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After almost two years of hard work and study, the 2025 cohort of the Ford Dorsey Master's in International Policy program (MIP) is preparing for the final stretch of their learning journey at the Freeman Spogli Institute for International Studies (FSI). 

Each year, second-year MIP students participate in the Policy Change Studio, which takes their learning out of the realm of theory and into hands-on, on-the-ground application. Recognizing that the world outside the classroom is much more complex, bureaucratic, and constrained than textbook case studies, the Studio is a two-quarter course designed to provide students with direct experience researching, developing, and implementing policy goals.   

Our students are setting out for Belgium, Mongolia, Ghana, Australia, and India to work directly with research groups, NGOs, and policy institutions on pressing challenges affecting local communities and global alliances alike. Keep reading to learn more about each project.

 

Securing Trust: A Framework for Effective Cyber Threat Information Sharing in NATO

Over the past few months, through problem identification and early solutions development, our research has identified three key challenges in NATO’s cyber threat information sharing landscape. First, despite the presence of existing protocols such as NCIRC and MISP, significant communication
[Left to right]: Emerson Johnston, Tiffany Saade, Chan Leem
Emerson Johnston, Tiffany Saade, Chan Leem, Markos Magana (not pictured)

gaps persist between stakeholders. This is exacerbated by the lack of clear, standardized specifications from NATO, leading to inconsistent implementation and operational friction. Second, at its core, this is an intelligence-sharing challenge: member states operate under different national frameworks, threat perceptions, and priorities, which influence what information they are willing (or unwilling) to share. Third, the fragmentation of sharing systems is not merely a technical hurdle but often a deliberate choice made for operational and security reasons, reflecting concerns over sovereignty, data protection, and strategic advantage.

While technological advancements can enhance interoperability, they alone will not drive adoption. Our research highlights that the underlying issue is one of trust and incentives—NATO must establish mechanisms that encourage collaboration beyond just technological solutions. Without a strong foundation of mutual trust, transparency, and shared benefits, even the most advanced systems will face resistance. Creating sustainable incentives for participation—whether through policy alignment, risk reduction assurances, or value-added intelligence sharing—will be essential in fostering a more effective and unified cyber defense posture within NATO.

 

Cultivating Community-Led Policies: GerHub and Mongolia’s Billion Trees Initiative

Our team is collaborating with GerHub in Mongolia to establish an influential policy think tank aimed at fostering community-informed and data-driven policymaking. Leveraging GerHub’s unique and extensive connections within the ger communities of Mongolia, we aim to empower policies that authentically reflect local needs and insights.
[Left to right]: Julia Ilhardt, Serena Rivera-Korver, Johanna von der Leyen, and Michael Alisky
Julia Ilhardt, Serena Rivera-Korver, Johanna von der Leyen, and Michael Alisky

A key component of our project involves conducting in-depth research and stakeholder interviews focused on Mongolia's "Billion Trees Initiative," where we will be seeking actionable insights to scale up the initiative effectively and sustainably.

 

Countering Coordinated Political Disinformation Campaigns in Ghana

Our team is working with the Africa Center for Strategic Studies to examine disinformation issues in Ghana. We are focusing on how coordinated influence operations are being used to create and spread political disinformation. We aim to understand how PR companies and
[Left to right]: Euysun Hwang, Sakeena Razick, Leticia Lie, and Julie Tamura
Euysun Hwang, Sakeena Razick, Leticia Lie, Julie Tamura, and Anjali Kumar (not pictured)

influencers work with politicians to coordinate these influence operations and shape public opinion. Our policy recommendations will address how governments and civil societies can work together to tackle this issue.

 

The recent ratification of the Technology Safeguard Agreement (TSA) by the United States and Australia lays the foundation for smoother exchange of commercial space technologies and permits U.S. commercial space launch companies to conduct reentry in Australia. With the sponsorship of the
[Left to right]: Samara Nassor, Gustavs Zilgalvis, and Helen Phillips
Samara Nassor, Gustavs Zilgalvis, Helen Phillips, and Joe Wishart (not pictured)

Australian Space Agency and U.S. Defense Innovation Unit, the goal of this project is to leverage Australia's strategic geographic position and investment in reentry infrastructure to mitigate the hurdles that U.S. commercial startups experience accessing military ranges for reentry. Our project aims to create a robust foundation for the development of orbital return capabilities in Australia, fostering greater commercial and national security collaboration between the U.S. and Australia.

 

Overcoming Computational Resource Gaps for Open Source AI in India

Our team is working with Digital Futures Lab (DFL), a non-profit research network in India that examines the intersection of technology and society in the Global South. Our project focuses on identifying the key components of open source AI in India and how limited access
[Left to right]: Sandeep Abraham, Sabina Nong, Kevin Klyman, and Emily Capstick
Sandeep Abraham, Sabina Nong, Kevin Klyman, and Emily Capstick

to computational resources acts as a barrier to adoption. India has a thriving tech sector, and openly available AI models have the potential to democratize access to this trailblazing technology. At the same time, AI is expensive to build and deploy, and access to the specialized computational resources needed to do so is limited even for top Indian companies. Our team aims to develop solutions in partnership with Digital Futures Lab that can help bolster the AI ecosystem across India.

 

Combating Human Trafficking in the Informal Mining Industry in Ghana

Our team is working with the Ghana Center for Democratic Development to identify ways to disrupt human trafficking into forced labor in Ghana’s informal mining sector. So far, our research and conversations with stakeholders has highlighted the complex systems — ranging from poverty to illicit networks —
[Left to right]: Alex Bue, Rachel Desch, and Marco Baeza
Alex Bue, Rachel Desch, Marco Baeza, and Hye Jin Kim (not pictured)

that contribute to this issue. During our fieldwork, we will explore community- and government-driven programs aimed at preventing and combating trafficking. Our final report will analyze existing policies, pinpoint gaps, and propose community-led interventions to address them.

