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<title>06 February, 2024</title>
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<title>Covid-19 Sentry</title><meta content="width=device-width, initial-scale=1.0" name="viewport"/><link href="styles/simple.css" rel="stylesheet"/><link href="../styles/simple.css" rel="stylesheet"/><link href="https://unpkg.com/aos@2.3.1/dist/aos.css" rel="stylesheet"/><script src="https://unpkg.com/aos@2.3.1/dist/aos.js"></script></head>
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<h1 data-aos="fade-down" id="covid-19-sentry">Covid-19 Sentry</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-preprints">From Preprints</a></li>
<li><a href="#from-clinical-trials">From Clinical Trials</a></li>
<li><a href="#from-pubmed">From PubMed</a></li>
<li><a href="#from-patent-search">From Patent Search</a></li>
</ul>
<h1 data-aos="fade-right" id="from-preprints">From Preprints</h1>
<ul>
<li><strong>XBB.1.5 monovalent booster improves antibody binding and neutralization against emerging SARS-CoV-2 Omicron variants</strong> -
<div>
The rapid emergence of divergent SARS-CoV-2 variants has led to an update of the COVID-19 booster vaccine to a monovalent version containing the XBB.1.5 spike. To determine the neutralization breadth following booster immunization, we collected blood samples from 24 individuals pre- and post-XBB.1.5 mRNA booster vaccination (~1 month). The XBB.1.5 booster improved both neutralizing activity against the ancestral SARS-CoV-2 strain (WA1) and the circulating Omicron variants, including EG.5.1, HK.3, HV.1, XBB.1.5 and JN.1. Relative to the pre-boost titers, the XBB.1.5 monovalent booster induced greater total IgG and IgG subclass binding, particular IgG4, to the XBB.1.5 spike as compared to the WA1 spike. We evaluated antigen-specific memory B cells (MBCs) using either spike or receptor binding domain (RBD) probes and found that the monovalent booster largely increases non-RBD cross-reactive MBCs. These data suggest that the XBB.1.5 monovalent booster induces cross-reactive antibodies that neutralize XBB.1.5 and related Omicron variants.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2024.02.03.578771v1" target="_blank">XBB.1.5 monovalent booster improves antibody binding and neutralization against emerging SARS-CoV-2 Omicron variants</a>
</div></li>
<li><strong>DNA Prime-Protein Boost Targeting Conformational Non-RBD Region for Broad Cross-Neutralization</strong> -
<div>
The preservation of antigen spatial conformation is crucial for inducing the high-quality neutralizing responses. Although the receptor-binding domain (RBD) antigen in SARS-CoV-2 vaccines shows satisfactory conformation preservation, it remains susceptible to the immune escape. Therefore, exploring conformational epitopes beyond the RBD region to achieve cross-neutralization becomes an attractive topic. In this study, we used a DNA prime-protein boost regimen to obtain potent humoral responses. Further analysis revealed that boosting antibody responses targeting conformational non-RBD region is crucial for enhancing cross-neutralization against the Wuhan-01, Delta and Omicron subvariants. Via analyzing the distribution of conformational epitopes, and quantifying epitope-specific binding antibodies, we verified a positive correlation between the proportion of binding antibodies against the N-terminal domain (NTD) supersite (a conformational non-RBD epitope) and SARS-CoV-2 neutralization potency. The current work highlights the importance of conformational non-RBD-specific binding antibodies in mediating viral cross-neutralization and provides a new insight in overcoming the immune escape of SARS-CoV-2 variants.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2024.02.04.578544v1" target="_blank">DNA Prime-Protein Boost Targeting Conformational Non-RBD Region for Broad Cross-Neutralization</a>
</div></li>
<li><strong>The accomplices: Heparan sulfates and N-glycans foster SARS-CoV-2 spike:ACE2 receptor binding and virus priming</strong> -
<div>
The SARS-CoV-2 spike glycoprotein mediates virus attachment to human host cells by binding angiotensin-converting enzyme 2 (ACE2) and heparan sulfate (HS) proteoglycans. To elucidate the structure, dynamics, and functional consequences of these interactions, we carried out microsecond-long all-atom molecular dynamics simulations, followed by random acceleration molecular dynamics simulations, of the fully glycosylated spike:ACE2 complex with and without heparin chains bound. We find that heparin, a model for HS, promotes structural and energetic stabilization of the active conformation of the spike receptor binding domain (RBD) and reorientation of ACE2 toward the N-terminal domain in the same spike subunit as the RBD. Spike and ACE2 N-glycans exert synergistic effects, promoting better packing, strengthening the protein:protein interaction, and prolonging the residence time of the complex. ACE2 and heparin binding trigger rearrangement of the S2' functional site through allosteric interdomain communication. HS thus has a multifaceted role in facilitating SARS- CoV-2 infection.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2024.02.05.578888v1" target="_blank">The accomplices: Heparan sulfates and N-glycans foster SARS-CoV-2 spike:ACE2 receptor binding and virus priming</a>
</div></li>
<li><strong>Who Can I Count On: Honor, Self-Reliance, and Family in the United States and Iran</strong> -
<div>
People in honor cultures take measures to uphold their reputations. However, it is unclear how aspects of honor vary between societies. Here, we explore the tension between competing views about honor – honor as self-defense narrowly defined in terms of self-reliant tendencies vs. honor broadly defined by demonstrations of strength and virtue. The former suggests that self-reliance, in demonstrating the ability of the individual to defend themself, is a crucial component of honor, while the latter allows the importance of self-reliance in honor to vary depending on moral and cultural factors. To examine these implications, we conducted studies in the U.S., where self-reliance is virtuous, and in Iran, where individual agency must be balanced against the interests of kin. Americans (Studies 1, 2; n = 978) who endorsed honor values tended to ignore governmental COVID-19 measures because they preferred relying on themselves. In contrast, honor-minded Iranians (Study 3; n = 201) adhered to public-health guidelines and did not prefer self-reliance. Moreover, honor-minded Iranians endorsed family-reliance, but did not moralize self-reliance (Study 4; n = 107), while honor-minded Americans endorsed family-reliance and moralized self-reliance (Study 4; n = 120). Results suggest that local norms may shape how honor is expressed across cultures.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/psyarxiv/h26pt/" target="_blank">Who Can I Count On: Honor, Self-Reliance, and Family in the United States and Iran</a>
</div></li>
<li><strong>Examining enduring effects of COVID-19 on college students’ internalizing and externalizing problems: A four-year longitudinal analysis</strong> -
<div>
The current study sets out to examine the extent to which college students’ trajectories of mental health symptoms (depression, social anxiety, impulsivity, and aggression) and problematic alcohol use changed as the COVID-19 pandemic progressed; we hypothesize increases in all levels and slopes of all outcomes over time following the pandemic’s onset. We also hypothesize greater mental health symptoms and problematic alcohol use (i.e., higher levels of and increases in outcomes over time) following COVID-19 among individuals who experienced higher levels of loneliness, financial strain, and health anxiety at the time of the pandemic’s onset.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/6c8y2/" target="_blank">Examining enduring effects of COVID-19 on college students’ internalizing and externalizing problems: A four-year longitudinal analysis</a>
</div></li>
<li><strong>Rapid worldwide return to nature after lockdown as a motivator for conservation and sustainable action</strong> -
<div>
Exposure to nature is increasingly regarded as a key part of human health, and the recognition that urban environments must provide access to green spaces for the wellbeing of citizens. The beginning of the COVID-19 pandemic in 2020 led to many governments issuing stay-at-home orders and closing parks, limiting the options of accessible green spaces for people seeking to safely socialise and cope with stress. Here, we gain a global perspective on how quickly people returned to nature (visiting parks and beaches) in comparison to necessities (accessing groceries and pharmaceuticals) and luxury activities (retail purchases and recreation) following COVID-19 lockdowns using Google Mobility data. We found that people from around the world returned to nature 76 days after peak lockdown, 28 days after people returned to necessities and 77 days before the return to luxuries. Central Asia, Europe, and Northern America returned to nature before necessities. These patterns held even after seasonally-detrending the data. We further found a strong negative correlation between the speed people pulsed back to nature and the strength of government response measures. ¬Combined, our data support the value of nature to people and the need to consider access to green and natural space for human well-being. At the same time, the large-scale return to nature also highlighted the need to promote messages on how to minimise the impacts of human activities in these spaces. We advocate for building and protecting green spaces, combined with strong eco-education, to foster pro-environmental behaviour.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/socarxiv/2ghu3/" target="_blank">Rapid worldwide return to nature after lockdown as a motivator for conservation and sustainable action</a>
</div></li>
<li><strong>Emotions in misinformation studies: Distinguishing affective state from emotional response and misinformation recognition from acceptance</strong> -
<div>
Emotions play a crucial role in information processing. Prior studies indicate that high-arousal emotions may elicit rapid, intuitive thinking, tricking people into judging misinformation as truthful. Yet, few studies have distinguished prior affective state from emotional reactions to false news, both of which may influence belief in falsehoods in different ways. Replicating and extending Martel et al. (2020), we conducted a pre-registered online survey in Austria (N = 422), investigating associations of emotions and discernment of false and real news related to COVID-19. We found no associations of affective state with discernment, but different emotional responses to false and real news — namely, more anger and less joy for false news. A curvilinear relationship of anger with discernment showed that both participants who were good and bad at discerning real from false news responded with anger. The automated analysis of 5,613 open-ended textual responses suggested that anger may have arisen for different reasons in these different groups. It seemed to also arise when people recognized the false news as such, not only when people accepted it. We conclude that studies need to distinguish between prior affective state and emotional response to misinformation and consider individuals’ prior beliefs as determinants of emotions.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/psyarxiv/udqms/" target="_blank">Emotions in misinformation studies: Distinguishing affective state from emotional response and misinformation recognition from acceptance</a>
</div></li>
<li><strong>Sex-Specific Development of ssRNA Virus Receptor Gene Expression in the Human Brain</strong> -
<div>
Background: The COVID-19 pandemic has focused research on the detrimental impact of neuroinvasive single-strand RNA (ssRNA) viruses. Those viruses cause a wide range of human diseases ranging from mild to severe life-threatening conditions, and host factors such as age, sex, and the expression of virus receptors can influence the severity of the infection. For example, older adults and males have a bias for severe disease with COVID-19 infection, but females have a higher risk of Long-COVID. However, there is a gap in understanding the expression of receptors for ssRNA viruses in the human brain and how that expression varies by age and sex. Here, we studied the expression of ssRNA virus receptors in the human brain and compared lifespan changes in females and males to identify age- and sex-specific developmental patterns. Methods: We used a publicly available transcriptomic database of human brain development to characterize the development of 67 viral host factor genes for 10 ssRNA virus families. A data-driven approach was applied to characterize the lifespan trajectories for those ssRNA receptors using samples from 15 brain areas (n=700, F=306, M=394, age range:4 mo-82 yrs). Then, high-dimensional trajectory analyses and visualizations, including tSNE, were used to compare lifespan changes for females and males among the 15 brain areas. Results: Unsupervised hierarchical clustering of the 2010 trajectories identified 25 different patterns with a range of sex bias from ones with only female data to ones with only male data. Differential Expression Sliding Window Analysis (DE-SWAN) found a brain-wide pattern of virus receptor sex differences in childhood, before puberty. The virus families had a range of sexual dimorphism, with the Pneumoveridae family being the most dimorphic. Finally, high dimensional visualization of ssRNA virus receptor development in the 15 brain areas showed that the cortex is distinct for females and males. Conclusions: Females are often described as developing precociously relative to males, but our findings paint a different picture. Instead, we found that sex differences in virus receptor development in the human brain do not reflect simply linear shifts and are best described as females and males following distinct high-dimensional trajectories.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.11.561925v2" target="_blank">Sex-Specific Development of ssRNA Virus Receptor Gene Expression in the Human Brain</a>
</div></li>
<li><strong>How Does The COVID-19 Pandemic Impact on Population Mental Health? A Network Analysis of COVID Influences On Depression, Anxiety and Traumatic Stress in the UK Population</strong> -
<div>
Background. The COVID-19 emergency has led to numerous attempts to assess the impact of the pandemic on population mental health. Findings indicate an increase in depression and anxiety but have been limited by the lack of specificity about which aspects of the pandemic (e.g. viral exposure or economic threats) have led to adverse mental health outcomes. Methods. Network analyses were conducted on data from wave 1 (N = 2025 recruited March 23rd – March 28th 2020) and wave 2 (N = 1406 recontacts, 22 April – 1 May 2020) of the COVID-19 Psychological Research Consortium Study, an online longitudinal survey of a representative sample of the UK adult population. Our models included depression (PHQ-9), generalised anxiety (GAD-7) and trauma symptoms (ITQ) and also measures of Covid-specific anxiety, exposure to the virus in self and close others as well as economic loss due to the pandemic. Results. A mixed graphical model at wave 1 indicated that economic adversity impacted on anxiety symptoms via specific anxiety about the pandemic. There was no association between viral exposure and symptoms. Ising network models using clinical cut-offs for symptom scores at each wave yielded similar findings with the exception of a modest effect of viral exposure on trauma symptoms at wave 1 only. Anxiety and depression symptoms formed separate clusters at wave 1 but not wave 2. Conclusions. The psychological impact of the pandemic evolved in the early phase of lockdown. Adverse psychiatric outcomes were particularly associated with exposure to the economic consequences of the pandemic.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/psyarxiv/8xtdr/" target="_blank">How Does The COVID-19 Pandemic Impact on Population Mental Health? A Network Analysis of COVID Influences On Depression, Anxiety and Traumatic Stress in the UK Population</a>
</div></li>
<li><strong>Viral interference between severe acute respiratory syndrome coronavirus 2 and influenza A viruses</strong> -
<div>
