MALLEABLE TERRITORIES: THE POLITICS AND EFFECTS OF MINING GOVERNANCE IN POST-SOVIET GEORGIA

On December 13, 2014, the Republic of Georgia’s central government made a rapid series of decisions behind closed doors. These legislative moves allowed RMG Gold, the Russian-owned mining company operating in Georgia’s southern Mashavera Valley, to destroy the archaeological site at Sakdrisi-Kachgariani – the oldest gold mine ever discovered and a national cultural heritage site. The government’s decision followed more than a year of contentious struggle among competing political factions, yet in the end the mining work moved forward and continues expanding today. RMG’s destruction of Sakdrisi was just one event within Georgia’s broader political transition, de-centralizing resource governance toward corporate interests through a territorially based system of extraction licenses. This dissertation investigates the political geographies of Georgia’s resource governance transition, analyzing the politics and effects of mining governance in this post-Soviet market-oriented democracy. I analyze this topic using a mixed methods approach, combining semi-structured interviews, discourse and textual analysis, and a spatial database of mining sites throughout the former Soviet Union. My analysis illustrates how these political practices contribute to the broader geopolitical shifts within the country and across the region, occurring in part through the narratives and embodied experiences of people living near the Sakdrisi-Madneuli mining complex. Through this investigation I argue that the Mashavera Valley’s “malleable territories” – my phrase for this territory’s flexible and governable nature, especially as it relates to mineral governance, mining, and the government of people and things – emerge from a range of political practices, geopolitical imaginations, and material experiences to reshape the political spaces of Georgia and the South Caucasus. Together these findings illustrate how environmental struggles and practices of resource governance contribute to broader shifting power geometries and a lived vision of geopolitics

Risk of COVID-19 after natural infection or vaccinationResearch in context

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially