Airstrikes are unlikely to deter the Houthis

Jamie Dettmer is opinion editor at POLITICO Europe.

TEL AVIV — In a preemptive bid to warn off Iran and its proxies in the wake of Hamas’ October attacks on southern Israel, United States President Joe Biden had succinctly said: “Don’t.” But his clipped admonition continues to fall on deaf ears.

As Shakespeare’s rueful King Claudius notes, “when sorrows come, they come not single spies but in battalions.” And while exasperated Western powers now try to halt escalation in the Middle East, it is the Iran-directed battalions that are bringing them sorrows.

Raising the stakes at every turn, Tehran is carefully calibrating the aggression of its partners — Hezbollah in Lebanon, Shiite militias in Iraq and Syria, and the Houthis in the Red Sea —ratcheting up to save Hamas from being destroyed by a vengeful Israel. And out of all this needling, it is the Houthis’ more then two dozen attacks in the Red Sea that crossed the line for Western powers — enough to goad the U.S. and the United Kingdom into switching from a defensive posture to launching strikes on dozens of Houthi targets.

As far as Washington and London are concerned, Western retaliation is meant to give teeth to Biden’s October warning, conveying a clear message to Iran: Stop. But why would it?

Privately, the U.S. has reinforced its warning through diplomatic channels. And U.K. Defense Minister Grant Shapps underscored the message publicly, saying the West is “running out of patience,” and the Iranian regime must tell the Houthis and its regional proxies to “cease and desist.”

Nonetheless, it’s highly questionable whether Tehran will heed this advice. There’s nothing in the regime’s DNA to suggest it would back off. Plus, there would be no pain for Iran at the end of it all — the Houthis would be on the receiving end. In fact, Iran has every reason to persist, as it can’t afford to leave Hamas in the lurch. To do so would undermine the confidence of other Iran-backed groups, weakening its disruptive clout in the region.

Also, from Iran’s perspective, its needling strategy of fatiguing and frightening Western powers with the prospect of escalation is working. The specter of a broadening war in the Middle East is terrifying for Washington and European governments, which are beset by other problems. Better for them to press Israel to halt its military campaign in Gaza and preserve the power of Hamas — that’s what Tehran is trying to engineer.

And Iranian mullahs have every reason to think this wager will pay off. Ukraine is becoming a cautionary tale; Western resolve seems to be waning; and the U.S. Congress is mired in partisan squabbling, delaying a crucial aid package for Ukraine — one the Europeans won’t be able to make good on.

So, whose patience will run out first — the West or Iran and its proxies?

Wearing down the Houthis would be no mean feat for the U.S. and the U.K. In 2015, after the resilient Houthis had seized the Yemeni capital of Sana’a, Saudi Arabia thought it could quickly dislodge them with a bombing campaign in northern Yemen. But nearly a decade on, Riyadh is trying to extricate itself, ready to walk away if the Houthis just leave them alone.

The United Arab Emirates was more successful in the country’s south, putting boots on the ground and training local militias in places where the Houthis were already unpopular. But the U.S. and the U.K. aren’t proposing to follow the UAE model — they’ll be following the Saudi one, albeit with the much more limited goal of getting the Houthis to stop harassing commercial traffic in the Red Sea.

Moreover, Western faith in the efficacy of bombing campaigns — especially fitful ones — has proven misplaced before. Bombing campaigns failed to bring Iraq’s Saddam Hussein to heel on their own. And Iran-aligned militias in Iraq and Syria have shrugged off Western airstrikes, seeing them as badges of honor — much like the Houthis, who, ironically, were removed from the U.S. terror list by Biden in 2021. They seem to be relishing their moment in the big leagues.

War-tested, battle-hardened and agile, the Houthis are well-equipped thanks to Iran, and they can expect military replenishment from Tehran. They also have a firm grip on their territory. Like Hamas, the Houthis aren’t bothered by the death and destruction they may bring down on their people, making them particularly difficult to cajole into anything. And if the U.S. is to force the pace, it may well be dragged in deeper, as the only way to stop Iran replenishing the Houthis would be to mount a naval blockade of Yemen.

Few seasoned analysts think the Houthis will cave easily. Tom Sharpe, a former Royal Navy captain and specialist anti-air warfare officer, said he’d suggest “just walk[ing] away.”

“Make going round the Cape the new normal,” he wrote last week, albeit acknowledging he’d expect his advice to be overruled due to the global economic implications. But degrading the Houthis enough to make the Red Sea safe again, he noted, would be “difficult to do without risking a wider regional conflict in which the U.S., U.K. and friends would be seen as fighting on the Israeli side.”

And that is half the problem. Now ensnared in the raging conflict, in the eyes of many in the region, Western powers are seen as enabling the death and destruction being visited on Gaza. And as the civilian death toll in the Palestinian enclave mounts, Israel’s Western supporters are increasingly being criticized for not doing enough to restrain the country, which is determined to ensure Hamas can never repeat what it did on October 7.

Admittedly, Israel is combating a merciless foe that is heedless of the Gazan deaths caused by its actions. The more Palestinians killed, the greater the international outrage Hamas can foment, presenting itself as victim rather than aggressor. But Israel has arguably fallen into Hamas’ trap, with the mounting deaths and burgeoning humanitarian crisis now impacting opinion in the region and more widely.

A recent poll conducted for the Washington Institute for Near East Policy found that 96 percent of the broader Arab world believe Arab nations should now sever ties with Israel. And in Britain, Foreign Secretary David Cameron told a parliamentary panel he feared Israel has “taken action that might be in breach of international law.”

Meanwhile, in addition to issuing warnings to Iran, Hezbollah, and others in the Axis of Resistance to stay out of it, Biden has also cautioned Israeli leaders about wrath — urging the Israeli war Cabinet not to “repeat mistakes” made by the U.S. after 9/11.

However, according to a poll by the Israel Democracy Institute, 75 percent of Jewish Israelis think the country should ignore U.S. demands to shift to a phase of war with reduced heavy bombing in populous areas, and 57 percent support opening a second front in the north and taking the fight to Hezbollah. Additionally, Gallup has found Israelis have lost faith in a two-state solution, with 65 percent of Jewish Israelis opposing an independent Palestinian state.

So, it looks as though Israel is in no mood to relent — and doesn’t believe it can afford to.



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Taiwan’s new president: Five things you need to know about William Lai

TAIPEI — Forget Xi Jinping or Joe Biden for a second. Meet Taiwan’s next President William Lai, upon whom the fate of U.S.-China relations — and global security over the coming few years — is now thrust.

The 64-year-old, currently Taiwan’s vice president, has led the Democratic Progressive Party (DPP) to a historic third term in power, a first for any party since Taiwan became a democracy in 1996.

For now, the capital of Taipei feels as calm as ever. For Lai, though, the sense of victory will soon be overshadowed by a looming, extended period of uncertainty over Beijing’s next move. Taiwan’s Communist neighbor has laid bare its disapproval of Lai, whom Beijing considers the poster boy of the Taiwanese independence movement.

All eyes are now on how the Chinese leader — who less than two weeks ago warned Taiwan to face up to the “historical inevitability” of being absorbed into his Communist nation — will address the other inevitable conclusion: That the Taiwanese public have cast yet another “no” vote on Beijing.

1. Beijing doesn’t like him — at all

China has repeatedly lambasted Lai, suggesting that he will be the one bringing war to the island.

