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      Providence Officials Approve Overdose Prevention Center

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      The facility, also known as a safe injection center, will be the first in Rhode Island and the only one in the U.S. outside New York City to operate openly.More than two years ago, Rhode Island became the first state in the nation to authorize overdose prevention centers, facilities where people would be allowed to use illicit drugs under professional supervision. On Thursday, the Providence City Council approved the establishment of what will be the state’s first so-called safe injection site.Minnesota is the only other state to approve these sites, also known as supervised injection centers and harm reduction centers, but no facility has yet opened there. While several states and cities across the country have taken steps toward approving these centers, the concept has faced resistance even in more liberal-leaning states, where officials have wrestled with the legal and moral implications. The only two sites operating openly in the country are in New York City, where Bill de Blasio, who was then mayor, announced the opening of the first center in 2021.The centers employ medical and social workers who guard against overdoses by supplying oxygen and naloxone, the overdose-reversing drug, as well as by distributing clean needles, hygiene products and tests for viruses.Supporters say these centers prevent deaths and connect people with resources. Brandon Marshall, a professor and the chair of the Department of Epidemiology at the Brown University School of Public Health, said studies from other countries “show that overdose prevention centers save lives, increase access to treatment, and reduce public drug use and crime in the communities in which they’re located.”Opponents of the centers, including law enforcement groups, say that the sites encourage a culture of permissiveness around illegal drugs, fail to require users to seek treatment and bring drug use into neighborhoods that are already struggling with high overdose rates.Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University, said that while supervised drug consumption sites “reduce risks while people use drugs inside them,” they reach only a few people and “don’t alter the severity or character of a neighborhood’s drug problem.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      A Midwestern Republican Stands Up for Trans Rights

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      As 2023 slouches to an ignominious end, some news came Friday that gave me an unexpected jolt of hope. I have spent much of the year watching with horror and trying to document an unrelenting legal assault on queer and trans people. Around 20 states have passed laws restricting access to gender-affirming care for trans and nonbinary people, and several have barred transgender and nonbinary people from using bathrooms that align with their gender identity.So it was shocking — in a good way, for once — to hear these words from Ohio’s Republican governor, Mike DeWine, as he vetoed a bill that would have banned puberty blockers and hormones and gender-affirming surgeries for trans and nonbinary minors in Ohio and blocked transgender girls and women from participating in sports as their chosen gender:“Were House Bill 68 to become law, Ohio would be saying that the state, that the government, knows better what is medically best for a child than the two people who love that child the most — the parents,” DeWine said in prepared remarks. “Parents are making decisions about the most precious thing in their life, their child, and none of us, none of us, should underestimate the gravity and the difficulty of those decisions.”DeWine, by situating his opposition to the bill on the chosen battlefield of far-right activists — parents’ rights — was tapping into an idiom that is at once deeply familiar to me and yet has almost entirely disappeared from our national political discourse: that of a mainstream, Midwestern Republican. It is a voice I know well because it is one I heard all my life from my Midwestern Republican grandparents.I did not agree with all of their beliefs, especially as I got older. But I understood where they were coming from. My grandfather, a belly gunner in the Pacific Theater in World War II, believed a strong military was essential to American security. My grandmother was a nurse, and she believed that science, medicine and innovation made America stronger. They made sure their children and grandchildren went to college — education was a crucial element of their philosophy of self-reliance. And above all, they believed the government should be small and stay out of people’s lives as much as humanly possible. This last belief, in individual freedom and individual responsibility, was the bedrock of their politics.And so I am not surprised that defeats keep coming for anti-transgender activists. At the ballot box, hard-right candidates in swing states have tried to persuade voters with lurid messaging about children being subjected to grisly surgeries and pumped full of unnecessary medications. But in race after race, the tactic has failed.Legally, the verdict has been more mixed, which is unsurprising given how politically polarized the judiciary has become. This week a federal judge in Idaho issued a preliminary ruling that a ban on transgender care for minors could not be enforced because it violated the children’s 14th Amendment rights and that “parents should have the right to make the most fundamental decisions about how to care for their children.” The state is expected to appeal the decision.In June, a federal court blocked an Arkansas ban on gender-affirming care for minors. “The evidence showed that the prohibited medical care improves the mental health and well-being of patients,” the ruling said, “and that, by prohibiting it, the state undermined the interests it claims to be advancing” of protecting children and safeguarding medical ethics. In 2021, Asa Hutchinson, then the governor, had vetoed the ban for reasons similar to DeWine, but the Arkansas Legislature overrode his veto. (The Ohio Legislature also has a supermajority of Republicans and may decide to override DeWine’s veto.)In other states, like Texas and Missouri, courts have permitted bans to go into effect, forcing families to make very difficult decisions about whether to travel to receive care or move to a different state altogether. The issue seems