National

Public health officials in Washington announced Monday they’re investigating the state’s first presumptively positive case of monkeypox.

Details: The case involves an adult man who recently traveled to an undisclosed country where other monkeypox cases have been reported, state and local health officials said.

Driving the news: Washington now joins a handful of other states to report confirmed and possible cases, including Massachusetts, New York and Florida.

Several countries also have reported confirmed or presumptive monkeypox cases, including  Australia, Canada, Belgium, Italy, the United Kingdom, Portugal, Sweden, Spain, Netherlands, Germany and France, per the World Health Organization.

What they’re saying: Dr. Jeff Duchin, health officer for public health for Seattle and King County, said in a statement Monday that the public and health care providers “should be aware of the growing international monkeypox outbreak.”

The person believed to be infected with monkeypox is isolating and poses no risk at this time, Duchin said.

"At this time, we have no evidence that monkeypox is spreading locally, but if there are unrecognized cases, that is a possibility,” he added.

Why it matters: Health experts have said the current international outbreak is not likely to cause a global pandemic as COVID did, but some officials are increasingly voicing concern and raising public awareness about the virus.

President Biden, in his first public remarks about the monkeypox outbreak, said Sunday said the recent international outbreak is "something that everybody should be concerned about."

What we know about the new monkeypox outbreak

WHO concerned monkeypox could accelerate during summer months

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Health officials investigating possible monkeypox case in Washington

The case involves an adult man who recently traveled to an undisclosed country where other monkeypox cases have been reported.

Dr.Jeff Duchin, Health Officer for Public Health -- Seattle & King County, announced the first presumptive case of monkeypox in Washington state.

Dr. Jeff Duchin, health officer for public health for Seattle and King County. Photo: Jason Redmond/AFP via Getty Images

Washington State

Public health

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

Pedestrian deaths reached a 40-year high last year, according to preliminary data from the Governors Highway Safety Association.

By the numbers: Drivers struck and killed more than 7,400 people in 2021, and the percentage of children killed by speeding drivers more than doubled since 2018.

Pedestrian traffic fatalities, 2000–2021

Data: Governors Highway Safety Association; Chart: Jacque Schrag/Axios

State of play: Impaired driving and increased speeding contributed to the rise in pedestrian deaths, said Russ Martin, GHSA’s Senior Director of Policy and Government Relations.

"You also have this thought that well, I could be on a ventilator by the end of the week, I should take advantage of the time that I have. I think everyone's out there trying live their best life with an increased sense of urgency," he said. 

"So when it comes to the roadway, maybe that has contributed to more of a me first kind of attitude." 

Martin also pointed to larger vehicles on the road and crumbling infrastructure. Separating cars from pedestrians is one of the most effective engineering interventions, he said.  

The big picture: Data out this week from the Department of Transportation also revealed that an estimated 42,915 people died in motor vehicle traffic crashes in the U.S. in 2021, the highest number of traffic fatalities since 2005.

That's a 10.5% increase from 2020, when 38,824 deaths were reported.

Pedestrian deaths hit 40-year high

Pedestrian deaths reached their highest levels in four decades in 2021.

A graphic of a car moving into a crosswalk.

Deaths

People walk down a street in Philadelphia, Pennsylvania.

Share of counties that are maternity care deserts, by state

Data: March of Dimes; Map: Jacque Schrag/Axios

The red states poised to ban or severely limit abortion already tend to have limited access to health care, poor health outcomes and fewer safety net programs in place for mothers and children.

Why it matters: If the U.S. Supreme Court overturns Roe v. Wade, as it's expected to, the ensuing increase in births will likely leave families in tough circumstances and strain systems that are already hanging by a thread.

"What we're facing as a country is hundreds of thousands of births, probably disproportionately located in the states that have been most limited in what they do for pregnant women, infants and children. So this is the great paradox that we are dealing with," said Sara Rosenbaum, a health law and policy professor at George Washington University. 