As recently as last Thursday, Beijing was trying to talk Taiwanese voters out of electing its nemesis-in-chief into the Baroque-style Presidential Office in Taipei.

“Cross-Strait relations have taken a turn for the worse in the past eight years, from peaceful development to tense confrontation,” China’s Taiwan Affairs Office spokesman Chen Binhua said, adding that Lai would now be trying to follow an “evil path” toward “military tension and war.”

While Beijing has never been a fan of the DPP, which views China as fundamentally against Taiwan’s interests , the personal disgust for Lai is also remarkable.

Part of that stems from a 2017 remark, in which Lai called himself a “worker for Taiwanese independence,” which has been repeatedly cited by Beijing as proof of his secessionist beliefs.

Without naming names, Chinese President Xi harshly criticized those promoting Taiwan independence in a speech in 2021.

“Secession aimed at Taiwan independence is the greatest obstacle to national reunification and a grave danger to national rejuvenation,” Xi said. “Those who forget their heritage, betray their motherland, and seek to split the country will come to no good end, and will be disdained by the people and sentenced by the court of history.”

2. All eyes are on the next 4 months

Instability is expected to be on the rise over the next four months, until Lai is formally inaugurated on May 20.

No one knows how bad this could get, but Taiwanese officials and foreign diplomats say they don’t expect the situation to be as tense as the aftermath of then-U.S. House Speaker Nancy Pelosi’s visit to the island in 2022.

Already, days before the election, China sent several spy balloons to monitor Taiwan, according to the Taiwanese defense ministry. On the trade front, China was also stepping up the pressure, announcing a possible move to reintroduce tariffs on some Taiwanese products. Cases of disinformation and electoral manipulation have also been unveiled by Taiwanese authorities.

Those developments, combined, constitute what Taipei calls hybrid warfare — which now risks further escalation given Beijing’s displeasure with the new president.

3. Lai has to tame his independent instinct

In a way, he has already.

Speaking at the international press conference last week, Lai said he had no plan to declare independence if elected to the presidency.

DPP insiders say they expect Lai to stick to outgoing Tsai Ing-wen’s approach, without saying things that could be interpreted as unilaterally changing the status quo.

They also point to the fact that Lai chose as vice-presidential pick Bi-khim Hsiao, a close confidante with Tsai and former de facto ambassador to Washington. Hsiao has developed close links with the Biden administration, and will play a key role as a bridge between Lai and the U.S.

4. Taiwan will follow international approach

The U.S., Japan and Europe are expected to take precedence in Lai’s diplomatic outreach, while relations with China will continue to be negative.

Throughout election rallies across the island, the DPP candidate repeatedly highlighted the Tsai government’s efforts at diversifying away from the trade reliance on China, shifting the focus to the three like-minded allies.

Southeast Asia has been another top destination for these readjusted trade flows, DPP has said.

According to Taiwanese authorities, Taiwan’s exports to China and Hong Kong last year dropped 18.1 percent compared to 2022, the biggest decrease since they started recording this set of statistics in 1982.

In contrast, Taiwanese exports to the U.S. and Europe rose by 1.6 percent and 2.9 percent, respectively, with the trade volumes reaching all-time highs.

However, critics point out that China continues to be Taiwan’s biggest trading partner, with many Taiwanese businesspeople living and working in the mainland.

5. Lai might face an uncooperative parliament

While vote counting continues, there’s a high chance Lai will be dealing with a divided parliament, the Legislative Yuan.

Before the election, the Kuomintang (KMT) party vowed to form a majority with Taiwan People’s Party in the Yuan, thereby rendering Lai’s administration effectively a minority government.

While that could pose further difficulties for Lai to roll out policies provocative to Beijing, a parliament in opposition also might be a problem when it comes to Taiwan’s much-needed defense spending.

“A divided parliament is very bad news for defense. KMT has proven that they can block defense spending, and the TPP will also try to provide what they call oversight, and make things much more difficult,” said Syaru Shirley Lin, who chairs the Center for Asia-Pacific Resilience and Innovation, a Taipei-based policy think tank.

“Although all three parties said they wanted to boost defense, days leading up to the election … I don’t think that really tells you what’s going to happen in the legislature,” Lin added. “There’s going to be a lot of policy trading.”



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Ukraine needs a government of national unity

Adrian Karatnycky, a senior fellow of the Atlantic Council and the author of the forthcoming book, “Battleground Ukraine: From Independence to the War with Russia” (Yale University Press).

In recent weeks, discourse about the war with Russia has turned deeply pessimistic in Ukraine.

A difficult Ukrainian counter-offensive, with lesser results than anticipated, has fueled deeply dark discussions about a deadlocked and bloody long-term war with Russia. Meanwhile, analysts and politicians have started to snipe at Ukraine’s military and political leaders, blaming them for the war effort’s failure and even speculating about defeat.

Further feeding this atmosphere of pessimism is evidence of tension between Ukrainian President Volodymyr Zelenskyy and the country’s military command, as well as delays in military aid from the United States. And these pressures now need to be addressed.

Clearly, the period of euphoria propelled by major Ukrainian military victories and territorial advances is over. So, too, is the period of grandiose promises by Ukrainian officials.

Last winter, an official spokesman for the president had proclaimed he expected to spend the next summer in Crimea. No less extravagant a promise was echoed by the head of military intelligence, who predicted Crimea would be liberated within six months, bringing official promises of a major spring counter-offensive with significant territorial gains along with it.

Early battlefield success also contributed to near universal approval for Zelenskyy among Ukrainians. Despite slow Russian advances in the Donbas and scant Ukrainian victories later on, happy talk on the state-dominated TV “marathon” — joint programming produced by the bulk of the country’s main television networks — continued to promote frontline success, helping Zelenskyy maintain his popularity.

All this changed, however, when Ukraine’s 2023 counter-offensive stalled. The massive loss of fighters amid meagre gains and a slow-moving positional war eroded public trust in the president and his team for the first time since the war began.

A subsequent mid-November poll gave Zelenskyy a trust rating of only net 32 percent plus — meaning two-thirds of Ukrainians trusted the president, while a third now did not. This was a steep decline from polls earlier in the year, and far below the trust ratings of the armed forces and their commander, General Valery Zaluzhny.

A later poll conducted for the President’s Office and leaked to the Ukrainska Pravda news site showed Zelenskyy was neck and neck with Zaluzhny in a hypothetical race for president. Moreover, Zelenskyy’s Servant of the People party — which currently holds over two-thirds of the seats in parliament — would see its presence shrink dramatically if elections were held today.

And as Zelenskyy’s support weakens, Ukraine now faces a number of challenges and difficult decisions. These include a deadlock on the front, a rapidly depleting supply of munitions, some erosion of support from Europe, and an impasse in the U.S. Congress over a bill to provide for the military needs of both Ukraine and Israel. His star power notwithstanding, Zelenskyy faces new difficulties in maintaining high levels of military and financial support for Ukraine both in North America and in Europe.

Additionally, the ranks of Ukraine’s armed forces — initially populated by experienced military professionals with combat experience and highly motivated volunteers — have suffered mass casualties during these brutal two years of war. Аs a result, military recruiters — now called “people snatchers” — are scouring cities and villages in search of males aged 18 to 60 for military service. Sometimes, these recruiters are not merely using coercive tactics against draft dodgers but detaining and pressuring those not called or exempt from service into signing on. And such tactics are contributing to justifiable public anger toward the authorities

In addition to such unpopular tactics, Zelenskyy will soon likely need to need to dramatically widen the national military mobilization and shift social spending toward military expenditures, if only to hedge against any decline in, or interruption of, financing from key allies. Both moves will be highly unpopular.

