Health

Public Health Threats and Pandemics

  • COVID-19
    When Will COVID-19 Become Endemic?
    Government leaders are optimistic that COVID-19 is becoming more predictable and manageable, but the pandemic isn’t over yet.
  • United States
    Virtual Roundtable: Healthcare Worker Shortages on National Disaster Preparedness
    Play
    Prior to the pandemic, staffing shortages were a growing challenge for U.S. health systems. COVID-19 has catalyzed a national crisis in the health workforce with increasing rates of staff turnover and attrition. Seakers, Celine Gounder, senior fellow at the Kaiser Family Foundation, and Craig Spencer, emergency medicine physician and associate professor at the Brown University School of Public Health, discuss burnout and other factors driving away health workers as well as policy options for addressing the staffing shortages. This meeting was made possible by the generous support of Bloomberg Philanthropies
  • United States
    Virtual Roundtable: The Epidemic of Gun Violence in American Schools
    Play
    Gun violence has become integral to the American childhood. With an estimated three million U.S. children exposed to shootings every year, the physical, psychological, and societal toll of gun violence on the youngest generations continues to grow. Analyzing this crisis through the lens of public health could shed light on novel ways to alleviate and eliminate the burden of gun violence. Our speakers, Arne Duncan, former secretary of education, and Megan Ranney, academic dean at Brown University School of Public Health, discuss this ongoing epidemic of violence.
  • COVID-19
    Breaking Down the Barriers: A Call to Drop the Forty-Eight Hour PCR Test Requirement for Inbound Travelers to China
    China’s maintenance of the forty-eight hour pre-departure PCR testing requirement has been primarily driven by geopolitical considerations rather than public health concerns.
  • Public Health Threats and Pandemics
    Global Health Symposium: The Foreign Policy of Collective Action: Lessons for the Future of Global Health
    This symposium will take stock of the lessons of COVID-19 for the foreign policy of collective action and explore how those lessons should be applied to future global health challenges.
  • Health
    Three Years Into the Pandemic: What to Expect?
    Play
    Panelists discuss the current state of the COVID-19 pandemic, the evolution of the virus, vaccinations around the world, and lessons learned for future pandemic preparedness.
  • Climate Change
    Managing the Health Risks of Climate Change
    The health of millions stands to be harmed by climate change in the coming decades, but national governments and international organizations remain woefully underprepared. Elizabeth Willetts and Andy Haines suggest a path forward to bolter responsiveness and resilience.
  • Public Health Threats and Pandemics
    The Global Governance of Emerging Zoonotic Diseases
    Zoonotic diseases, naturally transmissible between humans and animals, have posed a growing public health threat for decades. However, existing institutional arrangements have fallen short. The wide-ranging, large-scale, and costly effects of the COVID-19 pandemic demonstrate the value of addressing those weaknesses in global governance.
  • Health
    How New Tobacco Control Laws Could Help Close the Racial Gap on U.S. Cancer
    This interactive examines how nationwide bans on menthol cigarettes and flavored cigars, as proposed by the Biden administration on April 28, 2022, could help shrink the racial gap on U.S. lung cancer death rates.
  • Public Health Threats and Pandemics
    Managing the Risks of Biotechnology Innovation
    Biotechnology advances offer immense public health and consumer potential, but come with serious risks. A recent workshop held by the Council on Foreign Relations brought experts together to discuss new forms of global governance to manage those risks. 
  • Disasters
    U.S. Preparedness for Nuclear and Radiological Threats
    Play
    J. Andrés Gannon, Stanton nuclear security fellow at CFR, discusses the likelihood of Russian deployment and use of nuclear missiles against Ukraine or its allies, and the implications for the United States should that occur. Jerrold T. Bushberg, chairman of the board and senior vice-president of the National Council on Radiation Protection and Measurements, discusses preparedness for nuclear and radiological disasters at the state and local level in the United States. TRANSCRIPT FASKIANOS: Welcome to the Council on Foreign Relations State and Local Officials Webinar. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR. Thank you for taking the time to join us for today’s discussion. As a reminder, the webinar is on the record and the audio, video, and transcript will be made available on CFR’s website, CFR.org. CFR is an independent and nonpartisan membership organization, think tank, publisher, and educational institution focusing on U.S. foreign policy. We are also the publisher of Foreign Affairs magazine. As always, CFR takes no institutional positions on matters of policy. Through our State and Local Officials Initiative, CFR serves as a resource on international issues affecting the priorities and agendas of state and local governments across the country by providing analysis on a wide range of policy topics. We’re delighted to have participants from approximately forty U.S. states and territories. I’m pleased to introduce our speakers today, Andrés Gannon and Jerrold Bushberg. Andrés Gannon is the Stanton nuclear security fellow at CFR. Previously, he was a post-doctoral research fellow at the Harvard Kennedy School Belfer Center and a Hans Morgenthau research fellow at the Notre Dame International Security Center, as well as a defense fellow at the NATO Defense College. His research focuses on the political origins of military power, what capabilities states arm themselves with and why, and how the distribution of military capabilities affects states’ conduct in international affairs. Jerrold Bushberg is a clinical professor of radiology and radiation oncology at the University of California Davis School of Medicine. He’s an expert on the biological effects, safety, and interactions of ionizing and nonionizing radiation and holds multiple radiation detection technology patents. He is also the chair of the board of directors and senior vice president of the National Council on Radiation Protection and Measurements—the NCRP—a congressionally-chartered institution which formulates and disseminates information, guidance, and recommendations on radiation protection and measurements, and he previously served as a commander in the U.S. Naval Reserve where he was executive officer of the Chemical/Biological/Nuclear Technical Unit 120 Pacific. So thank you both for being with us today. We appreciate it. Andrés, can you talk first about the possibility of deployment and/or use of nuclear weapons in Russia’s war in Ukraine, and U.S. options in response to such action if it were taken? GANNON: Sure. And thank you, again, for having me and thanks to all for participating. Nuclear use and Ukrainian nuclear use, in general, is, to sort of start, a low probability/high magnitude event. So like we think of a lot of natural disasters, we’re forecasting worst case scenarios because the consequence would be incredibly high. Even though it’s unlikely, those are things that we have to prepare for. I think in the Ukraine context there’s three