Category: Public Health

In Closed-Door UN Meetings, Trump Administration Officials Pushed Abstinence For International Women’s Health Programs

In closed-door meetings at the United Nations in March, Trump administration officials pushed socially conservative views on women’s rights issues — including abstinence-based policies over information about contraception — that were further to the right than those expressed by most other countries present, including Russia and the representative for the Arab states, UN officials who attended the meetings told BuzzFeed News.

The Trump officials’ approach at the UN meeting makes it clear that the administration intends to extend its views on abortion, contraception, and sexual education beyond US borders to an extent that is unusual even for Republican administrations.

The comments came during the annual UN Commission on the Status of Women, a two-week session described by a spokesperson for the US Mission to the United Nations as the UN’s “most important meeting on women’s empowerment.” The main event is a closed-door negotiation on language to include in an annual UN document that sets global standards and outlines potential policies pertaining to gender equality efforts in all member countries.

Early in this series of meetings, Bethany Kozma — a senior adviser for gender equality and women’s empowerment at the US Agency for International Development (USAID) and anti-transgender activist — emphasized that the US was a “pro-life nation,” sparking a strong reaction from delegates in the room, two officials in the room confirmed to BuzzFeed News.

“When she said that there was sort of a record scratch and silence,” one UN official who participated in the negotiations but asked not to be named so as to maintain a working relationship with the other member states present told BuzzFeed News. “Everyone was like, ‘are you kidding me?’”

Shannon Kowalski, the director of the International Women’s Health Coalition, said that the Trump administration’s stances on women’s health presented in the meeting were “further to the right” than they were at last year’s commission, or even under George W. Bush’s administration. While the Bush administration implemented anti-abortion policies abroad, the scope was limited to family planning programs. Trump’s policies already expand beyond those limits.

“They’re far more extreme than the US was under the Bush administration,” Kowalski told BuzzFeed News shortly after the session wrapped up. “We saw placement of ideologues within key roles who took similar positions back then, but they limited what they applied their views to.”

Throughout the two-week session, Trump administration officials discussed shifting international policy on women toward abstinence-oriented education and teaching women sexual “refusal skills.” Those views — as well as the US’s push for more conservative policies on immigration, trade and environmental regulation — ended up uniting most of the 45 CSW member states against the US on family planning issues, six sources who attended or were familiar with meetings told BuzzFeed News.

While negotiations at the UN are often political, two officials familiar with the negotiations said that they had never seen nearly all of the other membership states — many of whom have wildly different stances and priorities on family planning issues — come together against the US. The members include several countries where abortion is illegal and punishable by fines or jail time.

The Trump administration has not been shy about its stance on abortion. On his third day in office, President Donald Trump instated an expanded version of the Mexico City Policy, a rule that prevents the US from funding organizations that provide or discuss abortions with the populations they serve. While most Republican presidents have used that policy, Trump’s version applies to all US health funding abroad — not just family planning funds that prior Republican administrations regulated. This includes organizations devoted to curbing HIV/AIDS, which the Bush administration left alone, Kowalski said.

[Buzzfeed]

Notes, emails reveal Trump appointees’ war to end HHS teen pregnancy program

The Trump administration’s abrupt cancellation of a federal program to prevent teen pregnancy last year was directed by political appointees over the objections of career experts in the Department of Health and Human Services, which administers the program, according to internal notes and emails obtained by NBC News.

The trove shows three appointees with strict pro-abstinence beliefs — including Valerie Huber, the then-chief of staff for the department’s Office of the Assistant Secretary for Health — guided the process to end a program many medical professionals credit with helping to bring the nation’s teen pregnancy rate to an all-time low.

Prior to serving at HHS, Huber was the president of Ascend, an association that promotes abstinence until marriage as the best way to prevent teen pregnancy.

The $213 million Teen Pregnancy Prevention Program was aimed at helping teenagers understand how to avoid unwanted pregnancies. It had bipartisan support in Congress and trained more than 7,000 health professionals and supported 3,000 community-based organizations since its inception in 2010.

In the notes provided to NBC News, Evelyn Kappeler, who for eight years has led the Office of Adolescent Health, which administers the program, repeatedly expressed concerns about terminating the program, but appeared out of the decision-making loop and at one point was driven to tears.

In a July 17, 2017 note, she says she was admonished to “get in line” and told it was not her place to ask questions about the agency’s use of funds. In a July 28 note, Kappeler recalled she was “frustrated about the time this process is taking and the fact that (her staff) has not been part of the discussions.” She described being “so rattled” that “my reaction when I got on (sic) the phone was to cry.”

She and her staff “were not aware of the grant action until the last minute” — an apparent reference to the decision, it says.

Last month, Democracy Forward, a nonprofit law firm and advocacy group, sued the administration for unlawfully terminating the program after the agency took months to respond to its Freedom of Information Act request.

The group claims the newly obtained emails show that HHS violated the Administrative Procedure Act that bars arbitrary decision-making and that the political appointees thwarted the will of Congress.

“Now that we’ve seen these documents, there is no question to us why the Trump administration withheld” the emails, said Skye Perryman, the group’s lawyer. The decision to end the program “was made hastily, without a record of any reasoned decision making and under the influence of political appointees who have long opposed evidenced-based policy,” she said.