"We have not ever designed these programs for a world without Roe," she added. "You need a child welfare system, the likes of which we've never seen.”

Where it stands: Experts say there's already a growing shortage of obstetricians.

In 2020, more than 2 million women of childbearing age lived in counties that had no hospital offering obstetric care, no birth center and no obstetric provider, according to a report by March of Dimes. 

Millions more lived in areas with limited access to care.

Red states in the middle of the country — many of which will automatically ban abortion if Roe is overturned — are particularly likely to have a high number of maternity care deserts.

States with more abortion restrictions also tend to have higher maternal mortality rates and worse health care outcomes generally. 

A recent AP analysis found that states with the strictest abortion laws are also some of the most difficult places to have and raise healthy children.

Many of the states with abortion bans have also refused to expand Medicaid, meaning low-income women in those states have limited access to health care and thus may be in poor health before becoming pregnant.

By the numbers: In 2019, there were more than 600,000 abortions in the U.S., according to the CDC. About 3.75 million babies were born in the same year.

Between the lines: Experts say abortion bans would also likely put more pressure on U.S. foster and adoption systems. 

More than 600,000 children were served by the foster care system at some point in the 2020 fiscal year, according to HHS. 

As of September 2020, more than 100,000 of them were waiting to be adopted, and nearly 60,000 were adopted through a public agency that year. 

An increase in births that would have otherwise not occurred "almost certainly means more foster children," said Richard Shannon, chief quality officer for Duke Health. And while the foster care system is "a vital social service, it is in desperate need of further improvement and will only be stressed by an increase in pregnancies and live births among moms who can't take care of their kids."

What we're watching: The statistics around children who live in traumatic or volatile circumstances are grim.

"We know from focus on health outcomes that kids born into poverty, kids born into unstable social circumstances, tend to have higher incidence of early onset chronic diseases," Shannon said. "We also know that when those children are raised in unstable circumstances and have to be cared for in foster care, the outcomes there are really sobering."

Red states aren't prepared for a post-Roe baby boom

Millions more lived in areas with limited access to maternity care.

Abortion

Confirmed new monkeypox cases outside of Africa

Note: Monkeypox is more common and locally transmitted in west and central Africa; Data: WHO, Axios reporting; Map: Axios Visuals

A monkeypox outbreak in several European countries and one U.S. state may become the largest outbreak of the virus outside of Africa, but it's not likely to cause a global pandemic like COVID, an infectious disease expert tells Axios.

Why it matters: The CDC has confirmed at least one case in the United States. The current outbreak is small so far and scientists continue gathering data, but there may be community transmission of the virus.

"I'm sure that ultimately this will be the largest outbreak of monkeypox that we've had outside of the endemic areas in Africa," says Daniel Bausch, infectious disease expert and president of the American Society of Tropical Medicine & Hygiene.

"I don't think there's a reason for panic. I don't think we're going to have tens of thousands of cases," he tells Axios.

What's happening: Various countries are reporting confirmed and possible cases, including Australia, Canada, Belgium, Italy, the United Kingdom, Portugal, Sweden, Spain, Netherlands, Germany and France, per the World Health Organization.

Related to smallpox, monkeypox has two main types: the West African clade with a fatality rate of around 1% and the Congo Basin (Central African) clade, with a fatality rate of around 10%.

The current circulating strain appears to be the milder West African type that often starts with flu-like symptoms and swelling lymph node, progressing to a blistering rash. 

The smallpox vaccine is believed to be effective against monkeypox.

Details: Monkeypox, which can be transmitted by droplets and by close contact with infected skin lesions or contaminated materials, usually incubates in people for 6 to 13 days before symptoms appear.

Transmission can come from animals or human-to-human but "it is generally documented among very close contacts. So family members, people taking care of ill patients. Or health care providers," Andrea McCollum, the poxvirus epidemiology team lead at the CDC, told STAT News. 