distinct nuclear scenarios that we can see for potential use by Russia, and I sort of order these from the least immediately consequential in terms of sort of death counts, casualties, and other costs to most. The first is, as a signal, I think that Russia has not tested a nuclear weapon since they were the Soviet Union in the sort of late ’80s. But I could see them testing a nuclear weapon either somewhere remote in northern Russia, possibly somewhere near Ukraine, in the ocean or in the sea, to demonstrate a willingness to use a nuclear weapon. Even though the casualty of such an event would be close to zero—such an event would be designed to have a low casualty—there are environmental effects and, more importantly, effects on sort of morale and people’s thinking about the likelihood of using nuclear weapons. So when we think about the consequences that would have for other countries thinking about acquiring or detonating nuclear weapons, there’s, potentially, second order ramifications on that sort of international system. The second scenario is one in which a sort of smaller tactical battlefield nuclear weapon is used and this is a tricky one to think about because, as we’ve seen with a lot of other weapons that are things like chemical weapons, it’s really difficult to predict the effects of even small nuclear detonations an hour, a day, a week later. The radiation that would happen from such an event could be one that blows back towards Russia in ways that could negate their benefits. It could create a sort of no man’s land in the region in Ukraine that will be impassable for some short period of time by military personnel on both sides. But I think that’s precisely the reason such an event could happen or could be sort of logical or strategic on Russia’s end as a way of halting Ukrainian advances. I think that we can think of tactical Russian use of a nuclear weapon in some of these cases where they’ve been losing ground and where the Ukrainians have been seizing territory as being a way of creating sort of a large tank ditch that would be impassable for a short period of time to stop Ukraine from advancing. So I think that that’s the logic that could exist there, particularly in the eastern Ukrainian region. The third most immediately consequential scenario for Russian nuclear use would be a strategic use of a nuclear weapon that wouldn’t necessarily be a sort of large strategic ballistic missile but will be targeted at civilians. This could be civilians that are in Ukraine. This could be civilians that are in nearby NATO countries. I think that the latter scenario is very unlikely since Russia and NATO, I think, so far has sort of tacitly agreed to limit by design the degree to which they’re interacting with each other directly. But I could see a situation where Russia feels that a sort of way to escalate the current attacks that they’ve had on the public in Ukraine, the sort of missile strikes that they’ve been doing recently, to ratchet that up with nuclear use could be a way to break morale in a way that would make Ukraine halt their advances and possibly give up in the conflict, in general. So I sort of want to wrap up there from where I started, which is none of these scenarios are incredibly likely but they are all very consequential. And so I think that when we think about what the U.S. response should be to these situations we can think of the response ex ante—what are things that the U.S. can do in advance to make sure that these events don’t occur—and then what would be the U.S. response ex post in the sense of if they did occur what should we do. In terms of ex ante, I think it’s really important that the U.S. continues to communicate to Russia behind the scenes where red lines are but to remain ambiguous about the consequences of crossing those red lines. A lot of research that has been done on sort of these sorts of threats and red lines indicates that being clear that any nuclear use would be unacceptable but remaining ambiguous about what sort of retaliation or consequence Russia would face is the way to make sure that these threats are both credible because there’s a clear line in the sand that we’re telling Russia not to cross while still making sure that the United States has flexibility in how it decides to respond afterwards, given new information that’s revealed about the consequence, that motivation, the situation at hand, et cetera. And so there’s sort of a lot of secret information that’s existing at the government level but that communication has to continue to happen between the United States and Russia directly. In terms of ex post, I think a lot of the humanitarian aspects of nuclear use are relevant in all of these situations. There’s a lot of very good, important environmental monitoring that’s done by a lot of folks regarding, as I’m sure Jerrold will talk about, the sort of radiological effects of these sorts of weapons, what effect that has on crops and agriculture. We have already seen sort of the effect of the conflict on wheat exports and prices in Ukraine, which would only be amplified in this situation. Transportation, mobility, possible refugee flows out of the region is something that has to be anticipated. And so I think that these are things that sort of matter at the state and local level in the United States because public opinion also matters in a lot of these things. There are about twenty-nine U.S. states that currently have nuclear power plants and there’s 10 (million) to 15 million people last I checked that live within ten miles of a nuclear power plant in the United States. When sort of radiation, detonation, anything that involves the power plants in Ukraine, anything that happens there, I think, would be directly relevant for how U.S. people in state and local regions here feel about the consequences of having nuclear facilities nearby and whether or not that’s something that would, potentially, pose a danger to them. Thank you. FASKIANOS: Thank you very much. Let’s go now to you, Jerrold, to talk about emergency preparedness for nuclear and radiological events in the U.S., what it would mean if such an attack would happen, and how states and locals can best prepare for the threats of this kind. And you are muted. You could unmute or—hold on a minute. BUSHBERG: There we go. FASKIANOS: There we go. Perfect. BUSHBERG: Thank you. All right. Very good. OK. So thank you for the opportunity to present this information, and I think you’ve set it up very nicely. We’re going to just take some—a few minutes to talk about the kinds of incidents that could occur and what their effects would be and the—in particular, those effects that would, if it occurred somewhere else in the world, what would that mean for radiation exposure in the United States and what particular actions, if any, would be implemented. So my comments will cover a broad range of different types of nuclear yields, most of them likely much greater than I would anticipate from the discussions that we’ve just talked about previously. But I think before we get into more of the detail, I want to make sure I give you the bottom line up front, which is that even if there was a very large detonation anywhere in Europe there would be no need to take protective actions if you’re living in the United States or even its territories and outside the continental United States, including Hawaii and Alaska so—and the reason for this is several fold. One is, is that—and we know a lot about this because there