The public health response to the outbreak of monkeypox in the United States has so far failed to prevent significant community spread of the disease, leading to a call for a reassessment of the strategy for containing it.

Since the first reported U.S. case of the outbreak on May 17, the number of infections has soared to more than 5,000, with the majority found among men who have sex with men.

Although reporting of case numbers is scattered across different agencies, the U.S. appears to account for more than 25% of global cases identified during the current outbreak, which the World Health Organization has identified as a “public health emergency of international concern.”

‘You have to act fast’

Infectious disease experts have been dismayed by what they saw as a lack of urgency on the part of U.S. public health agencies in the early weeks of the outbreak.

“What I expected to see would have been a more vigorous kind of a response based on lessons that we’ve learned from … COVID-19, as well as lessons we’ve learned from the HIV response,” Dr. Wafaa El-Sadr, founder and director of ICAP at Columbia University Mailman School of Public Health, told VOA.

“When you have an outbreak, the most important thing is you have to act fast, you have to mobilize, and … you have to rally all your assets to work together really quickly to be able to do what’s needed,” El-Sadr said.

Facing criticism at the end of June, the White House announced what it called the “first phase” of a national monkeypox vaccine strategy designed to “help immediately address the spread of the virus by providing vaccines across the country to individuals at high risk.” The administration said that it would “rapidly deploy vaccines in the most affected communities and mitigate the spread of the disease.”

Similar to smallpox

The monkeypox virus comes from the same family as the deadly smallpox virus, but infections with the disease tend to be far less severe and are rarely fatal.

The disease typically presents with a fever and body aches, followed by the eruption of skin lesions, which can occur all over the body but which are often found on the face and hands.

Though the disease is rarely fatal, the skin lesions can cause severe pain lingering over several weeks.

International scope

According to data collected by the World Health Organization, diagnosed new cases of monkeypox have been concentrated in Europe and North America during the latest outbreak, with more than 14,000 reported in the WHO’s European Region and nearly 6,800 in North America.

By contrast, there are far fewer cases in other regions tracked by WHO. The agency’s African Region has reported only 328 cases, and numbers are far lower in the Western Pacific Region (65), the Eastern Mediterranean Region (26) and the South-East Asia Region (6.)

It should be noted that case numbers are affected by countries’ capacity to test and report active cases of monkeypox, meaning that in some developing countries, the numbers reported to the WHO may represent an undercount.

More manageable than COVID

Monkeypox is the sort of disease that the U.S. public health infrastructure ought to be able to combat effectively.

First, because it spreads primarily through close skin-to-skin contact, it is far less contagious than the virus that causes COVID-19, which can be transmitted through the air.

In addition, effective tests to diagnose the disease are available, as is a vaccine to prevent infection. There is also a highly effective treatment available for infected people.

However, the public health response in the U.S. has so far failed to take full advantage of the opportunity to counter monkeypox.

In a July 15 letter to senior public health officials, including Secretary of Health and Human Services Xavier Beccera and CDC Director Rochelle Walensky, a group of physicians and activists complained, “Multiple unnecessary regulatory barriers to treatments, diagnostics, and vaccines have prevented people in the United States from accessing medical countermeasures necessary to protecting their health, allowing the continued spread of monkeypox virus.”

Delays and confusion

While tests exist that can reliably identify cases of monkeypox, in the early weeks of the outbreak only labs affiliated with the Centers for Disease Control were authorized to administer them, creating significant backlogs in testing. They have since been made available to several large commercial laboratory chains, but the initial delay may have contributed to the early spread of the disease.

Even though there is an effective vaccine against monkeypox, U.S. officials failed to order new doses to add to the country’s limited stockpile until June, the month after the disease began spreading. In addition, U.S. regulators did not approve the use of a facility in Denmark, where the vaccine is manufactured, until the middle of July.

While the medication tecovirimat is known to be highly effective against smallpox and has shown success against monkeypox as well, at the beginning of the outbreak, the CDC required doctors to go through an onerous application process for each patient, greatly slowing the distribution of the medication.

‘Public health failure’

In a blistering op-ed published in the New York Times on Saturday, former Food and Drug Administration commissioner Dr. Scott Gottlieb wrote, “Our country’s response to monkeypox has been plagued by the same shortcomings we had with Covid-19. Now if monkeypox gains a permanent foothold in the United States and becomes an endemic virus that joins our circulating repertoire of pathogens, it will be one of the worst public health failures in modern times not only because of the pain and peril of the disease but also because it was so avoidable.”

He continued, “Our lapses extend beyond political decision making to the agencies tasked with protecting us from these threats. We don’t have a federal infrastructure capable of dealing with these emergencies.”

CDC Director Rochelle Walensky has challenged criticisms from Gottlieb in the past. Earlier in July, she said in a statement to CNN, “It is true that we have work to do — here and internationally — and are likely to see more monkeypox cases in the near term, but it is possible to significantly decrease the number of cases and contain the current monkeypox outbreak through education and increased testing and access to vaccines – all priorities we’ve made dramatic progress on.”

The CDC has launched an effort to support case identification and contact tracing nationwide, as well as support for testing and “case confirmation.” In addition, the agency has expanded outreach to medical professionals to help them identify cases of monkeypox and has expanded its efforts to communicate information about the disease to the public, particularly to the populations most at risk.

CDC researchers are also investigating the nature of the disease, including precisely how it is transmitted and what course the illness typically takes once a person is infected.

