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Long term aircraft noise is linked to incidence of high blood pressure




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Lying flat after stroke achieves similar outcomes to sitting up, trial finds




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Thrombectomy can be considered up to 24 hours after onset of stroke, says NICE




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NICE recommends implantable monitor to identify atrial fibrillation after stroke




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Stroke: “striking reductions” are seen in number of people with symptoms seeking help




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Stroke: Take test for genetic variant to ensure clopidogrel works for prevention, says NICE




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Stroke: New NHS campaign urges people to call 999 as soon as symptoms show




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GLP-1 receptor agonists: European drug regulator asks makers for evidence of self-harm




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FDA approves first over-the-counter blood glucose monitor for diabetes




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Type 1 diabetes: Randox removes adverts after claims that it was using fear to sell genetic test




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Covid-19: Progression to clinical type 1 diabetes accelerated after infection, study suggests




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Diabetes: One in 10 patients on NHS’s “soups and shakes” diet plan went into remission




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Helen Salisbury: GP collective action to end unfunded work




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SGLT-2 inhibitors for diabetes may help prevent dementia, study finds




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Patient related outcome measures (PROMs) in long term conditions—is it time to bring them into routine clinical practice?




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The road to COP27: In conversation with US Special Presidential Envoy for Climate John Kerry

The road to COP27: In conversation with US Special Presidential Envoy for Climate John Kerry 27 October 2022 — 3:00PM TO 4:00PM Anonymous (not verified) 20 October 2022 Chatham House and Online

What will progress on climate change look like at COP27?

With global attention zeroing in on COP27, policymakers and world leaders will meet in Egypt to take the next step in the fight against the climate crisis. The planet is on course to warm well beyond 1.5°C and climate hazards are increasing our exposure to climate risk. Violent and unpredictable weather events increasingly leave devastation among communities, particularly in vulnerable countries.

At the same time, the ripple effects of the conflict in Ukraine will have wide-ranging economic, social and geopolitical consequences for years to come. Whilst some finance is being made available, more is needed to properly address the damage caused by climate change and fund the transition to net zero worldwide. These challenges have become more acute as the world grapples with a growing energy crisis, the war in Ukraine and a troubling economic outlook.

Joined by US Special Presidential Envoy for Climate John Kerry, the following questions are considered:

  • Is ‘1.5 degrees’ still on track?

  • How can countries better collaborate to move to net zero faster?

  • How can we achieve progress on adaptation, climate finance, and loss and damage?

As with all members events, questions from the audience drive the conversation.

Read the transcript. 




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Thinking out loud: Is disinformation here to stay?

Thinking out loud: Is disinformation here to stay? 10 November 2022 — 6:00PM TO 6:45PM Anonymous (not verified) 25 October 2022 Chatham House

This event is postponed.

Have you ever wondered how Chatham House researchers approach the big deals that become research? Do you enjoy meeting other Chatham House members and engaging with questions that open your mind? ‘Thinking Out Loud’ invites a small group of members to a live, unscripted discussion with a Chatham House researcher. This in-person event is a way for researchers and members to think out loud to help shape ideas for future research.

Kate Jones, Associate Fellow, International Law Programme at Chatham House will pose some key questions facing how speech is governed in an online world:

  • How has big tech influenced the way we think about speech and its limitations?

  • Can disinformation be eliminated or even greatly reduced?

  • Where should the responsibilities fall between government and business when it comes to speech regulation?

  • What might the information landscape look like in 10 years’ time? Should that affect how we tackle disinformation today?

As with all members events, questions from the audience drive the conversation.




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Weathering the storm: The UK’s role in the world today

Weathering the storm: The UK’s role in the world today 29 November 2022 — 12:00PM TO 1:00PM Anonymous (not verified) 7 November 2022 Chatham House and Online

In conversation with David Miliband, examining the risks and opportunities for the UK in a critical year ahead. 

With a new government in the midst of a global order in flux, the UK’s position in the world needs re-examining.

Just 20 months since the UK’s Integrated Review on international policy and security, Britain’s global blueprint is being reviewed and updated in light of major global developments.

Today, Brexit and the Russia’s invasion of Ukraine require adjustments to the UK’s strategic thinking and positioning in the world.

As the economic and political turmoil of previous weeks begins to abate, this is an important moment to once again determine Britain’s role in Europe and beyond. 
 
Realigning British foreign policy in a rapidly shifting international order will be a major challenge for the new administration.  

International Rescue Committee’s CEO and President, and former UK Foreign Secretary, David Miliband, examines the risks and opportunities for a critical year ahead. 
 
Key questions include:

  • What are the crucial decisions the UK needs to make in the coming 12 months?
  • What should the UK’s priorities be for its role in the world? How should it project itself amidst geopolitical fracturing?
  • How can Britain best respond to humanitarian crises around the world?
  • Does the UK have the strategic and economic clout to keep up with its foreign policy and development commitments?

As with all Chatham House member events, questions from members drive the conversation.

Read the transcript. 




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The Director’s Annual Lecture 2023

The Director’s Annual Lecture 2023 10 January 2023 — 6:00PM TO 7:00PM Anonymous (not verified) 17 November 2022 Chatham House and Online

Bronwen Maddox looks ahead to the challenges of the year and sets out Chatham House’s recommendations for change.

Read a transcript of the event

A lecture and discussion on the year ahead in international relations with Bronwen Maddox, director and chief executive of Chatham House.

Although Russia’s war on Ukraine rightly dominated headlines in 2022, other challenges also grew, the climate became warmer, US/China competition intensified, deglobalization became a much-analysed theme, and the global economy suffered significant blows.

The UK has its third prime minister in less than one year as it grapples with its changing place in the world. And the world is still living in the shadow of COVID-19 and what the pandemic revealed about strengths and vulnerabilities, global inequity, and North/South divides.

This event examines how the forces that shaped 2022 may manifest in 2023, and what that means for progress in international relations:

  • What will progress look like on the climate agenda?
  • How will the new US Congress reposition America’s role in the world?
  • What does the North/South divergence on Russia’s war in Ukraine tell us about shared values and prospects for working together?
  • After a turbulent year, how will the UK recover its standing in Europe and beyond?




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Ten conflicts to watch in 2023

Ten conflicts to watch in 2023 11 January 2023 — 6:00PM TO 7:00PM Anonymous (not verified) 8 December 2022 Chatham House and Online

This event examines the most dangerous wars and crises through the lens of the International Crisis Group’s flagship annual report ‘10 Conflicts to watch in 2023’.

Each year, International Crisis Group compiles a list of the ten conflicts to watch that examines key conflicts across the globe. Please join us for this event at which Dr Comfort Ero, International Crisis Group president and CEO, discusses today’s and tomorrow’s most impactful wars and crises.

Key questions to consider include:

  • What far-reaching repercussions and knock-on effects of Russia’s war on Ukraine will have for Europe and the rest of the world?

  • Which crises beyond Ukraine warrant collective attention in the year ahead?

  • How do rising tensions among major powers impact multilateral efforts to resolve these conflicts, impede progress on global challenges and impact institutions working on crisis prevention?

As with all members events, questions from the audience drive the conversation.

Read the transcript. 




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The race to vaccinate

The race to vaccinate 16 January 2023 — 5:00PM TO 6:00PM Anonymous (not verified) 9 December 2022 Chatham House and Online

What are the lessons from the UK’s COVID-19 vaccination campaign?

The first COVID-19 vaccination in the UK was administered on 8 December 2020, eight months after the World Health Organization (WHO) declared COVID-19 a pandemic on 11 March.

With multiple rounds of vaccines having now been administered widely, the UK is in a position to live effectively with the virus and the prospects of more lockdowns and COVID-19 restrictions have diminished.

The story behind the UK’s biggest vaccination campaign in British history is told during this discussion with Kate Bingham and Tim Hames, authors of The Long Shot: The Inside Story of the Race to Vaccinate Britain, which describes the management of complex political and operational challenges.

Juggling vaccine suppliers, Whitehall and the media, all had the potential to threaten the Vaccine Taskforce’s efforts.

This event explores the UK’s experience and lessons learned. The panel explore:

  • How were the most challenging obstacles to the UK’s vaccine development, scale-up and delivery overcome?
  • What does the success of the UK vaccine development and delivery mean in an international context?
  • What has the COVID-19 pandemic highlighted about global cooperation on vaccine administration worldwide?
  • As the pandemic moves into the rear-view mirror, how can industry and government work better together for future vaccination campaigns?

As with all members events, questions from the audience drive the conversation.

Read the transcript. 




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Disruptive technologies by nation states and malign cyber actors – the US response

Disruptive technologies by nation states and malign cyber actors – the US response 16 February 2023 — 1:00PM TO 2:00PM Anonymous (not verified) 2 February 2023 Chatham House and Online

Lisa Monaco, the US deputy attorney general, discusses how autocratic governments and malign cyber actors use disruptive technologies to project power and engage in illicit activity.

Weaponizing data, ransomware attacks and other illicit cyber activity represent significant threats to national security. 

Governments and malicious cyber actors around the world exploit disruptive technology to engage in criminal activity, track citizens and coerce other countries thereby weakening the rules-based order and fundamental principles of democracy. 

Lisa Monaco discusses how the world is at an inflection point when it comes to meeting this challenge and describes how the US and partner nations are responding to protect their citizens and the broader international community.

Key questions to discuss include:

  • What steps does the US government need to take to properly address this threat?
  • How are countries coordinating policies to confront the problem?
  • To what extent does this challenge go beyond US-China competition?

As with all member events, questions from the audience drive the conversation.

Read the transcript.




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From Iraq to Ukraine: What did governments learn?

From Iraq to Ukraine: What did governments learn? 20 March 2023 — 12:00PM TO 1:00PM Anonymous (not verified) 6 March 2023 Chatham House and Online

What were the main lessons for today’s conflicts from the way in which the war in Iraq played out?

This March marks the 20th anniversary of the US and UK-led invasion of Iraq to oust Saddam Hussein. Based primarily on unfounded fears Iraq’s WMD (weapons of mass destruction) capability was buidling up in the absence of UN inspection and constraints on the IAEA (International Atomic Energy Agency) safeguards, the decision to go to war has reverberated throughout the Middle East, the intelligence communities, and Western political decision-making ever since.

In the 2002–03 period when UN inspectors were allowed back into Iraq, Hans Blix, chairman of UNMOVIC (UN Monitoring, Verification and Inspection Commission) and Mohamed ElBaradei, director general of the IAEA, were at the centre of a storm in which they were put under huge pressure to agree with the US/UK narrative on the ‘missing’ WMD.

Their problem was that the evidence they were uncovering did not support the claims, but the war went ahead – and Saddam was overthrown – despite these UN findings.

Much has changed since 2003. As the geopolitical landscape has shifted, so have geopolitics and capabilities. Today’s Russia’s war against Ukraine which includes WMD threats, cyberattacks, and an assertive disinformation campaign has opened up new ways of thinking about communicating information from open source and government intelligence analysis.

This panel explores the experiences of people involved with decision-making at the UN and in the UK in 2003 and how things have changed today.

  • What were the lessons from the way in which the war in Iraq played out?
  • How has that influenced the way in which NATO has responded to Russia’s wars against Ukraine?
  • How should information be communicated within governments and to the public?
  • How to deal with disinformation campaigns in the days of open source information and social media?

As with all member events, questions from the audience drive the conversation.




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Can rhetoric match reality? Britain’s international development future

Can rhetoric match reality? Britain’s international development future 27 April 2023 — 9:00AM TO 10:00AM Anonymous (not verified) 12 April 2023 Chatham House and Online

In conversation with Andrew Mitchell, minister of state, UK Foreign, Commonwealth and Development Office. 

Last month’s updated Integrated Review positioned international development as a key pillar of British foreign policy which sets out the importance of the UK’s efforts to shape the ‘global strategic environment’.

