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

The World Health Organization is meeting Thursday to consider whether to classify the ongoing monkeypox outbreak as a "global emergency."

Driving the news: There have been more than 3,200 confirmed cases of monkeypox and one death in the last six weeks, the WHO said Thursday. The outbreak has touched 48 countries.

"Person-to-person transmission is ongoing and is likely underestimated," WHO director-general Tedros Adhanom Ghebreyesus said Thursday.

The big picture: The WHO's "global emergency" designation would put monkeypox in the same category as the COVID-19 pandemic and ongoing efforts to wipe out polio, AP reports.

It is unlikely the WHO committee will announce any decisions before Friday, per AP.

What we're watching: The declaration would likely do little to curb the epidemic since most developed countries are already working to slow the spread of monkeypox, per AP.

The Department of Health and Human Services (HHS) announced Wednesday it would begin shipping monkeypox tests to five commercial laboratory companies to help boost testing for the disease, Axios' Shawna Chen writes.

New York City began offering vaccination against monkeypox to at-risk groups Thursday, too, per NBC New York.

The United Kingdom has offered vaccinations to higher-risk groups, per The Guardian.

WHO considers declaring monkeypox outbreak a "global emergency"

There have been at least 3,200 confirmed monkeypox cases across the world in the last six weeks.

Blood test vials and a syringe. Photo:  Nikos Pekiaridis/NurPhoto via Getty Images

Monkeypox

Online search interest in "How to stop vaping" is up amid news that impacts people who use vaping products nationwide, Google Trends data indicates.

Driving the news: The Food and Drug Administration on Thursday announced it will order Juul to remove its e-cigarettes out of the U.S. market, taking away an e-cigarette option for millions of smokers.

The FDA has been working to cap nicotine in cigarettes, while the Biden administration has been working to limit tobacco in the U.S.

The big picture: About 3.7% of American adults used e-cigarettes in 2020, according to recent data from the Centers for Disease Control and Prevention.

E-cigarettes are commonly used by America's youth, too. About 2 million middle and high school students used e-cigarettes in a 30-day period, according to 2021 data from the CDC.

What they're saying: “Vaping in the U.S. has gone up tremendously in the past few years,” said Suchitra Krishnan-Sarin, co-director of the Yale Tobacco Center for Regulatory Science, in a statement. 

“A big part of the problem is that kids are using e-cigarettes on a regular basis throughout the day, and they don’t know what nicotine concentration they are using. So, they develop an addiction, and they find it hard to quit.” 

Most e-cigarettes contain nicotine, which is an addictive and toxic substance that can harm brain development among young people, per the CDC.

E-cigarettes can also contain harmful ingredients such as diacetyl, which is a chemical linked to serious lung disease, per the U.S. surgeon general's website.

Heavy metals — including nickel, tin and lead — can be found in e-cigarettes, too.

Yes, but: E-cigarettes have the potential to benefit adults who smoke if used as a substitution for smoking regular cigarettes, the CDC said.

Researchers are still discovering more about the risks of e-cigarettes, per the CDC.

Quitting vaping isn't exactly easy since people will face immense challenges along the way, according to SmokeFreeTeen, a government resource on smoking for teens.

Challenges to quitting include cravings and constant temptations to smoke again.

People will most likely experience nicotine withdrawal, which includes symptoms such as irritation. frustration, trouble sleeping and the urge to consume nicotine, per the Cleveland Clinic.

Tips: Dr. J. Taylor Hays, a professor of medicine at the Mayo Clinic College of Medicine, told Truth Initiative that there are ways to steel yourself against withdrawal symptoms, including exercise and finding distractions.

“Find the activities that will keep your mind engaged for those few minutes,” Hays said.

Americans can't stop searching "How to stop vaping"

The FDA announced Thursday it will order Juul to remove its e-cigarettes out of the U.S. market.

A man smokes an electronic cigarette. On Thursday, June 02, 2022, in Krakow, Poland. 

A man smokes an electronic cigarette. Photo: Artur Widak/NurPhoto via Getty Images

Vaping

Where access to abortion pills prescribed via telemedicine is banned

Data: Guttmacher and Axios research; Map: Jacque Schrag/Axios

As the Supreme Court considers potentially overturning Roe v. Wade, abortion rights activists are heralding abortion pills as a potential option in places where clinics may have to close — but several red states are already cracking down on the pills.

The big picture: Almost half of U.S. states have banned or tightly restricted abortion pills — two medicines named mifepristone and misoprostol — and more could soon follow suit. 