At a global level, the CDC reports that it is sharing information with other countries to help coordinate a global response to the virus. This includes close cooperation with the government of Nigeria in an effort to sequence the DNA of the virus, in order to better understand its evolution.

Window is closing

El-Sadr, of Columbia University, told VOA that while she is concerned about the response to the disease this far, she believes there is still an opportunity to bring it under control.

“We have enough tools already,” she said. “If we could just mobilize and communicate and utilize those tools, I think we have a shot at stopping this outbreak. But the window of opportunity closes very fast when it comes to outbreaks and that’s the reason why there’s a profound need for urgency.”

Failure, she said, could leave the U.S. facing the prospect of monkeypox becoming endemic in the country, meaning that it would persist at a fixed level in the country even if no additional infected people arrive from other countries.
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New York City Mayor Eric Adams declared a state of emergency Monday over the spread of monkeypox.

“This order will bolster our existing efforts to educate, vaccinate, test, and treat as many New Yorkers as possible and ensure a whole-of-government response to this outbreak,” Adams said in a statement released with the executive order.

The order allows Adams to suspend local laws and temporarily impose new rules to control the spread of the outbreak.

Similarly, Gov. Kathy Hochul declared a state disaster emergency last Friday. She previously announced that over the next four to six weeks, the federal government would distribute 110,000 vaccine doses to the state in addition to the 60,000 already distributed.

As of Monday, New York City has reported 1,472 cases, according to monkeypox data on the NYC Health website. Most cases worldwide have affected men who have sex with men.

In an announcement Saturday declaring a public health emergency in the city, Adams and Health Commissioner Ashwin Vasan estimated that about 150,000 New Yorkers may be at risk of monkeypox infection.

Cases are continuing to rise across the country. New York currently has the highest number of recorded monkeypox cases among the 50 states, followed by California with 799 cases as of Friday, the CDC reports. San Francisco Mayor London Breed declared a state of emergency on Thursday.

Though California has distributed more than 25,000 vaccine doses, Gov. Gavin Newsom said in a KTVU-TV interview last week that the state is “not even close to where we need to be.”

The rapid spread of monkeypox worldwide has sparked alarm over the past few months. Since May, more than 22,000 cases have been reported in 80 countries, despite the virus naturally occurring only in Central and West Africa.

The World Health Organization declared a global health emergency over monkeypox on July 23.
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Whether it’s abstinence, avoiding nightclubs, limiting sexual partners or pushing for a swift vaccine rollout, Spain’s gay community is on the front line of the monkeypox virus and is taking action. 

“With this monkey thing, I prefer to be careful. … I don’t have sex anymore, I don’t go to parties anymore, and that’s until I’m vaccinated and have some immunity,” said Antonio, a 35-year-old from Madrid who declined to give his last name. 

Antonio, who often went to nightclubs and sometimes to sex parties, decided to act as cases continued to increase. 

Spain on Saturday reported its second monkeypox-related death. 

Outside of Africa, the only other such death has been in Brazil. 

More than 18,000 cases have been detected throughout the world outside of Africa since the beginning of May, according to the World Health Organization (WHO). 

Spain is one of the world’s worst-hit countries. The health ministry’s emergency and alert coordination center put the number of infected people at 4,298. 

As cases increase globally, the WHO has called on the group currently most affected by the virus, men who have sex with men, to limit their sexual partners. 

Lack of vaccines 

“This is not like Covid, the vaccine already exists, there’s no need to invent it. If it wasn’t a queer disease, we would have acted more — and faster,” said Antonio. 

Like other members of the gay community, he believes the authorities have not done enough. 

NGOs have denounced a lack of prevention, a shortage of vaccines and stigmatization linked to the virus.  

This is despite the WHO declaring the monkeypox outbreak a global health emergency. 

Early signs of the disease include a high fever, swollen lymph glands and a chickenpox-like rash. 

The disease usually heals by itself after two to three weeks, sometimes taking a month. 

A smallpox vaccine from Danish drug maker Bavarian Nordic, marketed under the name Jynneos in the United States and Imvanex in Europe, has been found to protect against monkeypox. 

It took Antonio three weeks to get an appointment to be vaccinated, after logging on to the official website every day at midnight. 

Appointments “are going as fast as tickets to the next Beyonce concert,” another said. 

So far, Spain has only received 5,300 doses, which arrived in late June. 

The Spanish health ministry declined to comment when contacted by AFP. 

‘Anyone can catch it’ 

Nahum Cabrera of the FELGTBI+ NGO, an umbrella group of more than 50 LGBTQ organizations from all over Spain, insists there is an urgent need to vaccinate those most at risk. 

That means not just gay men, but anyone who has “regular sex with multiple partners, as well as those who frequent swingers’ clubs, LGTBI saunas, etc.,” he said. 

“It risks creating a false sense of security among the general population, and they relax into thinking that they are safe and that it only happens to men who have sex with men,” he said. 

The target age group for vaccination is those ages 18 and 46, he added. 

Older people are vaccinated against smallpox which was eradicated in Europe in the early 1970s. 

“We are facing a health emergency… that affects the LGBTI community, so people think it is insignificant, that it is not serious,” said Ivan Zaro, of the Imagina MAS (Imagine More) NGO. “This is exactly what happened 40 years ago with HIV.” 

Image director Javier spent three days in hospital in early July after becoming infected.   

The 32-year-old, who is in a monogamous relationship, said he still did not know how he had caught it. 

“I warn everyone,” he said. “It’s an infectious disease, anyone can catch it.” 
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New York has declared a public health emergency due to a monkeypox outbreak.  Mayor Eric Adams and Department of Health and Mental Hygiene Commissioner Dr. Ashwin Vasan made the announcement Saturday.

The two officials said in a joint statement that “New York City is currently the epicenter of the outbreak, and we estimate that approximately 150,000 New Yorkers may currently be at risk for monkeypox exposure.”

“Over the past few weeks, we have moved as quickly as possible to expand outreach and access to vaccines and treatment to keep people safe,” the officials said.  “We will continue to work with our federal partners to secure more doses as soon as they become available. This outbreak must be met with urgency, action, and resources, both nationally and globally, and this declaration of a public health emergency reflects the seriousness of the moment.”

On Friday, New York state Governor Kathy Hochul issued an executive order declaring a state disaster emergency because of the monkeypox outbreak. In her executive order, Hochul said that “More than one in four monkeypox cases in this country are in New York State.”  Her declaration also expanded the number of health care individuals who can administer the monkeypox vaccines.

The World Health Organization has declared the global monkeypox outbreak a public health emergency of international concern.

WHO chief Dr. Tedros Adhanom Ghebreyesus said recently that while 98% of global monkeypox cases “are among men who have sex with men, anyone exposed can get monkeypox, which is why WHO recommends that countries take action to reduce the risk of transmission to other vulnerable groups, including children, pregnant women and those who are immunosuppressed.”

Tedros said, “In addition to transmission through sexual contact, monkeypox can be spread in households through close contact between people, such as hugging and kissing, and on contaminated towels or bedding.” 
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The bedsheets are big. Some are light pink, others hot pink or purple, connected and stretched taut by people holding wooden poles. Together, the sheets form a barrier across the parking lot. The activists, who are supporting a woman’s right to an abortion, wear bright pink vests with PRO-CHOICE in black emblazoned on the front.

This is the front line of protection for pregnant women who drive to this women’s center for an abortion. The sheeting forms a tunnel for them to leave their cars and enter the center, unseen by anti-abortion protesters trying to stop them.

‘There’s very little conversation’

This is the daily scene at the Bristol Regional Women’s Center.   The abortion-rights activists stay inside the center parking lot; the anti-abortion protesters stand on the sidewalk. They walk next to a busy street with posters reading “Love Your Baby and Yourself” or “Babies are Murdered Here” next to competing pink signs that read, “Honk Twice for Choice.”

A local church organizes the anti-abortion protesters. Natalie, who asked to use only her first name for safety reasons, is 24. She has been coming here weekly for seven years, saying, “This is what the Lord has called us to do.” She says  no patient has ever approached her for help.

Another young protester, Haven, says he’s handed out a few pamphlets but it is difficult to approach the women because of the sheeting. He has not spoken to the doctors or the abortion-rights protesters, adding, “There’s very little conversation that can happen.”

The abortion-rights protesters chose not to speak to VOA about their views and asked us to leave. One shone a flashlight into the lens of our video camera.

Inside the clinic, women are given an ultrasound on the first visit. If no fetal heartbeat is detected, they return for a second ultrasound in 48 hours. Again, if no cardiac activity is heard, they are given counseling before a medical abortion.

That is not the case in the adjacent state.

Legal and illegal separated by a street

Bristol, Tennessee, is a border town.

The state line is marked by numerous 20-centimeter-long brass plaques that run down the center of State Street, separating Tennessee from Virginia and its different laws.

As soon as the U.S. Supreme Court in June struck down abortion as a constitutional right, some states instituted “trigger laws” outlawing some or all abortions.

Tennessee’s trigger law outlawed surgical abortions and allowed medical abortions, which use medication to end a pregnancy, during the first six weeks of a pregnancy or until a heartbeat can be recognized, which typically occurs near that time limit.

That means abortions remain legal in Virginia but across State Street, they are restricted in Tennessee.

Olivia, who prefers to use only her first name for safety reasons, is a medical assistant at a women’s clinic in Bristol, Tennessee. She says in the past month, her clinic has had to turn away women in tears, some who had driven many hours to reach the clinic, because an ultrasound found fetal heart activity. The office refers them to Virginia offices if they live nearby. But some drive from eastern Tennessee, and a delay of an extra day to reach another state that’s closer than Virginia can affect the legality of an abortion.

“It becomes a bigger issue,” Olivia says, giving as an example, “North Carolina, [where] you have two separate visits with a 72-hour waiting period.”

Star Eans is a makeup artist on TikTok. The U.S. Supreme Court decision motivated her to become a abortion-rights activist. Eans had a medical abortion less than a year ago when she lived in Tennessee, and complications required a surgical abortion.

“It just makes me angry thinking that, like, if that had happened this year, I would have just died,” Eans says. “If I was still living in Tennessee, and I had to have this baby that I didn’t want, I was very much on the verge of ending myself.”

Doctor looks to move across the border

On Aug. 25, another Tennessee law will prohibit all abortions, surgical and medical.

Because of that, the doctor who runs the Bristol women’s center is considering a satellite office less than a mile away where abortions are legal in Bristol, Virginia.  A GoFundMe page has raised more than $100,000 for the new clinic, and an update on July 29 said it had opened.

But anti-abortion protesters held a rally earlier in July at the Virginia clinic and alerted residents, including Emmitt Russell, whose house is next door. He objects to the anti-abortion protesters and the clinic and says a Virginia ban would motivate him to the polls.

