Biden Avoids a Further Mideast Spiral as Israel and Iran Show Restraint. But for How Long?

President Joe Biden can breathe a bit easier, at least for the moment, now that Israel and Iran appear to have stepped back from the brink of tipping the Middle East into all-out war.

Israel's retaliatory strikes on Iran and Syria caused limited damage. The restrained action came after Biden urged Prime Minister Benjamin Netanyahu’s government to temper its response to Iran's unprecedented direct attack on Israel last week and avoid an escalation of violence in the region. Iran's barrage of drones and missiles inflicted little damage and followed a suspected Israeli attack on the Iranian consulate in Damascus this month that killed two generals.

Iran's public response to the Israeli strikes Friday also was muted, raising hopes that Israel-Iran tensions — long carried out in the shadows with cyberattacks, assassinations and sabotage — will stay at a simmer.

The situation remains a delicate one for Biden as he gears up his reelection effort in the face of headwinds in the Middle East, Russia and the Indo-Pacific. All are testing the proposition he made to voters during his 2020 campaign that a Biden White House would bring a measure of calm and renewed respect for the United States on the world stage.

Foreign policy matters are not typically the top issue for American voters. This November is expected to be no different, with the economy and border security carrying greater resonance.

But public polling suggests that overseas concerns could have more relevance with voters than in any US election since 2006, when voter dissatisfaction over the Iraq War was a major factor in the Republican Party losing 30 House and six Senate seats.

“We see this issue rising in saliency, and at the same time we're seeing voter appraisals of President Biden's handling of foreign affairs being quite negative,” said Christopher Borick, director of the Muhlenberg College Institute of Public Opinion. “That combination is not a great one for Biden.”

Biden has staked enormous political capital on his response to the Israel-Hamas war as well as his administration's backing of Ukraine as it fends off a Russian invasion.

The apparent de-escalation of tensions between Israel and Iran also comes as Congress moves closer to approving $95 billion in wartime aid for Ukraine, Israel and Taiwan, a measure that Biden has pushed for as Ukrainian forces run desperately short on arms.

After months of delay in the face of the threat of ouster by his party’s right flank, House Speaker Mike Johnson, R-La., pushed the package forward and final House passage was expected this weekend. That prospect — and a surge of weaponry to the front lines — is giving the White House renewed hope that Ukraine can right the ship after months of setbacks in the war.

Biden also has made bolstering relations in the Indo-Pacific a central focus of his foreign policy agenda, looking to win allies and build ties as China becomes a more formidable economic and military competitor.

But Republicans, including former President Donald Trump, have an argument to make that Biden’s policies have contributed to US dealing with myriad global quandaries, said Richard Goldberg, a senior adviser at the Washington think tank Foundation for the Defense of Democracies.

Republicans have criticized Biden's unsuccessful efforts earlier in his term to revive a nuclear deal with Iran brokered by the Obama administration and abandoned by Trump, saying that would embolden Tehran. The agreement had provided Iran with billions in sanctions relief in exchange for the country agreeing to roll back its nuclear program.

GOP critics have sought to connect Russia's invasion of Ukraine to Biden's decision to withdraw from Afghanistan and they blame the Obama administration for not offering a strong enough response to Russian President Vladimir Putin's 2014 seizure of Crimea.

“You can make an intellectual case, a policy case of how we got from Point A to B to C to D and ended up in a world on fire,” said Goldberg, a national security official in the Trump administration. “People may not care about how we got here, but they do care that we are here.”

Polling suggests Americans' concerns about foreign policy issues are growing, and there are mixed signs of whether Biden's pitch as a steady foreign policy hand is resonating with voters.

About 4 in 10 US adults named foreign policy topics in an open-ended question that asked people to share up to five issues for the government to work on in 2024, according to The Associated Press-NORC Center for Public Affairs Research poll published in January. That’s about twice as many as mentioned the topic in an AP- NORC poll conducted in the previous year.

Further, about 47% of Americans said they believe Biden has hurt relations with other countries, according to an AP-NORC poll published this month. Similarly, 47% said the same about Trump.

Biden was flying high in the first six months of his presidency, with the American electorate largely approving of his performance and giving him high marks for his handling of the economy and the coronavirus pandemic. But the president saw his approval ratings tank in the aftermath of the chaotic withdrawal of US troops from Afghanistan in August 2021 and they never fully recovered.

Now, Biden finds himself dealing with uncertainty of two wars. Both could shadow him right up to Election Day.

With the Israel-Hamas war, Republicans pillory him as being not being adequately supportive of Israel, and the left wing of his party harshly criticize the president, who has shown displeasure with Netanyahu's prosecution of the war, for not doing more to force the Israelis to safeguard Palestinian lives.

After Israel's carefully calibrated strikes on Iran, Middle East tensions have entered a “gray area” that all parties must navigate carefully, said Aaron David Miller, an adviser on Middle East issues in Republican and Democratic administrations.

“Does what has occurred over the last 10 days strengthen each sides' risk-readiness or has it made them drop back from the brink and revert into risk aversion?” Miller said. “Israel and Iran got away with striking each other's territory without a major escalation. What conclusions do they draw from that? Is the conclusion that we might be able to do this again? Or is it we really dodged a bullet here and we have to be exceedingly careful.”

Israel and Hamas appear far away from an agreement on a temporary ceasefire that would facilitate the release of remaining hostages in Hamas-controlled Gaza and help get aid into the territory. It's an agreement that Biden sees as essential to finding an endgame to the war.

CIA Director William Burns expressed disappointment this past week that Hamas has not yet accepted a proposal that Egyptian and Qatari negotiators had presented this month. He blamed the group for "standing in the way of innocent civilians in Gaza getting humanitarian relief that they so desperately need.”