Focusing heavily on Africa and the Indo-Pacific, international development will be central to the ambition of a ‘Global Britain’.

The Integrated Review outlines seven priority areas to revitalize the drive to meet the Global Goals, with a climate security strategy at its heart, while seeking to go beyond official development assistance (ODA).

However, there are major challenges ahead. Since 2021, the UK’s ODA has been cut from 0.7 per cent to 0.5 per cent gross national income (GNI). Some are concerned that since being subsumed by the UK Foreign Office, the UK Foreign, Commonwealth and Development Office has diluted the effectiveness of UK international development. Then there is the question of the strength of British public support for development assistance at a time of domestic economic hardship.

Can rhetoric match reality?

This event tackles questions including:

  • What does the UK’s vision for international development mean in practice?
  • Will aid and development help push Britain’s influence around the world?
  • Can policymakers and politicians garner domestic support for international aid in times of economic uncertainty, and if so, how?
  • Can the UK rebuild its reputation in the world while it doesn’t meet its 0.7 per cent GNI target?

This event will be balloted for in-person attendance. Register your interest to join and a confirmation email will be sent to you on Tuesday 25 May at 12:00 BST to confirm your place at the event.

As with all member events, questions from the audience drive the conversation.

A coffee reception will immediately follow this event.




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Former chair of BMA GP Committee wins right to tribunal for unfair dismissal

An employment judge has cleared the way for Farah Jameel, a former chair of the BMA’s General Practitioners Committee for England (GPCE), to go ahead with claims of discrimination and unfair dismissal against the association over her removal from the post during maternity leave.Jameel, who was elected the first female chair in November 2021, was put on temporary suspension in 2022 after complaints by BMA staff. The BMA told her in August 2023 that her contract was being terminated.The contract described her as a contractor providing consultancy services rather than an employee. But in a preliminary ruling the employment judge Natasha Joffe has held that Jameel was in reality an office holder and an employee, opening the way for her claims to proceed to a full hearing by an employment tribunal.The GPCE passed a vote of no confidence in Jameel in July 2023, as a means of electing a new...




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Rammya Mathew: GPs have to be able to request MRI scans for patients in primary care

At a recent clinical meeting, I heard that GPs local to me are about to lose the ability to request magnetic resonance imaging (MRI) scans for patients presenting with musculoskeletal symptoms. We’re instead advised to refer our patients to a musculoskeletal clinical assessment and triage service (CATS)—staffed largely by musculoskeletal advanced practitioners, who will assess our patients and determine whether imaging is warranted.The hope is that fewer patients will have unnecessary imaging and that this will reduce the potential harms of overdiagnosis. Radiologists rarely report musculoskeletal MRI scans as entirely normal, and it can be hard to know what to do with abnormal findings on an MRI. More often than not, patients with abnormal scans are referred to orthopaedic teams, even though there may not necessarily be a surgical target.At a population level, this is problematic on two fronts. Firstly, MRI scans are expensive and need to be used judiciously....




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Director’s breakfast briefing: Shifts in European foreign policy since 9/11

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.




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The law as a tool for EU integration could be ending

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.




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How do Eurasian kleptocracies earn and use their money?

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.




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Limited expectations as Scholz heads to Kyiv and Moscow

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.




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War on Ukraine: Exploring the humanitarian response to the conflict

War on Ukraine: Exploring the humanitarian response to the conflict 12 April 2022 — 12:00PM TO 1:00PM Anonymous (not verified) 6 April 2022 Online

This event explores the implications of the humanitarian realities from Russia’s invasion of Ukraine, the largest ground campaign in Europe since World War Two.

Reports from humanitarian organizations working in Ukraine are dire and reveal that a humanitarian disaster on an epic scale is unfolding.

The United Nations (UN) and other organizations estimate 12 million of Ukraine’s population are in need of assistance, 4.1 million have been displaced to neighbouring countries, and 6.4 million have become internally displaced.

Gillian Triggs, the assistant secretary-general and assistant high commissioner for protection at the UNHCR, joins other experts to discuss the humanitarian situation in Ukraine.

The panel considers:

  • What are the greatest needs in Ukraine now?
  • How can aid agencies meet those needs?
  • What are the short and long-term implications of the crisis for Ukraine and Europe?
  • How do international organizations work with local NGOs to provide food, medical aid and shelter?

This event is part of a regular series of events offering insight and analysis from experts and policymakers on how the war is affecting Ukraine, the region and the world.

This event is part of Chatham House’s ongoing work on the future of conflict.

Read the transcript




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Reshaping NATO for an uncertain future

Reshaping NATO for an uncertain future The World Today mhiggins.drupal 25 May 2022

A Chatham House expert panel outlines the challenges for delegates at the Madrid summit where the roadmap for the transatlantic alliance will be created

This year had already been earmarked as pivotal for the shape and direction of European security even before Russia, a nuclear superpower, rolled its tanks into Ukraine.

On the agenda at the NATO summit in Madrid in June is the Strategic Concept, which sets out the alliance’s direction and priorities for the next decade. There is much to discuss. From shared values to the state of the security environment, the Strategic Concept will have a direct impact on the global security landscape.

Ten years ago, the world was a very different place. The United States had just withdrawn from its bloody war in Iraq and was still embroiled in Afghanistan fighting the Taliban. In China, Xi Jinping was poised to become the next president, while refugees escaping the vicious civil war in Syria were heading towards Europe. In Africa, Islamist activity in Mali was about to spread throughout the Sahel.

Now, Russia’s illegal war in Ukraine rages on NATO’s doorstep, spurring the once neutral countries of Sweden and Finland to seek membership. How will Russia’s aggression towards Ukraine affect the western security agenda and what will be the shape of the new NATO that emerges from these talks?  To help answer these questions, The World Today convened a panel of Chatham House experts to consider what the next 10 years holds for NATO.

Here is what they said.

