Antibiotic-resistant bacteria, White House officials charge, poses not just a health threat, but an economic and national security threat as well.
People for more than a century have relied on antibiotics to cure everything from earaches and strep throat to gonorrhea and syphilis. But bacteria are constantly evolving and existing medications—especially if they are overused—will not be effective indefinitely.
In fact, the Centers for Disease Control and Prevention (CDC) estimates that drug resistance already leads to more than two million illnesses and 23,000 deaths each year. Experts expect those numbers to go up unless action is taken to address the problem of drug resistance.
The White House last week simultaneously released the National Strategy for Combating Antibiotic Resistance, a detailed report on the topic by the President’s Council of Advisors on Science and Technology (PCAST), and an executive order requiring action by early 2015. At a news conference on September 18, Jim Holdren, director of the White House Office of Science and Technology Policy, said, “The rise in antibiotic-resistant bacteria represents a serious domestic and international challenge to human and animal health, national security and the economy.”
The PCAST report explains that “responsible stewardship of antibiotics requires identifying the microbe responsible for disease (ideally with rapid and inexpensive diagnostics); administering the most effective antibiotic at the appropriate dose, route, and time; and discontinuing antibiotic therapy when it is no longer needed.”
It goes on to say that scientists need increased and improved surveillance to help better understand how resistant infections emerge and are transmitted.
Even with these advances, PCAST warns, “it is critical to develop new antibiotics, diagnostics, vaccines, and other interventions at a rate that outpaces the emergence of resistant microbes. A robust antibiotic pipeline is essential for creating new antibiotics to replace those being steadily lost to antibiotic resistance.”
Antibiotics—which are typically taken for no more than two weeks—are less profitable than drugs designed to treat chronic conditions that are often taken for many years. Pharmaceutical companies do not have the financial incentive necessary to put their research and development dollars into this pipeline.
This is among the problems that the National Strategy and the PCAST report aim to solve. The strategy lays out five goals, including curbing the overuse of antibiotics, encouraging the development of new drugs, and boosting the advancement of diagnostics tests that can immediately determine whether bacteria are drug resistant.
Though the strategy does not mention funding, the accompanying report suggests that reaching these goals will require doubling the government’s investment in fighting drug resistance from $450 million to $900 million per year. The president’s executive order does not mention funding either, but it does create a task force to look into the problem and mandates that the task force develop a five-year action plan by February 2015.
As a first step, the White House announced the launch of a $20 million prize for the development of rapid, point-of-care, diagnostic test for health-care providers to use to identify highly resistant bacterial infections.
Advocates for sexual health are particular interested in these new announcements because of the fear that an outbreak of antibiotic resistant gonorrhea is imminent.
As RH Reality Check reported last year, the CDC has called neisseria gonorrhoeae, the bacteria that causes gonorrhea, an “urgent threat.” Between 1940 and 2007, this bacteria became resistant to whole classes of drugs: sulfanilamides, penicillins, tetracyclines, and fluoroquinolones. Today, only cephalosporins remain effective to treat the estimated 800,000 cases of gonorrhea in this country each year.
The CDC now recommends ceftriaxone plus either azithromycin or doxycycline as first-line treatment for gonorrhea. In 2011, there were 3,280 cases of gonorrhea that had reduced susceptibility to ceftriaxone and 2,460 that had reduced susceptibility to azithromycin. Other countries are seeing cephalosporin-resistant cases.
Most recently, four cases of gonorrhea resistant to ceftriaxone were reported in Sweden.
Lynn Barclay, president of the American Sexual Health Association, told RH Reality Check that her organization was excited about the attention being paid to this issue: “Resistance to antibiotics, which is fueled in part by over-use of these common medications, is an enormous challenge to public health that increases costs and worsens patient outcomes. We’re down to one antibiotic to treat gonorrhea, that’s not just unacceptable, it’s actually scary. This plan, which seeks to facilitate more appropriate use of antibiotics while encouraging expanded pipelines of new products, is some of the best news we’ve heard in years. For my money it can’t be implemented quickly enough.”
William Smith, executive director of the National Coalition of STD Directors, which has asked for increased government investment in fighting antibiotic-resistant gonorrhea, is also excited about this plan.
“We’re really supportive of what the president is trying to do,” he said in an interview with RH Reality Check. “We think the goals are smart—particularly, the increased focus on creating diagnostic tests for resistance.”
Smith said that the problem is mammoth and more resources are needed.
“We need larger incentives for diagnostic companies to develop tests and larger investments in the development of new drugs,” he said. “But we also need a significant investment in the infrastructure of public health departments that have been subjected to repeated budget cuts. If we expect public health readiness when an antibiotic resistant outbreak hits, we need big dollar investment in those workers on the front lines.”
