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The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

Meta announced Wednesday it has removed over 600 Facebook and Instagram accounts linked to a Chinese influence operation that claimed the U.S. was pressuring the World Health Organization (WHO) to blame COVID on China.

Why it matters: Though Meta said the network was unsuccessful, it marks yet another COVID disinformation campaign instigated by China in an effort to discredit the U.S.

Details: A fake persona claiming to be a Swiss biologist created an account in July, two days after it was reported that the Chinese government had rejected a WHO plan for the second phase of a study into COVID origins, and posted a message alleging that "WHO sources and a number of fellow researchers" had complained of "enormous pressure and even intimidation" from the U.S. 

Within two days, the post had circulated among hundreds of accounts and some Chinese state media, according to Meta.

A number of these accounts had ties to individuals at the firm Sichuan Silence Information Technology and some Chinese state infrastructure companies, though Meta said it had not identified a connection between Sichuan Silence Information Technology and the Chinese government.

The campaign targeted English-speaking audiences in the U.S. and the U.K., as well as Chinese-speaking audiences in Taiwan, Hong Kong and Tibet. 

After reviewing reports about the original fake account, Meta removed 524 Facebook accounts, 20 pages, four groups and 86 accounts on Instagram. 

What they're saying: "In essence, this campaign was a hall of mirrors, endlessly reflecting a single fake persona," Meta said in its Adversarial Threat Report. "This is the first time we have observed an operation that included a coordinated cluster of state employees to amplify itself in this way."

"As we continue building our understanding of these emerging threats, we will keep sharing our findings with industry peers, independent researchers, law enforcement and policymakers–including on these new disruptions–so we can collectively improve our defenses."

Worth noting: A nine-month investigation by AP and the Atlantic Council’s DFRLab previously found that China "took the lead in spreading foreign disinformation about COVID-19’s origins, as it came under attack for its early handling of the outbreak." 

Meta removes accounts linked to COVID disinformation effort by China

"This is the first time we have observed an operation that included a coordinated cluster of state employees," Meta said in its report.

Photo of a sign showing the Facebook thumbs up emoji as a person walks by

Facebook's corporate headquarters campus in Menlo Park, California. Photo: Josh Edelson/AFP via Getty Images

China

Misinformation

Big Tech

Coronavirus

From the Valley to D.C., Big Tech players like Facebook, Google and Amazon are under more scrutiny than ever as new technology develops and privacy and antitrust concerns grow in lockstep with companies’ ambitions.

Technology

China is becoming the most formidable rival America has faced, and the risk of confrontation with Russia, North Korea or Iran still looms. Authoritarians are rising, the chaotic Afghanistan exit revealed the limits of U.S. power, and the pandemic, climate change and other critical challenges continue to pose grave threats.

World

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

The first known U.S. case of the Omicron variant was detected in California, the Centers for Disease Control and Prevention confirmed Wednesday. 

Driving the news: The confirmed case was detected in a traveler returning from South Africa who was fully vaccinated and has mild symptoms, according to the CDC.

The person, who California Gov. Gavin Newsom (D) said is a resident of San Francisco and tested positive on Nov. 28, is self-quarantining. All close contacts have been notified and tested negative, according to the CDC.  

The individual had not yet received a booster shot, NIAID director Anthony Fauci also noted in a White House press briefing. 

What they're saying: "The recent emergence of the Omicron variant ... further emphasizes the importance of vaccination, boosters and general prevention  strategies," the CDC said in a statement.

"We know what we need to do to protect people," Fauci said at the White House briefing following the CDC announcement. "Get vaccinated if you're not already vaccinated," he added. "If you’re eligible for boosting, get boosted right now.” 

White House COVID-19 response coordinator Jeff Zients said in a statement later Wednesday: "The President’s medical team continues to believe that existing vaccines will provide some level of protection against severe illness from Omicron, and individuals who have gotten boosters have even stronger protection."

