Today’s landmark deal between six world powers and Iran, which would limit Iran’s nuclear program in exchange for lifting economic sanctions, was an important step toward stopping Iran from building a nuclear bomb.

However, the key challenge for the international community will be making sure Iran keeps its part of the bargain, according to Stanford experts.

“Both sides have made a series of compromises that will help Iran’s economy in exchange for constraining its nuclear capabilities – and that’s a deal worth making, in my view,” said Scott Sagan, the Caroline S.G. Munro professor of political science and senior fellow at the Center for International Security and Cooperation.

“Iran will still have a technical capability to develop nuclear weapons, given the technology and materials that they have, but under this deal it will both take them a much longer period of time and would require them to take actions that would be easily discerned by the International Atomic Energy Agency, so it constrains their break-out capabilities in important ways.”

[[{"fid":"219719","view_mode":"crop_870xauto","fields":{"format":"crop_870xauto","field_file_image_description[und][0][value]":"","field_file_image_alt_text[und][0][value]":"","field_file_image_title_text[und][0][value]":"Final plenary session at the United Nations Office in Vienna, Austria. Photo credit: U.S. State Department","field_credit[und][0][value]":"","field_caption[und][0][value]":"","field_related_image_aspect[und][0][value]":"","thumbnails":"crop_870xauto","pp_lightbox":false,"pp_description":false},"type":"media","attributes":{"title":"Final plenary session at the United Nations Office in Vienna, Austria. Photo credit: U.S. State Department","width":"870","style":"width: 400px; height: 266px; float: right; margin-left: 15px","class":"media-element file-crop-870xauto"}}]]The U.S.-led negotiations also included fellow United Nations Security Council members Britain, China, France, and Russia, as well as Germany – a group known collectively as as the "P5+1."

Sig Hecker, former Los Alamos National Laboratory director and senior fellow at Stanford’s Center for International Security and Cooperation, said the nuclear deal was “hard-won and is better than any other reasonably achievable alternative.”

“Iran agreed to considerably greater restrictions on its program than what I thought was possible before the Joint Plan of Action was signed in November 2013,” said Hecker.

Abbas Milani, director of Iranian studies at Stanford and an affiliate at the Center for Democracy Development and the Rule of Law, called it the “least bad deal” for both Iran and the international community.

“Nobody gets everything they want,” Milani said. “Every side gets some of what they want.”

Under the deal, Iran would be allowed to continue to enrich uranium for peaceful purposes in its energy and health industries.

But it would have to reduce the number of its centrifuges from 19,000 to 6,000, and cut its stockpile of low enriched uranium down from more than 20 thousand pounds to about 660 pounds.

“Reducing that stockpile actually lengthens the breakout time more than any other measure,” said Hecker.

These limits were designed to increase the “breakout time” it would take for Iran to produce enough fissile material to make a nuclear weapon from the current two to three months, to one year over a period of the next 10 years.

The agreement still faces a series of political hurdles before it gets implemented, and will face tough scrutiny from a Republican-controlled U.S. Congress, as well as the parliaments of European countries that were parties to the talks.

“I think it’s going to be hard for the U.S. Congress and [European] parliaments to kill the deal and be perceived as the ones who would rather have a war than give diplomacy a chance,” said Thomas Fingar, distinguished fellow at the Freeman Spogli Institute for International Studies.

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“The key is going to be the effectiveness of the verification procedures and IAEA access,” Fingar said.

“There’s an element of trust, but a far more important part is the rigorous verification protocols.”

As soon as the IAEA confirms that Iran is abiding by the terms of the agreement, economic sanctions can be lifted.

Sagan warned that the international community should not be surprised if Iran pushed the limits of the agreement, and should be ready to reimpose economic sanctions if Iran violated the deal.

“We should anticipate that Iranian opponents to the agreement will try to stretch it and do things that are potential violations and that we have to call them on that, and not treat every problem that we see as unexpected,” said Sagan.

“We should anticipate such problems and be ready, if necessary, to reimpose sanctions. Having the ability to reimpose sanctions is the best way to deter the Iranians from engaging in such violations.”

But Hecker said the international community should focus on incentivizing Iran.

“The best hope is to make the civilian nuclear path so appealing – and then successful – that Tehran will not want to risk the political and economic consequences of that success by pursuing the bomb option,” he said.

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Iran faced the threat of military action if it continued to press forward with its nuclear program.