All this doesn’t mean Russia will prevail. Indeed, Ukraine has basically fought Russia to a standstill. Taking minor territorial losses in the Donbas, while gaining modest territory in the south and forcing Russia’s navy to the eastern reaches of the Black Sea, it has effectively restored freedom of navigation for commercial vessels in the sea’s west.

Zelenskyy has also been a courageous and successful wartime leader. But much of this was dependent on steadfast public support. Near-universal domestic approval gave him political carte blanche to shape policy and strategy. But while Ukrainians remain united in their aim of defending the country, unqualified support for Zelenskyy and his policies is declining. And the embattled democracy is subsequently witnessing a revival in national politics.

Zelenskyy’s team itself has contributed to this politicization. After Zaluzhny soberly spoke about the difficulties of Ukraine’s war effort, while providing a road map that could ensure victory, his public comments were shot down by officials from the President’s Office.

In early November, Zelenskyy’s foreign policy advisor Ihor Zhovkva went on national television to assert that Zaluzhny’s statement “eases the work of the aggressor” by stirring “panic,” adding there should be no public discussion of the situation at the front. Zelenskyy himself then chided the general in an interview, warning the military not to engage in politics.

Deputy Head of the Committee on National Security, Defense and Intelligence Maryana Bezuhla piled on, alleging Zaluzhny had ignored U.S. General Mark Milley’s recommendations to mine Ukraine’s border with Russian occupied Crimea back in 2021 — an act of negligence, she implied, that cost Ukraine large swaths of territory in the south. However, Zelenskyy is unlikely to seek Zaluzhny’s dismissal, as it would instantly launch the soldier on a political career.

And that’s not all. On the heels of this kerfuffle, Zelenskyy’s allies in parliament then blocked a visit to Poland and the U.S. by former Ukrainian President Petro Poroshenko. The ostensible reason behind this was a report from Ukraine’s security service suggesting Poroshenko’s trip would be exploited by Russian propaganda. Of particular concern was a planned meeting between Poroshenko and Hungarian Prime Minister Viktor Orbán.

The idea that a seasoned leader like Poroshenko, whose tenure as president earned Western praise for his diplomatic skills, could be manipulated is, on the face of it, preposterous. And it later turned out that Zelenskyy himself would be meeting Orbán and didn’t want to be preempted.

These clear fractures need to be dealt with now.

Furthermore, as importantly, as domestic support erodes, Zelenskyy’s term in office is due to formally expire in May 2024, while the parliament’s four-year term expired in October. New elections are well-nigh impossible with millions of voters outside the country, a million engaged at the front and millions more internally displaced or under Russian occupation. Elections amid bloody combat and constant missiles and drone attacks on urban centers are unlikely, and would require both legislative and constitutional changes.

This issue of expiring mandates would be moot were the ratings of Zelenskyy and his party unassailable, but polls show a creeping disenchantment with both.

In this context, the time is ripe for Ukraine’s president to consider establishing a broad-based government of national unity. Opening the government to opposition and civil society leaders in this way would instantly provide legitimacy to the leadership team, reduce opposition criticism and widen the circle of voices that have the president’s ear.

There are compelling precedents for such a step too. For example, as World War II began, Conservative Prime Minister Winston Churchill understood Britain faced an existential threat that required sustaining national unity and created a broad-based coalition government. Churchill installed his main rival — Labour leader Clement Attlee — as deputy prime minister, and added Labour’s Ernest Bevin, a former trade union leader, to the national unity cabinet.

Similarly, this practice was followed most recently by Israeli Prime Minister Benjamin Netanyahu, who offered opposition party leaders a place in a unity government after Hamas’s brutal October 7 attacks. The proposal was accepted by centrist Benny Gantz.

Since the beginning of his presidency, Zelenskyy has relied on an exceedingly narrow circle of trusted advisors. But while he meets with his top military command, intelligence officials, visiting Western leaders and the media, he has largely shut himself off from civic leaders, political critics and rivals — including some with important foreign policy, national security and economic experience.

Their inclusion in leadership posts would offer Zelenskyy additional input on policy options, allow for discussions of alternative tactics and contribute to new approaches when it comes to external relations. With national unity showing signs of fraying, a government that includes the opposition would truly give it a boost.

The only questions are whether Zelenskyy is flexible enough to overcome his contempt for most opposition leaders, and change his style of governing from highly centralized decision-making to more broad-based consensus-building.



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The right to breathe: how policymakers can tackle severe asthma

Asthma impacts over 330 million people worldwide. While severe asthma makes up only 5-10 percent of cases, it is accountable for over half of asthma-related costs globally.[1] It profoundly affects patients’ lives, undermining their physical, mental and economic well-being, and increasing the risk of preventable deaths. Despite its significance, severe asthma is often overshadowed by other health priorities, leading to inadequate resource allocation and substandard care, further straining already pressured health systems.

Severe asthma outcomes, like many other chronic diseases, are deeply entangled with a wide range of environmental and socio-economic factors. Therefore, addressing it is not merely about medical intervention, but about creating and implementing comprehensive, holistic strategies.

The challenges presented by severe asthma are not beyond our capabilities. Around the globe, there is a wide range of best practices, treatments, and approaches to asthma management. Yet, the path to transformation demands a unified commitment from a broad set of stakeholders, from policymakers to medical professionals, industry, patients and beyond. While the blueprint for a future unburdened by severe asthma exists, it is up to decision-makers to realize it together.

While the blueprint for a future unburdened by severe asthma exists, it is up to decision-makers to realize it together.

And the good news is that progress is already underway. Since autumn 2022, we have collaborated as an international expert group to support the development of the Copenhagen Institute for Futures Studies’ (CIFS) Severe Asthma Index. This tool assesses how 29 OECD countries manage severe asthma across various indicators, such as national strategies, treatment access, hospitalizations, societal costs and air quality, among others.

While the Severe Asthma Index is an important stride in tackling severe asthma, the true test lies in how its insights are applied in practice. Among the many actions needed to be taken to improve severe asthma care, the most pressing concern is policy change.

We have identified three actions, derived from the work we have conducted to date, for policymakers to kickstart strengthening health systems’ approaches to and management of severe asthma:

  1. Development and implementation of national asthma plans and strategies

The Severe Asthma Index has found that less than half of the countries analyzed have a national strategy for asthma, prevention, and management. There is, therefore, a need to formulate and actively implement dedicated national asthma programs, tailored to the unique challenges of individual health systems. These programs should not only emphasize prevention, early detection and diagnosis but also adapt best practices to specific national and local contexts.

Importantly, plans should be situated in the context of long-term strategies for improving population health outcomes.

“In England, work around respiratory illness is gaining traction,” notes Sir David Behan, chair of Health Education England, NHS, and expert group member. “Part of the initiative being developed [is] to ease pressure on the emergency care pathways and hospitals.”  

All approaches should promote awareness on respiratory diseases, support personalized care plans, empower patients and improve training and opportunities for training health care professionals working in respiratory care.

