Many people initially mocked the recommendations by health officials in several countries for women in Zika areas to avoid pregnancy for the next six months to two years. The statements also raised some very legitimate and important questions about women's health issues, contraception access, abortion laws and sexual violence in the countries where Zika is increasing.
However, in spite of the initial chorus of mocking and criticisms, the NYT reports today that some health experts are beginning to seriously consider the recommendation that women in areas with high incidence of Zika avoid pregnancies for the next year or two. That timeframe would allow Zika to run its course through the populations of the tropics and create a much higher level of individual and herd immunity. It also gives time to potentially develop a vaccine, though deployment of that vaccine will likely take longer, and allows countries to make additional progress on mosquito elimination. While the current research on Zika's effects on pregnant women remains unfinished, the difference of this timely recommendation could potentially be thousands of even tens of thousands of fewer babies born with birth defects in tropical areas.
This is very challenging issue because this is a recommendation that must be made very soon for it to be effective, and most health officials are correctly hesitant to make any recommendations without convincing evidence. Convincing and statistically significant evidence on Zika's causal link to infant microcephaly probably won't be available for another few years. Though the correlation appears to be there, it could turn out to not be a true causal link. If global health officials make the recommendation to delay pregnancy and it turns out that the link is not what we currently guess it is, or it turns out there is a second order consequence that we currently aren't considering, the criticisms will be abundant.
President Obama announced the United States will expand its assistance to Colombia next year. The $450 million, much of it coming under the renamed Peace Colombia initiative, is about 50% higher than previously budgeted. It will include consolidating security, expanding state presence and promoting justice for conflict victims. A separate fund of $33 million will go to landmine removal efforts.Separately, Colombia also announced an expansion of student exchanges and increased scientific research and cooperation to combat Zika and other mosquito-borne diseases.President Santos has expressed significant gratitude towards the US for its assistance to the country. Santos's visit to the US has led to a week of people praising Plan Colombia and offering their support for future initiatives. That's a successful trip.
One day after I wrote that Argentina's Congress could stand in the way of a debt deal, the Peronist coalition broke. From Reuters:
Argentina's main opposition party suffered a split on Wednesday after a dozen of its lawmakers quit, party leaders said, handing a boost to newly-elected President Mauricio Macri's hopes of pushing his legislative agenda through Congress....This is one of those events that looks obvious in hindsight, but few people predicted.
...The shift in Congress could prove key when it returns from recess in March. Perhaps Macri's biggest challenge this year will be securing Congressional approval for any eventual deal with U.S. creditors suing the country over unpaid debt.
A political party that loses an election will often have a major internal feud and even a divide. A political system with inchoate parties like Argentina is even more susceptible to seeing these sorts of party divisions amid an election loss. It's not as if Peronism is a clearly defined ideology. It is a party with a political platform that has changed with the whims of its leadership over the decades, so there is little ideological reason for people to remain in the party if there aren't other political incentives.
Of course the Peronist party is breaking apart now that they've lost the presidency and Kirchner is out of power. Of course a new president in his public opinion honeymoon is able to convince enough Peronists to defect in order to get his legislative agenda passed. It seems so obvious. But I dare you to find someone who predicted it and put that prediction in writing three months ago. I certainly did not.
An article in Foreign Policy suggests “A Plan Colombia for Afghanistan.” The article refers specifically to providing Afghanistan more intelligence sharing, precision guided munitions for the Air Force, and, implicitly, the level of success Colombia has seen in the past 15 years.
The good news about writing a blog for for as long as I have is that I’ve already addressed a similar request for a Plan Colombia in Afghanistan at Plan Colombia's ten year mark. In 2011 I wrote:
Over the past decade, there have been times the US has spent more in a day on its two wars than was spent in an entire year in Colombia. Additionally, Plan Colombia limited the number of troops and contractors in the country to less than 1,500 at any given time and the US was often well under the limits….The US spent about $50 billion in Afghanistan in 2015. That is about four times the amount spent in Colombia over its entire 15 year period. About 10,000 US troops remain in Afghanistan and at least 20,000 military contractors, far more than ever operated in Colombia.
