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Indonesia Ends Quarantine Requirement for Overseas Travelers | The information you requested is not available at this time, please check back again soon.
A traveler, right, arrives at Ngurah Rai International Airport in Bali, Indonesia, on Monday, March 7, 2022. Indonesia started to allow quarantine-free entry for foreigners traveling to Bali. Visitors from 23 countries, including the U.S., U.K. and Australia, can get a visa on arrival as long as they are fully vaccinated and test negative for Covid-19 prior to departure. Photographer: Putu Sayoga/Bloomberg, Bloomberg
( Bloomberg) -- Indonesia is lifting all quarantine rules for international travelers to end two years of border closure, following its neighbors to ease restrictions as Southeast Asia moves past the worst of the omicron wave.
The government will broaden its quarantine-free travel to the rest of the country, while still requiring a negative test result, said Tourism Minister Sandiaga Uno. The reopening comes after a successful two-week trial of quarantine-free travel to Bali, he added.
Canada joins U.S., U.K. in diplomatic boycott of Beijing games
Trudeau weighs auto-content rules as next U.S. trade flashpoint | general |
Asia octane: Key market indicators for March 21-25 | In this week’ s highlights: Prospects of a modest oil price recovery in the coming months are growing...
Demand for Asian gasoline is expected to increase over March 21-25 as more regional economies ease COVID-19 restrictions and ahead of the Muslim fasting month of Ramadan.
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However, demand for gasoline blending was reportedly low as margins remained poor, market sources said. The reforming spread, on the other hand, has been widening, which could improve blending economics going forward.
Nevertheless, Japan's appetite for gasoline blending components is expected to decline in the short term as the March 16 earthquake that rocked offshore Fukushima has hindered blending operations, market sources said.
At 0258 GMT March 21, May ICE Brent crude oil futures contract was up by more than 2.67% from the previous Asian close on March 18 at $ 111.08/b, data from S & P Global Commodity Insights showed.
* * Asian naphtha demand recovery was supported by improving reforming spreads and olefin margins, but downstream weakness continued to weigh on the complex.
* * Blendstock demand for naphtha was likely to improve as the reforming spread -- the difference between Singapore 92 RON gasoline and Singapore naphtha derivative -- widened 11.43% day on day to $ 19.45/b at the Asian close March 18, S & P Global data showed.
* * Naphtha steam cracker demand gained traction amid recovering olefin margins. The key CFR Northeast Asia ethylene and C+F Japan naphtha spread widened $ 70.625/mt week on week to $ 401/mt at the Asian close March 18, above the typical breakeven level for non-integrated producers of $ 350/mt, S & P Global data showed.
* * Downstream weakness was evident in the aromatics sector as the key CFR Taiwan/China paraxylene to C+F Japan naphtha cargo spread remained below the typical breakeven level of $ 280- $ 300/mt. The spread narrowed $ 13.045/mt week on week to $ 224/mt at the March 18 Asian close.
* * Asian MTBE prices are expected to be volatile this week, due to fluctuating energy values amid the Russia-Ukraine crisis. However, the MTBE FOB Singapore marker has been stable since March 18, after hitting the all-time high of $ 1,345/mt on March 7, S & P Global data showed.
* * Several MTBE producers were heard considering cutting run rates due to high feedstock costs. South Korean MTBE producer, Hyundai Oilbank, was heard to have reduced its new Daesan MTBE plant run rate to 70%.
* * South Korea halted exporting MTBE to Russia after the latter's invasion of Ukraine. South Korea exported two MTBE cargoes to Russia in November 2021 and January 2022, but none in February 2022.
* * Asian toluene prices are firming on tight spot supplies and supported by higher crude oil prices. April cargoes have mostly been placed and fewer are being sold from Korea, sources said.
* * Asian toluene was assessed up $ 45/mt day on day at $ 1,020/mt FOB Korea and up $ 45/mt at $ 1,050/mt CFR China March 18, S & P Global data showed.
* * Port inventory in east China was down 4,200 mt at 36,800 mt, from 41,000 mt ex-tank, a week ago, while in the south, stocks were low at 15,000 mt.
* * India was closed March 18 for the Holi festival so there fewer firm bids, but demand remains strong, sources said.
* * April cargoes remain tight given upstream volatility recently and the earthquake in Japan affecting MX supply-demand balance.
* * Isomer-MX market participants remain uncertain and continue to track upstream and paraxylene prices, looking to stabilize PX-MX and MX over feedstock naphtha margins. Current PX-MX margins have been hovering at around $ 110/mt, while MX margins over feedstock naphtha are hovering around $ 120- $ 140/mt, S & P Global data showed.
* * Gasoline prices at the pumps in Philippines touched Peso 80/liter at the week ended March 18, climbing from Pesos 72/liter at the end of the week before, a situation deemed worrying for gasoline and fuel ethanol consumption, sources said.
* * Buyers in the Philippines, having covered until June delivery, had stood on the sidelines during the week ended March 18 with offers in the Philippines steady at around $ 780/cu m CFR Philippines, S & P Global data showed.
* * US ethanol delivered to the Philippines slipped to $ 743/cu m on March 18 from $ 754/cu m on March 11, S & P Global data showed, as corn values sank on prospects of peace between Russia and Ukraine.
Product Mar-18 W-o-W Change RON Price per Ron ( $ /mt) Price per Ron ( $ /cu m) GASOLINE FOB Singapore 91 RON non-oxygenated $ 126.74/b -0.40% 91 NA NA FOB Singapore 92 RON oxygenated $ 125.24/b -0.18% 92 FOB Singapore 95 RON oxygenated $ 129.17/b -0.18% 95 FOB Singapore 97 RON oxygenated $ 130.47/b -0.18% 97 BLENDSTOCKS null FOB Singapore Naphtha $ 103.58/b -7.60% 72 6.62 7.56 FOB Korea Toluene $ 1020/mt 0.99% 115 -1.94 4.81 FOB Singapore MTBE $ 1115/mt -0.89% 115 2.19 2.57 FOB Korea Isomer-MX $ 1088/mt -7.56% 113 1.12 8.58 CIF Philippines Ethanol $ 743/cu m -1.46% 118 -4.84 -0.90
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Jak dosáhnout konsensu na zeleném zotavení by Lolwah Al-Khater & Brian Finlay | DAUHÁ – Globálním titulkům dnes sice vévodí ruská invaze na Ukrajinu, ale onemocnění covid-19 dál páchá po celém světě socioekonomickou spoušť. Pandemie si vyžádala více než šest milionů životů, dohnala 124 milionů lidí do extrémní chudoby a zbrzdila pokrok při plnění cílů trvale udržitelného rozvoje 2030. Naštěstí už přibližně pět miliard lidí obdrželo alespoň jednu dávku vakcíny proti covid-19 a Světová zdravotnická organizace ve spolupráci s aliancí Gavi si stanovily cíl naočkovat do letošního července ve všech zemích světa 70% lidí.
Nehledě na děsivou válku na Ukrajině budou pandemie a její oběti společně s klimatickými změnami nadále figurovat na prvním místě seznamu naléhavých globálních úkolů. Dopady krize v důsledku klimatických změn cítíme už nyní dnes a denně, jak ukazuje šestá hodnotící zpráva Mezivládního panelu pro změnu klimatu. Právě nedávno pustošily extrémní teploty a sucha západní Asii a severní Afriku. Stoupající hladiny moří ohrožují řadu ostrovních států a nízko položených zemí. Katastrofální povodně zaplavily části Evropy a Číny. A přes americký Západ a rozsáhlá území Austrálie se přehnaly lesní požáry.
Vědci dnes varují, že budeme-li se chovat, „ jako by se nechumelilo “, průměrná globální teplota se do konce století pravděpodobně zvýší o katastrofálních 3-4°Celsia oproti předindustriální úrovni. Abychom udrželi globální oteplování na mnohem bezpečnější úrovni pod 1,5°C, budou se emise oxidu uhličitého muset do roku 2030 snížit o 45% ( oproti úrovni z roku 2010) a do roku 2050 pak na čistou nulu.
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As Russian forces continue their indiscriminate attacks on Ukrainian civilians, pressure is growing globally to create a special tribunal to prosecute Russian President Vladimir Putin and his inner circle for the crime of aggression. Justice demands that this process begin immediately.
By nominating Ketanji Brown Jackson to the US Supreme Court, President Joe Biden has implicitly acknowledged that the administration of justice in a complex society requires institutions with `` affective appeal. '' Her appointment is not just good politics; it will also lead to better jurisprudence.
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Budowanie Konsensusu w Sprawie Ekologicznego Ożywienia Gospodarczego by Lolwah Al-Khater & Brian Finlay | DOHA – Podczas gdy inwazja Rosji na Ukrainę trafia na pierwsze strony gazet, wirus COVID-19 nadal sieje spustoszenie społeczno-gospodarcze na całym świecie. Pandemia odebrała życie ponad sześciu milionom osób, zepchnęła 124 miliony ludzi w skrajne ubóstwo i utrudniła postępy w realizacji Celów Zrównoważonego Rozwoju na rok 2030. Na szczęście około pięciu miliardów ludzi otrzymało już co najmniej jedną dawkę szczepionki przeciwko wirusowi COVID-19, a Światowa Organizacja Zdrowia i Gavi postawiły sobie za cel zaszczepienie 70% ludzi we wszystkich krajach do lipca tego roku.
Niezależnie od straszliwej wojny na Ukrainie, pandemia i jej długotrwałe żniwo - obok zmian klimatycznych - nadal będą znajdować się na szczycie listy ważnych problemów globalnych. Jak wynika z szóstego raportu oceniającego Międzyrządowego Zespołu do Spraw Zmian Klimatu, skutki tego ostatniego kryzysu są już odczuwalne na co dzień. Niedawno ekstremalne temperatury i susze spustoszyły Azję Zachodnią i Afrykę Północną. Podnoszący się poziom mórz zagraża wielu państwom wyspiarskim i krajom nisko położonym. Katastrofalne powodzie zalały część Europy i Chin. A dzikie pożary ogarnęły amerykański Zachód i duże połacie Australii.
Naukowcy ostrzegają obecnie, że `` niepodejmowanie działań '' prawdopodobnie spowoduje wzrost średniej temperatury na świecie w stosunku do poziomu sprzed epoki przemysłowej o katastrofalne 3-4°C do końca stulecia. Aby utrzymać globalne ocieplenie na znacznie bezpieczniejszym poziomie, poniżej 1,5ºC, emisja dwutlenku węgla będzie musiała spaść o 45% ( w stosunku do poziomu z roku 2010) do roku 2030, a następnie do zera netto do roku 2050.
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As Russian forces continue their indiscriminate attacks on Ukrainian civilians, pressure is growing globally to create a special tribunal to prosecute Russian President Vladimir Putin and his inner circle for the crime of aggression. Justice demands that this process begin immediately.
By nominating Ketanji Brown Jackson to the US Supreme Court, President Joe Biden has implicitly acknowledged that the administration of justice in a complex society requires institutions with `` affective appeal. '' Her appointment is not just good politics; it will also lead to better jurisprudence.
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Établir un consensus pour la relance verte by Lolwah Al-Khater & Brian Finlay | DOHA – Alors que l'invasion russe de l'Ukraine fait les gros titres, la COVID-19 continue de causer es ravages socio-économiques dans le monde entier. La pandémie a tué plus de six millions de gens, en a poussé 124 millions dans l'extrême pauvreté et a empêché des avancées dans la réalisation des Objectifs de développement durable à l'horizon 2030. Heureusement, près de cinq milliards de personnes ont reçu à ce jour au moins une dose de vaccin contre la COVID-19 et l'Organisation Mondiale de la Santé et Gavi ont établi l'objectif de vacciner 70% de la population de tous les pays d'ici le mois de juillet de cette année.
Malgré la guerre horrible en Ukraine, la pandémie et ses lourdes conséquences vont continuer à se classer en tête des problèmes mondiaux, aux côtés du changement climatique. Les effets de cette dernière crise se font déjà sentir au quotidien, comme le montre le Sixième rapport d'évaluation du GIEC. Jusqu ' à récemment, les températures et les sécheresses extrêmes ont ravagé l'Ouest de l'Asie et le Nord de l'Afrique. La hausse du niveau des mers menace de nombreux États insulaires et pays côtiers de basse altitude. Des inondations catastrophiques ont frappé des régions de l'Europe de la Chine. En outre, des incendies ont ravagé de part en part l'Ouest américain et de larges pans de l'Australie.
Les scientifiques nous mettent en garde à présent sur le fait qu'un « retour à notre ancienne manière de faire » va très certainement faire augmenter la température mondiale moyenne, par rapport aux niveau pré-industriels, à 3 à 4º Celsius d'ici la fin du siècle. Pour maintenir le réchauffement de la planète à un niveau bien plus sûr, en deçà de 1,5ºC, il faudra réduire les émissions de CO2 de 45% ( par rapport aux niveaux de 2010) d'ici 2030 puis à zéro émission nette d'ici 2050.
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As Russian forces continue their indiscriminate attacks on Ukrainian civilians, pressure is growing globally to create a special tribunal to prosecute Russian President Vladimir Putin and his inner circle for the crime of aggression. Justice demands that this process begin immediately.
By nominating Ketanji Brown Jackson to the US Supreme Court, President Joe Biden has implicitly acknowledged that the administration of justice in a complex society requires institutions with `` affective appeal. '' Her appointment is not just good politics; it will also lead to better jurisprudence.
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Generando el consenso por la recuperación verde by Lolwah Al-Khater & Brian Finlay | DOHA – Mientras la invasión de Rusia a Ucrania acapara los titulares mundiales, la COVID-19 sigue haciendo estragos en todo el planeta. La pandemia se ha cobrado más de seis millones de vidas, ha empujado a 124 millones de personas hacia la extrema pobreza y obstaculizado los avances para el logro de los Objetivos de Desarrollo Sostenible de 2030. Afortunadamente, cerca de cinco mil millones de personas han recibido al menos una dosis de una vacuna contra el COVID-19, y la Organización Mundial de la Salud y la Gavi han fijado la meta de vacunar a un 70% de la población mundial para julio próximo.
A pesar de la horrenda guerra en Ucrania, la pandemia y sus perdurables consecuencias seguirán ocupando los primeros lugares de la lista de preocupaciones globales urgentes, junto con el cambio climático. Ya se están haciendo sentir los efectos climáticos, como muestra el Sexto Informa de Evaluación del Panel Intergubernamental sobre el Cambio Climático. Hace muy poco, el oeste de Asia y el norte de África han sido asolados por temperaturas extremas y sequías. El ascenso del nivel del mar amenaza a varias islas-estados y países ubicados en áreas bajas. Partes de Europa y China han sufrido inundaciones catastróficas. Y el oeste estadounidense y grandes zonas de Australia han sido afectados por incendios muy difíciles de controlar.
Hoy los científicos advierten que, de seguir así, es probable que la temperatura global promedio aumente, en relación al nivel preindustrial, en unos catastróficos 3 a 4º Celsius para fines de siglo. Para mantener el calentamiento global a un nivel mucho más seguro, menos de 1,5º C, las emisiones de dióxido de carbono tendrán que caer en un 45% ( con respecto a los niveles de 2010) para 2030, y entonces a cero netas para 2050.
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As Russian forces continue their indiscriminate attacks on Ukrainian civilians, pressure is growing globally to create a special tribunal to prosecute Russian President Vladimir Putin and his inner circle for the crime of aggression. Justice demands that this process begin immediately.
By nominating Ketanji Brown Jackson to the US Supreme Court, President Joe Biden has implicitly acknowledged that the administration of justice in a complex society requires institutions with `` affective appeal. '' Her appointment is not just good politics; it will also lead to better jurisprudence.
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Достижение консенсуса по `` зеленому '' восстановлению by Lolwah Al-Khater & Brian Finlay | ДОХА – Пока вторжение России в Украину превалирует в заголовках мировых новостей, COVID-19 продолжает сеять социально-экономический хаос по всему миру. Пандемия унесла более шести миллионов жизней, ввергла в крайнюю нищету 124 миллиона человек и затормозила прогресс в достижении Целей устойчивого развития к 2030 году. К счастью, в настоящее время, по крайней мере одну дозу вакцины против COVID-19 получили около пяти миллиардов человек, и Всемирная организация здравоохранения и Гави поставили перед собой цель к июлю этого года вакцинировать 70% людей во всех странах.
Несмотря на ужасную войну в Украине, пандемия и ее пагубные последствия по-прежнему будут возглавлять список неотложных глобальных проблем наряду с изменением климата. Как показано в Шестом оценочном докладе Межправительственной группы экспертов по изменению климата, последствия последнего кризиса ощущаются уже практически ежедневно. Совсем недавно экстремальные температуры и засухи опустошили Западную Азию и Северную Африку. Повышение уровня моря угрожает многим островным государствам и низменным странам. Катастрофические наводнения затопили часть Европы и Китая. Лесные пожары охватили Американский Запад и большую часть Австралии.
Теперь ученые предупреждают, что к концу века “ business as usual ”, скорее всего, повысит среднюю глобальную температуру по сравнению с доиндустриальным уровнем на катастрофические 3-4 градуса по Цельсию. Для поддержания глобального потепления на гораздо более безопасном уровне, ниже 1,5ºC, выбросы углекислого газа должны сократиться на 45% ( по сравнению с уровнем 2010 года) к 2030 году, а затем до нуля к 2050 году.
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Lolwah Al-Khater, Assistant Foreign Minister at the Ministry of Foreign Affairs of the State of Qatar, is Executive Director of the Doha Forum.
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As Russian forces continue their indiscriminate attacks on Ukrainian civilians, pressure is growing globally to create a special tribunal to prosecute Russian President Vladimir Putin and his inner circle for the crime of aggression. Justice demands that this process begin immediately.
By nominating Ketanji Brown Jackson to the US Supreme Court, President Joe Biden has implicitly acknowledged that the administration of justice in a complex society requires institutions with `` affective appeal. '' Her appointment is not just good politics; it will also lead to better jurisprudence.
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| general |
Working With Post-Pandemic Juries On Science-Based Cases | It is hard to believe that this month marks two years since the World Health Organization declared COVID-19 a global pandemic. During this time, attorneys have had to adapt to a new way of litigating cases.Remote depositions and hearings became the norm. Courts have suspended and reinstated jury trials multiple times during the original outbreak, and surges of the delta and omicron variants.COVID-19-related changes in civil trial practice included reduction in jury size from 12 to six, limitations on the number of peremptory challenges, and fully virtual trials — each of which posed its own series of logistical and... | general |
DC Says Grubhub's Hidden Fees Harm Residents, Eateries | Grubhub charges hidden fees on top of its advertised delivery fee and made restaurants foot the bill for a discount program that was marketed as a way for customers to save money while supporting local eateries during the COVID-19 pandemic, the District of Columbia alleged in a lawsuit Monday.Grubhub Inc. made about $ 1.8 billion in revenue in 2020, but in order to keep up its success, it has been utilizing a number of unfair and deceptive business practices, including tricking customers into signing up for its subscription service for `` unlimited free delivery, '' while charging service fees, and making fake restaurant... | general |
Judge Says COVID-19 Justified Short-Notice Art Van Layoffs | A Delaware bankruptcy judge on Monday dismissed claims that bankrupt home furnishing retailer Art Van Furniture broke federal law when it laid off 700 workers with nearly no notice, saying the business had been struck with an unforeseeable setback in the form of COVID-19.U.S. Bankruptcy Judge Christopher Sontchi issued a summary judgment for the defense, saying in his opinion that the layoffs did not violate the federal Worker Adjustment and Retraining Notification Act because they were a response to the `` unforeseen business circumstance '' of nationwide orders shutting down nonessential businesses amid the `` natural disaster '' of the pandemic. `` The undisputed facts... | general |
Real Estate Co. Sues Factory Mutual Unit For Virus Coverage | Real estate developer Millennium Partners Management Inc. sued a Factory Mutual unit in New York state court, accusing the insurer of only providing partial coverage for one of its many properties after it filed claims for losses related to the COVID-19 pandemic.In a complaint filed Friday, Millennium said Affiliated FM Insurance Co. provided coverage under a communicable disease provision only to a property in Washington, D.C., but denied its claims for coverage under several other provisions for the developer's properties in D.C., Boston, Los Angeles, San Francisco and New York City.Real estate developer Millennium Partners is seeking coverage for losses it... | general |
Uncertainty, Activism And SPACs Top Of Mind For M & A Attys | Regulatory uncertainty dampening the deals environment, new rules changing the shareholder activism playbook, and special purpose acquisition company mergers underperforming expectations were among the hot topics at Tulane University Law School's 34th annual Corporate Law Institute.This year's conference was held in person last week in New Orleans, although a virtual option remained available after the 2021 event was forced online due to the COVID-19 pandemic. Attorneys had gathered in 2020 just before the country adopted strict pandemic-related safety measures, with attendees at the time being encouraged to bump elbows rather than shake hands.This year, there were 670 total attendees,... | general |
Sheppard Mullin Nabs Fees In Pasadena-Rose Bowl TM Fight | Sheppard Mullin Richter & Hampton LLP landed more than $ 400,000 in legal fees after defending the city of Pasadena from a trademark lawsuit over the relocation of the 2021 Rose Bowl due to California's COVID-19 restrictions.U.S. District Judge André Birotte Jr. said Friday the city can recover $ 409,000 in attorney fees from the Pasadena Tournament of Roses Association, the nonprofit group that puts on the annual college football game. The association sued Pasadena last year for falsely claiming rights to the Rose Bowl amid its pandemic-spurred move to Texas, but Judge Birotte in July axed what he called a `` puzzling '' case.Judge Birotte... | general |
Lessons From Recent PPP Loan And COVID Fraud Cases | On March 1, in his State of the Union address, President Joe Biden pledged to appoint a chief prosecutor to combat pandemic fraud, to seek increased funding and resources for the U.S. Department of Justice to expand investigations and prosecutions of pandemic fraud, and to call on Congress to heighten the penalties for egregious pandemic fraud. [ 1 ] On March 10, the department followed through with the announcement that Associate Deputy Attorney General Kevin Chambers will serve as the director for COVID-19 Fraud Enforcement. [ 2 ] Speaking to the COVID-19 fraud enforcement task roundtable following the announcement, the newly appointed director outlined plans to `` target... | general |
Stop kicking the can: Why companies must think long term to solve supply chain challenges | The global supply chain has been in crisis for many months now — and all signs point to disruption and uncertainty remaining the status quo for years to come. Findings for Protiviti's latest global Top Risks Survey show that manufacturers are very concerned about being able to deliver their products or services at acceptable margins now and in the future. The C-suite executives in the manufacturing and distribution industry group who responded to our annual survey ranked supply chain concerns as the top risk issue for their organizations not only for this year, but also for the next decade.
Raw material shortages, transportation delays, skyrocketing shipping costs, and the exponential growth of consumer demand via e-commerce channels are just some of the issues companies have been trying to overcome or meet throughout the COVID-19 pandemic. Other dynamics ratcheting up the pressure on fragile supply chain networks include surging inflation — which hit a 40-year high of 7.5% in the U.S. in January — looming interest rate hikes and increasing geopolitical tensions. Russia's invasion of Ukraine has sent global commodity prices soaring for everything from steel to sunflower oil.
According to a Federal Reserve survey of chief financial officers ( CFOs), almost 90% of businesses saw larger-than-normal cost increases in the fourth quarter of 2021 due to extraordinary supply chain constraints, with most CFOs reporting that they expect this trend to continue. Against this backdrop of complex supply chain challenges and rising costs, many companies are struggling to plan cash flow and revenue effectively — and consumers are literally paying the price.
In a recent Protiviti analysis on supply chain risks and their impact on the budgeting and forecasting process, 50% of senior executives across various industries reported that their companies are passing along higher supply chain costs to their customers. Many also report their companies are absorbing costs, to the detriment of their bottom line. Neither situation is sustainable, of course. Also unsustainable is inventory stockpiling as a strategy for managing potential revenue loss due to supply chain challenges. Yet, over half of the respondents indicated that they are employing this approach.
Companies can't keep hobbling along with short-term fixes for their supply chain woes, even if such measures do help ease pressure and aid in getting goods to customers. They also need to stop playing `` kick the can '' when encountering fundamental supply chain problems that demand long-term solutions. Operating the supply chain as a cost center, prioritizing leanness and cost-effectiveness above all else, and continually putting off supply chain network redesigns are not sustainable approaches in this volatile environment.
Flexibility and a forward-looking perspective are the keys to operating supply chains successfully moving forward. So, too, is understanding critical risk exposures end-to-end in supply chain networks.
Businesses used to have the luxury of creating financial forecasts monthly or quarterly. Now, this process must be conducted on a more real-time basis. The pandemic has caused many finance organizations to adapt their approach to forecasting. By working closely with the supply chain office on forecasting, finance organizations can help the supply chain to become more flexible, agile and predictive in meeting the challenge of future disruptions.
The value of connecting supply chain to financial forecasts is that it provides companies with insight into what they can and can not control — and, importantly, what they can do better — to find financially smart solutions to address supply chain challenges amid constantly changing market conditions.
Technology — especially machine learning and AI-powered solutions that offer both real-time insight and predictive capabilities — can help finance and supply chain work effectively as partners to connect supply chain scenarios with financial forecasting and planning.
Traditionally, the relationship between supply chain and finance teams hasn't been one of proactive collaboration. However, by getting these teams to work in greater harmony, organizations can identify the best short-term fixes to ease immediate supply chain disruptions and pressures while helping the business make more informed, strategic decisions that will lead to their supply chain becoming more resilient, flexible and predictive over time. And, then, there will no longer be any impulse to play kick the can.
For a more in-depth discussion, register for Protiviti's upcoming webinar: Think Long-Term and Flexible: Supply Chain Impacts on Budgeting and Planning.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
Robotics, conveyor belts and software become staples of the warehouse as e-commerce grows.
Heightened demand put Amazon's distribution buildout into overdrive. To speed up delivery and limit costs, it will have to invest more.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
Robotics, conveyor belts and software become staples of the warehouse as e-commerce grows.
Heightened demand put Amazon's distribution buildout into overdrive. To speed up delivery and limit costs, it will have to invest more.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more. | general |
U.S. Insurance Carriers Turn to Technology Platform Providers to Weather the Pandemic | The COVID-19 pandemic forced insurance carriers in the U.S. to rely on technology solutions to meet changing operational and market demands, and many have turned to technology platform providers for support, according to a new research report published today by Information Services Group ( ISG) ( Nasdaq: III), a leading global technology research and advisory firm.
“ These tools and technologies will enable them to respond quickly to changing market conditions and will facilitate innovation. ”
The 2021 ISG Provider Lens™ Insurance Platform Solutions Report for the U.S. finds the pandemic served as a catalyst for digital transformation efforts in the insurance industry. U.S. insurance carriers that had begun their digital transformation journeys before the pandemic had an advantage over their competitors, including the ability to move their workforces to a remote working model. Other carriers have been scrambling to catch up during the pandemic, the report says.
“ Many insurance carriers that had been lagging behind in technology adoption are now adopting and deploying technologies that will help them remain agile, ” said Paul Schreiner, ISG partner for the insurance industry. “ These tools and technologies will enable them to respond quickly to changing market conditions and will facilitate innovation. ”
Modern insurance platforms are helping carriers operate more efficiently, lower costs, comply with ever-changing regulations, and accelerate the development of new products for continued growth. Traditional insurers are adopting such platforms to effectively compete with non-traditional players and startups, which often can operate more nimbly without the burden of legacy infrastructure.
Insurance platform providers are enabling carriers to harness the power of their data to create new insights and gain efficiency, the report says. Carriers are using data analytics tools to deal with an overwhelming amount of structured and unstructured data from sources including social media, sensors and telematics. Many carriers also are turning to artificial intelligence and machine learning in areas like underwriting, customer service, claims and fraud detection.
The technology tools offered by top insurance platform providers also empower workers, boost productivity, help meet regulatory mandates, and respond to the changing needs of a more demanding public, the report adds. Technologies that carriers adopted during the pandemic will help them be more competitive after the pandemic.
The report sees growing demand for process automation tools, which can reduce operational costs, increase productivity and boost reliability. Carriers also are adopting low-code or no-code development techniques, which allow employees with no technical background to create websites and apps.
In addition, platform providers are moving to cloud-based platforms that can offer several benefits, including scalability, agility and shorter project timelines, the report says. The cloud also can link carriers to a large partner ecosystem and allow them to collaborate with InsurTechs and other vendors.
The 2021 ISG Provider Lens™ Insurance Platform Solutions Report for the U.S. evaluates the capabilities of 31 platform providers across two quadrants: Life and Retirement Platforms and Property and Casualty Platforms.
The report names DXC Technology and Majesco as Leaders in both quadrants. Accenture, BriteCore, Duck Creek, EIS, EXL, FAST ( Verisk), Guidewire, Infosys, Insurity, OneShield and Vitech were all named Leaders in one quadrant.
In addition, Appian was named a Rising Star—companies with “ promising portfolios ” and “ high future potential, ” by ISG’ s definition—in two quadrants. EIS and Illumifin were named Rising Stars in one quadrant. | tech |
Covid Tests Show the Omicron BA.2 Subvariant Is Gaining Ground in U.S. | The information you requested is not available at this time, please check back again soon.
SEATTLE, WASHINGTON - MARCH 09: A health worker waits at an empty Covid-19 testing center at the Washington State Convention Center on March 09, 2022 in Seattle, Washington. Once crowded, testing sites are mostly now devoid of patients. The city has also recently struggled with an uptick in homelessness and violent crime. ( Photo by John Moore/Getty Images), Photographer: John Moore/Getty Images North America
( Bloomberg) -- The omicron subvariant BA.2 is continuing to gain ground in the U.S., according to Covid-19 tests sequenced over the last two weeks.Helix, a San Diego-based genomics firm, has been watching the BA.2 variant since it first popped up in the U.S. in early January. Although it was initially slow to take hold, Helix now estimates that 50% to 70% of all Covid cases nationwide are BA.2.Will Lee, Helix’ s chief science officer, said this type of surveillance is essential and can help arm the U.S. health care system against future variants.
Data from the U.K. — where BA.2 has already caused cases to spike — show the country’ s rise in infections began around the same time that BA.2 surpassed the 50% mark of overall cases. So far, the variant appears to be no more severe than the initial omicron strain, but there’ s concern about its ability to reinfect people and its links to long Covid.Cases are still dropping overall in the U.S., but some health experts are worried that decline won’ t last for long. Already, cases are beginning to climb in New York City, where BA.2 accounts for a larger share of cases than in other parts of the country, according to data from the Centers for Disease Control and Prevention.
The CDC has yet to update its variant surveillance data for this past week, but the agency has reported BA.2 nearly doubling in prevalence each week since early February. The CDC most recently said BA.2 made up 23.1% of cases for the week ending March 12. Variant surveillance at Helix is funded by the CDC and its sequencing data is one of many the agency takes into account when creating its Nowcast estimates each week. According to Helix, the firm is able to process up to 150,000 Covid-19 tests per day across the country.Lee, the Helix scientist, said that although he expects cases to rise in coming weeks, he does not anticipate as significant a spike as was caused by the first omicron strain. That’ s due to the immunity people have already built up through vaccines and prior infections. | general |
Hywin Wealth, VP Bank Report Finds Strong APAC Demand for | March 20, 2022 22:00 ET | Source: Hywin Holdings Ltd. Hywin Holdings Ltd.
SHANGHAI, China, March 21, 2022 ( GLOBE NEWSWIRE) -- Demand for private market opportunities is strong among investors in the Asia Pacific region, according to a new industry report jointly issued by Hywin Holdings Ltd. ( `` Hywin Wealth '', “ Hywin ”, or the `` Company '') ( NASDAQ: HYW), a leading independent wealth management service provider in China, with Liechtenstein-based VP Bank Ltd. and WealthBriefingAsia.
Over three quarters, or 77% of wealth management professionals, perceive current APAC investor demand for private market investment opportunities as strong, while 16 percent say demand is very strong, according to the report, ‘ Why Wealth Managers Are the Ultimate Private Market Matchmakers’ ( download: https: //www.hywin.com.hk/wp-content/uploads/2022/03/Hywin VPBank Private Markets Report 2022.pdf). The joint report from Hywin Wealth, VP Bank, and WealthBriefingAsia provides a comprehensive overview of the rising APAC private markets and explains why wealth managers are an invaluable part of the ecosystem serving investors.
As the world enters a new era of fluidity and volatility in the aftermath of the COVID-19 pandemic, private markets are being “ re-discovered ” as an ecosystem for discerning, patient and strategically minded investors. Wealth managers are the ideal advisors for clients seeking private market opportunities as they have unmatched multi-disciplinary capabilities, relationship-building skills, and institutional clout.
“ Innovation and disruption are fueling a boom in private markets globally, ” Hywin Wealth Chief Executive Officer Madame Wang Dian says in the report. “ APAC has tremendous momentum in terms of private market assets, investors, funding and intermediaries. We think China will continue to be the engine of growth and innovation, whilst Southeast Asia and India are rising as investable private markets. ”
Private markets require investors to act on a long-term view, which can never be delegated to algorithms. It’ s an ideal arena for wealth managers to showcase their abilities, according to Wang.
The private markets in APAC are fascinating in size and variety. The report sheds light on all the players in the private markets, including high-net-worth ( HNW) and ultra-high-net-worth ( UHNW) clients, as well as fund managers, portfolio companies, and financial intermediaries, serving as a guide to navigate through this space.
The strongest driver of the private market boom is a desire for outsized returns, 50% of respondents said, followed by a need for greater portfolio diversification, according to 29% of respondents, the report found. Interesting investment opportunities, participating in real innovation, and ESG aims were also key factors observed. The majority of investors in APAC, or 42%, expect a minimum 11% -15% Internal Rate of Return ( IRR) from private markets, while 16% of respondents said investors target a 16-20% IRR, and 14% target a 21-25% IRR.
The typical net worth of an APAC private markets investor is over US $ 30 million, though there is also interest seen further down the wealth scale, in the sub- US $ 10 million range, according to the report.
Investors from Mainland China and Hong Kong SAR are perceived as showing the greatest enthusiasm for private markets, while investors from Singapore, Australia and New Zealand are also very keen, the report found.
Investors were most interested in private market opportunities in North America, 36%, followed by Southeast Asia, 33%, and China and North Asia, 29%.
The sector that draws most investor interest was technology, 62%, with healthcare/life sciences, 21%, coming in second.
As the demand for private markets opportunities grows, the biggest barrier for investors is lack of visibility over opportunities, according to 50% of respondents, followed by a lack of confidence or knowledge, 24%, the report found. For wealth managers, a lack of available expertise and regulatory complexity are seen as the biggest challenges.
Hywin Wealth is dedicated to providing industry-leading insights and knowledgeable advisory to both clients in Greater China and the global wealth management industry.
“ We are glad to join in publishing this report to share our insights on private markets, where Hywin Wealth has achieved great success, ” said Hywin Wealth Chief Financial Officer Lawrence Lok. “ More than half of our total client transaction value in fiscal year 2021, or RMB 78 billion, went towards private market investment products. Apart from data and analyses, this report is informed by our extensive client work across private equity, venture capital and hedge funds to offer a lively narrative. ”
About Hywin Holdings Ltd.Hywin ( NASDAQ: HYW) is a leading independent wealth management service provider in China focused on providing asset allocation advisory services and comprehensive financial products to high-net-worth clients. The Company’ s primary services are wealth management, asset management, and other comprehensive financial services. Wealth management is currently the Company’ s largest business segment, in which its onshore and offshore solution platforms serve clients across generations. For more information, please visit https: //ir.hywinwealth.com.
Safe Harbor StatementThis press release contains statements that may constitute “ forward-looking ” statements pursuant to the “ safe harbor ” provisions of the U.S. Private Securities Litigation Reform Act of 1995. These forward-looking statements can be identified by terminology such as “ anticipate, ” “ estimate, ” “ forecast, ” “ plan, ” “ project, ” “ potential, ” “ continue, ” “ ongoing, ” “ expect, ” “ aim, ” “ believe, ” “ intend, ” “ may, ” “ should, ” “ will, ” “ is/are likely to, ” “ could ” and similar statements. Statements that are not historical facts, including statements about the Company's beliefs, plans, and expectations, are forward-looking statements. Forward-looking statements involve inherent risks and uncertainties. Further information regarding these and other risks is included in the Company's filings with the SEC. All information provided in this press release is as of the date of this press release, and the Company does not undertake any obligation to update any forward-looking statement, except as required under applicable law.
Investor Contact: Hywin Holdings Ltd.Email: ir @ hywinwealth.com
Media Contact: ICR, LLCEdmond LococoPhone: +86 138-1079-1408Email: HywinPR @ icrinc.com
A photo accompanying this announcement is available at https: //www.globenewswire.com/NewsRoom/AttachmentNg/5d739c47-5e3f-43b6-8cbb-7b62dd4e4589 | general |
Daily Podcast: Uncertainty Is the New Certainty in Travel | Get exclusive stories and unlimited access to Skift.com news
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Rashaad Jorden, Skift
March 21st, 2022 at 5:27 AM EDT
Good morning from Skift. It's Monday, March 21, in New York City. Here's what you need to know about the business of travel today.
Rashaad Jorden
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Today’ s edition of Skift’ s daily podcast explains what uncertainty means to the travel industry now, why Fly Jinnah is entering the Asian low-cost airline market, and why the UK is lifting all Covid travel restrictions.
The United Kingdom has lifted all Covid-related restrictions two years after it first advised against all non-essential international travel, reports Corporate Travel Editor Matthew Parsons.
Unvaccinated visitors to the UK no longer have to take a Covid test prior to departure as well as one two days after arriving in the country. The rule requiring vaccinated travelers to the UK to take tests had already been dropped. In addition, the passenger locator forms that visitors to the country had to fill out have been scrapped.
The UK government said the new measures, which took effect Friday morning, reflect its “ Living with Covid ” plan and the fact most of the country’ s citizens are fully vaccinated. However, the UK has been grappling with a surge in Covid cases since the start of the month, leaving many to wonder how long the government will keep the measures in place.
Next, a trend Skift is exploring in-depth this year is uncertainty is the new certainty in travel, which includes companies having to deal with volatility in travel demand for the foreseeable future. So corporations will need to draw faster insights from their data to thrive, reports Senior Travel Tech Editor Sean O’ Neill.
As O’ Neill writes that companies need ways to see the future with more clarity in an increasingly volatile world, Jason Guggenheim, an executive at the Boston Consulting Group, said more corporations are looking for subtle shifts in travel demand. Guggenheim said technology can help companies pick up those shifts, citing software from his company that offers a mix of predictions and analysis.
In addition, Guggenheim said companies need to plan their operations much faster, providing airlines as an example. Carriers in the past might have taken up to six months in advance to plan their networks and schedule flights, but due to increasing volatility, Guggenheim believes airlines need to be able to adjust their supply much faster.
We end today in Pakistan. The South Asian country is set to welcome another carrier to its airspace as low-cost Fly Jinnah prepares to launch later this year, writes Asia Editor Peden Doma Bhutia.
Fly Jinnah — a joint venture between Air Arabia Group and Pakistani business conglomerate Lakson Group — aims to obtain its air operator’ s certificate in June, after which it will start flying domestically. The company has already started recruiting cabin crew members in several major Pakistani cities.
The launch of Fly Jinnah, Pakistan’ s fourth private airline, will increase the already fierce competition in the country’ s aviation sector. One industry expert believes the presence of another carrier will benefit consumers but could help drive some Pakistani airlines out of business. The debut of Serene Air in 2017 contributed to Shaheen Air folding after 24 years in business.
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Rashaad Jorden, Skift
March 21st, 2022 at 5:27 AM EDT
Edited By
Tom Lowry | general |
Ascot Publishes Inaugural Sustainability Report | March 21, 2022 19:00 ET | Source: Ascot Resources Ltd. Ascot Resources Ltd. Vancouver, British Columbia, CANADA
VANCOUVER, British Columbia, March 21, 2022 ( GLOBE NEWSWIRE) -- Ascot Resources Ltd. ( TSX: AOT; OTCQX: AOTVF) ( “ Ascot ” or the “ Company ”) is pleased to announce the publication of the Company’ s inaugural Sustainability Report. This report will be updated annually and will evolve as Ascot progresses from development into production next year. The 2021 Sustainability Report can be accessed and downloaded at the address below.
https: //ascotgold.com/sustainability/sustainability-reports/
Derek White, President and CEO, commented, `` Since this management team started in 2017, we have prioritized working with local communities and stewarding the environment. As Ascot progresses from exploration to construction and ultimately production, we have designed the Premier Gold Project with best-in-class environmental standards and it is in fact one of the lowest impact gold projects in Canada in terms of surface disturbance, water quality management, and greenhouse gas emissions.
With this inaugural Sustainability Report we have begun to track our performance in these areas, highlighting various initiatives which make us stand out, with goals so that we can continue to make a positive impact into the future. We look forward to expanding on this report as we progress into production and are eager to bring much prosperity to the local communities through employment, training, and contract opportunities. ”
As a feature of the 2021 Sustainability Report, Ascot is pleased to announce that Nisga’ a artist Ian Morven has created an original design for the Company ( see Figure 2). Mr. Morven’ s design is intended to show Ascot’ s collaborative relationship with Nisga’ a Nation and our ongoing commitment to working together, particularly with regard to caring for the environment.
In Mr. Morven’ s design, the human figure has his hand inviting you to come and join Ascot and Nisga’ a, and he will help you on your way. He has a talking stick to tell you the story of the adventures that have passed and those yet to come. He wears war paint to symbolize the obstacles overcome. The dragonfly symbolizes the environment, and the eagle represents the clan that was originally from the lands around Stewart and the Premier Gold Project.
Derek White, President and CEO, commented, “ It is important to Ascot that we celebrate Nisga’ a culture in all its forms from land stewardship to language and art. Ascot is proud to partner with Ian Morven to showcase his original design. ”
On behalf of the Board of Directors of Ascot Resources Ltd. “ Derek C. White ” President & CEO
David Stewart, P.Eng. VP, Corporate Development & Shareholder Communications dstewart @ ascotgold.com 778-725-1060 ext. 1024
Rhea Halfnight LeFlufyIndigenous Relationsindigenousrelations @ ascotgold.com
Ascot is a Canadian junior exploration and development company focused on re-starting the past producing Premier gold mine, located on Nisga’ a Nation Treaty Lands, in British Columbia’ s prolific Golden Triangle. Ascot shares trade on the TSX under the ticker AOT. Concurrent with progressing the development of Premier, the Company continues to successfully explore its properties for additional high-grade underground resources. Ascot is committed to the safe and responsible development of Premier in collaboration with Nisga’ a Nation as outlined in the Benefits Agreement.
For more information about the Company, please refer to the Company’ s profile on SEDAR at www.sedar.com or visit the Company’ s web site at www.ascotgold.com, or for a virtual tour visit www.vrify.com under Ascot Resources.
The TSX has not reviewed and does not accept responsibility for the adequacy or accuracy of this release.
All statements and other information contained in this press release about anticipated future events may constitute forward-looking information under Canadian securities laws ( `` forward-looking statements ''). Forward-looking statements are often, but not always, identified by the use of words such as `` seek '', `` anticipate '', `` believe '', `` plan '', `` estimate '', `` expect '' and `` intend '' and statements that an event or result `` may '', `` will '', `` should '', `` could '' or `` might '' occur or be achieved and other similar expressions. All statements, other than statements of historical fact, included herein are forward-looking statements, including statements in respect of Ascot’ s progress from exploration to construction and production and the timing related thereto. These statements involve known and unknown risks, uncertainties and other factors that may cause actual results or events to differ materially from those anticipated in such forward-looking statements, including risks associated with the business of Ascot; risks related to exploration and potential development of Ascot's projects; business and economic conditions in the mining industry generally; fluctuations in commodity prices and currency exchange rates; uncertainties relating to interpretation of drill results and the geology, continuity and grade of mineral deposits; the need for cooperation of government agencies and indigenous groups in the exploration and development of properties and the issuance of required permits; the need to obtain additional financing to develop properties and uncertainty as to the availability and terms of future financing; the possibility of delay in exploration or development programs and uncertainty of meeting anticipated program milestones; uncertainty as to timely availability of permits and other governmental approvals; risks associated with COVID-19 including adverse impacts on the world economy, construction timing and the availability of personnel; and other risk factors as detailed from time to time in Ascot's filings with Canadian securities regulators, available on Ascot's profile on SEDAR at www.sedar.com including the Annual Information Form of the Company dated March 21, 2022 in the section entitled `` Risk Factors ''. Forward-looking statements are based on assumptions made with regard to: the estimated costs associated with construction of the Project; the timing of the anticipated start of production at the Project; the ability to maintain throughput and production levels at the Premier Mill; the tax rate applicable to the Company; future commodity prices; the grade of Resources and Reserves; the ability of the Company to convert inferred resources to other categories; the ability of the Company to reduce mining dilution; the ability to reduce capital costs; and exploration plans. Forward-looking statements are based on estimates and opinions of management at the date the statements are made. Although Ascot believes that the expectations reflected in such forward-looking statements and/or information are reasonable, undue reliance should not be placed on forward-looking statements since Ascot can give no assurance that such expectations will prove to be correct. Ascot does not undertake any obligation to update forward-looking statements. The forward-looking information contained in this news release is expressly qualified by this cautionary statement. | general |
Rising diabetes diagnosis in long COVID - The Lancet Diabetes & Endocrinology | A few reports have raised the possibility that COVID-19 could increase the risk of type 2 diabetes.1Barrett CE Koyama AK Alvarez P et al.Risk for newly diagnosed diabetes > 30 days after SARS-CoV-2 infection among persons aged < 18 Years—United States, March 1, 2020–June 28, 2021.MMWR Morb Mortal Wkly Rep. 2022; 71: 59-65Google Scholar, 2Montefusco L Ben Nasr M D'Addio F et al.Acute and long-term disruption of glycometabolic control after SARS-CoV-2 infection.Nat Metab. 2021; 3: 774-785Google Scholar In The Lancet Diabetes & Endocrinology, Xie and Al-Aly3Xie Y Al-Aly Z Risks and burdens of incident diabetes in long COVID: a cohort study.Lancet Diabetes Endocrinol. 2022; ( published online March 21.) https: //doi.org/10.1016/S2213-8587 ( 22) 00044-4Google Scholar offer further evidence for the increased risk of diabetes beyond the first 30 days of infection ( post-acute phase) by analysing the US Department of Veterans Affairs national health-care records of those who survived the first 30 days after a positive COVID-19 test. These data raise important questions about the relationship between COVID-19 and diabetes concerning causality, biological mechanisms, and implications for clinical care and public health.
Incidence of diabetes and antihyperglycaemic medication use was compared between 181 280 COVID-19 survivors, 4 118 441 contemporary controls without COVID-19 infection from the same year, and 4 286 911 historical controls from 2017. Diabetes was defined by International Classification of Diseases-10 diagnosis codes or an HbA1c of more than 6·4% ( 46 mmol/mol). The authors used inverse probability weighted survival analyses, including predefined and algorithmically selected high dimensional variables and reported two measures of risk; hazard ratio ( HR) and burden per 1000 people at 12 months.
People who survived the first 30 days of SARS-CoV-2 infection exhibited an increased risk ( hazard ratio [ HR ] 1·40, 95% CI 1·36–1·44) and excess burden ( 13·46, 95% CI 12·11–14·84) of incident diabetes per 1000 people at 12 months, compared with contemporary controls. COVID-19 survivors also had an increased risk ( HR 1·85, 95% CI 1·78–1·92) and excess burden ( 12·35, 11·36–13·38) of incident antihyperglycaemic use. Results were consistent when historical controls were used. The association between COVID-19 and diabetes was consistent across strata of several potential confounders, namely, age, sex, race, BMI, diabetes risk score, steroid use, and area deprivation scores. The authors also did a full range of sensitivity analyses, including accounting for missing data with multiple imputation. Furthermore, an exposure–response relationship between severity of the acute infection, as shown by the care setting ( non-hospitalised, hospitalised, or admitted to intensive care), and diabetes incidence was found. Notably, even those with mild, non-hospitalised COVID-19 had an excess 1-year burden of 8·28 per 1000 persons ( 95% CI 6·97–9·62). However, a major weaknesses of the study is the inclusion of a study population that was predominantly White and male. Furthermore, socioeconomic factors imposed by COVID-19 were not taken into account and there was no assessment for differential diabetes testing between cases and controls. Nevertheless, these data warrant further multipronged investigations.
Carefully designed multi-ethnic prospective epidemiological studies of long-term COVID-19 consequences ( eg, incidence of diabetes types and associated conditions) across demographic and socioeconomic factors are needed to confirm or refute the findings from Xie and Al-Aly.3Xie Y Al-Aly Z Risks and burdens of incident diabetes in long COVID: a cohort study.Lancet Diabetes Endocrinol. 2022; ( published online March 21.) https: //doi.org/10.1016/S2213-8587 ( 22) 00044-4Google Scholar Studies should use standardised approaches to accurately measure exposure to SARS-CoV-2 infection ( eg, antigen and antibody tests) and diabetes ( eg, using oral glucose tolerance tests). Factors postulated to influence long-term complications of COVID-19 should also be measured, including severity of infection, viral load, and the presence of antibodies signalling auto-immune attack.4Su Y Yuan D Chen DG et al.Multiple early factors anticipate post-acute COVID-19 sequelae.Cell. 2022; ( published online Jan 25.) https: //doi.org/10.1016/j.cell.2022.01.014Google Scholar Variables that might help explain potential mechanisms for any association between COVID and diabetes should also be collected ( eg, multiple point insulins, C-peptides, pancreatic and hepatic ectopic fat, and body composition), as well as co-occurring conditions, such as cardiovascular events,5Xie Y Xu E Bowe B Al-Aly Z Long-term cardiovascular outcomes of COVID-19.Nat Med. 2022; ( published online Feb 7.) https: //doi.org/10.1038/s41591-022-01689-3Google Scholar that could share disease mechanisms with diabetes pathogenesis. Studies should examine the extent that biological effects of SARS-CoV-2 infection are specific to diabetes or generalised by similar mechanisms across multiple systems.
Mechanistic studies will also be needed to explore the SARS-CoV-2 and diabetes connection. Among the most intriguing of hypotheses to explain the COVID-19 and diabetes connection is that SARS-CoV-2 virus might infect and replicate in the pancreas, injuring exocrine and endocrine cells.6Müller JA Groß R Conzelmann C et al.SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas.Nat Metab. 2021; 3: 149-165Google Scholar, 7van der Heide V Jangra S Cohen P et al.Limited extent and consequences of pancreatic SARS-CoV-2 infection.Cell Rep. 2022; 38110508Google Scholar Analysis of autopsy samples suggests that COVID-19 infection could lead to beta cell transdifferentiation mediated by the eIF2 signalling pathway.8Tang X Uhl S Zhang T et al.SARS-CoV-2 infection induces beta cell transdifferentiation.Cell Metab. 2021; 33: 1577-1591Google Scholar Other potential mechanisms, which the authors mention, are also worthy of investigation, including autonomic dysfunction, immune response or induced autoimmunity, and low grade inflammation.3Xie Y Al-Aly Z Risks and burdens of incident diabetes in long COVID: a cohort study.Lancet Diabetes Endocrinol. 2022; ( published online March 21.) https: //doi.org/10.1016/S2213-8587 ( 22) 00044-4Google Scholar All of these factors should be considered within a real-world context of preadmission diabetes, steroid-induced diabetes, and sources of stress hyperglycaemia.9Khunti K Del Prato S Mathieu C Kahn SE Gabbay RA Buse JB COVID-19, hyperglycemia, and new-onset diabetes.Diabetes Care. 2021; 44: 2645-2655Google Scholar
The data presented by Xie and Al-Aly3Xie Y Al-Aly Z Risks and burdens of incident diabetes in long COVID: a cohort study.Lancet Diabetes Endocrinol. 2022; ( published online March 21.) https: //doi.org/10.1016/S2213-8587 ( 22) 00044-4Google Scholar have major implications for clinical policy and public health. If COVID-19 is indeed a risk factor for diabetes in the post-acute phase of infection, screening and management of dysglycaemia should be an integral part of clinical guidelines for COVID-19 diagnosis and follow-up. The long-term implications of SARS-CoV-2 infection increasing diabetes risk are profound. The rates of type 2 diabetes, and associated non-communicable diseases, are already growing, as shown on the diabetes atlas by the International Diabetes Federation. With large and growing numbers of people worldwide infected with SARS-CoV-2 ( 434 154 739 cumulative cases by Feb 28, 2022),10WHOWHO coronavirus ( COVID-19) dashboard.https: //covid19.who.int/Date accessed: February 15, 2022Google Scholar any COVID-19-related increases in diabetes incidence could lead to unprecedented cases of diabetes worldwide—wreaking havoc on already over-stretched and under-resourced clinical and public health systems globally, with devastating tolls in terms of deaths and suffering.
The potential connection between COVID-19 and diabetes highlights that infectious diseases ( eg, SARS-CoV-2) and chronic diseases ( eg, diabetes) can not be viewed in siloes. When we emerge out of the pandemic, the much-neglected non-communicable diseases, such as type 2 diabetes, will continue their relentless trajectory, possibly in an accelerated manner, as the leading burdens of global health.
We declare no competing interests. KMVN and LRS were partly supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health ( award number P30DK111024) and Rapid Acceleration of Diagnostics ( award number P30KD11024–05S1). LRS was also partly supported by Georgia Clinical and Translational Science Awards UL1 ( UL1TR002378) and KL2 ( KL2TR002381). The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.
Risks and burdens of incident diabetes in long COVID: a cohort studyIn the post-acute phase, we report increased risks and 12-month burdens of incident diabetes and antihyperglycaemic use in people with COVID-19 compared with a contemporary control group of people who were enrolled during the same period and had not contracted SARS-CoV-2, and a historical control group from a pre-pandemic era. Post-acute COVID-19 care should involve identification and management of diabetes. Full-Text PDF | tech |
Risks and burdens of incident diabetes in long COVID: a cohort study - The Lancet Diabetes & Endocrinology | BackgroundThere is growing evidence suggesting that beyond the acute phase of SARS-CoV-2 infection, people with COVID-19 could experience a wide range of post-acute sequelae, including diabetes. However, the risks and burdens of diabetes in the post-acute phase of the disease have not yet been comprehensively characterised. To address this knowledge gap, we aimed to examine the post-acute risk and burden of incident diabetes in people who survived the first 30 days of SARS-CoV-2 infection.MethodsIn this cohort study, we used the national databases of the US Department of Veterans Affairs to build a cohort of 181 280 participants who had a positive COVID-19 test between March 1, 2020, and Sept 30, 2021, and survived the first 30 days of COVID-19; a contemporary control ( n=4 118 441) that enrolled participants between March 1, 2020, and Sept 30, 2021; and a historical control ( n=4 286 911) that enrolled participants between March 1, 2018, and Sept 30, 2019. Both control groups had no evidence of SARS-CoV-2 infection. Participants in all three comparison groups were free of diabetes before cohort entry and were followed up for a median of 352 days ( IQR 245–406). We used inverse probability weighted survival analyses, including predefined and algorithmically selected high dimensional variables, to estimate post-acute COVID-19 risks of incident diabetes, antihyperglycaemic use, and a composite of the two outcomes. We reported two measures of risk: hazard ratio ( HR) and burden per 1000 people at 12 months.FindingsIn the post-acute phase of the disease, compared with the contemporary control group, people with COVID-19 exhibited an increased risk ( HR 1·40, 95% CI 1·36–1·44) and excess burden ( 13·46, 95% CI 12·11–14·84, per 1000 people at 12 months) of incident diabetes; and an increased risk ( 1·85, 1·78–1·92) and excess burden ( 12·35, 11·36–13·38) of incident antihyperglycaemic use. Additionally, analyses to estimate the risk of a composite endpoint of incident diabetes or antihyperglycaemic use yielded a HR of 1·46 ( 95% CI 1·43–1·50) and an excess burden of 18·03 ( 95% CI 16·59–19·51) per 1000 people at 12 months. Risks and burdens of post-acute outcomes increased in a graded fashion according to the severity of the acute phase of COVID-19 ( whether patients were non-hospitalised, hospitalised, or admitted to intensive care). All the results were consistent in analyses using the historical control as the reference category.InterpretationIn the post-acute phase, we report increased risks and 12-month burdens of incident diabetes and antihyperglycaemic use in people with COVID-19 compared with a contemporary control group of people who were enrolled during the same period and had not contracted SARS-CoV-2, and a historical control group from a pre-pandemic era. Post-acute COVID-19 care should involve identification and management of diabetes.FundingUS Department of Veterans Affairs and the American Society of Nephrology.
There is growing evidence suggesting that beyond the acute phase of SARS-CoV-2 infection, people with COVID-19 could experience a wide range of post-acute sequelae, including diabetes. However, the risks and burdens of diabetes in the post-acute phase of the disease have not yet been comprehensively characterised. To address this knowledge gap, we aimed to examine the post-acute risk and burden of incident diabetes in people who survived the first 30 days of SARS-CoV-2 infection.
In this cohort study, we used the national databases of the US Department of Veterans Affairs to build a cohort of 181 280 participants who had a positive COVID-19 test between March 1, 2020, and Sept 30, 2021, and survived the first 30 days of COVID-19; a contemporary control ( n=4 118 441) that enrolled participants between March 1, 2020, and Sept 30, 2021; and a historical control ( n=4 286 911) that enrolled participants between March 1, 2018, and Sept 30, 2019. Both control groups had no evidence of SARS-CoV-2 infection. Participants in all three comparison groups were free of diabetes before cohort entry and were followed up for a median of 352 days ( IQR 245–406). We used inverse probability weighted survival analyses, including predefined and algorithmically selected high dimensional variables, to estimate post-acute COVID-19 risks of incident diabetes, antihyperglycaemic use, and a composite of the two outcomes. We reported two measures of risk: hazard ratio ( HR) and burden per 1000 people at 12 months.
In the post-acute phase of the disease, compared with the contemporary control group, people with COVID-19 exhibited an increased risk ( HR 1·40, 95% CI 1·36–1·44) and excess burden ( 13·46, 95% CI 12·11–14·84, per 1000 people at 12 months) of incident diabetes; and an increased risk ( 1·85, 1·78–1·92) and excess burden ( 12·35, 11·36–13·38) of incident antihyperglycaemic use. Additionally, analyses to estimate the risk of a composite endpoint of incident diabetes or antihyperglycaemic use yielded a HR of 1·46 ( 95% CI 1·43–1·50) and an excess burden of 18·03 ( 95% CI 16·59–19·51) per 1000 people at 12 months. Risks and burdens of post-acute outcomes increased in a graded fashion according to the severity of the acute phase of COVID-19 ( whether patients were non-hospitalised, hospitalised, or admitted to intensive care). All the results were consistent in analyses using the historical control as the reference category.
In the post-acute phase, we report increased risks and 12-month burdens of incident diabetes and antihyperglycaemic use in people with COVID-19 compared with a contemporary control group of people who were enrolled during the same period and had not contracted SARS-CoV-2, and a historical control group from a pre-pandemic era. Post-acute COVID-19 care should involve identification and management of diabetes.
US Department of Veterans Affairs and the American Society of Nephrology.
A growing body of evidence suggests that beyond the first 30 days, the acute phase of the disease, people with COVID-19 could experience post-acute sequelae—referred to as long COVID—which can involve pulmonary and extrapulmonary organ system manifestations, including diabetes outcomes.1Al-Aly Z Xie Y Bowe B High-dimensional characterization of post-acute sequelae of COVID-19.Nature. 2021; 594: 259-264Google Scholar Although diabetes and other glycometabolic abnormalities have been widely reported during the acute phase of COVID-19, less is known about the risk and burden of diabetes and related outcomes in the post-acute phase of COVID-19.2Montefusco L Ben Nasr M D'Addio F et al.Acute and long-term disruption of glycometabolic control after SARS-CoV-2 infection.Nat Metab. 2021; 3: 774-785Google Scholar, 3Xie Y Bowe B Maddukuri G Al-Aly Z Comparative evaluation of clinical manifestations and risk of death in patients admitted to hospital with COVID-19 and seasonal influenza: cohort study.BMJ. 2020; 371m4677Google Scholar, 4Accili D Can COVID-19 cause diabetes?.Nat Metab. 2021; 3: 123-125Google Scholar, 5Sathish T Kapoor N Cao Y Tapp RJ Zimmet P Proportion of newly diagnosed diabetes in COVID-19 patients: a systematic review and meta-analysis.Diabetes Obes Metab. 2021; 23: 870-874Google Scholar, 6Rubino F Amiel SA Zimmet P et al.New-onset diabetes in COVID-19.N Engl J Med. 2020; 383: 789-790Google Scholar, 7Ayoubkhani D Khunti K Nafilyan V et al.Post-COVID syndrome in individuals admitted to hospital with COVID-19: retrospective cohort study.BMJ. 2021; 372: n693Google Scholar, 8Steenblock C Schwarz PEH Ludwig B et al.COVID-19 and metabolic disease: mechanisms and clinical management.Lancet Diabetes Endocrinol. 2021; 9: 786-798Google Scholar, 9Khunti K Del Prato S Mathieu C Kahn SE Gabbay RA Buse JB COVID-19, hyperglycemia, and new-onset diabetes.Diabetes Care. 2021; 44: 2645-2655Google Scholar A detailed assessment of the risk and burden of diabetes in the post-acute phase of COVID-19 is needed to inform post-acute COVID-19 care strategies.
In this study, we used the US Department of Veterans Affairs ( VA) national health-care databases, the Department of Veterans Health Administration ( VHA), to build a cohort of US Veterans who survived the first 30 days of COVID-19 between March 1, 2020, and Sept 30, 2021, and two control groups—a contemporary cohort consisting of non-COVID-19 infected participants who used the VHA services during 2019 and a historical cohort consisting of non-COVID-19 infected participants who used the VHA services during 2017. These cohorts were followed-up longitudinally to estimate the risks and burdens of incident diabetes, antihyperglycaemic use, and a composite outcome of these endpoints in the overall cohort and according to the care setting in the acute phase of the disease ( non-hospitalised, hospitalised, or admitted to intensive care).
Research in contextEvidence before this studyWe searched PubMed for human studies published between Dec 1, 2019, and Sept 6, 2021, using terms “ COVID-19 ”, “ SARS CoV-2 ” or “ long COVID ”, and “ diabetes ”, with no language restrictions. Small studies ( < 1000 people) limited to short follow-up periods ( up to 3 months) showed that people with COVID-19 might be at increased risk of incident diabetes. A large-scale in-depth assessment of the risks and burdens of incident diabetes over a longer time horizon has not been done. In this study, we aimed to examine the post-acute risk and burden of diabetes in people who survived the first 30 days of SARS-CoV-2 infection.Added value of this studyIn this study involving 181 280 people with COVID-19, 4 118 441 contemporary controls, and 4 286 911 historical controls, we provide estimates of risks and 12-month burdens of incident diabetes outcomes. Our results suggest that beyond the first 30 days of infection, COVID-19 survivors exhibited increased risks and burdens of incident diabetes and antihyperglycaemic use. The risks and burdens were significant among those who were non-hospitalised and increased in a graded fashion according to the care setting of the acute phase of the disease ( that is whether people were non-hospitalised, hospitalised, or admitted to intensive care during the acute phase of COVID-19). The risks and associated burdens were evident in comparisons versus both the contemporary control group and the historical control group.Implications of all the available evidenceAltogether, there is evidence to suggest that beyond the acute phase of COVID-19, survivors might be at an increased risk of developing incident diabetes, and increased risk of incident antihyperglycemic use in the post-acute phase of the disease. Diabetes should be considered as a facet of the multifaceted long COVID syndrome. Post-acute care strategies of people with COVID-19 should integrate screening and management of diabetes.
We searched PubMed for human studies published between Dec 1, 2019, and Sept 6, 2021, using terms “ COVID-19 ”, “ SARS CoV-2 ” or “ long COVID ”, and “ diabetes ”, with no language restrictions. Small studies ( < 1000 people) limited to short follow-up periods ( up to 3 months) showed that people with COVID-19 might be at increased risk of incident diabetes. A large-scale in-depth assessment of the risks and burdens of incident diabetes over a longer time horizon has not been done. In this study, we aimed to examine the post-acute risk and burden of diabetes in people who survived the first 30 days of SARS-CoV-2 infection.
In this study involving 181 280 people with COVID-19, 4 118 441 contemporary controls, and 4 286 911 historical controls, we provide estimates of risks and 12-month burdens of incident diabetes outcomes. Our results suggest that beyond the first 30 days of infection, COVID-19 survivors exhibited increased risks and burdens of incident diabetes and antihyperglycaemic use. The risks and burdens were significant among those who were non-hospitalised and increased in a graded fashion according to the care setting of the acute phase of the disease ( that is whether people were non-hospitalised, hospitalised, or admitted to intensive care during the acute phase of COVID-19). The risks and associated burdens were evident in comparisons versus both the contemporary control group and the historical control group.
Altogether, there is evidence to suggest that beyond the acute phase of COVID-19, survivors might be at an increased risk of developing incident diabetes, and increased risk of incident antihyperglycemic use in the post-acute phase of the disease. Diabetes should be considered as a facet of the multifaceted long COVID syndrome. Post-acute care strategies of people with COVID-19 should integrate screening and management of diabetes.
We did a cohort study using data from the US Department of VA, which operates the largest nationally integrated health-care system in the US and provides health care to veterans discharged from the US armed forces. We identified 6 242 360 users of the VHA in the year 2019. Within them, 285 656 had a record of COVID-19 positive tests between March 1, 2020, and Sept 30, 2021. We then selected 271 689 participants who were alive 30 days after their COVID-19 positive test. The date of testing positive was set as T0.
From 6 242 360 users of the VHA in 2019, 5 961 637 participants were alive as of March 1, 2020, 5 689 948 of whom were not in the COVID-19 group. To ensure that the contemporary control group had a similar follow-up distribution as the COVID-19 group, we assigned the T0 to the contemporary control group following the same T0 distribution as the COVID-19 group. 5 479 834 contemporary control participants were alive at T0, of whom 5 460 230 were alive 30 days after T0.
Separately, we constructed a historical comparison group by identifying 6 462 011 participants who used the VHA in 2017, of whom 6 151 063 were alive as of March 1, 2018. Within 5 900 962 of those not in the COVID-19 group, T0 was assigned as 2 years before T0 distribution of the COVID-19 group. 5 712 311 participants were alive at T0, of whom 5 695 490 were alive 30 days after T0.
To evaluate the incident diabetes events, we then further removed those with a record of HbA1c of more than 6·4% ( 46 mmol/mol); an International Classification of Diseases 10 ( ICD-10) diabetes diagnosis; or diabetes medication use in the year before T0, yielding a final analytic cohort of 181 280 participants in the COVID-19 group, 4 118 441 participants in the contemporary control group, and 4 286 911 in the historical control group. A description of the construction of the three cohorts is included in the appendix ( p 2).
The COVID-19 group was further categorised into those who were not hospitalised ( n=162 096), hospitalised for COVID-19 ( n=15 078), or admitted to an intensive care unit during the acute phase of the disease ( n=4106). Follow-up ended on Dec 20, 2021, for the COVID-19 and contemporary control groups and on Dec 20, 2019 for the historical control group ( appendix p 2).
The study was approved by the VA St. Louis Health Care System Institutional Review Board, which granted a waiver of informed consent.
