vox--2020-11-16--In 24 hours, Trump went from almost conceding to falsely claiming “I WON THE ELECTION!”

President Donald Trump continued his quixotic fight to overturn the results of the election he lost — by taking to Twitter to encourage supporters who believe the race was rigged and by blatantly ignoring reality .
These efforts came to a head late Sunday night with a tweet that read , “ I WON THE ELECTION !
” The president , of course , did no such thing — President-elect Joe Biden won both the popular vote , by 5.5 million , and 306 electoral college votes , 36 more than the 270 needed to win the White House and @ @ @ @ @ @ @ fact has not , and appears as though it will not , stop the president from falsely claiming otherwise .
Trump signaled he would not accept the results of the election before it was held , for instance telling Fox News ’ s Chris Wallace in July , that he would “ have to see ” whether he believed the results ought to be seen as valid .
And days before Election Day , Axios and others reported Trump planned to declare victory before enough votes had been counted to determine a winner @ @ @ @ @ @ @ , and since that time , he has worked to change election results in key states through a series of legal challenges — many of which have been dropped or rejected due to a lack of evidence of wrongdoing — and has spread conspiracy theories about voter fraud , something that election officials have found little to no evidence of .
Democrats and democracy experts have decried this behavior as corrosive , arguing that it weakens America ’ s system of government and seeds doubt about the country ’ s electoral process that @ @ @ @ @ @ @ .
Republican lawmakers have been largely supportive of the president , saying they believe there should be investigations into the nonexistent voter fraud .
And , perhaps lending credence to the fears of the president ’ s critics , much of Trump ’ s base has been energized by his rhetoric — so much so that several thousand of his supporters traveled to Washington , DC , on Saturday for a “ Million MAGA March ” at which they incorrectly claimed that the election is not over and that Democrats are trying to @ @ @ @ @ @ @ from him .
Trump rewarded these supporters with a brief appearance Saturday morning , driving by on his way to golf ; he later retweeted scenes and videos from the gathering , including ones that incorrectly claimed the current vote totals in states like Michigan — which Biden won — are wrong .
It seems inevitable that Biden will be installed in the White House — again , he won the election , states are about to certify their results , and electors are on track to cast their votes for or against @ @ @ @ @ @ @ as Vox ’ s Andrew Prokop has explained , even Republican leaders like Senate Majority Leader Mitch McConnell — who has said Trump is “ 100 percent within his rights to look into allegations of irregularities and weigh his legal options ” — have suggested that once the Electoral College ’ s votes are in , the election is settled as far as they are concerned .
“ At some point here we will find out finally who was certified in each of these states and the Electoral College will determine the winner @ @ @ @ @ @ @ Trump does not seem poised to follow McConnell ’ s lead , and neither do his most passionate supporters , who appear to have suspicions about how the 2020 election was conducted that even assurances of propriety from Trump ’ s own officials can ’ t seem to assuage .
And that is because they have their trust in Trump , and he continues to falsely say that many things were amiss with the election .
With lies and conspiracy theories , Trump is spreading doubt in the electoral process The president spent @ @ @ @ @ @ @ theory that machines manufactured by Dominion Voting Systems , a company that also makes voting software , were altered to misread ballots in order to ensure a Biden victory .
It ’ s a lie that was spread by QAnon adherents and amplified by far-right networks that have curried favor with the president , like the One American News Network ( OANN ) .
It has been repeated by Trump ’ s personal lawyer Rudy Giuliani and has been heavily featured on the president ’ s Twitter account .
The New York Times @ @ @ @ @ @ @ traction following Dominion machine user errors in Michigan and Georgia that led to the miscounting of a few thousand ballots in the former state and delayed results in the latter .
Those errors were found and swiftly corrected , but that did not stop the president and his allies from falsely claiming that something sinister was happening — in the president ’ s words , that the race was the “ Most fraudulent Election in history !
” That the president has been so effective in planting doubts about the election led to @ @ @ @ @ @ @ be able to convince his supporters that the election was over on Sunday , when he appeared to acknowledge — albeit alongside more conspiracy theories — for the first time that Biden won the election .
“ He won because the Election was Rigged , ” Trump tweeted .
The disinformation about the election aside , many — including , reportedly , at least one White House official — took the tweet as a concession , and incoming Biden officials seemed cautiously optimistic about the message , particularly given the president ’ s @ @ @ @ @ @ @ start of the official transition process .
But Trump followed that tweet with another a few hours later that made his intentions clear , writing , “ I concede NOTHING !
” That tweet was prefaced by a promise that “ WE WILL WIN !
, ” a sentiment that was disregarded shortly before midnight on Monday , replaced by Trump ’ s stronger , and factually incorrect assertion , “ I WON THE ELECTION !
” — one that was reiterated Monday morning : Nearly two weeks after voting concluded , Trump @ @ @ @ @ @ @ essentially where he was on election night : denying reality .
Early on November 4 , Trump said Democrats were trying to steal the election from him , and said the Supreme Court would help ensure his victory .
He suggested then that his legal challenges would help make this possible , but lawsuits in Pennsylvania , Arizona , and Michigan have failed , and it appears outstanding cases yet to be heard will fail as well .
The legal route looking increasingly dubious , Trump is now trying to steal the election @ @ @ @ @ @ @ actually happen at all and that election officials , voting companies , and the media are all lying to the American people .
His assertions are in one way futile .
States are working to certify their results and are scheduled to submit them to the federal government by December 8 .
The Electoral College plans to vote on December 14 .
And Biden ’ s inauguration is still scheduled for January 20 .
Nothing Trump says on Twitter can stop time from progressing toward these events .
But what he says clearly @ @ @ @ @ @ @ those who marched on Washington on Saturday to those who used rhetoric similar to the president ’ s in explaining to ABC ’ s This Week on Sunday why they don ’ t believe Biden won .
If these feelings take permanent root , Trump ’ s disinformation campaign won ’ t have been ineffectual at all .
Instead , it will mean one of his last acts as president will have been to create an alternate reality inhabited by many of his supporters in which the 2020 election was illegally stolen from @ @ @ @ @ @ @ be trusted to be free and fair .

President Donald Trump continued his quixotic fight to overturn the results of the election he lost — by taking to Twitter to encourage supporters who believe the race was rigged and by blatantly ignoring reality.
These efforts came to a head late Sunday night with a tweet that read, “I WON THE ELECTION!”
The president, of course, did no such thing — President-elect Joe Biden won both the popular vote, by 5.5 million, and 306 electoral college votes, 36 more than the 270 needed to win the White House and 74 more than Trump. But that fact has not, and appears as though it will not, stop the president from falsely claiming otherwise.
Trump signaled he would not accept the results of the election before it was held, for instance telling Fox News’s Chris Wallace in July, that he would “have to see” whether he believed the results ought to be seen as valid. And days before Election Day, Axios and others reported Trump planned to declare victory before enough votes had been counted to determine a winner.
He followed through on that plan, and since that time, he has worked to change election results in key states through a series of legal challenges — many of which have been dropped or rejected due to a lack of evidence of wrongdoing — and has spread conspiracy theories about voter fraud, something that election officials have found little to no evidence of.
Democrats and democracy experts have decried this behavior as corrosive, arguing that it weakens America’s system of government and seeds doubt about the country’s electoral process that will linger long after Trump leaves office. Republican lawmakers have been largely supportive of the president, saying they believe there should be investigations into the nonexistent voter fraud.
And, perhaps lending credence to the fears of the president’s critics, much of Trump’s base has been energized by his rhetoric — so much so that several thousand of his supporters traveled to Washington, DC, on Saturday for a “Million MAGA March” at which they incorrectly claimed that the election is not over and that Democrats are trying to steal Trump’s rightful second term from him.
Trump rewarded these supporters with a brief appearance Saturday morning, driving by on his way to golf; he later retweeted scenes and videos from the gathering, including ones that incorrectly claimed the current vote totals in states like Michigan — which Biden won — are wrong.
It was a GREAT honor to speak to TENS OF THOUSANDS of great Americans today at the #MarchForTrump
WE. ARE. THE. MAJORITY.
We are SILENT no longer.
We will ALWAYS fight for @realDonaldTrump and for FREE & FAIR elections.
God bless you ALL!
