By Jeremy Farrar/Davos

When I was a medical student in the mid-1980s, I contracted malaria in Papua New Guinea. It was a miserable experience. My head ached. My temperature soared. I became anaemic. But I took my medicine and I got better. The experience wasn’t pleasant, but thanks to cheap, effective malaria drugs I was never in very much danger.
The pills that cured me, chloroquine tablets, do not work anymore. Even at the time I was taking them, the parasite that causes malaria had already become resistant to chloroquine in many parts of the world; Papua New Guinea was one of the last places where the pills continued to be effective, and even there they were losing their potency. Today, chloroquine has basically disappeared from our medical arsenal.
The growing capacity of pathogens to resist antibiotics and other antimicrobial drugs is turning into the greatest emerging crisis in contemporary healthcare – and it is a crisis that cannot be solved by science alone.
Other pharmaceuticals are following in chloroquine’s wake. Multi-drug-resistant strains of tuberculosis, E. coli, and salmonella are now commonplace. Most gonorrhea infections are untreatable.
Superbugs, like methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, are proliferating. In India, antibiotic-resistant infections killed more than 58,000 newborns in 2013.
Today, malaria is often treated with a combination of artemisinin – a drug derived from a Chinese herb – and other antimalarial drugs. But these revolutionary medicines are now in danger of following chloroquine into obsolescence; resistant strains of malaria have been documented in Southeast Asia.
This is more than a medical problem; it is a potential economic disaster. Research commissioned by the Review on Antimicrobial Resistance, headed by the economist Jim O’Neill, has calculated that if current trends continue, drug-resistant infections will kill 10mn people a year by 2050 and cost the global economy some $100tn over the next 35 years.
Even that dramatic prediction may be a substantial underestimate, as it includes only the direct costs in terms of lives and wellbeing lost to infections. Many other aspects of modern medicine also rely on antibiotics. Cancer patients receiving chemotherapy take them to suppress bacteria that would otherwise overwhelm their weakened immune systems.
Many surgical operations now considered routine, including joint replacements and Caesarean sections, can be performed safely only when antibiotics prevent opportunistic infections.
The origins of drug resistance are a well-understood matter of evolution. If pathogens are exposed to the selective pressure of toxic drugs, eventually they will adapt.
The Wellcome Trust, which I lead, has invested hundreds ofmns of dollars into researching these mechanisms, improving diagnoses, and creating new drugs.
In order to address the problem effectively, this effort must be extended beyond the realm of biological science to areas not traditionally associated with medicine.
In rich and poor countries alike, we have become systematic abusers of antibiotics. The key to combating resistance is to delay the rate at which the pathogens can adapt.
But, by overprescribing antibiotics and failing to complete the required courses of treatment, we are exposing germs to just enough medicine to encourage resistance. In effect, we are vaccinating germs against the drugs we want to use against them.
That is because we have come to regard antibiotics almost as consumer goods – ours to demand from doctors, and ours to take or stop taking as we see fit.
Even the most informed patients misuse these wonder drugs. Research in the United Kingdom has found that even people who understand how resistance develops often contribute to the problem by taking antibiotics without a prescription or giving their drugs to members of their family.
Changing such destructive behaviour will require that we better understand the social and cultural factors that drive it. Disciplines like history, psychology, sociology, anthropology, economics, market research and social marketing can help.
This is true not only for antimicrobial resistance. It also applies to outbreaks like the Ebola epidemic. Combating the virus requires knowledge about its biology, the epidemiology of its transmission and the drugs and vaccines that could potentially be deployed against it.
But it also requires an understanding of the behaviours that have allowed infection to spread in Liberia, Sierra Leone and Guinea.
Explaining what made these societies so vulnerable requires learning about the region’s recent history and understanding why people there are deeply distrustful of public authorities. Isolation of patients and safe burial of the dead are crucial to containing Ebola, but both need to be introduced with cultural sensitivity – not just explanations of the science behind them.
Today’s great public-health threats have profound economic consequences. Minimising the risks they pose requires recognising that they are intertwined with the social, behavioural, and cultural landscape.
Science provides powerful tools. But we need more than science to use these tools effectively. - Project Syndicate

