National

Less than 325,000 of America's youngest children are fully vaccinated as hesitancy continues to dog the pandemic response.

Why it matters: Health officials are sounding the alarm over the potential of low child vaccination rates fueling transmission and carrying the risk of severe illness for some of the youngest Americans.

"What's at stake really with this is that we're going to be setting up a bunch of kids for risk of severe disease in the future," Daniel Blatt, a pediatric infectious disease physician at the University of Louisville and Norton Children's Hospital, told Axios.

"We don't really know what the next variant is gonna be. And the way to get ahead of that next variant is to give children a blueprint on how to fight it and that's what the vaccine does." 

Zoom in: In D.C., which has the highest percentage of young children vaccinated, less than one quarter of children 6 months to four years old have received one dose— and 7.5% have received both doses, per the Washington Post. 

The states with some of the lowest child vaccination rates — Alabama, Louisiana and Mississippi — have vaccination rates of less than 0.2%, the Post found. 

The big picture: The Food and Drug Administration in June authorized COVID-19 vaccines for children between 6 months and 5 years — about a year and a half after the first vaccines were made available for vulnerable adults. 

Children under 5 have had the highest rates of hospitalization from COVID among youth, per the CDC.  

State of play: Vaccine hesitancy is typically amplified among parents making decisions about their children's health, Blatt said.

"If a child is going to do something or we're going to do something to a child, a parent will always be more nervous if that child is younger, and we're seeing that with the COVID vaccine." 

Vaccine misinformation and insufficient communication about vaccinations are both contributing to the low rates, Peter Hotez, an infectious-disease physician and pediatrician at the National School of Tropical Medicine at Baylor College of Medicine, told the Post. 

"We haven’t done a good job explaining the long-term developmental consequences of long covid for younger children," Hotez said. 

The bottom line: "We do lots of things for safety for children ... they wear bicycle helmets, they eat nutritious food, they get regular checkups," Blatt said.

"These are things that are part of a routine medical care, and COVID vaccines, just like other routine vaccinations, is just part of the whole picture to keep a child safe."

Experts alarmed by COVID vaccination rates among America's youngest kids

"What's at stake really with this is that we're going to be setting up a bunch of kids for risk of severe disease in the future."

Illustration of a CDC Covid vaccine card with a big question mark drawn on in crayon.

COVID-19

Health

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 number of deaths from traffic accidents declined during the second quarter of 2022 — after seven consecutive quarters of year-to-year increases, the National Highway Traffic Safety Administration said Monday.

Why it matters: Motor vehicle traffic deaths have surged during the pandemic, and Monday's figures indicate that the trend may be cooling — but levels remain higher than before the pandemic.

"Although it is heartening to see a projected decline in roadway deaths in recent months, the number of people dying on roads in this country remains a crisis," Ann Carlson, NHTSA's acting administrator, said in a statement.

Driving the news: Overall, U.S. traffic deaths increased 0.5% during the first half of 2022, in comparison to the same period in 2021, NHTSA found.

Approximately 20,175 people died from traffic accidents during the first half of 2022 — the highest number of deaths during that period since 2006.

Preliminary data from the Federal Highway Administration also shows that vehicle miles traveled during the first half of 2022 increased by about 43.2 billion miles, or 2.8%.

The big picture: Traffic deaths in the U.S. have risen during the pandemic, despite fewer people on the roads.

Buttigieg in January announced a National Roadway Safety Strategy to bolster road safety, which uses layers of protection measures in an attempt to reduce deaths, Axios' Joann Muller reports.

What they're saying: "Traffic deaths appear to be declining for the first time since 2020, but they are still at high levels that call for urgent and sustained action," Transportation Secretary Pete Buttigieg said in a statement. 

"These deaths are preventable, not inevitable, and we should act accordingly." 

Go deeper... Pedestrian deaths hit 40-year high

U.S. traffic deaths fall but issue "remains a crisis"

"These deaths are preventable, not inevitable, and we should act accordingly."

