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Tag: short term

  • A Lifelong Project: Staying True to Your Mission in a Quick Fix World

    A Lifelong Project: Staying True to Your Mission in a Quick Fix World

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    In a world that rewards short-term thinking and instant gratification, staying true to a long-term mission is becoming increasingly rare. In this personal reflection, I share the challenges and rewards of dedicating 15 years to The Emotion Machine, and why fighting the temptation of rapid success is key to building something truly meaningful and lasting.

    When I first started this website in 2009, I told myself it was a lifelong project that I could continue to build on until the day I died. Fifteen years later, I still stubbornly hold onto this belief, but I underestimated the difficulty of this commitment.

    Our current society does not reward long-term thinking. We are taught to live in the moment, take what is right in front of you, and indulge in what is comfortable and convenient; not in what is meaningful, but hard.

    This short-term attitude has taken over all of our society from business to politics to relationships.

    It’s rare to see someone think on a long timeline, especially 10, 20, 50, or 100 years into the future. In many ways, our brains aren’t wired to think on this scale; but we’re capable of doing it, and developing real foresight and concern about the future is a necessary ingredient to almost all human greatness.

    But who is really thinking about the future today?

    Companies focus on their daily stock prices and quarterly earnings, politicians focus on their election seasons, new relationships are just one swipe away on a dating app, and modern work has become increasingly focused on gigs and temporary contracts.

    Today, it’s rare to see anyone committed to anything for over 10 years, whether it’s a career, a relationship, a creative hobby, or a personal goal.

    It’s not completely our faults. Our current world incentives this short-term thinking by promoting hedonism (“give pleasure now”), materialism (“money is the most important thing”), and nihilism (“nothing really matters because eventually I’ll die.”)

    All of these beliefs and attitudes come together to create an epidemic of shortsightedness and selfishness, which ultimately lead to a lack of real meaning and purpose. This is not just an individual problem, but a systemic problem that permeates our society and institutions on almost every level.

    Where are the long-term visions?

    Our society lacks long-term vision and it manifests itself in countless ways. One example I know from firsthand experience is short-term thinking within the online creator “self help” spaces.

    As someone who has been writing and sharing content for over a decade, I’ve seen thousands of other websites, blogs, and social media accounts come and go. Many of them get really hyped up on some version of “become your own boss” or “I’m going to be an influencer”-type mindset, and then give up after a couple months of disappointment.

    One fundamental problem is they weren’t ever emotionally invested in what they were building. Their work wasn’t driven by a long-term vision or deep-seated convictions, they were solely interested in what they perceived as an easy and convenient way to get popular or make money.

    Once again, materialism shows its weakness. Money can be a bad motivator – even a destructive one – when it clashes with certain goals that require you to think beyond a mere trader mindset to achieve. If you are only motivated by money, then you are at the whims of money. If you are motivated by something deeper, then it takes more than money (or lack of) to stop you.

    This same attitude reveals itself within a lot of startup and tech companies. Many of today’s entrepreneurs start new companies or new projects just so they can sell it to a bigger corporation in a couple years. They don’t build things from cradle-to-grave anymore. They don’t care about creative ownership of their projects, or what happens to what they’ve built when it reaches the marketplace, they just see these projects as vehicles for quick bucks and rapid exits.

    Fighting the allure of rapid and cheap success

    Over the years I’ve had many opportunities to abandon the mission of this website for quick personal gain, but I chose not to.

    I’ve rejected numerous money-making opportunities because I felt they jeopardized the integrity of the website, from paid sponsorships, to SEO backlinks, to advertisements, to having tempting offers to buy the website outright.

    In theory, I could sell this website overnight and it would be a massive financial relief to me, especially as costs of living increase and more people experience economic hardship and debt-based living.

    These are difficult temptations I wrestle with. This world incentives short-term thinking and immediate rewards. I have to remind myself on a daily basis what my core values are.

    I imagine my life if I sold this website. Sure, it takes care of financial problems and it gives me more free time. I definitely have other goals and passions that I could put more energy into like music or screenwriting, but it’s also walking away from fifteen years of blood, sweat, and tears. That’s an emotional investment that is hard to rebuild with anything.

    Most importantly, there’s more work to do. I still have hundreds of ideas and drafts for future articles that I need to write and publish. There’s still more to say – and I feel like I’d be doing a disservice to the world if I didn’t say it.

    I look around the self help space today and believe my work still adds something special and valuable.

    Building an evergreen website

    Fifteen years isn’t that long compared to the timescale I’m thinking on.

    All of the content on this site is designed to be evergreen, so someone can read an article a hundred years into the future and still take something valuable from it. In contrast, the majority of content on the internet that is focused on news, pop culture, or current events is barely relevant after a week.

    From an intergenerational perspective, The Emotion Machine could be a website that exists long after my death if I can find someone to pass it down to as a successor at some point. I would love for it to be an ongoing project. Our tagline is “Self Improvement in the 21st Century” so I’m at least thinking on a one hundred year scale. I’ll have to remember to update that in 2100.

    To be completely honest, I’m proud of the work accomplished here so far, even when I feel it isn’t fully appreciated. This site has a vast library of articles, quizzes, and worksheets, and while I find that most people (including monthly members) don’t fully take advantage of these resources, I know they stand on their own as evergreen education for whomever is willing to learn.

    A lifetime commitment

    This article is a declaration to myself more than anything. It’s been a tough year so far and I needed to remind myself what really matters to me and why I invest my energy in the things I do. People like you also help keep me going, especially those that join and support this work. Thank you.


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    Steven Handel

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  • The Ozempic Revolution Is Stuck

    The Ozempic Revolution Is Stuck

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    Millions more Americans are now eligible for obesity drugs. But the injections remain maddeningly hard to find.

    Illustration by The Atlantic. Source: Getty.

    The irony undergirding the new wave of obesity drugs is that they initially weren’t created for obesity at all. The weight loss spurred by Ozempic, a diabetes drug in the class of so-called GLP-1 agonists, gave way to Wegovy—the same drug, repackaged for obesity. Zepbound, another medication, soon followed. Now these drugs have a new purpose: heart health.

    On Friday, the FDA approved the use of Wegovy for reducing the risk of heart attack, stroke, and death in adults who are overweight and have cardiovascular disease. The move had been anticipated since the publication of a landmark trial in the fall, which showed the drug’s profound effects on cardiovascular  health. The decision could usher in a new era where GLP-1 drugs become mainstream, opening up access to millions of Americans who previously didn’t qualify for Wegovy.

    Some of the obstacles stopping people from getting the drug may also begin to crumble. Insurance companies commonly deny coverage of Wegovy because obesity is seen as a cosmetic concern rather than a medical one, but that argument may not hold up for cardiovascular disease. “This new FDA indication is HUGE,” Katherine Saunders, an obesity-medicine physician at Weill Cornell Medicine, told me in an email. Wegovy may soon be within reach for many more Americans—that is, if they can find it.

    In practice, Wegovy is maddeningly hard to get hold of. Shortages of injectable semaglutide, the active ingredient in Wegovy and Ozempic, have been ongoing since March 2022; currently, most doses of Wegovy are in limited supply. As the popularity of semaglutide has skyrocketed, demand has completely outstripped the capacity of its manufacturer, Novo Nordisk. The drug comes in injection pens containing a glass vial; “these are not easy products to make,” Lars Fruergaard Jørgensen, the CEO of Novo Nordisk, said in August. In response to the shortages, the company withheld its supply of lower Wegovy doses last year. Because treatment on the medication must begin in low doses, this meant that new patients who wanted to start on Wegovy functionally couldn’t. In January, the company began “more than doubling the amount of the lower-dose strengths” of the drug, a Novo Nordisk spokesperson told me, and it plans to gradually increase overall supply throughout the rest of the year.

    The ongoing shortages have left providers and patients feeling stuck. “It is devastating to prescribe a lifesaving medication for a patient and then find out it’s not covered or we can’t locate supply,” Saunders said. Doctors are scrambling to make do with what’s available. Ivania Rizo, an endocrinologist at Boston Medical Center, told me she has had to turn to older GLP-1 drugs such as Saxenda to “bridge” patients to higher doses of Wegovy, although now that is in shortage too. Patients can spend each day calling pharmacy after pharmacy in search of one with Wegovy in stock, Rizo said. In desperation, some have turned to versions of the drug that are custom-made by compounding pharmacies with little oversight, despite the FDA expressing concerns about them. The shots are supposed to be taken weekly, but others have attempted to stretch their doses beyond that.

    That the new FDA approval could very mainstream obesity drugs may create long-needed pressure to help resolve these shortages. It makes clear that Wegovy is a lifesaving medication not only for people with obesity but also for those with cardiovascular disease—the leading cause of death in the U.S.—putting the impetus on Novo Nordisk to ramp up production. But in the short term, the access issues may persist. “The new approval is very likely to worsen shortages, because the demand for Wegovy will continue to climb—now at an even faster pace,” Saunders said.

    If patients think they’re stuck now, they’re about to feel entrenched. Wegovy is the only obesity drug that has been approved to reduce the risk of heart attacks, but none of its competitors is easily available either. Supplies of certain dosages of Eli Lilly’s Mounjaro, a diabetes drug whose active ingredient is sold for obesity as Zepbound, are limited, and shortages are expected later this year. “We need supply to increase dramatically,” Saunders said. Both Novo Nordisk and Eli Lilly have invested heavily in expanding production capacity, but some of the new plants won’t open until 2029.

    For all of its advantages, the FDA approval has a sobering effect on the unrelenting hype around GLP-1s. So much of the excitement around obesity drugs has focused on the future, as dozens of pharmaceutical companies develop more powerful drugs, and commentators imagine a world without obesity. In the process, the issues of the present have gone overlooked. More drugs won’t make much of a difference if the drugs themselves are out of reach.

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    Yasmin Tayag

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  • Hypnosis Could Work Wonders on IBS

    Hypnosis Could Work Wonders on IBS

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    The change in Zack Rogers was sudden. In the middle of his 12th birthday party, his stomach started hurting. He went to bed early that night, missing much of his own slumber party, and then stayed home from school the whole next week. The stomach pain was excruciating, and he couldn’t keep any food down. He lost 40 pounds in just a few weeks.

