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Javier E

Warnings Ignored: A Timeline of Trump's COVID-19 Response - The Bulwark - 0 views

  • the White House is trying to establish an alternate reality in which Trump was a competent, focused leader who saved American people from the coronavirus.
  • it highlights just how asleep Trump was at the switch, despite warnings from experts within his own government and from former Trump administration officials pleading with him from the outside.
  • Most prominent among them were former Homeland Security advisor Tom Bossert, Commissioner of the Food and Drug Administration Scott Gottlieb, and Director for Medical and Biodefense Preparedness at the National Security Council Dr. Luciana Borio who beginning in early January used op-eds, television appearances, social media posts, and private entreaties to try to spur the administration into action.
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  • what the administration should have been doing in January to prepare us for today.
  • She cites the delay on tests, without which “cases go undetected and people continue to circulate” as a leading issue along with other missed federal government responses—many of which are still not fully operational
  • The prescient recommendations from experts across disciplines in the period before COVID-19 reached American shores—about testing, equipment, and distancing—make clear that more than any single factor, it was Trump’s squandering of out lead-time which should have been used to prepare for the pandemic that has exacerbated this crisis.
  • What follows is an annotated timeline revealing the warning signs the administration received and showing how slow the administration was to act on these recommendations.
  • The Early Years: Warnings Ignored
  • 2017: Trump administrations officials are briefed on an intelligence document titled “Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents.” That’s right. The administration literally had an actual playbook for what to do in the early stages of a pandemic
  • February 2018: The Washington Post writes “CDC to cut by 80 percent efforts to prevent global disease outbreak.” The meat of the story is “Countries where the CDC is planning to scale back include some of the world’s hot spots for emerging infectious disease, such as China, Pakistan, Haiti, Rwanda and Congo.”
  • May 2018: At an event marking the 100 year anniversary of the 1918 pandemic, Borio says “pandemic flu” is the “number 1 health security issue” and that the U.S. is not ready to respond.
  • One day later her boss, Rear Adm. Timothy Ziemer is pushed out of the administration and the global health security team is disbanded
  • Beth Cameron, former senior director for global health security on the National Security Council adds: “It is unclear in his absence who at the White House would be in charge of a pandemic,” Cameron said, calling it “a situation that should be immediately rectified.” Note: It was not
  • January 2019: The director of National Intelligence issues the U.S. Intelligence Community’s assessment of threats to national security. Among its findings:
  • A novel strain of a virulent microbe that is easily transmissible between humans continues to be a major threat, with pathogens such as H5N1 and H7N9 influenza and Middle East Respiratory Syndrome Coronavirus having pandemic potential if they were to acquire efficient human-to-human transmissibility.”
  • Page 21: “We assess that the United States and the world will remain vulnerable to the next flu pandemic or large scale outbreak of a contagious disease that could lead to massive rates of death and disability, severely affect the world economy, strain international resources, and increase calls on the United States for support.”
  • September, 2019: The Trump Administration ended the pandemic early warning program, PREDICT, which trained scientists in China and other countries to identify viruses that had the potential to turn into pandemics. According to the Los Angeles Times, “field work ceased when funding ran out in September,” two months before COVID-19 emerged in Wuhan Province, China.
  • 2020: COVID-19 Arrives
  • anuary 3, 2020: The CDC is first alerted to a public health event in Wuhan, China
  • January 6, 2020: The CDC issues a travel notice for Wuhan due to the spreading coronavirus
  • Note: The Trump campaign claims that this marks the beginning of the federal government disease control experts becoming aware of the virus. It was 10 weeks from this point until the week of March 16 when Trump began to change his tone on the threat.
  • January 10, 2020: Former Trump Homeland Security Advisor Tom Bossert warns that we shouldn’t “jerk around with ego politics” because “we face a global health threat…Coordinate!”
  • January 18, 2020: After two weeks of attempts, HHS Secretary Alex Azar finally gets the chance to speak to Trump about the virus. The president redirects the conversation to vaping, according to the Washington Post. 
  • January 21, 2020: Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Disease at the CDC tells reporters, “We do expect additional cases in the United States.”
  • January 27, 2020: Top White House aides meet with Chief of Staff Mick Mulvaney to encourage greater focus on the threat from the virus. Joe Grogan, head of the White House Domestic Policy Council warns that “dealing with the virus was likely to dominate life in the United States for many months.”
  • January 28, 2020: Two former Trump administration officials—Gottlieb and Borio—publish an op-ed in the Wall Street Journal imploring the president to “Act Now to Prevent an American Epidemic.” They advocate a 4-point plan to address the coming crisis:
  • (1) Expand testing to identify and isolate cases. Note: This did not happen for many weeks. The first time more than 2,000 tests were deployed in a single day was not until almost six weeks later, on March 11.
  • (3) Prepare hospital units for isolation with more gowns and masks. Note: There was no dramatic ramp-up in the production of critical supplies undertaken. As a result, many hospitals quickly experienced shortages of critical PPE materials. Federal agencies waited until Mid-March to begin bulk orders of N95 masks.
  • January 29, 2020: Trump trade advisor Peter Navarro circulates an internal memo warning that America is “defenseless” in the face of an outbreak which “elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.”
  • January 30, 2020: Dr. James Hamblin publishes another warning about critical PPE materials in the Atlantic, titled “We Don’t Have Enough Masks.”
  • January 29, 2020: Republican Senator Tom Cotton reaches out to President Trump in private to encourage him to take the virus seriously.
  • Late January, 2020:  HHS sends a letter asking to use its transfer authority to shift $136 million of department funds into pools that could be tapped for combating the coronavirus. White House budget hawks argued that appropriating too much money at once when there were only a few U.S. cases would be viewed as alarmist.
  • Trump’s Chinese travel ban only banned “foreign nationals who had been in China in the last 14 days.” This wording did not—at all—stop people from arriving in America from China. In fact, for much of the crisis, flights from China landed in America almost daily filled with people who had been in China, but did not fit the category as Trump’s “travel ban” defined it.
  • January 31, 2020: On the same day Trump was enacting his fake travel ban, Foreign Policy reports that face masks and latex gloves are sold out on Amazon and at leading stores in New York City and suggests the surge in masks being sold to other countries needs “refereeing” in the face of the coming crisis.
  • February 4, 2020: Gottlieb and Borio take to the WSJ again, this time to warn the president that “a pandemic seems inevitable” and call on the administration to dramatically expand testing, expand the number of labs for reviewing tests, and change the rules to allow for tests of people even if they don’t have a clear known risk factor.
  • Note: Some of these recommendations were eventually implemented—25 days later.
  • February 5, 2020: HHS Secretary Alex Azar requests $2 billion to “buy respirator masks and other supplies for a depleted federal stockpile of emergency medical equipment.” He is rebuffed by Trump and the White House OMB who eventually send Congress a $500 million request weeks later.
  • February 4 or 5, 2020: Robert Kadlec, the assistant secretary for preparedness and response, and other intelligence officials brief the Senate Intelligence Committee that the virus poses a “serious” threat and that “Americans would need to take actions that could disrupt their daily lives.”
  • February 5, 2020: Senator Chris Murphy tweets: Just left the Administration briefing on Coronavirus. Bottom line: they aren't taking this seriously enough. Notably, no request for ANY emergency funding, which is a big mistake. Local health systems need supplies, training, screening staff etc. And they need it now.
  • February 9, 2020: The Washington Post reports that a group of governors participated in a jarring meeting with Dr. Anthony Fauci and Dr. Robert Redfield that was much more alarmist than what they were hearing from Trump. “The doctors and the scientists, they were telling us then exactly what they are saying now,” Maryland Gov. Larry Hogan (R) said.
  • the administration lifted CDC restrictions on tests. This is a factually true statement. But it elides that fact that they did so on March 3—two critical weeks after the third Borio/Gottlieb op-ed on the topic, during which time the window for intervention had shrunk to a pinhole.
  • February 20, 2020: Borio and Gottlieb write in the Wall Street Journal that tests must be ramped up immediately “while we can intervene to stop spread.”
  • February 23, 2020: Harvard School of Public Health professor issues warning on lack of test capability: “As of today, the US remains extremely limited in#COVID19 testing. Only 3 of ~100 public health labs haveCDC test kits working and CDC is not sharing what went wrong with the kits. How to know if COVID19 is spreading here if we are not looking for it.
  • February 24, 2020: The Trump administration sends a letter to Congress requesting a small dollar amount—between $1.8 billion and $2.5 billion—to help combat the spread of the coronavirus. This is, of course, a pittance
  • February 25, 2020: Messonier says she expects “community spread” of the virus in the United States and that “disruption to everyday life might be severe.” Trump is reportedly furious and Messonier’s warnings are curtailed in the ensuing weeks.
  • Trump mocks Congress in a White House briefing, saying “If Congress wants to give us the money so easy—it wasn’t very easy for the wall, but we got that one done. If they want to give us the money, we’ll take the money.”
  • February 26, 2020: Congress, recognizing the coming threat, offers to give the administration $6 billion more than Trump asked for in order to prepare for the virus.
  • February 27, 2020: In a leaked audio recording Sen. Richard Burr, chairman of the Intelligence Committee and author of the Pandemic and All-Hazards Preparedness Act (PAHPA) and the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (reauthorization of PAHPA), was telling people that COVID-19 “is probably more akin to the 1918 pandemic.”
  • March 4, 2020: HHS says they only have 1 percent of respirator masks needed if the virus became a “full-blown pandemic.”
  • March 3, 2020: Vice President Pence is asked about legislation encouraging companies to produce more masks. He says the Trump administration is “looking at it.”
  • March 7, 2020: Fox News host Tucker Carlson, flies to Mar-a-Lago to implore Trump to take the virus seriously in private rather than embarrass him on TV. Even after the private meeting, Trump continued to downplay the crisis
  • March 9, 2020: Tom Bossert, Trump’s former Homeland Security adviser, publishes an op-ed saying it is “now or never” to act. He advocates for social distancing and school closures to slow the spread of the contagion.
  • Trump says that developments are “good for the consumer” and compares COVID-19 favorably to the common flu.
  • March 17, 2020: Facing continued shortages of the PPE equipment needed to prevent healthcare providers from succumbing to the virus, Oregon Senators Jeff Merkeley and Ron Wyden call on Trump to use the Defense Production Act to expand supply of medical equipment
  • March 18, 2020: Trump signs the executive order to activate the Defense Production Act, but declines to use it
  • At the White House briefing he is asked about Senator Chuck Schumer’s call to urgently produce medical supplies and ventilators. Trump responds: “Well we’re going to know whether or not it’s urgent.” Note: At this point 118 Americans had died from COVID-19.
  • March 20, 2020: At an April 2nd White House Press Conference, President Trump’s son-in-law Jared Kushner who was made ad hoc point man for the coronavirus response said that on this date he began working with Rear Admiral John Polowczyk to “build a team” that would handle the logistics and supply chain for providing medical supplies to the states. This suggestion was first made by former Trump Administration officials January 28th
  • March 22, 2020: Six days after calling for a 15-day period of distancing, Trump tweets that this approach “may be worse than the problem itself.”
  • March 24, 2020: Trump tells Fox News that he wants the country opened up by Easter Sunday (April 12)
  • As Trump was speaking to Fox, there were 52,145 confirmed cases in the United States and the doubling time for daily new cases was roughly four days.
Javier E

How Will the Coronavirus End? - The Atlantic - 0 views

  • A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk.
  • We realized that her child might be one of the first of a new cohort who are born into a society profoundly altered by COVID-19. We decided to call them Generation C.
  • “No matter what, a virus [like SARS-CoV-2] was going to test the resilience of even the most well-equipped health systems,”
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  • To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.
  • That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. “I’m not aware of any simulations that I or others have run where we [considered] a failure of testing,”
  • The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases.
  • None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country.
  • With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency.
  • That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition
  • Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear.
  • Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,”
  • “Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.”
  • it will be difficult—but not impossible—for the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April
  • A “massive logistics and supply-chain operation [is] now needed across the country,” says Thomas Inglesby of Johns Hopkins Bloomberg School of Public Health. That can’t be managed by small and inexperienced teams scattered throughout the White House. The solution, he says, is to tag in the Defense Logistics Agency—a 26,000-person group that prepares the U.S. military for overseas operations and that has assisted in past public-health crises, including the 2014 Ebola outbreak.
  • The first and most important is to rapidly produce masks, gloves, and other personal protective equipment
  • it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems.
  • This agency can also coordinate the second pressing need: a massive rollout of COVID-19 tests.
  • These measures will take time, during which the pandemic will either accelerate beyond the capacity of the health system or slow to containable levels. Its course—and the nation’s fate—now depends on the third need, which is social distancing.
  • There are now only two groups of Americans. Group A includes everyone involved in the medical response, whether that’s treating patients, running tests, or manufacturing supplies. Group B includes everyone else, and their job is to buy Group A more time. Group B must now “flatten the curve” by physically isolating themselves from other people to cut off chains of transmission.
  • Given the slow fuse of COVID-19, to forestall the future collapse of the health-care system, these seemingly drastic steps must be taken immediately, before they feel proportionate, and they must continue for several weeks.
  • Persuading a country to voluntarily stay at home is not easy, and without clear guidelines from the White House, mayors, governors, and business owners have been forced to take their own steps.
  • when the good of all hinges on the sacrifices of many, clear coordination matters—the fourth urgent need
  • Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. Such thinking is seductive, but flawed. It overestimates our ability to assess a person’s risk, and to somehow wall off the ‘high-risk’ people from the rest of society. It underestimates how badly the virus can hit ‘low-risk’ groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.
  • A recent analysis from the University of Pennsylvania estimated that even if social-distancing measures can reduce infection rates by 95 percent, 960,000 Americans will still need intensive care.
  • There are only about 180,000 ventilators in the U.S. and, more pertinently, only enough respiratory therapists and critical-care staff to safely look after 100,000 ventilated patients. Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.
  • If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it won’t be quick. “It could be anywhere from four to six weeks to up to three months,” Fauci said, “but I don’t have great confidence in that range.”
  • there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.
  • The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.
  • The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting
  • The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one.  By the end of the summer, the pandemic will have directly killed 2.2 million Americans,
  • The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.
  • there are no existing vaccines for coronaviruses—until now, these viruses seemed to cause diseases that were mild or rare—so researchers must start from scratch.
  • The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the virus’s genes for the first time and doctors injecting a vaccine candidate into a person’s arm. “It’s overwhelmingly the world record,” Fauci said.
  • The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. They’ll need to do animal tests and large-scale trials to ensure that the vaccine doesn’t cause severe side effects. They’ll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.
  • No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into people’s arms.
  • as the status quo returns, so too will the virus. This doesn’t mean that society must be on continuous lockdown until 2022. But “we need to be prepared to do multiple periods of social distancing,” says Stephen Kissler of Harvard.
  • First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect.
  • Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer.
  • scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. They’ll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.
  • Aspects of America’s identity may need rethinking after COVID-19. Many of the country’s values have seemed to work against it during the pandemic. Its individualism, exceptionalism, and tendency to equate doing whatever you want with an act of resistance meant that when it came time to save lives and stay indoors, some people flocked to bars and clubs.
  • “We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.”
  • The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. “But my hope and expectation is that the severity would decline, and there would be less societal upheaval,”
  • After infections begin ebbing, a secondary pandemic of mental-health problems will follow.
  • But “there is also the potential for a much better world after we get through this trauma,”
  • Testing kits can be widely distributed to catch the virus’s return as quickly as possible. There’s no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be.
  • Pandemics can also catalyze social change. People, businesses, and institutions have been remarkably quick to adopt or call for practices that they might once have dragged their heels on, including working from home, conference-calling to accommodate people with disabilities, proper sick leave, and flexible child-care arrangements.
  • Perhaps the nation will learn that preparedness isn’t just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose America’s social immune system, and that this system has been suppressed.
  • Attitudes to health may also change for the better. The rise of HIV and AIDS “completely changed sexual behavior among young people who were coming into sexual maturity at the height of the epidemic,”
  • Years of isolationist rhetoric had consequences too.
  • “People believed the rhetoric that containment would work,” says Wendy Parmet, who studies law and public health at Northeastern University. “We keep them out, and we’ll be okay. When you have a body politic that buys into these ideas of isolationism and ethnonationalism, you’re especially vulnerable when a pandemic hits.”
  • Pandemics are democratizing experiences. People whose privilege and power would normally shield them from a crisis are facing quarantines, testing positive, and losing loved ones. Senators are falling sick. The consequences of defunding public-health agencies, losing expertise, and stretching hospitals are no longer manifesting as angry opinion pieces, but as faltering lungs.
  • After COVID-19, attention may shift to public health. Expect to see a spike in funding for virology and vaccinology, a surge in students applying to public-health programs, and more domestic production of medical supplies.
  • The lessons that America draws from this experience are hard to predict, especially at a time when online algorithms and partisan broadcasters only serve news that aligns with their audience’s preconceptions.
  • “The transitions after World War II or 9/11 were not about a bunch of new ideas,” he says. “The ideas are out there, but the debates will be more acute over the next few months because of the fluidity of the moment and willingness of the American public to accept big, massive changes.”
  • One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trump’s approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero.
  • One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbors both foreign and domestic. The election of November 2020 becomes a repudiation of “America first” politics. The nation pivots, as it did after World War II, from isolationism to international cooperation
  • The U.S. leads a new global partnership focused on solving challenges like pandemics and climate change.
  • In 2030, SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.
  • On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5—the world’s highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.
Javier E

