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This chapter tells the largely untold story of the political economy of international drug regulation in the 1950s. It will tell the story of producer country efforts, led by Turkey, Iran and India, to agree an international quota system for opium and thus to divide up the licit global market. It examines the simultaneous efforts to suppress the global illicit market and minimise the numbers of producers to a small select few who would enjoy an enforced oligopoly. It highlights the quiet diplomatic pressure placed on countries viewed as epicentres of the global trade and a conscious ignorance of strategically important states – for example the US State Department refusing to criticise French Indochina and Mexico. Further, it tells the story of Harry Anslinger’s efforts to incorrectly portray Communist China as the world’s leading narcostate. It concludes with a look at the breakdown of multilateralism over the 1953 Opium Protocol, a treaty which few accepted but was rammed through by the US and some select allies. It was this Protocol which ultimately galvanised moderates and producer states around the need for a Single Convention to roll back the excesses of the 1953 Protocol.
To describe the cumulative seroprevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies during the coronavirus disease 2019 (COVID-19) pandemic among employees of a large pediatric healthcare system.
Design, setting, and participants:
Prospective observational cohort study open to adult employees at the Children’s Hospital of Philadelphia, conducted April 20–December 17, 2020.
Employees were recruited starting with high-risk exposure groups, utilizing e-mails, flyers, and announcements at virtual town hall meetings. At baseline, 1 month, 2 months, and 6 months, participants reported occupational and community exposures and gave a blood sample for SARS-CoV-2 antibody measurement by enzyme-linked immunosorbent assays (ELISAs). A post hoc Cox proportional hazards regression model was performed to identify factors associated with increased risk for seropositivity.
In total, 1,740 employees were enrolled. At 6 months, the cumulative seroprevalence was 5.3%, which was below estimated community point seroprevalence. Seroprevalence was 5.8% among employees who provided direct care and was 3.4% among employees who did not perform direct patient care. Most participants who were seropositive at baseline remained positive at follow-up assessments. In a post hoc analysis, direct patient care (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.03–3.68), Black race (HR, 2.70; 95% CI, 1.24–5.87), and exposure to a confirmed case in a nonhealthcare setting (HR, 4.32; 95% CI, 2.71–6.88) were associated with statistically significant increased risk for seropositivity.
Employee SARS-CoV-2 seroprevalence rates remained below the point-prevalence rates of the surrounding community. Provision of direct patient care, Black race, and exposure to a confirmed case in a nonhealthcare setting conferred increased risk. These data can inform occupational protection measures to maximize protection of employees within the workplace during future COVID-19 waves or other epidemics.
The division between internalist and externalist perspectives has dominated many areas of philosophy over the last few decades. In broadest terms, the issue is how best to individuate or otherwise categorize properties of agents that bear upon them being rational, perceiving, acting creatures. Are the properties internal to the agent, to the exclusion of external factors, or are they essentially involving of properties and things external to the agents? In the philosophy of language, the relevant properties pertain to general linguistic competence, and so we may ask if language itself (appropriately understood) is an internal property of speaker-hearers, or, say, if a word’s meaning is essentially world involving. Only a cursory survey of internalism in the philosophy of language would be possible in the space available; the chapter’s ambition, instead, is to offer something of a rapprochement.
This chapter outlines the early development of UN CND and how it progressed towards its first new international treaty in 1948. Emerging from the tense post-war negotiations the key uncertainties for CND were: how it would operate in practice; how it would fit into broader UN and geopolitical streams; and whether it would function as a talking-shop or, as per the US vision, a tool to enforce regulations and publicly bludgeon member states as needed. The first three meetings of CND in 1946– 1948 would be pivotal. The first two served to sound out the political context within which CND would operate and how the structures would function in practice. Following this, a major political push occurred around the Third Session, first concluding a new Protocol and then spring boarding into discussions on a new production limitation convention and even advocating a new ‘single convention’ to unify all previous drug treaties.
This introduces the topic of multilateral drug control, its contemporary relevance and the areas under examination within the book. It highlights the key themes grouped by three overarching focuses: historical, contemporary-legal and international relations theory. It examines the major debates under way in UN drug control and their direct relation to the historical-legal regulatory discussion encapsulated within the book. It outline existing historiography on international drug control and examines more recent developments. It points to continuing gaps in historiography, international relations, legal and policy literature which this book will fill. In particular it highlights the extensive literature on international legal fragmentation and its relevance for drug control debates. It offers an overview of regime theory and international relations approaches, suggesting a new and emerging framework based on evaluating drug control as a ‘regime complex’ in a similar lineage to climate change and intellectual property regimes, which will be covered in a more breadth in the Conclusion.
