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Two powerful accounts of Hong Kong’ s protest movements | The Impossible City. By Karen Cheung. Random House; 319 pages; $ 28 and £23
Indelible City. By Louisa Lim. Riverhead Books; 293 pages; $ 28
IN RETROSPECT, SOME calamities quickly assume the inevitability of tragedy. Of course Vladimir Putin could never accept an independent, Western-aligned Ukraine. Of course the Taliban would triumph in Afghanistan; just glance at the history of foreign involvement there. And, more certain still, of course China’ s Communist rulers would never tolerate a free, open, democratising city in a southern corner of their country. “ One country, two systems ” —the simple Sino-British formula under which Hong Kong would remain politically distinct from the rest of China for 50 years from 1997, when Beijing resumed the exercise of sovereignty—was always doomed.
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But nobody told Hong Kong. After all, it was supposed not to care. Many outsiders swallowed China’ s habitual line that Hong Kong was an “ economic ” city, a place of business that was not concerned with politics. Yet the generation that has grown up since 1997 has always posed and faced an awkward question that Karen Cheung formulates at the beginning of “ The Impossible City ”, her fine new book: “ Why are we not the ambivalent, apolitical generation that our leaders want us to be? ” Every few years since 2003, the territory has seen huge protests, building up to the occupation of parts of the city centre in the “ umbrella ” movement of 2014, and what amounted to an abortive insurrection in 2019. Whether to take part was a decision that Hong Kong’ s people could not dodge.
Ms Cheung and Louisa Lim, author of the equally good ( and similarly titled) “ Indelible City ”, both grew up in Hong Kong. Both occupy what Ms Cheung calls the “ liminal space of being local enough to write stories that white writers can’ t and ‘ international’ enough to write about Hong Kong for overseas readers ”. And both offer illuminating accounts of how the city descended into the mass street unrest of 2019, as demonstrators agitated for a more representative political system, and of the pandemic-abetted repression that has crushed protest since. Tear-gas, water cannons and police batons eventually cleared the streets. Covid-19 kept them empty.
Their perspectives are very different. Ms Lim is a journalist-turned-academic, who long covered China and Hong Kong for the BBC and National Public Radio; her previous book told of the Chinese Communist Party’ s efforts to erase the memory of the protest movement that roiled China in 1989 and its bloody suppression. She writes mostly as a coolly objective observer, but opens with an account of crossing the line into activism, on September 30th 2019, the eve of a big protest to mark China’ s National Day. On the roof of a skyscraper, she finds herself “ painting expletive-laden Chinese characters onto a protest banner eight storeys high, and wondering if I had just killed my career in journalism ”.
Though dominated by events since 1997, “ Indelible City ” also attempts a revisionist telling of Hong Kong’ s history. This challenges both the traditional Western view that it was nothing but a “ barren rock ” until British opium traders found a use for it, and the Chinese version: that it has been an integral part of the Chinese polity since time immemorial. Rather, in the past Hong Kong was “ a sanctuary for rebels and fugitives from central power ” and a haven for free-thinking.
Ms Lim describes Hong Kong people’ s efforts to rebuild a link with this past, including through the resurrection of an indigenous creation myth about the Lo Ting, fish-headed mermen who had come to Hong Kong’ s Lantau island in the fifth century, after a failed rebellion against the imperial dynasty. The character who gives her book its name is Tsang Tsou Choi, who died in 2007 and left behind a vast body of graffiti over public spaces in Hong Kong—much of it supporting his eccentric claim to be the king of Kowloon, the peninsula opposite Hong Kong island.
For those brought up in Hong Kong, questions of identity were unavoidable and virtually impossible to answer. Almost uniquely among colonised peoples, they were never offered independence. In 1972, shortly after it joined the United Nations, China asked the decolonisation committee to remove Hong Kong from its list of colonial territories, and Britain, as became customary in its treatment of its colony, connived in this implicit condemnation of Hong Kong to eventual Chinese rule. Ms Lim quotes an early British governor, from 1858, who pithily summed up the ethos of British sovereignty: “ We rule them in ignorance, and they submit in blindness. ”
So Hong Kongers, a term that, for her part, Ms Cheung says she has never heard anyone apply to themselves, “ defined themselves in negatives—not Communist, no longer colonial subjects ”. Her book, like Ms Lim’ s, shows how they did acquire a sense of identity. Sadly, it was still couched in the negative: in the thwarted struggle against the gradual erosion of their civil liberties under Chinese sovereignty—and the repeated frustration of their demands for a representative political system.
Like Ms Lim, Ms Cheung is a leading character in her book as well as its narrator. Hers is more personal, building up a sense of a unique Hong Kong identity through an account of her own life and interests and immersion in the local indie-music scene. A journalist for various outlets, still in her 20s, she complains of some foreign editors: “ It’ s best if our family stories are somehow representative of the rest of the Hong Kong population…They want your life stories, not your opinions. ”
Indeed. But her story is also Hong Kong’ s. The painful struggle with depression that she recounts becomes emblematic of a stunted generation living on the edge of desperation. She notes that between 2012 and 2016 the suicide rate among students jumped by 76%.
Both these books were largely written before the pandemic further cut off Hong Kong from the rest of the world—a shared isolation that has seemed more acute this year, as first Hong Kong and then parts of the mainland suffered widespread outbreaks of the Omicron variant. The joint pursuit with China of a zero-covid policy has been among the most powerful symbols of where Hong Kong’ s future lies. That future may indeed have been inevitable, but it has rarely looked so grim. ■
The crops can be delicious. But that is not the real point
The crops can be delicious. But that is not the real point
Published since September 1843 to take part in “ a severe contest between intelligence, which presses forward, and an unworthy, timid ignorance obstructing our progress. ”
Copyright © The Economist Newspaper Limited 2022. All rights reserved. | business |
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Backyard tourism continues to dominate as predicted — most Europeans will stick even closer to home this year. But their increased preference for air travel versus train, according to the report, is concerning and comes just as the European Union aims to crack down on emissions.
Lebawit Lily Girma
Leisure travel plans among European residents has hit an all-time high since the global pandemic. Three out of four Europeans now say they are gearing up to travel either regionally or domestically between the spring and summer seasons this year — undeterred by the war in Ukraine, Covid surges or increased cost of living. That’ s 77 percent of Europeans compared to 67 percent last summer.
More than half also plan to visit another European country, while 30 percent will stick closer to home and explore within their country’ s borders.
Those are the latest results from the European Travel Commission’ s monthly survey gauging travel sentiment for domestic and intra-European travel in Europe’ s top ten European source markets, including Germany, United Kingdom, France, Netherlands, Italy, Belgium, Switzerland, Spain, Poland and Austria.
“ European confidence in travelling is growing now that COVID-19 has largely become a fact of life, ” said Luis Araújo, president of the European Travel Commission. “ ETC is pleased to see that in spite of these uncertainties, appetite for travel is still on the rise and the European tourism sector remains resilient. ”
The survey ran during the second and third weeks of the Ukraine war, a sign that neither the ongoing pandemic nor conflict in Europe has impacted Europeans’ decision to travel as much as might have been expected. It also confirms what airlines have anticipated will be a busy summer with plans to fly only one percent less capacity in Europe in this upcoming third quarter compared to 2019.
Still, just one in four Europeans have fully booked their next trip, which the report indicates could point to some level of impact from the war casting uncertainty over the future. Last-minute bookings might increase as a result.
Western and southern Europe beach favorites continue to top the favorites’ list, with Spain, Italy and France among the most in demand. Croatia and Turkey, however, still rank in the top ten as interest in Eastern European destinations remains nearly the same as a year ago.
Family travel is dominating the demand as opposed to solo or couple travel, according to the survey, with boomers leading the way when it comes to intent to travel — at 83 percent — surpassing travel interest from Gen Z at 69 percent.
The most concerning data from this latest sentiment survey is that Europeans’ demand for air travel has increased by seven percent compared to an earlier survey from December 2021, while their interest in train and bus travel has decreased to a record low since August 2020.
Concerned that this will mean Europe’ s tourism transportation emissions increasing for the first time since 2019, the European Travel Commission’ s report recommends that destinations mitigate environmental impacts this upcoming peak season by finding ways to cooperate with rail companies and promoting alternatives to air travel for domestic visitors and those from neighboring countries. | general |
U.S. inflation quickens to 8.5%, ratcheting up pressure on Fed | The information you requested is not available at this time, please check back again soon.
U.S. consumer prices rose in March by the most since late 1981, underscoring the painfully high cost of living and reinforcing pressure on the Federal Reserve to raise interest rates even more aggressively.
The consumer price index increased 8.5 per cent from a year earlier following a 7.9 per cent annual gain in February, Labor Department data showed Tuesday. The widely followed inflation gauge rose 1.2 per cent from a month earlier, the biggest gain since 2005.
Gasoline costs drove half of the monthly increase, while food was also a sizable contributor, as Americans paid more for vegetables, meats and dairy products.
Excluding volatile food and energy components, so-called core prices increased 0.3 per cent from a month earlier and 6.5 per cent from a year ago, due in large part to the biggest drop in used vehicle prices since 1969 and a deceleration in price growth in other merchandise categories.
Treasuries rose and the dollar erased an earlier advance to weaken after the data showed core inflation rose less than forecast. The S & P 500 index opened higher.
Used car prices, which had been a driver of higher goods inflation for months, were down 3.8 per cent in March, the second straight monthly decline. New car prices, meanwhile, rose slightly.
The figures are “ a welcome respite from the sustained heated core increases of late, and fuel costs look to ease in response to the recent pullback in oil prices, ” Sal Guatieri, senior economist at BMO Capital Markets, said in a note.
“ However, food, rent, and a few other items look to remain troublesome and act to slow the expected retreat in inflation in the year ahead. ”
The March CPI reading represents what many economists expect to be the peak of the current inflationary period, capturing the impact of soaring food and energy prices after Russia’ s invasion of Ukraine.
While the Fed has opened the door for a half-percentage point increase in interest rates, inflation isn’ t likely to recede to the central bank’ s 2 per cent goal anytime soon -- especially given the war, COVID-19 lockdowns in China and greater demand for services like travel.
“ Slower core-goods inflation is partly offset by higher services inflation, underscoring the challenge the Fed faces in taming price pressures even if supply and demand in the goods sector were to balance. The Fed needs to hike rates expeditiously, but if goods demand continues to cool they may not need to hike as aggressively as the market -- now pricing in almost three 50-bps rate hikes this year -- currently expects. ”
President Joe Biden has come under fire for failing to rein in prices as Americans pay up for fuel and groceries. Inflation more broadly will complicate Democrats’ efforts to maintain their tight congressional margins in midterm elections later this year.
At the same time, risks that inflation will tip the economy into recession are building. A growing chorus of economists predict that activity will contract either because consumer spending declines in response to higher prices, or the Fed will over-correct in its effort to catch up. However, the majority still expects the economy to grow.
The report showed goods inflation stayed elevated, while services continued to advance. On a year-over-year basis, goods inflation excluding food, energy and used vehicles rose 8.1 per cent in March, the most since 1981. Food prices rose 1 per cent from February.
Prices for household furnishings and supplies rose 1 per cent from February after outsize gains in recent months. The index for furnishings and operations jumped 10.1 per cent from a year earlier, the most since 1975.
Services costs increased 5.1 per cent from a year ago, the biggest advance since 1991. Airline fares rose a record 10.7 per cent in March from a month earlier. Shelter costs, which include rents and hotel stays, rose 0.5 per cent for a second month.
The war in Ukraine, which started in late February, led to a spike in energy prices on fears that cutting off Russian oil and gas would stretch already-tight supply. The CPI report showed that energy prices rose 11 per cent in March from the prior month, the most since 2005, while gasoline prices jumped 18.3 per cent, the largest gain since 2009.
That said, gas prices have started to decline in recent weeks, in part because of sinking demand in China where several major cities are under strict COVID lockdowns. If sustained, the drop suggests that energy prices will have less of an impact on inflation in April.
Even so, inflation is projected to stay near 6 per cent by the end of the year, which will keep pressure on the Fed Chair Jerome Powell and his colleagues. The central bank is expected to hike interest rates by a half-point at its next policy meeting in May -- and possibly at one or more meetings after that -- while moving forward on plans to reduce its balance sheet.
Americans are also struggling because wages aren’ t keeping up with inflation, even as employers boost pay to attract and retain workers. Inflation-adjusted average hourly earnings dropped 2.7 per cent in March from a year earlier, the 12th straight decline, separate data showed Tuesday. | general |
Immunologists unravel battle plans of deadly coronaviruses -- ScienceDaily | The immunologists, led by Dr Nigel Stevenson, Assistant Professor in Viral Immunology at Trinity, have discovered how SARS and MERS proteins block the induction of antiviral proteins, which prevents us from mounting a strong innate immune response against infection.
The coronaviruses SARS and MERS emerged in 2002 and 2012, respectively. Both had higher fatality rates than COVID-19 ( around 10% and 40%, respectively), but both infected far fewer people ( around 10,000 and 3,000, respectively).
Although different, these two coronaviruses bear many similarities to SARS-COV-2 ( COVID-19), and thus drawing up blueprints of their battle plans provides insights with the potential to provide new therapeutic options for treating COVID-19 and future deadly coronaviruses that have yet to emerge.
Dr Stevenson and his team discovered that SARS and MERS viruses have proteins that essentially throw a spanner in the works of the Interferon antiviral pathway, which -- under normal circumstances -- activates a cascade of responses in human cells, to produce hundreds of antiviral proteins that block viral replication.
Dr Nigel Stevenson, Head of the Viral Immunology team in the School of Biochemistry and Immunology, is based in the Trinity Biomedical Sciences Institute ( TBSI). He is the senior author of a 2022 research article, which has just been published in the Journal, Viruses. He said:
`` Over time, humans have evolved to fight viral infections by producing molecules called Interferons. When a virus is encountered Interferons are produced, which, in turn, activates an antiviral pathway in our cells that is at the heart of our immediate immune response. The pathway produces specific proteins that switch hundreds of our anti-viral genes on. These genes then produce lots of different antiviral proteins that attack -- and in most cases -- kill the virus. In doing so, Interferons 'interfere ' with a virus ' life cycle. ''
`` However, viruses have also evolved over time to suppress and avoid our immune system responses. And our research aims to understand how viruses suppress the response to Interferons. Our current research has discovered that SARS and MERS prevent key proteins from being activated and entering the nucleus in our cells. The nucleus is where our DNA is stored and where genes are switched on, to generate a proper immune response.
`` The hope is that if we can design new drugs to inhibit the ability of coronaviruses to suppress the Interferon pathway, we should be able to treat people far more effectively. And given the similarity in coronaviruses and their modes of action, such a drug would likely prove effective against all the deadly coronaviruses. ''
Dr Stevenson added:
`` Therapeutic Interferon is a drug used to fight certain infections, but it has never proved very effective against coronaviruses. Now we think we know why -- if the Interferon pathway is essentially disabled, it can't stimulate a response.
`` If we could restore the natural ability of our immune systems to fight viral infection and prevent viral replication, we could treat infected people with much greater success. In addition, if we could develop a therapeutic that stop viruses from destroying the Interferon pathway, it would in theory open the door to directly attacking the virus. ''
First author on the research article is Yamei Zhang, who previously spent research time with Dr Stevenson's collaborators in Hong Kong University. She and Dr Stevenson were working on this research before SARS-CoV-2 emerged and the COVID-19 pandemic developed.
The work was funded by Science Foundation Ireland and the China Scholarship Council. A copy of the journal article is available on request. | science |
uk business TFG Hub | Your Monday morning coffee briefing from TFG. Stagflation: Over 80% of US and UK businesses have been hit by increased costs due to inflation. The Bank of England’ s ( BoE) chief economist backs the case for raising interest rates, and the BoE warns that a CBDC could reduce commercial bank despotis by 20%. The U-shaped recovery – ICISA’ s Richard Wulff discusses trade credit insurance and its bounce back from the pandemic. Dr. Joanna Burch-Brown explores the EU taxonomy and the ethics of green finance. And European gas shortages are expected to push up fertiliser costs and food prices.
18 March 2021: Private sector action to reverse the loss of biodiversity is “ absolutely fundamental ” to the UK’ s post-pandemic economic recovery, a new cross-business forum will warn today.
Plain sailing ahead for UK freeports? Probably not. TFG’ s McKenzie summarises the key points from the UK budget and what it means for trade.
COVID-19 has dominated the headlines for the last few months. But now, with the negotiations stepping up and the transition set to end by December, Brexit is moving back into the limelight. | general |
Financial literacy is low across all generations -- the school of hard knocks is failing | Experience may be the best teacher in other walks of life, but not when it comes to retirement investing.
In fact, according to a just-released study, experience counts for surprisingly little. When it comes to a working knowledge of finance, those with decades more experience are only slightly more literate than those in their 20s. Those with the most experience still are able to answer barely half of a couple dozen basic financial literacy questions.
That’ s the finding of
the new study from TIAA Institute and George Washington University’ s Global Financial Literacy Excellence Center ( GFLEC)
. The authors of the study are Paul Yakoboski, a senior economist with the TIAA Institute; Annamaria Lusardi, a professor economics and accountancy at GWU and the founder and director of GFLEC; and Andrea Hasler, a professor in financial literacy at GFLEC.
Take
MarketWatch’ s financial literacy quiz
— will you get a 10/10?
The survey they conducted this year represents the sixth year in a row in which the researchers have measured U.S. adults’ financial literacy. They did so by sending respondents a detailed survey with 28 questions testing their working knowledge of common financial situations—on issues ranging from saving, investing and borrowing to insurance and comprehending risk. The researchers distilled the answers into a single index—which they refer to as the P-Fin Index—which reflects the average percentage of questions that are answered correctly.
Read:
This man is on a mission to bring personal finance classes to all high schools. Here’ s the No. 1 lesson he says everyone should know
The latest P-Fin Index is 50%, which means that, on average, U.S. adults were able to correctly answer only 50% of the index questions. The P-Fin Index has remained remarkably steady since 2017, when it was 49%. It got as high as 52% in 2020. In an interview, Professor Hasler said that these variations in the yearly values of the P-Fin Index are not statistically significant, which means that the average level of financial literacy today is indistinguishable from where it stood in 2017.
Can it really be true our financial literacy hasn’ t improved over the last six years?
Experience a poor teacher
While this depressing result hints at the poor job that experience does in teaching financial literacy, another of the researchers’ results makes this conclusion even stronger. Upon calculating each generation’ s average P-Fin Index values, they found that the oldest adults did only marginally better than the youngest ones.
These results are summarized in the accompanying chart. On average, those in Generation Z had P-Fin Index values of 42%. This number grows with each older generation, but for the oldest generation is still only 54%. Those with the most experience still were unable to answer nearly half of the financial literacy questions.
In other words, a lifetime of learning from financial missteps increases the number of correct answers on the test by just three, on average—from 12 to 15. And note that, even if the oldest generation were able to answer all of the 28 financial literacy questions, it’ s still not clear that it would make much of a difference to their retirement financial security. That’ s because they needed that literacy the most early in their careers.
If experience is such a poor and inadequate teacher, what is the solution?
Professor Hasler says there is “ no way around financial education. ” Indeed, she and her co-researchers consider their results to be a loud and clear “ call to action. ”
Understanding risk and uncertainty
The need for financial education is particularly acute when it comes to correctly assessing risk and uncertainty, she added. Such an understanding is crucial to making wise decisions that will impact your lifetime financial security—and especially your retirement. But the researchers found that not only was this the subject area in which the average U.S. adult had the least financial literacy, their literacy has gone down in recent years.
In the 2017 P-Fin Index survey, U.S. adults on average correctly answered just 39% of the questions relating to comprehending risk. In this latest survey, it had fallen to 36% –a statistically significant decline, Professor Hasler said.
( The survey questions are proprietary, but at the end of this column I reproduce a risk-and-uncertainty question the authors included in the 2021 survey. I’ m sure all readers of this column will get the right answer.)
Though the researchers did not collect data on what might have caused this decline in the already-low financial literacy about risk and uncertainty, my suspicion is that a big culprit was the financial markets’ strength in the wake of the COVID-19 pandemic. It would have hardly been surprising for that pandemic and associated economic lockdowns to cause the stock market to enter an extended and punishing bear market. Yet far from causing that, the stock market enjoyed one of its strongest bull market runs in history.
No wonder investors are more confused than ever about risk!
The bottom line? Educate yourself. Consult with a qualified financial planner if you have to. Assume you don’ t know all the answers, since you probably don’ t.
Example of a risk-and-uncertainty question the P-Fin Index survey asked
Which of the following indicates the highest probability of getting a particular disease?
There is a one-in-twenty chance of getting the disease
2% of the population will get the disease
25 out of every 1,000 people will get the disease
Don’ t know
The answer, of course, is the first option. Yet, according to the researchers, only 28% of respondents got it right. That’ s sobering: If we can’ t get this simple question right, it’ s hard to imagine how we can make sound and wise financial decisions impacting our lifetime financial security.
Mark Hulbert is a regular contributor to MarketWatch. His Hulbert Ratings tracks investment newsletters that pay a flat fee to be audited. He can be reached at
mark @ hulbertratings.com
.
Now read:
To boost retirement accounts, talk of saving pennies of every dollar, not a percentage of wages
Also read MarketWatch’ s “ How to Invest ” series | business |
Can ocean-based CO₂ removal deliver on our climate goals? | The ocean has enormous – and largely untapped – potential to cycle and sequester excess atmospheric carbon through processes like seaweed cultivation. So how can stakeholders tap into this potential to scale CO₂ removal efforts and deliver climate wins?
“ At the end of the day, carbon dioxide removal is ocean conservation, ” Brad Ack, chief innovation officer of Ocean Visions told delegates at the recent World Ocean Summit. Ack, who transitioned to ocean biodiversity conservation mid-career, explained that though we’ re in a global race to preserve marine ecosystems, we’ ve been outpaced by the larger changes in the climate.
Surplus carbon dioxide is heavily concentrated in the upper layer of the ocean. This additional CO₂ contributes to excess heat that is driving marine heatwaves, changes in ocean currents, species migration and ocean acidification. Ack told delegates that the body of heat is roughly equivalent to five atomic bombs worth of heat going into the ocean every second.
In his estimation, the oceans have suffered some of the most egregious damage to the biosphere from excess CO₂. If left unchecked, these shifts in the ocean environment could lead an ecologic and economic cataclysm. For those in the aquaculture industry, it could mean trying to produce fish, crustaceans, molluscs and macroalgae in an increasingly hostile environment. For coastal populations in the Global South, changes in the ocean environment have dire implications for food security and local infrastructure.
The ocean is a critical part of the climate. The ocean crisis and the climate crisis are one and the same thing. They’ re simply two sides of the same coin.
“ The ocean is a critical part of the climate. The ocean crisis and the climate crisis are one and the same thing. They’ re simply two sides of the same coin, ” Ack told Oliver Morton, The Economist’ s briefings editor.
Ack explained that humans have put about 30 percent of this excess carbon into the ocean and that these changes will only continue as greenhouse gas ( GHG) concentrations continue to rise. At this point, reducing overall concentrations of GHGs is essential and learning how the ocean can help reduce atmospheric carbon is the next practical step.
Ack explained that the ocean stores 50 times more carbon in bicarbonate and carbonate forms – like shellfish, seagrasses and seaweeds – in the bottom of the sea than what’ s in the atmosphere today. This means that with minor tweaks that lead to increases in overall carbon storage, the ocean can make a huge dent in our collective carbon removal efforts.
© Harald Bjorgvin, Ocean Rainforest
Broadly speaking, the ocean cycles carbon in two patterns. One is chemical – where ocean water interacts with alkaline material to make it less acidic. Over millennia, these geologic processes allow the ocean to store carbon in safe forms in the benthic zone.
The other form of carbon cycling is biological – where photosynthetic organisms like microalgae, seaweed and mangroves capture carbon and keep it at the bottom of the sea. If carbon is stored in the seabed, it will remain inert and no longer contribute to global warming.
Of these pathways, the research community still doesn’ t know which ones will be the most successful – or the least harmful. Ack and other ocean stakeholders need additional research and development, with multiple replicates to answer the question. He also stresses that those potential solutions need to be tested in different marine environments to ensure they cycle as much carbon as possible.
“ [ Think about it as an ] antacid for an ocean that is in severe distress, ” Ack responded when asked about specific de-carbonising methods. “ We’ ve put all this acid into the ocean – that’ s what CO₂ is, it makes the ocean more acidic – we’ ve got a very upset ocean, [ so an ] antacid could possibly help to reverse that acidification problem. ”
© Offshore Shellfish
Though this might conjure images of ships dumping quicklime into the sea, Ack assured the audience that this wasn’ t what he had in mind. His startup, Ocean Visions, is working on “ roadmaps ” that outline key technologies and strategies to de-acidify and de-carbonise the ocean. When it comes to enhancing ocean alkalinity, seaweed cultivation is emerging as a viable strategy – but Ack stressed that more research and development ( R & D) was needed before he could give macroalgae production a full-throated endorsement.
He told Morton that Ocean Visions was convening global experts in technology pathways, ocean health and marine policy to assess the current de-carbonising approaches and outline the critical priorities for advancing our knowledge. Ideally, this would enable additional R & D that would lead to a credible governance framework for carbon removal. As part of this, he called for credible, verifiable and regulated carbon removal standards. “ We’ ve got to move beyond the hodgepodge of the voluntary carbon market that we see around the world, ” Ack said.
He likened the rapid scaling of R & D efforts to the world’ s approach to the Covid-19 pandemic in 2020. The monumental push and global cooperation on vaccine research, novel therapies and drug treatments stands out as a key bright spot in the crisis. The world is currently in a race against dangerous climate change and – in Ack’ s view – would benefit from similar urgency.
© Thierry Chopin
The ocean’ s ability to store and potentially sequester carbon presents a wealth of opportunities, but it also comes with an uncomfortable undercurrent. Given its capacity store carbon and regulate the climate, is harnessing this potential giving bad actors a way to skirt the hard work of cutting their GHG emissions?
“ I used to worry about that, ” Ack began, “ but then I watched for decades as we didn’ t give people that easy out and they continued to spew carbon into the atmosphere. ”
He has a point – advocates have been pushing political agreements to reduce CO₂ emissions for the last 40 years, yet global emissions keep increasing. “ To not talk about climate impacts and what we can do about them, to me, seems to be missing a very large part of the needed agenda, ” he said.
Instead, Ack says tells stakeholders to flip the moral hazard argument on its head. The hazard is not taking action to reverse the enormous damage we’ ve done to the planet. Talking about carbon removal isn’ t enabling polluters, it only prevents us from acting when we have the chance.
© Umitron
Ack believes that rapidly scaling the R & D effort is a necessary first step. Ocean Visions is currently accepting proposals for science on ocean alkalinity enhancement – a $ 10 million funding opportunity that hopes to identify approaches that safely, permanently and cost-effectively sequester atmospheric carbon at scale. Ack stressed that Ocean Visions isn’ t advocating for any specific decarbonisation strategy at present. “ We don’ t know enough yet to deploy them, ” he explained, but he wants to get the best minds together to make progress on the issue.
Ack also acknowledged that the existing governance structure for international waters might need to be re-assessed if ocean CO₂ removal gains traction. Contributions from maritime industries like aquaculture will be essential for testing and verifying de-carbonisation strategies. The existing laws that govern what individuals can do in international waters – the London Convention – might need expanded language around research to make inroads in this area.
We have randomly engineered the planet to within the brink of disaster by pouring every waste product we’ ve created into the biosphere. Now it’ s going to take conscious intervention [ and ] conscious engineering to get ourselves out of this.
Ack and Morton both agreed that the potential in the space is enormous. If the oceans can be effectively harnessed for CO₂ removal, we can collectively benefit from a healthier marine environment that sequesters atmospheric carbon while shoring up global food security. However, the best strategies to unlock the ocean’ s potential are unknown. Seaweed growers and blue carbon advocates still have a long way to go before they can be deployed as climate mitigation solutions.
“ There are no free lunches at this point in the pollution of our planet, ” Ack said. “ We have randomly engineered the planet to within the brink of disaster by pouring every waste product we’ ve created into the biosphere. Now it’ s going to take conscious intervention [ and ] conscious engineering to get ourselves out of this, ” he concluded.
The Economist World Ocean Summit was held from 1 to 4 March.
Megan Howell first started writing about aquaculture in 2019 as part of the editorial team at 5m Publishing and The Fish Site. She has a MSc in applied research methods from Trinity College Dublin. She currently lives and works in Ireland.
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ICC TFG Hub - Page 3 of 5 | The pandemic has undoubtedly had countless negative implications for the global community. However, amidst all the turmoil there have been some silver linings.
Your Monday morning coffee briefing from TFG. In the UK, over 40% of the population have received at least one vaccine dose. This compares to the US ( 24%), Italy ( 9%), Spain ( 9%) and France ( 9%). The UK government borrowed £19.1bn last month, the highest February borrowing since records began in 1993. Debt rose to £2.13tn, and consumer confidence rose to its highest level since last March.
Your Monday morning coffee briefing from TFG. The OECD upgraded its forecasts for global growth this year, mainly due to the sizeable $ 1.9t stimulus in the US. UK exports to the EU fell by a record 40.7% in January following the end of the post-Brexit transition period.
GSCFF updated its Standard Definitions for the Corporate Payment Undertaking ( CPU), Dynamic Discounting ( DD) and Bank Payment Undertaking ( BPU).
A commentary and foreword by ICC’ s Secretary General John W.H. Denton AO and WTO’ s Deputy Director-General Xiaozhun Yi, following the launch of WTO and TFG’ s 2020 Blockchain for Trade publication.
Distributed Ledger Technology ( DLT), colloquially termed ‘ blockchain’ has been touted to disrupt trade and supply chain, as well it’ s financing, for over 5 years. Following on from TFG, WTO and ICC’ s ‘ Periodic Table’ enlisting 39 projects in global trade utilising DLT, we’ ve relaunched our table, indicating that the industry has considerably matured and evolved in less than 12 months.
Having an understanding of the types of LC availability, and the differences between them, will help the beneficiary formulate the terms of the letters of credit that it would be willing to accept, and to mention such terms in their discussions and sales contracts with their clients. TFG heard from former Head of Product Management Asia, Trade Services and Finance, Société Générale, Tat-Yeen Yap.
The only way to make Trade Finance standardisation and harmonisation opportunity to realise is to make the needed standards coordination and development resources openly available for the business process and systems developers.
Your Monday morning coffee briefing from TFG.Almost half of all Covid-19 cases reported so far were from just three countries: the US, Brazil and India. Wearing masks became compulsory in UK shops and other enclosed public spaces. EU leaders agreed to create a €750bn EU recovery fund to support member states worst hit by COVID-19.
The ICC’ s Survey on Trade Finance reveals the industry-wide challenges and disruption as a result of the COVID-19 pandemic push trade and trade finance into a state of global uncertainty.
In the UK Boris Johnson announced a further loosening of lockdown restrictions, reopening most remaining leisure facilities and dropping advice that public transport should be used for essential journeys only.
Only through collaboration and interoperability with other key technologies like AI, RPA, and the IoT will the path of consortia be effective in making trade finance truly digital.
TFG heard from ICC’ s Secretary General John Denton and talked about actions needed from governments, private sector leaders and international institutions to ensure the continued viability of our MSMEs. | general |
Catherine Prasifka's debut and its inevitable comparisons to her sister-in-law Sally Rooney | Catherine Prasifka, author of None of This Is Serious. Picture: Joanna O Malley
In Catherine Prasifka’ s debut novel, the main character Sophie is at a party one night when a vast purple crack opens up in the sky. She and her friends reach for their smartphones, taking pictures and scrolling through their social media feeds to figure out what is happening. The apocalypse may be looming but life goes on.
This urge to find answers in our smartphone while simultaneously feeling completely powerless will echo with many people at the moment as the relentlessly grim news cycle moves from pandemic to war, with Covid still hovering in the background and the ever-present threat of climate change. It is a theme that was also tackled recently by the movie Don’ t Look Up — how we stare at our screens while the world burns.
“ It was quite funny when that came out, '' says Prasifka. `` When I was watching it, I was like, ‘ shit’. But I do think we approach the issues in a different way. In that film, people with the knowledge are trying to communicate it to others, whereas in my book, it is very much like, you are an individual as the apocalypse is happening around you and you know nothing. ”
The 26-year-old Dubliner says she wanted to attempt to capture the often overwhelming nature of life online, especially for younger people who have never known a world without the internet or social media.
“ There is a lot going on in the book, but that is just life. Often, when you are representing things in fiction, you go, okay, I don’ t want to overwhelm the reader, I am going to take a very narrow look at something but that is not my experience of being a young person on the internet, where you are just constantly scrolling through… it’ s like dog meme, dog meme, wildfires, war. ”
In the book, 22-year-old Sophie has just graduated from college and is flailing somewhat as her friends find partners and plan their careers. Like her main character, Prasifka had just finished college — she did English at Trinity College, Dublin, and a masters at the University of Glasgow — when she began writing None Of This Is Serious. Her future was uncertain to begin with, then the pandemic happened. | general |
Asos sinks to loss and reveals £14m expected hit from quitting Russia | Online fashion giant Asos has said it expects to take a £14 million hit from its decision to stop selling clothes in Russia, in response to the country’ s invasion of Ukraine.
The prediction comes as the retailer said it sank to a pre-tax loss for the six months to the end of February, spending heavily on an overhaul to win over more customers longer term.
Bosses said they saw a marked slowdown in sales during the period as the benefits from the Covid-19 pandemic eased with shoppers able to head back to high streets.
Sales still rose by 1% to £2 billion in the six month period but a £106.4 million pre-tax profit in 2021 turned to a £15.8 million pre-tax loss for the six months to the end of February.
| general |
Numinus to Acquire Novamind, Creating the North American Industry Leader in Psychedelic Therapy and Research | PR Newswire
VANCOUVER, BC and TORONTO, April 12, 2022
VANCOUVER, BC and TORONTO, April 12, 2022 /PRNewswire/ - Numinus Wellness Inc. ( `` Numinus '', the `` Company '') ( TSX: NUMI) ( OTCQX: NUMIF) and Novamind Inc. ( `` Novamind '') ( CSE: NM) ( OTCQB: NVMDF) ( FSE: HN2), are pleased to announce that they have entered into a definitive arrangement agreement ( the `` Agreement '') pursuant to which Numinus will acquire all of the issued and outstanding common shares of Novamind ( the `` Novamind Shares '') in an all-share transaction, by way of a court-approved plan of arrangement, for total consideration of approximately C $ 26.2 million on a fully diluted in-the-money basis ( the `` Transaction '').
Following the Transaction, the combined company will operate 13 wellness clinics and will be positioned as a leading psychedelic-assisted therapy provider in North America, leading its peer group in revenue with approximately C $ 10 million in annual pro-forma revenue based on the trailing four quarters.
`` Since Numinus began, we have always strived to be the most trusted, evidence-based leader in psychedelic-assisted therapy and medicine. The Novamind acquisition presents a transformational opportunity for Numinus to launch a strong U.S. platform through eight established, reputable, efficiently operating and revenue-producing clinics, '' says Payton Nyquvest, Founder and CEO, Numinus. `` We prioritize working with the best partners in this industry and Novamind's U.S. market presence, complementary client programming and respected clinical research capabilities allow us to accelerate our strategic growth plans and broaden access to healing and wellness. ''
Mr. Nyquvest continued: `` We expect this acquisition will significantly bolster our financial performance, growing Numinus ' annual revenue to more than five times our current levels, and driving meaningful margin improvement through identified operating efficiencies. Our combined capabilities will deliver exceptional value for our clients, employees, and shareholders. We look forward to welcoming the Novamind team to the Numinus family. ''
Yaron Conforti, CEO and Co-Founder, Novamind, said, `` This transaction offers significant value for Novamind's shareholders and provides compelling new opportunities for our employees, patients and research partners. The combination of Novamind's network of mental health clinics and research sites in the U.S. and Numinus ' leadership in psychedelic-assisted psychotherapy in Canada creates a best-in-class company. The combined entity is supported with over C $ 50 million in pro-forma capital and positioned with distinct capabilities to serve a growing and diverse group of stakeholders. We are excited to join Numinus, a true leader in mental health innovation. ''
Proposed Transaction
Under the terms of the Agreement, shareholders of Novamind ( `` Novamind Shareholders '') will receive 0.84 of a common share of Numinus ( the `` Exchange Ratio '') for each Novamind share held, implying an offer price of $ 0.44 per Novamind Share. The offer price represents a premium of 51% to Novamind's 20-day volume-weighted average price ( `` VWAP '') on the Canadian Securities Exchange ( the `` CSE '') as of April 8, 2022. After giving effect to the Transaction, Novamind Shareholders will hold ~18% ownership in the pro-forma company ( on a fully diluted in-the-money basis).
Key Transaction Highlights
Clinic Leadership
The combined company will operate 13 wellness clinics in focused geographies across the U.S. and Canada, and will continue developing and scaling innovative psychedelic therapy protocols and procedures for screening, preparation, dosing and integration targeting difficult-to-treat mental health conditions, including post-traumatic stress disorder ( PTSD), COVID-19 burnout, depression, addiction and eating disorders. Operationally, the combined company will benefit from a centralized client care center for managing client inquiries, scheduling clients with appropriate providers, coordinating physician referral intakes, fulfilling prescription requests and facilitating insurance authorizations. The company's Utah clinics have secured approval for direct billing of intravenous ( IV) ketamine for treatment-resistant depression from four major health insurance providers.
Research Leadership
The combined company will operate four clinical research sites and a bioanalytical laboratory, all of which are currently supporting leading drug developers in psychedelic medicine with critical infrastructure and services. Select ongoing psychedelic medicine clinical trials include:
The combined company will benefit from drug developers ' high R & D spend and offers unprecedented capabilities for psychedelic clinical research from pre-clinical studies through phase IV trials.
Pro-Forma Financial Information:
C $ from the last four reported quarters
Numinus ( Trailing 4 quarters ended Nov. 30, 2021)
Novamind ( Trailing 4 quarters ended December 31, 2021)
Combined ( Pro-Forma)
Revenue
$ 2,074,099
$ 7,906,423
$ 9,980,522
Gross Profit
$ 7,562
$ 3,777,296
$ 3,784,858
Gross Profit Margin
0.4%
47.8%
37.9%
Cash
$ 53.9 million ( as at Nov. 30, 2021)
$ 2.7 million ( as at Dec. 31, 2021)
$ 56.6 million
Additional Transaction Information
Key Novamind personnel have entered into employment agreements that will become effective on closing, and/or will enter into non-competition, non-solicitation and standstill agreements on closing.
Numinus ' executive team and board will remain in place, with the Company being led by CEO Payton Nyquvest.
Completion of the Transaction is subject to a number of conditions including the receipt of regulatory, TSX and CSE approvals. Pursuant to TSX and CSE rules, the Transaction must also be approved by both Numinus ' and Novamind's shareholders. Following anticipated shareholder approvals, the Transaction is expected to close in June 2022, at which point all Novamind operations will transition to Numinus branding.
Cozen O'Connor LLP is serving as legal counsel and Eight Capital is acting as financial advisor to Numinus. McMillan LLP is acting as legal counsel to Novamind.
Special Meetings and Information Circulars
Numinus will be convening a special meeting of its shareholders to consider the Transaction. Numinus currently anticipates that the special meeting will be held in early June 2022 and that an information circular containing additional details regarding the business of the special meeting will be mailed to shareholders in mid-May.
Novamind will be convening a special meeting of its shareholders to approve the Transaction. Novamind currently anticipates that the special meeting will be held in early June 2022 and that an information circular containing additional details regarding the business of the special meeting will be mailed to shareholders in mid-May.
Boards of Directors Recommendation and Voting Support
The arrangement has been unanimously approved by the boards of directors of both Numinus and Novamind ( with an interested director abstaining). Directors and officers of Novamind holding in aggregate 31% of the outstanding Novamind Shares, have entered into customary voting and support agreements to, amongst other things, vote in favour of the arrangement at the special meeting of Novamind shareholders to be held to consider the transaction.
Eight Capital is acting as financial advisor to Numinus ' board of directors. The board of directors, based upon their investigations, concluded that the Transaction is in the best interests of Numinus shareholders, and will be recommending that shareholders vote in favour of a resolution at the special meeting of shareholders.
Clarus Securities has provided a fairness opinion to Novamind's board of directors ( the `` Novamind Board '') and a special committee of independent directors of the Novamind Board ( the `` Novamind Special Committee '') formed to, among other things, review and evaluate the terms of the Transaction and has provided its opinion that, as of the date of the opinion and subject to the assumptions and limitations contained in such opinion, Numinus ' offered price is fair, from a financial point of view, to Novamind. The Novamind board of directors, based upon, among other things, their investigations and the recommendation of the Novamind Special Committee, including their consideration of that fairness opinion concluded that the Transaction is in the best interests of Novamind shareholders, and will be recommending that shareholders vote in favour of a resolution at its special meeting of shareholders.
Investor Presentation and Conference Call
A presentation for the investment community with highlights of the Transaction will be available on Numinus ' investor relations website at: https: //www.investors.numinus.com/events-and-presentations
Highlights of the Transaction will also be discussed on Numinus ' upcoming Q2 2022 results conference call, occurring at 5:30 pm ET / 2:30 pm PT on Thursday, April 14, 2022.
To listen to the live webcast, please register at: https: //event.on24.com/wcc/r/3723657/8A7C51BC48923FC18A54C2754EF10DBA
The webcast will also be archived on the Events and Presentations page of Numinus ' Investor Relations website: https: //www.investors.numinus.com/events-and-presentations
To participate in the live conference call, please use the following dial-in information:
1 ( 888) 330-3632 ( Toll-free North America) 1 ( 646) 960-0837 ( International)
Please ask to participate in Numinus ' Q2 2022 Results Call. To avoid any delays in joining the call, please dial in at least five minutes prior to the call start time. If prompted, please provide conference passcode 3547386.
About Numinus
Numinus Wellness ( TSX: NUMI) helps people to heal and be well through the development and delivery of innovative mental health care and access to safe, evidence-based psychedelic-assisted therapies. The Numinus model - including psychedelic production, research and clinic care - is at the forefront of a transformation aimed at healing rather than managing symptoms for depression, anxiety, trauma, pain and substance use. At Numinus, we are leading the integration of psychedelic-assisted therapies into mainstream clinical practice and building the foundation for a healthier society.
Learn more at www.numinus.com and follow us on LinkedIn, Facebook, Twitter, and Instagram.
About Novamind
Novamind is a leading mental health company enabling safe access to psychedelic medicine through a network of clinics and clinical research sites. Novamind provides ketamine-assisted psychotherapy and other novel treatments through its network of integrative mental health clinics and operates a full-service contract research organization specialized in clinical trials and evidence-based research for psychedelic medicine. For more information on how Novamind is enhancing mental wellness and guiding people through their entire healing journey, visit novamind.ca. | general |
With Shanghai at a standstill, supply chain problems are compounding | Concerns are rising that Shanghai's lockdown is only the beginning of months-long challenges.
After just over two years of a largely successful `` zero-COVID '' policy, China is facing its biggest test to date in the metropolis of Shanghai and the supply chain headaches that come with a massive lockdown.
On Monday morning, the city reported a record number of more than 25,000 new cases, according to state media. Officials have begun easing the lockdown for some areas despite the high case numbers, but the majority of the city remains immobilized.
Meanwhile, supply chain problems are compounding. Costs are rising and inputs can't be transported to factories. Trucking has slowed to a near standstill. As cases continue to climb and disruptions extend, executives and analysts are getting increasingly anxious about the scale of the lockdown's impact on global supply chains.
Truck drivers entering sites including Shanghai's port, airport and factories must show negative COVID-19 test results from as recently as the last 24 hours, said Cameron Johnson, head of APAC Strategy at FAO Global. As the country struggles to simultaneously process millions of tests, the requirements have caused a logistical nightmare to get goods moved.
`` Trucking is the lifeblood of the first and last mile, '' said Derek Bushaw, head of network operations, Asia, at Flexport. `` The first mile for the factories is that inbound delivery of components, and whether those are imported or domestically sourced, that's still a challenge because it depends on trucking. ''
Damage to supply chain efficiency is already evident. Some shipping companies earlier this month noted a 30% drop in efficiency due to a lack of trucking transport at the port, Everstream Analytics said in an email. In response, many companies are diverting cargo away from Shanghai. That includes Flexport, according to Bushaw, who said none of the company's deliveries in the city can be completed as of Monday morning.
On Friday, CMA CGM announced that it would waive change of destination administration fees for rerouting reefers to alternative ports, such as the nearby Port of Ningbo-Zhoushan. The ocean carrier is encouraging rerouting options because of `` drastically '' slower pick up times and `` excessively stretched '' dwell times in Shanghai.
For now, many facilities in and around Shanghai have so far been able to maintain relatively normal production thanks to a `` closed loop system, '' in which workers live on the factory or transport campus, Johnson said. But if restrictions aren't eased soon, `` eventually supplies will run out, '' according to Jena Santoro, manager of intelligence solutions for the Americas at Everstream Analytics.
Cracks in the closed-loop system are already forming. On Tuesday, Apple supplier Pegatron announced that it had halted production at both its Shanghai and Kunshan plants due to COVID-19 restrictions.
Johnson noted that the key timeframe for a faster bounce back to normalcy in supply chains is the end of April. If officials can contain the outbreak and lift lockdowns this month, the logistical backlog could be addressed within roughly a quarter.
`` If though it goes past April, then I think you 'll start to see major disruptions, '' Johnson said. `` You 'll see commodity prices rise, suppliers not getting paid. ''
Even when the lockdown does lift and logistics come back online in full, companies may face fresh headaches as they all vie for supplies at the same time, Johnson said. The ensuing supply constraints could cause commodity prices to rise another 4% to 5%.
Santoro emphasized that much remains uncertain when it comes to the degree of damage that supply chains will incur given that no one knows for certain when the lockdown will end. For the next few weeks, companies that source from manufacturers in China should consider rail, barge and air cargo while trucking remains difficult.
The longer-term concern among many observers is that this lockdown is only the beginning. The neighboring city of Kunshan has also faced tight restrictions since early April, prompting many factories to halt production.
Kunshan is home to several major automotive and electronics suppliers that service companies like Tesla in Shanghai, as well as Apple, said Santoro. Electronics and automotive supply chains will be hard hit by supplier shortages amid the dual restrictions.
`` The worry here is that the outbreak has just started, '' Santoro said. `` This is going to blow up. Whether or not Shanghai lifts in a week, this is just going to be the next one. ''
And with officials adamant about sticking to China's zero-COVID policy, lockdowns and the disruptions are likely to continue.
`` We have a real challenge in planning, because as soon as you get out of trouble in one area, a few weeks later you're into trouble in another area, '' Bushaw said. `` The biggest challenge is uncertainty and not knowing... when these challenges will come to an end. ''
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
The closures will affect more than 450 employees working in California, Pennsylvania and Tennessee, per state records.
The retailer hopes to grow its seller base and their sales with logistics services, which in turn can help boost its nascent advertising business.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
The closures will affect more than 450 employees working in California, Pennsylvania and Tennessee, per state records.
The retailer hopes to grow its seller base and their sales with logistics services, which in turn can help boost its nascent advertising business.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more. | general |
COVID-19 tests at times have been notoriously hard to find. Here's why. | At-home test manufacturers faced unique challenges with forecasting demand, leading to supply and demand mismatches.
When Carri Chan wanted to stock up on at-home COVID-19 tests last summer, she went from one New York City pharmacy to the next. If she was lucky, they had one box.
She would buy it and go to the next pharmacy in search of more. Chan then ordered 12 sets, the maximum allowed on Amazon, in anticipation of the start of in-person school. She waited six to eight weeks for their arrival.
With young and unvaccinated children at home, Chan, a business professor of decision, risk and operations in the healthcare arena and the faculty director of the healthcare and pharmaceutical management program at the Columbia Business School, wanted the tests in case anyone in her household woke up with a sore throat.
A few months later, the supply of at-home or rapid antigen tests had increased, with tests available on the drugstore shelf instead of behind the counter. No more waiting eight weeks on Amazon.
Just as stores are discounting the once scarce bottles of hand sanitizer, many people have more than enough rapid tests filling up their drawers. That includes the free tests shipped directly to homes by the U.S. government. And now insurance companies will directly pay for or reimburse the cost of eight tests per person per month, though this does not guarantee availability.
Supply chain difficulties have become standard for nearly all businesses during the pandemic, but at-home test manufacturers faced unique problems with forecasting demand. The challenges, in part, accounted for the wild inconsistencies in coronavirus test availability over the past year and a half.
One of the bigger issues with the COVID-19 testing supply chain is determining demand. Manufacturers including Abbott would shutter factories, only to scramble to reopen them when new waves of the virus pushed up demand.
Longhorn Vaccines and Diagnostics, which produces the transport medium for PCR test samples, received an FDA request to massively scale up demand in 2020. The company historically produced at most 100,000 units a year, and the FDA was requesting 3 million units a week.
Longhorn was able to make 50 million units that year after ordering large quantities of chemicals from China and working with two U.S. tube manufacturers to scale up production. At the start of 2021, the company decided to stock up even more on chemicals to ensure it could last through two years of peak COVID-19 numbers. Storage costs were high, but the company couldn't afford to run short on the chemicals, according to president Jeff Fischer.
Then, in February 2021, coronavirus testing slowed. One week Longhorn was selling 10 million units, and the next week, people were canceling orders.
At the time, the government did not have large purchasing agreements for at-home tests. Many clients had started swapping out testing sites for vaccination sites. So when orders stopped, the supply chain was already full of tests, Fischer said.
`` No one wants to get ahead of things for fear of being stuck with inventory they can’ t use. ''
Then, after the delta variant took hold, manufacturers were hesitant to start up production again in fear of making the same mistakes twice.
`` People were uncomfortable filling the supply chain with components at every stage, from basic raw materials to finished components, '' Fischer said. `` We all had been sitting on inventory all summer. And it was like seeing all your cash disintegrate in front of you. ''
Longhorn was able to get through its inventory, but companies were wary about the risk of procuring more.
`` No one wants to get ahead of things for fear of being stuck with inventory they can’ t use. ''
At-home testing is challenging because it's essentially a new market, said Chan, and it's hard to find similar products for comparison in forecasting. There is no historical data as a comparison.
There is also volatility over what is driving demand. It can be the community infection rate, office or school requirements, testing requirements for travel and events, policy issues, and cost.
Government messaging around at-home testing had an effect. Currently PCR ( molecular) testing is free nationwide. When vaccines were introduced, the federal government did not widely embrace rapid testing at a policy level, because it was not as accurate as PCR testing.
Predictive analytics can be used to anticipate demand, but these analytics must be taken with a grain of salt due to the volatility. There are costs of having too many and too few products: If a company estimates a demand for one million tests per week, does it expect variability between 900,000 and 1.1 million, or between 500,000 and 1.5 million? That affects production and logistics, with supply procurement, warehousing, and trucking reservations.
Port availability also plays into the uncertainty. If manufacturing or sourcing from abroad, companies must decide whether there's enough increased demand short term to pay shipping premiums to stock up or ramp up production. With anticipated later demand, companies may have enough stock to avoid paying expediting fees.
`` There's a cascade of decisions, and that's what makes it so difficult, '' Chan said.
This story was first published in our Operations Weekly newsletter. Sign up here.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
The retailer hopes to grow its seller base and their sales with logistics services, which in turn can help boost its nascent advertising business.
The acquisition has contributed to an approximately 35% reduction in delivery times, executives said on an earnings call.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
The retailer hopes to grow its seller base and their sales with logistics services, which in turn can help boost its nascent advertising business.
The acquisition has contributed to an approximately 35% reduction in delivery times, executives said on an earnings call.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more. | general |
Rihanna reveals she fears feeling ‘ out of control’ after birth of her child | Rihanna has revealed she is scared of the prospect of post-natal depression and feeling emotionally out of control after the birth of her baby.
The 34-year-old, who is preparing to welcome her first child with rapper Asap Rocky, spoke to American Vogue about her post-pregnancy hopes and fears.
As the magazine’ s May cover star, Rihanna explained what frightens her the most about having a baby, saying: “ Postpartum depression.
“ Will I feel out of control emotionally? Those are the stories I hear from other women that scare me. ”
She also revealed she is “ praying ” her body allows her to breastfeed successfully after reading about the benefits.
Since announcing her pregnancy in January, the Barbados-born singer has become known for pushing maternity style boundaries and said she hopes her pregnancy has been able to “ redefine what’ s considered ‘ decent’ for pregnant women, ” after embracing her changing body.
She added: “ My body is doing incredible things right now, and I’ m not going to be ashamed of that. This time should feel celebratory. Because why should you be hiding your pregnancy? ”
Rihanna, who launched her Savage X Fenty lingerie brand in 2018, said she never considered changing her style after finding out she was pregnant.
She said: “ When I found out I was pregnant, I thought to myself, There’ s no way I’ m going to go shopping in no maternity aisle.
“ I’ m sorry—it’ s too much fun to get dressed up. I’ m not going to let that part disappear because my body is changing. ”
She also spoke about her relationship with Asap Rocky, 33, revealing that he “ became ( her) family ” during the beginning of the Covid-19 pandemic. | general |
Boris Johnson, Carrie Johnson and Rishi Sunak to be fined over lockdown parties | Prime Minister Boris Johnson ( right) with Chancellor of the Exchequer Rishi Sunak are set to be fined over the gatherings. File Picture: PA
British Prime Minister Boris Johnson, his wife Carrie Johnson, and Chancellor Rishi Sunak have been told they will be fined as part of a police probe into allegations of lockdown parties held at Downing Street.
It comes after the Metropolitan Police announced 30 additional fines on Tuesday in relation to Operation Hillman, which is looking into breaches of Covid-19 regulations at the top of Government.
A No 10 spokeswoman said: “ The Prime Minister and Chancellor of the Exchequer have today received notification that the Metropolitan police intend to issue them with fixed penalty notices.
“ We have no further details, but we will update you again when we do. ”
Labour leader Keir Starmer said both Mr Johnson and Mr Sunak should quit following the confirmation.
“ Boris Johnson and Rishi Sunak have broken the law and repeatedly lied to the British public.
“ They must both resign, '' Mr Starmer said.
“ The Conservatives are totally unfit to govern. Britain deserves better. ”
Boris Johnson and Rishi Sunak have broken the law and repeatedly lied to the British public. They must both resign.The Conservatives are totally unfit to govern. Britain deserves better.
Police have opted not to name those facing fines, citing traditional practices when dealing with out-of-court matters such as speeding fines, but Downing Street said it would confirm if Mr Johnson was among those being penalised.
Scotland Yard said on Tuesday that it had made at least 50 referrals for fixed-penalty notices ( FPNs) – up from 20 at the end of March – to ACRO Criminal Records Office, which is responsible for issuing the fines.
Mr Johnson is understood to have been present at six of the at least 12 events being investigated.
The UK prime minister, speaking in the Commons in December after allegations about parties in Downing Street first emerged, said that “ all guidance was followed completely in No 10 ”.
However, since the police probe commenced, the Conservative Party leader has looked to deflect from answering questions until the inquiry has concluded and has poured his efforts into dealing with the Ukraine crisis.
In his response to Mr Johnson being told to expect a fine, Liberal Democrat leader Ed Davey called for Parliament’ s Easter break to be cut short in order to hold a no confidence vote in Mr Johnson's leadership. | general |
Boris Johnson broke his own lockdown rules | WHEN SOMEBODY has a lucky escape do they learn from their mistake, or are they emboldened to make the next one? That was the question facing Britain on April 12th after the prime minister, along with his wife and chancellor, received a “ fixed penalty notice ” —a small fine—for a get-together during the covid-19 lockdowns. The answer, alas, is that Boris Johnson has form. However repentant he now is in public, in private he will be revelling in his knack for wriggling out of the tightest spots like a greased piglet. For Britain, that is not a good outcome.
For several weeks, starting towards the end of last year, “ Partygate ” looked as if it might end Mr Johnson’ s career. Revelations emerged that the prime minister and his staff had been boozing at one knees-up after another, in breach of the government’ s own covid rules. Mr Johnson first told Parliament there had been no parties. When that proved false, he said he had not known about them. When he was shown to have been at several, he denied that they were really parties. When it was said he had been warned, he seemed to suggest that he had misunderstood his own government’ s rules.
Some Conservatives have argued that this week’ s fine is no more serious than a speeding ticket. In fact, it proves that the police have concluded Mr Johnson either lied to Parliament or was wildly ignorant of his government’ s policy on the biggest and most urgent issue of the day. He has, in other words, been a knave or a fool—and few would call the biographer of Churchill and Shakespeare a fool.
Lying to Parliament was a sacking offence before Partygate and it still should be. But Mr Johnson’ s fate is in the hands of Tory MPs and, at the moment, they believe that they need him if they are to keep their seats at the next election. It helps that Partygate no longer seems quite so heinous now that Russia is committing war crimes in Ukraine. Given that Mr Johnson has helped lead the international coalition against Vladimir Putin, Tory MPs now say he is too important to lose—though since Britain has changed prime ministers during its own wars, in 1916 and 1940, it is hard to see why it should shrink from doing so during someone else’ s.
Partygate will therefore not spell the end of Mr Johnson. But it will leave its Merlot-tinged mark on British politics. Mr Johnson has lost the trust of voters. Snap polls taken as news of the fine broke suggested that about 60% think he should resign and over 70% think he lied to Parliament. Britain faces an energy crisis, a huge backlog in the health service and a surge in the cost of living. It is a time for the hard choices that would stretch the nerves of even the most esteemed prime minister. Mr Johnson, who courts popularity, is more likely than ever to duck them.
This scandal also casts a pall over the Conservatives. The party of law and order has, with open eyes, chosen to associate itself with Mr Johnson’ s lies. It has been tainted by them. However much it pretends that there were extenuating circumstances, MPs will learn the lessons—that rules are for suckers, that the crime is getting caught and that, even if you are nabbed, braggadocio will see you through. And Mr Johnson and his party have eroded standards in public life. Because elections are blunt instruments, these are in effect self-policed. The prime minister is the chief enforcer of the ministerial code. Because he is assumed to be beyond reproach, there is no provision for when he himself is the problem.
Partygate is winding down. Sadly for Britain, the man with more gates to his name than Heathrow airport has got away with it again. You can count on the next one coming along soon.
Published since September 1843 to take part in “ a severe contest between intelligence, which presses forward, and an unworthy, timid ignorance obstructing our progress. ”
Copyright © The Economist Newspaper Limited 2022. All rights reserved. | business |
MOROCCO: Renault, Suez, and now BCP: Bensalah-Chaqroun discreetly adds new board to her list | French satellite operator Eutelsat will continue to broadcast Cameroon's public TV channel CRTV, one of the country's most influential media, and its other channels, until 2023. [... ]
The pandemic has pushed the problem of CIH Bank's faulty loans to friends of the royal family back into the forefront. Banque populaire ( BCP) may soon acquire the small bank, for the benefit of all parties involved. [... ]
The head of Advisory & Finance Group and husband of Mohammed VI's cousin Lalla Zineb is joining the board of the Casablanca water and power utility controlled by French water and waste management group Suez. [... ]
The world's biggest private water provider is keen for its Casablanca subsidiary Lydec to extend its municipal contract until 2027. It has given ex-SNCF boss Guillaume Pepy the job of ironing out disputes with the city council and the interior ministry. [... ]
Prince Moulay Rachid, the brother of Mohammed VI, is looking to open up his MAIC fund, set up to finance the creation TDM Aerospace, to Moroccan institutional investors with a view to expanding subcontracting opportunities with Boeing and Airbus. [... ]
Finance Minister Mohamed Benchaâboun has secretly instructed his favourite investment banks, Upline Corporate Finance and Attijari Corporate Finance, to structure the €4bn Mohammed VI Investment Fund which aims to revive Morocco's economy in the wake of the Covid-19 pandemic. [... ]
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Home-based: Regional Research on Girls’ Activism and Leadership for Climate Justice in Asia-Pacific | Plan International is an independent development and humanitarian organisation that advances children’ s rights and equality for girls. As an independent development and humanitarian organisation, we work alongside children, young people, our supporters, and partners to tackle the root causes of the challenges facing girls and all vulnerable children. We support children’ s rights from birth until they reach adulthood and enable children to prepare for and respond to crises and adversity. We drive changes in practice and policy at local, national, and global levels using our reach, experience, and knowledge. For over 80 years we have been building powerful partnerships for children, and we are active in over 75 countries.
The Asia-Pacific region is particularly vulnerable to climate change impacts due to a combination of geographic exposure to environmental shocks and stressors, and underlying systemic inequalities. As a result, disasters in the region, particularly water-related disasters such as floods, droughts, and storms, have affected 6.9 billion people in the past 50 years. [ 1 ] The geographic and demographic scale of the region challenges its people to address the rapidly increasing temperatures and fluctuating frequencies and intensities of disasters while also contributing to the progress of key goals in the 2030 Sustainable Development Goals.
Climate change poses disproportionate risks to different groups of people due to vulnerability and exposure. Groups who are socially, economically, culturally, politically, institutionally, or otherwise marginalised are especially vulnerable to climate change. Due to the combined effects of age and gender discrimination, girls, especially adolescent girls, are particularly vulnerable to climate change which has serious implications on their rights and development. Climate change magnifies the existing inequalities girls and young women face including their unequal access to health, sexual reproductive health and rights, education, participation, and protection. For example, girls and women face increased vulnerabilities to all forms of gender-based violence, including conflict-related sexual violence, human trafficking, child marriage, and other forms of violence. At the rate disasters are disproportionately affecting girls’ access to education, 12.5 million girls, specifically, may be prevented from completing their school each year by 2025. [ 2 ] Food shortages have seen young girls forcibly married as a negative “ coping strategy ” for many families impacted by environmental disasters. [ 3 ] It is estimated that 40 to 68 per cent of girls and young women, including those with disabilities will experience sexual violence and other types of gender based violence, before the age of 18. [ 4 ] Studies also suggest that in tropical cyclones in Bangladesh and the Philippines, girls and women are more likely than boys and men to suffer poor mental health, intimate partner violence and food insecurity. [ 5 ]
The COVID-19 pandemic and the socio-economic impacts of climate change and other natural and man-mad disasters have intersected to negatively affect girls and young women further. Due to droughts, rural girls and women spend more time fetching water and walking longer distances. With imposed social distancing and travel restrictions in place during the pandemic, the absence of clean water makes menstrual hygiene management an even greater burden which can lead to health complications and other consequences like school dropouts or increase in adolescent pregnancies and child, early and forced marriage. [ 6 ]
Although international laws frameworks such as Convention on the Rights of the Child ( CRC) and Convention on the Elimination of All Forms of Discrimination against Women ( CEDAW) are increasingly acknowledging the interlinkages between climate change and gender equality [ 7 ], governments in the Asia-Pacific region must reflect this into their policies and commitments. More importantly, governments must recognise the disproportionate impacts climate change has on girls and young women by strengthening their meaningful participation in climate decisions and action. But many climate change policies, from the local level to the global level, founder on the lack of “ political will ” — the unwillingness or inability of government officials to enact policies. Recently, the sixty-sixth session of the Commission on the Status of Women focused on the Climate Change, Risk Disaster Reduction and gender equality at the centre of solutions. At the country level, local government officials in Bangladesh have expressed support and have taken part in the Youth strikes, while activists have been invited to become “ young experts ” on the country’ s parliamentary standing committee in the Ministry of Environment, Forestry and Climate Change. However, leaving behind girls and young women will limit the resilience and adaptive capacity of communities and countries to climate change.
At the same time, girls and young women are not waiting to voice their concerns and demand climate justice. Across the region, young advocates are building and leading movements demanding action from their governments despite the shrinking civic space. Youth activist, Mitzi, and her organisation, Youth Advocates for Climate Action Philippines raise awareness of the implications of the climate aspect while demanding accountability from national leaders. In 2021, this youth-led organisation mobilized hundreds of activists during climate strikes, facilitated community education sessions and reached millions online through various campaign initiatives. [ 8 ] Australian, Izzy Raj-Seppings has led thousands of students in “ School Strike 4 Climate ” protests and joined seven other young activists on a Class Action against the extension of a coal mine. [ 9 ]
Plan International APAC Hub’ s 2021 Asia-Pacific Girls Report [ 10 ] found that digital technologies and social media played a significant role in the successes of youth movements. Another report found that youth are not only using social media to learn about climate change but also to amplify their advocacy. [ 11 ] The “ Youth Leading Learning in Climate-Resilient Value Chains in the Pacific ” project builds young people’ s knowledge about climate-resilient agriculture practices. As well as building the technical capacity of young male and female farmers, the project uses social media and digital technologies to support the documentation and dissemination of best organic farming practices for enhancing climate-resilience.
Despite the evident leadership of girls and young women on climate justice, few studies have focused on their advocacy and political engagement [ 12 ] towards achieving the climate justice, gender equality and sustainable development agenda. While literature on the increased vulnerabilities women experiences due to climate change, as well as their climate action have become more prevalent in recent years, there remains a gap on the unique lived experiences of girls and young women who continue to face persistent challenges when doing their work and advocacies on issues that ultimately affect their own lives.
To identify and analyse emerging trends/patterns of girls’ and young women ( 15-24 years old)’ s civic engagement and activism for climate justice and inclusive societies including issues they are advocating for and barriers they are facing in the Asia-Pacific region.
To better understand how girls and young women are using their voice and power to engage in decision making process as well as in the spaces they have created on climate justice.
Due to COVID-19 travel restrictions, the consultant ( s) will not be expected to travel. Data will be collected remotely with the support from Plan APAC and Country Offices.
The consultant will directly report to the Regional Civil Society, Youth, and Advocacy Lead and work in close collaboration with the APAC Regional Research Working Group [ 13 ]. The following deliverables are expected from the consultant ( s) after signing the contract:
1. An inception Report, at a minimum and to be should include:
2. Tools and materials submission according to the final inception report / As appropriate ( PDF, Word, survey link, etc.) / N/A / By June 10, 2022 /
3. Draft research report ( containing findings of desk review, interviews, social listening and case studies) / Word doc / Maximum 30 pages / By July 10, 2022
4. Final research report ( containing findings of desk review, interviews, social listening and case studies) /Word doc/ Maximum 30 pages / By August 20, 2022
5. A PowerPoint presentation of a summary research key findings / PowerPoint / N/A / By August 31, 202
The consultant should propose budget including VAT together with the proposed methodology in the research proposal for this consultancy work. The consultant is invited to submit a single budget for this consultancy. Payment will be made based on agreed amounts in the consultant’ s contract, and upon approval of invoices.
The assignment is estimated to be completed within 45 days starting from May 15, 2022 and to be completed by August 31, 2022. The timeframe is indicative and can be reevaluated in consultation between Plan International and the consultant ( s).
Task / Timeframe / Estimated no. of work days / Deliverable:
The primary users of the research will be Plan International programme, advocacy and campaign staff in Asia and the Pacific Country Offices.
The Regional Hub will also use the findings.
The intended external audiences of the research will be governments in the Asia-Pacific region, academics, non-governmental organisations, think-tanks and civil society.
Please note that the results of this research initiative and key findings from a separate study on Asia-Pacific Girls’ Leadership, to be commissioned at the same time, will be combined in order to produce Plan APAC’ s 2022 Asia-Pacific Girls Report. See the research conceptual framework below:
Please send your application to Supornchai.Nawataweeporn @ plan-international.org referencing “ Regional Research on Girls’ Activism and Leadership for Climate Justice in Asia-Pacific ” in the subject line and including supporting documents as outlined.
Application deadline is April 22th 2022 ( 5 PM, Bangkok time).
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L'ambiguïté stratégique américaine autour de Taïwan doit cesser by Abe Shinzō | TOKYO – L’ invasion de l’ Ukraine par la Russie en conduit beaucoup à songer à la précarité de la relation entre la Chine et Taïwan. La situation de l’ Ukraine et celle de Taïwan présentent trois similitudes, d’ importantes différences intervenant par ailleurs.
Une première analogie réside dans l’ écart considérable de puissance militaire entre Taïwan et la Chine, comme entre l’ Ukraine et la Russie. Cet écart ne cesse par ailleurs de se creuser année après année.
Deuxièmement, ni l’ Ukraine, ni Taïwan ne disposent d’ alliés militaires officiels. Les deux pays doivent faire face seuls aux menaces et aux attaques.
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Writing for PS since 2012 11 Commentaries
Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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Należy Zakończyć Amerykańską Dwuznaczność Strategiczną w Kwestii Tajwanu by Abe Shinzō | Inwazja Rosji na Ukrainę przypomniała nam o napiętych stosunkach między Chinami a Tajwanem. Ale choć istnieją trzy podobieństwa między sytuacją na Ukrainie i w Tajwanie, istnieją też znaczące różnice.
Pierwsze podobieństwo polega na tym, że między Tajwanem a Chinami istnieje bardzo duża luka w sile militarnej, podobnie jak między Ukrainą a Rosją. Co więcej, luka ta powiększa się z każdym rokiem.
Po drugie, ani Ukraina, ani Tajwan nie mają formalnych sojuszników wojskowych. Oba kraje są zmuszone do samotnego stawiania czoła zagrożeniom lub atakom.
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Writing for PS since 2012 11 Commentaries
Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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حتمية إنهاء الغموض الاستراتيجي الأميركي بشأن تايوان by Abe Shinzō | طوكيو ــ ذَكَّـرَ غزو روسيا لأوكرانيا كثيرين بالعلاقة المشحونة بين الصين وتايوان. ولكن على الرغم من وجود ثلاثة أوجه تشابه بين الوضع في أوكرانيا وتايوان، فإن الأمر لا يخلو أيضا من أوجه اختلاف كبرى.
يتمثل وجه التشابه الأول في الفجوة الكبيرة في القوة العسكرية بين تايوان والصين، تماما مثل الفجوة بين أوكرانيا وروسيا. علاوة على ذلك، تزداد هذه الفجوة اتساعا بمرور كل عام.
ثانيا، لا يوجد حلفاء عسكريون رسميون لأوكرانيا أو تايوان. فكل من البلدين مجبر على مواجهة التهديدات أو الهجمات بمفرده.
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Writing for PS since 2012 11 Commentaries
Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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L'ambiguità strategica degli Usa su Taiwan deve finire by Abe Shinzō | TOKYO – L’ invasione dell’ Ucraina da parte della Russia ha ricordato a molti osservatori i rapporti tesi che intercorrono tra la Cina e Taiwan. Ma se la situazione dell’ Ucraina e quella di Taiwan presentano tre aspetti di somiglianza, tra di esse vi sono anche notevoli differenze.
La prima similitudine riguarda l’ ampio divario in termini di forza militare tra Taiwan e la Cina, così come tra l’ Ucraina e la Russia, un divario che tende ad aumentare da un anno all’ altro.
La seconda è che né l’ Ucraina né Taiwan hanno alleati militari formali, ma sono costretti a fare fronte alle minacce o agli attacchi esterni da soli.
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Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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Abe states that both US and Japan respect the claim of China that Taiwan is part of China, and yet he is advising US to declare that US will defend Taiwan. Where is the logic?
Greatest foreign policy mind around. Deterrence from strength. It's the only way to be sure. Take note Washington.
As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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台湾に対する米国の戦略的曖昧政策は終わるべきだ by Abe Shinzō | ロシアによるウクライナ侵略は、中国と台湾の危機をはらんだ関係を多くの人に想起させた。
ウクライナと台湾をめぐる情勢には、3つの類似点がある。しかし深刻な違いもある。
第一の類似点は、ウクライナとロシアの関係においてそうだったと同様、台湾と中国の間には、非常に大きい軍事力の格差があるということだ。しかも差は年々大きくなる一方である。
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Writing for PS since 2012 11 Commentaries
Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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Abe states that both US and Japan respect the claim of China that Taiwan is part of China, and yet he is advising US to declare that US will defend Taiwan. Where is the logic?
Greatest foreign policy mind around. Deterrence from strength. It's the only way to be sure. Take note Washington.
As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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美国必须结束在台湾问题上的战略模糊态度 by Abe Shinzō | 东京—俄罗斯入侵乌克兰让许多人想起了中国和台湾之间令人担忧的关系。但尽管乌克兰和台湾局势有三点相似之处，但同时也存在巨大的差异。
第1个相似之处是，台湾和中国间存在巨大的军事实力差距，这一点很像乌克兰和俄罗斯。此外，这种差距每年都在不断扩大。
其次，乌克兰和台湾都没有正式的军事盟友。两国都被迫独自面对威胁或袭击。
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Writing for PS since 2012 11 Commentaries
Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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Greatest foreign policy mind around. Deterrence from strength. It's the only way to be sure. Take note Washington.
