The Ghost of Pandemics Future: Can India Stop The Rise of Superbugs?

Will Everything Be OK? : Ethnic Insurgency, Military Dictatorship and Mass Protest In Myanmar

On February 1st, 2021 the military of Myanmar, called the Tatmadaw, launched a coup against the democratically elected [https://www.bbc.com/news/world-asia-55882489]government of Aung San Suu Kyi on paper thin claims of massive voter fraud [https://www.bbc.com/news/55918746]. The people of Myanmar have decisively rejected the coup, with protests organizing almost immediately after the coup, with hundreds of thousands of people of all ethnicities [https://apnews.com/article/ethnic-minorities-protest-myanmar-coup-e750a4320dddc5955e5b7b760655f6e4]regularly [https://www.nbcnews.com/news/world/army-faces-crippling-mass-strike-hundreds-thousands-protest-myanmar-n1257914]gathering to demand the Tatmadaw return to the barracks. The military has cracked down, with at least 18 people [https://www.aljazeera.com/news/2021/2/28/one-reported-dead-many-hurt-as-myanmar-police-fire-at-protesters] killed by the armed forced on February 27th. The situation is rapidly changing on the ground, and todays podcast episode aims to give a historical background to Myanmar’s conflicts rather than an analysis of the current situation. I will discuss Myanmar’s long running ethnic conflict, the overwhelming force and power of the Tatmadaw, and the rise of a more liberal society in the last decade. Ethnic Insurgencies in Myanmar From [https://www.jstor.org/stable/20070309?seq=1]the late 17th century, the Konbaung Dynasty rapidly expanded a state based around the Irrawady delta and the Bamar people, forming the basis of the modern state of Myanmar. However, this state building project was interrupted by the British Empire, which in a series of wars conquered and absorbed Myanmar into the British Raj. The new state created by the British marginalized the once dominant Bamar majority, who make up roughly 62% [https://www.researchgate.net/publication/323889808_13_Public_perceptions_of_a_divided_Myanmar_Findings_from_the_2015_Myanmar_Asian_Barometer_Survey_War_Politics_Religion] of modern Myanmar’s population. Vast numbers [https://books.google.com/books?hl=en&lr=&id=nLq2BgAAQBAJ&oi=fnd&pg=PA109&dq=indians+chinese+burma&ots=4-i14ftupp&sig=pELPdLrPMDp1A9dDomOKalaM8H4#v=onepage&q=indians%20chinese%20burma&f=false] of Chinese and Indian immigrants flooded into Myanmar, with these minorities dominating the cities, business and government. Moreover, the armed forces were dominated [https://books.google.com/books?hl=en&lr=&id=g4bA3Oasvn4C&oi=fnd&pg=PR7&dq=tatmadaw+chin+karen+&ots=wxwkZWmjpY&sig=_8zceC_PG2y4H6jZe0lhreLLRsE#v=onepage&q=karen&f=false]by ethnic minorities such as the Chin, Kachin and especially the Karen. Unsurprisingly, the Japanese invasion of Myanmar during World War II was initially seen as an opportunity to end not just British imperialism, but an opportunity to assert the rights of the Bamar majority as well. Japanese brutality caused even the Bamar to revolt. As World War II ended, a pan-ethnic movement led by Aung San [https://pdfs.semanticscholar.org/a779/7535083eedbee863097c88461952918f85da.pdf], father of Aung San Suu Kyi and the founding father of Myanmar, took power and established a fragile democracy in the country. Myanmar broke into war almost immediately after independence. The Kuomitang invaded [https://muse.jhu.edu/article/256531/summary]Myanmar hoping to create a base of operation to retake China in the north of Myanmar, a communist insurgency calling for revolution emerged in the countryside, and the Karens attempted to violently carve out an independent state. The military, which became in increasingly Bamar institution after independence, launched a coup to restore order. However, the situation became only more violent after the coup, as other ethnic groups such as the Chin, Kachin and Shan joined the Karen in revolt. Armed groups [https://web.archive.org/web/20180312204620/http://mmpeacemonitor.org/stakeholders/stakeholders-overview/155-kio] with tens of thousands soldiers grabbed large swathes of territories in the mountaineous interior of the country. The armed forces responded [https://www.du.edu/korbel/hrhw/researchdigest/slavery/myanmar.pdf]with scorched earth tactics, making regular use of forced labor, destruction of villages, and civilian massacres [https://www.hrw.org/reports/2005/burma0605/3.htm]. While the Rohingya genocide is the best known abuse of human rights committed by the Tatmadaw, it was part of a broader pattern of extreme brutality. A complex political economy emerged in the border regions of Myanmar. From 1989 onwards, a new military regime took a more pragmatic approach to the insurgents. The government began signing truces with various insurgent groups, in order to concentrate its strength on others. Both [https://search.proquest.com/openview/794807944b7a869fa42ddb12e6ec69f5/1?pq-origsite=gscholar&cbl=1036373]the Tatmadaw and the ethnic insurgents engaged in illegal logging of teak, mining of jade. The Kokang and Wa states in the Shan State of Myanmar emerged as the most important source of heroin in the world in the 1980s. These same regions have become important hubs of the production of crystal meth, not just for Myanmar [https://www.crisisgroup.org/asia/south-east-asia/myanmar/299-fire-and-ice-conflict-and-drugs-myanmars-shan-state]but for the broader region of southeast Asia. Ethnic insurgencies continue to run in Myanmar. Since 2009 [https://www.economist.com/asia/2020/04/16/an-ethnic-militia-with-daring-tactics-is-humiliating-myanmars-army], the Arakan Army, representing the Buddhist majority in the Rakhine state where the Rohingya genocide occurred, has created an army of nearly 10,000 increasingly capable of taking the Tatmadaw head on. While many ethnic insurgents have been incorporated as semi-autonomous border guards [https://reliefweb.int/report/myanmar/myanmar-border-guard-force-plan-leads-end-ceasefire], it is unlikely ethnic insurgency will end any time soon. The Tatmadaw The Tatmadaw has been the dominant political and economic force in Myanmar since Ne Win’s military coup in 1962. The Tatmadaw imposed a xenophobic dictatorship cutting off contact with the outside world. The Tatmadaw expelled vast numbers of Indian and Chinese people, many of whom born and raised in the country and expropriated their businesses. Moroever, the Tatmadaw nationalized all private businesses, launching what they called the Burmese Way to Socialism [https://www.jstor.org/stable/3023620?read-now=1&refreqid=excelsior%3A73bc3b2edfdbe8349d03a56630834b3c&seq=7#page_scan_tab_contents]. However, the Tatmadaw did not have the capacity to manage Myanmar’s economy. Even as other nations in south east Asia such as Thailand, Indonesia and Malaysia saw spectacular economic growth, GDP per capita in Myanmar stagnated between 1962 and 1988. In 1988 [https://www.irrawaddy.com/specials/on-this-day/day-myanmar-experienced-socialist-eras-first-demonetization.html], the Tatmadaw’s mismanagement reached an extreme when the government invalidated almost all currency, wiping out the savings of millions, because the government wanted a currency divisible by nine for astrological reasons. A massive popular protest briefly unseated the Tatmadaw, but in 1989 the military reasserted its power. While the armed forces remained as brutal as ever, the Tatmadaw took a much more pragmatic approach to ethnic insurgents (as I discussed above) and the economy. From 1989, the military has allowed a partial liberalization, allowing economic growth the accelerate markedly from the early 1990s [https://www.google.com/search?sxsrf=ALeKk029-fh8twkB3fxMDgzRO1MaNhZn3w%3A1614751256420&source=hp&ei=GCY_YJa3F8yMwbkP0q6tkA4&iflsig=AINFCbYAAAAAYD80KCKVHaz25hqp_GwrEAqRNxPrWGVO&q=myanmar+gdp+growth&oq=myanmar+gdp+growth&gs_lcp=Cgdnd3Mtd2l6EAMyBAgjECcyAggAMgIIADICCAAyAggAMgIIADICCAAyAggAOgUIABCRAjoLCC4QsQMQxwEQowI6CAguEMcBEKMCOggIABCxAxCDAToECAAQQzoHCC4QsQMQQzoKCC4QhwIQsQMQFDoECC4QQzoFCAAQsQM6CAgAELEDEJECOgoIABCHAhCxAxAUUKcdWL8vYIQwaABwAHgAgAGgAYgB7g6SAQQ0LjEzmAEAoAEBqgEHZ3dzLXdpeg&sclient=gws-wiz&ved=0ahUKEwiWo6aYuZPvAhVMRjABHVJXC-IQ4dUDCAk&uact=5] onwards. The Tatmadaw has profited mightily from these trends. Two [http://210.148.106.166/library/English/Publish/Download/Brc/pdf/13_07.pdf]of Myanmar’s ten largest conglomerates are owned by the Tatmadaw, including UMEHL, one of the two largest conglomerates in the country. These military businesses benefit from preferential treatment, with military linked companies gaining access to protected teak forests and foreign companies forced to partner with military companies when investing in Myanmar. Even businesses [http://210.148.106.166/library/English/Publish/Download/Brc/pdf/13_07.pdf] not directly connected to the military require connections to the ruling Junta to thrive with two of Myanmar’s 10 largest conglomerates controlled by the sons of or married into elite military families. The Tatmadaw is so determined to stay in power in part because it wants to protect its control of private wealth, while at the same time the businesses the Tatmadaw controls gives it a level of independence from any civilian oversight. The Rise of a Fragile Liberalism During 8888 uprising in 1988, massive protests mobilizing millions [https://www.npr.org/2013/08/08/209919791/as-myanmar-opens-up-a-look-back-on-a-1988-uprising] were able to force long time dictator Ne Win from power. Aung San Suu Kyi emerged as a leader, and her National League for Democracy was able to win an overwhelming majority [https://www.jstor.org/stable/25798813] in 1990. Although the military rejected the 1990 election results with extreme brutality, it also lost interest in running Myanmar. The military did not want to be in charge of irrigation of the Irrawaday, or traffic in Yangon and from the 2000s onwards began a slow process [https://apps.dtic.mil/sti/pdfs/AD1045256.pdf] of letting an elected civilian government manage day to day governance, with the Tatmadaw controlling foreign affairs and security. The legitimacy of the Tatmadaw was further tarnished by a series of massive policy failures. In 2007, a government petrol price hike caused snowballs that protested into the Saffron Revolution [https://www.rfa.org/english/news/special/saffron/]. Supported by the powerful Burmese monkhood, mass protests were only put down with government repression. In 2008 Cyclone Nargis killed [https://www.theguardian.com/world/2009/feb/27/regime-blocked-aid-to-burma-cyclone-victims]over 140,000 people, but the Tatmadaw refused all international assistance. In 2011, massive protests forced the government to back down on the construction [https://www.reuters.com/article/us-myanmar-dam/myanmar-shelves-3-6-billion-mega-dam-officials-say-idUSTRE78T10H20110930]of a $3.6 billion China backed dam. The Tatmadaw felt pressured into transitioning [https://apps.dtic.mil/sti/pdfs/AD1045256.pdf]to a civilian government led by former generals in 2010, and genuine multiparty elections in 2015. Aung San Suu Kyi was released in 2010, and allowed to run in the 2015 elections. Her National League For Democracy [https://www.bbc.com/news/world-asia-33547036] again won an overwhelming victory, winning more than 80% of seats contestable. Myanmar’s democracy from the beginning was deeply flawed. Most importantly, Myanmar’s democratic leaders proved incapable of stopping the Rohingya genocide and actively defended [https://www.nytimes.com/2019/12/11/world/asia/aung-san-suu-kyi-rohingya-myanmar-genocide-hague.html]it in to the world. Moreover, Aung San Suu Kyi proved to be more than willing [https://www.aljazeera.com/news/2018/12/12/in-aung-san-suu-kyis-myanmar-free-press-hopes-wither]to imprison journalists and critics. Most importantly, the Tatmadaw controls a quarter [https://www.nytimes.com/2021/02/02/world/asia/myanmar-military-coup.html]of all seats in the legislature and there is no effective civilian control of the military. Despite the fragility of Myanmar’s liberalization, massive real change has occurred. Myanmar has consistently been one of the fastest growing economies in the world [https://www.imf.org/en/Publications/WEO], driven in particular by its ready made garment industry. Between 2019 and 2015 garment exports increased more than 6-fold from [https://www.trademap.org/]$900 million to $6 billion. Moreover, garments are largely by medium sized businesses either owned by international investors or local entrepreneurs with few ties to the big conglomerates. While still desperately poor by developed country standards, Yangon and Mandalay have seen rapid growth. Smartphones [https://www.marketwatch.com/story/the-world-is-watching-violent-events-unfold-in-myanmar-through-searing-smartphone-images-01615495392]and internet are becoming widespread, giving people access to information beyond government censorship. Conclusion After another overwhelming victory for Aung San Suu Kyi and the NLD, the NLD increasingly began discussing the structural limits to its power. The military responded with a coup based upon spurious [https://www.bbc.com/news/55918746]charges of vote rigging, charging Aaung San Suu Kyi with illegally owning walkie-talkies. While some ethnic minority leaders initially saw opportunity [https://asia.nikkei.com/Spotlight/Myanmar-Coup/Myanmar-military-woos-ethnic-minorities-after-coup]in the coup, the overwhelming majority [https://www.aljazeera.com/news/2021/2/20/myanmars-minorities-join-protest-in-show-of-unity-against-coup] of people of all ethnic groups are backing the protests. Millions of protestors have flooded the streets [https://anchor.hope.edu/campusandbeyond/myanmar-in-flux-millions-protest/], and strikes by civil servants and white collar professionals have given the pro-democracy real leverage. In particular, walkouts at the Myanmar Economic Bank has made it difficult for the