‘The Whole Voting Universe Has Been Turned Upside Down by Covid’

CounterSpin interview with Steven Rosenfeld on how to vote


JANINE JACKSON

https://fair.org/home/the-whole-voting-universe-has-been-turned-upside-down-by-covid/

Janine Jackson: There are more ways to make your voice heard than voting in presidential elections, for sure, but voting remains a primary means of societal participation. And organizing the vote can be a powerful tool for community engagement and education—with impacts well beyond electoral politics.

Given that this is 2020, listeners don’t need to hear all the reasons voting is critical. But given that this is 2020, we have plenty of questions and concerns about how to do it.

Our next guest is engaged with that critical and evolving set of questions. Reporter and author Steven Rosenfeld is the editor and chief correspondent of Voting Booth, a project of the Independent Media Institute. His most recent book is Democracy Betrayed: How Superdelegates, Redistricting, Party Insiders and the Electoral College Rigged the 2016 Election.

He joins us now by phone from San Francisco. Welcome back to CounterSpin, Steven Rosenfeld.

Steven Rosenfeld: Well, thank you. I’m glad to be here.


National Memo (8/8/20)

JJ: You have just written “The 2020 Fall Voter Guide: How to Make Sure Your Vote Counts,” and I would love to have you just talk us through some of the key elements there; my sense is that maybe the first thing is: act early.

SR: Yes. Basically, people need to make a plan—and a lot of people are beginning to say this now; we heard this at the Democratic Convention. But what making a plan really means is getting ahead of what’s going to be bureaucratic crunches and bottlenecks. Because the whole voting universe has been turned upside down by Covid, and what that means is that people are going to be unfamiliar with all the steps—including election officials and poll workers. So let’s talk about what people really need to do.

First of all, there’s three ways you can vote, and you have to figure out which one is going to work for you. You can vote by mail, or you can receive a ballot in the mail, then you can decide how you want to return it. Then you can vote early, which is at an in-person location, not necessarily a polling place; sometimes it’s a county office, city hall. And then there’s Election Day, which is November 3, which is also in-person.


Steven Rosenfeld: “It’s more important than ever not just to be registered, but to really, really make sure your registration information is correct.”

And in all those cases, it’s more important than ever not just to be registered, but to really, really make sure your registration information is correct. Because, if you’re going to be voting from home, the way that you’re going to get that ballot, and the way that that ballot is going to be vetted, whenever it’s returned, it’s going to be checked against your address, and the spelling of your name, and your signature—probably on your driver’s license.

So we can talk about this a little bit, but really, it all starts with getting your registration information up to date—and you can check online with almost every state for that. And then it gets a little more complicated, the whole voting-by-mail thing.

JJ: Do it.

SR: Here’s the thing about voting by mail: East of the Rockies, before Covid, most states did not have high volumes of people. States like Florida, which were one of the highest, maybe had a quarter of the people voting by mail. So what does that mean? It means, in most states, you have to apply to get a ballot. Now that’s a separate process, that’s a second application.

Now, some states—there are a handful, like New Jersey and Vermont—that are east of the Rockies will be sending out ballots, so voters don’t have to do anything, except being registered.

But in other states, you’ll either be getting an application sent to you (if you have registered), or if you have voted in the last couple of years, you’ll get one. If you haven’t voted in like three or four years, you might have to re-register, or check your registration, or update everything, so you’re not left off.

And then, in other states like Ohio, you’re totally on your own. You’ve got to figure out how to get an application—which usually means going online and downloading it and printing it. So it’s really a range.

JJ: It sounds like a lot of what you’re saying is that different states are different, and so you can’t just assume. Like maybe you hear a news story that says, “Oh, there’s going to be drop boxes!” But that might not be in your state, that might not be applicable to you. So it sounds like there’s really no substitute for proactively informing yourself about what the particular rules and regulations and processes are for your state, and better to do that early than to sit back and imagine it’s gonna come to you.

SR: When I talk to people who actually are developing the apps that, like, the Democratic campaigns are going to be using, and a lot of people are going to be using, they say that the best information is at your local county election office; you really want to deal with them. They say there are time lags between updating statewide government records and rolls; you really don’t want to deal with any middlemen. You don’t want to deal with non-profits, I have to say—and I work for one that does do voter registration, among other things.

