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Dr. Daniel Greene has been accepted as a 2022 Emerging Leaders in Biosecurity fellow from the Center for Health Security at John Hopkins University.

The Emerging Leaders in Biosecurity program supports talented career professionals in deepening their expertise, expanding their network, and building their leadership skills through a series of events coordinated by the center. The highly competitive program inspires and connects the next generation of leaders and innovators in the biosecurity community.

Dr. Daniel Greene received his Ph.D. in Education from Stanford University, and continues research focused on the societal risks and potential of the life sciences using a combination of data science, survey research, policy and analysis, and qualitative methods to help us understand our collective options for regulating life-science research. He has been a Postdoctoral Researcher in Biosecurity and Project Fellow for CISAC since 2019.

Center for Health Security Announcement

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Dr. Daniel Greene has been accepted as a 2022 Emerging Leaders in Biosecurity fellow from the Center for Health Security at John Hopkins University.


Yet there has been no national-level, comprehensive review of the evidence for public health emergency preparedness and response (PHEPR) practices. Recognizing this deficiency, the Centers for Disease Control and Prevention (CDC) went to the National Academies of Sciences, Engineering and Medicine three years ago and asked them to convene a national panel of public health experts to review the evidence for emergency preparedness and response. The committee members included Stanford Health Policy Director Douglas K. Owens. The committee issued its findings July 14 with a report at a Zoom conference.

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National Academies of Sciences, Engineering and Medicine
Jeremy Goldhaber-Fiebert
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Megan Palmer
Sam Weiss Evans
Jacob Beal
Kavita Berger
Diederik A. Bleijs
Alessia Cagnetti
Francesca Ceroni
Gerald L. Epstein
Natàlia Garcia-Reyero
David R. Gillum
Graeme Harkess
Nathan J. Hillson
Petra A. M. Hogervorst
Jacob L. Jordan
Geneviève Lacroix
Rebecca Moritz
Seán S. ÓhÉigeartaigh
Mark W. J. van Passel
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As biological research and its applications rapidly evolve, new attempts at the governance of biology are emerging, challenging traditional assumptions about how science works and who is responsible for governing. However, these governance approaches often are not evaluated, analyzed, or compared. This hinders the building of a cumulative base of experience and opportunities for learning. Consider “biosecurity governance,” a term with no internationally agreed definition, here defined as the processes that influence behavior to prevent or deter misuse of biological science and technology. Changes in technical, social, and political environments, coupled with the emergence of natural diseases such as coronavirus disease 2019 (COVID-19), are testing existing governance processes. This has led some communities to look beyond existing biosecurity models, policies, and procedures. But without systematic analysis and learning across them, it is hard to know what works. We suggest that activities focused on rethinking biosecurity governance present opportunities to “experiment” with new sets of assumptions about the relationship among biology, security, and society, leading to the development, assessment, and iteration of governance hypotheses.

Read the rest at Science


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Taiwan is only 81 miles off the coast of mainland China and was expected to be hard hit by the coronavirus, due to its proximity and the number of flights between the island nation and its massive neighbor to the west.

Yet it has so far managed to prevent the coronavirus from heavily impacting its 23 million citizens, despite hundreds of thousands of them working and residing in China.

According to the Johns Hopkins Coronavirus COVID-19 Global Cases map, as of Tuesday there were only 42 cases and one death in Taiwan, far behind China, with more than 80,000 cases and more than 2,900 deaths. The country also lags far behind its other Asian neighbors and ranks 17th in the world for the number of global cases. As of this writing, South Korea was second, with 5,186 cases; followed by Iran with 2,336 and Italy with 2,036 people infected with the virus.

The United States currently stands at 107 known cases and six deaths.

The viral outbreak in China occurred just before the Lunar New Year, during which time millions of Chinese and Taiwanese were expected to travel for the holidays.

So what steps did Taiwan take to protect its people? And could those steps be replicated here at home?

Stanford Health Policy’s Jason Wang, MD, PhD, an associate professor of pediatrics at Stanford Medicine who also has a PhD in policy analysis, credits his native Taiwan with using new technology and a robust pandemic prevention plan put into place at the 2003 SARS outbreak.