Children are at higher risk, and monkeypox can cause pregnancy complications or stillbirth, per the WHO.

In the U.S., there have been reports of individuals infected with monkeypox before, particularly in international travelers from Nigeria, including a case in Texas and one in Maryland last year. 

Per the CDC, monkeypox re-emerged in Nigeria in 2017 after more than 40 years with no reported cases. 

Between the lines: The improvement in the global infectious diseases surveillance system is paying off with not only COVID but disease like monkeypox, Bausch adds.

What's next: WHO is scheduled to meet next week to discuss pox viruses, per STAT. 

Go deeper: First U.S. monkeypox case confirmed in Massachusetts

Editor's note: This post was updated to include countries that announced new confirmed cases of monkeypox.

This could become the largest outbreak of monkeypox in countries outside of Africa — but there's no need to panic, an infectious disease expert says.

Monkeypox

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

If abortion were illegal and you had an unwanted or unplanned pregnancy, what would you do?

Data: Generation Lab; Chart: Simran Parwani/Axios

Over half of young women aged 18-29 say they would get an abortion if they had an unwanted or unplanned pregnancy — even if it were illegal, according to a new Generation Lab flash poll first provided to Axios.

Why it matters: Last week's news that the Supreme Court is prepared to overturn Roe v. Wade has raised questions on what access would look like without a federal right to an abortion. Even in states where they remain legal, abortions could be harder to access because those clinics could be flooded with patients from states that have cracked down.

Women in their 20s accounted for the majority of abortions between 2010 and 2019. 

By the numbers: 56% of respondents who identified as women said they would seek out an abortion provider even if it was illegal and they had an unwanted or unplanned pregnancy.

34% said they would have the baby in the event abortion was illegal, while 10% said they'd attempt to end the pregnancy at home.

45% of respondents who identified as men said they would take additional precautions like using physical contraceptives more often if abortion were illegal, while 43% said they would not change anything and 11% said they would be more likely to get a vasectomy.

49% of all respondents said abortion should be legal in all cases, 27% said it should be legal in most cases, 16% said it should be illegal in most cases and 8% said it should be illegal in all cases.

46% of respondents said they have a "mostly unfavorable" opinion of the Supreme Court, while 22% said their opinion was "very unfavorable." 28% said it was "mostly favorable," and only 4% said they had a "very favorable" opinion.

The big picture: Approximately six in 10 U.S. adults believe abortion should be legal in "all or most cases," according to a recent Pew Research Center survey.

Abortion clinics are already preparing to shift people and resources away from red states, while blue states are taking steps to plan for a potential influx in patients if Roe falls.

Methodology: This poll surveyed 813 people ranging from ages 18 to 29 between May 5 and 8. 460 people self-identified as women and 353 self-identified as men. 

Go deeper: The state of abortion in America

Poll: Over half of young women say they would get an abortion even if it were illegal

Women in their 20s accounted for the majority of abortions between 2010 and 2019.

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

Data: Guttmacher Institute; Map: Thomas Oide and Erin Davis/Axios

The number of U.S. women who get abortions has decreased dramatically in recent decades, with typical patients now tending to be in their 20s and living in blue states. 

Why it matters: Abortion access is likely to be drastically curtailed in red states should a leaked draft of a U.S. Supreme Court decision hold, gutting the federal right to an abortion. But the profile of abortion patients has trended older since that right was established, and the vast majority of procedures tend to be early in pregnancies.

State of play: In 2019, nearly 630,000 abortions were reported to the CDC, reflecting a rate of about 11.4 abortions per 1,000 women aged 15–44 years. 

Around 18% of all pregnancies in the U.S. end in abortion, according to the CDC. 

Women in their 20s accounted for the majority of abortions between 2010 and 2019 

That year, more than three-quarters of abortions were performed by nine weeks of a pregnancy, and rates were higher among Black and Hispanic women than among white women.