 

The Ford Dorsey Master's in International Policy

Want to learn more? MIP holds admission events throughout the year, including graduate fairs and webinars, where you can meet our staff and ask questions about the program.

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A collage of six student groups from the 2025 Policy Change Studio at the Ford Dorsey Master's in International Policy at the Freeman Spogli Institute for International Studies.
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Students in the Ford Dorsey Master's in International Policy program are practicing their policymaking skills through projects on cybersecurity within NATO, countering political disinformation in Ghana, commercial space technology in Australia, and more.

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Faculty Director, Stanford King Center on Global Development
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Katherine Casey is Professor of Political Economy at the Stanford Graduate School of Business and the Faculty Director of the King Center on Global Development. Her research explores the interactions between economic and political forces in developing countries, with particular interest in the role of information in enhancing political accountability and the influence of foreign aid on economic development. Her work has appeared in the American Economic Review, Journal of Political Economy, and Quarterly Journal of Economics, among others. 

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For many, spring break is synonymous with time away on laid back beaches. But for the hardworking students in the Ford Dorsey Master's in International Policy Class of 2024, the break from their normal classes was the perfect opportunity to meet with partners all over the world and conduct field research for their capstone projects.

Each year, second year master's students participate in a two quarter course called the Policy Change Studio. Built on the idea that hands-on experience navigating the realities of bureaucracy, resource constraints, and politics is just as important for students as book learning and theory, this capstone course pairs groups of students with governments, NGOs, and research institutes around the world to practice crafting policy solutions that help local communities.

From agricultural policy in Mongolia to public transportation in Ghana, cyber resilience in Taiwan and AI governance in Brazil, keep reading to see how our students have been making an impact!

 

Brazil

Poramin Insom, Justin Yates, Thay Graciano, and Rosie Lebel traveled to Rio de Janeiro to work with the Institute for Technology and Society to investigate ways to design a governance strategy for digital and AI tools in public defenders' offices.

Artificial Intelligence promises to transform Public Defenders in Brazil, as seen throughout our fieldwork trip in Rio de Janeiro. Our team spent the week discussing the integration of AI in legal practices with defenders from 13 states and experts from Instituto de Tecnologia e Sociedade (ITS Rio) and COPPE / UFRJ. We focused on developing AI tools tailored to reduce administrative burdens, enabling defenders to concentrate on advocacy. With nearly 80% of Brazilians entitled to free legal aid, AI can automate routine tasks like document categorization and grammatical corrections.

Significant challenges relate to privacy and potential biases in algorithms, underscoring the need for collaborative governance to ethically implement these solutions. Thus, a unified technological strategy is crucial. We hope that through our work, we can create a collaborative governance framework that will facilitate the development of digital and AI tools, ultimately helping citizens at large. We appreciated the opportunity to learn from incredibly dedicated professionals who are excited to find new ways to jointly develop tools.

 

China-Taiwan

Sara Shah, Elliot Stewart, Nickson Quak, and Gaute Friis traveled to Taiwan to gain a firsthand perspective on China’s foreign information manipulation and influence (FIMI), with a specific focus on the role that commercial firms are playing in supporting these campaigns.

We met with government agencies, legislators, military and national security officials, private sector actors, and civil society figures within Taiwan's vibrant ecosystem for countering Foreign Information Manipulation and Interference (FIMI). On the ground, the team found that China’s FIMI operations are evolving and increasingly subtle and complex. As generative AI empowers malign actors, our team assessed that the battle against sophisticated, state-sponsored influence campaigns requires a more integrated and strategic approach that spans legal, technological, and societal responses.

 

Ghana

Skylar Coleman and Maya Rosales traveled to Accra and Cape Coast in Ghana while Rosie Ith traveled to Washington DC and Toronto to better understand the transit ecosystem in Ghana and the financial and governing barriers to executing accessible and reliable transportation.

During their time in Ghana, Skylar and Maya met with various stakeholders in the Ghanaian transportation field, including government agencies, ride-share apps, freight businesses, academics, and paratransit operators. Presently, paratransit operators, known locally as "tro tros," dominate the public transportation space and with a variety of meetings with their union officials and drivers in terminals around Accra they were able to learn about the nature of the tro tro business and their relationships — and lack thereof — with the government.

In D.C., Rosie met with development organizations and transport officials and attended the World Bank’s Transforming Transportation Conference and their paratransit and finance roundtable. Collectively, they learned about the issues facing the transport industry primarily related to problems surrounding bankability, infrastructure and vehicle financing, and lack of government collaboration with stakeholders. Insights from the trip spurred their team away from conventional physical interventions and toward solutions that will bridge stakeholder gaps and improve transport governance and policy implementation.

 

Mongolia

Ashwini Thakare, Kelsey Freeman, Olivia Hampsher-Monk, and Sarah Brakebill-Hacke traveled to Mongolia and Washington D.C. to better understand grassland degradation, the role that livestock overgrazing plays in exacerbating the problem, and what is currently being done to address it.

Our team had the opportunity to go to Mongolia and Washington DC where we conducted over twenty structured interviews with a variety of stakeholders. We spoke with people including local and central government officials, officials of international organizations, representatives from mining and cashmere industries, community organizations, academic researchers, herder households, NGOs and Mongolian politicians. Though we knew the practice of nomadic herding is core to Mongolia’s national identity, we didn’t fully realize just how integrated this practice, and the problem of grassland degradation, are in the economy, society and politics of Mongolia.

