Sep 8, 2022 - Podcasts

Famine is coming to East Africa

More than 7 million people in Somalia are in dire need of food assistance. And the UN has warned that famine there is “at the door." East Africa has had four straight failed rainy seasons, for the first time in more than half a century. That, combined with rising food prices exacerbated by the war in Ukraine, are endangering an estimated 20 million people in the Horn of Africa region.

  • Plus, how a ruling on HIV PrEP meds could affect access to other preventative care.

Guests: Axios' Laurin-Whitney Gottbrath, Emily Peck, and Tina Reed.

Credits: Axios Today is produced by Niala Boodhoo, Sara Kehaulani Goo, Alexandra Botti, Lydia McMullen-Laird, Fonda Mwangi, Robin Linn, Alex Sugiura, and Ben O'Brien. Music is composed by Evan Viola. You can reach us at [email protected]. You can text questions, comments and story ideas to Niala as a text or voice memo to 202-918-4893.

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NIALA: Good morning! Welcome to Axios Today!

It’s Thursday, September 8th.

I’m Niala Boodhoo.

Here’s what you need to know today: how a ruling on HIV PrEP meds could affect access to other preventative care.

But first, today’s One Big Thing: famine is coming to East Africa.

NIALA: More than 7 million people in Somalia, half of its population, are in dire need of food assistance. And the UN has warned that famine there is “at the door.” East Africa has had four straight failed rainy seasons for the first time in more than half a century. That combined with rising food prices exacerbated by the war in Ukraine, are endangering an estimated 20 million people in the Horn of Africa region. Axios deputy world editor, Laurin-Whitney Gottbrath is here with the big picture. Hi Laurin-Whitney.

LAURIN-WHITNEY: Hi. Nice to be here.

NIALA: How much has the war made the food situation worse in Somali and East Africa?

LAURIN-WHITNEY: Yeah, well, a lot of these countries, particularly in the Horn of Africa have heavily relied on, um, wheat, and other food and also fertilizer, etc. from Ukraine and Russia. I think in Somalia, historically about 90% of their wheat has come from, um, one of the two countries. So when the war started, a, prices went up, because obviously, it was harder to get wheat out, but also Russia was blockading a lot of exports of wheat, particularly from, uh, Ukraine. We've seen some progress on getting some of that wheat out um, but it's, it's already had an enormous impact on countries that were relying on it.

NIALA: And what about climate change? How has the drought affected people's ability to grow their own food there?

LAURIN-WHITNEY: For years, climate scientists have said that Somalia and other parts of the horn of Africa would continue to face dry, dry seasons. And we've seen that, four consecutive rainy seasons that have failed. The fifth one is projected to fail. It might continue past that. So this is obviously having like an enormous impact on people who are trying to grow their own food, but also on places where Somalia was getting food from.

NIALA: Laurin-Whitney the last time famine was declared in Somalia was in 2011. Critics warned then though that the official famine designation came too late. Is the same thing happening now?

LAURIN-WHITNEY: Yeah. Aid groups say it is. And they're, they're warning that if international governments and groups continue to wait until formal declaration is put into place, it's gonna have detrimental impact on people in Somalia. And what's particularly heartbreaking about the situation now is UN officials and aid groups have warned that the situation today is exponentially worse than what Somali faced in 2011. And I think that's what's really scary. And also it comes at a time where the attention isn't necessarily on places like Somalia or the Horn of Africa or places that have had sort of protracted humanitarian crises. So it kind of just like floats under the radar. And I think that's what's really scary and sad. And as a reporter, that's what makes me wanna continue to focus on these sort of places that people often forget because it's become, unfortunately, the norm.

NIALA: Famine was avoided in this region in 2016 and 2017. And the UN talked about that this week too. What needs to happen so that we could hopefully be in that situation instead of 2011?