“I didn’t vote in the last two presidential elections … but I would vote against abortions in Virginia, yes,” he said.

No trigger laws exist in Virginia. But Republican Governor Glenn Youngkin is supporting making abortions illegal after 15 weeks. Republicans hold a majority in the state House and could support a ban, but experts think it would be defeated in the Democrat-controlled Senate.  
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Two of the hardest-hit U.S. regions have raised the alert level over the monkeypox outbreak.

San Francisco declared a public health emergency Thursday. The city accounts for 281 of California’s nearly 800 cases. The declaration gives health officials access to additional resources to deal with the outbreak.

New York, with nearly 1,400 cases statewide, made a similar declaration Thursday.

Worldwide, more than 21,000 cases have been reported in 78 countries, nearly all of them outside West and Central Africa, where the virus is endemic. The World Health Organization (WHO) raised the threat level to its highest ranking last weekend.

The U.S. case count is nearing 5,000, according to the U.S. Centers for Disease Control and Prevention (CDC).

The federal government has not declared an emergency but announced plans Thursday to distribute nearly 800,000 additional doses of monkeypox vaccine.

U.S. health officials said they had already distributed 340,000 doses, but many jurisdictions have reported that they have had to turn away patients because of short supplies.

Here are some answers to frequently asked questions.

Who gets monkeypox, and how?

The outbreak has been concentrated among men who have sex with men, though anyone can get monkeypox.

The virus spreads through contact with the rash that infected patients develop. It can also pass through bodily fluids, respiratory droplets after prolonged face-to-face contact or contaminated clothing, bedding or towels.

Men who have sex with men should have fewer sex partners in order to curb the spread, WHO chief Tedros Adhanom Ghebreyesus said Wednesday.

“This is an outbreak that can be stopped,” Tedros said. “The best way to do that is to reduce the risk of exposure.”

However, he added, intolerance of homosexuality would not help.

“Stigma and discrimination can be as dangerous as any virus, and can fuel the outbreak,” Tedros said.

What are the symptoms? Is it fatal?

The disease causes fever, headache, muscle pain, fatigue and swollen lymph nodes, followed by a rash, usually on the face, palms and soles of the feet. About a third of cases also develop a rash on the genitals.

The strain of monkeypox responsible for the global outbreak is rarely fatal but can be extremely painful, according to the CDC. About 10% of cases have been hospitalized “to manage the pain caused by the disease,” Tedros said.

Five deaths have been reported — three in Nigeria and two in the Central African Republic.

What about vaccines and treatments?

About 16 million doses of vaccine are available worldwide, but most will take several months to be packaged and distributed, according to the WHO, which is recommending vaccination only for people at high risk, including people exposed to an infected person, health workers and people with multiple sex partners.

People vaccinated against smallpox likely have some protection against monkeypox, which is a related virus. Smallpox vaccination ended after the disease was declared eradicated in 1980.

Several antiviral medications have been approved.

How unusual is this outbreak?

The current outbreak is the first time this many cases have occurred in such widely dispersed areas outside the endemic countries in West and Central Africa.

Europe accounts for two-thirds of the cases. Nearly one-fifth are in the United States.

WHO’s advisory committee did not agree on the magnitude of the threat at its meeting last Saturday, but Tedros made the decision to declare a “public health emergency of international concern,” the agency’s highest threat assessment.
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U.S. regulators said Friday they are no longer considering authorizing a second COVID-19 booster shot for all adults under 50 this summer, focusing instead on revamped vaccines for the fall that will target the newest viral subvariants.

Pfizer and Moderna expect to have updated versions of their shots available as early as September, the Food and Drug Administration said in a statement. That would set the stage for a fall booster campaign to strengthen protection against the latest versions of omicron.

The announcement means the U.S. won’t pursue a summer round of boosters using the current vaccines for adults under 50, as some Biden administration officials and outside experts previously suggested. They had argued that another round of shots now could help head off rising cases and hospitalizations caused by the highly transmissible omicron strains.

Currently, all Americans ages 5 and over are eligible for a booster shot five months after their initial primary series. Fourth doses of the Pfizer or Moderna shots — a second booster — are recommended for Americans 50 and older and for younger people with serious health issues that make them more vulnerable to COVID-19.

The FDA urged eligible adults who haven’t been boosted to get their extra shot now: “You can still benefit from existing booster options and leave time to receive an updated booster in the fall,” the agency said in a statement.

The White House has also emphasized that getting a fourth dose now won’t impact anyone’s ability to get omicron-targeted shots once they’re made available — although how long it’s been since their last dose will play a role in how soon they’re eligible.

Two omicron subvariants, BA.4 and BA.5, are even more contagious than their predecessors and have pushed new daily cases above 125,000 and hospitalizations to 6,300. Those are the highest levels since February, though deaths have remained low at about 360 per day, thanks to widespread immunity and improved treatments against the virus.

The subvariants are offshoots of the strain responsible for nearly all of the virus spread in the U.S. this year.

All the COVID-19 vaccines given in the U.S. until now have been based on the original version of the virus that began spreading across the country in early 2020.

In June, the FDA told the vaccine makers that any boosters for the fall would have to combine protection against omicron BA.4 and BA.5 and the original coronavirus strain. Both manufacturers have been speeding their production and data gathering to have those so-called bivalent vaccines ready for the fall.

The FDA and the Centers for Disease Control and Prevention would have to sign off on revamped shots before their launch.

