Coronavirus Q&A: What Is a Randomized-Controlled Trial? A health policy expert explains. by Zoe McLaren

A commonly used malaria drug was recently proposed as a treatment for COVID-19 during a White House press briefing, even though it hadn’t yet been properly evaluated in clinical trials or approved for this use. Does the urgency of the current pandemic give doctors a good reason to skip evaluation and rush an untested drug to patients?

The field of medicine considers randomized-controlled trials, also known as “clinical trials,” as the gold standard for assessing the effectiveness of new treatments. These studies set up a fair test for treatments and enable researchers to rule out alternate explanations. Without randomized-controlled trial evidence to guide them, doctors risk wasting resources on ineffective treatments or causing harm to patients.

What is a randomized-controlled trial?

A controlled trial means that study participants are split into two groups: One group is given the treatment and the other (the control group) is not. The control group may be given a placebo that mimics the actual treatment, but does not contain the treatment being tested.

For example, a sugar pill or an injection of saline solution may be used instead of a dose of the drug. This ensures the only meaningful difference between the two groups is whether they received the treatment or not.

The control group helps researchers learn what would have happened to the treatment group if they hadn’t received the treatment. For example, some patients may recover on their own. Researchers need to know how often this happens, so they don’t attribute all recoveries to the effect of the treatment.

Study participants are randomly assigned to one group or the other, a process similar to a coin toss. Just as a coin toss is equally likely to end up heads or tails, study participants are equally likely to end up in the treatment or the control group. With enough study participants, this results in two groups that closely resemble each other. The only difference is that one group got “heads” while the other got “tails.”

The randomization of randomized-controlled trials with large enough samples ensures that all possible differences are accounted for, even those that may not be observed, such as genetic traits.

If the treatment and control groups are similar at the start of the study but end up with different outcomes, the treatment is the most likely cause. The randomized-controlled trial allows researchers to rule out alternative explanations.

What if patients aren’t randomly assigned?

If doctors were allowed to choose which patients received the treatment, it’s likely the treatment and control groups would not resemble each other, making it much harder to rule out different factors at play.

For example, malaria drugs aren’t approved for use against COVID-19, but may be prescribed to patients under the Food and Drug Administration’s “expanded access” program. It allows certain drugs to be used as a last resort to treat seriously ill patients when no other treatments are available.

These “last resort” patients are frailer than those who had a milder form of the disease or who responded well to other treatments. When you’re comparing very sick patients to healthier patients, the effect of the treatment is hard to see because it may be obscured by important differences such as age, diet, cigarette use, heart disease or obesity.

If frail patients on treatment fared significantly better than strong patients without it, researchers could conclude the treatment was effective. But this situation is extremely rare, which is why doctors generally can’t draw valid conclusions about a drug’s effectiveness in a “last resort” situation. Too many other factors are likely at play.

Some researchers may be able to use sophisticated statistics techniques to account for the differences between frail and strong patients. But there is a long list of potential differences between frail and strong patients, so it is hard to address them all. Gauging the quality of such statistical analysis is also difficult, so these studies should be viewed with skepticism.

Approving drugs prematurely

Without results from randomized-controlled trials, doctors can’t be sure whether a potential new treatment will help patients, harm them or prove ineffective.

The case of the malaria drug hydroxychloroquine as a potential treatment for COVID-19 underscores this concern. In an early wave of optimism, doctors prescribed and some even stockpiled so much hydroxychloroquine that pharmacies reported shortages of the drug. Within weeks however, randomized-controlled trials demonstrated that not only was this treatment ineffective against COVID-19, it also caused some patients to develop serious heart rhythm problems. Prematurely prescribing this treatment to all but the “last resort” cases instilled false hope, wasted medical resources and, most importantly, put patients at risk.

Is Brazil Ripe for Another Impeachment? As the coronavirus crisis wreaks havoc in Brazil, the president’s popularity continues to plummet. by Marcos da Rocha Carvalho

Maybe, if the Brazilian Congress manages to pull off yet another presidential impeachment, it would be the third in less than thirty years. Riding on a wave of promising zero-tolerance with corruption, better security, and much-needed economic liberalization, Brazilians elected Jair Bolsonaro by a landslide in 2018. Bolsonaro is now reeling from recent accusations of unlawfully meddling in Brazil’s Federal Police, bending the rules in order to protect his sons suspected of being involved in criminal activities, in addition to botching the fight against the coronavirus pandemic. This may cost him his presidency. 

