The Europe Center invites the Stanford and area community to join us Friday, May 4th, for a roundtable discussion on the upcoming French elections.    (Sign-up here [link]).  Three analysts from different fields of expertise – Arthur Goldhammer, Laurent Cohen-Tanugi, and Jimia Boutouba – will discuss the election and its wider context.  The Europe Center is timing this public event  for the eve of round 2, with much to analyze from round 1, and policy options to consider for the impending winner.

Round 1 (April 22) results:

• François Hollande: 28.6%
• Nicolas Sarkozy 27.2%
• Marine Le Pen 17.9%
• Jean-Luc Melenchon 11.1%
• François Bayrou 9.1%
• Five other candidates 6.1%

Speculation during the two-week interim period between round 1 and 2 will focus on the leader of the far-right Front National – Marine Le Pen, who took her party to its highest vote tally in modern memory.  How will the two remaining candidates vie for these voters who were apparently preoccupied with a perceived threat from immigration, cultural dilution, and security?  Especially in the wake of the recent tragic violence in Toulouse, candidate Sarkozy courted such far-right voters, but candidate Hollande vociferously chastised the tactic as capitalizing on the tragedy.

Available opinion surveys note widespread disenchantment with incumbent President Nicolas Sarkozy, who has put his personal stamp on Euro-zone rescue and recovery and alliance with German Chancellor Angela Merkel, but who has failed to deliver such reform, stability, or growth in France.  President Sarkozy has also raised the profile of France and its international policy on the Afghan international peace-keeping force, as well as the Arab Spring and most recently international effort to enforce a cease fire in Syria.

French voters also express disappointment with Socialist candidate François Hollande, frequently labeling him and his party as vaguely center-right and having abandoned a clear commitment to the party’s traditional platform of equality and social justice.
Interest – and survey support – grew in the run-up to the first round of voting for the candidate Jean-Luc Mélenchon, who brings a background as a teacher and self-identified Trotskyite, to lead the party Front de Gauche – a loose coalition of ex-Communists, environmental left, and the rough equivalent of U.S. “99%” movement.  

What did not happen this year was to have an “alternative” candidates from what are seen as the edges of ideological spectrum can win enough votes to edge out Sarkozy or Hollande and survive to the second round – as happened in 2002 when Jean-Marie Le Pen (father of Marine) out-placed the Socialist Lionel Jospin, to make it to the second round, and effectively compel center-left Socialists to hand the election to Jacques Chirac.
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The French presidential election is organized to accommodate two rounds.  The first round took place Sunday, April 22.  Because no candidate won more than fifty percent of the vote, there will be a run-off election of the top two candidates, on Sunday, May 6.
Basic facts of the structure of the French Presidential election are at:
http://www.heraldtribune.com/article/20120420/API/1204200768?p=1&tc=pg

Latest blog entry by Arthur Goldhammer: http://artgoldhammer.blogspot.com/

Opinion poll results from the leading agency Ipsos Public Affairs are updated frequently at: http://www.ipsos.fr/presidentielle-2012/index.php

Returning to her office in Pyongyang from a site visit to an agricultural development project one day last year, Katharina Zellweger had a revelation to share with her colleagues:

“I saw trees, bushes, upland rice, maize, berries, and all kinds of other crops planted on the hillsides!” she said.

Life in North Korea today is much more vibrant than the stark slopes and muted grey concrete buildings Zellweger encountered when she began traveling to North Korea in the mid-1990s. Day-to-day existence is still a struggle for many people, especially in the countryside, but Zellweger, who is the 2011–12 Pantech Fellow with Stanford’s Korean Studies Program, has watched positive change slowly ripple throughout the country for 17 years.

“If you have the patience and perseverance, and try to understand the country as well as you can, it is possible to do work there that is meaningful for the survival of the people and for the future of the country,” she said during a recent interview. 