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New data released by the U.S. Census Bureau’s American Community Survey shows that seven out of eleven major metropolitan areas with rates of uninsured people higher than the national average are in states that have refused to expand Medicaid under the Affordable Care Act (ACA).
Twenty-three states have rejected expanding Medicaid under the ACA, many of them with Republican-controlled legislatures and all but one with Republican governors. Several of the states are in the South, where all seven of the metropolitan areas with higher-than-average rates of uninsured people are found.
Florida is home to the city with the highest percentage of uninsured people in the nation, as 25 percent of Miami’s residents are without health insurance. Tampa Bay also makes the list with 15.1 percent of residents uninsured. Florida’s 20 percent uninsured rate is among the highest in the nation.
Florida will lose more federal dollars than any other state due to refusal by the GOP-controlled legislature to expand Medicaid, according to a joint report by the Robert Wood Johnson Foundation and the Urban Institute. The state will lose $66.1 billion in federal funding over the next decade.
In 2012 Florida Gov. Rick Scott (R) rejected Medicaid expansion. After Scott modified his position, the Florida legislature voted to reject it. It remains unclear whether Scott or Charlie Crist, his Democratic opponent in the gubernatorial campaign, will support implementing Medicaid expansion.
Texas is home to three of the cities with rates of uninsured people higher than the national average: San Antonio at 20.8 percent, Dallas at 21.5 percent, and Houston 22.8 percent. Texas has the highest percentage of uninsured residents in the nation; 22.1 percent of residents have no health insurance.
The high uninsured rate and the state’s failure to expand Medicaid has led to about one million residents falling into the so-called coverage gap.
A joint report by the Robert Wood Johnson Foundation and the Urban Institute also found that Texas has a projected loss over ten years of $65.6 billion in federal funds by not expanding Medicaid.
In 2012 Texas Gov. Rick Perry (R) refused to expand Medicaid, and then in 2013 the state legislature failed to pass the “Texas Solution,” a market-based version of Medicaid expansion. Arkansas, Iowa, Michigan, and Pennsylvania also created private health insurance exchanges in an effort to expand Medicaid independently from the ACA, similar to the proposal in Texas. After the state’s program went into effect, Arkansas saw the sharpest drop in uninsured residents in the nation.
GOP leaders in Georgia and North Carolina have also refused to expand Medicaid. As a result, Atlanta and Charlotte are among the seven cities with the highest rates of uninsured people.
Georgia state lawmakers passed legislation earlier this year both rejecting Medicaid expansion and prohibiting legislators from advocating for the expansion. In 2012, North Carolina Gov. Pat McCrory (R) said the state would reject Medicaid expansion, and in 2013 McCrory signed legislation preventing its implementation in the state.
In addition to the rejection of Medicaid expansion, North Carolina Republican lawmakers have passed legislation to restrict voting rights and access to welfare benefits, all of which, taken together, sparked the protest movement known as Moral Mondays. The protests have spread to other states, including Georgia and Florida.
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It is rare that you can see something you’ve helped to create change the behavior of a government thousands of miles away. So imagine my surprise when I opened my email this morning to read the speech about reproductive justice (RJ) made by South Africa’s Minister of Social Development Bathabile Dlamini in front of the United Nations General Assembly on September 19. She didn’t speak in general language that could be interpreted to suggest reproductive justice; she actually used the specific term, acknowledging the role African-American women played in gifting this theory and framework to the world.
In addition to discussing sexual rights, reproductive health issues, and economic justice, she used the speech to explicitly embrace LGBTQ rights. As a representative of an African government that supports gay, lesbian, trans, bi, and intersex rights, her remarks act as an important backstop against the rampant anti-gay hysteria around the continent fomented by the evangelical religious right in Uganda and elsewhere. Yet it was her use of the reproductive justice language that started my heart pounding Tuesday morning.
It is no longer surprising that RJ has caught on in the United States among thousands of activists eager to move beyond the paralyzing pro-choice/anti-choice stalemate. It is very simple to embrace RJ as both a theoretical paradigm shift and a model for ideal practices because it’s easy to understand and, in a few words, can state the sum of our expectations. As I’ve written in other places, it comes with its own “elevator pitch:”
RJ is about three interconnected sets of human rights: 1) the right to have children; 2) the right not have children; and 3) the right to parent the children we have in safe and healthy environments.
As bell hooks says, “Any theory that cannot be shared in everyday conversation cannot be used to educate the public.”