Factors influencing the abortion rate include access to health care services and contraception; the availability of abortion providers; state regulations, such as mandatory waiting periods; parental involvement laws and legal restrictions on providers, the CDC writes. The state of the economy and resulting impact on family planning decisions and contraceptive use also play a role. 

Abortion rate by age group, 1973-2017

Data: Guttmacher Institute; Chart: Erin Davis/Axios Visuals

The big picture: Abortion rates have been declining for years, particularly among adolescents. The overall birth rate has also declined since 1973, according to the Guttmacher Institute.

Many of the states in the South and Midwest most immediately poised to act to eliminate access should the high court rule against a federal abortion right already have lower-than-average abortion rates. 

Zoom in: These national trends are largely encapsulated in Texas, one of the states that would automatically ban abortion if SCOTUS overturns its earlier ruling. 

In 2020, 58% of women who received an abortion were in their 20s and were disproportionately Black, according to a report released by the Texas Health and Human Services Commission.

84% were unmarried, 63% were receiving their first abortion and 39% were among women who hadn't given birth before. Nearly a quarter had given birth once before, 21% had had two previous live births and 16% had three or more. 

The state of abortion in America

Recently, the majority of abortions are received by women in their 20s.

Axios Explains: Abortion

A cure for multiple sclerosis remains elusive, but a decade of technological and scientific advances is starting to shed light on possible causes, better diagnostics and potential treatments for the disease.

Why it matters: MS — a central nervous system disease affecting almost 3 million people globally — has baffled doctors since it was discovered over a century and a half ago.

The disease can advance silently for years, but then attack myelin, the protective coating around nerve cells, and produce lesions that can cause vision problems, muscle weakness and more. It is unknown why the disease can progress in unpredictable and different ways.

MS is difficult to study, as many people are asymptomatic for the first several years and don't see a doctor until the disease has progressed, says Daniel S. Reich, neuroradiologist and senior investigator for NIH's National Institute of Neurological Disorders and Stroke.

FDA-approved treatments are designed to slow the progress of the disease or try to reverse myelin damage, but often have serious side effects, including possible liver damage, an elevated risk of certain cancers and rendering COVID-19 vaccines less effective. 

The latest: Researchers on Wednesday published a study that found four new autoantigens, or disease-driving immune cells, that could be targeted in both diagnostics and drugs.

Autoantigens "may lie at the core of MS" and could help researchers understand what aspects of the immune system MS is targeting, says study co-author Mattias Bronge, a Ph.D. student at Karolinska Institutet.

While this hasn't been tested yet, it might be possible to increase the immune system's tolerance for some antigens so the disease's effects are reduced, similarly to what is done in allergy treatments, Bronge says, and those four new identified proteins may help advance this idea.

Yes, but: Scientists must first better understand how "the immune system orchestrates damage to brain cells and what is required for the brain to repair itself better," Reich says.

Between the lines: MS is believed to be caused by a mix of genetic susceptibility, faulty immune systems, and environmental factors. A crucial discovery is the probable link of MS with the Epstein-Barr virus, a common herpes virus that infects almost all people by adulthood and is more well-known as a cause of mononucleosis.

A long-term study of more than 10 million young adults in the military found the risk of developing MS increased 32-fold after infection with EBV but not after infection with other viruses.

This bolsters the belief that MS may be a rare complication of EBV — but also also leads to questions on why such a small percentage of EBV-exposed people wind up having MS.

There are about 15 EBV vaccines in development, most in very early phases, as well as trials to transplant immune cells. But, determining whether or not these will help prevent MS will take years with large trials, Reich points out.

Meanwhile, diagnostics and assessments via high resolution MRIs, spinal fluid analysis techniques or genomics continue to rapidly improve, says Reich, whose lab uses MRI imaging in its MS research.

Some researchers are looking at imaging of the retina or central vein sign to improve early diagnostics.

