d All women with suspected endometriosis should be offered ultrasound scans, says NICE By www.bmj.com Published On :: 2024-11-12T07:26:00-08:00 The National Institute for Health and Care Excellence (NICE) has recommended that all women with suspected endometriosis be offered an early transvaginal ultrasound scan, even if the pelvic or abdominal examination is normal.In its updated guideline1 on the diagnosis and management of endometriosis, NICE recommends specialist ultrasound as an alternative to magnetic resonance imaging for investigating suspected cases of the condition in secondary care.The updated guideline follows recent reports from both the National Confidential Enquiry into Patient Outcome and Death2 and Endometriosis UK which highlighted problems with delayed diagnoses, partly owing to a lack of awareness among healthcare professionals of the condition and how it presents. Such delays can result in prolonged suffering, ill health, and risks to fertility, the reports warned.Other new and updated recommendations include asking women with suspected endometriosis if any first degree relatives have a history of the condition, and considering neurodiversity when taking into account... Full Article
d If I were still an MP I’d be voting against Kim Leadbeater’s bill on assisted dying By www.bmj.com Published On :: 2024-11-12T07:51:33-08:00 I’m often asked if I miss working in the House of Commons. Of course I do; it’s one of the most amazing places in the world and remains the cockpit of our nation.There are obviously days I miss it more than others, usually around the big national moments. Whatever your view of Kim Leadbeater’s private member’s bill—the Terminally Ill Adults (End of Life) Bill—its second reading this month will be one of those big moments.Kim is a friend of mine, and we spoke before she decided to put her bill forward after it topped the private members’ ballot at the start of the new parliament. My advice was to proceed with great care, to remember that this will take over your career in many ways, and to read the report produced earlier this year by the Health and Social Care Committee, which I chaired, on the subject of assisted dying/assisted... Full Article
d NHS targets will be missed this winter, trust leaders fear By www.bmj.com Published On :: 2024-11-12T08:11:01-08:00 Concerns are mounting over whether the NHS can meet key performance targets this winter, NHS Providers has said, after a survey of trust leaders highlighted pressure on hospitals, ambulance services, and community and mental health teams.1Over nine in 10 of the leaders who responded (96%) said that they were extremely or moderately concerned about the effect of winter pressures on their trust and local area. The most common reasons for concerns related to financial constraints and staffing provision. The top three greatest risks to the provision of high quality patient care over winter were identified as delayed discharge (57%), social care capacity (49%), and acute care bed capacity (43%).NHS Providers surveyed 171 trust leaders from 118 trusts in September and October, accounting for 56% of the provider sector.Most trust leaders (79%) were worried or very worried about whether their trusts had capacity to meet demand for services over the next... Full Article
d The World in Brief: European Court of Justice By www.chathamhouse.org Published On :: Thu, 29 Jul 2021 14:49:12 +0000 The World in Brief: European Court of Justice The World Today Anonymous (not verified) 29 July 2021 EU brings members into line over fundamental rights The European Union has had a challenging start to the summer trying to uphold the rule of law and avoid democratic regression in its member states. On July 14, the Polish constitutional court ruled that the country did not have to comply with the measures imposed by the European Court of Justice against its controversial judicial reforms, citing that these measures were not in line with the Polish constitution. The ruling Law and Justice Party, known as PiS, has introduced extensive changes to the judiciary since coming to power six years ago. In 2018, the government appointed new judges and set up a disciplinary chamber for the Supreme Court, which was given a temporary suspension by the European Court of Justice in an interim decision last year. PiS reasoned that the changes were necessary to eliminate corruption stemming from the communist era, but critics say it merely allows the government to punish judges it regards as disloyal. Under the disciplinary system, Polish judges can have sanctions imposed on them for their judgments in the lower courts or if they refer cases to EU courts for preliminary rulings. In the day following the Polish top court’s decision, the stand-off worsened when the European Court of Justice ruled that the disciplinary chamber undermines judicial independence and violates EU law. It ordered its immediate suspension and reiterated that the EU has primacy over national law – a vital condition countries agree to when joining the EU. Didier Reynders, the European justice commissioner, sent a letter to Warsaw with an August 16 deadline for an answer on whether Poland would comply with the ruling. If the EU does not receive a satisfactory answer, it will impose financial sanctions on the state. The former communist country, which joined the EU in 2004, is one of the bloc’s success stories. Its economy has boomed, and most people hold favourable views about the union – less than a handful of other member states have greater support for EU membership. The EU has had to step up its efforts as members express anger over the gradual dismantling of fundamental rights under populist governments, not only in Poland. A recent survey by the Bertelsmann Stiftung showed that ‘although only 35 per cent of Poles are satisfied with the democracy in their own country, a full 70 per cent express positive views on the state of democracy in the EU’. These figures feed into a larger picture of many Europeans welcoming the EU as a supervisory agent that is capable of intervening when individual states falter. Recently, however, the EU has had to step up its efforts as members express anger over the gradual dismantling of fundamental rights under populist governments, not only in Poland. The persistent backsliding in Viktor Orbán’s Hungary has led to concerns in the EU parliament, which is putting pressure on the European Commission to do more to protect the EU’s values and legal order. In a simultaneous battle in July, the commission launched legal action against Poland and Hungary, challenging anti-LGBTQ laws in those countries. It was triggered by a decision of more than 100 Polish regions to pass resolutions declaring themselves free of ‘LGBTQ ideology’, and a recently adopted law in Hungary banning any depiction of LGBTQ people on television or in books for under-18s. An annual report on the rule of law in the union, released by the commission in July, singled out the two countries for their non-compliance. The report, the second of its kind, is a new tool to address concerns that the union was not scrutinizing democratic backsliding within its own bloc. Critics were quick to point out, however, that there is no mention of enforcement actions. At the start of the year the EU vowed to be tougher in upholding democracy with a new regulation that lets it withhold money from member states that breach the rule of law. The EU has already delayed approving spending plans for Hungary and Poland as part of the €800 billion pandemic recovery fund. As the European Parliament calls for the commission to reduce budget allocations to those that undermine democratic rights, Poland and Hungary could see the new mechanism put to the test this autumn. Full Article
d Russia and 9/11: Roads not taken By www.chathamhouse.org Published On :: Thu, 09 Sep 2021 10:46:20 +0000 Russia and 9/11: Roads not taken Expert comment NCapeling 9 September 2021 Many Russia watchers recall the fleeting moment 20 years ago when the country could have moved away from a path of confrontation with the US. On 12 September 2001, Russian president Vladimir Putin was the first foreign leader to call George W. Bush to express his condolences – and to offer him support. Just the previous year, Putin had said Russia joining NATO was a possibility and it suited Russia to draw parallels between the terrorist attacks on the US and its own ‘anti-terrorist’ campaign in Chechnya at the time. Even though much of the Russian commentary about 9/11 professed empathy rather than sympathy, in their eyes the US was both a victim – as Russia likes to see itself – and ‘had it coming’ while Russia was blameless. At that time, many in the West were still tempted by the idea Putin’s Russia might develop in a liberal direction, and Putin himself wanted to be seen as constructive especially after Chechnya. He may also have also assumed that, if Russia joined the international alliance, it would be as a co-leader with the US. An offer which was never stated Whether he was sincere in his condolences or not, Putin was of course not offering something for nothing – but then few countries ever do. Although less than one-tenth into his time in control of Russia (so far), Putin was still feeling his way but was not a naive president having already been through the controversial sinking of the Kursk submarine. The quid pro quo, unstated and only dawning on Washington much later, was for the US to keep out of what Russia saw – and still sees – as its backyard His first move was to facilitate access to bases in Central Asia for the US campaign in Afghanistan – vital initially but less so later. Apparently, this offer was against the wishes of many of his senior military commanders – although the extent to which it was in his gift to grant such access is questionable. The quid pro quo, unstated and only dawning on Washington much later, was for the US to keep out of what Russia saw – and still sees – as its backyard. Putin probably misjudged that the US would have neither the inclination nor the capacity to be in that region for anything other than supply chain purposes. And he hoped America now needed Russia after the humiliations of the 1990s. Common interests could once have been the basis of a partnership with Russia; but to Moscow that meant a partnership of equals which recognized the Kremlin’s self-declared right to conduct out-of-area operations. But the US took a different view and, with nothing written down and no memorandum ever signed, the ensuing disappointment for Russia was gradual but inexorable. A purely practical reason for declining the ‘offer’ was that, despite its own illusions, Russia had little to bring to the table which was useful and could be offered on acceptable terms. Subsequent initiatives – from specific joint terrorism initiatives to a ‘grand reset’ – could not narrow differences to the point where the character of the relationship changed. The Northern Distribution Network for supplying US forces in Afghanistan – Russia’s most practical contribution to the notional common cause – took almost a decade to be established and was plagued by problems which often come with a dependence on Russian goodwill. The Kremlin also had the pleasure of watching US hubris lead to failure in Iraq. And, although knowing the US intervention in Afghanistan would never end well, even Russia could not have foreseen the scale of the defeat and humiliation of chaotic withdrawal. US achievements with Russia’s neighbours When it comes to Russia’s post 9/11 ‘offer’ and subsequent expectations, many of the other newly independent countries might never have achieved what they have over the past 20 years if the US had agreed – tacitly or otherwise – to sit back and accept Moscow’s droit de regard over them. Although knowing the US intervention in Afghanistan would never end well, even Russia could not have foreseen the scale of the defeat and humiliation of chaotic withdrawal From the Kremlin’s perspective, these states were Russia’s ‘kith and kin’ but it underestimated US willingness to support smaller states over a ‘great power’ – especially as George H.W. Bush pleaded to those states not to go too far too fast. Albeit uneven, most have benefitted from US support for their own independence as well as practical assistance to strengthen their institutions and diversify external relationships. The three Baltic states consolidated their democracies while their economies, which severed many ties with Russia early, are flourishing and prosperous in contrast to those still in the Russian orbit. They are not only members of NATO and the European Union (EU) but have on occasion been moral leaders as in the case of Lithuania facing down both Belarus and China. Ukraine has undergone two revolutions in attempting to follow the paths of the Baltic states that continues today. After many false starts Moldova has undergone a similar change recently but at the ballot box not on the streets, to give itself another shot at the prize of true democracy and international acceptance. Georgia conducted the most radical governance reforms seen in the region after its own revolution although it has taken a few steps backwards of late. Kazakhstan and Uzbekistan have strengthened their independence since then and adjusted their modus vivendi with Russia to their advantage. Putin would hardly be able to give the same assurances about use of bases there today – and indeed reportedly brushed off a request by Biden to use them in the current withdrawal. Only a minority of formerly Soviet republics have made no progress whatsoever at the governmental level – Belarus and Turkmenistan for sure, perhaps Azerbaijan and Tajikistan too depending on the criteria. The roads not taken America’s failure was not so much rejecting Russia’s offer of partnership but failing to pay sufficient attention to it because Russia was still regarded as weak despite being relatively strong in its immediate neighbourhood. The question of whether it was worth alienating Russia is a moral one. Refusing to sign the Paris Charter – which recognizes the right of independent states to form their own alliances – would have been a further betrayal of people who have long been subjected to their future being decided by stronger powers around them. But Russia may have chosen a path of confrontation anyway as, for the Kremlin, suzerainty over its former republics is considered an entitlement which comes with being a great power. Subscribe to our weekly newsletterOur flagship newsletter provides a weekly round-up of content, plus receive the latest on events and how to connect with the institute. Enter email address Subscribe Although impossible to conclusively prove, all previous frameworks of Russian assumptions and habits of Russian behaviour indicate Moscow would have pocketed the deal and simply moved on anyway. It certainly seems likely that Russia’s other outrages and offenses over the years – from the murders of Litvinenko and Skripal in the UK to the manipulation of information and elections – would still have occurred even if a shabby deal had been made over the heads of the new states on Russia’s borders. The atrocity of 9/11 was really an opportunity for Russia, a genuine potential turning point and a chance to create a new relationship with the outside world – but its expectations were unrealistic. Russia blew it with demands at the time that could not be met – and rightly were not met. The US rarely receives credit for withstanding Russian blandishments at a moment when its own aura of strength had been so cruelly and effectively punctured by the most brazen of attacks. Full Article
d Memory politics: the challenge of commemoration in post-Soviet Eastern Europe and the Caucasus By www.chathamhouse.org Published On :: Tue, 21 Sep 2021 15:39:42 +0000 Memory politics: the challenge of commemoration in post-Soviet Eastern Europe and the Caucasus 5 October 2021 — 1:00PM TO 2:30PM Anonymous (not verified) 21 September 2021 Online This event explores how to address memory and commemoration in the former Soviet states, considering their role in political processes and violent conflict. How the past is remembered and commemorated plays a large role – perhaps too large – in contemporary political debates and in how conflicts are negotiated. Perceptions of history influence people’s actions and are used to judge or dismiss the actions of others. Nowhere is this more so than in the political, territorial and social debates and disputes across the former Soviet Union. This event examines how to address the problems caused by entrenched memory debates – and proposes a framework for ‘ethical political commemoration’ for use across historical enquiry, political processes, and conflict transformation initiatives. The speakers explore the topic through the context of Turkey and the Armenian genocide, as well as more broadly through their own experiences in conflict transformation and peace processes. Full Article
d Director’s breakfast briefing: Shifts in European foreign policy since 9/11 By www.chathamhouse.org Published On :: Mon, 04 Oct 2021 10:14:41 +0000 Director’s breakfast briefing: Shifts in European foreign policy since 9/11 14 October 2021 — 8:00AM TO 9:15AM Anonymous (not verified) 4 October 2021 Chatham House Former MI6 chief, Sir Alex Younger, discusses shifts in European foreign policy since 9/11. Former MI6 chief Sir Alex Younger, discusses shifts in European foreign policy since 9/11. The dramatic events surrounding the withdrawal from Afghanistan demonstrates a profound shift in European security priorities since the beginning of the ‘war on terror’. Against the backdrop of the 20th anniversary of 9/11, former MI6 chief, Sir Alex Younger, discusses recent shifts in European foreign policy. How has the focus on counterterrorism changed over the last two decades particularly in light of new and evolving strategic challenges? Why were many long-term objectives in Afghanistan left unachieved? Has the threat of terrorism changed across Europe? How has cooperation between security and intelligence services across the world changed particularly across the Atlantic? And, 20 years on, is the ‘war on terror’ really over? This event is only open to Chatham House Partners and Major Corporate Members as well as selected giving circles of Chatham House. If you would like to attend, please RSVP to Linda Bedford at RSVP@chathamhouse.org. Full Article
d Undercurrents: Europe's far-right educational institutions By www.chathamhouse.org Published On :: Fri, 08 Oct 2021 12:25:28 +0000 Undercurrents: Europe's far-right educational institutions Audio bhorton.drupal 8 October 2021 In Hungary, France and Spain, new political movements from the far-right are attempting to reshape their education systems. Under the supportive eye of Prime Minister Viktor Orbán, the recently established National University of Public Service seeks to embed nationalist illiberal values in a new generation of Hungarian students. Meanwhile in France and Spain, far-right public figure Marion Maréchal has turned away from the electoral politics of the Front Nationale to set up a new conservative research institute, ISSEP. Both of these developments represent a challenge to the liberal values which underpin the existing international order. To find out more, Ben spoke with Professor Dorit Geva and Dr Felipe Santos, whose recent article in International Affairs considers the implications of this illiberal educational turn. Full Article
d Why Europe must end limbo for Afghans seeking asylum By www.chathamhouse.org Published On :: Thu, 14 Oct 2021 08:58:48 +0000 Why Europe must end limbo for Afghans seeking asylum Expert comment Anonymous (not verified) 14 October 2021 With a focus on evacuations from Afghanistan, the situation in Europe is often forgotten as thousands of asylum seekers continue to wait for their cases to be settled. Following the Taliban’s takeover of Afghanistan, European leaders shared messages to welcome those evacuated, but the reality of European responses to displacement in Afghanistan paints a more contentious picture. As of July 2021, 33,325 cases of Afghan asylum applicants were pending in Germany, in France 18,410 people were waiting on a decision, while in Greece the numbers were 13,660. Arguably, such numbers are manageable given European states’ size and their functioning asylum systems but, while 56 per cent of Afghans in Europe receive protection status, a large proportion is still in limbo in differing European countries’ asylum systems. Europe hosts fewer than ten per cent of the three million UN-registered displaced Afghans globally, as neighbouring countries carry the burden of Afghanistan’s forced displacement: Iran hosts almost one million Afghan refugees and Pakistan 1.5 million, and these numbers double when adding undocumented or Afghan passport holders. But despite these manageable numbers, national authorities in Europe often leave people waiting for months or even years to receive an asylum decision. Deportations to Afghanistan were halted only after the Taliban’s takeover of Kabul and even then there was resistance to this from certain European countries, while Austria suggested setting up ‘deportation centres’ in countries neighbouring Afghanistan. Europe remains a fortress The European Commission’s Draft Action Plan responding to the events in Afghanistan confirmed the willingness of the European Union (EU) to continue returns to non-European ‘third countries’. So Europe remains a fortress, despite pledging support for ‘the safe and orderly departure of foreign nationals and Afghans who wish to leave the country’. The wall by Greece at its border with Turkey and Poland’s treatment of Afghan asylum seekers trapped at its border with Belarus illustrate this hardline stance. The president of the European Council Charles Michel and EU Home Affairs Chief Ylva Johansson both confirm the priority is to secure European borders. This is further backed up by the European Council’s latest set of Conclusions on Afghanistan which focuses on security and ‘preventing illegal migration’ while avoiding reference to any domestic asylum efforts or the establishment of protection pathways for Afghans. Afghans in Europe need answers from European policymakers and, by strengthening domestic asylum responses alongside international humanitarian commitments, Europe’s actions would increasingly match its words. This disconnect is not new. At the national level, reports of illegal pushbacks on European land and sea borders alarmingly intensified in 2020 as authorities intercepted and sent migrants back to neighbouring countries without assessing asylum claims. At the EU level, development aid to countries such as Afghanistan has long been conditional on their governments’ adherence to the bloc’s migration objectives of preventing asylum seekers from reaching European borders and facilitating the repatriation of those refused asylum in Europe. But this latest displacement crisis from Afghanistan exposes clear inconsistencies in European approaches to asylum and humanitarianism. Migration remains a divisive issue in European politics, but European governments must act promptly to support Afghans already residing in their territories alongside establishing robust international commitments. Time for concrete action European countries should firstly improve the treatment of those Afghans currently in limbo within their respective asylum systems by expediting pending Afghan asylum applications and family reunification cases, re-examining rejected asylum applications, and facilitating integration. Secondly, national authorities should not return asylum seekers to Afghanistan or any third countries deemed ‘safe’. For Europe to coordinate evacuations from Afghanistan while simultaneously deporting asylum seekers undermines the international refugee regime and threaten Europe’s global credibility. Full Article