Parties suing over the action include the city of Baltimore and the Healthy Teen Network, which represents grantees across the country.

HHS has given different explanations about its decision to terminate the program, including claims that it was ineffective or that it did not conform to the president’s proposed budget. HHS did not respond to emails or answer questions about who was responsible for ending the program.

HHS spokesman Mark Vafiades directed NBC News to a fact sheet and announcement on the agency’s website. They state that 73 percent of the projects funded by the program “had no impact or had a negative impact on teen behavior, with some teens more likely to begin having sex, to engage in unprotected sex or to become pregnant.”

“The evidence stands in stark contrast to the promised results,” the statement says.

The story behind the program’s demise is one of a growing list of examples of the control Trump political appointees are exerting at federal agencies.

It is also part of a broader narrative about programs benefiting women and children becoming political targets under a president who insists he is an advocate for women’s rights and health. Under Trump, a mandate under the Affordable Care Act to cover contraceptive coverage has been rolled back, while Republicans in Congress have sought to defund Planned Parenthood and proposed budget cuts to Medicaid, which covers half of all births.

In July 2017, the Office of Adolescent Health notified 81 grantees including the University of New Mexico Health Sciences Center and Cuyahoga County, Ohio, that it would be discontinuing funding under the Obama-era program beginning this June, with some programs cut off immediately.

After the program’s 2010 inception, teen pregnancy and birth rates fell faster than ever. Health care experts say considerable research and money that has already been invested in the program will be wasted and the number of at-risk teens will increase.

The president of the American College of Obstetricians & Gynecologists and women’s health advocacy groups, such as Planned Parenthood, have expressed alarm.

Haywood L. Brown, president of ACOG, called the program “vital.” The administration’s decision, Brown said in a statement, is “highly unusual” and a “step backward for ensuring healthy moms and healthy babies.”

In an op-ed last year, Ron Haskins, previously a Republican co-chair of a bipartisan commission on evidence-based policy making established by House Speaker Paul Ryan, R-Wis., said that by ending the program, Trump has “exploded one of our most promising evidence-based programs.”

In a June 21 note by Kappeler, Steven Valentine, Huber’s deputy, is described as having “taken the lead” in reversing the program. Valentine directed Kappeler to halt the review process for the grants, the notes say.

Before coming to HHS, Valentine was a legislative assistant to Rep. Chris Smith, R-N.J., an outspoken abortion rights opponent. Valentine also worked for a short time at the Susan B. Anthony List, a political organization that supports candidates who oppose abortion rights.

Don Wright, a senior career official at HHS, stated in a July 28 email to Kappeler that he himself was only “tangentially” involved in the discussions about the program’s termination. But one set of notes documents him instructing skeptical career staff members on the appropriate behavior of civil servants. He later complained to Kappeler about “rolling of the eyes by some staff,” her notes say.

Weeks later, Wright was made acting secretary of the department.

Also according Kappeler’s notes, some staff “expressed concerns about being able to ask questions in this environment and the lack of engagement by policy staff directly with the program office.”

Kappeler’s memos “are quite revealing of the agency’s improper and unlawful decision making,” said Perryman, Democracy Forward’s lawyer.

“The documents also show HHS disregarded the views of experienced career employees including those of the director of the Office of Adolescent Health,” she said.

Another appointee involved in terminating the teen pregnancy program was Teresa Manning, an anti-abortion activist and Trump appointee who was in charge of the department’s family planning programs and who has publicly questioned the efficacy of several popular contraception methods. She was previously a lobbyist for the National Right to Life Committee and for the Family Research Council. In January, Manning abruptly resigned.

In November, HHS announced a $10 million research initiative to ensure “any sex education programs follow the science to improve youth health and well-being,” including “sexual risk avoidance.”

Despite their popularity in some conservative regions and school districts, abstinence-only programs have been shown not to work.

A June 2005 study conducted by Case Western Reserve University found that the sexual education programs that Huber ran in Ohio promoting abstinence-only education had “critical problems.” The study suggested the program conveyed “false and misleading information” about abortion, contraceptives and sexually transmitted infections and misrepresented “religious convictions as scientific fact.”

In King County, Washington — one of the parties in the suit challenging the program’s termination — grantees created a 15-lesson sex education curriculum known as Family Life and Sexual Health (FLASH).

The FLASH program educates students on options including abstinence, the use of birth control and the importance of consent before engaging in sexual activity. It is now used in 44 states and taught in every school district in King County, which has seen a 63 percent drop in teen pregnancies since 2008.

King County was granted $5 million to conduct the first scientific evaluation of the FLASH program, and now it is unable to complete the study. The $3 million already spent is now wasted taxpayer dollars, according to King County spokesman James Apa.

[NBC News]

Reality

Data shows clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S

Trump’s DOJ goes after Wisconsin county for pushing nurse assistant to get flu shot against her ‘sincerely held Christian belief’

The Trump Justice Department is suing Wisconsin’s Ozaukee County for alleged civil rights violations after requiring a worker at a county-run nursing home to get a flu shot — an action she said is against her religious beliefs.