Prior to the pandemic, the FDA said patients seeking abortion pills had to get the drug from hospitals or medical facilities in person. 

The FDA in December changed its guidance on abortion pills, permanently allowing people to access the medication through telemedicine and receive the pills by mail, where permitted by state law.

The latest: The Louisiana governor in June signed a law making it illegal for anyone to mail abortion pills, punishable by up to five years in prison and a $50,000 fine. 

In Tennessee, the governor signed a law in May making it a felony to mail abortion pills, with a penalty of 20-year imprisonment and a $50,000 fine. The law also adds further restrictions to medication abortion.

Texas and Indiana are the only two states that ban the use of abortion pills at seven weeks and 10 weeks, respectively. So do South Dakota, Oklahoma and Montana, though courts have blocked those laws.

Republican lawmakers in several states have moved to introduce legislation aimed at making abortion pills illegal. 

There's a bill moving through the Alabama legislature that would make it a crime to "manufacture, distribute, prescribe, dispense, sell, or transfer" abortion pills in the state.

The Wyoming state Senate passed a bill in March aimed at completely outlawing abortion pills. 

In Iowa and Ohio, laws require a physician to be present when a patient takes the medication. However, federal judges blocked those laws , saying the requirement places an "undue burden" on women. 

Of note: South Dakota Gov. Kristi Noem (R) attempted to prohibit the mailing of abortion pills via executive order instead of a legislation. However, a federal court temporarily blocked it. 

People in the state are still required to see a health provider when looking to access the pill, which is given in a two-dose regimen. They are allowed to take the second dose at home.

In March, Noem signed into law a bill to add more restrictions to medication abortion access. It is set to take effect if the state can convince the court to overturn its block on the governor's order.

What they're saying: "I think pretty much any state that is on the conservative side might expect to see similar legislation in 2022," Elizabeth Nash, state policy expert at the Guttmacher Institute, told Axios.

What's next: Some activists have been pointing to newer options that skirt certain telemedicine restrictions and operate in a legal gray area, including one online medication abortion provider, Aid Access, founded by a Dutch physician in 2018, which will mail abortion pills internationally.

Abortion rights advocates say people who want to end a pregnancy will use abortion pills no matter what the policy landscape is.

"It is going to be in their hands in the U.S., it's inevitable," said Elisa Wells, co-founder of Plan C, which provides information on how to access abortion pills online. "This is modern medical technology everybody should have access to. Whether people can use it under the radar without being criminalized is the question."

The other side: "Pro-life groups are encouraging states to take action to install safeguards for women that will ensure they are aware of the risks when undergoing a chemical abortion," said Prudence Robinson, a communications associate at Susan B. Anthony List, an anti-abortion advocacy group. 

"And the states are facing this threat head on. In this year alone, nearly 10 states enacted state-level restrictions on this dangerous method of abortion."

By the numbers: Medication abortion accounted for 54% of all U.S. abortions in 2020, an increase from 39% in 2017, according to the Guttmacher Institute.

Go deeper: Pills are the next big abortion battleground

Red states crack down on abortion pills

Several states have moved to restrict access to the pills and more could follow suit.

Abortion

Axios Explains: Abortion

Policymaking

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

Axios Vitals

Female scientists are less likely to be cited for their work in journal articles than their male peers, according to a study published in the journal Nature.

Why it matters: There is already a "well-documented gap" in published research between male and female researchers which only worsened during the pandemic.

 But this study from Ohio State University researchers shows part of this gap isn't just due to productivity differences, but instead due to women's contributions not being acknowledged.

Details: The researchers used the UMETRICS dataset available through the Institute for Research on Innovation and Science, which contained detailed information on sponsored research projects for 52 colleges and universities from 2013 to 2016.

Women who worked on a research project were 13% less likely to be named as authors in related publications compared to their male colleagues.

Women were 59% less likely than men to be credited on patents related to projects that they both worked on.

The trend held true across all scientific fields, the researchers said.

Female scientists less likely to get research credit

There's a "well-documented gap" in published research between male and female researchers.

Photo: Lynne Cameron/PA Images via Getty Images

Health care

The Food and Drug Administration on Thursday announced it will order top-seller Juul to take its e-cigarettes off the shelves in the U.S. market.

Why it matters: The move comes amid a push to cap nicotine in cigarettes and signals the Biden administration is escalating its attempt to limit tobacco use in the U.S., Axios' Arielle Dreher reports.

