As the Tsunamis Roll Out, A New Warning System for Indonesia has Yet to Roll In

            In 2018, the death toll in Indonesia rose to a record high of 4,500. This resulted from the combined effects of multiple high magnitude earthquakes and two tsunamis. Prior to both tsunamis, the Indonesian tsunami warning system experienced significant failure. The number of casualties increased due to the lack of earthquake and tsunami drills, which left many citizens unaware of the need to flee to higher ground. Straddling the Ring of Fire and containing 295 active fault lines, Indonesia frequently experiences seismic activity, which can trigger tsunamis. Improving the siren system and providing Indonesia with proper earthquake and tsunami procedure education has the potential to decrease the scope of the humanitarian crises brought on by these natural disasters.

In September, a 7.5 magnitude earthquake rattled the Indonesian island of Sulawesi triggering a tsunami which caused mass destruction. Warnings were issued, but were cancelled after 34 minutes based on data from tidal-gauges 125 miles away which indicated no risk of tsunami. Despite the initial issuance of the warning, however, many citizens insist they heard no warning sirens. The combined destruction of the tsunami waves and the earthquake killed 2,100 people and displaced roughly 70,000. In total 4,413 buildings collapsed. In December, the destruction increased after an underwater landslide triggered another tsunami, resulting in at least 281 deaths, 1,000 injuries, and thousands of displaced people. There was no seismic activity, so Indonesia’s earthquake-triggered early warning tsunami detection system did not sound. The failure of the warning system prior to both tsunamis put many Indonesians, who were caught off-guard by the waves, in danger.

Indonesia’s warning system received its last major update in 2004, following the devastating tsunami which killed 225,000 people and led to a nationwide push to improve tsunami detection. With the help of Germany and the United States, 22 warning buoys connected to seabed sensors were deployed. However, since 2012 these buoys have been inoperable due to neglect and vandalization. The UN Disaster Risk Reduction agency found that the area had only 56 of the 1000 warning sirens it needed, lacked 8,8,00 km of evacuation route, and was missing 2,150 evacuation centers. Indonesia was set to implement a new warning system which could detect tsunamis based on factors other than earthquakes, prior to the September earthquake and tsunami, though the Indonesian government’s lack of funds prevented its installation. The new system would have improved upon the current technology by implementing fiber optic cables, which send soundwaves into the ocean depths and collect data on potential tsunamis. A prototype for this system, off the coast of Padang, can detect tsunamis in one to three minutes, two to forty-two minutes faster than the current system. The new system would improve the accuracy of Indonesia’s tsunami detection capabilities, however, the current lack of education for the Indonesian people on tsunami safety procedure would undercut its effects.

The Red Cross and Crescent Society is working to fill this preparedness gap by providing Indonesians with earthquake and tsunami education, while also aiding in the disaster cleanup. Red Cross teams work in schools to teach earthquake preparedness to the children, procedures which Adam Switzer of the Earth Observatory of Singapore says need, “to be ingrained in every child in…Southeast Asia”. NGOs like Oxfam have also been cleaning up the wreckage and providing victims with water and other essential supplies. The extensive damage from these disasters and others has caused Indonesia to lose $2 billion annually. The new detection system with an estimated cost of $19.8 million a year per 200 km, could decrease the cost to the country while also protecting Indonesians from danger and displacement. The State Department should help fund the installation and maintenance of the new tsunami detection system and work to provide earthquake and tsunami preparedness education to the Indonesian citizens to protect them from future tsunamis. To do so, it should help fund organizations like the Red Cross and Oxfam to aid them in their efforts to educate and care for those affected by the tsunamis. Indonesia has an elevated vulnerability to tsunamis given its location on the Ring of Fire, and the State Department should allocate funds to reduce the impact of this vulnerability on the Indonesian people.

India: The Front Line in the War Against Antibiotic Resistance

by Emma Louise Keeler

In 1967, epidemiologist and United States Surgeon General William Stewart proclaimed that “the war against infectious diseases has been won.” Fifty-two years later, not only is the war against infectious diseases far from over, but humanity is increasingly on the losing side due to antibiotic resistance. Nowhere are our losses more apparent than in developing nations. The battle against resistant-pathogens is not one that each nation can fight separately; in order to win, nations must work multilaterally. Each year in the U.S. at least 2 million people are infected by antibiotic-resistant bacteria; of these people, at least 23,000 will die as a result of the infection. In order to fight resistance within our own country, it is necessary to first confront it at one of its origins — India.

For five decades, antibiotic resistance has placed a burden on India’s healthcare system and society. Resistance has undermined attempts to treat both common and lethal infectious diseases. Pneumonia, the number one cause of death for Indian children, causes approximately 410,000 deaths annually. Most, if not all, of these deaths are directly related to the shortage of effective antibiotics. Over 50% of bacterial infections in Indian hospitals are caused by antibiotic-resistant bacteria, and 24% of bacteria are resistant to last-resort, intravenous antibiotics called “carbapenems.”

