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Professor of Political Economy, Stanford GSB
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, Chase Lee, 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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Students from the Ford Dorsey Master's in International Policy Class of 2024 brainstorm ideas for their capstone projects in the Policy Impact Studio at the Freeman Spogli Institute for International Studies at Stanford University.
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Hands on Policy Practice: A Look at the MIP Capstone Projects of 2024

Taiwan, New Zealand, and Sierra Leone are just a few of the places students from the Ford Dorsey Master's in International Policy are headed this year for their capstone projects.
Hands on Policy Practice: A Look at the MIP Capstone Projects of 2024
The Ford Dorsey Master's in International Policy Class of 2024 at the Freeman Spogli Institute for International Studies.
Blogs

Meet the Ford Dorsey Master's in International Policy Class of 2024

The 2024 class of the Ford Dorsey Master’s in International Policy has arrived at Stanford eager to learn from our scholars and tackle policy challenges ranging from food security to cryptocurrency privacy.
Meet the Ford Dorsey Master's in International Policy Class of 2024
A photo collage of the 2023 cohort of the Ford Dorsey Master's in International Policy on their Policy Change Studio internships.
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Master's Students Tackle Policy Projects Around the Globe

From Egypt to England, the Maldives to Switzerland, Vietnam, Ghana, Kenya, and Fiji, the 2023 cohort of the Ford Dorsey Master's in International Policy has criss-crossed the world practicing their policymaking skills.
Master's Students Tackle Policy Projects Around the Globe
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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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Spring is just around the corner at the Farm, which means it's time for the students in the 2024 cohort of the Ford Dorsey Master's in International Policy program (MIP) to put down the books, roll up their sleeves, and get to work on their capstone projects.

Each year, second-year MIP students participate in the Policy Change Studio, an innovative two-quarter course that is designed to provide students with the know-how to bring about change in the world through hands-on projects. After a year and a half of studying the principles and frameworks of effective policymaking, our students take those ideas out of the classroom and put them into practice in projects sponsored by research groups, NGOs, and policy institutions all over the world.

This year our students are criss-crossing the globe to work on AI governance in Brazil, transportation systems in Ghana, sustainable agriculture in Mongolia, and much more. Keep reading to learn more about each project.

 

We are working with the National Taiwan Ocean University and the Taiwan Law and Technology Association led by Dr. Yachi Chiang (江雅綺) to help strengthen the security and integrity of Taiwan’s undersea cables. Specifically, our focus is on cable resiliency against PRC aggression, given that
Ford Dorsey Master's in International Policy students Dwight Knightly, Hamzah Daud, Tabatha Anderson, and Francesca Verville.
Dwight Knightly, Hamzah Daud, Francesca Verville, and Tabatha Anderson

the Taiwanese cables to the Matsu Islands have been cut 27 times, most recently in spring 2023. Our final report and presentation will analyze Taiwan’s current emergency management and resiliency plans, identify areas of improvement, and present solutions to fix these gaps. All of us care deeply about democracy and the rule of law, and the security of Taiwan against PRC aggression is central in the fight for those ideals. Our hope is that this work helps in some small way to improve the security of Taiwan and its people.

 

Combating Online Harms in Young Professionals in New Zealand

Our team is working with Netsafe, an online safety charity, to address online harms faced by 18-30-year-olds of Chinese descent in New Zealand. Netsafe works alongside government and law enforcement to address online safety. Due to a lack of continuity of online safety educational programs, young professionals
Ford Dorsey Master's in International Policy students Sebastian Ogando, Raul Ruiz-Solis, Chase Lee, and Aya Purwandaya (not pictured).
Sebastian Ogando, Raul Ruiz-Solis, Chase Lee, and Aya Purwandaya (not pictured)

need resources to be aware of online risks and the best measures to protect themselves. Netsafe has yet to find the most effective way to appeal to this demographic group.

We aim to understand the demographic's most frequently used online platforms, the most common types of online harms, cultural factors, and relevant stakeholders.

