Taiwan thing after another: the Solomon Islands

Hello and welcome to The Intelligence from The Economist. I'm your host, Jason Palmer. Every weekday, we provide a fresh perspective on the events shaping your world. In principle, British law allows for children with severe epilepsy to receive medical cannabis. In practice, only a handful of patients have received it. We ask why a proven treatment isn't being given to those with the most need. And alcohol has long been illegal in Saudi Arabia, but under a reformist crown prince, exceptions keep multiplying. This weekend, a new booze you can use question: will the winner of a Formula 1 race in Jeddah celebrate with champagne? But first— More peacekeeping troops are being sent to the Solomon Islands following an outbreak of deadly violence. Troops from New Zealand are joining an Australian-led mission deployed after protests calling for the removal of the island's prime minister. Demonstrators tore through the capital Honiara last week, ransacking businesses and burning buildings leaving 3 people dead.

Sad to see that our police station has been burned down by these disgruntled Solomon Islanders.

The string of Pacific islands is no stranger to ethnic unrest, but this time it's got a worryingly international dimension to it.

The Solomon Islands is a tiny state. It's a scattering of islands with only 700,000 people.

Dominik Ziegler writes Banyan, The Economist's column covering the Asia-Pacific region.

There are dozens of language communities scattered across those islands, and there've been longstanding tensions between some of those. Those tensions have been exacerbated by a geopolitical struggle that is taking place across the Indo-Pacific region between China and the United States.

Okay, so help me understand the source of the tension now. What's going on in terms of the disputes on the islands?

Well, there have been long simmering tensions between the most populous island of the Solomon Islands, and that's Malaita, and the main island, Guadalcanal, across Iron Bottom Sound, where the capital, Honiara, sits. Honiara has really always attracted the bulk of any investment that goes into the Solomon Islands. It's generated most of the jobs. So for decades, Malaitans have flocked across the sound in search of work. Now, over the years, that has stoked ethnic tensions. I mean, the tensions at their heart have to do with intense poverty. More than 9 out of 10 households on Malaita lack electricity. They have to do with inequality and they have to do with a very strong and justifiably perceived sense of corruption surrounding not just this government, but previous ones too.

And so it seems those tensions have boiled over again. But this time you say there's a, there's a geopolitical dimension to it.

Yes, the new issue is that when he came to power as Prime Minister 2 years ago, Manasseh Sogavare, without any consultation, decided to drop the Solomon Islands' diplomatic relations with Taiwan and instead pivot to China. But Malaita didn't like this. It has long had an independence-minded streak. It has always been very anti-communist. Most Malaitans are fervent Christians. Taiwanese embrace Christianity quite comfortably, unlike the Communist Party on mainland China. So the whole notion of whom the Solomon Islands should pivot to fed into the grievances and protests that erupted in Honiara last week.

So just a repeat then of the kinds of tensions the islands have seen before, but now there is this, this Chinese presence. I mean, how have things changed on the ground since this pivot to China?

Well, the way things have changed have several dimensions. The first is that China has indeed been spending money in the Solomon Islands, but not necessarily fairly. It's been putting money into, in effect, MPs' slush funds. It's been proposing some big infrastructure projects, but the benefits of those projects are not clear to many Solomon Islanders when you consider that most of the workers building roads, bridges, and the like will be Chinese, and that the money is not being donated or even lent at concessionary rates, but will certainly leave the Solomon Islands more indebted. And then there's also the concern that the resources of the Solomon Islands—its thick forests, the gold that lies under its mountains—will be stripped by China and the profits taken out of the country. So these things have fed into the unrest in Malaita.

So now that violence has broken out again with this added dimension to it, how are things going?

Well, there has always been a political dimension to social unrest and violence in the Solomon Islands. And indeed, the last serious outbreak of violence in 2006 was the opportunity for the current prime minister actually to ascend to power for his second term of four terms as prime minister. And now his own position is in jeopardy because of 8 Malaitan MPs in his government. 4 have already defected, and the other 4 are under great pressure from the opposition leader Matthew Wale and the Premier of Malaita, Daniel Suidani, also to defect. In turn, Mr. Sogavare accuses both of those men of being behind the violence and of aggravating violence and of destabilizing the country. So political tensions are rising fast. Mr. Wale has ensured that there will be a vote of no confidence in the government of Mr. Sogavare on December 6th, and that will be the key test of whether the prime minister, who is a great survivor, can stay in power.

You say that political tensions are rising fast domestically, but given the way things are laid out now, it's international political tensions that have a risk of rising as well.