In the coming weeks, the Brazilian Congress will be evaluating four different requests for opening impeachment procedures against Bolsonaro. Impeachments usually pay off for the Brazilian economy. Fernando Collor de Mello was removed from office in 1992; the following year, the Brazilian GDP grew by 4.6 percent. In 2015, President Dilma Rousseff (who at this point enjoyed ample support from then-senator Collor de Mello) was impeached. Her political fall gave momentum to further investigations into high-level corruption. Brazil has since enjoyed four years of GDP growth. Far from being a destabilizing boogeyman, as impeachment skeptics like to paint it, both instances helped clear the way for necessary reforms, which translated into greater economic growth.

Yet how did Bolsonaro arrive at this low point? According to pollsters XP/Ipespe, in January the president was enjoying a relatively high approval rate, with 40 percent of respondents saying he was doing a “great or good” job and with only 20 percent of respondents evaluating his performance as “bad or awful.” Today, the positive impression has dropped to 35 percent while the negative reviews have spiked to an all-time high of 26 percent. 

So, what happened?

This week was a perfect storm of poor optics combined with gross incompetence and a general sense that the president has attempted a heavy-handed political maneuver to protect his sons from the investigation. The past week saw Bolsonaro participate in a rally (at the height of the coronavirus pandemic) where protesters were holding signs openly asking for a return to a military regime, an opinion from which the president had sought to distance himself during his electoral campaign. Bolsonaro then decided to appoint an officer from the Brazilian intelligence agency, who is a close friend of the Bolsonaro family, to head Brazil’s Federal Police. This brought him into loggerheads with the minister of justice, Sergio Moro who resigned in protest. In Brazil, the Federal Police falls under the jurisdiction of the Ministry of Justice.

Prior to being appointed Minister of Justice, Segio Moro was the very popular judge responsible for investigating and arresting corrupt politicians (including former president Luis Inácio “Lula” da Silva, and industrialist Marcello Oderbrecht) in the Lava Jato Operation (Operation Carwash). This was the greatest investigation into corruption in Brazilian history. Moro quit the government citing pressure from the president for attempting to obstruct justice which immediately split the president’s supporter base losing him thousands, maybe millions of potential voters. Bolsonaro’s pick for replacing Moro is André Mendonça, a lawyer who also has very close ties to the Bolsonaro family. The presidents’ sons have several accusations hanging over them. Most recently his son, Carlos, who is also a politician, is suspected of using taxpayers’ money to fund a social-media blitz to threaten and defame judges as well as politicians. Brazilian stocks tanked after the announcement of Moro’s departure.

And lastly, Bolsonaro has dropped the ball in the fight against the coronavirus. Although he did mobilize the Brazilian army to build several field hospitals across the country and to ramp up the production of ventilators, Bolsonaro gave an absurd speech calling the virus “a little flu.” When asked about the mounting death toll in Brazil, he said: “So what? I may be a Messiah (his middle name Messias means Messiah in Portuguese) but I can’t make miracles;” thus striking a particularly tone-deaf note in the ears of a population struggling to cope with the pandemic. A month before Moro’s resignation, Bolsonaro had already fired his health minister, Luiz Henrique Mandetta, who had criticized the president’s handling of the coronavirus crisis.

In Brazil, impeachment proceedings tend to succeed in toppling presidents, being hugely popular with the electorate. By alienating Sergio Moro and his admirers, Bolsonaro has squarely placed himself on the opposite end of his campaign promises to fight corruption. As the coronavirus crisis wreaks havoc in Brazil, the president’s popularity continues to plummet. The combination of these factors with the president’s propensity to put his foot in his mouth could spell an early end to his mandate.

Biden Is Weak on China Joe Biden was a driving force behind giving China “permanent normal trading status” in 2000, which helped Beijing win admission to the World Trade Organization. It is from this privileged vantage that China has pursued fundamentally unfair trade practices while hypocritically parroting language about free trade and inducing our elite to do the same. by Christian Whiton

President Barack Obama’s first Secretary of Defense, Bob Gates, wrote what could ultimately form the perfect epitaph for former Vice President Biden: “Joe is simply impossible not to like. . .  . Still, I think he has been wrong on nearly every major foreign policy and national security issue over the past four decades.” 

