“We are here to make a choice between the quick and the dead …”

With these solemn words, Bernard Baruch, a trusted advisor to U.S. presidents, addressed the United Nations (UN) Atomic Energy Commission in June 1946. Less than a year had passed since the bombings of Hiroshima and Nagasaki, and the world stood at a crossroads. Baruch’s message was clear: humanity could either embrace the hope of global peace or face the terror of nuclear annihilation.

President Truman had appointed Baruch to present a groundbreaking proposal to halt the nuclear arms race before it began. The United States would surrender its nuclear arsenal to the UN, and all nations would be banned from producing atomic weapons. This bold plan reflected TTruman’srecognition of the devastation these weapons can unleash. Yet, despite its visionary promise, the plan failed. Nearly 80 years later, Baruch’s words remain hauntingly relevant as the world grapples with the persistent threat of nuclear war.

Dr. James Muller, a cardiologist and nuclear arms expert, offers an analogy between the cumulative risk of cardiac events and the existential threat of nuclear war. Cardiologists address even low annual cardiac risks by considering long-term probability and recommending interventions like smoking cessation, hypertension management, and weight loss to prevent catastrophic outcomes. Similarly, while the annual risk of nuclear war may seem negligible — as low as 1 percent — it accumulates to a 50 percent risk over 70 years. Such a devastating prospect demands a shift in behavior, much like the lifestyle changes cardiologists advocate to prevent heart attacks. Yet the stakes are far greater: the survival of humanity itself.

Preventing nuclear war is a critical public health imperative, often overshadowed by climate change, gun safety, or infectious diseases. The health consequences of nuclear conflict would be unparalleled—immediate mass casualties, long-term radiation-related illnesses, and catastrophic impacts on health care systems and infrastructure. Recognizing this, organizations like the American Public Health Association (APHA) have called on governments to work toward a nuclear weapons-free world, emphasizing the profound health implications of nuclear weapons. Similarly, Physicians for Social Responsibility highlights that any use of nuclear weapons would have devastating health, humanitarian, and environmental consequences, advocating for prevention as the only cure. Recognizing nuclear disarmament as a public health imperative could elevate its urgency and encourage international cooperation, much like efforts to combat pandemics and climate change.

For comparison, a coronary stent with a 1 percent annual complication rate results in a 20 percent risk over 20 years—an acceptable trade-off given its immediate benefits. However, applying this logic to nuclear deterrence exposes its peril. Over generations, even small risks compound into near certainties. Paradoxically, moments of acute crisis often catalyze meaningful change—just as a smoker might quit after a heart attack. In the nuclear era, such moments offer hope for breaking the cycle of high-risk behavior and embracing a safer future.

The nuclear arms race Truman sought to prevent not only continues but has escalated in complexity. Trump’s first presidency dealt a significant blow to nuclear nonproliferation efforts. His withdrawal from the Open Skies Treaty—an international agreement allowing unarmed surveillance flights to build trust among nuclear powers—and his refusal to extend a key arms control treaty with Russia, New START, unraveled decades of progress. Now, Trump’s return to the White House comes at an even more precarious moment for international security, underscoring the enduring struggle to balance nuclear danger with global peace.

Regional conflicts have also significantly heightened the risk of nuclear escalation. Russia’s war in Ukraine involves Russia openly threatening to use nuclear weapons. In November 2024, President Vladimir Putin revised Russia’s nuclear doctrine, lowering the threshold for deploying these weapons. This new policy permits a nuclear response to conventional attacks from any nation supported by a nuclear power, a direct warning to NATO and Western countries aiding Ukraine. Meanwhile, in the Middle East, tensions among regional powers like Iran, with its nuclear ambitions, create fertile ground for proliferation. Adding to these concerns, New START is set to expire on February 5, 2026. Without a replacement, the arms race will likely accelerate, eroding critical channels for dialogue that have historically prevented crises from spiraling out of control.

Domestically, President-elect Trump will soon assume command of nearly 1,000 nuclear weapons on hair-trigger alert, ready for rapid launch in the event of a perceived attack. This fragile system designed to deter threats is plagued by the risk of technical failure and human error. The 1983 Soviet false alarm – when the certainty of nuclear war was prevented only by common sense superseding protocol – demonstrated how dangerously close the world has come to accidental nuclear catastrophe.

Trump’s advocacy for reduced U.S. engagement in foreign affairs further destabilizes global alliances. If nations like Japan or South Korea lose confidence in the U.S.’s ability to protect them under its “nuclear umbrella,” they may feel compelled to develop their own nuclear capabilities. This could spark regional arms races and further weaken international nonproliferation efforts.

Despite the grim outlook, there are actionable steps to reduce the risk of intentional or accidental nuclear war. Ideas such as adopting a no-first-use policy or negotiating mutual agreements with Russia to take nuclear weapons off hair-trigger alert have long been proposed but remain unimplemented. Ironically, Trump himself once expressed interest in nuclear disarmament. In 1986, he contacted Physicians for the Prevention of Nuclear War (PPNW), a group that later co-founded the International Campaign to Abolish Nuclear Weapons (ICAN). ICAN was awarded the Nobel Peace Prize in 2017 for its work developing the Treaty on the Prohibition of Nuclear Weapons, which entered into force in 2021 with 94 signatories. Yet the U.S., Russia, and other nuclear-armed states continue to reject the treaty, insisting their arsenals are vital to national security.

Trump’s complicated history with nuclear diplomacy offers an unexpected twist when viewed alongside his relationships with world leaders. While his rapport with Putin draws criticism, the fact that the leaders of the nations controlling 90 percent of the world’s 12,500 nuclear weapons remain on speaking terms is not insignificant. Furthermore, North Korea has expressed greater willingness to negotiate under Trump’s leadership.

Throughout the campaign, candidates and the media largely ignored the threat of nuclear war—a neglect fueled by competing crises, desensitization to the nuclear threat, and lack of public awareness. Now, voters have chosen a leader whose hallmark is unpredictability and who promises transformational change. At first glance, Trump’s high-stakes style could push the world closer to a perilous breaking point. Yet his unconventional leadership might also create unexpected conditions for progress in nuclear diplomacy.

Nearly 80 years after Baruch’s speech, his words remain a stark reminder of the stakes: “We must elect World Peace or World Destruction.” The choice is as urgent now as it was then. Leaders must prioritize disarmament, restore dialogue between nuclear powers, and confront the existential threat posed by these weapons. The time for decisive action is now—before it is too late.

Nathan Swidler is a speechwriter. Jennifer Obel is a hematology-oncology physician.