In the run-up to Mongolia’s election in June, this issue was especially top of mind to those we interviewed. Everyone we spoke with had some form of direct connection with herding, mostly through their own families. Our interviews, as well as being in Ulaanbaatar and the surrounding provinces, helped us to deepen our understanding of the context in which possible interventions operate. Most especially we observed all the extensive work that is being done to tackle grassland degradation and that institutionalizing and supporting these existing approaches could help tackle this issue.

 

New Zealand

Andrea Purwandaya, Raul Ruiz, and Sebastian Ogando traveled to Auckland and Wellington in New Zealand to support Netsafe’s efforts in combating online harms among 18- to 30-year-olds of Chinese descent. This partnership aims to enhance online safety messages to build safer online environments for everyone.

While on the ground, our team met with members from Chinese student organizations and professional associations to gather primary evidence on the online harms they face. We also met with Tom Udall, the U.S. Ambassador to New Zealand, his team, and university faculty to brainstorm solutions to tackle this problem. We learned about the prevalent use of “super-apps” beyond WeChat in crowdsourcing solutions and support, and were able to better grasp the complexities of the relationships between public safety organizations and the focus demographic. In retrospect, it was insightful to hear from actors across the public, private, and civic sectors about the prevalence of online harms and how invested major stakeholders are in finding common solutions through a joint, holistic approach.

 

Sierra Leone

Felipe Galvis-Delgado, Ibilola Owoyele, Javier Cantu, and Pamella Ahairwe traveled to Freetown, Sierra Leone to analyze headwinds affecting the country's solar mini grid industry as well as potential avenues to bolster the industry's current business models.

Our team met with private sector mini grid developers, government officials from the public utilities commission and energy ministry, and rural communities benefiting from mini grid electrification. While we saw first-hand the significant impact that solar mini grids can have on communities living in energy poverty, we also developed a deeper understanding of the macroeconomic, market, and policy conditions preventing the industry from reaching its full potential of providing energy access to millions of Sierra Leoneans. Moving forward, we will explore innovative climate finance solutions and leverage our policy experience to develop feasible recommendations specific to the local environment.

 

Taiwan

Dwight Knightly, Hamzah Daud, Francesca Verville, and Tabatha Anderson traveled to Taipei, Keelung, and Hsinchu, Taiwan to explore the island democracy’s current posture and future preparedness regarding the security of its critical communications infrastructure—with a special focus on its undersea fiber-optic cables.

During our travels around Taiwan and our many meetings, we were surprised with the lack of consensus among local decision-makers regarding which potential solution pathways were likely to yield the most timely and effective results. These discrepancies often reflected the presence of information asymmetries and divergent institutional interests across stakeholders—both of which run counter to Taiwan’s most urgent strategic priorities. Revising existing bureaucratic authorities and facilitating the spread of technical expertise would enable—and enrich—investment in future resilience.

While we anticipated that structural inefficiencies would impede change to some degree, our onsite interviews gave us a clearer picture of where policy interventions will likely have the most positive effect for Taiwan's defense. With the insights from our fieldwork, we intend to spend the remainder of the quarter exploring new leads, delving into theory of change, and designing a set of meaningful policy recommendations.

 

The Ford Dorsey Master's in International Policy

Want to learn more? MIP holds admission events throughout the year, including graduate fairs and webinars, where you can meet our staff and ask questions about the program.

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The Ford Dorsey Master's in International Policy Class of 2024 at the Freeman Spogli Institute for International Studies.
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Students from the Class of 2024 of the Ford Dorsey Master's in International Policy traveled the globe over their spring break to meet with partners of the Policy Change Studio and research their projects in the field.
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Each spring, second year students in the Ford Dorsey Master's in International Policy spread out across the globe to work on projects affecting communities from Sierra Leone to Mongolia, New Zealand, and beyond.

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Jamie O’Connell is a Lecturer in Residence at Stanford Law School. He teaches and writes on political and legal development and has particular expertise in law and development, transitional justice, democratization, post-conflict reconstruction, and business and human rights. Until 2018, he was a Senior Fellow of the Honorable G. William and Ariadna Miller Institute for Global Challenges and the Law at the University of California, Berkeley, School of Law, as well as a Lecturer in Residence, teaching both law and undergraduate students.

O’Connell has worked on human rights and development in over a dozen countries in Africa, the Americas, Asia, and Europe, under the auspices of the United Nations, local and international non-governmental organizations, and academic institutions. He co-founded International Professional Partnerships for Sierra Leone, a non-governmental organization that worked with the government of Sierra Leone to enhance the performance of its agencies and civil servants. Earlier in his career, O’Connell studied international business as a researcher at Harvard Business School, publishing numerous case studies. He has directed the Human Rights Clinic at the University of Sierra Leone and taught as a visitor at Harvard Law School and Columbia Law School. O’Connell clerked for the Honorable James R. Browning on the U.S. Court of Appeals for the Ninth Circuit and is admitted to practice in California (inactive status) and New York. In 2016-17, he was a visiting professor and Fulbright Senior Scholar at the University of Valencia (Spain) Faculty of Law.