government to pay civil servants. Nevertheless, the Tatmadaw has a long history of violence, and scores [https://www.france24.com/en/live-news/20210226-myanmar-s-civil-servant-strikes-start-to-bite] of protestors have already lost their lives. It is unclear what it will take to finally remove the Tatmadaw from power. Select Sources: The Fall of the Burmese Kingdom in 1885: Review and Reconsideration [https://www.jstor.org/stable/20070309?seq=1], Ernest C.T Chew Indian and Chinese Immigrant Communities: Comparative Perspectives [https://books.google.com/books?hl=en&lr=&id=nLq2BgAAQBAJ&oi=fnd&pg=PA109&dq=indians+chinese+burma&ots=4-i14ftupp&sig=pELPdLrPMDp1A9dDomOKalaM8H4#v=onepage&q=indians%20chinese%20burma&f=false], Renaud Egretau Building the Tatmadaw: Myanmar Armed Forces Since 1948 [https://books.google.com/books?hl=en&lr=&id=g4bA3Oasvn4C&oi=fnd&pg=PR7&dq=tatmadaw+chin+karen+&ots=wxwkZWmjpY&sig=_8zceC_PG2y4H6jZe0lhreLLRsE#v=onepage&q=karen&f=false], Mung Aung Myoe The idea of freedom in Burma and the political thought of DawAung SanSuu Kyi [https://www.jstor.org/stable/2760725] , J Silverstein Even paranoids have enemies: Cyclone Nargis andMyanmar’sfears ofinvasion [https://muse.jhu.edu/article/256531/summary], A Selth Under the Iron Thumb: Forced Labor in Myanmar [https://www.du.edu/korbel/hrhw/researchdigest/slavery/myanmar.pdf]. Anil Raj PROFILING NON-STATE ARMED INSURGENT GROUPS OF MYANMAR, [https://search.proquest.com/openview/794807944b7a869fa42ddb12e6ec69f5/1?pq-origsite=gscholar&cbl=1036373] Tripathi Anurag Overshadowed by kala India­‑Burma Relations [file:///D:/Downloads/2231-Article%20Text-2877-1-10-20201228.pdf], Michael Lubina “The Burmese Way to Socialism” [https://www.jstor.org/stable/3023620?read-now=1&refreqid=excelsior%3A73bc3b2edfdbe8349d03a56630834b3c&seq=7#page_scan_tab_contents] , Fred R Von Der Mehden Businessconglomeratesin the context ofMyanmar’seconomic reform [http://210.148.106.166/library/English/Publish/Download/Brc/pdf/13_07.pdf] , A Min, T Kudo The 1990 Elections in Myanmar: Broken Promises or a Failure of Communication? [https://www.jstor.org/stable/25798813?seq=1]Derek Tonkin Burma in Transition: On the Path to Democracy [https://apps.dtic.mil/sti/pdfs/AD1045256.pdf], David Faehnle Burma’s Military Blocks Constitutional Amendments [https://crsreports.congress.gov/product/pdf/IF/IF11481], Congressional Research Service

Winning the Vaccination Race: Chile’s Success in Mass Vaccination

In December of 2020, the first announcement [https://share.upmc.com/2021/01/vaccines-moderna-pfizer/]of effective vaccines developed by Moderna and Pfizer heralded the end of the COVID-19 pandemic. Since then, additional vaccines developed by AstraZeneca [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00528-6/fulltext], Johnson and Johnson [https://www.jnj.com/johnson-johnson-covid-19-vaccine-authorized-by-u-s-fda-for-emergency-usefirst-single-shot-vaccine-in-fight-against-global-pandemic], and by the Russian [https://www.businessinsider.com/russia-sputnik-vaccine-40-countries-west-hoards-shots-2021-3], Chinese [https://www.scmp.com/news/china/diplomacy/article/3124239/china-offers-covid-19-vaccine-foreign-diplomats-will-they-take]and Indian [https://www.nytimes.com/2021/03/04/world/asia/india-coronavirus-vaccine-covaxin.html]companies have showed effectiveness. Nations across the developed world have raced to vaccinate as many people as possible, with the United States currently vaccinating 2 million people a day. However, the process of vaccination has been much slower in developing countries. Only roughly 10% of all vaccinations have occurred in developung countries despite the fact the overwhelming majority of the world’s population lives in developing [https://covid19-projections.com/]countries. Rich nations [https://www.bbc.com/news/health-55229894#:~:text=Rich%20countries%20are%20hoarding%20doses,vaccinate%20one%20in%2010%20people.] have crowded out developing countries with advanced purchases for three times as many people as their populations, while many of the most effective vaccinations have extensive vaccination requirements beyond the capacity of many underdeveloped nations. Currently [https://ourworldindata.org/covid-vaccinations], Brazil has given 5 vaccinations per 100 people, China 3 vaccinations per 100 people, Russia 3 vaccinations per 100 people and Mexico only 1 vaccination per 100 people. While most developing countries have struggled with vaccinations, Chile has been an exception to this general rule. So far [https://ourworldindata.org/covid-vaccinations], Chile has administered 23 vaccinations per 100 people, more than all but a handful of developed nations. Chile moved fast to acquire access to vaccines early on, with over 36 million [https://www.cnbc.com/video/2020/12/24/chile-has-secured-over-36-million-covid-vaccine-doses-vice-minister.html] doses of vaccines purchased by December of 2020, with overall government spending on vaccine procurement likely to exceed $300 million [https://www.theguardian.com/global-development/2021/feb/28/chile-covid-inoculations-vaccines-strategy]. The government of Chile has been willing to purchase vaccines from anyone selling vaccines, making large purchases [https://www.reuters.com/article/health-coronavirus-chile-vaccine/chile-says-in-talks-with-russia-to-acquire-sputnik-v-vaccine-idUSL1N2KF1MB] of Sputnik and Chinese vaccines that have been scorned by developed countries. Chile’s efforts to purchase efforts likely benefitted from the fact that Chile is the only major source for Chilean soapbark [https://www.theatlantic.com/science/archive/2020/10/single-tree-species-may-hold-key-coronavirus-vaccine/616792/] , an adjuvant or ingredient that strengthens the body’s immune response. Chile has also been ambitious in vaccinating people as fast as possible. The government of Chile has repurposed cold storage [https://salmonbusiness.com/cold-storage-business-used-by-salmon-companies-chosen-by-government-to-store-covid-19-vaccines/] for it salmon industry for Moderna and Pfizer vaccines. The government created databases [https://www.economist.com/the-americas/2021/03/06/vaccination-is-going-well-in-chile-why-not-its-neighbours]to keep better track of vaccine needs. The government has turned [https://kslnewsradio.com/1943491/how-chile-became-a-leader-in-covid-19-vaccination/]every public place into vaccination sites, with shopping malls and football stadiums. Between February 2nd and March 4th, the number of Chileans vaccinated [https://ourworldindata.org/covid-vaccinations]increased from 80,000 to 4.3 million people. Chile’s vaccination success is especially notable given that 21,000 Chileans have died from COVID-19, with one of the highest mortality rates from COVID-19 in the world. As global vaccination production soars, hopefully other countries will be able to replicate Chile’s success in vaccinating its people, bringing the COVID-19 pandemic to a close throughout the world.