d The law as a tool for EU integration could be ending By www.chathamhouse.org Published On :: Fri, 15 Oct 2021 08:29:03 +0000 The law as a tool for EU integration could be ending Expert comment NCapeling 15 October 2021 Poland is not the only EU member state challenging the supremacy of European law, as historic change is happening in how European integration functions. The Polish Constitutional Tribunal’s ruling that several articles of the European treaties are incompatible with the Polish constitution is prompting much debate, especially in terms of both the similarities and differences between it and rulings by the German constitutional court which have also challenged the European Court of Justice (ECJ). Pro-Europeans are keen to draw a sharp distinction between the reasoning deployed by the two courts. They see the Polish court’s challenge as an exceptional case which the European Union (EU) cannot ‘tolerate’ because it would lead to the ‘demolition of the EU’s legal order from within’ and argue the EU must take a tough approach to Poland by re-asserting the supremacy of EU law. But this view misses a bigger long-term shift in the EU. Both the German and Polish cases illustrate some of the basic conflicts within the EU’s legal system for decades. What is being challenged increasingly openly – even since the UK left the EU – is the idea of the EU as a de facto federation in which non-majoritarian institutions such as the ECJ have final say about the quality of democracy in member states. ECJ’s quiet revolution Historically ‘integration through law’ was central to the European project and the ECJ was a key institution driving forward integration – usually benefiting from what Erik Stein called ‘benign neglect by the powers that be and the mass media’. Even when European integration in the form of treaties stalled in the 1960s and 1970s, ‘judicial integration’ through the ECJ continued, including its notable 1964 decision that EU law was supreme. According to the German court’s theory of ‘constitutional pluralism’, there is in effect a constant dialogue and accommodation between the national and EU level rather than a simple primacy of EU law over national law This self-empowerment of the ECJ – what another scholar of European constitutionalism Joseph Weiler calls ‘a quiet revolution’ – was possible because there was a ‘permissive consensus’ in member states which allowed judicial integration to continue largely unchallenged. But this has now changed as both politicians and national courts are more willing to challenge what they see as judicial overreach. There are important differences between the approach of the German and the Polish constitutional courts. The Law and Justice Party has politicized the Polish court, packing it with judges sympathetic to that party, whereas the German court is more independent. In addition, whereas the German court made qualified and subdued objections to measures taken in response to the euro crisis during the past decade and, in particular, the steps towards the mutualization of eurozone debt – but often backed down with ‘all bark and no bite’ as Christoph Schmid put it – the Polish court is driven by political considerations and has challenged the supremacy of EU law in a more direct and general way. However, the German court has made it clear it is the guardian of the German constitution and seeks to impose limits on the ECJ’s self-empowerment by arguing Europe is not a federation. According to the German court’s theory of ‘constitutional pluralism’, there is in effect a constant dialogue and accommodation between the national and EU level rather than a simple primacy of EU law over national law. The court sees itself as the ultimate arbiter of whether steps in European integration are consistent with the German constitution, and is likely to challenge any further steps in fiscal integration even if the ECJ deems them in accordance with the treaties – as it did with the European Central Bank’s quantitative easing programme. Supremacy of EU law is under pressure Right across Europe, courts and politicians are increasingly challenging the ECJ and questioning the supremacy of EU law. Michel Barnier called for France to regain ‘legal sovereignty’ and should no longer be subject to the judgments of the ECJ – an extraordinary demand from the EU Brexit negotiator who regularly lectured the UK about the sanctity of the EU’s legal order. The Polish challenge is part of a historic change in how European integration functions – or does not function Other possible French presidential candidates such as Valérie Pécresse and Eric Zemmour are also openly challenging the primacy of EU law. The UK, of course, is fighting its own battle with the EU about the ECJ’s role in the Northern Ireland Protocol. It was not the current Polish government but the people of France and the Netherlands who blocked the attempt at explicit constitutionalisation of the EU in a referendum just one year after the 2004 enlargement. Whereas the Constitutional Treaty ‘would have codified the doctrine of EU legal supremacy’, that provision was dropped from its successor the Lisbon Treaty, again indicating consensus on EU legal supremacy is not as strong as is often claimed. Full Article
d How do Eurasian kleptocracies earn and use their money? By www.chathamhouse.org Published On :: Fri, 22 Oct 2021 15:54:24 +0000 How do Eurasian kleptocracies earn and use their money? 9 November 2021 — 1:00PM TO 2:30PM Anonymous (not verified) 22 October 2021 Chatham House and Online This event explores the presence of corrupt funds from Eurasia in Western democracies, what they are used for, and how they can be constrained. The Pandora Papers once again shone the spotlight on the UK being home to corrupt funds from kleptocracies, where the ruling elite abuse their political power for private gain. In recent years much focus has been placed on this term, and the possible effects such money could have on Western democracies. How do such states create this wealth in the first place? How do these funds make their way to the UK? Is the term kleptocracy appropriate for the majority of countries in Eurasia? What evidence is there that such funds are ‘weaponized’ to achieve foreign policy goals? This event discusses the term, how it can be applied, and the differences between how ’grey’ funds are used by various countries. It also highlights how the UK and the wider international community can counteract these flows, both from a legal point of view, and via other methods. Full Article
d Here we go again: Russia’s energy ‘diplomacy’ in Moldova By www.chathamhouse.org Published On :: Mon, 06 Dec 2021 14:54:49 +0000 Here we go again: Russia’s energy ‘diplomacy’ in Moldova Expert comment LJefferson 6 December 2021 The gas crisis shows that while the new Moldovan government may wish for geopolitics to go away, they are a weapon Russia will deploy at will. In October, Moldova came under the spotlight when Russia, its primary provider of gas, slashed supplies by a third and refused to extend the existing contract. The crisis was resolved at the end of October when Russia and Moldova signed a new contract, in which Moscow has used Moldova’s gas dependence to extract geopolitical concessions, weaken the new pro-western Chisinau government and drive a wedge between the EU and Moldova. A chronic failure to reform Moldova became a classic case of state capture when political elites – including nominally pro-European political elites – engaged in massive rent-extraction. Up until 2020, when pro-reform forces came to power, Moldovan politics offered rapid route to riches for both the nominally pro-European parties and the pro-Russian Socialist Party; each was responsible for playing up ethnic and geopolitical cleavages in the country to mobilize votes and shore up legitimacy. These predatory elites hollowed out Moldova economically and politically by a chronic failure to reform, in particular the energy sector which became a major source of rent. However, this started to change when the pro-reform forces came to power as a result of the 2020 presidential and then 2021 parliament elections. The pro-reformist Maia Sandu defeated the incumbent president Igor Dodon (58 per cent to 42 per cent) in November of that year. And then her party got 58 per cent of the vote in the parliamentary elections which followed in July 2021. The Party of Action’s winning formula was to focus on corruption and domestic reforms – rather than playing the ‘geopolitical’ card, a favourite strategy of their predecessors. Her Party of Action’s (PAS) winning formula was to focus on corruption and domestic reforms – rather than playing the ‘geopolitical’ card, a favourite strategy of their predecessors. As Sandu put it, the elections marked ‘the end of the reign of thieves in Moldova’. A gas crisis is initiated Russia’s response to these results was to initiate a gas crisis. Up until the victory of the pro-reform forces, Russia had annually renewed a gas contract signed in 2007. However, in September 2021, Russia refused to renew the contract as it had done many times before and instead insisted on a new contract, which allowed Russia to create linkages between energy prices, debt settlement, a halt on energy market reforms and, it can be logically inferred, further integration with the EU. Moldova’s national energy company, Moldovgaz, is 63.5 per cent de facto owned by Gazprom with the Moldovan government owning the remaining 35.5 per cent. (Moldova was forced to give Gazprom a controlling stake when faced with a cut in supplies in January 2006). It is therefore hardly surprising that no efforts were made to de-monopolise the sector and diversify energy supplies. This lack of modernization can be explained by the somewhat surreal fact that in any negotiations and planning, Moldovagaz – majority owned by Gazprom – represents the Moldovan side in negotiations with Gazprom. So, when it came to signing of the new five-year contract in October 2021, Russia, through Gazprom, was able to institute a contract which made gas prices conditional on various geopolitical conditions. It is noteworthy that Moldova’s original 2007 gas contract had been renewed annually despite the supposed accrual of debt. However, the very nature of this debt is suspect. While Moldova’s debt is said to be approximately $700 million, the debt of the much smaller breakaway Transnistria was around $7.3 billion. The exact level and source of the debt remain murky. Russia appears to be making Moldova liable to repay at least some of Transnistria’s debt while only demanding the debt settlement with Moldova, but not with Transnistria. High stakes for Moscow Moreover, the contract is used to derail liberalisation of the energy market in line with EU’s energy market rules (through the so-called unbundling of supplies and distribution) which Moldova had committed itself to since the country joined the Energy Community in 2010. Referring to ‘the non-application of forced reorganization and sanctions against Moldovagaz’, the new gas contract forces Moldova to postpone implementing the unbundling of supplies and distribution by making it conditional on resolving the energy debt. Furthermore, Moldova ominously agreed to create an ‘intergovernmental commission on economic cooperation’ with Russia, which effectively blocks Moldova’s economic integration with the EU. (This demand is hardly new as Russia previously requested, and was granted, a seat at the negotiating table on a bilateral trade agreement between the EU and Ukraine. The trilateral EU-Ukraine-Russia negotiations have made it clear that Russia is seeking a veto over European integration of all neighbouring countries.) Targeting Moldova’s new reformist government reflects high personal stakes for Moscow. Moldova’s caretaker (kurator) in the Kremlin is Dimitrii Kozak, who in 2003 masterminded the so-called ‘Kozak Memorandum’. This sought to reintegrate breakaway Transnistria into a Moldova-Transnistria federation. It was thwarted at the last minute but the Russian leadership has not given up on its plan. Now using his position as the deputy head of Presidential Administration, Kozak is masterminding Russia’s rehashed policy towards Moldova and has attempted to bring back his Memorandum as a political blueprint for a ‘settlement’. Russia’s heavy-handed energy ‘diplomacy’ The new Moldovan government is caught in a crossfire of domestic expectations and Russian geopolitical demands. The gas crisis shows that while the new government may wish for geopolitics to go away, they are a weapon Russia will deploy at will. The new Moldovan government is caught in a crossfire of domestic expectations and Russian geopolitical demands. The Moldovan government is brand new so it has relatively little experience of dealing with Russia’s heavy-handed ‘energy diplomacy’. But the EU has been on the receiving end of this before – this is a direct replica of Russia’s strategy toward Armenia and Ukraine – and neither ended well for the target countries or for the EU. So, Russia’s plans for Moldova are likely to have similar consequences for the EU’s latest attempts to be a convincing foreign policy actor. Full Article
d Belarus-EU border crisis reveals wider security threat By www.chathamhouse.org Published On :: Wed, 08 Dec 2021 10:09:43 +0000 Belarus-EU border crisis reveals wider security threat Expert comment NCapeling 8 December 2021 By engineering a crisis at the Belarus border, Lukashenka is attempting to exacerbate vulnerabilities within the EU. Securitizing migration is not the answer. When thousands of migrants began freezing to death in the forests on the Belarus border with Poland, Belarusian leader Aliaksandr Lukashenka was forcing the European Union (EU) into a tough choice – either give in to blackmail and welcome migrants whose attempts to trespass the EU border were a result of his policy of luring them to Belarus to put pressure on the EU, or keep the borders closed and declare solidarity with Poland despite its known mistreatment and illegal pushbacks of potential asylum-seekers. Lukashenka’s action was aptly exploiting three key pressure points of the EU – as a normative power where the human dignity of migrants is overlooked while the European border and coastguard agency Frontex stands by, as a geopolitical actor seeking to externalize its migration problem by signing readmission agreements with transit countries, and as a community of values with the EU-Poland dispute over rule of law. Now is the time for a robust strategy aimed at preventing what is currently a rogue state from turning into an outright terrorist regime His approach is typical ‘dictaplomacy’ and democracies which have confronted such a ‘continuation of war by other means’ in their past dealings with dictatorships know that blackmail mostly serves to divert attention away from a rogue leader’s misdemeanours towards his own population. But if this had been game of chess the EU would have been in check. Thankfully checkmate was avoided – so far – as a compromise was found following weeks of heightened diplomatic efforts. Lukashenka was forced to back-pedal and take care of the migrants, and no humanitarian corridor was needed as the EU sent funds and took measures to support organizations providing shelter for the migrants in Belarus, while airlines and governments in the source countries were pressured to restrict flights to Minsk and started repatriating part of the migrants. Causing a nuisance ‘Operation Gateway’ – the outline of which was allegedly drawn several years ago and tested by Russia in 2016 at its own borders with Norway and Finland – certainly caused a nuisance, but it ultimately backfired as Lukashenka now has to manage the remaining 2,000-5,000 migrants who refused to be flown back, as well as facing increased international sanctions. However, the fact that Angela Merkel had to personally call him made it look as if Lukashenka did not back down for nothing. The EU and NATO, including the UK, only reacted collectively to this crisis once it was already out of hand, leaving questions over whether this experience of Lukashenka’s dictaplomacy is a wake-up call to boost resilience against rogue warfare, and to upgrade strategic assessments of the ‘Lukashenka problem’ too. Back in June, the Belarus ministry of foreign affairs (MFA) announced its withdrawal from the Eastern Partnership and the visa facilitation and readmission agreement with the EU, while Lithuania sent early warnings about a ‘hybrid attack’ at its own border with Belarus. In August, Der Spiegel reported details of an alleged smuggling scheme whereby Tsentr Kurort – a company closely linked to the Administration of the President of Belarus with offices in the Middle East – was handling the shipping, accommodation, and relocation of migrants. The EU and NATO, including the UK, only reacted collectively to this crisis once it was already out of hand, leaving questions over whether this experience of Lukashenka’s dictaplomacy is a wake-up call to boost resilience against rogue warfare The smuggling of migrants was entirely predictable as Lukashenka has hinted many times Belarus could stop ‘protecting the EU from armed migrants’ seeking to enter it illegally. He has upped his rhetoric beyond notions of hybrid warfare by saying he needs Russian nuclear-capable bombers to ‘help him navigate the migrant crisis’, even hinting Belarus could station both Russian nuclear weapons and S-400 anti-aircraft missile systems. This shows Lukashenka is feeling increasingly cornered – which could lead to more unpredictable security crises. Russia and Belarus are deepening relations Although there is no smoking gun pointing to direct Russian involvement in orchestrating the hybrid attack at the EU’s borders, a new step in the military rapprochement between the two countries came when Putin and Lukashenka approved a new Military Doctrine of the Union-State of Russia and Belarus – a non-public document including a joint concept of migration policy. Lukashenka has also come off the fence over Crimea by openly accepting the legality of the peninsula’s integration with Russia. Given Russia is also sabre-rattling over Ukraine, the risk of an accidental escalation into armed conflict is increasing in what feels like a return to classic Cold War logic, with the difference that the East is now offensively using the South for confronting the West. In recognition of the threat, the UK has joined the US, Canada, and the EU in the fresh sanctions on Belarus. Full Article
d Crisis on Europe’s doorstep By www.chathamhouse.org Published On :: Tue, 04 Jan 2022 17:02:14 +0000 Crisis on Europe’s doorstep 2 February 2022 — 4:00PM TO 5:00PM Anonymous (not verified) 4 January 2022 Online Domestic instability and foreign interference is destabilizing Bosnia, with the declining strength of the 1995 Dayton Agreement symbolic of the troubles growing within the country. Milorad Dodik’s continuing efforts to remove the international judicial and security presence in Bosnia, along with calls for the secession of Republic Sprska and increasing Russian efforts to destabilize the country are concerning many, particularly nearby European Union (EU) member states. On 3 November 2021, the United Nations (UN) Security Council voted unanimously to extend the EU-led multinational stabilization force for another year, as well as NATO Headquarters Sarajevo. However, the role played by the Office of High Representative was absent from the outcome and leaves the implementation of civilian aspects emanating from the Dayton Accords in a position of uncertainty. Against a background of ongoing troubles in the country and the growing proxy conflict between the West and Russia, the situation in Bosnia is worrying. The expert panel discusses: Why has the situation in Bosnia been allowed to deteriorate to such a condition? What is Europe’s best solution to resolve issues in Bosnia and how is it acting to remedy them? How have international efforts been hampered to support development in Bosnia? What are Russia’s aims in the country? Does US foreign policy recognize Bosnia as a strategic partner? Read the transcript This event forms part of Chatham House’s work on Reinvigorating Multilateralism. Full Article