At the same time, the Biden administration has tried to demonstrate it is holding Israel accountable, imposing new penalties Friday on two entities accused of fundraising for extremist Israel settlers that were already under sanctions, as well as the founder of an organization whose members regularly assault Palestinians.

National security adviser Jake Sullivan and other administration officials met on Thursday with Israel's minister for strategic affairs, Ron Dermer, and national security adviser Tzachi Hanegbi. US officials, according to the White House, reiterated Biden's concerns about Israel's plans to carry out an operation in the southern Gaza city of Rafah, where some 1.5 million Palestinians have taken shelter.

Ross Baker, professor emeritus of political science at Rutgers University, said Biden may have temporarily benefited from Israeli-Iranian tensions driving attention away from the deprivation in Gaza.

“Sometimes salvation can come in unexpected ways,” Baker said. “But the way ahead has no shortage of complications.”

Scientists studying the new mpox strain that has spread out of Democratic Republic of Congo say the virus is changing faster than expected, and often in areas where experts lack the funding and equipment to properly track it.

That means there are numerous unknowns about the virus itself, its severity and how it is transmitting, complicating the response, half a dozen scientists in Africa, Europe and the United States told Reuters.

Mpox, formerly known as monkeypox, has been a public health problem in parts of Africa since 1970, but received little global attention until it surged internationally in 2022, prompting the World Health Organization to declare a global health emergency. That declaration ended 10 months later.

A new strain of the virus, known as clade Ib, has the world's attention again after the WHO declared a new health emergency.

The strain is a mutated version of clade I, a form of mpox spread by contact with infected animals that has been endemic in Congo for decades. Mpox typically causes flu-like symptoms and pus-filled lesions and can kill.

Congo has had more than 18,000 suspected clade I and clade Ib mpox cases and 615 deaths this year, according to the WHO. There have also been 222 confirmed clade Ib cases in four African countries in the last month, plus a case each in Sweden and Thailand in people with a travel history in Africa.

"I worry that in Africa, we are working blindly," said Dr. Dimie Ogoina, an infectious diseases expert at Niger Delta University Hospital in Nigeria who chairs the WHO's mpox emergency committee. He first raised the alarm about potential sexual transmission of mpox in 2017, now an accepted route of spread for the virus.

"We don’t understand our outbreak very well, and if we don't understand our outbreak very well, we will have difficulty addressing the problem in terms of transmission dynamics, the severity of the disease, risk factors of the disease," Ogoina said. "And I worry about the fact that the virus seems to be mutating and producing new strains."

He said it took clade IIb in Nigeria five years or more to evolve enough for sustained spread among humans, sparking the 2022 global outbreak. Clade Ib has done the same thing in less than a year.

MUTATING 'MORE RAPIDLY'

Mpox is an orthopoxvirus, from the family that causes smallpox. Population-wide protection from a global smallpox vaccine campaign 50 years ago has waned, as the vaccinating stopped when the disease was eradicated.

Genetic sequencing of clade Ib infections, which the WHO estimates emerged mid-September 2023, show they carry a mutation known as APOBEC3, a signature of adaptation in humans.

The virus that causes mpox has typically been fairly stable and slow to mutate, but APOBEC-driven mutations can accelerate viral evolution, said Dr. Miguel Paredes, who is studying the evolution of mpox and other viruses at Fred Hutchison Cancer Center in Seattle.

"All the human-to-human cases of mpox have this APOBEC signature of mutations, which means that it's mutating a little bit more rapidly than we would expect," he said.

Paredes and other scientists said a response was complicated by several mpox outbreaks happening at once.

In the past, mpox was predominantly acquired through human contact with infected animals. That is still driving a rise in Congo in clade I cases – also known as clade Ia - likely due in part to deforestation and increased consumption of bushmeat, scientists said.

The mutated versions, clade Ib and IIb, can now essentially be considered a sexually transmitted disease, said Dr. Salim Abdool Karim, a South African epidemiologist and chair of the Africa CDC’s mpox advisory committee. Most of the mutated clade Ib cases are among adults, driven at first by an epidemic among female sex workers in South Kivu, Congo.

The virus also can spread through close contact with an infected person, which is likely how clusters of children have been infected with clade Ib, particularly in Burundi and in eastern Congo’s displacement camps, where crowded living conditions may be contributing.

Children, pregnant women and people with weakened immune systems or other illnesses may be at greater risk of serious mpox disease and death, say the WHO and mpox scientists.

Clade I has typically caused more severe disease, with fatality rates of 4%-11%, compared to around 1% for clade II. Ogoina said data from Congo suggests few have died of the new Ib version, but he feared some data is being mixed up.

More research is urgently needed, but three teams tracking mpox outbreaks in Africa say they cannot even access chemicals needed for diagnostic tests. Clade Ib can also be missed by some diagnostic tests.

Planning a response, including vaccination strategies, without this is difficult, the scientists said.

Karim said around half of cases in eastern Congo, where Ib is particularly prevalent, are only being diagnosed by doctors, with no laboratory confirmation.

Getting samples to labs is difficult because the healthcare system is already under pressure, he said. And around 750,000 people have been displaced amid fighting between the M23 rebel group and the government.

Many African laboratories cannot get the supplies they need, said Dr. Emmanuel Nakoune, an mpox expert at the Institut Pasteur in Bangui, Central African Republic, which also has clade Ia cases.

"This is not a luxury," he said, but necessary to track deadly outbreaks.

Biden Avoids a Further Mideast Spiral as Israel and Iran Show Restraint. But for How Long?