Daily-Dose

Contents

From New Yorker

From Vox

Scenario 3: Shift the GOP’s position by winning the war of public opinion

Though abortion rights activists were well aware for years of the danger Roe was in, less-engaged American liberals may have simply taken it for granted, assuming it would be around forever. It had survived for so long, after all, so it would probably keep surviving, right?

But this safety was an illusion because abortion rights had never won the truly widespread public support it would take to entrench them nationally. Many conservatives continued to argue that abortion was deeply wrong and Roe should be overturned, and one of the country’s two major political parties has been committed to that viewpoint for decades.

Indeed, Roe was very nearly overturned three decades ago, in 1992, but conservatives on the Court fell one vote short of a majority to do so because moderate Republican-appointed justices voted with their more liberal colleagues. Anti-abortion activists then spent the next three decades trying to make sure that would never happen again. Their success in creating an anti-Roe Court majority certainly wasn’t inevitable — it took a very long time and required a good deal of good luck — but they do now seem to have achieved it.

The reality, then, is that even if Democrats do somehow manage to restore Roe’s protections nationally, all that would be subject to reversal the next time Republicans hold power. The Court could swing back and forth based on new appointments. Or, if Democrats eliminate the filibuster and codify Roe or pack the Court, Republicans could reverse those measures or enact further-right measures (say, with a national abortion ban) next time they’re in charge.

The only way to pull out of this spiral would be if anti-abortion activists lose their hold on the Republican Party, and probably on the Republican electorate too. Perhaps a national backlash against the GOP for overreaching on abortion will materialize, and they’ll feel compelled to moderate their position or lose power. Or perhaps even the red-state public, once abortion restrictions are implemented and their effects become clear, will grow convinced they actually aren’t desirable.

At the moment, such a scenario seems far-fetched, bordering on impossible. And maybe it is. But in the long term, that’s what would be needed to entrench abortion protections nationally. If a public opinion shift doesn’t happen, Roe protections, even if they are restored, would never truly be safe.

  1. The group had earlier risked arrest after distributing abortion pills from a tour bus.

    Activists note that medication abortion is far safer than many painkillers easily purchased over the counter, and the World Health Organization maintains that individuals can self-administer the drugs without direct supervision of a health care provider during their first trimester. New Lancet research published in February affirmed the safety of the Aid Access model, which also provides the medication at significantly lower cost than in-person surgical abortions or even the new crop of US startups like Hey Jane, Abortion on Demand, and Carafem.

    Aid Access says its work will continue in a post-Roe environment, and that requests for pills and information tripled in the wake of Monday’s leaked Roe opinion draft.

    Christie Pitney, a midwife who fills prescriptions for Aid Access patients in California, Massachusetts, Oregon, and DC, said that while patients in some states with trigger bans may have to switch from US-based providers like Pitney to Gomperts, Aid Access will keep serving them. “We’ll still be here,” she said.

    “We’re pretty nonplussed, to be honest,” Pitney told Vox. “I don’t see a route [to stopping us]. It’s not to say that it’s impossible, I just don’t see a route for politicians to eliminate access to Aid Access; they just don’t have the jurisdiction to criminalize an international doctor.”

    Other international doctors could also join Aid Access if Roe were struck down to help Gomperts prescribe the abortion pills, though she told Vox that thus far she has not been approached by any physicians.

    A struggle for internet traffic

    Despite the unique strategy Aid Access and Women on Web deploy, over the past two years, the organizations say they have been fighting against search engine algorithms that deprioritize their services, and opaque social media policies that limit or block their posts.

    Earlier this year, in an interview with the New York Review of Books, Gomperts said that “the algorithms of Google are suddenly becoming the de facto gatekeeper to access to safe abortion services in the US.” When Google set out to correct Covid-19 misinformation and started elevating more health sites that were officially government-sanctioned, Gomperts said it had the side effect of demoting sites like hers.

    Searches like “abortion by mail” and “online abortion” no longer led users to Gomperts’s groups, she says. Women on Web, for example, says it saw a 90 percent drop in daily global traffic after Google rolled out a new update on May 4, 2020. A subsequent update brought back some of what had disappeared, doubling its now-minuscule traffic, but then a third algorithmic update six months later took 40 percent of what remained. “We’re back to pretty low,” said Venny Ala-Siurua, the executive director.

