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Health & Environment

Vol. 4 No. 1 | Summer 2017
Water for Securit...

Water for Security 

Peter Engelke
(Jeff Vanuga/Public Domain)

In February 2017, California’s Oroville Dam threatened to collapse due to an unprecedented level of water in its reservoir. Faced with the possibility of calamity (Oroville Dam is the nation’s tallest at 770 feet), state officials evacuated 200,000 people from downstream areas.[1] The Oroville incident followed another high-profile water tragedy in the United States. In December 2015, Flint, Michigan Mayor Karen Weaver declared a state of emergency because lead contamination from Flint’s ancient water pipes poisoned the city’s water supply, making it unsafe to drink.[2] Michigan’s governor, Rick Snyder, and President Obama both followed with similar declarations. Flint sadly became a national symbol of incompetence, to some even proof of deliberate malfeasance by public officials. Despite remedies to fix the problem, Flint’s water remains unsafe, and the city’s residents continue to go about their lives drinking bottled water.


These cases are more than just poignant demonstrations of the truism that water is life. They show that even in advanced societies, there is a fine line between water security and insecurity, between having and not having on-demand clean water in exactly the right quantities at precisely the right moment. In the United States, we are the beneficiaries of past investments in water infrastructure that have removed water insecurity from our lives. We believe that simply turning a tap provides clean, drinkable water as a free good of nature, as readily available to everyone as it is to us.


Unfortunately, this assumption is not only untrue, it is dangerous to boot. A great many societies around the world are water insecure, meaning their inhabitants do not enjoy what Americans take as a given. As water is fundamental to public health, economic activity, energy and agricultural production, and countless other uses, the poor supply of water or disruption in that supply is a serious threat to domestic and international security...

As a longer article, this piece will only be offered in PDF format for easier reading. Download the PDF to read more.

[1] Kristine Guerra, “Officials were warned the Oroville Dam emergency spillway wasn’t safe. They didn’t listen,” Washington Post, February 13, 2017,

[2] Annabel Adams and Pat Harriman, “Revisiting the Flint, Michigan, lead-in-water crisis a year after its state of emergency,” UCI News, January 5, 2017,

Peter Engelke  

Peter Engelke is a resident senior fellow with the Atlantic Council’s Foresight, Strategy, and Risks Initiative. He works on assessing long-range strategic security trends and presents innovative responses to policymakers in Washington and beyond. He recently co-authored an Atlantic Council report on the need for the U.S. to develop a global water grand strategy in the 21st century. He was previously a fellow at the Stimson Center, on the research faculty at Georgia Tech Research Institute, and a Bosch Fellow in Stuttgart. He received his PhD from Georgetown and holds additional advanced degrees from Indiana University, the University of Maryland, and Georgetown’s Walsh School of Foreign Service. 


Epidemiological Insurgency:

Polio Persistence on the Afghanistan-Pakistan Border

Rand Quinn
(Lt.j.g. Matthew Stroup/Public Domain)

Despite a profound global impact over the first half of the twentieth century, polio is largely an afterthought throughout the developed world. Vaccines engineered in the late 1950s paved the way for a precipitous drop in global disease burden with the onset of the World Health Organization-led (WHO) Global Polio Eradication Initiative (GPEI) starting in 1988. Recent indicators of the program’s success include a declaration of eradication in India[1] and a teeteringly low infection rate in Nigeria;[2] two of the disease’s last bastions. This progress, however, has been notably stifled by the steady persistence of a wild poliovirus reservoir centered in northern Pakistan along the Afghanistan-Pakistan (Af-Pak) border.


Throughout significant portions of recorded history this region’s volatility has been well-documented, including a currently sustained network for the training of terrorist fighters dating back to the period of the 1979 Afghan-Soviet War.[3] These networks serve to both attract fledgling radical jihadist recruits and supply fighters globally, markedly providing many of the transnational fighters taking part in the Syrian Civil War. Their movement in and out of the Af-Pak region has provided a major disease vector for poliovirus.


