Will computers decide who lives and who dies? Ethics, Health, and AI in a COVID-19 world

“Brother! You doubting Thomases get in the way of more scientific advances with your stupid ethical questions! This is a brilliant idea! Hit the button, will ya?”

Calvin addressing Hobbes regarding the ‘Duplicator‘ (Waterson, 1990)

While talk about a post-COVID-19 world is ripe, reflecting more the desire for an economic relaunch than the medical reality of the moment, we are still struggling to understand the effects that the pandemic is having on our societies. Those ripple effects are likely both to outlive the pandemic, and even to make themselves visible after the pandemic has hopefully been eradicated. 

One of the conversations that has emerged most clearly is linked to the use of Artificial Intelligence (AI) in healthcare, and concerns both its effectiveness and its ethics. This article will follow two major ethical questions that have dominated the public sphere up to now: the use of data tracking systems for forecasting viral spread, and the possible use of AI as decision support for the allocation of medical resources in emergency situations. The main question underpinning this article is: how will our approach to these challenges impact our future?

Exploring the possible answers to this question will lead us to analyse the impact of the dynamic socio-cultural environment on the predictive capacities of algorithm-based AI models. The article will emphasise the importance of integrating culturally specific dimensions in developing and deploying AIs, and discuss how to approach ethics as applied to AI in a culturally aware manner. 

COVID-19

The pandemic we are living through has generated a series of unforeseen effects on local, regional and global scales. From raising instances of racism and subsequent domestic violence in conjunction with the lockdown measures, to major disruptions in human activities that may generate the biggest economic contraction since World War II, we are experiencing a combination of phenomena that reminds us of the interconnectedness of our world. 

The SARS-COV2 virus appeared in a context of decreased trust in public institutions and in scientific expertise at a global level, against a background of the increased dominance of social media in spreading fake news and pseudo-scientific theories. This was a perfect storm, which has allowed not only the weakening of democratic institutions and the rise of authoritarian leadership, but also the rapid spread of the virus itself. 

At the global level all efforts are geared towards controlling the spread of the virus, creating a vaccine, and treating those affected. Naturally, eyes turned to Artificial Intelligence and to the possibility of using it as a tool to help in these efforts. This process has revealed, and continues to reveal, complex and rather problematic interactions between AI models and the reality in which they are deployed, as well as the conflict between competing AI ethical principles.

Ethics: principles versus practices

In a lecture at Tübingen University, the former UN Secretary-General Kofi Annan said: “One thing that should be clear is that the validity of universal values does not depend on their being universally obeyed or applied. Ethical codes are always the expression of an ideal and an aspiration, a standard by which moral failings can be judged, rather than a prescription for ensuring that they never occur.” 

This is a powerful statement, touching at the core of the ethical challenges of leadership. However, it may also contain a major flaw: while ethical codes can be framed as an expression of universal aspirations, the standards by which we may judge moral failings cannot equally be universal. Whether we like it or not, morality is culturally dependent – and moral failings may certainly fall into a cultural blind-spot for many of us. Yet this does not mean that we can advocate abdicating universal ethical codes in the name of ‘cultural particularities’ (although this is a current practice among authoritarian figures, particularly regarding respect for human rights). It merely means that we need to be aware of how these aspirational universal codes are expressed in daily practices, and how the transformation of these practices can (and does) generate new moral norms that in their turn shed light on those very cultural blind-spots. 

Let’s take an example: Valuing human life is a universal ethical code. But what type of human life is more ‘valued‘ than others in different societies? And how do these societies make decisions on that basis? Is a young life more valuable than an old one? How is this valuing expressed in daily practices? Is life at any cost more valuable than an individual choice to ‘not resuscitate‘, or to retain dignity in dying? Is it possible to have an ‘equally valuable‘ approach to human life even in moments of scarcity? Is collective survival more important than individual well-being – and can these even be separated? 

These types of questions have emerged forcefully during the current COVID-19 pandemic crisis, and scientists, ethicists, and politicians are tackling the answers – or acting as if they knew them already. 

To continue, let’s follow two major conversations that have dominated the public sphere lately: the use of data tracking systems for forecasting viral spread, and the possible use of AI as decision support for the allocation of medical resources in emergency situations. By analysing the conversations and practices around this topic, this text will advocate a bottom-up approach towards the use of AI. The main arguments are that sometimes ethical codes may compete among themselves, and that trying to codify them in universally applicable AI algorithms would probably lead to the emergence of new types of biases instead of eliminating the existing ones. Thus, both deciding on the instances of using AI, and designing & relying on AI as decision-making mechanisms need to have the practices that embody moral norms as their starting points, and not universal ethical codes and their presumed possible codification in AI algorithms. The immateriality of AI models has received a reality check, and the same is about to happen to AI ethics.

A material world

At a higher level of analysis, the pandemic is a reminder that our world is material, despite a discourse that everything has now been virtualised, from markets to life itself. All of a sudden COVID-19 has forced us to experience at least three major types of materialisations: 

Materialisation of borders. While borders have not always been easy to cross, and some frontiers have been more material than others, in the past three months the transboundary movement has come to almost a complete halt. Most countries in the world have become inaccessible to those who are not their citizens or residents, and repatriation has more often than not been the only type of existing international travel. As I write this text the lockdown is easing in the European Union, but many other countries around the world remain closed to foreigners. 

In parallel, extraordinary forms of collaboration at regional and global levels have shown that only the continuation of an open type of approach may offer long-term solutions, for example the German hospitals taking in French patients at frontier regions in order to relieve the over-stretched French hospitals. At the same time, displays of solidarity have also been received with suspicion, raising questions about the use of solidarity as a mechanism of soft power, particularly in the case of China. 

(De-)Materialisation of movement. Movement has become at once materialised and virtual. Movement has entered a controlled phase at all levels during lockdown, with much of the workforce entering a mass experiment of working from home. Many who perceived the ability to move as ‘natural‘ are now experiencing it for the first time as a privilege. And movement has been displaced onto online platforms, dematerialising itself into bits and pieces of data (more on this later).