Data from the US Department of VA were used. The VA Corporate Data Warehouse ( CDW) provided demographic and clinical data.10Bowe B Xie Y Xian H Lian M Al-Aly Z Geographic variation and US County characteristics associated with rapid kidney function decline.Kidney Int Rep. 2016; 2: 5-17Google Scholar, 11Xie Y Bowe B Li T Xian H Yan Y Al-Aly Z Higher blood urea nitrogen is associated with increased risk of incident diabetes mellitus.Kidney Int. 2018; 93: 741-752Google Scholar, 12Bowe B Xie Y Yan Y Al-Aly Z Burden of cause-specific mortality associated with PM2.5 air pollution in the United States.JAMA Netw Open. 2019; 2e1915834Google Scholar, 13Xie Y Bowe B Yan Y Xian H Li T Al-Aly Z Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study.BMJ. 2019; 365l1580Google Scholar, 14Bowe B Xie Y Xian H Li T Al-Aly Z Association between monocyte count and risk of incident CKD and progression to ESRD.Clin J Am Soc Nephrol. 2017; 12: 603-613Google Scholar, 15Xie Y Bowe B Gibson A et al.Comparative effectiveness of the sodium-glucose co-transporter-2 inhibitor empagliflozin vs. other antihyperglycemics on risk of major adverse kidney events.Diabetes Care. 2020; 43: 2785-2795Google Scholar, 16Xie Y Bowe B Gibson AK McGill JB Maddukuri G Al-Aly Z Comparative effectiveness of sodium-glucose cotransporter 2 inhibitors vs sulfonylureas in patients with type 2 diabetes.JAMA Intern Med. 2021; 181: 1043-1053Google Scholar, 17Bowe B Cai M Xie Y Gibson AK Maddukuri G Al-Aly Z Acute kidney injury in a national cohort of hospitalized US veterans with COVID-19.Clin J Am Soc Nephrol. 2020; 16: 14-25Google Scholar, 18Xie Y Bowe B Gibson AK et al.Comparative effectiveness of SGLT2 Inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, and sulfonylureas on risk of kidney outcomes: emulation of a target trial using health care databases.Diabetes Care. 2020; 43: 2859-2869Google Scholar, 19Xie Y Bowe B Gibson AK McGill JB Maddukuri G Al-Aly Z Clinical implications of estimated glomerular filtration rate dip following sodium-glucose cotransporter-2 inhibitor initiation on cardiovascular and kidney outcomes.J Am Heart Assoc. 2021; 10e020237Google Scholar Diagnoses were obtained from VA CDW inpatient and outpatient encounters domains. Laboratory measurements were collected from the CDW laboratory results domain and medication data were collected from the CDW outpatient pharmacy domain and the CDW bar code medication administration domain.10Bowe B Xie Y Xian H Lian M Al-Aly Z Geographic variation and US County characteristics associated with rapid kidney function decline.Kidney Int Rep. 2016; 2: 5-17Google Scholar, 11Xie Y Bowe B Li T Xian H Yan Y Al-Aly Z Higher blood urea nitrogen is associated with increased risk of incident diabetes mellitus.Kidney Int. 2018; 93: 741-752Google Scholar, 12Bowe B Xie Y Yan Y Al-Aly Z Burden of cause-specific mortality associated with PM2.5 air pollution in the United States.JAMA Netw Open. 2019; 2e1915834Google Scholar, 13Xie Y Bowe B Yan Y Xian H Li T Al-Aly Z Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors among US veterans: cohort study.BMJ. 2019; 365l1580Google Scholar, 14Bowe B Xie Y Xian H Li T Al-Aly Z Association between monocyte count and risk of incident CKD and progression to ESRD.Clin J Am Soc Nephrol. 2017; 12: 603-613Google Scholar, 15Xie Y Bowe B Gibson A et al.Comparative effectiveness of the sodium-glucose co-transporter-2 inhibitor empagliflozin vs. other antihyperglycemics on risk of major adverse kidney events.Diabetes Care. 2020; 43: 2785-2795Google Scholar, 16Xie Y Bowe B Gibson AK McGill JB Maddukuri G Al-Aly Z Comparative effectiveness of sodium-glucose cotransporter 2 inhibitors vs sulfonylureas in patients with type 2 diabetes.JAMA Intern Med. 2021; 181: 1043-1053Google Scholar, 17Bowe B Cai M Xie Y Gibson AK Maddukuri G Al-Aly Z Acute kidney injury in a national cohort of hospitalized US veterans with COVID-19.Clin J Am Soc Nephrol. 2020; 16: 14-25Google Scholar, 18Xie Y Bowe B Gibson AK et al.Comparative effectiveness of SGLT2 Inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, and sulfonylureas on risk of kidney outcomes: emulation of a target trial using health care databases.Diabetes Care. 2020; 43: 2859-2869Google Scholar, 19Xie Y Bowe B Gibson AK McGill JB Maddukuri G Al-Aly Z Clinical implications of estimated glomerular filtration rate dip following sodium-glucose cotransporter-2 inhibitor initiation on cardiovascular and kidney outcomes.J Am Heart Assoc. 2021; 10e020237Google Scholar Information on COVID-19 was obtained from the VA COVID-19 shared data resource.20Department of Veterans AffairsCOVID-19: shared data resource.https: //vhacdwdwhweb100.vha.med.va.gov/phenotype/index.php/COVID-19: Shared Data Resource # Acknowledgements COVID-19 Shared Data ResourceDate: 2020Date accessed: December 30, 2021Google Scholar The Area Deprivation Index was used as a summary measure of contextual disadvantage at participants ' residential locations.21Kind AJH Buckingham WR Making neighborhood-disadvantage metrics accessible—the Neighborhood Atlas.N Engl J Med. 2018; 378: 2456-2458Google Scholar
Post-acute COVID-19 diabetes outcomes were examined in the period of follow-up from 30 days after T0 up to the end of follow-up. Diabetes status was defined based on the ICD-10 codes ( E08.X to E13.X) or a HbA1c measurement of more than 6·4% ( 46 mmol/mol), identified based on the Logical Observation Identifiers Names and Codes ( LOINC). Antihyperglycaemic use was defined based on prescription record of diabetes medications for more than 30 days. A composite endpoint was also defined as the first occurrence of diabetes or antihyperglycaemic use.
We used both predefined covariates and algorithmically selected high-dimensional covariates to adjust for the difference in baseline characteristics between groups. Predefined covariates were selected based on previous knowledge.1Al-Aly Z Xie Y Bowe B High-dimensional characterization of post-acute sequelae of COVID-19.Nature. 2021; 594: 259-264Google Scholar, 22Xie Y Bowe B Al-Aly Z Burdens of post-acute sequelae of COVID-19 by severity of acute infection, demographics and health status.Nat Commun. 2021; 126571Google Scholar, 23Bowe B Xie Y Xu E Al-Aly Z Kidney outcomes in long COVID.J Am Soc Nephrol. 2021; 32: 2851-2862Google Scholar, 24Xie Y Xu E Bowe B Al-Aly Z Long-term cardiovascular outcomes of COVID-19.Nat Med. 2022; ( published online Feb 7.) https: //doi.org/10.1038/s41591-022-01689-3Google Scholar, 25Xie Y Xu E Al-Aly Z Risks of mental health outcomes in people with COVID-19: cohort study.BMJ. 2022; 377e068993Google Scholar Covariates were assessed within 1 year before T0. Predefined baseline variables included age, race ( White, Black, or other race), sex, area deprivation index, BMI, smoking status ( current smoker, former smoker, or never smoke), use of long-term care ( including nursing homes and assisted-living centres), number of outpatient and inpatient encounters, and number of HbA1c measurements. Comorbidities such as cancer, cardiovascular disease, cerebrovascular disease, chronic lung disease, dementia, HIV, hyperlipidaemia, and peripheral artery disease were also included as predefined covariates. Additionally, we also adjusted for laboratory test results including estimated glomerular filtration rate ( eGFR) and HbA1c; vital signs including systolic and diastolic blood pressure; and medications including the use of steroids. Missingness of BMI, blood pressure, eGFR, and HbA1c were 1·02%, 1·28%, 6·20%, and 15·43%, respectively. Mean imputations conditional on age, race, sex, and group assignment were applied to missing values and continuous variables were transformed into restricted cubic spline functions to account for the potential non-linear relationships.
To further enhance the adjustment of potential confounding, and to complement our list of prespecified variables, we algorithmically selected and adjusted for potential confounders from data domains including diagnoses, medications, and laboratory test results.26Schneeweiss S Rassen JA Glynn RJ Avorn J Mogun H Brookhart MA High-dimensional propensity score adjustment in studies of treatment effects using health care claims data.Epidemiology. 2009; 20: 512-522Google Scholar We obtained all patient encounter data, prescription data, and laboratory data for the cohort of participants within 1 year before T0. We classified more than 70 000 ICD-10 diagnosis codes into 540 diagnostic categories based on the Clinical Classifications Software Refined ( version 2021.1), which is developed as part of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality.27Wei Y Wang Y Di Q et al.Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study.BMJ. 2019; 367l6258Google Scholar, 28Aubert CE Schnipper JL Roumet M et al.Best definitions of multimorbidity to identify patients with high health care resource utilization.Mayo Clin Proc Innov Qual Outcomes. 2020; 4: 40-49Google Scholar, 29Agency for Healthcare Research and QualityClinical Classifications Software Refined ( CCSR).https: //www.hcup-us.ahrq.gov/toolssoftware/ccsr/ccs refined.jspDate accessed: December 30, 2021Google Scholar We classified 3425 medications, on the basis of the VA drug classification system, into 543 medication classes.30Olvey EL Clauschee S Malone DC Comparison of critical drug-drug interaction listings: the Department of Veterans Affairs medical system and standard reference compendia.Clin Pharmacol Ther. 2010; 87: 48-51Google Scholar, 31Greene M Steinman MA McNicholl IR Valcour V Polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults with human immunodeficiency virus infection.J Am Geriatr Soc. 2014; 62: 447-453Google Scholar In total, 62 laboratory test abnormalities from 38 laboratory measurements were identified on the basis of LOINC. Because rare conditions occurring in less than 100 people in a group might not be sufficiently substantial to describe the characteristics of the group, only diagnoses, medications, or laboratory test abnormalities with an event of more than 100 within each group, which were not included as predefined variables, were used to further estimate the univariate relative risk for COVID-19 group assignment.1Al-Aly Z Xie Y Bowe B High-dimensional characterization of post-acute sequelae of COVID-19.Nature. 2021; 594: 259-264Google Scholar The top 100 variables with the strongest univariate relative risk were selected.23Bowe B Xie Y Xu E Al-Aly Z Kidney outcomes in long COVID.J Am Soc Nephrol. 2021; 32: 2851-2862Google Scholar The selection process was done independently for COVID-19 versus contemporary control groups, and COVID-19 versus historical control groups.
Baseline characteristics of the COVID-19 and control groups, as well as standardised mean differences between the groups were reported. To estimate the association between COVID-19 and post-acute diabetes outcomes, high dimensional propensity scores were used to adjust for the difference between the COVID-19 and control groups at baseline. For each study group, a logistic regression, including predefined and 100 algorithmically selected high dimensional variables, was used to estimate the propensity score as the probability of assignment to the target population, which was defined as VHA users in 2019 ( the year before the first COVID-19 infection occurred in the study population). The inverse probability weight for each participant was then constructed as the propensity score from the previous logistic regression divided by 1 minus the propensity score.32Austin PC An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399-424Google Scholar Inverse probability weighting was then applied to a Cox survival model to estimate the association between COVID-19 and diabetes outcomes. Two measures of risks were estimated, including the adjusted hazard ratios ( HRs) and excess burdens. To generate the excess burdens, burdens of diabetes outcomes at 12 months in each group were estimated based on the survival probability at 12 months of follow-up. Excess burdens per 1000 people at 12 months from COVID-19 compared with controls was estimated based on the difference on survival probability between groups and transformed as event rate difference. Comparisons were done between COVID-19 and contemporary control groups, and independently between COVID-19 and historical control groups. The analyses were then repeated in subgroups based on age ( ≤65 years and > 65 years), race ( White and Black; subgroup analyses for other race category were not done because of the heterogeneity within this category), sex ( male and female), BMI categories ( > 18·5 to ≤25 kg/m2; > 25 to ≤30 kg/m2; and > 30 kg/m2), area deprivation index quartiles, and diabetes risk score quartiles. A diabetes risk score was built using logistic regression to predict the probability of having a composite diabetes outcome within 1 year. The risk score was built within control groups based on diabetes risk factors including age, race, sex, BMI, HbA1c, cardiovascular disease, hypertension, and hyperlipidaemia status. The risk score was then applied to the COVID-19 group to evaluate the risk of diabetes outcomes before exposure to COVID-19.
To gain a better understanding of which subgroups with COVID-19 are more likely to have post-acute COVID-19 diabetes events, we estimated the effect of risk factors including diabetes risk scores, age, race, cardiovascular diseases, hypertension, hyperlipidaemia, prediabetes status ( HbA1c > 5·6% and < 6·4%), and BMI categories on diabetes outcomes within 30-day survivors of COVID-19. We constructed logistic regressions within each COVID-19 subgroup to estimate the probability of assignment to the target population, conditional on covariates other than the subgrouping definition. Inverse probability weightings were then computed, and survival models were used to examine the HRs and burdens of these risk factors on diabetes outcomes.
We then separated the COVID-19 group into three mutually exclusive groups based on the care setting of the acute phase of the disease; that is whether people were non-hospitalised, hospitalised, or admitted to intensive care during the first 30 days after a COVID-19 positive test. Logistic regressions were applied to each care setting group to estimate the inverse probability weights. Cox survival models with inverse probability weighting were then applied and HRs, burdens, and excess burdens were reported.
To test the robustness of our findings, we applied an alternative analytic plan. Only cohort participants with complete data and at least 12 months of follow-up were selected and censored at 12 months ( COVID-19 group n=62 110 and contemporary control group n=1 277 659). Multinomial logistic regression adjusting for predefined covariates was used to estimate the propensity scores for cohort participants. Average treatment effect weights were then constructed from the propensity score with stabilisation based on proportions of each group in the overall cohort. Weighted logistic regressions were then applied to estimate the odds ratios and predicted probabilities of having the outcome. Variance was estimated through generalised estimating equation, which considers the within-participant correlation after weightings.
We also did multiple additional sensitivity analyses to test the robustness of results to changes in specification of our primary approach. First, we repeated the analyses while additionally adjusting for the month of cohort enrolment, in consideration of the putative presence of a temporal confounding effect. Second, we defined outcomes based on their second occurrence during the follow-up. Third, we used 300 algorithmically selected high dimensional variables ( instead of the 100 used in the primary analyses) to adjust for potential additional confounders. Fourth, conversely, we estimated the association by using only predefined covariates ( ie, without the use of high dimensional variables). Fifth, instead of inverse probability weighting, we used overlap weighting to estimate the association.33Thomas LE Li F Pencina MJ Overlap weighting: a propensity score method that mimics attributes of a randomized clinical trial.JAMA. 2020; 323: 2417-2418Google Scholar, 34Li F Thomas LE Li F Addressing extreme propensity scores via the overlap weights.Am J Epidemiol. 2019; 188: 250-257Google Scholar Sixth, we applied the doubly robust adjustment method to further adjust for covariates after applying inverse probability weighting. Seventh, to further account for missing data, we applied multiple imputation to generate ten imputed datasets based on fully conditional specification regression method and estimated results.35van Buuren S Multiple imputation of discrete and continuous data by fully conditional specification.Stat Methods Med Res. 2007; 16: 219-242Google Scholar Eight, to remove the influence of steroid use during the acute phase of the infection, we additionally adjusted for steroid use during the acute phase of the infection. Finally, to reduce the bias associated with increased surveillance for COVID-19 patients during follow-up, we additionally adjusted for the number of outpatient visits, number of hospitalisations, and number of HbA1c measurements during the follow-up as time varying variables.
To evaluate the success of our approach, we first tested the association between COVID-19 and the risk of death as a positive outcome control—where established evidence suggests an association is expected. To detect the presence of spurious biases, we first examined the association between COVID-19 and risks of diagnostic codes based outcomes including hearing aid use and acne, and, separately, risk of laboratory-based outcomes including serum albumin of more than 5 g/dL, total protein of more than 8·5 g/dL, serum potassium of more than 5·1 mmol/L, serum calcium of more than 10·5 mg/dL, and high-density lipoprotein of less than 40 mg/dL as negative outcome controls—where there is no evidence to suggest that an association is expected. Successful reproduction of established knowledge ( positive outcome control), and the successful application of negative controls, would reduce concerns about biases related to cohort building, study design, analytic approach, outcome ascertainment, residual confounding, and other latent biases.36Lipsitch M Tchetgen Tchetgen E Cohen T Negative controls: a tool for detecting confounding and bias in observational studies.Epidemiology. 2010; 21: 383-388Google Scholar, 37Shi X Miao W Tchetgen ET A selective review of negative control methods in epidemiology.Curr Epidemiol Rep. 2020; 7: 190-202Google Scholar
Robust sandwich estimators were used to estimate variances when weightings were applied. For all analyses, a 95% CI that excluded unity or a p value of less than 0·05 was considered evidence of statistical significance. Analyses were done using SAS Enterprise Guide ( version 8.2) and results were visualised using SAS Enterprise Guide ( version 8.2) and R ( version 4.0.4).
The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
There were 4 299 721 US veterans in the cohort overall recruited from March 1, 2020, to Sept 30, 2021; 181 280 were in the COVID-19 group an 4 118 441 were in the contemporary control group. The median follow-up time was 352 ( IQR 244–406) days in the COVID-19 group and 352 ( 245–406) days in the contemporary control group, corresponding to 163 881 person-years and 3 763 155 person-years of follow-up, respectively.
To test the consistency of the results, we also built a historical cohort of 4 286 911 participants followed up for a median of 352 ( IQR 245–406) days, corresponding to 3 916 979 person-years of follow-up.
The demographic and health characteristics of the historical control group, contemporary control group, and COVID-19 group before weighting are provided in the appendix ( pp 8–9); characteristics after weighting are provided in the table. The absolute numbers and incident rates for outcomes before and after weighting are also provided in the appendix ( pp 10–11). Most incident diabetes outcomes were type 2 diabetes; 0·68% and 0·71% of the ICD-based outcomes in the COVID-19 group were diabetes type 1 in the unweighted and weighted cohort, respectively.TableDemographic and health characteristics of the COVID-19, contemporary control, and historical control groups after adjustmentCOVID-19 ( n=181 280) Contemporary control ( n=4 118 441) Historical control ( n=4 286 911) Absolute standardised differenceCOVID-19 and contemporary control * Standardised difference of less than 0·10 is considered good balance.COVID-19 and historical control * Standardised difference of less than 0·10 is considered good balance.Baseline characteristicsAge, years60·92 ( 17·02) 61·5 ( 17·08) 61·49 ( 17·13) 0·010·01RaceWhite138 949 ( 76·65%) 3 194 881 ( 77·58%) 3 326 214 ( 77·59%) 0·020·02Black34 015 ( 18·76%) 737 695 ( 17·91%) 766 543 ( 17·88%) 0·020·02Other†Latinx, Asian, American Indian Native Hawaiian, and patients of other races.8314 ( 4·59%) 185 865 ( 4·51%) 194 154 ( 4·53%) 0·000·00SexMale159 666 ( 88·08%) 3 655 034 ( 88·75%) 3 804 076 ( 88·74%) 0·020·02Female21 614 ( 11·92%) 463 407 ( 11·25%) 482 835 ( 11·26%) 0·020·02Smoking statusNever77 677 ( 42·85%) 1 840 243 ( 44·68%) 1 916 978 ( 44·72%) 0·040·04Former61 748 ( 34·06%) 1 366 746 ( 33·19%) 1 420 554 ( 33·14%) 0·020·02Current41 858 ( 23·09%) 911 452 ( 22·13%) 949 336 ( 22·15%) 0·020·02BMI, kg/m229·2 ( 6·06) 29·15 ( 5·98) 29·15 ( 6·02) 0·010·01Area deprivation index‡Area deprivation index is a measure of socioeconomic disadvantage, with a range from low to high disadvantage of 0–100.54·17 ( 18·97) 53·89 ( 19·06) 53·90 ( 19·05) 0·020·01Clinical characteristicsOutpatient encounter§Data collected within 1 year of cohort enrolment.Zero or one92 214 ( 50·87%) 2 137 471 ( 51·9%) 2 220 020 ( 51·79%) 0·020·02Two48 483 ( 26·75%) 1 118 445 ( 27·16%) 1 147 606 ( 26·77%) 0·010·00Three or more40 583 ( 22·39%) 862 484 ( 20·94%) 919 285 ( 21·44%) 0·040·02Number of HbA1cmeasurements‡Area deprivation index is a measure of socioeconomic disadvantage, with a range from low to high disadvantage of 0–100.0·43 ( 0·62) 0·42 ( 0·62) 0·42 ( 0·62) 0·030·03Long-term care¶Nursing homes and assisted-living centers.1017 ( 0·56%) 16 062 ( 0·39%) 17 233 ( 0·40%) 0·020·02Estimated glomerular filtration rate, mL/min per 1·73m281·67 ( 19·77) 81·32 ( 19·45) 81·32 ( 19·47) 0·020·02HbA1c5·53% ( 0·35) 5·54% ( 0·34) 5·53% ( 0·35) 0·020·02HbA1c, mmol/mol36·94 ( 3·83) 37·05 ( 3·72) 36·94 ( 3·83) 0·020·02Systolic blood pressure, mm Hg131·63 ( 12·44) 131·73 ( 12·31) 131·71 ( 12·37) 0·010·01Diastolic blood pressure, mm Hg78·32 ( 7·55) 78·24 ( 7·51) 78·25 ( 7·53) 0·010·01Cancer9330 ( 5·15%) 207 940 ( 5·05%) 217 818 ( 5·08%) 0·000·00Cardiovascular disease15 030 ( 8·29%) 339 277 ( 8·24%) 356 457 ( 8·32%) 0·000·00Cerebrovascular disease5730 ( 3·16%) 124 418 ( 3·02%) 130 879 ( 3·05%) 0·010·01Chronic lung disease16 942 ( 9·35%) 369 671 ( 8·98%) 386 937 ( 9·03%) 0·010·01Dementia4673 ( 2·58%) 98 678 ( 2·40%) 103 958 ( 2·43%) 0·010·01HIV758 ( 0·42%) 16 227 ( 0·39%) 17 019 ( 0·40%) 0·000·00Hyperlipidaemia49 092 ( 27·08%) 1 069 312 ( 25·96%) 1 119 141 ( 26·11%) 0·030·02Peripheral artery disease1026 ( 0·57%) 22 075 ( 0·54%) 23 707 ( 0·55%) 0·000·00Steroid prescription2779 ( 1·53%) 58 152 ( 1·41%) 61 131 ( 1·43%) 0·010·01Data are mean ( SD) or n (%). * Standardised difference of less than 0·10 is considered good balance.† Latinx, Asian, American Indian Native Hawaiian, and patients of other races.‡ Area deprivation index is a measure of socioeconomic disadvantage, with a range from low to high disadvantage of 0–100.§ Data collected within 1 year of cohort enrolment.¶ Nursing homes and assisted-living centers. Open table in a new tab
For all analyses, we provide two measures of risk: first, we estimated the adjusted HRs of incident diabetes outcomes; and second, we estimated the excess burden from the difference between the incident event rates per 1000 people at 12 months in the COVID-19 and control groups. Assessment of covariate balance after application of inverse probability weighting suggested that standardised mean differences are less than 0·1 ( indicating good balance) for predefined covariates, high dimensional covariates selected by our algorithm, and those not selected ( table and appendix p 3).
Compared to the contemporary control group, 30-day survivors of COVID-19 exhibited an increased risk ( HR 1·40, 95% CI 1·36–1·44) and excess burden ( 13·46, 95% CI 12·11–14·84, per 1000 people at 12 months) of incident diabetes; and an increased risk ( 1·85, 1·78–1·92) and excess burden ( 12·35, 11·36–13·38) of incident antihyperglycaemic use. Analyses to estimate the risk of a composite endpoint of incident diabetes or antihyperglycaemic use yielded a HR of 1·46 ( 95% CI 1·43–1·50) and an excess burden of 18·03 ( 16·59–19·51) per 1000 people at 12 months ( figure 1 and appendix pp 4, 12).Figure 1Risks and burdens of post-acute COVID-19 diabetes outcomes compared with the contemporary control groupShow full captionThe outcomes were ascertained from day 30 after COVID-19 infection until the end of follow-up. Adjusted hazard ratios and 95% CIs are presented in a base 10 logarithmic scale. Adjusted event rates per 1000 people at 12 months for the COVID-19 group and the contemporary control group, and the excess burden per 1000 people at 12 months and related 95% CIs are also presented.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
The outcomes were ascertained from day 30 after COVID-19 infection until the end of follow-up. Adjusted hazard ratios and 95% CIs are presented in a base 10 logarithmic scale. Adjusted event rates per 1000 people at 12 months for the COVID-19 group and the contemporary control group, and the excess burden per 1000 people at 12 months and related 95% CIs are also presented.
Subgroup analyses suggested that COVID-19 was associated with an increased risk of diabetes outcomes across age ( ≤65 years and > 65 years), race ( White and Black), sex ( male and female), BMI categories ( > 18·5 to ≤25 kg/m2, > 25 to ≤30 kg/m2, and > 30 kg/m2), and area deprivation index quartiles. We then examined the associations according to diabetes risk score quartiles; the results suggested that COVID-19 was associated with an increased risk of diabetes across all risk score quartiles, including the lowest risk score quartile ( appendix pp 13–14).
We then further examined the risks and burdens of post-acute incident diabetes, antihyperglycaemic use, and the composite outcome by the severity of disease during the acute phase of the infection ( non-hospitalised, hospitalised, and admitted to intensive care); demographic and health characteristics of these groups before and after weighting are provided in the appendix ( pp 15–18). Assessment of covariate balance after application of weights suggested covariates were well balanced. Compared with the contemporary control group, the risks and burdens of post-acute of incident diabetes, antihyperglycaemic use, and the composite outcome increased according to the severity of the acute infection ( figure 2 and appendix p 19) Figure 2Risks and burdens of post-acute COVID-19 diabetes outcomes by severity of the acute infection compared with the contemporary control groupShow full captionSeverity of the acute infection was defined as non-hospitalised ( blue), hospitalised ( purple), and admitted to intensive care ( orange). The outcomes were ascertained from day 30 after COVID-19 infection until the end of follow-up. Adjusted hazard ratios and 95% CIs are presented in a base 10 logarithmic scale. Adjusted event rates per 1000 people at 12 months for each care setting during the acute infection, contemporary control group, and excess burden per 1000 people at 12 months and related 95% CIs are also presented.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
Severity of the acute infection was defined as non-hospitalised ( blue), hospitalised ( purple), and admitted to intensive care ( orange). The outcomes were ascertained from day 30 after COVID-19 infection until the end of follow-up. Adjusted hazard ratios and 95% CIs are presented in a base 10 logarithmic scale. Adjusted event rates per 1000 people at 12 months for each care setting during the acute infection, contemporary control group, and excess burden per 1000 people at 12 months and related 95% CIs are also presented.
We examined the associations between COVID-19 and diabetes in analyses considering a historical control group as the reference category. The results suggested that COVID-19 was associated with an increased risk of diabetes outcomes in comparisons of COVID-19 versus the overall historical control group, and across all the subgroups examined ( appendix pp 5–6, 20–22), and were consistent with those evaluating the COVID-19 versus contemporary control groups.
We then did analyses by care setting of the acute phase of the COVID-19 infection compared with the historical control group. The results suggested that the risks of diabetes outcomes exhibited a graded increase according to the intensity of care during the acute phase of the infection and were consistent with analyses considering the COVID-19 group versus the contemporary control group ( appendix pp 7, 23–27).
To gain a deeper understanding of who is at most risk of post-acute diabetes outcomes, we did analyses among people who survived the first 30 days of COVID-19 to identify characteristics of individuals who were at highest risk of incident diabetes, antihyperglycaemic use, and the composite outcome. We found there was a graded increase in risks and burdens with increasing quartile of diabetes risk score ( figure 3A). People older than 65 years had higher risks and burdens than those younger than 65 years. Black participants exhibited higher risks and burdens than White participants. Those with cardiovascular disease, hypertension, hyperlipidaemia, or prediabetes also exhibited higher risks and burdens than people without these conditions. Compared to those with a BMI of > 18·5 kg/m2 to ≤25 kg/m2, there was a graded increase in risks and burdens in those with BMIs of > 25 kg/m2 and ≤30 kg/m2 and or in those with a BMI of > 30 kg/m2 ( figure 3B and appendix p 28).Figure 3Risks of post-acute diabetes outcomes among people with COVID-19Show full caption ( A) Diabetes risk score quartile. ( B) Individual risk factors including age, race, cardiovascular disease, hypertension, hyperlipidaemia, prediabetes, and BMI. The outcomes were ascertained from day 30 after COVID-19 infection until the end of follow-up. Adjusted hazard ratios and 95% CIs are presented in a base 10 logarithmic scale. Excess burden per 1000 people at 12 months and 95% CIs are also presented.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
( A) Diabetes risk score quartile. ( B) Individual risk factors including age, race, cardiovascular disease, hypertension, hyperlipidaemia, prediabetes, and BMI. The outcomes were ascertained from day 30 after COVID-19 infection until the end of follow-up. Adjusted hazard ratios and 95% CIs are presented in a base 10 logarithmic scale. Excess burden per 1000 people at 12 months and 95% CIs are also presented.
To test the robustness of our results, we applied an alternative analytic approach where we used predefined covariates based inverse probability weighted logistic regression within participants with at least 1 year of follow-up. The risk and burden of diabetes outcomes were consistent with the main findings ( appendix p 29).
All sensitivity analyses produced results consistent with the primary analyses ( appendix p 30).
To test whether our approach would reproduce established associations, we examined death as a positive outcome control; the results suggested that COVID-19 was associated with higher risk of death ( HR 1·49, 95% CI 1·44–1·55; appendix p 31).
We then tested the association between COVID-19 and the risks of hearing aid use and—independently—risk of acne as two ICD-10 based negative outcome controls where no previous knowledge suggests an association is expected. The results suggested no association between COVID-19 and the risk of hearing aid use or acne. We additionally tested the association between COVID-19 and laboratory-based negative outcome controls including serum albumin of more than 5 g/dL, total protein of more than 8·5 g/dL, serum potassium of more than 5·1 mmol/L, serum calcium of more than 10·5 mg/dL, and high-density lipoprotein of less than 40 mg/dL. The results suggested no association with any of the laboratory-based negative outcome controls ( appendix p 31).
In this study involving participants with COVID-19, contemporary controls, and historical controls, we provide evidence that suggests that beyond the first 30 days of infection, COVID-19 survivors exhibited increased risks and burdens of incident diabetes, and antihyperglycaemic use. The risks and burdens of all outcomes were significant among those non-hospitalised and increased in a graded fashion according to the care setting of the acute phase of the infection. The risks and burdens were also consistent in comparisons versus a historical control group. Altogether, our results indicate that beyond the acute phase of COVID-19, survivors are at an increased risk of developing incident diabetes and antihyperglycaemic use; therefore diabetes should be considered as a component of the multifaceted long COVID. Post-acute care strategies of people with COVID-19 should also integrate screening and management of diabetes.
The implications of our findings are clear. In the post-acute phase of the disease, COVID-19 was significantly associated with increased risk of incident diabetes. Although the risks and burdens increased according to the severity of the acute infection ( as proxied by the care setting), they were evident and not trivial among people who were not hospitalised for COVID-19—this group represents most people with COVID-19. For example, the excess burden of diabetes among non-hospitalised individuals was 8·28 per 1000 people at 12 months. Given the large and growing number of people infected with COVID-19 ( > 450 million people globally as of March 15, 2022),38WHOWHO coronavirus ( COVID-19) dashboard.https: //covid19.who.int/Date accessed: March 15, 2022Google Scholar these absolute numbers might translate into substantial overall population level burdens and could further strain already overwhelmed health systems. Governments and health systems around the world should be prepared to screen and manage the glycometabolic sequelae of COVID-19. Although the optimal composition of post-acute COVID clinics is still not clear, evidence from this report indicated that those should include attention and care for diabetes.
Our approach examines the risks and burdens of diabetes in comparisons versus a contemporary control group exposed to the same contextual forces of the pandemic ( eg, economic, social, and environmental stressors) and a historical control group from a pre-pandemic era that represents a baseline unaffected by the pandemic. COVID-19 consistently exhibited an increased risk of diabetes in comparisons versus both the contemporary and historical control groups, suggesting enhanced vulnerability to diabetes among people with COVID-19.
Our subgroup analyses suggest that even people with a low risk of diabetes before exposure to COVID-19 exhibited increased risk compared to both contemporary and historical controls. In addition, our analyses of who is at risk of diabetes among people with COVID-19 suggest that the relationship between COVID-19 and diabetes exhibited a graded association according to baseline risk of diabetes suggesting that diabetes could manifest in people at low risk ( compared with controls), and COVID-19 could likely amplify baseline risks and further accelerate manifestation of disease among individuals already at high risk.
Studies on the link between COVID-19 and diabetes are generally limited by short follow-up and most investigate outcomes in hospitalised individuals. Evidence in children and young adults is mixed. A study of two large databases of more than 2·5 million children ( aged < 18 years) suggested that those with COVID-19 exhibited a higher risk of new diabetes than those without COVID-19.47Wu CT Lidsky PV Xiao Y et al.SARS-CoV-2 infects human pancreatic β cells and elicits β cell impairment.Cell Metab. 2021; 33: 1565-1576Google Scholar Additionally, the risk of new diabetes was higher in COVID-19 than in those with pre-pandemic acute respiratory infections.47Wu CT Lidsky PV Xiao Y et al.SARS-CoV-2 infects human pancreatic β cells and elicits β cell impairment.Cell Metab. 2021; 33: 1565-1576Google Scholar This study did not report the proportion of type 1 or type 2 diabetes.47Wu CT Lidsky PV Xiao Y et al.SARS-CoV-2 infects human pancreatic β cells and elicits β cell impairment.Cell Metab. 2021; 33: 1565-1576Google Scholar An analysis, which has not yet been peer reviewed, of 1·8 million people aged younger than 35 years suggested increased risk of type 1 diabetes within, but not beyond, the first 30 days after SARS-CoV-2 infection.48Tang X Uhl S Zhang T et al.SARS-CoV-2 infection induces beta cell transdifferentiation.Cell Metab. 2021; 33: 1577-1591Google Scholar Studies in adults are generally more concordant and show evidence of increased risk of diabetes in people with COVID-19.49van der Heide V Jangra S Cohen P et al.Limited extent and consequences of pancreatic SARS-CoV-2 infection.Cell Rep. 2022; 38110508Google Scholar, 50Bowe B Xie Y Gibson AK et al.Ambient fine particulate matter air pollution and the risk of hospitalization among COVID-19 positive individuals: cohort study.Environ Int. 2021; 154106564Google Scholar, 51Xie Y Bowe B Yan Y Cai M Al-Aly Z County-level contextual characteristics and disparities in life expectancy.Mayo Clin Proc. 2021; 96: 92-104Google Scholar Our study sheds light on this and provides evidence of increased risk in adults among both non-hospitalised and hospitalised individuals at 1 year after COVID-19 diagnosis; and that most ( > 99%) of diagnoses of diabetes in our cohort relate to type 2 diabetes.
The mechanism ( s) underpinning the association between COVID-19 and risk of diabetes are not entirely clear. Several pancreatic cell types express three proteins ( angiotensin converting enzyme 2 receptor protein, TMPRSS2 enzyme protein, and neuropilin 1) on which SARS-CoV-2 depends for its entry into human cells.39Barrett CE K. A. Alvarez P et al.Risk for newly diagnosed diabetes > 30 days after SARS-CoV-2 infection among persons aged < 18 years—United States, March 1, 2020–June 28, 2021.Morb Mortal Wkly Rep. 2022; 71: 59-65Google Scholar Evidence suggests that SARS-CoV-2 can infect and replicate in insulin-producing pancreatic beta cells subsequently resulting in impaired production and secretion of insulin.40McKeigue PM et al.Relation of incident type 1 diabetes to recent COVID-19 infection: cohort study using e-health record linkage in Scotland.medRxiv. 2022; ( published online Feb 11.) ( preprint).https: //doi.org/10.1101/2022.02.11.22270785Google Scholar, 41Sathish T Kapoor N Cao Y Tapp RJ Zimmet P Proportion of newly diagnosed diabetes in COVID-19 patients: a systematic review and meta-analysis.Diabetes Obes Metab. 2021; 23: 870-874Google Scholar, 42Ayoubkhani D Khunti K Nafilyan V et al.Post-COVID syndrome in individuals admitted to hospital with COVID-19: retrospective cohort study.BMJ. 2021; 372: n693Google Scholar, 43Collaborative O et al.Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19: a descriptive cohort study within the OpenSAFELY platform.medRxiv. 2021; ( published online Jan 25.) ( preprint).https: //doi.org/10.1101/2021.01.22.21250304Google Scholar However, in-vitro SARS-CoV-2-infected human pancreatic islets exhibit largely non-cytopathic modest cellular perturbations and inflammatory responses – suggesting that direct infection of pancreatic cells is – on its own – unlikely to fully explain new onset diabetes in people with COVID-19.52Cai M Bowe B Xie Y Al-Aly Z Temporal trends of COVID-19 mortality and hospitalisation rates: an observational cohort study from the US Department of Veterans Affairs.BMJ Open. 2021; 11e047369Google Scholar Other potential explanations include autonomic dysfunction, hyperactivated immune response or autoimmunity, and persistent low-grade inflammation leading to insulin resistance.40McKeigue PM et al.Relation of incident type 1 diabetes to recent COVID-19 infection: cohort study using e-health record linkage in Scotland.medRxiv. 2022; ( published online Feb 11.) ( preprint).https: //doi.org/10.1101/2022.02.11.22270785Google Scholar, 41Sathish T Kapoor N Cao Y Tapp RJ Zimmet P Proportion of newly diagnosed diabetes in COVID-19 patients: a systematic review and meta-analysis.Diabetes Obes Metab. 2021; 23: 870-874Google Scholar, 42Ayoubkhani D Khunti K Nafilyan V et al.Post-COVID syndrome in individuals admitted to hospital with COVID-19: retrospective cohort study.BMJ. 2021; 372: n693Google Scholar, 43Collaborative O et al.Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19: a descriptive cohort study within the OpenSAFELY platform.medRxiv. 2021; ( published online Jan 25.) ( preprint).https: //doi.org/10.1101/2021.01.22.21250304Google Scholar It is also possible that people with COVID-19 might have differentially experienced some of the broader contextual changes ( social, economic, environmental, and other) that characterised the pandemic and that might have indirectly contributed to shaping the outcomes evaluated in this study.44Ziegler CGK Allon SJ Nyquist SK et al.SARS-CoV-2 receptor ACE2 is an interferon – stimulated gene in human airway epithelial cells and is detected in specific cell subsets across tissues.Cell. 2020; 181: 1016-1035Google Scholar, 45Müller JA Groß R Conzelmann C et al.SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas.Nat Metab. 2021; 3: 149-165Google Scholar
There are several strengths of this study. We leveraged the breadth and depth of the US Department of Veterans Affairs electronic health-care databases to build a large national cohort of veterans, without a history of diabetes, to investigate the association between COVID-19 and risks of diabetes outcomes. We tested the association using two large controls ( contemporary and historical controls), an approach that allowed us to deduce that the associations between COVID-19 and risks of diabetes are not related to the broader temporal changes between the pre-pandemic and the pandemic eras, but rather related ( possibly through both a direct and indirect pathway) to exposure to COVID-19 itself. Our covariates specification approach included 22 predefined variables selected based on previous evidence and 100 algorithmically selected variables from high dimensional data domains including diagnostic codes, prescription records, and laboratory test results. We evaluated several incident diabetes outcomes across the continuum of the severity scale, including diabetes diagnoses and initiation of antihyperglycaemic therapy. We tested robustness of our approach in multiple sensitivity analyses, and successfully applied positive and negative outcome controls. We provided estimates of risks on both the ratio scale ( HRs) and the absolute scale ( burden per 1000 people at 12 months). The absolute scale also reflects the contribution of baseline risk and provides an estimate of potential harm that is more easily explainable to the general public than risk reported on the ratio scale ( eg, HR).
This study has several limitations. The demographic composition of our cohort ( comprised mostly of White males) could limit the generalisability of the findings. Although we leveraged the breadth and depth of the vast electronic health-care databases to build our cohorts, required well defined criteria for cohort entry, and defined health characteristics based on validated definitions, we can not rule out misclassification bias; in particular, misclassification of diabetes type. Although we adjusted ( through inverse probability weighting) for a large set of predefined covariates and 100 algorithmically selected high dimensional covariates, we can not completely rule out residual confounding. We required a positive COVID-19 test for enrolment in the COVID-19 group. For the contemporary control group, it is possible that some of those enrolled might have contracted SARS-CoV-2 and were not tested for it, and if these people were present in large numbers within the contemporary control group, this might have biased the results towards the null hypothesis. Although we took care to balance the exposure groups at baseline, and did analyses adjusting for health resources use during follow-up, we can not rule out the possibility that some of the cases were undiagnosed diabetes cases that were formally diagnosed after COVID-19. Lastly, as the pandemic continues ( in the USA and in several areas around the globe), as new variants emerge, and as treatment strategies for acute COVID-19 continue to evolve, it is likely that the epidemiology of post-acute COVID-19 sequelae, including diabetes, will likely also change over time.46Yang L Han Y Nilsson-Payant BE et al.A human pluripotent stem cell-based platform to study SARS-CoV-2 tropism and model virus infection in human cells and organoids.Cell Stem Cell. 2020; 27: 125-136Google Scholar
In conclusion, we suggest that in the post-acute phase of the disease, people with COVID-19 exhibit increased risk and burden of diabetes, and antihyperglycaemic use. The risks and burdens were evident among those who were non-hospitalised during the acute phase of the infection and increased according to the severity of the acute infection as proxied by the care setting ( non-hospitalised, hospitalised, and admitted to intensive care). Taken together, current evidence suggests that diabetes is a facet of the multifaceted long COVID syndrome and that post-acute care strategies of people with COVID-19 should include identification and management of diabetes.
ZA-A was responsible for the research and study design; administrative, technical, or material support; and supervision and mentorship. YX acquired the data and did the statistical analysis. YX and ZA-A were responsible for the data analysis and interpretation, drafting the manuscript, and critical revision of the manuscript. Each author contributed important intellectual content during manuscript drafting or revision, and accept accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. ZA-A takes responsibility that this study has been reported honestly, accurately, and transparently; that no important aspects of the study have been omitted, and that any discrepancies from the study as planned have been explained. Both authors had full access to all the data, and both have verified the accuracy of all underlying data. Both authors had final responsibility for the decision to submit for publication.
The data that support the findings of this study are available from the US Department of Veterans Affairs ( VA), Office of Research and Development, VA Information Resource Center by emailing [ email protected ].
YX and ZA-A declare support from the US Department of Veterans Affairs for the submitted work. YX declares support for the American Society of Nephrology for the submitted work. ZA-A reports receiving consultation fees from Gilead Sciences and receipt of funding ( unrelated to this work) from Tonix Pharmaceuticals. ZA-A is a Member Board of Directors for Veterans Research and Education Foundation of Saint Louis, associate editor for the Journal of the American Society of Nephrology, and is a member of multiple editorial boards.
This study used data from the VA COVID-19 shared data resource. This research was funded by the US Department of Veterans Affairs to ZA-A and American Society of Nephrology grant to YX. The contents of this manuscript do not represent the views of the US Department of Veterans Affairs or the US Government.
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Rising diabetes diagnosis in long COVIDA few reports have raised the possibility that COVID-19 could increase the risk of type 2 diabetes.1,2 In The Lancet Diabetes & Endocrinology, Xie and Al-Aly3 offer further evidence for the increased risk of diabetes beyond the first 30 days of infection ( post-acute phase) by analysing the US Department of Veterans Affairs national health-care records of those who survived the first 30 days after a positive COVID-19 test. These data raise important questions about the relationship between COVID-19 and diabetes concerning causality, biological mechanisms, and implications for clinical care and public health. Full-Text PDF | tech |
Effectiveness of COVID-19 vaccines in older adults in Colombia: a retrospective, population-based study of the ESPERANZA cohort - The Lancet Healthy Longevity | BackgroundAlthough clinical trials showed that vaccines have high efficacy and safety, differences in study designs and populations do not allow for comparison between vaccines and age groups. The objective of this study was to evaluate the effectiveness of vaccines against COVID-19 in real-world conditions in adults aged 60 years and older in Colombia.MethodsIn this retrospective, population-based, matched cohort study, we evaluated the effectiveness of vaccines against COVID-19-related hospitalisation and death in people aged 60 years and older. The full cohort consisted of every person who was eligible to receive a COVID-19 vaccine in Colombia ( the ESPERANZA cohort). The exposed cohort consisted of older adults who were fully vaccinated with Ad26.COV2-S, BNT162b2, ChAdOx1 nCoV-19, or CoronaVac, and who did not have a history of confirmed SARS-CoV-2 infection. The unexposed cohort were people aged 60 years and older who had not received any dose of a COVID-19 vaccine during the study period. Participant follow-up was done between March 11, 2021, and Oct 26, 2021. Vaccine effectiveness was estimated as 1– hazard ratio from cause-specific proportional hazards models in the presence of competing risks. We estimated the overall effectiveness of being fully vaccinated, as well as effectiveness for each vaccine, adjusting by main potential confounders. The effectiveness of each vaccine was also assessed by age groups ( ages 60–69 years, 70–79 years, and ≥80 years).Findings2 828 294 participants were assessed between March 11 and Oct 26, 2021. For all ages, the overall effectiveness across all assessed COVID-19 vaccines at preventing hospitalisation without subsequent death was 61·6% ( 95% CI 58·0–65·0, p < 0·0001), 79·8% ( 78·5–81·1, p < 0·0001) for preventing death after hospitalisation with COVID-19, and 72·8% ( 70·1–75·3, p < 0·0001) for preventing death without previous COVID-19 hospitalisation. The effectiveness of all vaccines analysed at preventing death after hospitalisation for COVID-19 was 22·6% lower in adults who were aged 80 and older ( 68·4% [ 65·7–70·9 ], p < 0·0001) compared with adults aged between 60 and 69 years ( 91·0% [ 89·0–92·6 ], p < 0·0001).InterpretationAll vaccines analysed in this study were effective at preventing hospitalisation and death from COVID-19 in fully vaccinated older adults, which is a promising result for the national vaccination programme against COVID-19 in Colombia and in countries where these biologics have been applied. Efforts should be improved to increase coverage among older adults. In addition, given that we observed that the effectiveness of vaccines declined with increasing age, a booster dose is also justified, which should be prioritised for older adults.FundingColombian Ministry of Health and Social Protection.
Although clinical trials showed that vaccines have high efficacy and safety, differences in study designs and populations do not allow for comparison between vaccines and age groups. The objective of this study was to evaluate the effectiveness of vaccines against COVID-19 in real-world conditions in adults aged 60 years and older in Colombia.
In this retrospective, population-based, matched cohort study, we evaluated the effectiveness of vaccines against COVID-19-related hospitalisation and death in people aged 60 years and older. The full cohort consisted of every person who was eligible to receive a COVID-19 vaccine in Colombia ( the ESPERANZA cohort). The exposed cohort consisted of older adults who were fully vaccinated with Ad26.COV2-S, BNT162b2, ChAdOx1 nCoV-19, or CoronaVac, and who did not have a history of confirmed SARS-CoV-2 infection. The unexposed cohort were people aged 60 years and older who had not received any dose of a COVID-19 vaccine during the study period. Participant follow-up was done between March 11, 2021, and Oct 26, 2021. Vaccine effectiveness was estimated as 1– hazard ratio from cause-specific proportional hazards models in the presence of competing risks. We estimated the overall effectiveness of being fully vaccinated, as well as effectiveness for each vaccine, adjusting by main potential confounders. The effectiveness of each vaccine was also assessed by age groups ( ages 60–69 years, 70–79 years, and ≥80 years).
2 828 294 participants were assessed between March 11 and Oct 26, 2021. For all ages, the overall effectiveness across all assessed COVID-19 vaccines at preventing hospitalisation without subsequent death was 61·6% ( 95% CI 58·0–65·0, p < 0·0001), 79·8% ( 78·5–81·1, p < 0·0001) for preventing death after hospitalisation with COVID-19, and 72·8% ( 70·1–75·3, p < 0·0001) for preventing death without previous COVID-19 hospitalisation. The effectiveness of all vaccines analysed at preventing death after hospitalisation for COVID-19 was 22·6% lower in adults who were aged 80 and older ( 68·4% [ 65·7–70·9 ], p < 0·0001) compared with adults aged between 60 and 69 years ( 91·0% [ 89·0–92·6 ], p < 0·0001).
All vaccines analysed in this study were effective at preventing hospitalisation and death from COVID-19 in fully vaccinated older adults, which is a promising result for the national vaccination programme against COVID-19 in Colombia and in countries where these biologics have been applied. Efforts should be improved to increase coverage among older adults. In addition, given that we observed that the effectiveness of vaccines declined with increasing age, a booster dose is also justified, which should be prioritised for older adults.
Colombian Ministry of Health and Social Protection.
In addition to high rates of mortality,1Johns Hopkins University & MedicineCoronavirus resource center. Global map.https: //coronavirus.jhu.edu/map.htmlDate: 2021Date accessed: February 3, 2022Google Scholar the COVID-19 pandemic has generated one of the largest social, economic, and health crises in recent history, exacerbating social inequalities between and within countries. With the availability of vaccines with proven safety and efficacy, which were developed in record time, vaccination, together with non-pharmacological measures, became an essential resource to manage the pandemic and to control the spread of the virus.
People who are 60 years and older have been shown to be more likely than younger people to have severe COVID-19, require hospitalisation, and die from COVID-19.2Ho FK Petermann-Rocha F Gray SR et al.Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants.PLoS One. 2020; 15e0241824Google Scholar, 3Chen Y Klein SL Garibaldi BT et al.Aging in COVID-19: vulnerability, immunity and intervention.Ageing Res Rev. 2021; 65101205Google Scholar On Feb 23, 2021, Colombia's national vaccination plan against COVID-19 prioritised vaccinating health-care staff and older adults, with the first doses for this age group given to people aged 80 years and older.
Colombia has a diverse portfolio of vaccines for COVID-19 that were procured mainly on the basis of delivery timelines and the number of doses that producers offered. Colombia has also negotiated supply agreements with five pharmaceutical companies and has adhered to the COVAX procurement mechanism. Among the purchased vaccines are Ad26.COV2-S, BNT162b2, ChAdOx1 nCoV-19, CoronaVac, and mRNA-1273. Vaccine roll-out was done according to availability in Colombia. Although BNT162b2 was the first vaccine to arrive ( in February, 2021), CoronaVac was the first to be available in considerable amounts to immunise people aged 60 years and older, therefore it became the most frequently used biologic in this age group. On the contrary, the mRNA-1273 vaccine was the last to be available ( in July, 2021), and although some older adults were immunised with this biologic, we did not include these adults in this study because of the short time window available to observe the outcomes of interest.
Research in contextEvidence before this studyWe searched OVID MEDLINE and MedRxiv on Dec 15, 2021, to identify studies on vaccine effectiveness against COVID-19 in people aged ≥60 years using the search terms “ Effectiveness ”, “ COVID-19 ”, “ cohort studies ”, and “ Older adults ”, without date, language, or article type restrictions. In Spain, a large cohort study found that the effectiveness of mRNA COVID-19 vaccines at preventing hospitalisations in institutionalised people aged ≥60 years when fully vaccinated was 88·4% ( 95% CI 74·9–94·7) and 97·0% ( 91·7–98·9) for preventing deaths. Similar results were found in Catalonia in a retrospective cohort study that analysed 28 456 nursing home residents who were vaccinated with BNT162b2, which showed an adjusted effectiveness in people who were fully vaccinated of 95·0% ( 93·0–96·0) for preventing hospital admission and 97·0% ( 96·0–98·0) for preventing death by COVID-19. Also, a cohort study was conducted in Portugal in 1·8 million people who were aged 65 years and older to evaluate the effectiveness of mRNA vaccines against COVID-19 hospitalisations and deaths. This study found a reduction in the risk of hospitalisation in fully vaccinated older adults of 59·0% ( 95% CI 32·0–76·0) and a reduction in the risk of death in the same population of 81·0% ( 73·0–87·0). In a national cohort of people aged 16 years or older in Chile who were immunised with CoronaVac, the subgroup of older adults ( aged ≥60 years) who were fully immunised had an adjusted effectiveness of 89·2% ( 87·6–90·6) for preventing the admission to the intensive care unit, and 86·5% ( 84·6–88·1) for preventing COVID-19-related death. Other studies that evaluated the effectiveness of vaccines in older adults did not analyse effectiveness in fully vaccinated older adults or did not have a sufficient follow-up time to assess the effectiveness in preventing death. The studies found present methodological differences ( including the study population and predominant variant during the period of analysis). Furthermore, published articles focused on the effectiveness of mRNA COVID-19 vaccines. Only few studies were available that compared the effectiveness of various vaccines in older populations, including various vaccine platforms.Added value of this studyThis study presents real-world evidence for the effectiveness of Ad26.COV2-S, BNT162b2, ChAdOx1 nCoV-19, and CoronaVac vaccines, disaggregated by vaccine and age group, in people aged 60 years and older who were fully vaccinated and had no previous confirmed history of SARS-CoV-2 infection. Our results suggest that increasing age reduces the effectiveness of immunisation against COVID-19 and that the vaccine or vaccine platform used might also be associated with reduced effectiveness.Implications of all the available evidenceIn this study we provide evidence of reduced effectiveness of COVID-19 vaccines in people aged 70 years and older in Colombia, after adjusting for many confounders. Other studies have shown that additional doses rapidly increase antibody titters, hence offering an additional dose to those at higher risk of breakthrough infection might increase protection. These results support the use of a booster dose in people aged 60 years and older, regardless of the vaccine used.
We searched OVID MEDLINE and MedRxiv on Dec 15, 2021, to identify studies on vaccine effectiveness against COVID-19 in people aged ≥60 years using the search terms “ Effectiveness ”, “ COVID-19 ”, “ cohort studies ”, and “ Older adults ”, without date, language, or article type restrictions. In Spain, a large cohort study found that the effectiveness of mRNA COVID-19 vaccines at preventing hospitalisations in institutionalised people aged ≥60 years when fully vaccinated was 88·4% ( 95% CI 74·9–94·7) and 97·0% ( 91·7–98·9) for preventing deaths. Similar results were found in Catalonia in a retrospective cohort study that analysed 28 456 nursing home residents who were vaccinated with BNT162b2, which showed an adjusted effectiveness in people who were fully vaccinated of 95·0% ( 93·0–96·0) for preventing hospital admission and 97·0% ( 96·0–98·0) for preventing death by COVID-19. Also, a cohort study was conducted in Portugal in 1·8 million people who were aged 65 years and older to evaluate the effectiveness of mRNA vaccines against COVID-19 hospitalisations and deaths. This study found a reduction in the risk of hospitalisation in fully vaccinated older adults of 59·0% ( 95% CI 32·0–76·0) and a reduction in the risk of death in the same population of 81·0% ( 73·0–87·0). In a national cohort of people aged 16 years or older in Chile who were immunised with CoronaVac, the subgroup of older adults ( aged ≥60 years) who were fully immunised had an adjusted effectiveness of 89·2% ( 87·6–90·6) for preventing the admission to the intensive care unit, and 86·5% ( 84·6–88·1) for preventing COVID-19-related death. Other studies that evaluated the effectiveness of vaccines in older adults did not analyse effectiveness in fully vaccinated older adults or did not have a sufficient follow-up time to assess the effectiveness in preventing death. The studies found present methodological differences ( including the study population and predominant variant during the period of analysis). Furthermore, published articles focused on the effectiveness of mRNA COVID-19 vaccines. Only few studies were available that compared the effectiveness of various vaccines in older populations, including various vaccine platforms.
This study presents real-world evidence for the effectiveness of Ad26.COV2-S, BNT162b2, ChAdOx1 nCoV-19, and CoronaVac vaccines, disaggregated by vaccine and age group, in people aged 60 years and older who were fully vaccinated and had no previous confirmed history of SARS-CoV-2 infection. Our results suggest that increasing age reduces the effectiveness of immunisation against COVID-19 and that the vaccine or vaccine platform used might also be associated with reduced effectiveness.
In this study we provide evidence of reduced effectiveness of COVID-19 vaccines in people aged 70 years and older in Colombia, after adjusting for many confounders. Other studies have shown that additional doses rapidly increase antibody titters, hence offering an additional dose to those at higher risk of breakthrough infection might increase protection. These results support the use of a booster dose in people aged 60 years and older, regardless of the vaccine used.
These vaccines have shown their efficacy and safety in several clinical trials, hence being approved for emergency use in Colombia.4Sadoff J Gray G Vandebosch A et al.Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19.N Engl J Med. 2021; 384: 2187-2201Google Scholar, 5Polack FP Thomas SJ Kitchin N et al.Safety and efficacy of the BNT162b2 mRNA Covid-19 Vaccine.N Engl J Med. 2020; 383: 2603-2615Google Scholar, 6Falsey AR Sobieszczyk ME Hirsch I et al.Phase 3 safety and efficacy of AZD1222 ( ChAdOx1 nCoV-19) Covid-19 vaccine.N Engl J Med. 2021; 385: 2348-2360Google Scholar, 7Tanriover MD Doğanay HL Akova M et al.Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine ( CoronaVac): interim results of a double-blind, randomised, placebo-controlled, phase 3 trial in Turkey.Lancet. 2021; 398: 213-222Google Scholar, 8Baden LR El Sahly HM Essink B et al.Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine.N Engl J Med. 2021; 384: 403-416Google Scholar All of these vaccines showed a wide range in efficacy in preventing a range of COVID-19 severities, but estimates for preventing severe COVID-19 and death were highly uncertain because of the low sample size and low frequency of these outcomes in these trials. Therefore, it is necessary to study the effectiveness of vaccines in uncontrolled real-life conditions, especially in a highly clinically vulnerable population. Colombia's diverse portfolio of vaccines makes it a good setting for evaluating the effectiveness of various vaccines across age groups.
In our study, we aimed to compare the effectiveness of Ad26.COV2-S, BNT162b2, ChAdOx1 nCoV-19, and CoronaVac at preventing hospitalisation and death in people aged 60 years and older who were fully vaccinated and who had no previously confirmed history of SARS-CoV-2 infection ( according to the health information systems of Colombia), when the mu variant ( B.1.621) was the most prevalent variant in the country. We aimed for evidence generated in this study to inform the comprehensive evaluation of the national vaccination plan against COVID-19 in Colombia and to support decisions made by the Ministry of Health.
We conducted a population-based, match-paired cohort study to assess the effectiveness of a complete scheme ( ie, all required doses recommended in the manufacturer's guidelines) of COVID-19 vaccination in people aged 60 years and older in Colombia without a confirmed history of SARS-CoV-2 infection. The data used in this study was collected by the Ministry of Health and Social Protection of Colombia and the National Institute of Health.
The full cohort consisted of every person who was eligible to receive a COVID-19 vaccine in Colombia ( the ESPERANZA cohort). In this study, we included people aged 60 years and older, which, in 2021, was projected to be 7 107 914 individuals, according to the National Administrative Department of Statistics. Data for each cohort member was identified by searching each individual's personal identification number ( using an anonymised code) across several databases: ( 1) MiVacuna, which collected sociodemographic data of all people who were eligible to receive a COVID-19 vaccine; ( 2) PAIWEB, an individual-level vaccine registry; ( 3) SEGCOVID, which provides follow-up data of confirmed COVID-19 cases; ( 4) RUAF-ND, which provides a registry of all deaths, including the cause of death; and ( 5) the high-cost disease registry ( Cuenta de Alto Costo), which provides data for patients by disease diagnosis ( eg, chronic kidney disease, hypertension, diabetes, cancer, and HIV). These information sources are part of the integrated information system for social protection and satisfy the information quality standards defined in this framework. A flowchart of the database preparation is included in the appendix ( p 1).
In this study, we included all people aged 60 years and older who had a complete scheme of COVID-19 vaccination or who had not received any dose of a COVID-19 vaccine. Therefore, the exposed ( vaccinated) individuals in the cohort included people who had been immunised with two doses of BNT162b2, ChAdOx1 nCoV-19, or CoronaVac, or with one dose of Ad26.COV2-S; the unexposed ( non-vaccinated) individuals in the cohort consisted of people who had not received any dose of a COVID-19 vaccine during the entire study period. We excluded individuals with a confirmed diagnosis of COVID-19 before enrolment in the cohort ( we used SEGCOVID to identify those individuals who had a previous confirmed SARS-CoV-2 infection), as well as individuals with heterologous vaccination, and those who were diagnosed, hospitalised, or who had died from COVID-19 within the 14 days following any dose of a vaccine. We also excluded individuals who had incomplete records.
This study complies with the scientific, technical, and administrative regulation for human health research in Colombia, which classifies this study as research without risk as it only used secondary data sources of anonymised information. This study does not therefore require the review or approval of a research ethics committee.
Individuals who met the inclusion criteria were first allocated to groups according to their characteristics ( ie, potential confounders): sex; age at the time of vaccination ( for those vaccinated; in one-year categories); being diagnosed with cancer, diabetes, chronic kidney disease, hypertension, or HIV, which have been shown to be risk factors for severe COVID-19 and mortality from COVID-19; 9Cifuentes MP Rodriguez-Villamizar LA Rojas-Botero ML et al.Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: a cohort nationwide study.J Epidemiol Community Health. 2021; 75: 610-615Google Scholar, 10Nasiri MJ Haddadi S Tahvildari A et al.COVID-19 clinical characteristics, and sex-specific risk of mortality: systematic review and meta-analysis.Front Med. 2020; 7: 459Google Scholar health system regime affiliation ( contributory or subsidised); and municipality of residence ( or department of residence when municipality was missing). For identifying the covariates that should be considered in the matching and adjusting process, we created a directed acyclic graph. These groups were then separated into the exposed and the unexposed groups. Individuals in each group ( exposed and unexposed) were assigned a random number from a uniform distribution ( from zero to the last number, indicating the last individual in each subgroup that shares the same characteristics given by the matching variables). For each group, random numbers were generated, and a couple was generated by matching each individual of the exposed cohort, as the individual was vaccinated, with an individual randomly selected from the unvaccinated cohort group that had the same characteristics given by the variables used for matching ( ie, sex, age at the time of vaccine for those vaccinated [ in 1-year categories ]; being diagnosed with cancer, diabetes, chronic kidney disease, hypertension, or HIV diagnosis; health system affiliation regime [ contributory or subsidised ]; and municipality of residence [ or department of residence when municipality was missing ]). The unvaccinated individual was therefore assigned the same start of follow-up as their vaccinated counterpart. When the unvaccinated individual had an event ( hospitalisation or death) before 14 days after the vaccination of their vaccinated counterpart, that unvaccinated individual was replaced by the next unvaccinated individual in the defined order. This process was done iteratively until all the possible pairs were formed within each group. Individuals who were not matched were excluded from the analysis and no one was matched more than once.
The primary outcomes of interest in this study were hospitalisations and deaths from COVID-19. We used the definitions recommended by WHO for surveillance of COVID-19.11WHOPublic health surveillance for COVID-19. Interim guidance.https: //www.who.int/publications/i/item/who-2019-nCoV-surveillanceguidance-2020.8Date: 2020Date accessed: February 3, 2022Google Scholar Death from COVID-19 was defined as death that resulted from clinically compatible illness in a probable or confirmed COVID-19 case, unless there was a clear alternative cause of death that could not be related to COVID-19, without a defined period of complete recovery between illness and death.12Pan American Health OrganizationCase definitions for COVID-19 surveillance.https: //www.paho.org/en/case-definitions-covid-19-surveillance-16-december-2020Date: 2020Date accessed: February 3, 2022Google Scholar
During the observation period, each individual provided a specific follow-up duration. The follow-up duration for each vaccinated–unvaccinated pair began 15 days after the vaccinated individual in the pair received their last dose ( the time period for the vaccine to induce the immune response), the day of the event ( hospitalisation or death from COVID-19), or individual censoring. We had three types of right-censoring: people who died from causes other than COVID-19, those who received a booster dose of the vaccine, and those who finished the follow-up and observation period without having presented the outcome of interest. Furthermore, to control for immortal time bias, outcomes that occurred within 14 days of completion of the vaccination scheme were not considered in the analysis.
We conducted a descriptive analysis of participants according to the exposure ( ie, whether a vaccine was received, and type of vaccine received). Quantitative variables were summarised as median and IQR, and qualitative variables as percentages. We also used Kaplan-Meier estimates and risk tables to describe time to hospitalisation and time to death from COVID-19 across the entire cohort, by age groups ( ie, ages 60–69 years, 70–79 years, and ≥80 years), and by vaccine received.
Because events compete over time ( ie, hospitalisation with death as a competing risk), we used a competing risk survival analysis by creating a cause-specific Cox regression model with time of the event or the censored time-to-event. From these data we identified three possible outcomes: ( 1) hospitalisation without subsequent death; ( 2) death after hospitalisation for COVID-19; and ( 3) death without a previous record of hospitalisation for COVID-19.
Vaccine effectiveness was estimated as 1 – hazard ratio ( HR) from cause-specific proportional hazards models in the presence of competing risks. First, we estimated overall effectiveness ( across all vaccines) by including a single exposure variable in the model ( ie, being vaccinated or unvaccinated) and the matched pairs as a stratum, which allowed us to include the correlation structure among pairs. Thereafter, given that the specific vaccine was not included in the matching process, we estimated the effectiveness for each vaccine and age group in separate models that were adjusted for sex, age, diagnosis of hypertension, diabetes, cancer, kidney disease, or HIV, and health system affiliation regime. Municipality of residence was included as a random intercept ( in these models, we did not include the matched pairs as a stratum). For identifying the covariates that should be considered in the matching and adjusting process, we created a directed acyclic graph.
We verified the proportional hazards assumptions by checking the logarithms of the accumulated risks for vaccinated and unvaccinated cohorts, confirming that differences between the curves were constant over time. We also evaluated if the log ( survival) and log ( t) curves were parallel, and we did two sensitivity analyses for misclassification bias. For the first analysis, we randomly changed a proportion of non-vaccinated individuals to being fully vaccinated with any vaccine, which was done to explore how much vaccine effectiveness would change if we had 25%, 50%, and 75% of registered non-vaccinated individuals as fully vaccinated, which addresses problems such as a lag in reporting vaccination. The second sensitivity analysis tested the assumption that the 206 607 individuals with missing information on the first vaccination dose ( who were excluded from the main analysis), were, in fact, fully vaccinated individuals ( appendix pp 2–5).
We used R ( version 4.1.0), survival packages 3.2 to 11 ( to estimate Kaplan-Meier functions) and risk regression ( version 2020.12.08, for the competing risk Cox model) for the analyses.
The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
The 230-day observation period ran from March 11 to Oct 26, 2021, during which each individual provided a specific follow-up time between the 15th day after completion of the vaccination schedule of the exposed individual in the couple and the day of the individual event or date of censoring. The median time of follow-up was 118 days ( IQR 88–156), with longer follow-up time for individuals vaccinated with CoronaVac and shorter time for individuals who received ChAdOx1 nCoV-19 and Ad26.COV2-S. Of the individuals aged 60 years and older who were prioritised to receive a COVID-19 vaccine, we excluded 1 564 092 records because these individuals died before the study observation period, had data quality issues, or met at least one exclusion criterion ( appendix p 1). The last consultation of any of these databases was made on Nov 3, 2021.
We analysed a total of 2 828 294 individuals, who were assigned in a 1:1 ratio to the exposed group or to the unexposed group matched by sex, age, health system affiliation status, presence of comorbidities ( ie, hypertension, diabetes, chronic kidney disease, HIV, or cancer), municipality of residence, and an approximation of follow-up time.
