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    RFK Jr could have disastrous global impact on public health, experts fear

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    The appointment of a US health secretary with anti-vaccine views could cause deaths and have profound consequences around the world, global health experts fear.Robert F Kennedy Jr, Donald Trump’s pick for the position, has a history of spreading misinformation on vaccines and questioning the science of HIV and Aids.His nomination has been greeted with bemusement and alarm. One global health activist, speaking on background, said the move was akin to making the disgraced doctor Andrew Wakefield, who falsely claimed that the MMR vaccine caused autism, the UK’s health secretary.Prof Sir Simon Wessely, a regius professor of psychiatry at King’s College London, said of the move: “That sound that you just heard was my jaw dropping, hitting the floor and rolling out of the door.”Prof Sir Andrew Pollard, the director of the Oxford Vaccine Group, said there was real concern that Kennedy might use the platform “to pursue the same anti-science positions on life-saving public health interventions that he has advanced previously”.He added: “If this makes families hesitate to immunise against the deadly diseases that threaten children, the consequence will be fatal for some.”Prof Beate Kampmann, of the London School of Hygiene & Tropical Medicine, said the measles vaccine had averted more than 60m deaths worldwide in the last 25 years.“Progress will be rapidly lost in societies where vaccine hesitancy is promoted – as I fear will be the case in the US if Kennedy is appointed,” she said. Beyond US shores, the influence “could swing either way”, she said. “My worry is that polarisation on the topic will further increase.”The US is a huge force in global health as the largest funder and the home to many big pharmaceutical companies and leading health research institutes. The decisions of its regulators, such as the Food and Drug Administration, are closely watched by their equivalents elsewhere.Some of those institutions are likely to be disrupted by Kennedy’s pledge to “clear out corruption” at US health agencies and potentially eliminate entire departments. But the impact of a Trump administration on global health will be broader than any policies pursued by Kennedy alone. Trump could reinstate plans to withdraw from the World Health Organization and is almost certain to cut funding to UNFPA, the United Nations sexual and reproductive health agency that works in many poorer countries.As under all Republican presidents since Ronald Reagan, NGOs expect there to be a “global gag rule” banning recipients of US health funding from performing or promoting abortions anywhere in the world, which will potentially expand to cover even recipients of humanitarian aid.Kennedy’s stance on vaccination is being watched warily. Globally, routine vaccination coverage has yet to return to pre-pandemic levels. Lower immunisation rates led to a 20% annual increase in measles cases in 2023.Kennedy has previously made common cause with anti-vaccine groups overseas. In June 2019 he visited Samoa, where the measles vaccine was being blamed for the deaths of two babies a year earlier. It later emerged that the deaths had been caused by incorrect preparation of the vaccine mixture.Immunisation rates halved to 31% and not long after his visit a measles outbreak ended up infecting more than 57,000 people and killed 83, including children. Even as the outbreak raged, Kennedy wrote to the Samoan prime minister suggesting it might have been caused “by a defective vaccine” rather than inadequate coverage. Kennedy said previously he bore no responsibility for the outcome.His nomination was greeted with cautious civility in Berlin, where Kennedy made a name for himself as a coronavirus sceptic during the pandemic. The health minister, Karl Lauterbach, a qualified doctor, offered his congratulations but couched it in language that made his scepticism clear. “Here’s to a constructive collaboration. Will certainly not be just easy. But the choice of the voters is to be respected,” he wrote on X.Kennedy managed to enter Germany in 2020 despite tight travel restrictions in order to address coronavirus sceptics at a rally in the capital. He became a hero of the so-called Querdenker anti-coronavirus conspiracy theorist group, speaking to a demonstration attended by about 18,000 people.Kennedy drew parallels between his presence in Berlin, as a “fighter against totalitarianism”, and his uncle John F Kennedy’s appearance there in June 1963 during the cold war when he said the city had previously been a front against totalitarianism.On Friday, individuals and groups linked to the Querdenker movement welcomed the appointment, with some claiming Kennedy would “save the rest of the world”.The Hartmannbund association of German doctors voiced its concern about the overall effect a Trump presidency could have on Germany’s healthcare system. Its chair, Klaus Reinhardt, warned of the potential impact of any trade war between the US and Europe on the supply of medicines, saying issues over tariffs could greatly increase health costs and the individual contributions currently required by Germany’s health insurers.Scientific leaders say another pandemic is inevitable and that while during the Covid-19 pandemic Trump’s Operation Warp Speed aided the development, approval and mass manufacture of vaccines in record times, similar US leadership under Kennedy appears less likely.On other issues, experts are waiting for more detail on Kennedy’s plans. He has pledged to tackle chronic diseases and address the issue of overly processed foods. Leadership in those areas could be welcome in a world where diabetes rates have doubled in the past three decades.Many global health activists said they would agree with Kennedy that big pharma has questions to answer, but that companies should not be falsely accused of making vaccines that harm people; rather, they should be asked why so much of the world does not have access to affordable medicines. More