While Russia and China had both signaled that they were likely to abandon the sanctions regime if talks fell apart.

One of the key challenges to reaching an agreement was “finding a language that would allow both parties to declare victory”, according to Milani.

“Iran has clearly made some very substantive concessions, but Iran has also been allowed to keep enough of its infrastructure so that it can declare at least partial victory for the domestic political audience."

Now the scramble is on in Tehran to claim credit for the deal.

Reformists, led by current Iranian President Hassan Rouhani and former president Akbar Hashemi Rafsanjani, hope it will strengthen their hand as they head into the next election.

On the other side of the political spectrum, conservatives believe it could give them the edge in the battle to succeed Ayatollah Ali Khamenei as Iran’s Supreme Leader.

“They understand that whoever gets the credit for this will be in a much better position to determine the future leadership and future direction of Iran’s foreign policy,” said Milani.

It’s too early to tell what impact the agreement might have on Iran’s foreign policy, which is often at odds with U.S. interests in hot spots like Iraq, Syria, Yemen and Afghanistan. But Sagan said today’s deal was an important step in making sure that future conflicts with Iran don’t go nuclear.

“Hopefully those disagreements will be played out without the shadow of nuclear weapons hanging over the future, and that’s a good thing.”

Foreign aid to the public health sectors of developing countries often appears to be allocated backwards: The global burden of non-communicable diseases such as diabetes or heart disease is enormous – yet they receive little health aid. 

By comparison, the global burden of HIV is much smaller, yet it receives more health aid than any other single disease.

So will a wholesale reversal in health aid priorities improve global health? The answer, according to a new study by Stanford researchers, is that if the goal is to maximize the health benefits from each donor dollar, health aid is actually allocated pretty well.

Still, reallocating foreign aid to step up the fight against malaria and TB could lead to greater overall health improvements in developing nations. And it could be done without spending more money, the researchers have found.

Eran Bendavid, an assistant professor in the Department of Medicine and a core faculty member at the Center for Health Policy and Center for Primary Care and Outcomes Research, and three Stanford research assistants write in the July issue of Health Affairs that more health aid is going to disease categories with more cost-effective interventions.

"What we found, somewhat to our surprise, is that in nearly all countries, more aid was flowing to finance priorities with more cost-effective options,” Bendavid said in an interview. “That is partly because more aid was flowing to the treatment and prevention of infectious diseases such as HIV and malaria, and their management can be relatively inexpensive, even if the burden of these diseases is lower than that of non-communicable diseases.”

Bendavid, an infectious disease physician, added: “Conversely, even though the burden of non-communicable diseases is high and growing, addressing these chronic conditions such as diabetes and heart disease is, broadly, more costly than the unfinished infectious disease agenda.”

The authors also show that just because health aid is broadly allocated toward better cost-effectiveness does not mean that it cannot be better allocated.

The biggest gains would come from taking some of the foreign aid earmarked for HIV or maternal, newborn or child health, and putting it toward programs to treat malaria and tuberculosis, they write.

The Stanford research team reviewed the literature for cost-effectiveness of interventions targeting five disease categories: HIV, malaria, tuberculosis, non-communicable disease and maternal, newborn and child health.

What they found was that aid from wealthy nations to developing ones might be allocated efficiently, but that the money is not always spent in the best interest of curbing the communicable diseases that would improve the overall health of a nation.

It is crucial, therefore, to further study the consequences of realignment of donor funds.

Public health aid is critical to most developing countries. Development assistance from high-income countries to public health sectors of low- and middle-income countries amounts to nearly 40 percent of public health spending in countries with a per capita GDP of less than $2,000.

The researchers focused on 20 countries that received the greatest total amount of aid between 2008 and 2011, a period of historically unprecedented growth in health aid. Development assistance has since flattened, however, so the authors believe it’s increasingly important to consider best value when investing limited resources.

The 20 countries studied ­– from Afghanistan to Zambia – received $58 billion out of the total $103.2 billion in recorded health aid disbursements to 170 countries between 2001 and 2011.

“Over the period of 2001-2011, a greater amount of disbursements flowed to HIV programs than any other disease category,” the authors write. “On average, interventions addressing malaria and had the lowest incremental cost-effectiveness ratio (ICER), which indicates that malaria interventions could yield greater health improvements from each dollar compared with the interventions having a higher ICER.”

The authors analyzed the data and determined that the alignment improves if up to 61 percent of HIV aid is reallocated for TB control and up to 80 percent is reallocated for malaria control.