- Jeremy Farrar is director of the Wellcome Trust, a global charitable foundation dedicated to improving health.
Qatar government

must look beyond
hydrocarbons

Diversifying government revenue beyond hydrocarbons, although challenging, will enhance Qatar’s economy and create a thriving investment environment in the country.
Persistent drop in crude price remains a major challenge for all oil producers, both Opec members and non-Opec nations. Oil producers with well-diversified economies will be hit only marginally, whereas others are ought to face rough weather during the low price regime.
Qatar has a resilient oil and gas sector due to the country’s leading position in the LNG market and new gas sector developments.
Substantial government investments in improving the country’s basic infrastructure and developing other sectors such as health, education, transport and tourism will help the non-oil and gas sector outpace hydrocarbons.
Qatar’s target is to get an “AAA” credit rating clearly in view of its growing economic strength and expansion of the non-oil GDP portfolio.
The country’s non-hydrocarbon sector is expected to continue growing strongly following an 18% average annual growth rate between 2008 and 2013, a recent PwC report showed.
The non-hydrocarbon sector will receive further impetus with Qatar earmarking $182bn for project implementation over the next five years, of which $27.4bn will have been utilised in the current fiscal, QNB data show.
Qatar’s projected population growth, resilient oil and gas sector, non-energy sector growth and stable inflation should help the country’s real GDP growth maintain the desired momentum in the short to medium term. And many economists believe Qatar is one of the “best placed” GCC countries to weather the current fall in oil prices.
But Qatar will have to further strengthen its macro-fiscal capabilities to steer clear of the dark clouds in the global economic horizon.  
To meet the nation’s non-hydrocarbon financing goal, a larger non-hydrocarbon revenue base is required. Increased governmental expenditure and growth in governmental services are key to the diversification efforts of the Qatari government.
Experts have recommended speeding up the process of deepening Qatar’s capital markets and sources of funding; expanding the government’s revenue base; and managing government expenditure efficiently.
One of the prerequisites for an effective monetary policy, they say, is a deep and liquid local capital market and active sovereign debt market.
Qatar’s equity market is the third largest by market capitalisation in the GCC and has attracted more trading volumes following its graduation into the emerging countries group by MSCI in May 2014.
However, the number of equities listed on the stock exchange is low at 43 with only one IPO in the last four years, suggesting a scope for further growth, PwC points out.
It is suggested that Qatar Central Bank accelerate the deepening of capital markets and develop its liquidity framework to increase the potency of monetary policy and combat the threat of potentially rising and volatile inflation.
These measures will help Qatar to achieve the most sought-after AAA credit rating, develop a business environment attractive to private and international investors, diversify the economy and ensure prudent management of governmental expenditure.


