How Houthi rebels are threatening global trade nexus on Red Sea

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The U.S. is mustering an international armada to deter Iranian-backed Houthi militias from Yemen from attacking shipping in the Red Sea, one of the world’s most important waterways for global trade, including energy cargos.

The Houthis’ drone and missile attacks are ostensibly a response to the war between Israel and Hamas, but fears are growing that the broader world economy could be disrupted as commercial vessels are forced to reroute.

On Tuesday, U.S. Secretary of Defense Lloyd Austin held a videoconference with 43 countries, the EU and NATO, telling them that “attacks had already impacted the global economy and would continue to threaten commercial shipping if the international community did not come together to address the issue collectively.”

Earlier this week, the U.S. announced an international security effort dubbed Operation Prosperity Guardian that listed the U.K., Bahrain, Canada, France, Italy, the Netherlands, Norway, the Seychelles and Spain as participants. Madrid, however, said it wouldn’t take part. 

The Houthis were quick to respond. 

“Even if America succeeds in mobilizing the entire world, our military operations will not stop unless the genocide crimes in Gaza stop and allow food, medicine, and fuel to enter its besieged population, no matter the sacrifices it costs us,” said Mohammed Al-Bukaiti, a member of the Ansar Allah political bureau, in a post on X

Here’s what you need to know about the Red Sea crisis.

1. Who are the Houthis and why are they attacking ships?

International observers have put the blame for the hijackings, missiles and drone attacks on Houthi rebels in Yemen, who have stepped up their attacks since the Israel-Hamas war started. The Shi’ite Islamist group is part of the so-called “axis of resistance” against Israel and is armed by Tehran. Almost certainly due to Iranian support with ballistics, the Houthis have directly targeted Israel since the beginning of the war, firing missiles and drones up the Red Sea toward the resort of Eilat.

The Houthis have been embroiled in Yemen’s long-running civil war and have been locked in combat with an intervention force in the country led by Sunni Saudi Arabia. The Houthis have claimed several major strikes against high-value energy installations in Saudi Arabia over the past years, but many international observers have identified some of their bigger claims as implausible, seeing the Houthis as a smokescreen for direct Iranian action against its arch enemy Riyadh.

After first firing drones and cruise missiles at Israel, the rebels are now targeting commercial vessels it deems linked to Israel. The Houthis have launched about 100 drone and ballistic missile attacks against 10 commercial vessels, the U.S. Department of Defense said on Tuesday

As a result, some of the world’s largest shipping companies, including Italian-Swiss MSC, Danish giant Maersk and France’s CMA CGM, were forced to reroute to avoid being targeted. BP also paused shipping through the Red Sea. 

2. Why is the Red Sea so important?

The Bab el-Mandeb (Gate of Lamentation) strait between Djibouti and Yemen where the Houthis have been attacking vessels marks the southern entrance to the Red Sea, which connects to the Suez Canal and is a crucial link between Europe and Asia. 

Estimate are that 12 to 15 percent passes of global trade takes this route, representing 30 percent of global container traffic. Some 7 percent to 10 percent of the world’s oil and 8 percent of liquefied natural gas are also shipped through the same waterway. 

Now that the strait is closed, “alternatives require additional cost, additional delay, and don’t sit with the integrated supply chain that already exists,” said Marco Forgione, director general with the Institute of Export and International Trade.

Diverting ships around Africa adds up to two weeks to journey times, creating additional cost and congestion at ports.

3. What is the West doing about it?

Over the weekend, the American destroyer USS Carney and U.K. destroyer HMS Diamond shot down over a dozen drones. Earlier this month, the French FREMM multi-mission frigate Languedoc also intercepted three drones, including with Aster 15 surface-to-air missiles. 

Now, Washington is seeking to lead an international operation to ramp up efforts against the Iran-backed group, under the umbrella of the Combined Maritime Forces and its Task Force 153. 

“It’s a reinsurance operation for commercial ships,” said Héloïse Fayet, a researcher at the French Institute for International Relations (IFRI), adding it’s still unclear whether the operation is about escorting commercial vessels or pooling air defense capabilities to fight against drones and ballistic missiles. 

4. Who is taking part?

On Tuesday, the U.K. announced HMS Diamond would be deployed as part of the U.S.-led operation.

After a video meeting between Austin and Italian Defense Minister Guido Crosetto, Italy also agreed to join and said it would deploy the Virginio Fasan frigate, a 144-meter military vessel equipped with Aster 30 and 15 long-range missiles. The ship was scheduled to begin patrolling the Red Sea as part of the European anti-piracy Atalanta operation by February but is now expected to transit the Suez Canal on December 24.

France didn’t explicitly say whether Paris was in or out, but French Armed Forces Minister Sébastien Lecornu told lawmakers on Tuesday that the U.S. initiative is “interesting” because it allows intelligence sharing.