RT! pic.twitter.com/l2Ni1L98Dk — Alex Bruesewitz (@alexbruesewitz) November 14, 2020
It seems inevitable that Biden will be installed in the White House — again, he won the election, states are about to certify their results, and electors are on track to cast their votes for or against him as their states dictate. And as Vox’s Andrew Prokop has explained, even Republican leaders like Senate Majority Leader Mitch McConnell — who has said Trump is “100 percent within his rights to look into allegations of irregularities and weigh his legal options” — have suggested that once the Electoral College’s votes are in, the election is settled as far as they are concerned.
“At some point here we will find out finally who was certified in each of these states and the Electoral College will determine the winner,” McConnell said recently.
But Trump does not seem poised to follow McConnell’s lead, and neither do his most passionate supporters, who appear to have suspicions about how the 2020 election was conducted that even assurances of propriety from Trump’s own officials can’t seem to assuage.
And that is because they have their trust in Trump, and he continues to falsely say that many things were amiss with the election.
With lies and conspiracy theories, Trump is spreading doubt in the electoral process
The president spent part of the weekend promoting a conspiracy theory that machines manufactured by Dominion Voting Systems, a company that also makes voting software, were altered to misread ballots in order to ensure a Biden victory. It’s a lie that was spread by QAnon adherents and amplified by far-right networks that have curried favor with the president, like the One American News Network (OANN). It has been repeated by Trump’s personal lawyer Rudy Giuliani and has been heavily featured on the president’s Twitter account.
The New York Times notes the conspiracy theory appeared to gain traction following Dominion machine user errors in Michigan and Georgia that led to the miscounting of a few thousand ballots in the former state and delayed results in the latter. Those errors were found and swiftly corrected, but that did not stop the president and his allies from falsely claiming that something sinister was happening — in the president’s words, that the race was the “Most fraudulent Election in history!”
That the president has been so effective in planting doubts about the election led to hope among some observers that he would be able to convince his supporters that the election was over on Sunday, when he appeared to acknowledge — albeit alongside more conspiracy theories — for the first time that Biden won the election.
“He won because the Election was Rigged,” Trump tweeted.
He won because the Election was Rigged. NO VOTE WATCHERS OR OBSERVERS allowed, vote tabulated by a Radical Left privately owned company, Dominion, with a bad reputation & bum equipment that couldn’t even qualify for Texas (which I won by a lot!), the Fake & Silent Media, & more! https://t.co/Exb3C1mAPg — Donald J. Trump (@realDonaldTrump) November 15, 2020
The disinformation about the election aside, many — including, reportedly, at least one White House official — took the tweet as a concession, and incoming Biden officials seemed cautiously optimistic about the message, particularly given the president’s refusal to concede has held up the start of the official transition process.
But Trump followed that tweet with another a few hours later that made his intentions clear, writing, “I concede NOTHING!”
That tweet was prefaced by a promise that “WE WILL WIN!,” a sentiment that was disregarded shortly before midnight on Monday, replaced by Trump’s stronger, and factually incorrect assertion, “I WON THE ELECTION!” — one that was reiterated Monday morning:
I won the Election! — Donald J. Trump (@realDonaldTrump) November 16, 2020
Nearly two weeks after voting concluded, Trump’s latest tweets put the president essentially where he was on election night: denying reality.
Early on November 4, Trump said Democrats were trying to steal the election from him, and said the Supreme Court would help ensure his victory. He suggested then that his legal challenges would help make this possible, but lawsuits in Pennsylvania, Arizona, and Michigan have failed, and it appears outstanding cases yet to be heard will fail as well.
The legal route looking increasingly dubious, Trump is now trying to steal the election by saying what happened didn’t actually happen at all and that election officials, voting companies, and the media are all lying to the American people.
His assertions are in one way futile. States are working to certify their results and are scheduled to submit them to the federal government by December 8. The Electoral College plans to vote on December 14. And Biden’s inauguration is still scheduled for January 20. Nothing Trump says on Twitter can stop time from progressing toward these events.
But what he says clearly has sway over many Americans, from those who marched on Washington on Saturday to those who used rhetoric similar to the president’s in explaining to ABC’s This Week on Sunday why they don’t believe Biden won.
If these feelings take permanent root, Trump’s disinformation campaign won’t have been ineffectual at all. Instead, it will mean one of his last acts as president will have been to create an alternate reality inhabited by many of his supporters in which the 2020 election was illegally stolen from him and in which elections cannot be trusted to be free and fair.


vox--2020-11-16--What Moderna’s Covid-19 vaccine results mean for ending the pandemic

The biotech firm Moderna announced Monday that its Covid-19 vaccine candidate , mRNA-1273 , was shown to be 94.5 percent effective in protecting volunteers in a clinical trial against the disease .
“ This is a pivotal moment in the development of our COVID-19 vaccine candidate , ” said Stéphane Bancel , CEO of Moderna , in a statement .
“ This positive interim analysis from our Phase 3 study has given us the first clinical validation that our vaccine can prevent COVID-19 disease , including severe disease.
” It ’ s more good news following Pfizer and BioNTech ’ @ @ @ @ @ @ @ Covid-19 vaccine candidate trial a week ago .
But unlike Pfizer and BioNTech , Moderna offered far more information about the recipients of the vaccine , showing its efficacy across different ages and ethnic groups .
And its results offer a brighter ray of hope for rolling out a vaccine in 2021 as the United States faces its worst stretch of the pandemic yet , with record numbers of new cases and hospitalizations .
The announcements also mean that the world will likely have more than one highly effective vaccine for Covid-19 , @ @ @ @ @ @ @ be on the horizon .
High efficacy also means that fewer people would need to be vaccinated in order to achieve herd immunity , the threshold at which the virus can no longer spread easily from person to person .
However , there are some caveats : The results are preliminary , the vaccine requires two doses , there are some side effects , the clinical trial isn ’ t complete , and the findings were announced in a press release instead of a peer-reviewed paper .
Moderna did not respond to requests @ @ @ @ @ @ @ efficacy is important , the road to getting millions of people vaccinated is fraught with logistical challenges .
While this is an important result , a lot of difficult work on a Covid-19 vaccine still lies ahead .
How Moderna showed that its Covid-19 vaccine works Moderna ’ s announcement of almost 95 percent efficacy is based on a phase 3 clinical trial .
In particular , the results are from the COVE study , conducted in collaboration with the US government ’ s National Institute of Allergy and Infectious Diseases ( NIAID @ @ @ @ @ @ @ Development Authority ( BARDA ) .
Phase 3 is where the vaccine is tested against the virus spreading in the real world .
Since experimenters can ’ t deliberately infect people , they have to wait and see who gets sick with Covid-19 in their volunteer pool , comparing the group that received the actual vaccine to the group that received the placebo .
Moderna ’ s vaccine is administered as two doses spaced four weeks apart .
To speed up the process , researchers recruit thousands of volunteers so that the rate @ @ @ @ @ @ @ it only takes a handful of infections to demonstrate that the vaccine works .
“ If the vaccine doesn ’ t work at all , and 50 percent of people are in the vaccine group , 50 percent in the placebo group , we expect cases to be evenly split across the groups , ” explained Natalie Dean , an assistant professor of biostatistics at the University of Florida , in an email .
“ When the vaccine is working , we observe fewer cases in the vaccine group.
” According to Moderna @ @ @ @ @ @ @ of which 90 cases were in the placebo group compared to five cases in the group that received the actual vaccine .
The results show that the virus was spreading among volunteers in the clinical trial but it was drastically lower among those who received Moderna ’ s vaccine .
Why Moderna ’ s results , while preliminary , are still important and exciting There are a number of safeguards in place to ensure that vaccine manufacturers are not gaming the results .
In a clinical trial like this , neither the company @ @ @ @ @ @ @ vaccine and who received the placebo .
This is known as a double-blind study and is considered the gold standard for clinical research .
It ’ s done to prevent either side from changing their behavior or biasing the trial in a deliberate or unconscious way .
Someone who knows they received the actual vaccine may engage in riskier behavior , for example , or the company may be tempted to give the vaccine to people already at lower risk of exposure to boost the apparent efficacy .
Instead , there ’ s @ @ @ @ @ @ @ the government known as the Data Safety Monitoring Board ( DSMB ) that serves as an intermediary between the volunteers and the experimenters .
The DSMB knows who received what among the volunteers but doesn ’ t disclose that to the company right away .
Instead , the members monitor the trial pool to ensure there are no severe complications and can stop the trial if there are any problems .
The DSMB then convenes with the company and experimenters at predetermined checkpoints , namely when a certain number of infections are detected @ @ @ @ @ @ @ and from Pfizer and BioNTech both emerged from such a preliminary meeting , both at the 95 infection checkpoint .
