National

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

Britain's polio-free status may be in jeopardy for the first time in nearly 20 years as several samples of the polio virus were found during recent London sewage testing, the U.K. Health Security Agency said Wednesday.

Why it matters: The discovery means it's likely there has been some spread of a "vaccine-derived" polio virus between close contacts in London, the agency said. The last case of wild polio in the U.K. was confirmed in 1984 and the country has remained polio-free since 2003.

The United States has been polio-free since 1979, per the Centers for Disease Control and Prevention.

Driving the news: The health agency said it has found several "closely related viruses" to polio virus in sewage samples taken between February and May.

The recently discovered virus, which has continued to evolve, has been classified as a “vaccine-derived” poliovirus type 2, it said. 

It's unclear if community spread is happening as no cases have been reported.

Zoom out: In rare cases, the live polio virus in an oral vaccine can mutate and lead to a new outbreak, AP reports.

Polio virus samples will pop up after someone vaccinated with the oral polio vaccine shed traces of the "vaccine-like" polio virus in their excrement, the agency said. 

It's common to find one to three "vaccine-like" polio viruses in U.K. sewage samples every year, per the health agency, but those are often one-off findings that aren't detected again.

The concern: A "vaccine-derived" polio virus can cause serious illness, such as paralysis, in those who have not been fully vaccinated, the U.K. agency said.

Yes, but: Paralysis in about 1 out of 200 people infected with polio, the CDC says.

Most people with polio virus do not have any visible symptoms, per the CDC.

What they're saying: "Vaccine-derived polio virus is rare and the risk to the public overall is extremely low," Vanessa Saliba, consultant epidemiologist at the health agency, said in a statement.

"Most of the U.K. population will be protected from vaccination in childhood, but in some communities with low vaccine coverage, individuals may remain at risk," she added.

What's next: U.K. health officials encouraged the public to make sure their polio vaccinations are up to date.

Polio virus found in London sewage samples

The last case of wild polio was contracted in 1984 and the UK has remained polio-free since 2003.

 community health worker shows a vial of an oral polio vaccine.

 A community health worker shows a vial of an oral polio vaccine. Photo: Ezra Acayan/Getty Images

Polio

Top Trump administration officials ignored warnings and embraced a "herd immunity via mass infection" approach to containing COVID-19 to justify not taking meaningful action to curb the virus in the fall and winter of 2020-2021, a House oversight panel report concluded Tuesday.

Why it matters: The U.S. missed the boat on the kind of swift, early response that would have been most effective, according to many health experts, leading more Americans to die from November 2020 through February 2021 than during any other corresponding period throughout the pandemic.

Driving the news: The staff report from the Select Subcommittee on the Coronavirus Crisis focused on Scott Atlas, a senior fellow at the conservative Hoover Institution, who was among the most vocal opponents of public health measures to slow the spread of the virus and who quickly gained influence within the White House.

Atlas pressed the administration to weaken CDC's testing guidance without any countervailing measures, and discouraged the widespread use of masks, the report stated.

Atlas also recruited herd immunity proponents to meet with senior officials, including then-President Trump, Vice President Mike Pence and HHS Secretary Alex Azar. 

The report also detailed how White House senior adviser Jared Kushner convened "China Virus Huddles" three times a week with top officials to hone the Trump White House's messaging on the pandemic.

The background: The meetings were separate from those of the White House Coronavirus Task Force and were attended by White House coronavirus response coordinator Deborah Birx, senior counselor Kellyanne Conway, assistant to the president Hope Hicks and HHS deputy chief of staff for policy Paul Mango.

Birx told the select subcommittee that more than 130,000 American lives could have been saved after the first wave of the pandemic if Trump and his administration had implemented "optimal mitigation across this country."

House report critiques Trump administration's COVID response

The U.S. missed the boat on the kind of swift, early response that would have been most effective, according to health experts.

Former White House coronavirus adviser Scott Atlas speaks at a press conference in September 2020 as former President Trump looks on.

Former White House coronavirus adviser Scott Atlas speaks at a Sept. 2020 press conference as former President Trump looks on. Photo: Mandel Ngan/AFP via Getty Images

Health care

Axios Vitals

Share of U.S. adults who said they had trouble falling asleep most or all of the past 30 days

Data: Adjaye-Gbewonyo, et al., 2022, "Sleep Difficulties in Adults: United States, 2020"; Chart: Axios Visuals

Nearly 15% of Americans are struggling to get a good night's rest, according to new data from the CDC.

