The same logic that kept a nuclear war from breaking out between the United States and former Soviet Union is the best strategy to now pursue with North Korea, several scholars said Tuesday at Stanford.

The panel, convened at Stanford’s Center for International Security and Cooperation (CISAC), included political scientist Scott D. Sagan of CISAC; political scientist Mira Rapp-Hooper of Yale University; and political scientist Vipin Narang of MIT. The moderator was James D. Fearon, a political scientist at the Freeman Spogli Institute for International Studies. The event was titled “Can the U.S. Deter a Nuclear North Korea” and held in the William J. Perry Conference Room in Encina Hall.

Nuclear decision-making

The discussion revolved around whether North Korea will have the ability to strike the U.S. with nuclear warheads, and can the U.S. depend on a deterrence strategy like it did during the Cold War?

Deterrence theory holds that nuclear weapons are intended to deter other states from attacking with their nuclear weapons, through the promise of retaliation and possibly mutually assured destruction 

Sagan, who recently wrote an essay in Foreign Affairs magazine on the North Korea nuclear crisis, said he has come to decide deterrence is the best approach to the issue.

“I am not one who gladly listens to the siren song of nuclear deterrence,” he said, noting that while he is a self-described dove on disarmament issues, he is more hawkish on allowing countries to obtain nuclear weapons, which deterrence implies. “I accept deterrence reluctantly.”

In North Korea, he said, no military alternatives exist to solve the problem. For example, even if a decapitation strike were successful – and several U.S. attempts have failed in the past with regard to Saddam Hussein and Muammar Gaddafi – there’s no way to know if North Korean leader Kim Jong-un has already given his generals the green light to unleash nuclear or powerful conventional attacks in the case of his demise.

For Sagan, deterrence is a more complicated issue today than during the Cold War when the U.S. and U.S.S.R. were rational actors with thousands of nuclear weapons. He is especially concerned with the rhetoric and the preventive war suggestions emanating from the Trump Administration.

Senior U.S. military leaders, Sagan said, have a duty not to follow “impaired-decision making” that might come from the president. He invoked the prospect of using the Cabinet and the 25th Amendment to halt such an order and remove the president from office. Currently, he belives the nuclear decision process is problematic, as the president alone can directly order the Strategic Air Command to launch nuclear weapons.

Sagan advises that a revised nuclear chain of command should include both the U.S. Secretary of Defense and the U.S. Attorney General. A U.S. Senate hearing, led by Sen. Bob Corker, is actually studying the nuclear authorization process due to concerns with Trump's rhetoric and escalation of the North Korean issue.

“We need more checks on how we decide to use nuclear weapons,” said Sagan, who studies nuclear strategy, ethics and war, public opinion about the use of force, and nuclear non-proliferation and arms control.

He noted that U.S. National Security Advisor H.R McMaster recently criticized his predecessor, Susan Rice, for saying the U.S. could "tolerate" nuclear weapons in North Korea the same way we tolerated nuclear weapons in the Soviet Union​.

He quoted McMaster: “'A regime that poses a continuous threat to the its neighbors in the region and now may pose a threat, direct threat, to the United States with weapons of mass destruction? A regime that imprisons and murders anyone who seems to oppose that regime, including members of his own family, using sarin nerve gas in a public airport?'”

But Sagan said we have long tolerated such authoritarian regimes that have nuclear weapons. 

Stumbling accidentally into war with North Korea also seems like a rising risk. On Sept. 27, several U.S. service members and their families received a fraudulent “noncombatant evacuation operation” order via text and social media, he said. The fake notices were quickly reported up the chain of command and the U.S. issued a statement denouncing their validity – the perpetrators have not been found. But Sagan says it illustrates how easy it is to create a situation where North Korea felt a U.S. invasion and attack is imminent – and as a result, could choose to unleash a nuclear first strike.

‘Western fantasy’

Narang, who was once a CISAC visiting assistant professor, studies nuclear proliferation and strategy, South Asian security, and general security studies.

“Deterrence is your friend,” he said in explaining why it can work with North Korea. If the U.S. believes North Korea seeks to preserve its regime – a status quo intention – then deterrence theory works much like it did with the former Soviet Union.

On the other hand, if the U.S. believes North Korea has darker motives, such as reunifying the Korean peninsula through an invasion, then that perspective could lead to a U.S. first strike. Also, the existing U.S. demand of rolling back North Korea’s nuclear program – “denuclearization” – is a “Western fantasy.” They will not give up nuclear weapons, he said.