    Ala-Siurua told Vox that deprioritization in internet search results remains one of their biggest barriers. Google “keep[s] pushing up traditional health providers, brick-and-mortar clinics, but they’re missing what’s happening in the digital world today,” she said. “The algorithm is not neutral. It was built and written usually by white men in the Bay Area who might not really be in tune with what the needs are here.”

    Aid Access isn’t alleging Google is intentionally restricting access to its site specifically, but Gomperts told the New York Review of Books that they might eventually launch a lawsuit over this. “The algorithms are making it much harder to find the places where you can obtain these medicines,” she said. “That is what people don’t realize: It’s Google that is filtering people’s access to information.”

    Lara Levin, a Google spokesperson, told Vox that their search ranking systems “are designed to return relevant results from the most reliable sources, and on critical topics related to health matters, we place an even greater emphasis on signals of reliability.” Levin added that no update is made to benefit or penalize any one site. “We give site owners and content producers ample notice of relevant updates along with actionable guidance,” she said.

    The Facebook and Instagram accounts for Women on Web have had spending restrictions placed on them for more than a year, after their ads were flagged or hidden by other users who oppose their work or who found their content “to be offensive … violent, [or] about a sensitive topic.” Some of their ads for medication abortion have also been rejected, with rationales like “Ads must not promote the sale or use of unsafe supplements, as determined by Facebook in its sole discretion.” One Women on Web Instagram post that read, “You can now order abortion pills BEFORE you are pregnant,” and included a link for advanced provision was taken down for not following “community guidelines.”

    Courtesy of Women on Web

    A Women on Web Instagram post that was taken down this spring for not following “community guidelines.”

    Facebook did not respond to a request for comment on the Women on Web ads specifically, but pointed Vox to company policies from Meta (Facebook and Instagram’s parent company) including ad prohibitions for direct sales of prescription drugs, and for ads promoting reproductive health products or services to people under age 18. In November 2021, Facebook also announced it would remove ad targeting options for topics people may perceive as “sensitive” — including health-related causes.

    But at least one of the examples Women on Web showed Vox — the one about ordering pills before you’re pregnant — wasn’t an ad. It was a regular post to the group’s Instagram profile that they didn’t pay to amplify or target.

    The algorithmic battles playing out reflect broader challenges faced by tech companies, which are under pressure to crack down on misinformation and propaganda and to take clearer stands on polarized political issues that users may be researching. The last few years have also brought greater attention to the ways in which machine learning and AI more broadly can reflect bias and discrimination, even while purporting to be objective and neutral.

    “We have to be careful not to frame questions as one of adapting to technology,” said David Broniatowski, a professor at George Washington University who has studied anti-vaccination communities online. “The technology is out in the world, so we should ask how to remake technology so we can achieve goals that are of best benefit to society.”

    Aid Access has withstood legal challenges, so far

    Aid Access has faced one regulatory challenge, in 2019, when the FDA sent the group a cease-and-desist letter, claiming that its generic mifepristone drug represented a “misbranded and unapproved” drug that posed risk to consumers. (The FDA approved one brand of mifepristone, Mifeprex, in 2000, and in 2019 approved a generic version.)

    Aid Access, in turn, sued the FDA, alleging the agency was impeding Americans’ constitutional right to an abortion and that its drugs were, in fact, approved. Aid Access also maintained that the FDA had no legal jurisdiction over Gomperts. The case was dismissed in part because the FDA never took action following its letter.

    The Biden administration has taken a friendly stance toward medication abortion, but a change in the White House in 2024 or beyond could mean new challenges from the FDA or other agencies. Legal threats against Aid Access without the constitutional protection of Roe might make things even more complicated.

    Anti-abortion activists and lawmakers have been ramping up their efforts to crack down on abortion pills, an unsurprising development given that medication abortion accounted for 54 percent of all US abortions in 2020. In 2022 alone, according to the Guttmacher Institute, lawmakers in 22 states have introduced new legislation to restrict the drugs.

    Rather than punish those who seek abortions, the slew of anti-abortion laws introduced over the past decade has targeted physicians, clinics, and anyone else who helps to “aid and abet” someone who has an abortion, as Texas’s recent ban put it. Abortion activists have worried about the criminalization of patients, but so far efforts have been limited and largely unsuccessful.

    Whether any of these new laws could affect Aid Access’s operations or the patients who seek out its services remains an outstanding question. It’s hard to know what abortion access in the US will look like in a year, or five.

    But for Americans seeking to end their pregnancies now — whether they live in red states with heavy abortion restrictions or in blue states with more liberal laws but heavy financial barriers — Aid Access represents a lifeline. If they can find it.

