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What is Labour’s foreign policy?

What is Labour’s foreign policy? 24 January 2023 — 12:00PM TO 1:00PM Anonymous (not verified) 3 January 2023 Chatham House and Online

In conversation with David Lammy, the UK shadow foreign secretary.

David Lammy MP, shadow secretary of state for foreign, commonwealth and development affairs, outlines Labour’s plan for UK foreign policy if elected to government.

He addresses the UK’s strengths and opportunities in a world that has become more divided, more dangerous, and more unpredictable. He also offers a critique of the current UK government’s approach to foreign policy, particularly at strained relationships with allies and Britain’s economic woes.

The shadow foreign secretary explores the following key questions:

  • What would a future Labour government do to modernize Britain’s diplomacy and rebuild alliances to improve Britain’s global influence?

  • In a new age of warfare in Europe, how would Labour pursue security cooperation with allies?

  • How would Labour address high energy costs, energy security, and the climate crisis?

  • As Britain’s economy falters, how can foreign policy drive prosperity at home?

  • What is Labour’s plan for international development, following the UK government’s abandonment of the 0.7% commitment?

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

Read a transcript




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Members event

Members event 1 February 2023 — 7:00PM TO 7:30PM Anonymous (not verified) 1 February 2023 Chatham House




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Members event (open ticket)

Members event (open ticket) 1 February 2023 — 9:00PM TO 10:00PM Anonymous (not verified) 1 February 2023 Chatham House and Online




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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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The era of ‘reglobalization’

The era of ‘reglobalization’ 15 June 2023 — 6:00PM TO 7:00PM Anonymous (not verified) 14 February 2023 Chatham House and Online

How to balance international trade with efforts to enhance domestic economic resilience?

The global trade outlook remains challenging in 2023. Geopolitical tensions and national security concerns are playing a greater role in trade policy with a focus on strengthening supply chain resilience and reducing economic dependencies. In addition, the turn towards industrial policies has raised concerns about unfair trade practices and protectionism.

The debate about the future of globalization has only therefore deepened. While ‘deglobalization’ dominates the current public discourse on trade, is ‘reglobalization’ a better term to describe patterns of economic integration and fracturing across different economies and sectors?

The panel of experts discuss:

  • To what extent are efforts to meet climate goals and maintain technological leadership intertwined with industrial policy and national security objectives?

  • What do recent measures by the US – including the Inflation Reduction Act and a push on semiconductors – mean for cooperation with like-minded partners such as the EU?

  • Are any countries resisting the protectionist trend and continuing to champion open trade?

  • What steps can be taken to strengthen strategic and sensitive supply chains, for example, for critical minerals, high-capacity batteries and semiconductors?

  • Is it possible to develop and advance a positive trade agenda for a reglobalized world? If so, what would it look like?

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




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Is China's economy on the rebound?

Is China's economy on the rebound? 5 April 2023 — 6:00PM TO 7:00PM Anonymous (not verified) 28 February 2023 Chatham House and Online

Exploring the domestic and international signals from the first annual session of the 14th National People’s Congress.

2022 proved to be a difficult year for China. War, COVID-19 and economic turbulence presented a cocktail of significant challenges for the ruling CCP in China. Having dispensed of the infamous zero-COVID-19 policy, China is apparently back open for business.

On the international front, continued tensions with the West, war in Europe and climate change are just some of the obstacles standing in the way of Chinese economic recovery. 

Domestically, China must find ways to reinvigorate demand and move on from a low of 3 per cent GDP growth in 2022. With a frustrated population, people are also keen to be freed from the shackles of a stream of lockdowns and quarantining.

The in-tray for the 14th National People’s Congress, as it begins its first session, is substantial. The implications, at home and abroad, from its recent summit in Beijing reverberate around the world.

The experts on the panel discuss:

  • What has been the true extent of COVID-related damage to China’s economy and wider society?
  • What economic scars are visible post-recovery?
  • Will there be longer-term implications for China’s economic and diplomatic footprint globally post-COVID? 

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




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In conversation with Ehud Barak

In conversation with Ehud Barak 27 March 2023 — 12:00PM TO 1:00PM Anonymous (not verified) 21 March 2023 Chatham House and Online

The former prime minister of Israel discusses his country’s political outlook and foreign policy priorities.

On the eve of its 75th independence anniversary, Israel is at a critical crossroads. Weeks of long, intense protests surrounding judicial reforms pursued by the current government have widened the debate over the role played by the, so far independent, judiciary, notably the Supreme Court.

Supporters on both sides of the argument are fighting over different visions of Israel – a true liberal-democracy, or a much-reduced version of a democratic system. Whichever side of the argument people fall, the debate symbolizes tension in Israel’s society and decline in trust of its political and constitutional institutions.

Abroad, the situation remains intricate. Israel-Iran relations remain on a knife edge while the Abraham Accords normalized relations with parts of the Gulf. Then there are the continual issues surrounding relations with the Palestinians and their right to self-determination and statehood.

Old international challenges are now rubbing up against the new. Israel is part of a changing power dynamic in the Middle East, the result of a much-reduced US footprint. Furthermore, it must now contend with the other global superpower in China and continue to work on its response to the war in Ukraine.

Amid its domestic struggle to maintain its democratic character, fast-moving regional and international developments are in need of addressing. Friends and allies are deeply concerned with the country’s constitutional crisis, potentially re-evaluating their relations with the Jewish state.

Former prime minister of Israel Ehud Barak lays out his views on the complexities of domestic and international challenges facing Israel today.

Questions covered include:

  • What are the main root causes of the current constitutional crisis, and how could it be best resolved?
  • Could the current situation lead to a breakdown of the political system, even widespread violence?
  • How could the current circumstances in Israel and Palestine affect relations between the two and any prospect for peace negotiations?
  • How will US-Israel relations stand up against China’s influence in the region?
  • What is Israel’s interpretation of the war in Ukraine and how is the country affected?

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




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Chatham House exhibition - In conversation with the future

Chatham House exhibition - In conversation with the future 19 April 2023 — 6:00PM TO 8:00PM Anonymous (not verified) 31 March 2023 Chatham House

Hear from the innovative leaders and companies driving change towards a more sustainable future.

This event is an opportunity to hear from the innovative leaders and companies driving change towards a more sustainable future.

The evening begins with a panel discussion then, over sustainably sourced drinks and canapés, you are invited to walk through Chatham House and explore the innovative and experimental ideas enabling radical shifts to allow us to prosper without exhausting our planet’s resources.

Our exhibiting partners include Earthshot Prize winner NotPla, Hawkins Brown, Polymateria, and BEEN London. 

Bronwen Maddox, director of Chatham House, opens the evening at 6pm and introduces our panel of experts, chaired by Ana Yang, head of Chatham House’s Sustainability Accelerator. 

Please note that this event is operating a ballot for in-person attendance. Your place will be confirmed by Wednesday 12 April if you are successful.




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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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All women with suspected endometriosis should be offered ultrasound scans, says NICE

The National Institute for Health and Care Excellence (NICE) has recommended that all women with suspected endometriosis be offered an early transvaginal ultrasound scan, even if the pelvic or abdominal examination is normal.In its updated guideline1 on the diagnosis and management of endometriosis, NICE recommends specialist ultrasound as an alternative to magnetic resonance imaging for investigating suspected cases of the condition in secondary care.The updated guideline follows recent reports from both the National Confidential Enquiry into Patient Outcome and Death2 and Endometriosis UK which highlighted problems with delayed diagnoses, partly owing to a lack of awareness among healthcare professionals of the condition and how it presents. Such delays can result in prolonged suffering, ill health, and risks to fertility, the reports warned.Other new and updated recommendations include asking women with suspected endometriosis if any first degree relatives have a history of the condition, and considering neurodiversity when taking into account...




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If I were still an MP I’d be voting against Kim Leadbeater’s bill on assisted dying

I’m often asked if I miss working in the House of Commons. Of course I do; it’s one of the most amazing places in the world and remains the cockpit of our nation.There are obviously days I miss it more than others, usually around the big national moments. Whatever your view of Kim Leadbeater’s private member’s bill—the Terminally Ill Adults (End of Life) Bill—its second reading this month will be one of those big moments.Kim is a friend of mine, and we spoke before she decided to put her bill forward after it topped the private members’ ballot at the start of the new parliament. My advice was to proceed with great care, to remember that this will take over your career in many ways, and to read the report produced earlier this year by the Health and Social Care Committee, which I chaired, on the subject of assisted dying/assisted...




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NHS targets will be missed this winter, trust leaders fear

Concerns are mounting over whether the NHS can meet key performance targets this winter, NHS Providers has said, after a survey of trust leaders highlighted pressure on hospitals, ambulance services, and community and mental health teams.1Over nine in 10 of the leaders who responded (96%) said that they were extremely or moderately concerned about the effect of winter pressures on their trust and local area. The most common reasons for concerns related to financial constraints and staffing provision. The top three greatest risks to the provision of high quality patient care over winter were identified as delayed discharge (57%), social care capacity (49%), and acute care bed capacity (43%).NHS Providers surveyed 171 trust leaders from 118 trusts in September and October, accounting for 56% of the provider sector.Most trust leaders (79%) were worried or very worried about whether their trusts had capacity to meet demand for services over the next...




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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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The World in Brief: European Court of Justice

The World in Brief: European Court of Justice The World Today Anonymous (not verified) 29 July 2021

EU brings members into line over fundamental rights

The European Union has had a challenging start to the summer trying to uphold the rule of law and avoid democratic regression in its member states.

On July 14, the Polish constitutional court ruled that the country did not have to comply with the measures imposed by the European Court of Justice against its controversial judicial reforms, citing that these measures were not in line with the Polish constitution.

The ruling Law and Justice Party, known as PiS, has introduced extensive changes to the judiciary since coming to power six years ago. In 2018, the government appointed new judges and set up a disciplinary chamber for the Supreme Court, which was given a temporary suspension by the European Court of Justice in an interim decision last year.

PiS reasoned that the changes were necessary to eliminate corruption stemming from the communist era, but critics say it merely allows the government to punish judges it regards as disloyal. Under the disciplinary system, Polish judges can have sanctions imposed on them for their judgments in the lower courts or if they refer cases to EU courts for preliminary rulings.

In the day following the Polish top court’s decision, the stand-off worsened when the European Court of Justice ruled that the disciplinary chamber undermines judicial independence and violates EU law. It ordered its immediate suspension and reiterated that the EU has primacy over national law – a vital condition countries agree to when joining the EU.

Didier Reynders, the European justice commissioner, sent a letter to Warsaw with an August 16 deadline for an answer on whether Poland would comply with the ruling. If the EU does not receive a satisfactory answer, it will impose financial sanctions on the state.

The former communist country, which joined the EU in 2004, is one of the bloc’s success stories. Its economy has boomed, and most people hold favourable views about the union – less than a handful of other member states have greater support for EU membership.

The EU has had to step up its efforts as members express anger over the gradual dismantling of fundamental rights under populist governments, not only in Poland. 

