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      ‘It’s back to drug rationing’: the end of HIV was in sight. Then came the cuts

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      This year the world should have been “talking about the virtual elimination of HIV” in the near future. “Within five years,” says Prof Sharon Lewin, a leading researcher in the field. “Now that’s all very uncertain.”Scientific advances had allowed doctors and campaigners to feel optimistic that the end of HIV as a public health threat was just around the corner.Then came the Trump administration’s abrupt cuts to US aid funding. Now the picture is one of a return to the drugs rationing of decades ago, and of rising infections and deaths.But experts are also talking about building a new approach that would make health services, particularly those in sub-Saharan Africa, less vulnerable to the whims of a foreign power.The US has cancelled 83% of its foreign aid contracts and dismantled USAid, the agency responsible for coordinating most of them.Many fell under the President’s Emergency Plan for Aids Relief (Pepfar) programme, which has been the backbone of global efforts to tackle HIV and Aids, investing more than $110bn (£85bn) since it was founded in 2003 and credited with saving 26 million lives and preventing millions more new infections. In some African countries it covered almost all HIV spending.View image in fullscreenThere is a risk, says Lewin, director of Melbourne University’s Institute for Infection and Immunity and past president of the International Aids Society, of “dramatic increases in infections, dramatic increases in death and a real loss of decades of advances”.There is no official public list of which contracts have been cancelled, and which remain. It appears that virtually no HIV-prevention programmes funded by the US are still in operation, save a handful principally providing drugs to stop pregnant women passing on the infection to their babies. Countries report disruption to the most basic measures, such as condom distribution.Some treatment programmes have been spared, but not those whose focus conflicted with the Trump administration’s war on “gender ideology” or diversity, equity and inclusion (DEI), such as those working with transgender communities. Doctors, nurses and other healthcare workers have been laid off, while worried patients are hoarding drugs or stretching supplies, according to UNAids surveillance. UNAids itself has lost more than half of its funding.Even programmes that have survived the cull have faced turmoil since February, with instructions to stop work rescinded but with no certainty that funding will continue.View image in fullscreenIn only one example, the Elizabeth Glaser Paediatric Aids Foundation says it has had to halt HIV treatment for 85,000 people in Eswatini, including more than 2,000 children, and tests for thousands of pregnant women and babies to prevent transmission and begin life-saving medication.Access to drugs represents an “immediate crisis”, Lewin says. “If people with HIV stop the medications, then not only do they get sick themselves, which is tragic, but they also then become infectious to others.”As clinics on the frontline of treating the disease scrabble to secure access to basic drugs, scientists at this month’s Conference on Retroviruses and Opportunistic Infections in San Francisco were hearing that HIV might soon be preventable with a once-a-year injection.The drug lenacapavir was already generating huge excitement in the field, after trial results showed that a six-monthly jab could prevent HIV. New results from the manufacturer Gilead suggest that a tweak to the formula and how it is given could see its protective effects last even longer.Nevertheless, Lewin says, the mood at the meeting, packed with many of the world’s leading HIV specialists, was “dire”.As well as programme cancellations, there are “huge concerns around science and what’s going to happen to the [US] National Institutes of Health, [whose] funding of science has been so significant on every level”, she says.Some scientists in receipt of US funding have been told to remove their names from DEI-linked research, she says, even though DEI is fundamental to the HIV response.View image in fullscreen“I don’t mean that in a sort of touchy-feely way, I mean that’s what we need to do: you need to actually get those treatments to these diverse communities.”In 2022, 55% of all new HIV infections were within “key populations”, such as gay men, other men who have sex with men, sex workers, transgender people, prisoners and people who inject drugs.Prof Linda-Gail Bekker, of South Africa’s Desmond Tutu Health Foundation, has seen US funding for three trials of potential HIV vaccines involving eight countries cancelled and only reinstated after an appeal to the US supreme court.“We’re running around like chickens without heads to at least get one going, because the vaccines are sitting in the fridge and will expire,” she says.She led the lenacapavir trial that showed it offered 100% protection to young women in sub-Saharan Africa, but now worries about HIV/Aids prevention “falling off the radar completely”.The global community had been making headway towards the United Nations’ goal of ending Aids by 2030, she says, with a five-year plan to use “amazing new innovative tools and scale them up”, which would have led to “less dependence on foreign aid and more self-reliance” as new infections fell and attention shifted to maintaining treatment for people with HIV.“All of that is hugely at risk now because, without these funds, our governments will have to step up but they will concentrate on treatment,” she says. “We know they will do that, because that is what we did for the first 30 years.”Efforts to control Aids were entering “the last mile”, which was always likely to be more expensive, she says. “The people who were happy to come into health facilities, they would have come into health facilities.”It would be difficult to rely on government funding to reach the remaining groups, she says, not only because of fewer resources but also because in some countries it means targeting groups whose existence is illegal and unrecognised, such as sex workers or sexual minorities, and young girls may be reluctant to use government clinics if they are not supposed to be sexually active.“I feel like the odds are very stacked against us,” says Bekker, adding: “We’re obviously going to have to re-programme ourselves [and] formulate a different plan.”Pepfar had pledged funding to the Global Fund to Fight Aids, Tuberculosis and Malaria, to deploy 10m doses of lenacapavir in low-income countries. While the Global Fund has promised to maintain its commitment, it might receive fewer than the planned number of doses, Bekker fears.“Six months ago, I was saying the best thing we can do with lenacapavir is offer it to everybody in a choice environment. [Now] I think we’re gonna have to say who needs [injectable] prep,” she says, “and the rest have to do the best they can.“How do we make that decision? And what does that look like? It is back to sort of rationing.“When we started ARVs [antiretroviral drugs] way back in 2000,” Bekker recalls, “you would go, ‘you get treatment; you don’t, you don’t, you don’t’.“It feels terrible … but you have to get over that. You have to say it will be infection-saving for some people. And we’ve got to make it count.”View image in fullscreenFor Beatriz Grinsztejn, president of the International Aids Society, the disruption is critical and threatens many vulnerable people. But, she adds, it could present “an important opportunity for ownership – otherwise we are always left in the hands of others”.She worries about the impact of cuts to funding on younger scientists, with their potential loss from the research field “a major threat for the next generation”. But, she adds, the HIV community is “powerful and very resilient”.There have already been calls for new ways of doing things. It is “time for African leadership”, members of the African-led HIV Control Working Group write in the Lancet Global Health. There are now plans for Nigeria to produce HIV drugs and tests domestically.Christine Stegling, deputy director of UNAids, says it began “a concerted effort” last year to develop plans with countries about how their HIV programmes could become more sustainable domestically “but with a longer timeframe … now we are trying to do some kind of fast-tracking”.Governments are determined, she says, but it will require fiscal changes either in taxation or by restructuring debt.The goal of ending Aids by 2030 is still achievable, Stegling believes. “I think we have a very short window of opportunity now, in the next two, three months, to continue telling people that we can do it.“I keep on reminding people, ‘look, we need to get back to that same energy that we had when people were telling us treatment can’t be available in the global south, right?’ And we didn’t accept it. We made it happen.“We have national governments now who are also very adamant, because they can see what can happen, and they want to make it happen for their own populations.” More