    Zack spent the next three years in and out of hospitals and trying medicines that didn’t seem to work. His doctors eventually told the family that they had only one option: surgery to remove large parts of his damaged colon. But Zack’s mom, Angela Rogers, wasn’t on board. She had lost faith in his medical team and feared such an invasive step, so she asked another gastroenterologist for a second opinion. The new doctor suggested that Zack try one last treatment before surgery: hypnotherapy, in which a clinical professional helps a patient become deeply focused and relaxed in order to change their patterns of thinking.

    This time, the change was gradual, but no less dramatic. In the evening after his first hypnotherapy session, Zack felt nauseated but kept his dinner down. Over the next few weeks, he stopped throwing up in school and regained the stamina to play basketball and go for bike rides. Today, Zack is a freshman in college, living away from home—something he wouldn’t have thought was possible before he was hypnotized. “If I never did hypnosis,” he told me, “I would be a complete mess. I genuinely don’t know where I would be.”

    As far-fetched as it may seem, science supports the idea that digestive disorders can be treated with psychological interventions, including hypnosis. Research dating back to the 1980s suggests that, at least in the short term, hypnotherapy can be an effective treatment for irritable bowel syndrome, a gut disorder characterized by painful gastrointestinal symptoms but no visible damage to the gut. Now scientists are investigating whether it might also bring relief to patients with inflammatory bowel disease, who, like Zack, have observable damage to their digestive tract.

    Although hypnosis is a powerful relaxation tool on its own, in clinical settings, it’s most often combined with other, better-studied psychotherapy techniques, such as cognitive behavioral therapy. Research suggests that CBT, which is commonly used to treat conditions such as depression and anxiety, can also be helpful in the treatment of gastrointestinal disorders.

    Read: I got hypnotized over Skype and it actually worked

    Unlike CBT, hypnosis retains a reputation for quackery, and is regularly portrayed in pop culture and stage shows as a tool for exercising control over participants—willing or otherwise. And some practitioners do use it for debunked treatments, including recovered memory therapy. But whether hypnotherapy is legitimized as a medical tool has real stakes. Hypnosis practitioners believe—and there’s some research to back this up—that the technique may amplify the effectiveness of more well-established psychological interventions and therefore has the potential to provide rare benefit to patients

    Hypnosis has a long history as a pain reliever. In the first half of the 19th century, before anesthetics were widely available, some surgeons hypnotized their patients. Even today, hypnosis proponents claim that it may be an effective alternative treatment for chronic back pain and the stress of childbirth; a growing body of research suggests that hypnosis can be a cost-effective and side-effect free analgesic for some people with chronic pain, though good clinical data are hard to come by.

    The first randomized controlled trial of hypnotherapy for IBS was published in 1984. Among the participants—a small group of mostly female patients with severe, treatment-resistant disease— those who received hypnotherapy showed greater improvements in abdominal pain, bloating, and bowel function than those who received psychotherapy plus a placebo medication. A 2014 meta-analysis found that about half of IBS patients who try hypnotherapy see at least short-term improvements in their symptoms.

    Read: The rogue theory that gravity causes IBS

    The evidence for hypnotherapy isn’t as robust in the treatment of IBD, which is really an umbrella term for ulcerative colitis (Zack’s diagnosis) and Crohn’s disease. But there’s reason to believe that hypnosis could yield similar success in addressing symptoms of those conditions. The line between IBD and IBS can be murky; more than a quarter of IBD patients in remission have IBS as well. And although the evidence is still mixed—a study published in 2021, for example, found no difference in treatment outcomes between standard medical treatments and hypnotherapy—some early evidence suggests that hypnotherapy can also reduce inflammation in patients with ulcerative colitis. One small study found that just one session of hypnotherapy reduced ulcerative-colitis patients’ blood levels of several inflammatory markers.

    Perhaps most important, a large body of research shows a strong link between cognition and digestion. Millions of neurons, collectively known as the enteric nervous system, regulate our digestion and are in constant communication with the central nervous system. This connection, called the “brain-gut axis,” may be why we feel so many emotions in our gut, whether the butterflies of anxiety or the clench of anger. It might also explain why both anxiety and depression are more common among patients with IBD compared with the general population. “Unequivocally, stress plays a major role in any digestive disease,” Gary Lichtenstein, a gastroenterology professor and the director of the Inflammatory Bowel Disease Center at the Hospital of the University of Pennsylvania, told me.

    When this brain-gut axis gets out of whack, it’s known to worsen some digestive disorders. In patients with gastrointestinal issues, the tissues in the gut can become hypersensitive over time. The brain learns to interpret signals from the gut, including normal functioning, as discomfort. This faulty communication results in what experts now call disorders of gut-brain interaction (DGBIs), which include IBS, functional dyspepsia, and other digestive disorders (but not IBD). Hypnosis, proponents say, can help patients rewire the cognitive-digestive connection. In many IBS and IBD cases, “we know there’s a mind-gut connection that can only be helped by a mental-health expert,” says Mark Mattar, a gastroenterologist and director of the IBD center at MedStar Georgetown University Hospital.

    Read: When gut bacteria change brain function

    Mattar works closely with Ali Navidi, the clinical psychologist to whom Zack was referred in 2020. Navidi told me that at his practice, GI Psychology, 83 percent of patients with DGBIs who complete at least 10 hypnotherapy sessions achieve their treatment goals, which usually amount to reducing pain, bloating, and other uncomfortable symptoms enough to go about their day-to-day life. His data are unpublished but in line with other studies on IBS showing that more than 80 percent of patients who get gut-directed hypnotherapy as part of their treatment plan experience improvements in pain and other GI symptoms. Those numbers are even higher among children and adolescents.

    Such findings persuaded the American College of Gastroenterology to recommend gut-directed psychotherapies—including hypnosis and CBT—for the treatment of IBS symptoms in its 2021 guidelines. Still, even among IBS patients, they’re not commonly used. No one appears to have studied the popularity of hypnosis specifically among IBS patients, but a 2017 study found that only 15 percent of people diagnosed with IBS had ever pursued “psychological therapies” of any kind.

    For many patients who follow through with hypnotherapy, the experience is not what they expect. Patients may conflate clinical hypnosis with entertainment hypnosis, where subjects quack like a duck or forget their own name. But at practices like Navidi’s, the therapist instead focuses on helping the patient enter a trance state—the same type of consciousness we all experience when we lose track of time working, scrolling Instagram, or driving and suddenly arriving at our destination. “When we’re in a trance, we have this intense, focused concentration, and that can be used in powerful ways,” Navidi said.

    Once the patient is in a trance state, therapists use guided imagery and suggestion to target specific gastrointestinal symptoms. “People get into a very relaxed state, and in that state I start to make suggestions about how the brain and the gut can work together better,” Jessica Gerson, a psychologist at NYU Langone’s Inflammatory Bowel Disease Center, told me. Gerson instructs her IBD patients to imagine the lining of their intestines healing. During his trance states, Zack was able to envision a control room for his pain in which he could dial knobs up and down. “I could turn the stomach pain down to a one or a zero, and it would go away,” Zack recalled recently, a note of surprise still in his voice.

    Read: Can you quit smoking through hypnosis?

    Many patients initially fear that during hypnosis they are ceding control of their mind and body to the hypnotherapist, Gerson told me. But patients are always “totally conscious, totally in control.” Indeed, Navidi and Gerson use this trance state to show patients exactly how much control they have over their own body. “Having a sense of agency is therapeutic,” Gerson said.

    These days, many gastroenterologists see psychotherapies like hypnosis as an important part of a holistic treatment plan—even for IBD. (IBD patients who do respond to hypnotherapy are likely to continue to need medical monitoring and interventions, Lichtenstein said.) While gut-directed hypnotherapy still hasn’t been proved to help IBD patients without co-occurring IBS symptoms, there’s not much of a downside to trying. The experts I spoke with agreed that hypnosis is relatively risk-free as long as it is administered by a clinician, patients continue to be monitored by their medical doctors, and therapists screen potential patients for severe mental illness and untreated trauma. Patients, too, need to consider whether they can afford hypnotherapy. Like many mental-health services, it’s not always covered by insurance. Zack’s sessions were $265 each out of pocket, but according to Angela, “it was worth every cent and then some.”

    Zack remembers getting stressed out a lot as a kid—over grades, making friends, basketball games, or nothing in particular. He credits Navidi with alleviating not only his stomach pain but also the relentless anxiety; he still uses the relaxation techniques he learned from Navidi when he gets worried about school or a basketball game.

    Read: Reiki can’t possibly work. So why does it?

    Zack is still on medication for his ulcerative colitis; every eight weeks he has an injection of Stelara, a medication that works by blocking inflammatory proteins. But after two years of appointments with Navidi, for the first time since his 12th birthday, his symptoms are reliably under control—and stress doesn’t make them come roaring back. He hasn’t had a flare up in about a year and a half. Most days, he doesn’t think about his diagnosis at all.

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    Kate Wheeling

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  • Why the Fifth Circuit Keeps Making Such Outlandish Decisions

    Why the Fifth Circuit Keeps Making Such Outlandish Decisions

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    Where to even start in cataloging the most ridiculous—and alarming—recent rulings to come out of the U.S. Court of Appeals for the Fifth Circuit?

    There’s a case about whether a class action could go forward that boiled down to a dispute among three Fifth Circuit judges over the meaning of a Bible verse. There’s a case in which the Fifth Circuit allowed three doctors to sue the FDA over a tweet intended to discourage ivermectin use that read, “You are not a horse. You are not a cow. Seriously, y’all. Stop it.” There’s a case in which the Fifth Circuit barred the Biden administration from requiring Navy SEALs to be vaccinated against COVID, because the court’s conception of religious liberty supersedes the military’s need for frontline troops to be healthy. There’s a case in which the Fifth Circuit held that the way Congress funds the Consumer Financial Protection Bureau (a mechanism Congress has regularly used since America’s founding) is unconstitutional because Congress only imposed a limit on the appropriation, rather than putting a precise dollar figure on it. There’s the Fifth Circuit’s repeated insinuation that individual district judges, rather than the Biden administration, are better situated to supervise and direct federal immigration policy. There’s … you get the idea. When the hosts of the popular Strict Scrutiny podcast devoted an entire hour-long episode to flagging especially problematic Fifth Circuit rulings, they ran out of time.