Materialisation of our bodies. Most importantly, we have been called upon to acknowledge the full extent of the importance of our bodies. We, individually and collectively, have dramatically come to realise that our lives are very real and unequivocally linked to our material bodies. The variations of the abstract indicators of the economy show that the entire global complex system is not separated from, but is in fact heavily dependent on our human bodies, their health and their movement (see above). This will contribute to the gradual dismantling of the illusion that we may have had that we live in a virtual world in which the body is only an instrument among others, a tool to be refined in gyms and yoga sessions, or a resource to overstretch during long, caffeine-fuelled working hours. Somehow our bodies have become ourselves again.

Tracking

The data tracking systems (DTS) are not a novelty, and their use by the police is quite widespread in the US. So is their use by marketing companies that rely on ’data from individual users to push products through targeted advertising. As early as 2012 the question of data tracking while surfing the internet was brought to the public’s attention’. The generalisation of the use of smartphones has made possible the extension of tracking from virtual movement to material movement in space and time. Apps, which use the phones’ GPS system and a scantily disguised but default option for the user (‘allow the app to access your location’), track, store, and sell movement data to third parties for the purpose of marketing and targeted publicity. In some instances police forces can use the same data to track movements and ‘prevent crime’ – a contested practice that is not yet fully understood, let alone regulated. 

The European Union (EU) enacted a data protection act (the General Data Protection Regulation 2016/679, implemented as of May 2018) that obliges developers to allow for security protection, pseudonymisation and/or anonymisation of users in designing their products, and to fully inform and obtain consent from the consumers regarding their use of data. This regulation impacts the use of data tracking systems (DTSs), and makes it more difficult to apply it indiscriminately or sell it to third parties (as US-based corporations tend to do). More recently the EU has adopted a series of white papers regarding the more general use of AI, to which I will return. 

DTSs combine borders, movements and bodies, and recreate them in the immaterial world of algorithms, while juxtaposing them with pre-designed models, assigning the individual user to typologies within the models. It does not matter if the models are of consumer habits, potential delinquency, or the likelihood of paying off one’s mortgage. The trouble with models in AI has largely been discussed in the literature (O’Neil, 2019; Broussard, 2018; Galison, 2019), and it emerges from a few major sources: 

  1. The models are based on previous behaviour and aggregated data, and have a probability rate of correct identification. This means that they are not 100% accurate. While this may not be a major problem in cases in which we have models of success for an athlete’s performance, it is highly problematic if they are used to decide upon the finances of or the delivery of justice to individuals. It also means that they function as long as the reality matches the conditions within which the data has been collected, and they are highly dependent on the data quality and accuracy. Under normal circumstances (read long periods of status quo), the models more or less function as designed (my emphasis). But as the COVID-19 crisis has shown, any sudden disruption causes ‘model drift’: that is, the models no longer correspond to reality, and they need to be redesigned. This was first signalledin Amazon’s use of AI, and then spotted in all the major industries that use Artificial Intelligence.
  2. The use of proxy measurements in order to decide the value attributed to a typology. For example, in order to decide if one is a good educator, a model may use the measurement of children’s performance in a specific exam. However, that in itself depends on a series of other factors that have nothing to do with the educator’s qualities and qualifications. At the same time, performance scores may be tackled if an educator feels threatened in her livelihood, giving birth to further distortions (see O’Neil).
  3. Models are designed by humans, and more often than not they embed the biases held by their designers and developers. This is also a frequently discussed topic in AI ethics. The solutions offered range from increasing the diversity in designer and product development teams to renouncing the use of the tool itself altogether. 

With the COVID-19 pandemic, eyes have turned towards the possibility of using DTSs in order to predict and prevent the rapid spread of the virus by creating early warning mechanisms. The idea is relatively simple: once downloaded, the DTS apps track the user’s movements using their phones, and identify whether the user has been in the vicinity of someone who is already registered as being COVID-19 positive. The app would then alert the user, and also create an anonymous map of possible viral spread.

AI ethicists raised the first concerns, particularly having to do with the tension between two major ethical principles in AI: the autonomy of the user (including rights to privacy) and usage for the common good. First, the DTS cannot offer 100% autonomy, particularly when the GPS system is being used for tracking. When movement data becomes health data (as in this case), anonymity is all the more important. Individual health data is highly sensitive; it is stored in highly secure environments, anonymised and used exclusively by specialists in healthcare. What if movement is health? What if one’s own movement is used in the aggregated data set in order to evaluate, through approximate models, one’s health – and eventually sold to interested third parties? Can we decide based on this data who can and who cannot return to work, travel, or even visit friends? What about getting the treatment one may need?

This dilemma has generated different responses, and the solutions proposed gravitate around a twofold approach: use the device’s Bluetooth systems instead of the GPS to signal proximity only (and not location), and store all the relevant data on the device (and not on third parties’ servers). Downloading and using the app is voluntary. A diversity of apps featuring these solutions are being deployed as I write. 

The US took a fragmented approach, leaving the development and deployment of tracing apps, and the subsequent ethical decisions, to the latitude of private companies. European countries have a more centralised approach, in that the governments are more involved in financing and developing the apps, with features that must meet European privacy standards. Germany has only just started rolling out its 20-million euro app, and is reassuring its users that the data will not be made accessible to the platform provider they use (Android or Apple), but only to public healthcare specialists in the country. At the same time, Norway has decided to withdraw its own app because its reliability was questionable at the very least. Being based on voluntary download and reporting, and built on the assumption that people always carry their smartphones with them, the Norwegian government concluded that the app’s models do not necessarily correspond to human behaviour. 

To the external observer, the situation seems to be completely different in those countries that appear to have a centralised, all-powerful system of data tracking and AI use, such as China. While a European observer may readily conclude that the balance between the common good versus individual anonymity has already tilted towards the former in China’s case, and that China can already use its Social Credit System in order to track and prevent COVID-19 spread, this is not precisely the reality of the situation. The approach in China actually seems to be more fragmented than in some European countries. Some provinces have developed their own DTSs; some of the apps use GPS, while others are based on the user voluntarily inputting their location. Regional governments and cities may use different apps that may result in different ‘health scores’ assigned to the same person. As Ding (2018) observes in his analysis of China’s AI strategy, the Western perception is that AI deployment in China is top-down and monolithic, hypercentralised and controlled, with no room for ethics. But this is far from the truth, as Ding shows in his work. This perception is a common trope of the depiction of the ‘East’ in Western popular thinking. While the doctrine of social peace and its attainment does guide the actions taken in China, ethical debates are still present and are being conducted by private enterprises, such as Tencent’s Research Institute.