Zellweger’s projects in North Korea began in 1995 while she worked for the Hong Kong office of Caritas Internationalis, a Catholic network of humanitarian organizations, and continued when she moved to Pyongyang to lead the efforts of the Swiss Agency for Development and Cooperation, a part of Switzerland’s Federal Department of Foreign Affairs. She lived in Pyongyang and interacted with North Koreans on a daily basis for five years until coming to Stanford in October 2011.

Since her earliest visits to North Korea, Zellweger has introduced ways to help alleviate the formidable problem of food scarcity and hunger. North Korea has always been a country of urban dwellers, she said, and the 60 percent of North Koreans who live in cities drain the countryside of its crops. In an effort to carve out new places to grow food during the toughest years, farmers have resorted to stripping hillsides of their trees. The solution is short-term and unsustainable, though, as the denuded slopes can only be planted for a few years, and it leads to soil erosion and flooding.

“If you do not have enough to eat and you are hungry, that is what people do,” Zellweger said. 

She and her team tackled the problem in one province with a simple solution. They taught rural housewives to plant bands of deep-root vegetation every 10 meters along cleared hillsides. The slopes are a “no man’s land” outside of the commune system, and the women have official permission to either keep what they harvest or sell it in the market for extra income. The environment also reaps big benefits from this sustainable agricultural method, which is catching on in more provinces.

“The last time I visited the project, the women told me that they now grow about 15 species of crops, whereas previously they only had one or two,” Zellweger said. “It has brought biodiversity back to those areas.”

Along with receptiveness to new farming techniques, North Koreans have also embraced certain technological developments. Even though the city and countryside are relatively cut off from one another, for example, cell phone tower transmissions now crisscross most of North Korea. Already one million of North Korea’s 24 million citizens own cell phones, and can find coverage in 75 percent of the country.

“Mobile telephones are not just in the big cities—even farm managers have them,” Zellweger said. “With that, communication has improved a lot among the North Korean people.” 

Some ripples of change have also penetrated North Korea’s educational system. English replaced Russian a few years ago as the main foreign language taught in school, Zellweger said, who smiled as she described the warbling greetings of school children who would sometimes approach her to test out their language skills.

“Years ago, I would not even have eye contact with people,” she said. “People would simply look down, and I would feel like thin air, as if I did not exist. That has gone—there is now a certain amount of natural curiosity.”

When she first began visiting North Korea, the Pyongyang Business School, a professional development project close to Zellweger’s heart, did not exist yet. Under her leadership, several groups of 30 to 35 mid-level managers and government officials had the opportunity to participate in a special diploma program. During each 12-month program cycle, lecturers from the Hong Kong Management Association flew monthly to Pyongyang to teach an intensive three-day seminar on subjects ranging from finance to management.

“The Hong Kong lecturers would say, ‘We could not have more diligent students,’” Zellweger said. “The feedback from the students was also very, very positive.”  

As Zellweger experienced during her 17 years working in North Korea, change may unfold gradually there but it does come. And for the positive development to grow even more transformative, she said, the basic needs of everyday North Koreans must be met. 

“When basic needs like food and medical care are covered, I believe things will start moving forward at a different pace,” Zellweger said. “There are 24 million people in North Korea who just want to lead a decent life, and who have the same dreams and hopes as we all have. That goes beyond any political issue.” 

Zellweger will give a talk on May 11 about her work and the change she witnessed in North Korea.

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A once-a-day pill to help prevent HIV infection could significantly reduce the spread of AIDS, but only makes economic sense if used in select, high-risk groups, Stanford researchers conclude in a new study.

The researchers looked at the cost-effectiveness of the combination drug tenofovir-emtricitabine, which was found in a landmark 2010 trial to reduce an individual’s risk of HIV infection by 44 percent when taken daily. Patients who were particularly faithful about taking the drug reduced their risk to an even greater extent – by 73 percent.