Driving the news: The researchers looked at the share of U.S. adults who had difficulty getting to sleep or staying asleep in the past 30 days.

Women were more likely to struggle with sleep compared to men. Whites,  Hispanics and Blacks were also more likely to struggle compared to Asian individuals.

Health officials recommend adults get seven hours or more of sleep a night.

America has a sleep problem

Women were more likely to struggle with sleep compared to men.

Sleep

Where to get COVID vaccine appointments for children under 5

Parents can now schedule appointments for COVID vaccines for children under 5.

Young Americans are eligible to get vaccinated against COVID-19. Photo: Joseph Prezioso/AFP via Getty Images

COVID-19

Coronavirus

The Biden administration wants to make the tobacco industry cut back the amount of nicotine in cigarettes sold in the U.S. to non-addictive levels.

Why it matters: The bid to essentially take the buzz out of smoking cigarettes would be unprecedented in the long-running public health fight to curb tobacco use, which the FDA says leads to more than 480,000 deaths a year.

But it's sure to face vigorous opposition from tobacco interests, as well as libertarian-leaning consumer freedom groups.

Driving the news: The FDA can't actually just ban cigarettes, but can create "product standards" that make them less attractive, experts say. So on Tuesday, the agency proposed a rule to establish a maximum nicotine level in cigarettes and other certain finished tobacco products. It is unclear if they would do it at once or gradually.

"Because tobacco-related harms primarily result from addiction to products that repeatedly expose users to toxins, FDA would take this action to reduce addictiveness to certain tobacco products, thus giving addicted users a greater ability to quit," regulators said. 

The cap on nicotine would also discourage young people from getting a cigarette addiction to begin with, they said.

What they're saying: "This would be really historic," Dorothy Hatsukami, a professor at the University of Minnesota who researches tobacco policy, told the Wall Street Journal. She's among a number of researchers who study tobacco regulatory science — much of it funded by the FDA— and examined the positive impact of low-nicotine cigarettes on consumer behavior and health, per WSJ.

One such study led by Rachel Cassidy, an associate professor in the Center for Alcohol and Addiction Studies at Brown University, looked at the impact of gradual or immediate switches to low-nicotine cigarettes. 

Smokers who switched immediately to the lowest content of nicotine smoked fewer cigarettes per day and had lower nicotine intake. Younger smokers, in particular, indicated they did not like the cigarettes, she said. 

"We don't want to create a prohibition on nicotine. What we want is for people to shift from combustible cigarettes, which are incredibly harmful — they kill half the people who use them past the age of 40 — to other forms of nicotine which are far less harmful," Cassidy said.

The other side: Critics say the policy move would make little sense.

"The most harmful parts of smoking will remain legal," Guy Bentley,  the director of consumer freedom at the libertarian think tank Reason Foundation, told Axios. The non-profit, which is supported in part by private contributions, does get some funds from tobacco manufacturers which it says accounts for less than 2% of its annual budget.

He also called a nicotine limit a practical "ban" of cigarettes in the U.S. which would almost certainly fuel a black market of illegal cigarettes that would ultimately fail. 

He questioned the value of findings showing the benefits that low-nicotine cigarettes would have in the real world, saying smokers often find their full-strength cigarettes in the midst of those studies. Directly promoting products that reduce harm would be far more effective, he argued.

Between the lines: One thing backers and critics agree on is the reduction in nicotine could cause confusion among smokers who think cigarettes will become safer.

"We're very concerned about that. In some of my own research, we've seen teens might think they're safer, which they are not. They're less addictive but they’re not safer," Cassidy said. "That can be hard for people to grasp."

The big picture: The FDA first weighed setting a maximum nicotine level in cigarettes in 2018, elevating tobacco regulation to a level not seen since the George H.W. Bush and Clinton administrations.

The agency got the authority to regulate nicotine levels through the 2009 Tobacco Control Act.

The new plan comes just two months after the FDA proposed rules that would ban menthol cigarettes and flavored cigars saying the flavors "makes it more difficult for people to quit smoking."

Supporters told the Washington Post this fits well with the goals of the cancer moonshot he launched earlier this year, which calls to reduce the age-adjusted death rate from cancer by 50% over 25 years.

Biden administration wants to take the buzz out of cigarettes

The Biden administration wants to make the tobacco industry cut back the amount of addictive nicotine allowed in cigarettes sold in the U.S.

Illustration of a pack of cigarettes as a downward trending bar chart.

