SYDNEY — Australian authorities are being criticized for ruling out drug decriminalization at an international summit in Sydney this week, ignoring a call by many experts and health groups for a health care response to drug use and addiction rather than criminal penalties.

Several hundred politicians, policy experts, police officers and health professionals gathered this week for a summit on drug reform in Sydney.

The New South Wales government is examining ways to redraft the state’s drug laws and policies.

Calls for the decriminalization of drug use and possession were the focus of the meeting.

Campaigners say not treating drug use as a crime would encourage people to seek help without fear of legal consequences.

New South Wales Health Minister Ryan Park told local media Friday, though, there is not enough local support for such reform.

“The summit is not just about decriminalization, and for a government to move to decriminalize in the drugs … would be a seismic shift to the way in which we handle drugs in New South Wales,” Park said. “In relation to decriminalization, we think that is too significant to put on the table now without a clear mandate.”

The Sydney summit heard from the mayor of Portland, in the U.S. state of Oregon, Ted Wheeler. He told delegates that earlier this year, state lawmakers repealed laws that decriminalized the possession of small amounts of illicit drugs in the state. He said that the health system has been overwhelmed, and that drug-related crime has risen sharply because of the legislation.

International debate is passionate and divided.

A report by the Global Commission on Drug Policy, formed in 2011 to campaign for drug reform, called for a total reexamination of the approach to illicit substances.

Louise Arbour, a former U.N. high commissioner for human rights, was involved in the report and told the Australian Broadcasting Corporation that a new approach is needed.

“Globally, it is very clear that this so-called war on drugs has created a gigantic international illegal drug trade,” Arbour said. “The worst aspect of that war is that it has essentially been a war on people — been a war on people who use drugs and not a war on people who actually prey on them.”

The annual number of drug overdose deaths in Australia has almost doubled over the past 20 years, according to the Penington Institute, a nonprofit organization in Victoria state.

Some 100,000 people are estimated to die each year from drug overdoses in the United States, but the number of fatalities has decreased, according to research from the Centers for Disease Control and Prevention.
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Efforts to reduce the nation’s persistently high maternal mortality rates involve state panels of experts that investigate and learn from each mother’s death.

The panels — called maternal mortality review committees — usually do their work quietly and out of the public eye. But that’s not been the case recently in three states with strict abortion laws.

Georgia dismissed all members of its committee in November after information about deaths being reviewed leaked to the news organization ProPublica. Days later, The Washington Post reported that Texas’ committee won’t review cases from 2022 and 2023, the first two years after the state banned nearly all abortions. In Idaho, the state let its panel disband in 2023 only to reinstate it earlier this year.

“They’ve become more of a lightning rod than they were before,” said epidemiologist Michael Kramer, director of the Center for Rural Health and Health Disparities at Mercer University in Georgia.

Here’s what maternal mortality review committees across the nation do and what might happen next:

What are they?

“Maternal mortality review committees are important because they are the most comprehensive source of information about maternal mortality that we have,” said David Goodman, who leads the maternal mortality prevention team at the U.S. Centers for Disease Control and Prevention.

The panels review deaths that occur during pregnancy or within a year after it ends, whether directly related to the pregnancy or not. Causes of death can range from hemorrhage during childbirth to drug overdoses to traffic accidents.

The goal, Kramer said, is to examine maternal deaths and help “decide what we can do about them.”

All states, a few cities and Puerto Rico have these committees. Their membership varies and may include OB-GYNs, maternal-fetal medicine doctors, nurses, midwives, mental and public health experts and members of patient advocacy groups. Most have representatives from several areas of expertise, which the CDC recommends.

How members are selected also varies; people may apply, submit letters of interest or be invited to serve.

The selection shouldn’t be politically motivated, Kramer said, because “if there’s a systematic exclusion of certain data or certain perspectives” it’s difficult to truly understand what’s happening.

How do they look at deaths?