As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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De strategische dubbelzinnigheid van de VS over Taiwan moet ophouden by Abe Shinzō | TOKIO – De invasie van Rusland in Oekraïne heeft velen herinnerd aan de gespannen relatie tussen China en Taiwan. Maar hoewel er drie overeenkomsten zijn tussen de situatie in Oekraïne en die in Taiwan, zijn er ook belangrijke verschillen.
De eerste overeenkomst is dat er een zeer grote militaire machtskloof bestaat tussen Taiwan en China, net zoals er een was tussen Oekraïne en Rusland. Bovendien wordt die kloof elk jaar groter.
In de tweede plaats heeft noch Oekraïne noch Taiwan formele militaire bondgenoten. Beide landen zijn gedwongen bedreigingen of aanvallen op eigen kracht het hoofd te bieden.
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Writing for PS since 2012 11 Commentaries
Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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Abe states that both US and Japan respect the claim of China that Taiwan is part of China, and yet he is advising US to declare that US will defend Taiwan. Where is the logic?
Greatest foreign policy mind around. Deterrence from strength. It's the only way to be sure. Take note Washington.
As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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Strategická nejednoznačnost USA v otázce Tchaj-wanu musí skončit by Abe Shinzō | TOKIO – Ruská invaze na Ukrajinu připomněla mnoha lidem složitý vztah mezi Čínou a Tchaj-wanem. Je pravda, že situace na Ukrajině a situace na Tchaj-wanu vykazují tři podobnosti, ale zároveň mezi nimi existují významné rozdíly.
První podobnost spočívá v tom, že mezi Tchaj-wanem a Čínou existuje z hlediska vojenské síly stejně propastný rozdíl jako mezi Ukrajinou a Ruskem. Navíc se tento rozdíl rok od roku zvyšuje.
Za druhé nemají Ukrajina ani Tchaj-wan oficiální vojenské spojence. Obě země jsou nuceny čelit hrozbám či útokům samy.
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Writing for PS since 2012 11 Commentaries
Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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Abe states that both US and Japan respect the claim of China that Taiwan is part of China, and yet he is advising US to declare that US will defend Taiwan. Where is the logic?
Greatest foreign policy mind around. Deterrence from strength. It's the only way to be sure. Take note Washington.
As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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Die strategische Ambiguität der USA in Bezug auf Taiwan muss enden by Abe Shinzō | TOKIO – Der russische Einmarsch in der Ukraine hat viele an die gespannte Beziehung zwischen China und Taiwan erinnert. Doch während es drei Gemeinsamkeiten zwischen der Situation in der Ukraine und der in Taiwan gibt, gibt es auch beträchtliche Unterschiede.
Die erste Gemeinsamkeit ist, dass es ein sehr großes militärisches Machtgefälle zwischen Taiwan und China gibt, genau wie zwischen der Ukraine und Russland. Darüber hinaus wird dieses Gefälle mit jedem Jahr größer.
Zweitens haben weder die Ukraine noch Taiwan formale militärische Verbündete. Beide Länder sind gezwungen, sich Bedrohungen oder Angriffen allein zu stellen.
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Writing for PS since 2012 11 Commentaries
Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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Abe states that both US and Japan respect the claim of China that Taiwan is part of China, and yet he is advising US to declare that US will defend Taiwan. Where is the logic?
Greatest foreign policy mind around. Deterrence from strength. It's the only way to be sure. Take note Washington.
As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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ICC TFG Hub - Page 4 of 5 | Your morning coffee briefing from TFG. Countries around the world continue to ease lockdown restrictions. The collapse in the oil price and shrinking demand has sent inflation rates tumbling. Governments in the West are spending and borrowing on a vast scale as they counter the effects of the COVID-19 pandemic.
With the Covid-19 pandemic, our paper-based trade finance settlement system suddenly stopped working. It is about time businesses adopt paperless and digital workflow to safeguard trade finance operations.
Your Monday morning coffee briefing from TFG. The severe contraction of economic activity due to COVID-19 are being felt around the world. Associations are calling for state backed support for the private credit insurance market as the impact of bank lending severely impacts critical supply chains.
Industry bodies called for further government support towards supporting the global trade industry ( multilaterals, banks and insurers), as the coronavirus pandemic continues to disrupt all areas of the economy.
There have been 1.7 million confirmed cases of coronavirus globally, with over 100,000 deaths. The majority of countries around the world still have strict lockdowns in place, and the virus is still spreading rapidly.
As proud Media Partners of the International Chamber of Commerce ( ICC) Global Trade Survey, TFG invites its network of banks and financiers to participate in the Trade Finance Annual Survey on Global Trade.
Since 2000, global trade flows have trebled to US $ 18.5 trillion. Yet many challenges to the adoption of trade finance products remain.
With opportunities in mind and challenges addressed, we are free to look ahead to what the experts believe the future of the industry has in store. According to our survey… read more →
New York, World Trade Symposium. With the world trade order under threat from protectionist movements, tit-for-tat tariffs, and a shift away from free and open trade, TFG’ s Editor Deepesh Patel caught up with ICC’ s Secretary General and Member of the World Trade Board, John Denton at Finastra’ s World Trade Symposium.
The Universal Trade Network ( UTN), a project initially aimed to allow for interoperability between many of the blockchain and non-blockchain consortia and networks has been renamed and adopted by the International Chamber of Commerce ( ICC).
In Global Financial Integrity’ s 2019 update “ Illicit Financial Flows to and from 148 Developing Countries 2006 – 2015 ” the estimate of illicit outflows of trade related payments from developing economies for 2015 alone was counted in the hundreds of billions – greater in value in fact than the aid budgets flowing into those countries. | general |
An Interview with Eswar Prasad by Eswar Prasad | This week in Say More, PS talks with Eswar Prasad, Professor of Economics at Cornell University, a senior fellow at the Brookings Institution, and the author of The Future of Money: How the Digital Revolution Is Transforming Currencies and Finance.
Project Syndicate: Last year, you warned that the pandemic recovery would be uneven, with the 2020 recession leaving “ long-lasting scars on both GDP and employment ” in most regions, including Europe and Latin America. How is the Ukraine war, and the Western sanctions leveled against Russia in response, likely to affect the trajectory of the global recovery?
Eswar Prasad: This year will be a tough one for global growth, not only because of the Ukraine war, but also because of the resurgence of COVID-19 in China and the limited policy space that most governments have for responding to the economic pressures they face.
The pandemic’ s disruptive impact seems well contained in most parts of the world, but with new variants continuing to emerge, the coronavirus remains a wildcard. In China, however, an apparent determination to stick to an increasingly unviable zero-COVID strategy, which has recently necessitated lockdowns of major cities like Shanghai, already poses serious risks. China might have to resort to further stimulus measures to maintain decent growth.
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Writing for PS since 2006 18 Commentaries
Eswar S. Prasad is Professor of Economics in the Dyson School at Cornell University, a senior fellow at the Brookings Institution, and the author of The Future of Money: How the Digital Revolution Is Transforming Currencies and Finance ( Harvard University Press, 2021).
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The cryptocurrency trade shadows economist Friedrich Hayek views as echoed in `` The Denationalisation of Money ''. Hayek advocated `` the establishment of competitively issued private moneys, where he speculated that rather than entertaining an unmanageable number of currencies, markets would converge on one or only a limited number of monetary standards, on which institutions would base the issue of their notes. `` The `` Denationalization of money '' can be reinterpreted as the `` NATIONALISATION OF VALUE ''.The concept of having one value to determine all values in all markets is the `` value flaw '' in currency markets and cryptocurrency. An example of this VALUE FLAW is seen in the International Monetary Fund ( IMF) fixed cross rates is seen clearly on the 10th August 2021. The exchange rate between the US dollar and British Sterling pound on the 10th of August 2021 was £1 per US $ 1.385. This `` 1.385 '' cross rate appears in the US dollar and British Sterling pound of other national currencies as if they have the same US dollar/British Sterling pound liquidity in their national money markets to justify such an IMF fixed cross rate.For example the British Sterling pound exchange rate against the Japanese Yen on the said date was ¥152.878 per £1 against ¥110.371 gives a cross rate of 1.385. The Chinese Yuan Renminbi value against the British Sterling pound was ¥8.973 per British Sterling pound and ¥6.478 per US dollar gives a cross of 1.385. The North Korean Won against the British Sterling pound stood at W1,245.795 against W899.978 against the US dollar gives a cross rate of 1.385.The Euro against the British Sterling pound stood at €1.179 against €0.8519 per US dollar to give a cross rate of 1.385.The Canadian dollar against the British Sterling pound stood at C $ 1.739 and C $ 1.256 per US dollar to give a cross rate of 1.385.The Swedish Krona value in British Sterling pound stood at kr12.055 against kr8.7048 per US dollar giving a cross rate of 1.385. The Indian Rupee Sterling pound value on the 10 the August 2021 stood at R102.967 against R74.36 per US dollar giving a cross rate of 1.385. The South African Rand Sterling value stood at R20.422 against R14.752 per US dollar giving a cross rate of 1.385.Does it mean that North Korea, the European Union, Japan, Canada, China, India etc all have US dollar and Sterling pound liquidity within their money markets to justify the IMF fixed cross rates day in and day out? Therefore the concept of having just `` one value '' in all markets undermines the concept of real value driven by markets.One currency can have multiple values in a Free Floating Cross Rate System. A case in point as noted by the IMF managing director Mr. M. Gutt at Harvard University on the 13th February 1948, when he presented a paper `` The Practical Problem of Exchange Rates ''.Then the official direct Sterling-US dollar rate ruling in Britain and the United States is one Sterling pound to US $ 4, but the Lira-Sterling and Lira-US dollar direct rates are such that the Sterling pound-US dollar cross-rate in Italy is one Sterling pound to US $ 2.60. Americans found it cheaper to purchase goods from the UK via Italy until the IMF stepped in and imposed the IMF fixed cross-rate system in favor of the UK and not Italy nor the US. As we stare at the soul of economics one must understand the underlying axioms to Adam Smith's Supply and Demand Doctrine with respect to the STRUCTURE OF PAYMENT SYSTEMS. Adam Smith's Doctrine has underlying axioms that saw British goods being bought by the British Sterling pound. This set a price. If a German with D-marks wanted British goods they would FIRST have to change the German D-marks into British Sterling pounds and use those pounds to buy British goods. Even today go with a US dollar to the European Union to buy anything. They refuse until you FIRST change that US dollar into a Euro. But when the `` exorbitant privilege '' is used to DIRECTLY but commodities and services from other nations, it UNDERMINES the PRINCIPLES AND VALUES of the Supply and Demand Doctrine.Even China despite quoting in US dollars have their foreign currency regulations framed in such a way that the final payment settlement for Chinese firms is in Chinese Yuan Renminbi, hence a Chinese Yuan Renminbi payment settlement system. As noted by former Editor of the London Financial Times Mr Geoffrey Crowther in his book `` An outline of money '' ( it's online google) `` if a purchaser is some one who wants D-marks in order to pay for German exports, the fact that he can get his marks cheap is equivalent to a reduction in the price of exports; it will stimulate sales in exactly the same way as an ordinary depreciation of the exchange rate. ( Crowther Geoffrey ( 1951) p.260).It is this PAYMENT SETTLEMENT SYSTEM that in 1966 saw for example a variance in copper prices. As late as in April 1966 Roan Selection Trust ( RST) and Anglo American Corporation ( AAC) sold Zambian copper at £336 per ton which was then known as the PRODUCER PRICE as the payment settlement system was in the local currency, while the LMEprice was at £753 per ton. LME final payment settlement system only accepts the US dollar, British Sterling pound, the Japanese Yen, the Euro and in 2015 the Chinese Yuan Renminbi as acceptable currencies to buy copper and other base metals within the LME system.Much like commodity prices can vary according to which payment settlement system is used, the same equally applies to the US dollar against actual market liquidities to arrive at varying prices of the US dollar within national money markets while currency arbitrage between markets should equalize quotations or may not depending on currency inflows and trade. The MULTIVERSE US DOLLAR VALUE accurately describes the concept of value which will still keep it in the game.
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| general |
Researchers outline need for new approach to COVID-19 vaccine testing -- ScienceDaily | The commentary by bioethicist Nir Eyal and epidemiologists Tobias Gerhard and Brian Strom ( the latter is chancellor of Rutgers Biomedical and Health Sciences) -- published in Pharmacoepidemiology and Drug Safety -- examines how this parallel approach to vaccine trials can lead to faster and more accurate vaccine assessment and more effective pandemic response.
The researchers say that further vaccine testing could help settle remaining questions about how effective the shots are at blocking infection against old and new virus strains. It could also reveal the most effective dosing and timing between shots, the level of protection compared to natural immunity and how well vaccines work in groups that were underrepresented in initial trials.
While some researchers proposed at the beginning of the COVID-19 pandemic that challenge trials take place, others argued that too little was known about the virus and that conducting the trials would be too dangerous. They were not used for the studies that led to approval of the major COVID-19 vaccines but are now being used in testing.
`` The vigorous discussions about vaccine trial designs in the early months of the COVID-19 pandemic unfortunately played out as a mostly adversarial debate between pro-challenge trial and pro-conventional trial supporters. We felt that there was an overlooked third approach that involved combining strengths from both designs and could facilitate better outcomes throughout the remainder of the COVID-19 pandemic and in future pandemics, '' says Gerhard, Director, Center for Pharmacoepidemiology and Treatment Science at Rutgers Institute for Health, Health Care Policy and Aging Research ( IFH) and Professor, Rutgers Ernest Mario School of Pharmacy.
The Rutgers researchers ' parallel approach, called `` Combining Conventional and Challenge trials ( CCC), '' would involve trials of both types, conducted either simultaneously or at different times.
`` In a pandemic, the value of obtaining information as early as possible is so vast that 'CCC ' is ethically preferable to any single trial, and preparations for a future pandemic should include laying the groundwork for a CCC ', '' said Eyal, Henry Rutgers Professor of Bioethics and Director, Center for Population-Level Bioethics at Rutgers IFH.
Eyal and his colleagues say that researchers will be able to collect more information and increase confidence in the efficacy of vaccines.
`` When either human challenge- or conventional trials are permitted, it may be even more advisable to combine conventional and challenge testing for surer, faster, and more comprehensive vaccine assessments and a fuller understanding of the infection and the disease, '' said Gerhard.
Two trials instead of one would conserve resources, answer more questions, and increase the chance that at least one trial would be successful, they said.
`` The added value of faster, more informative completion of testing of the central weapon against a pandemic that threatens an exceptional number of people globally tends to be very high, '' Strom said. | science |
MALI: After ECOWAS, G5 Sahel ready to punish Mali | The presidential palace is taking baby steps to restore the ties it abruptly cut with the gas-rich emirate four years ago. [... ]
A US delegation led by the assistant secretary of state for international organisation affairs, Michele J. Sison, is scheduled to travel to Mali next week to meet with several officials in the country. [... ]
Mauritanian head of state Mohamed Ould Ghazouani, who, until now, has opted for dialogue with the regime in Mali, could change position following a recent border incident in which a number of Mauritanians lost their lives. [... ]
In a letter sent to Mali's foreign minister on 9 March, EU foreign policy chief Josep Borrell made the continuation of EU operations in Mali conditional on a strict separation from the activities of the Russian mercenary firm Wagner. [... ]
Since Africa Intelligence revealed that Bamako had been waiting more than five months for its ambassador to be accredited in Paris, this diplomatic incident has intruded itself upon the French presidential campaign, leading to heated exchanges between government spokesman Gabriel Attal and the Republican candidate Valérie Pécresse. [... ]
Togo's head of state Faure Gnassingbé made a secret visit to Bamako on 19 January to hold talks with the president of the Malian transition, Assimi Goita. [... ]
Ghana is trying to rally support from outside the ECOWAS states for the sanctions the regional body has slapped on the Malian junta. The African Union for its part met on Friday to discuss the issue. [... ]
Breaking news published on 17/12/21 at 18:00 - The French president has cancelled his trip to Mali on 20 to 21 December, in part due to the Covid-19 pandemic but mainly because both Paris and Bamako could not agree on what form the visit should take. [... ]
Chad's interim leader, who is also the current head of the G5 Sahel of which Mali is a member, is expected in Bamako by the end of the month. He hopes to dissuade coup leader Assimi Goita and the Malian junta from hiring the Russian paramilitary company Wagner. [... ]
Discreetly but insistently, France is working with its Western and African partners to prevent the junta going into partnership with Russian paramilitary group Wagner. Meanwhile, ECOWAS, egged on by Macron, is considering slapping sanctions on Mali's new leaders. [... ]
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A pioneer on the web since 1996, Africa Intelligence is the leading news site on Africa for professionals. | general |
MOROCCO: Al Mada eyes Marrakech Airport privatisation | The ICSID arbitration tribunal is due to settle a dispute between the state agency and Finetis, which operates the fibre optic network installed along motorways. The French group has close ties to the king's private secretary, Mounir al-Majidi, and his brother, the businessman Mahdi al-Majidi. [... ]
Later this month the royal holding company will present glowing 2020 figures at a shareholders ' annual general meeting, with unprecedented net profits and generous dividends. [... ]
The low-profile construction company Oulad Zerrad de Travaux Divers has won a contract to build the royal gendarmerie's Casablanca offices and is increasingly popular with the army. [... ]
On December 16th, the Moroccan Airports Authority ( ONDA) chose Equity Conseil to monitor and manage its online image. [... ]
Finance Minister Mohamed Benchaâboun has secretly instructed his favourite investment banks, Upline Corporate Finance and Attijari Corporate Finance, to structure the €4bn Mohammed VI Investment Fund which aims to revive Morocco's economy in the wake of the Covid-19 pandemic. [... ]
The minister of the economy, in the face of the coronavirus pandemic and with plans to create an entity to manage the state's public holdings, is to launch a major audit to assess the technical and financial management of the kingdom's airports. [... ]
Mohammed VI recently purchased the impressive Parisian property that previously belonged to a Saudi royal family member. [... ]
The king's private secretary, who owns GSM Al-Maghrib, Maroc Télécom mobile services exclusive distributor, is gunning for the business services market. He has also taken control of Sahatel, a dealer for the royal operator Inwi. [... ]
Controlled by Mohammed VI's former'steward ' Zouhair Fassi Fehri, Construction Management Services keeps bagging plum contracts, from renovating the opulent La Mamounia hotel in Marrakesh, to building Nareva's wind farm in Boujdour. [... ]
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A pioneer on the web since 1996, Africa Intelligence is the leading news site on Africa for professionals. | general |
Indian artists face inequalities in the NFT world, too — Quartz India | A much-discussed moment in the Indian art world’ s 2021 calendar was the October sale of La Petite Mort ( from The Orgasm Project) for $ 94,500 ( 71.7 lakh rupees) at the Sotheby’ s-Burning Man Project auction, the highest price paid until then for a non-fungible token by an Indian artist.
The NFT was of a “ phygital ” artwork created by Raghava KK ( aka NFT Punk) in collaboration with fellow artist Harshit Agrawal, neuroscience researcher Abhijeet Satani and Ben Tritt, founder of a technology-based art production company. The sold token certified ownership of both a digital representation of Raghava’ s brain activity during orgasm and a physical oil on canvas version made using a 3D painting robot.
Bengaluru-born Raghava was an early adopter of computer-based technologies in art, first engaging with them 25 years ago. When crypto rolled around, he recognised its value as an asset class. In 2017, Raghava started a project with American investor Mike Novogratz, for which he “ wrote up a vision statement, [ saying that ] essentially, if you can make an algorithm unique, it’ ll open a tsunami of value. ” Though he later moved on from the project, he continued to pursue his interest in the form now widely understood as the NFT, “ where every stakeholder [ in the blockchain ] participates. ”
The wider world learned of the term NFT in March 2021 after the sale of an artwork titled Everydays: The First 5000 Days by the artist Beeple ( aka Mike Winkelmann) for $ 69 million by the auction house Christie’ s created a furore by becoming the third most expensive by a living artist. It was heralded by some as a watershed moment in the history of art and reviled by others as the death of artistic value. What polarised public opinion was the fact that Everydays was a collage of 5,000 digital images, an NFT.
Unlike cryptocurrency, which like regular money is fungible ( i.e. any one unit can be exchanged for any other), crypto-art is analogous to fine art in that it is ostensibly a unique asset that can not be substituted by another. A certificate establishing ownership of a crypto-artwork, a non-fungible token or NFT exists as a code in a tamper-proof digital ledger or blockchain ( the most popular, including in India, is Ethereum and to a lesser extent, Polygon). Through 2021, deep into what came to be termed the “ JPEG summer “, the international contemporary art market seemed to be strafing towards a new frontier.
From the beginning, Indians were involved—the buyers of the Beeple work were Singapore-based Vignesh Sundaresan ( aka MetaKovan) and Anand Venkateswaran ( aka Twobadour), representing a “ crypto-exclusive ” fund called Metapurse. As significant as the sale appears, what immediately followed was controversy about a conflict of interest regarding Beeple’ s pre-existing 2% stake in a Metapurse crypto token, B20. What this report indicated was: the price of Metapurse’ s token shot up in response to its own massive bid on business partner Beeple’ s artwork. It’ s a quintessential NFT story involving digital art, lots of money, questionable manoeuvring and, of course, a massive amount of hype about the future.
In India, while the government wants to regulate cryptocurrency, artists, platform owners and auctioneers are hopeful about NFTs being the next horizon of Indian art, especially in the wake of the retarding effects of Covid-19. In the Indian art world too, there came something of a “ web3 winter, ” catalysed by the emergence of new crypto-art platforms, headline-making auction sales, and the emergence of influencer artists on social media.
Sandesh B Suvarna, vice-president at one of India’ s biggest crypto platforms WazirX, attributes the general craze for NFTs in India to “ an explosion of the South Asian passion economy ” during the covid-19 pandemic. Speaking specifically about art, Hari Pilaka, co-founder of White Noise, a platform launched in December 2021, cites three reasons he and his partners Parth Taco and Sajid Wajid see potential in the NFT art scene: “ We have a sizeable demographic of young artists, solid high-speed internet connectivity nationwide and rich, young collectors interested in crypto-art as stock. ”
But is the hype founded?
The NFT art market in India, like its share in the traditional global art market, is still very small and tough to track because there simply isn’ t enough data, according to Arvind Vijay Mohan, trade analyst and CEO of Artery, an asset advisory firm specialising in art. Speaking at a webinar called ‘ Decoding the NFT’ at Delhi’ s Dhoomimal Gallery, he elaborated, “ In the Indian context, NFTs have picked up a lot of young collectors. Day trading has taken off during covid-19 with the loss of jobs, and people want to diversify their portfolios. We aren’ t producing Peggy Guggenheims here. ” He reiterated this position in an interview to this writer:
“ In the Indian context, there’ s no talk as there is overseas of most expensive NFTs sold. If there were numbers of value, platforms would publicise them. So I don’ t think money is being put where mouths are…it’ s a case of the Emperor’ s New Clothes playing out. ”
Pushing back against this view are people like WazirX’ s Suvarna who believe that the blockchain model offers artists more than the gallery does. “ To buy physical art, you need to reach out to museums and galleries, ” Suvarna said. “ We have removed the entry barrier. Gallerists used to charge up to 40% whereas the platform fee is hardly 2-5%. ”
The blockchain-enabled decentralisation of art’ s production and distribution appears to promise more democratic participation, enabling more artists to easily monetise their work without having to deal with galleries and dealers. But how realistic is this claim? Who has access to this supposedly egalitarian apparatus? One aspect that came up with the artists and platforms interviewed was the issue of gas fees, the initial payment required to mint a token. The figures quoted varied widely, much like the flux of crypto market itself. WazirX is the cheapest at Rs50 because it caters mainly to Indians, though according to one artist, “ It crashes often—it’ s not built to handle large volumes of traffic and it has limited reach worldwide. ”
Discussing his own hesitation to mint, a young Indian artist speaking on condition of anonymity says that it’ s more complicated than every Indian artist with an internet connection ( and not everyone has that) suddenly being able to generate income. “ You might spend up to Rs25,000 in gas fees alone, ” he said. “ Plus, the market is very volatile and dependent on trends. There’ s no guarantee you’ ll be able to sell your work. ”
The gas price fluctuates based on the number of transactions at the time of minting, an indicator of how dynamic the market is, possibly to the detriment of the artist. Lazy minting is a process whereby the cost of minting is added to the price of the artwork, thus making it part of the buyer’ s bill. However, this lack of a filter also leads to platforms being flooded with copies. This is why WazirX doesn’ t have that feature, says Suvarna, opting instead for the methods of referral and review ( a lengthy process involving proving social media credibility and submission of a “ making of ” video) for whitelisting assets. Faridabad-based illustrator and comics maker Bhanu Pratap makes the point that the factors that influence access and success in the traditional art market, like caste, gender, and class, do so in the NFT space as well.
In 2018, as part of a two-member collective 64/1, Raghava helped mount Gradient Descent, the world’ s first Artificial Intelligence art show, at one of India’ s highest-profile galleries, Delhi’ s Nature Morte, co-directed by Aparajita Jain. Continuing her interest in the intersection of art and technology, in June 2021, Jain launched a blockchain-powered art platform called Terrain.art, straddling the trade of both physical art and crypto-art ( “ I would not call it NFT art, rather it’ s NFT-ed art. ”) Jain’ s business partner at Nature Morte, Peter Nagy, has been quoted describing NFTs as “ a charade “. Obviously, she doesn’ t agree, instead characterising the NFT era as “ a moment akin to the coming of photography. ”
She believes that NFTs have made artmaking accessible: “ NFTs do democratise the practice of art; we have artists from all over India on Terrain.art. ” She points out that in India, historically no artist gets royalty, but since NFTs are minted through smart contracts, these can be coded such that artists get a percentage each time their work is sold. But how many working artists would enjoy these benefits? As Vijay Mohan points out, few artists ever reach the point of secondary sales: “ For resale to matter, an artist needs to be in demand [ in the first place ]. [ Most of ] the guys selling NFTs—nobody even knows their names. The resale of art is usually driven by future value because of scarcity. In the case of an NFT, which is reproducible, the artist probably has years of practice ahead of him. Why pay top dollar? ”
Another advantage of these blockchained smart contracts is that at least theoretically they solve the longstanding problem of record of ownership that distinguishes fakes from authentic works. Jain explained, “ The entire NFT space is based on the idea of provenance, on giving security to the artist or buyer in perpetuity. NFTs make the process [ of establishing authenticity ] effortless. ” Terrain.art’ s trajectory seems to mirror growing confidence in this new infrastructure and form of art in India: though initially posted with each sale, Jain says that Terrain.art will soon stop issuing physical certificates of authenticity.
Pratap is sceptical, observing that NFT-ed art is forged all the same and that the blockchain can be as opaque as older forms of information. He expresses another concern: “ Even democratic spaces have security. This is not democratic. ” The crypto space in India, as elsewhere, is unregulated, by design of course since the entire point is to circumvent centralised control like big government, big banks and, in the case of NFTs, thumb a nose at ‘ big art’ ( already barely regulated). The downside to this is a lack of accountability and redressal ( except when companies want to exercise control, since the trust-based structure does tend to collapse). Pratap elucidated, “ Scams are everywhere. There is no recourse in case of data leaks [ phishing attacks ] and plagiarism [ called copyminting in the NFT community; Indian copyright law pertaining to NFTs is hazy because online anonymity shields violators. ] The first chump in this whole thing is the artist. ” He gives examples of scams, many of which have cognates in the traditional art market as well as in the West’ s NFT market: people buy their own works to drive up its price; sellers hire artists at low rates to produce tokens, exploiting their labour to earn profit. As such, leaving artists to the vagaries of the market can be disastrous in an already precarious economy.
One of the artists Terrain.art featured in its September 2021 show of physical works at Delhi’ s Bikaner House is Amrit Pal Singh, who had by November 2021 earned more than $ 1 million through the sale of NFTs over the course of nine months. He points out the broader context in which NFT success stories like his have emerged, “ There’ s been a rise in the creator’ s economy—lots of opportunities were created by NFTs, including increasing the reach of artists by 1000x. ” Singh mints his 3D series of portraits ( Toy Faces) and environments ( Toy Rooms) on foreign platforms Open Sea and Foundation and finds the blockchain to be more lucrative for artists than the traditional art market. “ Galleries aren’ t required anymore, ” Singh said. “ In terms of trends and choices, a lot of control is with the community, bringing new collectors into the space, most of whom made their money in crypto. ”
For Singh, it’ s the network of participators that holds appeal, more than the money. “ The NFT space is a very supportive community, ” he said. “ For Indian artists, the space is open. ” What about the artists who are being left out in the cold, unable to afford the initial gas fees or make sales? Of Singh’ s own experience, fees on an Ethereum-powered platforms abroad can be upwards of Rs15,000. He acceded, “ Obviously privilege is required to access the [ international ] market but I have seen a lot of junior designers and students doing it [ successfully ]. ”
Indrajit Chatterji, owner of Prinseps, the Mumbai-based auction house that in January 2022 launched India’ s first NFT auction, selling works by early 20th-century painter Gobardhan Ash, agrees that the NFT market in India is small, but he is optimistic, “ It’ s part of a natural evolution in how art is made, from cave paintings to using canvas. Not digital art, but its moment in India is still relatively nascent. ” Prinseps’ choice of art to mint was deliberate. Taking their cue from the OG NFT collectibles, the CryptoPunk collection, Chatterji accounts for the decision to sell Ash, “ The CryptoPunk avatars are created simplistically. A lot of the work Gobardhan Ash did between 1948 and 1951 was similar to avatars, displaying a certain emotion or personality trait. ”
Curating an internet persona is one of the reasons people buy NFT art. Pilaka suggests that the pandemic, when Indians got cut off from socialisation was possible only online, sped up the surge in demand for skins and avatars— ” extensions of the virtualisation of life. ” Gobardhan Ash’ s 70-year-old pieces were amenable to being deployed as part of buyers’ social media presence, making them prime NFT material.
But what happens to the question of intrinsic aesthetic value in the age of blockchain production? A lot of the art on Indian NFT platforms is plain bad, riffing off existing pop cultural forms, apparently devoid of original ideas and indistinguishable. The young artist who preferred anonymity is critical of the Indian NFT market saturated with memes and viral collectibles. “ At this point, [ most of ] it is far from fine art, ” he said. “ The templates are code-based and the human and conceptual approach is missing. The design of most NFT art is telling: it’ s an album run through with a code. They are versions of the same character, more of an investment from a collector’ s point of view. ”
Pratap too finds the dominant NFT aesthetic of “ the flat avatar, thumbnails and tiles ” on Indian platform to be fungible. “ It’ s hard to discern the qualitative features—there’ s no affect to the works, ” he said. “ Even from an artistic perspective, it’ s tough to embrace NFTs. People are buying storage space, not art. ” In the webinar, Vijay Mohan compares the majority of it to Clip Art. In the interview, he draws parallels between NFTs and “ mediocre art of the 2000s. ” A question arises about commoditisation and the link between the aesthetics and the political economy of NFT art in India, seemingly oriented towards investors rather than art makers and lovers.
Of course, this discourse is hardly new or exclusive to crypto-art. As Prinsep’ s Chatterji notes, “ Art has always been an [ investment ] asset the world over, we’ re not doing anything different in India. NFTs are a gamechanger because they convert art into a stock that can be traded within seconds. ” Despite the repeated characterisation of NFTs and crypto-art in India as “ disruptive, ” is it simply the next phase of a long-standing trajectory in India since the late 20th century, of the securitisation of art as an investment, culminating in the art boom of the 2000s? While Vijay Mohan agrees that there are similarities in terms of driving factors, Terrain.art’ s Aparajita Jain doesn’ t think so. “ There was no securitisation [ back then ], just lots of punting, ” she said. “ This [ now ] is backed by the blockchain. ” But the blockchain can only guarantee information. For value to be generated, the token has to be tethered to an actual asset with limited reserves, as it is with other commodities like precious minerals and physical fine art ( which there was in the 2000s).
In fact, one of the chief criticisms of crypto is ecological ( and therefore economic): unsustainable amounts of electricity must be generated in order to power servers that mine crypto, its scarcity consequently creating value for digital assets. Incentives to offset carbon footprints and other models of mining seem like greenwashing attempts to appease the conscience of individual consumers and reward the wealthy. Pratap does spot a pattern similar to the early-stage securitisation of art in India, albeit “ with a Web 2.0 spin. Back then it was some industrialist [ profiting off the art ], now it’ s a tech firm manager. The worrying part is the combination—the fine art grift, the fintech scams, and the gullible people. ” The very fact that auctions are being held suggests that NFTs are all too compatible with, and comfortably folded into, the very infrastructure they ostensibly seek to challenge.
For now, NFTs are not considered securities in India and are not governed by relevant laws. But given the Securities and Exchange Board of India’ s history of shutting down art funds in the 2000s that were similar to fractionalised NFTs ( shared ownership of a token), the jury is still out on what their regulatory future might look like.
In the meantime, the debate around what it means to own a work that can be right-clicked and saved by anyone else will continue to rage.
This post was originally published on Scroll.in. We welcome your comments at ideas.india @ qz.com. | tech |
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Russia’ s war in Ukraine threatens global crude supplies, but a resurgence of the coronavirus in China is curbing demand as the United States and other countries prepare to release oil from strategic reserves. The result: volatile prices.
Brent crude prices on Tuesday climbed more than 6% to about $ 104/bbl intraday following OPEC Secretary General Mohammad Barkindo’ s warning in a speech that the war could ultimately cut much deeper into global supplies.
“ We could potentially see the loss of more than 7 million b/d of Russian oil and other liquids exports, resulting from current and future sanctions or other voluntary actions, ” he told European Union ( EU) members. “ Considering the current demand outlook, it would be nearly impossible to replace a loss in volumes of this magnitude. ”
OPEC on Tuesday also officially slashed its expectations for both 2022 oil production and demand, with researchers emphasizing heightened uncertainty on both fronts.
The day marked another in a string of sharp turns for the oil market.
Brent prices, the international benchmark, hovered near $ 130/bbl at its 2022 peak in March, when fallout from economic sanctions against Russia ignited supply/demand imbalance fears. In protest of Russia’ s invasion of Ukraine, the United States banned imports of Kremlin-backed oil, and other countries followed suit, pushing more than 1 million b/d off the international market.
“ It was evident that replacing so much oil would be a massive undertaking, ” said Societe Generale Group’ s Michael Haigh, head of commodities research. However, “ prices pulled back amid demand concerns on the back of a rise in coronavirus cases, especially in China, which was experiencing the worst Covid-19 outbreak in two years. ”
Indeed, by Monday, the Brent June contract had dropped well below $ 100, as supplies destined for China were put on hold amid a pandemic rebound in Shanghai, China’ s largest city, and other markets in the country. China is the world’ s largest oil importer. Shanghai and other Chinese cities were locked down in recent weeks, limiting mobility and diminishing the need for oil-based travel fuels.
Despite the restrictions, Chinese officials reported more than 26,000 new daily infections in Shanghai on Sunday, a record for the city.
At the same time, virus cases have mounted anew in parts of Europe. U.S. officials have cautioned that the new fast-spreading Covid subvariant had begun to impact Americans this spring, creating a wild card as weather warms and travel usually picks up ahead of summer.
In the United States, there were more than 31,000 new virus cases reported at the start of this week, up about 3% from two weeks earlier, according to federal data. In some major cities on the East Coast, though, cases jumped more dramatically in the same span. In New York City, for example, cases were up more than 40%, driven by the highly contagious Omicron subvariant BA.2 and eased restrictions, said Anthony Fauci, chief medical adviser to the White House. Cases spiked more than 70% in Washington, DC.
If more increases follow, “ particularly of hospitalizations, we may need to revert back to being more careful and having more utilizations of masks indoors, ” Fauci said during an interview this week on ABC.
Already, on Monday, the City of Philadelphia said it would reinstitute an indoor mask mandate, affecting everything from schools to restaurants.
The latest variant has proven far less lethal than earlier strains of the virus – at least in part because of inoculation campaigns. Yet, one-third of the U.S. population is not fully vaccinated and therefore highly susceptible to illness caused by the Omicron subvariant, according to the Centers for Disease Control and Prevention.
At the same time, the United States and allied countries in the West committed to releasing 240 million bbl of oil from strategic reserves this year to offset the impacts of sanctions against Russia. President Biden vowed to unleash 1 million b/d from the U.S. Strategic Petroleum Reserve for the next six months, while other countries collectively promised to release 60 million bbl as part of a plan overseen by the International Energy Agency ( IEA).
“ The release of strategic government oil reserves should ease some market tightness over the coming months, reducing the need for oil prices to rise to trigger near-term demand destruction, ” said UBS Group AG strategist Giovanni Staunovo.
The Swiss investment bank UBS lowered its June Brent forecast by $ 10, though it still expects prices to reach $ 115/bbl this summer.
Other analysts also lowered expectations but from lofty levels. Bank of America ( BofA) maintained its expectation for Brent to average $ 102 over the course of this year and next, but the firm cut its summer spike price to $ 120 from $ 150.
“ The release of strategic government oil stocks and the rolling Covid-19 lockdowns in China have altered the oil price trajectory, ” the BofA team said.
Paris-based IEA said the releases from strategic stockpiles would cover much of the Russian shortfalls for a few months – barring further reductions.
However, on top of formal sanctions, IEA estimated that, because of a combination of pandemic hits to consumption and growing international revolts against Moscow’ s war in Ukraine, Russia may have to scale production back by 3 million b/d because of a lack of buyers. The EU is reportedly considering plans for a possible embargo on Russian oil should the war drag on.
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Against that backdrop, markets are watching closely for changes in both U.S. production and output from OPEC and its allies known as OPEC-plus.
U.S. production for the week ended April 1 ticked up to 11.8 million b/d – a 2022 high — after holding at 11.6 million b/d through most of February and March. Output, however, remains more than 1 million b/d below pre-pandemic highs.
American producers have been under pressure to increase crude supplies because of the war. Still, amid soaring inflation, they have been constrained by high labor and input costs. They also are under pressure from investors to divert spending away from fossil fuels and toward green energy.
OPEC-plus, meanwhile, recently agreed to extend monthly production increases of about 400,000 b/d into May. This has been policy since last August, and it sets a measured pace that gradually unwinds production cuts of nearly 10 million b/d made in April 2020 amid the pandemic.
OPEC researchers on Tuesday lowered their forecasts for both global oil demand and production in 2022, citing lighter economic growth and the Russia-Ukraine conflict. The cartel said consumption this year would grow by 3.7 million b/d to 100.5 million b/d, though that was about 500,000 b/d lower than its outlook last month.
The researchers said supplies from outside of OPEC-plus would rise by 2.7 million b/d this year. The latest forecast is about 300,000 b/d lower than the prior outlook. They said the war had cut into supplies in the wake of sanctions but also exacerbated inflation to a point that demand is tapering demand in some corners of the world.
OPEC cut its forecasts for global economic growth for the year to 3.9% from 4.2% in its earlier assessment, citing energy-driven inflation.
The outlook also “ takes into account the impact of the conflict in Eastern Europe, as well as the ongoing effects from the pandemic, with the risks skewed to the downside, ” the cartel’ s researchers said.
The U.S. Labor Department on Tuesday said the consumer-price index in March climbed at its fastest annual pace since December 1981 – 8.5%. That was up from 7.9% the previous month. Inflation has exceeded 6% for six consecutive months, which is the Federal Reserve’ s targeted 2% rate.
The Fed in March raised interest rates to tamp down spending and curb inflation. It signaled several more rate hikes were likely this year.
Rising rates would address inflation but also present new risk of stunting economic growth, OPEC researchers noted.
Holding the line on production may prove wise, given the developments in China and inflation. However, if the EU were to ban Russian oil, the supply/demand dynamic could shift substantially, according to Rystad Energy.
“ It is estimated that up to 2 million b/d of additional Russian crude production may be lost if the EU bans Russian oil, ” Rystad’ s Claudio Galimberti, senior vice president of analysis.
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“ If I’ m Out of Insulin, I’ m Going to Die ”: United States’ Lack of Regulation Fuels Crisis of Unaffordable Insulin | Help us continue to fight human rights abuses. Please give now to support our work
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Download the full report in English
Annex: Human Rights Watch correspondence
Download the full report in English
Annex: Human Rights Watch correspondence
United States’ Lack of Regulation Fuels Crisis of Unaffordable Insulin
Zoe Witt, a type 1 diabetic in Seattle, Washington, holds a 10-milliliter vial of Novolog, a name-brand insulin analog produced by the Danish company Novo Nordisk. © 2022 Bella Petro
In the United States, access to lifesaving medication is a privilege that many can not afford. Soaring medicine prices and inadequate health insurance coverage can result in unaffordable out-of-pocket costs that undermine the right to health, drive people into financial distress and debt, and disproportionately impact people who are socially and economically marginalized, reinforcing existing forms of structural discrimination.
“ We almost lost my sister, ” Sa’ Ra Skipper, 25, of Indianapolis, Indiana, told Human Rights Watch in June 2021. “ That was a really tough time, to see my sister lying in a hospital bed because she was just trying to help me out... she kept me alive. ”
In 2018, Skipper was working a job with health insurance that did not cover the insulin she needed, leaving her with monthly out-of-pocket costs of about $ 1,000. “ How is somebody supposed to afford that? ” she asked. “ I wasn’ t able to. ”
At the time, Skipper’ s sister, who also has diabetes, worked a lower-paying job and received free insulin from Medicaid, the US public health insurance program for people with low income. “ [ She ] was giving me insulin, ” Skipper explained. “ We were sharing insulin out of the same vial... I felt like I was taking from her.... But the system [ didn’ t ] give me any other choice but to make me live this way. ”
One night, Skipper took her nighttime dose of insulin and left the vial on the dresser for her sister to see. But her sister, unsure of whether Skipper had taken hers, took less than her normal dose to make sure that there was enough left. The next day, Skipper’ s sister went into diabetic ketoacidosis, a potentially lethal complication of high blood sugar, and had to be hospitalized for four days. “ She almost went into a diabetic coma. ”
“ They know that people are dying, that people can’ t afford this, ” Skipper told Human Rights Watch, speaking about the companies that manufacture the analog insulins upon which she and her sister depend.
As Skipper’ s story shows, people with chronic health conditions who depend on life-saving medication, such as many people with diabetes, are especially vulnerable to the human rights impacts of unaffordable medicine. As part of ongoing research into growing healthcare costs, medical debt, and abusive debt collection practices in the US, this report uses diabetes and access to insulin to describe how US authorities’ regulatory failures have allowed for a crisis of unaffordable drug prices.
As of 2018, nearly 27 million adults in the US have been diagnosed with diabetes, and approximately 8.2 million adults use one or more formulations of insulin to regulate their blood sugar. Without it, people who require insulin may experience high blood sugar, or hyperglycemia, which can lead to serious and even life-threatening complications.
Left unchecked, high blood sugar can kill. In the US, diabetes is the seventh leading cause of death and is the leading cause of renal failure, lower limb amputation, and blindness among adults. Diabetes increases risk of mortality from infections, cardiovascular disease, stroke, chronic kidney disease, chronic liver disease, Covid-19, and cancer, and has the second biggest negative total effect on reducing health-adjusted life expectancy worldwide.
Before the technique for extracting insulin from an animal’ s pancreas was discovered in 1921, children with diabetes rarely survived longer than a year after their diagnosis. Over the years, pharmaceutical manufacturers have produced insulin and found ways to improve its effectiveness as a tool for the treatment of diabetes.
But in the US, the most commonly prescribed forms of this lifesaving drug can cost a person more than $ 300 for a single vial, easily adding up to more than $ 1,000 a month if they do not have adequate health insurance coverage. As the experiences documented in this report show, the high cost of insulin in the US is not just paid in dollars, but with health, lives, and livelihoods.
The cost of insulin—what an individual must pay to acquire it—is a result of two factors: ( i) the price for the drug, and ( ii) the degree to which that price is lessened, whether by insurance, charitable assistance, or other forms of cost mitigation.
Based on interviews with 31 people with chronic health conditions about their experiences with the healthcare system, including 18 who have insulin-dependent diabetes, this report focuses on the first factor—the cost of the drug. Drawing from interviews with people who require insulin and experts, extensive data analyses, and secondary literature review, this report describes the human rights impacts of policies that allow drug manufacturers and pharmacies to sell this life-saving medication at unaffordable prices. Forthcoming research will explore the second factor, drawing from interviews with people with chronic health conditions to describe how profound flaws in the health insurance system in the US undermine access to life-saving health care and contribute to the destructive medical debt that affects millions.
The high price of insulin has drawn increased scrutiny of insulin manufacturers’ practices by advocates, lawmakers, and law enforcement officials in recent years. Less discussed, however, has been how the lack of federal regulation has allowed this to occur. As the US Congress considers potential reforms to the system of drug pricing in the US, this report outlines the necessary components of a rights-respecting, drug price-setting system and explores the catastrophic costs of inaction, highlighting the profound impacts of high insulin prices on the lives and human rights of people who require insulin.
Human Rights Watch conducted price analyses of three of the most widely used insulin analogs: Humalog, Novolog, and Lantus. Each of these drugs is produced by one of the three multinational pharmaceutical manufacturers that collectively dominate the global market for insulin, respectively: the US-based company, Eli Lilly; the Danish company, Novo Nordisk; and the French company, Sanofi.
In the US, the prices these manufacturers have set for these drugs—so-called list prices—have soared since their introduction to the market in the late 1990s and early 2000s.
Human Rights Watch analyzed publicly available price information and found that, when adjusted for inflation, Eli Lilly’ s list price for Humalog increased by about 680 percent, to $ 275 per vial in 2018, since it first began selling in the US in 1996. The inflation-adjusted list price for Novo Nordisk’ s Novolog rose about 403 percent, to about $ 289 per vial, between its market entry in 2000 and 2018. Similarly, Sanofi’ s list price for Lantus rose about 420 percent when adjusted for inflation since its US market entry in 2000, to about $ 276 per vial in 2019.
In recent years, these rapid list price increases have slowed or ceased, in a context of increased scrutiny by policymakers, patients, advocates, and the media. But Human Rights Watch found that these still-high list prices have driven up out-of-pocket costs and have adversely impacted the lives of people who require insulin, especially those lacking access to effective cost-mitigation through health insurance or charitable aid.
Almost every insulin-dependent person Human Rights Watch interviewed said they had rationed analog insulin because of out-of-pocket costs, taking it in ways not recommended by their physician in order to stretch their supply. As Skipper’ s story and others in this report show, insulin rationing can have damaging and potentially deadly consequences.
High out-of-pocket costs for essential medicines like analog insulin have an inherently regressive impact. All other factors being equal, people with less wealth must pay a much higher share of their income to satisfy equal medicinal needs than wealthier people. In turn, this disproportionate impact can negatively affect the standard of living for people who require insulin, as the money needed to acquire this lifesaving medicine can come at the expense of food, rent, and secure living conditions.
But even people with incomes that do not place them among the lowest paid workers in the country can find themselves unable to afford this lifesaving medicine.
Some of the most economically vulnerable people in the US may qualify for Medicaid, the income-based public health insurance program, or private charitable assistance programs, such as those funded by insulin manufacturers. However, income-based eligibility requirements for these programs can exclude low-income people who may earn too much to qualify, but not enough to afford, private health insurance or the cost of their medicines.
To qualify for Medicaid in 2021, a single person without dependents would need to earn below $ 17,774 in most states. But in the 12 states that have not adopted the 2010 Affordable Care Act so-called Medicaid expansion, no single-person households without dependents are eligible for this crucial safety net program. More than 2 million uninsured adults fall into this coverage gap nationwide, which disproportionately impacts Black, Indigenous, and other communities of color.
Communities and individuals marginalized from social, political, and economic power in the US are disproportionately impacted both by diabetes and its negative health outcomes. For example, according to 2016 data from the Centers for Disease Control and Prevention, about 356 people with diabetes underwent a lower-limb amputation every day in the US. Black adults in the US, however, were more than twice as likely to experience a diabetes-related amputation than white adults.
Similarly, a 2017 Yale Diabetes Center survey of 199 people with either type 1 or type 2 diabetes in Connecticut found that one-in-five white respondents rationed insulin in the past year, but were 18 percent less likely to ration insulin than the average. Both Latino/Hispanic and Black respondents, however, were more likely to ration insulin than the average, respectively about 10 and 22 percent more likely.
For many people, charitable initiatives funded by insulin manufacturers are a last line of defense against the high costs of these manufacturers’ products. But eligibility for their programs is limited, typically to US citizens or permanent residents who lack health insurance coverage for medications and have a household income at or below 400 percent of the Federal Poverty Level, or about $ 51,000 for a single individual.
While these manufacturer-funded initiatives can help lessen the burden of these manufacturers’ high insulin prices for some individuals, they do not present a universal nor sustainable model for addressing cost-related access issues and have clearly fallen short of preventing widespread insulin rationing because of cost.
Additionally, public and private financial assistance programs often restrict aid to US citizens or permanent residents, excluding both documented and undocumented immigrants, many of whom come from communities where diabetes is especially prevalent. Undocumented immigrants are already more than four times more likely to be uninsured than US citizens and are accordingly especially vulnerable to the harmful human rights impact of unaffordable insulin prices.
People who require lifesaving medicines like insulin will pay what they must to survive, regardless of its price. Or, as some of the experiences described in this report show, they will pay for as much as they can afford and hope not to die.
The drivers of the high prices for analog insulin in the US are clear. Since the 1984 Drug Price Competition and Patent Term Restoration Act, which established the modern system of federal drug regulations, pharmaceutical innovation and access in the US have relied on the premise that innovative drugs are rewarded with high prices during their window of patent protection, with generic competition quickly reducing prices thereafter.
In contrast to most other countries, the US does not directly regulate drug prices. There are no regulations in place that define a fair price for medicines before they enter the market or restrict how much manufacturers or intermediaries can increase their prices once they do.
Numerous studies have found that the US is an outlier regarding per capita spending on prescription drugs when compared with other high- and middle-income countries. For example, the US House of Representatives Ways and Means Committee analyzed international drug price data from 2017 and 2018 and found that insulin averaged $ 34.75 per dose in the US, compared to an average of $ 10.58 per dose in 11 other high-income countries. According to this study, Humalog’ s price was 294 percent higher per dose in the US than the international average, Novolog’ s was more than 320 percent higher, and Lantus’ was 75 percent higher.
Although unregulated pricing practices allow drug manufacturers to set very high prices, pharmaceutical manufacturers are not the sole drivers of unaffordability. A complicated web of intermediaries in the supply chain between a drug’ s manufacturer and purchaser contribute to the cost that individuals with insulin needs must bear to access their essential medicine.
In particular, the opaque system of rebates from drug manufacturers to pharmacy benefit managers ( PBM), powerful gatekeepers to health insurance companies’ drug formularies, appears to have created an upward pressure on insulin prices in past years. Manufacturers can lose access to large shares of the US market if their drug is excluded from or given restricted placement on these drug formularies, which service millions of people covered by health insurance plans. As a result, manufacturers of similar types of drugs, such as analog insulin, have competed to ensure that PBMs give their products beneficial placement.
But this competition is done through a largely unseen system of rebates: a negotiated cash payment, calculated as a percentage of the drug’ s list price, made by drug manufacturers to the PBMs and the health plans they represent for purchase of their product. This rebate system has allowed insulin manufacturers to compete over the years without sacrificing revenue or lowering the list price of medicines. To offer more generous rebates than their competitors without impacting their bottom line, manufacturers can simply increase the list price for their products.
Some people with health insurance may have never noticed the rapid list price increases documented in this report. But people without insurance or with inadequate insurance, who are much more likely to be from marginalized communities and working low-income jobs, may have had no choice but to bear the burden of their medicine’ s ever-increasing cost.
Seen together, this system creates a sequence of regressive subsidies. First, the absence of drug pricing regulations in the US allows insulin manufacturers to price their products far above what is allowed in peer-income countries. Second, within the US, the system of rebates effectively forces many economically vulnerable under- and uninsured people, who do not benefit from any potential discounts stemming from rebates, to subsidize both drug manufacturers’ revenues and other people’ s insurance premiums.
Unregulated pharmaceutical pricing in the US and market practices that incentivize price increases can result in out-of-pocket costs for essential medicines that are so expensive as to undermine their equal and affordable access, a cornerstone of the human right to health. This dynamic disproportionately impacts people based on their economic status and within that group further disadvantages particular racial and ethnic groups in violation of domestic and international law prohibiting discrimination.
The Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights ( ICESCR), which the US has signed but not ratified, affirm that governments are obligated to ensure that health care, including the provision of essential drugs as determined by the World Health Organization, is accessible to everyone without discrimination and affordable for all. This duty extends to preventing and protecting against human rights harms caused by businesses and other non-state actors, and may include or require effective regulation of their activities.
The International Covenant on Civil and Political Rights ( ICCPR), which the US has ratified, and the ICESCR prohibit discrimination based on race, property or other status. The International Convention on the Elimination of All Forms of Racial Discrimination ( ICERD), which the US has ratified, also includes specific prohibitions on discrimination based on race, ethnicity, and national origin, among other statuses. Under the ICERD, governments are obligated to act affirmatively to prevent or end policies with unjustified discriminatory racial impacts or effects.
Additionally, the Convention on the Rights of Persons with Disabilities ( CRPD), which the US has signed but not ratified, both affirms the right to health for people with disabilities and obligates states to provide health services to people with disabilities to minimize and prevent the development of further disabilities. As described in this report, widespread cost-based insulin rationing can contribute to the development of long-term disabilities, such as blindness.
The continued failure of the US government to implement policies to prevent the price increases documented in this report, combined with its failure to take other necessary steps to mitigate healthcare costs, undermines equal and affordable access to insulin analogs, contributes to cost-based medicine rationing, contravenes the right to health, and may be inconsistent with its obligations as a signatory to the ICESCR and CRPD to refrain from acts that would defeat these treaties’ object and purpose.
Companies also have a responsibility under the United Nations Guiding Principles on Business and Human Rights to respect human rights and ensure that their practices do not cause or contribute to human rights abuses. Fundamental to this responsibility is the requirement that companies carry out human rights due diligence to identify the possible, and actual, human rights effects of their operations and establish meaningful processes to prevent, mitigate, and remediate harm when it occurs.
This responsibility extends to all actors in the supply chain between drug manufacturers and consumers, which should address policies and practices that contribute to out-of-pocket costs for insulin that undermine equal and affordable access to the drug.
The US Congress should enact federal legislation to ensure that essential medications like insulin are, in practice, affordable to all people in the United States who need it, regardless of insurance, wealth, or citizenship status.
Congress should consider legislation to provide insulin to all insulin-dependent individuals in the country free-of-cost. But in the absence of such legislation, and given the inevitability of coverage gaps in existing health insurance systems, Congress should consider legislation to lower and regulate the prices for essential medications like insulin to levels that ensure affordable access and eliminate the de facto discriminatory impacts of drug prices on marginalized groups in the country.
Specifically, in consultation with key stakeholders, the US Congress should draft and enact legislation addressing the many profound flaws with the drug pricing system described in this report, including, among other things: establishing a consultative system to define the fair price for a drug before it enters the market; limiting how much manufacturers and intermediaries can increase the prices of their drugs after drugs enter the market; limiting the price-increasing influence of common industry practices like rebates and discounts; reforming the pharmaceutical patent system to limit abuse and provide for greater access to generics; and increasing transparency throughout the sector.
Federal departments, including the Department of Health and Human Services and Department of Commerce, and relevant agencies, such as the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Food and Drug Administration, and the Patent and Trademark Office, should also implement policies that will help lower prices for lifesaving medications like insulin to levels that ensure their affordable access.
“ We are the wealthiest country in the world, but people have to go without medication, ” said 29-year-old Emily Grant of Dallas, Texas, discussing the cost of her insulin. “ [ T ] here’ s nothing I can do about the trajectory of my illness except follow the treatment plans my doctors tell me. And I don’ t think it’ s okay to say, ‘ Oh well, you either afford it or you die.’ ”
Analog Insulin
A type of insulin that is genetically modified to alter its function within the body and more closely mimic insulin produced by the pancreas.
Authorized Generics
A non-branded version of a branded drug, produced by the same manufacturer as the branded drug.
Biologic
A type of drug composed of generally large, complex molecules that is often produced within a living organism or contains components of living organisms.
Biosimilar
A biologic drug that is highly similar to and has no clinically meaningful differences from an existing branded biologic drug approved by the FDA. Biosimilars are similar to generics but may require additional regulatory approval to be considered interchangeable with a branded biologic.
Copay
A payment made by a patient with health insurance at the point of sale for a covered service, usually a percentage of the overall cost, as defined by the terms of their health plan.
Deductible
A specific amount that an insured individual must pay out of pocket towards a specific service before their health insurance provider will begin to provide coverage for that service.
Diabetes
A chronic health condition that affects how the body produces or responds to the hormone insulin, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine.
FDA
The Food and Drug Administration, a federal agency of the US government that, among other things, regulates the safety and quality of food and medicines in the United States.
Follow-on
A copy of a branded, FDA-approved biologic drug produced by a different manufacturer. If a follow-on version of a biologic drug meets additional requirements, it can become a biosimilar. If a biosimilar meets additional requirements, it can be deemed interchangeable with the original, branded biologic drug.
Formulary
A list of medicines covered under a health insurance plan, often grouped into tiers that define different levels of cost-sharing.
Generics
A medication created to be the same as an already-marketed, branded drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use.
Insulin
A hormone produced within the pancreas of mammals that facilitates the transfer of glucose from the bloodstream into cells. This process is disrupted for people with diabetes, whose bodies may not produce or be resistant to the effects of insulin.
Interchangeable
A drug that is eligible under FDA regulations to be substituted by a pharmacist for its name brand version without the need for a different prescription, much like how generic drugs are routinely substituted for brand name drugs. This kind of pharmacy-level substitution is subject to state pharmacy laws.
List Price
The price manufacturers set for their medicine, also sometimes called the wholesale acquisition cost.
Net Price
The actual amount that a drug manufacturer receives from the downstream sale of a product they have made.
Rebate
A discount paid to the health insurance company from a manufacturer after the patient has received their medication.
Retail Price
The price for a drug from a pharmacy if someone pays out of pocket, without any form of cost mitigation, like coupons, discounts, health insurance, or other payment assistance.
Synthetic Insulin
Human insulin manufactured by inserting the insulin gene into bacteria, which are then farmed and harvested.
Type 1 Diabetes
An auto-immune, chronic condition in which the pancreas no longer produces any or sufficient insulin.
Type 2 Diabetes
A chronic condition in which the pancreas does not produce enough insulin and/or cells respond differently to insulin in a way that disrupts the metabolism of sugars.
Overarching Recommendation: Reform the US health and drug pricing systems to ensure that essential medicines, including analog insulin, are affordable to all people who need them in the United States, whether through effective regulation of drug pricing or through meaningful cost mitigation and health insurance coverage. In particular, consider legislation to provide insulin to all insulin-dependent individuals in the country free-of-cost. In the absence of such legislation, promptly:
This report is based on interviews, data analysis, and other secondary research conducted between March and July 2021 as a part of ongoing research into growing healthcare costs, medical debt, and abusive debt collection practices in the United States.
Human Rights Watch interviewed a total of 50 people in the US for this research, including 31 individuals with chronic health conditions. The remaining 19 were experienced professionals or activists including practicing physicians; researchers or organizers from nonprofit healthcare access advocacy organizations; academic researchers covering domestic and international healthcare economics, drug pricing, and insulin access; a reporter covering medical debt; and a hospital administrator.
Of the 31 people with chronic illnesses with whom we spoke:
Most interviews with people who require insulin were arranged with help from partner organizations, including Patients for Affordable Drugs, T1International, and Mutual Aid Diabetes. These interviews reflect a range of personal experiences shaped by different state policy environments, private and public insurance programs, income levels, and racial, gender, or sexual identities.
This report focuses on the experiences shared by the 18 people with whom we spoke who depend on insulin to regulate their blood sugar. However, many of the concerns covered in this report that contribute to issues of access and affordability for insulin, including US policy regarding drug pricing, are relevant to, and consistent with, the experiences of each of the 25 medicine-dependent people Human Rights Watch interviewed.
All those interviewed provided verbal informed consent to participate and to have their names and the contents of their interviews reproduced. Where relevant, some individuals requested anonymity to discuss certain subjects. Human Rights Watch notes such incidences in the footnotes of this report when citing to these interviews. No person interviewed received any compensation for their participation.
The number of people we interviewed who require insulin does not constitute a representative sample of all people with insulin-dependent diabetes nationwide. However, their experience is consistent with independent studies, extensive secondary research and data analysis that support a pattern of problems discussed in the report, providing insights for much-needed regulatory reforms.
Because of the Covid-19 pandemic, all interviews were conducted remotely by videoconference or telephone. Every interview was individual, except for two group interviews: one with two individuals who work with the organization, Mutual Aid Diabetes, both of whom have type 1 diabetes; and one with two researchers from a US-based medical school, who are among the 19 professionals consulted for this research.
In addition to interviews, this report draws extensively on publicly available secondary sources of information to corroborate and interpret the experiences of those with whom we spoke, including reports from nongovernmental organizations, federal investigations, publicly released and redacted internal company documents, government and academic studies, publicly available data from federal departments and agencies, medical literature, and relevant local and national reporting. Where relevant, the methodology for charts and data are explained in the footnotes.
Human Rights Watch also conducted price analyses of three of the most widely used insulin analogs: Humalog, Novolog, and Lantus. Each of these drugs is produced by one of the “ Big Three ” multinational pharmaceutical manufacturers that together control 96 percent of the global market for insulin by volume: the US-based company, Eli Lilly; the Danish company, Novo Nordisk; and the French company, Sanofi. The price analysis component of our research covers these three brands because these were most commonly used and raised by interviewees. Where interviewees or literature discussed other available synthetic human insulins, Human Rights Watch explicitly notes that in the relevant section.
Almost every person with diabetes whom we interviewed was currently using, or had previously used, either Humalog or Novolog, two of the three insulins included in this report, with many having switched between them at some point because of changes in health insurance coverage. Five were currently using or had previously used Lantus, a third brand of insulin that is included in our study.
Human Rights Watch wrote letters to six large companies involved in the insulin supply chain: three manufacturers of the insulins covered in this report, Eli Lilly and Company, Novo Nordisk, and Sanofi; and the three largest pharmacy benefit managers in the United States at time of writing, CVS Health, OptumRx ( owned by UnitedHealth Group), and Express Scripts ( owned by Cigna). These letters requested information and clarification regarding their practices. Of the six companies we contacted, five provided written responses, including all three manufacturers. Their responses are reflected throughout the report, including in some places to provide important contextual information about industry policies and practices. The complete correspondence with these six companies can be found in an online Annex to this report.
Throughout this report, we also cite to publicly available information provided by these companies, both regular public disclosures and internal documents released following a 2020 Senate Finance Committee investigation.
No matter what, you have to pay your rent first. But if I’ m out of insulin, I’ m going to die. So, I stopped paying rent and got evicted. I was homeless. But I never slept on the streets—I was staying with people. But I didn’ t have a legal residence for a few years. [ 1 ]
Zoe Witt of Seattle, Washington, left a salaried job with health insurance that covered her insulin needs in 2018 because of the work’ s impact on her mental health. “ I was suicidal, and I knew I needed to quit the job, ” she said. “ I quit, which I had never done before because I’ m a diabetic and I need health insurance. ” [ 2 ]
Soon after, she found work as a host in a restaurant, earning about US $ 13 an hour plus tips. But the position did not include health insurance coverage. Despite picking up extra shifts and working overtime, Zoe’ s take-home pay was about $ 2,200 a month, making her ineligible for Washington State’ s Medicaid program. [ 3 ] But after paying for rent in a high-cost-of-living area, student loans, utilities, credit card debt, and food, Zoe could not afford to purchase private health insurance either.
Witt told Human Rights Watch that each month she required one vial of both Lantus and Novolog, two commonly prescribed brands of analog insulin. But without insurance, the out-of-pocket cost for her prescribed insulin was about $ 600 a month, more than a quarter of her take-home pay at that time. [ 4 ] So, Witt started stretching her medication and using expired insulin:
Her out-of-pocket costs for insulin began to add up. Zoe skipped paying rent to afford her medication, got evicted, and moved in with acquaintances. This continued for almost a year before she was offered a promotion to a position that paid $ 19 an hour, which allowed her to purchase health insurance. [ 6 ]
But the impacts of insulin rationing can be long-lasting. [ 7 ] Only months after speaking with Human Rights Watch, Zoe had surgery for an advanced form of diabetic retinopathy and a partially detached retina, common complications of prolonged high blood sugar. [ 8 ]
Witt’ s story shows some of the struggles that people with insulin-dependent diabetes can experience when their insulin is unaffordable. Lack of affordability endangers their lives and health and deeply impacts their choice of career, performance at work, housing, and overall standard of living.
As of 2018, nearly 27 million adults in the United States have been diagnosed with diabetes, and approximately 8.2 million adults—about 2.5 percent of the total population—use one or more formulations of insulin to regulate their blood sugar. [ 9 ] Diabetes disrupts how insulin, a naturally occurring hormone produced by the pancreas, transfers glucose from the blood stream into cells. [ 10 ] Type 1 diabetes ( T1D) is an auto-immune condition in which the pancreas no longer produces any or sufficient insulin. [ 11 ] Type 2 diabetes ( T2D), which affects more than 90 percent of people diagnosed with diabetes in the US, occurs when the body is either resistant to the effects of insulin or does not produce enough. [ 12 ]
Many people with T2D and all people with T1D depend on externally supplied insulin. Without it, people who require insulin may experience high blood sugar, or hyperglycemia, which can lead to serious and even life-threatening complications. [ 13 ] Left unchecked, high blood sugar can kill. [ 14 ]
Diabetes is one of the top 10 causes of death around the world and insulin access and affordability is an urgent concern for millions of people living in lower- and middle-income countries. [ 15 ] But despite the immense wealth and pharmaceutical production capacity of the US, the country severely underperforms relative to high-income peer nations at ensuring that the medicines needed to effectively manage this disease are affordable. [ 16 ]
Since their introduction in the mid-1990s, genetically engineered human insulin analogs ( analog insulin) have become the dominant type of insulin prescribed and used in the US, accounting for more than 80 to 90 percent of insulin units used in recent years. [ 17 ] Whether analog insulins are generally more effective than older insulins remains a subject of debate in medical literature reviewed by Human Rights Watch, particularly when their cost is considered, but they are far more convenient for patients to regularly use. [ 18 ]
Three of the most common name-brand analog insulins are each made by a different manufacturer: Humalog ( insulin lispro), made by the US-based Eli Lilly; Novolog ( insulin aspart), made by the Denmark-based Novo Nordisk; and Lantus ( insulin glargine), made by the France-based Sanofi. [ 19 ]
Humalog and Novolog are known as rapid-acting insulins, which quickly reduce blood sugar once introduced into the bloodstream. [ 20 ] Lantus is prescribed as a long-acting insulin, which can regulate blood sugars for up to 24 hours and is often used alongside other faster-acting insulins. [ 21 ]
These analog insulins are the flagship insulin products for each of these three companies, which controlled 99 percent of the global human insulin market by value and 96 percent of the market by volume in 2016. [ 22 ]
Purchasing these drugs from a pharmacy without adequate health insurance coverage or charitable aid in the US can cost more than $ 300 for a single vial out-of-pocket. But patients with T1D typically require two or three vials of insulin per month, and some patients who are more resistant to insulin, including some with T2D, may need up to six or more vials per month. [ 23 ] As described below, these out-of-pocket costs are largely driven by insulin manufacturers’ list prices, which the government does not regulate.
In the US, drug prices are not static, but vary day-to-day, place-to-place and person-to-person. When someone goes to a pharmacy to purchase a drug that is medically prescribed, the out-of-pocket price they must pay for that drug can be influenced by a complicated web of contractual relationships, discounts, and rebates between numerous private intermediaries involved in the supply chain between the drug manufacturer and the patient. [ 24 ]
We wrote letters to the three insulin manufacturers included within the scope of this report, requesting information on, among other things, point-of-sale out-of-pocket cost data for their products. Neither Sanofi nor Novo Nordisk provided data responding to this specific request. [ 25 ] In its response, Eli Lilly wrote that:
Eli Lilly’ s response to Human Rights Watch did not make clear how many people have been helped through initiatives like the Lilly Insulin Value Program, which was created in 2020 in response to the Covid-19 pandemic, or for how long it will be offered. [ 27 ] But these average cost data provided by Eli Lilly include the experiences of people with adequate health insurance and other forms of cost assistance like direct financial aid, and may not reflect the experiences of those who lack such benefits and must pay out-of-pocket for the pharmacy’ s full retail price, known as the retail cash price. [ 28 ]
Human Rights Watch analyzed retail cash price data from GoodRx, a website commonly used by patients that tracks prescription medication costs and discounts, to create yearly average retail cash price estimates for a 10 mL vial of these three prevalent analog insulins from 2014 to 2021, all years for which this data is publicly available. [ 29 ]
According to these GoodRx data, the retail cash price for a 10 mL vial of Humalog increased by more than 45 percent between 2014 and 2021, to about $ 319 a vial. [ 30 ] Novolog increased by more than 53 percent, to about $ 348 a vial. [ 31 ] Lantus increased at a lower rate, 25 percent, as the average price was already higher in 2014, but sold for about $ 325 a vial in 2021. [ 32 ]
Yearly Average Retail Price for Select Insulin Analogs ( 10 mL vial) from 2014 to 2021
As the GoodRx pricing information indicates and Zoe’ s story shows, these out-of-pocket costs can quickly add up, especially for people with low incomes.
Drug wholesalers and pharmacies can contribute to these retail cash prices by marking up the price of a drug before it is dispensed to a patient. [ 33 ] But the impact of these practices on retail cash prices is limited, as the underlying price that manufacturers set for their drugs—the so-called list price—largely determines the out-of-pocket costs for patients without insurance or assistance. [ 34 ]
A number of studies by healthcare economists, advocacy organizations, and federal oversight bodies have documented how these list prices for insulin analogs in the US have rapidly increased since their introduction to the market in the late 1990s and early 2000s. [ 35 ]
Human Rights Watch wrote letters to the three insulin manufacturers included within the scope of this report, requesting historic list price data for the three drugs we studied. Their responses, reproduced in full in the Annex to this report, did not provide this data. [ 36 ]
Accordingly, we compiled list price data from available sources, including public disclosures by these manufacturers and internal company documents provided to a recent US Senate Finance Committee investigation. [ 37 ]
In 1996, Eli Lilly first sold Humalog in the US at a list price of just over $ 21 for a 10 mL vial, equivalent to about $ 35 in 2020 when adjusted for inflation. [ 38 ] By 2020, however, Humalog’ s list price was about $ 275—a 680 percent inflation-adjusted increase. [ 39 ] This increase was 10 times faster than inflation in the general economy and nearly 6 times faster than price inflation in the pharmaceutical sector specifically over this same time period. [ 40 ]
After Novo Nordisk’ s Novolog and Sanofi’ s Lantus were both approved for sale in the US in 2000, their list prices similarly soared past the price inflation for goods and services in other sectors of the economy. [ 41 ] Between 2001 and 2018, the most recently available list price data Human Rights Watch was able to gather, Novolog’ s list price rose about 403 percent when adjusted for inflation, from about $ 59 a vial to more than $ 289. [ 42 ] Similarly, between 2001 and 2019, the list price for Lantus rose about 420 percent, from an inflation-adjusted price of about $ 53 per vial to more than $ 283. [ 43 ] These list price increases for both brands vastly outpaced the price inflation experienced by the entire prescription drug sector during this period, which only grew by 77 percent between 2001 and 2020. [ 44 ]
Available information indicates that these high prices and drastic price increases for analog insulins are not primarily driven by the cost to produce these products. For example, the French insulin manufacturer Sanofi provided data to a US Senate Finance Committee investigation of insulin pricing practices in 2019. [ 45 ] In these documents, Sanofi stated that the per-unit manufacturing cost for a 10 mL vial of Lantus in 2018 was $ 3.61. [ 46 ] But that same year, their list price for a 10 mL vial of Lantus was over $ 266—a markup of several thousand percent. [ 47 ]
These documents from Sanofi also revealed that, between 2014 and 2018, their list price for Lantus increased at a rate about three-times faster than the cost to manufacture Lantus. According to these records, the per-unit cost of manufacturing Lantus increased by only 5 percent in total between 2014 and 2018. [ 48 ] Meanwhile, Sanofi’ s average list price for a 10 mL vial of Lantus grew by a total of 15 percent over this period, from about $ 230 to $ 266. [ 49 ]
Not all of this markup is profit, as other costs are involved in bringing a vial of insulin to market, including substantial rebates discussed further in Section III. For example, a 2017 study by researchers from the University of Southern California’ s Leonard D. Schaeffer Center for Health Policy and Economics estimated the average net profit margins—the percent of total revenue that is profit—for each of the different actors in the US pharmaceutical supply chain: manufacturers, wholesalers, pharmacy benefit managers, pharmacies, and insurers. [ 50 ] They found that, on average, nearly a third of drug manufacturers’ revenue from US-based sales of branded and generic drugs compensated for direct production costs, but 26.3 percent of their revenue was profit. [ 51 ]
US law currently does not require pharmaceutical companies to disclose drug production costs and companies do not typically publish this information. Accordingly, it is unclear to what degree other costs, in addition to manufacturing, may have influenced the list prices of these analog insulins. Human Rights Watch wrote to the three insulin manufacturers included in this report requesting data on, among other things, gross and per unit manufacturing costs for the insulin analogs covered in this report. Their responses, reproduced in full in the Annex to this report, did not provide this information.