A recent survey by the Bertelsmann Stiftung showed that ‘although only 35 per cent of Poles are satisfied with the democracy in their own country, a full 70 per cent express positive views on the state of democracy in the EU’. These figures feed into a larger picture of many Europeans welcoming the EU as a supervisory agent that is capable of intervening when individual states falter.

Recently, however, the EU has had to step up its efforts as members express anger over the gradual dismantling of fundamental rights under populist governments, not only in Poland.

The persistent backsliding in Viktor Orbán’s Hungary has led to concerns in the EU parliament, which is putting pressure on the European Commission to do more to protect the EU’s values and legal order.

In a simultaneous battle in July, the commission launched legal action against Poland and Hungary, challenging anti-LGBTQ laws in those countries. It was triggered by a decision of more than 100 Polish regions to pass resolutions declaring themselves free of ‘LGBTQ ideology’, and a recently adopted law in Hungary banning any depiction of LGBTQ people on television or in books for under-18s.

An annual report on the rule of law in the union, released by the commission in July, singled out the two countries for their non-compliance. The report, the second of its kind, is a new tool to address concerns that the union was not scrutinizing democratic backsliding within its own bloc. Critics were quick to point out, however, that there is no mention of enforcement actions.

At the start of the year the EU vowed to be tougher in upholding democracy with a new regulation that lets it withhold money from member states that breach the rule of law. The EU has already delayed approving spending plans for Hungary and Poland as part of the €800 billion pandemic recovery fund.

As the European Parliament calls for the commission to reduce budget allocations to those that undermine democratic rights, Poland and Hungary could see the new mechanism put to the test this autumn.




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The future of Europe post-Brexit

The future of Europe post-Brexit 28 September 2021 — 5:00PM TO 6:00PM Anonymous (not verified) 17 August 2021 Online

In conversation with Michel Barnier, Chief Brexit Negotiator, European Union (2016-2019).

Drawing on the diary he kept during the 1600 days of complex and acrimonious Brexit negotiations, Michel Barnier explores the political and practical implications for Europe post-Brexit.

Britain’s departure from the European Union has been a long and difficult journey. Many questions remain about what future lies ahead for the UK and EU and the relations between them.

  • To what extent were UK negotiating positions shaped by politics within the ruling Conservative government? How did domestic politics in EU member states shape EU positions? What were key turning points in the negotiations?
  • What are the hopes and expectations for bilateral relations between the UK and EU states?
  • What is the scope for UK – EU cooperation on transatlantic issues and relations with China

This event forms part of Chatham House’s ongoing work on Effective Multilateralism.

Read a transcript.

As with all Chatham House member events, questions from members drive the conversation. Attending this event and watching the full event video is for Chatham House members only. Not a member? Find out more.




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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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Why Europe must end limbo for Afghans seeking asylum

Why Europe must end limbo for Afghans seeking asylum Expert comment Anonymous (not verified) 14 October 2021

With a focus on evacuations from Afghanistan, the situation in Europe is often forgotten as thousands of asylum seekers continue to wait for their cases to be settled.

Following the Taliban’s takeover of Afghanistan, European leaders shared messages to welcome those evacuated, but the reality of European responses to displacement in Afghanistan paints a more contentious picture. 

As of July 2021, 33,325 cases of Afghan asylum applicants were pending in Germany, in France 18,410 people were waiting on a decision, while in Greece the numbers were 13,660. 

Arguably, such numbers are manageable given European states’ size and their functioning asylum systems but, while 56 per cent of Afghans in Europe receive protection status, a large proportion is still in limbo in differing European countries’ asylum systems. 

Europe hosts fewer than ten per cent of the three million UN-registered displaced Afghans globally, as neighbouring countries carry the burden of Afghanistan’s forced displacement: Iran hosts almost one million Afghan refugees and Pakistan 1.5 million, and these numbers double when adding undocumented or Afghan passport holders.
 
But despite these manageable numbers, national authorities in Europe often leave people waiting for months or even years to receive an asylum decision. Deportations to Afghanistan were halted only after the Taliban’s takeover of Kabul and even then there was resistance to this from certain European countries, while Austria suggested setting up ‘deportation centres’ in countries neighbouring Afghanistan. 

Europe remains a fortress

The European Commission’s Draft Action Plan responding to the events in Afghanistan confirmed the willingness of the European Union (EU) to continue returns to non-European ‘third countries’. So Europe remains a fortress, despite pledging support for ‘the safe and orderly departure of foreign nationals and Afghans who wish to leave the country’. 

The wall by Greece at its border with Turkey and Poland’s treatment of Afghan asylum seekers trapped at its border with Belarus illustrate this hardline stance. The president of the European Council Charles Michel and EU Home Affairs Chief Ylva Johansson both confirm the priority is to secure European borders. 

This is further backed up by the European Council’s latest set of Conclusions on Afghanistan which focuses on security and ‘preventing illegal migration’ while avoiding reference to any domestic asylum efforts or the establishment of protection pathways for Afghans. 

Afghans in Europe need answers from European policymakers and, by strengthening domestic asylum responses alongside international humanitarian commitments, Europe’s actions would increasingly match its words. 

This disconnect is not new. At the national level, reports of illegal pushbacks on European land and sea borders alarmingly intensified in 2020 as authorities intercepted and sent migrants back to neighbouring countries without assessing asylum claims. 

At the EU level, development aid to countries such as Afghanistan has long been conditional on their governments’ adherence to the bloc’s migration objectives of preventing asylum seekers from reaching European borders and facilitating the repatriation of those refused asylum in Europe. 

But this latest displacement crisis from Afghanistan exposes clear inconsistencies in European approaches to asylum and humanitarianism. Migration remains a divisive issue in European politics, but European governments must act promptly to support Afghans already residing in their territories alongside establishing robust international commitments.

Time for concrete action

European countries should firstly improve the treatment of those Afghans currently in limbo within their respective asylum systems by expediting pending Afghan asylum applications and family reunification cases, re-examining rejected asylum applications, and facilitating integration.

Secondly, national authorities should not return asylum seekers to Afghanistan or any third countries deemed ‘safe’. For Europe to coordinate evacuations from Afghanistan while simultaneously deporting asylum seekers undermines the international refugee regime and threaten Europe’s global credibility. 




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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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Belarus-EU border crisis reveals wider security threat

Belarus-EU border crisis reveals wider security threat Expert comment NCapeling 8 December 2021

By engineering a crisis at the Belarus border, Lukashenka is attempting to exacerbate vulnerabilities within the EU. Securitizing migration is not the answer.

When thousands of migrants began freezing to death in the forests on the Belarus border with Poland, Belarusian leader Aliaksandr Lukashenka was forcing the European Union (EU) into a tough choice – either give in to blackmail and welcome migrants whose attempts to trespass the EU border were a result of his policy of luring them to Belarus to put pressure on the EU, or keep the borders closed and declare solidarity with Poland despite its known mistreatment and illegal pushbacks of potential asylum-seekers.

Lukashenka’s action was aptly exploiting three key pressure points of the EU – as a normative power where the human dignity of migrants is overlooked while the European border and coastguard agency Frontex stands by, as a geopolitical actor seeking to externalize its migration problem by signing readmission agreements with transit countries, and as a community of values with the EU-Poland dispute over rule of law.

Now is the time for a robust strategy aimed at preventing what is currently a rogue state from turning into an outright terrorist regime

His approach is typical ‘dictaplomacy’ and democracies which have confronted such a ‘continuation of war by other means’ in their past dealings with dictatorships know that blackmail mostly serves to divert attention away from a rogue leader’s misdemeanours towards his own population. But if this had been game of chess the EU would have been in check.

Thankfully checkmate was avoided – so far – as a compromise was found following weeks of heightened diplomatic efforts. Lukashenka was forced to back-pedal and take care of the migrants, and no humanitarian corridor was needed as the EU sent funds and took measures to support organizations providing shelter for the migrants in Belarus, while airlines and governments in the source countries were pressured to restrict flights to Minsk and started repatriating part of the migrants.

Causing a nuisance

‘Operation Gateway’ – the outline of which was allegedly drawn several years ago and tested by Russia in 2016 at its own borders with Norway and Finland – certainly caused a nuisance, but it ultimately backfired as Lukashenka now has to manage the remaining 2,000-5,000 migrants who refused to be flown back, as well as facing increased international sanctions. However, the fact that Angela Merkel had to personally call him made it look as if Lukashenka did not back down for nothing.

The EU and NATO, including the UK, only reacted collectively to this crisis once it was already out of hand, leaving questions over whether this experience of Lukashenka’s dictaplomacy is a wake-up call to boost resilience against rogue warfare, and to upgrade strategic assessments of the ‘Lukashenka problem’ too.

Back in June, the Belarus ministry of foreign affairs (MFA) announced its withdrawal from the Eastern Partnership and the visa facilitation and readmission agreement with the EU, while Lithuania sent early warnings about a ‘hybrid attack’ at its own border with Belarus. In August, Der Spiegel reported details of an alleged smuggling scheme whereby Tsentr Kurort – a company closely linked to the Administration of the President of Belarus with offices in the Middle East – was handling the shipping, accommodation, and relocation of migrants.

The EU and NATO, including the UK, only reacted collectively to this crisis once it was already out of hand, leaving questions over whether this experience of Lukashenka’s dictaplomacy is a wake-up call to boost resilience against rogue warfare

The smuggling of migrants was entirely predictable as Lukashenka has hinted many times Belarus could stop ‘protecting the EU from armed migrants’ seeking to enter it illegally. He has upped his rhetoric beyond notions of hybrid warfare by saying he needs Russian nuclear-capable bombers to ‘help him navigate the migrant crisis’, even hinting Belarus could station both Russian nuclear weapons and S-400 anti-aircraft missile systems. This shows Lukashenka is feeling increasingly cornered – which could lead to more unpredictable security crises.

Russia and Belarus are deepening relations

Although there is no smoking gun pointing to direct Russian involvement in orchestrating the hybrid attack at the EU’s borders, a new step in the military rapprochement between the two countries came when Putin and Lukashenka approved a new Military Doctrine of the Union-State of Russia and Belarus – a non-public document including a joint concept of migration policy. Lukashenka has also come off the fence over Crimea by openly accepting the legality of the peninsula’s integration with Russia.

Given Russia is also sabre-rattling over Ukraine, the risk of an accidental escalation into armed conflict is increasing in what feels like a return to classic Cold War logic, with the difference that the East is now offensively using the South for confronting the West. In recognition of the threat, the UK has joined the US, Canada, and the EU in the fresh sanctions on Belarus.




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Ukraine crisis could trigger cascading risks globally

Ukraine crisis could trigger cascading risks globally Expert comment NCapeling 16 March 2022

The effects on the wider world from the Ukraine invasion go far beyond the waves of shock and horror being felt from this escalating conflict.

Russia and Ukraine rank 11th and 55th respectively in terms of their national economies but, for the global supply of critical resources such as energy, food, and minerals, these two countries together are far bigger hitters – and both the threat and reality of resource flows from them being reduced have already driven up global prices.