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      Is circular migration a solution to the crisis at the US border? Guatemala provides a clue

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      Arnoldo Chile, 33, drives his old Toyota pickup truck through the orchards that stretch across the slopes of the mountains surrounding the Guatemalan community of El Rejón in Sumpango, about 45 minutes from Antigua Guatemala, one of the country’s leading tourist destinations. People in this small village in the Sacatepéquez department rely almost entirely on agriculture as their primary source of income.View image in fullscreenHowever, most struggle to make a living, leading to poverty and social exclusion. Facing these challenges, several of Chile’s neighbours have emigrated illegally to the US, hoping to make enough money to support their families.His case, however, is different. Thanks to the circular migration programme by the Cuarto Pinos agricultural co-operative and the Juan Francisco García Foundation, he obtained an H-2A visa that allows him to work in agriculture in the US for several months each year.“At first, I was a bit sceptical that this project could work; I thought it might be a scam like others that have happened in Guatemala before. But since my first time in 2016, I’ve been to the US several times under this programme,” says Chile.He harvested broccoli, cabbage and lettuce in the early years, eventually being promoted to row boss, assisting the supervisor. “I earned $19 (£14.50) an hour and made about $3,500 (£2,700) a month, while here in Guatemala, I could only earn about $450 (£340) a month,” he says.Using his earnings, Chile bought a small plot of land near his village, El Rejón, and now provides work for several family members, primarily in blackberry production.View image in fullscreenAs migration across the US-Mexico border hit its lowest level in three years in the first few months of 2024, driven by the Joe Biden administration’s strict enforcement policy, the humanitarian costs of crossing are mounting. People arriving from South and Central America stranded in Mexico are facing increasing dangers, and reports of deaths at the border are on the rise.In this context, Guatemala’s circular migration offers legal, safer pathways for workers to make a living in the US and support their home communities – surely a better alternative to the migration crisis in the Americas.An estimated 2.9 million Guatemalans live outside their country, mainly in the US. According to Úrsula Roldán, who has a PhD in geography and is the director of the Institute of Socio-Humanistic Sciences at Rafael Landívar University, they usually migrate to escape low incomes, poverty and the risk of social exclusion in a country where the state often fails to meet their needs for education, health and other basic public services.Another reason, she says, is chain migration, when individuals already established in the US call for their relatives to join them. “With the climate crisis, the country has been facing floods and droughts that further worsen this situation. This results in crop failures, leaving rural families in even more dire conditions in Guatemala,” Roldán adds.The results of circular immigration leave scholars such as Roldán in little doubt about its efficiency. The immediate families of regular migrants who participate in these programmes receive better education and healthcare access, which is crucial in avoiding social exclusion.View image in fullscreen“This project was created in response to a combination of economic, social and environmental factors affecting rural families in our country,” says Vanessa García, the head of social responsibility at Cuatro Pinos. “Many families seek better job opportunities, and remittances sent by migrants have become a crucial source of income, motivating many to migrate irregularly.”Different studies suggest that over the years, gender roles tend to shift within families with regular migrants, showing a greater focus on gender equity and a gradual empowerment of women, those who migrated and those who remained in the home country managing the family income.“The communities have seen improvements in development as migrants have bought more land and increased their vegetable production for export, providing jobs for women and men in their communities,” says García.View image in fullscreen“There have also been improvements in housing, education, and the nutrition of their children, which is essential. Some families have also started businesses within the community,” she adds.skip past newsletter promotionafter newsletter promotionElsewhere in El Rejón, Juan Francisco Yucute, 32, reviews the accounts of the small store he managed to open with his wife, thanks to the money he made working in the US under the circular migration programme, where he earned about $12 (£9) an hour. He participated in the scheme on four occasions, and was away for four to five months each time.View image in fullscreenHe is has left the programme, as the company he worked for in Arizona no longer needed him. However, the money he saved allowed him to start his small business and build two adjacent premises he now rents to neighbours.“My wife and I used to work in the fields before I went to the US, just like most people in our community,” says Yucute, who thought about going to the US illegally until he heard about the circular migration scheme. “My idea of opening the store was so that she and my daughters could have a less strenuous job than agriculture, where you have to spend hours under the sun and rain, and in a village where the roads to the fields are dangerous.”According to a report, the expenses for circular migration typically range between $500 (£382) and $1,000 (£765), covering administrative costs, travel and other fees. This is significantly less than the $12,000 (£9,200) to $15,000 (£11,500) demanded by smugglers for irregular entry into the US, a method that does not always guarantee success.“For migrants, using coyotes [people smugglers] is an alternative route to reach the US. We know that US anti-immigration policies have tightened border controls, which has increased the risks posed by drug trafficking and organised crime along the migration route, making circular migration a viable option,” says Roldán.View image in fullscreenThe process to obtain a temporary work visa in the US is complex. It can take up to 120 days, as the Department of Labor requests certification to justify hiring foreign workers where there is no local workforce. If no local candidates are found for the position, the employer can apply for a visa for foreign workers and often starts international recruitment with the help of specialised agencies.Despite increasing numbers of Guatemalans seeking H-2A and H-2B visas to take part in circular migration programmes, irregular migration continues to prevail. In 2022, it was estimated that about 11,000 temporary workers from Guatemala arrived in the US under circular migration programmes.However, these numbers are significantly lower compared with the 55,302 Guatemalans deported by air from the US or the 222,085 encounters with law enforcement while attempting to cross the US border illegally in 2023.View image in fullscreenBlanca Paola Canel, 25, is well acquainted with this situation as her husband emigrated to the US irregularly. She choose to stay in their village of San José Yalú, near Sumpango, where she now runs the bakery they started together two years ago. Since then, her business has thrived. Not only has she succeeded, but she has also employed some of her relatives and several local young people.“I know many people from here who went to the US illegally. As for me, I never wanted to leave because I have this business that I need to oversee and manage,” says Canel. “I’ve been able to sustain and expand the business and offer employment to five or six people. I hope we can continue to create jobs in Guatemala.” More