In recent years, the rapid list price increases documented in these data have slowed or ceased, in a context of increased scrutiny by policymakers, patients, advocates, and the media. [ 52 ]
In letters to Human Rights Watch, the three insulin manufacturers we studied described different institutional responses to this scrutiny. [ 53 ] Since 2016, Novo Nordisk wrote, the company has been “ limiting any potential list price increases on medicines to no more than single digit percentages annually. ” [ 54 ] Similarly, Eli Lilly wrote that the company has not increased the list price for any of their insulin products since 2017. [ 55 ]
However, slowing or stopping additional price increases does not ameliorate the negative human rights impacts of already high list prices on the health, lives, and livelihoods of people who can not afford their medicine. [ 56 ] As the experiences of other peer-income nations discussed below show, these high prices are unique to the US among other peer income countries and reflect addressable policy failures.
Travis Paulson, age 48, of Northern Minnesota, uses several vials of Novolog each month to manage his T1D. He described regularly traveling to Canada to buy Novolog, where a six-month supply costs around US $ 700, about the price of two vials in the United States. [ 57 ]
Buying insulin across the border, where Novolog is more than 92 percent cheaper per dose than in the US, has allowed Paulson to avoid having to ration his insulin—taking it in amounts or manners not recommended by his physician to stretch out his supply—as he did in the past. [ 58 ] It has also allowed him to buy surplus insulin supplies that he can share with people in need. [ 59 ]
“ We’ ve seen enough people die, ” said Paulson, explaining the motivations of people with diabetes who participate in informal aid networks, which work to ensure access to insulin for those who can not afford it. “ It’ s more important to give people what they need, ” he said. “ If we find out that they are rationing, we send someone out to their house with a few vials. ” [ 60 ]
But not everyone in the US has access to cheaper medicines purchased abroad. [ 61 ] People without the means to access these cheaper international alternatives, in turn, must confront expensive US prices.
Numerous studies have found that the US is an outlier regarding the high cost of per capita spending on prescription drugs when compared with high- and middle-income countries. [ 62 ] A 2021 Rand Corporation study found that US drug list prices were 256 percent of the combined average for 32 other countries in the Organization for Economic Co-operation and Development ( OECD). [ 63 ] Similarly, a 2020 Rand Corporation study commissioned by the US Department of Health and Human Services found that analog insulin list prices in the US were more than 8 times the average across 32 other OECD countries. [ 64 ]
In 2018, the US House of Representatives Ways and Means Committee compared the per-dose list prices of 79 different drugs sold in the US to their list prices in 11 other high-income countries. [ 65 ] Their study found that drug prices in the US were nearly four times higher than the average price of the same drug abroad, with some drugs 67 times more expensive. [ 66 ]
The prices for the three analog insulins we examined—Humalog, Novolog, and Lantus—largely follow the general trend in US drug prices documented in this study, which are far above those in other high-income countries.
According to the House Committee’ s data from 2017 and 2018, Humalog’ s price was 294 percent higher per dose in the US than the international average. [ 67 ] Novolog was more than 320 percent higher. [ 68 ] Lantus is a rare example of a drug that was more expensive in several other countries studied by the House Committee, but it still cost 75 percent more in the US than the average price for the same drug abroad. [ 69 ]
Select insulin brands’ per-dose list prices were much higher in the US in 2017-2018 than in other countries or regions.
We all deserve to live a fulfilled life [ but ] I don’ t see how anyone is able to do that if you have to worry about [ either ] paying the bills or getting your medicine.
Of the 18 people Human Rights Watch interviewed who require insulin, 14 said they have rationed their insulin because of its high cost, taking it in amounts or manners not recommended by their physician to stretch out their supply. [ 70 ]
It is difficult to fully quantify how many people have to ration insulin because of costs. Nonetheless, four studies conducted between 2018 and 2021 suggest high rates of insulin rationing in the US and its potentially severe consequences. [ 71 ]
A September 2021 study of survey data collected by the advocacy organization T1International found that more than 25 percent of 542 US-based respondents rationed insulin in the past year due to cost. [ 72 ] In 2020, the American Diabetes Association estimated that about 650,000 insulin patients were skipping injections or taking less insulin than prescribed. [ 73 ] A 2019 survey by researchers at the Yale School of Medicine found that 25 percent of 199 respondents reported underusing prescribed insulin because of the cost within the past year. [ 74 ] Similarly, a 2018 American Diabetes Association survey of 535 individuals with diabetes found that 26 percent of respondents regularly took less insulin than prescribed in the past year because of the cost. [ 75 ]
“ I did it in the past, ” said Travis Paulson, age 48, of Minnesota, recalling a prolonged period of insulin rationing after losing his job during the economic recession in 2007. [ 76 ] Travis told Human Rights Watch that he has had dozens of eye operations over the past decade to repair damage that he attributes to his insulin rationing. [ 77 ] Still, he counted himself lucky to have survived:
Timely and regular access to insulin is a matter of life or death for people who require it. [ 79 ] But it is especially so for the roughly 1.4 million people in the US with T1D, whose bodies do not produce any insulin at all. [ 80 ] Without insulin, people with T1D can experience dangerous health complications, including potentially lethal spikes in blood sugar. [ 81 ]
The total number of people in the US who die because of an acute hyperglycemic crisis, such as diabetic ketoacidosis ( DKA), is unclear. [ 82 ] In 2020, the medical journal Diabetes Care published a study of national hospitalization records from 2017, which found that 835 people died after being admitted into a US hospital with a primary diagnosis of DKA that year—nearly 70 people each month. [ 83 ]
But these numbers may underestimate the total number of DKA deaths in the US, since this inpatient hospitalization data does not capture deaths that occurred at home or in an emergency room, for example. [ 84 ]
“ A lot of people get too sick to even get out of bed and they just die, ” said Paulson, who participates in an informal aid network that works to ensure access to insulin for those who can not afford it. “ They ration or go without, and they just go to sleep and never wake up. ” [ 85 ]
Memorials written by family members and published by the organization T1International describe tragic stories of people finding their loved one with T1D dead after rationing their insulin because of its cost. [ 86 ]
As many of these memorials illustrate, the dangers of unaffordable insulin are compounded by the high cost of seeking medical care in the US. Danielle Hutchinson, age 27, of Charlotte, North Carolina, explained how medical debt from previous hospital visits has caused her to delay medical care:
Allie Marotta, a 27-year-old with T1D who works with Mutual Aid Diabetes, an online-based mutual aid network that raises money for people struggling to afford their diabetes costs, despaired at how often people ration insulin and even die. “ [ W ] e see people who have an urgent need, [ but ] it was late, and they passed away, ” she said. “ The toll is death for our community. ” [ 88 ]
Imagine you don’ t have someone to loan you $ 250, and you die alone in your living room. But nobody is doing anything about it.... it ticks me off to no end.
Marcus LaCour, a 35-year-old with T1D from Ohio, described a period when he frequently moved between jobs, changing employer-sponsored health insurance programs, many of which did not adequately cover the cost of his insulin. After exhausting a stockpile of Novolog pens he had slowly saved up, each of which cost about $ 250 at the time, Marcus started relying on free samples from his doctor. [ 89 ]
LaCour said his family’ s financial circumstances were dire: “ My wife said that she would skip meals to help with the insulin costs.... That’ s hard to hear, but I [ knew ] that I [ had ] to survive. ” For about a year, Marcus managed largely by rationing free insulin product samples from his physician. But one day, his doctor ran out. [ 90 ]
Rationing his last insulin pen, LaCour recalled receiving a bill from his pharmacy for US $ 736. “ I call my doctor and he has no more samples, ” he said. “ I call the insurance company and say that I’ m down to my last pen and you all are going to screw me... There’ s no way I can get $ 730 right now. How am I supposed to get my meds? ” [ 91 ]
LaCour said that his health insurance provider at the time offered him an appeals process that would have taken 10 days. But before he ran out of insulin, his employer came to his aid:
High out-of-pocket costs for essential medicines like analog insulin are inherently regressive, as people living in or near poverty will always pay more, as a share of their income, to satisfy equal medicinal needs than higher-earning people will, unless those costs are mitigated by public or private assistance, like Medicaid. [ 93 ]
In turn, this disproportionate impact on economically vulnerable individuals threatens the right to an adequate standard of living for people who require insulin, as the money needed to acquire this lifesaving medicine can come at the expense of food, rent, and secure living conditions. [ 94 ]
Communities deprived of social, political, and economic power in the US because of systemic racism or other forms of discrimination are especially impacted by diabetes. [ 95 ] Age-adjusted prevalence data from the Centers for Disease Control and Prevention ( CDC) shows that diabetes is highly prevalent among the most socioeconomically vulnerable communities in the country, affecting nearly one-in-seven American Indian or Alaskan Native adults and around one-in-eight non-White Hispanic and non-Hispanic Black adults in the US. [ 96 ] In contrast, only about one-in-thirteen non-Hispanic, white adults have diabetes. [ 97 ]
This disparity in diabetes prevalence is largely driven by T2D, which is much more common among Black, Indigenous, and other communities of color in the US than among the non-Hispanic white population. [ 98 ] In turn, this high prevalence reflects the interrelated political, economic, and cultural drivers of socioeconomic marginalization, which shape the social determinants of health—the circumstances in which people are born, live, work, and age. [ 99 ]
But disparities based on race and ethnicity are not just reflected in the prevalence of diabetes, they are also reflected in its severity. [ 100 ] Black adults, for example, are more than twice as likely as white adults to be hospitalized for DKA. [ 101 ] Additionally, while about 356 people with diabetes underwent a lower-limb amputation every day in the US in 2016, Black adults were more than twice as likely to experience a diabetes-related amputation than white adults that year. [ 102 ]
Data from a 2017 Yale Diabetes Center survey of 199 people with either T1D or T2D in Connecticut also suggests that the burden of high insulin costs is also borne differently by different racial and ethnic groups. [ 103 ]
Although more than one-in-five white respondents rationed insulin in the past year, they were 18 percent less likely to ration insulin than the average. [ 104 ] Both Latino/Hispanic and Black respondents, however, were more likely to ration insulin than the average, respectively about 10 and 22 percent more likely. [ 105 ]
One-in-three Black survey respondents rationed insulin, as did more than one-in-four Latino or Hispanic respondents. White respondents were less likely to ration.
This study also found that patients with lower incomes were more likely to report cost-related underuse. [ 106 ] However, the rate of cost-related insulin rationing did not appear to scale linearly with income. [ 107 ] Of people earning under $ 10,000 a year, about 19 percent rationed insulin; this share rose to 25 percent for those earning between $ 10,000 to $ 25,000, and then to about 38 percent among individuals earning between $ 25,000 and $ 100,000. [ 108 ]
The increased incidence of insulin rationing for low and middle-income earners documented by this survey may reflect gaps in coverage for means-tested social health care programs, as those who did not fall in the lowest income brackets, and thus did not qualify for a potentially more robust publicly funded health plan, were more likely to ration insulin. [ 109 ]
Middle-Income Respondents Most Likely to Ration Insulin Because of Cost
Some of the most economically vulnerable people in the US may qualify for Medicaid, the income-based public health insurance program. But income-based eligibility requirements for these public assistance programs can exclude many low-income people who may earn too much to qualify, but not enough to afford private health insurance or the cost of their medicines. [ 110 ]
To qualify for Medicaid in 2021, a single person without dependents would need to earn below $ 17,774 in most states. [ 111 ] But in the 12 states that have not adopted the 2010 Affordable Care Act’ s so-called Medicaid expansion, no single-person households without dependents are eligible for this crucial safety net program. [ 112 ] More than 2 million uninsured adults fall into this coverage gap nationwide, which disproportionately impacts people of color, and especially Black Americans. [ 113 ]
In 2017, when the Yale survey was conducted, the national Federal Poverty Level ( FPL) for a single-person household was $ 12,060. [ 114 ] That year, Connecticut had a Medicaid income limit for a single-person household without dependents of 138 percent of the FPL, or $ 16,642. [ 115 ] Survey respondents who earned below this cut-off may have been eligible for free insulin through Medicaid. But those who earned more than this income limit were more likely to depend on private health insurance, whether employer-sponsored or self-purchased.
People stuck in this limbo, with an income too high to qualify for income-based public health insurance but too little to afford private insurance, may face unaffordable insulin costs. [ 116 ]
Both Sa’ Ra Skipper, 25, of Indianapolis, Indiana, and her sister have T1D. Skipper told Human Rights Watch about how her sister purposefully worked lower-paying jobs to qualify for Medicaid and other cost assistance programs, because slightly higher-paying jobs did not pay her enough to afford health insurance that covered her medical expenses. “ She gets her insulin covered, but she still doesn’ t make a living wage, ” Skipper said. [ 117 ]
In 2018, Skipper was working a job with health insurance that did not cover her insulin, leaving her with monthly out-of-pocket costs of about $ 1,000, which she was not able to afford. But Skipper’ s sister, who was receiving free insulin from Medicaid, rationed her medicine to share with Skipper. “ It felt like I was taking from her, ” Skipper said. “ We were sharing insulin out of the same vial... But the system [ didn’ t ] give me any other choice but to make me live this way. ” [ 118 ]
The consequences were devastating. Skipper described what happened in written testimony to the US House of Representatives Committee on Oversight and Reform in 2019:
Skipper watched her sister battle for life: “ We almost lost my sister. That was a really tough time, to see my sister laying in a hospital bed because she was just trying to help me out... she kept me alive. ” [ 120 ]
Insurance is always something I think about. With changing jobs, with possible career paths, with who and when I marry.
Each of the 31 individuals with chronic health conditions Human Rights Watch interviewed described how critical health insurance that offered adequate and affordable coverage for their condition, or the lack of it, was to their lives. For people who require insulin, the need to ensure health insurance that effectively covers usual medical expenses has profound and under-reported impacts on life choices.
“ I had to stay in an abusive situation in order to keep my insurance under my father, ” said an individual who did not wish to be named as they shared their experiences publicly for the first time. [ 121 ] They described how the need to maintain health insurance coverage to afford treatment for their T1D kept them in an abusive household:
Many of the people who spoke with Human Rights Watch about experiences with insulin rationing were able to eventually secure adequate insurance coverage that has prevented them from rationing. But interviews with Human Rights Watch made clear that high insulin costs can still force individuals with health insurance to face financial hardships that undermine their standard of living.
A 40-year-old father in Texas who spoke with Human Rights Watch estimated that he spent about $ 30,000 out-of-pocket to pay for insulin for him and his daughter between 2015 and 2020, despite having health insurance through his employer. [ 123 ] He explained that the health insurance coverage he received through his former employer had a yearly deductible of around $ 6,000; accordingly, at the beginning of each year, the deductible reset, and he paid that amount out-of-pocket before the insurer began to cover costs. [ 124 ] Year after year, he explained, he would meet his deductible with just a few visits to the pharmacy:
Approximately 30 percent of US adults with employer-sponsored health insurance are enrolled in one of these so-called high deductible health plans, which the Internal Revenue Service defines as requiring an annual deductible of at least $ 1,400 for an individual or $ 2,800 for a family. [ 126 ]
Almost every person with diabetes who Human Rights Watch interviewed stressed the importance of finding employment with health insurance coverage. This need, driven by the necessity to mitigate the high price of insulin, profoundly affects decision-making around jobs and careers. The 40-year-old father in Texas described how the cost of insulin has affected his daughter, who just graduated from high school and is preparing to enter college:
A contributor to the unaffordability of insulin in the US has been the shift away from synthetic human insulins, which are less expensive but more complicated to use, to more expensive human insulin analogs. [ 128 ] While the prices for both synthetic human insulins and human insulin analogs have increased over time, synthetic human insulins, which first came onto the market in the 1970s, are often sold at a much cheaper list price. [ 129 ]
While much cheaper, these older synthetic insulins can make effective blood sugar regulation much more difficult. [ 130 ] Two types of traditional, synthetic human insulin are sold over the counter for as little as $ 25 a vial: regular human insulin and Neutral Protamine Hagedorn ( NPH) insulin. [ 131 ]
Regular human insulin is taken several times a day to manage blood sugar around meals. [ 132 ] Compared with rapid-acting insulin analogs, such as Novolog or Humalog, regular insulin stays in the human body for a much longer time and peaks much later after injection. [ 133 ] Similarly, NPH insulin, also known as intermediate-acting insulin, provides background blood sugar regulation but has a peak approximately 4 to 6 hours after injection, unlike modern long-acting insulin analogs such as Lantus. [ 134 ]
Eli Lilly and Novo Nordisk produce both regular human insulins, Humulin R and Novolin R, as well as NPH insulin, Humulin N and Novolin N, respectively. [ 135 ] Both Novolin N and Novolin R are sold over the counter for only about $ 25 a vial at select stores. [ 136 ]
A regimen consisting of these older synthetic human insulins requires a person to adhere to a very rigid diet and schedule corresponding to these drugs’ various peaks and duration of effect. [ 137 ] Varying from this rigid routine of carbohydrates and injections could lead to damaging and potentially lethal blood sugar fluctuations. [ 138 ] Additionally, this regimen may also require more frequent blood glucose monitoring, which has its own financial costs. [ 139 ]
People who can not afford the out-of-pocket cost for analog insulins, which require a prescription in the US, may transition to synthetic human insulins that are available over the counter in pharmacies. But doing so without adequate medical guidance can be dangerous.
In 2019, USA Today reported that Josh Wilkerson, a 27-year-old with T1D from Virginia, died not long after losing his health insurance and switching to more affordable synthetic insulin. [ 140 ] Media reports and memorials written by family members and published by the advocacy organization T1International described similar tragic stories:
As the stories above show, some individuals are driven to cheaper alternatives to analog insulin because of changes to their health insurance coverage, whether because of a change in employment status or simply because they aged out of coverage under their parent’ s health plan. [ 144 ]
Medical literature reviewed by Human Rights Watch confirms that these cheaper synthetic human insulins are viable treatments for type 1 or type 2 diabetes, but generally assumes that these drugs will be used either under a physician’ s oversight or in a manner consistent with such oversight. [ 145 ] In the US, however, people who can not afford their prescription because of inadequate health insurance may also be unable to afford this necessary oversight. [ 146 ] But even if someone has access to a physician, as both the American Diabetes Society and Endocrine Society have noted, many healthcare providers in the US are no longer trained on how to use these older products. [ 147 ]
The result is a two-tiered system of insulin access in the US. The high list prices for more convenient insulin analogs effectively limit their access to individuals with adequate health insurance, charitable assistance, or sufficient personal wealth. Despite concerns regarding their effectiveness, low-income and uninsured people in the US often have no choice but to purchase these older synthetic options. [ 148 ] Or, as some of the experiences described in this report show, they will pay for as much analog insulin as they can afford and hope not to die.
For many people who do not have health insurance that adequately covers the cost of their insulin, manufacturer-funded charitable initiatives are a last line of defense against unaffordable insulin costs.
Each of the three insulin producers within the scope of this report—Eli Lilly, Novo Nordisk, and Sanofi—offer financial assistance that can reduce or temporarily eliminate out-of-pocket costs for eligible individuals. [ 149 ] These initiatives take various forms, including savings cards, co-pay assistance, or even direct charitable aid, where qualified individuals receive free or discounted insulin for a specified period. [ 150 ]
We wrote letters to these three insulin manufacturers requesting information on, among other things, data relating to patient assistance requests, including the total number and kinds of applications received, accepted, and denied as well as their methodology in determining such eligibility. [ 151 ] While these manufacturers provided some data and highlighted several supportive programs, discussed below, the information they provided was insufficient to determine how many people’ s medicine is made affordable through assistance provided by these programs in any given year.
In 2019, Eli Lilly provided more than 1.2 million vials or pens of insulin products to their foundation and more than 287,000 additional vials or pens of insulin products to other charitable organizations. [ 152 ] In 2018, Novo Nordisk’ s patient assistance program provided free insulin to nearly 60,000 patients, as well as more than $ 200 million in co-pay assistance. [ 153 ] Similarly, Sanofi provides both co-pay assistance, savings cards, and direct aid to patients. [ 154 ]
While manufacturer-funded initiatives may provide valuable assistance, they have clearly fallen short of preventing the cost-related insulin rationing and financial hardship described above. [ 155 ]
Eligibility for this assistance is often limited. [ 156 ] For example, each of these manufacturers’ patient assistance programs ( PAP), which offer a free one-year supply of insulin, are only available to either US citizens or permanent residents who lack health insurance coverage for medications, and have a household income at or below 400 percent of the Federal Poverty Level ( FPL), or about $ 51,000 for a single individual without dependents. [ 157 ] Additionally, people with government-funded insurance, such as Medicare or Medicaid, are generally not eligible for these programs because of federal restrictions. [ 158 ]
But not everyone who is eligible for these patient assistance programs is necessarily aware of them or able to apply for want of required materials or time. Zoe Witt of Seattle, Washington, expressed frustration with the burden that eligibility requirements can place on people in need. “ When you’ re rationing, you’ re literally dying. How are you expected to sift through forms and fill out tax info? ” [ 159 ]
Additionally, even if someone is accepted into one of these programs, they are generally not immediately accessible for people with urgent needs. [ 160 ] For example, Mutual Aid Diabetes, an online mutual aid organization that helps people fund their diabetes costs, received 34 requests from people to help pay for insulin between March and June 2021. Of these requests, 12 had to be addressed through direct peer-to-peer crowdfunding or a referral to community members who participate in insulin supply sharing because there were no feasible options—whether patient assistance programs, coupons, or clinics—that could cover the cost of that individual’ s insulin needs before their supply ran out. [ 161 ]
In letters to Human Rights Watch, insulin manufacturers described recently created programs implemented in response to the Covid-19 pandemic, such as Eli Lilly’ s Insulin Value Program and Novo Nordisk’ s Immediate Supply, which can offer quicker and more generally accessible assistance to individuals in urgent need. [ 162 ] However, their letters did not make clear how many people have been able to take advantage of these programs or for how long they would be offered. [ 163 ]
These manufacturer-funded initiatives can help lessen the burden of these manufacturers’ high insulin prices for some individuals, but they do not present a universal or sustainable model for addressing cost-related insulin access issues. Instead, these programs ameliorate, for some people, the negative impacts of a variable over which these companies have control: the list price of their drugs.
As discussed in the section below, the out-of-pocket costs driven by these high list prices are unique to the US among other peer income countries and reflect structural policy failures.
The list price of insulin, independently set by pharmaceutical manufacturers, is too high for a 100-year-old drug that has seen no significant innovations for decades. For years, insulin manufacturers have used loopholes in the patent system to stifle competition and increase prices.
Human Rights Watch found three structural causes that drive up insulin prices in the US and contribute to the high prices of other essential medicines: government failure to regulate drug prices before they enter the market; the lack of regulation over manufacturers’ post-approval drug pricing practices and the role of rebates in fueling list price increases; and policy gaps related to patents and market exclusivity that delay generics and extend manufacturers’ market monopolies over prices.
In each of the 11 high-income countries included in the House Ways and Means Committee’ s international drug price comparison discussed in Section I ( Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, Portugal, Sweden, Switzerland, and the United Kingdom), regulations require that once a drug is approved for use, its maximum price is negotiated based on various metrics, such as the therapeutic value when compared to available alternatives or a fixed percentage of the average prices paid in other countries. [ 164 ]
In sharp contrast, drug approval is the only step needed in the US. [ 165 ] US authorities leave it entirely to the discretion of private actors to determine drug prices. [ 166 ] There is no system to define a fair price for medicines before they enter the market, or restrict how much manufacturers or intermediaries can increase their prices once they do. [ 167 ]
In this unregulated market, insulin list prices averaged $ 34.75 per dose in the US, more than triple the average of $ 10.58 in the House report’ s 11 comparison countries, each of which have some form of mechanism for regulating drug prices. [ 168 ]
Although these countries have different types of price regulations in place, a 2020 study by researchers from Johns Hopkins University’ s School of Medicine, Bloomberg School of Public Health, and Carey Business School, suggests that any of these common price-setting systems is more effective at regulating drug prices than the US’ s approach. [ 169 ]
For example, although Canada, Japan, and the United Kingdom each employ different mechanisms to control drug prices, they paid relatively similar prices for a basket of 79 branded drugs when compared in the aggregate, with some prices higher for certain drugs but lower for others in each country. [ 170 ] However, when compared to the US, a policy outlier without any affordability protections that relies on market competition to set drug prices, each of these peer-income countries’ drug prices were considerably lower in almost all cases. [ 171 ]
The 2021 Senate Finance Committee report on the factors driving rising insulin costs found that rebates for insulin have risen significantly in recent years, with some pharmacy benefit managers securing rebates for insulins as high as 70 percent of the list price. [ 172 ]
These significant rebates, ostensibly designed to help lower premium costs for patients with health insurance, appear to be tied to increasing list prices generally and, according to the Senate Finance Committee, appear to have helped fuel the rapid increases in insulin analog list prices described in Section I, contributing to higher out-of-pocket costs for uninsured and underinsured patients who do not get discounts on the retail price of their medicine. [ 173 ]
In the US, manufacturers of similar types of drugs, such as analog insulin, compete for coverage under health insurance plans through a largely unseen system of rebates, where drug manufacturers pay back a certain percentage of their drug’ s list price to pharmacy benefit managers ( PBMs) and the health plans they represent. [ 174 ]
As a result of these rebates, drug manufacturers’ list prices may remain the same or increase while the companies paying for their products may get larger and larger discounts for purchasing them. [ 175 ]
Simplified Prescription Drug Supply Chain Comparison for Person without Insurance or with Employer-Sponsored Health Insurance or Medicare
This rebate system can allow manufacturers to compete with each other without sacrificing revenue. [ 176 ] In the absence of competition from generic manufacturers, manufacturers of competing branded drugs can offer more generous rebates than their competitors without impacting their bottom line by simply increasing the list price of their product, which is the underlying variable upon which these rebate calculations are made. [ 177 ]
Accordingly, a system that ostensibly is designed to lower drug costs for patients can contribute to increases in the underlying price for those drugs. [ 178 ] A 2020 white paper from the University of Southern California’ s Schaeffer Center for Health Policy & Economics found that, on average, a $ 1 increase in the rebate for a drug was associated with a $ 1.17 increase in the drug’ s underlying list price. [ 179 ]
The 2021 Senate Finance Committee investigation examined internal documents produced by Eli Lilly, Novo Nordisk, and Sanofi, similarly documenting a close relationship between increases in rebates and corresponding increases in list prices, particularly between 2013 and 2019. [ 180 ] Sanofi “ aggressively increased its list prices between 2012 and 2014, ” the Senate Finance Committee report found, in response to “ aggressive rebate and discount activity from Novo Nordisk. ” [ 181 ] In turn, Novo Nordisk engaged in a “ cat-and-mouse strategy of pricing that followed Sanofi’ s price increases closely, sometimes mirroring them within days or even hours. ” [ 182 ]
The influence that rebates have had on list prices is also shown in data published in 2018 by the American Diabetes Association’ s Insulin Access and Affordability Working Group, which documented how the list prices for certain analog insulins have increased considerably more than their net prices, the amount that manufacturers receive after rebates and discounts are deducted. [ 183 ]
According to data published in their study, the list price for Lantus more than doubled between 2007 and 2016, growing by 252 percent. [ 184 ] However, the estimated net price for the drug, which more accurately reflects the revenue Sanofi received from sales of Lantus, increased by only about 57 percent over this period, having declined from a high of over 100 percent in 2014. [ 185 ]
In letters to Human Rights Watch and other public documents and statements, the three big insulin manufacturers said that their gross revenue from the sale of insulin products had declined in recent years, in large part because of growing rebates. [ 186 ] For example, in its response to a Human Rights Watch letter requesting per vial price and cost data for Lantus, Sanofi wrote:
In its letter to Human Rights Watch, Sanofi described how the current system, which links supply chain payments with list price, creates “ perverse incentives that sometimes feed the cycle of higher list prices paired with higher rebates and fees … [ and that ] [ d ] eclining net prices are the result of substantial competition in the diabetes market putting downward pressure on net prices. ” [ 188 ]
Human Rights Watch also wrote letters to three of the largest PBMs in the US at time of writing, requesting information and clarification regarding their practices. [ 189 ] In its response to Human Rights Watch, OptumRx wrote:
Ultimately, many people with health insurance may never notice the list price increases caused by this shadow competition over PBM formularies. [ 191 ] But people without insurance or with inadequate insurance, who are much more likely to be from marginalized communities and working low-income jobs, must bear the burden of these list price increases, subsidizing both drug manufacturers’ revenues and other people’ s insurance premiums in the process. [ 192 ]
Since the 1984 Drug Price Competition and Patent Term Restoration Act, which established this system of federal drug regulations, pharmaceutical innovation and access in the US have operated on the premise that novel drugs are rewarded with high prices during their window of patent protection, with generic competition reducing prices thereafter. [ 193 ]
Generics have the same ingredients, dosage forms, strength, route of administration, and other clinical characteristics as branded drugs, but are produced without government-granted monopolies, or patents. [ 194 ]
In theory, this system should lower the price of drugs after the expiration of their patent window. [ 195 ] A 2017 US Food and Drug Administration study documented how the price discount between a brand-name drug and its generic scales with the number of generic manufacturers. [ 196 ] It found that branded drugs underwent a 39 percent average price reduction with a single generic manufacturer on the market, and a 95 percent reduction with six or more generic manufacturers on the market. [ 197 ]
However, not all drugs benefit from a timely generic alternative since there are a number of complications and barriers to their production, including potential patent litigation. [ 198 ]
Although there are some generic forms of analog insulin currently on the market, these lower-cost alternatives have failed to significantly drive down insulin prices or make insulin widely affordable for those who need it, in part because of their limited accessibility. [ 199 ]
For example, Sanofi’ s generic version of Eli Lilly’ s Humalog and Eli Lilly’ s generic version of Sanofi’ s Lantus are both commercially available in the US. [ 200 ] But after more than four years of market availability, these and other “ biosimilar ” versions of analog insulins only accounted for about 8 percent of insulin prescriptions in 2020, according to a recent study of outpatient medical visit data. [ 201 ]
Additionally, both Novo Nordisk and Eli Lilly have also introduced non-name-brand versions of their drugs into the US market at a lower cost. [ 202 ] These are known as authorized generics, and have the same chemical composition as their name-brand version but are sold with a different label and are much cheaper than their branded counterparts, at about half the price of their name-brand versions at time of writing. [ 203 ]
The Novo Nordisk-produced generic of Novolog has an average retail price of about $ 180 per 10 mL vial at time of writing in 2021, almost 50 percent cheaper than the name-brand’ s average retail price. [ 204 ] In September 2021, after Human Rights Watch had exchanged correspondence with Eli Lilly about this forthcoming report, the company lowered the list price of its self-produced generic to 70 percent cheaper than the list price of name-brand Humalog at time of writing. [ 205 ]
But access to these authorized generics is difficult for many patients. In December 2019, the staff for Senators Elizabeth Warren and Richard Blumenthal conducted a national telephone survey of pharmacies to understand why the fill rate for these non-name-brand versions of Humalog and Novolog was so low. [ 206 ] They found that 83 percent of the 386 pharmacies contacted across all US states, the District of Columbia and Puerto Rico, did not have Eli Lilly’ s Insulin Lispro available, and 69 percent of these pharmacies could not order Insulin Lispro even if the patient did not urgently need it. [ 207 ]
After more than a year on the US market, Eli Lilly’ s self-authorized generic only accounted for 35 percent of insulin lispro prescriptions filled at pharmacies in March 2020; Humalog, its branded version, accounted for the other 64 percent. [ 208 ] This rate has changed little, if at all, since then. In September 2021, Eli Lilly wrote in a letter to Human Rights Watch that the percentage of prescriptions filled with their generic accounted for “ nearly one-third of … prescriptions filled for [ insulin lispro ]. ” [ 209 ] Meanwhile, Novolog’ s self-authorized generic, approved in January 2020, amounted to 12 percent of filled prescriptions for insulin aspart after it had been on the market for more than two months. [ 210 ]
The rate of change towards these two authorized generics is unusually slow when compared with other drugs. [ 211 ] For example, when a different manufacturer began producing a generic version of Viagra, the popular brand of erectile dysfunction drug, the percentage of prescriptions filled for name-brand Viagra dropped by 75 percent within four months. [ 212 ]
The cause for this slow transition toward these self-produced generics of Novolog and Humalog is unclear. One possibility is that dynamics in the rebate system are limiting these authorized generics’ placement on health plan formularies, official lists of whether and how health insurance plans cover certain drugs. [ 213 ] Regarding patients’ access to the company’ s self-authorized generic, Eli Lilly wrote in a letter to Human Rights Watch:
Regardless of the cause for this stymied transition, these various generic products’ gradual entrance to the US market has neither driven down the list prices for these widely prescribed name-brand drugs nor ended the ongoing crisis of insulin affordability.
Unaffordable insulin products in the United States, especially insulin analogs, undermine rights protected under international human rights law, including the right to the highest attainable standard of health, the right to equal and affordable access to essential medicines, the right to equal protection under the law, and the right to an adequate standard of living. [ 215 ]
Even for those who are able to afford high out-of-pocket costs without resulting to rationing their medicine, allocating necessary funds for insulin may come with opportunity costs for people living with diabetes, limiting access to higher education, home ownership, and other life goals, and resulting in damaging stress and anxiety.
Health is a fundamental human right indispensable to the exercise of other human rights, and every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity. [ 216 ] Unregulated high prices of insulin products, especially insulin analogs, combined with inadequate cost mitigation or health insurance coverage, contribute to out-of-pocket costs that impact the livelihoods of patients and cause damaging and potentially lethal insulin rationing.
The Universal Declaration of Human Rights, which is widely accepted as reflecting customary international law, states that all people have “ the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. ” [ 217 ]
Similarly, the International Covenant on Economic, Social and Cultural Rights ( ICESCR) guarantees the rights to “ an adequate standard of living ” and “ the enjoyment of the highest attainable standard of physical and mental health, ” including the “ prevention, treatment and control of epidemic, endemic, occupational and other diseases ” and the “ creation of conditions which would assure to all medical service and medical attention in the event of sickness. ” [ 218 ]
The United States has signed, but not ratified, the ICESCR. As a signatory, the US is obligated to refrain from acts that would defeat the treaty’ s object and purpose. [ 219 ]
The Committee on Economic, Social and Cultural Rights ( CESCR), which interprets the ICESCR, has affirmed that states have “ a minimum core obligation to ensure the satisfaction of, at the very least, minimum essential levels of each of the rights. ” [ 220 ] This duty extends to preventing and protecting against deprivations of individuals’ human rights by businesses and non-state actors, including effective regulation of their activities. [ 221 ]
Governments have obligations to ensure health facilities, goods, and services are accessible to everyone without discrimination and affordable for all. [ 222 ] The right to health facilities, goods, and services includes “ the provision of equal and timely access to basic preventive ” services, “ appropriate treatment of prevalent diseases, ” and “ the provision of essential drugs. ” [ 223 ] States must ensure these health services are economically accessible, meaning “ affordable for all ” and of good quality, the CESCR has clarified. [ 224 ]
Additionally, “ when designing a framework on intellectual property rights, consistent with the Universal Declaration of Human Rights and with the right to enjoy the benefits of scientific progress stipulated in article 15 ” of the ICESCR, the CESCR has warned states they should ensure that intellectual property rights do not lead to denial or restriction of access to essential medicines necessary for the enjoyment of the right to health. [ 225 ] CESCR has pointed out that states have a positive duty “ to make available and accessible to all persons, without discrimination, especially to the most vulnerable, all the best available applications of scientific progress necessary to enjoy the highest attainable standard of health. ” [ 226 ]
In 2009, a gathering of experts from UN bodies including the Office of the High Commissioner for Human Rights, the CESCR, the World Intellectual Property Rights Organization, and the World Trade Organization, led by UNESCO and including other experts from academia, issued the Venice Statement on the Right to Enjoy the Benefits of Scientific Progress and its Applications ( Venice Statement). [ 227 ] The Venice Statement noted, “ the intellectual property regime... is a temporary monopoly with a valuable social function that should be managed in accordance with a common responsibility to prevent the unacceptable prioritization of profit for some over benefit for all. ” [ 228 ] In the context of the Venice Statement, the CESCR has clarified that states have an obligation to ensure that intellectual property regimes do not create a barrier to accessing health care. [ 229 ]
As documented in this report, the US government has abdicated its obligation to ensure equal and affordable access to essential medicines. In part, this is due to its failure to regulate drug prices, allowing businesses involved in the pharmaceutical supply chain to increase the prices for insulin products, especially insulin analogs, to levels that undermine their equal and affordable access, especially for those from low-income households and other marginalized populations.
In 2013, the UN Special Rapporteur on the highest attainable standard of physical and mental health noted that, “ [ w ] hile several aspects of the right to health are understood to be progressively realizable, certain core obligations cast immediate obligations on States, including the provision of essential medicines to all persons in a non-discriminatory manner. ” [ 230 ]
The World Health Organization ( WHO), maintains an Essential Medicines Library ( EML), which is a register of high-priority drugs that should always be available as part of a functioning health system for all people. [ 231 ] According to the WHO, essential medicines are those that “ satisfy the priority health care needs of the population, ” which are “ intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford, ” and which are “ selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. ” [ 232 ]
Although human insulin was included on the first WHO EML in 1977, long-acting insulin analogs were only added to this list of essential medicines in 2021, apparently delayed over concerns about affordability and access, and rapid-acting insulin analogs have not yet been added. [ 233 ] Even so, other high-income governments have long ago taken steps to regulate drug prices overall, including analog insulin prices. Nothing has prevented or now prevents the US government from similarly regulating drug prices, including the prices for analog insulins.
The failure to regulate drug prices, especially analog insulins, combined with inadequate health insurance or cost mitigation, has resulted in a two-tiered, discriminatory system of insulin access. A 2019 national survey of pharmacies estimated that over 18,000 vials of synthetic human insulins, which were originally developed in the 1970s, are sold over the counter each day in the US. [ 234 ] Despite concerns regarding their effectiveness, low-income and uninsured people in the US often have no choice but to purchase these older synthetic options, which many healthcare providers are no longer trained on how to use, as they can not afford analog insulins. [ 235 ]
Additionally, the Convention on the Rights of Persons with Disabilities ( CRPD), which the US has signed but not ratified, both affirms the right to health for people with disabilities and obligates states to provide health services to people with disabilities designed to minimize and prevent the development of further disabilities. [ 236 ] As a signatory to the CRPD, the US government is obligated to refrain from acts that would defeat the treaty’ s object and purpose, to “ promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. ” [ 237 ]
The CRPD has previously found that “ a health impairment which initially is conceived of as illness, ” such as diabetes, “ can develop into an impairment in the context of disability as a consequence of its duration or its chronicity. ” [ 238 ] As described in this report, widespread cost-based insulin rationing can contribute to the development of long-term disabilities, such as blindness.
Depending on its severity, diabetes can also be considered a protected disability under domestic anti-discrimination law in the US. [ 239 ] For example, technical guidance issued by the US Equal Employment Opportunity Commission, which enforces the employment provisions of the Americans with Disabilities Act ( ADA) and the ADA Amendments Act of 2008, states that “ individuals who have diabetes should easily be found to have a disability [ under the ADA ] because they are substantially limited in the major life activity of endocrine function. ” [ 240 ]
The US government’ s continued failure to implement policies to prevent the price increases documented in this report, which, combined with inadequate health insurance or cost mitigation policies, have undermined equal and affordable access to insulin analogs and contributed to cost-based rationing, may be inconsistent with its obligations as a signatory to the CRPD.
The International Covenant on Civil and Political Rights ( ICCPR), which the United States has ratified, and the ICESCR guarantee the right to equal treatment and protection under law, without discrimination on the basis of race, ethnicity, national origin, gender, property, or other status, including economic status. [ 241 ] The International Convention on the Elimination of All Forms of Racial Discrimination ( ICERD), which the United States has ratified, spells out in more detail protections against discrimination on the basis of race, ethnicity, and national origin, among others. [ 242 ]
US constitutional law requires a finding of discriminatory intent before courts will rule unconstitutional discriminatory practices that disproportionately burden a racial group. [ 243 ] But ICERD goes further, prohibiting policies and practices that have either the purpose or effect of restricting rights because of race. [ 244 ] It proscribes apparently race-neutral practices that affect fundamental rights, regardless of racist intent, if those practices create unwarranted racial disparities.
The Committee on the Elimination of Racial Discrimination, which interprets the ICERD, has specifically stated that “ indirect—or de facto—discrimination occurs where an apparently neutral provision, criterion or practice would put persons of a particular racial, ethnic or national origin at a disadvantage compared with other persons, unless that provision, criterion or practice is objectively justified by a legitimate aim and the means of achieving that aim are appropriate and necessary. ” [ 245 ]
Under the ICERD, governments may not ignore the need to secure equal treatment of all racial and ethnic groups, but rather must act affirmatively to prevent or end policies with unjustified discriminatory impacts. [ 246 ] Governments are obligated to “ undertake to prohibit and to eliminate racial discrimination... notably in the enjoyment of … the right to public health [ and ] medical care. ” [ 247 ]
The ostensibly neutral policies of drug companies and government agencies that have discriminatory impacts on particular racial and ethnic groups’ ability to access and use insulin to preserve health and life should therefore be substantially revised to eliminate such discriminatory impacts. Additionally, as discussed above, some non-citizens are unable to access certain patient assistance programs, impacting their basic right to health and essential medicines. [ 248 ]
Even in the absence of regulations, under the UN Guiding Principles on Business and Human Rights ( UN Guiding Principles), all businesses have a responsibility to respect human rights and ensure that they do not cause or contribute to actual or potential adverse human rights impacts. [ 249 ]
Fundamental to this responsibility is the requirement that companies carry out human rights due diligence to identify the possible and actual human rights impacts of their operations, and to establish meaningful processes to prevent and mitigate those risks and remedy adverse impacts. [ 250 ] The process should be ongoing and continuous. [ 251 ]
Companies should meaningfully consult with potentially affected groups and other relevant stakeholders at all stages of human rights due diligence. [ 252 ] This consultation should be meaningful and go beyond engaging with a few patient representatives.
Human rights due diligence also entails identifying and rectifying business practices with adverse human rights impacts that are part of a company’ s operations. The UN Guiding Principles state that businesses should look at their “ own activities ” and embed human rights policies across “ all relevant business functions. ” [ 253 ]
All companies that have a role in drug-price setting, including pharmaceutical manufacturers, pharmacy benefit managers ( PBMs), health plan providers, and pharmacies, should take steps to identify and rectify practices that contribute to rendering insulin unaffordable for people who need it. In the case of price-setting for insulin, human rights risks include insulin rationing and perpetuating a discriminatory and two-tiered system of insulin access.
For pharmaceutical manufacturers, measures that increase retail prices and impediments to more affordable versions of drugs are key human rights concerns that should be mitigated, especially for people who must pay full retail prices for their insulin. Measures to mitigate such harm could include re-evaluating extending market monopolies even after the company has recouped its private investments in the research and development of the drug; examining whether intellectual property litigation prevents cheaper generics from reaching patients in a timely manner; and reassessing practices around rebates to the extent that they perpetuate the risk of rising costs for individuals who must pay full retail prices for their insulin.
Pharmaceutical companies also have responsibilities as outlined in the 2008 Human Rights Guidelines for Pharmaceutical Companies in relation to Access to Medicines ( UN Guidelines for Pharmaceutical Companies), issued by the UN Special Rapporteur on the Right to Health. [ 254 ]
The 2008 report of the UN special rapporteur on the right to health, an independent expert mandated by the United Nation’ s Human Rights Council to explore a special theme or country situation, stated that the responsibilities for ensuring the right to the highest attainable standard of health and enhancing access to medicines is the primary duty of states but pharmaceutical manufacturers also have responsibilities. [ 255 ]
While voluntary, the UN Guidelines for Pharmaceutical Companies provide practical, constructive, and specific guidance to drug manufacturers, articulating best practices for realizing their shared human rights responsibilities. [ 256 ] The UN Guidelines for Pharmaceutical Companies state that human rights, including the highest attainable standard of health, should be integrated into the operations of pharmaceutical companies, and that specific attention should be given to the impacts of their activities on access to medicine for disadvantaged individuals, communities, and populations, including those living in poverty. [ 257 ]
Companies should aim to ensure that medicines are affordable to as many people as possible, the UN Guidelines for Pharmaceutical Companies state, and should give particular attention to ensuring its medicines are accessible to disadvantaged individuals. [ 258 ]
Companies should also be as transparent as possible, with a presumption in favor of disclosing information relating to access to medicines, including information about pricing, discount arrangement, quantity and value of drug donations, and the amount of tax benefit arising from its donations. [ 259 ]
“ Society has legitimate expectations of a company holding the patent on a life-saving medicine, ” the UN Special Rapporteur wrote to the General Assembly in 2009. [ 260 ] “ Because of its critical social function, a patent on a life-saving medicine places important right-to-health responsibilities on the patent holder. ” [ 261 ]
This report was researched and written by Matt McConnell, researcher in the Economic Justice and Rights Division of Human Rights Watch.
It was edited by Aruna Kashyap, associate director on corporate accountability, and Lena Simet, senior researcher and advocate on poverty and inequality, in the Economic Justice and Rights Division. Additional reviews were conducted by Kyle Knight, senior researcher, Lesbian, Gay, Bisexual, And Transgender Rights Program; Alison Leal Parker, managing director, US Program; Amanda Klasing, associate director, Women’ s Rights Division; Carlos Ríos-Espinosa, senior researcher and advocate, Disability Rights Division; and Arvind Ganesan, director, Economic Justice and Rights Division. Elizabeth Pfiester, founder and executive director of T1International, and Katherine J. Souris, global advocacy consultant with T1International, also provided external specialist review of this report.
Babatunde Olugboji, deputy program director, and Maria McFarland Sánchez-Moreno, senior legal advisor, provided program and legal review, respectively. The charts and figures included in this report were reviewed by Brian Root, senior quantitative analyst. We are also grateful to Lindsey Cherner, associate at Davis Wright Tremaine LLP, for her assistance. Additional editorial assistance was provided by Namratha Somayajula and Jack Spehn, associates in the Economic Justice and Rights Division. Jack Spehn also prepared this report for publication.
We are very grateful to the advocates and non-governmental organizations that assisted with our research, in particular Patients for Affordable Drugs, T1International, and Mutual Aid Diabetes. Above all, Human Rights Watch would like to thank the people who shared their experiences with us.
[ 1 ] Human Rights Watch telephone interview with Zoe Witt, May 12, 2021.
[ 2 ] Ibid.
[ 3 ] Ibid. Washington State’ s Medicaid program’ s annual income limit for single individuals without dependents in 2018 was 138 percent of the Federal Poverty Level of $ 12,140, or $ 16,753. Kaiser Family Foundation, “ Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level, ” January 1, 2021, https: //www.kff.org/health-reform/state-indicator/medicaid-income-eligibility-limits-for-adults-as-a-percent-of-the-federal-poverty-level ( accessed September 1, 2021).
[ 4 ] Human Rights Watch telephone interview with Zoe Witt, May 12, 2021.
[ 5 ] Ibid. See also US Institute of Medicine, Committee on the Consequences of Uninsurance, “ Care Without Coverage: Too Little, Too Late, ” 2002, https: //pubmed.ncbi.nlm.nih.gov/25057604/ ( accessed September 1, 2021) ( generally discussing the health-related consequences of being uninsured in the US).
[ 6 ] Human Rights Watch telephone interview with Zoe Witt, May 12, 2021.
[ 7 ] Regarding the relationship between diabetes, blood sugar control, and damage to the eye, see for example “ Diabetic retinopathy, ” American Optometric Association, https: //www.aoa.org/healthy-eyes/eye-and-vision-conditions/diabetic-retinopathy ( accessed March 7, 2022).
[ 8 ] Ibid. Zoe Witt, “ Op-Ed: Like many diabetics, I’ ve had to ration my insulin. It doesn’ t have to be this way, ” ( October 7, 2017) https: //www.latimes.com/opinion/story/2021-10-07/insulin-cost-cap-democrats-biden-congress ( accessed March 7, 2022).
[ 9 ] According to the Centers for Disease Control and Prevention, the total number of adults diagnosed with diabetes in the US was 26.8 million in 2018. Centers for Disease Control and Prevention, “ National Diabetes Statistics Report, Estimates of Diabetes and Its Burden in the United States, ” 2020, https: //www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf ( accessed September 1, 2021), p. 3. At time of writing, the most recent available data for the total numbers of adults with diabetes in the US who use insulin products were from 2018. The CDC’ s Diabetes Atlas found that among adults with diabetes in 2018, 3.6 million people use insulin alone and an additional 4.6 million use both insulin and oral medication to control blood sugar—for a total of 8.2 million. Centers for Disease Control and Prevention, “ Diabetes Atlas, ” https: //gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html # ( accessed September 1, 2021) ( searching for “ Diabetes Medication Use ” under “ Indicators ” and sorting by “ Number in 1,000,000s ”). Averaging the US Census Bureau’ s estimates of the total resident population of the country for each month of 2018 provides a rough figure of about 329.84 million individuals residing in the US during that year. See US Census Bureau, Population Division, “ Table 1. Monthly Population Estimates for the United States: April 1, 2010, to December 1, 2020 ( NA-EST2019-01), ” https: //www.census.gov/data/tables/time-series/demo/popest/2010s-national-total.html ( accessed March 8, 2022). Accordingly, we can roughly estimate that about 2.48 percent of the US population relies on one or more formulations of insulin to regulate blood sugar. However, this may undercount the actual prevalence, as insulin-dependent minors are not captured in the Diabetes Medication Use data from the Centers for Disease Control and Prevention.
[ 10 ] Mayo Clinic, “ Hyperglycemia in diabetes, Overview, ” June 27, 2020, https: //www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631 ( accessed September 1, 2021). There are other less-common forms of diabetes that may require insulin therapy, such as gestational diabetes, but these are excluded from our analysis. See, for example, International Diabetes Federation, “ Diabetes Atlas: 9th Edition, ” 2019, https: //diabetesatlas.org/en/resources ( accessed September 1, 2021), pp. 15-18.
[ 11 ] Mayo Clinic, “ Hyperglycemia in diabetes, Overview, ” June 27, 2020, https: //www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631 ( accessed September 1, 2021).
[ 12 ] Ibid.
[ 13 ] Ibid. For more information on the relationship between diabetes, blood sugar management and health, please see Centers for Disease Control and Prevention, “ Cost-Effectiveness of Diabetes Interventions, ” https: //www.cdc.gov/chronicdisease/programs-impact/pop/diabetes.htm ( accessed September 28, 2021) ( “ Effective blood sugar management can reduce the risk of eye disease, kidney disease, and nerve disease by 40%. ”); United States Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” 2020, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL% 201).pdf ( accessed September 1, 2021), p. 10; Centers for Disease Control and Prevention, “ National Diabetes Statistics Report, Estimates of Diabetes and Its Burden in the United States, ” 2020, https: //www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf ( accessed September 1, 2021), p. 12 ( “ In 2017, diabetes was the seventh leading cause of death in the United States ”); Lin, Xu, Pan, et al., “ Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025, ” Nature, September 8, 2020, https: //www.nature.com/articles/s41598-020-71908-9 ( accessed September 1, 2021), p. 1 ( finding that diabetes has the second biggest effect on reducing life expectancy worldwide).
[ 14 ] Mayo Clinic, “ Hyperglycemia in diabetes, Overview, ” June 27, 2020, https: //www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631 ( accessed September 1, 2021) ( describing the long-term health impacts of persistent hyperglycemia and the life-threatening nature of acute hyperglycemic crisis events like diabetic ketoacidosis and hyperglycemic hyperosmolar state). See also Michael Fowler, “ Hyperglycemic Crisis in Adults: Pathophysiology, Presentation, Pitfalls, and Prevention, ” Clinical Diabetes, Vol. 27, December 2009, https: //clinical.diabetesjournals.org/content/27/1/19 ( accessed September 1, 2021), pp. 19-23.
[ 15 ] See, for example, World Health Organization, “ Keeping the 100-year-old promise: making insulin access universal, ” Access to Medicines and Health Products, November 12, 2021, https: //www.who.int/publications/i/item/9789240039100 ( accessed December 1, 2021); Lin, Xu, Pan, et al., “ Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025, ” Nature, September 8, 2020, https: //www.nature.com/articles/s41598-020-71908-9 ( accessed September 1, 2021); Pastakia, Pekny, Manyara and Fischer, “ Diabetes in sub-Saharan Africa – from policy to practice to progress: targeting the existing gaps for future care for diabetes, ” Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol. 10, pp. 247-263, 2017, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5489055/ ( accessed September 1, 2021) ( “ In Mali, for instance, care for a person with diabetes consumes nearly 70% of a family’ s income. In Nigeria, a monthly mean cost of $ 33.10 for a person with diabetes was reported, which corresponds to 29% of the total monthly income of an individual on minimum wage. ”); International Diabetes Federation, “ Diabetes Atlas: 9th Edition, ” 2019, https: //diabetesatlas.org/en/resources/ ( accessed September 1, 2021), p. 55 ( finding a global average of 46.2 percent of deaths due to diabetes occurring before age 60, but 73.1 percent of deaths due to diabetes occurring before age 60 among African nations).
[ 16 ] For more information about US and international prices for analog insulins, see Comparing US Prices Internationally, below. See also World Health Organization, “ Keeping the 100-year-old promise: making insulin access universal, ” Access to Medicines and Health Products, November 12, 2021, https: //www.who.int/publications/i/item/9789240039100 ( accessed December 1, 2021). While insulin may be the most pressing and often largest expense for a person with diabetes, it is by no means the only expense, as costs for test-strips, devices, and other medications can quickly add up. In 2016, for example, the Healthcare Cost Institute estimated that per-person annual spending on insulin by people with T1D was $ 5,705, accounting for 31 percent of the over $ 18,000 in total per-person spending that year. Health Care Cost Institute, “ Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices, ” January 2019, https: //healthcostinstitute.org/diabetes-and-insulin/spending-on-individuals-with-type-1-diabetes-and-the-role-of-rapidly-increasing-insulin-prices, p. 2. See also The Endocrine Society, “ Addressing Insulin Access and Affordability: An Endocrine Society Position Statement, ” The Journal of Clinical Endocrinology & Metabolism, 2021, https: //www.endocrine.org/-/media/endocrine/files/advocacy/position-statement/insulin-position-statement-jcem.pdf ( “ [ Nationally it ] is estimated that insulin accounts for ~ $ 48 billion ( 20%) of the direct costs associated with diabetes care. ”).
[ 17 ] See Health Care Cost Institute, “ Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices, ” January 2019, https: //healthcostinstitute.org/diabetes-and-insulin/spending-on-individuals-with-type-1-diabetes-and-the-role-of-rapidly-increasing-insulin-prices ( accessed September 1, 2021), p. 4 ( finding that insulin analogs accounted for more than 90 percent of insulin units used in the US between 2012 and 2016, increasingly slightly over this period); Sarkar, Heyward, Alexander and Kalyani, “ Trends in Insulin Types and Devices Used by Adults With Type 2 Diabetes in the United States, 2016 to 2020, ” Journal of the American Medical Association, Diabetes and Endocinology, October 12, 2021, https: //jamanetwork.com/journals/jamanetworkopen/fullarticle/2784811 ( accessed December 1, 2021) ( analyzing millions of outpatient physician-patient interactions between 2016 and 2020 and finding that “ Analog insulin use predominated and accounted for more than 80% of total treatment visits across all years ” while “ The use of biosimilar insulin, which was first approved in 2015, increased from 2.6% in 2017 … to 8.2% in 2020. ”).
[ 18 ] Although the World Health Organization ( WHO) included human insulin on the first Model List of Essential Medicines for Adults ( EML) in 1977, long-acting insulin analogs were only added to the EML in 2021, and rapid-acting insulin analogs have not yet been added. See World Health Organization, “ WHO prioritizes access to diabetes and cancer treatments in new Essential Medicines Lists, ” October 1, 2021, https: //www.who.int/news/item/01-10-2021-who-prioritizes-access-to-diabetes-and-cancer-treatments-in-new-essential-medicines-lists ( accessed October 8, 2021). Prior to adding long-acting insulin analogs to the EML, much of the WHO’ s comparison between analog insulins and older human insulins rested on the question of cost. See, for example, World Health Organization, Health Technologies and Pharmaceuticals Programme, Regional Office for Europe, “ Consideration of diabetes medicines as part of the revisions to 2019 WHO Model List of Essential Medicines for adults ( EML), ” 2019, https: //www.euro.who.int/ data/assets/pdf file/0009/436563/2019-EML-DiabetesMeds-eng.pdf ( accessed September 1, 2021) ( “ The guideline panel concluded that the relatively modest overall benefit from insulin analogues was outweighed by the large price difference between human insulin and insulin analogues. ”). However, the comparative effectiveness of analog insulins remains a subject of debate in literature reviewed by Human Rights Watch. See, for example, David Beran, Bianca Hemmingsen, and John S. Yudkin, “ Analogue insulin as an essential medicine: the need for more evidence and lower prices, ” The Lancet, Vol. 7 ( 5), May 1, 2019, https: //www.thelancet.com/journals/landia/article/PIIS2213-8587 ( 19) 30111-1/fulltext ( arguing that adequate evidence of analog insulin’ s superiority to human insulin does not currently exist); Israel Hartman, “ Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence, ” Clinical Medicine & Research, Vol. 6 ( 2), pp. 54-67, September 2008, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC2572551/ ( arguing that insulin analogs provide a closer replication of a normal insulin profile). Regarding analog insulin’ s relative convenience to use when compared with synthetic human insulin, see University of California, San Francisco, Diabetes Teaching Center, “ Human Insulin, ” https: //dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/medications-and-therapies/type-1-insulin-therapy/types-of-insulin/human-insulin/ ( accessed September 1, 2021) ( `` Relative to the rapid-acting insulin analogs, Regular human insulin has undesirable features, such as a delayed onset of action, and variable peak and duration of action when it is injected under the skin. Because of this, fewer and fewer medical providers are prescribing Regular insulin. The delayed onset of action is the reason you have to inject the insulin and wait before eating. And the variable duration of action predisposes to low blood sugars long after the meal is over. ”).
[ 19 ] See, for example, See Health Care Cost Institute, “ Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices, ” January 2019, https: //healthcostinstitute.org/diabetes-and-insulin/spending-on-individuals-with-type-1-diabetes-and-the-role-of-rapidly-increasing-insulin-prices ( accessed September 1, 2021), p. 5. See also Mulcahy, Whaley, et al., “ Comparing Insulin Prices in the U.S. to Other Countries, ” RAND Health Care, September 2020, https: //aspe.hhs.gov/sites/default/files/migrated legacy files/196281/Comparing-Insulin-Prices.pdf ( accessed September 1, 2021), p. 5-8 ( discussing both the volume and sales shares of analog insulins across OECD countries).
[ 20 ] Ibid., p. 3; See also “ Types of Insulin: Topic Overview, ” University of Michigan Health, https: //www.uofmhealth.org/health-library/aa122570 ( accessed September 1, 2021).
[ 21 ] Ibid.
[ 22 ] Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021) ( citing Beran D, Ewen M, Laing R., “ Constraints and challenges in access to insulin: a global perspective, ” Lancet Diabetes Endocrinology, March 2016, pp. 275–285, https: //pubmed.ncbi.nlm.nih.gov/26857998 ( accessed March 7, 2022)). See also Beran, Laing, et al., “ A perspective on global access to insulin: a descriptive study of the market, trade flows and prices, ” Diabetes Medicine, June 2019, 36 ( 6), pp. 726-733, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6593686/ ( accessed September 1, 2021).
[ 23 ] David M. Tridgell, “ Insulin is too expensive for many of my patients. It doesn’ t have to be, ” The Washington Post, June 22, 2017, https: //www.washingtonpost.com/outlook/insulin-is-too-expensive-for-many-of-my-patients-it-doesnt-have-to-be/2017/06/22/c5091c42-56cf-11e7-a204-ad706461fa4f story.html ( accessed September 1, 2021).
[ 24 ] For more information about the complexity of insulin supply chains specifically, see, for example, Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1300 ( discussing the insulin supply chain and pricing mechanisms), p. 1302, Figure 3 ( mapping the interrelationships between various actors in the supply chain); Congressional Diabetes Caucus, “ Insulin: A Lifesaving Drug Too Often Out of Reach, ” November 5, 2018, https: //congress.gov/116/meeting/house/109502/documents/HHRG-116-IF02-20190402-SD001.pdf ( accessed September 1, 2021), pp. 7-9.
[ 25 ] Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021. Novo Nordisk did, however, write that “ [ s ] tudies and clinical experience suggest that three vials are an adequate supply to cover the monthly needs of most people living with diabetes. ” Letter from Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021, p. 2.
[ 26 ] Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 1.
[ 27 ] Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 1. See also “ New $ 35 Co-Pay Now Available Through Lilly Insulin Value Program in Response to COVID-19 Crisis in U.S., ” PR Newswire, April 7, 2020, http: //lilly.mediaroom.com/2020-04-07-New-35-Co-Pay-Now-Available-Through-Lilly-Insulin-Value-Program-in-Response-to-COVID-19-Crisis-in-U-S ( accessed March 7, 2022).
[ 28 ] Benita Lee, “ How Much Does Insulin Cost? Here’ s How 27 Brands and Generics Compare, ” GoodRx, November 6, 2020, https: //www.goodrx.com/blog/how-much-does-insulin-cost-compare-brands/ ( accessed September 1, 2021).
[ 29 ] Human Rights Watch extracted retail cash price data for a 10 mL ( 100 units/mL) vial of each of the insulin analogs we studied for all years between 2014 and 2020 from charts published by GoodRx. Ibid. ( “ This GoodRx analysis is based on a representative sample of U.S. prescription fills ( not GoodRx fills) and comes from several sources, including pharmacies and insurers. The reported prices per insulin unit are based on cash prices, the so-called “ usual and customary ” prices or retail prices at the pharmacy ( not including insurance copays or coinsurance). ”). For data from 2021, Human Rights Watch manually averaged the retail price listings for a 10 mL vial of each of the drugs we studied from the 10 pharmacies for which GoodRx tracks retail prices, as they appeared in September 2021. GoodRx, “ Humalog ( Insulin Lispro), ” https: //www.goodrx.com/humalog? dosage=10ml-of-100-units-ml & form=vial & label override=Humalog & quantity=1 & sort type=popularity ( accessed September 1, 2021); GoodRx, “ Novolog ( Insulin Aspart), ” https: //www.goodrx.com/novolog? dosage=10ml-of-100-units-ml & form=vial & label override=Novolog & quantity=1 & sort type=popularity ( accessed September 1, 2021); GoodRx, “ Lantus ( Insulin Glargine), ” https: //www.goodrx.com/lantus? dosage=10ml-of-100-units-ml & form=vial & label override=lantus & quantity=1 & sort type=popularity ( accessed September 1, 2021). We then created yearly averages and calculated the price for a 10 mL vial, by multiplying the price per insulin unit with the number of units per vial—1000. Hereinafter, these average out-of-pocket retail price estimates for insulin analogs will be cited to as “ Human Rights Watch Analysis of Retail Price Data from Benita Lee, “ How Much Does Insulin Cost? Here’ s How 27 Brands and Generics Compare, ” GoodRx, November 6, 2020, https: //www.goodrx.com/blog/how-much-does-insulin-cost-compare-brands/. ”
[ 30 ] Human Rights Watch Analysis of Retail Price Data from Benita Lee, “ How Much Does Insulin Cost? Here’ s How 27 Brands and Generics Compare, ” GoodRx, November 6, 2020, https: //www.goodrx.com/blog/how-much-does-insulin-cost-compare-brands/ ( accessed September 1, 2021).
[ 31 ] Ibid.
[ 32 ] Ibid.
[ 33 ] See, for example, Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021) ( “ Manufacturers typically sell their medications to wholesalers, who handle distribution to individual pharmacies…. Wholesalers typically purchase the medications for close to the list price, often receiving a handling fee from the manufacturer that is calculated as a fixed percentage of the list price. Wholesalers then sell the medications to pharmacies, with little to no markup. They may, however, charge the higher list price…. Pharmacies dispense the medication to individual patients and collect cost-sharing required by the patient’ s health plan ( if any). Pharmacies then submit a bill to the individual’ s health insurance plan ( if any) to be reimbursed for the cost of the medication dispensed to the patient, less any cost-sharing collected, plus a dispensing fee. If a patient does not have or use health insurance for the medication, the pharmacy typically charges the patient a price relatively close to its purchase price, with a markup. ”); Elizabeth Seeley, Surya Singh, “ Competition, Consolidation, and Evolution in the Pharmacy Market, ” The Commonwealth Fund, Issue Brief, August 12, 2021, https: //www.commonwealthfund.org/publications/issue-briefs/2021/aug/competition-consolidation-evolution-pharmacy-market ( accessed December 1, 2021); Jeroen van Meijgaard, “ Here’ s the Real Price of Prescription Drugs, ” GoodRx, May 11, 2018, https: //www.goodrx.com/corporate/news/heres-the-real-price-of-prescription-drugs ( accessed December 1, 2021). See also US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), pp. 23-24.
[ 34 ] Please note that manufacturer’ s list prices are also sometimes referred to synonymously with the term wholesale acquisition cost ( WAC). The amount that pharmacies markup the drugs that they purchase are highly variable and can depend in part on whether a drug is branded or generic. See, for example, Neeraj Sood et al., “ The Flow of Money Through the Pharmaceutical Distribution System, ” University of Southern California Leonard D. Schaeffer Center for Health Policy and Economics, June 2017, https: //healthpolicy.usc.edu/wp-content/uploads/2017/06/USC Flow-of-MoneyWhitePaper Final Spreads.pdf ( finding US pharmacies’ average gross profit margin on branded drug sales to be 3.5 percent, compared with manufacturers’ 76.3 percent; whereas pharmacies’ average gross profit margin on generic drugs was 42.7%, compared to manufacturers’ 29.8%); US Department Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, “ Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices, ” March 31, 2000, https: //www.aspe.hhs.gov/reports/report-president-prescription-drug-coverage-spending-utilization-prices ( accessed December 1, 2021) ( “ Some industry sources have suggested that retail markups in the range of 20 percent to 25 percent over the pharmacy's acquisition price are typical. This markup includes both the fixed operating costs of the pharmacy as well as taxes and profits. These same sources also suggest that the fixed costs represent most of this markup amount. ”). For analysis of how list price increases are passed along to downstream consumers, see Diane Li, at al., “ List Price Increases for Medications Lead to Higher Costs for Consumers, ” GoodRx Research, December 2020, https: //www.goodrx.com/blog/wp-content/uploads/2020/12/List price increase report goodrx december 2020.pdf ( accessed December 1, 2021), pp.3-5 ( “ we found 96% and 95% of list price increases resulted in price increases for the [ cash price ] 1 month later … We found that downstream price increases are just as substantial as the list price increases themselves. Turns out that … 47% of list price increases trickled down to … cash price increases 1 month later…. The average list price increase was 8.4%, with a … corresponding average cash price increase of 7.4% ”).
[ 35 ] See, for example, United States Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” 2020, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL% 201).pdf ( accessed September 1, 2021), p. 6 ( synthesizing list price increases over the past five years); Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021) ( ” The average list price of insulin has skyrocketed in recent years, nearly tripling between 2002 and 2013 … The average U.S. list price ( WAC) of the four insulin categories increased by 15% to 17% per year from 2012 to 2016 ”); The Endocrine Society, “ Addressing Insulin Access and Affordability: An Endocrine Society Position Statement, ” The Journal of Clinical Endocrinology & Metabolism, 2021, https: //www.endocrine.org/-/media/endocrine/files/advocacy/position-statement/insulin-position-statement-jcem.pdf ( accessed September 1, 2021); Health Care Cost Institute, “ Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices, ” January 2019, https: //healthcostinstitute.org/diabetes-and-insulin/spending-on-individuals-with-type-1-diabetes-and-the-role-of-rapidly-increasing-insulin-prices ( accessed September 1, 2021), pp. 7-9.
[ 36 ] US law does not currently require manufacturers to publicly disclose list price data for their products, and much of these drugs’ historic list price data is not publicly available. Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021; Letter from Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021; Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021.
[ 37 ] Since list prices can vary over the course of a year, Human Rights Watch aggregated available data into inflation-adjusted yearly averages. While data for Lantus’ list price at market entry was gathered from the Senate Finance Committee investigation, described further below, data for Novolog’ s and Humalog’ s list prices at market entry were extracted from a graph compiled by Andy Kiersz, quantitative editor at Business Insider, which plotted data provided from Truven Health Analytics. See Ramsey and Kiersz, “ The prices for life-saving diabetes medications have increased again, ” Business Insider, May 15, 2017, https: //www.businessinsider.com/insulin-pricesincreased-in-2017-2017-5 ( accessed September 1, 2021). Although these figures are not included in the Senate Finance Committee report, the list price information extracted from this chart has previously been cited to by other federal studies. See Congressional Diabetes Caucus, “ Insulin: A Lifesaving Drug Too Often Out of Reach, ” November 5, 2018, https: //congress.gov/116/meeting/house/109502/documents/HHRG-116-IF02-20190402-SD001.pdf ( accessed September 1, 2021), p. 11. For more information about the software used to extract data from these charts, please see Rohatgi, A., “ WebPlotDigitizer ( Version 4.2), ” Computer Software, Published April 2019, https: //automeris.io/WebPlotDigitizer/ ( accessed September 1, 2021). Eli Lilly and Company’ s 2020 Environmental, Social, and Governance ( ESG) reports included list price information for a 10 mL vial of Humalog from 2016 to 2020. Eli Lilly and Company, “ 2020 Environmental, Social, and Governance Report, Access and Affordability, ” https: //esg.lilly.com/social # tab-control-tab1 ( accessed September 1, 2021). List price information for Lantus, from 2014 to 2019, was gathered from documents provided by Sanofi to a Senate Finance Committee investigation. US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), Appendix 2, https: //www.finance.senate.gov/download/sanofi redacted ( accessed September 1, 2021), p. 31. Additionally, Sanofi published list price information for 2019 in “ How much should I expect to pay for Lantus? ”, Fact Sheet, Lantus.com, October 2019, https: //www.lantus.com/-/media/EMS/Conditions/Diabetes/Brands/lantus-final/Header/Lantus-Pricing.pdf ( accessed September 1, 2021) ( listing a vial at $ 283.56). Novo Nordisk’ s disclosures to the Senate Finance Committee investigation provided list price figures for Novolog between 2016 and 2018. US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), Appendix 3, https: //www.finance.senate.gov/download/novo redacted ( accessed September 1, 2021), p. 61. The Senate Finance Committee investigation also published Lantus’ 2001 list price based on internal company data. US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf, p. 50 ( finding it to have been $ 34.81). Hereinafter, these average list price estimates for insulin analogs will be cited to as “ List Price Data For Humalog, Novolog, And Lantus, Extracted From Various Single-Year And Multi-Year Sources From Market Entry, Including US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf. ”
[ 38 ] These list price data were adjusted for inflation using US Bureau of Labor Statistics Consumer Price Index annual averages. See US Bureau of Labor Statistics, “ Databases, Tables & Calculators By Subject, ” https: //www.bls.gov/data/ ( accessed September 1, 2021). Humalog was approved for sale in the United States by the US Food and Drug Administration on June 14, 1996. Food and Drug Administration, “ Drugs @ FDA: FDA-Approved Drugs, Biologic License Application ( BLA): 020563, ” https: //www.accessdata.fda.gov/scripts/cder/daf/index.cfm? event=overview.process & ApplNo=020563 ( accessed September 1, 2021).
[ 39 ] List Price Data For Humalog, Novolog, And Lantus, Extracted From Various Single-Year And Multi-Year Sources From Market Entry, Including US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021).