 

Understanding Commercial Influence Operations on Social Media from China

Our MIP capstone team is working with DoubleThink Lab in Taiwan to map the ecosystem of People's Republic of China (PRC)-backed commercial influence operations on social media. Currently so-called "dark PR" firms can support PRC
Ford Dorsey Master's in International Policy students Nickson Quak, Gaute Friis, Sara Shah, and Elliot Stewart.
Nickson Quak, Gaute Friis, Sara Shah, and Elliot Stewart

disinformation operations with near impunity. We’re particularly interested in how the development of new tools and tactics – like commercial firms’ use of paid influencers, or generative AI – will aid in further obscuring attribution and scaling operations. Our policy recommendations will address how governments, international organizations, and platforms can tackle this issue.

 

Our team is working with the Institute for Technology and Society of Rio de Janeiro (ITS) and the Public Defender's Office (PDO-RJ) in the State of Rio de Janeiro to develop a common governance mechanism for the implementation of artificial intelligence (AI)
Ford Dorsey Master's in International Policy students Poramin Insom, Justin Yates, Thay Graciano, and Rosie Lebel.
Poramin Insom, Justin Yates, Thay Graciano, and Rosie Lebel

tools. Our research focuses on how the different state PDOs in Brazil can collaborate and share AI tools to help reduce their demand and better serve their clients. The goal is for AI to be a "shared public infrastructure" that multiple PDOs can use to serve their clients.

 

Creating Accessible, Affordable Transport Systems in Ghana

Our team is working with the Ghana Center for Democratic Development to understand opportunities for commute time relief in Accra's congested traffic. Our current challenge is identifying sources of improvement in the transit system and
Ford Dorsey Master's in International Policy students Skylar Coleman, Rosie Ith, and Maya Rosales.
Skylar Coleman, Rosie Ith, and Maya Rosales

integrating solutions available at scale for the public. We aim to recommend policy interventions which reflect local demand, ensuring sustainable, efficient, and accessible transportation solutions for the community.

 

Overgrazing and Climate Change in Mongolia

Our capstone focuses on overgrazing in Mongolia where disruptions to the traditional practices of nomadic tribes threaten grassland health. Disruptions include the free market incentivizing increasing herd sizes and climate change reducing the quantity and diversity of vegetation. In the absence of strong
Ford Dorsey Master's in International Policy students Ashwini Thakare, Olivia Hampsher-Monk, Kelsey Freeman, and Sarah Brakebill-Hacke.
Ashwini Thakare, Olivia Hampsher-Monk, Kelsey Freeman, and Sarah Brakebill-Hacke

government interventions, local control of stock numbers, or strong market incentives, herds exceed the grassland carrying capacity in pockets that are becoming increasingly degraded. This threatens nomadic pastoralism, a traditional way of life. With such complex and interlinked drivers to this problem, it has been challenging to isolate the causes we should focus on. We have been working with our partners at The Asia Foundation who are in the early stages of piloting a solution.

 

Solar Mini-grids and Renewable Energy in Sierra Leone

We’re partnering with Sustainable Energy for All, who have identified solar mini-grids as a necessary tool to achieve greater energy access in Sierra Leone. Previous efforts to improve the market for mini-grids have focused on regulatory reform and financial backing from diverse donors. Unfortunately,
Ford Dorsey Master's in International Policy students Felipe Galvis-Delgado, Javier Cantu, Pamella Ahairwe, and Ibilola Owoyele.
Felipe Galvis-Delgado, Javier Cantu, Pamella Ahairwe, and Ibilola Owoyele

these interventions have not led to a widespread growth in mini-grid development, as the industry continues to struggle. We hope to further explore the market and regulatory landscape and learn how sub-interventions including cross-subsidization, de-risking investment, demand creation, and other innovative and locally-based solutions may help improve the industry’s viability and aid in increasing access to affordable, renewable energy in Sierra Leone.

 

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.