“The Taiwan government established the National Health Command Center (NHCC) after SARS and it’s become part of a disaster management center that focuses on large-outbreak responses and acts as the operational command point for direct communications,” said Wang, a pediatrician and the director of the Center for Policy, Outcomes, and Prevention at Stanford. The NHCC also established the Central Epidemic Command Center, which was activated in early January.

“And Taiwan rapidly produced and implemented a list of at least 124 action items in the past five weeks to protect public health,” Wang said. “The policies and actions go beyond border control because they recognized that that wasn’t enough.”

Wang outlines the measures Taiwan took in the last six weeks in an article published Tuesday in the Journal of the American Medical Association.

“Given the continual spread of COVID-19 around the world, understanding the action items that were implemented quickly in Taiwan, and the effectiveness of these actions in preventing a large-scale epidemic, may be instructive for other countries,” Wang and his co-authors wrote.

Within the last five weeks, Wang said, the Taiwan epidemic command center rapidly implemented those 124 action items, including border control from the air and sea, case identification using new data and technology, quarantine of suspicious cases, educating the public while fighting misinformation, negotiating with other countries — and formulating policies for schools and businesses to follow.

Big Data Analytics

The authors note that Taiwan integrated its national health insurance database with its immigration and customs database to begin the creation of big data for analytics. That allowed them case identification by generating real-time alerts during a clinical visit based on travel history and clinical symptoms.

Taipei also used Quick Response (QR) code scanning and online reporting of travel history and health symptoms to classify travelers’ infectious risks based on flight origin and travel history in the last 14 days. People who had not traveled to high-risk areas were sent a health declaration border pass via SMS for faster immigration clearance; those who had traveled to high-risk areas were quarantined at home and tracked through their mobile phones to ensure that they stayed home during the incubation period.

The country also instituted a toll-free hotline for citizens to report suspicious symptoms in themselves or others. As the disease progressed, the government called on major cities to establish their own hotlines so that the main hotline would not become jammed.

Some might say that because Taiwan is such a small country — about 19 times smaller than Texas — it is easier to mobilize during emergencies. Yet Taiwan is particularly challenged by its proximity to China and the fact that 850,000 of its citizens reside on the mainland; another 400,000 work there. Taiwan had 2.71 million visitors from China last year.

So when the WHO was notified on Dec. 31, 2019, of a pneumonia of unknown cause in Wuhan, China, Taiwanese officials began to board planes and assess passengers on direct flights from Wuhan for fever and pneumonia symptoms before passengers could deplane.

As early as Jan. 5, notification was expanded to include any individual who had traveled to Wuhan in the past 14 days and had a fever or symptoms of upper respiratory tract infection at the point of entry. Suspected cases were screened for 26 viruses, including SARS and MERS. Passengers displaying symptoms were quarantined at home and assessed whether medical attention at a hospital was necessary.

What the U.S. Could Learn

One of Wang’s co-authors, Robert H. Brook, M.D., ScD., of the David Geffen School of Medicine at the University of California, Los Angeles, said Washington could learn a great deal from Taiwan’s so-far successful management of the virus.

“In Taiwan, diverse political parties were willing to work together to produce an immediate response to the danger,” said Brook, also of the nonprofit RAND Corporation. “Transparency was critical and frequent communication to the public from a trusted official was paramount to reducing public panic.”

The other co-author of their study is Chun Y. Ng, MBA, MPH, of The New School for Leadership in Health Care, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.

Brook said Taiwan got out ahead of the epidemic by setting up a physical command center to facilitate rapid communications. The command center set the price of masks and used government funds and military personnel to increase mask production. By Jan. 20, the Taiwan CDC announced that it had a stockpile of 44 million surgical masks, 1.9 million N95 masks and 1,100 negative pressure isolation rooms.

“In a country as complex as the United States,” Brook said, “there needs to be a sharing of intelligence on a real-time basis among states and the federal government so that action is not delayed by going through formal channels.”

Please contact Beth Duff-Brown for media requests. 

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In keeping with Stanford University's March 3 message to the campus community on COVID-19 and current recommendations of the CDC, the Asia-Pacific Research Center is electing to postpone this event until further notice. We apologize for any inconvenience this may cause, and appreciate your understanding and cooperation as we do our best to keep our community healthy and well. 


