Not long ago, an experimental malaria vaccine made newspaper headlines. Over six months, it more than halved serious episodes of malaria in 2,000 children in rural Mozambique. The only trouble is that it will take at least 10 years to come to market.

Fortunately, there are new, effective drugs already available that could start to loosen malaria's stranglehold on many impoverished countries. With a modest global investment, these drugs could be mobilised today.

Malaria is one of the world's greatest threats to life and human performance. Each year, it kills more than 1m people, mainly children in sub-Saharan Africa, and triggers some 500m debilitating attacks in people of all ages throughout the tropics. The toll in lost productivity is a big contributor to Africa's poor economic performance.

All concerned with malaria know that new drugs are needed. After the second world war, a drug called chloroquine became standard. Until about 20 years ago, it worked well in Africa. In addition, it was cheap, averaging 10 cents per treatment. However, chloroquine-resistant strains, which first emerged in south-east Asia, are now rife throughout Africa. The death toll from malaria is rising once again.

What makes this situation more distressing is the existence of an effective alternative. When the first signs of drug-resistant malaria appeared in Asia during the Vietnam war, Chinese scientists developed a family of drugs from sweet wormwood, a common shrub that had been used for centuries in traditional medicine. These "artemisinin compounds" are now standard components of malaria treatment in Asia, where they have proved to be the best ever anti-malarial drugs. To circumvent future drug resistance, however, the time has come to partner artemisinins with other anti-malarial drugs, creating artemisinin combination therapies (ACTs) - the same strategy that underlies the treatment of HIV and tuberculosis. In 2002, the World Health Organisation went on record urging governments to adopt such therapies rapidly in order to provide more effective malaria treatment and slow the spread of drug resistance.

Now the only remaining obstacles to these treatments in Africa are economic. At present, ACTs cost about $2 a treatment, not 10 cents. Subsidies are needed - probably in the region of $500m a year, a small amount on any global scale. The other challenge is how this money enters the drug supply chain.

To overcome the need for a new system of delivery, a recent report from the Institute of Medicine, the US-based health advisory organisation, recommended that ACTs be bought at competitive prices by an international organisation such as Unicef, then resold at a deep discount to governments and private wholesalers in countries where malaria is endemic. The main condition underlying access to subsidised ACTs would be that they flow freely through public and private channels - just as chloroquine does now. This approach would accomplish two objectives: it would allow the existing private market to support the switch to ACTs and it would keep the treatment's cost to consumers down to about the price of chloroquine.

Centralised purchasing has other advantages. It would assure a market for producers, and in particular would encourage the planting of sweet wormwood to overcome the existing reported shortage of artemisinin. It would also facilitate quality control. Moreover, the scale of any international subsidy of combination therapy would discourage the distribution of any solo drug whose use might encourage new resistance down the line.

Above all, in the case of anti-malarial drugs, centralised purchasing would provide the impetus for a swift change in the way the world treats malaria. Without a co-ordinated programme, the change is far more likely to be gradual and incomplete, the scenario most likely to jeopardise the effectiveness of artemisinins over the next few years.

There can be no excuse for delay. Resistance is overwhelming the usefulness of existing drugs, and deaths due to drug-resistant malaria are accelerating daily, especially among the poor of Africa. The IOM has proposed a feasible plan to introduce ACTs quickly. All that remains is for the international donor and finance communities to embrace the logic, allocate funds and take action once and for all against malaria.

From the September/October 2004 issue of Foreign Affairs.

As the war on terrorism continues, statistics on terrorist attacks are becoming as important as the unemployment rate or the GDP. Yet the terrorism reports produced by the U.S. government do not have nearly as much credibility as its economic statistics, because there are no safeguards to ensure that the data are as accurate as possible and free from political manipulation. The flap over the error-ridden 2003 Patterns of Global Terrorism report, which Secretary of State Colin Powell called "a big mistake" and which had to be corrected and re-released, recently brought these issues to the fore. But they still have not been adequately addressed.