...Those limitations benefited Colombia. Having a smaller budget and a troop/contractor cap prevented the US from throwing excessive troops and resources at the problem, which often creates temporary success but also a level of dependency that make it hard to step away. The limitations on US assistance meant Colombia had to succeed on its own because the US was legislatively self-limited from imposing temporary "success" from the outside by ramping up troops or aid.
A Plan Colombia style package for Afghanistan would require significant cuts in terms of budget and personnel. It would probably be about $20-25 billion over the next ten years (not per year, that's total) and a hard limit of 2,500-3,000 military personnel plus contractors. And sure, that plan should include some intelligence sharing and precision guided munitions. Given how the fight in Afghanistan has gone in recent years, it's a proposal that should be on the table and debated (and some of the budget savings could go to Colombia and Central America), but I don’t think that’s what people mean when they suggest a Plan Colombia for Afghanistan.
Argentina has reached a deal to pay $1.35 billion in cash to a group of Italian creditors who hold unpaid sovereign debt stemming from the South American country's record default in 2002, the investors said on Tuesday.This was likely the easiest part of the negotiations, but the fact they reached the deal on this initial 30% of the outstanding debt is very positive for Macri's desire to normalize the country's international financial situation.
At least two bigger challenges remain. First, the Macri government is still negotiating with several holdouts including Elliott Management who are going to demand a harder bargain. Macri needs to show he is willing to walk away from a bad deal in order to have leverage to negotiate a good deal. Ideally, the two sides will skip that show and get straight to a good deal, but I wouldn't be surprised if the negotiations broke down at least once while the sides test each other's limits.
Second, these agreements must be approved by Argentina's Congress. Lawmakers in the Kirchner camp are going to try to sink any deal, for both ideological and political reasons. Additionally, while Macri is still experiencing some honeymoon levels of popularity, the "vulture funds" are wildly unpopular in Argentina and any deal is going to be hard to sell to the public.
Voters are strategic. While I’m sure many Iowans considered voting for Martin O’Malley at some point during the campaign, the media narrative of the Democratic primary being a two-way race pushed many of them to choose one of the two candidates leading the state and national polls. O’Malley didn’t meet the minimum threshold at most caucus sites and has suspended his campaign after one state.
I’m proud to have supported O’Malley. He provided an important alternative in the primary. His views on immigration, deportations and the security crisis in Central America provided some compassion to contrast the candidates in the Republican field who are competing to be the most anti-migrant. His call for a 100% renewable energy grid by 2050 was the most progressive environmental policy in the field. I hope to see the Clinton and Sanders campaigns, as well as the DNC, adopt some of O’Malley’s policies and positions as they continue this election cycle.
I try to keep readers informed of my biases. I'll be sure to write if I choose to support any other campaigns this election.
Colombia President Santos is visiting the US this week to discuss Colombia's peace process and celebrate the 15th anniversary of Plan Colombia. Secretary Kerry writes that the Obama administration will soon launch a new Colombia aid program to help the post-conflict environment. WOLA has some notable criticisms of Plan Colombia, though they do admit that the security statistics of the country improved more than they had expected.
In the fall of 2014 I was asked to write about US security policy in the region, but that paper was never published. As long as everyone is writing about Plan Colombia this week, it's a good time to plagiarize myself and publish a portion of the paper here. Copied below is a section in which I discussed using the lessons of Plan Colombia for Central America.
Many US policymakers and analysts (this author included) look to Plan Colombia as a success story and would like to see the successes replicated in a very different security environment Central America. In that, it is important to draw the correct lessons from the Plan Colombia experience while also realizing its limitations.