This Cal Ripken-like streak of unbroken erroneousness is remarkable:

Biden thought the removal of the Shah of Iran amid the 1979 Islamic revolution was a step in the right direction for human rights.  

He opposed the Reagan defense buildup that helped the free world win the Cold War.  

He voted against the Gulf War, which was a great success.  

He voted for the Iraq War, which was not.

Biden also opposed the raid in which U.S. forces killed Osama bin Laden—arguably the only solid foreign policy accomplishment of the eight-year administration of which he was nominally second in command.

However, some of Biden’s greatest strides toward being in the wrong center around China. This is topical, because his aides and supporters are eager to reconstruct him as tough on China given strong voter sentiment against the Chinese government amid the Wuhan coronavirus pandemic.

With his long tenure in Congress, Biden was present at the creation of the policies that exported U.S. manufacturing to China and set the stage for Beijing to rob us of technology and undertake a high-tech military buildup. Specifically, Biden was a driving force behind giving China “permanent normal trading status” in 2000, which helped Beijing win admission to the World Trade Organization. It is from this privileged vantage that China has pursued fundamentally unfair trade practices while hypocritically parroting language about free trade and inducing our elite to do the same.  

During the debate, Biden captured the essence of the soothing fiction for abetting China’s rise: “This growing prosperity for the Chinese people, in turn, has put China on a path toward ever-greater political and economic freedom.”  

Biden also said of the foremost alternative economic model to capitalism and free markets in the world: “They have been forced to acknowledge the failure of communism, and have conceded the irrefutable superiority of an open market economy.”

But most devastating—and ready-made for an anti-Biden campaign commercial—was his flippant dismissal of the economic carnage he was unleashing: “Nor do I see the collapse of the American manufacturing economy, as China, a nation with the impact on the world economy about the size of the Netherlands’, suddenly becomes our major economic competitor.”

Oops. As it turned out, the world’s most populous country, run by a despotic, kleptocratic, and belligerent government, was a more formidable threat than Holland.

Of course, the debates of the early twenty-first century might seem like ancient history to some voters. For them, Biden offers much fresher conduct on China to ponder.  

The Obama-Biden administration at varying points declared it would “pivot” our strategic focus and military power to Asia. This language was later modified to “rebalancing” to Asia, prompting some wags to proclaim a policy of “repivulance.” In reality, it was just a rhetorical cover for that administration’s attempt to withdraw rapidly from the Middle East, which proved a boon to ISIS and Iran, and yet somehow left us entangled in Iraq and Syria.  

While the Pentagon added forces in the Pacific that included part-time rotations of Marines to Australia and Littoral Combat Ships—the Navy’s Edsel—to Singapore, the Obama-Biden administration would leave a military posture in the Pacific in 2017 that was weaker than the one it inherited in 2009. 

Speaking in 2013, Biden told a foreign leader, “I want to make one thing absolutely clear: Obama’s decision to rebalance to the Pacific basin is not in question. The United States never says anything it does not do.” Unfortunately, no one believed this absurd statement, least of all the Chinese.  

More recently, on the campaign trail, Biden rambled of China: “I mean, you know, they’re not bad folks, folks. But guess what, they’re not, they’re not competition for us.” Meanwhile, Gallup revealed in March that only 33 percent of Americans held a favorable view of China, down from a recent high of 53 percent in 2018.  

Biden’s weak record on China contrasts negatively with that of President Donald Trump, who has successfully pursued a trade war against Beijing. This led to a deal earlier this year that left in place tariffs on more than half of Chinese imports—tariffs that Biden refuses to say he will continue if elected.

Trump and his aides have fought Huawei and other Chinese instruments of cyberwar that seek to dominate telecommunications and data, and he has begun the difficult process of extracting the U.S. military from playing cowboys and Indians in Middle East backwaters to deter strategic threats like China.  

Meanwhile, Vice President Mike Pence, Secretary of State Mike Pompeo, and Matt Pottinger, the deputy national security advisor, have talked up human-rights concerns in China and asked whether the Chinese people might like an accountable government with the rule of law. This robs Democrats of the human-rights issue they held dear from the Jimmy Carter administration until it was cashiered by Obama and Biden.  

As the coronavirus crisis passes, Americans are likely to turn to retribution and steps to end America’s vulnerability to China. Does Biden have a leg to stand on?