Hence, because of the matching process, vaccinated and unvaccinated individuals had comparable sociodemographic and clinical characteristics. However, there were differences in these characteristics according to the vaccine administered ( table 1).Table 1Social, demographic, and medical characterisation of study participants by vaccineAd26.COV2-S ( n=64 997) BNT162b2 ( n=400 136) ChAdOx1 nCoV-19 ( n=265 730) CoronaVac ( n=683 284) Fully vaccinated with any vaccine ( n=1 414 147) Unvaccinated ( n=1 414 147) AgeMedian, years65·0 ( 62·0–70·0) 66·0 ( 63·0–69·0) 66·0 ( 63·0–70·0) 72·0 ( 64·0–80·0) 68·0 ( 63·0–75·0) 68·0 ( 63·0–75·0) Age group60–69 years48 553 ( 74·7%) 301 302 ( 75·3%) 188 934 ( 71·1%) 282 196 ( 41·3%) 820 205 ( 58·0%) 820 205 ( 58·0%) 70–79 years13 064 ( 20·1%) 87 630 ( 21·9%) 69 621 ( 26·2%) 219 334 ( 32·1%) 390 304 ( 27·6%) 390 304 ( 27·6%) ≥80 years3380 ( 5·2%) 11 204 ( 2·8%) 7175 ( 2·7%) 181 754 ( 26·6%) 203 638 ( 14·4%) 203 638 ( 14·4%) SexMale34 118 ( 52·8%) 175 260 ( 43·8%) 128 879 ( 48·5%) 308 161 ( 45·1%) 646 265 ( 45·7%) 64 626 ( 45·7%) Female30 679 ( 47·2%) 224 876 ( 56·2%) 136 851 ( 51·5%) 375 123 ( 54·9%) 767 882 ( 54·3%) 767 882 ( 54·3%) Affiliation regime to the health systemContributory12 674 ( 19·5%) 194 066 ( 48·5%) 104 698 ( 39·4%) 263 748 ( 38·6%) 575 558 ( 40·7%) 575 558 ( 40·7%) Subsidised52 323 ( 80·5%) 206 070 ( 51·5%) 161 032 ( 60·6%) 419 536 ( 61·4%) 838 589 ( 59·3%) 838 589 ( 59·3%) ComorbiditiesAt least one comorbidity10 725 ( 16·5%) 102 435 ( 25·6%) 67 230 ( 25·3%) 204 302 ( 29·9%) 384 648 ( 27·2%) 384 648 ( 27·2%) Cancer325 ( 0·5%) 4401 ( 1·1%) 2657 ( 1·0%) 6833 ( 1·0%) 14 141 ( 1·0%) 14 141 ( 1·0%) Diabetes2665 ( 4·1%) 28 810 ( 7·2%) 18 601 ( 7·0%) 51 246 ( 7·5%) 101 818 ( 7·2%) 101 818 ( 7·2%) Chronic kidney disease1235 ( 1·9%) 14 405 ( 3·6%) 9034 ( 3·4%) 38 264 ( 5·6%) 62 222 ( 4·4%) 62 222 ( 4·4%) Hypertension9880 ( 15·2%) 93 232 ( 23·3%) 61 915 ( 23·3%) 192 686 ( 28·2%) 357 779 ( 25·3%) 357 779 ( 25·3%) HIV65 ( 0·1%) 400 ( 0·1%) 266 ( 0·1%) 01414 ( 0·1%) 1414 ( 0·1%) Data are median ( IQR) or n (%). On account of the matching process, data for vaccinated and unvaccinated cohorts are identical. Open table in a new tab
Data are median ( IQR) or n (%). On account of the matching process, data for vaccinated and unvaccinated cohorts are identical.
The cohort consisted of mostly women ( 1 535 764 [ 54·3% ] of 2 828 294 participants), with a median age of 68 years ( IQR 12 years [ 63–75 ]). 1 677 178 ( 59·3%) of 2 828 294 participants were affiliated to the subsidised health system regime. 769 296 ( 27·2%) had at least one underlying disease identified as a risk factor for becoming seriously ill and dying from COVID-19. As CoronaVac was the first vaccine to be available in the country for mass use, people vaccinated with CoronaVac were older than people who received the other vaccines ( table 1).
Table 2 shows the occurrence of each main outcome by vaccine manufacturer. The median follow-up time was 118 days ( IRQ 89–156) for all individuals who were fully vaccinated with any vaccine and 117 days ( 87–156) for all unvaccinated individuals. As Coronovac was the first vaccine available to older adults in Colombia, the longest follow-up time was for this vaccine ( median 146 days; IQR 112–171). The shortest follow-up time was for ChAdOx1 nCoV-19 ( 70 days; 60–78 days), owing to the longer interval needed between doses to finish the schedule.Table 2Occurrence of main studied outcomes through the study period by vaccineAd26.COV2-S ( n=64 997) BNT162b2 ( n=400 136) ChAdOx1 nCoV-19 ( n=265 730) CoronaVac ( n=683 284) Fully vaccinated with any vaccine ( n=1 414 147) Unvaccinated ( n=1 414 147) OutcomesHospitalisation without death17 ( < 1%) 71 ( < 1%) 19 ( < 1%) 555 ( < 1%) 662 ( < 1%) 1684 ( < 1%) Death after hospitalisation17 ( < 1%) 56 ( < 1%) 15 ( < 1%) 1061 ( < 1%) 1149 ( < 1%) 5413 ( < 1%) Death without hospitalisation2 ( < 1%) 42 ( < 1%) 12 ( < 1%) 511 ( < 1%) 567 ( < 1%) 1987 ( < 1%) Time of follow-upMedian, days88·0 ( 74·0–94·0) 135·0 ( 110·0–151·0) 70·0 ( 60·0–78·0) 146·0 ( 112·0–171·0) 118·0 ( 89·0–156·0) 117·0 ( 87·0–156·0) Data are n (%) or median ( IQR). Open table in a new tab
Data are n (%) or median ( IQR).
The risk of hospitalisation and death due to COVID-19 was higher in the unvaccinated cohort, as shown in the Kaplan-Meier survival curves ( long rank test p < 0·0001; figure 1).Figure 1Kaplan-Meier survival curves for adults aged 60 years and older in ColombiaShow full caption ( A) Time to hospitalisation due to COVID-19. ( B) Time to death due to COVID-19. HR=hazard ratio.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
( A) Time to hospitalisation due to COVID-19. ( B) Time to death due to COVID-19. HR=hazard ratio.
For people aged 60 years and older, the effectiveness of the COVID-19 vaccines in preventing hospitalisations and deaths ranged between 61·6% and 79·8% ( table 3). For any vaccine, the effectiveness for preventing hospitalisation without death was 61·6% ( 95% CI 58·0–65·0, p < 0·0001) across all age groups, with the highest effectiveness in adults aged 60–69 years ( 76·1% ( [ 71·2–80·2 ], p < 0·0001) and the lowest in adults aged 80 years and older ( 46·9% [ 38·5–54·1 ], p < 0·0001).Table 3Effectiveness of vaccines in preventing hospitalisation and death due to COVID-19 in adults aged 60 years and older in ColombiaHospitalisation without death ( 95% CI); n=2 828 294Death after hospitalisation ( 95% CI); n=2 828 294Death without hospitalisation ( 95% CI); n=2 828 294Any vaccineTotal61·6% ( 58·0–65·0) 79·8% ( 78·5–81·1) 72·8% ( 70·1–75·3) 60–69 years76·1% ( 71·2–80·2) 91·0% ( 89·0–92·6) 87·6% ( 83·4–90·7) 70–79 years60·8% ( 54·6–66·2) 85·0% ( 83·1–86·7) 78·9% ( 74·6–82·4) ≥80 years46·9% ( 38·5–54·1) 68·4% ( 65·7–70·9) 61·2% ( 56·3–65·6) Ad26.COV2-STotal60·9% ( 36·8–75·8) 85·8% ( 77·1–91·2) 95·5% ( 82·0–98·9) 60–69 years45·8% ( 7·5–68·2) 85·0% ( 69·9–92·5) 95·0% ( 64·2–99·3) 70–79 years77·9% ( 31·1–92·9) 88·6% ( 72·5–95·3) 93·4% ( 52·7–99·1) ≥80 years.. 81·9% ( 51·7–93·2).. BNT162b2Total83·0% ( 78·4–86·6) 94·8% ( 93·3–96·0) 88·3% ( 84·1–91·4) 60–69 years84·0% ( 77·8–88·5) 94·0% ( 91·4–95·8) 88·1% ( 81·3–92·4) 70–79 years81·3% ( 72·5–87·3) 96·2% ( 93·9–97·6) 89·9% 82·9–94·1) ≥80 years79·3% ( 49·9–91·4) 92·7% ( 85·4–96·4) 83·4% ( 66·6–91·7) ChAdOx1 nCoV-19Total90·8% ( 85·5–94·2) 97·5% ( 95·8–98·5) 93·9% ( 89·3–96·6) 60–69 years88·4% ( 79·4–93·5) 98·3% ( 95·4–99·4) 93·7% ( 84·9–97·4) 70–79 years92·4% ( 84·0–96·4) 96·6% ( 93·7–98·2) 95·7% ( 88·4–98·4) ≥80 years.. 98·0% ( 85·7–99·7) 86·5% ( 57·9–95·7) CoronaVacTotal47·3% ( 41·9–52·3) 72·1% ( 70·1–73·9) 64·9% ( 61·2–68·2) 60–69 years63·4% ( 52·8–71·6) 83·3% ( 78·5–87·1) 82·5% ( 73·7–88·3) 70–79 years44·0% ( 34·5–52·2) 78·1% ( 75·1–80·7) 70·7% ( 64·4–76·0) ≥80 years43·4% ( 34·5–51·2) 66·3% ( 63·4–69·0) 59·1% ( 53·8–63·7) All estimators were statistically significant ( p < 0·0001). The results for any vaccine were obtained from a cause-specific Cox regression model, in which each pair of vaccinated and unvaccinated individuals represented a stratum within the model, according to the study design. The results for each vaccine were obtained from multivariate cause-specific Cox regression models, which were adjusted by age, sex, affiliation regime to the Colombian health system, cancer, diabetes, hypertension, kidney disease, and HIV, with a random effect for municipality of residence. The reference group corresponds to people who have not received any dose of the COVID-19 vaccine. Open table in a new tab
All estimators were statistically significant ( p < 0·0001). The results for any vaccine were obtained from a cause-specific Cox regression model, in which each pair of vaccinated and unvaccinated individuals represented a stratum within the model, according to the study design. The results for each vaccine were obtained from multivariate cause-specific Cox regression models, which were adjusted by age, sex, affiliation regime to the Colombian health system, cancer, diabetes, hypertension, kidney disease, and HIV, with a random effect for municipality of residence. The reference group corresponds to people who have not received any dose of the COVID-19 vaccine.
The effectiveness across all vaccines analysed for preventing death after hospitalisation was 79·8% ( 95% CI 78·5–81·1, p < 0·0001) across all ages, with the highest effectiveness in adults aged 60–69 years ( 91·0% [ 89·0–92·6 ], p < 0·0001) and the lowest effectiveness in adults aged 80 years and older ( 68·4% [ 65·7–70·9 ], p < 0·0001). Finally, the effectiveness across all vaccines for preventing death without hospitalisation was 72·8% ( 70·1–75·3, p < 0·0001), being higher in adults aged 60–69 years ( 87·6% [ 83·4–90·7 ], p < 0·0001), reducing to 78·9% ( 74·6% –82·4%, p < 0·0001) in adults aged 70–79 years, and 61·2% ( 56·3–65·6, p < 0·0001) in those aged 80 years and older.
Table 3 also shows the effectiveness of each vaccine by age group. We observed high effectiveness for every vaccine analysed, particularly for preventing death. BNT162b2 and ChAdOx1 nCoV-19 were most effective at preventing all outcomes of interest, with overlapping CIs in people aged 60–79 years. Across all age groups, the effectiveness of BNT162b2 in preventing hospitalisation without death was 83·0% ( 95% CI 78·4–86·6, p < 0·0001), 94·8% ( 93·3–96·0, p < 0·0001) in preventing death after hospitalisation, and 88·3% ( 84·1–91·4, p < 0·0001) in preventing death without hospitalisation. Regarding ChAdOx1 nCoV-19, across all age groups, effectiveness in preventing hospitalisation without death was 90·8% ( 85·5–94·2, p < 0·0001), 97·5% ( 95·8–98·5, p < 0·0001) in preventing death after hospitalisation, and 93·9% ( 89·3–96·6, p < 0·0001) in preventing death without hospitalisation. For ChAdOx1 nCoV-19, the estimators of effectiveness for each outcome were very similar for the different age groups.
CoronaVac, although showing a high effectiveness in preventing all outcomes, had a lower effectiveness compared with BNT162b2 and ChAdOx1 nCoV-19, with some of the CIs not overlapping ( table 3, figure 2). CoronaVac prevented hospitalisation without death in 47·3% ( 95% CI 41·9–52·3, p < 0·0001) of participants, prevented death after hospitalisation in 72·1% ( 70·1–73·9, p < 0·0001) of participants, and prevented death without hospitalisation in 64·9% ( 61·2–68·2, p < 0·0001) of participants. The effectiveness of the CoronaVac vaccine showed a clear tendency to decrease with age. For instance, for adults aged 80 years and older, CoronaVac was 43·4% ( 34·5–51·2, p < 0·0001) effective at preventing hospitalisation without death, 66·3% ( 63·4–69·0, p < 0·0001) effective at preventing death after hospitalisation, and 59·1% ( 53·8–63·7, p < 0·0001) effective at preventing death without hospitalisation.Figure 2Forest plot of vaccine effectiveness at preventing hospitalisation and death due to COVID-19 in adults aged 60 years and older in ColombiaView Large Image Figure ViewerDownload Hi-res image Download ( PPT)
Finally, regarding Ad26.COV2-S, this vaccine prevented hospitalisation without death in 60·9% ( 95% CI 36·8–75·8, p < 0·0001) of participants, prevented death after hospitalisation in 85·8% ( 77·1–91·2, p < 0·0001) of participants, and prevented death without hospitalisation in 95·5% ( 82·0–98·9, p < 0·0001) of participants. It is possible that the estimates by interval of the effectiveness by age group of this vaccine were imprecise given the small sample size and low numbers of participants vaccinated by this vaccine, so it was not possible to establish if there were significant differences.
In brief, the effectiveness of the vaccines evaluated decreased with age. We found better outcomes among people aged 60–69 years, followed by those aged 70–79 years, with the lowest effectiveness in people aged 80 years and older ( figure 2). Although all the vaccines analysed showed a reduction in effectiveness as age increased, this reduction was greater for the CoronaVac vaccine.
For some of the vaccines evaluated, a point estimate of vaccine effectiveness could not be estimated because no outcomes occurred in that age group. In other instances, the CIs were wide because of the low number of people who received that specific vaccine, or the short duration of follow-up. Results of both sensitivity analyses were consistent with results of our primary analyses, suggesting that results are robust and consistent ( appendix pp 4–5).
We conducted a retrospective, national-cohort study to evaluate the effectiveness of vaccines against COVID-19 in people aged 60 years and older in Colombia. We included individuals who received the complete vaccination schedule between March 11 and Oct 26, 2021, when the mu variant was the most prevalent in the country. The results of this study confirm the high effectiveness of the available vaccines in Colombia for preventing hospitalisations and deaths due to COVID-19. These results are congruous with those reported by vaccine manufacturers, obtained from controlled clinical trials.4Sadoff J Gray G Vandebosch A et al.Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19.N Engl J Med. 2021; 384: 2187-2201Google Scholar, 5Polack FP Thomas SJ Kitchin N et al.Safety and efficacy of the BNT162b2 mRNA Covid-19 Vaccine.N Engl J Med. 2020; 383: 2603-2615Google Scholar, 6Falsey AR Sobieszczyk ME Hirsch I et al.Phase 3 safety and efficacy of AZD1222 ( ChAdOx1 nCoV-19) Covid-19 vaccine.N Engl J Med. 2021; 385: 2348-2360Google Scholar, 7Tanriover MD Doğanay HL Akova M et al.Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine ( CoronaVac): interim results of a double-blind, randomised, placebo-controlled, phase 3 trial in Turkey.Lancet. 2021; 398: 213-222Google Scholar
For all vaccines studied, we found an overall effectiveness of 61·6% for preventing hospitalisation without subsequent death, 79·8% for preventing death after hospitalisation, and 72·8% for preventing death without previous hospitalisation. These results are similar to those found in similar populations in other countries. A study13Mazagatos C Monge S Olmedo C et al.Effectiveness of mRNA COVID-19 vaccines in preventing SARS-CoV-2 infections and COVID-19 hospitalisations and deaths in elderly long-term care facility residents, Spain, weeks 53 2020 to 13 2021.Euro Surveill. 2021; 262100452Google Scholar done in fully vaccinated older long-term care residents in Spain found that the effectiveness of mRNA COVID-19 vaccines in preventing hospitalisations was 88·4% ( 95% CI 74·9–94·7) and 97·0% ( 91·7–98·9) for preventing death. Similarly, a retrospective cohort study14Cabezas C Coma E Mora-Fernandez N et al.Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia: prospective cohort study.BMJ. 2021; 374n1868Google Scholar in Catalonia, which analysed 28 456 nursing home residents who were vaccinated with BNT162b2, had an adjusted effectiveness in those who were fully vaccinated of 95·0% ( 93·0–96·0) for preventing hospital admission and 97·0% ( 96·0–98·0) for preventing death. Also, a cohort study15Nunes B Rodrigues AP Kislaya I et al.mRNA vaccine effectiveness against COVID-19-related hospitalisations and deaths in older adults: a cohort study based on data linkage of national health registries in Portugal, February to August 2021.Euro Surveill. 2021; 262100833Google Scholar done in Portugal evaluated the effectiveness of mRNA vaccines against COVID-19 hospitalisations and deaths in 1·8 million people who were aged 65 years and older and found a reduction in the risk of hospitalisation ( 59·0% [ 32·0–76·0 ]) and death ( 81·0% [ 73·0–87·0 ]) in fully vaccinated older adults.
In our study, vaccine effectiveness was negatively correlated with older age, regardless of the vaccine used, but not all vaccine platforms were affected the same. Among the vaccines included in this study, viral vector and mRNA vaccines were associated with higher effectiveness with increasing age than inactivated virus vaccines. Colombia used CoronaVac for the prioritised older population because it was the first vaccine to be available in sufficient quantities. Although mRNA vaccines have a higher vaccine effectiveness than CoronaVac, waiting several months for them to become available in Colombia would have been an unnecessary risk. This rationale had already been suggested by other authors, in which early vaccination with less effective biologics outweighed the advantages of waiting for other, more effective vaccines to become available.16Ahuja A Athey S Baker A et al.Preparing for a pandemic: accelerating vaccine availability. National Bureau of Economic Research, 2021https: //www.nber.org/papers/w28492Date accessed: February 3, 2022Google Scholar
In Chile, one study17Jara A Undurraga EA González C et al.Effectiveness of an inactivated SARS-CoV-2 vaccine in Chile.N Engl J Med. 2021; 385: 875-884Google Scholar analysed a national cohort of people aged 16 years or older who were immunised with CoronaVac. In the subgroup of older adults ( aged 60 years and older) who were fully immunised, CoronaVac was 89·2% ( 95% CI 87·6–90·6) effective at preventing older adults from admission to the intensive care unit, and 86·5% ( 84·6–88·1) effective at preventing COVID-19-related death. Other studies that evaluated the effectiveness of vaccines in older people did not analyse vaccine effectiveness in older adults who were fully vaccinated or did not have a sufficient follow-up time to assess the effectiveness of preventing death.18Lopez Bernal J Andrews N Gower C et al.Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study.BMJ. 2021; 373n1088Google Scholar
These studies present methodological differences, including the study population and predominant variant during the period of analysis, thus the above studies should be compared against our results carefully. Furthermore, these other studies focused on mRNA COVID-19 vaccines.5Polack FP Thomas SJ Kitchin N et al.Safety and efficacy of the BNT162b2 mRNA Covid-19 Vaccine.N Engl J Med. 2020; 383: 2603-2615Google Scholar, 8Baden LR El Sahly HM Essink B et al.Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine.N Engl J Med. 2021; 384: 403-416Google Scholar, 13Mazagatos C Monge S Olmedo C et al.Effectiveness of mRNA COVID-19 vaccines in preventing SARS-CoV-2 infections and COVID-19 hospitalisations and deaths in elderly long-term care facility residents, Spain, weeks 53 2020 to 13 2021.Euro Surveill. 2021; 262100452Google Scholar, 15Nunes B Rodrigues AP Kislaya I et al.mRNA vaccine effectiveness against COVID-19-related hospitalisations and deaths in older adults: a cohort study based on data linkage of national health registries in Portugal, February to August 2021.Euro Surveill. 2021; 262100833Google Scholar Only a small number of studies are available for comparing the effectiveness of various vaccines in older populations, including various vaccine platforms.18Lopez Bernal J Andrews N Gower C et al.Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study.BMJ. 2021; 373n1088Google Scholar, 19Cerqueira-Silvaa T de Araújo V Boaventura V et al.Influence of age on the effectiveness and duration of protection of Vaxzevria and CoronaVac vaccines: a population-based study.Lancet Reg Health Am. 2022; 6100154Google Scholar
We observed that the effectiveness across vaccines in preventing death after hospitalisation decreased by 22·6% and decreased by 26·4% in preventing death without previous hospitalisation for those aged 80 years and older compared with adults aged 60–69 years. Possible explanations for this lower effectiveness include the greater probability of pre-existing conditions in older people, in conjunction with age-related frailty20Hoogendijk EO Afilalo J Ensrud KE Kowal P Onder G Fried LP Frailty: implications for clinical practice and public health.Lancet. 2019; 394: 1365-1375Google Scholar and immunosenescence, which can cause poor responses to vaccination.21Crooke SN Ovsyannikova IG Poland GA Kennedy RB Immunosenescence and human vaccine immune responses.Immun Ageing. 2019; 16: 25Google Scholar These results are congruent with those presented in other studies.22Ranzani OT Hitchings MDT Dorion M et al.Effectiveness of the CoronaVac vaccine in the elderly population during a gamma variant-associated epidemic of COVID-19 in Brazil: a test-negative case-control study.BMJ. 2021; 374n2015Google Scholar, 23Li M Yang J Wang L et al.A booster dose is immunogenic and will be needed for older adults who have completed two doses vaccination with CoronaVac: a randomised, double-blind, placebo-controlled, phase 1/2 clinical trial.medRxiv. 2021; ( published online July 21.) ( preprint).doi.org/10.1101/2021.05.19.21257472Google Scholar
Older adults have already been identified as the population with the highest risk of severe illness and death from COVID-19. Our findings show the need for additional prevention strategies for this age group. A booster dose has been found to increase the immune response, and therefore represents a potential solution to the decreased effectiveness of vaccines in older people.24Flaxman A Marchevsky N Jenkin D et al.Tolerability and immunogenicity after a late second dose or a third dose of ChAdOx1 nCoV-19 ( AZD1222).SSRN. 2021; ( published online June 28.) ( preprint).https: //doi.org/10.2139/ssrn.3873839Google Scholar On the basis of our findings, Colombia started offering booster doses to people aged 50 years and older from early October, 2021.
The mu variant was predominant in Colombia throughout the observation period. Although there is no information on genomic sequencing in instances of breakthrough infections, the high observed effectiveness of vaccines indirectly suggests that all vaccines used in Colombia confer adequate protection against this variant and other variants circulating during the study period. However, our study was not able to assess the effectiveness of vaccines for any specific variant of SARS-CoV-2, given that the evaluated outcomes did not distinguish the variant involved in the clinical course of the patients. Therefore, our results could not be totally extrapolated to other contexts in which other variants are predominant.
The differences in self-selection to access the application of the vaccines could be a source of confounding in this study ( eg, an unvaccinated adult might also be less likely to wear a mask or take precautions, thereby exposing themselves to greater risk of infection, which could contribute to the observed differences). However, we consider that this bias, if present, would have only a small effect on the estimations. This is because, first, according to previous surveys of vaccination intention in Colombia, older adults had a high willingness to get vaccinated. Second, vaccination coverage in older adults at the end of December, 2021, was above 90%, which confirms that vaccine hesitancy was not an issue in this age group. Finally, according to international evidence, one of the factors associated with refusal to be vaccinated is social class. This factor was partly controlled for in this study by adjusting for affiliation regime to the health system, which is a strong proxy indicator of social class in Colombia.
However, as any cohort study, this different propensity to be exposed ( vaccinated in this instance) could be related to unobserved ( or unobservable) variables that could affect the estimates. It should be considered that this might mean that unvaccinated people did not get vaccinated because of individual characteristics that are also associated with a higher risk of infection, such as lower self-care, which could lead to overestimating the effect.
Thus, because there are many factors that influence whether people are vaccinated, and the bias could either lead to overestimation or underestimation of the observed effectiveness estimates, this is a limitation of the study. However, this limitation is minimised because of the high willingness and rate of vaccination in Colombia, as well as the study indirectly controlling for social class in this age group and by the matching process in the design.
We identified delays in reporting to the individual-level vaccination registry system ( PAIWEB), which introduced a high probability of misclassification bias. The vaccinated population who had not been registered as such is likely to have reduced the differences in risk for outcomes of interest between the exposed cohort and the unexposed cohort. This bias tended to underestimate the observed effectiveness, so we believe that the presented estimators are lower than the actual effectiveness values. We conducted a sensitivity analysis in which we randomly changed a proportion of non-vaccinated individuals as being fully vaccinated with any vaccine, equal to the estimated proportion of people fully vaccinated but not registered as such ( appendix p 4). By the cutoff date ( Oct 26), approximately 24% of those vaccinated had not been registered, although people aged 60 years and older were more likely to be reported because they were the first to be vaccinated. Results of this analysis suggest a higher vaccine effectiveness when individuals in the unexposed cohort were randomly assigned as being exposed, suggesting that our observed effectiveness was underestimated.
Another limitation of our study was that 2 06 607 people had a record labelled as a second dose, but without the first dose being registered. These records were excluded from our analysis. A sensitivity analysis that included all records, assuming that all individuals were fully vaccinated, showed similar results to our primary analysis and did not show a significant increase in overall vaccination effectiveness, suggesting that these records might correspond to mislabelling and that our estimates are robust.
Another limitation of this study is the short follow-up period for people vaccinated with Ad26.COV2-S and ChAdOx1 nCoV-19, which led to a small number of observed events, especially for Ad26.COV2-S, and therefore lower precision of the estimators. For future studies, we recommend repeating this analysis with a longer follow-up period. Moreover, it was not possible to control for other possible confounding variables, such as frailty or residing in nursing homes, among others. So, it is possible that our results have some residual confounding.
Our study had several strengths. To the best of our knowledge, this study is the first investigation to analyse and report the effectiveness of four different vaccines against COVID-19 in older adults disaggregated by age group. There have only been few publications that compare inactivated virus vaccines with mRNA and viral vector vaccines in the same country in high-risk populations. This makes our study relevant for countries where inactivated virus vaccines were widely used in older populations to act towards better protecting those at higher risks of severe illness from COVID-19. In addition, the competing risk analysis we used had the advantage that, instead of estimating a separate model for each outcome, it fitted a joint model for all outcomes. This analysis is especially useful since outcomes ( hospitalisation and death from COVID-19 in this instance) might occur at different points in time, especially when one of them might have affected the censoring and risk of the other.25Austin PC Lee DS Fine JP Introduction to the analysis of survival data in the presence of competing risks.Circulation. 2016; 133: 601-609Google Scholar Also, we conducted several sensitivity analyses, which allowed us to confirm the robustness of our findings ( appendix pp 4–5).
Our study generates solid evidence on vaccination effectiveness in older people in Colombia and might inform the administration of these vaccines in older populations across the world and decision-making that considers risk stratification approaches to target the most vulnerable people according to their demographic and epidemiological characteristics.
LA-C and JF-N conceptualised the effectiveness evaluation of COVID-19 vaccines strategy. LA-C, MR-B, and JF-N conceptualised the design and statistical analysis plan for the present study. LR-M built the dataset. BT-V advised the study design and the statistical analysis. AP-C and LR-M cleaned the data. AP-C and MR-B did the statistical analysis. LA-C, JF-N, LR-M, MR-B, and MG-P verified the data underlying the study. LA-C, MR-B, and MP-Á wrote the first draft. All authors reviewed and discussed the results and approved the final version of the manuscript. JF-N, AP-C, and LA-C accessed and verified the data. All authors agree with the viewpoints expressed in the article and contributed to the review and editing of the manuscript.
FR-G, LA-C, and JF-N are members of the Colombian COVID-19 vaccine advisory committee. All other authors declare no competing interests.
This study was conducted by the Ministry of Health and Social Protection of Colombia. Workers were from the Directorate of Medicines and Health Technologies, and Directorate of Epidemiology and Demography. Funding from the Ministry was given indirectly through the wage of and payments to the statistician of the project. In Colombia, public data from health information systems at the individual level are managed and safeguarded by the Ministry of Health and Social Protection. In the case of information on vaccination and covariates at the individual level, these will be publicly available once the technical and regulatory requirements of the Ministry have been adjusted, which is currently in process. The databases are not yet available to the public because authorisation from the Ministry has not been obtained. However, according to regulations, these data can be requested by researchers who ask for the information, who must also send the objective of the investigation, a plan of analysis, and a publication plan to the Ministry of Health ( https: //www.minsalud.gov.co/atencion/Paginas/Solicitudes-sugerencias-quejas-o-reclamos.aspx). Each request will be evaluated in accordance with the regulations and legal requirements defined in the country.
Download.pdf (.84 MB) Help with pdf files Supplementary appendix
Assessing the effectiveness of COVID-19 vaccines in older people in Latin AmericaFollowing their introduction towards the end of 2020, COVID-19 vaccines have been evaluated in terms of prevention of complications, hospitalisation rates, and mortality levels among those who are vaccinated compared with those who are not.1 Assessing the efficacy of vaccines is crucial for their use, but studies that assess real-world effectiveness of vaccines are also highly relevant, especially those comparing the efficacy of available vaccines in a specific country and those assessing efficacy in specific population groups that differ on certain factors ( eg, age and gender). Full-Text PDF Open Access | tech |
TA GLOBAL LAUNCHES EXCITING NEW HOSPITALITY BRAND: PARADOX | Kuala Lumpur, March 21, 2022 ( GLOBE NEWSWIRE) -- TA Global Berhad today announced the launch of its highly anticipated Paradox collection of hotels and resorts. Paradox is a Canadian-born boutique hospitality brand inspired by the tastes and desires of the new generation of travellers. The Paradox brand is set to stand out of the traditional hospitality norms through a series of quirky, cultured and highly experiential offerings, capturing the true spirit of each city where a Paradox hotel is located.
“ The hospitality sector is currently going through a key moment of transformation as technology, and social media are quickly changing the way we travel and interact with others. We recognized a shift was occurring in how people engage with each other and also with the built environment. The height of the COVID-19 pandemic was the global catalyst for a resurgence of interest in authentic human connection and a greater expectation of personalised hospitality. As an industry leader, it was an opportune moment to realign and reinvent our business proposition to meet and adapt the current needs and desires of the market, ” says Joo Kim Tiah, CEO of TA Global.
He continues, “ Paradox Hotel Group was born out of an extensive study of this evolution. We have always wanted to consolidate our hotels, and the time to embark on this meaningful journey is right now. Our global teams possess decades of experience and an established network of industry partners, having developed and operated numerous high-profile hotels across the world. Passionate about what we do, our team has a strong understanding of every aspect of hospitality business, from concept development to operations. We strongly believe that a distinct identity rooted in local culture is crucial for a successful hotel group. We strive to be at the vanguard of curating inspiring and exceptional experiences for our travellers, so it was imperative to not only come out with our own distinct brand, but also create something that would exceed expectations by challenging the industry status quo. ”
The unique concept of Paradox will make its debut in Vancouver, Canada, with its flagship hotel, Paradox Hotel Vancouver, set to open its doors in April 2022. The brand will also be introduced in Southeast Asia, with Paradox Resort & Residences Phuket which opened in January 2022, and Paradox Singapore Merchant Court at Clarke Quay in April 2022. Also joining the Paradox portfolio are independently branded properties Summit Lodge Boutique Hotel and Aava Hotel in Whistler. With five hotels and resorts located in distinct destinations around the world, Paradox Hotel Group provides an exciting journey of brand discovery for its international guests.
“ This transition to one cohesive brand positioning will not compromise the unique heritage and distinctive personalities of each Paradox hotel, most of which have already gained global recognitions from the hospitality and travel industry. We are confident that the diversity of our Paradox hotel, resort and lifestyle-hospitality offerings will serve as an immersive gateway to culturally enriching destinations worldwide; truly exemplifying the strength and momentum behind our ambition to be recognised among the top boutique hotel brands in the coming years, ” added Tiah.
As the first international hotel group to emerge from Vancouver, all Paradox destinations will proudly channel the true spirit of Canadian hospitality –manifested through thoughtful design, best-in-class facilities and guest services, and bespoke dining and gathering concepts. Curated to highlight the different characteristics of each respective location, the multifaceted experience will differ from one destination to another; celebrating the individuality and vibrant perspective each city offers.
The curious and adventurous guests seeking culture, history, shopping, and culinary rendezvous will always find a like-minded travel companion, a welcoming home away from home, and a sophisticated playground at Paradox, no matter where they are.
Sharing the brand inspiration behind Paradox, Head of Brand Experience, Lorraine Simonds depicts Paradox as playfully refined and curiously unconventional. “ The name Paradox aptly embodies the duality of this new genre of lifestyle-oriented hotels we are creating – they are tasteful and well-designed while remaining approachable, witty and clever.
More importantly, Paradox holds the foundational belief in placing authentic human-to-human relationships first. We strive to demonstrate how selfless, thoughtful and everyday acts of grace can inspire, elevate and add a touch of delightfully unexpected whimsy to everyday moments, and touch the lives of everyone we meet, ” she explained.
Tapping into its 20-year experience as a global hotelier and developer of some of the most exclusive properties across North America, Australia and Southeast Asia, TAG has plans to steadily expand Paradox’ s international presence in the next decade, launching new boutique lifestyle hotels and resorts in taste-making destinations around the globe.
TA Group of Companies proudly boasts over 30 years of excellence with an astounding track record in the financial and property market in Malaysia. The reputation has set the foundation for success for its property arm, TA Global Berhad which was incorporated in 2008. TA Global Berhad, a leading property developer in Malaysia, is involved in a diversified range of property services which includes property development, property management, property investment, trading and hospitality operations. The company has made significant strides in establishing itself as a niche luxury lifestyle property developer with its successful launches of niche premium residential properties. The Group also boasts an extensive global hotel portfolio spanning five countries on three continents in Australia, Singapore, Thailand, China and Canada. Over the years, the company continued to expand their business, gaining a truly outstanding reputation as a leading property developer recognized locally and internationally. For more information about TA Global, please visit http: //taglobal.com.my/
Paradox Hotel Group is an innovative hospitality brand and award-winning hotel collective that develops, operates, and markets exceptional boutique lifestyle hotels & resorts across the world. All Paradox hotels proudly showcase Canadian hospitality, manifested through thoughtful design, best-in-class facilities and guest services, and bespoke dining and gathering concepts. Each location features multifaceted experiences that differ from the others, celebrating individuality and vibrant perspectives. Paradox Hotel Vancouver is the first Paradox-branded hotel in Canada under the Paradox Hotel Group umbrella, including Summit Lodge Boutique Hotel and Aava Hotel in Whistler, and global locations Paradox Resort & Residences in Karon Beach Phuket, and Paradox Hotel Merchant Court at Clarke Quay in Singapore. For more information, please visit www.paradoxhotels.com | general |
Hong Kong lays out broad COVID easing plan as frustration rises | Hong Kong scrapped some travel curbs and laid out a road map for easing social-distancing measures, seeking to appease a city frustrated by two years of pandemic restrictions even as its worst ever COVID-19 outbreak continues to flare.
A ban on flights from nine countries including the U.S. and U.K. will be lifted from April 1, and the amount of time travelers spend in mandatory hotel quarantine will be cut in half, provided they test negative, Chief Executive Carrie Lam said Monday, unveiling the results of a review of the city’ s approach to the pandemic.
While the travel easing had been foreshadowed by local media, Lam went a step further in laying out a plan to ease Hong Kong’ s social-distancing rules in phases, starting from April 21 as long as there is no rebound in infections, she said. First, dining in at restaurants for dinner with as many as four people will be allowed, then gyms, massage parlors, and public entertainment centers will be reopened.
The sweeping changes in how Hong Kong handles its still active outbreak come after Lam acknowledged that residents’ tolerance for COVID-19 restrictions was fading and financial institutions were losing patience with the city’ s isolationist approach.
“ There is a need for our society to function continuously and for the economy to move forward progressively, ” Lam said. “ This is entirely to pave the way for the relaunch of our economy. ”
The adjustments follow Chinese President Xi Jinping’ s pledge to reduce the economic impact of the country’ s virus-fighting policy two years into the pandemic. Last week, Xi signaled a shift in the country’ s longstanding “ COVID zero ” strategy, which Hong Kong also follows, that has minimized fatalities but is starting to weigh on business and consumption as other countries normalize.
While Lam said Hong Kong is still targeting COVID zero, the plans detailed Monday — while new cases remain in the tens of thousands — resemble the shift other places made as they prepared to reopen their economies and live alongside the virus. Australia, New Zealand and Singapore also sought virus elimination in the first 18 months of the pandemic, but have gradually pivoted as it became endemic.
In another sign Hong Kong is moving away from the mainland’ s approach — at least for now — Lam also said plans to test the entire city for COVID-19 would be put on hold. She cited logistical challenges and the stress it would cause in the densely populated city. A key part of Beijing’ s COVID-suppression toolkit, mass testing needs to be conducted at the start or near the end of a COVID-19 outbreak to help eliminate transmission, she said.
“ In Hong Kong freedom is much emphasized, and our society is rather egocentric — it’ s hard to achieve total compliance, ” Lam said.
Hong Kong reported 246 deaths and 14,149 new confirmed COVID-19 cases on Sunday, the lowest daily toll in more than three weeks. The caseload is down from more than 50,000 a day earlier in the month, though the way infections are counted has shifted somewhat in that time, as the outbreak got out of control.
While Lam’ s announcement is a step in the right direction, the government needs to do much more in order to improve business sentiment, according to Tom Bakker, general manager of the Dutch Chamber of Commerce in Hong Kong. “ Many businesses will be happy with this announcement but to really regain confidence we need a road map, ” he said.
Executives will be cautious, he added, since the government last summer briefly reduced the quarantine period to seven days, only to rescind the policy a few weeks later.
“ This is a nice step but it might also be reversed in one or two months, ” he said. “ That still creates uncertainty. Companies will be happy with lifting some restrictions but it will not sufficient. ”
In the second phase of lifting domestic curbs, other venues including bars and sports facilities, will reopen, with a maximum headcount of eight people per table, with longer opening times. In phase three, most restrictions will be removed and only mask and vaccination requirements will remain in place.
Experts greeted the news cautiously, saying it was obvious Hong Kong needed to adjust its approach given how far it had fallen short of the goals of COVID zero.
“ It is clear that the recent criticisms of the Hong Kong government’ s approach have had an impact on policy thinking, although the number of infections have also been dropping, ” said Nicholas Thomas, associate professor at City University of Hong Kong.
The government has chosen to prioritize practical measures over realigning with Beijing’ s COVID zero mandate in the near term, according to Jin Dong-yan, a virologist at the University of Hong Kong.
“ If they continue to do what they used to do it will incur major losses, ” Jin said in an interview. “ It will be hard to maintain its status as an international finance center and businesses are languishing. ” | tech |
CRH: Sustainability Report 2021 PDF Download | Empowering sustainability through our building solutions
CRH Sustainability Report 2021
02 CRH Sustainability Report 2021
Overview
Sustainability priorities
Sustainability performance
Inside this year's report
At CRH, we are the global leader in sustainable building materials. We are uniquely placed to integrate materials, value-added products and building solutions, which play an important role in shaping a more sustainable built environment. In this year's report, we demonstrate how we are responding to the global trends shaping the future
of construction and collaborating with our stakeholders to embed sustainability through our integrated building solutions.
Section overview
Contents
Overview
03-18
Index
Overview
Our global business
03
A message from our Chief Executive
04
CRH 2021 highlights
05
The world today
06
Focusing on long-term sustainability
09
Achieving real growth and lasting value
10
Delivering sustainable value
11
Supporting the UN SDGs
12
Managing risk and building resilience
13
Enterprise risk management in action
14
Materiality assessment
15
CRH sustainability targets
17
Navigation
Look for this icon to find out additional information in the Sustainability Report on a specific topic
Look for this icon throughout the Sustainability Report for more information on additional reports and assessments, available on crh.com
Look for this icon throughout the Sustainability Report to find more information on CRH, our businesses and our sustainability performance, available on crh.com
Our sustainability priorities 19-64
Our sustainability priorities
Safety
20
Environment
26
People
40
Products
46
Collaboration
50
Integrity
59
Our sustainability performance
Reporting history, scope and basis
66
Sustainability policies
67
Look for this icon throughout the
Sustainability Report to find out
TARGETS
more information on our targets and
ambitions
Our report has been
independently assured every
year since 2005.
Our sustainability performance 65-88
Data summary
68
TCFD
75
SASB index
76
GRI index
77
DNV assurance statement
85
External recognition and benchmarks
87
03 CRH Sustainability Report 2021
CRH at a glance
We are organised as three operating Divisions of scale comprising Americas Materials, Europe Materials and Building Products.
Overview
Sustainability priorities
Sustainability performance
Americas
Materials
Sales
40%
$ 12.4billion
Global sales
+10% 2020: $ 11.3 billion
c. 28,300 employees
Products and services
c. 1,605 operating locations
46 US states, six Canadian Provinces
3
Divisions
Products and services index
Aggregates
Cement
Lime
Readymixed
Asphalt
Concrete
Infrastructural
Infrastructure
Architectural
Construction
Paving & Construction
Concrete
Products
Products
Accessories
Services
Europe
34%
Materials
Sales
Global sales
$ 10.6billion
Products and services
+16% 2020: $ 9.1 billion
c. 25,600 employees
c. 1,120 operating locations
20 Countries
Building
Products
26%
Sales
$ 8.0billion
Global sales
+11% 2020: $ 7.2 billion
c. 23,500 employees
Products and services
c. 510 operating locations
19 Countries
The inclusion of CRH public limited company in any MSCI Index, and the use of MSCI logos, trademarks, service marks or index names herein, do not constitute a sponsorship, endorsement or promotion of CRH public limited company by MSCI or any of its affiliates. The MSCI Indexes are the exclusive property of MSCI. MSCI and the MSCI Index names and logos are trademarks or service marks of MSCI or its affiliates.
Copyright ©2022 Sustainalytics. All rights reserved. This Report contains information developed by Sustainalytics ( www.sustainalytics.com). Such information and data are proprietary of Sustainalytics and/or its third party suppliers ( Third Party Data) and are provided for informational purposes only. They do not constitute an endorsement of any product or project, nor an investment advice and are not warranted to be complete, timely, accurate or suitable for a particular purpose. Their use is subject to conditions available at www.sustainalytics.com/legal-disclaimers
04 CRH Sustainability Report 2021
Overview
Sustainability priorities
Sustainability performance
+ A message from our Chief Executive
A message from our Chief Executive
CRH is a sustainability leader within the building materials industry. By combining our materials, products and services, including recycled end-of-life materials, we are providing integrated solutions which can be delivered more efficiently and sustainably. That way we can better serve the emerging needs of customers and support them in meeting the challenges of modern construction.
Building a more sustainable future
Market demand and societal expectation for building materials and products is evolving. To meet these demands, in 2021, we continued to deliver value for our stakeholders and advance our sustainability goals by producing climate-friendly materials and investing in our employees.
Driving actions for carbon neutrality
As CRH and the world around us transitions to a low carbon economy over the coming decades, it is increasingly important how we navigate climate-related risks and opportunities. As the leader in our industry, we recognise our responsibility to reduce the impact of construction on our world. We have a long track record in successful emissions reduction initiatives and we recently set ourselves a new, SBTi-approved industry leading target for a 25% absolute reduction in group-wide Scope 1 and Scope 2 CO2 emissions by 2030.
Protecting our people
Safety remains our top priority. Through risk management and continuous investment into safety, we protected our employees throughout the COVID-19 pandemic and will continue to care for the safety and wellbeing of our people into the future. We recognise that a healthy and engaged workforce is vital to the success of our business.
Advancing our inclusive culture
In 2021, we made good progress in building a more inclusive company, one which fosters a sense of belonging and empowers people to be their best. As a global business, it is important that our workforce reflects the communities in which we operate.
With this in mind, we have established Inclusion
Collaborating for biodiversity
We have continued our efforts to conserve biodiversity, recognising that healthy economies depend on a healthy environment. We are working to ensure that biodiversity is managed at all our relevant locations, while also striving to enhance natural systems beyond our operations. Through collaboration efforts with stakeholders, such as the Wildlife Habitat Council, we are actively engaging in measures to promote biodiversity.
Strengthening our performance
We are scaling our ambitions as we strive to ensure a long‑term sustainable future for our business and a positive impact on the world around us. As part of our ongoing commitment to sustainability, we have accelerated our progress on a number of our sustainability targets ( see page 17-18) and we have further advanced our disclosures in line with the Financial Stability Board's 'Task Force on Climate-related Financial Disclosures ' ( TCFD) standards.
Looking ahead
As I write this message events in Ukraine are developing rapidly and we continue to closely monitor the evolving situation. The safety of our employees remains our top priority and I am relieved to say that for the moment everyone is safe and in a known location. Looking to the future, we aim to continue to drive progress for society and the environment through our sustainability approach and the delivery of value-added solutions and products.
05 CRH Sustainability Report 2021
2021 Highlights
For over 50 years, we have continued to evolve, adapting our business model to address the changing needs of our customers and the growing demand for integrated building solutions to reduce the impact of construction on our world.
Safety
Environment
People
94%
$ 207m
2.4m
zero accident
invested in
hours of employee
locations
environmental
training across our
initiatives
business
$ 300m
1.2 kg CO2 / $
22%
invested in health
revenue GHG Scope 1
females in senior
and safety over the
and 2 CO2 emissions
leadership
last 5 years
Read more about how we
Read more about how we are
Read more about how we
are contributing to our safety
contributing to our environment
are contributing to our people
priorities on pages
20-25
priorities on pages
26-39
priorities on pages
40-45
Overview
Sustainability priorities
Sustainability performance
We are proud of the work we have done this year to encourage sustainable growth, strengthen our inclusive and diverse culture, support our communities and act as stewards of the environment.
Products
Collaboration
Integrity
46%
$ 7.1m
c.32,600
product revenue from
donated to local
employees trained
sustainable products
organisations and
in Code of Business
initiatives
Conduct
39.5m
c.1,100
c.8,500
tonnes of alternative
stakeholder engagement
employees received
fuels and raw materials
events hosted by
Advanced Compliance
recycled
Group companies
Training
Read more about how we are
Read more about how we are
Read more about how we
contributing to our product
contributing to our collaboration
are contributing to our people
priorities on pages
46-49
priorities on pages
50-58
priorities on pages
59-64
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CRH plc published this content on 21 March 2022 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 21 March 2022 16:58:08 UTC. | business |
U.S., EU allies to coordinate on China in NATO, G7 meetings this week | The United States and its allies will discuss providing weaponry and humanitarian assistance to Ukraine and the Ukrainian refugee crisis at an extraordinary NATO summit, meeting of the Group of Seven economies, and a European Council summit on Thursday.
But after his inconclusive talks with Chinese President Xi Jinping on Friday, Biden also plans to coordinate a response to Beijing if it provides material support to Russia's invasion of Ukraine with European leaders, U.S. administration officials say.
`` During his visit to Brussels, President Biden will coordinate with our EU partners on all aspects of our response to President Putin's unprovoked and unjustified war on Ukraine, and this includes the concerns we share with the EU if China provides material support to Russia, '' said a senior Biden administration official.
The success of close coordination on economic sanctions, export controls and trade measures imposed on Russia have brought Europe and the United States closer together, a second senior U.S. official said. These democratic leaders have growing concerns about China's potential role in the conflict.
`` The challenges that we face... are the same ones the Europeans face. And so I really do think that there is... an inflection point here in many ways, '' the second official said.
European nations and the United States have been working behind the scenes for weeks to try to convince Chinese officials not to back Putin's invasion of Ukraine, which Moscow calls a `` special operation, '' and to push Putin for a cease fire. The war has killed hundreds of civilians, destroyed towns and displaced millions.
The Chinese ambassador to the United States, Qin Gang, told CBS News ' `` Face the Nation '' on Sunday that China was not sending arms or financial assistance to Russia. However, he and other Chinese officials have publicly rejected a push to change course, claiming China is on the right side of history.
Some diplomats and analysts see signs that Beijing is shifting. Recent statements from Beijing have called for a cease fire, and emphasized the war's cost to the global economy, one European official noted, a split from Russia's position.
In the year since Biden took office, Xi has shown no sign of buckling to various U.S. demands, and has been using closer ties with Russia as a counterweight against pressures exerted on China by the West.
Xi has rejected investigations into the origin of the coronavirus in Wuhan, China, in 2019. He has refused to pressure North Korea to rein in its nuclear weapons program and rejected criticism of Chinese treatment of Uyghurs in Xinjiang. He has raised tensions with Taiwan and continued a quest to dominate the South China Sea.
However, China's close economic ties to Group of Seven wealthy democracies, which buy about one-third of its exports, could provide leverage in the bid to distance Xi from Putin.
( Reporting By Steve Holland, Andrea Shalal and David Brunnstrom in Washington and John Irish in Paris; Editing by Heather Timmons and Alistair Bell) | business |
China ferrous futures range-bound as COVID outbreak dents demand | - Chinese ferrous futures drifted in a narrow range on Monday, as the recent COVID-19 outbreak dented peak seasonal demand while disrupting production and transportation as well.
Mainland China reported 2,027 confirmed coronavirus cases for March 20, including 1,947 locally transmitted, the country's health authority said.
Hebei, the country's top steelmaking province, had 51 cases for Sunday, with two reported in the steel manufacturing hub of Tangshan.
The Tangshan government has implemented traffic control and suspended all public transportation to avoid further infections.
`` The pandemic outbreak in many regions has led to lower downstream demand, and logistics in some areas were disrupted, '' analysts with SinoSteel Futures wrote in a note.
As the steel sector has entered the traditional peak season, the resurgent COVID cases could have a negative impact on consumption, they said.
The most-active steel rebar contract on the Shanghai Futures Exchange, for May delivery, dipped 0.02% to 4,923 yuan ( $ 773.64) a tonne at close.
Hot-rolled coils, used in cars and home appliances, inched up 0.6% to 5,132 yuan per tonne. Shanghai stainless steel futures slipped 0.4% to 19,780 yuan a tonne.
Benchmark iron ore futures on the Dalian Commodity Exchange ended up 1% to 833 yuan a tonne. Spot 62% iron ore < SH-CCN-IRNOR62 > jumped $ 3.5 to $ 150 per tonne on Friday, according to SteelHome consultancy.
Coking coal futures on the Dalian bourse rose 1% to 3,019 yuan a tonne and coke prices faltered 0.6% to 3,603 yuan per tonne. ( $ 1 = 6.3634 Chinese yuan renminbi) ( Reporting by Min Zhang in Beijing and Enrico Dela Cruz in Manila; Editing by Subhranshu Sahu) | business |
COVID-19 tracker: Tokyo posts lowest cases since Jan. 17 | The Tokyo Metropolitan Government posted 3,855 new COVID-19 cases in the capital on Monday, marking the lowest tally since Jan. 17.
The figure, which also represented the 18th straight day of week-on-week decline, compared with 4,836 cases a week earlier. There were six new fatalities.
The seven-day average of new infections stood at 7,449.1, compared with 8,631.9 a week before. The number of severely ill patients under the metropolitan government’ s criteria stood unchanged at 46.
Japanese markets were closed Monday due to the Vernal Equinox Day holiday.
Although the pace of increase in cumulative cases has been slowing following the peak of the sixth wave, some experts are concerned that a fresh wave could hit the country amid the spread of the highly transmissible BA.2 omicron variant.
Across the country, Japan confirmed 39,659 new coronavirus cases Sunday, down 11,285 from the week before. The daily tally was below 40,000 for the first time since last Monday. There were 66 COVID-19 fatalities, while the number of severely ill coronavirus patients fell 28 from Saturday to 955. | tech |
Analysis: China Eastern crash could set back Boeing's China recovery, return of MAX | The 737-800 that crashed on Monday does not have the equipment that led to 737 MAX crashes more than three years ago, but that may not make a difference to Chinese passengers and a national regulator known for scrupulous safety requirements.
China Eastern said the cause of the crash was under investigation. Such accidents typically involve multiple factors, and experts warned it was far too early to draw any conclusions on the potential causes, especially in light of the scarce information available.
China was the first country to ground the 737 MAX after fatal crashes in Indonesia and Ethiopia more than three years ago, and it is the only major market where the MAX has not resumed commercial flights.
A 737 MAX built for China Eastern subsidiary Shanghai Airlines took off from Seattle bound for Boeing's completion plant in Zhoushan last week, industry sources said, in a sign the model's return to service in China was close.
The plane landed in Guam on March 15 as part of a multi-leg journey and has not moved in the week since, according to flight tracking website FlightRadar24. Boeing declined to comment.
Colin Scarola, senior equity analyst at CFRA Research, said he would not be surprised if the crash further delays the return of the MAX in China, where the aviation regulator is known for being very thorough on safety issues.
Chinese airlines do not need new MAX planes because demand is down following the country's biggest COVID-19 outbreaks in two years, industry sources said. But the U.S. manufacturer has more than 140 MAX jets already built for Chinese customers waiting to be delivered once the jet returns to commercial service there, a person familiar with the matter said.
Boeing's shares closed 3.6% lower on Monday.
The 737-800 that crashed is an earlier model with a strong safety record and there are nearly 1,200 in service in China, making it the world's largest market for the plane, according to aviation consulting firm IBA.
More than 4,200 737-800s are in service globally, data from aviation firm Cirium shows.
China Eastern has grounded its fleet of 737-800s, state media reported. It is the country's sixth-largest operator of the type, with 89 planes, IBA said, but other Chinese carriers are continuing to fly the jets and China Eastern has not grounded its similar but slightly smaller 737-700s.
Jefferies analysts said China's aviation regulator was unlikely to ground the 737-800 fleet unless it specifically suspected a technical failure as the root cause because of the operational consequences of grounding more than 1,000 planes in the world's second-biggest domestic aviation market.
However, there are concerns the Chinese public could look to avoid flying on 737-800s until the cause of the crash is determined, given the broader reputational issues with the 737 family caused by the MAX, Cowen analyst Cai von Rumohr said in a note.
`` Hence, isolating the cause of the crash will be critical, '' he added, noting the leading causes of commercial air transport crashes tend to be maintenance issues, pilot error or sabotage, rather than manufacturing or design issues.
Boeing cancelled a meeting of its senior executives scheduled for this week in Miami to focus its attention on assisting the investigation and China Eastern, a second person familiar with the matter told Reuters.
`` We have been in close communication with our customer and regulatory authorities since the accident, and have offered the full support of our technical experts to the investigation, '' Boeing CEO Dave Calhoun said in a memo to employees, which was seen by Reuters.
( Reporting by Jamie Freed in Sydney and Eric M. Johnson in Seattle; additional reporting by Abhijith Ganapavaram in Bengaluru, Allison Lampert in Montreal, David Shepardson in Washington and Rajesh Kumar Singh in Chicago; Editing by Peter Henderson and Leslie Adler)
By Jamie Freed and Eric M. Johnson | business |
U.S. FDA advisers to discuss COVID vaccine boosters in April | The U.S. Food and Drug Administration said no vote was planned at this meeting and there will not be any discussion of any of the COVID vaccine makers ' applications for additional boosters.
Pfizer and its German partner BioNTech SE, as well as rival Moderna Inc last week sought emergency use authorization from U.S. health regulators for a second COVID booster shot, as a surge in cases in some parts of the world fuels fears of another wave of the pandemic.
The FDA's Vaccines and Related Biological Products Advisory Committee's ( VRBPAC) discussion will focus particularly on factors that need to be looked at to update the strains that make up the vaccines as well as the timing and populations for booster doses.
`` Now is the time to discuss the need for future boosters as we aim to move forward safely, with COVID-19 becoming a virus like others such as influenza that we prepare for, protect against, and treat, '' said Peter Marks, director of FDA's Center for Biologics Evaluation and Research.
( Reporting by Manojna Maddipatla and Leroy Leo in Bengaluru; Editing by Devika Syamnath and Shinjini Ganguli) | business |
Assessing the effectiveness of COVID-19 vaccines in older people in Latin America - The Lancet Healthy Longevity | Following their introduction towards the end of 2020, COVID-19 vaccines have been evaluated in terms of prevention of complications, hospitalisation rates, and mortality levels among those who are vaccinated compared with those who are not.1Liu Q Qin C Liu M Liu J Effectiveness and safety of SARS-CoV-2 vaccine in real-world studies: a systematic review and meta-analysis.Infect Dis Poverty. 2021; 10: 132Google Scholar Assessing the efficacy of vaccines is crucial for their use, but studies that assess real-world effectiveness of vaccines are also highly relevant, especially those comparing the efficacy of available vaccines in a specific country and those assessing efficacy in specific population groups that differ on certain factors ( eg, age and gender).2Young-Xu Y Zwain GM Powell EI Smith J Estimated effectiveness of COVID-19 messenger RNA vaccination against SARS-CoV-2 infection among older male veterans health administration enrollees, January to September 2021.JAMA Netw Open. 2021; 4e2138975Google Scholar
Nevertheless, even as late as March, 2022, there is still a low number of such studies in low-income and middle-income countries, particularly in Latin America and Africa.3Hitchings MDT Ranzani OT Dorion M et al.Effectiveness of ChAdOx1 vaccine in older adults during SARS-CoV-2 Gamma variant circulation in São Paulo.Nat Commun. 2021; 126220Google Scholar A study analysing the effectiveness of COVID-19 vaccines in Latin America was conducted in Chile,4Jara A Undurraga EA González C et al.Effectiveness of an inactivated SARS-CoV-2 vaccine in Chile.N Engl J Med. 2021; 385: 875-884Google Scholar with a cohort of approximately 10·2 million people. This study assessed the CoronaVac vaccine in people aged 60 years or older, and showed effectiveness of 86·3% ( 95% CI 84·5–87·9) for the prevention of COVID-19-related hospitalisation and 86·5% ( 84·6–88·1) for the prevention of COVID-19-related deaths among people who were fully vaccinated ( ie, ( ≥14 days after receipt of the second dose), after adjusting for covariates..
In The Lancet Healthy Longevity, Leonardo Arregocés-Castillo and colleagues5Arregoces-Castillo L Fernández-Niño J Rojas-Botero M et al.Effectiveness of COVID-19 vaccines in older adults in Colombia: a retrospective, population-based study of the ESPERANZA cohort.Lancet Healthy Longev. 2022; ( published online March 21.) https: //doi.org/10.1016/S2666-7568 ( 22) 00035-6Google Scholar explored the effectiveness of Ad26.COV2-S, BNT162b2, ChAdOx1 nCoV-19, and CoronaVac, which were the first four available COVID-19 vaccines in Colombia, using a population-based matched-pair cohort study ( called the ESPERANZA cohort) that included over 2 million participants ( n=2 828 294) aged 60 years and older. This older age group is considered a population with a higher risk of severe disease, complications, and death than younger age groups due to age and associated risk factors ( eg, the higher presence of comorbidities, such as obesity, diabetes, hypertension, and cardiovascular disease).6Rodriguez-Morales AJ Cardona-Ospina JA Gutiérrez-Ocampo E et al.Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis.Travel Med Infect Dis. 2020; 34101623Google Scholar In their study, Arregocés-Castillo and colleagues found that the overall effectiveness of the available vaccines for preventing hospitalisation without subsequent death was 61·6% ( 95% CI 58·0–65·0), 79·8% ( 78·5–81·1) for preventing death after hospitalisation for COVID-19, and 72·8% ( 70·1–75·3) for preventing death without previous COVID-19 hospitalisation.
The overall effectiveness did not differ significantly by specific vaccine, though BNT162b2 and ChAdOx1 nCoV-19 were shown to be most effective. These highly relevant findings reinforce the importance of vaccination among older people to prevent not only the risk of infection and severe disease, but also hospitalisation and death. This study also highlights the importance of these assessments amid the pandemic, accounting for dynamic changes that include the circulation of multiple variants of concern.7Schlagenhauf P Patel D Rodriguez-Morales AJ Gautret P Grobusch MP Leder K Variants, vaccines and vaccination passports: challenges and chances for travel medicine in 2021.Travel Med Infect Dis. 2021; 40101996Google Scholar These new variants pose novel challenges for the effectiveness of vaccines, especially in high-risk populations.8Tao K Tzou PL Nouhin J et al.The biological and clinical significance of emerging SARS-CoV-2 variants.Nat Rev Genet. 2021; 22: 757-773Google Scholar Arregocés-Castillo and colleagues ' findings in Colombia were consistent with the benefit of vaccination in older people identified by the aforementioned study done in Chile.4Jara A Undurraga EA González C et al.Effectiveness of an inactivated SARS-CoV-2 vaccine in Chile.N Engl J Med. 2021; 385: 875-884Google Scholar Nevertheless, a limitation of the Colombian study is that it only assessed the effectiveness of vaccines against the circulating variants of concern during the study period. Future studies should consider this limitation.
As Arregocés-Castillo and colleagues indicated, although expected, the effectiveness of vaccines decreased by age. An additional or booster dose can effectively contribute to improving the immune response, therefore becoming a possible solution to the decreased effectiveness of vaccines in older people. On the basis of these findings, in early October, 2021, Colombia started offering booster doses to people older than 50 years and later extended this to younger groups.
“ Esperanza ” means hope in Spanish. Indeed, the findings of the study by Arregocés-Castillo and colleagues are part of the hope that health authorities continue to use effective COVID-19 prevention measures, including vaccination, jointly with other public health measures, while maintaining an evidence-based approach to managing COVID-19. Only through a thorough and collective approach can there be hope to achieve appropriate control of the pandemic and, hopefully, shortly bring an end to the ongoing pandemic phase of COVID-19 and the deleterious consequences on populations worldwide. Therefore, Colombia, as well as other low-income and middle-income countries in Latin America, Africa, and Asia, need to assess the effectiveness of COVID-19 vaccine boosters in older people throughout 2022 and broaden the access and availability of vaccines to all individuals who could benefit within and beyond the limits of specific counties.
International, national, and regional health authorities must keep working on population access to and education on basic hygiene and sanitation, as well as the safety, efficacy, and effectiveness of COVID-19 vaccines. Despite the overwhelming evidence for the effectiveness of vaccines, vaccination coverage is far from 100%, even in high-income countries. There is large room for improvement, in which public health scientists and practitioners could have a key role.9Urrunaga-Pastor D Bendezu-Quispe G Herrera-Añazco P et al.Cross-sectional analysis of COVID-19 vaccine intention, perceptions and hesitancy across Latin America and the Caribbean.Travel Med Infect Dis. 2021; 41102059Google Scholar Evidence-based information is crucial for disseminating correct health messages to enhance public trust and interest to adhere to vaccine schedules and boosters,10Rodriguez-Morales AJ Franco OH Public trust, misinformation and COVID-19 vaccination willingness in Latin America and the Caribbean: today's key challenges.Lancet Reg Health Am. 2021; 3100073Google Scholar especially in high-risk populations such as older people.
Only a global approach that secures access to vaccines for all who need them presents a meaningful pathway to an effective resolution of this catastrophe. The solutions have been developed in record time, with not only one, but multiple effective vaccines. These vaccines now need to be distributed to all that need them. Adequate distribution, education, and information are key factors and represent some of the essential learnings that have been extracted from the current crisis. These learnings need to be implemented to avert and better respond to future pandemics.
We declare no competing interests.
Effectiveness of COVID-19 vaccines in older adults in Colombia: a retrospective, population-based study of the ESPERANZA cohortAll vaccines analysed in this study were effective at preventing hospitalisation and death from COVID-19 in fully vaccinated older adults, which is a promising result for the national vaccination programme against COVID-19 in Colombia and in countries where these biologics have been applied. Efforts should be improved to increase coverage among older adults. In addition, given that we observed that the effectiveness of vaccines declined with increasing age, a booster dose is also justified, which should be prioritised for older adults. Full-Text PDF Open Access | tech |
Ucrânia: assegurem evacuação e abrigo seguros para civis de Mariupol | Moradores descrevem condições severas durante ataque russo
( Lviv) – Trinta e dois civis que conseguiram escapar da cidade sitiada de Mariupol, no sudeste da Ucrânia, na semana passada, contaram à Human Rights Watch como lutaram para sobreviver em temperaturas abaixo de zero enquanto as forças russas atacavam implacavelmente a cidade. Eles descreveram homens, mulheres e crianças abrigados em porões com pouco ou nenhum acesso a água corrente, energia, aquecimento, assistência médica ou serviço de telefonia móvel desde o início do cerco em 2 de março de 2022.
As forças russas que cercam Mariupol devem imediatamente garantir que não seja negado ou impedido o acesso a itens essenciais a sobrevivência aos civis, como água, alimentos e remédios, e devem facilitar a passagem segura para áreas sob controle das forças ucranianas para civis que optam por deixar a cidade.
“ Os moradores de Mariupol descreveram a paisagem como infernalmente congelante, repleta de cadáveres e prédios destruídos ”, disse Belkis Wille, pesquisador sênior de crises e conflitos da Human Rights Watch. “ E estes tiveram sorte, pois conseguiram escapar, deixando para trás milhares que estão isolados do mundo na cidade sitiada. ”
O atual número de mortos em Mariupol permanece desconhecido. Um assistente do prefeito da cidade, Petro Andryushchenko, disse à Human Rights Watch em 20 de março que mais de 3.000 civis podem ter morrido desde o início dos combates, mas ele disse que o número exato não é claro. As autoridades locais relataram que pelo menos 80% dos edifícios residenciais da cidade foram danificados ou destruídos. A Human Rights Watch não conseguiu verificar esses números ou avaliar quantos dos mortos eram civis.
Nos dias 16 e 17 de março, a Human Rights Watch entrevistou pessoalmente 30 moradores de Mariupol em um centro de registro improvisado em Zaporizhzhia, uma cidade a cerca de 220 quilômetros a noroeste de Mariupol. Eles estavam entre os vários milhares de moradores de Mariupol que fugiram da cidade nos dias 15 e 16 de março em comboios organizados de forma independente com carros particulares, em viagens que duravam entre 24 e 72 horas. A Human Rights Watch também entrevistou um casal em Zaporizhzhia que estava esperando que seus dois filhos chegassem de Mariupol. Somente em 16 de março, ao menos 3.200 pessoas de Mariupol chegaram a Zaporizhzhia, segundo dois funcionários locais que trabalham no centro de registro. A Human Rights Watch conversou por telefone com outros dois moradores de Mariupol que conseguiram escapar da cidade.
“ As últimas duas semanas foram puro horror ”, disse um diretor de escola de Mariupol à Human Rights Watch. “ Saímos porque nossa cidade não existe mais. ” Uma mulher de 32 anos que fugiu para Zaporizhzhia com seus três filhos disse que, quando partiram, sua casa em Mariupol estava tão danificada que parecia uma peneira, coberta de buracos causados pelos ataques persistentes. Uma mulher de 64 anos disse: “ Acho que aqueles que sobrarem serão mortos ou morrerão de fome. Não temos para onde voltar. ”
Mariupol é uma cidade costeira entre duas regiões atualmente sob o controle efetivo das forças russas. Desde aproximadamente de 2 de março, as forças russas cercaram completamente a cidade e bloquearam o porto. Relatos de combates no centro da cidade surgiram nos últimos dias, e muitos dos moradores que fugiram disseram ter visto soldados russos e ucranianos e equipamentos militares em seus bairros. Andryushchenko disse à Human Rights Watch que, em 20 de março, pelo menos 200.000, do total de 400.000 habitantes de antes o início da guerra, permanecem na cidade.
Moradores que escaparam disseram que hospitais, escolas, lojas e inúmeras casas foram danificadas ou destruídas pelos bombardeios. Muitos disseram que seus familiares ou vizinhos sofreram ferimentos graves e, em alguns casos, fatais por fragmentos metálicos de explosivos e que viram cadáveres espalhados pelas estradas quando ao se arriscarem para procurar comida ou água ou para encontrar sinal para seus telefones celulares.
