US Panel Recommends New Adult Vaccine Against Hepatitis B

A federal advisory panel is recommending a new vaccine against hepatitis B.

 

The vaccine called Heplisav-B was licensed in November and is the first new hepatitis B vaccine in 25 years.

 

Hepatitis B vaccines have been in childhood shots for decades. The new vaccine is for adults.

 

The hepatitis B virus can damage the liver and is spread through contact with blood or other bodily fluids. Cases have been rising, a trend linked to the heroin and opioid epidemic. Meanwhile, researchers found older vaccines falter in diabetics and older adults.

 

The new vaccine uses an additive that boosts the body’s immune response. It is two shots given over one month.

 

The Advisory Committee on Immunization Practices endorsed the vaccine Wednesday in Atlanta. The government usually adopts its recommendations.

 

 

Bollywood Menstruation Movie Sparks Conversation on Taboo Subject

Drafting a menstrual hygiene program to be taught in schools in India’s western Maharashtra state posed a challenge: How to train teachers to become comfortable talking about a subject that is never openly spoken about, even inside homes, and has long been surrounded by taboos.

“It is a very inhibiting environment,” said Bharathy Tahiliani in Mumbai, who helped design the teaching modules for the program spearheaded by United Nations Children’s Agency. “It puts a lot of fears in the hearts and minds of girls.”

Now a Bollywood film, Padman, dubbed the world’s first feature film to address the subject of menstruation, could make it easier to confront the stigma that surrounds the hushed topic. Winning accolades and a huge audience since it opened this month, the movie has helped catapult words such as sanitary napkins and periods into newspaper articles, television debates and social media.

Starring a top hero, Akshay Kumar, the film is based on the true-life story of a social entrepreneur in South India who set out on a mission to make low-cost sanitary napkins after he discovers his wife uses rags. 

In one scene, Padman shows him cycling around a village wearing a sanitary napkin he has made and using animal blood to test if it leaked. It also depicts the horror in the small town as he openly talks about menstruation. 

Dozens of Bollywood actors and actresses have joined in to spread the message: In a country where shopkeepers discreetly pack sanitary napkins in black plastic bags under the counter so that they are not visible, they have tweeted photos of themselves holding up sanitary pads.

“It is fantastic,” the overjoyed film director, R. Balki, told VOA after witnessing the reaction of some viewers. “There were men with their wives and they were coming out of the theater and talking about just not the film, they were talking about a pad as if it is an everyday conversation. Just to make that come out in the open is a big, big deal.”

Social activists say the buzz generated by the movie could help efforts to tackle the issue of menstrual hygiene and sanitation in villages, slums and other low-income communities.

Targeting myths, taboos

In India, as in several countries, the myths and taboos about menstruation are many: Women cannot visit temples, take part in religious ceremonies or prepare food. The greater challenge is that an estimated 20 percent of adolescent girls drop out of school after puberty, and unhygienic practices lead to infections.

Pointing out that this reinforces gender inequalities, Tahiliani said education is the key to correcting misconceptions. But she said that for a very long time, “who owns the subject” was itself a challenge, with few willing to wade into a hyper-sensitive topic. That has been slowly changing in recent years, and several states like Maharashtra are implementing menstrual hygiene programs in schools and communities, often in partnership with voluntary groups.

One of them, the Center for Advocacy and Research, has been helping set up adolescent forums in slums and low-income areas in cities like Delhi and Kolkata to create awareness.

A member of a forum in the eastern city of Kolkata, 20-year-old Rehana Khatun said she was hesitant to attend programs on menstrual awareness when she was young. “People used to discourage us,” she said. “Why do you go there? They teach you dirty things.” Now, she is on the frontlines of those going around schools and communities to talk about it. “Young girls should not get scared the way I did, I thought I had some illness,” she recalled about the onset of puberty.

Another volunteer, Mohini Khatun, hopes the conversation that Padman has generated will bring the subject out of the closet, especially within families.

“Our adolescent group will go and watch it,” she said. “It is essential that our mothers and fathers should also go.”

Into rural India and beyond

However, while the movie is helping generate discussions in cities and towns, it remains to be seen whether it will do the same in rural India.

The makers of Padman say they are trying to take the film to tens of thousands of villages across the country. “The problem is there are lots of places where there are no theaters. We are trying to tie up with various foundations to screen this film in lots of villages free of cost,” said director Balki.

And although Bollywood movies are a rage in several Asian countries, it is uncertain how this film will fare outside India, where similar sensitivities exist. The challenge will not be easy. Already Pakistan’s censor board has banned the film, saying that the movie is about a taboo subject and releasing it would go against culture and tradition.

Vice President Brings Advisory Group to Kennedy Space Center

Vice President Mike Pence has brought a newly revived advisory group to Florida’s Kennedy Space Center for a rundown on how best to get Americans back to the moon, a half-century after NASA’s Apollo heydays.

Pence convened the meeting Wednesday morning inside the building where NASA once prepped pieces of the International Space Station.

This is the second meeting of the National Space Council. Pence, its chairman, named a group of candidates to advise the council that includes Buzz Aldrin and other former astronauts and aerospace industry leaders.

Wednesday’s meeting focuses on the Trump administration’s plan to return astronauts to the moon and get them to Mars and “worlds beyond.”

Pence toured Kennedy last summer just as the space council was being re-established after two decades.

Drought Over: US Women Win 1st Olympic Cross-country Gold

The long Olympic drought is over for the United States in cross-country skiing.

Jessica Diggins and Kikkan Randall became the first Americans to win an Olympic gold medal in the sport on Wednesday by shocking powerhouses Norway and the Sweden in the women’s team sprint at the Pyeongchang Games.

 

Diggins passed Norway’s Marit Bjoergen, the most decorated Winter Olympian of all time, on the final lap and out-sprinted Sweden’s Stina Nilsson to the finish. Diggins screamed as she crossed the finish line, setting off a huge celebration for the red, white and blue.

 

As Diggins collapsed to the ground, Randall jumped on her and American teammates cheered from behind the wall guarding the entrance to the course. Soon they all joined together in one huge celebration.

 

To put the victory in perspective, the United States had never won a medal of any kind in women’s cross-country skiing prior to the race.

 

The only American to previously win an Olympic medal in the sport was Bill Koch, who took silver in the 30-kilometer race in the 1976 Winter Games in Innsbruck.

 

The Americans posted the fastest time in the semifinals to start on the front row in the final. Diggins passed the Swedes and the Norwegians on the final lap to secure the elusive win. Sweden took silver and Norway finished with a bronze, which allowed Bjoergen to secure her record 14th medal in the Winter Games. That broke her tie with Norwegian biathlete Ole Einar Bjourndalen for most medals in the Winter Olympics.

