My Response to The New Yorker article.
The RSV shot shortage isn’t just a supply problem
“It’s more complicated to fix the fragmented US health care system that creates big barriers to Beyfortus access for some kids, O’Leary said. That system is structured such that many pediatricians have to take huge financial risks to keep Beyfortus in stock. For patients who get care at those practices, access will likely be a little touch-and-go until demand also stabilizes and pediatricians can better forecast how much to stock.
Why is it so risky for some pediatricians to stock certain immunization products?
It has to do with who’s paying for the products, and how much they cost. Pediatric vaccines are paid for and distributed in the US through two main mechanisms. About half of American kids get vaccines paid for by the federal government through a program called Vaccines for Children, or VFC. The program’s goal is to ensure cost isn’t a barrier to vaccinating kids, so eligibility is restricted to kids who are Medicaid-eligible, under- or uninsured, or American Indian or Alaska Native.
The other half of American kids get vaccines paid for by private insurance companies, but only after the pediatrician administers it. What insurance companies pay for each vaccine isn’t always enough to cover its full cost, and the pediatrician often doesn’t know how much an insurance company will pay them for a vaccine until after the fact.
This setup means ordering any vaccine is somewhat of a financial risk to pediatric practices. But because most vaccines are relatively cheap, and because their familiarity to most parents makes demand relatively predictable, the risk is relatively small.
The math is totally different for Beyfortus, though: One dose costs a doctor’s office nearly $500 — and as a totally novel immunization, its popularity was hard to forecast. “For a medium-sized practice, they might have to spend $250,000 to cover their patient population,” O’Leary said. “And that is not money they have lying around.””
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“A universal vaccination program that made vaccines available across the lifespan, free of charge, would be wonderful, O’Leary said, and it’s what other industrialized countries like Canada and the United Kingdom do. “But that’s not where we are,” he said.”
https://www.vox.com/2023/10/25/23931321/rsv-beyfortus-nirsevimab-shortage-supply-vfc-vaccines-for-children-respiratory-syncytial-virus
CNN visited the exposed tunnel shaft in the Al-Shifa hospital compound. Here’s what we saw
“Standing on the edge of the tunnel shaft, it was apparent that the structure itself was substantial. At the top, the remains of a ladder hung over the lip of the opening. In the center of the round shaft, a center pole looked like a hub for a spiral staircase. The shaft itself extended down farther than we could see, especially in the meager light of our headlamps.
Video released by the IDF from inside the shaft showed what we could not see from the top of the opening. The video shows a spiral staircase leading down into a concrete tunnel. The IDF said the tunnel shaft extends downwards approximately 10 meters and the tunnel runs for 55 meters. At its end stands a metal door with a small window.
“We need to demolish the underground facility that we found,” said IDF spokesperson Rear Admiral Daniel Hagari. “I think the leadership of Hamas is in great pressure because we found this facility, and we are now going to demolish it. It’s going to take us time. We’re going to do it safely, but we’re going to do it.”
It is arguably the most compelling evidence thus far that the IDF has offered that there may be a network of tunnels below the hospital. It does not establish without a doubt that there is a command center under Gaza’s largest hospital, but it is clear that there is a tunnel down below. Seeing what connects to that tunnel is absolutely critical.
For Israel, the stakes could not be higher. Israel has publicly asserted for weeks, if not years, that Hamas has built terror infrastructure below the hospital. The ability to continue to prosecute the war in the face of mounting international criticism depends to a large extent on Israel being able to prove this point.