Some respiratory viruses can cause a viral interference through the activation of the interferon (IFN) pathway that reduces the replication of another virus. Epidemiological studies of coinfections between SARS-CoV-2 and other respiratory viruses have been hampered by non-pharmaceutical measures applied to mitigate the spread of SARS-CoV-2 during the COVID-19 pandemic. With the ease of these interventions, SARS-CoV-2 and influenza A viruses can now co-circulate. It is thus of prime importance to characterize their interactions. In this work, we investigated viral interference effects between an Omicron variant and a contemporary influenza A/H3N2 strain, in comparison with an ancestral SARS-CoV-2 strain and the 2009 pandemic influenza A/H1N1 virus. We infected nasal human airway epitheliums with SARS-CoV-2 and influenza, either simultaneously or 24 h apart. Viral load was measured by RT-qPCR and IFN-/{beta}/{lambda}1/{lambda}2 proteins were quantified by immunoassay. Expression of four interferon-stimulated genes (ISGs; OAS1/IFITM3/ISG15/MxA) was also measured by RT-droplet digital PCR. Additionally, susceptibility of each virus to IFN-/{beta}/{lambda}2 recombinant proteins was determined. Our results showed that influenza A, and especially A/H3N2, interfered with both SARS-CoV-2 viruses, but that SARS-CoV-2 only interfered with A/H1N1. Consistently with these results, influenza, and particularly the A/H3N2 strain, caused a higher production of IFN proteins and expression of ISGs than SARS-CoV-2. The IFN production induced by SARS-CoV-2 was marginal and its presence during coinfections with influenza was associated with a reduced IFN response. All viruses were susceptible to exogenous IFNs, with the ancestral SARS-CoV-2 and Omicron being less susceptible to type I and type III IFNs, respectively. Thus, influenza A causes a viral interference towards SARS-CoV-2 most likely through an IFN response. The opposite is not necessarily true, and a concurrent infection with both viruses leads to a lower IFN response. Taken together, these results help us to understand how SARS-CoV-2 interacts with another major respiratory pathogen.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2024.02.02.578538v1" target="_blank">Viral interference between severe acute respiratory syndrome coronavirus 2 and influenza A viruses</a>
</div></li>
<li><strong>Development of a cell-based DIFF-rGFP assay system for generalized discovery of viral protease Inhibitors</strong> -
<div>
Viral protease is an attractive target for antiviral therapeutics, but current viral protease inhibitor screening methods still need to be improved. Here, we systematically investigated the sites that may accommodate exogenous short peptides within Enhanced Green Fluorescent Protein (EGFP)and constructed a series of recombinant green fluorescent proteins (rGFPs). Meanwhile, a cell-based, simple and reliable assay system named DIFF-rGFP was developed relying on the co-expression of rGFP and the protease for protease inhibitor screening with the example of 3CLpro, in which the fluorescence intensity increases with the action of the inhibitor. The DIFF-rGFP assay avoided the requirement of a higher biosafety lab and can be performed in a high-throughput manner. For proof of concept, we demonstrated this method to discover novel inhibitors against SARS-CoV-2. We believe the proposed method, in combination with available drug libraries, may accelerate the identification of novel antivirals.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2024.02.01.577684v1" target="_blank">Development of a cell-based DIFF-rGFP assay system for generalized discovery of viral protease Inhibitors</a>
</div></li>
<li><strong>OpenSAFELY: a platform for analysing electronic health records designed for reproducible research</strong> -
<div>
Electronic health records (EHRs) and other administrative health data are increasingly used in research to generate evidence on the effectiveness, safety, and utilisation of medical products and services, and to inform public health guidance and policy. Reproducibility is a fundamental step for research credibility and promotes trust in evidence generated from EHRs. At present, ensuring research using EHRs is reproducible can be challenging for researchers. Research software platforms can provide technical solutions to enhance the reproducibility of research conducted using EHRs. In response to the COVID-19 pandemic, we developed the secure, transparent, analytic open-source software platform OpenSAFELY designed with reproducible research in mind. OpenSAFELY mitigates common barriers to reproducible research by: standardising key workflows around data preparation; removing barriers to code-sharing in secure analysis environments; enforcing public sharing of programming code and codelists; ensuring the same computational environment is used everywhere; integrating new and existing tools that encourage and enable the use of reproducible working practices; and providing an audit trail for all code that is run against the real data to increase transparency. This paper describes OpenSAFELY’s reproducibility-by-design approach in detail.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/hj2sg/" target="_blank">OpenSAFELY: a platform for analysing electronic health records designed for reproducible research</a>
</div></li>
<li><strong>Recapitulating memory B cell responses in a Lymphoid Organ-Chip to evaluate mRNA vaccine boosting strategies</strong> -
<div>
Predicting the immunogenicity of candidate vaccines in humans remains a challenge. To address this issue, we developed a Lymphoid Organ-Chip (LO chip) model based on a microfluidic chip seeded with human PBMC at high density within a 3D collagen matrix. Perfusion of the SARS-CoV-2 Spike protein mimicked a vaccine boost by inducing a massive amplification of Spike-specific memory B cells, plasmablast differentiation, and Spike-specific antibody secretion. Features of lymphoid tissue, including the formation of activated CD4+ T cell/B cell clusters and the emigration of matured plasmablasts, were recapitulated in the LO chip. Importantly, myeloid cells were competent at capturing and expressing mRNA vectored by lipid nanoparticles, enabling the assessment of responses to mRNA vaccines. Comparison of on-chip responses to Wuhan monovalent and Wuhan/Omicron bivalent mRNA vaccine boosts showed equivalent induction of Omicron neutralizing antibodies, pointing at immune imprinting as reported in vivo. The LO chip thus represents a versatile platform suited to the preclinical evaluation of vaccine boosting strategies.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2024.02.02.578553v1" target="_blank">Recapitulating memory B cell responses in a Lymphoid Organ-Chip to evaluate mRNA vaccine boosting strategies</a>
</div></li>
<li><strong>Stratification of viral shedding patterns in saliva of COVID-19 patients</strong> -
<div>
Living with COVID-19 requires continued vigilance against the spread and emergence of variants of concern (VOCs). Rapid and accurate saliva diagnostic testing, alongside basic public health responses, is a viable option contributing to effective transmission control. Nevertheless, our knowledge regarding the dynamics of SARS-CoV-2 infection in saliva is not as advanced as our understanding of the respiratory tract. Here we analyzed longitudinal viral load data of SARS-CoV-2 in saliva samples from 144 patients with mild COVID-19 (a combination of our collected data and published data). Using a mathematical model, we successfully stratified infection dynamics into three distinct groups with clear patterns of viral shedding: viral shedding durations in the three groups were 11.5 days (95% CI: 10.6 to 12.4), 17.4 days (16.6 to 18.2), and 30.0 days (28.1 to 31.8), respectively. Surprisingly, this stratified grouping remained unexplained despite our analysis of 47 types of clinical data, including basic demographic information, clinical symptoms, results of blood tests, and vital signs. Additionally, we quantified the expression levels of 92 micro-RNAs in a subset of saliva samples, but these also failed to explain the observed stratification, although the mir-1846 level may have been weakly correlated with peak viral load. Our study provides insights into SARS-CoV-2 infection dynamics in saliva, highlighting the challenges in predicting the duration of viral shedding without indicators that directly reflect an individual's immune response, such as antibody induction. Given the significant individual heterogeneity in the kinetics of saliva viral shedding, identifying biomarker(s) for viral shedding patterns will be crucial for improving public health interventions in the era of living with COVID-19.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2024.01.30.578034v1" target="_blank">Stratification of viral shedding patterns in saliva of COVID-19 patients</a>
</div></li>
<li><strong>Adaptive Regularized Tri-Factor Non-Negative Matrix Factorization for Cell Type Deconvolution</strong> -
<div>
Motivation: Accurate deconvolution of cell types from bulk gene ex- pression is crucial for understanding cellular compositions and uncovering cell-type specific differential expression and physiological states of diseased tissues. Existing deconvolution methods have limitations, such as requiring complete cellular gene expression signatures or neglecting partial biological information. Moreover, these methods often overlook varying cell-type mRNA amounts, leading to biased proportion estimates. Additionally, they do not effectively utilize valuable reference information from external studies, such as means and ranges of population cell-type proportions. Results: To address these challenges, we introduce an Adaptive Regular- ized Tri-factor non-negative matrix factorization approach for deconvolution (ARTdeConv). We rigorously establish the numerical convergence of our algorithm. Through benchmark simulations, we demonstrate the superior per- formance of ARTdeConv compared to state-of-the-art reference-free methods. In a real-world application, our method accurately estimates cell proportions, as evidenced by the nearly perfect Pearson’s correlation between ARTdeConv estimates and flow cytometry measurements in a dataset from a trivalent influenza vaccine study. Moreover, our analysis of ARTdeConv estimates in COVID-19 patients reveals patterns consistent with important immunological phenomena observed in other studies. Availability and implementation: The proposed method, ARTdeConv, is implemented as an R package and can be accessed on GitHub for researchers and practitioners at https://github.com/gr8lawrence/ARTDeConv. Keywords: Cell-type deconvolution, Convergence analysis, Multiplicative update algorithm, Non-negative matrix factorization, RNA sequencing, Single cell data
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.12.07.570631v2" target="_blank">Adaptive Regularized Tri-Factor Non-Negative Matrix Factorization for Cell Type Deconvolution</a>
</div></li>
</ul>
<h1 data-aos="fade-right" id="from-clinical-trials">From Clinical Trials</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>SMILE: Clinical Trial to Evaluate Mindfulness as Intervention for Racial and Ethnic Populations During COVID-19</strong> - <b>Conditions</b>: Anxiety; COVID-19 Pandemic <br/><b>Interventions</b>: Behavioral: Mindfulness <br/><b>Sponsors</b>: University of North Carolina, Chapel Hill; National Institute on Minority Health and Health Disparities (NIMHD); RTI International <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Study to Learn About a Combined COVID-19 and Influenza Shot in Healthy Adults</strong> - <b>Conditions</b>: Influenza, Human, SARS-CoV-2 Infection, COVID-19 <br/><b>Interventions</b>: Biological: BNT162b2 (Omi XBB.1.5)/RIV; Biological: BNT162b2 (Omi XBB.1.5); Biological: RIV; Other: Normal saline placebo <br/><b>Sponsors</b>: Pfizer <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Effects of Nutritional Intervention on Health Parameters in Participants With Type 2 Diabetes Mellitus</strong> - <b>Conditions</b>: Diabetes Mellitus Type 2; Diabetes Mellitus Type 2 in Obese; Diabetes; Diabetes Mellitus Non-insulin-dependent; Hypertension; Type 2 Diabetes Mellitus <br/><b>Interventions</b>: Behavioral: Nutritional Intervention <br/><b>Sponsors</b>: Sao Jose do Rio Preto Medical School; Fundação de Amparo à Pesquisa do Estado de São Paulo <br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Impact of the Covid-19 Pandemic on Orthopedic Trauma Management</strong> - <b>Conditions</b>: Trauma; COVID-19 Pandemic <br/><b>Interventions</b>: Other: epidemyolojical <br/><b>Sponsors</b>: Bakirkoy Dr. Sadi Konuk Research and Training Hospital <br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Open-label, Multi-centre, Non-Inferiority Study of Safety and Immunogenicity of BIMERVAX for the Prevention of COVID-19 in Adolescents From 12 Years to Less Than 18 Years of Age.</strong> - <b>Conditions</b>: SARS CoV 2 Infection <br/><b>Interventions</b>: Biological: BIMERVAX <br/><b>Sponsors</b>: Hipra Scientific, S.L.U; Veristat, Inc.; VHIR; Asphalion <br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Study of Amantadine for Cognitive Dysfunction in Patients With Long-Covid</strong> - <b>Conditions</b>: Long COVID; Post-Acute COVID-19 Syndrome <br/><b>Interventions</b>: Drug: Amantadine; Other: Physical, Occupational, Speech Therapy; Other: Provider Counseling; Other: Medications for symptoms management <br/><b>Sponsors</b>: University of Texas Southwestern Medical Center <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Study on the Effect of Incentive Spirometer-based Respiratory Training on the Long COVID-19</strong> - <b>Conditions</b>: COVID-19 Pandemic; Diabetes; Hypertension; Cardiac Disease; Long COVID <br/><b>Interventions</b>: Behavioral: Incentive Spirometer respiratory training <br/><b>Sponsors</b>: National Taipei University of Nursing and Health Sciences; Tri-Service General Hospital <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Balance Acceptance and Commitment Therapy for Long COVID</strong> - <b>Conditions</b>: Post-COVID-19 Syndrome; Long COVID <br/><b>Interventions</b>: Behavioral: Balance Acceptance and Commitment Therapy <br/><b>Sponsors</b>: King’s College London <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Predict + Protect Study: Exploring the Effectiveness of a Predictive Health Education Intervention on the Adoption of Protective Behaviors Related to ILI</strong> - <b>Conditions</b>: Influenza; Influenza A; Influenza B; COVID-19; Respiratory Syncytial Virus (RSV) <br/><b>Interventions</b>: Behavioral: ILI Predictive Alerts, Reactive Content, and Proactive Content; Behavioral: ILI Predictive Alerts, Reactive Content; Behavioral: Proactive Content; Behavioral: No Intervention <br/><b>Sponsors</b>: Evidation Health; Biomedical Advanced Research and Development Authority <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Long COVID-19 [11C]CPPC Study</strong> - <b>Conditions</b>: COVID Long-Haul <br/><b>Interventions</b>: Drug: [11C]CPPC Injection; Drug: [11C]CPPC Injection <br/><b>Sponsors</b>: Johns Hopkins University; Radiological Society of North America <br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Thrombohemorrhagic Complications of COVID-19</strong> - <b>Conditions</b>: COVID-19 (Coronavirus Disease 2019) <br/><b>Interventions</b>: Diagnostic Test: Prevention algorithm <br/><b>Sponsors</b>: Volgograd State Medical University <br/><b>Active, not recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Combined Use of Immunoglobulin and Pulse Steroid Therapies in Severe Covid-19 Patients</strong> - <b>Conditions</b>: Pulse Steroid and Immunoglobulins Drugs in Covid 19 Patients <br/><b>Interventions</b>: Drug: pulse steroid and nanogam <br/><b>Sponsors</b>: Konya City Hospital <br/><b>Completed</b></p></li>
</ul>