Why Coronavirus May Do More Damage to America’s Reputation Than to China’s The United States has defied many a declinist prognostication, and it may be able to do so again if it modernizes its social compact and commits itself anew to developing coalitions that can address present and future transnational emergencies. But it will likely have to work much harder than China to recover its pre-pandemic standing, assuming that the pervasive perception of an enfeebled and insular superpower has not already calcified. by Ali Wyne

Observers are intensely debating whether the coronavirus is likely to deal greater damage to America’s standing in the world or to China’s. One might make four observations—the first two, evaluative; the third, speculative; and the fourth, in admittedly immediate contradiction, cautionary.

First, albeit for different reasons, neither country has acquitted itself especially well; historians of the pandemic may be more likely to weigh which one’s reputation suffered less than which one’s improved more. The Lowy Institute’s Michael Fullilove succinctly summarizes the prevailing judgment that “smaller, more agile countries” have contained the spread of the virus within their borders more effectively than “the superpowers.”

Second, while the pandemic is unfolding amid—and sadly reinforcing—the erosion of strategic distrust between the United States and China, it does not lend itself to sweeping narratives about the contest between liberalism and authoritarianism. As Rachel Kleinfeld, a senior fellow at the Carnegie Endowment for International Peace notes, both democracies and autocracies have mixed records thus far in slowing the transmission of the virus. In addition, she explains, our sample size is not yet sufficiently large to assess with much credibility the correlation between type of regime and efficacy of response: “The disease has not yet ravaged developing countries, making it impossible to include poorer autocracies and democracies in the comparison.” Pandemic postmortems will entail the further task of distinguishing how different varieties of democracies and autocracies responded. Surveying Asian powers that have won widespread plaudits for their responses to date—especially Taiwan and Singapore, but also Hong Kong, Japan, and South Korea—the Lee Kuan Yew School’s James Crabtree offers a more prosaic explanation: “The thread uniting the countries that did well was that…they were strong, technocratically capable states, largely unhampered by partisan divisions. Public health drove politics, rather than the other way around.”

Third, while both the United States and China are likely to emerge from this pandemic having incurred significant reputational damage, the former may experience greater relative damage, for it has failed to fulfill the expectations that most observers have of the world’s lone superpower—expectations that they may not have of its putative replacement. Most would not have expected the country that accounts for a fourth of the global economy and commands an unrivaled capacity for force projection to run out of personal protective equipment for its doctors and nurses so quickly after the virus broached its borders. Nor, considering how often it has mobilized collective action to address global crises over the past three-quarters of a century, would they have expected it to be as inward-looking and as at loggerheads with longstanding allies and international institutions.

The headline of Katrin Bennhold’s recent article—“‘Sadness’ and Disbelief from a World Missing American Leadership”—reflects a widespread belief that the United States should—and perhaps an underlying hope that it ultimately will—provide that necessity. It is difficult to imagine a comparable headline about China: while other countries will, of course, welcome assistance that it provides as the world struggles to overcome the pandemic, few expect it to lead that response, even as Beijing seeks to depict itself as upholding a fraying architecture of cooperation that Washington is undermining.

Shortly after stepping down as assistant secretary of state for democracy, human rights, and labor, Tom Malinowski observed that “in the refugee camps and war zones that I’ve visited, I’ve never met anyone who told me they were angry at China or France or Russia for failing to help them. Where people are desperate, it is still America they count on, whether they love or scorn it, and America they blame when aid does not come.” Fairly or not, then, the United States bears a unique burden: others’ hopes. The more severe a test the postwar order confronts, the more damage its reputation stands to suffer when its performance is incongruous with those expectations. Having taken close to three hundred thousand lives in just four and a half months, and threatening a global downturn more acute than the Great Depression, the coronavirus is about as dire a challenge as one can imagine.

Fourth, and finally, any and all predictions about a post-pandemic order should be made humbly and treated skeptically. The sobering likelihood is that we are only in the nascent stages of the pandemic; many observers believe that its human toll and economic costs are likely to continue growing rapidly until a vaccine is widely available. Narratives about America and China’s respective responses—domestic and global—are not fixed; they are likely to continue evolving over the coming months. Just consider how significantly storylines about China’s responses have changed. In mid-March it was common to read assessments that Beijing had swiftly contained the coronavirus in Wuhan and was playing a central role in facilitating the rest of the world’s recovery. In recent weeks, though, its standing has fallen considerably, with high-ranking government officials peddling conspiracy theories about the origins of the virus, demanding that recipients of its medical equipment express their gratitude publicly, and dismissing the growing number of reports of defects in the medical equipment China has provisioned.