d The West must face down Putin By www.chathamhouse.org Published On :: Tue, 01 Feb 2022 16:12:51 +0000 The West must face down Putin The World Today MVieira 1 February 2022 If Russia’s ambitions are not checked, the implications will be global, warns James Nixey After seven years of invasions, annexations, assassinations, abuses and now the current crisis in European security over the fate of Ukraine, one thing has been laid bare: the true nature of the Russian state. Moscow made its ambition clear in mid-December with the unprecedented and public issuing of ultimatums in the form of draft treaty proposals. Portrayed by Russia as an attempt to end Nato’s expansion eastwards, the Kremlin is in fact demanding that the United States and western institutions roll back their security guarantees to Eastern Europe. These are not two sides of the same coin if one believes and accepts the principles of the Helsinki Accords that the successor states to the Soviet Union are just as independent and sovereign as Russia. Russia’s demands laid bare equate to giving it a free hand in Eastern Europe. This should not be reduced to simplistic labels such as ‘territorial expansionism’ or a ‘return to the Soviet Union’, both of which can be picked at for a lack of accuracy. Russia has gone beyond being an awkward player at the negotiation table or a bully who can be dealt with further down the line But it is, in Russia’s own words, the most explicit statement yet of its long-standing desire to return to a former age, where great powers directed their respective spheres of influence – a yearning for a time of empire and a disregard for the flow of history. The intense diplomatic and media focus since then suggests there is a consensus that Russia has gone beyond being an awkward player at the negotiation table or a bully who can be dealt with further down the line. But this has not as yet led to the operational conclusion that Russia must be challenged and ultimately faced down, no matter how unpalatable. The logical response to the exposure of Russia’s true intentions would be an overhaul of western policy. Yet the West persists in its article of faith that dialogue with Russia will bring about a change in its behaviour – despite all evidence to the contrary. Western politicians have been anxious to avoid direct confrontation with Russia. But the Kremlin is likely to see this course of action as confirmation that it can proceed unchecked. When Moscow has chosen the path of conflict, efforts at dialogue rarely bring a peaceful resolution. When Moscow has chosen the path of conflict, efforts at dialogue rarely bring a peaceful resolution Russia is blessed with particularly talented negotiators. While it has its fair share of angry ultra-nationalists who are easily dismissed, it also has more subtle brains at official and unofficial levels with whom western politicians are eager to engage to claim morsels of intelligence or to show that the Kremlin is not beyond redemption. Sergei Lavrov, Russia’s foreign minister, is an intelligent and experienced man, who is adept at dismissing the protests of most of his western counterparts. In such circumstances, and with such a pressing need to avoid a war, dialogue must be tightly contained as it has the potential to lead to compromise in areas where there should be none. Russia’s ambitions for a land empire Eastern European states which were part of the Soviet Union or signatories to the Warsaw Pact are geographically closer to Russia and as a result more physically at risk. But their history and close relations with Moscow in the past have allowed them to acquire experience and expertise in dealing with their more powerful neighbour. They uphold principled stances on sovereign rights, which has led the Kremlin to brand the Baltic states, Ukraine and more recently Moldova as traitors. To the West, on the other hand, they can often be seen as awkward or getting in the way. While the sandwiched eastern states may have much to teach us about dealing with Russia, some central European countries have a closer relationship with Moscow. Serbia’s security services have recently been exposed as being under the influence of Russia’s own FSB, the Federal Security Service, successor to the KGB, and have colluded in repressing Moscow’s political opponents. At the same time, Viktor Orbán’s Hungary continues to defy the European Union with its repressions and is one of the few states that looks to Russia as a model. By failing to address the real nature of Russia’s demands, Europe is avoiding critical decisions What is at stake here is a basic grasp of the nature of relations between states in the 21st century. What Russia is insisting on is its right to a land empire which is entirely at odds with the principles of statehood that now govern Europe, and indeed much of the rest of the world. By failing to address the real nature of Russia’s demands, Europe is avoiding critical decisions that will affect its future security for generations to come. The implications of that avoidance do not only affect Europe – they are global in importance. Other powers, most notably China, will watch closely how the West responds to Russia and gauge its willingness to support allies, friends and partners against aggression. Any failure to respond firmly to Russia’s approach of demanding limits on the sovereignty of its neighbours, backed by the threat of military force, can only encourage similar strong-arm tactics elsewhere. It is notable that, from Chechnya to Syria, Russia has not yet suffered an unambiguous defeat when it has asserted its ambitions through military power. Facing down Russia will take skill, time, spine, money, grit and self-sacrifice Resolving the incompatibility between the way Russia sees itself and what the rest of Europe views as the acceptable limits of Russian power will be a long, painful process. Facing down Russia will take skill, time, spine, money, grit and self-sacrifice. Sanctions, for example, hurt those imposing them as well as the receiver. These are attributes in short supply in what Russia considers to be the weak, decadent West. Since such resources are unlikely to be found, the unappetizing future for relations is most likely to involve Russia continuing to chip away at European sovereignty while its own structural flaws further weaken it to the point of irrelevance, or to push it to take ever more extreme risks. Full Article
d Limited expectations as Scholz heads to Kyiv and Moscow By www.chathamhouse.org Published On :: Mon, 14 Feb 2022 14:08:25 +0000 Limited expectations as Scholz heads to Kyiv and Moscow Expert comment NCapeling 14 February 2022 After heavy criticism for an initially timid response, the approach of Germany’s new government to the Ukraine crisis is improving as its position on Russia evolves. Olaf Scholz is a famously quiet and cautious communicator and, as concerns mounted in Washington and London about the possibility of a Russian invasion of Ukraine, the new German chancellor remained silent. This time his silence reflected the fact that his government was unprepared for its first major foreign policy test, with marked divisions between the SPD and the Greens on how to manage a rapidly deteriorating relationship with Russia. When he did speak, Scholz caused dismay in several NATO capitals by defending the controversial Nord Stream 2 pipeline. He called it ‘a purely private economic project’ even though the company building the pipeline is a subsidiary of Russia’s state-owned Gazprom. Scholz has prepared the ground carefully for his visits to Kyiv and Moscow, extensively coordinating with NATO allies, such as France and Poland – as part of the Weimar Triangle – and the three Baltic states The absence of crisis management from Berlin was a stark reminder of the gap left by Angela Merkel. Her knowledge of Russia and Ukraine, and her personal experience of dealing with Vladimir Putin, were key assets in 2014 in developing a unified western response to Russia’s annexation of Crimea and its destabilization of south-eastern Ukraine. Germany has coordinated with its allies Scholz has prepared the ground carefully for his visits to Kyiv and Moscow, extensively coordinating with NATO allies, such as France and Poland – as part of the Weimar Triangle – and the three Baltic states. His inaugural visit to Washington helped align positions on US-EU efforts to develop an economic deterrent against further Russian intervention in Ukraine. Scholz has also repeated Merkel’s language from 2014 to signal to Moscow that Germany and its partners are ‘united and determined’ to stand their ground. And he has spoken of Germany’s continuing double strategy of ‘clear announcements’ to Moscow of the price it would pay for further aggression accompanied by a readiness to use all possible channels of dialogue to preserve peace. The continuation of Germany’s established policy will not surprise Moscow. But under the surface Germany’s discourse on Russia is evolving as the political class internalizes the fact that the current Russian leadership is openly threatening to use military force to impose its will on Ukraine and re-configure Europe’s security arrangements. Despite deep concerns about Germany’s dependence on Russian gas – more than half of the gas it consumes comes from Russia – there is broad acceptance that Nord Stream 2 cannot go ahead if Russia invades Ukraine. But typically, Scholz has not yet said as much publicly, limiting himself to stating ‘all options are on the table.’ Despite its mantra that there is no alternative to the Minsk Agreements, Berlin now admits these currently offer no prospect of resolving the war in Donbas Robert Habeck, Germany’s vice-chancellor as well as economic affairs and climate action minister, says the ‘geopolitical situation’ requires Germany to diversify its gas supplies and infrastructure for importing gas. For years, a strong pro-Russian gas lobby has dominated the thinking of the Economics Ministry and one consequence is the complete absence of facilities to import liquefied natural gas. The German debate on Russia is shifting A public debate has also started about weapons deliveries to Ukraine, even though this runs counter to deeply embedded pacifist tendencies in German society. Some MPs, former diplomats, and experts have begun to make the case for Germany to supply weapons to Ukraine so it can exercise its right to self-defence and deter military attack. Christoph Heusgen, a former long-standing foreign policy adviser in the Federal Chancellery, says Berlin’s decision not to deliver arms to Ukraine to avoid endangering the Minsk peace process requires revision now Moscow has abandoned the path of negotiation. Despite its mantra that there is no alternative to the Minsk Agreements, Berlin now admits these currently offer no prospect of resolving the war in Donbas because Russia is not prepared to implement them properly. Other taboos are also being broken inside Germany. Heavyweight left-of-centre Die Zeit published the first results of its investigation into the SPD’s links with Russia and their place in Russia’s channels of influence in Germany. And even the SPD’s Sigmar Gabriel, an outspoken champion of Nord Stream 2 during his time as a government minister, has raised the question of Germany terminating energy imports from Russia if there is a drastic deterioration of the security situation. Full Article
d Ukraine crisis could trigger cascading risks globally By www.chathamhouse.org Published On :: Wed, 16 Mar 2022 13:14:07 +0000 Ukraine crisis could trigger cascading risks globally Expert comment NCapeling 16 March 2022 The effects on the wider world from the Ukraine invasion go far beyond the waves of shock and horror being felt from this escalating conflict. Russia and Ukraine rank 11th and 55th respectively in terms of their national economies but, for the global supply of critical resources such as energy, food, and minerals, these two countries together are far bigger hitters – and both the threat and reality of resource flows from them being reduced have already driven up global prices. The world is already facing a cost-of-living squeeze coming out of the COVID-19 pandemic, so further price spikes or supply constraints have the potential to seriously undermine food and energy security, equitable access to basic goods and services, and social stability around the world – which can then potentially create systemic risks for economies and societies. The global implications of the Ukraine conflict are only just beginning to be explored fully but the immediate impacts of the crisis on global markets are already well-documented. In the first few days after Russia’s invasion, energy prices spiked, triggering further fertilizer price rises – as fertilizer production is highly energy intensive – which in turn is contributing to food price rises because fertilizer costs are an important factor in food production. Further price spikes or supply constraints have the potential to seriously undermine food and energy security, equitable access to basic goods and services, and social stability around the world Interruptions to shipping in the region around Ukraine – as well as globally – have impeded the flow of goods which pushed prices up even further, while economic sanctions on cross-border flows of goods and finance are further adding to market pressures. But this is just the start – these impacts will bring ripple effects which propagate far beyond their point of origin, known as ‘cascading risks’. Risk is a combination of hazard, exposure, and vulnerability – in terms of the Ukraine invasion, the hazard is the conflict and its immediate impacts on the societies and economies of Ukraine and Russia, while exposure relates to the degree to which other countries are likely to be affected depending on how much they are integrated into the global economy or the ‘just in time’ nature of their supply chains. Vulnerability relates to a society’s capacity to mitigate the harmful impacts of the conflict, such as controlling borders, sourcing alternative goods from suppliers, or protecting against price or supply shocks. Risk cascades – the second- and third-order impacts of the original hazard and of responses to that hazard – can interact across sectoral boundaries – as with energy and food, for example – and their compound effect can lead to overall systemic risks for society. Anticipating this potential is essential to understanding the nature and scale of the global ramifications being felt from the Ukraine conflict. Recent work in the UK to assess levels of cascading risks resulting from a changing climate – the UK Climate Change Risk Assessment – provides a valuable framework for thinking about this area. It examines key pathways for risk to cascade through global systems – when applied to the situation in Ukraine, these pathways and their interactions offer an indication of the scale of crisis that citizens face far beyond Ukraine’s and Russia’s borders. Interruptions to the flows of goods and energy In globalized trade networks, localized disruption to supply chains rapidly yields widespread international impacts – of particular concern is the immediate supply of food because most countries rely on lean supply chains and some may only have a few days food within their own borders. Experience from previous food price crises indicate even small interruptions to trade can result in runs on the market and rapid price inflation. In the case of this conflict, the trade interruption will be far from small because, between them, Russia and Ukraine export around one-quarter of all traded wheat, more than three-quarters of traded sunflower oil, and one-sixth of traded maize. Given many people are understandably fleeing this conflict, other countries may struggle to cope as the cost-of-living crisis and urgent efforts to bolster national security infrastructure may squeeze available public funds Energy markets are also a concern because many countries use more energy than they produce and therefore rely on imports of energy or fuel for domestic use. Russia produces around ten per cent of the world’s commercial energy with a concentration of sales in major regions such as the European Union (EU) and China. As with food, a shortfall in energy provision leads to market runs and rapid inflation as actors compete in a tightening space, while poorly designed policy interventions by nations trying to ensure their own security add further pressure to global supply and worsen price rises. In addition, the closely interconnected nature of energy markets means disruption to one fuel – such as gas in this case – affects global prices for other forms of energy. The impact of moving people and money As the last decade richly illustrates, the cross-border flows of people impact those societies absorbing them – for example, contributing to a rise in nationalism – as well as increase the costs of supplying essential resources. Given many people are understandably fleeing this conflict, other countries may struggle to cope as the cost-of-living crisis and urgent efforts to bolster national security infrastructure may squeeze available public funds. Financial flows are crucial to the functioning of global economies, whether for inward investment or insurance and – as Russian citizens may be about to discover – restricting the global flow of money has a serious impact on households. Beyond Russia, the outflow of money from major financial centres such as London to meet insurance claims or to enable infrastructure reinvestment post-conflict may also have severe knock-on economic impacts. The impact on governance and health The global spikes in energy and food prices resulting from these supply chain disruptions will see many countries struggle with rising food and energy insecurity as well as increased inequality. Taken together these conditions create many issues beyond immigration pressures and the associated politics, including increased inequality and civil unrest. This potentially destabilizes governments which has consequences for the stability of an entire region such as interrupted supply chains, the need to deploy peacekeeping forces, or significant flows of aid – all with global consequences far beyond the countries in question. Populations may suffer mental health impacts arising from the Ukraine invasion, whether from the trauma of being forced to leave home to escape conflict, anxiety for the wellbeing and safety of families and friends caught up in it, or a more general anxiety arising from the perception of living in an unstable world. Full Article
d Ukraine exposes Europe’s double standards for refugees By www.chathamhouse.org Published On :: Wed, 30 Mar 2022 13:20:31 +0000 Ukraine exposes Europe’s double standards for refugees Expert comment NCapeling 30 March 2022 As European governments provide swift protection assurances to those fleeing Ukraine, non-European asylum-seekers continue to face violence at the EU’s borders. One month after Russia’s invasion of Ukraine, the European Union (EU) already faces its largest refugee crisis since World War Two, with more than ten million people having fled their homes – 6.5 million displaced within Ukraine and 3.9 million escaping to neighbouring countries. Acting quickly and decisively, European governments have opened borders and European citizens have opened their homes in an unprecedented showing of solidarity towards refugees. But, with all eyes on Ukraine, the Greek coastguard continues to illegally push back asylum-seekers crossing from Turkey while Spanish police forcefully repel those who dare to jump the fence in Melilla. The painful contrast exposes the double standards in the EU’s approach to refugees. With Europe’s grim history of restrictive asylum policies, it is wishful thinking that the warm welcome to Ukrainians will extend to all asylum-seekers. The EU solidarity to displaced Ukrainians illustrates the deeply politicized – and often discriminatory – nature of providing refugee protection. The waves of women and children leaving Ukraine prompted a surge of humanitarian action but they are also a chilling reality check of Europe’s double standards However, the hope is this turning point in European history can at least set an important precedent for treating refugees more humanely. Undoubtedly, EU solidarity towards people fleeing the horrors of Putin’s war is critically important and the initial response is positive in its efforts to meet immense humanitarian needs. Solidarity with Ukrainians The EU activation of the Temporary Protection Directive (TPD) is a significant step towards a more humane protection regime and fairer responsibility-sharing among member states. Without the need for the examination of individual applications, those fleeing Ukraine can access harmonized rights across the EU for three years – including residence, housing, medical assistance, and access to the labour market and education. The TPD is also a move away from the strict ‘Dublin’ rules which put the pressure of hosting refugees onto the countries of ‘first arrival’. Ironically, the fiercest opponents of intra-EU solidarity, such as Poland and Hungary, are the ones benefiting from this change now but, in the case of Ukraine, geographical proximity and shared histories must be considered when analysing Europe’s response. Eastern European and Baltic countries share a post-Soviet history and fear of Russian aggression, and Ukrainians already enjoyed 90 days of visa-free travel in the EU – with a large diaspora, many have established networks across Europe. But even considering these distinctive connections with Ukrainian displacement, the initial response still shows that European countries have both the political will and the capacity to host refugees. Unlike the usual – often media-fuelled – narratives of refugee ‘invasions’ into Europe, the waves of women and children leaving Ukraine prompted a surge of humanitarian action but they are also a chilling reality check of Europe’s double standards. The EU has used agreements with countries such as Turkey and Libya to prevent arrivals and outsource asylum responsibilities, while border violence, detention, and lengthy asylum procedures await the few asylum seekers who manage to enter Europe from the Middle East, Asia, and Africa. These ‘fortress Europe’ legacies have even undercut the humanitarian response in Ukraine, with reports of incidents of discrimination towards people of colour at the EU borders being condemned by the United Nations (UN) and the African Union (AU), the media facing allegations of racist reporting, and comments from Bulgarian PM Kiril Petkov providing a stark reminder of the islamophobia, racism, and history of colonization which still pervades European asylum policies. The unity shown over Ukraine can help reshape and refocus political efforts towards increased responsibility-sharing among EU member states – the perennial ‘hot potato’ of the EU asylum system Foreign policy also influences how EU leaders treat the right to asylum, as the geopolitics of Europe’s efforts to create a united front against Russian aggression is an undercurrent to the prompt European response to Ukrainians. But only a few months ago, non-European asylum-seekers trapped in freezing forests at the Poland-Belarus border were used as political pawns by Belarusian leader Aliaksandr Lukashenka and then dehumanised as a ‘hybrid attack’ by EU leaders. A turning point for asylum in Europe? Despite entrenched discriminatory precedents, it is worth looking ahead at this moment of reckoning. Although policy changes remain far off, the unity shown over Ukraine can help reshape and refocus political efforts towards increased responsibility-sharing among EU member states – the perennial ‘hot potato’ of the EU asylum system. Full Article