Alice Billon-Galland
We shouldn’t expect a revolution, but more an adaptation of reforms that have taken place at NATO for quite a long time, especially since the Wales summit in 2014. NATO allies will have to decide on the Russian threat perception and decide how they want to reinforce their deterrence and defence posture in the East, and how this affects their ability to maintain a 360-degree approach and to carry out the ambitious NATO 2030 agenda.

Patricia Lewis
We need to understand how deterrence works far better and we should have better metrics by now. Russia and NATO do not wish to engage in conventional warfare with each other, which suggests that Nato’s conventional deterrence is working. That said, Putin’s nuclear threats have not been within the framework of deterrence. But nuclear deterrence has not worked in the way strategists imagined since the end of the Cold War, and we need a much clearer hard look at these weapons once this is all over.

Had we followed through on disarmament in the 1990s, Putin would have held very little sway today. Nuclear weapons and despots are not a good mix and with these weapons there are no small mistakes. We would be foolish to imagine that rationality will hold when it comes to nuclear decision-making.

It is time to put arms control back on the agenda and strengthen our efforts to prevent nuclear proliferation. We need to put the elimination of these weapons back on the UN Security Council agenda.

Andrew Dorman
Finland and Sweden coming into NATO completely transforms the Baltic. It makes the deployment of reinforcements to the Baltic states an awful lot easier. From the Kremlin’s point of view, the last thing they want is another border with NATO. Russia is already overly committed and hasn’t got enough forces to deal with Ukraine. Its border with Finland is enormous. And NATO would be gaining two very robust, well-organized military forces. You are seeing a lot more NATO assets starting to look at the high north.

Hans Kundnani
I am actually slightly less worried about the Russian threat to NATO countries than I was before February 24. The war has demonstrated how weak the Russian military is, and so the idea that it might present a threat to Finland and Sweden seems less plausible than before. It is not even clear to me that Russia could do very much in other south-eastern European countries. It already seems pretty overstretched. This should make us more relaxed, rather than more worried, about threats to other countries and in particular to NATO countries or to Finland and Sweden.

Leslie Vinjamuri
Sweden and Finland moving forward with their requests for membership is a sign of success for the West, but it also raises important questions for the future of European security. The possibility that we lock in a division that might suit Europe and the United States now does not bode well for a Russia maybe 10 years out or with a different leader.

Alice Billon-Galland
We need to avoid mission creep, but we also need to avoid going back to a position where NATO only focuses on Russia and then set an agenda for 10 years based on that threat assessment alone. We will risk missing out on the next big challenge if we go back on something too specific. We risk being reactive, whereas the Strategic Concept is an exercise that should be proactive and provide a space for transatlantic partners to share broader common security concerns.

Patricia Lewis
NATO is open to all countries in the transatlantic area, and it is even possible that Russia could join in the future should they wish to apply. But it is important to remember that NATO is a political-military alliance, and its politics are fundamental to its cohesion, far more than that of any weapon system or a specific enemy. It will continue to address a wider range of threats as it has in, for example, Afghanistan and many of those will be directly related to the impacts of climate change.

One thing to note, in light of Russia’s nuclear threats, is that NATO’s characterization of itself as a ‘nuclear alliance’ should be revised. NATO needs to be resilient to ebbs and flows of weapon systems and not become over-reliant on one system which has recently demonstrated severe negative impacts.

Hans Kundnani
During the Cold War, what held the alliance together was a shared perception of a threat from the Soviet Union – not a set of shared values. After all, there were authoritarian states in NATO. After the end of the Cold War that overwhelming sense of a shared threat from the Soviet Union disappeared and NATO tried to reinvent itself as a community alliance of democracies with shared values.

But we now once again have authoritarian states in NATO. So it was really in danger of being pulled apart. The war in Ukraine has refocused NATO on its original, historic mission: collective security in relation to Russia. In that sense it has given NATO a lifeline.

Creon Butler
Shared values are still an awful lot stronger as an element of what ties NATO together now than they were in the past. I think you now have the threat perception coming back full force. But I still think you have that very strong element of values, indeed the extra countries that are coming in are very strong democratic countries.

The interesting question is the out-of-area stuff – the Afghanistan-related stuff and counterterrorism more generally, and how important those threats remain. I guess there is an element to that which is a global kind of threat, counterterrorism, but there is also the out-of-area activity which obviously has been transformed following the withdrawal from Afghanistan.

Alice Billon-Galland
The crisis management mandate needs to be looked at again with some of the lessons learnt after Afghanistan and Libya, especially given what happened in Kabul, and all the discussion around cooperative security. The question is not only how do we work with partners and countries in the region, but how do we want to engage with China, for instance? How do we want to work on new technologies? How do we want to work with the European Union, with the United Nations?

The alliance must decide what it wants to do versus  what it wants to set aside and have other organizations do, while it refocuses on its core historic tasks.

Andrew Dorman
One of the sensitive, ongoing debates within NATO is whether it has a global role or whether it has a more transatlantic role. There are divisions within NATO about which is its focus. I think the answer, to a degree, is both. One of the real challenges for policymakers, particularly the Biden administration, is that they are going to be pushing for NATO to act as a global player.

This is one of the dilemmas that NATO faces. It could spend all its time focused purely on the short term – that is Russia –  and ignore China, and then suddenly need to think, ‘Oh heck’. What happens if , as a result of this, Russia is essentially dropped into the China camp and Putin becomes Xi Jinping’s poodle? That is a real dilemma, and why I think the US is going to focus on a global NATO.

Leslie Vinjamuri
NATO may have a role to play in Washington’s China strategy. But it won’t be the most important institution. The Biden administration is relying on multiple frameworks for engaging in the Indo-Pacific. For example, the Quad – a partnership between the US, Japan, India and Australia – is designed to secure India’s participation. Pulling India into the region where it has economic power, influence, military and security capabilities and can move the needle. It is both an intelligent and pragmatic strategy to have a number of groupings, a patchwork of overlapping partnerships, including existing alliances. That seems right to me.

Patricia Lewis
It is unlikely that the US would want to create a global NATO. The US and its allies in other regions may wish to model future alliances on NATO, that have strong relationships with it in areas such as political coherence, interoperability, and joint training and exercises and such. But political decision-making would be better suited to sit within specific regional contexts.