In conclusion, the use of DTSs poses ethical dilemmas because they reveal the opposition between individual autonomy and the common good, and they raise practical issues regarding accuracy and efficiency because of the way in which data is collected, stored, and used.

Triage 

The spread of COVID-19 has put serious strain on healthcare systems in many countries, and each of them has had to find a different way of coping with the crisis. From avoiding testing and sending home those patients who were not in a critical state, as happened in the UK in the first phase of the pandemic, to carefully planning the lockdown and the bed allocations in places like Germany, the entire range of systemic behaviour has been displayed during this crisis. Among these, uplifting shows of solidarity between countries have been displayed, for example when border hospitals from Germany accepted patients from neighbouring France in order to help ease congestion in the French system. 

The strain on hospital beds and respiratory units, and the need to allocate scarce resources to an increasing number of patients in critical states have placed a lot of pressure on medical personnel. Ideally every national health system should have guidelines for extreme situations such as pandemics. More often than not, though, these guidelines contain a set of recommendations about triaging the patients and allocating scarce resources, but they do not necessarily describe practical ways in which these recommendations can be implemented. Thus, nurses and doctors are left scrambling to devise their own procedures in this type of emergency. 

The particularity of this pandemic is putting strain on the Intensive Care Units (ICUs) rather than on Emergency Rooms (ER). ERs around the world are currently using a diversity of triage systems, where one usually decides what type of treatment a patient needs, and in what order of emergency. This is different from the pandemic situation in overstretched ICUs, where treatment may not be available for everyone who needs it, and access to it has to be selective. This is an important distinction, and this is what happens today in many ICUs around the world. ER triage procedures do not apply to this situation. So what are the healthcare providers around the world doing? They are trying to follow the recommendations and to devise their own procedures, in order not only to best serve their patients and the common good, but also to reduce their own enormous emotional stress. There are a few criteria they may use, and as Philip Rosoff, ethicist and MD at Duke University explained, we know how not to take a decision of this kind: not in a rush, not at the bedside, and not using judgment based on privilege. In his words, in healthcare, at least in the US, there are ordinary situations in which there is a distinction made between VIPs and VUPs (Very Unfortunate Persons). In the case of the COVID-19 pandemic this distinction is eliminated, and so is the question of age. Age is not a decisive factor in providing treatment in case of scarcity (contrary to what some may believe). 

The only criterion that should play a role, Rosoff explained, is the clinical chances the patient has of surviving. This can be assessed by healthcare professionals based on the healthcare records of the respective patient and on the current clinical state displayed. Here, one can see that AI-powered tools may come into play to a very significant degree. Electronic Health Records (EHR) facilitate the preservation of patients’ medical history and, combined with the data of the current chart of a patient, they could theoretically match the patient’s history and current state with a recommendation regarding a triage decision. This may provide certain relief in high-stress situations, and the decision may be supported by this type of evidence-based approach. 

However, two important factors need to be taken into consideration here: 

  1. The AI models embedded that pass a judgment on the state of health of the patients may themselves be flawed: the use of proxy measures in order to establish the state of a patient’s health (such as the money they have spent in the past x years on health-related issues) can be very misleading: for example, one such AI-powered tool kept showing that black patients’ health is much better that of white ones, and as a result they may receive less medical attention. This was in fact due to a reversed causation: blacks in the US receive less medical attention due to financial hardships and systemic racism, resulting in their spending less money on health. The AI system considered this a sign of good health. If a subsequent decision is taken based on this, it will in fact continue the spiral of inequality (Obermeyer et al., 2019). 
  2. The risk of errors induced by the way in which the humans interact with the machines. One important element in AI as a decision support tool, particularly in healthcare, is that the system should remain a tool for support, and should not be transformed into a decision-maker. However, the high emotional stress combined with the workload experienced by health workers may generate the so-called “suspension of clinical thinking”, that is, taking the AI’s recommendation as the ultimate authoritative decision. In other words, under a variety of circumstances, particularly high stress, humans may be tempted to offload the weight of the decision onto the machine. While this may be possible in a driverless car, it may prove disastrous in medical settings. Ironically, it seems easier (although it is not) to create an algorithm advising doctors (because everything happens between the screen and the health worker) than an integrated AI system that drives a car. 

In conclusion, AI may provide assistance in patient triage for resource allocation in a pandemic situation, but it should not be transformed into an automated decision-making instrument, precisely because previous biases and model dysfunctionalities may create irremediable medical errors. And of course, the question of accountability may have to be considered.

AI ethics and models

Both the instances analysed above (DTSs and the possible use of AIs in triage for medical resource allocation in the ICU) have in common concerns regarding ethics. 

We should distinguish between making an ethical decision and the method with which we arrive at that decision. The methods used to arrive at an ethical decision are the equivalent of ethical codes, or principles. The decisions we take (or which we let the AI take in an automated manner) are the result of choosing the precedence of one principle or code over another. When subsequently analysing the decision under the lenses of a different code, the decision taken may appear unethical.

In ethical decision-making theories, there are five major methods of coming to an ethical decision: the utilitarian approach (make the most good and the least harm), the rights-based approach (what best protects the moral rights of those affected), the fairness and justice approach (whether the decision is fair), the ‘common good’ approach, and the virtue approach (is the decision in accordance with the decision-maker’s values?).These methods are present and expressed as AI ethical codes in most of the approaches.