“France already has a strong presence in the region,” he added, referring to the EU’s Atalanta and Agénor operations.  

However, Spain — despite being listed as a participant by Washington — said it will only take part if NATO or the EU decide to do so, and not “unilaterally,” according to El País, citing the government.

5. Who isn’t?

Lecornu insisted regional powers such as Saudi Arabia should be included in the coalition and said he would address the issue with his Saudi counterpart, Prince Khalid bin Salman Al Saud, in a meeting in Paris on Tuesday evening. 

According to Bradley Bowman, senior director of the Center on Military and Political Power at Washington’s Foundation for Defense of Democracies, a number of Middle Eastern allies appear reluctant to take part.

“Where’s Egypt? Where is Saudi Arabia? Where is the United Arab Emirates?” he asked, warning that via its Houthi allies Iran is seeking to divide the West and its regional allies and worsen tensions around the Israel-Hamas war.

China also has a base in Djibouti where it has warships, although it isn’t in the coalition.

6. What do the Red Sea attacks mean for global trade?

While a fully-fledged economic crisis is not on the horizon yet, what’s happening in the Red Sea could lead to price increases.

“The situation is concerning in every aspect — particularly in terms of energy, oil and gas,” said Fotios Katsoulas, lead tanker analyst at S&P Global Market Intelligence.

“Demand for [maritime] fuel is already expected to increase up to 5 percent,” he said, and “higher fuel prices, higher costs for shipping, higher insurance premiums” ultimately mean higher costs for consumers. “There are even vessels already in the Red Sea that are considering passing back through the Suez Canal to the Mediterranean, even if they’d have to pay half a million dollars to do so.”

John Stawpert, a senior manager at the International Chamber of Shipping, said that while “there will be an impact in terms of the price of commodities at your supermarket checkout” and there may be an impact on oil prices, “there is still shipping that is transiting the Red Sea.” 

This is not “a total disruption” comparable to the days-long blockage of the canal in 2021 by the Ever Given container ship, he argued. 

Forgione, however, said he was “concerned that we may end up with a de facto blockade of the Suez Canal, because the Houthi rebels have a very clear agenda.”

7. Why are drones so hard to fight?

The way the Houthis operate raises challenges for Western naval forces, as they’re fending off cheap drones with ultra-expensive equipment. 

Aster 15 surface-to-air missiles — the ones fired by the French Languedoc frigate — are estimated to cost more than €1 million each while Iran-made Shahed-type drones, likely used by the Houthis, cost barely $20,000. 

“When you kill a Shahed with an Aster, it’s really the Shahed that has killed the Aster,” France’s chief of defense staff, General Thierry Burkhard, said at a conference in Paris earlier this month. 

However, if the Shahed hits a commercial vessel or a warship, the cost would be a lot higher.

“The advantage of forming a coalition is that we can share the threats that could befall boats,” IFRI’s Fayet said. “There’s an awareness now that [the Houthis] are a real threat, and that they’re able to maintain the effort over time.”  

With reporting by Laura Kayali, Antonia Zimmermann, Gabriel Gavin, Tommaso Lecca, Joshua Posaner and Geoffrey Smith.



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The right to breathe: how policymakers can tackle severe asthma

Asthma impacts over 330 million people worldwide. While severe asthma makes up only 5-10 percent of cases, it is accountable for over half of asthma-related costs globally.[1] It profoundly affects patients’ lives, undermining their physical, mental and economic well-being, and increasing the risk of preventable deaths. Despite its significance, severe asthma is often overshadowed by other health priorities, leading to inadequate resource allocation and substandard care, further straining already pressured health systems.

Severe asthma outcomes, like many other chronic diseases, are deeply entangled with a wide range of environmental and socio-economic factors. Therefore, addressing it is not merely about medical intervention, but about creating and implementing comprehensive, holistic strategies.

The challenges presented by severe asthma are not beyond our capabilities. Around the globe, there is a wide range of best practices, treatments, and approaches to asthma management. Yet, the path to transformation demands a unified commitment from a broad set of stakeholders, from policymakers to medical professionals, industry, patients and beyond. While the blueprint for a future unburdened by severe asthma exists, it is up to decision-makers to realize it together.

While the blueprint for a future unburdened by severe asthma exists, it is up to decision-makers to realize it together.

And the good news is that progress is already underway. Since autumn 2022, we have collaborated as an international expert group to support the development of the Copenhagen Institute for Futures Studies’ (CIFS) Severe Asthma Index. This tool assesses how 29 OECD countries manage severe asthma across various indicators, such as national strategies, treatment access, hospitalizations, societal costs and air quality, among others.

While the Severe Asthma Index is an important stride in tackling severe asthma, the true test lies in how its insights are applied in practice. Among the many actions needed to be taken to improve severe asthma care, the most pressing concern is policy change.