Christian Post reported Wednesday that nursing assistant Barnell Williams, who worked Lasata Care Center in a town roughly 26 miles north of Milwaukee, spoke with her highest-ranking supervisor about getting a religious exemption for a policy requiring employees to get flu shots.

“Under the nursing home’s then policy,” the Christian Post noted, “an employee’s failure to receive the mandatory shot without a formal religious or medical exemption, was deemed a ‘voluntary resignation.’”

Based on her interpretation of the Bible, Williams told Campus Administrator Ralph Luedtke it was her “sincerely held Christian beliefs” that she could not put “certain foreign substances, including vaccinations, in her body because it is a ‘Holy Temple.’”

The administrator told Williams she’d need a signed letter from her pastor attesting to that belief, and when she explained that she was unaffiliated with any church, Luedtke gave her an ultimatum — get the shot or “consider this your last day.”

Williams acquiesced and got the shot, but immediately “became emotionally distraught and cried uncontrollably” in the aftermath, the DOJ’s lawsuit claims.

“Williams suffered severe emotional distress from receiving the flu shot in violation of her religious beliefs, including withdrawing from work and her personal life, suffering from sleep problems, anxiety, and fear of ‘going to Hell’ because she had disobeyed the Bible by receiving the shot,” it continued.

The suit claims that Lasata Care Center “could have reasonably accommodated Williams’ religious objection to receiving the mandatory flu shot,” and noted that it has in the interim changed its policy and no longer requires letters from clergy for religious exemptions.

[Raw Story]

Major EPA reorganization will end science research program

A federal environmental program that distributes grants to test the effects of chemical exposure on adults and children is being shuttered amidst a major organization consolidation at the Environmental Protection Agency (EPA).

The National Center for Environmental Research (NCER) will no longer exist following plans to combine three EPA offices, the agency confirmed to The Hill Monday.

The program provides millions of dollars in grants each year.

Perhaps best known for its handling of fellowships that study the effects of chemicals on children’s health, NCER will be dissolved and science staff serving there will be reassigned elsewhere within the department, EPA said.

The merger will involve EPA’s Office of Administrative and Research Support, Office of Program Accountability and Resource Management, and the grants and contracts managed by NCER to create a new Office of Resource Management.

Other EPA functions consolidated into the new office include the handling of Freedom of Information Act (FOIA) requests, records management and budget formulation functions.

An EPA spokesperson said the extensive organizational changes are meant to create more efficiency within the agency.

“EPA’s Office of Research and Development is one of the world’s leading environmental and human health research organizations. In order to maintain the quality and focus of our research, senior leaders from the research and development office are proactively taking steps to create management efficiencies within the organization,” the spokesperson said. “These changes will help EPA’s Office of Research and Development be more responsive to agency priorities and funding realities.”

Both of the White House’s fiscal 2018 and 2019 budgets proposed zeroing out major programs under NCER, but the cuts were not taken up in the most recent congressional budget.

An EPA spokesperson said that under the planned overhaul, employees currently working at NCER will not be fired, but may have their positions altered.

“At the appropriate time, the science staff currently in NCER will be redeployed to the ORD labs/centers/offices matching their expertise to organizational needs. This reorganization could result in a change of positions or functions. Staff in the affected organizations will retain the grade and career ladder of their position of record,” the spokesperson said.

NCER is largely known for the funding it provides through its premiere program, Science To Achieve Results (STAR). Under the STAR program, grants are given to the Children’s Environmental Health and Disease Prevention Research Centers, which were established in 1988 to discover methods to reduce children’s health risks from environmental factors.

“Those programs have been so successful in advancing our scientific understanding and our ability to address the ways that environmental chemicals can impact children’s health,” said Tracey Woodruff, a former senior scientist and policy advisor at the EPA under the Clinton and Bush administrations. “The children centers were really the first and only centers to undercover the relationship with prenatal exposure to flame retardants and IQ deficiencies in children.”

A report released by the National Academy of Sciences last year that was compiled at EPA’s request, championed the STAR program for its “numerous successes.”

“STAR has had numerous successes, such as in research on human health implications of air pollution, on environmental effects on children’s health and well-being, on interactions between climate change and air quality, and on the human health implications of nanoparticles. Those are just a few examples; many more could be cited,” the report read.

Woodruff called the decision to merge NCER with the other offices, which currently do not focus on handling grants, extremely concerning.

“They make it sound like this is a way to create efficiency, but it masks what’s happening to this actually programmatic, scientific function of NCER and the STAR program. That makes you think, ‘Is this really just an efficiency argument masking their real intention to get rid of the research grant program, which they have said they want to do in the past?’ she said. “Answering FOIAs and administering scientific grants are not the same thing.”

EPA has recently acknowledged a slow-down in the rate of FOIA requests answered, citing a backlog in previous requests made under the Obama administration and an uptick in FOIA requests sent since President Trump took office.

The EPA official did not acknowledge how the agency rearrangement may address those issues.

[The Hill]

Trump’s Plan to Solve the Opioid Crisis Might Involve Executing Drug Dealers

While signing a bill that aims to combat the opioid crisis last month, President Trump hinted that he’d come up with the solution to the complex problem, but couldn’t talk about it.

“There is an answer. I think I actually know the answer, but I’m not sure the country is ready for it yet,” Trump said. “Does anybody know what I mean? I think so.”