    The Fifth Circuit is the federal appeals court covering Louisiana, Mississippi, and Texas (where I live), and it has in recent years become the place where just about every right-wing litigant who can brings lawsuits to test novel and extreme legal arguments. It’s not that a disproportionate percentage of major legal issues are arising in those three states; it’s that conservative and right-wing litigants are deliberately steering disputes to a handful of sympathetic district judges in Texas, from where they know that any appeal will go to the Fifth Circuit—whose judges are far more likely than others in the country to take their side.

    A nationwide challenge to the FDA’s approval of mifepristone? Filed in Amarillo. Nationwide challenges to the Biden administration’s immigration policies? Filed in Victoria. Elon Musk’s new (and laughably weak) lawsuit against Media Matters, which has no geographic connection to the Fifth Circuit whatsoever? Filed in Fort Worth. These aren’t exactly destinations for vacations, but they’re the typical destinations today for overwhelming majority of litigation with an obvious rightward ideological or partisan tilt.

    Back in April, David A. Graham wrote in The Atlantic about the rise of “total politics”—where our political institutions have gravitated away from behaving with prudence in favor of scoring short-term political points. All that matters is #winning, long-term institutional consequences be damned.

    The decision that could end voting rights

    As alarming a development as that is in the context of the democratically elected branches (where voters could at least theoretically push back), it’s even worse when it comes from unelected judges—whose legitimacy depends on at least a loose public belief in their prudence. And especially when these rulings have consequences far outside the borders of its three states, the Fifth Circuit’s run of sweeping decisions undermines public faith in the federal judiciary nationally—not just from the eastern border of New Mexico to the western border of Alabama.

    What the Fifth Circuit is doing is participating in an extraordinary power grab, indifferent to the procedural rules that are supposed to constrain the powers of unelected judges. For instance, the Fifth Circuit regularly holds that challengers to whom it is sympathetic have standing—the right to bring a suit—in contexts in which the Supreme Court has, for decades, held to the contrary.

    The judges do this not because they have an unusually capacious approach to standing; they routinely reject the standing of plaintiffs to whom they are less sympathetic. Rather, they bend over backwards to take procedural shortcuts when they want to rule on the merits, such as in the challenges to the Biden administration’s proposed requirement that large employers require COVID vaccinations or regular tests. Even though the Fifth Circuit had only a 10 percent chance of winning the “inter-circuit lottery” that randomly assigns this type of dispute to a federal appeals court, it decided to jump the gun—issuing a premature decision, before the lottery took away its power, that the Biden rule was unlawful. (The Sixth Circuit, which “won” the lottery, quickly vacated the Fifth Circuit’s decision.)

    Moreover, the Fifth Circuit’s approach to both constitutional and statutory interpretation reflects a rather wooden application of even the conservative methodologies championed by the current Supreme Court. Consider the court of appeals’ ruling in United States v. Rahimi, in which the panel struck down a federal law barring people subject to domestic-violence-related restraining orders from possessing firearms. Even though the federal government offered numerous examples of founding-era laws that restricted firearm possession by “dangerous” individuals, the court of appeals rejected that analogy—concluding that domestic-violence restraining orders were too specific a subcategory of danger for the comparison to hold. (In another bizarre procedural move, the court subsequently amended its analysis although no party asked it to—perhaps in response to some of the public criticisms that had emerged.)

    The same cherry-picking of historical examples can be found in the CFPB case, in which the court of appeals either ignored or unpersuasively distinguished countless historical examples of similar congressional-funding statutes. When, at the recent Supreme Court oral argument in the case, Justice Samuel Alito tried to defend the Fifth Circuit’s efforts, U.S. Solicitor General Elizabeth Prelogar sarcastically conceded that, at the very least, none of those examples involved an agency with the same name.

    The Supreme Court’s extreme power grab

    The Fifth Circuit’s approach to statutory interpretation has been just as transparently results-oriented. One especially notorious example is the court’s conclusion that the Nuclear Regulatory Commission lacks the statutory power to promulgate rules for the temporary storage of spent nuclear fuel—at least in part because the court determined that the Atomic Energy Act didn’t clearly delegate such authority. But if the NRC isn’t authorized to provide for the temporary storage of nuclear waste, who is? (The court’s opinion doesn’t say.)

    The upshot of these statutory holdings is not, as some of the court’s judges have insisted, to return power to Congress; it’s to frustrate federal regulation in general—because even a functioning Congress (to say nothing of the current one) would have neither the time nor the wherewithal to legislate with the amount of subject-matter specificity that the Fifth Circuit demands.

    Throughout these decisions, the Fifth Circuit has shown a remarkable lack of regard for the Supreme Court—which not only keeps reversing it, but keeps granting emergency relief in cases in which the Fifth Circuit refused to do so, or vacating emergency relief that the Fifth Circuit agreed to provide. Take just three examples: After a federal judge blocked a controversial Texas law barring most content moderation by social-media providers, the Fifth Circuit unblocked it pending appeal, only to have the Supreme Court step in to put the law back on hold. Even though the Supreme Court’s intervention signaled that at least five justices were likely to side with the district court and conclude that the Texas law was unconstitutional, the Fifth Circuit went ahead and decided that the Texas law was kosher.

    A similar story unfolded in the mifepristone case—where the Supreme Court issued a stay of Judge Matthew J. Kacsmaryk’s ruling (which would have massively limited nationwide access to the abortion pill), after the Fifth Circuit had refused to do so. Once again, the Supreme Court sent a pretty clear message that Kacsmaryk’s ruling was not likely to survive, but the Fifth Circuit affirmed it on the merits anyway. And just last month, the Fifth Circuit struck down the Biden administration’s rule limiting the distribution of “ghost guns,” even though the Supreme Court intervened twice earlier this summer to put the rule back into effect after the Fifth Circuit had blocked it. So far this term, the Supreme Court has granted emergency relief three times. Not only did all three of those cases come from the Fifth Circuit; in all three, the Fifth Circuit had gone the other way.

    This disregard for the Supreme Court has the ironic effect of making the justices look more moderate. Last term, for example, the Supreme Court reversed the Fifth Circuit in seven of the nine cases it reviewed—the highest rate for any lower court in the country. A similar theme is likely to emerge from this term, in which as many as 20 percent of the cases the justices decide are likely to come from Louisiana, Mississippi, and Texas, and most are likely heading for reversal. The point is not that the Supreme Court is less ideologically extreme than its critics charge; it’s that the Court is less ideologically extreme than the Fifth Circuit. These days, that’s not saying all that much.

    Even conservative scholars have started expressing alarm about these trends. In the November issue of the Harvard Law Review, the professors William Baude and Samuel Bray warned that “we have arrived, for the first time in our national history, at a state of affairs where almost every major presidential act is immediately frozen” by federal courts—most commonly in the Fifth Circuit—forcing the Supreme Court to step in at premature stages. In their words, “This is bad law and bad democracy. It cannot go on forever.”

    The care and feeding of Supreme Court justices

    But whereas conservative scholars have begun to raise concerns about these developments, the Supreme Court, which has not been shy about chastising misbehaving lower courts in the past, has thus far been mum. The lack of rebuke may explain why some Fifth Circuit judges are leaning into their newfound infamy. One of the court’s most visible judges, James Ho, regularly lectures law-school audiences about the importance of judicial “courage”—that judges shouldn’t shy away from unpopular opinions.

    Ho’s not-so-subtle message is that criticism is actually evidence of good judicial rulings; in his world, there’s no such thing as bad publicity. But whether this is what these judges truly believe or just how they think they need to behave in order to have any shot at a Supreme Court nomination in a future Republican presidency, the bottom line is the same: The Fifth Circuit is the bull in the rule-of-law china shop—and it seems remarkably indifferent to what happens to public faith in the judiciary when it keeps breaking things.

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    Stephen I. Vladeck

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  • The Republicans Have No Majority

    The Republicans Have No Majority

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    Mike Johnson now knows what Kevin McCarthy was dealing with.

    At the new speaker’s behest, House Republicans today relied on Democratic votes to avert a government shutdown by passing legislation that contains neither budget cuts nor conservative policy priorities. The bill was a near replica of the funding measure that McCarthy pushed through the House earlier this fall—a supposed surrender to Democrats that prompted hard-liners in his party to toss him from the speakership.

    Johnson is unlikely to suffer the same fate, at least not yet. But today’s vote laid bare a reality that’s become ever more apparent over the past year: Republicans may hold more seats than Democrats, but they don’t control the House.

    Under McCarthy and now Johnson, Republicans have been unable to pass just about any important legislation without significant help from Democrats. The three most consequential votes this year have been the spring budget deal that prevented a catastrophic U.S. debt default, September’s stopgap spending bill that averted a shutdown, and today’s proposal that keeps the government funded through early 2024. More Democrats than Republicans have voted for all three measures.

    Read: Kevin McCarthy finally defies the right

    GOP leaders have struggled to pass their own proposals on spending bills, leaving the party empty-handed in negotiations with the Democratic-led Senate and the Biden administration. Like McCarthy before him, Johnson pledged that Republicans would advance individual appropriations bills to counter the Senate’s plans to combine them into legislative packages that are too big for lawmakers to adequately review. But in the past week, he’s been forced to scrap votes on two of these proposals because of Republican opposition.

    McCarthy surrendered to Democrats in late September after his members refused to pass a temporary spending bill containing deep cuts and provisions to lock down the southern border. When it was his turn, Johnson didn’t even bother to try a conservative approach. On Saturday, he unveiled a bill that maintains current spending levels—enacted by Democratic majorities in 2022—for another two months. He did not include additional funding for either Israel or Ukraine, nor did he include any policy provisions that might turn off Democrats. Johnson’s only wrinkle was to create two different deadlines for the next funding extension; funding for some departments will run out on January 19, while money for the rest of the government, including the Defense Department, will continue for another two weeks after that.

    The Louisiana Republican said that the dual deadlines would spare Congress from having to consider a trillion-dollar omnibus spending package right before Christmas, as it has done repeatedly over the past several years. “That is no way to run a railroad,” Johnson said this morning on CNBC. “This innovation prevents that from happening, and I think we’ll have bipartisan agreement that that is a better way to do it.”

    Johnson’s decision to avoid a partisan shutdown fight seemed to catch Democrats off guard. The White House initially slammed his proposal, but once party leaders on Capitol Hill realized that the spending bill contained no poison pills, they warmed to it. Democratic support became necessary once it was clear that Republicans would not be able to pass the measure on their own. Conservatives couldn’t even agree to allow a floor vote on the proposal, forcing Johnson to bring it up using a procedure that ultimately required the bill to receive a two-thirds majority to pass.