While these results are not peer-reviewed per se , implicit in these announcements is that a group of independent scientists have verified these results .
That ’ s why many scientists who have been paying attention to these clinical trials are so excited about the findings , even though they are preliminary .
“ The vaccine is on its way , folks , so hang in there , hang tough , ” Anthony @ @ @ @ @ @ @ last week in response to the Pfizer and BioNTech announcement .
“ We ’ re going to get over this together.
” Moderna expects the final analysis of its clinical trial to be conducted when 151 Covid-19 infections are confirmed in the trial pool .
It ’ s hard to say when it will get that many cases , but given the uncontrolled spread of Covid-19 in the United States , it ’ s likely to happen within the next two months .
There are some caveats to Moderna ’ s Covid-19 vaccine @ @ @ @ @ @ @ in a press release — like the Pfizer and BioNTech vaccine results , Moderna ’ s announcement came directly from the company itself .
There have been several peer-reviewed interim studies about its mRNA-1273 vaccine , but Monday ’ s efficacy announcement didn ’ t come with any published data .
That doesn ’ t mean the results are wrong , but they are only a snapshot in time , and without more details , it ’ s hard to unpack critical nuances needed to interpret them , like what kinds of underlying @ @ @ @ @ @ @ vaccine .
These for-profit companies also have a financial incentive to play up good news and smooth over any bumps on the road to an approved vaccine .
As the trial proceeds , the results could be reinforced or undermined .
“ When we do finally have a viable Covid-19 immunization , the public needs to be able to trust that it ’ s safe and effective , ” wrote Vox ’ s Julia Belluz .
“ And the road to building that confidence isn ’ t paved with preliminary , sparsely detailed @ @ @ @ @ @ @ the real work of vetting the vaccines is done.
” But as mentioned above , the fact that these results have independent validation gives them more weight .
So there is cause for optimism and skepticism .
Moderna revealed some of the demographics of who is in its trial pool , but more information is still needed ; it ’ s unlikely that a vaccine will be equally effective in all groups of people , so it ’ s important to pay close attention to the demographics of who gets sick and who @ @ @ @ @ @ @ According to Moderna , the 95 Covid-19 cases were detected in 15 adults over the age of 65 and 20 participants identifying as having a minority background , including 12 Hispanic or Latinx people , four Black or African American people , three Asian American people , and one multiracial person .
This shows that the trial recruited a broad spectrum of participants .
This is immensely valuable information for public health and can help guide a vaccination strategy .
But health officials still need more information about things like preexisting conditions in @ @ @ @ @ @ @ exposure to the virus people experienced .
There are some side effects — Moderna said volunteers generally tolerated their vaccine pretty well , and most problems tended to be mild to moderate .
Reported problems included injection site pain ( 2.7 percent ) after the first dose , and after the second dose , recipients reported fatigue ( 9.7 percent ) , muscle pain ( 8.9 percent ) , arthralgia ( 5.2 percent ) , headache ( 4.5 percent ) , pain ( 4.1 percent ) and redness at the injection site ( @ @ @ @ @ @ @ in these numbers among patients who experienced more than one effect .
Most of these effects were short-lived .
A final safety evaluation will still be needed once the trial is run to completion .
While these effects are fairly mild , it ’ s important to pay close attention to them since vaccines will ultimately have to be distributed to millions , if not billions , of people .
Rare complications will be more likely to show up once lots of people get the shot .
And clinical trials of other Covid-19 @ @ @ @ @ @ @ vaccine or the University of Oxford and AstraZeneca vaccine — have already been paused due to complications among recipients .
For vaccinations , safety is paramount .
The Moderna vaccine has other important advantages Monday ’ s vaccine efficacy announcement also illustrated some critical lessons about how Moderna was able to achieve these results and other details that could influence a vaccination strategy .
RNA is a viable way to make a vaccine : Moderna ’ s vaccine is now the second RNA-based vaccine that has demonstrated a high efficacy against Covid-19 .
@ @ @ @ @ @ @ case a variant known as mRNA — is a new vaccine technology .
Such an approach has never received approval for widespread use , so these results are an important validation .
The way it works is that the instructions for making a piece of the virus are inserted into the body .
After cells read the instructions and manufacture the component of the virus , the immune system detects it and starts to mount a response .
This is a huge shift from conventional vaccines , which typically use a weakened version @ @ @ @ @ @ @ dead virus , or a fragment of the virus .
With RNA and similar DNA-based vaccines , there is no viral structure injected .
Like the Pfizer and BioNTech vaccine , Moderna ’ s RNA-based vaccine also codes for the spike protein of SARS-CoV-2 , the virus that causes Covid-19 .
The spike is the part of the virus that lets it enter cells and take them over , and teaching the immune system to target this component has now been demonstrated to be a viable strategy .
Moderna ’ s vaccine appears @ @ @ @ @ @ @ : Efficacy in this context is defined as the share of vaccinated people who actually receive protection against the disease in question .
For Covid-19 , Food and Drug Administration guidelines say that a vaccine needs to provide protection against the coronavirus for at least 50 percent of the people who get it .
That means at least half of the people who get the vaccine have to have some form of protection .
At 94.5 percent efficacy , Moderna ’ s results vault over this benchmark .
But the company went a @ @ @ @ @ @ @ the 11 severe Covid-19 cases it identified in its trial pool , all were in the placebo group and none in the vaccine group .
What this shows is that the vaccine is effective against severe manifestations of the illness .
It may be the case that someone who gets vaccinated could still get a mild infection , but it ’ s likely the vaccine will keep them out of the hospital .
While 11 is a small number of cases , it ’ s unlikely to have occurred by chance .
One @ @ @ @ @ @ @ t disclosed how long this protection will last , and it may not be able to find out without simply waiting and seeing .
Figuring out the duration of protection from a vaccine will likely require long-term monitoring .
Government support played a crucial role : Just about every vaccine candidate has benefited from the government ’ s efforts to speed up trials .
The FDA allowed experimenters to run phases of clinical trials concurrently and accelerated many of their regulatory approval processes .
The US government has also committed to buy millions @ @ @ @ @ @ @ manufacturer crosses the line under Operation Warp Speed , a US government initiative aimed at procuring 300 million Covid-19 vaccine doses by January 2021 .
That ’ s a big reason a Covid-19 vaccine may be on the market in record time , likely within two years instead of the typical decades-long development that vaccines usually require .
Moderna also received a direct boost under Operation Warp Speed .
The Department of Health and Human Services awarded the company $ 483 million in April , followed by $ 472 million in July to @ @ @ @ @ @ @ , HHS announced $ 1.5 billion in manufacturing support for Moderna ’ s vaccine .
It ’ s easier to keep Moderna ’ s vaccine cool than the one from Pfizer and BioNTech : Moderna was quick to highlight that its vaccine candidate has much lighter logistical requirements and can be stored at warmer temperatures than the one developed by Pfizer and BioNTech .
Moderna ’ s vaccine requires long-term storage at minus 20 degrees Celsius ( minus 4 degrees Fahrenheit ) and is stable for 30 days between 2 and 8 degrees @ @ @ @ @ @ @ Fahrenheit ) .
That ’ s well within the temperature range of conventional refrigerators .
Pfizer and BioNTech ’ s vaccine , however , demands temperatures of minus 70 degrees Celsius ( minus 94 degrees Fahrenheit ) or lower , which requires ultra-cold freezers and careful shipping .
That means the logistics of getting Moderna ’ s vaccine to people are much easier .
However , Moderna ’ s vaccine , like Pfizer and BioNTech ’ s candidates , is still a two-dose vaccine , which means every recipient will have to come @ @ @ @ @ @ @ injection .
And that means vaccinations will require twice the number of doses as a single-dose vaccine , adding to the cost of the effort .
What happens next for a Covid-19 vaccine There are still several key steps between the results as they were announced , completing a trial , getting approval , and getting it to everyone that needs it .
The trial still has to run to completion , and both vaccine candidates — from Moderna and from Pfizer and BioNTech — need more safety data before they can seek @ @ @ @ @ @ @ be able to apply for an Emergency Use Authorization from the FDA .
That would allow the vaccine to be used in limited cases for people facing some of the highest exposures to Covid-19 , like health workers and workers in essential roles .
