Around the Halls: Assessing the 2022 National Security Strategy
On October 12, 2022, U.S. President Joe Biden’s administration released the 2022 National Security Strategy (NSS). Brookings experts reflect on the document…
By Shadi Hamid, Daniel S. Hamilton, Ryan Hass, Bruce Jones, Patricia M. Kim, Suzanne Maloney, Amy J. Nelson, Michael E. O'Hanlon, Natan Sachs, Bruce Riedel, Melanie W. Sisson, Constanze Stelzenmüller, Andrew Yeo
On October 12, 2022, U.S. President Joe Biden’s administration released the 2022 National Security Strategy (NSS). Brookings experts reflect on the document and what it reveals about the United States’ security trajectory.
It is little surprise that the NSS has a lot to say about democracy in theory as well as practice. The long struggle between democracies and autocracies, as systems of government, has become the distinctive mark of Biden’s foreign policy.
In the past, I have been critical of the administration’s tendency to instrumentalize democracy by suggesting that its strength and value hinges on its ability to produce “good” outcomes. As I argue in “The Problem of Democracy“, this way of thinking about the democratic idea can easily lead to incoherence. Policymakers have little choice but to be incoherent, some of the time; the world is complicated. Still, identifying these tensions is worthwhile, in anticipation of when they might cause problems for U.S. foreign policy. In this case, they almost certainly will, because they already have.
The NSS says, for example, that “many non-democracies join the world’s democracies in foreswearing these behaviors.” The behaviors in question include “waging or preparing for wars of aggression, actively undermining the democratic political processes of other countries [and] leveraging technology and supply chains for coercion.” The strategy singles out Russia and China as countries that do not forswear such behaviors. But the reason they don’t is related to the fact that they are non-democracies. Either regime type is relevant, or it’s not.
The incoherence is most striking in the Middle East section, which calls for “a more integrated Middle East that empowers our allies and partners will advance regional peace and prosperity, while reducing the resource demands the region makes on the United States over the long term.” Our Arab allies and partners are among the world’s most repressive regimes, so how might empowering them fit into Biden’s insight into the relevance of regime type? To put a finer point on it, the NSS’s discussion of the Middle East seems to contradict — or, at best, lie in direct tension — with much of the rest of the document.
One might take issue with my assessment and highlight Arab non-democracies as the good ones that forswear the aggressive behaviors listed above. But even this wouldn’t be accurate. Two of our closest allies in the region — Saudi Arabia and the United Arab Emirates — wage wars of aggression (Yemen), actively undermine democratic processes in other countries (Tunisia, Egypt), and leverage technology or supply chains for coercion. Again, the reasons are instructive. It is in the nature of authoritarian regimes, when they are regionally dominant, to undermine democratic processes elsewhere in the region. The mere existence of democratic counter-models offers up a constant reminder that another way is possible. And, for such regimes, another way is not possible.
These days, the Middle East is easily dismissed as a distraction. But, as far as regions go, it remains a laboratory for the contradictions at the heart of American policy. To the extent that a “democracy-first” strategy is an organizing principle in the confrontation with China and Russia, U.S. administrations will — sooner or later — have little choice but to reckon with the realities of the world’s most undemocratic region. If organizing principles are only relevant when they are convenient or serve a particular purpose, then they’re not exactly organizing principles.
The NSS clearly articulates U.S. values and interests in a new age of disruption, and offers a compelling strategy for protecting and advancing them. It addresses China’s challenges and Russia’s threats without conflating them, as previous strategies have done. It frames these state-centric tests within a context of growing transnational challenges that the United States will be unable to address alone. It is a sober yet confident strategy that builds on the ingenuity and resilience of the American people, the unique strengths of our oft-maligned democracy, and the capacities offered by our vast and unparalleled networks of alliances and partnerships, reinforced by agile diplomacy and a strong military.
The strategy underscores how U.S. interests are threatened by those who weaponize the interdependencies that were created during the now-bygone post-Cold War era. The United States and our like-minded allies and partners have long been accustomed to protecting our territories. We must now be equally focused on protecting our connectedness – the values that bind us and the critical flows of goods, services, energy, people, and technology that underpin our security and well-being. This is not a strategy of decoupling; it is a strategy to redefine the terms of our interdependence in a competitive and dangerous world. In this new age of disruption, our national security rests on our resilience – as a society, as a partner and ally, and as a global power.