The U.S. has a contract to buy 105 million doses of the Pfizer combination shots once they’re ready, and 66 million of Moderna’s version. But how soon large amounts would become available isn’t clear. The government contracts include options to purchase 300 million doses each but reaching that total will require more funding from Congress, the Biden administration said.

As for timing, getting a booster too soon after the previous dose means missing out on its full benefit — something policymakers will have to take into consideration when rolling out revamped shots.

The White House has at times been frustrated by the pace of decision-making at the FDA and CDC, most notably last summer, when the regulators took weeks to decide whether to authorize the first booster dose for U.S. adults. Privately, West Wing officials believe the delay cost lives, preventing optimum protection amid the delta and omicron surges, and also fed into doubts about vaccine and booster effectiveness that affected their uptake.

In recent weeks, some of those frustrations have bubbled up again, as regulators considered whether to recommend a fourth shot for all adults, not just those at highest risk from the virus. Some in the White House believe that the additional dose would have helped somewhat with the rapidly spreading BA.5 subvariant, and also lift the confidence of anyone worried that their protection had waned.

Still, officials across the government have acknowledged the risks of vaccine fatigue among Americans, including tens of millions who still haven’t received their first booster. Government figures show less than half of those eligible for a booster have gotten that third shot.
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Scientists say wildfires in the American West are bigger, hotter and more destructive than in the past.
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Human-caused climate change made last week’s deadly heat wave in England and Wales at least 10 times more likely and added a few degrees to how brutally hot it got, a study said.

A team of international scientists found that the heat wave that set a new national record high at 40.3 degrees Celsius was made stronger and more likely by the buildup of heat-trapping gases from the burning of coal, oil and natural gas. They said Thursday that temperatures were 2 to 4 degrees Celsius warmer in the heat wave than they would have been without climate change, depending on which method scientists used.

The study has not been published in a peer-reviewed scientific journal yet but follows scientifically accepted techniques, and past such studies have been published months later.

“We would not have seen temperatures above 40 degrees in the U.K. without climate change,” study senior author Friederike Otto, a climate scientist at Imperial College of London, said in an interview. “The fingerprint is super strong.”

World Weather Attribution, a collection of scientists across the globe who do real-time studies of extreme weather to see whether climate change played a role in an extreme weather event and if so how much of one, looked at two-day average temperatures for July 18 and 19 in much of England and Wales and the highest temperature reached in that time.

The daily highest temperatures were the most unusual, a one-in-1,000-year event in the current warmer world, but “almost impossible in a world without climate change,” the study said. Last week’s heat smashed the old national record by 1.6 degrees Celsius. The average over two hot days and nights is a once a century event now but is “nearly impossible” without climate change.

When the scientists used the long history of temperatures in England to determine the impact of global warming, they saw a stronger climate change influence than when they used simulations from climate models. For some reason that scientists aren’t quite certain about, climate models have long underestimated extreme weather signals in the summer in Western Europe, Otto said.

With climate models, the scientists simulate a world without the 1.2 degrees Celsius of warming since pre-industrial times and see how likely this heat would have been in that cooler world without fossil fuel-charged warming. With observations they look at history and calculate the chances of such a heat wave that way.

“The methodology seems sound, but candidly, I didn’t need a study to tell me this was climate change,” said University of Georgia meteorology professor Marshall Shepherd, who wasn’t on this study team but was on a U.S. National Academy of Sciences panel that said these types of studies are scientifically valid. “This new era of heat is particularly dangerous because most homes are not equipped for it there.”

The World Weather Attribution study refers to another analysis that estimates a heat wave like this would kill at least 800 people in England and Wales, where there is less air conditioning than in warmer climates.

Otto, who had to sleep and work in the basement because of the heat, said as the world warms, these record-smashing heat waves will continue to come more frequently and be hotter.

In addition to spurring people to cut greenhouse gas emissions, study co-author Gabe Vecchi said, “this heat wave and heat waves like it should be a reminder that we have to adapt to a warmer world. We are not living in our parents’ world anymore.”
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Los Angeles County dropped a plan to impose a universal indoor mask mandate this week as COVID-19 infections and rates of hospitalizations have stabilized, a top health official said Thursday. 

Health director Barbara Ferrer said two weeks ago that the nation’s most populous county could again require face coverings if trends in hospital admissions continued under criteria set by the U.S. Centers for Disease Control and Prevention. 

On Thursday, she said the county had dodged imposition of the broad mask rule. The county remains at the “high” CDC level of community transmission, but it could drop to “medium” in coming weeks. 

Ferrer made the announcement during a briefing at which she displayed flat and declining data graphs. She said transmission had dropped steadily since July 23, “potentially signaling the beginning of a downward trend in cases.” Hospitalizations are also down. 

“We’re on a decline right now, and it’s hard for us to imagine reinstating universal indoor masking when we’re on this significant of a decline,” Ferrer said. But she added that health officials would reassess things should case rates and hospital admissions spike again. 

While masks won’t be required in most indoor spaces, Ferrer reminded residents that face coverings remain an effective tool to reduce the spread of the coronavirus. 

As it has for most of the pandemic, L.A. County will still require masks in some indoor spaces, including health care facilities, mass transit vehicles, airports, jails and homeless shelters. 

The new mandate, which would have gone into effect Friday, would have expanded the requirement to all indoor public spaces, including shared offices, manufacturing facilities, warehouses, retail stores, restaurants and bars, theaters and schools. 