Because you have to make sure that the people who will be sending you a ballot, or giving you one at a polling place, have your information, and it’s correct. And you can’t necessarily trust that somebody else is going to do it for you.

Now you’re right, it really varies state by state, and within some states, even varies county to county.


National Memo (8/31/20)

So let me tell you about one thing that I’ve been looking at this week, and I can’t get clear answers on. This is a perfect indication about why people have to be proactive, and there’s more work. In Michigan, Pennsylvania and Wisconsin, the three final swing states for 2016, the application forms to request an absentee ballot in the primaries have multiple boxes to check on them. And some people just checked, “I want it for the primary,” and some people just checked, “I want it for the rest of the year,” and nobody can tell me how many people did either one.

So that means that some people may have checked boxes, thinking, “Oh, I got this in the primary, I’m all set!” Or they did it in such a rush, because the pandemic was breaking, they don’t remember.

What that means is that people, if they’re going to vote by mail, they have to go back and either update or confirm or apply again: It’s a big pain in the butt.

But this is a starting-line detail, it’s a small thing that has such big consequences—and this is indicative of the landscape we’re in. Now we can talk about other things, but really, this starting line, if you want to be in the game, not just being registered, you’ve gotta be on track to get that mailed out ballot.

JJ: Absolutely. And just as people, it’s going to be very frustrating to read on November 4 about chaos in the polling places, and confusion. It’s the story now, about how to make it work properly, or as well as it can, and not something that we want to look back on after it’s been a mess.

What I’m getting is decide early how you want to vote, and make sure your information is up to date. But one of the other points that you make in that guide is, be ready to pivot, have a plan B. Do your early thing, but if you get frustrated or thwarted, you can’t give up.

SR: Yes. In the spring, the intelligentsia of the election policy world basically said, “Oh! Everyone can just vote by mail, it’s not going to be a problem.” They didn’t realize that a lot of people, especially non-white people in metro areas, in urban areas, don’t want to vote by mail, because they want to cast it and see it taken and counted; they just don’t trust the system.

And in other places, the people just didn’t even talk about voting early. So what happened now is, there’s been a little bit of a recalibration. But really, what people should try to do is think of Election Day as the last resort.

So what happens is, like my parents in New York, when they did not get their ballots in time for the New York primary—what should they have done?

Well, my dad, he didn’t want to take the risk of going out, because he’s in his upper 80s. And that’s really sad. And other people might be in the same kind of situation. What do you do when your ballot doesn’t arrive when you order one?

Well, there are things to do, we can tell people about that later, but really, it involves showing up in person and having the right credentials. And that goes back to, “Hey, is your registration correct? Is the address correct? Did they spell your name properly? Did you have a middle initial on the form, or on your driver’s license? Does your signature look like it looks on your driver’s license?”

Because this is the kind of stuff, in states where Republicans are going to get very finicky, they’re going to use this to try to disqualify. Or they’re gonna yell and scream about this. And the only antidote for that is to have everything be really orderly. So that’s where we’re at.

JJ: Covid-19 was obviously a curveball; ham-fisted interference with the Postal Service another curveball of sorts. But then again, we need resilience and responsiveness built in to our systems.

So looking forward, once we get through this, if we can take the liberty to imagine that, what is suggested to you in terms of substantive improvements to the process?

SR: Everything that deletes unnecessary bureaucratic steps from the starting line to the finish line. And we could list a lot of those. I mean, come on, states like California, Nevada, Utah—Utah’s not exactly a blue state—are mailing everybody a ballot. They don’t have this ridiculous application process, which creates a ton of costs for printing, postage, a ton of manpower hours—it’s just unnecessary bureaucracy.

The same thing is true when it comes to people who don’t get their ballots in the mail, they show up at a polling place. They have the same technology in Los Angeles and Georgia; in Los Angeles, they will check you in and take you off the list getting mailed out ballots, and give you a regular ballot, and you’re off and you vote. In Georgia, they have to call the county election board to get permission to do that whole thing.