A Deadly Coronavirus Was Inevitable. Why Was No One Ready? - WSJ - 0 views

  • When Disease X actually arrived, as Covid-19, governments, businesses, public-health officials and citizens soon found themselves in a state of chaos, battling an invisible enemy with few resources and little understanding—despite years of work that outlined almost exactly what the virus would look like and how to mitigate its impact.
  • Governments had ignored clear warnings and underfunded pandemic preparedness. They mostly reacted to outbreaks, instead of viewing new infectious diseases as major threats to national security. And they never developed a strong international system for managing epidemics, even though researchers said the nature of travel and trade would spread infection across borders.
  • Underlying it all was a failure that stretches back decades. Most everyone knew such an outcome was possible. And yet no one was prepared.
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  • Last year, a Chinese scientist he worked with published a specific forecast: “It is highly likely that future SARS- or MERS-like coronavirus outbreaks will originate from bats, and there is an increased probability that this will occur in China.”
  • Humans today are exposed to more deadly new pathogens than ever. They typically come from animals, as global travel, trade and economic development, such as meat production and deforestation, push people, livestock and wildlife closer together
  • Scientists knew infectious disease outbreaks were becoming more common, with 2010 having more than six times the outbreaks of pathogens from animal origins than in 1980, according to data in a study by Brown University researchers.
  • Yet plenty was left undone, in areas including funding, early-warning systems, the role of the WHO and coordination with China. A big chunk of U.S. funding went toward protecting Americans against a bioterror attack. Government funding for pandemics has come largely in emergency, one-time packages to stop an ongoing outbreak.
  • She said a better solution would be to fund public health more like national defense, with much more guaranteed money, year in, year out.
  • “Will there be another human influenza pandemic?” Dr. Webster asked in a paper presented at an NIH meeting in 1995. “The certainty is that there will be.”
  • Experts including Dr. Webster were particularly concerned about the potential for spillover in southern China, where large, densely populated cities were expanding rapidly into forests and agricultural lands, bringing people into closer contact with animals. Two of the three influenza pandemics of the 20th century are thought to have originated in China.
  • Dr. Webster and others warned it could re-emerge or mutate into something more contagious. With U.S. funding, he set up an animal influenza surveillance center in Hong Kong. The WHO, which hadn’t planned for pandemics before, started compiling protocols for a large-scale outbreak, including contingency plans for vaccines.
  • At a dinner back in the U.S., he remembers one guest saying, “Oh, you really needed to have someone in the U.S. to be impacted to really galvanize the government.”
  • That “drove home the reality in my own mind of globalization,” said Dr. Fukuda. SARS showed that viruses can crisscross the globe by plane in hours, making a local epidemic much more dangerous.
  • The WHO’s director-general, Gro Harlem Brundtland, publicly criticized China. The government under new leaders reversed course. It implemented draconian quarantines and sanitized cities, including a reported 80 million people enlisted to clean streets in Guangdong.
  • By May 2003, the number of new SARS cases was dwindling. It infected around 8,000 people world-wide, killing nearly 10%.
  • After SARS, China expanded epidemiologist training and increased budgets for new laboratories. It started working more closely in public health with the U.S., the world’s leader. The U.S. CDC opened an office in Beijing to share expertise and make sure coverups never happened again. U.S. CDC officials visiting a new China CDC campus planted a friendship tree.
  • In Washington in 2005, a powerful player started driving U.S. efforts to become more prepared. President George W. Bush had read author John M. Barry’s “The Great Influenza,” a history of the 1918 flu pandemic
  • Mr. Bush leaned toward the group of 10 or so officials and said, “I want to see a plan,” according to Dr. Venkayya. “He had been asking questions and not getting answers,” recalled Dr. Venkayya, now president of Takeda Pharmaceutical Co. ’s global vaccine business unit. “He wanted people to see this as a national threat.”
  • Mr. Bush launched the strategy in November, and Congress approved $6.1 billion in one-time funding.
  • The CDC began exercises enacting pandemic scenarios and expanded research. The government created the Biomedical Advanced Research and Development Authority to fund companies to develop diagnostics, drugs and vaccines.
  • A team of researchers also dug into archives of the 1918 pandemic to develop guidelines for mitigating the spread when vaccines aren’t available. The tactics included social distancing, canceling large public gatherings and closing schools—steps adopted this year when Covid-19 struck, though at the time they didn’t include wide-scale lockdowns.
  • A year after the plan was released, a progress report called for more real-time disease surveillance and preparations for a medical surge to care for large numbers of patients, and stressed strong, coordinated federal planning.
  • A European vaccine makers’ association said its members had spent around $4 billion on pandemic vaccine research and manufacturing adjustments by 2008.
  • The $6.1 billion Congress appropriated for Mr. Bush’s pandemic plan was spent mostly to make and stockpile medicines and flu vaccines and to train public-health department staff. The money wasn’t renewed. “The reality is that for any leader it’s really hard to maintain a focus on low-probability high-consequence events, particularly in the health arena,” Dr. Venkayya said.
  • In the U.S., President Barack Obama’s administration put Mr. Bush’s new plan into action for the first time. By mid-June, swine flu, as it was dubbed, had jumped to 74 countries. The WHO officially labeled it a pandemic, despite some evidence suggesting the sickness was pretty mild in most people.
  • That put in motion a host of measures, including some “sleeping” contracts with pharmaceutical companies to begin vaccine manufacturing—contracts that countries like the United Kingdom had negotiated ahead of time so they wouldn’t have to scramble during an outbreak.
  • In August, a panel of scientific advisers to Mr. Obama published a scenario in which as many as 120 million Americans, 40% of the population, could be infected that year, and up to 90,000 people could die.
  • H1N1 turned out to be much milder. Although it eventually infected more than 60 million Americans, it killed less than 13,000. In Europe, fewer than 5,000 deaths were reported.
  • The WHO came under fire for labeling the outbreak a pandemic too soon. European lawmakers, health professionals and others suggested the organization may have been pressured by the pharmaceutical industry.
  • France ordered 94 million doses, but had logged only 1,334 serious cases and 312 deaths as of April 2010. It managed to cancel 50 million doses and sell some to other countries, but it was still stuck with a €365 million tab, or about $520 million at the time, and 25 million extra doses.
  • The WHO had raised scares for SARS, mad-cow disease, bird flu and now swine flu, and it had been wrong each time, said Paul Flynn, a member of the Council of Europe’s Parliamentary Assembly and a British lawmaker, at a 2010 health committee hearing in Strasbourg.
  • Ultimately, an investigation by the council’s committee accused the WHO and public-health officials of jumping the gun, wasting money, provoking “unjustified fear” among Europeans and creating risks through vaccines and medications that might not have been sufficiently tested.
  • “I thought you might have uttered a word of regret or an apology,” Mr. Flynn told Dr. Fukuda, who as a representative of the WHO had been called to testify.
  • Back in Washington, scientist Dennis Carroll, at the U.S. Agency for International Development, was also convinced that flu wasn’t the only major pandemic threat. In early 2008, Dr. Carroll was intrigued by Dr. Daszak’s newly published research that said viruses from wildlife were a growing threat, and would emerge most frequently where development was bringing people closer to animals.
  • If most of these viruses spilled over to humans in just a few places, including southern China, USAID could more easily fund an early warning system.
  • “You didn’t have to look everywhere,” he said he realized. “You could target certain places.” He launched a new USAID effort focused on emerging pandemic threats. One program called Predict had funding of about $20 million a year to identify pathogens in wildlife that have the potential to infect people.
  • Drs. Daszak, Shi and Wang, supported by funds from Predict, the NIH and China, shifted their focus to Yunnan, a relatively wild and mountainous province that borders Myanmar, Laos and Vietnam.
  • One key discovery: a coronavirus resembling SARS that lab tests showed could infect human cells. It was the first proof that SARS-like coronaviruses circulating in southern China could hop from bats to people. The scientists warned of their findings in a study published in the journal Nature in 2013.
  • Evidence grew that showed people in the area were being exposed to coronaviruses. One survey turned up hundreds of villagers who said they recently showed symptoms such as trouble breathing and a fever, suggesting a possible viral infection.
  • Over the next several years, governments in the U.S. and elsewhere found themselves constantly on the defensive from global viral outbreaks. Time and again, preparedness plans proved insufficient. One, which started sickening people in Saudi Arabia and nearby
  • On a weekend morning in January 2013, more than a dozen senior Obama administration officials met in a basement family room in the suburban home of a senior National Security Council official. They were brainstorming how to help other countries upgrade their epidemic response capabilities, fueled by bagels and coffee. Emerging disease threats were growing, yet more than 80% of the world’s countries hadn’t met a 2012 International Health Regulations deadline to be able to detect and respond to epidemics.
  • The session led to the Global Health Security Agenda, launched by the U.S., the WHO and about 30 partners in early 2014, to help nations improve their capabilities within five years.
  • Money was tight. The U.S. was recovering from the 2008-09 financial crisis, and federal funding to help U.S. states and cities prepare and train for health emergencies was declining. Public-health departments had cut thousands of jobs, and outdated data systems weren’t replaced.
  • “It was a Hail Mary pass,” said Tom Frieden, who was director of the CDC from 2009 to 2017 and a force behind the creation of the GHSA. “We didn’t have any money.”
  • At the WHO, Dr. Fukuda was in charge of health security. When the Ebola outbreak was found in March 2014, he and his colleagues were already stretched, after budget cuts and amid other crises.
  • The United Nations created a special Ebola response mission that assumed the role normally played by the WHO. Mr. Obama sent the U.S. military to Liberia, underscoring the inability of international organizations to fully handle the problem.
  • It took the WHO until August to raise an international alarm about Ebola. By then, the epidemic was raging. It would become the largest Ebola epidemic in history, with at least 28,600 people infected, and more than 11,300 dead in 10 countries. The largest outbreak before that, in Uganda, had involved 425 cases.
  • Congress passed a $5.4 billion package in supplemental funds over five years, with about $1 billion going to the GHSA. The flood of money, along with aggressive contact tracing and other steps, helped bring the epidemic to a halt, though it took until mid-2016.
  • Global health experts and authorities called for changes at the WHO to strengthen epidemic response, and it created an emergencies program. The National Security Council warned that globalization and population growth “will lead to more pandemics,” and called for the U.S. to do more.
  • r. Carroll of USAID, who had visited West Africa during the crisis, and saw some health workers wrap themselves in garbage bags for protection, started conceiving of a Global Virome Project, to detect and sequence all the unknown viral species in mammals and avian populations on the planet.
  • Billionaire Bill Gates warned in a TED talk that an infectious disease pandemic posed a greater threat to the world than nuclear war, and urged world leaders to invest more in preparing for one. The Bill & Melinda Gates Foundation helped form a new initiative to finance vaccines for emerging infections, the Coalition for Epidemic Preparedness Innovations.
  • Congress established a permanent Infectious Diseases Rapid Response Fund for the CDC in fiscal 2019, with $50 million for that year and $85 million in fiscal 2020.
  • In May 2018, John Bolton, then President Trump’s national security adviser, dismantled an NSC unit that had focused on global health security and biodefense, with staff going to other units. The senior director of the unit left.
  • It pushed emerging disease threats down one level in the NSC hierarchy, making pandemics compete for attention with issues such as North Korea, said Beth Cameron, a previous senior director of the unit. She is now vice president for global biological policy and programs at the Nuclear Threat Initiative.
  • Deteriorating relations with China reduced Washington’s activities there just as researchers were becoming more certain of the threat from coronaviruses.
  • Dr. Carroll had earlier been ordered to suspend his emerging pandemic threats program in China.
  • Dr. Carroll pitched to USAID his Global Virome Project. USAID wasn’t interested, he said. He left USAID last year. A meeting that Dr. Carroll planned for last August with the Chinese CDC and Chinese Academy of Sciences to form a Chinese National Virome Project was postponed due to a bureaucratic hang-up. Plans to meet are now on hold, due to Covid-19.
Javier E

The Center Cannot Hold | Foreign Affairs - 0 views

  • the debate over whether great-power competition or transnational threats pose the greater danger to the United States is a false one. Look back at strategic assessments from ten years ago on China and Russia, on the one hand, and those on pandemics and climate change, on the other, and it is clear that Washington is experiencing near-worst-case scenarios on both. Great-power rivalry has not yet sparked a hot war but appears to be on the brink of sparking a cold one. Meanwhile, the worst pandemic in a century is not yet over, and the climate crisis is only accelerating. 
  • What COVID-19 has made powerfully clear is that this is an age of transnational threats and great-power competition—one in which the two phenomena exacerbate each other.
  • By the same token, ramping up competition with China without a plan to rally the world to deal with transnational threats (which can themselves fuel rivalry between great powers) would only guarantee future disasters. 
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  • Attempting to ease tensions with China to make cooperation on global public health possible won’t work, partly because Beijing cannot credibly commit to being more transparent and cooperative in the future.
  • For China’s leaders, the pandemic revealed the inexorable decline of the West, confirmed Beijing’s power and capabilities, and created more latitude for the CCP to do as it wished.
  • But in case cooperation fails, it must have a backup plan to rally allies and partners to provide a much greater share of global public goods, even if that means shouldering more of the costs.
  • as a number of U.S. embassy officials told the foreign policy analyst Colin Kahl and me for our book Aftershocks, this team’s cooperation with the Chinese government became more challenging as U.S.-Chinese rivalry intensified, largely because of China’s actions.
  • When COVID-19 hit, the Chinese Communist Party (CCP) maintained near-absolute secrecy. All channels of communication between Beijing and Washington went silent, as they did between Beijing and other governments. Chinese leaders sought to conceal vital information about the emerging epidemic in China from the rest of the world, even attempting to prevent Chinese scientists from sharing the genetic sequence of the virus with scientists in other countries.
  • It is impossible to say for certain why the Chinese government behaved the way it did, but secrecy and control make sense in light of what the vast majority of China experts believe to be Xi’s top priority: regime survival.
  • Xi did not want to facilitate an international response to COVID-19 that could have attributed blame to China or isolated it through travel restrictions, either of which might have damaged the regime’s domestic legitimacy. Instead, Xi leveraged the pandemic to his advantage: China’s suppression of the virus became a matter of national pride, held up by Beijing in sharp contrast to the experience of the United States.
  • according to the UN, the pandemic could force a total of 490 million people into poverty—defined as the loss of access to clean water, adequate food, or shelter—pushing the global poverty rate to around seven percent by 2030, compared with the pre-pandemic target of three percent. 
  • Contrary to popular belief, some senior Trump administration officials grasped the national security threat posed by the virus faster than their European counterparts did. Top officials in the National Security Council began focusing on the pandemic in early January, just days after news of the outbreak in Wuhan, China, became public.
  • ven though Pottinger and other NSC officials were wise to the danger, they ultimately failed to persuade Trump to make the necessary preparations to deal with the pandemic when it inevitably reached the United States. 
  • As the administration began to formulate its response, those who favored a more comprehensive public health approach both at home and abroad were excluded or marginalized at crucial moments. The result was that the Trump administration focused more on holding China responsible for the outbreak and reducing U.S. reliance on Beijing than on the minutiae of global public health policy or the hard work of rallying the world to tackle the pandemic.
  • the pandemic and China’s response to it helped unify the administration behind a more comprehensive strategy to push back against Beijing. Between March 2020 and the end of the year, the senior official said, the United States put in place more containment measures than it had in the previous three years, including restrictions on Chinese technology firms, sanctions on Chinese officials, looser regulations on diplomatic contacts with Taiwan, and recognition of the repression in Xinjiang as a genocide. In this sense, the pandemic was a pivotal moment in the U.S.-Chinese rivalry. 
  • Competition between the two countries overwhelmed everything else, including U.S. cooperation with allies on the pandemic, leaving a global leadership vacuum that no one could fill.
  • The EU tried to step up by increasing funding for the WHO and for COVAX, the global initiative to share vaccines, but it never came close to organizing a global response. China’s assertive foreign policy, and its attempts to use pandemic assistance to advance its interests, aggravated European leaders and convinced them to harden their positions toward China throughout the course of 2020. 
  • During this period, there was hardly any international cooperation on vaccine development or distribution, no coordination on travel restrictions or the distribution of medical supplies, and limited cooperation on achieving a cessation of hostilities in conflict zones
  • The United States needs a strategy to address transnational threats under the conditions of great-power competition. It must aim to cooperate with rivals, especially China, to prepare for future pandemics and to tackle climate change
  • The economic disruption caused by COVID-19 devastated low-income countries, which received little in the way of international assistance. Especially hard hit were countries, such as Bangladesh, that had made significant development gains in the last two decades and were propelling themselves into the lower tier of middle-income economies.
  • Pandemics are not the only transnational threat that promises to intensify great-power rivalry and diminish the prospects for much-needed cooperation. Climate change could do the same.
  • the real challenge is determining what to do when cooperation with China and other rivals falls short of what is required. The United States needs a backup plan to tackle shared challenges through coalitions of the willing.
  • Countries that aggressively decarbonize could place sanctions and other trade restrictions on countries that do not, leading to counterresponses and new trade wars.
  • the impediments to cooperation between Europe and China on climate change “are becoming higher” and warn that “decision-makers must not underestimate the highly competitive aspects of how China is changing its energy production and consumption.” 
  • The United States and Europe will both compete with China for access to raw materials and in developing the technology needed to make their economies carbon neutral: magnets, batteries, high-performance ceramics, and light-emitting diodes, among other things
  • even if the U.S. government remains broadly aligned with Europe on climate policy, the Europeans could still become disaffected if Congress blocks meaningful climate action, such as commitments to cut carbon emissions or invest in clean technology. This, in turn, could diminish Europe’s willingness to help uphold the U.S.-led international order.
  • If, on the one hand, they mean softening U.S. rhetoric without conceding much of substance to China, they would do well to look to Europe, where governments were much more inclined than the Trump administration to cooperate with China, but China did not take them up on the offer.
  • If, on the other hand, they mean unilaterally making major geopolitical concessions to China—on its territorial acquisitions in the South China Sea, for instance, or the status of Taiwan—the United States would not only pay an extremely high price but also likely embolden Beijing further without actually securing cooperation on pandemics or climate change beyond what Beijing has already offered.
  • There is no getting around strategic competition with Beijing: it is deeply embedded in the international order, mainly because China seeks to expand its sphere of influence in Asia at the expense of the United States and its allies, which are in turn committed to thwarting Beijing’s plans.
  • The United States and China are also engaged in what Jake Sullivan, Biden’s national security adviser, recently called “a competition of models.” China is seeking to make the world safe for the CCP and to demonstrate the effectiveness of its system. This entails pushing back against what it sees as pressure from liberal democratic countries that could thwart its objectives. For its part, the United States worries about the negative externalities of Chinese authoritarianism, such as censorship of international criticism of Beijing or the export of its tools of repression to other countries.
  • The United States also worries about what would happen to the military balance of power if China secured an enduring advantage in key technologies.
  • Even in diplomacy, friction will be endemic to the U.S.-Chinese relationship and will affect the broader international order for the foreseeable future. Outright confrontation can be avoided—but competition cannot. 
  • This competition places real limits on cooperation. Take the arena of global public health: many studies on how to improve pandemic preparedness call on world leaders to dramatically strengthen the WHO, including by giving it the same power to enforce international health regulations as the International Atomic Energy Agency enjoys with nuclear nonproliferation rules
  • The problem is getting every government to agree to a universally applicable mechanism for sanctions or some other enforcement mechanism. China will not agree to any reform that would involve intrusive inspections of its scientific research facilities.
  • The need for cooperation on transnational threats must change how the United States competes with China—not whether it competes.
  • U.S. officials should not give up on China entirely; instead, they should make a good-faith effort to work with Beijing, both bilaterally and in multilateral settings. Recognizing that there are strict limits on U.S.-Chinese cooperation is not the same as saying that no cooperation is possible.
  • Rather than unite the world around a common purpose, climate change is likely to deepen competition between major powers, especially as the transition away from fossil fuels creates economic winners and losers.
  • When it comes to pandemic preparedness, this means fully supporting the WHO (including by pressing for needed reforms) but also forging a coalition of like-minded states: a global alliance for pandemic preparedness that would regularly convene at the head-of-state level and work alongside nongovernmental organizations and the private sector.
  • Crucially, whenever the WHO declared an international public health emergency, alliance members would coordinate on travel and trade restrictions, as well as on public messaging and financial penalties and sanctions. Those penalties and sanctions would be aimed at those states that failed to provide sufficient access to or fully cooperate with the WHO. The alliance would support, not supplant, the WHO.
  • Sustained, managed competition with China could potentially help the United States build bipartisan support for investments in clean technology that would prevent Beijing from gaining an enduring advantage in this area.
  • ut the United States and the European Union will also need to build coalitions of the willing to deal with the international security consequences of accelerated climate change, such as extreme weather events that threaten large numbers of people, and to address the foreign policy dimensions of climate action, including managing the risk that a shift away from fossil fuels could destabilize countries and regions that are dependent on oil exports.
  • Cooperation across this divide should always be the first choice in times of shared crisis, but as the COVID-19 pandemic has demonstrated, the U.S.-led constellation must always have a backup plan. It did not have one in 2020. It needs one for the next crisis
Javier E