“Our evidence suggests that the greatest improvements in the efficiency of global health dollars could result from reallocating funds to malaria and TB control programs,” the authors write.

“This study shows, for the first time, that the current allocation of health aid is generally aligned with the cost-effectiveness of targeted interventions. Contrary to common views that advocate for reprioritization toward non-communicable diseases, our data suggest that the alignment could best be improved by focusing on malaria and TB, especially where addressing those diseases is highly cost effective.”

The other authors of the study are Andrew Duong and Gillian Raikes, both research assistants in the Program of Human Biology; and Charlotte Sagan, a RA in the School of Medicine.

The increasing resistance to antimicrobial drugs is a growing public health concern, particularly in low- and middle-income countries that require high out-of-pocket payments for prescription drugs.

“Understanding the drivers of antibiotic resistance in low- to middle-income countries is important for wealthier nations because antibiotic-resistant pathogens, similar to other communicable diseases, do not respect national boundaries,” said Marcella Alsan, MD, PhD, MPH, the lead author of the study, which was published July 9 in The Lancet Infectious Disease.

Alsan is an assistant professor of medicine at Stanford, an investigator at the Veterans Affairs Palo Alto Health Care System and a core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research.

“Out-of-pocket health expenditures are a major source of health-care financing in the developing world,” said Jay Bhattacharya, MD, PhD, senior author of the study and a professor of medicine, a senior fellow at the Freeman Spogli Institute for International Studies and another core faculty member at CHP/PCOR.

Read the full article here.

The United Nations has thus far fulfilled its charter to prevent a third world war, but with 60 million refugees, continued bloodshed with unresolved civil conflicts and terrorism spreading like cancer, the world's leading peacekeeping organization must spearhead global action, U.N. Secretary-General Ban Ki-moon said Friday at Stanford on the 70th anniversary of the international organization.

Ban, the U.N.'s eighth secretary-general, did not rest on any laurels during his speech at a public event sponsored by the Walter H. Shorenstein Asia-Pacific Research Center (APARC). "I humbly accept criticism that the U.N. is not doing enough," he said. 

However, the situation could have been worse if not for the United Nations, he continued. "Without peacekeepers, or without the U.N.'s continued humanitarian assistance and advocacy of human rights, I'm afraid to tell you that this world would have been poorer, more dangerous and even bloodier without the United Nations."

Ban's visit to Stanford – his second to the university in less than three years – was part of a trip to the Bay Area to commemorate the signing of the U.N. charter. In 1945, representatives from 50 nations gathered in San Francisco to create the United Nations – an international organization aimed at saving future generations from the "scourge of war."

Today, the United Nations has grown to 193 member nations. Its challenges – from climate change and poverty to civil wars and terrorism – have never been greater, Ban said.

"This is a critical year; 2015 is a year of global action," he said. "The U.N. cannot do it alone. We need strong solidarity among government, business communities and civil societies, from each and every citizen."

The fact that so many young people around the globe are drawn to violent narratives is worrisome, Ban said. "Violent terrorism is spreading like cancer around the world."

The rise in terrorist activities stems from "a failure of leadership," he said. That's why the United Nations needs to develop a comprehensive plan of action to address extremism, he maintained.

The U.N.'s 70th anniversary coincidentally fell on a momentous day of tragedy and celebration around the world. Dozens were killed when terrorists launched horrific attacks across three continents – in France, Tunisia and Kuwait – fueling anger, sadness and fear of more violence.

But in the United States, celebrations rang out in response to a landmark U.S. Supreme Court ruling that legalizes same-sex marriages nationwide.

Ban, who has long advocated for equality and last year pushed the United Nations to recognize same-sex marriages of its staff, drew a round of applause when he heralded the court ruling as "a great step forward for human rights."

The June 26 event was co-sponsored by Shorenstein APARC and the Freeman Spogli Institute for International Studies at Stanford University, with promotional co-sponsors Asia Society, Asia Foundation and the World Affairs Council of Northern California. 

May Wong is a freelance writer for the Stanford News Service.