More Lows Than Highs: The Fight Against Drugs in China, Mexico and the Philippines

Before the COVID-19 pandemic, the most dangerous [https://www.cdc.gov/grand-rounds/pp/2011/20110217-drug-overdoses.html] public health threat faced by the United States was the spectacular rise of drug overdoses in recent decades. Between 1999 and 2019 the number of drug overdoses has increased [https://www.drugabuse.gov/sites/default/files/images/ODR2020Slide1.jpeg]from 19,000 to 77,000. While the early days of the drug overdose epidemic was driven by the unethical prescription and abuse of prescription drugs, in recent years overdose deaths are driven by synthetic opiates. Between 2013 and 2019, the number of overdoses from synthetic opiates from 2,000 to 38,000 [https://www.drugabuse.gov/sites/default/files/images/ODR2020Slide2.jpeg]. Although coverage of the drug overdose crisis in the United States focuses overwhelmingly on its domestic causes and effects, the drug crisis has both international causes and consequences. In today’s podcast episode I will be discussing the role China plays in the manufacture of fentanyl and other synthetic opiates, the damage the trafficking of fentanyl is having upon Mexico, and effects of the drug war unleased by the Philippines Rodrigo Duterte to reduce consumption of narcotics in his country. The New Opium Wars In 1839 and 1856, a coalition of European armies went to war [https://www.britannica.com/topic/Opium-Wars]against the Qing Empire to force the Chinese government to allow the trade of opium. The Opium Wars are one of the defining injustices that fuel modern Chinese nationalism, and so it is highly ironic that China has emerged as the modern center for the production of deadly drugs. It is unclear to say to what extent fentanyl in the United States comes from China, but the DEA estimates the overwhelming majority of synthetic opiates entering the United States come from China. The Chinese drug industry has its origins in China’s massive chemical and drug industry. China is the largest [https://www.uscc.gov/sites/default/files/2019-11/Chapter%203%20Section%203%20-%20Growing%20U.S.%20Reliance%20on%20China%E2%80%99s%20Biotech%20and%20Pharmaceutical%20Products.pdf]maker of APIs, active pharmaceutical ingredients, in the world with 40% of global chemical revenue coming from China. Indeed, the Chinese government has heavily subsidized this industry, offering [https://www.uscc.gov/sites/default/files/2019-11/Chapter%203%20Section%203%20-%20Growing%20U.S.%20Reliance%20on%20China%E2%80%99s%20Biotech%20and%20Pharmaceutical%20Products.pdf]a plethora subsidies to chemical and pharmaceutical industries including duty exemptions, VAT rebates and subsidized land with the government investing about $30 billion [https://www.uscc.gov/sites/default/files/2019-11/Chapter%203%20Section%203%20-%20Growing%20U.S.%20Reliance%20on%20China%E2%80%99s%20Biotech%20and%20Pharmaceutical%20Products.pdf] per year in these industries. While reasonable as part of a development strategy, they also helped fuel the current fentanyl crisis as subsidies were extended to firms for the production of NPP and 4-ANPP, the primary precursors compounds for fentanyl. Yuancheng, a Wuhan based chemical companies, has long dominated [https://www.theatlantic.com/health/archive/2019/08/chinese-company-helping-fuel-opioid-epidemic/596254/] not just the Chinese, but the global markets for the production of fentanyl precursors. One channel by which fentanyl arrives in the United States is through large numbers of small labs based in China. Yuancheng sells fentanyl precursor to these labs, many of which until recently operated almost entirely in the open. After the Chinese government first banned [https://www.cnn.com/2017/02/16/health/fentanyl-china-ban-opioids/index.html] many fentanyl products in 2015, many small labs simply tweaked the formula of new fentanyl products to remain legal, or went semi-underground. US consumers and small scale drug dealers could then easily purchase fentanyl through the darkweb [https://www.justice.gov/usao-sdny/pr/prolific-dark-web-dealer-carfentanil-and-fentanyl-sentenced-17-years-prison]. Fentanyl production and trafficking could occur semi-openly because for a long time the Chinese government put little emphasis on enforcement because synthetic opiates are rarely consumed [https://www.brookings.edu/research/fentanyl-and-geopolitics-controlling-opioid-supply-from-china/] in China. However, China has come under pressure from both the Obama and Trump administrations to clamp down on fentanyl. The Chinese government passed major restrictions of fentanyl production in 2015 and 2017. In March of 2019, China passed a landmark [https://www.brookings.edu/research/fentanyl-and-geopolitics-controlling-opioid-supply-from-china/]law that allowed the government to ban fentanyl and all tweaked analogues, as well as almost all precursors that could be used to make fentanyl. Moreover, the government has dramatically increased screening of parcels leaving China, and has shut down hundreds of fentanyl lab over the last year. It is difficult to say to what extent these measures have been successful [https://www.brookings.edu/research/fentanyl-and-geopolitics-controlling-opioid-supply-from-china/]. For example, some potential fentanyl precursors have not been banned because they have potential dual uses. Moreover, those fentanyl labs not caught by the state have been able to use complex mail forwarding systems to obscure precisely where fentanyl analogues are coming from. Moreover, geopolitical conflict [https://www.brookings.edu/research/fentanyl-and-geopolitics-controlling-opioid-supply-from-china/] with the US will make it difficult for American DEA to develop the close cooperative relationship with their Chinese counterparts. Chinese fentanyl labs have already developed [https://www.npr.org/2020/11/17/916890880/we-are-shipping-to-the-u-s-china-s-fentanyl-sellers-find-new-routes-to-drug-user]complex mail forwarding systems to obscure the origin of narcotics. Finally, production fentanyl precursors are increasingly moving to other weakly governed developing drug markets such as India. India has long been the primary manufacturing base for illegal tramadol [https://www.economist.com/the-economist-explains/2018/08/23/west-africas-opioid-crisis], another opiate heavily consumed in the Middle east and Africa, and DEA agents have caught Mexican drug cartels purchasing fentanyl from India. Increasingly, fentanyl precursors are smuggled to third markets such as Mexico, and processed into usable narcotics outside of China. Fentanyl Fuels Cartel Wars in Mexico Mexico has long struggled with drug related violent crime. Between [https://www.macrotrends.net/countries/MEX/mexico/murder-homicide-rate]2007 and 2011 the homicide rate soared 8 per 100,000 to 24 per 100,000 driven by American demand for narcotics. However, between 2011 and 2014 Mexico appeared to be getting its violent crime problem under control [https://americasquarterly.org/fulltextarticle/yes-violence-and-murder-are-decreasing-in-mexico/#:~:text=According%20to%20Mexico's%20Insituto%20Nacional,deaths%20have%20decreased%20even%20faster.]