A incapacidade de se comunicar com parentes, amigos e o mundo externo era um desafio particular para as pessoas em Mariupol. Quase todas as torres de telefonia celular pararam de fornecer sinal em 2 de março, com apenas sinais fracos em locais específicos depois disso. Uma designer gráfica disse que todos os dias ela caminhava dois quilômetros e meio em direção a uma torre de celular Kyivstar para tentar obter recepção, deitando-se no chão toda vez que um avião sobrevoava.
Todos os entrevistados apontaram que a falta de informação causada por rupturas nas telecomunicações e na eletricidade tornou muito difícil descobrir como evacuar a cidade com segurança.
Os entrevistados descreveram ter ficado em porões por dias em condições de superlotação e insalubridade, sem poder tomar banho e com pouco para comer ou beber. Uma mulher disse que ficou por duas semanas em um porão que tinha cerca de 300 metros quadrados com pelo menos 80 pessoas; um homem ficou com 50 pessoas em um porão de 50 metros quadrados; e outro homem disse que ficou com 18 pessoas em um porão de 10 metros quadrados.
Idosos e pessoas com deficiência descreveram os desafios adicionais que enfrentaram: incapazes de se mudar para seus porões para se abrigar, eles se sentaram em seus apartamentos com janelas estouradas e paredes vibrando a cada ataque. Um homem de 82 anos que ficou em seu apartamento no sexto andar desde que os ataques começaram, disse que se distraiu limpando os cacos de vidro que cobriam o chão: “ Eu tremia enquanto as bombas caíam. As paredes estavam tremendo, e eu estava com medo de que o prédio desmoronasse. Mas passei meus dias tentando limpar os cacos de vidro. Eu estava apenas limpando, eu tinha que me ocupar de alguma forma. Era inútil, mas era tudo o que eu podia fazer para me manter ocupado. ”
Em 9 de março, as forças russas atacaram um complexo hospitalar em Mariupol, ferindo pelo menos 17 civis, incluindo equipe médica e mulheres grávidas. Uma mulher grávida teria morrido em decorrência de lesões depois de ser transferida para outro hospital após o ataque. A Human Rights Watch verificou e analisou 7 vídeos e 10 fotografias mostrando as consequências do ataque, incluindo a destruição a fachada inteira do hospital infantil, marcas aparentes de fragmentação na fachada da maternidade vizinha e uma grande cratera de impacto da detonação de uma munição lançada do ar na parte sul do pátio. A Rússia mais tarde confirmou que tinha como alvo o hospital, alegando que forças ucranianas o ocupavam e que haviam alertado os civis para deixarem o local. A Human Rights Watch não conseguiu verificar essas alegações.
Em 16 de março, um teatro em Mariupol que abrigava pelo menos 500 pessoas foi atacado. Nas imagens de satélite do teatro de 14 de março, era nitidamente visível a palavra “ crianças ” escrito em russo em letras maiúsculas da escrita cirílica no chão na frente e atrás do teatro. Uma mãe e o filho que se abrigaram no teatro por duas semanas disse que centenas de pessoas ainda estavam nele quando eles tinham saído, às 9h do dia 16 de março, poucas horas antes do ataque. Parece que a maioria das pessoas abrigadas no teatro sobreviveram pois estavam escondidas no porão, de acordo com as autoridades locais. O Ministério da Defesa russo negou ter realizado o ataque e culpou as forças apoiadas pelo governo ucraniano.
As forças russas e ucranianas concordaram com os termos de um cessar-fogo temporário e a criação de um corredor humanitário em 4 de março para permitir que os civis evacuem de Mariupol com segurança. Pelo menos sete esforços iniciais para cumprir o acordo e facilitar as evacuações falharam e o cessar-fogo foi quebrado.
De acordo com Kirill Timoshenko, vice-chefe de gabinete do presidente da Ucrânia, pelo menos 9.000 moradores de Mariupol conseguiram fugir para Zaporizhzhia usando um corredor humanitário acordado nos dias anteriores. No entanto, o assistente do prefeito, Andryushchenko, disse que o acordo cobria apenas um corredor entre a cidade de Berdyansk, controlada pela Rússia, 65 quilômetros a sudoeste de Mariupol, e Zaporizhzhia. Ele disse que a rota que sai de Mariupol para Berdyansk ainda está sujeita a fortes ataques e que os civis não receberam nenhuma garantia específica com relação a um corredor humanitário ou passagem segura para esse trecho.
Em 19 de março, as autoridades locais em Mariupol relataram que as forças russas levaram “ entre 4.000 e 4.500 moradores de Mariupol foram forçados a cruzar a fronteira ” para o sudoeste da Rússia. O Ministério da Defesa russo anunciou em 20 de março que cerca de 60.000 moradores de Mariupol foram “ evacuados para a Rússia ” nos últimos três dias, e que os moradores de Mariupol têm uma “ escolha voluntária ” sobre qual corredor utilizar ou permanecer na cidade. A Human Rights Watch não conseguiu verificar essas informações. Se os residentes de Mariupol foram transferidos à força para a Rússia, isso pode constituir um crime de guerra. De acordo com o Direito Internacional Humanitário, a transferência de civis, individualmente ou em massa, não é voluntária e, portanto, é proibida, simplesmente porque o civil concorda com isso. Uma transferência pode ser forçada quando uma pessoa se oferece como voluntária porque teme consequências como violência, coação ou detenção se permanecer, e a potência ocupante está aproveitando um ambiente coercitivo para realizar a transferência.
Tanto a Rússia quanto a Ucrânia têm obrigações de garantir o acesso de civis à assistência humanitária e tomar todas as medidas viáveis para permitir que a população civil evacue com segurança, se assim o desejarem, independentemente de um acordo para estabelecer corredores humanitários entrar em vigor ou não. A Rússia está proibida de exigir que civis, individualmente ou em massa, evacuem para lugares na Rússia ou em outros países como a Bielorrússia.
O uso de armas explosivas com impacto de ampla área em zonas povoadas aumenta as preocupações de ataques ilegais, indiscriminados e desproporcionais. Essas armas têm um grande raio destrutivo, são inerentemente imprecisas ou possuem várias munições ao mesmo tempo. Isso inclui o uso de projéteis de grande calibre não guiados e não observados e bombas de aviação. O uso dessas armas deve ser evitado em áreas populosas.
O Tribunal Penal Internacional, a Comissão de Inquérito do Conselho de Direitos Humanos da ONU e outras jurisdições relevantes devem investigar possíveis crimes de guerra em Mariupol, com o objetivo de processar os grandes responsáveis, disse a Human Rights Watch.
“ Para aqueles que conseguiram escapar de Mariupol, deixando amigos e familiares para trás, as notícias das recentes evacuações lhes deram um pouco de esperança de que seus entes amados poderia deixar a cidade vivos ”, disse Wille. “ As forças russas e ucranianas devem urgentemente fazer o que for preciso para proteger os civis que permanecem em Mariupol e permitir que aqueles que desejam deixar a cidade sitiada o façam em segurança ”.
Para relatos de moradores de Mariupol que conseguiram escapar e uma visão geral das obrigações legais relevantes, veja abaixo em inglês.
Accounts from Mariupol Residents
Those interviewed are either not identified by name or identified by their first names only for their protection.
Explosive Weapons with Wide-Area Effects
All 32 Mariupol residents interviewed by Human Rights Watch described periods of sustained and often intensifying attacks with explosive weapons, from the beginning of fighting on February 24 to the moment they fled the city. Witnesses described attacks that killed and injured their neighbors as they took shelter in their homes, prepared food, and fetched water, throwing them from buildings and piercing them with fragments. The attacks also destroyed and damaged homes, businesses, and critical civilian infrastructure, such as hospitals and schools, collapsing and burning buildings in numerous parts of the city. The descriptions of the attacks and their effects are consistent with the use of explosive weapons with wide-area effects.
Serhii, a shipping inspector, said he was on the balcony of his father’ s apartment, when a detonation occurred, catapulting a man out of the window of the building next door and to the ground outside, killing him. The same attack started a fire in one of the stairwells of his father’ s building. “ We don’ t know if there were casualties because that part of the building collapsed, and no one could search for people in the rubble because of the constant shelling, ” he said. Several days after that incident, he said: “ I was just coming out of the building carrying some water, and I saw [ a neighbor’ s ] body … His dead body was just lying there, with his intestines hanging out. ”
Several residents described attacks that killed or injured people as they were on their way to get what little food was available, or to collect water from nearby rivers or springs.
One man said that three women were on their way to buy bread when an attack took place, killing one of the women, tearing off her hands, and seriously injuring the two others. He said he started to take one woman who had a serious stomach wound to the hospital until he came across Ukrainian soldiers who said they would take her to get treatment.
A 37-year-old man described how his neighbor was killed. “ On March 8, an attack hit while a young man from our building was outside trying to start a fire to cook, ” he explained. “ He was pierced by pieces of metal, including to his heart, and he died. Because of the continued attacks, his family has not been able to bury him yet, so his body is still in a van outside. ”
A doctor from Mariupol said that the hospital where she worked was damaged in an attack on March 10. The hospital had been closed since February 24. A school principal said that two munitions exploded in the yard of his school on March 15. “ A lot of windows were broken, ” he said, adding that dozens of other schools in the city were also damaged.
Access to Water and Sanitation
Everyone interviewed said that running water had stopped in the city on or around March 2, and that they had not been able to shower since. To try to get potable and non-potable water, they waited in line for up to six hours at fresh springs and at water trucks in the city, melted snow, collected buckets of rainwater, or flushed out their buildings’ heating systems.
One man, Valery, said that on March 8, International Women’ s Day, the men sheltering in his basement collected as much snow as possible to melt and boil over a fire, so that the women and children could wash themselves.
Some people said they had to defecate in buckets. One woman said the 30 people sheltering in her basement had only one bucket.
Access to Food
Those interviewed said they survived on food that they had at home before the fighting started and shared their dwindling stocks with those sheltering with them. Once looters had broken into shops, some said, they also went in and stole food. However, many of those interviewed owned personal vehicles and had considerable stockpiles of foodstuffs, so their experience was not necessarily representative of the experience of other civilians remaining in the city.
Viktoria, a graphic designer, said that her family and her neighbor’ s family eventually only had expired cans of paté left to eat, with the adults eating only one meal a day. Several families said they ran out of baby formula early on. Everyone said they cooked their food on open fires in the yards outside their buildings, or in kitchens that were near their basements.
Several people interviewed who had been sheltering in larger basements with more people said that volunteers, the military, and the police sometimes came to their basements to deliver some food, water, and medicine.
None of those interviewed said they saw Russian forces distributing aid at any point. According to Ukrainian authorities, a convoy of humanitarian vehicles trying to bring aid into Mariupol was stuck in the Russian-controlled city of Berdyansk, 65 kilometers southwest of Mariupol, as of March 15. The convoy had reportedly turned back by March 20 without reaching Mariupol or delivering the aid.
Access to Electricity
Everyone interviewed said they lost electricity on around March 2. Valery said his basement had a generator, but it was destroyed in an attack on March 10. One woman noted that, even in those buildings with generators, families eventually ran out of fuel for them to run.
Human Rights Watch recognizes that the internationally protected right to an adequate standard of living includes everyone’ s right, without discrimination, to sufficient, reliable, safe, clean, accessible, and affordable electricity. Access to electricity is critical to ensuring other basic rights, including but not limited to the rights to health, housing, and water. Steps should be taken to restore reliable electricity access for civilians to safeguard their other basic rights.
Access to Information
Once Mariupol was besieged, people in the city lost access to phone lines, television, and most local radio stations ( with the exception of some medium wave stations that were faint). They had no ability to access information about what was happening inside or outside the city. Everyone interviewed said that this lack of information was one of the things that made it the most difficult for them to figure out how to leave the city safely.
Valery said he lived in a building next to a mobile phone tower, which initially gave him a weak signal. But after several attacks next to the tower, including the one that destroyed his building’ s generator, the tower itself was hit on March 10, and the signal was completely gone.
In an example of how residents struggled to reach their loved ones, Ganna, an anesthesiologist, showed researchers a picture she had taken of a piece of paper that a mother had stuck to a water cistern in the city, where many people were going to fetch water, hoping her daughters might see it. “ We made it out of the left [ bank ], now in Kirovskii [ neighborhood ] at Natasha's, ” the note said.
Serhii, a factory foreman, and his wife were waiting at the reception center in Zaporizhzhia for their daughter, son, and grandson. They said they had not heard from them for eight days, and only found out they were alive the night before, when their children called them from a city between Mariupol and Zaporizhzhia. “ You see how grey my hair is? ” Serhii said. “ It turned grey in these 8 days. ”
Russian forces took over local radio broadcasts just after they encircled the city, and they sent text messages to those inside the city, which came through when residents happened to pick up a signal. One man said that he heard Russian forces announcing on the radio: “ Give up soldiers. Come out with a white flag on your gun, leaning it onto your left shoulder and approach us and we guarantee food, clothes, and will let you join your family after the fighting stops. ”
Two people said that at one point when their phones were on, they received text messages that they assumed had been sent by the Russian forces. Ina, the graphic designer, said she received a message from the number 777 that read: “ Ukrainian army surrender. ”
Those interviewed said they did not receive any messages directed at civilians warning them to take precautions prior to attacks or about access to humanitarian assistance or routes for safe passage.
Access to Health Care
Some people interviewed said they did not know whether any hospitals in the city were functioning, while others said that they had heard of one or two civilian and military hospitals that were still open, but with wait times spanning days. Human Rights Watch spoke to the daughter of a man who lost his eye after an explosion on March 6, which also damaged their home. When they rushed him to the hospital, she said there was no running water and limited electricity from their generators that they were using only to perform life-saving operations.
Andri, an engineer, said his home was about 200 meters from the main hospital in Mariupol that was treating Covid-19 patients. He said that on March 12, staff at the hospital told him that they had run out of oxygen days earlier and as a result people with serious respiratory symptoms were dying.
One man working as a volunteer delivering aid to shelters said that several people had come into the basement where he was sheltering with wounds from metal fragments caused by explosions. They were unable to make it to a hospital. “ Sometimes the ambulance started driving toward us, but then had to turn back because of the shelling and come back later, ” he said.
Oksana, a wheelchair user who can not walk since an accident 17 years ago, has been on daily medication to treat thyroid cancer for the past six years. She said she ran out of her medicine soon after the fighting started, when the pharmacies had already been looted and emptied out. She went to the hospital near her home that was open, but doctors there said they had run out of the medication she was on and gave her a substitute. She has no idea what the impact of being off her required medication for so long will mean for her future.
Mykola, the principal, said that even though his school had sheltered up to 200 people, they only had basic medicine there and the teachers, all trained in first aid, had to start acting as medics. “ We gave medical assistance as we could with the means that we had, ” he said.
A medic working at the reception center in Zaporizhzhia said that 55 people had been treated at their makeshift clinic, and that one woman who arrived on March 15 with a serious wound caused on March 8 by a metal fragment, had to be rushed straight to the hospital. On March 17, the World Health Organization expressed concern that there is “ the potential for multidrug-resistant infections ” in the case of such injuries “ given the previous high rates of over-the-counter antimicrobials, and limited access to treatments. ”
The Route Out
Following what residents described as days of especially heavy shelling on March 13 and 14, some of them with access to private cars decided to try to leave the city on their own, despite the ongoing shelling and needing to pass through Russian checkpoints. A convoy of about 160 cars left Mariupol on March 14, and hundreds more left on March 15. Serhii, the shipping inspector, told Human Rights Watch he estimated that, for each car in Mariupol that still functioned, he had seen at least 50 other cars destroyed during the bombardment, seriously limiting the ability of many Mariupol residents to escape.
Residents described passing through between 15 and 20 Russian military checkpoints between Mariupol and Zaporizhzhia. They all said that Russian soldiers either asked for the documents of the driver or for everyone’ s documents. Serhii said the soldiers were paying particular attention to the registered address that is written in Ukrainian passports to see if people were from Mariupol or elsewhere. “ I suspect they did this because, if they came across a man not from Mariupol, they would assume he was a soldier, ” he said. The Russian forces also made Serhii expose his shoulders, apparently to look for signs of bruising which might indicate that a person had used a firearm. Another resident said that they inspected the hands of the adult men for signs that they had been fighting or using a weapon.
Four people interviewed said that soldiers inspected their phones at the checkpoints, something that they had heard might happen, so they had deleted any photos of the damage from Russian forces’ bombardment in Mariupol before leaving the city. At one checkpoint, a Russian soldier asked Olexsandr if he had any “ forbidden ” photos on his phone. “ I asked him what was considered forbidden, and the soldier told me any photos of any Russian military vehicles, ” Olexsandr said. He had wiped his phone before passing through the checkpoints.
None of the Mariupol residents described serious mistreatment by soldiers at the checkpoints. One of them said that the Russian soldiers treated everyone in his car correctly, but several people were detained from the vehicle that was two cars ahead of them at the checkpoint. When that car made it to the checkpoint, he said, the soldiers fired their weapons in the air after what seemed to be a verbal altercation. One soldier then dragged a man out of the car, bent him over a barricade, and fired a weapon over his head. After that, everyone in the car was detained. The witness did not know what had led to the detentions or what happened to those who were detained.
Another person said his car was fired upon, he presumed by Russian forces because he was driving through an area fully under Russian control, but it was too dark to see. Later he examined the car and said the side had been pierced by a metal fragment. Mykola, the principal, said that between Mariupol and exiting the area under Russian control, he saw at least 10 burned cars on the sides of the road or in fields, and in one case, he saw a dead body lying next to a burned-out car.
Those Left Behind
As of March 17, several thousand residents – a small fraction of the residents still trapped in Mariupol by the intense fighting – were able to flee. Everyone interviewed said that they had only been able to leave because they had their own car or were able to find a ride with someone who did, and that many people with whom they had sheltered in basements and those with limited mobility had stayed behind.
Because electricity and telecommunications are not functioning, those who were able to leave had no information about those who are still in the city. One woman who was able to find a ride said she was forced to leave her mother who could not make it down the stairs to the shelter in her wheelchair.
Ina said that she left with about 16 other people, and about 65 others remained in the basement where they were sheltering. “ As we were leaving, we noticed there was only about two-days’ worth of food stocks left for everyone, so I don’ t know what will happen to them, ” she said.
Mykola said at one point his school, where he was sheltering, had housed 200 people. When he left, he said at least 50 people remained in the school with no means of transport out.
Several residents cited locations housing hundreds of people at the time they left the city, and they were worried that these areas might come under attack.
Legal Obligations and Relevant International Humanitarian Law
Sieges directed at military targets, which includes enemy forces, and for the purpose of capturing an enemy-controlled area, are permitted under the laws of war, as a legitimate military objective. Siege tactics can not include starving a civilian population or attacking, destroying, removing, or rendering useless objects indispensable to the civilian population’ s survival. Deliberate employment of such tactics is a war crime. Tactics that arbitrarily deny civilians access to items essential for their well-being such as water, food, and medicine are also prohibited, and all parties should protect objects indispensable to the survival of the civilian population, including those necessary for water distribution and sanitation.
The laws of war prohibit deliberate and indiscriminate attacks on civilians and civilian objects and attacks that cause anticipated harm to civilians disproportionate to the expected military benefit. Unlawful and wanton excessive destruction of property, not militarily justified, is a war crime. Both parties are required, as far as feasible, to take necessary precautions to protect the civilian population, individual civilians, and civilian objects under their control against the dangers resulting from military operations.
Evacuations of civilians in and around Mariupol who want to leave, should be facilitated. When an agreement to establish humanitarian corridors is put into effect, parties should not breach that agreement in any way that places civilians at risk. All parties must abide by their obligations not to carry out attacks that would target or cause harm to civilians who are on the move, including along railway and road routes being used to leave. Parties should allow access for neutral and independent humanitarian actors to support civilians at particular risk who may need assistance to leave, including people with disabilities, older people, pregnant people, children, and people with chronic or severe medical conditions.
Parties to the conflict are prohibited from deporting or forcibly transferring the civilian population of an occupied territory, in whole or in part, unless it is demanded by civilian security or imperative military reasons. The fourth Geneva Convention prohibits individual or mass forcible transfers of civilians from occupied territory to the territory of the occupying power or any other country, occupied or not, regardless of their motive. If for material reasons it is impossible to avoid such displacement, provisional, temporary evacuations may occur, but those evacuated must be transferred back to their homes as soon as the specific hostilities in the area in question have ceased. Violation of this prohibition is a grave breach of the Geneva Conventions and prosecutable as a war crime. The International Criminal Court, which has opened an investigation into potential war crimes in Ukraine, can prosecute the war crime of “ the deportation or transfer [ by the Occupying Power ] of all or parts of the population of the occupied territory within or outside this territory. ”
Ukraine, and Russia in the areas that it currently controls access to or occupies, should ensure that there is adequate supply of food, water, and medicine, and that services vital for the civilian population continue.
Both parties should abide by obligations to allow and facilitate the rapid passage of humanitarian aid for all civilians in need and not deny access or arbitrarily interfere with distribution. Starving civilians as a method of warfare is a war crime. | general |
Creare il consenso per una ripresa verde by Lolwah Al-Khater & Brian Finlay | DOHA – Se da un lato l’ invasione dell’ Ucraina da parte della Russia è su tutte le prime pagine dei giornali a livello globale, dall’ altro il Covid-19 continua a creare il caos a livello socioeconomico in tutto il mondo. La pandemia ha provocato più di sei milioni di decessi, ha portato 124 milioni di persone all’ indigenza e ha ostacolato i progressi nel raggiungimento degli obiettivi di sviluppo sostenibile 2030. Fortunatamente, circa cinque miliardi di persone hanno ricevuto almeno una dose di vaccino e l’ Organizzazione Mondiale per la Sanità insieme al Gavi hanno fissato come target la vaccinazione del 70% delle persone in tutti i paesi entro luglio.
Senza contare la terribile guerra in Ucraina, la pandemia e le sue conseguenze continuano a essere tra le principali preoccupazioni a livello globale insieme al cambiamento climatico. Gli effetti del cambiamento climatico si sentono già ogni giorno, come dimostra il Sesto rapporto del Pannello intergovernativo sul cambiamento climatico. Proprio recentemente, temperature estreme e siccità hanno devastato l’ Asia occidentale e il Nordafrica, mentre l’ aumento del livello del mare sta minacciando diversi stati insulari e paesi che si trovano sotto il livello del mare. Inoltre, delle alluvioni catastrofiche hanno inondato parti dell’ Europa e della Cina, mentre nell’ America occidentale e in vaste aree dell’ Australia sono scoppiati numerosi incendi.
Gli scienziati avvertono che la ripresa regolare delle attività comporterà un aumento della temperatura media globale di 3-4º gradi centigradi entro la fine del secolo rispetto ai livelli pre-industriali, il che rappresenta una vera e propria catastrofe. Per mantenere il riscaldamento globale a un livello ben più sicuro, ovvero al di sotto di 1,5ºC, è quindi strettamente necessario ridurre le emissioni di diossido di carbonio del 45% ( rispetto ai livelli del 2010) entro il 2030, per poi eliminarle entro il 2050.
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Writing for PS since 2022 1 Commentary
Lolwah Al-Khater, Assistant Foreign Minister at the Ministry of Foreign Affairs of the State of Qatar, is Executive Director of the Doha Forum.
Writing for PS since 2021 2 Commentaries
Brian Finlay is President and CEO of the Stimson Center.
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As Russian forces continue their indiscriminate attacks on Ukrainian civilians, pressure is growing globally to create a special tribunal to prosecute Russian President Vladimir Putin and his inner circle for the crime of aggression. Justice demands that this process begin immediately.
By nominating Ketanji Brown Jackson to the US Supreme Court, President Joe Biden has implicitly acknowledged that the administration of justice in a complex society requires institutions with `` affective appeal. '' Her appointment is not just good politics; it will also lead to better jurisprudence.
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| general |
DC sues Grubhub, claiming its app is full of hidden fees and jacked-up prices | District of Columbia Attorney General Karl Racine is suing Grubhub for deceptive business practices, saying its food delivery app covertly inflates prices for diners who order through it. The suit demands an end to a laundry list of allegedly illegal practices as well as financial restitution and civil penalties.
The newly filed lawsuit argues that Grubhub’ s promises of “ free ” online orders — and “ unlimited free delivery ” for Grubhub Plus — are misleading. While customers can make pickup orders for free, the company charges delivery and service fees for standard orders and service fees for Grubhub Plus orders, displaying the service fee until recently as part of a single line with sales taxes. “ Grubhub misled District residents and took advantage of local restaurants to boost its own profits, even as District consumers and small businesses struggled during the COVID-19 pandemic, ” said Racine in a statement. “ Grubhub charged hidden fees and used bait-and-switch advertising tactics — which are illegal. ”
The complaint says Grubhub orders often cost more than ordering the same item at a restaurant and argues that the company fails to reasonably disclose this to consumers. “ Because Grubhub already charges consumers several different types of fees for its services... consumers expect that the menu prices listed on Grubhub are the same prices offered at the restaurant or on the restaurant’ s website, ” it says.
As previously reported by news outlets including The Verge, Grubhub has also listed many restaurants without their permission to expand its service, routing orders through its services and taking a commission. The complaint says it listed “ over a thousand ” restaurants in DC that had no connection with the company, asserting that the unapproved listings often contained menu errors and resulted in orders that would “ take longer to fill, would be filled incorrectly, would be delivered cold, or would eventually be cancelled altogether. ”
Grubhub — which also operates Seamless and several other food delivery apps — has made more elaborate attempts to insert itself into restaurant transactions as well. The lawsuit notes its launch of unsanctioned microsites that appear to be official restaurant sites, as well as custom phone numbers that let it charge fees when customers call restaurants, even when the calls didn’ t result in orders. The company also offered a “ Supper for Support ” promotion that required restaurants to foot the bill for a special discount; it offered restaurants $ 250 in compensation after a backlash.
Grubhub indicated that it would fight the lawsuit and said many of the practices it describes are either appropriately disclosed or have been discontinued. “ During the past year, we’ ve sought to engage in a constructive dialogue with the DC attorney general’ s office to help them understand our business and to see if there were any areas for improvement, ” said Katie Norris, director of corporate communications, in a statement to The Verge. “ We are disappointed they have moved forward with this lawsuit because our practices have always complied with DC law, and in any event, many of the practices at issue have been discontinued. We will aggressively defend our business in court and look forward to continuing to serve DC restaurants and diners. ”
Grubhub’ s statement says the app no longer lists restaurants that haven’ t agreed to work with it, and it’ s retired its microsites and the Supper for Support program. It also includes disclosures in its terms of use — although “ moving forward, ” it will more prominently tell users that prices might be lower when ordering directly from the restaurant, and it will specify in marketing that only pickup orders are free. “ Grubhub has not misrepresented its fees, ” it says.
Grubhub is far from the only delivery app charging higher fees that customers aren’ t necessarily aware of, nor is it the only one that’ s come under legal fire. Last year, the city of Chicago sued both Grubhub and DoorDash on similar grounds, and it publicized an amended complaint last month. Conversely, Grubhub and other delivery app companies have sued cities for fee caps implemented during the COVID-19 pandemic — which the companies have called a legal overreach. | tech |
Crude oil futures climb for third day as supply outlook remains tight | In this week's Market Movers Americas, presented by Jeff Mower: * US Gulf of Mexico offshore output...
Crude oil futures were higher in mid-morning Asian trade March 21, as the supply outlook remained tight on the back of reduced Russian supplies and a continued recovery in global oil demand from the COVID-19 hit.
일일 이메일 알림과 구독자 노트를 받고 이용 경험을 내게 맞게 설정하세요.
Falling pandemic cases in China also boosted investor sentiment.
At 11:00 am Singapore time ( 0300 GMT), the ICE May Brent futures contract was up $ 3.15/b ( 2.92%) from the previous close at $ 111.08/b, while the NYMEX April light sweet crude contract rose $ 3.26/b ( 3.11%) at $ 107.96/b.
`` The market continues to fret about supply disruptions, with data suggesting they are already impacting, '' said ANZ Research analysts Brian Martin and Daniel Hynes in a Mar. 21 note.
The International Energy Agency late last week warned of a potential global oil supply shock, with an estimated 3 million b/d of Russian oil production likely to be shut in next month due to sanctions and buyers shunning the major exporter.
The IEA forecast a crude oil deficit in the supply-demand balance of 700,000 b/d in the second quarter, assuming Middle East producers in the OPEC+ group stick with their current quota plans as expected, as well as a continued potential supply deficit crunch in Q3.
Despite a sharp drop in ICE Brent crude prices in recent weeks from a 13-year high of $ 139/b in early March, analysts said oil prices were poised for a rebound in the absence of a quick fix in the supply-demand gap.
US oil production has remained unchanged at 11.6 million b/d for the prior five weeks up till March 11, most recent data from the Energy Information Administration showed.
In China, falling COVID-19 cases calmed investor fears of infections spiraling out of control in the world's second largest economy. The country's National Health Commission reported 1,656 locally transmitted cases on Mar. 19, down from 2,157 the previous day.
`` Falling new cases underscored the country's prompt and stringent measures, including lockdowns and mass tests, in containing the rapid spread of the virus. This may help to boost investor confidence amid the country's most severe viral outbreak since 2020, '' said IG DailyFX strategist Margaret Yang in a Mar. 21 note.
Dubai crude swaps were higher in mid-morning trade in Asia March 21 from the previous close, though inter-month spreads and the Brent/Dubai Exchange of Futures for Swaps spread were lower.
The May Dubai swap was pegged at $ 101.83/b at 11 am Singapore time ( 0300 GMT), up $ 3.30/b ( 3.35%) from the Asian market close March 18.
The April-May Dubai swap intermonth spread was pegged at $ 3.37/b at 11 am, down 10 cents/b over the same period, and the May-June intermonth spread was pegged at $ 2.12/b, down 4 cents/b.
The May Brent/Dubai EFS was pegged at $ 9.25/b, down 41 cents/b.
등록은 쉽고 무료입니다. 아래 버튼을 클릭하시면 되고, 등록 절차가 완료되면 다시 이 페이지로 돌아옵니다. | business |
Board of Directors of 21 March 2022: approval of solo and consolidated 2021 financial results; proposal of dividend per share of 0,20; Ordinary Shareholders ' meeting convocation. |
PRESS RELEASE
Board of directors ' meeting of 21 March 2022:
the geopolitical and macroeconomic context with increasing
international tensions
Full confirmation of preliminary results approved on 8 February 2022
The Board of Directors of Banca Popolare di Sondrio, met today under the chairmanship of Prof. Avv. Francesco Venosta, examined and approved the draft financial statements and consolidated financial statements as at December 31, 2021, confirming the preliminary results, with a Group net profit of € 268.6 million, approved on 8 February 2022.
Banca Popolare di Sondrio spa's gross dividend per share proposal
The Board of Directors also resolved to propose to the Ordinary Shareholders ' Meeting the distribution of a gross dividend per share of € 0.20. The payment of the dividend, in compliance with current provisions and considering that the ex-dividend date is 23 May 2022, will commence on 25 May 2022. The profit proposed for distribution amounts to
6
Banca Popolare di Sondrio
a total of € 90,677,155. The dividend is subject to taxation in accordance with current legislation; in particular, dividends paid to individuals are subject to a 26% withholding tax. The distribution of the remainder of the net profit will be proposed as follows: to reserves € 121,121,990, to the charity fund € 300,000.
Convocation of Ordinary Shareholders ' Meeting of Banca Popolare di Sondrio spa
The Ordinary Shareholders ' Meeting of Banca Popolare di Sondrio spa is convened at the registered office in Sondrio, Piazza Garibaldi 16, at 10 a.m. on Saturday, April 30, 2022, in a single call. Taking into account the containment measures imposed due to the emergency situation resulting from the Covid-19 epidemic and in accordance with fundamental principles of health protection, pursuant to the provisions of Article 106, paragraph 4, of Legislative Decree no. 18 of 17 March 2020, as subsequently amended and supplemented, attendance at the Shareholders ' Meeting by those entitled to participate will take place, without access to the meeting rooms, exclusively through
the Representative appointed pursuant to Article 135-undecies of Legislative Decree
no. 58 of 24 February 1998. The related notice of call, as well as the documentation
required by the regulations, will be published within the terms of the law.
Appointment of five directors for the three-year period 2022/2024
The Ordinary Shareholders ' Meeting shall appoint, inter alia, five directors for the three- year period 2022-24. The Board of Directors, availing itself of the provisions of Article 23, paragraph 4 of the Statute, reserves the right to submit its own list of candidates, which will be made public in advance of the deadline for shareholders to deposit their lists.
Expected evolution of operations and postponement of the approval of business plan
Following the recent events concerning Russia and Ukraine, international trade and economic dynamics as a whole are currently characterised by a high level of uncertainty, which is leading to a substantial revision of the original forecasts on macroeconomic developments in 2022 and in the medium term.
7
Banca Popolare di Sondrio
As regards Italy, it is expected that the estimates released at the beginning of the year by the main research centres, which predicted a continuation of the phase of robust economic growth with an expected increase in GDP of around 4%, will be adjusted downwards.
In adherence to the Consob warning of March 18, 2022 on the impact of the war in Ukraine on insider information and financial reporting, it should be noted that Banca Popolare di Sondrio has begun a functional activity to determine direct exposures to entities residing in Russia and Ukraine. The result so far is a very limited direct credit exposure. For indirect exposures, relating to customers operating in sectors potentially affected by the crisis, activities are underway to analyse the expected impacts. Financial risk exposures are also currently being monitored on a daily basis. As far as the risk of cyber attacks is concerned, to date there have been no security incidents related to the crisis. The bank constantly verifies the adequacy of its IT systems in response to a potential high-impact attack, with protection systems under control and fully active.
In this context, Banca Popolare di Sondrio Group has in any case recorded a positive start to the year, marked by the stability of revenues from its core banking business and by cost dynamics in line with the pursuit of efficiency objectives aligned to the best market standards. In the absence of further strong instability in international relations and/or financial market trends, the Group is therefore likely to achieve good levels of profitability also in 2022, confirming the resilience of its business model.
In the Bank's view, however, there remains a significant level of uncertainty associated with the evolution of ongoing geopolitical tensions, with numerous points of attention that unanimously concern banking institutions, particularly related to the expected growth of the economy, the dynamics of reference rates and government spreads, the cost of risk and the performance of debt and equity markets, and inflation indices.
Therefore, with regard to medium-term projections, while waiting for the geopolitical situation to stabilize so that more precise estimates can be made on the evolution of the main macroeconomic variables underlying the Bank's profitability objectives, the Board of Directors decided prudentially to postpone approval of the new business plan.
8
Banca Popolare di Sondrio
In the meantime, Banca Popolare di Sondrio Group, while having an insignificant
exposure to entities based in the areas at the centre of the conflict, will continue to
monitor developments in the crisis with particular attention and will strive to strictly
implement the measures introduced by European and international authorities for the
application of sanctions against Russia.
* * * * * * * *
DECLARATION
The manager responsible for preparing the company's financial reports, Maurizio Bertoletti, declares, pursuant to paragraph 2 of Article 154- bis of Legislative Decree no. 58 of 24 February 1998, that the accounting information contained in this press release corresponds to the documented results, books and accounting records.
Signed:
Maurizio Bertoletti, manager responsible for preparing the company's financial reports.
9
Banca Popolare di Sondrio
Company contacts:
Investor Relations
External relations
Michele Minelli
Paolo Lorenzini
0342-528.745
0342-528.212
michele.minelli @ popso.it
paolo.lorenzini @ popso.it
Image Building
Cristina Fossati
Anna Pirtali
02-890.11.300
popso @ imagebuilding.it
Sondrio, 21 March 2022
The English translation is provided only for the benfit of the reader and in the case of discrepancies the Italian version shall prevail.
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Banca Popolare di Sondrio
Attachments
Disclaimer
Banca Popolare di Sondrio Scpa published this content on 21 March 2022 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 21 March 2022 16:08:04 UTC. | business |
'Deipnophobia ' — understanding the fear of dining with others | While many people feel they are missing out amid COVID-19 restrictions imposed on group dining, with it regarded as a factor that leads to the spread of infections, there are some who feel relieved by the current situation.
Nishinippon Shimbun’ s team of reporters on its “ Journalism On Demand ” beat received a note from a 61-year-old man living in the Kyushu region who suffers from “ deipnophobia ” — anxiety around eating in public.
In many cases, deipnophobia is triggered by past traumatic events related to eating. Some people even have to give up employment or other public activities because they are unable to dine with others.
For the Kyushu man, the condition came on suddenly at a friend’ s house during his second year of high school.
In a gathering together with four other boys and girls, the group was chatting while enjoying snacks. The man was holding a snack in his hand, but all of a sudden he realized he couldn’ t put it in his mouth. He felt like he was floating in the air, and broke into a cold sweat.
A friend noticed that something was wrong with him and encouraged him to eat more, but he couldn’ t take even one more bite.
Since then, he has been unable to eat with anyone other than his family. He gets intensely worried and scared of others seeing him eat, as he fears he might not be eating in a proper way. He tries putting food into his mouth but is unable to chew it properly, and ends up just sweating all over.
Ever since that time the man has declined invitations to meals, making up excuses and saying he has things to do or is not feeling well. Being unable to do normal things, he feels irritated and ashamed of himself.
Having thought long and hard about why he might have developed such an affliction, what came to mind were memories of the time before he entered elementary school. He recalled his normally calm parents arguing during dinner at home; his father raised his voice, and a bowl thrown by his mother smashed against a low dining table and broke. At the time, he remained perfectly still and waited for the moment to pass.
There were two such incidents, and he thinks they might be the reason for his condition. After becoming an adult, he was able to enjoy dining with others with the help of alcohol. But he would never do it without drinking.
The man feels jealous of food reporters on TV programs who appear to enjoy eating while talking. When he sees them, he feels like they are showing off a joy in meeting others that he has been unable to experience.
People develop deipnophobia when a part of the brain called the amygdala that affects emotions such as anxiety and fear becomes overactive, due to negative events in the past related to eating.
A support group created by those with deipnophobia conducted a survey in 2019 covering 642 people with the symptoms, and 34.7% of the respondents said they had developed the fear because of the experience of being instructed or forced not to leave anything when eating their meals.
Among them, 72.1% had received such instruction from teachers during lunchtimes at school, 14.3% were chastised by family or relatives and 9.4% by instructors of club activities.
Osamu Tajima, a psychiatrist and professor emeritus at Kyorin University who is well-versed in deipnophobia, said people with the phobia “ not only suffer from physical symptoms, including nausea and shaking, but also face difficulties such as losing opportunities to interact with others. ”
There are cases of such people becoming sick as they were unable to eat meals during training camps for club activities, or quitting a company because they couldn’ t eat during the induction program for new employees.
The first step to treat the phobia is to get rid of false assumptions that you have to eat in a proper way, or that people will get mad at you if you leave some food. It will make things worse if you avoid dining with other people or make yourself eat all the food on your plate.
Experts say the phobia is relatively easy to overcome with continued treatment with both medication and cognitive behavioral therapy.
Kenta Yamaguchi, head of the support group, said, “ While people with deipnophobia are relieved that there are fewer chances of group dining due to the COVID-19 pandemic, they are also concerned that there are fewer opportunities for treatment and feel uneasy thinking about dining with others after the pandemic settles down. ”
The group organizes an event about once a month at cafes in Tokyo or Osaka or online, during which people with deipnophobia can eat things they like while talking with others, or intentionally leave food.
The group also operates a website in Japanese to offer information including guides for school teachers.
“ In order for them to overcome the symptoms, it is important to have an environment where they can feel comfortable, ” Yamaguchi said. “ We want to create a society where many people can enjoy having meals. ”
This section features topics and issues from the Kyushu region covered by the Nishinippon Shimbun, the largest daily newspaper in Kyushu. The original article was published Feb. 24. | tech |
Brazil's JBS earns $ 1.31 bln in Q4, above analysts expectations | - Brazilian meat giant JBS SA earned $ 1.31 billion in the final quarter of 2021, beating analysts ' expectations on the back of sales to China, the destination of more than a quarter of the company's overall exports last year.
In the fourth quarter, JBS recorded consolidated net revenue of 97.2 billion reais ( $ 19.69 billion), a 27.8% rise compared with the same period a year ago, with growth across all business units.
In 2021, net revenue reached a record of 350.7 billion reais, the company said citing a good performance of its U.S. beef and pork businesses and resilience of its poultry operations there.
At Pilgrim's Pride, which JBS owns, management faced '' a challenging and volatile market due to rising costs, disruption in the supply chain, labor shortages and [ the effects of ] COVID-19 pandemic. ''
In its home market, division JBS Brasil had revenue growth of 5.1% from the same year-ago quarter, despite a 3% fall in cattle processed due to a shortage of animals for slaughtering, and the temporary suspension of Brazilian beef exports to China between early September and mid-December.
In the United States, where JBS derives most of its total revenue, demand for beef remained above supply capacity, benefiting its domestic and export business. In particular, Asia's demand for U.S. beef remained so strong last year that the overall volume of U.S. beef exports into the continent exceeded exported volumes by more than 16% from 2020, JBS said.
`` The highlight remains China, which increased its share month after month, and has already become the third largest destination for American exports of this protein, '' JBS said.
The company also posted adjusted earnings before interest, tax, depreciation and amortization, a measure of operating income known as EBITDA, stood at 13.15 billion reais in the period, compared with a median forecast of 10.2 billion reais. ( $ 1 = 4.9444 reais) ( $ 1 = 4.9361 reais) ( Reporting by Ana Mano and Nayara Figueiredo in São Paulo; Editing by Chris Reese and Marguerita Choy) | business |
Quake-hit Tohoku Shinkansen service to resume full operations around April 20 | East Japan Railway Co. ( JR East) said Monday it will aim to resume full operations of the quake-hit Tohoku Shinkansen service around April 20.
The powerful quake that hit the country’ s northeast on March 16 derailed 16 cars of a 17-car shinkansen train some 2 kilometers from a station in Shiroishi, Miyagi Prefecture. The company said Sunday it expects to take at least two weeks to remove the derailed train.
Until Monday, the service was suspended between Nasushiobara and Morioka stations. Starting Tuesday, the service is to be restored between Nasushiobara and Koriyama stations and between Ichinoseki and Morioka stations, leaving operations between Koriyama and Ichinoseki Station still suspended.
The company then plans to resume operations between Koriyama and Fukushima stations around April 2, and between Sendai and Ichinoseki stations around April 4, it said in a statement.
The firm has also suspended the Joban Line service between Tomioka and Shinchi stations since the quake. But operations between Tomioka and Haranomachi stations will resume on Tuesday due to the progress of restoration work in some sections.
If restoration work progresses smoothly, operations between Haranomachi and Shinchi stations are expected to resume on Thursday, the company said.
The magnitude 7.4 quake struck off Fukushima Prefecture late Wednesday, leaving three people dead and more than 180 injured across 12 prefectures.
The delay in relaunching full services has created concern over the impact on tourism in the region and the local economy as a whole.
The government is set to fully lift the COVID-19 quasi-emergency at the end of Monday, and JR East is hoping that tourists will flock to the Tohoku region during the Golden Week holidays from late April to early May.
Meanwhile, all expressway closures caused by the quake were lifted by Friday, with numerous cracks and bumps having been restored in less than two days. | tech |
The past is the future | So often, when asked to think about the future, connoisseurs of the present come up with far-flung, bombastic thoughts that are all trapped within today’ s imaginations.
imagined what the year 2000 would look like back in 1900 – a world of robot hairdressers and buses powered by whales – but hindsight is a beautiful thing, and we seem to keep falling into the same prediction trap decade after decade.
Perhaps a more realistic way of trying to figure out what the future holds is to actually look backwards. Hear me out. Cast your mind back 20 years to the heady days of 2002 ( if you’ re old enough to remember). Think what has changed between then and now? In a way, everything – and nothing.
On the one hand, we have the emergence of big tech, insanely intelligent phones, and services that have made the world so much smaller in scale ( imagine trying to navigate Covid-19 WFH in 2002). Yet some of the pubs we love still stand. The buildings remain, even if the shopfronts are different. The landscape when we look out the window doesn’ t have flying cars and robot helpers. We still had mobile phones 20 years ago, it’ s just what they do that has fundamentally changed. When you really look, is 2022 as fundamentally different as some predicted in 2002?
When the future lands, often it’ s somewhat more subtle than expected. It creeps up on you, maintaining the old order slightly while injecting the new intravenously. The process of change is often organic. This is especially true when it comes to creativity.
For me, all creativity comes from copying. Admit it, we all do it, consciously or subconsciously. And, honestly, there’ s absolutely nothing wrong with that
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Making the move to domiciliary | News and features about the latest developments relating to professional support from across optics. This includes updates from optical organisations such as the AOP and the GOC
Jennie Atyeo ( JA): I did my pre-reg year with a High Street practice and, following that, I worked full-time as an optometrist at their Weston-Super-Mare store. I made the move into the domiciliary sector in August 2021. Due to the flexibility that OutsideClinic offers its clinicians, I’ m still able to work for one day a week at the High Street practice.
JA: I’ ve always wanted to work for OutsideClinic. My university lecturer had worked in domiciliary optometry and gave me great feedback about the sector. OutsideClinic’ s mission to ensure that everyone who needs it has access to clinically excellent optometry services at home aligns very much with my values, and I find domiciliary eye care really interesting and rewarding. Given the patient demographic, you see a wide range of ocular pathology and are able to make a real difference.
Another key factor for me was knowing that I would have access to the latest technology, whether that’ s a digital fundus camera, mobile slit lamp, or an I-care tonometer. There’ s a myth that the technology available in the domiciliary sector is inferior to what is available in High Street practices. It’ s simply not true – I have access to everything I need to deliver a comprehensive eye test.
JA: Whilst I enjoy my dual working life, and have fully embraced the benefits of both as each brings a different dynamic. Domiciliary work ensures I get a good work-life balance as I don’ t work weekends or Bank Holidays. I have three children, so it’ s great to have more quality time with my family, which is incredibly important to me. Another key difference is the fact that working in the domiciliary sector means I’ m able to swap the darkened room of a High Street opticians for getting outside in the fresh air and visiting patients, which is great for wellbeing.
Working for OutsideClinic, I also benefit from longer appointments with patients, which enables me to really connect with them and provide them with the high-quality care they need to make a tangible difference to their lives. Seeing people in their own homes means I’ m able to see and understand their challenges first-hand, which is also very different from my experience of working on the High Street.
JA: Although I work alone, I am never alone as I can rely on the company’ s professional services and clinical excellence teams for help and advice if needed. For me, that’ s invaluable and means I feel 100% supported. Some people might also be surprised at just how advanced and digitalised OutsideClinic’ s patient care systems are – they are brilliant. With my company iPad, I can very quickly and easily access patient notes, and referring patients takes a matter of seconds. It’ s all incredibly straightforward and efficient.
JA: There is so much opportunity to develop as an optometrist within the domiciliary sector. I’ m really benefitting from OutsideClinic’ s training and peer support, advancing my skills and knowledge in key areas.
JA: I’ m involved in the delivery of every aspect of optometry, including dispensing, whereas on the High Street, an optometrist never really gets involved in the dispensing side of things. Some people might find that more challenging, but I’ m really enjoying the opportunity to put a wide range of skills and knowledge to good use. I find it incredibly rewarding.
JA: The COVID-19 pandemic resulted in many older people preferring to book home visits rather than travel to their High Street optician, and, consequently, demand for OutsideClinic’ s services surged. It makes me proud to know that we’ re supporting the people who most need our help during these challenging times, delivering clinically excellent eye care to the highest safety standards.
Shane O’ Rawe ( SO): My pre-reg year was with Specsavers. After qualifying in 2016 I worked as a locum within independent and multiple practices, before making the switch to OutsideClinic and the domiciliary sector last summer. The domiciliary sector appealed to me because it offers amazing opportunities to develop a broad range of optometry skills. It’ s brilliant in terms of professional development – and the support I receive from our clinical and professional services teams is second-to-none.
SO: The great thing about working at OutsideClinic is that you don’ t just learn from one person – you get the opportunity to learn from so many people on a daily basis. I’ ve had the opportunity to shadow a number of experienced domiciliary optometrists and I’ ve found this invaluable, particularly at this early stage in my domiciliary career.
SO: More awareness about the benefits, rewards, and opportunities of working in domiciliary is needed. Projections show people aged 65 and over will account for almost 25% of the UK population by 2038, and the home healthcare market will grow by 6.4% by 2026, so domiciliary eye care is a growth sector. There have never been greater opportunities for domiciliary optometrists.
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Best campervans 2022: the ultimate staycation machines | ► Which campervans are best? ► We round up top options for luxury staycations► Something for all budgets
Over the pandemic, the popularity of campervans exploded, and it's not so hard to see why. When international travel was plagued with uncertainty, a holiday you can take in the UK with no pre-departure Covid tests, no risk of travel restrictions and a good deal of freedom seemed like the best of all worlds.
And these little motorhomes aren't just useful for going on holiday, either. They make incredibly handy second vehicles - capable of load-lugging with the best of estate cars, or if you choose the right model converting into a practical people-carrier with ease.
Many people have also found them useful for sporting pursuits or even leaving them parked on the drive to be used as a spare bedroom or a homeworking office away from the kids.
And whatever you use it for during the week, these vehicles offer the freedom of the UK's thousands of campsites at the weekend with no more preparation than filling the cupboards with cornflakes.
How much does it cost to insure a campervan? Find out with our partner Mustard
Though expensive to buy, they can last for years and years of happy holidays. And now, you even have a choice of manufacturer backed campervans – vehicles sold and warranted by major vehicle brands rather than small third-party outfits.
We’ ve put two of the best of these – the Volkswagen California and the Ford Transit Custom Nugget – head-to-head below, so scroll down if you want to read that. Or, click here to skip straight past it and read up on the alternatives you might also be considering.
For a more detailed comparison of these two campervans on our sister site, Parkers.co.uk, click here.
Both of these vehicles look extremely appealing if you’ re hunting for a mid-sized campervan. They’ re based on two of the best panel vans you can buy today, Volkswagen’ s classy Transporter and Ford’ s best-selling Transit Custom. They both sleep a family of four, have pop-up canvas roofs to provide standing room, and offer everything you need to make them your self-contained home away from home.
They both cost around £65,000, too, though the Volkswagen California Ocean seen here steps that up to £72,000 with several optional extras including a near-£3,000 paint job.
But there’ s plenty to separate them, and in our eyes – a clear winner, too.
Though larger campervans are nearly all based on Fiats, in this mid-sized category, the Volkswagen Transporter reigns supreme. There are a variety of reasons for that, but one of the most compelling must be nostalgia – the classic VW Camper is as much an icon as any Beetle or Mini.
Transporters are great to drive, with the latest T6 vans featuring technology lifted wholesale from VW’ s passenger cars, powerful diesel engines and slick DSG automatic gearboxes. They also have a really classy image and feel solidly built. And third-party converters like their high payloads, unobstructed interiors, and strong reliability record.
VWs have been converted into campers ever since their introduction, but the California name first appeared on a T3 Transporter-based motorhome in the 1980s. Back then, the duties of conversion went to camping giant Westfalia. But in 2003, VW itself resurrected the name and began building its own Californias in a dedicated factory in Germany.
In an interesting twist of fate, it’ s Westfalia that’ s responsible for the conversion on the Ford Transit Custom Nugget. Ford has no part in the building of these campers – but like the Volkswagen, you can buy, service and maintain it at a main Ford dealer and it benefits from a full manufacturer warranty on both the base vehicle and the conversion.
The Transit Custom makes a brilliant base vehicle in and of itself, too. This is the best-selling van in the UK for a reason – it’ s great to drive, hugely versatile and so ubiquitous that maintenance is cheap and easy.
Both vehicles are offered with a pair of engine choices. For the Ford, it’ s a 2.0-litre diesel with either 128bhp or 183bhp, the latter paired to a six-speed automatic gearbox. The VW also has a 2.0-litre diesel, offered with 148bhp or 197bhp. All Ocean models have a seven-speed DSG automatic, and four-wheel drive is optional.
It’ s the Transit that’ s the better steer here, though VW’ s automatic gearbox is slicker and its diesel engine more efficient. Really, though, there’ s little to separate the two beyond personal preference. There’ s more to moan on the equipment front, though, as the California Ocean trounces the Transit when it comes to in-cab comforts – boasting climate control, LED headlights and a fully digital dashboard. Not things that matter to your average van driver, but when you're spending thousands on a home away from home...
These two vans use totally different layouts. The California’ s the more traditional of the two – it has a side-mounted furniture unit, rear-hinged rising roof and a rock’ n’ roll bed downstairs. The majority of campervans of this size use this layout, and for good reason, as it’ s simple and versatile.
Two can sleep up top in the electrically-operated roof and two below, while there are four belted travel seats. Along the side kitchen unit you’ ll find the facilities – a sink with hot and cold running water, a twin-burner gas hob ( fed by a gas cylinder in the rear) and a top-loading fridge.
Behind the rear bed there’ s a wardrobe and a ‘ boot’ area of sorts – this is great if you’ re using the California as a secondary car, or for storing suitcases and bed linens when on the move.
The Nugget’ s totally different. Its kitchen is L-shaped, and situated at the rear of the van – with a front-hinged roof providing standing room around the sink, twin gas burners and top-loading fridge.
The rear seat – this time a three-seat bench – sits ahead of this, closer to the two front seats. It makes up into a bed, though not in as intuitive a way as the California’ s, and the top beds of both vans are very similar.
Which layout you like best is a matter of personal preference. We prefer the California’ s traditional layout – it’ s more versatile, feels more spacious and that ‘ boot’ area is super useful. However, others have pointed out that the Nugget’ s more split personality can be useful. One parent can cook in the rear of the van while another entertains the kids in the front, for example.
The Ford’ s twin sliding doors and three-seat rear bench make it more useful as a people-mover, too, though it’ s worth noting it’ ll still only sleep four. The California can be optioned with a third rear seat as a separate unit, but it’ s an expensive and awkward addition.
No, what really sets these two vans apart is the quality and usability of their interior conversions, and it’ s something that a few minutes with either van will display. The Volkswagen California’ s interior is a model of clarity, quality and ease-of-use, and the Ford Transit Custom Nugget’ s feels awkward and clunky in comparison.
Take something as simple as folding out the downstairs bed, for example. In the California, it’ s a three-step process – drop the rear headrests at the touch of a button, slide the seat forward, and drop its backrest down flat. In the Nugget, that process takes twice as long, uses incredibly stiff and uncomfortable levers, and is very difficult to do without stepping out of the van – not ideal if you’ re pitching on a cold or rainy night.
Then there’ s the little things. Who’ d’ ve thought curtains would be such a problem? The Nugget has them on every window, fastened with desperately fiddly popper buttons. By the time you’ ve closed one, you could easily have dropped all of the California’ s one-handed roller blinds. The same goes for the front windows, where the California has magnetic blinds that fasten in an instant while the Ford has insulated screens held on by suction cups. Or barely held on, in our case – we stepped down from the top bed in the morning to find they’ d fallen off in the night.
These issues may not be big deals to you, and given that both of these vans are available to eye up, poke around and experience in main dealers means you can – Covid-permitting – make a totally educated decision. For our money, though, it’ s the California all day long. To save cash we’ d sack off the options our test van came with ( though it’ d be hard to skip the £2,880 two-tone paint job…) and opt for the lower-powered 150hp engine, which is still far from sluggish.
The resulting van would be effortlessly competent and beautifully built, with residual values most cars could only dream of. It’ s easy to dismiss the California, and vans like it, as expensive toys – but the memories you could make in a decade of stress-free ownership would be priceless.
Don’ t fancy a Ford or a VW? There’ s one other campervan sold in the UK with the full backing of its base vehicle manufacturer – the Mercedes-Benz Marco Polo. Coronavirus prevented us from testing this van alongside the two above, but we tested one back in 2019.
It’ s as luxurious as any vehicle carrying that three-pointed star, based on the V-Class people-carrier and fitted with powerful diesel engines and smooth nine-speed autos. For a couple, definitely a higher-class option, but we’ d say it’ s not quite as family-friendly as the Volkswagen California. It’ s similar in price though, and well worth considering.
If space is your concern – you want more of it on the inside and don’ t mind how much you take up on the outside – then look at the Grand California. This is based on the Volkswagen Crafter, itself a brilliant large panel van, and takes everything we enjoy about the regular California and scales it up.
So now not only do you get four seats and a kitchen, but you get a permanent bed at the rear, standing room throughout, and best of all – a wetroom with shower and toilet.
The conversion inside is all Volkswagen’ s work, and the quality is, of course, spectacular. Though it’ s more pricey and less practical as a daily drive than the standard California, this really is a true home-away-from-home, and one we rated very highly when we drove it.
You 've optioned up ( above) now it's time to option down in the California range. Set to hit UK roads in 2022, the Caddy California is a marvel of packaging - it's the size of a family car ( and could even be used as one) but features a large double bed and even a kitchen round the rear.
It's more aimed at day trippers and quick overnight stays than it is at those doing a week-long vacation, but an optional drive-away awning turns it from somewhere just to sleep and eat into a real base of operations. We 've not had the chance to stay overnight in this one yet, but we 've driven it and had a good poke around. We're very excited for its launch, especially with the range starting at less than £30,000.
Another one we 've not had the chance to test yet, this is a conversion by Yorkshire-based Wellhouse Leisure that's been approved by Vauxhall - so, like the Marco Polo and Nugget, consider it 'manufacturer-supported '. Wellhouse is well regarded for its camper conversions and the Vivaro looks intriguing - nothing groundbreaking, but solid and attractive.
The Vivaro's also a really good van to drive, and a little more compact than the Ford, Mercedes or VW siblings. As soon as we're able we 'll get our hands on one and give it the full going-over.
Like the Vauxhall above, this is a Wellhouse Leisure conversion - and since the Proace is functionally identical to the Vivaro these vans are essentially the same. However, with a Toyota you benefit from up to ten years of warranty cover on the base vehicle.
Just because you can buy a campervan from a main dealer, doesn’ t mean you have to. The UK is littered with motorhome dealers who’ ll sell you any number of third-party conversions – vehicles that hail from all across Europe and come in a dizzying array of specs and layouts.
If you have specialist needs, a third-party conversion is the way to go, as you’ ve so much more choice. It’ s even possible to spec your own from the ground up, ideally suiting it to your own needs. If you need extra seats, or wheelchair accessibility; if you want a bigger kitchen, or a longer bed or a wine cooler or crocodile-skin upholstery – there’ s a converter out there for you.
Some even specialise in campervans built on used base vehicles, helping to bring the price down to a level that might be more manageable. | general |
The Radical Hood Library Is the L.A. Headquarters of Noname Book Club | Nestled in an old commercial-building structure on Los Angeles’ s Jefferson Boulevard, alongside a panadería and a preschool, is a little library. Unlike the city library up the street, this one is solely focused on circulating books that explore radical political ideas, such as abolition and anarchism. There’ s poetry, too, and even some zines.
The Radical Hood Library opened its doors in September, but can only do so one day a week due to the ongoing COVID pandemic. The library, founded by poet and musician Fatimah Warner, whose stage name is Noname, is the headquarters for the Noname Book Club. Although the book club bears Noname’ s moniker, the efforts are not hers alone — and she would probably be the first to tell you so.
The book club is a Black-led worker cooperative — meaning that the business is owned and self-managed by those who are working in it — and is currently operated by four people: Fatimah, who describes herself as “ the ideas person in the corner, ” primarily runs the social media accounts; Natalie Matos is the project manager; Sage is the prison chapter coordinator; and Michael Anderson is the educational coordinator.
“ For me and developing my politics, it was important to have practice and actually engage in the theoretical stuff that I 'm reading, ” Fatimah tells Teen Vogue. “ I 've been the sole owner of different aspects of my music business, and it's okay, but it's a lot. I don't know why people... I mean, I get, obviously, capitalists are like, ‘ me, me, me,’ the individualism. But who wants to hold the whole weight of an organization by themselves? ”
During a recent Zoom interview, Fatimah and Natalie talk at length about radicalizing libraries, the recent wave of book bans in public schools, the U.S. prison system, building a more collaborative future, and, of course, books themselves.
Fatimah says working in a co-op has been both challenging and rewarding: “ Everyone's labor, care, and expertise come together to make this thing happen every month. ”
Natalie agrees, noting that the cooperative offers members the closest path to revolutionary practices that they can practice within the confines of capitalism. “ This is consensus, '' she says. `` This is practicing building community and being part of something larger than yourself. ”
The book club first took off in 2019, after Noname, who has hundreds of thousands of followers on Twitter, shared a post with them about what she was reading at that time. That spark turned into the Noname Book Club, which now has 12 book club chapters across the United States, one in London, and soon another in South Africa. The opening of the library space in Los Angeles, which they hope is just one of the first, is meant to confirm the group's commitment to providing free revolutionary literature to people in their community and in prison.
The library is located in the historical Black community of Jefferson Park, east of West Adams and north of Leimert Park. Gentrification is a problem throughout Los Angeles, and the communities that surround the library are deep in the throes of it. When Fatimah, who is from Chicago, first announced that they had opened the library in Los Angeles, there were mixed reviews in the Twitterverse. Some commended the effort, while others called out the location choice, asking why a celebrity who is not from Los Angeles would start this project in a rapidly gentrifying neighborhood. Would the library accelerate ongoing community displacement?
Says Fatimah of her response to the concerns and the praise, “ I do think that the criticisms around gentrification and the space becoming increasingly white, based on my fan base and white people liking shit, I think those are definitely real concerns to be had. They're concerns that we had. ”
As an artist, Noname has publicly discussed her frustrations with making music for people like her and then seeing mostly white people at her shows. So these concerns have carried over to the library: “ I am Noname, and most of the people who follow me and know me... they are white people, and the space is not for them. ”
For that reason, the group initially didn’ t disclose the location of the library, but that only made the space seem “ cliquish, ” Fatimah says. She expresses frustration that people didn’ t approach the conversation in better faith. “ I wish people would have come to us a little less argumentative and just telling us how horrible it's going to be and maybe offer some resources. Like, ‘ How can we avoid that? What would you suggest?’ But that's obviously not Twitter. ”
Natalie thinks those concerns would diminish if people came to visit the space themselves. “ Once people started coming in and seeing what the demographic is that spends a lot of time here, and that we really do put a lot of care into making sure that our neighbors know about this library, '' she says. “ Just come to the space and check it out — maybe it's not as evil as you think. ”
A few weeks after our call, I visit the library for myself. When you walk in, there’ s a small room that works as a welcome area and feeds into the larger space next door. Parable of the Sower by Octavia Butler, Heavy by Kiese Laymon, and Captive Genders, edited by Eric A. Stanley and Nat Smith, are a few of the titles that fill the library's walls. One wall mostly filled with Lorenzo Kom’ Boa Elvin’ s book Anarchism and the Black Revolution features a note that reads, “ PRISON CHAPTER BOOKS. DO NOT TOUCH. ”
In April 2021, Noname Book Club started to focus on sending books to people who are incarcerated. That wing of the book club is directed by Sage, but the chapters themselves form through a different process. “ Book club chapters happened organically inside the prisons, not because we designed them, but because people were talking with each other, '' Natalie tells Teen Vogue. `` People are natural organizers when they're put in a position where they have to really think about the injustices. ” A black, painted map of the United States hangs in the library, dotted by more than a dozen little red flags that represent locations where a prison chapter has begun.
Part of that organizing has involved connecting members within jails and prisons to those participating from the outside. Explaining how the book club can help build those bridges, Fatimah says, “ Once I started reading more about the prison industrial complex and abolition as a framework, I really thought about the way that the state disappears people and how that can be disrupted a little bit, and I thought [ the ] book club was a perfect opportunity. ”
But not all of the books make it through the prison gates. Natalie and Fatimah share that they receive rejection letters for some of the books they try to send through, especially titles that hit too close to home, such as Derecka Purnell’ s Becoming Abolitionists: Police, Protests, and the Pursuit of Freedom. “ There's a lot of energy and thought and intentionality behind this, but prisons are not meant to be equitable, or sensical even, ” Natalie says in frustration.
In addition to trying to get radical books inside prison walls, the book club has managed to spread radical knowledge to local communities simply by increasing the number of radical books in circulation. In an effort to get people to stop using Amazon ( the rapper declared January 11 as National F * ck Amazon Day), they’ ve partnered with local libraries across the country by giving them a list of the books the club will be reading. “ An accidental side effect of Noname Book Club was that now libraries and bookstores are carrying more of this reading material, ” says Natalie.
Isn’ t that the right’ s biggest nightmare? Amid national political conversation about which books should be taught in schools, libraries can help make sure that young people — that all people — can access important texts that might otherwise be lost to the newest round of culture wars.
“ We're reading Live From Death Row right now, Mumia Abu-Jamal's book, and there was one copy floating around throughout the entire Los Angeles Public Library system, ” Fatimah says. `` When you have situations like that, I think it's important that we do have as many free spaces as possible where people can come and read and learn. ”
In coordination with the book club, the Radical Hood Library hosts monthly meetups where people can get together in person to discuss the reading materials. In February they read The Nation on No Map by William C. Anderson and bell hooks’ s Salvation. They have also held film screenings of documentaries and opened their doors to local activist organizations.
Toward the end of our conversation, we discuss the longing for a radical community and how book clubs can serve as a way to fight alienation. Even I started a book club during the pandemic. We read Black Marxism by Cedric Roberson. Although the club dissolved after we finished the tome, it was nice to have a way to connect with friends I was temporarily unable to see in person.
If you’ re looking to start your own book club, whether to make new friends or have someone to talk with about books, Natalie and Fatimah offer the following advice: When you’ re reading something heavy, pair it with “ something light ”; try to meet at least once a month; and have an accountability process. If you’ re not completely caught up on the reading, don’ t let that discourage you or others from participating in the conversation.
The Radical Hood Library and the Noname Book Club, including the prison chapters, are largely supported by nearly 12,000 patron supporters. To learn more about how to visit, join a book club, or provide support, go to Noname Book Club’ s website for more information.
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U.S. cherry blossom festival opens ahead of peak bloom | WASHINGTON – With the peak for cherry blossoms in the U.S. capital forecast for later this week, the opening ceremony of the National Cherry Blossom Festival was held Sunday at a Washington theater.
The annual spring festival returned to an in-person format for the first time since the coronavirus pandemic started. Prior to the pandemic, more than 1.5 million people had visited the capital annually to enjoy the cherry blossoms along the Potomac River, as well as a series of Japan-related events.
The cherry blossoms serve as a reminder of the friendship between the United States and Japan. This year marks the 110th anniversary of the 1912 gift of 3,000 nursery cherry trees to Washington from Tokyo’ s then-mayor, Yukio Ozaki.
U.S. first lady Jill Biden, who serves as honorary chairwoman of the festival, said in a video message, “ Since receiving them more than a century ago, Japan’ s cherry trees have become so much more than a gift of diplomacy. ”
“ Like the ‘ yujou ‘ — or friendship — they represent, the roots of the cherry blossoms have grown deep. Now, they are part of who we are, adding to the unique and beautiful character of our capital, ” she said.
Japanese Ambassador to the United States Koji Tomita said the cherry blossoms have become “ a living symbol ” of Japan-U.S. friendship and he believes the festival this year will be a special celebration of “ freedom ” after living under the shadow of the pandemic for two years.
U.S. first lady Jill Biden in a video message during the opening ceremony of the National Cherry Blossom Festival, in Washington, on Sunday | KYODO
The ceremony featured performances by shamisen player Keisho Ohno, as well as musical group Minyo Crusaders, a band that combines Japanese traditional minyo folk songs with various rhythmic backings such as from Latin and Afro-Caribbean music. A samurai performance also took place.
The National Park Service has predicted peak bloom to fall between Tuesday and Friday. The festival will continue through April 17, including a parade and what the organizers call a “ cherry-blossom themed ” basketball game involving the NBA’ s Washington Wizards, to which Rui Hachimura from Japan belongs. | tech |
Cleveland-Cliffs to Fully Redeem its 9.875% Senior Secured Notes due 2025 | Cleveland-Cliffs to Fully Redeem its 9.875% Senior Secured Notes due 2025
Cleveland-Cliffs Inc. ( NYSE: CLF) announced today that it has instructed the trustee to provide notice of redemption for the entirety of its remaining $ 607 million aggregate principal amount of outstanding 9.875% Senior Secured Notes due October 2025. Pursuant to the terms of the Notes and the Indenture governing the Notes, the Company expects the total payment to holders of the Notes including the redemption premium to be approximately $ 677 million, plus accrued and unpaid interest, if any, to, but not including, the redemption date, which is expected to be on April 20, 2022. The Notes will be redeemed with available liquidity. The cash interest associated with these notes is approximately $ 60 million per year.
