Korea could be stronger, safer, more prosperous, and happier, not just for the people of North Korea but for all Koreans.

We all remember the earthquake that hit a very poor and unprepared Haiti last year, killing at least 100,000 people and leaving a million homeless. The terrible earthquake that Japan has just experienced was 1,000 times more powerful. Just imagine the consequences if Japan had not prepared as well as it had. It is time for the Republic of Korea to begin to prepare seriously for the eventual political earthquake on the Korean Peninsula.

[나와 통일]4. 스트라우브 스탠퍼드대 부소장

1994년 김일성이 사망한 뒤, 나는 미국의 많은 고위관리들이 사견으로 북한 정권이 몇 개월내 혹은 몇년 내 붕괴할 것이라고 예측하는 것을 들었다. 그때 나는 그들 스스로가 무엇을 얘기하고 있는지 알고 있다고 추측했다. 그러나 그들은 몰랐다. 그들은 단순히 북한을, 공산주의 정권이 붕괴됐던 소련과 동유럽의 상황과 비교했고, 이 같은 상황이 매우 다른 환경의 북한에서도 발생할 것이라고 생각했다. 미국인들은 북한정권을 좋아하지 않기 때문에 (북한이 망할 것이라는) ‘희망적 생각'(wishful thinking)도 이런 일치된 예측에 기여했다.
▲ 데이비드 스트라우브 스탠퍼드대 아태연구소 한국학 부소장은 남북한의 통일 비용이 결국은 투자가 될 것이라고 강조했다.

요즘 북한에서 권력 승계가 진행되면서, 많은 사람들이 북한 정권의 ‘붕괴'에 대해 다시 추측하고 있다. 이 문제와 관련해 명확한 사실은, 누구도, 심지어 평양에 있는 사람도, 거기서 실제 무슨 일이 일어나고 있는지 정확히 모른다는 것이다. 나는 북한 정권에 상당한 변화가 있을 수 있지만, 그 정권이 수십년 더 지속하는 것이 가능하다고도 생각한다.

●北시스템 강한만큼 깨지기도 쉬워

전직 동료인 윌리엄 뉴콤(전 미 재무부 경제자문관)은 최근 북한 상황을 ‘단층대를 따라 고조되는 압력'에 비유했다. 그는, 누구도 어떤 특별한 지진이 언제 발생할 것이고 얼마나 클 것인지 예측할 수 없지만, 오늘날 과학자들은 대규모 지진이 불가피하게 어느 지역에서 결국 발생할 것이라고 확신을 갖고 말할 수 있다고 지적했다.

평양은 정말로 이런 상황과 같다. 나는 조만간 북한에 큰 변화가 있을 것이라고 생각한다. 북한의 시스템은 매우 강할 수 있지만 역시나 매우 깨지기 쉽다. 민주주의적 선거 과정과 표현의 자유 없이, 사람들의 수요와 변하는 환경을 충족시키기 위한 평탄하고 단계적인 조정은 불가능하다.

평양에서 ‘정치적인 지진'이 조만간 일어나든 아니든, 철저하게 대비하는 것이 현명하다. 미국과 다른 나라들은 북한에 극적인 변화가 일어날 경우 한국을 도울 것이다. 그러나 남한과 남북한 사람들이 불가피하게 가장 위험을 감수하고, 가장 많은 이득도 얻게 될 것이다.

우리는 변화가 언제 어떻게 올지, 그것의 모습이 무엇일지 정확하게 예측하기 어렵다. 때문에 남한 사람들과 동맹국들, 우방들은 지금부터 많은 가능성에 대해 준비해야 한다.

나는 일부 남한 사람들이 그런 논의가 북한을 화나게 할 것이고 북한 내 문제를 유발할 것이라고 걱정하는 것을 알고 있다.

그러나 준비하지 않는 것의 결과는 훨씬 나쁠 수 있다. 이것은 붕괴를 재촉하는 문제가 아니라, 실제로 맞닥뜨릴 위험과 기회에 대해 신중하게 준비해 나가야 하는 문제다.