    Republican hard-liners have been no more willing to compromise under Johnson than they were under McCarthy. The conservative House Freedom Caucus, which initially suggested the two-deadline approach, ultimately opposed the bill anyway. “It contains no spending reductions, no border security, and not a single meaningful win for the American People,” the group said in a statement. “While we remain committed to working with Speaker Johnson, we need bold change.”

    Buried in that final expression of support for Johnson was the first hint of a warning. Conservatives have given the untested speaker some leeway in his opening weeks. Even McCarthy received something of a grace period; when the speaker negotiated a debt-ceiling deal with President Joe Biden, conservatives voted against the bill but didn’t try to overthrow him. Hard-liners haven’t threatened to remove Johnson, but that could change if he keeps relying on Democratic votes. When McCarthy caved to Democrats on spending for the second time, he lost his job a few days later.

    The former speaker and his allies warned his GOP critics that his replacement would find themselves in the same position: managing a majority that isn’t large enough to exert its will. “I’m one of the archconservatives,” Johnson told reporters before the vote, trying to defend himself. “I want to cut spending right now, and I would have liked to put policy riders on this. But when you have a three-vote majority, as we do right now, we don’t have the votes to be able to advance that.”

    Read: ‘We put sharp knives in the hands of children’

    Johnson has now used up one of his free passes. The question is how many more he’ll get. In the coming weeks, the speaker will have to navigate a series of fiscal fights over funding for Israel, Ukraine, and the southern border. The bill that the House passed today buys Congress another two months to hash out its differences over spending, but it doesn’t resolve them. Johnson vowed not to agree to any more “short-term” extensions of federal funding, increasing the risk of a shutdown early next year. The speaker will also have to decide whether to press forward with an impeachment of Biden that could please conservatives but turn off Republicans in swing districts.

    In the meantime, frustrated lawmakers from both parties are racing to leave Congress. Since McCarthy’s ouster, nine members, five of them Republicans, have announced their plans to resign or forgo reelection. Many more are likely to do so before the end of the year. After fewer than two terms in the House, GOP Representative Pat Fallon of Texas even considered returning to his old seat in the state legislature, which Republicans have long dominated, before changing his mind today. The frustration extended to other corners of the House GOP. “We got nothing,” another Texas Republican, Representative Chip Roy, lamented to reporters yesterday.  He shouldn’t have been surprised. At the moment, Republicans in the House have a majority in name only.

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    Russell Berman

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  • Kevin McCarthy’s Defeat Could Cost Republicans the House

    Kevin McCarthy’s Defeat Could Cost Republicans the House

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    Few Americans are shedding tears for Kevin McCarthy. The former House speaker engendered little public sympathy as he tried, and ultimately failed, to wrangle a narrow and fractured Republican majority into a functioning governing body. His ouster on Tuesday has, in the short term, paralyzed Congress and increased the likelihood of a prolonged government shutdown in the coming weeks.

    Republicans are only now beginning to contemplate the significant political ramifications of tossing McCarthy. Retaining their narrow majority in the House next year was already going to be a challenge. But the GOP will now have to defend its four-seat advantage without a leader who, for all of McCarthy’s political shortcomings, was widely recognized as its best fundraiser, candidate recruiter, and campaign strategist. “They just took out our best player,” a rueful Representative Tom Cole of Oklahoma told me on Thursday, referring to the eight renegade Republicans who voted to remove McCarthy.

    Cole, the chair of the Rules Committee and a 22-year veteran of the House, was a McCarthy loyalist to the end. He could become his successor if neither of the declared GOP candidates, Majority Leader Steve Scalise and Representative Jim Jordan, the Judiciary Committee chair, are able to secure the votes needed to become speaker. Cole has declined offers to run for the job himself—he told me the chances that the gavel lands in his hands are “very low, and if I have anything to say about it, zero”—but as someone with good relationships across the party, he’s seen as a solid backup.

    For now, Cole is, like other McCarthy allies, still seething at the unprecedented vote to overthrow the speaker and is backing efforts to change the House rules so that whoever replaces McCarthy does not face the same ever-present threat. “We put sharp knives in the hands of children, and they used them,” Cole said.

    Read: Kevin McCarthy’s brief speakership meets its end

    In an hour-long phone interview, he told me that the hard-liners’ revolt against McCarthy could “very easily” cost the GOP its majority next year. “I think these guys materially hurt our chances to hold the majority,” Cole said. “That’s just the reality.”

    McCarthy is neither a policy wonk nor a brilliant legislator. But his strengths  were underappreciated, Cole said. Committees he controlled raised more than half a billion dollars for the House Republican majority in recent years. McCarthy has also played a leading role in persuading promising Republicans to run for pivotal House seats. “This guy was by far the best political speaker that I’ve seen,” he told me. (Democrats and more than a few Republicans would dispute that assertion, pointing to the fact that Republicans won a much slimmer majority under McCarthy’s leadership in 2022 than they were expected to.)

    “This is going to cost us candidates,” Cole said, and “God knows how much money.” The spectacle of an internal leadership war bringing the House to a halt also undercuts the GOP’s credibility as a governing party, he lamented. “They just messed up the House. They had no exit plan, no alternative strategy, no alternative candidate.”

    Both Jordan and Scalise are more conservative than McCarthy, as is a third potential candidate, Representative Kevin Hern of Oklahoma, who heads the Republican Study Committee, the GOP’s largest bloc of conservative members. None of them, however, can match McCarthy’s fundraising prowess. Cole told me he’s “leaning pretty strongly” toward Scalise, the second-ranking House Republican. Donald Trump has endorsed Jordan, but Scalise is nevertheless considered the favorite to win the party’s nomination for speaker in a secret ballot based on his years in the leadership and because he’s more palatable to Republicans in swing districts. The internal vote, expected next week, will test how much sway the former president has in a leadership battle that typically plays out more in private than in public. (GOP lawmakers reportedly recoiled at plans for Fox News to host a televised debate between the candidates, who normally make their pitches behind closed doors.)

    Scalise is well-liked within his party, but he’s undergoing treatment for blood cancer, which Cole acknowledged was a concern for some Republicans. “People are worried,” he said. “They’re worried that we’re going to put him in a job where he hurts himself.” In 2017, Scalise underwent several months of rehab after being shot by a would-be assassin targeting Republican lawmakers at a baseball practice.

    Jordan is by far the more bombastic of the two. A former college-wrestling champion, he helped found the House Freedom Caucus and made his name as a conservative foe of former Speaker (and fellow Ohioan) John Boehner. Jordan’s antagonism toward the leadership alienated many rank-and-file Republicans then, but he struck something of a truce with McCarthy, his onetime rival. McCarthy didn’t stand in the way of Jordan’s promotion to become the top Republican on first the House Oversight Committee and then on the Judiciary Committee, a perch from which he’s launched aggressive investigations into President Joe Biden and his son Hunter. Jordan returned the favor by backing McCarthy’s bid to become speaker, sticking by him during all 15 rounds of voting in January and during this week’s revolt.

    Peter Wehner: Kevin McCarthy got what he deserved

    Scalise would likely have an easier time than Jordan winning the 218 Republican votes needed to secure the speakership in the public House floor vote. Representative Matt Gaetz of Florida, who led the effort to topple McCarthy, has said he would support either candidate. Jordan’s close ties to Trump and his disdain for bipartisan compromise could make him a problem for politically vulnerable Republicans, particularly those from New York and California who represent districts that Biden carried in 2020. His nomination would also likely revive questions about his handling of allegations of sexual misconduct against a wrestling-team physician at the Ohio State University when Jordan served as a coach. Jordan has denied wrongdoing, but former student athletes have said he knew about the physician’s abuse and failed to report it.

    The scandal could haunt Republicans come election time if Jordan is the speaker, but the issue animating the leadership race is whether to, as Cole put it, “take away the knives” and restrict the procedural tool, known as the “motion to vacate,” that Gaetz used to remove McCarthy. “We’ve driven out three speakers now with this weapon,” Cole said. Boehner resigned in 2015 after it became clear that he might lose the speakership in a floor vote, and his successor, Paul Ryan, was under increasing pressure from his right flank when he chose to retire three years later.

    The Main Street Caucus, a coalition of more pragmatic and ideologically flexible Republicans, is pushing to change the rules, and a few members have said they’ll only support a candidate who promises to do so. Currently, any single lawmaker can force a vote on a motion to vacate. To raise that threshold, Republicans might need votes from Democrats, who refused to help rescue McCarthy. “I think it would get a lot of Democratic support,” Cole said. “We’d have to endure another hour of ‘I told you so.’ That’s fair enough.” Though he was critical of Democrats for voting to remove McCarthy, he said he understood why they did. “If we had the opportunity to take out [Nancy] Pelosi,” Cole said, “we probably would have done the same thing.”

    He recounted a conversation with a long-serving House Democrat, Representative Bill Pascrell of New Jersey, who alluded to worries that dissident Democrats could use the same tactic to oust a future speaker in their party. “We have our nuts too,” Cole recalled him whispering in an elevator. (Pascrell did not respond to a request for comment.)

    The outcome of the rules debate could determine when Republicans are able to elect a speaker, reopen the House, and repair the harm they’ve done to their chances in next year’s elections. For his part, Cole is hoping that whoever they choose can quickly win a majority in a floor vote next week. And if they don’t? “Then,” he said, “it’s really a chaotic situation.”

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    Russell Berman

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  • The New Pro-life Movement Has a Plan to End Abortion

    The New Pro-life Movement Has a Plan to End Abortion

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    The unpleasant reality facing the anti-abortion movement is that most Americans don’t actually want to ban abortion.

    This explains why the pro-life summer of triumph, after the U.S. Supreme Court overturned Roe v. Wade, led to a season of such demoralizing political outcomes. Voters in Montana, Kansas, and Kentucky in November rejected ballot measures to make abortion illegal; just last month, in Wisconsin, voters elected an abortion-rights supporter to the state supreme court.

    Yet the movement’s activists don’t seem to care. Thirteen states automatically banned most abortions with trigger laws designed to go into effect when Roe fell; a Texas judge this month stayed the FDA approval of the abortion pill mifepristone, setting in motion what is sure to be a drawn-out legal battle; and some lawmakers are pursuing restrictions on traveling out of state for the procedure—what they call “abortion trafficking.”