Newsom echoed the administration officials in a tweet, saying there’s "no reason to panic--but we should remain vigilant. That means get vaccinated. Get boosted. Wear a mask indoors."

The big picture: Since the variant was first identified by scientists in South Africa earlier last month, Omicron cases have been confirmed across Europe, Canada, Israel, Hong Kong and Australia, among other countries. 

The U.S. was one of several countries to impose travel restrictions on southern African nations in response.

Dutch scientists confirmed Tuesday the variant had been circulating in the Netherlands before it was discovered in South Africa. 

What to watch: President Biden is expected to discuss the administration's plan for fighting the virus through the winter on Thursday. 

"We're going to fight COVID this winter. Not with shutdowns or lockdowns, but with more widespread vaccinations, boosters, testing and more," Biden said earlier this week. 

Editor's note: This story has been updated with additional details throughout.

First known U.S. case of Omicron variant identified in California

"This new variant is cause for continued vigilance, not panic," Biden administration officials said.

Dr. Anthony Fauci speaks during the daily briefing at the White House on Dec. 1. Photo: Mandel Ngan/AFP via Getty Images

Omicron variant COVID

Moderna loses patent battles tied to COVID vaccine

Moderna now could face patent infringement lawsuits from Arbutus.

A hand holds a box of Moderna's COVID-19 vaccine, with other boxes in the background.

Moderna could be forced to share profits of its COVID vaccine with Arbutus. Photo: Wolfgang Kumm/picture alliance via Getty Images

Moderna

After a record economic expansion, the coronavirus pandemic sent the U.S. economy into a recession as unemployment soared to staggering heights. The country now faces urgent questions about how much stimulus is needed for reeling consumers and businesses, and what a recovery might look like.

Economy & Business

The Supreme Court on Wednesday seemed likely to weaken abortion rights and perhaps to let states ban the procedure altogether.

The intrigue: The court seemed likely to throw out the framework established in Roe v. Wade, but it wasn't clear whether a majority of the justices were inclined to overturn the court's precedents entirely.

The big picture: The court heard oral arguments this morning in Dobbs v. Jackson Women's Health Organization, a case challenging a Mississippi law that bans abortions after 15 weeks. Mississippi seemed likely to win, one way or another.

The court's main abortion precedents, Roe v. Wade and Planned Parenthood v. Casey, say that women have a right to an abortion until about the 24th week of pregnancy, when a fetus is considered viable.

Chief Justice John Roberts and his conservative colleagues all questioned whether the "viability line" makes sense, indicating that they're inclined to do away with that standard.

Overruling the "viability line" standard "is the same as overruling Roe and Casey," said Julia Rikelman, an attorney representing Jackson Women's Health Organization, during a press call on Wednesday.

"If there's no clear line for courts to enforce, many states will try to ban abortion earlier and earlier," she added. 

Some justices seemed interested in going further. Justice Samuel Alito at one point during questioning said that "the fetus has an interest in having a life and that doesn't change from the point before viability to the point after viability."

Justice Neil Gorsuch also criticized the court's "undue burden" standard, which prohibits abortion regulations that impose a "substantial obstacle" on access. Gorsuch said the standard is "unworkable" and difficult for courts to administer.

Justice Brett Kavanaugh several times asked questions about whether the Supreme Court should remain neutral when it comes to abortion, suggesting that the issue should fall entirely to the elected branches.

Arguing on behalf of Mississippi, the state's solicitor general, Scott Stewart, argued that safe haven laws — which allow for a parent to forfeit responsibility for their child, giving way to adoption — along with access to birth control measures were valid alternatives for abortions.

Justice Amy Coney Barrett seemed to agree with the adoption argument, asking how the growing availability of adoption changes the reliance interest in abortions. 

Solicitor general Elizabeth Prelogar, representing the U.S. government, said there is "nothing new" in terms of access to adoption as it has existed even before Roe and Casey.

When referring to birth control measures, Prelogar added that since contraceptives are not completely effective, they cannot qualify as an alternative to abortion. 