The world is already facing a cost-of-living squeeze coming out of the COVID-19 pandemic, so further price spikes or supply constraints have the potential to seriously undermine food and energy security, equitable access to basic goods and services, and social stability around the world – which can then potentially create systemic risks for economies and societies.

The global implications of the Ukraine conflict are only just beginning to be explored fully but the immediate impacts of the crisis on global markets are already well-documented. In the first few days after Russia’s invasion, energy prices spiked, triggering further fertilizer price rises – as fertilizer production is highly energy intensive – which in turn is contributing to food price rises because fertilizer costs are an important factor in food production.

Further price spikes or supply constraints have the potential to seriously undermine food and energy security, equitable access to basic goods and services, and social stability around the world

Interruptions to shipping in the region around Ukraine – as well as globally – have impeded the flow of goods which pushed prices up even further, while economic sanctions on cross-border flows of goods and finance are further adding to market pressures. But this is just the start – these impacts will bring ripple effects which propagate far beyond their point of origin, known as ‘cascading risks’.

Risk is a combination of hazard, exposure, and vulnerability – in terms of the Ukraine invasion, the hazard is the conflict and its immediate impacts on the societies and economies of Ukraine and Russia, while exposure relates to the degree to which other countries are likely to be affected depending on how much they are integrated into the global economy or the ‘just in time’ nature of their supply chains.

Vulnerability relates to a society’s capacity to mitigate the harmful impacts of the conflict, such as controlling borders, sourcing alternative goods from suppliers, or protecting against price or supply shocks.

Risk cascades – the second- and third-order impacts of the original hazard and of responses to that hazard – can interact across sectoral boundaries – as with energy and food, for example – and their compound effect can lead to overall systemic risks for society.

Anticipating this potential is essential to understanding the nature and scale of the global ramifications being felt from the Ukraine conflict. Recent work in the UK to assess levels of cascading risks resulting from a changing climate – the UK Climate Change Risk Assessment – provides a valuable framework for thinking about this area.

It examines key pathways for risk to cascade through global systems – when applied to the situation in Ukraine, these pathways and their interactions offer an indication of the scale of crisis that citizens face far beyond Ukraine’s and Russia’s borders.

Interruptions to the flows of goods and energy

In globalized trade networks, localized disruption to supply chains rapidly yields widespread international impacts – of particular concern is the immediate supply of food because most countries rely on lean supply chains and some may only have a few days food within their own borders.

Experience from previous food price crises indicate even small interruptions to trade can result in runs on the market and rapid price inflation. In the case of this conflict, the trade interruption will be far from small because, between them, Russia and Ukraine export around one-quarter of all traded wheat, more than three-quarters of traded sunflower oil, and one-sixth of traded maize.

Given many people are understandably fleeing this conflict, other countries may struggle to cope as the cost-of-living crisis and urgent efforts to bolster national security infrastructure may squeeze available public funds

Energy markets are also a concern because many countries use more energy than they produce and therefore rely on imports of energy or fuel for domestic use. Russia produces around ten per cent of the world’s commercial energy with a concentration of sales in major regions such as the European Union (EU) and China.

As with food, a shortfall in energy provision leads to market runs and rapid inflation as actors compete in a tightening space, while poorly designed policy interventions by nations trying to ensure their own security add further pressure to global supply and worsen price rises. In addition, the closely interconnected nature of energy markets means disruption to one fuel – such as gas in this case – affects global prices for other forms of energy.

The impact of moving people and money

As the last decade richly illustrates, the cross-border flows of people impact those societies absorbing them – for example, contributing to a rise in nationalism – as well as increase the costs of supplying essential resources. Given many people are understandably fleeing this conflict, other countries may struggle to cope as the cost-of-living crisis and urgent efforts to bolster national security infrastructure may squeeze available public funds.

Financial flows are crucial to the functioning of global economies, whether for inward investment or insurance and – as Russian citizens may be about to discover – restricting the global flow of money has a serious impact on households. Beyond Russia, the outflow of money from major financial centres such as London to meet insurance claims or to enable infrastructure reinvestment post-conflict may also have severe knock-on economic impacts.

The impact on governance and health

The global spikes in energy and food prices resulting from these supply chain disruptions will see many countries struggle with rising food and energy insecurity as well as increased inequality. Taken together these conditions create many issues beyond immigration pressures and the associated politics, including increased inequality and civil unrest.

This potentially destabilizes governments which has consequences for the stability of an entire region such as interrupted supply chains, the need to deploy peacekeeping forces, or significant flows of aid – all with global consequences far beyond the countries in question.

Populations may suffer mental health impacts arising from the Ukraine invasion, whether from the trauma of being forced to leave home to escape conflict, anxiety for the wellbeing and safety of families and friends caught up in it, or a more general anxiety arising from the perception of living in an unstable world.




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Ukraine exposes Europe’s double standards for refugees

Ukraine exposes Europe’s double standards for refugees Expert comment NCapeling 30 March 2022

As European governments provide swift protection assurances to those fleeing Ukraine, non-European asylum-seekers continue to face violence at the EU’s borders.

One month after Russia’s invasion of Ukraine, the European Union (EU) already faces its largest refugee crisis since World War Two, with more than ten million people having fled their homes – 6.5 million displaced within Ukraine and 3.9 million escaping to neighbouring countries.

Acting quickly and decisively, European governments have opened borders and European citizens have opened their homes in an unprecedented showing of solidarity towards refugees. But, with all eyes on Ukraine, the Greek coastguard continues to illegally push back asylum-seekers crossing from Turkey while Spanish police forcefully repel those who dare to jump the fence in Melilla.

The painful contrast exposes the double standards in the EU’s approach to refugees. With Europe’s grim history of restrictive asylum policies, it is wishful thinking that the warm welcome to Ukrainians will extend to all asylum-seekers. The EU solidarity to displaced Ukrainians illustrates the deeply politicized – and often discriminatory – nature of providing refugee protection.

The waves of women and children leaving Ukraine prompted a surge of humanitarian action but they are also a chilling reality check of Europe’s double standards

However, the hope is this turning point in European history can at least set an important precedent for treating refugees more humanely. Undoubtedly, EU solidarity towards people fleeing the horrors of Putin’s war is critically important and the initial response is positive in its efforts to meet immense humanitarian needs.

Solidarity with Ukrainians

The EU activation of the Temporary Protection Directive (TPD) is a significant step towards a more humane protection regime and fairer responsibility-sharing among member states. Without the need for the examination of individual applications, those fleeing Ukraine can access harmonized rights across the EU for three years – including residence, housing, medical assistance, and access to the labour market and education.

The TPD is also a move away from the strict ‘Dublin’ rules which put the pressure of hosting refugees onto the countries of ‘first arrival’. Ironically, the fiercest opponents of intra-EU solidarity, such as Poland and Hungary, are the ones benefiting from this change now but, in the case of Ukraine, geographical proximity and shared histories must be considered when analysing Europe’s response.

Eastern European and Baltic countries share a post-Soviet history and fear of Russian aggression, and Ukrainians already enjoyed 90 days of visa-free travel in the EU – with a large diaspora, many have established networks across Europe. But even considering these distinctive connections with Ukrainian displacement, the initial response still shows that European countries have both the political will and the capacity to host refugees.

Unlike the usual – often media-fuelled – narratives of refugee ‘invasions’ into Europe, the waves of women and children leaving Ukraine prompted a surge of humanitarian action but they are also a chilling reality check of Europe’s double standards.

The EU has used agreements with countries such as Turkey and Libya to prevent arrivals and outsource asylum responsibilities, while border violence, detention, and lengthy asylum procedures await the few asylum seekers who manage to enter Europe from the Middle East, Asia, and Africa.

These ‘fortress Europe’ legacies have even undercut the humanitarian response in Ukraine, with reports of incidents of discrimination towards people of colour at the EU borders being condemned by the United Nations (UN) and the African Union (AU), the media facing allegations of racist reporting, and comments from Bulgarian PM Kiril Petkov providing a stark reminder of the islamophobia, racism, and history of colonization which still pervades European asylum policies.

The unity shown over Ukraine can help reshape and refocus political efforts towards increased responsibility-sharing among EU member states – the perennial ‘hot potato’ of the EU asylum system

Foreign policy also influences how EU leaders treat the right to asylum, as the geopolitics of Europe’s efforts to create a united front against Russian aggression is an undercurrent to the prompt European response to Ukrainians. But only a few months ago, non-European asylum-seekers trapped in freezing forests at the Poland-Belarus border were used as political pawns by Belarusian leader Aliaksandr Lukashenka and then dehumanised as a ‘hybrid attack’ by EU leaders.

A turning point for asylum in Europe?

Despite entrenched discriminatory precedents, it is worth looking ahead at this moment of reckoning. Although policy changes remain far off, the unity shown over Ukraine can help reshape and refocus political efforts towards increased responsibility-sharing among EU member states – the perennial ‘hot potato’ of the EU asylum system.




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Putin’s Eurasian dream may soon become a nightmare

Putin’s Eurasian dream may soon become a nightmare Expert comment NCapeling 3 May 2022

The Ukraine invasion has detrimental consequences for the Russia-led Eurasian Economic Union, a project which has been stumbling since its inception.

The Eurasian Economic Union (EAEU) – consisting of Russia with Armenia, Belarus, Kazakhstan, and Kyrgyzstan – represents the culmination of Russia’s pursuit of regional integration with its post-Soviet neighbours.

Officially, the Union has an ambitious economic goal – the creation of a market based on common rules for its five member states and their 180 million citizens – and Russia likes to portray the EAEU as an Eurasian replica of the European Union (EU).

But although a common market was placed at the heart of the EAEU as a way to appeal to member states, it is of marginal importance for the Russian economy. For Moscow, the EAEU is primarily a geopolitical tool to help re-assert its regional and global role.

In a world of evermore powerful trading blocs, Moscow wants to use the EAEU to establish its own economic power base in the new polycentric world order. But Russia’s limited interest in the technocratic intricacies needed for the economic union to live up to its lofty proclamations exposes the real geopolitical ambitions.

The Kremlin has no qualms about disregarding the common rules when they clash with Russia’s own foreign policy, and it soon became evident the EAEU was a means to an end rather than an equitable institution within which Russia would accept constraints on its unilateral behaviour.

A crisis in the making

Although the EAEU has enabled some internal trade liberalization as well as the movement of people and labour to the benefit of its members reliant on labour migrant remittances, it has failed to tackle institutional barriers or promote growth and development policies.

Russia’s limited interest in the technocratic intricacies needed for the economic union to live up to its lofty proclamations exposes the real geopolitical ambitions

It has been hampered by weak common institutions and a lack of institutional capacity of its member states, while Russia’s dubious commitment is also problematic. The EAEU lacks the institutional features of a genuine common market and any attempts to address these shortcomings have been essentially empty promises.

EAEU membership does benefit the political elites of its member states, because its hub-and-spoke model relies on bilateral high-level political deals between Russia and each member state individually. And by using the enticement of security guarantees and both political and financial support, Moscow has succeeded in attracting new members to join.

But a member’s political survival – or defence against political and economic reform – is dependent on military, economic, financial, and political support from Russia. This has been evidenced by the Armenian-Azerbaijan conflict, and by Russia’s backing of the Lukashenka regime in Belarus and the Tokayev government in Kazakhstan.