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      JD Vance and those threats from within | Letters

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      Among the justified furore around America’s new position in the world, one part at least triggers a bit of nostalgia (JD Vance stuns Munich conference with blistering attack on Europe’s leaders, 14 February). JD Vance’s description of the “threat from within” brings back memories of Margaret Thatcher’s designation of those who disagreed with her as “the enemy within”. I still have a badge with that somewhere. Maybe it’s time I dusted it off.Steve TownsleyCowbridge, Vale of Glamorgan As JD Vance lectures European leaders about freedom of speech, Louisiana is banning health officials from promoting vaccinations and libraries across the US are having to purge their shelves of any books that make mention of subjects that Republicans dislike. No hypocrisy there, then?Tony GreenIpswich, Suffolk Britain thought it had a special relationship with the US. Seems we got dumped on Valentine’s Day.Emma TaitLondon Your report (‘Guess who’s back?’: the inside story of Nigel Farage’s quest for power, 15 February) confirmed what I already suspected: Reform is basically a party run by millionaires, for the benefit of millionaires, with a good dollop of nativism added to the mix.Alan PavelinChislehurst, Kent Re remarks in school reports (Letters, 14 February), my favourite is from around 1971, courtesy of a great history teacher: “Intelligent answers, a mastery of the facts would help.” I’m sure CP Scott would have agreed with him.Kevin McGillPrestwood, Buckinghamshire More

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      The Guardian view on supporting vaccines: humans can work miracles – so why wouldn’t we? | Editorial