destined to reach the Supreme Court soon. The A.C.L.U. has asked the Supreme Court to hear its challenge to the care ban in Tennessee on behalf of a 15-year-old transgender girl. Given how swiftly and decisively the court moved to gut abortion rights, it seems quite possible that the conservative supermajority could choose to severely restrict access to transgender health care for children or even adults.But maybe not. After all, the overturning of Roe has deeply unsettled the country, unleashing a backlash that has delivered unexpected victories to Democrats and abortion-rights advocates. Ohio voters just chose by a wide margin to enshrine the right to end a pregnancy in the state Constitution.This is why I think DeWine’s veto speaks to a much bigger truth: Americans simply do not want the government making decisions about families’ private medical care. Polling on abortion finds a wide array of views on the morality of ending a pregnancy at various points up to viability, but one thing is crystal clear: Large majorities of Americans believe that the decision to have an abortion is none of the government’s business.Rapidly changing norms around gender have many people’s heads spinning, and I understand how unsettling that can be. Gender is one of the most basic building blocks of identity, and even though gender variations of many kinds have been with us for millenniums, the way these changes are being lived out feel, to some people, like a huge disruption to their way of life. Even among people who think of themselves as liberal or progressive, there has been a sense that gender-affirming care has become too easily accessible, and that impressionable children are making life-changing decisions based on social media trends.It has become a throwaway line in some media coverage of transgender care in the United States that even liberal European countries are restricting care for transgender children. But this is a misleading notion. No democracy in Europe has banned, let alone criminalized, care, as many states have done in the United States. What has happened is that under increasing pressure from the right, politicians in some countries have begun to limit access to certain kinds of treatments for children through their socialized health systems, in which the government pays for care and has always placed limits on what types are available. In those systems, budgetary considerations have always determined how many people will be able to get access to treatments.But private care remains legal and mostly accessible to those who can afford it.Republicans are passing draconian laws in the states where they have total control, laws that could potentially lead to parents being charged with child abuse for supporting their transgender children or threaten doctors who treat transgender children with felony convictions. These statutes have no analog in free Europe, but they have strong echoes of laws in Russia, which is increasingly criminalizing every aspect of queer life. These extreme policies have no place in any democratic society.Which brings me back to my Midwestern Republican grandparents, Goldwater and Reagan partisans to their core. My grandfather died long before Donald Trump ran for president, and 2016 was the first presidential election in which my grandmother did not vote for the Republican candidate. But she did not vote for Hillary Clinton, choosing another candidate she declined to name to me. Like a lot of Republicans, she really didn’t like Clinton, and one of the big reasons was her lifelong opposition to government health care. She didn’t want government bureaucrats coming between her and her doctors, she told me.I think many, many Americans agree with that sentiment. Transgender people are no different. They don’t want government bureaucrats in their private business.“I’ve been saying for years that trans people are a priority for enemies and an afterthought to our friends,” Gillian Branstetter, a strategist who works on transgender issues at the A.C.L.U., told me. “I’ve made it my job to try and help people understand that transgender rights are human rights, not just because transgender people are human people, but because the rights we’re fighting for are grounded in really core democratic principles, like individualism and self-determination.”Those are core American values, but 2024 is an election year, and even though transphobia has proved to be a loser at the ballot box, many Republicans are sure to beat that drum anyway. Mike DeWine has me hoping that some Republicans will remember what was once a core principle of their party, and embrace the simple plain-spoken truth of my heartland forebears: Keep the government out of my life, and let me be free to live as I choose.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow the New York Times Opinion section on Facebook, Instagram, TikTok, X and Threads. More

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      DeSantis Leans Into Vaccine Skepticism to Energize Struggling Campaign

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      The Florida governor has so far found little success in getting his criticism of the Trump administration’s Covid-19 policies to stick, but that has not stopped him from trying.Gov. Ron DeSantis had hoped that his response to the coronavirus pandemic, which helped propel him to a resounding re-election in Florida last year, would produce similar results in the Republican presidential primary.But despite leaning into his record on Covid-19, Mr. DeSantis remains adrift in the polls and badly trailing former President Donald J. Trump, whose administration he has castigated for how it handled the pandemic. Mr. DeSantis points to how he guided Florida through the pandemic — reopening schools and businesses early and forbidding local governments and businesses from imposing mask and vaccine mandates — as a model for the nation.While Mr. Trump recently warned against the return of “Covid hysteria,” his administration led the rapid development of the Covid-19 vaccines that many Republicans now question. Studies show the shots prevented millions of deaths and hospitalizations in the United States. But over the summer, Mr. Trump acknowledged to Fox News that the shots were “not a great thing to talk about” in his party.Mr. DeSantis has sought to exploit that anti-vaccine sentiment as a way to pry primary voters away from Mr. Trump, publicly casting doubt on their safety and effectiveness against the coronavirus. Scientific experts have labeled his views — and