"We need to develop MRI technologies that can get us down to the resolution of a few cells. We're not quite there yet, but we're a lot closer than we were five or 10 years ago," Reich says.

What's next: Taken together, these incremental advances will likely begin to answer some fundamental questions in the next few years about why some people get MS and how it might be treated, Reich says.

"The MS research field is moving forward with great speed at the moment," Bronge says. "I’m absolutely optimistic, and I think we have a very exciting decade ahead of us."

Tackling the century-long mystery of multiple sclerosis

While there's no cure in sight yet, recent advances are bringing some optimism.

Illustration of a person with a cane near a hole shaped like a red cross symbol.

Multiple sclerosis

Pfizer and BioNTech asked the Food and Drug Administration (FDA) on Tuesday to authorize a COVID vaccine booster dose for children ages 5 through 11.

Why it matters: If approved, it would be the first booster accessible to children of this age group, who have been hit hard in recent months. Infections rose most sharply among children and adolescents during the Omicron surge, according to the Centers for Disease Control and Prevention.

Details: Data from a clinical trial showed that children ages 5 through 11 who received a booster about six months after their second Pfizer shot developed a "strong immune response," according to the company.

Boosters are currently only authorized for people who are 12 and older in the U.S.

The FDA authorized Pfizer's two-shot vaccine for kids ages 5 through 11 in October.

Worth noting: Pfizer said it plans to also submit the data to the European Medicines Agency and other global regulatory agencies for authorization in the coming weeks.

The big picture: The FDA said Monday it had expanded approval of the COVID-19 treatment Veklury, also known as remdesivir, for children 28 days and older in an effort to boost protections for young kids.

A majority of Americans, including three in four children, have had COVID-19 as a result of the Omicron surge this past winter.

Pfizer asks FDA to authorize COVID booster for children 5 to 11

If approved, it would be the first booster accessible to children of this age group, who were hit hard by Omicron.

Photo of a child in red with their sleeve rolled up as a nurse injects a COVID shot into their left arm

A child receives a dose of the Pfizer-BioNTech COVID-19 vaccine at an elementary school vaccination site for children ages 5 to 11 in Miami on Nov. 22, 2021. Photo: Eva Marie Uzcategui/Bloomberg via Getty Images

Pfizer

Coronavirus

Axios World

No big country has struggled to roll out vaccines more than Democratic Republic of Congo, where less than 1% of the population is fully vaccinated.

State of play: Vaccines still aren’t available in some remote provinces of the central African giant, but vaccination rates are very low even in the capital, Kinshasa, home to 17 million people. 

Seth Berkley, CEO of the Gavi vaccine alliance and point person for the global COVAX initiative, recently told Axios that supply was no longer an issue. COVAX is prepared to send more doses to DRC, he said, if and when the existing supply is rolled out.

On the ground: “When we started in November, there was not much interest” in getting vaccinated, says Freddy Nkosi, DRC director for VillageReach, an NGO that works on health care delivery in low-income countries.

VillageReach operates four vaccination centers in Kinshasa, which Nkosi says are conveniently located near bus stops or markets, and they're open seven days a week with no appointment necessary. They are offering five different vaccines: Pfizer, Moderna, J&J, AstraZeneca and Sinovac.

Nkosi says demand has been increasing over the past two to three months as people grow "more and more confident."

He adds “rumors” — that vaccines had killed people or contained ingredients that would violate religious practices — have been the biggest obstacle. Nkosi thinks some of that misinformation was imported from the West via social media, while some are specific to the DRC.

Between the lines: Asked why the vaccination rate in DRC is so much lower than other low-income countries with similar challenges, Nkosi was uncertain, though he noted that a strike among health care workers didn’t help.

Somewhat surprisingly, the uptick in vaccination is coming as fear of COVID fades and life largely returns to normal, Nkosi says.

Many people decided to come in after someone they knew was vaccinated. Others need vaccines for work or travel.