 

To Get a Ride, Uber Says Take a Walk

The latest variation of an Uber ride will require a short walk.

In eight U.S. cities, the ride-hailing company is rolling out a service called “Express Pool,” which links riders in the same area who want to travel to similar destinations. Once linked, riders would need to walk a couple of blocks to be picked up at a common location. They also would be dropped off at a site that would be a short walk from their final destinations.

Depending on time of day and metro area, Express Pool could cost up to 75 percent less than a regular Uber ride and up to half the cost of Uber’s current shared-ride service called Pool, said Ethan Stock, the company’s product director for shared rides.

Pool, which will remain in use, doesn’t require any walking. Instead it takes an often circuitous route to pick up riders at their location and drops them at their destination. But that can take longer than Express, which travels a more direct route.

Uber has been testing the service since November in San Francisco and Boston and has found enough ridership to support running it 24 hours per day. Within the next two days, the around-the-clock service will start running in Los Angeles; Philadelphia; Washington, D.C.; Miami, San Diego and Denver. More cities will follow, Uber said.

The new service could spell competition for mass transit, but just how much depends on how well it works and how good the mass transit is, said Mark Hallenbeck, director of the Washington State Transportation Center at the University of Washington. If buses or subways are overcrowded and Uber can provide service for a similar price, that will help with mobility.

“If, however, you are cannibalizing transit that’s not over-subscribed, then that becomes a bad thing,” Hallenbeck said.

Also, if the ride-sharing service pulls people off mass transit and creates more automobile traffic, that will add to congestion, he said.

The service could complement Uber X, the company’s door-to-door taxi service — or draw passengers away from it.

Stock said the system should work well with public transit, providing first-mile and last-mile service for transit riders and by providing service to low passenger volume areas where it’s not cost effective for public transit to serve. He also says it will reduce congestion by cutting the number of personal vehicle trips.

Express already has ride-sharing competitors such as Via, which operates in New York, Chicago and Washington, D.C.

Express Pool will have normal-sized cars, at least initially, and optimally will carry a maximum of three passengers so riders aren’t crammed into the vehicles. It could be expanded to six-passenger vehicles, Stock said.

It will take one to two minutes for Uber’s computers to match a rider to a driver and other riders and select a pick-up point, Stock said.

The lower cost of the service should help Uber grow, Stock said. “More riders can afford to take more trips for more reasons,” he said. Already Uber Pool accounts for 20 percent of Uber trips in the cities where it’s available.

S. Korea official: GM 0ffers $2.8B Investment in S.Korea Over 10 Years

General Motors has proposed $2.8 billion of fresh investment into its South Korean operations over the 10 years as part of its plan to restructure the embattled unit, a South Korean senior government official said on Wednesday.

The offer comes as the Detroit carmaker and the South Korean government discuss restructuring options at loss-making GM Korea, one of GM’s largest offshore operations.

The official with direct knowledge of the matter said GM had also asked South Korea to inject funds into GM Korea in which the country’s state bank also holds a stake. However, the official added that a close look into GM’s proposal was necessary to determine whether the investment plan was sufficient to rescue the unit, which directly employs some 16,000 workers.

“We need to have a closer look through the audit,” the official said.

South Korea’s trade minister said the government has also asked for an audit into GM’s “opaque” management in the country.

“By opaque we mean the high rate of profits to raw material costs, interest payments regarding loans and unfair financial support made to GM’s headquarters,” said Minister Paik Un-gyu told lawmakers in parliament.

Last week, the U.S. automaker announced it would shut down a factory in Gunsan, southwest of Seoul, and said it was mulling the fate of its three remaining plants in South Korea.

A South Korean lawmaker said earlier that GM had put forward a proposal including the investment plan and a debt to equity swap of the Korea unit’s borrowings to the parent company.

In return, GM requested South Korea to take part in financing the investment and raising capital, according to a statement by Jung You-sub, the lawmaker from Bupyeong where GM runs its biggest factory in South Korea.

Jung’s office was not immediately available for comment.

On Tuesday, Reuters reported GM had offered to convert debt of around $2.2 billion owed by its ailing South Korean operation into equity in exchange for financial support and tax benefits from Seoul, four sources with direct knowledge of the matter said.

 

Researchers Harness the Power of Algae to Generate Really Green Energy

Fuel made from plants like corn, soybeans, even algae have been around for decades. Now, researchers have developed an algae-powered fuel cell that is ,self-repairing, self-replicating, biodegradable and much more sustainable than existing models. Faith Lapidus has details.

S. Korea’s Cryptocurrency Industry Welcomes Regulator’s Dramatic Change of Heart

South Korea’s cryptocurrency industry is anticipating much better times as the market regulator changes tack from its tough stance on the virtual coin trade, promising instead to help promote blockchain technology.

The regulator said Tuesday that it hopes to see South Korea — which has become a hub for cryptocurrency trade — normalize the virtual coin business in a self-regulatory environment.

“The whole world is now framing the outline [for cryptocurrency] and therefore [the government] should rather work more on normalization than increasing regulation,” Choe Heung-sik, chief of South Korea’s Finance Supervisory Service (FSS), told reporters.

FSS has been leading the government’s regulation of cryptocurrency trading as part of a task force.

Cryptocurrency operators have drawn a new optimism from Choe’s comments, seeing them clearly indicating the government’s cooperation in their plans for self-regulation.

“Though the government and the industry have not yet reached a full agreement, the fact that the regulator himself made clear the government’s stance on cooperation is a positive sign for the markets,” said Kim Haw-joon of the Korea Blockchain Association.

Wednesday’s news is a stark reversal of the justice minister’s warnings in January that the government was considering shutting down local cryptocurrency exchanges, throwing the market into turmoil.

Instead, South Korea banned the use of anonymous bank accounts for virtual coin trading as of January 30 to stop cryptocurrencies being used in money laundering and other crimes.

Bitcoin, the world’s most heavily traded cryptocurrency, is now changing hands at a three-week high of $11,086 on the Luxembourg-based Biststamp exchange after falling as low as $5,920.72 in early February.

South Korean electronics giant Samsung has already started production of cryptocurrency mining technologies, local media reported in January.

S. Korea Signs Free Trade Deals With 5 Central America Countries

South Korea said on Wednesday it is signing free trade agreements with five Central American nations aimed at boosting market access for the Korean auto sector and electronics makers.