남한 사람들은 북한에 결국 무슨 일이 발생하든 신속하고 효과적으로 대응할 수 있도록 지혜와 자원을 공유할 필요가 있다. 정부와 민간에서 통일을 포함, 한반도에서 발생 가능한 다양한 위기들에 대해 어떻게 대처할 것인지에 대한 더 많은 철저한 연구와 논쟁이 필요하다.

나는 독일 통일 직후 미 국무부에서 독일 담당 업무를 했다. 당시 독일 정부가 용감하게 노력했지만 심각한 실수를 많이 한 것을 관측했다. 화폐 단일화, 임금, 연금, 재산권 등과 관련된 정책들이 20년이 지난 오늘날에도 맴돌고 있는 국민 고통과 문제를 야기했다. 한국의 관료들과 대중 가운데 이런 문제들에 대해 얼마나 이해하고 있는가?

●신속 대응위한 지혜·자원 공유를

많은 남한 사람들이 독일 통일로부터 결론을 내린 것으로 보이는 것들 중 하나는, 통일은 매우 위험하고 비용이 많이 들 것이라는 것이다. 통일이 이뤄질 때 위험과 비용은 당연히 클 것이다.

그러나 통일은 남한 사람들이 원하든 원치 않든, 준비가 돼 있든 아니든 일어날 수 있다. 그리고, 대부분의 비용은, 주의 깊게 계획된다면, 실제로는 투자가 될 것이다. 게다가 위험만 있는 것은 아니다. 엄청난 이득을 위한 기회도 있을 것이다.

통일된 한국은 단지 북한 사람들뿐 아니라 모든 한국인들을 더 강하고, 안전하고, 번영하고, 행복하게 할 수 있다.

우리는 지난해 준비되지 않은 아이티를 강타한 지진의 엄청난 피해를 기억한다. 최근 일본의 대지진은 아이티 지진보다 1000배 강력했다. 일본이 준비하지 않았다면 어떤 결과가 발생했을지 상상해 보라. 이제 남한은 한반도의 정치적 지진에 대해 심각하게 준비해야 한다.

번역·정리 김미경기자 chaplin7@seoul.co.kr

●약력

▲57 세 ▲미 루이빌대·하버드대 박사과정 ▲주서독 미대사관 근무 ▲주한 미대사관 근무 ▲주일 미대사관 근무 ▲미 국무부 독일팀장 ▲주한 미대사관 공사참사관 ▲미 국무부 한국과장·일본과장 ▲미 존스 홉킨스대·서울대 강의 ▲현재 미 스탠퍼드대 아태연구소 한국학 부소장

Each president of the United States enters office thinking he will be able to define the agenda and set the course of America's relations with the rest of the world. And, almost invariably, each confronts crises that are thrust upon him-wars, revolutions, genocides, and deadly confrontations. Neither Woodrow Wilson nor FDR imagined having to plunge America into world war. Truman had to act quickly, and with little preparation, to confront the menace of Soviet expansion at war's end. JFK, for all his readiness to "bear any burden" in the struggle for freedom, did not expect his struggle to contain Soviet imperial ambitions would come so close to the brink of nuclear annihilation. Nixon was tested by a surprise war in the Middle East. Carter's presidency was consumed by the Shah's unraveling and the Iranian revolution. George H.W. Bush rose to the challenge of communism's collapse and Saddam Hussein's invasion of Kuwait. Clinton squandered the opportunity to stop a genocide in Rwanda and waited tragically too long before stopping one in Bosnia. George W. Bush mobilized the country to strike back after September 11, but, in the view of many, he put most of his chips in the wrong war.