O’Connell’s scholarship includes “Representation, Paternalism, and Exclusion: The Divergent Impacts of the AKP’s Populism on Human Rights In Turkey” in Human Rights in a Time of Populism: Challenges and Responses (2020); “When Prosecution Is Not Enough: How the International Criminal Court Can Prevent Atrocity and Advance Accountability by Emulating Regional Human Rights Institutions” (with James L. Cavallaro, Yale Journal of International Law, 2020); “Common Interests, Closer Allies: How Democracy in Arab States Can Benefit the West” (Stanford Journal of International Law, 2012); “Empowering the Disadvantaged after Dictatorship and Conflict: Legal Empowerment, Transitions and Transitional Justice,” in Legal Empowerment: Practitioners’ Perspectives (2010); “East Timor 1999,” in The Responsibility to Protect: Moving the Campaign Forward (2007); “Gambling with the Psyche: Does Prosecuting Human Rights Violators Console Their Victims?” (Harvard International Law Journal, 2005); “Here Interest Meets Humanity: How to End the War and Support Reconstruction in Liberia, and the Case for Modest American Leadership” (Harvard Human Rights Journal, 2004); and Sierra Leone’s Truth and Reconciliation Commission and Special Court: A Citizen’s Handbook (with Paul James-Allen and Sheku B.S. Lahai, 2003).

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Disaster risk is the product of a complex set of networked processes. Development professionals often use participatory tools to help understand disasters. However, such tools are not designed to capture the interconnections that shape risk. Using flooding in the slums of Freetown, Sierra Leone, as a case study, this article demonstrates how the tools of network analysis can be employed to develop network maps using participatory datasets and discusses the utility of such displays in designing interventions to reduce risk. The article suggests that networked approa ches to risk analysis are uniquely suited to capturing the intricate processes that shape disaster risk and can provide a path forward for developing policies and interventions that seek to address complex phenomena. The article includes an Appendix A with instructions for those seeking to conduct participatory network analysis.

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Michele Barry, MD: Medicine and Tropical Diseases; Center for Innovation in Global Health

Doug Owens, MD: Medicine; Center for Health Policy/Primary Care Outcomes Research

David Relman, MD: Medicine, Microbiology & Immunology; Center for International Security and Cooperation

Stephen J. Stedman: Center on Democracy, Development and the Rule of Law

Paul Wise, MD: Pediatrics; Center for Health Policy/Primary Care Outcomes Research

 

Co-sponsors:

Freeman Spogli Institute for International Studies

Stanford University School of Medicine

Center for African Studies

Center for Health Policy/Center for Primary Care and Outcomes Research

Center for Innovation in Global Health

Center for International Security and Cooperation

Center on Democracy, Development, and the Rule of Law

McCoy Family Center for Ethics in Society

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Michele Barry Panelist

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Executive Assistant: Soomin Li, soominli@stanford.edu
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Henry J. Kaiser, Jr. Professor
Professor, Health Policy
Senior Fellow, Freeman Spogli Institute for International Studies
Professor, Management Science & Engineering (by courtesy)
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Douglas K. Owens is the Henry J. Kaiser, Jr. Professor, Chair of the Department of Health Policy in the Stanford University School of Medicine and Director of the Center for Health Policy (CHP) in the Freeman Spogli Institute for International Studies (FSI). He is a general internist, a Professor of Management Science and Engineering (by courtesy), at Stanford University; and a Senior Fellow at the Freeman Spogli Institute for International Studies.

Owens' research includes the application of decision theory to clinical and health policy problems; clinical decision making; methods for developing clinical guidelines; decision support; comparative effectiveness; modeling substance use and infectious diseases; cardiovascular disease; patient-centered decision making; assessing the value of health care services, including cost-effectiveness analysis; quality of care; and evidence synthesis.

Owens chaired the Clinical Guidelines Committee of the American College of Physicians for four years. The guideline committee develops clinical guidelines that are used widely and are published regularly in the Annals of Internal Medicine. He was a member and then Vice-Chair and Chair of the U.S. Preventive Services Task Force, which develops national guidelines on preventive care, including guidelines for screening for breast, colorectal, prostate, and lung cancer. He has helped lead the development of more than 50 national guidelines on treatment and prevention. He also was a member of the Second Panel on Cost Effectiveness in Health and Medicine, which developed guidelines for the conduct of cost-effectiveness analyses.

Owens also directed the Stanford-UCSF Evidence-based Practice Center. He co-directs the Stanford Health Services Research Program, and previously directed the VA Physician Fellowship in Health Services Research, and the VA Postdoctoral Informatics Fellowship Program.

Owens received a BS and an MS from Stanford University, and an MD from the University of California-San Francisco. He completed a residency in internal medicine at the University of Pennsylvania and a fellowship in health research and policy at Stanford. Owens is a past-President of the Society for Medical Decision Making. He received the VA Undersecretary’s Award for Outstanding Achievement in Health Services Research, and the Eisenberg Award for Leadership in Medical Decision Making from the Society for Medical Decision Making. Owens also received a MERIT award from the National Institutes on Drug Abuse to study HIV, HCV, and the opioid epidemic. He was elected to the American Society for Clinical Investigation (ASCI) and the Association of American Physicians (AAP.)

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Thomas C. and Joan M. Merigan Professor
Professor of Medicine
Professor of Microbiology and Immunology
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David A. Relman, M.D., is the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and of Microbiology and Immunology at Stanford University, and Chief of Infectious Diseases at the Veterans Affairs Palo Alto Health Care System in Palo Alto, California. He is also Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford, and served as science co-director at the Center for International Security and Cooperation at Stanford from 2013-2017. He is currently director of a new Biosecurity Initiative at FSI.

Relman was an early pioneer in the modern study of the human indigenous microbiota. Most recently, his work has focused on human microbial community assembly, and community stability and resilience in the face of disturbance. Ecological theory and predictions are tested in clinical studies with multiple approaches for characterizing the human microbiome. Previous work included the development of molecular methods for identifying novel microbial pathogens, and the subsequent identification of several historically important microbial disease agents. One of his papers was selected as “one of the 50 most important publications of the past century” by the American Society for Microbiology.

