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Happy New Year wherever you may reside.
Public Affairs Insight: environment, science, foreign affairs, economics & the arts
Sunday 31 December 2023
2024 - The New Year beckons
Friday 29 December 2023
Conflict in 2024
Will the world see more wars or unrest in 2024? Here are 5 hotspots to watch
Jessica Genauer, Flinders UniversitySadly, 2023 has been a violent one on the global stage. War broke out between Israel and Hamas in Gaza, leading to the deaths of thousands of Palestinians and hundreds of Israelis, including many children on both sides. And the bitter war between Russia and Ukraine continued with no end in sight.
As a result of the focus on these two conflicts, other countries have dropped off the radar for many people. Some of these nations have been dealing with simmering unrest, however, which could erupt in 2024 and seize the global spotlight.
So, where should we be watching in the coming year? Here are five places where I believe civil conflicts or unrest could worsen and potentially lead to violence.
Myanmar
Myanmar descended into chaos in 2021 when a military coup overthrew the democratically elected government led by Aung San Suu Kyi and sparked widespread civil protests that eventually morphed into an armed resistance.
The country, home to 135 ethnic groups, has rarely known peace. For years before the coup, there was a ongoing, low-grade civil conflict between the military and several minority ethnic groups who have long sought control over natural resources in their regions and independence from the state.
This exploded after the coup as ethnic militia groups joined forces with pro-democracy fighters from the Bamar majority protesting the junta.
Their resistance escalated in late 2023 with a coordinated northern offensive dealing the military its most significant losses in many years.
Insurgents won control of towns and villages on the northeastern border with China, including control over key trade routes. This led to renewed fighting in western Rakhine state, as well as in other areas.
The tenacity of the resistance of these minority groups, paired with the refusal of the military to compromise, suggests the country’s civil war may worsen considerably in 2024 and regain international attention.
Mali
In Mali, a nation in the turbulent Sahel region of Africa, tensions escalated throughout 2023 and now threaten to erupt into full-scale civil war.
Mali has long battled insurgent activity. In 2012, Mali’s government fell in a coup and Tuareg rebels, backed by Islamist militants, seized power in the north.
A United Nations peacekeeping mission was established in 2013 to bring stability to Mali. Then, in 2015, key rebel groups signed a peace agreement with the Mali government.
After two more coups in 2020 and 2021, military officers consolidated their power and said they would restore the state’s full territorial control over all of Mali. The regime insisted the UN peacekeeping mission withdraw from the country, which it did in June 2023. Subsequently, violence broke out between the military and rebel forces over future use of the UN bases.
In November, the military, reportedly backed by Russia’s Wagner Group, took control of the strategic northern town of Kidal which had been held by Tuareg forces since 2012. This undermines the fragile peace that has held since 2015.
It is unlikely the military will regain complete control over all rebel-held areas in the north. At the same time, insurgents are emboldened. With the 2015 peace agreement now all but dead, we can expect increased volatility in 2024.
Lebanon
In 2019, widespread civil protest broke out in Lebanon against leaders who were perceived not to be addressing the day-to-day needs of the population.
The situation continued to deteriorate, with a reshuffled government, escalating economic crisis and a massive port explosion that exposed corrupt practices.
The International Monetary Fund criticised Lebanon in September for a lack of economic reform. The Lebanese government has also failed to reach agreement on appointing a president, a post that has been vacant for more than a year.
This risks undermining the fragile power-sharing arrangement in Lebanon in which the key political posts of prime minister, speaker and president are allocated to a Sunni-Muslim, Shia-Muslim and Christian Maronite, respectively.
Most recently, the war between Israel and Hamas has threatened to spill over to Lebanon, home to the Hezbollah militant group, which claims to have an army of 100,000 fighters. Importantly, this jeopardises tourism as a key hope for Lebanon’s economic recovery.
These factors may precipitate a more serious economic and political collapse in 2024.