Currently a series of bodies are devising principles for creating ethical AIs, that is, the things one needs to take into consideration when designing and using AIs. The EU has put forth seven principles for trustworthy AI: Human agency and oversight, Technical robustness and safety, Privacy and data governance, Transparency, Diversity, Non-discrimination and fairness, Societal and environmental well-being, and Accountability. Under each of these principles we can find a list of recommendations meant to explain what they mean. Under privacy and data governance we may find anonymity, respect for individual rights; under Societal and environmental well-being we may find concerns for the common good, and so on. As argued above, these principles may compete in different cases. They are also highly abstract, and they may mean different things in different socio-cultural contexts.

AI models interact with institutional, social and cultural contexts, and may fail if they are not designed for the appropriate context. In fact, this happens in most cases where AIs work directly with humans: a very recent example comes from health again, when a retina scan AI diagnosis system by Google performed perfectly in lab conditions but failed consistently in Thailand. This happened simply because the workflows differed from the lab, the light conditions were variable, and the health technicians understood the deployment of machines as an authoritative measure to which they had to respond perfectly; sometimes they photoshopped the images so that the AI algorithm would accept the quality of the shot.

Ethical models do the same, and in order to avoid drift, we should develop them by starting with observing practices. The ethical codes themselves do not exist in theory, 

despite the fact that some ethicists generate them theoretically first. In fact they are initially expressed in different practices. Their very meaning is translated through practices; but practices vary in time and space. Different practices show the cracks in the models, as in the AI deployment cases. We should look at practices and their variations first in order to make our way back to judgements on values and ethics. Returning to the question of rights and valuing life: how is this expressed in various practices? How can we design decision-making mechanisms (automated or not) that correspond to the variability of practices and their dynamic transformations? 

Matter matters

The major lesson for AI and for ethics which COVID-19 has taught us is that adoption means adaptation in a world in which matter matters. Therefore we must conclude: 

  • AI is a tool: it does not need to be ethical (it’s absurd). It should be designed in accordance with ethical principles understood contextually, leading to it acting ethically within the context. Therefore, we first need to understand the context – ask an anthropologist.
  • Assume that models are always wrong. Models do not drift because people behave weirdly – they drift to begin with because they are models; their accuracy is limited over time, and the faster we change, the faster they drift. Carrying them across contexts will implicitly lead to drift. So first, one needs to study the model’s cultural context (regional, institutional, professional) and to work one’s way back from there into the design of the AI systems. 
  • The design process should start in the field, and not in labs. We need to design for the cultural context: build models starting with reality, and do not try to model reality on abstract models (including ethics) – sooner or later they will drift, and one of the domains in which they fail is ethics. 
  • And last but not least, we need to create constant evaluation feedback loops. Remember, AI is material: it has a material support and it interacts with the material world. That means it is not going to flow smoothly. Be prepared to reassess and adjust based on how the adoption process develops. 

COVID-19 is here to stay. There is no post-COVID world. Even if a vaccine becomes readily available, the virus will only be subdued by its generalised use. Just as with measles or polio, stopping vaccination would mean the return of the virus. The ripple effects of the current pandemic will be felt in economy, culture, and politics. For AI it means both a great opportunity to show where it is really helpful, and a wake-up call to demystify some of the hype around it. One major lesson is that AI not only interacts with a material world in continuous transformation, but that its functioning depends on this very materiality (and material culture). The crisis has also re-emphasised the importance of understanding socio-cultural variations (geographical or institutional) when approaching ethics, and to be more aware of the ethical implications of AI design, deployment and adoption. One major question that was overlooked till recently would be: what domains and instances need the deployment of AI? Is AI as a decision-making support a really good idea in a particular domain or not? Should we automate decision-making support in all domains? Should we optimise everything just because we can? As Rosoff observed in his dialogue with David Remnick, healthcare is a multibillion-dollar business in the US. In this particular context, optimising processes with AI may not always be in the best interest of the patient. So let’s be patient, and instead consider where AI can be useful, and where it has the potential of becoming a ‘weapon of math destruction’. 

References:

Broussard, Meredith (2018). Artificial Unintelligence. How Computers Misunderstand the World. Cambridge, Massachusetts and London, England: The MIT Press.

Ding, Jeffrey (2018). Deciphering China’s AI Dream The context, components, capabilities, and consequences of China’s strategy to lead the world in AI. Centre for the Governance of AI, Future of Humanity Institute, University of Oxford.

Galison, Peter, ‘Algorists Dream of Objectivity’, in Brockman, John (ed.) (2019) Possible Minds. 25 Ways of Looking at AI. New York: Penguin Press. pp. 231-240

O’Neil, Cathy (2019). Weapons of Math Destruction. How Big Data Increases Inequality and Threatens Democracy, New York: Broadway Books.

Obermeyer, Ziad, Brian Powers, Christine Vogeli, Sendhil Mullainathan (2019), ‘Dissecting racial bias in an algorithm used to manage the health of populations’, Science, Vol. 366, Issue 6464, pp. 447-453, DOI: 10.1126/science.aax2342

Waterson, Bill (1990). ‘Calvin and Hobbes’, January 9, 10, 11, in The Complete Calvin and Hobbes, Book Three 1990-1992, Kansas City, Sydney, London: Andrew McMeel Publishing, p. 9

The West should avoid the Beatles’ predicament and become more like the Rolling Stones – interview with Dr. John C. Hulsman

In your latest book – To Dare More Boldly; The Audacious Story of Political Risk – you talk about the ‘butterfly effect’ (where random events have outsized consequences), and quote the British prime minister Macmillan – “Events, dear boy, events.” Do you see COVID-19 in such a disruptive manner for the international order? What trends, new or old, would you expect to accelerate? 

Going into COVID-19, there was a 20-year pattern, a generational pattern of a poker game between the Europeans, the Chinese and the Americans. The Americans were the richest people at the poker table, the Europeans were the oldest player, while the Chinese were the up-and-comer. And every year in the game the Chinese tended to win, the Americans broke even and the Europeans lost for a variety of reasons. Now with COVID-19 you see all the cards thrown up in the air. The question is who plays them fastest and best. COVID-19 was a disruptive event to a very routinised and predictable pattern.

