America’s public health efforts have stalled

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This is an edition of Up for Debate, a newsletter from Conor Friedersdorf. On Wednesday, it summarizes timely conversations and solicits readers’ responses to a thought-provoking question. Later, he posts some thoughtful responses. Sign up for the newsletter here.


question of the week

I need a week’s break from the big news, so it’s time for your shots: what do you love or hate about summer – nostalgic stories are everything absolutely allowed – and where does it rank among the seasons? (Additional credit if you end your post by naming a best summer song.)

Send responses to [email protected].


Note conversations

Public health is the priority this week, but don’t worry, dear reader: I’m not going to scold you, as so often happens when you hear these words; I will scold American public health officials, whose failures continue to escalate in ways that suggest, at best, continued dysfunction.

The scope of failure is far greater than the coronavirus pandemic, although that’s where we’ll start. Over time, as the virus evolved, mRNA vaccines became less and less effective. Fortunately, they can be changed. Unfortunately, regulators are moving far too slowly.

In the boring slow newsletter Matt Yglesias explains:

We’ve gone from the impressive technical achievement of deploying the original vaccines in record time to a sad situation where the FDA only allows boosters optimized for Omicron after Omicron is gone… We’re not going to not even really getting them shots in people’s arms in time to protect them from BA.2 – we’re hoping to catch BA.5 with a vaccine that has two variants. What is particularly shocking is the clinical trials of the optimized Omicron vaccine which began on January 25. The science itself was done before the trials began. As Eric Topol writes, “it took over 7 months for the Omicron BA.1 booster to be tested, an extremely long and unacceptable delay compared to the original vaccine validation and production schedule of 10 months in 2020” .

Yglesias concludes: “Slowly updating vaccines to drive out variants that are already in the rearview mirror is not an acceptable global Covid strategy. We need to accelerate the pace of clinical trials. Topol adds, “It all comes down to the vital need for a new generation of universal vaccines…and the critical importance of nasal vaccines in promoting mucosal immunity.”

Of course, even an approved vaccine is of limited use if it doesn’t make it into people’s arms to prevent disease. Which brings us to monkeypox, another disease that is currently spreading. Josh Barro, one of the lucky few to get vaccinated, explains the situation in his newsletter:

Monkeypox is very unlikely to kill you, but it is a very nasty disease that… you should take steps to avoid it if you are at a significant risk of catching it – that is usually, if you’re a gay man who has skin-to-skin contact with other gay men… We already have an FDA-approved, government-stocked vaccine that prevents monkeypox. There may be around 5 million adult gay men in the United States, but the number who truly meet the relevant risk criteria is much smaller than that – we’re probably talking no more than a few hundred thousand. people who are short-term candidates. for the vaccine and – as we learned the hard way from COVID – not everyone who is a good candidate for the vaccine will really want to get it.

So how difficult could it be to get the vaccine to those affected who want it? Well, it could be quite difficult, actually, since the government’s strategic stockpile only contains tens of thousands of doses of the affected vaccine, called JYNNEOS… This extremely tight vaccine supply seems to be what has led to an absurd situation in New York for the past two weeks. On Thursday, June 23, the city’s health department suddenly announced a monkeypox vaccination clinic for men who have sex with men who would begin administering doses, apparently realizing the risk of spreading the virus. monkeypox during the Pride festivities which were due to begin on Friday, June 24. This was announced on the morning of June 23, minutes before the clinic opened. And the news spread among some of New York’s gay party-goers like a PTA phone tree.

The problem was that the city only had 1,000 doses of JYNNEOS to distribute based on risk factors alone, so all appointments were made about an hour after the announcement. The health department’s website said they would offer more appointments once they have more supply from the CDC, and to check on that on Sunday (June 26) – but the CDC didn’t. actually sent more doses (probably because of the very limited domestic supply) and so there were no additional appointment slots to speak of. The city now says the CDC has agreed to send about 6,000 more doses, but they’re not there yet, and as of July 5, there are still no more appointments offered. To say a lot of people I know are angry about this would be an understatement.

Meanwhile, as The hill reports, “Infectious disease experts and public health advocates are warning that the Biden administration has been too slow to respond to the monkeypox outbreak and that the United States risks losing control of the disease.” He quotes David Harvey of the National Coalition of STD Directors. “Where we have fallen behind is streamlining testing, making vaccines available and streamlining access to the best treatments,” he said. “All three areas have been bureaucratic and slow, meaning we haven’t contained this outbreak.”

Last year, I wrote about the deadly nature of FDA delays.

In all honesty, pandemics and epidemics are particularly difficult circumstances. How well are US public health officials operating on more pedestrian, non-emergency issues? Amanda Mull notes that the active ingredient in sunscreen Americans are using is the same as ever, while consumers in Europe, Asia and Australia have access to new, superior technology.

Mull writes:

In official statements and position papers, physicians and cancer prevention advocates express considerable interest in bringing new sunscreen ingredients to the U.S. market, but little optimism about the soon availability of some. The FDA hasn’t added a new active ingredient to its sunscreen monograph — the document that details what’s legally allowed in products marketed in the United States — for decades… In 2014, Congress passed a law to expedite access to sunscreen ingredients that have been widely used in other countries for years, but it hasn’t really worked…According to FDA spokesperson Courtney Rhodes, manufacturers have submitted eight new active ingredients for review. The agency has asked them to provide additional data to support these claims, but none of them have yet met the agency’s requirements.

Economist Alex Taarrok was already complaining about it in 2013.

Considering all of this, you might think the FDA is marshaling as many resources as possible to improve the speed and efficiency of urgent matters. In fact, he is battling with vaping company Juul.

American pediatrician John Gall speculated in his 1975 book, General systematics, that the systems are attractive:

They promise to do a tough job faster, better, and easier than you could do yourself. But if you put a system in place, you’ll likely find that your time and effort is now spent caring for and nurturing the system itself. New problems are created by its very presence. Once installed, it does not go away, it grows and encroaches. He starts doing weird and wonderful things. Breaks down in ways you never thought possible. It recoils, hinders and opposes its own function. Your own perspective is distorted by being in the system. You get anxious and push on it to make it work. Eventually, you come to believe that the poorly designed product he begrudgingly delivers is what you really wanted all the time. At this point, the encroachment has become complete. You have become engrossed. You are now a systems person.

American public health officials are truly “system people.”

challenge of the week

In “The medium is the threat”, Andrey Mir writes:

Instant gratification for online activity drives the user engagement that internet platforms need to be profitable. But when practiced nearly eight hours a day (the amount of time the average American spends online), this behavior also forms a habit – a neuro-disposition, tuned to certain interactions with the world. The brain rewires itself…

Digital natives are adapted to their new environment but not to the old one. Coaches complain that teenagers are unable to hold a hockey stick or do pull-ups. The peripheral vision of digital natives, necessary for safety in physical space, is deteriorating. With these deficits come benefits in the digital realm. The eye adapts to tunnel vision – a digital native can see details on screen that a digital immigrant cannot. When playing video games, digital immigrants still instinctively dodge bullets or punches, but not digital natives. Their bodies don’t perceive an imaginary digital threat as a real threat, which is only logical. Their sensorium has readjusted to ignore fake digital threats that simulate physical threats. No need for an instinctive fear of heights or trauma: in the digital world, even death can be overcome by reappearing. Yet what will happen when millions of young people with weak grip strength, peripheral blindness and no instinctive fear of collision start, for example, driving cars? Will the evolution of media be there in time to replace drivers with autopilots in self-driving vehicles?

There is much more interest in the full essay at city ​​newspaper.

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