First, the panels work with state vital statistics offices and epidemiologists to identify deaths associated with pregnancy by examining death certificates and looking for a pregnancy checkbox or a related cause of death. They may also search for links to birth and fetal death records, or delve into hospital discharge data, media reports and obituaries.

Once they identify cases, they collect as much information as possible, such as prenatal care records, hospital and social service records, autopsy reports and interviews with family members. Professional “abstractors” distill all this into case narratives, which committee members pore over. Most use a standardized review process developed by the CDC — and all panels can get help and guidance from the agency.

They consider questions such as: Was the death pregnancy-related? What was the underlying cause? Was it preventable? What factors contributed?

States generally have privacy rules that protect committee members and people who provide information on the deaths.

The groups then issue public reports that don’t name moms or hospitals but include overall findings, trends and recommendations. Some come out a couple of years or more after the deaths.

Across the nation in 2023, Goodman said, 151 recommendations from those reports were implemented by communities, hospitals, medical professionals and policymakers.

What about Georgia, Texas and Idaho?

Georgia will rebuild its committee through a new application process, the state public health commissioner said.

Texas’ committee has been reviewing 2021 deaths and will start on 2024 cases at its next meeting, Texas Department of State Health Services spokesperson Lara Anton said in an email to The Associated Press.

“Reviewing cases is a lengthy process and legislators have asked for more recent data. Starting the next review cycle with 2024 cases will allow us to provide that in the next report,” Anton said, adding that maternal and child health epidemiologists will continue to analyze and publish data for 2022 and 2023.

In Idaho, the reconstituted review committee now falls under the state board of medicine, which licenses doctors, instead of the state’s health and welfare department. It will operate like it always has, said Bob McLaughlin, spokesperson for the medical board. Members met for the first time in November and plan to issue a report by Jan. 31. Because the legislature wanted the most up-to-date information, McLaughlin said the first report will cover only 2023 cases, and the group will review 2022 deaths next.

Goodman said he’s encouraged that every state has a review committee now — only 20 had them in 2015.
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A surprising study of temperature-related deaths in Mexico upends conventional thinking about what age group is hit hardest by heat. Researchers found at higher temperatures and humidity, the heat kills far more young people under 35 than those older than 50.

For decades, health and weather experts have warned that the elderly and the youngest children were most vulnerable in heat waves. But this study looking at all deaths in Mexico from 1998 to 2019 shows that when the combination of humidity and temperature reach uncomfortable levels, around 30 degrees Celsius and 50% relative humidity, there were nearly 32 temperature-related deaths of people 35 years old for every temperature-related death of someone 50 and older.

The study in Friday’s journal Science Advances shows an especially surprising spike of heat-related deaths in an age group thought to be young and robust: people between 18 and 35. That age group alone had nine times as many temperature-related deaths as those older than 50.

Study authors and outside experts are scrambling to figure out why. Demographics alone don’t explain why more young adult Mexicans are dying in high heat than their elders. Two theories: Outdoor workers who can’t escape the heat, and young people who don’t know their limits.

The trend is likely to widen as the world warms from human-caused climate change, according to computer simulations run by the study team.

“We found that younger people are especially vulnerable to humid heat,” study co-author Jeffrey Shrader, a climate economist at Columbia University, said. “As the climate warms, we’re really going to be shifting the burden of temperature-related mortality towards younger individuals and away from older individuals who tend to be more vulnerable to cold temperatures.”

Data from cold weather shows more than 300 deaths of Mexican residents 50 and older for every young person dying from cold temperatures, according to the study.

“People of all ages are increasingly at risk from the rising temperatures, and this study shows that those that we might have considered relatively safe from heat-related adverse health outcomes might not be so much so,” said Marina Romanello, executive director of the Lancet Countdown that monitors health effects of climate change. She was not part of the study team.

“Heat is a much more dangerous silent killer than most people acknowledge it to be, and that heat is increasingly putting our health and survival at risk,” Romanello said in an email.