The location of a terrorist network transit hub in by far the world’s largest remaining reservoir of wild poliovirus poses a major challenge for policymakers. Due to several factors, including a decline in healthcare infrastructure throughout the western world, the situation presents a legitimate epidemiological threat. However, the issue is more importantly an exemplar of the morphing nature of multidimensional threats, which are likely to become more prevalent in an era of globalization, failed states, and an inability to effectively address social issues amidst the threat of kinetic warfare...


As a longer article, this piece will only be offered in PDF format for easier reading. Download the PDF to read more.



[1] World Health Organization. South-East Asia Regional Certification Commission for Polio Eradication. Polio-free Certification: WHO South-East Asia. WHO, 27 Mar. 2014. Web. 19 Mar. 2017. <>.

[2] World Health Organization. Media Centre. Government of Nigeria Reports 2 Wild Polio Cases, First since July 2014. WHO, 11 Aug. 2016. Web. 19 Mar. 2017. <>.

[3] Bearden, Milton. "Afghanistan, Graveyard of Empires." Foreign Affairs Nov.-Dec. 2001.


Rand Quinn   


Rand Quinn is a former monitoring and evaluation officer, having worked on projects funded by a range of organizations, including: CDC, DFID, USAID, UNDP, USDOS, and the WHO.  A graduate of Miami University and the Fletcher School of Law and Diplomacy, Rand has focused professionally on strategy, operations, and management in healthcare and emerging market finance programs across Sub-Saharan Africa, the Caribbean, and South Asia.  This article emerged from previous work and research in Pakistan.

Bird Flu - It's Wh...

Bird Flu — It’s What’s for Dinner

What Human Population Growth and Climate Change Mean for the Future of Avian Influenza Outbreaks

Dr. Nahid Bhadelia, MD, MA

China is currently experiencing its fifth epidemic of “bird flu,” or avian influenza H7N9, since 2013 when it was first noted to cause human infections. The virus, which is mainly transmitted from poultry to humans, is also prone to limited human-to-human transmission. To date, there have been 1,258 human cases, with one-third of those cases (460) occurring during this year’s epidemic alone.[1] There are many “subtypes” of avian influenza circulating in birds around the world and most of these viruses cause limited or no human infections. However, two avian influenzas subtypes causing high human mortality have jumped from birds to humans in the last decade, H5N1 and then H7N9. The significant potential of this class of viruses to cause a human pandemic is a global public health concern, particularly because the conditions leading to the rise of these infections are becoming more favorable — for the viruses.


The story of how new avian influenza viruses end up infecting humans is similar to other instances of “spillover,” an event that allows the viruses to adapt over time to infecting species other than their natural reservoirs. Wild aquatic birds are the natural reservoirs of avian influenza, and human infections can occur when the virus is exchanged between wild fowl and domestic poultry (or other animal species), and then mutates enough to be transmitted from poultry to humans.[2] Spillovers are likely happening all the time but they do not necessarily “take” every single time. Influenza viruses are notorious at mutating quickly and hence can take advantage of similarity between hosts as well as the increased frequency of interactions between species. Closer habitation of wild and domestic birds such as poultry, and then of humans and poultry, allows a slow percolating phenomenon where influenza viruses adapt over multiple interactions between the species to become better at infecting humans.


Unfortunately, the largest driving force in making these jumps possible is human population growth. The world population has pushed past 7.3 billion and the United Nations predicts, despite a declining population growth rate, that by 2050 the human population will be 9.7 billion.[3] As we grow, we affect changes in land use, extending farmlands and decreasing areas of wetlands which serve as natural reserves for wild water fowl due to increased demands for fresh drinking water.[4] The U.S. has seen a loss of 50 percent of its wetlands over the last couple of centuries.[5] Together with climate change,[6] these changes have altered the distribution, composition, and movement of wild bird species, and in some cases have forced closer cohabitation of domestic and wild birds, allowing myriads of chances for the first step of the spillover process to occur.