d Putin’s Eurasian dream may soon become a nightmare By www.chathamhouse.org Published On :: Tue, 03 May 2022 13:11:31 +0000 Putin’s Eurasian dream may soon become a nightmare Expert comment NCapeling 3 May 2022 The Ukraine invasion has detrimental consequences for the Russia-led Eurasian Economic Union, a project which has been stumbling since its inception. The Eurasian Economic Union (EAEU) – consisting of Russia with Armenia, Belarus, Kazakhstan, and Kyrgyzstan – represents the culmination of Russia’s pursuit of regional integration with its post-Soviet neighbours. Officially, the Union has an ambitious economic goal – the creation of a market based on common rules for its five member states and their 180 million citizens – and Russia likes to portray the EAEU as an Eurasian replica of the European Union (EU). But although a common market was placed at the heart of the EAEU as a way to appeal to member states, it is of marginal importance for the Russian economy. For Moscow, the EAEU is primarily a geopolitical tool to help re-assert its regional and global role. In a world of evermore powerful trading blocs, Moscow wants to use the EAEU to establish its own economic power base in the new polycentric world order. But Russia’s limited interest in the technocratic intricacies needed for the economic union to live up to its lofty proclamations exposes the real geopolitical ambitions. The Kremlin has no qualms about disregarding the common rules when they clash with Russia’s own foreign policy, and it soon became evident the EAEU was a means to an end rather than an equitable institution within which Russia would accept constraints on its unilateral behaviour. A crisis in the making Although the EAEU has enabled some internal trade liberalization as well as the movement of people and labour to the benefit of its members reliant on labour migrant remittances, it has failed to tackle institutional barriers or promote growth and development policies. Russia’s limited interest in the technocratic intricacies needed for the economic union to live up to its lofty proclamations exposes the real geopolitical ambitions It has been hampered by weak common institutions and a lack of institutional capacity of its member states, while Russia’s dubious commitment is also problematic. The EAEU lacks the institutional features of a genuine common market and any attempts to address these shortcomings have been essentially empty promises. EAEU membership does benefit the political elites of its member states, because its hub-and-spoke model relies on bilateral high-level political deals between Russia and each member state individually. And by using the enticement of security guarantees and both political and financial support, Moscow has succeeded in attracting new members to join. But a member’s political survival – or defence against political and economic reform – is dependent on military, economic, financial, and political support from Russia. This has been evidenced by the Armenian-Azerbaijan conflict, and by Russia’s backing of the Lukashenka regime in Belarus and the Tokayev government in Kazakhstan. The design of the EAEU ties it to Russia’s own fate, and so the impact of harsh sanctions imposed on Russia for invading Ukraine are in stark evidence across its member states. Both Kazakhstan and Kyrgyzstan are reeling from the adverse effects on their domestic currencies and remittances, and the trade bans of key commodities. And although the ban Russia imposed on grain export to EAEU members has softened, it shows the extent to which Russia was prepared to disregard the rules and sacrifice the EAEU to rescue its own economy. Members are incurring direct economic losses from Putin’s war against Ukraine and the fluctuation of the rouble has created a major impediment to trade with Russia. Russia seems to increasingly view the Union as a convenient tool to bypass sanctions, with massive implications for its partner countries. And the supposed advantages of EAEU membership – enhanced trade, growth, and modernization – have simply not materialized. Due to the rapid economic decline of Russia – a fall of 10-15 per cent is anticipated for 2022 – the EAEU is even less likely to deliver the promised economic benefits, while also putting members at risk of secondary sanctions. The Ukraine invasion has also reignited domestic sensitivities and regional tensions. In Kazakhstan, Tokayev has failed to endorse Russia’s justification for the invasion and refuses to recognize the ‘independence’ of the separatist LNR and DNR. Russia’s invasion of Ukraine clearly reduces the benefits of Eurasian integration even further than before and imposes higher cost on the partner countries than were envisaged when they joined Meanwhile Azerbaijan has pursued territorial gains in Nagorno-Karabakh while Russia is distracted by its invasion of Ukraine, and has requested the withdrawal of Russian peacekeeping from the disputed territory. Russia is keen for partner countries to help mitigate the economic impact of sanctions by providing alternative transit routes for imports to Russia. But the EAEU faces challenges even at its most basic level because the sharing of custom duties among member states was denominated in dollars, which Russia now wants to move away from. No easy escape Russia’s invasion of Ukraine clearly reduces the benefits of Eurasian integration even further than before and imposes higher cost on the partner countries than were envisaged when they joined. They have been dragged into a geopolitical calamity over which they have no control – the inability of EAEU institutions to mediate or constrain Russia’s behaviour is stark. Full Article
d War in Ukraine: Can the EU survive without Russian oil and gas? By www.chathamhouse.org Published On :: Thu, 05 May 2022 15:32:55 +0000 War in Ukraine: Can the EU survive without Russian oil and gas? Audio NCapeling 5 May 2022 The fourth episode of our podcast mini-series examines how reliant the European Union (EU) is on Russian energy. What would an all-out ban on Russian oil look like? Which countries would be most affected? Does this offer an opportunity for renewable energy? Clips used: Bloomberg News This episode was produced by Anouk Millet of Earshot Strategies on behalf of Chatham House. Full Article
d Africa and Europe: Cooperation on digital transitions and new technologies By www.chathamhouse.org Published On :: Thu, 12 May 2022 09:02:13 +0000 Africa and Europe: Cooperation on digital transitions and new technologies 26 May 2022 — 8:00AM TO 12:30PM Anonymous (not verified) 12 May 2022 Online The 11th Africa Day International Conference takes place under the auspices of the president of the Republic of Slovenia, HE Mr Borut Pahor, and within the framework of the Bled Strategic Forum. Slovenia’s annual high-level Africa event seeks to improve policy outcomes for citizens in Europe and Africa as a result of a mutual understanding and strengthened cooperation between the two regions. The event is co-hosted by the Ministry of Foreign Affairs of the Republic of Slovenia, the Chatham House Africa Programme and the European Commission. Expert discussions at this year’s edition will examine collaborative links between Africa and Europe in promoting responsible innovation and governance of emerging technologies, as well as the role of technology in shaping creative and cultural economies. The conference will be broadcast live on this website, on the Slovenian Ministry of Foreign Affairs website and on the Africa Programme Facebook page. 11th Africa Day International Conference Agenda (PDF) Full Article
d Culture notes: Populists of the world unite By www.chathamhouse.org Published On :: Wed, 25 May 2022 09:11:06 +0000 Culture notes: Populists of the world unite The World Today rsoppelsa.drupal 25 May 2022 America’s hard-right has successfully played a long game at home, and now it’s schmoozing Europe. We should be worried, says Catherine Fieschi The politics of advanced democracies is a rather Janus-faced affair these days. No sooner have we breathed a sigh of relief at the results of the French presidential election than a leaked United States Supreme Court document on Roe v Wade signals American abortion rights are under threat. Yes, Europe seems to be maintaining political unity in its support of Ukraine, and the US is lavishing eye-watering sums on it both in military and humanitarian aid. Yet one cannot help but feel that these might be short-lived spells of relief in the face of mounting storm clouds on the political horizon. Both at the domestic and international level, populist politics looks to be gathering pace still. On the domestic front, we should be cautious in our relief. In the French elections Emmanuel Macron was indeed re-elected, and comfortably so, but there is no denying the space occupied by populist politicians on the left and the right. In the first round, Marine Le Pen gained 23 per cent of the vote, left populist candidate Jean-Luc Mélenchon 22 per cent, and far-right candidate Éric Zemmour 7 per cent. Add to this a record low turnout, and the picture is one of a system in which mainstream politics has overall been rejected in favour of various populist options. The Hungarians weren’t so lucky, and Viktor Orbán’s capture of the media and quashing of the opposition over his years in power delivered solid victory. What should be cause for further concern is what is happening in the United States, as well as its potential impact on European politics. A quick flick through American politics today suggests dysfunctionalities of staggering magnitude and depth, and the full extent of the success of the right-wing Republican project, as confirmed by the intention to reverse Roe v Wade. Any reversal of Roe v Wade is a further step towards a drastic re-territorialization of American politics: into red states and blue states, into urban v rural, into places where taxes fund public education and public goods and where they won’t. It is also about a re-territorialization of institutional power away from the federal and into state institutions. The words of JD Vance, the Ohio Republican senatorial candidate – author of the rather good memoir Hillbilly Elegy – pander to an ‘American heartlands’ view of the United States’ role in the world. Asked about the fate of Ukraine, Vance simply replied that he ‘didn’t really care what happens to Ukraine one way or another’. On an even more basic level, we would do well to keep in mind that there were 440 anti-voter bills in 49 states at the end of 2021 and rising, calling into question citizens’ basic rights to vote. Republicans have pursued this agenda relentlessly. They have played a long game and invested in media, education and minor and not so minor projects – all of which have secured them a social and political base that is well-disposed towards the deep reversal of the American liberal global project and that of its allies across the world. The arrival of the Fox News-driven Conservative Political Action Conference in Hungary in May is deeply worrying And it is perhaps on this last point that we should be most alarmed. Between May 18-20, the Conservative Political Action Conference, an American conclave of the right, was held in Europe. Viktor Orbán gave the keynote speech, and other speakers included the Brazilian President Jair Bolsonaro’s son, Eduardo, and the president of Spain’s far-right party Vox, Santiago Abascal, as well as some well-known American Trumpian voices, including Trump himself. Marine Le Pen, whose earlier appearance at the conference had met with rapturous applause, chose not to cosy-up too closely to Orbán in the run-up to the French parliamentary elections in June but she sent her deputy. The export of the Fox News-driven conference from across the Atlantic is deeply worrying. Up until now populists have failed in their attempts at international alliances. At the European Union level their nationalism has always been in the way of their working together, and their groups tend to be short-lived or ineffective as a result. As for American attempts in Europe, the one led by Steve Bannon, the former White House adviser, in 2020 that aimed to create an Academy for the Judeo-Christian West ended as a damp squib – possibly not helped by his dismissal from the White House amid charges of defrauding donors. But something may be changing: the conference’s embrace of Orbán and an international smattering of ‘strongmen’ hailing from the hard-right, aligned with Putin and sup-ported by Trump and a media empire, suggests that we are entering a Trumpian-infused second act that in its triumphal revanchism is seeking to create an international right-wing populist, or even authoritarian front. This is about politics, media, but also money – something European populist parties have been short of. As Marine Le Pen explained to French voters, her party is so poor it had to borrow money from a Russian bank. As some have pointed out, the Russian aggression against Ukraine has complicated matters when it comes to Russian funding of disinformation to the West. Many routes have been shut down. But a new route between the US and Hungary as a platform to floss Europe with dirty money is a good replacement to the old Russian route. Full Article
d Review: One-man bandwagons By www.chathamhouse.org Published On :: Wed, 25 May 2022 09:46:00 +0000 Review: One-man bandwagons The World Today rsoppelsa.drupal 25 May 2022 The ills of strongman politics are diagnosed sharply in this accessible overview – but a cure is nowhere to be found, says Natasha Lindstaedt The Age of the Strongman: How the Cult of the Leader Threatens Democracy around the WorldGideon Rachman, Bodley Head, £20.00 For anyone reading the headlines, it should come as no surprise that democracy has regressed to where it was in 1989. The profound geopolitical and technological changes in the post-Cold World era have led to chaos, polarization, nationalist backlash and nostalgia for strong leadership in democracies. Countries such as Russia and China have provided a new model for leadership that has become frighteningly infectious – the strongman. Gideon Rachman charts this new era, offering an accessible overview of 14 examples, including Britain’s Boris Johnson, Donald Trump of the United States, Narendra Modi of India, Jair Bolsonaro of Brazil, Viktor Orbán of Hungary, Xi Jinping of China and – the archetype – Vladmir Putin of Russia. The idea that we are living in the age of strongman politics is not particularly novel. Scholars of authoritarian politics have noted for years that there has been a steady rise in ‘personalist’ dictatorship and personalism in democracy in general. Nearly 40 per cent of all dictatorships are personalist, meaning domination by a single person, compared with 23 per cent in 1988. Autocracies have become increasingly aggressive, using sharp power to undermine democracy, which signals a shift. Autocracies used to focus on their own stability and didn’t interfere with democracies. Rachman focuses on this threat that the strongman poses to democracy while macho one-man rule spreads across the globe. He provides a well-written, clear overview of why each leader fits the strongman label, what explains their appeal and what informs their worldview. Where Rachman is effective is in weaving together the commonalities of these strongmen – and they are all men – and their relationship to each other. Despite their ultra-nationalism, they have created an unofficial, multilateral network of mutual support. This includes leaders whose religious convictions may appear to be in conflict – such as Benjamin Netanyahu of Israel and Muhammed bin Salman of Saudi Arabia. This is not just a network of dictators – autocratic-style leaders of democratic countries have been welcomed to the club. In this system, strongmen openly admire each other, revel in their disdain for liberalism and human rights, and share advice and inspiration. This contrasts with western European leaders who fail to build such iron-clad bonds. Each chapter is peppered with anecdotes about Rachman’s first-hand impressions of some of these leaders and other notables in positions of power gained from his decades as a foreign correspondent and analyst. His colourful commentary complements his understanding of how they operate. A common theme throughout is that the strongman’s appeal appears as a breath of fresh air for democracy, liberalism or peace. They are often labelled as anti-elitist and men of the people. This honeymoon period ends when each leader shows their true colours: attacking political opponents, sometimes in ruthless purges, disregarding the rule of law, weakening the courts and vilifying or controlling the media. Democracy is like a tram you ride until you arrive at your destination Recep Erdogan, President of Turkey A well-placed quote from Recep Erdogan sums this up: ‘Democracy is like a tram you ride until you arrive at your destination.’ Genuine public support exists for these manoeuvres. Dislocation from unmanaged globalization and economic crises has created an audience for political entrepreneurs. Strongman leaders have earned the distinction of being relatable and telling it like it is, despite many being considered to be liars and often filthy rich. Their ability to tap into people’s fears of the West, crime, immigrants or other ethnic and religious groups has helped gain them a fiercely loyal following. According to Rachman, strongman politics is linked to fear that a majority group that was once dominant is being threatened – something leaders such as Donald Trump have astutely tapped into. Unlike some of the kleptocratic regimes of the 1970s and 1980s that were the embodiment of venal opportunists – think of Ferdinand Marcos of the Philippines, Mobutu of the Democratic Republic of the Congo and Jean-Claude Duvalier of Haiti – the strongmen of today have been inspired by the ideology of hyper-nationalism and anti-liberalism. Rachman links strongmen to the work of Carl Schmitt, a Nazi Party member, who was a vociferous critic of parliamentary democracy and cosmopolitanism, while touting the importance of illiberal norms to exercise power. Rachman argues that we are in a war of ideas, with liberalism under attack. He hones in on the perennial target George Soros, and how his support for liberal democracy has garnered the unwanted attention from the world’s right-wing ideologues and strongmen. Social media has been usurped by these leaders and their regimes to forge closer, direct relationships with their supporters, to churn out fake news and create dangerous echo chambers. They are snake oil salesmen, making huge promises but offering very little in practice. They are never as they initially appear, and their images are carefully crafted. Another theme emerges on the career pathway. Many served as a mayor of a cosmopolitan city. An interesting chapter on Johnson explains how he comes across like a relatable ‘good chap’, being able to handle embarrassing photo-ops. He was also a devoted Europhile, attended Eton and Oxford, and championed multi-culturalism as Mayor of London. Always the opportunist, Johnson had few qualms about campaigning for Brexit, and then later breaking the law to make it happen. Yet there are some gaps in Rachman’s analysis. It is never made clear why leaders such as Abdel Fattah el-Sisi of Egypt, Nicolás Maduro of Venezuela and Kim Jong-un of North Korea are largely missing, or a number of other strongman dictators in sub-Saharan Africa. Though there is a chapter devoted to Abiy Ahmed of Ethiopia, along with a few paragraphs devoted to Paul Kagame of Rwanda, Meles Zenawi also of Ethiopia, Emmerson Mnangagwa of Zimbabwe and Jacob Zuma of South Africa, the chapter on African strongmen does not acknowledge that this is the only continent where the regional trend is not as depressing. Rachman only occasionally engages with data on dictatorships to verify some of the patterns that he explores in the book. And his work would benefit from an examination of the institutional factors that may explain the rise of strongman politics, such as the pre-existing weakness of parties, parliaments and courts. Rachman believes that strongman rule cannot deal with succession – that is largely true, but the Kim dynasty has managed handovers Nor does he go in depth into how strongmen interact with their institutions and what the implications of this brand of politics are for conflict and development. The failures of strongmen to address Covid-19 are mentioned, but it is never explained why they may be so poorly equipped to govern. So, is democracy dead? Though Rachman is largely pessimistic, he acknowledges that politics tends to go in waves. There is little advice about how the West can expedite the end of this particular wave. The one positive Rachman offers is that strongman rule cannot deal with succession. This is largely true, though handovers have taken place, such as with the Kim dynasty. But there are definitely more questions raised than answers provided. What is left after strongmen are no longer in power? What must democracies do to undermine strongmen or prevent their rise? Where will the next strongman appear? Rachman’s book doesn’t provide these answers, but he does offer an interesting overview of the leaders dominating the headlines. Full Article