[ 40 ] Ibid. For comparison, Human Rights Watch pulled the Bureau of Labor Statistics’ monthly Consumer Price Index data on All Urban Consumers ( Current Series) for the following sectors of the economy for the years between 1996 and 2020: ( 1) U.S. city average, All items, Seasonally Adjusted; ( 2) U.S. city average, Prescription drugs, Seasonally Adjusted; ( 3) U.S. city average, Physicians ' services, Seasonally Adjusted; ( 4) U.S. city average, Hospital services, Seasonally Adjusted. We then created annual averages based on these monthly data for each sector, and then calculated the percent increase between each year’ s annual average from the annual average in 1996. Bureau of Labor Statistics, Consumer Price Index ( CPI) All Urban Consumers ( Current Series), https: //www.bls.gov/cpi/data.htm ( accessed September 1, 2021). We then calculated both ( 1) the list price increases for each these three drugs and ( 2) the CPI price inflation data as a percent difference from their relative baselines—both 1996 and 2001. This partially replicates the analysis conducted by the Insulin Initiative, “ The List Price, ” https: //www.theinsulininitiative.com/the-list-price ( accessed September 1, 2021).
[ 41 ] Ibid. Novolog was approved for sale in the United States by the US Food and Drug Administration on June 7, 2000, the first full year of available data is for 2001. US Food and Drug Administration, “ Drug Approval Package, Application No.: 20-986, ” June 7, 2000, https: //www.accessdata.fda.gov/drugsatfda docs/nda/2000/20-986 NovoLog.cfm ( accessed September 1, 2021). Lantus was approved for sale in the United States by the US Food and Drug Administration on April 20, 2000, the first full year of available data is for 2001. Food and Drug Administration, “ Drug Approval Package, Application No.: 21-081, ” April 20, 2000, https: //www.accessdata.fda.gov/drugsatfda docs/nda/2000/21081 Lantus.cfm ( accessed September 1, 2021). Between 2001 and 2018, the last year for which Human Rights Watch has list price estimate data for all three insulin analogs, the price for all goods and services in the US economy grew by about 42 percent ( 41.78), according to the BLS Consumer Price Index Data. During this period, hospital services increased by 147 percent. Novolog, meanwhile, increased by 614 percent. Lantus’ percent increase stayed well above all the non-insulin sectors of the economy studied, growing by 647 percent between 2001 and 2018.
[ 42 ] Adjusted to 2018-dollar amounts. List Price Data For Humalog, Novolog, And Lantus, Extracted From Various Single-Year And Multi-Year Sources From Market Entry, Including US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021). Compare with Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1307, Figure 7 ( finding that the list price for a Novolog vial increased by 353 percent between 2001 and 2016 when adjusted for inflation).
[ 43 ] Adjusted to 2019-dollar amounts. List Price Data For Humalog, Novolog, And Lantus, Extracted From Various Single-Year And Multi-Year Sources From Market Entry, Including US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021).
[ 44 ] Ibid.; Bureau of Labor Statistics, Consumer Price Index ( CPI) All Urban Consumers ( Current Series), https: //www.bls.gov/cpi/data.htm ( accessed September 1, 2021).
[ 45 ] See US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), Appendix 2, https: //www.finance.senate.gov/download/sanofi redacted ( accessed September 1, 2021).
[ 46 ] Ibid., p. 50. Gotham D, Barber MJ, and Hill A., “ Production costs and potential prices for biosimilars of human insulin and insulin analogues, ” BMJ Global Health, 2018, https: //gh.bmj.com/content/bmjgh/3/5/e000850.full.pdf, p. 5.
[ 47 ] $ 266 is a roughly 7,268 percent increase from $ 3.61. Documents provided by Sanofi to a Senate Finance Committee investigation also included list price information for Lantus, from 2014 to 2019. US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), Appendix 2, https: //www.finance.senate.gov/download/sanofi redacted ( accessed September 1, 2021), p. 3. For per unit price information, please see Ibid., pp. 30, 50.
[ 48 ] For each of the following years, the listed per-unit manufacturing cost was: 2014, 3.43; 2015, 2.95; 2016, 3.27; 2017, 3.72; 2018, 3.61. The five-year average was 3.39, with a standard deviation for the range of 0.30. See Ibid., Appendix 2, https: //www.finance.senate.gov/download/sanofi redacted ( accessed September 1, 2021), p. 50.
[ 49 ] List Price Data For Humalog, Novolog, And Lantus, Extracted From Various Single-Year And Multi-Year Sources From Market Entry, Including US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021).
[ 50 ] Neeraj Sood et al., “ The Flow of Money Through the Pharmaceutical Distribution System, ” University of Southern California Leonard D. Schaeffer Center for Health Policy and Economics, June 2017, https: //healthpolicy.usc.edu/wp-content/uploads/2017/06/USC Flow-of-MoneyWhitePaper Final Spreads.pdf ( accessed March 7, 2022).
[ 51 ] Ibid. On average, 28.1 percent of manufacturers’ revenue from US-based sales of name brand drugs was profit according to this study. For generic drugs, this figure was 18.2 percent.
[ 52 ] For examples of increased scrutiny from lawmakers, see, for example, Alison Kodjak, “ Pharmaceutical Company CEOs Face Grilling In Senate Over High Drug Prices, ” National Public Radio, February 26, 2019, https: //www.npr.org/sections/health-shots/2019/02/26/698136259/pharmaceutical-company-ceos-face-grilling-in-senate-over-high-drug-prices ( accessed September 1, 2021); US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021); Peter Sullivan, “ Minnesota AG sues drug companies over insulin price hikes, ” The Hill, October 16, 2018, https: //thehill.com/policy/healthcare/411662-minnesota-attorney-general-sues-drug-companies-over-insulin-price-spikes ( accessed September 1, 2021); Peter Callaghan, “ State wins legal challenge to Minnesota’ s insulin affordability program, ” MinnPost, March 17, 2021; “ Maine Makes Insulin More Affordable by Capping Insulin Co-Pays at $ 35, ” American Diabetes Association, March 31, 2020, https: //www.diabetes.org/newsroom/press-releases/2020/maine-affordable-insulin ( accessed September 1, 2021). For information on online activism from patients, see, for example, T1International, “ # insulin4all Action on U.S. Insulin Pricing, ” https: //www.t1international.com/usainsulin4allaction/ ( accessed September 1, 2021).
[ 53 ] Aside from the two letters cited below, see Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 11 ( “ Should Sanofi take a list price increase on one of our medicines, our guiding principle is to limit the total annual increase during our fiscal year … to a level at or below the projected growth rate for National Health Expenditures ( NHE) … Should Sanofi take a price increase above the NHE growth rate for a given medicine that results in a list price increase greater than $ 15 for a full course of treatment per year, we will provide our rationale, highlighting clinical value, real-world evidence, regulatory change, new data or other circumstances that support our decision. ”).
[ 54 ] “ Cognizant of the impact of list prices, Novo Nordisk Inc. has not increased its list price on any of its insulin products in the United States except for one, Xulto-phy, a combination of insulin degludec and liraglutide ( a non-insulin GLP-1 RA) since 2019. ” Letter from Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021, p. 1.
[ 55 ] Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 3.
[ 56 ] For studies quantifying the impact of list price increases on patient out-of-pocket costs, see, for example, Yang, Galan and Thombley, “ Changes in Drug List Prices and Amounts Paid by Patients and Insurers, ” Journal of the American Medical Association, Health Policy, December 9, 2020, https: //jamanetwork.com/journals/jamanetworkopen/fullarticle/2773825 ( accessed December 1, 2021) ( “ the median drug wholesale list price … increased by 129% from 2010-2016, while median patient out-of-pocket costs increased by 53% and median insurance payments after rebates and discounts increased by 64% ”); Diane Li, at al., “ List Price Increases for Medications Lead to Higher Costs for Consumers, ” GoodRx Research, December 2020, https: //www.goodrx.com/blog/wp-content/uploads/2020/12/List price increase report goodrx december 2020.pdf ( accessed December 1, 2021).
[ 57 ] Human Rights Watch telephone interview with Travis Paulson, April 29, 2021.
[ 58 ] Ibid. For international Novolog per-dose prices, see US House of Representatives, Ways and Means Committee, “ A Painful Pill to Swallow: U.S. vs. International Prescription Drug Prices, ” September 2019, https: //waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/U.S.% 20vs.% 20International% 20Prescription% f20Drug% 20Prices 0.pdf ( accessed September 1, 2021), p. 52 ( listing Novlog’ s per-unit list price in the US as $ 36.55 and $ 2.79 in Ontario, Canada).
[ 59 ] Human Rights Watch telephone interview with Travis Paulson, April 29, 2021.
[ 60 ] Ibid.
[ 61 ] As Human Rights Watch has previously documented, transportation is already one of the greatest barriers to life-saving health care faced by Black women in the US. See Human Rights Watch, “ It Should Not Happen: Alabama’ s Failure to Prevent Cervical Cancer Death in the Black Belt, ” November 29, 2018, https: //www.hrw.org/report/2018/11/29/it-should-not-happen/alabamas-failure-prevent-cervical-cancer-death-black-belt # ( accessed September 1, 2021).
[ 62 ] See, for example, Mulcahy, Whaley, et al., “ International Prescription Drug Price Comparisons Current Empirical Estimates and Comparisons with Previous Studies, ” RAND Corporation Research Report, 2021, https: //www.rand.org/pubs/research reports/RR2956.html ( accessed September 1, 2021), p. ix ( “ In general, the studies that we reviewed found that U.S. prices are considerably higher than those in comparison countries when analyzing all drugs together, including brand-name originator and unbranded generic drugs. ”); Dana O. Sarnak, David Squires, and Shawn Bishop, “ Paying for Prescription Drugs Around the World: Why Is the U.S. an Outlier? ” webpage, Commonwealth Fund, October 5, 2017, https: //www.commonwealthfund.org/publications/issue-briefs/2017/oct/paying-prescription-drugs-around-world-why-us-outlier ( accessed September 1, 2021). For information on international insulin prices specifically, see, for example, Beran, Laing, et al., “ A perspective on global access to insulin: a descriptive study of the market, trade flows and prices, ” Diabetes Medicine, June 2019, 36 ( 6), https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6593686/ ( accessed September 1, 2021), pp. 728-29. See also Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021), pp. 500 ( citing Kang, DiStefano, Socal, and Anderson, “ Using external reference pricing in Medicare Part D to reduce drug price differentials with other countries, ” 2019, Health Affairs, Vol.38 ( 5), pp. 804–811) ( “ The study also showed that the longer the branded drug remained on the market, the greater the price differential between the United States and these comparison countries. This widening of the price differential is because prices in the United States tend to go up following the drug launch, whereas prices in other countries tend to go down. Other industrialized countries have employed various mechanisms to control postlaunch drug prices, whereas the United States allows pharmaceutical companies to increase drug prices as much as they want based on the market situation throughout the drug life cycle. ”).
[ 63 ] Mulcahy, Whaley, et al., “ International Prescription Drug Price Comparisons Current Empirical Estimates and Comparisons with Previous Studies, ” RAND Corporation Research Report, 2021, https: //www.rand.org/pubs/research reports/RR2956.html ( accessed September 1, 2021), p. vii. This study also did an analysis of retail prices for the drugs studied, finding that US drug retail prices were 245 percent of the combined average for the 32 OECD comparison countries. Similarly, the subset of biologic drugs in the US, which includes insulin analogs, were 295 percent of the combined international average price. Ibid., p. xiv.
[ 64 ] Mulcahy, Whaley, et al., “ Comparing Insulin Prices in the U.S. to Other Countries, ” RAND Health Care, September 2020, https: //aspe.hhs.gov/sites/default/files/migrated legacy files/196281/Comparing-Insulin-Prices.pdf ( accessed September 1, 2021), p. 12 ( Figure 2.10). See also, ibid, p. 5 ( finding that, among 33 OECD countries, the US accounted for 31.6 percent of insulin units sold by volume, but 83.6 of all insulin sales in USD).
[ 65 ] The 11 comparison countries were: the United Kingdom ( UK), Japan, Ontario, Australia, Portugal, France, the Netherlands, Germany, Denmark, Sweden, and Switzerland. US House of Representatives, Ways and Means Committee, “ A Painful Pill to Swallow: U.S. vs. International Prescription Drug Prices, ” September 2019, https: //waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/U.S.% 20vs.% 20International% 20Prescription% 20Drug% 20Prices 0.pdf ( accessed September 1, 2021), pp. 3, 17-18.
[ 66 ] Ibid.
[ 67 ] HRW Analysis of US House of Representatives, Ways and Means Committee, “ A Painful Pill to Swallow: U.S. vs. International Prescription Drug Prices, ” September 2019, https: //waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/U.S.% 20vs.% 20International% 20Prescription% 20Drug% 20Prices 0.pdf ( accessed September 1, 2021), p. 52 ( Novolog), p. 53 ( Lantus and Humalog).
[ 68 ] Ibid.
[ 69 ] Ibid.
[ 70 ] Regarding the four individuals who did not describe insulin rationing: one had a stable history of employer-sponsored health insurance coverage and did not require significant exogenous insulin for the treatment of their type 2 diabetes; one had a history of stable health insurance coverage under their parents health plan and moved to the United Kingdom, where their insulin needs are affordably met without such insurance, before aging out of that coverage; one is an individual with cystic fibrosis, whose health insurance deductible is quickly and regularly met by the total cost of their medications; and one individual was diagnosed with type 1 diabetes later in life, and has managed to maintain adequate, albeit expensive, health insurance coverage to supply their insulin needs.
[ 71 ] In addition to the studies on the prevalence of insulin rationing in the US cited below, see, for example, Type1International, “ 2018 T1International Out-of-Pocket Cost Survey, ” 2018, https: //www.t1international.com/access-survey/ ( accessed September 1, 2021). For more information on the potential health impacts of rationing, see, for example, The Endocrine Society, “ Addressing Insulin Access and Affordability: An Endocrine Society Position Statement, ” The Journal of Clinical Endocrinology & Metabolism, 2021, https: //www.endocrine.org/-/media/endocrine/files/advocacy/position-statement/insulin-position-statement-jcem.pdf ( accessed September 1, 2021), p. 3 ( “ One study indicates that improved adherence among people with diabetes could prevent nearly 700,000 emergency department visits, 34,100 hospitalizations and save $ 4.7 billion annually ”); Robert A. Gabbay, “ Examining the Reality of What Insulin Costs Do to Patients, ” Evidence-Based Diabetes Management, Volume 25, Issue 10, September 2019, https: //www.ajmc.com/view/examining-the-reality-of-what-insulin-costs-do-to-patients ( accessed September 1, 2021) ( “ The consequences of rationing, such as more time in hyperglycemia or greater risk of diabetic ketoacidosis, increase the likelihood of complications such as blindness and kidney failure. ”).
[ 72 ] Elizabeth Pfiester, Katarina Braune, et al., “ Costs and underuse of insulin and diabetes supplies: Findings from the 2020 T1International cross-sectional web-based survey, ” Diabetes Research and Clinical Practice, Vol. 179, September 2021, https: //www.sciencedirect.com/science/article/pii/S0168822721003557 ( accessed October 6, 2021). However, this study also found that other forms of rationing were common among those surveyes. When all international responses were combined, prevalence of “ rationing of blood glucose testing strips [ 41.3% ] … was higher than rationing of insulin [ 25.9% ]. ” Ibid. See also T1International, “ 2018 T1International Out-of-Pocket Cost Survey, ” 2018, https: //www.t1international.com/access-survey/ ( accessed September 1, 2021).
[ 73 ] American Diabetes Association, “ Diabetes and COVID-19: New Data Quantifies Extraordinary Challenges Faced by Americans with Diabetes During Pandemic, ” July 2020, https: //www.diabetes.org/sites/default/files/2020-07/7.29.2020 dQA-ADA% 20Data% 20Release.pdf ( accessed September 1, 2021), p. 4
[ 74 ] Patients who reported cost-related insulin underuse in this study were three times more likely to have poor blood sugar control, after adjusting for other factors. Herkert, Vijayakumar, Luo, et al., “ Cost-Related Insulin Underuse Among Patients With Diabetes, ” Journal of the American Medical Association, Vol. 179, January 2019, https: //jamanetwork.com/journals/jamainternalmedicine/fullarticle/2717499 ( accessed September 1, 2021).
[ 75 ] American Diabetes Association and Vault, “ Insulin Affordability Survey, 2018, ” May 22, 2018, http: //main.diabetes.org/dorg/PDFs/2018-insulin-affordability-survey.pdf ( accessed September 1, 2021), pp. 8, 16.
[ 76 ] Human Rights Watch telephone interview with Travis Paulson, April 29, 2021.
[ 77 ] Ibid. Regarding the relationship between diabetes, blood sugar control, and damage to the eye, see for example “ Diabetic retinopathy, ” American Optometric Association, https: //www.aoa.org/healthy-eyes/eye-and-vision-conditions/diabetic-retinopathy ( “ Over time, diabetes damages small blood vessels throughout the body, including the retina…. When people with diabetes experience long periods of high blood sugar, fluid can accumulate in the lens inside the eye that controls focusing…. Patients with diabetes who can better control their blood sugar levels will slow the onset and progression of diabetic retinopathy. ”).
[ 78 ] Human Rights Watch telephone interview with Travis Paulson, April 29, 2021.
[ 79 ] Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299, ( accessed September 1, 2021).
[ 80 ] See, for example, Junior Diabetes Research Foundation, “ Type 1 Diabetes Facts, ” https: //www.jdrf.org/t1d-resources/about/facts/ ( accessed September 1, 2021); Centers for Disease Control and Prevention, “ National Diabetes Statistics Report, Estimates of Diabetes and Its Burden in the United States, ” 2020, https: //www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf ( accessed September 1, 2021), p. 4. See also, the following memorials written by family members of people with T1D who passed after rationing their insulin, Nicole Smith-Holt, “ Statement to Eli Lilly, ” May 7, 2018, https: //www.t1international.com/media/assets/file/Nicole Smith-Holt Statement to Eli Lilly 5.7.18.pdf ( accessed September 1, 2021); Erin Weaver, “ Josh Died Because His Insulin Cost Too Much, ” T1Internatonal, August 1, 2019, https: //www.t1international.com/blog/2019/08/01/josh-died-because-his-insulin-cost-too-much/ ( accessed September 1, 2021); Jazmine Baldwin, “ My Sister Jada Should Never Have Died, ” July 18, 2019, https: //www.t1international.com/blog/2019/07/18/my-sister-jada-should-never-have-died/ ( accessed September 1, 2021); Janelle Lutgen, “ Remembering Jesse in the Fight for # insulin4all, ” T1International, July 1, 2019, https: //www.t1international.com/blog/2019/07/01/remembering-jesse-fight-insulin4all/ ( accessed September 1, 2021); Joanne Koepp, “ Fighting in Micah's Memory, ” T1International, February 15, https: //www.t1international.com/blog/2019/02/15/fighting-micahs-memory/ ( accessed September 1, 2021).
[ 81 ] For more information on hyperglycemic crises, see, for example, Mayo Clinic, “ Hyperglycemia in diabetes, Overview, ” June 27, 2020, https: //www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631 ( accessed September 1, 2021); Michael Fowler, “ Hyperglycemic Crisis in Adults: Pathophysiology, Presentation, Pitfalls, and Prevention, ” Clinical Diabetes, Vol. 27 ( 1), pp. 19-23, December 2009, https: //clinical.diabetesjournals.org/content/27/1/19 ( accessed September 1, 2021); Juvenile Diabetes Research Foundation, “ Diabetic Ketoacidosis ( DKA): Symptoms and Prevention, ” https: //www.jdrf.org/t1d-resources/about/symptoms/ketoacidosis/ ( accessed September 1, 2021).
[ 82 ] Ibid.
[ 83 ] Ramphul and Joynauth, “ An Update on the Incidence and Burden of Diabetic Ketoacidosis in the U.S., ” Diabetes Care, October 2020, https: //care.diabetesjournals.org/content/diacare/early/2020/10/11/dc20-1258.full.pdf ( accessed September 1, 2021). For more information on the National Inpatient Sample that this study analyzed, please see Agency for Healthcare Research and Quality, “ Healthcare Cost and Utilization Project, NIS Overview, ” April 2021, https: //www.hcup-us.ahrq.gov/nisoverview.jsp ( accessed September 1, 2021).
[ 84 ] This study used data from the National Inpatient Sample ( NIS), a database of US regional and national estimates of inpatient utilization, access, charges, quality, and outcomes, published by the Healthcare Cost and Utilization Project of the US Agency for Healthcare Research and Quality. As these are inpatient records, they necessarily exclude data about deaths at home or deaths that occur within the emergency department, which does not require a formal admission into the hospital. See, for example, Centers for Medicare and Medicaid Services, “ Inpatient or outpatient hospital status affects your costs, ” https: //www.medicare.gov/what-medicare-covers/what-part-a-covers/inpatient-or-outpatient-hospital-status ( accessed September 1, 2021). Although the limitations of this dataset are not discussed in Ramphul and Joynauth’ s study, another study of DKA deaths that relied on this same NIS data noted that “ the findings in this report are subject to at least four limitations [ … ] mortality rates at home or in the emergency department setting were not investigated. ” Benoit, Zhang, et al., “ Trends in Diabetic Ketoacidosis Hospitalizations and In-Hospital Mortality — United States, 2000–2014, ” Centers for Disease Control, Morbidity and Mortality Weekly Report ( MMWR), Vol. 67 ( 12), pp. 362-365, March 30, 2018, https: //www.cdc.gov/mmwr/volumes/67/wr/mm6712a3.htm ( accessed September 1, 2021).
[ 85 ] Human Rights Watch telephone interview with Travis Paulson, April 29, 2021. See also Mayo Clinic, “ Hyperglycemia in diabetes, Overview, ” June 27, 2020, https: //www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631 ( accessed September 1, 2021) ( describing the long-term health impacts of persistent hyperglycemia and the life-threatening nature of acute hyperglycemic crisis events like diabetic ketoacidosis and hyperglycemic hyperosmolar state). See also Michael Fowler, “ Hyperglycemic Crisis in Adults: Pathophysiology, Presentation, Pitfalls, and Prevention, ” Clinical Diabetes, Vol. 27, December 2009, https: //clinical.diabetesjournals.org/content/27/1/19 ( accessed September 1, 2021), pp. 19-23.
[ 86 ] See, for example, Harry Rybold, “ People Over Profit Might Have Saved Jeremy, ” T1International, September 27, 2019, https: //www.t1international.com/blog/2019/09/27/people-over-profit-might-have-saved-jeremy/ ( accessed September 1, 2021); Mindi Patterson, “ Losing Meaghan to the Perfect Storm, ” T1International, February 8, 2019, https: //www.t1international.com/blog/2019/02/08/losing-meaghan-perfect-storm/ ( accessed September 1, 2021); Nicole Hood, “ I Lost Allen Because He Was Forced to Ration Insulin, ” T1International, July 6, 2019, https: //www.t1international.com/blog/2019/07/06/rationing-insulin-caused-andys-death/ ( accessed September 1, 2021); Sarah Ferguson, “ Rationing While Waiting on a Refill Took Kayla’ s Life, ” T1International, August 29, 2019, https: //www.t1international.com/blog/2019/08/29/rationing-while-waiting-refill-took-kaylas-life/ ( accessed September 1, 2021); Katherine Reamy, “ Losing Andy to America’ s Unkind Healthcare System, ” T1International, August 26, 2019, https: //www.t1international.com/blog/2019/08/26/losing-andy-americas-unkind-healthcare-system/ ( accessed September 1, 2021); Cindy Boyd, “ Our Jesy, Gone Too Soon, ” T1International, August 12, 2019, https: //www.t1international.com/blog/2019/08/12/our-jesy-gone-too-soon/ ( accessed September 1, 2021); Antroinette Worsham, “ Honoring Antavia as I Fight for Affordable Insulin, ” T1International, July 25, 2019, https: //www.t1international.com/blog/2019/07/25/honoring-antavia-i-fight-affordable-insulin/ ( accessed September 1, 2021); Becky Jones, “ Losing Rachel, Our Only Daughter, ” T1International, June 23, 2019, https: //www.t1international.com/blog/2019/06/23/losing-rachel-our-only-daughter/ ( accessed September 1, 2021).
[ 87 ] Human Rights Watch telephone interview with Danielle Hutchinson, May 25, 2021.
[ 88 ] Human Rights Watch telephone interview with Allie Marotta and Emily Miller, May 7, 2021.
[ 89 ] Human Rights Watch telephone interview with Marcus LaCour, May 26, 2021.
[ 90 ] Ibid.
[ 91 ] Ibid.
[ 92 ] Ibid.
[ 93 ] This regressive impact may be reflected in income-based differences in rates of medicine nonadherence documented in some studies. See, for example, Herkert, Vijayakumar, Luo, et al., “ Cost-Related Insulin Underuse Among Patients With Diabetes, ” Journal of the American Medical Association, Vol. 179, January 2019, https: //jamanetwork.com/journals/jamainternalmedicine/fullarticle/2717499 ( accessed September 1, 2021) ( “ Patients with lower incomes were more likely to report cost-related underuse; nearly two-thirds of these patients also experienced difficulty affording diabetes equipment, indicating broader cost barriers to diabetes management. ”).
[ 94 ] Regarding income-based disparities in the prevalence of diabetes, see, for example, Hill-Briggs, Adler et al., “ Social Determinants of Health and Diabetes: A Scientific Review, ” Diabetes Care, Vol. 44 ( 1), pp. 258-279, January 2021, https: //care.diabetesjournals.org/content/44/1/258 ( accessed September 1, 2021) ( “ Prevalence of diabetes increases on a gradient from highest to lowest income … Compared with those with high income, the relative percentage difference in prevalence of diabetes for those classified as middle income, near poor, and poor, was 40.0%, 74.1%, and 100.4% … T2D was found to be significantly higher and concentrated in census tracts characterized by factors including lower incomes, lower high school graduation rates, more single-parent households, and crowded housing. ”).
[ 95 ] See, for example, Walker, Williams and Egede, “ Impact of Race/Ethnicity and Social Determinants of Health on Diabetes Outcomes, ” American Journal of the Medical Sciences, Vol. 351, pp. 366-373, April 2016, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC4834895/ ( accessed September 1, 2021).
[ 96 ] These figures equate to 14.7 percent of American Indian and Alaskan Native ( AIAN) adults, 11.7 percent of non-Hispanic Black adults, 12.5 percent of Hispanic adults, and 7.5 percent of non-Hispanic white adults. Note that non-Hispanic Asian adults, as a combined group, had a total prevalence percentage of 9.2, below other communities of color but still above non-Hispanic white adults. However, these prevalence estimates are not evenly distributed among adults of different national or ethnic backgrounds within these cohorts. According to these data, 12.6 percent of Asian Indian adults have diagnosed diabetes, while only 5.6 percent of Chinese adults do. Similarly, although 12.5 percent of Hispanic adults are estimated to have diagnosed diabetes, this cohort prevalence data includes both 6.5 percent of Cuban adults and 14.4 percent of Mexican adults. Additionally, these prevalence data are not evenly distributed among Men and Women within these cohorts. For example, AIAN Women had a prevalence of diagnosed diabetes of 14.8 percent—the second-highest group, behind Mexican Men ( 16.2 percent) —whereas non-Hispnaic white Women had a prevalence of only 6.6 percent—among the lowest of any group. See Centers for Disease Control and Prevention, “ National Diabetes Statistics Report, Estimates of Diabetes and Its Burden in the United States, ” 2020, https: //www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf ( accessed September 1, 2021), p. 16 ( Appendix Table 3. Age-adjusted prevalence of diagnosed diabetes by detailed race/ethnicity, education level, and sex among adults aged 18 years or older, United States, 2017–2018).
[ 97 ] Ibid.
[ 98 ] In contrast, data published by the CDC suggests that the incidence of T1D among non-Hispanic White youth is higher than amog other other cohorts. Ibid., p. 7 ( Figure 5). For more information on the differences between T2D and T1D, see, for example, US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), pp. 11-13.
[ 99 ] See Walker, Williams and Egede, “ Impact of Race/Ethnicity and Social Determinants of Health on Diabetes Outcomes, ” American Journal of the Medical Sciences, Vol. 351 ( 4), pp. 366-373, April 2016, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC4834895/ ( accessed September 1, 2021)
[ 100 ] Aside from the example given below, see, for example, ibid. ( reviewing medical literature discussing race- and ethnic-based differences in clinical outcomes for people with diabetes in the US, with particular focus on glycemic control, blood pressure control, and blood lipid control); Centers for Disease Control and Prevention, “ Diabetes Atlas, ” https: //gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html # ( accessed September 1, 2021) ( searching by “ Health Status and Disability ” and “ Visual Impairment ”) ( most recent available data at time of writing, from 2018, found that the age-adjusted rate of visual impairment for adults with diabetes to be 21.1 percent among non-Hispanic White adults, 27.2 percent among non-Hispanic Black adults, and 31.6 percent among Hispanic adults).
[ 101 ] Most recent available data at time of writing, from 2016, found that, when adjusted for age, 15.4 non-Hispanic Black adults per 10,000 are hospitalized for DKA, compared with 7.0 per 10,000 white adults and 5.2 per 10,000 Hispanic adults. See Centers for Disease Control and Prevention, “ Diabetes Atlas, ” https: //gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html # ( accessed September 1, 2021) ( searching by “ Diabetes-Related Complications ” and “ Hospitalization for Diabetic Ketoacidosis ”).
[ 102 ] Ibid. ( searching by “ Lower Extremity Diseases ” and “ Hospitalization for Level of Amputation ”). In 2016, the most recent available data at time of writing, there were about 130,000 total discharges for lower-limb amputation among adults with diabetes in the US—equating to roughly 356 individual discharges per day over the course of that year. This includes amputations of the toe, foot, below knee, and above knee. When controlling for prevalence, Black adults with diabetes had a combined age-adjusted rate of lower-limb amputation discharge of 6.5 per 1,000 in 2016, compared with 4.5 per 1,000 among white adults and 4.3 among Hispanic adults. However, given the higher prevalence of diabetes among Black and Hispanic adults in the US when compared with white adults, the race- and ethnicity-based differences in age-adjusted discharge rates for lower limb amputation increase significantly when compared to the entire adult population and not just adults with diabetes: 8.7 non-Hispanic Black adults per 10,000; 6.0 Hispanic adults per 10,000; and 3.8 non-Hispanic white adults per 10,000. Accordingly, non-Hispanic Black adults were 128.9 percent more likely than non-Hispanic white adults to be discharged for a diabetes-related lower-limb amputation in 2016.
[ 103 ] The survey asked participants about whether they had underused insulin in the past year because of the cost, as well as various demographic factors, such as income. Herkert, Vijayakumar, Luo, et al., “ Cost-Related Insulin Underuse Among Patients With Diabetes, ” JAMA Internal Medicine, Vol. 179, pp. 112-114, January 2019, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6583414/ ( accessed September 1, 2021). See also Elijah E. Cummings, “ High-Prescription Drug Prices Hurt the Black Community, ” The Skanner, August 3, 2017, https: //www.theskanner.com/opinion/commentary/25741-high-prescription-drug-prices-hurt-the-black-community ( accessed September 1, 2021) ( describing the double bind facing Black Americans, who are much more likely to suffer from chronic diseases like diabetes while also earning less than white counterparts at every education level, on average).
[ 104 ] 21.5 percent of White respondents compared with 25.5 percent overall. Herkert, Vijayakumar, Luo, et al., “ Cost-Related Insulin Underuse Among Patients With Diabetes, ” JAMA Internal Medicine, Vol. 179, pp. 112-114, January 2019, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6583414/ ( accessed September 1, 2021).
[ 105 ] Ibid. 28.6 percent of Latino/Hispanic and 32.7 percent of Black respondents compared with 25.5 percent overall.
[ 106 ] Ibid.
[ 107 ] Ibid.
[ 108 ] Ibid.
[ 109 ] Ibid.
[ 110 ] In addition to income-based requirements, many immigrants without permanent resident status, many of whom come from communities where diabetes is especially prevalent, are ineligible for Medicaid. See Healthcare.gov, “ Coverage for lawfully present immigrants, ” https: //www.healthcare.gov/immigrants/lawfully-present-immigrants/ ( accessed September 1, 2021). Undocumented immigrants are more than four-times more likely to be uninsured than US citizens and are accordingly especially vulnerable to insulin costs. “ Health Coverage of Immigrants, ” Kaiser Family Foundation, July 15, 2021, https: //www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-of-immigrants/ ( accessed September 1, 2021).
[ 111 ] Eligibility for Medicaid is determined by each state and often involves various eligibility metrics, such as household size, number of dependents, and immigration status, but typically requires an otherwise-qualified individual to earn under a certain percentage of the Federal Poverty Level ( FPL) to be eligible. See Brooks, Gardner, et al., “ Medicaid and CHIP Eligibility and Enrollment Policies as of January 2021: Findings from a 50-State Survey, ” Kaiser Family Foundation, March 8, 2021, https: //www.kff.org/report-section/medicaid-and-chip-eligibility-and-enrollment-policies-as-of-january-2021-findings-from-a-50-state-survey-report/ ( accessed September 1, 2021). The FPL for a single-person household in 2021 was $ 12,880. US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, ” 2021 Poverty Guidelines, ” https: //aspe.hhs.gov/2017-poverty-guidelines ( accessed September 1, 2021). In most states that have adopted the so-called Medicaid expansion, the Medicaid FPL limit for unmarried adults without dependents is 138 percent of the FPL—or $ 17,774. See Kaiser Family Foundation, “ Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level, ” January 1, 2021, https: //www.kff.org/health-reform/state-indicator/medicaid-income-eligibility-limits-for-adults-as-a-percent-of-the-federal-poverty-level/ ( accessed September 1, 2021).
[ 112 ] As of time of writing, the 12 states that have not expanded Medicaid coverage to single-person households without dependents are: Alabama, Florida, Georgia, Kansas, Mississippi, Missouri, North Carolina, South Carolina, South Dakota, Tennessee, Texas, and Wyoming. See Kaiser Family Foundation, “ Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level, ” January 1, 2021, https: //www.kff.org/health-reform/state-indicator/medicaid-income-eligibility-limits-for-adults-as-a-percent-of-the-federal-poverty-level/ ( accessed September 1, 2021). Although Wisconsin has not adopted the Medicaid Expansion under the Affordable Care Act, they have a section 1115 demonstration, which provides Medicaid coverage to some additional low-income adults earning up to 100 percent of the FPL. Note that Missouri and Oklahoma voters approved Medicaid ballot expansion measures in August 2020 and June 2020 respectively. At time of writing, Medicaid expansion implementation for both states were set to begin in 2021. Ibid. See also Brooks, Gardner, et al., “ Medicaid and CHIP Eligibility and Enrollment Policies as of January 2021: Findings from a 50-State Survey, ” Kaiser Family Foundation, March 8, 2021, https: //www.kff.org/report-section/medicaid-and-chip-eligibility-and-enrollment-policies-as-of-january-2021-findings-from-a-50-state-survey-report/ ( accessed September 1, 2021); “ Oklahoma and the ACA’ s Medicaid expansion, ” HealthInsurance.Org, June 3, 2021, https: //www.healthinsurance.org/medicaid/oklahoma/ ( accessed September 1, 2021); “ Missouri and the ACA’ s Medicaid expansion, ” HealthInsurance.Org, June 3, 2021, https: //www.healthinsurance.org/medicaid/missouri/ ( accessed September 1, 2021).
[ 113 ] See Rachel Garfield, Kendal Orgera, and Anthony Damico, “ The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid, ” January 21, 2021, https: //www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/ ( accessed September 1, 2021); Samantha Artiga, Latoya Hill, Kendal Orgera, and Anthony Damico, “ Health Coverage by Race and Ethnicity, 2010-2019, ” https: //www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/ ( accessed September 1, 2021) ( “ For example, nonelderly uninsured Black … people more likely than their White counterparts to fall in the coverage gap in states that have not expanded Medicaid, and uninsured nonelderly Hispanic and Asian people are more likely to be ineligible for coverage due to immigration status, reflecting higher shares of noncitizens among these groups. ”).
[ 114 ] US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, ” 2017 Poverty Guidelines, ” https: //aspe.hhs.gov/2017-poverty-guidelines ( accessed September 1, 2021).
[ 115 ] HealthInsurance.Org, “ Connecticut and the ACA’ s Medicaid expansion, ” November 13, 2018, https: //www.healthinsurance.org/medicaid/connecticut/ ( accessed September 1, 2021).
[ 116 ] See, for example, Vincent Rajkumar, “ The High Cost of Insulin in the United States: An Urgent Call to Action, ” Commentary, Mayo Clinic Proceedings, Vol. 95, pp. 22-28, https: //www.mayoclinicproceedings.org/article/S0025-6196 ( 19) 31008-0/fulltext ( accessed September 1, 2021) ( “ people without insurance … including people who can not afford insurance ( but are not poor enough to qualify for Medicaid or patient assistance programs) bear the full brunt of the list price. ”).
[ 117 ] Human Rights Watch telephone interview with Sa’ Ra Skipper, June 1, 2021.
[ 118 ] Ibid.
[ 119 ] Sa’ Ra Skipper, “ AIN, Sa'Ra Skipper Testimony, ” US House of Representatives, https: //www.congress.gov/116/meeting/house/109861/witnesses/HHRG-116-GO00-Wstate-SkipperS-20190726.pdf ( accessed September 1, 2021).
[ 120 ] Human Rights Watch telephone interview with Sa’ Ra Skipper, June 1, 2021.
[ 121 ] Human Rights Watch telephone interview with anonymous individual July 2021.
[ 122 ] Ibid.
[ 123 ] Human Rights Watch telephone interview with anonymous individual, May 2021.
[ 124 ] Ibid.
[ 125 ] Ibid.
[ 126 ] United States Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” 2020, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL% 201).pdf ( accessed September 1, 2021), p. 28.
[ 127 ] Human Rights Watch telephone interview with anonymous individual, May 2021.
[ 128 ] Regarding this shift in prescribing practices, see, for example, Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021) ( “ Another important trend affecting overall costs for insulin in the last decade is the shift in insulin utilization from the less expensive human insulins to more expensive human insulin analogs. ”). See also Health Care Cost Institute, “ Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices, ” January 2019, https: //healthcostinstitute.org/diabetes-and-insulin/spending-on-individuals-with-type-1-diabetes-and-the-role-of-rapidly-increasing-insulin-prices ( accessed September 1, 2021), p. 4 ( finding that insulin analogs accounted for more than 90 percent of insulin units used in the US between 2012 and 2016, increasingly slightly over this period); Sarkar, Heyward, Alexander and Kalyani, “ Trends in Insulin Types and Devices Used by Adults With Type 2 Diabetes in the United States, 2016 to 2020, ” Journal of the American Medical Association, Diabetes and Endocinology, October 12, 2021, https: //jamanetwork.com/journals/jamanetworkopen/fullarticle/2784811 ( accessed December 1, 2021) ( analyzing millions of outpatient physician-patient interactions between 2016 and 2020 and finding that “ Analog insulin use predominated and accounted for more than 80% of total treatment visits across all years ” while “ The use of biosimilar insulin, which was first approved in 2015, increased from 2.6% in 2017 … to 8.2% in 2020. ”). Regarding analog insulin’ s relative convenience to use when compared with synthetic human insulin, see, for example, University of California, San Francisco, Diabetes Teaching Center, “ Human Insulin, ” https: //dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/medications-and-therapies/type-1-insulin-therapy/types-of-insulin/human-insulin/ ( accessed September 1, 2021) ( `` Relative to the rapid-acting insulin analogs, Regular human insulin has undesirable features, such as a delayed onset of action, and variable peak and duration of action when it is injected under the skin. Because of this, fewer and fewer medical providers are prescribing Regular insulin. The delayed onset of action is the reason you have to inject the insulin and wait before eating. And the variable duration of action predisposes to low blood sugars long after the meal is over. ”).
[ 129 ] Goldstein, Patel, Bland, et al., “ Frequency of Sale and Reasons for Purchase of Over-the-Counter Insulin in the United States, Journal of the American Medical Association, Vol. 179 ( 5), pp. 722-727, February 18. 2019, https: //jamanetwork.com/journals/jamainternalmedicine/article-abstract/2724389 ( accessed September 1, 2021) ( “ While the prices of both types of insulin have increased, the difference in pricing between them has substantially added to insulin costs. ”). See also Jeremy Greene, Kevin Riggs, “ Why Is There No Generic Insulin? Historical Origins of a Modern Problem, ” The New England Journal of Medicine, 2015, No. 372:12, https: //www.nejm.org/doi/full/10.1056/NEJMms1411398 ( accessed September 1, 2021), p. 1172 ( discussing the series of innovations in insulin development).
[ 130 ] See, for example, University of California, San Francisco, Diabetes Teaching Center, “ Human Insulin, ” https: //dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/medications-and-therapies/type-1-insulin-therapy/types-of-insulin/human-insulin/ ( accessed September 1, 2021).
[ 131 ] See University of California, San Francisco, Diabetes Teaching Center, “ Human Insulin, ” https: //dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/medications-and-therapies/type-1-insulin-therapy/types-of-insulin/human-insulin/ ( accessed September 1, 2021); Goldstein, Patel, Bland, et al., “ Frequency of Sale and Reasons for Purchase of Over-the-Counter Insulin in the United States, Journal of the American Medical Association, Vol. 179, pp. 722-727, February 18. 2019, https: //jamanetwork.com/journals/jamainternalmedicine/article-abstract/2724389 ( accessed September 1, 2021).
[ 132 ] See “ Types of Insulin: Topic Overview, ” University of Michigan Health, https: //www.uofmhealth.org/health-library/aa122570 ( accessed September 1, 2021); University of California, San Francisco, Diabetes Teaching Center, “ Human Insulin, ” https: //dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/medications-and-therapies/type-1-insulin-therapy/types-of-insulin/human-insulin/ ( accessed September 1, 2021).
[ 133 ] Ibid.
[ 134 ] Ibid.
[ 135 ] See GoodRx, “ Humulin R, ” https: //www.goodrx.com/humulin-r ( accessed September 1, 2021); GoodRx, “ Humulin N, ” https: //www.goodrx.com/humulin-n ( accessed September 1, 2021); GoodRx, “ Novolin R, ” https: //www.goodrx.com/novolin-r ( accessed September 1, 2021); GoodRx, “ Novolin N, ” https: //www.goodrx.com/novolin-n ( accessed September 1, 2021).
[ 136 ] See GoodRx, “ Novolin R, ” https: //www.goodrx.com/novolin-r ( accessed September 1, 2021); GoodRx, “ Novolin N, ” https: //www.goodrx.com/novolin-n ( accessed September 1, 2021); Julia Belluz, “ Walmart’ s $ 25 insulin can’ t fix the diabetes drug price crisis, ” Vox, April 11, 2019, https: //www.vox.com/science-and-health/2019/4/10/18302238/insulin-walmart-relion ( accessed September 1, 2021); Natalie Shure, “ Walmart’ s Play for the Insulin Market Is the Latest Crack in Our Broken Health Care System, ” The New Republic, July 6, 2021, https: //newrepublic.com/article/162906/walmart-insulin-market-health-care-system ( accessed September 1, 2021). See also See US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, Appendix 3, https: //www.finance.senate.gov/download/novo redacted ( accessed September 1, 2021), p. 3.
[ 137 ] See Ginger Vieira, “ Everything You Need to Know About Walmart Insulin, ” Diabetes Strong, January 24, 2020 ( Updated March 18, 2020), https: //diabetesstrong.com/walmart-insulin/ ( accessed September 1, 2021).
[ 138 ] Julia Belluz, “ Walmart’ s $ 25 insulin can’ t fix the diabetes drug price crisis, ” Vox, April 11, 2019, https: //www.vox.com/science-and-health/2019/4/10/18302238/insulin-walmart-relion ( accessed September 1, 2021) ( citing Goldstein, McCrary, and Lipska, “ Is the Over-the-Counter Availability of Human Insulin in the United States Good or Bad?, ” Journal of the American Medical Association Internal Medicine, Vol. 178 ( 9), pp. 1157-1158, https: //jamanetwork.com/journals/jamainternalmedicine/article-abstract/2687531 ( accessed September 1, 2021)).
[ 139 ] For information on costs related to blood glucose monitoring, see, for example, Health Care Cost Institute, “ Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices, ” January 2019, https: //healthcostinstitute.org/diabetes-and-insulin/spending-on-individuals-with-type-1-diabetes-and-the-role-of-rapidly-increasing-insulin-prices, p. 2.
[ 140 ] Joshua Bote, “ A man who switched to more affordable insulin died. Here's what happened in the viral story, ” USA Today, August 9, 2019, https: //www.usatoday.com/story/news/nation/2019/08/09/man-dies-otc-insulin/1942908001/ ( accessed September 1, 2021). See also Erin Weaver, “ Josh Died Because His Insulin Cost Too Much, ” T1Internatonal, August 1, 2019, https: //www.t1international.com/blog/2019/08/01/josh-died-because-his-insulin-cost-too-much/ ( accessed September 1, 2021).
[ 141 ] Mindi Patterson, “ Losing Meaghan to the Perfect Storm, ” T1International, February 8, 2019, https: //www.t1international.com/blog/2019/02/08/losing-meaghan-perfect-storm/ ( accessed September 1, 2021). See also Ken Alltucker, “ Struggling to stay alive: Rising insulin prices cause diabetics to go to extremes, ” USA Today, March 21, 2019, https: //www.usatoday.com/in-depth/news/50-states/2019/03/21/diabetes-insulin-costs-diabetics-drug-prices-increase/3196757002/ ( accessed December 1, 2021).
[ 142 ] Harry Rybolt, “ People Over Profit Might Have Saved Jeremy, ” T1International, September 27, 2019, https: //www.t1international.com/blog/2019/09/27/people-over-profit-might-have-saved-jeremy/ ( accessed September 1, 2021). See also Shari Rudavsky, “ 'This is just a rip off ': Expensive insulin contributed to man's death at age 39, ” Indianapolis Star, December 29, 2019, https: //www.indystar.com/story/news/health/2019/12/29/diabetes-lead-to-death-who-cant-afford-insulin/2617976001/ ( accessed December 1, 2021).
[ 143 ] Nicole Hood, “ I Lost Allen Because He Was Forced to Ration Insulin, ” T1International, July 6, 2019, https: //www.t1international.com/blog/2019/07/06/rationing-insulin-caused-andys-death/ ( accessed September 1, 2021). See also Adela Uchida, “ Cost of prescription drugs, like insulin, weighs heavily on the minds of Democratic voters, ” CBS Austin, March 1, 2020, https: //cbsaustin.com/news/local/cost-of-prescription-drugs-like-insulin-weighs-heavily-on-the-minds-of-democratic-voters ( accessed December 1, 2021).
[ 144 ] Several individuals who spoke with Human Rights Watch described the age 26 as particularly significant for people with chronic health conditions. This is because the Affordable Care Act requires all private health insurance plans that offer coverage to dependent children, whether purchased on the individual marketplace or through an employer, to make that dependent child coverage available until a child reaches the age of 26. US Department of Labor, “ Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Businesses and Families FAQs, ” https: //www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/young-adult-and-aca ( accessed September 1, 2021).
[ 145 ] The comparative effectiveness of analog insulins remains a subject of debate in literature reviewed by Human Rights Watch. See, for example, David Beran, Bianca Hemmingsen, and John S. Yudkin, “ Analogue insulin as an essential medicine: the need for more evidence and lower prices, ” The Lancet, Vol. 7 ( 5), May 1, 2019, https: //www.thelancet.com/journals/landia/article/PIIS2213-8587 ( 19) 30111-1/fulltext ( arguing that adequate evidence of analog insulin’ s superiority to human insulin does not currently exist); Israel Hartman, “ Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence, ” Clinical Medicine & Research, Vol. 6 ( 2), pp. 54-67, September 2008, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC2572551/ ( arguing that insulin analogs provide a closer replication of a normal insulin profile); see, for example, Jeremy Greene, Kevin Riggs, “ Why Is There No Generic Insulin? Historical Origins of a Modern Problem, ” The New England Journal of Medicine, 2015, No. 372:12, https: //www.nejm.org/doi/full/10.1056/NEJMms1411398, pp. 1173-74 ( accessed September 1, 2021) ( “ it has yet to be shown that analogues lead to better long-term outcomes than standard recombinant human insulin does. ”); David Beran, Bianca Hemmingsen, and John S. Yudkin, “ Analogue insulin as an essential medicine: the need for more evidence and lower prices, ” The Lancet, Vol. 7 ( 5), May 1, 2019, https: //www.thelancet.com/journals/landia/article/PIIS2213-8587 ( 19) 30111-1/fulltext ( accessed September 1, 2021) ( arguing more evidence of analog insulins’ advantages over regular human insulin is needed); Wolfgang Landgraf and Juergen Sandow, “ Recombinant Human Insulins – Clinical Efficacy and Safety in Diabetes Therapy, ” European Endocrinology, Vol. 12 ( 1), pp. 12-17, March 2016, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5813452/ ( accessed September 1, 2021) ( “ When considering efficacy, there is clearly an established place for human insulin formulations in the therapy of type 1 ( multiple daily injections) and type 2 diabetes.… When comparing cost of therapies, recombinant human insulin formulations are the choice for countries in patients with limited resources. ”). See also Julia Belluz, “ Walmart’ s $ 25 insulin can’ t fix the diabetes drug price crisis, ” Vox, April 11, 2019, https: //www.vox.com/science-and-health/2019/4/10/18302238/insulin-walmart-relion ( accessed September 1, 2021) ( “ Human insulins are a reasonable option for many patients with Type 2 diabetes … But the drug isn’ t optimal for everybody. ”).
[ 146 ] Nearly 30 million people—9.2 percent of the country—are uninsured. Human Rights Watch Analysis of Kaiser Family Foundation, “ Health Insurance Coverage of the Total Population, ” 2019, https: //www.kff.org/other/state-indicator/total-population ( accessed September 1, 2021).
[ 147 ] See Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1310; The Endocrine Society, “ Addressing Insulin Access and Affordability: An Endocrine Society Position Statement, ” The Journal of Clinical Endocrinology & Metabolism, 2021, https: //www.endocrine.org/-/media/endocrine/files/advocacy/position-statement/insulin-position-statement-jcem.pdf ( accessed September 1, 2021), p. 4.
[ 148 ] A 2019 national survey of pharmacies estimated that over 18,000 vials of synthetic human insulin are sold over the counter each day in the US. This study found that more than half of the pharmacies surveyed were aware of patients who purchased these older synthetic human insulins because they could not afford the copay for their prescription. Goldstein, Patel, Bland, et al., “ Frequency of Sale and Reasons for Purchase of Over-the-Counter Insulin in the United States, Journal of the American Medical Association, Vol. 179 ( 5), pp. 722-727, February 18. 2019, https: //jamanetwork.com/journals/jamainternalmedicine/article-abstract/2724389 ( accessed September 1, 2021).
[ 149 ] J. Hunter Fraker and Mariana P. Socal, “ Manufacturer-Sponsored Cost-Sharing Programs for Insulin: Are Patients Getting the Help They Need? ”, Journal of General Internal Medicine, 23 May 2021, https: //link.springer.com/article/10.1007/s11606-021-06892-5 ( accessed September 1, 2021) ( outlining the various patient assistance programs available for people with insulin-dependent diabetes in the US). See also Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 2-3; Letter from Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021, p. 2-3; and Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 5-11.
[ 150 ] For additional information about each manufacturer’ s programs, see also US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf, Appendix 1, https: //www.finance.senate.gov/imo/media/doc/Eli% 20Lilly Redacted% 20v1.pdf ( accessed September 1, 2021), p. 25; Appendix 2, https: //www.finance.senate.gov/download/sanofi redacted ( accessed September 1, 2021), pp. 26-30; and Appendix 3, https: //www.finance.senate.gov/download/novo redacted ( accessed September 1, 2021), pp. 3, 52-54.
[ 151 ] Both our letters to these manufacturers and their responses can be viewed in full in the Annex to this report.
[ 152 ] Ibid., Appendix 1, https: //www.finance.senate.gov/imo/media/doc/Eli% 20Lilly Redacted% 20v1.pdf ( accessed September 1, 2021), p. 25.
[ 153 ] Ibid., Appendix 3, https: //www.finance.senate.gov/download/novo redacted ( accessed September 1, 2021), pp. 3, 52-54.
[ 154 ] Ibid., Appendix 2, https: //www.finance.senate.gov/download/sanofi redacted ( accessed September 1, 2021), pp. 26-30. See also Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 5-11.
[ 155 ] In 2020, the American Diabetes Association estimated that about 650,000 insulin patients were skipping injections or taking less insulin than prescribed. American Diabetes Association, “ Diabetes and COVID-19: New Data Quantifies Extraordinary Challenges Faced by Americans with Diabetes During Pandemic, ” July 2020, https: //www.diabetes.org/sites/default/files/2020-07/7.29.2020 dQA-ADA% 20Data% 20Release.pdf ( accessed September 1, 2021), p. 4. See also, Elizabeth Pfiester, Katarina Braune, et al., “ Costs and underuse of insulin and diabetes supplies: Findings from the 2020 T1International cross-sectional web-based survey, ” Diabetes Research and Clinical Practice, Vol. 179, September 2021, https: //www.sciencedirect.com/science/article/pii/S0168822721003557 ( accessed October 6, 2021) ( finding that more than 25 percent of 542 US-based respondents rationed insulin in the past year due to cost); Patients who reported cost-related insulin underuse in this study were three times more likely to have poor blood sugar control, after adjusting for other factors. Herkert, Vijayakumar, Luo, et al., “ Cost-Related Insulin Underuse Among Patients With Diabetes, ” Journal of the American Medical Association, Vol. 179, January 2019, https: //jamanetwork.com/journals/jamainternalmedicine/fullarticle/2717499 ( accessed September 1, 2021) ( finding that 25 percent of 199 respondents reported underusing prescribed insulin because of the cost within the past year); American Diabetes Association and Vault, “ Insulin Affordability Survey, 2018, ” May 22, 2018, http: //main.diabetes.org/dorg/PDFs/2018-insulin-affordability-survey.pdf ( accessed September 1, 2021), pp. 8, 16 ( finding that 26 percent of respondents regularly took less insulin than prescribed in the past year because of the cost). See also T1International, “ 2018 T1International Out-of-Pocket Cost Survey, ” 2018, https: //www.t1international.com/access-survey/ ( accessed September 1, 2021). For more information on the potential health impacts of rationing, see, for example, The Endocrine Society, “ Addressing Insulin Access and Affordability: An Endocrine Society Position Statement, ” The Journal of Clinical Endocrinology & Metabolism, 2021, https: //www.endocrine.org/-/media/endocrine/files/advocacy/position-statement/insulin-position-statement-jcem.pdf ( accessed September 1, 2021) ( “ One study indicates that improved adherence among people with diabetes could prevent nearly 700 000 emergency department visits, 341 00 hospitalizations and save $ 4.7 billion annually ”), p. 6.
[ 156 ] In addition to the income-based limitations discussed in greater detail below, the common requirement limiting aid from these patient assistance programs to US citizens and permanent residents also has the de facto effect of excluding certain documented and undocumented immigrants, many of whom come from communities where diabetes is especially prevalent. See Centers for Disease Control and Prevention, “ National Diabetes Statistics Report, Estimates of Diabetes and Its Burden in the United States, ” 2020, https: //www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf ( accessed September 1, 2021), p. 16 ( documenting the higher prevalence of diabetes among different racial and ethnic communities in the US). Undocumented immigrants, who are largely excluded from federally funded public assistance programs like Medicaid, are already more than four-times more likely to be uninsured than US citizens and are accordingly especially vulnerable to insulin costs. “ Health Coverage of Immigrants, ” Kaiser Family Foundation, July 15, 2021, https: //www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-of-immigrants/ ( accessed September 1, 2021). See also Martin J. Kyalwazi and Camila Hurtado, “ The California Insulin Crisis Explained: A Primer on Insulin Pricing, Past Legislative Action, and the Path Forward, ” California Initiative for Health Equity & Action ( Cal-IHEA), June 2020, https: //healthequity.berkeley.edu/sites/default/files/cal-ihea insulin affordability policy brief final.pdf ( accessed September 1, 2021).
[ 157 ] See Novo Nordisk, “ Patient Assistance Program, ” December 2020, https: //www.novocare.com/diabetes-overview/let-us-help/pap.html ( accessed September 1, 2021); Lilly Cares Foundation, “ Check Your Eligibility, ” https: //www.lillycares.com/how-to-apply # check-eligibility ( accessed September 1, 2021); and Sanofi, “ Patient Assistance Connection, ” https: //www.sanofipatientconnection.com/ ( accessed September 1, 2021). The Federal Poverty Level for a single-person household in 2021 was $ 12,880. US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, ” 2021 Poverty Guidelines, ” https: //aspe.hhs.gov/2017-poverty-guidelines ( accessed September 1, 2021). As of August 1, 2021, Minnesota is the only state in the US that has passed legislation requiring these programs to amend their eligibility requirements and selection processes. Minnesota Board of Pharmacy, “ Minnesota Insulin Safety Net Program, ” https: //mn.gov/boards/pharmacy/insulinsafetynetprogram/ ( accessed September 1, 2021). However, in a letter to Human Rights Watch, Novo Nordisk wrote that the restrictions on health insurance coverage were a major filter for many seeking assistance through their programs. See Letter from Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021, p. 2-3 ( “ Since January 2019, approximately 252,000 patients … have applied to the company’ s PAP and approximately 218,000 patients … have been enrolled. While most applications are approved, the primary reason that patients are denied participation in the PAP is because the patient has insurance. ”).
[ 158 ] See Department of Health and Human Services, Office of the Inspector General, “ Pharmaceutical Manufacturer Copayment Coupons, ” Special Advisory Bulletin, September 2014, https: //www.oig.hhs.gov/fraud/docs/alertsandbulletins/2014/SAB Copayment Coupons.pdf ( accessed September 28, 2021) ( interpreting the federal Anti-Kickback Statute to prohibit drug manufacturers from offering co-pay support through PAPs for prescriptions covered by public health plans ( e.g., Medicare and Medicaid)). “ There is no application or enrollment process ( beyond the individual confirming he or she is over 18 years old, a U.S. resident, and not covered by a government insurance program. ” Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 1. Each of the three insulin manufacturers included within this report also participate in Medicare Part D’ s Senior Savings Model. Ibid., ( “ Nationally, approximately 50 percent of eligible seniors who use insulin enrolled in a participating plan. According to CMS, seniors who take insulin and enroll in a participating Senior Savings Model plan are expected to save an average of $ 446 in annual out-of-pocket costs for insulin—over 66 percent—with premiums increasing less than $ 1 per month. ”); Letter from Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021, p. 3; and Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 8-9.
[ 159 ] Human Rights Watch telephone interview with Zoe Witt, May 12, 2021.
[ 160 ] See, for example, Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 7-8 ( “ In 2021, on average, it took approximately 3 business days for Sanofi’ s vendor to process a completed PAP application. Patients receive their free medicine at their physician’ s office approximately 4 business days after enrollment. ”).
[ 161 ] Twitter Post, @ mutualaidbetes, June 27, 2021, https: //twitter.com/MutualAidBetes/status/1409350044398981120 ( accessed September 1, 2021). Human Rights Watch text exchange with Zoe Witt, June 28, 2021.
[ 162 ] Both our letters to these manufacturers and their responses can be viewed in full in the Annex to this report. See, for example, Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 1 ( “ Today, anyone is eligible [ under the Lilly Insulin Value Program ] to purchase a monthly prescription of Lilly insulin for $ 35, whether they use commercial insurance, Medicare Part D, Medicaid, or have no insurance at all ”); Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021, p. 2-3 ( “ In response to the COVID-19 pandemic and the effect that it has had on those living with diabetes, Novo Nordisk expanded its diabetes Patient Assistance Program … to offer a free 90-day supply of insulin to those who have lost health care coverage because of a change in job status due to the COVID-19 pandemic. ”). Novo Nordisk’ s Immediate Supply provides “ a free, one-time, immediate supply of up to three vials. ” Ibid. While helpful, this emergency stopgap protection is only available once per calendar year, and it is similarly unclear how many people have been able to take advantage of the program. Ibid. See also Novo Nordisk, “ Immediate Supply offer terms and conditions, ” https: //www.novocare.com/content/novocare/en/eligibility/immediate-supply.html ( accessed September 28, 2021). In a letter to Human Rights Watch, Sanofi also stated that the company “ made a number of temporary changes to the Sanofi Patient Connection PAP to address documentation and product supply challenges in the early part of the COVID-19 pandemic, ” and provide certain programs to individuals regardless of income level. Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 6-11.
[ 163 ] Ibid.
[ 164 ] US House of Representatives, Ways and Means Committee, “ A Painful Pill to Swallow: U.S. vs. International Prescription Drug Prices, ” September 2019, https: //waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/U.S.% 20vs.% 20International% 20Prescription% 20Drug% 20Prices 0.pdf ( accessed September 1, 2021). Please note that data for Canada is drawn exclusively from the province of Ontario, Canada. Ibid, pp. 3, 10-12. For information about these countries’ price-setting regimes, see, for example, Gross, Ratner, et al., “ International Pharmaceutical Spending Controls: France, Germany, Sweden, and the United Kingdom, ” Health Care Finance Review, Vol. 15 ( 3), 1994, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC4193451/ ( accessed September 1, 2021); Rajkumar and Harousseau, “ Next-generation multiple myeloma treatment: a pharmacoeconomic perspective, ” Blood, Vol. 128 ( 24), December 15, 2016, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5159700/ ( accessed September 1, 2021); “ What’ s being done to bring down high drug costs?, ” SwissInfo.CH, December 28, 2017, https: //www.swissinfo.ch/eng/us -- -swiss-health-series what-s-being-done-to-bring-down-high-drug-costs-/43785228 ( accessed September 1, 2021); Boonen, Van der Geest, et al., “ Pharmaceutical policy in the Netherlands: from price regulation towards managed competition, ” Advances in Health Economics and Health Services Research, Vol.22, pp. 53-76, 2010, https: //pubmed.ncbi.nlm.nih.gov/20575228/ ( accessed September 1, 2021); Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021), pp. 505-507; Kaiser and Ullrich, “ Regulation of pharmaceutical prices: Evidence from a reference price reform in Denmark, ” Journal of Health Economics, Vol. 36, pp. 174-187, July 2014, https: //www.sciencedirect.com/science/article/abs/pii/S0167629614000460 ( accessed September 1, 2021); “ Regulatory, Pricing and Reimbursement, ” Pharma Boardroom, October 22, 2018, https: //pharmaboardroom.com/legal-articles/regulatory-pricing-and-reimbursement-portugal/ ( accessed September 1, 2021). For discussion of external or therapeutic reference pricing, therapeutic valuation, or health technology assessments, see, for example, Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021), pp. 505-507 ( discussing the different price mechanisms in UK, Australia, Germany, France, Ontario, Canada and Japan); Rajkumar and Harousseau, “ Next-generation multiple myeloma treatment: a pharmacoeconomic perspective, ” Blood, Vol. 128 ( 24), December 15, 2016, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5159700/ ( discussing countries with therapeutic value based price-setting mechanisms).
[ 165 ] For more information on the US Food and Drug Administration’ s approval process, See US Food and Drug Administration, “ Development & Approval Process, Drugs, ” October 28, 2019, https: //www.fda.gov/drugs/development-approval-process-drugs ( accessed September 1, 2021). See, for example, Rajkumar and Harousseau, “ Next-generation multiple myeloma treatment: a pharmacoeconomic perspective, ” Blood, Vol. 128 ( 24), December 15, 2016, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5159700/ ( accessed September 1, 2021) ( “ In many European countries, Canada, and Australia, regulatory approval is only the first step. The price of the drug is then subject to negotiation based on the value it provides. [ … ] In the United States, there is no system to define fair price. ”).
[ 166 ] Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021), p. 505 ( “ Unlike the United States, most industrialized countries do not rely primarily on market forces to control drug prices. Instead, they employ various forms of rate setting and price regulations such as external or therapeutic reference pricing, therapeutic valuation, and health technology assessment. ”).
[ 167 ] For a discussion of this dynamic, see, for example, US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), p. 5 ( “ a combination of factors contributed to consumers facing higher costs for insulin over the last 15 years. First and foremost, pharmaceutical manufacturers have complete control over setting the list price … for their products. ”). See also Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021), pp. 500 ( citing Kang, DiStefano, Socal, and Anderson, “ Using external reference pricing in Medicare Part D to reduce drug price differentials with other countries, ” 2019, Health Affairs, Vol.38 ( 5), pp. 804–811) ( “ The study also showed that the longer the branded drug remained on the market, the greater the price differential between the United States and these comparison countries. This widening of the price differential is because prices in the United States tend to go up following the drug launch, whereas prices in other countries tend to go down. Other industrialized countries have employed various mechanisms to control postlaunch drug prices, whereas the United States allows pharmaceutical companies to increase drug prices as much as they want based on the market situation throughout the drug life cycle. ”).
[ 168 ] US House of Representatives, Ways and Means Committee, “ A Painful Pill to Swallow: U.S. vs. International Prescription Drug Prices, ” September 2019, https: //waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/U.S.% 20vs.% 20International% 20Prescription% 20Drug% 20Prices 0.pdf ( accessed September 1, 2021), p. 20. However, the study also found that seven non-insulin medications used to treat Type 2 diabetes were priced 600 to 1,100 percent higher in the United States than abroad. Insulin medications tended to have price differentials close to the average U.S.- international price differential, but non-insulin diabetes medications had much higher prices compared to the international average. Ibid.
[ 169 ] See Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021), pp. 505-507, p. 508 ( “ The US system does not seem to work effectively given that the prices in the other countries are typically much lower than US prices. The various industrialized countries have utilized many different approaches to determine drug prices, including external reference pricing, therapeutic reference pricing, and [ health technology assessment ]. However, in spite of adopting different mechanisms, the prices the various countries pay for a market basket of drugs are relatively similar, and the main variation seems to be the income of the country and not the mechanism for setting the payment rate. ”).
[ 170 ] Ibid., pp. 500, 507 ( citing Kang, DiStefano, Socal, and Anderson, “ Using external reference pricing in Medicare Part D to reduce drug price differentials with other countries, ” 2019, Health Affairs, Vol.38 ( 5), pp. 804–811) ( “ Some countries paid higher prices for some drugs compared with the other countries; however, these countries paid lower prices for other drugs, which offset the higher prices. In almost all cases, the United States is the outlier, with considerably higher prices. ”).
[ 171 ] Ibid., p. 507. See also Mulcahy, Whaley, et al., “ International Prescription Drug Price Comparisons Current Empirical Estimates and Comparisons with Previous Studies, ” RAND Corporation Research Report, 2021, https: //www.rand.org/pubs/research reports/RR2956.html ( accessed September 1, 2021). For additional discussion of how the lack of drug price regulations in the US may allow companies to generate comparatively greater revenue from the US market than international markets, see, for example, US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), p. 52 ( “ Sanofi understood the risk of its decision [ to increase US list prices ] and ‘ went into 2013 with eyes wide open that the significant price increases planned would inflame [ its ] customers’ … However, it was seeking to make up for ‘ shortfalls with Lantus demand generation and global profit shortfalls’ which it said, ‘ put pressure on the US to continue with the price increases to cover gaps.’. ”).
[ 172 ] United States Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” 2020, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL% 201).pdf ( accessed September 1, 2021), pp. 39, 67-69, 7 ( “ Rebates for insulins have increased exponentially since 2013. In July 2013, Sanofi offered rebates between 2% and 4% for preferred placement on CVS Caremark’ s client’ s commercial formulary. Five years later, in 2018, Sanofi rebates were as high as 56% for preferred formulary placement. ”). See also Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), ( “ Novo Nordisk, Eli Lilly, and Sanofi have reported that rebates have grown rapidly in recent years—representing more than 40% of U.S. gross sales in some cases. ”). Between 2006 and 2014, the average rebate for drugs in Medicare’ s pharmaceutical program increased from 8.6 percent of the list price to 14.3 percent, pointing to a growing influence of rebates on the entire pharmaceutical sector. See Dusetzina, Conti et al., “ Association of Prescription Drug Price Rebates in Medicare Part D With Patient Out-of-Pocket and Federal Spending, ” JAMA Internal Medicine, Vol. 177 ( 8), pp. 1185-1188, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5722464/ ( accessed September 1, 2021).
[ 173 ] See US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), p. 5 ( “ These price increases appear to have been driven, in part, by tactics PBMs [ Pharmacy Benefit Managers ] employed in the early 2010s. At that time, PBMs began to more aggressively pit manufacturers against each other by implementing formulary exclusions in the insulin therapeutic class … this tactic appears to have been more effective in boosting the size of rebates than suppressing the upward march of [ list ] prices. As a result, pharmaceutical manufacturers continued to raise [ list ] prices aggressively—increases that were often closely timed with price changes made by competitors ”), pp. 29, 34 ( “ A product’ s formulary placement can also affect a patient’ s out-of-pocket spending, as demonstrated by an internal Sanofi analysis of Part D formularies operated by CVS Caremark that found co-pays for Lantus could “ range... from $ 236 ( 34% co-ins) to as high as $ 348 ( 50% co-ins) ” depending on its formulary tier. ”). See also Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1303-06; Congressional Diabetes Caucus, “ Insulin: A Lifesaving Drug Too Often Out of Reach, ” November 5, 2018, https: //congress.gov/116/meeting/house/109502/documents/HHRG-116-IF02-20190402-SD001.pdf ( accessed September 1, 2021), pp. 10, 16.
[ 174 ] Pharmacy Benefit Managers ( PBM), one of the least visible actors in the pharmaceutical supply chain, help health insurance companies manage their operations in relation to prescription and over-the-counter drugs. This includes negotiating with drug manufacturers and pharmacies on behalf of the insurer, helping decide whether and how drugs should be covered in health plan formularies, and administering claims from pharmacies. As PBMs define whether and how prescription and over the counter drugs are covered by the insurance companies they represent, they have an extraordinary influence on the business practices of pharmaceutical manufacturers. See Bai, Sen, and Anderson, “ Pharmacy Benefit Managers, Brand-Name Drug Prices, and Patient Cost Sharing, ” Annals of Internal Medicine, Vol. 168 ( 8), pp. 436-437, March 20, 2018, https: //www.acpjournals.org/doi/10.7326/m17-2506 ( accessed September 1, 2021); Soon, Ribero, Tyan and Van Nuys, “ The Association Between Drug Rebates and List Prices, ” White Paper, USC Schaeffer Center for Health Policy & Economics, February 11, 2020, https: //healthpolicy.usc.edu/research/the-association-between-drug-rebates-and-list-prices/ ( accessed September 1, 2021); The Commonwealth Fund, “ Pharmacy Benefit Managers and Their Role in Drug Spending, ” April 22, 2019, https: //www.commonwealthfund.org/publications/explainer/2019/apr/pharmacy-benefit-managers-and-their-role-drug-spending ( accessed September 1, 2021); US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), pp. 29-30. The PBM market in the US is highly concentrated, with recent studies estimating that just three PBMs serve approximately 80 percent of people in the US with health insurance. See Soon, Ribero, Tyan and Van Nuys, “ The Association Between Drug Rebates and List Prices, ” White Paper, USC Schaeffer Center for Health Policy & Economics, February 11, 2020, https: //healthpolicy.usc.edu/research/the-association-between-drug-rebates-and-list-prices/ ( accessed September 1, 2021). Different studies cite different levels of market concentration, however. See, for example, Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1303 ( “ Nationally, PBMs administer the prescription medication benefit for more than 266 million Americans, and the three major PBMs ( CVS Caremark, Express Scripts, and OptumRx) manage about 70% of all prescription claims. ”); US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), pp. 29-30.For information on formularies and tier pricing, see Trisha Torrey, “ What Is a Health Insurer's Drug Formulary and Tier Pricing?, ” VeryWell Health, February 26, 2020, https: //www.verywellhealth.com/drug-formulary-tiers-pricing-health-insurance-plans-2615042 ( accessed September 1, 2021).
[ 175 ] Some studies suggest that PBMs may favor drugs that offer large rebates over similar drugs that may have much lower costs but lower rebates. See Soon, Ribero, Tyan and Van Nuys, “ The Association Between Drug Rebates and List Prices, ” White Paper, USC Schaeffer Center for Health Policy & Economics, February 11, 2020, https: //healthpolicy.usc.edu/research/the-association-between-drug-rebates-and-list-prices/ ( accessed September 1, 2021); Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021); US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), pp. 29, 55; Dusetzina, Conti et al., “ Association of Prescription Drug Price Rebates in Medicare Part D With Patient Out-of-Pocket and Federal Spending, ” JAMA Internal Medicine, Vol. 177 ( 8), pp. 1185-1188, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5722464/ ( accessed September 1, 2021); Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), pp. 1305-06 ( “ The health plans the Working Group interviewed reported that plans and PBMs have an incentive to select medications for their formularies that offer a higher rebate. ”).