In the eye of the historical storm, and in the absence of a challenge as immediate and overpowering as September 11, Pearl Harbor, or the Nazis' march across Europe, it is risky to identify any set of world events as game-changing. Yet that is what many analysts, including myself, believe the Arab revolutions of 2011 are. And a surprising number of specialists-including hard-eyed realists like Fareed Zakaria-have seized upon the crisis in Libya as a defining moment not just for the United States in the region but for the foreign policy presidency of Barack Obama as well.

To date, one could say that Obama has had a surprisingly good run for a foreign policy neophyte. He has revived the momentum for arms control with a new START treaty with Russia, while pressing the issue of human rights within Russia. He has managed the meteoric rise of China decently, while improving relations with India. He has not cut and run from Iraq-as most Republicans were convinced he would. And he has ramped up but at least set limits to our involvement in Afghanistan. As the Arab revolutions have gathered momentum, he has increasingly positioned the United States on the side of democratic change. His statements and actions have not gone as far as democracy promotion advocates (like myself) would have preferred, but they have overridden cautionary warnings of the foreign policy establishment in the State Department, the Pentagon, think tanks, and so on. Without Obama's artful choreography of public statements and private messages and pressures, Hosni Mubarak might still be in power today.

All of this, however, may appear in time only a prelude to the fateful choice that Obama will soon have to make-and, one fears, is already making by default in a tragically wrong way-in Libya. Why is Libya-with its six million people and its significant but still modest share of global oil exports-so important? Why must the fight against Muammar Qaddafi-a crazy and vicious dictator, but by now, in his capacity for global mischief, a largely defanged one-be our fight?

When presidents are tested by crisis, the world draws their measure, and the impressions formed can have big consequences down the road. After watching Jimmy Carter's weak and vacillating posture on Iran, the Soviets figured he'd sit on the sidelines if they invaded and swallowed Afghanistan. They misjudged, but Afghanistan and the world are still paying the price for that misperception. In the face of mixed messages and a long, cynical game of balance-of-power, Saddam too, misjudged that he could get away with swallowing up Kuwait in 1991. When the United States did not prepare for war as naked aggression swept across Asia and Europe, the Japanese thought a quick strike could disable and knock out the slumbering American giant across the Pacific. When Slobodan Milosevic and his Bosnian Serb allies launched their war of "ethnic cleansing," while "the West"-which is always to say, first and foremost, the United States-wrung its hands, many tens of thousands of innocent people were murdered and raped before President Bill Clinton finally found the resolve to mix air power and diplomacy to bring the genocidal violence to a halt.

If Muammar Qaddafi succeeds in crushing the Libyan revolt, as he is well on his way to doing, the U.S. foreign policy establishment will heave a sad sigh of regret and say, in essence, "That's the nasty business of world politics." In other words: nasty, but not our business. And so: not their blood on our hands. But, when we have encouraged them to stand up for their freedom, and when they have asked for our very limited help, it becomes our business. On February 23, President Obama said: "The United States ... strongly supports the universal rights of the Libyan people. That includes the rights of peaceful assembly, free speech, and the ability of the Libyan people to determine their own destiny. These are human rights. They are not negotiable. ... And they cannot be denied through violence or suppression." Yet denying them through murderous violence and merciless suppression-with a massacre of semi-genocidal proportions likely waiting as the end game in Benghazi-is exactly what Qaddafi is in the process of doing.

Barack Obama has bluntly declared that Qaddafi must go. The Libyan resistance, based in Benghazi, has appealed urgently for the imposition of a no-fly zone. Incredibly, the Arab League has endorsed the call, as has the Gulf Cooperation Council. France has recognized the rebel provisional government based in Benghazi as Libya's legitimate government-while Obama studies this all. Can anyone remember a time when France and the Arab League were ahead of the United States on a question of defending freedom fighters?

There is much more that can be done beyond imposing a no-fly zone. No one in their right mind is calling for putting American boots on the ground in Libya. But we can jam Qaddafi's communications. We can, and urgently should, get humanitarian supplies and communications equipment, including satellite modems for connection to the Internet, to the rebels in Benghazi, where they can be supplied by sea. And we should find a way to get them arms as well. Benghazi is not a minor desert town. It is Libya's second largest city, a major industrial and commercial hub, and a significant port. Through it, a revolt can be supplied. If Benghazi falls to Qaddafi, it will fall hard and bloodily, and the thud will be heard throughout the world.