Lourenco Goncalves, Cliffs ' Chairman, President and Chief Executive Officer said, “ With expectations for our free cash flow generation continuing to rise, our top priority for the use of this cash remains the reduction in debt. This redemption is an important accomplishment for our deleveraging goals, removing our highest-coupon and nearest dated major debt tranche that was issued during the peak of pandemic uncertainty. We will have significantly lower interest expenses as a result. ”
This release is for informational purposes only and is neither an offer to buy nor a solicitation to sell any of the Notes. The foregoing does not constitute a notice of redemption under the Indenture governing the Notes and is qualified in its entirety by the redemption notice that will be distributed to the holders of the Notes. A notice of redemption setting forth the redemption procedures will be provided to registered holders of the Notes by The Depository Trust Company.
Cleveland-Cliffs is the largest flat-rolled steel producer in North America. Founded in 1847 as a mine operator, Cliffs also is the largest manufacturer of iron ore pellets in North America. The Company is vertically integrated from mined raw materials, direct reduced iron, and ferrous scrap to primary steelmaking and downstream finishing, stamping, tooling, and tubing. We are the largest supplier of steel to the automotive industry in North America and serve a diverse range of other markets due to our comprehensive offering of flat-rolled steel products. Headquartered in Cleveland, Ohio, Cleveland-Cliffs employs approximately 26,000 people across its operations in the United States and Canada.
This release contains statements that constitute “ forward-looking statements ” within the meaning of the federal securities laws. All statements other than historical facts, including, without limitation, statements regarding our current expectations, estimates and projections about our industry or our businesses, are forward-looking statements. We caution investors that any forward-looking statements are subject to risks and uncertainties that may cause actual results and future trends to differ materially from those matters expressed in or implied by such forward-looking statements. Investors are cautioned not to place undue reliance on forward-looking statements. Among the risks and uncertainties that could cause actual results to differ from those described in forward-looking statements are the following: disruptions to our operations relating to the ongoing COVID-19 pandemic, including the heightened risk that a significant portion of our workforce or on-site contractors may suffer illness or otherwise be unable to perform their ordinary work functions; continued volatility of steel, iron ore and scrap metal market prices, which directly and indirectly impact the prices of the products that we sell to our customers; uncertainties associated with the highly competitive and cyclical steel industry and our reliance on the demand for steel from the automotive industry, which has been experiencing a trend toward light weighting and supply chain disruptions, such as the semiconductor shortage, that could result in lower steel volumes being consumed; potential weaknesses and uncertainties in global economic conditions, excess global steelmaking capacity, oversupply of iron ore, prevalence of steel imports and reduced market demand, including as a result of the prolonged COVID-19 pandemic; severe financial hardship, bankruptcy, temporary or permanent shutdowns or operational challenges, due to the ongoing COVID-19 pandemic or otherwise, of one or more of our major customers, including customers in the automotive market, key suppliers or contractors, which, among other adverse effects, could lead to reduced demand for our products, increased difficulty collecting receivables, and customers and/or suppliers asserting force majeure or other reasons for not performing their contractual obligations to us; risks related to U.S. government actions with respect to Section 232 of the Trade Expansion Act of 1962 ( as amended by the Trade Act of 1974), the United States-Mexico-Canada Agreement and/or other trade agreements, tariffs, treaties or policies, as well as the uncertainty of obtaining and maintaining effective antidumping and countervailing duty orders to counteract the harmful effects of unfairly traded imports; impacts of existing and increasing governmental regulation, including potential environmental regulations relating to climate change and carbon emissions, and related costs and liabilities, including failure to receive or maintain required operating and environmental permits, approvals, modifications or other authorizations of, or from, any governmental or regulatory authority and costs related to implementing improvements to ensure compliance with regulatory changes, including potential financial assurance requirements; potential impacts to the environment or exposure to hazardous substances resulting from our operations; our ability to maintain adequate liquidity, our level of indebtedness and the availability of capital could limit our financial flexibility and cash flow necessary to fund working capital, planned capital expenditures, acquisitions, and other general corporate purposes or ongoing needs of our business; our ability to reduce our indebtedness or return capital to shareholders within the currently expected timeframes or at all; adverse changes in credit ratings, interest rates, foreign currency rates and tax laws; the outcome of, and costs incurred in connection with, lawsuits, claims, arbitrations or governmental proceedings relating to commercial and business disputes, environmental matters, government investigations, occupational or personal injury claims, property damage, labor and employment matters, or suits involving legacy operations and other matters; supply chain disruptions or changes in the cost or quality of energy sources, including electricity, natural gas and diesel fuel, or critical raw materials and supplies, including iron ore, industrial gases, graphite electrodes, scrap metal, chrome, zinc, coke and metallurgical coal; problems or disruptions associated with transporting products to our customers, moving manufacturing inputs or products internally among our facilities, or suppliers transporting raw materials to us; uncertainties associated with natural or human-caused disasters, adverse weather conditions, unanticipated geological conditions, critical equipment failures, infectious disease outbreaks, tailings dam failures and other unexpected events; disruptions in, or failures of, our information technology systems, including those related to cybersecurity; liabilities and costs arising in connection with any business decisions to temporarily idle or permanently close an operating facility or mine, which could adversely impact the carrying value of associated assets and give rise to impairment charges or closure and reclamation obligations, as well as uncertainties associated with restarting any previously idled operating facility or mine; our ability to realize the anticipated synergies and benefits of our recent acquisition transactions and to successfully integrate the acquired businesses into our existing businesses, including uncertainties associated with maintaining relationships with customers, vendors and employees and known and unknown liabilities we assumed in connection with the acquisitions; our level of self-insurance and our ability to obtain sufficient third-party insurance to adequately cover potential adverse events and business risks; challenges to maintaining our social license to operate with our stakeholders, including the impacts of our operations on local communities, reputational impacts of operating in a carbon-intensive industry that produces greenhouse gas emissions, and our ability to foster a consistent operational and safety track record; our ability to successfully identify and consummate any strategic capital investments or development projects, cost-effectively achieve planned production rates or levels, and diversify our product mix and add new customers; our actual economic mineral reserves or reductions in current mineral reserve estimates, and any title defect or loss of any lease, license, easement or other possessory interest for any mining property; availability of workers to fill critical operational positions and potential labor shortages caused by the ongoing COVID-19 pandemic, as well as our ability to attract, hire, develop and retain key personnel; our ability to maintain satisfactory labor relations with unions and employees; unanticipated or higher costs associated with pension and other postretirement benefit obligations resulting from changes in the value of plan assets or contribution increases required for unfunded obligations; the amount and timing of any repurchases of our common shares; and potential significant deficiencies or material weaknesses in our internal control over financial reporting. The Company undertakes no obligation to publicly update forward-looking statements, whether as a result of more information, future events or otherwise.
For additional factors affecting the business of Cliffs, refer to Part I – Item 1A. Risk Factors of our Annual Report on Form 10-K for the year ended December 31, 2021, and other filings with the U.S. Securities and Exchange Commission.
View source version on businesswire.com: https: //www.businesswire.com/news/home/20220321005354/en/
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Carbon Footprint Management Global Market Report 2022 | New York, March 21, 2022 ( GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report `` Carbon Footprint Management Global Market Report 2022 '' - https: //www.reportlinker.com/p06246522/? utm source=GNW, SAP SE, Johnson Controls, Accenture PLC, IBM Corporation, Schneider Electric S.E., Natural Capital Partners, VelocityEHS and Carbon Trust.The global carbon footprint management market is expected to grow from $ 8.63 billion in 2021 to $ 9.42 billion in 2022 at a compound annual growth rate ( CAGR) of 9.1%. The change in growth trend is mainly due to the companies stabilizing their output after catering to the demand that grew exponentially during the COVID-19 pandemic in 2021. The market is expected to reach $ 12.20 billion in 2026 at a CAGR of 6.7%.The carbon footprint management market consists of sales of carbon footprint management solutions and services by entities ( organizations, sole traders, and partnerships) that use the software to track the carbon footprint of an organization.A carbon footprint management system is a technological solution for measuring the impact of human activity on the environment expressed as a carbon dioxide equivalent.This tool allows organizations to identify opportunities for reducing material, water, waste, and energy use, thus reducing the carbon footprint of the company.The main types of components in carbon footprint management are solutions and services.The services provided by carbon footprint management include consulting, integration and deployment, support and maintenance, and system integration.The different modes of deployment include on-premise, cloud and are implemented in various verticals such as manufacturing, IT and telecom, residential and commercial buildings, transportation and logistics, energy and utilities, others.North America was the largest region in the carbon footprint management market in 2021.The Asia Pacific is expected to be the fastest-growing region in the forecast period.The regions covered in this report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, and Africa.The introduction of various carbon emission policies by governments in carbon footprint management is expected to propel the growth of the carbon footprint management market during forecast period.Governments across the world have taken various initiatives to reduce carbon footprint and pollution.For instance, in May 2021, the German government set new targets to reduce its carbon footprint.Under the new targets, Germany will aim for a 65%, 88%, and nearly 0% net carbon emission by 2030, 2040, and 2045 respectively.As a result, organizations have been instructed by governments to follow the norms and regulations. The adherence requirements for reducing carbon footprint would result in a growth in the demand for carbon footprint management systems as it assists organizations in identifying avenues for reducing their carbon footprint.The rising focus on enterprise sustainability among organizations is a key trend gaining popularity in the carbon emission management market.Major companies operating in the carbon emission management sector are focused on launching new products to meet the rising market demand for regulating their carbon emission.For instance, in June 2021, a France-based information technology services and consulting company, Capgemini, launched “ Sustainable IT ”, an offering designed to assist IT companies in reducing their carbon footprint. The new offering is meant to support clients on their sustainability journey through its technical expertise, customized approach, and strong partner ecosystem using Capgemini’ s global sustainability offering framework.In October 2020, Radicle Group Inc., a carbon reduction solutions company based in Canada acquired Climate Smart Businesses Inc. for an undisclosed amount. Through this acquisition, Radicle Group aims to better address the needs of clients seeking to calculate emissions and then manage a carbon strategy to strengthen their business. Climate Smart Businesses is a Canada-based company that provides carbon footprint management services.The countries covered in the carbon footprint management market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA.Read the full report: https: //www.reportlinker.com/p06246522/? utm source=GNWAbout ReportlinkerReportLinker is an award-winning market research solution. Reportlinker finds and organizes the latest industry data so you get all the market research you need - instantly, in one place. | general |
Indian Morning Briefing: Asian Markets Mixed After Hawkish Fed Comments | Investors sold stocks and government bonds after Federal Reserve Chairman Jerome Powell reiterated the central bank's commitment to controlling inflation through a rapid series of interest-rate increases.
The S & P 500 edged lower by less than 0.1% following comments from Mr. Powell about the possibility of more-aggressive interest-rate moves to tame inflation. Treasury yields rose following his comments, reaching their highest level since May 2019.
The tech-focused Nasdaq Composite Index lost 0.4% while the Dow Jones Industrial Average slipped 0.6%. Boeing shares fell 3.6% after a Boeing 737 passenger plane operated by China Eastern Airlines carrying more than 130 people crashed in southern China.
Investors digested comments from Mr. Powell as he discussed the economic outlook. Speaking at the National Association for Business Economics, he said the central bank was prepared to raise interest rates in half-percentage-point steps-and high enough to deliberately slow the economy-if needed.
Japanese stocks were higher, led by gains in financial stocks, as the yen weakened against the dollar, thanks to gains in U.S. Treasury yields overnight. USD/JPY rose to 119.82, the highest level since February 2016, compared with 118.76 as of Friday's Tokyo stock market close. Japanese markets were closed Monday for a national holiday. Investors remain focused on headlines on Ukraine. The Nikkei Stock Average was 1.4% higher at 27204.21.
South Korea's Kospi rose 0.5% to 2699.57 in early trade, led by transport and energy stocks. Investors were awaiting more economic data while parsing Fed Chairman Powell's comments that the U.S. central bank is prepared to raise interest rates in half-percentage-point steps, if warranted, to tame inflation. Retail and institutional investors were net buyers, while foreign investors remained net sellers.
Hong Kong's Hang Seng Index rose 0.5% to 21319.19 in early trade. The strength of the U.S. dollar index is unlikely to be favorable for Hong Kong-listed stocks, KGI Securities said. It expects the index to trade range-bound during the session and for investors to continue to focus on upcoming company earnings releases.
Chinese stocks were lower in morning trade as auto stocks weighed. The Shanghai Composite Index declined 0.3% to 3243.86, the Shenzhen Composite Index was 0.4% lower at 2151.42 and the ChiNext Price Index was down 0.8% at 2703.24. Auto stocks led the declines, with SAIC Motor off 0.2% and BYD Co. down 1.0%. Coronavirus-related developments continued to beclosely watched, following Hong Kong's move to gradually lift its Covid-19 restrictions. `` This move could be an essential step for China to gradually cede its Covid Zero policy, '' SPI Asset Management said.
The US dollar strengthened against the euro and slightly against the yen. The WSJ Dollar Index was up 0.17 point or 0.19% to 91.26. Goldman Sachs said three possible shifts in capital flows could be dollar-negative: inflows back to the euro area as the ECB exits negative rates, outflows from the US due to weaker equity returns, and de-dollarization efforts by official institutions in order to cut exposure to dollar-centric payment networks and for other geopolitical reasons. `` US officials are aware that faster de-Dollarization could be a side effect of aggressive use of financial sanctions, '' Goldman's Zach Pandl said, noting Saudi Arabia is considering changing the FX denomination of some of its oil sales. The dollar is likely tied to Ukraine and Fed-related developments near-term but the threat of accelerated de-dollarization by other nations adds to the structural USD bear case, he said.
Gold declined in early Asian trade following comments by Federal Reserve Chairman Jerome Powell who said the central bank was prepared to raise its key rate by half a percentage point to cool inflation; some investors consider higher rates to be a negative for gold prices as bond yields become more attractive. The precious metal may gain some near-term support from rising commodity prices, which helps to underpin gold's allure as an inflation hedge, ANZ said. `` Its safe haven status is also coming to the fore amid the Ukraine conflict. '' Spot gold was 0.3% lower at $ 1,929.83/oz.
Oil rose in early Asian trade, on reports that support for a European Union-wide ban on the purchase of Russian oil is growing inside the bloc. News that Houthi rebels have launched multiple attacks at some Saudi Aramco sites was also driving oil prices higher, Oanda said. `` The oil rollercoaster ride remains a geopolitical trade and right now it seems the risks are growing and that could push crude prices higher, '' Oanda said. Front-month WTI crude oil futures and Brent were each 1.8% higher at $ 114.16/bbl and $ 117.65/bbl, respectively.
Transparency is how we protect the integrity of our work and keep empowering investors to achieve their goals and dreams. And we have unwavering standards for how we keep that integrity intact, from our research and data to our policies on content and your personal data.
We’ d like to share more about how we work and what drives our day-to-day business.
We sell different types of products and services to both investment professionals and individual investors. These products and services are usually sold through license agreements or subscriptions. Our investment management business generates asset-based fees, which are calculated as a percentage of assets under management. We also sell both admissions and sponsorship packages for our investment conferences and advertising on our websites and newsletters.
How we use your information depends on the product and service that you use and your relationship with us. We may use it to:
To learn more about how we handle and protect your data, visit our privacy center.
Maintaining independence and editorial freedom is essential to our mission of empowering investor success. We provide a platform for our authors to report on investments fairly, accurately, and from the investor’ s point of view. We also respect individual opinions––they represent the unvarnished thinking of our people and exacting analysis of our research processes. Our authors can publish views that we may or may not agree with, but they show their work, distinguish facts from opinions, and make sure their analysis is clear and in no way misleading or deceptive.
To further protect the integrity of our editorial content, we keep a strict separation between our sales teams and authors to remove any pressure or influence on our analyses and research.
Read our editorial policy to learn more about our process. | business |
Indian Morning Briefing: Asian Markets Mixed After Hawkish Fed Comments | Investors sold stocks and government bonds after Federal Reserve Chairman Jerome Powell reiterated the central bank's commitment to controlling inflation through a rapid series of interest-rate increases.
The S & P 500 edged lower by less than 0.1% following comments from Mr. Powell about the possibility of more-aggressive interest-rate moves to tame inflation. Treasury yields rose following his comments, reaching their highest level since May 2019.
The tech-focused Nasdaq Composite Index lost 0.4% while the Dow Jones Industrial Average slipped 0.6%. Boeing shares fell 3.6% after a Boeing 737 passenger plane operated by China Eastern Airlines carrying more than 130 people crashed in southern China.
Investors digested comments from Mr. Powell as he discussed the economic outlook. Speaking at the National Association for Business Economics, he said the central bank was prepared to raise interest rates in half-percentage-point steps-and high enough to deliberately slow the economy-if needed.
Japanese stocks were higher, led by gains in financial stocks, as the yen weakened against the dollar, thanks to gains in U.S. Treasury yields overnight. USD/JPY rose to 119.82, the highest level since February 2016, compared with 118.76 as of Friday's Tokyo stock market close. Japanese markets were closed Monday for a national holiday. Investors remain focused on headlines on Ukraine. The Nikkei Stock Average was 1.4% higher at 27204.21.
South Korea's Kospi rose 0.5% to 2699.57 in early trade, led by transport and energy stocks. Investors were awaiting more economic data while parsing Fed Chairman Powell's comments that the U.S. central bank is prepared to raise interest rates in half-percentage-point steps, if warranted, to tame inflation. Retail and institutional investors were net buyers, while foreign investors remained net sellers.
Hong Kong's Hang Seng Index rose 0.5% to 21319.19 in early trade. The strength of the U.S. dollar index is unlikely to be favorable for Hong Kong-listed stocks, KGI Securities said. It expects the index to trade range-bound during the session and for investors to continue to focus on upcoming company earnings releases.
Chinese stocks were lower in morning trade as auto stocks weighed. The Shanghai Composite Index declined 0.3% to 3243.86, the Shenzhen Composite Index was 0.4% lower at 2151.42 and the ChiNext Price Index was down 0.8% at 2703.24. Auto stocks led the declines, with SAIC Motor off 0.2% and BYD Co. down 1.0%. Coronavirus-related developments continued to beclosely watched, following Hong Kong's move to gradually lift its Covid-19 restrictions. `` This move could be an essential step for China to gradually cede its Covid Zero policy, '' SPI Asset Management said.
The US dollar strengthened against the euro and slightly against the yen. The WSJ Dollar Index was up 0.17 point or 0.19% to 91.26. Goldman Sachs said three possible shifts in capital flows could be dollar-negative: inflows back to the euro area as the ECB exits negative rates, outflows from the US due to weaker equity returns, and de-dollarization efforts by official institutions in order to cut exposure to dollar-centric payment networks and for other geopolitical reasons. `` US officials are aware that faster de-Dollarization could be a side effect of aggressive use of financial sanctions, '' Goldman's Zach Pandl said, noting Saudi Arabia is considering changing the FX denomination of some of its oil sales. The dollar is likely tied to Ukraine and Fed-related developments near-term but the threat of accelerated de-dollarization by other nations adds to the structural USD bear case, he said.
Gold declined in early Asian trade following comments by Federal Reserve Chairman Jerome Powell who said the central bank was prepared to raise its key rate by half a percentage point to cool inflation; some investors consider higher rates to be a negative for gold prices as bond yields become more attractive. The precious metal may gain some near-term support from rising commodity prices, which helps to underpin gold's allure as an inflation hedge, ANZ said. `` Its safe haven status is also coming to the fore amid the Ukraine conflict. '' Spot gold was 0.3% lower at $ 1,929.83/oz.
Oil rose in early Asian trade, on reports that support for a European Union-wide ban on the purchase of Russian oil is growing inside the bloc. News that Houthi rebels have launched multiple attacks at some Saudi Aramco sites was also driving oil prices higher, Oanda said. `` The oil rollercoaster ride remains a geopolitical trade and right now it seems the risks are growing and that could push crude prices higher, '' Oanda said. Front-month WTI crude oil futures and Brent were each 1.8% higher at $ 114.16/bbl and $ 117.65/bbl, respectively.
( END) Dow Jones Newswires
03-21-22 2315ET | business |
A critique of the marketisation of long-term residential and nursing home care - The Lancet Healthy Longevity | Long-term care systems across countries within the Organisation for Economic Co-operation and Development have undergone a progressive marketisation and financialisation in recent decades, characterised by the embedding of neoliberal market values such as competition, consumer choice, and the profit motive. In this Personal View, we argue that these make poor guiding principles for the care sector, identifying the dysfunctional dynamics that arise as a result, and reflecting on the clinical implications of each, with a focus on facility-based care. We outline why providers can scarcely respond to competitive forces without compromising care quality. We explain why the promotion of consumer choice can not effectively motivate improvements to quality of care. And we explore how privatisation opens the door to predatory financial practices. We conclude by considering how far proposals for reform can take us, ultimately arguing for a rejection of neoliberal market ideology, and calling for sector-wide discussions about what principles would be more fitting for a caring economy.
Long-term care systems across countries within the Organisation for Economic Co-operation and Development have undergone a progressive marketisation and financialisation in recent decades, characterised by the embedding of neoliberal market values such as competition, consumer choice, and the profit motive. In this Personal View, we argue that these make poor guiding principles for the care sector, identifying the dysfunctional dynamics that arise as a result, and reflecting on the clinical implications of each, with a focus on facility-based care. We outline why providers can scarcely respond to competitive forces without compromising care quality. We explain why the promotion of consumer choice can not effectively motivate improvements to quality of care. And we explore how privatisation opens the door to predatory financial practices. We conclude by considering how far proposals for reform can take us, ultimately arguing for a rejection of neoliberal market ideology, and calling for sector-wide discussions about what principles would be more fitting for a caring economy.
Long-term care systems across countries within the Organisation for Economic Co-operation and Development ( OECD) have undergone a progressive marketisation and financialisation over the last 30 years. From the UK,1Barron DN, West E. The quasi-market for adult residential care in the UK: do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care? Soc Sci Med 179: 137–46.Google Scholar Australia,2Cousins S Experts criticise Australia's aged care failings over COVID-19.Lancet. 2020; 396: 1322-1323Google Scholar and Germany,3Curry N Schlepper L Hemmings N What can England learn from the long-term care system in Germany?. Nuffield Trust, London2019Google Scholar to Sweden,4Brennan D Cass B Himmelweit S Szebehely M The marketisation of care: rationales and consequences in Nordic and liberal care regimes.J Eur Soc Policy. 2012; 22: 377-391Google Scholar Switzerland,5Crivelli L Filippini M Lunati D Regulation, ownership and efficiency in the Swiss nursing home industry.Int J Health Care Finance Econ. 2002; 2: 79-97Google Scholar and the USA,6Grabowski DC The market for long-term care services.Inquiry. 2008; 45: 58-74Google Scholar principles of competition and consumer choice have been embedded in provisioning and commissioning processes, and for-profit companies are now responsible for a significant proportion of care delivery. The broad motivation behind this move towards marketisation has been the idea that market forces will deliver improvements in cost-efficiency and quality, as well as providing consumers ( ie, service users) with a greater choice of providers.1Barron DN, West E. The quasi-market for adult residential care in the UK: do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care? Soc Sci Med 179: 137–46.Google Scholar, 7Pavolini E Ranci C Restructuring the welfare state: reforms in long-term care in Western European countries.J Eur Soc Policy. 2008; 18: 246-259Google Scholar However, despite indications that for-profit care providers are often ( although not always5Crivelli L Filippini M Lunati D Regulation, ownership and efficiency in the Swiss nursing home industry.Int J Health Care Finance Econ. 2002; 2: 79-97Google Scholar) more cost-efficient,8Anderson R Weeks H Hobbs B Webb J Nursing home quality, chain affiliation, profit status and performance.J Real Estate Res. 2003; 25: 43-60Google Scholar, 9Garavaglia G Lettieri E Agasisti T Lopez S Efficiency and quality of care in nursing homes: an Italian case study.Health Care Manage Sci. 2011; 14: 22-35Google Scholar the evidence that they deliver on average worse clinical outcomes and poorer working conditions is compelling.10Comondore VR Devereaux PJ Zhou Q et al.Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.BMJ. 2009; 339b2732Google Scholar, 11Hillmer MP Wodchis WP Gill SS Anderson GM Rochon PA Nursing home profit status and quality of care: is there any evidence of an association?.Med Care Res Rev. 2005; 62: 139-166Google Scholar Although many of these trends hold for home-based care and facility-based care alike, in this paper we focus specifically on the dynamics within the residential and nursing home sectors.
A meta-analysis from Comondore and colleagues10Comondore VR Devereaux PJ Zhou Q et al.Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.BMJ. 2009; 339b2732Google Scholar found that for-profit care homes across Australia, Canada, Taiwan, and the USA had 0·42 fewer staff hours per resident per day, and an 8·4% greater relative risk of pressure ulcers ( an indicator of care quality) among residents, than public and voluntary sector homes. Non-profit and public nursing homes in the USA have been repeatedly found to provide better quality care than for-profit homes, while public homes outperform both non-profit and for-profit facilities on access to care for low-income individuals.12Amirkhanyan AA Kim HJ Lambright KT Does the public sector outperform the nonprofit and for-profit sectors? Evidence from a national panel study on nursing home quality and access.J Policy Anal Manage. 2008; 27: 326-353Google Scholar In the UK, research suggests that quality ratings ( which capture a range of clinical and non-clinical quality criteria) and staff pay are both lower in for-profit facilities, as compared with their voluntary and public sector counterparts,1Barron DN, West E. The quasi-market for adult residential care in the UK: do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care? Soc Sci Med 179: 137–46.Google Scholar, 13Trades Union CongressNew Economics FoundationOutsourcing public services. London: Trades Union Congress.https: //www.tuc.org.uk/research-analysis/reports/outsourcing-public-servicesDate: 2015Date accessed: November 22, 2021Google Scholar and strategies such as restricting annual leave, decreasing staff-to-resident ratios, and removing sick pay are common.14Burns DJ Hyde PJ Killett AM How financial cutbacks affect the quality of jobs and care for the elderly.Ind Labor Relat Rev. 2016; 69: 991-1016Google Scholar
Marketisation has also opened the door to the increasing involvement of financial entities in the sector. Private equity firms now own several of the largest care home chains in the UK, USA, Sweden, and Norway, among other places.15Harrington C Jacobsen FF Panos J Pollock A Sutaria S Szebehely M Marketization in long-term care: a cross-country comparison of large for-profit nursing home chains.Heal Serv Insights. 2017; 10 ( 1178632917710533) Google Scholar Widespread use of predatory financial practices by these entities has sparked concerns about the implications of financialisation for quality of care, working conditions, and economic and operational stability across the sector.16Corlet Walker C Druckman A Jackson T Careless finance: operational and economic fragility in adult social care. CUSP Working Paper No 26. Centre for the Understanding of Sustainable Prosperity, Guildford2021Google Scholar
In this Personal View, we explore whether the neoliberal market principles of competition, consumer choice, and profit—which have been used to guide commissioning and provisioning decisions for the past 30 years—are fit for purpose. As progress against Sustainable Development Goal 3 ( ensuring healthy lives and wellbeing at all ages) has stalled and even reversed during the COVID-19 pandemic,17United Nations Economic and Social CouncilProgress towards the Sustainable Development Goals. Report of the Secretary-General.https: //unstats.un.org/sdgs/files/report/2021/secretary-general-sdg-report-2021 -- EN.pdfDate: April, 2021Date accessed: November 22, 2021Google Scholar reconsidering the suitability of our care infrastructure in this way has become a timely task. The discussion presented in this paper does not apply to all countries globally, and our analysis focuses primarily on four high-income countries of interest ( the UK, the USA, Australia, and Sweden); however, many of the dynamics discussed can be extrapolated to a greater or lesser extent to other marketised care systems, and we try to make clear throughout the piece where this is the case. The paper is structured as follows: we begin by describing two key economic characteristics of long-term care, which inform our subsequent discussions of market structures. We then explore several problematic dynamics that emerge in care markets, calling into question the suitability of the above guiding principles. Finally, we reflect on how far reforms can take us towards a well-functioning care sector.
Before turning to the challenges associated with market structures, we briefly consider two characteristics that are central to the way that we understand care and its economic dynamics. These characteristics hold for most facility-based care systems across the world. First, care work is time-intensive and not easily amenable to increases in labour productivity18Ozbugday FC Tirgil A Kose EG Efficiency changes in long-term care in OECD countries: a non-parametric Malmquist Index approach.Socioecon Plann Sci. 2020; 70100733Google Scholar ( defined in terms of output per unit of time worked), particularly in the long run. In other words, at some point it becomes difficult to squeeze more care out of an hour of a care worker's time. As a result, the care sector is subject to a dynamic known as Baumol's cost disease, in which the cost of care increases compared with the cost of other goods and services in the economy.19Jackson T Prosperity without growth: foundations for the economy of tomorrow. Routledge, Oxford2017Google Scholar, 20Baumol W The cost disease: why computers get cheaper and health care doesn't. Yale University Press, New Haven, CT2012Google Scholar This is largely because of the rising cost of labour. It holds true whether the services are in the hands of public or private providers, and might form part of the explanation for why expenditure on health care has risen year on year as a percentage of gross domestic product.21OECDProjecting OECD health and long-term care expenditures: what are the main drivers? OECD Economics Department Working Papers, No 477. OECD Publishing, Paris2006Google Scholar Keeping up with the rising relative costs of care represents a considerable challenge—alongside our ageing populations22Kingston A Comas-Herrera A Jagger C Forecasting the care needs of the older population in England over the next 20 years: estimates from the Population Ageing and Care Simulation ( PACSim) modelling study.Lancet Public Health. 2018; 3: e447-e455Google Scholar, 23Colombo F Llena-Nozal A Mercier J Tjadens F Help wanted? Providing and paying for long-term care. OECD Publishing, Paris2011Google Scholar—to the long-run funding of long-term care across the OECD. Moreover, the time-intensive nature of care work means that attempts to increase labour productivity, particularly where this involves restricting the time a carer has with each client, are likely to reduce the perceived quality of care delivered16Corlet Walker C Druckman A Jackson T Careless finance: operational and economic fragility in adult social care. CUSP Working Paper No 26. Centre for the Understanding of Sustainable Prosperity, Guildford2021Google Scholar and increase pressure on care workers.24Jackson T Victor P Productivity and work in the ‘ green economy’: some theoretical reflections and empirical tests.Environ Innov Soc Transit. 2011; 1: 101-108Google Scholar
The second core characteristic of facility-based care is that service users are “ sticky ” ( ie, there is some reason why they are unwilling or unable to change care provider). Although the evidence of a diagnosable condition referred to as “ relocation stress syndrome ” or “ transfer trauma ” is mixed, many older people do report emotional and physical distress when moving between care homes. In particular, transferring between care homes has been associated with increased anxiety, depression, and fall risk,25Capezuti E Boltz M Renz S Hoffman D Norman RG Nursing home involuntary relocation: clinical outcomes and perceptions of residents and families.J Am Med Dir Assoc. 2006; 7: 486-492Google Scholar, 26Costlow K Parmelee PA The impact of relocation stress on cognitively impaired and cognitively unimpaired long-term care residents.Aging Ment Health. 2020; 24: 1589-1595Google Scholar especially where there is a lack of preparation or individual agency around the move.27Scheibl F Fleming J Buck J Barclay S Brayne C Farquhar M The experience of transitions in care in very old age: implications for general practice.Fam Pract. 2019; 36: 778-784Google Scholar, 28Holder JM Jolley D Forced relocation between nursing homes: residents ' health outcomes and potential moderators.Rev Clin Gerontol. 2012; 22: 301-319Google Scholar Anticipation of poor outcomes is reflected in the low absolute rates of transfer between care homes,29Hirth RA Banaszak-Holl JC Fries BE Turenne MN Does quality influence consumer choice of nursing homes? Evidence from nursing home to nursing home transfers.Inquiry. 2003; 40: 343-361Google Scholar and is particularly acute for residents with dementia or other high-level needs.30Grabowski DC Hirth RA Competitive spillovers across non-profit and for-profit nursing homes.J Health Econ. 2003; 22: 1-22Google Scholar The high degree of perceived and actual risks that come with relocation mean that residents often can not respond to poor or declining quality care by changing provider, without risking potentially significant personal consequences. This relative immobility of service users is a core component of any care sector and motivates the existence of quality regulators, such as the Care Quality Commission ( UK), Aged Care Quality and Safety Commissioner ( Australia), and Centers for Medicare and Medicaid Services ( USA), as well as safeguarding laws.
The critical question is what happens to the above characteristics when they come face to face with the driving forces of marketisation. Competition, consumer choice, and the introduction of for-profit entities ( and hence the profit motive) in service delivery form the core tenets of marketisation, broadly understood.31Anttonen A Meagher G Mapping marketisation: concepts and goals.in: Meagher G Szebehely M Marketisation in Nordic eldercare: a research report on legislation, oversight, extent and consequences. Stockholm University, Stockholm2013: 13-22Google Scholar Their use as guiding principles in the provisioning and commissioning of care reflects a wider process of embedding neoliberal market ideology in the delivery of foundational welfare services.32Horton A Financialization and non-disposable women: real estate, debt and labour in UK care homes.Environ Plann A. 2019; 0: 1-16Google Scholar It has been long-established that many of the conditions necessary, according to classical economic theories, for a market to produce optimal outcomes for producers and consumers ( eg, that consumers should be adequately able to assess product quality) are not met by the health-care sector.33Arrow KJ Uncertainty and the welfare economics of medical care.Am Econ Rev. 1963; 53: 941-973Google Scholar, 34Goddard M Competition in healthcare: good, bad or ugly?.Int J Health Policy Manag. 2015; 4: 567-569Google Scholar, 35Katz ML Provider competition and healthcare quality: more bang for the buck?.Int J Ind Organ. 2013; 31: 612-625Google Scholar The social care sector fails to meet many of these conditions too. Such market failures are a key reason that countries regulate their health and social care markets. However, certain core characteristics of many long-term care systems ( including the two raised in the previous section) mean that, even in a regulated market, the application of competition, consumer choice, and the profit-motive can lead to dysfunctional outcomes. In this section, we discuss these characteristics, what kinds of care systems they hold for, and how they interact with each neoliberal market principle. Competition and consumer choice directly affect all provider types, while profit motive predominantly affects outcomes in the for-profit segment of the market. See table 1 for a summary of our arguments, and table 2 for a matrix of key market attributes for four countries of interest to our analysis.Table 1Five core characteristics of long-term care that can create dysfunctional outcomes when placed in a neoliberal market settingCharacteristic of long-term care sectorGuiding principleConsequence1There is limited scope for labour productivity gains in the workforceCompetitionLabour becomes relatively more expensive over time per unit output. Attempts to increase labour productivity in response to competition can have a negative impact on quality of care and clinical outcomes for residents.2Bulk purchasers ( eg, governments) have market power over providersCompetitionGovernments that purchase services on behalf of a large number of individuals have the power to set prices in the market, sometimes unsustainably low. This dynamic is exacerbated under conditions of intense competition between providers.3There is lack of access to information about price and quality in the marketConsumer choiceA lack of reasonable access to information about price and quality in the market inhibits consumer choice and, when combined with the market power of governments to set prices unsustainably low, it can lead to price discrepancies between public and private residents.4There are high switching costs associated with changing providersConsumer choiceThe high switching costs associated with changing providers means that residents are unable to easily respond to poor quality care, undermining the notion of consumer choice. As a result, providers can more easily express their own preference for profit over wages or investment without being penalised by declining occupancy rates.5A substantial portion of long-term care is delivered by private companiesProfit motivePrivatisation exposes the sector to predatory financial strategies such as debt-leveraged buyouts, asset stripping, intra-group loans, sale and leaseback arrangements, and the use of offshore tax havens. These strategies put returns to investors in direct competition with investments in service provision, such as wages and the built environment. They can also reduce the financial flexibility of the social care company, potentially undermining its long-term economic viability.Not all characteristics apply equally to all long-term care sectors, and we explore the scope and relevance of each in the main text. Analysis adapted from our 2021 report on operational and economic fragility in adult social care.16Corlet Walker C Druckman A Jackson T Careless finance: operational and economic fragility in adult social care. CUSP Working Paper No 26. Centre for the Understanding of Sustainable Prosperity, Guildford2021Google Scholar Open table in a new tab Table 2Market attributes for four countries of interestProvider mixConsumer choiceProvider competitionAccess to informationPublic coverageUKCare homes ( 2019): 84% for-profit, 13% non-profit, 3% local authority.36Blakeley G Quilter-Pinner H Who cares? The financialisation of adult social care. Institute for Public Policy Research, London2019www.ippr.org/research/publications/financialisation-in-social-careDate accessed: November 22, 2021Google ScholarBoth privately and publicly funded individuals can choose their preferred care home. Publicly funded residents must choose from homes that meet the local authority's contractual terms.37Forder J Allan S The impact of competition on quality and prices in the English care homes market.J Health Econ. 2014; 34: 73-83Google ScholarProviders compete for private-paying customers as well as for local authority contracts.The Care Quality Commission publishes quality inspection reports for all care homes in England. Frequency of inspection is higher for poorly performing homes. Reports are largely descriptive and categorical, with limited data on health outcomes. There is currently no centralised database on prices.Means-tested support is offered to those with wealth below £23 250.38UK GovernmentAdult social care charging reform: further details.https: //www.gov.uk/government/publications/build-back-better-our-plan-for-health-and-social-care/adult-social-care-charging-reform-further-detailsDate accessed: March 8, 2022Google Scholar This is due to increase in October, 2023 to £100 000. 41% of residents are wholly self-funded, 37% are fully funded by local authorities, and the remainder are either part-funded or receive funding from other sources.39Competition & Market AuthorityCare homes market study: update paper. Competition & Market Authority, London2017Google ScholarUSANursing homes ( 2016): 69% for-profit, 24% non-profit, 7% government. Residential care homes ( 2016): 81% for-profit, 18% non-profit, 1% government.40Harris-Kojetin L Sengupta M Lendon JP Rome V Valverdo R Caffrey C Long-term care providers and services users in the United States, 2015–2016. Vital Health Statistics, Series 3, Number 43.https: //www.cdc.gov/nchs/data/series/sr 03/sr03 43-508.pdfDate: January, 2019Date accessed: November 22, 2021Google ScholarIndividuals choose their preferred nursing or residential home. Medicaid and Medicare recipients choose from a list of certified homes.Providers compete for individual customers.Certified nursing homes submit data to the Centers for Medicare & Medicaid Services, who publish the information on a national website. The website contains information about staffing, clinical outcomes, and health or safety breaches.41Tamara Konetzka R Yan K Werner RM Two decades of nursing home compare: what have we learned?.Med Care Res Rev. 2021; 78: 295-310Google Scholar There is no national price database, although some state administered databases include information on price.42Hefele JG Acevedo A Nsiah-Jefferson L et al.Choosing a nursing home: what do consumers want to know, and do preferences vary across race/ethnicity?.Health Serv Res. 2016; 51: 1167-1187Google ScholarIndividuals must pay out of their own pocket for long-term care until they meet the criteria for Medicaid or Medicare support. 62% of nursing home residents have Medicaid as their payer source. 17% of residential care residents have Medicaid as their payer source.40Harris-Kojetin L Sengupta M Lendon JP Rome V Valverdo R Caffrey C Long-term care providers and services users in the United States, 2015–2016. Vital Health Statistics, Series 3, Number 43.https: //www.cdc.gov/nchs/data/series/sr 03/sr03 43-508.pdfDate: January, 2019Date accessed: November 22, 2021Google ScholarAustraliaResidential care homes ( 2021): 33% for-profit, 56% not-for-profit, 11% state, territory, or local government.43Royal Commission into Aged Care Quality and SafetyFinal Report: Care, dignity and respect. Volume 2: The current system. Commonwealth of Australia, 2021https: //agedcare.royalcommission.gov.au/publications/final-report-volume-2Date accessed: November 22, 2021Google ScholarIndividuals who have been assessed as eligible for residential care choose their preferred facility from a list of approved providers.43Royal Commission into Aged Care Quality and SafetyFinal Report: Care, dignity and respect. Volume 2: The current system. Commonwealth of Australia, 2021https: //agedcare.royalcommission.gov.au/publications/final-report-volume-2Date accessed: November 22, 2021Google ScholarThere is competition among providers to become approved aged care providers and be allocated government-funded care places.43Royal Commission into Aged Care Quality and SafetyFinal Report: Care, dignity and respect. Volume 2: The current system. Commonwealth of Australia, 2021https: //agedcare.royalcommission.gov.au/publications/final-report-volume-2Date accessed: November 22, 2021Google ScholarMy Aged Care website contains information on room prices, service type, and quality for all government-subsidised care services. However, a recent report found the website information to be inconsistent and incomplete.43Royal Commission into Aged Care Quality and SafetyFinal Report: Care, dignity and respect. Volume 2: The current system. Commonwealth of Australia, 2021https: //agedcare.royalcommission.gov.au/publications/final-report-volume-2Date accessed: November 22, 2021Google ScholarThe Australian Government offers means-tested support for aged care services. People contribute to accommodation and care through a mix of co-payments and means-tested fees. There is an annual cap of approximately AU $ 28 000 on means-tested fees, and a lifetime cap of around AU $ 67 000.43Royal Commission into Aged Care Quality and SafetyFinal Report: Care, dignity and respect. Volume 2: The current system. Commonwealth of Australia, 2021https: //agedcare.royalcommission.gov.au/publications/final-report-volume-2Date accessed: November 22, 2021Google ScholarSwedenNursing homes ( 2014): 18–19% for-profit, 2–3% non-profit, 79% government.15Harrington C Jacobsen FF Panos J Pollock A Sutaria S Szebehely M Marketization in long-term care: a cross-country comparison of large for-profit nursing home chains.Heal Serv Insights. 2017; 10 ( 1178632917710533) Google ScholarIndividuals are free to choose between all authorised providers who meet the necessary requirements.44Moberg L User choice and the changing notion of social citizenship in Swedish elderly care.Nord Soc Work Res. 2021; ( published online July 6.) https: //doi.org/10.1080/2156857X.2021.1948443Google ScholarAuthorised providers compete for individual customers.44Moberg L User choice and the changing notion of social citizenship in Swedish elderly care.Nord Soc Work Res. 2021; ( published online July 6.) https: //doi.org/10.1080/2156857X.2021.1948443Google ScholarThe National Board of Health and Welfare was providing centralised information on clinical outcomes, staff training and turnover, and housing quality in their “ Elderly Guide ”.45Meagher G Szebehely M Marketisation in Nordic eldercare: a research report on legislation, oversight, extent and consequences. Stockholm University, Stockholm2013Google Scholar At the time of writing, this website was not in operation.There is universal coverage, meaning that 100% of nursing home residents are paid for by the government, with eligibility based on needs assessments.15Harrington C Jacobsen FF Panos J Pollock A Sutaria S Szebehely M Marketization in long-term care: a cross-country comparison of large for-profit nursing home chains.Heal Serv Insights. 2017; 10 ( 1178632917710533) Google Scholar Open table in a new tab
Not all characteristics apply equally to all long-term care sectors, and we explore the scope and relevance of each in the main text. Analysis adapted from our 2021 report on operational and economic fragility in adult social care.16Corlet Walker C Druckman A Jackson T Careless finance: operational and economic fragility in adult social care. CUSP Working Paper No 26. Centre for the Understanding of Sustainable Prosperity, Guildford2021Google Scholar
Competition is a core pillar of many long-term care markets across the OECD, both in terms of competition for individual customers, as well as competitive tendering processes for government contracts ( eg, the Nordic countries, Australia, and the UK45Meagher G Szebehely M Marketisation in Nordic eldercare: a research report on legislation, oversight, extent and consequences. Stockholm University, Stockholm2013Google Scholar). However, contrary to common understandings about the role of competition in driving innovation and improving product quality,46Hunt SD Morgan RM The comparative advantage theory of competition.J Mark. 1995; 59: 1-15Google Scholar, 47Office of Fair TradingGovernment in markets: why competition matters – a guide for policy makers. Office of Fair Trading, London2009https: //assets.publishing.serviceg, ov.uk/government/uploads/system/uploads/attachment data/file/284451/OFT1113.pdfDate accessed: November 22, 2021Google Scholar and thus tempering the incentives of the for-profit approach, studies from the USA and the UK have found that increased competition among care providers is often associated with lower quality care, as measured by health outcomes, processes, and instances of breaches in regulatory minimum standards for care.37Forder J Allan S The impact of competition on quality and prices in the English care homes market.J Health Econ. 2014; 34: 73-83Google Scholar, 48Bowblis JR Market structure, competition from assisted living facilities, and quality in the nursing home industry.Appl Econ Perspect Policy. 2012; 34: 238-257Google Scholar, 49Castle NG Nursing home closures, changes in ownership, and competition.Inquiry. 2005; 42: 281-292Google Scholar As Forder and Allan37Forder J Allan S The impact of competition on quality and prices in the English care homes market.J Health Econ. 2014; 34: 73-83Google Scholar note, “ higher competition reduces revenue which pushes down quality ”. This unexpected dynamic is, in part, rooted in care providers ' ability to respond effectively to increases in competition. As competition between providers intensifies, this should in theory translate into a pressure to innovate, driving better quality care or cost-efficiency savings ( or both). However, the limited scope for labour productivity gains in the workforce, combined with modest opportunities for economies of scale in the delivery of care50Christensen EW Scale and scope economies in nursing homes: a quantile regression approach.Health Econ. 2004; 13: 363-377Google Scholar and the already low wages of care workers across Europe,51EurofoundLong-term care workforce: employment and working conditions. Publications Office of the European Union, Luxembourg2020Google Scholar act to dampen providers ' ability to achieve cost-efficiencies without compromising service quality and clinical outcomes. This has long been understood by care providers. In the UK, for example, after the introduction of the National Living Wage in 2016, providers reported that they had “ few choices other than to absorb the cost because of the inability of the sector to improve productivity without worsening the care provided to service users ”.52D'Arcy C Davies G Weighing up the wage floor: employer responses to the National Living Wage. Resolution Foundation, London2016Google Scholar
The difficulty that providers face in effectively responding to competition without compromising quality of care is likely to be present to some extent in all countries with a concentrated market of competing providers. However, this dynamic can become especially problematic in those countries where providers are competing for contracts from a purchaser with significant market power. In particular, where local government is buying services on behalf of a large number of individuals ( eg, the UK, Australia, Sweden, Norway), this enables them to negotiate ( or set) prices at a lower level than they would be in a demand-competitive market. Where this price constraint meets stubborn labour costs, providers ' margins are quickly squeezed, and shareholder profit and employee wages find themselves in direct competition with one another. This argument draws on the “ channels of adjustment ” literature, which argues that companies have a limited number of ways that they can respond when faced with a new cost or a pressure to reduce prices.53Schmitt J Why does the minimum wage have no discernible effect on employment?. Center for Economic and Policy Research, Washington, DC2013Google Scholar The lower wages and reduced staff time per resident in the for-profit portion of the long-term care market, compared with the non-profit portion,10Comondore VR Devereaux PJ Zhou Q et al.Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.BMJ. 2009; 339b2732Google Scholar, 51EurofoundLong-term care workforce: employment and working conditions. Publications Office of the European Union, Luxembourg2020Google Scholar suggest that labour is losing this fight with shareholders.
The scope and depth of these problems depends partly on the proportion of the market that is privatised. For example, in the UK 86% of care homes are operated by for-profit companies, whereas in Sweden just 18–19% are.15Harrington C Jacobsen FF Panos J Pollock A Sutaria S Szebehely M Marketization in long-term care: a cross-country comparison of large for-profit nursing home chains.Heal Serv Insights. 2017; 10 ( 1178632917710533) Google Scholar Competition for individual customers is still present in Sweden, but profit is not a factor for the majority of providers. The effect of this dynamic is also likely to depend on the extent to which governments exercise their market power to cap prices—something that has been reported as an ongoing issue in countries such as Australia,43Royal Commission into Aged Care Quality and SafetyFinal Report: Care, dignity and respect. Volume 2: The current system. Commonwealth of Australia, 2021https: //agedcare.royalcommission.gov.au/publications/final-report-volume-2Date accessed: November 22, 2021Google Scholar the UK,54Allan S Gousia K Forder J Exploring differences between private and public prices in the English care homes market.Health Econ Policy Law. 2021; 16: 138-153Google Scholar and the USA,55Stewart KA Grabowski DC Lakdawalla DN Annual expenditures for nursing home care: private and public payer price growth, 1977 to 2004.Med Care. 2009; 47: 295-301Google Scholar where the budgets of local government appear to play the most significant role in determining care sector spending, rather than the true cost of providing care.
In order for increases in competition to reliably lead to improvements in service quality, not only do providers need to be able to respond to competition, but so too do consumers.1Barron DN, West E. The quasi-market for adult residential care in the UK: do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care? Soc Sci Med 179: 137–46.Google Scholar The broad principle that most people are best placed to make their own choices about who should care for them and how is well supported. In this section, however, we critique the neoclassical notion of consumer choice, and its specific operationalisation through neoliberal welfare policies. In particular, we dispute the argument that promoting choice among different providers in the care market is sufficient to motivate quality and efficiency improvements. The well-informed, rational, utility-maximising consumer with complete and transitive preferences ( homo economicus) is a long-contested pillar of neoclassical theories of consumer choice.56Thaler R Toward a positive theory of consumer choice.J Econ Behav Organ. 1980; 1: 39-60Google Scholar A body of behavioural and experimental economics literature has demonstrated time and time again how ill-fitting that characterisation is.57Henrich J Boyd R Bowles S et al.In search of homo economicus: behavioral experiments in 15 small-scale societies.Am Econ Rev. 2001; 91: 73-78Google Scholar Nonetheless, choice-based commissioning of residential and nursing care ( where individuals can select their care provider) is commonplace, particularly in the Nordic and liberal care systems.4Brennan D Cass B Himmelweit S Szebehely M The marketisation of care: rationales and consequences in Nordic and liberal care regimes.J Eur Soc Policy. 2012; 22: 377-391Google Scholar
We are concerned with two particular distortions to this model, as currently operationalised. First, in those countries where consumers lack reasonable access to information about price or quality in the market ( eg, the UK,54Allan S Gousia K Forder J Exploring differences between private and public prices in the English care homes market.Health Econ Policy Law. 2021; 16: 138-153Google Scholar Australia,43Royal Commission into Aged Care Quality and SafetyFinal Report: Care, dignity and respect. Volume 2: The current system. Commonwealth of Australia, 2021https: //agedcare.royalcommission.gov.au/publications/final-report-volume-2Date accessed: November 22, 2021Google Scholar and the USA58Huang SS Hirth RA Quality rating and private-prices: evidence from the nursing home industry.J Health Econ. 2016; 50: 59-70Google Scholar), this can lead to suboptimal outcomes for consumers.4Brennan D Cass B Himmelweit S Szebehely M The marketisation of care: rationales and consequences in Nordic and liberal care regimes.J Eur Soc Policy. 2012; 22: 377-391Google Scholar One consequence of these kinds of informational asymmetries is that they can distort prices. For example, in the UK, private residents often pay higher fees than their public sector counterparts, even for the same service.59Wanless D Wanless social care review. Securing good care for older people: taking a long-term view. King's Fund, London2006Google Scholar This price discrepancy can be understood, in part, as an attempt by the UK's care providers to maintain their margins ( to protect profit, wages, and other costs), in a context where local governments are not paying the true cost of care. However, it represents a hidden subsidy paid by some private residents. Similar issues around a lack of pricing and quality transparency, disparities between public and private spending on care, and price differentials between for-profit and not-for-profit facilities, are also present in the USA.55Stewart KA Grabowski DC Lakdawalla DN Annual expenditures for nursing home care: private and public payer price growth, 1977 to 2004.Med Care. 2009; 47: 295-301Google Scholar, 60Huang SS Banaszak-Holl J Yuan S Hirth RA The determinants and variation of nursing home private-pay prices: organizational and market structure.Med Care Res Rev. 2021; 78: 173-180Google Scholar Drives to improve access to information in this context have been found to increase price differentials between high-quality and low-quality facilities58Huang SS Hirth RA Quality rating and private-prices: evidence from the nursing home industry.J Health Econ. 2016; 50: 59-70Google Scholar and improve overall quality in more competitive settings.61Grabowski DC Town RJ Does information matter? Competition, quality, and the impact of nursing home report cards.Health Serv Res. 2011; 46: 1698-1719Google Scholar The relationship between information availability and service price has not been investigated in many OECD countries, and will vary depending on contextual market factors such as the concentration of providers and the public–private payer mix. However, what is clear from the above examples is that those countries implementing a consumer choice model of care that have a paucity of accurate, accessible information about price and quality are fundamentally undermining the possibility of a well-informed consumer.
Second, and perhaps more crucially, there are very high switching costs associated with changing providers in the long-term care market, owing to the potentially high physical and emotional consequences of moving care home ( as outlined earlier). This translates into a high degree of consumer stickiness. Put another way, it undermines the idea of a consumer who can, or is willing to, act freely on their preferences ( in terms of quality and price) between providers. Hirth and colleagues29Hirth RA Banaszak-Holl JC Fries BE Turenne MN Does quality influence consumer choice of nursing homes? Evidence from nursing home to nursing home transfers.Inquiry. 2003; 40: 343-361Google Scholar report low absolute transfer rates in the USA and find a small effect size when looking at the relationship between poor care quality and likelihood of transfer. Although care-home-to-care-home transfer data is not available for many countries, we might fairly assume that this dynamic is present across most marketised care sectors. Furthermore, the medical conditions of many residents can make it challenging for them to enforce quality standards from providers, in situ.62Eika KH The challenge of obtaining quality care: limited consumer sovereignty in human services.Fem Econ. 2009; 15: 113-137Google Scholar As a result, residents are left exposed to poor and declining quality care. In this context, many individuals and their families look to alternative, non-market mechanisms to effect change, such as advocacy and campaigning.
This attribute is particularly problematic in a for-profit setting. The imbalance in market power created by such high switching costs, among other factors, enables care providers to more easily express their own preference for profit ( over increased wages or investment in quality, for instance) without the risk of losing customers.16Corlet Walker C Druckman A Jackson T Careless finance: operational and economic fragility in adult social care. CUSP Working Paper No 26. Centre for the Understanding of Sustainable Prosperity, Guildford2021Google Scholar Quality regulators work to offset this risk; 1Barron DN, West E. The quasi-market for adult residential care in the UK: do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care? Soc Sci Med 179: 137–46.Google Scholar however, worse-than-average clinical outcomes ( and other quality indicators) for residents in for-profit care homes10Comondore VR Devereaux PJ Zhou Q et al.Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.BMJ. 2009; 339b2732Google Scholar signal that the tension between profit margins and quality of care is likely an inherent feature of a for-profit care market.
The expansion of for-profit providers has been a common feature in the evolution of care sectors across the OECD in recent decades. The reasons for this expansion are manifold and the characteristics of for-profit care sectors differ by country ( in terms of market concentration, which type of clientele are targeted, primary source of revenue, etc). Among other factors, flexible access to capital has enabled a greater responsiveness by for-profit providers to the growth in demand for care services, as compared with non-profit providers.63Bos A Kruse FM Jeurissen PPT For-profit nursing homes in the Netherlands: what factors explain their rise?.Int J Health Serv. 2020; 50: 431-443Google Scholar The benefit of this capability in the for-profit part of the market is that it creates the potential to develop services in a timely manner for a population with rapidly growing needs. However, part of the flexibility in access to capital means that long-term care organisations ( and their employees and residents) are placed at risk of predatory financial practices.
According to industry analytics, there has been “ a clear increase in capital targeted at the elderly care home and senior living property market in recent years ” in Europe, both in absolute terms ( from approximately €3 billion of rolling investment in 2015, to more than €6·5 billion in 2019), but also as a proportion of all commercial property transactions.64Knight FrankEuropean healthcare: Elderly care market, research 2020. Knight Frank, London2020Google Scholar This sharp rise in private investment highlights the importance of shedding light on the financial practices and ownership structures within the care sector. Below we begin this task, drawing on our earlier research16Corlet Walker C Druckman A Jackson T Careless finance: operational and economic fragility in adult social care. CUSP Working Paper No 26. Centre for the Understanding of Sustainable Prosperity, Guildford2021Google Scholar to outline how particular financial engineering practices can and have been used to support ongoing value extraction from care home companies, and to increase short-term returns to private investors, often at the expense of operational and economic stability within the sector. The extent to which these practices have emerged, or are likely to emerge, in each country depends both on the proportion of the market that is privatised, and the national financial regulations governing the sector, among other factors.
Leveraged buyouts ( LBOs) and asset stripping are two well-documented methods for increasing the rate of return on investment of private equity firms.65Froud J Williams K Private equity and the culture of value extraction.New Polit Econ. 2007; 12: 405-420Google Scholar They have become commonplace across the care market15Harrington C Jacobsen FF Panos J Pollock A Sutaria S Szebehely M Marketization in long-term care: a cross-country comparison of large for-profit nursing home chains.Heal Serv Insights. 2017; 10 ( 1178632917710533) Google Scholar, 66Dela Rama M Edwards M Dalton B Green J Honourable intentions? Analysing the interests of private equity in the aged care sector.Third Sect Rev. 2010; 16: 63-82Google Scholar, 67Burns D Cowie L Earle J et al.Where does the money go? Financialised chains and the crisis in residential care. Centre for Research on Socio-Cultural Change.https: //hummedia.manchester.ac.uk/institutes/cresc/research/WDTMG% 20FINAL% 20-01-3-2016.pdfDate: March, 2016Date accessed: November 22, 2021Google Scholar and both have potentially malign consequences for the target care home companies. First, investment firms use debt financing to reduce the amount of capital they need to put up when purchasing a long-term care company. Once the loan is in place—usually 60–90% of the cost of purchase68Kaplan SN Strömberg P Leveraged buyouts and private equity.J Econ Perspect. 2009; 23: 121-146Google Scholar and secured against the assets of the target company69Sherwin EL Creditors ' rights against participants in a leveraged buyout.Minn Law Rev. 1988; 72: 449-522Google Scholar—the cash flow of the acquired care home company is used to “ service and repay ” the debt.70Rosenbaum J Pearl J Leveraged buyouts.in: Investment banking: valuation, leveraged buyouts, and mergers & acquisitions. John Wiley & Sons, Hoboken, NJ2009: 161-194Google Scholar This increases the equity portion of the company's capital structure over time ( compared with the debt portion), thereby translating into a potentially sizeable return for investors when they sell the company on. There are also tax advantages to using debt financing.71Kotecha V Plugging the leaks in the UK care home industry. Strategies for resolving the financial crisis in the residential and nursing home sector. Centre for Health and the Public Interest, London2019Google Scholar Thanks to their generally large asset base, the near ubiquity of rapidly ageing populations across the OECD, and the legislative duty of many governments to provide access to care for their citizens, care home companies can make appealing LBO targets. Second, asset stripping can be used to achieve similar ends. In the adult social care sector, this typically involves the sale of the care providers ' properties to an external buyer, on the agreement that they be leased back to the operating business. This provides the owners of the care homes with a lump sum of cash, either to pay special, one-off dividend payments to shareholders,72Pendleton A Gospel H Financialization, new investment funds, and weakened labour: the case of the UK.in: Gospel H Pendleton A Vitols S Financialization, new investment funds, and labour: an international comparison. Oxford University Press, Oxford2014: 86-114Google Scholar or to expand the business through investments and acquisitions.67Burns D Cowie L Earle J et al.Where does the money go? Financialised chains and the crisis in residential care. Centre for Research on Socio-Cultural Change.https: //hummedia.manchester.ac.uk/institutes/cresc/research/WDTMG% 20FINAL% 20-01-3-2016.pdfDate: March, 2016Date accessed: November 22, 2021Google Scholar
In addition, many investment-firm owned care home chains ( as well as other, non-investment-firm owned chains) have a raft of financial structures in place to facilitate the ongoing extraction of cash from the core operating company. For example, complex corporate group structures often sit above the core operating businesses, with dozens of related subsidiary and parent companies, registered in a range of locations, many in low-tax jurisdictions. Examples of these structures have been explored in Norway, the UK, and the USA, among other countries.15Harrington C Jacobsen FF Panos J Pollock A Sutaria S Szebehely M Marketization in long-term care: a cross-country comparison of large for-profit nursing home chains.Heal Serv Insights. 2017; 10 ( 1178632917710533) Google Scholar A combination of high interest loans, rental payments, and management fees are used to move money from one related company to another on an ongoing basis. For example, sometimes the sale and leaseback arrangements described above are used to sell the care home properties to a related company, rather than an external landlord. High rental charges can then be used to divert money out of the core operating business.72Pendleton A Gospel H Financialization, new investment funds, and weakened labour: the case of the UK.in: Gospel H Pendleton A Vitols S Financialization, new investment funds, and labour: an international comparison. Oxford University Press, Oxford2014: 86-114Google Scholar If the recipient company is based in a low-tax jurisdiction, this can reduce the tax obligations of the corporate group and, in so doing, improve the returns to investors.71Kotecha V Plugging the leaks in the UK care home industry. Strategies for resolving the financial crisis in the residential and nursing home sector. Centre for Health and the Public Interest, London2019Google Scholar, 73Bayliss K Gideon J The privatisation and financialisation of social care in the UK. Working paper No. 238. SOAS University of London, London2020https: //www.soas.ac.uk/economics/research/workingpapers/file150390.pdfDate accessed: November 22, 2021Google Scholar Many of these practices ( and others, such as the issuing of preference shares) ensure that owners can extract cash “ whether or not the company is profitable ” on the face of it.67Burns D Cowie L Earle J et al.Where does the money go? Financialised chains and the crisis in residential care. Centre for Research on Socio-Cultural Change.https: //hummedia.manchester.ac.uk/institutes/cresc/research/WDTMG% 20FINAL% 20-01-3-2016.pdfDate: March, 2016Date accessed: November 22, 2021Google Scholar
The unfortunate by-product of these strategies is that the core operating business must meet substantial ongoing interest, rental, and management fees, thus reducing their financial flexibility74De Maeseneire W Brinkhuis S What drives leverage in leveraged buyouts? An analysis of European leveraged buyouts ' capital structure.Account Finance. 2012; 52: 155-182Google Scholar and increasing the risk of insolvency.75Ayash B Rastad M Leveraged buyouts and financial distress.Finance Res Lett. 2021; 38101452Google Scholar According to the Centre for Health and the Public Interest, as much as 16% of the weekly fee for a residential bed goes towards interest payments on company debt within the UK's largest financialised care home chains.71Kotecha V Plugging the leaks in the UK care home industry. Strategies for resolving the financial crisis in the residential and nursing home sector. Centre for Health and the Public Interest, London2019Google Scholar
These kinds of practices demonstrate a prioritisation of profit over quality of care, with the costs and risks of heavily financialised corporate group structures arguably being shifted from investors onto workers and service users through low wages, poor working conditions, high prices, and cuts to services.16Corlet Walker C Druckman A Jackson T Careless finance: operational and economic fragility in adult social care. CUSP Working Paper No 26. Centre for the Understanding of Sustainable Prosperity, Guildford2021Google Scholar Research looking at the consequences of these financial engineering practices on quality of care is sparse, but a growing body of evidence coming out of the USA indicates that private equity-owned care homes are likely to be associated with reduced staffing levels, lower staff skills, and in some cases worse health outcomes for service users.76Harrington C Choiniere J Goldmann M et al.Nursing home staffing standards and staffing levels in six countries.J Nurs Scholarsh. 2012; 44: 88-98Google Scholar, 77Pradhan R Weech-Maldonado R Harman JS Al-Amin M Hyer K Private equity ownership of nursing homes: implications for quality.J Health Care Finance. 2014; 42: 1-14Google Scholar, 78Gupta A Howell ST Yannelis C Gupta A Does private equity investment in healthcare benefit patients? Evidence from nursing homes. Working Paper 28474. National Bureau of Economic Research, Cambridge, MA2021Google Scholar, 79Bos A Harrington C What happens to a nursing home chain when private equity takes over? A longitudinal case study.Inquiry. 2017; 54 ( 46958017742761) Google Scholar
There are two main types of reform that are relevant for addressing the problems generated by a neoliberal care system: ( 1) those that aim to reduce the prevalence of predatory financial practices; and ( 2) those that aim to correct market failures. We discuss both below, reflecting on the extent to which they can truly rectify the challenges outlined in the previous sections. In the long run, we argue for the rejection of the neoliberal market principles of competition, consumer choice, and profit within care, and instead call for a sector-wide conversation about what a new set of guiding principles, fit for a caring economy, might look like.
Improved financial transparency is a key part of calls for reform, with a particular focus on revealing how much of company revenues are going towards direct and indirect service provision costs, as compared with interest payments, rent, dividends, and management fees.71Kotecha V Plugging the leaks in the UK care home industry. Strategies for resolving the financial crisis in the residential and nursing home sector. Centre for Health and the Public Interest, London2019Google Scholar Notably, however, moves towards transparency in the USA ( eg, the Nursing Home Transparency Act 2009) have not deterred private equity investment in the health-care industry,80Appelbaum E Batt R Private equity buyouts in healthcare: who wins, who loses? Working Paper No. 118. Center for Economic and Policy Research, Washington, DC2020Google Scholar nor have they apparently limited the use of these extractive financial practices. Four out of five of the largest for-profit care companies in the USA still hold their properties in real estate investment trusts under leaseback arrangements, and all five are registered in Delaware, a tax haven.15Harrington C Jacobsen FF Panos J Pollock A Sutaria S Szebehely M Marketization in long-term care: a cross-country comparison of large for-profit nursing home chains.Heal Serv Insights. 2017; 10 ( 1178632917710533) Google Scholar At the moment, the registration of certain entities within a corporate group structure in jurisdictions where financial accounts often are not made public ( eg, Jersey, Cayman Islands, etc) can obscure group-wide transparency. This has led some to argue for a shift in the “ locus of accountability ” from facility-level to chain-level, thereby including the accounts of related corporate group entities in any transparency-targeted policies.77Pradhan R Weech-Maldonado R Harman JS Al-Amin M Hyer K Private equity ownership of nursing homes: implications for quality.J Health Care Finance. 2014; 42: 1-14Google Scholar In practice, this would be difficult to enforce for offshore entities. More direct regulations offer an alternate route, though not necessarily an easier one. For example, some authors have proposed mandating that the top ( or ultimate) parent company of a long-term care provider be registered in the country ( or state) in which the provider operates, also known as “ on-shore ownership ”.73Bayliss K Gideon J The privatisation and financialisation of social care in the UK. Working paper No. 238. SOAS University of London, London2020https: //www.soas.ac.uk/economics/research/workingpapers/file150390.pdfDate accessed: November 22, 2021Google Scholar Others have argued for pursuing tax on corporate entities located offshore, or implementing limits on the proportion of public fees that can be put towards financial costs, as compared with service provision.71Kotecha V Plugging the leaks in the UK care home industry. Strategies for resolving the financial crisis in the residential and nursing home sector. Centre for Health and the Public Interest, London2019Google Scholar
Other proposals in this vein aim to discourage financial practices that might undermine the long-term stability of care companies ( eg, LBOs and asset stripping). This means “ lifting the corporate veil ” so that complex webs of holding companies can not be used to insulate owners from the financial and legal risks associated with the actions of the core operating business or other subsidiaries.81Muchlinski P Limited liability and multinational enterprises: a case for reform?.Cambridge J Econ. 2010; 34: 915-928Google Scholar It also likely means setting stricter capital adequacy standards to prevent over-leveraging.71Kotecha V Plugging the leaks in the UK care home industry. Strategies for resolving the financial crisis in the residential and nursing home sector. Centre for Health and the Public Interest, London2019Google Scholar, 73Bayliss K Gideon J The privatisation and financialisation of social care in the UK. Working paper No. 238. SOAS University of London, London2020https: //www.soas.ac.uk/economics/research/workingpapers/file150390.pdfDate accessed: November 22, 2021Google Scholar, 82Royal Commission into Aged Care Quality and SafetyFinal Report: Care, dignity and respect. Volume 1: Summary and recommendations. Commonwealth of Australia, 2021https: //agedcare.royalcommission.gov.au/publications/final-report-volume-1Date accessed: November 22, 2021Google Scholar
Last, some reforms focus on correcting the market failures created by competitive tendering, price-setting, and informational asymmetries. For example, nursing home quality report cards in the USA,61Grabowski DC Town RJ Does information matter? Competition, quality, and the impact of nursing home report cards.Health Serv Res. 2011; 46: 1698-1719Google Scholar proposals to move away from competitive tendering in the UK,83House of CommonsHealth and Care Bill: explanatory notes.https: //bills.parliament.uk/bills/3022/publicationsDate accessed: November 22, 2021Google Scholar and recent requirements for providers in Australia to publish their prices on a centralised database84Australian Government Department of HealthPrice transparency for Home Care Packages.https: //www.health.gov.au/initiatives-and-programs/home-care-packages-program/managing-home-care-packages/price-transparency-for-home-care-packagesDate: 2019Date accessed: March 30, 2021Google Scholar each aim to improve market functionality, while preserving the core of the marketised system.