E-cigarette

Public health

Axios Finish Line

When we wrote on the virtues of coffee, we heard from dozens of tea-drinking readers who wondered if their beverage of choice came with health perks too.

Why it matters: It turns out tea — all types of it — is great for you, with benefits that touch everything from your brain to your gut to your immune system.

Your brain: L-theanine, which is found in green tea and oolong tea, has been linked to lower a risk of developing cognitive diseases such as Alzheimer's and Parkinson's. Chamomile tea is an effective natural enemy of anxiety.

Your muscles: Chamomile tea also relaxes sore muscles and helps you sleep.

Your immune system: White tea is chock-full of antioxidants that have been linked to lower cancer risk. Black tea has all-around immune benefits too.

Your teeth: White tea also has fluoride for your dental health — but black tea can stain your teeth.

Your gut: Hibiscus tea can curb cravings. Peppermint tea fights irritable bowel syndrome and constipation. And rooibos tea can boost your good cholesterol and lower your bad cholesterol, the University of Pennsylvania's medical school notes.

And the perks don't come from drinking alone. You can press steamed and cooled black tea on your cuts and bruises to reduce swelling and relieve pain, per UPenn.

But, but, but: Just like with coffee, watch how you drink tea. Adding cream and sugar and syrups to make tea lattes can wipe away the natural benefits — and add tons of calories.

And don't fall for the slew of "detox" or "weight loss" teas that are peddled on Instagram and Facebook.

The bottom line: Whether you start your day with coffee or tea, drink up and reap the benefits.

The power of tea

The benefits touch everything from your brain to your gut to your immune system.

Illustration of a tea cup with bubbles and a lemon slice creating a smiley face

Immune system

Louisiana Gov. John Bel Edwards (D) on Tuesday signed into law a bill that will prohibit pregnant people from getting abortion pills via mail.

Driving the news: The bill makes "delivering, dispensing, distributing, or providing" an "abortion-inducing drug" to a pregnant person a crime, and requires patients to take the medication in person, despite federal guidance that says that it is safe to access the pills via telemedicine. 

Details: Besides making the mail of abortion pills illegal, the bill says that if a person who is not a licensed provider "knowingly performs" a medication abortion, they can be subject to a fine of up to $50,000 and a maximum five-year imprisonment. 

If a medication abortion results in "the death or serious bodily injury" of the pregnant person, whoever mailed the pills can face up to 10 years in prison and a fine of up to $75,000. If that pregnant person is a minor, the penalty increases to up to 50 years in prison and a fine of up to $100,000.

Any person who mails an abortion pill shall face a fine of up to $1,000 and imprisonment of up to six months.

The bill explicitly says that it will not outlaw the use of contraceptive methods, Plan B and other types of emergency contraception.

The pregnant person cannot be punished under this bill.

Context: In Louisiana, pregnant people were already required to take abortion pills in a doctor's office or a clinic, but it was not a criminal act.

This new bill now explicitly includes mailing or providing abortion pills into its definition of "criminal abortion."

Don't forget: Louisiana is one of the 13 states that have "trigger" laws banning abortion that would kick in right away if the Supreme Court completely overturns its precedents protecting access in the U.S. — which it might be ready to do.

Edwards on Tuesday also signed into law a bill to strengthen the state's "trigger" law, making providing an abortion punishable by up to 10 years in prison and a fine of up to $100,000 in the absence of Roe.

Go deeper: Red states crack down on abortion pills

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

Louisiana governor signs into law bill to make mailing abortion pills a crime

The law makes "delivering, dispensing, distributing, or providing" an "abortion-inducing drug" to a pregnant person a crime.

Picture of a person holding a sign that says "keep abortion safe and legal"

Abortion

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

Louisiana Gov. John Bel Edwards (D) signed a bill into law Tuesday that would ban nearly all abortions in the state and criminalize providers if the Supreme Court overturns Roe v. Wade.

The big picture: Louisiana is one of the 13 states with "trigger" laws, which are near-total abortion bans that would take effect shortly after a Roe overturn. The bill that was just enacted makes the state's post-Roe ban much more severe.

An abortion would only be allowed to save the life of the pregnant person, to "save the life or preserve the health" of the fetus, to remove an ectopic pregnancy, or to remove the remains of a miscarriage.

Be smart: Under the state's previous "trigger" law, abortion providers faced a fine of up to $1,000 and no more than two years in prison.

The newly signed law, S.B. 342, increases the penalty, making providing an abortion punishable by up to 10 years in prison and a fine of up to $100,000.