Study authors decided to examine weather-related deaths in Mexico because that country not only has detailed mortality data, but it has a variety of different climates making it an ideal place to study in depth, Shrader said.

Researchers also want to figure out whether this is just a situation in Mexico or other warmer sections of the globe have similar spikes in young adult deaths in high heat and humidity.

Initially the team just wanted to look at deaths and what scientists call wet-bulb globe temperatures, but when they looked at age differences, they were surprised and looked in more detail, Shrader said. Wet-bulb temperature, which is intended to mirror how the body cools itself, is derived using a complicated measurement system that factors in humidity and solar radiation. A wet-bulb globe temperature of 35 degrees Celsius is thought to be the limit for human survivability. Most places don’t reach that level.

Researchers determined temperature-related mortality by complex statistical analysis that compares numerous factors in the number of deaths and removes everything they can except temperature fluctuations, said study co-author Andrew Wilson, a Columbia climate economics researcher.

Researchers also calculated the ideal temperature for when there are the fewest excess deaths at each age group. Younger adults’ sweet temperature spot is about 5 degrees Celsius cooler than it is for older people, Shrader and Wilson said.

Some outside health and climate experts were initially puzzled at the higher youth mortality seen in the study. Co-author Patrick Kinney, a professor of urban health and sustainability at Boston University, said it was likely the study included a higher proportion of outdoor workers exposed to heat than prior studies did.

Study co-author Tereza Cavazos, a climate scientist at the Ensenada Center for Scientific Research and Higher Education in Mexico, said she remembers her father’s generations taking siestas in the high heat of the day and that was healthy. That doesn’t happen so much now, she said.

“There is a lot of population that is vulnerable in the future. Not even in the future, right now,” Cavazos said. She mentioned three Mexican heat waves this year that hit in the middle of the country and kept the deadly heat going overnight so people had little relief. Usually cool nights allow a body to recover.

Younger people often have a sense of invulnerability to weather extremes and do things that increase their risk, such as play sports in high heat, Cavazos said.

“High humidity makes it a lot harder for the body to cool itself through sweating – which is how our body primarily stays cool,” said Dr. Renee Salas, an emergency medicine physician and climate change expert at Massachusetts General Hospital and Harvard Medical School. She was not part of the study team. “So someone young and healthy working outside in heat and high humidity can reach a point where the body can no longer cool itself safely – causing a deadly form of heat injury called heat stroke.” 
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The U.S. space agency, NASA, is leading an effort to return astronauts to the surface of the moon and establish a routine presence on the lunar surface. As VOA’s Kane Farabaugh reports, NASA says it will push the next mission of its Artemis program from late 2025 to early 2026.
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LONDON — As a landmark climate change case reached its halfway mark Friday at the International Court of Justice in The Hague, clear divisions have emerged over whether nation states can be held legally liable for global warming under international human rights laws.

The 15 judges at the United Nations’ top court have been asked to give an opinion on whether nation states are obliged under such laws to cut their greenhouse gas emissions and to address damage caused by climate change.

Existential threat

Small island and coastal states say their very existence is at stake due to rising sea levels. They argue that international human rights law must apply.

“Territories are disappearing. Livelihoods are being destroyed. Fundamental rights are being violated as we speak,” said Margaretha Wewerinke-Singh, the lead counsel for the Pacific Islands state of Vanuatu.

“The destruction of the Earth’s climate system and other parts of the environment constitutes grave breaches of international law. So, our hopeful expectation is that the court will recognize this and articulate the legal consequences of these violations,” she said.

“Legal consequences of violations of international law are always twofold. The wrongful conduct — the breaching conduct — must cease, it must be put to an end. And secondly, reparations must be made,” Wewerinke-Singh told reporters at The Hague at the opening of the hearing Monday.

Big polluters

However, the world’s biggest polluters — including the United States, China and India — argue that only global climate change agreements have any legal relevance. Human rights, they say, do not apply.