Reproductive justice does not privilege the production of babies as the only goal of women’s biology; instead, it is based on the human right to make personal decisions about one’s life, and the obligation of government and society to ensure that the conditions are suitable for implementing one’s decisions. Although the SisterSong Women of Color Reproductive Justice Collective publicized the concept of RJ, it does not only apply to women of color. Human rights are what everyone deserves, and so everyone is included in the RJ framework. In particular, reproductive justice draws attention to the lack of physical, reproductive, and cultural safety that affects our “choices.” Reproductive justice focuses on oppression—the structures of injustice and inequality.
In 1994, when 12 Black women sat in a hotel room in Chicago and envisioned the concept of reproductive justice as a way to create new avenues of resistance and strategies for change, we had no idea that 20 years later, we’d be discussing how RJ has changed the pro-choice movement in the United States in addition to being used by activists around the world. I’ve been invited to speak about reproductive justice in Ireland, South Africa, China, and Brazil. Activists in these countries told me that using the RJ framework has opened up political spaces to talk about sexual rights and reproductive health issues in a way that moves the lens from centering only on abortion; instead, it enfolds abortion in a larger conversation about people’s lives and human rights. As in the United States, this paradigm shift has brought new allies into the conversation and has thwarted opponents who only want to focus on fetuses instead of the full spectrum of our lived experiences.
In the United States, some adopters of the RJ framework have only focused on the inherent concept of intersectionality, based on the works of Kimberlé Crenshaw. Intersectionality, according to her, “mediates the tension between assertions of multiple identities and the ongoing necessity of group politics,” while at the same time providing a “basis for reconceptualizing” a single identity as coalition, such as “race as a coalition between men and women of color.” Intersectionality is certainly a process that the RJ framework uses as a pathway toward understanding our multiple identities. But it is just that: a process, not a goal. The goal is the full achievement of human rights for everyone.
To get there, we need a legal regime that pushes beyond the limited U.S. Constitution and the tenuous interpretation of “privacy” to protect women’s rights. Incidentally, this is also why Crenshaw conceptualized intersectionality as a lawyer in 1989, when she analyzed the inability of U.S. laws to deal with the compounding of race and gender in cases involving Black women plaintiffs.
In fact, to not reference “human rights” as an international set of laws and standards in discussions and applications of reproductive justice is to divest RJ of its power to challenge the U.S. government to live up to the obligation to protect our people. When RJ is stripped of its most radical potential, we have to ask ourselves, whose interests does that serve?
Nonetheless, back to South Africa. It was wonderful for me that Minister Dlamini referenced the 1994 International Conference on Population and Development (ICPD) in Cairo in her speech. That was where things crystallized for me, 20 years ago: that the ability of any woman to manage her own fertility is directly dependent on the circumstances of the community in which she is embedded. To promote contraceptives in a community that lacks basic health-care infrastructure is a form of population control, not a sincere understanding of the needs of women or their communities. This was the message—in other words, the African philosophical concept of Ubuntu—that global feminists agreed upon at the ICPD, and we pushed it together to ensure that it was included in RJ’s Plan of Action.
On Friday, Dlamini called upon all African countries to improve their human rights commitments for everyone and to stop limiting protections by invoking the phrase “in accordance with national laws and policies.” This mealy-mouthed half-stepping basically admits that existing national laws that violate human rights, such as Uganda’s “kill the gays” law, will not be changed. This is a salutary lesson for the United States. The primary reason we have not ratified the majority of the available human rights treaties—including the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)—is because of Congress’ reluctance to bring U.S. laws into harmony with international human rights laws.
So I celebrate this morning in company with my co-creators Toni Bond Leonard, “Able” Mable Thomas, Cynthia Newbille, Rev. Alma Crawford, Evelyn Field, and seven others who were with us in that hotel room. We’ll have our SisterSong-organized reunion in Chicago from November 7 to 9, but we’ll arrive there celebrating the fact that, in the words of South African women, the stone we tossed in 1994 “dislodged a boulder.” Amandla!
Image: GovernmentZA / Flickr
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An inquiry by California Democratic Congresswoman Jackie Speier has found that CVS illegally charged 11,000 women a co-pay for contraceptives.
Rep. Speier sent letters to the CEOs of CVS Health and Walgreens this month calling for them to correct a coding error that led to the illegal charges, and to provide remedies to women who had been unjustly charged.
Sol J. Ross, head of federal affairs at CVS Health, wrote Speier that refund checks will be issued to those affected and should all be received by October 1.
Ross wrote that CVS was “very concerned to hear that the care and service we provided fell far short of expectations” and that there were inappropriate charges made.