Steve Jordan/AFP via Getty Images
Researchers collect samples from a bat inside a cave in the Zadie region of Gabon in November 2020.

That was the concept behind one plank of Predict’s work, which sampled “at least 931 novel virus species from 145,000 samples of wildlife, livestock, and humans,” according to a 2020 paper by biologist Colin Carlson, of Georgetown University.

The Global Virome Project has a similar aim. Launched in 2018 and estimated to cost between $1 billion and $4 billion, it aims to go out into the wild and test animals for viruses. (The Global Virome Project did not reply to a request for comment.)

The key idea behind Predict, the Global Virome Project, and Deep Vzn was that if we build a catalog of hundreds of thousands of viruses out there in nature, we will figure out which ones threaten humans, and then we’ll be better prepared if and when they spill over.

“Developing these tools now is essential for being better prepared for the future when new viruses spillover and stopping them from causing outbreaks that could become pandemics,” USAID’s announcement of Deep Vzn as a program declared.

The idea behind these initiatives makes intuitive sense. The notion of being proactive in searching for the next deadly virus that could hobble humanity certainly holds appeal, especially in the post-Covid age. But scientifically, the rationale for such a program rests on more questionable ground than many of its backers assume, according to some experts.

“I still fail to see at this point how it’s going to better prepare the human race for the next infectious disease that jumps from animals to humans,” Michael Osterholm, the director of the University of Minnesota’s Center for Infectious Disease Research and Policy, has argued.

“Before the pandemic, the dominant paradigm was that if we could find these threats we could predict and prevent [the next pandemic],” Carlson, the biologist, told me. “It was a silly thing to believe even without the pandemic. … There has been a disconnect between the proposed benefits and the reality for a while.”

Carlson’s paper goes further. “History tells us viral discovery is not enough to prevent pandemics: influenza was first isolated in 1933, Zika in 1947, chikungunya in 1952, and amid the emergence of severe acute respiratory syndrome coronavirus in 2003 and Middle East respiratory syndrome coronavirus in 2012, nearly two decades of wildlife sampling has turned up hundreds of new coronavirus species,” he writes.

And yet, knowing that a virus exists among thousands of viruses in nature, it appears, doesn’t by itself do much of anything to help us defend against it. Supporters argue that it can help with developing vaccines or treatments. But there’s yet to be an example of a successful human vaccine or treatment development program for a virus identified only in the wild — and most of the time it takes to get vaccines or treatments ready for wide-scale use is spent on clinical trials in humans that are not conducted for viruses that have been found only in animals.

It’s hard to rule out that any particular avenue of scientific research might turn up an important insight down the line. Not much has come of the viral discovery elements of Predict (more on that below), but there’s always the chance something is just around the corner to be discovered.

But with all that said, many prominent researchers remain skeptical. “Broad genomic surveys of animal viruses will … be of little practical value when it comes to understanding and mitigating the emergence of disease,” leading virologists Edward Holmes, Andrew Rambaut, and Kristian Andersen argued in Nature in 2018, in a commentary titled “Pandemics: spend on surveillance, not prediction.” “We urge those working on infectious disease to focus funds and efforts on a much simpler and more cost-effective way to mitigate outbreaks — proactive, real-time surveillance of human populations.”

And there’s an even worse risk here to ponder.

Could viral discovery risk causing the pandemics it’s meant to stop?

In general, much pandemic prevention work has focused on minimizing human-animal interfaces — for example, encouraging people not to hunt and eat animals that are disease reservoirs, and not to go in caves full of disease-carrying bats.

Nichole Sobecki/Washington Post/Getty Images
A market in Brazzaville, Republic of Congo, sells both imported and wild pig, including the red river hog and other popular forms of bushmeat, in February 2015. Scientists have speculated that the practice of eating bushmeat, which is popular across Africa, was responsible for the Ebola outbreak that year.

But virus hunting itself frequently involves exposure to the highest-risk human-animal interfaces. One 2021 Science article about Predict tells an anecdote about the virology researchers trying to find new viruses in the Amazon: “Monkeys have bitten and sneezed on Gordo [a virus hunter profiled], and on this trip a syringe broke as he squeezed the plunger, spraying monkey blood on his face shield. He says his wife complains when he stashes monkey carcasses in their home fridge.” The tone is lighthearted, but the content is, considered from the perspective of closely working with potentially dangerous viruses, fairly terrifying.