Time may be running out. As the Los Angeles Times reported yesterday, "All that stands between Kadafi and rebel headquarters in Benghazi are disorganized volunteers and army defectors spread thinly along the coastal highway." They have passion and courage, but they lack weaponry, strategy, and training. Like so many rebel movements, they need time to pull these all together. Time is what a no-fly zone and an emergency supply line can buy them.

Libya's rebels are pleading for our help. "Where is America?" asked one of them, quoted in the L.A. Times, who was manning a checkpoint in Port Brega. "All they do is talk, talk, talk. They need to get rid of these planes killing Libyan people." The "they" he was referring to was the Americans, beginning with their leader-one would hope, still the leader of the "free world"-President Obama.

Many prudent reasons have been offered for doing nothing. It is not our fight. They might lose anyway. We don't know who these rebels really are. We have too many other commitments. And so on. The cautions sound reasonable, except that we have heard them all before. Think Mostar and Srebrenica. And we had a lot of commitments in World War II as well, when we could have and should have bombed the industrial infrastructure of the Holocaust. As for the possibility that the rebels might lose-a prospect that is a possibility if we aid them and a near certainty if we do not-which would be the greater ignominy: To have given Libya's rebels the support they asked for while they failed, or to have stood by and done absolutely nothing except talk while they were mowed down in the face of meek American protests that the Qaddafi's violence is "unacceptable"?

Oh yes. There is also the danger that China will veto a U.N. Security Council Resolution calling for a no-fly zone. Part of us should hope they do. Let the rising superpower-more cynical than the reigning one ever was-feel the first hot flash of hatred by Arabs feeling betrayed. Go ahead, make our day.

Presidents do not get elected to make easy decisions, and they certainly never become great doing so. They do not get credit just because they go along with what the diplomatic and military establishments tell them are the "wise and prudent" thing to do. This is not Hungary in 1956. There is no one standing behind Qaddafi-not the Soviet Union then, not the Arab League now, not even the entirety of his own army. That is why he must recruit mercenaries to save him. Qaddafi is the kind of neighborhood bully that Slobodan Milosevic was. And he must be met by the same kind of principled power. For America to do less than that now-less than the minimum that the Libyan rebels and the Arab neighbors are requesting-would be to shrink into global vacillation and ultimately irrelevance. If Barack Obama cannot face down a modest thug who is hated by most of his own people and by every neighboring government, who can he confront anywhere?

For the United States-and for Barack Obama-there is much more at stake in Libya than the fate of one more Arab state, or even the entire region. And the clock is ticking.

On February 25 and 26, the Center on Democracy, Development, and the Rule of Law at Stanford University, in partnership with the Canadian Department of Foreign Affairs and International Trade, hosted a symposium titled, "Addressing the Accountability Gap in Statebuilding: The Case of Afghanistan." This event brought together leading experts, government officials, diplomats, practitioners, and academics to examine the problems of accountability, corruption, and election fraud that have risen in the wake of international statebuilding efforts in Afghanistan.

This unique forum allowed participants-both Afghan actors and members of the international community- who are heavily involved in building the institutions of the Afghan state, to participate in an honest exchange with their peers to surface challenges and generate recommendations to improve the practice of statebuilding moving forward. 

Panels were designed around the following questions: how to establish accountability in statebuilding, address electoral fraud evidenced in 2009 and 2010, manage powerbrokers who monopolize informal governance networks, coordinate anti-corruption efforts, and develop a political strategy for Afghanistan's future. What surfaced throughout these presentations and discussion was the issue of the "double compact" in Afghanistan-the failure of Afghans to self-govern and the failure of the international community to construct the institutions of a functioning state.

