How would I use a load balancer to fail traffic between, say, London and Amsterdam with no fiber in place between them? Where would the load balancer physically exist in that scenario and how would it fail to the other when power is lost in one location? Would I make a third PoP to isolate it? What would then be my redundancy story for that PoP? How would I relocate traffic to my backup load balancer PoP number four?

Within a single network, sure, load balance all you want. That’s not the scenario low TTLs go after.