Tag: global advocacy

On the Word ‘Global’

The word ‘global’ has become so frequently used in Western strategic debate that is has almost become background music. On one level, overuse robs it of resonance. But on another, it might be contributing to the conceptual and rhetorical overstretch that has led the US to overextend itself.

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Peter Piot’s Memoir on Infectious Disease

I just finished reading Peter Piot’s lively memoir No Time to Lose of his time as an epidemiologist helping identify the Ebola virus in the 1970s through to his service as the first director of UNAIDS. It is an engaging read not least because Piot conveys a profound empathy for those affected by disease. Piot also projects additional warmth and humanity, from his appreciation for Congolese music to good beer.

More substantively, Piot has a proportionate sense of the outrageousness of bureaucratic politics in the UN system, while recognizing the need to navigate in those shark-filled waters.

Unlike many memoirs, there is some bite here, with some choice words for donors who talk a big game but don’t provide much money (here, France and Italy were named) to mid-level careerists who put turf before those they are meant to serve, as well as some for campaigners whose occasional “extreme” demands or tactics can backfire (his account of an AIDS activist calling France a shit-hole on a live fundraising telethon was on point here).

One aspect of the book made me rethink what I thought I knew about transnational advocacy movements, and his epilogue made me question what scope there is for coordination not only in the UN system but also within the interagency process in the U.S. government.

Who Are the Advocates? 

When we think of transnational advocacy movements, our paradigmatic actors are activists, the charismatic leaders of groups leading protests and petitions like Greenpeace, Oxfam, ACT UP, and Doctors Without Borders. However, if you go back to Keck and Sikkink’s foundational book Activists Beyond Borders, you will find that the advocacy networks in their view may also include state actors and representatives of intergovernmental organizations (pg. 9).  However, these are the final items six and seven in their list, and in the ten years plus since Keck and Sikkink came out, NGO activists captured the lion’s share of scholarly attention in the literature (This is not a systematic finding but my sense as a reader of that literature). 

But when you read Piot’s account of his efforts to help cobble together a broad coalition to fight AIDS, you realize that Piot was an advocate and that those change agents inside governments and international organizations deserve more attention as central figures in transnational campaigns. Piot captured some of the breadth of this movement:

But by the turn of the of the millennium our “brilliant coalition” was taking shape in its diversity and apparent chaos. What could the South African Chamber of Mines, Anglican Church, Community Party, and trades unions have in common with the Treatment Action Campaign, Medecins Sans Frontieres, and UNAIDS? A common goal: defeating the AIDS epidemic and caring for its victims. A powerful joint desire to be a force for change.

The Piots of this world need to take center stage in our analysis, not least because every activist campaign needs countless Piots inside to have their ideas become policy. 
Can Organizations Work Together?
In a sense, this book is a coming of age story, of Piot’s transition from medical professional to skilled political operator. So much of what passes for politics in this book is the jostling for position among mid-level careerists in intergovernmental organizations and within countries. UNDP and UNICEF jockey for turf internationally with similar dynamics at play inside countries with the CDC and the NIH having difficulty at times playing nice within the U.S. government. 
Among these, Piot comes across as an adult, and for such petty games, Piot has little patience. Nonetheless, he became sufficiently attuned to their inherent part of the game. To survive in this business, he describes his persona as chameleonic (something in common with his UNAIDS successor Michel Sidibe). In an obsessive desire to help those suffering, Piot adopted a healthy, ethical pragmatism and flexibility, of a willingness to work with whoever was needed to get the job the done. 
But, his epilogue to the book, leaves me uneasy about the scope and capacity for coordinated action. Even if the financial crisis were not leading to more miserly patterns of foreign aid, the collective response of the international system may be largely unmanageable. Here, Piot wrote of his sense that UNAIDS, the “most advanced” attempt to coordinate various UN agencies to “deliver as one” was fraught:

Over the years I became increasingly skeptical as to whether the current UN coordination governance could ever by effective operationally, despite the goodwill of many, if not most, staff. The two main obstacles for delivering as one UN were the institutional interests of individual agencies — careers, political influence, budgets–and the incoherence and volatility of its member states, which not only had different, sometimes mutually exclusive, interests, but which also lacked internal coherence…

This resonated strongly with me as this week the Obama Administration issued an enigmatic statement suggesting that the much ballyhooed interagency Global Health Initiative would be reconceived/mothballed, leading analysts like Laurie Garrett and Amanda Glassman to parse what went wrong in this grandiose effort to conduct a “whole of government” response.

Here, Piot’s conclusions are ones we should take to heart when we think about global and national governance of development, health, and foreign policy writ large:

My conclusion on UN coordination was that it was a collective failure, and that the international community goes for some bold mergers and acquisitions as the current plethora of organizations is too expensive, or that it accepts that pluralism is a strength, as long as only effective and well-managed institutions are supported and others closed down.