LAURIN-WHITNEY: Yeah, I mean, I think first and foremost, the UN says that they need more resources and they need more funding. There's been a lot of funding shortfalls, not just in Somalia or East Africa, but sort of across the world due to the war in Ukraine. Obviously, um, it was great that governments have poured money into helping Ukrainian refugees or those displaced inside Ukraine. But that means there's a lot of money that isn't going to sort of these protracted conflicts or humanitarian crises. And that's really, really hard on humanitarian groups, and the UN who are sort of at the forefront of trying to stop things like famine from happening. So I think that's probably what the UN would say is most needed in the situation right now.

NIALA: Axios deputy world editor Laurin-Whitney Gottbrath. Thanks Laurin-Whitney.


NIALA: So a follow-up and clarification for you on a story from yesterday. It was about Bank of America’s pilot program to offer ‘zero down’ mortgages for first-time home buyers in predominantly Black and Brown neighborhoods in Charlotte, Dallas, Detroit, Miami and LA. The announcement gained a lot of attention, but the loans are a little different than they may sound. Axios Markets Correspondent Emily Peck took a closer look at the fine print.

EMILY PECK: There's something that everyone is missing here. These mortgages actually do require a down payment. The cool thing is the bank grants people that money. So this isn't a program where folks borrow a hundred percent of the cost of a new home. That's a dodgy practice that can leave home buyers on very shaky financial footing, like what we saw happen during the run up to the great recession. This program now is a different kind of thing and the experts I'm talking to have high hopes that if this kind of things catch on more widely, that it's a way to make a dent in the home ownership gap between Black and white americans. I'm watching this very closely to see if they catch on. Stay tuned.

NIALA: That’s Axios’ Emily Peck.

In a moment: a new ruling around religious freedom could change access to some kinds of preventative healthcare.

Plus, how a ruling on HIV PrEP meds could affect access to other preventative care

NIALA: Welcome back to Axios Today. I'm Niala Boodhoo. A federal judge in Texas yesterday ruled the government can't require companies to cover preventative medication for HIV. Two Christian businesses, and six other plaintiffs argued the affordable care act mandate to cover HIV prep violated their religious rights. And the judge agreed. Axios’ Tina Reid says this could have far reaching consequences for preventative care. Hi Tina.


NIALA: Tina. How effective is prep and who was it meant for?

TINA: PREP is more than 90% effective in preventing the transmission of HIV, and it's recommended for adults who are at high risk of getting HIV, which includes men who have sex with other men.

NIALA: So what exactly does the ACA say about preventative care? How did this come under the mandate?

TINA: So under the Affordable Care Act, most insurance plans must cover certain recommended preventative services. That includes HIV testing for people ages 15 to 65 and HIV prep for adults who are at high risk of getting HIV.

NIALA: And so what did the judge say about why he ruled this way?

TINA: The judge in this case said that the Department of Health and Human services did not provide any compelling evidence to argue that private religious corporations should be required to cover HIV, preexposure prophylaxis or PREP. And that it actually violated something known as the Religious Freedom Restoration Act, which is a law that ensures that interests in religious freedom are protected

NIALA: And so how could this have far reaching consequences? What other preventative care services or populations could be affected by this decision?

TINA: So there are a number of different preventative services that are covered under this piece of the ACA. And so it'll be hard to find people that won't be impacted. It covers everything from breast cancer screenings, lung cancer screenings, cervical cancer screenings, to tobacco cessation services, certain prenatal care services, fall prevention for older adults, depression screening. So it covers a really wide range of different preventative services.

NIALA: So then if all of these other preventative screenings could be affected, does that mean people would lose access to this in the short term?

TINA: So to be clear, the judge struck down an ACA requirement that insurers provide these services recommended by the US Preventive Services Task Force without cost sharing. What this could mean is that insurers may not be required to provide every single one of those services without cost sharing while most likely they would offer some of them. So actually, while this case was about religious freedom, it has much more far reaching implications. Whether insurers will have to cover a wide range of these no-cost preventive health services in the future. And that's what advocates are worried about.

NIALA: Axios’ Tina Reed. Thank you.

TINA: Thank you Niala.

NIALA: That’s it for us today! You can reach our team at podcasts at or reach out to me on twitter. Or you can text me at (202) 918-4893.

I’m Niala Boodhoo - thanks for listening - stay safe and we’ll see you back here tomorrow morning.

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