Amidst evolving geopolitical shifts, the foundation of U.S. nuclear deterrence, forged in the crucible of the Cold War, faces a new set of challenges. The principle of mutually assured destruction (MAD), once the bedrock of deterrence, is now being tested by Russia's aggressive posturing and China's strategic advancements. In the wake of Russia's invasion of Ukraine and signals of a willingness to employ tactical nuclear weapons, questions arise about the efficacy of traditional deterrence strategies. Concurrently, China's expanding nuclear arsenal adds complexity to the equation. Do these developments mean America needs to rethink its deterrence strategy? 

In a new paper, “China’s Nuclear Enterprise: Trends, Developments, and Implications for the United States and Its Allies,” FSI Center Fellow Oriana Skylar Mastro focuses on the Chinese perspective of the equation and examines recent trends in Chinese military doctrine and their implications for U.S. deterrence strategy. Mastro’s contribution is part of a new report, Project Atom 2023: A Competitive Strategies Approach for U.S. Nuclear Posture through 2035, produced by the CSIS Project on Nuclear Issues.

A fundamental premise underlying Mastro’s analysis is that China merits distinct scrutiny differently from Russia, and that the two countries should not be considered  “nuclear peers.” Although China is indeed engaging in nuclear force modernization, Mastro contends that the nation is still adhering to its fundamental nuclear policy: minimal retaliation capability and a no-use-first pledge.

While some have been troubled by China’s turn to regional nuclear options like the DF-26, an intermediate-range ballistic missile capable of carrying both conventional and nuclear warheads, Mastro asserts that this is because “they are regional weapons lower on the escalation ladder.” Rather than trying to achieve parity with the United States, she contends that Beijing’s objective is to preserve a credible second-strike capability, which is essential to the concept of deterrence.

Instead of prescribing specific alterations to U.S. force posture or nuclear modernization, Mastro suggests that any changes in U.S. defense strategies carefully consider the impact on Chinese nuclear strategy. The key is to preserve China’s minimal retaliation capability and its pledge to refrain from initiating nuclear warfare: “the most important goal for U.S. deterrence policy should be to ensure it does not encourage a change in China’s nuclear policy and in posture.”

Other steps the United States should take, according to Castro, include preventing the “co-mingling” of nuclear and conventional weapons on vessels apart from ballistic missile submarines. This precaution aims to eliminate ambiguity and mitigate the risk of possible conflict escalation. She also believes that there may be “more costs than benefits” in the proliferation of nuclear weapons among Asian allies — South Korea, Japan, and Australia. These threaten the non-proliferation regime and increase the possibility of accidents. The answer, Mastro holds, is not deployment of U.S. nuclear weapons on foreign soil, but rather increased consultations and joint planning with allies. Such collaborative efforts could reassure allies and partners of U.S. intentions even as they have minimal impact on Chinese contingency planning. 
 

Telemedicine has faced an uphill battle in South Korea and in fact, under the nation’s Medical Services Act, it is currently prohibited, a result of opposition from the medical community and other stakeholders. However, during the height of the COVID-19 pandemic, the South Korean government temporarily allowed for prescriptions and counseling by phone, which gave investigators the opportunity to examine patient preferences toward the service. 

It has been demonstrated that for consultations on chronic diseases—diabetes, hypertension, and heart disease—telemedicine is effectively equal to in-person visits, and moreover is convenient. Previous studies have looked at patient attitudes toward telemedicine but not many have used the COVID-19 pandemic as a backdrop. 

A new study, published in the Asia Pacific Journal of Public Health, helps to address this knowledge gap. The researchers focused on patients with the chronic diseases of diabetes and hypertension in South Korea and asked them about their preferences for telemedicine versus in-person care, including under different levels of recommended social distancing.

The co-authors of the study are Karen Eggleston, director of the Asia Health Policy Program at Shorenstein APARC; Annie Chang, ’21, MS ’22, currently an MD candidate at Icahn School of Medicine at Mount Sinai in New York City, who started the project as a Stanford student; Richard Liang, MD/PhD candidate at Stanford, and Daejung Kim of the Korea Institute for Health and Social Affairs.

The data was collected from a larger study on the impacts of the pandemic on the management of chronic disease in a number of Asian countries.

Chang notes that her research with Eggleston began after taking her course Health and Healthcare Systems in East Asia: “As a Korean American, I was naturally interested in learning more about South Korea and its healthcare system. I had the opportunity to work with Dr. Eggleston during the COVID-19 pandemic, when telemedicine usage surged globally.”

The study findings indicate that respondents did not have a strong preference for telemedicine services during the COVID-19 pandemic. This could be attributed to the prohibition of such services outside of the pandemic, to unfamiliarity with the technology, or to other factors.

However, the results show that attitudes toward telemedicine differed among demographic segments: younger patients, who tend to be more familiar with new technologies, had a higher preference for telemedicine, as did males (who are more likely to be employed, restricting their time for in-person visits), and those whose access to healthcare was more restricted.

This research carries significant policy implications concerning the advancement of telemedicine in South Korea and elsewhere. To make better use of telemedicine, policymakers should raise awareness of and familiarity with the services, especially among older populations who are less comfortable with new technologies. There is also a need to develop basic guidelines for telemedicine practices like reimbursement and data security to encourage the adoption of telemedicine as a viable alternative to in-person consultations.