We have identified three actions, derived from the work we have conducted to date, for policymakers to kickstart strengthening health systems’ approaches to and management of severe asthma:

  1. Development and implementation of national asthma plans and strategies

The Severe Asthma Index has found that less than half of the countries analyzed have a national strategy for asthma, prevention, and management. There is, therefore, a need to formulate and actively implement dedicated national asthma programs, tailored to the unique challenges of individual health systems. These programs should not only emphasize prevention, early detection and diagnosis but also adapt best practices to specific national and local contexts.

Importantly, plans should be situated in the context of long-term strategies for improving population health outcomes.

“In England, work around respiratory illness is gaining traction,” notes Sir David Behan, chair of Health Education England, NHS, and expert group member. “Part of the initiative being developed [is] to ease pressure on the emergency care pathways and hospitals.”  

All approaches should promote awareness on respiratory diseases, support personalized care plans, empower patients and improve training and opportunities for training health care professionals working in respiratory care.

2. Coordination and harmonization of policies and care guidelines

There is a patchwork of country approaches to severe asthma, illustrated by the observation that more than two-thirds of the country guidelines assessed in the Severe Asthma Index do not fully align with the Global Initiative for Asthma’s (GINA) guide for Difficult-to-treat and Severe Asthma in Adolescence And Adult Patients. Policymakers must strive to coordinate their approaches to severe asthma by harmonizing policies and guidelines for asthma care to the greatest possible extent, with the aim of reducing outcome disparities, bolstering equity and promoting health system sustainability.

In doing so, there should be an emphasis on identifying and scaling best practices, promoting cross-border collaboration, and championing holistic solutions informed by the widely-acclaimed Health in All Policies approach.

The Australian National Asthma Council’s Australian Asthma Handbook is a strong example of a best practice in this area that policymakers could draw inspiration from in acting on this point.

3. Supporting improved data collection and the development of a more robust evidence base for severe asthma

Policymakers should incentivize and ultimately mandate improved production, recording and utilization of asthma- and severe asthma-specific data, as well as identifier data such as prescription data, adherence to treatment regimes, lung function analysis and demographic and socioeconomic indicators, following a set of common standards.

Currently, despite the existence of clinical codes for severe asthma, the condition remains significantly underreported in clinical settings due in large part to inconsistent coding practices, leading to an increased probability of patients receiving inadequate care and suboptimal allocation of health system resources. The dearth of severe asthma data and barriers to accessing the few datasets that do exist render it difficult to develop a comprehensive and consistent understanding of the full impact of severe asthma.

National policymakers need to prioritize financial and logistical support for country-level asthma research. Research activities should aim to produce a solid evidence base that will offer a nuanced understanding of each country’s needs, challenges and opportunities regarding asthma care. Support for research activities granted over the long term will enable longitudinal studies so that national trends and progress can be accurately tracked.

Only 3 percent of the European Union’s budget for health [is] spent on lung health, although 13 percent of Europeans have lung disease.

“Only 3 percent of the European Union’s budget for health [is] spent on lung health, although 13 percent of Europeans have lung disease,” says Susanna Palkonen, director of the European Federation of Allergy & Airways Diseases Patients’ Associations (EFA) and expert group member.

The International Severe Asthma Registry (ISAR) initiative provides a strong basis for continued work in this area.

The path ahead requires that these actions evolve in tandem with the latest advancements in respiratory care and approaches to the management and prevention of noncommunicable diseases. This is not simply about updating and developing new policies — it’s about crafting robust and well-rounded solutions that proactively address a health challenge that is both global and local and supporting a much-needed vision for improved respiratory health outcomes.

As we look forward, we cannot just treat asthma. We must transform our approach to ensure that every patient’s right to breathe becomes a global reality.


Author(s):
Patrick Henry Gallen, senior advisor and futurist at Copenhagen Institute for Futures Studies

Bogi Eliasen, director of health at Copenhagen Institute for Futures Studies

Professor Dr. Vibeke Backer, MD, DMSci, chief respiratory physician at Department of ENT and Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark

Sir David Behan, chair Health Education England, National Health System (NHS), U.K.​

Dr. Mark Levy, board member, Global Initiative for Asthma (GINA), U.K.​

Mikaela Odemyr, chair European Lung Foundation (ELF) Patient Advisory Committee; chair Swedish Asthma and Allergy Association, Sweden

Susanna Palkonen, director, European Federation of Allergy and Airways Diseases Patients’ Associations (EFA)  

Professor Dr. Arzu Yorgancıoğlu, chair European Respiratory Society (ERS) Advocacy Council; member of Global Initiative on Asthma (GINA) Board; chair of GINA Dissemination and Implementation Committee; chair of the WHO GARD Executive Committee Turkey 


References:
[1] Al Efraij K, FitzGerald JM. Current and emerging treatments for severe asthma. J Thorac Dis 2015;7(11):E522-E525



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The state of the planet in 10 numbers

This article is part of the Road to COP special report, presented by SQM.