    Even as the anti-abortion movement lacks a Next Big Objective, a new generation of anti-abortion leaders is ascendant—one that is arguably bolder and more uncompromising than its predecessors. This cohort, still high on the fumes of last summer’s victory, is determined to construct its ideal post-Roe America. And it’s forging ahead—come hell, high water, or public disgust.

    The groups this new generation leads “are not afraid to lose short term if they think the long-term gain will be eliminating abortion from the country,” Rachel Rebouché, a family-law professor at Temple University, told me.

    One such leader is Kristan Hawkins, the president of the anti-abortion group Students for Life. After Dobbs v. Jackson Women’s Health Organization, “some organizations had to go through this period where they had to reflect and figure out what they were going to do,” she told me. “But nothing changed in our organization—we’d already had that conversation years ago.” Students for Life participants have been calling themselves “the post-Roe generation” since 2019; that’s the year they launched a political-action committee to beef up their state-level presence and begin drafting legislation for a post-Roe society. In 2021, the organization started the Campaign for Abortion-Free Cities to promote what they call “alternatives to abortion” and neighborhood resources for pregnant women.

    Read: What winning did to the anti-abortion movement

    “What the anti-abortion movement is, who’s leading it, and what it stands for are still being contested,” Mary Ziegler, a UC Davis law professor who has written about abortion for The Atlantic, told me. But organizations such as Students for Life will, in all likelihood, “be the ones running the movement going forward.” To understand the goals of people like Hawkins is, in other words, to peer into the future of America’s anti-abortion project.

    The thing about Hawkins is that she’s an optimist—and not a cautious one. So when the draft opinion suggesting that the Supreme Court was about to overrule Roe v. Wade leaked last May, she wasn’t particularly surprised, she told me—she felt vindicated. Other pro-lifers had refused “to let themselves even dare think that a post-Roe America was coming,” Hawkins said. “Of course it was.” She’d always assumed it would happen in her lifetime.

    As soon as the draft opinion came out, anti-abortion leaders began to consider their response. Some were worried that taking any kind of victory lap would be inappropriate—that it might scare the justices into moderating or reversing their ultimate decision. Hawkins didn’t care about any of that. “Why would we be guarded? It was important, good news!” she told me. “Folks across the country needed to see this generation celebrating.” Students for Life was one of the first anti-abortion organizations to release a statement praising the draft opinion—while being careful to condemn the leak itself.

    Hawkins, who is 37, styles herself as a straight shooter. She doesn’t dress up arguments with religious rhetoric—despite being Catholic herself—and she can be an effective, if sometimes abrasive, debater. Which makes sense, because she came to the pro-life movement through electoral politics. Hawkins knocked on doors for local and state Republican candidates; in college, she worked for the Republican National Committee to reelect President George W. Bush—and, for a year, she worked in his administration. Then, when Students for Life came looking for a new president in 2006, she eagerly accepted.

    Hawkins “saw the politics in this in ways a lot of people don’t,” Ziegler told me—and she brought that acumen to the movement. She knew how to lead a grassroots campaign, and how a state legislature functions. Then just 20, she was younger than other pro-life leaders, so she had a better idea of how to engage young people. Hawkins is trying, Ziegler said, “to grow the movement in a way that no one else really ever did.”

    The organization’s 14,000 participants campaign for state-level anti-abortion candidates and legislation in their local legislatures. Hawkins, who oversees a staff of 100 paid employees, spends her days traveling to meet with chapter leaders, organizing demonstrations, delivering speeches, and generally doing her best, as she put it to me, “to stir up discussion.” In March, during a visit to Virginia Commonwealth University, protesters shouted over Hawkins when she tried to speak. Demonstrators called her a Nazi and a fascist. Eventually, campus security shut down the event, and police arrested two protesters (who weren’t actually VCU students). Hawkins, who livestreamed the drama, later went on Fox News to offer a full account.

    The Students for Life YouTube channel has a 22-minute highlight reel called “Greatest Pro-Choice Takedowns,” in which Hawkins responds to questions from young, often-emotional abortion-rights advocates. As you might expect, the videos feel mean. In each clip showing Hawkins facing off against a different student with a shaky voice, she makes them look silly and ill-informed, a relatively easy thing to do when your opponent is not being paid to perfect her talking points. But these exchanges don’t seem intended to change minds; they’re meant instead to humiliate—and thereby reveal the purported weaknesses in abortion-rights arguments.

    Doggedness and moral conviction have always characterized the anti-abortion movement. Activists have sustained their energy for 50 years “by believing that success was possible, even in the absence of clear victories,” Daniel K. Williams, a history professor at the University of West Georgia, told me. Dobbs gave this new generation a taste of victory. Activists like Hawkins are bolder now. Without Roe, they reason, anything is possible.

    Daniel K. Williams: This really is a different pro-life movement

    Students for Life, in particular, is “more abolitionist than prior generations of similar groups,” Rebouché told me. In contrast to other organizations that have pursued incremental progress, the group adopts strategies that are “totalizing and absolute.” Throwing out the rule book, they operate as though they’ve got nothing to lose.

    “I admire their persistence; I admire their sacrifices,” Lila Rose, the president of the anti-abortion nonprofit Live Action, says of previous generations of anti-abortion activists. “But we’re playing to win. This isn’t just some nonprofit job.” Rose, who is 34, achieved early prominence in the movement back in 2006 for partnering with the conservative activist James O’Keefe to film undercover exposés at abortion clinics. Live Action doesn’t have the kind of nationwide membership that Students for Life has, but its email list contains more than 1 million contacts, Rose told me, and its social-media following runs into the millions.

    Students for Life and Live Action frame their anti-abortion efforts as not just saving babies but empowering women—enabling them to avoid the depression and regret the organizations say can be caused by having an abortion. These aren’t new ideas in themselves, but they’ve been repackaged in a way that mimics the language of a modern social-justice movement appealing to young people. “They’re using phrases like born privilege,” Jennifer Holland, a gender-and-sexuality professor at the University of Oklahoma, told me. “Language that’s hip—in the culture—but that still leads back to this one point of view that maybe you thought was old or conservative.”

    Historically, there’s been “a lack of vision” in the movement, Rose said. It was great, she allowed, that the National Right to Life Committee fought so hard in the 2000s to ban what they called “partial-birth abortion” (using a pro-life term not recognized by medical professionals). But, to Rose, pill-induced abortion is just as “anti-human and anti-woman”; a 15-week abortion limit is nothing to celebrate. “I don’t think that we do ourselves any favors as a movement by, like, walking over to the opponent’s side of the field and saying that that’s a victory.”

    Hawkins’s master plan to completely eradicate abortion in America begins with passing as many state controls as possible. She calculates that 26 state legislatures contain enough anti-abortion Republicans to be amenable to a strict ban of some sort, and her organization is pushing an “early abortion” model, which means that it drafts and supports legislation restricting abortion either entirely or after six weeks. Hawkins claims credit for pressuring reluctant Republican state leaders in Florida to take up the six-week abortion ban that Governor Ron DeSantis signed late Friday night. Gone are the days of small-ball second-trimester limits, Hawkins says, because most abortions happen before then. “We’re not going to spend a significant amount of resources to pass legislation that’s going to save only 6 percent of children.”

    Right now the centerpiece of Students for Life’s campaigning is the effort to ban medication abortion—what Hawkins and her allies call “chemical abortion.” For two years, the group lobbied Republicans in Wyoming to prohibit mifepristone from being sold in pharmacies; the governor signed that measure into law last month. Now it’s setting its sights on the pharmacy chains Walgreens, Rite Aid, and CVS—which Hawkins singles out as “the nation’s largest abortion vendor.”

    Mary Ziegler: The Texas abortion-pill ruling signals pro-lifers’ next push

    On campuses, Students for Life leaders are trying to mobilize young people who might otherwise be ambivalent about the abortion pill; Hawkins says they’ve had luck with the message that mifepristone, when flushed, enters the water system and threatens the health of humans and wildlife. “Young people are aghast to find out that something they care deeply about—the environment—is now conflicting with their views on abortion,” Hawkins told me. Never mind that there is no evidence for these claims. According to Tracey Woodruff, the director of the Program on Reproductive Health and the Environment at UC San Francisco, the amount of mifepristone found in drinking water is so small that it might not even be measurable.

    “Of all the things we have to worry about with our drinking water,” she told me, “this is not one of them.” Students for Life’s messaging on this, she added, is “a perverse use of science.” The organization is nonetheless backing new laws in several states that would require women prescribed abortion pills to use medical-waste “catch kits” and return them to a health-care provider.

    Hawkins is realistic about the fact that her movement’s progress has a ceiling. Some states, especially the liberal strongholds of Illinois and New York, are never going to go for the kinds of laws that she’s pushing for. This is when, she says, her organization will shift its emphasis to the federal government—pushing for a constitutional amendment that would recognize fetal personhood, or for a ruling from the Supreme Court to affirm that the Fourteenth Amendment already does.

    Abortion should become “both illegal and unthinkable” in America, Hawkins said. But even when the anti-abortion movement can no longer change hearts and minds, it plans to find a way to change the law anyway. She favors using the law as a tool because, in her view, people tend to derive morality from legality: “Nothing’s going to change their minds until the law changes their minds.” Hawkins envisions a future, 20 years from now, in which university students will discover with abject horror that other states allow the murder of babies in the womb—culturally, she believes, “that’s gonna be massive.” The idea that young people in college would be shocked to learn that different states have different laws on abortion may seem implausible now, but Hawkins is articulating her larger goal—of making abortion unconscionable.

    Yet American culture seems to be moving in the opposite direction. The Dobbs ruling, though exciting for anti-abortion activists, was so enraging for abortion-rights supporters that, in some places, they responded by enshrining the right to abortion into state law. These and other political losses suggest that the pro-life movement is already overreaching—and generating a backlash. “It’s breathtaking to see people so motivated and so well funded to push an agenda that is so incredibly unpopular,” Jamie Manson, the president of the abortion-rights organization Catholics for Choice, told me. The months since Dobbs have exposed a fundamental tension between the outcome that abortion-rights opponents want and the one democracy supports.