He said the U.S. does not like to be deterred from making a first strike – as in preventive war – but that is what it must accept if it decides to follow the deterrence course. North Korea, once it possesses an ICBM capable of hitting the U.S. mainland, would pose such a deterrence in the balance of power between the two countries.

“The good news is that deterrence can work, coupled with coercive diplomacy,” Narang said. “We know how to play this game.”

He believes Jong-un is a rational actor, though a cruel dictator. “There’s nothing to suggest he’s crazy.” Ultimately, he said, an effective deterrence policy depends on clarity, consistency, coherence and communications.

U.S. nuclear shield, alliances

An expert on security in the Asia-Pacific region and alliance politics, Rapp-Hooper talked about the U.S. relationships, especially with Japan and South Korea, and the “nuclear shield” over these countries that those agreements offer. As a result, neither country has developed nuclear weapons.

This dynamic, however, could change if a North Korean missile could reach the U.S., said Rapp-Hooper, who earned a bachelor’s degree in history at Stanford.

“North Korea is eroding U.S. security guarantees over time,” she said, adding that once those missiles are capable of hitting a U.S. city, would the U.S. government still protect Seoul from attack and let an American city be hit?

The Korean situation, Rapp-Hooper said, is much different than Europe in the Cold War, when such an American nuclear shield existed against a Soviet invasion. Many different U.S. agreements exist now than during that time; no U.S. nuclear weapons are forwardly deployed in northeast Asia, like in Europe then; and the unilateral threats coming from the Trump Administration are unprecedented in nuclear diplomacy.

On the latter point, she called it the “Trump multiplier” effect. “That’s the most exacerbating thing of all,” she said, noting that elements of the White staff are pushing a “better-use-it-now” or preventive attack approach, whereas Secretary of Defense James Mattis and Secretary of State Rex Tillerson see North Korea as more concerned with preserving its regime.

Sagan also pointed out how President Trump’s speech at the United Nations in September led to a realization among the North Koreans that they had no choice but to continue to develop nuclear weapons.

That’s when the president said, “’Rocket Man is on a suicide mission for himself and for his regime,’” Sagan noted.

​He then recalled Kim Jong Un’s response to Trump’s speech, quoting the North Korean leader: “’His remarks which described the U.S. option through straightforward expression of his will have convinced me, rather than frightening or stopping me, that the path I chose is correct and that it is the one I have to follow to the last.’”​

Paul Wise watched as children ran around a playground attached to a health clinic at a displaced persons camp on the outskirts of Mosul — the northern city in Iraq once controlled by the Islamic State but now back in the hands of the Iraqi government.

The children had survived the Battle of Mosul, which had fallen to ISIS in 2014 but was retaken by the government forces and allied militias during a nine-month military campaign that ended in July. Many of the children suffer from physical and mental wounds and Wise wondered how they would recover with so little medical infrastructure.

Wise was part of a small delegation of physician-academics asked to evaluate a World Health Organization-led system to treat civilians injured in the Mosul fighting. Wise and his colleagues recently slipped into Mosul to visit field hospitals, review health care on the ground and determine whether there is a better way to distribute medical aid during armed conflict.

The visit left the Stanford Medicine professor of pediatrics and senior fellow at the Freeman Spogli Institute for International Studies with questions about health care, humanitarian ethics, and conduct of war: Are there better ways to deliver emergency medical care during the height of battle? How do relief workers maintain neutrality when embedded with government security forces? Has the system of financing humanitarian interventions — one that was essentially created during the Cold War — become dangerously outdated?

Answering these questions is the mission of a new health-and-security initiative at Stanford led by Wise, a core faculty member at Stanford Health Policy who has spent 40 years working to improve the health of children impacted by conflict. Much of his work has been in Guatemala through his Children in Crisis project, the first university-based program to address the needs of children in areas of unstable governance and civil war.

“In talking with the groups that are running these humanitarian efforts in Mosul, there was this uneasiness, this kind of disorientation with the way things are now,” said Wise. “It was a kind of recognition that humanitarian norms are changing, the health personnel and facilities are at greater risk; the financial gap between humanitarian need and humanitarian capability is growing; and the old way of financing humanitarian intervention is inadequate, archaic.”