At the outbreak of War in 1939 the drug control system stood as a mixture of contradictions and uncertainty. On the one side were the strict control advocates, led by the United States. On the other side were producing states, agrarian countries whose economic, cultural and political systems were entwined with the very drugs the system sought to limit. In the middle were the old colonial powers, recognised the role opium played within many their colonies. The outbreak of war would fundamentally reshape international drug control. Moreover, it was driven by US-led bilateral efforts, utilising its wartime leverage, while other states were confined to rear-guard defensive actions. The reshaping of control during wartime was in many ways the result of aggressive wartime diplomatic manoeuvring by Harry Anslinger and key members of the Washington drug control lobby. The most radical wartime departure occurred in 1943 when Britain and Holland promised to adopt a policy of total prohibition of opium smoking and monopolies in many of their colonial territories. This shift, enabled Anslinger to bring new pressure to bear on the traditionally recalcitrant states such as Iran and Afghanistan to impose stricter controls and prohibitions.
This chapter examines the legal legal of the Single Convention and its successor treaties. The passage of the Single Convention represented a high-water mark in the international regulatory system. While it contained little in terms of innovation, it streamlined the complex array of drug treaties, while moving the terrain of control forward marginally. It essentially solidified an economic regulatory framework for a global licit commodity market in certain essential medicines. To enforce this market it mandated certain action around controlling and prohibiting non-medical production and manufacturing. Key questions around dealing with ‘addiction’ and suppressing non-medical consumption were left largely unanswered. The US may have lost the battle around the Single Convention and control of the system in the 1960s but they would enter the 1970s ready to refight many of these battles, beginning with the declaration of the ‘war of drugs’ and an aggressive new round of bilateral drug diplomacy. Ultimately the ‘war on drugs’ was not an inevitable outgrowth of these documents, but instead represented a specific set of interpretations, bureaucratic and normative trajectories and member state implementations.
This chapter charts the occasionally tense inter- and intra-governmental infighting surrounding the creation of the UN drug control system. It highlights the key institutional, legal and geopolitical issues as well as foundational member state divisions over market control, regulatory reach and legal enforcement capabilities. The deep regulatory and oversight structures of the League treaty system were transferred wholesale, with no formal wartime interruption. However, reconstruction of the political apparatus proved a much more contested issue. Strict control advocates in the US pushed the creation of a more uniform, stringent and enforcement-oriented system. The majority of states, however, simply aimed for conservatism and continuity with the League drug apparatus. They were supported in this aim by the US State Department which sought to minimise areas of disagreement within the fledgling UN organisation. Drug control was far from a strategic or geopolitical post-war priority and entrenched interests among producing states and colonial powers remained. Astride the enormous economic, social and political challenges facing the post-war world, a consensus-oriented system appeared the path of least resistance for most, including the US State Department.
This chapter argues that whereas much of the past century was geared towards a legal and institutional homogenisation of international drug control, the coming decades appear underpinned by recourse to ‘policy pluralism’ as a mechanism to enable policy evolution. It is precisely these endogenous processes of pluralism, devolution and increasing diversity of global drug policies that provide the most promising avenues for various actors to influence policies at local, national, regional and international levels. It further argues that the international drug control system is undergoing a long-term process of fragmentation and evolution towards what international relations scholars in other spheres would term a ‘regime complex’. It concludes by suggesting that these endogenous regime changes likely provide the greatest opportunity to draw exogenous actors and regimes into the system’s orbit and thereby modernise and adapt drug policies to new global realities.
This chapter examines the role of the Opium Wars and great power conflict between Britain and China within the context of drug control. Within the Opium Wars, the foundational elements for the coming global drug control system were laid. These included straining bilateral relations between great powers as well as the emergence of nationalist and moralist coalitions of diplomats and missionaries driving ‘reformist’ agendas globally. The first international treaty, the 1912 International Opium Convention, aimed to create reciprocal state responsibilities for limiting the flow of mind-altering drugs. After World War I, the new multilateral drug control system was quickly absorbed by the League of Nations. However, the US’ simultaneous interest in the issue and unwillingness to join the League of Nations proved complicating. Throughout the 1920s and 1930s a whole series of treaties and institutional changes gave the system regulatory shape. The League Opium Advisory Committee, precursor to the UN Commission on Narcotic Drugs (CND) ultimately sank. The enforcement and monitoring bodies, survived and fled Geneva for the safety of Washington DC. The chapter concludes with a brief introduction to the main diplomats of the wartime era, most prominently, Harry J. Anslinger.
This chapter examines the creation of the 1961 UN Single Convention on Narcotic Drugs. It was also a period when transatlantic relations reached a new low in drug diplomacy. Minor cooperation in the aftermath of the 1953 Opium Conference gave way to divisions leading to an eventual rupture over the Single Convention, particularly between Britain and the US. This breakdown was ultimately was the result of failures of US leadership as well as deep divisions over policy and economic interests. The US found itself increasingly alone in negotiations. State Department leadership sought a more conciliatory approach towards producers like Iran and Afghanistan. Nevertheless, with Anslinger increasingly absent and with a lack of institutional knowledge within the State Department US delegations struggled to develop a US grand strategy. Britain, continuing to carve out a role of quiet, consensual and self-interested drug diplomacy, found the new environment conducive and became increasingly assertive. London pragmatically worked with shifting coalitions, while building a moderate bloc of manufacturing states in Europe to help protect British domestic interests via the Single Convention. The result was a consensus-based treaty and one largely rejected by the US, which tried and failed to torpedo the treaty.