Customers with questions about an illegal co-pay charge are also encouraged to call 1-800-704-6589 and ask to speak with a Tier 2 representative or supervisor so that their issue will be heard by a more senior staff member with override capabilities.
The Affordable Care Act requires coverage of preventive women’s health services, including contraception, with no cost-sharing under federal law. But Speier said she feared many women don’t know their rights under the law, and would either be charged unnecessarily or even go without birth control entirely if they couldn’t afford the co-pay.
A recent study from the Guttmacher Institute found that a drastically higher percentage of women (67 percent in spring of 2014) were able to get contraceptive pills with no cost-sharing than were able to before the Affordable Care Act was passed (15 percent in the fall of 2012).
The coverage gap, the report says, is due to exceptions in the law. Insurers can charge co-pays for brand name drugs with generic equivalents, for instance, or if a woman uses an out-of-network provider. Certain religious employers are also exempt from providing contraceptive coverage on their health plans.
But some of that gap can also be explained by health plans charging co-pays where they shouldn’t, and by administrative snafus in pharmacies like this one.
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Congress last week was unable to pass a budget bill that, among many other things, included funding to reduce the backlog in rape kits across the country, passing instead only a continuing resolution—a stop-gap appropriations bill—to keep the government funded through mid-December.
Rape kits—a collection of the evidence taken from a person’s body after they report a sexual assault to police—are often essential for solving a crime. After evidence is collected from a victim, the rape kit is ideally sent to local law enforcement for processing and then to a crime lab for testing.
The DNA collected through the kits, once tested, can identify the victim’s assailant, connect that assailant to other crimes, and exonerate innocent suspects.
The problem is that many kits are never tested. The Rape Kit Action Project estimates that there are 100,000 kits awaiting testing in public crime labs across the country and another 300,000 that have not made it from law enforcement storage to the lab.
In recent years, as public outcry over the backlogs has increased, some state and local governments have stepped up to increase timely testing. Illinois and Colorado have come out the strongest, enacting legislation requiring law enforcement agencies to submit kits to crime labs for timely analysis. Several other states have passed legislation to inventory untested kits but have stopped short of requiring those kits to then be tested.
State initiatives to reduce the backlog have proven effective in solving crimes and bringing justice for sexual assault survivors. In 2009, after more than 11,000 untested kits were found abandoned in a police warehouse in Detroit, the city was awarded several grants to test the kits. After testing the first 2,000, more than 100 potential serial rapists were identified, and 14 people have been convicted.
Still, the backlog across the country remains enormous, and states complain that a lack of resources and personnel prevent them from tackling the problem with full force.
For its part, the federal government has given money to state and local testing initiatives, like the one in Detroit. And in 2004 Congress passed the Debbie Smith Act, a law aimed at supporting state and local government efforts to reduce their backlogs.
But the Debbie Smith Act has its problems. For example, a 2013 report found that of the $691 million given to the program between 2008 and 2012, nearly half had been used for purposes other than directly reducing the backlog, like making lab improvements and testing of evidence not from rape kits. And even the Debbie Smith Act is an empty promise without funding from Congress.
To supplement the Debbie Smith Act and the efforts of state and local governments, Obama included in his 2015 budget proposal a plan to allocate an additional $35 million in grants for community rape kit initiatives.
The Department of Justice would spearhead the program, which would help pay for state and local kit testing, as well as the investigation and prosecution of sexual assault cases that emerge from the tests, according to the Washington Post. It would also help guide comprehensive rape kit processing reform and best practices.
In general, reducing rape-kit backlogs has bipartisan support on both state and federal levels. The Debbie Smith Act, for example, was reauthorized this month with ease.
For much of this year, Congress seemed poised to fund the Department of Justice program. In May, the House passed a version of the 2015 budget bill that included $41 million for the initiative—$6 million more than the Obama administration had originally requested.
Like every budget proposal in the past few years, Congress has proven incapable in coming to a decision on funding.
In June, Senate Majority Leader Harry Reid (D-NV) pulled the budget bill from the floor after Republicans added several partisan amendments, including one making it more difficult for the EPA to regulate coal-fired power plants. Finally, this week, Congress passed a short-term budget that will keep the government funded until mid-December and does not include funding for new programs. The $41 million is not going anywhere, having fallen victim to political battles unrelated to rape-kit testing.
Image: Capitol via Shutterstock
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A Louisiana state judge ruled Monday that the state’s ban on same-sex marriages is unconstitutional.
Judge Edward Rubin of the 15th Judicial District Court ruled the ban violates the due process and equal protection clauses of the 14th Amendment to the U.S. Constitution.