This is just intentional. There are so many things like this that just slow things down, and people leave…. It’s just, do you want to be an efficient, transparent process, where technology works well, and you have paper and digital technology backing each other up? Or do you want to create these ridiculous steps and procedures that really cause people to turn away?

These technicalities, they have political overtones and implications—and, you know, they’re not just technicalities.

JJ: All right then. We’ve been speaking with Steven Rosenfeld, the editor and chief correspondent of Voting Booth, of the Independent Media Institute. You can find the voters guide we’ve been discussing through their site, IndependentMediaInstitute.org. It’s also online at NationalMemo.com.

Steven Rosenfeld, thank you so much for joining us this week on CounterSpin!

SR: Well, it’s really a pleasure, thank you!

There Is No Ethical Capitalism

 

https://www.youtube.com/watch?v=VcQYlPuofbA&ab_channel=TheMichaelBrooksShow

Unions Fracture Over Climate

This week, we explore the tug of war between protecting union jobs and the transition to a cleaner economy.

September 6, 2020 Debra Kahn, Samantha Maldonado and Catherine Boudreau POLITICO

https://portside.org/2020-09-06/unions-fracture-over-climate

A DIVIDED MOVEMENT — Organized labor is often viewed as a cheerleader for the left, helping shape the agendas of Democratic lawmakers. But in statehouses from coast to coast and at the national level, unions have had no problem blocking green initiatives if they decide they're not in their members' interests.

Those who stand to lose the most from tightening environmental policies have been wielding their power the past few months to kill proposals in statehouses across the country. Broadly, the split among unions is most marked between trade unions whose jobs are tied to the fossil fuel industry and those representing the service sector, like health care, government and custodial workers.

“In recent years, the public employees have been siding mostly with the environmentalists and the private sector have been siding with our opinion, which is yes, we're pro-environment but ... we also want to be able to afford to live here and have jobs here,” said Kate Gibbs, deputy director of the Engineers Labor-Employer Cooperative, a trades union.

Environmental protection and union jobs are a fault line among Democrats, which will only be magnified nationwide if Joe Biden defeats President Donald Trump in November. Biden will be under pressure from the left to enact major climate action similar to the "Green New Deal," which many national labor union leaders oppose. The Democratic National Committee last month scrapped language in its platform calling for an end to fossil fuel tax breaks and subsidies, despite Biden's campaign arguing the move would ultimately benefit unions.



If Joe Biden wins in November, he will be under pressure to enact major climate action similar to the Green New Deal, which many national labor union leaders oppose. | Alex Wong/Getty Images

Take California, where Democrats dominate state government. In a recent tug of war over the blue-collar constituency, the unions proved decisive. Electrical and ironworkers, pipe fitters, boilermakers and construction workers, along with oil companies and the state Chamber of Commerce, persuaded three Democratic senators to vote against a bill that would have mandated no-drill zones around certain populous areas — killing the effort for the year.

"We've got a little bit stronger voice for working people than most other people," said Robbie Hunter, president of the State Building and Construction Trades Council of California, the parent organization for 160 local unions that represent 400,000 workers across more than a dozen different trades, which spearheaded opposition to the bill.

In Pennsylvania, Democratic state lawmakers were recently frustrated by AFL-CIO, Building Trades and International Brotherhood of Electrical Workers' support of a bill that would block the state from joining the Regional Greenhouse Gas Initiative, a cap-and-trade program to reduce emissions from the power sector.

“It's this fundamental tension,” a California state lawmaker said on condition of anonymity to avoid political repercussion. “It underlies everything from the Green New Deal at the national level to California's climate action agenda.”

‘Just worried about today': Unions have found common ground with environmentalists on issues like replacing lead pipes, upgrading stormwater infrastructure and developing offshore wind, an industry slated to create thousands of manufacturing and construction jobs. In California, electrical, pipe trades and sheet metal workers' unions are working with environmentalists on a bill to fund HVAC and water-system improvements in schools.

In New Jersey, a coalition called Jersey Renews — whose membership includes branches of the food, health care, communications and steelworkers unions, among others — has attempted to consolidate the support of disparate groups to advance climate change mitigation strategies.

Kevin Brown, New Jersey State Director of SEIU 32BJ that represents 175,000 service workers across the Northeast and is a member of Jersey Renews, said climate change became a top concern for his members after they were disproportionately affected by the devastation of Hurricane Sandy.