Crises don’t tend to make things new; they tend to clarify things that are already going on.China has already been rising, but now that it’s getting through COVID-19 quicker, it has a first-mover advantage. It got hammered in the first quarter but it’s coming out now, whereas the Americans and the Europeans are going to be hammered in the second quarter. So in the short run, the Chinese have the freedom to act while all their enemies are preoccupied. So what do the Chinese do? They are going to settle their unfinished business, because no one is going to stop them. China is on the march. They crack down on Hong Kong, they bully the Indian army along its shared Himalayan border, they cause trouble in Vietnam and the South China Sea. All these moves suggest that they know that in the short run they have an advantage. Everyone is going to be preoccupied so they are going to be aggressive. The problem with being aggressive is that doesn’t change the longer-term problem that they have. The Chinese economy is 14 trillion dollars, while the American one is 22 trillion dollars. The US is still by far the dominant economy in the world, while China is clearly second. By bullying all the neighbours, the Chinese are giving the United States a tremendous opportunity to gather allies both in Europe and in Asia, NATO plus the Quad basically, and a League of Democracies in the long run. If the United States can husband together the resources of NATO and the Quad-plus (Australia, India above all, Japan plus the ASEAN countries) in a global League of Democracies, the US will be in a perfectly good position. The Chinese have an immediate, fantastical advantage, but they are overplaying that, because they don’t see the strategy behind things. 


“Events, dear boy, events.”

Harold Macmillan and John Kennedy had totally different histories, and that explains their different points of view. I have a historical approach to political risk, as opposed to most of my competitors that have a more political science approach. History is the experience of lived life, the way we’ve lived in society since time began, meaning it’s empirically based on how humans actually behave. So here is a man whose entire cast of life was shaped by Balliol College, Oxford and WWI (of the 28 students who were in his year at Balliol, only one other classmate survived the Great War), and he has this gloomy view of human affairs; Kennedy, on the other hand, has this WWII rationalist can-do kind of mind-set. They got along really well: they were both intellectuals, both had a sense of humour, had fairly decent lives, but when Macmillan says to Kennedy, what do you worry about, Kennedy the rationalist said he worried about the deficit and nuclear weapons – things with numbers, political science stuff. Kennedy was scared of the known. Macmillan, on the other side, is a historian and says, “I worry about the events, I worry about the things I don’t know are coming, I worry about the unknown.” COVID-19 is the greatest example of that. 


Is Donald Trump the right steward and the ideal builder of a League of Democracy? The concept is an old one – it was used by John McCain in his 2008 campaign, now it’s being embraced by Joe Biden as a core concept of his foreign policy.

The easy answer is that he is not the right guy. I am unique among the people you are going to interview. I neither love or hate Trump. Most analysts love or hate Trump. It gets in the way of their analysis. I don’t love or hate the people I analyse. I analyse. As a disruptive force, Trump has done some good things. It has forced the Europeans to pay more money for NATO. I was polite to Europeans for 20 years. How much progress did I make? Thank you for laughing. Zero. Trump made good inroads in Central and Eastern Europe. That’s a good thing. Trump got most of the Americans to see China as the next Cold War enemy. That’s an incredibly important historical thing. When I left Washington everybody was pro-Chinese. When I go back everyone is a hawk. Trump is the catalyst in that change. All that is to the good. 

Saying that, given that world I just described, smart realists have always said that institutions can be a force multiplier for power. Hard realists don’t think that. Of course, institutions should be used as power maximisers. NATO and the Quad are two great examples. This nuanced argument is what separates realist internationalism from isolationism and unilateralism. So no. It disturbs me that he spends all his time insulting our friends. It disturbs me that he doesn’t see that it is in America’s interest – if you really are ‘America first’ – to work with as many natural democratic allies as humanly possible. He is very useful on pointing the finger at China, but to best China you need a different kind of leader. 

On the other hand let’s not assume that that is a Wilsonian democrat who doesn’t understand the power realities of the world at all. Talking shops are no good if they are talking shops. If they maximise power and reach common decisions that suit people’s interests, then they are good. Joe Biden has his own problems to deal with. More importantly for him, he has a real record of weakness on China. He has been part of the old pro-Chinese consensus, and this is going to come to bite him, and I imagine Trump will spend a lot of energy on that. Frankly neither of them is ideal for the world we are living in. But it is up to those of us across the party lines that see that the League of Democracy is the future to band together for this argument, and take someone who is not a natural ally and convert him to this idea. 

How can the West be re-invented as a geopolitical & geo-economical unit for a world shaped by great-power competition? Should we start planning in terms of the resilience of the West? What initiatives should be contemplated for strengthening the West?

That is the question. We have to remember what unites us, and not necessarily the obvious things that divide us. We need to go back to first principles. We are democratic. When we see what the Chinese are doing in Xijiang province with a million people in concentration camps; when we see the door closing on freedom in Hong Kong, where they totally neutralised the agreements made in 1997 to the British and where the ‘two systems, one country’ mantra falls apart; when we see the way they threaten the Taiwanese for nearly having democratic elections; when we see them throwing their weight around in the South China Sea; when they ignore international ruling and treaties that don’t suit them, or trying to bully the democratic Indian state – this is all part of a larger pattern. Yes, I am a realist; there are times when you have to engage authoritarian countries, when you have common interests you have to do things with them. However, values do matter. In the West we share a certain way of looking at the world: individuals matter, the state doesn’t dominate everything, we have free internal elections where people make the decision, when I mention Thomas Jefferson is a common point of reference, when we say democratic, we broadly mean the same thing. This is a tremendous amount in common, and it puts us on the side of the Hong Kong protesters, on the side of the Uighurs, on the side of the Indians, on the side of the Hague Court ruling on the law of the sea. It puts us all on the same side on all these policy issues. Let’s take a deep breath and remember: for as annoying as a NATO meeting can be – and God, they can be annoying – it is better to have friends with disagreements than be surrounded by people who don’t see the world as we do, and normatively are against it.

Second point, the US needs to be agnostic about Europe. Through COVID, Europe has yet another navel-gazing exercise about what it is: is it a Hamiltonian state? (which I think it will never be, given its history) is it a Jeffersonian confederation? (that might be possible) or a free formation of nation states? That isn’t our concern. That’s up for Europeans to decide.