The coronavirus COVID-19 outbreak has sickened thousands and its control measures constrain millions of lives. What do we know, and need to know, about the epidemic’s social and economic impacts in East Asia, the broader Asia-Pacific region, and the world? APARC social scientists offer multidisciplinary perspectives on this question.



Portrait of Karen Eggleston
Karen Eggleston is Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University, Director of the Stanford Asia Health Policy Program and Deputy Director of the Walter H. Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Eggleston earned her PhD in public policy from Harvard University in 1999. She has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies, and has been a consultant to the World Bank, the Asian Development Bank, and the World Health Organization regarding health system reforms in China.


Portrait of Don Emmerson

Donald K. Emmerson is the Director of the Southeast Asia Program at the Walter H. Shorenstein Asia-Pacific Research Center and is affiliated with CDDRL and the Abbasi Program in Islamic Studies. Emmerson has also taught courses on Southeast Asia in the International Relations and International Policy Studies Programs, in the Department of Political Science, and for the Bing Overseas Studies Program. He is also active as an analyst of current policy issues involving Asia. Emmerson’s policy concerns run from specific issues such as sovereignty disputes in the South China Sea to broad questions involving China-Southeast Asia relations, the American “rebalance” toward Asia, and the future of the Association of Southeast Asian Nations (ASEAN). His recent publications include: “Facts, Minds, and Formats: Scholarship and Political Change in Indonesia” in Indonesian Studies: The State of the Field (2013); “Is Indonesia Rising? It Depends” in Indonesia Rising (2012); “Southeast Asia: Minding the Gap between Democracy and Governance,” Journal of Democracy (April 2012); “The Problem and Promise of Focality in World Affairs,” Strategic Review (August 2011); An American Place at an Asian Table? Regionalism and Its Reasons (2011); Asian Regionalism and US Policy: The Case for Creative Adaptation (2010); “The Useful Diversity of ‘Islamism’” and “Islamism: Pros, Cons, and Contexts” in Islamism: Conflicting Perspectives on Political Islam (2009); and “Crisis and Consensus: America and ASEAN in a New Global Context” in Refreshing U.S.-Thai Relations (2009). His analyses of current events since 2009 have been carried by Asia Times Online and the East Asia Forum among other outlets.


Portrait of Thomas Fingar
Thomas Fingar is a Shorenstein APARC Fellow in the Freeman Spogli Institute for International Studies at Stanford University. He was the inaugural Oksenberg-Rohlen Distinguished Fellow from 2010 through 2015 and the Payne Distinguished Lecturer at Stanford in 2009. From 2005 through 2008, he served as the first deputy director of national intelligence for analysis and, concurrently, as chairman of the National Intelligence Council. Fingar served previously as assistant secretary of the State Department’s Bureau of Intelligence and Research (2000-01 and 2004-05), principal deputy assistant secretary (2001-03), deputy assistant secretary for analysis (1994-2000), director of the Office of Analysis for East Asia and the Pacific (1989-94), and chief of the China Division (1986-89). Between 1975 and 1986 he held a number of positions at Stanford University, including senior research associate in the Center for International Security and Arms Control.


Portrait of Matthew Kohrman
Matthew Kohrman joined Stanford’s faculty in 1999. His research and writing bring multiple methods to bear on the ways health, culture, and politics are interrelated. Focusing on the People's Republic of China, he engages various intellectual terrains such as governmentality, gender theory, political economy, critical science studies, and embodiment. His first monograph, Bodies of Difference: Experiences of Disability and Institutional Advocacy in the Making of Modern China, examines links between the emergence of a state-sponsored disability-advocacy organization and the lives of Chinese men who have trouble walking. In recent years, Kohrman has been conducting research projects aimed at analyzing and intervening in the biopolitics of cigarette smoking and production. These projects expand upon analytical themes of Kohrman’s disability research and engage in novel ways techniques of public health.