Washington has formal alliances in the Indo-Pacific region that commit the US to, for example, the defence of Australia through the Anzus security treaty, as well as Japan. As Washington increases its focus on the Pacific, the existing political-military relationships in the region could become more coherent. We might see a version of a Pacific-Asia Treaty Organization emerge – a Pato. All this depends on how China uses its power and how perspectives in the region evolve.

Creon Butler
I am not sure it is a problem that NATO does not have a specific focus on dealing with the China threat. It potentially has a role in dealing with those things that are seen by the membership as common threats. Which clearly is Russia now but has added terrorism in the past and may well include other things. China is not a common threat in the way that Russia is perceived to be. Of course, something could happen, not least something with Taiwan, which would change that, but that is not where NATO is at present.

Alice Billon-Galland
I think we should really avoid a false dichotomy between ‘NATO should do only Russia’ and ‘NATO should do everything’ because there are lots of activities in the middle where the alliance can bring some added value – and that is exactly what we should be discussing. The issue around China and NATO is being completely overblown. We need to be very clear that the purpose of NATO is to defend the Euro-Atlantic space, but that may include keeping an eye on ‘when China comes to us’, as NATO Secretary-General Jens Stoltenberg often says.

Hans Kundnani
None of the regional partners in Asia that you need to deal with the China challenge are in NATO – and can’t be – so it is just the wrong vehicle to deal with the Indo-Pacific. But there is also a bit of a tension here between Indo-Pacific and Euro-Atlantic. People in Asia also look at the different threat perceptions in completely different ways than we do in Europe. There are a number of reasons why people in India do not support the war in the Ukraine, but one of them is that they see China, not Russia, as the real threat.

Andrew Dorman
I think so much of the debate we have had so far is about political NATO as supposed to military NATO. One of its key roles is how military forces operate, engage and conduct operations, plan operations through deterrents and so forth. NATO as the template of the West does work. That is why it is in the interest of the US to keep this going. It is one of the ways of making sure, for example, the US Pacific fleet remains compatible with the US Atlantic fleet by forcing them to operate the same system, which is the NATO system.

It is one of the things the American forces learnt out of Afghanistan and Iraq. There is a NATO way which is a global footprint. NATO’s role within the African Union is as a template for peacekeeping operations. You have got the likes of Australia and South Korea and Japan very much integrated into NATO. It doesn’t have to be a formal political NATO, but it does strike me to be in the interest of the West to have them reach forces capable of operating with one another.

Patricia Lewis
One of the most interesting developments in the past year has been the creation of Aukus, the security pact between Australia, Britain and the United States. That grew out of the Five Eyes intelligence partnership which led to the need to develop new, interoperable equipment such as nuclear-powered submarines. We will have to see how it develops, but maybe it could be the start of a PATO in the region.  

Creon Butler
In the current situation, we have a crucial partnership between NATO and the EU over Russia, in terms of the long-term future they hold out for Ukraine, but also with the G7 because that is the place to organize the financial support for Ukraine and the economic and financial sanctions against Russia. They are different memberships but the combination of the EU, G7 and NATO is an absolutely crucial alliance of different alliances, with different memberships serving different purposes but having an overall impact that can potentially be very effective.

Leslie Vinjamuri
We work with the institutions that we have, but not always with a clear recognition of their limitations. We are facing a dark moment for the UN Security Council, with one of its founder members blatantly violating the UN’s most important norm. Yet many people in the rest of the world say, ‘Yes, but in 2003, the United States violated Iraq’s sovereignty …’ Where the West sees moral clarity, and so condemns Russia’s invasion of Ukraine, there is an assumption by much of the rest of the world of moral equivalence between these two invasions.

Working through the UN Security Council is going to be difficult for some time. This means that states are probably going to find different strategies for working around, rather than through, the Security Council.




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How Oslo adds a touch of style to the UN

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.’ 
 




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NATO must now transform old missions into new strategy

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.




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Issues to watch in 2023

Issues to watch in 2023 The World Today mhiggins.drupal 29 November 2022

From nuclear proliferation to African debt, here are the issues six of our expert contributors expect to make the news in the year ahead.

Europe’s energy outlook

Mike Bradshaw, Professor of Global Energy, Warwick Business School

There is cautious optimism that Europe will endure this winter without an energy crisis. Gas prices have fallen, storage is 95 per cent full, and the autumn was mild. High summer gas prices cut industrial demand but domestic heating demand will be critical over the winter. Already, France’s problematic nuclear fleet and lower hydroelectric output mean Europe is using more gas to generate power. 

The problem is next winter when ensuring adequate gas storage will be much harder

Russian pipeline gas supply to southern Europe has fallen by 55 per cent. While Asian demand has fallen, Europe has still paid record prices to secure additional liquefied natural gas (LNG), largely from America but also Russia. European demand for LNG this winter will push prices up, and these will rise even higher if China relaxes its Zero-Covid policy and demand recovers. However, with luck, Europe will avoid power cuts in early 2023. The problem is next winter. With less Russian pipeline gas and a tight LNG market, 90 per cent winter gas storage levels will be much harder to achieve. 

NATO’s resurgence

Alice Billon-Galland, Research Fellow, Europe Programme, Chatham House and one of 14 NATO Young Leaders

In response to Russia’s invasion of Ukraine, NATO adopted a new strategic concept. Member states will reinforce NATO battlegroups and bolster higher readiness forces from 40,000 troops to more than 300,000, while striving to avoid escalation with Russia. Turkey’s attempts to block Sweden and Finland’s NATO membership will preoccupy Jens Stoltenberg, the Secretary-General, until he leaves his post next autumn.

Infrastructure vulnerabilities such as the sabotaged Nord Stream pipeline will be a NATO focus

Expect arguments on defence spending in the run-up to the July summit in Vilnius. Although only nine of its 30 members are expected to meet the 2 per cent spending target, the debate is moving towards 3 per cent, in part to reduce dependency on American assets and hedge against the uncertainty of the 2024 US presidential election. Infrastructure vulnerabilities, such as the Nord Stream pipeline sabotage in the Baltic, will also be a focus. Otherwise, NATO ’s eyes will be on China: from its relations with Russia to the threat of cyberattacks.

Universal health reforms

Robert Yates, Executive Director, Centre for Universal Health, Chatham House

In response to the perma-crisis experienced by many populations this past year, some leaders are launching or extending universal health reforms. New left-wing leaders in Chile, Colombia and Brazil have promised to rebuild their publicly financed universal health systems. In Brazil, newly elected president Lula da Silva has pledged to increase public health spending and improve access to medicines. It is hoped Malaysia’s new coalition will carry forward its predecessor’s pledge to raise health spending to 5 per cent of GDP by 2027 to provide a universal package of free health services.

Might a US presidential candidate propose a publicly financed health system? 

In September, world leaders will discuss universal health coverage at the UN General Assembly. There, Chatham House will publish its Commission for Universal Health report, identifying countries in which crises may trigger new national health programmes. Might this be when a US presidential candidate announces a platform to create a publicly financed health system?

Weapons of mass destruction

Patricia Lewis, Director of the International Security Programme, Chatham House

Since its illegal invasion of Ukraine, Russia has attacked civil nuclear power stations, falsely accused Ukraine of possessing bioweapons and radiological bombs, and threatened to use nuclear weapons. In contrast, NATO has instead demonstrated that deterrence can be highly effective with conventional weaponry. In the coming year, the Kremlin’s nuclear brinkmanship will still be a focus. Washington will try to restart bilateral nuclear negotiations with Moscow and similarly try to engage Beijing.

North Korea’s nuclear weapons programme is a growing threat

Following the failure of the nuclear Non-Proliferation Treaty Review Conference to reach consensus in August, the next review cycle will start by looking at strengthening the process. Iran’s nuclear capabilities remain a concern, and North Korea’s nuclear weapons programme is a growing threat. So, we are left with a question: will 2023 be the year of  nuclear conflict or the year when states get busy again on non-proliferation and disarmament?  

Africa’s mounting debt

Joseph Asunka, Chief Executive Officer, Afrobarometer

Inflation is at historic highs in several African economies. Meanwhile, many African countries including Nigeria, Zimbabwe and Democratic Republic of Congo will hold  elections in 2023, driving up public spending, increasing inflationary pressures and exacerbating poverty. According to Afrobarometer data, the proportion of Africans experiencing high levels of poverty has increased from 19 per cent in 2014/2015 to  26 per cent in 2021/2022.

Zimbabwe is in debt distress and Nigeria is at risk, which makes their elections in 2023 critical

Worse still, many of those countries holding elections are either, like Zimbabwe, in debt distress – that is unable to honour their obligations to creditors – or at high risk of debt distress, like Nigeria. This makes the elections in Zimbabwe and Nigeria critical. The expiration of the World Bank/IMF-backed debt service suspension initiative in 2021 has only amplified this risk. What are viable policy options to tackle this dire economic predicament? A debt service moratorium, debt cancellation and serious attention to fiscal discipline.

Feminist foreign policy

Daniela Philipson García, Co-founder of Internacional Feminista, and a PhD candidate, Monash University

Feminist Foreign Policy (FFP) is under threat. The war in Ukraine led to strengthened military budgets and alliances at odds with FFP’s human security and peace-centred approaches. Sweden’s new right-wing government reversed its FFP. In Mexico, the first Global South country to adopt an FFP, Congress has voted to expand the military’s role to curb cartel-related violence, in contradiction of its FFP. The second anniversary of the US withdrawal from Afghanistan will be a moment to assess how foreign policy, diplomacy and women’s and girls’ rights have been affected globally. 

Colombia has announced a feminist foreign policy along with a National Action Plan on Women, Peace and Security

There is hope. Germany, whose coalition government adopted an FFP in 2021, is to publish more guidelines in the spring. The governments of Colombia and Chile have announced their own FFPs. Colombia’s first National Action Plan on Women, Peace and Security, to be announced at the UN General Assembly in September, is expected to set a standard for a region submerged in violence. 




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Russian imperial mindset must change for real victory

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.




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Independent Thinking: Sweden, Finland, and NATO

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.




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[68Ga]Ga-PSMA-11 PET/CT-Positive Hepatic Inflammatory Pseudotumor: Possible PSMA-Avid Pitfall in Nuclear Imaging




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C-X-C Motif Chemokine Receptor 4-Directed Scintigraphy Using [99mTc]Tc-Pentixatec in Primary Aldosteronism: A Proof-of-Concept Study

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.




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Design, Synthesis, and Preclinical Evaluation of a High-Affinity 18F-Labeled Radioligand for Myocardial Growth Hormone Secretagogue Receptor Before and After Myocardial Infarction

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.




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[68Ga]Ga-RAYZ-8009: A Glypican-3-Targeted Diagnostic Radiopharmaceutical for Hepatocellular Carcinoma Molecular Imaging--A First-in-Human Case Series

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.




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Dual Somatostatin Receptor/18F-FDG PET/CT Imaging in Patients with Well-Differentiated, Grade 2 and 3 Gastroenteropancreatic Neuroendocrine Tumors

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.




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Composite Prediction Score to Interpret Bone Focal Uptake in Hormone-Sensitive Prostate Cancer Patients Imaged with [18F]PSMA-1007 PET/CT

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.