Trade minister Kim Hyun-chong will meet representatives from Costa Rica, El Salvador, Honduras, Nicaragua and Panama in Seoul on Wednesday to sign five separate bilateral pacts which will eliminate duties on about 95 percent of traded goods and services, Korea’s trade ministry said in an e-mailed statement.

The agreements are subject to parliamentary approval in each country, and is likely to take effect at different times depending on the ratification process.

The five trade pacts open South Korea to key Central American countries after its deals with the U.S., the European Union and China helped boost exports.

“The South Korea-Central America free trade deals will enable the countries to build a more comprehensive, strategic partnerships going forward,” Kim said.

The ministry expects the five deals to accelerate South Korea’s economic growth by an overall 0.02 percent in the next 10 years, by boosting exports of cars, steel, cosmetics products, and auto components.

Artificial Intelligence Poses Risks of Misuse by Hackers, Researchers Say

Rapid advances in artificial intelligence are raising risks that malicious users will soon exploit the technology to mount automated hacking attacks, cause driverless car crashes or turn commercial drones into targeted weapons, a new report warns.

The study, published on Wednesday by 25 technical and public policy researchers from Cambridge, Oxford and Yale universities along with privacy and military experts, sounded the alarm for the potential misuse of AI by rogue states, criminals and lone-wolf attackers.

The researchers said the malicious use of AI poses imminent threats to digital, physical and political security by allowing for large-scale, finely targeted, highly efficient attacks. The study focuses on plausible developments within five years.

“We all agree there are a lot of positive applications of AI,” Miles Brundage, a research fellow at Oxford’s Future of Humanity Institute. “There was a gap in the literature around the issue of malicious use.”

Artificial intelligence, or AI, involves using computers to perform tasks normally requiring human intelligence, such as making decisions or recognizing text, speech or visual images.

It is considered a powerful force for unlocking all manner of technical possibilities but has become a focus of strident debate over whether the massive automation it enables could result in widespread unemployment and other social dislocations.

The 98-page paper cautions that the cost of attacks may be lowered by the use of AI to complete tasks that would otherwise require human labor and expertise. New attacks may arise that would be impractical for humans alone to develop or which exploit the vulnerabilities of AI systems themselves.

It reviews a growing body of academic research about the security risks posed by AI and calls on governments and policy and technical experts to collaborate and defuse these dangers.

The researchers detail the power of AI to generate synthetic images, text and audio to impersonate others online, in order to sway public opinion, noting the threat that authoritarian regimes could deploy such technology.

The report makes a series of recommendations including regulating AI as a dual-use military/commercial technology.

It also asks questions about whether academics and others should rein in what they publish or disclose about new developments in AI until other experts in the field have a chance to study and react to potential dangers they might pose.

“We ultimately ended up with a lot more questions than answers,” Brundage said.

Tiger Named as US Ryder Cup Vice Captain


Fourteen-times major winner Tiger Woods will serve as one of the vice captains on the U.S. Ryder Cup squad that will try to snap a 25-year drought on European soil later this year, Jim Furyk said on Tuesday.

Furyk, who will serve as captain when holders United States battle Europe in September at the Golf National on the outskirts of Paris, also announced 12-times PGA Tour winner Steve Stricker as a vice captain.

“To win in Paris will be a great challenge, and to have Steve and Tiger share in the journey is important for me and for American golf,” said Furyk, who made the announcement from the PGA of America Headquarters in Palm Beach Gardens, Florida.

Served as vice captain in 2016

“The deep appreciation they both have for competition, the concept of team, and the Ryder Cup is infectious. Their knowledge and experience will be an invaluable resource in our effort to retain the Ryder Cup.”

Woods, who this week will make his third start of the PGA Tour season after a year-long absence during which he had back surgery, first served as a vice captain at Hazeltine in 2016.

The 42-year-old Woods is a veteran of seven Ryder Cups as a player, most recently in 2012. He said he was thankful to be selected as a vice captain but is still keen to earn a spot on the team as a player.

“My goal is to make the team, but whatever happens over the course of this season, I will continue to do whatever I can to help us keep the Cup,” Woods said in a video played at the news conference. “I’m excited about the challenge.”

Furyk said Woods possesses an ability to effectively pair players together in foursomes and fourballs while also inspiring a young team room filled with players who took up the game in the hope of emulating Woods.

Woods may have plenty of ground to make up if he hopes to be a playing vice captain, but Furyk did not rule out the greatest golfer of his generation filling a dual role.

“I want to do what’s best for Tiger and I want to do what’s best for the team and that would be a bridge we cross when we got there,” said Furyk. “If he could be valuable as a player, I mean, I’m sure we would want him playing on this team. But there’s so much time to go.”

Third time for Stricker

This year’s Ryder Cup, to be played from Sept. 28-30, will mark Stricker’s third stint as a vice captain, having served at Gleneagles in 2014 and in the 2016 U.S. victory at Hazeltine.

Furyk previously appointed former Ryder Cup captain Davis Love III as a vice captain and will announce additional vice captains at a later date.

The United States won the biennial matchplay event at home in 2016, marking their first triumph since 2008, but they have not celebrated on European soil since a 15-13 victory at The Belfry in England in 1993. 

Brazil’s ‘What a Shot’ Music Video Stirs Debate Amid Violent Crime Wave

A viral music video called “What a shot” is stirring debate in Brazil about the glamorization of crime and freedom of expression, as surging crime in Rio de Janeiro has led the government to put troops in charge of security in the tourist city.

The hit by Jordana Gleise de Jesus Menezes — known as JoJo Todynho — has spawned myriad parody videos on YouTube since it was released in December.

The clips often show children and adults collapsing to the ground as a shot rings out following the lyrics “What a shot,” before the person stands up and begins to dance as the music picks up.

The spoofs have revived debate about whether the popular dance music genre from Rio de Janeiro, known as funk, glamorizes violence. On Friday, Brazil’s government ordered the army to take over command of police forces in Rio de Janeiro state to curb violence after killings increased by nearly 8 percent last year to 6,731.

A petition to outlaw funk music because of its explicit treatment of violence, sex and drugs gained more than 20,000 signatures last year but has failed to gain traction in Congress. In a population of around 210 million people, the government recorded 59,080 gun deaths in 2015, putting it in the top 10 World Bank list of the most murderous countries.

In a music video featuring images of coffins and the faces of young children killed by stray bullets in Rio, rapper Gabriel O Pensador, also from Rio, Brazil’s second-largest city, objected to the parodies.

“What a shot? No, I’m not going to fall to the floor … I’m a joker too, but joking has a time and a place,” he raps. “The Rio that we love celebrates carnival and this violence is terrifying.”