Portrait of David M. Lampton
David M. Lampton is Oksenberg-Rohlen Fellow and Research Scholar at FSI and affiliated with Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC).  He also is the Hyman Professor of China Studies and Director of the China Studies Program at the Johns Hopkins School of Advanced International Studies (SAIS) Emeritus.  Professor Lampton's current book project is focused on the development of high-speed railways from southern China to Singapore.  He is the author of a dozen books and monographs, including Following the Leader: Ruling China, from Deng Xiaoping to Xi Jinping  (University of California Press, 2014, and second edition 2019) and The Three Faces of Chinese Power: Might, Money, and Minds (University of California Press, 2008).  He has testified at multiple congressional and commission sessions and published numerous articles, essays, book reviews, and opinion pieces in many venues, popular and academic, in both the western world and in Chinese-speaking societies, including Foreign Affairs, Foreign Policy, The American Political Science Review, The China Quarterly, The New York Times, and The Washington Post.


Portrait ot Yong Suk Lee
Yong Suk Lee is the SK Center Fellow at the Freeman Spogli Institute for International Studies and Deputy Director of the Korea Program at the Walter H. Shorenstein Asia-Pacific Research Center at Stanford University. Lee’s main fields of research are in labor economics, technology and entrepreneurship, and urban economics. Some of the issues he has studied include technology and labor markets, entrepreneurship and economic growth, entrepreneurship education, and education and inequality. He is also interested in both the North and South Korean economy and has examined how economic sanctions affect economic activity in North Korea, and how management practices and education policy affect inequality in South Korea. His current research focuses on how the new wave of digital technologies will affect labor, education, entrepreneurship, and productivity, and he is pursuing several projects in this regard. His research has been published in both Economics and Management journals including the Journal of Urban EconomicsJournal of Economic GeographyJournal of Business VenturingJournal of Health Economics, and Labour Economics. Lee also regularly contributes to policy reports and opinion pieces on contemporary issues surrounding both North and South Korea.


Portrait of Hongbin Li
Hongbin Li is the James Liang Director of the China Program at the Stanford King Center on Global Development. He obtained a PhD in economics from Stanford University in 2001 and joined the economics department of the Chinese University of Hong Kong, where he became a full professor in 2007. He was also one of the two founding directors of the Institute of Economics and Finance at the Chinese University of Hong Kong. He taught at Tsinghua University in Beijing from 2007 to 2016 and was C.V. Starr Chair Professor of Economics in the School of Economics and Management. He also founded and served as the executive associate director of the China Data Center. Li’s research has been focused on China and is concerned with two general themes: i) the behaviors of governments, firms and banks in the context of economic transition; and ii) human capital and labor markets in the context of economic development. Research results have been published in journals such as PNAS, Journal of Political Economy, American Economic Review Papers and Proceedings, Journal of Economic Perspectives, Economic Journal, Review of Economics and Statistics, Journal of Labor Economics, Journal of Development Economics, Journal of Public Economics, Journal of Comparative Economics, Journal of International Economics, and Demography¸ among others. His research has been widely covered by media around the world and well read by top policy makers in China.


Portrait of Gi-Wook Shin
Gi-Wook Shin is the director of the Walter H. Shorenstein Asia-Pacific Research Center; the William J. Perry Professor of Contemporary Korea; the founding director of the Korea Program; a senior fellow of the Freeman Spogli Institute for International Studies; and a professor of sociology, all at Stanford University. As a historical-comparative and political sociologist, his research has concentrated on social movements, nationalism, development, and international relations. Shin is the author/editor of more than twenty books and numerous articles. His recent books include Strategic, Policy and Social Innovation for a Post-Industrial Korea: Beyond the Miracle (2018); Superficial Korea (2017); Divergent Memories: Opinion Leaders and the Asia-Pacific War (2016); Global Talent: Skilled Labor as Social Capital in Korea (2015); Criminality, Collaboration, and Reconciliation: Europe and Asia Confronts the Memory of World War II (2014); New Challenges for Maturing Democracies in Korea and Taiwan (2014); Asia’s Middle Powers? (2013); Troubled Transition: North Korea's Politics, Economy, and External Relations (2013); History Textbooks and the Wars in Asia: Divided Memories (2011); South Korean Social Movements: From Democracy to Civil Society (2011); and One Alliance, Two Lenses: U.S.-Korea Relations in a New Era (2010). His articles have appeared in academic journals including American Journal of SociologyComparative Studies in Society and HistoryPolitical Science QuarterlyInternational SociologyNations and NationalismPacific AffairsAsian Survey, and Journal of Democracy.