The United States has defied many a declinist prognostication, and it may be able to do so again if it modernizes its social compact and commits itself anew to developing coalitions that can address present and future transnational emergencies. But it will likely have to work much harder than China to recover its pre-pandemic standing, assuming that the pervasive perception of an enfeebled and insular superpower has not already calcified.

Coronavirus Relief Bill: North Korea Banned From Cannabis Industry The 1,815-page bill has a lot of unexpected provisions. by Matthew Petti

Congress’s latest coronavirus relief bill includes a provision making sure that “the Government of Iran, North Korea, Syria,” or any state sponsor of terrorism is not included in banking channels opened for the legal cannabis industry.

Speaker of the House Nancy Pelosi (D–Calif.) proposed the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act as a fourth package of coronavirus relief funding this week, after Senate Majority Leader Mitch McConnell (R–Ky.) said that he would “hit pause” on further economic relief.

The $3 trillion bill comes out to 1,815 pages, and includes direct economic relief as well as national security measures to prevent another pandemic and provisions that Democrats say will indirectly help deal with the fallout of the novel coronavirus.

One of them is the Secure And Fair Enforcement (SAFE) Banking Act, which would allow legal cannabis businesses to access the U.S. banking system—except for businesses that pose a “threat to national security.”

Rep. Ed Perlmutter (D–Col.) wrote in a statement that he had “been pushing for this” because the “crisis has only exacerbated the risk posed to cannabis businesses & their employees & they need relief just like any other legitimate business.”

The HEROES Act also includes other, more germane national security proposals related to pandemics.

The bill creates a new council of U.S. officials to implement the Global Health Security Agenda, a framework created in 2014 by the United States and several other countries.

It also requires the President to appoint a Coordinator for Global Health Security and joins the United States to an international vaccine development project called the Coalition for Epidemic Preparedness Innovations.

The bill also includes several priorities that Senate Democrats have said are necessary for coping with the coronavirus crisis, including expanded early voting and vote by mail, and financial relief to state and local governments.

But the leadership of the Republican Party, which controls the Senate, has signaled that it will oppose the relief bill.

McConnell said on Tuesday that the HEROES Act was not a bill that “deals with reality” but a collection of “pet priorities” for the Democratic Party.

He instead proposed “narrowly crafted liability protection” for businesses, something President Donald Trump has voiced his support for as well.

"We now have a debt the size of our economy," McConnell said. "So I've said, and the president has said as well, that we have to take a pause here and take a look at what we've done."

Democrats, however, contend that their legislation cannot wait.

“There are those who said, let’s just pause,” Pelosi said on Tuesday. “For the families who are suffering, though, hunger doesn’t take a pause. Rent doesn’t take a pause. Bills don’t take a pause."

Environmental Activist Leilani Münter Warns America Needs Better Pandemic Preparations How a former NASCAR driver and environmental activist believes we can help prevent the next global contagion. by Joseph Cirincione and Zack Brown

The coronavirus pandemic is not only a public health issue, said former NASCAR driver and environmental activist Leilani Münter. It’s also a showcase for the threats posed by the strain humanity is putting on the planet.  

Case in point: while we still don’t know the exact source of COVID-19, we do know that it originally leaped from an animal host. And that host may have been forced into contact with humans as habitat destruction continues to rise globally; some 31,000 square miles of forest are destroyed each year, an area roughly the size of South Carolina. 

Münter, who joined the national security podcast Press The Button, is no stranger to this issue. In 2015, she starred in Racing Extinction, a documentary which detailed the ongoing global mass extinction of plant and animal species caused by human activity. She said the film has gained renewed traction in recent months, in part because of scenes filmed in a wet market in the Chinese city of Guangzhou, a location similar to the Wuhan wet market near which COVID-19 is thought to have originated.

Back then, the United States was still running a program called PREDICT, an international network of scientists tasked with hunting down viruses likely to jump from animals to humans. Coronaviruses, like the one that caused the severe acute respiratory syndrome (SARS), were a major concern; in 2007, researchers from the University of Hong Kong said the prevalence of SARS-like viruses in bats was a “time bomb.” 