A city in the northeastern state of Alagoas tried to ban the song being played during Carnival this month, arguing it incited violence. Authorities sought to impose a fine of 2,000 reais ($616) for each violation, but a court stopped the city from punishing musicians before a final ruling is reached, media reports said.

Todynho, 21, whose artistic name refers to a popular brand of chocolate milk, is from Rio’s tough western neighborhood of Bangu. She said the phrase is used to mean “how cool,” in a song mostly about sambaing with your girlfriends.

The official music video, with over 136 million views, made the rounds as national attention was focused on violence during the Carnival festivities in Rio, with images of gangs robbing tourists en masse repeatedly broadcast on national TV.

Performers of funk music often say they are only reflecting the harsh reality of Rio de Janeiro and the country at large.

The music has also been toned down as it has moved from the favelas to the mainstream. Todynho herself has lashed back at her detractors.

“First of all, don’t talk about what you haven’t lived through,” she said on Instagram, referring to rampant violence in the shanty towns of the city of six million people. “I would never make music encouraging violence.”

Filmmaker Ford Dares Viewers to Analyze Their Own Biases, Fears, Tolerance

In the Oscar-nominated documentary Strong Island, Yance Ford stares back at the camera with profound sorrow and unshakable resilience.

Strong Island, a Netflix release, is Ford’s investigation into the killing of his brother, William Ford, in 1992 in Central Islip, New York. Ford, a 22-year-old black man, was shot and killed by a 19-year-old white mechanic Mark Reilly after a verbal altercation. But an all-white grand jury declined to indict Reilly and the investigation has remained sealed.

“I’m not angry,” Yance Ford says into the camera. “I’m also not willing to accept that someone else gets to say who William was. And if you’re uncomfortable with me asking these questions, you should probably get up and go.”

Ford’s film is a kind of investigative memoir that burrows into not only the justice of his brother’s death but also the still-quaking reverberations that William’s loss has had on their family, one that moved from South Carolina to Brooklyn before settling in the suburbs of Long Island.

Much of the film’s power comes from the raw, emotional first-person filmmaking of Ford, 44, a former producer for the PBS documentary program POV, making his feature film debut. By framing himself in searing close-ups, Ford dares viewers to analyze their own biases, fears and tolerance for injustice.

On a recent winter day, Ford spoke about making Strong Island and making Oscar history. Ford is the first transgender filmmaker nominated by the Academy Awards. “I am as proud of my occupying this place as the first transgender director,” said Ford, “as I am of the nomination itself.” 

 

Associated Press: Did you always know that you would take this deeply personal approach in Strong Island?

Ford: It turned into this realm of a personal film because in the absence of due process, in the absence of justice, the personal film is the only thing that you have left. My producer Joslyn Barnes says it really well when she says personal filmmaking is the language of the dispossessed. Yes, it was a film based in personal experience but it’s not really personal. It’s just an illustration of what many, many people have gone through.

​AP: Tell me about your brother.

Ford: The funny thing about answering that question, now, 25 years later, what you see in the film is my character attempting to get to know William better. So my answer has to be tempered with what I remember of my brother. The cruel thing about time is that it does things like: I’ve forgotten what his voice sounds like. Thankfully my sister and I have his diaries. I can tell you that he was a kind, compassionate, loyal person, that he believed in defending his family but also he had aspiration of being a law enforcement officer. He was a young man who was trying.

AP: Your film does much to reclaim his story from the narrative described by investigators. Has there been any catharsis for you in making the documentary?

Ford: Grief is a very complicated monster. There’s no real exorcising of it. It has a different form every day. But one of the things that I am really happy about is Strong Island has pushed something that is consistently sidelined back into our conversation, which is: why it’s so easy to take the life of black people in the United States and be unpunished for it. What systemic bias looks like when it’s lived by ordinary people is this. It looks like my family.

AP: Your film very directly asks the audience to question itself.

Ford: Someone pointed out — Scott MacDonald, the film theorist — that I’ve brought the audience closer to my face than anyone can actually get with the human eye. So you really do have to confront blackness. And for some people it’s a foreign experience. And for some people it’s a familiar experience. That proximity puts me into direct conversation with you. I’m speaking directly to you. I wanted to be talking to each individual in the audience.

AP: Have you heard from any of the authorities?

Ford: (Laughs.) No. No, and I don’t expect to. (The) Suffolk County criminal justice system is in trouble right now. The police chief was arrested — I won’t even list what he was arrested for. But the DA was also arrested. The Suffolk County criminal justice system is broken right now.

​AP: A video captured your excitement on Oscar morning. What was that moment like?

Ford: That moment was brought to you by my social media consultant, a millennial who — I essentially do whatever she tells me and then it winds up on the 5 o’clock news. I had absolutely no idea I would have the reaction I did. But to have that kind of once-in-a-lifetime thing happen, it was just incredible.

AP: You made history that day as the first trans filmmaker ever nominated for an Oscar. What did that mean to you?

Ford: My transgender identity is new to you because I don’t live a public life. It’s not new in my life but it’s new publicly. I’m incredibly proud to be the first trans director to be nominated for an Oscar. I’m also incredibly proud to occupy a place in what is actually a historic class of nominees for many reasons — to share the space with Daniela Vega, (a trans actress whose A Fantastic Woman is nominated for best foreign language film), the oldest woman to be nominated (Agnes Varda) and the first woman to be nominated in cinematography (Rachel Morrison). Steve James’ nomination is historic. Firas Fayyad with Last Men in Aleppo, his nomination is historic. So much that cracked open this year.

AP: What kind of reactions to the film and your nomination have you experienced?

Ford: At every screening since we premiered, at least one person identifies as having survived homicide. And that’s been happening for a year. The thing that tells me is that we are a culture awash in violence. We need to look at how to fix, once and for all, the systemic brokenness of our criminal justice system.

With Medicine Running Out, Venezuelans With Transplants Live in Fear

Yasmira Castano felt she had a fresh chance at life when she received a kidney transplant almost two decades ago. The young Venezuelan was able to finish high school and went on to work as a manicurist.

But late last year, Castano, now 40, was unable to find the drugs needed to keep her body from rejecting the organ, as Venezuela’s health care system slid deeper into crisis following years of economic turmoil.

On Christmas Eve, weak and frail, Castano was rushed to a crumbling state hospital in Venezuela’s teeming capital, Caracas. Her immune system had attacked the foreign organ and she lost her kidney shortly afterward.