Participants proposed a new framework for governance that adopts a more participatory approach with the international community, Afghan government, and the public as equal partners in statebuilding endeavors. While challenges emerged there were also a number of key recommendations and strategies proposed  that can be pioneered by this influential group of policymakers and practitioners to ease the transition of responsibility to the Afghan government in 2014.  

The keynote address was delivered by former Afghan Minster of Finance and 2009 presidential candidate Dr. Ashraf Ghani, to an audience of more than 100 students and members of the local community. Dr. Ghani provided an honest and pragmatic account of the parallel and conflicting systems driven by the international community, which have given rise to systemic failure and corruption in Afghanistan.

"We are dealing with a crooked playing field," Dr. Ghani said recognizing that both the Afghan and international community were jointly responsible for this outcome. "When the field itself is crooked the nature of reform and change that we must initiate are very different. "

Dr. Ghani spent considerable time discussing the outsourcing of development to Washington-based firms that manage million dollar contracts and outsource technical work to foreign technocrats. This in Dr. Ghani's opinion does little to strengthen the internal capacities of the state, provide training opportunities to Afghans or allocate resources effectively to the general public.

Dr. Ghani stressed the importance of speaking honestly about these dysfunctions in the development system, "We need to start talking truth to each other if we are going to deal with this phenomenon. This double failure now is the genesis of the present."

Dr. Ghani channeled the sentiments of the Afghan public into the room by emphasizing the uncertainty that defines their lives. "Today it is the sense of injustice that drives conflict," Dr. Ghani said. "The level of conflict is driven by injustice. What Afghans yearn for is normalcy-the sense that the lives of our children and grandchildren will be better and what my generation endured will not be repeated."

The level of conflict is driven by injustice. What Afghans yearn for is normalcy-the sense that the lives of our children and grandchildren will be better and what my generation endured will  not be repeated.                    -Dr. Ashraf Ghani 

 Looking forward, Dr. Ghani advised that accountability mechanisms and feedback loops must be implemented to ensure that the necessary auditing and accounting mechanisms are in place to control corruption and ensure transparency. In addition, he called for one coherent system of rules that must be developed and agreed upon to govern development and prevent parallel systems from circumventing these rules. Finally, he advised adopting national programs that model the success of the National Solidarity Program, which reduced child mortality rates by 16%.

Dr. Ghani commented on the unique position that Afghanistan occupies at the crossroads of Asia, in the middle of "four huge hubs of change," China, India, Russia, and the Gulf. "A new regional era has to be created, if France and Germany could overcome hundreds of years of conflict we must create another sense of opportunity."

Dr. Ghani concluded by placing the hope and responsibility for Afghanistan's future in the hands of its younger generation, "We must talk about the generation compact in Afghanistan, our sons and daughters-both literal and figurative-are the source of growth and the source of dynamism...The women of Afghanistan, the youth of Afghanistan, and the poor of Afghanistan are the three numerical majorities that have been reduced to political and economic minority. Without investing in women, investing in youth and tackling the challenge of poverty, we are not going to have stability."

At the end of the two day symposium, participants collectively called for a comprehensive political strategy to facilitate the peaceful and legal transfer of power in 2014, which marks the end of President Karzai's term in office. With this important milestone in the near future, the international community remains committed to working with their Afghan counterparts to introduce political reform measures that will strengthen accountability mechanisms between the Afghan state and society. 

As Dr. Ghani eloquently stated at the end of his presentation, "We have to have an agenda of the future, we must engage in writing the history of the future."

President Obama's vision of a "world free of nuclear weapons" -- first enunciated in Prague in April 2009 -- has been derided by his critics as a utopian fantasy that will have no influence on the nuclear strategies of other nations.

But in a special issue of The Nonproliferation Review, entitled Arms, Disarmament, and Influence: International Responses to the 2010 Nuclear Posture Review, 13 prominent researchers from around the world examined foreign governments' policy responses to Obama's 2010 Nuclear Posture Review (NPR), the landmark document published a year and a day after his Prague speech.