Ryan Hass (@ryanl_hass) Senior Fellow, Center for East Asia Policy Studies and John L. Thornton China Center
Whereas the 2017 National Security Strategy treated China and Russia as an interchangeable threat to America’s security and prosperity, this strategy draws distinctions between them. This NSS clarifies that Russia and the People’s Republic of China (PRC) “pose different challenges” that demand differentiated responses. The NSS explains that the United States “will prioritize maintaining an enduring competitive edge over the PRC while constraining a still profoundly dangerous Russia.”
This shift in how the United States views China and Russia is subtle but significant. It suggests the United States has opted against embracing fatalistic conclusions that nothing can be done to affect the China-Russia relationship and that the United States must simply gird for ideologically infused bloc confrontation. The Biden administration was wise to reject such oversimplified analysis. There is no profit for the United States to treat China and Russia as interchangeable foes. If it did so, Washington would find few followers.
To be sure, the United States’ relationship with both countries will remain confrontational for the foreseeable future. The China-Russia relationship is animated by shared antagonism against the United States. There is virtually no chance the United States will drive a wedge between China and Russia, as it did during the Cold War.
At the same time, painting China and Russia with black and white brushes obscures that those countries do not have perfectly aligned interests. Russia is more of an arsonist of the existing international order, whereas China seeks to be an architect of a revised order. China and Russia have different perspectives on Central Asia and the Arctic. Since China is still rising while Russia is not, Beijing has more to lose and hold at risk than Moscow. Recognizing such distinctions is a critical step toward crafting approaches to act upon them.
The new NSS puts to rest the least edifying debate in Washington: Should geopolitics or transnational threats primarily pre-occupy U.S. foreign policy? The obvious answer, decisively rendered here, is both. There’s no escaping the reality of great power contestation, and the strategy embraces it. But there’s also no escaping the fact that American lives have been profoundly shaken by transnational challenges. The NSS kicks off a needed debate, too, about how to sustain some type of cooperation against shared challenges while contesting vigorously in the strategic domain. But as Chrystia Freeland reminded us in her barn raiser of a speech on October 11, in the Cold War we know how to both contain and engage; time to re-learn that lesson.
The NSS also takes U.S. strategy to a better place in diplomacy, putting the president’s emphasis on the democracy/autocracy divide in a wider context. The text — and even more so, U.S. National Security Adviser Jake Sullivan in his launch speech — makes clear that the United States will work with any state, of whatever regime type, that is willing to work within the framework of the key treaties of the order, especially the U.N. Charter, including China when that is in our interests. Engaging in that way will put us in a stronger position when push comes to shove — as it likely will, in one form or another — and we need to rally support to push back, when China or Russia or others engage in more pernicious behavior.
Patricia M. Kim(@patricia_m_kim)
David M. Rubenstein Fellow, John L. Thornton China Center and Center for East Asia Policy Studies
The 2022 NSS reinforces key themes that have been consistently emphasized throughout the Biden administration — strengthening the United States at home, aligning with like-minded partners, and competing responsibly with China to advance U.S. interests and its vision of a “free, open, secure and prosperous world.” It wisely makes the case the United States must pursue a “dual-track approach” that involves working with both like-minded allies and partners, as well as geopolitical rivals, to address the many global challenges, from climate change to food insecurity, that pose an existential threat to all.
Laudably, the NSS directly confronts the sheer challenge of advancing cooperation among great powers on transnational threats in an era of heightened geopolitical competition. While making clear that the United States rejects China’s attempts to link cooperation on shared challenges to concessions in other areas, the document does not offer any answers on how, then, Washington will actively spur Beijing’s constructive contributions and unlock a “race to the top,” as the NSS puts it.
To be fair, these are extremely difficult questions to answer, and the document sets low, if realistic, expectations for the bilateral relationship with China. The NSS concludes that the United States government will “continually assess and reassess our approach” in the implementation of the strategy, which is a welcome statement as it will be critical to grasp for more imaginative roadmaps, be it with rivals or less like-minded counterparts, to secure the foundations for a more stable and prosperous future in this “decisive decade.”