Nationwide, the latest COVID-19 surge is driven by the highly transmissible BA.5 variant, which now accounts for a majority of cases. It has shown a remarkable ability to get around the protection offered by vaccination.
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President Joe Biden’s administration is launching a renewed push for COVID-19 booster shots for those eligible, pointing to the enhanced protections they offer against severe illness as the highly transmissible BA.5 variant spreads across the country. 

The initiatives include direct outreach to high-risk groups, especially seniors, encouraging them to get “up to date” on their vaccinations, with phone calls, emails and new public service announcements. 

Americans ages 5 and older should all get boosters five months after their initial primary series, according to the Centers for Disease Control and Prevention. It also says those age 50 and older, or those who are immunocompromised, should get their second boosters four months after their first. According to the CDC, tens of millions of eligible Americans haven’t received their first boosters, and only 30% of those who have received their first boosters have also received their second. 

The CDC has released a “booster calculator” to help people determine when to get a booster shot. 

Biden, who received his second booster shot in March, tested positive for the virus last week and recovered after experiencing mild symptoms for five days. 

“Given the rise of the Omicron BA.5 variant, it is essential that Americans stay up to date on their COVID-19 vaccinations — with booster shots — to achieve the highest level of protection possible,” the White House said. COVID-19 is killing about 366 people in the U.S. each day, the vast majority of whom are not up to date on their vaccinations. The administration says those deaths are largely preventable. 

‘Undervaccinated’

In May, according to the CDC, prior to the dominance of the BA.5 variant in the U.S., people over 50 who had received only their first booster shots were four times more likely to die of COVID-19 than those with two or more booster doses. 

“Currently, many Americans are undervaccinated, meaning they are not up to date on their COVID-19 vaccines,” CDC Director Dr. Rochelle Walensky said this month. “Staying up to date on your COVID-19 vaccines provides the best protection against severe outcomes.” 

As part of the new booster push, the White House says pharmacies in the federal pharmacy program will step up outreach to those eligible for second booster doses. It says Walgreens will make more than 600,000 phone calls, and Rite Aid will send nearly 9 million emails to people encouraging them to get shots. 

The Centers for Medicare and Medicaid Services will also reach out to 600 nursing homes that have reported booster uptake rates under 80% to offer additional federal support, including setting up on-site clinics and sending medical providers and infectious disease experts to educate people about the benefits of the shots. CMS will also email booster reminders to the 16 million people who receive their Medicare emails and added a booster reminder message to its 1-800-MEDICARE call-in line. 

The U.S. Department of Health and Human Services will also continue to run public service announcements encouraging boosters during commercial breaks on shows with significant viewership among seniors.
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Russia announces plans to sever a long-term space partnership. Plus, a private spaceflight company extends its record of successful launches, and NASA scores a win for its upcoming moon mission. VOA’s Arash Arabasadi brings us The Week in Space. 
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The World Health Organization is calling for greater investment in the development of new vaccines to keep pace with the rapidly evolving variants of the coronavirus.

As world attention is focused on the monkeypox outbreak, WHO chief Tedros Adhanom Ghebreyesus warns the COVID-19 pandemic is far from over. He says new tools must be developed to curb this deadly disease while public health measures that are known to work must be maintained and strengthened.

He says one of the most effective ways to save lives is to vaccinate the right groups first. By this he means health workers, older people, and other at-risk groups such as those with underlying health conditions.

He notes COVID-19 cases and deaths have been increasing for the last five weeks. The latest WHO report puts the number of confirmed global cases at nearly 566 million, including more than 6.3 million deaths.

Tedros says several countries also are reporting increasing hospitalizations, following waves of transmission driven by omicron subvariants. “While vaccines have saved countless lives, they have not substantially reduced transmission. So, it is vital for governments and the private sector to continue collaborating and investing in the development of new vaccines that prevent both infection and disease.”

Tedros adds vaccines should be developed that can be delivered more easily, such as through nasal sprays or drops.

The WHO executive director for health emergencies, Mike Ryan, says more attention must be paid to pandemic preparedness. He says risks from diseases such as COVID-19, monkeypox, Marburg, and polio are accelerating because nations tend to be reactive, rather than active in tackling these diseases.

“I think we need to really take a much more systematic look at how we prioritize pathogens for the future and then how we invest… It will cost money and it does cost money. But it is a fantastic investment in protecting us down the line. And a dollar spent in preparedness is worth a thousand dollars spent on response.”

WHO chief Tedros agrees. He urges all countries to assess and strengthen their readiness and response plans for future waves of transmission.

He adds that as new vaccines and other COVID-19 tools are developed, it is crucial they are equitably available in all countries.
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Every week, tons of electronic waste cross the border from Israel to the West Bank. Thousands of Palestinian families make a living off the waste by burning it to extract copper they can sell. But the burning is taking a toll on residents’ health. Linda Gradstein reports. Camera: Ricki Rosen.
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The United Nations AIDS program says progress is stalling on ending HIV/AIDS as a public health crisis by 2030 and action is needed to get it back on track.

The UNAIDS program issued its assessment in a new report pointing to recent data that showed 1.5 million people were newly infected with HIV, the virus that causes AIDS. That is over a million more new infections than the global estimate set by the United Nations. The report found that in the span of a year, the AIDS pandemic took one life every minute, around 650,000 deaths.

Mary Maby, the director for impact with UNAIDS, called those deaths preventable. She notes effective HIV treatment and tools to prevent, detect, and treat opportunistic infections are available but are not provided equitably across the world.