    As it becomes clear that abortion is not always an election winner—that, on occasion, it is even a predictable loser—some Republican legislators have broken from the movement in order to support rape and incest exceptions; others have simply avoided the issue. “Most of the members of my conference prefer that this be dealt with at the state level,” Senate Minority Leader Mitch McConnell told reporters last fall. Hawkins and Rose are happy to criticize those Republicans they see as wishy-washy on abortion. When former President Donald Trump blamed Republicans’ 2022 midterm losses on the extremism of the anti-abortion movement, Rose called it “sniveling cowardice.” But Hawkins and Rose may be underestimating how much more challenging and complex the post-Roe environment is.

    “This is much more expensive politics around abortion,” Holland said. “It used to be cheap: You could promise all sorts of things” without penalty, because with Roe intact, such radical measures would never pass.

    Does this give Hawkins any pause—the idea that her movement’s aims are so antithetical to what most Americans want? Hawkins said that public opinion doesn’t concern her. The fact that most Americans support abortion access doesn’t make them morally correct, she argued, and neither does it make her own efforts undemocratic. “Do I look upon abolitionists in pre–Civil War America as undemocratic for trying to change people’s minds and prevent the proliferation of owning another human being for your own financial gain? No,” she said.

    Hawkins has spent a lot of time thinking about this question. Consider the civil-rights era, she went on. “We had states that stubbornly refused to integrate.” In the end, federal legislation forced them to comply. The implication is that the same sort of national ban should eventually happen for abortion.

    Given this goal, we can expect that abortion will be an issue in almost every single election, in almost every single state, for the next many cycles. In some parts of the country, the anti-abortion-rights movement will fail. In others, it will skate along with utter success. Lawmakers will tighten laws, ban pills, and restrict travel. They may even feel audacious enough to venture into the broader realm of reproductive tools—outlawing or restricting IUDs, the morning-after pill, and even in vitro fertilization.

    Post-Roe, we can expect these hungry, mobilized activists to seek new conquests. But even as they do, pro-life leaders will have to wonder whether they are guiding their movement toward righteous victory—or humiliating defeat.

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    Elaine Godfrey

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  • COVID Vaccines Are Turning Into Flu Shots

    COVID Vaccines Are Turning Into Flu Shots

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    For all the legwork that public-health experts have done over the past few years to quash comparisons between COVID-19 and the flu, there sure seems to be a lot of effort nowadays to equate the two. In an advisory meeting convened earlier today, the FDA signaled its intention to start doling out COVID vaccines just like flu shots: once a year in autumn, for just about everyone, ad infinitum. Whatever the brand, primary-series shots and boosters (which might no longer be called “boosters”) will guard against the same variants, making them interchangeable. Doses will no longer be counted numerically. “This will be a fundamental transition,” says Jason Schwartz, a vaccine policy expert at Yale—the biggest change to the COVID-vaccination regimen since it debuted.

    Hints of the annual approach have been dropping, not so subtly, for years. Even in the spring of 2021, Pfizer’s CEO was floating the idea of yearly shots; Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research, teased it throughout 2022. This past September, Joe Biden officially endorsed it as “a new phase in our COVID-19 response,” and Ashish Jha, the White House’s COVID czar, memorably highlighted the convenience of combining a flu shot and a COVID shot into a single appointment: “I really believe this is why God gave us two arms.”

    Still, in today’s meeting, FDA officials were pushier than ever in their advocacy for the flu-ification of COVID vaccines. “We think that simplification of the vaccination regimen would contribute to easier vaccine deployment, better communication, and improved vaccine coverage,” Jerry Weir, the FDA’s director of the division of viral products, said at the meeting. The timing is important: After renewing the U.S.’s pandemic-emergency declaration earlier this month, the Biden administration seems set to allow its expiration this coming April. That makes the present moment awfully convenient for repackaging a chaotic, crisis-caliber vaccination paradigm as a scheduled, seasonal, normal-seeming one. A once-a-year strategy, modeled on a routine recommendation, suggests that “we’re no longer in emergency mode,” says Maria Sundaram, a vaccine researcher at the Marshfield Clinic Research Institute. Or at least, that’s the message that the public is likely to hear.

    But federal regulators may be trying to fit a COVID-shaped peg into a flu-shaped hole. The experts I spoke with largely agreed: Eventually, someday, annual autumn shots for COVID “will probably be sufficient,” says Gregory Poland, a vaccinologist at Mayo Clinic. “Are we ready for that yet? I’m not sure that’s the case at all.”

    Even in the short term, COVID-vaccination tactics need a revamp. “It’s clear above all that the current approach isn’t working,” Schwartz told me. Despite abundant supply, demand for COVID boosters in the U.S. has been abysmal—and interest seems to be declining with each additional dose. Last fall’s bivalent shot has reached the arms of only 15 percent of Americans; even among adults over 65—a majority of whom sign up for flu shots each fall—the vaccination rate hasn’t yet reached 40 percent.

    For most of the time that COVID shots have been around, figuring out when to get them has been a hassle, with different guidelines and requirements that depend on age, sex, risk factors, vaccination history, and more. Pharmacies have had to stock an absurd number of vials and syringes to accommodate the various combinations of brands and dose sizes; record-keeping on flimsy paper cards has been a total joke. “I do this for a living, and I can barely keep track,” Schwartz said. Recommendations on the proper timing and number of doses have also changed so many times that many Americans have simply checked out. After the bivalent recipe debuted, polls found that an alarming proportion of people didn’t even know the shot was available to them.

    Streamlining COVID-vaccine recommendations will remove a lot of that headache, Sundaram told me. Most people would need to keep only one mantra in mind—one dose, each fall—and could top off their flu and COVID immunity at the same time. Burdens on pharmacies and clinics would be lower, and communication would be far easier—a change that could make an especially big difference for those with children, among whom COVID-vaccine uptake has been the lowest. “It’ll be more scheduled, more systematic,” says Charlotte Hobbs, a pediatric infectious-disease specialist at the University of Mississippi Medical Center. COVID shots could simply be offered at annual well-child visits, she told me. “It’s something we already know works well.”

    The advantages of a flu-ified COVID shot aren’t just about convenience. If we have to shoehorn COVID vaccines into an existing paradigm, Sundaram told me, influenza’s is the best candidate. SARS-CoV-2, like the flu, is excellent at altering itself to dodge our defenses; it spreads readily in winter; and our immunity to infection tends to fade rather quickly. All of that adds up to a need for regularly updated shots. Such a system has been in place for decades for the flu: At the end of each winter, a panel of experts convenes to select the strains that should be targeted by the next formulation; manufacturers spend the next several months whipping up big batches in time for an autumn-ish rollout. The pipeline depends on a global surveillance system for flu viruses, as well as regular surveys of antibody levels in the community to suss out which strains people are still protected against. The premise has been so well vetted by now that researchers can skip the chore of running large-scale clinical trials to determine the efficacy and safety of each new, updated recipe.

    But a seasonal strategy works best for a seasonal virus—and SARS-CoV-2 just isn’t there yet, says Hana El Sahly, an infectious-disease physician at Baylor College of Medicine. Though flu viruses tend to hop between the globe’s hemispheres, alternately troubling the north and the south during their respective cold months, this new coronavirus has yet to confine its spread to one part of the calendar. (Marks, of the FDA, tried to address this concern at today’s meeting, asserting that “we’re starting to see some seasonality” and that fall was indeed the very sensible for an annual rollout.) SARS-CoV-2 has also been spitting out concerning variants and subvariants at a faster rate than the flu (and flu shots already have a hard time keeping up with evolution). The FDA’s new proposal suggests picking SARS-CoV-2 variants in June to have a vaccine ready by September, a shorter timeline than is used for flu. That still might not be fast enough: “By the time we detect a variant, it will have ripped through the global population and, in a few more weeks, died down,” El Sahly told me. The world got a preview of this problem with last year’s bivalent shot, which overlapped with the dominance of its target subvariants for only a couple of months. A flu model for COVID would make more sense “if we had stable, predictable dynamics,” says Avnika Amin, a vaccine epidemiologist at Emory University. “I don’t think we’re at that point.”

    Murkiness around vaccine effectiveness makes this transition complicated too. Experts told me that it’s gotten much more difficult to tell how well our COVID vaccines are working, and for how long, fueling debates over how often they should be given and how often their composition should change. Many people have now been infected by the virus multiple times, which can muddy calculations of vaccine effectiveness; better treatments also alter risk profiles. And many researchers told me they’re concerned that the data shortcuts we use for flu—measures of antibodies as a proxy for immune protection—just won’t fly for COVID shots. “We need better clinical data,” El Sahly told me. In their absence, the hasty adoption of a flu framework could lead to our updating and distributing COVID shots too often, or not often enough.

    A flu-ish approach also wouldn’t fix all of the COVID vaccines’ problems. Today’s discussion suggested that, even if a new COVID-shot strategy change goes through, officials will still need to recommend several different dose sizes for several different age groups—a more complex regimen than flu’s—and may advise additional injections for those at highest risk. At the same time, COVID shots would continue to be more of a target for misinformation campaigns than many other vaccines and, at least in the case of mRNA-based injections, more likely to cause annoying side effects. These issues and others have driven down interest—and simply pivoting to the flu paradigm “is not going to solve the uptake problem,” says Angela Shen, a vaccine-policy expert at Children’s Hospital of Philadelphia.

    Perhaps the greatest risk of making COVID vaccines more like flu shots is that it could lead to more complacency. In making the influenza paradigm a model, we also threaten to make it a ceiling. Although flu shots are an essential, lifesaving public-health tool, they are by no means the best-performing vaccines in our roster. Their timeline is slow and inefficient; as a result, the formulations don’t always match circulating strains. Already, with COVID, the world has struggled to chase variants with vaccines that simply cannot keep up. If we move too quickly to the fine-but-flawed framework for flu, experts told me, it could disincentivize research into more durable, more variant-proof, less side-effect-causing COVID shots. Uptake of flu vaccines has never been stellar, either: Just half of Americans sign up for the shots each year—and despite years of valiant efforts, “we still haven’t figured out how to consistently improve that,” Amin told me.

    Whenever the COVID-emergency declaration expires, vaccination will almost certainly have to change. Access to shots may be imperiled for tens of millions of uninsured Americans; local public-health departments may end up with even fewer resources for vaccine outreach. A flu model might offer some improvements over the status quo. But if the downsides outweigh the pluses, Poland told me, that could add to the erosion of public trust. Either way, it might warp attitudes toward this coronavirus in ways that can’t be reversed. At multiple points during today’s meeting, FDA officials emphasized that COVID is not the flu. They’re right: COVID is not the flu and never will be. But vaccines can sometimes become a lens through which we view the dangers they fight. By equating our frontline responses to these viruses, the U.S. risks sending the wrong message—that they carry equal threat.