No one knew what he meant. “Yeah, I wondered about that,” said Republican Senator Shelley Moore Capito, who was at the signing. “I didn’t follow up and ask.”

Many dismissed the comment as more of Trump’s regular, incoherent ramblings. However, now it seems the president may actually have a secret plan to fight the opioid epidemic, beyond hiring a 24-year-old ingenue as his deputy drug czar and an ad campaign that was supposed to launch during the Super Bowl but didn’t come together in time. Axios’s Jonathan Swan reports that he’s been telling friends for months that drug dealers should face the death penalty, citing policies in Singapore and the Philippines.

“He says that a lot,” said a source. “He says, ‘When I ask the prime minister of Singapore do they have a drug problem [the prime minister replies,] ‘No. Death penalty’.”

Trump is reportedly convinced that the key to ending America’s drug problems is making dealers fear for their lives and kids fear that even trying drugs will kill them — but he’s also acknowledged that the U.S. probably won’t pass a law mandating that all drug dealers be executed.

Kellyanne Conway, who is leading the administration’s anti-drug efforts, told Swan that Trump’s plan is more nuanced. “The president makes a distinction between those that are languishing in prison for low-level drug offenses and the kingpins hauling thousands of lethal doses of fentanyl into communities, that are responsible for many casualties in a single weekend,” she said.

In lieu of mass executions, the White House may push to toughen drug-sentencing laws. Per Axios:

Trump may back legislation requiring a five-year mandatory minimum sentence for traffickers who deal as little as two grams of fentanyl. Currently, you have to deal forty grams to trigger the mandatory five-year sentence. (The DEA estimates that as little as two milligrams is enough to kill people.)

Singapore has some of the strictest drug laws in the world. Police can perform random drug tests and those who test positive can face years-long sentences. Those caught with more than a few grams of certain drugs are presumed to be trafficking, and in higher quantities offenders are sentenced to death. In the Philippines, President Rodrigo Duterte instituted a brutal crackdown on both drug dealers and drug users in 2016. While the government claims that fewer than 4,000 suspects have been killed, Human Rights Watch puts the number at more than 12,000.

Trump has made it clear that unlike his predecessor, he has a cosy relationship with Duterte. He invited him to visit the White House, ignored questions about human-rights abuses during their first meeting in the Philippines, and congratulated him for doing an “unbelievable job on the drug problem” during a phone call. It was assumed that this was all part of Trump’s general admiration for authoritarian leaders, but perhaps he’s been taking more specific policy inspiration.

[New York Magazine]

Reality

The Eighth Amendment to the United States Constitution states that “cruel and unusual punishments [shall not be] inflicted.” The general principles the United States Supreme Court relied on to decide whether or not a particular punishment was cruel and unusual were determined by Justice William Brennan.[4] In Furman v. Georgia, 408 U.S. 238 (1972), Justice Brennan wrote, “There are, then, four principles by which we may determine whether a particular punishment is ‘cruel and unusual’.”

  • The “essential predicate” is “that a punishment must not by its severity be degrading to human dignity,” especially torture.
  • “A severe punishment that is obviously inflicted in wholly arbitrary fashion.” (Furman v. Georgia temporarily suspended capital punishment for this reason.)
  • “A severe punishment that is clearly and totally rejected throughout society.”
  • “A severe punishment that is patently unnecessary.”

And he added: “The function of these principles, after all, is simply to provide means by which a court can determine whether a challenged punishment comports with human dignity. They are, therefore, interrelated, and, in most cases, it will be their convergence that will justify the conclusion that a punishment is “cruel and unusual.” The test, then, will ordinarily be a cumulative one: if a punishment is unusually severe, if there is a strong probability that it is inflicted arbitrarily, if it is substantially rejected by contemporary society, and if there is no reason to believe that it serves any penal purpose more effectively than some less severe punishment, then the continued infliction of that punishment violates the command of the Clause that the State may not inflict inhuman and uncivilized punishments upon those convicted of crimes.”

Continuing, he wrote that he expected that no state would pass a law obviously violating any one of these principles, so court decisions regarding the Eighth Amendment would involve a “cumulative” analysis of the implication of each of the four principles. In this way the United States Supreme Court “set the standard that a punishment would be cruel and unusual [,if] it was too severe for the crime, [if] it was arbitrary, if it offended society’s sense of justice, or if it was not more effective than a less severe penalty.”

Kellyanne Conway’s ‘opioid cabinet’ sidelines drug czar’s experts

President Donald Trump’s war on opioids is beginning to look more like a war on his drug policy office.

White House counselor Kellyanne Conway has taken control of the opioids agenda, quietly freezing out drug policy professionals and relying instead on political staff to address a lethal crisis claiming about 175 lives a day. The main response so far has been to call for a border wall and to promise a “just say no” campaign.

Trump is expected to propose massive cuts this month to the “drug czar” office, just as he attempted in last year’s budget before backing off. He hasn’t named a permanent director for the office, and the chief of staff was sacked in December. For months, the office’s top political appointee was a 24-year-old Trump campaign staffer with no relevant qualifications. Its senior leadership consists of a skeleton crew of three political appointees, down from nine a year ago.