In China, a researcher looking for bat coronaviruses “once forgot personal protective equipment and was splattered with bat urine, leading him to quarantine at home for two weeks. On multiple occasions, bat blood squirted onto his skin while he was trying to grasp the animals with a clamp,” the Washington Post reported, citing interviews in Chinese state media.

Research under those conditions might find previously undiscovered viruses. It also might spread them.

“USAID takes biosafety and biosecurity extremely seriously and has established detailed safety protocols and procedures to ensure this work is done safely,” a USAID spokesperson told me, though they did not share details.

Another concern is what happens once viruses are taken to the lab for testing and characterization, which often involves infecting lab animals with the virus to see whether and how they’re affected.

“They want to take the viruses that look the scariest, and take them back to the lab, and do experiments on them to determine which really pose a threat of a pandemic,” said Kevin Esvelt, a biologist at MIT known for his pioneering work on the gene-editing technology CRISPR. “As soon as you take them back to the lab and start working with them, you run the risk of accidental pandemics” — for example, from lab escapes, where a virus under controlled conditions makes it out of the lab and into the general population.

But that’s not even the most significant risk from such research, Weber says. “The biggest concern is that in the process of identifying potential pandemic pathogens we are actually giving a cookbook to potential bad actors,” he warns.

His argument: Let’s say you are a state actor starting a bioweapons program, or a terrorist group like the Aum Shinrikyo cult, which in the 1990s actively tried to build biological agents it could use to harm civilians.

Wouldn’t a public, neatly ordered list of genomes for all the most dangerous viruses humanity has been able to identify — for which there is no natural immunity and no stockpiled vaccines — provide the perfect shopping list?

“Once a pandemic-capable pathogen has been identified, its genome features high dual-use potential: it may inform biosurveillance while also constituting a blueprint to cause widespread harm,” a recent preprint paper from researchers at Oxford and Georgetown concluded.

Part of USAID’s plan for Deep Vzn is that all of the discovered genomes would be fully public, which is itself a response to legitimate previous concerns that viral discovery work involved the US going into poor countries and collecting data that the US then didn’t share with locals.

Esvelt puts it like this: “As soon as we publicly identify pandemic-capable viruses, we’ll be giving tens of thousands of individuals the ability to kill as many people as a nuclear device could.” In other words, knowing in advance that a virus might spill over and kill millions of people would theoretically be great. But if scientists effectively tell the world “this virus, if it infected humans, would kill millions of people,” then they’ve created a clear information hazard, accidentally opening the door to potential cataclysmic harm.

Developing effective bioweapons is difficult — but the hard part isn’t the doing, it’s identifying the rare one that is contagious and dangerous to human beings. If well-intentioned research does that part and a list of such viruses is published, then weaponizing them is quite doable even for a small team. “My own skills are rusty but I could probably do it myself,” Esvelt told me.

“The way the life sciences work is that they post the DNA of everything publicly,” Weber told me. “That’s inevitably going to enable bad actors. The sequences are the recipes for the world’s most dangerous weapons.”

Laurent Cipriani/AP

Researchers wearing protective gear work in the P4 European High Level Security Laboratory in Lyon, France, in 2009. The lab, which normally handles only the most deadly viruses such as Ebola, was preparing to receive the then- new swine flu influenza virus H1N1.

How much of a threat is that, really? Don’t we already have deadly diseases? Sure, terrorists could build a pandemic virus identified through Deep Vzn, but couldn’t they also build smallpox or the 1918 flu? (The genomes for both are available.)

“We live in an era where people can create viruses if they have the blueprint,” Carlson told me. But he’s not worried that virus hunting could add new blueprints: “I believe that in terms of containment scenarios a flu is a bigger fear, and we certainly don’t say that all flu sequences should be confidential. The marginal risk is very small.”

Esvelt disagrees. “The key point to get across … is that right now we don’t actually know of any pandemic-capable viruses” that spread in humans for which a vaccine doesn’t exist, he told me. There’s smallpox, but the US has hundreds of millions of vaccine doses on hand (and for complicated technical reasons, poxes are harder to create from a blueprint in a lab than flus or coronaviruses are, though not impossible). There are influenzas that have already hit human populations, for which we also have vaccines (and some natural immunity).

“We are partly protected by our limited knowledge of specific genotypes, mechanisms, and other critical biological details” of how best to kick off a deadly pandemic, the Oxford/Georgetown paper finds.

Is identifying new recipes for mass death worth it? That comes down to a crucial question: Does having such recipes aid in “defense” against pandemics more than it aids in “offense”?