Now-common practices used to collect and disseminate vital economic statistics could offer the State Department valuable guidance. Not long ago, economic statistics were also subject to manipulation. In 1971, President Richard Nixon attempted to spin unemployment data released by the Bureau of Labor Statistics (BLS) and transferred officials who defied him. This meddling prompted the establishment of a series of safeguards for collecting and disseminating economic statistics. Since 1971, the Joint Economic Committee of Congress has held regular hearings at which the commissioner of the BLS discusses the unemployment report. More important, in the 1980s, the Office of Management and Budget issued a directive that permits a statistical agency's staff to "provide technical explanations of the data" in the first hour after principal economic indicators are released and forbids "employees of the Executive Branch" from commenting publicly on the data during that time.

The State Department should adopt similar protections in the preparation and dissemination of its reports. In addition to the global terrorism report, the State Department is required by Congress to report annually on international bribery, human rights practices, narcotics control, and religious freedom. Gathering and reporting data for congressional oversight is presently a low-level function at the State Department. The department rarely relies on high-quality, objective data or on modern diagnostic tests to distinguish meaningful trends from chance associations. Adopting safeguards against bias, both statistical and political, would enable Congress to better perform its constitutional role as the White House's overseer and allow the American public to assess the government's foreign policy achievements.

A PATTERN OF ERRORS

Congress requires that the State Department provide each year "a full and complete report" that includes "detailed assessments with respect to each foreign country ... in which acts of international terrorism occurred which were, in the opinion of the Secretary, of major significance." The global terrorism reports are intended to satisfy this requirement, but, over time, they have become glossy advertisements of Washington's achievements in combating terrorism, aimed as much at the public and the press as at congressional overseers.

The 2003 global terrorism report was launched at a celebratory news conference in April. Deputy Secretary of State Richard Armitage and Ambassador J. Cofer Black, the State Department coordinator for counterterrorism, outlined some remaining challenges, but principally they announced the Bush administration's success in turning the terrorist tide. Black called the report "good news," and Armitage introduced it by saying, "You will find in these pages clear evidence that we are prevailing in the fight." The document's first paragraph claimed that worldwide terrorism dropped by 45 percent between 2001 and 2003 and that the number of acts committed last year "represents the lowest annual total of international terrorist attacks since 1969." The report was transmitted to Congress with a cover letter that interpreted the data as "an indication of the great progress that has been made in fighting terrorism" after the horrific events of September 11.

But we immediately spotted errors in the report and evidence contradicting the administration's claims. For example, the chronology in Appendix A, which lists each significant terrorist incident occurring in the year, stopped on November 11-an unusual end to the calendar year. Clearly, this was a mistake, as four terrorist attacks occurred in Turkey between November 12 and the end of 2003. Yet it was impossible to tell whether the post- November 11 incidents were inadvertently dropped off the chronology and included in figures in the body of the report or completely overlooked.

More important, even with the incomplete data, the number of significant incidents listed in the chronology was very high. It tallied a total of 169 significant events for 2003 alone, the highest annual count in 20 years; the annual average over the previous five years was 131. How could the number of significant attacks be at a record high, when the State Department was claiming the lowest total number of attacks since 1969? The answer is that the implied number of "nonsignificant" attacks has declined sharply in recent years. But because nonsignificant events were not listed in the chronology, the drop could not be verified. And if, by definition, they were not significant, it is unclear why their decrease should merit attention.

On June 10, after a critical op-ed we wrote in The Washington Post, a follow-up letter to Powell from Representative Henry Waxman (D-Calif.), and a call for review from the Congressional Research Service, the State Department acknowledged errors in the report. "We did not check and verify the data sufficiently," spokesman Richard Boucher said. "... [T]he figures for the number of attacks and casualties will be up sharply from what was published."

At first, Waxman accused the administration of manipulating the data to "serve the Administration's political interests." Powell denied the allegation, insisting that "there's nothing political about it. It was a data collection and reporting error." Although there is no reason to doubt Powell's explanation, if the errors had gone in the opposite direction-making the rise in terrorism on President George W. Bush's watch look even greater than it has been-it is a safe bet that the administration would have caught them before releasing the report. And such asymmetric vetting is a form of political manipulation.

Critical deficiencies in the way the report was prepared and presented compromised its accuracy and credibility. Chief among these were the opaque procedures used to assemble the report, the inconsistent application of definitions, insufficient review, and the partisan release of the report. These deficiencies resulted in a misleading and unverifiable report that appeared to be tainted by political manipulation.