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      It is easy to become so used to scientific and social advances that we take them for granted. But sometimes we should pause to celebrate – to feel genuine awe – at the wonders that we have seen. Amid all the wars, the disasters and the crimes of the last half century, we have witnessed nothing short of a miracle.Vaccination, in addition to clean water, sanitation and improved nutrition, has been one of the greatest contributors to global health. It is responsible for much of the astounding fall in child mortality, which plummeted by 59% between 1990 and 2022. It has saved more than 150 million lives, mostly of infants, since the Expanded Programme on Immunisation was launched by the World Health Organization in 1974. Initially designed to protect children against diseases including smallpox, tuberculosis, polio and measles, the scheme has since been extended to cover more pathogens. Then, in 2000, came the Global Alliance for Vaccines and Immunisation (Gavi), a public-private organisation that provides financial and technical support for vaccination in poorer countries and negotiates with manufacturers to lower costs.The results have been remarkable. Prevention is better – and cheaper and easier – than cure. Smallpox was declared eradicated in 1980. Almost all the world is now polio-free. Cases of many other diseases have been slashed. Much more can be done: an estimated 5 million children have been protected against malaria since routine vaccinations were launched a year ago. And from a scientific perspective, we are entering a golden age of vaccines.Yet this is a dangerous moment in other ways. The climate crisis is spurring disease outbreaks. Conflict has dramatically increased the number of unprotected children. Vaccine scepticism has grown. Now cuts to funding threaten to turn the clock back. The trashing of USAid will hinder delivery and has halted a groundbreaking programme to create new malaria vaccines. Robert F Kennedy Jr – who once claimed that “no vaccine is safe and effective” and who tried to persuade the US government to rescind authorisation for the coronavirus vaccine at the height of the pandemic – was confirmed this week as health secretary.Now the UK, one of Gavi’s founding donors and the country which has given most to its core programme, is considering a significant cut to its support. This would be a grave error. While some aspects of Gavi’s approach have faced sensible scrutiny in the past, it has vaccinated over 1 billion children and done so cost-effectively: 97 pence in every pound it is given goes on vaccine programmes. Its success is also evident in the number of countries which have graduated from being beneficiaries to paying their own way; some, including Indonesia, are becoming donors in turn. And Gavi’s stockpiles help to keep people safe in wealthier countries too, as well as ensuring that poorer nations are healthier and more stable.For all these reasons, Gavi has long enjoyed bipartisan support in the UK, which has given it more than £2bn over the last four years. Now, more than ever, its funding must be sustained. The world is full of apparently intractable conflicts and complex moral dilemmas. Few decisions are truly simple for governments. But this one is a no-brainer. It should astonish us that we can so easily save lives. It should be self-evident that we must continue to seize that opportunity. More

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      Robert F Kennedy Jr has mass appeal despite his extreme ideas. This theory explains why | Darren Loucaides