his administration’s decision to recommend that Floridians under 65 not receive the updated Covid-19 shot — as dangerous and extreme, even as many acknowledge that the school closures that Mr. DeSantis opposed went on for too long in some states.On Wednesday, Mr. DeSantis again tried to rally vaccine-skeptic voters to his side, headlining a “Medical Freedom” town hall at a ski area in Manchester, N.H., alongside Florida’s Surgeon General, Dr. Joseph Ladapo. During the event, which was hosted by Mr. DeSantis’s super PAC, the Florida governor insisted that federal public health agencies had spewed “nonsense” throughout the pandemic and needed a complete overhaul.He claimed that the Covid shots have been rolled out without proper clinical studies and that federal officials had either lied or were flatly wrong about the benefits and risks — a view that has been roundly condemned by a wide array of public health experts, academics and scientists. “We know the federal government muffed this in many different ways and we need a reckoning,” the governor said.Mr. DeSantis has found little success in getting his criticism of the Trump administration’s Covid-19 policies to stick, demonstrating the former president’s remarkable resilience with Republicans in the face of criminal indictments, growing attacks from rival candidates and his own verbal missteps.In interviews with The New York Times across the early nominating states, many voters have said they do not fault Mr. Trump for his response to a new and unknown virus, saying that he did his best in an uncertain situation. Such attitudes are common even among some of Mr. DeSantis’s supporters.“I’m always inclined to cut President Trump some slack on the epidemic because he was listening to people who supposedly knew what they were talking about,” said Richard Merkt, 74, who attended the town hall on Wednesday and said he plans to vote for Mr. DeSantis in the New Hampshire primary. Mr. Merkt is a former New Jersey assemblyman who has run for office in New Hampshire, where he retired. Bob Wolf, an undecided Iowa voter, said he admired Mr. DeSantis’s handling of the pandemic but did not blame Mr. Trump. “When Trump was in charge, I don’t think everyone knew what the facts were,” Mr. Wolf, a 44-year-old firefighter, said in an interview this fall.Still, Mr. DeSantis is clinging to his Covid policies as a pillar of a campaign. In September, he and Dr. Ladapo recommended that Floridians under the age of 65 should not get the updated Covid shot that targets the virus’s more recent variants. That guidance contradicted the advice of the Food and Drug Administration and the Centers for Disease Control and Prevention, which had recommended the shot for most Americans six months and older.At the town hall, Dr. Ladapo praised Mr. DeSantis.“To read the data, to reach a conclusion, to know that conclusion is right, and all of these Harvard Ph.D’s and M.D.’s are wrong? That takes courage,” said Dr. Ladapo, who himself holds degrees from Harvard.Florida’s Surgeon General, Dr. Joseph Ladapo, regularly appears with Gov. Ron DeSantis at events in the state, but this week joined him on the campaign trail. Chris O’Meara/Associated PressMore than 1.13 million Americans have died from Covid-19 since the pandemic began, with the fatality rate far higher for the unvaccinated than for the vaccinated. A partisan divide has emerged in the nation’s death rate, which has been greater in Republican-leaning counties. Republicans now tend to be more skeptical than Democrats of vaccines of all types, a post-pandemic development.Florida was an early leader in vaccinating older residents against Covid, but achieved far lower vaccination rates for younger age groups as the governor shifted from a vocal advocate to a skeptic of shots. A New York Times analysis in July found that unlike the nation as a whole, Florida lost more lives to Covid after vaccines became available to all adults, not before.Mr. DeSantis has suggested that he is the only Republican who can capture general election voters who are angry about the government’s response to the pandemic, particularly with Robert F. Kennedy Jr., a prominent anti-vaccine activist and conspiracy theorist, in the race as a third-party candidate.“RFK Jr. will be a vessel for anti-lockdown and anti-Fauci voters, if Trump is the nominee,” Mr. DeSantis said last month, in a reference to Anthony S. Fauci, the nation’s former top infectious disease expert, whom he has said should be prosecuted. “If I’m the nominee, they all go to me.”When Mr. Kennedy was still running in the Democratic primary against President Biden, Mr. DeSantis even suggested that the longtime liberal might have a place in his presidential administration — a clear sign that he hoped to court supporters of Mr. Kennedy who share his views on vaccines.But so far, Mr. DeSantis’s efforts to break through in the Republican field have failed.Although the Florida governor generally has high favorability ratings among G.O.P. voters, Mr. Trump has maintained his dominant lead in Iowa, New Hampshire and South Carolina. One recent poll showed that former Gov. Nikki Haley of South Carolina had caught up to Mr. DeSantis in Iowa — where he has staked his entire campaign. Polling averages put Ms. Haley ahead of him in both New Hampshire and South Carolina.Not only have the governor’s criticisms of Covid vaccines produced few political dividends in the primary, scientific experts characterize them as dangerous public health policy.Dr. Paul A. Offit directs the vaccine education center at Children’s Hospital of Philadelphia and serves on the F.D.A.’s panel of outside vaccine experts that authorized the vaccines. He said tens of millions of Americans under the age of 65 suffer from underlying medical conditions that increase their risk of severe disease or death from Covid.“Does he think that only those over 65 are at risk?” he asked, referring to Mr. DeSantis’s refusal to recommend the shots for younger age groups. “We’ve moved, sadly, from scientific illiteracy to scientific denialism. Science doesn’t matter.”Dr. Scott Rivkees, Florida’s state surgeon general for more than two years under Mr. DeSantis, said the state was now quite isolated in its approach to Covid vaccinations.“I’m not aware of other states that have said that individuals younger than 65 should not get vaccinated against Covid,” said Dr. Rivkees, who left the administration in September 2021 and is now a professor at Brown University’s School of Public Health.Mr. DeSantis’s team dismisses such criticism as more grousing from a “tyrannical medical establishment” that led the nation astray during the pandemic.