“It’s just a difference of opinion, one that’s really a matter of life and death, and the trades are just worried about today, and that's a huge mistake," Brown said.

SEIU 32BJ opposed the construction of the controversial PennEast natural gas pipeline and the New Jersey Turnpike Authority’s capital plan — which called for widening highways that may increase traffic. Trade unions backed both projects. For almost a month, trade unions also stymied momentum for groundbreaking legislation preventing polluting facilities from being placed in certain neighborhoods. Ultimately, environmental justice advocates prevailed.
THE WORKFORCE

A ‘JUST TRANSITION' TO A CLEAN ECONOMY — The blue-green divide over tackling climate change largely comes down to this: What happens to the unionized workers displaced by the shift to renewable energy? Will these new green jobs be just as well-paid and come with benefits? Will they be created in the most economically distressed areas and communities of color? What should training look like?

The BlueGreen Alliance, which unites 13 labor unions and environmental groups, has some answers for state governments. It developed a policy guide that includes mandating labor agreements as a condition of awarding contracts for new projects, investing in apprenticeships, enforcing local and targeted hiring policies that consider candidates who are women, minorities, veterans, the formerly incarcerated or Indigenous people, as well as establishing a wage floor that contractors must pay. The Alliance said failing to account for income and racial inequality would only exacerbate current trends and leave middle-class workers more vulnerable to economic crises.

The document doesn't discuss the politically fraught issue of compensating workers who are displaced, however. In Colorado, Democratic Gov. Jared Polis last year enacted clean energy laws backed by state labor groups, which secured a provision requiring the government to make up the difference between coal workers’ pay from their old jobs and their new ones, among other guarantees.

Phil Smith, director of communications and government affairs for United Mine Workers of America, said sweeping climate platforms offered by congressional Democrats and Joe Biden haven’t been specific enough about how they would make coal workers whole.

“We shouldn’t be solving the problem on the backs of Appalachian coal miners, or those working in oil and gas fields,” Smith said. “We don’t believe any climate legislation should be enacted if it doesn’t include a significant and specific program to help workers and communities disproportionately impacted. And it can’t just be training for something else. Workers and families have to be kept as whole as possible.”

UMWA, which isn't a member of BlueGreen Alliance, in the next month plans to talk to Congress about what should be included in legislation. The union’s president endorsed a bill introduced by Sen. Tammy Duckworth (D-Ill.) in July that would expand Medicare to all coal workers who have lost their jobs, make higher education free for them and their families, and invest in renewable energy development in their communities.

Payton Wilkins is national director of the Coalition of Black Trade Unionists’ Education Center. The coalition has about 8,000 members and recently endorsed Biden — marking only the third time since being founded in 1972 that it picked a candidate. Even though the coalition is “pretty radical” in supporting climate justice, members get skittish when discussions about compensating displaced workers arise, Wilkins said.



“Some people call it socialism, some call it communism. A lot of people are turned off by the notion of a universal basic income, but want to know what their income will be during a transition [to a cleaner economy],” Wilkins added, noting that Black workers also wrestle with an additional burden: the American stereotype that they are lazy.

“Members understand the link between health and the workplace. But we don’t want to exchange the public health crisis of being exposed to pollution for an economic one where we can’t put food on the table,” he said.
IDEAS LAB

CAPTURING THE PROBLEM — Some unions are holding out for widespread adoption of technology that catches greenhouse gas emissions at their source and stops them from entering the atmosphere. That way, extractive industries can stay in business and keep people employed.

Capturing carbon, storing it in the ground or using it for another industrial purpose, is many fossil fuel companies’ answer to climate change, and the Intergovernmental Panel on Climate Change in its 2018 report said keeping global temperatures from rising above catastrophic levels likely involves the technology.

There are only 10 large-scale operational facilities in the U.S. today, and another 11 around the world, according to the Global CCS Institute, a think tank working to expand the technology.

Smith of United Mine Workers of America said even though coal plants are being shut down in the U.S., hundreds of new plants are still being built around the world, including in China and India, which are top contributors to man-made climate change.