[ 176 ] Manufacturers can lose access to large shares of the US market if their drug is excluded from or given restricted placement on these drug formularies that service millions of people on those insurance plans. As a result, manufacturers of similar types of drugs, such as analog insulin, compete to ensure that PBMs give their products beneficial placement. See US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), p. 5 ( “ drug manufacturers increased insulins’ [ Wholesale Acquisition Cost ] in part to give them room to offer larger rebates to PBMs and health insurers, all in the hopes that their product would receive preferred formulary placement. This pricing strategy translated into higher sales volumes and revenue for manufacturers. In some cases, manufacturers appear to have been concerned that decreasing WAC prices would be viewed negatively by PBMs, since PBMs capture a portion of rebate revenue and are also paid administrative fees based on a percentage of WAC. ”). Ibid, Appendix 1, https: //www.finance.senate.gov/imo/media/doc/Eli% 20Lilly Redacted% 20v1.pdf ( accessed September 1, 2021), p. 5 ( “ it has become increasingly common for insurers and PBMs to offer only one insulin manufacturer’ s line of insulins on their formularies to achieve the greatest discount ( rebate) and thereby the lowest cost. As a result, Lilly and other manufacturers aggressively compete for placement on insurers’ formularies and pay rebates to PBMs and insurers to keep medicines available on those formularies in crowded drug classes and, importantly, available to insureds. Overall, average Lilly discounts on U.S. list prices for our products have grown from 41% to 54% in the past five years, with rebates for our insulin products substantially above these rates. ”), p. 79.
[ 177 ] See, for example, Soon, Ribero, Tyan and Van Nuys, “ The Association Between Drug Rebates and List Prices, ” White Paper, USC Schaeffer Center for Health Policy & Economics, February 11, 2020, https: //healthpolicy.usc.edu/research/the-association-between-drug-rebates-and-list-prices/ ( accessed September 1, 2021).
[ 178 ] However, “ There is considerable debate regarding how much the PBMs actually lower prices. ” See, for example, Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021), pp. 503 ( “ Understanding PBMs’ preferences for rebates, which are based on the difference between the list price and the actual net price, branded drug companies keep increasing their list prices and paying higher rebates. There is considerable debate regarding how much the PBMs actually lower prices. However, as noted at the beginning of this article, payers in the United States pay much higher prices than do those in other countries, and the price differential has grown larger over time ”), p. 508 ( “ The drug supply chain in the United States promotes higher, not lower, prices. ”).
[ 179 ] Soon, Ribero, Tyan and Van Nuys, “ The Association Between Drug Rebates and List Prices, ” White Paper, USC Schaeffer Center for Health Policy & Economics, February 11, 2020, https: //healthpolicy.usc.edu/research/the-association-between-drug-rebates-and-list-prices/ ( accessed September 1, 2021).
[ 180 ] See generally, US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021).
[ 181 ] Ibid., pp. 4-5, 6, 50-51.
[ 182 ] Ibid., pp. 6, 52-54. Internal company documents showed that both Eli Lilly and Sanofi also, at a minimum, “ closely tracked and responded to price increases ” from their competitors. For example, a 2014 email from an Eli Lilly official discussing potential price increases, published in the Committee report, notes that “ Novo took a 9.9% price increase across their Insulin portfolio. Ibid., pp. 62-63.
[ 183 ] “ This finding of greater increases in list prices than net prices raises the following questions. Who else has benefited or lost from the substantial increase in insulin list prices over the last decade? And why has the financial burden for people with diabetes who use insulin continued to increase—especially for those without insurance who may have to pay the full list price? ” See Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1306 ( citing Roland D, Loftus P., “ Insulin prices soar while drugmakers’ share stays flat, ” Wall Street Journal, 7 October 2016. https: //www.wsj.com/articles/insulin-prices-soar-while-drugmakers-share-stays-flat-1475876764 ( accessed September 1, 2021)), p. 1301 ( “ The Working Group found a number of examples from public sources showing that the net price to the insulin manufacturers has grown at a slower rate, or has gone down, compared to list prices. For example, the net price of the insulin formulation Lantus ( glargine) increased more or less in parallel with the list price from 2007 to 2013. However, the net price has decreased in recent years ( 2014–2016). As a result, the net price increased by 57% between 2007 and 2016, increasing 23% as fast as the list price reported as a 252% increase over the same period. ”). See also, Ibid., p.1301-1302 ( “ Bloomberg News reported an estimate by an independent market research firm that the list price of Eli Lilly’ s human insulin analog, Humalog, increased by 138% between 2009 and 2015, while the net price to the manufacturer increased by 6%. Novo Nordisk also published data for two of their insulin products, NovoLog and NovoLog FlexPen. Since the early 2000s, th [ compounding annual growth rate ] for the list prices for NovoLog … have been in the range of 9.8–9.9%. This translated into large total increases in the list prices: 353% ( 2001–2016) for a NovoLog … In contrast, net prices received by the manufacturer increased at a more modest rate ( 3–36%) with [ compounding annual growth rates ] of 0.2–2.1%. Novo Nordisk, Eli Lilly, and Sanofi have reported that rebates have grown rapidly in recent years representing more than 40% of U.S. gross sales in some cases. ”).
[ 184 ] Ibid., p. 1301.
[ 185 ] Sanofi’ s letter to Human Rights Watch provided an updated figure for this for the period between 2012 and 2020. Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 11 ( “ the average net price for Sanofi’ s insulins has declined by 53 percent between 2012 and 2020 … since 2012 the net price in commercial and Medicare Part D plans for our most prescribed insulin, Lantus, has fallen by 44.9 percent. ”). Public data published by Eli Lilly also indicates that the list price for a vial of Humalog has been similarly stagnant; however, the net price figures used by Lilly aggregate net price values from Humalog and the self-authorized generic, insulin lispro. See Eli Lilly and Company, “ 2020 Environmental, Social, and Governance Report, ” 2021, https: //images.ctfassets.net/1o78rkhl3da6/4G7O4eiTriXm5PfSjs5qSR/9ca8946c735585fa759eb88a05c095b0/article-inline-image-humilog price.png ( accessed September 1, 2021).
[ 186 ] See, for example, Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 2-3; Letter from Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021, p. 4; Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 11; Eli Lilly and Company, “ 2020 Environmental, Social, and Governance Report, Access and Affordability, ” https: //esg.lilly.com/social # tab-control-tab1 ( accessed September 1, 2021). See also “ Testimony of Michael B. Mason, Senior Vice President, Connected Care and Insulins at Eli Lilly and Company, to United States House of Representatives, Committee on Energy and Commerce, Subcommittee on Oversight & Investigations, ” April 10, 2019, https: //energycommerce.house.gov/sites/democrats.energycommerce.house.gov/files/documents/Testimony-Mason% 2004.10.2019.pdf ( accessed September 1, 2021); “ Testimony Of Douglas J. Langa, Novo Nordisk Inc., Before The U.S. House Of Representatives, Committee On Energy And Commerce, Subcommittee On Oversight And Investigations, ” April 10, 2019, https: //energycommerce.house.gov/sites/democrats.energycommerce.house.gov/files/documents/Testimony-% 20Langa% 2004.10.2019.pdf ( accessed September 1, 2021); “ Testimony of Kathleen W. Tregoning, Executive Vice President, External Affairs, Sanofi, Before the House Energy and Commerce Subcommittee on Oversight and Investigations, ” April 10, 2019, https: //energycommerce.house.gov/sites/democrats.energycommerce.house.gov/files/documents/Testimony-Tregoning% 2004.10.2019.pdf ( accessed September 1, 2021). See also US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), at: Appendix 2, https: //www.finance.senate.gov/download/sanofi redacted ( accessed September 1, 2021), p. 23; Appendix 3, https: //www.finance.senate.gov/download/novo redacted ( accessed September 1, 2021), p. 4; Appendix 1, https: //www.finance.senate.gov/imo/media/doc/Eli% 20Lilly Redacted% 20v1.pdf ( accessed September 1, 2021), p. 5.
[ 187 ] Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 11 ( Lantus’ “ net price is lower today than it was in 2006 ”). Note that the 2021 Senate Finance Committee, analyzing data from 2016, found that each of these three manufacturers were retaining more revenue from the sale of insulin products than they were ten to fifteen years ago. Regarding Sanofi, the Senate Finance Committee found that the average net price for Lantus decreased by $ 32 between 2014 and 2016; however, the 2016 net price ( $ 87.48) was still roughly twice the 2005 net price ( $ 46.92). US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), pp. 4-5, 6, 50-51, 7, 45. Aside from the example cited below, Eli Lilly reported a steady increase in Humalog revenue for more than a decade, the Committee report states, from $ 1.5 billion in 2007 to more than $ 3 billion in 2018. Ibid., p. 7-8. Sanofi’ s response to Human Rights Watch indicates that the per-vial rebate offered for Lantus products has likely increased in the five years since 2016; however, the company did not provide net price data that allowed us to independently verify this claim. Ibid.
[ 188 ] Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 11-12.
[ 189 ] CVS Health, OptumRx ( owned by UnitedHealth Group), and Express Scripts ( owned by Cigna). This correspondence, included responses from OptumRx and CVS Health, is reproduced in full in the Annex to this report.
[ 190 ] Letter from Heather Cianfrocco, Chief Executive Officer, OptumRx, to Human Rights Watch, September 20, 2021, pp 1-2. In its response to Human Rights Watch, CVS Health wrote: “ CVS Health is committed to making prescription drugs, including insulin, as affordable as possible. Drug manufacturers alone are responsible for setting insulin list prices. To counter these high prices, CVS Health’ s PBM offers our clients proven strategies to help diabetics access insulin at an affordable cost and prevent diabetes-related complications, including blindness, stroke, and renal failure. ”). See Letter from Joshua Fredell, Vice President, Product Development, CVS Health, to Human Rights Watch, September 23, 2021, p. 1.
[ 191 ] A 2019 letter from Eli Lilly to the Senate Finance Committee investigation stated, “ about 95% of patients filling prescriptions for Humalog [ … ] at a retail pharmacy pay less than $ 100 and 90% of patients pay less than $ 50. ” Almost 9 out of 10 patients who pay more than $ 100 to fill their Humalog prescription, the 2019 Eli Lilly letter stated, were patients on Medicare Part D plans that had high deductible or coverage gap phases. The rest of those shouldering high out-of-pocket costs, comprising roughly 6,000 people in their estimates, included approximately 1,600 likely uninsured patients on Humalog pay near the list price. US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, Appendix 1, https: //www.finance.senate.gov/imo/media/doc/Eli% 20Lilly Redacted% 20v1.pdf ( accessed September 1, 2021), p. 4, Fn. 5. See also Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1304 ( describing how health insurers can distribute rebates to lower user costs). See also Letter from Heather Cianfrocco, Chief Executive Officer, OptumRx, to Human Rights Watch, September 20, 2021, p. 2 ( “ 76% of our patients are paying zero or have $ 15 - $ 30 flat co-pays and virtually all of our Medicaid members pay $ 3 or less for insulin. ”).
[ 192 ] See Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1302 ( “ This finding of greater increases in list prices than net prices raises the following questions. Who else has benefited or lost from the substantial increase in insulin list prices over the last decade? And why has the financial burden for people with diabetes who use insulin continued to increase especially for those without insurance who may have to pay the full list price? ”).
[ 193 ] Also referred to as the Hatch-Waxman Act. Jeremy Greene, Kevin Riggs, “ Why Is There No Generic Insulin? Historical Origins of a Modern Problem, ” The New England Journal of Medicine, 2015, No. 372:12, https: //www.nejm.org/doi/full/10.1056/NEJMms1411398 ( accessed September 1, 2021), p. 1171. See also Aaron S. Kesselheim, “ Determinants of Market Exclusivity for Prescription Drugs in the United States, ” September 13, 2017, https: //www.commonwealthfund.org/publications/journal-article/2017/sep/determinants-market-exclusivity-prescription-drugs-united ( accessed September 1, 2021) ( “ In total, most brand-name drug manufacturers have a 12-to-16-year window during which their products are free from competition from lower-cost generics…. After discovering a new drug, manufacturers typically apply for a 20-year patent. However, after completing preclinical research and up to seven years of clinical trials, only part of this period remains. [ Although the ] drug manufacturers can extend the length of patent protection several ways. ”); Patients for Affordable Drugs, “ The Truth About Insulin Prices, ” 2019, https: //patientsforaffordabledrugs.org/wp-content/uploads/2019/11/The-Insulin-Report-Final-V.-1-1.pdf ( accessed September 1, 2021), p. 3. During this period of market exclusivity, manufacturers have free rein to increase their list prices without generic competition, with the expectation that generic manufacturing will lower patient costs after patents expire. See, for example, Vincent S. Rajkumar, “ The high cost of prescription drugs: causes and solutions, ” Blood Cancer Journal, Vol. 10, 2020, https: //www.nature.com/articles/s41408-020-0338-x.pdf ( accessed September 1, 2021). These government-granted monopolies are meant to foster investment by drug companies into research and development by providing time for patent holders to recoup development costs. But the near-total lack of regulatory price transparency requirements has allowed pharmaceutical companies to benefit from this monopoly pricing without any obligation to reveal the research and development costs that they are ostensibly seeking to recoup. Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021), p. 501 ( discussing the purpose of patents); Wouters, McKee and Luyten, “ Estimated Research and Development Investment Needed to Bring a New Medicine to Market, 2009-2018, ” Journal of the American Medical Association, March 3, 2020, https: //jamanetwork.com/journals/jama/fullarticle/2762311 ( accessed September 1, 2021) ( discussing research and development costs, which can range from $ 314 million to $ 2.8 billion USD). Each of the three insulin manufacturers included within the scope of this report described ongoing research and development initiatives to improve diabetes patient outcomes. See, for example, Letter from Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021, p. 4-5. Similarly, Sanofi wrote that the company “ spent approximately €5.5 billion globally on R & D ” in 2020. Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 4. In a letter to Human Rights Watch, Eli Lilly wrote: “ In 2020, Lilly invested 25 percent of its revenue into research and development, more than nearly every other company in the pharmaceutical industry. Over the last five years, Lilly has invested more than $ 25 billion into R & D, including $ 6 billion in 2020 alone to develop treatments for diabetes, cancer, Alzheimer’ s, COVID-19, and other conditions. ” Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 3.
[ 194 ] Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021), p. 502.
[ 195 ] Ibid. See also Sanofi, “ US Securities and Exchange Commission, Form 20-F, ” 2019, https: //www.sanofi.com/-/media/Project/One-Sanofi-Web/Websites/Global/Sanofi-COM/Home/common/docs/investors/2020 03 23 Sanofi-Report-2019-20F-accessible.pdf ( accessed September 1, 2021), p. 8 ( “ “ [ A ] n expiration of effective intellectual property protections for our products typically results in the market entry of one or more lower-priced generic competitors, often leading to a rapid and significant decline in revenues on those products ”); Eli Lilly and Company, “ Securities and Exchange Commission, Form 10-K, ” 2020, https: //investor.lilly.com/static-files/01da2e96-912a-4580-970a-4a0b455f9838 ( accessed September 1, 2021), p. 25 ( “ loss of exclusivity [ … ] typically results in the entry of one or more generic competitors, leading to a rapid and severe decline in revenues, especially in the U.S. ”); and Novo Nordisk, “ Securities and Exchange Commission, Form 20-F, ” 2020, https: //sec.report/Document/0001628280-20-001021/ ( accessed September 1, 2021), p.7 ( “ Novo Nordisk anticipates that the expiration of certain patents could impact sales within the coming years. ”).
[ 196 ] US Food and Drug Administration, “ Generic Competition and Drug Prices, ” Center for Drug Evaluation and Research, 2017, https: //www.fda.gov/about-fda/center-drug-evaluation-and-research/genericcompetition-and-drug-prices ( accessed September 1, 2021).
[ 197 ] Ibid. When it comes to the price of generic drugs, the US is actually a positive outlier, with unbranded generics 16 percent cheaper than average when compared to other OECD countries. In 2018, unbranded generic drugs accounted for 84 percent of US prescription drugs by volume, but only 12 percent of prescription drug spending at manufacturer prices. In contrast, brand-name originator drugs accounted for only 11 percent by volume, but 82 percent of US drug spending. Mulcahy, Whaley, et al., “ International Prescription Drug Price Comparisons Current Empirical Estimates and Comparisons with Previous Studies, ” RAND Corporation Research Report, 2021, https: //www.rand.org/pubs/research reports/RR2956.html ( accessed September 1, 2021), pp. xi, xv.
[ 198 ] See Colorado Department of law, “ Prescription Insulin Drug Pricing Report, ” November 2020, https: //coag.gov/app/uploads/2020/11/Insulin-Report-102020.pdf ( accessed December 1, 2021), p. 39 ( “ Many insulin products have received additional patents, exclusivities, and extensions, adding decades of protection and monopoly prices. Evergreening is a familiar tactic for best-selling insulin products: Eli Lilly’ s Humalog added 17 years of protection; Novo Nordisk’ s Novolog added 27 years of protection; Sanofi’ s Lantus added 28 years of protection. ”), p. 46-48 ( “ Manufacturers of biopharmaceutical insulin have successfully controlled the market and have thus far prevented many generics or biosimilars from entering the marketplace through the use of patents and tactics to extend their exclusivity period … many insulin products have received additional patents, exclusivities, and extensions, adding decades of protection and monopoly prices. ”). See also I-MAK, “ Overpatented, Overpriced Special Edition Lantus ( insulin glargine), ” 2018, http: //www.i-mak.org/wp-content/uploads/2018/10/I-MAK-Lantus-Report-2018-10-30F.pdf ( accessed September 1, 2021), p. 4; I-MAK, “ Overpatented, Overpriced: How Excessive Pharmaceutical Patenting is Extending Monopolies and Driving Ip Drug Prices, ” 2018, http: //www.i-mak.org/wp-content/uploads/2018/08/I-MAK-Overpatented-Overpriced-Report.pdf ( accessed September 1, 2021); Andrew Dunn, “ Insulin drugmakers under scrutiny for pricing, patent practices, ” BioPharma Dive, November 2, 2018, https: //www.biopharmadive.com/news/insulin-drugmakers-under-scrutiny-for-pricing-patent-practices/541275/ ( accessed September 1, 2021). Patents’ ability to limit generic entry is especially true for biologic drugs, such as insulin analogs, which require complex manufacturing techniques and may have numerous secondary patents protecting specific methods used in their production. See, for example, Warren Kaplan and Reed Beall, “ Insulin Patent Profile, ” Health Action International, Addressing the Challenge and Constraints of Insulin Sources and Supply, April 2016, https: //www.researchgate.net/profile/Reed-Beall/publication/303785920 Insulin Patent Profile/links/5751ed8308ae17e65ec36d9a/Insulin-Patent-Profile.pdf ( accessed September 1, 2021), pp. 9-10, 12; University of College London, Therapeutic Innovation Networks, “ Differences between Biologics and Small Molecules, ” https: //www.ucl.ac.uk/therapeutic-innovation-networks/differences-between-biologics-and-small-molecules ( accessed September 1, 2021); US Food and Drug Administration, “ Biosimilar and Interchangeable Biologics: More Treatment Choices, ” March 3, 2020, https: //www.fda.gov/consumers/consumer-updates/biosimilar-and-interchangeable-biologics-more-treatment-choices ( accessed September 1, 2021); Jeremy Greene, Kevin Riggs, “ Why Is There No Generic Insulin? Historical Origins of a Modern Problem, ” The New England Journal of Medicine, 2015, No. 372:12, https: //www.nejm.org/doi/full/10.1056/NEJMms1411398 ( accessed September 1, 2021), pp. 1171-1173; Dean Baker, “ The Future of the Pharmaceutical Industry: Beyond Government-Granted Monopolies, ” The Journal of Law, Medicine & Ethics, Vol. 49, 21 April 2021, https: //www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/article/future-of-the-pharmaceutical-industry-beyond-governmentgranted-monopolies/EA8810BB435446B2FEFF76D130DD3E2C ( accessed September 1, 2021). In a letter to Human Rights Watch, Novo Nordisk stated that it “ has not taken legal action against other pharmaceutical companies relating to efforts to manufacture or market biosimilar versions of NovoLog. ” Letter from Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021, p. 4. In a letter to Human Rights Watch, Sanofi wrote: “ Sanofi does not enter into “ pay for delay ” or “ reverse payment ” agreements that prohibit generic drug or biosimilar development after the expiration of a patent. Sanofi has reached settlements in patent infringement cases, and these agreements have allowed the generic company to commercialize its product before the expiration of the branded product’ s patent ( s). ” Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021. For its part, Eli Lilly states that that company “ does not pay for delays ” in public materials and has engaged in zero “ settlements of Abbreviated New Drug Application ( ANDA) litigation that involved payments and/or provisions to delay bringing an authorized generic product to market for a defined time period. ” See Eli Lilly and Company, “ 2020 Environmental, Social, and Governance Report, Access and Affordability, ” https: //esg.lilly.com/transparency # tab-control-tab2 ( accessed September 1, 2021).
[ 199 ] Aside from structural access issues relating to rebates, discussed further below, non-biosimilar generics of these analog insulins, also sometimes described as follow-on drugs, are not considered automatically interchangeable with the brand name version, meaning that pharmacists can not substitute a prescription for a brand name analog insulin with a cheaper follow-on version without a new prescription. As such, the moderate cost saving potential of switching from one of these branded drugs to the follow-on version requires more steps, such as another visit to the doctor. However, in a positive development, the Food and Drug Administration approved the first-ever interchangeable biosimilar, Semglee, a generic version of Sanofi’ s Lantus in July 2021. Because it is interchangeable, this biosimilar may have a larger positive impact on patient costs than Eli Lilly’ s already available follow-on version of Lantus. But while the list price for this interchangeable biosimilar is about one-third of that for Lantus, it will still cost $ 98 per vial. Food and Drug Administration, “ FDA Approves First Interchangeable Biosimilar Insulin Product for Treatment of Diabetes, ” News Release, July 28, 2021, https: //www.fda.gov/news-events/press-announcements/fda-approves-first-interchangeable-biosimilar-insulin-product-treatment-diabetes ( accessed September 1, 2021); Bob Herman, “ The $ 100 `` generic '' insulin, ” Axios, July 30, 2021, https: //www.axios.com/fda-biosimilar-insulin-viatris-semglee-interchangeable-d8ffac02-c4e7-4282-b087-1ea32e432c72.html ( accessed September 1, 2021). See also John White and Jennifer Goldman, “ Biosimilar and Follow-on Insulin: The Ins, Outs, and Interchangeability, ” Journal of Pharmacy Technology, Vol. 35 ( 1), pp. 25-35, September 28, 2018, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6313268/ ( accessed September 1, 2021), p. 30, p. 33; US Department of Health and Human Services, Food and Drug Administration, “ Considerations in Demonstrating Interchangeability With a Reference Product Guidance for Industry, ” May 2019, https: //www.fda.gov/media/124907/download ( accessed September 1, 2021); Robert King, “ FDA finalizes guidance to spur biosimilar availability, ” Modern Healthcare, May 10, 2019, https: //www.modernhealthcare.com/operations/fda-finalizes-guidance-spur-biosimilar-availability ( accessed September 1, 2021); Mariana Socal and Jeremy Greene, “ Interchangeable Insulins — New Pathways for Safe, Effective, Affordable Diabetes Therapy, ” The New England Journal of Medicine, Vol. 382 ( 11), March 12, 2020, https: //pubmed.ncbi.nlm.nih.gov/32160658/ ( accessed September 1, 2021) ( discussing the importance of adopting new interchangeability guidance to improve availability and access to insulin products); Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1307 ( discussing formulary decisions and biosimilars); Amanda Brooks, “ Generic Insulins Are on the Market — So Why Aren’ t People Using Them?, ” GoodRx, April 3, 2020, https: //www.goodrx.com/blog/generic-insulins-see-low-fills-insulin-lispro-insulin-aspart/ ( accessed September 1, 2021).
[ 200 ] John White and Jennifer Goldman, “ Biosimilar and Follow-on Insulin: The Ins, Outs, and Interchangeability, ” Journal of Pharmacy Technology, Vol. 35 ( 1), pp. 25-35, September 28, 2018, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6313268/pdf/10.1177 8755122518802268.pdf ( accessed September 1, 2021), pp. 25-26 ( discussing the various follow-on products, including Basaglar and Admelog, available in 2019). Eli Lilly brought its generic version of Sanofi’ s Lantus, Basaglar, to market under a court-ordered settlement agreement. See “ Lilly and Sanofi Reach Settlement Agreement in U.S. Insulin Glargine Litigation, ” Eli Lilly, September 28, 2015, https: //investor.lilly.com/news-releases/news-release-details/lilly-and-sanofi-reach-settlement-agreement-us-insulin-glargine ( accessed September 1, 2021). See also Timothy Aungst, “ Lantus vs. Basaglar: Are They Really the Same Insulins? ”, GoodRx, September 9, 2019, https: //www.goodrx.com/blog/lantus-vs-basaglar-effectiveness-dosing-side-effects-cost/ ( accessed September 1, 2021). Sanofi’ s strategy with Lantus succeeded in scaring away other generic competitors, including one which had already received tentative FDA approval for their own biosimilar. See MAK, “ Overpatented, Overpriced Special Edition Lantus ( insulin glargine), ” 2018, http: //www.i-mak.org/wp-content/uploads/2018/10/I-MAK-Lantus-Report-2018-10-30F.pdf ( accessed September 1, 2021), p. 4; Eric Sagonowsky, “ Sanofi sues Mylan over Lantus patents, seeking to defend its top-selling drug, ” Fierce Pharma, October 25, 2017, https: //www.fiercepharma.com/legal/seeking-to-defend-key-sales-sanofi-sues-mylan-for-lantus-patent-infringement ( accessed September 1, 2021). See also Warren Kaplan and Reed Beall, “ Insulin Patent Profile, ” Health Action International, Addressing the Challenge and Constraints of Insulin Sources and Supply, April 2016, https: //www.researchgate.net/profile/Reed-Beall/publication/303785920 Insulin Patent Profile/links/5751ed8308ae17e65ec36d9a/Insulin-Patent-Profile.pdf ( accessed September 1, 2021), p. 10. Notably, Eli Lilly did not engage in similar litigation when Sanofi brought a follow-on version of Humalog to market after its primary patent expired in 2014. Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 2. See also Eli Lilly and Company, “ 2020 Environmental, Social, and Governance Report, Access and Affordability, ” https: //esg.lilly.com/social # tab-control-tab1 ( accessed September 1, 2021); Ibid., ” https: //esg.lilly.com/social # tab-control-tab1 ( accessed September 1, 2021).
[ 201 ] In 2020, the number of insulin treatment visits in the US broke down into the following percentages: biosimilar insulin ( 8.2 percent); human insulin ( 5.5 percent); and branded or self-authorized generic versions of analog insulin ( 86.3 percent). Sarkar, Heyward, Alexander and Kalyani, “ Trends in Insulin Types and Devices Used by Adults With Type 2 Diabetes in the United States, 2016 to 2020, ” Journal of the American Medical Association, Diabetes and Endocinology, October 12, 2021, https: //jamanetwork.com/journals/jamanetworkopen/fullarticle/2784811 ( accessed December 1, 2021) ( analyzing millions of outpatient physician-patient interactions between 2016 and 2020 and finding that “ Analog insulin use predominated and accounted for more than 80% of total treatment visits across all years ” while “ The use of biosimilar insulin, which was first approved in 2015, increased from 2.6% in 2017 … to 8.2% in 2020. ”). See also Zhai, Sarpatwari, and Kesselheim, “ Why Are Biosimilars Not Living up to Their Promise in the US? ”, AMA Journal of Ethics, August 2019, https: //journalofethics.ama-assn.org/article/why-are-biosimilars-not-living-their-promise-us/2019-08 ( accessed September 1, 2021) ( examining the current landscape of the biosimilar market and tactics employed by biologics manufacturers to delay market entry and deter prescribing of biosimilars).
[ 202 ] Patients for Affordable Drugs, “ The Truth About Insulin Prices, ” 2019, https: //patientsforaffordabledrugs.org/wp-content/uploads/2019/11/The-Insulin-Report-Final-V.-1-1.pdf ( accessed September 1, 2021), pp. 3-4. There are nearly 1,200 of these authorized generics of different drugs approved for sale in the US. These generics offer a way for brand manufacturers to crowd out potential competition over drugs with expiring patents and can be quite profitable, returning $ 50 for every dollar invested on average, even while being cheaper than their branded counterparts. Jay Hancock and Sydney Lupkin, “ Drugmakers Master Rolling Out Their Own Generics To Stifle Competition, ” Kaiser Health News, August 5, 2019, https: //khn.org/news/drugmakers-now-masters-at-rolling-out-their-own-generics-to-stifle-competition/ ( accessed September 1, 2021); Cutting Edge Information, “ Drug Industry Study Finds a 5,100% ROI for Implementing Authorized Generics Strategies, ” December 4, 2015, https: //www.globenewswire.com/news-release/2015/12/04/1180907/0/en/Drug-Industry-Study-Finds-a-5-100-ROI-for-Implementing-Authorized-Generics-Strategies.html) ( accessed September 1, 2021). See also Sydney Lupkin and Jay Hancock, “ Trump Administration Salutes Parade Of Generic Drug Approvals, But Hundreds Aren’ t For Sale, ” Kaiser Health News, February 7, 2019, https: //khn.org/news/trump-administration-salutes-parade-of-generic-drug-approvals-but-hundreds-arent-for-sale/ ( accessed September 1, 2021) ( “ The [ FDA ] has approved more than 1,600 generic drug applications since January 2017.… But more than 700, or about 43 percent, of those generics still weren’ t on the market as of early January … Even more noteworthy: 36 percent of generics that would be the first to compete against a branded drug are not yet for sale. ”). In addition to its authorized generic, discussed below, Novo Nordisk sells a non-branded form NovoLog at Walmart. See Letter from Jennifer Duck, Vice President, Public Affairs, Novo Nordisk Inc., to Human Rights Watch, September 20, 2021, p. 2 ( “ Novo Nordisk Inc. is also proud to have part-nered with WalMart for more than 20 years to make human insulin available via the ReliOn label at $ 25/vial; as well as the expansion of our partnership in 2021 through WalMart’ s introduction of a short-acting analog insulin with ReliOn NovoLog®and ReliOn NovoLog®Mix. ”).
[ 203 ] Generics are medications created to be the same as an already-marketed, branded drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use. Kang, Bai, et al., “ Comparative Approaches to Drug Pricing, ” Annual Review of Public Health, Vol. 41, pp. 499-512, April 2020, https: //www.annualreviews.org/doi/full/10.1146/annurev-publhealth-040119-094305 ( accessed September 1, 2021), p. 502 ( describing generics). An authorized generic, by contrast, is a non-branded version of a branded drug, produced by the same manufacturer as the branded drug. See Jay Hancock and Sydney Lupkin, “ Drugmakers Master Rolling Out Their Own Generics To Stifle Competition, ” Kaiser Health News, August 5, 2019, https: //khn.org/news/drugmakers-now-masters-at-rolling-out-their-own-generics-to-stifle-competition/ ( accessed September 1, 2021). See also Vincent Rajkumar, “ The High Cost of Insulin in the United States: An Urgent Call to Action, ” Commentary, Mayo Clinic Proceedings, Vol. 95, pp. 22-28, https: //www.mayoclinicproceedings.org/article/S0025-6196 ( 19) 31008-0/fulltext ( accessed September 1, 2021). See also US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, Appendix 1, https: //www.finance.senate.gov/imo/media/doc/Eli% 20Lilly Redacted% 20v1.pdf ( accessed September 1, 2021), p. 3 ( “ By introducing an authorized generic, we can provide a lower-priced insulin more quickly without disrupting access to branded Humalog. ”).
[ 204 ] Human Rights Watch analysis of current retail price averages for 10 listed pharmacies on GoodRx for both “ Novolog ( Brand) ” and “ Insulin Aspart ( Generic), ” GoodRx, https: //www.goodrx.com/novolog? dosage=10ml-of-100-units-ml & form=vial & label override=Novolog & quantity=1 & sort type=popularity ( accessed September 1, 2021).
[ 205 ] Ciara Linnane, “ Eli Lilly to reduce list price of Insulin Lispro injection by an additional 40% from Jan. 1, restoring it to 2008 levels, ” MarketWatch, September 28, 2021, https: //www.marketwatch.com/story/eli-lilly-to-reduce-list-price-of-insulin-lispro-injection-by-an-additional-40-from-jan-1-restoring-it-to-2008-levels-2021-09-28 ( accessed September 29, 2021).
[ 206 ] Amanda Brooks, “ Generic Insulins Are on the Market — So Why Aren’ t People Using Them?, ” GoodRx, April 3, 2020, https: //www.goodrx.com/blog/generic-insulins-see-low-fills-insulin-lispro-insulin-aspart/ ( accessed September 1, 2021) ( citing US Senate Offices of Elizabeth Warren and Richard Blumenthal, “ Inaccessible Insulin: The Broken Promise of Eli Lilly’ s Authorized Generic, ” December 16, 2019, https: //www.fdanews.com/ext/resources/files/2019/12-16-19-InaccessibleInsulinreport.pdf? 1576536304 ( accessed September 1, 2021)).
[ 207 ] US Senate Offices of Elizabeth Warren and Richard Blumenthal, “ Inaccessible Insulin: The Broken Promise of Eli Lilly’ s Authorized Generic, ” December 16, 2019, https: //www.fdanews.com/ext/resources/files/2019/12-16-19-InaccessibleInsulinreport.pdf? 1576536304 ( accessed September 1, 2021), pp. 3-4 ( methodology), p. 1 ( findings).
[ 208 ] Amanda Brooks, “ Generic Insulins Are on the Market — So Why Aren’ t People Using Them?, ” GoodRx, April 3, 2020, https: //www.goodrx.com/blog/generic-insulins-see-low-fills-insulin-lispro-insulin-aspart/ ( accessed September 1, 2021).
[ 209 ] Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 2.
[ 210 ] Ibid.
[ 211 ] See Amanda Brooks, “ Generic Insulins Are on the Market — So Why Aren’ t People Using Them?, ” GoodRx, April 3, 2020, https: //www.goodrx.com/blog/generic-insulins-see-low-fills-insulin-lispro-insulin-aspart/ ( accessed September 1, 2021); Amanda Brooks, “ 3 Reasons Most People Still Fill for Expensive Brand Insulins, Even Though Affordable Options Are Available, ” GoodRx, https: //www.goodrx.com/blog/why-people-still-fill-for-brand-insulins/ ( accessed September 1, 2021); Bram Sable-Smith, “ How Much Difference Will Eli Lilly’ s Half-Price Insulin Make?, ” Kaiser Health News, March 12, 2019, https: //khn.org/news/how-much-difference-will-eli-lillys-half-price-insulin-make/ ( accessed September 1, 2021); Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1307 ( discussing formulary decisions and biosimilars).
[ 212 ] Tori Marsh, “ Viagra Generic Leads to Surge in Prescriptions, ” GoodRx, May 1, 2018, https: //www.goodrx.com/blog/viagra-generic-leads-to-surge-in-prescriptions/ ( accessed September 1, 2021).
[ 213 ] This kind of rebate trap can occur when the intermediaries between a manufacturer and the consumer choose not to stock or cover the generic version of a drug so as to not jeopardize the substantial volume-based rebates or discounts they may receive for the name-brand version. For more discussion of this dynamic, please see Sydney Lupkin, “ Secretive ‘ Rebate Trap’ Keeps Generic Drugs For Diabetes And Other Ills Out Of Reach, ” Kaiser Health News, January 18, 2019, https: //khn.org/news/secretive-rebate-trap-keeps-generic-drugs-for-diabetes-and-other-ills-out-of-reach/ ( accessed September 1, 2021) ( discussing how rebates influence what are placed on formularies in the context of insulin generics); Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, Vol. 41 ( 6) ( accessed September 1, 2021), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( discussing how rebates may be stifling biosimilar adoption). For more information about formulary decision making, see US Senate Finance Committee, “ Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug, ” Staff Report, 2021, https: //www.finance.senate.gov/imo/media/doc/Grassley-Wyden% 20Insulin% 20Report% 20 ( FINAL).pdf ( accessed September 1, 2021), p. 34.
[ 214 ] Letter from Shawn O’ Neail, Vice President, Government Affairs, Eli Lilly and Company, to Human Rights Watch, September 20, 2021, p. 1. Human Rights Watch also wrote letters to three of the largest PBMs in the US at time of writing— CVS Health, OptumRx ( owned by UnitedHealth Group), and Express Scripts ( owned by Cigna) —requesting information and clarification regarding their practices. This correspondence, included responses from OptumRx and CVS Health, is reproduced in full in the Annex to this report. In a letter to Human Rights Watch, OptumRx wrote: “ The list price of insulin, independently set by pharmaceutical manufactures, is too high for a 100-year-old drug that has seen no significant innovations for decades. For years, insulin manufacturers have used loopholes in the patent system to stifle competition and increase prices. For example, there is only one interchangeable, or “ generic, ” insulin product available in the U.S. We believe drug pricing reforms can lower prices while maintaining access to innovative products. ”). See Letter from Heather Cianfrocco, Chief Executive Officer, OptumRx, to Human Rights Watch, September 20, 2021, pp 1-2. In its response to Human Rights Watch, CVS Health wrote: “ CVS Health is committed to making prescription drugs, including insulin, as affordable as possible. Drug manufacturers alone are responsible for setting insulin list prices. To counter these high prices, CVS Health’ s PBM offers our clients proven strategies to help diabetics access insulin at an affordable cost and prevent diabetes-related complications, including blindness, stroke, and renal failure. ”). See Letter from Joshua Fredell, Vice President, Product Development, CVS Health, to Human Rights Watch, September 23, 2021, p. 1.
[ 215 ] See Office of the United Nations, High Commissioner for Human Rights and World Health Organization, “ The Right to Health: Fact Sheet No. 31, ” https: //www.ohchr.org/documents/publications/factsheet31.pdf ( accessed September 1, 2021), p. 3 ( “ The right to health contains entitlements [ including ] [ a ] ccess to essential medicines. ”).
[ 216 ] UN Committee on Economic, Social and Cultural Rights, “ General Comment No. 14, The Right to the Highest Attainable Standard of Health, ” UN Doc. E/C.12/2000/4, August 11, 2000, https: //www.refworld.org/pdfid/4538838d0.pdf ( accessed September 1, 2021), para. 1.
[ 217 ] Universal Declaration of Human Rights ( UDHR), adopted December 10, 1948, G.A. Res. 217A ( III), U.N. Doc. A/810, https: //www.un.org/sites/un2.un.org/files/udhr.pdf ( accessed September 1, 2021), art. 25 ( 1).
[ 218 ] The US signed the Covenant in 1977. International Covenant on Economic, Social and Cultural Rights ( ICESCR), adopted December 16, 1966, G.A. Res. 2200A ( XXI), 21 U.N. GAORR Supp. ( No. 16) at 49, U.N. Doc. A/6316 ( 1966), 993 U.N.T.S. 3, entered into force January 3, 1976, https: //www.ohchr.org/en/professionalinterest/pages/cescr.aspx ( accessed September 1, 2021), arts. 11 ( 1), 12 ( c) ( d).
[ 219 ] The Vienna Convention is widely viewed as being reflective of customary international law. Vienna Convention on the Law of Treaties adopted May 22, 1969, G.A. Res. 2166 ( XXI), 2287 ( XXII), 1155 U.N.T.S. 331, U.N. Doc, https: //legal.un.org/ilc/texts/instruments/english/conventions/1 1 1969.pdf ( accessed September 1, 2021), Art. 18.
[ 220 ] UN Committee on Economic, Social and Cultural Rights, “ General Comment No. 3, The Nature of States Parties Obligations, ” UN Doc. E/1991/23, December 14, 1990, para. 10.
[ 221 ] UN Committee on Economic, Social and Cultural Rights, “ The Maastricht Guidelines on Violations of Economic, Social and Cultural Rights, ” U.N. Doc. E/C.12/2000/13, October 2, 2000, para. 18.
[ 222 ] UN Committee on Economic, Social and Cultural Rights, “ General Comment No. 14, The Right to the Highest Attainable Standard of Health, ” UN Doc. E/C.12/2000/4, August 11, 2000, https: //www.refworld.org/pdfid/4538838d0.pdf ( accessed September 1, 2021), para. 39.
[ 223 ] Ibid., para. 17.
[ 224 ] Ibid., paras. 12 ( b) ( ii), 12 ( d).
[ 225 ] UN Committee on Economic, Social and Cultural Rights, “ General Comment No. 24 on State obligations under the International Covenant on Economic, Social and Cultural Rights in the context of business activities, ” 2017, https: //www.refworld.org/docid/5beaecba4.html ( accessed September 1, 2021), para. 24. See also UN Committee on Economic, Social and Cultural Rights, “ General comment No. 25 ( 2020) on science and economic, social and cultural rights, ” 2020, https: //undocs.org/E/C.12/GC/25 ( accessed September 1, 2021), para. 69.
[ 226 ] UN Committee on Economic, Social and Cultural Rights, “ General comment No. 25 ( 2020) on science and economic, social and cultural rights, ” 2020, https: //undocs.org/E/C.12/GC/25 ( accessed September 1, 2021), para. 70.
[ 227 ] UN Educational, Scientific and Cultural Organization ( UNESCO), “ The Right to Enjoy the Benefits of Scientific Progress and its Applications ( Venice Statement), ” 2009, https: //unesdoc.unesco.org/ark: /48223/pf0000185558 ( accessed September 1, 2021).
[ 228 ] Ibid., para. 10.
[ 229 ] UN Committee on Economic, Social and Cultural Rights, “ General comment No. 25 ( 2020) on science and economic, social and cultural rights, ” 2020, https: //undocs.org/E/C.12/GC/25 ( accessed September 1, 2021), para. 69.
[ 230 ] “ Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Anand Grover, on access to medicines, ” May 1, 2013, A/HRC/23/42, https: //www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session23/A-HRC-23-42 en.pdf ( accessed September 1, 2021). See also UN Committee on Economic, Social and Cultural Rights, “ General Comment No. 14, The Right to the Highest Attainable Standard of Health, ” UN Doc. E/C.12/2000/4, August 11, 2000, https: //www.refworld.org/pdfid/4538838d0.pdf ( accessed September 1, 2021), para. 43.
[ 231 ] See M. Purgato and C. Barbui, “ What is the WHO essential medicines list? ”, Epidemiology and Psychiatric Sciences, Vol. 21, pp. 342-345, July 30, 2012, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6998134/ ( accessed September 1, 2021).
[ 232 ] The World Health Organization is migrating pages on their website and this information was accessed through the WayBackMachine. World Health Organization, “ Essential Medicines, ” https: //web.archive.org/web/20210211035430/http: //www.who.int/topics/essential medicines/en/ ( accessed September 1, 2021).
[ 233 ] See World Health Organization, “ WHO prioritizes access to diabetes and cancer treatments in new Essential Medicines Lists, ” October 1, 2021, https: //www.who.int/news/item/01-10-2021-who-prioritizes-access-to-diabetes-and-cancer-treatments-in-new-essential-medicines-lists ( accessed October 8, 2021); T1International, “ T1International Advocates Win: WHO Adds Long-Acting Insulin Analogues to EML, ” 1 October 2021, https: //www.t1international.com/blog/2021/10/01/T1International-WHO-Win/ ( accessed October 8, 2021); World Health Organization, Health Technologies and Pharmaceuticals Programme, Regional Office for Europe, “ Consideration of diabetes medicines as part of the revisions to 2019 WHO Model List of Essential Medicines for adults ( EML), ” 2019, https: //www.euro.who.int/ data/assets/pdf file/0009/436563/2019-EML-DiabetesMeds-eng.pdf ( accessed September 1, 2021).
[ 234 ] Goldstein, Patel, Bland, et al., “ Frequency of Sale and Reasons for Purchase of Over-the-Counter Insulin in the United States, Journal of the American Medical Association, Vol. 179 ( 5), pp. 722-727, February 18, 2019, https: //jamanetwork.com/journals/jamainternalmedicine/article-abstract/2724389 ( accessed September 1, 2021).
[ 235 ] See Cefalu, Dawes, et al., “ Insulin Access and Affordability Working Group: Conclusions and Recommendations, ” Diabetes Care, American Diabetes Association, June 2018, 41 ( 6), pp. 1299-1311, https: //care.diabetesjournals.org/content/41/6/1299 ( accessed September 1, 2021), p. 1310; The Endocrine Society, “ Addressing Insulin Access and Affordability: An Endocrine Society Position Statement, ” The Journal of Clinical Endocrinology & Metabolism, 2021, https: //www.endocrine.org/-/media/endocrine/files/advocacy/position-statement/insulin-position-statement-jcem.pdf ( accessed September 1, 2021), p. 4.
[ 236 ] The US signed the Covenant in 2009. Convention on the Rights of Persons with Disabilities ( CRPD), adopted December 13, 2006, G.A. Res. 61/106, U.N. Doc. A/RES/61/106 ( 2007), 993 U.N.T.S. 3, entered into force May 3, 2008, https: //treaties.un.org/doc/source/docs/A RES 61 106-E.pdf ( accessed October 13, 2021), art. 25.
[ 237 ] The Vienna Convention is widely viewed as being reflective of customary international law. Vienna Convention on the Law of Treaties adopted May 22, 1969, G.A. Res. 2166 ( XXI), 2287 ( XXII), 1155 U.N.T.S. 331, U.N. Doc. A/CONF.39/11/Add.2, entered into force January 27, 1980, https: //legal.un.org/ilc/texts/instruments/english/conventions/1 1 1969.pdf ( accessed September 1, 2021), art. 18.
[ 238 ] UN Committee on the Rights of Persons with Disabilities, “ Communication No. 10/2013, ” October 28, 2014, para. 6.3.
[ 239 ] See, for example, Social Security Administration, “ Red Book: A Summary Guide To Employment Supports For People With Disabilities Under The Social Security Disability Insurance ( Ssdi) And Supplemental Security Income ( SSI) Programs, ” https: //www.ssa.gov/pubs/EN-64-030.pdf ( accessed September 1, 2021), p. 5 ( “ To meet our definition of disability, you must not be able to engage in any substantial gainful activity ( SGA) because of a medically-determinable physical or mental impairment ( s) that is either: Expected to result in death [ or ] Has lasted or is expected to last for a continuous period of at least 12 months… We use the term “ substantial gainful activity ” to describe a level of work activity and earnings. ”); American Diabetes Association, “ Is Diabetes a Disability? ”, https: //www.diabetes.org/tools-support/know-your-rights/discrimination/is-diabetes-a-disability ( accessed September 1, 2021).
[ 240 ] See “ Diabetes in the Workplace and the ADA, ” US Equal Employment Opportunities Commission, EEOC-NVTA-2013-4 ( May 15, 2013) https: //www.eeoc.gov/laws/guidance/diabetes-workplace-and-ada ( accessed September 1, 2021).
[ 241 ] International Covenant on Civil and Political Rights ( ICCPR), adopted December 16, 1966, G.A. Res. 2200A ( XXI), entered into force 23 March 1976, ratified by the United States on June 8, 1992, https: //www.ohchr.org/en/professionalinterest/pages/ccpr.aspx ( accessed September 1, 2021), arts. 2, 26.
[ 242 ] International Convention on the Elimination of All Forms of Racial Discrimination ( ICERD), adopted December 21, 1965, G.A. Res. 2106 ( XX), 20 U.N. GAOR Supp. ( No. 14) at 47, U.N. Doc. A/6014 ( 1966), entered into force January 4, 1969, ratified by the United States on October 21, 1994, https: //www.ohchr.org/en/professionalinterest/pages/cerd.aspx ( accessed September 1, 2021), art. 1; US Constitution, art. XIV.
[ 243 ] See Human Rights Watch, “ Targeting Blacks: Drug Law Enforcement and Race in the United States, ” May 2008, https: //www.hrw.org/sites/default/files/reports/us0508 1.pdf ( accessed September 1, 2021), pp. 56-58. See also Jody Feder, “ Racial Profiling: Legal and Constitutional Issues, ” Congressional Research Service, April 16, 2012, https: //fas.org/sgp/crs/misc/RL31130.pdf, pp. 4-9 ( summarizing caselaw). In certain other contexts—such as statutory claims of employment or housing discrimination under civil rights laws—practices and procedures that have a disparate impact on a racial group can also trigger liability under United States law. See Lawrence Rosenthal, “ Saving Disparate Impact, ” Cardozo Law Review, Vol. 34, 2013, https: //papers.ssrn.com/sol3/papers.cfm? abstract id=2045688 ( accessed September 1, 2021).
[ 244 ] Under ICERD, racial discrimination is defined as “ any distinction, exclusion, restriction or preference based on race, colour, descent, or national or ethnic origin which has the purpose or effect of nullifying or impairing the recognition, enjoyment or exercise, on an equal footing, of human rights and fundamental freedoms in the political, economic, social, cultural or any other field of public life. ” ICERD, Part I, Article 1 ( 1).
[ 245 ] UN Committee on the Elimination of Racial Discrimination ( CERD), “ Consideration of Reports Submitted by State Parties under Article 9 of the Convention: Concluding Observations, United States of America, ” CERD/C/USA/CO/6, February 2008, http: //www2.ohchr.org/english/bodies/cerd/docs/co/CERD-C-USA-CO-6.pdf ( accessed September 1, 2021), para. 10.
[ 246 ] ICERD, Part I, Article 2 ( 1) ( a).
[ 247 ] Ibid. Article 5 ( e) ( iv).
[ 248 ] The ICESCR does not exclude non-nationals from its protections, except to note that “ [ d ] eveloping countries, with due regard to human rights and their national economy, may determine to what extent they would guarantee the economic rights recognized in the present Covenant to non-nationals. ” ICESCR, Art. 2 ( 3).
[ 249 ] Office of the High Commissioner for Human Rights, “ UN Guiding Principles on Business and Human Rights, Implementing the United Nations ‘ Protect, Respect, and Remedy’ Framework, ” 2011, http: //www.ohchr.org/Documents/Publications/GuidingPrinciplesBusinessHR EN.pdf ( accessed September 1, 2021). See also Letter from Adam Gluck, Senior Vice President, Corporate Affairs, Sanofi, to Human Rights Watch, September 24, 2021, p. 2 ( “ Sanofi’ s senior executives expressly recognize that multinational healthcare companies have a concurrent duty and social responsibility—alongside states and governments—to protect and advance human rights in all of its business operations and public positions. With this goal in mind, Sanofi’ s governance policies and practices adhere not only to national laws and regulations related to human rights, but also seek to implement the standards and principles established by leading international instruments on human rights, including the UN Guiding Principles for Businesses and Human Rights, the Universal Declaration of Human Rights, the Children’ s Rights and Business Principles, the OECD Guidelines for Multinational Enterprises, and the 2008 Human Rights Guidelines for Pharmaceutical Companies in relation to Access to Medicines, among others. ”).
[ 250 ] Special Representative of the Secretary-General on the issue of human rights and transnational corporations and other business enterprises, “ Guiding Principles on Business and Human Rights: Implementing the United Nations 'Protect, Respect and Remedy ' Framework, '' UN document A/HRC/17/31, March 21, 2011, https: //www.ohchr.org/Documents/Issues/Business/A-HRC-17-31 AEV.pdf ( accessed September 1, 2021), principles 17, 18, 21. The UN Guiding Principles also call on businesses to externally communicate how they address their human rights impacts in “ a form and frequency that … are accessible to its intended audiences. ” Ibid., principle 21, p. 23.
[ 251 ] Ibid., principle 17 ( c).
[ 252 ] Ibid., principle 18.
[ 253 ] Ibid., principle 19. See also Ibid, p. 21.
[ 254 ] Paul Hunt, UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, “ Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, ” https: //www.who.int/medicines/areas/human rights/A63 263.pdf ( accessed September 1, 2021), para. 26.
[ 255 ] Ibid. See also Suerie Moon, “ Respecting the right to access to medicines: Implications of the UN Guiding Principles on Business and Human Rights for the pharmaceutical industry, ” Health and Human Rights, Vol. 15 ( 1), June 2013, https: //www.hhrjournal.org/2013/10/respecting-the-right-to-access-to-medicines-implications-of-the-un-guiding-principles-on-business-and-human-rights-for-the-pharmaceutical-industry/.
[ 256 ] Paul Hunt, UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, “ Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, ” https: //www.who.int/medicines/areas/human rights/A63 263.pdf ( accessed September 1, 2021), para. 46.
[ 257 ] Ibid., Annex, paras. 2, 5.
[ 258 ] Ibid., Annex, para. 33. See also Ibid., paras. 34-35 ( “ The same medicine, for example, may be priced and packaged differently for the private and public sectors within the same country.… The arrangements should extend to all medicines manufactured by the company, including those for non-communicable conditions, such as heart disease and diabetes. ”).
[ 259 ] Ibid., Annex, paras. 6, 37. | general |
South Africa sees uptick in 5G population coverage | Despite 5G disinformation in the wake of the COVID-19 pandemic, South Africa’ s 5G population coverage grew from 0.7% in 2020, to 7.5% in 2021.
This is based on data in the latest State of the ICT Sector Report, compiled by the Independent Communications Authority of South Africa ( ICASA), which shows national population coverage of the emerging technology is on the uptick.
Telcos like MTN and Vodacom used the temporary spectrum granted to mobile operators as a result of the pandemic to deploy 5G services in SA’ s cities.
In the case of national population coverage for 3G, the report indicates it was at 99.9% in 2021. Coverage for 4G/LTE was at 97.7% in 2021.
The 2020 figures show national population coverage for 3G and 4G/LTE stood at 99.8% and 96.4%, respectively.
Last year’ s Ericsson Mobility Report stated 5G subscriptions in Sub-Saharan Africa will represent around 10% of all mobile subscriptions by 2027, with SA expected to lead the adoption rate in the region.
5G technology is expected to grow faster than 4G, accounting for around 50% of all mobile subscriptions worldwide – covering 75% of the world’ s population and carrying 62% of the global smartphone traffic by 2027, according to the Ericsson report.
First produced in 2015, the ICASA report examines performance and developments in the ICT sector, focusing on three areas regulated by the authority: telecoms, broadcasting and postal services.
According to ICASA, the findings are based on data collected over a 12-month period ending 30 September 2021, collected from secondary sources such as Statistics SA, OOKLA, as well as through a detailed questionnaire sent to relevant stakeholders.
When looking at rural population network coverage, the ICASA report found that in 2021, with respect to 2G and 3G, all provinces are at 100% coverage as reported by the licensees.
As to 4G/LTE coverage, all provinces are above 96% for the same period, it states.
Within the rural population network coverage, the report shows the Free State, Gauteng and Western Cape as having 5G coverage.
On urban population, all provinces have recorded 99% to 100% with respect to 2G, 3G and LTE coverage.
The report reads: “ 5G coverage in urban areas is showing a positive growth in all provinces…with KwaZulu-Natal in the lead with 20% for the same period. ”
Turning to mobile cellular and smartphone subscriptions, the state of ICT report shows mobile cellular subscriptions increased from 94 million in 2020, to 103 million in 2021.
Smartphone subscriptions were 60 million in 2020 and 65 million in 2021, says the report.
A further breakdown of subscriptions shows prepaid and postpaid mobile-cellular telephone subscriptions increased by 9.3% and 5.3%, respectively, in 2021.
“ For a period of seven years, the total mobile cellular phone voice subscriptions increased by 2.9%. ”
ICASA’ s report findings support the data released by Stats SA in its 2020 General Household Survey ( GHS).
According to the 2020 GHS report, the proportion of South Africa’ s households with access to only cellular phones is at 89.4% nationally.
The Eastern Cape is the highest at 96.4%, followed by Mpumalanga at 92.2%, and the lowest is Gauteng at 88.2% for the same period.
As to households with no access to either a cellular phone or landline, Limpopo is the highest at 3.2% and the lowest is Mpumalanga at 1.1% for the same period.
For households with access only to landline phones, both Northern Cape and Western Cape are the highest at 1.4% for the same period.
“ The total mobile cellular phone voice subscriptions increased by 8.7% from 94 million in 2020 to 103 million in 2021. Postpaid mobile cellular telephone subscriptions for urban and rural areas increased by 5.3% and 5.4%, respectively, in 2021. ”
According to ICASA, fixed-line voice subscriptions decreased in all categories; namely analogue fixed-telephone lines, ISDN voice channel equivalents, VOIP subscriptions, fixed-public payphone, as well as fixed wireless local loop subscriptions.
“ Over a seven-year period, fixed-line subscriptions decreased by 14.9%, ” reveals the report.
Turning to fixed-line broadband subscriptions, the report shows an increase of 20.4%, with fibre-to-the-home/building internet subscriptions increasing by 34.4% in 2021.
However, DSL internet subscription decreased by 30.2% for the same period, it notes. “ For a period of seven years, fixed broadband subscriptions increased by 8.4%. ”
* ICASA defines a smartphone as `` a mobile phone with advanced features: it has WiFi connectivity, web browsing capabilities, a high-resolution touch-screen display and the ability to use apps ''.
* All graphs sourced from ICASA's State of ICT Sector in SA 2022 report. | general |
AI in real life | When it comes to AI, businesses are spoiled for choice. There are multiple technologies, brands, and categories, and over the past couple of years, a few of these technologies have made plenty of progress, such as natural language processing ( NLP), machine learning ( ML), cognitive chatbots – all are part of AI services. And because of ML techniques, bots are getting wiser over time as they’ re exposed to increasing amounts of conversational data. So says Sumit Kumar Sharma, enterprise architect and head of advisory services at In2IT Technologies.
“ All these technologies will continue maturing in the coming years. We will also see more implementations of computer vision, deep learning and AI cloud services with big technology players providing more comprehensive AI ecosystems coupled with low code or no code development platforms. ”
When implementing AI in your business, it shouldn’ t be regarded as a ‘ one-size-fits-all’ approach, as each business needs its AI strategy to be personalised to its needs. To begin, define the business objective for implementing AI technologies. Companies need to understand their data maturity, readiness for change and customer needs. For example, if an organisation is a business-to-consumer company, it should look more closely at chatbots and NLP, if it’ s seeking to improve communication channels with its customer base. However, if a business is more of a research organisation that needs to understand consumer behaviours or demand patterns, ML and advanced data analytics would be more beneficial.
When it comes to implementing AI effectively, Varsha Ramesar, managing executive, data and analytics at iOCO, says that a 2018 Harvard Business Review survey found that three-quarters of respondents believed that AI will substantially transform their companies within three years. However, the study revealed that highly ambitious projects are less likely to be successful than ‘ low-hanging fruit’ projects. Not much has changed in the years since, and many AI projects fail because they’ re too ambitious.
She believes that companies should look at AI through the lens of business capabilities rather than technologies. “ Before embarking on an AI initiative, companies must understand which technologies perform what types of tasks, and the strengths and limitations of each. There is also a gap between current and desired AI capabilities, but this isn’ t always obvious, so companies should create pilot projects for AI implementations before rolling them out across the entire enterprise. Similarly, there's a stark difference between what you want to accomplish and what you have the organisational ability to actually achieve. Skills, in particular, are scarce, and companies need to leverage the capabilities of key employees, such as data scientists, who have the statistical and big data skills necessary to learn the nuts and bolts of these technologies. If they don’ t have data science or analytics capabilities in-house, they will have to build an ecosystem of external service providers. ”
Sharma adds that businesses also need to know that there’ s a dark side of AI and it’ s not just limited to transforming the skill requirements to run the business using traditional technologies. There are numerous examples of AI technologies being flawed by human bias, and now businesses are starting to see AI governance and responsible AI brought to the fore.
Don’ t reinvent the wheel by building an AI system that has become an industry standard, warns Ramesar. “ It’ s a waste of your company’ s time and resources. Instead, buy it from a company that has done research and development for years, and has launched a product that has been used and trusted by many users. Building an AI system in-house is a costly and risky endeavour, so leverage a partner’ s experience.
There are numerous examples of AI technologies being flawed by human bias, and now businesses are starting to see AI governance and responsible AI brought to the fore.
“ Many AI systems use deep learning and require thousands, millions, or even billions of training examples in order to perform a particular task. If the AI system that you need is an application that relies on supervised learning, you need to ask if you have the data to train the AI system, and whether the quality and the volume of data is adequate to achieve the expected performance, ” she says.
“ Uncertainties are inherent in an AI project, so don’ t expect it to work first time. Instead, plan AI development to be an iterative process, with multiple attempts needed to succeed. The first and most important step of implementing AI in enterprises is to define specific, measurable, achievable, relevant, and time-bound goals, and start small, with a specific use case and invest in the fundamentals to create a good foundation. This is an opportunity to learn what works and what doesn’ t, to learn from mistakes and implement better AI solutions in the future, to refine and improve, ” Ramesar says.
Drilling down into some specific industries, Ryan Falkenberg, CEO of Clevva, says for financial services businesses, it’ s critical to start by understanding your ‘ as-is’ reality, and to be clear on what AI can and can’ t do for you. It’ s important to know what’ s needed to make AI work, particularly considering compliance and regulatory requirements. Try to solve a specific business problem with a targeted capability. “ Take customer service, for example. Initially, many companies raced to deploy a chatbot on their website, only to frustrate customers and implode the customer experience. This is because they fell in love with the concepts of natural language and machine learning. The idea of a free-talking chatbot that could self-learn to serve customers seemed too good to be true. And it was. Soon the prescribed nature of query resolution logic, together with the contextual richness of customer realities, proved too difficult to get right using predictive logic. It may have worked for info-bots, but not for resolving complex queries. ”
We are seeing a convergence of the physical world and the metaverse, and a convergence of technologies such as AI and robotics.
Falkenberg says banks operate in a regulated industry, and every customer query, whether sales- or support-related, needs to be handled in a very specific way. Unfortunately, most chatbots aren’ t designed to handle the complex rules and contexts that influence how any query gets resolved. As a result, while they embraced one aspect of AI ( natural language understanding), they failed in another ( getting the chatbot’ s brain to resolve contextual, rule-driven queries off a generic knowledge base and simple decision trees). This highlights the importance of starting with the business challenge and finding the right solution. However, financial service companies can now deploy digital experts that can resolve complex, contextual queries in a consistent, compliant and hyper-personalised way. A digital expert is capable of understanding what the customer is asking for, then shifting to navigating them through a structured, contextually-adaptive resolution journey that results in a processed outcome. In short, the magic is in the mix, and we’ re now building digital workforces designed to perform a specific job using the required capabilities, not building digital workers who are built from all the best in AI technology, but aren’ t fit to do a specific job.
On the subject of how AI is being used to transform the retail sector, Ajay Lalu, co-founder and director of Q-Hop, a division of CIRT, says AI is the golden thread running through all the revolutionary changes taking place in global retail. “ Retail of the future will be seamlessly omnichannel, hyper-personalised and convenient in ways we can not yet imagine – and this will all be enabled by AI. ”
While it’ s very hard to predict how AI will take shape in five years, looking at the current landscape, we can see a few patterns, says In2IT’ s Sumit Kumar Sharma.
“ We will start recognising AI as an architecture domain and not just an enterprise initiative. We will see lot of successful projects that will deliver cross-functional AI capabilities to the enterprises, which will result in formal AI architectures, strategies, roadmaps, maturity models and suchlike. ”
Enterprises would also need a matured AI delivery model. It will be worth exploring ‘ ModelOps’ for speedy deployment of AI from pilot to production.
AI biases will become a serious issue in coming years, as AI continues to replace humans in decision-making. In coming years, we will see more deliberate efforts from organisations to bring fairness and transparency by making AI a ‘ responsible AI’. Another related upward trend in AI we will witness is ‘ digital ethics’.
In the next five years, first-line support agents are going to be the ‘ digital workforce’, a combination of hyper-automation, cognitive bots, supported by matured NLP, advanced analytics and more.
Highly anticipated and closely watched, autonomous vehicles will continue maturing as well.
There are a few other players in AI that are comparatively still less popular today. “ I will eagerly keep an eye on the evolution of ‘ Transformers’ ( a neural network architecture used for language understanding), ” says Sharma. “ It’ s an existing AI breakthrough from Google’ s stables, with a lot of promise. Although we’ re still scratching the surface, in the coming years, we will see this area develop a lot. ”
Lalu cites several examples. “ AI can allow retailers to make personalised offers to upsell and build loyalty, identify and retain customers that retailers risk losing, streamline supply chains, and predict changes in markets and patterns of behaviour, to adapt manufacturing processes and stock levels timeously. ”
Q-Hop is currently launching pilots of a use case for AI – analysing shopping preferences and using this data to make hyper-personalised and real-time offers to the customer at the point of decision-making.
“ We simulated over 20 million transactions to train the algorithm, and its predictability looks very good. For example, it will find a pattern in which a customer buys milk and bread every Sunday and offer a discount on bread next time they buy milk on a Sunday. This builds customer loyalty. But retailers can go a step further by upselling to the customer, offering them a three-for-one discount on bread when they buy milk, or a special on the brand of chocolate they occasionally treat themselves to.
Lalu says retailers – particularly in SA – have not fully adapted to the fact that the power now sits in the hands of the consumer. “ They still tend to do ‘ spray and pray’ advertising on leaflets, and some don’ t know what a customer’ s preferences are – even with decades of loyalty card information at their disposal. They’ re moving too slowly to embrace AI, even though they typically would like to use big data analysis to improve operations and business. Most retailers have vast volumes of data, but the challenge is that it’ s all over the place in legacy systems. These were never built to be data-oriented businesses. Turning that situation around could take years if managed in-house, whereas change must happen now. Retailers need to move into broader ecosystems and collaborate with organisations that are built from the ground up to manage and analyse data. Instead of thinking in silos, retailers should be part of intelligent ecosystems including analytics, payment, manufacture and logistics. AI is the golden thread that binds all these ecosystems together, making each component smarter and more efficient. ”
AI is transforming drug discovery, innovation and analytics in the medical sector too, says Kale-ab Tessera, a key member of InstaDeep’ s AI research engineering team in SA.
“ We’ ve seen things like the launch of solutions such as DeepMind’ s AlphaFold, which solved a 50-year-old protein folding prediction problem, or Google’ s Pathways, a system that can solve multiple tasks at once.
“ InstaDeep is working with leading vaccine maker BioNTech, including applying the latest advances in AI and machine learning technology to develop novel immunotherapies for a range of cancers and infectious diseases, and applying InstaDeep’ s DeepChain protein design platform to engineer new mRNA sequences for protein targets. For advanced analytics, a prominent example is InstaDeep and BioNTech's high-risk Covid variant early warning system. ”
The system identified more than 90% of variants of concern, on average two months before their designation by the World Health Organisation. It detected the highly transmissible Omicron on the day its sequence became available among more than 70 000 novel variants discovered in October and November 2021.
This year has brought a fresh wave of cybersecurity attack examples that demonstrate the ever-changing landscape of threat detection and hacker threat mutations, says Yashmita Bhana, CEO at Nihka Technology Group.
In short, the magic is in the mix, and we are now building digital workforces designed to perform a specific job using the required capabilities.
Self-learning AI in the cybersecurity world is the new foundational mechanism to drive what is fast becoming known as AIOps. These tools combine AI and ML to determine threat severity in real-time. Gartner predicts that 40% of companies will be using AIOps by 2023 for application and network infrastructure monitoring.
AIOps is a natural companion to process ever-growing datasets and behaviours to detect known and unknown threats. Using the internationally recognised and trusted MITRE ATT & CK Framework to process and learn from the data sourced from endpoint telemetry, AIOps tools are the natural addition to any cybersecurity strategy.
“ In essence, the use of self-learning AI transcending into artificial general intelligence in cybersecurity surpasses the traditional methods in detection and prevention of threats and vulnerabilities through speed, quicker learning, prediction. ”
While traditional methods require security analysts and teams to go systematically through a framework, AIOps tools like Fortitude does this seamlessly in a day and can assess the entire security posture, both internal and external.
* This feature was first published in the April edition of ITWeb's Brainstorm magazine. | general |
Huawei actively develops African ICT talent | Huawei has embarked on a digital talent development programme in an effort to advance ICT skills in Sub-Saharan Africa.
Announced at its ICT Competition Awards Ceremony at the weekend, Huawei’ s LEAP programme aims to train 100 000 people in digital skills over the next three years.
This comes as the COVID-19 pandemic has accelerated digital adoption, while also exposing the digital skills gap that persists on the African continent.
A study by the International Finance Corporation, a member of the World Bank, found that 230 million jobs across the continent will require some level of digital skills by 2030.
LEAP − which is short for leadership, employability, advancement and possibilities − will foster digital leadership, create a skilled ICT workforce, build a digital talent pool and promote digital literacy among Sub-Saharan African citizens, reveals Huawei.
Huawei Southern Africa president Leo Chen stressed the importance of ICT skills transfer and talent development, calling on collaboration between government, industry and academia to create an ecosystem that everyone can contribute to and benefit from.
The programme’ s launch was also attended by Sub-Saharan African ministers in the ICT, education, science and communications portfolios, including minister Khumbudzo Ntshavheni.
Says Ntshavheni: “ COVID-19 took us into the digital era, but we should not need a pandemic to do this for us in the future; we need to be deliberate and intentional to leapfrog our countries.
“ We need innovation, we need to support local innovators, and we need to promote our own platforms throughout the continent to reach scale and develop our economies. We are only bigger when our market is bigger, and we must walk together. ”
Ntshavheni’ s counterpart professor Eliamani Sadoyeka, Tanzania’ s permanent secretary in the ministry of education science and technology, stressed that Africa’ s future is in the hands of its youth population.
“ Digitisation is deeply rooted in people. Because we digitise for people and by people, ” states Sadoyeka. “ Through the programme, we strive to cultivate more youth leaders in ICT, who can explore more possibilities for themselves, their families, community and ultimately their nations. ”
According to Huawei, LEAP will see more than 1 200 instructors facilitate 3 000 ICT courses.
Furthermore, it will fund a number of facilities, including training centres, hardware installation bases, innovation hubs, mirror labs and ICT academies. Huawei currently has ICT academies at more than 300 universities and colleges in the region.
Some of the digital initiatives Huawei’ s rolled out over the years include the training of 6 000 South African post-graduate ICT students or practitioners in 5G and fourth industrial revolution technologies.
In June 2020, Huawei and the South African College Principals Organisation joined forces to cultivate ICT talent in Technical and Vocational Education and Training colleges. The partnership was extended in December of that year. | general |
Sajo Systems Switches to Rimini Street Support for SAP S/4HANA and Enables IT Innovation | Rimini Street Inc. ( Nasdaq: RMNI), a global provider of enterprise software products and services, the leading third-party support provider for Oracle and SAP software products, and a Salesforce partner, today announced that Sajo Systems, a division of Korean Sajo Group, has partnered with Rimini Street to provide a higher level of award-winning support and software maintenance services for its SAP S/4HANA system. Working in collaboration with Rimini Street, Sajo Systems will refocus its IT staff and investments on transformational projects and digital initiatives, providing the company with the tools needed to drive business innovation.
This press release features multimedia. View the full release here: https: //www.businesswire.com/news/home/20220412005279/en/
Award-winning Support that Helps Clients take the Smart Path
Sajo Systems is an affiliate of Sajo Group, a major fisheries company in Korea, that supports IT, logistics and assets. Sajo Systems uses its customized SAP system to support the distribution and logistics for the group, with various other business solutions integrated with this system. Citing a need to improve the quality of support services received while realizing cost efficiencies, the company investigated and, after an extensive search, selected Rimini Street to optimize its IT operations on SAP and continue to evolve and innovate within the existing system.
“ Rimini Street provides customized support services based on careful analysis of Sajo Systems’ current business environment and requirements, including the need to reduce costs due to the prolonged COVID-19 crisis and service problems related to existing vendors, ” said Kim Sang-beom, director of the Information Division at Sajo Systems.
Sajo Systems expects faster resolution of its support cases with Rimini Street's award-winning support and extraordinary, proven engineers, who achieve an average client satisfaction score of 4.9 out of 5.0.
As Rimini Street expands its global portfolio of solutions on its road to achieving $ 1B in annual revenue by 2026, it is enabling clients like Sajo Systems to chart a smart path forward by helping them optimize, evolve and transform their technology landscape and systems as they build and execute their business of tomorrow.