Portrait of Scott Rozelle
Scott Rozelle is the Helen F. Farnsworth Senior Fellow and the co-director of the Rural Education Action Program in the Freeman Spogli Institute for International Studies at Stanford University. He received his BS from the University of California, Berkeley, and his MS and PhD from Cornell University. Previously, Rozelle was a professor at the University of California, Davis and an assistant professor in Stanford’s Food Research Institute and department of economics. He currently is a member of several organizations, including the American Economics Association, the International Association for Agricultural Economists, and the Association for Asian Studies. Rozelle also serves on the editorial boards of Economic Development and Cultural ChangeAgricultural Economics, the Australian Journal of Agricultural and Resource Economics, and the China Economic Review. His research focuses almost exclusively on China and is concerned with: agricultural policy, including the supply, demand, and trade in agricultural projects; the emergence and evolution of markets and other economic institutions in the transition process and their implications for equity and efficiency; and the economics of poverty and inequality, with an emphasis on rural education, health and nutrition.


Portrait of Xueguang Zhou
Xueguang Zhou is the Kwoh-Ting Li Professor in Economic Development, a professor of sociology, and a Freeman Spogli Institute for International Studies senior fellow. His main area of research is on institutional changes in contemporary Chinese society, focusing on Chinese organizations and management, social inequality, and state-society relationships. His recent publications examine the role of bureaucracy in public goods provision in rural China (Modern China, 2011); interactions among peasants, markets, and capital (China Quarterly, 2011); access to financial resources in Chinese enterprises (Chinese Sociological Review, 2011, with Lulu Li); multiple logics in village elections (Social Sciences in China, 2010, with Ai Yun); and collusion among local governments in policy implementation (Research in the Sociology of Organizations, 2011, with Ai Yun and Lian Hong; and Modern China, 2010). Before joining Stanford in 2006, Zhou taught at Cornell University, Duke University, and Hong Kong University of Science and Technology. He is a guest professor at Peking University, Tsinghua University, and the People's University of China. Zhou received his PhD in sociology from Stanford University in 1991.


Advisory on Novel Coronavirus (COVID-19)

In accordance with university guidelines, if you (or a spouse/housemate) have returned from travel to mainland China, South Korea, Italy, or Iran in the last 14 days, we ask that you DO NOT come to campus until 14 days have passed since your return date and you remain symptom-free. For more information and updates, please refer to the Stanford Environmental Health & Safety website:

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This event is part of the Contemporary Asia Seminar Series, sponsored by the Shorenstein Asia-Pacific Research Center.



Karen Eggleston (Moderator) <br><i>Senior Fellow at the Freeman Spogli Institute for International Studies; Director of the Asia Health Policy Program, Shorenstein Asia-Pacific Research Center</i><br><br>
Donald K. Emmerson <br><i>Senior Fellow Emeritus at the Freeman Spogli Institute for International Studies; Director, Southeast Asia Program</i><br><br>
Thomas Fingar <br><i>Shorenstein APARC Fellow</i><br><br>
Matthew Kohrman <br><i>Senior Fellow, by courtesy, at the Freeman Spogli Institute for International Studies; Associate Professor of Anthropology</i><br><br>
David M. Lampton <br><i>Oksenberg-Rohlen Fellow, Freeman Spogli Institute for International Studies (FSI), Stanford University</i><br><br>
Yong Suk Lee <br><i>SK Center Fellow at the Freeman Spogli Institute for International Studies; Deputy Director of the Korea Program at Shorenstein APARC</i><br><br>
Hongbin Li <br><i>James Liang Director of the China Program, Stanford King Center on Global Development</i><br><br>
Scott Rozelle <br><i>Senior Fellow at the Freeman Spogli Institute for International Studies; Co-director at the Rural Education Action Program</i><br><br>
Gi-Wook Shin <br><i>Senior Fellow at the Freeman Spogli Institute for International Studies Professor of Sociology; Director of the Shorenstein Asia-Pacific Research Center; Director of the Korea Program</i><br><br>
Xueguang Zhou <br><i>Senior Fellow at the Freeman Spogli Institute for International Studies; Kwoh-Ting Li Professor in Economic Development</i><br><br>
Panel Discussions