An Interdisciplinary Approach

Wise believes academics are well suited to help resolve these humanitarian conundrums.

“So we are going to move ahead and try to bring all the players together to reconsider this global challenge. Here at Stanford, we have the capacity to draw upon remarkable resources,” he said.

The new biosecurity initiative led by Stanford Medicine physician and FSI senior fellow, David Relman, together with world-renowned political scientists, security specialists, computer scientists and health policy experts will “attempt to craft new strategies for the provision of critical services to populations affected by conflict and political stability.”

The initiative will collaborate with other institutions such as Johns Hopkins, UCSF, Harvard, and the American Academy of Arts and Sciences. It will also seek the engagement of partners committed to providing humanitarian services, including WHO, the U.N. High Commissioner for Refugees, Doctors Without Borders and the International Committee of the Red Cross.

“The voice of communities impacted by war should also be an essential element in this ambitious effort,” Wise said. “To break new ground, we’re going to have to do things differently; the health strategies need to take into consideration fundamental understanding of the political dynamics. But we have a special opportunity here at Stanford because we take an interdisciplinary approach.”

Children of War

Most of the children Wise saw will never be the same, he said, nor the humanitarian workers who risked their lives to treat them, their families, and fighters from all sides of the battle to oust the Islamic extremists from the city on the Tigris River.

“I look at these little kids with horrendous emotional trauma and PTSD, and I think to myself, it’s the collision of all these questions playing out within a 50-square-meter little playground,” he said. “It’s these broader, strategic and ethical questions that are really profound. And as a pediatrician who is dedicating the last phase of my career to these questions of security and the political dimensions — I have to engage on all of these levels. That’s not easy.”

Wise traveled with WHO officials, as well as Paul Spiegel, a physician who leads the Center for Humanitarian Health at Johns Hopkins Bloomberg School of Public Health; Adam Kushner, a trauma surgeon affiliated with Johns Hopkins; and Kent Garber, a surgical resident at UCLA and research associate at Johns Hopkins.

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Spiegel also believes academics are uniquely positioned to help assess the current system of responding to medical crises during conflict.

“I believe that we can bring objectivity and rigor to analyzing and evaluating important and innovative responses, such as the trauma response by WHO and others in Mosul,” Spiegel said. “Humanitarian organizations are often busy responding quickly to rapidly changing situations; they don’t always have the luxury of time to do what academic humanitarians can do.”

Making the two-hour drive from Erbil to Mosul in armored, bulletproof SUVs provided by the United Nations, they slipped into field hospitals to meet with Iraqi physicians and medical teams with the humanitarian agencies.

Wise, who was able to take a few photos and video on his smartphone, described the devastation on the ground, noting that not since the siege of Leningrad has a city of this size experienced such street-by-street fighting. In large parts of the city, virtually every building was bombed or bulleted. It will take years to clear the rubble and rebuild.

“It’s just a remarkable story of tragedy and resilience,” he said.

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Since the city was not long ago controlled by ISIS, the field hospitals are still surrounded by massive concrete barricades and tactical trucks stationed outside with mounted machine guns.

The team found that at the height of the battle for Mosul, there was tremendous pressure to treat injured civilians and discharge patients very quickly, due to the lack of medical infrastructure and personnel and the continuous wave of new injuries coming in.

“The charge for us was to evaluate the system and how well it worked, what ways could it be improved, how many lives that it saved,” Wise said. “One of the concerns, for example, was that in order to put in medical people that close to the frontline, you have to give them some kind of security. This raised issues among the humanitarians about their need for independence and neutrality, since you’re essentially embedding them with Iraqi security forces.”

Epidemiology and Ethics

“We are looking at the technical issues and the epidemiologic issues, but also dealing with the ethical issues and their implications,” he said.

They intend to write an internal report and then publish their findings in a major medical journal, to get the word out about the issue and gain support for ongoing collaborative work. They’re looking to partners like the American Academy of Arts and Sciences, which recently devoted an entire issue of its journal, Daedalus, to the factors and influences of contemporary civil war. One of the essays in that issue by Wise and his Stanford colleague, Dr. Michele Barry, who directs the Center for Innovation in Global Health, talks about the threat of a global pandemic as a potential byproduct of the 30 ongoing civil wars around the world.

“We’re trying to get the report completed quickly because the model of trauma care for civilians in Mosul is a new model and could be implemented in other combat areas, like the fighting in Syria and other places in Iraq,” Wise said.