The long-awaited public release of the NSS contained no real surprises, arriving as it did well after the scaffolding of the administration’s approach to the world had been made tangible over the course of the first half of Biden’s term in office. With an emphasis on the essential synergies between America’s strength at home and on the world stage, the NSS showcases the administration’s industrious track record of initiatives to make progress on both fronts. And it offers a compelling narrative that seeks to reaffirm the president’s stirring rhetoric around the contest between democracy and authoritarianism as the foremost challenge of our times without handcuffing the U.S. policy with intractable Manichaeism or instigating a new Cold War.
However, as with any articulation of strategy, the document inevitably elides the messy tradeoffs inherent in advancing core U.S. interests. As has already been evident, Biden’s stirring rhetoric faces real world complications in its implementation – how to balance the urgent (Russia) with the essential (China); how to build multilateral coalitions that are both “inclusive” and effective; how to counter Beijing’s military and economic aggression while preserving capacity for cooperation around the global commons, especially the climate crisis; and how to strengthen democracy at home and abroad even as the forces threatening these values are amplifying.
This is one of several reasons why the document’s short shrift on the Middle East, while understandable, seems particularly unfortunate. If there is one region where the best of intentions and an enormous investment of strategic energy and resources has come up short in advancing our values or durably securing our stated interests, it is there – in large part due to our disregard of the yawning chasm between our rhetoric and the reality. The NSS is right to decisively draw an end to the 9/11 era, but a reckoning with our own track record will be essential to prevailing in addressing the even more daunting challenges of strategic competition.
Amy J. Nelson (@amyjnelsonphd) David M. Rubenstein Fellow, Strobe Talbott Center for Security, Strategy, and Technology
The NSS reflects an approach to national security that is increasingly inclusive of non-defense factors. It also really amplifies the role of technology in national security, and is particularly notable for its integration of foreign policy with technology policy. The result is an approach that is consistent with the notion that foreign policy and tech policy are increasingly one and the same.
On emerging tech, the NSS calls out its transformational effect on warfare, and the need to invest in technologies for cyber, space, missile defense, AI, and quantum. Importantly, it notes that security requires new tech to be delivered quickly — an age-old struggle for the Department of Defense. Historically, innovating tech and protecting have lived in separate spheres. Because they actually go hand-in-hand, it was good to also see the intent to continue to evolve the U.S. approach to strategic trade controls to protect sensitive technologies and maintain technological superiority and advantage.
The NSS also discusses the role of allies and partners in implementing the strategy at length, leaning heavily on collective action through multilateral partnerships. It notes, for example, the “connective tissue — on technology, trade and security — between our democratic allies and partners” and the “allied techno-industrial base.” This amounts to perhaps a renewal of ties that had frayed under the previous administration, a doubling down on the proliferation of “minilaterals” as strategy, and, critically, the acknowledgement that national security requires technology cooperation among allies.
Also striking is the repeated mention of the word “competition” (44 times) — as if the post-Cold War era is being replaced by one predominantly characterized by a pervasive and unavoidable competition: “We will use impulses released by an era of competition to create a race to the top and make progress on shared challenges.” In this way, competition is described as an unavoidable force that will continue to drive behaviors and shape outcomes. Competition is linked to pervasive technology and its innovation: “Competition to develop and deploy foundational technologies that will transform our security and economy is intensifying.” And competition is again discussed in the context of allies: even among allies, we will experience competition. In this way, the NSS seems to note the implicit tension between the need to work together with allies and partners, pooling “technical expertise and complementary industrial capacity,” while in an era of competition. And this will be a major challenge for decades to come.
Given that I have recently written a fairly positive assessment of the administration’s achievements to date, I will content myself in this short blog with several specific critiques of what is otherwise a solid (if acronym-laden) document. Specifically:
The elevation of China as our top national security concern seems incongruous with the reality that Russia is waging a hot war and making nuclear threats on the other side of the planet. Although the language used to describe China is carefully chosen, and muted — it is a “pacing challenge,” or our “most consequential strategic competitor” according to the NSS — one cannot help but walk away with the sense the administration views China as public enemy number one. To me this is wrongheaded. China wants to bend the existing global order in a direction it desires, but unlike Russia it does not generally seek to break it, and the distinction is important.