The design of the EAEU ties it to Russia’s own fate, and so the impact of harsh sanctions imposed on Russia for invading Ukraine are in stark evidence across its member states. Both Kazakhstan and Kyrgyzstan are reeling from the adverse effects on their domestic currencies and remittances, and the trade bans of key commodities.

And although the ban Russia imposed on grain export to EAEU members has softened, it shows the extent to which Russia was prepared to disregard the rules and sacrifice the EAEU to rescue its own economy. Members are incurring direct economic losses from Putin’s war against Ukraine and the fluctuation of the rouble has created a major impediment to trade with Russia.

Russia seems to increasingly view the Union as a convenient tool to bypass sanctions, with massive implications for its partner countries. And the supposed advantages of EAEU membership – enhanced trade, growth, and modernization – have simply not materialized.

Due to the rapid economic decline of Russia – a fall of 10-15 per cent is anticipated for 2022 – the EAEU is even less likely to deliver the promised economic benefits, while also putting members at risk of secondary sanctions.

The Ukraine invasion has also reignited domestic sensitivities and regional tensions. In Kazakhstan, Tokayev has failed to endorse Russia’s justification for the invasion and refuses to recognize the ‘independence’ of the separatist LNR and DNR.

Russia’s invasion of Ukraine clearly reduces the benefits of Eurasian integration even further than before and imposes higher cost on the partner countries than were envisaged when they joined

Meanwhile Azerbaijan has pursued territorial gains in Nagorno-Karabakh while Russia is distracted by its invasion of Ukraine, and has requested the withdrawal of Russian peacekeeping from the disputed territory.

Russia is keen for partner countries to help mitigate the economic impact of sanctions by providing alternative transit routes for imports to Russia. But the EAEU faces challenges even at its most basic level because the sharing of custom duties among member states was denominated in dollars, which Russia now wants to move away from.

No easy escape

Russia’s invasion of Ukraine clearly reduces the benefits of Eurasian integration even further than before and imposes higher cost on the partner countries than were envisaged when they joined. They have been dragged into a geopolitical calamity over which they have no control – the inability of EAEU institutions to mediate or constrain Russia’s behaviour is stark.




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Review: One-man bandwagons

Review: One-man bandwagons The World Today rsoppelsa.drupal 25 May 2022

The ills of strongman politics are diagnosed sharply in this accessible overview – but a cure is nowhere to be found, says Natasha Lindstaedt

The Age of the Strongman: How the Cult of the Leader Threatens Democracy around the World
Gideon Rachman, Bodley Head, £20.00

For anyone reading the headlines, it should come as no surprise that democracy has regressed to where it was in 1989. The profound geopolitical and technological changes in the post-Cold World era have led to chaos, polarization, nationalist backlash and nostalgia for strong leadership in democracies. 

Countries such as Russia and China have provided a new model for leadership that has become frighteningly infectious – the strongman. 

Gideon Rachman charts this new era, offering an accessible overview of 14 examples, including Britain’s Boris Johnson, Donald Trump of the United States, Narendra Modi of India, Jair Bolsonaro of Brazil, Viktor Orbán of Hungary, Xi Jinping of China and – the archetype – Vladmir Putin of Russia.

The idea that we are living in the age of strongman politics is not particularly novel. Scholars of authoritarian politics have noted for years that there has been a steady rise in ‘personalist’ dictatorship and personalism in democracy in general. Nearly 40 per cent of all dictatorships are personalist, meaning domination by a single person, compared with 23 per cent in 1988. Autocracies have become increasingly aggressive, using sharp power to undermine democracy, which signals a shift. 

Autocracies used to focus on their own stability and didn’t interfere with democracies.

Rachman focuses on this threat that the strongman poses to democracy while macho one-man rule spreads across the globe. He provides a well-written, clear overview of why each leader fits the strongman label, what explains their appeal and what informs their worldview. 

Where Rachman is effective is in weaving together the commonalities of these strongmen – and they are all men – and their relationship to each other. Despite their ultra-nationalism, they have created an unofficial, multilateral network of mutual support. This includes leaders whose religious convictions may appear to be in conflict – such as Benjamin Netanyahu of Israel and Muhammed bin Salman of Saudi Arabia. 

This is not just a network of dictators – autocratic-style leaders of democratic countries have been welcomed to the club. In this system, strongmen openly admire each other, revel in their disdain for liberalism and human rights, and share advice and inspiration. 

This contrasts with western European leaders who fail to build such iron-clad bonds.

Each chapter is peppered with anecdotes about Rachman’s first-hand impressions of some of these leaders and other notables in positions of power gained from his decades as a foreign correspondent and analyst. His colourful commentary complements his understanding of how they operate. 

A common theme throughout is that the strongman’s appeal appears as a breath of fresh air for democracy, liberalism or peace. They are often labelled as anti-elitist and men of the people. This honeymoon period ends when each leader shows their true colours: attacking political opponents, sometimes in ruthless purges, disregarding the rule of law, weakening the courts and vilifying or controlling the media. 

Democracy is like a tram you ride until you arrive at your destination

Recep Erdogan, President of Turkey

A well-placed quote from Recep Erdogan sums this up: ‘Democracy is like a tram you ride until you arrive at your destination.’

Genuine public support exists for these manoeuvres. Dislocation from unmanaged globalization and economic crises has created an audience for political entrepreneurs. Strongman leaders have earned the distinction of being relatable and telling it like it is, despite many being considered to be liars and often filthy rich. 

Their ability to tap into people’s fears of the West, crime, immigrants or other ethnic and religious groups has helped gain them a fiercely loyal following. According to Rachman, strongman politics is linked to fear that a majority group that was once dominant is being threatened – something leaders such as Donald Trump have astutely tapped into.

Unlike some of the kleptocratic regimes of the 1970s and 1980s that were the embodiment of venal opportunists – think of Ferdinand Marcos of the Philippines, Mobutu of the Democratic Republic of the Congo and Jean-Claude Duvalier of Haiti – the strongmen of today have been inspired by the ideology of hyper-nationalism and anti-liberalism. 

Rachman links strongmen to the work of Carl Schmitt, a Nazi Party member, who was a vociferous critic of parliamentary democracy and cosmopolitanism, while touting the importance of illiberal norms to exercise power. Rachman argues that we are in a war of ideas, with liberalism under attack. He hones in on the perennial target George Soros, and how his support for liberal democracy has garnered the unwanted attention from the world’s right-wing ideologues and strongmen.

Social media has been usurped by these leaders and their regimes to forge closer, direct relationships with their supporters, to churn out fake news and create dangerous echo chambers. They are snake oil salesmen, making huge promises but offering very little in practice. They are never as they initially appear, and their images are carefully crafted.

Another theme emerges on the career pathway. Many served as a mayor of a cosmopolitan city. An interesting chapter on Johnson explains how he comes across like a relatable ‘good chap’, being able to handle embarrassing photo-ops. He was also a devoted Europhile, attended Eton and Oxford, and championed multi-culturalism as Mayor of London. Always the opportunist, Johnson had few qualms about campaigning for Brexit, and then later breaking the law to make it happen.

Yet there are some gaps in Rachman’s analysis.

It is never made clear why leaders such as Abdel Fattah el-Sisi of Egypt, Nicolás Maduro of Venezuela and Kim Jong-un of North Korea are largely missing, or a number of other strongman dictators in sub-Saharan Africa. 

Though there is a chapter devoted to Abiy Ahmed of Ethiopia, along with a few paragraphs devoted to Paul Kagame of Rwanda, Meles Zenawi also of Ethiopia, Emmerson Mnangagwa of Zimbabwe and Jacob Zuma of South Africa, the chapter on African strongmen does not acknowledge that this is the only continent where the regional trend is not as depressing. 

Rachman only occasionally engages with data on dictatorships to verify some of the patterns that he explores in the book. And his work would benefit from an examination of the institutional factors that may explain the rise of strongman politics, such as the pre-existing weakness of parties, parliaments and courts. 

Rachman believes that strongman rule cannot deal with succession – that is largely true, but the Kim dynasty has managed handovers

Nor does he go in depth into how strongmen interact with their institutions and what the implications of this brand of politics are for conflict and development. The failures of strongmen to address Covid-19 are mentioned, but it is never explained why they may be so poorly equipped to govern. 

So, is democracy dead? Though Rachman is largely pessimistic, he acknowledges that politics tends to go in waves. There is little advice about how the West can expedite the end of this particular wave. 

The one positive Rachman offers is that strongman rule cannot deal with succession. This is largely true, though handovers have taken place, such as with the Kim dynasty. 

But there are definitely more questions raised than answers provided. What is left after strongmen are no longer in power? What must democracies do to undermine strongmen or prevent their rise? Where will the next strongman appear? 

Rachman’s book doesn’t provide these answers, but he does offer an interesting overview of the leaders dominating the headlines.
 




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Polish-British Belvedere Forum 2022

Polish-British Belvedere Forum 2022 7 July 2022 TO 8 July 2022 — 12:00PM TO 4:00PM Anonymous (not verified) 13 June 2022 Chatham House and Online

The Belvedere Forum is a leading annual British and Polish dialogue that seeks to strengthen the extensive social, economic and political partnership between the two countries.

Please note this event has reached full in-person capacity. You are welcome to join virtually via the Zoom link: https://chathamhouse.zoom.us/webinar/register/WN_QFwXsXb0RoSt-1ywkuPjfQ  

The video on this page is of the opening remarks from the Belvedere Forum, with addresses from Sir Robin Niblett KCMG, Dr Sławomir Dębski, Prof Zdzisław Krasnodębski, Sir Malcolm Rifkind KCMG QC, Ambassador Anna Clunes CMG OBE, Lord (Tariq) Ahmad of Wimbledon, Min Marcin Przydacz, and Ambassador Piotr Wilczek.

This and other session videos are available to watch on the Belvedere Forum 2022 playlist on YouTube. Photos by Mateusz Jozwiak, Zuzanna Nowak/PISM.

The Belvedere Forum is a leading annual British and Polish bilateral dialogue bringing together a diverse group of actors from civil society, politics, business, academia and NGOs.

It seeks to strengthen and deepen the extensive partnership between the two countries by exploring political, economic, social and cultural issues through debate and discussion.

The forum is an annual event alternating between the UK and Poland. Originally created in 2017 by the governments of the UK and Poland, the forum is now jointly organized by Chatham House and the Polish Institute of International Affairs (PISM) in Warsaw.

The forum brings together a diverse group of actors to debate and discuss not only current British-Polish relations, but also the British and Polish responses to key European and global challenges.




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America's abortion ban will hurt women everywhere

America's abortion ban will hurt women everywhere The World Today mhiggins.drupal 9 August 2022

In the final part of a series on the impact of the Roe v Wade ruling, Nina van der Mark assesses the global impact of America’s reverse on reproductive rights.