However, Smith acknowledged that a window of opportunity is closing. Widespread adoption of carbon capture and storage requires potentially tens of billions in public and private sector investment for research, development and construction. Right now, without a price on carbon, there are few short-term economic benefits for companies. On Capitol Hill, Republicans don't want to invest a lot of federal money in what they argue should primarily be market driven. Many Democrats are open to it, but also feel pressure from some green groups, who note that the technology can be used for oil recovery and argue it keeps the country subsidizing fossil fuels.

There was bipartisan support for a tax credit that Congress included in must-pass federal spending legislation two years ago, targeted to companies building new carbon capture and storage projects through 2023. But the IRS hasn't issued complete guidance yet. Given the delay, some lawmakers are pushing to extend the deadline for using the tax break.
WHAT WE'RE READING

— The Trump administration on Monday completed its latest effort to help the ailing coal sector, issuing a final rollback of an Obama-era rule aimed at protecting drinking water supplies from toxic heavy metal pollution from coal-fired power plants. POLITICO's Annie Snider has the details.

— The world’s largest asset managers are opposed to a Labor Department proposal that would make it more difficult to incorporate environmental, social and governance factors when making investment decisions, Bloomberg reports.

— About 80 percent of Americans are concerned about single-use plastics, a drop from last year when 87 percent said they were concerned, according to a new survey by The Consumer Brands Association that represents food, beverage and consumer product companies. Only 17 percent of respondents said the U.S. should ban single-use plastic entirely, while 62 percent agreed that improving the recycling system to process more plastic is the best way to deal with waste.

More than 200 airlifted to safety as California wildfires rage

 

https://www.youtube.com/watch?v=RWhuQyEtnAI

What lies ahead for Mali?

 

https://www.youtube.com/watch?v=7fUBhu1wt2w&ab_channel=AlJazeeraEnglish

‘The Biggest Monster’ Is Spreading. And It’s Not the Coronavirus.

Tuberculosis kills 1.5 million people each year. Lockdowns and supply-chain disruptions threaten progress against the disease as well as H.I.V. and malaria.

September 6, 2020 Apoorva Mandavilli NEW YORK TIMES




https://portside.org/2020-09-06/biggest-monster-spreading-and-its-not-coronavirus




It begins with a mild fever and malaise, followed by a painful cough and shortness of breath. The infection prospers in crowds, spreading to people in close reach. Containing an outbreak requires contact tracing, as well as isolation and treatment of the sick for weeks or months.

This insidious disease has touched every part of the globe. It is tuberculosis, the biggest infectious-disease killer worldwide, claiming 1.5 million lives each year.

Until this year, TB and its deadly allies, H.I.V. and malaria, were on the run. The toll from each disease over the previous decade was at its nadir in 2018, the last year for which data are available.

Yet now, as the coronavirus pandemic spreads around the world, consuming global health resources, these perennially neglected adversaries are making a comeback.

“Covid-19 risks derailing all our efforts and taking us back to where we were 20 years ago,” said Dr. Pedro L. Alonso, the director of the World Health Organization’s global malaria program.

It’s not just that the coronavirus has diverted scientific attention from TB, H.I.V. and malaria. The lockdowns, particularly across parts of Africa, Asia and Latin America, have raised insurmountable barriers to patients who must travel to obtain diagnoses or drugs, according to interviews with more than two dozen public health officials, doctors and patients worldwide.

Fear of the coronavirus and the shuttering of clinics have kept away many patients struggling with H.I.V., TB and malaria, while restrictions on air and sea travel have severely limited delivery of medications to the hardest-hit regions.

About 80 percent of tuberculosis, H.I.V. and malaria programs worldwide have reported disruptions in services, and one in four people living with H.I.V. have reported problems with gaining access to medications, according to U.N. AIDS. Interruptions or delays in treatment may lead to drug resistance, already a formidable problem in many countries.

In India, home to about 27 percent of the world’s TB cases, diagnoses have dropped by nearly 75 percent since the pandemic began. In Russia, H.I.V. clinics have been repurposed for coronavirus testing.

Malaria season has begun in Africa, which has 90 percent of malaria deaths in the world, but the normal strategies for prevention — distribution of insecticide-treated bed nets and spraying with pesticides — have been curtailed because of lockdowns.