have been a number of nuclear detonations, I think over four hundred up until 1980. So we know about what the distribution of radioactive materials is like, and there are two principal things that occur. One is that the material—the radioactive material—gets injected into the atmosphere and at different levels in the atmosphere it behaves in different ways, and primarily a material that goes into not the troposphere but above that—in the next level above that, which is over about six thousand feet or so, that material pretty much stays there for a relatively long period of time, and the material that’s lower and the percent that goes into the lower versus the upper really depends on the yield and how far above ground it was detonated and a lot of other technical factors. But I really think the point here is, is that there’s a tremendous amount of dilution that occurs because of the normal dispersion of this material, and also if you look at the air currents in that—in the world they move from west to east. So even if there were a detonation somewhere in Ukraine it wouldn’t take the four-thousand-mile shortcut directly to us. It would have to go kind of the long way around the Earth, which will result in even greater dilution. The other aspect of it is that the radioactive material has different life spans, if you will. We call them half-lives. But I think one way to characterize it is that after twenty-four hours approximately 80 percent of the radioactive material that was generated will have decayed and after about two weeks or so it’s about 90 percent. So the concerns are, really, for people that are in that region or for the sort of immediate aftermath within the twenty-four, forty-eight hours, and for them the critical issues are—and we’ll talk about this in a minute a little bit more—are about seeking shelter and preventing contaminations and fallout. OK. A couple other things I wanted to mention. There are a number of guidance documents that are available both from the NCRP and from the federal agencies, and we can provide that link later and make it available to those who are interested. The radioactive material that’s produced, as I said, mixes up in the atmosphere and the dilution and decay result in very, very little of the radioactive material ending up in the United States from a detonation outside of the United States. And so one of the questions that often comes up is, well, can you—would we detect any increase in radiation and the answer is, yeah, we would. Why is that? Well, because we have incredibly sensitive radiation detectors and the amount that we can detect with our detectors is, literally, tens of thousands of times smaller than the level that would be of concern for public health. So the mere detection of a(n) increase would not necessarily pose a health threat and there are, as mentioned earlier, a number of monitoring stations in the United States that are run by governments and states and universities that monitor radiation levels 24/7/365. So we would know if the increase occurred and also if it occurred from a nuclear detonation as opposed to some release from a nuclear power plant. Experts can distinguish between those kinds of releases. So there has been a tremendous amount of study into this, and those kinds of rapid determinations are well within the United States’ and other countries’ capabilities. So I think one of the important things that—lessons learned from other releases—accidental releases—that have occurred like at Hiroshima—I’m sorry, like at Fukushima and at the Chernobyl nuclear power plant accident—is that people have seen a lot of material either on social media or on the internet telling people to take various anti-radiation drugs or so forth and so on, and that should not be done either. There is no reason to take these kinds of medications and, in fact, the vast majority of them are only good for very specific radionuclides and they do have side effects. So the most important advice is to listen to your state and local officials and follow that guidance, and so there will be official guidance available both at the local, state, and federal level. And to help put some of this—the amount of radiation into perspective for you, let’s say that we go back to the 1980s and China’s last aboveground detonation was in multiple megaton, which is a very, very large nuclear weapon, and the average dose to people around the world was, you know, about 1/1000, so about 1 percent of the dose that we all get from natural background radiation. Just to say a little bit more about that, you know, all of us are exposed to radiation all the time from what we refer to as naturally occurring background radiation and it comes both from cosmic rays and as well as the naturally occurring radioactive material that’s in the ground and that gets into the plants and, therefore, gets into the animals, and we eat plants and animals and so we have radioactive material in us. And so, on average, the—in the United States the typical background radiation is about three millisieverts per year and the amount of radiation that you might get, which is—well, to put that in perspective, it’s about the amount of radiation you get from a thoracic CT scan. That’s the amount of radiation, and the amount that you—that people got from those detonations, the very large aboveground nuclear test, was, you know, hundreds of times less than that. So the take home point, really, is that regardless of the yield anywhere outside of the United States, the amount of radiation we receive will be very small. There are very accurate monitoring stations around the United States that can detect very small increases in radiation and the government has a very well thought out and very rapidly implemented program for responding to such events to provide both information and monitoring information. And I think that as long as we don’t overreact to a situation like this and, you know, it is a critical situation but we need to remain calm, listen to the authorities, not overreact or certainly don’t take the advice of individuals who might be going on television or might be coming from other areas but are not representing what we typically refer to as, you know, the consensus of scientific opinion, I think we’ll be fine. So, with that, I’ll wrap it up with that and then be happy to respond to any questions that come up. FASKIANOS: Great. Thank you very much. And, yes, we will send out a link to the sources that you recommend after this. Now let’s go to all of you for your questions and comments and, of course, we—this is a forum to share best practices. So if there are things that you’re doing in your municipality please share those with us. It’s good information for your colleagues. So you can either raise your hand by clicking on the icon and I will call on you. You can also write your question in the Q&A box, and if you do write your question then please also include your affiliation and state so that we can give context. So I’m going to look now for any raised hands. We have two already. So I’m going to go first to Mike Ladd and if you could unmute yourself—accept the unmute prompt, rather—that would be great. Q: Yes, ma’am. Can you hear me OK? FASKIANOS: We can, and identify yourself. Q: Yeah. My name is Mike Ladd. I’m the deputy emergency manager for Clay County, Florida, which is just southwest of Jacksonville. First, thank you so much for the presentation and answering this niche. I think the one assumption that’s made