Traffic moves through midtown Manhattan on August 31, 2022 in New York City.

Traffic in midtown Manhattan. Photo: Spencer Platt/Getty Images

National Highway Traffic Safety Administration (NHTSA)

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

Generate

Axios Generate

Three blockbuster storms struck different coasts this weekend, causing widespread damage in Puerto Rico, Alaska and Japan.

The big picture: Each storm either exhibited unusual characteristics in its formation and intensification or in its interaction with built infrastructure.

Their damage offers examples of what we can expect more of in a rapidly warming world.

In Alaska: The most intense storm ever recorded in the Bering Sea during the month of September blasted communities across a 1,000-mile stretch of Alaska's western coastline with hurricane-force winds and record storm surge flooding. 

The villages hit include names familiar to the climate community for being vulnerable to erosion and seeking to move to higher ground, such as Kivalina and Shishmaref.

Severe flooding was also seen in Nome, the endpoint of the Iditarod sled dog race. The flooding there beat any seen since November 1974.

By battering already vulnerable coastal communities, the storm will make them more susceptible to the Bering Sea's notorious winter storms.

In Puerto Rico: Hurricane Fiona struck on Sunday, causing an island-wide blackout that illustrates the country's challenges with repairing its electrical grid in the wake of Hurricane Maria in 2017.

Hardening infrastructure against increasingly potent extreme weather events is a major challenge facing the U.S.

At one point Sunday evening, nearly the entire island was under a flash flood warning, with "catastrophic" flooding underway.

In Japan: Typhoon Nanmadol, the country's fourth-most intense typhoon to make landfall, struck the island of Kyushu on Sunday morning eastern time.

The storm dropped more than two feet of rain in 24 hours on parts of that island, threatening to cause landslides, along with wind and storm surge flooding.

Climate change is enabling hurricanes and typhoons to dump more rainfall and stay stronger further north.

Prior to its landfall, the storm had rapidly intensified — a process with climate change ties and reached Category 4 intensity.

Zoom in: The Alaska storm has the clearest links to climate change from a physical science standpoint, scientists told Axios.

The storm evolved from Typhoon Merbok, which underwent an unusually rapid and explosive transition process over the North Pacific into a storm that feeds off jet stream energy.

Scientists told Axios the storm's formation, transition and impacts have global warming ties.

Tweet about the size of the Alaska storm.

Between the lines: The typhoon formed unusually far to the east, over anomalously warm waters, said Rick Thoman, a climate scientist at the University of Alaska at Fairbanks, via email.

It then passed over record warm waters in the North Pacific, which injected more energy.

"This is surely a climate change connection," Thoman said.

Brian Brettschneider, a climate scientist based in Alaska, said such intense, out-of-season storms may become more frequent as climate change progresses.

Scientists have long warned that rapid Arctic warming, with melting permafrost, sea level rise and longer ice-free seasons would imperil Alaska's coastal communities.

Shaktoolik, an Iñupiat community of about 320 people, lost its protective berm, leaving them fully exposed to future storm surge flooding.

"We're pretty heartbroken," the mayor told Alaska Public Media News.

Three massive storms slam U.S. and Japan, each with climate change ties

Of all the storms, the Alaska cyclone was the largest, engulfing the Bering Sea.

Satellite image showing a massive storm over Alaska in Sept. 2022.

Satellite image showing a massive storm over western Alaska. Image: NOAA

extreme weather

Extreme weather

Climate change

Ominous forecasts about the impact of climate change serve as the backdrop for the world — led by U.S. lawmakers and companies — to debate big action on the problem, which could upend energy systems and our way of life.

Energy & Environment

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

Pro Rata

Axios Pro Rata

The PayPal Mafia has had a good run, but it may be time to shift focus to alumni of a less fashionable Internet pioneer: LinkedIn.