d How Oslo adds a touch of style to the UN By www.chathamhouse.org Published On :: Wed, 25 May 2022 13:06:24 +0000 How Oslo adds a touch of style to the UN The World Today rsoppelsa.drupal 25 May 2022 Seventy years ago, Norway paid for the interior of ‘the most important room in the world’. Now it’s rediscovering the soft power of its design heritage The view from the roof terrace of Oslo’s newest museum takes in the deep blue fjord and harbour but also the recently opened Munch Museum, whose tilting tower leans over the white iceberg of the opera house. All are emblematic of the transformation of Norway’s capital, one of Europe’s fastest growing cities, into a cultural destination. The £500 million National Museum, which opens on June 11, is another statement building in a city which has tended to value modesty over self-promotion. Locals may call it ‘the bunker’ but Denise Hagströmer, a senior curator who compiled its design galleries, believes the museum’s monumental scale and the range of its displays mark a change in Norway’s idea of itself: ‘The country that in the past was thought of as the “little brother” of Scandinavia is now speaking with a completely different voice.’ When Norway paid for the interior of the Security Council Chamber 70 years ago, it had yet to discover the oil that would make the country rich Norway, with a population of only 5.5 million people, has a history of excelling when it comes to using cultural soft power as a tool of foreign policy, says Hagströmer. One of the exhibits in the design galleries is the blue and gold wallpaper used in the United Nations Security Council Chamber in New York, dubbed ‘the most important room in the world’. In here, the Security Council imposes sanctions, dispatches peacekeeping missions and authorizes the use of force. — Norwegian textile artist Else Poulsson designed the Security Council chamber’s wallpaper (Photo: Ivan Brodey) Designed by Else Poulsson, the Norwegian textile artist, its motifs represent faith, hope and love, reflecting the aspirations of the UN. Norway’s decision to pay for the interior of the Security Council Chamber 70 years ago came at a time when the country was recovering from Nazi occupation, while the oil that would make it rich had yet to be discovered. Trygve Lie, the first UN Secretary-General, a Norwegian Labour politician, is said to have played a central role in pushing the project, intended to show the effectiveness of design as a cultural ambassador. ‘Norway elevated its position on the world stage and achieved an oversized presence at the UN for such a small country,’ says Sarah Lichtman, a design historian from the Parsons School of Design in New York. Even though it doesn’t have a permanent seat on the Security Council, Norway embedded its identity in the room through the legacy of the architecture and interior design, she adds. The world we abandoned cannot be erased just like that, but one can build a bridge over the adversity and from that journey to a new society Per Krohg, the artist who created the Security Council mural While other Scandinavian architects in the UN complex went for the fashionable modernist look in the Trusteeship and Economic and Social Council chambers, Norwegian Arnstein Arneberg opted for a more classic, even conservative style. In a letter to the Norwegian Foreign Ministry, he wrote: ‘This interior must represent Norway in a worthy manner.’ As well as Poulsson, Arneberg hired his fellow countryman Per Krohg to paint a giant mural. Krohg, who had been a prisoner of the Nazis in the Second Word War, turned his commission into an altarpiece to peace. ‘The world we abandoned cannot be erased just like that, but one can build a bridge over the adversity and from that journey to a new society,’ he said of his mural, which measures five metres by nine metres. The connection between design and politics is explored further in the new Oslo museum’s design galleries and in a separate exhibition, Scandinavian Design & the United States, which show how Nordic objects were charged with democratic values in the post-war period. ‘Design plays an important role in the Cold War battles that are not just about bombs and missiles but also about lifestyle and ideology,’ says the Swedish writer, Sara Kristoffersson. — Norway’s recently redesigned passports (Photo: Catharino Caprino) Scandinavian design is rooted in egalitarian ideals of social democracy. Ornate decoration that valued one object above another was replaced with clean forms, craftsmanship and natural materials such as leather, wood and wool, says Astrid Skjerven, a professor at the department of product design at Oslo Metropolitan University. Shortly after the Security Council chamber was completed, Norwegian designers participated with Danes, Swedes and Finns in the Design in Scandinavia exhibition that was hugely popular in America in the mid-1950s. The Norwegians, who were the least known internationally, had the most to gain from the three-year tour, with stores in Manhattan showcasing their designs. First Lady Jacqueline Kennedy and Emperor Hirohito of Japan each bought pieces by the Norwegian designer Torbjørn Afdal. Norway’s neighbours capitalized on the international demand for Scandi style by supporting their furniture makers with state funding, promotional campaigns abroad and a national design strategy. Yet despite creating prize-winning, mid-century pieces, Norway ended up as ‘the underdog of Nordic design’, according to Morten Hippe, a Norwegian industrial designer, who in 2016 started a company, Eikund, to reproduce furniture from the golden era of Norwegian design. The market in Norway for these goods was tiny, and the discovery of oil in 1969 meant many craftsmen moved to more lucrative jobs. Across the Atlantic, Norwegian soft power had made its mark in the halls of the UN. By 2006, the Security Council Chamber and the rest of the UN complex needed renovating. The permanent members stipulated that restoration work must preserve the chamber in its original form. They also insisted on having the room duplicated in their temporary space elsewhere in the UN building, with a smaller photographic reproduction of the Krohg mural. The painting had become integral to the function of the room, argues Lichtman – ‘like Picasso’s Guernica or one of those paintings with a moralizing tale that reminds the people in the room of the horrors of war’. Norway gave $5 million to the restoration, which was finished in 2013. — Norway’s mission to the UN evokes the country’s landscapes and showcases its designers (Photo: Laura Guerrero Almeida) Recently, Norwegian diplomats also realized that design could be used more broadly to communicate values and ideas. A new, minimalist passport was issued in 2020 which reflects Norway’s reputation for design excellence. When the country’s joint consulate and UN mission in New York had to move location, it was an opportunity to create an open-plan office that reflected the non-hierarchical structure of most private and public bodies back home. The corner office, with the best views, has a communal table that everyone can use. The room’s design has echoes of a wooden cabin, the typical weekend bolt hole for many Norwegians. Carpets resemble a forest floor, birdsong plays in the bathrooms and futuristic ‘Extreme’ chairs designed by Terje Ekstrom are framed by views of Manhattan. Consul General Heidi Olufsen says visitors to the offices are taken aback when they find a little slice of Norwegian life. Olufsen’s official residence is sparer and more elegant. The mid-century dining table and chairs designed by Fredrik Kayser are from Eikund and the bright velvet Bollo chairs by Andreas Engesvik, seen by many as the country’s top furniture designer. Olufsen wants the decor to make guests ‘feel they are in the modern Norway of 2022’, she says, with more to offer than just mountains and fjords. Yet Olufsen admits there is still a way to go: ‘We still have more to do to boost our self-confidence and demand more space for Norwegian design.’ Full Article
d Polish-British Belvedere Forum 2022 By www.chathamhouse.org Published On :: Mon, 13 Jun 2022 10:27:13 +0000 Polish-British Belvedere Forum 2022 7 July 2022 TO 8 July 2022 — 12:00PM TO 4:00PM Anonymous (not verified) 13 June 2022 Chatham House and Online The Belvedere Forum is a leading annual British and Polish dialogue that seeks to strengthen the extensive social, economic and political partnership between the two countries. Please note this event has reached full in-person capacity. You are welcome to join virtually via the Zoom link: https://chathamhouse.zoom.us/webinar/register/WN_QFwXsXb0RoSt-1ywkuPjfQ The video on this page is of the opening remarks from the Belvedere Forum, with addresses from Sir Robin Niblett KCMG, Dr Sławomir Dębski, Prof Zdzisław Krasnodębski, Sir Malcolm Rifkind KCMG QC, Ambassador Anna Clunes CMG OBE, Lord (Tariq) Ahmad of Wimbledon, Min Marcin Przydacz, and Ambassador Piotr Wilczek. This and other session videos are available to watch on the Belvedere Forum 2022 playlist on YouTube. Photos by Mateusz Jozwiak, Zuzanna Nowak/PISM. The Belvedere Forum is a leading annual British and Polish bilateral dialogue bringing together a diverse group of actors from civil society, politics, business, academia and NGOs. It seeks to strengthen and deepen the extensive partnership between the two countries by exploring political, economic, social and cultural issues through debate and discussion. The forum is an annual event alternating between the UK and Poland. Originally created in 2017 by the governments of the UK and Poland, the forum is now jointly organized by Chatham House and the Polish Institute of International Affairs (PISM) in Warsaw. The forum brings together a diverse group of actors to debate and discuss not only current British-Polish relations, but also the British and Polish responses to key European and global challenges. Agenda - Polish-British Belvedere Forum 2022 (PDF) Full Article
d NATO must now transform old missions into new strategy By www.chathamhouse.org Published On :: Tue, 21 Jun 2022 10:29:06 +0000 NATO must now transform old missions into new strategy Expert comment NCapeling 21 June 2022 As the war in Ukraine becomes prolonged and unpredictable, risks for the transatlantic alliance will increase, as will the global shockwaves of the conflict. As a revitalized NATO alliance deals with a crisis that has major economic and humanitarian as well as military dimensions, the need for it to develop both a European and a global containment strategy grows ever more urgent. Bolstering NATO’s defences so as to provide the capability to repel any form of Russian attack on land, at sea, in the air, or through space and cyberspace is a key aspect of this strategy as, in recent weeks, more combat forces able to defend territory have taken the form of additional troops, ships, and aircraft reinforcing the Baltic states and the Black Sea coastlines of Poland and Romania. Ten allies have so far contributed to this effort, placing 40,000 troops under direct NATO command. Those sceptical about the future of the transatlantic security relationship have been confounded by the major role the US has played in this effort, sending parts of the 82nd Airborne Division and 3rd Armoured Division to Poland, and redeploying US Stryker brigades from Germany and Italy to the Baltic states and Romania. Although many other allies have sent useful assets – such as French and UK aircraft to Romania or German and Netherlands Patriot batteries to Slovakia – the US contribution still surpasses all European efforts put together. The US now has 100,000 troops in Europe, the most it has deployed there since the mid-1990s. Transitioning from temporary to permanent deployment NATO has also mobilized its high-readiness Reaction Force for the first time and aims to establish four new multinational battalions in the Black Sea region – with France offering to lead the one in Romania, Italy in Bulgaria, and the Czech Republic in Slovakia. Most of these deployments are on a temporary basis, but the receiving allies would understandably like them to stay longer and for NATO to commit to permanent stationed forces. The decision of Germany to increase its defence spending to two per cent of GDP and to devote €100 billion to modernizing the Bundeswehr makes it technically possible for NATO to move to a Cold War-style forward, armoured defence Although this would oblige the alliance to break formally from the pledge it made to Moscow in 1997 not to station substantial combat forces or nuclear weapons or build military infrastructure on the territory of its new member states in eastern Europe, this was a political undertaking linked to circumstances prevailing at the time. Given Russia’s behaviour, there is no reason why NATO should not now abandon it. There is also a question over whether NATO could also repeal the NATO-Russia Founding Act and the NATO-Russia Council, or simply leave them in suspension for a future, more cooperative, and less bellicose Russian regime. Beyond showing the flag along its eastern flank, NATO does face longer-term issues which need to be clarified in its new Strategic Concept. First is whether to abandon its current strategy of reinforcement and military mobility across Europe – known as the Enhanced Forward Presence in the NATO jargon – in favour of the deployment of heavy armoured brigades or even divisions in fixed positions close to borders. This will be expensive in the long-run and deprive allies of the flexibility they have enjoyed since the end of the Cold War to use their forces as and where they wish – from deployments in the Sahel or Afghanistan to fighting forest fires or building emergency hospitals for COVID-19 patients at home. The only exception is when they have put forces on rotation into the NATO high readiness forces or the European Union (EU) Battle Groups. Germany’s commitment gives NATO more options The decision of Germany to increase its defence spending to two per cent of GDP and to devote €100 billion to modernizing the Bundeswehr makes it technically possible for NATO to move to a Cold War-style forward, armoured defence. But it is unclear how quickly Berlin could raise its new divisions given its problems with procurement and government/industry relations in the defence sector. It may make more sense for Germany not to launch new acquisition programmes but to buy existing off-the-shelf capabilities – as it has recently done with its decision to buy 35 US F35 aircraft – which other European countries are also acquiring, offering economies of scale and cheaper operating and maintenance costs. But if Germany abandons ambitious defence projects with France – which prefers a ‘buy European’ approach – such as the Future European Air Combat System, the relationship with France will become strained and French plans for EU self-reliance in the military field put at risk. As a country averse to war fighting and narrow military approaches to security, it is uncertain how much of the conventional defence burden in NATO Germany would be willing to take on, so this could be the opportunity to create more integrated European units with France, the Benelux, Poland, and Italy, even with the post-Brexit UK. In reinforcing the alliance’s eastern flank, allies have sent forces to wherever they like and largely under national command, but this would not work in a real war The UK has doubled the size of its forces in Estonia and sent 1,000 troops to Poland, as well as devoting a substantial portion of its army, navy, and airforce to regular NATO exercises in the Baltic region. London was also the first ally to grant Sweden and Finland a temporary security guarantee pending full integration into the alliance. NATO will likely settle on a compromise, increasing the size of its battalions on its eastern flank – turning them into battle groups – but giving each one a larger reserve force which will remain in Germany or other European allied countries. A NATO strategic plan is now needed The other issue for NATO is to develop a single theatre-wide strategic plan managed by the Supreme Allied Commander, Europe (SACEUR) and the NATO command structure. In reinforcing the alliance’s eastern flank, allies have sent forces to wherever they like and largely under national command, but this would not work in a real war. One thing NATO has done well in this crisis is its political messaging. As Russia has become more threatening and reckless, it has been essential for NATO to be consistent and predictable NATO must revise its exercises to prepare and train for the new threat level, ensuring its forward deployed forces are fully integrated with local forces and the police and border guards to anticipate and respond to any Russian hybrid war tactics. It also needs to step up its joint planning and interoperability with Sweden and Finland and bring their territories into its standing defence plans. One thing NATO has done well in this crisis is its political messaging. As Russia has become more threatening and reckless, it has been essential for NATO to be consistent and predictable. Re-affirming its core defensive purpose, calmly rejecting Putin’s nuclear posturing, and refusing to put NATO forces in Ukraine may be frustrating for some but it is vital not to play into Putin’s playbook regarding an ‘aggressive NATO’ or give him the sense he is being pushed into a corner. However, NATO strategic ambiguity can be useful when considering how to respond to a Russian escalation in Ukraine itself, such as using chemical weapons. The key questions for NATO are: What should be the balance between permanently deployed and rotational forces in NATO’s new posture? What should be the balance of US/Canadian and European forces in this posture? How can the capability development programmes under EU Strategic Autonomy (such as PESCO and the European Defence Fund) be geared to support the European role and responsibility in the alliance? Air and missile defence would seem to be priorities given Russia’s reliance on long range strikes. How can the EU’s Strategic Compass, NATO’s next Strategic Concept and the third NATO-EU Joint Declaration be harmonized to bring the two institutions more closely together in responding to Russian hybrid operations and influence campaigns, and in assisting both Ukraine and others such as Georgia and Moldova? What should be the balance between forces for collective defence with heavy armour and directed artillery fire, and those for expeditionary missions beyond Europe such as counterterrorism, stabilization and peacekeeping? NATO is revived and refocused Although the Russian invasion of Ukraine is a catastrophe for Ukraine and Europe more generally, the multilateral system has discovered a new energy and sense of purpose as NATO has been revived and refocused on its core mission. The EU and the US have pulled together with daily coordination of their policies and actions, and the EU is also facing up to its geo-political role, as recognizing the EU aspirations of Ukraine, Moldova, and Georgia as well as the countries of the western Balkans shows its responsibility for the security and economic integration of the whole of Europe. Full Article
d President Maia Sandu on democracy and politics in Moldova By www.chathamhouse.org Published On :: Mon, 04 Jul 2022 17:05:20 +0000 President Maia Sandu on democracy and politics in Moldova Video jon.wallace 4 July 2022 The president covers Moldova’s challenges as it seeks closer integration with the European Union. President Maia Sandu discusses challenges to Moldovan democracy and society during an interview at Chatham House’s 2022 London Conference. She covers issues including corruption, the presence of Russian troops in the Transnistria region, neutrality in Moldova’s constitution, popular support for EU membership and refugees from Russian aggression in Ukraine. Full Article
d Gorbachev's complex legacy is beyond the popular belief By www.chathamhouse.org Published On :: Sat, 03 Sep 2022 09:45:59 +0000 Gorbachev's complex legacy is beyond the popular belief Expert comment NCapeling 3 September 2022 The last major figure with a decisive Cold War role, Mikhail Gorbachev was not as bad as Putin’s Russia portrays him, but also not as heroic as the West thinks. Arguably the worst year of the Cold War since the Cuban Missile Crisis was 1983, with three major incidents which escalated East-West tensions – and any one of them could have led to a full-scale war. The first was the Korean Airline KAL007 being shot down by an SU15 fighter aircraft for straying into Soviet airspace, killing all 269 passengers and crew. Then came the identification of signals from Soviet satellites as being incoming US intercontinental ballistic missiles – Colonel Stanislav Petrov, going against all protocols, thankfully decided to report them as a false alarm before he could be sure. The third was perhaps the most dangerous, being the misinterpretation of a live-fire NATO exercise which was believed by some in both East Germany and Russia to be a front for an imminent attack. The greatest disappointment in Gorbachev’s legacy was he completely believed the USSR could be reformed and still survive as an entity while others, such as Boris Yeltsin and Ronald Reagan, understood it had to be dismantled All three incidents occurred in the few months following the infamous March 1983 ‘Star Wars’ speech by US president Ronald Reagan, in which he talked about nuclear arms control and laid out the US case for a ballistic missile defence programme. At that time Mikhail Sergeyevich Gorbachev was the youngest serving member of the USSR Politburo, known to be a favourite of Soviet leader Yuri Andropov, and it is highly likely he had been aware of these close calls and was part of discussions within Kremlin decision-making circles. A changemaker both inside and outside the USSR Following the deaths of Andropov in 1984 and his replacement Konstantin Chernenko in 1985, Gorbachev’s appointment as general secretary of the Communist Party saw him immediately begin to change the Soviet Union from within – and also change relationships with the major Western powers, especially the US, Germany, and the UK. His policies of glasnost (openness) and perestroika (restructuring) were primarily aimed at internal reforms but translated into a major reset of international relations and international security. During his six years as leader, Gorbachev initiated many arms control negotiations which resulted in treaties and increased both the transparency and the confidence between the USSR and the US. These included the 1986 Stockholm Accord which emanated from the Helsinki Process and allowed for the observation and inspection of large-scale military exercises, the 1985 resumption of the Strategic Arms Reduction Talks which lead to START I, and the 1987 INF Treaty in which the USSR ‘out-yessed’ the US – the most open and transparent disarmament treaty in terms of notification and verification measures ever agreed. There was also a reciprocal moratorium on nuclear weapons tests starting from 1985 – which laid the groundwork for the 1996 CTBT – the 1991 Chemical Weapons Convention, and the 1990 Conventional Forces in Europe (CFE) Treaty. The most dramatic moment of all was when Gorbachev and Reagan met at a summit in Reykjavik and came close to deciding to eliminate nuclear weapons – but the initiative failed to reach agreement, mainly because Reagan could not drop his commitment to ballistic missile defences and Gorbachev could not accept the offer of joint development. Nonetheless, all these nuclear arms control treaties led the way for their descendants which have kept nuclear weapons in check ever since and are still in place in the form of the New START agreement. During his six years as leader, Gorbachev initiated many arms control negotiations which resulted in treaties and increased both the transparency and the confidence between the USSR and the US But despite these outstanding achievements, Gorbachev had blind spots – such as enabling rather than destroying the USSR bioweapons programme, unlike the US which had dismantled its own bioweapons offensive capability by 1973. And it is now known that, despite negotiating the Chemical Weapons Convention, Russia withheld information on new chemical weapons agents – Novichoks – which have since been used to lethal effect by Russia in Salisbury and against figures opposing the current regime. His misguided faith in a Soviet future Gorbachev was markedly different to his predecessors as secretary general. He was neither as decrepit nor as hardline, and he understood from the outset that the Soviet Union was, by the 1980s, finally dying. Using the intellectual abilities of Aleksandr Yakovlev, he forced through the reforms which simultaneously captured the imagination of the free world and liberated his countrymen and women. But although he built solid relationships – even friendships – with the world’s major heads of state and improved the USSR’s human rights, releasing dissidents such as Andrei Sakharov, but many – especially Ukrainian dissidents – continued to languish in camps. The greatest disappointment in Gorbachev’s legacy was he completely believed the USSR could be reformed and still survive as an entity while others, such as Boris Yeltsin and Ronald Reagan, understood it had to be dismantled. This shortcoming is especially uncomfortable as today’s Russia continues to insist it has a given right to control other former Soviet states, to the extent it is willing to destroy them if they do not concede. Full Article