The specific accusation that China is committing genocide against the Uighurs of Xinjiang province is also a mistake. I don’t care what the State Department lawyers say: What China is doing there is plenty bad, but it is not genocide. That loaded and inflammatory term has a powerful historic meaning and whatever the PRC’s other flaws, it is not currently guilty of genocide. We need to stay cool in handling this relationship and avoid pushing Beijing closer to Moscow unnecessarily.
Sullivan emphasized in his discussion at Georgetown University on October 12 that we mean no ill will against the Chinese people; our beef is with the PRC government. That is a reasonable point, but it implies that the Chinese people do not share their government’s views on key issues. In fact, however, the Chinese people are themselves nationalistic, and they are themselves insistent that Taiwan is part of China, so it would be wrong to view the current government in Beijing as somehow an outlier on many of the key issues that create discord in the U.S.-China relationship.
North Korea policy remains too purist. We are not going to negotiate complete nuclear disarmament with Pyongyang anytime soon; we need a more serious and incremental strategy that seeks to verifiably dismantle North Korea’s nuclear production capacity and ban future nuclear as well as intercontinental ballistic missile tests in exchange for a partial lifting of sanctions and caps on the size of U.S.-South Korean military exercises. To stay on the current course is simply making the problem worse (as Pyongyang keeps building and testing weapons) and risking another major crisis (we can closer to war in 2017, as well as 1994, than many realize).
Latin America remains close to an afterthought at a time when the opioid crisis is killing 100,000 Americans a year, largely due to drugs coming over the southern border, and when immigration and crime and border issues remain hugely divisive in American politics. The administration needs a big idea akin to a Marshall Plan (or, at a minimum, something on the scale of former U.S. President George W. Bush’s PEPFAR initiative on AIDS) for Central America and Mexico.
The NSS is an ambitious and impressive articulation of a new era of American foreign policy. The Middle East is an uneasy fit: It was the central theater of the past, not the present, and it strains the democracy-themed world order Biden envisions. The NSS thus tries to thread a needle: “The most pressing strategic challenge…” is not from autocracies, per se, but “from powers that layer authoritarian governance with a revisionist foreign policy.” This leaves the door open to partnerships with autocracies if they “subscribe to the rules-based international order.”
The NSS articulates “a new framework” for Middle East policy. It emphasizes freedom of maritime navigation (implying energy supplies), coalition building and diplomacy (an attempted return to the Obama-era Joint Comprehensive Plan of Action). It stresses military deterrence — primarily against Iran — but eschews the military-based approaches of the past (read: Bush 43). It embraces regional integration (invoking the Trump-era Abraham Accords and further efforts under Biden, including the India-Israel-UAE-U.S. quad, aka “I2-U2”, that is still in search of substance). It breaks clearly with former U.S. President Donald Trump in a rhetorical commitment to “promote human rights” and in calling for an Israeli-Palestinian two-state solution “along the 1967 lines, with mutually agreed swaps,” a far cry from the Trump plan.
The new framework for Middle East policy is thus appropriately modest: “It is time to eschew grand designs in favor of more practical steps”. As a secondary theater, the Middle East is now meant to fit into a broader global agenda, rather than dominate it.
BRUCE RIEDEL
Senior Fellow, Center for Middle East Policy and Strobe Talbott Center for Security, Strategy, and Technology, and Director, The Intelligence Project
Biden’s new national security strategy faces an immediate and urgent challenge in the Middle East. America’s oldest ally in the region, Saudi Arabia, has opted to support Russia in its invasion of Ukraine by dramatically cutting oil production to raise prices which benefits Moscow. Since the president unwisely journeyed in July to Jidda to embrace Saudi Crown Prince Mohammed bin Salman, known as MBS, the Saudis have also dramatically stepped up repression of domestic critics, especially women.