1) Security vs Drugs. US drug policy and Plan Colombia’s original design were built around a mistaken belief that stopping drugs would improve security in the hemisphere. One of the lessons from Plan Colombia is that the causality is reversed. Though Plan Colombia was designed as a counter-drug program, it had very limited success in directly reducing drug cultivation, manufacturing and trafficking. Instead, it was the portions of the program that built capacity in the security forces and improved governance across the country that improved security statistics, degraded the country’s illegally armed groups made the program a success. Drug flows did not slow out of Colombia until several years after the security conditions began improving on the ground there.
2) Size and time. Plan Colombia was small compared to US operations in the Middle East and South Asia. However, it was significantly larger and longer lasting than the programs that have been proposed in recent years for Mexico and Central America. Success and institution building in Central America is not going to come quick or cheap. Efforts to improve capacity on the cheap won’t lead to actual results on the ground, which will lead to everyone wondering ten years from now why things haven’t improved. Plan Colombia’s size and time scale should be seen as a minimum standard for future security programs in the region.
3) Leadership. The success of Plan Colombia required strong leadership from the country. It couldn’t be artificially implemented by the US. That will be true in Central America as well. Participation and leadership from Central America’s politicians, businesses and civil society is required. Unfortunately, some in the US have begun using this leadership lesson from Plan Colombia as an excuse for inaction or low budgets in Central America. Plan Colombia was also a lesson in US leadership, a willingness for a bipartisan coalition to cooperate and pass a major budget item for the region even though it was unclear whether Colombia could successfully implement a security plan. Colombia’s leadership came after the US’s and we should be willing to show similar leadership, a willingness to spend more in Central America and a willingness to commit for a long term across multiple administrations.
4) Human Rights. Colombia’s military forces worked with paramilitary groups in the 1980’s and 1990’s in an effort to fight the FARC. That collaboration led to some of the worst human rights abuses over the decades of conflict. The efforts to build up the capabilities of Colombian security forces and stop them from working with paramilitary units was critical to the country’s success in the 2000’s. The US declaration of the AUC as a terrorist group (coincidentally on 10 September 2001) was symbolically important for recognizing that the US would not tolerate that sort of collaboration going forward. Colombia did not succeed through using non-governmental paramilitary forces. In fact, they didn’t succeed until they cut those illegal forces out and built their own capacity. That’s a lesson that must be replicated in Central America, where private security firms dominate much of the security space and too many police and military forces also operate with or as illegal groups.
The four lessons above can be applied to Northern Triangle of Central America, understanding that the isthmus is facing a very different situation today than Colombia faced one or two decades ago.
- The United States must offer flexibility on drug policy and focus its strategy on reducing violence and improving governance in Central America.
- The US must provide assistance that is both large enough to meet the scale of the problem and long enough in duration that it provides governments with an ability to plan their own long term efforts.
- Central American participation and leadership is vital to success, but the US would be wrong to wait for the perfect conditions of leadership in Central America before assisting.
- Any solution must include respect for human rights and cannot support shortcuts that use private or illegal groups as proxies for capable security forces.
The WHO will establish an emergency committee on Zika that will hold its first meeting today. Unannounced but obvious, the committee will be spending a lot of time looking at Brazil. Brazil data are key to determining the connection between Zika and microcephaly. Brazil is hosting the Olympics in a few months, which could increase the rate that Zika spreads across the globe.
Zika isn't ebola. It's not even at the level of dengue. In fact, for the average non-pregnant person, Zika is a weak disease, only 20% of people who get it even show symptoms, and one of the lesser concerns of traveling to the tropics. From a personal health perspective, it would be far worse to catch dengue or malaria or get food poisoning or drink contaminated water, all of which come with a similar or higher mortality risk than Zika.
That weakness is what is going to make Zika a particularly difficult public health crisis. The threat to most individuals is quite low. The threat to public health, however, is potentially very high.
The top public health concern is the rate in which Zika impacts pregnant women and newborns. Brazil had over 4,000 reported cases of microcephaly last year and research suggests Zika may be contributing to brain development issues or eyesight problems in newborns who don't show physical signs of microcephaly. While the exact causal link between Zika and microcephaly is unclear, the increase in birth defects in Zika-prone areas is a problematic correlation that is worth an urgent response. There are high numbers and the disease is just starting to spread.