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      What is the Pepfar fight and what does it mean for Africa?

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      What is Pepfar and why is it in the news?Pepfar is an acronym for the US “president’s emergency plan for Aids relief”. It was set up two decades ago by George W Bush to address the HIV epidemic.It’s the biggest government-run fund of its kind. Since 2003, the project has donated about $110bn (£90.5bn) to governments, universities and nonprofits in 50 countries, either directly or through agencies such as USAid.Until now Pepfar has been funded in five-year cycles. In the past the programme has had virtually unanimous support from Republicans and Democrats. But the next funding cycle (from 2023 to 2028) became ensnared in US abortion politics and the fallout contributed to Congress missing the 30 September deadline to allow another five-year funding cycle for the initiative.What’s the link between Pepfar and abortion?US laws already prevent Pepfar (or any state agencies) from paying for abortion services, according to the California-based policy research group, Kaiser Family Foundation (KFF). But in May, a coalition of conservative thinktanks and lawmakers began to make waves with arguments that Joe Biden’s administration has “hijacked” Pepfar to promote abortion instead of treating and preventing HIV.That’s where the risk to Pepfar’s five-year budget emerged – because the Republican lawmakers then refused to sign off on a spending bill for Pepfar if there weren’t stricter rules in place to stop Pepfar funds from overlapping with abortion services in any way.According to Brian Honermann, deputy director of public policy at the US-based Foundation for Aids Research, the allegations that Pepfar has been usurped to push a “radical social agenda” overseas are “baseless” and “stitched together from unrelated policy speeches, documents and assertions about how those apply to Pepfar”.What will happen to Pepfar now?The multibillion-dollar health programme is a permanent part of US law. That means Pepfar funding will continue, but it will lose its favoured position of receiving five years of funding at a time.The failure to reauthorise Pepfar will mean some of its built-in rules will expire, including a guideline that requires 10% of Pepfar money to go to orphans and children in need.Will organisations and governments lose their Pepfar grants?The fund has enough money to pay governments and civil society organisations until September 2024 (about $6.8bn), but a state department spokesperson warns that Pepfar won’t escape unscathed in the long term.Moreover, getting funding for only one year at a time will make it harder for Pepfar to plan ahead and to source crucial HIV tools, such as condoms or medicine, at the best prices. This could ultimately imperil the people that rely on the fund’s support, the spokesperson warned.The symbolic power of a five-year commitment will also be lost, says Honermann. “It shows partner countries that the US is invested for a significant period of time and that Pepfar won’t just disappear.”The threat of a permanent ‘gag rule’Another factor has swirled around Pepfar’s funding drama: some lawmakers have said they’ll only agree to restart the five-year funding regime if the fund is once again subject to the “Mexico City policy”, also called the “gag rule”.The gag rule bans organisations and governments from providing or promoting termination of pregnancy services regardless of whose money they’re using to do it. It was expanded to apply to Pepfar for the first time in 2017. It is only ever enforced when there’s a Republican president in the White House, so is not currently in effect.And while there is no finalised legislation that would make a permanent gag rule a reality (and Honermann argues it would be unlikely to get past the Democrats), the threat of it may already have done some damage.Research conducted by Fòs Feminista, a global alliance that advocates for sexual and reproductive rights, found that the 2022 decision to roll back the national right to an abortion in the US had a contagious impact in a number of countries. In Nigeria, for instance, respondents told Fòs Feminista that local lawmakers were using the change in US abortion laws to push back on a more liberal law in their country. Terminations are legal in Nigeria only if carrying the foetus to term threatens the mother’s life.Recipients of US government funding are often so worried about losing it that they enforce abortion laws more harshly than is necessary. Research shows that confusion about whether the gag rule had been revoked at the start of the Biden administration resulted in the policy – and its harms – being in place for much longer in practice.And the Pepfar wrangling and attendant media coverage has already resulted in mixed messages reaching health advocates in Africa. Some South African activists told the Guardian they were concerned that the news would be calamitous for civil society in the country. Such organisations receive the most Pepfar dollars (44%) in South Africa according to 2020 tracking data. The government gets just under 1.5% of the money.Honermann says that there is an intentional political strategy to keep communication about the changes in restrictions vague. “It’s a way to encourage over-enforcement for fear of falling on the wrong side of this.”He adds: “For now, Pepfar will continue as long as funding is made available. But these political threats to the programme are ultimately playing with the lives of millions of people worldwide who rely on this programme.”What has the reaction been in Africa?Dave Clark is the chief operating officer at the Aurum Institute, a non-profit that works on HIV and tuberculosis (TB) projects in South Africa, Mozambique, Ghana, Lesotho and Eswatini.Aurum is a partner for Pepfar’s Dreams project which works towards an Aids-free future for girls and women aged 10 to 24 by providing HIV services, contraception and violence prevention support for women, adolescents and their sexual partners.One of the major strengths of Pepfar, Clark says, is that it’s a sure-fire source of carefully planned funding for global health in a world that is often more talk than action.He explains: “The debate in America should not throw us off saving lives. Pepfar is what it says on the label: president’s emergency plan for Aids relief. That’s its extraordinary power and legacy.” More