and kind of want to get your thoughts on it is, largely, this discussion is circulated around an initial or one or a singular nuclear detonation. However, there’s a lot of doctrine out there that that may trigger more and what if we have a whole bunch and not—you know, the whole retaliation? I understand that’s very hard to scope and scale. But in some of the commonalities that were discussed about 90 percent, you know, degradation of radiological hazard after about two weeks, what are your thoughts as far as how to sew that into a comprehensive emergency management plan? BUSHBERG: Well, I think that the most important thing to understand is that if you’re talking about a detonation that would be in the continental United States or let’s take it the other direction, say, that there are U.S. citizens in a region where a detonation occurred, you know, the most important thing that one can do is to—you know, is to seek shelter and to tune in to the local emergency broadcast for further information. The real risk is to those individuals that are outside the zone of lethality but are in an area where there could be significant amounts of fallout that could occur over the hours, days, and weeks later. But in the first few hours is really the most important response, or I guess most critical response time. And for that you would want to seek as much shelter that puts—in a building, maybe in the center of a taller building that puts a lot of material between you and the fallout, and that can substantially reduce the risk and the amount of radiation that individuals would receive. So if we’re talking about the sort of worst case situation where individuals are close to such a detonation that would be the appropriate actions. FASKIANOS: Thank you. I’m going to go next to Jeffery Warren. And, Andrés, if you want to add anything please feel free to jump in. Q: Thank you. Jeff Warren, Memphis City Council in Memphis, Tennessee. I just was wondering what Andrés thought about the possibility of this going completely south—it goes along with the question prior to that—and how aggressive we should be on the local level to be thinking about stocking fallout shelters and doing things that have occurred before. GANNON: Yeah. It’s a good thought. I have two sort of things I’m thinking about in response. The first is a weird part of the way that we’ve thought about it, the logic behind why a nuclear weapon wouldn’t be used is your target will fire back and neither side wants to be on the receiving end so no one will use it. That logic seems to make sense until the first missile is launched, in which case if Russia launches a missile on the United States and it’s—well, we’re supposed to respond. That’s what all the books have said, you know, since the 1950s. And that’s sort of a tricky and a hard thing to think through. And so I don’t think that we know, thankfully, given lack of experience, of what that escalation trajectory would look like. But I do think that the military and sort of high-level political officials involved are starting to think about the role that nonnuclear weapons would play in response and having this sort of cross-domain or cross-capability conflict. What that sort of means at the state and local level, I think, is difficult to figure out. But it’s a place that the research is going now that, I think, is important. In terms of what this means for state and local officials in the United States if this were to go south, there’s a lot of sort of research that we don’t know that’s classified regarding targeting that, I think, is something that’s worth thinking about. Nuclear strategists think about targeting, broadly speaking, in two dimensions. You can target what your opponents value, meaning their population centers and civilians, or you can target what is strategically important, meaning their military installations. You know, U.S. targeting is, largely, classified with the exception of some recently early Cold War documents. We don’t know what Russia’s targets would be in the event that they were to attack the United States but they probably have some plans there. I think if I were to speculate, the smartest thing to do in the early phases of a war is to target your enemies’ military capabilities. Those are the things that could be launched sort of against you and that would cause the most damage. So what this means is that states and localities where U.S. nuclear weapons are housed—our ICBM facilities that are in the Dakotas, you know, Wyoming, Nebraska, the Midwest in general—also, possibly places on the coast where U.S. nuclear submarines are based from or where they sort of get their intelligence, refueling, and maintenance. If I was Russia that would sort of be the first round of attack before I started thinking about the Los Angeleses, the D.C.s, the San Franciscos, et cetera. And so I think that that’s sort of a way to think about where this thing might go south if it were to start going in that direction. Now, how far would the escalation go? Would we end up with all military targets on both sides taken out and then we’re swapping city for city? It’s hard to say. But I think that if we think about the first step it would be places that are militarily-valuable targets for Russia to think about in the United States. Q: Well, in Memphis, you know, we just worry about logistics with FedEx. So we’re, you know, wondering how—where we would be on their list. GANNON: Yeah. I can’t speak to Memphis itself but I do think that your point about sort of transportation, infrastructure, logistical hubs is really important. I know that, for example, in Long Beach they’ve put a lot of work into making sure that the ports there are safe and secure in detecting, you know, possible radiological use and, you know, possible terrorist attacks that could happen there precisely because of the value that these ports have. So I think that that emphasis is well placed in the same way that, you know, we have things like TSA, not necessarily because airports are the most likely to be targeted but because the cost is really high. I think that infrastructure hubs that can do similar measures for security are putting resources in places that make sense. Q: Thank you. FASKIANOS: Thank you. I’m going to take a written question from Linda Lewison, who’s with the Nuclear Energy Information Service—it’s a safe energy watchdog in Illinois—and the question written is other than modeling has there ever been an actual emergency response exercise for a nuclear power plant accident that would release large amounts of radioactive waste into the atmosphere in a relatively short timeframe? We, in Chicago, will probably have, perhaps, an hour or so to respond. Then she notes that there’s more radiological waste in Illinois than any other state. I don’t know who wants to take that. BUSHBERG: Well, I guess—I’m sorry. Was the question what would one do if there was or has there ever been a release from a—there have been—you know, so there was the Three Mile Island accident in the United States, which did not release a tremendous amount of radioactive material. In fact, quite, quite small amounts compared— FASKIANOS: I think— BUSHBERG: —to the others. But was there—and is there something else that they wanted a response to? FASKIANOS: It was more a question about is there—has there ever been an emergency response exercise. Like, what kind of gaming and— BUSHBERG: Oh. Yeah. FASKIANOS: —and responses to—you know, just like we have fire drills or— BUSHBERG: Yes. The— FASKIANOS: —those kind of things. BUSHBERG: Right. FASKIANOS: What’s happening on that front? BUSHBERG: Sure. So the Nuclear Regulatory Commission requires all nuclear power plants in the United States to not only plan an exercise for a potential release but also work with local hospitals and medical and emergency response assets that would be responding to or supporting such an accident. There’s also very detailed emergency planning guidance that details evacuation zones should they be required. In the case of a nuclear power plant accident, you know, we’re concerned about sort of different radionuclides than we would from a nuclear weapons detonation. And there are things like radioactive iodine or something we’d be particularly concerned about and local health officials have planning guidance about whether potassium iodide, which is something that can block the thyroid gland from taking up radioactive iodine, would be necessary and they have stockpiles of this local to the nuclear power plants that are available for local health officials to dispense if that turns out to be a suggested guidance. But, you know, the most important thing one could do if you heard about any sort of radiological release in our national guidance, and this would apply even to a very large release, is to—you know, you would get inside, stay inside, and stay tuned. So if you just remember those three words or three phrases—to get inside, stay inside, and stay tuned—you will protect yourself from the vast majority of any potential harm that can occur because the real concern is fallout or deposition of radioactive material contamination. FASKIANOS: Right. So, Jerrold, there’s a written question, and this is for you to clarify, from Samer Jaafar, who is in Wayne County, Michigan, and, perhaps, this is not what you said but writing—you state not to take KI potassium iodide that you feel will not benefit and—benefit you anyhow. They are advised by the State Department of Environmental Quality of an air sample or dosimeter when it reaches a certain exposure level during our training preparedness for REP. So can you clarify what you meant? BUSHBERG: You bet. Yeah. Thank you for that question. FASKIANOS: That would be great. Thank you. BUSHBERG: Thank you for the question. What I was saying is that if there was a detonation in Ukraine, there is under—there would be no circumstances under which potassium iodide would ever be recommended because there is just not going to be enough exposure to warrant it. Now, that’s different than what I just talked about, which was maybe a release from a nuclear power plant, for which potassium iodide is very effective at blocking just radioactive iodine. None of the other nucleotides that might be released; potassium iodide would not have any effect on those. So planning guidance does provide for state and local officials guidance on environmental monitoring and at what levels they might suggest the distribution of potassium iodide, but that would be a public health decision in coordination with both the state and federal agencies. FASKIANOS: Great. Thank you. I’m going to go next to Ted Voorhees, who has a raised hand, from Orange County in Virginia. If you can unmute yourself. Q: No question. I’m sorry. FASKIANOS: There we go. Oh, you don’t have a question. OK. Q: No. Thanks. FASKIANOS: All right. Thank you.                     I’m going to go next to John Jaszewski. And excuse my pronunciation. And if you can unmute yourself. Q: Now can you hear me? FASKIANOS: We can. (Laughs.) Q: OK. Thank you. I’m John Jaszewski. I’m calling from Mason City, Iowa, which is in northern Iowa. And I’m curious as to whether or not you can forecast, if Russia releases a tactical weapon in Ukraine or somewhere in Eastern Europe, would it follow that they’ll eventually release a strategic weapon toward the United States. GANNON: I can start with that one. I don’t—what that answer depends on is what do we think is Russia’s goal in Ukraine, what do we think is Putin’s goal in Ukraine. And there’s a variety of different answers that all point to different expectations about the degree to which they would go further and escalate in a conflict. Maybe their goal is just material and strategic. Maybe Russia does want this territory, these sort of four areas that they’ve taken, and they want Crimea because they think that it’s a part of Ukraine, and maybe access to the naval base in Sevastopol is helpful. That’s fairly limited. Maybe it’s a little bit more, in that there’s some sort of nationalistic impulse of people that they think are truly Ukrainian people, sort of pushing back against Western expansion and embarrassment since the end of the Cold War and NATO expansion, in which case Russia’s aims are a little broader. Maybe Russia just wants to sort of once again be an imperial superpower and the most dominant state in the world, in which case they really want to push back against the West and they have greater sort of territorial and reputational ambitions. In reality, it might be some combination of all of these things. We don’t know and I don’t know that we’ll ever know. But I think whatever events we start seeing about Russian escalation shed some light on what we can infer as the likely motivations. I think that tactical nuclear use in Ukraine would be helpful—potentially be helpful for Russia towards any of those gains. I explain sort of one way in which it could be helpful to them militarily, and it would be helpful in terms of taking territory and showing the West that sort of they are a powerful, dominant country. I think that if they were to then take the next step and attacking NATO or the United States directly with a strategic nuclear weapon, that’s not a decision that you make if your goal is to get access to a naval base and if your goal is to have control over these four regions, some of which you have kind of controlled so far. That demonstrates sort of larger imperial ambitions maybe at the personalistic level for Putin himself that are very different. So I know that that doesn’t really answer the question because it doesn’t tell you what I sort of think are the likelihood of all of these things, but that’s because I don’t think that that can be answered ahead of time. And I think that people that sort of have—the stronger someone’s opinion is about what is Russia’s true motivation, the less confident I am in sort of the reasons that they’ve given for why that’s the case. But I think that the scenario in which Russia decides that their aims are best served by directly attacking the United States with nuclear weapons is a situation where Russia and Putin’s geopolitical ambitions are largely unparalleled and inconsistent with a lot of actions that we’ve seen so far. And whether or not he thinks that that’s something that would help him because he’s backed into a corner and this is sort of a Hail Mary strategy for maintaining power, or whether he thinks that this is the nail in the coffin for defeating the West, I think both of those scenarios are hard to say. So I think that we have to see many, many other actions happen first before we get that scenario. It wouldn’t be a bolt from the blue. FASKIANOS: Great. There is a written question from Cailey Hansen-Mahoney from the Ohio General Assembly: Have you seen any successful legislation to protect nuclear power facilities/storage at the state level? Any recommendations for best practices for state legislatures to support incident command/emergency