(1) Chartbook 313 Being realistic in the polycrisis? Or, does the West/global North kno... - 0 views

  • The challenge of actually being in medias res as fully as possible, is what preoccupies me in recent books, shorter writing, this newsletter and the podcast.
  • More simply this challenge can also be formulated in a series of snappy questions: Where are we? Do we know what planet we are actually on? Can we come back down to earth? Who is “we”? And, most urgently, the classic refrain: “What time is it?
  • Do we know, do we really know how fast the clock is ticking and where we are on the timeline of history?
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  • In this spirit, in my FT column I’ve repeatedly harped on questions of global development as particularly glaring examples of the way in which Western governments and their publics fail to rise to the scale of contemporary global challenges.
  • Conversely, flights from reality, blindspots and structural hypocrisies are profoundly telling as to our actual interests and willingness to summon the will, the power and the resources to act effectively in the world we are actually in.
  • These questions are not contemplative. They are not posed out of idle curiosity. They are urgent and practical. They are the first step, if we want to claim to be realistically engaged with the world as it is and thus to have any hope of informed and purposive agency.
  • In previous one column I addressed the failure of rich countries to seize the huge opportunity of investing at scale in global public health
  • In a world of polycrisis, in which intersecting problems compound each other and there are few easy wins, it is all the more important to recognise those policy choices that are truly obvious. Vaccines are one such investment. Since the 1960s, global vaccination campaigns have eradicated smallpox, suppressed polio and contained measles
  • . Modest expenditures on public health have saved tens of millions of lives, reduced morbidity and allowed children around the world to develop into adults capable of living healthy and productive lives.  … Unfortunately, in public policy, pandemic preparedness is all too often relegated to the cash-starved budgets of development agencies or squeezed into strained health budgets.
  • Where such spending properly belongs is under the flag of industrial policy and national security. 
  • As the IMF declared: “vaccine policy is economic policy.” And pandemic preparedness belongs under national security because there is no more serious threat to a population. A far larger percentage of the UK died of Covid between 2020 and 2023 (225,000 out of 67mn) than were killed by German bombs in the second world war (70,000 out of 50mn)
  • The annual defence budget of just one of the larger European countries would suffice to pay for a comprehensive global pandemic preparedness programme
  • The money lavished on just one of the UK’s vainglorious aircraft carriers was enough to have made the world safe against both the ghastly Ebola and Marburg viruses. 
  • After last week’s Brics meeting in South Africa, the question hangs in the air: what does the west have to offer a new, multipolar world? Nowhere is that question more urgent than in Africa. The Niger coup extends the comprehensive rout of western strategy across the Sahel. The debacle of western military intervention, notably on the part of the French, is embarrassing. But the wave of coups also represents a failure of Europe’s effort to link economic development and security in the programme known as the Sahel Alliance
  • This multinational group jointly promoted by France and Germany co-ordinated aid and development projects across the region. Launched in July 2017, as of 2023 it counts more than 1,100 projects with a cumulative funding commitment of €22.97bn. For Niger, project commitments under the Sahel Alliance come to over €5.8bn. And this is only a part of the financial assistance that Niger was receiving in the years prior to the coup.
  • According to OECD data, the combined total of official development assistance for Niger in 2021 came to $1.78bn. These numbers sound impressive until you place them in relation to the scale of the Sahel’s development needs. The western Sahel is home to 100mn of some of the poorest people on Earth. Niger’s population of 25mn has the third-lowest human development index in the world and the highest birth rate. Long hailed as the western bastion in the region, almost two-thirds of the population cannot read. Niger desperately needs investment in education, irrigation and basic health services. To meet these priorities, on a per capita basis foreign aid in 2021 came to just $71 for every inhabitant of Niger, or $1.37 per week. Of this miserly total, roughly 7 cents were spent on education, 15 cents on health, and 30 cents on production and infrastructure. Twenty-six cents were devoted to the basics of keeping alive.
  • Last month I took up the issue of the prevailing fatalism in the USA when it comes to the question of development in Central America
  • The attack line from the Republicans is predictable: Kamala Harris was Biden’s border tsar. The crisis on the border with Mexico shows that she failed. So too is the response from the Democrats: No, the vice-president never was in charge of the border. Her role was to address the root causes of migration from El Salvador, Guatemala and Honduras. No one can blame her for failing. It was mission impossible
  • The striking thing about this retort is not that it is unreasonable, but that it sets such a low bar. Whereas for the Republicans the desperation in Central America is reason to seal the border even more firmly, for the Democrats the deep-seated nature of those problems is an excuse. Apparently, no one expects Harris or anyone else to succeed in addressing the poverty and insecurity in the region. Shrugging its shoulders, the US settles down to live with polycrisis on its doorstep.
  • I returned to the question of the scale of global aid and European aid in particular for the African continent.
  • Uncontentious estimates of global development need put the sum of investment required to achieve comprehensive sustainable develoment at between $ 3 and 4 trillion per annum. That is an immense amount, but given the rewards on offer and the fact that global GDP stands at $105 trillion it cannot be dismissed out of hand as “utopian”.
  • FDI and private lending will do some of the work. But it is highly volatile and not willing to take the risks necessary for comprehensive development. So support and derisking, on carefully managed terms, must come from public balance sheets. Some will come from multilateral development banks like the World Bank. But a substantial amount will depend on concessional loans and aid in the form of grants. The crucial question is, how much is being made available? How far does it reflect the needs of the moment?
  • According to the OECD, the volume of official development assistance (ODA) in 2023 was 224 billion, a new high. Of that amount only $36 billion went to Africa, the continent with the most dramatic development needs.
  • So, what might these figures look like, if the West was actually invested in changing the trajectory of Africa’s development through material assistance? To this question, too the OECD data provide an answer.
  • The upshot is startling: In 2023 money flows to Ukraine classified by the OECD as official development assistance (ODA) exceeded the equivalent flows to the entire African continent.
  • At this moment, millions in Sudan are at risk of outright famine. The UN’s funding appeal for Sudan famine relief is for $2.6 billion, less than the monthly rate of support for Ukraine in 2023. So far it has raised $1 billion.
  • This is a stark measure of the difference between a crisis in which the Western donors see their interests directly and urgently engaged and one to which they are relatively indifferent.
  • It is the difference between a crisis happening to “people just like us”, people who have been welcomed in their millions into their neighboring European countries, and a crisis happening in Africa to black people with whom the donor populations feel on the whole only an abstract form of sympathy and identification.
  • It is the difference between crises happening on either side of the global colour line.
  • These discrepancies reveal the extraordinary extent to which, for all the common place talk of globalization, racial hierarchies and geographical division continue to undergird our political discourse and policy.
  • They are a sad commentary on where we are at and what time we are in. They also force the question of whether and by what means this line will be maintained and at what cost.
Javier E

How Emergent BioSolutions Put an 'Extraordinary Burden' on the U.S.'s Troubled Stockpil... - 0 views

  • Government purchases for the Strategic National Stockpile, the country’s emergency medical reserve where such equipment is kept, have largely been driven by the demands and financial interests of a handful of biotech firms that have specialized in products that address terrorist threats rather than infectious disease.
  • “Today, I think, we would not allow anthrax to take up half the budget for a guaranteed supply of vaccines,” he said, adding, “Surely after such a calamity as the last year, we should take a fresh look at stockpiles and manufacturing and preparing for the next pandemic.”
  • Under normal circumstances, Emergent’s relationship with the federal stockpile would be of little public interest — an obscure contractor in an obscure corner of the federal bureaucracy applying the standard tools of Washington, like well-connected lobbyists and campaign contributions, to create a business heavily dependent on taxpayer dollars.
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  • Security concerns, moreover, keep most information about stockpile purchases under wraps. Details about the contracts and inventory are rarely made public, and even the storage locations are secret.
  • Former Emergent employees, government contractors, members of Congress, biodefense experts and current and former officials from agencies that oversee the stockpile described a deeply dysfunctional system that contributed to the shocking shortages last year.
  • Purchases are supposed to be based on careful assessments by government officials of how best to save lives, but many have also been influenced by Emergent’s bottom line
  • The stockpile has long been the company’s biggest and most reliable customer for its anthrax vaccines, which expire and need to be replaced every few years.
  • In the two decades since the repository was created, Emergent’s aggressive tactics, broad political connections and penchant for undercutting competitors have given it remarkable sway over the government’s purchasing decisions related to the vaccines
  • While national security officials still consider anthrax a threat, it has not received specific mention since 2012 in the intelligence community’s annual public assessment of dangers facing the country, a report that has repeatedly warned of pandemics.
  • Emergent bought the license for the country’s only approved anthrax vaccine in 1998 from the State of Michigan. Over time, the price per dose the government agreed to pay Emergent increased nearly sixfold, accounting for inflation, contributing to record revenues last year that topped $1.5 billion
  • The company, whose board is stocked with former federal officials, has deployed a lobbying budget more typical of some big pharmaceutical companies
  • Competing efforts to develop a better and cheaper anthrax vaccine, for example, collapsed after Emergent outmaneuvered its rivals, the documents and interviews show.
  • preparations for an outbreak like Covid-19 almost always took a back seat to Emergent’s anthrax vaccines
  • the government approved a plan in 2015 to buy tens of millions of N95 respirators — lifesaving equipment for medical workers that has been in short supply because of Covid-19 — but the masks repeatedly lost out in the competition for funding over the years leading up to the pandemic
  • After Dr. Frieden and others in the Obama administration tried but failed to lessen Emergent’s dominance over stockpile purchases, the company’s fortunes rose under Mr. Trump, who appointed a former Emergent consultant with a background in bioterrorism to run the office that now oversees the stockpile
  • “If I could spend less on anthrax replenishment, I could buy more N95s,” Dr. Kadlec said in an interview shortly after leaving office. “I could buy more ventilators. I could buy more of other things that quite frankly I didn’t have the money to buy.”
  • And now, as some members of Congress push for larger reserves of ventilators, masks and other equipment needed in a pandemic, a trade group led in part by a top Emergent lobbyist has warned that the purchases could endanger companies focused on threats like anthrax and smallpox by drawing down limited funds.
  • Last year, as the pandemic raced across the country, the government paid Emergent $626 million for products that included vaccines to fight an entirely different threat: a terrorist attack using anthrax.
  • “I think it’s pretty clear that the benefit of the vaccine is marginal,” he said in an interview
  • “They’re very vicious in their behavior toward anybody they perceive as having a different point of view,” said Dr. Tara O’Toole, a former Homeland Security official who says she ran afoul of Emergent in 2010 after telling Congress that the nation needed a newer and better anthrax vaccine.
  • That year, the company that would become Emergent — then known as BioPort — paid Michigan $25 million to buy the license for a government-developed anthrax vaccine and an aging manufacturing plant.
  • The company opened its doors with one product, called BioThrax, and one customer, the Defense Department, which required the vaccine for service members.
  • Emergent’s anthrax vaccine was not the government’s first choice. It was more than 30 years old and plagued by manufacturing challenges and complaints about side effects. Officials instead backed a company named VaxGen, which was developing a vaccine using newer technology licensed from the military.
  • Emergent’s successful campaign against VaxGen — deploying a battalion of lobbyists, publicly attacking its rival and warning that it might cease production of its own vaccine if the government didn’t buy it — established its formidable reputation. By 2006, VaxGen had lost its contract and the government had turned to Emergent to supply BioThrax.
  • “They were totally feared by everybody,” Dr. Philip Russell, a top health official in the administration of President George W. Bush, said in an interview. He said that he clashed with Emergent when he backed VaxGen, and that his reputation came under attack, which was documented by The Times in 2006. (Dr. Russell died this January.)
  • the group of federal officials who make decisions about the stockpile and other emergency preparations — known as the Phemce, for the Public Health Emergency Medical Countermeasures Enterprise — ordered up a study. It found in 2010 that the government could not afford to devote so much of its budget to a single threat.
  • Instead, the review concluded, the government should invest more in products with multiple applications, like diagnostic tests, ventilators, reusable respirator masks and “plug and play” platforms that can rapidly develop vaccines for a range of outbreaks.
  • from 2010 through 2018, the anthrax vaccine consumed more than 40 percent of the stockpile’s budget, which averaged $560 million during those years.
  • Emergent and the government have withheld details of the stockpile contracts, including how much the company has charged for each dose of BioThrax, but executives have shared some of the missing information with investors.
  • The company in 1998 agreed to charge the government an average of about $3.35 per dose, documents show. By 2010, the price had risen to about $28, according to financial disclosures and statements by Emergent executives, and now it is about $30
  • Over the past 15 years, the company recorded a gross profit margin of about 75 percent for the vaccine, in an arrangement that one Emergent vice president called a “monopoly.”
  • Emergent’s rise is the stuff of lore in biodefense circles — a tale of savvy dealings, fortuitous timing and tough, competitive tactics.
  • One afternoon in October 2010, Wall Street investors gathered at the Millennium Broadway Hotel in Manhattan for a presentation by Mr. Burrows. He shared with them a secret number: 75 million.That was how many BioThrax doses the government had committed to stockpiling, and it was the backbone of Emergent’s thriving business. In pursuit of that goal, the government had already spent more than $900 million, and it continued to buy virtually every dose Emergent could produce. It had even awarded the company more than $100 million to expand its Michigan factory.
  • “The best approach toward anthrax is antimicrobial therapy,” Dr. Anthony S. Fauci, the government’s top infectious-disease expert, told Congress as early as 2007.
  • In an analysis published in 2007, the firm determined that giving antibiotics immediately after a large outdoor anthrax attack was likely to reduce serious illnesses by more than 80 percent. Administering the vaccine would then cut serious illnesses only by an additional 4 percent.
  • Dr. Ali S. Khan, who ran the C.D.C. office managing the stockpile until 2014, said bluntly: “We overpaid.”
  • “A bunch of people, including myself, were sitting in a room and asking what kind of attack might happen,” said Dr. Kenneth Bernard, a top biodefense adviser to Mr. Bush, recalling a meeting in the months after the 2001 attacks.
  • “And somebody said, ‘Well, I can’t imagine anyone attacking more than three cities at once,’” he said. “So we took the population of a major U.S. city and multiplied by three.”
  • A team of Homeland Security and health officials began doing just that in 2013. The group determined, in a previously undisclosed analysis, that the government could stockpile less BioThrax and still be prepared for a range of plausible attacks, according to two people involved in the assessment. Separately, government researchers concluded that two doses of BioThrax provided virtually the same protection as three.
  • the National Intelligence Council, which helped draft the assessments during Mr. Obama’s second term, said in an interview that the idea of a three-city attack affecting 25 million people was “straining credulity.”
  • “If you talk to the head of the House Intelligence Committee,” Don Elsey, Emergent’s chief financial officer, told investors in 2011, “and you say, ‘What are you most worried about?’ he’ll say, ‘Let me see: Number one, anthrax; number two, anthrax; number three, anthrax.’”
  • Emergent’s sales strategy was to address that fear by promising the federal government peace of mind with its vaccine.
  • “There’s a political element involved,” Mr. Burrows, the company’s vice president of investor relations, said at an industry conference in 2016. “I don’t have a marketing expense. I have lobbying expense.”
  • Since 2010, the company has spent an average of $3 million a year on lobbying — far outspending similarly sized biotech firms, and roughly matching the outlays of two pharmaceutical companies with annual revenues at least 17 times greater, AstraZeneca and Bristol Myers Squibb
  • In 2015, as stockpile managers questioned the large purchases of BioThrax, the spending topped $4 million
  • “They were pouring it on — how poor they were and how this was going to ruin the company, and they’d have to close down factories, and America was going to be left without anthrax vaccine,”
  • “Their revolving door is moving at 60 miles per hour,” said former Senator Claire McCaskill, a Democrat from Missouri who had questioned spending on the vaccine while in the Senate. “There is really a lot of incestuousness because it’s such a specialized field.”
  • Ms. DeLorenzo, the Emergent spokeswoman, said the lobbying was necessary because government investment “in biodefense and other public health threats has not been as strongly prioritized as it should be.”
  • Over the past 10 years, Emergent’s political action committee has spread almost $1.4 million in campaign contributions among members of both partie
  • The move followed a yearslong pattern of retaining a bipartisan lobbying corps of former agency officials, staff members and congressmen, including Pete Hoekstra of Michigan, Tom Latham of Iowa and Jim Saxton of New Jersey.
  • “You have people coming and saying, ‘There’s no market for this — nobody’s going to produce this unless you buy enough of it to keep the production line open,’” he said. “It’s an absolutely appropriate argument to make.”
  • Emergent’s campaign proved effective. Despite the 2015 recommendation by the stockpile managers, Senate overseers made clear they opposed the reduction, and the government went ahead and bought $300 million worth of BioThrax.
  • Emergent executives, meanwhile, warned that there could be job losses at the factory in Lansing, Mich. — the capital of a swing state at the center of a contentious presidential campaign between Mr. Trump and Hillary Clinton.
  • Because Emergent was the sole manufacturer of a product deemed critical to national security, the company has played what one former executive described to The Times as “the we’re-going-to-go-bankrupt card.”
  • Dr. Hatchett said the idea gave him pause. But, he explained in an interview, “if there’s only one partner that can provide a product and only one customer for that product, the customer needs the partner to survive.”
  • Just a year later, Emergent spent about $200 million in cash, and made other financial commitments, to acquire Sanofi’s smallpox vaccine and GlaxoSmithKline’s anthrax treatment, two products with established pipelines to the stockpile. The purchases expanded Emergent’s hold over the reserve.
  • Ms. DeLorenzo said the acquisitions did not suggest the company was better off than it had claimed, but Dr. Bright said he and others involved in the bailout felt used.
  • a plan five years earlier to create an emergency supply of N95 respirators was simply not funded. A team of experts had proposed buying tens of millions of the masks to fill the gap during an outbreak until domestic manufacturing could ramp up, according to five officials involved in the assessment, which has not been previously disclosed.
  • By the time the novel coronavirus emerged, the stockpile had only 12 million of the respirators. The stockpile has since set a goal of amassing 300 million.
  • Dr. Kadlec, the Trump administration official overseeing the stockpile, said he used the previous administration’s mask recommendation to raise alarms as early as 2018.
  • Dr. Annie De Groot, chief executive of the small vaccine company EpiVax, spoke about the need to break Emergent’s lock on research dollars at a biodefense forum in 2015.
  • “Politicians want to look like they’ve addressed the problem,” she said. “But we need to actually listen to the scientists.”
  • Over the last five years, Emergent has received nearly a half-billion dollars in federal research and development funding, the company said in its financial disclosures.
  • “We know ahead of time when funding opportunities are going to come out,” Barbara Solow, a senior vice president, told investors in 2017. “When we talk to the government, we know how to speak the government’s language around contracting.”
  • The company used federal money to make improvements to BioThrax, and also found a way to earn government money from a competing anthrax vaccine it had excoriated. After the demise of VaxGen in 2006, Emergent bought the company’s unfinished vaccine and in 2010 persuaded the federal government to continue paying for research on it
  • By the time the research contract was canceled in 2016, Emergent had collected about $85 million, records show. The company then shelved the vaccine. “If the U.S. government withdraws funding, we re-evaluate whether there is any business case for continuing,” Ms. DeLorenzo said.
  • For more than 30 years, the government had been encouraging the development of a BioThrax replacement. In 2002, the Institute of Medicine had concluded that an alternative based on more modern technology was “urgently needed.” By 2019, there were three leading candidates, including one made by Emergent, known as AV7909.
  • Emergent’s candidate was hardly the breakthrough the government was seeking, former health officials said. AV7909 was essentially an enhanced version of BioThrax. The competitors were using more modern technology that could produce doses more rapidly and consistently, and were promising significant cost savings for the stockpile.
  • To qualify for emergency authorization, a vaccine must be at an advanced stage of development with no approved alternatives. Emergent acknowledged in its financial disclosures that there was “considerable uncertainty” whether the new vaccine met those requirements.
  • The election of Mr. Trump as president was good news for Emergent.
  • Dr. Lurie, the senior health official in the Obama administration who had tried to scale back BioThrax purchases, was out. Mr. Trump’s pick to replace her was Dr. Kadlec, a career Air Force physician and top biodefense official in the Bush administration who was fixated on bioterrorism threats, especially anthrax, current and former officials said
  • Soon after entering the Trump administration in 2017, Dr. Kadlec took a series of actions that he characterized as streamlining a cumbersome bureaucracy but that had the effect of benefiting Emergent.
  • He assumed greater control of purchasing decisions, diminishing the authority of the Phemce, the oversight group that had proposed buying less BioThrax. And in 2018, he backed a decision to move control of the stockpile to his office in the Department of Health and Human Services and away from the C.D.C., which is based in Atlanta and prides itself on being insulated from the influence of lobbyists.
  • Dr. Frieden, the former C.D.C. director, was strongly opposed. The move, he said, “had almost as an explicit goal to give the lobbyists more say in what got purchased.”
  • That July, the government made the announcement Emergent had been banking on, committing to buying millions of doses. Separately, it said it would stop funding Emergent’s competitors.
  • The decision to side with Emergent did not surprise Dr. Khan, the former C.D.C. official overseeing the stockpile.“Again and again, we seem unable to move past an old technology that’s bankrupting the stockpile,” he said.
  • Last month, as the death toll from Covid-19 neared a half-million, Mr. Kramer, the company’s chief executive, told analysts there had been no “evidence of a slowdown or a delay or a deprioritization,” and echoed a statement he had made in April when asked whether the pandemic might interrupt Emergent’s sales to the stockpile.“It’s pretty much business as usual,” he said then.
delgadool