2. Coordination and harmonization of policies and care guidelines

There is a patchwork of country approaches to severe asthma, illustrated by the observation that more than two-thirds of the country guidelines assessed in the Severe Asthma Index do not fully align with the Global Initiative for Asthma’s (GINA) guide for Difficult-to-treat and Severe Asthma in Adolescence And Adult Patients. Policymakers must strive to coordinate their approaches to severe asthma by harmonizing policies and guidelines for asthma care to the greatest possible extent, with the aim of reducing outcome disparities, bolstering equity and promoting health system sustainability.

In doing so, there should be an emphasis on identifying and scaling best practices, promoting cross-border collaboration, and championing holistic solutions informed by the widely-acclaimed Health in All Policies approach.

The Australian National Asthma Council’s Australian Asthma Handbook is a strong example of a best practice in this area that policymakers could draw inspiration from in acting on this point.

3. Supporting improved data collection and the development of a more robust evidence base for severe asthma

Policymakers should incentivize and ultimately mandate improved production, recording and utilization of asthma- and severe asthma-specific data, as well as identifier data such as prescription data, adherence to treatment regimes, lung function analysis and demographic and socioeconomic indicators, following a set of common standards.

Currently, despite the existence of clinical codes for severe asthma, the condition remains significantly underreported in clinical settings due in large part to inconsistent coding practices, leading to an increased probability of patients receiving inadequate care and suboptimal allocation of health system resources. The dearth of severe asthma data and barriers to accessing the few datasets that do exist render it difficult to develop a comprehensive and consistent understanding of the full impact of severe asthma.

National policymakers need to prioritize financial and logistical support for country-level asthma research. Research activities should aim to produce a solid evidence base that will offer a nuanced understanding of each country’s needs, challenges and opportunities regarding asthma care. Support for research activities granted over the long term will enable longitudinal studies so that national trends and progress can be accurately tracked.

Only 3 percent of the European Union’s budget for health [is] spent on lung health, although 13 percent of Europeans have lung disease.

“Only 3 percent of the European Union’s budget for health [is] spent on lung health, although 13 percent of Europeans have lung disease,” says Susanna Palkonen, director of the European Federation of Allergy & Airways Diseases Patients’ Associations (EFA) and expert group member.

The International Severe Asthma Registry (ISAR) initiative provides a strong basis for continued work in this area.

The path ahead requires that these actions evolve in tandem with the latest advancements in respiratory care and approaches to the management and prevention of noncommunicable diseases. This is not simply about updating and developing new policies — it’s about crafting robust and well-rounded solutions that proactively address a health challenge that is both global and local and supporting a much-needed vision for improved respiratory health outcomes.

As we look forward, we cannot just treat asthma. We must transform our approach to ensure that every patient’s right to breathe becomes a global reality.


Author(s):
Patrick Henry Gallen, senior advisor and futurist at Copenhagen Institute for Futures Studies

Bogi Eliasen, director of health at Copenhagen Institute for Futures Studies

Professor Dr. Vibeke Backer, MD, DMSci, chief respiratory physician at Department of ENT and Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark

Sir David Behan, chair Health Education England, National Health System (NHS), U.K.​

Dr. Mark Levy, board member, Global Initiative for Asthma (GINA), U.K.​

Mikaela Odemyr, chair European Lung Foundation (ELF) Patient Advisory Committee; chair Swedish Asthma and Allergy Association, Sweden

Susanna Palkonen, director, European Federation of Allergy and Airways Diseases Patients’ Associations (EFA)  

Professor Dr. Arzu Yorgancıoğlu, chair European Respiratory Society (ERS) Advocacy Council; member of Global Initiative on Asthma (GINA) Board; chair of GINA Dissemination and Implementation Committee; chair of the WHO GARD Executive Committee Turkey 


References:
[1] Al Efraij K, FitzGerald JM. Current and emerging treatments for severe asthma. J Thorac Dis 2015;7(11):E522-E525



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Making water the engine for climate action

Much progress has been made on water security over recent decades, yet for the first time in human history, our collective actions have pushed the global water cycle out of balance. Water is life: it is essential for health, food, energy, socioeconomic development, nature and livable cities. It is hardly surprising that the climate and biodiversity crises are also a water crisis, where one reinforces the other. Already, a staggering four billion people suffer from water scarcity  for at least one month a year and two billion people lack access to safely-managed drinking water. By 2030, global water demand will exceed availability by 40 percent. By 2050, climate-driven water scarcity could impact the economic growth of some regions by up to 6 percent of their Gross Domestic Product per year.

Meike van Ginneken, Water Envoy of the Kingdom of the Netherlands

Right now, the world’s first Global Stocktake is assessing the progress being made toward the goals of the Paris Agreement and global leaders are convening at COP28 in Dubai to agree on a way forward. We have a critical opportunity to catalyze global ambition and recognize that water is how climate change manifests itself. While wealthier, more resilient nations may be able to manage the devastating impacts of climate change, these same challenges are disastrous for lesser developed, more vulnerable communities.

Rainfall, the source of all freshwater, is becoming more erratic. Changes in precipitation, evaporation and soil moisture are creating severe food insecurity. Droughts trap farmers in poverty, as the majority of cultivated land is rain-fed. Extreme drought reduces growth in developing countries by about 0.85 percentage points. Melting glaciers, sea-level rise and saltwater intrusion jeopardize freshwater supplies. Floods destroy infrastructure, damage homes and disrupt livelihoods. The 2022 Pakistan floods affected 33 million people and more than 1,730 lost their lives, while 2023 saw devastating floods in Libya among other places.  

Now more than ever, it is urgent that we work together to make water the engine of climate action. Already, many countries are investing in technology and climate-resilient water infrastructure. Yet, we need more than technology and engineering to adapt to a changing climate. To advance global water action, we must radically change the way we understand, value and manage water with an emphasis on two necessary measures.

First, we need to make water availability central to our economic planning and decision-making. We need to rethink where and how we grow our food, where we build our cities, and where we plan our industries. We cannot continue to grow thirsty crops in drylands or drain wetlands and cut down forests to raise our cattle. In a changing climate, water availability needs to guide where we undertake economic activity.

In a changing climate, water availability needs to guide where we undertake economic activity.  

Second, we must restore and protect natural freshwater stocks, our buffers against extreme climate events. Natural freshwater storage is how we save water for dry periods and freshwater storage capacity is how we store rainwater to mitigate floods. 99 percent of freshwater storage is in nature. We need to halt the decline of groundwater, wetlands and floodplains. But our challenge is not only about surface and groundwater bodies, or blue water. We also need to preserve and restore our green water stocks, or the water that remains in the soil after rainfall. To reduce the decline of blue water and preserve green water, we need to implement water-friendly crop-management practices and incorporate key stakeholders, such as farmers, into the decision-making process.

Addressing the urgency of the global water crisis goes beyond the water sector. It requires transformative changes at every level of society. National climate plans such as Nationally Determined Contributions (NDCs) and National Adaptation Plans are key instruments to make water an organizing principle to spatial, economic and investment planning. Much like the Netherlands did earlier this year when the Dutch parliament adopted a policy that makes water and soil guiding principles in all our spatial planning decisions. Right now, about 90 percent of all countries’ NDCs prioritize action on water for adaptation. NDCs and National Adaptation Plans are drivers of integrated planning and have the potential to unlock vast investments, yet including targets for water is only a first step.