So Saudi Arabia fragrantly violates the human rights provision of the new strategy and partners with Russia against NATO. MBS’s closest Arab partner, President and Crown Prince of the United Arab Emirates Muhammed bin Zayd, has just traveled to Moscow to support Russian President Vladimir Putin in person. The Saudis and Emiratis have backed the loser in the war enthusiastically.
So the administration has to show it intends to live up to its promise to support human rights and democratic states against autocratic regimes. It should immediately suspend military cooperation with the kingdom and halt provision of spare parts to the Saudi military. It should rally our NATO allies including Britain and France to do the same. American military forces in the kingdom should be redeployed to Qatar.
The Saudis are led today by a reckless and dangerous prince whom the president rightly said two years ago should be treated as a global pariah. The new strategy is being challenged by that prince, and the administration needs to fight back.
Reading the Biden-Harris administration’s 2022 NSS calls to mind the advice famously dispensed by Coco Chanel: “Before you leave the house, look in the mirror and take one thing off.” In this case, it’s the many criticisms of China – which range from oblique references to unnamed autocracies that “abuse the global economic order” to specific opprobrium of China’s “unwillingness to cooperate” with the international response to COVID-19 and “genocide…in Xinjiang” – that distract the eye from the strategy’s considerable strengths. These inclusions interrupt the overall message, which is that the administration (rightly) is focused on what the United States needs to do at home – invest in the enablers of human security, talent, and productivity – to be able to do what it wants abroad: create conditions that are conducive to the global movement of people, ideas, investments, and goods, and that disincentivize governments from using violence to pursue their national interests.
So too does delivering these demerits in the administration’s marquee document provide Beijing yet more fodder with which to reinforce its narrative that the United States unfairly, and zealously, seeks to contain, constrain, and suppress China. While the administration’s intent may be to draw an explanatory and compelling contrast between the two nations’ visions for international relations, the effect is an unhelpful dilution of its affirmative, pragmatic message and an avoidable addition to China’s negative one.
CONSTANZE STELZENMÜLLER (@ConStelz)
Senior Fellow, Center on the United States and Europe and Fritz Stern Chair on Germany and trans-Atlantic Relations
For Europeans, there is much to like, to respect, and to work with in the Biden administration’s sober and nuanced new national security strategy. Despite endorsing the strategic competition framing of its 2018 predecessor document, it emphasizes the need for cooperation — even with autocrats and adversaries — on global challenges and public goods. It is reassuringly tough on Russia. Even more remarkably, it is both clear-eyed about China’s intent to reshape global order to its liking, and moderate in offering to work together with Beijing on issues of common concern. It acknowledges the importance of democratic allies as essential leverage for American strategic purposes; but it rejects messianic advocacy of democratic transformation and promises repeatedly to work with non-aligned countries that do not share the West’s vision. Despite the United States’ unquestioned leadership in the conflict with the Kremlin, it highlights Europe’s contribution “at the front lines” of the fight to defend Ukraine; and it calls the European Union an “indispensable partner.”
Critics of America — especially in Germany — might note the document’s explicit rejection of some of their favorite strawmen (decoupling from China, bloc-building, a new Cold War). But above all, Europeans should take to heart its strong tone of urgency (“we are in the early years of a decisive decade for America and the world”). The midterm elections may well reinforce that note.
Andrew Yeo (@AndrewIYeo) Senior Fellow, Center for East Asia Policy Studies and SK-Korea Foundation Chair in Korean Studies
The NSS is bold and ambitious in its aim to protect a “free, open, prosperous, and secure world.” But can the United States sustain international order if it remains preoccupied with “out-competing” China?
Competition emerges as a dominant theme throughout the 2022 NSS. Terms such as competition(s), competitor(s), and compete(s) appear no less than 25, 21, and 15 times, respectively. In contrast, cooperation, cooperate, and collaboration/collaborate appear 19, five, and five times, respectively. Including “partnership(s)” adds an additional 18 words.
The Biden administration clearly believes the United States must gear up for serious competition with adversaries in the next decade. The NSS fact sheet also acknowledges the a priori nature of competition, declaring, “We cannot compete successfully to shape the international order unless we have an affirmative plan to tackle shared challenges, and we cannot do that unless we recognize how heightened competition affects cooperation and act accordingly.”