The big picture: The decision follows a nearly two-year review by the FDA of Juul's data as the vaping company sought authorization for its products to stay on the U.S. market, according to the Wall Street Journal.

Details: The order impacts the JUUL device and four types of JUULpods, the FDA said.

The agency said that the company's application to market the product "lacked sufficient evidence ... to demonstrate that marketing of the products would be appropriate for the protection of the public health."

What they're saying: "Today's action is further progress on the FDA's commitment to ensuring that all e-cigarette and electronic nicotine delivery system products currently being marketed to consumers meet our public health standards," FDA commissioner Robert M. Califf said in a statement.

He added that Juul products may have played a "disproportionate role in the rise in youth vaping."

Joe Murillo, the chief regulatory officer at Juul Labs, said in a statement that the company disagrees with the FDA's decision.

Murillo said the company believes the data sent to the FDA in its application showed that Juul products have met public health standards.

"We remain committed to doing all in our power to continue serving the millions of American adult smokers who have successfully used our products to transition away from combustible cigarettes, which remain available on market shelves nationwide," Murillo said.

The company will seek a stay and explore other options "under the FDA’s regulations and the law, including appealing the decision and engaging with our regulator."

The decision deals a blow to Altria, which in 2018 paid $12.8 billion for a 35% stake in Juul.

Since then, Juul's value has plummeted amid regulatory crackdowns and declining sales.

Altria valued its Juul stake at $1.6 billion as of March 31, per the WSJ.

Flashback: In 2021, FDA removed thousands of electronic cigarettes off U.S. shelves but delayed its decision on Juul.

The agency rejected applications for about 950,000 flavored e-cigarettes and related products because of their appeal to underage teens and flavor profiles.

The FDA based its review of the applications on whether e-cigarettes are effective in getting smokers to quit and, if so, whether the benefits to smokers outweigh the health damage to new users, including teenagers.

Juul has also faced scrutiny from regulators, public health officials, and lawmakers over its products. The company halted U.S. sales for several of its flavors back in 2019 due to pressure from critics who said the product was being targeted at minors, Reuters reports.

Worth noting: The decision comes as the FDA announced plans for a proposed product standard that would decide on maximum nicotine to level to reduce the addictiveness of cigarettes and other tobacco products.

Editor's note: This story was updated with a statement from Juul Labs.

FDA orders Juul e-cigarettes off U.S. market

In 2021, FDA removed thousands of electronic cigarettes off U.S. shelves but delayed its decision on Juul.

Packages of Juul mint flavored e-cigarettes are displayed at San Rafael Smokeshop on November 07, 2019 in San Rafael, California.

Packages of Juul mint flavored e-cigarettes. Photo: Justin Sullivan/Getty Images

E-cigarette

Proposed insulin price cap poses test for Dems

A Senate deal to cap the cost of insulin at $35 a month for individuals with private insurance and Medicare poses a new test of whether Democrats can make good on campaign pledges to rein in drug costs, Axios' Adriel Bettelheim writes.

Photo: Joan Slatkin/UCG/Universal Images Group via Getty Images

Insulin

Health care costs

The Food and Drug Administration is poised to sweep Juul e-cigarette products off store shelves, the Wall Street Journal reported on Wednesday, in what could be a major turning point for an agency that's taken a sluggish, at times disjointed approach to regulating the vaping industry.

Why it matters: The move, coming amid a push to cap nicotine in cigarettes, may signal the Biden administration is ready to try to put tobacco use behind us.

Where it stands: The FDA is ready to deny Juul a marketing order for its menthol and tobacco-flavored products after a two-year review that weighed the products' benefits for adult smokers against risks to teens, the WSJ reported, citing people familiar with the matter.

Juul has been in regulatory limbo for several years, even while its market share swelled, driven in part by flavored products popular among teens.

Now, all e-cigarette products must go through pre-marketing reviews at the FDA, which missed a court-ordered deadline last fall to decide which products could be sold. 

The agency reviewed many smaller manufacturers' products, denying close to 1 million, but hasn't yet ruled on Juul. 

What they're saying: The FDA wouldn't confirm or deny the WSJ report or provide a status on its Juul deliberations. 

Juul did not respond to emailed request for comment.

Groups that oppose youth smoking say taking the company off the market would mark a dramatic step to discourage youth smoking.

"This is a most-welcomed and a long-overdue decision," Erika Sward, assistant vice president of advocacy for the American Lung Association, told Axios.