Wise worries some see Stanford University as an insulated Silicon Valley institution in a beautiful setting and not always engaged in the real world.

“Well, this is about as engaged in the real world as you can get — this is Stanford moving and doing things out there, not just sitting around in seminar rooms. Sometimes you need to get close to the front lines to save lives,” he said.

When asked what surprised him during this trip to Mosul, Wise smiled.

“I’m sort of old and I’ve seen a lot of the world and not a lot surprises me anymore,” he said. “But it was a reminder of how desperate are the lives of millions of people — that we could do so much more. It’s a reminder of just how fragile physical security really is in this world."

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The Center for International Security and Cooperation now has more than 46 podcasts, dating all the way back to Oct. 19, 2016. Listen to them on the CISAC page on the iTunes website. Simply mouse over the title and click play. Open iTunes to download and subscribe to CISAC podcasts. Seminars and events at CISAC are routinely audiotaped for use as podcasts. Also, the Freeman Spogli Institute for International Relations offers the World Class podcast series, featuring scholars and experts from FSI, CISAC and beyond.

CISAC's Siegfried Hecker this week won the Dwight D. Eisenhower award from the American Nuclear Society. He received the honor, along with former Senator Richard Lugar (R-IN) and former Senator Sam Nunn (D-GA), for his "historic achievements in the advancement of nuclear nonproliferation, arms control, and peaceful uses of nuclear energy." The annoucement from the American Nuclear Society noted:

"Dr. Siegfried Hecker, an international expert in plutonium metallurgy, is being recognized for his nuclear non–proliferation efforts during and following his tenure as the Director of the Los Alamos National Laboratory. Dr. Hecker was part of a historic visit by a U.S. delegation to Sarov, Russia, known as Arazamas-16 during the Cold War.  This was the first visit to the closed city by the U.S., and it laid the foundation for a series of programs aimed at securing nuclear materials in Russia and all of its former republics. Dr. Hecker’s current research at Stanford University’s Center for International Security and Cooperation is focused on reducing the risks of nuclear terrorism worldwide, the nuclear challenges in India, North Korea, Pakistan, and the nuclear aspirations of Iran."

CISAC co-director Amy Zegart wrote the following essay in the Oct. 25 online edition of The Atlantic:

Pity the professionals. In the past month, President Trump has sideswiped certification of the Iran nuclear deal, sandbagged his own secretary of state’s diplomatic efforts with North Korea, and even provoked the ever-careful Senate Foreign Relations Committee Chairman, Bob Corker, to uncork his deepest fears in a series of bombshell interviews. “The volatility, is you know, to anyone who has been around, is to a degree alarming,” Corker told the Times earlier this month, revealing that many in the administration were working overtime to keep the president from “the path to World War III.” He doubled down on those comments a few weeks later, declaring that Trump, among other things, was “taking us on a path to combat” with North Korea and should “leave it to the professionals for a while.”

The professionals sure have their hands full. So far, the Trump Doctrine in foreign policy appears to consist of three elements: baiting adversaries, rattling allies, and scaring the crap out of Congress. The administration has injected strategic instability into world politics, undermining alliances and institutions, hastening bad trends, and igniting festering crises across the globe. “America first” looks increasingly like “America alone.” The indispensable nation is becoming the unreliable one. Even without a nuclear disaster, the damage inflicted by the Trump presidency won’t be undone for years, if ever.

But it’s also important to understand that today’s foreign-policy challenges— whether it’s Iran’s hegemonic ambitions in the Middle East, North Korea’s breakneck nuclear breakout, China’s rise, Russia’s nihilism, Europe’s populism and fragmentation, Syria’s civil war, or transnational terrorism and cyber threats—did not start with Trump. This is the most challenging foreign-policy environment any White House has confronted in modern history.

Three swirling complexities explain why.

Threat complexity

Take a look at any of the annual threat assessments issued by the Director of National Intelligence over the past few years. They will make your head spin. They are filled with rising states, declining states, weak states, rogue states, terrorists, hackers, and more. Bad actors don’t just threaten physical space these days. Adversaries are working on ways to cripple America in cyberspace and even outer space—by compromising all those satellite systems on which its digital society depends. In this threat landscape, the number, identity, magnitude, and velocity of dangers facing America are all wildly uncertain. Exactly how many principal adversaries does the United States have? Who are they and what do they want? What could they do to us? How are these threats changing and how can we keep up without spending ourselves into oblivion or leaving ourselves vulnerable to other nasty surprises? These are fundamental questions. There are no consensus answers. Uncertainty is what fuels America’s foreign-policy anxieties today.