<h1 data-aos="fade-right" id="from-pubmed">From PubMed</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Terpenes and cannabidiol against human corona and influenza viruses-Anti-inflammatory and antiviral in vitro evaluation</strong> - The activity of the terpenes and Cannabidiol (CBD) against human coronavirus (HCoV) strain OC43 and influenza A (H1N1) was evaluated in human lung fibroblasts (MRC-5 cells). Also, we examined whether these ingredients inhibit pro-inflammatory cytokines in peripheral blood mononuclear cells (PBMC). The tested preparations exhibited both anti-inflammatory and antiviral effects. The combination of terpenes was effective against both HCoV-OC43 and influenza A (H1N1) virus. The addition of CBD…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Plasma and urine proteomics and gut microbiota analysis reveal potential factors affecting COVID-19 vaccination response</strong> - The efficacy of COVID-19 vaccination relies on the induction of neutralizing antibodies, which can vary among vaccine recipients. In this study, we investigated the potential factors affecting the neutralizing antibody response by combining plasma and urine proteomics and gut microbiota analysis. We found that activation of the LXR/FXR pathway in plasma was associated with the production of ACE2-RBD-inhibiting antibodies, while urine proteins related to complement system, acute phase response…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Relative deficiency in interferon-γ-secreting CD4+ T cells is strongly associated with poorer COVID-19 vaccination responses in older adults</strong> - Although the two-dose mRNA vaccination regime provides protection against SARS-CoV-2, older adults have been shown to exhibit poorer vaccination responses. In addition, the role of vaccine-induced T-cell responses is not well characterised. We aim to assess the impact of age on immune responses after two doses of the BNT162b2 mRNA vaccine, focussing on antigen-specific T-cells. A prospective 3-month study was conducted on 15 young (median age 31 years, interquartile range (IQR) 25-35 years) and…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Structural Basis for coronaviral main proteases Inhibition by a 3CL Protease Inhibitor- GC376</strong> - The main protease (M^(pro)) of coronaviruses participates in viral replication, serving as a hot target for drug design. GC376 is able to effectively inhibit the activity of M^(pro), which is due to nucleophilic addition of GC376 by binding covalently with Cys145 in M^(pro) active site. Here, we used fluorescence resonance energy transfer (FRET) to analyze the IC(50) values of GC376 against M^(pro)s from six different coronaviruses (SARS-CoV-2, HCoV-229E, HCoV-HUK1, MERS-CoV, SARS-CoV,…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>PCSK9 inhibition with orally administered NNC0385-0434 in hypercholesterolaemia: a randomised, double-blind, placebo-controlled and active-controlled phase 2 trial</strong> - BACKGROUND: Currently available injectable drugs that target proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce serum LDL cholesterol and improve cardiovascular outcomes. This phase 2 study assessed NNC0385-0434, an oral PCSK9 inhibitor, in individuals receiving oral lipid-lowering therapy.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>In vitro broad-spectrum antiviral activity of MIT-001, a mitochondria-targeted reactive oxygen species scavenger, against severe acute respiratory syndrome coronavirus 2 and multiple zoonotic viruses</strong> - The COVID-19 pandemic caused by SARS-CoV-2 becomes a serious threat to global health and requires the development of effective antiviral therapies. Current therapies that target viral proteins have limited efficacy with side effects. In this study, we investigated the antiviral activity of MIT-001, a small molecule reactive oxygen species (ROS) scavenger targeting mitochondria, against SARS-CoV-2 and other zoonotic viruses in vitro. The antiviral activity of MIT-001 was quantified by RT-qPCR and…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Exploration of the P1 residue in 3CL protease inhibitors leading to the discovery of a 2-tetrahydrofuran P1 replacement</strong> - The virally encoded 3C-like protease (3CL^(pro)) is a well-validated drug target for the inhibition of coronaviruses including Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Most inhibitors of 3CL^(pro) are peptidomimetic, with a γ-lactam in place of Gln at the P1 position of the pseudopeptide chain. An effort was pursued to identify a viable alternative to the γ-lactam P1 mimetic which would improve physicochemical properties while retaining affinity for the target. Discovery of…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>In-situ synthesized and induced vertical growth of cobalt vanadium layered double hydroxide on few-layered V<sub>2</sub>CT<sub>x</sub> MXene for high energy density supercapacitors</strong> - Two-dimensional (2D) MXene nanomaterials display great potential for green energy storage. However, as a result of self-stacking of MXene nanosheets and the presence of conventional binders, MXene-based nanomaterials are significantly hindered in their rate capability and cycling stability. We successfully constructed a self-supported stereo-structured composite (TMA-V(2)CT(x)/CoV-LDH/NF) by in-situ growing 2D cobalt vanadium layered double hydroxide (CoV-LDH) vertically on 2D few-layered…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Possible pharmacological targets and mechanisms of sivelestat in protecting acute lung injury</strong> - Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a life-threatening syndrome induced by various diseases, including COVID-19. In the progression of ALI/ARDS, activated neutrophils play a central role by releasing various inflammatory mediators, including elastase. Sivelestat is a selective and competitive inhibitor of neutrophil elastase. Although its protective effects on attenuating ALI/ARDS have been confirmed in several models of lung injury, clinical trials have presented…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Natural products from Streptomyces spp. as potential inhibitors of the major factors (holoRdRp and nsp13) for SARS-CoV-2 replication: an in silico approach</strong> - The COVID-19 pandemic caused unprecedented damage to humanity, and while vaccines have been developed, they are not fully effective against the SARS-CoV-2 virus. Limited targeted drugs, such as Remdesivir and Paxlovid, are available against the virus. Hence, there is an urgent need to explore and develop new drugs to combat COVID-19. This study focuses on exploring microbial natural products from soil-isolated bacteria Streptomyces sp. strain 196 and RI.24 as a potential source of new targeted…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>NSP6 inhibits the production of ACE2-containing exosomes to promote SARS-CoV-2 infectivity</strong> - The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a global pandemic, which severely endangers public health. Our and others’ works have shown that the angiotensin-converting enzyme 2 (ACE2)-containing exosomes (ACE2-exos) have superior antiviral efficacies, especially in response to emerging variants. However, the mechanisms of how the virus counteracts the host and regulates ACE2-exos remain unclear. Here, we identified that SARS-CoV-2 nonstructural…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Activity and inhibition of the SARS-CoV-2 Omicron nsp13 R392C variant using RNA duplex unwinding assays</strong> - SARS-CoV-2 nsp13 helicase is an essential enzyme for viral replication and a promising target for antiviral drug development. This study compares the double-stranded RNA (dsRNA) unwinding activity of nsp13 and the Omicron nsp13^(R392C) variant, which is predominant in currently circulating lineages. Using in vitro gel- and fluorescence-based assays, we found that both nsp13 and nsp13^(R392C) have dsRNA unwinding activity with equivalent kinetics. Furthermore, the R392C mutation had no effect on…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Phospho-eIF4E stimulation regulates coronavirus entry by selective expression of cell membrane-residential factors</strong> - The eukaryotic translation initiation factor eIF4E can regulate cellular translation via phosphorylation on serine 209. In a recent study, by two rounds of TMT relative quantitative proteomics, we found that phosphorylated eIF4E (p-eIF4E) favors the translation of selected mRNAs, and the encoded proteins are mainly involved in ECM-receptor, focal adhesion, and PI3K-Akt signaling. The current paper is focused on the relationship between p-eIF4E and the downstream host cell proteins, and their…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Comparative immunogenicity and neutralizing antibody responses post heterologous vaccination with CoronaVac (Sinovac) and Vaxzevria (AstraZeneca) in HIV-infected patients with varying CD4+ T lymphocyte counts</strong> - The immune response to heterologous coronavirus disease (COVID-19) vaccination in people living with HIV (PLWH) is still unclear. Herein, our prospective cohort study aimed to compare the immune response of heterologous vaccination with CoronaVac (Sinovac) and Vaxzevria (AstraZeneca) between PLWH having CD4 counts ≤ 200 cells/µL (low CD4+) and &gt; 200 cells/µL (high CD4+). Anti-receptor-binding domain (RBD) immunoglobulin G (IgG) levels and the percentage inhibition of neutralizing antibodies…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial</strong> - Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual…</p></li>
</ul>
<h1 data-aos="fade-right" id="from-patent-search">From Patent Search</h1>
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<h1 data-aos="fade-down" id="daily-dose">Daily-Dose</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-new-yorker">From New Yorker</a></li>
<li><a href="#from-vox">From Vox</a></li>
<li><a href="#from-the-hindu-sports">From The Hindu: Sports</a></li>
<li><a href="#from-the-hindu-national-news">From The Hindu: National News</a></li>
<li><a href="#from-bbc-europe">From BBC: Europe</a></li>
<li><a href="#from-ars-technica">From Ars Technica</a></li>
<li><a href="#from-jokes-subreddit">From Jokes Subreddit</a></li>
</ul>
<h1 data-aos="fade-right" id="from-new-yorker">From New Yorker</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Why Trump’s G.O.P. Sock Puppets Are Sinking a Bipartisan Effort to Tighten Up Border Security</strong> - The former President fears losing his signature campaign issue, and congressional Republicans are bowing to his wishes. - <a href="https://www.newyorker.com/news/our-columnists/why-trumps-gop-sock-puppets-are-sinking-a-bipartisan-effort-to-tighten-up-border-security">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Friendship Challenge</strong> - How envy destroyed the perfect connection between two teen-age girls. - <a href="https://www.newyorker.com/magazine/2024/02/12/the-friendship-challenge">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Art World Before and After Thelma Golden, by Calvin Tomkins</strong> - When Golden was a young curator in the nineties, her shows, centering Black artists, were unprecedented. Today, those artists are the stars of the art market. - <a href="https://www.newyorker.com/magazine/2024/02/12/the-art-world-before-and-after-thelma-golden">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Teen’s Fatal Plunge Into the London Underworld</strong> - After Zac Brettler mysteriously plummeted into the Thames, his grieving parents were shocked to learn that he’d been posing as an oligarch’s son. Would the police help them solve the puzzle of his death? - <a href="https://www.newyorker.com/magazine/2024/02/12/a-teens-fatal-plunge-into-the-london-underworld">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Photos from a Late-Stage Abortion Clinic</strong> - At a clinic in Maryland, desperate patients arrive from all over the country to terminate their pregnancies. - <a href="https://www.newyorker.com/magazine/2024/02/12/a-safe-haven-for-late-abortions">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>Is your medication out of stock? Here’s how to get it anyway.</strong> -
<figure>
<img alt="Empty blister packs sit on a pink background." src="https://cdn.vox-cdn.com/thumbor/BZtl0uEaJANrDbVVz2a_BlftSWE=/342x0:5707x4024/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/73115287/GettyImages_1387042817.0.jpg"/>
<figcaption>
Aitor Diago for Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The pharmaceutical supply chain is broken, but if you’re facing a drug shortage, you have more power than you think.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="F7Rlik">
By the time people get to <a href="https://www.angelsforchange.org/story">Laura Bray</a>, they’ve been failed<em> </em>by the US government, all of its agencies, and the entire global pharmaceutical supply chain.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6n9CMU">
So when someone calls her at <a href="https://www.angelsforchange.org/">Angels for Change</a>, the patient advocacy organization she founded in 2019 with a mission of ending drug shortages, one of the first things Bray does is reassure them that they’re not the problem. “I want you to know that drug shortages are real. You deserve access to their medicine,” she tells them. “And it’s not their fault, and somebody should have done better. And they all cry,” she says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AnUIKJ">
Bray gets it. When her young daughter was getting leukemia treatment, one of the chemotherapy drugs she needed was unavailable due to a global shortage. She was stunned: A professor of business in Tampa, Florida, she knew other distribution channels weren’t nearly so brittle. A bank about to run out of cash would never be allowed to fail. Redundancy and resilience is built into our monetary, food, and oil supply chains, she thought, “but it’s just not there for pharmaceuticals. Why?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DzSfcH">
Five years later, drug shortages in the US are at a 10-year high. The putative reasons are manifold: As the Food and Drug Administration has scrambled to catch up on inspections of routine drug manufacturing facilities in the wake of pandemic closures, the deficits they’re finding — and the production delays they’re leading to — are piling up all at once, says <a href="https://pharmacyservices.utah.edu/residency/drug-info-staff">Erin Fox</a>, a doctor of pharmacy and medication shortage specialist at the University of Utah, whose drug information service provides content to a drug shortage database run by the <a href="https://www.ashp.org/drug-shortages/current-shortages/drug-shortages-list?page=All&amp;loginreturnUrl=SSOCheckOnly">American Society of Health-System Pharmacists</a> (ASHP). Simultaneously, a large <a href="https://ascopost.com/issues/december-10-2023/on-mark-cuban-and-the-chemotherapy-crisis/#:~:text=Two%20common%20chemotherapy%20agents%E2%80%94cisplatin,product%20and%20more%20dramatic%20shortage.">chemotherapy drug plant </a><a href="https://www.washingtonpost.com/business/2023/06/27/cancer-drug-shortage-generics/">shut</a><a href="https://ascopost.com/issues/december-10-2023/on-mark-cuban-and-the-chemotherapy-crisis/#:~:text=Two%20common%20chemotherapy%20agents%E2%80%94cisplatin,product%20and%20more%20dramatic%20shortage."> down</a> due to quality problems; opioid settlement rules have reduced pharmacy ordering capacity for controlled substances, <a href="https://www.vox.com/policy/2023/4/10/23671128/adhd-medication-adderall-shortage-2023#:~:text=Bloomberg%20reported%20this%20week%20that,pharmacy%20with%20an%20Adderall%20order.">including ADHD drugs</a>; and rising rates of syphilis are chewing through an already-low supply of <a href="https://www.statnews.com/2023/06/22/bicillin-syphilis-pfizer-penicillin-shortage/">injectable penicillin</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JuJcGz">
The real reason shortages keep happening, says Bray, is because patient outrage never reaches the supply chain. She’s on a quest to change that: After thousands of phone calls eventually got her daughter the treatment she needed, she created an organization aimed not only at serving individuals’ medication needs but at unifying their voices to <a href="https://democrats-energycommerce.house.gov/committee-activity/hearings/hearing-on-examining-the-root-causes-of-drug-shortages-challenges-in">demand better</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hZsxdy">
Few people have the time or the background to spend hours on the phone with hospitals, pharmacies, lawmakers, and pharmaceutical companies to get a medication. And while there’s been more awareness about drug shortages in the past year than the US has seen in some time, they’re not going away any time soon.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6F30Hw">
You can and should get hopping mad about drug shortages. And if you’re affected by one yourself, you have more power than you might think when it comes to getting the medication you need.
