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• W4387229287 abstract "Back to table of contents Previous article Next article CommentaryFull AccessReducing the Risks of Nuclear War: The Role of Health ProfessionalsKamran Abbasi, M.D., Parveen Ali, Ph.D., M.Sc.N., Virginia Barbour, M.A.Camb., M.B.B.Chir., D.Phil., M.R.C.P., Kirsten Bibbins-Domingo, M.D., Ph.D., Peng Gong, Ph.D., Andy Haines, F.Med.Sci., Ira Helfand, M.D., Richard Horton, M.B.Ch.B., Bob Mash, M.B.Ch.B., Ph.D., Arun Mitra, M.B.B.S., Carlos Monteiro, M.D., Ph.D., Elena N. Naumova, Ph.D., Marcel G.M. Olde Rikkert, M.D., Ph.D., Eric J. Rubin, M.D., Ph.D., Tilman Ruff, M.B.B.S. (Hons), Peush Sahni, Ph.D., James Tumwine, M.B.Ch.B., M.Med., Ph.D., Paul Yonga, M.B.Ch.B., M.S.P.H., F.R.C.P.E., Chris Zielinski, B.Sc., M.Sc.Kamran AbbasiSearch for more papers by this author, M.D., Parveen AliSearch for more papers by this author, Ph.D., M.Sc.N., Virginia BarbourSearch for more papers by this author, M.A.Camb., M.B.B.Chir., D.Phil., M.R.C.P., Kirsten Bibbins-DomingoSearch for more papers by this author, M.D., Ph.D., Peng GongSearch for more papers by this author, Ph.D., Andy HainesSearch for more papers by this author, F.Med.Sci., Ira HelfandSearch for more papers by this author, M.D., Richard HortonSearch for more papers by this author, M.B.Ch.B., Bob MashSearch for more papers by this author, M.B.Ch.B., Ph.D., Arun MitraSearch for more papers by this author, M.B.B.S., Carlos MonteiroSearch for more papers by this author, M.D., Ph.D., Elena N. NaumovaSearch for more papers by this author, Ph.D., Marcel G.M. Olde RikkertSearch for more papers by this author, M.D., Ph.D., Eric J. RubinSearch for more papers by this author, M.D., Ph.D., Tilman RuffSearch for more papers by this author, M.B.B.S. (Hons), Peush SahniSearch for more papers by this author, Ph.D., James TumwineSearch for more papers by this author, M.B.Ch.B., M.Med., Ph.D., Paul YongaSearch for more papers by this author, M.B.Ch.B., M.S.P.H., F.R.C.P.E., Chris ZielinskiSearch for more papers by this author, B.Sc., M.Sc.Published Online:1 Oct 2023https://doi.org/10.1176/appi.ajp.20230595AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In January 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 seconds before midnight, reflecting the growing risk of nuclear war (1). In August 2022, the UN Secretary-General António Guterres warned that the world is now in “a time of nuclear danger not seen since the height of the Cold War” (2). The danger has been underlined by growing tensions between many nuclear armed states (1, 3). As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet—and urge action to prevent it.Current nuclear arms control and non-proliferation efforts are inadequate to protect the world’s population against the threat of nuclear war by design, error, or miscalculation. The Treaty on the Non-Proliferation of Nuclear Weapons (NPT) commits each of the 190 participating nations “to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament, and on a treaty on general and complete disarmament under strict and effective international control” (4). Progress has been disappointingly slow and the most recent NPT review conference in 2022 ended without an agreed statement (5). There are many examples of near disasters that have exposed the risks of depending on nuclear deterrence for the indefinite future (6). Modernization of nuclear arsenals could increase risks: for example, hypersonic missiles decrease the time available to distinguish between an attack and a false alarm, increasing the likelihood of rapid escalation.Any use of nuclear weapons would be catastrophic for humanity. Even a “limited” nuclear war involving only 250 of the 13,000 nuclear weapons in the world could kill 120 million people outright and cause global climate disruption leading to a nuclear famine, putting 2 billion people at risk (7, 8). A large-scale nuclear war between the United States and Russia could kill 200 million people or more in the near term, and potentially cause a global “nuclear winter” that could kill 5–6 billion people, threatening the survival of humanity (7, 8). Once a nuclear weapon is detonated, escalation to all-out nuclear war could occur rapidly. The prevention of any use of nuclear weapons is therefore an urgent public health priority and fundamental steps must also be taken to address the root cause of the problem—by abolishing nuclear weapons.The health community has had a crucial role in efforts to reduce the risk of nuclear war and