It is unclear exactly how the report was assembled. The report notes that the U.S. government's Incident Review Panel (IRP) is responsible for determining which terrorist events are significant. It says little, however, about the panel's members: how many there are, whether they are career employees or political appointees, or what affiliations they have. Nor does it describe how they decide whether an event is significant. Do they work by consensus or majority rule? What universe of events do they consider?

The State Department announced a decline in total terrorist attacks, which resulted from a decline in nonsignificant events. But without information about the nonsignificant events, readers were essentially asked to blindly trust the nameless experts who prepared it.

The report's broad definitions, moreover, are sometimes too blunt to help classification. Terrorism is defined as "premeditated, politically motivated violence perpetrated against noncombatant targets by subnational groups or clandestine agents, usually intended to influence an audience." The report specifies that an international terrorist attack is an act committed by substate actors from one nation against citizens or property of another. An incident "is judged significant if it results in loss of life or serious injury to persons, major property damage, and/or is an act or attempted act that could reasonably be expected to create the conditions noted."

But hardly any explanation was provided about how the IRP distinguishes significant from nonsignificant events. When is property damage too minor for an event to be significant? How are nonsignificant events identified? Is the IRP responsible for making these determinations too? Has the source and scope of their information changed over time? The corrected 2003 report, the first to list individual nonsignificant acts, defines as "major" property damage that exceeds $10,000. It does not indicate, however, whether that criterion applied to previous reports.

Admittedly, measuring international terrorism is no easy task. Even scholarly reckonings are not free from subjective judgment, and there are inevitably close calls to be made. The most one can hope for in many cases is consistent application of ambiguous definitions.

Unfortunately, in the global terrorism reports the rules have been applied inconsistently. Many cross-border attacks on civilians in Africa have not been included in the reports, for example, even though similar attacks in other regions have been. The report for 2002, moreover, counts as significant a suicide attack by Chechen shaheeds (Islamist martyrs) against a government building in Moscow that killed 72 people. Yet none of the numerous suicide attacks by the Chechen "black widows" that terrorized Russia and killed scores in 2003 was tallied as an international terrorist attack in the latest report. After one such attack, Russian President Vladimir Putin said, "Today, after a series of recent terrorist attacks, we can say that the bandits active in Chechnya are not just linked with international terrorism, they are an integral part of it." If the State Department considers such attacks domestic, rather than international, it should do so consistently from one year to the next.

Another problem is that the staff that prepared the 2003 global terrorism report did not participate in releasing it; in fact, they have yet to be identified. High-level Bush administration officials presented the report to the media, using it to support White House policies and take credit for the alleged decline in terrorism. Even after the report's flaws were recognized, they continued to spin the figures. When the corrected version was released, Black repeated that "we have made significant progress," despite being pressed to acknowledge that last year the number of significant attacks reached a 20-year high. Given the war on terrorism's central role in the upcoming presidential election, such presentation gives the appearance that the report is being manipulated for political gain.

The State Department has tried to explain the report's flaws using language eerily reminiscent of the Bush administration's justification of the failure to find weapons of mass destruction in Iraq. Spokesman Boucher told reporters that previous claims that the war on terrorism was succeeding had been based "on the facts as we had them at the time [and] the facts that we had were wrong." Even Powell partook in the spinning. On the one hand, he announced that "the [original] narrative is sound and we're not changing any of the narrative." On the other hand, he acknowledged, "We will change the narrative wherever the narrative relates to the data."

To his credit, Powell instructed those responsible for preparing the report to brief Waxman's staff on the procedures they had used and the origins of their mistakes. Based on a summary of the briefing by Waxman's staff, much has come to light. Authority for compiling the list of attacks was shifted from the CIA to the Terrorist Threat Integration Center (TTIC), an organization created in May 2003 to "merge and analyze all threat information in a single location." The TTIC provided information to the IRP, which, it was disclosed, consists of representatives from the CIA, the Defense Intelligence Agency, the National Security Agency, and the State Department's Bureau of Intelligence and Research. A TTIC representative chaired the meetings and could cast a vote to break ties on the classification of an event as significant or nonsignificant.

At least this year, chaos prevailed. The IRP's members changed from meeting to meeting-when they attended the meetings at all. The CIA employee responsible for the database left but was never replaced; in mid-process, an outside contractor who entered data was replaced by another contractor. Because of technical incompetence, the report relied on the wrong cutoff date.