Driving the news: Dylan Field was a data analytics intern at LinkedIn in 2010. He later founded Figma, which last week agreed to sell to Adobe for $20 billion.

His LinkedIn team was led by DJ Patil, who went on to become U.S. chief data scientist and an early exec at both RelateIQ (acquired by Salesforce) and Devoted Health ($15 billion valuation).

Patil, who first met Field when the Figma founder was just 16 years-old, tells Axios: "On my team we had an explicit hosting framework of (1) Would you give 10% of YOUR equity to this person? (2) Would you consider starting a company with this person/ or be in a trench with them for hours (proxy for spending lots of time together and having to be able to work out conflict)? (3) Do you see them doing something amazing in four to six years?"

Field also worked closely with the group led by Adam Nash, who went on to run robo-adviser Wealthfront, is founding CEO at Daffy and was a seed investor in Figma. 

Other unicorn company founders with LinkedIn backgrounds include: Steven Galanis (Cameo), Akshay Kothari (Notion), Jay Kreps & Neha Narkhede (Confluent), Arvind Rajan (Cricket Health), Sid Viswanathan (Truepill) and Gordon Wintrob (Newfront Insurance). Unicorn CEOs include Mike Gamson (Relativity) and Russell Glass (Ginger, now Headspace).

Plus a ton of near-unicorn founders (e.g., Curated's Eduardo Vivas, Superhuman's Rahul Vohra), and a slew of VC firm founders and top partners. 

And, yes, there are through lines between the PayPal and LinkedIn groups. Most notably Greylock's Reid Hoffman (who's played an outsized role in LinkedIn's alumni network) and Founders Fund's Keith Rabois (who also co-founded unicorn company Opendoor). Plus, Field participated in the fellowship program created by PayPal co-founder Peter Thiel.

What they're saying: Jeff Weiner, LinkedIn's CEO for more than 11 years and its current exec chair, explains: "When an organization is truly purpose driven (from vision to values), the underlying ethos that develops may not be singular or proprietary to the company's sense of purpose, but highly supportive of people trying to have positive impact in other ways and at other companies. 

"That's not to say we didn’t work hard to retain our top talent — we did.  However, when recognizing they were destined to do great things elsewhere, as was the case with Dylan at Figma and others that would follow to pursue their own startup dreams, many of us would try to be as supportive as we could through introductions, mentorship, and capital."

Go deeper: Adobe-Figma deal likely to attract antitrust scrutiny

Editor's note: This item has been corrected to identify Mike Gamson and Russell Glass as unicorn CEOs, rather than unicorn founders.

It's time to talk about the LinkedIn Mafia

LinkedIn alums have founded such companies as Figma, Cameo, Confluent and Notion.

Illustration of a golden sparkling briefcase. 

LinkedIn

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

A Russian missile exploded less than 1,000 feet from a nuclear power plant in southern Ukraine in an act that Ukraine's Ministry of Defense called "nuclear terrorism."

Why it matters: The strike, which did not cause immediate casualties, comes days after Russian President Vladimir Putin signaled his intent to escalate attacks on Ukraine's civilian infrastructure after his country faced one of its greatest setbacks of the war.

Driving the news: The missile struck near the South Ukraine Nuclear Power Plant, which is also known as Pivdennoukrainsk, just after midnight local time, per video footage released by Ukraine's Defense Ministry.

"Kremlin's nuclear terrorism continues," the ministry wrote on Twitter. "Russia is the threat to the whole world."

A building was damaged in the strike and "elements of the energy complex were turned off," an adviser to the minister of Internal Affairs of Ukraine said. 

The big picture: The strike landed near the country's second-largest nuclear power station, per the New York Times.

Putin last week warned that his troops would increase attacks on Ukrainian infrastructure if Ukrainian offensives continued, AP reports.

"If the situation develops this way, our response will be more serious," Putin said.

What they're saying: "A few hundred meters and we would have woken up in a completely different reality," Kyrylo Tymoshenko, the deputy head of the Ukrainian president's office, said on Telegram.