Dr. Relman received an S.B. (Biology) from MIT, M.D. from Harvard Medical School, and joined the faculty at Stanford in 1994. He served as vice-chair of the NAS Committee that reviewed the science performed as part of the FBI investigation of the 2001 Anthrax Letters, as a member of the National Science Advisory Board on Biosecurity, and as President of the Infectious Diseases Society of America. He is currently a member of the Intelligence Community Studies Board and the Committee on Science, Technology and the Law, both at the National Academies of Science. He has received an NIH Pioneer Award, an NIH Transformative Research Award, and was elected a member of the National Academy of Medicine in 2011.

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Senior Fellow at the Freeman Spogli Institute for International Studies
Professor, by courtesy, of Political Science
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Stephen Stedman is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) and the Center on Democracy, Development and the Rule of Law (CDDRL), an affiliated faculty member at CISAC, and professor of political science (by courtesy) at Stanford University. He is director of CDDRL's Fisher Family Honors Program in Democracy, Development and Rule of Law, and will be faculty director of the Program on International Relations in the School of Humanities and Sciences effective Fall 2025.

In 2011-12 Professor Stedman served as the Director for the Global Commission on Elections, Democracy, and Security, a body of eminent persons tasked with developing recommendations on promoting and protecting the integrity of elections and international electoral assistance. The Commission is a joint project of the Kofi Annan Foundation and International IDEA, an intergovernmental organization that works on international democracy and electoral assistance.

In 2003-04 Professor Stedman was Research Director of the United Nations High-level Panel on Threats, Challenges and Change and was a principal drafter of the Panel’s report, A More Secure World: Our Shared Responsibility.

In 2005 he served as Assistant Secretary-General and Special Advisor to the Secretary- General of the United Nations, with responsibility for working with governments to adopt the Panel’s recommendations for strengthening collective security and for implementing changes within the United Nations Secretariat, including the creation of a Peacebuilding Support Office, a Counter Terrorism Task Force, and a Policy Committee to act as a cabinet to the Secretary-General.

His most recent book, with Bruce Jones and Carlos Pascual, is Power and Responsibility: Creating International Order in an Era of Transnational Threats (Washington DC: Brookings Institution, 2009).

Director, Fisher Family Honors Program in Democracy, Development and Rule of Law
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Richard E. Behrman Professor of Child Health and Society
Senior Fellow, Freeman Spogli Institute for International Studies
rsd15_081_0253a.jpg MD, MPH

Dr. Paul Wise is dedicated to bridging the fields of child health equity, public policy, and international security studies. He is the Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics, Division of Neonatology and Developmental Medicine, and Health Policy at Stanford University. He is also co-Director, Stanford Center for Prematurity Research and a Senior Fellow in the Center on Democracy, Development, and the Rule of Law, and the Center for International Security and Cooperation, Freeman Spogli Institute for International Studies, Stanford University. Wise is a fellow of the American Academy of Arts and Sciences and has been working as the Juvenile Care Monitor for the U.S. Federal Court overseeing the treatment of migrant children in U.S. border detention facilities.

Wise received his A.B. degree summa cum laude in Latin American Studies and his M.D. degree from Cornell University, a Master of Public Health degree from the Harvard School of Public Health and did his pediatric training at the Children’s Hospital in Boston. His former positions include Director of Emergency and Primary Care Services at Boston Children’s Hospital, Director of the Harvard Institute for Reproductive and Child Health, Vice-Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital and Harvard Medical School and was the founding Director or the Center for Policy, Outcomes and Prevention, Stanford University School of Medicine. He has served in a variety of professional and consultative roles, including Special Assistant to the U.S. Surgeon General, Chair of the Steering Committee of the NIH Global Network for Women’s and Children’s Health Research, Chair of the Strategic Planning Task Force of the Secretary’s Committee on Genetics, Health and Society, a member of the Advisory Council of the National Institute of Child Health and Human Development, NIH, and the Health and Human Secretary’s Advisory Committee on Infant and Maternal Mortality.

Wise’s most recent U.S.-focused work has addressed disparities in birth outcomes, regionalized specialty care for children, and Medicaid. His international work has focused on women’s and child health in violent and politically complex environments, including Ukraine, Gaza, Central America, Venezuela, and children in detention on the U.S.-Mexico border.  

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(Updated Nov. 7, 2014)

The Centers for Disease Control and Prevention reported on Nov. 4 that the death toll from the Ebola outbreak in West Africa has risen to above 4,960 and that an estimated 8,168 people, mostly in Liberia, Sierra Leone and Guinea, have contracted the virus since March. It is the largest and most severe outbreak of the Ebola virus since it was first detected four decades ago. All but nine of the deaths were in those three countries; eight were in Nigeria and one patient died in the United States.

The CDC in October proclaimed that in the worst-case scenario, Sierra Leone and Liberia could have 1.4 million cases by Jan. 20, 2015, if the disease keeps spreading without immediate and immense intervention to contain the virus.

Two American aid workers infected with Ebola while working in West Africa were transported to a containment unit at Emory University in Atlanta for treatment, raising public fears about international spread of the highly virulent virus that has no known cure. The two were released from the hospital after being the first humans to receive an experimental Ebola drug called ZMapp. Another man who recently helped an Ebola victim in Liberia traveled to Texas and died in a Dallas hospital. Two of the nurses who treated him caught the virus as well, but have been released from the hospital. Some states have struggled with the moral 

We ask CISAC biosecurity experts David Relman and Megan Palmer to answer several questions about Ebola and the public health concerns and policy implications. Relman is the co-director of the Center for International Security and Cooperation who has served on several federal committees investigating biosecurity matters. He is the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine and of Microbiology and Immunology at Stanford University School of Medicine, and Past-President of the Infectious Diseases Society of America.