Arithmetic errors were rampant. Larry Johnson, a retired CIA and State Department professional, discovered that the total number of fatalities in the chronology exceeded the number listed in the statistical review in Appendix G. According to Black, the errors resulted from "a combination of things: inattention, personnel shortages and database that is awkward and is antiquated and needs to have very proficient input be made in order for to be sure that the numbers will spill then to the different categories that are being captured [sic]." The debacle is more like an episode of the Keystone Kops than a chapter from Machiavelli, but even that analogy is not very comforting.

SETTING THE RECORD STRAIGHT

Despite the data's limitations, the chronology of significant events in the 2003 global terrorism report yields important information about terrorism's trends, its geographical characteristics, and its magnitude.

Time-series analysis, which seeks to discern trends in given phenomena over time, requires a consistent approach to collecting data. The State Department's terrorism report presents time-series analysis, but by focusing on the total number of attacks it misleadingly combines verifiable data on significant events with nonverifiable data on insignificant ones. And because, as TTIC director John Brennan admitted, "many nonsignificant events occur throughout the world that are not counted in the report," one must also be concerned about consistency in the measurement of the total number of terrorist events. Even if the nonsignificant events were listed (and thus could be verified), trends in significant events are more relevant because they track events that, by definition, are more important. Accurately measuring these trends is a prerequisite for understanding the factors that underlie them and the policies that shape them. In fact, an analysis of the revised report reveals that the number of significant attacks increased from 124 to 175, or by 41 percent, from 2001 to 2003-a significant fact indeed.

The detailed chronology also allows analysts to cumulate terrorist events for each country and cross-classify them according to the country where they occurred and the perpetrators' country of origin. These figures can then be related to the countries' characteristics, yielding information that can help policymakers devise strategies to address terrorism's root causes. Using the global terrorism reports for the years 1997-2002, the authors of this article have previously found that terrorists tend to come from nondemocratic countries, both rich and poor, and generally target nationals from rich, democratic countries.

The State Department has rightly emphasized that the threat of terrorism remains serious, but a close examination of its data helps put the magnitude of the threat in perspective. In 2003, a total of 625 people--including 35 Americans--were killed in international terrorist incidents worldwide. Meanwhile, 43,220 died in automobile accidents in the United States alone, and three million died from AIDS around the world. Comparative figures, particularly when combined with forecasts of future terrorism trends, can help focus debate on the real costs people are willing to bear--in foregone civil liberties and treasure--to reduce the risk posed by terrorism.

CHANGING TRACKS

The State Department currently uses, and Congress accepts, nineteenth-century methods to analyze a twenty-first-century problem. To prevent errors of the type that riddled the 2003 global terrorism report, Congress has two alternatives. It could reassign the State Department's reporting responsibilities to a neutral research agency, such as the GAO (the General Accounting Office, recently renamed the Government Accountability Office) which routinely uses appropriate statistical practices. The problem is that the GAO has little foreign policy expertise and does not necessarily have access to the (sometimes classified) information that goes into the reports. Alternatively, Congress could keep the reports within the State Department's purview but demand that its practices for data collection and analysis be improved and that the reports be insulated from partisan manipulation.

If responsibility remains within the State Department, Congress should establish a statistical bureau in the department to ensure that scientific standards are respected in all reports, thereby elevating the status of data-gathering and statistics there. The bureau would promote consistency, statistical rigor, and transparency. When appropriate, it could seek input from the scientific community. And, while respecting classified sources, it could also insist that sufficient information be released to independent analysts for verification.

To overcome conflicts of interest facing political appointees who issue government reports, the State Department should adopt rules similar to those that govern the production and dissemination of key economic indicators. Career staff who prepare the reports should be given an hour to brief the media on technical aspects of the data, during which time political appointees would be precluded from making public comments. (After the hour elapses, it is expected that political appointees would offer their interpretations.) Career staff should be protected so they can prepare mandated reports without interference from political appointees and then present them for review by the statistics bureau. Once the reports are finalized, but before they are publicly released, they should be circulated to designated political appointees who need to prepare for their release. Disclosure dates should be announced long in advance to prevent opportunistic timing by political appointees.