Second, Zika appears to be contributing to a rise of Guillain-Barré syndrome, though much more evidence must be collected on that. While it is a very small number of patients who suffer from that, meaning the individual risk is quite low, an increase across the whole population is damaging and taxing on healthcare systems.
It's the divide between the average individual risk and public health risk that will make Zika hard to contain. At an individual level, there is really no reason to avoid travel to Brazil or other places with Zika unless you're pregnant or thinking of becoming pregnant. Once the initial Zika panic dies down, most people will likely ignore it. However, at a societal level, we need to think about how to contain this virus to avoid thousands of infant deaths, birth defects, and potential other secondary consequences.
I was having lunch in San Pedro Sula, Honduras, yesterday when a colleague picked up the phone, spoke briefly, and then turned to me to say, “He has Zika,” referring to the person she had been talking to. It was the second case I had heard about in 24 hours. I’m in the world’s second most dangerous city and I’ve spent more time talking about a mosquito-borne disease than homicides by gang members.
Anecdotes aren’t data. So here are some numbers. So far in 2016, there have been 1,300 reported cases of Zika in the city of San Pedro Sula and another 650 cases in the surrounding area. That is about twice the rate of reported infections this year of dengue or chikungunya, two other diseases transmitted by the same Aedes mosquito. The high rate is likely due to Zika being a new disease that nobody in this region has been exposed to before. When considering these numbers, also realize only about 20% of Zika infections show symptoms (and therefore are reported), while dengue and chikungunya have much lower asymptomatic rates.
What is troubling is that Honduras’s national government just reported that they had topped the 1,000 case mark this year while health officials just in San Pedro Sula have documented over 1,800 cases. That suggests a disconnect among those monitoring the disease spread. That disconnect isn’t just in Honduras, but is mirrored in many other countries of the hemisphere where data collection is weak or nonexistent. Tracking data is the first important step to understanding and responding. We can’t stop it if we aren’t tracking it.
Yesterday, doctors in the Journal of the American Medical Association wrote Zika has “explosive pandemic potential” and urged the WHO to convene an emergency committee to monitor the disease, make recommendations and focus resources. President Obama was briefed this week on Zika and called for increase research on diagnostics and potential vaccines.
Zika is new, but the past five years have seen the rapid spread of chikungunya and an increased incidence of dengue in many of this hemisphere's countries. Not enough resources are going into tracking the diseases or killing the mosquitos behind them. Zika is not a reason for panic, but it is a reason to focus our actions and resources on these diseases that we should be able to slow or stop.
Both Reuters and WSJ have interviews with Henry Ramos Allup, Venezuela’s new national assembly leader. Within the interviews, he makes abundantly clear that he views his goal as the constitutional removal of President Maduro. He reiterates his claim that they will decide in the coming six months how to proceed with that effort.
In the Reuters article, he makes clear that he has heard some strategically suggest that they should let Maduro stay in office to feel the brunt of the economic collapse over the coming years, but Ramos Allup says that would be irresponsible of the opposition.
This may all be a negotiating position. Ramos Allup may be using the threat to democratically remove Maduro to force the president to deal with the new assembly and its constitutional powers. However, it doesn’t appear to me that Ramos Allup is bluffing. Anyone who has watched Venezuelan politics over the past two decades (and few have watched it closer than Ramos Allup) know that the threats are more likely to increase tensions, not lead to negotiations.
That means the opposition likely has a plan to invoke a recall referendum or other process later this year, the belief being that nothing can be done to fix the economy until the political power struggle is decided.
There are a lot of smaller political battles to be fought in the meantime. The NYT highlights the opposition proposal to give property rights to those who have received government housing. The ongoing battle over the removed legislators and the Supreme Court still needs to be cleared up. At some point, the opposition will want to remove the top election officials before any new election process is started. It is important to watch the smaller political battles with an eye on how they shape the opposition leader's stated end goal of removing the president.