Stewart argued that, overall, the right to an abortion is not written explicitly in the Constitution and should therefore not be considered a constitutional right.

Justice Sonia Sotomayor shot back at Mississippi's interest in having the court overturn Roe, asking Stewart, "How is your interest anything but a religious view?"

"The issue of when life begins has been hotly debated by philosophers since the beginning of time. It’s still debated in religions. So when you say this is the only right that takes away from the state the ability to protect a life, that’s a religious view, isn’t it?" she added.

Alito interrupted Sotomayor's questions, saying that secular bioethicists also question when life begins.

What's next: A decision from the court is expected to come in June.

Supreme Court appears likely to roll back abortion rights

It remains unclear whether the justices would ultimately overrule Roe and Casey.

Picture of the Supreme Court building with people holding signs in front of it in support and against abortion.

Abortion rights advocates and anti-abortion protesters demonstrate in front of the Supreme Court in Washington, D.C., on Dec. 1. Photo: Olivier Douliery/AFP via Getty Images

Abortion

Nigeria, Saudi Arabia and South Korea on Wednesday became the latest countries to report cases of the Omicron variant of COVID-19. They followed similar announcements made in Brazil and Japan on Tuesday. 

Why it matters: The arrival of the "variant of concern" in more countries underscores the difficulties governments are facing as they seek to reopen economies stalled by nearly two years of pandemic restrictions in the era of global air travel.

The big picture: Since the variant was identified by scientists in South Africa last month, Omicron cases have been confirmed across Europe, Canada, Israel, Hong Kong and Australia. The U.S. was among several countries to impose travel restrictions on southern African nations in response. 

Dutch scientists confirmed Tuesday the variant had been circulating in the  Netherlands before it was discovered in South Africa.

What's happening: Saudi Arabia's Health Ministry on Wednesday reported its first Omicron case, according to the kingdom's state-run Saudi Press Agency. The case involved a "citizen arriving back from a North African country," SPA reported.  

South Korean officials reported the country's first five known cases of the Omicron variant, per Reuters.

Health officials in Brazil on Tuesday reported two positive test results for Omicron, confirming the first cases of the variant in Latin America, per Reuters.

Japanese officials reported the country's first Omicron case earlier Tuesday, the Japan Times reported. It reported a second case on Wednesday, per AP.

Nigeria's health institute said on Wednesday it has identified the country's first three Omicron cases. Those cases involved individuals who arrived in Nigeria from South Africa in the past week, according to the Nigeria Centre for Disease Control (NCDC). 

Earlier Wednesday, the NCDC reported that it also detected the Omicron variant in a sample collected in October, but it later retracted that statement, per the New York Times. An NCDC spokesperson told the Times that the October sample was the Delta variant. 

The NCDC did not immediately respond to Axios' request for comment.

Editor's note: This story has been updated with additional details throughout. 

Omicron variant detected in more countries

The announcements underscore the difficulties governments are facing as they seek to reopen economies.

People walk at the boarding area at the Galeao International airport in Rio de Janeiro, Brazil on April 13

The Galeao International airport in Rio de Janeiro, Brazi. Photo: Mauro Pimentel/AFP via Getty Images

Latin America and Latinos

The Centers for Disease Control and Prevention said Tuesday night that it is working to impose stricter testing requirements for international travelers due to the spread of the new Omicron variant.

The big picture: The new rules would require all international travelers, regardless of vaccination status, to show a negative test taken a day before their flight to the U.S. Currently, the CDC says fully vaccinated travelers are allowed to show a test taken no more than three days before their departure.

Unvaccinated individuals are required to show a test conducted no more than one day before their flight.

Catch up quick: CDC director Rochelle Walensky had said Tuesday during the White House COVID-19 press briefing that the agency was "evaluating how to make international travel as safe as possible, including pre-departure tests closer to time of flight."

What they're saying: "CDC is working to modify the current Global Testing Order for travel as we learn more about the Omicron variant; a revised order would shorten the timeline for required testing for all international air travelers to one day before departure to the United States," the CDC said in an emailed statement.