“ Moderna intends to submit for an Emergency Use Authorization ( EUA ) with U.S. FDA in the coming weeks and expects the EUA to be based on the final analysis of 151 cases and a median follow-up of more than 2 months , ” according to Moderna ’ @ @ @ @ @ @ @ gets approved , a global supply chain , from the glass vials that hold the vaccine to the syringes used to inject them , needs to spool up to make huge quantities of the vaccine .
Manufacturers will also have to ensure that vaccines remain intact and under strict temperature controls from the factory to the hospitals and clinics where they will be used .
The process of manufacturing , distributing , and administering a vaccine could take months .
And vaccine research doesn ’ t end once a vaccine gets approved .
@ @ @ @ @ @ @ track complications across millions of people and pay attention to how quickly immunity wanes .
It ’ s also important to remember that a vaccine is not enough on its own to end the pandemic .
Measures like social distancing , good hygiene , and wearing face masks will remain essential to control the spread of Covid-19 until a vaccine is widely available .
Public acceptance will also be a major issue , and health officials will have to overcome a rising wave of vaccine hesitancy .
While the end of the pandemic @ @ @ @ @ @ @ latest vaccine announcements , a lot of hard work is still needed , and some of the toughest days of the Covid-19 pandemic lie ahead .

The biotech firm Moderna announced Monday that its Covid-19 vaccine candidate, mRNA-1273, was shown to be 94.5 percent effective in protecting volunteers in a clinical trial against the disease.
“This is a pivotal moment in the development of our COVID-19 vaccine candidate,” said Stéphane Bancel, CEO of Moderna, in a statement. “This positive interim analysis from our Phase 3 study has given us the first clinical validation that our vaccine can prevent COVID-19 disease, including severe disease.”
It’s more good news following Pfizer and BioNTech’s announcement of positive results from their Covid-19 vaccine candidate trial a week ago. But unlike Pfizer and BioNTech, Moderna offered far more information about the recipients of the vaccine, showing its efficacy across different ages and ethnic groups. And its results offer a brighter ray of hope for rolling out a vaccine in 2021 as the United States faces its worst stretch of the pandemic yet, with record numbers of new cases and hospitalizations.
The announcements also mean that the world will likely have more than one highly effective vaccine for Covid-19, and the end of the pandemic could be on the horizon. High efficacy also means that fewer people would need to be vaccinated in order to achieve herd immunity, the threshold at which the virus can no longer spread easily from person to person.
Very exciting to see 94% efficacy of @moderna_tx #SARSCoV2 vaccine at interim analysis of 95 events. This replication of Pfizer's high efficacy tells us the virus is eminently vaccinatable. https://t.co/YpxQdkyUjF — Eric Topol (@EricTopol) November 16, 2020
However, there are some caveats: The results are preliminary, the vaccine requires two doses, there are some side effects, the clinical trial isn’t complete, and the findings were announced in a press release instead of a peer-reviewed paper. Moderna did not respond to requests for comment.
And while demonstrating high efficacy is important, the road to getting millions of people vaccinated is fraught with logistical challenges. While this is an important result, a lot of difficult work on a Covid-19 vaccine still lies ahead.
How Moderna showed that its Covid-19 vaccine works
Moderna’s announcement of almost 95 percent efficacy is based on a phase 3 clinical trial. In particular, the results are from the COVE study, conducted in collaboration with the US government’s National Institute of Allergy and Infectious Diseases (NIAID) and the Biomedical Advanced Research and Development Authority (BARDA).
Phase 3 is where the vaccine is tested against the virus spreading in the real world. Since experimenters can’t deliberately infect people, they have to wait and see who gets sick with Covid-19 in their volunteer pool, comparing the group that received the actual vaccine to the group that received the placebo. Moderna’s vaccine is administered as two doses spaced four weeks apart.
To speed up the process, researchers recruit thousands of volunteers so that the rate of accumulating infections goes up. But it only takes a handful of infections to demonstrate that the vaccine works.
Of course, I'll start with the topline result of 94.5% efficacy (90 placebo cases, 5 vaccinated cases). For a high efficacy vaccine, 95 cases is a lot of data. In event-driven trials, the number of cases matters more than the number of participants. 2/10https://t.co/fTEB6homTT — Natalie E. Dean, PhD (@nataliexdean) November 16, 2020
“If the vaccine doesn’t work at all, and 50 percent of people are in the vaccine group, 50 percent in the placebo group, we expect cases to be evenly split across the groups,” explained Natalie Dean, an assistant professor of biostatistics at the University of Florida, in an email. “When the vaccine is working, we observe fewer cases in the vaccine group.”
According to Moderna, experimenters detected 95 Covid-19 cases, of which 90 cases were in the placebo group compared to five cases in the group that received the actual vaccine. The results show that the virus was spreading among volunteers in the clinical trial but it was drastically lower among those who received Moderna’s vaccine.
Why Moderna’s results, while preliminary, are still important and exciting
There are a number of safeguards in place to ensure that vaccine manufacturers are not gaming the results.
In a clinical trial like this, neither the company nor the volunteers know who received the vaccine and who received the placebo. This is known as a double-blind study and is considered the gold standard for clinical research. It’s done to prevent either side from changing their behavior or biasing the trial in a deliberate or unconscious way. Someone who knows they received the actual vaccine may engage in riskier behavior, for example, or the company may be tempted to give the vaccine to people already at lower risk of exposure to boost the apparent efficacy.
Instead, there’s a group of independent scientists known as the Data Safety Monitoring Board (DSMB) that serves as an intermediary between the volunteers and the experimenters. The DSMB knows who received what among the volunteers but doesn’t disclose that to the company right away. Instead, the members monitor the trial pool to ensure there are no severe complications and can stop the trial if there are any problems.
The DSMB then convenes with the company and experimenters at predetermined checkpoints, namely when a certain number of infections are detected. The recent vaccine announcements from Moderna and from Pfizer and BioNTech both emerged from such a preliminary meeting, both at roughly the 95 infection checkpoint. While these results are not peer-reviewed per se, implicit in these announcements is that a group of independent scientists have verified these results. That’s why many scientists who have been paying attention to these clinical trials are so excited about the findings, even though they are preliminary.
“The vaccine is on its way, folks, so hang in there, hang tough,” Anthony Fauci, director of NIAID, said last week in response to the Pfizer and BioNTech announcement. “We’re going to get over this together.”
Moderna expects the final analysis of its clinical trial to be conducted when 151 Covid-19 infections are confirmed in the trial pool. It’s hard to say when it will get that many cases, but given the uncontrolled spread of Covid-19 in the United States, it’s likely to happen within the next two months.
There are some caveats to Moderna’s Covid-19 vaccine results
Moderna’s results were announced in a press release — like the Pfizer and BioNTech vaccine results, Moderna’s announcement came directly from the company itself. There have been several peer-reviewed interim studies about its mRNA-1273 vaccine, but Monday’s efficacy announcement didn’t come with any published data.
Caution: this is a press release not a scientific paper. Looking forward to more detailed efficacy and safety data e.g. https://t.co/DQctLPM0li — Saad B. Omer (@SaadOmer3) November 16, 2020
That doesn’t mean the results are wrong, but they are only a snapshot in time, and without more details, it’s hard to unpack critical nuances needed to interpret them, like what kinds of underlying health conditions influence the efficacy of a vaccine.
These for-profit companies also have a financial incentive to play up good news and smooth over any bumps on the road to an approved vaccine. As the trial proceeds, the results could be reinforced or undermined.
“When we do finally have a viable Covid-19 immunization, the public needs to be able to trust that it’s safe and effective,” wrote Vox’s Julia Belluz. “And the road to building that confidence isn’t paved with preliminary, sparsely detailed news releases that are later overturned when the real work of vetting the vaccines is done.”
But as mentioned above, the fact that these results have independent validation gives them more weight. So there is cause for optimism and skepticism.
Moderna revealed some of the demographics of who is in its trial pool, but more information is still needed; it’s unlikely that a vaccine will be equally effective in all groups of people, so it’s important to pay close attention to the demographics of who gets sick and who gets protected in a vaccine trial.
According to Moderna, the 95 Covid-19 cases were detected in 15 adults over the age of 65 and 20 participants identifying as having a minority background, including 12 Hispanic or Latinx people, four Black or African American people, three Asian American people, and one multiracial person. This shows that the trial recruited a broad spectrum of participants.
This is immensely valuable information for public health and can help guide a vaccination strategy. But health officials still need more information about things like preexisting conditions in the trial pool and the amount of exposure to the virus people experienced.