Now, Castano needs dialysis three times a week to filter her blood. But the hospital attached to Venezuela’s Central University, once one of South America’s top institutions, frequently suffers water outages and lacks materials for dialysis.

“I spend nights not sleeping, just worrying,” said Castano, who weighs around 77 pounds (35 kg), as she lay on an old bed in a bleak hospital room, its bare walls unadorned by a television or pictures.

Her roommate Lismar Castellanos, who just turned 21, put it more bluntly.

“Unfortunately, I could die,” said Castellanos, who lost her transplanted kidney last year and is struggling to get the dialysis she needs to keep her body functioning.

The women are among Venezuela’s roughly 3,500 transplant recipients. After years leading normal lives, they now live in fear as Venezuela’s economic collapse under President Nicolas Maduro has left the once-prosperous OPEC nation unable to purchase sufficient foreign medicine or produce enough of its own.

Some 31 Venezuelans have seen their bodies start to reject their transplanted organs in the last month due to lack of medicine, according to umbrella health group Codevida, a nongovernmental organization.

At least seven have died due to complications stemming from organ failure in the last three months.

A further 16,000 Venezuelans, many hoping for an elusive transplant, are dependent on dialysis to clean their blood — but here, too, resources and materials are sorely lacking.

Nearly half of the country’s dialysis units are out of service, according to opposition lawmaker and oncologist Jose Manuel Olivares, a leading voice on the health crisis who has toured dialysis centers to assess the scale of the problem.

‘Straight to the cemetery’

In the last three weeks alone, seven people have died due to lack of dialysis, according to Codevida, which staged a protest to decry the critical drug shortages.

Once-controlled diseases like diphtheria and measles have returned, due partly to insufficient vaccines and antibiotics, while Venezuelans suffering chronic illnesses like cancer or diabetes often have to forgo treatment.

Hundreds of thousands of desperate Venezuelans, meanwhile, have fled the country over the past year, including many medical professionals.

Amid a lack of basics like catheters and crumbling hospital infrastructure, doctors who remain struggle to cope with ever scarcer resources.

“It’s incredibly stressful. We request supplies; they don’t arrive. We call again and they still don’t arrive. Then we realize it’s because there aren’t any,” said a kidney specialist at a public hospital, asking to remain anonymous because health workers are not allowed to speak publicly about the situation.

Venezuela’s Social Security Institute, tasked with providing patients with drugs for chronic conditions, did not respond to a request for comment.

Terrified transplant patients are indebting themselves to buy pricey medicine on the black market, begging relatives abroad to funnel drugs into the country or dangerously reducing their daily intake of pills to stretch out stock.

Larry Zambrano, a 45-year-old father of two with a kidney transplant, resorted to taking immunosuppressants designed for animals last year.

Guillermo Habanero and his brother Emerson both underwent kidney transplants after suffering polycystic kidney disease.

Emerson, a healthy 53-year-old former police officer, died in November after a month without immunosuppressants.

“If you lose your kidney, you go to dialysis but there are no materials. So you go straight to the cemetery,” said Habanero, 56, who runs a small computer repair shop in the poor hillside neighborhood of Catia.

Blaming Maduro, who blames sanctions

A Reuters reporter went to the Health Ministry to request an interview, but was asked at the entrance to give her contact details instead. No one called or emailed.

Reuters was also unable to contact the Health Ministry unit in charge of transplants, Fundavene, for comment. Its website was unavailable. Multiple calls to different phone numbers went unanswered. An email bounced back and no one answered a message on the unit’s Facebook page.

Maduro’s government has said the real culprit is an alleged U.S.-led business elite seeking to sabotage its socialist agenda by hoarding medicine and imposing sanctions.

“I see the cynicism of the right-wing, worried about people who cannot get dialysis treatment, but it’s their fault: They’ve asked for sanctions and a blockade against Venezuela,” Socialist Party heavyweight Diosdado Cabello said in recent comments on his weekly television program.

Health activists blame what they see as Maduro’s inefficient and corrupt government for the medical crisis and contend that government announcements of more imports for dialysis are totally insufficient.

Despite his unpopularity, Maduro is expected to win a new six-year term in an April 22 presidential election. The opposition is likely to boycott the vote, which it has already denounced as rigged in favor of the government.

Maduro has refused to accept food and medicine donations, despite the deepening health care crisis. Health activists and doctors smuggle in medicines, often donated by the growing Venezuelan diaspora, in their suitcases, but it is far from enough.

In the decaying hospital and dialysis center visited by Reuters, patients clamored for humanitarian aid.

Dolled up for her birthday and surrounded by cakes, the 21-year-old Castellanos took selfies with her friends and spoke excitedly about one day returning to dance, one of her passions.

But fears for her future permeated the room. A hospital worker stopped by to wish Castellanos many more birthday celebrations, but her worried face betrayed doubts.

“Other countries need to help us,” Castellanos said.

Illicit Financial Flows Outpace Development in Africa, OECD Says

Through medication and narcotics smuggling, ivory and people trafficking, oil theft and piracy, Africa is, by conservative estimates, losing about $50 billion a year in illicit financial flows — more, in fact, than it receives in official development assistance. 

A report by the Paris-based Organization for Economic Cooperation and Development offers a bigger look at the illegal economy behind the losses and how African and richer nations can fight it.

The OECD report zooms in on West Africa, and one sector in particular stands out. Catherine Anderson, who heads governance issues as the OECD, said 80 percent of illicit financial flows from West Africa are generated from the theft of natural resouces, principally oil.

But West African countries aren’t the only ones losing out from illicit flows, Anderson said. So are developed nations. Migrant trafficking, a hot-button issue in Europe, is a case in point.

“One of our case studies is on al-Qaida in the Islamic Maghreb, which is benefiting from the kidnap-for-ransom activities,” she said. “They are interdicting the trade and passage of goods across the Sahel, levying protection fees and revenues from the population. These have significant implications, not just for West African populations but for OECD countries, for Europe, in terms of insecurity and instability.”

She said illegal resource flows need to be tackled holistically — not only by the countries of origin, but also by those where the finances are transiting, and those where they finally end up, including developed countries. Doing so can be particularly tricky in West Africa, where a huge informal economy blurs the boundary of what is legal and what isn’t.

Ambassador Según Apata of Nigeria is a member of a U.N. high-level panel looking into illicit financial flows from Africa. He said some African governments are beginning to tackle the problem, but they don’t always have the capacity to do so.

“We have not made giant strides yet,” Apata said. “We are still at the elementary, at the mundane level of implementation.”

Apata said that if the $50 billion in losses from illegal activities were channeled into development in West Africa, it could help check the illegal migration that European countries worry about.