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      Biden accused of U-turn over Egypt’s human rights abuses

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      “It’s a hostage negotiation and it has been all along,” said Sherif Mansour, describing the arrest of his cousin Reda Abdel-Rahman by Egyptian security forces last August as an attempt to intimidate Mansour into silence.Abdel-Rahman has been imprisoned without trial for nine months. Mansour, an outspoken human rights advocate in Washington with the Committee to Protect Journalists, has since learned that he and his father are listed on the same charge sheet, all accused of joining a terrorist group and spreading “false news”.Mansour is one of a growing number of activists, dissidents and analysts angry at the US administration’s suddenly warm relations with Egypt. They point to Egyptian officials’ escalating threats against critics living in exile in the US, including arresting their family members or contacts in Egypt, many of whom are imprisoned like Abdel-Rahman on spurious charges.Twelve members of Mansour’s family have been detained and interrogated by Egyptian security agents since Abdel-Rahman’s detention.“They ask about us, when we last spoke to them, what we spoke about,” Mansour said. “They go through their phones – and if they don’t provide passwords they’re beaten in order to find anything that connects them to us, including Facebook conversations.“It’s why we haven’t been in touch: I’ve stopped talking to my family in order not to give them any reason to harass them,” he said.Joe Biden and the Egyptian president, Abdel Fatah al-Sisi, held their first official call in late May, four months after Biden took office. As a candidate, Biden promised that there would be “no blank checks” for the man Donald Trump once addressed as “my favourite dictator”. Yet when they spoke, the two leaders discussed human rights in terms of a “constructive dialogue” and “reaffirmed their commitment to a strong and productive US-Egypt partnership”, according to the White House.This followed Egyptian mediation of a ceasefire between Israel and Hamas, including a recent rare public visit by the Egyptian intelligence chief, Abbas Kamel, to Tel Aviv and Ramallah, and Israel’s foreign minister, Gabi Ashkenazi, travelling to Cairo – the first visit by an Israeli foreign minister in 13 years.HA Hellyer, of the Carnegie Endowment for International Peace thinktank, said: “The latest crisis in the Palestinian occupied territories and the Israeli bombardment reminded DC of a very clear and present reality: that there is no capital in the region that has direct and workable relations with the Israelis and the Palestinians in Gaza and the West Bank other than Cairo.”Biden’s administration capped his warm exchange with the Egyptian president with a decision to request $1.38bn (£1bn) in annual military aid for Egypt – the maximum amount possible.A coalition of human rights groups expressed “strong disappointment” at the administration’s decision. “President Biden campaigned on ‘no more blank checks’ for Egypt’s regime, but requesting the same amount the United States has provided annually since 1987 despite Egypt’s deteriorating human rights record is, effectively, another blank check,” they said.Mansour agreed. “They abandoned the rhetoric calling publicly on Egypt to respect human rights by agreeing to this ‘constructive dialogue’,” he said. “It makes my blood boil to hear this term in many ways. Not just because it’s a repetition of what we as Egyptians, and the United States, have heard from all previous dictators, but it also underscores how naive and timid this administration is when it comes to Egypt.”Since coming to power in a military coup in 2013, Sisi has overseen the broadest crackdown on dissent and free speech in Egypt’s recent history. Tens of thousands remain behind bars for their political views or for activities as benign as a Facebook comment; Egypt’s prisons are at double their capacity, according to Amnesty International.The Freedom Initiative, a Washington-based human rights organisation founded by the Egyptian-American activist Mohamed Soltan, has tracked the increasing numbers of arrests of family members of outspoken Egyptians in exile abroad. It said that threatening phone calls and even physical intimidation were now regularly used against Egyptian dissidents worldwide.