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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In 2018, the South Korean Supreme Court passed a series of rulings requiring Mitsubishi Heavy Industries and Nippon Steel of Japan to compensate 14 Korean citizens for their unpaid labor. As of yet, neither company has agreed to comply with the ruling. The South Korean government has since announced plans to compensate survivors who were forced to work in Japanese mines and factories during the wartime period, but this remains a unilateral decision on the part of the Yoon administration, not a bilateral position between South Korea and Japan.

These tensions have ripple effects far outside of East Asia. Writing for Toyo Keizai, Daniel Sneider, an FSI Lecturer in International Policy with a focus on Asia, explains the broader geopolitical implications of these issues:

“The Americans have been urging the two countries to settle these problems in order to ease the way to the kind of security cooperation that has become visible in recent months. Joint military exercises for missile defense and other small steps to intensify trilateral coordination are taking place and a resolution of the history of problems may be key to moving ahead.”

Steps Forward

The last year has seen increased efforts to restore more functionality to the South Korea-Japan relationship. President Yoon and Prime Minister Kishida met briefly on the sidelines of the September 2022 UN General Assembly meeting in New York, which was followed by respective visits of Yoon to Tokyo in March 2023 and Kishida to Seoul two months later in May, the first such visits in over 11 years.

The Camp David summit, which brought the U.S., South Korea, and Japan together as strategic partners, is the latest step on the hoped-for road to institutionalized security cooperation between the three nations.

Speaking to NBC, Shorenstein Fellow Thomas Fingar explained the significance of the weekend.

“The importance of this [summit] is that it was a genuine trilateral meeting, which means the Japanese and the Koreans are talking to one another as opposed to the U.S. dealing separately with each of them.”

In contrast to the idyllic Camp David setting, the three leaders are faced with a weighty set of issues, noted Sneider, including the crisis triggered by the Ukraine war, North Korea’s aggressive posture, as well as growing concerns about China.

Oriana Skylar Mastro, an FSI Center Fellow and an expert on security, conflict resolution, and the Chinese military elaborated further on the mutual pressures South Korea, Japan, and the United States face:

“Since President Biden came into office, he’s really stressed strengthening alliances and partnerships as a way of protecting U.S. interests abroad. I'm sure there has been much work behind the scenes to try to get these two countries to come together. In terms of the timing [of this summit], it's of course partially because of the accumulation of these concerns over China. I think also the war in Ukraine has done a lot to really open up leaders' eyes to the dangers of having neighbors with territorial hopes and claims that also have strong militaries that could potentially be undeterred from using force. I think it's fair to say that this has also pushed these two countries to rethink their own strategies for security.”

An Uncertain Future

The official summit documents outline both a vision of partnership and offer a variety of practical agreements on everything from annual leadership summits to meetings on economic and cyber security, and a proposal for how to move forward with joint military exercises. Notably, the two-paragraph ‘commitment to consult’ on responses to ‘regional challenges, provocations, and threats affecting our collective interests and security’ — while not a fully embodied collective security agreement — is nonetheless a “stunning achievement,” says Daniel Sneider.

Despite agreeing on a hefty laundry list of shared concerns and security goals, the way forward for additional trilateralization between the United States, Japan, and South Korea is not necessarily clear. Oriana Mastro explained: 

“Even though they might have shared threat perceptions, there is still a lot of trust that has to happen between nations for them to take coordinated military approaches. If two countries, for example, exercise together — and that's one of the things that the Biden administration is hoping to get out of this summit: more routine trilateral exercises — you get to learn a lot about another country's military, and that only really happens between friends. That’s also true of intel sharing. When you share intelligence, you’re not only sharing information, you're sharing how you get intelligence, which can also be sensitive. So while they've shared these threats for a while, it hasn't really gotten to the level in which they were willing to take risks in terms of the relationship between South Korea and Japan to become closer in the security space in a way that would help them combat these issues together.”

Besides the challenges of international diplomacy, Yoon, Kishida, and Biden also face domestic hurdles that could hinder further cooperation.

In a comment to the Wall Street Journal, Gi-Wook Shin noted that, “Yoon only entered politics a few years ago. If his party loses the election, I don’t know who will stay with him.” Improving South Korea-Japan relations was a major platform of the Yoon campaign, and backlash against his administration could yield disinterest or even renewed hostility toward continuing his efforts. 

Daniel Sneider sees similar challenges for Biden and Kishida. Writing in East Asia Forum, he cautioned:

“President Joe Biden is already embroiled in an election campaign that threatens to bring Donald Trump and his isolationist views back to power. The Camp David summit was barely noticed amid the constant flow of domestic political news, though it mostly received welcome praise in the media. . . Imprisoned by domestic politics, the White House will likely be unable to give substance to this emergent partnership.”

In the case of Kishida, the decision to release wastewater from the Fukushima nuclear site, which came just days after the conclusion of the summit, has been particularly counterproductive. Sneider continued:

“Prime Minister Fumio Kishida has been waiting for a bump from the Camp David summit. But he is experiencing a deepening slide in opinion polls. The Fukushima release faces opposition within Japan, including from fishermen and others worried about boycotts of Japanese products in China and South Korea. Talk of an early parliamentary election in Japan, intended to consolidate Kishida’s claim to long-term leadership, is now on hold.”

Where is the trilateral U.S.-Japan-South Korea relationship headed next? Follow FSI scholars to stay informed about the latest developments. Register to receive alerts to your inbox either weekly or monthly.