From Clinton to Trump, 20 years of boom and mostly bust in prepping for pandemics - 0 views

  • In April 1998, President Bill Clinton read a Richard Preston novel, "The Cobra Event," about a biological attack on the U.S. using a lethal virus that spreads like the common cold.
  • the result was the first federal government effort to marshal resources in preparation for a pandemic, including the creation of the National Emergency Medical Stockpile, which stowed vaccines and medical gear in secret locations around the country. Bernard was appointed as the first official on the National Security Council whose sole job was to focus on health threats.
  • Instead, it kicked off a boom-and-bust cycle of pandemic preparedness that persisted into the Trump administration. By many accounts, Trump fell on the bust side of the equation when he fired his top biosecurity adviser, allowed the disbanding of his global health unit, and initially downplayed the coronavirus as it spread across the world.
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  • The result was a perfect storm: A U.S. government not well prepared for a pandemic, run by a president who was slow to act after his intelligence community and public health advisers were warning about the dangers.
  • U.S. government over 20 years of successive administrations and Congresses failed to heed the warnings by taking basic steps that would have made it easier to quickly respond to a fast spreading and lethal pathogen. They didn't set up and fund a large volunteer medical reserve corps, for example, or build surplus hospital capacity, or create a system to quickly produce and deploy virus tests.
  • elected officials from both parties have never fully geared up for the biological threat, former officials and public health experts told NBC News. Each new White House deprioritized the issue, only to elevate it later after some defining event led to a presidential revelation. They then belatedly scrambled to respond with ambitious plans and initiatives, which faded after a few years.
  • "Here's the problem: In 10 years, if there's no pandemic, then everybody starts getting a bit relaxed," said Michael Leavitt, a former Utah governor who served as secretary of Health and Human Services in the Bush administration.
  • officials deserved "at least a B-plus," and Mount Sinai virologist Peter Palese called the overall response "excellent." Republicans in Congress praised the CDC for developing a vaccine in six months.
  • But after 9/11 and the subsequent anthrax attacks, the newly created Department of Homeland Security hired Bernard back, with added staff, to run a bio-preparedness unit.
  • After Bush read a book about the 1918 influenza pandemic in 2005, he forced his administration to double down on pandemic preparation, replenishing the stockpile and creating an early warning system.
  • When President George W. Bush took office in 2001, Bernard wrote a transition memo. He soon learned the Bush team had eliminated his job as White House biodefense czar.
  • When Ebola erupted in Africa in 2014, Obama brought in an outsider, Ron Klain, to run the federal response. The effort was widely praised, as was Obama's response to the 2016 Zika virus outbreak. But afterward, the Obama administration failed to fully replenish the federal stockpiles, according to research by ProPublica and USA Today.
  • Under Obama and a mostly Republican-controlled Congress, public health spending declined. Per capita public health spending, adjusted for inflation, rose from $39 in 1960 to $281 in 2008, and fell by 9.3 percent from 2008 to 2016, according to a 2016 study published in the American Journal of Public Health. It has fallen further under the Trump administration, records show.
  • During the transition from Obama to Trump, Obama officials conducted a tabletop exercise based on a pandemic with incoming Trump aides. But in his second year as president, Trump fired his top official in charge of pandemic response, Tom Bossert, and did not replace him. Trump then allowed his national security adviser to disband the NSC's global health unit. As a result, when alerts about coronavirus began to emanate from the intelligence and public health communities, there was no senior official in the White House to coordinate a response.
  • "Every administration has at some point in time gotten religion and realized there is a program and dusted it off and used it," Clarke told NBC News."Except this one."
  • "The disease-causing microbes of the planet," wrote Garrett, "far from having been defeated, [are] posing ever greater threats to humanity."
  • The exercise predicted many of the problems besetting the coronavirus response – confused lines of authority, shortages of medical gear, controversies over social distancing.
  • They failed to set up a system that would insure the rapid deployment of tests for a novel virus. And they failed to replenish a federal stockpile that hospital officials say is both insufficiently stocked and rife with defective gear.
  • Those failures — and the late start on gear purchases by the Trump administration — have severely hampered the U.S. response to coronavirus, said Scott Gottlieb, who ran the FDA from 2017 to 2019.
  • "In no way, shape or form can anyone say that we weren't warned, that the information wasn't available and shared with them," he said. "We've known about the risk of pandemics, and war gamed them literally going back some 30 years."
Javier E

The nation's public health agencies are ailing when they're needed most - The Washingto... - 0 views

  • At the very moment the United States needed its public health infrastructure the most, many local health departments had all but crumbled, proving ill-equipped to carry out basic functions let alone serve as the last line of defense against the most acute threat to the nation’s health in generations.
  • Epidemiologists, academics and local health officials across the country say the nation’s public health system is one of many weaknesses that continue to leave the United States poorly prepared to handle the coronavirus pandemic
  • That system lacks financial resources. It is losing staff by the day.
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  • Even before the pandemic struck, local public health agencies had lost almost a quarter of their overall workforce since 2008 — a reduction of almost 60,000 workers
  • The agencies’ main source of federal funding — the Centers for Disease Control and Prevention’s emergency preparedness budget — had been cut 30 percent since 2003. The Trump administration had proposed slicing even deeper.
  • According to David Himmelstein of the CUNY School of Public Health, global consensus is that, at minimum, 6 percent of a nation’s health spending should be devoted to public health efforts. The United States, he said, has never spent more than half that much.
  • the problems have been left to fester.
  • Delaware County, Pa., a heavily populated Philadelphia suburb, did not even have a public health department when the pandemic struck and had to rely on a neighbor to mount a response.
  • With plunging tax receipts straining local government budgets, public health agencies confront the possibility of further cuts in an economy gutted by the coronavirus. It is happening at a time when health departments are being asked to do more than ever.
  • While the country spends roughly $3.6 trillion every year on health, less than 3 percent of that spending goes to public health and prevention
  • “Why an ongoing government function should depend on episodic grants rather than consistent funding, I don’t know,” he added. “That would be like seeing that the military is going to apply for a grant for its regular ongoing activities.”
  • Compared with Canada, the United Kingdom and northern European countries, the United States — with a less generous social safety net and no universal health care — is investing less in a system that its people rely on more.
  • Himmelstein said that the United States has never placed much emphasis on public health spending but that the investment began to decline even further in the early 2000s. The Great Recession fueled further cuts.
  • Plus, the U.S. public health system relies heavily on federal grants.
  • “That’s the way we run much of our public health activity for local health departments. You apply to the CDC, which is the major conduit for federal funding to state and local health departments,” Himmelstein said. “You apply to them for funding for particular functions, and if you don’t get the grant, you don’t have the funding for that.”
  • Many public health officials say a lack of a national message and approach to the pandemic has undermined their credibility and opened them up to criticism.
  • Few places were less prepared for covid-19’s arrival than Delaware County, Pa., where Republican leaders had decided they did not need a public health department at all
  • At the same time, many countries that invest more in public health infrastructure also provide universal medical coverage that enables them to provide many common public health services as part of their main health-care-delivery system.
  • Taylor and other elected officials worked out a deal with neighboring Chester County in which Delaware County paid affluent Chester County’s health department to handle coronavirus operations for both counties for now.
  • One reason health departments are so often neglected is their work focuses on prevention — of outbreaks, sexually transmitted diseases, smoking-related illnesses. Local health departments describe a frustrating cycle: The more successful they are, the less visible problems are and the less funding they receive. Often, that sets the stage for problems to explode again — as infectious diseases often do.
  • It has taken years for many agencies to rebuild budgets and staffing from deep cuts made during the last recessio
  • During the past decade, many local health departments have seen annual rounds of cuts, punctuated with one-time infusions of money following crises such as outbreaks of Zika, Ebola, measles and hepatitis. The problem with that cycle of feast or famine funding is that the short-term money quickly dries up and does nothing to address long-term preparedness.
  • “It’s a silly strategic approach when you think about what’s needed to protect us long term,”
  • She compared the country’s public health system to a house with deep cracks in the foundation. The emergency surges of funding are superficial repairs that leave those cracks unaddressed.
  • “We came into this pandemic at a severe deficit and are still without a strategic goal to build back that infrastructure. We need to learn from our mistakes,”
  • With the economy tanking, the tax bases for cities and counties have shrunken dramatically — payroll taxes, sales taxes, city taxes. Many departments have started cutting staff. Federal grants are no sure thing.
  • 80 percent of counties have reported their budget was affected in the current fiscal year because of the crisis. Prospects are even more dire for future budget periods, when the full impact of reduced tax revenue will become evident.
  • Christine Hahn, medical director for Idaho’s division of public health and a 25-year public health veteran, has seen the state make progress in coronavirus testing and awareness. But like so many public health officials across the country taking local steps to deal with what has become a national problem, she is limited by how much government leaders say she can do and by what citizens are willing to do.
  • “I’ve been through SARS, the 2009 pandemic, the anthrax attacks, and of course I’m in rural Idaho, not New York City and California,” Hahn said. “But I will say this is way beyond anything I’ve ever experienced as far as stress, workload, complexity, frustration, media and public interest, individual citizens really feeling very strongly about what we’re doing and not doing.”
  • “I think the general population didn’t really realize we didn’t have a health department. They just kind of assumed that was one of those government agencies we had,” Taylor said. “Then the pandemic hit, and everyone was like, ‘Wait, hold on — we don’t have a health department? Why don’t we have a health department?’ ”
  • “People locally are looking to see what’s happening in other states, and we’re constantly having to talk about that and address that,”
  • “I’m mindful of the credibility of our messaging as people say, ‘What about what they’re doing in this place? Why are we not doing what they’re doing?’ ”
  • Many health experts worry the challenges will multiply in the fall with the arrival of flu season.
  • “The unfolding tragedy here is we need people to see local public health officials as heroes in the same way that we laud heart surgeons and emergency room doctors,” Westergaard, the Wisconsin epidemiologist, said. “The work keeps getting higher, and they’re falling behind — and not feeling appreciated by their communities.”
katherineharron

Opinion: Whoever wins in November is going to have to solve the Covid-19 crisis - CNN - 0 views

  • Despite the deep divisions ravaging our country ahead of the presidential elections, many Americans are looking for answers to a common threat -- the coronavirus. As the daily number of cases and deaths have risen, we remain in the throes of a pandemic that has killed more than 225,000 of our fellow citizens and torpedoed our economy. Indeed, the US is averaging more than 68,000 new cases a day.
  • the next president will confront a dual challenge: managing the current pandemic and ensuring that the country and the world are better prepared when the next plague strikes -- as it inevitably will.
  • Nothing has undercut the US response to Covid-19 more than the failure to develop -- to this day -- a comprehensive nationwide system of testing and tracing that allows public health authorities to rapidly identify infected individuals and their contacts in order to isolate the sick from healthy populations.
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  • It is past time for the nation to make the investments we need to prevent, detect and respond quickly to emerging infectious diseases, like the coronavirus, before they sicken Americans and force catastrophic economic shutdowns.
  • authorities are too often flying blind, uncertain of the trajectory of the disease, slow to identify hot spots and unable to stop the spread of the virus through targeted measures that do not require shutting down entire communities and economies.
  • The success of public health measures like contact tracing, mask-wearing, and social distancing depends on individuals and communities trusting and adhering to advice from medical professionals and scientists, sometimes delivered by elected and other officials
  • That public trust must be earned and sustained.
  • Elected US officials, including the President, often have fallen short as communicators in this pandemic.
  • The pandemic has taken a grievous toll on the elderly and nursing home residents specifically. It has also hit essential workers hard, and Black, Latino, Native and low-income Americans suffer disproportionately. As of the end of September, according to the Atlantic, Black Americans have died from Covid-19 at 2.3 times the rate of White Americans, comprising 21% of all US deaths from the disease
  • US government authorities at all levels should target public health investments to increase the resilience of these communities, including universal paid sick leave in declared pandemics, accessible and free testing, and workplace protections and personal protective equipment for essential workers. Social justice and equity in our existing health care system is not just a moral mandate -- it is a matter of basic pandemic preparedness.
  • The smarter choice is to reform and strengthen the WHO as an essential cornerstone of global pandemic preparedness
  • The coronavirus demonstrates that an international framework for pandemic detection and response that relies so heavily on the transparency, judgment and discretion of individual national governments leaves too many opportunities for failure.
  • Alerts from that network should, in turn, notify national public health agencies and the WHO -- and trigger an international response.
  • Finally, the next president must resist the siren song of vaccine nationalism
  • So far, the US has chosen not to join COVAX, a groundbreaking consortium of more than 150 countries created not only to develop a vaccine but to ensure that when one emerges it is shared equitably, rather than hoarded by individual countries. We hope that the next president -- whoever he may be -- will reconsider this decision.
  • When it comes to pandemics, we all sink or swim together,
Javier E