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    Katherine J. Wu

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  • Trying to Stop Long COVID Before It Even Starts

    Trying to Stop Long COVID Before It Even Starts

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    Three years into the global fight against SARS-CoV-2, the arsenal to combat long COVID remains depressingly bare. Being vaccinated seems to reduce people’s chances of developing the condition, but the only surefire option for avoiding long COVID is to avoid catching the coronavirus at all—a proposition that feels ever more improbable. For anyone who is newly infected, “we don’t have any interventions that are known to work,” says Akiko Iwasaki, an immunologist and long-COVID researcher at Yale.

    Some researchers are hopeful that the forecast might shift soon. A pair of recent preprint studies, both now under review for publication in scientific journals, hint that two long-COVID-preventing pills might already be on our pharmacy shelves: the antiviral Paxlovid and metformin, an affordable drug commonly used for treating type 2 diabetes. When taken early in infection, each seems to at least modestly trim the chance of developing long COVID—by 42 percent, in the case of metformin. Neither set of results is a slam dunk. The Paxlovid findings did not come out of a clinical trial, and were focused on patients at high risk of developing severe, acute COVID; the metformin data did come out of a clinical trial, but the study was small. When I called more than half a dozen infectious-disease experts to discuss them, all used hopeful, but guarded, language: The results are “promising,” “intriguing”; they “warrant further investigation.”

    At this point, though, any advance at all feels momentous. Long COVID remains the pandemic’s biggest unknown: Researchers still can’t even agree on its prevalence or the features that define it. What is clear is that millions of people in the United States alone, and countless more worldwide, have experienced some form of it, and more are expected to join them. “We’ve already seen early data, and we’ll continue to see data, that that will emphasize the impact that long COVID has on our society, on quality of life, on productivity, on our health system and medical expenditures,” says Susanna Naggie, an infectious-disease physician and COVID-drug researcher at Duke University. “This needs to be a high priority,” she told me. Researchers have to trim long COVID incidence as much as possible, as soon as possible, with whatever safe, effective options they can.

    By now, news of the inertia around preventive long-COVID therapies may not come as much of a shock. Interventions that stop disease from developing are, on the whole, a neglected group; big, blinded, placebo-controlled clinical trials—the industry gold standard—usually look to investigate potential treatments, rather than drugs that might keep future illness at bay. It’s a bias that makes research easier and faster; it’s a core part of the American medical culture’s reactive approach to health.

    Read: Long COVID has forced a reckoning for one of medicine’s most neglected diseases

    For long COVID, the terrain is even rougher. Researchers are best able to address prevention when they understand a disease’s triggers, the source of its symptoms, and who’s most at risk. That intel provides a road map, pointing them toward specific bodily systems and interventions. The potential causes of COVID, though, remain murky, says Adrian Hernandez, a cardiologist and clinical researcher at Duke. Years of research have shown that the condition is quite likely to comprise a cluster of diverse syndromes with different triggers and prognoses, more like a category (e.g., “cancer”) than a singular disease. If that’s the case, then a single preventive treatment shouldn’t be expected to cut its rates for everyone. Without a universal way to define and diagnose the condition, researchers can’t easily design trials, either. Endpoints such as hospitalization and death tend to be binary and countable. Long COVID operates in shades of gray.

    Still, some scientists might be making headway with vetted antiviral drugs, already known to slash the risk of developing severe COVID-19. A subset of long-COVID cases could be caused by bits of virus that linger in the body, prompting the immune system to wage an extended war; a drug that clears the microbe more quickly might lower the chances that any part of the invader sticks around. Paxlovid, which interferes with SARS-CoV-2’s ability to copy itself inside of our cells, fits that bill. “The idea here is really nipping it in the bud,” says Ziyad Al-Aly, a clinical epidemiologist and long-COVID researcher at Washington University in St. Louis, who led the recent Paxlovid work.

    Paxlovid has yet to hit the scientific jackpot: proof from a big clinical trial that shows it can prevent long COVID in newly infected people. But Al-Aly’s study, which pored over the electronic medical records of more than 56,000 high-risk patients, offers some early optimism. People who took the pills, he and his colleagues found, were 26 percent less likely to report lingering symptoms three months after their symptoms began than those who didn’t.

    Read: Inside the mind of an anti-Paxxer

    The pills’ main benefit remains the prevention of severe, acute disease. (In the recent study, Paxlovid-takers were also 30 percent less likely to be hospitalized and 48 percent less likely to die.) Al-Aly expects that the drug’s effectiveness at preventing long COVID—if it’s confirmed in other populations—will be “modest, not huge.” Though the two functions could yet be linked: Some long-COVID cases may result from severe infections that damage tissues so badly that the body struggles to recover. And should Paxlovid’s potential pan out, it could help build the case for testing other SARS-CoV-2 antivirals. Al-Aly and his colleagues are currently working on a similar study into molnupiravir. “The early results are encouraging,” he told me, though “not as robust as Paxlovid.” (Another study, run by other researchers, that followed hospitalized COVID patients found those who took remdesivir were less likely to get long COVID, but a later randomized clinical trial didn’t bear that out.)

    A clinical trial testing Paxlovid’s preventive potency against long COVID is still needed. Kit Longley, a spokesperson for Pfizer, told me in an email that the company doesn’t currently have one planned, though it is “continuing to monitor data from our clinical studies and real-world evidence.” (The company is collaborating with a research group at Stanford to study Paxlovid in new clinical contexts, but they’re looking at whether the pills  might treat long COVID that’s already developed. The RECOVER trial, a large NIH-funded study on long COVID, is also focusing its current studies on treatment.) But given the meager uptake rates for Paxlovid even among those in high-risk groups, Al-Aly thinks his new data could already serve a useful purpose: providing people with extra motivation to take the drug.

    The case for adding metformin to the anti-COVID tool kit might be a bit muddier. The drug isn’t the most intuitive medication to deploy against a respiratory virus, and despite its widespread use among diabetics, its exact effects on the body remain nebulous, says Stacey Schultz-Cherry, a virologist at St. Jude Children’s Research Hospital. But there are many reasons to believe it might be useful. Some research has shown that metformin can mess with the manufacture of viral proteins inside of human cells, Bramante told me, which may impede the ability of SARS-CoV-2 and other pathogens to reproduce. The drug also appears to rev up the disease-dueling powers of certain immune cells, and to stave off inflammation. Studies have shown that metformin can improve responses to certain vaccinations in humans and rodents, and researchers have found that people taking the drug seem less likely to get seriously sick from influenza. Even the diabetes-coronavirus connection may not be so tenuous: Metabolic disease is a risk factor for severe COVID; infection itself can put blood-sugar levels on the fritz. It’s certainly plausible that having a metabolically altered body, Schultz-Cherry told me, could make infections worse.

    Read: The promising treatment we’re not even trying for long COVID

    But the evidence that metformin helps prevent long COVID remains sparse. Carolyn Bramante, the scientist who led the metformin study, told me that when her team first set out in 2020 to investigate the drug’s effects on SARS-CoV-2 infections in a randomized, clinical trial, long COVID wasn’t really on their radar. Like many others in their field, they were hoping to repurpose established medicines to keep infected people out of the hospital; early studies of metformin—as well as the two other drugs in their trial, the antidepressant fluvoxamine and the antiparasitic ivermectin—hinted that they’d work. Ironically, two years later, their story flipped around. A large analysis, published last summer, showed that none of the three drugs were stellar at preventing severe COVID in the short term—a disappointing result (though Bramante contends that their data still indicate that metformin does some good). Then, when Bramante and her colleagues examined their data again, they found that study participants that had taken metformin for two weeks around the start of their illness were 42 percent less likely to have a long-COVID diagnosis from their doctor nearly a year down the road. David Boulware, an infectious-disease physician who helped lead the work, considers that degree of reduction pretty decent: “Is it 100 percent? No,” he told me. “But it’s better than zero.”

    Metformin may well prove to prevent long COVID but not acute, severe COVID (or vice versa). Plenty of people who never spend time in the hospital can still end up developing chronic symptoms. And Iwasaki points out that the demographics of long-haulers and people who get severe COVID don’t really overlap; the latter skew older and male. In the future, early-infection regimens may be multipronged: antivirals, partnered with metabolic drugs, in the hopes of keeping symptoms both mild and short-lived.

    But researchers are still a long way off from delivering that reality. It’s not yet clear, for instance, whether the drugs work additively when combined, Boulware told me. Nor is it a given that they’ll work across different demographics—age, vaccination status, risk factors, and more. Bramante and Boulware’s study cast a decently wide net: Although everyone enrolled in the trial was overweight or obese, many were young and healthy; a few were even pregnant. The study was not enormous, though—about 1,000 people. It also relied on patients’ individual doctors to deliver long-COVID diagnoses, likely leading to some inconsistencies, so other studies that follow up in the future could find different results. For now, this isn’t enough to “mean we should run out and use metformin,” Schultz-Cherry, who has been battling long COVID herself, told me.

    Other medications could still fill the long-COVID gaps. Hernandez, the Duke cardiologist, is hopeful that one of his ongoing clinical trials, ACTIV-6, might provide answers soon. He and his team are testing whether any of several drugs—including ivermectin, fluvoxamine, the steroid fluticasone, and, as a new addition, the anti-inflammatory montelukast—might cut down on severe, short-term COVID. But Hernandez and his colleagues, Naggie among them, appended a check-in at the 90-day mark, when they’ll be asking their patients whether they’re experiencing a dozen or so symptoms that could hint at a chronic syndrome.

    That check-in questionnaire won’t capture the full list of long-COVID symptoms, now more than 200 strong. Still, the three-month benchmark could give them a sense of where to keep looking, and for how long. Hernandez, Naggie, and their colleagues are considering whether to extend their follow-up period to six months, maybe farther. The need for long-COVID prevention, after all, will only grow as the total infection count does. “We’re not going to get rid of long COVID anytime soon,” Iwasaki told me. “The more we can prevent onset, the better off we are.”