India’s governmental and economic conditions have generated an ideal breeding ground for resistance. The availability and insufficient regulation of antibiotics have promoted inappropriate antibiotic usage and subsequent resistance. Although it is illegal to sell unregulated antibiotics, millions are sold annually due to the lack of enforcement. A study published by the British Journal of Clinical Pharmacology revealed that nearly two thirds of the fixed-dose combination antibiotics sold in India have not received regulatory approval. This is particularly concerning when considering India’s place as one of the five BRICS countries (Brazil, Russia, India, China, and South Africa), accounting for 75% of the 36% rise in worldwide antibiotic consumption between 2000 and 2010. Out of the BRICS countries, India is responsible for 23% of the increase in retail sales.

Indian medical professionals often irresponsibly prescribe antibiotics at an incorrect dose, frequency, or duration. For example, 45 to 80% of patients with symptoms of acute respiratory infections, common colds, or diarrhea are given an antibiotic despite most of these ailments being viral, not bacterial. The issue of inappropriate prescriptions is exacerbated by both a lack of microbiology facilities and little willingness of patients to undergo tests.

For decades, India’s notoriously poor healthcare infrastructure has suffered from inadequate public finance. The Indian government has also turned a blind eye to the determinants and effects of resistance. However, the recent emergence of the enzyme New Delhi Metallo-beta-lactamase-1 (NDM-1) has galvanized the government into instituting antibiotic-related policies. A Ministry of Health and Family Welfare task force announced a national antimicrobial policy, the National Policy for Containment of Antimicrobial Resistance, that will focus on conducting infection and resistance surveillance, promoting rational drug use through education, banning the selling of antibiotics over-the-counter and restricting the use of potent antibiotics (i.e. carbapenems).

In 2010, 13% of infection-causing bacteria in India were “superbugs” endowed with the NDM-1 enzyme. This enzyme was first isolated from a Swedish patient of Indian origin in 2008 and was shortly detected in India, hence the name New Delhi Metallo-beta-lactamase-1. This specific enzyme makes bacteria resistant to all beta-lactam antibiotics (i.e. penicillins, cephalosporins, carbapenems). Once a bacterium acquires this enzyme, it is virtually unharmed by mainstream antibiotics. Furthermore, this enzyme can be passed between different bacterial pathogens through horizontal gene transfer.

Each year, more than 5.4 million Indians travel internationally, in addition to the 20 million Indian nationals living throughout the world. Due to this, India’s issue of antibiotic resistance, especially that related to the NDM-1 enzyme, is no longer confined to its borders — it is a worldwide concern. Effective antibiotics are as much a globally shared resource, as they are a shared responsibility. The battle against antibiotic resistance must be fought together, starting with an understanding of the situation in other nations.

Agrarian Crisis in India

During the month of October 2018, thousands of farmers from across India marched on New Delhi in in protest and in order to draw attention to the challenges that the countryside faces. Protests have also disrupted life in cities like Kolkata and Mumbai. The farmers have made demands for higher prices for their crops, cheaper fuel and electricity bills and other changes. The government reports that farmers make around $100 a month on average, although the reality is often much less. One leader of the protests, Yogendra Yadav has said that “for a majority of them, the income is probably less than $50 a month. That is the level at which they survive”. Last year there was a protest held in New Delhi where Farmers held skulls to bring awareness to the many farmers who have committed suicide after struggling with debt and crop failure. At least 300,000 farmers have killed themselves since 1995 or have attempted to quit farming, although there is a lack of other routes they can take to make a living. When there is such a great level of unrest and disorder in a country, political leaders must make sure to listen and act on the problems promptly.

The Indian agricultural sector plays a massive role for the country, making up around 16 percent of the country’s economy and providing up to 49 percent of employment according to India’s Economic Survey. Out of India’s 1.3 billion people, most live in rural areas.  

The Indian rupee has fallen greatly in value, and as a result fuel prices in India have increased to the highest level ever before. Diesel prices rose 25 cents in 2018 due to higher prices for crude oil and increased costs of oil imports. Farmers not only work day and night to produce their crops, but must also pay high prices for necessities like fertilizer. When farmers go to sell their crops, they often do not receive enough to make a profit and many of the farmers are deep in debt from trying to carry out their work. India’s erratic weather patterns have also been a challenge for farmers. In some areas there has been prolonged droughts that can destroy a farmers work. Up to half of India’s farmers do not have access to irrigation systems and rely on rain.

Rural support is very important politically for any party to win. Opposition to India’s current Prime Minister is quickly growing and could seriously pose a problem for him if he wishes to be succesfull in this years scheduled elections. The federal government sets the prices for produce and also buys produce from farmers, and government investment in the rural sector has run short. Prime Minister Narendra Modi has promised to double rural income by 2022 and has raised the minimum support price for certain crops. This will not be enough to make an impact on most rural communities. If Prime Minister Modi is not motivated to make change in order to save such a large section of his country’s people, then hopefully he will be motivated politically.