planning as we discuss this possibility? BUSHBERG: Well, starting sort of with the last part first, yes, there is—are some outstanding documents. NCRP has a number of documents that speak to these questions directly. NCRP Report 165, which is entitled “Responding to Radiological or Nuclear Terrorism Incidents: A Guide for Decision Makers,” this is free to download from the NCRP website. The NCRP website is ncrponline.org. And so that document is freely available, and there are a number of other documents that NCRP scientists have put together that go into some significant detail about both preparing for, planning, and executing response to radiological releases. Now the—now I’m forgetting what the first part was. Oh yes, the fuel onsite—protecting the onsite fuel. So the Nuclear Regulatory Commission has regulations about the storage or protection of this radioactive waste, which are essentially the materials that once the fuel rods have been in the reactor for a certain period of time and they have expended their practical usefulness that are taken out. And at that point, they’re extremely radioactive. They’re put into pool storage where water is circulated to remove the heat, and then ultimately are put into what’s referred to as dry storage. In the United States today, all of that sort of spent nuclear fuel is stored onsite at the reactors because we don’t have a long-term storage repository in the United States. So the—all of the utilities have precautions and protections of that material, and it is stored in very robust and hardened facilities that would make the release of that material very, very difficult. (Pause.) OPERATOR: Irina, can you please unmute yourself? FASKIANOS: Yes. There you go. (Laughs.) I want to go next to Bill, who has raised his hand. And if you could identify yourself. Q: My name is Bill Stoutenborough. I’m in Madison County, Illinois. I think we’re being a little bit naïve in saying we don’t know what Russia’s goals are. It appears that—let’s go by what they’re doing instead of what they’re saying. They want to weaken NATO. They want to exercise controls over the EU. They had controls with oil lines, pipelines, fertilizer, et cetera. What they—the strongest control they can get is food, and Ukraine has more production area than any other in the European area. They supply over 30 percent of the food to Europe and to other areas of the world. Now, they’re not attacking military targets; they’re attacking infrastructure, such as knocking out the electricity. That is being done here in the United States. We talked about nuclear. Their former president has indicated they want to move battleships armed with their hypersonic weapons within the areas of the—political areas of the allies supporting Ukraine. They even specifically indicate Washington is within the 600-mile range of hypersonic missiles, which cannot easily be detected because they’re a low-trajectory item. What type of—I guess at some point in time I think we’re going to have to fight Russia. We are being reactive and never proactive. I think that we should proceed in getting the other two Scandinavian countries into NATO. I think we should even allow Ukraine to start its—restart its process into NATO and Article 5. FASKIANOS: Thank you. Thank you very much. Andrés, do you want to respond to that comment? GANNON: Sure. Yeah. Thank you, Bill, for those thoughts. I think that there are sort of ways that we can infer what Russia’s goals might be based on what they’ve done. You’re certainly correct about that. What I think is challenging to do in the long term is figure out: Where would Russia be satisfied? What, for them, is an outcome where they will say we’re OK with this, there’s no other changes that we want to make to the world? Does that mean having part of Ukraine be Russian territory? Does that mean all of Ukraine? Does that mean NATO pushes back to the sort of pre-NATO-expansion boundaries? Does that mean NATO doesn’t exist? Does that mean the United States doesn’t exist? These are all sort of hypotheticals that I think are hard to think about, but all are very different in terms of what they think that—or, what they suggest the U.S. strategy should be. As far as the point about preempting what Russia is doing, I think that’s something that’s currently in discussion by national policymakers. But what’s tricky is Russia isn’t the only thing that the U.S. is concerned about when it comes to great power competition. We saw in the recent National Security Strategy increased concern about China’s activities, the U.S. sort of starting to think about a new tripolar or trilateral world, where there’s two threats that we’re thinking about simultaneously. And so I think that as we think about what, if anything, should we do to weaken Russia, where those resources come from is an open question that I don’t have the answer to, but that I hope that those that are in charge of making those decisions are thinking about. FASKIANOS: Great. Thank you. Jeffrey Semancik has written a couple things in the Q&A—suggestions, best practices. And I thought maybe you could just share with the group rather than having me read. And so I would like to invite you to unmute yourself. Q: Yeah, hi. This is, yeah. Can you hear me? FASKIANOS: We can. If you can just identify yourself too for the group and just— Q: Yeah. This is Jeffrey Semancik. (Off mic.) FASKIANOS: OK, we can’t hear you now. (Laughs.) Jeff, can you—we can’t hear you anymore. OK. Q: I got it. No, I got it now. FASKIANOS: OK, good. Q: So, yeah, I’m sorry. Just we’re in a conference room here trying to organize some stuff. But so just wanted to point out a couple resources available to state and local officials. I think Jerrold presented NCRP reports. There was also some recent guidance from FEMA related to a nuclear detonation published in May of 2022 that’s available from FEMA’s website. And finally, there is a group that we’re working with to try to build nuclear subject matter experts on nuclear—on response to nuclear and radiological events. It’s called the Radiological Operations Support Specialists, the ROSS. And I provided an email address for folks that are trying to work through some planning guidance. And these are folks that are volunteers of a type by FEMA that can come in and provide consistent—you know, some information consistent with the latest guidance documents, help you understand the consequences, answer your questions on a local and state level. So may be something that folks might be interested in. And I provided an email contact to FEMA if you’re interested. FASKIANOS: Fantastic. So, yes, in the Q&A—and Jeff is with the Connecticut Department of Energy and Environmental Protection. The email address is [email protected]. And, again, we will be sending our links, and we can include that email address too, so that you can go there as well, along with the Report 165 that was published by the NCRP. OK— BUSHBERG: Let me just mention, if I could— FASKIANOS: Yes, go ahead, Jerrold. That’s great. Thank you. BUSHBERG: You know, Jeff, thank you for reminding me about those, that I hadn’t mentioned them. But, you know, the Nuclear Regulatory Commission, the Department of Agriculture, Food and Drug Administration, the CDCPA, and FEMA, as you suggest, all have excellent documents on various aspects of responding for—responding to and planning for such events, from very small to very large. And we will provide all those things to the audience, for their use after the conclusion of