Hamas has repeatedly denied that there is a network of tunnels below Shifa hospital. Health officials who have spoken with CNN have said the same, insisting it is only a medical facility.”
https://www.yahoo.com/news/cnn-visited-exposed-tunnel-shaft-043130146.html
America’s unique, enduring gun problem, explained
“No other high-income country has suffered such a high death toll from gun violence. Every day, 120 Americans die at the end of a gun, including suicides and homicides, an average of 43,375 per year. According to the latest available analysis of data from 2015 to 2019, the US gun homicide rate was 26 times that of other high-income countries; its gun suicide rate was nearly 12 times higher. Mass shootings, defined as attacks in which at least four people are injured or killed excluding the shooter, have been on the rise since 2015, peaking at 686 incidents in 2021. There have been 565 mass shootings in the US in 2023 as of late October, including the Lewiston shooting, and at the current pace, the US is set to eclipse the 2021 record this year.”
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“According to a database maintained by Advanced Law Enforcement Rapid Response Training Center at Texas State University, there were 520 active attacks — defined as when one or more people are “actively killing or attempting to kill multiple unrelated people in a public space,” including but not limited to shootings — between 2000 and 2022. In many of those cases, police were unable to stop the attacker, either because the attack had already ended by the time they arrived or because the attacker surrendered or committed suicide. Only in 160 cases were police able to successfully intervene by shooting or otherwise subduing the attacker.
nother 2021 study from Hamline University and Metropolitan State University found that the rate of deaths in 133 mass school shootings between 1980 and 2019 was 2.83 times greater in cases where there was an armed guard present. The researchers argue the results suggest the presence of an armed guard increased shooters’ aggression and that because many school shooters have been found to be suicidal, “an armed officer may be an incentive rather than a deterrent.””
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“In 2008, the Supreme Court effectively wrote NRA CEO Wayne LaPierre’s “good guy with a gun” theory into the Constitution. The Court’s 5-4 decision in District of Columbia v. Heller (2008) was the first Supreme Court decision in American history to hold that the Second Amendment protects an individual right to possess a firearm. But it also went much further than that.
Heller held that one of the primary purposes of the Second Amendment is to protect the right of individuals — good guys with a gun, in LaPierre’s framework — to use firearms to stop bad guys with guns. As Justice Antonin Scalia wrote in Heller, an “inherent right of self-defense has been central to the Second Amendment right.”
As a matter of textual interpretation, this holding makes no sense. The Second Amendment provides that “a well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.”
We don’t need to guess why the Second Amendment protects a right to firearms because it is right there in the Constitution. The Second Amendment’s purpose is to preserve “a well-regulated Militia,” not to allow individuals to use their weapons for personal self-defense.
For many years, the Supreme Court took the first 13 words of the Second Amendment seriously. As the Court said in United States v. Miller (1939), the “obvious purpose” of the Second Amendment was to “render possible the effectiveness” of militias. And thus the amendment must be “interpreted and applied with that end in view.” Heller abandoned that approach.
Heller also reached another important policy conclusion. Handguns, according to Scalia, are “overwhelmingly chosen” by gun owners who wish to carry a firearm for self-defense. For this reason, he wrote, handguns enjoy a kind of super-legal status. Lawmakers are not allowed to ban what Scalia described as “the most preferred firearm in the nation to ‘keep’ and use for protection of one’s home and family.”
This declaration regarding handguns matters because this easily concealed weapon is responsible for far more deaths than any other weapon in the United States — and it isn’t close. In 2021, for example, a total of 14,616 people were murdered in the US, according to the FBI. Of these murder victims, at least 5,992 — just over 40 percent — were killed by handguns.”
https://www.vox.com/23142734/lewiston-maine-mass-shooting
Ukraine’s Counteroffensive Has Failed…
Biden-Xi Meeting | The Capital Cable #82
In the West Bank, Israeli settlers are on an anti-Palestinian rampage
“According to a September UN report, there had been roughly two settler attacks on Palestinians per day in 2022, a doubling of the previous year’s average. In the first eight months of 2023, the daily average went up to three — the highest figure since the UN began recording data on the topic in 2006. The violence between 2022 and August 2023 displaced roughly 1,100 Palestinians and emptied four communities, with scant accountability. The UN found that while 81 percent of Palestinian communities reported incidents to Israeli authorities, only 6 percent said they were aware of Israel acting on the provided information.”