The more the US meddles in that, the worse we will do. Obama overdid it with Brexit by saying we will never support Brexit; that didn’t help the cause. And Donald Trump overdoes it by saying ‘I hate everything the EU does’.

That doesn’t help either. We need to say that because we share democratic norms, that’s up to you. What is up to us is that – whether Hamiltonian, Jeffersonian, or free nation states – we will work with you. We want to work with you: we share interests, we share values. 

In Asia it is much easier because the Chinese are throwing their weight around. I would argue that we are in a better strategic position in Asia than Europe because, with the Chinese doing all these things, the outcome is that our new best friends are the old best friends. We are closer to Japan, Australia and India (that is the key to the region) than we have ever been. This happens not because we are nice guys, but because the Chinese are behaving like a neighbourhood bully and an offshore balancing friend is always better than the bully next door. Even the ASEAN countries that are not democratic, like Vietnam, are doing things with us because they are aware they’re next door to a very angry and a very brutal neighbour.

To unite the West we need to find ways to get the Europeans interested in a common position that says, yes, you can commercially do things with China given certain limitations, but let’s be very careful not to sell the strategic silver and pay the butcher. For this reason we need common standards against Huawei. We didn’t let the bloody KGB run the telephone network in the 1980s, why should we let Huawei in the British network now?

Given the Chinese situation, we need Europeans to play a role there. Europe is great with trade. This Cold War will be much more about trade, about standards, things that are European strengths. At the same time, Europe has a tradition of being involved in Asia. We need Europeans to do more in a global way. If we do all these things, and at the same time work on a free trade deal (here Biden would be much better than Trump) – a version of TTIP with Europe uniting Europe and the US at last – this will put the West in a much better position. The worst thing Trump has done was getting rid of TPP. We had a brilliant trade deal with all of Asia who was united in an anti-Chinese, pro-free trade, pro-American position, and we threw it away. Easily the worst thing we’ve done. We need to go back to first principles, and resurrect those alliances and link that world together. We need to remember that we have each other. If we do all those things, that is an agenda for a Harry Truman-style presidency and that is what we need back – a transformative presidency policy that will resurrect the West. 

You are always the best in crafting gifted metaphors to explain visually key geopolitical predicaments. So let’s discuss a bit the implications of the Beatles vs. Rolling Stones as alternative futures for the West.

The problem with foreign policy is that you have to know in what system you are – is the system stable, and how is the power working in the system? Rather than talking about what in IR we are calling Waltzian systemic analysis (I am bored even saying that), instead it seemed to me more interesting to talk about the breakup of the Beatles, as a cautionary tale for today’s Western world as a whole, and the rise of the Rolling Stones. We all understand the story and you can visualise it. The basic point is that the Beatles in a very short period of time went from being a very stable, very happy band, and everything was great from about 1965 to 1967, when they did their best work – they do Rubber SoulRevolver and Sgt. Pepper’s Lonely Hearts Club Band. The reason everything worked so well was that the system was stable. George Harrison got two to three songs, Ringo got one, with everything else being Lennon/McCartney originals. Everybody was happy with that system. That system began to break down because George Harrison got better and better, John Lennon lost interest and Paul McCartney was resentful for being the force holding the band together when it frankly would do other things.

In a very short period of time, between 1967 to 1970, the whole thing breaks up. What makes it a great metaphor is to put geostrategic realities in that. What does the world look like today? If the global ordering system is the Beatles, then John Lennon is Europe utterly preoccupied with himself, with Yoko Ono, with his past, wanting to get out from the tours around the world – neo-isolationist, self-involved, and not very helpful. When I go to Germany I talk to them about China; they are polite, but they are more interested in the future of the EU, how do we get off our knees economically, what we are going to do with the French – that’s what drives them. They are not driven by China, it’s a longer term issue.

Europe is doing a pretty good impersonation of John Lennon.

On the other hand, the US is a harassed Paul McCartney. We keep calling NATO meetings demanding more from people, we keep calling meetings with the Quad in Asia and demanding people work together.

But we are angrier as we do it, hence the Trump phenomenon. We keep grinding everyone up, we are resentful, they are resentful. Eventually this is what happens with Paul McCartney. Increasingly, Paul finally says in 1970 – I’ve had enough, I am going my own way – Make Paul Great Again. 

George Harrison is China in this scenario. He can’t understand why, despite his increasingly dominant position, he still was not being given real opportunities to rise in the Beatles’ system. He soon becomes resentful and distrustful, and after a while he says I don’t like the system anymore, it doesn’t give me room to grow so I want out. So by the time we hit the ’70s, they all want out for different reasons, and the system breaks down. 

We are at this key moment at about 1968 in this analogy, the system hasn’t broken down yet, but nothing new has taken its place. One of the outcomes is that things break down, and we have naked jungle-living great-power competition. But there is another model, the Rolling Stones – a system that evolves over time to change to the power reality. Originally, under Brian Jones, the founder and original leader of the Rolling Stones, the system was unipolar. He was the manager of the band, he picked the other band members and the profit places. But that didn’t work because he didn’t write the music, and was increasingly incapable of sustaining performances because of alcohol and drug problems. Over time the band evolves into a multipolar power triumvirate of Jones-Jagger-Richards, not much liking each other, but working together. That doesn’t work either, so Jagger and Richards ruthlessly get rid of Jones. A month later, he dies mysteriously in his swimming pool, but now the system has lasted for 50 years as the band was able to adopt a power relationship that mirrors its basic creative forces. Richards and Jagger are the creative powers of the band, and they have been since 1969. The power and the reality of who does what is the same, and when that is the case, the system works. So I would argue that a League of Democracies linking Europe (while in relative decline, still important and viable) to up-and-coming powers like India and the Asian world, to the greatest single power still in the world – the US. That is a strategic threesome that has the dominant power to sustain itself in terms of global governance – if it wants to. It is a duty thing. But if it does that instead of the Beatles’ outcome, we are going to end up like the Rolling Stones.