. Chapo Guzman was finally caught by Mexican authorities. The Zetas, Mexico’s most viciously violent cartel, was defeated by the state and less murderous crime groups. In Michoacan, the state and local vigilante groups, not only defeated the largest cartels but allowed a certain measure of the rule of law to be enforced. Between 2011 and 2014 [https://www.statista.com/statistics/714113/mexico-homicide-rate/] the homicide rate fell from 24 per 100,000 to 17 per 100,000. However, the rise of fentanyl has erased this progress. From 2014 to 2019 [https://www.macrotrends.net/countries/MEX/mexico/murder-homicide-rate], Mexico’s homicide rate increased from 14 per 100,000 to 29 per 100,000, a homicide rate five times that of the United States. The primary points [https://www.wilsoncenter.org/sites/default/files/media/documents/publication/fentanyl_insight_crime_final_19-02-11.pdf] of entry for fentanyl into Mexico are the Pacific ports of Manzanillo and Lazaro Cardenas. Fentanyl precursors, smuggled in the shipping holds of ships, are then transported to small labs that process precursors into drugs and pressed into pills. Fentanyl is then trafficked northwards to the United States. Although many smaller criminal organizations are involved in this process, with many small groups specializing in specific aspects of this process, two cartels dominate the narco industry in China. The Sinaloa Cartel and the Jalisco New Generation have emerged as the largest cartels. Both cartels are based along the western coast of Mexico, and a map of narco dominance would show a checkerboard [https://www.gob.mx/hacienda]pattern across the west of Mexico. Control of transportation routes has been fierce. While the port of Lazaro Cardenas is firmly under the control of the Jalisco New Generation Cartel, and does not have an unusually high homicide rate. However, Manzanillo lies in contested land, and as a result has a homicide rate of over 200 [https://mexiconewsdaily.com/news/cargos-down-homicides-up-in-five-pacific-coast-ports/#:~:text=There%20were%20117%20homicides%20in,the%20same%20period%20of%202019.] per 100,000 making it one of the most violent places in the world and Colima, the state Manzanillo is located in, is the most dangerous [https://insightcrime.org/news/analysis/colima-mexico-homicides-cartels/] in Mexico. Today fierce battles over control of highways and border posts from where drugs are exported and guns imported have fueled unprecedented violence. While the government of Mexico has had some success in capturing the leadership of the most powerful cartels, the result has been organized crimes splintering into ever smaller groups. Moreover, these smaller cartels, locked out of the most lucrative segments of the drug trade are increasingly turning to illegal mining, extortion and oil theft. Organized crime is embedding itself deeper into Mexican society, making its eventual eradication more difficult. Phillipines Drug War Drug consumption, just as much as its production and trafficking is a problem in developing countries. The primary drug consumed in the Phillipines [https://alcoholrehab.com/drug-addiction/effects/crystal-meth-in-the-philippines-shabu/]is crystal meth, known as shabu, with precursors originating [http://www.reuters.com/investigates/special-report/philippines-drugs-china/]in China. Although overall levels of drug consumption are not unusual by global standards, with 1.1% of Fillipinos reporting [https://wdr.unodc.org/wdr2020/]using illicit substances in 2016. However, a moral panic emerged among Filipino people about drug use. Rodrigo Duterte in his successful 2016 bid to become the president of the Philippines promising to use extreme force to destroy drug abuse. From January of 2016, Filipino police were given a license to kill suspected of using or dealing drugs. Local officials drew up lists of suspected drug users and dealers whom police were authorized to kill. Rordigo Duterte himself had long been affiliated with the Davao Death Squad, a vigilante death squad in the city of Davao where he was long mayor. Moreover, the government incentivized murder by paying bounties [https://www.amnesty.org.uk/philippines-president-duterte-war-on-drugs-thousands-killed]to vigilante groups [https://www.reuters.com/article/us-philippines-duterte-police-specialrep/special-report-police-describe-kill-rewards-staged-crime-scenes-in-dutertes-drug-war-idUSKBN17K1F4] for killing suspected drug users and dealers. The result was a cataclysm of death, with the Philippines Council on Human Rights estimating 27,000 killed in the drug war. It is difficult to say to what extent the drug war has been successful. One one hand, Rodrigo Duterte remains overwhelmingly popular, with 82% [https://www.reuters.com/article/us-philippines-drugs/filipinos-give-thumbs-up-to-dutertes-excellent-drugs-war-poll-idUSKBN1W803M] of Filipinos supporting the drug war. However, only an estimated [https://www.scmp.com/week-asia/politics/article/3044894/dutertes-3-year-drug-war-has-seized-just-1-cent-philippines]1% of crystal meth has been interdicted by the police, and the price of Shabu has fallen [https://www.reuters.com/article/us-philippines-drugs-performance-exclusi/exclusive-shock-and-awe-has-failed-in-philippines-drug-war-enforcement-chief-says-idUSKBN2010IL]from $164 per ounce to $132 per ounce suggesting the drug war has had limited effect on the flow of drugs into the Philippines. Indeed, many of the drug warriors have turned into criminals themselves, with innocent bystanders and the victims of score settling regularly losing their lives. The Kuratong Baleleng, once [https://www.philstar.com/headlines/2020/12/01/2060750/duterte-warns-cops-reviving-kuratong-baleleng-you-dont-stand-chance-vs-govt]one of the Phillipines largest cartels, had its links in anti-Communist vigilante [https://www.esquiremag.ph/long-reads/features/kuratong-baleleng-parojinog-a1729-20180918-lfrm3]groups. At least one former head of national police has been indicted on reselling [https://www.aljazeera.com/news/2019/10/14/dutertes-top-police-chief-resigns-amid-drug-allegations]confiscated drugs to cartels. The manifest failures of the drug war has resulted in the government quietly shifting away from such poliies Selected Sources: 2018 National Drug Threat Assessment [https://www.dea.gov/sites/default/files/2018-11/DIR-032-18%202018%20NDTA%20final%20low%20resolution.pdf], Drug Enforcement Administration SECTION 3: GROWING U.S. RELIANCE ON CHINA’S BIOTECH AND PHARMACEUTICAL PRODUCTS [https://www.uscc.gov/sites/default/files/2019-11/Chapter%203%20Section%203%20-%20Growing%20U.S.