In overturning the constitutional right to an abortion established by Roe v Wade, the Supreme Court of the United States placed the US alongside Poland, El Salvador and Nicaragua as countries that have restricted access to abortion in recent decades. While the Dobbs ruling is a domestic reversal, the US remains the largest funder of global health, family planning and reproductive health services. There is a lot at stake for women and girls around the world. 

Here are four potential global impacts to consider.

Millions of women will be at greater risk 

The Guttmacher Institute, a research and policy organization that aims to improve sexual and reproductive health worldwide, calculated that in 2021 American international family planning assistance saw an estimated 27.2 million women and couples receive contraceptive services, some 12 million pregnancies averted, four million unsafe abortions prevented and 19,000 maternal deaths avoided. These outcomes help to improve gender equity as well as increase women’s education and employment opportunities and boost economic growth. 

This happens despite US funding for international family planning being in decline over the past decade. It peaked during the Obama administration at $715 million in 2010 but since 2017 averaged about $607 million a year. Using US aid to directly fund abortions as a method of family planning is prohibited under the terms of the Helms Amendment of 1973.

In America, the Dobbs ruling has so far led 14 Republican-controlled states to enact anti-abortion legislation. This, in turn, has motivated pro-choice campaigners – on August 2, a referendum in the staunchly conservative state of Kansas returned a decisive vote to preserve abortion rights. That result gives hope to abortion-rights groups that the issue will cut across traditional political loyalties and bring swing voters to their cause in the mid-term congressional elections in November.  

That is important because Congress decides on the level of funding for America’s global health programmes, including family planning and reproductive health. The stakes are high. For instance, Kenya, Nigeria and Ethiopia, with a combined population of more than 370 million, are among the top 10 recipients of US Overseas Development Assistance, most of which goes to health programmes. Nigeria, for instance, received $794 million in such funding from America in 2019-2020. 

A sudden policy reversal affecting funding for reproductive health would lead to clinic closures, reduced access to help and shortages of essential family planning commodities. The result would be more unintended pregnancies, more unsafe abortions and a potential increase in maternal mortality. 

Women will have more unsafe abortions

The Helms Amendment, which prevents recipients of American aid directly funding abortion services, was passed by Congress in 1973 following the Roe v Wade decision. The Global Gag Rule, first enacted by Ronald Reagan in 1984, goes further, forbidding NGOs abroad in receipt of American aid from promoting or counselling abortion as a form of family planning, even when using their own funds. Since its introduction, Republican administrations have enforced the rule while Democratic administrations have rescinded it, as Biden did in January 2021.  

Restricting access to safe abortion services increases the number of unsafe abortions, whereas legalizing abortion services reduces them. During the Bush administration, the Global Gag Rule prompted a 12-per-cent increase in pregnancies in rural Ghana, which led to an additional 200,000 abortions. 

Another study found a substantial increase in abortions, a decline in contraceptive use and an increase in pregnancies in 26 countries in sub-Saharan Africa affected by the rule across three US administrations. It’s estimated that 77 per cent of abortions in the region are unsafe. In 2019 that translated into 6.2 million unsafe abortions.

The failure of America to consistently support safe abortion services contributes to the more than 35 million unsafe abortions that take place each year across 132 lower middle-income countries.  

Under the Trump administration, the Global Gag Rule was extended from family planning funding to cover all US global health assistance, increasing the level of US funding affected from around $600 million to $8.8 billion. Were a Republican administration to be elected in 2024 there is little doubt the rule would be reinstated, possibly in the most restrictive form that Trump enforced. 

Anti-abortion movements will double their efforts 

The repeal of Roe v Wade has not occurred in a silo, nor are its effects contained within the US.

News of the Dobbs ruling, which overturned Roe v Wade, prompted One of Us, a European anti-abortion platform, to mount an immediate, 20,000-strong anti-abortion demonstration in Spain, including leaders of the conservative Vox party.  On Twitter, Sara Larin, an anti-abortion activist from El Salvador, likened the Dobbs ruling to the abolition of slavery in the US, calling it ‘the beginning of the end for abortion [worldwide]’. 

Countries have based their legal protections for abortion access on Roe v Wade or cited it in their case law, which now opens them up to legal challenge domestically. A Christian anti-abortion group in Kenya is legally challenging a pro-choice ruling based on Roe v Wade. Such challenges may increase: anti-choice groups in Mexico and Peru cited the Dobbs ruling as an encouraging development. 

An offshoot of the American Center for Law and Justice contributed to the legal case that helped overturn abortion rights in Poland

Many American Christian right-wing groups fund anti-abortion activities abroad. OpenDemocracy, an independent global media platform, recently reported that 28 Christian right-wing organizations spent more than $280 million internationally between 2007-2018 on anti-choice activities, targeting Europe primarily, followed by Africa and Asia.  

The American right is not afraid to take direct legal action abroad either. The European Center for Law and Justice, an offshoot of the Trump-backed American Center for Law and Justice, has made interventions in dozens of court cases on sexual and reproductive health and rights in the European Court, including in the case that overturned abortion rights in Poland.   

The European parliament in its most recent motion on the topic expressed concern about the potential for the Dobbs ruling to prompt a surge in the flow of money to anti-choice groups around the world.  

America’s global standing will take a hit 

The Dobbs ruling immediately attracted criticism from many world leaders.  ‘Watching the removal of a woman’s fundamental right to make decisions over their own body is incredibly upsetting,’ said Jacinda Ardern, the New Zealand prime minister. ‘To see that principle now lost in the United States feels like a loss for women everywhere.’  

President Emmanuel Macron of France tweeted: ‘I wish to express my solidarity with the women whose liberties are being undermined by the Supreme Court of the United States.’ 

Javier Milei, a potential candidate in Argentina’s presidential election, welcomed the Dobbs ruling

The ruling is in conspicuous opposition to the Biden administration’s more progressive stance on sexual and reproductive health and rights and its advocacy abroad. It sends a clear message from the world’s most powerful democracy that these rights are not guaranteed. 

While many world leaders reacted to the Dobbs ruling with dismay, other senior figures from the conservative right welcomed it, including the Brazilian President Jair Bolsonaro’s son, Eduardo, and Javier Milei, a potential candidate in Argentina’s presidential election next year.  

In 2020, the Trump administration co-sponsored the ‘Geneva Consensus Declaration on Promoting Women’s Health and Strengthening the Family,’ declaring that there was ‘no international right to abortion.’ It was signed by more than 30 countries, including autocratic and right-wing governments in Brazil, Poland, Hungary and Saudi Arabia.  

The Biden administration withdrew from it – but its signatories are the governments who may yet take advantage of America’s self-inflicted erosion of authority on reproductive rights.  

The Dobbs ruling exposes the limitation of the American executive to act within the US legal system while opening up questions on American support of, and dedication to, fundamental rights.

Read the other two articles in this series: ‘Empowering women aids climate resilience’ and ‘Counting the cost of the abortion ban

 




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Gorbachev's complex legacy is beyond the popular belief

Gorbachev's complex legacy is beyond the popular belief Expert comment NCapeling 3 September 2022

The last major figure with a decisive Cold War role, Mikhail Gorbachev was not as bad as Putin’s Russia portrays him, but also not as heroic as the West thinks.

Arguably the worst year of the Cold War since the Cuban Missile Crisis was 1983, with three major incidents which escalated East-West tensions – and any one of them could have led to a full-scale war.

The first was the Korean Airline KAL007 being shot down by an SU15 fighter aircraft for straying into Soviet airspace, killing all 269 passengers and crew. Then came the identification of signals from Soviet satellites as being incoming US intercontinental ballistic missiles – Colonel Stanislav Petrov, going against all protocols, thankfully decided to report them as a false alarm before he could be sure.

The third was perhaps the most dangerous, being the misinterpretation of a live-fire NATO exercise which was believed by some in both East Germany and Russia to be a front for an imminent attack.

The greatest disappointment in Gorbachev’s legacy was he completely believed the USSR could be reformed and still survive as an entity while others, such as Boris Yeltsin and Ronald Reagan, understood it had to be dismantled

All three incidents occurred in the few months following the infamous March 1983 ‘Star Wars’ speech by US president Ronald Reagan, in which he talked about nuclear arms control and laid out the US case for a ballistic missile defence programme.

At that time Mikhail Sergeyevich Gorbachev was the youngest serving member of the USSR Politburo, known to be a favourite of Soviet leader Yuri Andropov, and it is highly likely he had been aware of these close calls and was part of discussions within Kremlin decision-making circles.

A changemaker both inside and outside the USSR

Following the deaths of Andropov in 1984 and his replacement Konstantin Chernenko in 1985, Gorbachev’s appointment as general secretary of the Communist Party saw him immediately begin to change the Soviet Union from within – and also change relationships with the major Western powers, especially the US, Germany, and the UK.

His policies of glasnost (openness) and perestroika (restructuring) were primarily aimed at internal reforms but translated into a major reset of international relations and international security. During his six years as leader, Gorbachev initiated many arms control negotiations which resulted in treaties and increased both the transparency and the confidence between the USSR and the US.

These included the 1986 Stockholm Accord which emanated from the Helsinki Process and allowed for the observation and inspection of large-scale military exercises, the 1985 resumption of the Strategic Arms Reduction Talks which lead to START I, and the 1987 INF Treaty in which the USSR ‘out-yessed’ the US – the most open and transparent disarmament treaty in terms of notification and verification measures ever agreed.

There was also a reciprocal moratorium on nuclear weapons tests starting from 1985 – which laid the groundwork for the 1996 CTBT – the 1991 Chemical Weapons Convention, and the 1990 Conventional Forces in Europe (CFE) Treaty.

The most dramatic moment of all was when Gorbachev and Reagan met at a summit in Reykjavik and came close to deciding to eliminate nuclear weapons – but the initiative failed to reach agreement, mainly because Reagan could not drop his commitment to ballistic missile defences and Gorbachev could not accept the offer of joint development.

Nonetheless, all these nuclear arms control treaties led the way for their descendants which have kept nuclear weapons in check ever since and are still in place in the form of the New START agreement.

During his six years as leader, Gorbachev initiated many arms control negotiations which resulted in treaties and increased both the transparency and the confidence between the USSR and the US

But despite these outstanding achievements, Gorbachev had blind spots – such as enabling rather than destroying the USSR bioweapons programme, unlike the US which had dismantled its own bioweapons offensive capability by 1973.

And it is now known that, despite negotiating the Chemical Weapons Convention, Russia withheld information on new chemical weapons agents – Novichoks – which have since been used to lethal effect by Russia in Salisbury and against figures opposing the current regime.

His misguided faith in a Soviet future

Gorbachev was markedly different to his predecessors as secretary general. He was neither as decrepit nor as hardline, and he understood from the outset that the Soviet Union was, by the 1980s, finally dying.

Using the intellectual abilities of Aleksandr Yakovlev, he forced through the reforms which simultaneously captured the imagination of the free world and liberated his countrymen and women.

But although he built solid relationships – even friendships – with the world’s major heads of state and improved the USSR’s human rights, releasing dissidents such as Andrei Sakharov, but many – especially Ukrainian dissidents – continued to languish in camps.