The COP28 climate summit comes at a critical moment for the planet. 

A summer that toppled heat records left a trail of disasters around the globe. The world may be just six years away from breaching the Paris Agreement’s temperature target of 1.5 degrees Celsius, setting the stage for much worse calamities to come. And governments are cutting their greenhouse gas pollution far too slowly to head off the problem — and haven’t coughed up the billions of dollars they promised to help poorer countries cope with the damage.

This year’s summit, which starts on Nov. 30 in Dubai, will conclude the first assessment of what countries have achieved since signing the Paris accord in 2015. 

The forgone conclusion: They’ve made some progress. But not enough. The real question is what they do in response.

To help understand the stakes, here’s a snapshot of the state of the planet — and global climate efforts — in 10 numbers. 

1.3 degrees Celsius

Global warming since the preindustrial era  

Human-caused greenhouse gas emissions have been driving global temperatures skyward since the 19th century, when the industrial revolution and the mass burning of fossil fuels began to affect the Earth’s climate. The world has already warmed by about 1.3 degrees Celsius, or 2.3 degrees Fahrenheit, and most of that warming has occurred since the 1970s. In the last 50 years, research suggests, global temperatures have risen at their fastest rate in at least 2,000 years.  

This past October concluded the Earth’s hottest 12-month span on record, a recent analysis found. And 2023 is virtually certain to be the hottest calendar year ever observed. It’s continuing a string of recent record-breakers — the world’s five hottest years on record have all occurred since 2015. 

Allowing warming to pass 2 degrees Celsius would tip the world into catastrophic changes, scientists have warned, including life-threatening heat extremes, worsening storms and wildfires, crop failures, accelerating sea level rise and existential threats to some coastal communities and small island nations. Eight years ago in Paris, nearly every nation on Earth agreed to strive to keep temperatures well below that threshold, and under a more ambitious 1.5-degree threshold if at all possible. 

But with just fractions of a degree to go, that target is swiftly approaching — and many experts say it’s already all but out of reach.

$4.3 trillion  

Global economic losses from climate disasters since 1970  

Climate-related disasters are worsening as temperatures rise. Heat waves are intensifying, tropical cyclones are strengthening, floods and droughts are growing more severe and wildfires are blazing bigger. Record-setting events struck all over the planet this year, a harbinger of new extremes to come. Scientists say such events will only accelerate as the world warms. 

Nearly 12,000 weather, climate and water-related disasters struck worldwide over the last five decades, the World Meteorological Organization reports. They’ve caused trillions of dollars in damage, and they’ve killed more than 2 million people.  

Ninety percent of these deaths have occurred in developing countries. Compared with wealthier nations, these countries have historically contributed little to the greenhouse gas emissions driving global warming – yet they disproportionately suffer the impacts of climate change.  

4.4 millimeters  

Annual rate of sea level rise

Global sea levels are rapidly rising as the ice sheets melt and the oceans warm and expand. Scientists estimate that they’re now rising by about 4.4 millimeters, or about 0.17 inches, each year – and that rate is accelerating, increasing by about 1 millimeter every decade.

Those sound like small numbers. They’re not.  

The world’s ice sheets and glaciers are losing a whopping 1.2 trillion tons of ice each year. Those losses are also speeding up, accelerating by at least 57 percent since the 1990s. Future sea level rise mainly depends on future ice melt, which depends on future greenhouse gas emissions. With extreme warming, global sea levels will likely rise as much as 3 feet by the end of this century, enough to swamp many coastal communities, threaten freshwater supplies and submerge some small island nations.  

Some places are more vulnerable than others. 

“Low-lying islands in the Pacific are on the frontlines of the fight against sea level rise,” said NASA sea level expert Benjamin Hamlington. “In the U.S., the Southeast and Gulf Coasts are experiencing some of the highest rates of sea level rise in the world and have very high future projections of sea level.”  

But in the long run, he added, “almost every coastline around the world is going to experience sea level rise and will feel impacts.”

Less than 6 years

When the world could breach the 1.5-degree threshold

The world is swiftly running out of time to meet its most ambitious international climate target: keeping global warming below 1.5 degrees Celsius. Humans can emit only another 250 billion metric tons of carbon dioxide and maintain at least even odds of meeting that goal, scientists say. 

That pollution threshold could arrive in as little as six years.

That’s the bottom line from at least two recent studies, one published in June and one in October. Humans are pouring about 40 billion tons of carbon dioxide into the atmosphere each year, with each ton eating into the margin of error.  

The size of that carbon buffer is smaller than previous estimates have suggested, indicating that time is running out even faster than expected.  

“While our research shows it is still physically possible for the world to remain below 1.5C, it’s difficult to see how that will stay the case for long,” said Robin Lamboll, a scientist at Imperial College London and lead author of the most recent study. “Unfortunately, net-zero dates for this target are rapidly approaching, without any sign that we are meeting them.”