The United States should take a strong stand against actors wishing to undermine a free and open order. However, there is a danger in overselling competition against China. It may unnecessarily create blind spots for opportunities of engagement with China and other adversaries. It can also spook potential partners who may choose to stay on the sidelines rather than become embroiled in zero-sum competition. Finally, it may ultimately harden the lines of a growing bifurcated global order and undermine the inclusive form of governance that is needed to address future problems confronting all of humanity: climate change, pandemics, and nuclear non-proliferation.
It was Jan. 11, 2024 when software giant Microsoft (MSFT) briefly passed Apple (AAPL) as the most valuable company in the world.
Microsoft's stock closed 0.5% higher, giving it a market valuation of $2.859 trillion.
It rose as much as 2% during the session and the company was briefly worth $2.903 trillion. Apple closed 0.3% lower, giving the company a market capitalization of $2.886 trillion.
"It was inevitable that Microsoft would overtake Apple since Microsoft is growing faster and has more to benefit from the generative AI revolution," D.A. Davidson analyst Gil Luria said at the time, according to Reuters.
The two tech titans have jostled for top spot over the years and Microsoft was ahead at last check, with a market cap of $3.085 trillion, compared with Apple's value of $2.684 trillion.
Analysts noted that Apple had been dealing with weakening demand, including for the iPhone, the company’s main source of revenue.
Demand in China, a major market, has slumped as the country's economy makes a slow recovery from the pandemic and competition from Huawei.
Sales in China of Apple's iPhone fell by 24% in the first six weeks of 2024 compared with a year earlier, according to research firm Counterpoint, as the company contended with stiff competition from a resurgent Huawei "while getting squeezed in the middle on aggressive pricing from the likes of OPPO, vivo and Xiaomi," said senior Analyst Mengmeng Zhang.
“Although the iPhone 15 is a great device, it has no significant upgrades from the previous version, so consumers feel fine holding on to the older-generation iPhones for now," he said.
A man scrolling through Netflix on an Apple iPad Pro. Photo by Phil Barker/Future Publishing via Getty Images.
Counterpoint said that the first six weeks of 2023 saw abnormally high numbers with significant unit sales being deferred from December 2022 due to production issues.
Apple is planning to open its eighth store in Shanghai – and its 47th across China – on March 21.
The company also plans to expand its research centre in Shanghai to support all of its product lines and open a new lab in southern tech hub Shenzhen later this year, according to the South China Morning Post.
Meanwhile, over in Europe, Apple announced changes to comply with the European Union's Digital Markets Act (DMA), which went into effect last week, Reuters reported on March 12.
Beginning this spring, software developers operating in Europe will be able to distribute apps to EU customers directly from their own websites instead of through the App Store.
"To reflect the DMA’s changes, users in the EU can install apps from alternative app marketplaces in iOS 17.4 and later," Apple said on its website, referring to the software platform that runs iPhones and iPads.
"Users will be able to download an alternative marketplace app from the marketplace developer’s website," the company said.
Apple has also said it will appeal a $2 billion EU antitrust fine for thwarting competition from Spotify (SPOT) and other music streaming rivals via restrictions on the App Store.
The company's shares have suffered amid all this upheaval, but some analysts still see good things in Apple's future.
Bank of America Securities confirmed its positive stance on Apple, maintaining a buy rating with a steady price target of $225, according to Investing.com.
The firm's analysis highlighted Apple's pricing strategy evolution since the introduction of the first iPhone in 2007, with initial prices set at $499 for the 4GB model and $599 for the 8GB model.
BofA said that Apple has consistently launched new iPhone models, including the Pro/Pro Max versions, to target the premium market.
Analyst says Apple selloff 'overdone'
Concurrently, prices for previous models are typically reduced by about $100 with each new release.
This strategy, coupled with installment plans from Apple and carriers, has contributed to the iPhone's installed base reaching a record 1.2 billion in 2023, the firm said.
Apple has effectively shifted its sales mix toward higher-value units despite experiencing slower unit sales, BofA said.
This trend is expected to persist and could help mitigate potential unit sales weaknesses, particularly in China.