How Coronavirus Overpowered the World Health Organization - WSJ - 1 views

  • The WHO spent years and hundreds of millions of dollars honing a globe-spanning system of defenses against a pandemic it knew would come. But the virus moved faster than the United Nations agency, exposing flaws in its design and operation that bogged down its response when the world needed to take action.
  • The WHO relied on an honor system to stop a viral cataclysm. Its member states had agreed to improve their ability to contain infectious disease epidemics and to report any outbreaks that might spread beyond their borders. International law requires them to do both.
  • Time and again, countries big and small have failed to do so. The WHO, which isn’t a regulatory agency, lacks the authority to force information from the very governments that finance its programs and elect its leaders
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  • years of painstakingly worded treaties, high-level visits and cutting-edge disease surveillance—all meant to encourage good-faith cooperation—have only bitten around the edges of the problem.
  • “It can’t demand entry into a country because they think something bad is happening.”
  • Nearly 200 countries were counting on an agency whose budget—roughly $2.4 billion in 2020—is less than a sixth of the Maryland Department of Health’s. Its donors, largely Western governments, earmark most of that money for causes other than pandemic preparedness.
  • In 2018 and 2019, about 8% of the WHO’s budget went to activities related to pandemic preparedness
  • It took those experts more than four months to agree that widespread mask-wearing helps, and that people who are talking, shouting or singing can expel the virus through tiny particles that linger in the air. In that time, about half a million people died.
  • To write its recommendations, the WHO solicits outside experts, which can be a slow process.
  • the agency’s bureaucratic structure, diplomatic protocol and funding were no match for a pandemic as widespread and fast-moving as Covid-19.
  • As months rolled on, it became clear that governments were reluctant to allow the U.N. to scold, shame or investigate them.
  • In particular, The Wall Street Journal found:
  • * China appears to have violated international law requiring governments to swiftly inform the WHO and keep it in the loop about an alarming infectious-disease cluster
  • —there are no clear consequences for violations
  • * The WHO lost a critical week waiting for an advisory panel to recommend a global public-health emergency, because some of its members were overly hopeful that the new disease wasn’t easily transmissible from one person to another.
  • * The institution overestimated how prepared some wealthy countries were, while focusing on developing countries, where much of its ordinary assistance is directed
  • Public-health leaders say the WHO plays a critical role in global health, leading responses to epidemics and setting health policies and standards for the world. It coordinates a multinational effort every year to pick the exact strains that go into the seasonal flu vaccine, and has provided public guidance and advice on Covid-19 when many governments were silent.
  • The world’s public-health agency was born weak, created in 1948 over U.S. and U.K. reluctance. For decades, it was legally barred from responding to diseases that it learned about from the news. Countries were required to report outbreaks of only four diseases to the WHO: yellow fever, plague, cholera and smallpox, which was eradicated in 1980.
  • SARS convinced governments to retool the WHO. The next year, delegates arrived in the Geneva palace where the League of Nations once met to resolve a centuries-old paradox: Countries don’t report outbreaks, because they fear—correctly—their neighbors will respond by blocking travel and trade.
  • Nearly three times that amount was budgeted for eradicating polio, a top priority for the WHO’s two largest contributors: the U.S. and the Bill & Melinda Gates Foundation.
  • “Everybody pushed back. No sovereign country wants to have this.”
  • China wanted an exemption from immediately reporting SARS outbreaks. The U.S. argued it couldn’t compel its 50 states to cooperate with the treaty. Iran blocked American proposals to make the WHO focus on bioterrorism. Cuba had an hourslong list of objections.
  • Around 3:15 a.m. on the last day, exhausted delegates ran out of time. The treaty they approved, called the International Health Regulations, imagined that each country would quickly and honestly report, then contain, any alarming outbreaks
  • In return, the treaty discouraged restrictions on travel and trade. There would be no consequences for reporting an outbreak—yet no way to punish a country for hiding one.
  • The treaty’s key chokepoint: Before declaring a “public health emergency of international concern,” or PHEIC, the WHO’s director-general would consult a multinational emergency committee and give the country in question a chance to argue against such a declaration.
  • Delegates agreed this could give some future virus a head start but decided it was more important to discourage the WHO from making any unilateral announcements that could hurt their economies.
  • Over the next few years, emergency committees struggled over how to determine whether an outbreak was a PHEIC. It took months to declare emergencies for two deadly Ebola epidemics
  • On Jan. 3, representatives of China’s National Health Commission arrived at the WHO office in Beijing. The NHC acknowledged a cluster of pneumonia cases, but didn’t confirm that the new pathogen was a coronavirus, a fact Chinese officials already knew.
  • That same day, the NHC issued an internal notice ordering laboratories to hand over or destroy testing samples and forbade anyone from publishing unauthorized research on the virus.
  • China’s failure to notify the WHO of the cluster of illnesses is a violation of the International Health Regulations
  • China also flouted the IHR by not disclosing all key information it had to the WHO
  • The WHO said it’s up to member states to decide whether a country has complied with international health law, and that the coming review will address those issues.
  • While Chinese scientists had sequenced the genome and posted it publicly, the government was less forthcoming about how patients might be catching the virus.
  • WHO scientists pored over data they did get, and consulted with experts from national health agencies, including the CDC, which has 33 staff detailed to the WHO.
  • Then a 61-year-old woman was hospitalized in Thailand on Jan. 13.
  • The next day, Dr. van Kerkhove told reporters: “It’s certainly possible that there is limited human-to-human transmission.” MERS and SARS, both coronaviruses, were transmissible among people in close quarters. Epidemiological investigations were under way, she said.
  • On Jan. 22, a committee of 15 scientists haggled for hours over Chinese data and a handful of cases in other countries. Clearly, the virus was spreading between people in China, though there was no evidence of that in other countries. The question now: Was it mainly spreading from very sick people in hospitals and homes—or more widely?
  • The committee met over two days, but was split. They mostly agreed on one point: The information from China “was a little too imprecise to very clearly state that it was time” to recommend an emergency declaration,
  • On Jan. 28, Dr. Tedros and the WHO team arrived for their meeting with Mr. Xi
  • Leaning across three wooden coffee tables, Dr. Tedros pressed for cooperation. In the absence of information, countries might react out of fear and restrict travel to China, he repeated several times throughout the trip. Mr. Xi agreed to allow a WHO-led international team of experts to visit. It took until mid-February to make arrangements and get the team there.
  • China also agreed to provide more data, and Dr. Tedros departed, leaving Dr. Briand behind with a list of mysteries to solve. How contagious was the virus? How much were children or pregnant women at risk? How were cases linked? This was vital information needed to assess the global risk, Dr. Briand said
  • Back in Geneva, Dr. Tedros reconvened the emergency committee. By now it was clear there was human-to-human transmission in other countries. When it met on Jan. 30, the committee got the information the WHO had been seeking. This time the committee recommended and Dr. Tedros declared a global public-health emergency.
  • President Trump and New York Gov. Andrew Cuomo both assured constituents their health systems would perform well. The U.K.’s chief medical officer described the WHO’s advice as largely directed at poor and middle-income countries. As for keeping borders open, by then many governments had already closed them to visitors from China.
  • The WHO shifted focus to the developing world, where it believed Covid-19 would exact the heaviest toll. To its surprise, cases shot up just across the border, in northern Italy.
  • the WHO’s health emergencies unit should report to the director-general and not member states, and its budget should be protected so it doesn’t have to compete with other programs for money.
  • If there were one thing the WHO might have done differently, it would be to offer wealthier countries the type of assistance with public-health interventions that the WHO provides the developing world
  • the WHO’s warning system of declaring a global public-health emergency needs to change. Some want to see a warning system more like a traffic light—with color-coded alarms for outbreaks, based on how worried the public should be
  • Emergency committees need clearer criteria for declaring a global public-health emergency and should publicly explain their thinking
  • The WHO should have more powers to intervene in countries to head off a health crisis
  • Lessons learned
  • Implementing many of those ideas would require herding diplomats back for another monthslong slog of treaty revisions. If and when such talks begin, new governments will likely be in place, and political priorities will float elsewher
  • “Unfortunately, I’m very cynical about this,” he said. “We are living through cycles of panic and neglect. We’ve been through all of this before.”
Javier E

Steve Bannon: 'We're going to war in the South China Sea ... no doubt' | US news | The ... - 0 views

  • The United States and China will fight a war within the next 10 years over islands in the South China Sea, and “there’s no doubt about that”.
  • At the same time, the US will be in another “major” war in the Middle East.
  • Those are the views – nine months ago at least – of one of the most powerful men in Donald Trump’s administration, Steve Bannon,
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  • in radio shows Bannon hosted for Breitbart he makes plain the two largest threats to America: China and Islam.
  • Bannon’s sentiments and his position in Trump’s inner circle add to fears of a military confrontation with China, after secretary of state Rex Tillerson said that the US would deny China access to the seven artificial islands. Experts warned any blockade would lead to war.
  • “You have an expansionist Islam and you have an expansionist China. Right? They are motivated. They’re arrogant. They’re on the march. And they think the Judeo-Christian west is on the retreat,” Bannon said during a February 2016 radio show.
  • China’s military warned that war between the two countries was a real possibility. “A ‘war within the president’s term’ or ‘war breaking out tonight’ are not just slogans, they are becoming a practical reality,” an official wrote on the website of the People’s Liberation Army.
  • Bannon focused heavily on China’s oppression of Christian groups. “The one thing the Chinese fear more than America … they fear Christianity more than anything,” he said.
  • “Some of these situations may get a little unpleasant,” Bannon said in November 2015. “But you know what, we’re in a war. We’re clearly going into, I think, a major shooting war in the Middle East again.”
katyshannon

Obama seeks funds to fight Zika; sees no cause for panic | Reuters - 0 views

  • President Barack Obama will ask the U.S. Congress for more than $1.8 billion in emergency funds to fight Zika at home and abroad and pursue a vaccine, the White House said on Monday, but he added there is no reason to panic over the mosquito-borne virus.
  • Zika, spreading rapidly in South and Central America and the Caribbean, has been linked to severe birth defects in Brazil, and public health officials' concern is focused on pregnant women and women who may become pregnant.
  • Obama's request to Congress includes $200 million for research, development and commercialization of new vaccines and diagnostic tests for the virus.
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  • At least 12 groups are working to develop a vaccine.
  • European Medicines Agency (EMA), Europe's drugs regulator, said it established an expert task force to advise companies working on Zika vaccines and medicines, mirroring similar action during the two-year-long Ebola epidemic that started in December 2013 and the pandemic flu outbreak in 2009.
  • There are no vaccines or treatment for Zika and none even undergoing clinical studies. Most infected people either have no symptoms or develop mild ones like fever and skin rashes.
  • "The good news is this is not like Ebola; people don't die of Zika. A lot of people get it and don't even know that they have it," Obama told CBS News
  • Most of the money sought by Obama, who faces pressure from Republicans and some fellow Democrats to act decisively on Zika, would be spent in the United States on testing, surveillance and response in affected areas, including the creation of rapid-response teams to contain outbreak clusters.
  • Much remains unknown about Zika, including whether the virus actually causes microcephaly, a condition marked by abnormally small head size that can result in developmental problems.Brazil is investigating the potential link between Zika infections and more than 4,000 suspected cases of microcephaly. Researchers have identified evidence of Zika infection in 17 of these cases, either in the baby or in the mother, but have not confirmed that Zika can cause microcephaly. 
  • Obama's funding request to Congress includes $335 million for the U.S. Agency for International Development to support mosquito-control, maternal health and other Zika-related public health efforts in affected countries in the Americas.
  • Fauci said he anticipated beginning a so-called Phase 1 trial this summer for a Zika vaccine that would take about three months to test if it is safe and induces a good immune response before further studies can be conducted.
  • The CDC said its Zika emergency operations center, with a staff of 300, has been placed on its highest level of activation, reflecting a need for accelerated preparedness for possible local virus transmission by mosquitoes in the continental United States.
  • Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention, said she was not expecting "large-scale amounts of serious Zika infections" in the continental United States as warmer months bring larger and more active mosquito populations.
  • Word that Zika can be spread by sexual transmission and blood transfusions and its discovery in saliva and urine of infected people have added to concern over the virus.
  • The World Health Organization declared the outbreak an international health emergency on Feb. 1, citing a "strongly suspected" relationship between Zika infection in pregnancy to microcephaly.
  • Brazil is grappling with the virus even as it prepares to host the Olympic Games in Rio de Janeiro in August, with tens of thousands of athletes and tourists anticipated.The U.S. Olympic Committee has told U.S. sports federations that athletes and staff concerned about their health due to Zika should consider not going to the Olympics.
  • Former Olympian Donald Anthony, president and board chairman of USA Fencing, said, "One of the things that they immediately said was, especially for women that may be pregnant or even thinking of getting pregnant, that whether you are scheduled to go to Rio or no, that you shouldn't go."
Javier E

Lest We Forget - The Atlantic - 0 views

  • , to the extent Americans remember World War I at all, it is as a futile war, a massive, utterly senseless butchery of a damned generation. That was not the way Americans at the time conceived it. More controversially, it is an excessively simple way of conceiving it even now.
  • Like their country, the soldiers of the AEF were abundant, enthusiastic, and ill-prepared for what awaited. Having foresworn military preparedness, the Wilson administration was woefully unready to wage wa
  • Nor was the high command much to admire. General John “Black Jack” Pershing was adamantly determined to keep his forces separate and unified, even if it jeopardized the cohesion of a lin
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  • Premier Georges Clemenceau of France sourly warned him that either the French could teach the Americans about modern battle, or the Germans would. To an unnecessary degree, Pershing opted for the latter
  • Above all, it convinced many Americans that they could, and should, withdraw behind their Atlantic and Pacific moats, and look to their own interests while the world went its own wicked ways.
  • A German victory in Europe was worth fighting to stop. It would have created an imperial power bound to clash with the United States, and indeed intent on so doing. It would have bred even more wars in its wake.
  • The Versailles settlement of 1919 was flawed, but it was a remarkable achievement given the ruined world of 1918, and it could have been made to work—if the United States had displayed the statecraft that it did from 1945 to 1950
Javier E