%20Reliance%20on%20China%E2%80%99s%20Biotech%20and%20Pharmaceutical%20Products.pdf], US China Economic and Security Review Commission Fentanyl, Inc.: How Rogue Chemists Are Creating the Deadliest Wave of the Opioid Epidemic [https://www.amazon.com/dp/B07QP962CK/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1], Ben Westhoff Fentanyl and geopolitics: Controlling opioid supply from China [https://www.brookings.edu/research/fentanyl-and-geopolitics-controlling-opioid-supply-from-china/], Vanda Felbab-Brown Mexico’s Role in the Deadly Rise of Fentanyl [https://www.wilsoncenter.org/sites/default/files/media/documents/publication/fentanyl_insight_crime_final_19-02-11.pdf], Steven Dudley, Tristan Klavel, Deborah Bonello DRUG WAR STORIES AND THE PHILIPPINE PRESIDENT [https://www.researchgate.net/profile/Dan_Jerome_Barrera2/publication/317773993_Drug_War_Stories_and_the_Philippine_President/links/59fc0ed7a6fdcca1f29316f1/Drug-War-Stories-and-the-Philippine-President.pdf], Dan Jerrome Barrera

Closing The Shop Down: The Dispiriting End of Operation Car Wash in Brazil

On March 17th 2014, Sergio Moro, a little known [https://www.washingtonpost.com/world/the_americas/brazils-new-hero-is-a-nerdy-judge-who-is-tough-on-official-corruption/2015/12/23/54287604-7bf1-11e5-bfb6-65300a5ff562_story.html] judge from the Brazilian state of Curitiba, authorized an investigation of suspicious money transfers at a gas station. The resulting investigation, known as Operation Car Wash or Lava Jato, uncovered a web of corruption that shook Brazilian society to its core. The largest construction companies in Brazil had created a cartel to bribe senior administrators in Petrobras, the state oil company, to overcharge [https://www.nytimes.com/2015/08/09/business/international/effects-of-petrobras-scandal-leave-brazilians-lamenting-a-lost-dream.html]for constructions and oil services. Conservative estimates [https://www.wsj.com/articles/brazils-petrobras-reports-nearly-17-billion-impairment-on-assets-corruption-1429744336] show at least $2 billion in bribes and $17 billion worth of losses in overinflated assets. Three former [https://en.mercopress.com/2018/11/28/three-out-of-five-living-ex-brazilian-presidents-defendants-in-corruption-cases]presidents of Brazil, a third [https://www.cbsnews.com/news/brazil-operation-car-wash-involves-billions-in-bribes-scores-of-politicians/]of the cabinet and 90 members of the legislature, and Brazil’s wealthiest man [https://www.nytimes.com/2018/07/03/world/americas/brazil-tycoon-eike-batista-sentenced.html] were either accused or convicted of wrong doing in the resulting scandal. The corruption scandal spread outside of Brazil, roiling politics across Latin America, with scandal bringing down presidents and powerful politicians in Peru [https://nyujlpp.org/quorum/operation-car-wash-and-its-impact-in-peru/], Mexico [https://www.occrp.org/en/component/tags/tag/operation-car-wash]and other nations. While many hoped Operation Car Wash augured the beginning of creating a set of institutions that could fight corruption, the reform efforts were stymied at every corner. Although the government passed some important campaign finance [https://www.reuters.com/article/us-brazil-politics-reform/brazils-congress-sets-up-fund-to-cover-lack-of-campaign-finance-idUSKBN1CA04U] reforms, the political class was able to undermine anti-corruption efforts. Dilma Rousseuf, the left wing President of Brazil, was impeached on dubious [https://www.theguardian.com/news/2016/aug/31/dilma-rousseff-impeachment-brazil-what-you-need-to-know]grounds despite their being no direct link between her and Operation Car Wash. The next president of Brazil, Michel Temer, was an exemplar of a corrupt political class and moved to block [https://theintercept.com/2017/08/03/brazils-corrupt-congress-protects-its-bribe-drenched-president-finalizing-elites-two-year-plot/]corruption investigations of centrist and right wing politicians. Lula, once the most popular [https://www.newsweek.com/brazils-lula-most-popular-politician-earth-79355] politician in the world, was convicted of corruption in a trial considered by many to be politically motivated [https://www.nytimes.com/2017/07/12/world/americas/brazil-lula-da-silva-corruption.html]. By the 2018 elections, the Brazilian electorate had become cynical of the entirety of the political class, and instead voted in a crude, racist, sexist populist [https://www.aljazeera.com/news/2019/1/1/who-is-jair-bolsonaro-brazils-new-far-right-president]outsider Jair Bolsonaro to president in 2018. Bolsonaro’s appointment of Sergio Moro was interpreted by some as a sign [https://www.economist.com/the-americas/2020/04/30/jair-bolsonaros-dangerous-divorce]that he retained a commitment to drain Brazil’s swamp. However, it is clear Bolsonaro had limited interest in fighting corruption. One of his sons, Flavio Bolsonaro [https://www.nytimes.com/2019/01/24/world/americas/jair-bolsonaro-davos.html], has been accused of accepting bribes and funneling money to right wing vigilante groups. Sergio Moro resigned from his position as Minister of Justice after the president blocked attempts to prosecute another son of Jair Bolsonaro on charges of corruption. The COVID-19 crisis further put the fight against corruption on the backburner. Over 250,000 [https://www.worldometers.info/coronavirus/] Brazilians have lost their lives, and new variants have resulted in Brazil [https://www.worldometers.info/coronavirus/]suffering a second wave even as cases and deaths collapse in the rest of the world. In all this tumult, Operation Car Wash was quietly cancelled [https://brazilian.report/power/2021/02/06/the-acrimonious-end-of-brazil-operation-car-wash/] in February of 2021. The fight against corruption in Brazil ended not with a bang, but with a whimper.

The Ghost of Pandemics Future: Can India Stop The Rise of Superbugs?