Palmer is the William J. Perry Fellow in International Security at CISAC and a Researcher at the UC Berkeley Center for Quantitative Biosciences (QB3), and served as Deputy Director of Policy & Practices for the Multi-University NSF Synthetic Biology Engineering Research Center (SynBERC).

The two of them have answered the questions together.

What is Ebola and how dangerous is it compared to other diseases?

Ebola is an acute viral infectious disease, often associated with severe hemorrhagic fever. While initial symptoms are flu-like, they can rapidly progress, and include vomiting, reduced ability to regulate immune responses and other physiological processes, sometimes leading to internal and external bleeding. The disease has an incubation period that can last up to 21 days, but patients typically become ill four to nine days after infection, and die about seven to ten days later. Fatality rates for the current Ebola outbreak are nearing 60% (according to the CDC), while past outbreaks in the Republic of Congo have seen rates as high as 90%. This outbreak to date has resulted in nearly 1,000 deaths, more than any previous Ebola outbreak.

Ebola virus is believed to reside in animals such as fruit bats where it does not cause disease, but is then transmitted to and among humans and other primates, in whom disease typically does occur. The route by which the virus crosses between species remains largely unknown. People become infectious once they become symptomatic. Ebola is transmitted via blood or bodily fluid, but can persist outside the body for a couple days. Infection can occur through unprotected contact with the sick, but also when contaminated equipment such as needles cut through healthcare workers’ protective gear, and also through contact with infected individuals postmortem.

David Relman
Photo Credit: Rod Searcey

Ebola’s horrific symptoms provoke public fear, and it becomes easy to lose perspective on the relative spread and toll of this outbreak. Ebola is relatively difficult to transmit. This means the latest Ebola outbreak is still small in comparison to the hundreds of thousands of people killed each year via more easily transmitted airborne influenza strains and other diseases such as malaria and tuberculosis. It’s important that we not lose sight of more chronic, but less headline-grabbing diseases that will be pervasive, insidious long-standing challenges for Africa and elsewhere.

Is there a vaccine or cure?

There is no vaccine for Ebola and no tried-and-true cure. Health workers can only give supportive care to patients and try to stop the spread to new victims.

Several experimental therapies for Ebola are under development. One receiving attention is ZMapp, a mix of antibodies produced by mice exposed to the virus that have been adapted to improve their human compatibility. Limited tests in primates show early promise, but the drug had not been tried on humans -- until now. Two Americans transported back to the U.S. from West Africa received the experimental therapy. While the two seem to be improving, it isn’t clear that ZMapp was responsible; another issue is that ZMapp and other potential therapies have not been cleared by the FDA for wider use in humans.

The process for approval, and who gets priority access to such drugs, are complex policy issues. The WHO will be convening leaders and medical ethicists next week to discuss how to develop and distribute experimental therapies. This is not a simple task; many factors need to be taken into consideration and balanced with limited information to guide decisions.

Successful or not, and despite any approval, it’s still uncertain whether enough of such drugs could even be produced quickly enough to respond to this particular outbreak, and if not - whether they’d be effective in a future outbreak.

 

You can listen to Relman in this KQED Public Radio talk show.

Relman joins other experts in a Stanford panel on Ebola

 

Why has this Ebola outbreak involved so many more people, and spread to a wider geographic area,  than previous outbreaks?

This is an evolving investigation and many potential contributing factors are being examined by scientists racing to collect information that can help them get ahead of the outbreak.

One factor is population density. This latest outbreak spread early into denser population areas within Liberia and Sierra Leone, rather than remain confined to isolated villages, as in earlier outbreaks in Central Africa. With a greater number of people being exposed within a smaller geographic area, the likelihood of transmission increases. Of particular concern is the prospect that the virus might take hold in Lagos, Nigeria, where a handful of cases have been recently identified. If this were to spread in Lagos, Africa’s most populous city, the death toll would likely increase dramatically.   

Another factor is the ability of affected regions to mount an effective public health response. This outbreak is occurring in three of the poorest African countries: Sierra Leone, Liberia, and Guinea. Civil wars have likely contributed to degradation of an already relatively poor public health infrastructure. This is also the first Ebola outbreak in the region, and the inexperience of local authorities can delay responses and fuel fearful community responses, undermining the ability to deal with the outbreak early when it’s more easily contained.

Cultural practices around the care of the sick and the dead can also fuel progression of an outbreak. In some parts of Western Africa, washing deceased relatives is commonplace. Customs like these increase the likelihood of the infection spreading through proximity between infected individuals and their family members

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What can be done to curtail the outbreak?

Isolation and quarantine are key to fighting the spread of Ebola. Isolation involves removing infected individuals from the general population to prevent the spread of disease. Quarantine, however, involves removing uninfected or potentially infected individuals from the general population to limit the spread of disease.

Thus far, the strategy to fight Ebola is dependent on isolating infected patients. Unsurprisingly, isolation efforts have proven hard to enforce. Some families, faced with the prospect of being confined to their homes, have denied the existence of Ebola in their localities, or refuted doctors who claim that one of their family members is sick. This is not unique to Africa; Americans had violent reactions to quarantine during the spread of smallpox. Some regions are now taking more extreme measures: Sierra Leone has deployed its army to enforce isolation at clinics and infected families’ homes, but this also risks civil unrest.

