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Sign up for our free Health Check email to receive exclusive analysis on the week in health Get our free Health Check email The government’s former deputy chief medical adviser has revealed he thought about quitting after his family was threatened with having their throats cut during the pandemic. Testifying at the Covid inquiry on […] More
Here is a simple moral proposition. No one in America, or anywhere in the world, should die or suffer unnecessarily because they cannot afford a prescription drug which, in many cases, costs a few cents or a few dollars to manufacture.As Chairman of the US Senate Health, Education, Labor and Pensions Committee (Help) I’m going to do everything I can to develop a new approach to the development and manufacturing of prescription drugs that responds to medical need, rather than short-term shareholder profit. Given the power and greed of the pharmaceutical industry this is not an easy task, but it’s one that must be pursued.The tragic reality is that, today, millions of people around the world are suffering, and dying, from preventable diseases because they can’t afford the outrageous prices charged by pharmaceutical companies. According to the World Health Organization (WHO), one third of humanity lacks access to essential medicines. For a staggering number of people around the world, this leads to what the WHO calls “a cascade of preventable misery and suffering.”There are a number of reasons why this tragic reality continues to happen.First, too often drug companies abuse patent monopolies to charge outrageous prices or otherwise keep lifesaving drugs out of reach for people around the world. For example, the Boston-based drug company Vertex is neither selling a transformative new treatment for cystic fibrosis in the developing world, nor allowing other local companies to produce it. Put simply, the company is not only refusing to bring a life-raft to people drowning with cystic fibrosis in poor countries, it is also blocking others from deploying their own life-rafts to people who need them to stay alive.Second, far too often, the medicines that are desperately needed by millions of people in poor countries are not being produced by the pharmaceutical industry because the drug companies cannot make sufficient profits by doing so. In the US and other developed countries people often pay exorbitant prices for life-saving medicines. Poor people in developing countries can’t. They don’t have the money. The result: they die. Because the business model of the pharmaceutical industry values dollars gained over lives saved, there are not enough companies looking for transformative treatments, especially for diseases that afflict poor people.Consider the case of tuberculosis (TB) – a disease that killed more than 1.3 million people in 2022, and is on the rise as a result of the Covid-19 pandemic. The TB vaccine still used today is more than a hundred years old, and only protects young children, even though adolescents and adults account for the majority of TB transmission. The testing of a promising new publicly-funded TB vaccine that could potentially save millions of lives was delayed after its corporate owner, GSK, decided to focus on more profitable vaccines.The scientist who brought GSK the idea of the TB vaccine decades ago now acknowledges that Big Pharma cannot deliver for developing countries. “You get a big company to take it forward? Bullshit,” he told ProPublica. “That model is gone. It’s failed. It’s dead. We have to create a new one.”Clearly, we must do better. The life of a millionaire in New York City is not worth more than the life of a person living in extreme poverty in South Sudan.Fundamentally, we need to transform how we pay for the development of new prescription drugs. This starts with funding open-source research, so lifesaving information is shared, and scientists around the world can work together to research and manufacture their own breakthroughs. Patents should not stand in the way of public health.If we can provide $886bn to the Pentagon for military spending, we can provide scientists with the money they need to develop cutting-edge cures that are accessible to everyone.People should not die because of their income or where they were born. We know what it will take to save lives. Now we must have the courage to stand up to the pharmaceutical industry. Let’s do it.