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“The more egregious the settlers’ actions become, the more likely Palestinian militants are to respond with brutal violence of their own. The more violent they get, the more settlers and the Israeli military will retaliate. And the more Israel inflicts violence on Palestinians, the more likely it is that violence erupts into a full-fledged uprising across the West Bank.”
https://www.vox.com/world-politics/2023/11/9/23945651/west-bank-israeli-settler-palestine-gaza-war-violence
It’s getting increasingly dangerous to be a newborn in the US
“in 2022, the death rate for American infants increased for the first time in 20 years.”
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“rates of congenital syphilis — that is, syphilis infections acquired in the womb — have risen tenfold over the past decade.
Although a lot of different risk factors drive each of these trends, there’s an important one they have in common: bad — and worsening — health care access for mothers and babies.
In the US, the obstacles mothers face in accessing health care are too often insurmountable — and as this latest data shows, the consequences to American children are dire. Things might only get worse, some experts fear, as financial, political, and social pressures drive providers further from many of the places where they’re needed most.
“We only are hearing about more [obstetricians] leaving and more maternity wards closing,” said Tracey Wilkinson, a pediatrician who specializes in reproductive health issues at Indiana University’s medical school. “I am terrified about what the data is going to look like next year.””
https://www.vox.com/23952456/syphilis-mortality-death-infant-newborn-congenital-babies-prenatal-maternity-pregnancy-desert
The gap between the Biden administration and the Netanyahu government over Gaza’s future is widening
“Biden administration officials are increasingly at odds with Israeli Prime Minister Benjamin Netanyahu’s government over how it is conducting its military assault on Hamas and how the two countries envision the political future of Gaza, current and former U.S. officials say.
Amid dire scenes from hospitals in Gaza and a rising civilian death toll, frustration is building among administration officials who have repeatedly appealed to Netanyahu and his government to take more action to protect Palestinian civilians and allow more humanitarian aid into Gaza.
“We are concerned that they aren’t doing everything possible to reduce civilian casualties,” said one administration official. The comments came as Israeli forces moved in on Gaza City’s main hospital, where they said Hamas militants have been operating from an underground command center.
The friction between the two governments is over crucial long-term questions about who will govern the Palestinian enclave after Israel completes its military offensive. That includes the role of the Palestinian Authority — which currently governs the West Bank — and reviving diplomatic efforts for a two-state solution and the establishment of a Palestinian state, current and former officials said.
“There’s a looming gap between the U.S. and Israel on where we’re going to be in a month or two,” one former U.S. official said.
Although the U.S. and Israel have tried to present a united front publicly, the divide was exposed after Netanyahu last week said that Israel would have a security role in Gaza for an indefinite period.
Less than 24 hours later, Secretary of State Antony Blinken pushed back, making it clear the U.S. would not accept any suggestion of a reoccupation of the Gaza Strip or a blockade of the enclave.
The U.S. believes there can be “no reoccupation of Gaza after the conflict, hence, no attempt to blockade or besiege Gaza,” and “no reduction in the territory of Gaza,” Blinken said during a visit to Tokyo.
Blinken also laid out his most detailed vision yet for the future of Gaza, saying it “must include Palestinian-led governance and Gaza unified with the West Bank under the Palestinian Authority.”
The Palestinian Authority, which was pushed out of Gaza by its rivals in Hamas, administers semiautonomous areas of the Israeli-occupied West Bank. The U.S. and other world powers view the Palestinian Authority, which is internationally recognized but lacks strong popular support, as the only realistic alternative to Hamas, which the U.S. and other Western nations considers a terrorist organization.
Netanyahu, in turn, brushed off Blinken’s proposal, telling NBC News’ “Meet the Press” that Gaza needed to be demilitarized and deradicalized and any Palestinian force including the Palestinian Authority was not up to the job.”
https://www.yahoo.com/news/gap-between-biden-netanyahu-teams-222449759.html