There are some side effects — Moderna said volunteers generally tolerated their vaccine pretty well, and most problems tended to be mild to moderate.
Nice safety profile, and participants will continue to be followed. Remember - evaluation of vaccine safety never stops, even after vaccines are approved and deployed. We have an adverse event reporting system to continually monitor all vaccines. 7/10 pic.twitter.com/ynGsXjArei — Natalie E. Dean, PhD (@nataliexdean) November 16, 2020
Reported problems included injection site pain (2.7 percent) after the first dose, and after the second dose, recipients reported fatigue (9.7 percent), muscle pain (8.9 percent), arthralgia (5.2 percent), headache (4.5 percent), pain (4.1 percent) and redness at the injection site (2 percent), with some overlap in these numbers among patients who experienced more than one effect. Most of these effects were short-lived. A final safety evaluation will still be needed once the trial is run to completion.
While these effects are fairly mild, it’s important to pay close attention to them since vaccines will ultimately have to be distributed to millions, if not billions, of people. Rare complications will be more likely to show up once lots of people get the shot. And clinical trials of other Covid-19 vaccine candidates —like the Johnson & Johnson vaccine or the University of Oxford and AstraZeneca vaccine — have already been paused due to complications among recipients. For vaccinations, safety is paramount.
The Moderna vaccine has other important advantages
Monday’s vaccine efficacy announcement also illustrated some critical lessons about how Moderna was able to achieve these results and other details that could influence a vaccination strategy.
RNA is a viable way to make a vaccine: Moderna’s vaccine is now the second RNA-based vaccine that has demonstrated a high efficacy against Covid-19. Using RNA genetic material — in this case a variant known as mRNA — is a new vaccine technology. Such an approach has never received approval for widespread use, so these results are an important validation. The way it works is that the instructions for making a piece of the virus are inserted into the body. After cells read the instructions and manufacture the component of the virus, the immune system detects it and starts to mount a response.
This is a huge shift from conventional vaccines, which typically use a weakened version of the live virus, a whole dead virus, or a fragment of the virus. With RNA and similar DNA-based vaccines, there is no viral structure injected.
Like the Pfizer and BioNTech vaccine, Moderna’s RNA-based vaccine also codes for the spike protein of SARS-CoV-2, the virus that causes Covid-19. The spike is the part of the virus that lets it enter cells and take them over, and teaching the immune system to target this component has now been demonstrated to be a viable strategy.
Moderna’s vaccine appears to protect against mild and severe Covid-19: Efficacy in this context is defined as the share of vaccinated people who actually receive protection against the disease in question. For Covid-19, Food and Drug Administration guidelines say that a vaccine needs to provide protection against the coronavirus for at least 50 percent of the people who get it. That means at least half of the people who get the vaccine have to have some form of protection.
At 94.5 percent efficacy, Moderna’s results vault over this benchmark. But the company went a step further, reporting that out of the 11 severe Covid-19 cases it identified in its trial pool, all were in the placebo group and none in the vaccine group.
What this shows is that the vaccine is effective against severe manifestations of the illness. It may be the case that someone who gets vaccinated could still get a mild infection, but it’s likely the vaccine will keep them out of the hospital. While 11 is a small number of cases, it’s unlikely to have occurred by chance.
One lingering concern is that Moderna hasn’t disclosed how long this protection will last, and it may not be able to find out without simply waiting and seeing. Figuring out the duration of protection from a vaccine will likely require long-term monitoring.
Government support played a crucial role: Just about every vaccine candidate has benefited from the government’s efforts to speed up trials. The FDA allowed experimenters to run phases of clinical trials concurrently and accelerated many of their regulatory approval processes. The US government has also committed to buy millions of doses of a vaccine from whichever manufacturer crosses the line under Operation Warp Speed, a US government initiative aimed at procuring 300 million Covid-19 vaccine doses by January 2021.
That’s a big reason a Covid-19 vaccine may be on the market in record time, likely within two years instead of the typical decades-long development that vaccines usually require.
Moderna also received a direct boost under Operation Warp Speed. The Department of Health and Human Services awarded the company $483 million in April, followed by $472 million in July to support clinical trials. Then in August, HHS announced $1.5 billion in manufacturing support for Moderna’s vaccine.
It’s easier to keep Moderna’s vaccine cool than the one from Pfizer and BioNTech: Moderna was quick to highlight that its vaccine candidate has much lighter logistical requirements and can be stored at warmer temperatures than the one developed by Pfizer and BioNTech.
Moderna’s vaccine requires long-term storage at minus 20 degrees Celsius (minus 4 degrees Fahrenheit) and is stable for 30 days between 2 and 8 degrees Celsius (36 degrees to 46 degrees Fahrenheit). That’s well within the temperature range of conventional refrigerators. Pfizer and BioNTech’s vaccine, however, demands temperatures of minus 70 degrees Celsius (minus 94 degrees Fahrenheit) or lower, which requires ultra-cold freezers and careful shipping.
That means the logistics of getting Moderna’s vaccine to people are much easier.
However, Moderna’s vaccine, like Pfizer and BioNTech’s candidates, is still a two-dose vaccine, which means every recipient will have to come back after several weeks for a second injection. And that means vaccinations will require twice the number of doses as a single-dose vaccine, adding to the cost of the effort.
What happens next for a Covid-19 vaccine
There are still several key steps between the results as they were announced, completing a trial, getting approval, and getting it to everyone that needs it.
The trial still has to run to completion, and both vaccine candidates — from Moderna and from Pfizer and BioNTech — need more safety data before they can seek full approval. However, they may be able to apply for an Emergency Use Authorization from the FDA. That would allow the vaccine to be used in limited cases for people facing some of the highest exposures to Covid-19, like health workers and workers in essential roles.
“Moderna intends to submit for an Emergency Use Authorization (EUA) with U.S. FDA in the coming weeks and expects the EUA to be based on the final analysis of 151 cases and a median follow-up of more than 2 months,” according to Moderna’s press release.
Related A vaccine may not be enough to end the pandemic
Once a vaccine gets approved, a global supply chain, from the glass vials that hold the vaccine to the syringes used to inject them, needs to spool up to make huge quantities of the vaccine. Manufacturers will also have to ensure that vaccines remain intact and under strict temperature controls from the factory to the hospitals and clinics where they will be used. The process of manufacturing, distributing, and administering a vaccine could take months.
And vaccine research doesn’t end once a vaccine gets approved. Researchers and companies will still have to track complications across millions of people and pay attention to how quickly immunity wanes.
It’s also important to remember that a vaccine is not enough on its own to end the pandemic. Measures like social distancing, good hygiene, and wearing face masks will remain essential to control the spread of Covid-19 until a vaccine is widely available. Public acceptance will also be a major issue, and health officials will have to overcome a rising wave of vaccine hesitancy.
A vaccine on its own will not end the #COVID19 pandemic. We will still need to continue:
-Surveillance
-Testing, isolating & caring for cases
-Tracing & quarantining contacts
-Engaging communities
-Encouraging individuals to be careful #ACTogether #EB147 — Tedros Adhanom Ghebreyesus (@DrTedros) November 16, 2020
While the end of the pandemic is now coming into focus with the latest vaccine announcements, a lot of hard work is still needed, and some of the toughest days of the Covid-19 pandemic lie ahead.
Julia Belluz contributed reporting to this story.


vox--2020-11-16--Biden can do 3 things on day one to unwind Trump’s war on reproductive health

Again and again over the last four years , the Trump administration has made it harder for Americans — and people abroad — to get basic reproductive health care .
In 2017 , the administration reimposed and broadened a rule , sometimes called the Mexico City policy , barring health organizations around the world that get US aid from providing or even discussing abortions .
The result was a reduction in access to abortion , as well as services like contraception and prenatal care .
The same year , Trump ’ s Health and Human Services Department issued rules weakening @ @ @ @ @ @ @ insurance that covers birth control , allowing them to claim an exemption if they had a religious or moral objection .
Those rules have been tied up by lawsuits , but just won a major victory at the Supreme Court in July .
And in 2019 , the Trump administration finalized what reproductive health advocates call a “ domestic gag rule , ” barring health care providers that get federal family planning funds under the Title X program from performing or referring for abortions .
As a result , hundreds of clinics have @ @ @ @ @ @ @ to provide birth control services in half .
These actions have had a real and serious impact on patients , only compounded by a pandemic that has made it even harder for many Americans , especially low-income people of color , to access reproductive health care .