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      “Back at home in the United States, the newspapers are saying that I came here today to speak to about 5,000 Nazis,” Robert F Kennedy Jr told a large crowd in Berlin. Estimated at 38,000 people, the crowd was a mix of hippies, anti-war types, Green party voters and anti-vaxxers, rubbing shoulders with a smattering of skinheads. It was late August 2020 and a group called Querdenken had rallied this motley crew together in defiance of Covid-19 restrictions.“Governments love pandemics,” Kennedy said. “They love pandemics for the same reason they love war – it gives them the ability to impose controls that the population would otherwise never accept.”Last month, in Senate confirmation hearings for his appointment as the US secretary of health and human services, Kennedy was questioned on having previously compared the Center for Disease Control’s work to that of “Nazi death camps”, calling Covid-19 a bioweapon genetically engineered to target black and white people while sparing Ashkenazi Jews and Chinese people, and blaming school shootings on antidepressants. “He has made it his life’s work to sow doubt and discourage parents from getting their kids life-saving vaccines,” said the Democratic senator Ron Wyden. “It has been lucrative for him and put him on the verge of immense power.”Kennedy has gone from courting the conspiratorial fringes of the internet to the halls of the White House. He could be confirmed within days. With hindsight, the Berlin speech he gave five years ago was the moment a dangerous new political phenomenon went global. It’s called diagonalism.Coined by the political theorist William Callison and the historian Quinn Slobodian, diagonalism describes the union of disparate groups across the political spectrum around a suspicion of all power being involved in conspiracy. Diagonal movements see big tech, big pharma, banks, climate science and traditional media as accomplices in totalitarianism, evidenced by Covid mandates through to innocuous intergovernmental proposals such as the “great reset” and 15-minute cities.For diagonalists, the control of electoral processes by powerful interests means that governments are de facto illegitimate. And so they advocate for distributed power – not to empower any community, but the individual. By definition they are susceptible to far-right radicalisation. Callison and Slobodian trace their use of the term back to Querdenken – which roughly translates as “lateral thinkers” – the group that organised the Berlin rally addressed by Kennedy.Kennedy recalled his uncle’s visit to the same city decades earlier, even repeating the historic line “Ich bin ein Berliner”. “And today again, Berlin is the frontline against global totalitarianism,” he said, before working through a bingo card of conspiracy theories. An extended “quote” Kennedy read from Hermann Göring’s testimony at the Nuremberg trials, including that “the only thing a government needs to make people into slaves is fear”, was copy and pasted across social media for months afterwards – even though there is no record of Göring saying those words.But Kennedy’s Berlin speech and the Querdenken rally itself were not merely notable for the controversy they caused. In drawing together veterans of anti-war and anti-globalist groups alongside health influencers, environmentalists and the far right, Querdenken became the blueprint for diagonal movements. Through its anti-power conspiratorial framing and the mirroring of methods used by decentralised grassroots movements, Querdenken was able to draw diagonal lines across pre-existing political allegiances, cultural divides and single issues, such as the climate or vaccines, to forge a mass coalition of support. Kennedy himself epitomises this new coalition – one that was nascent at the time, but is now at the heart of Trumpism.As a former environmental lawyer, Kennedy spoke with eloquence and passion in the past about corporations contaminating rivers and polluting the skies, the plight of asthma especially afflicting black people, and the existential threat of the climate crisis. In the Berlin speech, Kennedy mingled conspiracy theories with genuine concerns and anxieties held by the public. He said he saw “people who want leaders who are not going to lie to them, people who want leaders who will not make up arbitrary rules and regulations to orchestrate the obedience of the population. We want health officials who don’t have financial entanglements with the pharmaceutical industry, who are working for us and not big pharma.”In her book Doppelganger, Naomi Klein writes powerfully on how diagonal movements and influencers often identify real issues that progressives had grown timid about – the sway of oligarchical wealth over politics, the rise of digital surveillance, the impact of rampant capitalism on our mental and physical health. But instead of articulating the actual causes or plausible solutions, they have constructed bogus metanarratives. Rather than increasingly antidemocratic billionaires, it was an organised cabal of global elites, unaccountable deep-state bureaucrats who secretly ran the world – or, at the furthest end, blood-sucking satanists, as QAnon followers believed. A mirrorworld had emerged. And it is demagogues such as Trump who have benefited.“Despite claims of post-partisanship, it is right-wing, often far-right, political parties around the world that have managed to absorb the unruly passions and energy of diagonalism,” says Klein, “folding its Covid-era grievances into preexisting projects opposing ‘wokeness’ and drumming up fears of migrant ‘invasions’. Still, it is important for these movements to present themselves (and to believe themselves to be) ruptures with politics-as-usual; to claim to be something new, beyond traditional left-right poles.”While the crowd that listened to Kennedy’s speech that day in 2020 was a heterogeneous mix, a few miles away, a mob of far-right activists and QAnon supporters tried to storm the Reichstag, home to Germany’s parliament, after one of their number falsely announced Trump was in Berlin to liberate the country. The violent scenes would be replicated in the more deadly assault on the Capitol on 6 January 2021. This was the extreme end of diagonalism exploding into life. (An investigation I led into Covid-sceptic groups found that by then, Querdenken and others had become obsessed with Trump – and gravely radicalised.)If Robert F Kennedy Jr is confirmed to Trump’s cabinet, a once-staunch environmentalist and defender of women’s reproductive rights turned conspiracy theorist and super-spreader of health misinformation will dictate health policy in the US. Diagonalism has ascended to the pinnacle of global power. The mirrorworld is becoming our reality.

      Darren Loucaides is a writer based in Barcelona and London

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      Mitch McConnell condemns petition to revoke approval of polio vaccine by RFK Jr adviser