“ I am delighted that Sajo Systems is leveraging Rimini Street as their partner to support them in creating their business-driven IT roadmap and strengthening the central driver for future digital competitiveness, ” said Hyungwook Kevin Kim, group vice president and regional general manager of Korea at Rimini Street. “ Rimini Street enables companies like Sajo Systems and thousands around the world to direct their talent, resources, and innovation efforts towards digital transformation initiatives by optimizing, evolving, and transforming systems that fuel competitive advantage and growth. ” | general |
Worldwise: Atlas Obscura Founder Dylan Thuras’ Favorite Things | Dylan Thuras co-founded Atlas Obscura as an online “ art project ” in 2009, mining its tiny community for unusual travel ideas. Today, Atlas Obscura boasts a staff of 60, a string of bestselling books, and divisions overseeing entertainment, tours, and brand partnerships. Its tagline: “ The Definitive Guide to the World’ s Hidden Wonders. ”
“ It’ s still about taking people around the world, and sharing wonderful stories of places they haven’ t heard of, ” Thuras, 39, tells Penta from the Rosendale, N.Y. home he shares with his wife, Michelle, and two children.
A longtime New Yorker who had worked in film and television, Minneapolis-born Thuras grew up in the Midwest. His first book, 2016’ s Atlas Obscura: An Explorer's Guide to the World's Hidden Wonders, sold more than a million copies, and remains the top-selling travel book of the last decade. A 2021 followup, Gastro Obscura: A Food Adventurer’ s Guide, also topped bestseller lists. “ Amazingly, the print products are the most popular things we do, ” Thuras says. “ You can open to a random page and get a bit of joy and surprise and wonder. ”
While the pandemic presented “ an existential crisis ” for the business, with “ zero ” revenue for a short time, Atlas Obscura pivoted with major brand partnerships and new online businesses like course learning, Thuras said. The enterprise ended up with its best-ever year in 2020, “ and 2021 doubled revenue again, ” Thuras says.
This year, “ we’ re taking more people around the world than ever, ” he says, with more than 100 trips planned, from Armenian relics to tasting cuisine in Queens, New York. “ It’ s a complicated business, because you’ re in the real world. But Americans are ready, and they’ re booking big, adventurous trips to places like Patagonia and India. We’ ll see a big return to travel. But there’ s a level of uncertainty, between Covid and war, that’ s keeping it fluent. ”
Thuras shared his favorite things around the world with Penta.
The place I’ m most looking forward to visiting in 2022… is Scotland. We’ re trying to take a trip with our entire family. I haven’ t scouted out the full thing of it, but there’ s a Scottish cave called Fingal’ s Cave. It’ s got geometric basalt hexagonal columns. There’ s huge lore around it—stories of battling giants, connections with Ireland, musical connections.
The most underappreciated place in the world is… this answer’ s a bit of a cheat, but the most underappreciated place in the world is wherever you live. Most people develop a kind of local’ s blindness.
If we’ re looking at the world, I’ d say Turkmenistan, where we led trips before the pandemic. An astonishingly small number of people visit Turkmenistan—fewer than visit North Korea. It’ s got an autocratic government, but its people are yearning to make contact with the outside world, and it’ s got a fledgling travel industry wanting to show off an astonishingly beautiful country. It’ s got quirks; if you smile in your visa photo, you won’ t get approved. You have to present a dour, non-smiling photo. Turkmenistan would benefit from being slightly less opaque to the world.
And the most overrated place in the world is… I don’ t trash-talk places. There’ s always something good. It’ s all about what you get from a place. I have a soft spot for tourist traps. I could come up with something amazing about the Mall of America. I have a long defense for Times Square.
That said, the Uffizi in Florence is an incredible museum with incredible art. But I see all these people waiting in long lines, and I could point them to La Specola, 10 minutes away, with its incredible anatomical wax figures and taxidermy. It drives me crazy to see tourists at a place that’ s just on some top-10 list, but with no idea why. So the place that’ s most overrated is the place you’ re going because you think you have to go because it’ s famous.
The advice I always give about travel is… it’ s advice I don’ t always follow: Try not to do too much. Go a little slower. Ask people you meet what’ s interesting. When you get to that place, ask another person. You’ d be amazed where that chain of questioning can get you. Try to resist the pressure of feeling like travel is a checklist. I understand why people feel they need to see something famous. But go to places and parts of a city you don’ t know about. The most satisfying travel experience offers a sense of uncertainty that reveals something amazing.
My favorite city in the world is… Budapest. I lived there for a year. It’ s got a combination of Austro-Hungarian Empire with Soviet grittiness and incredible culture. It’ s got the best public baths of any city in the world. It’ s a magical place.
The book I’ m reading right now is… The Ministry for the Future by Kim Stanley Robinson. I 'm a big sci-fi fantasy fan. His work is similar to Neal Stephenson, another author I love. It’ s “ cli-fi ” —climate fiction.
On my home-office playlist, you’ ll hear… this is my “ chill dad ” list: Colleen, an electronica artist who’ s kind of lo-fi. An incredible harpist named Mary Lattimore. “ Modern Country ” by [ Nashville singer-songwriter ] William Tyler. And [ American electro-pop duo ] 100 gecs. | business |
Dubai’ s Most Expensive Villa Is This Massive Megamansion, Which Sold for AED 280 Million | A custom-built, 33,300-square-foot megamansion that sold last week for AED 280 million ( US $ 76.2 million), now holds the record for Dubai’ s most expensive villa.
The sale price of the megamansion was about 33% more than the previous record, set in 2015, of AED 185 million, according to Property Monitor, the Dubai-based real estate platform. The company confirmed last week’ s sale was the priciest residence ever sold in the city.
“ To see a transaction of this magnitude illustrates the ongoing strength of Dubai’ s property market particularly in the ultra-high-end segment, ” Zhann Jochinke, Property Monitor’ s COO, said in a statement. “ The transaction not only beats Dubai’ s previous record but closes the gap between Dubai’ s luxury market and those of leading global cities such as London, New York and Hong Kong. ”
Located on the north frond of the man-made island Palm Jumeirah, the residence features close to 230 feet of private beachfront on the Persian Gulf. It also has a host of other amenities, according to listing agent Conor McKay of Belleview Real Estate.
“ It happens to be the only villa on the Palm Jumeirah which offered an indoor swimming pool, ” he said in an email. “ The property boasts 10 bedroom suites, a huge rooftop terrace, a wine cave, a cinema, a gym and seven-star spa facilities. ”
Mansion Global could not identify the buyer.
The villa—which has double-height ceilings and walls of windows that frame water and city views—is also one of only a few residences on Palm Jumeirah measuring more than 33,000 square feet, requiring two side-by-side signature villa plots, he added.
Imported and hand selected marble can be found throughout the residence, supplied by Giorgetti and Minotti, Italian furniture houses.
“ The marble is also the finest grade A, book-matched slabs, ” Mr. McKay said.
That’ s on display in the bathroom of the primary bedroom suite, which also has several seating areas, a large dressing room and a spa tub, listing photos show. Marble is also replete in the spa area, which includes a hair salon, sauna and steam and massage rooms.
Other amenities include an aquarium and a rooftop hot tub.
Dubai has experienced a robust market since the beginning of the Covid-19 pandemic, and there were more sales of homes priced above $ 10 million in the first quarter of 2022 than any other year since 2015, Mr. McKay said.
Part of the strength of the market can be attributed to the government’ s response to the virus, the agent added.
“ While we experienced a very strict lockdown, within six weeks Dubai had one of the most comprehensive testing infrastructures globally, allowing life to return to normal almost immediately, ” he said. “ Within 12 months, 89.7% of the population was vaccinated. This response saw an influx of high-net-worth individuals from overseas. Combine that with an already undervalued property market and the result is the explosive growth we witnessed last year. ” | business |
Partnership between Sizwe Africa IT Group, Boston IT Solutions brings HPC to SA | The need for deeper insights in today’ s digital world is clear, and high performance computing ( HPC) is being recognised as the go-to platform for those organisations seeking such knowledge. Known for its ability to perform complex mathematical calculations, HPC can, in fact, span an array of fields, while enabling users to analyse data, simulate processes and predict outcomes.
According to Itumeleng Mochocho, Executive for Technology Partnerships at Sizwe Africa IT Group, HPC can be applied across a range of verticals, from financial services – where it is ideal for fraud prevention – to healthcare.
“ Think how important it has been to properly map the spread of the COVID-19 virus, and to model the disease to understand its growth and spread. HPC is the answer for something like this, where speed and accuracy are of paramount importance, ” he says.
It is for this reason that Sizwe has formed a partnership with Boston IT Solutions SA, one of the key HPC players in the country. “ We have a number of clients who operate in sectors that can derive enormous benefit from access to HPC, so our partnership aims to grow and develop the use of this technology in the country. ”
According to Chris Coetzee, Business Director at Boston IT Solutions SA, HPC is still in its infancy in South Africa, so the organisation has made a commitment to the South African government to work on enabling and developing the HPC channel.
“ Having Sizwe as a partner in this is the perfect fit, as they have a number of customers in the education and public sector arenas, which are both prime users of HPC. More crucially, alongside these long-standing relationships, they have the requisite skills in-house, so it is a natural fit, ” he says.
“ Having a skilled partner sitting next to us when scoping projects, and which can not only identify issues that need to be tackled, but also help with developing a relevant solution in conjunction with us, will be vital in opening HPC up to the broader market. ”
Mochocho adds that from a Sizwe perspective, it is very important for the organisation to have a partnership of such relevance with one of the leaders in the HPC space. What Boston has to offer, he notes, will be of enormous value to many of the company’ s clients.
“ For example, the universities that are customers of ours usually have large research projects under way, and most of the students undertaking serious research require computers that are able to do high-speed calculations. Thus, having access to an HPC cluster will be of enormous value to them.
“ Sizwe is certainly happy to be partnering with a world leader in the HPC space. Boston has a global reach and extensive experience in this space. To add to this, Sizwe has both local reach and local understanding of the market, coupled with the necessary technical skills and a significant and relevant customer base, ” he states.
Finally, says Coetzee, it is worth noting that Boston also has a lab where customers can come to conduct tests on any type of hardware, adding that both Sizwe and its end-customers have full access to this. In other words, he points out, if a client wants to test a new processor, for example, they can work with Sizwe and have full access to this lab to undertake benchmarking and testing.
“ Access to these state-of-the-art Boston Labs facilities will be granted remotely to businesses in South Africa wanting to test the latest technologies, solutions and services. Boston IT is excited for a future in which HPC can assist South African businesses to use speed, accuracy and processing power to solve increasingly complex challenges, ” he concludes. | general |
La ambigüedad estratégica de Estados Unidos con Taiwán debe terminar by Abe Shinzō | TOKIO – La invasión rusa de Ucrania fue para muchos un recordatorio de la tensa relación entre China y Taiwán. Pero a pesar de que entre Taiwán y Ucrania hay tres semejanzas, también existen importantes diferencias.
El primer parecido es la gran divergencia de poder militar entre Taiwán y China ( como la que también existía entre Ucrania y Rusia). Una divergencia que además se acrecienta año tras año.
En segundo lugar, ni Ucrania ni Taiwán tienen aliados militares formales. Ambos países están obligados a confrontar solos cualquier amenaza o ataque.
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Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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| general |
Decoy nanoparticles trick coronavirus as it evolves | Apr 12, 2022
Decoy nanoparticles trick coronavirus as it evolves
( Nanowerk News) They might look like cells and act like cells. But a new potential COVID-19 treatment is actually a cleverly disguised trickster, which attracts viruses and binds them, rendering them inactive.
As the ever-evolving SARS-CoV-2 virus begins to evade once promising treatments, such as monoclonal antibody therapies, researchers have become more interested in these “ decoy ” nanoparticles. Mimicking regular cells, decoy nanoparticles soak up viruses like a sponge, inhibiting them from infecting the rest of the body.
In a new study, Northwestern University synthetic biologists set out to elucidate the design rules needed make decoy nanoparticles effective and resistant to viral escape. After designing and testing various iterations, the researchers identified a broad set of decoys — all manufacturable using different methods — that were incredibly effective against the original virus as well as mutant variants.
In fact, decoy nanoparticles were up to 50 times more effective at inhibiting naturally occurring viral mutants, compared to traditional, protein-based inhibitor drugs. When tested against a viral mutant designed to resist such treatments, decoy nanoparticles were up to 1,500 times more effective at inhibiting infection.
Although much more research and clinical evaluations are needed, the researchers believe decoy nanoparticle infusions someday could potentially be used to treat patients with severe or prolonged viral infections.
The study was published in the journal Small ( Elucidating Design Principles for Engineering Cell-Derived Vesicles to Inhibit SARS-CoV-2 Infection). In the paper, the team tested decoy nanoparticles against the parent SARS-CoV-2 virus and five variants ( including beta, delta, delta-plus and lambda) in a cellular culture.
They might look like cells and act like cells. But a new potential COVID-19 treatment is actually a cleverly disguised trickster, which attracts viruses and binds them, rendering them inactive. ( Image: Northwestern University)
“ We showed that decoy nanoparticles are effective inhibitors of all these different viral variants, ” said Northwestern’ s Joshua Leonard, co-senior author of the study. “ Even variants that escape other drugs did not escape our decoy nanoparticles. ”
“ As we were conducting the study, different variants kept popping up around the world, ” added Northwestern’ s Neha Kamat, co-senior author of the study. “ We kept testing our decoys against the new variants, and they just kept working. It’ s very effective. ”
Leonard is an associate professor of chemical and biological engineering in Northwestern’ s McCormick School of Engineering. Kamat is an assistant professor of biomedical engineering in McCormick. Both are key members of Northwestern’ s Center for Synthetic Biology.
‘ Evolutionary rock and a hard place’
As the SARS-CoV-2 virus has mutated to create new variants, some treatments have become less effective in fighting the ever-evolving virus. Just last month, the U.S. Food and Drug Administration ( FDA) paused several monoclonal antibody treatments, for example, due to their failure against the BA.2 omicron subvariant.
But even where treatments fail, the decoy nanoparticles in the new study never lost effectiveness. Leonard said this is because the decoys put SARS-CoV-2 “ between an evolutionary rock and a hard place. ”
SARS-CoV-2 infects human cells by binding its infamous spike protein to the human angiotensin-converting enzyme 2 ( ACE2) receptor. A protein on the surface of cells, ACE2 provides an entry point for the virus.
To design decoy nanoparticles, the Northwestern team used nanosized particles ( extracellular vesicles) naturally released from all cell types. They engineered cells producing these particles to overexpress the gene for ACE2, leading to many ACE2 receptors on the particles’ surfaces. When the virus came into contact with the decoy, it bonded tightly to these receptors rather than to real cells, rendering the virus unable to infect cells.
“ For the virus to get into a cell, it has to bind to the ACE2 receptor, ” Leonard said. “ Decoy nanoparticles present an evolutionary challenge for SARS-CoV-2. The virus would have to come up with an entirely different way to enter cells in order to avoid the need to use ACE2 receptors. There is no obvious evolutionary escape route. ”
Future benefits
In addition to being effective against drug-resistant viruses, decoy nanoparticles come with several other benefits. Because they are biological ( rather than synthetic) materials, the nanoparticles are less likely to elicit an immune response, which causes inflammation and can interfere with the drug’ s efficacy. They also exhibit low toxicity, making them particularly well-suited for use in sustained or repeated administration for treating severely ill patients.
When the COVID-19 pandemic began, researchers and clinicians experienced an unnerving gap between discovering the virus and developing new drugs to treat it. For the next pandemic, decoy nanoparticles could provide a quick, effective treatment before vaccines are developed.
“ The decoy strategy is one of the most immediate things you can try, ” Leonard said. “ As soon as you know the receptor that the virus uses, you can start building decoy particles with those receptors. We could potentially fast-track an approach like this to reduce severe illness and death in the crucial early stages of future viral pandemics. ”
Source: By Amanda Morris, Northwestern University
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Hidden Carbon Subsidies Will Destroy Us by Jayati Ghosh & Debamanyu Das | Western governments have been heavily subsidizing their own fossil-fuel industries even as they exhort much poorer countries to do more to reduce greenhouse-gas emissions. But the full extent of these subsidies has been hidden by the methods used to measure them.
NEW DELHI – The latest report from the Intergovernmental Panel on Climate Change should terrify policymakers and ordinary people around the world. The IPCC warns that some disastrous climate outcomes are now likely to occur not in the distant future, but within the next 15 years, or even the next decade.
But instead of waking up to the threat and responding quickly, policymakers remain focused on Russia’ s horrific war against Ukraine and its immediate consequences. While this may be understandable, the Ukraine crisis has also exposed the excessively short-term policy orientation of Western governments. Many have quickly reneged on even the relatively meager and obviously inadequate climate pledges they made only a few months ago at the United Nations Climate Change Conference in Glasgow.
The invasion of Ukraine and the subsequent Western-led sanctions against Russia triggered a dramatic increase in fuel prices, when the energy market was already heating up because of the economic recovery in the United States and Europe. Yet, instead of seeing this price spike as an opportunity to hasten the shift away from fossil fuels, governments in advanced economies have tried to reduce the pain by keeping domestic energy prices low, for short-term political reasons.
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Jayati Ghosh, Professor of Economics at the University of Massachusetts Amherst, is a member of the UN Secretary-General’ s High-Level Advisory Board on Effective Multilateralism.
Writing for PS since 2022 1 Commentary
Debamanyu Das is a research scholar at the University of Massachusetts Amherst.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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Oil futures: Prices rally 6% as OPEC issues warning over Russian output | Crude oil futures Tuesday were sharply higher after OPEC again warned it would be impossible for the group to increase output enough to offset lost supplies from Russia, as peace talks appear to falter.
Front-month June ICE Brent futures were trading at $ 104.74/b ( 1845 GMT), compared to Monday's settle of $ 98.48/b.
At the same time, May NYMEX WTI was trading $ 100.60/b, versus Monday's settle of $ 94.29/b.
OPEC Secretary-General Mohammad Barkindo told EU officials Monday it would be impossible to replace Russian barrels fully and that oil markets could experience a loss of as much as 7 million bpd under a full embargo.
`` These crises have compounded to create a highly volatile market, '' Barkindo said in his opening remarks. `` I must point out, however, that these are non-fundamental factors that are totally out of our control at OPEC. ''
Meanwhile, OPEC cut its oil demand growth forecast for 2022 by 480,000 bpd, which was largely shrugged off by the market.
Europe remains under pressure to tighten energy sanctions against Russia amid further reports of human rights abuses in Ukraine, including unconfirmed reports of chemical weapons use.
`` With the war ongoing and the risk of additional sanctions or actions by Russia the downside risk to crude oil remains limited, '' said Ole S Hansen, Head of Commodity Strategy at Saxo Group in a note, adding the bank's recently published Quarterly Outlook highlighted the reasons why oil may trade within a $ 90 to $ 120 range this quarter.
President Vladimir Putin said on Tuesday peace talks with Ukraine were “ at a dead end ”, vowing to continue Russia’ s invasion.
Meanwhile, additional oil from Iran is looking less likely, with Iran saying the 2015 nuclear deal is alive but in the `` emergency room ''.
Prices also found support after Shanghai's relaxation of some Covid-19 restrictions, as more than 7,000 residential units were classified as lower-risk areas after reporting no new infections for 14 days.
But China's Premier Xi issued a third warning about economic growth risks in less than a week, suggesting heightened concerns about the outlook amid Covid lockdowns and disruption to productivity. | general |
KKR Hires Pamela Alexander to Lead Philanthropy and Corporate Citizenship | Global alternative asset and private equity investor KKR announced today the appointment of Pamela Alexander as Managing Director and Head of Corporate Citizenship.
In her new role, Alexander will be responsible for overseeing KKR’ s corporate citizenship and strategic philanthropy programs globally and she will also serve as a resource on citizenship to KKR’ s portfolio companies. KKR launched its citizenship platform in 2016, aimed at helping the firm and its employees and portfolio companies create healthier and more resilient communities.
In recent years, the firm launched a $ 50 million KKR Relief Fund to support those most impacted by the COVID-19 pandemic. The platform also includes the KKR Cares initiative, encouraging employees to engage with nonprofits and communities through a matching gift program, providing employees with 40 hours of paid time to volunteer with community projects, connecting executives with nonprofit board service opportunities, and pro-bono consulting and technical assistance to nonprofits and social enterprises.
Ken Mehlman, Partner, Global Head of Public Affairs and Co-Head of Global Impact at KKR, said:
“ We believe that purpose and citizenship work hand-in-hand to drive performance and employee engagement. Our employees care deeply about their communities and we want to provide the best possible platform and resources for them to have a positive impact on the world around them. I am thrilled to welcome Pamela to our team and am confident that her impressive track record of driving impactful citizenship initiatives and building strong relationships with non-profits and community leaders will be invaluable to us as we continue to build out this platform for the benefit of our employees, investors, portfolio companies and their communities. ”
Prior to joining KKR, Alexander served at Ford for over 20 years, most recently as Director of Community Development for the Ford Motor Company Fund, and in other senior community development and government relations roles. She recently oversaw the Ford Fund’ s philanthropic response to COVID in the US, including a small business grant program, an emergency fund designed to assist college students with basic needs and technology, and support for first responders and frontline workers.
Alexander said:
“ I am honored to be joining a company that shares my passion for community engagement and belief in the power that corporate citizenship can have in driving positive impact and empowering people and communities to reach their full potential. I look forward to building and expanding upon this important work through my new role at KKR and am excited for what’ s ahead. ” | esg |
China stocks fall as COVID concerns outweigh credit growth cheer | - China stocks hit a four-week low on Tuesday, weighed down by the country's worst COVID-19 outbreak in two years and strict anti-virus policy, even though data showed a jump in credit growth as the central bank tried to support the slowing economy.
The CSI300 index fell 0.4% to 4,084.97 by the end of the morning session, while the Shanghai Composite Index lost 0.7% to 3,146.11.
The Hang Seng index dropped 0.5% to 21,102.21. The Hong Kong China Enterprises Index lost 0.6% to 7,164.56.
* * New bank lending in China rose more than expected in March, while broad credit growth accelerated from the previous month.
* * `` Strong credit supply is helpful, but the economy will likely stay weak with many cities under lockdown, '' said Zhiwei Zhang, chief economist at Pinpoint Asset Management, adding that the COVID outbreaks and the zero tolerance policy were the most important uncertainties faced by the economy.
* * Mainland China reported 1,272 new confirmed coronavirus cases and 23,387 new asymptomatic cases on April 11.
* * China will step up the implementation of macro policies as the downward pressure on the economy is increasing, state media on Monday quoted Premier Li Keqiang as saying.
* * China is also encouraging long-term investors to buy more equities and major shareholders of listed firms to increase their holdings when stocks slump.
* * Real estate developers and semiconductor makers lost roughly 1.5% each, while new energy shares retreated 1%.
* * Liquor makers gained 1.4%, led by a 5.1% rise in Shanxi Xinghuacun Fen Wine after it said it expected a 70% year-on-year jump in Q1 net profit.
* * Tourism added 2.2%, and transport rose 1.3%.
* * Online gaming stocks rose as authorities granted licences to 45 internet games in April, the first time since July.
* * Morningstar analysts said this `` should bring much-needed relief to a sector that has been shaken by negative headlines. ''
* * In Hong Kong, Bilibili surged 7.4% and Tencent gained 2.3% even though their games were not in the list.
* * Meanwhile, the Hang Seng Tech Index retreated 0.8%, with Kuaishou slumping more than 10%.
( Reporting by Shanghai Newsroom; Editing by Subhranshu Sahu) | business |
Dior, Louis Vuitton power first-quarter sales at LVMH | - Robust demand for Louis Vuitton and Dior products boosted first-quarter sales at the world's largest luxury goods conglomerate LVMH, kicking off earnings season for the industry with a show of resilience despite geopolitical tensions, COVID-19 lockdowns in China and volatile stock markets.
High-end fashion brands drove a 30% rise in sales of its largest division, fashion and leather goods, on a like-for-like basis, beating analyst expectations of 17%, according to consensus estimates cited by RBC.
`` The year starts on a high note, '' said Luca Solca of Bernstein, citing `` another material beat '' of consensus expectations, particularly the fashion and leather goods activity.
Dior and Celine grew faster than other labels, while Louis Vuitton `` is never very far from the average for the division, '' LVMH Chief Financial Officer Jean-Jacques Guiony told analysts in a call.
The group will continue to raise prices at its fashion labels - but reasonably - to reflect the cost of business, said the executive.
Luxury industry prices have increased over the last six months by around 8 percent since September last year, with hikes in the range of 20% -23% at Louis Vuitton and Tiffany, according to recent estimates from HSBC.
Watches and jewellery labels also performed strongly, with sales for the high end products up 19%, boosted by Tiffany, particularly in the United States. The American luxury brand is undergoing a renewal drive led by its new French owner targeting younger audiences, with marketing campaigns featuring K-pop star Rose wearing chunky gold jewellery.
Traffic in Sephora stores in the U.S. and France helped push up sales at the selective retail division, which clocked 24% organic sales growth. But the luxury group's DFS travel retail business continued to suffer from travel restrictions in Asia, including Hong Kong where tourists have not yet returned.
Turnaround efforts at DFS could help it break even this year, predicted Guiony.
The executive sought to reassure investors concerned about disruptions in China from restrictions aimed at preventing the spread of coronavirus, although he cautioned that in addition to lockdowns in Shanghai and Shenzhen, traffic is down in cities that are not affected by such measures, with people travelling less.
`` Obviously this is an impact - it's a fairly recent impact so you don't see it in the numbers, '' he said, noting that the effects seen in April so far are similar to the second half of March. Drawing on experience from previous lockdowns in China, the executive predicted that demand would return quickly once restrictions ease.
`` It is probably worth looking beyond 2Q China disruption, '' said Citi, which plans to retain a buy rating on shares. Overall sales at LVMH rose by 23% on a like-for-like basis, which strips out the effect of currency changes, in the three months to March to 18 billion euros, beating a consensus estimate for 18% growth, cited by Jefferies.
Hermes reports first-quarter sales on April 14 and Kering on April 21. ( Reporting by Mimosa Spencer; editing by David Evans; Editing by David Gregorio, Bernard Orr) | business |
Global stocks pare gains, bond yields slip on inflation data | ( Updates prices, quotes)
* Stocks reverse earlier gains, European shares slip
* Oil prices up over 6%
* Dollar rises
WASHINGTON, April 12 ( Reuters) - Global equities reversed earlier gains on Tuesday, while U.S. Treasury yields slipped as data showing a jump in U.S. inflation was in line with expectations gave investors some relief.
The U.S. consumer price index rose 1.2% last month, the biggest increase in 16-1/2 years and cementing the case for a 50 basis points interest rate hike from the Federal Reserve next month.
However, the benchmark 10-year Treasury yield was last down 6.1 basis points to 2.721%, its first decline in eight sessions, as the inflation number had been priced in and also reflecting the market's unease that an aggressive policy response to inflation from the Federal Reserve could undermine economic growth.
`` Inflation is still a really big part of the macro narrative here ( but) we're seeing some encouraging signs beneath the surface, '' said Mike Reynolds, vice president of investment strategy at Glenmede. '
`` Market has been picking up today on the fact that the CPI was a bit softer than expected... Anything that indicates a softening momentum on the inflation front is going to mean that the Fed perhaps may not have to go as aggressively in tightening monetary policy. ''
Oil prices climbed on Tuesday as Russian oil and gas condensate production fell to 2020 lows and OPEC said it would be impossible to replace potential supply losses from Russia.
On Wall Street, the Dow Jones Industrial Average fell 0.02% and the S & P 500 lost 0.02%.
Meanwhile, the Nasdaq Composite added 0.12%.
The pan-European STOXX 600 index lost 0.35% and MSCI's gauge of stocks across the globe shed 0.24%.
`` Markets have decided that central banks are late and need to do more to tame inflation, and moderate volatility in equities is not enough to stop this, '' said Nordea chief analyst Jan von Gerich. `` The reason for the wobble in equity markets is higher rates and geopolitics. ''
While U.S. 10-year Treasury yields pulled back from their highs, they are up almost 45 basis points so far this month.
More disconcerting for equities is the move in real or inflation-adjusted yields, with the yield on the 10-year U.S. Treasury Inflation-Protected Securities ( TIPS) approaching 0%.
In Europe, German Bund yields climbed to almost 0.88%, their highest level since 2015, British gilt yields rose to fresh multi-year highs.
Germany's ZEW economic research institute said its economic sentiment index fell to -41.0 points from -39.3 in March, declining less than expected.
Investors also await Wednesday's first-quarter earnings season for big banks, many of which are expected to report a sharp decline in earnings from a year earlier, according to analysts, who noted many lenders benefited from exceptionally strong deal-making, trading and funds set aside for loan losses being released.
ASIA MARKETS GAIN GROUND
The dollar index, a measure of the greenback's value against six peers, rose 0.26%, after earlier in the week touching its highest level in almost two years.
Japan's yen, however, has been hurt by the Bank of Japan's commitment to maintaining ultra-easy policy even as the Fed embarks on tightening monetary policy.
The latest warnings from Japanese policymakers, with Prime Minister Fumio Kishida saying on Tuesday that rapid currency moves are undesirable, failed to shore up the yen, which has shed over 3% this month.
`` Markets at this point are not sure policymakers are genuinely inclined to intervene on the yen and that's why we have most likely seen a limited impact, '' said James Lord, global head of FXEM Strategy at Morgan Stanley. `` Typically verbal intervention doesn't have much impact on currency markets, and that's not specific to the yen. ''
The euro traded down 0.53% to $ 1.0825, unable to hold gains from a mini-relief rally on Monday, after French leader Emmanuel Macron beat far-right challenger Marine Le Pen in the first round of presidential voting.
China's markets and oil prices gained ground as signs emerged that some of the COVID-19 restrictions were easing in financial hub Shanghai.
A relaxation of China's regulations on the gaming sector also gave investors heart after a multi-year crackdown on parts of the country's technology industry.
China's blue chip CSI300 Index dipped into negative territory mid-session but roared back later to rally almost 2%.
U.S. crude rose 7.17% to $ 101.05 per barrel and Brent was at $ 105.12, up 6.74% on the day.
The European Union has yet to agree any embargo on Russian oil over the war in Ukraine, but some foreign ministers have said the option is under discussion.
( Additional reporting by Dhara Ranasinghe in London and Scott Murdoch in Hong Kong Editing by Nick Macfie, Chizu Nomiyama, Susan Fenton and Barbara Lewis) | business |
Ryse Health Raises $ 3.4M in Seed Funding | Ryse Health, a Baltimore, MD- and Arlington, Va.-based healthtech startup, raised $ 3.4M in seed funding.
The round was led by W Health Ventures with participation from:
Founded by Erin Kane, MD, co-founder and chief medical officer, and Richard Gurley, MBA, co-founder and chief executive officer, Ryse Health provides tech-enabled office-based and virtual care to patients with type 2 diabetes. Its technology platform includes a continuous glucose monitor ( CGM) and a custom app to synthesize data, support self-management, and facilitate smooth communication. Their care team comprises health coaches, endocrinologists, and a broad care team of registered dieticians ( RDs), certified diabetes care and education specialists ( CDCESs), and licensed clinical social workers ( LCSWs) to help patients navigate the psychosocial barriers to overcoming chronic disease.
Dr. Kane is a Harvard- and Hopkins-trained physician. She has led multiple care-delivery redesign initiatives, including as an early leader of the Hopkins Capacity Command Center and a GW COVID-19 remote monitoring program. She also has experience as a McKinsey management consultant and a deep understanding of healthcare operations. Mr. Gurley was a leader at two successful value-based, tech-enabled healthcare services startups ( Evolent Health and WelbeHealth). He has served as an advisor to seven leading healthcare growth companies, including Doctor on Demand, Modern Fertility and Vera Whole Health. He also has prior experience in McKinsey health payer/provider practice and the Tennessee government.
FinSMEs
12/04/2022 | business |
Just Eat Takeaway.com partners with grocer Ahold in Netherlands | - Just Eat Takeaway.com, Europe's largest online food ordering service, said on Tuesday it will partner with supermarket operator Ahold's flagship Dutch Albert Heijn chain to deliver groceries and convenience products.
Financial terms were not disclosed.
While a tie up between the country's biggest food delivery service and its biggest grocer had seemed logical, Ahold also operates its own grocery delivery service, as well as e-commerce site Bol.com, which is more popular than Amazon in the Netherlands.
The companies said the partnership will focus on a smaller range of around 1,200 products, with a focus on fresh produce and convenience products -- items that usually have higher margins.
`` Fast grocery '' services such as Gorillas, Flink and Getir saw blistering growth in the Netherlands during the coronavirus pandemic.
However in recent months, Amsterdam, Rotterdam and other major cities have imposed bans on new distribution centres, the '' dark stores '' they rely on, in residential areas.
Ahold and Takeaway said they would target a 30 minute delivery time for orders, slightly longer than the 10 or 15 minutes promised by some of the fast grocery startups.
Takeaway shares, which have lost two-thirds of their value since October 2020, were trading flat at 30.50 euros at 0709 GMT.
( Reporting by Toby Sterling, editing by Ed Osmond, Kirsten Donovan) | business |
Mercedes-Benz bets on India's nouveau riche to drive luxury car sales | * Start-up frenzy, stock market boom create new millionaires
* Average age of Mercedes car buyer less than 40 years
* Sale of its top-end luxury models grew 80% in 2021
PUNE, India, April 12 ( Reuters) - Germany's Mercedes-Benz is betting that an expanding pool of young new millionaires will drive demand for luxury cars in India, creating faster sales growth than for mass market cars, a top company official said.
India's increasing numbers of `` dollar millionaires '' include young entrepreneurs or high-earning professionals who appreciate the luxury element and technology of the cars, said Martin Schwenk, chief executive of Mercedes-Benz India.
`` The base is getting broader and gradually moving beyond our traditional customers, '' Schwenk told Reuters in a recent interview in the western industrial city of Pune, home to Mercedes ' India headquarters and manufacturing plant.
`` Going forward we will see higher growth rates in the luxury segment than we see in the mass market, '' he said, adding that buyers ' average age had also fallen below 40, from more than 45 earlier.
Mercedes is the top-selling luxury car brand in India, with a market share of more than 40%, says auto market data provider JATO Dynamics, and it competes with Audi, BMW and Tata Motors ' Jaguar Land Rover.
Global carmakers ' biggest growth hurdle is a shortage of semiconductors and logistics woes worsened by Russia's invasion of Ukraine. For Mercedes India, this has led to an order backlog of 4,000 cars and wait times of more than six months in some cases, Schwenk said.
`` We have very good sales momentum, the concerns are on the supply side. You have congestion at the ports that cause really significant delays and that is hampering our output, '' he said.
India's start-up frenzy and stock market boom are creating a new breed of wealthy splurgers on luxury brands such as Rolex, Louis Vuitton and Gucci, the 2021 Hurun India Wealth Report showed.
The number of Indian households with a net worth of at least a million dollars grew 11% in 2021 to 458,000 and is expected to increase by 30% over the next five years, the report said.
India is largely a small and low-cost car market in which luxury models account for just over 1% of total annual sales of about 3 million.
Mercedes ' India sales rose more than 40% to 11,242 cars in 2021, coming off a low of 7,893 during the pandemic-hit year of 2020.
But the carmaker saw growth of 80% in top-end models such as the GLS, S-Class and GLS Maybach, all cars costing more than 10 million rupees ( $ 131,337).
Schwenk said while the pandemic had driven some of this demand, as more people `` spent for their own pleasure, '' India's luxury car market showed potential for higher growth, a feature missing over the last six to eight years.
To capitalize on the momentum, the company plans to launch 10 models in 2022, including its locally assembled electric sedan EQS.
While growth in India's luxury and mass markets are not directly comparable, Mercedes ' high-end models doing well reflects the wealth of the nation, said Ravi Bhatia, president for India at JATO.
`` The rich have become richer and some of them have ended up upgrading their lifestyle, '' Bhatia said.
JATO's analysis also showed that Mercedes ' product mix and pricing led to a lower average weighted price of its cars, putting upgrades to the luxury segment within reach of more customers, he added.
Mercedes ' sales in India in 2021, however, were still lower than its peak of more than 15,500 cars in 2018. Schwenk said sales could approach 2018 levels this year if there were no further supply chain disruptions because of COVID or geopolitical issues.
Lowering Indian taxes on luxury cars, which he said were among the highest in the world, would also help grow the segment and benefit the car market. ( Reporting by Aditi Shah; Editing by Clarence Fernandez and Susan Fenton) | business |
Diversifying supply chains from China 'probably good for everyone ' -World Bank chief | Malpass said cross-border trade would remain important to the global economy, and China - already the world's second largest economy and likely to become the largest - had a big role to play as both a consumer and producer of goods.
But, speaking at an event in Warsaw, he said China also needed to be part of a value system shared by other countries in the global trading system, and added, `` I don't know that that will happen. ''
Asked about whether China was headed for a crisis due to severe COVID-19 lockdowns and debt problems in its property sector, Malpass said: `` They're having setbacks, major setbacks in various areas, and the forecasts for growth have been brought down. ''
But he said the World Bank continues to work well with China, which is a major shareholder and a borrower whose use of the lender's financing is shrinking. The bank is also working closely with China to encourage more transparency its lending to developing countries, Malpass said.
`` So I guess the way I think of it is that the world needs to interact with China, recognizing that it's important in the world and growing in importance, '' Malpass said.
He also said he did not believe the world faced a new `` Bretton Woods moment, '' a reference to the 1944 conference that revamped the international financial architecture and created the World Bank and the International Monetary Fund amid the ruins of World War Two.
That system, with the U.S. dollar at its core, `` works pretty well, '' he added.
`` My view is we're not at that point now at all. There's not a sense of the world being lost, '' Malpass said. `` There's this sense actually of unity of a great deal of the world in one endeavor, which is to end the war in Ukraine. ''
( Reporting by Andrea Shalal and David Lawder; editing by Richard Pullin)
By Andrea Shalal and David Lawder | business |
Ark's Wood remains bullish on Tesla as U.S. recession fears rise | `` What we said during COVID about innovation solving problems will move into overdrive, '' she told a webinar, with Tesla poised to `` deliver truly exponential growth for many, many years '' as it expands its autonomous driving programs.
Wood's bullish stance on technology comes as yields of two-year Treasuries have moved above those of 10-year Treasuries in recent weeks, which is often considered a precursor to a recession.
Wood, whose ARK Innovation ETF was the top-performing U.S. equity fund in 2020, said that she expects `` truly disruptive innovation '' will come back into favor as investors turn to technology to solve economic problems.
Tesla is down 6% for the year to date, while Wood's second-largest position, Teladoc Health Inc, is down nearly 26% over the same time.
Overall, ARK Innovation is down 36.7% for the year to date, a performance that puts it in the worst percentile among the 615 U.S. Mid-Cap Growth funds tracked by Morningstar. Shares of the fund rose 0.5% in afternoon trading Tuesday.
Investors have pulled approximately a net $ 791 billion out of the fund over last three weeks, according to Lipper data.
That three-week losing streak was its longest since November.
( Reporting by David Randall; Editing by Cynthia Osterman)
By David Randall | business |
Relief is on its Way: How Top American Banks Cope with the Post-pandemic Crisis | Our brief guide covers 10 world-known banks and their relief policies to date. Of course, the list is not full; our purpose is to highlight the top players in the US. But even those who are covered in it may change their policies over time. If you don’ t find your credit card issuer here, then contact them directly. Post-pandemic relief is not something you should neglect. Any easing measure like reduced or suspended payments, late fee waivers, or reduced APR can give you more control over your credit card debt in turbulent financial times. How Banking Giants Deal with Covid-19 Consequences: 10 Relief Program Examples American Express Since the beginning of the recession, American Express has been conducting a financial hardship program online. There, it provides cardholders with consultation on difficult circumstances. Unlike American Express, most credit card issuers don’ t have a dedicated website for relief programs. Instead, you will have to go through customer service first, which only adds to your waiting time. Per AmEx’ s relief program, customers can get reduced monthly payments and APR for a limited time. Also, late payment and card membership fees can be suspended while you take part in the program. The program provides two payment plans to choose from: a short-term 12-month relief and a longer-term payment plan for 36 or 60 months. However, the eligibility criteria is stricter for long-term plans. To enroll, customers must confirm their delinquency status, card balance, and even prior enrollment in the program. Those who choose a short-term payment plan should remember that all their fees waived, or cut, during the program will resume once it ends. Bank of America To help clients through challenging times, the bank provides 60-day payment deferrals for businesses and individuals. The relief program also suggests refunds for late fees usually charged if the customer can not pay on the due date. However, each case is personal, meaning that one should discuss the relief options available with a bank representative. Besides that, at the beginning of the pandemic, Bank of America extended the period during which eligible cardholders could earn sign-up bonuses. Specifically, that period was extended to 90 days for consumers and businesses who opened accounts between January 1 and March 31, 2020. Barclays From now on, Barclays cardholders can skip the minimum payment due during the next two payment due dates. However, the interest will continue to accrue during that period. As in the case with the previous banks, cardholders can also ask for relief online. Besides credit cards, Barclays’ relief programs include business credit cards, personal loans, and even available for those customers who have used up their benefits already — in which case, they simply need to reapply for more help. Capital One Though Capital One is not too specific about its relief programs on its website ( you won’ t find much info even on your account page), it encourages customers to contact customer service to find out about viable options. In the same way as Barclays, Capital One offers relief depending on the case, finding the best solution possible for each customer’ s financial situation. The bank works with both business and personal cardholders. Chase Chase cardholders ( including businesses and individuals) who have been hit by COVID-19 can now delay their card payments. Auto loan and mortgage owners can do the same simply by logging into their Chase accounts and deferring the required payment from there. However, if that option is unavailable, only customer service can resolve that issue. Citi As a part of Citi’ s relief program, holders of City credit/debit cards can be eligible for temporal forbearance of collections. The bank pauses all collection actions against the customer, provided that they fall behind their payments. Also, late fees may be waived and minimum fees may be deferred for two months ( depending on the bank’ s resolution). Even during the waiver period, the bank continues reporting account information to credit bureaus. That is, if the account was delinquent before that period began, the bank will continue reporting it as delinquent without regarding payments the account holder will make during that period. Discover Discover isn’ t so open about its relief programs; you won’ t find the related info either on Discover’ s website or on your account page. However, relief options are available along with the waving of some late fees, but eligibility depends on each case. Therefore, to find out if you can qualify for relief, you need to contact Discover’ s support. HSBC HSBC also has its own relief program for the victims of COVID-19. Besides the common solutions, such as reduced payments and late fee waivers, the bank also makes no changes to reporting the account status. Therefore, if the customer is enrolled in, say, a 90-day relief program, their monthly payment will be 50% less. However, the bank won’ t charge any additional interest or fees during the program. U.S. Bank As in the case with many other banks, U.S. Bank doesn’ t provide any related information about its relief program on its website but encourages customers to contact them directly to find out ( the bank has a dedicated COVID-19 emergency line for such issues). Besides telling you about eligibility criteria, the bank will advise if waiving late fees or deferring payments is a good option in your financial circumstances. Wells Fargo Finally, Wells Fargo also provides relief help on a case-by-case basis. Typically, its relief options suggest deferring payments, yet you still need to contact them personally to find out if you are eligible. If you were enrolled in the program before and received payment deferral, you may count on other perks, such as credit card annual fee delay or late fee waivers. Bottom Line Most credit card issuers have relief programs helping to overcome the post-pandemic recession. Also, we see that most of them encourage customers to contact them directly to learn about relief programs. So, if you plan to contact your bank, think about the type of relief that applies to you. For example, if you can pay your balance at least partially, but it’ s less than the regular monthly sum, it would be wise to ask for a reduction. But if you can’ t pay at all, then temporary deferment is a more appropriate option. If your past credit history is really something that you can be proud of, don’ t forget to point out that fact when asking for an interest rate reduction, payment deferment, or fee waivers. If in the past you have always paid on time, the bank will be more willing to help you. Besides deferrals and fee waivers, there are more plausible account change options for your benefit. For example, you may ask to switch a high-interest credit card ( if you have one) to one with no annual fees. Or, if the sum is still affordable but you need more time to reimburse it, you may ask for a due date postponement. Whenever you ask for changes to your credit card account and they are approved, you should always have them documented. Therefore, you will have written proof of your agreement with the bank. In this case, you will have no problem applying for a new credit relief program after the current one runs out.
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US EIA sees summer fuel prices at eight-year high, but relief may be on the horizon | Center-South Brazil's crop officially started on April 1, and although more than 70% of the expected...
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Oil price outlook falls to $ 97.96/b WTI, $ 103.37/b Brent
US drivers will see fuel prices this summer at their highest levels in eight years, but recent federal actions to quell crude supply disruption concerns as Russia continues its invasion of Ukraine are expected to help put downward pressure on oil prices, the US Energy Information Administration said April 12.
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In its summer fuels outlook released alongside the April Short-Term Energy Outlook, the EIA forecast retail gasoline prices over the summer driving season from April through September to average $ 3.84/gal and retail diesel prices to average $ 4.57/gal, the highest inflation-adjusted prices for the summer since 2014.
The agency attributed the high prices to economic recovery from the pandemic and increased levels of geopolitical risk that have boosted oil market prices and volatility.
Despite higher prices, the EIA expects both gasoline and diesel consumption to increase this summer, with diesel nearly equaling its pre-pandemic demand level at almost 3.9 million b/d. The EIA put gasoline consumption at 9.2 million b/d, up nearly 1% from last summer but still below the 9.5 million b/d level seen in 2019.
`` We expect refinery utilization to continue increasing and remain elevated through the summer as long as crack spreads remain high, which will contribute to gasoline inventories rising above the five-year average by June and to gradually falling prices, '' the EIA said.
But the extent to which US refiners can increase the production and export to Europe of distillates, which include diesel and heating oil, `` remains uncertain and is likely to affect US diesel prices, '' the agency said.
It also stressed a high level of uncertainty in its forecast as the production and availability of Russian crude oil remains a major wildcard, as do actions countries and companies could take in response to Russia's aggression.
While stronger economic growth typically leads to increased gasoline and diesel demand, high fuel costs could make consumers think twice before hitting the road and the potential for new COVID-19 variants and spikes in cases remains a factor to watch, the EIA said.
Weather-related disruptions at Kazakhstan's Caspian Pipeline Consortium terminal along Russia's Black Sea Coast and a fire following a Houthi missile attack at a Saudi Aramco oil storage and distribution facility added to volatility and supply risk already heightened by escalating sanctions against Russia and a US import ban on Russian energy products, the EIA said.
But the agency also noted actions that have helped offset these supply disruption risks, including announcements by the US and International Energy Agency to release a combined 240 million barrels of oil from strategic reserves over the next six months. Lockdowns in China following a surge in COVID-19 cases also added demand-side risks that put additional downward pressure on crude oil prices, the agency said.
`` We forecast that rising consumption, falling oil production in Russia, and the risk of supply outages amid low global inventory levels will support crude oil prices in the coming months, '' the agency said. `` However, we expect the release of strategic reserves by the US and the IEA will limit upward price pressures. ''
As such, the EIA lowered its 2022 oil price expectations. It now sees WTI in 2022 averaging $ 97.96/b, down $ 3.21/b from last month, and expects Brent in 2022 to average $ 103.37/b, down $ 1.85/b from the prior month.
For 2023, EIA expects WTI at $ 88.57/b, up $ 3.59/b from March, and sees Brent at $ 92.57/b, also up $ 3.59/b from the prior month.
The EIA lowered by 810,000 b/d to 99.80 million b/d its global oil demand estimate for 2022 and attributed the cut to downward revisions to global GDP growth made by Oxford Economics. The EIA's global demand forecast for 2023 was similarly lowered by 820,000 b/d to 101.73 million b/d, but would be a 1.9 million b/d rise over the prior year.
`` Lower expected oil production is primarily driven by reduced expectations of petroleum production in Russia, while lower expected consumption reflects reduced expectations of economic growth and associated fuels demand, as well as the impact of present COVID-19 responses in China, '' the EIA said.
The agency forecast oil output in Russia to fall by 1.7 million b/d from February 2022 to the end of 2023, but said that `` global oil production will nonetheless increase as a result of higher production elsewhere, mostly from the US and OPEC. ''
OPEC crude production is expected to average 28.59 million b/d in the second quarter of 2022, a cut of 460,000 b/d from the prior estimate, while EIA raised its forecast for Q3 2022 by 10,000 b/d to 29.10 million b/d.
The EIA nudged down its 2022 outlook for US oil production by 20,000 b/d to 12.01 million b/d. EIA's estimate for US oil production in 2023 also fell by 40,000 b/d to 12.99 million b/d but would still surpass the previous record for annual average output of 12.3 million b/d set in 2019.
That increased production `` will be sufficient to contribute to net global builds in total petroleum inventories in 2Q22, and we expect global inventory to continue to build on a quarterly basis through the end of 2023, '' the EIA said.
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Feature: Asian lockdowns prompt further uncertainty in container market | In this week's Market Movers Americas, presented by Jeff Mower: * US Gulf of Mexico offshore output...
Prolonged factory shutdowns following coronavirus pandemic outbreaks in China have stoked concerns of escalating port congestion and supply chain backlogs, sources said.
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Shanghai, among other regions in China, is under a lockdown with strict testing and checking protocols, resulting in disrupted trucking activity and strained port operations. While lockdown protocols have been largely lifted in Hong Kong and Shenzhen, inland transportation remains a challenge, sources said.
As of April 12, Platts cFlow trade analytics software showed 315 vessels waiting in the Shanghai/Ningbo region queue and 141 in the Hong Kong region.
`` The impact of the lockdowns will depend on which way the situation is going to go.... `` a shipper said, and speaking of the ports, adding, `` My biggest concern is even when they're open, we don't have enough truckers because they have to go through several tests, and face severe bottlenecks. ''
A logistics pricing manager said: `` We have already started receiving updates from liners... on delays and non-performance of shipment from these locations. Port closure would definitely worsen the situation. ''
He added that the cargo pileup will lead to a huge backlog, further distorting the supply-demand balance.
Meanwhile, some industry participants spotted a silver lining in the situation and expected the slowdown in trade to give carriers room for operational restructuring.
This sentiment has been echoed across the market in what appears to be familiar territory following the closure of the Yantian port complex in 2021 amid a coronavirus outbreak.
Despite the weaker demand picture and an increased number of void sailings as carriers sought to keep volume allocations as high as possible, delays in European ports were still present, with the same issues of slow movement of goods to the hinterlands a problem, potentially impacting the carriers ' and ports ' abilities to realign their operations to facilitate easier movement of goods.
`` Shutdowns in China could assist to give ports in Europe and Asia some breathing room.... `` an ocean carrier source said. `` Shipping lines could shuffle some capacity into other trades like North Atlantic, Indian Subcontinent or Middle East. ''
One effect of origin region shutdowns, and resulting sliding cargo volumes, has been a general easing in global freight rates.
The Platts Container Rate Index, a weighted average of S & P Global's key global assessments, was assessed April 11 at $ 6,149.65/FEU, after losing $ 1,126 from the start of the year.
On a more granular level, PCR13 -- North Asia-to-West Coast North America -- is down 17.9%, or $ 1,700/FEU, against the start of the year. This decline is slightly less than the fall of 18.4% registered during the year-ago period but constitutes a higher dollar value than the $ 900/FEU lost in 2021.
On the North Asia-to-North Continent routing, a more dramatic decline has taken place, and the PCR1 was down $ 3,900/FEU April 12 against the start of the year as demand for Asian goods in Europe had yet to return to pre-Lunar New Year levels.
Market sentiment holds bearish, and rates are expected to regain lost ground as China comes out of lockdown and backlogged volumes begin to mount.
On top of renewed pandemic lockdowns, rising crude oil prices and the consequent increase in bunker fuel costs point to a supported freight rate environment in the near term, sources said.
With the rising cost of bunker fuel impacting operational costs for container ships, some carriers are increasingly eyeing implementing emergency fuel surcharges to tackle the volatile cost of carrying freight. This has been met with some pessimism from the shippers who see the costs for shipping as already too high, so additional costs will likely not be welcomed in the market.
Platts Bunker Charge 1 -- North Asia-to-North Europe -- rose to $ 556.26/FEU from $ 299.72/FEU a year earlier, but this remained 22.7% lower than the peak of $ 719.85/FEU March 9.
This comes at a time where void sailings are on the increase for ex-Asia cargoes in response to waning demand into April.
`` Prices are coming off because demand is weak -- it is that simple, '' a European freight forwarder said. `` People don't want to get caught in the delays, so why pay up when you can wait, pay less and still get goods at the same time? ''
Despite blanked sailings, some in the market are slightly less optimistic about freight rates going forward and instead lay the blame firmly on the carrier side of the market.
`` Most carriers have reduced capacity allotment in India despite a slowdown in global trade amid the ongoing Russia-Ukraine war and China shutdowns, '' a freight forwarder based in India said. ``... There is no clear explanation, but they keep using capacity crunch as an excuse to quote high rates. ''
There are already talk of new GRIs coming in for May, another freight forwarder based in the subcontinent said.
`` It's really convenient for the carriers to state that there is a space issue then introduce big GRIs, '' the freight forwarder said. ``... Even contracted shippers aren't getting their full capacity. ''
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Interview: Mongolia eyes ramp-up of coking coal, copper exports to China in 2022: minister | Mongolia is ramping up its efforts to supply raw material such as coking coal and copper to China in 2022 after a lackluster trade in 2021, as it expands its mining sector and boosts its transport network, said Batnairamdal Otgonshar, Vice-Minister at Mongolia's Mining and Heavy Industry Ministry.
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Mongolia is a key metallurgical coal and copper concentrates suppliers to China, with most of the trade happening through trucks. Mongolian truck suppliers in 2021 faced severe logistics issues in hauling shipments from land ports to China due to the pandemic-led restrictions at border crossings.
Mongolia is looking to launch three railway lines this year, which will bring the country's mining sector to a whole new level, Otgonshar said in an interview with S & P Global Commodity Insights.
Railway shipments will be much convenient, cost-effective, and safer with less human contact amid COVID-19 border restrictions compared to trucks, once the rail networks come online, Otgonshar said.
Suppliers will use the new railway lines to ship coking coal and copper concentrates.
The Tavantolgoi-Gashuunsukhait railway line will come online in July, with 75% of the project complete so far, the minister said.
Meanwhile, construction on Zuunbayan-Khangi/Mandal railway lines started in March, and the country is aiming to start their operations later this year, Otgonshar said.
Transportation of Mongolia's Erdenet copper concentrate through China's Erenhot rail port was disrupted through December 2021 to January, due to China's zero-COVID control policy.
Mongolian government is watching the logistics issue closely, Otgonshar said.
Despite transportation challenges, Mongolia still managed to export 335,000 mt of copper concentrates to China in the first quarter of this year, already meeting 25.6% of its annual target, he said.
Mongolia would just focus on China market as transportation costs for other markets are very high, and China's market is big enough to absorb Mongolia's increasing production, the minister added.
Copper concentrate from the Oyu Tolgoi mine was sold to Japanese and Korean smelters previously as a trial, according to market sources.
Mongolia exported 1.2 million mt of copper concentrates to China in 2021, accounting for 5.1% of China's copper concentrate purchases, the minister said.
Mongolia is advancing its mining industry capabilities and the country has the potential to become the world's fifth-largest copper player by 2030, Otgonshar said.
This is expected to happen following a major ramp-up of the Oyu Tolgoi mine, as full production is expected to reach in the next few years, Otgonshar added.
Oyu Tolgoi, in the South Gobi region of Mongolia, is one of the largest known copper and gold deposits in the world and it is expected to be the world's fourth largest copper mine.
Mongolia has developed skills in running mines over the past 30 years and now it is time to move to the next level, going to more value-added processing, Otgonshar said.
The government is planning to build up a copper smelter in Erdenet mine by 2025-2026 while another copper smelter at the Oyu Tolgoi mine is also under discussion, the minister said.
Overcoming past hurdles, the Mongolian government reached an agreement with Rio Tinto and Oyu Tolgoi in January to commence underground mining operation.
As the government and Rio Tinto has resolved binding constraints, they can focus on production, processing concentrates, and produce more value-added products, Otgonshar said.
Oyu Tolgoi is expected to produce around 500,000 mt of copper per year on an average from 2028 to 2036 from the open pit and underground operations, according to Rio Tinto. An average of around 350,000 mt of copper is expected to be produced from the operations for further five years. The mine produced 163,000 mt in 2021.
China's coking coal supplies were strained last year at a time of huge demand as Mongolian supplies struggled due to border restrictions.
Meanwhile, shipments from Australia — China's traditional coal supplier — remained largely absent in 2021 due to an unofficial ban, sparking volatility in coking coal prices for most part of the year.
Platts assessed premium low-vol hard coking coal CFR China more than doubled to $ 615/mt in October 2021 from January 2021 level, according to S & P Global Commodity Insights data.
Given the price increase in coking coal, it shows more demand for the product in China, Otgonshar said.
Mongolia is aiming to make a big comeback in China's coking coal markets in 2022.
There was enough demand for Mongolia's coking coal from China and many buyers showed increasing interests to buy more coking coal and thermal coal, even though the border challenge issues remained, Otgonshar said.
Mongolia is ready to export as much as they could to meet the demand in China, and hopefully the border issues will improve over the time, the minister added.
Transportation of Mongolian coking coal to China slowed down significantly from more than 2,000 trucks per day in 2020 to current 200-300 trucks per day.
Mongolia is looking to export 36.7 million mt of coking coal to China this year, Otgonshar said.
If realized, Mongolian shipments in 2022 would post a 161% jump from 2021 level. The country exported 14.04 million mt of coking coal to China in 2021, accounting for a quarter of China's total imports.
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Uniper: Sustainability Report 2021 | Sustainability Report 2021
Sustainability highlights in 2021
TCFD
Uniper published its first Task Force on Climate-related Financial Disclosures ( TCFD) Report.
-35%
Uniper has set a new group-wide target; to reduce indirect carbon emissions ( Scope 3) by 35% by 2035 compared to 2021 as the base year.
5
Uniper conducted five major voluntary initiatives that enhance biodiversity in 2021.
DEI
Uniper adopted a Company-wide diversity, equity, and inclusion ( DEI) strategy.
Top 10%
Uniper is among Sweden's top 10% of employers in terms of working conditions.
Health Award
Uniper won the Corporate Health Award from EUPD Research.
89%
A new compliance eLearning module on the basic principles of the Uniper Code of Conduct was successfully introduced to Uniper Group employees. At year-end, the completion rate was at 89%.
6
In 2021, we conducted six formal dialogues with critical stakeholders.
35
We were working on 35 projects whose main aim includes decarbonization at year-end 2021.
2
Diversified generation portfolio
Net capacity by fuel type ( GW) 1
17.0 Natural gas2
Net electricity generation volumes by technology ( TWh)
Hard coal3 18.1
Nuclear 12.9
58.9 Natural gas
Lignite 6.2
Hydro 13.0
1 Net capacity as of December 31, 2021 ( accounting view), note: deviations may occur due to rounding.
2 Including approx. 2.7 GW capacity ( thereof coal: 0.9 GW, gas: 0.6 GW, other: 1.2 GW) foreseen for final closure, that is currently under German grid reserve schemes due to system relevance.
3 FY 2021 hard coal volumes include 1.2 TWh co-feed biomass.
3
Foreword
GRI 102-14 Sustainability is high on our agenda. It lies at the core of Uniper's strategy and purpose - Empower Energy Evolution. I am proud of what we have already achieved on our chosen path towards decarbonization and sustainability.
Looking ahead, in light of the impacts of the dreadful Russia-Ukraine war, Uniper bears a special responsibility to diversify and secure the European energy supply. We operate critical infrastructure and sup-ply energy to large parts of the German industry and many people in Germany and across Europe. It is of utmost importance to maintain the existing energy flows, and at the same time find ways and means to make the gas supply for Germany and Europe more diverse and thus less vulnerable to geopolitical risks. This report highlights how we manage the challenges of securing and diversifying our energy sup-ply, while remaining fully committed to achieving our climate targets.
Uniper is serious about global warming. Not only are we well ahead of our initial plan to phase out coal-fired generation in Europe to meet our 2035 climate neutrality target for the European Generation segment, we 've also set ourselves a new goal. In December 2021, we and Fortum announced a Scope 3 emissions reduction target: to reduce indirect emissions by 35% by 2035, compared to the base year 2021. This report presents the steps Uniper is taking to reach our climate targets and enable the energy transition; from exciting developments in our hydrogen and renewable energy businesses, to successful feasibility studies on carbon-free fuel for our gas turbines.
I am proud that we have also increased our ambitions in other sus-tainability topics, such as just transition. As we close our coal-fired power plants, we are committed to ensuring a fair transition for the employees that work on-site and for our value chain. In the area of diversity, equity, and inclusion ( DEI), we adopted a new Company-wide strategy. Our vision is to embrace DEI in everything that we do. We want to empower all employees to seize their full potential - it's only then that Uniper can reach its full potential.
Our employees are our most valuable asset. As the Covid-19 pan-demic continued in 2021, I am pleased that we could support the employees with our extensive health and well-being program. In addition to offering our German employees Covid-19 vaccinations, we could further support our employees working from home by providing ergonomic office equipment. We are paving the way for a hybrid working environment with the NewNormal working style which provides maximum flexibility for employees.
The 2021 Sustainability Report highlights Uniper's successes - but also shows that we still have many important steps to take to achieve our targets, some of which were not met in 2021. Our cli-mate targets for 2030, 2035, and 2050 are ambitious. Despite exten-sive emissions reductions since 2015, we still have quite some challenges ahead to decarbonize while tackling the growing chal-lenges of ensuring a secure energy supply going forward.
I am confident that we are on the right path and I look forward to further delivering on Uniper's commitment to Empower Energy Evolution.
David Bryson
Chief Operating Officer and Chief Sustainability Officer
Sustainability 2021
E Overview
5
E Planet
15
E People & Society
39
E Responsible Governance 62
E Appendix
84
E Sustainability highlights in 2021
E Foreword
E About this report
E Our material topics and sustainability strategy
E How Uniper contributes to the SDGs
E Ratings and rankings
E
Climate change and greenhouse gas emissions
E Emissions to air, land, and water
E Energy efficiency
E Water use and optimization
E Circular economy and waste management
E Biodiversity
E Environmental management
E Secure and affordable energy supply
E Human rights
E Just transition
E Health, safety, and well-being
E Fair and attractive employer
E Diversity, equity, and inclusion
E
Corporate citizenship
E Corporate Governance
E Business ethics and compliance
E Stakeholder engagement
E Innovation and digitalization
E Customer rights and satisfaction
E Key Figures
E Disclaimer
E Publication details
E Contact us
Uniper
Sustainability Report 2021
5
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Uniper SE published this content on 12 April 2022 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 12 April 2022 09:50:10 UTC. | business |
European stocks fall as healthcare and banking sectors suffer losses | * Deutsche Bank slumps after stake sale
* Leonardo up on Deutsche upgrade
* U.S. consumer prices accelerate in March
April 12 ( Reuters) - European shares fell on Tuesday as Deutsche Bank and Commerzbank slumped after a big stake sale, while a U.S. reading on inflation kept aggressive Federal Reserve tightening bets from ramping up.
The pan-European STOXX 600 index fell 0.3%, paring some losses from earlier in the day, with healthcare stocks leading losses, and banks among the worst hit.
Deutsche Bank and Commerzbank fell 9.4% and 8.5%, respectively, after an undisclosed investor sold stakes of more than 5% in Germany's top lenders.
The appetite for shares firmed slightly from earlier in the day after U.S. data showed consumer prices in the world's largest economy rose largely in line with estimates, pushing U.S. Treasury yields lower.
After a strong rebound from March lows, the STOXX 600 has been stuck in a range on worries about the fallout of the Ukraine war, aggressive rate hikes by the Federal Reserve to tame inflation and rising coronavirus cases in China.
`` That sinking feeling hit European shares amid concerns that inflationary pressures are still mounting and growing evidence that consumer confidence is suffering amid the cost of living squeeze, '' said Susannah Streeter, senior investment and markets analyst at Hargreaves Lansdown.
`` The increasingly entrenched Ukraine conflict has already sent commodity prices soaring... The sanctions screw expected to be turned tighter on Russia, and the European Union is thought to be inching closer towards agreeing a Russian oil embargo, '' she said, adding that the associated supply fears were pushing up crude prices.
Oil & gas stocks gained 1.3% as crude prices rose after falling below $ 100 a barrel in the previous session.
U.S. quarterly earnings season is set to begin this week with Wall Street banks. In Europe, the reporting season will kick into high gear later this month, with analysts ' predicting a 19.9% rise in profit for STOXX 600 companies, as per Refinitiv data.
Italian defense group Leonardo rose 2.7% as Deutsche Bank upgraded the stock to `` buy '' on expectations of higher defense spending in the company's main markets.
Nokia slipped 1.4% after Pekka Lundmark, chief executive officer of the telecoms equipment maker, told Reuters the firm is pulling out of the Russian market.
German investor sentiment fell by less than expected in April, a survey showed, as a decline in inflation expectations gave some cause for hope about the outlook for Europe's largest economy.
( Reporting by Sruthi Shankar and Anisha Sircar in Bengaluru; Editing by Arun Koyyur and Mike Harrison) | business |
Monument Group partner Bart Molly: “ 2022 – a promising but volatile year ahead ” | Private equity fundraising rebounded to record levels last year with the industry hauling in a mammoth $ 940bn, despite fears over the appetite of LPs to commit to more risk-on assets like alternatives amid the fallout from the Covid-19 crisis. Huge fundraises such as Hellman & Friedman’ s $ 24.4bn Fund X, KKR’ s $ 15bn fourth Asia fund and | business |
REFINERY NEWS ROUNDUP: German plants face challenge to replace Russian crude | In this week's highlights: Oil markets to focus on monthly reports from OPEC and the International...
German refiners are facing a 'major challenge ' to replace imports of Russian crude by the year end...
As the flow of coal from Russia to Europe trickles down to a stop, the immediate concern is...
German refiners are facing a 'major challenge ' to replace imports of Russian crude by the year end after Europe's biggest economy and world's second largest buyer of Russian oil revealed plans to phase out almost all Russian supplies by the end of this year.
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Speaking March 25, Germany's economy minister Robert Habeck said Russian oil imports to Germany will be halved by mid-year and almost phased out by the end of this year as part of efforts to cut Germany's reliance on Russian energy due to Moscow's invasion of Ukraine.
`` Our members have already stopped signing new contracts for Russian crude oil imports. However, ongoing contractual obligations, which often run until the end of the year, must be met, '' a spokesperson for the Berlin-based German Fuels & Energy Association ( en2x) said in a statement.
No further details on how the phase-out of Germany's Russian oil imports will be achieved have been provided by the economy and climate ministry, a spokesperson said.
`` A large-scale exit from Russian oil by the end of the year is a major challenge. Together with our mineral oil companies and the ministry, we are intensively examining the fastest possible replacement of Russian oil with other imports. This also means considerable demands on logistics, both for global product flows and for Germany. ''
The economy ministry said alternative oil supplies will need to come from its Rostock port on the Baltic Sea or Poland's Gdansk port in addition to being supplied from the west by truck and railway.
Germany, Europe's biggest refiner and most exposed to Russian crude imports, buys Russia's Urals crude via the northern branch of Druzhba, or `` Friendship '', pipeline system which moves around 1 million b/d of crude from Russian fields to central Europe. PCK refinery at Schwedt and TotalEnergies ' Leuna refinery are both supplied via Druzhba, although they could also get alternative supplies via the Baltic Sea ports.
Meanwhile, Polish Prime Minister Mateusz Morawiecki said March 30 the country planned to stop using Russian oil and gas by the end of this year and called on the European Commission to introduce a tax on Russian hydrocarbons.
`` We have prepared ourselves and that is why we are presenting the most radical plan to abandon [ Russian ] hydrocarbons in Europe, '' he said.
In terms of oil, Poland's largest refiner PKN Orlen sources about 50% of the crude feedstock for its Plock refinery under contracts with Russian suppliers.
The company has been diversifying away from Russian oil, buying non-Russian oil on the spot market as well as signing a supply deal with Saudi Aramco. As recently as 2013, Russian crude covered 95% of Plock's needs.
Slovakia will be able to meet its crude oil needs through increased use of the Adria pipeline if Russian supplies through the Druzhba ( Friendship) pipeline are cut, the Slovak economy ministry said in a statement March 31.
`` In the case that Russian supplies are cut, Minister of Economy, Richard Sulik, has a written promise from the Slovnaft company that the necessary oil will be delivered using the Adria pipeline, '' the economy ministry said in the statement.
Slovnaft, which is 100% owned by Hungarian-based oil giant MOL, is Slovakia's sole oil refining company. Most of Slovakia's and Slovnaft's crude oil supplies are shipped from Russia by the southern arm of the Druzhba pipeline, which runs through Belarus and Ukraine and continues after Slovakia to the Czech Republic.
Separately, the JANAF pipeline could halt crude supplies to Serbia's Pancevo refinery from May 15 for an unidentified period, it said on its website. The pipeline, which moves seaborne crude from the Croatian terminal of Omisalj, said it was acting following the EU decision from March 15 for restrictive measures with regards to Russia after its invasion of Ukraine.
The refinery has a contract for receiving up to 3.2 million mt of crude via the pipeline this year. It is majority owned by Gazprom Neft. The JANAF-Adria pipeline can supply crude to refineries in six countries in Southeast and Central Europe.
In other news, Italian demand for refined oil products in February rose 12.6% to 4.3 million mt from the same month last year, data from industry group Unione Energie per la Mobilita showed. Gasoline and diesel demand gained 9.9% and 17.9% respectively, of which 539,000 mt was made up of gasoline and 1.9 million mt of diesel, while jet fuel demand jumped 129.5% to 179,500 mt.
Italy's demand for refined oil products rose 11.3% year on year to 8.6 million mt in the first two months of 2022.
* * The restart of France's Donges refinery has paused due to a strike, according to local media reports. France's Donges refinery commenced a restart March 16 which was due to continue for around two weeks, the refinery has said. The planned restart follows maintenance work on 60% of the refinery units between November 2021 and February 2022. During the maintenance work Donges was also building a new desulfurization unit. TotalEnergies halted operations at Donges on Nov. 30, 2020, due to weak margins. Meanwhile, a new railway to bypass the Donges plant, meaning other rail traffic will not have to pass through the site, is set to start operations in October. Work on the railway, which has been a condition for modernizing the refinery, started in 2020. The French government, local authorities, railway operator SNCF and TotalEnergies signed a memorandum of intent in 2016 to build the railway bypassing the refinery. TotalEnergies has said previously that, following the bypass agreement, it would proceed with the planned upgrade. The bypass was due to be ready in 2022.
* * The gasoline units of the Milazzo refinery have been fully restarted after the plant was forced offline following an incident March 28, according to information provided by a source close to the refinery at the start of April. It's not clear when the rest of the refinery will be fully operational, though the other units are currently in the process of being restarted, the source said. The incident was caused by a drop in the electricity supply which triggered a security mechanism as well as a large flame in one of its furnaces. The refinery was forced to take some units offline.
* * Major maintenance at Austria's Schwechat will start April 20 and will last approximately seven weeks. According to local media report the works are expected to last until June 4. OMV has previously said that it was planning a turnaround at Schwechat in Q2. A major turnaround is due every six years. The maintenance this year affects only the fuels part of the refinery. Another turnaround on the petrochemical units at the site is planned for 2023, the company said.
* * Croatia's Rijeka refinery is in the process of restarting in late March after maintenance, according to market sources. The refinery, which started a planned temporary shutdown for a catalyst replacement at the end of October, is currently ramping up production. According to media reports, the maintenance work also involved modification of the hydrodesulfurization reactor at the hydrocracker.
* * Israel's Ashdod refinery is planning full maintenance, scheduled to begin in May, the company confirmed. Market sources had previously said it is planning maintenance between May and June.
* * Eni's Sannazzaro de Burgondi refinery will delay its maintenance cycle originally planned for May until after the summer. Last year the refinery carried out maintenance on the plant's slurry technology ( EST) unit, which was taken offline following a fire in 2016, as well as on the refinery's hydrocracking unit, the visbreaking plant and the gas depuration unit, among others. Eni's EST plant had originally been scheduled to restart in past years but has been kept offline so far amid the nationwide slump in demand due to the COVID-19 pandemic.
* * Romania's Petromidia and Vega refineries have successfully completed their turnaround, the company said April 4. The procedure for restarting the production units has been initiated. The units `` will gradually enter the technological flows and will reach capacities in about a week, '' the company said. The maintenance was planned to last between March 11-April 3. During the maintenance, Petromidia completed `` the rehabilitation of the Petroleum Diesel Hydrotreater ( HPM) unit, affected by last year's technical incident. The installation is currently being tested and will re-enter the operational stream in the next period. '' The refinery expects to increase its diesel output by around 10%. Petromidia aims to process 5.66 million mt of raw materials in 2022 and produce 1.2 million mt of gasoline and 2.7 million mt of diesel. The company has `` sufficient stocks of raw materials to restart and achieve optimal processing capabilities as soon as possible, '' it said, adding that Petromidia processes crude from Kazakhstan. It has previously said it is not expecting to be impacted by the outage of the CPC terminal on the Black Sea. The Vega facility, `` which operates with finished and semi-finished materials from Petromidia, '' had also carried out works and resumed operations.