“His actions have exposed the ‘experts’ for the political actors that the country now knows them to be — and that’s why they continue to attack him with failed science and fake narratives,” Bryan Griffin, press secretary for the DeSantis campaign, said in a statement. He said that Mr. DeSantis had “prioritized the truth” as governor and would “do the same for our nation as president.”Sarafina Chitika, a spokeswoman for the Democratic National Committee, said in a statement: “Ron DeSantis’s attempt to resurrect his old and tired anti-vaccine tantrum today is a reminder to voters that he played political games with Florida’s Covid response at every turn in a cheap effort to score political points with the extreme MAGA movement.” Public health authorities give Mr. DeSantis credit for insisting that Florida schools open their doors to students in the fall of 2020. Many experts now agree that too many school districts offered only remote learning for far too long. But they have heaped criticism on him for casting doubt on Covid shots.Mr. DeSantis claimed Wednesday, as he has previously, that federal authorities misled people into believing that the vaccines prevented infection. In fact, shots were authorized based on evidence that they reduced risks of severe disease and death, not infection.The governor also claimed that Dr. Ladapo had properly identified risks of the shots for young men. But the heads of the F.D.A. and the C.D.C. publicly warned Dr. Ladapo that his statements were misleading, saying such misinformation “puts people at risk of death or serious illness.”Mr. DeSantis also played up a state grand jury investigation he instigated nearly a year ago into what he claimed was possible criminal misconduct by Covid vaccine manufacturers. Critics labeled it a political stunt, and it has so far come to naught.But at the town hall Mr. DeSantis suggested that the issue would continue to come up on the campaign trail, saying: “There may be a report or something like that pretty soon.” More

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      Why We Are So Obsessed With Biden’s Age

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      To our intensifying discussion about whether President Biden has grown mentally fuzzy and too old for a second term, I’d like to add this question: How would we even notice Donald Trump’s lapse into incoherence, when derangement is essentially his brand?Pretty much any interview he gives is a babble bonanza, and his recent lovefest with Tucker Carlson was no exception. He went on wacky tangents, including one about the wages of building the Panama Canal: “We lost 35,000 people to the mosquito. Malaria. We lost 35,000 people. We lost 35,000 people because of the mosquito. Vicious. They had to build under nets. It was one of the true great wonders of the world.”“One of the nine wonders,” he added, then corrected himself. “No, no, it was one of the seven.” Seven, nine – he seemed unable to decide, unwilling to commit. “You could make nine wonders,” he ventured. I guess that’s some limit. Once you hit 10, they’re just curiosities. Wonder-ettes.But was there a bevy of headlines about a brain ravaged by time? Were there notations that Trump, at 77, was already as old as Ronald Reagan at the end of his presidency, and that after another four years in the White House, Trump would be a touch older than Biden at the end of his first term and thus the oldest president ever?Most certainly not. And that’s both noteworthy and troubling, because we can’t know — really know — that Biden’s occasionally prolonged, futile search for the right word or name is firmer evidence of cognitive fade than Trump’s hallucinatory musings are.I’m not claiming that Biden, 80, and Trump project the same degree of vigor. I have eyes and ears. Trump talks louder and faster than Biden does and moves with a thudding force. He’s like a freight train to Biden’s cable car, or a big, bulbous tuba to Biden’s tremulous piccolo. Listening to Biden, I want a volume knob I can turn up. Listening to Trump, I crave nonsense-canceling headphones.I’m also aware and suspicious of the paucity of Biden’s interactions with journalists, his avoidance of unscripted public appearances and a schedule that can seem strangely light. I’ve heard from influential Democrats who have crossed paths with him and were alarmed by how slowly he was moving and how disoriented he seemed.But the situation is more complicated than that, and the conversation about it omits dynamics that it shouldn’t. Trump is a mere three years younger than Biden, and he’s overweight. His diet is garbage. His cardio is golf putts. Biden, on the other hand, is a trim tribute to regular exercise.And Trump diverts attention from his age by going to significant lengths to conceal it.A thought exercise: Imagine Biden with more hair — or at least some swooping, swirling, painstakingly contrived facsimile of more hair. Color it a shade of orange-gold that’s less a sneaky evasion of gray than a desperate pummeling of it. Now get to work on his face. Cloak his age spots under a fake tan. Spackle his wrinkles with makeup. Then dress him in suits so dark and baggy that they veil time’s toll on the body they’re tenting.You’ve turned Biden at least partway into Donald Trump. Does he seem a little less ancient?In several recent surveys, roughly three in four Americans, including a majority of Democrats, deemed Biden too old to be effective through a second term. In a recent Associated Press/NORC poll, a much smaller fraction — just over half — expressed reservations about Trump’s age.At least a bit of that discrepancy surely reflects right-wing media organizations’ obsessive focus on Biden’s stumbles and mumbles and such. Their left-wing counterparts don’t home in on Trump’s dubious physical fitness in the same way –— they have so much else on their radar. After all, a candid image of Trump in flab-revealing golf wear or a shot of the wind exposing the truth about his tresses matters little next to candid audio of him hectoring a state official in Georgia to steal the 2020 election.With Trump, it is always thus: The frequency of his outrages and volume of his vices guarantee that no single flaw stands out as it should. It’s just another ingredient in a gumbo of God-help-us.We should also bear in mind that all the hints of Biden’s feebleness are amplified by a larger narrative of older politicians clinging to power despite their obvious physical deterioration. Every image of Senator Dianne Feinstein, 90, being wheeled through the Capitol hurts Biden. So does every second that Senator Mitch McConnell, 81, stands frozen and speechless before a group of journalists.