Among those disproportionately affected by new infections, she says, are young women and adolescent girls.

“Adolescent girls and young women are three times as likely to acquire HIV as adolescent boys and young men in sub-Saharan Africa. While men are less likely than women to obtain anti-retroviral therapy or achieve viral suppression, this leads to continued new infections in their female partners,” said Maby.

The report finds new HIV infections have been rising for several years in eastern Europe and Central Asia, the Middle East, North America, and Latin America. It says new infections are rising in Asia and the Pacific, the world’s most populous region. Officials say the rise is particularly alarming as infections in the region previously had been falling.

Maby says the picture in sub-Saharan Africa is mixed.

“East and southern Africa, West and Central Africa are still seeing declines,” said Maby. “But the east and southern Africa decline is slowing down. That rate in which it was dropping before is not as fast as it was before. West and Central Africa have seen a rapid increase in treatment, mostly in Nigeria, which is slowing the epidemic as well in terms of new infections.”

The report says global disruptions, including the COVID-19 pandemic and the war in Ukraine, have slowed many HIV prevention efforts. Those crises, it notes, have created difficulties for many people to access services to receive the lifesaving treatment they need.  

The assessment comes ahead of the 24th International AIDS Conference being held in Montreal, Canada and virtually this week. The talks run from July 29th through August 2. 
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When images beamed back to Earth by NASA’s largest, most powerful space telescope were released earlier this month, U.S. Senator Marco Rubio shared one of them on Twitter accompanied by a Bible verse: “The heavens declare the glory of God.”

The Webb telescope is orbiting the sun nearly two million kilometers from Earth. The observatory is on a mission to locate the universe’s first galaxies using extremely sensitive infrared cameras. The initial images released to the public provided the first-ever glimpse of ancient galaxies lighting up the sky.

The reaction to Rubio’s post was inundated with remarks like, “You do realize you can only see that due to science?” And, “If only you were scientifically literate enough to understand all of the ways that this image disproves your mythology.”

Reason versus superstition?

The skeptical comments are emblematic of the long-standing, ongoing debate about whether science and religion can be reconciled.

“There are a gazillion religions, each one making a different set of claims about reality, not just about the nature of God, but about history, about miracles, about what happened. And they’re all different, so they can’t all be true,” says Jerry A. Coyne, an evolutionary biologist and professor emeritus at the University of Chicago.

Coyne, who likens religion to superstition, wrote a book called, “Faith Versus Fact: Why Science and Religion are Incompatible.”

“The incompatibility is that both science and religion make statements about what is true in the universe,” Coyne says. “Science has a way of verifying them and religion doesn’t. So, science is based on this sort of science toolkit of empirical reasoning or duplication experiments, whereas religion is based on faith.”

Coyne says he was raised a secular Jew and became an atheist as a teenager.

“Scientists are, in general, much less religious than the general public. And the more accomplished you get as a scientist, the less religious you become,” he says.

A 1998 survey found that 93% of the members of the National Academy of Sciences, one of the most prestigious scientific organizations in the U.S., don’t believe in God.

“I personally think there’s a couple of reasons for that,” says Kenneth Miller, a devout Roman Catholic and professor of molecular biology, cell biology and biochemistry at Brown University in Rhode Island. “One of them, to be perfectly honest, is the out-and-out hostility that many religious institutions or many religious groups display towards science. And I think that tends to drive people with deep religious faith away from science.”

Mixing science and faith

Some of the world’s foremost scientists have been people of faith, however.

The Big Bang theory, which explains the origins of the universe, was first proposed by a Catholic priest who was also an astronomer and physics professor.

Frances Collins, the former head of the National Institutes of Health who headed the international effort that first mapped the entire human genome, is a one-time atheist who now identifies as an evangelical Christian.

Farouk El-Baz, a professor in the departments of archaeology and electrical and computer engineering at Boston University, says most of his scientific colleagues see no conflict between science and religion. For El-Baz, the son of an Islamic scholar, the marvel of the Webb telescope’s discoveries deepens both.

“Science actually underlines the importance of religion because God told us that He created the Earth and the heavens,” says El-Baz, who is also director of the Center for Remote Sensing at Boston University. “And the heavens, there are supposed to be all kinds of things out there. And scientific investigations have actually proved that, yes, there are all kinds of things out there.”

Evolution, creationism or both

For many, the conflict between science and religion is often rooted in the perceived incongruity between creationism — which suggests that a divine being created Earth and the heavens — and evolution, which holds that living organisms developed over 4.5 billion years.

Miller accepts the theory of evolution and says much of scripture is metaphorical, an explanation of the relationship between Creator and His creation in language that could be understood by people living in a prescientific age.

“[The book of] Genesis, taken literally, is a recent product of certain religious interpretations of scripture,” Miller says. “In particular, it’s an interpretation that became quite influential in the latter part of the 19th century among Christian fundamentalists in the United States. And the reality is that much of scripture is figurative rather than literal.”

Jewish tradition also accepts evolution, according to intellectual historian Hava Tirosh-Samuelson, who suggests that the rise of the religious Christian right in the United States also influenced more observant Jews to harden their position against evolution.

“Medieval Jewish philosophy basically followed the Muslim paradigm,” says Tirosh-Samuelson, a professor of history and director of the Center for Jewish Studies at Arizona State University. “The Muslim theologians and the Muslim scholars showed Jews how you can integrate a monotheistic tradition together with Greek and Hellenistic science … and showed how scientific knowledge is always a tool that enables you to understand the divinely created world better.”