A look at viral discovery’s track record

The case for work like Deep Vzn’s viral discovery is simple: What if scientists had known in advance that Covid-19 was circulating in wild animals, and had known it posed a threat to humans?

In that case, they could have gotten a head start on developing vaccines and treatments. If the next Covid-19 is identified while it’s still in animal hosts, the world could potentially prevent it from spilling over — or least be ready for it if it does by designing broad-spectrum vaccines and treatments.

The problem is that the world did take exactly this approach to identifying risky coronaviruses after SARS outbreaks in the early 2000s. US programs like Predict funded research to collect pathogens in the wild, including partnerships with the Wuhan Institute of Virology to collect and study coronaviruses — partnerships that hit the headlines when the coronavirus pandemic began in Wuhan.

Whether or not the Wuhan Institute of Virology’s coronavirus work had anything to do with causing the last pandemic — many virologists argue that a natural origin is more likely — there was widespread agreement among the experts I talked to that the huge collection of coronaviruses amassed before the pandemic had limited utility in developing treatments or vaccines once Covid-19 began spreading.

Hector Retamal/AFP via Getty Images
Members of the World Health Organization team investigating the origins of the Covid-19 coronavirus arrive at the Wuhan Institute of Virology in Wuhan, China, on February 3, 2021.

“After having done this work for 15 years, I think there’s little to show for it. As the intelligence community concluded, it’s plausible that it actually caused this pandemic, and to me that’s enough,” Weber told me. “We don’t have to be sure what caused this pandemic to reduce the risk of the next pandemic. It was of zero help in preventing this pandemic or even predicting this pandemic.”

“As best as I can tell, the only thing we needed for the vaccine was the prior work on the spike protein,” Esvelt told me, “and that did not result from any virus discovery or characterization in the lab.”

A USAID spokesperson disputed that claim. Predict, they told me, “advanced the current knowledge of several different viral families, including an understanding of where risks are and the human behavior leading to contact with animals that increases the potential for spillover. This information is being used by scientists to develop broadly protective vaccines and medicines, critical tools to have available for when/if a new coronavirus causes an outbreak in the future.”

Predict’s critics say that while almost any research can technically be said to have “advanced the current knowledge” of viruses, the benefits here are oversold to the public: nothing major, exciting, or especially promising came out of Predict’s viral discovery work — and the most valuable work Predict did was in testing humans near wildlife-human interfaces for diseases that had already crossed over into humans.

“Predict only discovered a single conclusive zoonotic virus that spilled over into humans — and this not through wildlife sampling, but from analyzing patient samples,” the recent Oxford and Georgetown paper on large-scale viral surveillance programs noted.

“Since the SARS-CoV-1 outbreak in 2003, numerous animal coronaviruses have been gathered and investigated, but this work did little to prevent the COVID-19 pandemic or inform vaccine design,” the researchers wrote, concluding the most valuable work was studies of MERS and SARS — the coronaviruses that had caused severe disease in humans.

The crucial zoonotic crossover work isn’t viral discovery

All of this isn’t to say that efforts to study zoonotic crossover aren’t hugely important, or don’t have a major role to play in pandemic preparedness. Much of Predict’s other work was hugely valuable — for example, research on reducing human-wildlife contact and enhancing international disease response partnerships.

There is no question that lots more preparedness work is needed to prevent the next pandemic. It’s just a matter of what work is best — and safest. “Ultimately, what makes one spillover event into a pandemic versus an isolated outbreak has a lot more to do with policies and health systems (i.e., community awareness, surveillance systems, rapid response capabilities) than it does about knowing ahead of time what sort of characteristics the virus has,” Georgetown biologist Claire Standley, one of the authors of the paper looking at surveillance programs, told me.

The paper ultimately highlights a more narrow approach as likely more cost-effective and lower-risk: focusing on response capabilities and human infections in areas where zoonotic crossover is a possibility. “Adopting such a highly focused approach for zoonotic risk prediction may not only reduce safety and security risks associated with the large-scale collection of wildlife viruses, but also generate more actionable insights — and likely at a lower price tag,” the paper concludes.

Esvelt’s ultimate takeaway? “Let’s not learn to make pandemics until we can reliably defend against them. Instead, we could take all of these funds that we were going to use to identify which particular viruses cause pandemics and pour it back into preventing spillover.”

From The Hindu: Sports

From The Hindu: National News

From BBC: Europe

From Ars Technica

From Jokes Subreddit