The greatest disappointment in Gorbachev’s legacy was he completely believed the USSR could be reformed and still survive as an entity while others, such as Boris Yeltsin and Ronald Reagan, understood it had to be dismantled.

This shortcoming is especially uncomfortable as today’s Russia continues to insist it has a given right to control other former Soviet states, to the extent it is willing to destroy them if they do not concede.




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Central and Eastern Europe become hawkish on China

Central and Eastern Europe become hawkish on China Expert comment LJefferson 16 September 2022

The recent withdrawal of the Baltic countries from the ‘17+1’ format displays changing perceptions of China due to its ambiguity towards the war in Ukraine.

While the Russian invasion of Ukraine only confirmed Central and Eastern Europe’s views of Russia, it is also affecting their relations with China. Although the relationship was already complicated due to unfulfilled Chinese economic promises to CEE countries and growing indications of efforts to influence their domestic politics, China’s support for Russia is pushing Central and Eastern Europeans even further away.

This shift was highlighted, and formalized, recently by several countries in the region leaving the ‘17+1’ format, through which China cooperates with a group of countries from the region. The shifting attitudes towards China will also influence the relationship between the European Union as a whole and China.

A Trojan Horse that never was

When the format was launched in 2012 between 16 CEE countries at the time and China, the countries jumping on board expected a wave of Chinese investment and an opportunity to diversify mostly west-bound trade.

These hopes never fully materialized as Chinese foreign direct investment (FDI) in CEE has been generally lower compared to the rest of Europe and China never became an important export destination for any of the countries. The growing disillusionment and concern about Chinese security threats has led to some of the countries speaking up about the perceived perils of closer cooperation.

The first to withdraw from what had become ‘17+1’ by 2021 was Lithuania, which also took an interest in strengthening ties with Taiwan and allowed it to open a Taiwanese representative office in Vilnius. This triggered a breakdown in the bilateral relations with China. As a retaliatory response, China blocked Lithuanian imports and imports from other EU states containing inputs from Lithuania, leading the EU to launch an official dispute at the WTO.

War in Ukraine

Since the invasion started, CEE countries have been dealing with large numbers of Ukrainian refugees, organizing shipments of military equipment to Ukraine, and at the same time worrying whether they could be next on Russia’s list.

However, the concerns and security environment that these countries face seems to be almost entirely disregarded by China. On the sidelines of the 2022 Winter Olympics in Beijing, Xi and Putin signed the joint communiqué in which China backed Moscow’s demands to reverse NATO borders to the pre-1997 situation, completely disregarding CEE’s security interests.

Since the invasion started, CEE countries have been dealing with large numbers of Ukrainian refugees, organizing shipments of military equipment to Ukraine, and at the same time worrying whether they could be next on Russia’s list.

China’s implicit support for Russia after the invasion has sowed deep mistrust of its respect for the sovereignty of other nations. The Chinese diplomatic apparatus clearly noticed this changing mood among CEE governments and sent a special envoy to eight capitals in April-May tasked with ‘eliminating misunderstandings regarding Russia-Ukraine conflict’.

However, the trip was not particularly successful. The delegation failed to secure high-level meetings, with the most prominent case being the Polish minister of foreign affairs declining to meet Huo Yuzhen, the Chinese Special Councilor for CEEC cooperation. Given that Andrzej Duda, President of Poland, was the only head of an EU state who attended the Beijing Olympics opening ceremony just before the Russian invasion in February, the change in attitudes is clear.

Following the envoy’s visit to the Czech Republic, the Czech parliament’s foreign affairs committee unanimously approved a resolution calling for the country to quit the ‘16+1’ format and the government is expected to act upon it in the near future. Meanwhile, Latvia and Estonia recently jointly announced that they would no longer be participating in the cooperation framework, turning it into ‘14+1’.




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Why the UK must deliver on Nordic-Baltic security

Why the UK must deliver on Nordic-Baltic security Expert comment NCapeling 16 December 2022

Hard choices are needed but it is crucial the UK provides security and leadership to its European partners given the wider context of the war in Ukraine.

The UK’s role in Nordic-Baltic security has been growing over the past decade. The region is key to core British strategic interest and engagement, and UK threat assessment closely aligns with long-held regional perspectives – the 2021 Integrated Review defines Russia as ‘the most acute threat to our security’.

Since Russia’s invasion of Ukraine, the UK’s strong stance towards Moscow and the concrete steps taken to assist Ukraine and strengthen defence and deterrence on NATO’s eastern flank have been widely appreciated in the Nordic-Baltic region.

The UK is seen as a reliable partner but, for it to continue to deliver in the region, difficult choices must be made with regards to UK defence spending and military capabilities, and London’s more global ambitions.

The UK is a major contributor to NATO’s deterrence posture on the eastern flank, serving as a framework nation for NATO’s Enhanced Forward Presence (EFP) battlegroup in Estonia, and contributing to another battlegroup in Poland.

UK remains crucial to regional security

Coupled with its contribution to NATO’s Baltic Air Policing mission and maritime forces in the area, the UK is a crucial security partner both in the region and in a broader arch across Europe.

The UK offers military capability, strong political will, a long-standing tradition of engagement in the Nordic-Baltic area, and fast decision-making

Over the past decade and a half, the UK has been developing a dense network of bilateral and minilateral relations in the region which are major assets in the current security environment.

It leads the Joint Expeditionary Force (JEF) which is a military cooperation format highly valued for its flexibility in responding to the needs of the participating nations – including non-NATO Sweden and Finland – and is increasingly focused on the North Atlantic, High North and wider Baltic areas. The UK has also seen increased bilateral defence cooperation with Norway, Denmark, Estonia, and other regional allies and partners.

There are reasonable expectations that Germany or France may at some point assume a greater role in this part of Europe, building on France’s participation in the EFP in Estonia, and Germany’s lead of the EFP in Lithuania.

However, while Paris remains more focused on NATO’s southern (and south-eastern) flank and building the European Union’s defence role, Berlin often underperforms as a leading or an organizing power of collaborative efforts across Europe.

Both also have a credibility problem in the Nordic-Baltic region due to their past policies towards Russia that occasionally reappear when discussing military support to Ukraine or how to treat Russia in the post-war European security order.

By contrast, the UK offers military capability, strong political will, a long-standing tradition of engagement in the Nordic-Baltic area, and fast decision-making.

The latter is exemplified by the bilateral security guarantees provided to Sweden and Finland during their accession to NATO, and the surge of assets sent to the region in the wake of Russia’s full-scale invasion of Ukraine such as an additional battlegroup and Chinook helicopters to Estonia, as well as forward-deployed elements of the Standing Joint Force Headquarters to Latvia and Lithuania as part of the JEF.

Such pragmatic and resolute engagement help substantiate the UK’s post-Brexit claim that although it left the EU, it did not leave Europe. London also understands and facilitates the pivotal role that the US plays in European security – a shared perspective with the Nordic-Baltic partners.

Only the US – which has just recently decided to step up its military presence in the Baltics – has a greater appeal than the UK as a major ally. But Washington’s truly global responsibilities make it more difficult for it to play a regional leadership role.

With the context of the war in Ukraine, the centre of gravity of European security is moving east. The Nordic-Baltic region is likely to feature more prominently in the upcoming refresh of the UK’s Integrated Review, as the war in Ukraine and NATO’s new forward defence approach will focus UK attention and military capabilities on Europe for the foreseeable future.

But the UK still has limited resources and, despite the worsening security environment, there is currently no commitment by the Rishi Sunak government to increase defence spending beyond two per cent of GDP, as set out in the recently-published Autumn Statement.

This difficult fiscal reality contrasts UK ambition to also increase its footprint and engagement in the Indo-Pacific, a region highlighted by Rishi Sunak in his first foreign policy speech. London is already confronted with increasing expectations from its Nordic and Baltic partners, which are rattled by Russia’s aggression and seek more engagement and commitments from larger and more resourceful allies, and are insisting on prompt implementation of NATO’s new defence and deterrence plans.

This all comes on top of the resources that further assistance to Ukraine will require in the coming months and years. Balancing competing priorities and demands from partners is routine for a major power with global ambition but, in the current context, if the UK government fails to prioritize and increase resources, over-extension is in sight for its armed forces.

The war in Ukraine confirms that, beyond the rhetoric around the ‘Indo-Pacific tilt’, the Euro-Atlantic is – and will remain – the priority theatre of engagement for the UK. To keep delivering in the Nordic-Baltic region and remain a reliable partner, UK ambitions should be set clearly, and expectations managed with regional partners.

A good example is the recent UK-Estonia joint statement and defence roadmap, which is an attempt to reconcile London’s vision of modern deterrence with Tallinn’s preference for ‘more boots on the ground’.

The UK gains many benefits from deepening and widening its engagement in the Nordic-Baltic region, and not only by showcasing its regional leadership at a time of dire need or having more weight in Europe and across the Atlantic

The joint statement also clarifies initial misunderstandings regarding the upcoming withdrawal of the second UK battlegroup deployed to Estonia in the wake of Russia’s invasion of Ukraine – support Tallinn expected to continue ‘as long as necessary’ but London saw as temporary. It offsets the poor political ‘optics’ of the withdrawal while providing solid ground for deepening the common agenda in the near future.

By the 2023 NATO summit in Vilnius, progress on implementing the roadmap will be a crucial measure of success for the bilateral relationship, and for the UK’s broader regional role. It should serve as an opportunity for the UK to reflect on its force development priorities and balance, with Baltic partners arguing in favour of the UK rebuilding some mass in its armed forces and providing more resources to the land component.

Much to gain for the UK

The UK gains many benefits from deepening and widening its engagement in the Nordic-Baltic region, and not only by showcasing its regional leadership at a time of dire need or having more weight in Europe and across the Atlantic in strategic debates about future security architecture.




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In conversation with Edi Rama, prime minister of Albania

In conversation with Edi Rama, prime minister of Albania 23 March 2023 — 5:30PM TO 6:30PM Anonymous (not verified) 13 March 2023 Chatham House and Online

From migration to Russia and China, how is Albania responding to the geopolitical challenges of today?

In late 2022, the UK government made a pointed remark that many of the illegal migrants attempting to get into the country were from Albania. In response, Albania prime minister Edi Rama replied that targeting Albanians as the cause of Britain’s crime and border problems ‘makes for easy rhetoric but ignores hard fact’. 

This nuanced response demonstrated the challenges and complexities that Albania faces, the same as many other countries. As well as being embroiled in the major challenge of international migration, Albania has suffered from a serious cyber-attack in July 2022 from Iran. Government networks were compromised for a month with Tirana removing the Iranian embassy in the capital.

Then there is the ongoing threat from Russia and China. Nestled in the already volatile Balkans, Albania has been at the heart of international affairs in recent months.

Prime Minister Rama speaks at Chatham House to discuss:

  • How is Albania responding to Russian aggression and what is its stance on Ukraine?
  • Where does Tirana believe China poses the most serious threat?
  • How can countries in Europe best respond to illegal migration and better control the flow of people?
  • How is the region of the Western Balkans effected by the war in Ukraine and how can it contribute to the security challenges posed by the war?