Well, that's absolutely right. So yes, the international geopolitical tensions, the rising competition between the two great powers, the United States and China, have fed into the Solomon Islands' domestic instability. The Trump administration promised $25 million, a tenth of all new funding in the South Pacific, to go not to the government, the central government of the Solomon Islands, but to go to the subnational government of Malaita, This is highly unusual and certainly fed into strains within society on the Solomon Islands. Taiwan also, after it broke ties with the Solomon Islands, attempted to show a good PR side by delivering medical and protective equipment, again, only to Malaita, not to the rest of the country. To me and to analysts in the region, you know, this attempt to curry favor with local actors really doesn't take into account the impact on the deeper political and social currents. And because those currents have not been taken into account, they've undermined social cohesion in the Solomon Islands. So the big powers fighting their big battle should share some of the blame for the current mess.

So it seems then that lots of countries have a stake in what's going on in the Solomon Islands now. How do you see this progressing?

Yes, lots of countries have a stake, but Australia remains the go-to power in the region. The last time it sent a regional assistance mission to the Solomon Islands, it stayed there for 14 years. This time, the Australian, Papua New Guinean, and Fijian police and troop presence is much smaller. The Australians must be wondering whether they can reimpose peace and pull out quickly. I suspect that they'll find that hard. And that they'll be in the Solomon Islands for longer than they dared hope for.

Dom, thank you very much for your time.

Jason, a great pleasure.

In 2018, the British government gave a medical cannabis license to 12-year-old Billy Caldwell. He had epilepsy and severe seizures because of it. His mother Charlotte had gone to Canada for cannabis oil to treat the condition, but when she returned to London, it was confiscated.

I am now calling for an urgent meeting with the Health Secretary and the Home Secretary. I will ask them to urgently implement a program that now provides immediate access to the meds that Billy so desperately needs. Worked.

Billy and another boy, Alfie Dingley, set a precedent in Britain by obtaining licenses to receive cannabis treatments legally.

Cases like Billy's, Alfie Dingley's, and others like it have shown that we now need to look more closely at the use of cannabis-based medicines in the healthcare sector in the UK.

That autumn, cannabis was legalized for patients with exceptional clinical need. But 3 years on, children who have that need still aren't getting hold of it.

If you're an adult and medical cannabis is appropriate, you can usually get it on a private prescription. But it's a very different story for these children with neurological disorders. The situation for access to medical cannabis for children is not a good one at the moment.

Natasha Loder is The Economist's health policy editor.

Billy Caldwell is one of only 3 children who've been given prescriptions by the National Health Service. Britain's public health provider. And there are a small number of children who have managed to get this treatment privately. Private cannabis prescriptions for these children is something that a few very specialist neurologists can do. But at the moment, there are only two that can do it, and neither is taking on new patients.

But presumably there are other treatment options for children with epilepsy.

Yes, for most epileptic children, there are other far better options. You know, there's a range of anti-epileptic drugs. There's even a diet, the ketogenic diet helps. And there are also some interventions. But some children don't respond to these treatments, and they're having hundreds of seizures a week, sometimes even hundreds a day. And these cause neurological damage, progressive neurological damage sometimes. And they also often pose a risk of death as well to these children. You know, these are children who may struggle to have any kind of normal life, and then they cannot develop in the way that other children can, and they spend huge amounts of time in and out of hospital. And it's in these cases that their parents say cannabis that contains a small amount of tetrahydrocannabinol, or THC, which is the psychoactive compound in cannabis, can really transform their lives.

And so why is access to that particular formulation so restricted?

Well, many people are pointing to guidelines from the British Paediatric Neurology Association, and this organization doesn't advise using medical cannabis with THC because it feels there's not enough data on safety and efficacy. The BPNA says it's concerned about the possible adverse events that cannabis with THC might bring to these children. And I spoke to the head of the BNPA, Alistair Parker, and he says in animal trials, small quantities of THC have actually made seizures worse, and that THC has been associated with psychological problems in teenagers. What parents are saying is, look, this treatment has such a transformative effect on children who are in such dire circumstances You know, these sort of theoretical concerns are just not primary and shouldn't be primary in the minds of clinicians. Children who have accessed these medicines, they may be able to go to school, they may be able to do all sorts of things that they just can't do if they're having seizures all the time and they're in hospital.

But those BPNA guidelines you mentioned aren't binding, right? Doctors can make their own call as to what to prescribe, can they not?

Doctors pay a lot of attention to how other professionals in the field behave, and so when you have guidelines like this, they do carry a lot of weight. And, you know, not only does the association not advise that this treatment is prescribed, they also tacitly suggest that clinicians could be held responsible if anything were to go wrong. And I think advocates were really expecting more flexibility for doctors with these guidelines. Something that would say, well, you know, in really tragic situations, really difficult situations, that they would be allowed to exercise more of their own individual judgment. In a lot of countries, there is a little bit more flexibility in what sorts of drugs are available. And, you know, with regards to the evidence, we do know that medical cannabis does work to reduce seizures because we also have lots of trials. They're not randomized controlled trials, which is the gold standard of evidence, but there are lots of trials and many studies that have shown that medical cannabis can have an effect on epilepsy.

So is it just a matter then of the BPNA sort of catching up with that, that received wisdom and amending its guidelines? Is there anything else to be done?