But there is likely an end in sight for many of the Trump administration ’ s policies : Since they were enacted by executive action , they can be undone by President-elect Joe Biden when he takes office , without any help from Congress .
Biden @ @ @ @ @ @ @ spelling out in campaign documents his plan to reverse many of Trump ’ s actions .
“ President-elect Biden believes that health care is a right that should not be determined by one ’ s zip code or income , ” Mariel Sáez , women ’ s media director for the Biden campaign , wrote in a statement to Vox .
But the question for many is not whether the Biden campaign will simply roll back Trump ’ s policies — it ’ s whether he will go further to repair America ’ @ @ @ @ @ @ @ it for the future .
“ The harms are so complex and , now , ingrained , that it ’ s going to be a real battle and a real fight , ” Zarah Ahmed , associate director of federal issues at the Guttmacher Institute , told Vox .
“ We ’ re going to have to use every tool we can to undo those harms.
” Biden can reverse many of Trump ’ s policies .
Advocates say he needs to do more .
The Trump administration has made opposition not just @ @ @ @ @ @ @ of contraception , a cornerstone of its public health policy .
Likely with the help of Vice President Mike Pence , a longtime opponent of abortion and Planned Parenthood , Trump staffed his department of Health and Human Services with numerous anti-abortion rights advocates .
And time and again , his administration has issued rules that reduce access to abortion , contraception , and more .
These are three the Biden administration has pledged to roll back : Also known as the “ global gag rule , ” this policy has been enacted @ @ @ @ @ @ @ Reagan , and repealed by every Democratic president .
But President Trump enacted an even broader version of the policy — while previous Republican administrations had barred family planning organizations abroad that receive US aid from discussing abortion , Trump made the policy apply to any health organization that receives US money .
That means nonprofits that work on tuberculosis , malaria , and all other health issues are banned from even bringing up abortion , lest they lose their funding , as Sarah Wildman reported at Vox in 2017 .
The results @ @ @ @ @ @ @ For example , a 2019 study across Kenya , Nepal , Nigeria , and South Africa found reduced access not just to abortion , but to contraception , prenatal care , HIV testing , and screening for breast and prostate cancer .
Like Democrats in the past , Biden has pledged to rescind the policy .
“ This rule currently bars the US federal government from supporting important global health efforts — including for malaria and HIV/AIDS — in developing countries simply because the organizations providing that aid also offer information on abortion @ @ @ @ @ @ @ this year as part of its “ agenda for women.
” But reproductive health advocates want to see him do more .
They are urging him to champion the Global Health , Empowerment , and Rights ( HER ) Act , which would permanently repeal the Mexico City policy .
And Guttmacher is calling on the Biden administration to significantly increase the US contribution to international family planning programs , from the $ 575 million currently set aside for 2021 to $ 1.66 billion .
Both those moves would require the approval of @ @ @ @ @ @ @ retain control of the Senate after January ’ s runoff elections in Georgia .
But Biden should lead on reproductive health not just with executive orders , but with all the tools at his disposal , including pressure on Congress , Ahmed said .
“ The Trump administration has gone after and attacked reproductive health on so many fronts , so aggressively , that our response and the response from the Biden administration has to be equally aggressive and equally multifaceted.
” The Obama administration in 2011 designated contraception as one of the @ @ @ @ @ @ @ to cover without a copay under the Affordable Care Act ( ACA ) .
That meant the millions of Americans who get insurance through their jobs could get birth control — including IUDs , which can cost more than $ 1,000 to insert — at no upfront cost .
But the Trump administration in 2017 announced broad exemptions to the mandate , allowing employers with a religious or moral objection to birth control to get out of covering it with relative ease .
Those exemptions were soon tied up in court , but @ @ @ @ @ @ @ upheld the exemptions in the case Little Sisters v. Pennsylvania .
While they are not in effect yet — the Court referred the relevant cases back to lower courts for final decisions — the ruling in Little Sisters led many to expect they might take effect soon .
That ’ s unlikely to happen now .
During the campaign , Biden stated that he would restore the contraceptive mandate without the Trump exemptions , leaving in place only Obama-era accommodations that allow houses of worship and religious nonprofits to decline to offer birth @ @ @ @ @ @ @ insurance party or third-party administrator is required to offer the coverage instead .
Meanwhile , reproductive health advocates are asking Biden to go beyond ending the Trump exemptions to improve all Americans ’ access to contraception and other reproductive health care .
A lot of their asks revolve around another program the Trump administration has weakened : Title X .
Established under President Richard Nixon , Title X is supposed to provide family planning assistance to low-income and other underserved Americans .
It does not provide funding for abortions .
But in 2019 @ @ @ @ @ @ @ care providers that receive Title X money from performing or referring for abortions — even though they weren ’ t actually using the money to pay for abortions themselves .
The rule was largely viewed as an attempt to strip funding from Planned Parenthood , a longtime goal of Republicans and especially Pence , who introduced the first bill to do so as a member of Congress in 2007 ( it didn ’ t pass ) .
And indeed , Planned Parenthood exited the Title X program as a result of the new @ @ @ @ @ @ @ — an estimated 981 clinics in total , according to Guttmacher .
That reduced the program ’ s ability to provide contraceptive services by at least 46 percent , the group estimates .
And it wasn ’ t just birth control .
Many Title X clinics also offer services like STI testing , prenatal care , and cancer screening — and in many cases , a Title X provider may be the only doctor a patient sees all year .
With clinics having to reduce hours or services , or even shut down @ @ @ @ @ @ @ money , some patients lost their only real source of routine medical care .
Biden has promised to change that , reversing the Trump administration ’ s Title X rule — one of the key planks of the campaign ’ s reproductive health agenda was “ restore federal funding for Planned Parenthood.
” But restoring health care access won ’ t be as simple as getting rid of the Trump-era rule .
As Alina Salganicoff , senior vice president and director of women ’ s health policy at the Kaiser Family Foundation , @ @ @ @ @ @ @ when services go away , it ’ s not like you flip a switch and they start again.
” Clinics that lost funding under Trump may have closed their doors or laid off staff , and increasing capacity again will take time , and potentially more money .
To strengthen the Title X program , advocates are calling on Biden not just to reverse Trump ’ s rule , but also to push Congress to significantly expand funding for the program .
The Blueprint for Sexual and Reproductive Health , Rights , and @ @ @ @ @ @ @ a coalition of reproductive health and justice organizations of which Guttmacher is a part , estimates the needed figure at $ 954 million .
“ As a budget is a reflection of priorities , ” the Blueprint members said in a recent statement , “ the president ’ s budget must demonstrate a commitment to sexual and reproductive health.
” Biden ’ s plans for reproductive health go beyond these three areas — he has also promised , for example , to restore health care protections for LGBTQ Americans rolled back by the @ @ @ @ @ @ @ to address the country ’ s ongoing maternal mortality crisis , which disproportionately impacts Black women , by embracing California ’ s data-driven strategy for reducing birth complications .
Some of Biden ’ s promises , like reversing Trump ’ s executive orders , will be easy to carry out .
Others , like increasing funding , will be a lot harder .
But reproductive health advocates say it ’ s not enough just to undo what Trump did .
“ It ’ s not just about bringing the US and the world @ @ @ @ @ @ @ , ” Ahmed said .
“ Things weren ’ t great in 2016 — a lot of people didn ’ t have access to care they needed and wanted and deserved .
Yes , we have to undo this damage , but we also have to get to a far more equitable place .
”

Again and again over the last four years, the Trump administration has made it harder for Americans — and people abroad — to get basic reproductive health care.
In 2017, the administration reimposed and broadened a rule, sometimes called the Mexico City policy, barring health organizations around the world that get US aid from providing or even discussing abortions. The result was a reduction in access to abortion, as well as services like contraception and prenatal care.
The same year, Trump’s Health and Human Services Department issued rules weakening an Obama-era mandate requiring employers to offer insurance that covers birth control, allowing them to claim an exemption if they had a religious or moral objection. Those rules have been tied up by lawsuits, but just won a major victory at the Supreme Court in July.
And in 2019, the Trump administration finalized what reproductive health advocates call a “domestic gag rule,” barring health care providers that get federal family planning funds under the Title X program from performing or referring for abortions. As a result, hundreds of clinics have exited the program, cutting its ability to provide birth control services in half.
These actions have had a real and serious impact on patients, only compounded by a pandemic that has made it even harder for many Americans, especially low-income people of color, to access reproductive health care.