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




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Virtual breakfast: The state of the EU in 2023

Virtual breakfast: The state of the EU in 2023 3 May 2023 — 8:30AM TO 9:30AM Anonymous (not verified) 5 April 2023 Online

In this breakfast discussion, we will explore the current state of play in the EU with one the most prominent experts on European politics.

While the European Union has come together in its response to the invasion of Ukraine, significant divisions remain on other issues. East-West tensions remain high and troublesome German-French relations are hampering the bloc’s traditional engine of integration.
 
Furthermore, the EU is pushing through legislation at breakneck speed, including in its attempts to kickstart green industrial policy with its responses to the American Inflation Reduction Act. At the same time, the main players within the EU continue to disagree on what the bloc’s fiscal rules should look like.

  • What are the implications of the recent wave of protests in France against President Macron’s pension reforms?
  • What is the outlook of EU-UK relations following the successful completion of the Windsor Framework?
  • Where are the fiscal rules likely to land and when will they be back in place?
  • Are we seeing the emergence of a new Central and Eastern European power bloc within the EU?

In short, despite having avoided an energy crisis over the winter, the EU continues to face significant challenges. In this breakfast event, we will explore the current state of play in the EU with one of the most prominent experts on European politics.




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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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Ultrashort Oncologic Whole-Body [18F]FDG Patlak Imaging Using LAFOV PET

Methods to shorten [18F]FDG Patlak PET imaging procedures ranging from 65–90 to 20–30 min after injection, using a population-averaged input function (PIF) scaled to patient-specific image-derived input function (IDIF) values, were recently evaluated. The aim of the present study was to explore the feasibility of ultrashort 10-min [18F]FDG Patlak imaging at 55–65 min after injection using a PIF combined with direct Patlak reconstructions to provide reliable quantitative accuracy of lung tumor uptake, compared with a full-duration 65-min acquisition using an IDIF. Methods: Patients underwent a 65-min dynamic PET acquisition on a long-axial-field-of-view (LAFOV) Biograph Vision Quadra PET/CT scanner. Subsequently, direct Patlak reconstructions and image-based (with reconstructed dynamic images) Patlak analyses were performed using both the IDIF (time to relative kinetic equilibrium between blood and tissue concentration (t*) = 30 min) and a scaled PIF at 30–60 min after injection. Next, direct Patlak reconstructions were performed on the system console using only the last 10 min of the acquisition, that is, from 55 to 65 min after injection, and a scaled PIF using maximum crystal ring difference settings of both 85 and 322. Tumor lesion and healthy-tissue uptake was quantified and compared between the differently obtained parametric images to assess quantitative accuracy. Results: Good agreement was obtained between direct- and image-based Patlak analyses using the IDIF (t* = 30 min) and scaled PIF at 30–60 min after injection, performed using the different approaches, with no more than 8.8% deviation in tumor influx rate value (Ki) (mean difference ranging from –0.0022 to 0.0018 mL/[min x g]). When direct Patlak reconstruction was performed on the system console, excellent agreement was found between the use of a scaled PIF at 30–60 min after injection versus 55–65 min after injection, with 2.4% deviation in tumor Ki (median difference, –0.0018 mL/[min x g]; range, –0.0047 to 0.0036 mL/[min x g]). For different maximum crystal ring difference settings using the scan time interval of 55–65 min after injection, only a 0.5% difference (median difference, 0.0000 mL/[min x g]; range, –0.0004 to 0.0013 mL/[min x g]) in tumor Ki was found. Conclusion: Ultrashort whole-body [18F]FDG Patlak imaging is feasible on an LAFOV Biograph Vision Quadra PET/CT system without loss of quantitative accuracy to assess lung tumor uptake compared with a full-duration 65-min acquisition. The ultrashort 10-min direct Patlak reconstruction with PIF allows for its implementation in clinical practice.




b

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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Molecular Imaging of p53 in Mouse Models of Cancer Using a Radiolabeled Antibody TAT Conjugate with SPECT

Mutations of p53 protein occur in over half of all cancers, with profound effects on tumor biology. We present the first—to our knowledge—method for noninvasive visualization of p53 in tumor tissue in vivo, using SPECT, in 3 different models of cancer. Methods: Anti-p53 monoclonal antibodies were conjugated to the cell-penetrating transactivator of transcription (TAT) peptide and a metal ion chelator and then radiolabeled with 111In to allow SPECT imaging. 111In-anti-p53-TAT conjugates were retained longer in cells overexpressing p53-specific than non–p53-specific 111In-mIgG (mouse IgG from murine plasma)-TAT controls, but not in null p53 cells. Results: In vivo SPECT imaging showed enhanced uptake of 111In-anti-p53-TAT, versus 111In-mIgG-TAT, in high-expression p53R175H and medium-expression wild-type p53 but not in null p53 tumor xenografts. The results were confirmed in mice bearing genetically engineered KPC mouse–derived pancreatic ductal adenocarcinoma tumors. Imaging with 111In-anti-p53-TAT was possible in KPC mice bearing spontaneous p53R172H pancreatic ductal adenocarcinoma tumors. Conclusion: We demonstrate the feasibility of noninvasive in vivo molecular imaging of p53 in tumor tissue using a radiolabeled TAT-modified monoclonal antibody.




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The Emission of Internal Conversion Electrons Rather Than Auger Electrons Increased the Nucleus-Absorbed Dose for 161Tb Compared with 177Lu with a Higher Dose Response for [161Tb]Tb-DOTA-LM3 Than for [161Tb]Tb-DOTATATE

Preclinical data have shown that 161Tb-labeled peptides targeting the somatostatin receptor are therapeutically more effective for peptide receptor radionuclide therapy than are their 177Lu-labeled counterparts. To further substantiate this enhanced therapeutic effect, we performed cellular dosimetry to quantify the absorbed dose to the cell nucleus and compared dose–response curves to evaluate differences in relative biological effectiveness in vitro. Methods: CA20948 cell survival was assessed after treatment with [161Tb]Tb- and [177Lu]Lu-DOTATATE (agonist) and with [161Tb]Tb- and [177Lu]Lu-DOTA-LM3 (antagonist) via a clonogenic assay. Cell binding, internalization, and dissociation assays were performed up to 7 d to acquire time-integrated activity coefficients. Separate S values for each type of particle emission (Auger/internal conversion [IC] electrons and β particles) were computed via Monte Carlo simulations, while considering spheric cells. Once the absorbed dose to the cell nucleus was calculated, survival curves were fitted to the appropriate linear or linear-quadratic model and corresponding relative biological effectiveness was evaluated. Results: Although the radiopeptide uptake was independent of the radionuclide, [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 delivered a 3.6 and 3.8 times higher dose to the nucleus, respectively, than their 177Lu-labeled counterparts on saturated receptor binding. This increased nucleus-absorbed dose was mainly due to the additional emission of IC and not Auger electrons by 161Tb. When activity concentrations were considered, both [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 showed a lower survival fraction than did labeling with 177Lu. When the absorbed dose to the nucleus was considered, no significant difference could be observed between the dose–response curves for [161Tb]Tb- and [177Lu]Lu-DOTATATE. [161Tb]Tb-DOTA-LM3 showed a linear-quadratic dose response, whereas [161Tb]Tb-DOTATATE showed only a linear dose response within the observed dose range, suggesting additional cell membrane damage by Auger electrons. Conclusion: The IC, rather than Auger, electrons emitted by 161Tb resulted in a higher absorbed dose to the cell nucleus and lower clonogenic survival for [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 than for the 177Lu-labeled analogs. In contrast, [161Tb]Tb-DOTATATE showed no higher dose response than [177Lu]Lu-DOTATATE, whereas for [161Tb]Tb-DOTA-LM3 an additional quadratic response was observed. Because of this quadratic response, potentially caused by cell membrane damage, [161Tb]Tb-DOTA-LM3 is a more effective radiopeptide than [161Tb]Tb-DOTATATE for labeling with 161Tb.




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Theranostic GPA33-Pretargeted Radioimmunotherapy of Human Colorectal Carcinoma with a Bivalent 177Lu-Labeled Radiohapten

Radiolabeled small-molecule DOTA-haptens can be combined with antitumor/anti-DOTA bispecific antibodies (BsAbs) for pretargeted radioimmunotherapy (PRIT). For optimized delivery of the theranostic - and β-emitting isotope 177Lu with DOTA-based PRIT (DOTA-PRIT), bivalent Gemini (DOTA-Bn-thiourea-PEG4-thiourea-Bn-DOTA, aka (3,6,9,12-tetraoxatetradecane-1,14-diyl)bis(DOTA-benzyl thiourea)) was developed. Methods: Gemini was synthesized by linking 2 S-2-(4-isothiocyanatobenzyl)-DOTA molecules together via a 1,14-diamino-PEG4 linker. [177Lu]Lu-Gemini was prepared with no-carrier-added 177LuCl3 to a molar-specific activity of 123 GBq/μmol and radiochemical purity of more than 99%. The specificity of BsAb-177Lu-Gemini was verified in vitro. Subsequently, we evaluated biodistribution and whole-body clearance for [177Lu]Lu-Gemini and, for comparison, our gold-standard monovalent [177Lu]Lu-S-2-(4-aminobenzyl)-DOTA ([177Lu]Lu-DOTA-Bn) in naïve (tumor-free) athymic nude mice. For our proof-of-concept system, a 3-step pretargeting approach was performed with an established DOTA-PRIT regimen (anti-GPA33/anti-DOTA IgG-scFv BsAb, a clearing agent, and [177Lu]Lu-Gemini) in mouse models. Results: Initial in vivo studies showed that [177Lu]Lu-Gemini behaved similarly to [177Lu]Lu-DOTA-Bn, with almost identical blood and whole-body clearance kinetics, as well as biodistribution and mouse kidney dosimetry. Pretargeting [177Lu]Lu-Gemini to GPA33-expressing SW1222 human colorectal xenografts was highly effective, leading to absorbed doses of [177Lu]Lu-Gemini for blood, tumor, liver, spleen, and kidneys of 3.99, 455, 6.93, 5.36, and 14.0 cGy/MBq, respectively. Tumor–to–normal tissue absorbed-dose ratios (i.e., therapeutic indices [TIs]) for the blood and kidneys were 114 and 33, respectively. In addition, we demonstrate that the use of bivalent [177Lu]Lu-Gemini in DOTA-PRIT leads to improved TIs and augmented [177Lu]Lu-Gemini tumor uptake and retention in comparison to monovalent [177Lu]Lu-DOTA-Bn. Finally, we established efficacy in SW1222 tumor-bearing mice, demonstrating that a single injection of anti-GPA33 DOTA-PRIT with 44 MBq (1.2 mCi) of [177Lu]Lu-Gemini (estimated tumor-absorbed dose, 200 Gy) induced complete responses in 5 of 5 animals and a histologic cure in 2 of 5 (40%) animals. Moreover, a significant increase in survival compared with nontreated controls was noted (maximum tolerated dose not reached). Conclusion: We have developed a bivalent DOTA-radiohapten, [177Lu]Lu-Gemini, that showed improved radiopharmacology for DOTA-PRIT application. The use of bivalent [177Lu]Lu-Gemini in DOTA-PRIT, as opposed to monovalent [177Lu]Lu-DOTA-Bn, allows curative treatments with considerably less administered 177Lu activity while still achieving high TIs for both the blood (>100) and the kidneys (>30).