To drive global action, the Netherlands and the Republic of Tajikistan co-hosted the United Nations 2023 Water Conference, bringing the world together for a bold Water Action Agenda to accelerate change across sectors and deliver on the water actions in the 2030 Agenda for Sustainable Development and the Paris Agreement. To elevate the agenda’s emphasis on accelerating implementation and improved impact, the Netherlands is contributing an additional €5 million to the NDC Partnership to support countries to mitigate the impacts of climate change, reduce water-related climate vulnerability and increase public and private investments targeting water-nexus opportunities. As a global coalition of over 200 countries and international institutions, the NDC Partnership is uniquely positioned to support countries to enhance the integration of water in formulating, updating, financing and implementing countries’ NDCs.

One example showcasing the importance of incorporating water management into national planning comes from former NDC Partnership co-chair and climate leader, Jamaica. Jamaica’s National Water Commission (NWC), one of the largest electricity consumers in the country, mobilized technical assistance to develop an integrated energy efficiency and renewables program to reduce its energy intensity, building up the resilience of the network, while helping reduce the country’s greenhouse gas emissions. With additional support from the Netherlands, the International Renewable Energy Agency (IRENA) and the United Nations Development Programme (UNDP), together with Global Water Partnership (GWP)-Caribbean, the government of Jamaica will ensure the National Water Commission is well equipped for the future. Implementation of climate commitments and the requisite financing to do so are key to ensuring targets like these are met.

Water has the power to connect. The Netherlands is reaching out to the world.

Water has the power to connect. The Netherlands is reaching out to the world. We are committed to providing political leadership and deploying our know-how for a more water-secure world. As we look towards the outcomes of the Global Stocktake and COP28, it is essential that we make water the engine of climate action. 



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Transforming HIV prevention in Europe

This article is part of POLITICO Telescope: The New AIDS Epidemic, an ongoing exploration of the disease today.

The world’s battle to end the HIV epidemic is being fought on two fronts. The first involves getting as many people as possible who are living with the virus diagnosed and rapidly onto antiretroviral medication. This reduces the virus inside their bodies to such a low level that it is undetectable and therefore cannot be passed to others. The approach is known as “undetectable = untransmittable” or “U=U*.”

The second front is focused on protecting people from contracting the virus in the first place, even if they have been exposed to it — an approach known as pre-exposure prophylaxis, or PrEP. Taken as prescribed, PrEP makes a person’s body almost entirely resistant to HIV infection.

There is a critical need to bring forward new PrEP options that are informed by and designed for the communities that could benefit from PrEP in Europe.

Jared Baeten MD, PhD, vice president for HIV clinical development at Gilead Sciences

PrEP comprises antiretroviral drugs that can be taken intermittently, around the time someone expects to be sexually active. They protect against the virus in two ways: by increasing the production of antibodies in the cells in the rectal or vaginal lining, making them less receptive to HIV in the first place, and by interfering with the ability of HIV to replicate in the body.

Nearly 5 million people around the world have taken PrEP at least once — including about 2.8 million in Europe — and it has been shown to reduce the incidence of HIV infection during sex by 99 percent. In the European Union, new HIV infections have fallen by about 45 percent since PrEP was licensed in 2016, although this decline is also partly due to U=U.

PrEP as part of combination prevention strategies

Missing doses or running out of PrEP can mean becoming susceptible to HIV again. I via Shutterstock

Today, PrEP comes primarily in the form of an oral tablet, which has the advantage of being cheap to produce and easy to store. But it is not a universal solution. Because it needs to be taken regularly while someone is sexually active, missing doses or running out can mean becoming susceptible to HIV again. What’s more, in the same way that some bacteria are developing resistance to antibiotics, the HIV that does enter the bodies of people who have paused or discontinued their use of PrEP has a greater chance of being resistant to subsequent antiretroviral medications they may then need.

PrEP taken in tablet form is also an issue for people who need to keep their use of PrEP private, perhaps from family members or partners. Having to take a pill once a day or two or three times a week is something that may be hard to hide from others. And some people, such as migrants, who may not be fully integrated with a country’s health care system, may find it hard to access regular supplies of daily medication. Limitations such as these have prompted the development of alternative, innovative ways for people to protect themselves that are more tailored to their needs and life situations. These include longer-acting drugs that can be injected.

Like existing oral medications, injectable PrEP works by preventing HIV from replicating in a person’s body, but its effect lasts much longer. In September, the EU approved the use of the first intramuscular injectable that can be given every two months. Gilead is, until 2027, running trials of another injectable option, which, once the required efficacy and safety have been demonstrated, could be administered subcutaneously just once every six months. This would be more convenient for many people and more adapted to the circumstances of certain populations, such as migrants, and may therefore lead to better adherence and health outcomes.

HIV continues to be a public health threat across Europe, where in 2022 more than 100,000 people were newly diagnosed with HIV.

Jared Baeten MD, PhD, vice president for HIV Clinical Development at Gilead Sciences

Further ahead — but still in the early stages of development and testing — are patches and implants, which would provide a continuous supply of antiretroviral drugs, and immunotherapies. Immunotherapies would comprise a broad spectrum of naturally produced or manufactured antibodies against HIV, which, in theory, would pre-arm their bodies to resist infection.

As more types of PrEP become available, we will see a greater awareness of its benefits, as more people are able to find the version of PrEP that best suits their living conditions and personal requirements. This is a fundamental principle of “combination prevention,” or innovative interventions that reflect the specific needs of the people they are trying to reach.

Preparing for the future

Despite clear scientific evidence of the benefits of PrEP, there are still some hurdles we need to overcome to make it a powerful tool to end HIV altogether. These include investments and funding in prevention and availability, and programs to combat stigma.

Although the EU licensed PrEP in 2016, availability varies across the bloc. In France, the U.K., Spain, Germany and, more recently, Italy, oral PrEP is available at no cost to those who would benefit from it. In Romania, although PrEP is included in the country’s new HIV National Strategy, it is not yet funded, and it is only available via non-governmental organizations that rely on external funding sources. And in Poland, Hungary and Bulgaria, PrEP is not state funded and there are no current plans to make it so. In many member states, even though PrEP is technically licensed, in practice it can be hard to get hold of, in particular for specific communities, such as women, migrants or trans people. Potential users may find it hard, for example, to access testing or even doctors who are willing to prescribe it.

Jared Baeten MD, PhD, vice president for HIV clinical development at Gilead Sciences

Another key challenge that health systems and providers face is communicating the importance of PrEP to those who would most benefit, and thereby increase uptake. Many respondents in multiple studies have indicated that they don’t feel HIV is something that affects them, or they have indicated that there is a general stigma in their communities associated with sexual health matters. And some groups that are already discriminated against, such as sex workers, people who inject drugs, and migrants, may be hesitant to engage with health care systems for fear of reprisals. Again, injectable PrEP could help reach such key populations as it will offer a more discreet way of accessing the preventive treatment.

“There is a critical need to bring forward new PrEP options that are informed by and designed for the communities that could benefit from PrEP in Europe,” says Jared Baeten MD, PhD, vice president for HIV clinical development at Gilead Sciences. “At Gilead, we are excited to engage with communities and broader stakeholders to inform our trials efforts and partner with them in our goal to develop person-centered innovations that can help end the HIV epidemic in Europe.”

Europe is leading the world’s efforts toward ending HIV, but, even in the bloc, PrEP usage and availability varies from country to country and demographic to demographic. If the region is to become the first to end the HIV epidemic entirely, the European Commission, the European Parliament and the governments of member states will need to lead the way in fighting stigma, promoting and prioritizing HIV prevention in all its aspects including innovation in therapeutics strengthening the financing and funding of healthcare systems, and establishing effective pathways to zero transmission to end HIV entirely.