43 percent 

How much greenhouse gas emissions must fall by 2030 to hit the temperature target

The world would have to undergo a stark transformation during this decade to have any hope of meeting the Paris Agreement’s ambitious 1.5-degree cap. 

In a nutshell, global greenhouse gas emissions have to fall 43 percent by 2030, and 60 percent by 2035, before reaching net-zero by mid-century, according to a U.N. report published in September on the progress the world has made since signing the Paris Agreement. That would give the world a 50 percent chance of limiting global warming to 1.5 degrees. 

But based on the climate pledges that countries have made to date, greenhouse gas emissions are likely to fall by just 2 percent this decade, according to a U.N. assessment published this month

Governments are “taking baby steps to avert the climate crisis,” U.N. climate chief Simon Stiell said in a statement this month. “This means COP28 must be a clear turning point.” 

$1 trillion a year 

Climate funding needs of developing countries

In many ways, U.N. climate summits are all about finance. Cutting industries’ carbon pollution, protecting communities from extreme weather, rebuilding after climate disasters — it all costs money. And developing countries, in particular, don’t have enough of it. 

As financing needs grow, pressure is mounting on richer nations such as the U.S. that have produced the bulk of planet-warming emissions to help developing countries cut their own pollution and adapt to a warmer world. They also face growing calls to pay for the destruction wrought by climate change, known as loss and damage in U.N.-speak. 

But the flow of money from rich to poor countries has slowed. In October, a pledging conference to replenish the U.N.’s Green Climate Fund raised only $9.3 billion, even less than the $10 billion that countries had promised last time. An overdue promise by developed countries to deliver $100 billion a year by 2020 to help developing countries reduce emissions and adapt to rising temperatures was “likely” met last year, the Organization for Economic Cooperation and Development said this month, while warning that adaptation finance had fallen by 14 percent in 2021. 

As a result, the gap between what developing countries need and how much money is flowing in their direction is growing. The OECD report said developing countries will need around $1 trillion a year for climate investments by 2025, “rising to roughly $2.4 trillion each year between 2026 and 2030.”

$7 trillion 

Worldwide fossil fuel subsidies in 2022

In stark contrast to the trickle of climate finance, fossil fuel subsidies have surged in recent years. In 2022, total spending on subsidies for oil, natural gas and coal reached a record $7 trillion, the International Monetary Fund said in August. That’s $2 trillion more than in 2020. 

Explicit subsidies — direct government support to reduce energy prices — more than doubled since 2020, to $1.3 trillion. But the majority of subsidies are implicit, representing the fact that governments don’t require fossil fuel companies to pay for the health and environmental damage that their products inflict on society. 

At the same time, countries continue pumping public and private money into fossil fuel production. This month, a U.N. report found that governments plan to produce more than twice the amount of fossil fuels in 2030 than would be consistent with the 1.5-degree target. 

66,000 square kilometers

Gross deforestation worldwide in 2022

At the COP26 climate summit two years ago in Glasgow, Scotland, nations committed to halting global deforestation by 2030. A total of 145 countries have signed the Glasgow Forest Declaration, representing more than 90 percent of global forest cover. 

Yet global action is still falling short of that target. The annual Forest Declaration Assessment, produced by a collection of research and civil society organizations, estimated that the world lost 66,000 square kilometers of forest last year, or about 25,000 square miles — a swath of territory slightly larger than West Virginia or Lithuania. Most of that loss came from tropical forests. 

Halting deforestation is a critical component of global climate action. The U.N.’s Intergovernmental Panel on Climate Change warns that collective contributions from agriculture, forestry and land use compose as much as 21 percent of global human-caused carbon emissions. Deforestation releases large volumes of carbon dioxide back into the atmosphere, and recent research suggests that carbon losses from tropical forests may have doubled since the early 2000s.  

Almost 1 billion tons

The annual carbon dioxide removal gap 

Given the world’s slow pace in reducing greenhouse gas pollution, scientists say a second approach is essential for slowing the Earth’s warming — removing carbon dioxide from the atmosphere.

The technology for doing this is largely untested at scale, and won’t be cheap.  

A landmark report on carbon dioxide removals led by the University of Oxford earlier this year found that keeping warming to 2 degrees Celsius or less would require countries to collectively remove an additional 0.96 billion tons of CO2-equivalent a year by 2030.

About 2 billion tons are now removed every year, but that is largely achieved through the natural absorption capacity of forests. 

Removing even more carbon will require countries to massively scale up carbon removal technologies, given the limited capacity of forests to absorb more carbon dioxide. 

Carbon removal technologies are in the spotlight at COP28, though some countries and companies want to use them to meet net-zero while continuing to burn fossil fuels. Scientists have been clear that carbon removal cannot be a substitute for steep emissions cuts. 