The decision came in the adoption case of Angie Costanza and Christy Brewer. They were married in 2008 in California, but their marriage was not recognized by the State of Louisiana due to the ban. The couple sued the state in 2013 when Costanza wanted to adopt her partner’s son and be listed as a parent on his birth certificate.
In his ruling, Judge Rubin compared the state’s argument to those made in Plessy v. Ferguson, the infamous U.S. Supreme Court decision that ruled Louisiana’s system of “separate but equal” railcars for whites and other cars for Blacks were constitutional, writing, “[t]here are those who might argue that gays and lesbians can be treated differently, and yet be considered to be equal to the rest of Americans.”
As reported by the New Orleans Times-Picayune, state Attorney General Buddy Caldwell plans to appeal the decision directly to the Louisiana Supreme Court.
Monday’s ruling does not immediately grant same-sex couples the right to marry in Louisiana. Instead, the court would first have to order clerks to issue marriage licenses to those same-sex couples that wanted to marry. According to the Times-Picayne, that has not happened yet.
Judge Rubin’s ruling conflicts with a federal court decision from District Judge Martin Feldman in early September, which said the Louisiana ban did not violate the U.S. Constitution. Judge Feldman’s decision was the first from a federal court to side with anti-marriage equality advocates since the Supreme Court’s 2013 decision in U.S. v. Windsor striking down a federal law that defined marriage as only those unions between one man and one woman.
That case is currently being appealed to the Fifth Circuit Court of Appeals. Meanwhile, the U.S. Supreme Court is set to consider next week a series of requests to decide the issue of whether or not states can constitutionally ban or limit same-sex marriages.
Image: Court via Shutterstock
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09.23.14 - (PRESS RELEASE) Today Spanish Prime Minister Mariano Rajoy announced the withdrawal of a draft bill that would have criminalized abortion in Spain, with exceptions only in cases of rape and when a woman’s health or life is at risk.
The restrictive abortion bill, spearheaded by Prime Minister Rajoy and Justice Minister Gallardón, was scrapped after failing to build enough political support to move forward. National and international groups sent a joint letter in May to Prime Minister Rajoy opposing the proposed restrictions that posed “a serious threat to women’s sexual and reproductive health and rights.” Signatories included Alianza por la Solidaridad, European NGOs for Sexual and Reproductive Health and Rights, Population and Development (EuroNGOs), Federación de Planificación Familiar Estatal, Human Rights Watch and Rights International Spain and the Center for Reproductive Rights.
In proposing the bill the Spanish government moved against the overwhelming trend of expanding access to safe and legal abortion both in Europe and globally—against the views of the vast majority of Spanish citizens. Following the news of the defeated abortion law, Spanish Justice Minister Alberto Ruiz Gallardón announced resignation from his post, as well as from his seat in Parliament and as member of the Popular Party.
Said Lilian Sepúlveda, director of the Global Legal Program at the Center for Reproductive Rights:
“Today is a huge victory for the countless Spanish women and men who have fought so hard to see their country’s laws changed to protect safe and legal abortion, and to keep these vital legal protections in place.
“The outcry provoked by the introduction of this law sent a clear message to both Prime Minister Rajoy and Justice Minister Gallardón that playing politics with reproductive rights is unacceptable.
“We commend the advocates for women’s health and rights in Spain for their unwavering commitment and tireless work to put a stop to these vicious attacks on women.”
While the attempt to ban abortion in Spain was halted, Prime Minister Rajoy announced that the current abortion regulations will soon be amended to require parental consent for young women 17 years of age and under who seek to end a pregnancy.
“Restricting young women’s access to essential reproductive health care services, including abortion, poses serious threats to their health and human rights.We will continue to stand alongside the women of Spain and committed advocates to build on today’s victory and block any effort to roll back the country’s abortion law,” added Sepúlveda.
Abortion was first decriminalized in Spain in 1985, but even then the procedure was legal only for rape victims and when a woman’s pregnancy had severe fetal impairments or posed a serious risk to her life or health. In 2010, the Spanish government took an historic step and amended the law to recognize abortion as a fundamental right, allowing this reproductive health service through 14 weeks of pregnancy for all women, without restriction as to reason.
According to a new Center report, 35 countries have amended their laws to expand access to safe and legal abortion services in the last 20 years—a trend that has marked incredible progress to improving women’s rights and lives, including significantly reducing rates of maternal mortality due to unsafe abortion. The report was released alongside the Center’s updated World’s Abortion Laws map—one of the most comprehensive resources on abortion laws across the globe.Abortion Worldwide: 20 Years of Reform