"This strengthens already robust protocols in place for international travel, including requirements for foreign travelers to be fully vaccinated."

What to watch: The CDC has not provided a timeline for when new testing rules will be implemented, but President Biden is set to provide more details on Thursday on how the administration will be fighting the coronavirus this winter.

CDC prepares tougher testing rules for international travelers

All international travelers could be required to show a negative test taken a day before their flight to the U.S.

Picture of a yellow sign that says testing is available in this airport

Travelers with their luggage arrive at a COVID-19 testing location at the airport in Los Angeles, Calif., on Nov. 23, 2021. Photo: Frederic J. Brown/AFP via Getty Images

Centers for Disease Control and Prevention (CDC)

Axios Vitals

Laboratories across the U.S. are on the lookout for the new COVID-19 variant Omicron, which officials have said will almost inevitably be detected here.

Why it matters: The world is on high alert as scientists race to understand if the variant could be a game-changer in the pandemic. Early detection, in theory, gives officials more time to understand its characteristics and respond.

The big picture: CDC director Rochelle Walensky told reporters during a briefing on Tuesday the U.S. has a "robust" surveillance system. 

She pointed to U.S. international travel policies that require pre-departure testing both for the unvaccinated and vaccinated. "We do have the mechanisms in place we need to find it should and when it occurs," she said. 

The CDC also announced it planned to expand surveillance at four U.S. airports, CNN reported.

Yes, but: Some public health experts have raised the question about whether the new variant omicron may have already arrived and gone undetected, surfacing questions about America's COVID surveillance capabilities. 

 "We're not doing nearly enough genomic sequencing in this country still," Céline Gounder, an infectious disease specialist and epidemiologist at New York University and Bellevue Hospital, told the Guardian. 

"I'm sure we have Omicron here in the U.S.; we just haven’t detected it yet," she said.

Driving the news: Despite a slow start, the U.S. is catching up when it comes to participating in global surveillance, officials at the Association of Public Health Laboratories told reporters Tuesday.

The U.S. is now able to sequence about 5% to 10% of tests, up from 1% about a year ago. It is able to sequence 40,000 to 80,000 tests weekly between about 70 state and local health labs, as well as CDC labs, the Associated Press reported.

"We're in a much, much better place than a year ago or even six or nine months ago," said Kenny Beckman of the University of Minnesota, per the AP.

The U.S. laboratory system can detect variants "down to 0.01% of circulating viruses so are confident it can be found," Association of Public Health Laboratories CEO Scott Becker tweeted.

But, but, but: There are concerns that the U.S. sequencing continues to be uneven by region. And about two dozen countries are still sequencing a larger proportion of positive samples than the U.S., William Moss of the Johns Hopkins Bloomberg School of Public Health told the AP. 

"I think we still have a long way to go," Moss said.

The bottom line: Surveillance can only do so much, Peter Hotez, a vaccine researcher at the Baylor College of Medicine, told comedian Trevor Noah.

"By the time we identify a new variant, it's already gone global," Hotez said.

U.S. on the lookout for Omicron cases

Laboratories across the U.S. are on the lookout for the new COVID-19 variant Omicron which officials have said will almost inevitably be detected here.

Illustration of a surveillance camera with a covid cell in the middle

Data: Myers Abortion Facility Database on OSF; Map: Thomas Oide and Sara Wise/Axios

If the Supreme Court overturns Roe v. Wade, the average American could have to travel around 125 miles to reach the nearest abortion provider, compared to the current average of 25 miles, according to the Myers Abortion Facility Database. 

State of play: 12 states will immediately restrict abortion if Roe disappears, and others would be likely to impose significant new restrictions.

Driving the news: The Supreme Court is scheduled to hear a challenge today to a Mississippi law that bans nearly all abortions after the 15th week of pregnancy. The case is a direct challenge to Roe.