Coverage and related multimedia links:

Remarks at Stanford University by Ban Ki-moon (U.N. News Centre, 6/26/15)

Photos of Ban Ki-moon at Stanford University (U.N. Photo, 6/26/15)

At Stanford University, Ban says U.N. ready to build a better future for all (U.N. News Centre, 6/27/2015)

U.N. Secretary-General Ban Ki-moon welcomes growing engagement of India, China (NDTV, 6/27/2015)

U.N. Secretary-General Ban Ki-moon speaks at Stanford, celebrates U.N.'s 70th anniversary (Stanford Daily, 6/29/15)

Hoover archival photographs featured at lecture delivered by U.N. Secretary-General Ban Ki-moon (Hoover Institution, 6/29/2015)

“I am the first child of my parents. I have a small brother at home. If the first child were a son, my parents might be happy ... but I am a daughter. I complete all the household tasks, go to school, again do the household activities in the evening … my parents do not give value or recognition to me.”

Stanford Assistant Professor of Medicine Marcella Alsan often refers to this comment by a 15-year-old girl from Nepal when she talks about how the division of labor among men and women starts at a young age in the developing world.

“Anecdotally, girls must sacrifice their education to help out with domestic tasks, including taking care of children, a job that becomes more onerous if their younger siblings are ill,” said, Alsan, a core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research (CHP/PCOR) within the Freeman Spogli Institute of International Studies, and the Department of Medicine.

More than 100 million girls worldwide fail to complete secondary school, despite research that shows a mother’s literacy is the most robust predictor of child survival. So Alsan is analyzing whether medical interventions in children under 5 tend to lead their older sisters back to school.

She is one of two winners of this year’s Rosenkranz Prize for Health Care Research in Developing Countries, awarded by CHP/PCOR to promising young Stanford researchers.

Her Stanford Department of Medicine colleague, Jason Andrews, is the other recipient of the $100,000 prize given to young Stanford researchers to investigate ways to improve access to health care in developing countries.

Andrews is looking at cheap, effective diagnostic tools for infectious diseases, while Alsan is researching how older girls in poorer countries are impacted by the health of their younger siblings.

“My proposed work lays the foundation for a more comprehensive understanding of how illness in households and early child health interventions impact a critical determinant of human development: an older girl’s education,” she said.

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Alsan, the only infectious-disease trained economist in the United States, said Stanford is the ideal place to carry out her interdisciplinary global health research.

“I am humbled and honored to receive this prize, since Dr. Rosenkranz has done so much for women’s health worldwide,” she said.

Alsan – an MD with a specialty in infectious disease who has a PhD in economics from Harvard – said she intends to estimate the impact that illnesses in under-5 children have on older girls’ schooling using econometric tools.

She will compile data from more than 100 Demographic and Health Surveys (DHS) covering nearly 4 million children living in low- and middle-income countries.

The surveys ask about episodes of diarrhea, pneumonia and fever in children under 5 and record data on literacy and school enrollment for every child in the household.

Alsan also intends to collaborate with partners in sub-Saharan Africa to study the gendered effect of household illness on time use, using culturally appropriate questionnaires.

Douglas K. Owens, a Stanford professor of medicine and director of CHP/PCOR, called Alsan’s work “groundbreaking.”

“Although training is critical, more importantly, her work to date shows a degree of innovation, creativity and rigor that led us to conclude she was likely to become one of the top investigators in her field worldwide,” he said.

Low-Cost Diagnostic Tools

Andrews, also an assistant professor of medicine, has been working on ways to bring low-cost diagnostic tools to impoverished communities that bear the brunt of disability and death from infectious disease.

“I began working in rural Nepal as an undergraduate student and as a medical student founded a nonprofit organization that provides free medical services in one of the most remote and impoverished parts of the country,” Andrews said. “As I became a primary physician, and then an infectious diseases specialist, one of the consistent and critical challenges I encountered in this setting was routine diagnosis of infectious disease.”

He said those routine diagnostics were typically hindered by lack of electricity, limited laboratory infrastructure and lack of trained lab personnel.

“In my experiences working throughout rural Nepal – and in India, South Africa, Brazil, Peru and Ethiopia – I found these challenges to be common across rural resource-limited settings,” said Andrews, who founded a nonprofit Nyaya Health – recently renamed Possible Health – which provides modern, low-cost healthcare to rural Nepal.

Andrews has been collaborating with engineers to develop an electricity-free, culture-based incubation and identification system for typhoid; low-cost portable microscopes to detect parasitic worm infections; and most recently an easy-to-use molecular diagnostic tool that does not require electricity.

“The motivation for these projects was not to develop fundamentally new diagnostic approaches, but rather to find simple, low-cost means to make established laboratory techniques affordable and accessible,” he said.