“In rendering its advisory opinion, the court may exercise due caution to avoid devising new or additional obligations beyond what is already agreed to under the existing climate change regime, which take into consideration historic emissions, climate justice and the principles of equity,” India’s representative, Luther Rangreji, told the court on Thursday.

Other major economies have made similar arguments during the first week of the hearing, according to analyst Elena Kosolapova of the International Institute for Sustainable Development.

“For example, Canada has argued that human rights obligations do not encompass the obligation to mitigate greenhouse gas emissions. Germany said the goal of human rights treaties is to protect actual victims of concrete violations and not abstract persons from abstract risks,” Kosolapova told VOA.

“Spain was a notable exception in this camp because it argued that governments actually have human rights obligations in relation to the response to climate change,” she said.

Reparations

Many developed nations fear the financial consequences if human rights laws are invoked, Kospolova said.

“Under the law of state responsibility, any breach of an international obligation, known as an ‘international wrongful act,’ entails certain consequences,” she said. “And many vulnerable countries have highlighted this during the hearings. The responsible state is obligated to make reparations for the injury caused by the wrongful act.”

Those reparations could take the form of compensation.

“Compensation was explicitly excluded from the loss and damage talks under the [climate change] convention and from the Paris Agreement itself,” Kospolova said. “So, I think it would be very interesting to see what the court has to say about it.”

Crucial year

The judges will hear another week of evidence before delivering their legal opinion next year, which is expected to be a crucial year for climate legislation. Over the next few months, nation states are due to publish action plans known as Nationally Determined Contributions, or NDCs, which outline how they plan to cut greenhouse gas emissions.

The NDCs will form a central part of the COP30 climate summit in November, to be held in the Brazilian city of Belem on the edge of the Amazon rainforest.
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Tehran, Iran — Iran successfully launched on Friday its heaviest space payload, which includes a satellite and a space tug, using a domestically developed satellite carrier, official media reported.

Weighing 300 kilograms, the payload consisted of the Fakhr-1 telecommunications satellite and the Saman-1 space tug, according to state television.

The Saman-1 is an “orbital transmission system” designed to transport satellites from lower orbits to higher ones, as described by the Iran Space Research Center when it was unveiled in 2017.

The launch marks an “operational step” toward transferring satellites into higher orbits, the TV report said.

The system was first introduced in February 2017 at a ceremony attended by Iran’s then-president, Hassan Rouhani, and was test-launched in 2022.

The payloads were launched using the homegrown Simorgh satellite carrier from the Imam Khomeini launch base in Semnan province.

Named after a mythical Iranian bird, the Simorgh is a two-stage, liquid-fueled satellite launch vehicle developed by Iran’s defense ministry.

In September, Iran said it successfully put the Chamran-1 research satellite into orbit using the Ghaem-100 carrier, which is produced by the Revolutionary Guards’ aerospace division.

Western governments, including the United States, have repeatedly warned Iran against such launches, arguing technology used for satellites could be applied to ballistic missiles, potentially capable of carrying nuclear warheads.

Iran denies it wants nuclear weapons. It has consistently stated that its satellite and rocket launches are focused on civil and defense applications.

Last month, Russia launched 55 satellites, including two built by Iran — Koswar and Hodhod — reflecting the deepening political, economic and military relations between the two nations.
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KINSHASA, CONGO — Public health officials in Africa urged caution Thursday as Congo’s health minister said the government was on alert over a mystery flu-like disease that in recent weeks killed dozens of people.

Jean Kaseya, the head of Africa Centers for Disease Control and Prevention, told reporters that more details about the disease should be known in the next 48 hours as experts receive results from laboratory samples of infected people.

“First diagnostics are leading us to think it is a respiratory disease,” Kaseya said. “But we need to wait for the laboratory results.” He added that there are many things that are still unknown about the disease — including whether it is infectious and how it is transmitted.

Authorities in Congo have so far confirmed 71 deaths, including 27 people who died in hospitals and 44 in the community in the southern Kwango province, Health Minister Roger Kamba said.

“The Congolese government is on general alert regarding this disease,” Kamba said, without providing more details.