Public health challenges in the Middle East

By Dr Cesar Chelala
New York


Despite modest growth and poverty reduction, some important gains in the health status of the population have been achieved in the Middle East, thanks to improvements in technology, health service delivery and public health programmes. However, the whole region still faces important public health challenge.
For example, although the region has decreasing rates of communicable diseases, it has increasing rates of non-communicable diseases (NCDs). This is a group of diseases, also known as chronic diseases, are not passed from person to person and tend to be in general of slow progression.
The four main types among these diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes.
These diseases are driven by factors that include ageing, rapid unplanned urbanisation, and the globalisation of unhealthy lifestyles. Among the latter are unhealthy diets, tobacco use, lack of physical activity and obesity. They may lead to raised blood pressure, increased blood glucose levels, and elevated blood lipids.
The economic costs of these diseases can be considerable.
In low-resources households, health care costs for cardiovascular diseases, cancers, respiratory diseases and diabetes can quickly drain those resources and drive families into further poverty and hinder the countries economic development.
Some relatively new diseases are emerging, such as HIV/Aids and, in some areas old diseases are re-emerging, as is the case with tuberculosis. Although HIV prevalence rates are low in the countries in the Middle East, the risks for further spread exist. Should this happen, the infection could have significant social and economic consequences.
Communicable diseases, by contrast, spread from one person to another or from animal to person.
The spread usually happens via airborne viruses or bacteria, but also through blood or other body fluids. Among this group of diseases are malaria, tuberculosis, measles, HIV/Aids, Ebola, influenza, hepatitis and poliomyelitis.
Malaria, tuberculosis and measles are responsible for a significant proportion of the region’s morbidity.
The conflicts afflicting the region have provoked an increase in the incidence of communicable diseases. This is the case in Gaza, where the recent conflicts have led to outbreaks of water-borne and food-borne diseases as a result of contamination of drinking water with raw sewage. International health organizations confirmed these facts.
The wars in some countries such as Syria and Iraq have led to a substantial emigration of doctors which has added to the problems of already insufficient qualified health personnel. In Iraq, the amount of physicians has been decimated by the continuing conflict in that country.
In addition, the conflicts have led to the destruction of a significant part of the health infrastructure in the country.
Although progress has been made in the health status of mothers and children in most countries in the region, disparities within these countries persist, making this progress inequitable, as has been reported by Unicef.
“The health and well-being of mothers and children is often determined not by the country they live in, but by their income and where they live within a country,” said Shashia Azfar, Unicef Regional Director for the Middle East and North Africa.
Most health services in the region are still based on a curative model, which is expensive to maintain and also inefficient in addressing new health challenges.
That is why health-care services will have to increasingly include the provision of preventive and promotion services and improve primary health care to attend the most immediate health needs.
Although some countries have the economic resources to face this challenge, they have to be redirected in a way to make them more effective.
Because the Middle East region is composed of a diverse mix of countries ranging from very poor ones to wealthy oil exporting countries, there are no solutions that uniformly apply to all of them. A thorough evaluation of the situation in each country, however, can provide the information to apply the best approach to solve the health problems in each of them.
 
lDr Cesar Chelala is an international public health consultant, and a winner of an Overseas Press Club of America award, and a national journalism award from Argentina.





Key ingredients needed for
a successful growth strategy

The key to a successful growth strategy is to
ensure that policies
reinforce and enhance one another
By Michael Spence
Milan