Bernie Sanders is a US Senator, and chairman of the health education labor and pensions committee. He represents the state of Vermont, and is the longest-serving independent in the history of Congress More
What is Pepfar and why is it in the news?Pepfar is an acronym for the US “president’s emergency plan for Aids relief”. It was set up two decades ago by George W Bush to address the HIV epidemic.It’s the biggest government-run fund of its kind. Since 2003, the project has donated about $110bn (£90.5bn) to governments, universities and nonprofits in 50 countries, either directly or through agencies such as USAid.Until now Pepfar has been funded in five-year cycles. In the past the programme has had virtually unanimous support from Republicans and Democrats. But the next funding cycle (from 2023 to 2028) became ensnared in US abortion politics and the fallout contributed to Congress missing the 30 September deadline to allow another five-year funding cycle for the initiative.What’s the link between Pepfar and abortion?US laws already prevent Pepfar (or any state agencies) from paying for abortion services, according to the California-based policy research group, Kaiser Family Foundation (KFF). But in May, a coalition of conservative thinktanks and lawmakers began to make waves with arguments that Joe Biden’s administration has “hijacked” Pepfar to promote abortion instead of treating and preventing HIV.That’s where the risk to Pepfar’s five-year budget emerged – because the Republican lawmakers then refused to sign off on a spending bill for Pepfar if there weren’t stricter rules in place to stop Pepfar funds from overlapping with abortion services in any way.According to Brian Honermann, deputy director of public policy at the US-based Foundation for Aids Research, the allegations that Pepfar has been usurped to push a “radical social agenda” overseas are “baseless” and “stitched together from unrelated policy speeches, documents and assertions about how those apply to Pepfar”.What will happen to Pepfar now?The multibillion-dollar health programme is a permanent part of US law. That means Pepfar funding will continue, but it will lose its favoured position of receiving five years of funding at a time.The failure to reauthorise Pepfar will mean some of its built-in rules will expire, including a guideline that requires 10% of Pepfar money to go to orphans and children in need.Will organisations and governments lose their Pepfar grants?The fund has enough money to pay governments and civil society organisations until September 2024 (about $6.8bn), but a state department spokesperson warns that Pepfar won’t escape unscathed in the long term.Moreover, getting funding for only one year at a time will make it harder for Pepfar to plan ahead and to source crucial HIV tools, such as condoms or medicine, at the best prices. This could ultimately imperil the people that rely on the fund’s support, the spokesperson warned.The symbolic power of a five-year commitment will also be lost, says Honermann. “It shows partner countries that the US is invested for a significant period of time and that Pepfar won’t just disappear.”The threat of a permanent ‘gag rule’Another factor has swirled around Pepfar’s funding drama: some lawmakers have said they’ll only agree to restart the five-year funding regime if the fund is once again subject to the “Mexico City policy”, also called the “gag rule”.The gag rule bans organisations and governments from providing or promoting termination of pregnancy services regardless of whose money they’re using to do it. It was expanded to apply to Pepfar for the first time in 2017. It is only ever enforced when there’s a Republican president in the White House, so is not currently in effect.And while there is no finalised legislation that would make a permanent gag rule a reality (and Honermann argues it would be unlikely to get past the Democrats), the threat of it may already have done some damage.Research conducted by Fòs Feminista, a global alliance that advocates for sexual and reproductive rights, found that the 2022 decision to roll back the national right to an abortion in the US had a contagious impact in a number of countries. In Nigeria, for instance, respondents told Fòs Feminista that local lawmakers were using the change in US abortion laws to push back on a more liberal law in their country. Terminations are legal in Nigeria only if carrying the foetus to term threatens the mother’s life.Recipients of US government funding are often so worried about losing it that they enforce abortion laws more harshly than is necessary. Research shows that confusion about whether the gag rule had been revoked at the start of the Biden administration resulted in the policy – and its harms – being in place for much longer in practice.And the Pepfar wrangling and attendant media coverage has already resulted in mixed messages reaching health advocates in Africa. Some South African activists told the Guardian they were concerned that the news would be calamitous for civil society in the country. Such organisations receive the most Pepfar dollars (44%) in South Africa according to 2020 tracking data. The government gets just under 1.5% of the money.Honermann says that there is an intentional political strategy to keep communication about the changes in restrictions vague. “It’s a way to encourage over-enforcement for fear of falling on the wrong side of this.”He adds: “For now, Pepfar will continue as long as funding is made available. But these political threats to the programme are ultimately playing with the lives of millions of people worldwide who rely on this programme.”What has the reaction been in Africa?Dave Clark is the chief operating officer at the Aurum Institute, a non-profit that works on HIV and tuberculosis (TB) projects in South Africa, Mozambique, Ghana, Lesotho and Eswatini.Aurum is a partner for Pepfar’s Dreams project which works towards an Aids-free future for girls and women aged 10 to 24 by providing HIV services, contraception and violence prevention support for women, adolescents and their sexual partners.One of the major strengths of Pepfar, Clark says, is that it’s a sure-fire source of carefully planned funding for global health in a world that is often more talk than action.He explains: “The debate in America should not throw us off saving lives. Pepfar is what it says on the label: president’s emergency plan for Aids relief. That’s its extraordinary power and legacy.” More
In a public advisory, written back in the summer, Dr Vivek Murthy warned of a growing ‘epidemic of loneliness and isolation’, which he believes is not just destined to affect the physical and mental health of individuals but could end up being detrimental to democracy itself.