These tensions underscore the necessity of improved education and enforcement mechanisms within public health strategies. Response measures involve fundamental tradeoffs between liberty and safety. Because negotiations occur through complex local, national and international processes, one of the biggest risks is that decisions don’t keep pace with disease spread.

It’s important that we not lose sight of more chronic, but less headline-grabbing diseases that will be pervasive, insidious long-standing challenges for Africa and elsewhere."

How likely is it that the disease will spread into and within the United States?

Currently, airports in Liberia, Sierra Leone, and Guinea are screening all outbound passengers for Ebola symptoms such as fever. This includes asking passengers to complete healthcare questionnaires. However, it is difficult to reliably know who has been infected until they are symptomatic. Individuals could theoretically board a plane before they show symptoms, but develop them upon landing in the United States or elsewhere. This makes containing Ebola difficult, but not impossible.

If the virus were to enter the United States, it would be easier to contain and harder to spread. This virus does not transmit that easily to other humans, especially in settings with good infection control and isolation.

As viruses spread, the chances of genetic variation increase. Yet despite all the concerns from the current outbreak, Ebola is relatively bad at spreading in comparison to respiratory viral diseases such as influenza or measles. The likelihood of a pandemic Ebola virus in the near future seems slim as long as it cannot be transmitted via air.  While it’s possible that the Ebola virus could evolve, there is little evidence to suggest major genetic adaptations at this time.

What are some broader lessons about the dynamics and ecology of emerging infectious diseases that can help prevent or respond to outbreaks now and in the future?

These latest outbreaks remind us that potential pathogens are circulating, replicating and evolving in the environment all the time, and human action can have an immense impact on the emergence and spread of infectious disease.

We are starting to see common factors that may be contributing to the frequency and severity of outbreaks. Increasing human intrusion into zoonotic disease reservoir habitats and natural ecosystems, increasing imbalance and instability at the human-animal-vector interface, and more human population displacement all are likely to increase the chance of outbreaks like Ebola.

Megan Palmer
Photo Credit: Rod Searcey

The epicenter of this latest outbreak was Guéckédou, a village near the Guinean Forest Region. The forest there has been routinely exploited, logged, and neglected over the years, leading to an abysmal ecological status quo. This, in combination with the influx of refugees from conflicts in Guinea, Liberia, Sierra Leone, and Cote d’Ivoire, has compounded the ecological issues in the area, potentially facilitating the spread of Ebola. There seems to be a strong relationship between ecological health and the spread of disease, and this latest outbreak is no exception.

While forensic analyses are ongoing, unregulated food and animal trade in general is also a key factor in the spread of infectious diseases across large geographic regions. Some studies suggest that trade of primates, including great apes, and other animals such as bats, may be responsible for transit of this Ebola strain from Central to Western Africa.

What are some of the other political and security implications of the outbreak and response?

Disease outbreaks can catalyze longer-term political and security issues in addition to more acute tensions.

There are complex international politics involved in emergency response and preparedness. Disease outbreaks often occur in poor regions, and demand help from more wealthy regions. The nature of the response reflects many factors - technical, social, political, legal and economic. Leaders often lack the expertise to take all these factors into account. It is an ongoing challenge to adapt our governance processes to be more reliable and move from damage control to planning. Organizations like the World Health Organization can provide guidance, but more resources and expertise are needed to get ahead of future disasters.

When help is provided, there is often mistrust of non-local workers, who can even be seen as sources of the disease. At a political level, distrust has been fueled by disguising political missions as health interventions, as was the case with the effort that led to the locating of Osama Bin Laden.

There are other security implications of this latest epidemic. This outbreak has led to a dramatic increase in the availability of Ebola virus in unsecured locations across West Africa, as well as to a growing number of labs across the world studying the disease. The immediate need to study the disease and develop beneficial interventions needs to be coupled to considerations of safety and security. From a safety standpoint, a rise in the handling of Ebola samples risks accidental transmission. From a security standpoint, those who wish to cause harm with this virus could acquire it from bodies, graves and other natural sources in the affected region. Both of these risks demand attention and efforts at mitigation.

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Fourteen Stanford researchers addressing global poverty through a range of academic disciplines are receiving a total of $4.6 million in awards from the university-wide Global Development and Poverty (GDP) initiative.

Their projects, which are the first to be funded by the GDP, deal with challenges of health, violence, economics, governance and education in the developing world.

“GDP seeks to transform scholarly activity and dialogue at Stanford around the topic of global poverty, so that the university may have a greater impact on poverty alleviation in developing economies,” said GDP faculty co-chair Jesper B. Sørensen. “By focusing on placing a small number of big bets, GDP encourages researchers to think big, and to move beyond the conventional way of doing things. We are thrilled by the inaugural set of awardees, as they demonstrate the creative, inter-disciplinary approaches that will make Stanford a leader in this area.”

The GDP initiative is part of the Stanford Institute for Innovation in Developing Economies (SEED) and is administered in partnership with Stanford's Freeman Spogli Institute for International Studies (FSI). The GDP is co-chaired by Sørensen, the faculty director for SEED and the Robert A. and Elizabeth R. Jeffe Professor of Organizational Behavior at the Graduate School of Business; and Mariano-Florentino Cuéllar, senior fellow and director of FSI and the Stanley Morrison Professor at Stanford Law School.

SEED, which seeks to alleviate poverty by stimulating the creation of economic opportunities through innovation, entrepreneurship and the growth of businesses, was established in 2011 through a generous gift from Robert King, MBA '60, and his wife, Dorothy.