1,000 gigawatts 

Annual growth in renewable power capacity needed to keep 1.5 degrees in reach  

The shift from fossil fuels to renewables is underway, but the transition is still far too slow to meet the Paris Agreement targets. 

To keep 1.5 degrees within reach, the International Renewable Energy Agency estimates that the world needs to add 1,000 gigawatts in renewable energy capacity every year through 2030. By comparison, the United States’ entire utility-scale electricity-generation capacity was about 1,160 gigawatts last year, according to the Department of Energy.

Last year, countries added about 300 gigawatts, according to the agency’s latest World Energy Transitions Outlook published in June. 

That shortfall has prompted the EU and the climate summit’s host nation, the United Arab Emirates, to campaign for nations to sign up to a target to triple the world’s renewable capacity by 2030 at COP28, a goal also supported by the U.S. and China.

“The transition to clean energy is happening worldwide and it’s unstoppable,” International Energy Agency boss Fatih Birol said last month. “It’s not a question of ‘if’, it’s just a matter of ‘how soon’ – and the sooner the better for all of us.”

This article is part of the Road to COP special report, presented by SQM. The article is produced with full editorial independence by POLITICO reporters and editors. Learn more about editorial content presented by outside advertisers.



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Britain’s COVID-19 inquiry exposes the rot at the heart of Whitehall

LONDON — Everyone knew the British state had problems. This week revealed just how deep the rot goes.

Britain’s public inquiry into the handling of the COVID-19 pandemic stepped up a gear this week, with a procession of key witnesses taking the stand who were at the heart of the U.K. government in 2020.

The punchy oral testimony — and sweary WhatsApp messages — of Dominic Cummings, the former No. 10 Downing Street adviser turned arch enemy of Boris Johnson, grabbed all the headlines, as he attacked his old boss while struggling to account for his own crude and abusive language.

But it was Cummings’ long, incisive written statement to the inquiry, along with the testimony of a former top civil servant, Helen MacNamara, which contained the starkest home truths for the British state.

“I think we are absolutely fucked. I think the country is heading for a disaster. I think we are going to kill thousands,” MacNamara was revealed to have told colleagues in March 2020, as coronavirus began to grip the U.K.

Those words, from the-then second most powerful civil servant in the country, came as she and other senior officials abruptly realized the U.K. government had no real plan to deal with a global pandemic of that nature — despite years of confident reassurances to the contrary.

“I have just been talking to the [U.K. government] official Mark Sweeney, who is in charge of coordinating with the Department for Health,” MacNamara recalled saying. “He said — ‘I have been told for years that there is a whole plan for this. There is no plan.’ We are in huge trouble.”

What followed that dawning realization was an intense period of chaos, as ministers and officials grappled with never-before-considered questions such as whether to ban people from meeting their loved ones, and whether to place Britain into a strict lockdown.

Fingers are now being pointed at both individuals and wider systems for all that went wrong.

The blame game

Unsurprisingly, Britain’s ex-Prime Minister Boris Johnson has taken his fair share of criticism this week.

“It was the wrong crisis for this prime minister’s skillset,” Lee Cain, Johnson’s former director of communications, said in his evidence Tuesday. Others were less diplomatic — including Cain himself, in private WhatsApp messages handed to the inquiry by ex-colleagues.

In one such WhatsApp exchange, Cummings and Cain — old friends from the 2016 ‘Vote Leave’ campaign — detailed how they found Johnson “exhausting” to work with due to his lurches back and forth on key policy decisions.

“Pretty much everyone calls him ‘the trolley’,” Cummings told the inquiry, referring to a disparaging nickname he invented for Johnson due to the ex-PM’s inability to hold a clear line.

But beyond the Boris-bashing, Cummings and other ex-officials focused their ire on the broader state of Britain’s governing systems, rather than bungling individuals at its centre.

Cummings described the all-important Cabinet Office department — responsible for organizing the business of government and linking different departments together — as a “bombsite” and a “dumpster fire,” with a “huge problem of quality control … inconsistent data, inconsistent facts.”

This disorganization had consequences.

On March 16, 2020, Cummings said he received an email from a senior official warning that the Cabinet Office had yet to see any real plans for the pandemic from government departments — “never mind evaluated and fixed them,” he said. The virus had been in the U.K. for almost three months.

“[The Cabinet Office] cannot drive priorities or fix problems with departments,” Cummings wrote.

What became clear over the course of this week was that the British government was slow to take the virus seriously in early 2020 and even slower at figuring out a coherent and consistent plan to deal with it, jumping back and forth between early efforts aimed at pursuing herd immunity — until it became clear such an approach would be catastrophic.

“There are many signs that the way the Cabinet Office works was extremely ill-suited to this crisis,” Giles Wilkes, a former No. 10 adviser and senior fellow at the Institute for Government think tank, told POLITICO.

“It is very good for bringing together the people needed to avoid rows blowing up the government. In our system that is really valuable. But from [Cummings’] very compelling account, it was not brilliantly set up to be the body that focusses the PM and his power on a rapidly changing, dangerous situation,” Wilkes added.