Read More

The Ford Dorsey Master's in International Policy Class of 2025 at the Freeman Spogli Institute for International Studies.
Blogs

Meet the Ford Dorsey Master's in International Policy Class of 2025

From tackling challenges caused by climate change to honing leadership skills for the armed services, the Class of 2025 has arrived at Stanford and is ready to get to work.
Meet the Ford Dorsey Master's in International Policy Class of 2025
Raul Ruiz at Duco Internship
Blogs

Thinking Like a CEO: Navigating San Francisco's Start-Up and Technology Landscape

Interning at Duco Experts, Raúl Ruiz-Solís (Master's in International Policy '24) gained an understanding of the start-up ecosystem in San Francisco, as well as some of the most pressing areas of opportunity in the field of cybersecurity and emerging technologies.
Thinking Like a CEO: Navigating San Francisco's Start-Up and Technology Landscape
The Ford Dorsey Master's in International Policy Class of 2024 at the Freeman Spogli Institute for International Studies.
Blogs

Meet the Ford Dorsey Master's in International Policy Class of 2024

The 2024 class of the Ford Dorsey Master’s in International Policy has arrived at Stanford eager to learn from our scholars and tackle policy challenges ranging from food security to cryptocurrency privacy.
Meet the Ford Dorsey Master's in International Policy Class of 2024
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Taiwan, New Zealand, and Sierra Leone are just a few of the places students from the Ford Dorsey Master's in International Policy are headed this year for their capstone projects.

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This week we launched the long-awaited 17th year of the Center on Democracy, Development and the Rule of Law's Draper Hills Summer Fellowship Program. Founded in 2005 with generous support from Bill and Phyllis Draper and Ingrid von Mangoldt Hills, Draper Hills is an executive training program for world leaders striving to promote democracy. For the next two weeks, Fellows will participate in workshops led by an interdisciplinary team of faculty to study new theories and approaches to democratic development.

Fellows in the class of 2021 were selected from among thousands of applicants for their ground-breaking work to defend democracy. These 34 leaders drawn from 30 countries around the world are pioneering new approaches and models to advance social and political change in some of the most challenging global contexts. Representing business, government, and the nonprofit sector, our fellows are working on the frontlines of democratic change to combat the global rise of authoritarianism and populism. In countries moving towards democracy, our fellows are working to institutionalize new systems and practices to support democratic transitions.

An Unconventional Year


Traditionally, Fellows would travel from their home countries to the U.S. and spend three weeks on campus at Stanford learning together. However, due to the ongoing COVID-19 pandemic, the program is currently taking place virtually for the first time (for the same reasons, the program did not run in 2020). The shift to online programming posed a number of logistical obstacles – from what time to run virtual sessions when participants span over a dozen time zones, to how to foster the sense of belonging and personal connections that occur more naturally with in-person settings.

To begin addressing the latter, Fellows were sent welcome packages to build excitement and foster community both within the program and Stanford. Upon receiving hers, Aisha Yesufu of Nigeria shared "I am so excited at the different people I'll be meeting from all over the world, and also learning from different people, lecturers, professors... It's going to be quite interesting and, for me, that is what I am most looking forward to," along with the video below:

"One of the most important things I have ever been involved with."


Opening against the backdrop of the fall of Kabul to the Taliban in Afghanistan, the importance of the Draper Hills program and the need to promote democratic change is now more evident than ever.

The inaugural session for the 2021 cohort began with Francis Fukuyama introducing the fellows to several of the esteemed faculty they will be learning from over the next two weeks, including Larry Diamond, Erik Jensen, and Michael McFaul. McFaul shared that not only did he found the program, but "it is one of the most important things I have ever been involved with." Jensen later added that "participating in this program is one of the great pleasures I have every year."

More to Come


Throughout the next two weeks, our Draper Hills Fellows will examine the political development, democratic transitions, and the relationship of law to economic development, public administration, administrative law, transitional justice, food security, and global health policy, among others. The group is eager to learn, and we look forward to seeing the many great things the training they receive here will enable them to do in their home countries and beyond.

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For the next two weeks, Fellows will participate in workshops led by an interdisciplinary team of faculty to study new theories and approaches to democratic development.

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Lecturer in Residence, Stanford Law School
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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

Bechtel Conference Center

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Michele Barry Panelist

Encina Commons, Room 201 
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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.)

Chair, Department of Health Policy, School of Medicine
Director, Center for Health Policy, Freeman Spogli Institute for International Studies
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Doug Owens Panelist

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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
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Stephen Stedman is a Freeman Spogli senior fellow at the Center on Democracy, Development, and the Rule of Law and FSI, an affiliated faculty member at CISAC, and professor of political science (by courtesy) at Stanford University. 

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).

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Richard E. Behrman Professor of Child Health and Society
Senior Fellow, Freeman Spogli Institute for International Studies
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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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