‘The nation’s doctor’ speaks to Jonathan Freedland about why some bad faith actors are choosing to manipulate this problem and how political leaders on all sides can address it before it gets worse
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New York City public hospitals will now offer abortion care via telehealth, placing them among the first public health systems in the US to do so.The city’s mayor, Eric Adams, announced on Monday that abortion pill prescriptions would now be available by telephone or online, adding that such access can happen from “the comfort of your home”.As a result of the move, New York City residents will now be able to connect with health practitioners for those prescriptions, building on previous legislations to protect abortions rights in New York.“If you are clinically eligible, that provider will be able to prescribe abortion medication that would be delivered to your New York City address within days,” Adams said during Monday’s announcement.“We will not stand idly by as these attacks continue and the far-rights seeks to strip our citizens of their basic rights,” Adams added, referring to abortion restrictions being legislated across the country.Abortion rights organizations celebrated Monday’s announcement as an essential step to protect reproductive rights.“Today marks a historic win for abortion access in New York City,” said Wendy Stark, president and CEO of Planned Parenthood of Greater New York.“When we make abortion care more accessible, we empower individuals to make the best decisions for themselves, their families and their futures,” Stark added.The expanded access to abortion care comes after the supreme court’s elimination last year of the federal abortion rights established by Roe v Wade.Since then, at least 20 states have passed restrictions on abortions, the New York Times reports.Fourteen states, mainly in the south, have enacted total bans on the medical procedure.US courts have also limited access to abortion medication. In August, a US appeals court ruled that the abortion pill mifepristone should be regulated according to rules set prior to 2016.skip past newsletter promotionafter newsletter promotionIn August 2022, Adams signed legislation protecting the right to abortions in New York City after the supreme court’s decision to overturn Roe v Wade.The measures signed by Adams – six in total – also made abortion medication free at all of New York’s department of health and mental hygiene clinics.The New York state legislature has also passed legislation protecting medical professionals in the state who provide abortion pills to patients in places where the procedure is banned, the New York Times reported.Other Democratic-led cities and states have passed similar measures protecting reproductive rights.In January, the governor of Illinois, JB Pritzker, signed legislation expanding abortion access by allowing more practitioners to provide the medical procedure and mandating that agencies in the state cover the procedure, the television news outlet WTTW reported. More
Laurie Bertram Roberts never expected Americans to keep forking over money to pay for other people’s abortions. But the abortion fund director didn’t think it would get this dire.When the US supreme court overturned Roe v Wade last year, people donated tens of thousands of dollars to Roberts’ organization, the Mississippi Reproductive Freedom Fund, which is dedicated to helping people afford abortions and the many costs that come with it. But, in August, Mississippi Reproductive Freedom Fund had to stop funding abortions. It’s now closed until January 2024.“We just don’t have the money,” said Roberts, who co-founded the fund a decade ago. “It’s a strategic decision, to focus on fundraising for the next couple months, so that when we reopen, we’ll have money.”For now, the fund – which has historically also helped people with other costs of living and parenting – is only offering access to its pantry of food and household supplies. This will be the longest the Mississippi Reproductive Freedom Fund has ever been shut down.“I didn’t think the emergency funding was gonna stay the same,” Roberts said in reference to the post-Roe donation spike. “But I didn’t expect for our funding to dip by 35 to 40% from last year.”When the US supreme court overturned Roe, Americans rushed to rage-donate millions to abortion funds and clinics scattered across the United States.Now, with the first year of post-Roe life in the rearview mirror, much of that money has been spent and the flow of donations has dried up for many organizations. And yet, as states continue to enact new bans and restrictions, the demand for help – and the cost of providing that help – has only grown.The Mississippi Reproductive Freedom Fund isn’t the only abortion fund that’s had to turn its lights off recently. In mid-June, just three days before the anniversary of Roe’s overturning, Indigenous Women Rising announced that its abortion fund had hit its monthly budget and would cease operations until July. The Mountain Access Brigade, which serves people in Appalachia, closed its support hotline for 10 days in July to save money. By mid-July, the Utah Abortion Fund announced that it had already exceeded its monthly budget and would close until late August.