Of the victims at the hospitals, 10 died due to lack of blood transfusion and 17 because of respiratory problems, he said.

The deaths were recorded between November 10 and 25 in the Panzi health zone of Kwango province. There were around 380 cases, almost half of which were children under the age of 5, according to the minister.

The Africa CDC recorded slightly different numbers, with 376 cases and 79 deaths. The discrepancy was caused by problems with surveillance and case definition, Kaseya said.

Authorities have said that symptoms include fever, headache, cough and anemia. Epidemiological experts are in the region to take samples and investigate the disease, the minister said.

The Panzi health zone, located around 700 kilometers from the capital, Kinshasa, is a remote area of the Kwango province, making it hard to access.

The epidemiological experts took two days to arrive there, the minister said. Because of the lack of testing capacity, samples had to be taken to Kikwit, more than 500 kilometers away, said Dieudonne Mwamba, the head of the National Institute for Public Health.

“The health system is quite weak in our rural areas, but for certain types of care, the ministry has all the provisions, and we are waiting for the first results of the sample analysis to properly calibrate things,” Kaseya said.

Mwamba said that Panzi was already a “fragile” zone, with 40% of its residents experiencing malnutrition. It was also hit by an epidemic of typhoid fever two years ago, and there is currently a resurgence of seasonal flu across the country.

“We need to take into account all this as context,” Mwamba said.

A Panzi resident, Claude Niongo, said his wife and 7-year-old daughter died from the disease.

“We do not know the cause, but I only noticed high fevers, vomiting … and then death,” Niongo told The Associated Press over the phone. “Now, the authorities are talking to us about an epidemic, but in the meantime, there is a problem of care [and] people are dying.”
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FREETOWN, SIERRA LEONE — Authorities in Sierra Leone on Thursday started a nationwide rollout of the single-dose Ebola vaccine, the first such campaign in West Africa, where a deadly outbreak 10 years ago resulted in the death of thousands.

The 2014 Ebola outbreak — the deadliest in history — was primarily in West Africa but affected Sierra Leone the most, with nearly 4,000 deaths out of the more than 11,000 recorded globally. The country also lost 7% of its health care workforce to the outbreak.

The nationwide vaccine campaign, implemented by the government in partnership with the global vaccine alliance Gavi, the World Health Organization and the United Nations children’s agency, will target 20,000 front-line workers across the country, officials said.

“This is an investment in the safety of our people and a healthier Sierra Leone,” Health Minister Austin Demby said.

There had been no approved vaccine at the time of the 2014 outbreak, which recorded up to 28,000 cases, starting in Guinea before spreading across land borders to Sierra Leone and Liberia, the other two countries affected the most.

Three years have passed since the last case was recorded in Guinea, although officials have spoken of remaining threats in endemic regions.

Among those killed by the disease during the 2014 outbreak were nine relatives of Hassan Kamara, a resident of Freetown. Of the 11 people he was living with at the time, only he and his baby daughter survived.

“They died in front of me,” he said. “I feel bad sometimes speaking about this because of what I went through.”

Thursday’s campaign, which launched in the capital, Freetown, was welcomed by health workers.

Collins Thomas, a community health worker in Freetown, remembers losing many colleagues in 2014 as they managed patients during the outbreak in Freetown.

“It was scary, because we knew nothing about the disease and learned along the line. With this vaccine, we know we are protected,” Thomas said.

Gavi Chief Executive Sania Nishtar said the organization is “incredibly proud” of how its support for timely and equitable access to vaccines has helped save lives and protect communities.

“To have the first nationwide preventive vaccination campaign take place in the country most deeply impacted by the 2014 outbreak makes this historic milestone even more meaningful,” he said.
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WASHINGTON — The Supreme Court is hearing arguments Wednesday in just its second major transgender rights case, which is a challenge to a Tennessee law that bans gender-affirming health care for minors.