</p>
<h3 id="rsSt1X">
Broken financial incentives and a lack of transparency are at the heart of drug shortages
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zWOnfQ">
Fundamentally, shortages are related to problems that decrease a drug’s supply and increase its demand. Most shortages are rooted in supply problems — and in about two-thirds of cases that the FDA reports in its own <a href="https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm">drug shortage database</a>, Fox says, quality problems at a manufacturing facility are at the heart.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PyL4bd">
Many of the quality problems affect the production of generic drugs, which are both most commonly used and cheapest for consumers. “It’s just a race to the bottom with these companies trying to gain market share,” says Fox. Pharmaceutical companies make so little money on generics that many eventually either stop making them, cut corners on quality, or opt not to upgrade the facilities that produce them. All of that makes production lines that produce generic drugs particularly vulnerable to shutdown — which, because the drugs are used so widely, ends up affecting a <em>lot</em> of people.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SZZNlM">
<em>[Related: </em><a href="https://www.vox.com/policy/2023/4/10/23671128/adhd-medication-adderall-shortage-2023"><em>The ongoing, unnecessary Adderall shortage, explained</em></a><em>]</em>
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WbgJkx">
Profit considerations also have a lot to do with the other one-third of drug shortages that the FDA reports, says Fox, which include related production stoppages unrelated to quality. For example, if a manufacturer can produce a more profitable drug in the same plant where it produces a less profitable drug, it might simply choose to make more of the one that nets more money. <a href="https://www.nytimes.com/2023/12/06/opinion/drug-shortages-pharmaceuticals.html">Nobody can force the company</a> to make the less profitable drug.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="V17JHV">
Production problems related to raw material shortages or <a href="https://www.vox.com/natural-disaster">natural disasters</a> — like <a href="https://www.theguardian.com/us-news/2018/jan/10/hurricane-maria-puerto-rico-iv-bag-shortage-hospitals">Hurricane Maria</a>, which shut down a Puerto Rico factory that made bags of saline, and a <a href="https://www.usp.org/supply-chain/pfizers-rocky-mount-facility-tornado-damage-impact-on-pharmaceutical-supply-chain">tornado</a> that hit a Pfizer plant in North Carolina — can also cause big disruptions in the drug supply.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mhYRdY">
These shortages would be a problem even if there were a robust system for reallocating the drugs they affect. But that system doesn’t exist, says <a href="https://publichealth.jhu.edu/faculty/3523/mariana-p-socal">Mariana Socal</a>, a physician and researcher who studies the US pharmaceutical industry at Johns Hopkins University’s Bloomberg School of Public Health. Part of the reason: Nobody outside the FDA knows exactly where the problems are.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5s3nNR">
“There’s no transparency” around what triggers any one shortage because private entities are allowed to keep that information under wraps, says Socal. She thinks about drug shortages every time she unpacks her groceries: “A box of fruit or vegetables says ‘Produced in California’ or ‘Origin: Mexico,’” she says, but you have no idea where a container of generic Tylenol came from or whether you can feel confident in the product.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iK2X3p">
The opaqueness of the production system, and the absence of a method for equitably allocating drugs when there is a shortage, means that only the savviest pharmacies get what’s left of a drug supply when it’s running low. “It’s like Hunger Games,” says Fox. “Whoever can order ahead, whoever has the most resources to kind of hear about a shortage first, to try to put in as many back orders with different companies as possible — those places are more likely to get some product in.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UJkGeY">
Fox has tried to change this herself. Ten years ago, when there was a spate of pediatric cancer drug shortages, she asked the FDA and pharmaceutical companies to reserve the remaining drug supply for sale only to pediatric cancer centers. “Everyone was like ‘Oh, it’s a free market — we can’t tell these manufacturers what to do,’” she says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZlERr7">
So when waves of illness increase the demand for certain drugs — as surging syphilis rates have done for penicillin, and as cold and flu season does for <a href="https://www.npr.org/sections/health-shots/2022/12/03/1140185521/children-fever-medicine-tylenol-motrin-hard-to-find">fever reducers</a> and <a href="https://www.vox.com/policy-and-politics/23484040/rsv-flu-amoxicillin-tamiflu-abuterol-drug-adderall-shortages">amoxicillin</a> — consumers are left holding the (empty) bag.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iCpyey">
<a href="https://www.mcw.edu/find-a-doctor/ehrenfeld-jesse">Jesse Ehrenfeld</a>, a physician and current president of the American Medical Association, says solving drug shortages requires a multipronged approach. Any fix should prioritize developing more capacity for producing key medications, putting plans in place to minimize supply chain disruptions, creating a larger pool of generic drug manufacturers, and changing FDA processes to allow more drugs into the marketplace.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mSr1lW">
There’s hope for seeing some of this happen: Despite the US government’s reluctance to regulate private business — especially in industries with <a href="https://www.vox.com/2023/6/16/23760650/medicare-big-pharma-prescription-drug-prices-lawsuit">powerful</a> <a href="https://www.vox.com/policy-and-politics/2017/1/31/14453740/trump-medicare-prescription-drugs">lobbies</a> — Fox says there’s been more advocacy before <a href="https://www.vox.com/congress">Congress</a> on drug shortages this year than she has seen in her two decades following the issue.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0O7zbf">
Much of the draft legislation is what Bray describes as “pet projects”: bills too narrowly focused on one part of the supply chain to really fix the problem. However, she was pleased to see a more robust approach in a <a href="https://www.finance.senate.gov/imo/media/doc/white_paper_preventing_drug_shortages.pdf">white paper</a> the Senate finance committee recently released and says the Senate energy and commerce committees have also been doing good work.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="bhhcn9">
Bray also says the <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2023/11/27/fact-sheet-president-biden-announces-new-actions-to-strengthen-americas-supply-chains-lower-costs-for-families-and-secure-key-sectors/">White House plan to address drug shortages</a> announced in late 2023 is a good start. Notably, that plan proposed designating a government employee to provide the service Bray has been providing for people who reach out for help. Currently, she is the only person she knows of who directly links people affected by drug shortages with emergency supplies of their medications — and she’s a private individual, effectively a one-woman operation, alone in a Tampa office park except for a single employee who helps her with social media. “I could do it so much better if I had more people,” she says.
</p>
<h3 id="2RlpAZ">
What to do if there’s a shortage of a drug you need
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TL8BpL">
Bray gets an average of four requests a day, and depending on who’s calling, the work she does in response may help anywhere from a handful to thousands of patients. Although many of her calls come from clinics, hospitals, and manufacturers, she often hears from individual patients — and when she does, she suggests they take the series of steps outlined below, which I’ve interspersed with tips from the other experts I spoke with.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Rip6mI">
Although it’s easy to feel a sense of panic when facing down a shadowy tangle of dysfunctional institutions, take a deep breath and know that there is a path forward, and there are resources and advocates out there that can help.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="eGwPwQ">
It’s obviously less stressful to have a few days to deal with a drug shortage rather than a few hours. When you can, plan ahead: If you’re reupping a drug you’re already taking, “give it a few extra days as opposed to waiting until the last minute to request a refill,” says <a href="https://ncpa.org/newsroom/qam/2022/03/18/ncpas-beckner-named-publication-advisory-board">John Beckner</a>, a pharmacist who directs strategic initiatives at the <a href="https://ncpa.org/">National Community Pharmacists Association</a> (NCPA).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wbU17i">
Before you do too much work, it’s worth seeing whether an independent pharmacy in your area can locate a supply of the drug you need. They’re less likely to just say “We’re out of stock — we can’t get it,” says Beckner. “They’re going to explore other means to try to obtain that drug.” That may mean calling around to smaller drug wholesalers or buying a small quantity of a medication that might not be on the radar of a drugstore that buys medications by the pallet. You can find a local independent pharmacy using the NCPA’s <a href="https://ncpa.org/pharmacy-locator">pharmacy locator</a> website.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7bVooB">
If you’re still unable to get the medication you need, here’s what Bray counsels people to do. Parts of this process are things patients must do on their own, but Bray is happy to help people who get stuck at any point along the way and welcomes contact by <a href="https://www.angelsforchange.org/contactus">phone or email</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QiiSaa">
<strong>1) Look for the generic form of the drug in the two drug shortage databases</strong> that contain all the information available to the American public about specific medicines’ availability: the one maintained by the <a href="https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm">FDA</a> and the one run by the <a href="https://www.ashp.org/drug-shortages/current-shortages/drug-shortages-list?page=All&amp;loginreturnUrl=SSOCheckOnly">ASHP</a>. They’re similar, although the ASHP database has a lower threshold for reporting a shortage, says Bray.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="A8ZmmB">
This first step helps patients determine not only which brands and dosages of a drug are unavailable, but also which <em>are</em> available.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Et8F6Y">
<strong>2) Call your insurance company</strong>, ask to speak with a manager, explain that you are affected by a drug shortage, and ask them to give you coverage for whatever alternative form, brand, or dose of the drug you might be able to get access to.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="leaqkS">
The reason to do this is that insurance companies cut deals with various drug intermediaries — called <a href="https://www.vox.com/2023/5/10/23709448/what-are-pbms-pharmacy-benefit-managers-bernie-sanders">pharmacy benefit managers</a> — for specific medicines within each class of drugs and specific dosages of those medicines. Ostensibly, they do this so they can buy those specific medicines in bulk quantities at a discount and cover most of their cost when they are prescribed to you. The list of medicines and dosages an insurance company covers, its hot list of sorts, is called its formulary.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WDn1hz">
But where there’s a hot list, there’s a not list: If you’re prescribed a dosage or brand of a medicine that isn’t on your insurer’s formulary, or a similar medicine that isn’t on its formulary, the company won’t cover it — and you’ll have to pay for it out of pocket, which can be wildly expensive.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="z4KEjZ">
Patients can ask their insurers to temporarily cover a drug that isn’t on their formulary in a shortage situation like this, says Bray. “Say, ‘I’m going to be talking to my physician about giving me access to the [forms, brands, or dosages of the drug] that are available here and changing my prescription. Can you ensure that you open up the formularies while this shortage is happening so that I can get access to any of them?’”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xneDbG">
Bray suggests explaining that you would not be asking for this change if the on-formulary drug were available to you, but it’s not. The conversation — one patients or their policy holders must have with their providers themselves — is usually successful, she says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="esBSe5">
<strong>3) Contact the health provider who prescribes the unavailable drug</strong>, let them know there’s a shortage, and ask which of the available alternatives they can prescribe you. Bray suggests sending them a link to these alternatives. They’re easy to find in the <a href="https://www.ashp.org/drug-shortages/current-shortages/drug-shortages-list?page=All&amp;loginreturnUrl=SSOCheckOnly">ASHP database</a> — just click on the name of the drug in shortage and scroll down to “Available Products.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rutza9">
Providers are often aware of shortages and generally want to do the right thing to help patients get through them, says Ehrenfeld.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="k75vje">
If your provider sends the alternative prescription to your pharmacy (or a hospital’s pharmacy, if you’re calling on behalf of a hospitalized patient) and the drug is in stock, this might be the triumphant end of your road. If not …
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="W4EVGm">
<strong>4) Seek an alternative pharmacy. </strong>If your usual pharmacy is part of a large chain, staff may be able to check the inventory of other local chain outlets, either online or over the phone — just ask.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9wDayv">
Again, nimbler independent mom-and-pop pharmacies may be better able to fill in drug availability gaps. In addition to having access to different supply lines, their staff may have more time to make calls about small quantities of scarce medications or their alternatives. In general, says Beckner, your pharmacist — whether independent or at a chain — “can really become your advocate and confidant,” especially if you’ve established a good relationship.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="8hwesZ">
<strong>5) Call Angels for Change </strong>if you’re still struggling to find the medication you need after all of this, urges Bray. She can work to identify the supply map for a medication, and she can reach out to its manufacturers to inquire about any emergency supply they may have on hand and clarify the timeline for having more supply available.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zZDKh8">
It might be tempting to look online for a medication when you’re affected by a shortage, either on social media or by ordering from a sketchy internet pharmacy. All of the experts I spoke to recommend against this approach. You never know whether the medication was stored properly or whether it’s counterfeit, and you’re at risk for being price-gouged, says Fox.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="z5yF5V">
Bray’s strategy is one “that requires sophistication and a lot of work that just should not be necessary in this day and age, with all the technology that we have and all of the resources in the nation,” says Ehrenfeld. “It’s because we have erected barriers to getting people the care that they need.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KEHPCb">
</p></li>
<li><strong>Welcome to the “neomedieval era”</strong> -
<figure>
<img alt="A photo collage shows Xi Jinping, Vladimir Putin, and Joe Biden in a scene of medieval art elements." src="https://cdn.vox-cdn.com/thumbor/9pp0HMAAMUVIBPEKZmDBx5muqB0=/240x0:1680x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/73115240/Vox_Neomedievalism_JaredBartman.0.png"/>
<figcaption>
Jared Bartman for Vox/Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Nations like the US have more firepower than ever before — but they also appear weaker than ever. The upshot is a world that feels out of control
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ACC4gG">
The world, we are told, is entering a new era of “great-power rivalry.” Or at least, it was supposed to be.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4GDdxC">
The most recent <a href="https://www.whitehouse.gov/wp-content/uploads/2022/10/Biden-Harris-Administrations-National-Security-Strategy-10.2022.pdf">US National Security Strategy</a>, issued by <a href="https://www.vox.com/joe-biden">President Joe Biden</a>’s administration in 2022, confidently asserted that “the post-Cold War era is definitively over,” and that we were entering an era defined by “competition between the United States and the world’s largest autocracies” — namely, <a href="https://www.vox.com/china">China</a> and <a href="https://www.vox.com/russia">Russia</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Mc0k6I">
The strategy explicitly states that the US does not seek a “new Cold War,” but its framing of the world as an ideologically driven competition between democracy and autocracy makes it hard to avoid the comparison, particularly since the same superpowers are involved this time around, just with a little economic and political rebranding.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iNzNoH">
But is the Cold War the right analogy for what’s happening now? There is no shortage of alternatives. Pointing to Vladimir Putin’s territorial aggression, Ukraine’s leaders and their defenders <a href="https://twitter.com/ZelenskyyUa/status/1496787304811315202">have cast their comparison</a> to World War II, with Russia now in the role of Hitler’s Germany. (Putin himself wouldn’t argue — he just <a href="https://www.nytimes.com/interactive/2022/07/02/world/europe/ukraine-nazis-russia-media.html">portrays the other side as the Nazis</a>.) Perhaps, some cautious “realists” suggest, the entangling alliances drawing Western countries into conflict make this moment <a href="https://foreignpolicy.com/2022/10/27/ukraines-war-is-like-world-war-i-not-world-war-ii/">more like the lead-up to World War I</a>. Certainly the reemergence of trench warfare on the European continent for the first time in decades makes it hard to resist the comparison.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wk2swP">
To suggest as the Biden administration has that we’re entering a new age of superpower conflict, whatever historical comparison you reach for, is also to argue that we’re turning the page on an era in which America’s main <a href="https://www.vox.com/defense-and-security">national security</a> concern was not other powers, greater or lesser, but non-state terrorist groups. There was reason to think this after the decimation of al-Qaeda and ISIS. But the October 7 <a href="https://www.vox.com/politics/2023/10/10/23911661/hamas-israel-war-gaza-palestine-explainer">Hamas</a> attacks on <a href="https://www.vox.com/israel">Israel</a> were a <a href="https://www.vox.com/world-politics/2023/12/13/23998928/hamas-taliban-isis-attacks-terrorism-extremist-groups-israel-palestine">shocking reminder</a> that, while we might not be interested in non-state terrorist groups, they’re still interested in us.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IiTXlz">
The result is that the US now finds itself operating in two strategic eras at the same time. In one, heavily armed industrial militaries fight a catastrophic war over a chunk of Europe (with a potentially even more catastrophic invasion <a href="https://www.vox.com/world-politics/2024/1/6/24026992/taiwan-china-president-war-xi-jinping-asia-semiconductors-chips">scenario lurking in Asia</a>). And in another, a <a href="https://www.vox.com/world-politics/24010092/houthis-red-sea-shipping-yemen-israel-gaza">Yemeni rebel group using rudimentary drone and missile technology</a> shows itself capable of causing a <a href="https://www.cnbc.com/2024/01/18/red-sea-crisis-already-bigger-issue-for-shipping-than-covid-data-show.html?__source=sharebar%7Ctwitter&amp;par=sharebar">disruption to global supply chains on par with Covid-19</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6DQRjX">
To comprehend this chaotic era — one in which nation-states boast historically destructive firepower but in many ways appear weaker than ever, unable to mobilize their populations around a common call or control their international environment — we need to go beyond the well-worn 20th-century analogies. We need to get medieval.