“You have increasing costs and decreasing donations,” said Hayley McMahon, who sits on the board of the Appalachian abortion fund Holler Health Justice and studies barriers to abortion at Emory University’s Rollins School of Public Health. “Those two things combined are a perfect storm for just absolutely wiping out abortion funds.”Much of the south and midwest have now banned or significantly limited abortion, forcing people in those states who want abortions to travel farther. Over the summer, Indiana, North Carolina and South Carolina all implemented significant new restrictions, which put even more pressure on abortion funds. In July, the Abortion Fund of Ohio helped 355 people. In August, the same month that neighboring Indiana outlawed almost all abortions, that number surged to 562.Lexi Dotson-Dufault, the Abortion Fund of Ohio’s patient navigation program manager, said that the money trickling into the fund is simply not enough to meet the demand. With three months left to go in 2023, the Abortion Fund of Ohio has already offered assistance to roughly 2,400 people. That’s 700 more than it helped in 2022, and almost three times as many people as it helped in 2021.“We don’t want to have to set limits as to what we can give people,” Dotson-Dufault said. “I think if the money doesn’t come in the way we need to, we will start to have to.”Three-quarters of US abortion patients have incomes below the federal poverty line. The cost of an abortion, meanwhile, has perhaps never been higher: more and more people have to travel for the procedure, buying flights and gas, booking hotel rooms, taking time off work. More than 60% of people who have had abortions have already given birth before, so they may also need to secure childcare.Although the vast majority of US abortions take place in the first trimester of pregnancy, abortion fund callers are more often in their second trimester, according to a study of callers to the National Network of Abortion Funds between 2010 and 2015. Post-Roe, people who work at abortion funds told the Guardian that they are now seeing even more people who are later on in their pregnancies – which becomes a problem both for abortion seekers and the funds, because abortion becomes more expensive later in pregnancy. It also becomes harder to find – not every clinic will perform abortions into the second trimester – so people often have to travel even further.From July 2021 through June 2022, the Missouri Abortion Fund spent about $235,000 helping people get abortions. Between July 2022 and June 2023, they spent over $1m – but they only helped 300 more people than the previous year, said Jess Lambrecht, the fund’s executive director. The typical client used to cost less than $1,000; now, they frequently cost multiple thousands of dollars.“Basically, our budget tripled, but so has our cost,” Lambrecht said.The Nevada-based Silver State Hope Fund has already been forced to become “very, very frugal” when giving out money, said Erin Bilbray-Kohn, the fund’s vice-president and acting executive. Within three days of Roe’s demise, Bilbray-Kohn raised $50,000 for the fund. But now, the fund’s finances have become so strained that it’s using the money it had once set aside to pay for next spring.Before Roe’s demise, the fund spent about $10,000 each year. Now, it’s spending $16,000 each month. So many people are desperate for help: the woman who got pregnant by her abusive partner, the woman with Type I diabetes whose pregnancy threatened her life, the girl whose college scholarship would have been jeopardized if she had a baby.“I wake up in the morning worried we’re not going to have enough funds,” said Bilbray-Kohn, who started to cry as she shared her clients’ stories. “I’m working really aggressively to try to raise that money so that we can fill up those coffers and be OK in the spring.”The Silver State Hope Fund is also currently suing, aided by the ACLU, to abolish a Nevada law that blocks people from using Medicaid to pay for abortions. Roughly 80% of the people calling the Silver State Hope Fund are Medicaid-eligible, Bilbray-Kohn estimated. If the fund wins its lawsuit, many of its current callers could rely on Medicaid instead and the fund could free up money to pay for other callers.Abortion funds aren’t the only abortion rights organizations that are now scrambling for money. The clinics left behind in states that have now banned the procedure are also struggling to stay open, as they pivot to offering more broad