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      US Senate minority leader and polio survivor Mitch McConnell has condemned attempts to undermine the polio vaccine after reports that a lawyer affiliated with Robert F Kennedy Jr – the health secretary pick for Donald Trump’s second presidency – petitioned for the Food and Drug Administration to revoke its approval of the vaccine.In a statement reported by numerous outlets on Friday, McConnell, who contracted the disease as a child in 1944 – 11 years before the licensing of the world’s first polio vaccine – said: “The polio vaccine has saved millions of lives and held out the promise of eradicating a terrible disease. Efforts to undermine public confidence in proven cures are not just uninformed – they’re dangerous.”The 82-year-old went on to add: “Anyone seeking the Senate’s consent to serve in the incoming administration would do well to steer clear of even the appearance of association with such efforts.”McConnell’s latest comment comes after the New York Times first reported that Aaron Siri, a lawyer helping Kennedy select incoming health officials for Trump’s second White House term, filed a petition in 2022 in which he called on the FDA to revoke its polio vaccine approval. Trump has nominated Kennedy, an avowed vaccine skeptic, as health secretary for his incoming administration – a move widely criticized by health experts.According to the New York Times, Siri filed the petition on behalf of the Informed Consent Action Network, a major anti-vaccination organization in the US. Siri has also asked federal regulators to withdraw or suspend vaccines for hepatitis B and 13 other vaccines, the outlet reported.Kennedy’s anti-vaccination beliefs have been widely debunked, including the unsupported link between vaccines and autism.Polio, also known as poliomyelitis, is a highly infectious viral disease that mostly affects children under five years old. Transmitted through contaminated water, food or contact with an infected person, the poliovirus destroys nerve cells in the spinal cord, in turn causing muscle wasting and paralysis.Since 1988, polio cases have decreased by more than 99% across the world, the US Centers for Disease Control and Prevention stated on its website, adding that polio vaccines have prevented approximately 20m cases of paralysis in children since then.skip past newsletter promotionafter newsletter promotionIn response to the reports, a Trump spokesperson for Kennedy Jr told the Washington Post that Siri “has never had a conversation about these petitions with Mr Kennedy or any of the [health and human services] nominees at any point”.Among other things, the spokesperson added that the vaccine “should be investigated and studied appropriately”, which it already has been. More

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      RFK Jr to research unsupported link between vaccines and autism, Trump says

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      Donald Trump has said Robert F Kennedy Jr, his nominee for health secretary, may investigate a supposed link between vaccines and autism – despite a consensus among the medical establishment debunking any such connection.In a wide-ranging interview with NBC, the US president-elect claimed an investigation was justified by the increasing prevalence of autism diagnoses among American children over the past 25 years.“When you look at what’s going on with disease and sickness in our country, something’s wrong,” Trump said after the interviewer, Kristen Welker, asked him if he wanted to see some vaccines eliminated – a position for which Kennedy has argued.“If you take a look at autism, go back 25 years, autism was almost nonexistent. It was, you know, one out of 100,000 and now it’s close to one out of 100.”According to the Centers for Disease Control and Prevention (CDC), one out of every 36 children in the US were diagnosed with autism in 2020, compared with one in 150 in 2000.Kennedy, a noted vaccine sceptic, has repeatedly peddled discredited theories that the conditions is caused by childhood vaccinations.“I do believe that autism does come from vaccines,” he said in a 2023 Fox News interview in which he called for more vaccine testing.“We should have the same kind of testing place or control trials that we have for other every other medication. Vaccines are exempt from pre-licensing control trials, so that there’s no way that anybody can tell the risk profile of those products, or even the relative benefits of those products before they’re mandated. We should have that kind of testing.”Trump – who has previously said Kennedy would be allowed to “go wild” on health – said his health secretary pick would not “reinvent the wheel totally”.“He’s not going to upset any system,” he said.But on autism, he added: “Somebody has to find out. If you go back 25 years ago, you had very little autism. Now you have it … When you talk about autism, because it was brought up, and you look at the amount we have today versus 20 or 25 years ago, it’s pretty scary.”Scientists have attributed the rise in autism diagnoses to improved screening methods while saying it is caused by a complex mix of factors, including genetics, environment and conditions during pregnancy and birth.The World Health Organization has definitely ruled out a connection between autism and the measles, mumps and rubella (MMR) vaccine or other childhood inoculations.Research led by the British doctor Andrew Wakefield asserting a link between autism and the MMR jab was later discredited, with the Lancet, a medical journal, issuing a full retraction of a paper it had published based on it.Wakefield was later banned from practicing in Britain after being found by the country’s general medical council to have broken its rules on research and to have acted “dishonestly” and with a “callous disregard” for children’s health.The Guardian reported in 2018 that Wakefield had attended an inaugural ball marking the start of Trump’s first presidency the previous year at which he was quoted calling for a shakeup of the US medical establishment.“What we need now is a huge shakeup at the Centers for Disease Control and Prevention – a huge shakeup,” he said. “We need that to change dramatically.” More