At a time of lacklustre economic growth, countries around the world are attempting to devise and implement strategies to spur and sustain recovery.
The key word is strategy: to succeed, policymakers must ensure that measures to open the economy, boost public investment, enhance macroeconomic stability and increase reliance on markets and incentives for resource allocation are implemented in reasonably complete packages. Pursuing only some of these objectives produces distinctly inferior results.
China provides a telling example. Before Deng Xiaoping launched the policy of “reform and opening up” in 1978, the country had relatively high levels of public-sector investment. But the centrally planned economy lacked market incentives and was largely closed to the global economy’s major markets for goods, investment and technology.
As a result, returns on public investment were modest, and China’s economic performance was mediocre.
China’s economic transformation began with the introduction in the 1980s of market incentives in the agricultural sector.
These reforms were followed by a gradual opening to the global economy, a process that accelerated in the early 1990s. Economic growth surged ahead and returns on public investment soared, reaching an annual growth rate above 9% of GDP, shortly after the reforms were implemented.
The key to a successful growth strategy is to ensure that policies reinforce and enhance one another. For example, boosting returns on public investment – critical to any growth plan – demands complementary policies and conditions, in areas ranging from resource allocation to the institutional environment.
In terms of effectiveness, the policy package is more than the sum of its parts.
Of course, the specific portfolio of policies varies depending on the stage of a country’s development; early-stage growth dynamics are distinctly different from those in middle-income and advanced countries. But the imperative is the same.
Just as a developing China achieved rapid growth only when a comprehensive policy package was implemented, the advanced countries struggling to restore sustainable growth patterns today have found that incomplete policy packages produce slow recoveries and below-potential growth and job creation.
Consider the post-crisis performance of the European Union and the United States. Though both have had their share of problems, the US is performing somewhat better (though it still faces major challenges in generating middle-income employment).
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The difference is not that the US launched a large fiscal stimulus focused on public-sector investment; no such stimulus was implemented, though many economists, including me, believe that it would have generated a faster recovery and stronger long-term growth.
Nor is the difference greater political effectiveness; few would say that the US government is functioning well nowadays, given rising partisanship and sharp disagreement about its proper role.
The US economy has benefited from two factors: its greater structural flexibility and dynamism relative to Europe, and the broader mandate of the US Federal Reserve, which has pursued a far more aggressive monetary policy than has the European Central Bank.
Though analysts differ on the relative importance of these two factors – and, indeed, it is difficult to weight them – it is safe to say that both played a role in facilitating the US recovery.
Europe is now placing a large bet on an increase in public-sector investment, using a combination of EU-level funding and national investment programmes, perhaps augmented by a modification of the EU’s fiscal rules.
Given that public-sector underinvestment is a common cause of subpar growth, this is a step in the right direction.
But public investment is not enough. Without complementary structural reforms that encourage private investment and innovation – and thus enable economies to adapt and compete in a global, technology-driven economy – a public-investment programme will have a disappointingly weak impact on growth.
Instead, debt-financed public investment will produce a short-run stimulus, at the cost of longer-term fiscal stability.
The problem is that structural reforms are notoriously difficult to implement. For starters, they face political resistance from short-run losers, including the companies and sectors that existing rigidities protect.
Moreover, in order to ensure that such reforms ultimately benefit everyone, there must be a strong culture of trust and a determination to prevent more flexible arrangements from leading to abuses.
Finally, structural reforms require time to take effect. This is particularly true in the eurozone, whose members abandoned a crucial tool for accelerating the process – exchange-rate adjustments to account for different economies’ productivity levels – when they adopted the common currency.
ECB president Mario Draghi recently argued that, because individual EU countries’ growth-retarding policies have negative external effects, perhaps they should not have unimpeded control in certain policy areas.
Though member countries’ financial supervisory authority is already being limited through centralisation of bank regulation and resolution mechanisms, Draghi’s suggestion is more far-reaching.
One wonders if Draghi’s proposal is politically feasible in the EU context. Even if it were, would it be necessary? All economies have sub-units across which economic productivity, growth, and dynamism vary considerably.
 Indeed, differentials in the quality of governance and policies seem persistent, even in economies that perform pretty well overall.
Perhaps part of the answer is to prevent sub-units – in the EU’s case, member countries – from falling short on reforms. But centralisation carries its own costs.
Given the risk inherent in betting on policy convergence, labour mobility – which enables highly valuable human capital, especially well-educated young people, to leave lagging regions for those that offer more and better employment opportunities – could prove to be a critical tool for adjustment.
As it stands, labour mobility is imperfect in the EU. But, with language training and the implementation of something like the Lisbon strategy for growth and jobs (which aimed to create an innovative “learning economy”, underpinned by inclusive social and environmental policies), mobility could be enhanced.
But more fluid labour mobility is no panacea. As with every other element of a growth strategy, mutually reinforcing efforts are the only way to achieve success.
Half a loaf may be better than none, but half the ingredients do not translate into half of the hoped-for results. - Project Syndicate

lMichael Spence, a Nobel laureate in economics, is professor of economics at New York University’s Stern School of Business and senior fellow at the Hoover Institution. His latest book is The Next Convergence – The Future of Economic Growth in a Multispeed World.