The Cold War was different. Then, certainty was what fueled American foreign-policy anxieties. It was clear to all that the U.S. faced a single principal adversary. The Soviet Union had territory on a map and soldiers in uniforms. Thanks to U.S. intelligence, Soviet intentions and capabilities were fairly well understood. The threat landscape was deadly but slower-moving: Communists never met a five-year plan they didn’t like. And while superpower nuclear dangers were terrifying, they were also constraining in a helpful but insane sort of way. In 1961, President Kennedy invoked the specter of a “nuclear sword of Damocles, hanging by the slenderest of threads” over the earth. Every American foreign-policy decision had to consider the question: What would Moscow think of that? Today, the nuclear sword of Damocles is still hanging—indeed, China, India, Pakistan, and North Korea have all successfully tested nuclear devices since 1961—but no singular threat guides U.S. foreign policy as the Soviet Union once did.

Organizational complexity

As threats have grown more complex, organizational arrangements to deal with them have, too. Coordinating Soviet policy was one thing. Developing coherent U.S. foreign policy in the face of so much uncertainty across so many issues is quite another. Little wonder special advisers, envoys, commissions, boards, initiatives, czars, and new agencies have been growing like mushrooms. This may not sound so bad. But it is. Every new agency or czar or special arrangement says, “the regular process here ain’t working.” The crux of the problem is that bureaucracies are notoriously hard to kill or change. Ronald Reagan famously quipped that bureaucracy is the closest thing to immortal life on earth. Whenever a crisis hits, the natural response is to add a new organization and stir. But if today’s chief challenge is developing coherent, coordinated policy in the face of complexity, creating more organizations to coordinate doesn’t get you very far. Over time, the whole bureaucratic universe just keeps growing bigger, filled with obsolete organizations alongside new organizations; fragmented jurisdictions, overlapping jurisdictions, and unclear jurisdictions; and silos so specialized that nobody can see across all the key issues easily.

Cognitive complexity

Humans are not superhuman. Research finds that most people can remember at most seven items at a time, fewer as they grow older. Even the biggest brains have limits. In 2001, Peter Pronovost of Johns Hopkins noticed that highly trained medical teams at the university’s medical center were screwing up insertions of central line catheters, causing infections in critically ill patients at alarming rates. Why? Because they often forgot one of just five simple steps (like washing their hands) before starting the procedure. (Pronovost instituted a checklist that has since become widely used and is credited with saving thousands of lives.)

In foreign policy, too, the stakes are high and humans are frequently overloaded by complexity, resulting in catastrophic errors that nobody ever intended. One of the chief findings of the 9/11 Commission, for example, was that many inside the FBI simply didn’t know or couldn’t remember all the legal requirements and rules for sharing intelligence and law-enforcement information. Even the Bureau’s own 1995 guidelines were “almost immediately misunderstood and misapplied,” the commission concluded. As a result, clues to the terror plot emerged weeks before 9/11 but were marooned in different parts of the bureaucracy.

In 1935, an advanced bomber nicknamed “the Flying Fortress” crashed during a test flight. The Army Air Corps investigation found that the machine worked fine. The problem was the human. The airplane was so sophisticated, flying required the pilot to remember too many things, and he forgot one of them: unlocking the rudder and elevator controls during takeoff. It was “too much airplane for one man to fly,” one reporter later wrote. That crash sparked the invention of pilot checklists which have been used for nearly a century, transforming global aviation.

U.S. foreign policy is becoming too much airplane for one person to fly. “The professionals” surrounding Trump—Secretaries James Mattis and Rex Tillerson, Chief of Staff John Kelly, National-Security Adviser H.R. McMaster, and others—are trying to keep the whole thing from crashing with a pilot who has never flown before. Let’s hope they can.

America’s approach to the world is a complicated mess, for reasons that predate the current president.

Amy Zegart is co-director of the Center for International Security and Cooperation and professor of political science, by courtesy. She is also the Davies Family Senior Fellow at the Hoover Institution and directs the Cyber Policy Program. She wrote this essay as a contributing editor to The Atlantic.