Even if we were to successfully implement each of these reforms, however, the central characteristics of the care sector still remain: that care work is rooted in the relationship between care-giver and care-receiver ( and is therefore time-dependent), and that many service users are unable or unwilling to vote with their feet by changing care provider. These two characteristics are not as amenable to reform or regulation, and create fundamental challenges for a sector modelled on competition, consumer choice, and profit. Increasing use of care robots and tele-care, although advantageous in some contexts ( eg, triaging, administration, manual handling, etc), could present a somewhat dystopian approach to improving labour productivity if used to replace human contact.85Druckman A Mair S Wellbeing, care and robots: prospects for good work in the health and social care sector. CUSP Working Paper No 21. University of Surrey, Guildford2019https: //www.cusp.ac.uk/wp-content/uploads/WP21-2019-Wellbeing-Care-and-Robots.pdfDate accessed: November 22, 2021Google Scholar Meanwhile, quality regulators can develop more stringent oversight and monitoring functions, better quality guidelines, and so on, to protect service users from poor quality. However, this hints at the core problem with all of the proposals discussed so far. By focusing on reforms that seek to preserve the privatised, marketised core of the current system, we will find ourselves constantly having to develop new regulations and mechanisms to limit the ability of for-profit companies to make profit.86Armstrong P Regulating care: lessons from Canada.in: Meagher G Szebehely M Marketisation in Nordic eldercare: a research report on legislation, oversight, extent and consequences. Stockholm University, Stockholm2013: 217-228Google Scholar This is not a trivial point. No matter how clever regulations are, there will always be those who seek to game the system ( and who do so successfully), often with disastrous consequences.
Ultimately, we must recognise the categorical error that led to the marketisation of care in the first place: that care is not a commodity to be freely traded on the market, but an intimate act that requires trust, attention, and relationship. In light of this, we argue for the rejection of neoliberal market ideology, as enacted through the principles of competition, consumer choice, and profit, and the embedding of a new set of guiding principles, more fitting to the core aims and characteristics of long-term care.
Social care is not created in a vacuum, and any plans for transformation must contend with existing realities to navigate a path to better care: the amount of existing debt on the books of facility-based care providers; the degree to which neoliberal ideology has permeated welfare policy; the lobbying power of large for-profit companies; the preparedness of non-profit actors to rapidly upscale delivery; the level of integration of long-term care with broader acute care services; and longstanding workforce, quality oversight, and funding challenges. These all define the context in which transformation takes place and demand flexibility and adaptability in our vision of social care, in terms of ownership structures, provider types, and commissioning processes. For this reason, the task of detailing what guiding principles might replace those associated with neoliberal market ideology, and of offering country-specific policy proposals for progressing towards a new vision of care, is one best tackled by workers, residents, policy makers, and providers in each country.
Instead, here we offer several policy directions that would begin to address some of the problematic dynamics identified throughout this paper. In the short term, these include reforms such as those discussed above: ( 1) reining in financialisation through drastically improved corporate group level transparency and mandatory onshore ownership; and ( 2) improving service users ' access to information about price and quality. It also includes more transformational changes such as: ( 3) letting go of the assumption that consumer choice within a market setting will automatically translate into better quality care for residents, and finding more effective ways to drive quality improvements ( eg, co-production of services, consumer advocacy models, improvements to quality monitoring processes, etc); ( 4) increasing public funding to the sector, in line with the true local cost of care ( this should lessen the likelihood that providers are pushed to cut costs at the expense of residents and staff, even in a for-profit context); ( 5) encouraging commissioners, or anybody with the power to set prices in the market, to move from a cost-minimisation mindset to a primarily quality-oriented one; and ( 6) strengthening workers ' rights to enable them to demand a fair wage and to prevent them from becoming a squeeze point.
In the long run, moving to a non-profit care sector ( whether nationalised or a mix of non-profit provider types) would reduce the opportunity for predatory financial practices of the kind outlined above. And although removing the profit motive wouldn't eliminate all imbalances and abuses of power, it would certainly relieve some of the wider tensions between profit, wages, and quality of care described in this piece. This means building capacity among non-profit providers and making a broader ideological transition away from neoliberal welfare policies. Ultimately, however, we call for sector-wide discussions in each country about what kinds of guiding principles are fit to lead us through the recovery and regeneration of our caring economy in the coming years, reflecting local economic and political challenges and centring the experiences and outcomes of those receiving care, and the knowledge and value of the care workers delivering it.
In this Personal View we have summarised the challenges created by trying to run long-term care systems as competitive, consumer-choice-based, for-profit markets. We have shown how the core characteristics of care—that there are limits to improving labour productivity and that consumers are inherently “ sticky ” —make it wholly inappropriate to be managed through the principles of neoliberal market ideology. We have demonstrated to the best of our abilities what happens when we do try to marketise long-term care, emphasising the poor clinical outcomes and working conditions that often emerge as a result, although the data are scarce and the research nascent in many places. The pieces of the puzzle that are in place show that the sector defies classical theories about competition, with reduced quality of care in areas of high competition; that informational deficits and high switching costs render the notion of consumer choice effectively meaningless; and that predatory financial practices, pursued in the name of making profit, are prevalent. Reforms are welcome in the immediate term, to improve financial transparency, limit extractive financial structures, and rectify market failures. However, ultimately, we argue that tinkering at the edges of a neoliberal care sector will only stave off the wolves temporarily. It will not turn them into sheep. Instead, a fundamental rethink is needed of our commissioning and provisioning systems, to better reflect the needs of workers and service users, rather than those of investors and profiteers.
All authors were involved in the conceptualisation of this Personal View. CCW wrote the original draft and provided project administration. AD and TJ reviewed and edited the manuscript and provided project supervision.
We declare no competing interests. The Economic and Social Research Council funded this project ( as per statement below), and we used University of Surrey resources ( eg, office space and IT equipment) in the preparation of this manuscript.
This work was supported by the Economic and Social Research Council ( ESRC; grant number ES/P00072/X). It also forms part of the ESRC-funded interdisciplinary research programme at the Centre for the Understanding of Sustainable Prosperity ( grant number ES/M010163/1). Neither funding source had any role in writing or deciding to submit this manuscript for publication. We would like to thank Ben Gallant, Nick Taylor, Madeleine Bunting, Stephen Allan, Amy Horton, and the participants of a parliamentary workshop on social care for the many fruitful discussions that informed this work. We gratefully acknowledge the support of the ESRC and the Laudes Foundation in the preparation of this paper. | tech |
Ukraine: Ensure Safe Passage, Aid for Mariupol Civilians | Help us continue to fight human rights abuses. Please give now to support our work
Residents Describe Harsh Conditions During Russian Attack
Thirty-two civilians who managed to escape southeastern Ukraine’ s besieged city of Mariupol last week told Human Rights Watch how they struggled to survive in below-freezing temperatures as Russian forces relentlessly attacked the city. They described men, women, and children sheltering in basements with little to no access to running water, power, heating, medical care, or mobile phone service since the siege began on March 2, 2022.
Russian forces laying siege to Mariupol should immediately ensure that civilians in Mariupol are not being denied access to items essential for their survival such as water, food, and medicine, and should facilitate safe passage to areas under control of Ukrainian forces for civilians who choose to leave the city.
“ Mariupol residents have described a freezing hellscape riddled with dead bodies and destroyed buildings, ” said Belkis Wille, senior crisis and conflict researcher at Human Rights Watch. “ And these are the lucky ones who were able to escape, leaving behind thousands who are cut off from the world in the besieged city. ”
The current death toll in Mariupol remains unknown. An assistant to the city’ s mayor, Petro Andryushchenko, told Human Rights Watch on March 20 that more than 3,000 civilians may have died since the fighting began, but he said the exact number was unclear. Local authorities have reported that at least 80 percent of the city’ s residential buildings had been damaged or destroyed. Human Rights Watch has not been able to verify these figures, or to assess how many of those killed were civilians.
On March 16 and 17, Human Rights Watch interviewed 30 Mariupol residents in person at a makeshift registration center in Zaporizhzhia, a city about 220 kilometers northwest of Mariupol. They were among several thousand Mariupol residents who fled the city on March 15 and 16 in personally arranged convoys with private cars, on journeys that took between 24 and 72 hours. Human Rights Watch also interviewed a couple in Zaporizhzhia who were waiting for their two children to arrive from Mariupol. On March 16 alone, at least 3,200 people from Mariupol made it to Zaporizhzhia, according to two local officials working at the registration center. Human Rights Watch spoke by phone with two other Mariupol residents who had managed to escape the city.
“ The last two weeks were pure horror, ” a school principal from Mariupol told Human Rights Watch. “ We left because our city is no more. ” A 32-year-old woman who fled to Zaporizhzhia with her three children said that, by the time they left, their house in Mariupol was so damaged that it looked like a strainer, covered with holes caused by the persistent attacks. A 64-year-old woman said: “ I think those who are left will get killed or starve to death. We have nowhere to come back to. ”
Mariupol is a coastal city between two regions currently under the effective control of Russian forces. Since around March 2, Russian forces have completely surrounded the city and blocked the port. Reports of fighting within the city center have emerged in recent days, and many of the residents who fled said they saw Russian and Ukrainian soldiers and military equipment in their neighborhoods. Andryushchenko told Human Rights Watch that, as of March 20, at least 200,000 of the city’ s pre-war population of over 400,000 remain in the city.
Residents who escaped said that hospitals, schools, shops, and countless homes had been damaged or destroyed by shelling. Many said that their family members or neighbors had suffered serious and, in some cases, fatal injuries from metal fragments of explosives and that they saw dead bodies strewn on the roads when they ventured out to look for food or water or to find a signal for their mobile phones.
The inability to communicate with relatives, friends, and the outside world was a particular challenge for people in Mariupol. Almost all cell phone towers had stopped delivering a signal by March 2, with only faint signals in specific locations after that. A graphic designer said that every day she would walk two and a half kilometers each way to a Kyivstar cellphone tower to try to get reception, ducking down to the ground every time a plane flew overhead.
Everyone interviewed noted that the lack of information caused by ruptures in telecommunication and electricity made it very difficult to figure out how to evacuate the city safely.
Those interviewed described staying in basements for days in crowded and unsanitary conditions, unable to shower and with little to eat or drink. One woman said she stayed for two weeks in a basement with at least 80 people that was about 300 square meters; a man stayed with 50 people in a basement that was 50 square meters; and another man said he stayed with 18 people in a basement that was 10 square meters.
Older people and people with disabilities described the additional challenges they faced: unable to move to their basements for shelter, they sat in their apartments with blown out windows, the walls vibrating with each attack. An 82-year-old man who stayed in his sixth-floor apartment since the attacks began, said he distracted himself by cleaning up the glass shards that littered the floors: “ I was shaking as the bombs were dropping. The walls were shaking, and I was afraid the building would collapse. But I spent my days trying to clean the glass shards. I was just cleaning, I had to somehow occupy myself. It was pointless, but it was all I could do to keep busy. ”
On March 9, Russian forces attacked a hospital complex in Mariupol, reportedly wounding at least 17 civilians, including medical staff and pregnant women. One pregnant woman reportedly died from her injuries after being transferred to another hospital following the attack. Human Rights Watch verified and analyzed 7 videos and 10 photographs showing the aftermath of the attack, including the destruction of the entire front wall of the children’ s hospital, apparent fragmentation marks on the façade of the neighboring maternity ward, and a large impact crater from the detonation of an air-dropped munition on the southern part of the courtyard. Russia later confirmed that it had targeted the hospital, alleging that Ukrainian forces had been occupying it and that they had warned civilians inside to leave. Human Rights Watch was unable to verify these claims.
On March 16, a drama theater in Mariupol that had been sheltering at least 500 people came under attack. In satellite imagery of the theater from March 14, the Russian word for “ children ” is clearly visible in large Cyrillic script on the ground in front of and behind the theater. A mother and son who sheltered in the theater for two weeks said that hundreds of people were still in the theater when they left at 9 a.m. on March 16, just hours before the attack. It appears that most people sheltering in the theater managed to survive while hiding in the basement, according to local authorities. The Russian Defense Ministry denied carrying out the attack and blamed Ukrainian government-backed forces.
Russian and Ukrainian forces reportedly agreed to the terms of a temporary ceasefire and creation of a humanitarian corridor on March 4 to allow civilians to evacuate from Mariupol safely. At least seven initial efforts to carry out the agreement and facilitate evacuations failed as ceasefires were broken.
According to Kirill Timoshenko, deputy head of the office of the president of Ukraine, at least 9,000 Mariupol residents had been able to flee to Zaporizhzhia using an agreed-upon humanitarian corridor over the previous few days. However, the mayor’ s assistant, Andryushchenko, said that agreement only covered a corridor between the Russian-controlled city of Berdyansk, 65 kilometers southwest of Mariupol, and Zaporizhzhia. He said that the route traveling out of Mariupol to Berdyansk is still subject to ongoing heavy fighting, and that civilians have not been offered any specific guarantees with respect to a humanitarian corridor or safe passage for this stretch.
Local authorities in Mariupol also reported on March 19 that Russian forces had taken “ between 4,000 and 4,500 Mariupol residents forcibly across the border ” into southwestern Russia. The Russian ministry of defense announced on March 20 that nearly 60,000 Mariupol residents were “ evacuated to Russia ” over the past three days, and that Mariupol residents have a “ voluntary choice ” regarding which corridor to take or whether to stay in the city. Human Rights Watch has not been able to verify these accounts. If Mariupol residents have been forcibly transferred to Russia, that could constitute a war crime. Under international humanitarian law, the transfer of a civilian, individually or en masse, is not voluntary, and is therefore prohibited, simply because the civilian agrees to it. A transfer can be forcible when a person volunteers because they fear consequences such as violence, duress, or detention if they remain, and the occupying power is taking advantage of a coercive environment to conduct the transfer.
Both Russia and Ukraine have obligations to ensure access for humanitarian assistance to civilians and to take all feasible steps to allow the civilian population to evacuate safely, if they choose, whether or not an agreement to establish humanitarian corridors is put into effect. Russia is prohibited from forcibly requiring civilians, individually or en masse, to evacuate to places in Russia or other countries such as Belarus.
The use of explosive weapons with wide area effects in populated areas heightens concerns of unlawful, indiscriminate, and disproportionate attacks. These weapons have a large destructive radius, are inherently inaccurate, or deliver multiple munitions at the same time. This includes the use of unguided and unobserved large-caliber projectiles and aviation bombs. The use of these weapons should be avoided in populated areas.
The International Criminal Court, the UN Human Rights Council’ s Commission of Inquiry, and other relevant jurisdictions should investigate potential war crimes in Mariupol, with a view to prosecuting those most responsible, Human Rights Watch said.
“ For those who were able to escape Mariupol, leaving friends and families behind, the news of recent evacuations has given them a bit of hope that those they love may make it out of the city alive, ” Wille said. “ Russian and Ukrainian forces should urgently do what it takes to protect civilians remaining in Mariupol, and to allow those who want to leave the besieged city to do so in safety. ”
Accounts from Mariupol Residents
Those interviewed are either not identified by name or identified by their first names only for their protection.
Explosive Weapons with Wide-Area Effects
All 32 Mariupol residents interviewed by Human Rights Watch described periods of sustained and often intensifying attacks with explosive weapons, from the beginning of fighting on February 24 to the moment they fled the city. Witnesses described attacks that killed and injured their neighbors as they took shelter in their homes, prepared food, and fetched water, throwing them from buildings and piercing them with fragments. The attacks also destroyed and damaged homes, businesses, and critical civilian infrastructure, such as hospitals and schools, collapsing and burning buildings in numerous parts of the city. The descriptions of the attacks and their effects are consistent with the use of explosive weapons with wide-area effects.
Serhii, a shipping inspector, said he was on the balcony of his father’ s apartment, when a detonation occurred, catapulting a man out of the window of the building next door and to the ground outside, killing him. The same attack started a fire in one of the stairwells of his father’ s building. “ We don’ t know if there were casualties because that part of the building collapsed, and no one could search for people in the rubble because of the constant shelling, ” he said. Several days after that incident, he said: “ I was just coming out of the building carrying some water, and I saw [ a neighbor’ s ] body … His dead body was just lying there, with his intestines hanging out. ”
Several residents described attacks that killed or injured people as they were on their way to get what little food was available, or to collect water from nearby rivers or springs.
One man said that three women were on their way to buy bread when an attack took place, killing one of the women, tearing off her hands, and seriously injuring the two others. He said he started to take one woman who had a serious stomach wound to the hospital until he came across Ukrainian soldiers who said they would take her to get treatment.
A 37-year-old man described how his neighbor was killed. “ On March 8, an attack hit while a young man from our building was outside trying to start a fire to cook, ” he explained. “ He was pierced by pieces of metal, including to his heart, and he died. Because of the continued attacks, his family has not been able to bury him yet, so his body is still in a van outside. ”
A doctor from Mariupol said that the hospital where she worked was damaged in an attack on March 10. The hospital had been closed since February 24. A school principal said that two munitions exploded in the yard of his school on March 15. “ A lot of windows were broken, ” he said, adding that dozens of other schools in the city were also damaged.
Access to Water and Sanitation
Everyone interviewed said that running water had stopped in the city on or around March 2, and that they had not been able to shower since. To try to get potable and non-potable water, they waited in line for up to six hours at fresh springs and at water trucks in the city, melted snow, collected buckets of rainwater, or flushed out their buildings’ heating systems.
One man, Valery, said that on March 8, International Women’ s Day, the men sheltering in his basement collected as much snow as possible to melt and boil over a fire, so that the women and children could wash themselves.
Some people said they had to defecate in buckets. One woman said the 30 people sheltering in her basement had only one bucket.
Access to Food
Those interviewed said they survived on food that they had at home before the fighting started and shared their dwindling stocks with those sheltering with them. Once looters had broken into shops, some said, they also went in and stole food. However, many of those interviewed owned personal vehicles and had considerable stockpiles of foodstuffs, so their experience was not necessarily representative of the experience of other civilians remaining in the city.
Viktoria, a graphic designer, said that her family and her neighbor’ s family eventually only had expired cans of paté left to eat, with the adults eating only one meal a day. Several families said they ran out of baby formula early on. Everyone said they cooked their food on open fires in the yards outside their buildings, or in kitchens that were near their basements.
Several people interviewed who had been sheltering in larger basements with more people said that volunteers, the military, and the police sometimes came to their basements to deliver some food, water, and medicine.
None of those interviewed said they saw Russian forces distributing aid at any point. According to Ukrainian authorities, a convoy of humanitarian vehicles trying to bring aid into Mariupol was stuck in the Russian-controlled city of Berdyansk, 65 kilometers southwest of Mariupol, as of March 15. The convoy had reportedly turned back by March 20 without reaching Mariupol or delivering the aid.
Access to Electricity
Everyone interviewed said they lost electricity on around March 2. Valery said his basement had a generator, but it was destroyed in an attack on March 10. One woman noted that, even in those buildings with generators, families eventually ran out of fuel for them to run.
Human Rights Watch recognizes that the internationally protected right to an adequate standard of living includes everyone’ s right, without discrimination, to sufficient, reliable, safe, clean, accessible, and affordable electricity. Access to electricity is critical to ensuring other basic rights, including but not limited to the rights to health, housing, and water. Steps should be taken to restore reliable electricity access for civilians to safeguard their other basic rights.
Access to Information
Once Mariupol was besieged, people in the city lost access to phone lines, television, and most local radio stations ( with the exception of some medium wave stations that were faint). They had no ability to access information about what was happening inside or outside the city. Everyone interviewed said that this lack of information was one of the things that made it the most difficult for them to figure out how to leave the city safely.
Valery said he lived in a building next to a mobile phone tower, which initially gave him a weak signal. But after several attacks next to the tower, including the one that destroyed his building’ s generator, the tower itself was hit on March 10, and the signal was completely gone.
In an example of how residents struggled to reach their loved ones, Ganna, an anesthesiologist, showed researchers a picture she had taken of a piece of paper that a mother had stuck to a water cistern in the city, where many people were going to fetch water, hoping her daughters might see it. “ We made it out of the left [ bank ], now in Kirovskii [ neighborhood ] at Natasha's, ” the note said.
Serhii, a factory foreman, and his wife were waiting at the reception center in Zaporizhzhia for their daughter, son, and grandson. They said they had not heard from them for eight days, and only found out they were alive the night before, when their children called them from a city between Mariupol and Zaporizhzhia. “ You see how grey my hair is? ” Serhii said. “ It turned grey in these 8 days. ”
Russian forces took over local radio broadcasts just after they encircled the city, and they sent text messages to those inside the city, which came through when residents happened to pick up a signal. One man said that he heard Russian forces announcing on the radio: “ Give up soldiers. Come out with a white flag on your gun, leaning it onto your left shoulder and approach us and we guarantee food, clothes, and will let you join your family after the fighting stops. ”
Two people said that at one point when their phones were on, they received text messages that they assumed had been sent by the Russian forces. Ina, the graphic designer, said she received a message from the number 777 that read: “ Ukrainian army surrender. ”
Those interviewed said they did not receive any messages directed at civilians warning them to take precautions prior to attacks or about access to humanitarian assistance or routes for safe passage.
Access to Health Care
Some people interviewed said they did not know whether any hospitals in the city were functioning, while others said that they had heard of one or two civilian and military hospitals that were still open, but with wait times spanning days. Human Rights Watch spoke to the daughter of a man who lost his eye after an explosion on March 6, which also damaged their home. When they rushed him to the hospital, she said there was no running water and limited electricity from their generators that they were using only to perform life-saving operations.
Andri, an engineer, said his home was about 200 meters from the main hospital in Mariupol that was treating Covid-19 patients. He said that on March 12, staff at the hospital told him that they had run out of oxygen days earlier and as a result people with serious respiratory symptoms were dying.
One man working as a volunteer delivering aid to shelters said that several people had come into the basement where he was sheltering with wounds from metal fragments caused by explosions. They were unable to make it to a hospital. “ Sometimes the ambulance started driving toward us, but then had to turn back because of the shelling and come back later, ” he said.
Oksana, a wheelchair user who can not walk since an accident 17 years ago, has been on daily medication to treat thyroid cancer for the past six years. She said she ran out of her medicine soon after the fighting started, when the pharmacies had already been looted and emptied out. She went to the hospital near her home that was open, but doctors there said they had run out of the medication she was on and gave her a substitute. She has no idea what the impact of being off her required medication for so long will mean for her future.
Mykola, the principal, said that even though his school had sheltered up to 200 people, they only had basic medicine there and the teachers, all trained in first aid, had to start acting as medics. “ We gave medical assistance as we could with the means that we had, ” he said.
A medic working at the reception center in Zaporizhzhia said that 55 people had been treated at their makeshift clinic, and that one woman who arrived on March 15 with a serious wound caused on March 8 by a metal fragment, had to be rushed straight to the hospital. On March 17, the World Health Organization expressed concern that there is “ the potential for multidrug-resistant infections ” in the case of such injuries “ given the previous high rates of over-the-counter antimicrobials, and limited access to treatments. ”
The Route Out
Following what residents described as days of especially heavy shelling on March 13 and 14, some of them with access to private cars decided to try to leave the city on their own, despite the ongoing shelling and needing to pass through Russian checkpoints. A convoy of about 160 cars left Mariupol on March 14, and hundreds more left on March 15. Serhii, the shipping inspector, told Human Rights Watch he estimated that, for each car in Mariupol that still functioned, he had seen at least 50 other cars destroyed during the bombardment, seriously limiting the ability of many Mariupol residents to escape.
Residents described passing through between 15 and 20 Russian military checkpoints between Mariupol and Zaporizhzhia. They all said that Russian soldiers either asked for the documents of the driver or for everyone’ s documents. Serhii said the soldiers were paying particular attention to the registered address that is written in Ukrainian passports to see if people were from Mariupol or elsewhere. “ I suspect they did this because, if they came across a man not from Mariupol, they would assume he was a soldier, ” he said. The Russian forces also made Serhii expose his shoulders, apparently to look for signs of bruising which might indicate that a person had used a firearm. Another resident said that they inspected the hands of the adult men for signs that they had been fighting or using a weapon.
Four people interviewed said that soldiers inspected their phones at the checkpoints, something that they had heard might happen, so they had deleted any photos of the damage from Russian forces’ bombardment in Mariupol before leaving the city. At one checkpoint, a Russian soldier asked Olexsandr if he had any “ forbidden ” photos on his phone. “ I asked him what was considered forbidden, and the soldier told me any photos of any Russian military vehicles, ” Olexsandr said. He had wiped his phone before passing through the checkpoints.
None of the Mariupol residents described serious mistreatment by soldiers at the checkpoints. One of them said that the Russian soldiers treated everyone in his car correctly, but several people were detained from the vehicle that was two cars ahead of them at the checkpoint. When that car made it to the checkpoint, he said, the soldiers fired their weapons in the air after what seemed to be a verbal altercation. One soldier then dragged a man out of the car, bent him over a barricade, and fired a weapon over his head. After that, everyone in the car was detained. The witness did not know what had led to the detentions or what happened to those who were detained.
Another person said his car was fired upon, he presumed by Russian forces because he was driving through an area fully under Russian control, but it was too dark to see. Later he examined the car and said the side had been pierced by a metal fragment. Mykola, the principal, said that between Mariupol and exiting the area under Russian control, he saw at least 10 burned cars on the sides of the road or in fields, and in one case, he saw a dead body lying next to a burned-out car.
Those Left Behind
As of March 17, several thousand residents – a small fraction of the residents still trapped in Mariupol by the intense fighting – were able to flee. Everyone interviewed said that they had only been able to leave because they had their own car or were able to find a ride with someone who did, and that many people with whom they had sheltered in basements and those with limited mobility had stayed behind.
Because electricity and telecommunications are not functioning, those who were able to leave had no information about those who are still in the city. One woman who was able to find a ride said she was forced to leave her mother who could not make it down the stairs to the shelter in her wheelchair.
Ina said that she left with about 16 other people, and about 65 others remained in the basement where they were sheltering. “ As we were leaving, we noticed there was only about two-days’ worth of food stocks left for everyone, so I don’ t know what will happen to them, ” she said.
Mykola said at one point his school, where he was sheltering, had housed 200 people. When he left, he said at least 50 people remained in the school with no means of transport out.
Several residents cited locations housing hundreds of people at the time they left the city, and they were worried that these areas might come under attack.
Legal Obligations and Relevant International Humanitarian Law
Sieges directed at military targets, which includes enemy forces, and for the purpose of capturing an enemy-controlled area, are permitted under the laws of war, as a legitimate military objective. Siege tactics can not include starving a civilian population or attacking, destroying, removing, or rendering useless objects indispensable to the civilian population’ s survival. Deliberate employment of such tactics is a war crime. Tactics that arbitrarily deny civilians access to items essential for their well-being such as water, food, and medicine are also prohibited, and all parties should protect objects indispensable to the survival of the civilian population, including those necessary for water distribution and sanitation.
The laws of war prohibit deliberate and indiscriminate attacks on civilians and civilian objects and attacks that cause anticipated harm to civilians disproportionate to the expected military benefit. Unlawful and wanton excessive destruction of property, not militarily justified, is a war crime. Both parties are required, as far as feasible, to take necessary precautions to protect the civilian population, individual civilians, and civilian objects under their control against the dangers resulting from military operations.
Evacuations of civilians in and around Mariupol who want to leave, should be facilitated. When an agreement to establish humanitarian corridors is put into effect, parties should not breach that agreement in any way that places civilians at risk. All parties must abide by their obligations not to carry out attacks that would target or cause harm to civilians who are on the move, including along railway and road routes being used to leave. Parties should allow access for neutral and independent humanitarian actors to support civilians at particular risk who may need assistance to leave, including people with disabilities, older people, pregnant people, children, and people with chronic or severe medical conditions.
Parties to the conflict are prohibited from deporting or forcibly transferring the civilian population of an occupied territory, in whole or in part, unless it is demanded by civilian security or imperative military reasons. The fourth Geneva Convention prohibits individual or mass forcible transfers of civilians from occupied territory to the territory of the occupying power or any other country, occupied or not, regardless of their motive. If for material reasons it is impossible to avoid such displacement, provisional, temporary evacuations may occur, but those evacuated must be transferred back to their homes as soon as the specific hostilities in the area in question have ceased. Violation of this prohibition is a grave breach of the Geneva Conventions and prosecutable as a war crime. The International Criminal Court, which has opened an investigation into potential war crimes in Ukraine, can prosecute the war crime of “ the deportation or transfer [ by the Occupying Power ] of all or parts of the population of the occupied territory within or outside this territory. ”
Ukraine, and Russia in the areas that it currently controls access to or occupies, should ensure that there is adequate supply of food, water, and medicine, and that services vital for the civilian population continue.
Both parties should abide by obligations to allow and facilitate the rapid passage of humanitarian aid for all civilians in need and not deny access or arbitrarily interfere with distribution. Starving civilians as a method of warfare is a war crime.
Abuses Against Older People in Armed Conflict | general |
Super backwardation trips up commodity carry trade | The transition from LIBOR to RFR has brought challenges for structured products. There are still legacy IBOR products to consider and at the same time the pricing and risk systems need to be upgraâ¦
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Edited by Bill Coen and D. R. Maurice
Commodities markets are roaring. But for one quant strategy, that’ s not great news.
Historic spikes in prices sparked by pandemic recovery and war in Ukraine have flipped commodity futures curves back to front and inside out. And for so-called curve carry strategies, that’ s about as bad as it could get: a trade that delivered positive returns in all but one of the past 19 years is suddenly bleeding cash.
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EU trading venue definition could crush innovation, fear bank execs | The transition from LIBOR to RFR has brought challenges for structured products. There are still legacy IBOR products to consider and at the same time the pricing and risk systems need to be upgraâ¦
To ease the pain associated with meeting compliance targets, global institutions are exploring ways to become more efficient by integrating regulatory and business initiatives.
Wire payment fraud is a major growing risk for financial institutions in the aftermath of the COVID-19 pandemic. These cases of fraud donât just hurt finâ¦
Asia Risk is proud to present Asia Risk Live, a face-to-face event in Hong Kong and Singapore. An opportunity to reconnect in person to learn and exchange new ideas.
View our latest in market leading training courses, both public and in-house.
The Energy Risk Awards recognise the leading firms in energy risk management. Corporates, financial players, technology and data firms, consultancies, brokers and exchanges are all welcome to submit â¦
The Asia Risk Awards recognize best practices in risk management and derivatives use by banks and financial institutions around the region.
Take a look at the wide variety of events and training on offer.
This eBook is based on the 2021 industry research by Acuiti, as well as the FIS Readiness Report. Youâll find plenty of support for a move to AI-powered cloud computing, a modular approach that ensurâ¦
Maximising value from better risk management and deal efficiency This Risk.net survey and white paper, commissioned by SS & C Intralinks, assesses the outlook for the CMBS market in the US and Europe, â¦
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Edited by Bill Coen and D. R. Maurice
In late January, Europe’ s markets regulator published its opinion on the definition of a multilateral system and asked for comment from the industry. The consultation lays out the European Securities and Markets Authority’ s ideas on what constitutes such a trading venue and the firms that would need to seek authorisation.
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Norway oil fund’ s derivatives book balloons 192% in H2 2021 | The transition from LIBOR to RFR has brought challenges for structured products. There are still legacy IBOR products to consider and at the same time the pricing and risk systems need to be upgraâ¦
To ease the pain associated with meeting compliance targets, global institutions are exploring ways to become more efficient by integrating regulatory and business initiatives.
Wire payment fraud is a major growing risk for financial institutions in the aftermath of the COVID-19 pandemic. These cases of fraud donât just hurt finâ¦
Asia Risk is proud to present Asia Risk Live, a face-to-face event in Hong Kong and Singapore. An opportunity to reconnect in person to learn and exchange new ideas.
View our latest in market leading training courses, both public and in-house.
The Energy Risk Awards recognise the leading firms in energy risk management. Corporates, financial players, technology and data firms, consultancies, brokers and exchanges are all welcome to submit â¦
The Asia Risk Awards recognize best practices in risk management and derivatives use by banks and financial institutions around the region.
Take a look at the wide variety of events and training on offer.
This eBook is based on the 2021 industry research by Acuiti, as well as the FIS Readiness Report. Youâll find plenty of support for a move to AI-powered cloud computing, a modular approach that ensurâ¦
Maximising value from better risk management and deal efficiency This Risk.net survey and white paper, commissioned by SS & C Intralinks, assesses the outlook for the CMBS market in the US and Europe, â¦
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Edited by Bill Coen and D. R. Maurice
Norway’ s sovereign wealth fund radically reshaped its hedging profile in 2021’ s volatile second half, nearly tripling the amount of derivatives notional on its book.
The fund, known formally as the Government Pension Fund Global ( GPFG), held Nkr1.1 trillion ( $ 125 billion) notional of derivatives as of December 31, up 192% from June 30 and 153% from end-2020.
Foreign currency forwards and interest rate swaps led the increase, with notional ballooning 189% to Nkr791.7 billion and 237%
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Build resilience before it’ s too late | The transition from LIBOR to RFR has brought challenges for structured products. There are still legacy IBOR products to consider and at the same time the pricing and risk systems need to be upgraâ¦
To ease the pain associated with meeting compliance targets, global institutions are exploring ways to become more efficient by integrating regulatory and business initiatives.
Wire payment fraud is a major growing risk for financial institutions in the aftermath of the COVID-19 pandemic. These cases of fraud donât just hurt finâ¦
Asia Risk is proud to present Asia Risk Live, a face-to-face event in Hong Kong and Singapore. An opportunity to reconnect in person to learn and exchange new ideas.
View our latest in market leading training courses, both public and in-house.
The Energy Risk Awards recognise the leading firms in energy risk management. Corporates, financial players, technology and data firms, consultancies, brokers and exchanges are all welcome to submit â¦
The Asia Risk Awards recognize best practices in risk management and derivatives use by banks and financial institutions around the region.
Take a look at the wide variety of events and training on offer.
This eBook is based on the 2021 industry research by Acuiti, as well as the FIS Readiness Report. Youâll find plenty of support for a move to AI-powered cloud computing, a modular approach that ensurâ¦
Maximising value from better risk management and deal efficiency This Risk.net survey and white paper, commissioned by SS & C Intralinks, assesses the outlook for the CMBS market in the US and Europe, â¦
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Edited by Bill Coen and D. R. Maurice
This article was paid for by a contributing third party.More Information.
Corporate resilience is more relevant today than ever, and the Covid‑19 pandemic has only sharpened the focus on it. Supply chain disruptions will cause 65% of annual debt/earnings before interest, taxes, depreciation and amortisation –known as debt/EBITDA – loss over the course of the next 10 years, and cyber crimes could cost $ 1 trillion worldwide annually, and the figures are growing
The impact of operational risk is far greater than the immediate loss, and it is expected to impact shareholder returns five times the direct reported loss.
The International Monetary Fund notes that global uncertainty has grown since 2000. Additional data reveals that cyber incidents have risen 24% since 2013 and the frequency of natural disasters is also rising. All of this calls for companies to arm themselves with the most potent resilient defences.
According to Risk.net research, the top 10 operational risk losses for 2021 totalled $ 15 billion. The largest op risk losses of 2021 by sheer mass occurred in the hinterland of institutional finance – the world of cryptocurrency trading – where two mega-heists of more than $ 2 billion apiece topped the charts.
Although the top 10 largest losses of 2021 represent a significant proportion of the year’ s total losses in the field, institutional op risk losses by volume and by number fell from $ 28 billion in 2020 to $ 15 billion in 2021, and from 490 events to 466 in the same period.
When thinking about corporate resilience, companies must think about technology, organisational, reputational and business model resilience. The holistic, 360° look at resilience provides an incredible source of competitive advantage.
At a recent McKinsey summit on the subject, industry leaders shared their views on how best to boost resilience at any organisation.
“ We think that building back community-based connection is an incredibly important part of building up that social fabric of society, and hence resilience at a global level, ” said Sarah Friar, chief executive of Nextdoor and Walmart board member.
Friar highlighted the importance of neighbourhood and communities, and how human contact helps people recover. Local community connection has never been more important, and this is a lasting change, she added.
The more engaged neighbourhoods are pre-crisis, the faster communities will recover from crises. The power of proximity in a neighbourhood is also vital. The second thing she noted was just how much residents needed a way to find each other.
“ In the case of Hurricane Harvey, the neighbour who got in a boat, took the boat over to your house, helped you off the roof and took you to a place of safety – this demonstrates true resiliency at the local level. ”
She added that policy-makers need to invest in hyper-local communities online and offline before a crisis to get ready ahead of time.
Leaders also stressed the importance of having a clear value system. Alain Bejjani, chief executive at Majid Al Futtaim Holding and executive director, Majid Al Futtaim Holding Board, emphasised the importance of having a ‘ North Star’ to guide an organisation and its leaders.
“ In addition to values, you really need to have a clear North Star. All of us leaders make a lot of choices. A lot of these choices could be right, but could also be wrong. And you should have a North Star that guides you on what matters and where you want to go, not just based on your values today but where do you see yourself in the future.
“ We need clarity, and the only way to have clarity is to take the time to think forward. What do we want to do, and how does it work? When you have a set of very real anchored values and you have clarity of where you’ re going, decision-making is much easier. ”
A company must plan for how it can be agile for future situations of uncertainty, he added. To be agile in a time of need or to make the right call in a heated moment, a company must first have clearly defined its North Star and be deeply rooted in a set of values.
Bejjani highlighted the importance of efficiency in building resilience.
Having business continuity in place is not enough. “ What mattered prior to the pandemic was efficiency: how can we do more for less, how can we be as efficient as possible, how can we optimise stock quantities and how can we be efficient on a different level? ”
He said having one eye on the immediate and one eye on the future is equally important. “ You need to have one eye in the microscope and the other in the telescope when you are in crisis. Today we are living a great example of both eyes in the microscope. ”
Thinking about resilience is very important, he added, and companies need to make sure that their core is very strong. “ I would say resilience gives us the perspective that we need to think forward during crisis. ”
Setting clear business objectives is also extremely important, said Howard Davies, chairman at NatWest Group.
“ We did have a very clear alignment around that objective, which carried us through with minimum disruption and distractions. That’ s often the case with people being a bit too hopeful – and gambling on resurrection. We had a common view at the board that we’ d done enough gambling on resurrection, the bank had done enough of that in the previous crisis. ”
Concerns of inflation and overexposure are threats to resilience. The secret to navigating a crisis for a company is coherence around objectives. Executives must be clear on what the overall objectives are, said Davies.
“ The main secret to getting through all of that, which has been very difficult at times, has been to ensure the executive and board were clear on what the priorities were. And we were clear that the priority had to be to achieve a position where we were not under threat of capital shortage, ” he added.
Greg Case, chief executive of Aon, said that Covid-19 became an incredible catalyst for how we view long-tail risk, and has opened up patterns we can see in other categories, such as cyber, climate change and intellectual property. Fundamentally, resilience is the business. Resilience is taking action at scale.
“ Now it’ s no longer the risk leaders. It’ s the chief financial officers, the treasuries, the chief executives and boards of directors that are asking questions. How do we deal with this new type of volatility that will impact supply chain, demand, and so on? ”
He added: “ If you think about resilience as a capability – fundamental in terms of company-building – it’ s a completely different orientation. It changes the psychology in terms of how companies think about it – it certainly has for Aon. In essence, resilience is really about the ability to take action and action at scale – to both ‘ defend the house’ and ‘ build the house’. ”
Case said Aon has seen as much opportunity to build the house in times of volatility as it has to defend the house.
“ The other piece is around the resources. How do you build it? What do you do? Often we hear talk about how we’ re making investments in resilience. We’ re spending money. But the source of resilience we find most compelling, most durable, is around organisational conduct and how you approach the world as a company. From Aon’ s standpoint, 15 years ago we were doing fine as a firm, but we realised we need to keep up with our clients in terms of their innovation and what they were doing and evolving. ”
Case emphasised that companies must take a view that reflects the idea that resilience isn’ t a discrete investment. “ It really is an orientation. If resilience really does drive opportunity in times of volatility, it’ s not a side part of your business, it means taking action at scale to improve your business.
“ That’ s why it is really an organisational investment, not a one-off investment, and driven by this kind of organisational orientation that we want to work together and see opportunity in volatility, as opposed to risk in volatility. ”
According to McKinsey, companies can take three steps to get started in building resilience for the years ahead: describe how resilient you are today, determine the degree and nature of resilience you need for the future, and design your approach to building and maintaining the resilience you need.
Companies that understand the resilience they need for the future can implement sensible change today, and be better prepared for what the future might hold.
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Rural American Healthcare During COVID19 Worse Than 3rd World | The entire notion of a “ 3rd World ” is a weird political framing of the world by the French. Economist Alfred Sauvy in 1952 spoke of Africa and Asia being like France’ s “ Third Estate “. The vast majority of people in pre-Revolution France belonged neither to a clergy ( 1st) nor nobility ( 2nd), thus had less privileges and were unrepresented in government, which led to their Revolution.
With that in mind, Politico has an article making it clear that rural Americans are tiny in number yet experience worse healthcare than the worst in the world.
“ We have a residency program at Guyana, on the coast of South America, ” Russ said. “ These are the types of things that [ I see ] when I go down and work in Guyana. We see this for the Amerindian population that are coming out of the villages and need a canoe to get, you know, to a hospital. This isn’ t the type of thing that we’ re used to seeing in the United States. ”
Tennessee lost over 1,200 staffed hospital beds between 2010 and 2020 despite a population that grew by over half a million, according to the American Hospital Directory and census data. Mississippi, with the most Covid-19 deaths per capita, lost over 1,100 beds over that decade. Alabama, second only to Mississippi in per-capita deaths from the virus, lost over 800.
Apparently living in rural America with a need for healthcare is like having a canoe without a paddle.
As much as this may seem like news, I remember experiencing this myself in rural America for decades. A trip to a hospital was considered a minimum 30 minute drive. Even that was to an outpost where chance of meeting someone with any clue about science was marginal at best.
More recently when I tried to setup a primary care physician, a step required to use health insurance, I was told there was zero availability. No doctors would accept any new patients because a healthcare crisis ( COVID19) meant zero capacity.
At one point the healthcare “ system ” advised I try to find a Muslim woman doctor because she would more likely take new patients.
* * * This is a Security Bloggers Network syndicated blog from flyingpenguin authored by Davi Ottenheimer. Read the original post at: https: //www.flyingpenguin.com/? p=38817 | general |
CNAPP and the World of Cloud Security | Recently we’ ve been seeing more and more talk about CNAPP. It’ s a relatively new term coined by Gartner that stands for cloud-native application protection platform. Gartner has added CNAPP to their hype cycle, especially as they predict that the use of public cloud will outstrip private data center usage. That’ s a pretty big claim for a pretty big acronym. Let’ s dig a little deeper into it.
As cloud-first becomes the norm, many companies are moving away from older tools and older ways of working into models and platforms which can handle the multi-cloud and hybrid cloud way of working. There simply isn’ t time for security teams to be checking multiple security tools for each cloud framework and yet another different platform for edge protection. What the cloud protection world is moving toward is holistic integrated protection from single platforms; hence, CNAPP.
CNAPP, in this sense, is more than just a combination of earlier terms and technologies. Though it may appear to be a combination of a cloud workload protection platform ( CWPP) and cloud security posture management ( CSPM), it’ s more than that. CNAPP covers more of the cloud-native application development life cycle, an area not necessarily covered by the other two acronyms. We call that shifting left.
If you think of the development life cycle as a linear process, moving from left to right, many traditional protection platforms only protected the very end of the process; the finished product. CNAPP shifts protection left to cover more of the application build process. This is crucial for catching issues and errors earlier in the development life cycle, meaning more effort and cost are saved. It also means that the security, development and operations teams are all using the same tool to monitor the environments. There’ s no longer the need for a handoff between the dev environment and security platform to the live environment and security platform.
A combination of CWPP, CSPM and CNAPP can deliver end-to-end protection of your infrastructure, cloud environments, workloads and your cloud-native applications.
Cloud workload protection platforms are a so-called single-pane-of-glass for monitoring and securing cloud-based workloads. According to Gartner, “ Organizations continue to adopt public cloud, private cloud, containers and serverless computing at higher rates as the result of COVID-19 and digital transformation. Technology service providers ( TSPs) must meet this demand by offering broad CWPP capabilities that align with all forms of cloud workloads. ”
Having only one dashboard to check, regardless of the number of cloud workloads or cloud infrastructure providers, cuts down on time and effort for security teams in their monitoring and prevention efforts. A good CWPP security solution should cover all the ingredients of the modern hybrid and multi-cloud environments, including on-premises, physical and virtual machines and containers as well as anything else that might reasonably be called cloud.
Cloud security posture management is a different approach primarily based on protecting cloud workloads from threats due to misconfiguration. An increasing number of organizations rely on public cloud infrastructure but may not know best practices or best configurations of that infrastructure. CSPM is the art and practice of monitoring infrastructure, detecting misconfiguration using best practices and documented fixes to resolve issues. These best practices and fixes should be drawn from a multitude of sources, including vendor-based knowledge bases and vendor-neutral industry-standard sources, which cover the most effective principles of cloud security. Integrating all of this information can give your security teams the power to spot and remediate issues and vulnerabilities as fast as possible.
CNAPP is aiming to be a holistic approach, encompassing many cloud environments and cloud-native apps. It provides both the proactive management and monitoring of a CSPM solution while adding in the protection element from a CWPP.
CNAPPs guard against configuration drift and misconfiguration across VMs, containers, hybrid cloud and multi-cloud.
CNAPP isn’ t likely to replace CWPP and CSPM, but it is a powerful complement to the previous tools that were available. There is still value in the CWPP and CSPM approaches but, as the tools and market for cloud security continues to grow, we may find many people trading in their old tools for new tools that put all the issues, and their solutions, at the fingertips of the teams that need to fix them. | general |
Your Data, Their Gain: How Threat Actors Leverage Tax Season to Commit Fraud | In 2020, the IRS identified over US $ 2.3 billion in tax fraud schemes, including tax return fraud. And in 2021, we identified 113 breaches which resulted in more than 69 million exposed records, including tax information, documents, and other sensitive data; this year, we’ ve already identified 15 breaches and 3 million exposed records. This number is certain to grow.
While tax return fraud is an issue throughout the year, it is, of course, most prevalent during tax season. Around the time when winter turns to spring, threat actors pursue W2 and other tax-related forms, which are chock-full of personally identifiable information ( PII) and may provide them with the data they need to commit tax fraud, among other illegal activities.
It is vital to prepare for, preempt, and ultimately prevent attacks that can lead to various kinds of tax fraud. In this article, we:
Also referred to as stolen identity refund fraud ( SIRF), tax return fraud occurs when a return is filed under someone else’ s identity. Threat actors accomplish tax return fraud through the use of stolen personal information, which is leveraged to file tax returns under another individual’ s identity. Threat actors targeting tax return fraud typically file electronic returns as early as possible in the tax season in order to claim refunds before the legitimate filer.
To prepare for this scheme, fraudsters build up information on their victim through collecting tax documents, Social Security numbers ( SSNs), full names, addresses, credit reports, and other personal information. Identities used for fraudulent returns can be sourced from a number of places including data breaches, phishing campaigns, spear-phishing scams targeting tax professionals, and Remote Desktop Protocol ( RDP) accesses. Fraudsters can target both individuals and tax preparation services, building up “ fullz ” ( slang for “ full package of personally identifiable information ”) to file returns en-masse, or attempting to gain access to personal information and tax software accessible by tax preparers.
Threat actors will either purchase “ fullz ” on an illicit marketplace, or otherwise identify a victim and aggregate additional personal information like full names, addresses, phone numbers, employment, education, and Social Security Numbers. This information can be gleaned from publicly accessible background check tools, social media profiles, data breaches, and phishing attacks.
Once a victim is identified, the fraudster can then begin the filing process—again, the earlier in the tax season the better. Some fraudsters do so with the help of stolen tax documents, although many manually calculate figures using the IRS’ s tax withholding estimator to create their desired refund amount and avoid incorrect calculations.
Many fraudsters work within the underground economy of illicit forums and marketplace to form “ partnerships ”; trading information and sharing resources to help gather fullz, file correctly, and cash out successfully.
Threat actors may also target RDP ( Remote Desktop Protocol) accesses to PCs with access to tax preparation software. These accesses allow fraudsters to file on legitimate and registered tax software, helping falsely filed returns avoid additional scrutiny.
Automated filing software, observed in multiple online forums and illicit chat services, helps fraudsters file hundreds of fraudulent returns en-masse. Threat actors input fullz information into the program, where it automatically fills out tax returns with the victim’ s information. While fraudsters must manually complete email and CAPTCHA verifications, threat actors claim such programs can submit up to 1,000 returns in an hour.
Threat actors appear to primarily target the IRS’ s FreeFile system with this tactic, though Flashpoint has observed other tax services targeted with similar software. While this method appears to have relatively low rates of acceptance and successful cash out, analysts assess that threat actors will continue to target tax services with similar tactics.
The unique landscape brought about by the COVID-19 pandemic has also created increased opportunities for stolen identity refund fraud. The third round of Economic Impact Payments ( EIP), ( advance payments of the 2021 Recovery Rebate Credit) can be claimed on a 2021 tax return as a tax credit. The third installment of EIPs, worth US $ 1,400, is an attractive target for threat actors in the 2021 tax season. Unclaimed stimulus checks are relatively easy for fraudsters to claim, especially from victims who recently turned 18, or other filers who did not previously qualify for the Economic Impact Payments.
Discrepancies involving claims for the Recovery Rebate Credit also contributed to the IRS’ s backlog of unprocessed returns, which has created additional opportunities for fraudsters to commit tax return fraud. As of December 2021, the IRS reported that 35.3 million returns still await manual processing from the 2020 tax season. This backlog enables fraudsters to take advantage of unfinalized Adjusted Gross Income ( AGI) figures—a figure from the previous year’ s tax return used by filers to verify their identity. Unfinalized returns do not have an accurate AGI figure, meaning that fraudsters do not need to verify that information to file a return.
Threat actors and threat actor groups leverage social engineering tactics, like phishing or voice phishing ( vishing) in order to trick human resource departments to disclose employee PII—in the form of W2s. In some instances, the actor could pretend to be a CEO or director requesting employee data for tax filing or auditing purposes. In 2018, the FBI warned of tax season-related W2 phishing scams.
Threat actors consistently target organizations using business email compromise ( BEC) and other fraud schemes that attack executives to access confidential data. BEC accounted for an adjusted loss of $ 1.8 billion in 2020, according to the FBI’ s Internet Crime Complaint Center’ s annual Internet Crime Report. During tax season, BEC is often used to trick employees into sending PII to individuals pretending to be company executives or other trusted parties, including W2 and other tax forms.
Stolen identity refund fraudsters who successfully file an accepted tax return will then attempt to cash out their refunds. While some fraudsters may attempt to create bank accounts under their victim’ s name for cash out, prepaid cards offered by some tax preparation services are considered an easy way to receive funds.
“ Cashout ” services are also offered by threat actors in illicit forums and marketplaces, wherein fraudsters will launder tax refund payments within the automated clearing house ( ACH) network to cash out illicit funds. They can act as recipient accounts for transactions of compromised funds from electronic payment systems with stolen credit cards linked to them.
Threat actors may also attempt to launder funds into cryptocurrency. The decentralized nature of peer-to-peer cryptocurrency exchanges is highly attractive to actors seeking to launder funds. Although these services are legitimate, the accountability and transparency adhered to by a number of larger centralized exchanges is not mandated, and they therefore challenge law enforcement efforts to track potential cases of abuse.
Frauders will likely employ tried and true methods of business email compromise, buying and selling of fullz, and offering tax fraud-related services as they generally require little technical acumen or sophistication.
The identity theft fraud landscape has grown due to the use of third-party vendors along the software supply chain, like cloud service providers, who introduce a host of new risk apertures into the tax fraud space. Fraudsters may target cloud resources storing personally identifiable information that could be used to file for fraudulent tax returns. They could also target resources that directly store tax documents or information.
Accounting services, including CPA’ s, tax preparation, payroll services, and bookkeeping, were responsible for 24.7% of 2021 tax breaches. Financial services, including banks, credit unions, savings & loans, mortgage brokers, and financial advisors, were responsible for 23.3% of 2021 tax breaches.
Other business groups, including manufacturing, real estate, and insurance were also targeted, demonstrating that all industries are at risk.
Common tactics include the aforementioned social engineering tactics, as well as ransomware and malware, exploited software vulnerabilities, and misconfigured databases that left records exposed.
In 2018, the FBI suggested that to best protect against social engineering attacks like business email compromise, organizations should consider implementing additional security measures like implementing a PIN or other form of multi-factor authentication to approve transfer of tax-related information. In November 2021, the IRS outlined basic safeguards to protect against identity theft as the 2022 tax season approaches. Among these are the use of updated security software, using the “ stop malware ” feature on anti-virus software, being cognizant of phishing scams, using strong and unique passwords, using multi-factor authentication whenever possible, only shopping on sites that are TLS encrypted ( HTTPS over HTTP), not using public or unsecure Wifi, securing your home WiFi network with a password, backing up files from your computer and mobile phones, and creating a virtual private network ( VPN) to connect to external networks like that of an office. The IRS also notes common warning signs that could possibly lead to identity theft. They note that fraudsters will try to impersonate government agencies via email or text message, relaying false information about refunds or stimulus payments. The IRS notes that they will never call or send unexpected messages about refunds.
Flashpoint gives you the threat intelligence needed to have visibility into threat actor groups, the risk apertures they seek to exploit, and the potentially serious threats they pose to organizations across both the public and private sectors, including tax fraud and other illicit activities that may ensue when credentials are compromised. Sign up for a free trial today to keep your organization’ s assets, data, infrastructure, and personnel safe from threats.
The post Your Data, Their Gain: How Threat Actors Leverage Tax Season to Commit Fraud appeared first on Flashpoint.
* * * This is a Security Bloggers Network syndicated blog from Blog – Flashpoint authored by Veronica Drake. Read the original post at: https: //www.flashpoint-intel.com/blog/why-tax-season-is-high-time-for-tax-fraud/ | general |
MedMe Health Secures CAD $ 2.7M Seed Funding | MedMe Health, a Toronto, Canada-based provider of a virtual care and clinical services technology platform, raised CAD $ 2.7M in Seed funding.
The round was led by M12, with participation from Graphite Ventures, Y Combinator and MaRS IAF.
The company intends to use the funds to accelerate growth, product development and global expansion.
Led by CEO Purya Sarmadi, MedMe Health a web-based platform supporting pharmacy scheduling, documentation and management of clinical services at scale. Real-time patient engagement, streamlined workflows and automated documentation empower pharmacists to optimize pharmacy operations, build patient relationships and diversify revenue through clinical services. To date the company has facilitated over 14 million unique patient interactions at more than 3,600 pharmacies including Rexall, Shoppers Drug Mart, Jean Coutu Group, Guardian, IDA, The Medicine Shoppe, Remedy’ sRx, and Pharmasave. In 2021 the platform enabled pharmacies administer more than 544,000 flu shots, 2,220,000 COVID vaccine doses and more than 155,000 COVID tests. In December 2021 alone the platform booked 760,000 appointments.
MedMe Health is a Y Combinator W21.
FinSMEs
21/03/2022 | business |
Nordea believes strong salmon prices will offset cost increases | Handles the inflation shock better than the meat industry.
Inflation spiked as the world reopened after the Covid pandemic. At the same time, extensive bottlenecks on production and logistics were uncovered, sending prices for a wide range of raw materials and transport skywards.
High inflation, which has hardly been seen in Europe since the 70s and 80s, is eating away at people’ s purchasing power and increasing costs for many industries, including salmon farming. The most important cost component for salmon farming, fish feed, rose to an all time high in the fourth quarter of 2021.
Keeping pace Feed is not going to get cheaper soon, not least because the war in Ukraine involves two of the world’ s largest grain producers, who together produce a quarter of global grain products.
Read also: Feed price for new top listing: It has never been more expensive to feed salmon
“ I have done a little digging work on how the costs to meat producers are affected by increased raw material prices. Meat producers will probably have to increase their prices by 20-40 percent to keep up with cost increases, ” salmon analyst Herman Aleksander Dahl in Nordea Markets told Finansavisen.
The relative “ The fish farmers do relatively well since the feed conversion factor is so low. We estimate that the cost increases for feed are four times greater for beef producers than for salmon. With increased prices for other proteins, it should be possible to increase the demand for salmon, ” Dahl believes.
According to Dahl, the average production cost for the farmers was NOK 43 ( €4.5) per hectare kilo last year. Due to increased costs, he calculates an average cost of NOK 48 ( €5) per kilo now.
On Friday, the sales price for salmon ( for fish farmers) was around NOK 85 ( €9) per kilo.
post @ salmonbusiness.com | general |
CANADIAN-BORN BOUTIQUE HOSPITALITY BRAND PARADOX OPENS | Vancouver, BC, March 21, 2022 ( GLOBE NEWSWIRE) -- Paradox Hotel Group and TA Global Berhad are thrilled to announce that Paradox Hotel Vancouver will be opening its doors to the public on April 1st, 2022. The hotel, located in downtown Vancouver's Coal Harbour, is the flagship location for Paradox Hotel Group – a global hotel and hospitality brand with locations worldwide.
In a city known for its stunning natural environment, diverse culture and progressive outlook, Paradox Hotel Vancouver represents the birth of a new identity in hospitality – one that is both familiar and surprisingly unconventional. The Paradox brand was developed by a team of experienced hoteliers in Vancouver; both the hotel and global brand focus on creating a unique guest experience.
The hotel's opening welcomes the global return to travel and tourism in Vancouver with an approach to hospitality that is true to its roots, one that delivers a genuine, attention-to-detail service experience that combines world-class amenities alongside an authentic and relatable human touch.
`` The hospitality sector is currently going through a key moment of transformation as technology, and social media are quickly changing the way we travel and interact with others. We recognized a shift was occurring in how people engage with each other and also with the built environment. The height of the COVID-19 pandemic was the global catalyst for a resurgence of interest in authentic human connection and a greater expectation of personalized hospitality. As an industry leader, it was an opportune moment to realign and reinvent our business proposition to meet and adapt to the current needs and desires of the market, '' says Joo Kim Tiah, CEO of TA Global.
He continues, `` Paradox Hotel Group was born out of an extensive study of this evolution. We have always wanted to consolidate our hotels, and the time to embark on this meaningful journey is right now. Our global teams possess decades of experience and an established network of industry partners, having developed and operated numerous high-profile hotels worldwide. Passionate about what we do, our team has a strong understanding of every aspect of hospitality business from concept development to operations. We strongly believe that a distinct identity rooted in local culture is crucial for a successful hotel group. We strive to be at the vanguard of curating inspiring and exceptional experiences for our travellers, so it was imperative to not only come out with our own distinct brand but also create something that would exceed expectations by challenging the industry status quo. ''
The design vision for Paradox Hotel Vancouver was to create a space for the new era of cultural tastemakers to congregate and celebrate the convergence of community in a way that is both thoughtful and unapologetically fearless. The hotel showcases a laid-back contemporary design with an upscale ambiance. It will be a global destination for travellers and locals seeking a unique experience and offering a broader spectrum of services and amenities.
`` We wanted to create a hotel concept that embodied the paradoxical spirit of Vancouver, where the brand was created; a city in which world-class luxury and laid-back lifestyles go hand-in-hand, '' says Paradox's Head of Brand Experience Lorraine Simonds. `` Paradox Hotel Vancouver is one of the most stunning luxury buildings in the city, but it's about more than luxurious travel accommodations. Our vision for the hotel is to create interactive social spaces that facilitate authentic relationships between our guests, the city and its people. ''
Alongside celebrated local fine-dining favourite Mott 32 by award-winning restaurant group Maximal Concepts, Paradox Hotel Vancouver will be home to two brand new hotel-centric F & B and nightclub concepts by legendary local champions After Dark Hospitality. The highly anticipated Karma Lounge and Mansion Nightclub will open in late Spring 2022, bringing the best of Vancouver's nightlife to the hotel's upper lobby and multi-level nightclub venues.
For Tony Medd, co-founder of the global brand and General Manager for Paradox Hotel Vancouver, the staff and teams behind the Paradox experience are the essential backbone to the brand's success.
`` We like to challenge the status quo of how traditional hotel teams work internally and trust that it will give a distinct flavour to how our guests experience our hospitality. That starts by empowering and training our staff from groundskeepers to senior management to make decisions so that they can be a true host no matter what the ebb and flow of the industry brings. ''
Following the April 1st opening, Paradox Hotel Vancouver will be hosting a series of events leading up to its grand opening party; details for the Summer 2022 event will be announced in the coming months.
`` We are excited to present the Paradox Hotel Vancouver to the city of Vancouver and the world, '' says Medd. `` We have put together an incredible team to develop the hotel experience, and we can't wait to show off our flagship location. ''
Paradox Hotel Group is an innovative hospitality brand and award-winning hotel collective that develops, operates, and markets exceptional boutique lifestyle hotels & resorts across the world. All Paradox hotels proudly showcase Canadian hospitality, manifested through thoughtful design, best-in-class facilities and guest services, and bespoke dining and gathering concepts. Each location features multifaceted experiences that differ from the others, celebrating individuality and vibrant perspectives. Paradox Hotel Vancouver is the first Paradox-branded hotel in Canada under the Paradox Hotel Group umbrella, including Summit Lodge Boutique Hotel and Aava Hotel in Whistler, and global locations Paradox Resort & Residences in Karon Beach Phuket, and Paradox Hotel Merchant Court at Clarke Quay in Singapore. For more information, please visit www.paradoxhotels.com
Paradox Hotel Vancouver boasts 147 guest rooms, including 16 one-bedroom suites and one penthouse suite. Framed by Vancouver’ s iconic twisting tower designed by Arthur Erickson, the hotel features seven event venues totalling 15,000 sq.ft., a 3,982 sq.ft. wrap-around terrace, indoor pool and walk-out whirlpool, a fitness centre and 3,000 sq.ft. spa facility. Paradox has partnered with Vancouver's top food and beverage champions to deliver the best in fine dining, cocktails, locally-sourced fare and entertainment – with Mott 32, Karma Lounge and Mansion Nightclub offering elite service to impress even the most discerning guests. For more information, please visit www.paradoxhotels.com/vancouver
TA Group of Companies proudly boasts over 30 years of excellence with an astounding track record in the financial and property market in Malaysia. The reputation has set the foundation for success for its property arm, TA Global Berhad which was incorporated in 2008. TA Global Berhad, a leading property developer in Malaysia, is involved in a diversified range of property services which includes property development, property management, property investment, trading and hospitality operations. The company has made significant strides in establishing itself as a niche luxury lifestyle property developer with its successful launches of niche premium residential properties. The Group also boasts an extensive global hotel portfolio spanning five countries on three continents in Australia, Singapore, Thailand, China and Canada. Over the years, the company continued to expand their business, gaining a truly outstanding reputation as a leading property developer recognized locally and internationally. For more information about TA Global, please visit http: //taglobal.com.my/ | general |
U.S. seafood workers at increased risk for COVID-19 during pandemic, research finds -- ScienceDaily | `` The U.S. seafood industry was hit pretty hard, especially workers in high-density workplaces like seafood processing plants where social distancing was difficult, '' said Easton White, assistant professor of biological sciences. `` Even though COVID-19 precautions were set in place reducing the number of workers on processing lines it meant longer shifts and increased exposure overall. Fishing vessels had similar issues, where crews on crowded boats faced challenges wearing PPE, or masks, in wet and windy conditions. ''
In the study, recently published in the journal PeerJ Life & Environment, researchers show how U.S. seafood workers were disproportionally affected by COVID-19, highlighting the various direct and indirect effects of the virus and tracking the number of cases and outbreaks. They reviewed news reports, scientific articles and white papers and found most cases of COVID-19 among the seafood workers were reported during the height of the pandemic, in the summer of 2020 and the beginning of 2021, and the majority were among workers involved in seafood processing who tend to work in close proximity to each other for long hours. Cases of COVID-19 were found in all U.S. coastal areas however Alaska, home to 60% of the U.S. commercial fisheries, experienced the largest number of outbreaks. Researchers also noticed more physical and mental taxing conditions like concerns about workplace safety, contracting COVID-19, access to medical services, vaccination and paid sick leave. They also took into consideration the economic consequences of the pandemic including changes in markets, supply and demand, in addition to revenue loss, price fluctuations, supply chain issues and labor shortages.
The researchers point to the effectiveness of the preemptive response to COVID-19 from the Massachusetts town of New Bedford which contains a massive shipping port and compare it to pandemic practices in Dutch Harbor and the Aleutian Islands in Alaska, home of the two largest commercial fisheries in the country. New Bedford was one of the first to open both testing centers and vaccination sites specifically for seafood workers leading to limited number of cases and outbreaks while the fishing industry in Alaska reportedly had trouble managing the virus.
`` We hope this research sets the foundation for future practices in the seafood sector in relation to the COVID-19 pandemic, improving the overall workplace and recognizing the importance of collecting systematic social and economic data about workers, '' said White. | science |
CF Industries Holdings, Inc. Announces Redemption of Senior Notes Due 2023 | CF Industries Holdings, Inc. Announces Redemption of Senior Notes Due 2023
CF Industries Holdings, Inc. ( NYSE: CF) today announced that its wholly owned subsidiary CF Industries, Inc. has elected to redeem in full on April 21, 2022 all of the $ 500,000,000 outstanding principal amount of its 3.450% Senior Notes due 2023 ( the “ Notes ”), in accordance with the optional redemption provisions of the indenture governing the Notes. CF intends to use cash on hand to fund the redemption.
This press release does not constitute a notice of redemption. Beneficial owners of the Notes with any questions should contact the brokerage firm or financial institution through which they hold the Notes.
About CF Industries Holdings, Inc.
At CF Industries, our mission is to provide clean energy to feed and fuel the world sustainably. With our employees focused on safe and reliable operations, environmental stewardship, and disciplined capital and corporate management, we are on a path to decarbonize our ammonia production network – the world’ s largest – to enable green and blue hydrogen and nitrogen products for energy, fertilizer, emissions abatement and other industrial activities. Our nine manufacturing complexes in the United States, Canada, and the United Kingdom, an unparalleled storage, transportation and distribution network in North America, and logistics capabilities enabling a global reach underpin our strategy to leverage our unique capabilities to accelerate the world’ s transition to clean energy. CF Industries routinely posts investor announcements and additional information on the Company’ s website at www.cfindustries.com and encourages those interested in the Company to check there frequently.
All statements in this communication by CF Industries Holdings, Inc. ( together with its subsidiaries, the “ Company ”), other than those relating to historical facts, are forward-looking statements. Forward-looking statements can generally be identified by their use of terms such as “ anticipate, ” “ believe, ” “ could, ” “ estimate, ” “ expect, ” “ intend, ” “ may, ” “ plan, ” “ predict, ” “ project, ” “ will ” or “ would ” and similar terms and phrases, including references to assumptions. Forward-looking statements are not guarantees of future performance and are subject to a number of assumptions, risks and uncertainties, many of which are beyond the Company’ s control, which could cause actual results to differ materially from such statements. These statements may include, but are not limited to, statements concerning the redemption of the Notes.