must continue to do so in the future (9). In the 1980s the efforts of health professionals, led by the International Physicians for the Prevention of Nuclear War (IPPNW), helped to end the Cold War arms race by educating policy makers and the public on both sides of the Iron Curtain about the medical consequences of nuclear war. This was recognised when the 1985 Nobel Peace Prize was awarded to the IPPNW (10). (http://www.ippnw.org).In 2007, the IPPNW launched the International Campaign to Abolish Nuclear Weapons, which grew into a global civil society campaign with hundreds of partner organisations. A pathway to nuclear abolition was created with the adoption of the Treaty on the Prohibition of Nuclear Weapons in 2017, for which the International Campaign to Abolish Nuclear Weapons was awarded the 2017 Nobel Peace Prize. International medical organisations, including the International Committee of the Red Cross, the IPPNW, the World Medical Association, the World Federation of Public Health Associations, and the International Council of Nurses, had key roles in the process leading up to the negotiations, and in the negotiations themselves, presenting the scientific evidence about the catastrophic health and environmental consequences of nuclear weapons and nuclear war. They continued this important collaboration during the First Meeting of the States Parties to the Treaty on the Prohibition of Nuclear Weapons, which currently has 92 signatories, including 68 member states (11).We now call on health professional associations to inform their members worldwide about the threat to human survival and to join with the IPPNW to support efforts to reduce the near-term risks of nuclear war, including three immediate steps on the part of nuclear-armed states and their allies: first, adopt a no first use policy (12); second, take their nuclear weapons off hair-trigger alert; and, third, urge all states involved in current conflicts to pledge publicly and unequivocally that they will not use nuclear weapons in these conflicts. We further ask them to work for a definitive end to the nuclear threat by supporting the urgent commencement of negotiations among the nuclear-armed states for a verifiable, timebound agreement to eliminate their nuclear weapons in accordance with commitments in the NPT, opening the way for all nations to join the Treaty on the Prohibition of Nuclear Weapons.The danger is great and growing. The nuclear armed states must eliminate their nuclear arsenals before they eliminate us. The health community played a decisive part during the Cold War and more recently in the development of the Treaty on the Prohibition of Nuclear Weapons. We must take up this challenge again as an urgent priority, working with renewed energy to reduce the risks of nuclear war and to eliminate nuclear weapons.Editor-in-Chief, British Medical Journal (Abbasi); Editor-in-Chief, International Nursing Review (Ali); Editor-in-Chief, Medical Journal of Australia (Barbour); Editor-in-Chief, Journal of the American Medical Association (Bibbins-Domingo); Editor-in-Chief, Chinese Science Bulletin (Gong); London School of Hygiene and Tropical Medicine (Haines); Past President, International Physicians for the Prevention of Nuclear War (Helfand); Editor-in-Chief, The Lancet (Horton); Editor-in-Chief, African Journal of Primary Health Care & Family Medicine (Mash); Past President, International Physicians for the Prevention of Nuclear War (Mitra); Editor-in-Chief, Revista de Saúde Pública (Monteiro); Editor-in-Chief, Journal of Public Health Policy (Naumova); Editor-in-Chief, Dutch Journal of Medicine (Olde Rikkert); Editor-in-Chief, New England Journal of Medicine (Rubin); Past President, International Physicians for the Prevention of Nuclear War (Ruff); Editor-in-Chief, National Medical Journal of India (Sahni); Editor-in-Chief, African Health Sciences (Tumwine); Editor-in-Chief, East African Medical Journal (Yonga); University of Winchester, World Association of Medical Editors (Zielinski).Send correspondence to Dr. Zielinski ([email protected]).Supported by Principal Investigator Pathfinder Initiative 2020–2025 (Dr. Haines, co-investigator), Sustainable Healthy Food Systems research programme2017-2023 (Dr. Haines, co-investigator), and Complex Urban Systems for Sustainability and Health (CUSSH) 2017–2023, all funded by the Wellcome Trust, with additional funding from the Oak Foundation for the Pathfinder initiative (Dr. Haines); research grants from the Dutch Research council (NOW grant