this event. FASKIANOS: Great. Thank you. I don’t see any more questions from new people, so I’m going to go back to Linda Lewison, who has written a few in the—in the chat. But maybe you could talk a little bit about how is the U.S. protected from the new super weapons from Russia that are going around the world in submarines? Are they—can get they got into a position to attack our coastlines? And, Andrés, maybe you can answer that. GANNON: Yeah. So the new Russian weapons have largely puzzled me, to be honest, because they don’t offer anything new for Russian in terms of targets that they can hit, or in terms of the lethality of potential strikes that exist there. It’s largely been an open secret among the superpowers, even since, you know, the Strategic Defense Initiative way back during the Cold War, that missile defense is almost impossible. It’s incredibly difficult to do. If there was a target in the United States that Russia wanted to hit, they have been able to hit it for decades. What these new weapons do is they provide some degree of speed, which might be helpful in terms of—to minimize the amount of preparedness that can happen at the local level. But I think that that’s largely minor. And a lot of it is political. It’s a way of showcasing their sort of increase resolve or their willingness to do things, because they’re investing more in being able to sort of have a high-technology military. There’s also a lot of just prestige-related reasons why countries want to have the best and the shiniest military capabilities, even if they don’t offer that much strategic utility on the battlefield. We see this a lot with conventional military capabilities, where some of the best U.S. aircraft carriers, for example, or naval and air capabilities are ten, twenty, thirty, forty years old. And they’re really good. Nd the newest ones are marginally better, but not that much better than some of the capabilities that we’re largely relying on. So I think that we should think about these new advanced Russian hypersonic missiles, et cetera, as being less about having military utility in terms of giving them an edge in a conflict, and more about having political utility in terms of how Putin and the Russian government sell this to the Russian public, how they communicate this to the United States, and how they think these things would impact U.S. resolve. So I think a lot of it is theater. And I don’t say that to diminish it. I think that theater is really important. I think a lot of politics is about theater and communication. But it’s about sort of communicating things rather than enacting particular military things differently. FASKIANOS: Thank you. Cindy Wolf has raised—a raised hand. If you want to unmute yourself. Q: Hi. I come from a county that is surrounded by various military installations. But we are remote, and we are an archipelago. So I have some interest in a clarity on time scale and kind of some red flags that we might want to look for in terms of this Ukraine-Russia conflict escalating to something where we would start to need to be concerned about educating our people want to do on short notice. GANNON: I can start with that one. One place that Russia has been oddly unimpressive in the Ukraine conflict is electronic warfare. We have not seen many successful uses by Russia on that front. There’s some sort of hypotheses people are positing now for why is Russia’s electronic warfare so bad? And to clarify, what I mean by that is the parts of warfare that deal with, like, jamming, radar, and communications, making computers unable to work and function, radios, things like that, maybe Ukraine is really good at defending against electronic warfare. They have capabilities that are decent, but nothing that should be way better than what Russia is doing. Maybe Russia can’t jam because their equipment is too similar to the Ukrainians, and so they sort of get their wires cross and it could affect them. But I think that’s an under-discussed part of the Ukraine conflict that has ramifications for exactly what you described. If Russia were to sort of be engaged in a direct conflict against the United States, the first two things that they would need to do, or would be smart for them to do, is, as I mentioned a little bit earlier, direct kinetic attacks on capabilities that would be relevant in U.S. first strike. So targeting U.S. ICBM installations, places like bomber bases where we have sort of nuclear-based bombers, et cetera. And the second is for other things, especially naval and air capabilities, electronic warfare-type strategies to deal with command and control centers that communicate to U.S. capabilities that are deployed further away. So, like, U.S. submarines and surface fleets have communication with the mainland United States for the types of operations that they’re doing overseas. The sort of general best practice in militaries is rather than try to attack every single boat, attack the command and control centers that communicate with those boats to render them in the dark. And that’s a place where we’ve seen Russia performing poorly. So on the one hand, I think that’s some sort of vote of confidence, in an answer to your question, that I don’t think that Russia will be able to turn the lights out at U.S. military bases in the continental United States very, very quickly. On the other hand, that’s something that they know they’re going to have to do. And so I think that this is a place that I expect Russia to try to increase investments to how successful they can be at doing so, given sanctions and the amount of spending in their defense industrial base, I think is hard to say. But I think if you are in a locality that is militarily relevant for the United States, for reasons that are not the first forty-eight hours of warfare—meaning, ICBMs, nuclear bombs, et cetera—then I think that the electronic and the sort of grid capacity is the one that’s the most important to think about, in terms of the immediate effects. FASKIANOS: Thank you. I’m going to take—go ahead, Jerrold. BUSHBERG: Yeah. The only thing I would add to that is I think she asked about, you know, preparation and training. And I believe Jeff was the one that mentioned the FEMA documents and all the planning guidance for response to a nuclear detonation. It’s the third edition that was published in May of 2022. And it is the most recent complication of information that provides guidance not only on preparedness but response and also the guidance for emergency response part of the community, as well as local and state assets. So I would heavily recommend that. And, again, we’ll provide these links after the meeting. FASKIANOS: Great. Thank you. I’m going to take a written question from Commissioner Tyler Shuff, who is the commissioner of the Seneca County Commission: Why aren’t our schools teaching kids what to do in case of the bombs getting stopped? Why and when did this stop? Andrés, have you studied this? GANNON: I have a bit. Part of it is—so, Jerrold was making some good points earlier about sort of the immediate blast radius, and sort of what happens afterwards, the sort of radioactive zone. If you’re in that immediate blast radius, stop, drop, and roll is not going to do a lot for you. I think there was some recognition of that during the Cold War when this was taught, but people need something. We think about sort of the human and the political element of this, I think it’s hard to tell people: Prepare for a nuclear attack the