A larger human population also has caused the demand for protein sources to surge. We are raising more birds, along with pigs and cows, for meals. Since 1961, global meat production has quadrupled,[7] responding not just to population growth but also increasing wages and urbanization. The UN Food and Agriculture Organization reported that poultry meat makes up most of the addition meat consumption worldwide, because poultry is cheaper to produce and more affordable to buy than other meats.[8] Industrialized nations consume the most protein per capita but the new demand is actually arising from China, as well as low- and middle-income countries, where population growth rate is higher. By 2024, poultry will make up almost half of the source of meat worldwide, all translating into a greater number of cohorted birds in industrialized farms or on domestic pastures interacting with other animals and wild foul. Bird flu already wreaks significant losses on the poultry industry worldwide, both because of the direct deaths of sick birds but also the massive killing of healthy birds undertaken as control measure.[9],[10]


Not only are the human and poultry numbers increasing, the growth of cities is creating crowded living conditions that could serve as tinder if a highly infectious strain of avian influenza were to adapt to spreading between humans. Half of the world’s population now lives in cities and towns.[11] “Wet” poultry markets, or store fronts that sell live birds, in urban centers have been implicated in the transmission of prior and current avian influenza outbreaks in humans and their temporary closure has been a key intervention in halting the spread of new human infections.[12] These markets bring humans, poultry and other domestic animals near each other, allowing a steady learning environment for influenza viruses to adapt to infecting new species.


The mosaic of forces behind the emergence of avian influenza perfectly encompass the concept of Planetary Health, the idea that climate change, human health, and animal health work in tandem, and imbalance in any part of system can lead to devastating effects everywhere.[13] Research attempts at predicting the rise of new avian influenza viruses in humans consider not just infectious diseases biology but also climate change science, animal conservation, human behavioral and agricultural practices, and satellite information.[14] These multi-disciplinary approaches will be important not just in the scientific world but also in the public health sector, as we wade further into an era where humans become a bigger and bigger threat to their own existence.


[1] Helen Branswell, “Human Cases of Bird Flu are Surging, Alarming Public Health Officials,” STAT, February 28, 2017, <> (accessed April 11, 2017).

[2] Kirsty R. Short, Mathilde Richard, Josanne H. Verhagen, Debby van Riel, Eefje J.A. Schrauwen, Judith M.A. van den Brand, Benjamin Mänz, Rogier Bodewes, and Sander Herfst, "One Health, Multiple Challenges: The Inter-species Transmission of Influenza A Virus," One Health 1 (2015): 1–13.

[3] “World Population Projected to Reach 9.7 billion by 2050,” United Nations Department of Economic and Social Affairs, July 29, 2015, <> (accessed April 11, 2017).

[4] Kurt J. Vandegrift, Susanne H. Sokolow, Peter Daszak, and A. Marm Kilpatrick, "Ecology of Avian Influenza Viruses in a Changing World," Annals of the New York Academy of Sciences 1195 (1) (2010): 113–128.

[5] Wetlands Protection, U.S. Environmental Protection Agency 843-F-01-002a, September 2011.

[6] M. Gilbert, J. Slingenbergh, and X. Xiao, “Climate Change and Avian Influenza,” Revue Scientifique et Technique (International Office of Epizootics) 27 (2) (2008): 459–466.

[7] Michael Renner, “Peak Meat Production Strains Land and Water Resources,” Vital Signs, August 22, 2014, <> (accessed April 11, 2017).

[8] OECD/FAO, OECD–FAO Agricultural Outlook 2016–2025, 2016 (Paris: OECD Publishing, 2016), 1–12.

[9] Peggy Lowe and Sarah Boden, “Avian Flu Outbreak Takes Poultry Producers into Uncharted Territory,” broadcast on “Morning Edition,” National Public Radio, May 21, 2015.

[10] Lisa Schnirring, “Vietnam Reports H5N6 and H5N1 Outbreaks as Europe Battles More H5N8,” Center for Infectious Disease Research and Policy, February 20, 2017, <> (accessed April 11, 2017).

[11] United Nations Population Fund, “Urbanization,” October 3, 2016, <> (accessed April 11, 2017).