 Details: The law also adds a new section on abortions performed later in the pregnancy. If an abortion is performed after 15 weeks of pregnancy, the provider shall be imprisoned for no more than 15 years and be fined up to $200,000.

The patient receiving the abortion cannot be prosecuted under the law.

The law takes effect if the Supreme Court "upholds the authority of the states to prohibit abortions," or if a constitutional amendment is adopted that "would restore to the state of Louisiana the authority to prohibit abortions."

What they're saying: The Louisiana bill is "the latest step in a growing attack against the fundamental freedoms of Americans," said White House press secretary Karine Jean-Pierre when the law passed the state legislature.

Jean-Pierre called the measure "extreme" and "radical."

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

Louisiana bill criminalizing abortion providers if Roe falls signed into law

Under Louisiana's new "trigger" ban, providers would face up to 10 years in prison and a fine of up to $100,000.

Picture of three people holding signs in support of abortion rights

Photo: Paul Weaver/SOPA Images/LightRocket via Getty Images

Axios Space

Scientists are tracking diseases from space and getting a new view of human health.

Why it matters: The proliferation of easy-to-use, relatively cheap and more comprehensive satellite data is allowing researchers to get a holistic view of what's happening on Earth during disease outbreaks and possibly learn how to predict the next one. 

How it works: By keeping an eye from above on changes to vegetation and other ecosystem factors that can lead to outbreaks, researchers are starting to piece together correlations between habitat loss and urbanization, among other factors, and infectious disease.

For example, a study published in 2010, used remote sensing data to find that a major predictor of monkeypox cases in humans was the proximity of people to dense forests and habitats where rope squirrels that can carry the virus lived.

If those areas are closely monitored, it could help people on the ground figure out which areas are at the highest risk for infection.

Habitat loss particularly impacts predators, leaving a plethora of infected prey that could circulate the disease or transmit it to other species.

Remote sensing can be used "to measure how much habitat we are losing, at what speed, in which direction and in which area," Luis Escobar, an assistant professor at Virginia Tech, told Axios.

What to watch: Space data could one day be used to aid in a range of public health responses to certain diseases — from monitoring to mitigation.

If health officials on the ground know when there's a high risk for a given outbreak, then they can put measures in place to help prevent it, according to Farhan Asrar, a clinician and researcher at the University of Toronto.

"Once things happen, can we use those [satellite] images to prepare an ideal situation to set up offices and support facilities," Asrar said.

Where it stands: Satellites have already been used to learn more about the source of the Ebola virus, track an outbreak of Rift Valley fever and aid in the response to Zika.

During the early months of the COVID-19 pandemic, satellite companies like Planet were able to track economic impacts of the virus from orbit, keeping an eye on empty parking lots and traffic.

NASA also joined other space agencies to create a COVID-19 dashboard, making relevant information gathered from satellites easily available to the public and epidemiologists.

But, but, but: While this type of research holds promise, it's still in the relatively early academic phase.

The scientists working with the remote sensing data and epidemiologists aren't yet collaborating with each other, making it hard to find the right applications for this kind of data and research.

"We don't see strong collaboration between experts in geospatial analysis and epidemiology and remote sensing processing or generation of this data," Escobar said. "So I guess that's the first step."

At the moment, the data isn't as accessible and available as it needs to be in order to have robust and frequent collaborations across specialties, and training is needed in order to make use of remote sensing data, Escobar added.

The bottom line: By understanding patterns seen from orbit, scientists could one day be able to predict where outbreaks will occur before they happen.

What scientists can learn from tracking disease outbreaks from space

Space data could one day be used to aid in a range of public health responses to certain diseases — from monitoring to mitigation.

Space

A look at the scientific breakthroughs changing the world, explorations in space and in worlds beyond our own and the threats posed to us by our own planet, both out of our control and of our own making.

Science

Medicare could have saved up to $3.6 billion in a single year if it were purchasing generic drugs as billionaire businessman Mark Cuban's online pharmacy does, says a research report published in the Annals of Internal Medicine. 

Why it matters: Medicare is overpaying for some generics, the authors said.

Details: The Mark Cuban Cost Plus Drug Company (MCCPDC) launched in January, selling more than 100 generic prescriptions at the cost of ingredients and manufacturing plus a 15% margin, $3 pharmacy dispensing fee and a $5 shipping fee.

How much Medicare could've saved with Mark Cuban's generic drug company

Medicare is overpaying for some generics, a research report says.

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