Through complementary areas of focus, GDP funding and other SEED research initiatives will stimulate research, novel interdisciplinary collaborations and solutions to problems of global poverty and development. GDP research aims to pursue answers to crucial questions that are essential to an understanding of how to reduce global poverty and promote economic development. That includes governance and the rule of law, education, health, and food security – all of which are essential for entrepreneurship to thrive. By contrast, other SEED research focuses on innovation, entrepreneurship, and the growth of businesses in developing economies.

Since 2012, SEED’s Entrepreneurship and Innovation in Developing Economies Award program also has doled out 22 awards and seven PhD fellowships to help support and scale businesses in developing economies. Among the $1 million in funded projects were studies of how to improve the livelihoods of small-holder cacao farmers throughout the tropics; how to identify startups with high job- and wealth-creating potential in Chile; how political accountability affects the ability to attract investment in Sierra Leone; and how managerial practices affect trade entrepreneurship in China.

First GDP Awards

The first 14 GDP award recipients are professors of economics, political science, law, medicine, pediatrics, education and biology, and senior fellows from FSI, the Woods Institute, and the Stanford Institute for Economic Policy Research (SIEPR).

“Each of these projects cuts across disciplines, reflects innovative thinking, and has the potential to generate crucial knowledge about how to improve the lives of the poor around the world,” Cuéllar said. “These projects, along with a variety of workshops engaging the university and external stakeholders, will help us strengthen Stanford’s long-term capacity to address issues of global poverty through research, education and outreach.”

Among the award recipients is Pascaline Dupas, an associate professor of economics and senior fellow at SIEPR. Dupas, along with faculty from the Center for Health Policy and Center on Democracy, Development and the Rule of Law, will launch the Stanford Economic Development Research Initiative using GDP funds.  This initiative will focus on collecting high-quality institutional and individual-level data on economic activity in a number of developing countries over the long term, and making these data available to scholars around the world.

Beatriz Magaloni, an associate professor of political science and senior fellow at FSI, is receiving an award to lead a team focused on criminal violence and its effects on the poor in developing economies, and the practical solutions for increasing security in those regions.

Douglas K. Owens, a professor of medicine and FSI senior fellow, was awarded an award to help him lead a team that will develop models to estimate how alternative resource allocations for health interventions among the poor will influence health and economic outcomes.

Stephen Haber, a professor of political science and history and a senior fellow at the Hoover Institution, received an award to bring together Stanford researchers interested in examining the long-term institutional constraints on economic development. Their goal will be to provide policymakers with a framework for determining the conditions under which particular innovations are likely to have positive payoffs, and the conditions under which resources will likely be wasted.

Other projects will address the educational impacts of solar lighting systems in poor communities; identifying interventions to improve the profits and safety among poor, smallholder pig farmers in Bangladesh and China; the role of law and institutions in economic development and poverty reduction; and how to rethink worldwide refugee problems. Awards are also being provided to researchers focused on microfinance, online education and teacher training.

The project proposals were reviewed by an interdisciplinary faculty advisory council chaired by Cuéllar and Sørensen. 

“We were very encouraged by the impressive number of project proposals from a wide range of areas and are looking forward to introducing several new capacity and community-building activities in the fall,” Sørensen said.. “This wide range of research initiatives will form a vibrant nucleus for Stanford’s growing community of scholars of global development and poverty.”

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Zainab Hawa Bangura of Sierra Leone is Special Representative on Sexual Violence in Conflict at the level of Under-Secretary-General at the United Nations.

Prior to this appointment, Ms. Bangura was the Minister of Health and Sanitation for the Government of Sierra Leone, and brings to the position over 20 years of policy, diplomatic and practical experience in the field of governance, conflict resolution and reconciliation in Africa. She was previously the second female Minister of Foreign Affairs and International Cooperation, including Chief Adviser and Spokesperson of the President on bilateral and international issues. Ms. Bangura has been instrumental in developing national programmes on affordable health, advocating for the elimination of genital mutilation, managing the country’s Peace Building Commission and contributing to the multilateral and bilateral relations with the international community. She is experienced in meeting with interlocutors in diverse situations, including rebel groups, and familiar in dealing with State and non-State actors relevant to issues of sexual violence while fighting corruption and impunity.

Ms. Bangura has on-the-ground experience with peacekeeping operations from within the United Nations Mission in Liberia (UNMIL), where she was responsible for the management of the largest civilian component of the Mission, including promoting capacity-building of government institutions and community reconciliation. She is an experienced results-driven civil society, human and women’s rights campaigner and democracy activist, notably as Executive Director of the National Accountability Groups, Chair and Co-founder of the Movement for Progress Party of Sierra Leone, as well as Coordinator and Co-founder of the Campaign for Good Governance.

Ms. Bangura is a former fellow of the Chartered Insurance Institute of London, possessing Diplomas in Insurance Management from the City University Business School of London and Nottingham University. She received her Bachelor of Arts from the Fourah Bay College, University of Sierra Leone.

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Zainab Bangura United Nations Special Representative on Sexual Violence in Conflict Speaker
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Why do some armed groups commit massive wartime rape, whereas others never do? Using an original dataset, I describe the substantial variation in rape by armed actors during recent civil wars and test a series of competing causal explanations. I find evidence that the recruitment mechanism is associated with the occurrence of wartime rape. Specifically, the findings support an argument about wartime rape as a method of socialization, in which armed groups that recruit by force—through abduction or pressganging—use rape to create unit cohesion. State weakness and insurgent contraband funding are also associated with increased wartime rape by rebel groups. I examine observable implications of the argument in a brief case study of the Sierra Leone civil war. The results challenge common explanations for wartime rape, with important implications for scholars and policy makers.

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