b

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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Optimizing the Therapeutic Index of sdAb-Based Radiopharmaceuticals Using Pretargeting

Single-domain antibodies (sdAbs) demonstrate favorable pharmacokinetic profiles for molecular imaging applications. However, their renal excretion and retention are obstacles for applications in targeted radionuclide therapy (TRT). Methods: Using a click-chemistry–based pretargeting approach, we aimed to reduce kidney retention of a fibroblast activation protein α (FAP)–targeted sdAb, 4AH29, for 177Lu-TRT. Key pretargeting parameters (sdAb-injected mass and lag time) were optimized in healthy mice and U87MG (FAP+) xenografts. A TRT study in a pancreatic ductal adenocarcinoma (PDAC) patient-derived xenograft (PDX) model was performed as a pilot study for sdAb-based pretargeting applications. Results: Modification of 4AH29 with trans-cyclooctene (TCO) moieties did not modify the sdAb pharmacokinetic profile. A 200-µg injected mass of 4AH29-TCO and an 8-h lag time for the injection of [177Lu]Lu-DOTA-PEG7-tetrazine resulted in the highest kidney therapeutic index (2.0 ± 0.4), which was 5-fold higher than that of [177Lu]Lu-DOTA-4AH29 (0.4 ± 0.1). FAP expression in the tumor microenvironment was validated in a PDAC PDX model with both immunohistochemistry and PET/CT imaging. Mice treated with the pretargeting high-activity approach (4AH29-TCO + [177Lu]Lu-DOTA-PEG7-tetrazine; 3 x 88 MBq, 1 injection per week for 3 wk) demonstrated prolonged survival compared with the vehicle control and conventionally treated ([177Lu]Lu-DOTA-4AH29; 3 x 37 MBq, 1 injection per week for 3 wk) mice. Mesangial expansion was reported in 7 of 10 mice in the conventional cohort, suggesting treatment-related kidney morphologic changes, but was not observed in the pretargeting cohort. Conclusion: This study validates pretargeting to mitigate sdAbs’ kidney retention with no observation of morphologic changes on therapy regimen at early time points. Clinical translation of click-chemistry–based pre-TRT is warranted on the basis of its ability to alleviate toxicities related to biovectors’ intrinsic pharmacokinetic profiles. The absence of representative animal models with extensive stroma and high FAP expression on cancer-associated fibroblasts led to a low mean tumor-absorbed dose even with high injected activity and consequently to modest survival benefit in this PDAC PDX.




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Whole-Body HER2 Heterogeneity Identified on HER2 PET in HER2-Negative, -Low, and -Positive Metastatic Breast Cancer

Understanding which patients with human epidermal growth factor receptor 2 (HER2)–negative or –low metastatic breast cancer (MBC) benefit from HER2-targeted strategies is urgently needed. We assessed the whole-body heterogeneity of HER2 expression on 89Zr-trastuzumab PET (HER2 PET) and the diagnostic performance of HER2 PET in a large series of patients, including HER2-negative and -low MBC. Methods: In the IMPACT-MBC study, patients with newly diagnosed and nonrapidly progressive MBC of all subtypes were included. Metastasis HER2 status was determined by immunohistochemistry and in situ hybridization.89Zr-trastuzumab uptake was quantified as SUVmax and SUVmean. HER2 immunohistochemistry was related to the quantitative 89Zr-trastuzumab uptake of all metastases and corresponding biopsied metastasis, uptake heterogeneity, and qualitative scan evaluation. A prediction algorithm for HER2 immunohistochemistry positivity based on uptake was developed. Results: In 200 patients, 89Zr-trastuzumab uptake was quantified in 5,163 metastases, including 186 biopsied metastases. With increasing HER2 immunohistochemistry status, uptake was higher (geometric mean SUVmax of 7.0, 7.6, 7.3, and 17.4 for a HER2 immunohistochemistry score of 0, 1, 2, or 3+, respectively; P < 0.001). High uptake exceeding 14.6 (90th percentile) was observed in one third of patients with a HER2-negative or -low metastasis biopsy. The algorithm performed best when lesion site and size were incorporated (area under the curve, 0.86; 95% CI, 0.79–0.93). Conclusion: HER2 PET had good diagnostic performance in MBC, showing considerable whole-body HER2 heterogeneity and uptake above background in HER2-negative and -low MBC. This provides novel insights into HER2-negative and -low MBC compared with standard HER2 immunohistochemistry on a single biopsy.




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Development of 18F-Fluoromisonidazole Hypoxia PET/CT Diagnostic Interpretation Criteria and Validation of Interreader Reliability, Reproducibility, and Performance

Tumor hypoxia, an integral biomarker to guide radiotherapy, can be imaged with 18F-fluoromisonidazole (18F-FMISO) hypoxia PET. One major obstacle to its broader application is the lack of standardized interpretation criteria. We sought to develop and validate practical interpretation criteria and a dedicated training protocol for nuclear medicine physicians to interpret 18F-FMISO hypoxia PET. Methods: We randomly selected 123 patients with human papillomavirus–positive oropharyngeal cancer enrolled in a phase II trial who underwent 123 18F-FDG PET/CT and 134 18F-FMISO PET/CT scans. Four independent nuclear medicine physicians with no 18F-FMISO experience read the scans. Interpretation by a fifth nuclear medicine physician with over 2 decades of 18F-FMISO experience was the reference standard. Performance was evaluated after initial instruction and subsequent dedicated training. Scans were considered positive for hypoxia by visual assessment if 18F-FMISO uptake was greater than floor-of-mouth uptake. Additionally, SUVmax was determined to evaluate whether quantitative assessment using tumor-to-background ratios could be helpful to define hypoxia positivity. Results: Visual assessment produced a mean sensitivity and specificity of 77.3% and 80.9%, with fair interreader agreement ( = 0.34), after initial instruction. After dedicated training, mean sensitivity and specificity improved to 97.6% and 86.9%, with almost perfect agreement ( = 0.86). Quantitative assessment with an estimated best SUVmax ratio threshold of more than 1.2 to define hypoxia positivity produced a mean sensitivity and specificity of 56.8% and 95.9%, respectively, with substantial interreader agreement ( = 0.66), after initial instruction. After dedicated training, mean sensitivity improved to 89.6% whereas mean specificity remained high at 95.3%, with near-perfect interreader agreement ( = 0.86). Conclusion: Nuclear medicine physicians without 18F-FMISO hypoxia PET reading experience demonstrate much improved interreader agreement with dedicated training using specific interpretation criteria.




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Association Between CA 15-3 and 18F-FDG PET/CT Findings in Recurrent Breast Cancer Patients at a Tertiary Referral Hospital in Kenya

The tumor marker cancer antigen 15-3 (CA 15-3) is that most commonly used to monitor metastatic breast cancer during active therapy and surveillance for disease recurrence after treatment. The association of CA 15-3 and 18F-FDG PET/CT findings can be considered complementary, since any significant rise may indicate the presence of disease and imaging is able to map the tumor sites. Although current guidelines do not recommend the routine performance of CA 15-3 in asymptomatic patients being followed up after definitive breast cancer treatment, most oncologists perform serial assessment of the tumor markers as part of routine follow-up of patients. The aim of this study was to evaluate the correlation between CA 15-3 levels and 18F-FDG PET/CT scan findings in patients with recurrent breast cancer. Methods: This was a cross-sectional study with data collected retrospectively. Patients being evaluated for breast cancer recurrence with 18F-FDG PET/CT imaging and CA 15-3 level were included. Evaluation of the association between CA 15-3 levels and 18F-FDG PET/CT scan findings was then done. Results: In total, 154 cases were included in this study; 62 patients had recurrence (positive) on the 18F-FDG PET/CT scans, whereas 92 patients had normal (negative) findings on follow-up 18F-FDG PET/CT scans. There was an association between CA 15-3 levels and the presence or absence of recurrence on 18F-FDG PET/CT scans, with 84.4% (27/32) of patients who had elevated CA 15-3 levels having disease recurrence on 18F-FDG PET/CT and 84.4% (27/32) of patients who had elevated CA 15-3 levels having disease recurrence on 18F-FDG PET/CT as well as a correlation with the burden of metastases. Most patients with disease recurrence on 18F-FDG PET/CT, however, had normal CA 15-3 levels. Conclusion: Higher CA 15-3 levels correlate with breast cancer recurrence on 18F-FDG PET/CT as well as with burden of metastasis. Notably, CA 15-3 levels within the reference range do not exclude breast cancer disease recurrence since more than half of patients with recurrence had normal CA 15-3 levels. 18F-FDG PET/CT should therefore be considered in patients with suspected breast cancer recurrence but normal CA 15-3 levels.




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1,090 Publications and 5 Years Later: Is FAP-Targeted Theranostics Really Happening?




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Nuclear Imaging of Bispecific Antibodies on the Rise

Bispecific antibodies (bsAbs) are engineered to target 2 different epitopes simultaneously. About 75% of the 16 clinically approved bsAbs have entered the clinic internationally since 2022. Hence, research on biomedical imaging of various radiolabeled bsAb scaffolds may serve to improve patient selection for bsAb therapy. Here, we provide a comprehensive overview of recent advances in radiolabeled bsAbs for imaging via PET or SPECT. We compare direct targeting and pretargeting approaches in preclinical and clinical studies in oncologic research. Furthermore, we show preclinical applications of imaging bsAbs in neurodegenerative diseases. Finally, we offer perspectives on the future directions of imaging bsAbs based on their challenges and opportunities.




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The Rise of Molecular Image-Guided Robotic Surgery

Following early acceptance by urologists, the use of surgical robotic platforms is rapidly spreading to other surgical fields. This empowerment of surgical perception via robotic advances occurs in parallel to developments in intraoperative molecular imaging. Convergence of these efforts creates a logical incentive to advance the decades-old image-guided robotics paradigm. This yields new radioguided surgery strategies set to optimally exploit the symbiosis between the growing clinical translation of robotics and molecular imaging. These strategies intend to advance surgical precision by increasing dexterity and optimizing surgical decision-making. In this state-of-the-art review, topic-related developments in chemistry (tracer development) and engineering (medical device development) are discussed, and future scientific robotic growth markets for molecular imaging are presented.




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Is ChatGPT a Reliable Ghostwriter?




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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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Can Cyprus Be Reunified?

Can Cyprus Be Reunified? 18 July 2018 — 12:30PM TO 1:30PM Anonymous (not verified) 29 June 2018 Chatham House | 10 St James's Square | London | SW1Y 4LE

The latest round of Cyprus peace negotiations to resolve the Cypriot issue broke down in Crans-Montana, Switzerland in July 2017. The speaker will offer the Turkish Cypriot perspective on future developments to reunifying the divided island.

THIS EVENT IS NOW FULL AND REGISTRATION HAS CLOSED.




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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.