The bottom line: "We are hoping to turn the tide," Nkosi says. "We started at a snail’s pace, but I do have hope we can still catch up."

Go deeper: 44 countries have COVID vaccination rates under 20%

DRC hopes to "turn the tide" on low COVID vaccination rate

Less than 1% of the population is fully vaccinated.

Carrying doses in Goma, DRC. Photo: Guerchom Ndebo/Getty Images

Health workers carry a box of COVID vaccine doses in Goma, DRC. Photo: Guerchom Ndebo/Getty Images

Democratic Republic Of The Congo (DRC)

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

Vice President Harris said Thursday that the U.S. must confront its "crisis on the issue of maternal health," especially the disproportionate rate of maternal mortality among Black women.

Why it matters: Roughly 700 women die in the U.S. each year as a result of pregnancy or delivery complications, according to the Centers for Disease Control and Prevention. Compared to white women, Black women are over three times more likely and Native women over two times as likely to die.

What she's saying: The U.S. is "facing a crisis on the issue of maternal health — it’s real," Harris said in remarks at the University of California, San Francisco. "Women in our nation are dying at a higher rate from pregnancy-related causes than in any other wealthy or developed nation in our world."

"And we know that for certain women the risk is much higher, regardless of income level, regardless of education level," she added, pointing to Black and Native women's maternal mortality rates.

"A big factor which contributes to these outcomes is systemic inequities," Harris added. "Differences in how people are treated based on who they are ... disparities that are often a matter of life and death."

"Women are the pillars of so many families and communities," she said. "Let us all continue to work together to ensure every woman and mother in our nation has the care she needs to thrive."

The big picture: More Black women have spoken out about their struggles with delivery in recent years, especially their challenges with racism in the health care system.

Tennis star Serena Williams wrote in Elle Magazine earlier this month about how she nearly died from giving birth to her baby because her doctors refused to listen to her.

A 2019 study by the National Institutes of Health found that health care providers are less likely to perceive pain in Black faces compared to white faces.

Worth noting: Harris, who convened the first-ever federal Maternal Health Day of Action last December, met with Cabinet officials last week to discuss the Biden administration's whole-of-government approach to addressing maternal mortality and morbidity.

Harris: U.S. must address maternal mortality "crisis"

Black women are over three times more likely to die from pregnancy-related complications compared to white women.

Photo of Kamala Harris speaking at a podium on a stage, with the California state flag in the backdrop

U.S. Vice President Kamala Harris speaks after meeting with members of the maternal health care workforce at the University of California, San Francisco on April 21, 2022. Photo: Terry Schmitt/UPI/Bloomberg via Getty Images

Maternal deaths

Axios Future

The just-approved malaria vaccine could represent one of the biggest ever achievements in global development.

Why it matters: Malaria kills more than 400,000 people a year, more than half of whom are under the age of 5, and it notably slows the pace of economic growth in the sub-Saharan countries most affected by the mosquito-borne disease.

Preventative measures and treatments do exist, but a vaccine would be the fastest way to cheaply save millions of lives over time.

Blunting malaria's impact on the economy matters even more because COVID-19 could result in as many as 88 million Africans falling into extreme poverty, as the pandemic throws decades of global development progress into reverse.

Driving the news: The World Health Organization on Wednesday recommended the first vaccine against malaria for widespread use for children in sub-Saharan Africa and other at-risk regions, my Axios colleague Ivana Saric reported today.

"Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease," Matshidiso Moeti, WHO regional director for Africa, said in a statement.

The malaria vaccine could be a game-changer for global development

Mosquirix could be one of the biggest achievements ever in global development

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Public health

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The malaria vaccine could be a game-changer for global development

America's deepening drinking habit

America's poor health is jeopardizing its future

How the world could monitor for potential pandemic viruses

Saving the elderly from coronavirus

Pandemic re-emphasizes need for universal flu vaccine

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