BofA also noted Apple's dominance in the high-end market, maintaining a market share of over 90% in the $1,000 and above price band for the past three years.
The firm also cited the anticipation of a multi-year iPhone cycle propelled by next-generation AI technology, robust services growth, and the potential for margin expansion.
On Monday, Evercore ISI analysts said they believed that the sell-off in the iPhone maker’s shares may be “overdone.”
The firm said that investors' growing preference for AI-focused stocks like Nvidia (NVDA) has led to a reallocation of funds away from Apple.
In addition, Evercore said concerns over weakening demand in China, where Apple may be losing market share in the smartphone segment, have affected investor sentiment.
And then ongoing regulatory issues continue to have an impact on investor confidence in the world's second-biggest company.
“We think the sell-off is rather overdone, while we suspect there is strong valuation support at current levels to down 10%, there are three distinct drivers that could unlock upside on the stock from here – a) Cap allocation, b) AI inferencing, and c) Risk-off/defensive shift," the firm said in a research note.
Major typhoid fever surveillance study in sub-Saharan Africa indicates need for the introduction of typhoid conjugate vaccines in endemic countries
There is a high burden of typhoid fever in sub-Saharan African countries, according to a new study published today in The Lancet Global Health. This high…
There is a high burden of typhoid fever in sub-Saharan African countries, according to a new study published today in The Lancet Global Health. This high burden combined with the threat of typhoid strains resistant to antibiotic treatment calls for stronger prevention strategies, including the use and implementation of typhoid conjugate vaccines (TCVs) in endemic settings along with improvements in access to safe water, sanitation, and hygiene.
Credit: IVI
There is a high burden of typhoid fever in sub-Saharan African countries, according to a new study published today in The Lancet Global Health. This high burden combined with the threat of typhoid strains resistant to antibiotic treatment calls for stronger prevention strategies, including the use and implementation of typhoid conjugate vaccines (TCVs) in endemic settings along with improvements in access to safe water, sanitation, and hygiene.
The findings from this 4-year study, the Severe Typhoid in Africa (SETA) program, offers new typhoid fever burden estimates from six countries: Burkina Faso, Democratic Republic of the Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria, with four countries recording more than 100 cases for every 100,000 person-years of observation, which is considered a high burden. The highest incidence of typhoid was found in DRC with 315 cases per 100,000 people while children between 2-14 years of age were shown to be at highest risk across all 25 study sites.
There are an estimated 12.5 to 16.3 million cases of typhoid every year with 140,000 deaths. However, with generic symptoms such as fever, fatigue, and abdominal pain, and the need for blood culture sampling to make a definitive diagnosis, it is difficult for governments to capture the true burden of typhoid in their countries.
“Our goal through SETA was to address these gaps in typhoid disease burden data,” said lead author Dr. Florian Marks, Deputy Director General of the International Vaccine Institute (IVI). “Our estimates indicate that introduction of TCV in endemic settings would go to lengths in protecting communities, especially school-aged children, against this potentially deadly—but preventable—disease.”
In addition to disease incidence, this study also showed that the emergence of antimicrobial resistance (AMR) in Salmonella Typhi, the bacteria that causes typhoid fever, has led to more reliance beyond the traditional first line of antibiotic treatment. If left untreated, severe cases of the disease can lead to intestinal perforation and even death. This suggests that prevention through vaccination may play a critical role in not only protecting against typhoid fever but reducing the spread of drug-resistant strains of the bacteria.
There are two TCVs prequalified by the World Health Organization (WHO) and available through Gavi, the Vaccine Alliance. In February 2024, IVI and SK bioscience announced that a third TCV, SKYTyphoid™, also achieved WHO PQ, paving the way for public procurement and increasing the global supply.
Alongside the SETA disease burden study, IVI has been working with colleagues in three African countries to show the real-world impact of TCV vaccination. These studies include a cluster-randomized trial in Agogo, Ghana and two effectiveness studies following mass vaccination in Kisantu, DRC and Imerintsiatosika, Madagascar.