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Clinical Factors That Influence Repeat 68Ga-PSMA-11 PET/CT Scan Positivity in Patients with Recurrent Prostate Cancer Under Observation After a Negative 68Ga-PSMA-11 PET/CT Scan: A Single-Center Retrospective Study

This analysis aimed to identify clinical factors associated with positivity on repeat 68Ga-PSMA-11 PET/CT after a negative scan in patients with recurrent prostate cancer (PCa) under observation. Methods: This single-center, retrospective analysis included patients who underwent at least 2 68Ga-PSMA-11 PET/CT scans (PET1 and PET2) at UCLA between October 2016 and June 2021 for recurrent PCa with negative PET1 and no PCa-related treatments between the 2 scans. Using Prostate Cancer Molecular Imaging Standardized Evaluation criteria to define negative and positive scans, the final cohort was divided into PET2-negative (PET2-Neg) and PET2-positive (PET2-Pos). The same PET1 was used twice in the more than 2 PET cases with inclusion criteria fulfilled. Patient characteristics and clinical parameters were compared between the 2 cohorts using Mann–Whitney U test and Fisher exact test. Areas under the curve (AUCs) of the receiver operating characteristic and the Youden index were computed to determine the discrimination ability of statistically significant factors and specific cut points that maximized sensitivity and specificity, respectively. Results: The final analysis included 83 sets of 2 PET/CT scans from 70 patients. Thirty-nine of 83 (47%) sets were PET2-Neg, and 44 of 83 (53%) sets were PET2-Pos. Prostate-specific antigen (PSA) increased from PET1 to PET2 for all 83 (100%) sets of scans. Median PSA at PET1 was 0.4 ng/mL (interquartile range, 0.2–1.0) and at PET2 was 1.6 ng/mL (interquartile range, 0.9–3.8). We found higher serum PSA at PET2 (median, 1.8 vs. 1.1 ng/mL; P = 0.015), absolute PSA difference (median, 1.4 vs. 0.7 ng/mL; P = 0.006), percentage of PSA change (median, +270.4% vs. +150.0%: P = 0.031), and median PSA velocity (0.044 vs. 0.017 ng/mL/wk, P = 0.002) and shorter PSA doubling time (DT; median, 5.1 vs. 8.3 mo; P = 0.006) in the PET2-Pos cohort than in the PET2-Neg cohort. Receiver operating characteristic curves showed cutoffs for PSA at PET2 of 4.80 ng/mL (sensitivity, 34%; specificity, 92%; AUC, 0.66), absolute PSA difference of 0.95 ng/mL (sensitivity, 62%; specificity, 71%; AUC, 0.68), percentage of PSA change of a positive 289.50% (sensitivity, 48%; specificity, 82%; AUC, 0.64), PSA velocity of 0.033 ng/mL/wk (sensitivity, 57%; specificity, 80%; AUC, 0.70), and PSA DT of 7.91 mo (sensitivity, 71%; specificity, 62%; AUC, 0.67). Conclusion: Patients with recurrent PCa under observation after a negative 68Ga-PSMA-11 PET/CT scan with markedly elevated serum PSA levels and shorter PSA DT are more likely to have positive findings on repeat 68Ga-PSMA-11 PET/CT.




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Predicting Pathologic Complete Response in Locally Advanced Rectal Cancer with [68Ga]Ga-FAPI-04 PET, [18F]FDG PET, and Contrast-Enhanced MRI: Lesion-to-Lesion Comparison with Pathology

Neoadjuvant therapy in patients with locally advanced rectal cancer (LARC) has achieved good pathologic complete response (pCR) rates, potentially eliminating the need for surgical intervention. This study investigated preoperative methods for predicting pCR after neoadjuvant short-course radiotherapy (SCRT) combined with immunochemotherapy. Methods: Treatment-naïve patients with histologically confirmed LARC were enrolled from February 2023 to July 2023. Before surgery, the patients received neoadjuvant SCRT followed by 2 cycles of capecitabine and oxaliplatin plus camrelizumab. 68Ga-labeled fibroblast activation protein inhibitor ([68Ga]Ga-FAPI-04) PET/MRI, [18F]FDG PET/CT, and contrast-enhanced MRI were performed before treatment initiation and before surgery in each patient. PET and MRI features and the size and number of lesions were also collected from each scan. Each parameter’s sensitivity, specificity, and diagnostic cutoff were derived via receiver-operating-characteristic curve analysis. Results: Twenty eligible patients (13 men, 7 women; mean age, 60.2 y) were enrolled and completed the entire trial, and all patients had proficient mismatch repair or microsatellite-stable LARC. A postoperative pCR was achieved in 9 patients (45.0%). In the visual evaluation, both [68Ga]Ga-FAPI-04 PET/MRI and [18F]FDG PET/CT were limited to forecasting pCR. Contrast-enhanced MRI had a low sensitivity of 55.56% to predict pCR. In the quantitative evaluation, [68Ga]Ga-FAPI-04 change in SULpeak percentage, where SULpeak is SUVpeak standardized by lean body mass, had the largest area under the curve (0.929) with high specificity (sensitivity, 77.78%; specificity, 100.0%; cutoff, 63.92%). Conclusion: [68Ga]Ga-FAPI-04 PET/MRI is a promising imaging modality for predicting pCR after SCRT combined with immunochemotherapy. The SULpeak decrease exceeding 63.92% may provide valuable guidance in selecting patients who can forgo surgery after neoadjuvant therapy.




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EU-Turkey Customs Union: Lessons for Brexit

EU-Turkey Customs Union: Lessons for Brexit 15 March 2018 — 11:00AM TO 12:00PM Anonymous (not verified) 5 March 2018 Chatham House, London

Turkey and the EU are preparing to open negotiations to modernize their 22 year old customs union and expand its scope beyond goods to include services, public procurement and a more liberal regime for agriculture. At the same time, the UK is debating whether to seek a customs union with the EU to facilitate a frictionless flow of goods and to prevent a hard border with Ireland. The speaker will discuss Turkey’s customs union modernization agenda and share his insights on the lessons for the UK’s future relationship with the EU.

Attendance at this event is by invitation only.




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How to Explain Turkey's Early Elections

How to Explain Turkey's Early Elections 14 June 2018 — 12:30PM TO 1:30PM Anonymous (not verified) 29 May 2018 Chatham House | 10 St James's Square | London | SW1Y 4LE

On 24 June 2018 Turkey will go to the polls to vote in early presidential and parliamentary elections. Following a constitutional referendum last spring and against the backdrop of Turkey’s continued intervention in Syria and rising economic problems, President Erdogan has argued that an early election would help reduce uncertainty and set the country on a course to greater prosperity. The elections, likely to be held under the state of emergency in place since the attempted coup in July 2016, will also mark the country’s transformation from a parliamentary democracy to one with a powerful executive presidency.