d Central and Eastern Europe become hawkish on China By www.chathamhouse.org Published On :: Fri, 16 Sep 2022 18:14:53 +0000 Central and Eastern Europe become hawkish on China Expert comment LJefferson 16 September 2022 The recent withdrawal of the Baltic countries from the ‘17+1’ format displays changing perceptions of China due to its ambiguity towards the war in Ukraine. While the Russian invasion of Ukraine only confirmed Central and Eastern Europe’s views of Russia, it is also affecting their relations with China. Although the relationship was already complicated due to unfulfilled Chinese economic promises to CEE countries and growing indications of efforts to influence their domestic politics, China’s support for Russia is pushing Central and Eastern Europeans even further away. This shift was highlighted, and formalized, recently by several countries in the region leaving the ‘17+1’ format, through which China cooperates with a group of countries from the region. The shifting attitudes towards China will also influence the relationship between the European Union as a whole and China. A Trojan Horse that never was When the format was launched in 2012 between 16 CEE countries at the time and China, the countries jumping on board expected a wave of Chinese investment and an opportunity to diversify mostly west-bound trade. These hopes never fully materialized as Chinese foreign direct investment (FDI) in CEE has been generally lower compared to the rest of Europe and China never became an important export destination for any of the countries. The growing disillusionment and concern about Chinese security threats has led to some of the countries speaking up about the perceived perils of closer cooperation. The first to withdraw from what had become ‘17+1’ by 2021 was Lithuania, which also took an interest in strengthening ties with Taiwan and allowed it to open a Taiwanese representative office in Vilnius. This triggered a breakdown in the bilateral relations with China. As a retaliatory response, China blocked Lithuanian imports and imports from other EU states containing inputs from Lithuania, leading the EU to launch an official dispute at the WTO. War in Ukraine Since the invasion started, CEE countries have been dealing with large numbers of Ukrainian refugees, organizing shipments of military equipment to Ukraine, and at the same time worrying whether they could be next on Russia’s list. However, the concerns and security environment that these countries face seems to be almost entirely disregarded by China. On the sidelines of the 2022 Winter Olympics in Beijing, Xi and Putin signed the joint communiqué in which China backed Moscow’s demands to reverse NATO borders to the pre-1997 situation, completely disregarding CEE’s security interests. Since the invasion started, CEE countries have been dealing with large numbers of Ukrainian refugees, organizing shipments of military equipment to Ukraine, and at the same time worrying whether they could be next on Russia’s list. China’s implicit support for Russia after the invasion has sowed deep mistrust of its respect for the sovereignty of other nations. The Chinese diplomatic apparatus clearly noticed this changing mood among CEE governments and sent a special envoy to eight capitals in April-May tasked with ‘eliminating misunderstandings regarding Russia-Ukraine conflict’. However, the trip was not particularly successful. The delegation failed to secure high-level meetings, with the most prominent case being the Polish minister of foreign affairs declining to meet Huo Yuzhen, the Chinese Special Councilor for CEEC cooperation. Given that Andrzej Duda, President of Poland, was the only head of an EU state who attended the Beijing Olympics opening ceremony just before the Russian invasion in February, the change in attitudes is clear. Following the envoy’s visit to the Czech Republic, the Czech parliament’s foreign affairs committee unanimously approved a resolution calling for the country to quit the ‘16+1’ format and the government is expected to act upon it in the near future. Meanwhile, Latvia and Estonia recently jointly announced that they would no longer be participating in the cooperation framework, turning it into ‘14+1’. Full Article
d Russian imperial mindset must change for real victory By www.chathamhouse.org Published On :: Thu, 08 Dec 2022 09:47:14 +0000 Russian imperial mindset must change for real victory Expert comment NCapeling 8 December 2022 The attitude of Russia’s elite – and wider population – to the states which used to constitute the USSR needs to change in order to solve the Russia challenge. Although the reverberations of Russia’s invasion of Ukraine clearly stretch around the globe, the strongest shocks are – and will continue to be – felt by those countries Moscow used to directly rule. These countries struggle to shrug off a Soviet legacy as, to varying degrees – linguistically, technologically, culturally, and politically – they bear psychological and physical scars of Russia’s colonial past and its present mentality. It does not help that these countries lack an appropriate collective descriptor. Over the years there has been ‘Newly Independent States’ – hardly appropriate after 31 years – the now-defunct ‘Commonwealth of Independent States’, the ‘post-Soviet space’ and ‘Former Soviet Union’ which both reference the past, and simply ‘Eurasia’ which is hardly appropriate for either Ukraine or Turkmenistan. Some of these former ‘colonies’ are as badly governed and as sinister – albeit not as lethal beyond their borders – as Russia itself. Others, most notably the Baltic states, are modern, liberal, affluent societies, but Moscow’s shadow still looms. There is a strong mindset in most of Russia’s citizens that, because that it used to rule these other countries, it either still has privileged rights over them or they are not real countries at all – but instead historical aberrations to be extinguished. What is past is gone As historian Timothy Snyder has noted, whatever the wrongs of Putin’s ‘history-based’ assertions about the ‘return of historic lands’, all historical claims are bunkum anyway. If the past brings validity, almost no land border on earth would be beyond dispute. It is agreements which count, and Russia signed away the other successor states in 1991. There is a strong mindset in most of Russia’s citizens that, because that it used to rule these other countries, it either still has privileged rights over them or they are not real countries at all The Russia and Eurasia programme at Chatham House has, for the last 31 years, always taken as a starting position that these countries are as sovereign as any other. This of course this means they can choose to be in Russia’s embrace if they wish. But none do because Russia is insufficiently attractive. Some have better relationships with Moscow than others – mainly the more autocratic ones – but no former slave goes back to their master willingly. At the recent Chatham House conference Russia’s war: How will it shape the region’s future? (note the avoidance of a specific descriptor), the overwhelming consensus was that Russia must lose, that Ukraine must be reconstructed and planning for that must start now, and that the regional economy is convulsing. But another key view was that, in Russia, rent seeking and buying loyalty are likely to lead to the separation of the Russian people and the regime, especially as the population ages and young men being sent to die at the front. Putin may still be popular in some places in Russia, but not in others – although popularity can rise and fall fast in Russia. However, few at the conference foresaw the disintegration of Russia any time soon. With continued skill, determination, and more weaponry, Ukraine may well vanquish Russia on the battlefield, and this remains a necessary pre-requisite for European security. But even a Ukraine victory will not erase malign intent. Getting Russians to look upon their neighbours as equals requires widescale self-reassessment in a post-Putin Russia The Russian imperial itch is so deeply embedded, it must be excised not just from Russian capability but from the intention and mindset of elites and in the popular imagination. That is hard to achieve when so many believe in it as fervently as a religion – even the Russian Orthodox Church invokes a messianism in Russia’s imperial ‘rights’. The wider region is suffering Getting Russians to look upon their neighbours as equals requires widescale self-reassessment in a post-Putin Russia. But, for now, the wider region will surely be looking to simply neuter Russia’s destructive capacities. Full Article
d Why the UK must deliver on Nordic-Baltic security By www.chathamhouse.org Published On :: Fri, 16 Dec 2022 12:02:39 +0000 Why the UK must deliver on Nordic-Baltic security Expert comment NCapeling 16 December 2022 Hard choices are needed but it is crucial the UK provides security and leadership to its European partners given the wider context of the war in Ukraine. The UK’s role in Nordic-Baltic security has been growing over the past decade. The region is key to core British strategic interest and engagement, and UK threat assessment closely aligns with long-held regional perspectives – the 2021 Integrated Review defines Russia as ‘the most acute threat to our security’. Since Russia’s invasion of Ukraine, the UK’s strong stance towards Moscow and the concrete steps taken to assist Ukraine and strengthen defence and deterrence on NATO’s eastern flank have been widely appreciated in the Nordic-Baltic region. The UK is seen as a reliable partner but, for it to continue to deliver in the region, difficult choices must be made with regards to UK defence spending and military capabilities, and London’s more global ambitions. The UK is a major contributor to NATO’s deterrence posture on the eastern flank, serving as a framework nation for NATO’s Enhanced Forward Presence (EFP) battlegroup in Estonia, and contributing to another battlegroup in Poland. UK remains crucial to regional security Coupled with its contribution to NATO’s Baltic Air Policing mission and maritime forces in the area, the UK is a crucial security partner both in the region and in a broader arch across Europe. The UK offers military capability, strong political will, a long-standing tradition of engagement in the Nordic-Baltic area, and fast decision-making Over the past decade and a half, the UK has been developing a dense network of bilateral and minilateral relations in the region which are major assets in the current security environment. It leads the Joint Expeditionary Force (JEF) which is a military cooperation format highly valued for its flexibility in responding to the needs of the participating nations – including non-NATO Sweden and Finland – and is increasingly focused on the North Atlantic, High North and wider Baltic areas. The UK has also seen increased bilateral defence cooperation with Norway, Denmark, Estonia, and other regional allies and partners. There are reasonable expectations that Germany or France may at some point assume a greater role in this part of Europe, building on France’s participation in the EFP in Estonia, and Germany’s lead of the EFP in Lithuania. However, while Paris remains more focused on NATO’s southern (and south-eastern) flank and building the European Union’s defence role, Berlin often underperforms as a leading or an organizing power of collaborative efforts across Europe. Both also have a credibility problem in the Nordic-Baltic region due to their past policies towards Russia that occasionally reappear when discussing military support to Ukraine or how to treat Russia in the post-war European security order. By contrast, the UK offers military capability, strong political will, a long-standing tradition of engagement in the Nordic-Baltic area, and fast decision-making. The latter is exemplified by the bilateral security guarantees provided to Sweden and Finland during their accession to NATO, and the surge of assets sent to the region in the wake of Russia’s full-scale invasion of Ukraine such as an additional battlegroup and Chinook helicopters to Estonia, as well as forward-deployed elements of the Standing Joint Force Headquarters to Latvia and Lithuania as part of the JEF. Such pragmatic and resolute engagement help substantiate the UK’s post-Brexit claim that although it left the EU, it did not leave Europe. London also understands and facilitates the pivotal role that the US plays in European security – a shared perspective with the Nordic-Baltic partners. Only the US – which has just recently decided to step up its military presence in the Baltics – has a greater appeal than the UK as a major ally. But Washington’s truly global responsibilities make it more difficult for it to play a regional leadership role. With the context of the war in Ukraine, the centre of gravity of European security is moving east. The Nordic-Baltic region is likely to feature more prominently in the upcoming refresh of the UK’s Integrated Review, as the war in Ukraine and NATO’s new forward defence approach will focus UK attention and military capabilities on Europe for the foreseeable future. But the UK still has limited resources and, despite the worsening security environment, there is currently no commitment by the Rishi Sunak government to increase defence spending beyond two per cent of GDP, as set out in the recently-published Autumn Statement. This difficult fiscal reality contrasts UK ambition to also increase its footprint and engagement in the Indo-Pacific, a region highlighted by Rishi Sunak in his first foreign policy speech. London is already confronted with increasing expectations from its Nordic and Baltic partners, which are rattled by Russia’s aggression and seek more engagement and commitments from larger and more resourceful allies, and are insisting on prompt implementation of NATO’s new defence and deterrence plans. This all comes on top of the resources that further assistance to Ukraine will require in the coming months and years. Balancing competing priorities and demands from partners is routine for a major power with global ambition but, in the current context, if the UK government fails to prioritize and increase resources, over-extension is in sight for its armed forces. The war in Ukraine confirms that, beyond the rhetoric around the ‘Indo-Pacific tilt’, the Euro-Atlantic is – and will remain – the priority theatre of engagement for the UK. To keep delivering in the Nordic-Baltic region and remain a reliable partner, UK ambitions should be set clearly, and expectations managed with regional partners. A good example is the recent UK-Estonia joint statement and defence roadmap, which is an attempt to reconcile London’s vision of modern deterrence with Tallinn’s preference for ‘more boots on the ground’. The UK gains many benefits from deepening and widening its engagement in the Nordic-Baltic region, and not only by showcasing its regional leadership at a time of dire need or having more weight in Europe and across the Atlantic The joint statement also clarifies initial misunderstandings regarding the upcoming withdrawal of the second UK battlegroup deployed to Estonia in the wake of Russia’s invasion of Ukraine – support Tallinn expected to continue ‘as long as necessary’ but London saw as temporary. It offsets the poor political ‘optics’ of the withdrawal while providing solid ground for deepening the common agenda in the near future. By the 2023 NATO summit in Vilnius, progress on implementing the roadmap will be a crucial measure of success for the bilateral relationship, and for the UK’s broader regional role. It should serve as an opportunity for the UK to reflect on its force development priorities and balance, with Baltic partners arguing in favour of the UK rebuilding some mass in its armed forces and providing more resources to the land component. Much to gain for the UK The UK gains many benefits from deepening and widening its engagement in the Nordic-Baltic region, and not only by showcasing its regional leadership at a time of dire need or having more weight in Europe and across the Atlantic in strategic debates about future security architecture. Full Article
d Culture notes: Will the EU find its voice at last? By www.chathamhouse.org Published On :: Mon, 30 Jan 2023 13:09:06 +0000 Culture notes: Will the EU find its voice at last? The World Today mhiggins.drupal 30 January 2023 Russia’s invasion of Ukraine has galvanized the bloc, but doubt remains about how it can capitalize on this moment, writes Catherine Fieschi. Despite its reticence to believe that Russia would attack Ukraine, once Vladimir Putin’s tanks rolled across the Donbas, the European Union finally grasped the momentous nature of the events unfolding on its eastern flank. The immediate reaction of Europe’s member states was one of unity, resolve and uncharacteristically rapid decision-making, at least on sanctions and energy policy. That they would need to act in concert across a concatenation of crises that would be either triggered (energy), worsened (inflation) or heightened (geopolitical instability) by Putin’s move was obvious. And so, Europe’s collective narrative of this past year slid into place, and it goes something like this: We gave Russia the benefit of every doubt, including after their invasion of Crimea when we still tried to bring them back to the negotiating table, but Putin has made the fundamental choice of turning away from democracy and the rule of law. Europe had long been in need of an arc to follow Now, the narrative goes on, we have to treat them as enemies and give ourselves the means to become resilient in the face of aggression as Ukraine is all that stands – both symbolically and geographically – between us and the chaos of a Europe-wide war. Like any good narrative, it is anchored in previous trials and exploits. Having learnt from its failure to coordinate action during the eurozone crisis and then the migration crisis, Europe was keen to make the most of its resilience in the face of the Covid pandemic in the form of the joint vaccine purchases and a massive recovery plan. The Russian invasion of Ukraine is an added – albeit dramatic and costly – opportunity to pursue further collective action and discover the next chapter of its shared purpose, as a political and perhaps even a defence alliance. Europe had long been in need of an arc to follow. In the aftermath of the Second World War, peace and prosperity seemed enough. But the new multipolar world that emerged from the ashes of the Cold War and then 9/11 were more difficult to navigate for a largely commercial and regulatory alliance. Could the EU, then, ever find its political voice? David vs Goliath While Brexit and Covid created rallying points, the shock and tragedy of the invasion delivered everything the EU needed in narrative terms: a David and Goliath story, with the opportunity to feature on Team David in European terms while allying with the United States, and a ‘band of brothers’ element to shore up a union bruised by the defection of a key but troubled member. Above all, the appearance of an arch-villain in the form of Vladimir Putin put Europe back into the familiar and mythical territory of the 1940s and then the Cold War. When on May 28, 2016, Putin seated himself on the throne of the Byzantine emperors in Mount Athos’ Protaton Church in Greece in a scene truly worthy of Game of Thrones, the writing should have been on the wall. That day he explicitly laid out his aim to appoint himself as the new Eastern emperor who would fight the decadence of the West. ‘Today,’ Putin told the world, ‘we restore the values of patriotism, historical memory and traditional culture.’ Later, he cited Ukraine as the biggest unfinished mission of his years in power. That Europe – and Germany in particular – had taken so long to decipher Putin’s dark designs only adds to the narrative’s epic quality, positioning Europe as a victim of its own good faith and open heart. Cracks in the narrative But the narrative is not free from cracks. The Baltic states would argue that they had long warned of Putin’s nefarious intentions; and Poland has always been convinced of the threat posed by its neighbour. Full Article
d In conversation with Edi Rama, prime minister of Albania By www.chathamhouse.org Published On :: Mon, 13 Mar 2023 17:22:14 +0000 In conversation with Edi Rama, prime minister of Albania 23 March 2023 — 5:30PM TO 6:30PM Anonymous (not verified) 13 March 2023 Chatham House and Online From migration to Russia and China, how is Albania responding to the geopolitical challenges of today? In late 2022, the UK government made a pointed remark that many of the illegal migrants attempting to get into the country were from Albania. In response, Albania prime minister Edi Rama replied that targeting Albanians as the cause of Britain’s crime and border problems ‘makes for easy rhetoric but ignores hard fact’. This nuanced response demonstrated the challenges and complexities that Albania faces, the same as many other countries. As well as being embroiled in the major challenge of international migration, Albania has suffered from a serious cyber-attack in July 2022 from Iran. Government networks were compromised for a month with Tirana removing the Iranian embassy in the capital. Then there is the ongoing threat from Russia and China. Nestled in the already volatile Balkans, Albania has been at the heart of international affairs in recent months. Prime Minister Rama speaks at Chatham House to discuss: How is Albania responding to Russian aggression and what is its stance on Ukraine? Where does Tirana believe China poses the most serious threat? How can countries in Europe best respond to illegal migration and better control the flow of people? How is the region of the Western Balkans effected by the war in Ukraine and how can it contribute to the security challenges posed by the war? As with all member events, questions from the audience drive the conversation. Full Article