But there is likely an end in sight for many of the Trump administration’s policies: Since they were enacted by executive action, they can be undone by President-elect Joe Biden when he takes office, without any help from Congress.
Biden has promised to do exactly that, spelling out in campaign documents his plan to reverse many of Trump’s actions. “President-elect Biden believes that health care is a right that should not be determined by one’s zip code or income,” Mariel Sáez, women’s media director for the Biden campaign, wrote in a statement to Vox.
But the question for many is not whether the Biden campaign will simply roll back Trump’s policies — it’s whether he will go further to repair America’s reproductive health care system and strengthen it for the future. “The harms are so complex and, now, ingrained, that it’s going to be a real battle and a real fight,” Zara Ahmed, associate director of federal issues at the Guttmacher Institute, told Vox. “We’re going to have to use every tool we can to undo those harms.”
Biden can reverse many of Trump’s policies. Advocates say he needs to do more.
The Trump administration has made opposition not just to abortion, but to some forms of contraception, a cornerstone of its public health policy. Likely with the help of Vice President Mike Pence, a longtime opponent of abortion and Planned Parenthood, Trump staffed his department of Health and Human Services with numerous anti-abortion rights advocates. And time and again, his administration has issued rules that reduce access to abortion, contraception, and more. These are three the Biden administration has pledged to roll back:
The Mexico City policy
Also known as the “global gag rule,” this policy has been enacted by every Republican president starting with Ronald Reagan, and repealed by every Democratic president. But President Trump enacted an even broader version of the policy — while previous Republican administrations had barred family planning organizations abroad that receive US aid from discussing abortion, Trump made the policy apply to any health organization that receives US money. That means nonprofits that work on tuberculosis, malaria, and all other health issues are banned from even bringing up abortion, lest they lose their funding, as Sarah Wildman reported at Vox in 2017.
The results have been devastating around the world. For example, a 2019 study across Kenya, Nepal, Nigeria, and South Africa found reduced access not just to abortion, but to contraception, prenatal care, HIV testing, and screening for breast and prostate cancer.
Like Democrats in the past, Biden has pledged to rescind the policy. “This rule currently bars the US federal government from supporting important global health efforts — including for malaria and HIV/AIDS — in developing countries simply because the organizations providing that aid also offer information on abortion services,” his campaign stated earlier this year as part of its “agenda for women.”
But reproductive health advocates want to see him do more. They are urging him to champion the Global Health, Empowerment, and Rights (HER) Act, which would permanently repeal the Mexico City policy. And Guttmacher is calling on the Biden administration to significantly increase the US contribution to international family planning programs, from the $575 million currently set aside for 2021 to $1.66 billion.
Both those moves would require the approval of Congress, a significant barrier if Republicans retain control of the Senate after January’s runoff elections in Georgia. But Biden should lead on reproductive health not just with executive orders, but with all the tools at his disposal, including pressure on Congress, Ahmed said. “The Trump administration has gone after and attacked reproductive health on so many fronts, so aggressively, that our response and the response from the Biden administration has to be equally aggressive and equally multifaceted.”
The contraceptive mandate
The Obama administration in 2011 designated contraception as one of the preventive care services that employer-provided insurance had to cover without a copay under the Affordable Care Act (ACA). That meant the millions of Americans who get insurance through their jobs could get birth control — including IUDs, which can cost more than $1,000 to insert — at no upfront cost.
But the Trump administration in 2017 announced broad exemptions to the mandate, allowing employers with a religious or moral objection to birth control to get out of covering it with relative ease. Those exemptions were soon tied up in court, but earlier this year, the Supreme Court upheld the exemptions in the case Little Sisters v. Pennsylvania. While they are not in effect yet — the Court referred the relevant cases back to lower courts for final decisions — the ruling in Little Sisters led many to expect they might take effect soon.
That’s unlikely to happen now. During the campaign, Biden stated that he would restore the contraceptive mandate without the Trump exemptions, leaving in place only Obama-era accommodations that allow houses of worship and religious nonprofits to decline to offer birth control. In those cases, an insurance party or third-party administrator is required to offer the coverage instead.
Meanwhile, reproductive health advocates are asking Biden to go beyond ending the Trump exemptions to improve all Americans’ access to contraception and other reproductive health care. A lot of their asks revolve around another program the Trump administration has weakened: Title X.
The Title X “domestic gag rule”
Established under President Richard Nixon, Title X is supposed to provide family planning assistance to low-income and other underserved Americans. It does not provide funding for abortions.
But in 2019, Trump finalized a rule barring health care providers that receive Title X money from performing or referring for abortions — even though they weren’t actually using the money to pay for abortions themselves.
The rule was largely viewed as an attempt to strip funding from Planned Parenthood, a longtime goal of Republicans and especially Pence, who introduced the first bill to do so as a member of Congress in 2007 (it didn’t pass). And indeed, Planned Parenthood exited the Title X program as a result of the new rule. So did many smaller providers — an estimated 981 clinics in total, according to Guttmacher. That reduced the program’s ability to provide contraceptive services by at least 46 percent, the group estimates.
And it wasn’t just birth control. Many Title X clinics also offer services like STI testing, prenatal care, and cancer screening — and in many cases, a Title X provider may be the only doctor a patient sees all year. With clinics having to reduce hours or services, or even shut down due to the lack of Title X money, some patients lost their only real source of routine medical care.
Biden has promised to change that, reversing the Trump administration’s Title X rule — one of the key planks of the campaign’s reproductive health agenda was “restore federal funding for Planned Parenthood.”
But restoring health care access won’t be as simple as getting rid of the Trump-era rule. As Alina Salganicoff, senior vice president and director of women’s health policy at the Kaiser Family Foundation, told Vox earlier this year, “when services go away, it’s not like you flip a switch and they start again.” Clinics that lost funding under Trump may have closed their doors or laid off staff, and increasing capacity again will take time, and potentially more money.
To strengthen the Title X program, advocates are calling on Biden not just to reverse Trump’s rule, but also to push Congress to significantly expand funding for the program. The Blueprint for Sexual and Reproductive Health, Rights, and Justice, a policy agenda developed by a coalition of reproductive health and justice organizations of which Guttmacher is a part, estimates the needed figure at $954 million. “As a budget is a reflection of priorities,” the Blueprint members said in a recent statement, “the president’s budget must demonstrate a commitment to sexual and reproductive health.”
Biden’s plans for reproductive health go beyond these three areas — he has also promised, for example, to restore health care protections for LGBTQ Americans rolled back by the Trump administration. And he has pledged to address the country’s ongoing maternal mortality crisis, which disproportionately impacts Black women, by embracing California’s data-driven strategy for reducing birth complications.
Some of Biden’s promises, like reversing Trump’s executive orders, will be easy to carry out. Others, like increasing funding, will be a lot harder.
But reproductive health advocates say it’s not enough just to undo what Trump did.
“It’s not just about bringing the US and the world back to where we were in 2016,” Ahmed said. “Things weren’t great in 2016 — a lot of people didn’t have access to care they needed and wanted and deserved. Yes, we have to undo this damage, but we also have to get to a far more equitable place.”


vox--2020-11-16--I paid off all my student loans. I still support student loan forgiveness.

This is adapted from an essay originally published in 2019 .
I paid off my student loans in full without assistance .
Yet when , in a recent interview , Chuck Schumer floated the idea of President-elect Joe Biden canceling the first $ 50,000 of student loan debt , editorialists suggest the plan will be interpreted as “ unfair ” to those of us who already paid off our loans — they ’ re certainly not speaking for me .
It ’ s the kind of argument designed to tug at our most selfish impulses while ignoring the economic and @ @ @ @ @ @ @ of college graduates struggling under an unprecedented mountain of student debt .
I graduated college in 1985 with $ 18,000 in student loans ( about $ 42,500 in 2019 dollars ) , and then diligently paid them off over the next 10 years .
As a father , I saved enough for my daughter ’ s education to assure that she could graduate college 100 percent debt-free .
I ’ m not rich .
I didn ’ t always make the best financial choices .
But I worked hard , played by the @ @ @ @ @ @ @ debts .
I could be the poster child for those claiming student loan forgiveness is “ unfair.
” But you know what ’ s really unfair ?
The huge advantage I enjoyed graduating into the 1985 job market .
I graduated with a BA in history — not the most valuable field of study when it comes to job qualifications .