“HIV continues to be a public health threat across Europe, where in 2022 more than 100,000 people were newly diagnosed with HIV,” says Baeten. “HIV prevention is critical and has the potential to change the trajectory of the epidemic, but stigma and other barriers limit the impact that PrEP medications can have on reducing HIV infections in Europe. We all have a responsibility to collaboratively partner to make this work.”

*U=U is true on two premises: taking HIV medicines as prescribed and getting to and staying undetectable for at least six months prevents transmitting HIV to partners through sex. Undetectable means that the virus cannot be measured by a viral load test (viral load <200 copies/mL)



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Kamala Harris at climate summit: World must ‘fight’ those stalling action

DUBAI — The vast, global efforts to arrest rising temperatures are imperiled and must accelerate, U.S. Vice President Kamala Harris told the world climate summit on Saturday. 

“We must do more,” she implored an audience of world leaders at the COP28 climate talks in Dubai. And the headwinds are only growing, she warned.

“Continued progress will not be possible without a fight,” she told the gathering, which has drawn more than 100,000 people to this Gulf oil metropolis. “Around the world, there are those who seek to slow or stop our progress. Leaders who deny climate science, delay climate action and spread misinformation. Corporations that greenwash their climate inaction and lobby for billions of dollars in fossil fuel subsidies.” 

Her remarks — less than a year before an election that could return Donald Trump to the White House — challenged leaders to cooperate and spend more to keep the goal of containing global warming to 1.5 degrees Celsius within reach. So far, the planet has warmed about 1.3 degrees since preindustrial times.

“Our action collectively, or worse, our inaction will impact billions of people for decades to come,” Harris said.

The vice president, who frequently warns about climate change threats in speeches and interviews, is the highest-ranking face of the Biden White House at the Dubai negotiations.

She used her conference platform to push that image, announcing several new U.S. climate initiatives, including a record-setting $3 billion pledge for the so-called Green Climate Fund, which aims to help countries adapt to climate change and reduce emissions. The commitment echoes an identical pledge Barack Obama made in 2014 — of which only $1 billion was delivered. The U.S. Treasury Department later specified that the updated commitment was “subject to the availability of funds.”

Meanwhile, back in D.C., the Biden administration strategically timed the release of new rules to crack down on planet-warming methane emissions from the oil and gas sector — a significant milestone in its plan to prevent climate catastrophe.

The trip allows Harris to bolster her credentials on a policy issue critical to the young voters key to President Joe Biden’s re-election campaign — and potentially to a future Harris White House run. 

“Given her knowledge base with the issue, her passion for the issue, it strikes me as a smart move for her to broaden that message out to the international audience,” said Roger Salazar, a California political strategist and former aide to then-Vice President Al Gore, a lifetime climate campaigner. 

Yet sending Harris also presents political peril. 

Biden has taken flak from critics for not attending the talks himself after representing the United States at the last two U.N. climate summits since taking office. And climate advocates have questioned the Biden administration’s embrace of the summit’s leader, Sultan al-Jaber, given he also runs the United Arab Emirates’ state-owned oil giant. John Kerry, Biden’s climate envoy, has argued the partnership can help bring fossil fuel megaliths to the table.

Harris has been on a climate policy roadshow in recent months, discussing the issue during a series of interviews at universities and other venues packed with young people and environmental advocates. The administration said it views Harris — a former California senator and attorney general — as an effective spokesperson on climate. 

“The vice president’s leadership on climate goes back to when she was the district attorney of San Francisco, as she established one of the first environmental justice units in the nation,” a senior administration official told reporters on a call previewing her trip. 

Joining Harris in Dubai are Kerry, White House climate adviser Ali Zaidi and John Podesta, who’s leading the White House effort to implement Biden’s signature climate law. 

Biden officials are leaning on that climate law — dubbed the Inflation Reduction Act — to prove the U.S. is doing its part to slash global emissions. Yet climate activists remain skeptical, chiding Biden for separately approving a series of fossil fuel projects, including an oil drilling initiative in Alaska and an Appalachian natural gas pipeline.

Similarly, the Biden administration’s opening COP28 pledge of $17.5 million for a new international climate aid fund frustrated advocates for developing nations combating climate threats. The figure lagged well behind other allies, several of whom committed $100 million or more.

Nonetheless, Harris called for aggressive action in her speech, which was followed by a session with other officials on renewable energy. The vice president committed the U.S. to doubling its energy efficiency and tripling its renewable energy capacity by 2030, joining a growing list of countries. The U.S. also said Saturday it was joining a global alliance dedicated to divorcing the world from coal-based energy. 

Like other world leaders, Harris also used her trip to conduct a whirlwind of diplomacy over the war between Israel and Hamas, which has flared back up after a brief truce.

U.S. National Security Council spokesperson John Kirby said Harris would be meeting with “regional leaders” to discuss “our desire to see this pause restored, our desire to see aid getting back in, our desire to see hostages get out.”

The war has intruded into the proceedings at the climate summit, with Israeli President Isaac Herzog and Palestinian Authority leader Mahmoud Abbas both skipping their scheduled speaking slots on Friday. Iran’s delegation also walked out of the summit, objecting to Israel’s presence.

Kirby said Harris will convey “that we believe the Palestinian people need a vote and a voice in their future, and then they need governance in Gaza that will look after their aspirations and their needs.”

Although Biden won’t be going to Dubai, the administration said these climate talks are “especially” vital, given countries will decide how to respond to a U.N. assessment that found the world’s climate efforts are falling short. 

“This is why the president has made climate a keystone of his administration’s foreign policy agenda,” the senior administration official said.

Robin Bravender reported from Washington, D.C. Zia Weise and Charlie Cooper reported from Dubai. 

Sara Schonhardt contributed reporting from Washington, D.C.



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Israel’s appetite for high-tech weapons highlights a Biden policy gap

Within hours of the Hamas attack on Israel last month, a Silicon Valley drone company called Skydio began receiving emails from the Israeli military. The requests were for the company’s short-range reconnaissance drones — small flying vehicles used by the U.S. Army to navigate obstacles autonomously and produce 3D scans of complex structures like buildings.

The company said yes. In the three weeks since the attack, Skydio has sent more than 100 drones to the Israeli Defense Forces, with more to come, according to Mark Valentine, the Skydio executive in charge of government contracts.

Skydio isn’t the only American tech company fielding orders. Israel’s ferocious campaign to eliminate Hamas from the Gaza Strip is creating new demand for cutting-edge defense technology — often supplied directly by newer, smaller manufacturers, outside the traditional nation-to-nation negotiations for military supplies.

Already, Israel is using self-piloting drones from Shield AI for close-quarters indoor combat and has reportedly requested 200 Switchblade 600 kamikaze drones from another U.S. company, according to DefenseScoop. Jon Gruen, CEO of Fortem Technologies, which supplied Ukrainian forces with radar and autonomous anti-drone aircraft, said he was having “early-stage conversations” with Israelis about whether the company’s AI systems could work in the dense, urban environments in Gaza.

This surge of interest echoes the one driven by the even larger conflict in Ukraine, which has been a proving ground for new AI-powered defense technology — much of it ordered by the Ukrainian government directly from U.S. tech companies.

AI ethicists have raised concerns about the Israeli military’s use of AI-driven technologies to target Palestinians, pointing to reports that the army used AI to strike more than 11,000 targets in Gaza since Hamas militants launched a deadly assault on Israel on Oct 7.