same why that you prepare for an earthquake or a tsunami or a typhoon or a tornado. There is a lot of overlap. Like, 80-90 percent of it is the same. A lot of what Jerrold said about, you know, stay inside, have water, have food, have access to information and batteries and flashlights—that’s the same for all these things. But that’s sort of deeply unsatisfying at sort of a psychological level for people to think, oh, there’s nothing that I should do? There’s nothing that can help if this is nuclear as opposed to just a tornado? And so think that’s a thing from sort of the non, sort of, physical science or radiological perspective. From the political perspective, that’s worth thinking about for messaging, is what can you do to make people feel as if there’s something that is within their control when they come to preparation. I think this is why, like, the iodine tablets are popular, because people can feel, just, I bought something that someone said could help me in certain situations. I think I carry one on me. Oddly, there’s, like, these very small $10 or $15 basically sheets of paper you can have that have a detection of how much accumulation of radiation you’ve gotten on your body. That is mildly helpful in some situations, but it’s not going to make a world of difference. But these are the kinds of things that people want to do and want to think about, something that’s sort of within their control, or some decision that they’ve made. And so I think that your point or your question about why has this stopped in schools is along those lines. That’s just we want to feel as if there’s something that we can do, but it’s really not any different than a lot of the other drills we do for safety. That is, stay calm, stay inside, and make sure that you’re getting your information from trustworthy sources. And I think that last one is a point that we haven’t really explored here and probably don’t have time to, but is an important one for state and local officials to do. We saw, you know, since the 2016 election a lot of misinformation that is coming about politics. And it’s hard to know who to trust. I would be very, very shocked if any nuclear attack was not accompanied by a flurry of misinformation by the attackers about is it safe to go outside? What pills should you take? Where should you go? Who should you listen to? And that’s a place where I think state and local governments can do a lot to inform their people. Here are all the websites, here are the accounts that will tell you the actual information about when it’s safe to go outside. Right, not the person you found on Twitter who sends a picture that says: I’m outside. Everything is fine. That’s the kind of place where I think a lot of education can go a long way, and make people feel as if there is something within their control that they are doing that’s helping with preparation. I think that that’s something that can happen in schools that’s different from fire drills or hide under your desk. But at this point, I think it’s more helpful. BUSHBERG: Yeah, just to amplify that point a little bit—thank you for that—you know, it seems somewhat counterintuitive but I think, you know, people think about evacuating an area that has been subject to such a detonation or an attack. But if you’re outside of that zone of lethality where you haven’t been killed by the blast, that there following such a detonation, people I think instinctively would try and evacuate, or run, or get away. But that’s the wrong thing to do. (Audio break)—detonation is to seek shelter, and seek shelter immediately. And the best shelter is the largest, closest building you can find and be in the—sort of as close to the middle of that building as you can, with as much building on top of you, below you, and on the sides. And this is really to reduce the amount of radiation one gets from fallout. But the most important part of it is that you’re not trying to evacuate, you get stuck in traffic, you know, you have fallout occurring now over the next hours, and that can be lethal from a nuclear detonation if you are exposed to it directly early on. And so I can’t overemphasize the importance of this very, very prompt seeking of shelter, and to stay inside until the emergency and local public health officials can provide additional guidance. FASKIANOS: We have two minutes left. I’m going to just try to sneak in the question—or, a question from Eno Mondesir. If you could be quick, that would be great. And then people—you know, Andrés and Jerrold, if you can answer and give you closing thoughts, that would be terrific. And you need to unmute yourself. OPERATOR: Looks like we’re having some— Q: Sorry. FASKIANOS: Oh, there we go. No problem. Q: Yeah, I just wonder if any of the two experts could tell us how many nations already have nuclear capabilities, and what are the potential ones also? GANNON: So I think the count now is around nine nuclear states. U.S., Russia, China, India, Pakistan, North Korea, U.K., France, Israel. The states that are most likely to develop a nuclear weapon coming up would be Iran, sort of the one that’s being discussed. South Africa is the one case of a country that had a nuclear weapon and voluntarily sort of gave up that capability, which is a real interesting place to—that a lot of people are producing good academic work. So that’s where we are as far as who has nuclear weapons. There’s a weird way of thinking about who’s most likely to use nuclear weapons. Well, one answer is they’re being used every day, and that they are changing states’ calculations about what types of decisions to make and how they interact. Whether that’s a good or a bad thing I think is a subject of very important and unresolved debates, but one that hopefully continues. FASKIANOS: Jerrold, any closing thoughts? BUSHBERG: Well, I would just repeat, you know, really the two key items, which is, you know, if there is a detonation that occurs in Ukraine, there—it will not pose any serious threat to citizens of the United States. And if there were happen to be a detonation in the U.S., outside that zone of lethality it is survivable, if you seek shelter promptly. So we’ll leave it at those two comments. And, again, we can—we will provide these additional links to—where you can go into much greater detail after this seminar is over. FASKIANOS: Wonderful. Thank you so much. So we appreciate you both being with us, Andrés Gannon and Jerrold Bushberg. And again, we will send out the links to this webinar, as well as resources. Please, I encourage you to visit CFR.org, ForeignAffairs.com, and ThinkGlobalHealth.org for more expertise and analysis. And you can email us at [email protected] to offer suggestions of other topics we should cover or speakers that could support the important work that you are doing in your communities. So thank you, again, for being with us today. We appreciate it. And we look forward to reconvening again. (END)
  • Health
    Daughters and Sons Guest Event: A Conversation With Anthony Fauci
    Play
    After more than five decades at the National Institutes of Health, physician-scientist Anthony S. Fauci, MD recently stepped down as director of the National Institute of Allergy and Infectious Diseases (NIAID) and President Biden’s chief medical advisor. Here he discusses his thirty-eight years as NIAID director, the international response to the COVID-19 pandemic; the latest developments with emerging infectious diseases; and how countries should prepare for the next pandemic.