Pakistan
Since Pakistan’s independence in 1947, the military has played an interventionist role in politics. Though Pakistani leaders are popularly elected, military officials have at times removed them from power.
In 2022, Pakistani Prime Minister Imran Khan fell out of favour with Pakistan’s militant leaders. He was subsequently ousted from power in a parliament vote and later arrested on charges that his supporters claim are politically motivated.
Violent demonstrations broke out nationwide after his arrest – a display of anger against the military that was once unthinkable.
Pakistan also faces spillover from instability in neighbouring Afghanistan and increased terror attacks. These security challenges have been compounded by a struggling economy and ongoing costs from the devastating 2022 floods.
Pakistan is expected to hold parliamentary elections in February 2024, after which the current military caretaker government is expected to transfer power back to civilian rule. Many are watching the military closely. If this transfer of power does not take place, or there are delays, civil unrest may result.
Sri Lanka
Sri Lanka faced a debilitating economic crisis in 2022 that led to critical fuel, food and medical shortages. Civil protests caused then-President Gotabaya Rajapaksa to flee the country. He was quickly replaced by current President Ranil Wickremesingh.
Stability returned in 2023 as Sri Lanka began implementing economic reforms as part of a bailout agreement with the International Monetary Fund. However, widespread dissatisfaction with political elites and the underlying drivers of the country’s economic hardship have not been addressed.
Elections are also due in Sri Lanka by late 2024. While Wickremesingh, the incumbent, is likely to run for a second term, he has low trust with the public. He is viewed as too close to corrupt political elites.
This dissatisfaction could lead to renewed protests – particularly if the economy stumbles again – in a repeat of the situation that led to Rajapaksa’s ousting in 2022.
Jessica Genauer, Senior Lecturer in International Relations, Flinders University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Sunday 24 December 2023
Christmas 2023
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In an uncertain world with conflict, existential climate and environmental impacts and economic unknowns, it's important to find time to find some time for peace, serenity and connection with family and friends.
Seasonal greetings wherever you are and whatever your faith or beliefs.
Wednesday 22 November 2023
Emissions in an industrialised world - COP28
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COP28 to be held shortly in the United Arab Emirates (UAE) will open with the acceptance that the current efforts to limit greenhouse gas (GHG) emissions are well short of targets to prevent the global temperature increasing beyond 1.5C. The UAE's COP28 president has highlighted that approx 22 gigatons of GHG emissions need to be cut over the next seven years. This means a reduction of 43% in emissions from the 2019 levels that would need to be achieved by 2030. These are staggering numbers and represent the continuing failure globally to make any measurable difference thus far.
COP28 website: COP28 UAE
Wednesday 15 November 2023
COP28 - Will meaningful action on global warming come from this forum ?
The next Council of the Parties (COP 28) for the United Nations Framework Convention on Climate Change will be held in the United Arab Emirates between 30 November and 12 December 2023. As the conference numbering suggests, this is the 28th meeting of representatives from countries around the world yet with climate change now measurably underway, how effective have the previous 27 meetings been ? And will the 28th meeting achieve more substantial progress than its predecessors ?
With a conference theme and buzzword being "actionism", the Conference promises that the first global stocktake of the implementation of the Paris Agreement will conclude at COP28 with the aim of assessing the world's collective progress towards achieving its climate goals. It may be a disappointing exercise given current global environment trends.
PFAS chemicals - a world wide contamination
Contamination of both the general environment and the human population from chemicals has long been a deep concern and for the most part, the issue has been one that can be controlled with the ''its-not-too-late" ethos. For this issue however, that ethos cannot apply.
The US Centers for Disease Control (CDC) provides the basic understanding of the scale of the problem that is now an irreversible contamination of world-wide significance.