Vision of God

In Miller’s view, the concept of God as a designer who worked out every intricate detail of every single living thing is too narrow a vision of the Creator.

“The God that is revealed by evolution is not a God who has to literally tinker with every little piece of trivia in every living organism, but rather a God who created a universe in a world where the very physical conditions of matter and energy were sufficient to accomplish his ends,” Miller says. “And to me, that conception of God creating this extraordinary process that nature itself allows to come about is a much grander vision than a God who has to concern himself with every little detail.”

El-Baz says some people fear that science will reduce their religiosity, but the reverse is true for him.

“We understood through God’s guidance that humans evolved from other creatures, and evolution is still going on, and there’s absolutely no conflict between what science and religion are informing us,” he says. “It’s very easy to consider that a creator, or a force of creation — God or whatever faith you have — that it’s a force that put all of these things together, that created all of this.”

Tirosh-Samuelson says Judaism is not a literalist tradition but rather favors open ended interpretation, which is in keeping with her reaction to the Webb discoveries.

“The grandeur of the universe. The grandeur of God. The grandeur of the human. And in my view, there’s no contradiction between those three. On the contrary, there’s a lot of complementarity between the three,” she says.

“Jewish culture is really pretty much open to discussion and debate about practically every topic. So, there’s something very much in accord with the scientific spirit of inquiry, questioning, uncertainty, skepticism. That’s exactly the opposite of a position that is about certainty and rigidity and closed-mindedness.”
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On the 32nd anniversary of the Americans with Disabilities Act (ADA), the U.S. remains one of a handful of countries that have not ratified the 2006 United Nations Convention on the Rights of Persons with Disabilities (CRPD) — an international treaty the U.S. legislation inspired.  

The ADA, signed into law by President George H.W. Bush on July 26, 1990, prohibits discrimination based on disability in public accommodations, employment, transportation and community living, and provides recourse for people with disabilities who faced discrimination.    

“It’s hard for the newer generation to imagine the injustices suffered before the ADA,” President Joe Biden said Tuesday in a House Bipartisan Disabilities Caucus event to celebrate the ADA’s anniversary. Biden, who is still in isolation from his COVID-19 diagnosis, delivered his remarks virtually.  

“If you’re disabled, stores can turn you away, and employers can refuse to hire you. If you use a wheelchair, there was no accommodation to take the bus or train to school or to work. America simply wasn’t built for all Americans,” Biden said. 

The administration on Tuesday announced $1.75 billion to make it easier for people with disabilities to get on board the nation’s public transportation systems, including $343 million to help agencies retrofit train and subway stations built prior to the disabilities act. 

During the caucus event, House Speaker Nancy Pelosi said Democrats will not give up trying to ratify the CRPD. A National Security Council spokesperson told VOA the administration “would certainly support its ratification.” 

However, with only 48 Democrats and two independents in the 100-seat U.S. Senate, and an urgent legislative agenda in the pipeline, it is unlikely that the Biden White House will take up the matter anytime soon.  

Global disability movement 

Since its passing, the ADA has inspired disability laws in various countries and sparked a movement for disability rights around the world that culminated in the CPRD. The U.S. also provided technical assistance during the convention’s negotiation and drafting process. 

The CPRD came into force in 2008 and was signed by President Barack Obama in 2009. But in 2012, it fell five votes short of the two-thirds majority required for the U.S. Senate to adopt it, largely due to a reluctance to submit to international law on a domestic policy matter. 

Out of 193 U.N. member countries, 185 have ratified the CRPD that aims to promote, protect and ensure full and equal enjoyment of all human rights for persons with disabilities.  

“We’re always very much open and honest in recognizing we haven’t ratified the CRPD,” Sara Minkara, special adviser on international disability rights, told VOA.  

Minkara, who is legally blind, leads the Office of International Disability Rights at the U.S. Department of State, which promotes the rights of persons with disabilities around the world through American diplomacy and development aid. The position was created under the Obama administration, and her office was made permanent by the Biden administration last November. 

In various countries, views on people with disabilities often fall between pity or inspiration from their suffering, Minkara said, and those extreme narratives contribute to societies leaving people with disabilities behind. 

“We need to normalize disability. We need to change how we look at the word disability. We need to change how we look at disabilities and identities, not from a pity lens but from a strength and value-based lens.”  

The administration says it supports “disability-inclusive development and humanitarian action” around the world.  

However, there is no mechanism to ensure full disability inclusion in U.S. foreign assistance, said Eric Rosenthal, executive director of the advocacy group Disability Rights International. 

“You can offer your assistance and say our assistance is available to all people, but the truth is, people with disabilities have a hard time finding the aid,” Rosenthal told VOA. “There has to be more active outreach efforts.” 

People with intellectual disabilities, psychiatric and psychosocial disabilities are particularly vulnerable, Rosenthal said. In many places, they are often stripped of legal rights and put away in institutions. 

“There are very serious human rights violations against them in most countries, and the advocacy movements are usually way behind the advocacy movements for other disability groups,” Rosenthal said. “So, that’s an example of a very at-risk group that needs to be targeted for more attention.” 

Disability Rights International and other groups have endorsed a concept for a U.S. bill to support the efforts of disability advocates worldwide to stop children with disabilities from being institutionalized, where they often face serious neglect and abuse. 

Katherine Gypson and Cindy Saine contributed to this report.

 
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