The Israeli defense ministry did not elaborate in response to questions about its use of AI.

These sophisticated platforms also pose a new challenge for the Biden administration. On Nov. 13, the U.S. began implementing a new foreign policy to govern the responsible military use of such technologies. The policy, first unveiled in the Hague in February and endorsed by 45 other countries, is an effort to keep the military use of AI and autonomous systems within the international law of war.

But neither Israel nor Ukraine are signatories, leaving a growing hole in the young effort to keep high-tech weapons operating within agreed-upon lines.

Asked about Israel’s compliance with the U.S.-led declaration on military AI, a spokesperson for the State Department said “it is too early” to draw conclusions about why some countries have not endorsed the document, or to suggest that non-endorsing countries disagree with the declaration or will not adhere to its principles.

Mark Cancian, a senior adviser with the CSIS International Security Program, said in an interview that “it’s very difficult” to coordinate international agreement between nations on the military use of AI for two reasons: “One is that the technology is evolving so quickly that the description constraints you put on it today may no longer may not be relevant five years from now because the technology will be so different. The other thing is that so much of this technology is civilian, that it’s hard to restrict military development without also affecting civilian development.”

In Gaza, drones are being largely used for surveillance, scouting locations and looking for militants without risking soldiers’ lives, according to Israeli and U.S. military technology developers and observers interviewed for this story.

Israel discloses few specifics of how it uses this technology, and some worry the Israeli military is using unreliable AI recommendation systems to identify targets for lethal operations.

Ukrainian forces have used experimental AI systems to identify Russian soldiers, weapons and unit positions from social media and satellite feeds.

Observers say that Israel is a particularly fast-moving theater for new weaponry because it has a technically sophisticated military, large budget, and — crucially — close existing ties to the U.S. tech industry.

“The difference, now maybe more than ever, is the speed at which technology can move and the willingness of suppliers of that technology to deal directly with Israel,” said Arun Seraphin, executive director of the National Defense Industrial Association’s Institute for Emerging Technologies.

Though the weapons trade is subject to scrutiny and regulation, autonomous systems also raise special challenges. Unlike traditional military hardware, buyers are able to reconfigure these smart platforms for their own needs, adding a layer of inscrutability to how these systems are used.

While many of the U.S.-built, AI-enabled drones sent to Israel are not armed and not programmed by the manufacturers to identify specific vehicles or people, these airborne robots are designed to leave room for military customers to run their own custom software, which they often prefer to do, multiple manufacturers told POLITICO.

Shield AI co-founder Brandon Tseng confirmed that users are able to customize the Nova 2 drones that the IDF is using to search for barricaded shooters and civilians in buildings targeted by Hamas fighters.

Matt Mahmoudi, who authored Amnesty International’s May report documenting Israel’s use of facial recognition systems in Palestinian territories, told POLITICO that historically, U.S. technology companies contracting with Israeli defense authorities have had little insight or control over how their products are used by the Israeli government, pointing to several instances of the Israeli military running its own AI software on hardware imported from other countries to closely monitor the movement of Palestinians.

Complicating the issue are the blurred lines between military and non-military technology. In the industry, the term is “dual-use” — a system, like a drone-swarm equipped with computer-vision, that might be used for commercial purposes but could also be deployed in combat.

The Technology Policy Lab at the Center for a New American Security writes that “dual-use technologies are more difficult to regulate at both the national and international levels” and notes that in order for the U.S. to best apply export controls, it “requires complementary commitment from technology-leading allies and partners.”

Exportable military-use AI systems can run the gamut from commercial products to autonomous weapons. Even in cases where AI-enabled systems are explicitly designed as weapons, meaning U.S. authorities are required by law to monitor the transfer of these systems to another country, the State Department only recently adopted policies to monitor civilian harm caused by these weapons, in response to Congressional pressure.

But enforcement is still a question mark: Josh Paul, a former State Department official, wrote that a planned report on the policy’s implementation was canceled because the department wanted to avoid any debate on civilian harm risks in Gaza from U.S. weapons transfers to Israel.

A Skydio spokesperson said the company is currently not aware of any users breaching its code of conduct and would “take appropriate measures” to mitigate the misuse of its drones. A Shield AI spokesperson said the company is confident its products are not being used to violate humanitarian norms in Israel and “would not support” the unethical use of its products.

In response to queries about whether the U.S. government is able to closely monitor high-tech defense platforms sent by smaller companies to Israel or Ukraine, a spokesperson for the U.S. State Department said it was restricted from publicly commenting or confirming the details of commercially licensed defense trade activity.

Some observers point out that the Pentagon derives some benefit from watching new systems tested elsewhere.

“The great value for the United States is we’re getting to field test all this new stuff,” said CSIS’s Cancian — a process that takes much longer in peacetime environments and allows the Pentagon to place its bets on novel technologies with more confidence, he added.



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AWS digital sovereignty pledge: A new, independent sovereign cloud in Europe

From day one, Amazon Web Services (AWS) has believed it is essential that customers have control over their data, and choices for how they secure and manage that data in the cloud. Last year, we introduced the AWS Digital Sovereignty Pledge, our commitment to offering AWS customers the most advanced set of sovereignty controls and features available in the cloud.

AWS offers the largest and most comprehensive cloud infrastructure globally. Our approach from the beginning has been to make AWS sovereign-by-design. We built data protection features and controls in the AWS cloud with input from financial services, health care and government customers — who are among the most security- and data privacy-conscious organizations in the world. This has led to innovations like the AWS Nitro System, which powers all our modern Amazon Elastic Compute Cloud (Amazon EC2) instances and provides a strong physical and logical security boundary to enforce access restrictions so that nobody, including AWS employees, can access customer data running in Amazon EC2. The security design of the Nitro System has also been independently validated by the NCC Group in a public report.

With AWS, customers have always had control over the location of their data. In Europe, customers who need to comply with European data residency requirements have the choice to deploy their data to any of our eight existing AWS Regions (Ireland, Frankfurt, London, Paris, Stockholm, Milan, Zurich and Spain) to keep their data securely in Europe. To run their sensitive workloads, European customers can leverage the broadest and deepest portfolio of services, including AI, analytics, compute, database, internet of things, machine learning, mobile services and storage. To further support customers, we’ve innovated to offer more control and choice over their data. For example, we announced further transparency and assurances, and new dedicated infrastructure options with AWS ‘Dedicated Local Zones’.

To deliver enhanced operational resilience within the EU, only EU residents who are located in the EU will have control of the operations and support.

Announcing the AWS European Sovereign Cloud

When we speak to public-sector and regulated-industry customers in Europe, they share how they are facing incredible complexity with an evolving sovereignty landscape. Customers tell us they want to adopt the cloud, but are facing increasing regulatory scrutiny over data location, European operational autonomy and resilience. We’ve learned that these customers are concerned that they will have to choose between the full power of AWS or feature-limited sovereign cloud solutions. We’ve had deep engagements with European regulators, national cybersecurity authorities, and customers to understand how the sovereignty needs of customers can vary based on multiple factors, like location, sensitivity of workloads, and industry. We recently announced our plans to launch the AWS European Sovereign Cloud, a new, independent cloud for Europe, designed to help public sector organizations and customers in highly-regulated industries meet their evolving sovereignty needs. We’re designing the AWS European Sovereign Cloud to be separate and independent from our existing ‘regions’, with infrastructure located wholly within the European Union, with the same security, availability and performance our customers get from existing regions today. To deliver enhanced operational resilience within the EU, only EU residents who are located in the EU will have control of the operations and support for the AWS European Sovereign Cloud. The AWS European Sovereign Cloud will launch its first AWS Region in Germany available to all European customers.