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    Katherine J. Wu

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  • America’s COVID Booster Rates Are a Bad Sign for Winter

    America’s COVID Booster Rates Are a Bad Sign for Winter

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    And just like that, with the passing of Labor Day, fall was upon us. Seemingly overnight, six-packs of pumpkin beer materialized on grocery shelves, hordes of city dwellers descended upon apple orchards—and America rolled out new COVID boosters. The timing wasn’t a coincidence. Since the beginning of the pandemic, cases in North America and Europe have risen during the fall and winter, and there was no reason to expect anything different this year. Spreading during colder weather is simply what respiratory diseases like COVID do. The hope for the fall booster rollout was that Americans would take it as an opportunity to supercharge their immunological defenses against the coronavirus in advance of a winter wave that we know is going to come.

    So far, reality isn’t living up to that hope. Since the new booster became available in early September, fewer than 20 million Americans have gotten the shot, according to the CDC—just 8.5 percent of those who are eligible. The White House COVID-19 response coordinator, Ashish Jha, said at a press conference earlier this month that he expects booster uptake to increase in October as the temperatures drop and people start taking winter diseases more seriously. That doesn’t seem to be happening yet. America’s booster campaign is going so badly that by late September, only half of Americans had heard even “some” information about the bivalent boosters, according to a recent survey. The low numbers are especially unfortunate because the remaining 91.5 percent of booster-eligible people have already shown that they’re open to vaccines by getting at least their first two shots—if not already at least one booster.

    Now the bungled booster rollout could soon run headfirst into the winter wave. The virus is not yet surging in the United States—at least as far as we can tell—but as the weather cools down, cases have been on the rise in Western Europe, which has previously foreshadowed what happens in the U.S. At the same time, new Omicron offshoots such as BQ.1 and BQ.1.1 are gaining traction in the U.S., and others, including XBB, are creating problems in Singapore. Boosters are our best chance at protecting ourselves from getting swept up in whatever this virus throws at us next, but too few of us are getting them. What will happen if that doesn’t change?

    The whole reason for new shots is that though the protection conferred by the original vaccines is tremendous, it has waned over time and with new variants. The latest booster, which is called “bivalent” because it targets both the original SARS-CoV-2 virus and BA.5, is meant to kick-start the production of more neutralizing antibodies, which in turn should prevent new infection in the short term, Katelyn Jetelina, a public-health expert who writes the newsletter Your Local Epidemiologist, told me. The other two goals for the vaccine are still being studied: The hope is that it will also broaden protection by teaching the immune system to recognize other aspects of the virus, and that it will make protection longer-lasting.

    In theory, this souped-up booster would make a big difference heading into another wave. In September, a forecast presented by the Advisory Committee on Immunization Practices (ACIP), which advises the CDC, showed that if people get the bivalent booster at the same rate as they do the flu vaccine—optimistic, given that about 50 percent of people have gotten the flu vaccine in recent years—roughly 25 million infections, 1 million hospitalizations, and 100,000 deaths could be averted by the end of March 2023.

    But these numbers shouldn’t be taken as gospel, because protection across the population varies widely and modeling can’t account for all of the nuance that happens in real life. Gaming out exactly what our dreadful booster rates mean going forward is not a simple endeavor “given that the immune landscape is becoming more and more complex,” Jetelina told me. People received their first shots and boosters at different times, if they got them at all. And the same is true of infections over the past year, with the added wrinkle that those who fell sick all didn’t get the same type of Omicron. All of these factors play a role in how much America’s immunological guardrails will hold up in the coming months. “But it’s very clear that a high booster rate would certainly help this winter,” Jetelina said.

    At this point in the pandemic, getting COVID is far less daunting for healthy people than it was a year or two ago (although the prospect of developing long COVID still looms). The biggest concerns are hospitalizations and deaths, which make low booster uptake among vulnerable groups such as the elderly and immunocompromised especially worrying. That said, everyone aged 5 and up who has received their primary vaccine is encouraged to get the new boosters. It bears repeating that vaccination not only protects against severe illness and death but has the secondary effect of preventing transmission, thereby reducing the chances of infecting the vulnerable.

    What will happen next is hard to predict, Michael Osterholm, an epidemiologist at the University of Minnesota, told me, but now is a bad time for booster rates to be this low. Conditions are ripe for COVID’s spread. Protection is waning among the unboosted, immunity-dodging variants are emerging, and Americans just don’t seem to care about COVID anymore, Osterholm explained. The combination of these factors, he said, is “not a pretty picture.” By skipping boosters, people are missing out on the chance to offset these risks, though non-vaccine interventions such as masking and ventilation improvements can help, too.

    That’s not to say that the immunity conferred by the vaccination and the initial boosters is moot. Earlier doses still offer “pretty substantial protection,” Saad Omer, a Yale epidemiologist, told me. Not only are eligible Americans slacking on booster uptake, but lately vaccine uptake among the unvaccinated hasn’t risen much either. Before the new bivalent shots came around, less than half of eligible Americans had gotten a booster. “That means we are, as a population, much more vulnerable going into this fall,” James Lawler, an infectious-diseases expert at the University of Nebraska Medical Center, told me.

    If booster uptake—and vaccine uptake overall—remains low, expecting more illness, particularly among the vulnerable, would be reasonable, William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center, told me. Hospitalizations will rise more than they would otherwise, and with them the stress on the health-care system, which will also be grappling with the hundreds of thousands of people likely to be hospitalized for flu. While Omicron causes relatively minor symptoms, “it’s quite capable of producing severe disease,” Schaffner said. Since August, it has killed an average of 300 to 400 people each day.

    All of this assumes that we won’t get a completely new variant, of course. So far, the BA.5 subvariant targeted by the bivalent booster is still dominating cases around the world. Newer ones, such as XBB, BQ.1.1, and BQ.1, are steadily gaining traction, but they’re still offshoots of Omicron. “We’re still very hopeful that the booster will be effective,” Jetelina said. But the odds of what she called an “Omicron-like event,” in which a completely new SARS-CoV-2 lineage—one that warrants a new Greek letter—emerges out of left field, are about 20 to 30 percent, she estimated. Even in this case, the bivalent nature of the booster would come in handy, helping protect against a wider crop of potential variants. The effectiveness of our shots against a brand-new variant depends on its mutations, and how much they overlap with those we’ve already seen, so “we’ll see,” Omer said.

    Just as it isn’t too late to get boosted, there’s still time to improve uptake in advance of a wave. If you’re three to six months out from an infection or your last shot, the best thing you can do for your immune system right now is to get another dose, and do it soon. Though there’s no perfect and easy solution that can overcome widespread vaccine fatigue, that doesn’t mean trying isn’t worthwhile. “Right now, we don’t have a lot of people that feel the pandemic is that big of a problem,” and people are more likely to get vaccinated if they feel their health is challenged, Osterholm said.

    There’s also plenty of room to crank the volume on the messaging in general: Not long ago, the initial vaccine campaign involved blasting social media with celebrity endorsers such as Dolly Parton and Olivia Rodrigo. Where is that now? Lots of pharmacies are swimming in vaccines, but making getting boosted even easier and more convenient can go a long way too. “We need to catch them where they come,” said Omer, who thinks boosters should be offered at workplaces, in churches and community centers, and at specialty clinics such as dialysis centers where patients are vulnerable by default.

    After more than two years of covering and living through the pandemic, believe me: I get that people are over it. It’s easy not to care when the risks of COVID seem to be negligible. But while shedding masks is one thing, taking a blasé attitude toward boosters is another. Shots alone can’t solve all of our pandemic problems, but their unrivaled protective effects are fading. Without a re-up, when the winter wave reaches U.S. shores and more people start getting sick, the risks may no longer be so easy to ignore.

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    Yasmin Tayag

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  • Palm Springs, CA Residents Will Finally Get to Vote if STRs Belong in Residential Neighborhoods

    Palm Springs, CA Residents Will Finally Get to Vote if STRs Belong in Residential Neighborhoods

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    Press Release
    –


    updated: Feb 22, 2018


    PALM SPRINGS, Calif., February 22, 2018 (Newswire.com)
    –
    The local citizens’ group, Palm Springs Neighbors for Neighborhoods, has announced that June 5 will be the voting date for their ballot initiative to limit absentee-owner short-term rentals (STRs) in R1 zoned residential neighborhoods. 

    If it passes, the Measure: 

    As is, residents have no protection from the proliferation of short-term rentals in their neighborhoods.

    Steve Rose, Organizer, Palm Springs Neighbors for Neighborhoods

    ✓ Will limit absentee-owner rentals to a minimum of 28 days or more per stay in residential R1-zoned single-family neighborhoods.

    ✓ Will give STR owners two years to adjust their business model or relocate their business to an area not zoned R-1.

    ✓ Will not affect home sharing or owner-hosted vacation rentals. 

    ✓ Will not affect Condos which have HOA’s that set their own rules.  And it won’t affect Apartment Renters.  In 2016, Palm Springs passed an ordinance stopping apartment units from converting to short-term rentals.

    This initiative represents the first time residents of a major tourist city have taken this issue to the ballot box.

    Palm Springs, with approximately 2,000 STRs,  has more single-family short-term vacation rentals per capita than any other city in the country.   It has become a mecca for out of town investors to own and operate full-time commercial mini-hotels throughout the city’s many residential neighborhoods.

    Steve Rose, the group’s organizer said, “I was shocked when I read the City’s Impact Report. It states that 467,000 visitors stayed in short-term vacation rentals in 2017.  This is an outrageous number of strangers to inject into R1-zoned residential neighborhoods, which house fewer than 28,000 residents. Everyone deserves somewhere safe and secure to call home, that is what living in a neighborhood is all about.  As is, residents have no protection from the proliferation of short-term rentals in their neighborhoods.”

    “It should not be the responsibility of residential neighborhoods to generate business tax revenue. Palm Springs has a multitude of hotels, motels and boutique inns for our tourists to stay in – and more in the works.  Citizens’ requests for reasonable restrictions on STRs have been dismissed for the last time.  It is time for the residents to have their voices heard,” said Rob Grimm, PSN4N Campaign Manager. 

    Residents of Palm Springs will be able to vote on the ballot measure in the California state primary on June 5.

    More information can be found at the group’s website www.psn4n.org

    For media inquiries, contact PSN4N campaign manager at RobGrimm@psn4n.org or (760) 464-1724.

    Source: Palm Springs Neighbors for Neighborhoods

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