Seminar Recording:


About this Event: The governance of big data and the prevention of their misuse is among the most topical issues in current debates among security experts. But what does it mean when security is not an issue for the stakeholders governing big biomedical data? This paper answers this question by looking at what it describes as a peculiar omission of the issue of security in the biggest harmonization cluster of biomedical research in Europe - BBMRI-ERIC. While it does treat personal data, the risks and threats are constructed through a language of anticipation and self-governance rather than security. The analysis explains why: based on document analysis, interviews, and field research, it studies (1) how are risks and threats constructed in the research with big biomedical data, (2) what regime of their governance is established in this area, and (3) what are the implications for the practices of science and the politics of security. The paper argues that this silence is a by-product of bureaucratization and responsibilization of security, which is in biobanking characteristic by discourse and practices of responsible research, ethics, and law. The paper suggests that this regime of governance precludes the prospects of addressing bigger questions that biobanks may need to deal with in the future, such as regarding the access to the biomedical data by state or private actors and their use for policing, surveillance, or other types of population governance.


Speaker's Biography: Dagmar Rychnovská is Marie Sklodowska-Curie Fellow at the Techno-science and societal transformation group at the Institute for Advanced Studies in Vienna. She holds a PhD in International Relations (Charles University in Prague), an MA in Comparative and International Studies (ETH Zurich and University of Zurich), and an LLM in Law and Politics of International Security (VU University Amsterdam). Her research interests lie at the intersection of international relations, security studies, and science and technology studies. Her current research explores security controversies in research and innovation governance, with a focus on bioweapons, biotechnologies, and biobanks.

Dagmar Rychnovská Institute for Advanced Studies
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U.S. government aid for treating children and adults with HIV and malaria in developing countries has done more than expand access to lifesaving interventions: It has changed how people around the world view the United States, according to a new study by researchers at the School of Medicine.

Compared with other types of foreign aid, investing in health is uniquely associated with a better opinion of the United States, improving its “soft power” and standing in the world, the study said.  

Favorability ratings of the United States increased in proportion to health aid from 2002 to 2016 and rose sharply after the implementation of the President’s Emergency Plan for AIDS Relief in 2003 and the launch of the President’s Malaria Initiative in 2005, the researchers report.

Their findings were published this week in the American Journal of Public Health. The lead author is postdoctoral scholar Aleksandra Jakubowski, PhD, MPH. The senior author is Eran Bendavid, MD, associate professor of medicine and a core faculty member at Stanford Health Policy.

“Using data on aid and opinions of the United States, we found that investments in health offer a unique opportunity to promote the perceptions of the United States abroad, in addition to disease burden relief,” the authors wrote. “Our study provides new evidence to support the notion that health diplomacy is a net win for the United States and recipient countries alike.”

The Trump administration, however, has proposed a 23% cut in foreign aid in its 2020 budget, including large reductions to programs that fight AIDS and malaria overseas.

The Stanford researchers believe their study is the first to add heft to the argument that U.S. health aid boosts the “soft power” that wins the hearts and minds of foreign friends and foes.

“Our study shows that investing in health aid improves our nation’s standing abroad, which could have important downstream diplomatic benefits to the United States,” Jakubowskisaid. “Investments in health aid help the United States accumulate soft power. Allowing the U.S. reputation to falter would be contrary to our own interests.” 

A Policy Debate

Many politicians and economists consider spending U.S. tax dollars on foreign aid as an ineffective, and possibly harmful, enterprise that goes unappreciated and leads to accusations of American meddling in other countries’ national affairs.

The U.S. government, for the past 15 years, has contributed more foreign health aid than any other country, significantly reducing disease burden, increasing life expectancy and improving employment in recipient countries, the authors wrote. Still, this generosity has historically constituted less than 1% of the U.S. gross domestic product.