According to one estimate, a three-month lockdown across different parts of the world and a gradual return to normal over 10 months could result in an additional 6.3 million cases of tuberculosis and 1.4 million deaths from it.

A six-month disruption of antiretroviral therapy may lead to more than 500,000 additional deaths from illnesses related to H.I.V., according to the W.H.O. Another model by the W.H.O. predicted that in the worst-case scenario, deaths from malaria could double to 770,000 per year.

Several public health experts, some close to tears, warned that if the current trends continue, the coronavirus is likely to set back years, perhaps decades, of painstaking progress against TB, H.I.V. and malaria.

The Global Fund, a public-private partnership to fight these diseases, estimates that mitigating this damage will require at least $28.5 billion, a sum that is unlikely to materialize.
Delays in diagnosis

If history is any guide, the coronavirus’s impact on the poor will be felt long after the pandemic is over. The socioeconomic crisis in Eastern Europe in the early 1990s, for example, led to the highest rates in the world of a kind of TB that was resistant to multiple drugs, a dubious distinction the region holds even today.

The starting point in this ruinous chain of events is a failure to diagnose: The longer a person goes undiagnosed, and the later treatment begins, the more likely an infectious disease is to spread, sicken and kill.

For malaria, a short delay in diagnosis can swiftly turn fatal, sometimes within just 36 hours of a spiking fever. “It’s one of those diseases where we cannot afford to wait,” Dr. Alonso said.

Apprehensive about malaria’s rise in West Africa, the W.H.O. is now considering giving entire populations antimalarial drugs — a strategy of last resort used during the Ebola epidemic in West Africa and the Boko Haram insurgency.

Across sub-Saharan Africa, fewer women are coming to clinics for H.I.V. diagnosis. A six-month disruption in access to drugs that prevent H.I.V.-positive pregnant women from passing the infection to their babies in utero could increase H.I.V. infections in children by as much as 139 percent in Uganda and 162 percent in Malawi, according to U.N. AIDS.

Diminishing diagnostic capacity may have the greatest effect on TB, leading to dire consequences for households because, like the coronavirus, the bacterium spreads most efficiently in indoor air and among people in close contact.

Each person with TB can spread the disease to another 15 individuals over a year, sharply raising the possibility of people infected while indoors spreading it among their communities once lockdowns end. The prospect is especially worrisome in densely populated places with high rates of TB, such as the favelas of Rio de Janeiro or the townships of South Africa.

“The more you leave undiagnosed and untreated, the more you will have next year and the year after,” said Dr. Lucica Ditiu, who heads the Stop TB Partnership, an international consortium of 1,700 groups fighting the disease.

The infrastructure built to diagnose H.I.V. and TB has been a boon for many countries grappling with the coronavirus. GeneXpert, the tool used to detect genetic material from the TB bacteria and from H.I.V., can also amplify RNA from the coronavirus for diagnosis.

But now most clinics are using the machines only to look for the coronavirus. Prioritizing the coronavirus over TB is “very stupid from a public health perspective,” Dr. Ditiu said. “You should actually be smart and do both.”

In country after country, the pandemic has resulted in sharp drops in diagnoses of TB: a 70 percent decline in Indonesia, 50 percent in Mozambique and South Africa, and 20 percent in China, according to the W.H.O.

In late May in Mexico, as coronavirus infections climbed, TB diagnoses recorded by the government fell to 263 cases from 1,097 the same week last year.

Dr. Giorgio Franyuti, the executive director of Medical Impact, an advocacy group based in Mexico, normally works in the country’s remote jungles, diagnosing and treating TB in the Lacandon people. Unable to travel there during the pandemic, he has worked at a makeshift army hospital treating Covid-19 patients in Mexico City.

There, he has seen nine patients with a sputum-filled cough — characteristic of TB — that began months earlier but who were presumed to have Covid-19. The patients later contracted the coronavirus in the hospital and became seriously ill. At least four have died.

“Nobody is testing for TB at any facility,” he said. “The mind of clinicians in Mexico, as well as decision makers, is stuck with Covid-19.”