“I see people lumping every old person together and using the term ‘gerontocracy’,” Rosanne M. Leipzig, who specializes in geriatrics at the Icahn School of Medicine at Mount Sinai in New York City, told me. But Biden isn’t McConnell, no more than McConnell is Feinstein. “There’s no group of people who are more different than older adults,” Leipzig said. “We even have a term for it — the heterogeneity of aging.”Biden is also hurt, in a different way, by Representative Nancy Pelosi, 83, who seems amply vigorous but surrendered her position of House Democratic leadership last year with the proclamation that “the hour has come for a new generation.” If that’s true in the House, why not in the White House?Bob Kerrey, a former senator and onetime governor who ran for the Democratic presidential nomination in 1992, told me: “I would rather Joe did what Nancy did.” Kerrey turned 80 himself just two weeks ago, and he said that he’d never pursue the presidency at his age.“It’s an offensive act if I were to do it,” he said. “I had my chance.” He added that there are “plenty of 40- and 60-year-olds who can step up and run.” But he’s cognitively up to the task, he said, and so is Biden. Believing in generational change doesn’t mean disbelieving Biden’s competence.And judging competence can be a guessing game, given the partial and selective information that most older political candidates and their physicians divulge. To determine aging’s impact “through superficial means is not an accurate measure,” Bob Blancato, the national coordinator of the Elder Justice Coalition, a bipartisan advocacy group, cautioned. “Aging is a profoundly personal journey.”Similarly, our takes on it are subjective — and can be colored by irrelevant details. Leipzig noted that to some people, Biden’s cultural frame of reference, embrace of tradition and old-fashioned vocabulary (“God love ya’,” “c’mon man,” “malarkey”) read old, while Trump’s rebel pose reads young.I happen to think that Democrats would be safer with a nominee who’s younger than Biden is and radiates more energy than he does. But I believe at least as strongly that if the unideal choice before Americans winds up being Biden, with his imperfections, or Trump, with his, rejecting Biden because of how old he has grown isn’t a grown-up decision.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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      Zimbabwe Voters to Elect President While Trained Workers Flee

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      Nurses, doctors and workers of all kinds are seeking to escape the country’s economic turmoil, an issue that has become a central theme in the election scheduled for Wednesday.The hospital where Warren George worked as a nurse in Zimbabwe was so short of basic supplies, like plaster, that he could not make casts to treat people with broken bones. He soon sought to join the exodus of more than 4,000 nurses who have fled the southern African nation in the past two years.But the government has refused to give him and many others the documents they would need to work in, say, Britain or Canada. He says that he now earns only about $500 a month as a traveling nurse and has to pick up extra shifts on his days off to ensure his family has enough to eat.Zimbabweans are scheduled to go to the polls on Wednesday in only the second election since Robert Mugabe, the liberation leader turned strongman president, was ousted in a coup.The vote amounts to a referendum on President Emmerson Mnangagwa, who is seeking a second term after, critics say, failing to steady the economy or stop the flight of workers, including a crippling “brain drain” of educated professionals. The departure of nurses and doctors has increased since the Covid pandemic, contributing to a widespread shortage of health workers on the African continent.Mr. Mnangagwa at an election rally in Harare this month. He is seeking a second term.Tsvangirayi Mukwazhi/Associated PressTriple-digit inflation has become the norm — it spiked to 176 percent in June. The country is $18 billion in debt and cannot get international loans because of political instability. Jobs are sparse, with economists estimating that 90 percent of work is informal. The local currency has become so worthless that the price grocery stores charge for bread has skyrocketed to 12,000 Zimbabwean dollars from 860 in April. Many use the U.S. dollar instead, when they can.“Everyone you meet in the streets, they are desperate to leave the country,” said Dr. Norman Matara, head of the Zimbabwe Association of Doctors for Human Rights, an advocacy organization.“Some of our colleagues have gone outside — you see them doing well in South Africa, in the U.K., in Canada,” he added. “You get the motivation to also leave because, honestly, we are just wasting our time.”This election, like past ones, is taking place in a jittery environment with fears of violence and of vote-rigging in favor of ZANU-PF, the party of Mr. Mnangagwa, which has governed Zimbabwe since independence in 1980.Mr. Mnangagwa came to power through a coup in 2017 that unseated Mr. Mugabe, who became increasingly autocratic during his nearly four decades in power. In the 2018 election, Mr. Mnangagwa eked out a victory, winning 50.8 percent of the vote over his closest rival, Nelson Chamisa, who is now president of the main opposition party, the Citizens Coalition for Change.Makeshift polling stations in Mbare, a township in Harare, on Monday.Siphiwe Sibeko/ReutersThis election is a rematch, and while polls suggest a tight race, many international and domestic observers doubt that the election will be free and fair.