By the numbers: The percentage of people living over 200 miles away from a provider would increase from 1% to 29%, according to the database. 

Myers' data complements a report from the Guttmacher Institute, an organization that researches reproductive rights, which found that people seeking abortions in southern and Midwest states would have to travel hundreds of miles to access the procedure.

In Florida, for example, the average one-way driving distance under a total abortion ban would be 575 miles — a 6,803% increase. Currently, people travel around 8 miles one-way to reach the closest provider. 

Louisiana residents seeking abortion care would have to travel the longest distances, 666 miles one-way. Currently, they travel approximately 37 miles one-way.

What it's like now: "Large areas of the U.S. — particularly in the central region of the country — already have no options within a 250-mile drive, and some counties are at least 350 miles from the nearest abortion provider," Axios' Tina Reed reported.

West Texas, Oklahoma, Kansas, Nebraska, North Dakota and South Dakota all have areas that are at least a four-hour drive from a provider.

Between the lines: The Supreme Court is currently considering two cases challenging Texas' near-total abortion ban.

As soon as the law was enacted, clinics in other states — such as Colorado, Oklahoma, Kansas and New Mexico — started receiving calls from Texans looking to end their pregnancies, even as some struggled to support patients from their own states, per The 19th.

Women have been driving for hours to access reproductive health care. Some traveled for four hours, about 70 miles one-way, to reach an abortion clinic in Louisiana, AP reported.

Go deeper: What abortion access would look like if Roe v. Wade is overturned

Methodology: To choose which states are "highly likely" to ban abortion, the Myers Abortion Facility used a report from the Center for Reproductive Rights. However, after reviewing legal predictions, Myers did not include Wisconsin or Pennsylvania. 

Abortions could require 200-mile trips if Roe is overturned

The Supreme Court is scheduled to hear a challenge to a Mississippi law that could overturn Roe v. Wade.

Axios Explains: Abortion

The U.S. Supreme Court heard oral arguments Tuesday about whether the federal government had the authority to cut hospitals' payments for outpatient drugs.

Why it matters: The controversial case involves billions of dollars for hospitals, pits not-for-profit hospitals against rural and for-profit facilities, and tests the broader legal theory of whether federal agencies can take matters into their own hands when laws are vague.

Details: Justices questioned Donald Verrilli, the former U.S. Solicitor General representing the American Hospital Association and other hospitals, and Christopher Michel of the Department of Justice.

Hospitals pocket large savings when acquiring certain drugs through a federal program called 340B. 

Medicare, under the Trump administration, instituted a 28.5% cut to those drug payments starting in 2018. Research indicated some hospitals were profiting excessively from the program.

Justices peppered both sides about whether Medicare's rate adjustment abided with the law.

Zoom in: The crux of the case falls on the so-called Chevron doctrine, which says federal agencies like Medicare have some leeway to interpret ambiguous laws, and courts should defer to them.

However, after decades of using this legal doctrine, "How much ambiguity is enough?" Justice Neil Gorsuch asked.

"I'm not sure anybody's answered that question," Michel said. And in this case, "I don't think there's much ambiguity at all," he said.

The bottom line: A ruling against hospitals would redistribute large sums of money from a drug discount program that many experts believe the hospital industry has abused, and it would solidify Medicare's ability to make these types of adjustments based on current law.

Go deeper: Overviews from legal experts Nicholas Bagley and Allison Hoffman.

Supreme Court weighs whether hospital drug cuts are valid

SCOTUS dug into the depths of 340B and Chevron.

A doctor in blue protective gear stands in a hospital COVID-19 unit with medical equipment outside of rooms.

Photo: Megan Jelinger/AFP via Getty Images

Hospitals

Health care costs

A new United Nations report warns that global tourism will see only modest revenue gains in 2021 after last year's historic losses amid the COVID-19 pandemic.

Why it matters: Tourism revenues in 2020 fell by more than half from the previous year — a significant blow to the global economy, according to an analysis by the UN World Tourism Organization (UNWTO).