“It’s fair to say the ONDCP has pretty much been systematically excluded from key decisions about opioids and the strategy moving forward,” said a former Trump administration staffer, using shorthand for the Office of National Drug Control Policy, which has steered federal drug policy since the Reagan years.

The office’s acting director, Rich Baum, who had served in the office for decades before Trump tapped him as the temporary leader, has not been invited to Conway’s opioid cabinet meetings, according to his close associates. His schedule, obtained under a Freedom of Information Act request, included no mention of the meetings. Two political appointees from Baum’s office, neither of whom are drug policy experts, attend on the office’s behalf, alongside officials from across the federal government, from HHS to Defense. A White House spokesperson declined to disclose who attends the meetings, and Baum did not respond to a request for comment, although the White House later forwarded an email in which Baum stressed the office’s central role in developing national drug strategy.

The upheaval in the drug policy office illustrates the Trump administration’s inconsistency in creating a real vision on the opioids crisis. Trump declared a public health emergency at a televised White House event and talked frequently about the devastating human toll of overdoses and addiction. But critics say he hasn’t followed through with a consistent, comprehensive response.

He has endorsed anti-drug messaging and tougher law enforcement. But he ignored many of the recommendations from former New Jersey Gov. Chris Christie’s presidential commission about public health approaches to addiction, access to treatment, and education for doctors who prescribe opioids. And he hasn’t maintained a public focus. In Ohio just this week, it was first lady Melania Trump who attended an opioid event at a children’s hospital. The president toured a manufacturing plant and gave a speech on tax cuts.

Much of the White House messaging bolsters the president’s call for a border wall, depicting the opioid epidemic as an imported crisis, not one that is largely home-grown and complex, fueled by both legal but addictive painkillers and lethal street drugs like heroin and fentanyl.

“I don’t know what the agency is doing. I really don’t,” said Regina LaBelle, who was the drug office’s chief of staff in the Obama administration. “They aren’t at the level of visibility you’d think they’d be at by now.”

Conway touts her opioids effort as policy-driven, telling POLITICO recently that her circle of advisers help “formalize and centralize strategy, coordinate policy, scheduling and public awareness” across government agencies.

That’s exactly what the drug czar has traditionally done.

Conway’s role has also caused confusion on the Hill. For instance, the Senate HELP Committee’s staff has been in touch with both Conway and the White House domestic policy officials, according to chairman Lamar Alexander’s office. But lawmakers who have been leaders on opioid policy and who are accustomed to working with the drug czar office, haven’t seen outreach from Conway or her cabinet.

“I haven’t talked to Kellyanne at all and I’m from the worst state for this,” said Sen. Shelley Moore Capito, a Republican from West Virginia, which has the country’s highest overdose death rate. “I’m uncertain of her role.” The office of Sen. Rob Portman (R-Ohio), another leader on opioid policy, echoed that — although Portman’s wife, Jane, and Conway were both at the event with Melania Trump this week.

Some drug abuse experts and Hill allies find a silver lining, noting that Conway’s high rank brings White House muscle and attention.

“If I want technical advice, I’m going to work with Baum,” said Rep. Tom MacArthur (R-NJ), a co-chair of the Bipartisan Heroin Task Force. “If I want to get a message to the president, Kellyanne is somebody that I know I can talk to.”

“It’s a really good sign that one of the president’s top advisers has been assigned to such an important topic,” said Jessica Hulsey Nickel, president and CEO of the Addiction Policy Forum.

Baum’s email called the drug office the “lead Federal entity in charge of crafting, publishing and overseeing the implementation of President Trump’s National Drug Control Strategy,” which multiple agencies review. He called Conway’s opioids cabinet an “interagency coordinating apparatus for public-facing opioids-related initiatives” and said that it was not overseeing national policy. But several administration officials did say her cabinet was indeed focused on a variety of policies.

Whatever Conway’s ties to the president, her career has been in polling and politics, not public health, substance abuse, or law enforcement.

Some of her “cabinet” participants do have a broad, general health policy background. But they don’t match the experience and expertise of the drug office’s professional staff. In her circle is Lance Leggitt, the deputy director of the White House’s Domestic Policy Council who was also chief of staff to former HHS Secretary Tom Price. Another top Price aide, Nina Schaefer, recently returned to the Heritage Foundation. The conservative think tank then touted her as having managed “the development of the HHS response to the opioid abuse crisis,” but when POLITICO recently tried to contact her, she said through a spokesperson she was not an expert on the topic.

Among the people working on the public education campaign that Trump promised is Andrew Giuliani, Rudy Giuliani’s 32-year-old son, who is a White House public liaison and has no background in drug policy, multiple administration sources told POLITICO. Nor has Conway spent her career in the anti-opioid trenches.

“Kellyanne Conway is not an expert in this field,” said Andrew Kessler, the founder of Slingshot Solutions, a consulting group that’s worked on substance abuse with many federal agencies. “She may be a political operative and a good political operative,” he added. “But look. When you appoint a secretary of Labor, you want someone with a labor background. When you appoint a secretary of Defense, you want someone with a defense background. The opioid epidemic needs leadership that ‘speaks’ the language of drug policy.”