“Our results suggest that the dollars invested in health aid offer good value for money,” the researchers wrote. “That is, the relatively low investment in health aid (in terms of GDP) has provided the United States with large returns in the form of improved public perceptions, which may advance the U.S. government’s ability to negotiate international policies that are aligned with American priorities and preferences.”

The researchers used 258 Global Attitudes Surveys, based on interviews with more than 260,000 respondents, conducted by the Pew Research Center in 45 low- to middle-income countries between 2002 and 2016.

Their analysis focused on the health sector, which includes several large programs for infectious disease control, but also support for nutrition, child health and reproductive health programs. They compared health aid to other major areas of U.S. investment: governance, infrastructure, humanitarian aid and military aid. They also constructed a database of news stories that mentioned the President’s Emergency Plan for AIDS Relief or the President’s Malaria Initiative by crawling through the online archives of the top three newspapers by circulation in each of the 45 countries.

They found that the probability of populations holding a very favorable opinion of the United States was 19 percentage points higher in the countries where and years when U.S. donations for health care were highest, compared with countries where and years when health aid donations were lowest. Using another metric, the researchers found that every additional $100 million in health aid was associated with a nearly 6 percentage-point increase in the probability of respondents indicating they had a “very favorable” opinion of the United States. 

In contrast, the researchers found, aid for governance, infrastructure, humanitarian and military purposes was not associated with a better opinion of the United States.

Bendavid, an infectious diseases physician and core faculty member of Stanford Health Policy, said that when he set out to conduct this research, he believed it would result “in a resounding thud” — that the “soft power” of health aid would have no impact on public opinion.

“For me, the notion that this program — hatched and headquartered in D.C. — would have impacts among millions in Nairobi and Dakar, seemed farfetched,” Bendavid said. “I was incredulous until all the pieces were in place.”

The ‘America First’ Agenda

The Trump administration’s “America First” agenda is calling for significant cuts to global health aid, particularly to the highly successful AIDS relief program, which was established by President George W. Bush. The administration’s budget, released in March, proposed a $860 million cut to the program; the President’s Malaria Initiative is facing a $331 million reduction in federal funding. That’s a decline of 18% and 44%, respectively.

The U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria would also decline by 17%, or $225 million, according to the Kaiser Family Foundation.

Yet beyond the reputational damage to the United States, such cuts could be a major setback to improving health outcomes in developing countries, the researchers said. After all, HIV knows no borders, and having more resilient health care systems is instrumental when facing public health crises, such as the Ebola outbreak in the Democratic Republic of Congo, Jakubowski said.

“The most direct impact of cutting the United States’ health aid allocations is the potential to undermine or reverse the progress that has been enabled by U.S. aid in curbing mortality and the spread of disease,” Bendavid said. “However, this study suggests there are also repercussions to the United States: the relationships the U.S. has built with recipient nations could also be undermined.”            

Other Stanford co-authors are Steven Asch, MD, MPH, professor of medicine, and former graduate student Don Mai.

Stanford’s Department of Medicine supported the work.

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This study’s purpose was to highlight the changing safety and security landscape engendered by the emergence of new genome editing technologies, help policy-makers and other stakeholders navigate this space, and illuminate broader trends in the life sciences that may impact the biosecurity landscape.

The two-year Editing Biosecurity study was led by four researchers from George Mason University and Stanford University. The centerpiece of the study was three invitation-only workshops that brought together the study leads and the core research group for structured discussions of the benefits, risks, and governance options for genome editing.

The study leads and research assistants prepared two working papers to frame the workshop discussions. The first working paper reviewed past studies that assessed the risks posed by emerging dual-use technologies. The goal of this working paper was to provide a baseline for understanding the security implications of genome editing and to identify best practices in risk assessment. The second working paper provided an overview of the current governance landscape for biotechnology and a framework for evaluating governance measures. Each workshop included a range of scientific, policy, ethics, and security experts. The study leads gathered additional information from subject-matter experts in the form of five commissioned issue briefs. Several of the study’s experts served as discussants who critically engaged the content of the issue briefs through iterative commentary and feedback. The study leads and core research group have backgrounds in various disciplines, including the life sciences, social sciences, and the humanities, an approach designed to ensure a rigorous research process underpinned by the inclusion of a variety of perspectives, and further complemented by numerous areas of expertise. The study and its products relied on unclassified, open, and publicly accessible information. The study was an independent academic work in which the charge and scope were determined by the research team. In combination, these factors were motivated by the team’s goal of producing open and accessible research outputs that can assist stakeholders in crafting more effective and informed policies.