Tourism was the sector most affected by the pandemic, per the report, which was published Monday.

By the numbers: The UNWTO estimates 2021 global tourism revenue will amount to $1.9 trillion — a modest bump from 2020's low of $1.6 trillion.

Before the pandemic, 2019's global tourism revenue clocked in at $3.5 trillion, or 4% of world GDP.

The UN finds the drop in tourism is responsible for 70% of the total drop in world GDp last year.

In all, the pandemic will likely cost the global tourism sector $2 trillion in lost revenue in 2021, according to the UNWTO.

What they're saying: UNWTO Secretary-General Zurab Pololikashvili said in a statement Monday that data for the third quarter of 2021 was "encouraging."

But Pololikashvili noted that arrivals were still 76% below pre-pandemic levels "and results across the different global regions remain uneven."

What to watch: Governments are increasingly concerned about the spread of the Omicron variant of COVID-19, as they seek to reopen economies stalled by nearly two years of pandemic restrictions.

Pololikashvili noted that with cases rising and the emergence of new variants, there needed to be continued "efforts to ensure equal access to vaccinations, coordinate travel procedures, make use of digital vaccination certificates to facilitate mobility, and continue to support the sector."

UN report: Pandemic set to cost global tourism $2 trillion in 2021

The UN projects 2021 global tourism will generate $1.9 trillion in revenue, only a slight increase from 2020's low.

Woman with suitcase takes selfie in front of Eiffel tower.

A tourist in front  of the Eiffel Tower in Paris on Nov. 25.  Photo:Chesnot/Getty Images

Travel

The Biden administration was temporarily blocked from enforcing COVID-19 vaccine mandates for millions of workers by federal judges in two states on Tuesday.

The big picture: The orders, by federal judges in Kentucky and Louisiana, come one day after a federal judge in Missouri halted the mandate, which has a Jan. 4 deadline, in 10 states.

The preliminary injunction of U.S. District Judge Terry Doughty in Monroe, Louisiana, temporarily prevents the Centers for Medicare & Medicaid Services from enforcing its vaccine mandate for health care workers until legal challenges have concluded.

The ruling in the case brought by Louisiana Attorney General Jeff Landry (R) and joined by attorneys general in 13 other states, applies in all states except for the 10 already affected by the Missouri order.

Meanwhile, U.S. District Judge Gregory Van Tatenhove issued a similar ruling in Frankfort, Kentucky, which temporarily prevents the enforcement of a vaccine mandate clause in new government contracts, per Reuters.

This ruling affects the states of Kentucky, Ohio and Tennessee, which challenged the requirement in a lawsuit.

What they're saying: Doughty wrote in Tuesday's opinion that the Biden administration does not have the authority to bypass Congress in this case.

"If the executive branch is allowed to usurp the power of the legislative branch to make laws, two of the three powers conferred by our Constitution would be in the same hands," he wrote. 

"If human nature and history teach anything, it is that civil liberties face grave risks when governments proclaim indefinite states of emergency."

"During a pandemic such as this one, it is even more important to safeguard the separation of powers set forth in our Constitution to avoid erosion of our liberties," he added.

What to watch: An appeal of Doughty's ruling would head to the 5th U.S. Circuit Court of Appeals in New Orleans, which affirmed a lower court decision to block President Biden's vaccine mandate for businesses with more than 100 workers.

The Justice Department declined to comment.

 Editor's note: This article has been updated to include details of the Kentucky ruling.

2 federal judges temporarily block Biden vaccine mandates

The administration doesn't have the authority to bypass Congress in requiring health workers to get vaccinated, said one judge.

Photo of Joe Biden speaking from a podium

President Biden delivers remarks on the Omicron COVID-19 variant at the White House on Nov. 29. Photo: Anna Moneymaker via Getty Images

Coronavirus vaccines

President Joe Biden walks on the South Lawn of the White House after arriving on Marine One in Washington, D.C., U.S., on Tuesday, Nov. 30.

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