The set-up befuddles other experts who’ve worked on substance abuse for prior administrations. Fresh ideas are fine, they say. But the drug office has a purpose.

“The whole reason we created ONDCP in 1988 was to be a coordinating force with power in the government and to bring together 20 agencies, many reluctant to be involved in drug control,” said Bob Weiner, who served in that office in both the George W. Bush and Clinton White Houses. “This is exactly when the agency should get maximum support from the White House,” he added.

An ONDCP spokesperson told POLITICO the office “works closely with other federal agencies and White House offices, including Kellyanne Conway’s office, to combat the opioid crisis” but declined to say whether the office’s career experts have attended any of her “opioids cabinet” sessions. The drug office is still crafting the annual drug control strategy, outside the Conway group, administration officials said.

A senior White House official confirmed that officials considered kicking off the media campaign with a big splash during the Super Bowl, but that fell through. Beyond that, many experts on drug policy and substance abuse say messaging alone won’t solve the problem anyway. People with addiction need treatment, and many people get addicted in the first place to painkillers their doctors have prescribed. An ad campaign won’t solve that.

One big test for the drug office will come when Trump releases his budget Monday, which is expected to slash the office’s budget, turning much of its work over to HHS and the Department of Justice. Both departments are developing their own opioid approaches; in past administrations, the drug czar would have coordinated. Lawmakers are already sounding the alarms over the budget plan.

A bipartisan group of senators last week wrote a letter to White House budget director Mick Mulvaney, urging him to reconsider and maintain the office’s programs that “prevent and fight against the scourge of drug abuse.”

Pushback to a similar proposal last year led the Trump administration to reverse the decision and maintain the office’s budget. Lawmakers hope that there will be a similar outcome this time — along with a smarter utilization of the drug policy office.

“What we haven’t seen is the kind of coordination of critical programs that ONDCP has traditionally done,” said Sen. Maggie Hassan, a Democrat from New Hampshire, another state with one of the highest overdose death rates in the country.

Trump officials say it was the Obama administration that began undermining the drug policy office, demoting the director from the Cabinet, shrinking the staff and stressing the health aspects more than a law enforcement-focused “war on drugs.” They say the emergency requires a new approach.

Bob Dupont, who served as the second White House drug czar under President Gerald Ford, before the formal drug policy office was created, and still informally advises the Justice Department on drug policy, believes the White House will eventually realize it needs the expertise that ONDCP has to offer.

The West Wing doesn’t “have the staff or capability” to carry out drug policy work like ONDCP does, Dupont told POLITICO. “I don’t think swashbuckling your approach is going to last very long.”

[Politico]

CDC to cut by 80 percent efforts to prevent global disease outbreak

Four years after the United States pledged to help the world fight infectious-disease epidemics such as Ebola, the Centers for Disease Control and Prevention is dramatically downsizing its epidemic prevention activities in 39 out of 49 countries because money is running out, U.S. government officials said.

The CDC programs, part of a global health security initiative, train front-line workers in outbreak detection and work to strengthen laboratory and emergency response systems in countries where disease risks are greatest. The goal is to stop future outbreaks at their source.

Most of the funding comes from a one-time, five-year emergency package that Congress approved to respond to the 2014 Ebola epidemic in West Africa. About $600 million was awarded to the CDC to help countries prevent infectious-disease threats from becoming epidemics. That money is slated to run out by September 2019. Despite statements from President Trump and senior administration officials affirming the importance of controlling outbreaks, officials and global infectious-disease experts are not anticipating that the administration will budget additional resources.

Two weeks ago, the CDC began notifying staffers and officials abroad about its plan to downsize these activities, because officials assume there will be “no new resources,” said a senior government official speaking on the condition of anonymity to discuss budget matters. Notice is being given now to CDC country directors “as the very first phase of a transition,” the official said. There is a need for “forward planning,” the official said, to accommodate longer advance notice for staffers and for leases and property agreements. The downsizing decision was first reported by the Wall Street Journal.

The CDC plans to narrow its focus to 10 “priority countries,” starting in October 2019, the official said. They are India, Thailand and Vietnam in Asia; Jordan in the Middle East; Kenya, Uganda, Liberia, Nigeria and Senegal in Africa; and Guatemala in Central America.

Countries where the CDC is planning to scale back include some of the world’s hot spots for emerging infectious disease, such as China, Pakistan, Haiti, Rwanda and Congo. Last year, when Congo experienced a potentially deadly Ebola outbreak in a remote, forested area, CDC-trained disease detectives and rapid responders helped contain it quickly.

In Congo’s capital of Kinshasa, an emergency operations center established last year with CDC funding is operational but still needs staffers to be trained and protocols and systems to be put in place so data can be collected accurately from across the country, said Carolyn Reynolds, a vice president at PATH, a global health technology nonprofit group that helped the Congolese set up the center.

This next phase of work may be at risk if CDC cuts back its support, she said. “It would be akin to building the firehouse without providing the trained firemen and information and tools to fight the fire,” Reynolds said in an email.

If more funding becomes available in the fiscal year that starts Oct. 1, the CDC could resume work in China and Congo, as well as Ethiopia, Indonesia and Sierra Leone, another government official said, also speaking on the condition of anonymity to discuss budget matters.