Built on more than a decade of experience operating multiple independent clouds for the most critical and restricted workloads.

The AWS European Sovereign Cloud will be sovereign-by-design, and will be built on more than a decade of experience operating multiple independent clouds for the most critical and restricted workloads. Like existing regions, the AWS European Sovereign Cloud will be built for high availability and resiliency, and powered by the AWS Nitro System, to help ensure the confidentiality and integrity of customer data. Customers will have the control and assurance that AWS will not access or use customer data for any purpose without their agreement. AWS gives customers the strongest sovereignty controls among leading cloud providers. For customers with enhanced data residency needs, the AWS European Sovereign cloud is designed to go further and will allow customers to keep all metadata they create (such as the roles, permissions, resource labels and configurations they use to run AWS) in the EU. The AWS European Sovereign Cloud will also be built with separate, in-region billing and usage metering systems.

Delivering operational autonomy

The AWS European Sovereign Cloud will provide customers with the capability to meet stringent operational autonomy and data residency requirements. To deliver enhanced data residency and operational resilience within the EU, the AWS European Sovereign Cloud infrastructure will be operated independently from existing AWS Regions. To assure independent operation of the AWS European Sovereign Cloud, only personnel who are EU residents, located in the EU, will have control of day-to-day operations, including access to data centers, technical support and customer service.

Control without compromise

Though separate, the AWS European Sovereign Cloud will offer the same industry-leading architecture built for security and availability as other AWS Regions. This will include multiple ‘Availability Zones’, infrastructure that is placed in separate and distinct geographic locations, with enough distance to significantly reduce the risk of a single event impacting customers’ business continuity.

Continued AWS investment in Europe

The AWS European Sovereign Cloud represents continued AWS investment in Europe. AWS is committed to innovating to support European values and Europe’s digital future. We drive economic development through investing in infrastructure, jobs and skills in communities and countries across Europe. We are creating thousands of high-quality jobs and investing billions of euros in European economies. Amazon has created more than 100,000 permanent jobs across the EU. Some of our largest AWS development teams are located in Europe, with key centers in Dublin, Dresden and Berlin. As part of our continued commitment to contribute to the development of digital skills, we will hire and develop additional local personnel to operate and support the AWS European Sovereign Cloud.

Our commitments to our customers

We remain committed to giving our customers control and choices to help meet their evolving digital sovereignty needs. We continue to innovate sovereignty features, controls and assurances globally with AWS, without compromising on the full power of AWS.



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Atopic dermatitis: Timely access is needed now

Moderate-to-severe atopic dermatitis (AD) is not just an itch and may not just go away on its own.

It is neither a small rash nor just some dry skin, and it doesn’t only impact children.

The fact of the matter is that one in three pediatric AD patients have moderate-to-severe disease. Not all will outgrow their AD; those that don’t face a lifetime of disruptive symptoms. A lifetime of intense itching, redness, inflammation and discomfort can have a profound impact on an individual’s physical and emotional well-being.

Misunderstandings about the complex nature of the condition means that AD is often managed with less-than-optimal outcomes. However, too many people require more than just topical and anti-inflammatory treatment. In fact, millions who live with moderate-to-severe AD without the necessary treatment experience lifelong implications, impacting life events such as education, career, marriage and personal family decisions.

Furthermore, AD has implications beyond the individuals living with it. Being a caregiver for someone living with AD can have substantial mental, physical and financial consequences. For example, research has shown that parents can spend approximately 22 hours a week applying any treatment they can find for their children – including moisturizers, wet wraps or bleach baths – to alleviate painful, chronic, debilitating flare-ups of inflamed, raw and bleeding skin.

Ensuring children with AD and their caregivers have appropriate access to effective treatment can be vital to address the frustrating, inefficient and recurring cycle of time-consuming visits to general practitioners.

Ensuring children with AD and their caregivers have appropriate access to effective treatment can be vital to address the frustrating, inefficient and recurring cycle of time-consuming visits to general practitioners to try and manage symptoms and stop chronic flare-ups. Importantly, this approach would not only improve health outcomes, but it could also positively impact AD patients and their families.

Impact of AD is beyond the visible and the individual

While it is easy to think of AD as a skin disease, the lifetime impact of the condition on a person is more than what people see.

While it is easy to think of AD as a skin disease, the lifetime impact of the condition on a person is more than what people see.

For instance, missing school and social activities can become a normal occurrence for children with severe AD. Their daily routine is frequently overshadowed by appointments, treatments and flare-ups, as well as the emotional burden of shame and low self-confidence about their physical appearance. This burden results in some children struggling to keep up with their peers, which has a bearing on their quality of life and their educational and social development. A study has shown that 12.5% of children under three who have severe AD experience developmental delays in motor skills, communication, relationships and play.

An often-overlooked aspect of living with AD is that the condition can lead to significant sleep disturbances, often caused by persistent itching.

“Sleep is a huge factor that’s affected by AD and lack of sleep affects every aspect of your life. It doesn’t allow you to concentrate in school if you’re sleep deprived [and] you’re definitely more moody,” explained Dr. Patrick Finklea, a pediatrician and parent of a child living with AD.

As children get older, AD-associated issues broaden the gap with their peers, leading to increased social difficulties, isolation and a significant mental health impact. According to a survey from the National Eczema Association, 20% of parents say that their child is bullied at school because of their eczema (including AD, the most common form of the condition) and 75% highlight that their child experienced lower self-esteem as a result.

In addition to the physical and emotional strain on caregivers, the financial burden of attempting to alleviate a child’s chronic symptoms, arising from lifestyle adjustments, lost wages and out-of-pocket costs, are substantial. Caregivers may also have to consider a career change or give up work altogether due to the demands of looking after someone with AD.

Act now to ensure a brighter future

It is vital to stop thinking about AD as a childhood issue – one that will be outgrown. Instead, it needs to be prioritized as a serious lifelong condition and recognized as a chronic and debilitating disease with lasting and profound impacts.

It is vital to stop thinking about AD as a childhood issue – one that will be outgrown. Instead, it needs to be prioritized as a serious lifelong condition and recognized as a chronic and debilitating disease with lasting and profound impacts; a disease that not only affects the individual but also the social ecosystem.

In Europe alone, the total direct cost to society associated with moderate-to-severe AD is estimated at €30B annually.

Given the substantial individual and societal costs of AD, decision-makers need to urgently implement an effective response to meet the needs of patients. In Europe alone, the total direct cost to society associated with moderate-to-severe AD is estimated at €30B annually. Therefore, prioritizing investment in early and effective AD interventions – including timely access to specialists and effective treatments – can have significant impacts on the overall cost and outcomes of disease management.

As MEP Sirpa Pietikäinen (EPP, Finland) said at a POLITICO Spotlight debate last year, “Countries always reimburse the cheapest drug on the market, then the next cheapest, then the next one. This ladder approach is wasting money and enabling the condition of the patient to deteriorate so much they can’t recuperate.”

We call on decision makers to implement evidence-based policies to improve access to care and prioritize timely intervention to manage AD – all with the aim to advance the health and well-being of individuals and contribute to the long-term economic and social prosperity of society.

MAT-GLB-2305184 V1.0 | October 2023



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