But when I entered the job market in 1985 , employers were eager to hire smart kids from good universities , whatever their degree .
I got the first and only job @ @ @ @ @ @ @ job I knew absolutely nothing about — at a starting salary of $ 35,000 a year .
That ’ s about $ 82,000 in today ’ s money .
But that ’ s how the job market worked for white , male boomers like me back in the 1960s , ’ 70s , and ’ 80s : Companies actually invested in their employees , expecting to train you on the job rather than requiring a STEM degree or years of experience at an under- or unpaid internship or fellowship .
By comparison , @ @ @ @ @ @ @ millennials who graduated into a post-Great Recession job market so mean and miserly that it literally had them eating out of Dumpsters .
Except for those grads at the very top of the pay scale , our current tight job market hardly treats them much better .
Over the past couple decades , real median wages for college graduates have either stagnated or declined , even as the costs of achieving and maintaining a middle-class lifestyle have gone through the roof , especially child care , health care , housing — and of @ @ @ @ @ @ @ clear , the only reason I graduated with so much debt was I had the privilege of attending a pricey private university .
But had I chosen to attend a public institution , I likely would have graduated free and clear .
That ’ s not the case for young people today .
Whenever an old white guy like me reminds you that “ I worked my way through college , ” remind them that in the 1981-1982 academic year , the average in-state tuition and fees at a four-year public college or @ @ @ @ @ @ @ when the federal minimum wage was $ 3.35 an hour .
That means I could have paid for my entire freshman year tuition and fees with less than seven weeks of full-time minimum-wage work at just about any shitty summer job .
But over the past four decades , average public university tuition and fees have increased more than 11-fold , to $ 10,230 a year , while the federal minimum wage of $ 7.25 an hour has barely doubled .
Do the math : Today , the only way to work your @ @ @ @ @ @ @ job would be to extend the summer break from June through February .
So why have public universities gotten so expensive ?
It ’ s not what you probably think .
Adjusted for inflation , the cost of educating students at public universities has actually increased only modestly .
Rather , it ’ s the price that ’ s gone through the roof , thanks in large part to a massive shift in costs from taxpayers to students .
According to the Center on Budget and Policy Priorities , student tuition as a @ @ @ @ @ @ @ ’ s public colleges and universities rose from 24 percent in 1988 to 46 percent in 2015 .
And in some states , this shift in costs has been far worse .
In my adopted state of Washington , once home to one of the most affordable public university systems in the nation , the funding split dramatically flipped from 70 percent state , 30 percent tuition in 1991 , to 30 percent state , 70 percent tuition by 2013 .
Boomers like me have pulled up the ladder behind us after being @ @ @ @ @ @ @ wonder young people have piled up more than $ 1.5 trillion in student debt .
My father , who grew up poor , used to tell us that he worked hard so that he could give his kids all the things he never had .
And by far the greatest gift he gave us was the sense of economic security that defines what it means to be middle class .
I want the same for my daughter , which is why it was so important to me that she graduate into today ’ @ @ @ @ @ @ @ ’ t the economy we boomers grew up in .
Tuition is expensive , wages are stagnant , and housing prices are so outrageous that the only way my daughter will likely ever own a house in Seattle like the one she grew up in is if I die in it .
And if my child deserves a debt-free college education , doesn ’ t every child ?
So , yes , as a late-wave boomer with absolutely nothing to gain from a student loan forgiveness plan , I enthusiastically support both student @ @ @ @ @ @ @ just because it would be damn good for the economy by giving a whole generation saddled by debt more freedom to build up savings , buy homes , and contribute to the economy .
But because I believe in the golden rule : Give unto future generations the same opportunities and privileges my generation enjoyed .
David Goldstein is a senior fellow at Civic Ventures , a Seattle-based public policy incubator , and a co-host of the podcast Pitchfork Economics .

Editor’s note: This essay was originally published in 2019. President Biden announced $10,000 to $20,000 of loan forgiveness on August 24, 2022.
I paid off my student loans in full without assistance. Yet when, in a recent interview, Chuck Schumer floated the idea of President-elect Joe Biden canceling the first $50,000 of student loan debt, editorialists suggest the plan will be interpreted as “unfair” to those of us who already paid off our loans — they’re certainly not speaking for me.
It’s the kind of argument designed to tug at our most selfish impulses while ignoring the economic and political transformations that have left a generation of college graduates struggling under an unprecedented mountain of student debt.
I graduated college in 1985 with $18,000 in student loans (about $42,500 in 2019 dollars), and then diligently paid them off over the next 10 years. As a father, I saved enough for my daughter’s education to assure that she could graduate college 100 percent debt-free. I’m not rich. I didn’t always make the best financial choices. But I worked hard, played by the rules, and made good on my debts. I could be the poster child for those claiming student loan forgiveness is “unfair.”
But you know what’s really unfair? The huge advantage I enjoyed graduating into the 1985 job market.
I graduated with a BA in history — not the most valuable field of study when it comes to job qualifications. But when I entered the job market in 1985, employers were eager to hire smart kids from good universities, whatever their degree. I got the first and only job I applied for — a cushy tech job I knew absolutely nothing about — at a starting salary of $35,000 a year. That’s about $82,000 in today’s money.
But that’s how the job market worked for white, male boomers like me back in the 1960s, ’70s, and ’80s: Companies actually invested in their employees, expecting to train you on the job rather than requiring a STEM degree or years of experience at an under- or unpaid internship or fellowship.
By comparison, I know smart, talented, debt-laden millennials who graduated into a post-Great Recession job market so mean and miserly that it literally had them eating out of Dumpsters. Except for those grads at the very top of the pay scale, our current tight job market hardly treats them much better.
Over the past couple decades, real median wages for college graduates have either stagnated or declined, even as the costs of achieving and maintaining a middle-class lifestyle have gone through the roof, especially child care, health care, housing — and of course, college tuition. To be clear, the only reason I graduated with so much debt was I had the privilege of attending a pricey private university. But had I chosen to attend a public institution, I likely would have graduated free and clear. That’s not the case for young people today.
Whenever an old white guy like me reminds you that “I worked my way through college,” remind them that in the 1981-1982 academic year, the average in-state tuition and fees at a four-year public college or university was just $909 … back when the federal minimum wage was $3.35 an hour. That means I could have paid for my entire freshman year tuition and fees with less than seven weeks of full-time minimum-wage work at just about any shitty summer job. But over the past four decades, average public university tuition and fees have increased more than 11-fold, to $10,230 a year, while the federal minimum wage of $7.25 an hour has barely doubled.
Do the math: Today, the only way to work your way through college on the typical summer job would be to extend the summer break from June through February.
So why have public universities gotten so expensive? It’s not what you probably think. Adjusted for inflation, the cost of educating students at public universities has actually increased only modestly. Rather, it’s the price that’s gone through the roof, thanks in large part to a massive shift in costs from taxpayers to students.
According to the Center on Budget and Policy Priorities, student tuition as a share of total spending at our nation’s public colleges and universities rose from 24 percent in 1988 to 46 percent in 2015. And in some states, this shift in costs has been far worse. In my adopted state of Washington, once home to one of the most affordable public university systems in the nation, the funding split dramatically flipped from 70 percent state, 30 percent tuition in 1991, to 30 percent state, 70 percent tuition by 2013.
Boomers like me have pulled up the ladder behind us after being educated largely at taxpayer expense. No wonder young people have piled up more than $1.5 trillion in student debt.
My father, who grew up poor, used to tell us that he worked hard so that he could give his kids all the things he never had. And by far the greatest gift he gave us was the sense of economic security that defines what it means to be middle class. I want the same for my daughter, which is why it was so important to me that she graduate into today’s job market debt-free.
This isn’t the economy we boomers grew up in. Tuition is expensive, wages are stagnant, and housing prices are so outrageous that the only way my daughter will likely ever own a house in Seattle like the one she grew up in is if I die in it. And if my child deserves a debt-free college education, doesn’t every child?
So, yes, as a late-wave boomer with absolutely nothing to gain from a student loan forgiveness plan, I enthusiastically support both student debt forgiveness and debt-free college. Not just because it would be damn good for the economy by giving a whole generation saddled by debt more freedom to build up savings, buy homes, and contribute to the economy. But because I believe in the golden rule: Give unto future generations the same opportunities and privileges my generation enjoyed.
David Goldstein is a senior fellow at Civic Ventures, a Seattle-based public policy incubator, and a co-host of the podcast Pitchfork Economics.