“TB is the biggest monster of them all. If we’re talking about deaths and pandemics, 10 million cases a year,” he said, Covid doesn’t compare yet to that toll.

India went into lockdown on March 24, and the government directed public hospitals to focus on Covid-19. Many hospitals shuttered outpatient services for other diseases.

The impact on TB diagnoses was immediate: The number of new cases recorded by the Indian government between March 25 and June 19 was 60,486, compared with 179,792 during the same period in 2019.

The pandemic is also shrinking the supply of diagnostic tests for these killers as companies turn to making more expensive tests to detect the coronavirus. Cepheid, the California-based manufacturer of TB diagnostic tests, has pivoted to making tests for the coronavirus. Companies that make diagnostic tests for malaria are doing the same, according to Dr. Catharina Boehme, the chief executive of the Foundation for Innovative New Diagnostics.

Coronavirus tests are much more lucrative, at about $10, compared with 18 cents for a rapid malaria test.

These companies “have tremendous demand for Covid right now,” said Dr. Madhukar Pai, the director of the McGill International TB Centre in Montreal. “I can’t imagine diseases of poverty getting any attention in this space.”
Treatment interruptions

The pandemic has hindered the availability of drugs for H.I.V., TB and malaria worldwide by interrupting supply chains, diverting manufacturing capacity and imposing physical barriers for patients who must travel to distant clinics to pick up the medications.

And these shortages are forcing some patients to ration their medications, endangering their health. In Indonesia, the official policy is to provide a month’s supply of drugs at a time to H.I.V. patients, but antiretroviral therapy has lately been hard to come by outside of Jakarta.

Even in the city, some people are stretching a month’s supply to two, said “Davi” Sepi Maulana Ardiansyah, an activist with the group Inti Muda.

Mr. Ardiansyah has done so himself, although he knows it has jeopardized his well-being. “This pandemic and this unavailability of the medicines is really impacting our mental health and also our health,” he said.

During the lockdown in Nairobi, Thomas Wuoto, who has H.I.V., borrowed antiretroviral pills from his wife, who also is infected. As a volunteer educator for H.I.V., Mr. Wuoto knew only too well that he was risking drug resistance by mixing or skipping medications. When he finally made it to the Mbagathi County Hospital, he had gone 10 days without his H.I.V. medicines, the first time since 2002 that he had missed his therapy.

People with H.I.V. and TB who skip medication are likely to get sicker in the short term. In the long term, there’s an even more worrisome consequence: a rise in drug-resistant forms of these diseases. Already drug-resistant TB is such a threat that patients are closely monitored during treatment — a practice that has mostly been suspended during the pandemic.

According to the W.H.O., at least 121 countries have reported a drop in TB patients visiting clinics since the pandemic began, threatening hard-fought gains.

“This is really difficult to digest,” Dr. Ditiu said. “It took a lot of work to arrive where we are. We were not at the peak of the mountain, but we were away from the base. But then an avalanche came and pushed us back to the bottom.”

The lockdowns in many places were imposed so swiftly that drug stocks were rapidly depleted. Mexico already had expired drugs in its supply, but that problem has been exacerbated by the pandemic, according to Dr. Franyuti.

In Brazil, H.I.V. and TB drugs are purchased and distributed by the ministry of health. But the coronavirus is racing through the country, and distribution of these treatments has become increasingly difficult as health care workers try to cope with the pandemic’s toll.

“It’s a big logistical challenge to have municipalities have higher stock so they can supply,” said Dr. Betina Durovni, a senior scientist at the Fiocruz Foundation, a research institute in Brazil.

Even if governments are prepared, with some help from big aid agencies, to buy drugs months in advance, the global supply may soon run out.

The pandemic has severely restricted international transport, hindering the availability not just of chemical ingredients and raw materials, but also of packaging supplies.

“The disruption of supply chains is really something that worries me — for H.I.V., for TB, for malaria,” said Dr. Carlos del Rio, chair of the scientific advisory board of the President’s Emergency Plan for AIDS Relief.

The hype over chloroquine as a potential treatment for the coronavirus has led to hoarding of the drug in some countries like Myanmar, depleting its global stocks.