12 Rules for Life: An Antidote to Chaos (Jordan B. Peterson) - 0 views

  • RULES? MORE RULES? REALLY? Isn’t life complicated enough, restricting enough, without abstract rules that don’t take our unique, individual situations into account? And given that our brains are plastic, and all develop differently based on our life experiences, why even expect that a few rules might be helpful to us all?
  • “I’ve got some good news…and I’ve got some bad news,” the lawgiver yells to them. “Which do you want first?” “The good news!” the hedonists reply. “I got Him from fifteen commandments down to ten!” “Hallelujah!” cries the unruly crowd. “And the bad?” “Adultery is still in.”
  • Maps of Meaning was sparked by Jordan’s agonized awareness, as a teenager growing up in the midst of the Cold War, that much of mankind seemed on the verge of blowing up the planet to defend their various identities. He felt he had to understand how it could be that people would sacrifice everything for an “identity,”
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  • the story of the golden calf also reminds us that without rules we quickly become slaves to our passions—and there’s nothing freeing about that.
  • And the story suggests something more: unchaperoned, and left to our own untutored judgment, we are quick to aim low and worship qualities that are beneath us—in this case, an artificial animal that brings out our own animal instincts in a completely unregulated way.
  • Similarly, in this book Professor Peterson doesn’t just propose his twelve rules, he tells stories, too, bringing to bear his knowledge of many fields as he illustrates and explains why the best rules do not ultimately restrict us but instead facilitate our goals and make for fuller, freer lives.
  • Peterson wasn’t really an “eccentric”; he had sufficient conventional chops, had been a Harvard professor, was a gentleman (as cowboys can be) though he did say damn and bloody a lot, in a rural 1950s sort of way. But everyone listened, with fascination on their faces, because he was in fact addressing questions of concern to everyone at the table.
  • unlike many academics who take the floor and hold it, if someone challenged or corrected him he really seemed to like it. He didn’t rear up and neigh. He’d say, in a kind of folksy way, “Yeah,” and bow his head involuntarily, wag it if he had overlooked something, laughing at himself for overgeneralizing. He appreciated being shown another side of an issue, and it became clear that thinking through a problem was, for him, a dialogic process.
  • for an egghead Peterson was extremely practical. His examples were filled with applications to everyday life: business management, how to make furniture (he made much of his own), designing a simple house, making a room beautiful (now an internet meme) or in another, specific case related to education, creating an online writing project that kept minority students from dropping out of school by getting them to do a kind of psychoanalytic exercise on themselves,
  • These Westerners were different: self-made, unentitled, hands on, neighbourly and less precious than many of their big-city peers, who increasingly spend their lives indoors, manipulating symbols on computers. This cowboy psychologist seemed to care about a thought only if it might, in some way, be helpful to someone.
  • I was drawn to him because here was a clinician who also had given himself a great books education, and who not only loved soulful Russian novels, philosophy and ancient mythology, but who also seemed to treat them as his most treasured inheritance. But he also did illuminating statistical research on personality and temperament, and had studied neuroscience. Though trained as a behaviourist, he was powerfully drawn to psychoanalysis with its focus on dreams, archetypes, the persistence of childhood conflicts in the adult, and the role of defences and rationalization in everyday life. He was also an outlier in being the only member of the research-oriented Department of Psychology at the University of Toronto who also kept a clinical practice.
  • Maps of Meaning, published nearly two decades ago, shows Jordan’s wide-ranging approach to understanding how human beings and the human brain deal with the archetypal situation that arises whenever we, in our daily lives, must face something we do not understand.
  • The brilliance of the book is in his demonstration of how rooted this situation is in evolution, our DNA, our brains and our most ancient stories. And he shows that these stories have survived because they still provide guidance in dealing with uncertainty, and the unavoidable unknown.
  • this is why many of the rules in this book, being based on Maps of Meaning, have an element of universality to them.
  • We are ambivalent about rules, even when we know they are good for us. If we are spirited souls, if we have character, rules seem restrictive, an affront to our sense of agency and our pride in working out our own lives. Why should we be judged according to another’s rule?
  • And he felt he had to understand the ideologies that drove totalitarian regimes to a variant of that same behaviour: killing their own citizens.
  • Ideologies are simple ideas, disguised as science or philosophy, that purport to explain the complexity of the world and offer remedies that will perfect it.
  • Ideologues are people who pretend they know how to “make the world a better place” before they’ve taken care of their own chaos within.
  • Ideologies are substitutes for true knowledge, and ideologues are always dangerous when they come to power, because a simple-minded I-know-it-all approach is no match for the complexity of existence.
  • To understand ideology, Jordan read extensively about not only the Soviet gulag, but also the Holocaust and the rise of Nazism. I had never before met a person, born Christian and of my generation, who was so utterly tormented by what happened in Europe to the Jews, and who had worked so hard to understand how it could have occurred.
  • I saw what now millions have seen online: a brilliant, often dazzling public speaker who was at his best riffing like a jazz artist; at times he resembled an ardent Prairie preacher (not in evangelizing, but in his passion, in his ability to tell stories that convey the life-stakes that go with believing or disbelieving various ideas). Then he’d just as easily switch to do a breathtakingly systematic summary of a series of scientific studies. He was a master at helping students become more reflective, and take themselves and their futures seriously. He taught them to respect many of the greatest books ever written. He gave vivid examples from clinical practice, was (appropriately) self-revealing, even of his own vulnerabilities, and made fascinating links between evolution, the brain and religious stories.
  • Above all, he alerted his students to topics rarely discussed in university, such as the simple fact that all the ancients, from Buddha to the biblical authors, knew what every slightly worn-out adult knows, that life is suffering.
  • chances are, if you or someone you love is not suffering now, they will be within five years, unless you are freakishly lucky. Rearing kids is hard, work is hard, aging, sickness and death are hard, and Jordan emphasized that doing all that totally on your own, without the benefit of a loving relationship, or wisdom, or the psychological insights of the greatest psychologists, only makes it harder.
  • focused on triumphant heroes. In all these triumph stories, the hero has to go into the unknown, into an unexplored territory, and deal with a new great challenge and take great risks. In the process, something of himself has to die, or be given up, so he can be reborn and meet the challenge. This requires courage, something rarely discussed in a psychology class or textbook.
  • Jordan
  • views of his first YouTube statements quickly numbered in the hundreds of thousands. But people have kept listening because what he is saying meets a deep and unarticulated need. And that is because alongside our wish to be free of rules, we all search for structure.
  • the first generation to have been so thoroughly taught two seemingly contradictory ideas about morality, simultaneously—at their schools, colleges and universities, by many in my own generation. This contradiction has left them at times disoriented and uncertain, without guidance and, more tragically, deprived of riches they don’t even know exist.
  • morality and the rules associated with it are just a matter of personal opinion or happenstance, “relative to” or “related to” a particular framework, such as one’s ethnicity, one’s upbringing, or the culture or historical…
  • The first idea or teaching is that morality is relative, at best a…
  • So, the decent thing to do—once it becomes apparent how arbitrary your, and your society’s, “moral values” are—is to show tolerance for people who think differently, and…
  • for many people one of the worst character flaws a person can have is to be “judgmental.”* And, since we don’t know right from wrong, or what is good, just about the most inappropriate thing an adult can…
  • That emphasis on tolerance is so paramount that for many people one of the worst character flaws a person can have is to be “judgmental.”* And, since we don’t know right from wrong, or what is good, just about the most inappropriate thing an…
  • And so a generation has been raised untutored in what was once called, aptly, “practical wisdom,” which guided previous generations. Millennials, often told they have received the finest education available anywhere, have actually…
  • professors, chose to devalue thousands of years of human knowledge about how to acquire virtue, dismissing it as passé, “…
  • They were so successful at it that the very word “virtue” sounds out of date, and someone using it appears…
  • The study of virtue is not quite the same as the study of morals (right and wrong, good and evil). Aristotle defined the virtues simply as the ways of behaving that are most conducive to happiness in life. Vice was…
  • Cultivating judgment about the difference between virtue and vice is the beginning of wisdom, something…
  • By contrast, our modern relativism begins by asserting that making judgments about how to live is impossible, because there is no real good, and no…
  • Thus relativism’s closest approximation to “virtue” is “tolerance.” Only tolerance will provide social cohesion between different groups, and save us from harming each other. On Facebook and other forms of social media, therefore, you signal your so-called…
  • Intolerance of others’ views (no matter how ignorant or incoherent they may be) is not simply wrong; in a world where there is no right or wrong, it is worse: it is a sign you are…
  • But it turns out that many people cannot tolerate the vacuum—the chaos—which is inherent in life, but made worse by this moral relativism; they cannot live without a moral compass,…
  • So, right alongside relativism, we find the spread of nihilism and despair, and also the opposite of moral relativism: the blind certainty offered by ideologies…
  • Dr. Norman Doidge, MD, is the author of The Brain That Changes Itself
  • so we arrive at the second teaching that millennials have been bombarded with. They sign up for a humanities course, to study the greatest books ever written. But they’re not assigned the books; instead they are given…
  • (But the idea that we can easily separate facts and values was and remains naive; to some extent, one’s values determine what one will pay…
  • For the ancients, the discovery that different people have different ideas about how, practically, to live, did not paralyze them; it deepened their understanding of humanity and led to some of the most satisfying conversations human beings have ever had, about how life might be lived.
  • Modern moral relativism has many sources. As we in the West learned more history, we understood that different epochs had different moral codes. As we travelled the seas and explored the globe, we learned of far-flung tribes on different continents whose different moral codes made sense relative to, or within the framework of, their societies. Science played a role, too, by attacking the religious view of the world, and thus undermining the religious grounds for ethics and rules. Materialist social science implied that we could divide the world into facts (which all could observe, and were objective and “real”) and values (…
  • it seems that all human beings are, by some kind of biological endowment, so ineradicably concerned with morality that we create a structure of laws and rules wherever we are. The idea that human life can be free of moral concerns is a fantasy.
  • given that we are moral animals, what must be the effect of our simplistic modern relativism upon us? It means we are hobbling ourselves by pretending to be something we are not. It is a mask, but a strange one, for it mostly deceives the one who wears it.
  • Far better to integrate the best of what we are now learning with the books human beings saw fit to preserve over millennia, and with the stories that have survived, against all odds, time’s tendency to obliterate.
  • these really are rules. And the foremost rule is that you must take responsibility for your own life. Period.
  • Jordan’s message that each individual has ultimate responsibility to bear; that if one wants to live a full life, one first sets one’s own house in order; and only then can one sensibly aim to take on bigger responsibilities.
  • if it’s uncertain that our ideals are attainable, why do we bother reaching in the first place? Because if you don’t reach for them, it is certain you will never feel that your life has meaning.
  • And perhaps because, as unfamiliar and strange as it sounds, in the deepest part of our psyche, we all want to be judged.
  • Instead of despairing about these differences in moral codes, Aristotle argued that though specific rules, laws and customs differed from place to place, what does not differ is that in all places human beings, by their nature, have a proclivity to make rules, laws and customs.
  • Freud never argued (as do some who want all culture to become one huge group therapy session) that one can live one’s entire life without ever making judgments, or without morality. In fact, his point in Civilization and Its Discontents is that civilization only arises when some restraining rules and morality are in place.
  • Aleksandr Solzhenitsyn, the great documenter of the slave-labour-camp horrors of the latter, once wrote that the “pitiful ideology” holding that “human beings are created for happiness” was an ideology “done in by the first blow of the work assigner’s cudgel.”1 In a crisis, the inevitable suffering that life entails can rapidly make a mockery of the idea that happiness is the proper pursuit of the individual. On the radio show, I suggested, instead, that a deeper meaning was required. I noted that the nature of such meaning was constantly re-presented in the great stories of the past, and that it had more to do with developing character in the face of suffering than with happiness.
  • I proposed in Maps of Meaning that the great myths and religious stories of the past, particularly those derived from an earlier, oral tradition, were moral in their intent, rather than descriptive. Thus, they did not concern themselves with what the world was, as a scientist might have it, but with how a human being should act.
  • I suggested that our ancestors portrayed the world as a stage—a drama—instead of a place of objects. I described how I had come
  • to believe that the constituent elements of the world as drama were order and chaos, and not material things.
  • Order is where the people around you act according to well-understood social norms, and remain predictable and cooperative. It’s the world of social structure, explored territory, and familiarity. The state of Order is typically portrayed, symbolically—imaginatively—as masculine.
  • Chaos, by contrast, is where—or when—something unexpected happens.
  • As the antithesis of symbolically masculine order, it’s presented imaginatively as feminine. It’s the new and unpredictable suddenly emerging in the midst of the commonplace familiar. It’s Creation and Destruction,
  • Order is the white, masculine serpent; Chaos, its black, feminine counterpart. The black dot in the white—and the white in the black—indicate the possibility of transformation: just when things seem secure, the unknown can loom, unexpectedly and large. Conversely, just when everything seems lost, new order can emerge from catastrophe and chaos.
  • For the Taoists, meaning is to be found on the border between the ever-entwined pair. To walk that border is to stay on the path of life, the divine Way. And that’s much better than happiness.
  • trying to address a perplexing problem: the reason or reasons for the nuclear standoff of the Cold War. I couldn’t understand how belief systems could be so important to people that they were willing to risk the destruction of the world to protect them. I came to realize that shared belief systems made people intelligible to one another—and that the systems weren’t just about belief.
  • People who live by the same code are rendered mutually predictable to one another. They act in keeping with each other’s expectations and desires. They can cooperate. They can even compete peacefully, because everyone knows what to expect from everyone else.
  • Shared beliefs simplify the world, as well, because people who know what to expect from one another can act together to tame the world. There is perhaps nothing more important than the maintenance of this organization—this simplification. If it’s threatened, the great ship of state rocks.
  • It isn’t precisely that people will fight for what they believe. They will fight, instead, to maintain the match between what they believe, what they expect, and what they desire. They will fight to maintain the match between what they expect and how everyone is acting. It is precisely the maintenance of that match that enables everyone
  • There’s more to it, too. A shared cultural system stabilizes human interaction, but is also a system of value—a hierarchy of value, where some things are given priority and importance and others are not. In the absence of such a system of value, people simply cannot act. In fact, they can’t even perceive, because both action and perception require a goal, and a valid goal is, by necessity, something valued.
  • We experience much of our positive emotion in relation to goals. We are not happy, technically speaking, unless we see ourselves progressing—and the very idea of progression implies value.
  • Worse yet is the fact that the meaning of life without positive value is not simply neutral. Because we are vulnerable and mortal, pain and anxiety are an integral part of human existence. We must have something to set against the suffering that is intrinsic to Being.*2 We must have the meaning inherent in a profound system of value or the horror of existence rapidly becomes paramount. Then, nihilism beckons, with its hopelessness and despair.
  • So: no value, no meaning. Between value systems, however, there is the possibility of conflict. We are thus eternally caught between the most diamantine rock and the hardest of places:
  • loss of group-centred belief renders life chaotic, miserable, intolerable; presence of group-centred belief makes conflict with other groups inevitable.
  • In the West, we have been withdrawing from our tradition-, religion- and even nation-centred cultures, partly to decrease the danger of group conflict. But we are increasingly falling prey to the desperation of meaninglessness, and that is no improvement at all.
  • While writing Maps of Meaning, I was (also) driven by the realization that we can no longer afford conflict—certainly not on the scale of the world conflagrations of the twentieth century.
  • I came to a more complete, personal realization of what the great stories of the past continually insist upon: the centre is occupied by the individual.
  • It is possible to transcend slavish adherence to the group and its doctrines and, simultaneously, to avoid the pitfalls of its opposite extreme, nihilism. It is possible, instead, to find sufficient meaning in individual consciousness and experience.
  • How could the world be freed from the terrible dilemma of conflict, on the one hand, and psychological and social dissolution, on the other? The answer was this: through the elevation and development of the individual, and through the willingness of everyone to shoulder the burden of Being and to take the heroic path. We must each adopt as much responsibility as possible for individual life, society and the world.
  • We must each tell the truth and repair what is in disrepair and break down and recreate what is old and outdated. It is in this manner that we can and must reduce the suffering that poisons the world. It’s asking a lot. It’s asking for everything.
  • the alternative—the horror of authoritarian belief, the chaos of the collapsed state, the tragic catastrophe of the unbridled natural world, the existential angst and weakness of the purposeless
  • individual—is clearly worse.
  • a title: 12 Rules for Life: An Antidote to Chaos. Why did that one rise up above all others? First and foremost, because of its simplicity. It indicates clearly that people need ordering principles, and that chaos otherwise beckons.
  • We require rules, standards, values—alone and together. We’re pack animals, beasts of burden. We must bear a load, to justify our miserable existence. We require routine and tradition. That’s order. Order can become excessive, and that’s not good, but chaos can swamp us, so we drown—and that is also not good. We need to stay on the straight and narrow path.
  • I hope that these rules and their accompanying essays will help people understand what they already know: that the soul of the individual eternally hungers for the heroism of genuine Being, and that the willingness to take on that responsibility is identical to the decision to live a meaningful life.
  • RULE 1   STAND UP STRAIGHT WITH YOUR SHOULDERS BACK
  • Because territory matters, and because the best locales are always in short supply, territory-seeking among animals produces conflict. Conflict, in turn, produces another problem: how to win or lose without the disagreeing parties incurring too great a cost.
  • It’s winner-take-all in the lobster world, just as it is in human societies, where the top 1 percent have as much loot as the bottom 50 percent11—and where the richest eighty-five people have as much as the bottom three and a half billion.
  • This principle is sometimes known as Price’s law, after Derek J. de Solla Price,13 the researcher who discovered its application in science in 1963. It can be modelled using an approximately L-shaped graph, with number of people on the vertical axis, and productivity or resources on the horizontal.
  • Instead of undertaking the computationally difficult task of identifying the best man, the females outsource the problem to the machine-like calculations of the dominance hierarchy. They let the males fight it out and peel their paramours from the top.
  • The dominant male, with his upright and confident posture, not only gets the prime real estate and easiest access to the best hunting grounds. He also gets all the girls. It is exponentially more worthwhile to be successful, if you are a lobster, and male.
  • dominance hierarchies have been an essentially permanent feature of the environment to which all complex life has adapted. A third of a billion years ago, brains and nervous systems were comparatively simple. Nonetheless, they already had the structure and neurochemistry necessary to process information about status and society. The importance of this fact can hardly be overstated.
  • evolution works, in large part, through variation and natural selection. Variation exists for many reasons, including gene-shuffling (to put it simply) and random mutation. Individuals vary within a species for such reasons. Nature chooses from among them, across time. That theory, as stated, appears to account for the continual alteration of life-forms over the eons.
  • But there’s an additional question lurking under the surface: what exactly is the “nature” in “natural selection”? What exactly is “the environment” to which animals adapt?
  • Nature “selects.” The idea of selects contains implicitly nested within it the idea of fitness. It is “fitness” that is “selected.” Fitness, roughly speaking, is the probability that a given organism will leave offspring (will propagate its genes through time). The “fit” in “fitness” is therefore the matching of organismal attribute to environmental demand.
  • But nature, the selecting agent, is not a static selector—not in any simple sense.
  • As the environment supporting a species transforms and changes, the features that make a given individual successful in surviving and reproducing also transform and change. Thus, the theory of natural selection does not posit creatures matching themselves ever more precisely to a template specified by the world. It is more that creatures are in a dance with nature, albeit one that is deadly.
  • Nature is not simply dynamic, either. Some things change quickly, but they are nested within other things that change less quickly (music
  • It’s chaos, within order, within chaos, within higher order. The order that is most real is the order that is most unchanging—and that is not necessarily the order that is most easily seen. The leaf, when perceived, might blind the observer to the tree. The tree can blind him to the forest.
  • It is also a mistake to conceptualize nature romantically.
  • Unfortunately, “the environment” is also elephantiasis and guinea worms (don’t ask), anopheles mosquitoes and malaria, starvation-level droughts, AIDS and the Black Plague.
  • It is because of the existence of such things, of course, that we attempt to modify our surroundings, protecting our children, building cities and transportation systems and growing food and generating power.
  • this brings us to a third erroneous concept: that nature is something strictly segregated from the cultural constructs that have emerged within it.
  • It does not matter whether that feature is physical and biological, or social and cultural. All that matters, from a Darwinian perspective, is permanence—and the dominance hierarchy, however social or cultural it might appear, has been around for some half a billion years.
  • The dominance hierarchy is not capitalism. It’s not communism, either, for that matter. It’s not the military-industrial complex. It’s not the patriarchy—that disposable, malleable, arbitrary cultural artefact. It’s not even a human creation; not in the most profound sense. It is instead a near-eternal aspect of the environment, and much of what is blamed on these more ephemeral manifestations is a consequence of its unchanging existence.
  • We were struggling for position before we had skin, or hands, or lungs, or bones. There is little more natural than culture. Dominance hierarchies are older than trees.
  • The part of our brain that keeps track of our position in the dominance hierarchy is therefore exceptionally ancient and fundamental.17 It is a master control system, modulating our perceptions, values, emotions, thoughts and actions. It powerfully affects every aspect of our Being, conscious and unconscious alike.
  • The ancient part of your brain specialized for assessing dominance watches how you are treated by other people. On that evidence, it renders a determination of your value and assigns you a status. If you are judged by your peers as of little worth, the counter restricts serotonin availability. That makes you much more physically and psychologically reactive to any circumstance or event that might produce emotion, particularly if it is negative. You need that reactivity. Emergencies are common at the bottom, and you must be ready to survive. Unfortunately, that physical hyper-response, that constant alertness, burns up a lot of precious energy and physical resources.
  • It will leave you far more likely to live, or die, carelessly, for a rare opportunity at pleasure, when it manifests itself. The physical demands of emergency preparedness will wear you down in every way.21
  • If you have a high status, on the other hand, the counter’s cold, pre-reptilian mechanics assume that your niche is secure, productive
  • You can delay gratification, without forgoing it forever. You can afford to be a reliable and thoughtful citizen.
  • Sometimes, however, the counter mechanism can go wrong. Erratic habits of sleeping and eating can interfere with its function. Uncertainty can throw it for a loop. The body, with its various parts,
  • needs
  • to function like a well-rehearsed orchestra. Every system must play its role properly, and at exactly the right time, or noise and chaos ensue. It is for this reason that routine is so necessary. The acts of life we repeat every day need to be automatized. They must be turned into stable and reliable habits, so they lose their complexity and gain predictability and simplicity.
  • It is for such reasons that I always ask my clinical clients first about sleep. Do they wake up in the morning at approximately the time the typical person wakes up, and at the same time every day?
  • The next thing I ask about is breakfast. I counsel my clients to eat a fat and protein-heavy breakfast as soon as possible after they awaken (no simple carbohydrates, no sugars,
  • I have had many clients whose anxiety was reduced to subclinical levels merely because they started to sleep on a predictable schedule and eat breakfast.
  • Other bad habits can also interfere with the counter’s accuracy.
  • There are many systems of interaction between brain, body and social world that can get caught in positive feedback loops. Depressed people, for example, can start feeling useless and burdensome, as well as grief-stricken and pained. This makes them withdraw from contact with friends and family. Then the withdrawal makes them more lonesome and isolated, and more likely to feel useless and burdensome. Then they withdraw more. In this manner, depression spirals and amplifies.
  • If someone is badly hurt at some point in life—traumatized—the dominance counter can transform in a manner that makes additional hurt more rather than less likely. This often happens in the case of people, now adults, who were viciously bullied during childhood or adolescence. They become anxious and easily upset. They shield themselves with a defensive crouch, and avoid the direct eye contact interpretable as a dominance challenge.
  • With their capacity for aggression strait-jacketed within a too-narrow morality, those who are only or merely compassionate and self-sacrificing (and naïve and exploitable) cannot call forth the genuinely righteous and appropriately self-protective anger necessary to defend themselves. If you can bite, you generally don’t have to. When skillfully integrated, the ability to respond with aggression and violence decreases rather than increases the probability that actual aggression will become necessary.
  • Naive, harmless people usually guide their perceptions and actions with a few simple axioms: people are basically good; no one really wants to hurt anyone else; the threat (and, certainly, the use) of force, physical or otherwise, is wrong. These axioms collapse, or worse, in the presence of
  • individuals who are genuinely malevolent.27
  • I have had clients who were terrified into literally years of daily hysterical convulsions by the sheer look of malevolence on their attackers’ faces. Such individuals typically come from hyper-sheltered families, where nothing
  • terrible is allowed to exist, and everything is fairyland wonderful (or else).
  • When the wakening occurs—when once-naïve people recognize in themselves the seeds of evil and monstrosity, and see themselves as dangerous (at least potentially)— their fear decreases. They develop more self-respect. Then, perhaps, they begin to resist oppression. They see that they have the ability to withstand, because they are terrible too. They see they can and must stand up, because they begin to understand how genuinely monstrous they will become, otherwise,
  • There is very little difference between the capacity for mayhem and destruction, integrated, and strength of character. This is one of the most difficult lessons of life.
  • even if you came by your poor posture honestly—even if you were unpopular or bullied at home or in grade school28—it’s not necessarily appropriate now. Circumstances change. If you slump around, with the same bearing that characterizes a defeated lobster, people will assign you a lower status, and the old counter that you share with crustaceans, sitting at the very base of your brain, will assign you a low dominance number.
  • the other, far more optimistic lesson of Price’s law and the Pareto distribution: those who start to have will probably get more.
  • Some of these upwardly moving loops can occur in your own private, subjective space.
  • If you are asked to move the muscles one by one into a position that looks happy, you will report feeling happier. Emotion is partly bodily expression, and can be amplified (or dampened) by that expression.29
  • To stand up straight with your shoulders back is to accept the terrible responsibility of life, with eyes wide open.
  • It means deciding to voluntarily transform the chaos of potential into the realities of habitable order. It means adopting the burden of self-conscious vulnerability, and accepting the end of the unconscious paradise of childhood, where finitude and mortality are only dimly comprehended. It means willingly undertaking the sacrifices necessary to generate a productive and meaningful reality (it means acting to please God, in the ancient language).
  • So, attend carefully to your posture. Quit drooping and hunching around. Speak your mind. Put your desires forward, as if you had a right to them—at least the same right as others. Walk tall and gaze forthrightly ahead. Dare to be dangerous. Encourage the serotonin to flow plentifully through the neural pathways desperate for its calming influence.
  • Thus emboldened, you will embark on the voyage of your life, let your light shine, so to speak, on the heavenly hill, and pursue your rightful destiny. Then the meaning of your life may be sufficient to keep the corrupting influence of mortal despair at bay. Then you may be able to accept the terrible burden of the World, and find joy.
  • RULE 2   TREAT YOURSELF LIKE SOMEONE YOU ARE RESPONSIBLE FOR HELPING
  • People are better at filling and properly administering prescription medication to their pets than to themselves. That
  • It is difficult to conclude anything from this set of facts except that people appear to love their dogs, cats, ferrets and birds (and maybe even their lizards) more than themselves. How horrible is that? How much shame must exist, for something like that to be true? What could it be about people that makes them prefer their pets to themselves?
  • To understand Genesis 1, the Priestly story, with its insistence on speech as the fundamental creative force, it is first necessary to review a few fundamental, ancient assumptions (these are markedly different in type and intent from the assumptions of science, which are, historically speaking, quite novel).
  • those who existed during the distant time in which the foundational epics of our culture emerged were much more concerned with the actions that dictated survival (and with interpreting the world in a manner commensurate with that goal) than with anything approximating what we now understand as objective truth.
  • Before the dawn of the scientific worldview, reality was construed differently. Being was understood as a place of action, not a place of things.31 It was understood as something more akin to story or drama. That story or drama was lived, subjective experience, as it manifested itself moment to moment in the consciousness of every living person.