"FDA should have acted years ago, but if it acts now and we do more to educate young people, this is a reversible epidemic," Matt Myers, president of the Campaign for Tobacco-Free Kids, told Axios.

Background: A 2016 FDA rule required makers of tobacco products to submit applications for products made after 2007.

A court ordered the FDA to make decisions by September 2021. After the agency missed the deadline, the American Lung Association and other advocacy groups and pediatricians successfully sued to speed up the process. 

Now, all e-cigarette manufacturers have to show products are "appropriate for the protection of public health," per the FDA.

Congress also recently gave the FDA the authority to regulate synthetic nicotine products, which are subject to the same application requirements.

Flashback: The FDA banned Juul flavored products as part of a bigger crackdown on flavored vapes, prompting many teens to use disposable e-cigarettes and menthol-flavored products that are still sold.

From February 2020 to February 2022, disposable e-cigarette sales increased by 215.4%, data from the CDC Foundation show, and more than half of youth who reported smoking in 2021 used disposable e-cigs.

Public health groups say it's important for the FDA to finally have a clear, consistent policy on vaping, without loopholes.

The other side: The e-cigarette industry is worried regulators will take a carte blanche approach to policing its products.

Juul's application process involved nearly two years of submitting data and evidence to the FDA, WSJ reported, and industry leaders say its data was sound.

"If that level of science isn't sufficient, it begs the question of what is," Tony Abboud, executive director of the Vapor Technology Association, told Axios.

E-cigarette industry groups are calling on the FDA to go after bad actors that are skirting the review process.

The industry also claims its products are used successfully to wean adult smokers off cigarettes, and that removing e-cigarettes from the market will force people to return to cigarettes again.

"FDA's staggering indifference to ordinary Americans and their right to switch to the vastly safer alternative of vaping will surely rank as one of the greatest episodes of regulatory malpractice in American history," American Vapor Manufacturers Association President Amanda Wheeler said in a statement.

Context: Juul's rise in popularity from 2017 to 2019 coincided with more than a million teens getting hooked on nicotine, while flavored vape cartridges and pods were still available.

A study in Pediatrics assessed found most new tobacco use during that time was among teens using e-cigs.

"There was no evidence that [older] smokers were using them," John Pierce, one of the study authors, told Axios.

What's next: The FDA still has many products to review and a bipartisan group of lawmakers in Congress is calling on the agency to expedite the process and take aim at addictive products marketed towards teens.

The bottom line: If Juul is pulled from the market, health risks to youths will have trumped arguments for using e-cigarettes as cessation products.

FDA may toss Juul e-cigs from store shelves

With pressure from Congress and health groups mounting, FDA may order Juul to take its products off the market this week.

Illustration of a juul device forming a "no" symbol with a cloud of vapor around it

Public health

The Department of Health and Human Services (HHS) announced Wednesday that it has begun shipping monkeypox tests to five commercial laboratory companies in a bid to boost access to testing for the disease.

Why it matters: A lack of testing has kept public health officials in the dark about the scope of the outbreak in the U.S.

The Centers for Disease Control and Prevention (CDC) has reported 156 confirmed cases as of Wednesday.

Details: In an effort to address the issue, HHS has shipped tests to commercial laboratory companies including Aegis Science, Labcorp, Mayo Clinic Laboratories, Quest Diagnostics and Sonic Healthcare.

Health care providers will be able to use these labs by early July, with testing via these companies expected to ramp up throughout the month, according to the federal agency.

What they're saying: "All Americans should be concerned about monkeypox cases. Thankfully we have right now the tools to fight and treat cases in America,” HHS Secretary Xavier Becerra said in a statement. 

"By dramatically expanding the number of testing locations throughout the country, we are making it possible for anyone who needs to be tested to do so."

The big picture: The World Health Organization's European chief has warned that the monkeypox outbreak "poses a real risk" to public health and urged countries to conduct contact tracing, testing and sequencing to identify new cases.

The WHO, which has announced plans to change the name of the virus due to concerns about racism and stigma, is slated to convene an emergency meeting on Thursday to decide whether the current outbreak constitutes a public health emergency.

U.S. expands monkeypox testing in bid to better track scope of outbreak

The CDC has reported 156 confirmed cases as of today.

A suspected monkeypox sample at the microbiology laboratory of La Paz Hospital in Madrid last month. Photo: Pablo Blazquez Dominguez via Getty Images

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

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

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

America has a sleep problem

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

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