They found that many nations, though not all, had been "strongly influenced by Washington's post-Prague policy and nuclear posture developments," which reduced the role of nuclear weapons in U.S. national strategy, and assured non-nuclear nations that the U.S. would never use nuclear arms against them provided they remained in compliance with their obligations under the Nuclear Non-Proliferation Treaty.

Indeed, the 11 case studies presented "demonstrate that U.S. pronouncements and actions influenced bureaucratic infighting and domestic debates inside a number of important foreign governments, and that some of these governments have adjusted their own policies and actions accordingly."

Read the full report here.

See a presentation about the report here, or listen to a different one here.

Read CISAC co-director Scott Sagan's essay on "Obama's Disarming Influence" in the Bulletin of the Atomic Scientists.  

Read Thomas Fingar's essay on "How China Views U.S. Policy" in the Bulletin of the Atomic Scientists. 

Highlights:

* Russia adopted a nuclear doctrine that was considerably more moderated than it would have been had the United States not pushed ahead with its own policy changes. In the run up to the April 2010 publication of the NPR, Washington "reset" relations with Russia, ended the deployment of missile defense components in Poland and the Czech Republic, and resumed the disarmament negotiations that ultimately led to the ratification of the New START treaty. As a result of this process, and continuous consultation with Russia about the NPR, Moscow narrowed the role of nuclear weapons in its policy and the range of circumstances in which it would consider using them. (page 39)

* "The most important short-term success of Obama's nuclear weapons policy," along with the "Prague Spirit," has been to halt the erosion of the NPT. "Obama's policies helped extract a minimum positive result from the 2010 NPT Review Conference, a favorable outcome compared to the chaos that his predecessor's representatives had created at the 2005 conference." The Obama policy was welcomed as a positive development, which allowed "key players, such as Egypt and Brazil, to strive for compromise, and others, such as Russia and China, not to block it." (page 219)

* The U.S. effort to encourage other governments to reduce the role of nuclear weapons in their policy was successful in the United Kingdom, which adopted a nuclear posture that was very similar to that to the U.S. (page 238)

* Due in large part to the Obama policy, some of the non-nuclear weapons states in NATO began to push for the removal of sub-strategic nuclear weapons from Europe. At the November 2010 NATO summit, members agreed to a new Strategic Concept that called for negotiations with Russia and a linkage between the reduction and eventual elimination of nuclear weapons in NATO Europe to comparable reductions in western Russia. (page 238)

* Obama's new nuclear doctrine was a driving force behind a May 2010 agreement among 189 nations at the Nonproliferation Review Conference to a set of disarmament objectives and steps to reinforce the nuclear non-proliferation regime. (page 238)

* The Obama disarmament initiatives encouraged Indonesia's decision to begin the process of ratifying the Comprehensive Test Ban Treaty. (page 238)

* China continues to view Washington's nuclear doctrine with suspicion. Although Beijing viewed the 2010 NPR favorably compared to its 2001 predecessor, it still found serious cause for concern. This is partly the result of timing: the NPR came out amid a period of rising tension between U.S. and China. It also reflected a tendency among Chinese leaders to view virtually all U.S. doctrine and actions as part of a concerted effort to constrain its rise. In this view, the NPR would foster comparisons between nuclear decreases in Russia and the U.S., and increases in China, and be used as leverage to force Beijing to engage in an expensive conventional arms race. In keeping with this China-centric view, Chinese officials were also concerned about the U.S. military's continued development of missile defense capabilities. (page 243)