d Review: Rediscovering Milan Kundera’s European tragedy By www.chathamhouse.org Published On :: Tue, 28 Mar 2023 11:47:01 +0000 Review: Rediscovering Milan Kundera’s European tragedy The World Today mhiggins.drupal 28 March 2023 The Czech writer’s 40-year-old essay on the roots of Russia’s empire-building, ‘A Kidnapped West’, reads all too presciently, writes Stefan Auer. A Kidnapped West: The Tragedy of Central EuropeMilan Kundera, Faber, £10 ‘In November 1956, the director of the Hungarian News Agency, shortly before his office was flattened by artillery fire, sent a telex to the entire world with a desperate message announcing that the Russian attack against Budapest had begun. The dispatch ended with these words: “We are going to die for Hungary and for Europe.”’ Thus, Milan Kundera began his 1983 essay for the French journal Le Débat, reflecting on the 1956 Hungarian Uprising. A seminal essay The Czech author might well have written a near-identical passage about the fraught hours immediately after Russia’s invasion of Ukraine in 2022. In the event, Russian tanks failed to occupy Kyiv, unlike Budapest in 1956. Nevertheless, Faber has chosen this moment, 40 years later, to republish Kundera’s seminal essay on Europe and Russian aggression in its original translation for the New York Review of Books by Edmund White. How salient are its observations today? Thanks to the Cold War, the countries of Central Europe were denied their true destiny, Kundera thought, in the democratic West The essay’s original French title, ‘Un Occident kidnappé ou la tragédie de l’Europe centrale’ (The Kidnapped West, or the Tragedy of Central Europe), described the fate of Hungary, Czechoslovakia in 1968 and, to an extent, Poland in 1980-81 at the hands of the Soviet Union. Owing to the Cold War division of Europe, the countries of Central Europe were denied their true destiny, Kundera thought, to be an integral part of the liberal, democratic West. Kundera himself fled Czechoslovakia for France in 1975. The author of The Unbearable Lightness of Being might no longer be as well-known as he was at the height of his fame in the 1980s, but his novels and essays still deserve attention. So, it is pleasing to see Kundera’s masterpiece republished, even as it is awful to witness the enduring relevance of the questions it raises. What did the Hungarian journalist mean when he declared his willingness to die for Europe, Kundera asked? That ‘Russians, in attacking Hungary, were attacking Europe itself. He was ready to die so that Hungary might remain Hungary and European’. The journalist did indeed die in the uprising. It is a line that President Volodymyr Zelenskyy and his supporters abroad have echoed time and again: that Ukrainian soldiers are not just dying for their country, they are dying for Europe at large. Kundera’s suspicion of Russia has been validated. His frustration about the indifference of the West less so The ‘tragedy’ in Kundera’s essay was that the West didn’t care. ‘Europe hasn’t noticed the disappearance of its cultural home,’ Kundera wrote, ‘because Europe no longer perceives its unity as a cultural unity.’ In other words, as the cultural sphere in Central Europe continued to defy the political restrictions imposed by the Soviet empire, it embodied the western values of freedom and democracy more than the West itself did. The extent to which this analysis remains relevant today will prove decisive for Europe’s future. As timely as ever Kundera’s essay is as timely as ever but in ways that both vindicate and challenge his key arguments. His suspicion of Russia has been validated. His frustration about the indifference of the West less so. But the true tragedy of Ukraine would be if the West has not changed sufficiently. So far, the West appears to be doing enough to enable Ukraine to defend itself, but not enough to defeat the aggressor. [A small nation] is one whose very existence can be put in question at any moment; a small nation can disappear and it knows it Milan Kundera Faber has made an excellent decision in combining The Tragedy of Central Europe with a lesser-known text by Kundera: his 1967 speech to the Czech Writers’ Congress given the year before the ill-fated Prague Spring. In it, Kundera addressed what was to become a lifelong preoccupation: the fate of small nations. ‘For Czechs’, Kundera wrote, ‘nothing has ever constituted an indisputable possession – neither their language nor their belonging to Europe.’ Rather than reflecting the size of its territory or population, a small nation ‘is one whose very existence can be put in question at any moment; a small nation can disappear, and it knows it.’ In this way Ukraine, Europe’s largest country, apart from Russia, is fighting to avoid the fate of Kundera’s ‘small nation’. Historically, the ‘small’ nations of Central Europe were threatened by both Germany and Russia. But after the Second World War, the threat was from the Soviet Union, which for Kundera was indistinguishable from Russia (tacitly including Ukraine). In its expansiveness, Russia was the opposite of Central Europe. While the latter was based on the principle of ‘the greatest variety within the smallest space’, the former represented ‘the smallest variety within the greatest space’. Kundera was criticized for observations that smack of civilizational racism, yet his bleak view of Russia remains prescient In this sense, authoritarian communism was the fulfilment of Russian history, Kundera argued, writing that ‘Russian communism vigorously reawakened Russia’s old anti-western obsessions and turned it brutally against Europe’. Vladimir Putin’s Russia appears to build on these same pernicious impulses. Kundera was widely criticized for observations in his essay that smack of civilizational racism (including by me) describing Russians as fundamentally different from us: ‘Russia knows another (greater) dimension of disaster, another image of space (a space so immense that entire nations are swallowed up in it), another sense of time (slow and patient), another way of laughing, living, and dying’. Full Article
d Eurovision, war and the geopolitics of pop By www.chathamhouse.org Published On :: Tue, 28 Mar 2023 15:46:39 +0000 Eurovision, war and the geopolitics of pop The World Today mhiggins.drupal 28 March 2023 Europe’s great song competition may strive for continental harmony, but bitter conflicts and voting blocs often drag it off key, writes Saskia Postema. In May, the city that spawned the Beatles will add another notch to its cultural belt as Liverpool hosts the Eurovision Song Contest. The pop competition has been celebrating extravagance, dramatic acts and lots of glitter since 1956. It is expressly designed to be non-political, with performers barred from promoting political interests, yet it exists for a specific political purpose – to promote European unity. The organizer, the European Broadcasting Union (EBU), has certainly succeeded in part with its mission. While Europe Day on May 9 comes and goes without much fanfare, Eurovision is an eagerly anticipated fixture on the cultural calendar. Cultural diplomacy While some may dismiss it as simply an extravagant party, there is more to it than that: it is a form of cultural diplomacy. Beyond artistry, acts are expected to bring their cultural identity to the stage as they bid for douze points, Eurovision’s highest score, from national juries. Like any popular forum, it reflects popular opinion. So, when war threatens the European harmony Eurovision is meant to exude, politics inevitably manifests itself. This was evident last year. Following Russia’s invasion of Ukraine in February, Eurovision’s organizers reiterated their apolitical stance stating both countries would be allowed to participate. But when various countries threatened to withdraw if Russia was allowed to compete, the EBU changed its tune and broke off ties with Russian broadcasting agencies indefinitely. As reluctant as it was to act in this capacity, the organization still inadvertently highlighted its role as a political gatekeeper and confirmed Eurovision does function as a political arena. The first ‘nul points’ awarded to the UK in 2003 was seen as a backlash against the Iraq war Unsurprisingly, all eyes were on the Ukrainian entry that year. Kalush Orchestra’s Stefania, presenting a blend of traditional Ukrainian folk music with hip hop beats, went on to win the contest resoundingly. And while the winning nation normally hosts next year’s competition, due to the war this honour passed to the runner-up, the United Kingdom. Britain, coincidentally, has been one of the most visible supporters of Kyiv’s war efforts. Boris Johnson, the former prime minister, was among the first leaders to visit Kyiv after the Russian invasion. Last year’s second place ended a long spate of poor results for the UK in the competition. The first year it scored nul points was 2003 when the UK entry was Cry Baby by the duo Jemini. The result was seen widely as a backlash against Britain’s entry into the Iraq war earlier that year. In the intervening years it has been placed last twice and received nul points again in 2021 when the entry was Embers sung by James Newman. With last year’s second place for Sam Ryder’s Space Man, the UK redeemed itself and will get to host Eurovision in Liverpool, a city twinned with Odesa since 1957. It is not the first time that Russia’s geopolitical relations have led to Eurovision controversy. In 2008, following the Russo-Georgian war, Russia recognized the self-proclaimed independence of South Ossetia and Abkhazia which had broken away from Georgia. Despite Russian objections, Ukraine’s 2016 entry about Stalin’s deportation of Crimean Tatars was permitted – and won As a result, Georgia initially refused to take part in the 2009 Eurovision as it was to be held in Moscow. It changed its mind, however, submitting a song by Stefane and 3G called We Don’t Wanna Put In. The submission was rejected by the EBU, which said it contained obvious references to the Russian leader, something Georgia denied. In 2015, Ukraine withdrew from Eurovision following the Russian annexation of Crimea. The following year the EBU was faced with a similar problem when Ukraine submitted a song, 1944,sung by Jamala, which told the story of her great-grandmother who lived through the mass deportation of Crimean Tatars in the Soviet Union under Josef Stalin. This time the EBU allowed the entry, despite the Russian Duma calling for its rejection. The song went on to win. " class="video-embed-field-lazy"> — A year after Russia annexed Crimea, Ukraine’s triumphant 2016 Eurovision entry, ‘1944’ by Jamala, touched on the mass deportation of Crimean Tatars in the Soviet Union. Country-level voting behaviour, in general, can reveal interesting trends, starting with neighbourly support. Geographical voting blocs are a reality – whether it is Belgium and the Netherlands awarding each other points, the former Soviet Bloc countries showing preference for one another, or the Nordic states exchanging highest scores. In 2004 hosts Turkey refused to screen a map of the Republic of Cyprus Similarly, voting trends might be indicative of large diaspora communities living in a particular country. They can also provide insights into political trends. Amid rising tensions between Armenia and Azerbaijan in 2009, police reportedly questioned all 43 Azerbaijan judges who had voted for Armenia, resulting in a fine from the EBU. On the flipside, when Istanbul hosted the 2004 contest, it marked the first time that Turkey and Cyprus recognized each other through voting despite ongoing tensions, although Turkey still refused to screen a map of the Republic of Cyprus, which it does not recognize, when that country’s votes were announced as is custom. Participation means recognition Indeed, participation means recognition for countries. It shows kinship to the European continent, particularly attractive in the early 2000s during the initial waves of accession to the European Union by Eastern Bloc countries. Participation also offers individual recognition for the acts, whose mere involvement may promote diversity and inclusion. Having achieved a cult following from the LGBT community, Eurovision has become a platform for the promotion of human rights as well, exemplified by Austria’s 2014 winner Rise Like a Phoenix by Conchita Wurst, a moustachioed drag performer in a ball gown. " class="video-embed-field-lazy"> — The drag performer Conchita Wurst won Eurovision for Austria in 2014 with ‘Rise Like a Phoenix’. Eurovision acts as a gauge for cultural trends across the continent. As a result, it simply cannot be apolitical, not when countries such as Hungary withdraw from the competition calling Eurovision ‘too gay’. Interestingly, when China censored Ireland’s 2018 entry because it included two men dancing together, the EBU chose not to break ties. Full Article
d Independent Thinking: Sweden, Finland, and NATO By www.chathamhouse.org Published On :: Fri, 31 Mar 2023 09:24:17 +0000 Independent Thinking: Sweden, Finland, and NATO Audio NCapeling 31 March 2023 Episode 21 of our weekly podcast examines the latest developments relating to Sweden and Finland’s proposed accession to NATO. The Hungarian parliament has finally ratified Finland’s membership to the NATO alliance, two weeks after President Erdogan in Turkey gave his seal of approval following a meeting with the Finnish president. Sweden however remains trapped in limbo, with both Turkey and Hungary delaying Stockholm’s membership and Erdogan in particular asking for more concessions. The panel discusses why Turkey and Hungary took issue with Sweden and Finland, what the strategic situation in the Baltic looks like now with only Finland joining NATO, and the challenges facing Sweden amid its fraught ties with President Erdogan. We also look ahead to Turkey’s presidential election in May as recent opinion polls point to a neck-and-neck race, with some polls even showing President Erdogan falling behind the opposition. The panel examines what the sentiment is like in Turkey ahead of the election, and how the world would respond if there was a change in power in Ankara for the first time in 20 years. Joining Bronwen Maddox on the podcast this week is Henri Vanhanen, research fellow with the Finnish Institute of International Affairs, and Galip Dalay, associate fellow with our Middle East and North Africa programme. About Independent Thinking A weekly podcast hosted by Chatham House director Bronwen Maddox, in conversation with leading policymakers, journalists, and Chatham House experts providing insight on the latest international issues. Full Article
d Africa and Europe: Climate security for the future By www.chathamhouse.org Published On :: Fri, 31 Mar 2023 10:37:14 +0000 Africa and Europe: Climate security for the future 20 April 2023 TO 21 April 2023 — 7:30AM TO 12:00PM Anonymous (not verified) 31 March 2023 Slovenia and Online The 12th Africa Day International Conference hosted in Slovenia offers a platform for interregional exchange and policy cooperation between African and European countries on climate security. The 12th Africa Day International Conference offers a platform for inter-regional exchange and cooperation to further contribute to progress on climate security. The 12th Africa Day International Conference is hosted by the Ministry of Foreign and European Affairs of the Republic of Slovenia, in collaboration with the European Commission and the Chatham House Africa Programme. This high-level annual event seeks to improve policy outcomes for citizens in Europe and Africa on the basis of mutual understanding and cooperation between the two regions, while strengthening bilateral relations between Slovenia and African countries. Climate change poses one of the most serious threats to global security. No individual country or region can face it alone; strong regional and international partnerships are crucial. Analysing risk and taking action can help towards achieving a number of SDGs and a more secure and sustainable future. Addressing climate security is essential for the well-being and future stability of nations and societies around the world, and for the global community as a whole. This conference will offer a platform for interregional exchange and cooperation on the topic of climate security policy. It will bring together decision-makers and experts from Europe, Africa and across the globe to identify the key challenges and policy priorities in addressing climate security. The conference will be broadcast live on the Slovenian Ministry of Foreign Affairs webpage, and on the Africa Programme Facebook page. Full Article
d [68Ga]Ga-PSMA-11 PET/CT-Positive Hepatic Inflammatory Pseudotumor: Possible PSMA-Avid Pitfall in Nuclear Imaging By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Full Article
d Ultrashort Oncologic Whole-Body [18F]FDG Patlak Imaging Using LAFOV PET By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Methods to shorten [18F]FDG Patlak PET imaging procedures ranging from 65–90 to 20–30 min after injection, using a population-averaged input function (PIF) scaled to patient-specific image-derived input function (IDIF) values, were recently evaluated. The aim of the present study was to explore the feasibility of ultrashort 10-min [18F]FDG Patlak imaging at 55–65 min after injection using a PIF combined with direct Patlak reconstructions to provide reliable quantitative accuracy of lung tumor uptake, compared with a full-duration 65-min acquisition using an IDIF. Methods: Patients underwent a 65-min dynamic PET acquisition on a long-axial-field-of-view (LAFOV) Biograph Vision Quadra PET/CT scanner. Subsequently, direct Patlak reconstructions and image-based (with reconstructed dynamic images) Patlak analyses were performed using both the IDIF (time to relative kinetic equilibrium between blood and tissue concentration (t*) = 30 min) and a scaled PIF at 30–60 min after injection. Next, direct Patlak reconstructions were performed on the system console using only the last 10 min of the acquisition, that is, from 55 to 65 min after injection, and a scaled PIF using maximum crystal ring difference settings of both 85 and 322. Tumor lesion and healthy-tissue uptake was quantified and compared between the differently obtained parametric images to assess quantitative accuracy. Results: Good agreement was obtained between direct- and image-based Patlak analyses using the IDIF (t* = 30 min) and scaled PIF at 30–60 min after injection, performed using the different approaches, with no more than 8.8% deviation in tumor influx rate value (Ki) (mean difference ranging from –0.0022 to 0.0018 mL/[min x g]). When direct Patlak reconstruction was performed on the system console, excellent agreement was found between the use of a scaled PIF at 30–60 min after injection versus 55–65 min after injection, with 2.4% deviation in tumor Ki (median difference, –0.0018 mL/[min x g]; range, –0.0047 to 0.0036 mL/[min x g]). For different maximum crystal ring difference settings using the scan time interval of 55–65 min after injection, only a 0.5% difference (median difference, 0.0000 mL/[min x g]; range, –0.0004 to 0.0013 mL/[min x g]) in tumor Ki was found. Conclusion: Ultrashort whole-body [18F]FDG Patlak imaging is feasible on an LAFOV Biograph Vision Quadra PET/CT system without loss of quantitative accuracy to assess lung tumor uptake compared with a full-duration 65-min acquisition. The ultrashort 10-min direct Patlak reconstruction with PIF allows for its implementation in clinical practice. Full Article
d Improving 18F-FDG PET Quantification Through a Spatial Normalization Method By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Quantification of 18F-FDG PET images is useful for accurate diagnosis and evaluation of various brain diseases, including brain tumors, epilepsy, dementia, and Parkinson disease. However, accurate quantification of 18F-FDG PET images requires matched 3-dimensional T1 MRI scans of the same individuals to provide detailed information on brain anatomy. In this paper, we propose a transfer learning approach to adapt a pretrained deep neural network model from amyloid PET to spatially normalize 18F-FDG PET images without the need for 3-dimensional MRI. Methods: The proposed method is based on a deep learning model for automatic spatial normalization of 18F-FDG brain PET images, which was developed by fine-tuning a pretrained model for amyloid PET using only 103 18F-FDG PET and MR images. After training, the algorithm was tested on 65 internal and 78 external test sets. All T1 MR images with a 1-mm isotropic voxel size were processed with FreeSurfer software to provide cortical segmentation maps used to extract a ground-truth regional SUV ratio using cerebellar gray matter as a reference region. These values were compared with those from spatial normalization-based quantification methods using the proposed method and statistical parametric mapping software. Results: The proposed method showed superior spatial normalization compared with statistical parametric mapping, as evidenced by increased normalized mutual information and better size and shape matching in PET images. Quantitative evaluation revealed a consistently higher SUV ratio correlation and intraclass correlation coefficients for the proposed method across various brain regions in both internal and external datasets. The remarkably good correlation and intraclass correlation coefficient values of the proposed method for the external dataset are noteworthy, considering the dataset’s different ethnic distribution and the use of different PET scanners and image reconstruction algorithms. Conclusion: This study successfully applied transfer learning to a deep neural network for 18F-FDG PET spatial normalization, demonstrating its resource efficiency and improved performance. This highlights the efficacy of transfer learning, which requires a smaller number of datasets than does the original network training, thus increasing the potential for broader use of deep learning–based brain PET spatial normalization techniques for various clinical and research radiotracers. Full Article
d C-X-C Motif Chemokine Receptor 4-Directed Scintigraphy Using [99mTc]Tc-Pentixatec in Primary Aldosteronism: A Proof-of-Concept Study By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 C-X-C motif chemokine receptor 4 (CXCR4)–directed imaging has gained clinical interest in aiding clinical diagnostics in primary aldosteronism (PA). We retrospectively evaluated the feasibility of CXCR4-directed scintigraphy using the novel CXCR-4 ligand [99mTc]Tc-pentixatec in patients with PA. Methods: Six patients (mean age ± SD, 49 ± 15 y) underwent CXCR4-directed scintigraphy (including planar imaging and SPECT/CT) 30, 120, and 240 min after injection of 435 ± 50 MBq of [99mTc]Tc-pentixatec. Adrenal CXCR4 expression was analyzed by calculating lesion-to-contralateral ratios (LCRs). Imaging results were correlated to clinical information. Histopathology and clinical follow-up served as the standard of reference. Results: Three subjects showed lateralization of adrenal tracer accumulation, with a mean maximum lesion-to-contralateral ratio of 1.65 (range, 1.52–1.70), which correlated with morphologic findings on CT. One individual underwent adrenalectomy and presented with complete biochemical and clinical remission at follow-up. Histopathologic workup confirmed unilateral aldosterone-producing adenoma. Conclusion: [99mTc]Tc-pentixatec scintigraphy with SPECT in patients with PA is feasible and might offer a valuable alternative to CXCR4-directed imaging with [68Ga]Ga-pentixafor PET. Full Article