Fearing Tourist Drought, Cape Town Charts a New Relationship with Water

When Markus Rohner flew into Cape Town’s airport this month, he found an unexpected line at the men’s washroom.

With the city facing an unprecedented water shortage, airport authorities had turned off all the sink taps but one, leaving visitors to wait in line to wash their hands, under the watchful eye of a bathroom attendant.

“In Johannesburg, there were a lot of jokes about the situation. People were saying to each other: ‘Let’s go to Cape Town for a dirty weekend,'” said Rohner, who visited both cities recently for his job as a sales and marketing director for a Swiss machinery manufacturer.

Cape Town, which is battling to keep its taps flowing as reservoirs run close to dry following a three-year drought, declared a national disaster this month. Without rain, Cape Town could run out of water by July 9, city authorities predict.

For visitors thinking of flying into one of the world’s tourism hotspots, threats of a water “Day Zero” raise a range of questions: Will a visit waste scarce water local people need? Will I be able to flush my hotel toilet and have a shower? Should I come at all?

Sisa Ntshona, who heads the tourism marketing arm of South Africa’s government, has the answer you’d expect: Tourists — who support an estimated 300,000 jobs in South Africa’s Western Cape province — should come but they should be prepared to help out and “Save like a local,” as the slogan goes.

In a city where residents now are expected to use no more than 50 liters of water a day — enough to drink, have a 90-second shower, flush the toilet at least once and wash a few clothes or dishes — tourists “don’t have special privileges,” he said.

That means no baths, swimming pools now sporting salt water instead of fresh, sheets and towels changed less regularly, and signs urging visitors to flush toilets as infrequently as possible.

At one Cape Town hotel, visitors who insist on a bath — which takes 80 liters of water — now have to conspicuously carry a large rubber duck placed in their bathtub to reception to exchange it for a bath plug.

With climate change expected to bring worsening water shortages to cities around the world — from Sao Paulo to Los Angeles to Jakarta — such changes are going to be needed in many places in years to come, said Ntshona, the CEO of South African Tourism.

“How do we recalibrate the norm for global tourism?” he asked, on a visit to London to reassure potential visitors. “Tourists are aware of recycling, carbon emissions. But now it’s water.”

“This is the new norm,” he said. “Even if it rains tomorrow, we can never go back to the old way of consuming water.”

Tourist cash

For Cape Town, keeping tourists flowing through the city is an urgent priority.

Foreign tourists represent only about 1 percent of the people in the city even at peak times, but tourism — foreign and South African — contributes $3.4 billion to the province’s economy each year, said Ravi Nadasen, deputy chair of the Tourism Business Council of South Africa.

Any tourism drop-off in Cape Town also hits the rest of the country, Ntshona said. With many visitors booking itineraries that start in Cape Town and move east, he said, a loss of visitors to Table Mountain also means fewer people at the country’s game parks, vineyards and beaches.

“If South Africa falls off the tourism radar screen globally, to get it back on will take so much attention and focus,” he said.

Bookings for the first quarter of the year have so far not fallen, Ntshona and Nadasen say, though they have been fielding inquiries from worried potential visitors.

“We’ll get a better sense by the end of March, when we look at forward bookings for the next six months,” Ntshona said.

Tourism officials are well aware of the potential threat, however. In 2014, an Ebola crisis in West Africa — a six-hour plane flight away — led to a 23 percent drop in visitors to Ebola-free South Africa as tourists shunned African destinations, Ntshona said.

To try to prevent a repeat of that disaster, government and business leaders are rushing to shore up water supplies — and confidence.

Organizers of dozens of big conferences held in Cape Town each year are making plans to ship in water from other less thirsty parts of the country, Ntshona said.

Hotels have installed low-flow showerheads, turned off fountains and replaced cloth napkins with paper ones.

A Cape Town subsidiary of leading hotel chain Tsogo Sun is this week taking delivery of a pioneering desalination plant, to suck seawater from Cape Town’s harbor and churn out enough fresh water for the chain’s 1,400 Cape Town hotel rooms.

Cape Town itself is also making plans to bring in desalination plants — though not quickly enough to deal with the impending “Day Zero,” now pushed back to July after a successful campaign to cut the city’s water consumption by half.

Political obstacles

Experts have warned of water risks in Cape Town for years, but political infighting has gotten in the way of action, Ntshona admits.

Cape Town is run by an opposition party to the ruling African National Congress — and even the ANC saw its embattled leader, President Jacob Zuma, pushed out of office last week.

“Part of the lesson we’re learning as a country is that when you have a crisis, stop bickering and focus on the issues,” Ntshona said.

Another lesson, he said, is that water shortages — predicted to become longer and deeper across southern Africa as climate change strengthens droughts — cannot be seen as a passing problem.

Winter rains are expected in Cape Town starting in May or June. If they arrive, the current crisis will ease, officials predict.

But, regardless, “we need to recalibrate our relationship with water as a country,” Ntshona said.

Off-grid Power Pioneers Pour Into West Africa

Standing by a towering equatorial forest, Jean-Noel Kouame’s new breeze-block house may be beyond the reach of Ivory Coast’s power grid, but it’s perfectly located for solar power entrepreneurs.

Buoyed by success in East Africa, off-grid solar power startups are pouring into West Africa, offering pay-as-you-go kits in a race to claim tens of millions of customers who lack reliable access to electricity.

At least 11 companies, including leading East African players such as Greenlight Planet, d.light, Off-Grid Electric (OGE), M-KOPE Solar, Fenix International and BBOXX, have moved into the region, most within the last two years.

With a potential market worth billions of dollars, major European energy companies such as French utilities EDF and Engie are taking notice too.

“It’s important to be there now, because the race has already started,” said Marianne Laigneau, senior executive vice president of EDF’s international division.

The main challenge facing smaller companies now is how to raise enough capital to supply the expensive solar kits in return for small upfront payments from customers.

Mobilizing funding for firms providing home solar systems is also part of the U.S. government’s Power Africa initiative.

Major power generation projects have been slow to get off the ground so Power Africa has partnered with startups such as OGE, M-KOPE and d.light, among others, to accelerate off-grid access.

In Abidjan, Kouame doesn’t know when, or if, the national grid will reach the outer edge of the urban sprawl, but thanks to his new solar panel kit he has indoor lighting, an electric fan and a television.

But it’s the light bulb hanging outside his front door that he values the most.

“At night we were scared to go outside,” the 31-year-old taxi driver says as his pregnant wife watches a dubbed Brazilian soap opera. “Where there is light there is safety.”