  • subjective pain. That’s something so real no argument can stand against it. Everyone acts as if their pain is real—ultimately, finally real. Pain matters, more than matter matters. It is for this reason, I believe, that so many of the world’s traditions regard the suffering attendant upon existence as the irreducible truth of Being.
  • In any case, that which we subjectively experience can be likened much more to a novel or a movie than to a scientific description of physical reality.
  • The Domain, Not of Matter, but of What Matters
  • the world of experience has primal constituents, as well. These are the necessary elements whose interactions define drama and fiction. One of these is chaos. Another is order. The third (as there are three) is the process that mediates between the two, which appears identical to what modern people call consciousness.
  • Chaos is the domain of ignorance itself. It’s unexplored territory. Chaos is what extends, eternally and without limit, beyond the boundaries of all states, all ideas, and all disciplines. It’s the foreigner, the stranger, the member of another gang, the rustle in the bushes in the night-time,
  • It is, in short, all those things and situations we neither know nor understand.
  • Chaos is also the formless potential from which the God of Genesis 1 called forth order using language at the beginning of time. It’s the same potential from which we, made in that Image, call forth the novel and ever-changing moments of our lives. And Chaos is freedom, dreadful freedom, too.
  • Order, by contrast, is explored territory. That’s the hundreds-of-millions-of-years-old hierarchy of place, position and authority. That’s the structure of society. It’s the structure provided by biology, too—particularly insofar as you are adapted, as you are, to the structure of society. Order is tribe, religion, hearth, home and country.
  • Order is the public façade we’re called upon to wear, the politeness of a gathering of civilized strangers, and the thin ice on which we all skate. Order is the place where the behavior of the world matches our expectations and our desires; the place where all things turn out the way we want them to.
  • But order is sometimes tyranny and stultification, as well, when the demand for certainty and uniformity and purity becomes too one-sided.
  • In order, we’re able to think about things in the long term. There, things work, and we’re stable, calm and competent. We seldom leave places we
  • understand—geographical or conceptual—for that reason, and we certainly do not like it when we are compelled to or when it happens accidentally.
  • When the same person betrays you, sells you out, you move from the daytime world of clarity and light to the dark underworld of chaos, confusion and despair. That’s the same move you make, and the same place you visit, when the company you work for starts to fail and your job is placed in doubt.
  • Before the Twin Towers fell—that was order. Chaos manifested itself afterward. Everyone felt it. The very air became uncertain. What exactly was it that fell? Wrong question. What exactly remained standing? That was the issue at hand.
  • Chaos is the deep ocean bottom to which Pinocchio voyaged to rescue his father from Monstro, whale and fire-breathing dragon. That journey into darkness and rescue is the most difficult thing a puppet must do, if he wants to be real; if he wants to extract himself from the temptations of deceit and acting and victimization and impulsive pleasure and totalitarian subjugation; if he wants to take his place as a genuine Being in the world.
  • Chaos is the new place and time that emerges when tragedy strikes suddenly, or malevolence reveals its paralyzing visage, even in the confines of your own home. Something unexpected or undesired can always make its appearance, when a plan is being laid out, regardless of how familiar the circumstances.
  • Our brains respond instantly when chaos appears, with simple, hyper-fast circuits maintained from the ancient days, when our ancestors dwelled in trees, and snakes struck in a flash.32 After that nigh-instantaneous, deeply reflexive bodily response comes the later-evolving, more complex but slower responses of emotions—and, after that, comes thinking, of the higher order, which can extend over seconds, minutes or years. All that response is instinctive, in some sense—but the faster the response, the more instinctive.
  • Things or objects are part of the objective world. They’re inanimate; spiritless. They’re dead. This is not true of chaos and order. Those are perceived, experienced and understood (to the degree that they are understood at all) as personalities—and that is just as true of the perceptions, experiences and understanding of modern people as their ancient forebears. It’s just that moderners don’t notice.
  • Perception of things as entities with personality also occurs before perception of things as things. This is particularly true of the action of others,34 living others, but we also see the non-living “objective world” as animated, with purpose and intent.
  • This is because of the operation of what psychologists have called “the hyperactive agency detector” within us.35 We evolved, over millennia, within intensely social circumstances. This means that the most significant elements of our environment of origin were personalities, not things, objects or situations.
  • The personalities we have evolved to perceive have been around, in predictable form, and in typical, hierarchical configurations, forever, for all intents and purposes. They have been…
  • the category of “parent” and/or “child” has been around for 200 million years. That’s longer than birds have existed. That’s longer than flowers have grown. It’s not a billion years, but it’s still a very long time. It’s plenty long enough for male and female and parent and child to serve as vital and fundamental parts of the environment to which we have adapted. This means that male and female and parent and child are…
  • Our brains are deeply social. Other creatures (particularly, other humans) were crucially important to us as we lived, mated and evolved. Those creatures were…
  • From a Darwinian perspective, nature—reality itself; the environment, itself—is what selects. The environment cannot be defined in any more fundamental manner. It is not mere inert matter. Reality itself is whatever we contend with when we are striving to survive and reproduce. A…
  • as our brain capacity increased and we developed curiosity to spare, we became increasingly aware of and curious about the nature of the world—what we eventually conceptualized as the objective…
  • “outside” is not merely unexplored physical territory. Outside is outside of what we currently understand—and understanding is dealing with and coping with…
  • when we first began to perceive the unknown, chaotic, non-animal world, we used categories that had originally evolved to represent the pre-human animal social world. Our minds are far older than mere…
  • Our most…
  • category—as old, in some sense, as the sexual act itself—appears to be that of sex, male and female. We appear to have taken that primordial knowledge of structured, creative opposition and…
  • Order, the known, appears symbolically associated with masculinity (as illustrated in the aforementioned yang of the Taoist yin-yang symbol). This is perhaps because the primary…
  • Chaos—the unknown—is symbolically associated with the feminine. This is partly because all the things we have come to know were born, originally, of the unknown, just as all beings we encounter were born of mothers. Chaos is mater, origin, source, mother; materia, the substance from which all things are made.
  • In its positive guise, chaos is possibility itself, the source of ideas, the mysterious realm of gestation and birth. As a negative force, it’s the impenetrable darkness of a cave and the accident by the side of the road.
  • Chaos, the eternal feminine, is also the crushing force of sexual selection.
  • Most men do not meet female human standards. It is for this reason that women on dating sites rate 85 percent of men as below average in attractiveness.40
  • Women’s proclivity to say no, more than any other force, has shaped our evolution into the creative, industrious, upright, large-brained (competitive, aggressive, domineering) creatures that we are.42 It is Nature as Woman who says, “Well, bucko, you’re good enough for a friend, but my experience of you so far has not indicated the suitability of your genetic material for continued propagation.”
  • Many things begin to fall into place when you begin to consciously understand the world in this manner. It’s as if the knowledge of your body and soul falls into alignment with the knowledge of your intellect.
  • And there’s more: such knowledge is proscriptive, as well as descriptive. This is the kind of knowing what that helps you know how. This is the kind of is from which you can derive an ought. The Taoist juxtaposition of yin and yang, for example, doesn’t simply portray chaos and order as the fundamental elements of Being—it also tells you how to act.
  • The Way, the Taoist path of life, is represented by (or exists on) the border between the twin serpents. The Way is the path of proper Being. It’s the same Way as that referred to by Christ in John 14:6: I am the way, and the truth and the life. The same idea is expressed in Matthew 7:14: Because strait is the gate, and narrow is the way, which leadeth unto life, and few there be that find it.
  • We eternally inhabit order, surrounded by chaos. We eternally occupy known territory, surrounded by the unknown. We experience meaningful engagement when we mediate appropriately between them. We are adapted, in the deepest Darwinian sense, not to the world of objects, but to the meta-realities of order and chaos, yang and yin. Chaos and order make up the eternal, transcendent environment of the living.
  • To straddle that fundamental duality is to be balanced: to have one foot firmly planted in order and security, and the other in chaos, possibility, growth and adventure.
  • Chaos and order are fundamental elements because every lived situation (even every conceivable lived situation) is made up of both.
  • you need to place one foot in what you have mastered and understood and the other in what you are currently exploring and mastering. Then you have positioned yourself where the terror of existence is under control and you are secure, but where you are also alert and engaged. That is where there is something new to master and some way that you can be improved. That is where meaning is to be found.
  • The serpent in Eden therefore means the same thing as the black dot in the yin side of the Taoist yin/yang symbol of totality—that is, the possibility of the unknown and revolutionary suddenly manifesting itself where everything appears calm.
  • The outside, chaos, always sneaks into the inside, because nothing can be completely walled off from the rest of reality. So even the ultimate in safe spaces inevitably harbours a snake.
  • We have seen the enemy, after all, and he is us. The snake inhabits each of our souls.
  • The worst of all possible snakes is the eternal human proclivity for evil. The worst of all possible snakes is psychological, spiritual, personal, internal. No walls, however tall, will keep that out. Even if the fortress were thick enough, in principle, to keep everything bad whatsoever outside, it would immediately appear again within.
  • I have learned that these old stories contain nothing superfluous. Anything accidental—anything that does not serve the plot—has long been forgotten in the telling. As the Russian playwright Anton Chekhov advised, “If there is a rifle hanging on the wall in act one, it must be fired in the next act. Otherwise it has no
  • business being there.”50
  • Eve immediately shares the fruit with Adam. That makes him self-conscious. Little has changed. Women have been making men self-conscious since the beginning of time. They do this primarily by rejecting them—but they also do it by shaming them, if men do not take responsibility. Since women bear the primary burden of reproduction, it’s no wonder. It is very hard to see how it could be otherwise. But the capacity of women to shame men and render them self-conscious is still a primal force of nature.
  • What does it mean to know yourself naked
  • Naked means vulnerable and easily damaged. Naked means subject to judgment for beauty and health. Naked means unprotected and unarmed in the jungle of nature and man. This is why Adam and Eve became ashamed, immediately after their eyes were opened. They could see—and what they first saw was themselves.
  • In their vulnerability, now fully realized, they felt unworthy to stand before God.
  • Beauty shames the ugly. Strength shames the weak. Death shames the living—and the Ideal shames us all.
  • He tells the woman that she will now bring forth children in sorrow, and desire an unworthy, sometimes resentful man, who will in consequence lord her biological fate over her, permanently. What might this mean? It could just mean that God is a patriarchal tyrant, as politically motivated interpretations of the ancient story insist. I think it’s merely descriptive.
  • women pay a high price for pregnancy and child-rearing, particularly in the early stages, and that one of the inevitable consequences is increased dependence upon the sometimes unreliable and always problematic good graces of men.
  • then God banishes the first man and the first woman from Paradise, out of infancy, out of the unconscious animal world, into the horrors of history itself. And then He puts cherubim and a flaming sword at the gate of Eden, just to stop them from eating the Fruit of the Tree of Life.
  • Perhaps Heaven is something you must build, and immortality something you must earn.
  • so we return to our original query: Why would someone buy prescription medication for his dog, and then so carefully administer it, when he would not do the same for himself?
  • Why should anyone take care of anything as naked, ugly, ashamed, frightened, worthless, cowardly, resentful, defensive and accusatory as a descendant of Adam? Even if that thing, that being, is himself?
  • We know how we are naked, and how that nakedness can be exploited—and that means we know how others are naked, and how they can be exploited. We can terrify other people, consciously. We can hurt and humiliate them for faults we understand only too well. We can torture them—literally—slowly, artfully and terribly. That’s far more than predation. That’s a qualitative shift in understanding. That’s a cataclysm as large as the development of self-consciousness itself. That’s the entry of the knowledge of Good and Evil into the world.
  • Only man could conceive of the rack, the iron maiden and the thumbscrew. Only man will inflict suffering for the sake of suffering. That is the best definition of evil I have been able to formulate.
  • with this realization we have well-nigh full legitimization of the idea, very unpopular in modern intellectual circles, of Original Sin.
  • Human beings have a great capacity for wrongdoing. It’s an attribute that is unique in the world of life. We can and do make things worse, voluntarily, with full knowledge of what we are doing (as well as accidentally, and carelessly, and in a manner that is willfully blind). Given that terrible capacity, that proclivity for malevolent actions, is it any wonder we have a hard time taking care of ourselves, or others—or even that we doubt the value of the entire human enterprise?
  • The juxtaposition of Genesis 1 with Genesis 2 & 3 (the latter two chapters outlining the fall of man, describing why our lot is so tragedy-ridden and ethically torturous) produces a narrative sequence almost unbearable in its profundity. The moral of Genesis 1 is that Being brought into existence through true speech is Good.
  • The original Man and Woman, existing in unbroken unity with their Creator, did not appear conscious (and certainly not self-conscious). Their eyes were not open. But, in their perfection, they were also less, not more, than their post-Fall counterparts. Their goodness was something bestowed, rather than deserved or earned.
  • Maybe, even in some cosmic sense (assuming that consciousness itself is a phenomenon of cosmic significance), free choice matters.
  • here’s a proposition: perhaps it is not simply the emergence of self-consciousness and the rise of our moral knowledge of Death and the Fall that besets us and makes us doubt our own worth. Perhaps it is instead our unwillingness—reflected in Adam’s shamed hiding—to walk with God, despite our fragility and propensity for evil.
  • The entire Bible is structured so that everything after the Fall—the history of Israel, the prophets, the coming of Christ—is presented as a remedy for that Fall, a way out of evil. The beginning of conscious history, the rise of the state and all its pathologies of pride and rigidity, the emergence of great moral figures who try to set things right, culminating in the Messiah Himself—that is all part of humanity’s attempt, God willing, to set itself right. And what would that mean?
  • And this is an amazing thing: the answer is already implicit in Genesis 1: to embody the Image of God—to speak out of chaos the Being that is Good—but to do so consciously, of our own free choice.
  • Back is the way forward—as T. S. Eliot so rightly insisted
  • We shall not cease from exploration And the end of all our exploring Will be to arrive where we started And know the place for the first time.
  • If we wish to take care of ourselves properly, we would have to respect ourselves—but we don’t, because we are—not least in our own eyes—fallen creatures.
  • If we lived in Truth; if we spoke the Truth—then we could walk with God once again, and respect ourselves, and others, and the world. Then we might treat ourselves like people we cared for.
  • We might strive to set the world straight. We might orient it toward Heaven, where we would want people we cared for to dwell, instead of Hell, where our resentment and hatred would eternally sentence everyone.
  • Then, the primary moral issue confronting society was control of violent, impulsive selfishness and the mindless greed and brutality that accompanies it.
  • It is easy to believe that people are arrogant, and egotistical, and always looking out for themselves. The cynicism that makes that opinion a universal truism is widespread and fashionable.
  • But such an orientation to the world is not at all characteristic of many people. They have the opposite problem: they shoulder intolerable burdens of self-disgust, self-contempt, shame and self-consciousness. Thus, instead of narcissistically inflating their own importance, they don’t value themselves at all, and they don’t take care of themselves with attention and skill.
  • Christ’s archetypal death exists as an example of how to accept finitude, betrayal and tyranny heroically—how to walk with God despite the tragedy of self-conscious knowledge—and not as a directive to victimize ourselves in the service of others.
  • To sacrifice ourselves to God (to the highest good, if you like) does not mean to suffer silently and willingly when some person or organization demands more from us, consistently, than is offered in return. That means we are supporting tyranny, and allowing ourselves to be treated like slaves.
  • I learned two very important lessons from Carl Jung, the famous Swiss depth psychologist, about “doing unto others as you would have them do unto you” or “loving your neighbour as yourself.”
  • The first lesson was that neither of these statements has anything to do with being nice. The second was that both are equations, rather than injunctions.
  • If I am someone’s friend, family member, or lover, then I am morally obliged to bargain as hard on my own behalf as they are on theirs.
  • there is little difference between standing up and speaking for yourself, when you are being bullied or otherwise tormented and enslaved, and standing up and speaking for someone else.
  • you do not simply belong to yourself. You are not simply your own possession to torture and mistreat. This is partly because your Being is inexorably tied up with that of others, and your mistreatment of yourself can have catastrophic consequences for others.
  • metaphorically speaking, there is also this: you have a spark of the divine in you, which belongs not to you, but to God. We are, after all—according to Genesis—made in His image.
  • We can make order from chaos—and vice versa—in our way, with our words. So, we may not exactly be God, but we’re not exactly nothing, either.
  • In my own periods of darkness, in the underworld of the soul, I find myself frequently overcome and amazed by the ability of people to befriend each other, to love their intimate partners and parents and children, and to do what they must do to keep the machinery of the world running.
  • It is this sympathy that should be the proper medicament for self-conscious self-contempt, which has its justification, but is only half the full and proper story. Hatred for self and mankind must be balanced with gratefulness for tradition and the state and astonishment at what normal, everyday people accomplish
  • You have some vital role to play in the unfolding destiny of the world. You are, therefore, morally obliged to take care of yourself.
  • To treat yourself as if you were someone you are responsible for helping is, instead, to consider what would be truly good for you. This is not “what you want.” It is also not “what would make you happy.”
  • You must help a child become a virtuous, responsible, awake being, capable of full reciprocity—able to take care of himself and others, and to thrive while doing so. Why would you think it acceptable to do anything less for yourself?
  • You need to know who you are, so that you understand your armament and bolster yourself in respect to your limitations. You need to know where you are going, so that you can limit the extent of chaos in your life, restructure order, and bring the divine force of Hope to bear on the world.
  • You need to determine how to act toward yourself so that you are most likely to become and to stay a good person.
  • Don’t underestimate the power of vision and direction. These are irresistible forces, able to transform what might appear to be unconquerable obstacles into traversable pathways and expanding opportunities.
  • Once having understood Hell, researched it, so to speak—particularly your
  • own individual Hell—you could decide against going there or creating that.
  • You could, in fact, devote your life to this. That would give you a Meaning, with a capital M. That would justify your miserable existence.
  • That would atone for your sinful nature, and replace your shame and self-consciousness with the natural pride and forthright confidence of someone who has learned once again to walk with God in the Garden.
  • RULE 3   MAKE FRIENDS WITH PEOPLE WHO WANT THE BEST FOR YOU
  • It would be more romantic, I suppose, to suggest that we would have all jumped at the chance for something more productive, bored out of our skulls as we were. But it’s not true. We were all too prematurely cynical and world-weary and leery of responsibility to stick to the debating clubs and Air Cadets and school sports that the adults around us tried to organize. Doing anything wasn’t cool.
  • When you move, everything is up in the air, at least for a while. It’s stressful, but in the chaos there are new possibilities. People, including you, can’t hem you in with their old notions. You get shaken out of your ruts. You can make new, better ruts, with people aiming at better things. I thought this was just a natural development. I thought that every person who moved would have—and want—the same phoenix-like experience.
  • What was it that made Chris and Carl and Ed unable (or, worse, perhaps, unwilling) to move or to change their friendships and improve the circumstances of their lives? Was it inevitable—a consequence of their own limitations, nascent illnesses and traumas of the past?
  • Why did he—like his cousin, like my other friends—continually choose people who, and places that, were not good for him?
  • perhaps, they don’t want the trouble of better. Freud called this a “repetition compulsion.” He thought of it as an unconscious drive to repeat the horrors of the past
  • People create their worlds with the tools they have directly at hand. Faulty tools produce faulty results. Repeated use of the same faulty tools produces the same faulty results.
  • It is in this manner that those who fail to learn from the past doom themselves to repeat it. It’s partly fate. It’s partly inability. It’s partly…unwillingness to learn? Refusal to learn? Motivated refusal to learn?
  • People choose friends who aren’t good for them for other reasons, too. Sometimes it’s because they want to rescue someone.
  • it is not easy to distinguish between someone truly wanting and needing help and someone who is merely exploiting a willing helper. The distinction is difficult even for the person who is wanting and needing and possibly exploiting.
  • When it’s not just naïveté, the attempt to rescue someone is often fuelled by vanity and narcissism.
  • But Christ himself, you might object, befriended tax-collectors and prostitutes. How dare I cast aspersions on the motives of those who are trying to help? But Christ was the archetypal perfect man. And you’re you.
  • How do you know that your attempts to pull someone up won’t instead bring them—or you—further down?
  • The same thing happens when well-meaning counsellors place a delinquent teen among comparatively civilized peers. The delinquency spreads, not the stability.65 Down is a lot easier than up.
  • maybe you’re saving someone because you want to convince yourself that the strength of your character is more than just a side effect of your luck and birthplace. Or maybe it’s because it’s easier to look virtuous when standing alongside someone utterly irresponsible.
  • Or maybe you have no plan, genuine or otherwise, to rescue anybody. You’re associating with people who are bad for you not because it’s better for anyone, but because it’s easier.
  • You know it. Your friends know it. You’re all bound by an implicit contract—one aimed at nihilism, and failure, and suffering of the stupidest sort.
  • Before you help someone, you should find out why that person is in trouble. You shouldn’t merely assume that he or she is a noble victim of unjust circumstances and exploitation. It’s the most unlikely explanation, not the most probable.
  • Besides, if you buy the story that everything terrible just happened on its own, with no personal responsibility on the part of the victim, you deny that person all agency in the past (and, by implication, in the present and future, as well).
  • It is far more likely that a given individual has just decided to reject the path upward, because of its difficulty. Perhaps that should even be your default assumption, when faced with such a situation.
  • failure is easy to understand. No explanation for its existence is required. In the same manner, fear, hatred, addiction, promiscuity, betrayal and deception require no explanation. It’s not the existence of vice, or the indulgence in it, that requires explanation. Vice is easy.
  • Failure is easy, too. It’s easier not to shoulder a burden. It’s easier not to think, and not to do, and not to care. It’s easier to put off until tomorrow what needs to be done today,
  • Success: that’s the mystery. Virtue: that’s what’s inexplicable. To fail, you merely have to cultivate a few bad habits. You just have to bide your time. And once someone has spent enough time cultivating bad habits and biding their time, they are much diminished.
  • I am not saying that there is no hope of redemption. But it is much harder to extract someone
  • from a chasm than to lift him from a ditch. And some chasms are very deep. And there’s not much left of the body at the bottom.
  • Carl Rogers, the famous humanistic psychologist, believed it was impossible to start a therapeutic relationship if the person seeking help did not want to improve.67 Rogers believed it was impossible to convince someone to change for the better. The
  • none of this is a justification for abandoning those in real need to pursue your narrow, blind ambition, in case it has to be said.
  • Here’s something to consider: If you have a friend whose friendship you wouldn’t recommend to your sister, or your father, or your son, why would you have such a friend for yourself?
  • You are not morally obliged to support someone who is making the world a worse place. Quite the opposite. You should choose people who want things to be better, not worse. It’s a good thing, not a selfish thing, to choose people who are good for you.
  • It is for this reason that every good example is a fateful challenge, and every hero, a judge. Michelangelo’s great perfect marble David cries out to its observer: “You could be more than you are.”
  • Don’t think that it is easier to surround yourself with good healthy people than with bad unhealthy people. It’s not. A good, healthy person is an ideal. It requires strength and daring to stand up near such a person.
  • RULE 4   COMPARE YOURSELF TO WHO YOU WERE YESTERDAY, NOT TO WHO SOMEONE ELSE IS TODAY
  • IT WAS EASIER FOR PEOPLE to be good at something when more of us lived in small, rural communities. Someone could be homecoming queen. Someone else could be spelling-bee champ, math whiz or basketball star. There were only one or two mechanics and a couple of teachers. In each of their domains, these local heroes had the opportunity to enjoy the serotonin-fuelled confidence of the victor.
  • Our hierarchies of accomplishment are now dizzyingly vertical.
  • No matter how good you are at something, or how you rank your accomplishments, there is someone out there who makes you look incompetent.
  • We are not equal in ability or outcome, and never will be. A very small number of people produce very much of everything.
  • People are unhappy at the bottom. They get sick there, and remain unknown and unloved. They waste their lives there. They die there. In consequence, the self-denigrating voice in the minds of people weaves a devastating tale. Life is a zero-sum game. Worthlessness is the default condition.
  • It is for such reasons that a whole generation of social psychologists recommended “positive illusions” as the only reliable route to mental health.69 Their credo? Let a lie be your umbrella. A more dismal, wretched, pessimistic philosophy can hardly be imagined:
  • Here is an alternative approach (and one that requires no illusions). If the cards are always stacked against you, perhaps the game you are playing is somehow rigged (perhaps by you, unbeknownst to yourself). If the internal voice makes you doubt the value of your endeavours—or your life, or life itself—perhaps you should stop listening.
  • There will always be people better than you—that’s a cliché of nihilism, like the phrase, In a million years, who’s going to know the difference? The proper response to that statement is not, Well, then, everything is meaningless. It’s, Any idiot can choose a frame of time within which nothing matters.
  • Standards of better or worse are not illusory or unnecessary. If you hadn’t decided that what you are doing right now was better than the alternatives, you wouldn’t be doing it. The idea of a value-free choice is a contradiction in terms. Value judgments are a precondition for action.
  • Furthermore, every activity, once chosen, comes with its own internal standards of accomplishment. If something can be done at all, it can be done better or worse. To do anything at all is therefore to play a game with a defined and valued end, which can always be reached more or less efficiently and elegantly.
  • We might start by considering the all-too-black-and-white words themselves: “success” or “failure.” You are either a success, a comprehensive, singular, over-all good thing, or its opposite, a failure, a comprehensive, singular, irredeemably bad thing.
  • There are vital degrees and gradations of value obliterated by this binary system, and the consequences are not good.
  • there is not just one game at which to succeed or fail. There are many games and, more specifically, many good games—
  • if changing games does not work, you can invent a new one. I
  • and athletic pursuits. You might consider judging your success across all the games you play.
  • When we are very young we are neither individual nor informed. We have not had the time nor gained the wisdom to develop our own standards. In consequence, we must compare ourselves to others, because standards are necessary.
  • As we mature we become, by contrast, increasingly individual and unique. The conditions of our lives become more and more personal and less and less comparable with those of others. Symbolically speaking, this means we must leave the house ruled by our father, and confront the chaos of our individual Being.
  • We must then rediscover the values of our culture—veiled from us by our ignorance, hidden in the dusty treasure-trove of the past—rescue them, and integrate them into our own lives. This is what gives existence its full and necessary meaning.
  • What is it that you actually love? What is it that you genuinely want? Before you can articulate your own standards of value, you must see yourself as a stranger—and then you must get to know yourself. What
  • Dare to be truthful. Dare to articulate yourself, and express (or at least become aware of) what would really justify your life.
  • Consult your resentment. It’s a revelatory emotion, for all its pathology. It’s part of an evil triad: arrogance, deceit, and resentment. Nothing causes more harm than this underworld Trinity. But resentment always means one of two things. Either the resentful person is immature, in which case he or she should shut up, quit whining, and get on with it, or there is tyranny afoot—in which case the person subjugated has a moral obligation to speak up.
  • Be cautious when you’re comparing yourself to others. You’re a singular being, once you’re an adult. You have your own particular, specific problems—financial, intimate, psychological, and otherwise.
  • Those are embedded in the unique broader context of your existence. Your career or job works for you in a personal manner, or it does not, and it does so in a unique interplay with the other specifics of your life.
  • We must see, but to see, we must aim, so we are always aiming. Our minds are built on the hunting-and-gathering platforms of our bodies. To hunt is to specify a target, track it, and throw at it.
  • We live within a framework that defines the present as eternally lacking and the future as eternally better. If we did not see things this way, we would not act at all. We wouldn’t even be able to see, because to see we must focus, and to focus we must pick one thing above all else on which to focus.
  • The disadvantage to all this foresight and creativity is chronic unease and discomfort. Because we always contrast what is with what could be, we have to aim at what could be.
  • The present is eternally flawed. But where you start might not be as important as the direction you are heading. Perhaps happiness is always to be found in the journey uphill, and not in the fleeting sense of satisfaction awaiting at the next peak.
  • Called upon properly, the internal critic will suggest something to set in order, which you could set in order, which you would set in order—voluntarily, without resentment, even with pleasure.
  • “Excuse me,” you might say to yourself, without irony or sarcasm. “I’m trying to reduce some of the unnecessary suffering around here. I could use some help.” Keep the derision at bay. “I’m wondering if there is anything that you would be willing to do? I’d be very grateful for your service.” Ask honestly and with humility. That’s no simple matter.
brookegoodman