Before the start of the COVID-19 pandemic, the global health crisis that kept the most public health experts up at night was the rise of antimicrobial resistant (AMR) microbes. According to the World Health Organization, 700,000 [https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf] people lose their lives to multi-drug resistant microbes a year. If no steps are taken to control the growth of AMR microbes, 10 million people a year could die from AMR microbes, more than times the number of people killed by COVID-19. Basic medical procedures we take for granted, such as knee surgeries, would start carrying the risk of deadly sepsis. Today the superbug crisis is most visible in the developing world [https://www.thenews.com.pk/print/444010-pakistan-among-countries-with-highest-levels-of-antimicrobial-resistance-study], where high levels of infectious disease spread and systematic misuse of medication is highest. According to the CDDEP, India has one of the highest rates [http://Global Trends in Antimicrobial Resistance in Animals in Low- and Middle-Income Countries] of antimicrobial resistance in the world. My own grandfather lost his life to a hospital acquired antibiotic resistant drug last year. Today 60,000 children [https://www.downtoearth.org.in/blog/health/what-should-india-do-to-control-antimicrobial-resistance-74267#:~:text=The%20containment%20of%20antimicrobial%20resistance,resistant%20to%20first%20line%20antibiotics.] die of AMR sepsis every year, and it is estimated deaths from AMR microbes will increase to 2 million a year by 2050. Today’s podcast episode will explore why AMR microbes have become such a huge problem in India, some of the consequences of the rise of AMR, and the steps taken by the Indian government to bring AMR microbes under control. The Rise of Superbugs in India One of the major advantages bacteria have against humans in our fight to control them is the speed at which they replicate. Many bacteria can double their population in under 20 minutes under ideal conditions [https://vlab.amrita.edu/?sub=3&brch=73&sim=1105&cnt=1#:~:text=The%20time%20taken%20by%20the,aureus%20it%20is%2030%20minutes.]. As a result, bacteria rapidly evolve defense mechanisms against whatever medications we develop to combat them. The first effective antibiotics, sulfamides, were discovered in 1937. The first cases of antibiotic resistance [https://mmbr.asm.org/content/74/3/417] emerged in just two years. We have since then been locked in a cycle of discovering new drugs, and the effectiveness of these drugs reduced by antimicrobial resistance since then. The risk of bacteria gaining resistance increases if an antibiotic course is not completed, or if bacteria face trace amounts of antibiotics in the environment. Bacteria that face antibiotics have evolutionary pressure to gain defenses against antibiotics, and the more often bacteria face antibiotics but are not killed by them, the graeter the chances of resisistance arising. One of the major forces making AMR bacteria such a major problem in developing countries such as India is poor prescribing habits. From anecdotal experience, many doctors in India have only a limited understanding of the risks of over-prescribing antibiotics. Moreover, India today has [https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?most_recent_value_desc=true] only.9 physicians per 100,00 people, only one third the physicians per capita as the United States, with the shortage [https://scroll.in/article/970941/interview-shortage-of-doctors-in-rural-india-will-hamper-effective-response-to-covid-19-pandemic#:~:text=More%20than%2060%25%20of%20India's,health%20centres%20in%20rural%20areas.]far more severe in rural areas. As a result, pharmacists are the first medical providers many Indians go to, to receive medical treatment. However, three quarters of pharmacists have no training. Most engage in practices such as offering antibiotics as a prophylactic during the winter, prescribing antibiotics for common colds where they are unlikely to be useful, or only giving partial courses of antibiotics to save poor sick people money. Antibiotic misuse expands beyond human use of antibiotics. India has one of the world’s largest herds of livestock in the world. India has a total cattle inventory of over 300 million cows, with large numbers of chicken, pigs and other animals. Antibiotics are often used [https://www.who.int/news/item/07-11-2017-stop-using-antibiotics-in-healthy-animals-to-prevent-the-spread-of-antibiotic-resistance] liberally to treat animal diseases, with many receiving antibiotics as prophylactics or to accelerate growth. Currently about 70% [https://www.cidrap.umn.edu/news-perspective/2016/12/fda-antibiotic-use-food-animals-continues-rise#:~:text=Approximately%2070%25%20of%20all%20medically,96%25%20from%202009%20to%202015.]of all antibiotics are used on animals in the US with the share rising every year, with similar numbers in other countries with industrialized agriculture systems. Agriculture in India is less industrialized, and only three percent [https://cddep.org/wp-content/uploads/2017/06/india_abx_report-2.pdf] of antibiotics used globally on livestock are used in India. However, antibiotic use in farming is growing rapidly, with antibiotic use expected [https://cddep.org/wp-content/uploads/2017/06/india_abx_report-2.pdf]to more than double over the next decade. Between 2000 and 2018 the percent of chickens showing antibiotic resistance increased [https://thewire.in/health/drug-resistance-in-farm-animals-threatens-human-health-in-india]from 15% to 41%, with over 70% of chicken showing resistance to most antibiotics in Northeast India. It is likely that many bacteria in animals that resistant to antibiotics will have the same effect in humans as well. Finally, India has a massive and rapidly growing [https://wealthofnationspodcast.com/cheap-fast-and-good-enough-how-india-became-the-worlds-pharmacy/] pharmaceuticals industry. Today, 40% [https://www.nytimes.com/2014/02/15/world/asia/medicines-made-in-india-set-off-safety-worries.html]of over the counter medicines in the United States are made in India. Until recently, India had few regulations controlling the disposal of wastewater from pharmaceutical pharmacies. The high but ambient levels of antibiotics in wastewater create an ideal environment [http://Industrial wastewater treatment plant enriches antibiotic resistance genes and alters the structure of microbial communities] for bacteria to gain resistance to antibiotics. Those without access to clean water or who rely upon fish caught from rivers, a disproportionately poor group of people, are especially at risk of getting infected by antibiotic resistant bacteria. The Consequences of Rising Drug Resistance According to the CDDEP, India consistently has some of the highest prevalence of antibiotic resistance in the world. For example [https://resistancemap.cddep.org/AntibioticResistance.php] 87% of Indian enterobacteria are resistance to fluoroquinones as compared to just 5% in the US. Similarly, 84% of E Coli in India is resistant to antibiotics as compared to 34% in the US. One of the consequences of this is that it is increasingly difficult [https://www.chop.edu/news/preventing-antibiotic-resistance-and-spread-superbugs]to use narrow spectrum antibiotics that target specific pathogens in India. Instead broad spectrum antibiotics must be used that often kill helpful gut biome bacteria and can be toxic for children and the elderly. Moreover, many broad spectrum antibiotics are our last line of defense against drug resistant bacteria. One of the AMR bacteria that scare public health experts the most is multi-drug resistant tuberculosis. TB kills nearly 500,000 [https://pubmed.ncbi.nlm.nih.gov/31813430/#:~:text=Abstract,more%20than%201400%20every%20day.] people every year. Currently [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089296/]23% of TB strains in India are resistant to one antibiotic, and 3% resistant to all but the most powerful antibiotics with rates of resistance increasing rapidly. The rise of drug resistant bacteria is a problem not just for India, but for the world. Many drug resistant bacteria can be transmitted from person to person, and across international borders. For example, there has been at least one documented cases [https://thewire.in/health/antimicrobial-resistance-mrsa-st672] of a tourist carrying drug resistant MRSA from India to Paris. The spread