The CDC states " The per-and polyfluoroalkyl substances (PFAS) are a group of chemicals used to make fluoropolymer coatings and products that resist heat, oil, stains, grease and water. Fluoropolymer coatings can be in a variery of products. These include clothing, furniture, adhesives, food packaging, heat-resistant non-stick cooking surfaces, and the insulation of electrical wire. Many PFAS, including perfluorooctanoic sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA), are a concern because they:
- do not break down in the environment
- can move through soils and contaminate drinking water
- build up (bioaccumulate) in fish and wildlife
A fact sheet can be obtained at this link: CDC biomonitoring PFAS Fact Sheet
A Bloomberg video explains the issue further -
Wednesday 8 November 2023
Antibiotics - bacterial resistance an increasing threat
The rise and fall of antibiotics. What would a post-antibiotic world look like?
Antimicrobial resistance is one of the biggest global threats to health, food security and development. This month, The Conversation’s experts explore how we got here and the potential solutions.
These days, we don’t think much about being able to access a course of antibiotics to head off an infection. But that wasn’t always the case – antibiotics have been available for less than a century.
Before that, patients would die of relatively trivial infections that became more serious. Some serious infections, such as those involving the heart valves, were inevitably fatal.
Other serious infections, such as tuberculosis, weren’t always fatal. Up to a half of people died within a year with the most severe forms, but some people recovered without treatment and the remainder had ongoing chronic infection that slowly ate away at the body over many years.
Once we had antibiotics, the outcomes for these infections were much better.
Life (and death) before antibiotics
You’ve probably heard of Alexander Fleming’s accidental discovery of penicillin, when fungal spores landed on a plate with bacteria left over a long weekend in 1928.
But the first patient to receive penicillin was an instructive example of the impact of treatment. In 1941, Constable Albert Alexander had a scratch on his face that had become infected.
He was hospitalised but despite various treatments, the infection progressed to involve his head. This required removing one of his eyes.
Howard Florey, the Australian pharmacologist then working in Oxford, was concerned penicillin could be toxic in humans. Therefore, he felt it was only ethical to give this new drug to a patient in a desperate condition.
Constable Alexander was given the available dose of penicillin. Within the first day, his condition had started to improve.
But back then, penicillin was difficult to produce. One way of extending the limited supply was to “recycle” penicillin that was excreted in the patient’s urine. Despite this, supplies ran out by the fifth day of Alexander’s treatment.
Without further treatment, the infection again took hold. Constable Alexander eventually died a month later.
We now face a world where we are potentially running out of antibiotics – not because of difficulties manufacturing them, but because they’re losing their effectiveness.
What do we use antibiotics for?
We currently use antibiotics in humans and animals for a variety of reasons. Antibiotics reduce the duration of illness and the chance of death from infection. They also prevent infections in people who are at high risk, such as patients undergoing surgery and those with weakened immune systems.
But antibiotics aren’t always used appropriately. Studies consistently show a dose or two will adequately prevent infections after surgery, but antibiotics are often continued for several days unnecessarily. And sometimes we use the wrong type of antibiotic.
Surveys have found 22% of antimicrobial use in hospitals is inappropriate.
In some situations, this is understandable. Infections in different body sites are usually due to different types of bacteria. When the diagnosis isn’t certain, we often err on the side of caution by giving broad spectrum antibiotics to make sure we have active treatments for all possible infections, until further information becomes available.
In other situations, there is a degree of inertia. If the patient is improving, doctors tend to simply continue the same treatment, rather than change to more appropriate choice.
In general practice, the issue of diagnostic uncertainty and therapeutic inertia are often magnified. Patients who recover after starting antibiotics don’t usually require tests or come back for review, so there is no easy way of knowing if the antibiotic was actually required.
Antibiotic prescribing can be more complex again if patients are expecting “a pill for every ill”. While doctors are generally good at educating patients when antibiotics are not likely to work (for example, for viral infections), without confirmatory tests there can always be a lingering doubt in the minds of both doctors and patients. Or sometimes the patient goes elsewhere to find a prescription.
For other infections, resistance can develop if treatments aren’t given for long enough. This is particularly the case for tuberculosis, caused by a slow growing bacterium that requires a particularly long course of antibiotics to cure.