Go deeper... Biden: Putin using nuclear weapons would see "consequential” U.S. response

Ukraine says Russian missile strike came close to nuclear reactor

"A few hundred meters and we would have woken up in a completely different reality," a Ukrainian official said.

A Ukrainian woman is seen with a bicycle in front of a demolished building in Izium, Kharkiv Oblast, Ukraine on September 18

A Ukrainian woman with a bicycle in front of a demolished building in Izium, Kharkiv Oblast, Ukraine, on Sept. 18. Photo: Metin Aktas/Anadolu Agency via Getty Images

Russia

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

U.S. Navy veteran Mark Frerichs, who was kidnapped in Afghanistan two years ago, was released Monday by the Taliban in an exchange with Afghan drug kingpin Bashir Noorzai, a senior Biden administration official confirmed to Axios. 

Why it matters: Frerichs, who worked as a contractor for a decade before his kidnapping, is the last remaining American known to be held hostage in Afghanistan, Axios' Zachary Basu reports.

Driving the news: Frerichs was exchanged at the Kabul airport with Noorzai, a drug lord who was serving out a life sentence in the U.S., acting foreign minister Amir Khan Muttaqi said at a news conference, Reuters reports. 

"The Islamic Emirate of Afghanistan is ready to solve problems by negotiation with all, including the United States," Muttaqi said, per Reuters. 

"His release is the culmination of years of tireless work by dedicated public servants across our government and other partner governments, and I want to thank them for all that effort," President Biden said in a statement. 

"Bringing the negotiations that led to Mark’s freedom to a successful resolution required difficult decisions, which I did not take lightly," he said. 

The big picture: The U.S. had been calling for the Taliban to release Frerichs "before it can expect any consideration of its aspirations for legitimacy," Biden said earlier this year. 

The Taliban had previously offered to release Frerichs in exchange for Noorzai, who was sentenced in 2009 to life in prison on drug and conspiracy charges. 

The Biden administration "will continue to work intensively ... to bring home all Americans wrongfully detained or held hostage abroad and Mark’s successful release is evidence of our commitment," the senior administration official said.

What he's saying: "Our priority now is to make sure Mark receives a healthy and safe return and is given the space and time he needs to transition back into society," Biden said.

"My administration continues to prioritize the safe return of all Americans who are held hostage or wrongfully detained abroad, and we will not stop until they are reunited with their families," he added.

"We have much more work to do in many other cases, but Mark’s release demonstrates our enduring commitment."

Go deeper... One year on: Afghanistan in anguish

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

Taliban release American Mark Frerichs in prisoner swap

Frerichs is the last American known to be held hostage in Afghanistan

Bashar Noorzai (C), a warlord and Taliban associate attends press event at the Intercontinental Hotel in Kabul on September 19, 2022.

Bashir Noorzai attends a press event at the Intercontinental Hotel in Kabul on Sept. 19. Photo: Wakil Kohsar/AFP via Getty Images

Afghanistan

Britain and world leaders mourned Queen Elizabeth II, the country's longest-reigning monarch, at a state funeral Monday in Westminster Abbey.

The big picture: The funeral drew presidents, kings, princes and prime ministers — and authorities expected up to 1 million people to line the streets of London.

The queen's coffin was transported to Windsor Castle, where she'll be buried next to her husband, Prince Philip.

The state funeral, the U.K.'s first since Winston Churchill died, included a country-wide moment of silence that lasted for two minutes.

Over the weekend, hundreds of thousands of mourners lined up to file past Queen Elizabeth's coffin lying in state in the 900-year-old Westminster Hall.

The queue stretched five miles with a wait time on Friday of at least 14 hours.