“It’s history repeating itself, except that ZANU-PF has perfected the system of rigging,” said Ibbo Mandaza, a political analyst in Harare, Zimbabwe’s capital, who runs an independent social-science think tank.The police have shut down dozens of rallies of the Citizens Coalition for Change and arrested dozens of its supporters. A new law that could result in the death penalty for Zimbabweans deemed to have betrayed the national interest has made many fearful to share their views.Even so, in surveys, Zimbabweans overwhelmingly say that they are dissatisfied with the direction of the country and the economy under Mr. Mnangagwa. If he prevails, political analysts say, there could be a surge in mass migration of Zimbabweans, straining other countries in the region — especially South Africa, where a struggling economy of its own has fueled violence against immigrants. Harare on Saturday. While polls suggest a tight vote, many international and domestic observers doubt that the election will be free and fair.John Wessels/Agence France-Presse — Getty ImagesMany African countries are short on health workers, more than any other region. The continent produces about 150,000 trained medical workers a year, but one in three cannot get jobs because there is not enough money to fund positions, according to James Avoka Asamani, who leads the World Health Organization’s work force team for Africa. The W.H.O. has identified 55 nations with critical shortages of health workers and suggests that foreign countries should not recruit from them. Thirty-seven of those nations are in Africa, including Zimbabwe, added this year, where the government estimates that the country will need at least an additional 69,000 medical workers by 2030.When Angela Khulu, an 84-year-old grandmother, was hit by a car recently and stumbled into a hospital in Bulawayo, in Zimbabwe’s south, most of the administrative nurses and hospital clerks were already ending their day shifts. She waited in a long line while the few medical workers on duty bounced between patients.Praying for a peaceful election during a church service in Harare on Sunday.John Wessels/Agence France-Presse — Getty ImagesAfter two hours, with pain radiating down her left side, she was seen by a doctor, who recommended checking for internal bleeding. But the hospital, Mpilo Central, did not have enough radiographers — or X-ray films — so, despite her serious symptoms, she was sent home and told to come back the following day.Dr. Tawanda Mapfumo, who works at Mpilo Central, says he has become accustomed to the chaos at the hospital, where about three dozen patients cram onto wooden benches in the corridors and waiting rooms. He says he cannot shake the guilt of seeing patients die because there are no resources to treat them.Those trying conditions have created an opening for Britain, in particular, to lure away Zimbabwean health workers. Nearly 22,000 Zimbabweans have received health care work visas from Britain over the past three years (though not everyone who receives one actually moves).Britain’s recruitment has drawn the ire of Zimbabwe’s government. In April, the vice president, Constantino Chiwenga, who is also the health minister, suggested introducing a law to criminalize the recruitment of Zimbabwean health workers by foreign countries. No law has been formally introduced yet.But within the past two years, health workers in Zimbabwe said, the Health Ministry has made it more difficult for them to get the letters of good standing they need to be hired abroad.A 31-year-old doctor, who requested anonymity to avoid trouble with the Zimbabwean government, said that in 2020, when he applied for his letter to move to Namibia to practice, he paid $40 and received the letter the same day.But when he sought another letter from the Zimbabwean authorities in early 2021 to move from Namibia to South Africa for more training, he was confronted with a fee of $150 and a five-page form with questions he considered intrusive. He filled out the form and paid but has still not received his letter.A hospital in Harare last year. The W.H.O. has identified 55 nations with critical shortages of health workers. Thirty-seven of those countries are in Africa, including Zimbabwe.Jekesai Njikizana/Agence France-Presse — Getty ImagesNonetheless, he said he was fortunate because he still works in Namibia, where his $3,000 monthly salary is roughly 10 times what he made in Zimbabwe.“It’s not worth your time or dignity,” he said, referring to the poor pay in Zimbabwe.The Zimbabwean Health Ministry did not respond to requests for comment. Christopher Mutsvangwa, spokesman for ZANU-PF, said that the government was not opposed to citizens going abroad for jobs but that it needed to control the flow to ensure that some skilled workers remained.Despite the government’s barriers, Zimbabweans are still finding ways to flee.Wynter Banda swapped her life as a hairdresser in Harare to become a nursing home aide in Britain. She and her husband, Godwill, a teacher, sold their car and borrowed from friends to come up with the $5,000 she needed for the visa fee and other moving expenses.Her husband eventually joined her and works as a science teacher. Things are tight, she said, because of debt and high rent. Still, she said they had made the right decision.“Even though it’s not easy and the working hours are very long and stressful, I can’t imagine going back to Zimbabwe,” she said. “We suffered there.”Studying during a power cut in Harare last year. Critics say that Mr. Mnangagwa’s government has failed to steady the economy or stop the flight of workers.Associated PressJeffrey Moyo More

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      Biden Should Take Voters’ Concerns About Age Seriously

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      Only 47 percent of Democrats want to see Joe Biden on the ballot in 2024, according to the latest Associated Press poll. That’s not because they think he’s done a bad job in office. Democrats tend to like President Biden and continue to give him good marks on handling the economy and foreign policy.But many Democrats, particularly younger ones, are worried that he will simply be too old to be effective in a second term, which would end when he is 86. “My problem with him running in 2024 is that he’s just so old,” one Democrat told pollsters.That may be deeply unfair — people age at different rates — and in Mr. Biden’s case, it’s impossible to deny that politics and conspiracy theories, rather than facts, fuel at least some of the concern. But candidates shouldn’t pretend, as Mr. Biden often does, that advanced age isn’t an issue. Mr. Biden is 80 now, the oldest American to serve as president, and even supporters, including the political strategist David Axelrod, have expressed deep worries that his age will be both a political liability in 2024 and a barrier to a successful second term. If Mr. Biden runs again, as he recently said he intends to, questions will persist about his age until he does more to assure voters that he is up to the job.Mr. Biden’s age makes him an outlier even in an era when the nation’s political leadership is getting