Interestingly, he suggests that setting up institutions outside of the UN system like the Global Fund is “not a solution” as much as he tried to make it a success. Frankly, I’m not sure what to do with that.

Any Regrets?

Aside from the time away from family, Piot’s main regret is whether or not he could have done more   to save lives earlier and faster. Here, I’m struck by the other quasi-memoir on HIV/AIDS that also came out this year Tinderbox by journalist Craig Timberg and public health professional David Halperin. In that book, they charge Piot with late attention to male circumcision, a powerful AIDS prevention technology that took too long to gain currency. 

Piot at one point, in what might be a veiled reference to the duo, dimisses efforts to identify what prevention strategy worked in Uganda to stem the tide of new infections – was it A (abstinence), was it B (be faithful), or was it C (condoms), writing: “However, some scientists and journalists continue to fuel the debate in a fairly obsessive search for the magic bullet in HIV in prevention…” And to be fair, Halperin has long been obsessive about male circumcision, but as I wrote in a piece for CSIS in 2008, perhaps rightfully so. 

Was Piot slow to the uptake on the promise of male circumcision? He praises it as one strategy among many that have taken center stage of late on prevention, but I don’t know the internal history well enough to judge. In general though, I agree with those like Mead Over who see the prevention agenda to have largely been a failure amidst this incredible and important turn to treatment access over the last decade. 
But, I would be wary of blaming Piot for that. While one can quibble on the margins with aspects of his service (I think some campaigners would say he was too accommodating of the branded pharmaceuticals companies), Peter Piot clearly has been on the right side of history on HIV/AIDS with remarkable skill, poise, grace, and pragmatism.
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Rethinking War Deaths in the Congo

Nicholas Kristof is writing about Congo again this morning:

It’s easy to wonder how world leaders, journalists, religious figures and ordinary citizens looked the other way while six million Jews were killed in the Holocaust. And it’s even easier to assume that we’d do better.

But so far the brutal war here in eastern Congo has not only lasted longer than the Holocaust but also appears to have claimed more lives. A peer- reviewed study put the Congo war’s death toll at 5.4 million as of April 2007 and rising at 45,000 a month. That would leave the total today, after a dozen years, at 6.9 million.

What those numbers don’t capture is the way Congo has become the world capital of rape, torture and mutilation…

Kristof is right about that – though not quite in the way he seems to mean. Actually the 5.4 million number from April 2007 has just been debunked by a new report out from the Human Security Report Project at Simon Fraser University, which argues that two of the five International Rescue Committee studies from which the estimate was derived woefully under-estimated the baseline peacetime national mortality in the Congo and therefore dramatically exaggerated the number of deaths in the country caused by the war.

In determining the excess death toll, the “baseline” mortality rate is critically important. If it is too low, the excess death toll will be too high.

The IRC uses the sub-Saharan average of 1.5 deaths per 1,000 per month as its baseline mortality rate for all but the very last survey when the sub-Saharan average drops to 1.4. Using the sub-Saharan African average mortality rate as a comparator––to indicate how high death rates were in the east of the DRC compared to the rest of sub-Saharan Africa, for example—would have been both instructive and appropriate. Using it as a measure of the pre-war mortality rate in the DRC itself makes little sense.

The IRC argues the sub-Saharan average mortality rate is a conservative choice for pre-war DRC because it was the highest estimate available. In 2002 the IRC recorded no violent deaths in the western region––which it refers to as the “nonconflict” zone. Yet, the mortality rate in this zone is 2.0 deaths per 1,000 of the population per month––a third higher than the sub-Saharan African average that the IRC uses as its pre-war baseline mortality rate.

But, the DRC is in no sense an average sub-Saharan African country—indeed, it is ranked at, or near, the bottom of every sub-Saharan African development indicator. The baseline mortality rate for the country as a whole should therefore be considerably higher than the sub-Saharan African average. The survey evidence from the western part of the country suggests that this is indeed the case.

The fighting in the DRC was also heavily concentrated in the eastern provinces during the period covered by the first two surveys. This suggests that in this period too there was no significant violent death toll in the western part of the country. Indeed, this is precisely the assumption the IRC makes in arriving at its 5.4 million excess death toll estimate for the DRC for the period 1998 to 2007.

The report breaks down the numbers in much greater detail and contrasts them to the much more conservative and, it argues, rigorously arrived at estimates – estimates that have been largely ignored by the press.

If “only” some 3 million people, instead of 5.4 million, died by 2007, does this undermine Kristof’s call for action on the Congo? By no means. A more useful metric may not be the absolute numbers (which in themselves don’t seem to incite much policy attention) but rather the relative numbers: Congo is one of the few places in the world where, according to this report, violence has reached sufficient levels to actually raise the national mortality rate (which is declining in nations elsewhere around the globe in both war and peacetime). According to their data, the one other case in which this occurred in recent decades is Rwanda.

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