The coffin of Queen Elizabeth II is carried into Westminster Abbey on Monday. Photo: Gareth Cattermole/Getty Images

The coffin of Queen Elizabeth II is carried in The state hearse as it proceeds towards St. George's Chapel on September 19, 2022

The coffin of Queen Elizabeth II is carried in the state hearse. Photo: Ryan Pierse/Getty Images

The hearse carrying the coffin of Queen Elizabeth II travels along the Long Walk. 

The hearse carrying the coffin of Queen Elizabeth II travels along the Long Walk in Windsor. Photo: Jason Alden/Bloomberg via Getty Images

Members of the Royal Household walking corgis near the service at Windsor Castle.

Members of the Royal Household walk corgis near the service at Windsor Castle. Photo: Justin Setterfield/Getty Images

Prince William and Prince Harry follow a gun carriage carrying the coffin of their grandmother. Photo: Emilio Morenatti/Pool via AP

Members of the Royal Family attend the state funeral and burial of Britain's Queen Elizabeth. 

Members of the Royal Family attend the state funeral and burial of Britain's Queen Elizabeth II. Photo: Phil Noble/Pool/AFP via Getty Images

Former UK prime ministers at the State Funeral of Queen Elizabeth II, held at Westminster Abbey, on September 19, 2022 in London, England.

Former UK prime ministers John Major, Tony Blair, Gordon Brown, David Cameron, Theresa May and Boris Johnson arrive at the state funeral. Photo: Jack Hill-WPA Pool/Getty Images

President Biden and first lady Jill Biden arrive today at Westminster Abbey, crossing a green marble memorial to Winston Churchill. Photo: Gareth Cattermole/Pool via AP

 King Charles III and Princess Anne arrive at Westminster Abbey.

King Charles III and Princess Anne arrive at Westminster Abbey. Photo: Getty Images

U.K. Prime Minister Liz Truss delivers a reading during the state funeral of Queen Elizabeth II.

U.K. Prime Minister Liz Truss delivers a reading during the state funeral of Queen Elizabeth II. Photo:  Gareth Cattermole/Getty Images

Coldstream Guards in formation outside Buckingham Palace pay their respects during the state funeral of Queen Elizabeth II.

Coldstream Guards in formation outside Buckingham Palace pay their respects during the state funeral of Queen Elizabeth II. Photo: Chip Somodevilla/Getty Images

The Coldstream Guards travel along The Mall on September 19, 2022 in London, England.

Coldstream Guards travel along The Mall. Photo: Dan Kitwood/Getty Images

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

Britain and world leaders mourn Queen Elizabeth at state funeral

The funeral drew presidents and kings, princes and prime ministers.

The coffin of Queen Elizabeth II with the Imperial State Crown resting on top of it departs Westminster Abbey during the state funeral of Queen Elizabeth II.

The coffin of Queen Elizabeth II with the Imperial State Crown resting on top of it departs Westminster Abbey during the state funeral of Queen Elizabeth II. Photo: Gareth Cattermole/Getty Images

Queen Elizabeth II

Soaring medical debt is setting U.S. adults up for higher risks of eviction, food insecurity and bad health outcomes regardless of insurance or income, a new study found.

Why it matters: Uninsured or middle-to-low-income patients are more likely to get stuck with medical debt while the rich are largely spared. But even private insurance offers little protection against unaffordable bills, according to the study published in JAMA Open Network on Friday.

"Private insurance is a defective product. You pay for it and then when you get sick, there's co-payments, there's deductibles, there's out-of-network fees, there's things that aren't covered at all," said Steffie Woolhandler, a physician and public health professor at Hunter College who co-authored the study. 

The big picture: More than 100 million Americans live with medical debt, per an investigation by Kaiser Health News and NPR.

Mounting costs coupled with stagnant wages can force people into delaying necessary care, taking on multiple jobs, sacrificing essentials like groceries and depleting savings to the point of financial ruin.

Yes, but: People in states that expanded Medicaid reported an average of $3,000 less in medical debt than those in states who hadn’t, signaling a link between comprehensive coverage and lower bills.