</p>
<h3 id="4vHArg">
Back to the future
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GCGsei">
A <a href="https://www.rand.org/pubs/research_reports/RRA1887-1.html">recent paper </a>published by the RAND Corporation argued that to understand the risks involved in superpower competition between the US and China, it’s vital to understand that we live in what the authors describe as a “neomedieval era.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NiRA57">
“There’s so many anomalous things about our current situation that I found existing theories very unsatisfying,” said one of the paper’s co-authors, Timothy Heath, a senior defense researcher and China specialist at RAND. He points to unexpected events like the increasing <a href="https://www.vox.com/2022/10/23/23419022/xi-jinping-third-term-communist-party-china-congress">centralization of power</a> in Xi Jinping’s China and the political fault lines exposed by the <a href="https://www.vox.com/policy-and-politics/2021/1/6/22217657/us-capitol-breach-trump-rally-presidential-election">January 6 </a>insurrection in the US. “ What I’ve realized is that the last 200 years in many ways stand out as an incredible anomaly in human history, and that the situation we’re in now actually has a lot more features in common with the pre-1800 world than the recent past.”
</p>
<figure class="e-image">
<img alt="The rubble of buildings is seen in Rafah." src="https://cdn.vox-cdn.com/thumbor/_0mOLnqZ5eZw-GoiooD7FrMmtGg=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25268025/GettyImages_1959393424.jpg"/> <cite>Ahmad Hasaballah/Getty Images</cite>
<figcaption>
Citizens inspect the effects of the destruction of the Omar bin Abdul Aziz Mosque, and the houses adjacent to it, due to Israeli airstrikes on January 25, 2024, in Rafah, Egypt.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pGTsK4">
Saying we live in a “neomedieval” moment doesn’t mean that a US-China war would be fought with broad swords and chain mail. The authors define the neomedieval era, which they argue began around 2000, as being “characterized by weakening states, fragmenting societies, imbalanced economies, pervasive threats, and the informalization of warfare.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="D8G4RG">
Thinking about the world this way requires a bit of a mental adjustment, largely because we’re accustomed to thinking of states as the core units of international relations. “States,” according to the sociologist Max Weber’s <a href="http://fs2.american.edu/dfagel/www/class%20readings/weber/politicsasavocation.pdf">classic definition</a>, are the entity that claims a monopoly on the legitimate use of force within a given territory. And the world map as we know it is divided up into 193 or so of these territories, which we call “countries.” They have flags, capitals, and United Nations ambassadors.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="12A08V">
But this is a relatively recent arrangement. Historians generally date the emergence of the modern state system back to 17th-century Europe. Before that, nationality had what the historian <a href="https://www.nyrb.com/products/the-thirty-years-war">C.V. Wedgwood described </a>in her history of the Thirty Years’ War as a “fluidity which is startling to the modern mind.” Governmental authority was often divided between royal families and religious authority. Royals could be of a completely different nationality from the people they governed, with authority rooted in heredity and marriage rather than popular consent. (Britain’s ruling House of Windsor, currently led by King Charles III, <a href="https://www.thoughtco.com/the-houses-of-windsor-and-hanover-4069109">traces its origins</a> to what is now Germany.) The authority of a king could be challenged by local barons and dukes. “No one thought it strange that a French soldier should command an army against the French and loyalty to a cause, to a <a href="https://www.vox.com/religion">religion</a>, to a master, was commonly more highly esteemed than loyalty to a country,” Wedgwood wrote.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zmk6ja">
The idea that geopolitics might be going back to the future isn’t new. Back in 1977, the international relations theorist <a href="https://cup.columbia.edu/book/the-anarchical-society/9780231161299">Hedley Bull wrote</a> that it was “conceivable that sovereign states might disappear and be replaced not by a world government but by a modern and secular equivalent of the kind of political organization that existed in Western Christendom in the Middle Ages.” He defined this organization as one in which “no ruler or state was sovereign in the sense of being supreme over a given territory.” In other words, the state is no longer the only game in town when it comes to governance.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5wRBez">
The neomedieval analogy had a <a href="https://faculty.wharton.upenn.edu/wp-content/uploads/2012/05/hartrev2.pdf">moment of popularity</a> in the 1990s, when theorists sought to capture the sudden political and economic complexity of a post-Cold War world torn loose from the two poles of the US and the Soviet Union. Neomedievalism was dusted off to explain a world in which multinational corporations, often with senior executives from multiple countries and little loyalty to the country where they were based, could acquire a level of political power that rivaled national governments. “The hierarchies of international capitalism resemble the feudal arrangements under which an Italian noble might swear fealty to a German prince, or a Norman duke declare himself the vassal of an English king,” the journalist Lewis Lapham <a href="https://faculty.wharton.upenn.edu/wp-content/uploads/2012/05/hartrev2.pdf">wrote in 1988</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Gq8eUk">
Neomedievalism was also used to explain arrangements by which governments would voluntarily surrender a certain level of sovereignty to multinational bodies, as the nations of Europe did with the <a href="https://www.vox.com/european-union">European Union</a>, culminating in the introduction of a common currency in 1999.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="aIoqjh">
In an influential and controversial <a href="https://www.theatlantic.com/magazine/archive/1994/02/the-coming-anarchy/304670/">1994 Atlantic article</a> — later expanded into a book, <a href="https://bookshop.org/p/books/the-coming-anarchy-shattering-the-dreams-of-the-post-cold-war-robert-d-kaplan/8509039?gclid=CjwKCAiA_OetBhAtEiwAPTeQZ3OykqOOBSmn91OwX2Mh4P0Z7jNeLYm773PCFxXTT83-HeuYPIcLKBoCXaEQAvD_BwE"><em>The Coming Anarchy</em></a> — journalist Robert Kaplan portrayed West Africa’s chaotic civil wars, fought in territories where national boundaries drawn by colonial powers that often had little relation to ethnic realities on the ground, as a preview of a world where national borders were less relevant and “a pre-modern formlessness governs the battlefield, evoking the wars in medieval Europe.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ypibEN">
In more recent years, the idea has been taken up by writers like the paratrooper-turned-military contractor-turned-academic Sean McFate. His 2015 book <a href="https://www.amazon.com/Modern-Mercenary-Private-Armies-World/dp/0199360103"><em>The Modern Mercenary</em></a><em> </em>argued that the increasing prevalence of private military contractors, such as America’s Blackwater or Russia’s Wagner Group, in conflicts around the world presaged a neomedieval world in which “states did not enjoy the monopoly of force and subsequent special authority in world politics.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SIu9Wo">
“States are not timeless,” McFate told Vox. “They’re not universal. They had a beginning, a middle, and they may have an end.”
</p>
<h3 id="Wqi8pw">
The court of Putin
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Tvh7X2">
For all its resemblances to 20th-century warfare, the ongoing Russian <a href="https://www.vox.com/russia-invasion-ukraine">war in Ukraine</a> has some clearly premodern characteristics. Which makes sense, given who is prosecuting that war —the UK-based Russia analyst Mark Galeotti <a href="https://www.economist.com/by-invitation/2023/06/27/mark-galeotti-on-vladimir-putins-self-inflicted-wounds">describes Russia</a> under Vladimir Putin as “a peculiar hybrid: an almost medieval court perched atop a modern, bureaucratic state.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6lLGgO">
Galeotti explained to Vox that in terms of “day-to-day aspects of governance,” Russia is “really not that different from any other European country,” with typical bureaucracies running day-to-day affairs — your ministries of finance or foreign affairs. But, he says, “from time to time, someone from far, far above reaches down and changes things, whether it’s something as basic as arranging for someone to be arrested, or having someone’s driving offenses erased, or dramatic changes to macroeconomic policy.” The power of the people who can make these changes is determined — as in a medieval court — solely by their proximity to the absolute ruler. “Those people who have the favor or the ear of Putin can basically do whatever they want.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dL4X1z">
This dynamic was illustrated most dramatically in the decision to invade Ukraine, and in how war has been conducted. “This war is being fought the way that Putin and his collection of cronies, none of whom have military experience, decided to fight it rather than the war that the generals would have fought,” said Galeotti. It was the act not of a president, which Putin technically is, but a king — or, better, an emperor.
</p>
<figure class="e-image">
<img alt="Burned cars stand in the courtyard of a residential high-rise building after a Russian missile attack on January 23, 2024, in Kharkiv, Ukraine." src="https://cdn.vox-cdn.com/thumbor/T5yCm8uJ9K4k-kuqGIXmSmtgH5k=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25268026/GettyImages_1956915630.jpg"/> <cite>Eugene Hertnier/Global Images Ukraine via Getty Images</cite>
<figcaption>
Burned cars stand in the courtyard of a residential high-rise building after a Russian missile attack on January 23, 2024, in Kharkiv, Ukraine
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vD0uaY">
And for all of Putin’s constant invocations of the Great Patriotic War, as World War II is known in Russia, it is abundantly clear that Putin has little hope of mobilizing society on the level that Josef Stalin did during that conflict. Russia is set to spend about <a href="https://carnegieendowment.org/politika/90753#:~:text=For%20the%20first%20time%20in,driver%20of%20Russia's%20economic%20growth.">6 percent of its gross domestic product on defense and military spending</a> this year. This may be an unprecedented number in modern times, but it is nothing <a href="https://markets.businessinsider.com/news/commodities/russia-economy-spending-war-ukraine-defense-budget-gdp-europe-investing-2023-6">compared to the 61 percent</a> of GDP the Soviet Union spent during World War II (or the 50 percent spent by the US in that war, for that matter).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="s91PtU">
For all that Russians may support what Putin calls the “special military operation” in principle, they don’t seem particularly eager to put their lives, or their children’s lives, on the line for it the way their grandparents did in the Great Patriotic War. Nor does Putin have the ability to compel service as Stalin did without risking his own position. In the fall of 2022, Russia announced a “partial mobilization,” to call up around 300,000 men to fight in the war, but a far greater number than that — perhaps as many as 700,000, according to some estimates — <a href="https://www.reuters.com/world/europe/where-have-russians-been-fleeing-since-mobilisation-began-2022-10-06/">chose instead to flee the country</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Opx84O">
Galeotti cautions against thinking of this unwillingness to die for the cause as just a Russian issue. “I was talking to someone recently from the British Ministry of Defence, who was saying, ‘God only knows what would happen if we had to try and call up our reserves.’” Indeed, a <a href="https://yougov.co.uk/politics/articles/48473-more-than-a-third-of-under-40s-would-refuse-conscription-in-the-event-of-a-world-war">recent poll</a> found that nearly a third of Britons ages 18 to 40 say they would refuse to serve in the military if a world war broke out and the country was under imminent threat of invasion.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="74XMKf">
The Ukraine war has also exposed the unreadiness of most Western powers to produce the firepower needed for an all-out industrial-scale conflict. The US has had to scramble to ramp up production artillery shells after it became clear that Ukraine was firing about <a href="https://www.vox.com/world-politics/24002840/ukraine-russia-war-united-states-aid-volodymyr-zelensky-vladimir-putin-europe-congress-border">half the number of shells in a day</a> that the US was producing in a month before the war. According to one estimate, near the start of the Ukraine war, Germany had only about enough shells in its reserves for <a href="https://www.thetimes.co.uk/article/germany-weapons-war-ammunition-stocks-ukraine-ptc69qdcz">two days of heavy fighting</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="aoTARy">
Ukraine may end up being the exception that proves the rule. It’s a throwback to mid-20th-century warfare, but the Ukrainian conflict makes it very clear that 21st-century countries are not at all equipped to fight that kind of war.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cj7XIR">
“The only way to fight a total war is to basically become an authoritarian socialist system,” said Galeotti. “The point of the matter is modern states aren’t used to doing this kind of thing.”