If the experts can't resolve the differences, it may end up landing in the laps of politicians once again. It may be necessary for politicians to make a sort of clearer statement about what their intent was when the law was changed in 2018 to allow for medical cannabis to be used. And it seems to me at least that their intent very much was that these children should be able to access these medications. My sense though is that politicians are reluctant to get involved now because it looks like a dispute between doctors. But parents are going to continue to put quite a lot of pressure on politicians to resolve this somehow. They're getting very frustrated. They're also turning to the black market. Some of them may have to leave the country to get treatment. There are other countries like Holland or Canada where getting access to this medicine for children in these conditions is just not an issue. And so it seems to me that without some kind of political solution, it isn't going to get resolved anytime soon. And that's going to have a potentially devastating effect on a number of families and the poor children who are trying to get treatment.

Thanks very much for joining us, Natasha.

Thank you, Jason.

Do me a favor, take a moment today or over the weekend to have your say in our survey. We want to know what listeners think, what you like and what you don't. Head over to economist.com/intelligencesurvey or just click the link that's in the notes for today's show. Many thanks. This Sunday marks the inaugural Saudi Arabian Grand Prix. While Formula 1 fans are intrigued to see what the circuit in Jeddah has to offer, others will be more closely watching what happens after the checkered flag waves.

Traditionally, the winner of a Formula 1 race sprays a shower of champagne over his teammates.

Nicholas Pelham is The Economist's Middle East correspondent.

That's going to create a huge problem for officials in Saudi Arabia because alcohol is banned, although there are signals that they might ease up on their ban for this racing event.

So this could be an unusually boozy Sunday in Saudi?

Saudi watchers are predicting boozy parties on yachts and perhaps at select venues on land. That would be in keeping with the reforms of Mohammed bin Salman, the crown prince who runs the country on a day-to-day basis. He's been jailing puritanical clerics, pushing them aside, and he's curbed the morality police. And under his stewardship, we've seen the breaking of taboos. Cinemas have opened, women are driving, concerts were prohibited not long ago, but now you have female DJs who are performing in public. Crowds are starting to tentatively jive, and one senior official says that this Formula One race could mark the beginning of the lifting of the alcohol ban.

And so the lifting of that ban, I guess, would be in keeping with the kinds of reforms that Mohammed bin Salman is carrying out.

Yeah, part of this drive isn't just about changing the social mores of the kingdom. It's also about a drive for business. The kingdom is trying to lure tourists away from destinations like the United Arab Emirates, which has long allowed foreigners to partake of alcohol and legalized drinking for everyone last year. He also wants to attract foreigners from outside. And so as part of that drive, we've seen Prince Mohammed investing in cruise ships that serve alcohol offshore. He's carved out vast royal preserves of his own which have non-Islamic bylaws. He's hosted a Red Sea festival where booze flows. Luxury hotels are going up on the kingdom's Red Sea coast and near tourist sites inland. And at one private launch party that I attended in October, for one of the hotels featured a sangria laced with whiskey. There was a rave between the rocks. And this is really a kingdom undergoing a cultural revolution.

And how does that sit with the more conservative, the more puritanical in Saudi Arabia?

There's a lot of muttering, a lot of unease. I think a lot of people are just simply confused about kind of what they were told was once haram or forbidden and is now halal or permitted. There are those that point to the Quran as a reference point. The Quran sort of seems to take a nuanced approach to alcohol. It, you know, one of the verses says that the sin of drinking wine is greater than the benefit, which is kind of a rather mild indictment and rather different from the way in which punishments for the consumption of alcohol have been enforced until now in Saudi Arabia. Saudi judges routinely sentence offenders to 80 or more lashes if they're caught drinking. But that said, Islam for much of its history has taken a much more tolerant approach. So those who are looking for Islamic references for this transition can point to a much more liberal tradition within the faith. And that's, I think, one in which, you know, some around Prince Mohammed would wish he would take rather than this radical switch from one era to the next.

And I guess on Sunday we'll see just how radical that is by watching what exactly is sprayed around on the winner's podium.

I'm not sure a final decision has yet been taken, but if you look at what's happening in neighboring countries when they've hosted these big racing events, Bahrain, Qatar, United Arab Emirates, they all resorted to a blander fizzy drink or rose water or lemonade. But ultimately, it's raw commerce that is deciding what liquid is going to be sprayed and also how far Prince Mohammed's reforms are actually going to go.

Thanks very much for joining us, Nicholas, and enjoy the race.

Jason, thank you for having me.

That's all for this episode of The Intelligence. The show's editors this week are Marguerite Howell and Chris Impey, and our sound engineer is Will Roe. Our senior producers are Stevie Hertz, Sam Colbert, Sam Westron, and lamentably for the last time, Duncan Barber. Our producers are William Warren, Jason Hoskin, Rory Galloway, and Alizée Jean-Baptiste, and assistant producer Ebisoye Oshendairo, with extra production help this week from Emily Elias. We'll all see you back here on Monday.