of MRSA is especially worrying as studies have found mortality rates anywhere between 15% and 60%, and the rapid growth of MRSA would make any surgical procedure a deadly risk. What Can We DO? Part of controlling the rise of antimicrobial resistance in India is solving India’s broader public health crisis. For example [https://data.worldbank.org/indicator/SH.STA.BASS.ZS] 12% of Brazilians and 15% of Chinese people lacks access to basic sanitation, as opposed to 40% in India. Steps such as better nutrition, prenatal healthcare for mothers, and better access to sanitation all reduce the number of people who need antibiotics in the first place. This both reduces the risk of people catching drug resistant drugs, and for bacteria gaining resistance to antibiotics. It especially important for Indian pharmacies and hospitals to stop prescribing antibiotics unnecessarily, and making sure patients complete their antibiotic courses. Hospitals in particular have emerged as epicenters for antibiotic resistance. My own grandfather lost his live to multidrug resistant antibiotics last year after catching multi-drug resistant pneumonia in an Indian hospital. American hospitals once faced similar problems with antimicrobial resistance. Although the US still sees approximately [https://www.cdc.gov/mmwr/volumes/68/wr/mm6809e1.htm#:~:text=Invasive%20methicillin%2Dresistant%20Staphylococcus%20aureus,of%20decline%20has%20recently%20slowed.&text=Nearly%20120%2C000%20Staphylococcus%20aureus%20bloodstream,the%20United%20States%20in%202017.]20,000 deaths from MRSA a year, the numbers of hospital and community rates of MRSA infection have declined by 74% and 40%. Steps such as regular handwashing, cleaning of all equipment, and proper disposal of waste can all dramatically reduce the rate at which bacteria become resistant to pharmaceuticals in hospital settings. There are likely still far more people in India who die because of a lack of access to antibiotics than people who die from superbugs, and so any restrictionist policies are not tenable. However, in 2017 India’s government, working with the WHO, launched [https://www.bmj.com/content/357/bmj.j2049#:~:text=The%20National%20Action%20Plan%20on,infection%20control%20and%20antimicrobial%20surveillance.]its first National Action Plan on Antimicrobial Resistance. Steps include much greater education for pharmacists and doctors on the risk of drug resistance. The government plans on increasing access to veterinary services to small livestock owners so they have options to treat sick animals other than dousing with antibiotics. While most of these steps involve recommendation and education, the Indian government is also substantially strengthening regulations on the disposal of pharmaceutical factory wastewater. While it is unclear whether these steps will be effective, they mark important first steps. In the long race against bacteria, we’re going to have to go beyond public health measures and develop new antibiotics capable of fighting superbugs. However, the development of new antibiotics suffer massive misaligned incentives. Between [https://www.pewtrusts.org/en/research-and-analysis/reports/2016/05/a-scientific-roadmap-for-antibiotic-discovery]1940 and 1986, 26 new classes of antibiotics were discovered. However [http://A Scientific Roadmap for Antibiotic Discovery], since 1986 not a single new class of antibiotics has been developed. It can take 10 to 15 years and $1 billion to discover a novel antibiotic with a high chance the drug not making it through FDA approval. After drug discovery, it is likely the new antibiotic will be reserved for drug resistant cases, making their use sporadic driving up the price necessary to make drug discovery profitable. Moreover, there is a broader political economy problem that the overwhelming majority of deaths from drug resistant microbes happen in low income countries where neither the government, nor the private sector has the capacity to develop new antibiotics. However, India is an exception to this general principle. In 2020, Wockhardt became the first Indian company to get approval [https://www.business-standard.com/article/companies/wockhardt-becomes-first-indian-company-to-get-nod-for-novel-antibiotics-120011600612_1.html]for a new antibiotic. Moreover, Indian government labs are not only directly conducting research, but working with private companies to accelerate new antibiotic discovery. For example, the Indian government has financed the creation of a biotech incubator [https://www.bloomberg.com/news/features/2018-06-25/the-indian-startups-waging-war-against-superbug-bacteria]aimed at creating health problems faced disproportionately by developing countries by India. Companies created by this incubator include Bugworks, a company that has received from financing from leading global public [https://www.vccircle.com/3one4-capital-backed-biopharma-startup-bugworks-raises-fresh-funding/]and private [https://www.bloomberg.com/news/features/2018-06-25/the-indian-startups-waging-war-against-superbug-bacteria]funds aimed at accelerating antibiotics research. It is likely that the combination of India’s supply of low cost researchers, and government and private sector with a stake in developing antibiotics, India will be at the forefront of solving the antimicrobial resistance problem as well as creating it. The global COVID-19 pandemic has caused [https://www.worldometers.info/coronavirus/]over 2 million recorded deaths, and massive reduction [https://www.imf.org/en/Publications/WEO]in economic activity. It is all but certain that public health authorities across the world will massively increase the resources dedicated to monitoring and containing Coronaviruses. However, it is imperative we extend these resources to other public health threats such as the rise of superbugs. Moreover, making sure the nightmare scenario of 10 million deaths a year requires more than just a one off intervention, but sustained changes in everything from R&D to livestock management to contain. Selected Sources: Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations, World Health Organization Global Trends in Antimicrobial Resistance in Animals in Low- and Middle-Income Countries, Ramanan Laxminarayan Scoping Report on Antimicrobial Resistance in India [https://cddep.org/wp-content/uploads/2017/11/AMR-INDIA-SCOPING-REPORT.pdf], CDDEP Antimicrobial Resistance: Progress in the Decade since Emergence of New Delhi Metallo-β-Lactamase in India [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437806/], Avika Dixit, Neeta Kumar Origins and Evolution of Antibiotic Resistance [https://mmbr.asm.org/content/74/3/417], Julian Davies, Dorothy Davies What drives inappropriate antibiotic dispensing? A mixed-methods study of pharmacy employee perspectives in Haryana, India [https://bmjopen.bmj.com/content/7/3/e013190.abstract], Anna Barker, Kelli Brown NO TIME TO WAIT: SECURING THE FUTURE FROM DRUG-RESISTANT INFECTIONS, World Health Organization [https://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_final_report_EN.pdf?ua=1] Heavy use of prophylactic antibiotics in aquaculture: a growing problem for human and animal health and for the environment [https://sfamjournals.onlinelibrary.wiley.com/doi/full/10.1111/j.1462-2920.2006.01054.x], Feliber C Cabello Antibiotic Use and Resistance in Food Animals Current Policy and Recommendations [https://cddep.org/wp-content/uploads/2017/06/india_abx_report-2.pdf], CDDEP Global trends in antimicrobial resistance in animals in low- and middle-income countries, Reshma Silvester [https://thewire.in/health/drug-resistance-in-farm-animals-threatens-human-health-in-india], Julia Wong Industrial wastewater treatment plant enriches antibiotic resistance genes and alters the structure of microbial communities [https://www.sciencedirect.com/science/article/abs/pii/S0043135419305950], Milena Milakovic Why are people dying due to tuberculosis? A study from Alappuzha District [https://pubmed.ncbi.nlm.nih.gov/31813430/#:~:text=Abstract,more%20than%201400%20every%20day.], Kerala, India, M Karthika, Sairu Phillip Antibiotic Resistance, Sanitation, and Public Health , Juliana De Araujo [https://link.springer.com/chapter/10.1007/698_2020_470] Antimicrobial resistance and its containment in India http://origin.searo.who.int/india/topics/antimicrobial_resistance/amr_containment.pdf [http://origin.searo.who.int/india/topics/antimicrobial_resistance/amr_containment.pdf]