Some 1.2 billion people around the world have no access to a power grid, according to the International Energy Agency (IEA).

Lighting and phone charging alone costs them about $27 billion a year and some estimates put their total annual energy costs at more than $60 billion.

While governments in much of the developing world are extending access to national networks, Africa is lagging, with less than 40 percent of African households connected, IEA figures show.

But what has long been decried as a major obstacle to Africa’s development is viewed as an opportunity by entrepreneurs such as Nir Marom, co-founder of Lumos Global, the Dutch startup that built and sold Kouame his kit.

“I read an article about people paying 50 cents a day for kerosene and candles, and that just didn’t make sense,” said Marom. “I said I can give them four kilowatt hours for the price of kerosene. And that started everything.”

Off-grid expansion

Lumos Global’s kits, which cost about $600, include a solar panel linked to a battery that supports power sockets, a mobile phone adapter and LED light bulbs.

Kouame, who paid 30,000 CFA francs ($57) upfront for his kit, is now leasing-to-own. A digital counter on the yellow battery pack tells him when he needs to top up his account using his mobile phone.

If he doesn’t pay, the kit, which also houses a global positioning system, shuts down. But in five years, he’ll own it outright and his solar power will be free.

“Five years is nothing,” he says, already weighing the option of another system to run a large freezer sitting empty and unplugged in the corner of his living room. “So my wife can do a little business.”

Pay-as-you-go solar home systems (SHS) like Kouame’s have been the main driver of off-grid power expansion in Africa.

In 2010, when most purchases were limited to simple lighting systems, customers spent $30 to $80 on average over a product’s lifetime, according to GOGLA, an independent off-grid industry association.

Now it’s $370 to $1,120.

Global revenues from the pay-as-you-go SHS sector were $150 million to $200 million in 2016, GOGLA estimates. That should jump to $6 billion to $7 billion in 2022.

Most of the main players in West Africa cut their teeth in East Africa, drawn by the widespread use of mobile money transfers, a key element of the pay-as-you-go off-grid model.

Success there drove annual sector-wide growth of about 140 percent from 2013 to 2016. But as the East African market becomes more crowded and mobile money services spread across the continent, many are now heading west.

“I remember doing a market sizing very early on and from a number of metrics West Africa was a better market,” said Xavier Helgesen, CEO of Tanzania-based Off-Grid Electric (OGE), one of the sector leaders.

About half of the overall African off-grid population are in West and Central Africa, according to the IEA. Nigeria, sub-Saharan Africa’s biggest economy and most populous nation, is  alone home to roughly 90 million people with no grid access.

Lumos is an outlier to the extent it picked West Africa as its first market. It launched in Nigeria in 2016 and by the end of 2017 had sold 73,000 kits and was averaging 16 percent month-on-month revenue growth. Late last year, it expanded into Ivory Coast, French-speaking West Africa’s largest economy.

Still, despite the rapid growth to date, off-grid solar startups say more must be done to improve the capacity of solar home systems and to bring down their cost so the sector can reach its full potential.

“I don’t believe off-grid electrification is a stop-gap,” said Jamie Evans, director of partnerships with d.light.

“I believe it’s here to stay. If the price of batteries starts dropping precipitously, then it will almost certainly change the face of the industry,” he said.

Capital  intensive

The need to provide consumer financing for the relatively expensive kits means expansion requires significant capital.

But banks, lacking expertise in the new sector, often shy away from lending to off-grid companies, said Rolake Akinkugbe, head of energy at Nigeria’s FBNQuest Merchant Bank.

“There’s also a size issue. Most of the off-grid solutions, particularly those that deal with pay-as-you-go, from a funding perspective, are not within the threshold for banks,” she said.

That means startups have largely relied on venture capital, impact investors looking to generate social benefits as well as a profit, and development finance institutions. But the model has its drawbacks.

“Right now off-grid companies are having to constantly fundraise,” said Lyndsay Handler, CEO of Uganda-based Fenix International.

In what was considered a milestone in the African off-grid sector, Engie bought Fenix in October.

With access to Engie’s capital, Handler says Fenix aims to become a pan-African off-grid leader, serving millions in the near term and tens of millions further down the road.

“Hundreds of millions of dollars of investment are needed to have the impact we want to have,” she said.

Facing stagnating customer growth in their home markets, European energy companies such as Engie are increasingly looking abroad. Africa’s underserved, growing population is seen by many as the future.

The number of Africans without grid access actually increased by nearly 14 percent between 2000 and 2016 to 588 million people. By 2030, the IEA estimates that some 80 percent of the global off-grid population will be in sub-Saharan Africa.

Raphael Tilot, Engie Africa’s head of customer solutions, likens off-grid solar to the rise of the mobile phone, which leap-frogged landline networks on the continent.

“Today, no one is thinking about putting telecom wires to individual houses in these places. You can look at energy in the same way today,” he said. “Mini-grids or solar home systems are a far better solution.”

In addition to Engie, French giants Total and EDF also hold stakes in off-grid startups, or are partnering with them. Italian utility Enel and Germany’s E.ON are investing in solar mini-grid companies.

Evidence of the market growth is on exhibit on Kouame’s hillside in Abidjan, where several rooftops, including his neighbor’s, are now crowned with solar panels.

“He asked me how it worked,” Kouame smiles. “Then he went and bought one of his own.”

Study: Seas to Rise About a Meter Even If Climate Goals Met

Sea levels will rise between 0.7 and 1.2 meters (27-47 inches) in the next two centuries even if governments end the fossil fuel era as promised under the Paris climate agreement, scientists said Tuesday.

Early action to cut greenhouse gas emissions would limit the long-term rise, driven by a thaw of ice from Greenland to Antarctica that will re-draw global coastlines, a German-led team wrote in the journal Nature Communications.

Sea-level rise is a threat to cities from Shanghai to London, to low-lying swaths of Florida or Bangladesh, and to entire nations such as the Maldives in the Indian Ocean or Kiribati in the Pacific.

By 2300, the report projected that sea levels would gain by 0.7-1.2 meters, even if almost 200 nations fully meet goals under the 2015 Paris Agreement, which include cutting greenhouse gas emissions to net zero in the second half of this century.

Ocean levels will rise inexorably because heat-trapping industrial gases already emitted will linger in the atmosphere, melting more ice, it said. In addition, water naturally expands as it warms above four degrees Celsius (39.2°F).

The report also found that every five years of delay beyond 2020 in peaking global emissions would mean an extra 20 centimeters (8 inches) of sea-level rise by 2300.