But PREDICT, which had cost about $207 million over its ten year existence—or less than the cost of two F-35B fighter jets—was ultimately shut down by the Trump administration in October 2019, the same month COVID-19 may have made its first leap from animal to human. 

Münter believes this move was tragically shortsighted. “The CDC estimates that three quarters of new human diseases originate from animals,” she said. “These high impact threats that humanity is facing but that we know are coming should actually be called gray rhinos instead of black swans,” Münter continued, citing the term popularized by Michelle Wucker. “They’re dangerous, we know for certain they are in our future, and we can see them coming towards us.”

Animal-transmitted diseases will become more likely as the combined effects of climate change and habitat destruction force animals and humans into closer contact. “We’re increasing the frequency where these viruses have the opportunity to make the jump [from animal to human],” Münter warned. “Either from the wild or a wild species interacting with livestock and then making the jump to humans through our livestock consumption.” 

Such a threat assessment calls out for a reprioritization of federal funds, argued Münter. “Our future challenges and threats to our national security are going to come from a lot of places that have nothing to do with weapons and guns,” she said, pointing to the sixty percent of discretionary spending that goes to the Pentagon each year. Military spending “is not going to protect us against future pandemics. It’s not going to protect us against climate change.” 

Even if the U.S. government did divert Pentagon funds to combat climate change and future pandemics, the more difficult challenge may be convincing Americans to adopt more climate-friendly lifestyles such as eating less meat or buying an electric vehicle, said Münter. But the self-professed “vegan hippie chick with a race car” is used to swimming upstream. 

“What I was trying to do in the racing world was reach out to people that didn’t agree with me,” Münter explained. “You have to get outside of your box.” She pointed to her NASCAR collaboration with Operation Free, a group of veterans and national security experts working to promote climate change awareness and a clean energy future. 

“It was such a powerful message because the NASCAR community has a longstanding relationship” with the military, said Münter. “So, it was powerful for these NASCAR fans to come to my tent at the racetrack and meet military generals and veterans from Iraq and Afghanistan” who would talk about the geopolitical and environmental risks entailed by American oil dependence. 

“Of course, there was a little confrontation” to her vocal climate advocacy, Münter admitted. But the recent coronavirus pandemic has only sharpened her belief that the world needs to change, and that the difficult task of persuading people to act is worth it. 

“As long as we continue on this path that we are on,” she explained, “we are setting ourselves up to take ourselves off the planet.” 

The U.S. Must Beat China at its Own Game in South China Sea To date, diplomacy has not worked to roll back China’s actions in the South China Sea, nor will it so long as China believes its salami-slicing works. Perhaps, then, to be effective and to signal support for allies and protect freedom of navigation, it is time for Washington to join Beijing for a salami-themed picnic. by Michael Rubin

Mike Pompeo’s greatest legacy as Secretary of State may be as the first chief diplomat to stand up systematically to Chinese propaganda, Beijing’s underhandedness, the communist regime’s rampant theft of hundreds of billions of dollars’ worth of international property, and the country’s general flouting of international norms. Previous administrations may have had an occasional tough word for China, but few sustained them or moved beyond the rhetoric. China’s economic might, trade importance, and military potency gave prior administrations pause. All knew something needed to be done but, like those American officials who place hopes in Iranian reformists never mind that such a gamble has never paid off, they placed all their bets on the idea that China’s political moderation would follow its economic liberalization. They believed China would embrace the post-World War II liberal order rather than seek to defeat it.

Obfuscation about the origins of the COVID-19 crisis is a symptom of Chinese political culture, but it was a reactive response to a crisis rather than proactive strategy to foment one. The same cannot be said about China’s actions in the South China Sea where it is increasingly engaged in an unprecedented grab of maritime territory. If President Xi Jinping successfully fulfills his ambition to transform low-tide elevations and rocks into islands and claim not only a 12 nautical mile territorial sea around each one, but also a 200 nautical mile exclusive economic zone, the total territory China now seeks to control puts it on par with European powers’ nineteenth-century imperial grabs.

The historical and legal basis of the People’s Republic of China’s claims to the South China Sea are fantastical with no basis in history, international law, or geology. China roots its claims in the so-called “Nine-Dash Line” which first appeared on maps only in 1947; Chinese maps from centuries past, however, show no such claims. While Chinese officials also back Beijing’s claims by arguing that the areas included within the Nine-Dash Line were traditional Chinese fishing grounds, this argument is meaningless as Vietnamese, Filipinos, and Malaysian fishermen also plied the same waters historically.