reproductive healthcare services.When the supreme court overturned Roe, the West Alabama Women’s Center had to stop performing abortions and send its patients out of state. Within 48 hours, it raised $180,000 for patients’ travel, recalled Robin Marty, the clinic’s executive director. “Now I go and I try to ask for any sort of funding online, and we can get maybe $50 to $100 every time I do it,” Marty said.As of late August, though, Marty estimated that she had enough money in the bank to pay her staff’s salaries through October.For now, the Mississippi Reproductive Freedom Fund’s phone line is still open; the organization is redirecting people towards other, open abortion funds. But the phone line will be shut down entirely for the month of December.“I know we are making the right decision, but it feels horrible to tell people no,” Roberts said. But, Roberts added, “If we’re not making strategic plans to make sure that we’re sustaining ourselves and sustaining fundraising, we’re not gonna make it. We won’t be here next year and we won’t be here the year after that and I want to make sure we’re still here. There’s not less of a fight to fight. It’s just getting more intense.” More
Sign up for our free Health Check email to receive exclusive analysis on the week in health Get our free Health Check email The government has committed to introducing Martha’s rule in hospitals, to give families and patients the right to a second assessment if they feel their concerns are dismissed by NHS staff. Health […] More
The Florida supreme court on Friday will hear arguments in a case that could drastically limit abortion access in the south-eastern United States.Abortion providers in Florida filed a lawsuit to block the state’s ban on abortion after 15 weeks of pregnancy.If the state’s high court upholds the 15-week ban, a separate, stricter law would take effect prohibiting abortion after six weeks, before most people know they are pregnant.“It would be devastating for providers to have to turn even more folks away under a six-week ban,” said Whitney White, a staff attorney with the ACLU’s Reproductive Freedom Project. “They’re already having to turn away patients under the current 15-week ban.”Friday’s hearing is the culmination of Republican efforts to end Florida’s legacy as a safe haven for abortion seekers in neighboring states. Five of the seven justices on the current state supreme court were selected by the conservative governor, Ron DeSantis, fueling the concerns of Floridians who support abortion access.After signing the six-week trigger ban into effect in April, Governor DeSantis said in a brief statement that he was “proud to support life and family in the state of Florida”. The Florida governor has been hesitant to discuss abortion on the campaign trial.A whopping 62% of American adults believe abortions should be legal in “all or most cases”, according to a 2022 report published by Pew Research Center. A 2020 Ipsos/Reuters poll found that 56% of likely voters in Florida believe abortion should be legal in most cases. And abortion rights supporters in Florida say the bans violate the explicit privacy protections found in the state constitution.Despite DeSantis’s conservative overhaul of the state’s high court, White remained confident about the case in the run-up to Friday’s hearing.“No justice of the Florida supreme court has ever written a decision questioning the conclusion that abortion rights are protected by the privacy clause,” White said.Florida Republicans passed the 15-week ban on abortion in April 2022, months before the US supreme court ended the federal right to abortion. That same month, a judge revived a 2015 state law that mandated patients wait 24 hours between getting an initial consultation for an abortion and undergoing the procedure.“It’s been one restriction after another,” said Dr Kanthi Dhaduvai, a Jacksonville abortion provider with Physicians for Reproductive Health.Dhaduvai felt “nervous and frustrated” about the hearing, fearing a court ruling that would make it impossible for her patients to receive “what is often life-saving care”.skip past newsletter promotionafter newsletter promotionRoughly half of Dhaduvai’s patients come to Florida from states like Georgia, Louisiana, Mississippi, Alabama – even Texas.“I think a lot of people are not aware as to how dangerous this could be, not just for Florida, but the entire region,” she said. “Florida has been a huge access point for people, we already have people traveling these great distances to get care.”In the months after the US supreme court overturned Roe v Wade, Florida saw the greatest increase in the number of legal abortions performed per month, according to a report released this April from the Society of Family Planning.“I’m still providing care and I’m going to continue providing care, within legal limits, even after the decision,” Dhaduvai said. More