Important factors that could cause actual results to differ materially from those in the forward-looking statements include, among others, the cyclical nature of the Company’ s business and the impact of global supply and demand on the Company’ s selling prices; the global commodity nature of the Company’ s nitrogen products, the conditions in the international market for nitrogen products, and the intense global competition from other producers; conditions in the United States, Europe and other agricultural areas; the volatility of natural gas prices in North America and Europe; weather conditions; the seasonality of the fertilizer business; the impact of changing market conditions on the Company’ s forward sales programs; difficulties in securing the supply and delivery of raw materials, increases in their costs or delays or interruptions in their delivery; reliance on third party providers of transportation services and equipment; risks associated with cyber security; the Company’ s reliance on a limited number of key facilities; acts of terrorism and regulations to combat terrorism; risks associated with international operations; the significant risks and hazards involved in producing and handling the Company’ s products against which the Company may not be fully insured; the Company’ s ability to manage its indebtedness and any additional indebtedness that may be incurred; the Company’ s ability to maintain compliance with covenants under its revolving credit agreement and the agreements governing its indebtedness; downgrades of the Company’ s credit ratings; risks associated with changes in tax laws and disagreements with taxing authorities; risks involving derivatives and the effectiveness of the Company’ s risk measurement and hedging activities; potential liabilities and expenditures related to environmental, health and safety laws and regulations and permitting requirements; regulatory restrictions and requirements related to greenhouse gas emissions; the development and growth of the market for green and blue ( low-carbon) ammonia and the risks and uncertainties relating to the development and implementation of the Company’ s green and blue ( low-carbon) ammonia projects; risks associated with expansions of the Company’ s business, including unanticipated adverse consequences and the significant resources that could be required; risks associated with the operation or management of the strategic venture with CHS ( the “ CHS Strategic Venture ”), risks and uncertainties relating to the market prices of the fertilizer products that are the subject of the supply agreement with CHS over the life of the supply agreement, and the risk that any challenges related to the CHS Strategic Venture will harm the Company’ s other business relationships; and the impact of the novel coronavirus disease 2019 ( COVID-19) pandemic, including measures taken by governmental authorities to slow the spread of the virus, on our business and operations.
More detailed information about factors that may affect the Company’ s performance and could cause actual results to differ materially from those in any forward-looking statements may be found in CF Industries Holdings, Inc.’ s filings with the Securities and Exchange Commission, including CF Industries Holdings, Inc.’ s most recent annual report on Form 10-K, which are available in the Investor Relations section of the Company’ s web site. It is not possible to predict or identify all risks and uncertainties that might affect the accuracy of our forward-looking statements and, consequently, our descriptions of such risks and uncertainties should not be considered exhaustive. There is no guarantee that any of the events, plans or goals anticipated by these forward-looking statements will occur, and if any of the events do occur, there is no guarantee what effect they will have on our business, results of operations, cash flows, financial condition and future prospects. Forward-looking statements are given only as of the date of this communication and the Company disclaims any obligation to update or revise the forward-looking statements, whether as a result of new information, future events or otherwise, except as required by law.
Media Chris Close Director, Corporate Communications 847-405-2542 – cclose @ cfindustries.com
Investors Martin Jarosick Vice President, Investor Relations 847-405-2045 – mjarosick @ cfindustries.com
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War in Ukraine and barriers to diabetes care | The conflict and violence that followed the military invasion of Ukraine in late February, 2022, has already left substantial scars on the population. The human cost of the combat becomes more evident each passing day. On March 15, 2022, the ongoing hostilities affected hundreds of thousands of inhabitants and substantially damaged crucial civilian infrastructure in eastern Ukraine, including homes, schools, hospitals, and water and gas pipelines. In some southeastern cities, such as Mariupol, people have been facing critical shortages of food, water, and life-saving medicines, which were aggravated by the blockade of humanitarian convoys trying to reach the region with supplies.1UN Office for the Coordination of Humanitarian AffairsUkraine: humanitarian impact situation report ( as of 3:00 p.m. ( EET) on 14 March 2022).https: //reliefweb.int/report/ukraine/ukraine-humanitarian-impact-situation-report-300-pm-eet-14-march-2022Date: March 14, 2022Date accessed: March 15, 2022Google Scholar According to the UN High Commissioner for Human Rights, a total of 691 civilian deaths were confirmed by March 14, 2022—a number that is probably underestimated.2StatistaNumber of civilian casualties in Ukraine during Russia's invasion verified by OHCHR as of March 14, 2022.https: //www.statista.com/statistics/1293492/ukraine-war-casualties/ # statisticContainerDate accessed: March 15, 2022Google Scholar In the middle of this social and humanitarian crisis, patients who have chronic diseases perceive health resources deteriorating at an unprecedented rate, raising concerns about their sustainability. For people living with a disease as prevalent as diabetes, the scarce access to essential health resources is even more worrisome. According to the International Diabetes Federation Atlas, there were about 2 325 000 inhabitants with type 2 diabetes in Ukraine in 2021, representing a prevalence of 7·1%. For type 1 diabetes, around 6700 children and adolescents had the diagnosis in the past year.3International Diabetes FederationIDF Diabetes Atlas.10th edn. International Diabetes Federation, Brussels2021Google Scholar
The effects of the military conflict, which began on Feb 24, 2022, might have the potential to affect different domains of diabetes care. First, some infrastructures such as deliveries and pharmacy services have been disrupted, resulting in shortages and rationing of insulin and supplies for blood glucose control. Without receiving the appropriate treatments, especially in cases of type 1 diabetes, there is a risk of life-threatening complications, such as diabetic ketoacidosis. Notwithstanding, the military conflict brought the need to reallocate resources to support victims of the war, overloading the health system, and making it difficult to predict the availability of care, if care became necessary. Second, the disruption of food distribution is potentially serious for these patients, who are at risk of hypoglycaemia without proper meals. Third, the effect on these individuals ' mental health is immeasurable. In usual situations, patients with diabetes have up to four times higher prevalence of depression and anxiety when compared with their peers without diabetes, in addition to a higher risk of suicide.4Bădescu SV Tătaru C Kobylinska L et al.The association between diabetes mellitus and depression.J Med Life. 2016; 9: 120-125Google Scholar, 5Alessi J Scherer GDLG Erthal IN et al.One in ten patients with diabetes have suicidal thoughts after 1 year of the COVID-19 pandemic: we need to talk about diabetes and mental health not only during Suicide Prevention Awareness Month.Acta Diabetol. 2022; 59: 143-145Google Scholar Added to this vulnerability, there is the concern about the potential scarcity of vital medications for the treatment of diabetes, and the emotional effect inherent to the war itself. These situations become the complete scenario for an imminent psychological disaster.
This is a moment of solidarity and empathy with the people of Ukraine, especially for those living with diabetes. While we wait for negotiations and diplomacy, we need strategies to help these patients in a timely fashion. Groups led by peers with diabetes from neighbouring countries have been mobilising online to get donations of insulin and supplies for the Ukrainian population, but the uncertainty of how long this confrontation will last makes it difficult to estimate whether these efforts will be enough. The use of technologies, such as uncrewed aircraft systems, to distribute supplies to more vulnerable areas might be a potentially useful strategy. Even so, negotiating green corridors is crucial for the delivery of medicines and humanitarian aid to vulnerable areas. In addition, the provision of online consultations by volunteers, endocrinologists, and mental health professionals might be a partial solution to the difficulties in accessing the health system. Nevertheless, robust strategies need to be developed so that, in similar situations in the future, there is a clear and effective action plan to support patients with diabetes. It is hard to believe that, just after celebrating the 200th anniversary of the discovery of insulin, we find ourselves in a situation in which insulin is scarce in Ukraine, for political reasons. We hope that, at least in this battle, diabetes treatment will win.
We declare no competing interests. This Correspondence was supported by Mykolayiv Odessa Diabetic Association and the Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul. | tech |
ETF issuers face dilemma with frozen Russian funds | The transition from LIBOR to RFR has brought challenges for structured products. There are still legacy IBOR products to consider and at the same time the pricing and risk systems need to be upgraâ¦
To ease the pain associated with meeting compliance targets, global institutions are exploring ways to become more efficient by integrating regulatory and business initiatives.
Wire payment fraud is a major growing risk for financial institutions in the aftermath of the COVID-19 pandemic. These cases of fraud donât just hurt finâ¦
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Edited by Bill Coen and D. R. Maurice
Issuers of exchange-traded funds ( ETFs) invested in Russian stocks and bonds are in a dilemma. They can leave the ETFs, which were suspended in the first week of March, in hibernation and continue to pay out hefty fixed costs. Or they can liquidate the funds, returning the net asset value of the investments to their clients, and run the risk of being sued.
BlackRock, VanEck and Lyxor Asset Management run the three largest ETFs that invest in Russian securities. All three have been in a state of
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Valuation and risk management of vanilla Libor swaptions in a fallback | The transition from LIBOR to RFR has brought challenges for structured products. There are still legacy IBOR products to consider and at the same time the pricing and risk systems need to be upgraâ¦
To ease the pain associated with meeting compliance targets, global institutions are exploring ways to become more efficient by integrating regulatory and business initiatives.
Wire payment fraud is a major growing risk for financial institutions in the aftermath of the COVID-19 pandemic. These cases of fraud donât just hurt finâ¦
Asia Risk is proud to present Asia Risk Live, a face-to-face event in Hong Kong and Singapore. An opportunity to reconnect in person to learn and exchange new ideas.
View our latest in market leading training courses, both public and in-house.
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The Asia Risk Awards recognize best practices in risk management and derivatives use by banks and financial institutions around the region.
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This eBook is based on the 2021 industry research by Acuiti, as well as the FIS Readiness Report. Youâll find plenty of support for a move to AI-powered cloud computing, a modular approach that ensurâ¦
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Georgios Skoufis uses the SABR model to derive a valuation formula for a vanilla swaption whose payoff involves a Libor swap rate constructed from a nonlinear function of a swap rate on a risk-free rate index. The analysis shows that the convexity effects can be expressed as symmetric quadratic derivatives, which are valued analytically with the SABR model
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Chinese Boeing jet crashes in mountains with 132 on board, no sign of survivors | Media said there were no signs of survivors on the domestic flight.
The airline said it deeply mourned the passengers and crew, without specifying how many people had been killed on the jet, an earlier model to the 737 MAX with a strong safety record.
Boeing said it was ready to assist China Eastern and was in contact with U.S. transportation safety regulators over the incident.
Chinese media carried brief highway video footage from a vehicle's dashcam apparently showing a jet diving to the ground behind trees at an angle of about 35 degrees off vertical. Reuters could not immediately verify the footage.
Flight MU5735 was en route from the southwestern city of Kunming, capital of Yunnan province, to Guangzhou, capital of Guangdong, bordering Hong Kong, when it crashed.
China Eastern said the cause of the crash was under investigation. Such accidents typically involve multiple factors and experts warned it was far too early to draw any conclusions on the potential causes, especially in light of the scarce information available.
Investigators will be scouring the wreckage and flight recorders for factors that could have caused the plane to plummet vertically and slam into the mountains at high speed.
The airline said it had sent a working group to the site. There were no foreigners on the flight, Chinese state television reported, citing China Eastern.
Relatives, friends and colleagues of passengers gathered late on Monday in a cordoned off area at the jet's destination, Guangzhou Baiyun International Airport.
One man surnamed Yan said that a colleague had been on the plane, and that he had notified the 29-year-old's mother.
`` When she picked up the phone, she choked up, '' said Yan, adding that he had a `` heavy heart '' when he heard the news.
China Eastern staff were making arrangements for relatives who wished to travel to the crash site on Tuesday, Yan said. Reuters was not able to independently verify Yan's identity.
The aircraft, with 123 passengers and nine crew on board, lost contact over the city of Wuzhou, China's Civil Aviation Administration of China ( CAAC) and the airline said.
The flight left Kunming at 1:11 p.m. ( 0511 GMT), FlightRadar24 data showed, and had been due to land in Guangzhou at 3:05 p.m. ( 0705 GMT).
The plane, which the flight tracking service said was six years old, had been cruising at 29,100 feet at 0620 GMT. The same flight number a day earlier began a normal gradual descent from the same altitude, also at 0620 GMT, and landed safely in Guangzhou, according to Flightradar24.
The flight that crashed instead began a rapid descent to 7,425 feet before recovering briefly to 8,600 feet and then descended rapidly again, FlightRadar24 data showed. The last tracked altitude was 3,225 feet above sea level.
Media cited a rescue official as saying the plane had disintegrated and caused a fire destroying bamboo trees. The People's Daily quoted a provincial firefighting department official as saying there was no sign of life among the debris.
State media showed a piece of the plane on a scarred, earthen hillside. There was no sign of a fire or personal belongings.
DESCENT STAGE
Crashes during the cruise phase of flights are relatively rare, even though this period accounts for the majority of flight time. Crashes during the descent stage when the plane first leaves cruising altitude are even more uncommon.
Boeing said last year 13% of fatal commercial accidents globally between 2011 and 2020 occurred during the cruise phase, whereas 3% occurred on descent, none on initial approach, 28% on final approach and 26% on landing.
Online weather data showed partly cloudy conditions with good visibility in Wuzhou at the time of the crash.
President Xi Jinping called for investigators to determine the cause of the crash as soon as possible, state broadcaster CCTV reported.
Boeing said in a statement that its thoughts were with the passengers and crew.
`` Boeing is in contact with the U.S. National Transportation Safety Board ( NTSB) and our technical experts are prepared to assist with the investigation led by ( CAAC), '' the company said.
The disaster comes as Boeing seeks to rebound from several overlapping crises including the coronavirus pandemic and crashes involving its 737 MAX model. Shares of the planemaker closed 3.6% lower.
China Eastern has grounded its fleet of 737-800 planes, state media reported. It has 109 of the aircraft, according to FlightRadar24.
Shares of China Eastern Airlines in Hong Kong closed down 6.5% after news of the crash emerged, while its U.S.-listed shares closed 6.3% lower.
'GOOD RECORD '
Aviation data provider OAG said this month that state-owned China Eastern Airlines was the world's sixth-largest carrier by scheduled weekly seat capacity.
The 737-800 has a good safety record and is the predecessor to the 737 MAX model that has been grounded in China for more than three years after fatal crashes in Indonesia and Ethiopia.
The crash has again thrust the U.S. manufacturer's most sold aircraft family into the spotlight and comes as it works to emerge from the 737 MAX safety crisis and global pandemic, which decimated air travel demand and strained its finances.
Investigators will search for the plane's black boxes - the flight data recorder and cockpit voice recorder - to shed light on the crash.
The U.S. NTSB said it had appointed a senior air safety investigator as an accredited U.S. representative to China's probe.
Air crash investigations are typically led by the country of the accident and include participation by the plane's country of origin, so U.S. investigators would be expected to join the probe of the U.S.-made Boeing jet.
China's airline safety record has been among the best in the world for a decade, although it is less transparent than in countries like the U.S. and Australia where regulators release detailed reports on non-fatal incidents, according to Greg Waldron, Asia managing editor at industry publication Flightglobal.
( Reporting by Beijing and Shanghai newsrooms and Jamie Freed in Sydney; Additional reporting by David Shepardson in Washington, Eric M. Johnson in Seattle, Allison Lampert in Montreal and Rajesh Kumar Singh in Chicago; Writing by Robert Birsel, Nick Macfie and Rami Ayyub; Editing by Simon Cameron-Moore, Hugh Lawson and Bernard Orr)
By Martin Quin Pollard | business |
Quake deals blow to northeastern Japan's tourism industry | Sendai – Wednesday’ s earthquake off Fukushima Prefecture has dealt a blow to tourism businesses in northeastern Japan, where hopes had been running high ahead of the coronavirus pre-emergency measures ending.
The earthquake reached upper 6, the second-highest level on the Japanese seismic intensity scale, in some parts of the Tohoku region. Many buildings in the region have been damaged.
Among those hit by the quake are the Saryo Soen ryokan inn in the Akiu hot spring resort in Sendai.
“ We were almost fully booked for this three-day weekend ” through Monday, said Saryo Soen manager Toyoko Kaneko.
The quake caused the inn to temporarily close as it broke water pipes, flooding parts of the inn’ s facilities.
Saryo Soen plans to reopen on March 28, but Kaneko is uneasy.
“ We were warned that an aftershock may strike within a week to 10 days. We’ re worried that our facilities may be damaged further, ” Kaneko said.
An All Nippon Airways aircraft on a special flight to Sendai parked at Haneda Airport in Tokyo on Friday. The company started providing special flights to Sendai from Haneda as the Tohoku Shinkensen line remains partially closed after last week’ s quake. | KYODO
The quake happened less than a week before Japan fully exits the coronavirus pre-emergency measures, currently in place in 18 prefectures including Tokyo, at the end of Monday.
All expressway sections closed due to the quake have reopened.
But the JR East’ s Tohoku Shinkansen train line remains closed between Nasushiobara Station in Tochigi Prefecture and Morioka Station in Iwate Prefecture. Sendai Station is in the closed section.
“ It’ s very quiet despite the higan period ” for Buddhist memorial services, said Tsukasa Sato, 54, a senior official at a local ryokan association.
Reservations were canceled not only for this three-day weekend but also for the Golden Week holiday period from late April.
“ We’ ve taken an additional blow just as we’ re recovering from the coronavirus crisis, ” Sato said. “ Some inns had just reopened after repairing damage from the powerful quake in February last year. ”
“ Last year, our sales recovered a little, and we expected customers to return if things go well, ” said Chikafusa Mori, 53, president of Akiu Winery.
Seven years ago, Mori quit a company to establish the winery, hoping to support the reconstruction of Tohoku after the March 2011 earthquake and tsunami.
He reopened the winery two days after Wednesday’ s quake. But the number of visitors slumped.
“ The halt to the shinkansen service hurts us. Nobody comes from Kanto, ” Mori said. “ We hope that the service will be restored before the Golden Week period. ”
Passengers at Sendai Station board a special train bound for Nasushiobara Station in Tochigi Prefecture on Saturday as the Tohoku Shinkansen line remains partially closed due to a major quake. | KYODO
JR East expects to fully reopen the closed shinkansen section in April or even later. On Sunday, the company started work to remove a shinkansen train derailed in the section due to Wednesday’ s quake.
Meanwhile in Fukushima Prefecture, the Hamanoeki Matsukawaura food store in the city of Soma partially reopened on Sunday after a three-day shutdown caused by the temblor.
“ If we aren’ t open, the whole of Soma will be seen as hopeless, ” manager Takashi Tokoyoda, 62, said. “ We must open as a symbol of reconstruction. ”
The quake has created cracks on walls of the store. Running water remains unavailable, while the nearby fishing port and seafood processing factory have been damaged.
It is uncertain when the supply of local fish will resume, but the store sells seafood from other prefectures.
“ It’ s wrong to say ‘ We can’ t do this because such and such are unavailable, ' ” Tokoyoda said. “ We must accept it and move ahead. ”
“ We’ ll improve our lineups so we can help revitalize our region, ” he stressed. | tech |
OIL FUTURES: Crude rallies 7% as market eyes potential EU sanctions on Russian energy | Crude futures settled sharply higher March 21 as the possibility of EU sanctions on Russian oil raised supply concerns.
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NYMEX April WTI settled up $ 7.42 at $ 112.12/b and ICE May Brent climbed $ 7.69 at $ 115.62/b.
The foreign ministers of Lithuania and Ireland said March 21 that it was time for the EU to start looking at sanctions on Russian oil, according to a Reuters report. Current EU sanctions packages have refrained from targeting the energy sector.
`` Looking at the extent of the destruction in Ukraine right now, it's very hard to make the case that we shouldn't be moving in on the energy sector, particularly oil and coal, '' said Irish Foreign Minister Simon Coveney, according to a report from the news agency.
`` [ The market ] is starting to see this growing belief that eventually the EU is going to be put in a position where they will have to ban Russian energy supplies, '' OANDA senior market analyst Ed Moya said, adding, `` this drastic measure will really hurt the Russian economy, and you will see this market subject to some potentially severe disruptions in the near future. ''
NYMEX April RBOB settled 13.28 cents higher at $ 3.3716/gal and April ULSD finished up 20.28 cents at $ 3.8009/gal.
Russia is finding ways to bypass sanctions on its oil supplies and customers are `` happy to buy '' its discounted crude, the country's top energy official said March 21.
`` Now there are new challenges linked to supply chain disruptions, the insurance of ships that transport our products, and with issues of financing and payment... these issues are being resolved at the moment, '' deputy prime minister Alexander Novak said, the Prime news agency reported.
The US, the UK, and Canada have announced plans to end imports of Russian oil by the end of 2022.
The discount for a Suezmax cargo of Urals against Dated Brent hit a record-high $ 33.36 on a FOB Novorossiisk basis March 15, S & P Global Commodity Insights ' Platts assessment showed.
A drone attack perpetrated by Yemeni Iran-aligned Houthi rebels on the Yasref oil facilities in Saudi Arabia over the weekend added to supply risks.
According to media reports, the attack had resulted in a temporary decrease in output at the refinery, but there were no casualties.
`` The assault on Yasref facilities has led to a temporary reduction in the refinery's production, which will be compensated for from the inventory, '' the company said. Yanbu Aramco Sinopec Refining Company is a joint venture between Saudi Aramco and China Petrochemical Corporation.
Falling coronavirus cases in China have eased investor fears of infections spiraling out of control in the world's second-largest economy. The country's National Health Commission reported 1,656 locally transmitted cases March 19, down from 2,157 the previous day.
`` Falling new cases underscored the country's prompt and stringent measures, including lockdowns and mass tests, in containing the rapid spread of the virus. This may help boost investor confidence amid the country's most severe viral outbreak since 2020, '' said IG DailyFX strategist Margaret Yang in a March 21 note.
Chinese authorities had imposed restrictions across nearly 20 provinces and municipalities in recent weeks in a bid to contain the outbreak.
The areas of Guangdong, Shandong, Jilin, and Shanghai, which were among the epicenters of the coronavirus outbreak this time, accounted for around 30% of China's oil consumption in 2021, S & P Global Commodity Insights data showed.
The lockdowns had prompted concerns of demand destruction that weighed on crude prices during the week ended March 18.
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COVID-19 has left GPs struggling around the world, new study shows -- ScienceDaily | The review, published in the British Journal of General Practice and led by the University of York, also found that women doctors in primary care reported more psychological problems, whilst those who are older reported greater stress and burnout.
Researchers reviewed research literature and identified 31 studies evaluating the impact of COVID-19 on the mental health and wellbeing of doctors in primary care.
Healthcare systems vary across countries and this review identified only three studies of GPs working in the UK. Studies used a wide variety of measures to assess psychological wellbeing and lacked measurements from before the pandemic, which makes comparisons difficult.
There were, though, common themes highlighting the difficulties faced by doctors working in primary care settings ( similar to NHS GPs) around the world.
Sources of stress during the pandemic included changed working practices, exposure to COVID-19 and inadequate PPE, information overload, lack of preparedness for the pandemic and poor communication across health sectors.
The studies demonstrated an impact on primary care doctors ' psychological wellbeing, with some also experiencing a fear of COVID-19 and lower job satisfaction. A third of the studies also explored physical symptoms -- with GPs reporting migraines and headaches, tiredness and exhaustion, sleep disorders and increased eating, drinking and smoking.
One UK study which focused on GPs with symptoms of long COVID found GPs felt 'let down ' and expressed frustration at the lack of support and recognition for the condition.
Study author, Dr Laura Jefferson from the Department of Health Sciences said: `` Many GPs have reported stress and burnout over recent years, which is potentially damaging not just to doctors themselves, but also to patients and healthcare systems.
`` The COVID-19 pandemic has presented additional challenges for GPs, including rapid change, risks of infection, remote working, pent-up demand and reductions in face-to-face patient care.
`` While there has been a tendency for research like this to focus on hospital roles, there was a need to synthesise evidence and explore factors associated with GPs ' mental health and wellbeing during the pandemic.
`` This is the first systematic review exploring the psychological wellbeing of primary care doctors during the COVID-19 pandemic. ''
Seven studies reported statistically significant differences in outcomes for women GPs, including higher stress levels, greater reporting of burden, burnout and anxiety. Older age was associated with higher stress levels in three studies.
The research concluded that policy and infrastructure are needed to support GPs and further research is needed to explore gender and age differences; identifying interventions targeted to these groups.
This report was funded by the Department of Health and Social Care NIHR Policy Research Programme, exploring the impact of COVID-19 on GPs ' wellbeing.
The paper called, `` General practitioner wellbeing during the COVID-19 pandemic. A systematic review, '' is published in the British Journal of General Practice. | science |
COVID-19 Increases risk of type 2 diabetes, study finds -- ScienceDaily | Studies show that the human pancreas can also be a target of the SARS-CoV-2 ( severe acute respiratory syndrome coronavirus type 2 virus). Following a Covid-19 infection, reduced numbers of insulin secretory granules in beta cells and impaired glucose-stimulated insulin secretion have been observed. In addition, after Covid-19 disease, some patients developed insulin resistance and had elevated blood glucose levels although they had no previous history of diabetes. SARS-CoV-2 infection may lead to a strong release of pro-inflammatory signaling substances ( cytokines). Activation of the immune system may persist for months after a SARS-CoV-2 infection and impair insulin effectiveness ( muscle, fat cells, liver).
To date, however, it is unclear whether these metabolic changes are transient or whether Covid-19 disease increases the risk of persisting diabetes. To investigate this question, researchers from the German Diabetes Center ( DDZ), German Center for Diabetes Research ( DZD) and IQVIA ( Frankfurt) conducted a retrospective cohort study.
The cohort study included a representative panel of 1,171 physician practices across Germany ( March 2020 to January 2021: 8.8 million patients). Follow-up continued until July 2021. `` The aim of our study was to investigate the incidence of diabetes after infection with SARS-CoV-2, '' said first author Wolfgang Rathmann, head of the Epidemiology Research Group at the DDZ. As a control group, the researchers selected people with acute upper respiratory tract infections ( AURI), which are also frequently caused by viruses. The two cohorts were matched for sex, age, health insurance, month of Covid-19 or AURI diagnosis, and comorbidities ( obesity, hypertension, high cholesterol, heart attack, stroke). Patients on corticosteroid therapy were excluded from the study.
During the study period, 35,865 people were diagnosed with Covid-19. `` Our analyses showed that patients with Covid-19 developed type 2 diabetes more frequently than people with AURI. The incidence of diabetes with Covid-19 infection was 15.8 compared to 12.3 per 1000 people per year with AURI. Statistical analysis resulted in an incidence rate ratio ( IRR) of 1.28. Put simply, this means that the relative risk of developing type 2 diabetes was 28% higher in the Covid-19 group than in the AURI group, '' Rathmann said, summarizing the results.
Although type 2 diabetes is unlikely to be a problem for the vast majority of people with mild Covid-19 disease, the authors recommend that anyone who has recovered from Covid-19 be alert to the warning signs and symptoms, such as fatigue, frequent urination and increased thirst and seek immediate treatment. | science |
Hong Kong to Lift Travel Ban for 9 Countries in April | Get exclusive stories and unlimited access to Skift.com news
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Peden Doma Bhutia, Skift
March 21st, 2022 at 4:40 AM EDT
The resumption of flights may be a step in the right direction. However, it remains to be seen if Hong Kong will prioritize the reopening of the border with the Mainland over opening the international border.
Peden Doma Bhutia
Hong Kong will resume international flight operations from nine countries, including the U.S., UK, France, and India, from April 1. Hong Kong CEO Carrie Lam announced that the mandatory hotel quarantine period for incoming travelers would also be reduced from 14 to seven days.
Travelers are required to carry a negative nucleic acid test report to enter Hong Kong and would need to undergo a Covid test at the airport before proceeding for hotel quarantine. A PCR test would be conducted on day 5, if that tests negative, and all the rapid antigen tests show negative results, then travelers can choose to leave their hotel quarantine after seven days. However, a PCR test on day 12 is mandatory for all.
As the Omicron outbreak surged worldwide in January, the island nation imposed a flight ban from eight countries — U.S., UK, France, Australia, Canada, India, The Philippines, and Pakistan. Nepal got added to this list in February.
Lam’ s administration has been criticized and attacked for its strict zero-Covid policy. However, in a press meet on January 22, Lam had said that Hong Kong was not aiming to attain an absolute zero as a strategy. “ The alternative to this type of strategy will be the so-called ‘ living with the virus’ — in other words, we open our borders, we have no social distancing measures, we will, like one country, announce that you don’ t even have to wear your mask. ”
Explaining why Hong Kong does not possess the prerequisites to go for the “ living with the virus ” approach, Lam said: “ One is because we still want to open the border, not only with the Mainland but also with the rest of the world; and secondly, our vaccination rate is not yet ideal. ”
However, after a massive brain drain and with its international status at stake, the global financial hub has finally decided to resume international flight operations with some of its biggest inbound markets and opt for more relaxed quarantine methods.
Concerned about the socio-economic development, Lam said they would consult with various stakeholders to come up with a more permanent pathway for Hong Kong to tackle any public health crisis in a more targeted manner that will, other than the overriding mission of protecting the safety and health of the Hong Kong people, be also based on evidence. “ We should also take into account the impact on the social and economic development, ” she said.
Hong Kong’ s provisional visitor arrivals of February were 1,810, a 52.4 percent decrease year-on-year. Hong Kong saw a cumulative visitor arrival of around 9,700 from January to February this year, a 1.8 percent drop year-on-year. Following stringent border control norms, a majority of inbound travelers visited Hong Kong for family visits or out of necessity. The number of leisure visitors remained close to zero.
Hong Kong’ s travel and operational restrictions continue to constrain flag carrier Cathay Pacific’ s ability to operate more passenger flight capacity. Calling the operating environment “ very challenging ”, Cathay’ s chief customer and commercial officer Ronald Lam said of February numbers in a release: “ We operated below 2 percent of pre-Covid levels, a reduction of about 28 percent compared with January 2022. ”
The airline carried a total of 31,253 passengers in February, an increase of 47.9 percent compared to February 2021, and a 98.9 percent decrease compared to February 2019.
“ We will always, as an international city and a very important business and aviation hub, have to take into account not only connectivity with the outside world but also connectivity with the Mainland, ” Lam said.
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Booster for immune protection after coronavirus infection: Research proves benefit of vaccination after recovery from COVID-19 -- ScienceDaily | Our immune protection is provided by two systems working hand in hand. When infected with a virus, the immune system reacts by producing antibodies that can prevent the virus from infecting further cells. At the same time, so-called T-killer cells can recognise the foreign virus components and thus kill already infected cells. During the immune reaction, the antibodies constantly improve and are finally tailor-made for the pathogen. The amount of these neutralising antibodies indicates how well a new infection can be fought off by the body.
Unique collaboration between biochemists, immunologists, clinicians and the Dortmund health department
`` When the corona pandemic broke out, we as immunologists were of course interested in how our immune system defends itself against the corona virus. That's why, together with our colleagues from the Max Planck Institute and the Dortmund Hospital, we developed a reliable test system to detect neutralising antibodies, '' IfADo Director Carsten Watzl says. In order to be able to fish antibodies out of the blood in a targeted manner, you need an appropriate bait. One of the main targets of the immune system is the spike protein, which is used by the virus to bind to human cells and then infect them. `` We have been able to produce a part of this protein, or more precisely the area that docks with the cell, in high purity in the test tube, '' reports Jan-Erik Hoffmann, head of protein production at the MPI Dortmund. With this exact copy and blood samples from the `` Klinikum Dortmund '' the researchers at IfADo were able to develop a reliable and meaningful detection system for coronavirus antibodies. In close exchange with the Dortmund health department and the Dortmund hospital, the scientists used this system to perform a study with about 140 volunteers from a Dortmund health facility with several documented cases of SARS-CoV-2 infection at the beginning of the pandemic ( March 2020)
5 times higher antibody levels after vaccination in recovered patients
Effective amounts of neutralising antibodies against the spike protein could be detected in almost all of the subjects tested positive for SARS-CoV-2. And even after 300 days, the antibody levels had hardly decreased in three out of four subjects. However, test persons were infected with the original variant of the coronavirus and neutralising antibodies against the original spike protein were measured. As we know, the virus has now evolved in such a way that immunity to the original virus currently offers significantly less protection. Therefore, the researchers also investigated the effect of vaccination with the vaccines from AstraZeneca and BioNTech on the immune system. The astonishing result: After complete vaccination, recovered test persons developed up to five times more neutralising antibodies than vaccinated persons without prior infection. This should also provide better protection against current variants.
`` There are now several studies on the immune response after a COVID-19. Our study differs from this in that we had blood samples before and from the first weeks of the pandemic. So we knew exactly whether a test person was already infected or not. In addition to this unbiased data, the long period of the study of almost one year is also remarkable, '' Watzl says. `` The rules of the game have changed in the meantime, of course, because there are new variants like Omikron. However, it is important to know how long immunity actually lasts, because this can also protect against a severe course of the disease in the case of a new infection with other coronavirus variants. Currently, we are also using our jointly developed test systems to study the immune response to the COVID-19 vaccines and their protection against different coronavirus variants. ''
`` This study is a prime example of successful interdisciplinary cooperation that not only yields important scientific findings but is also highly relevant to society, '' emphasises PD Dr. Bernhard Schaaf, Director of the Department of Pneumology and Infectious Diseases at Klinikum Dortmund. `` This is transfer of knowledge into everyday life and at the same time transparent cooperation at eye level. '' | science |
Russia’ s Use of Cluster Munitions and Other Explosive Weapons Shows Need for Stronger Civilian Protections | Help us continue to fight human rights abuses. Please give now to support our work
In the current armed conflict in Ukraine, Russian forces have relied heavily on two types of weapons that are notorious for the unacceptable and often unlawful harm they inflict on civilians. The weapons are cluster munitions, which have been banned by most countries in the world, and explosive weapons with wide area effects, which when used in populated areas are among the major causes of civilian casualties in contemporary armed conflict.
Attacks with these weapons have already killed and injured hundreds of civilians, turned buildings into rubble, and led to mass displacement. Judging by the experience of past conflicts, they will most likely also leave Ukraine with a legacy of harm that lingers long after active hostilities end.
Cluster munitions, large weapons that contain dozens or hundreds of smaller weapons called submunitions, endanger civilians for two reasons. First, they have a wide area effect because they spread their submunitions over a broad footprint, commonly the size of a football field. These submunitions can not distinguish soldiers from civilians when used in populated areas. Second, many of their submunitions do not explode on impact, becoming de facto landmines that pose threats to civilians for months, years, or even decades after a conflict. These so-called “ duds ” are frequently detonated by children who think they are toys, farmers who hit them with their plows, or refugees who return home.
The immediate harm caused by cluster munitions has already been evident in Ukraine. Human Rights Watch ( where I am a senior researcher) documented a strike by Russian forces near a hospital in Vuhledar in the Ukraine-controlled Donetska region on Feb. 24. A 9M79-series Tochka ballistic missile delivered a 9N123 cluster munition warhead, containing 50 submunitions. The attack killed four civilians and injured another 10, including six healthcare workers. It damaged a hospital building, an ambulance, and civilian vehicles.
Four days later, on Feb. 28, Russian forces launched 9M55K Smerch cluster munition rockets in three neighborhoods of Kharkiv, Human Rights Watch found. Each of these rockets, which are often fired in volleys of 12, carries 72 9N235 submunitions. The United Nations reported nine civilian deaths and 37 injuries in attacks across the city that day.
Russian forces launched Smerch and Uragan cluster munitions into the city of Mykolaiv on Mar. 7, 11, and 13, reportedly killing nine civilians in line at a cash machine on the last day alone, according to more recent Human Rights Watch research. Other organizations and journalists have also reported cluster munition attacks in Ukraine.
International humanitarian law ( IHL)’ s rule of distinction requires parties to a conflict to distinguish between civilians and combatants and between civilian objects and military objectives. The use of cluster munitions, at least where civilians may be present, violates this rule. Human Rights Watch and others argue they are inherently indiscriminate. At the time of attack, the wide-area effect of these weapons prevents them from distinguishing between combatants and non-combatants. In addition, the unexploded submunitions they leave behind makes them indiscriminate because their effects can not be limited. Attacks using cluster munitions in populated areas may also violate the principle of proportionality, which prohibits attacks in which expected injury to civilians or damage to civilian objects is excessive in relation to anticipated military advantage.
The people who order or carry out cluster munitions attacks against civilians or civilian objects with criminal intent—that is, willfully or recklessly—are responsible for war crimes.
Due to the unacceptable harm cluster munitions cause and their indiscriminate nature, the 2008 Convention on Cluster Munitions bans their use, production, transfer, and stockpiling. Although Russia and Ukraine have not joined the treaty, 110 countries are party, including most NATO countries ( although not the United States).
The convention also obligates each state party to “ promote the norms it establishes and … make its best efforts to discourage States not party to this Convention from using cluster munitions. ” In compliance with this provision, at least 15 states parties have condemned or expressed concern about Russia’ s use of cluster munitions in Ukraine.
The president of the Convention on Cluster Munitions, which is currently the United Kingdom, along with the NATO Secretary-General, the UN High Commissioner for Human Rights, and the European Union have also condemned the use of cluster munitions in Ukraine.
While cluster munitions are especially horrific for civilians, they are just one type of explosive weapon. The broader category of explosive weapons, which encompasses artillery shells, mortar rounds, rockets, missiles, enhanced blast ( aka thermobaric) weapons, and aerial bombs, among others, has caused the bulk of the conflict-related damage in Ukraine.
The use of explosive weapons in populated areas has grave humanitarian consequences both during and after attacks. Those effects are magnified when the weapons have wide area effects because: they have a large blast or fragmentation radius; they are inaccurate; they deliver multiple munitions at once ( e.g., cluster munitions); or they have a combination of the above.
Russia’ s bombing and shelling of Ukraine’ s cities and towns has taken a physical and psychological toll on the civilian population. According to Human Rights Watch, Russian artillery shelling and airstrikes killed or injured more than 450 civilians in the city of Kharkiv in the first 11 days of the conflict. The attacks have also leveled homes, apartment buildings, and other primarily civilian structures and infrastructure, and damaged the environment.
The costs of this method of war, however, extend beyond its direct effects. The use of explosive weapons with wide-area effects in populated areas also causes indirect and reverberating effects. The destruction of infrastructure can interfere with essential services and in turn infringe on an array of human rights.
In 2016, I co-authored an in-depth report on the effects of explosive weapons’ use on health care in the earlier conflict in eastern Ukraine, which was published by Harvard Law School’ s International Human Rights Clinic ( where I teach) and PAX. We found, for example, that damage to power plants and communication lines seriously affected hospitals and the provision of health care, and thus undermined the right to health. Such reverberating impacts will almost certainly be more severe in the current – much larger – conflict.
The use of explosive weapons in populated areas also exacerbates displacement. As of Mar. 18, more than three million people had fled Ukraine as a result of the conflict, according to the UN Refugee Agency ( UNHCR). The attacks on urban centers with explosive weapons are one of the driving factors.
In a statement to the UN Security Council, a representative from the UN Office for the Coordination of Humanitarian Affairs ( OCHA) noted that many of these effects were already being felt by Feb. 28. “ As we all feared, civilians are already paying the price, ” he said. “ The scale of civilian casualties and damage to civilian infrastructure, even in these very early days, is alarming. ”
Explicitly highlighting the dangers of the use of explosive weapons with wide-area effects, he continued, “ Civilians will undeservedly suffer the most from these attacks on densely populated urban centres.... And the longer this goes on, the greater the cost will be for civilians. ”
Using explosive weapons with wide-area effects in populated areas can be expected to result in indiscriminate attacks with a high loss of civilian life. The patterns of harm to civilians that these weapons cause, including their reverberating effects, are well documented and heighten concerns that attacks will also be disproportionate. In addition, the use of explosive weapons with wide area effects in populated areas is generally counter to the IHL duty to take all feasible precautions to minimize civilian harm. Those who are responsible for using explosive weapons unlawfully with criminal intent are committing war crimes.
While explosive weapons, unlike cluster munitions in particular, are not banned by any instrument of international law, countries have been working toward a political declaration that addresses the humanitarian consequences of their use in populated areas. The next round of negotiations of this Ireland-led process, which had been postponed by the Covid-19 pandemic, are now scheduled for April 6-8.
The events in Ukraine underscore how important it is for countries to include in the declaration a commitment to avoid the use of these weapons in populated areas. This political commitment, although non-binding, would set important standards for dealing with a deadly practice of modern war.
The concern regarding Russia’ s use of explosive weapons in Ukraine’ s urban centers from countries including Austria and Ireland, and as stated in the UN Human Rights Council resolution of Mar. 4, demonstrates the growing support for these standards.
The horrific images and accounts emerging from Ukraine offer a glimpse of the immediate harm that Russian cluster munitions and explosive weapons are inflicting on Ukraine’ s civilians. Documentation of the effects of these weapons in past conflicts suggest the harm will be long term.
To prevent furthering the humanitarian crisis, Russia should immediately cease the use of cluster munitions and avoid using explosive weapons with wide area effects in populated areas. Other countries and the United Nations should support documentation efforts to ensure domestic and international accountability for any violations of IHL and international human right law and in particular support the International Criminal Court’ s Ukraine investigation.
Other states and the United Nations should also explicitly condemn the use of cluster munitions and explosive weapons with wide area effects in populated areas. Such focused criticism will not only increase pressure on Russia to change its practices in Ukraine. It will also strengthen the international norms against these means and methods of war. | general |
Saliva testing for COVID-19 quicker, safer than nasal swabs -- ScienceDaily | `` That is important because people can spread COVID-19 before they know that they have it, '' said coauthor Donald K. Milton, M.D., DrPH, a professor of occupational and environmental health at the Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park. `` Earlier detection can reduce the disease's spread. ''
The research was motivated by the problem that early in the pandemic, an urgent need to increase testing was accompanied by a shortage of supplies, notably nasal swabs, which were then the standard method for collecting samples for testing.
To identify people with COVID-19 the investigators began conducting weekly tests of saliva samples from healthy community volunteers in May 2020 and continued over the next 2 years. Of the asymptomatic volunteers who tested positive, Milton and his colleagues found that those patients would typically show symptoms a day or 2 later. `` That made us wonder whether saliva was better for catching pre-symptomatic patients than the traditional nasal swabs, '' he said.
To answer that question, the researchers used data from a companion study of close contacts of people with confirmed cases of COVID-19. In the study, `` We collected saliva and mid-turbinate [ nasal ] swab samples from contacts every 2 or 3 days during their quarantine period, '' said Milton. `` All samples were tested using real-time reverse transcription polymerase chain reaction [ RT-PCR ] to detect SARS-CoV-2 and measure how much viral RNA was in the samples. We then analyzed how these results changed in the days before and after symptom onset. ''
`` Early in the course of infection, saliva was significantly more sensitive than mid-turbinate nasal swabs, '' notably so before onset of symptoms, according to the study, which noted that previous studies had shown that pre-symptomatic transmission plays a greater role than symptomatic transmission of SARS-CoV-2.
The findings have implications for improving public acceptance of COVID-19 testing, reducing the cost of mass COVID-19 screening and improving the safety of healthcare workers who conduct testing. In the latter case, saliva self-testing avoids the close contact between patient and healthcare worker that nasal swabbing entails and avoids causing patients to cough and sneeze, thereby spreading virus particles as a result of swabbing the sensitive nasal passages, as well as discomfort to patients.
`` Our research supports the use of saliva in large-scale screening in schools and workplaces, as a means of improving screening rates, as well as early detection, '' said Milton. `` We expect that if rapid saliva tests become available, they could be a major advance from the current nasal swab-based rapid tests. '' | science |
Hong Kong should cut quarantine to one week, lawmaker says | Hong Kong should reduce the amount of time travelers need to quarantine to one week, but the city shouldn’ t open up to the world without locking down and testing the whole population for COVID-19, lawmaker Michael Tien said.
Tien said a mandatory testing blitz of Hong Kong’ s 7.5 million residents should coincide with a nine-day city-wide lockdown to curb the city’ s worst COVID-19 outbreak since the pandemic started. He also said opening the border to China should be a “ secondary consideration ” at the moment.
“ I think the hotel quarantine period for anyone coming in should be reduced to seven days, ” Tien said in an interview with Bloomberg Television on Monday. “ At this point I think letting come back and relaxing quarantine for overseas travelers is more important to Hong Kong ” than opening the border with China, he added.
The testing drive and lockdown should occur in mid-April, said Tien, a Hong Kong lawmaker and founder of the G2000 Group chain of clothing stores.
Hong Kong Chief Executive Carrie Lam is expected to later Monday announce changes to the city’ s pandemic response, after last week flagging a review spurred by frustration within the financial and general community.
Hong Kong reported 14,149 confirmed COVID-19 cases Sunday, the lowest daily toll in more than three weeks, signaling the outbreak is trending down from a peak of more than 50,000 daily cases earlier this month. Still, fatalities have remained at the highest levels since the pandemic began and the death rate is among the world’ s worst.
Authorities have come under intense scrutiny for their handling of the outbreak, with a lack of preparation leading to an explosion in cases and wave of deaths, particularly among the under-vaccinated elderly. The financial hub focused on keeping the virus out with border curbs and some of the lengthiest traveler quarantines in the world, leaving it vulnerable when the more contagious omicron variant managed to snake through those defenses.
The approach has left the financial hub highly isolated, as it persists with the “ COVID zero ” policy favored by the mainland. The travel curbs are a key concern of Hong Kong’ s financial community, with bankers from Goldman Sachs Group Inc. to Bank of America Corp. caught up in the oft-shifting restrictions. The curbs and explosive outbreak have spurred record outflows of people from the city, with many either heading to the mainland or to other parts of Asia, particularly rival financial center Singapore. | tech |
U.S. FDA advisers to discuss second COVID vaccine boosters in April | A panel of independent advisers to the U.S. Food and Drug Administration is set to meet on April 6 to discuss considerations for use of COVID-19 vaccine booster doses from Pfizer Inc and Moderna Inc.
The panel will also discuss the process for selecting COVID-19 vaccine strain to address current and emerging variants, the U.S. FDA said. ( Reporting by Manojna Maddipatla and Leroy Leo in Bengaluru; Editing by Devika Syamnath) | business |
Opinion: Countries around the world are slashing education budgets. Children will suffer most | This article has been edited from its original version. It was originally published in its entirety in the International Monetary Fund's
Spring 2022 issue of Finance & Development magazine
. Yamini Aiyar is president and chief executive of India's Center for Policy Research. The opinions expressed in this commentary are her own.
My children last entered their school gates on March 10, 2020, weeks before India's national lockdown was announced. Two years on, schools in much of the country remain closed. Some states went against the tide and reopened in 2021 — but only partially, limiting attendance to higher grades and only half the student body on a given day. Each time cases surged, schools were the first to close and only restarted in person months after every other economic activity had resumed.
The physical classroom has been replaced by the Zoom room, where my children wave to their friends and talk to their teachers through a little box. The emotional, developmental and learning costs of this transition from the classroom to the Zoom room are visible every day.
But my children are among the privileged few. For most of India, even the Zoom room is a luxury. In September 2021, a
survey
of 1,400 schoolchildren from disadvantaged homes across 15 states found that just 8% of children in rural areas and 24% in urban areas had access to regular online education. In effect, the bulk of India's children have had no regular schooling for two years.
India is not alone. School closures affected 1.6 billion children across the globe. However, lower- and middle-income countries have closed schools for far longer than most higher-income countries. In parts of South Asia, Latin America and Africa, schools have been fully closed for over 80 weeks. Uganda, which reopened schools in January 2022, topped the charts with 82 weeks of partial or full closure.
Countries with the lowest digital access have also had the longest closures. Using data from the International Telecommunication Union, a 2021 study by the Asian Development Bank ( ADB) estimates that only 41% of households in Asia's lower-middle income economies have internet access.
Read More
In West and Central Africa, broadcast media substituted for school classrooms because of limited internet access. However, only 26% of households in rural areas owned a television.
In India, remote learning takes place primarily through mobile phones, but a 2021 survey by nongovernmental organization Pratham, the Annual Status of Education Report ( ASER), shows that only 68% of households with primary-school-age children in rural India owned smartphones. And of those, only a quarter of students had access to these phones; they therefore had no schooling for nearly two years.
Underprivileged children study at an improvised classroom set up beneath a bridge under construction in New Delhi on January 24. Many children are unable to afford laptops or tablet computers needed for online classes, leaving them without access to education amid the Covid-19 pandemic. The improvised school is provided tuition-free by graduate students.
Regardless of digital access, the quality of learning has been poor. For India, the ASER survey offers the only comparative assessment of learning levels before and during the pandemic in selected rural areas. In the State of Chhattisgarh, which reopened schools in August 2021, the survey found that the ability of Standards 3 and 5 students to read a basic Standard 2 textbook had declined by over 15 percentage points. In rural Karnataka, 19.2% of students in Standard 3 were at grade level in 2018 ( that is, they could read a Standard 2 textbook). This dropped to 9.8% in 2020. There are similar losses in basic arithmetic. Just 17.3% of students could do simple subtraction in 2020, compared with 26.3% in 2018.
India is not unique. The ADB estimated that in April 2021, students in South Asia, where schools have been closed the longest, lost about 0.55 learning-adjusted years of schooling. Compare this with the Pacific region, where schools mostly stayed open, and children lost just 0.08 learning-adjusted years.
The costs of learning losses to lifetime productivity are significant. A recent study looked at the impact on Pakistani students of 14 weeks of lost schooling after the 2005 earthquake and estimated that learning deficits among these children may result in lifetime earnings losses of 15%. Consider now what nearly two years of school closures and limited remote learning will do. According to the ADB, losses to future productivity and lifetime earnings for affected students could be $ 1.25 trillion for developing Asia, equivalent to 5.4% of the region's 2020 GDP.
US jobs are recovering, but women are still being left behind
Now, two years into the pandemic, as the third wave recedes, even recalcitrant countries such as India are taking steps to reopen schools. But schools are not opening to business as usual. This reopening affords an opportunity to bridge the learning losses of these two years and repair long-term damage. This will require significant financial resources to provide for physical classrooms, teaching materials, and — crucially — teachers.
Bridging learning deficits will require much more. Classrooms in many parts of the world have long been victim to a pedagogy that focuses on syllabus completion and curriculum standards, rather than on what children know. Two years of school closure have rendered the curriculum, in its present form, irrelevant. To remedy learning losses, school systems need to go back to basics ( foundational literacy and numeracy) and allow children to reconnect and catch up. This means investing in measuring learning losses and providing students with remedial teaching before they progress to the next grade and reenter the race to complete the syllabus.
All this will require financial resources. But spending demands are becoming critical at a time when countries are looking to scale down pandemic-induced expenditure stimulus and reimpose fiscal discipline. India, which announced its annual budget for 2022-2023 on February 1, for instance, intends to cut public expenditure by 2.5% of GDP, from 2020-2021, in the new fiscal year. Education budgets, slashed at the peak of the pandemic, fell victim to fiscal deficit targets and have not been increased. Given the long-term economic costs of school closures, this reluctance to spend on education is shortsighted. The need to invest in education is urgent. Otherwise, the costs of Covid-19 will be felt long into the future.
Correction: An earlier version of this article incorrectly stated the source of internet access estimates, which are based on data from the International Telecommunication Union, and the incomes of those studied, who are lower-middle income. It also misstated the region where schools have mostly stayed open, which is the Pacific region. | general |
Две трети домохозяйств с детьми лишились дохода во время пандемии | НЬЮ-ЙОРК, 10 марта 2022 года – Согласно новому докладу, опубликованному сегодня ЮНИСЕФ и Всемирным банком, с тех пор как два года назад разразилась пандемия COVID-19, по меньшей мере две трети домохозяйств с детьми лишились дохода.
В докладе Impact of COVID-19 on the welfare of households with children ( « Влияние COVID-19 на благосостояние домохозяйств с детьми »), который содержит выводы, сделанные на основе полученых в 35 странах данных, отмечается, что домохозяйства с тремя и более детьми чаще всего теряли доход: более трех четвертей из них столкнулись с сокращением заработка. Для сравнения, доля домохозяйств с одним ребенком или двумя детьми, оказавшихся в аналогичной ситуации, составила 68 процентов.
В докладе также отмечается, что из-за потери дохода взрослые в каждом четвертом домохозяйстве с детьми остаются без еды в течение суток и более. Взрослые из почти половины домохозяйств с детьми сообщили, что они пропускают прием пищи из-за нехватки денег. В докладе указывается, что около четверти взрослых в домохозяйствах с детьми или без детей сообщили о прекращении работы после начала пандемии.
« Незначительный прогресс, достигнутый в последние годы в деле сокращения детской нищеты, может быть сведен на нет во всех регионах мира. Семьи столкнулись с потерями, масштабы которых просто ошеломляют. Хотя в прошлом году инфляция достигла самого высокого уровня за последние годы, более двух третей домохозяйств с детьми заработали меньше денег. Семьи не могут позволить себе продукты питания или базовые медико-санитарные услуги. Они не могут позволить себе жилье. Это ужасная ситуация, и беднейшие домохозяйства еще глубже погружаются в нищету », – отметил Санджай Виджесекера, директор Группы по программам ЮНИСЕФ.
В докладе говорится, что дети лишаются самого необходимого: в 40 процентах домохозяйств они не участвовали ни в одном учебном мероприятии, пока их школы были закрыты. С учетом того, что сбор данных ведется на уровне домохозяйств, фактический коэффициент участия на индивидуальном уровне, по всей вероятности, еще ниже, особенно для детей из домохозяйств с тремя и более детьми.
« Сбои в организации учебного процесса и медицинского обслуживания детей в сочетании с оплачиваемыми из собственных средств катастрофическими расходами на медицинскую помощь, которые затрагивают более 1 миллиарда человек, могут затормозить развитие человеческого капитала – образования, здоровья и благополучия, необходимых людям для того, чтобы стать продуктивными членами общества, – заявила Каролина Санчес-Парамо, глобальный директор Глобальной практики Всемирного банка в области борьбы с бедностью и обеспечения социальной справедливости. – Это может закрепить рост неравенства в следующих поколениях, снизив вероятность того, что дети будут жить лучше, чем их родители или бабушки и дедушки ».
Домохозяйства с тремя и более детьми чаще прочих сталкивались с потерей дохода, но при этом чаще прочих получали государственную помощь: такой помощью воспользовались 25 процентов из них по сравнению с 10 процентами домохозяйств без детей. В докладе отмечается, что это способствовало уменьшению негативного воздействия кризиса на домохозяйства, получавшие поддержку.
Согласно докладу, до появления COVID-19 каждый шестой ребенок в мире ( то есть 356 миллионов мальчиков и девочек) жил в условиях крайней нищеты, при которой члены домохозяйства пытались выжить на сумму менее 1,90 долл. США в день. Более 40 процентов детей жили в умеренной нищете. Доля детей, находившихся в условиях многомерной нищеты в развивающихся странах, достигала почти 1 миллиарда человек; в результате пандемии этот показатель увеличился на 10 процентов.
ЮНИСЕФ и Всемирный банк настоятельно призывают к быстрому расширению систем социальной защиты детей и их семей. Поддержка, включающая переводы денежных средств и универсализацию детских пособий, является важнейшей инвестицией, которая может помочь семьям выйти из экономического кризиса и подготовиться к будущим потрясениям. С начала пандемии более 200 стран или территорий ввели тысячи мер социальной защиты, а Всемирный банк предоставил странам около 12,5 млрд долл. США на их реализацию, охватив почти 1 млрд человек в разных регионах мира.
Доклад основан на информации, полученной в рамках серии телефонных опросов, проводившихся с высокой периодичностью ( в 35 странах), и посвящен исключительно влиянию кризиса на детей. В настоящей статье анализируются первоначальное воздействие кризиса ( на основе данных опросов, собранных в период с апреля по сентябрь 2020 года) и его последующее изменение ( на основе данных опросов, собранных в период с октября 2020 года по май 2021 года). Первоочередное внимание уделяется следующим согласованным ключевым показателям благополучия детей, охватывающим их индивидуальные условия и условия домохозяйств, в которых они живут: i) потеря дохода и работы; ii) отсутствие продовольственной безопасности ( домохозяйства сообщают, что взрослый член семьи целый день не ел или пропустил прием пищи по причине нехватки денег/ресурсов); iii) программы социальной защиты ( получали ли домохозяйства какую-либо помощь от государства после начала пандемии); и iv) образование ( участие в любых учебных мероприятиях после закрытия образовательных учреждений в связи с COVID-19).
ЮНИСЕФ работает в крайне трудных условиях, с тем чтобы охватить наиболее обездоленных детей в мире. Мы осуществляем свою деятельность в 190 странах и территориях на благо каждого ребенка, повсюду в мире, стремясь сделать его лучше для всех.
С дополнительной информацией о ЮНИСЕФ и его деятельности в интересах детей можно ознакомиться на сайте https: //www.unicef.org/eca/. | general |
Could the Covid-19 vaccine become an annual shot? Some experts think so |
Some scientists think we might be rolling up our sleeves each year not just for flu shots but for Covid-19 jabs too.
Public health experts aren't quite clear on what the future holds for Covid-19 vaccines -- but some say it's looking more and more like these shots could be needed on a yearly basis, similar to how flu shots are recommended each fall.
`` In order to keep it under control, we likely will need some form of periodic vaccination. Now, whether that's annual or every two years or every five years, we don't really know that yet. I think that that will emerge as we gather more data, '' Dr. Archana Chatterjee, dean of the Chicago Medical School at
Rosalind Franklin University
, said Monday.
`` But I do anticipate that this will be required on a periodic basis to keep it under control, '' said Chatterjee, who's also a member of the US Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee. She added that her comments do not reflect the opinions of the committee or the FDA.
Covid-19 could eventually be seasonal, scientists say
The committee is
scheduled to meet April 6
to discuss the need for Covid-19 vaccine booster doses in the future, including how often they might be needed -- if at all.
Read More
The FDA said Monday that representatives from the US Centers for Disease Control and Prevention and the National Institutes of Health also will participate in the meeting.
The meeting is intended to assist the FDA in developing a `` general framework '' that will inform when further Covid-19 vaccine booster doses might be needed and what might warrant updating the makeup of vaccines to target specific coronavirus variants.
No official vote is planned, and there will be no discussion of authorization or approval for any specific products.
`` As we prepare for future needs to address COVID-19, prevention in the form of vaccines remains our best defense against the disease and any potentially severe consequences, '' Dr. Peter Marks, director of the FDA's Center for Biologics Evaluation and Research,
said in a news release
Monday.
`` Now is the time to discuss the need for future boosters as we aim to move forward safely, with COVID-19 becoming a virus like others such as influenza that we prepare for, protect against, and treat, '' Marks said. `` Bringing together our panel of expert scientific external advisors in an open, transparent discussion about booster vaccination is an important step to gain insight, input and expert advice as we begin to formulate the best regulatory strategy to address COVID-19 and virus variants going forward. ''
'It's heading towards this vaccine becoming an annual vaccine '
The day before the FDA announced the meeting date, former FDA Commissioner Dr. Scott Gottlieb said he also thinks Covid-19 vaccines may become an annual shot.
`` I think it's heading towards this vaccine becoming an annual vaccine, at least for the foreseeable future, until we really understand the epidemiology of this disease and understand whether this coronavirus starts to recede into the background like the four circulating strains of the coronavirus that we 've become accustomed to have, '' Gottlieb, a Pfizer board member,
told Margaret Brennan on CBS `` Face the Nation
`` on Sunday.
Coronaviruses that are known to infect humans were
first identified in the 1960s
, and among them are four circulating strains that cause common colds. The other human coronaviruses are Middle East respiratory syndrome, or MERS; severe acute respiratory syndrome, or SARS; and SARS-CoV-2, the virus that causes Covid-19.
When it comes to Covid-19, `` I think this is really a six-month vaccine in terms of providing really meaningful protection against symptomatic disease and infection, '' Gottlieb said. `` And this is likely to become an annualized vaccine for the majority of Americans. ''
It won't be a pandemic forever. Here's what could be next
It remains clear that the coronavirus that causes Covid-19 is not disappearing any time soon. Rather, some researchers say we can expect the pandemic to transition into an endemic phase.
Endemic
means a disease has a constant presence in a population but is not affecting an alarmingly large number of people, as typically seen in a pandemic.
So SARS-CoV-2 could still circulate, but hopefully it would be at low enough levels that it no longer overwhelms our health systems.
`` In terms of the virus itself, what we can expect is that it's not going to go away, that we will have recurrent surges and that our immunity will wane over time, '' said Dr. Abraar Karan, an infectious disease fellow at
Stanford University
.
Several studies have shown that the immunity against Covid-19 elicited by the Pfizer/BioNTech, Moderna and Johnson & Johnson vaccines can
wane over several months
,
especially among older adults
who might have weaker immune systems.
`` So the combination of our immunity waning and then the virus mutating means that future surges are unpredictable, '' Karan said.
`` We will need boosters again in the future -- probably later this year is my guess -- and they will need to be tweaked more closely to what the most recent strain is that's spreading, '' he said. `` We do this, obviously, annually for flu.... But flu has a more predictable seasonality to it. ''
What a future booster might look like
Future Covid-19 boosters might be completely different formulas from the vaccines that are administered now.
A fourth Covid-19 shot might be recommended this fall, as officials 'continually ' look at emerging data
Some companies, including Pfizer and Moderna, are developing variant-specific vaccines that could target whatever variant of the SARS-CoV-2 virus is circulating when the booster might be needed.
Pfizer and Moderna have said they are working on a vaccine that would specifically protect against the Omicron variant, even though it's not clear whether one is needed.
Pfizer CEO Albert Bourla said
the company is also hoping to make a vaccine that will protect against Omicron as well as all other variants of SARS-CoV-2.
The goal is to create `` something that can protect for at least a year, '' Bourla told CBS this month. `` And if we are able to achieve that, then I think it is very easy to follow and remember so that we can go back to really the way [ we ] used to live. ''
A universal vaccine could be the future of the coronavirus fight
Moderna and the biotechnology company Novavax also are working on two-in-one combination vaccines that can offer protection against both flu and Covid-19.
`` Our goal is to be able to have a single annual booster -- so that we don't have compliance issues where people don't want to get two to three shots a winter, but they get one dose where they get a booster for corona and they get a booster for flu and RSV, to make sure that people get their vaccines, '' Moderna CEO
Stéphane Bancel said at the World Economic Forum
in January of a single vaccine for Covid-19, influenza and respiratory syncytial virus, a common virus that causes cold-like symptoms.
There could be a benefit to having a combination Covid-19 and flu vaccine, Chatterjee said.
`` There are logistical benefits: The number of injections that need to be given is reduced; the benefits to the storage facilities that are delivering, administering these vaccines don't have to store as many vaccines because they're in a combined form, '' she said.
But she added that there are some limitations, as well.
`` There are a couple of different issues with combinations. You have to make sure that they work together, which doesn't always happen. Sometimes, the vaccine components can interfere with each other, and you don't get as good an immune response as you would like, '' Chatterjee said. `` And then there's the safety factor. As you add more vaccines together, often you get more reactions, particularly local reactions. ''
Covid-19 booster shot uptake is at all-time low in the US, CNN analysis finds
Another element: Will enough people even take the vaccine?
The pace of Covid-19 booster administration in the United States has slowed. Although more than 65% of the US population is fully vaccinated with at least their initial series, only 29% of the population has received a third dose.
The uptake of flu shots in the United States also has room for improvement.
Traditionally, about half of adults get their flu shots. During the 2020-21 flu season, among adults 18 an older, coverage was 50.2%,
according to CDC data
.
Chatterjee said a combination flu and Covid-19 vaccine might improve that uptake.
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The Results Are In with Dr. Sanjay Gupta
every Tuesday from the CNN Health team.
`` I would assume -- and this is an assumption on my part -- that those who currently get the influenza vaccine would probably continue to get them, and if they were offered as combinations, most of them would probably take the combination vaccine, '' Chatterjee said.
`` And then for those who received the Covid vaccine, perhaps they will be encouraged to take the combination also, so that they get double protection against flu, '' she added. `` Am I optimistic? I am that we will get better coverage for both types of viruses through combination vaccine. ''
CNN's
Jen Christensen
contributed to this report. | general |
Scandal-hit Credit Suisse shakes up board with Schwan exit | Switzerland's second largest bank said that Schwan, 54, who was its lead independent director as well as chief executive of Roche, would not stand for re-election to the board of directors at Credit Suisse's annual general meeting on April 29.
Schwan faced criticism for leading the Swiss pharmaceuticals firm while at the same time acting as vice chair of Credit Suisse, a demanding position as the bank grappled with several risk-management scandals which hit its share price.
Schwan was not immediately available for comment.
Another two of the 13 members of the Credit Suisse board, Kai S. Nargolwala and Juan Colombas, will also not stand for re-election, the bank said in a statement.
The Zurich-based bank said it had nominated Christian Gellerstad to succeed Schwan, who joined the board in 2014 and has been vice chair and lead independent director since 2017.
Schwan was also a member of the governance and nominations committee which picked Antonio Horta-Osorio as chairman. Horta-Osorio left in January less than nine months into the job after a probe into breaches of COVID-19 rules.
Credit Suisse has been hit by scandals and losses, notably from the collapse of U.S. family office Archegos Capital Management and British financier Greensill Capital.
Shares in the bank, which lost more than 22% of their value last year and a further 14.5% this year, were up 0.5% at 7.63 Swiss francs at 1158 GMT.
Investor representative group Actares said it was pleased that Schwan was going in the wake of the chairman fiasco and the scandals which occurred during the time he was on the board.
The bank said it had nominated Mirko Bianchi, who served as chief financial officer at UniCredit, Keyu Jin, a professor of economics at the London School of Economics, and Amanda Norton, who most recently served at Wells Fargo as group chief risk officer, for election as non-executive members.
Axel Lehmann, who took over as chairman after Horta-Osorio's abrupt departure, thanked the outgoing board members, saying Schwan and Nargolwala had `` helped steer the company through some challenging periods ''.
( Reporting by Silke Koltrowitz; Additional reporting by Oliver Hirt in Zurich and John O'Donnell in Frankfurt; Editing by Zuzanna Szymanska, Paul Carrel and Alexander Smith)
By Silke Koltrowitz | business |
Effectiveness of BNT162b2 against COVID-19 in adolescents - The Lancet Infectious Diseases | In the UK, COVID-19 vaccination for adults began in December, 2020.1Joint Committee on Vaccination and ImmunisationOptimising the COVID-19 vaccination programme for maximum short-term impact.https: //www.gov.uk/government/publications/prioritising-the-first-covid-19-vaccine-dose-jcvi-statement/optimising-the-covid-19-vaccination-programme-for-maximum-short-term-impactDate: 2021Date accessed: February 21, 2022Google Scholar Because children and adolescents have a low risk of severe COVID-19 and due to concerns about rare but potentially severe myocarditis after mRNA vaccination—mainly after the second dose in young adult males—the UK Joint Committee on Vaccination and Immunisation ( JCVI) initially recommended one dose for 16–17-year-olds from Aug 4, 2021,2Public Health EnglandJCVI issues updated advice on COVID-19 vaccination of young people aged 16 to 17.https: //www.gov.uk/government/news/jcvi-issues-updated-advice-on-covid-19-vaccination-of-young-people-aged-16-to-17Date: 2021Date accessed: February 10, 2022Google Scholar and recommended against vaccinating 12–15-year-olds because of marginal benefits versus risk. UK ministers subsequently recommended vaccinating this group with BNT162b2 ( Comirnaty, Pfizer-BioNTech) or mRNA-1273 ( Spikevax, Moderna) from Sept 13, 2021, to prevent education disruption.3Public Health EnglandUniversal vaccination of children and young people aged 12 to 15 years against COVID-19.https: //www.gov.uk/government/publications/universal-vaccination-of-children-and-young-people-aged-12-to-15-years-against-covid-19Date: 2021Date accessed: February 21, 2021Google Scholar Contrary to the authorised 3-week interval, the UK recommends 8–12 weeks between doses, because of the high protection provided by the first dose and higher antibody responses after a later second dose.4Amirthalingam G Bernal JL Andrews NJ et al.Serological responses and vaccine effectiveness for extended COVID-19 vaccine schedules in England.Nat Commun. 2021; 127217Google Scholar The UK strategy provided a unique opportunity to assess single-dose mRNA vaccine effectiveness in adolescents during a period of high community infection with the highly transmissible delta ( B.1.617.2) variant and subsequently with the more transmissible, and now dominant, omicron ( B.1.1.529) variant.