* Many non-nuclear weapons states--such as Egypt, Brazil, and South Africa--emphasize their opposition to any constraints being placed on their right to enjoy the benefits of civilian nuclear energy. Some of their opposition is "due to post-colonial sensitivity about any apparent inequality in the terms of international agreements that divide the world into 'haves' and 'have-nots.'" Others are engaged in bargaining, waiting to see what nuclear-weapons states will do regarding disarmament before offering to accept more constraints on nuclear technology development. Some governments also appear to be engaged in "hedging behavior--protecting their ability to enrich uranium or reprocess plutonium" to be closer to acquiring nuclear weapons in the future, should they choose to do so. This may be disappointing for Washington policymakers, but it should not be surprising. After all, the U.S. employs a similar "hedging strategy" in its management of its own nuclear stockpile. As a result, it is imperative to begin discussions of how to reduce the danger of both kinds of nuclear hedging behavior. (page 255)

* The Obama administration must continue "to ensure there is consistency and discipline in the messages" emanating from the military and the government bureaucracy. Some foreign governments viewed the NPR's guarantees as mere rhetoric. "Such a skeptical view is encouraged whenever a senior US military officer makes statements that reflect a lack of understanding or lack of discipline regarding nuclear use policy." Even after the NPR was released, a top U.S. general insisted that the United States had not altered its "calculated ambiguity" policy. (page 258)

The special issue of the Nonproliferation Review was coordinated by Scott D. Sagan, co-director of the Center for International Security and Cooperation at Stanford University, and Jane Vaynman, a PhD candidate at the Department of Government at Harvard University, and a National Security Studies Fellow at the Weatherhead Center for International Affairs. The journal is published by the James Martin Center for Nonproliferation Studies at the Monterey Institute of International Studies, and it is edited by Stephen Schwartz.

Authors:

Irma Argüello is founder and chair of the NPSGlobal Foundation, a private nonprofit initiative that focuses on improving global security and reducing risks stemming from WMD proliferation.

Ralph A. Cossa is President of the Pacific Forum CSIS in Honolulu. He is senior editor of the Forum's quarterly electronic journal, Comparative Connections. 

Ambassador Nabil Fahmy is the founding Dean of the School of Global Affairs and Public Policy at the American University in Cairo. He is also the Chair of the James Martin Center for Nonproliferation Studies' Middle East Project.

Thomas Fingar is the Oksenberg-Rohlen Distinguished Fellow and Senior Scholar in the Freeman Spogli Institute for International Studies at Stanford University.

Brad Glosserman is Executive Director of the Pacific Forum CSIS in Honolulu. Mr. Glosserman is co-editor of Comparative Connections, the Pacific Forum's quarterly electronic journal, and writes, along with Ralph Cossa, the regional review.

S. Paul Kapur is associate professor in the Department of National Security Affairs at the U.S. Naval Postgraduate School and a faculty affiliate at Stanford University's Center for International Security and Cooperation.

Mustafa Kibaroglu is an Assistant Professor at Bilkent University.

Michael Krepon is the co-founder of the Stimson Center, a Washington-based think tank specializing in national and international security problems. 

Harald Müller is executive director of Peace Research Institute Frankfurt and Professor at International Relations at Goethe University Frankfurt.

Pavel Podvig is an independent analyst based in Geneva, Switzerland, where he manages the research project Russian Nuclear Forces.

Scott D. Sagan is the Caroline S.G. Munro Professor of Political Science, co-director of Stanford's Center for International Security and Cooperation, and a Senior Fellow at the Freeman Spogli Institute. He also serves as the co-chair of the American Academy of Arts and Science's Global Nuclear Future Initiative.

Scott Snyder is Director of the Center for U.S.-Korea Policy at The Asia Foundation, Senior Associate at Pacific Forum CSIS, and Adjunct Senior Fellow for Korean Studies at the Council on Foreign Relations.

Jane Vaynman is a PhD candidate at the Department of Government at Harvard University and a National Security Studies Fellow at the Weatherhead Center for International Affairs.

^{The Center for International Security and Cooperation (CISAC), part of the Freeman Spogli Institute for International Studies (FSI), is an interdisciplinary university-based research and training center addressing some of the world's most difficult security problems with policy-relevant solutions. The Center is committed to scholarly research and to giving independent advice to governments and international organizations.}