</p>
<h3 id="pG5XqH">
Between the lines in the Middle East
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="oDtBNL">
A neomedieval perspective can be helpful in analyzing the dizzyingly complex interlocking conflicts in today’s Middle East — and not only because it’s one of the few regions where absolute monarchies, like Saudi Arabia and its Gulf neighbors, are still major power players.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6b1u5f">
The escalating regional crisis set off by the October 7 attacks is one in which questions of nationality are as fluid as they were more broadly in the premodern era. The territory referred to as “<a href="https://www.vox.com/palestine">Palestine</a>,” including <a href="https://www.vox.com/2018/11/20/18080046/gaza-palestine-israel">Gaza</a> and the <a href="https://www.vox.com/2018/11/20/18080034/west-bank-israel-palestinians">West Bank</a>, is geographically noncontiguous, politically divided, and not fully sovereign in terms of having a monopoly on the use of force over its territory. The groups in <a href="https://www.vox.com/iran">Iran</a>’s “Axis of Resistance” — Hamas, Hezbollah, the Houthis, the various Shia militias of Iraq and Syria — occupy a sort of in-between status in the international system, not quite one thing or another.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nsppS9">
Hezbollah is a political party serving in Lebanon’s internationally recognized government, and the de facto governing authority in parts of the country, and a militia group fighting against Israel as well as on behalf of the Bashar al-Assad regime in Syria, and a kind of vassal force on behalf of its chief patron, Iran. Yemen’s Houthis are routinely referred to as “rebels” and not recognized as the legitimate government of Yemen by the international community, even though they control the country’s capital. Hamas is viewed by Iran as a tool for projecting regional power but often seems to act independently.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qxZGkL">
In other words, it’s a region where looking at the lines on the map will only tell you half the story of what’s happening.
</p>
<h3 id="XRN8z7">
A different kind of superpower clash
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dqfDNv">
What would a true World War look like in a neomedieval world? The RAND paper argues that during the 19th and 20th centuries, industrial societies experienced a strong degree of “social cohesion” that included a “stronger sense of collective purpose, shared culture, and common values.” This cohesion often came at the expense of ethnic and sexual minorities who experience discrimination and exclusion within those societies, but it also made possible the social and industrial mobilizations necessary to fight world wars.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Vzyy5h">
That’s not the case today. “In China and the United States, social disorder has grown, to which governments have struggled to respond. The result has been a further erosion in state legitimacy,” the paper suggests. Even as tensions between the two superpowers have grown, “Neither side has mobilized its citizenry against the other, and strategies of mass mobilization do not appear plausible for the foreseeable future.”
</p>
<figure class="e-image">
<img alt="Military vehicles carrying DF-5B intercontinental ballistic missiles participate in a military parade at Tiananmen Square in Beijing on October 1, 2019, to mark the 70th anniversary of the founding of the People’s Republic of China." src="https://cdn.vox-cdn.com/thumbor/03kMVkgtwJuUPV7JAfga8yfRl2I=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25268035/GettyImages_1175318269.jpg"/> <cite>Greg Baker/AFP via Getty Images</cite>
<figcaption>
Military vehicles carrying DF-5B intercontinental ballistic missiles participate in a military parade at Tiananmen Square in Beijing on October 1, 2019, to mark the 70th anniversary of the founding of the People’s Republic of China.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4Y5G14">
A theoretical US-China war, most likely over Taiwan, would look nothing like what Americans have gotten used to in the last 50 or even 75 years. Even one of the more optimistic simulations of combat over Taiwan foresees the Americans losing half as <a href="https://www.vox.com/world-politics/2024/1/6/24026992/taiwan-china-president-war-xi-jinping-asia-semiconductors-chips">many troops in three weeks</a> as in 20 years of fighting in Iraq and <a href="https://www.vox.com/afghanistan">Afghanistan</a>. Americans have gotten used to a world in which a small fraction of the population fights its wars: Less than <a href="https://www.pewresearch.org/short-reads/2023/11/08/the-changing-face-of-americas-veteran-population/#:~:text=The%20share%20of%20the%20U.S.,military%20draft%20ended%20in%201973.">1 percent of adults are in the military</a>, and less than 6 percent have served. America’s armed forces increasingly rely on what some experts have termed a “<a href="https://slate.com/news-and-politics/2017/08/the-warrior-caste-of-military-families-that-fight-americas-wars.html">warrior caste</a>” of multigenerational military families. The US military now regularly <a href="https://www.npr.org/2023/10/05/1203766333/us-army-military-recruit-pentagon-air-force-navy">falls short of its recruitment goals</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XpJXSq">
Perhaps American society would “rally around the flag” in what seems like it could be World War III. But public trust in the military, while still high, has been falling dramatically in the US in recent years, <a href="https://news.gallup.com/poll/509189/confidence-military-lowest-two-decades.aspx">including among conservatives</a> during the years when <a href="https://www.vox.com/donald-trump">President Donald Trump</a> was frequently feuding with his military commanders. Events like the January 6 insurrection and<a href="https://www.vox.com/scotus/2024/1/27/24051657/supreme-court-texas-border-immigration-greg-abbott-biden-invasion"> Texas’s conflict with the federal government </a>over border policy do not suggest a level of societal cohesion remotely necessary for global conflict as we knew it in the 20th century.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nmDnfj">
China might seem at first like well equipped for such a conflict: a relatively ethnically homogeneous society with a powerful authoritarian state and little public dissent. But, RAND’s analysts argue, appearances can be deceiving. Modern China, they say, is struggling with “corruption, malfeasance, and the failure to reverse destabilizing levels of inequality,” and has resorted to brute force to quell regional discontent in places like Xinjiang and Hong Kong. The <a href="https://carnegieendowment.org/2022/12/01/china-s-zero-covid-policy-is-double-edged-sword-pub-88535">social strains exposed</a> by China’s “zero-Covid” response to the pandemic, which included rare public protests and a <a href="https://www.bloomberg.com/news/features/2024-01-17/china-migration-wave-arrives-in-unexpected-places-after-pandemic?sref=C3P1bRLC">new wave of out-migration</a>, raise some questions about the Communist Party’s ability to maintain public commitment to a deadly and protracted all-out war.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gdsaHT">
“Compare Xi Jinping’s power to Mao Zedong’s,” says RAND’s Heath. “The people tried their best to carry out Mao’s schemes, even when they cost tens of millions of lives. By contrast, Xi Jinping <a href="https://asia.nikkei.com/Politics/China-s-party-congress/Transcript-President-Xi-Jinping-s-report-to-China-s-2022-party-congress">has admitted</a> on numerous occasions that the Chinese state simply can no longer meet the needs of the people.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7Tywu5">
Analysts have suggested that China, which has not fought a war since an ill-fated invasion of Vietnam in the 1970s, would <a href="https://themessenger.com/grid/test-imagining-the-unimaginable-the-us-china-and-war-over-taiwan">need to send 1 million to 2 million </a>troops across the Taiwan Strait to have a hope of taking the island. (Russia’s pre-invasion ground force in Ukraine, for comparison was around 360,000, and did not need to make an incredibly complex amphibious landing.) Its forces would likely take heavy losses even if they were successful. Is Xi Jinping really willing to bet the future of his regime on the assumption that many Chinese families would be willing to sacrifice their <a href="https://www.vox.com/future-perfect/23558772/china-population-overpopulation-one-child-policy-demographics-aging-beijing-xi-jinping">only children</a> to his war?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="crCLLC">
The significance of all of this, the authors argue, is that great power rivalry in the years to come will “bear little resemblance to the titanic struggles of the past two centuries” and that “should the U.S.-China rivalry escalate to hostilities, the weakness of the states will seriously constrain their options. Incapable of mobilizing their societies for total war, the two sides might instead fight through proxy conflicts or by provoking political unrest in the rival’s homeland.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="e4LqOG">
A blockade scenario, cutting Taiwan off from food, energy, and other vital supplies, would be very much in the spirit of neomedievalism, evoking the siege tactics of centuries past.
</p>
<h3 id="oG6HVF">
The center cannot hold. But does that matter?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gM7OaN">
Neomedievalism also seems an appropriate framework for a time when national leaders of major industrial power are, with a few notable exceptions, <a href="https://pro.morningconsult.com/trackers/global-leader-approval">universally unpopular</a>. There are increasing doubts about the ability of modern states to cope with factors like the <a href="https://www.vox.com/climate">climate crisis</a>, geopolitical instability, financial volatility, demographic decline, and rapid developments in technologies like <a href="https://www.vox.com/2023/4/28/23702644/artificial-intelligence-machine-learning-technology">artificial intelligence</a> — a set of interlocking complex challenges some commentators have termed the “<a href="https://www.vox.com/future-perfect/23920997/polycrisis-climate-pandemic-population-connectivity">polycrisis</a>.” It’s also a sobering worldview to consider when looking at what appears to be a <a href="https://www.vox.com/world-politics/2024/1/25/24049551/war-increasing-ukraine-gaza-sudan-ethiopia">pronounced uptick</a> in the number of armed conflicts around the world and the number of casualties in those conflicts, after years of declines in both.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XAjGOG">
Yet while the concept of a neomedieval world might bring to mind images of a Hobbesian war of all-against-all or a Mad Max-like anarchy, many advocates of the term are not so pessimistic. The Princeton professor Philip Cerny instead predicts that the neomedieval world will be one of “<a href="https://europe.princeton.edu/people/philip-cerny">durable disorder</a>,” where some power is distributed from state to non-state actors but where key problems and global challenges can still be addressed. The dark ages were not always dark. Cerny points out that the medieval era in Europe “was one of increasing social, economic, and political development” as well as “growing surpluses [and] the spread of knowledge and innovation.”
</p>
<figure class="e-image">
<img alt="Crew members stand by an F/A-18 on the flight deck onboard the USS Carl Vinson aircraft carrier during a three-day maritime exercise between the US and Japan in the Philippine Sea on January 31, 2024." src="https://cdn.vox-cdn.com/thumbor/v87QJasavF5hEoUh9ByBQ3DoBbM=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25268041/GettyImages_1968678935.jpg"/> <cite>Richard A. Brooks/AFP via Getty Images</cite>
<figcaption>
Crew members stand by an F/A-18 on the flight deck onboard the USS Carl Vinson aircraft carrier during a three-day maritime exercise between the US and Japan in the Philippine Sea on January 31, 2024.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="icI9LD">
Neomedievalism “helps people make sense of a world that doesn’t have order, but it’s not collapsing,” said McFate. “And I think increasingly, that’s what the 21st century kind of looks like.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QnbuSS">
And Heath’s framing of the risks of a potential US-China conflict shows that, rather than being more violent, a neomedieval world might actually be somewhat more peaceful, or at least one in which powerful states are more constrained in their ability to wage all-out war on each other.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7Gb61w">
To be sure, though, one factor that neomedievalism can’t account for is nuclear warfare, which could allow leaders to inflict far higher levels of destruction with far less effort. If leaders are unable to mobilize their societies or industrial sectors to fight total wars, pushing the nuclear button might become more tempting.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xmpVRY">
Neomedievalism might help us understand how the wars of the future will begin, but leaders today have a lot more firepower they can use to end them than they did 400 years ago.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="72xJBF">
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="trQiR6">
</p></li>
<li><strong>Trump’s legal arguments for staying on the ballot are embarrassingly weak</strong> -
<figure>
<img alt="" src="https://cdn.vox-cdn.com/thumbor/TQEDoRp658hG72bLN09kfuPJhyA=/135x0:2276x1606/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/73115195/1094227856.0.jpg"/>
<figcaption>
Then-President Donald Trump greets two of his appointees to the Supreme Court, Neil Gorsuch, left, and Brett Kavanaugh. | Al Drago/Bloomberg via Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
It’s hard to imagine this Supreme Court removing Trump from the ballot. But his lawyers gave the justices very little to work with.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kKzQpB">
Well, the <a href="https://www.vox.com/scotus">Supreme Court</a> fight over our insurrectionist former president is finally upon us.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ix8z3n">
On Thursday, the Court will hear oral arguments in <a href="https://www.scotusblog.com/case-files/cases/trump-v-anderson/"><em>Trump v. Anderson</em></a>, the case asking whether Colorado’s highest court was right to remove former <a href="https://www.vox.com/donald-trump">President Donald Trump</a> from the ballot because of his role in the January 6 insurrection. If the justices affirm the state court, that would most likely mean that Trump is removed from the ballot everywhere — because a constitutional ruling by the Supreme Court binds every judge in the country.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5a80Ts">
Section 3 of the 14th Amendment provides that no person who previously held high office may serve in such office again if they “<a href="https://www.law.cornell.edu/constitution/amendmentxiv">have engaged in insurrection or rebellion</a>” against the Constitution. The Colorado Supreme Court ruled that Trump violated this clause when he <a href="https://www.vox.com/scotus/2023/12/20/24009521/supreme-court-donald-trump-colorado-ballot-insurrection-fourteenth-amendment-anderson-griswold">incited his followers to attack the US Capitol</a>, in a failed attempt to overturn the <a href="https://www.vox.com/2020-presidential-election">2020 election</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zYAyWK">
Anyone who thinks <em>Anderson</em> will be the deus ex machina that saves America from the Bad Orange Man, however, would do well to remember <a href="https://www.vox.com/scotus/2023/12/20/24009521/supreme-court-donald-trump-colorado-ballot-insurrection-fourteenth-amendment-anderson-griswold">who sits on the Supreme Court of the United States</a>. The Court has a 6-3 Republican supermajority, and half of the Republican justices were appointed by Trump.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="b1NCas">
That said, Trump’s lawyers, in their <a href="https://www.supremecourt.gov/DocketPDF/23/23-719/298125/20240118171750343_Trump%20v%20Anderson%20Petitioner%20Brief%20on%20the%20Merits.pdf">brief to the justices</a>, gave his fellow partisans on the Court little to work with. As election law scholar Rick Hasen writes, “the arguments that Trump has advanced in his most recent brief are <a href="https://slate.com/news-and-politics/2024/01/trump-lawyers-strategy-supreme-court-ballot.html">weaker and more hedged than I would have expected</a>,” and “it’s hard to know exactly where the court goes from here,” given this meager performance by the former president’s attorneys.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5Gaz4l">
So, if you are a gambler, you’d be wise to bet on Trump prevailing in the Supreme Court, even though it is far from clear how the justices will justify such a decision.