You’ve lived in Europe for the past 15 years. You’ve seen the weaknesses and the strengths, the debates without end, the cleavages between North and South, East and West. Can Europe become structurally ready for a more great power-centric world, and become ready to go beyond a Steven Pinker belief in the ‘Better Angels of Our Nature’ strategic mindset?

The good news is that Europe is kind of the key power, along with a rising Asia. If the US and China are by far the two dominant powers, certainly who scrambles for allies matters immensely. Does the Quad emerge as a Chinese or a pro-American group, or is it neutralist? More importantly, does Europe maintain its pro-Western, pro-American and trans-Atlantic outlook, meaning that it is broadly anti-China and broadly pro-America? If it does that, that’s enough power in the group to dominate. But if it is neutral, which Europe could well be given what’s going on, then we are living in a very different world. Given the structural position, Europe has a real say in what kind of world we are living in.


For the past fourteen years, Dr. John C. Hulsman has been the President and Managing Partner of John C. Hulsman Enterprises (www.john-hulsman.com), a prominent global political risk-consulting firm. Presently, John is also the widely-read senior columnist for City AM, the newspaper for the city of London. Dr. Hulsman is also a life member of the US Council on Foreign Relations, the pre-eminent US foreign policy institution. The author of all or part of 14 books, Hulsman has given over 1540 interviews, written over 790 articles, prepared over 1330 briefings, and delivered more than 540 speeches on global political risk and foreign policy for blue-chip corporations and governments around the world, making a name for himself as an uncannily accurate predictor of global geopolitical risk (and reward) in our new multipolar era. In recognition of this, Hulsman presently sits on the Editorial Board of the prestigious Italian Foreign Affairs Journal, Aspenia. His most recent work, the best-selling To Dare More Boldly; The Audacious Story of Political Risk, was published by Princeton University Press in April 2018, and is available for order on Amazon.


An agenda for reviving the West

“First, it must re-engage the emerging market powers – on new terms that actually reflect today’s changed multipolar global geopolitical and macroeconomic realities. It must forge a new global democratic alliance with rising regional powers, connecting itself more substantially to South Africa, Australia, Canada, Israel, Japan, Indonesia, Brazil, Mexico, and India. The single greatest strategic challenge for the next generation is determining whether the emerging regional democratic powers can be successfully integrated into today’s global order.”

Second, the West itself must be bound together anew; Lennon-McCartney must recommit to the band, in this case the project of serving as the ordering powers in an increasingly factious world. The common grand strategic project of enticing the emerging democratic powers into becoming stakeholders of the present international order can serve as a large portion of the glue that relinks Britain, Europe and America.”

Excerpt from To Dare More Boldly; The Audacious Story of Political Risk  published by Princeton University Press, 2018.

 

“Governments can band together in a fight against China and authoritarianism, but the real threat is more from inside” – interview with Mathew Burrows

Dr. Mathew J. Burrows, the director of the Atlantic Council’s Foresight, Strategy, and Risks Initiative in the Scowcroft Center for Strategy and Security

What would you expect to be the possible geopolitical fallout/aftershocks that will shape the post-coronavirus world? 

The obvious path that we are on at the moment is a world shaped by bipolarity, in particular by the competition between the U.S. and China. Within the West there are some common concerns about China. The Chinese side seems to feel more and more embattled, becoming more defensive in their diplomacy and announcements. There is very little multilateralism. The US pullout of the WHO, while a terrible idea, is also a leading indicator of the mood inside the Trump administration. There are other measures too: the Trump administration not allowing the US government pension system to invest in Chinese stocks; there is growing support for the repatriation of the supply chains in order to have far less dependence on China (especially for pharmaceutical supplies). If anything, I would say that we are seeing less globalisation (at least in terms of trade and investment flows), more political antagonism between the US and China and very little global cooperation. There will be less economic growth, a downturn in trade and investment across borders, and the movement of people will diminish, but none of all this will disappear unless the US and China get into a conflict which would end this period of globalisation.

There will be less economic growth, a downturn in trade and investment across borders, and the movement of people will diminish, but none of all this will disappear unless the US and China get into a conflict which would end this period of globalisation.

Can the COVID crisis become also an opportunity – a change in mindset for a more united West, especially a Europe ready to embrace the great power competition against China? Even the debate inside NATO has lately taken a China angle. Is COVID an opportunity for the Atlantic system, for reinventing the Atlantic strategic unity & solidarity?

I see Europe being ambivalent about going along with the US on all the measures that the Trump administration is taking against China: on tariffs plus a prohibition against Huawei in Western networks. I don’t think many in Europe want to be too closely aligned with the US in such strident attacks against China. They understand the US point of view and share many of the concerns, but they are also fearful of bipolarity, of getting into a world that sends everybody back to a 1950s and 1960s-style Cold War. There is another issue within Europe, a division over China, as some are increasingly economically dependent, reliant on China as an investor: for some countries in the south and east that are already bending towards China, the crisis could accelerate this path even more. Moreover, the EU took a blow in this pandemic, where every member state had to fend for itself. Certainly Italy felt that it didn’t get the support from the other member states that it was entitled to or from the EU as a whole. There is an ongoing debate about the economic recovery: who pays? Many feel that Germany and Nordic countries should be much more generous in terms of the economic recovery support. There is a lot of division, and Europe remains far from speaking with one voice.

For sure, NATO is also split. A key factor on the European side is the distress created by the Trump administration. Germans worry that the Trump administration could impose tariffs on the automobile industry, an export which the entire German economy depends on. Of course, if there would be a sudden Russian move against the Baltic states, I would still see NATO coming together. The problem to me is when there is no major live external threat like that, and given that you have different interests by all the players and a US administration that is disengaged, disintegration has the upper hand.  

Europeans are also fearful of bipolarity, of getting into a world that sends everybody back to a 1950s and 1960s-style Cold WarThere is another issue within Europe, a division over China, as some are increasingly economically dependent, reliant on China as an investor: for some countries in the south and east that are already bending towards China, the crisis could accelerate this path even more.

How would you see the EU faring in a world in which power politics, not multilateralism is again the new normal? 