older. The current Senate, where the average age is 63.9 years, is the second oldest since 1789. The House, where the average age is 57.5 years, is the third oldest. By comparison, the average age in the United States is 38.8 years.Concerns about age — both in terms of fitness for office and being out of touch with the moment — are legitimate, as Mr. Biden acknowledged in an interview in February with ABC News. His standard line, repeated in that interview, is: “The only thing I can say is, ‘Watch me.’”But Mr. Biden has given voters very few chances to do just that — to watch him — and his refusal to engage with the public regularly raises questions about his age and health.The usual White House method of demonstrating a president’s mastery is to take tough questions in front of cameras, but Mr. Biden has not taken advantage of that opportunity, as The Times reported on Friday. He has held fewer news conferences and media interviews than most of his modern predecessors. Since 1923, only Richard Nixon and Ronald Reagan took fewer questions per month from reporters, and neither represents a model of presidential openness that Mr. Biden should want to emulate. His reticence has created an opening for critics and skeptics.The president also needs to talk about his health openly and without embarrassment, and to end the pretense that it doesn’t matter. Those who are watching him with an open mind have seen a strong performance this year. His State of the Union address on Feb. 7 shattered the Republican attempts to portray him as doddering. With a passion rarely seen at one of these speeches — let alone in his political history — Mr. Biden presented a remarkably effective defense of his presidency and gave a preview of what is likely to be an imminent re-election campaign.The Times reported last summer that Mr. Biden’s overall energy level has declined, and he continues to stumble over words in his public appearances. But those flaws alone don’t signal a politician who is too old to run again. His first term, in fact, is already full of accomplishment: The economy has added 12.6 million jobs since he took office, inflation is cooling, and he has signed significant legislation to fight climate change, improve access to health care, and make investments in manufacturing and infrastructure. He has stood up to Russia’s destructive campaign in Ukraine, and rallied the West to Ukraine’s side.Nonetheless, as Mr. Biden nears his actuarial life expectancy, concerns about his ability to handle the demands of campaigning and a potential second term are unlikely to disappear. Only a combination of performance and complete candor will change the minds of skeptical voters. Old age remains a sensitive topic, and many people, particularly men, are reluctant to discuss personal infirmities for fear of demonstrating weakness or being pushed aside by impatient younger generations. There is good reason for the federal government’s prohibition of age discrimination in employment — a protection that begins at age 40. Ageism is real.That law, however, doesn’t apply to people who are running for office. Voters have every right to ask questions about the medical condition of a candidate who wants their support. In 2016 both Donald Trump and Hillary Clinton gave the public very few details about their health. (Mr. Trump released a particularly preposterous doctor’s letter claiming he would be “the healthiest individual ever elected to the presidency.”)Mr. Biden acknowledged during the lead-up to the 2020 campaign that he was “chronologically” old but said it was up to voters to decide whether that was important. In that election, against an opponent who was only four years younger, the answer was clearly no. In November 2021, he released a medical report that said he was a “healthy, vigorous 78-year-old” and noted nothing more serious than a stiffened gait due to spinal changes and some acid reflux that caused him to cough.His most recent health summary, released on Feb. 16, said much the same thing, describing him as a “healthy, vigorous 80-year-old male who is fit to successfully execute the duties of the presidency.” But his cognitive abilities went unmentioned. That’s something he should discuss publicly and also demonstrate to the voters, who expect the president to reflect the nation’s strength.If he runs again, Mr. Biden will need to provide explicit reassurance to voters; many of them have seen family members decline rapidly in their 80s. Americans are watching what Mr. Biden says and does, just as he has asked them to do.Source photograph by Azure-Dragon, via Getty Images.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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      Should Candidates Be Transparent About Their Health?

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      More from our inbox:Revised Drone RulesLiving in Political FearPreparing for Future PandemicsHow Fossil Fuel Donations Sway Climate PoliticsLt. Gov. John Fetterman of Pennsylvania greets supporters following a Senate campaign rally.Kriston Jae Bethel/Agence France-Presse — Getty ImagesTo the Editor:Re “Candidates Must Disclose Medical Issues,” by Lawrence K. Altman (Opinion guest essay, Sept. 30):Dr. Altman correctly calls for the full disclosure of medical issues by major candidates, especially presidential. He has championed this cause for years, but his voice has gone unheeded.The most famous candidate health cover-up was J.F.K.’s adrenal insufficiency, Addison’s disease. But John McCain’s recurrent melanoma, Bill Bradley’s atrial fibrillation, Joe Biden’s cerebral aneurysm in his 1988 campaign and Bernie Sanders’s significant coronary disease requiring a stent were all either downplayed or denied.The most egregious example of health misrepresentation was in 1992, when Paul Tsongas and his physicians declared he was cured of his non-Hodgkin’s lymphoma when he was not. If he had been elected president rather than Bill Clinton, he would have required ongoing cancer treatments while in office, which would have compromised his ability to fulfill his duties. He died on Jan. 18, 1997.With the likelihood of one or more candidates over 75 running for president in 2024, the case for full medical disclosure is more compelling than ever. The country would be well served to remember the advice given by William Safire in 1987, when he wrote, “The president’s body is not wholly his own; that is why we go to such lengths to protect it.”Kevin R. LoughlinBostonThe writer is a retired urologic surgeon and a