“They said they could hire someone here in the States to go after me,” said Aly Hussin Mahdy, an influencer and dissident now in exile in the US. Mahdy described how his family members were detained earlier this year as a way to stop him speaking out against the Egyptian government on social media; his father remains in detention. The threats against Mahdy escalated to menacing phone calls from someone purporting to be an Egyptian intelligence agent after he openly discussed his family members’ arrests.The Freedom Initiative described what it termed “hostage-taking tactics” involving five American citizens whose families were detained in Egypt in order to silence their activism in the US. In addition, it found more than a dozen cases of US citizens or residents whose close relatives were detained in Egypt last year, although it believes the true number to be far higher.It added that one US citizen was warned against speaking to US lawmakers on their release from detention in Egypt, and told that doing so would result in harm to their family.Yet US law contains mechanisms to curb cooperation with countries that threaten US citizens and dissidents abroad. These include the Leahy law, which stops the US funding foreign security forces that violate human rights; the Global Magnitsky Act, which allows the government to sanction human rights abusers and prevent them from entering the US; and the “Khashoggi ban”, curbing visas for those engaged in anti-dissident activities.The White House did not initially respond when contacted for comment on this issue. The secretary of state, Antony Blinken, told a congressional hearing this week that “I think we’ve seen some progress in some areas” of human rights in Egypt, but that “when it comes to freedom of expression, when it comes to civil society, there are very significant problems that we need to address directly with our Egyptian partners – and we are. So we hope and expect to see progress there.”US-based activists expressed disappointment at lawmakers’ reluctance to employ sanctions against Egyptian officials, who they say more than qualify for punitive measures.“The fact that Egypt feels it can get away with taking citizens hostage, and so far it did, will continue to be a stain on the Biden administration,” said Mansour. More

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      Biden restores $200m in US aid to Palestinians slashed by Trump

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      The US will restore more than $200m (£145m) in aid to Palestinians, reversing massive funding cuts under the Trump administration that left humanitarian groups scrambling to keep people from plunging into poverty.
      “[We] plan to restart US economic, development, and humanitarian assistance for the Palestinian people,” the secretary of state, Antony Blinken, said in a statement.
      The aid includes $75m in economic and development funds for the occupied West Bank and Gaza, which will provide food and clean water to Palestinians and help small businesses. A further $150m will be provided to the United Nations relief and works agency for Palestine refugees in the near east (UNRWA), a UN body that supports more than 5 million Palestinian refugees across the region.
      After Donald Trump’s row with the Palestinian leadership, President Joe Biden has sought to restart Washington’s flailing efforts to push for a two-state resolution for the Israel-Palestinian crisis, and restoring the aid is part of that. In his statement, Blinken said US foreign assistance “serves important US interests and values”.
      “The United States is committed to advancing prosperity, security, and freedom for both Israelis and Palestinians in tangible ways in the immediate term, which is important in its own right, but also as a means to advance towards a negotiated two-state solution,” he said.
      Palestinian leaders and the UN welcomed the resumption of aid. Israel, however, criticised the decision to restore funds to UNRWA, a body it has long claimed is a bloated, flawed group.
      “We believe that this UN agency for so-called refugees should not exist in its current format,” said Israel’s ambassador to the UN, Gilad Erdan. Pro-Israel US lawmakers joined the country in opposition to the aid and said they would scrutinise it in Congress.
      From 2018, Trump gradually cut virtually all US money to Palestinian aid projects after the Palestinian leadership accused him of being biased towards Israel and refused to talk. The US president accused Palestinians of lacking “appreciation or respect”.
      The former president cancelled more than $200m in economic aid, including $25m earmarked for underfunded East Jerusalem hospitals that have suffered during the Covid-19 crisis. Trump’s cuts to UNRWA, which also serves Palestinian refugees in war-stricken Syria and elsewhere in the Middle East, was described by the agency’s then head as “the biggest and most severe” funding crisis since the body was created in 1949. The US was previously UNRWA’s biggest donor.