Coronavirus vaccine: when will it be ready? | World news | The Guardian - 0 views

  • Even at their most effective – and draconian – containment strategies have only slowed the spread of the respiratory disease Covid-19. With the World Health Organization finally declaring a pandemic, all eyes have turned to the prospect of a vaccine, because only a vaccine can prevent people from getting sick.
  • This unprecedented speed is thanks in large part to early Chinese efforts to sequence the genetic material of Sars-CoV-2, the virus that causes Covid-19. China shared that sequence in early January, allowing research groups around the world to grow the live virus and study how it invades human cells and makes people sick.
  • Coronaviruses have caused two other recent epidemics – severe acute respiratory syndrome (Sars) in China in 2002-04, and Middle East respiratory syndrome (Mers), which started in Saudi Arabia in 2012. In both cases, work began on vaccines that were later shelved when the outbreaks were contained. One company, Maryland-based Novavax, has now repurposed those vaccines for Sars-CoV-2, and says it has several candidates ready to enter human trials this spring. Moderna, meanwhile, built on earlier work on the Mers virus conducted at the US National Institute of Allergy and Infectious Diseases in Bethesda, Maryland.
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  • All vaccines work according to the same basic principle. They present part or all of the pathogen to the human immune system, usually in the form of an injection and at a low dose, to prompt the system to produce antibodies to the pathogen. Antibodies are a kind of immune memory which, having been elicited once, can be quickly mobilised again if the person is exposed to the virus in its natural form.
  • Cepi’s original portfolio of four funded Covid-19 vaccine projects was heavily skewed towards these more innovative technologies, and last week it announced $4.4m (£3.4m) of partnership funding with Novavax and with a University of Oxford vectored vaccine project. “Our experience with vaccine development is that you can’t anticipate where you’re going to stumble,” says Hatchett, meaning that diversity is key. And the stage where any approach is most likely to stumble is clinical or human trials, which, for some of the candidates, are about to get under way.
  • An illustration of that is a vaccine that was produced in the 1960s against respiratory syncytial virus, a common virus that causes cold-like symptoms in children. In clinical trials, this vaccine was found to aggravate those symptoms in infants who went on to catch the virus. A similar effect was observed in animals given an early experimental Sars vaccine. It was later modified to eliminate that problem but, now that it has been repurposed for Sars-CoV-2, it will need to be put through especially stringent safety testing to rule out the risk of enhanced disease.
  • Once a Covid-19 vaccine has been approved, a further set of challenges will present itself. “Getting a vaccine that’s proven to be safe and effective in humans takes one at best about a third of the way to what’s needed for a global immunisation programme,” says global health expert Jonathan Quick of Duke University in North Carolina, author of The End of Epidemics (2018). “Virus biology and vaccines technology could be the limiting factors, but politics and economics are far more likely to be the barrier to immunisation.”
  • Because pandemics tend to hit hardest those countries that have the most fragile and underfunded healthcare systems, there is an inherent imbalance between need and purchasing power when it comes to vaccines. During the 2009 H1N1 flu pandemic, for example, vaccine supplies were snapped up by nations that could afford them, leaving poorer ones short. But you could also imagine a scenario where, say, India – a major supplier of vaccines to the developing world – not unreasonably decides to use its vaccine production to protect its own 1.3 billion-strong population first, before exporting any.
  • • This article was amended on 19 March 2020. An earlier version incorrectly stated that the Sabin Vaccine Institute was collaborating with the Coalition for Epidemic Preparedness Innovations (Cepi) on a Covid-19 vaccine.
katherineharron

Covid-19: Why America has the world's most confirmed cases (opinion) - CNN - 0 views

  • On Thursday, we hit a grim watershed. The US overtook Italy and China as the country with the highest number of confirmed Covid-19 cases. This is a dire crisis and an extraordinary failure of President Donald Trump. Americans are suffering and dying because the Trump administration failed to act quickly and decisively to prevent the virus' spread. The US has now seen about 1,195 deaths and the number is rising rapidly.
  • On Thursday, the US saw an increase of more than 15,000 cases in one day -- a shocking surge that can be explained by both the spread of the virus and increased testing after weeks of shortages -- pushing the total number of confirmed cases over 82,000. China, in comparison, has reported 81,285 cases.
  • Trump bears direct responsibility for America's unpreparedness and failed response to the epidemic. Since Trump came into office, he has systematically taken apart our protective public health system. The pandemic unit at the National Security Council was dismantled in 2018 under his watch. Trump slashed the CDC's epidemic control teams in 39 countries, including China. And when the epidemic hit, Trump ignored it, downplayed it, and made repeated false claims. Even now, he spouts vulgar nonsense about restarting the economy by Easter when public health experts say the threat is going to persist for far longer.
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  • On Thursday, we hit a grim watershed. The US overtook Italy and China as the country with the highest number of confirmed Covid-19 cases. This is a dire crisis and an extraordinary failure of President Donald Trump. Americans are suffering and dying because the Trump administration failed to act quickly and decisively to prevent the virus' spread. The US has now seen about 1,195 deaths and the number is rising rapidly.
Javier E

Opinion | Testing Can't Stop Coronavirus Now, But There Are Still Things We Can Do - Th... - 0 views

  • Of all the resources lacking in the Covid-19 pandemic, the one most desperately needed in the United States is a unified national strategy, as well as the confident, coherent and consistent leadership to see it carried out
  • The country cannot go from one mixed-message news briefing to the next, and from tweet to tweet, to define policy priorities. It needs a science-based plan that looks to the future rather than merely reacting to latest turn in the crisis.
  • rom an epidemiological perspective, the current debate, which pits human life against long-term economics, presents a false choice.
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  • Just as a return to even a new normal is unthinkable for the foreseeable future — and well past Easter, Mr. Trump — a complete shutdown and shelter-in-place strategy cannot last for months
  • A middle-ground approach is the only realistic one — and defining what that looks like means doing our best to keep all such workers safe.
  • In three to four weeks, there will be a major shortage of chemical reagents for coronavirus testing
  • When leaders tell the truth about even near-desperate situations, when they lay out a clear and understandable vision, the public might remain frightened, but it will act rationally and actively participate in the preservation of its safety and security.
  • begin by stating a number of hard truth
  • The first is that no matter what we do at this stage, numerous hospitals in the United States will be overrun. Many people, including health care workers, will get sick and some will die. And the economy will tank. It’s too late to change any of this now.
  • It also means leadership. Above all, it means being realistic about what is possible and what is not, and communicating that clearly to the American public.
  • Much better, instead, to immediately gear up for epidemic intelligence
  • it simply won’t be available.
  • The second hard truth is that at this stage, any public health response that counts on widespread testing in the United States is doomed to fail.
  • illness surveillance, in which epidemiologists survey a sample of doctors’ offices in a given geographic region each day to learn how many patients sought care for illnesses with symptoms of fever, cough and muscle aches.
  • A third hard truth is that shortages of personal protective equipment — particularly N-95 masks — for health care workers will only get worse in the United States as global need continues to rise precipitously
  • If you can’t make nearly enough masks to meet the need, then you must conserve the masks you can make. Unfortunately, some hospitals in the United States are not employing science-based methods for conserving these invaluable lifesaving masks.
  • Making ventilators — machines that breathe for patients who cannot effectively do so on their own — poses an even more formidable challenge
  • a Medtronic ventilator has about 1,500 parts, supplied by 14 separate countries.
  • More machines might, at best, be manufactured by the hundreds a month — but not by the thousands, as is needed right now.
  • a national strategy and leadership are crucial. Otherwise, hospitals, governors and politicians will only vie against one anothe
  • “Respirators, ventilators, all of the equipment — try getting it yourselves,” Mr. Trump said
  • This is exactly the wrong message. The White House must take charge, keeping track of national inventory, purchasing the precious resources and distributing them where they are most needed at the moment.
  • More than anything, what the United States needs right now is for the president to undertake an intellectual Manhattan Project: gather the best minds in public health, medicine, medical ethics, catastrophe preparedness and response; political leadership; and private-sector manufacturing and the pharmaceutical industry.
  • The effort against Covid-19 will need to be bear fruit within days — and come up with a comprehensive but realistic blueprint for getting America through the next 12 to 18 months, or however long it takes for a vaccine to become widely available or herd immunity to take hold in the population
nrashkind

'That's when all hell broke loose': Coronavirus patients overwhelm US hospitals - CNN - 0 views

shared by nrashkind on 29 Mar 20 - No Cached
  • "We ended up getting our first positive patients -- and that's when all hell broke loose," said one New York City doctor.
  • "We don't have the machines, we don't have the beds," the doctor said.
  • "To think that we're in New York City and this is happening," he added. "It's like a third-world country type of scenario. It's mind-blowing."
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  • At first, patients skewed toward the 70-plus age group, but in the past week or so there have been a number of patients younger than 50.
  • "Two weeks ago, life was completely different."
  • There are simultaneous effort to procure ventilators for the most severe patients. According to Cuomo, New York has procured 7,000 ventilators in addition to 4,000 already on hand, and the White House said Tuesday that the state would receive two shipments of 2,000 machines this week from the national stockpile. But the state needs 30,000, Cuomo said.
  • "There is a very different air this week than there was last week."
  • Public health experts, including US Surgeon General Dr. Jerome Adams, have warned the US could "become Italy," where doctors in hospitals filled with Covid-19 patients have been forced to ration care and choose who gets a ventilator.
  • Cuomo also described the extreme measures hospitals are planning to take to increase their capacity for patients who need intensive care.
  • It's not just New York that's feeling the pressure. Hospitals across the country are seeing a surge of patients, a shortage of personal protective equipment such as masks and gowns, and health care workers who feel that they, their families and their patients are being put at risk.
  • Several nurses around the country also spoke to CNN on condition of anonymity, also fearing they could lose their jobs.
  • Judy Sheridan-Gonzalez, an ER nurse at Montefiore Medical Center and president of the New York State Nurses Association, said that "everybody is terrified" about becoming infected because many lack the proper protective gear, and many are being told to reuse the same mask between multiple patients.
  • to become sick and we also don't want to become carriers," she said. "In my own hospital -- and I don't think it's unique -- we have a nurse who is on a ventilator right now who contracted the virus."
  • The goal: to prevent hospitals from seeing a massive spike of patients arriving around the same time.
  • "Obviously, no one is going to want to tone down things when you see things going on like in New York City," Fauci said Tuesday.
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