no. COMPL.21COV.001) and the Netherlands Organisation for Health Research (ZonMw: grant no: 09120012010063) to Dr. Olde Rikkert.This editorial is being published simultaneously in multiple journals. For the full list of journals see https://www.bmj.com/content/full-list-authors-and-signatories-nuclear-risk-editorial-august-2023Dr. Haines reports receiving book royalties from Cambridge University Press and consultancy fees paid to his institution from the Wellcome Trust. Dr. Helfand reports honoraria for several speaking engagements, all donated to Back from the Brink, the International Physicians for the Prevention of Nuclear War, or Physicians for Social Responsibility; and travel/meeting support for Nobel Peace Laureates’ Summit, the World Federation of Public Health Associations World Congress, and the UN Human Rights Commission Youth Summit. Dr. Ruff has received consulting fees from the U.S. Institute for Energy and Environmental Research; speaking honoraria from Choisun Ilbo media group, Gangwon Province, Hyogo Medical Practitioners Association, Peace Boat, and the University of Sydney; and has served as an expert witness on behalf of Environmental Justice Australia and Mine-Free Glenaladale. Dr. Yonga serves as the Principal Investigator of a trial funded by Atea Pharmaceuticals, has received honoraria from bioMerieux and Pfizer Pharmaceuticals and serves on an advisory board for Pfizer Pharmaceuticals. Dr. Zielinski has received consulting fees from the International Physicians for the Prevention of Nuclear War. The remaining authors report no financial relationships with commercial interests.References1. Science and Security Board, Bulletin of the Atomic Scientists: A time of unprecedented danger: it is 90 seconds to midnight. 2023 Doomsday Clock Statement, 2023. https://thebulletin.org/doomsday-clock/current-time/ (accessed Jun 1, 2023) Google Scholar2. Future Generations Counting on Our Commitment to Step Back from Abyss, Lift Cloud of Nuclear Annihilation for Good, Secretary-General Tells Review Conference. 2022. Press Release SG/SM/21394. https://press.un.org/en/2022/sgsm21394.doc.htm (accessed Jul 10, 2023) Google Scholar3. Tollefson J: Is nuclear war more likely after Russia’s suspension of the New START treaty? Nature 2023; 615:386Crossref, Medline, Google Scholar4. 2005 Review Conference of the Parties to the Treaty on the Non-Proliferation of Nuclear Weapons (NPT). 2005. https://www.un.org/en/conf/npt/2005/npttreaty.html (accessed Jun 2, 2023) Google Scholar5. Mukhatzhanova: 10th NPT Review Conference: Why it was Doomed and How it Almost Succeeded. Arms Control Association, 2022. https://www.armscontrol.org/act/2022-10/features/10th-npt-review-conference-why-doomed-almost-succeeded (accessed Jun 2, 2023) Google Scholar6. Lewis P, Williams H, Pelopidas B, et al.: Too Close for comfort, Cases of Near Nuclear Use and Options for Policy. Chatham House Report, 2014. https://www.chathamhouse.org/2014/04/too-close-comfort-cases-near-nuclear-use-and-options-policy (accessed Jun 1, 2023) Google Scholar7. Bivens M: Nuclear famine. IPPNW. 2022 (accessed Jun 1, 2023). https://www.ippnw.org/wp-content/uploads/2022/09/ENGLISH-Nuclear-Famine-Report-Final-bleed-marks.pdf Google Scholar8. Xia L, Robock A, Scherrer K, et al.: Global food insecurity and famine from reduced crop, marine fishery and livestock production due to climate disruption from nuclear war soot injection. Nat Food 2022; 3:586–596Crossref, Medline, Google Scholar9. Helfand I, Lewis P, Haines A: Reducing the risks of nuclear war to humanity. Lancet 2022; 399:1097–1098Crossref, Medline, Google Scholar10. Nobel Prize Outreach AB: International Physicians for the Prevention of Nuclear War—Facts. 1985. https://www.nobelprize.org/prizes/peace/1985/physicians/facts/ (accessed Jun 1, 2023) Google Scholar11. UN Office for Disarmament Affairs. Treaties Database: Treaty on the Prohibition of Nuclear Weapons, Status of the Treaty. 2023. https://treaties.unoda.org/t/tpnw (accessed Jun 1, 2023) Google Scholar12. Center for Arms Control and Non-Proliferation: No First Use: Frequently Asked Questions. 2023. https://armscontrolcenter.org/issues/no-first-use/no-first-use-frequently-asked-questions/ (accessed Jun 2, 2023) Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 180Issue 10 October 1, 2023Pages 712-713 Metrics KeywordsSociopolitical IssuesPhysician IssuesPDF download History Published online 1 October 2023 Published in print 1 October 2023" @default.
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