      To outcry from aid workers, leaked emails suggested the move may have partly been a political tactic to weaken the Palestinian leadership. Those emails alleged that Trump’s son-in-law and adviser Jared Kushner had argued that “ending the assistance outright could strengthen his negotiating hand” to push Palestinians to accept their blueprint for an Israeli-Palestinian deal.
      The cuts were decried as catastrophic for Palestinians’ ability to provide basic healthcare, schooling and sanitation, including by prominent Israeli establishment figures.
      Last April, as the coronavirus pandemic hit, Trump’s government announced it would send money to Palestinians. The $5m one-off donation was roughly 1% of the amount Washington provided a year before Trump began slashing aid. More

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      The Good American review: Bob Gersony and a better foreign policy

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      What adjective should describe “the American” active in foreign policy? Graham Greene chose “quiet”, as his character harmed a country he did not understand. Eugene Burdick and William Lederer used “ugly”.
      Robert D Kaplan, one of America’s most thoughtful chroniclers of foreign affairs, proposes “good” to describe Bob Gersony, who in “a frugal monastic existence that has been both obscure and extraordinary” has devoted his life to using the power and treasure of the US to serve others through humanitarian action.
      A son of Holocaust refugees, he never held a formal government position. He was instead a contractor for the state department, USAid or the United Nations. Yet his work improved the lives of millions, saving many, and corrected policies that might otherwise have been implemented by “ugly” or “quiet” figures who did not understand the countries in which they operated.
      Gersony’s method was simple: to conduct interviews through a trusted translator with individuals fleeing conflict, to stay “in continuous, tactile contact with the evidence”. It was exhausting work in extraordinarily difficult circumstances but his information, transmitted to senior policymakers in highly detailed “Gersony reports”, was both essential and frequently (as in Mozambique and Bosnia) the opposite of what the policy community believed or wished to believe.
      The truth about a place “emerges from the bottom up”, he said, and thus “you must always believe refugees”.
      Accountability, absolute integrity, objectivity and boldness in speaking to authority were his watchwords. His independence meant personal insecurity. He often shared a simple shack with a translator and slept with his notes under his pillow. Personal danger and hardship were part of the job, yet in no other way could the truth emerge and successful policy be formulated.
      “When you listen to ordinary people,” Gersony believed, “there is so much wisdom.”
      Kaplan calls Gersony “a business-oriented math brain with a non-ideological conservative streak … think of him as an emotionally tortured character straight out of a Saul Bellow novel, engrossed throughout his life in the brooding and dangerous tropical settings defined by Joseph Conrad.”
      This is also the story of another era of US foreign policy, one in which realism and humanitarianism combined to include human rights in the national interest, against the backdrop of the cold war, so often hot in the developing world. Human rights and grand strategy complemented each other. Gersony had bosses who were “authentic, heartland Americans … the ultimate selfless public servants … deeply moral without being ideological, while operating at the top of the power structure”.
      Gersony started in Guatemala, where he began a language school and after the 1976 earthquake worked with relief organizations. He took charge of hurricane relief in Dominica, standing up to the prime minister, asserting, “If you empower people, they won’t be corrupt.” Moving on to El Salvador in the civil war, he recommended massive employment programs for displaced persons, building sewage canals and cobblestone streets – practical improvements that also discouraged guerrillas from attacking the people.
      His solutions were often elegantly simple because they provided the dignity of work and reflected what people actually wanted. And yet, as Kaplan writes, “He still had no credentials … in the ordinary careerist sense, he had risen as far as he ever would.” For Kaplan, as for Gersony, “a meaningful life is about truth, not success.”
      The assignments kept coming: Vietnamese boat people in Thailand; Sudan and Chad; Honduras, where his counterintuitive but accurate recommendation showed once again that “ground-level fieldwork … triumphs over the discussion of big abstract ideas”. In Uganda’s Lowero Triangle, he uncovered genocide with the unexpected help of a British officer advising President Obote. The secretary of state, George Shultz, cut off aid.
      As Kaplan writes, “History pivoted in southern Africa thanks to Bob Gersony.” After an unusual meeting with Shultz and Maureen Reagan, daughter of the president, the US did not aid Renamo guerrillas in Mozambique. Gersony tackled a highly complex situation in Somalia and in the aftermath of the Rwandan genocide worked with UNHCR on the repatriation of Hutus. As one official said, his unwelcome truth-telling “stopped the killing machine”. He worked in northern Uganda with World Vision long before Joseph Kony became a hashtag. Knowing the dangers of travel in that region, “he treated the motor pool chief like a high official”.
      Gersony worked tirelessly. “If we skipped lunch,” he said, “we could interview one more refugee, and each refugee was precious – you never knew which one would yield a breakthrough in understanding.”
      By Kaplan’s own admission, his book is also something of his own story, a lament for a time when internationalist moderates dominated both parties and the foreign service enjoyed “the last golden age of American diplomacy … when the bureaucracy at all levels had sufficient money and rewarded talent” in furthering “that sturdy, moderate national security consensus that no longer exists”.
      Embed
      Kaplan does not quite regret the end of the cold war but he does note the resulting separation between idealism and power.
      Indeed, Gersony’s career ended in a very different world. Kaplan sees Plan Colombia, an early 2000s push against leftwing guerrillas and drug cartels, as “a precursor for the fiascos in Afghanistan and Iraq”, where gigantic projects and a “dysfunctional interagency process” often failed for lack of perspective. Gersony’s later tasks included tracking food assistance for North Korea, examining the Maoist insurgency in Nepal (and wishing USAid had continued road-building there), and disaster planning in Micronesia, where “in this emerging naval century … Oceania was indeed at the heart of geopolitics” and control of shipping lanes.
      Can realism and idealism combine again? Only through what the French academic Gérard Prunier wrote about Gersony’s “great respect for the factual truth. The world is not just an interpretation or a place for competing narratives.” In the end, Kaplan’s life of Gersony recalls the advice of another quintessential American, Mark Twain: “Do the right thing. It will gratify some people and astonish the rest.”
      The Good American is published in the US by Random House More