More than 80 percent of the global supply of antiretroviral drugs comes from just eight Indian companies. The cost of these alone could rise by $225 million per year because of shortfalls in supplies and work force, transport disruptions and currency fluctuations, according to U.N. AIDS.

There is also a real risk that Indian companies will turn to more profitable medicines, or will not be able to meet the global demand because migrant workers have deserted cities as the coronavirus spreads.

The Indian government may even decide not to export TB medicines, saving its supply for its own citizens.

“We’re very dependent on a few key developers or manufacturers for all of the drugs around the world, and that needs to be diversified,” said Dr. Meg Doherty, who directs H.I.V. programs at the W.H.O. “If you had more locally developed drug depots or drug manufacturers, it would be closer to the point of need.”

Aid organizations and governments are trying to mitigate some of the damage by stretching supplies and stockpiling medications. In June, the W.H.O. changed its recommendation for treatment of drug-resistant TB. Instead of 20 months of injections, patients may now take pills for nine to 11 months. The change means patients don’t have to travel to clinics, increasingly closed by lockdowns.

More than half of 144 countries surveyed by the W.H.O. said they have opted to give patients H.I.V. drugs sufficient to last for at least three months — six months, in the case of a few countries like South Sudan — in order to limit their trips to hospitals. But it’s unclear how successful those efforts have been.

In some countries, such as the Philippines, advocacy groups have set up depots for patients to pick up antiretroviral pills or arrange to drop them off at patients’ homes.

In a few nations, like South Africa, most patients already pick up medications from community centers rather than from hospitals, said Dr. Salim S. Abdool Karim, a global health expert in South Africa and the chair of a government advisory committee on Covid-19. “That has been an important advantage in a way.”
‘What are we not doing right?’

The pandemic has exposed deep fissures in the health care systems of many countries.

In Zimbabwe, staffs in public hospitals were working reduced shifts even before the pandemic, because the government could not afford to pay their full salaries. Some hospitals like the Sally Mugabe Central Hospital in Harare — which was operating at half capacity because of water shortages and other problems — have since closed their outpatient departments, where TB and H.I.V. patients received their medications.

“Hospitals are functioning in an emergency mode,” said Dr. Tapiwa Mungofa, a physician at the Sally Mugabe Hospital.

The situation is no better in KwaZulu-Natal, which has the highest prevalence of H.I.V. in South Africa. Dr. Zolelwa Sifumba was a teenager when she saw images of skeletal patients dying of AIDS. Over the past few years in KwaZulu-Natal, she is again seeing patients with full-blown AIDS.

“We’re seeing people come in at the stage where they’re kind of on death’s door,” she said. “What are we not doing right?”

Some remote parts of the world are being decimated by the coronavirus — but their very remoteness makes the pandemic’s impact on these other big infectious killers impossible to measure.

The town of Tabatinga in Amazonas, the biggest state in Brazil, is more than 1,000 miles from the closest city with an I.C.U., Manaus. The government has been using airplanes to transport coronavirus patients to Manaus, but many cases are being missed, said Dr. Marcelo Cordeiro-Santos, a researcher at the Tropical Medicine Foundation in Manaus.

Hospitals are giving chloroquine to people with Covid-19, at the recommendation of the Brazilian ministry of health, even though evidence now suggests it does not help and may even be harmful.

Chloroquine is also a crucial malaria medicine, and its indiscriminate use now may lead to resistance to the drug, Dr. Cordeiro-Santos warned — with possibly dire consequences for those infected in the future. But he also said it’s possible that widespread distribution of chloroquine may help protect residents of Amazonas from malaria.

Other experts said they hope the coronavirus pandemic brings some silver linings.

Aid agencies have long recommended that countries buy drugs in bulk and provide several months’ supply at a time to their citizens. Some governments are considering doing so now for H.I.V., according to Dr. Doherty at the W.H.O.

Health care providers are also embracing video and phone calls to counsel and treat patients, which many people find far easier than traveling to distant clinics.

“Sometimes systems are tough to change,” said Dr. del Rio, “but I think there’s nothing better than a crisis to change the system, right?”

How Governments Try To Control People, with NSA Whistle-blower BILL BINNEY

 

https://www.youtube.com/watch?v=dtAKzd8OuGo&ab_channel=TheJimmyDoreShow