The justices’ decision, not expected for several months, could affect similar laws enacted by 25 other states and a range of efforts to regulate the lives of transgender people, including which sports competitions they can join and which bathrooms they can use.

The case is coming before a conservative-dominated court after a presidential election in which Donald Trump and his allies promised to roll back protections for transgender people.

There were dueling rallies outside the court in the hours before the arguments. Speeches and music filled the air on the sidewalk below the court’s marble steps. Advocates of the ban bore signs like “Champion God’s Design” and “Kids Health Matters,” while the other side proclaimed “Fight like a Mother for Trans Rights” and “Freedom to be Ourselves.”

Four years ago, the court ruled in favor of Aimee Stephens, who was fired by a Michigan funeral home after she informed its owner that she was a transgender woman. The court held that transgender people, as well as gay and lesbian people, are protected by a landmark federal civil rights law that prohibits sex discrimination in the workplace.

The Biden administration and the families and health care providers who challenged the Tennessee law are urging the justices to apply the same sort of analysis that the majority, made up of liberal and conservative justices, embraced in the case four years ago when it found that “sex plays an unmistakable role” in employers’ decisions to punish transgender people for traits and behavior they otherwise tolerate.

The issue in the Tennessee case is whether the law violates the equal protection clause of the 14th Amendment, which requires the government to treat similarly situated people the same.

Tennessee’s law bans puberty blockers and hormone treatments for transgender minors, but not “across the board,” lawyers for the families wrote in their Supreme Court brief. The lead lawyer, Chase Strangio of the American Civil Liberties Union, is the first openly transgender person to argue in front of the justices.

The administration argues there is no way to determine whether “treatments must be withheld from any particular minor” without considering the minor’s sex.

“That is sex discrimination,” Solicitor General Elizabeth Prelogar wrote in her main court filing.

The state acknowledges that the same treatments that are banned for transgender minors can be prescribed for other reasons. But it rejects the claim that it is discriminating on the basis of sex. Instead, it says lawmakers acted to protect minors from the risks of “life-altering gender-transition procedures.”

The law “draws a line between minors seeking drugs for gender transition and minors seeking drugs for other medical purposes. And boys and girls fall on both sides of that line,” Tennessee Attorney General Jonathan Skrmetti wrote in the state’s Supreme Court brief.

While the challengers invoke the 2020 ruling in Bostock v. Clayton County for support, Tennessee relies on the court’s precedent-shattering Dobbs decision in 2022 that ended nationwide protections for abortion and returned the issue to the states.

The two sides battled in their legal filings over the appropriate level of scrutiny the court should apply. It’s more than an academic exercise.

The lowest level is known as rational basis review and almost every law looked at that way is ultimately upheld. Indeed, the federal appeals court in Cincinnati that allowed the Tennessee law to be enforced held that lawmakers acted rationally to regulate medical procedures, well within their authority.

The appeals court reversed a trial court that employed a higher level of review, heightened scrutiny, that applies in cases of sex discrimination. Under this more searching examination, the state must identify an important objective and show that the law helps accomplish it.

If the justices opt for heightened scrutiny, they could return the case to the appeals court to apply it.

Gender-affirming care for youth is supported by every major medical organization, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association.

But Tennessee is pointing to health authorities in Sweden, Finland, Norway and the United Kingdom that found the medical treatments “pose significant risks with unproven benefits.”

None of those countries has adopted a ban like the one in Tennessee, and individuals can still obtain treatment, Prelogar wrote in response.

The Williams family of Nashville, Tennessee, are among those challenging the state law. Brian Williams said that because of puberty blockers and hormone treatments, his transgender daughter, L.W., is a “16-year-old planning for her future, making her own music and looking at colleges.”

But because of Tennessee’s ban, she has to travel to another state to receive the health care that “we and her doctors know is right for her.”
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In Zambia, an education and prevention program known as the Total Control of the Epidemic project is focused on ending AIDS as a public health threat by 2030. Kathy Short reports from Petauke, Zambia. Camera: Jawadu Sumaili
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