As in humans, antibiotics are also used to prevent and treat infections in animals. However, a proportion of antibiotics are used for growth promotion. In Australia, an estimated 60% of antibiotics were used in animals between 2005-2010, despite growth-promotion being phased out.
Why is overuse a problem?
Bacteria become resistant to the effect of antibiotics through natural selection – those that survive exposure to antibiotics are the strains that have a mechanism to evade their effects.
For example, antibiotics are sometimes given to prevent recurrent urinary tract infections, but a consequence, any infection that does develop tends to be with resistant bacteria.
When resistance to the commonly used first-line antibiotics occurs, we often need to reach deeper into the bag to find other effective treatments.
Some of these last-line antibiotics are those that had been superseded because they had serious side effects or couldn’t be given conveniently as tablets.
New drugs for some bacteria have been developed, but many are much more expensive than older ones.
Treating antibiotics as a valuable resource
The concept of antibiotics as a valuable resource has led to the concept of “antimicrobial stewardship”, with programs to promote the responsible use of antibiotics. It’s a similar concept to environmental stewardship to prevent climate change and environmental degradation.
Antibiotics are a rare class of medication where treatment of one patient can potentially affect the outcome of other patients, through the transmission of antibiotic resistant bacteria. Therefore, like efforts to combat climate change, antibiotic stewardship relies on changing individual actions to benefit the broader community.
Like climate change, antibiotic resistance is a complex problem when seen in a broader context. Studies have linked resistance to the values and priorities of governments such as corruption and infrastructure, including the availability of electricity and public services. This highlights that there are broader “causes of the causes”, such as public spending on sanitation and health care.
Other studies have suggested individuals need to be considered within the broader social and institutional influences on prescribing behaviour. Like all human behaviour, antibiotic prescribing is complicated, and factors like what doctors feel is “normal” prescribing, whether junior staff feel they can challenge senior doctors, and even their political views may be important.
There are also issues with the economic model for developing new antibiotics. When a new antibiotic is first approved for use, the first reaction for prescribers is not to use it, whether to ensure it retains its effectiveness or because it is often very expensive.
However, this doesn’t really encourage the development of new antibiotics, particularly when pharma research and development budgets can easily be diverted to developing drugs for conditions patients take for years, rather than a few days.
The slow moving pandemic of resistance
If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine – David Cameron, former UK Prime Minister
Antibiotic resistance is already a problem. Almost all infectious diseases physicians have had the dreaded call about patients with infections that were essentially untreatable, or where they had to scramble to find supplies of long-forgotten last-line antibiotics.
There are already hospitals in some parts of the world that have had to carefully consider whether it’s still viable to treat cancers, because of the high risk of infections with antibiotic-resistant bacteria.
A global study estimated that in 2019, almost 5 million deaths occurred with an infection involving antibiotic-resistant bacteria. Some 1.3 million would not have occurred if the bacteria were not resistant.
The UK’s 2014 O'Neill report predicted deaths from antimicrobial resistance could rise to 10 million deaths each year, and cost 2-3.5% of global GDP, by 2050 based on trends at that time.
What can we do about it?
There is a lot we can do to prevent antibiotic resistance. We can:
raise awareness that many infections will get better by themselves, and don’t necessarily need antibiotics
use the antibiotics we have more appropriately and for as short a time as possible, supported by co-ordinated clinical and public policy, and national oversight
monitor for infections due to resistant bacterial to inform control policies
reduce the inappropriate use of antibiotics in animals, such as growth promotion
reduce cross-transmission of resistant organisms in hospitals and in the community
prevent infections by other means, such as clean water, sanitation, hygiene and vaccines
continue developing new antibiotics and alternatives to antibiotics and ensure the right incentives are in place to encourage a continuous pipeline of new drugs.
Read the other articles in The Conversation’s series on the dangers of antibiotic resistance here.
Allen Cheng, Professor of Infectious Diseases, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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