In the meantime, the CDC will continue its work with dozens of countries on other public health issues, such as HIV, tuberculosis, malaria, polio eradication, vaccine-preventable diseases, influenza and emerging infectious diseases.

Global health organizations said critical momentum will be lost if epidemic prevention funding is reduced, leaving the world unprepared for the next outbreak. The risks of deadly and costly pandemic threats are higher than ever, especially in low- and middle-income countries with the weakest public health systems, experts say. A rapid response by a country can mean the difference between an isolated outbreak and a global catastrophe. In less than 36 hours, infectious disease and pathogens can travel from a remote village to major cities on any continent to become a global crisis.

On Monday, a coalition of global health organizations representing more than 200 groups and companies sent a letter to U.S. Health and Human Services Secretary Alex Azar asking the administration to reconsider the planned reductions to programs they described as essential to health and national security.

“Not only will CDC be forced to narrow its countries of operations, but the U.S. also stands to lose vital information about epidemic threats garnered on the ground through trusted relationships, real-time surveillance, and research,” wrote the coalition, which included the Global Health Security Agenda Consortium and the Global Health Council.

The coalition also warned that complacency after outbreaks have been contained leads to funding cuts, followed by ever more costly outbreaks. The Ebola outbreak cost U.S. taxpayers $5.4 billion in emergency supplemental funding, forced several U.S. cities to spend millions in containment, disrupted global business and required the deployment of the U.S. military to address the threat.

“This is the front line against terrible organisms,” said Tom Frieden, the former CDC director who led the agency during the Ebola and Zika outbreaks. He now heads Resolve to Save Lives, a global initiative to prevent epidemics. Referring to dangerous pathogens, he said: “Like terrorism, you can’t fight it just within our borders. You’ve got to fight epidemic diseases where they emerge.”

Without additional help, low-income countries are not going to be able to maintain laboratory networks to detect dangerous pathogens, Frieden said. “Either we help or hope we get lucky it isn’t an epidemic that travelers will catch or spread to our country,” Frieden said.

The U.S. downsizing could also lead other countries to cut back or drop out from “the most serious multinational effort in many years to stop epidemics at their sources overseas,” said Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.

CDC spokeswoman Kathy Harben said the agency and federal partners remain committed to “prevent, detect and respond to infectious disease threats.”

The United States helped launch an initiative known as the Global Health Security Agenda in 2014 to help countries reduce their vulnerabilities to public health threats. More than 60 countries now participate in that effort. At a meeting in Uganda in the fall, administration officials led by Tim Ziemer, the White House senior director for global health security, affirmed U.S. support to extend the initiative to 2024.

“The world remains under-prepared to prevent, detect, and respond to infectious disease outbreaks, whether naturally occurring, accidental, or deliberately released,” Ziemer wrote in a blog post before the meeting. “. . . We recognize that the cost of failing to control outbreaks and losing lives is far greater than the cost of prevention.”

The CDC has about $150 million remaining from the one-time Ebola emergency package for these global health security programs, the senior government official said. That money will be used this year and in fiscal 2019, but without substantial new resources, that leaves only the agency’s core annual budget, which has remained flat at about $50 million to $60 million.

Officials at the CDC, the Department of Health and Human Services and the National Security Council pushed for more funding in the president’s fiscal 2019 budget to be released this month. A senior government official said Thursday that the president’s budget “will include details on global health security funding,” but declined to elaborate.

[Washington Post]

Trump administration ends EPA clean air policy opposed by fossil fuel companies

The Trump administration announced Thursday it is doing away with a decades-old air emissions policy opposed by fossil fuel companies, a move that environmental groups say will result in more pollution. The Environmental Protection Agency (EPA) said it was withdrawing the “once-in always-in” policy under the Clean Air Act, which dictated how major sources of hazardous air pollutants are regulated.

Under the EPA’s new interpretation, such “major sources” as coal-fired power plants can be reclassified as “area sources” when their emissions fall below mandated limits, subjecting them to differing standards.

Though formal notice of the reversal has not yet been filed, EPA said the policy it has followed since 1995 relied on an incorrect interpretation of the landmark anti-pollution law.

“This guidance is based on a plain language reading of the statute that is in line with EPA’s guidance for other provisions of the Clean Air Act,” said Bill Wehrum, assistant administrator of EPA’s Office of Air and Radiation. “It will reduce regulatory burden for industries and the states, while continuing to ensure stringent and effective controls on hazardous air pollutants.”

Prior to his confirmation by the GOP-dominated Senate in November, Wehrum worked as a lawyer representing fossil fuel and chemical companies. The American Petroleum Institute was among the industry groups that had called for the longstanding policy to be scraped.

The Clean Air Act defines a “major source” as one that has the potential to emit 10 tons or more per year of any hazardous air pollutant, or 25 tons per year of any combination of hazardous air pollutants. For more than 20 years, EPA’s “once-in always-in” required major sources to remain subject to stricter control standards, even if they took steps to reduce their pollution below the threshold.

Republicans quickly cheered the move by EPA Administrator Scott Pruitt, especially those from states that produce oil, gas and coal.