* * A unit at France's Port Jerome-Gravenchon refinery will restart after works during the afternoon of April 7, the company said. The gradual restart commenced April 6 and could cause flaring for approximately one week, ExxonMobil, operator of the refinery, said on the Allo Industrie website. The refinery had been undergoing partial maintenance since Feb. 23, of the type that is carried out every six-to-seven years and involved the main parts of the refinery, such as the alkylation unit, FCC and a gofiner.
* * Spain's Bilbao refinery is restarting two more halted units as it concludes a major turnaround that started in mid February, it said April 11. The H3 hydrogen units, offline since March 1, and the P2 platforming unit, offline since March 3 were due back online April 11. Those follow the restart of the fluid catalytic cracker and desulfurization units April 8. During the halt, several large units were halted including the coker, VDU and fuel reduction units. The refinery halted its AK3 alkylation unit Feb. 17 and its vacuum unit V3 Feb. 18. It halted on March 3 the P2 platforming unit and N1 naphtha desulfurization unit. On March 1 it halted the G4 diesel desulfurization unit, H3 hydrogen production unit and cogeneration CG6 units. The larger crude distillation unit 2, VDU and coker were taken offline Feb. 15. The CDU was restarted April 4. The furnace of the conversion plant 3 restarted April 1 and the alkylation unit March 28.
* * Israel's Bazan is expected to complete works on its FCC units around mid-April, according to market sources. The company has said previously that it is currently carrying out maintenance of the FCC alongside maintenance at all the Carmel Olefin facilities which has been planned for the first quarter of 2022. Bazan previously said it had delayed scheduled maintenance of the FCC at Haifa from Q2 2021 to the first half of 2022 when there would also be maintenance at all the Carmel Olefin facilities.
* * Denmark's Crossbridge Energy Fredericia refinery restarted some units between April 8-10, with the process expected to cause flaring. On April 5 a fire broke out on a pipe carrying oil products, which resulted in halting the unit where it occurred. Meanwhile, its maintenance was completed at the beginning of April. The units which were part of the maintenance restarted April 2-3. The planned maintenance on some of the units commenced Feb. 26. The refinery was expected to run at reduced capacity during the shutdown. The refinery was renamed to Crossbridge Energy Fredericia after its acquisition by US-based Postlane Partners from Shell in January 2021.
* * Greece's Elefsis ( Elefsina) refinery, which started maintenance in early February, was expected back in early April, according to trading sources. The maintenance at Elefsina was brought forward by an incident at the end of January and was due to last until the end of March for half of the refinery and the flexicoker would be back a few weeks later.
* * The ISAB refinery in Sicily is currently running a series of maintenance and upgrade works on pumps, compressors, pipelines, jetties, desulfurization and conversion units, both at its north and south refinery plants. The maintenance had started earlier in March.
* * Norway's Mongstad will undergo planned maintenance in Q2, the company said. The works will start April 23 and last around six weeks. The refinery had previously postponed works that were planned for 2020.
* * ExxonMobil's Antwerp refinery is currently carrying out maintenance works, according to market sources. The works, whose extent has not been confirmed, are likely to last until the end of March.
* * Italy's Eni is considering converting its Livorno refinery into a biorefinery that will produce hydrogenated biofuel, according to local media reports.
Livorno can also produce biojet as well as lubricants. The plan has been discussed at a meeting with the authorities and labor unions organized by the ministry of economic development. The company however has asked for the sector to be supported by the government and a further discussion will follow.. Last year, the company unveiled plans to stop refining crude and suspend all related activities at the Livorno refinery by end 2022, according to information provided by labor unions.
* * Spain's A Coruna has started planned work on four conversion units, Repsol said March 11. The company will invest Eur10 million in the work, which started March 10 and is expected to last 33 days. During the work, Repsol will carry out work on the hydrotreatment unit that will boost biofuel output. The work will allow it to process vegetable oils alongside used cooking oil to produce 5,500 mt/year in 2022, with the volume rising to 10,500 mt/year by 2024. The remainder of the work, which will generally target sulfur reduction units, will aid the overall transformation of the refinery to produce more biofuels and other low-carbon fuels.
* * Poland's second largest refiner Grupa Lotos said that it will start the shutdown of refinery units for maintenance at its Gdansk refinery on March 9. The partial turnaround will shut down 50 of the refinery's 65 installations and is expected to last until April 16. The bulk of the maintenance will be carried out in March and individual units will be restarted in early April. The last stage of the project will involve the renovation of the hydrogen generation unit between April 17 and May 14. This is the second part of the planned overhaul, with the first stage taking place between February and May last year. Lotos said it estimates that `` the maximum throughput reduction attributable directly to the shutdown will be approximately 7% on an annual basis '' but that it is implementing `` operational measures '' to minimize this.
* * TotalEnergies ' Antwerp refinery is due to carry out maintenance this spring, according to traders. The works will most likely take place in April.
* * Turkey's Tupras reported an extensive maintenance schedule for 2022. For its Izmit refinery, periodic maintenance of the isomerization unit lasting five weeks was reported to be ongoing. Periodic maintenance of the vacuum and desulfurizer units were reported as planned for Q1, each lasting three weeks, with periodic maintenance of the crude oil and vacuum unit and the HYC unit both planned for the end of Q3 and both lasting six weeks. For its Izmir refinery, periodic maintenance of the vacuum unit and lubes complex were reported as ongoing during Q1, both lasting six weeks. The company said that in Q4 at Izmir it plans to revamp the crude unit, CCR & isomerization unit and desulfurizer -- all lasting nine weeks -- and the HYC unit, expected to last four weeks. Seasonal maintenance of the crude oil and vacuum unit at Tupras ' Batman plant was reported as ongoing for 13 weeks during Q1 with further work on the same unit planned for four weeks in Q4.
* * In the second half of 2022, Repsol will carry out a smaller turnaround at its Tarragona refinery, which will involve the isomax and hydrocracker units.
* * Greece's Hellenic Petroleum plans full turnaround at Thessaloniki in the second half of the year. The maintenance at Thessaloniki will last between six and eight weeks.
* * MOL will schedule the bulk of its 2022 maintenance activities in the first half of the year, including works at MOL Petrochemicals, as well as at the distillation and conversion units of its Danube and Slovnaft refineries.
* * OMV plans a general maintenance at the Burghausen refinery between June 22-Aug. 7. It has previously said the turnaround would be in Q3. The turnaround will include also the Borealis polyolefin production site. The last turnaround took place in 2014, followed by a partial shutdown of the refinery in May 2018. `` In order to continue to ensure safe, environmentally friendly operation and the efficiency of the plants, all plants will be shut down during the turnaround, cleaned and inspected, '' the company said. In addition, expansion work will be carried out to increase ethylene and propylene production. The turnaround will be used to expand and modernize the steam cracker and subsequently increase the capacities for ethylene and propylene production, S & P Global Platts has reported previously. The expansion is expected to facilitate increased annual ethylene and propylene production by around 50,000 mt/year.
* * Shell plans to end crude processing at the Wesseling site within the Rhineland refining complex in 2025 as the facilities are repurposed for non-fossil fuel feedstocks and renewable hydrogen production. Shell outlined plans for the facility to take a variety of new biogenic and waste feedstocks, underlining that no final investment decision had yet been taken, and crude processing would still take place at the adjoining Godorf site. The Wesseling portion of the Rhineland refinery accounts for half the overall refining capacity, or 8 million mt/year.
* * Lithuania's Orlen Lietuva plans to suspend operations for a major maintenance in May. The works will last from May 22 to June 14.
* * Shell Energy and Chemicals Park Rotterdam -- formerly known as the Pernis refinery -- which will undergo major maintenance between end January-end June, will ensure continuity of the plant's operations during the works so that while one installation is shut down, another will continue production, the company said. Therefore no total shutdown will be involved, and the refinery will stock `` enough product to ensure continuity of supply for the time an installation is down for maintenance. '' The maintenance aims to further improve the safety, reliability and efficiency of the refinery's installations as well as to carry out `` legally required inspections and repairs, '' the refinery also said.
* * Gunvor Group said that its Ingolstadt refinery in Germany will undertake projects focused on heating systems and exchangers `` to continue improving its energy efficiency and reduce its emissions. '' A planned turnaround in 2023 will allow additional reductions, by carrying out projects on the FCC.
* * Czech Unipetrol said that following the turnaround at its Litvinov plant in Q2'20 the refinery has prepared production for a new four-year cycle. Thus, the next turnaround is due in 2024.
* * Two months of maintenance at the Sarpom refinery in Trecate, Italy, originally scheduled for October 2019 have been pushed back. Details on which units at the refinery will be upgraded as part of the maintenance -- of the kind needed every 3-4 years -- had yet to emerge.
* * The Holborn refinery near Hamburg, northern Germany, plans its next turnaround in 2023. Its previous maintenance was in the autumn of 2018. The refinery carries out major works every five years.
* * Total's Feyzin is considering mothballing a visbreaker unit as demand for heavy fuel is gradually declining and the unit works on average no more than three days a month.
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Country registers 36 new COVID-19 cases, 24 recoveries | Azerbaijan registered 36 new COVID-19 cases in the past 24 hours, Operational Headquarters under the Cabinet of Ministers reported on April 12.
Some 24 patients have recovered and no patients have died in the reported period.
So far, 792,289 COVID-19 cases have been registered in the country. Some 782,375 patients have recovered, and 9,703 people have died. Currently, 211 people are under treatment in special hospitals.
Over the past day, 4,775 tests were conducted in Azerbaijan to reveal coronavirus cases.
In general, 6,750,860 tests have been conducted in Azerbaijan so far.
So far, some 13,558,968 COVID-19 vaccines have been provided to Azerbaijani citizens. In the past 24 hours, some 9,660 citizens have been vaccinated against COVID-19. | general |
A ambiguidade estratégica dos EUA sobre Taiwan tem de acabar by Abe Shinzō | TÓQUIO – A invasão da Ucrânia pela Rússia tem lembrado muita gente da relação tensa entre a China e Taiwan. Porém, embora existam três semelhanças entre a situação na Ucrânia e em Taiwan, há também diferenças significativas.
A primeira semelhança é uma lacuna de poder militar muito grande entre Taiwan e a China, como a que havia entre a Ucrânia e a Rússia. Além disso, essa lacuna vem crescendo a cada ano.
Em segundo lugar, nem Ucrânia nem Taiwan têm aliados militares formais. Ambos os países são forçados a enfrentar sozinhos ameaças ou ataques.
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Writing for PS since 2012 11 Commentaries
Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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Abe states that both US and Japan respect the claim of China that Taiwan is part of China, and yet he is advising US to declare that US will defend Taiwan. Where is the logic?
Greatest foreign policy mind around. Deterrence from strength. It's the only way to be sure. Take note Washington.
As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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| general |
Covid-19 cases trend up again in the US, driven by the growth of BA.2 |
Covid-19 case numbers have begun to edge up in the United States, and nearly all of them are caused by the Omicron subvariant BA.2.
According to the latest estimates from the US Centers for Disease Control and Prevention, BA.2 caused 86% of new Covid-19 cases nationwide last week.
In some ways, this feels like a familiar place. Cases are going up again. At least one major city is reinstating its mask mandate. Broadway shows have canceled some performances.
But there continue to be reasons for optimism.
Despite BA.2's near-complete takeover from two other circulating Omicron subvariants, BA.1 and BA 1.1, US hospitalizations are at record low levels, and they continue to drop. Deaths also continue to fall.
Read More
Even though those numbers tend to lag behind case counts, the US hasn't seen a steep increase in infections. Whether that's likely to happen is still an open question.
Even Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, doesn't know what BA.2 will do. As a nation, transmission has to get down to a level that's `` low enough that it doesn't disrupt our population or the economy, our daily economic, workplace and social lives, which means it has to be low enough that it isn't a serious threat to the health of the nation, '' he says. He doesn't know if we're out of the woods.
`` We are certainly seeing the beginning of a surge of new infections, '' Fauci said. `` It depends on how high we go up in the surge, and it depends on whether the surge is associated with an increase in severe disease.
`` I can't say where we are right now, because we're transitioning, '' he said.
Cases rising regionally
Across the nation, Covid-19 cases have ticked up 24% from where they were two weeks ago, and the US is now averaging about 38,000 cases a day. This is a jump from last week, probably because Florida recently reported a two-week backlog. Even so, it's one of the lowest daily rates since July.
State by state, however, the picture is more mixed. Cases are rising in 25 states, falling in 16 and holding steady in nine others.
Cases are rising fastest in the Northeast, the region of the US that has the most BA.2 transmission.
On Monday, Philadelphia became the first major US city to announce a
return to indoor mask requirements
. Cases have climbed 50% there over the past 10 days, pushing the city over the threshold that triggers the mask mandates.
`` I suspect that this wave will be smaller than the one we saw in January, '' Dr. Cheryl Bettigole, Philadelphia's public health commissioner, said Monday.
`` But if we wait to find out and to put our masks back on, we 'll have lost our chance to stop the wave. ''
Several universities, including Johns Hopkins, American, George Washington and Georgetown, have also reinstated indoor masking.
New York City had been reconsidering its mask requirements for preschoolers, but with cases rising in the city, Mayor Eric Adams recently said masks would be continue to be required for the youngest children, who had higher rates of hospitalizations during Omicron than in previous waves.
With fewer cases and less demand, many Covid-19 testing sites are shutting down
Beyond case counts, which may be a less reliable pandemic metric because testing numbers have dropped, coronavirus levels in wastewater are telling a largely reassuring story.
Wastewater monitoring is considered a reliable warning of what's on the way. US numbers are trending up slightly but are still at one of the lowest levels seen since July, according to Biobot Analytics, a company that analyzes wastewater samples from across the country.
Different countries, different stories
The situation with BA.2 here appears to be a departure from the one seen in the UK and Europe.
According to the variant-tracking website Covariants.org, the Netherlands was near the peak of its BA.2 wave when the subvariant reached 83% of infections there in the second week of March. Switzerland was also close to its BA.2 peak when the subvariant reached 80% of infections in mid-March. After falling for weeks, cases in the UK had doubled from a low point on February 25 and would soon reach the height of the BA.2 wave when the subvariant was causing 88% of cases there between March 7 and March 21.
The BA.2 experience in the US looks a lot more like what happened in South Africa. In the second and third weeks of February, when BA.2 was responsible for about 88% of transmission there, cases made a slight bump up but then continued to fall over the month of March.
`` I 've been cautiously optimistic about BA.2 because of the trends that it's not been as exponential a rise in cases, like we saw when Omicron first emerged, '' said Pavitra Roychoudhury, who studies the spread of infectious diseases at the University of Washington's School of Medicine.
She said the tidal wave of Omicron that hit the US over the winter has left a lot of immunity in its wake. We're also more vaccinated and boosted as a country than we 've ever been -- though health officials say we could do a lot better on boosters.
Some are heeding that warning. The pace of vaccination has roughly doubled over the past two weeks as more people seek out second boosters.
An average of about 502,000 vaccine doses have been administered each day over the past week, according to CDC data. That's up from about 219,000 doses a day on March 29, when the CDC and the US Food and Drug Administration authorized a second booster shot for people 50 and older, though the CDC isn't specifically counting second boosters.
`` That might be explaining our somewhat more optimistic outlook compared to places like the UK, where there was a significant surge and it was associated with BA.2, '' Roychoudhury said.
BA.2 in the UK
Overall during the pandemic, health officials have pointed to the UK as a harbinger of things to come in the US, but that kind of extrapolation may be getting harder to do as the populations develop different types and degrees of immunity.
After a wave of cases caused by Omicron's BA.1 subvariant that peaked in January and then fell, the UK saw a
second increase in cases
and hospitalizations with BA.2. That wave peaked in late March, and since then, cases have been on a steep decline.
Adam Kucharski, an epidemiologist at the London School of Hygiene & Tropical Medicine who tracks infectious disease outbreaks, believes that the BA.2 wave in the UK was at least partly due to the timing of its booster campaign.
The UK began offering booster shots, or third vaccine doses, in mid-September, just a few days before the US did. But more people got them: In the UK, 68% of people over the age of 12 who are eligible for a booster dose have gotten one; in the US, that number is just 45%, according to the CDC.
Many people in the UK who got a booster in September or October still had high antibody protection when Omicron arrived.
Antibodies are the first line of defense in an infection. They act quickly to contain the spread of a virus through the body. Antibodies are highest in the first few months after vaccination and decline over time. But even after they 've dropped off, the body retains its immune memory to vaccines and can gear up quickly to make more if it's infected.
Omicron was identified in late November, when many in the UK were still within the window of highest protection from their booster doses.
`` I think we were fortunate that the boosters, in the short term at least, provided quite a lot of protection, '' Kucharski said.
People who 'd had recent boosters had such good immunity that if even if they got infected with BA.1, they might not have known it because their symptoms were so mild. It was likely that they weren't contributing to transmission, Kucharski thinks, so boosters did a good job of holding down Omicron's rampant spread through the UK over the winter.
Fast-forward three months, however, and many people who 'd gotten boosters as recommended were six months past their shots. Studies show that antibody levels decline four or five months after the third dose, so their protection against infection was probably much lower just as BA.2 arrived on the scene.
And now, Kucharski says, with BA.2, even the boosted group began getting `` mild, mild symptoms or enough to detect that and test positive '' and be counted as a case.
As immunity waned, BA.2 crept in
Whether the US will see a fresh wave of cases from BA.2 will depend a lot on two things, Kucharski said: the current level of immunity in the population and our behavior.
About half of those who are eligible for a booster dose in the US have had one, and millions more were infected by Omicron, giving an estimated nearly 95% of Americans some degree of protection against the coronavirus, according to the CDC.
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But for those who have lost their immunity over time because protection from their original two-dose vaccinations have waned or because they were infected a year or more ago with an older variant, the virus might find a way to spread.
`` I think if BA.2
can find susceptibility, that will translate into growth in cases, '' Kucharski said.
But he stresses that a lot will depend on what Americans do right now.
`` I think the question is what happens in the meantime, if actually booster campaigns and other things line up, then that might offset [ the subvariant ]. But I think based on what we're seeing a lot of countries in Europe, if there's susceptibility, either because people haven't had a booster or they had it a while ago, then that can translate into growing epidemic, '' he said. | general |
New 3D printing technique: A game changer for medical testing devices ( w/video) | Apr 12, 2022
New 3D printing technique: A game changer for medical testing devices ( w/video)
( Nanowerk News) Microfluidic devices are compact testing tools made up of tiny channels carved on a chip, which allow biomedical researchers to test the properties of liquids, particles and cells at a microscale. They are crucial to drug development, diagnostic testing and medical research in areas such as cancer, diabetes and now COVID-19.
However, the production of these devices is very labor intensive, with minute channels and wells that often need to be manually etched or molded into a transparent resin chip for testing. While 3D printing has offered many advantages for biomedical device manufacturing, its techniques were previously not sensitive enough to build layers with the minute detail required for microfluidic devices. Until now.
Researchers at the USC Viterbi School of Engineering have now developed a highly specialized 3D printing technique that allows microfluidic channels to be fabricated on chips at a precise microscale not previously achieved.
The research, led by Daniel J. Epstein Department of Industrial and Systems Engineering Ph.D. graduate Yang Xu and Professor of Aerospace and Mechanical Engineering and Industrial and Systems Engineering Yong Chen, in collaboration with Professor of Chemical Engineering and Materials Science Noah Malmstadt and Professor Huachao Mao at Purdue University, was published in Nature Communications ( In-situ transfer vat photopolymerization for transparent microfluidic device fabrication).
An example of a microfluidic chip created by the research team. ( Image: Yang Xu)
The research team used a type of 3D printing technology known as vat photopolymerization, which harnesses light to control the conversion of liquid resin material into its solid end state.
“ After light projection, we can basically decide where to build the parts ( of the chip), and because we use light, the resolution can be rather high within a layer. However, the resolution is much worse between layers, which is a critical challenge in the building of microscale channels, ” Chen said.
“ This is the first time we’ ve been able to print something where the channel height is at the 10 micron level; and we can control it really accurately, to an error of plus or minus one micron. This is something that has never been done before, so this is a breakthrough in the 3D printing of small channels, ” he said.
Vat photopolymerization makes use of a vat filled with liquid photopolymer resin, out of which a printed item is constructed layer by layer. Ultraviolet light is then flashed onto the object, curing and hardening the resin at each layer level. As this happens, a build platform moves the printed item up or down so additional layers can be built onto it.
But when it comes to microfluidic devices, vat photopolymerization has some disadvantages in the creation of the tiny wells and channels that are required on the chip. The UV light source often penetrates deeply in the residual liquid resin, curing and solidifying material within the walls of the device’ s channels, which would clog the finished device.
“ When you project the light, ideally, you only want to cure one layer of the channel wall and leave the liquid resin inside the channel untouched; but it’ s hard to control the curing depth, as we are trying to target something that is only a 10 micron gap, ” Chen said.
He said that current commercial processes only allowed for the creation of a channel height at the 100 microns level with poor accuracy control, due to the fact that the light penetrates a cured layer too deeply, unless you are using an opaque resin that doesn’ t allow as much light penetration.
“ But with a microfluidic channel, typically you want to observe something under microscope, and if it’ s opaque, you can not see the material inside, so we need to use a transparent resin, ” Chen said.
In order to accurately create channels in clear resin at a microscale level suitable for microfluidic devices, the team developed a unique auxiliary platform that moves between the light source and the printed device, blocking the light from solidifying the liquid within the walls of a channel, so that the channel roof can then be added separately to the top of the device. The residual resin that remains in the channel would still be in a liquid state and can then be flushed out after the printing process to form the channel space.
The new research using the auxiliary platform is demonstrated in this video from the USC Viterbi research team.
Microfluidic devices have increasingly important applications in medical research, drug development and diagnostics.
“ There are so many applications for microfluidic channels. You can flow a blood sample through the channel, mixing it with other chemicals so you can, for example, detect whether you have COVID or high blood sugar levels, ” Chen said.
He said the new 3D printing platform, with its microscale channels, allowed for other applications, such as particle sorting. A particle sorter is a type of microfluidic chip that makes use of different sized chambers that can separate different sized particles. This could offer significant benefits to cancer detection and research.
“ Tumor cells are slightly bigger than normal cells, which are around 20 microns. Tumor cells could be over 100 microns, ” Chen said. “ Right now, we use biopsies to check for cancer cells; cutting organ or tissue from a patient to reveal a mix of healthy cells and tumor cells. Instead, we could use simple microfluidic devices to flow ( the sample) through channels with accurately printed heights to separate cells into different sizes so we don’ t allow those healthy cells to interfere with our detection. ”
Chen said the research team was now in the process of filing a patent application for the new 3D printing method, and is seeking collaboration to commercialize the fabrication technique for medical testing devices.
Source: University of Southern California
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Splunk: State of Security Research Details Essential Strategies for the Year Ahead | This year, security teams face more challenges - old and new - and grapple with high rates of burnout. Cloud complexity, supply chain attacks and additional obstacles are pushing security teams to the limits, and inspiring new responses. New research points to key strategies that will help organizations weather the complex challenges and attacks ahead.
Today, Splunk published The State of Security 2022, research conducted with the Enterprise Strategy Group. The global survey of more than 1,200 security leaders reveals that we're seeing not only an increase in detected attacks, but also a rise in breaches. Sixty-five percent of organizations report that they're facing more attacks, and 49% say they suffered a data breach in the past two years ( up from 39% a year ago).
Ransomware attacks are up, and more organizations are forced to pay up. Among respondents who fell victim to a successful ransomware attack, 66% paid the ransom, and only 33% restored from backup instead. Notably, among those who have not yet fallen victim, only 42% think that their organization is likely to pay off the attackers, suggesting that a significant percentage are overconfident.
Security teams struggle to keep up with an increasingly complex threat landscape, made worse by the two-year-old COVID-19 pandemic, the steep rise in remote work, and high-impact ransomware and supply chain attacks. Organizations are literally paying the price - $ 33.6 million is the average annual cost of cybercrime-induced downtimes in our survey group.
It's particularly concerning that security teams today are mired in reactive firefighting. Instead of focusing their efforts on preventing attacks before they happen, 59% of security teams say they have to devote significant time and resources for remediation. Close to a third of their time is spent responding to crises rather than preparing for supply chain, ransomware and other advanced attacks.
The top security challenges that keep teams in this reactive state include overwhelming tool complexity, hiring and retention challenges, and cloud complexity and lack of visibility. With too many tools, too few analysts and not enough time, security teams have experienced their own version of the Great Resignation: Nearly three-quarters report that colleagues have quit due to burnout, and 70% have considered quitting themselves.
Despite these troubling trends, organizations are taking stock of these challenges and adopting advanced technologies to improve resilience. Among the security leaders surveyed, the main responses include:
Some particular measures to highlight here include investing in analytics and automation, which will help security teams detect and respond to more incidents in less time, as well as allow them to shift attention from mind-numbing, easily automated tasks to higher-priority issues. We're already seeing organizations increase investments in these areas, and we 'll also see security analytics play a bigger role in shaping security strategies and decisions.
Rising adoption of DevSecOps processes also is improving organizations ' security postures, and we expect to see increased reliance on the SBOM, or a software bill of materials, to itemize all the components of an organization's software to facilitate quick, thorough response to supply chain issues.
The task of defending our data and infrastructures against attacks never ends, but as strategies shift and organizations put more resources into security, we can hope to apply a few new tricks to stay ahead of our adversaries.
For more on the challenges that security organizations face, and the strategies they're relying on, read The State of Security 2022.
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Inequality Is a Business Risk by Philippe Heim & Bertrand Badré | Managing the fallout from recent global crises will require not just solidarity and collective action but also a stronger commitment to reducing inequality in all its forms. But governments can't do everything, while businesses – particularly banks and financial institutions – will need to do more.
PARIS – “ We live in a more shock-prone world, ” IMF Managing Director Kristalina Georgieva recently observed, “ and we need the strength of the collective to deal with shocks to come. ” She’ s right. In the space of just a few weeks, Russia’ s invasion of Ukraine has already shifted geopolitical lines, plunging the world into widespread uncertainty and opening new diplomatic rifts. Societies will need to redefine their choices to account for new global dynamics affecting fundamental issues such as food, energy, and digital security, and the organization of global trade.
While globalization may not end imminently, its acute vulnerabilities certainly have been exposed. Structural changes in how business is done are already materializing, as demonstrated by the complex reorganization of manufacturing infrastructure associated with near- and re-shoring. Companies and governments alike are assessing their dependencies.
In such a challenging environment, building collective resilience is of the utmost importance. But it will require solidarity and political cooperation at all levels: global, supranational ( particularly in Europe), national, and between businesses, public authorities, and civil society. Success will depend on our ability to achieve not just energy and food security but also equity and fairness in decision-making. After all, existing inequalities have continued to deepen, jeopardizing the capacity for collective action. We will need to put aside arguments about the pros and cons of globalization and start to work toward a more sustainable and inclusive economy.
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Writing for PS since 2019 2 Commentaries
Philippe Heim is CEO of La Banque Postale.
Writing for PS since 2014 22 Commentaries
Bertrand Badré, a former managing director of the World Bank, is CEO and Founder of Blue like an Orange Sustainable Capital and the author of Can Finance Save the World? ( Berrett-Koehler, 2018).
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Actually businesses that are not aligned with society's values and expectations are putting all economic development and the most basic rooted bases of any democracies at risk. Here is an example of what is happening to the grandest scale, that should NOT be happening. This Example is one of the absolutely mis-aligned up and coming businesses based on an ultimate example of exploitation of actually everyone in any society in 2022: https: //www.technologyreview.com/2022/04/06/1048981/worldcoin-cryptocurrency-biometrics-web3/? Finance is definitely NOT saving the world in 2022 nor the near future.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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Johnson and Sunak are 'guilty men ' and should resign, says Keir Starmer – video | The Labour leader, Keir Starmer, has said Boris Johnson and Rishi Sunak 'have to go ', calling them 'guilty men ' after the two were given fixed-penalty notices over parties held in Downing Street when government rules forbade gatherings during the Covid lockdown.
The prime minister paid the penalty issued by the Metropolitan police. Amid calls for him to resign, Johnson said this experience had made him more determined to level up across the UK
Source: Reuters
Tue 12 Apr 2022 19.30 BST Last modified on Tue 12 Apr 2022 22.30 BST | general |
US Strategic Ambiguity Over Taiwan Must End by Abe Shinzō | For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
TOKYO – Russia’ s invasion of Ukraine has reminded many people of the fraught relationship between China and Taiwan. But while there are three similarities between the situation in Ukraine and Taiwan, there are also significant differences.
The first similarity is that there is a very large military power gap between Taiwan and China, just as there was between Ukraine and Russia. Moreover, that gap is growing larger every year.
Second, neither Ukraine nor Taiwan has formal military allies. Both countries are forced to confront threats or attacks alone.
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Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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The Incredible Bouncing Ruble by Sergei Guriev | The Russian ruble's return to its pre-war exchange rate should not be mistaken as a sign of strength or resilience. Rather, the currency has benefited from factors that will eventually become major drags on both the federal budget and the real economy.
PARIS – After plummeting in value following Russia’ s invasion of Ukraine, the ruble has clawed its way back to its pre-war levels. But this should be of little comfort to the Kremlin, because the factors that drove the ruble’ s rebound augur additional problems for Russia’ s economic performance.
The West has exhibited near-unprecedented unity and resolve in its response to Russian President Vladimir Putin’ s war on Ukraine. Within just three days of the invasion, Western governments had frozen much of the Russian central bank’ s foreign-currency reserves within their respective jurisdictions.
This move triggered financial panic within Russia – and spurred a powerful policy response. On February 28, the central bank imposed strict capital controls, tightened currency-trading restrictions, and hiked its key policy rate from 9.5% to 20%.
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For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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Asia markets: U.S. inflation report; China trade data | SINGAPORE — Shares in Asia-Pacific were mixed on Wednesday as investors watched for market reaction to the release of Chinese trade data. New Zealand also hiked its rate by 50 basis points, its biggest increase in more than 20 years.
Mainland China's Shanghai composite slipped 0.82%, closing at 3,186.82 while the Shenzhen component dropped 1.601% to 11,568.17. Hong Kong's Hang Seng index rose about 0.1%, as of its final hour of trading.
Data released Wednesday showed Chinese exports rising more than expected in March. China's dollar-denominated exports grew 14.7% year-on-year in March, according to official customs data. That was above expectations for a 13% increase in a Reuters poll.
Chinese imports, on the other hand, saw a 0.1% year-on-year decrease in March. That was much lower than the 8% growth predicted in a Reuters poll.
Investors were also watching concerns around the mainland's Covid situation.
Elsewhere, the Nikkei 225 in Japan jumped 1.93% on the day to 26,843.49 while the Topix index advanced 1.42% to 1,890.06.
South Korea's Kospi rose 1.86%, closing at 2,716.49 while the S & P/ASX 200 in Australia edged 0.34% higher to finish the trading day at 7,479.
MSCI's broadest index of Asia-Pacific stocks outside Japan gained around 0.6%.
The Reserve Bank of New Zealand on Wednesday announced its decision to raise the official cash rate by 50 basis points to 1.5%. The move represented the RBNZ's fourth consecutive hike and its largest rate increase in more than 20 years, according to data from Factset.
`` The Committee agreed it is appropriate to continue to tighten monetary conditions at pace to best maintain price stability and support maximum sustainable employment, '' the central bank said in a release.
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Following the decision, the New Zealand dollar initially strengthened but later fell back, last trading at $ 0.6788 against an earlier high of $ 0.6901.
U.S. consumer prices rose 8.5% in March as compared with a year ago, the fastest annual gain since December 1981, according to official data released Tuesday. The consumer price index print was above the Dow Jones estimate for 8.4%.
The core consumer price index which excludes food and energy, however, showed signs it may be ebbing. It rose 0.3% for the month, lower than the 0.5% estimate.
The inflation report released Tuesday `` validates expectations '' for a 50 basis points rate hike by the U.S. Federal Reserve in May, Silvia Dall'Angelo, senior economist at Federated Hermes, wrote in a note.
`` US CPI inflation might have peaked this month, assuming there is no further escalation of the conflict in Ukraine and oil prices evolve in line with the future curve going forward. However, there are still considerable external and domestic price pressures in the pipeline, '' Dall'Angelo said.
The U.S. dollar index, which tracks the greenback against a basket of its peers, was at 100.502 as it continued to hold above the 100 level.
The Japanese yen traded at 126.18 per dollar, weaker than levels below 125.1 seen against the greenback earlier this week. The Australian dollar was at $ 0.7426 following an earlier high of $ 0.7475.
Oil prices were lower in the afternoon of Asia trading hours, with international benchmark Brent crude futures slipping 0.17% to $ 104.46 per barrel. U.S. crude futures declined 0.21% to $ 100.39 per barrel.
— CNBC's Jeff Cox contributed to this report. | business |
Wout van Aert could still ride Roubaix, just not for himself | Wout van Aert could still ride Paris-Roubaix on Sunday, but it would be “ impossible ” for him to ride for the win, Jumbo-Visma DS Merijn Zeeman has told Het Laatste Nieuws.
“ We want to make the decision on Thursday, but if Wout rides Roubaix, it will be to help a teammate. Winning himself seems impossible, ” Zeeman explained.
The Belgian champion has been training in Spain after being given the all-clear from team doctors to resume training. The team chose to send Van Aert to Spain to benefit from the warm weather and avoid the risk of further illness from training in bad weather.
“ Everyone has seen what the weather was like in Belgium last week. In order to be able to pick up training in a good way after his Covid infection, Wout left for the sun. Where that is, is irrelevant. It is true that he can train in sunny conditions, ” said Zeeman. “ After many examinations, he received the green light from the doctors to calmly resume training. We have decided not to do it in the rain and cold of Belgium, but in sunny conditions. ” | general |
Die versteckten Kohlenstoffsubventionen werden uns zerstören by Jayati Ghosh & Debamanyu Das | NEW DELHI – Der jüngste Bericht des Weltklimarats ( IPCC) sollte Politiker und Normalbürger weltweit in Angst und Schrecken versetzen. Der IPCC warnt, dass einige katastrophale Folgen des Klimawandelns nicht in ferner Zukunft, sondern vermutlich bereits innerhalb der nächsten 15 Jahre oder sogar des nächsten Jahrzehnts eintreten werden.
Doch statt sich die Bedrohung bewusst zu machen und rasch darauf zu reagieren, konzentrieren sich die Politiker weiterhin auf Russlands schrecklichen Krieg gegen die Ukraine und seine unmittelbaren Folgen. Während dies verständlich sein mag, hat die Ukraine-Krise zugleich die übermäßig kurzfristige Orientierung der westlichen Regierungen deutlich gemacht. Viele haben rasch selbst die relativ mageren und offensichtlich unzureichenden Klimazusagen gebrochen, die sie erst vor wenigen Monaten auf der UN-Klimakonferenz in Glasgow abgegeben hatten.
Die Invasion der Ukraine und die darauf folgenden, vom Westen ausgehenden Sanktionen gegenüber Russland haben einen dramatischen Anstieg der Brennstoffpreise ausgelöst, und das zu einem Zeitpunkt, an dem der Energiemarkt aufgrund der wirtschaftlichen Erholung in den USA und Europa bereits am Erhitzen war. Doch statt diesen Preisanstieg als Chance zu begreifen, den Wandel weg von fossilen Brennstoffen zu forcieren, versuchen die Regierungen in den hochentwickelten Volkswirtschaften aus kurzsichtigen innenpolitischen Gründen, die Schmerzen abzumildern, indem sie die nationalen Energiepreise niedrig halten.
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Jayati Ghosh, Professor of Economics at the University of Massachusetts Amherst, is a member of the UN Secretary-General’ s High-Level Advisory Board on Effective Multilateralism.
Writing for PS since 2022 1 Commentary
Debamanyu Das is a research scholar at the University of Massachusetts Amherst.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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Europe’ s Economy on a Knife Edge by Barry Eichengreen | Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
BERKELEY – Europe’ s economy is finely poised between recession and growth. The knife edge is sharp because European policymakers have exactly zero control over the outcome.
Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. Industrial production rose in January, and retail trade rebounded. Economic sentiment improved in the first half of February, surpassing pre-pandemic levels. But then the war dented consumer confidence by heightening uncertainty and raising energy and commodity prices. In mid-March, the European Commission’ s consumer confidence indicator fell to its lowest level since the start of the pandemic.
So far, however, the data show only a mild softening of demand and limited disruptions to supply. They signal nothing remotely resembling the collapse in activity that accompanied 2020-21 pandemic lockdowns. The OECD’ s weekly tracker of economic activity, which uses machine learning and Google Trends data to infer real-time changes, similarly points to only a mild slowdown. Box office receipts are stable. Restaurant receipts are stable. Data from the navigation service TomTom do not suggest much decline in mobility-related activity.
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Barry Eichengreen, Professor of Economics at the University of California, Berkeley, is a former senior policy adviser at the International Monetary Fund. He is the author of many books, including In Defense of Public Debt ( Oxford University Press, 2021).
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What provision in the international rules based system or American’ s domestic rule-of-law would allow the US government to allocate Russia’ s foreign reserves or escrow accounts to Ukraine for rebuilding?
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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Со стратегической двойственностью США в отношении Тайваня нужно покончить by Abe Shinzō | ТОКИО – Нападение России на Украину многим напомнило о напряжённых отношениях между Китаем и Тайванем. Но хотя есть три сходства в ситуации вокруг Украины и Тайваня, имеются также и значительные отличия.
Первое сходство – очень большая разница между Тайванем и Китаем в их военном потенциале, и такая же разница существовала между Украиной и Россией. Более того, с каждым годом этот отрыв становится всё больше.
Во-вторых, ни Украина, ни Тайвань не имеют официальных военных союзников. Обе страны вынуждены противостоять угрозам или атакам в одиночку.
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Abe Shinzō was Prime Minister of Japan from 2006-07 and 2012-20.
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As I was reading the article, I thought Abe Shinzo was going to come out in favor of the US saying it was not going to defend Taiwan. Seems to me that's the logical conclusion.
Alienating both Russia and China is a losing proposition for the U.S. We're going to have to pick one, an put up with things we don't like.
Interesting that Japan annexed Senkaku Islands ( Diaoyu Islands) during the first Sino-Japanese war. Even though Japan had to ultimately retreat from all the territories occupied by the Japanese Imperial army during WWII, the status of the islands were left hanging since China did not have a seat on the negotiation table. On the other hand, Russia's annexation of Crimea with more the less the same means is decried by Japan as a violation of Ukrainian sovereignty. If Ukraine one day becomes militarily more powerful than Russia, I am sure Japan will support any military activity to reclaim the territory. Japan, being a loser in WWII, nevertheless wants to reclaim the islands occupied by Russia. And while Taiwan has been Chinese territory since the 17th Century but was ceded to Japan during the first Sino-Japanese war, but unlike the Senkaku/Diaoyu Islands, was returned to China after WWII. When the Nationalist dictatorship lost the Chinese civil war and retreated to Taiwan, they claimed to be the legitimate government of China, and that Taiwan was part of Chinese territory. Now that Communist China has been recognised as the ruler of China, the Taiwanese government might try to claim that Taiwan is not Chinese territory after all. Therefore, there seems to be no rhyme or reason why any country should lay claim to a territory. Japan claims sovereignty over territories it annexed through its military adventures, while denying legitimacy to territories acquired through the same means by other countries. While it wants to reclaim territories lost during WWII to Russia, it also advocates separating Taiwan from China. Of course, it will use the usual rhetoric of `` Taiwan is a democracy, China is a dictatorship blah blah.... '', but it still hangs on to territories gained by force when Japan was a military dictatorship. If this is not double standard, I don't know what is.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
For 40 years, the United States has made a point of not saying whether it would defend Taiwan against a Chinese invasion, an approach that proved effective in deterring rash action by China and by pro-independence Taiwanese. But now that circumstances have changed, so, too, must America's strategy.
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New omicron XE variant detected in Japan as UK cases rise | Japan has reported its first case of omicron XE — a new Covid-19 strain first detected in the U.K. — just as British cases of the subvariant rise.
The XE variant was found in a woman in her 30s who arrived at Narita International Airport from the U.S. on March 26. The woman, whose nationality was not immediately disclosed, was asymptomatic, Japan's health ministry said Monday.
It comes as cases of the new strain have almost doubled in Britain, according to the latest statistics from the U.K. Health Security Agency.
As of April 5, 1,125 cases of XE had been identified in the U.K., up from 637 on March 25. The earliest confirmed case has a specimen date of Jan. 19 of this year, suggesting it could have been in circulation in the population for several months.
XE has since been detected in Thailand, India and Israel. It is suspected that the latter Israeli cases may have developed independently. The U.S. has not yet reported any XE cases.
XE is what's known as a `` recombinant, '' a type of variant that can occur when an individual becomes infected with two or more variants at the same time, resulting in a mixing of their genetic material within a patient's body.
In the case of XE, it contains a mix of the previously highly infectious omicron BA.1 strain, which emerged in late 2021, and the newer `` stealth '' BA.2 variant, currently the U.K.'s dominant variant.
Such recombinants are not uncommon, having occurred several times during the course of the coronavirus pandemic. However, health experts say it is too soon to draw conclusions on the new subvariant's severity or ability to evade vaccines.
`` We continue to monitor cases of the recombinant XE variant in the U.K., which currently represents a very small proportion of cases, '' Meera Chand, director of clinical and emerging infections at UKHSA, said in a statement.
On Sunday, the U.K. reported 41,469 new Covid cases, with a seven-day average of 59,578 cases. As such, XE likely accounts for only a small percentage of total Covid cases currently.
Early estimates suggest XE may be more transmissible than earlier strains, having so far demonstrated a slightly higher growth rate than its predecessor.
UKHSA data shows XE has a growth rate of 9.8% above that of BA.2, while the World Health Organization has so far put that figure at 10%.
However, experts say they expect it to wane in severity even as it spreads more easily. XE has so far not been declared a variant of concern.
`` XE seems to be moving in the same direction as BA.2, having an increased transmissibility to BA.1 but being less severe, '' Jennifer Horney, professor of epidemiology at the University of Delaware, told CNBC.
`` It is the devil we know, so to speak. [ It is ] essentially a reshuffling of the same deck of cards, '' added Mark Cameron, associate professor in the School of Medicine at Case Western Reserve University.
Read CNBC's latest global coverage of the Covid pandemic:
XE contains spike and structural proteins from the same virus family, i.e. omicron, meaning that it should, theoretically at least, behave as omicron has done before. Existing vaccines and immunity should, therefore, provide some level of protection against infection.
`` Recombinants that contain the spike and structural proteins from a single virus ( like XE or XF) are fairly likely to act similarly to [ their ] parental virus, '' Tom Peacock, virologist at Imperial College London's Department of Infectious Disease, wrote in a thread of tweets in mid-March. XF refers to another recombinant previously detected in the U.K. in February.
However, other recombinants containing spike and structural proteins from different virus families continue to emerge. That includes the XD subvariant, recently discovered in Germany, the Netherlands and Denmark, which contains delta structural proteins and omicron spike proteins and which Peacock described as `` a little more concerning. ''
As such, all new emergences need to be closely monitored, especially in their early phases, to ensure they don't evolve into something more serious.
`` The virus is still capable of evolving, recombining and developing a new branch of its family tree, '' Cameron said.
`` The key takeaway is that for each of these variants and subvariants, risk of hospitalization and death appears to be, on average, lower where vaccination rates are higher, indicating that vaccination, including a third dose, should be effective in reducing risk for severe disease, '' added Stephanie Silvera, professor of public health at Montclair State University. | business |
China inflation makes it harder for PBOC to cut interest rates US Fed | BEIJING — Persistent inflation in China narrows the window for when the People's Bank of China can cut interest rates and support growth, economists said.
Official measures of producer and consumer prices in China rose in March by more than analysts expected, according to data released Monday.
`` Rising food and energy price inflation limits the space for the PBoC to cut interest rates, despite the rapidly worsening economy, '' Nomura's chief China economist Ting Lu and a team said in a note Monday.
Lu referred to his team's report earlier this month that noted how China's 1-year benchmark deposit rate is only slightly above the rate of consumer price increases. That reduces the relative value of Chinese bank deposits.
On an international level, higher U.S. interest rates narrows the gap between the benchmark U.S. 10-year Treasury yield and its Chinese counterpart, reducing the relative attractiveness of Chinese bonds. Cutting rates in China would reduce that gap further.
The yield on China's 10-year government bond fell below that of the U.S. for the first time in 12 years on Monday, according to Reuters. Previously the Chinese bond yield tended to trade at a 100 to 200 basis point premium to the U.S.
`` We think April could be the last chance for China to have a rate cut in the near term before [ the ] Fed's potential balance sheet shrink, '' said Bruce Pang, head of macro and strategy research at China Renaissance.
Fed meeting minutes released last week showed how policymakers generally agreed to reduce the central bank's holdings of bonds, likely starting in May, at about double the rate prior to the pandemic. U.S. consumer price data is due out overnight.
`` Rising inflation, if [ it ] continues, could further limit China's room for policy maneuvers, '' Pang said.
He noted how Chinese investors increasingly expect the PBOC to act after high-level government comments this month.
China will adjust monetary policy `` when appropriate '' to support growth, Premier Li Keqiang said at a meeting last week of the State Council, the top executive body.
The producer price index rose by 8.3% in March, slower than the 8.8% increase in February and the lowest since April 2021, according to Wind data. Coal and petroleum products contributed some of the largest gains.
Within the consumer price index, the largest increase was in transportation fuel, up by 24.1% year-on-year in March. The global price of oil has surged since the Russia-Ukraine war began in late February.
China's consumer price index rose by 1.5% in March, up from 0.9% in February and the fastest since consumer prices rose by the same pace in December, Wind data showed. A sharp, 41.4% year-on-year decline in pork prices continued to drag down food inflation. Vegetable prices rose by 17.2%.
`` China's inflation dynamics implied a continued margin pressure on Chinese corporates, '' said Bruce Liu, Beijing-based CEO of Esoterica Capital, an asset manager.
`` March inflation was not the only force that brought down Chinese equity markets [ on Monday ], and the rising-real-yield-induced equity sell-off last Friday in the U.S. spilled over, '' Liu said. `` More Covid worries in multiple places outside Shanghai ( Guangzhou, Beijing, etc.) also weighed on market sentiment, and investors got their hands full at the moment. ''
The U.S. 10-year Treasury yield climbed to a three-year high Friday and rose further overnight on Monday to 2.793%, its highest since January 2019. China's 10-year government bond yield held around 2.8075% Tuesday, according to Wind Information.
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Citi analysts expect the PBOC could, as soon as this month, cut at least a policy rate or the reserve requirement ratio — a measure of how much cash banks need to have on hand. They said the prolonged omicron wave requires more monetary easing.
`` Inflation won't constrain monetary policy for now, in our view, '' the analysts said, `` but could become more a source of concern in H2. ''
They expect the producer price index to moderate due to last year's high base — for a 5.6% annual increase — while the consumer price index will likely rise slightly — rising 2.3% for the year— as food prices remain elevated.
— CNBC's Chris Hayes contributed to this report. | business |
In Shanghai, residential gates are locked and millions are running low on food | Mask on and cell phone in hand, I step outside before the volunteers in hazmat suits have time to knock. If you miss the call, they 'll keep knocking until someone answers. No one is exempt.
This massive city of 25 million people is at the center of China's efforts to stamp out the country's largest ever Covid outbreak. No one is allowed to leave their residential compounds, even to buy food, meaning we rely on the government or private delivery drivers stretched thin by the massive demand. That's creating huge pressure on the system -- and for many people, the restrictions are more distressing than the threat of the virus.
Outside my apartment, hazmat-suited community workers lead me and my neighbors in a socially distanced procession past our locked front gate, the only time I 'm allowed out of my apartment. But they never lead us out of the gate -- it's been sealed with padlocks and bicycle locks for more than three weeks.
As we walk to a table covered with a blue tent where medics are waiting to administer the test, I feel a surge of emotions -- relief at being allowed out into the fresh air and spring sunshine, and anxiety -- what if I test positive? I worry about being sent to Shanghai's spartan quarantine system for days or weeks. Images of the facilities suggest I could face cramped, unsanitary conditions with overflowing trashcans, no running water and dirty communal toilets.
But I 'm more uneasy about what may happen to Chairman, my rescue dog.
What happens to your pet if you test positive remains an unsettling gray area with no clear solution. Horror stories circulate online about pets being left behind and one was recently killed with a shovel by a person in a hazmat suit.
If I 'm taken to quarantine, I 'm hopeful one of the local vets or community groups might be allowed to take care of my dog. I 've packed a small bag of Chairman's essentials that sits by the door in case someone is able to take him in if I 'm sent away.
But that may be unlikely. Aside from essential workers, the entire city is like me, locked down and locked in.
Scrambling for extra food
In late March, before the city was ordered to stay home, panicked buyers left grocery store shelves empty.
Now, desperation has set in.
Videos show people screaming at community workers, pleading with them for food, saying they're starving. Others show crowds at a quarantine food distribution site fighting over a small delivery of vegetables.
In my community, the government delivers food once every few days. Deliveries range from a box of vegetables and eggs, to a vacuum-sealed piece of pork or some Traditional Chinese Medicine ( TCM). The handouts alone are not enough to feed one person, let alone an entire family, beyond a day or so.
I ration my food and make the most of what arrives in the box and any extra food my community has been able to source. Lately, most of my meals have been a combination of eggs and carrots -- you have to get creative.
Many communities have set up group chats with their neighbors on Chinese social media app WeChat. Occasionally there are offers for group food buys, but options are limited. Shops are shuttered, delivery drivers locked down, supply chains disrupted.
One of my neighbors writes in the chat group, `` What should I do if I have no food? '' The community liaison writes back, `` There is no group purchase -- vegetables are in short supply now. ''
I spend much of my lockdown days trying to place multiple grocery orders, hoping one will arrive. Last week, I was woken by a call just after midnight -- one of my orders had actually shown up.
I urgently tried to get a hold of our community liaison officers to help retrieve it, but after a long day's work they were asleep. So, I had to leave the groceries sitting in a box on the street outside the compound until 6 a.m., hoping that nothing was taken or spoiled by the time I could get it. Thankfully, it was still there in the morning.
Some of us have resorted to creating contact-less `` drop spots, '' where we swap food to vary our diets.
For example, after walking back home from a community Covid test, one of my neighbors sent me a message: She had left a block of cheese in the shaded spot above her bicycle. When I headed out to my Covid test later, I took her cheese and replaced it with two oranges. She then collected the fruit when she was allowed out for her next Covid test.
Authorities seem to be hearing the complaints. Over the weekend, Shanghai vice mayor Zong Ming choked up at a news conference, apologizing to the city's residents for failing to meet expectations. And on Monday, authorities promised to begin easing lockdowns in some areas.
Anger and an uncertain future
From Wuhan onward, I 've covered every aspect of this outbreak in China. The early mishandling and alleged cover-up of the initial spread seemed to have been forgotten by the public as the central government forged ahead with its `` zero-Covid '' policy.
For two years, China largely succeeded in keep the virus out, by closing borders and introducing a seemingly sophisticated contact tracing system that uses smartphone technology to track us and our potential exposure to the virus.
Officials have perfected mass testing with capabilities to quickly process cities of populations in the tens of millions. And they 've relied mostly on targeted, snap lockdowns -- closing down a neighborhood, office or even a shopping mall with a confirmed case or close contact inside -- trying to avoid shutting down entire cities so as to minimize social and economic damage.
In recent months, entire cities have gone into lockdown -- including Xi'an, Tianjin, and Shenzhen -- but nothing on the scale of Shanghai, where the adrenaline and communal spirit to contain the virus has been replaced by fatigue, frustration and despair.
From the confines of my 600-square foot apartment, I ask myself, is this really happening? In Shanghai, of all places?
A modern city of highrises and restaurants, Shanghai once rivaled cosmopolitan centers like Paris and New York. Now millions of residents are scrambling for basic necessities from the confines of their homes.
That's not to say life in Shanghai won't resume as it was, but the actions -- or inaction -- of the past several weeks, coupled with the constant uncertainty over the past two years about what harsh restrictions could suddenly surface in the name of Covid prevention, leaves many feeling increasingly disconnected to this city and each other.
On Monday, the US State Department ordered non-essential consular personnel and their families to leave the city, citing the surge in Covid-19 cases and the impact of restrictions imposed to contain it.
Most expats I know have either already left or are determined to get out. The reason? `` This is not sustainable '' is a common refrain.
Mentally. Emotionally. Physically. It's not. | business |
Covid-19'superspreading ' can still happen, but now we have the tools to slow it | Covid-19 superspreading, which involves the virus spreading at a single event on a larger scale than what is typically expected, is still possible and poses a risk. But in this stage of the pandemic, a large event may not necessarily be an invitation to widespread, unchecked illness -- if people use tools now available to limit risk, according to public health experts.
Now, there are more tools to curb the spread of Covid-19: authorized vaccinations that limit illnesses and infections, robust supplies of at-home tests that can indicate whether someone needs to isolate, face masks to wear in high-risk situations and therapeutics that can reduce severe disease.
`` We used to be concerned because these superspreading events would put a lot of people in the hospital and as a consequence, some in intensive care units, and even some people dying. This is less likely to happen now, '' said Dr. William Schaffner, a professor in the Division of Infectious Diseases at Vanderbilt University Medical Center. `` Given the level of natural immunity as well as vaccination in our communities, most people infected now are going to get mild illness that doesn't require them to be hospitalized. ''
Meanwhile, it's also more complicated to pin Covid-19 cases to specific events. Contact tracing has virtually disappeared, and people can encounter Covid-19 in any number of circumstances as workplaces, shops and restaurants reopen and masks come off.
But by using the right tools at the right times, there are hopes that Covid-19 superspreading could become a thing of the past.
'The pandemic isn't over '
Earlier in the Covid-19 pandemic, superspreading at business conferences, political events and even choir practice helped shape understanding of just how transmissible the coronavirus could be.
In one case, a biotech conference was attended by 200 people in late February 2020 and may have been connected to about 20,000 Covid-19 cases in the Boston area, according to research from the Broad Institute of MIT, Harvard University and other institutions.
A report published by the US Centers for Disease Control and Prevention in May 2020 described how a symptomatic person with Covid-19 attended a choir practice in Washington state. Afterward, about 87% of the other choir members developed Covid-19.
But those superspreading events happened before it was exactly clear how the virus spread and who was most at risk, and long before Covid-19 vaccines were made available in December 2020.
`` The pandemic isn't over. We're still going to see cases of this virus spreading, and we have to continue to be vigilant. We have to continue to be careful, '' Dr. Ashish Jha, the White House's new coronavirus response coordinator, said on ABC's `` Good Morning America '' on Monday.
Jha said he is not aware of anyone getting severely ill after the Gridiron dinner in Washington. `` As long as people are vaccinated and boosted, we now have a lot of treatments available, put that together, and the good news is, no one out of that so far has gotten particularly sick.
`` And that's what we have to be tracking -- making sure that when there are outbreaks, we can take care of people. ''
Some infectious disease experts argue that despite greater access to vaccines and testing, Covid-19 superspreading events aren't over.
`` I do think this event in Washington was akin to a superspreading event. It was clearly an event where people were gathered together, and the virus attended and made itself known to a lot of people and infected people, '' Schaffner said.
Covid-19 superspreading events are not `` a thing of the past, '' he said. `` So do they still happen? Sure. How important are they? Well, they put a fair number of people out of commission for a while, at least having to isolate at home because they were infected. ''
The United States is averaging more than 38,000 new Covid-19 cases per day and about 515 new Covid-19 deaths per day, according to CNN's analysis of data from the US Centers for Disease Control and Prevention and Johns Hopkins University. The Department of Health and Human Services says there are more than 14,700 people hospitalized with Covid-19.
About 66% of the US population is fully vaccinated.
`` Although I don't think superspreading events will cause surges in hospitalizations, they may continue to augment and accelerate transmission of the virus, causing milder disease in our communities, '' Schaffner said.
As we transition to living with Covid-19 long-term, there will be more chances to encounter someone with a mild -- but still transmissible -- infection through everyday activities like going to school, the office, a neighborhood block party, church, a sporting event or happy hour.
But there are also more chances to identify them.
`` We're much more likely now to find people who are positive but asymptomatic than we were two years ago, '' said Dr. Georges Benjamin, executive director of the American Public Health Association. But identifying several cases around the same time at the same place does not necessarily mean all of those people were infected at the same event.
`` Is that a superspreading event? Some of them may have gotten infected someplace else before they came together -- unless, of course, they test themselves before they go, '' Benjamin said.
'Outbreaks can happen '
The concept of a superspreading event `` is not new, '' said Keri Althoff, epidemiologist at the Johns Hopkins Bloomberg School of Public Health.
`` In history, we identify individuals who were superspreaders, '' she said. `` For example, Typhoid Mary. ''
The world's understanding of superspreading events dates back to Mary Mallon, commonly known as `` Typhoid Mary. '' Mallon was born in Ireland in the late 1860s and emigrated to the United States, where she worked in a variety of domestic positions for wealthy households before becoming a cook. Researchers have found that Mallon unknowingly carried the bacterium Salmonella typhi, which causes typhoid fever. As a cook, she spread the illness to others -- leading to an outbreak in New York.
`` She infected hundreds, if not thousands, of people with typhoid because she carried it in her gallbladder and she worked as a cook. Wherever she went, people would get sick, '' said Dr. Preeti Malani, chief health officer in the Division of Infectious Diseases at the University of Michigan in Ann Arbor.
The New York Health Department forced Mallon to quarantine.
`` She was exiled for decades because she kept infecting others with typhoid, '' Althoff said. `` She was asymptomatic. ''
Mallon's case is an example of how pathogens can spread on a far-reaching scale, leading to a superspreading event. But she is also an example of how the term `` superspreader '' can isolate and stigmatize those carrying pathogens, even unknowingly.
In the case of Typhoid Mary, the term `` superspreader '' was used to describe a person, whereas more recently, the term is being used to describe an event during which many people are infected, probably from more than one infected person at the event. Many experts call the term problematic when used to blame a person for having an illness.
Althoff thinks the United States is at a point where Covid-19 superspreading events are shifting to a thing of the past as the coronavirus circulates widely in our communities.
Events that result in a larger number of infections that wouldn't otherwise have happened can be better described as outbreaks, Althoff said, similar to how we see outbreaks of other vaccine-preventable respiratory diseases like measles or flu.
`` Very early in the pandemic, when the case numbers were low, we saw and investigated superspreading events, and those investigations provided important information about the virus when we knew very little, '' Althoff said. `` Large-scale outbreaks continue to provide information about how this variant is interacting with a population that has a much higher level of population immunity now than what we had in the beginning of the pandemic. ''
So now, when clusters of cases emerge, `` instead of'superspreader, ' I think the word 'outbreak ' is a bit more reasonable, '' Althoff said. `` Outbreaks can happen whenever we find ourselves in higher-risk settings. ''
How Covid-19 spreads now
Though `` superspreading '' events were seen as drivers of Covid-19 transmission early in the pandemic, they are of `` much less concern '' now, according to Malani.
`` A lot of transmission during the Omicron and BA.2 era has been household contact, where the entire family or your household unit gets infected. But really, what I see -- and I emphasize this over and over -- is that it is social gatherings that are unmasked, '' Malani said.
A big difference between the social gatherings happening now and the weddings, funerals or choir practices during the pandemic's earlier days is that many people now have some immunity against Covid-19 from getting vaccinated, being infected or both.
Based on information from blood samples, about 95% of Americans 16 and older have antibodies against Covid-19 as of December, the most recent date that data is available, according to estimates from the CDC.
The current Covid-19 vaccines are more effective at preventing severe Covid-19 leading to hospitalization or death, but they also offer some protection against infection in the first place. And `` staying up to date with COVID-19 vaccination also means you are less likely to spread the disease to others and increases your protection against new variants of SARS-CoV-2, the virus that causes COVID-19, '' according to the CDC.
`` What is happening at this point in the pandemic is that people are able to protect themselves differently, '' Malani said, adding that people now can gauge their risk for Covid-19 before attending an event by finding out whether others have been tested or vaccinated.
Many Covid-19 outbreaks still happen in pockets of the United States where there are many unvaccinated people, Benjamin said.
`` In those areas of the country, those communities where we still have people unvaccinated and numbers of people unboosted, in those cases, we're certainly going to see bigger, larger numbers of people who test positive, '' he said. Superspreading could be more likely in such communities.
Although superspreading events are no longer as much of a concern now as they were earlier in the pandemic, they `` are still going to occur, '' Benjamin said. `` They're definitely going to be one of the patterns we're going to see for some time to come from the disease, as long as we still have a variant out there that's highly infectious and a variety of people in various stages of immune protection. '' | business |
Covid-19 cases trend up again in the US, driven by the growth of BA.2 | According to the latest estimates from the US Centers for Disease Control and Prevention, BA.2 caused 86% of new Covid-19 cases nationwide last week.
In some ways, this feels like a familiar place. Cases are going up again. At least one major city is reinstating its mask mandate. Broadway shows have canceled some performances.
But there continue to be reasons for optimism.
Despite BA.2's near-complete takeover from two other circulating Omicron subvariants, BA.1 and BA 1.1, US hospitalizations are at record low levels, and they continue to drop. Deaths also continue to fall.
Even though those numbers tend to lag behind case counts, the US hasn't seen a steep increase in infections. Whether that's likely to happen is still an open question.
Even Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, doesn't know what BA.2 will do. As a nation, transmission has to get down to a level that's `` low enough that it doesn't disrupt our population or the economy, our daily economic, workplace and social lives, which means it has to be low enough that it isn't a serious threat to the health of the nation, '' he says. He doesn't know if we're out of the woods.
`` We are certainly seeing the beginning of a surge of new infections, '' Fauci said. `` It depends on how high we go up in the surge, and it depends on whether the surge is associated with an increase in severe disease.
`` I can't say where we are right now, because we're transitioning, '' he said.
Cases rising regionally
Across the nation, Covid-19 cases have ticked up 24% from where they were two weeks ago, and the US is now averaging about 38,000 cases a day. This is a jump from last week, probably because Florida recently reported a two-week backlog. Even so, it's one of the lowest daily rates since July.
State by state, however, the picture is more mixed. Cases are rising in 25 states, falling in 16 and holding steady in nine others.
Cases are rising fastest in the Northeast, the region of the US that has the most BA.2 transmission.
On Monday, Philadelphia became the first major US city to announce a return to indoor mask requirements. Cases have climbed 50% there over the past 10 days, pushing the city over the threshold that triggers the mask mandates.
`` I suspect that this wave will be smaller than the one we saw in January, '' Dr. Cheryl Bettigole, Philadelphia's public health commissioner, said Monday.
`` But if we wait to find out and to put our masks back on, we 'll have lost our chance to stop the wave. ''
Several universities, including Johns Hopkins, American, George Washington and Georgetown, have also reinstated indoor masking.
New York City had been reconsidering its mask requirements for preschoolers, but with cases rising in the city, Mayor Eric Adams recently said masks would be continue to be required for the youngest children, who had higher rates of hospitalizations during Omicron than in previous waves.
Beyond case counts, which may be a less reliable pandemic metric because testing numbers have dropped, coronavirus levels in wastewater are telling a largely reassuring story.
Wastewater monitoring is considered a reliable warning of what's on the way. US numbers are trending up slightly but are still at one of the lowest levels seen since July, according to Biobot Analytics, a company that analyzes wastewater samples from across the country.
Different countries, different stories
The situation with BA.2 here appears to be a departure from the one seen in the UK and Europe.
According to the variant-tracking website Covariants.org, the Netherlands was near the peak of its BA.2 wave when the subvariant reached 83% of infections there in the second week of March. Switzerland was also close to its BA.2 peak when the subvariant reached 80% of infections in mid-March. After falling for weeks, cases in the UK had doubled from a low point on February 25 and would soon reach the height of the BA.2 wave when the subvariant was causing 88% of cases there between March 7 and March 21.
The BA.2 experience in the US looks a lot more like what happened in South Africa. In the second and third weeks of February, when BA.2 was responsible for about 88% of transmission there, cases made a slight bump up but then continued to fall over the month of March.
`` I 've been cautiously optimistic about BA.2 because of the trends that it's not been as exponential a rise in cases, like we saw when Omicron first emerged, '' said Pavitra Roychoudhury, who studies the spread of infectious diseases at the University of Washington's School of Medicine.
She said the tidal wave of Omicron that hit the US over the winter has left a lot of immunity in its wake. We're also more vaccinated and boosted as a country than we 've ever been -- though health officials say we could do a lot better on boosters.
Some are heeding that warning. The pace of vaccination has roughly doubled over the past two weeks as more people seek out second boosters.
An average of about 502,000 vaccine doses have been administered each day over the past week, according to CDC data. That's up from about 219,000 doses a day on March 29, when the CDC and the US Food and Drug Administration authorized a second booster shot for people 50 and older, though the CDC isn't specifically counting second boosters.
`` That might be explaining our somewhat more optimistic outlook compared to places like the UK, where there was a significant surge and it was associated with BA.2, '' Roychoudhury said.
BA.2 in the UK
Overall during the pandemic, health officials have pointed to the UK as a harbinger of things to come in the US, but that kind of extrapolation may be getting harder to do as the populations develop different types and degrees of immunity.
After a wave of cases caused by Omicron's BA.1 subvariant that peaked in January and then fell, the UK saw a second increase in cases and hospitalizations with BA.2. That wave peaked in late March, and since then, cases have been on a steep decline.
Adam Kucharski, an epidemiologist at the London School of Hygiene & Tropical Medicine who tracks infectious disease outbreaks, believes that the BA.2 wave in the UK was at least partly due to the timing of its booster campaign.
The UK began offering booster shots, or third vaccine doses, in mid-September, just a few days before the US did. But more people got them: In the UK, 68% of people over the age of 12 who are eligible for a booster dose have gotten one; in the US, that number is just 45%, according to the CDC.
Many people in the UK who got a booster in September or October still had high antibody protection when Omicron arrived.
Antibodies are the first line of defense in an infection. They act quickly to contain the spread of a virus through the body. Antibodies are highest in the first few months after vaccination and decline over time. But even after they 've dropped off, the body retains its immune memory to vaccines and can gear up quickly to make more if it's infected.
Omicron was identified in late November, when many in the UK were still within the window of highest protection from their booster doses.
`` I think we were fortunate that the boosters, in the short term at least, provided quite a lot of protection, '' Kucharski said.
People who 'd had recent boosters had such good immunity that if even if they got infected with BA.1, they might not have known it because their symptoms were so mild. It was likely that they weren't contributing to transmission, Kucharski thinks, so boosters did a good job of holding down Omicron's rampant spread through the UK over the winter.
Fast-forward three months, however, and many people who 'd gotten boosters as recommended were six months past their shots. Studies show that antibody levels decline four or five months after the third dose, so their protection against infection was probably much lower just as BA.2 arrived on the scene.
And now, Kucharski says, with BA.2, even the boosted group began getting `` mild, mild symptoms or enough to detect that and test positive '' and be counted as a case.
As immunity waned, BA.2 crept in
Whether the US will see a fresh wave of cases from BA.2 will depend a lot on two things, Kucharski said: the current level of immunity in the population and our behavior.
About half of those who are eligible for a booster dose in the US have had one, and millions more were infected by Omicron, giving an estimated nearly 95% of Americans some degree of protection against the coronavirus, according to the CDC.
But for those who have lost their immunity over time because protection from their original two-dose vaccinations have waned or because they were infected a year or more ago with an older variant, the virus might find a way to spread.
`` I think if BA.2 can find susceptibility, that will translate into growth in cases, '' Kucharski said.
But he stresses that a lot will depend on what Americans do right now.
`` I think the question is what happens in the meantime, if actually booster campaigns and other things line up, then that might offset [ the subvariant ]. But I think based on what we're seeing a lot of countries in Europe, if there's susceptibility, either because people haven't had a booster or they had it a while ago, then that can translate into growing epidemic, '' he said.
| business |
Opinion: The metaverse holds great promise — and great risk | Most would agree that the metaverse could be a series of connected virtual environments that resemble and function similar to our physical world; or, a three-dimensional immersive version of the Web. And we have a sense for what it will be because many of its components already exist: social interactions, economic interactions, are all features of a future metaverse that are not new.
What is new about the metaverse? Separate applications could connect into a seamless experience. You already likely engage in several metaverses every day. Our discreet virtual spaces of today might become one virtual universe tomorrow. The three-dimensional environments of modern games, the connectivity of social media and the commercial power of e-commerce might be all in one seamless, persistent space accessible to everyone on Earth.
The dream is very much alive — if a dream is a herd of tech companies stampeding to cash in. For Meta, Microsoft and other Big Tech players, this vision of the metaverse represents an enormous opportunity, specifically, the chance to be a platform not just for gaming or social media, but for life itself — a place where we work, learn, earn and spend; sort of an operating system for our digital lives.
And why might this happen now? Covid has forged new ground in regard to our digital comfort zones. Many more of us are comfortable with living online.
But for a true metaverse to be realized, it will need to include two features: money and freedom.
Let's start with money. If it's to thrive, the metaverse will need to function similarly to a real-world economy. Like the real world ( at least in any capitalist society), it has to incentivize individuals to participate in and grow the economy. And we're already seeing early signs of this.
But, what we still need for that second key component of this metaverse promise to pan out: specifically freedom, or at least interoperability. There's no point earning magic internet money if you can't spend it wherever you want — online or offline. And that goes for all other forms of capital you build online as well: your social capital — friends, connections, followers; and your possessions, your stuff.
Why buy clothes if you can't wear them out of the store? Why buy a Birkin bag if you can't show it off in the metaverse? Or wear my Fortnite outfit on a Call of Duty raid? Or at a Lil Nas X concert on Roblox? I bought it. I own it. It's mine.
Also, I should be able to sell it anywhere I want. The freedom, and frankly convenience, of decentralization and interoperability has been promised not only by the metaverse but Web3.
In the promise of the metaverse, and in those hints of the metaverse that currently exist on platforms including Roblox, Twitter, Fifa, World of Warcraft, or even the app store, users can build the worlds that they want to live in — and it needs to be one world. This stands in stark contrast to today's closed-off digital silos or walled gardens.
That's the real potential here. The metaverse needs to be a reasonable facsimile of the real world, where I can spend my money and wear my Adidas where I want. Not only will it remind us of the physical world, but the best version of the metaverse will adopt and synchronize with the best elements of our offline life.
Also familiar? The risks. Just as in the physical world, freedom is easily lost and our lives easily manipulated. No metaverse built by humans is going to be void of the human instinct to want power, and that power could be enormous.
So who has the vision, the resources and maybe the arrogance to want to be our scientific God? To believe that they could be the most powerful person on Earth?
One guess. The company formerly known as Facebook. | business |
Over a quarter of a billion more people could be living in extreme poverty by end of the year- Oxfam | The report projected that rising global food prices alone will push 65 million more people into extreme poverty in 2022. That's in addition to the 198 million extreme poor the World Bank predicted earlier this year, pushing the total expectation to 263 million. The number at risk of crashing into such levels of poverty is equivalent to the combined populations of the UK, Germany, France and Spain.
`` Without immediate radical action, we could be witnessing the most profound collapse of humanity into extreme poverty and suffering in memory, '' said Gabriela Bucher, Oxfam International's executive director.
`` This terrifying prospect is made more sickening by the fact that trillions of dollars have been captured by a tiny group of powerful men who have no interest in interrupting this trajectory, '' she added.
The report also states that `` entire countries are being forced deeper into poverty '' as Covid-19 has depleted their financial reserves and they are pushed into austerity measures.
Were enough governments willing to increase taxes on the richest, starting with a 2% annual wealth tax on millionaires and 5% on billionaires, it would be enough to `` lift 2.3 billion people out of poverty, make enough vaccines for the world, and deliver universal healthcare and social protection for everyone living in low- and lower middle-income countries, '' the report said.