Some diplomats bend over backwards to accommodate the narratives of those sitting across the table. History, however, is not so flexible. As part of the 1898 Treaty of Paris ending the Spanish-American War, Spain sold the Philippines to the United States for $20 million. Both Madrid and Washington considered Mischief Reef and Scarborough Shoal—the former occupied by China and the latter administered by it despite a Permanent Court of Arbitration ruling against Beijing--to be Filipino territory. Likewise, when the Philippines gained their full independence on July 4, 1946, they assumed control over both the Scarborough Shoal and Mischief Reef. Simply put—and as the arbitration ruling concluded—China has no valid legal or historic claims to either.

The same story continues across the South China Sea. The Center for Strategic and International Studies’ invaluable Asia Maritime Transparency Initiative publishes and analyzes open-source satellite imagery of the islands, rocks, and low-tide elevations which dot the South China Sea and show visually China’s ‘salami-slicing’ strategy of slowly transforming reefs and rocks into artificial islands and building military bases, anti-aircraft batteries, and surveillance stations on them.

While Pompeo’s willingness to take on Chinese propaganda is welcome, it is questionable whether winning in the court of public opinion will be enough to alter Chinese behavior. Diplomacy has value, but can only provide a solution when both sides approach it for the same purposes. For too long, however, China’s Ministry of Foreign Affairs has approached diplomacy as an asymmetric warfare strategy with which to tie opponents’ hands together while they advance their military position.

The United States sees the South China Sea as international waters and refuses to recognize the basin’s reefs and low-tide elevations as islands deserving of exclusive economic zones. Perhaps, however, it is time to make an exception.

China’s claims that the rocks, shoals, and reefs it illegally occupies are islands are discernably false.  One feature in the South China Sea, however, does meet the criteria to be an island. While its claim is disputed by China, Vietnam, and the Philippines, Taiwan possesses Itu Aba (Taiping Island), the largest land feature in the Spratley chain. Taiwan has long claimed that Itu Aba is an island deserving of its own exclusive economic zone although, in 2016, an arbitration panel convened at the Philippines' request found that Itu Aba was merely a rock deserving only of 12 nautical mile territorial waters. The ruling itself, however, was flawed. One of the major features of an island is that it possesses fresh water to sustain life. Residents on Itu Aba trap rainwater and so they do access enough freshwater and can support a meaningful economy. The 2016 ruling’s logic was likely convoluted and discarded precedent.

To beat China at its own game and better protect freedom of navigation, Secretary of State Mike Pompeo should recognize both Itu Aba’s status as an island and Taiwan’s claim it. Many detractors will suggest that China would point to such a move to justify its own island claims, but Beijing is doing so anyway. The difference between any potential U.S. recognition of Taiwan’s claim to Itu Aba and the various reefs and artificial islands that China now possesses is that Itu Aba has geology on its side. To recognize Itu Aba as an island is not to bless land reclamation on China-occupied features, but rather is simply to end neutrality on the matter which is counterproductive to a major U.S. ally.

U.S. officials might begin by visiting Itu Aba during tours of the region. Consider that a slice of salami: China will not risk war because a deputy assistant secretary of Defense spent an afternoon touring its airport, nature reserve, airport, or hospital. China often uses scientific missions to provide cover to its own military engineers. A second slice of salami would be the dispatch of parallel-group of American geologists, engineers, and marine biologists to the island. Perhaps Itu Aba could host an office of the American Institute of Taiwan to host them. A third slice would be the provision of radar and surface-to-air missiles to help defend the island from regional predators, something with which the aforementioned engineers might help. Ultimately, Taipei and Washington might celebrate their long history of strategic relations by scheduling port calls on the island. After all, Xi’s actions helped catapult COVID-19 from a localized outbreak into a global pandemic. Travel is difficult, but Itu Aba’s isolation makes it a perfect and safe rest-and-relaxation destination for the U.S. military.

To date, diplomacy has not worked to roll back China’s actions in the South China Sea, nor will it so long as China believes its salami-slicing works. Perhaps, then, to be effective and to signal support for allies and protect freedom of navigation, it is time for Washington to join Beijing for a salami-themed picnic.