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      Biden move to refund UN population agency is 'ray of hope for millions'

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      The decision by US president Joe Biden to refund the UN population fund, UNFPA, offers “a ray of hope for millions of people around the world”, said the agency’s executive director.
      Dr Natalia Kanem said the announcement on Thursday would have an “enormous” impact on the agency’s work, particularly as the world continues to grapple with the coronavirus pandemic.
      In 2017, the Trump administration halted funding to the UNFPA, claiming it supported coercive abortion and involuntary sterilisation – claims strongly denied by the agency.
      The US was one of the agency’s largest funders. In 2016, it provided $69m (£50m) to support its work in more than 150 countries.
      “Ending funding to UNFPA has become a political football, far removed from the tragic reality it leads to on the ground. Women’s bodies are not political bargaining chips, and their right to plan their pregnancies, give birth safely and live free from violence should be something we can all agree on,” said Kanem.
      She added that the pandemic had hit particularly hard the vulnerable communities in which the UNFPA works. “US support will be instrumental in helping us build back better and fairer.”
      US secretary of state Antony Blinken said his department would appropriate $32.5m to support the UNFPA this year.
      “UNFPA’s work is essential to the health and wellbeing of women around the world and directly supports the safety and prosperity of communities around the globe, especially in the context of the global Covid-19 pandemic,” he said.
      Blinken also confirmed that the US would withdraw its support for the “Geneva Consensus Declaration” – an anti-abortion policy introduced last year by the then secretary of state Mike Pompeo, and signed by more than 30 countries, including Brazil, Hungary and Uganda.
      “The United States is re-engaging multilaterally to protect and promote the human rights of all women and girls, consistent with the longstanding global consensus on gender equality and sexual and reproductive health and reproductive rights,” said Blinken. More