Dr. Birkneh Tilahun Tadesse, Associate Director General at IVI and Head of the Real-World Evidence Department, explains, “Through these vaccine effectiveness studies, we aim to show the full public health value of TCV in settings that are directly impacted by a high burden of typhoid fever.” He adds, “Our final objective of course is to eliminate typhoid or to at least reduce the burden to low incidence levels, and that’s what we are attempting in Fiji with an island-wide vaccination campaign.”
As more countries in typhoid endemic countries, namely in sub-Saharan Africa and South Asia, consider TCV in national immunization programs, these data will help inform evidence-based policy decisions around typhoid prevention and control.
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About the International Vaccine Institute (IVI)
The International Vaccine Institute (IVI) is a non-profit international organization established in 1997 at the initiative of the United Nations Development Programme with a mission to discover, develop, and deliver safe, effective, and affordable vaccines for global health.
IVI’s current portfolio includes vaccines at all stages of pre-clinical and clinical development for infectious diseases that disproportionately affect low- and middle-income countries, such as cholera, typhoid, chikungunya, shigella, salmonella, schistosomiasis, hepatitis E, HPV, COVID-19, and more. IVI developed the world’s first low-cost oral cholera vaccine, pre-qualified by the World Health Organization (WHO) and developed a new-generation typhoid conjugate vaccine that is recently pre-qualified by WHO.
IVI is headquartered in Seoul, Republic of Korea with a Europe Regional Office in Sweden, a Country Office in Austria, and Collaborating Centers in Ghana, Ethiopia, and Madagascar. 39 countries and the WHO are members of IVI, and the governments of the Republic of Korea, Sweden, India, Finland, and Thailand provide state funding. For more information, please visit https://www.ivi.int.
Incidence of typhoid fever in Burkina Faso, Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria (the Severe Typhoid in Africa programme): a population-based study
We’ve added 60% to national debt since 2018. Germany - a country with major economic woes - added ‘just’ 32%.
Maybe it will never matter. Maybe MMT is real. Maybe we just cancel or inflate it out. Maybe career real estate borrowers or career politicians aren’t the answer.
I have no idea. Only time will tell. But it’s going to be fascinating to watch it play out.
He is right: it will be fascinating, and the latest budget deficit data simply confirmed that the day of reckoning will come very soon, certainly sooner than the two years that One River's Eric Peters predicted this weekend for the coming "US debt sustainability crisis."
According to the US Treasury, in February, the US collected $271 billion in various tax receipts, and spent $567 billion, more than double what it collected.
The two charts below show the divergence in US tax receipts which have flatlined (on a trailing 6M basis) since the covid pandemic in 2020 (with occasional stimmy-driven surges)...
... and spending which is about 50% higher compared to where it was in 2020.
The end result is that in February, the budget deficit rose to $296.3 billion, up 12.9% from a year prior, and the second highest February deficit on record.
And the punchline: on a cumulative basis, the budget deficit in fiscal 2024 which began on October 1, 2023 is now $828 billion, the second largest cumulative deficit through February on record, surpassed only by the peak covid year of 2021.
But wait there's more: because in a world where the US is spending more than twice what it is collecting, the endgame is clear: debt collapse, and while it won't be tomorrow, or the week after, it is coming... and it's also why the US is now selling $1 trillion in debt every 100 days just to keep operating (and absorbing all those millions of illegal immigrants who will keep voting democrat to preserve the socialist system of the US, so beloved by the Soros clan).
... having already surpassed total US defense spending and soon to surpass total health spending and, finally all social security spending, the largest spending category of all, which means that US debt will now rise exponentially higher until the inevitable moment when the US dollar loses its reserve status and it all comes crashing down.
We conclude with another observation by CNBC's Brian Sullivan, who quotes an email by a DC strategist...
.. which lays out the proposed Biden budget as follows:
The budget deficit will growth another $16 TRILLION over next 10 years. Thats *with* the proposed massive tax hikes.
Without them the deficit will grow $19 trillion.
That's why you will hear the "deficit is being reduced by $3 trillion" over the decade.
No family budget or business could exist with this kind of math.
Of course, in the long run, neither can the US... and since neither party will ever cut the spending which everyone by now is so addicted to, the best anyone can do is start planning for the endgame.
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