The results generated so much interest that the Stanford researchers decided to see if it would be cost-effective to prescribe the pill daily in large populations, a prevention technique known as pre-exposure prophylaxis, or PrEP.

They created an economic model focused on gay men, as they account for more than half of the estimated 56,000 new infections annually in the United States, according to the Centers for Disease Control and Prevention.

“Promoting PrEP to all men who have sex with men could be prohibitively expensive,” said Jessie Juusola, a PhD candidate in management science and engineering in the School of Engineering and first author of the study. “Adopting it for men who have sex with men at high risk of acquiring HIV, however, is an investment with good value that does not break the bank.”

For instance, using the pill in the general population of gay men would cost $495 billion over 20 years, compared to $85 billion when targeted to those at particularly high risk, the researchers found. The study will be published in the April 17 issue of the Annals of Internal Medicine.

Senior author Eran Bendavid, an affiliate of Stanford Health Policy at the Freeman Spogli Institute, said the results are a departure from a previous study. Earlier research found PrEP was not cost-effective when compared with other commonly accepted prevention programs.

The new Stanford study differs in a few important respects, taking into consideration the decline in transmission rates over time as more individuals take the pill. The Stanford team also assumed individuals would stop taking PrEP after 20 years, not stay on the drug for life, as the previous study had assumed.

The pill combination, marketed under the brand name Truvada, is widely used for treating HIV infection. But it wasn’t until a landmark trial, published in the New England Journal of Medicine in November 2010, that individuals and their doctors began to seriously consider using the drug as a preventive therapy. The drug’s maker, Foster City, Calif.-based Gilead Sciences Inc., has filed a supplemental new drug application to market it for prevention purposes.

The CDC issued interim guidelines on the drug’s use in January 2011, suggesting that if practitioners prescribe it as a preventive measure, they regularly monitor patients for side effects and counsel them about adherence, condom use and other methods to reduce their risk of infection.

In developing their model, the Stanford researchers took into account the cost of the drug – about $26 a day, or almost $10,000 a year – as well as the expenses for physician visits, periodic monitoring of kidney function affected by the drug, and regular testing for HIV and sexually transmitted diseases.

“We’re talking about giving uninfected people a drug that has some toxicities, so it’s crucial to have them monitored regularly,” said Bendavid, who is an assistant professor of medicine in Stanford’s School of Medicine.

Without PrEP, the researchers calculated there would be more than 490,000 new infections among gay men in the United States in the next 20 years. If just 20 percent of these men took the pill daily, there would be nearly 63,000 fewer infections.

However, the costs are substantial. Use of the drug by 20 percent of gay men would cost $98 billion over 20 years; if every man in this group took PrEP for 20 years, the costs would be a staggering $495 billion.

Given these figures, the researchers looked at the option of giving PrEP only to men who are at high risk – those who have five or more sexual partners in a year. If just 20 percent of these high-risk individuals took the drug, 41,000 new infections would be prevented over 20 years at a cost of about $16.6 billion.

At less than $50,000 per quality-adjusted life year gained (a measure of how long people live and their quality of life), that strategy represents relatively good value, according to Juusola.

“However, even though it provides good value, it is still very expensive,” she said. “In the current health care climate, PrEP’s costs may become prohibitive, especially given the other competing priorities for HIV resources, such as providing treatment for infected individuals.”

She said the costs could be significantly reduced if the pill is found to be effective when used intermittently, rather than on a daily basis. Current trials are examining the effectiveness of the drug when used less often.

Other co-authors are Margaret L. Brandeau, the Coleman F. Fung Professor of Engineering, and Douglas K. Owens, the Henry J. Kaiser, Jr. Professor at Stanford and senior investigator at the Veterans Affairs Palo Alto Health Care System. Owens also is director of Stanford’s Center for Health Policy and Center for Primary Care and Outcomes Research.

The study was funded by the National Institutes of Health and the Department of Veterans Affairs and supported by Stanford’s departments of Medicine and Management Science and Engineering.