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      in US Politics

      Joe Biden axes 'global gag rule' but health groups call on him to go further

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      Health groups around the world are celebrating the end of a harmful policy banning US funding for overseas aid organisations that facilitate or promote abortion, which was scrapped by the US president, Joe Biden, in a presidential memorandum on Thursday.Reproductive rights advocates are urging the new administration to now go further and permanently repeal the Mexico City policy – known as the “global gag rule” – to prevent it being reinstated by a future Republican president. The policy has been blamed for contributing to thousands of maternal deaths in the developing world over the past four years.The gag rule prevents overseas organisations that receive American aid from using their own money to provide information about abortion, or carry out abortions. First adopted by the Reagan administration in 1984, it has been repealed by every Democratic administration and reinstated by every Republican one in the years since.In a short appearance in the Oval Office on Thursday afternoon, Biden said he ended the policy as part of an effort to “protect women’s health at home and abroad”.But Donald Trump went further than previous Republican presidents. The policy usually applies to family planning organisations. But the Trump administration expanded the policy to include all global health programmes, including programmes that address HIV, nutrition, malaria and cholera.Widening the rule increased the pool of aid funds it affected from roughly $600m to about $12bn (£8.7bn), according to the Guttmacher Institute, a health policy research group.“We can breathe,” said Serra Sippel, the president of the Center for Health and Gender Equity, of Biden’s plans to repeal the policy. “There’s just so much hope and optimism in Washington DC right now. We have a lot of work to do, but it’s so much better.”The consequences of Thursday’s memorandum will ripple out from Washington into more than 70 countries including some of the poorest places in the world, where essential women’s health operations were abruptly halted or scaled down after Trump reinstated the rule in January 2017.In Zimbabwe, a women’s health team run by Abebe Shibru, from the organisation MSI Reproductive Choices, cut its operations by 60%. “We reduced our outreach from 700,000 women to about 300,000,” Shibru, who now heads the organisation’s Ethiopian operations, told the Guardian.“Women missed out on information, they had no access to family planning, and in return they were exposed to unintended pregnancy and unsafe abortion, which contributed to higher maternal mortality.”Zimbabwe’s teenage pregnancy rate increased by 2% over the past four years, according to Unicef data, a trend Shibru said was exacerbated by cuts as a result of the gag rule.“We were not providing services to rural women, so they had no choice but to get pregnant against their wish,” he said.Pledging conferences attracted hundreds of millions of dollars in donations from governments and private groups to try to bridge the gap in American funding, but could not meet the total shortfall.An assessment of the rule’s impact released last year, surveying health organisations in Nigeria, Kenya, South Africa and Nepal, found a sector in “crisis” with confusion over what was banned and permitted using US aid, a growing stigma around reproductive health services and widespread closures and scaling downs of programmes.Trump’s ban also spawned a new wave of activism, including a new grassroots movement, SheDecides, which is pressuring policymakers around the world to commit to upholding reproductive and sexual health rights.Zara Ahmed, the associate director of federal issues at the Guttmacher Institute, said repealing the gag rule “is just the first step in undoing [the US’s] current status as the greatest global hindrance to reproductive health”.“We are glad that the Biden-Harris administration is addressing the global gag rule …… But let’s be clear, repealing the global gag rule is the bare minimum this administration can do to address the harm caused by the previous administration’s coercive and spiteful approach to foreign policy,” she said.“The Biden-Harris administration can, and must, take a comprehensive approach to unravelling the dangerous, punitive and coercive policies the outgoing administration has woven into our foreign policy, and it must take action to address longstanding harmful policies like the Helms amendment.”The Helms amendment has been widely misinterpreted as a total ban on US funding used for abortion overseas, when in fact it can be used to support abortion in cases of rape, incest or a woman’s life being in danger. A bill to permanently repeal it was introduced last year.On Thursday, the Global Health, Empowerment and Rights Act (Global HER Act) to permanently repeal the global gag rule will be introduced for the third time in Congress. The bill, cosponsored by the new vice-president, Kamala Harris, has received cross-party support, and hopes are high it will pass.“It’s not automatic and it’s not going to be easy but we’re starting in a very strong place to get the act passed,” said Sippel. “If not the bill itself, but the language of the bill incorporated into another bill. Getting rid of the GGR, that’s what we’re striving for.”Sippel also called on the Biden administration to disavow the “Geneva consensus declaration” – an anti-abortion policy Trump promoted last year – to “signal to the world that abortion and LGBTQ rights and sexual and reproductive rights are important, and to state that loudly to the world”.She added that some activists wanted the Biden administration to issue a formal apology for US policies on sexual and reproductive health and rights over the past four years.Biden also ordered funding restored to the UN population fund, UNFPA, which Trump stopped.The agency’s executive director, Natalia Kanem, hailed the “enormous” impact of the decision.“Ending funding to UNFPA has become a political football, far removed from the tragic reality it leads to on the ground. Women’s bodies are not political bargaining chips, and their right to plan their pregnancies, give birth safely and live free from violence should be something we can all agree on,” she said. More