[12] Xiaoyan Zhou, Yin Li, Youming Wang, John Edwards, Fusheng Guo, Archie C.A. Clements, Baoxu Huang, Ricardo J. Soares Magalhaes, “The Role of Live Poultry Movement and Live Bird Market Biosecurity in the Epidemiology of Influenza A (H7N9): A Cross-Sectional Observational Study in Four Eastern China Provinces,” Journal of Infection 71 (4) (October 2015): 470–479.

[13] Sonila Cook and Oren Ahoobim, “The Planet’s Health Is Essential to Prevent Infectious Disease,” The Guardian, May 15, 2016, <> (accessed April 11, 2017).

[14] UC Davis Veterinary Medicine, “PREDICT Activities: What We Do,” <> (accessed April 11, 2017).


Dr. Nahid Bhadelia, MD, MA   


Dr. Nahid Bhadelia, MD, MA is an infectious diseases physician, Assistant Professor at the Boston University School of Medicine and the Director of Infection Control and Medical Response at National Emerging Infectious Diseases Laboratory (NEIDL) at Boston University (BU). Her specialization is in infection control issues related to emerging pathogens and highly communicable infectious diseases. She is the director of the medical response program for BU’s biosafety level 4 laboratories at the NEIDL, one of 6 such programs in the US. Aside from her clinical training in infectious diseases, she has a master’s degree in international affairs from the Fletcher School of Law and Diplomacy and a background in health and human security with a focus on the impact of pandemics on macro level health indicators and community security. She has previously worked on projects with United Nations International Strategy for Disaster Reduction and the Global Fund to Fight AIDS, Tuberculosis and Malaria. She has served as a front-line physician providing care to Ebola patients in Sierra Leone with World Health Organization. She is a Senior Policy and Technical Advisor to Partners in Health for their Ebola response program in Sierra Leone. She has also been an instructor for the US CDC/FEMA and Taiwan CDC’s healthcare worker preparedness courses for the Ebola Response.

The Future of U.S...

The Future of U.S. Partnerships

A Conversation with Hans Binnendijk

Interviewed by Robert Pulwer

Fletcher Security Review: You wrote an article in December [“Can Trump Make a Deal with Putin?,” authored with William Courtney] mentioning that Trump should engage with Vladimir Putin including on things related to cyber security. Given the events leading up to Donald Trump’s inauguration, have your thoughts on this changed substantially?


Hans Binnendijk: Well it’s pretty clear that Russia did engage in hacking efforts primarily with the Democratic Party. I think this highlights part of the problem. We have to have new rules of the road with Russia and with others. So as part of the much broader effort, I think Trump is going to try to engage in improving relations with Russia. Creating rules of the road for cybersecurity would be an important element of that, but this is just a part of a much broader picture.


So if one looks at our principal potential adversaries across the world, one can identify perhaps five of them. They would include Russia, China, North Korea, ISIS, and Iran potentially, if things go off the rails there. If you look at Russia and China, the two major powers that might be potential adversaries, one could argue, looking at it analytically as I do in my book [Friends, Foes, and Future Directions: U.S. Partnerships in a Turbulent World, published by RAND], that we have a significant interest with China in terms of maintaining good relations, primarily for economic reasons. We also run the risk that Russia and China could be driven together by U.S. and Western policies.


What’s really interesting about Trump’s thinking on this is that, rather than trying to get closer to China and therefore prevent closer Chinese–Russian relations, he’s doing the opposite. He sees our relationship with China as contentious, primarily on economic terms. And if you look at his cabinet appointments and his sub-cabinet appointments, many of them are people who have focused on the trade patterns and economic patterns with China, seeing China as an economic adversary...


As a longer article, this piece will only be offered in PDF format for easier reading. Download the PDF to read more.

Dr. Hans Binnendijk  


Dr. Hans Binnendijk is Vice Chairman of the Fletcher School Board. He has served in senior positions at the National Security Council, the Senate Foreign Relations Committee and the State Department. He has directed think tanks at Georgetown University, the National Defense University, and in Europe. He writes frequently on national security policy.

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