Last October, in a candid memorandum to top aides that was leaked to the press, Secretary of Defense Donald Rumsfeld admitted, "Today, we lack metrics to know if we are winning or losing the global war on terror. Are we capturing, killing, or deterring and dissuading more terrorists every day than the madrassas [Islamic schools] and the radical clerics are recruiting, training, and deploying against us?" The statement was a stinging acknowledgment that the government lacks both classified and unclassified data to make critical policy decisions. It is also a reminder that only accurate information, presented without political spin, can help the public and decision-makers know where the United States stands in the war on terrorism and how best to fight it.

In a May 14 lecture hosted by the Center on Democracy, Development and the Rule of Law, Francis Fukuyama, PhD -- professor of international political economy at Johns Hopkins University and renowned author of The End of History and the Last Man -- discussed the problem of weak, underdeveloped nation-states; the effectiveness of various approaches to strengthening such states; and the importance of culture, context and history in the task of state-building. His lecture, titled "State-building: A Framework for Thinking about the Transfer of Institutions to Developing Countries," drew a full room of attendees to the Bechtel Conference Center in Encina Hall

A former member of the RAND Corp. and the U.S. Department of State who has written widely on issues of democratization and international political economy, Fukuyama first presented a framework with which nation-states can be evaluated according to two key criteria: the strength of the state, and the scope of its functions. The first refers to a state's ability to enforce its own laws and policies; the second refers to how involved the state becomes in carrying out various societal functions, ranging from basic functions such as maintaining law and order and protecting public health, to more "activist" functions such as running industries and redistributing wealth.

Fukuyama asserted that from a development standpoint, nation-states should be strong but should carry out only the minimum necessary functions. He said that only one country he has studied -- New Zealand -- has effectively moved toward this ideal in recent years. He noted that many struggling, developing nations, such as Brazil, Mexico, Pakistan and Turkey, are overly ambitious in their scope -- attempting to run vast industries, for example -- but are weak and unable to carry out their policies because of factors like corruption. Other states that Fukuyama identified as "failed states," such as Haiti and Sierra Leone, are both limited in scope and weak, attempting to carry out only the most basic governmental functions and not doing it very well.

Fukuyama then discussed and evaluated various approaches to strengthening developing nations. He noted that in recent years much emphasis has been placed on encouraging such nations to reduce the scope of their functions, through deregulation and privatization, but said the effectiveness of this approach is now in question. A more effective approach, he said, is helping weak nation-states build their own strong institutions, such as political parties, public health networks and central banking.

Unfortunately, Fukuyama said, sometimes the efforts of outside organizations to strengthen a country's institutions only make things worse, because solutions are imposed from outside rather than developed from within. "Ideally, we would want a country's own public health system to handle that country's problems with AIDS or malaria," he said. "But when you flood the country with your organization's own doctors and nurses and infrastructure, what do the local doctors do? They quit their government posts to get on the payroll of your NGO." In a few months or years, when the organization withdraws its support, Fukuyama noted, the system collapses, because it was not built to be self-sustaining.

At the end of his talk, Fukuyama emphasized the importance of understanding local culture, context and history in the task of state building. For example, he said, those who run programs aiming to reduce the spread of HIV/AIDS in Africa should consider working with traditional faith healers, as they are an important part of the healthcare system in Africa.

Paul Farmer, MD, PhD, a physician, infectious disease expert and medical anthropologist who has dedicated his life to treating some of the world's poorest populations, spoke to an overflow crowd on April 8, 2004 at the Stanford Institute for International Studies. Farmer spoke in his capacity as the inaugural S.T. Lee Lecturer.

In his talk, titled "The Nexus of Health and Human Rights," Farmer spoke about the clinic he directs in Cange, Haiti. The clinic has become the center of a thriving community-based medical care system that is tackling Haiti's HIV problem head-on, demonstrating that complex medical treatments can be implemented successfully in poor, underdeveloped nations. Farmer, who has won several awards for his humanitarian work, also talked about promoting access to medical care as a basic human right.

The S.T. Lee Lectureship is named for Seng Tee Lee, a business executive and noted philanthropist. Mr. Lee endowed the lectureship in order to raise public understanding of the complex policy issues facing the global community today.