“Sea level is often communicated as a really slow process that you can’t do much about … but the next 30 years really matter,” lead author Matthias Mengel, of the Potsdam Institute for Climate Impact Research, told Reuters.

Governments are not on track to meet the Paris pledges.

Global emissions of carbon dioxide, the main greenhouse gas emitted by burning fossil fuels, rose last year after a three-year plateau.

And U.S. President Donald Trump, who doubts that human activities are the prime cause of warming, plans to quit the Paris deal and instead promote U.S. coal, oil and natural gas.

‘Brink of inundation’

Maldives Environment Minister Thoriq Ibrahim, who chairs the 44-member Alliance of Small Island States, said Tuesday’s findings showed a need for faster action to cut emissions, especially by rich nations.

“Unfortunately, the study confirms what small island nations have been saying for years: Decades of procrastination on climate change have brought many of us to the brink of inundation,” he told Reuters.

Professor John Church, of the Climate Change Research Center at the University of New South Wales, who was not involved in the study, said 100 million people now live within one meter of the high tide mark.

“More people are moving to live within the coastal zone, increasing the vulnerable population and infrastructure,” he said in a statement. “Adaptation to sea-level rise will be essential.”

Ebola’s Impact Reached Beyond Death Toll to Basic Health Care

More than 100,000 malaria cases went untreated when Liberia’s health care system buckled under the 2014-2015 Ebola outbreak, according to a new study.

The research, published in the journal PLOS Medicine, shows how the toll of the Ebola outbreak goes beyond the 11,000 killed in West Africa by the virus itself. Basic health care took a major hit as well.

Ebola kills about half of the people it infects. It causes flu-like symptoms, followed by vomiting and diarrhea, and can lead to internal and external hemorrhaging. The disease spreads through contact with an infected person’s bodily fluids. 

The countries of West Africa were ill-equipped to deal with the 2014-15 outbreak. Many clinics lacked the most basic tools for dealing with the disease, including latex gloves and face masks. 

“Rightfully so, people were afraid to go to the clinic because they might get Ebola when they’re at the clinic,” said study lead author Brad Wagenaar at the University of Washington.

Wagenaar and colleagues found that by four months into the epidemic, clinics were delivering one-third to two-thirds fewer basic services, which he described as a “huge, dramatic decrease.” 

‘Huge, dramatic decrease’

The researchers studied monthly data on health visits from 379 clinics outside the capital, Monrovia, from 2010 through 2016. 

They found measles vaccinations dropped by 67 percent. Anti-malarial treatment fell by 61 percent. Thirty-five percent fewer pregnant women came in for their first pre-natal visits.

It took more than a year-and-a-half for all services to return to pre-outbreak levels. 

Lost opportunities

In that time, more than three-quarters of a million clinic visits were lost, the researchers estimate, based on extrapolations from pre-outbreak trends. 

That includes more than 5,000 births at health care facilities, in a country with one of the world’s highest rates of maternal death, along with a loss of 100, 000 malaria treatments. These figures, Wagenaar adds, suggest a loss of other services that may have a long-term impact, such as distributing bed nets and spraying houses with insecticides.

“Some of these other things didn’t happen during the Ebola outbreak because the health system and other partners were busy with other issues,” he said. “And now, the cases have been increasing.”

Malaria cases were 50 percent higher in December of 2017 than they were before the Ebola epidemic.

Wagenaar says the research highlights how more attention must be devoted to maintaining basic services during a health emergency. The data his group analyzed could be used in other outbreaks to prioritize services that have been overlooked. 

Funding for public health systems

And after the emergency, funding should focus on strengthening public health systems. 

“We know that this epidemic happened in Liberia due to multiple factors, but one being the public sector ministry of health system has been underfunded,” he said, adding that remains the case.

Donors earmarked funds for strengthening the health system, he said. But, “that money never really materialized,” he added.

Macron’s State Reform Tsar Looks to Technology to Cut Red-Tape

France is ready to invest in artificial intelligence, blockchain and data mining to “transform” its sprawling bureaucracy instead of simply trimming budgets and jobs, its administration reform tsar said.

The 39-year old former telecoms executive whom President Emmanuel Macron has charged with reforming the public sector said he believed technology would win support from government employees and in the end produce less costly public services.

Macron himself is coming under pressure from budget watchdogs and Brussels to spell out how he plans to cut 60 billion euros ($74 billion) in public spending and 120,000 public sector jobs to fulfill pledges made in his election campaign.

Chatbots – software that can answer users’ questions with a conversational approach – or algorithms helping the taxman to target potential tax evaders, were some of the possibilities offered by technology, Thomas Cazenave told Reuters in an interview.

“The state … must not fall behind, get ‘uberized’ and shrivel up,” Cazenave said.

“The potential created by digitalization, data and artificial intelligence will help put fewer employees on some tasks, while reinvesting in others,” he added.

A 700-million-euro ($864-million) fund will help invest in IT projects over the next five years to help modernize administration in the highly centralized country and automate some activities.

‘Macron boy’

Cazenave is one of the ‘Macron boys’ whose mix of top civil service pedigree and private sector experience is being used to shake up France’s 5.5 million-strong army of government employees and cut one of the highest public spending ratios in the world.

Only two months younger than Macron, the two met over 10 years ago when they joined the highly selective corps of finance civil servants after graduating from ENA, a graduate school of public administration for the French elite.

Cazenave then became the number 2 human resources executive at telecoms firm Orange, a company which transitioned from government monopoly to globalized private champion. In 2016, Macron prefaced Cazenave’s book, “The State in Start-Up Mode.”

“Like me, the president feels very deeply that these are no longer times where public services can be reformed with small tweaks. Major transformations are needed,” Cazenave said.

Sensitive subject

However, despite frequently referring to transformation and revolution, Macron has taken a cautious approach on belt-tightening measures, with very few details given so far on where the ax will fall.

His budget minister said this month a voluntary redundancy plan could be on the cards, but did not elaborate. More details are expected to be announced in March/April but legislation is not expected before early 2019.

Cazenave said taking time to consult employees was necessary to get government employees on board and to review which public services still need to be ran by government, and which can be outsourced or even abandoned.

He also said previous spending cut plans, such as former conservative leader Nicolas Sarkozy’s decision not to fill one in two vacancies left by retiring baby-boomers had failed to curb spending because the state’s remit had not been changed.

Outsourcing some public services is currently being considered, he said, but the example of British outsourcing firm Carillion’s collapse showed it could not be replicated everywhere.

“There is no place for ideology on the outsourcing debate, in one way or another. The private sector doesn’t have a definitive superiority to the public sector,” he said.