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Policy Briefs
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Megan Palmer
David Relman
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From genome editing to “hacking” the microbiome, advances in the life sciences and its associated technological revolution have already altered the biosecurity landscape, and will continue to do so. What does this new landscape look like, and how can policymakers and other stakeholders navigate this space? A new report by Stanford scholars David Relman and Megan Palmer along with George Mason University’s Jesse Kirkpatrick and Greg Koblentz assesses this emerging biosecurity landscape to help answer these questions and illustrates gaps in governance and regulation through the use of scenarios.

The report—the product of two years of workshops, issue briefs, and white papers authored by different participants—involved people from different organizations and backgrounds ranging from life sciences and medicine to social science and ethics. “The project process was just as important as the product,” said Palmer. “It was a truly interdisciplinary effort.”

Genome editing, including CRISPR, is disruptive to the biosecurity landscape, and it serves as an illustration of more general trends in the evolving landscape, the authors write. CRISPR technology does not exist in a vacuum—rather, it is enabled by, represents, and gives rise to a suite of technologies with potential benefits and that require new approaches to adaptive policy making and governance.

Scenarios illustrating governance gaps in in the report include:

  • A reckless CRISPR user who develops and markets a probiotic created with genome editing that has serious unanticipated effects for consumers;
  • An agricultural biotechnology firm conducting dual use genome editing research that lies outside current oversight, but nonetheless could have negative consequences for human health
  • An intentional release of a gene drive organism from a lab, that while having limited physical harm, feeds a state-based misinformation campaign with large economic impacts
  • An accidental release of a gene drive organism due to lack of awareness and uncertainty about the risk classifications and protocols for handling new technologies
  • A terrorist group using commercial firms that lack strong customer and order screening to use genome editing to weaponize a nonpathogenic bacteria
  • A state-sponsored program to develop biological weapons for new strategic uses, including covert assassination, using largely publicly available research

In each of these examples, the researchers play out a hypothetical situation exposing a number of security and governance gaps for policymakers and other stakeholders to address.

In the report, the authors conclude that genome editing has tremendous potential benefits and economic impacts. The authors note that the market for genome editing is expected to exceed $3.5 billion by 2019, but a security incident, safety lapse, reckless misadventure, or significant regulatory uncertainty could hurt growth. Increased reliance on the “bio-economy,” they write, means biosecurity is increasingly critical to economic security as well as human health.

Other key takeaways:

Genome editing has the potential to improve the human condition. Genome editing is poised to make major beneficial contributions to basic research, medicine, public health, agriculture, and manufacturing that could reduce suffering, strengthen food security, and protect the environment.

Genome editing is disruptive to the biosecurity landscape. The threat landscape has, and continues to expand to include new means of disrupting or manipulating biological systems and processes in humans, plants, and animals. Genome editing could be used to create new types of biological weapons. Further, technical advances will make misuse easier and more widespread.

CRISPR illuminates broader trends and the challenges of an evolving security landscape. An approach to biosecurity that accounts for these trends, and encompasses risks posed by deliberate, accidental, and reckless misuse, can help address the complex and evolving security landscape.

Technology must be taken seriously.  A thorough, informed, and accessible analysis of any emerging technology is crucial to considering the impact that it may have on the security landscape.

Key stakeholders must be engaged. Stakeholders in the genome editing field encompass a more diverse array of actors than those that have been involved so far in biosecurity discussions. These stakeholders range from international organizations to government agencies to universities, companies, lay communities writ large, and scientists.

Applied research is needed to create and implement innovative and effective policies. Applied research is necessary to continue the process of modifying existing governance measures, and testing and adapting new ones, as new genome editing technologies and applications are developed, new stakeholders emerge, and new pathways for misuse are identified.

Download the executive summary and full report at


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