We used a test-negative, case-control design to estimate vaccine effectiveness after one BNT162b2 dose against PCR-confirmed symptomatic infection with the delta and omicron variants of SARS-COV-2 in England, as described previously.5Andrews N Stowe J Kirsebom F et al.Effectiveness of COVID-19 vaccines against the omicron ( B.1.1.529) variant of concern.N Engl J Med. 2022; ( published online March 2.) https: //doi.org/10.1056/NEJMoa2119451Google Scholar Vaccination status in symptomatic 12–15-year-olds and 16–17-year-olds with PCR-confirmed SARS-CoV-2 infection was compared with vaccination status in symptomatic adolescents in the same age groups who had a negative SARS-CoV-2 PCR test ( appendix pp 1–3).
From Sept 13, 2021, onwards, there were 617 259 eligible tests for 12–15-year-olds and 225 670 for 16–17-year-olds with a test date within 10 days of symptom onset date that could be linked to the National Immunisation Management system ( match rate 92·5%; appendix pp 4–6). Vaccine uptake and confirmed infections by age group and over time are summarised in the appendix ( p 9).
After one vaccine dose in 12–15-year-olds, vaccine effectiveness against symptomatic disease caused by the delta variant peaked at days 14–20 after vaccination ( 74·5% [ 95% CI 73·2–75·6 ]) and then declined gradually, reaching 45·9% ( 41·2–50·1) at days 70–83 ( figure A; appendix p 10). For the omicron variant, vaccine effectiveness was significantly lower at these timepoints, peaking at 49·6% ( 95% CI 43·9–54·8) at days 14–20 after the first dose before dropping to 16·1% ( 12·1–20·0) at days 70–83. After two doses, vaccine effectiveness increased and peaked 7–13 days later at 93·2% ( 81·5–97·5) for the delta variant and at 83·1% ( 78·2–86·9) for the omicron variant ( appendix p 10).FigureVaccine effectiveness in 12–15-year-olds ( A) and 16–17-year-olds ( B) with symptomatic, PCR-confirmed COVID-19Show full captionError bars are 95% CI.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
For 16–17-year-olds, vaccine effectiveness after dose one against symptomatic disease with the delta variant peaked at days 14–20 ( 75·9% [ 95% CI 74·3–77·3 ]) and declined gradually to 29·3% ( 25·9–32·6; figure B; appendix p 10) at days 84–104. For omicron, the vaccine effectiveness peak was significantly lower at 52·7% ( 43·3–60·5) between days 21–27 and fell to 12·5% ( 6·9–17·8) from day 105 onwards. After dose two, vaccine effectiveness peaked at 14–34 days ( 96·1% [ 95·2–96·8 ]) for the delta variant and at 7–13 days ( 76·1% [ 73·4–78·6 ]) for the omicron variant. Effectiveness fell rapidly for omicron after day 34, reaching 22·6% ( 14·5–29·9) 70 days after dose two, compared with 83·7% ( 72·0–90·5) for the delta variant ( appendix p 10).
For the delta variant, vaccine effectiveness against hospitalisation at 28 days after dose one was 83·4% ( 95% CI 54·0–94·0; appendix p 11) for 12–15-year-olds and 76·3% ( 61·1–85·6; appendix p 11) for 16–17-year-olds. There was insufficient follow-up time for assessing hospitalisation after two doses and for the omicron variant in both age groups.
Vaccination with BNT162b2 in both adolescent age groups was associated with lower vaccine effectiveness against symptomatic COVID-19 caused by the omicron variant compared with the delta variant. By 84 days after dose one, vaccine effectiveness against symptomatic disease with the omicron variant dropped to 20·5% for day 84–104 in 16–17-year-olds, highlighting the need for a second dose in both age groups. A second dose was associated with a rapid increase in vaccine effectiveness within 2 weeks of vaccination, with higher protection against the delta variant compared with the omicron variant. 16–17-year-olds were vaccinated earlier than 12–15-year-olds; therefore, they had longer follow-up. In 16–17-year-olds, vaccine effectiveness against the omicron variant dropped rapidly compared with the delta variant, consistent with observed trends in UK adults receiving a similar two-dose extended BNT162b2 schedule.5Andrews N Stowe J Kirsebom F et al.Effectiveness of COVID-19 vaccines against the omicron ( B.1.1.529) variant of concern.N Engl J Med. 2022; ( published online March 2.) https: //doi.org/10.1056/NEJMoa2119451Google Scholar Similar trends will probably occur in 12–15-year-olds over time. Reassuringly, very high protection was reported against hospitalisations due to the delta variant, even after a single vaccine dose. More follow-up is needed to assess protection against hospitalisation due to the omicron variant, any additional protection offered by the second dose, and duration of protection against hospitalisation for both variants.
Prelicensure trials reported 93% ( mRNA-1273) to 100% ( BNT162b2) efficacy in preventing COVID-19 in 12–15-year-olds from 7 days ( BNT162b2) or 14 days ( mRNA-1273) after two doses given 3–4 weeks apart, 6Frenck Jr, RW Klein NP Kitchin N et al.Safety, immunogenicity, and efficacy of the BNT162b2 COVID-19 vaccine in adolescents.N Engl J Med. 2021; 385: 239-250Google Scholar, 7Ali K Berman G Zhou H et al.Evaluation of mRNA-1273 SARS-CoV-2 vaccine in adolescents.N Engl J Med. 2021; 385: 2241-2251Google Scholar but the short interval between doses prevents comparison with our cohort. Real-world vaccine effectiveness data after two BNT162b2 doses include a US study using a similar test-negative case-control design as this study, which estimated 93% ( 95% CI 83–97) vaccine effectiveness against hospitalisation from June 30, to Sept 30, 2021; 8Olson SMNM Newhams MM Halasa NB et al.Effectiveness of Pfizer-BioNTech mRNA vaccination against COVID-19 hospitalization among persons aged 12-18 years—United States, June-September 2021.MMWR Morb Mortal Wkly Rep. 2021; 70: 1483-1488Google Scholar early Israeli data estimated 91·5% ( 88·2–93·9) vaccine effectiveness against delta variant infection in 12–15-year-olds.9Glatman-Freedman A Hershkovitz Y Kaufman Z Dichtiar R Keinan-Boker L Bromberg M Effectiveness of BNT162b2 vaccine in adolescents during outbreak of SARS-CoV-2 delta variant infection, Israel, 2021.Emerg Infect Dis. 2021; 27: 2919-2922Google Scholar
To date, this study is the only vaccine effectiveness evaluation against the omicron variant in adolescents after one and two mRNA vaccine doses. In adults from the UK, a similar high vaccine effectiveness against symptomatic disease was observed for both the delta ( 91%) and omicron ( 66%) variants 2–4 weeks after two BNT162b2 doses given 8–12 weeks apart,5Andrews N Stowe J Kirsebom F et al.Effectiveness of COVID-19 vaccines against the omicron ( B.1.1.529) variant of concern.N Engl J Med. 2022; ( published online March 2.) https: //doi.org/10.1056/NEJMoa2119451Google Scholar which was similar to data from South Africa reporting vaccine effectiveness of 70% against the omicron variant 2 weeks or more after the second vaccine dose.10Collie S Champion J Moultrie H Bekker L-G Gray G Effectiveness of BNT162b2 vaccine against omicron variant in South Africa.N Engl J Med. 2022; 386: 494-496Google Scholar
The rapid waning of protection after the first and second BNT162b2 dose against symptomatic disease with the omicron variant, the now dominant variant in the UK and worldwide, indicates that the current adolescent immunisation programme as a stand-alone intervention is unlikely to sustain suppression of infections in the medium-to-long term. If the aim of the programme is to reduce infections, then regular boosters will likely be needed.
We declare no competing interests. NA and SNL contributed equally. UKHSA has legal permission, provided by Regulation 3 of The Health Service ( Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases and as such, individual patient consent is not required to access records.
Download.pdf (.83 MB) Help with pdf files Supplementary appendix | tech |
India considers opening COVID boosters to all adults, sources say | - India is considering making all adults eligible for booster doses of COVID-19 vaccine, two sources with knowledge of the matter said on Monday, as infections grow in some countries and some Indians find it hard to travel abroad without a third dose.
Only frontline workers and those older than 60 are currently allowed to take booster doses in India, whether free in government centers or paid for in private hospitals.
The government is debating whether to provide boosters to other groups for free, said one of the sources, who both sought anonymity as the government has yet to make a decision.
A health ministry spokesperson wrote in a WhatsApp group for reporters: `` no decision yet. ''
The Serum Institute of India ( SII), whose Covishield vaccine dominates India's immunization program, said on Monday it stopped the shot's production in December but still had a stock of 200 million doses. It has produced 1.9 billion doses in total.
Its Chief Executive Adar Poonawalla told CNBC-TV18 that they would restart production of the vaccine, a version of the AstraZeneca shot, if demand returned through boosters or any other way.
India's health ministry, meanwhile, has urged states to boost COVID-19 surveillance measures, citing a resurgence in some parts of Asia and Europe. China and Italy have seen a recent rise in cases.
Infections in India, however, have fallen to their lowest in more than a year, with 1,549 new cases reported in the past 24 hours and 31 deaths. India's total infections now stand at more than 43 million, with 516,510 deaths.
The country of about 1.4 billion people has administered 1.81 billion vaccine doses, more than 20 million as boosters.
On Twitter some Indians have said organizers of some events overseas have limited attendance to those who have taken booster doses. Countries such as Israel, for example, do not consider vaccination complete in the absence of booster doses.
( Reporting by Krishna N. Das; Editing by Clarence Fernandez, Emelia Sithole-Matarise and Jonathan Oatis) | business |
North American Morning Briefing: Stock Futures Edge Down, Oil Prices Rise | MARKET WRAPS
Watch For:
Chicago Fed National Activity Index for February; Nike results.
Opening Call:
Stock futures edged lower and oil prices rose after major indexes notched their strongest week since November 2020.
Ukrainian officials rejected a Russian demand that their forces in Mariupol surrender as the U.K. Ministry of Defense said that heavy fighting continues north of Kyiv.
The White House said President Joe Biden will hold a call with President Emmanuel Macron of France, Chancellor Olaf Scholz of Germany, Prime Minister Mario Draghi of Italy, and Prime Minister Boris Johnson of the United Kingdom to discuss events, and later meet chief executives.
`` This is the main driver of markets in the coming days and maybe even weeks-it is about everything that comes out of the Ukraine conflict, '' said Carsten Brzeski, ING Groep's global head of macro research.
Mr. Brzeski said he is awaiting surveys of purchasing managers at businesses in the U.S. and Europe, due Thursday, for an initial assessment of how the war is beginning to hit economies.
The pan-continental Stoxx Europe 600 was flat. Russia's stock market remains closed. Russia's central bank will purchase government bonds when trading resumes Monday, Gov. Elvira Nabiullina said. She said the Moscow Exchange, which has been closed since Feb. 25, would reopen gradually but provided no details beyond the bond buying.
Boeing shares slumped in premarket action after China state media reported that a 737 jet crashed.
Stocks to Watch:
Anaplan, a provider of business-planning software, agreed to be acquired by private-equity firm Thoma Bravo for $ 66 a share, or $ 10.7 billion.
The offer is a premium of about 46% to the volume weighted average price of Anaplan stock for the five days ended March 18, the companies said in a press release.
Shares of Anaplan were jumping almost 27% to $ 64.21 in premarket trading Monday. The stock closed Friday at $ 50.59. Prior to Monday, the shares have risen 10.3% year to date but have fallen nearly 7% over the past one year.
The deal is expected to close in the first half of 2022. Anaplan will become a privately held company once the deal closes.
-- -
Warren Buffett's Berkshire Hathaway agreed to buy Alleghany shares for $ 848.02 a share in cash, or a total equity value of about $ 11.6 billion.
The deal represents a 29% premium to Alleghany's average stock price over the last 30 days, the companies said in a statement.
Shares of Alleghany, the property-and-casualty reinsurance company, closed Friday at $ 676.75.
Forex:
The dollar should rise this week, supported by stronger U.S. economic growth compared to other countries affected by the Russia-Ukraine conflict and the Federal Reserve's decision Wednesday to start raising interest rates, ING said.
The dollar is likely to find some support against low-yielding currencies and the bloc of European currencies in the near term, while other economically-sensitive currencies, like the outperforming Australian and New Zealand dollars, should remain in demand, ING analysts said.
The DXY dollar index could rise back to 99.00 by the end of the week, they said.
-- -
EUR/USD could undergo a short-term recovery, based on technical charts, CMC Markets said. Its upside momentum remains constructive, as the four-hour relative-strength-index oscillator has continued to hover above key support at the 41% level.
Also, EUR/USD formed a weekly bullish `` Morning Star '' candlestick pattern last week that indicates a shift in sentiment to positive from negative, which in turn may start at least a potential tactical rebound in coming weeks, CMC Markets said, pegging intermediate resistance at 1.1120 and key medium-term pivotal support at 1.0900.
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Sterling might struggle to recover versus the dollar after the Bank of England's cautious tone at Thursday's meeting, ING said. The scaling back of the market's U.K. interest rate rise expectations after the BOE's meeting means GBP/USD is unlikely to rise above 1.32-1.33, ING analysts said.
`` At the same time, the euro's greater exposure to lingering uncertainty in Ukraine could still favor a EUR/GBP decline to the 0.8300 mark in the near term. ''
The BOE raised its benchmark interest rate 25 basis points to 0.75% on Thursday but was more cautious about the prospect of further rises compared to the Fed at its meeting on Wednesday.
Bonds:
In bond markets, the yield on the benchmark 10-year Treasury note ticked up to 2.192% from 2.146% Friday.
Capital Economics raises its forecast for the 10-year U.S. Treasury yield for 2022 and 2023, attributing the upgrade to the war in Ukraine and a more hawkish Federal Reserve, its economists said.
`` While in the near term the outlook for financial markets will depend on the evolution of the war, which is hard to predict, we think that the changes to the macroeconomic backdrop... warrant four broad revisions to our market forecasts, '' they said.
CE raises its end-2022 and end-2023 forecasts for the yield of 10-year Treasurys to 2.5% and 3.0%, respectively, up from 2.25% and 2.75% previously.
-- -
Morgan Stanley forecasts a few near-term tailwinds for 10-year German Bund yields, leading to a stabilization, its rates strategists said. They point to a very cheap valuation, oversold technical conditions, and a more supportive net supply net of QE.
This could lead to a prolonged stay of 10-year Bund yields in the 0.25% to 0.40% range before a resumption of the bear market -- a rise in yields, they say.
Commodities:
Oil rose after talks between Ukraine and Russia show little signs of progress. Financial markets are still largely determining oil prices by assessing the likelihood of a diplomatic solution to the Ukraine conflict, CBA said.
`` Physical shortages, linked to current sanctions on Russia, though will eventually play a more dominant role in oil price determination, '' CBA said.
Meanwhile, the market is also keeping an eye on the fresh wave of Covid-19 outbreaks in China, which has resulted in some of the heaviest virus-related restrictions since early 2020, ANZ said.
-- -
Gold was slightly lower in European trade. Gold futures had settled lower Friday following a decision by the Fed last week to raise benchmark interest rates for the first time since 2018.
Focus will likely be on any progress in the talks between Russia and Ukraine, Commerzbank says. `` For a time, hopes that the peace talks between representatives of Russia and Ukraine could lead to an end to the war had weighed on its price, '' it said.
TODAY 'S TOP HEADLINES
Boeing 737 Carrying More Than 130 People Crashes in Southern China
BEIJING-A Boeing 737 passenger plane operated by China Eastern Airlines Corp. carrying more than 130 people crashed in southern China, the country's state media reported.
The plane crashed in the southern province of Guangxi on Monday, state media including Xinhua News Agency reported. There were no immediate reports on the number of casualties, and rescue teams have been sent to the area, the reports said.
Nielsen Rejects Roughly $ 9 Billion Takeover Offer From Private-Equity Consortium
Nielsen Holdings PLC rejected a roughly $ 9 billion takeover offer from a private-equity consortium, saying that it undervalues the TV-ratings company.
The Wall Street Journal reported last week that Elliott Management Corp. was part of a private-equity group in advanced talks to buy Nielsen for roughly $ 15 billion including debt. Nielsen said Sunday it wouldn't proceed with a bid that would have valued the company at $ 25.40 a share, without naming members of the consortium.
Thoma Bravo to Buy Anaplan for $ 10.7 Billion
Private-equity firm Thoma Bravo LP has struck a deal to buy Anaplan Inc. for $ 10.7 billion, the latest in a recent string of big leveraged buyouts.
Under the terms of the deal, which was reported earlier by The Wall Street Journal, Anaplan shareholders are to receive $ 66 a share in cash, the company said. Anaplan Chief Executive Frank Calderoni plans to continue to lead the company.
Aramco Profit Hits $ 110 Billion as Saudis Seek to Expand Investments
DUBAI-State oil giant Saudi Aramco said Sunday its 2021 net profit more than doubled to $ 110 billion, a boon to the Middle East's largest economy as it seeks to use its hefty profits for investment opportunities domestically and abroad.
The world's largest oil exporter is benefiting from rapidly rising oil prices and said it raised its spending target this year as demand surges and the impacts from the pandemic recede. Brent crude, the global oil benchmark, surged to an average of $ 70.86 a barrel last year after falling to an average of $ 41.96 a year earlier. It settled Friday at $ 107.93 a barrel, down 4.2% for the week. Early this month, oil at times traded above $ 130 a barrel.
China Huarong Asset Management Swung to Profit in 2021
China Huarong Asset Management Co. swung to a profit in 2021, a year after the country's biggest buyer of bad loans announced multibillion-dollar losses.
The Beijing-based company, which is majority owned by China's Finance Ministry, said Monday that it expects to post a net profit of 370 million yuan ( $ 58.36 million) supported by accelerated cash recovery and a faster turnover of its M & A business.
Canadian Pacific Railway Work Stoppage Threatens New Supply-Chain Snarl
Canadian Pacific Railway Ltd. trains were halted Sunday morning, stalling global shipments of key manufactured goods and commodities such as fertilizers, after an impasse in contract negotiations between the company and its conductors and engineers.
Canadian Pacific and the Teamsters Canada Rail Conference, which represents more than 3,000 conductors, engineers and yard workers at the railway, disagreed over what triggered the breakdown in talks. The railway has been in negotiations and mediation since September with the union, which seeks increased wage and pension benefits and more rest times.
( MORE TO FOLLOW) Dow Jones Newswires
03-21-22 0611ET | business |
Crude settles up more than 7% as EU mulls Russian oil ban | * EU nations and U.S. president set to hold talks
* Saudi refinery attack adds to market jitters
* Some OPEC+ producers still falling short of quotas
HOUSTON, March 21 ( Reuters) - Oil prices settled up more than 7% on Monday, with global benchmark Brent climbing above $ 115 a barrel, as European Union nations disagreed on whether to join the United States in a Russian oil embargo after an attack on Saudi oil facilities.
Brent futures settled at $ 115.62 per barrel, up $ 7.69 or 7.12%, while U.S. West Texas Intermediate ( WTI) crude futures settled at $ 112.12 per barrel, up $ 7.42 or 7.09%.
Such an embargo `` could be the precipice for global trouble supply-wise, '' said John Kilduff, a partner at Again Capital LLC.
Given the uncertainty about the EU's potential ban of Russian petroleum imports, U.S. gasoline futures jumped 5%.
European Union governments will consider whether to impose an oil embargo on Russia over its invasion of Ukraine as they gather this week with U.S. President Joe Biden for a series of summits designed to harden the West's response to Moscow.
The EU and allies have already imposed a panoply of measures against Russia, including freezing its central bank's assets.
Ukraine defied a Russian demand that its forces lay down arms before dawn on Monday in Mariupol, where hundreds of thousands of civilians have been trapped in a city under siege.
With little sign of the conflict easing, the focus returned to whether the market would be able to replace Russian barrels hit by sanctions.
`` Optimism is seeping away about progress in talks to achieve a ceasefire in Ukraine and that’ s sent the price of oil on the march upwards, '' Susannah Streeter, senior markets analyst at UK-based asset manager Hargreaves Lansdown, said.
Over the weekend, attacks by Yemen's Iran-aligned Houthi group caused a temporary drop in output at a Saudi Aramco refinery joint venture in Yanbu, feeding concern in a jittery oil products market, where Russia is a major supplier and global inventories are at multi-year lows.
Saudi Arabia on Monday said it would not be responsible for any global oil supply shortages after these attacks, in a sign of growing Saudi frustration with Washington's handling of Yemen and Iran.
The latest report from the Organization of the Petroleum Exporting Countries and allies including Russia, together known as OPEC+, showed some producers are still falling short of their agreed supply quotas.
Oil prices were also sensitive to talk of Hong Kong lifting COVID-19 restrictions, which could increase demand, and to the growing list of U.S. companies retreating from Russia - including Baker Hughes, ExxonMobil, Shell, and BP. ( Additional reporting by Noah Browning in Londo, Sonali Paul in Melbourne and Florence Tan in Singapore Editing by Marguerita Choy and Barbara Lewis) | business |
UK Stocks-Factors to watch on March 21 | Britain's FTSE 100 index is seen opening flat on Monday, with futures up 0.1%.
* ASTRAZENECA: AstraZeneca said on Monday its antibody-based cocktail to prevent and treat COVID-19 was shown to retain neutralising activity against the Omicron coronavirus variants, including BA.2 subvariant, in independent lab studies.
* SHELL: Australia's offshore petroleum watchdog has cleared the way for Shell to restart its Prelude floating liquefied natural gas site off northwestern Australia, after a power outage forced a shutdown in December.
* ASTRAZENECA: Bristol Myers Squibb Co, in a lawsuit made public on Friday, said AstraZeneca's cancer treatment Imfinzi violates patents related to its blockbuster cancer drug Opdivo.
* CVC: Europe's biggest private equity firm CVC Capital Partners is planning to shun London and take its multibillion-euro initial public offering to the Netherlands, the Financial Times reported on Saturday.
* BUDGET: British finance minister Rishi Sunak, preparing for a budget update this week, said on Sunday he would help where he could with a cost-of-living squeeze but warned that the Ukraine crisis and sanctions on Russia would add to the economy's problems.
* UK HOUSES: Asking prices for British houses have recorded their sharpest monthly jump for the time of year since March 2004, despite a growing squeeze on households ' disposable income from higher energy bills and rising interest rates.
* FTSE 100: British stocks ended near session highs on Friday and the blue-chip index clocked its best weekly performance in over a year as investors digested negotiations over the Ukraine-Russia conflict and a dovish outlook from the Bank of England this week.
* For more on the factors affecting European stocks, please click on:
TODAY 'S UK PAPERS
> Financial Times
> Other business headlines ( Reporting by Aby Jose Koilparambil and Sinchita Mitra in Bengaluru) | business |
Tencent Music social services slump takes shine off upbeat quarter | China's Tencent Music said its mainstay social entertainment services business shrank in the fourth quarter, overshadowing the company's in-line results and sending its shares down more than 9% in extended trading.
While most of Tencent Music's users are in its music streaming unit, social entertainment services including karaoke platforms where users can live stream concerts and shows are its biggest revenue drivers.
Revenue from social entertainment services and others fell 15.2% to 4.73 billion yuan ( $ 742 million), while paying users in the social entertainment category slumped 16.7%.
The weakness was wrought by stiff competition from rivals and the changing macro environment, Executive Chairman Cussion Pang said in a statement on Monday.
A resumption of in-person events in the quarter after COVID-19 receded in the country was expected to weigh on the company's results, according to analysts.
The results come against the backdrop of China's intense regulatory crackdown on local tech firms and threats of U.S. penalties if Beijing supports Moscow in its invasion of Ukraine.
In a bright spot, Tencent Music's online music services business posted revenue growth of 4.3%. Total revenue of the Tencent Holdings-controlled company fell 8.7% to 7.61 billion yuan, in line with market estimates, according to Refinitiv data.
Excluding items, the company earned 0.50 yuan per ADS, meeting analysts ' expectations.
( $ 1 = 6.36 Chinese yuan renminbi) ( Reporting by Yuvraj Malik in Bengaluru; Editing by Devika Syamnath) | business |
Fed will raise rates more aggressively if needed, Powell says | In remarks that sent financial markets scrambling to recalibrate for a higher probability of the Fed lifting interest rates by a half-percentage point at one or more of its remaining meetings this year, Powell signaled an urgency to the central bank's inflation challenge that was less visible than just a week ago, when the Fed delivered its first rate hike in three years.
`` The labor market is very strong, and inflation is much too high, '' Powell told a National Association for Business Economics conference. `` There is an obvious need to move expeditiously to return the stance of monetary policy to a more neutral level, and then to move to more restrictive levels if that is what is required to restore price stability. ''
In particular, he added, `` if we conclude that it is appropriate to move more aggressively by raising the federal funds rate by more than 25 basis points at a meeting or meetings, we will do so. ''
AIG's global head of strategy, Constance Hunter, called it Powell's `` the buck stops here '' speech.
U.S. stocks fell, and traders -- already betting on at least a quarter-point interest rate increase at each of the year's remaining six Fed meetings -- moved to price in a better-than even chance of half-point interest rate increases at each of the Fed's next two meetings in May and June.
That would lift the short-term policy rate - pinned for two years near zero - to a range of 2.25% to 2.5% by the end of the year, higher than the 1.9% that Fed policymakers just last week anticipated.
Most Fed policymakers see the `` neutral '' level as somewhere between 2.25% and 2.5%.
Powell repeated on Monday that the Fed's reductions to its massive balance sheet could start by May, a process that could further tighten financial conditions.
`` This is not just going to be a near-term tactical phenomenon, '' said Kevin Flanagan, head of fixed income strategy at WisdomTree Investments in New York. `` This is a more strategic type of messaging, I think, from the Fed. ''
A consensus for more aggressive tightening - or at least an openness to it - appears to be growing.
Atlanta Fed President Raphael Bostic, who expects a slightly gentler path of rate increases than most of his colleagues, said earlier on Monday he is open to bigger-than-usual rate hikes `` if that's what the data suggests is appropriate. ''
Speaking on Friday, Fed Governor Chris Waller said he would favor a series of half-percentage point rate increases to have a quicker impact on inflation.
TIGHT LABOR MARKET, INFLATION RISKS
The U.S. unemployment rate currently is at 3.8% and per-person job vacancies are at a record high, a combination that's pushing up wages faster than is sustainable.
`` There's excess demand, '' Powell said, adding that `` in principle '' less accommodative monetary policy could reduce pressure in the labor market and help stabilize inflation without pushing up unemployment, generating a `` soft landing '' rather than a recession.
Inflation by the Fed's preferred gauge is three times the central bank's 2% goal, pushed upward by snarled supply chains that have taken longer to fix than most had expected and that could get worse as China responds to new COVID-19 surges with fresh lockdowns.
Adding to the pressure on prices, Russia's war in Ukraine is pushing up the cost of oil, threatening to move inflation even higher. The United States, now the world's biggest oil producer, is better able to withstand an oil shock now than in the 1970s, Powell noted.
Although the Fed in normal times would not likely tighten monetary policy to address what in the end may be a temporary spike in commodity prices, Powell said, `` the risk is rising that an extended period of high inflation could push longer-term expectations uncomfortably higher. ''
Last year, the Fed repeatedly forecast that supply chain pressures would ease and then was repeatedly disappointed.
`` As we set policy, we will be looking to actual progress on these issues and not assuming significant near-term supply-side relief, '' Powell said on Monday. Policymakers began this year expecting inflation would peak this quarter and cool in the second half of the year.
`` That story has already fallen apart, '' Powell said. `` To the extent it continues to fall apart, my colleagues and I may well reach the conclusion we 'll need to move more quickly and, if so, we 'll do so. ''
Fed policymakers hope to rein in inflation without stomping on growth or sending unemployment back up, and their forecasts released last week suggest they see a path for that, with the median view for inflation falling to 2.3% by 2024 but unemployment still at 3.6%.
Powell said he expects inflation to fall to `` near 2% '' over the next three years, and that while a `` soft landing '' may not be straightforward, there is plenty of historical precedent.
`` The economy is very strong and is well-positioned to handle tighter monetary policy, '' he said, adding that he doesn't expect a recession this year.
It is a difficult trick to finesse, analysts said.
Powell was `` reasonably forthcoming that there's uncertainty, '' said Seth Carpenter, chief global economist at Morgan Stanley. `` If you keep going until you see the outcome that you desire, chances are you 've gone too far. ''
( Reporting by Ann Saphir and Lindsay DunsmuirAdditional reporting by Herb LashEditing by Paul Simao and Alistair Bell)
By Ann Saphir and Lindsay Dunsmuir | business |
Ghana imposes record interest rate hike to slow inflation | The Bank of Ghana raised its main lending rate by 250 basis points to 17%, signalling an aggressive stance against the rocketing price of goods from flour to sugar to fuel, and against a depreciating local currency that has dented investor confidence.
It is the largest increase in Ghana's history, according to government records, more than double the 100-basis-point rise predicted by a Reuters poll of 10 economists last week.
`` The uncertainty surrounding price development and its impact on economic activity is weighing down business and consumer confidence, '' the bank's governor, Ernest Addison, told a news conference. `` The risks to inflation are on the upside. ''
Ghana was long seen as a rising star among Africa's emerging market economies, but underwhelming oil revenues and supply chain disruptions amid the COVID-19 pandemic have dampened expectations.
Consumer inflation reached 15.7% year-on-year in February, the highest since 2016. Food, transportation and housing prices have seen the greatest spikes.
Restaurants and bakeries have downsized menus and laid off staff. The national taxi drivers union has threatened to strike over spiralling fuel costs. [ L5N2VD7O1 ]
The war in Ukraine will likely make things worse. Ghana imports nearly a quarter of its wheat from Russia and around 60% of its iron ore from Ukraine, Addision said, though he expects inflation to return to its targeted band of 8% plus-or-minus 2% by the end of the year.
Meanwhile, Ghana's cedi has weakened by about 20% against the dollar this year, making it the second-weakest currency after the Russian rouble in a list of some 20 emerging market units tracked by Reuters.
Addison blamed that in part on recent downgrades by credit ratings agencies Moody's and Fitch, which he said shook investor confidence.
Ghana's total public debt stands at $ 50.8 billion ( 351.8 billion Ghanaian cedi), according to central bank figures, about 80% of the country's gross domestic product.
The central bank has made efforts to improve the situation. Monday's rate hike marks the first time it has increased the prime rate twice within one year since 2015, after a previous one in November.
Economists have warned the fiscal deficit may spark a full-on debt crisis if more money doesn't come in.
Ghana's ruling party says the solution lies in a 1.75% tax on all electronic payments, locally known as the ' e-levy ', a proposal so detested by the opposition that it caused a brawl in parliament last year.
Others have suggested a debt relief programme through the International Monetary Fund which Ghanaian authorities have so far resisted.
( Reporting by Christian Akorlie and Cooper Inveen; Additional reporting by Nellie Peyton; Editing by Edward McAllister and Emelia Sithole-Matarise)
By Christian Akorlie and Cooper Inveen | business |
Nations vet 3,000-page handbook to halt climate crisis | Hi, what are you looking for?
Nearly 200 nations gather to grapple with a question how does a world addicted to fossil fuels prevent carbon pollution from making Earth unliveable?
By
Published
Nearly 200 nations gather Monday to grapple with a question that will outlive Covid-19 and Russia’ s invasion of Ukraine: how does a world addicted to fossil fuels prevent carbon pollution from making Earth unliveable?
A partial answer is set for April 4 after closed-door, virtual negotiations approve a nearly 3,000-page report detailing options for drawing down greenhouse gases and extracting them from the air.
“ The impacts are costly and mounting, but we still have some time to close the window and get ahead of the worst of them if we act now, ” said Alden Meyer, a senior analyst at climate and energy think-tank E3G.
“ This report will supply the answers as to what we need if we’ re serious about getting there. ”
In August 2021, the Intergovernmental Panel on Climate Change ( IPCC) laid out the physical science: the pace of global warming and sea level rise, along with shifts in the frequency, duration and intensity of cyclones, heatwaves and droughts.
That was part one in a three-part assessment, the sixth since 1990.
It projected that Earth’ s surface temperature will rise 1.5 degrees Celsius above preindustrial levels, perhaps within a decade.
A 1.5C cap on global warming — the aspirational goal of the 2015 Paris climate accord — has been embraced as a target by most of the world’ s nations.
It’ s not hard to see why: barely 1.1C of warming so far has ushered in a crescendo of deadly extreme weather across the globe.
Recently renewed national carbon-cutting commitments, however, still put us on a catastrophic path toward 2.7C of warming by 2100.
– ‘ Overshooting’ 1.5C –
Part two of the IPCC report — described by UN chief Antonio Guterres as an “ atlas of human suffering ” — details past and future climate impacts and the limits of our ability to adapt.
Delaying climate action would severely reduce the chances of a “ livable future, ” it concluded.
Part three is about how to keep planet-warming gases out of the atmosphere, with chapters on the key sectors where rapid and deep change is needed: energy, transport, industry, agriculture, among others.
“ We are talking about the large-scale transformation of all the major systems, ” climate economist and co-author Celine Guivarch told AFP.
The main focus is on weaning the global economy of fossil fuels and moving to low- or zero-carbon sources of energy, from solar and wind to nuclear, hydro and hydrogen.
Helping that transition is the fact that renewable energy is now cheaper than energy generated by fossil fuels in many markets.
The IPCC also details ways to reduce demand for oil, gas and coal, whether by making buildings more energy efficient or encouraging shifts in lifestyle, such as eating less beef and not flying half-way around the world for a week-long holiday.
But humanity has waited so long to take action that switching supply and reducing demand are not enough: we also need to pull CO2 out of the air.
In theory — because the technology does not yet exist at scale — carbon dioxide removal will compensate for hard-to-decarbonise sectors such as aviation and shipping, and extract excess CO2 if temperatures “ overshoot ” the Paris Agreement targets.
– Likely to fail? –
“ Delivering on the climate commitments that we’ ve made internationally and nationally is far more challenging than we have been prepared to accept, ” said Kevin Anderson, a professor of energy and climate change at the University of Manchester.
“ Right now, we are very likely to fail. But if we don’ t try, we are guaranteed to fail, ” he told AFP.
The IPCC “ solutions ” report draws from hundreds of models projecting development pathways that keep Earth within the bounds of the Paris temperature goals.
“ There are scenarios that show high renewables and low nuclear, and scenarios that show the opposite, ” said Taryn Fransen, an analyst at the World Resources Institute in Washington DC.
“ This report lays out those pathways. Now it’ s up now to our leaders to take that to heart. ”
Besides feeding into UN political negotiations, which resume in November in Egypt at COP 27, the IPCC findings will also be important “ for the conversation going on in the US and Europe around the need to transition away from Russian oil and gas, ” said Meyer.
The head of the IPCC delegation from Ukraine made this point in a dramatic statement at a closed plenary in February, only days after Russian troops invaded her country.
“ Human-induced climate change and the war on Ukraine have the same roots — fossil fuels — and our dependence on them, ” said Svitlana Krakovska, according to multiple sources.
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
The horrors of the war in Ukraine can be seen in 13-year-old Volodymyr's empty expression as he lies in the children's hospital in Kyiv.
Tens of thousands of farmers and others from the countryside warned the Spanish government their lifestyles are in danger - Copyright AFP Shahid Saeed...
This case will create either ripples or waves throughout the global regulatory and civil legal environment.
Israeli microbiologists and chemists identified and characterised over 700 different bacterial species isolated from the gut.
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Fed prepared to raise interest rates 'aggressively: ' Powell | Hi, what are you looking for?
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The US central bank is prepared to raise interest rates by bigger steps than the quarter-point hike announced last week if that is what’ s needed to contain “ much too high ” inflation, Federal Reserve Chair Jerome Powell said Monday.
Consumer prices in the world’ s largest economy have surged to the highest seen in four decades, and the Fed last week raised the benchmark lending rate for the first time since the Covid-19 pandemic began to try to tamp down inflation pressures.
“ If we conclude that it is appropriate to move more aggressively by raising the federal funds rate by more than 25 basis points at a meeting or meetings, we will do so, ” Powell said in a speech to an economics conference.
Inflation was already rising before the Russian invasion of Ukraine added to new price pressures and supply chain impediments that could spill over to the US economy, he told the National Association for Business Economics.
“ There is an obvious need to move expeditiously ” to remove the stimulus the Fed provided to the American economy during the pandemic, but Powell said central bankers are prepared to go beyond “ neutral ” and tighten policy if needed to achieve their goal.
Last week’ s rate hike was billed as the first in a series, and several policymakers have expressed willingness — or the need — to move in bigger steps.
– ‘ Very strong’ economy –
St Louis Fed Bank President James Bullard dissented in the vote at last week’ s meeting of the policy-setting Federal Open Market Committee, because he wanted a half-point increase as the first move.
Atlanta Fed Bank President Raphael Bostic, who spoke to the NABE conference early Monday, said he will “ adapt ” his views to the data, even if it means raising a full point.
“ I’ m comfortable with more aggressive movements if that’ s what the data and the evidence suggests is appropriate, ” said Bostic, who unlike Bullard is not currently a voting member of the FOMC.
“ I’ m going to be very, very open in terms of my approach … it could at some point be move nothing. It could be 25; it could be 50; it could be 75; it could be one, ” Bostic told reporters.
Like Bostic, Powell said the key issue is containing prices, and he dismissed the idea of raising the Fed’ s inflation target to three percent from two percent.
“ Inflation is much too high. We have the necessary tools, and we will use them to restore price stability, ” he said.
The labor market is posing challenges however, with employers struggling to fill open positions, and many people staying out to the workforce, in part to care for children.
The Fed chief noted that the sum of jobs and vacancies is about five million bigger than the size of the US labor force.
“ This is a labor market that is out of balance, ” Powell said in response to a question, adding “ We need the labor market to be sustainably tight. ”
He was optimistic the Fed can grind down inflation and sustain a strong job market without tipping the US economy into a recession, an elusive goal known as a “ soft landing ” — and he does not see “ elevated ” risk of recession in the next year.
Even with the oil price shock sparked by the conflict in Ukraine, he noted that “ today the economy is very strong and is well positioned to handle tighter monetary policy. ”
But he cautioned that “ very little is straightforward in the current context, ” and there is high uncertainty about the impact of the war.
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
The horrors of the war in Ukraine can be seen in 13-year-old Volodymyr's empty expression as he lies in the children's hospital in Kyiv.
Australia has returned 29 religious and cultural artefacts to India, among them several stolen or illegally exported from the country.
A China Eastern passenger jet carrying 132 people crashed onto a mountainside in southern China on Monday causing a large fire.
The EU’ s foreign policy chief Josep Borrell calls Russia’ s attack on port city of Mariupol “ a massive war crime. ”
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LeapXpert Launches iMessage Integration for Regulated Industries | LeapXpert has added iMessage data capture and archiving to its Federated Messaging Orchestration Platform ( FMOP), joining other supported tools like WhatsApp, WeChat, Telegram, Signal, Line and SMS.
iMessage integration for regulated firms is the first of its kind, LeapXpert said in a news release.
“ LeapXpert is excited to add iMessage to its robust data capture and governance platform, ” Dima Gutzeit, founder and CEO of LeapXpert, said in the release. “ As companies seek to remain secure and compliant while finding new ways to reach customers, this expanded functionality provides opportunities to archive conversations with the countless iMessage users who are customers of regulated companies. ”
Regulated industries have long relied on legacy communication channels like phone, fax and email to communicate with customers, but the continued proliferation of new messaging apps adds a layer of complexity when it comes to balancing consumer demand with regulatory oversight.
“ The preferred method of communication for one region is not necessarily the preferred method for another, ” Avi Pardo, co-founder and COO of LeapXpert, said in the release. “ As companies enter new domestic or international markets, the ability to open all channels can be a powerful message to their clientele saying they are open to all for business. ”
Support for iMessage will be released immediately for several beta clients, while general availability of the solution is expected this spring.
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Spring COVID-19 booster launches for over-75s and high risk in England | Those aged 75 and over, alongside residents in care homes and those with weakened immune systems, can now book an extra COVID-19 booster jab in England. This news comes as statistics show that infection rates are rising across all age groups.
The rollout follows recommendations from the UK’ s vaccine advisers who say that additional jabs will help top-up protection for the most vulnerable. Spring boosters are already currently being rolled out in Wales and Scotland.
A wider booster programme for the general population is anticipated this Autumn. This comes as the UK sees rising cases of COVID-19, with an estimated one in every 20 people infected.
Health Secretary Sajid Javid has said that people with symptoms of the virus should “ behave sensibly ”, but it is up to the individual to decide whether or not to take a test. `` I think we need to step back and think about how we learn to live with COVID-19 and focus on our very best form of defence and that's the vaccination programme. ”
A second booster dose is due to be offered to adults aged 75 years and over, residents in a care home for older adults, and individuals aged 12 years and over who are immunosuppressed, or have weakened immune systems. This means that approximately five million people in the UK will be eligible to book their extra booster jab, and the first 600,000 people will be invited from this week. | tech |
Market Movers Asia, March 21-25: China's COVID-19 curbs hit oil, gas, coal demand | In this episode of the Oil Markets Podcast, S & P Global Commodity Insights editors Paul Hickin, Emma...
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After settling at its highest price in over a decade on April 7, the NYMEX Henry Hub prompt-month...
This week: All eyes will be on Chinese oil companies ' business strategies for 2022, China's nickel buyers are holding off their purchases amid price volatility, and Asian consumers are likely to turn to Australian and Indian wheat amid absent Black Sea supplies.
But first, tight movement restrictions and regional lockdowns in China to control the largest COVID-19 outbreak are expected to impact oil and gas demand in the coming weeks. Restrictions have been imposed across nearly 20 provinces and municipalities, and daily confirmed cases have been over 2500 for many consecutive days.
The areas of Guangdong, Shandong, Jilin and Shanghai—some of epicenters of the current COVID-19 outbreak -- accounted for around 30% of China's oil consumption in 2021. According to S & P Global Commodity Insights ' estimates, China is expected to see oil demand destruction to the tune of 650,000 barrels a day in March and 400,000 barrels a day in April. The restrictions could also impact product exports in April.
Market sources estimate that total trucked LNG sales are also likely to drop by at least 15%. Trucked LNG loading schedules have slowed at several terminals in northern and southern China in the first half of March. LNG terminals have been enforcing testing requirements for drivers, hitting transportation between cities.
There are expectations that Beijing may adjust its zero COVID-19 approach to ensure that it meets its 2022 GDP growth target. President Xi Jinping has pushed for `` swift containment '' of the pandemic but at a minimum cost. That brings us to our social media question for the week: Will China's COVID-19 outbreak dampen the sentiment and weaken oil prices to below $ 100/b? Share your thoughts on Twitter and LinkedIn.
Staying with China, all eyes will be on the 2021 annual results and subsequent conference calls of China's listed oil companies. The energy industry will see if state-owned companies show interest in acquiring Russian energy assets. This comes at a time many US and European firms are exiting their Russian energy investments due to the country's invasion of Ukraine.
The oil companies ' business strategies, upstream and refining production targets for 2022 will also be in focus.
In metals, Chinese downstream nickel consumers are awaiting pricing cues as they held back procurements amid volatile prices. Global nickel prices are expected to remain volatile in the near term due to the Russia-Ukraine war and the uncertainty around nickel trading on the London Metal Exchange.
LME's resumption on nickel trading was off to a rough start last week due to errors that allowed a small number of trades below the daily price limit on its LMEselect electronic market. LME has since widened the daily upper and lower price limits for nickel trading to 8% from 5%.
In the Asian thermal coal market, Indonesian thermal coal prices are likely to remain volatile this week as Chinese demand remains low amid lockdowns. However, supply tightness in Indonesia due to heavy rains and barge unavailability could continue to support export prices. Buyers in India are expected to remain on the sidelines due to high import prices and may choose to procure domestic stocks from ports.
And finally, in agriculture, grain markets will be closely watching the movement of Australian prime wheat prices, which rose to an all-time high of 447 dollars per metric ton on March 8 but have since declined over the last 2 weeks. A fall in prices may provide some relief to global wheat importers, particularly the Asian countries, as supplies from the Black Sea region remain disrupted. Australia and India are expected to fill the gap from absent Black Sea supplies.
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Insurance companies could face some cancellation claims in light of the sporting world's response to Russia's invasion of Ukraine, but they will be far more limited than what the industry experienced from events canceled or postponed by COVID-19.
A number of major sporting events that had been set to take place in Russia have been relocated, and many Russian national teams have been banned from competition across the globe. For instance, UEFA moved the May 28 final of this year's men's Champions League to Paris from St. Petersburg. Also, FIFA and UEFA suspended all Russian soccer teams until further notice.
Formula One pumped the brakes on auto racing in Russia, confirming that it terminated its contract with the Russian Grand Prix promoter. A host of other sports bodies, including World Rugby, the International Ice Hockey Federation and the Badminton World Federation, have also taken various actions against Russia.
Kroll Bond Rating Agency analyst Peter Giacone said the wording of most cancellation policies typically contains sanctions clauses given the legal requirements to comply with any sanctions levied. War is excluded on `` virtually all '' event cancellation policies, said Scott Schachter, Northeast entertainment leader at Risk Strategies, with the exception of coverage buybacks for ultra-large events. If war coverage was purchased, the F1 cancellation `` could be large '' and the relocation of the Champions League final could present a sizable extra expense loss, Schachter said.
Schachter does not expect sports bans against Russia to hit insurers nearly as hard as cancellations related to the COVID-19 pandemic. Based on his conversations with `` some of the largest markets in the space, '' loss exposure is limited for the cancellation insurance market as a whole, though there are some political risk markets in London that may have more exposure than the contingency and cancellation markets.
Insurers paid out hundreds of millions of dollars in claims when the 2020 Tokyo Olympics were pushed back to 2021 because of the pandemic. Swiss Re AG CFO John Dacey during a March 2020 earnings call said the reinsurer had a specific exposure of $ 250 million to the Tokyo Olympics.
While the Summer Games eventually did take place, spectators were banned from in-person viewing of the competition. That added to the bill that insurance companies faced from their coverage of the event. Bloomberg Intelligence analyst Charles Graham estimated in a note that had the Tokyo Olympics been completely canceled, insured losses would have been in the $ 2 billion to $ 3 billion range.
Swiss Re, Munich Re and Chubb Ltd. declined to comment for this story. UEFA and F1 did not reply to requests for comment. | business |
Peru cancels, rebids tenders to cope with high Latin American ULSD prices | Peru has canceled two distillate tenders, awarded only one light ends cargo out of three for another tender, and put the other two cargoes up for rebid March 21, sources said, reflecting Latin American entities ' struggle in coping with high diesel and gasoline prices.
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Crude futures settled sharply higher March 21 on the possibility of EU sanctions on its key Russian supply, with ICE May Brent up $ 7.69/b to $ 115.62/b. NYMEX April RBOB futures settled 13.28 cents higher at $ 3.3716/gal, and April ULSD finished 20.28 cents higher at $ 3.8009/gal.
Diesel and gasoline have mostly outpaced crude oil's price increases in March, evidenced by crack spreads that have blown out to some of the highest levels on record.
Russia supplied Europe with diesel and naphtha, forcing Europe to turn more instead to the US, the main sourcing hub for Latin America. The naphtha switch has also hurt Brazil more than usual because it needs a naphtha blend instead of finished gasoline due to its higher ethanol standards.
Crude prices also dropped more last week than diesel and gasoline as news of China's coronavirus lockdowns prompted concerns of demand destruction for crude.
Platts cargo assessments for Eastern Mexico rose $ 5.34 to $ 133.85/b for gasoline, $ 6.23 to $ 149.66/b for ULSD and $ 6.03 to $ 146.47 for jet fuel March 21, according to March 21 data from S & P Global Commodity Insights. Similar hikes were seen in Brazil, with Santos ULSD S10 CRF up $ 5.97 to $ 151.02/b and gasoline up $ 5.54 to $ 129.10/b.
The cargoes were mostly priced 15-30 days out, so a large backwardation for distillates tempered their price increases. But import parity prices, designed to reflect the prevailing three days of local prices, rose $ 9.20 to $ 155.64/b for ULSD in Peru, jumped $ 9.39 to $ 149.95/b for ULSD in Colombia, and increased $ 9.41 to $ 157.34/b for ULSD in Santos, S & P Global data showed.
State-owned oil companies continued to cope with high prices by holding back as much as possible on tenders, or canceling or rebidding ones already issued. Petroperú, for instance, awarded Marathon only one out of three cargoes in a light ends tender issued March 14, and reissued the other two cargoes March 21 in a new tender with similar dates and specs, sources said. Marathon was heard to have provided the only offer only for the second cargo of cracked naphtha and HOGBS to be delivered in May.
A source said that two other tenders dating back to early March for two split cargoes of ULSD and jet fuel and for diesel and biodiesel were canceled.
Petroperu had sought one 320,000-barrel cargo of B5-S50 diesel/biodiesel for delivery April 4-8, with offers due March 8. Another tender, due March 4, asked for one cargo of 10,000 barrels of ULSD and 110,000 barrels of jet fuel for delivery for delivery March 15-18.
Sources called it an emergency purchase at the time, but never heard of any award. IPP prices at the time for Peru hit $ 157.70/b for ULSD on March 4, almost equal to current prices, with wide swings up and down since then.
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Ottawa under pressure as CP Rail stoppage enters second day as talks continue | CALGARY — Industry groups that rely on Canadian Pacific Railway Ltd. for the shipment of goods are pleading with the federal government to take action as the work stoppage at the Calgary-based railway continues into its second day.
Leaders of the Canadian Cattlemen's Association and the National Cattle Feeders ' Association were in Ottawa Monday, urging the government to immediately bring an end to the work stoppage they say could devastate their industry.
`` If these trains don't run, we 've got maybe two weeks of feed left, '' said Cattlemen's Association president Bob Lowe, explaining that western Canadian cattle producers have been reliant on shipments of feed by rail from the U.S. this year in the wake of last summer's drought and resultant widespread feed shortage.
`` There is no Plan B. We have no other source of feed. ''
Fertilizer Canada chief executive Karen Proud said the work stoppage couldn't have come at a worse time.
`` We are, in Canada, about four to six weeks from seeding season... which means that farmers may not get all the fertilizer they need, '' Proud said, adding that's particularly concerning this year given the war in Ukraine and its impacts on global fertilizer supplies as well as the prices of wheat and other grains.
`` The concern for the average consumer is, if we're not able to maximize our ( crop) yields... the prices of food are likely going to go up. ''
Industry leaders and politicians are urging Labour Minister Seamus O'Regan to end the labour dispute after 3,000 conductors, engineers and train and yard workers were off the job over the weekend.
The company and union both blamed each other for causing the work stoppage, though both also said they were still talking with federal mediators on Sunday.
Canadian Chamber of Commerce President Perrin Beatty said O'Regan must table back to work legislation immediately. He warned the consequences to the supply chain — already battered by the COVID-19 pandemic and uncertainty in northern Europe — could be severe.
The House of Commons resumed Monday following a two-week break, so legislation could come immediately if the government so chooses.
O'Regan was in Calgary on Monday and said in an emailed statement he will remain there until the two parties reach an agreement.
`` Canadians expect them to do that ASAP, '' O'Regan said in the statement.
This report by The Canadian Press was first published March 21, 2022.
© 2022 The Canadian Press. All rights reserved., source Canadian Press DataFile | business |
Africa’ s Governments Can Do More to Protect Pregnant Students | Help us continue to fight human rights abuses. Please give now to support our work
African Committee Should Press Countries to Respect Girls’ Right to Education
Across Africa each year, tens of thousands of adolescent girls drop out of school or suffer discrimination or exclusion from schools because they are pregnant or have become mothers. Throughout the Covid-19 pandemic, teenage pregnancies have increased in various African countries. Many girls’ futures are at stake and a pan-African response is greatly needed.
The African Union’ s African Committee of Experts on the Rights and Welfare of the Child will convene this week to review compliance with the African child rights treaty of the Republic of the Congo, Eritrea, the Seychelles, and Uganda. All four countries have an obligation under this treaty to protect girls’ right to education and ensure girls who get pregnant can stay in school.
During this session, the African Committee has an important opportunity to review how these countries treat students who are pregnant or are adolescent mothers and whether their laws and policies hinder or protect their access to education.
Over 30 African governments have adopted measures that protect adolescent girls’ right to stay in school during pregnancy and motherhood, but Human Rights Watch has found that the levels of protection and implementation vary. Governments often lack clear guidelines on how these students may continue their education, or have conditional re-entry policies, leading to irregular enforcement.
For example, girls in Uganda are required to go on mandatory maternity leave from school when they are at least three months pregnant. They are only allowed to resume schooling after one year when their child is at least 6 months old, regardless of their personal situation.
Some African countries, such as the Republic of the Congo, do not have explicit protections related to the retention of pregnant girls or adolescent mothers in schools, thus jeopardizing the lives and futures of thousands of girls. Such nations should take affirmative measures to guarantee the right to education for these students, including by adopting human rights-compliant policies to ensure students may remain in school for as long as they choose, and that they are able to resume their education in public schools free from complex processes for withdrawal and re-entry.
All girls have a right to education regardless of their pregnancy or motherhood status. The African Committee session provides a timely opportunity to remind African governments to ensure that this right is protected.
Armed Separatist Attacks on Students, Teachers, and Schools in Cameroon’ s Anglophone Regions | general |
Vaccination against all odds in Brazil - The Lancet Child & Adolescent Health | In a country internationally praised for its effective immunisation logistics, Brazil is lagging when it comes to vaccinating its younger population against COVID-19. A shortage of doses, the proliferation of fake news, the surge of the Omicron variant, and the lack of a strong vaccination campaign by the federal Government have slowed down the pace of vaccination of 5–11 year olds. But despite the obstacles, parents are still lining up to vaccinate their children, say experts.
According to Renato Kfouri, immunologist and director of the Brazilian Society of Immunization, “ many regions of the country suffered with a lack of vaccines [ for children ] during the first 2 weeks of the campaign [ Jan 15–30, 2021 ]. Many children have not been vaccinated not because they reject the vaccine, but rather because they haven't had the chance to get the vaccine ”. Kfouri told The Lancet Child & Adolescent Health that São Paulo, which primarily uses CoronaVac ( produced by Brazil's Butantan Institute), was able to vaccinate almost 60% of those aged 5–11 years, but places like Rio de Janeiro, which rely on Pfizer, have had to halt vaccination at least twice.
In addition to a lack of sufficient doses, mixed signals from some high-ranking government officials have cast doubt on the vaccine's safety and efficacy, keeping some parents from getting their children vaccinated. Brazilian President, Jair Bolsonaro, has appeared as an anti-vaccine champion, proclaiming several times that he will not take the vaccine or vaccinate his 11-year-old daughter.
Bolsonaro and Health Minister Marcelo Queiroga tried to delay the start of the vaccination campaign by suggesting a public consultation period before vaccines started to be administered. When that didn't work, Queiroga stated he would recommend vaccination for 5–11 year-olds only with medical prescription and signed parental consent. Although these ideas were later discarded, they delayed the start of vaccination by almost a month, allowing the spread of a huge amount of fake news about side-effects, such as causing long-term debilitations. By contrast, Kfouri stated that “ there is no reason to imagine that there is any risk to taking the vaccine. This is the result of misinformation, of a denialist Government that did everything it could to avoid vaccinating children. ”
Festivities at the end of 2021 and the easing of COVID-19 restrictions slowed the rate of vaccination, and the Omicron variant surged at the start of 2022. “ We have never had so many cases of hospitalisations for a single disease in the history of this hospital as we are having now with COVID-19 ”, said Victor Horácio de Souza Costa Jr, paediatric infectious disease specialist and director at Pequeno Principe Hospital, Curitiba: Brazil's largest paediatric hospital. According to Costa Jr, there were more hospitalisations of children aged 5–11 years with COVID-19 in January, 2022, than in the whole of 2021.
In these conditions, parents were hesitant to vaccinate their children. “ The surge of the virus in January certainly was a deterrent for parents ”, said Dr Daniella Moore, paediatrician and clinical researcher at Fernandes Figueira Institute, part of Oswaldo Cruz Foundation ( Fiocruz), Rio de Janeiro. Moore told The Lancet Child & Adolescent Health: “ Basic health units were filled with people getting tested for COVID-19 in the same physical space as that used for vaccinating children, so there was a reluctance in taking the children into these units. ” This reluctance, she notes, does not indicate unwillingness. Moore coordinated a vaccine hesitancy study, not yet published, finding that a minority of parents were skeptical about vaccinating their children. The study, dubbed VacinaKids, surveyed 15 297 parents of children aged 0–18 years across Brazil, from Nov 17 to Dec 14, 2021, finding that over 80% of parents want to vaccinate their children against COVID-19, with 13% of parents of children aged 5–11 years showing some hesitation. Moore explained that several factors create this hesitancy. Brazilian media, for example, reported false information released by officials that the vaccine is experimental and could change children's DNA. Most of the parents who showed uncertainty about vaccination were swayed by fake news, Moore said. “ Fake news can end up undermining the trust that the Brazilian population has in the entire immunisation programme. Even the smallest detail can stir fear among parents and is enough to raise more doubts about the vaccine. ”
Adding to this picture, a nationwide survey by Brazil's Datafolha Institute on Jan 12–13, 2021, with 2023 people around the country, found that 79% were in favour of vaccinating children aged 5–11 years, while only 17% were against. Thus, despite the unsupported suspicions raised by government officials and the current slow immunisation rate, experts believe that parents will increasingly allow their children to be vaccinated. “ We have a population that, despite an anti-vaccine president, trusts vaccines ”, said Kfouri, adding that “ this trust in vaccines is cultural and historical. We have a 50-year history of immunisation programmes that have won the trust of the population. ” As of March 13, 2022, over 10·5 million children aged 5–11 years in Brazil had received their first dose, corresponding to 52% of the population in this age group, and over 700 000 ( 4%) had already received their second dose. | tech |
The invasion of Ukraine is making life difficult for right-wing populists | IT WAS THE sort of crowd you might expect on Amsterdam’ s Leidseplein, around the corner from the Bulldog Palace marijuana café. Several dozen demonstrators—awkward young men, middle-aged couples and ageing hippies—turned out on March 13th to support Forum for Democracy ( FvD), a far-right populist party that thinks covid is a hoax and blames Russia’ s invasion of Ukraine on the West. A DJ played electronic dance music atop a trailer festooned with posters of Thierry Baudet, the FvD’ s leader, a dandyish Eurosceptic with a PhD in legal philosophy. The party has five seats in the Netherlands’ 150-seat parliament.
Soon Mr Baudet’ s ally, Willem Engel, a dreadlocked salsa-dance instructor and covid-sceptic internet influencer, took the stage. “ We can not let ourselves get dragged into a war, ” said Mr Engel, denouncing Dutch shipments of anti-tank and anti-aircraft missiles to Ukraine’ s defenders. The media, he said, was whipping up hatred towards Russians just as the Nazis had towards Jews. ( “ Ach, the media ”, tutted a woman in the crowd.)
Almost every Western country has groups like the FvD: nationalist-populist outfits that oppose immigration, Islam, multiculturalism, the EU and UN, gay or transgender rights and liberalism in general, and that warn of an elite globalist conspiracy. In America they are often known as the alt-right, in Europe as the identitarian right. Many have cultivated Vladimir Putin, seeing him as a Christian conservative or at least a fellow opponent of globalism. ( In mid-February Mr Baudet called Mr Putin “ a terrific guy who was so right about NATO aggression, the war-hungry EU, the World Economic Forum and so on ”.) They often have ties to Russian-sponsored think-tanks and get help from Russian state-backed media and internet trolls.
In 2016, the year of the Brexit vote and the election of Donald Trump, history seemed to be going their way. But their fortunes since have been mixed, and the invasion of Ukraine looks like a turning-point. Outrage against Russian aggression puts those who have defended Mr Putin on the back foot. The war has energised the centrist parties with which they compete, and revived enthusiasm for liberal internationalism and the EU. Russian subsidies for think-tanks are drying up. Russian propaganda outlets such as RT and Sputnik have been expelled from some countries and kicked off platforms like YouTube. And nationalist-populist politicians have been forced to choose: find some way to excuse Mr Putin’ s invasion, or condemn it and admit that they were wrong about him.
In Europe the dilemma has been most embarrassing for France’ s Marine Le Pen and Eric Zemmour, and for Italy’ s Matteo Salvini. Mr Salvini, leader of the far-right Northern League party, praised Mr Putin in 2019 as “ one of the best men in government in the world ”. He has tried to redeem himself by supporting Ukrainian refugees, but has failed to condemn the Russian invasion explicitly. On a visit to the Polish border town of Przemysl on March 8th he was humiliated by the mayor, who presented him with a T-shirt featuring Mr Putin—similar to one Mr Salvini wore smilingly in a photo on Red Square in 2014 ( see picture: Mr Salvini is on the right).
Ms Le Pen, who argued that the West should acquiesce to Russia’ s annexation of Crimea and took a €9m ( $ 12m) campaign loan from a Russian bank in 2014, contests a presidential election on April 10th and 24th. The press has grilled her over a campaign pamphlet which features a photo of her shaking hands with Mr Putin. She has condemned Russia’ s invasion, and admits it changed her view of the Russian president, whom she now calls an “ authoritarian ”. That seems to have been, electorally, the right move: Ms Le Pen has remained steady in the polls at about 17%. Mr Zemmour, her farther-right rival, blames the war partly on NATO. His support has dropped abruptly since the invasion, from 15% to 12%. The invasion has bolstered the chances of the incumbent, President Emmanuel Macron. ( He is overwhelmingly likely to win, according to The Economist’ s forecasting model.)
Germany’ s Alternative for Germany ( AfD) party faces an even thornier problem. Its base is in the former East Germany, where voters are more sympathetic to Russia than in the country’ s west. It also draws votes from ethnic Germans who lived in the Soviet Union and came to Germany after its collapse. Most speak Russian and watch Russian state media. Alice Weidel, the leader of the AfD’ s mps, has tried to equivocate, blaming Russia for invading but also the West for suggesting Ukraine could join NATO. She has looked miserably uncomfortable making the argument.
For Mr Putin’ s right-wing friends in western Europe the war is mainly a political problem. For those in central and eastern Europe it is often a practical one: Russia does economic favours for them. Viktor Orban, Hungary’ s president, is a nationalist-populist who, like Mr Putin, claims to defend Christian Europe against a global liberal conspiracy. His takeover of Hungary’ s courts and media is sometimes described as a soft version of Putinism, and he tried to restrain EU sanctions after Russia invaded Crimea in 2014. Mr Orban’ s friendliness towards Mr Putin has secured Hungary discounts on Russian gas and billions of dollars’ worth of loans in a deal to upgrade its Soviet-built nuclear power plant. This, not ideology, is the main reason Mr Orban now opposes EU sanctions on Russian energy, thinks Anton Bendarzsevszkij of the Danube Institute, a government-linked think-tank in Budapest.
In the Balkans, too, Russia’ s ties are deep. Serbia has received Russian backing since the Kosovo war of 1999. It has a hard-right populist government that resembles Mr Putin’ s and signed a deal last year for cheap Russian gas. It has refused to implement sanctions, and its state media repeat baseless Russian propaganda accusing Ukraine of genocide against Russian-speakers. This is a matter of old grudges, says Nermina Kuloglija, a journalist in Sarajevo: nationalists who never accepted that Serbs committed genocide against Bosnian Muslims in the 1990s embrace Russian claims in order to “ accuse the West of double standards ”. But choosing the Russian side in the conflict could wreck Serbia’ s dormant application for EU membership.
As for Mr Putin’ s apologists across the ocean, the war in Ukraine has been a political mess. Mr Trump, who was bizarrely deferential towards the Russian leader during his presidency, at first called his recognition of the independence of the Donbas on February 22nd “ genius ”. That was not well received even by Mr Trump’ s fans. He has gradually altered his tone since the invasion, but still praises Mr Putin as “ smart ”.
In parts of America’ s populist right this still plays well. At a meeting of the far-right America First Political Action Committee on February 26th the crowd chanted Mr Putin’ s name. Alt-right influencers such as Tucker Carlson, a TV host, Candace Owens, a podcaster, and Madison Cawthorn, a freshman Republican congressman, have deflected blame for the war away from Mr Putin and questioned America’ s arms deliveries to Ukraine. Some use Twitter to celebrate the prowess of Russian military technology, or amplify Kremlin propaganda about rising anti-Russian “ racism ” in the West.
But that pits them against most of the right. Republican voters blame the war on Russia just as much as Democrats do, according to several polls this month; they criticise Joe Biden mainly for not giving Ukraine enough weapons. Conservative Republicans are more likely than moderate ones to want to do more for Ukraine. By equivocating over the war, the populists are lending confidence to Republican politicians who have cautiously begun to challenge Mr Trump’ s dominance.
For some nationalist-populists, the war in Ukraine is merely a manageable headache. Mr Orban has stopped boasting of his good relations with Mr Putin and reluctantly accepted EU sanctions. With an election coming up on April 3rd, he is campaigning on keeping Hungary out of the war, saying the country must resist being used as a “ piece on a chessboard ” by the great powers. He has near-total control of Hungary’ s media, so his message seems to be working. Spain’ s Vox party quickly condemned Russia’ s invasion, proclaimed it was eager to welcome Ukrainian refugees ( as opposed to Muslim ones) and attacked the governing left-wing coalition as the real friends of Mr Putin.
For others the war is far afield. Jair Bolsonaro, Brazil’ s populist president, has not suffered much from the odd decision to make his first-ever visit to Moscow in mid-February. He now wants to use sanctions on Russia as an excuse to relax rules on mining. Populists who were adamantly anti-Russian from the start, such as Poland’ s governing Law and Justice party, have done fine, too. Indeed, they may benefit from wartime solidarity: the EU is expected to relax its punishment of Poland over the government’ s attempt to take over the courts.
But Mr Putin’ s invasion has probably put an end to the vision of a global alt-right, with himself among its leaders. Half a decade ago, Americans were worrying that the online propaganda that won Mr Trump the election had been hatched in troll factories in St Petersburg. Western conservative Christians were staging conferences with groups from the state-backed Russian Orthodox Church to fume against “ gender ideology ”. The idea of a unified nationalist-populist movement against Western liberalism, stretching from Moscow via Budapest to Washington, seemed worryingly plausible.
Now it looks fanciful and out-of date. The great majority of American and European conservatives have been horrified by the invasion. Crippled by sanctions, Russia lacks the means to continue its support for the international identitarian right. It had already cut back before the war: Russian-backed think-tanks have been dormant for years. “ There were so many meetings and congresses, but they never came up with anything that would unite them, ” says Anton Shekhovtsov, an expert on Russia and the far right at the Free Russia Foundation.
As for Mr Baudet’ s FvD, it is isolated. The Netherlands’ other nationalist-populist parties have all condemned Russia’ s invasion. Curiously, the FvD was founded, in the far-right’ s banner year of 2016, to promote a Dutch referendum against Ukraine’ s association agreement with the EU. It had already begun to splinter in late 2020: three MPs defected over suspicions that Mr Baudet was becoming a fascist. Of course, the FvD’ s adherents have an explanation for that split, too. “ There was a coup in the party, ” says Mr Engel, directed by agents of the Dutch secret service. It is, he says, part of the military-industrial complex that Dwight Eisenhower warned of. It’ s all part of the script. ■
The following is a transcript of our interview with Ukraine’ s foreign minister. It has been lightly edited for clarity and to remove off-the-record remarks
The following is a transcript of our interview with Ukraine’ s foreign minister. It has been lightly edited for clarity and to remove off-the-record remarks
Published since September 1843 to take part in “ a severe contest between intelligence, which presses forward, and an unworthy, timid ignorance obstructing our progress. ”
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