d Design, Synthesis, and Preclinical Evaluation of a High-Affinity 18F-Labeled Radioligand for Myocardial Growth Hormone Secretagogue Receptor Before and After Myocardial Infarction By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 The peptide hormone ghrelin is produced in cardiomyocytes and acts through the myocardial growth hormone secretagogue receptor (GHSR) to promote cardiomyocyte survival. Administration of ghrelin may have therapeutic effects on post–myocardial infarction (MI) outcomes. Therefore, there is a need to develop molecular imaging probes that can track the dynamics of GHSR in health and disease to better predict the effectiveness of ghrelin-based therapeutics. We designed a high-affinity GHSR ligand labeled with 18F for imaging by PET and characterized its in vivo properties in a canine model of MI. Methods: We rationally designed and radiolabeled with 18F a quinazolinone derivative ([18F]LCE470) with subnanomolar binding affinity to GHSR. We determined the sensitivity and in vivo and ex vivo specificity of [18F]LCE470 in a canine model of surgically induced MI using PET/MRI, which allowed for anatomic localization of tracer uptake and simultaneous determination of global cardiac function. Uptake of [18F]LCE470 was determined by time–activity curve and SUV analysis in 3 regions of the left ventricle—area of infarct, territory served by the left circumflex coronary artery, and remote myocardium—over a period of 1.5 y. Changes in cardiac perfusion were tracked by [13N]NH3 PET. Results: The receptor binding affinity of LCE470 was measured at 0.33 nM, the highest known receptor binding affinity for a radiolabeled GHSR ligand. In vivo blocking studies in healthy hounds and ex vivo blocking studies in myocardial tissue showed the specificity of [18F]LCE470, and sensitivity was demonstrated by a positive correlation between tracer uptake and GHSR abundance. Post-MI changes in [18F]LCE470 uptake occurred independently of perfusion tracer distributions and changes in global cardiac function. We found that the regional distribution of [18F]LCE470 within the left ventricle diverged significantly within 1 d after MI and remained that way throughout the 1.5-y duration of the study. Conclusion: [18F]LCE470 is a high-affinity PET tracer that can detect changes in the regional distribution of myocardial GHSR after MI. In vivo PET molecular imaging of the global dynamics of GHSR may lead to improved GHSR-based therapeutics in the treatment of post-MI remodeling. Full Article
d Molecular Imaging of p53 in Mouse Models of Cancer Using a Radiolabeled Antibody TAT Conjugate with SPECT By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Mutations of p53 protein occur in over half of all cancers, with profound effects on tumor biology. We present the first—to our knowledge—method for noninvasive visualization of p53 in tumor tissue in vivo, using SPECT, in 3 different models of cancer. Methods: Anti-p53 monoclonal antibodies were conjugated to the cell-penetrating transactivator of transcription (TAT) peptide and a metal ion chelator and then radiolabeled with 111In to allow SPECT imaging. 111In-anti-p53-TAT conjugates were retained longer in cells overexpressing p53-specific than non–p53-specific 111In-mIgG (mouse IgG from murine plasma)-TAT controls, but not in null p53 cells. Results: In vivo SPECT imaging showed enhanced uptake of 111In-anti-p53-TAT, versus 111In-mIgG-TAT, in high-expression p53R175H and medium-expression wild-type p53 but not in null p53 tumor xenografts. The results were confirmed in mice bearing genetically engineered KPC mouse–derived pancreatic ductal adenocarcinoma tumors. Imaging with 111In-anti-p53-TAT was possible in KPC mice bearing spontaneous p53R172H pancreatic ductal adenocarcinoma tumors. Conclusion: We demonstrate the feasibility of noninvasive in vivo molecular imaging of p53 in tumor tissue using a radiolabeled TAT-modified monoclonal antibody. Full Article
d The Emission of Internal Conversion Electrons Rather Than Auger Electrons Increased the Nucleus-Absorbed Dose for 161Tb Compared with 177Lu with a Higher Dose Response for [161Tb]Tb-DOTA-LM3 Than for [161Tb]Tb-DOTATATE By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Preclinical data have shown that 161Tb-labeled peptides targeting the somatostatin receptor are therapeutically more effective for peptide receptor radionuclide therapy than are their 177Lu-labeled counterparts. To further substantiate this enhanced therapeutic effect, we performed cellular dosimetry to quantify the absorbed dose to the cell nucleus and compared dose–response curves to evaluate differences in relative biological effectiveness in vitro. Methods: CA20948 cell survival was assessed after treatment with [161Tb]Tb- and [177Lu]Lu-DOTATATE (agonist) and with [161Tb]Tb- and [177Lu]Lu-DOTA-LM3 (antagonist) via a clonogenic assay. Cell binding, internalization, and dissociation assays were performed up to 7 d to acquire time-integrated activity coefficients. Separate S values for each type of particle emission (Auger/internal conversion [IC] electrons and β– particles) were computed via Monte Carlo simulations, while considering spheric cells. Once the absorbed dose to the cell nucleus was calculated, survival curves were fitted to the appropriate linear or linear-quadratic model and corresponding relative biological effectiveness was evaluated. Results: Although the radiopeptide uptake was independent of the radionuclide, [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 delivered a 3.6 and 3.8 times higher dose to the nucleus, respectively, than their 177Lu-labeled counterparts on saturated receptor binding. This increased nucleus-absorbed dose was mainly due to the additional emission of IC and not Auger electrons by 161Tb. When activity concentrations were considered, both [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 showed a lower survival fraction than did labeling with 177Lu. When the absorbed dose to the nucleus was considered, no significant difference could be observed between the dose–response curves for [161Tb]Tb- and [177Lu]Lu-DOTATATE. [161Tb]Tb-DOTA-LM3 showed a linear-quadratic dose response, whereas [161Tb]Tb-DOTATATE showed only a linear dose response within the observed dose range, suggesting additional cell membrane damage by Auger electrons. Conclusion: The IC, rather than Auger, electrons emitted by 161Tb resulted in a higher absorbed dose to the cell nucleus and lower clonogenic survival for [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 than for the 177Lu-labeled analogs. In contrast, [161Tb]Tb-DOTATATE showed no higher dose response than [177Lu]Lu-DOTATATE, whereas for [161Tb]Tb-DOTA-LM3 an additional quadratic response was observed. Because of this quadratic response, potentially caused by cell membrane damage, [161Tb]Tb-DOTA-LM3 is a more effective radiopeptide than [161Tb]Tb-DOTATATE for labeling with 161Tb. Full Article
d Theranostic GPA33-Pretargeted Radioimmunotherapy of Human Colorectal Carcinoma with a Bivalent 177Lu-Labeled Radiohapten By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Radiolabeled small-molecule DOTA-haptens can be combined with antitumor/anti-DOTA bispecific antibodies (BsAbs) for pretargeted radioimmunotherapy (PRIT). For optimized delivery of the theranostic - and β-emitting isotope 177Lu with DOTA-based PRIT (DOTA-PRIT), bivalent Gemini (DOTA-Bn-thiourea-PEG4-thiourea-Bn-DOTA, aka (3,6,9,12-tetraoxatetradecane-1,14-diyl)bis(DOTA-benzyl thiourea)) was developed. Methods: Gemini was synthesized by linking 2 S-2-(4-isothiocyanatobenzyl)-DOTA molecules together via a 1,14-diamino-PEG4 linker. [177Lu]Lu-Gemini was prepared with no-carrier-added 177LuCl3 to a molar-specific activity of 123 GBq/μmol and radiochemical purity of more than 99%. The specificity of BsAb-177Lu-Gemini was verified in vitro. Subsequently, we evaluated biodistribution and whole-body clearance for [177Lu]Lu-Gemini and, for comparison, our gold-standard monovalent [177Lu]Lu-S-2-(4-aminobenzyl)-DOTA ([177Lu]Lu-DOTA-Bn) in naïve (tumor-free) athymic nude mice. For our proof-of-concept system, a 3-step pretargeting approach was performed with an established DOTA-PRIT regimen (anti-GPA33/anti-DOTA IgG-scFv BsAb, a clearing agent, and [177Lu]Lu-Gemini) in mouse models. Results: Initial in vivo studies showed that [177Lu]Lu-Gemini behaved similarly to [177Lu]Lu-DOTA-Bn, with almost identical blood and whole-body clearance kinetics, as well as biodistribution and mouse kidney dosimetry. Pretargeting [177Lu]Lu-Gemini to GPA33-expressing SW1222 human colorectal xenografts was highly effective, leading to absorbed doses of [177Lu]Lu-Gemini for blood, tumor, liver, spleen, and kidneys of 3.99, 455, 6.93, 5.36, and 14.0 cGy/MBq, respectively. Tumor–to–normal tissue absorbed-dose ratios (i.e., therapeutic indices [TIs]) for the blood and kidneys were 114 and 33, respectively. In addition, we demonstrate that the use of bivalent [177Lu]Lu-Gemini in DOTA-PRIT leads to improved TIs and augmented [177Lu]Lu-Gemini tumor uptake and retention in comparison to monovalent [177Lu]Lu-DOTA-Bn. Finally, we established efficacy in SW1222 tumor-bearing mice, demonstrating that a single injection of anti-GPA33 DOTA-PRIT with 44 MBq (1.2 mCi) of [177Lu]Lu-Gemini (estimated tumor-absorbed dose, 200 Gy) induced complete responses in 5 of 5 animals and a histologic cure in 2 of 5 (40%) animals. Moreover, a significant increase in survival compared with nontreated controls was noted (maximum tolerated dose not reached). Conclusion: We have developed a bivalent DOTA-radiohapten, [177Lu]Lu-Gemini, that showed improved radiopharmacology for DOTA-PRIT application. The use of bivalent [177Lu]Lu-Gemini in DOTA-PRIT, as opposed to monovalent [177Lu]Lu-DOTA-Bn, allows curative treatments with considerably less administered 177Lu activity while still achieving high TIs for both the blood (>100) and the kidneys (>30). Full Article
d Preclinical Evaluation of 177Lu-OncoFAP-23, a Multivalent FAP-Targeted Radiopharmaceutical Therapeutic for Solid Tumors By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Fibroblast activation protein (FAP) is abundantly expressed in the stroma of most human solid tumors. Clinical-stage radiolabeled FAP ligands are increasingly used as tools for the detection of various cancer lesions. To unleash the full therapeutic potential of FAP-targeting agents, ligands need to remain at the tumor site for several days after administration. We recently described the discovery of OncoFAP, a high-affinity small organic ligand of FAP with a rapid accumulation in tumors and low uptake in healthy tissues in cancer patients. Trimerization of OncoFAP provided a derivative (named TriOncoFAP, or OncoFAP-23) with improved FAP affinity. In this work, we evaluated the tissue biodistribution profile and the therapeutic performance of OncoFAP-23 in tumor-bearing mice. Methods: OncoFAP-23 was radiolabeled with the theranostic radionuclide 177Lu. Preclinical experiments were conducted on mice bearing SK-RC-52.hFAP (BALB/c nude mice) or CT-26.hFAP (BALB/c mice) tumors. 177Lu-OncoFAP and 177Lu-FAP-2286 were included in the biodistribution study as controls. Toxicologic evaluation was performed on Wistar rats and CD1 mice by injecting high doses of OncoFAP-23 or its cold-labeled counterpart, respectively. Results: 177Lu-OncoFAP-23 emerged for its best-in-class biodistribution profile, high and prolonged tumor uptake (i.e., ~16 percentage injected dose/g at 96 h), and low accumulation in healthy organs, which correlates well with its potent single-agent anticancer activity at low levels of administered radioactivity. Combination treatment with the tumor-targeted interleukin 2 (L19-IL2, a clinical-stage immunocytokine) further expands the therapeutic window of 177Lu-OncoFAP-23 by potentiating its in vivo antitumor activity. Proteomics studies revealed a potent tumor-directed immune response on treatment with the combination. OncoFAP-23 and natLu-OncoFAP-23 exhibited a favorable toxicologic profile, without showing any side effects or signs of toxicity. Conclusion: OncoFAP-23 presents enhanced tumor uptake and tumor retention and low accumulation in healthy organs, findings that correspond to a strongly improved in vivo antitumor efficacy. The data presented in this work support the clinical development of 177Lu-OncoFAP-23 for the treatment of FAP-positive solid tumors. Full Article
d [68Ga]Ga-RAYZ-8009: A Glypican-3-Targeted Diagnostic Radiopharmaceutical for Hepatocellular Carcinoma Molecular Imaging--A First-in-Human Case Series By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 To date, the imaging and diagnosis of hepatocellular carcinoma (HCC) rely on CT/MRI, which have well-known limitations. Glypican-3 (GPC3) is a cell surface receptor highly expressed by HCC but not by normal or cirrhotic liver tissue. Here we report initial clinical results of GPC3-targeted PET imaging with [68Ga]Ga-DOTA-RYZ-GPC3 (RAYZ-8009), a peptide-based GPC3 ligand in patients with known or suspected HCC. Methods: [68Ga]Ga-RAYZ-8009 was obtained after labeling the peptide precursor with 68Ga from a 68Ge/68Ga generator and heating at 90°C for 10 min followed by sterile filtration. After administration of [68Ga]Ga-RAYZ-8009, a dynamic or static PET/CT scan was acquired between 45 min and 4 h after administration. Radiotracer uptake was measured by SUVs for the following tissues: suspected or actual HCC or hepatoblastoma lesions, non–tumor-bearing liver, renal cortex, blood pool in the left ventricle, and gastric fundus. Additionally, tumor–to–healthy-liver ratios (TLRs) were calculated. Results: Twenty-four patients (5 patients in the dynamic protocol; 19 patients in the static protocol) were scanned. No adverse events occurred. Two patients had no lesion detected and did not have HCC during follow-up. In total, 50 lesions were detected and analyzed. The mean SUVmax of these lesions was 19.6 (range, 2.7–95.3), and the mean SUVmean was 10.1 (range, 1.0–49.2) at approximately 60 min after administration. Uptake in non–tumor-bearing liver and blood pool rapidly decreased over time and became negligible 45 min after administration (mean SUVmean, <1.6), with a continuous decline to 4 h after administration (mean SUVmean, 1.0). The opposite was observed for HCC lesions, for which SUVs and TLRs continuously increased for up to 4 h after administration. In individual lesion analysis, TLR was the highest between 60 and 120 min after administration. Uptake in the gastric fundus gradually increased for up to 45 min (to an SUVmax of 31.3) and decreased gradually afterward. Conclusion: [68Ga]Ga-RAYZ-8009 is safe and allows for high-contrast imaging of GPC3-positive HCC, with rapid clearance from most normal organs. Thereby, [68Ga]Ga-RAYZ-8009 is promising for HCC diagnosis and staging. Further research is warranted. Full Article
d Dual Somatostatin Receptor/18F-FDG PET/CT Imaging in Patients with Well-Differentiated, Grade 2 and 3 Gastroenteropancreatic Neuroendocrine Tumors By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Our purpose was to prospectively assess the distribution of NETPET scores in well-differentiated (WD) grade 2 and 3 gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) and to determine the impact of the NETPET score on clinical management. Methods: This single-arm, institutional ethics review board–approved prospective study included 40 patients with histologically proven WD GEP NETs. 68Ga-DOTATATE PET and 18F-FDG PET were performed within 21 d of each other. NETPET scores were evaluated qualitatively by 2 reviewers, with up to 10 marker lesions selected for each patient. The quantitative parameters that were evaluated included marker lesion SUVmax for each tracer; 18F-FDG/68Ga-DOTATATE SUVmax ratios; functional tumor volume (FTV) and metabolic tumor volume (MTV) on 68Ga-DOTATATE and 18F-FDG PET, respectively; and FTV/MTV ratios. The treatment plan before and after 18F-FDG PET was recorded. Results: There were 22 men and 18 women (mean age, 60.8 y) with grade 2 (n = 24) or grade 3 (n = 16) tumors and a mean Ki-67 index of 16.1%. NETPET scores of P0, P1, P2A, P2B, P3B, P4B, and P5 were documented in 2 (5%), 5 (12.5%), 5 (12.5%) 20 (50%), 2 (5%), 4 (10%), and 2 (5%) patients, respectively. No association was found between the SUVmax of target lesions on 68Ga-DOTATATE and the SUVmax of target lesions on 18F-FDG PET (P = 0.505). 18F-FDG/68Ga-DOTATATE SUVmax ratios were significantly lower for patients with low (P1–P2) primary NETPET scores than for those with high (P3–P5) primary NETPET scores (mean ± SD, 0.20 ± 0.13 and 1.68 ± 1.44, respectively; P < 0.001). MTV on 18F-FDG PET was significantly lower for low primary NETPET scores than for high ones (mean ± SD, 464 ± 601 cm3 and 66 ± 114 cm3, respectively; P = 0.005). A change in the type of management was observed in 42.5% of patients after 18F-FDG PET, with the most common being a change from systemic therapy to peptide receptor radionuclide therapy and from debulking surgery to systemic therapy. Conclusion: There was a heterogeneous distribution of NETPET scores in patients with WD grade 2 and 3 GEP NETs, with more than 1 in 5 patients having a high NETPET score and a frequent change in management after 18F-FDG PET. Quantitative parameters including 18F-FDG/68Ga-DOTATATE SUVmax ratios in target lesions and FTV/MTV ratios can discriminate between patients with high and low NETPET scores. Full Article
d Quantitative SPECT/CT Metrics in Early Prediction of [177Lu]Lu-DOTATATE Treatment Response in Gastroenteropancreatic Neuroendocrine Tumor Patients By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Our objective is to explore quantitative imaging markers for early prediction of treatment response in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) undergoing [177Lu]Lu-DOTATATE therapy. By doing so, we aim to enable timely switching to more effective therapies in order to prevent time-resource waste and minimize toxicities. Methods: Patients diagnosed with unresectable or metastatic, progressive, well-differentiated, receptor-positive GEP-NETs who received 4 sessions of [177Lu]Lu-DOTATATE were retrospectively selected. Using SPECT/CT images taken at the end of treatment sessions, we counted all visible tumors and measured their largest diameters to calculate the tumor burden score (TBS). Up to 4 target lesions were selected and semiautomatically segmented. Target lesion peak counts and spleen peak counts were measured, and normalized peak counts were calculated. Changes in TBS (TBS) and changes in normalized peak count (nPC) throughout treatment sessions in relation to the first treatment session were calculated. Treatment responses were evaluated using third-month CT and were binarized as progressive disease (PD) or non-PD. Results: Twenty-seven patients were included (7 PD, 20 non-PD). Significant differences were observed in TBSsecond-first, TBSthird-first, and TBSfourth-first (where second-first, third-first, and fourth-first denote scan number between the second and first, third and first, and fourth and first [177Lu]Lu-DOTATATE treatment cycles), respectively) between the PD and non-PD groups (median, 0.043 vs. –0.049, 0.08 vs. –0.116, and 0.109 vs. –0.123 [P = 0.023, P = 0.002, and P < 0.001], respectively). nPCsecond-first showed significant group differences (mean, –0.107 vs. –0.282; P = 0.033); nPCthird-first and nPCfourth-first did not reach statistical significance (mean, –0.122 vs. –0.312 and –0.183 vs. –0.405 [P = 0.117 and 0.067], respectively). At the optimal threshold, TBSfourth-first exhibited an area under the curve (AUC) of 0.957, achieving 100% sensitivity and 80% specificity. TBSsecond-first and TBSthird-first reached AUCs of 0.793 and 0.893, sensitivities of 71.4%, and specificities of 85% and 95%, respectively. nPCsecond-first, nPCthird-first, and nPCfourth-first showed AUCs of 0.764, 0.693, and 0.679; sensitivities of 71.4%, 71.4%, and 100%; and specificities of 75%, 70%, and 35%, respectively. Conclusion: TBS and nPC can predict [177Lu]Lu-DOTATATE response by the second treatment session. Full Article
d Composite Prediction Score to Interpret Bone Focal Uptake in Hormone-Sensitive Prostate Cancer Patients Imaged with [18F]PSMA-1007 PET/CT By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Unspecific bone uptake (UBU) related to [18F]PSMA-1007 PET/CT imaging represents a clinical challenge. We aimed to assess whether a combination of clinical, biochemical, and imaging parameters could predict skeletal metastases in patients with [18F]PSMA-1007 bone focal uptake, aiding in result interpretation. Methods: We retrospectively analyzed [18F]PSMA-1007 PET/CT performed in hormone-sensitive prostate cancer (PCa) patients at 3 tertiary-level cancer centers. A fourth center was involved in performing an external validation. For each, a volume of interest was drawn using a threshold method to extract SUVmax, SUVmean, PSMA tumor volume, and total lesion PSMA. The same volume of interest was applied to CT images to calculate the mean Hounsfield units (HUmean) and maximum Hounsfield units. Clinical and laboratory data were collected from electronic medical records. A composite reference standard, including follow-up histopathology, biochemistry, and imaging data, was used to distinguish between PCa bone metastases and UBU. PET readers with less (n = 2) or more (n = 2) experience, masked to the reference standard, were asked to visually rate a subset of focal bone uptake (n = 178) as PCa metastases or not. Results: In total, 448 bone [18F]PSMA-1007 focal uptake specimens were identified in 267 PCa patients. Of the 448 uptake samples, 188 (41.9%) corresponded to PCa metastases. Ongoing androgen deprivation therapy at PET/CT (P < 0.001) with determination of SUVmax (P < 0.001) and HUmean (P < 0.001) independently predicted bone metastases. A composite prediction score, the bone uptake metastatic probability (BUMP) score, achieving an area under the receiver-operating-characteristic curve (AUC) of 0.87, was validated through a 10-fold internal and external validation (n = 89 bone uptake, 51% metastatic; AUC, 0.92). The BUMP score’s AUC was significantly higher than that of HUmean (AUC, 0.62) and remained high among lesions with HUmean in the first tertile (AUC, 0.80). A decision-curve analysis showed a higher net benefit with the score. Compared with the visual assessment, the BUMP score provided added value in terms of specificity in less-experienced PET readers (88% vs. 54%, P < 0.001). Conclusion: The BUMP score accurately distinguished UBU from bone metastases in PCa patients with [18F]PSMA-1007 focal bone uptake at PET imaging, offering additional value compared with the simple assessment of the osteoblastic CT correlate. Its use could help clinicians interpret imaging results, particularly those with less experience, potentially reducing the risk of patient overstaging. Full Article