This is not the world that Europe expected. A decade ago the EU was looking forward to a postmodern world in which there were far fewer conflicts, where  European integration would become the model for others. Obviously that world is not happening. What is essential is Europe’s ability to reach or retain a political consensus. In the recent crises (whether the euro-crisis or the migration crisis) the end result has instead been a deepening of the divisions between east and west, north and south. The pandemic looks like that, too, deepening the same cleavages. That is what I worry the most about. Unless Europe finds a way of overcoming these divisions, the EU will gradually disappear or become irrelevant, particularly for younger generations. In general, the EU has a tendency of coming together at the eleventh hour, but in finding a solution at the last minute it allows hard feelings and resentments to accumulate. Trying to speed up some of the solutions will help the process of binding together the community again, necessary for remaining a force on the world stage.  

It is said that history rhymes. To some observers the current pandemic brings parallels with the type of world in which Spanish Influenza was spreading after WWI – intense geopolitical competition, inward focus and protectionism, nationalism on steroids and nation-first type of responses, democratic recession, a crisis of international architecture, all wrapped up in a profound economic recession. What can be done to avoid/ tame such an interwar cycle? What lessons should we be reminded of?

We should be very worried about the economic recovery. High unemployment and income stagnation could bolster populism and widespread discontent in those countries where the middle class are already under pressure. If you look at the economic recovery after 2008, it led to more inequality and to a part of society, the lower middle class, feeling its interests were not being looked after, that they were losers. The bankers got bailed out, it was the ordinary guys that paid the price. So if you have another iteration of the same pattern, you will create a class that feels that they have few stakes in society or in a democratic government that doesn’t work for them. This would be a very dangerous turn of events, and we know that part of what happened in the 1920s and 1930s was a middle class which felt dispossessed (by the combined conditions generated by WWI and the economic collapse that followed). Consequently, it didn’t have any particular faith in democracy and saw its salvation in strong leaders. That could happen again, although we are much more sensitive to the signs of that happening. The tendency with many economic crises has been that they do prop up the strong, and those that are weaker pay the biggest price. This has to be our number one concern. Another concern should be not to fall in the trap (which we see the US falling into) of seeking shelter under protectionism, even if the feeling against China is running very high. This is another lesson of the 1920s and 1930s, that protectionism may feel good in the short term, but it will make it harder to recover in the long run.

Unless Europe finds a way of overcoming internal divisions, the EU will gradually disappear or become irrelevant, particularly for younger generations.

These days we see the revival of an old idea meant to fix to some extent the crisis of multilateralism, but also to respond to the new revisionism – a global concert/alliance of democracies (supported in the past by John McCain, embraced today by Joe Biden, promoted in a certain version also by Heiko Maas). Is such an idea feasible and operationalised?

I am not sure that it solves what I think is the real issue. People lost faith in democracies because they don’t seem to be working particularly well for the less skilled or the lower strata of the middle class. There are very few people in the US that think this democracy works. So governments can band together in a fight against China and authoritarianism, but the real threat is more from inside than from the outside.

Are you worried about the domestic resilience of the West? Are we already too far in this process of polarising ourselves and becoming more like Sunni vs. Shia/Hutu vs. Tutsi? Can we come back? 

During the pandemic there was an initial period where people were coming together. Congress passed in record time the 3 trillion dollar stimulus and rescue plans. In the recent weeks it has returned to the old pattern of partisanship. The pandemic seems to be reinforcing the division between Blue and Red states. Blue states like New York and California have suffered far more so far than Red ones. At the same time Donald Trump openly tries to deepen these divisions as part of his strategy is to keep his base mobilised. It is very hard for both sides to work across the aisle, because they are stuck in a system in which they derive more advantages from this polarised atmosphere. Partisanship is deeply entrenched. In the long run, you may have more populism on the left, the kind of Bernie Sanders type of socialism focused especially on providing free university tuition and better healthcare to those struggling in the middle class. What certainly will be different for the US is that the state is going to be a lot more powerful as a result of it having to save the economy in this pandemic. In this context, it is very likely that we are going to see a revival too of the Tea Party on the right, opposed to the big government and to moving the US closer to the European model.

Is the West, and especially Europe in danger of over-learning the lessons of the post-9/11 campaigns, in the sense of ‘never again’? Everyone is running away from the liberal interventionism, stabilisation operations or R2P today. But sometimes they might be needed. Can Europe recapture the patience of winning the peace? Especially in a world in which Europe continues to be affected by MENA instabilities that could be even more significant in a post-pandemic world?

High unemployment and income stagnation could bolster populism and widespread discontent in those countries where the middle class are already under pressure. If you look at the economic recovery after 2008, it led to more inequality and to a part of society, the lower middle class, feeling its interests were not being looked after, that they were losers.

I don’t really see anybody prepared to do what the US and NATO did in the Balkans in the 1990s. In Europe the main effort will be to protect itself against huge flows of refugees. The effort will be focused on not allowing the crisis to get to the worst-case scenario. It will be an effort to drive down some of the worst outcomes of conflict, but not to really settle them. 

In the 1990s, the West — both the US and Europe — was at the height of its power, which also made it confident of solving others’ problems. Hence the wish to solve the world’s ills, from the Iraqi invasion of Kuwait, to the disintegration of Yugoslavia. There are groups today within Western societies — NGOs and civil society — that remain activists. The Bill and Melinda Gates Foundation has done enormous good in combatting disease in Africa and other developing regions. But because of the internal problems, Western governments don’t have the means or bandwidth to solve the world’s big problems. Instead of offense, it’s defence. They get involved if there is the threat of the conflict having the potential to spill over in the form of terrorism, threatening the West. And then the effort is to seal off the problem, not solve it. Syria is a prime example. The US effort was geared to combating ISIS, not supporting the rebels against Assad.     

Dr. Mathew J. Burrows serves as the director of the Atlantic Council’s Foresight, Strategy, and Risks Initiative in the Scowcroft Center for Strategy and Security. He was appointed counselor to the National Intelligence Council (NIC) in 2007 and director of the Analysis and Production Staff (APS) in 2010. He was the principal drafter for the NIC publication Global Trends 2030: Alternative Worlds.