‘Toxic’ culture

MacNamara, second in command in the Cabinet Office at the time, drew similarly damning conclusions.

She described how the British government “moved up the gears more slowly than the pace of the crisis,” and remained fixated on standard day-to-day government business as the pandemic began to rage.

She also lambasted the culture at the heart of government — arguing a “macho” and “toxic” environment fostered by a largely male leadership team hampered the broader response.

She said female experts were ignored, and senior women in government “looked over.” She pointed to a lack of consideration of childcare during school closures, and of the impact of lockdown restrictions upon victims of domestic violence, as examples of policy areas that suffered due to a lack of a “female perspective” inside government.

One result of that toxic environment saw MacNamara herself targeted by Cummings with misogynistic language in a WhatsApp message to a colleague revealed by the inquiry. She said she was “disappointed” Johnson didn’t do more to keep his top adviser in check.

Britain’s current top brass are pushing back, at least a little. Speaking Thursday, U.K. Science Secretary Michelle Donelan insisted she did not recognize MacNamara’s account of the culture inside government.

Coming attractions

Cummings has argued — including in multiple tweets since his evidence session ended — that observers should focus on his arguments about the broader failures of the system.

But it is the failings of one particular individual, Johnson, who was ultimately responsible for directing the government, which will continue to be scrutinized in the months ahead.

“If the PM at the heart of this is not a functional entity, cannot make a decision, has fundamentally poor judgment or lack of attention, then it doesn’t matter if the system around him is brilliant or rubbish. Things will go awry when they reach his desk,” Wilkes told POLITICO.

“The central role of the PM, and his rubbishness, cannot be evaded.”

Johnson’s former Health Secretary Matt Hancock has also come under intense fire this week, for his role in the lack of apparent planning for a pandemic, his handling of testing targets, and the crisis in British care homes as COVID-19 hit.

Both MacNamara and Cummings accused Hancock of telling falsehoods during the pandemic — or, in MacNamara’s case, she agreed he had a habit of “regularly telling people things that they later discovered weren’t true.”

Johnson’s successor-but-one as prime minister, Rishi Sunak — who was U.K. chancellor during the pandemic — also has questions to answer. He will likely face particular scrutiny for his now-infamous “eat out to help out” scheme — a government-sponsored discount to encourage diners back into restaurants in the summer of 2020 — which some medical experts believe helped spread the virus.

Conveniently enough, all three men — Johnson, Sunak and Hancock — are slated to appear before the inquiry in the same week at the end of November, two people with knowledge of the inquiry told POLITICO.

All of Westminster is holding its breath.



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Beyond forgetfulness: Why we must act on Alzheimer’s disease now

In the face of an increasingly aging population, today’s reality reveals a harsh truth: health systems in the EU and beyond are ill-equipped to provide early and timely diagnosis of Alzheimer’s disease and embrace innovative treatments that could help to preserve memory and, with it, independence.  

Recent advances suggest that timely intervention may hold the promise to slow the memory decline in Alzheimer’s disease, making early diagnosis more critical than ever before. Yet without the necessary health care infrastructure in place to diagnose and provide treatment, we risk missing the crucial early window and the opportunity to delay — and hopefully in the near future prevent — distressing symptoms for patients and heartbreaking experiences for families.  

The EU and its member countries have the opportunity to be remembered for leading in this space by increasing funding for research, improving health care infrastructure to support accurate diagnosis and timely intervention, and enhancing support services at a national and regional level. The forthcoming European Parliament elections in June 2024 are the ideal moments to make that pledge. For individuals, families and health care systems, Alzheimer’s disease is a ticking time bomb unless we invest in our future health today.  

The EU is not prepared for Alzheimer’s disease  

In Europe, approximately 7 million people are affected by Alzheimer’s disease, a number set to double to 14 million by 2050.1 On top of the physical and emotional distress this will cause, there are direct financial and social implications on families and communities, with Alzheimer’s costs expected to reach a staggering €250 billion by 20302 — bigger than the GDP of Portugal3 — placing an additional and substantial weight on global health care systems that are already struggling under cost and capacity burdens.4 

Timely diagnosis stands as a cornerstone in determining the appropriate treatment for patients.

That’s why MEP Deirdre Clune is leading the call for a European Parliament hearing to discuss a focused EU strategy on dementia and Alzheimer’s disease. “Timely diagnosis stands as a cornerstone in determining the appropriate treatment for patients,” argues Clune. “Therefore, the EU must create a strategic framework which lays out clear recommendations for national governments and recognises the toll of dementia and Alzheimer’s disease on societies across Europe, encourage innovation and take on board best practices to develop effective and efficient approaches. Together, with a unified approach and firm commitment, the EU can pave the way for better Alzheimer’s care.”