“The EPA’s decision today is consistent with President Trump’s agenda to keep America’s air clean and our economy growing,” said Senate Environment Committee Chairman John Barrasso of Wyoming. “Withdrawal of this policy means manufacturers, oil and gas operations, and other types of industrial facilities will have greater incentive to reduce emissions.”

Environmentalists predicted the change would drastically weaken limits on toxic heavy metals emitted from power-plant smokestacks.

“This is among the most dangerous actions that the Trump EPA has taken yet against public health,” said John Walke, the director for clean air issues at the Natural Resources Defense Council. “Rolling back longstanding protections to allow the greatest increase in hazardous air pollutants in our nation’s history is unconscionable.”

John Coequyt, who leads climate policy initiatives for the Sierra Club, said the move will lead directly to dirtier air and more deaths.

“Trump and Pruitt are essentially creating a massive loophole that will result in huge amounts of toxic mercury, arsenic, and lead being poured into the air we breathe, meaning this change is a threat to anyone who breathes and a benefit only to dangerous corporate polluters,” Coequyt said.

[CBS News]

Trump administration rescinds Obama guidance on defunding Planned Parenthood

The Trump administration announced Friday it is rescinding guidance from the Obama administration that made it harder for states to defund Planned Parenthood.

The guidance, issued in 2016, warned states that ending Medicaid funding for Planned Parenthood or other health-care providers that offer abortions could be against federal law.

The Obama administration argued Medicaid law only allowed states to bar providers from the program if those providers were unable to perform covered services or if they can’t bill for those services.

However, the Trump administration rescinded that guidance Friday in a letter to state Medicaid directors, arguing it was part of the Obama administration’s effort to favor abortion rights.

“Reinstating the pre-2016 standards frees up states to once again decide for themselves what reasonable standards they use to protect Medicaid programs and their beneficiaries,” Charmaine Yoest, assistant Health and Human Services secretary for public affairs, said in a press call with reporters Friday morning.

“This is part of the Trump administration’s effort to roll back regulations the Obama administration put out to radically favor abortion.”

Anti-abortion groups cheered the announcement Friday as another step toward defunding Planned Parenthood.

“President Trump and his administration have taken … an important step toward getting American taxpayers out of funding the abortion industry, especially Planned Parenthood,” said Marjorie Dannenfelser, president of the Susan B. Anthony List, an anti-abortion group in Washington, D.C.

She urged Congress to “finish what this pro-life administration has started” by defunding Planned Parenthood.

States such as Texas have tried to ban Planned Parenthood from its Medicaid programs but were blocked by the Obama administration.

While rescinding the guidance won’t automatically allow states to ban Planned Parenthood from their Medicaid programs, it signals that the administration supports such efforts.

Texas submitted a request to the Trump administration last year requesting permission to bar Planned Parenthood from its Medicaid program, but the administration has not yet responded.

Approval from the administration would likely spark similar efforts in other conservatives states but also would encourage legal challenges.

Planned Parenthood on Friday said rescinding the guidance would effectively encouraging states to block the organization from state Medicaid programs.

“They couldn’t get the votes to pass it in Congress, so now they are pushing states to try and block care at Planned Parenthood,” said Dawn Laguens, executive vice president for Planned Parenthood Action Fund.

“Without Planned Parenthood, many of our patients would lose access to health care altogether — either because there are no other providers in their community or because other clinics cannot serve all of our patients.”

he administration has already taken several actions in President Trump’s first year in office supporting its anti-abortion stance.

In April, Trump signed legislation that nullified an Obama-era rule that effectively barred state and local governments from withholding federal funding for family planning services to groups that provide abortions.

The announcement on Friday comes the same day as the March for Life, an annual march against abortion in Washington, D.C.

Trump is set to speak at the march live via video, the first president to do so.

Also set to speak at the event are House Speaker Paul Ryan (R-Wis.) and GOP Reps. Jaime Herrera Beutler (Wash.) and Chris Smith (N.J.)

[The Hill]

Trump fires council advising on HIV/AIDS

President Trump has fired the entire council that advises his administration about the HIV/AIDS epidemic, the Washington Post reported on Saturday.

Patrick Sullivan, an epidemiologist at Emory University in Atlanta who works on HIV testing programs, told the newspaper the members were informed by letter this week that their terminations were effective immediately.

The Washington Post said the council, which was set up in 1995, makes national HIV/AIDS strategy recommendations — a five-year plan which sets out how health officials should respond to the epidemic.
The council is made up of doctors, members of industry, members of the community and people living with the disease.

The Washington Blade, an LGBTI newspaper, cited sources with knowledge of the terminations as saying that the terms of several council members appointed during the Obama era still had time to run.

Anger Over Trump’s Health Cuts
The mass dismissal follows the resignation in June of six other representatives of the Presidential Advisory Council on HIV/AIDS, who said at the time they were frustrated with Trump’s health care policies.

Several members slammed Trump’s planned American Health Care Act (AHCA), saying it would leave many of the 1.1 million Americans with HIV/AIDS without access to proper treatment. AHCA failed to pass in Congress this year, despite several attempts.

Council members also complained that, since taking office, Trump had failed to appoint a director of the Office of National AIDS Policy, a position first created during the Clinton administration.

https://www.usatoday.com/story/news/politics/2017/12/30/president-trump-fires-council-advising-hiv-aids/992426001/

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