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“We then perform isothermal amplification heated by a reusable, solar-heated, phase-change material,” Andrews said, adding that the entire process is completed in less than 20 minutes and can be performed by anyone with minimal training.

Andrews will enroll 250 patients with suspected cases of cholera in Nepal, using the new diagnostic tools and adapting as many local supplies as possible.

Andrews also intends to establish and curate a website to gather open-source ideas and evidence on diagnostic techniques for use in the developing world.

“Stanford is one of the world’s greatest hubs for innovation and information sharing as pertains to science and technology and is an ideal home for this venture,” he said.

In the current scientific climate, most National Institutes of Health grants go to established researchers. The Rosenkranz Prize aims to stimulate the work of Stanford’s bright young stars – researchers who have the desire to improve health care in the developing world, but lack the resources.

The award’s namesake, George Rosenkranz, first synthesized cortisone in 1951, and later progestin, the active ingredient in oral birth control pills. He went on to establish the Mexican National Institute for Genomic Medicine, and his family created the Rosenkranz Prize in 2009.

The award embodies Dr. Rosenkranz’s belief that young scientists hold the curiosity and drive necessary to find alternative solutions to longstanding health-care dilemmas.

“As in past years, the competition was extremely tough,” said Grant Miller, a senior fellow at the Freeman Spogli Institute and associate professor of medicine who chaired the prize committee this year.

“It’s exciting to see all of the truly innovative global health research being done by junior scholars at Stanford,” he said. “Both Jason and Marcella really exemplify this – and the legacy of George Rosenkranz.”

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Ban Ki-moon, the eighth secretary-general of the United Nations, will deliver a public speech at Stanford University on Friday, June 26.

Ban’s visit will highlight the 70^th anniversary of the founding of the U.N., part of a larger trip to the Bay Area to commemorate the San Francisco Conference, where the charter establishing the U.N. was signed in 1945. After his speech, he will participate in a question and answer session with Ambassador Kathleen Stephens, the U.S. ambassador to the Republic of Korea (2008-11).

The Stanford event will take place at 3 p.m. RSVP is required by June 24; seating is first come, first served. Media must pre-register by 9 a.m. on June 25.

It is Ban’s second visit to Stanford in under three years. In Jan. 2013, he delivered a speech to mark the occasion of the Walter H. Shorenstein Asia-Pacific Research Center (APARC)’s thirtieth anniversary.

“I believe we face a unique opportunity,” Ban said in Dinkelspiel Auditorium. “Because the changes we face are so profound – the decisions we make will have a deeper and more lasting impact than perhaps any other set of decisions in recent decades.”

Calling on students to be ‘global citizens,’ he spoke about the ongoing crisis in Syria, the mandate to act on climate change, and the need for a sustainable peace worldwide.

“Growing up, the U.N. was a beacon of hope for me and my country,” he said. “I urge you to harness that same spirit and make a difference.”

Ban was born in the Republic of Korea in 1944. As a youth, more than fifty years ago, Ban visited California during his first trip to the United States with a Red Cross, saying “my trip here opened my eyes to the world.” He has since held a 37-year career in public service in the Ministry of Foreign Affairs, including the role of minister of foreign affairs and trade, foreign policy advisor and chief national security advisor to the president.

“It’s truly our pleasure to host Secretary-General Ban Ki-moon on the seventieth anniversary of the U.N.,” said Gi-Wook Shin, a Stanford professor and director of Shorenstein APARC. “The U.N. has had a profound impact on the shaping of global order in the postwar era. And Ban’s leadership has steered the organization toward the world’s most pressing aims.”

Ban is reaching the end of his term as secretary-general. He assumed office in Jan. 2007 and was reelected for a second term in June 2011. Over his tenure, Ban has led a major push toward peace and non-proliferation activities, youth, women’s rights and the environment. He has urged leaders of China, Japan and South Korea to work harder on reconciliation over the wartime past to ensure long-term stability in the region.

The June 26 event, which can be followed at #UNatStanford, is co-sponsored by Shorenstein APARC and the Freeman Spogli Institute for International Studies at Stanford University; with promotional co-sponsors Asia Society, Asia Foundation and the World Affairs Council of Northern California.

CONTACT: Event inquires may be directed to Debbie Warren, dawarren@stanford.edu or (650) 723-8387; Media inquires may be directed to Lisa Griswold, lisagris@stanford.edu or (650) 736-0656