In this session, the speaker will discuss what other factors led President Erdogan to call for an early election, what the state of the opposition is and what we can expect from Turkey should Erdogan win another term.

Attendance at this event is by invitation only.




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Turkey Is on the Road to a Severe Economic Crisis

Turkey Is on the Road to a Severe Economic Crisis Expert comment sysadmin 12 July 2018

The deteriorating state of the economy is President Erdoğan’s Achilles’ heel and the biggest threat to his currently unrivalled leadership.

A special one lira coin minted for the presidential inauguration of Recep Tayyip Erdogan. Photo: Getty Images.

Fifteen days after Turkey’s parliamentary and presidential elections, Turkish President Recep Tayyip Erdoğan appointed a new government under radically enhanced executive powers granted by the constitution. He chose 16 loyalists and partisan figures to ensure that he remains front and centre in decision-making and policy formation.

Most notably, Erdoğan sacrificed the former deputy prime minister and ex-Merrill Lynch chief economist Mehmet Şimşek in favour of his inexperienced son-in-law Berat Albayrak as finance and treasury minister to manage the fragile economy. Whether he has the competence to placate jittery financial markets and foreign investors is debatable.

Erdoğan will prioritize short-term growth at all costs to the detriment of macroeconomic and financial stability. That entails foregoing interest rate hikes needed to contain runaway double-digit inflation and to support a plummeting lira that depreciated nearly 20 per cent this year. It also means loosening the purse strings, flooding the markets with cheap credit and sponsoring rampant construction and mega-infrastructure projects.

True to his promise, he has appropriated to himself, by presidential decree, the right to hire the central bank governor, deputies and monetary policy committee members for a four-year term. This completes the politicization of the once-respected and independent central bank and is in line with his unorthodox monetary views that higher interest rates equates with higher inflation.

Erdoğan associates progress with gleaming high-rise buildings, gargantuan infrastructure show-pieces and elevated growth rates. He is spiking the fuel to boost the speed of the sputtering mid-sized Audi-style Turkish economy to achieve superior Ferrari growth rates. As any mechanic knows, these tactics are unsustainable in the long term. Eventually, the engine will burn out.

He does not seem to appreciate that Turkey’s growth model requires an overhaul to join the league of rich economies. It is too reliant on consumer spending and government-sponsored infrastructure and construction projects funded by speculative financial flows rather than on sustained private investment and exports.

Net result: the corporate sector’s foreign-exchange liabilities have climbed to a record $328 billion as of the end of 2017. When netted against foreign-exchange assets, it is still a worrying $214 billion. Its US dollar and euro debt pile has more than doubled since 2008, 80 per cent of which is held by domestic banks. Given these acute balance-of-payments conditions, it is not farfetched that Turkey may impose capital controls in the short-to-medium term to restrict the outflow of foreign assets. At $50 billion, the current account deficit – defined as the sum of the trade balance and financial flows – is not even covered by the central bank’s net international reserves at nearly $45 billion.

Unsurprisingly, some major Turkish companies are negotiating with their bondholders to restructure their sizeable foreign loan obligations as lira devaluation increases the financial burden. Should a significant number of Turkish corporates default on their foreign obligations, this would reverberate across the Turkish economy, cause mass consumer panic, shake the confidence of international financial markets and potentially lead to a crisis within the Turkish financial system and to a deep and prolonged economic recession.

Revealingly, Erdoğan’s nationalist allies, the Nationalist Movement Party (MHP), refused to join his government. Perhaps Devlet Bahçeli, the MHP leader, learned the lessons of the 2001 financial crisis as a member of a three-party government. So he is opting to project influence from the outside, rather than risk being tainted with responsibility for an economic downturn.

Turkey’s president is doubling down on his singular approach to governance irrespective of the fallout. Notwithstanding his current political dominance, the deteriorating state of the economy is his Achilles’ heel and the biggest threat to his currently unrivalled leadership.




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Taking Stock of Turkey's Trade Policy

Taking Stock of Turkey's Trade Policy 11 September 2018 — 5:00PM TO 6:15PM Anonymous (not verified) 23 August 2018 Chatham House | 10 St James's Square | London | SW1Y 4LE

As the only large economy outside of the EU with a customs union agreement, Turkey has a unique trade policy. Amid domestic economic challenges, Turkey’s trade minister, Ruhsar Pekcan, will discuss prospects for upgrading the EU-Turkey customs union. She will also discuss relations between the UK and Turkey and outline strategies for post-Brexit trade.

Attendance at this event is by invitation only.




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EU-Turkey Customs Union: Prospects for Modernization and Lessons for Brexit

EU-Turkey Customs Union: Prospects for Modernization and Lessons for Brexit 12 December 2018 — 12:30PM TO 1:30PM Anonymous (not verified) 26 November 2018 Chatham House | 10 St James's Square | London | SW1Y 4LE

Turkey and the EU have been in a customs union since 1995. Both sides recognize that the current agreement is in need of modernization and have agreed to open negotiations to expand its scope to include services, public procurement, agriculture and other elements that would help bring it into the 21st century.

At the same time, the UK Parliament is debating whether to approve the agreement on the UK’s withdrawal from the EU. It includes a backstop which – if triggered – would keep the UK and the EU in a single customs territory which would limit the disruption of withdrawal but hamper Britain’s ability to pursue an independent trade policy. The political declaration proposes building on this customs arrangement as the basis for the future relationship.

In this context, the speaker will discuss the current EU-Turkey customs union arrangement and its shortcomings, examine the prospects for its modernization and share his insights on the lessons for the UK’s future trading relationship with the EU.

The event will launch the briefing paper ‘EU-Turkey Customs Union: Prospects for Modernization and Lessons for Brexit’.

Attendance at this event is by invitation only.