In the next EU political mandate, policymakers must answer the call by developing a comprehensive EU Beating Dementia Plan that specifically addresses the unique challenges posed by Alzheimer’s disease and building on established coordinated action plans for other significant health burdens, such as the EU Beating Cancer Plan. The European Brain Council and EFPIA’s, RETHINKING Alzheimer’s disease White Paper is a useful resource, calling for policymakers to rethink Alzheimer’s and offering policy recommendations to make tangible changes to improve the lives of people living with the disease.  

EU member countries must commit to investing in diagnostic infrastructure, technology and integrated care that can help to detect Alzheimer’s disease at an early stage and ensure timely intervention resulting in the preservation of memory and, thereof, independent living and normal social functioning.  

Laying the foundations at national level  

While action is certainly needed at the EU level, huge opportunity lies at the national and regional levels. Each member country has the chance to apply well-funded national dementia plans that tailor their strategies and responses to address the distinct needs of their populations, making a real and meaningful impact on the people and health systems in their country.  

Inspiration stems from Italy, which recently launched its Parliamentary Intergroup for Neuroscience and Alzheimer’s, dedicating its efforts to raising awareness, fostering discussions among national and regional institutions, promoting clinician and patient involvement, supporting novel research, implementing new diagnostic models, and strengthening patient access to care. 

Italian MP Annarita Patriarca, co-host of the Parliamentary Intergroup, affirms: “Primary responsibility of a member state is to ensure to all citizens the greatest standards of diagnosis and access to treatment and care. Thus, it is necessary to put in place a strong collaboration between the public and private sector to strengthen investments in neurological diseases. Improving patients’ diagnostic and care pathways, especially in a disease area like AD with such a high unmet medical need and societal impact will be the core focus of the intergroup.” 

Additionally, during the Alzheimer’s and Neuroscience Conference: a priority for the country in July, members of the Italian Parliament importantly put forward legislative and regulatory solutions to ensure an early and accurate diagnosis. 

Leading the conversation on the international stage   

Amid the growing burden of Alzheimer’s disease globally, this is a moment for policymakers to hold each other accountable. Member countries are uniquely placed to do this within the EU but also across the wider health care ecosystem, calling on countries and leaders to honor prior commitments that prioritized investment in relieving major health burdens, including Alzheimer’s.  

Encouragingly, the May G7 Hiroshima Leaders’ Communiqué specifically recognized and supported dementia as a freestanding issue, breaking away from the typical categorization with NCDs. Moreover, the G7 health ministers published a joint Communiqué spotlighting the priority to “enhance early detection, diagnosis and interventions, including developing care pathways and capability and capacity building of health and primary care providers by strengthening primary health care (PHC)”.  

These promising steps mean that Alzheimer’s disease is beginning to gain the recognition it deserves but also acts as a line in the sand to ensure complacency doesn’t creep in. Collectively, EU countries must assume a leading voice within the international fora, ensuring that Alzheimer’s disease remains a global health care priority and receives the investment it warrants. 

Time to commit to action in Alzheimer’s disease  

September marks World Alzheimer’s Month, and its theme Never Too Early, Never Too Late, reiterates the importance of early diagnosis. It presents a valuable foundation to initiate discussions on country- and regional-level strategies to drive and strengthen diagnostic infrastructure and services for the prevention, diagnosis, case management, monitoring and treatment of Alzheimer’s disease. 

Unless we act now, a generation of people will be forgotten as they begin to lose their memories.

“Unless we act now, a generation of people will be forgotten as they begin to lose their memories,” shares Frédéric Destrebecq, executive director of The European Brain Council. “By recognizing the urgency of the situation and making concerted investments, we can forge a path toward a more compassionate, empowered future for individuals, families and communities impacted by Alzheimer’s, and remember all those who’ve been lost to this devastating disease.”

It is never too early, never too late, to be remembered for taking action against this debilitating disease.  

References:  

1 – Jones RW, Mackell J, Berthet K, Knox S. Assessing attitudes and behaviours surrounding Alzheimer’s disease in Europe: key findings of the Important Perspectives on Alzheimer’s Care and Treatment (IMPACT) survey. The journal of nutrition, health & aging. 2010 Aug;14:525-30.  

2 – Cimler R, Maresova P, Kuhnova J, Kuca K. Predictions of Alzheimer’s disease treatment and care costs in European countries. PLoS One. 2019;14(1):e0210958. Published 2019 Jan 25. doi:10.1371/journal.pone.0210958 

3 – Published by Statista Research Department, 20 J. GDP of European countries 2022. Statista. June 20, 2023. Accessed August 1, 2023. https://www.statista.com/statistics/685925/gdp-of-european-countries/. 

4 – The Economist. Why health-care services are in chaos everywhere. Available at:  https://www.economist.com/finance-and-economics/2023/01/15/why-health-care-services-are-in-chaos-everywhere. Accessed: July 2023.  



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