professor emeritus at Harvard Medical School.To the Editor:I would like to respectfully disagree that candidates owe their voters full medical transparency. Confidentiality of medical records exists for good reason, and to throw it away — citing confusion over John Fetterman’s health in the Pennsylvania Senate campaign — is the wrong approach.For example: Does a female candidate owe it to voters to reveal whether she has ever had an abortion? Some would argue yes, she should. I would argue that it’s none of the voters’ business.What else should a candidate reveal? Therapist’s notes? Past substance use?A real-life example is Thomas Eagleton, who was tapped to be George McGovern’s running mate in 1972 until it was revealed that he had undergone electroshock therapy for depression 12 years earlier. Because of this, he was dropped from the ticket.In the U.S., we are extremely fortunate to have the rights we have, including a right to privacy. We should not be looking for ways to chip away at these rights.Gregory FedynyshynMalden, Mass.Revised Drone RulesAn Air Force Predator drone, right, returning from a mission in the Persian Gulf region in 2016. The new policy suggests that the United States intends to launch fewer drone strikes away from recognized war zones.John Moore/Getty ImagesTo the Editor:Re “Rules on Counterterrorism Drone Strikes, Eased by Trump, Are Tightened by Biden” (news article, Oct. 8):Are we supposed to be assured that the United States is now acting ethically, legally and judiciously with President Biden’s revised drone assassination policy?Our clandestine killing of terrorist leaders outside conventional war zones only provokes greater risk for American citizens and soul-searching trauma for drone operators thousands of miles way. It deeply stains our own sense of national righteousness.This is not a policy that needs to be reformed. It’s a policy that should be abandoned for ethical, tactical and practical reasons.Dave PasinskiFayetteville, N.Y.Living in Political FearHouse and Senate leaders have their own security details, including plainclothes officers and armored vehicles, but it can be more difficult for others to obtain such protection.Andrew Harnik/Associated PressTo the Editor:Re “Lawmakers Fearing the Worst as Intimidation Tactics Grow” (front page, Oct. 2):The appalling acrimony and threats directed against duly elected representatives have a chilling trickle-down effect to citizens as well. I recently received what I considered a banal lawn sign from the League of Women Voters. One side states, “Vote — Our Democracy Depends on It,” and the other, “Vote 411 — Election Information You Need.”In other election years, I would have placed it on my lawn without thinking twice. But after the Jan. 6 insurrection, I’m hesitant. Even though I live in a mostly progressive, blue-voting Westchester community, I know that many of my neighbors hold other political beliefs. There are a surprising number of “Blue Lives Matter” banners and “1776” flags in my neighborhood, which make me wonder how many of these neighbors doubt the legitimacy of the 2020 election.I worry that displaying a message that our democracy depends on voting would be more of a red flag than a civic reminder.And I am ashamed that in our current fractious, and dangerously degraded, political climate, my fear will keep me from exercising my political beliefs.Merri RosenbergArdsley, N.Y.Preparing for Future Pandemics Brynn Anderson/Associated PressTo the Editor:Re “Unprepared for Covid and Monkeypox. And the Next Outbreak, Too” (news analysis, Oct. 1):Apoorva Mandavilli highlights an important issue when she writes that the United States “remains wholly unprepared to combat new pathogens.”Governments do need to be ready for future pandemics when they hit, but their priority must be preventing them in the first place. We know that most infectious diseases can be traced to pathogen transmission between wildlife and people, particularly in our increasingly degraded and exploited natural world.Governments across the globe must prioritize efforts to reduce the risks of future pathogen spillovers, including via trade and at wildlife markets.A critical first step is recognizing the intrinsic links between the health of humans, animals and the ecosystem, and acknowledging the foundational importance of an intact and functioning environment to our well-being.A new international treaty or agreement can help bring governments together to catalyze needed change. With several hundred thousand yet undiscovered viruses in wildlife that can potentially infect humans, this is not the time to ignore the science and avoid action.The adage that “an ounce of prevention is worth a pound of cure” is now truer than ever.Susan LiebermanChris WalzerDr. Lieberman is the vice president for international policy at the Wildlife Conservation Society. Dr. Walzer is its executive director for health.How Fossil Fuel Donations Sway Climate PoliticsFrom left, Florida’s governor, Ron DeSantis, and two senators, Rick Scott and Marco Rubio, in 2019.Kevin Lamarque/ReutersTo the Editor:Re “Republicans Talk About Rebuilding, but Not the Cause of Climate Change” (news article, Oct. 5):Large political contributions from fossil fuel interests are blocking federal action against climate change even in Florida, one of the areas most vulnerable to hurricanes. Its vulnerability is fueled by warmer oceans along with storm surges worsened by rising seas and downpours increased by a warmer atmosphere that holds more moisture.The United States could become the world leader in battling climate change, inspiring and helping other countries to do more while creating millions of jobs. Incredibly, Florida’s Republican governor and two senators have voted against action to mitigate climate change.Why? “If you’re from Florida, you should be leading on climate and environmental policy, and Republicans are still reticent to do that because they’re worried about primary politics,” Carlos Curbelo, a former Republican congressman from South Florida, is quoted as saying.That is, Republicans who stray from the fossil fuel line will face a primary opponent well funded by fossil fuel interests.Public funding of election campaigns must replace big contributions if we want our democracy to stop being distorted. Indeed, if we want to safeguard our planet.Richard BarsantiWestern Springs, Ill. More

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      Biden Shows Off a New Accessory: A Walking Boot

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