This echoes a 2021 Stanford study that found medical debt was highest in the South and among lower-income communities in states without Medicaid expansion

"The idea that we have medical debt, those are all policy decisions," Woolhandler told Axios.

By the numbers: The average amount of medical debt in 2018 was $21,867, according to the researchers' analysis of the Census Bureau's Survey Income and Program Participation.

For those in poor health, the burden rose to nearly $43,000, while uninsured patients had an average debt of more than $38,000.

People with medical debt were two to three times more likely to be unable to pay rent or utilities and experience eviction than those without health care bills, per the study.

Compared to white households, Black and Latino people were more likely to have medical debt, which can affect credit and the ability to build wealth.

Of note: In April, the Biden administration announced a push to lessen the medical debt burden on Americans.

But it doesn't address the impact of not having national health insurance or expanding Medicaid and letting wages determine the level of benefits, said Wes Yin, an economics professor at UCLA who was a co-author of the Stanford study.

"The price of health care keeps on rising at dramatic rates and that has to do with provider consolidation and mergers and acquisition. That really hasn't been shown to benefit health outcomes," Yin told Axios.

The bottom line: "Shining the light on hospitals to solve this deeper issue of household financial vulnerability is like patching the holes on a roof. The root causes here are much deeper than that," Yin said.

Study: Medical debt threatens people's health, housing

A new study found that even private insurance offers little protection against unaffordable bills.

Illustration of a close up of a tower of cards made out of money. 

Medical billing

Markets

Axios Markets

Work-life policies like paid sick and medical leave, as well as reasonable hours and scheduling, are becoming a more high-stakes economic issue, as in-person workers exercise their increased leverage in a tight labor market — and cope with more than two years of working on the front lines of a pandemic.  

Driving the news: A fight over paid sick leave and working conditions almost brought the country's economy to a standstill last week. Railway workers, who say they don't have easy access to paid sick time, were ready to strike if their employers wouldn't improve working conditions.   

These issues make up the human side of the supply chain, which proved fragile in the crisis. 

"These are human beings, you know, they're not machines," says Sharita Gruberg, a vice-president at the National Partnership for Women and Families.

Background: The railroad companies, in an effort to keep costs down and profits up, instituted a restrictive policy requiring employees to be on call more often, and penalizing them with a point-based system for taking unscheduled time off, the New York Times reported.   

Rail workers didn't get any paid sick time, they said. 

During the supply chain crisis, when business picked up, the harsh policies "pushed workers to the limits of their physical and mental health," per the NYT.

The tentative agreement reached last week gives railroad workers unpaid time off for medical care and illness, and sets a key precedent for the unions in bargaining for leave — something they hadn't done before.

Meanwhile: Workers in many fields are more willing to strike, demanding better pay and — crucially — improved conditions, the Wall Street Journal reports, noting that it reflects how the pandemic has reshaped jobs and attitudes about work.

In Minnesota last week, 15,000 nurses walked off the job over stalled contract negotiations. Nurses say they're burned out after three years of working in a pandemic.

Work-life policies are increasingly high-stakes economics

A fight over paid sick leave and working conditions almost brought the country's rail network to a standstill last week

Monday's top stories

Experts alarmed by COVID vaccination rates among America's youngest kids

U.S. traffic deaths fall but issue "remains a crisis"

Three massive storms slam U.S. and Japan, each with climate change ties

It's time to talk about the LinkedIn Mafia

Ukraine says Russian missile strike came close to nuclear reactor

Taliban release American Mark Frerichs in prisoner swap

Britain and world leaders mourn Queen Elizabeth at state funeral

Study: Medical debt threatens people's health, housing

Work-life policies are increasingly high-stakes economics

Recycling data centers' heat could be an environmental win-win

Employers' coming health care crunch

Hurricane Fiona brings "catastrophic" flooding, power outages to Puerto Rico

Biden: U.S. forces would defend Taiwan if China's military invaded

Biden: "The pandemic is over"