</p>
<h3 id="5jUZCn">
Trump’s legal arguments, briefly summarized
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="92Y7BO">
Trump’s brief leaves what is probably his strongest legal argument on the table.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="a8RjsX">
In the Colorado Supreme Court, two of the dissenting justices suggested that the somewhat truncated process a trial court used to determine whether Trump should remain on the ballot <a href="https://www.vox.com/scotus/2023/12/20/24009521/supreme-court-donald-trump-colorado-ballot-insurrection-fourteenth-amendment-anderson-griswold">did not provide him with due process</a>. But Trump’s brief does not make this argument. Indeed, it only mentions it in passing, in a section of the brief describing what happened in the lower courts.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ikg8Ad">
One possible explanation for this oversight is a decision holding that Colorado committed a process violation wouldn’t resolve the question of whether Trump gets to stay on the ballot. Some other state could disqualify Trump by conducting a trial that meets whatever procedural threshold is required, and Colorado could even reopen this issue by retrying Trump.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="F8qsuW">
But Trump’s brief leans into other arguments that would merely delay a reckoning over Trump’s eligibility to be president. Specifically, Trump accuses Colorado’s highest court of violating the state’s laws when it ruled against him. This is a weak argument because each state’s highest court, and not the US Supreme Court, is generally understood to <a href="https://www.vox.com/policy-and-politics/2022/12/4/23481063/supreme-court-moore-harper-independent-state-legislature-doctrine-elections">have the final word on all questions of state law</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0z04Ke">
In its last term, however, the Court considered a many-times-rejected legal argument, known as the “independent state legislature doctrine” (ISLD), that would allow the justices to bypass this rule. But the Court <a href="https://www.vox.com/scotus/2023/6/27/23775378/supreme-court-moore-harper-john-roberts-independent-state-legislature-north-carolina-bush-gore">almost entirely neutralized the ISLD</a> after a bipartisan array of legal experts warned the justices that this theory would lead to chaotic and untenable results. Even Steven Calabresi, the co-chair of the conservative Federalist Society, told the justices that the ISLD “<a href="https://www.supremecourt.gov/DocketPDF/21/21-1271/243761/20221024133404048_21-1271%20Amicus%20Brief.pdf">flout[s] core tenets of the American Founding</a>.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DOfVBQ">
Trump, in other words, is asking the Court to open a Pandora’s box that it slammed shut after hearing widespread alarm from across the legal profession — including some of the conservative movement’s most dedicated activists.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="OJZWPD">
And then there’s Trump’s primary argument for staying on the ballot. The 14th Amendment uses the term “<a href="https://www.law.cornell.edu/constitution/amendmentxiv">officer of the United States</a>” to describe former officials who are disqualified from serving after engaging in an insurrection. Trump makes the extraordinary argument that the president, the highest-ranking officer-holder in the United States and the commander-in-chief of its military, <a href="https://www.supremecourt.gov/DocketPDF/23/23-719/298125/20240118171750343_Trump%20v%20Anderson%20Petitioner%20Brief%20on%20the%20Merits.pdf">does not qualify as an officer of the United States</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xTcqjP">
In support of this argument, Trump’s legal team points to a handful of constitutional provisions — all drafted nearly a century before the 14th Amendment was ratified — that seem to exclude the president from the term “officers of the United States.” One provision, for example, says that the president “shall Commission all the Officers of the United States.” Read in isolation, this provision does suggest that the president is not an officer.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ehSL2w">
But the Constitution is riddled with other provisions suggesting the president is, in fact, an officer of the United States. As the Colorado Supreme Court noted, “<a href="https://www.vox.com/scotus/2024/1/3/24022580/supreme-court-donald-trump-ballot-insurrection-fourteenth-amendment-colorado-anderson">the Constitution refers to the Presidency as an ‘Office’ twenty-five times</a>.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kCHsj5">
The plaintiffs challenging Trump’s eligibility point to <a href="https://www.supremecourt.gov/DocketPDF/23/23-719/298854/20240126115645084_23-719%20Anderson%20Respondents%20Merits%20Brief.pdf">myriad evidence</a> indicating that, by the time the 14th Amendment was ratified in 1868, the term “officer of the United States” was understood to include the president. This includes an <a href="https://law.resource.org/pub/us/case/reporter/F.Cas/0026.f.cas/0026.f.cas.1211.1.pdf">1823 opinion</a> by Chief Justice John Marshall, which states that if an office-holder is “employed on the part of the United States, he is an officer of the United States.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5lt3YW">
It also includes an opinion by Henry Stanbery, who served as US attorney general while the 14th Amendment was in the process of ratification, which said that the term “officers of the United States” includes any “person who has at any time prior to the rebellion held any office, civil or military, under the United States, and has taken an official oath to support the Constitution of the United States.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0ELnbI">
So the bulk of the evidence supports the unremarkable proposition that the highest-ranking official in the United States government is, indeed, an officer of the United States. And it’s hard to imagine any judge signing onto Trump’s argument in a case that didn’t involve the same brain-scramblingly high political stakes as <em>Trump v. Anderson.</em> Trump’s lawyers claim that the framers of the 14th Amendment intended to ban former officials who engage in insurrection from holding office, <a href="https://www.vox.com/scotus/2024/1/3/24022580/supreme-court-donald-trump-ballot-insurrection-fourteenth-amendment-colorado-anderson">unless they held the most powerful office in the United States government</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jaYXER">
Indeed, their argument is even more absurd than that. As the <em>Anderson</em> plaintiffs note in their brief, Trump is proposing a “<a href="https://www.supremecourt.gov/DocketPDF/23/23-719/298854/20240126115645084_23-719%20Anderson%20Respondents%20Merits%20Brief.pdf">Trump-only exception</a>” to the 14th Amendment because he is the only president (aside from George Washington) who never served in a sub-presidential office. Everyone agrees that former senators (like Presidents Biden and Obama), former governors (like President George W. Bush), and the like are disqualified if they engage in insurrection. So Trump is claiming that he and he alone among former presidents is immune from the 14th Amendment.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AAdg3B">
It’s clear that Trump’s lawyers think this is their strongest argument. Trump’s brief <a href="https://www.supremecourt.gov/DocketPDF/23/23-719/298125/20240118171750343_Trump%20v%20Anderson%20Petitioner%20Brief%20on%20the%20Merits.pdf">spends about 26 pages</a> laying out its case for leaving Trump on the ballot. Half of those pages are devoted to the claim that the president is not an officer of the United States.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VqZEya">
Trump’s <a href="https://www.supremecourt.gov/DocketPDF/23/23-719/298125/20240118171750343_Trump%20v%20Anderson%20Petitioner%20Brief%20on%20the%20Merits.pdf">lead attorney is Jonathan Mitchell</a>, a lawyer who specializes in trying to convince judges to give legal texts the same sort of malicious construction that “<a href="https://americanliterature.com/author/w-w-jacobs/short-story/the-monkeys-paw">The Monkey’s Paw” gives to wishes</a>. Mitchell is best known as the <a href="https://www.npr.org/2023/05/07/1174672358/jonathan-mitchell-the-legal-mind-behind-the-texas-abortion-ban">mastermind behind Texas’s SB 8</a>, an anti-<a href="https://www.vox.com/abortion">abortion</a> law enacted while <a href="https://www.vox.com/2022/5/3/23055125/roe-v-wade-abortion-rights-supreme-court-dobbs-v-jackson"><em>Roe v. Wade</em></a> was still in effect, which allows private bounty hunters — and <a href="https://www.vox.com/2021/8/31/22650303/supreme-court-abortion-texas-sb8-jackson-roe-wade-greg-abbott">only private bounty hunters</a> — to collect limitless bounties from abortion providers.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DxSQcj">
The law was written that way because the Supreme Court has held that plaintiffs alleging that a state law violates the Constitution should <a href="https://www.vox.com/2021/8/31/22650303/supreme-court-abortion-texas-sb8-jackson-roe-wade-greg-abbott">sue the state official charged with enforcing that law</a>, and Mitchell reasoned that, if state employees did not enforce the law, it could not be blocked.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XINlYE">
The Supreme Court backed this play in its 5-4 decision in <a href="https://www.supremecourt.gov/opinions/21pdf/21-463_3ebh.pdf"><em>Whole Woman’s Health v. Jackson</em></a> (2021). So the fact that Mitchell’s primary argument in support of Trump would lead to an absurd result is no guarantee that it won’t prevail. This Supreme Court has already shown that it is willing to endorse truly preposterous arguments raised by the very same lawyer Trump hired to represent him, at least when those preposterous arguments align with the justices’ personal preferences.
</p>
<h3 id="BHpgnr">
Trump asks the justices to revive the most dangerous legal argument the Court has heard recently
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3umqKk">
Last June, the justices decided a case that filled even many sober-minded conservatives with a sense of dread: <a href="https://www.supremecourt.gov/opinions/22pdf/21-1271_3f14.pdf"><em>Moore v Harper</em></a> (2023), the case that led one of the Federalist Society’s top leaders to warn that the Republican Party was pushing an argument that “<a href="https://www.supremecourt.gov/DocketPDF/21/21-1271/243761/20221024133404048_21-1271%20Amicus%20Brief.pdf">flout[s] core tenets of the American Founding</a>.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZxtE6N">
<em>Moore </em>turned on a pair of constitutional provisions that say the method each state uses to elect federal office-holders shall be determined by the “legislature” of that state.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pL3AUd">
The Supreme Court first held in <a href="https://scholar.google.com/scholar_case?case=6094069846348614449&amp;hl=en&amp;as_sdt=6&amp;as_vis=1&amp;oi=scholarr"><em>Davis v. Hildebrant</em></a> (1916) that the word “legislature,” when used in this context, refers to whatever body within a state has the power to make laws. So a state governor may veto an election-related bill, even though governors are typically members of a state’s executive branch and not its legislative branch. Similarly, a state may use ballot initiatives or other forms of direct democracy to enact election laws, even though most people who vote for such initiatives are not members of the state’s elected legislature.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="HDn3ur">
<em>Davis</em> has been reaffirmed by the Court <a href="https://www.vox.com/policy-and-politics/2022/12/4/23481063/supreme-court-moore-harper-independent-state-legislature-doctrine-elections">many times over the course of the last century</a>. Nevertheless, the independent state legislature doctrine claims that these decisions were wrong, and only a state’s elected legislative branch may decide how a state conducts federal elections.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="D0XVA1">
If taken seriously, this theory is an <a href="https://www.vox.com/policy-and-politics/2022/12/4/23481063/supreme-court-moore-harper-independent-state-legislature-doctrine-elections">existential threat to US democracy</a>. Under the strongest version, state governors cannot veto laws impacting federal elections, state courts cannot strike down those laws if they violate the state constitution, and state constitutional provisions protecting <a href="https://www.vox.com/voting-rights">voting rights</a> effectively cease to function. It could have allowed gerrymandered state legislatures to cancel the <a href="https://www.vox.com/2024-elections">2024 presidential election</a> and simply award their state’s electoral votes to Trump.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Lla4zU">
The good news is that none of this parade of horribles is likely to happen. Though five of the Court’s six Republican appointees had, at some point in the past, endorsed various versions of the doctrine, the Court’s opinion in <em>Moore</em> <a href="https://www.vox.com/scotus/2023/6/27/23775378/supreme-court-moore-harper-john-roberts-independent-state-legislature-north-carolina-bush-gore">largely shut it down</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="lIQq4j">
That said, <em>Moore</em> included an ominous line suggesting the Supreme Court could revive the doctrine if five justices think that a state court read that state’s own law very badly. “State courts,” according to <em>Moore</em>, “may not so exceed the bounds of ordinary judicial review as to unconstitutionally intrude upon the role specifically reserved to state legislatures.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vQnYwU">
It’s not at all clear what this line means or just how badly a state court must depart from the federal justices’ preferred reading of a state statute. But Trump’s brief claims that <em>Anderson</em> is such a case.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Sr9592">
Specifically, Mitchell points to a provision of Colorado law that says “<a href="https://casetext.com/statute/colorado-revised-statutes/title-1-elections/general-primary-recall-and-congressional-vacancy-elections/article-4-elections-access-to-ballot-by-candidates/part-12-presidential-primary-elections/section-1-4-1203-presidential-primary-elections-when-conduct">each political party that has a qualified candidate</a> entitled to participate in the presidential primary election pursuant to this section is entitled to participate in the Colorado presidential primary election,” and he accuses the state Supreme Court of misreading this provision to exclude presidential aspirants who aren’t “qualified candidates.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LQmVpG">
It’s fair to say that this provision has more to say about which parties can participate in a presidential election than it does about which individuals<em> </em>may do so — although the reference to “a qualified candidate” does imply that some candidates do not qualify.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ljiYwQ">
But even if you accept Mitchell’s reading of this provision, a different provision of Colorado law says that the state’s law governing presidential primaries should “<a href="https://law.justia.com/codes/colorado/2022/title-1/article-4/part-12/section-1-4-1201/">conform to the requirements of federal law</a>” — and Section 3 of the 14th Amendment, like all provisions of the Constitution, is a federal law. So, at most, the state Supreme Court is guilty of citing the wrong provision of state law to support the proposition that constitutionally ineligible candidates may not appear on a presidential primary ballot.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5X10X5">
It would be extraordinary if the Supreme Court ruled that this alleged, penny-ante citation error so “exceed[s] the bounds of ordinary judicial review” as to justify invoking the independent state legislature doctrine — a doctrine the Supreme Court has rejected many times over the course of a century and that it recently rejected after <a href="https://www.supremecourt.gov/DocketPDF/21/21-1271/243970/20221026122043996_Ret.%20Admirals%20AmicusBrief%20-%20Moore%20v.%20Harper.pdf">an array of retired generals and admirals</a> warned the justices that it threatens <a href="https://www.vox.com/defense-and-security">national security</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="b386GC">
And what would the US Supreme Court hope to accomplish by such a decision? If the justices rule that the Colorado decision must be tossed out because of a minor error in the court’s construction of state law, that would do nothing to resolve the broader question of whether Trump is disqualified under the 14th Amendment.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pd5ekP">
The Court, in other words, would deploy one of the most dangerous weapons in its doctrinal arsenal in order to delay resolution of this case by maybe a few weeks.
</p>
<h3 id="Ag6gTk">
Trump makes the weakest version of his best argument
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="d61sjA">
As noted above, Trump’s brief does not even raise his strongest argument: the argument that Colorado’s courts <a href="https://www.vox.com/scotus/2023/12/20/24009521/supreme-court-donald-trump-colorado-ballot-insurrection-fourteenth-amendment-anderson-griswold">failed to provide him with due process</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="EcuEBf">
That said, the brief does make one argument that is, at least, plausible. But Mitchell devotes only about two pages to his best argument, and he makes a weak version of this argument to boot.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IOitZZ">
The Colorado Supreme Court concluded that Trump engaged in an insurrection when he made a series of public statements that incited his supporters to attack the Capitol, including a January 6 speech where, in the state Supreme Court’s words, Trump “<a href="https://www.courts.state.co.us/userfiles/file/Court_Probation/Supreme_Court/Opinions/2023/23SA300.pdf">literally exhorted his supporters to fight at the Capitol</a>.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="J8yMkh">
Among other things, Trump told his supporters that “we’re going to walk down to the Capitol” where they “have to show strength” and “fight like hell.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rDQR5T">
Mitchell argues that the First Amendment does not permit Trump to be sanctioned for these and other, similar statements. The reason why this is a relatively strong argument, at least compared to the other arguments in Trump’s brief, is that, while the Supreme Court has held that speech that incites people to illegal action is not protected by the Constitution, the legal standard for what constitutes “incitement” is very hard to clear.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FhqXo0">
The seminal case is <a href="https://supreme.justia.com/cases/federal/us/395/444/"><em>Brandenburg v. Ohio</em></a> (1969), which held that the government may not “forbid or proscribe advocacy of the use of force or of law violation except where such advocacy is directed to inciting or producing imminent lawless action and is likely to incite or produce such action.” And it is notoriously difficult for the government to meet this test.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pTqpyo">
<em>Brandenburg</em> involved a speech at a Ku Klux Klan rally, attended by “12 hooded figures, some of whom carried firearms,” where a speaker said that “if our President, our Congress, our Supreme Court, continues to suppress the white, Caucasian race, it’s possible that there might have to be some revengeance taken.” Yet, even though this speech advocated violence against the highest US officials, the Court tossed out the law used to prosecute this speaker, holding that a state cannot punish “mere advocacy” of violence, but only “imminent lawless action.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dhzH8e">
Trump’s speech, however, was quite different from the Klansman’s speech in <em>Brandenburg</em>. For starters, while the <em>Brandenburg</em> speech took place at a farm in Ohio — far away from the president, Congress, or the Supreme Court — Trump delivered his speech to a crowd of angry supporters as they gathered to march on the Capitol itself.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="r0rwmN">
There were also strong indications that many members of this crowd understood Trump’s speech to be a direct call for an immediate insurrection. According to the Colorado Supreme Court, “after President Trump instructed his supporters to march to the Capitol, members of the crowd shouted, <a href="https://www.courts.state.co.us/userfiles/file/Court_Probation/Supreme_Court/Opinions/2023/23SA300.pdf">‘[S]torm the capitol!’; ‘[I]nvade the Capitol Building!’; and ‘[T]ake the Capitol!’</a>”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JBVz7N">
And, of course, Trump’s speech was, in fact, followed by a mob of his supporters — many of whom had just listened to his speech — invading the Capitol in an attempt to overthrow the election that Trump had just lost.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7JcuhO">
Mitchell’s discussion of <em>Brandenburg</em> is brief and difficult to parse, but he <a href="https://www.supremecourt.gov/DocketPDF/23/23-719/298125/20240118171750343_Trump%20v%20Anderson%20Petitioner%20Brief%20on%20the%20Merits.pdf">appears to argue that Trump’s speech was not “likely” to result in violence</a>. As Mitchell correctly notes, Trump’s speech is unprotected by the First Amendment only if it was “‘intended’ and ‘likely’” to incite imminent violence,” and he notes that a speech cannot lose First Amendment protections solely based on “the intent of the speaker.” So, read together, these two claims suggest that Mitchell thinks Trump’s statements were not likely to result in violent or lawless action.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="B3dJdd">
But this argument is difficult to take seriously. As the Colorado Supreme Court explains, Trump’s January 6 speech was only one in a series of statements where Trump seemed to encourage violence or where Trump cheered on his supporters after they committed violence on his behalf.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AfHiQy">
Georgia election official Gabriel Sterling, for example, publicly warned Trump “to ‘stop inspiring people to commit potential acts of violence’ or ‘[s]omeone’s going to get killed,’” but Trump responded by “retweeting a video of Sterling’s press conference with a message repeating the very rhetoric that Sterling warned would result in violence.” Similarly, after a November 14, 2020, pro-Trump rally turned violent, Trump responded by justifying this violence “as self-defense against ‘ANTIFA SCUM.’”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="eP89hX">
The single most damning piece of evidence against Trump, meanwhile, is that one hour after Trump learned that a mob of his supporters had attacked the Capitol, the former president tweeted that “<a href="https://www.courts.state.co.us/userfiles/file/Court_Probation/Supreme_Court/Opinions/2023/23SA300.pdf">Mike Pence didn’t have the courage</a> to do what should have been done to protect our Country and our Constitution.” So, at the very moment that the January 6 insurrection was underway, Trump didn’t just egg on the insurrectionists, he suggested that they target <a href="https://www.vox.com/mike-pence">Pence</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nHfzIU">
While <em>Brandenburg</em> sets a high standard for incitement, Trump’s lawyers do not make any arguments that could justify tossing this case out on First Amendment grounds. Most statements that advocate violence are not likely to result in imminent violence. But Trump told a mob made up of his supporters to target a specific individual as that mob was actively engaged in criminally violent activity.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Djv32X">
This is the equivalent of standing on the sidelines of a fistfight and yelling at one of the combatants to “beat him harder” while the fight is ongoing — and the law generally <a href="https://scholar.google.com/scholar_case?case=15589157465631233809&amp;hl=en&amp;as_sdt=6&amp;as_vis=1&amp;oi=scholarr">permits someone who actively cheers on an ongoing fight</a> to face legal consequences.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GyrtD0">
<em>Trump v. Anderson</em> is a frustrating case. It’s hard to imagine this Supreme Court removing Trump from the ballot. But Trump and his lawyers give the justices very little to rely on when they sit down to write an opinion ruling in favor of Trump. Mitchell’s arguments range from silly (the president is not an “officer of the United States”) to unpersuasive (Trump’s many statements encouraging violence were not likely to result in violence) to outright dangerous (the entire independent state legislature doctrine).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5IkbLc">
If that’s the best that Trump’s supporters can come up with, it will be very difficult for the justices to show their partisan loyalty without embarrassing themselves.
</p></li>
</ul>
<h1 data-aos="fade-right" id="from-the-hindu-sports">From The Hindu: Sports</h1>
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<h1 data-aos="fade-right" id="from-the-hindu-national-news">From The Hindu: National News</h1>
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<h1 data-aos="fade-right" id="from-bbc-europe">From BBC: Europe</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Spanish farmers join wave of protests</strong> - Across Spain, farmers have been protesting at EU regulations and demanding more help from their government.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>How a grieving mother exposed the truth of Turkey’s deadly earthquake</strong> - After losing her son, Nurgül Göksu set out to investigate how building alterations left his home vulnerable to earthquakes.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Baby killed in Russian strike on Ukrainian hotel</strong> - A two-month-old boy is killed in the latest cross-border attack on Ukraine’s Kharkiv region.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Former Irish PM John Bruton dies after long illness</strong> - Politicians have paid tribute to Mr Bruton, who played a key rold in the NI peace process.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>‘Russia’s Google’ owner pulls out of home country</strong> - Yandex has previously been accused of hiding information from Russia’s public about the Ukraine war.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-ars-technica">From Ars Technica</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>AI can now master your music—and it does shockingly well</strong> - Suddenly, everyone can master their own music. - <a href="https://arstechnica.com/?p=2000601">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>As if two Ivanti vulnerabilities under exploit weren’t bad enough, now there are 3</strong> - Hackers looking to diversify, began mass exploiting a new vulnerability over the weekend. - <a href="https://arstechnica.com/?p=2001230">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Trio wins $700K Vesuvius Challenge grand prize for deciphering ancient scroll</strong> - The 2024 Challenge has also been announced, with a $100,000 grand prize. - <a href="https://arstechnica.com/?p=2001066">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>4chan daily challenge sparked deluge of explicit AI Taylor Swift images</strong> - New AI image filters are “just another obstacle to ‘defeat,’” researcher says. - <a href="https://arstechnica.com/?p=2001127">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Google and Mozilla don’t like Apple’s new iOS browser rules</strong> - Google and Mozilla want iOS’s new EU browser rules to apply worldwide. - <a href="https://arstechnica.com/?p=2001030">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A secret agent is sent to Ireland to deliver a top secret package</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Go to this small town in Ireland, find our agent named O’Malley and say the following to him: ‘the shadows of the moon are getting dark.’ He’ll reply ‘but the sun will guarantee the light.’ When he says that, give him the package and head home.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
So the agent goes to the small Irish town but only sees a handful of shops and a farm. He walks up to the farmer and says “I’m looking for a man named O’Malley.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The farmer replies “you need to be more specific than that. The bank manager is named O’Malley, the Butcher is O’Malley, the undertaker is O’Malley and for that matter I’m O’Malley too.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Hearing that he says to the farmer in a hushed voice “the shadows of the moon are getting dark.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The farmer replies “oh your looking for O’Malley the spy. He lives in the next community west.”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/AssociationSubject85"> /u/AssociationSubject85 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/1ajqtvu/a_secret_agent_is_sent_to_ireland_to_deliver_a/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/1ajqtvu/a_secret_agent_is_sent_to_ireland_to_deliver_a/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Saudi Arabian prince is going to college in England</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He texts his father, “Dad, I feel weird driving my Lamborghini to school when all my classmates take a train” His father replies; “Son, I have transferred 500 million dollars into your account. Go out and buy a train and stop embarrassing this family”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/kickypie"> /u/kickypie </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/1ak1bpu/a_saudi_arabian_prince_is_going_to_college_in/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/1ak1bpu/a_saudi_arabian_prince_is_going_to_college_in/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>My wife secretly dressed up in a superhero costume trying to spice things up for us in the bedroom.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
I arrived home exhausted after a hard day at work. Shuffling into the bedroom I then collapsed face down on the bed moaning.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Just at that moment I heard the bedroom door suddenly crash open and my wife leaped through with her fists on her hips in a superhero pose. Yalping loudly she boldly exclaims “<em>SUPERSEX!</em>”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Hearing this but too tired to move I groaned sleepily through the pillow
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“I’ll take the soup….”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Yup_Shes_Still_Mad"> /u/Yup_Shes_Still_Mad </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/1ajy9wk/my_wife_secretly_dressed_up_in_a_superhero/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/1ajy9wk/my_wife_secretly_dressed_up_in_a_superhero/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Am I Adopted?</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Alfie: Mummy, am I adopted?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Mum: Heavens, no. Why would you ask such a thing?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Alfie: we all did a DNA test in school today, &amp; mine is different from yours AND daddy’s.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Mum: DARRYL! come here. What’s all this about? (and she explains to hubby).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Dad: Of course he’s not ours! Do you remember that 2nd night in the hospital &amp; the baby hadn’t stopped crying for 2 days? You told me you were exhausted &amp; asked me if I could change the baby.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
SO I DID!
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/DocRogue2407"> /u/DocRogue2407 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/1ajwwsf/am_i_adopted/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/1ajwwsf/am_i_adopted/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>One day a guy decided to go to a museum of natural history.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He was enjoying himself and was particularly amazed by the large dinosaur skeletons reconstructed from their fossil remains.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He was looking at one and saw a museum worker standing by. He asked him how old was this particular dinosaur.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The guy looked at it and said, “Oh, this one. It is 64 million years and five months.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“64 million years and five months!” the guy exclaims. “How can you know that precisely?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Well, he said,”It was 64 million years old when I started working here and that was five months ago."
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Bjarki56"> /u/Bjarki56 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/1ajyv24/one_day_a_guy_decided_to_go_to_a_museum_of/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/1ajyv24/one_day_a_guy_decided_to_go_to_a_museum_of/">[comments]</a></span></p></li>
</ul>
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