`` We reject any notion that governments do not have the money or means to lift all people out of poverty and hunger and ensure their health and welfare. We only see the absence of economic imagination and political will to actually do so, '' Bucher said. | business |
Perseus Discovers More High-Grade Gold at Yaouré Mine | PERTH, Western Australia, April 12, 2022 ( GLOBE NEWSWIRE) -- Perseus Mining Limited ( ASX/TSX: PRU) is pleased to report further strong results from exploration drilling at its Yaouré Gold Mine in Côte d’ Ivoire. Perseus will use the results to upgrade the CMA Underground Inferred Mineral Resource estimate to the Indicated category and complete a Pre-Feasibility Study ( PFS) for a Yaouré underground mining operation in the June 2022 Quarter.
“ Having reached our goal of producing gold at a rate of 500,000oz per year across our three gold mines, we are now working to maintain that level of production over the next decade and beyond. These latest drill results from Yaouré give us further confidence in the high-grade gold contained beneath the CMA open pit and we are working towards a Mineral Resource upgrade, that will enable us to complete a Pre-Feasibility Study and maiden Ore Reserve for the CMA Underground Project during the current quarter. Beyond this, we look forward to progressing Perseus’ s first underground mining development which is likely to be the first large scale underground mine operating in Côte d’ Ivoire. ”
Perseus continued to focus recent exploration activities on the Yaouré permits at the CMA Underground prospect, located 2 kilometres south of the Yaouré mill ( Appendix 1 - Figure 1.1). Results received continue to demonstrate the potential for the Company to materially grow its gold inventory at Yaouré through further drilling success.
As detailed previously ( refer to news releases announcements dated October 14, 2021 and January 19, 2022), Perseus has focused on infill drilling at the CMA Underground to firm up a previously defined Inferred Mineral Resource of 1.8 million tonnes grading 6.1 g/t Au extending below the currently planned CMA pit. This resource extends to a maximum 275 metre down dip beneath the open pit resource ( refer to Resources and Reserves release August 24, 2021), with potential for further mineralisation down dip beyond this ( Appendix 1 – Figure 1.2). Perseus has also completed a Scoping Study which identified the potential to mine the CMA structure using underground mining methods ( refer to “ Perseus Mining Completes Scoping Study for Potential Underground Mine at Yaouré ” dated November 5, 2018).
Drilling during the last quarter comprised 29,805 metres in 136 reverse circulation ( RC) pre-collared diamond ( DD) holes, infilling the existing 50 x 50 metres coverage to a nominal 25 x 25 metre pattern to allow conversion of the Inferred resource to Indicated. Results continue to provide strong encouragement, with the latest intercepts comparable in grade, thickness and style to those previously encountered ( Appendix 1 - Figures 1.3-1.5).
Better intercepts from the CMA infill drilling are shown in Table 1 below, with a complete summary of significant results included in Appendix 2 – Table 2.1.
Perseus received further results for drilling completed in late 2021 to investigate the next 300 metre down-dip from the current CMA Underground resource. The step-out program, guided by Perseus’ s early 2020 3D seismic survey, is being drilled on an initial 100 x 200 metre pattern to better define the position of the CMA structure and the intensity of mineralisation. If results remain encouraging, this will be infilled to 100 x 100 metres to allow an initial Inferred Mineral Resource Estimate. This program, currently on hold while the CMA Underground resource conversion drilling is completed, will resume in the next quarter.
Better intercepts from the Yaouré step out drilling are shown in Table 1 below and on Figure 1.6, with a complete summary of significant results included in Appendix 2 – Table 2.2.
This announcement has been approved for release by Perseus’ s Managing Director and Chief Executive Officer, Jeff Quartermaine.
Competent Person Statement: The information in this report and the attachments that relate to exploration drilling results at the Yaouré Project is based on, and fairly represents, information and supporting documentation prepared by Dr. Douglas Jones, a Competent Person who is a Chartered Professional Geologist. Dr. Jones is the Group General Manager Exploration of the Company. Dr. Jones has sufficient experience, which is relevant to the style of mineralisation and type of deposit under consideration and to the activity being undertaken, to qualify as a Competent Person as defined in the 2012 Edition of the ‘ Australasian Code for Reporting of Exploration Results, Mineral Resources and Ore Reserves’ ”) and to qualify as a “ Qualified Person ” under National Instrument 43-101 – Standards of Disclosure for Mineral Projects ( “ NI 43-101 ”). Dr. Jones consents to the inclusion in this report of the matters based on his information in the form and context in which it appears.
This report contains forward-looking information which is based on the assumptions, estimates, analysis and opinions of management made in light of its experience and its perception of trends, current conditions and expected developments, as well as other factors that management of the Company believes to be relevant and reasonable in the circumstances at the date that such statements are made, but which may prove to be incorrect. Assumptions have been made by the Company regarding, among other things: the price of gold, continuing commercial production at the Yaouré Gold Mine, the Edikan Gold Mine and the Sissingué Gold Mine without any major disruption due to the COVID-19 pandemic or otherwise, the receipt of required governmental approvals, the accuracy of capital and operating cost estimates, the ability of the Company to operate in a safe, efficient and effective manner and the ability of the Company to obtain financing as and when required and on reasonable terms. Readers are cautioned that the foregoing list is not exhaustive of all factors and assumptions which may have been used by the Company. Although management believes that the assumptions made by the Company and the expectations represented by such information are reasonable, there can be no assurance that the forward-looking information will prove to be accurate. Forward-looking information involves known and unknown risks, uncertainties, and other factors which may cause the actual results, performance or achievements of the Company to be materially different from any anticipated future results, performance or achievements expressed or implied by such forward-looking information. Such factors include, among others, the actual market price of gold, the actual results of current exploration, the actual results of future exploration, changes in project parameters as plans continue to be evaluated, as well as those factors disclosed in the Company's publicly filed documents. The Company believes that the assumptions and expectations reflected in the forward-looking information are reasonable. Assumptions have been made regarding, among other things, the Company’ s ability to carry on its exploration and development activities, the timely receipt of required approvals, the price of gold, the ability of the Company to operate in a safe, efficient and effective manner and the ability of the Company to obtain financing as and when required and on reasonable terms. Readers should not place undue reliance on forward-looking information. Perseus does not undertake to update any forward-looking information, except in accordance with applicable securities laws.
Figure 1.1: Yaouré Gold Project – Tenements and Prospects: https: //www.globenewswire.com/NewsRoom/AttachmentNg/4388bff5-33ed-44c0-94f4-50610f70e7d6
Figure 1.2: CMA Underground Resource Drilling and Results Summary: https: //www.globenewswire.com/NewsRoom/AttachmentNg/75a24191-9b85-4cf0-9dfa-32861fe97d6e
Figure 1.3: CMA Underground Resource – Long Section: https: //www.globenewswire.com/NewsRoom/AttachmentNg/6295ec9d-1eaf-452d-a344-9eac4d2f260c
Figure 1.4: CMA Underground Resource – Drill Section 777010mN: https: //www.globenewswire.com/NewsRoom/AttachmentNg/5e21cb1d-93bb-4510-83b7-1a464623af48
Figure 1.5: CMA Underground Resource – Drill Section 777185mN: https: //www.globenewswire.com/NewsRoom/AttachmentNg/a52bebb0-a54f-408e-92f7-083b4f102a6d
Figure 1.6: CMA Down-dip Drilling and Results Summary: https: //www.globenewswire.com/NewsRoom/AttachmentNg/2157434c-739f-4a3a-ac0e-585b24237f38
Table 2.1: CMA Underground Resource Drilling - drill holes and significant assays
( Based on lower cut-off of 0.5 g/t Au with maximum 2m internal waste < 0.5 g/t)
Table 2.2: CMA Down-Dip Extension - drill holes and significant assays | general |
Madison Pacific Properties Inc. announces the results | April 12, 2022 19:00 ET | Source: Madison Pacific Properties Inc. Madison Pacific Properties Inc.
VANCOUVER, British Columbia, April 12, 2022 ( GLOBE NEWSWIRE) -- Madison Pacific Properties Inc. ( the Company) ( TSX: MPC and MPC.C), a Vancouver-based real estate company announces the results of operations for the six months ended February 28, 2022.
The results reported are pursuant to International Financial Reporting Standards ( IFRS) for public companies.
For the six months ended February 28, 2022, the Company is reporting net income of $ 20.3 million ( 2021: $ 22.3 million); cash flows from operating activities before changes in non-cash operating balances of $ 4.3 million ( 2021: $ 4.9 million); and income per share of $ 0.33 ( 2021: $ 0.34). Included in net income is an after-tax net gain from the fair value adjustment on investment properties of $ 8.5 million ( 2021: $ 14.9 million).
The Company currently owns approximately $ 713 million in investment and development properties, including the Company’ s proportionate share of properties held through jointly-controlled partnerships. The Company’ s investment portfolio comprises 54 properties with approximately 1.9 million rentable sq. ft. of industrial and commercial space and a 50% interest in a 54 unit multi-family rental property. Approximately 99.5% of available space within the industrial and commercial investment properties is currently leased. The Company’ s development properties include a 50% interest in the Silverdale Hills Limited Partnership which owns approximately 1,407 acres of residential designated development lands in Mission, British Columbia. In June 2020, the partnership commenced development of 162 townhomes and 65 single family lots on the site, which consumed approximately 38 acres of land inventory. Sales and presales on the four phase townhome development and sales on the single family lots has commenced.
The COVID-19 pandemic has continued to cause economic disruption. The Company is currently well positioned, with a diversified income portfolio of industrial, office, retail, multi-family rental and residential assets. Approximately 82% of the Company’ s commercial investment properties are located in British Columbia where most of the provincial government restrictions have been lifted. These are uncertain and challenging times and management will be continuing to monitor business developments and market conditions and any effect they may have on the business.
For a review of the risks and uncertainties to which the Company is subject see its most recently filed annual and interim MD & A. | general |
This is how IBM focuses on Equitable Impact | The disparate impact of the COVID-19 pandemic has further underscored what we had been advocating and working towards for many years: institutions must contribute to economic opportunity in the communities in which we live and work. That is why IBM has created IBM Impact, a comprehensive framework for addressing society’ s most urgent needs and helping to build a more sustainable, equitable, and ethical future.
Trust, transparency, and leadership are the values that underpin how IBM is making a lasting, positive impact in the communities. It is through those qualities that our employees, stakeholders and others can benefit from our culture, building from inside out, permeating not only IBMers, but also, the communities where we operate.
Developing and supporting our current and future workforce is a priority for IBM. Recruitment, retention and development is the foundation to build a successful culture. For us, IBMers are the first group we turn to for better understanding our progress and direction. And while 81.4% of IBMers say today that they would recommend IBM as a great place to work, we are always working to push further.
Demographic changes, market demands, and technological progress can create a demand for more workers in the economy – making it imperative that the public and private sectors collaborate on education and training. As a result, IBM has committed to skill 30 million people with new skills for the jobs of tomorrow by 2030. This commitment gives new generations of workers the tools they need to be successful in an ever-changing economy. In 2021, IBM’ s combined education initiatives reached 3.5 million participants.
For example, IBM is helping to close the global skills gap through IBM SkillsBuild, which as of February 2021, has helped 1.72 million students and job seekers globally to complete 4 million learning hours in cybersecurity, data analysis, and other technical disciplines. Through our IBM’ s Global University Programs, IBM is providing technology, supporting research and creating assets to advance relevant skills for today’ s workforce to more than 900,000 students across 10,000 universities. The company is also providing students with mentoring and paid work experience through the P-TECH program. Since its 2011 launch, the program has grown to include over 300 schools with more than 600 industry partners and has provided over 1,000 paid IBM internships in the US.
Many aforementioned programs are being led by IBMer volunteer efforts and are providing access to services in education, sustainability, and other areas to some of the most marginalized or vulnerable communities.
With the support of IBMers, we have committed to give 4 million volunteer hours by 2025, to make a lasting, positive impact in the communities we work and serve.
Finally, these efforts also extend beyond our company. We have set a goal of dedicating 15% of first tier supplier diversity spend from Black-owned suppliers by 2025. IBM increased opportunities for diverse communities through investments, partnerships, external advocacy, and promotion of legislation like the Equality Act and the Dream Act. And our Allyship programs aim to create a supportive workplace that fosters a sense of inclusion and belonging for everyone.
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[ 1 ] “ More people globally see racial, ethnic discrimination as a serious problem in the U.S. than in their own society. ” Pew Research Center, Washington, D.C. ( November 2, 2021). https: //www.pewresearch.org/fact-tank/2021/11/02/more-people-globally-see-racial-ethnic-discrimination-as-a-serious-problem-in-the-u-s-than-in-their-own-society/ | tech |
Comical, severe and forever fighting: James Shaw's return to WorldTour stage racing after four years away | James Shaw would be a fine restaurant critic.
`` You know when someone tells you how amazing some food is, '' he starts, the analogy still forming in his mind as the wind blows, `` and then you try it and you're like, 'yeah it was good, but it wasn't that good. It's a bit like that. ''
The topic, for clarification, is not the EF Education - EasyPost rider's take on the small but filling pintxos that are available in every single last bar and restaurant in the Basque Country, but instead the region's bike race that every bike rider who has ever ridden it professes is the hardest stage race in the world.
`` I think, in my head, I had built it up to be worst than it actually is, '' he goes on. `` Mind you, I 've still got two days to go, I 've still got to get around. '' In the end, Shaw did, but not without a fight.
This was the 25-year-old's first WorldTour stage race since the Tour of Poland in August 2018, his time spent away from cycling's top-table well chronicled as he twice dropped to Continental level after two years as a young pro with Lotto-Soudal, had his progress hindered by the pandemic, and then returned to the highest tier on the back of multiple high placings against WorldTour riders last year.
`` It's been a while! '' he tells us on day two of the race. `` For me, to drop out of this level and then to come back is quite a proud achievement because it's difficult to do. I 've always thought that the second [ WorldTour ] contract is the hardest one to get. The first one comes as you come out of U23 ranks, but to get another one, that's the tough bit, so I 'm happy. ''
A day after placing 23rd in the opening day's time trial, Shaw prefaces the struggles ahead. `` I 've been warned it's a grippy week. '' We tell him it's brutal. `` Yeah, cheers for that, really making me feel better now. I 've never raced Basque. Never ridden here. I 've driven through on the odd occasion but that's it. Everyone just says it's tough. ''
Shaw is a good sport. He smiles, speaks in hushed tones, and has the cheery, relaxed vibe of someone totally content in where he is currently at. He's worked damned hard to be at this level once again.
He had predicted a few days before that `` it's a day-by-day thing: I 'm gon na take each day as if it's an individual race, as if each stage is its own Classic. I 'll give it a bash and see what happens. '' He returns to the same assessment 72 hours later. `` It actually is like racing an Ardennes Classic every day. The nature of this race is small, twisty roads and I 've never raced somewhere with climbs like this before. It's never anything over six kilometres, but it's relentlessly steep. ''
`` The last thing I want is my Pro Cycling Stats page being peppered with DNFs ''
The race had felt like a slow-burner up until stage five's fireworks, and while Shaw shares that assessment before the explosions, he imparts some insight into the inner-workings of the peloton. His look adopts a confused one.
`` There's always the narrowest of roads, '' he says, `` so there's always a good run-in to a climb. You start the climb already a little bit tired as you 've already pushed numbers to get to the front, and then you have to keep your position on the front and then do the climb. But often you hit the bottom of the climb and... nothing actually happens.
`` Yesterday [ stage four ] I think we took two minutes from the breakaway fighting to get to the bottom of this climb, and no-one did anything! I was sat there thinking, 'Oh, alright, if we all just agreed at the start that this guy [ can win ], let's not panic '. But instead every DS is there going 'get to the front, get to the front ', and we're like, 'yeah, alright, OK! ' ''
He laughs about the absurdity of it, but he's buzzing from it, too. `` I enjoy the racing in the peloton, '' he adds. `` You know, getting involved in the washing machine at the front, fighting for position. I love the fast descents, the twists, stuff like that. '' Giving it a bash, though, didn't really come to fruition. Half an hour or so after we speak, stage five's flag dropped. Nine kilometres later he punctured and required a wheel change. He spent the remaining 160km chasing, solo, fighting to the finish, not seeing even the rear of the peloton. `` Looking back now I can laugh, '' he wrote on Instagram, `` but at the time this wasn't as funny as it seems now. [ It was ] the most comical day I 've ever had on the bike. ''
They talk, in mythical tones, about the racing, but for Shaw it was also a week of cultural learning. After Ukrainian Mark Padun dropped out on stage three, Shaw was surrounded by three South Americans and a Portuguese. Not really ideal when `` my Spanish is non-existent. ''
But he's excited by how diverse the team is, saying `` we 've got staff from every point of the globe. EF are the polar opposite from Lotto where there was not one non-Belgian staff. The cultural experience here is something else. '' The team's doctor at the race was Mexican. `` I was talking to him quite a bit, '' Shaw reveals. `` He's convinced me to go to the Day of the Dead Festival in November. It sounds crazy. I 've even been looking at flights already. ''
There were other factors that hampered him, chiefly among them a certain pandemic virus. `` I had Covid a few weeks ago and it knocked me more than I thought it did, '' he says, confirming that he won't be riding the Giro d'Italia now due to his infection. `` Coming here has magnified just how much I 've lost.
`` I thought I 'd just lost a bit, and I 'll be alright, but here it's like, actually... I just feel ridiculously unfit. I only have five days off the bike, but the Covid knocked me for six. I didn't really have much time to train and get back to fitness, and then I went straight into Milano-Torino and Milan-San Remo and I was like,'s * * t! ' My current fitness levels are giving me a good kicking. ''
Covid is still on his mind when we speak after the race, but it's more out of a desire to illuminate his point rather than his frustration. `` On Saturday, I was 36 watts down on a 20 minute power session compared to the Tour du Haut Var in February [ where he finished ninth overall ]. And both times I was full gas. That's how much Covid has cost me. It's like, when I get to 400 watts, that's it; I can't turn the screw any more - I max out. ''
He's pragmatic, though, saying, `` loads of people have had the same issues, it's a thing, this post-virus fatigue. 90 percent of the peloton's had an illness, and the other 10 percent will get it too. You can't avoid it this year. ''
I point out to Shaw how relaxed he has looked; there's been nothing to suggest that he's fighting for his place or that he is desperate to prove his status as a WorldTour rider after four years away. He concurs, but he's still conscious of impressing. `` I have waited a long time to return to a WorldTour stage race, '' he says. `` There were moments when I thought it would never happen. But finally I could pin a number on this week and start a race.
`` On Saturday, the last day, the team car came up to me and said I could climb off and prepare for Wednesday [ where he's racing De Brabantse Pijl ] but there was 50km to the finish and I wanted to cross the line. I wanted to do the full distance. As long as if I can cross the line I am content. I hate looking on Pro Cycling Stats and seeing a DNF.
`` I remember at the end of 2020 I went to the Road World Championships and I got dropped with about 85km to go. I didn't have a contract for the next year and I thought that a DNF looks way worse than finishing 87th. So I kept on riding, passing the bus three or four times which is mentally the hardest thing you can do. But you know that people look at a result, and it doesn't tell the full story of it - you could have done an absolutely blinding job for the team, but then record a DNF which just doesn't reflect you as honestly as it should. The last thing I want is my Pro Cycling Stats page being peppered with DNFs. ''
As we wrap-up our series of exchanges, he jokes again about the Basque Country, how it is `` really hard '' and `` the severity of the climbs ''. I imagine him re-writing his analogy, but instead he's forming a dream.
`` I 'd like to come back in better shape, give it a proper bash, the justice it deserves, '' he says. `` I 'm not saying I 'd be fighting for podiums, top-10s or top-15s, but if I was in the shape I was in in February, there's no reason I couldn't be competitive in stages. I don't see why that's not a million miles away. If anything, I just want to turn the clock back and ride it again in the best possible shape. I hope one day the stars align and I 'll go there with power in my legs. ''
He's been told by peers in the peloton that fitness levels are back to pre-Covid levels after around 10 weeks. `` So that's in two weeks for me, '' he confirms. `` The legs will come - it's just a waiting game. '' He's got pretty good at persevering and overcoming setbacks, has James Shaw. | general |
Les subventions cachées en faveur du charbon, un danger pour l'humanité by Jayati Ghosh & Debamanyu Das | NEW DELHI – Le dernier rapport du GIEC ( Groupe d'experts intergouvernemental sur l'évolution du climat) a de quoi terroriser les dirigeants politiques et les populations à travers le monde. Ce rapport tire la sonnette d'alarme: des catastrophes climatiques pourraient survenir, non pas dans un avenir lointain, mais au cours des 15 prochaines années, voire dès la prochaine décennie.
Mais au lieu de répondre rapidement à la menace, les dirigeants politiques restent focalisés sur l'horrible guerre que mène la Russie contre l'Ukraine, et ses conséquences immédiates. C'est peut être compréhensible, néanmoins la crise ukrainienne met en évidence l'orientation bien trop court-termiste des gouvernements occidentaux. Beaucoup d'entre eux ont renié les engagements qu'ils ont pris il y a seulement quelques mois à Glasgow lors de la Conférence de l'ONU sur le climat - des engagements pourtant relativement limités et manifestement pas à la hauteur des enjeux.
L'invasion de l'Ukraine et les sanctions occidentales contre la Russie ont déclenché une hausse spectaculaire du prix des carburants, alors que le marché de l'énergie était déjà en surchauffe en raison de la reprise économique aux USA et en Europe. Pourtant les gouvernements des pays avancésn'ont pas considéré cette flambée des prix comme l'occasion d'accélérer l'abandon des combustibles fossiles; pour des raisons politiques à court terme, ils ont tenté de faire passer la pilule en évitant une trop forte hausse du prix de l'énergie domestique.
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Jayati Ghosh, Professor of Economics at the University of Massachusetts Amherst, is a member of the UN Secretary-General’ s High-Level Advisory Board on Effective Multilateralism.
Writing for PS since 2022 1 Commentary
Debamanyu Das is a research scholar at the University of Massachusetts Amherst.
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Before Russian President Vladimir Putin’ s attack on Ukraine, Europe’ s recovery from the damage wrought by the COVID-19 pandemic was solidifying. But now European policymakers have exactly zero control over whether their economies ' rebound continues.
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| general |
U.S. State Department orders all non-emergency government staff in Shanghai to leave as Covid surges | The U.S. State Department has ordered all non-emergency government staff and their family members in Shanghai to leave as Covid surges and told U.S. citizens to reconsider travel to China, according to an announcement dated April 11.
`` Reconsider travel to the People's Republic of China ( PRC) due to arbitrary enforcement of local laws and COVID-19-related restrictions, '' the State Department said.
`` Do not travel to the PRC's Hong Kong Special Administrative Region ( SAR), Jilin province, and Shanghai municipality due to COVID-19-related restrictions, including the risk of parents and children being separated, '' the statement said. `` Reconsider travel to the PRC's Hong Kong SAR due to arbitrary enforcement of local laws. ''
The State Department announcement followed one over the weekend by the U.S. Mission China in Beijing that said non-emergency U.S. government employees and family members of emergency and non-emergency U.S. government employees could leave Shanghai voluntarily.
The U.S. had issued a travel advisory on April 8 with the same language on warnings about `` arbitrary enforcement of local laws '' and Covid-19 restrictions.
China is `` strongly dissatisfied '' with and `` firmly opposes '' the United States ' `` groundless accusation '' of China's Covid policy, Foreign Ministry spokesperson Zhao Lijian said Saturday, according to a CNBC translation of the Chinese statement.
He said the announcement for voluntary evacuation was the U.S.'s own decision, and that the Chinese side has assisted foreign diplomats and consular staff on Covid-related issues as much as policy allowed.
In the last several weeks, mainland China has faced its worst Covid outbreak since the initial phase of the pandemic in early 2020.
While cases have been reported across the country, the northern province of Jilin and the southeastern city of Shanghai are among the hardest hit, with local authorities imposing stringent stay-home measures and travel restrictions in an attempt to control the outbreaks.
Last week, Shanghai authorities eased quarantine measures that had separated parents from their children. This week, the city announced a phased process for easing lockdowns.
The city had attempted one of the most targeted Covid control policies to control a spike in cases since late February, but eventually locked down the city in two stages beginning in late March — in the name of conducting mass testing.
Shanghai is a hub for many foreign businesses in China, while Jilin is home to many auto factories.
`` The employees and family members will depart on commercial flights, '' U.S. Mission China said Tuesday in a separate statement. `` The Department ordered the departure due to the ongoing COVID-19 outbreak. '' | business |
China: Covid lockdowns are causing chaos in the world's biggest car market | China's worst Covid outbreak in two years has prompted authorities to ramp up the country's zero-Covid policy, locking down several major cities and tens of millions of people.
The strict lockdown measures in places such as Shanghai and Jilin province have forced automakers to shut down manufacturing and risk delayed shipments at a time when global demand for vehicles is strong.
Volkswagen's ( VLKPF) factories in Shanghai and Changchun, the provincial capital of Jilin, have been shut for weeks, the company said on Monday.
`` Due to the current Covid situation, production in our factories in Changchun ( since mid-March) and Anting/Shanghai ( since April 1) is currently on hold, '' Volkswagen said in a written response to CNN Business. `` This is currently causing a delay in production. ''
The company added that it will compensate for the production stoppages `` if the situation eases in the near future, '' through extra shifts and other measures. `` At present, we are assessing the situation from day to day, '' it added.
Toyota ( TM) has also closed its factory in Changchun for nearly a month.
`` Due to the travel restrictions in Changchun, the impact on supplier operations, and the perspective of ensuring the safety and security of employees and all related parties, Toyota has been suspending operations at the Changchun plant from March 14 onwards, '' a company spokesperson told CNN Business.
Tesla ( TSLA) has halted production at its Shanghai factory since the city imposed a lockdown on March 28, according to Reuters. The company didn't respond to a request from CNN Business for comment.
Nio ( NIO), a Chinese electric vehicle maker, said Saturday that it had suspended production because of Covid-related disruptions.
`` Since March, due to the pandemic, the company's supplier partners in several places including Jilin, Shanghai and Jiangsu suspended production one after the other and have yet to recover, '' the company said in a statement. `` Consequently, Nio has halted car production, '' it said, adding that the company will postpone deliveries of its EVs to users.
It's not just individual manufacturers. The Beijing auto show, one of the industry's largest global gatherings, has been postponed until further notice due to the recent surge in Covid cases. The event was originally scheduled to be held from April 21 to April 30.
`` We will pay close attention to the development of the pandemic, '' Secretariat of Auto China said in a post on its official WeChat account on Saturday, adding that it will announce new dates in due course.
That means several new car launches will be delayed. Chinese EV makers Nio, XPeng, and Li Auto have previously said they would unveil new models at the Beijing autoshow.
The Covid restrictions have also taken a toll on the country's car sales.
Auto sales in China plunged 12% in March from a year ago, reversing a 19% increase in February and ending two straight months of growth, data from the China Association of Automobile Manufacturers showed on Monday.
The association attributed the decline to the recent surge in Covid cases.
Monday's data showed one bright spot, however — China's demand for electric vehicles remains strong.
About 455,000 new energy vehicles, including hybrids and pure EVs, were sold in March, up 122% from a year ago, according to separate data from the China Passenger Car Association.
Tesla's China sales were particularly strong, ranking first among pure-electric brands.
The company delivered 65,814 China-made vehicles in March, with the majority of those sold in the Chinese market. That number was up 85% from a year ago.
BYD ( BYDDF), meanwhile, sold the most new energy vehicles in China, delivering 104,878 units in March. Among them, 53,664 were pure-electric models.
Tesla didn't immediately respond to a request for comment about its March sales numbers. | business |
30,000 foreign students entered Japan since COVID border curbs eased | Around 30,000 foreign students have arrived in Japan since March when the government eased COVID-19 border controls, education minister Shinsuke Suematsu said Tuesday.
The government estimates around 110,000 overseas students were waiting to enter Japan as of last month after being kept out for roughly two years by the country’ s strict border restrictions.
It aims to accept all those waiting by May, and the minister said progress toward that goal is “ generally going well. ”
Japan’ s long-running and stringent border controls drew fierce criticism from impacted students and academics ahead of the April start of the school year.
In late November, Japan effectively imposed an entry ban on nonresident foreign nationals to limit the spread of the highly transmissible omicron variant of the coronavirus.
But Japan’ s measures were later relaxed to allow businesspeople, students, and returning Japanese nationals and foreign residents to enter. The border remains closed to tourists.
The daily cap on overseas arrivals has been increased in phases — up to 7,000 from 5,000 on March 14 and to 10,000 from Sunday.
The government has prioritized foreign students by allocating them empty seats on weekday flights into Japan. | tech |
Biden arrives in Iowa to unveil plan to reduce gas prices amid soaring inflation – as it happened | Richard Luscombe
Tue 12 Apr 2022 21.07 BST First published on Tue 12 Apr 2022 14.25 BST
9.07pm BST 21:07
We’ re closing the US politics blog now, following Joe Biden’ s announcement in Iowa seeking to lower gas prices amid the nation’ s worst inflation crisis in more than 40 years.
The president said the move to allow sales of higher ethanol E15 gasoline this summer, following the relaxing of federal laws, could save families 10 cents a gallon, although the fuel will not be widely available nationwide.
Thanks for joining us today. Our live blog on the New York subway shooting will continue for a while here, and you can follow developments in the Ukraine-Russia war on our 24-hour live blog here.
Here’ s where else our day went:
9.05pm BST 21:05
Joe Biden is preparing to speak at a bioprocessing plant in Menlo, Iowa, to announce that he’ s waiving a federal rule banning summer sales of E15 gasoline - fuel with a higher blend of ethanol than regular gas - in an effort to bring down prices at the pump.
The president is pledging to lower energy costs after blaming the Ukraine war, and in particular the Russian president Vladimir Putin, for soaring prices affecting American families. Earlier today, it was announced US inflation reached 8.5% in March, its worst level in more than 40 years.
Biden will speak after touring the plant in the corn-rich state, where even Republicans seem to be on board with his plans. Biden insists the sale of plant-based E15 during the summer, during which it is usually banned because it creates denser levels of smog in higher temperatures, could save families 10 cents a gallon.
“ Homegrown Iowa biofuels provide a quick and clean solution for lowering prices at the pump, and bolstering production would help us become energy independent once again, ” the Iowa Republican senator Chuck Grassley said, according to the Associated Press.
Grassley was among nine Republican and seven Democratic senators from midwestern states who sent Biden a letter last month urging him to allow year-round E15 sales, the AP said.
Industry groups, however, doubt the impact of the plan. E15, they say, will be available only at about 2,300 of the nation’ s more than 100,000 gas stations, concentrated in the Midwest and the South, including Texas.
8.07pm BST 20:07
Three former Minneapolis police officers facing state charges over George Floyd’ s death have rejected a plea deal with prosecutors, the Minnesota attorney general’ s office told CNN.
Tou Thao, J Alexander Kueng and Thomas Lane are scheduled to stand trial in June charged with aiding and abetting convicted murderer and fellow former Minneapolis officer Derek Chauvin while he knelt on Floyd’ s neck for nine minutes in May 2020.
Floyd’ s death sparked protests across the US and other countries through the summer of 2020, and contributed to the rise to prominence of the Black Lives Matter movement.
Chauvin was sentenced to 22.5 years for second degree murder after his trial last summer, while Thao, Kueng and Lane are free on bail following their conviction in February on federal charges of violating Floyd’ s civil rights.
According to CNN, the officers were offered the plea deals on 22 March, the Minnesota attorney general’ s office said. No details of the proposed plea deals have been made public, although they are expected to be revealed when the state trial gets under way.
CNN said it had contacted lawyers for all three former officers. Tom Plunkett, attorney for Kueng, declined to share details on why the offer was rejected. The network did not hear back from attorneys for the other two.
7.46pm BST 19:46
The South Dakota attorney general Jason Ravnsborg has been suspended pending the outcome of a state senate trial, after he was impeached Tuesday by the state’ s legislature over a fatal 2020 road accident in which he originally claimed he had hit a deer.
Ravnsborg was fined $ 1,000 plus court costs, but avoided jail time last year when he pleaded no contest to two misdemeanor traffic charges in the death of pedestrian Joseph Boever, 55, as he drove home from a political event.
Investigators said the attorney general was browsing political websites immediately before the collision, and that he called 911 to say he had struck a deer. Boever’ s body was found the next day, and his cellphone was discovered inside Ravnsborg’ s car.
On Monday night, Ravnsborg wrote to lawmakers urging them to vote against impeachment, the Associated Press reported.
But in a 36-31 vote, the House rejected the recommendation of a GOP-backed majority report from a special investigative committee and sided with the state’ s Republican governor Kristi Noem, who said Ravnsborg was guilty of lying to investigators.
Democrats also had pushed for impeachment, arguing that he was not “ forthcoming ” to law enforcement officers and had abused the power of his office, the AP reported.
7.21pm BST 19:21
The White House has set out some details of Joe Biden’ s upcoming address in Iowa, where he will speak at a bioprocessing plant in rural Menlo later today about measures to combat soaring inflation and reduce the price of gas at the pump.
“ The administration’ s strategy to spur the development of homegrown biofuels is critical to expanding Americans’ options for affordable fuel in the short-term and to building real energy independence in the long-term by reducing our reliance on fossil fuels, ” a fact sheet released by the White House says.
To that end, Biden will announce that the environmental protection agency ( EPA) will issue an emergency waiver allowing E15 gasoline, fuel containing 15% ethanol, to be sold during the summer.
In ordinary times, sales of E15, which the White House says is on average 10 cents a gallon cheaper than regular gas, but which some analysts say is more harmful to the environment because of its smog-producing ingredients, is not permitted in the summer months.
“ An emergency waiver can help increase fuel supplies, give consumers more choice to get lower prices, and provide savings to many families, ” the White House release says.
“ Allowing higher levels of blending will also reduce our dependency on foreign fuels as we rely more heavily on home-grown biofuels. This will help us bridge towards real energy independence. ”
The president will also expand on his administration’ s financial investment in alternative energy, including more than $ 800m for the biofuel industry from pandemic assistance programs.
Biden has attracted criticism for expanding the fossil fuel industry, despite his investments in green energy. In this opinion piece for the Guardian last month, climate scientist and author Peter Kalmus took the administration to task:
6.58pm BST 18:58
Jen Psaki also spoke briefly about the New York subway attack, confirming that White House “ senior staff ” were in contact with officials in Brooklyn, and that Joe Biden was being kept informed of developments.
There was a possibility the president would speak later in Iowa about the situation, she said.
“ We’ ve offered everything we can provide, ” Psaki said, noting that Biden’ s senior aides had spoken directly with the New York mayor Eric Adams and city police commissioner Keechant Sewell.
“ I just spoke with the president about it earlier on the plane and he reiterated his request… anything they need, anything they want, we are here to help them and provide that to them, ” she said.
6.43pm BST 18:43
The White House has announced that Joe Biden spoke by phone with the British prime minister Boris Johnson earlier today, affirming their “ commitment ” to support Ukraine.
Few details were contained in the readout of the call, which the White House press secretary Jen Psaki announced during Biden’ s flight to Iowa, where he will later speak about inflation and reducing gasoline prices.
The statement said:
President Joseph R. Biden, Jr. spoke today with Prime Minister Boris Johnson of the United Kingdom about the Prime Minister’ s recent visit to Ukraine. The leaders affirmed their commitment to continue providing security and humanitarian assistance to Ukraine in the face of ongoing atrocities by Russia.
They also welcomed ongoing cooperation with allies and partners to impose severe costs on Russia for its unprovoked and unjustified war.
Psaki was asked about Ukraine during a press “ gaggle ” aboard Air Force One, her answers barely decipherable on the extremely broken live audio feed.
She said there had been “ no confirmation ” of earlier reports that Russia had used a chemical weapon in eastern Ukraine, but that the Biden administration expected the Russian president Vladimir Putin to step up his military’ s attacks in the east, following their withdrawal from around the capital Kyiv.
“ We expect Russia will continue to launch air and missile strikes to the rest of the country to cause military and economic damage and cause terror, because Russia’ s goal in the end is to weaken Ukraine as much as possible, ” she said, pledging a continuation of US support in humanitarian aid and weapons systems.
“ We also expect that this stage of the conflict could last a long time. We should have no illusions that Russia will adjust tactics. So of course the focus is on continuing to provide a range of security assistance. We essentially look at and review requests made by Ukrainian leaders. ”
Updated at 6.48pm BST
6.10pm BST 18:10
Sam Levine
In one of the final acts in a 24-year political career, the Republican chief justice of the Ohio supreme court is defying her party and refusing to let them distort electoral districts to their advantage, a move that has some fellow Republicans calling for her impeachment.
Full story:
5.44pm BST 17:44
It’ s been a busy Tuesday so far. Here’ s where things stand midway through the day:
Updated at 5.48pm BST
5.21pm BST 17:21
Robert Reich
The Russian people know little about Vladimir Putin’ s war on Ukraine because Putin has blocked their access to the truth, substituting propaganda and lies.
Years ago, pundits assumed the internet would open a new era of democracy, giving everyone access to the truth. But dictators like Putin and demagogues like Donald Trump have demonstrated how naive that assumption was.
At least the US responded to Trump’ s lies. Trump had 88 million Twitter followers before Twitter took him off its platform – just two days after the attack on the Capitol, which he provoked, in part, with his tweets. ( Trump’ s social media accounts were also suspended on Facebook, YouTube, Instagram, Snapchat, Twitch and TikTok.)
These moves were necessary to protect American democracy. But Elon Musk – the richest man in the world, with 80 million Twitter followers – wasn’ t pleased. Musk tweeted that US tech companies shouldn’ t be acting “ as the de facto arbiter of free speech ”.
Musk continues to tell his 80 million followers all sorts of things. I disagree with many of his positions, but ever since I posted a tweet two years ago criticizing him for how he treated his Tesla workers he has blocked me – so I can’ t view or post criticisms of his tweets to his followers.
Seems like an odd move for someone who describes himself as a “ free speech absolutist ”. Musk advocates free speech but in reality it’ s just about power.
Read on:
4.58pm BST 16:58
Martin Pengelly
Donald Trump is “ very intent on bringing my brother down ”, Joe Biden’ s sister said.
“ The only race I wasn’ t enthusiastic about Joe getting involved in was the 2020 presidency, ” Valerie Biden Owens told CBS News.
“ Because I expected, and was not disappointed, that it would be ugly and mean, and it would be an attack on my brother, Joe, personally and professionally, because the former president is very intent on bringing my brother down. ”
A year and a half into his presidency, Biden is battling crises at home including inflation and the coronavirus pandemic and abroad, over the Russian invasion of Ukraine.
Trump dominates the Republican party, propagating the “ big lie ” about voter fraud in his defeat by Biden which fueled the January 6 attack on the US Capitol, continuing to attack Biden as incapable of the demands of office, flirting with a third White House run and dispensing endorsements to candidates in the midterm elections.
On Sunday, the Republican House minority leader, Kevin McCarthy, claimed Republicans would not swiftly impeach Biden “ for political purposes ”, should as expected the party take the House in November.
Biden Owens helped raise her brother’ s children after his first wife and daughter were killed in a car crash and has worked on all his campaigns. She has written a book called Growing Up Biden: A Memoir.
“ I assumed from the beginning that the former president and his entourage would attack my brother by going and attacking my family, ” she said.
Read more here:
4.47pm BST 16:47
A vast majority of Americans no longer consider the Covid-19 pandemic a ‘ crisis’, according to an Axios-Ipsos poll published on Tuesday.
Instead, more than three-quarters of the population think coronavirus is a “ manageable problem, ” while one in six people do not consider it a problem at all, the poll found.
The news that fewer than one in 10 Americans thinks the pandemic is still a crisis comes as the Covid-19 subvariant BA.2 continues to spread across the nation, and Philadelphia became the first major city in the US to reimpose an indoor mask mandate.
CDC figures show daily case numbers beginning to increase again after a massive fall following the Omicron variant peak at the beginning of this year.
“ People aren’ t following the Covid case numbers on a daily basis, ” Ipsos pollster and senior vice president Chris Jackson said.
“ People see coverage and... assume the trend line is continuing even if it doesn’ t. ”
Read more:
Updated at 6.24pm BST
4.28pm BST 16:28
The Oklahoma governor Kevin Stitt has signed a law that makes it a felony to perform an abortion, punishable by up to 10 years in prison, further advancing the push in numerous Republican states to curtail or eliminate abortion rights.
Legal challenges are certain to follow as the law, approved by state legislators a week ago, is set to take effect 90 days after the state’ s legislature adjourns next month. That will likely be ahead of the expected decision by the US supreme court this summer that could overturn the landmark 1973 Roe v Wade ruling that protected a woman’ s right to the procedure.
“ We want to outlaw abortion in the state of Oklahoma, ” Stitt said during a signing ceremony for the bill, flanked by anti-abortion lawmakers, clergy and students, according to the Associated Press.
“ I promised Oklahomans that I would sign every pro-life bill that hits my desk, and that’ s what we’ re doing here today. ”
Under the bill, anyone convicted of performing an abortion would face up to 10 years in prison and a $ 100,000 fine. It does not authorize criminal charges against a woman for receiving an abortion, the AP said.
Read more here:
4.05pm BST 16:05
New York’ s lieutenant governor Brian Benjamin was arrested Tuesday for bribery and wire fraud, among other charges, as part of a federal corruption investigation.
The US attorney’ s office in Manhattan unsealed an indictment accusing Benjamin, a Democratic former state senator, of conspiring to obtain campaign contributions from a real estate developer in exchange for helping guide a $ 50,000 grant to a nonprofit the developer controlled, according to the Associated Press.
Benjamin turned himself in this morning, and is expected to appear in federal court in New York City later today, NBC News reported.
The investigation by the FBI and federal prosecutors in Manhattan has been ongoing since at least November, according to WNBC New York, two months after he joined the administration of the incoming New York governor Kathy Hochul.
The channel said the inquiry was sparked by the indictment for fraud and identity theft of developer Gerald Migdol, Benjamin’ s long-term fundraiser, last year.
The Harlem state senator was, at that time, “ not suspected ” of any wrongdoing, prosecutors said.
Today’ s indictment alleges that Benjamin and Migdol: “ falsified campaign donor forms, misled municipal regulators and provided false information in vetting forms Benjamin submitted while he was being considered to be appointed as lieutenant governor. ”
A spokesperson for Benjamin has been approached for comment, CNN said, adding that Damian Williams, US Attorney for the Southern District of New York, is expected to hold a press conference later.
3.44pm BST 15:44
Joe Biden has been briefed on Tuesday’ s subway shooting in New York city, the White House press secretary Jen Psaki has said.
According to her tweet, sent as the president prepares to travel to Iowa later this morning aboard Air Force One to give an address on inflation, Biden’ s aides have spoken with the New York mayor Eric Adams and police commissioner Keechant Sewell.
@ POTUS has been briefed on the latest developments regarding the New York City subway shooting. White House senior staff are in touch with Mayor Adams and Police Commissioner Sewell to offer any assistance as needed.
“ White House senior staff are in touch with Mayor Adams and Police Commissioner Sewell to offer any assistance as needed, ” Psaki wrote.
Read more here:
3.25pm BST 15:25
David Smith
“ I haven’ t been in court for a few years, so excuse me if I’ m a bit rusty, ” said Doug Emhoff. “ You know, not too much has changed in my life – except for the Secret Service, Air Force Two, the selfies, the cameras following me everywhere, and oh: my wife is the vice-president of the United States. ”
The theatre erupted in whoops and clapping. Kamala Harris, sitting in the fifth row with her sister Maya, blew kisses through a black face mask and applauded her husband.
It was one of those only-in-Washington moments. On Monday, the Shakespeare Theatre Company hosted a “ mock trial ” inspired by William Shakespeare’ s romantic comedy Much Ado About Nothing and presided over by retiring supreme court justice and good sport Stephen Breyer.
Much Ado is best known for Beatrice and Benedick, two proud intellects who only fall in love after others play Cupid. That seemed fitting for Harris and Emhoff, who were set up on a blind date by a mutual friend and married just shy of their 50th birthdays.
But the question before the not-so-serious court was: should Margaret be held liable for Don John’ s defamation of Hero? Emhoff, who was a prominent entertainment lawyer for nearly 30 years, was lead advocate on Margaret’ s behalf.
The event, full of inside-the-Beltway topical gags, had been due to take place last month but was postponed after the second gentleman came down with coronavirus.
“ I thank your honours for granting my motion for a continuance due to plague, ” began Emhoff, wearing a dark suit, blue shirt and blue tie, and standing at a lectern under bright stage lights. “ The White House apothecary told me my symptoms would be wild but – whew! ”
The mock trial is a longstanding Shakespeare Theatre Company tradition but had gone virtual for the past couple of years, due to the pandemic. Monday marked a return to an in-person audience at the Sidney Harman Hall but it was also livestreamed.
Emhoff, an amiable and slightly goofy presence, remarked: “ My parents tonight are watching the livestream but I might have told them that I was arguing in front of the United States supreme court so, cameraperson, can you just keep a very tight shot …? ”
Read David Smith’ s sketch here:
3.05pm BST 15:05
Barack Obama is offering thoughts on the war in Ukraine, telling NBC in an interview to air Wednesday that “ the danger was always there ” in terms of Russian president Vladimir Putin’ s “ recklessness ”.
The network launched a teaser of the 44th president’ s remarks this morning, interviewer Al Roker noting that Obama was in the White House when Putin annexed Crimea in 2014.
According to the former president:
Putin has always been ruthless, against his own people as well as others. He has always been somebody who’ s wrapped up in this twisted, distorted sense of grievance and ethnic nationalism. That part of Putin has always been there.
What we have seen, with the invasion of Ukraine, is him being reckless in a way that you might not have anticipated eight, 10 years ago, but you know, the danger was always there.
Obama’ s stance towards Putin over his two terms of office has long been the subject of discussion. An interesting analysis published by the New York Times magazine quotes Fiona Hill, a former Russia adviser for multiple presidents, as not being particularly complimentary.
“ He either didn’ t understand the man or willfully ignored the advice, ” Hill said after Obama described Putin as “ looking like the bored kid in the back of the classroom ” at a 2013 news conference.
“ We said openly, ‘ Don’ t dis the guy - he’ s thin-skinned and quick to take insults’, ” Hill said.
In the NBC News interview, which will air tomorrow morning on the Today show, Obama likens events in Ukraine to attacks on democracy globally, including in the US:
What we’ re seeing consistently is a reminder of why it’ s so important for us not to take our own democracy for granted. Why it’ s so important to stand for and align ourselves with those who believe in freedom and independence. I think the current administration is doing what it needs to be doing.
Other topics that the interview will cover, according to Roker: Obama’ s recovery after he tested positive for Covid-19 last month, and the former president’ s advice on “ becoming an empty nester ” after daughters Malia and Sasha left home.
2.33pm BST 14:33
Dominic Rushe
Prices in the US climbed at their highest rates since 1981, rising 8.5% over the year to the end of March as the war in Ukraine drove up energy costs for Americans, the labor department announced on Tuesday.
The latest Consumer Price Index ( CPI) – which measures the prices of a basket of goods and services – comes after the index rose by 7.9% in the year through February, the fastest pace of annual inflation in 40 years.
Driven up by continuing supply chain issues, soaring demand and rising energy prices, inflation is now at levels unseen in the US since Ronald Reagan took the White House from Jimmy Carter.
The price increases are broad – with the cost of rent, gas and food causing particular hardship for lower income Americans and are a major blow to the Biden administration, already facing tough odds of retaining control of Congress in November’ s midterm elections.
Soaring gas prices were the main driver of the rise. The gasoline index rose 18.3% in March and accounted for over half of the all items monthly increase. Gas prices have begun to fall, in a sign that some economists have argued may suggest inflation has reached its peak.
The White House warned it was expecting a bad set of figures ahead of the report. On Monday White House press secretary, Jen Psaki, told reporters that the labor department’ s previous report had not included the majority of the jump in oil and gas costs caused by the Kremlin’ s invasion of Ukraine.
“ We expect March CPI headline inflation to be extraordinarily elevated due to Putin’ s price hike, ” Psaki said.
Read more here:
2.25pm BST 14:25
Good morning, welcome to the US politics blog, and happy Tuesday.
It’ s not quite so happy for Joe Biden, given the soaring inflation figures released this morning but, as they say, he has a plan. The president is traveling to rural Iowa today and will announce later “ actions to lower costs for working families, reduce the impact of ‘ Putin’ s Price Hike’ and ‘ Build a Better America’, ” which is expected to include new measures to help reduce gas prices.
The Guardian’ s live 24-hour news blog is running here to bring you all the developments in the Russia-Ukraine war.
And here’ s what else we’ re watching in the US today: | general |
‘ Person of interest’ named in NYC subway shooting that wounded 10 people, injured 13 others | New York City police named a `` person of interest `` in the shooting Tuesday morning aboard a subway train in Brooklyn.
Ten people were shot and 13 others were injured after a man wearing a gas mask threw two smoke canisters and then opened fire aboard a subway car on the N train as it approached the 36th Street Station in Brooklyn during the morning rush hour, authorities said.
New York Police Chief of Detectives James W. Essig said at a news conference Tuesday night that Frank R. James, 62, rented a U-Haul van, the keys of which were found at the scene of the shooting in Brooklyn's Sunset Park neighborhood.
`` We are looking for Frank James, '' he said. `` We know he rented that U-Haul van. ''
James, who has addresses in Wisconsin and Philadelphia, was not named as a suspect, and detectives want to determine whether he witnessed the attack, Essig said. The van was rented in Philadelphia, he said.
More from NBC News:
Police said they were looking into social media posts from someone with the same name that mentioned homelessness, New York and Mayor Eric Adams, leading officials to beef up the mayor's security detail.
The shooter set off two smoke canisters and opened fire with a Glock 9 mm handgun, shooting 33 rounds that struck the 10 gunshot victims, authorities said.
Investigators later recovered from the subway station a gun with a magazine attached, two additional magazines, ammunition, a hatchet and a container of what is believed to be gasoline, New York Police Commissioner Keechant Sewell said at the news conference.
Any possible motive was unknown.
The attack triggered a massive law enforcement response, and a manhunt continued into Tuesday evening.
Police had said they were looking for a man believed to be about 5-foot-5 and 180 pounds who was wearing a green construction vest during the attack.
`` This person is dangerous, '' New York Gov. Kathy Hochul said at a news conference Tuesday.
The FBI and the Bureau of Alcohol, Tobacco, Firearms and Explosives have joined in the investigation.
The chaos, which was caught on video and photos, started at 8:24 a.m., Sewell told reporters.
`` The suspect was in the train car. The shooting began in the train car, '' she said. `` As the train was pulling into the station, the subject put on a gas mask. He then opened a canister that was in his bag, and then the car began to fill with smoke. After that he began shooting. ''
None of the wounded have life-threatening injuries, and the attack isn't being considered an act of terrorism, authorities said.
However, Adams said he considered the attack to have been an act intended to bring terror to subway riders.
`` Any time you have a person that uses a smoke device, you have a person who discharges a weapon in the system, that appeared to place a gas mask on his face, that is a person that is intentionally trying terrorize our system, '' Adams told MSNBC.
Adams, a former police officer elected to office by voters with an increased fear of crime, said he would significantly boost police presence on the rails.
`` What we're going to do to help... [ to ] ease some of the apprehension. We're going to double our enforcement, '' he said. `` We're keeping our day tour police officers to complement the 4-to-12-tour police officers. ''
Before the U-Haul van was located on Kings Highway in Brooklyn early Tuesday evening, police said additional evidence, including a bag that contained additional smoke canisters and retail fireworks, was discovered at the subway station and could be connected to the attack, law enforcement sources told NBC New York.
The gun that was used jammed during the attack, possibly limiting injuries, the sources said.
Passengers, including some of the wounded, stumbled out of the train, with a few of them boarding an R train across the platform to get away, witnesses and law enforcement sources told NBC New York.
In addition to the 10 people who were shot, 13 others were hurt in the rush to get away from the N train, the New York Fire Department said.
The injuries for the latter 13 were related to inhalation of canister smoke, tripping or falling while fleeing or panic attacks, Essig, the chief of detectives, said Tuesday night.
Investigators believe they have images of the gunman taken from nearby businesses — but a security camera in the station is broken, law enforcement sources told NBC New York.
Police explained at the evening news conference that the camera was nonfunctional as a result of user error, as someone had failed to switch frequencies, from UHF to VHF, or vice versa, so its images could be transmitted and stored.
Essig said hundreds of detectives were combing through other security video to determine whether it recorded imagery of the shooter.
Authorities also said no officers were at the 36th Street subway station when the shooting happened: They're not assigned there at all hours, but they are often there.
Commuter Kenneth Foote-Smith said the scene was `` like a horror movie. ''
He said he heard shots coming from a neighboring car as it filled with smoke. Adding to the panic, riders fleeing the smoke-filled car couldn't get into his car for safety because of a jammed door, Foote-Smith said.
The train stopped just short of the station, presumably for a red light, leading to more panic.
`` We can't even see the faces of the people in the train car anymore, '' Foote-Smith told NBC New York.
`` We luckily pull up to the station very shortly after that. And we all run out once the doors open, and it's absolute bedlam. There's people fleeing up the stairs. Luckily an R train pulled up. There's people running into the R train. ''
The fire department initially reported that several undetonated devices were found at the scene, but the police department said later that no `` active explosive devices '' were immediately found.
Several commuters posted images of bloodshed and smoke in the subway station immediately after the attack.
The station is a busy hub, and service was disrupted for hours.
Mobile phones across the five boroughs buzzed hours after the incident, telling New Yorkers to stay away from the Sunset Park neighborhood.
Several schools were put on lockdown, and most stores in the neighborhood evacuated.
President Joe Biden said his staff is in touch with New York City authorities and pledged federal help in bringing the gunman to justice.
`` My wife, Jill, and I are praying for those who are injured and all those touched by that trauma, '' Biden said in Menlo, Iowa.
`` And we're grateful for all the first responders who jumped in action, including civilians, civilians who didn't hesitate to help their fellow passengers and tried to shield them. ''
Tuesday's bloodshed comes as New York City companies and employees struggle with return-to-office debates and whether workers should be forced back to offices they 've barely seen over the last two years because of the Covid-19 pandemic.
Hochul, the governor, said: `` This morning, ordinary New Yorkers woke up in anticipation of a relatively normal day. They left their homes, they went to school, they went to their jobs.
`` That sense of tranquility and normalness was disrupted, brutally disrupted, by an individual so cold-hearted and depraved of heart that [ he ] had no caring about the individuals that they assaulted as they simply went about their daily lives. '' | business |
Broadcom adds speed and reliability with Wi-Fi 7 chipsets | We are excited to bring Transform 2022 back in-person July 19 and virtually July 20 - 28. Join AI and data leaders for insightful talks and exciting networking opportunities. Register today!
In a move that the company says will more than double the speed of current Wi-Fi 6 and Wi-Fi 7 performance, Broadcom has announced the availability of chipset solutions for the Wi-Fi 7 ecosystem ( product details below). This will greatly improve the user experience by delivering reliable, low-latency communications and extended range. It doubles Wi-Fi channel bandwidth with the introduction of 320 MHz channels.
“ Wi-Fi 7 will be beneficial everywhere, from [ the ] general enterprise space for better virtual meetings with video to any vertical market requiring higher data rates and/or more reliable connectivity, ” said Phil Solis, an analyst at IDC. “ It adds value to many different product types and especially to primary devices such as smartphones that have the combination of heavy volume and heavy data usage across a wide variety of applications in both consumer and enterprise settings. ”
Demand for high-performance Wi-Fi has accelerated since COVID-19 served as a catalyst to work-from-home. People are keen to take advantage of the steady improvement in features and performance offered by Wi-Fi networks over the past decade.
Wi-Fi 4 provided basic features for internet and multi-device homes, but lacked enterprise capabilities. Wi-Fi 5 not only solved the exploding need for consumer/home video consumption, it provided enough bandwidth, resilience and speed to make wireless communication attractive for businesses. But the growth of bidirectional video applications such as WhatsApp and WebEx and social media videos from TikTok and Facebook Live called for a redesign.
Wi-Fi 6 streamlined wireless transmissions and improved uploads. Such was its popularity that regulatory efforts against unlicensed access brought about Wi-Fi 6E, which boosted performance yet again. As a result, 60% of consumers upgraded their home Wi-Fi in 2021 and 75% plan to purchase additional Wi-Fi devices in 2022, according to Comcast’ s Wi-Fi Trends Report. Broadcom benefitted, too. It has shipped over a billion Wi-Fi 6 and 6E devices since 2019.
10G broadband is coming soon. It will drive further demand for high-speed wireless offering data at low, deterministic latencies across the home or office. Thus, wireless networks are gearing up to be able to connect large numbers of devices in one locale without a loss in performance.
Enter Wi-Fi 7 as the bridge between mobile devices and multi-gig broadband for homes, event venues and offices. In combination with the impending launch of Automatic Frequency Coordination ( AFC), Wi-Fi 7 uses optimal spectrum allocation to enable high-power access points and extends the 6 GHz transmit range in both indoor and outdoor environments.
Broadcom’ s Wi-Fi 7 design with native AFC makes is said to offer up to 63 times more transmit power than low power indoor 6 GHz Wi-Fi devices.
“ Wi-Fi 7 improves network capacity and latency performance, both of which are as important for enterprise deployments as for residential access, ” said Vijay Nagarajan, vice president, Wireless Connectivity Division at Broadcom. “ Together with AFC, Wi-Fi 7 will now bring the ability to operate in 6 GHz bands both indoors and outdoors. Venues, office buildings, hospitals and other dense environments will all benefit from these improvements. ”
He added that Wi-Fi 7 bridges mobile devices and multi-gig broadband entering homes. Wi-Fi 7’ s focus on speeds, latency and de-congesting network performance is in line with connectivity improvements across the digital value chain.
“ This meets the demanding trends evolving from a mixed-mode work office where you see greater collaboration over the Internet, ” said Nagarajan. “ Applications using augmented reality and virtual reality for rendering, diagnostics and training are expected to become more mainstream as Wi-Fi 7 is made available. ”
Those bringing this technology into a business setting are likely to need upgrades to complement Wi-Fi 7. As well as upgrading routers and access points, there will be a need for more data storage, cloud resources and network edge servers, devices and networking.
With the rise of remote and home-based work, as well as growing demand for immersive gaming and streaming in the consumer sphere, Wi-Fi 7’ s 320 MHz channels, together with 4096-QAM modulation, more than double the throughput of Wi-Fi 6E for residential customers.
“ Enterprise settings will benefit from Wi-Fi 7’ s faster speeds and lower latencies from the improved specification, heavy use of the large 6 GHz band and backwards compatibility with Wi-Fi 6 and 6E, ” said Solis. “ More importantly, network capacity will be much more deterministic because there is more spectrum across the three bands and especially the 6 GHz band, there is more efficient use of non-contiguous pieces of spectrum and different access points can use the same channels at the same time. ”
Enterprise and residential networks will also find value in the advanced multi-link operation ( MLO) capabilities of Wi-Fi 7. MLO enables devices to aggregate channels and switch rapidly between channels. This opens the door to guaranteed commercial-grade quality of service. A higher percentage of organizational data has much lower latency than with prior Wi-Fi generations.
In a high-density, congested network, the device load gets balanced across multiple channels. Each device is optimized for congestion and capacity improves by up to five times for congested networks, compared to Wi-Fi 6. Further, Wi-Fi becomes capable of serving a time-sensitive networks for industrial and internet of things ( IoT) applications, as well as video streaming and applications that require reliability in congested environments.
“ The performance metrics for Wi-Fi 7 — speed, latency and determinism — solve the edge connectivity challenge with many devices competing for airtime with relatively low-latency, high-data needs, ” said Nagarajan. “ With Wi-Fi 7, our partners have inspired products and applications for immersive gaming experiences in the backyard, job training in the comfort of [ a ] living room, real-time fan experiences that make you feel like you’ re there — all while smart speakers, security cameras, sprinkler systems and 4K/8K TVs are connected to the home network. Further, Wi-Fi 7’ s focus on low latency, high reliability and high-speed communication can power bandwidth-intense applications in hospitals, stadiums, office buildings, hotels and beyond. ”
Solis added that two separate connections can be made between the client and access point for increased speed and reliability – one link might have a little interference while the other is stable – or the device can connect to an access point and a peripheral ( AR headset for example) at the same time.
“ This is something that has existed in Wi-Fi for a while but will be standardized and improved upon, ” said Solis.
Rather than release a few Wi-Fi 7 tools, Broadcom has announced a family of available connectivity solutions for residential ( BCM67263, BCM6726), enterprise ( BCM43740, BCM43720) and client devices ( BCM4398).
The BCM67263 for the residential Wi-Fi access point market includes the following features:
The BCM6726 is optimized for the residential Wi-Fi access point market. Key features include the following
The BCM43740 for the enterprise Wi-Fi access point market includes the following:
The BCM43720 for the enterprise Wi-Fi access point market includes the following:
The BCM4398 is an integrated Wi-Fi 7 and Bluetooth 5 combo chip for mobile handset applications. Key features include:
Broadcom has begun sampling these Wi-Fi 7 chips to early access partners and customers in retail, enterprise and smartphone, service provider and carrier segments. Meanwhile, companies such as Arcadyan, Asus, Extreme Networks, NetGear, Sagemcom, Sercomm, Technicolor Connected Home and TP-Link have announced products such as routers, gateways, access points and client devices that support these new Wi-Fi 7 Broadcom chipsets.
“ We forecast that in five years, Wi-Fi revenue will exceed that of any other Wi-Fi technology, ” said Chris DePuy, an analyst at 650 Group. “ Wi-Fi 7 takes advantage of the new 6 GHz spectrum. The emergence of 6 GHz is so compelling that we expect well over half of the revenues for both the consumer and enterprise markets to come from Wi-Fi systems based on 6 GHz devices. ”
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How MxD is Using Supply Chain Issues to Predict Future Risks | How MxD is Using Supply Chain Issues to Predict Future Risks | designnews.com
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Organizations can use a unified system to fix and improve the supply chain to offset time and costs.
More than two years into the COVID-19 pandemic, and while organizations are working hard to resolve the supply chain problems impacting the United States and the rest of the world, global disruption persists and has impacted nearly every industry.
, is dedicated to identifying how organizations can bolster supply chains to lessen the severity and duration of future shortages. He has created several supply chain projects that optimize secured data sharing and artificial intelligence ( AI) to predict how supply chains can be affected by future situations.
MxD, located in Chicago, has a cutting-edge innovation center with a 22,000 square foot factory floor for demonstrating and experimenting with digital manufacturing and cybersecurity.
is confirmed to participate in a keynote panel with three of his peers this week at IME West. He will break down how organizations can use a unified system to fix and improve the supply chain to offset time and costs. Along with improved infrastructure, he expects the economy to thrive under these new implementations, even in the face of something unprecedented like a pandemic.
Design. Engineer. Build. Conference
, slated to take place from April 12 to 14 at the Anaheim Convention Center, facilitates new product and technology discovery and advances the multi-billion-dollar manufacturing industry. Attendees can meet with peers and uncover the latest trends, technologies, and solutions under one roof while expanding their technical know-how through robust educational programming featuring dozens of expert-led panels.
With the event kicking off this week, I had the pleasure of speaking with Berardino; we discussed how organizations can move forward amid today’ s supply chain challenges and how he envisions MxD staying ahead of the curb to handle any future disruptions of this magnitude.
I am the vice president of projects and engineering for MxD. In this role, I work closely with MxD’ s partners and internal teams to develop, test and commercialize advanced Industry 4.0 concepts and manufacturing technologies to increase innovation, capacity, and efficiency among U.S. manufacturers. In addition, I oversee MxD Cyber, which seeks to raise the cybersecurity profile of small and medium manufacturers to strengthen America’ s supply chain and MxD Learn, which aims to develop the manufacturing workforce of the future through a series of new skilling, re-skilling, and up-skilling cybersecurity and advanced manufacturing curriculum programs.
I have over 25 years of diverse experience, including recent roles as senior director of technology strategy for MxD, CEO of Potentia Analytics – an AI healthcare startup – and general manager of Freescale Semiconductor’ s multimedia applications division. Prior to these roles, I led the strategy, marketing, and business development team for Freescale’ s wireless and mobile systems group. I began my career with Metrowerks Corporation, a leading provider of software development tools, where I led engineering through its growth from a startup to a public organization through acquisition by Motorola Corporation. I received my Bachelor of Mechanical Engineering ( Honors) from McGill University.
The COVID-19 pandemic has deepened the urgency and imperative for a secure, resilient, and robust supply chain. For MxD and our members, the COVID pandemic has only increased the sense of urgency around accelerating the use of these technologies so manufacturers can restart and thrive as the economy recovers. We know that expanding predictability into the manufacturing supply chain is more critical now than ever.
To date, MxD has funded 12 supply chain projects, including Supply Chain Risk Alert ( SCRA) and Supply Chain Risk Alert 2 ( SCRA2). MxD’ s active supply chain projects focus on increased supply chain visibility, secure data sharing, and artificial intelligence to predict future supply chain risks.
SCRA developed a rapid analysis tool that provides policymakers and supply chain leaders an ability to efficiently assess a wide range of value chain designs for pandemic scenarios to optimize supply chain resiliency and agility during an emergency, so it is directly drawing from Industry 4.0 principles.
For SCRA2, MxD, along with industry partners, aims to develop a supply chain illumination and risk management middleware platform that provides policymakers and supply chain leaders the ability to understand who is in their supply chain and efficiently assess a wide range of potential and existing risks to their supply chain. The platform allows supply chain leaders to analyze the value chain designs of risk scenarios to optimize supply chain resiliency and agility during an emergency.
The tool developed through this project can modernize manufacturing for critical items such as medical device parts and help the Department of Defense and key manufacturing sectors map existing supply chains to identify vulnerabilities, foreign dependencies, and single-source suppliers. It also provides a pathway to identify alternate or indirect suppliers and model “ what if ” scenarios involving alternate supply chains to assess the benefit versus the risk of potential changes. This tool enables manufacturers to make data-informed decisions in times of crisis or urgency and minimize the impact on production capabilities.
DERISC, which stands for Digital Education, Resilience, and Innovation for Supply Chain, is another important initiative that aims to provide U.S. manufacturers with a unified and systematic approach to renewing and securing their supply chains by providing the tools, protocols, skills, and information they need to undertake a secure digital transformation.
DERISC brings three components ( 10K Manufacturers Awareness Campaign, MxD Cyber Marketplace, and MxD Learn Virtual Training Center) together in a comprehensive manner and lays out a clear path for how MxD, the national leader in digital manufacturing and cybersecurity for manufacturing, will leverage its assets to inform, empower and train U.S. manufacturers and their workforce to lead in the opportunities and challenges they face today and in the years to come.
DERISC establishes the foundation of a unique offering by empowering thousands of manufacturers to update and secure their supply chains.
Attendees can look forward to learning about the different ways we can approach fixing and improving the supply chain. We will be discussing how to approach global risk management and resiliency with a focus on governmental policies and the impact on internal finances and manufacturing quality control. The other keynote panelists and I will also address how data and the automation of technologies, predictive maintenance, robotics, and virtualization can provide solutions to small and medium manufacturers.
I will also touch on the nuances of reshoring and how it can benefit the supply chain. The COVID-19 pandemic amplified some problems that already existed. An increased interest in where our products come from indicates a greater awareness and appetite for reshoring manufacturing. Reshoring hinges on training and upskilling the workforce and coordinated investment and planning across the public and private sectors. We can not sit here and watch foreign governments make considerable investments in their manufacturing sectors and expect to compete without the same magnitude of resources.
The U.S. should also explore shortening the supply chain's length by conducting as much manufacturing as possible here.
The supply chain is too opaque; many manufacturers don’ t know where all their outsourced parts are coming from nor where to turn if that supply is interrupted.
I am excited to be in person with my peers and be a part of this esteemed panel. As we know, the pandemic has impacted not only the supply chain but also the ability to gather in-person to hold these types of events.
This panel and conference are terrific opportunities to be among peers and like-minded individuals working toward similar goals. It is a space to share and exchange ideas for the greater cause.
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Consumer prices rose 8.5% in March, slightly hotter than expected and the highest since 1981 | Prices that consumers pay for everyday items surged in March to their highest levels since the early days of the Reagan administration, according to Labor Department data released Tuesday.
The consumer price index, which measures a wide-ranging basket of goods and services, jumped 8.5% from a year ago on an unadjusted basis, above even the already elevated Dow Jones estimate for 8.4%.
Excluding food and energy, so-called core CPI increased 6.5% on a 12-month basis, in line with the expectation. However, there were signs that core inflation appeared to be ebbing, as it rose just 0.3% for the month, less than the 0.5% estimate. That in turn sparked some hope that inflation overall was easing and that March might represent the peak.
Markets reacted positively to the report as stocks rose and government bond yields declined.
`` The big news in the March report was that core price pressures finally appear to be moderating, '' wrote Andrew Hunter, senior U.S. economist at Capital Economics. Hunter said he thinks the March increase will `` mark the peak '' for inflation as year-over-year comparisons drive the numbers lower and energy prices subside.
Federal Reserve Governor Lael Brainard said the slowing increase in core CPI is a `` welcome '' development in the effort to bring down inflation.
`` `` I 'll be looking to see whether we continue to see moderation in the months ahead, '' Brainard told the Wall Street Journal.
The data reflected price rises not seen in the U.S. since the stagflation days of the late 1970s and early '80s. March's headline reading in fact was the highest since December 1981. Core inflation was the hottest since August 1982.
Due to the surge in inflation, worker wages, despite rising 5.6% from a year ago, weren't keeping pace with the cost of living. Real average hourly earnings posted a seasonally adjusted 0.8% decline for the month, according to a separate Bureau of Labor Statistics report.
The inability of wages to keep up with costs could add to inflation pressures.
The Atlanta Federal Reserve wage tracker for March indicated gains of another 6% which is `` symptomatic of inflation pressures continuing to broaden, '' said Brian Coulton, chief economist at Fitch Ratings. Coulton pointed out that the core inflation deceleration was due largely to a drop in auto prices, while other prices continued to show increases.
Shelter costs, which make up about one-third of the CPI weighting, increased another 0.5% on the month, making the 12-month gain a blistering 5%, the highest since May 1991.
To combat inflation, the Fed has begun raising interest rates and is expected to continue doing so through the remainder of the year and into 2023. The last time prices were this high, the Fed raised its benchmark rate to nearly 20%, pulling the economy into a recession that finally defeated inflation.
Economists generally don't expect a recession this time around, though many on Wall Street are raising the probability of a downturn.
`` Overall, this report is encouraging, at the margin, though it is far too soon to be sure that the next few core prints will be as low; much depends on the path of used vehicle prices, which is very hard to forecast with confidence, '' wrote Ian Shepherdson, chief economist at Pantheon Macroeconomics. `` We're sure they will fall, but the speed of the decline is what matters. ''
Price increases came from many of the usual culprits.
Food rose 1% for the month and 8.8% over the year, as prices for goods such as rice, ground beef, citrus fruits and fresh vegetables all posted gains of more than 2% in March. Energy prices were up 11% and 32%, respectively, as gasoline prices popped 18.3% for the month, boosted by the war in Ukraine and the pressure it is exerting on supply.
One sector that has been a major driver in the inflation burst subsided in March. Used car and truck prices declined 3.8% for the month, though they are still up 35.3% on the year. Also, commodity prices excluding food and energy fell by 0.4%.
Those declines, however, were offset by gains in clothing, services excluding energy and medical care, each of which increased 0.6% for the month. Transportation services also rose 2%, bringing its 12-month gain to 7.7%.
In a sign of economic recovery from a sector hard-hit during the Covid pandemic, airline fares jumped by 10.7% in the month and were up 23.6% from a year ago. | business |
Novak Djokovic loses in first match since February |
Men's world No. 1 tennis player Novak Djokovic lost his opening match at the Monte Carlo Masters on Tuesday to Alejandro Davidovich Fokina, ranked 46th in the world.
It was Djokovic's first match since February and only his fourth in 2022.
The 34-year-old Serbian star had been forced to miss the Australian Open and many of the ATP Tour's biggest tournaments this year due to his Covid-19 vaccination status.
Djokovic, a two-time champion at Monte Carlo, lost to the 22- year-old Spaniard in three sets, 6-3, 6-7 ( 5), 6-1.
In February, Djokovic lost his world No. 1 spot to Daniil Medvedev, but the 20-time grand slam champion returned to the top of the rankings three weeks later after Medvedev's second-round loss to Gael Monfils at Indian Wells.
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He
said on
Sunday ahead of the game in Monte Carlo that he is ready to put a difficult start to the year behind him.
`` You have to deal with everything that probably has been dormant inside and is maybe waiting to come out, '' Djokovic said as he reflected on the Australian Open debacle.
`` I 'm trying to deal with it on a daily basis or weekly basis, whatever. If something surfaces, I acknowledge it, but I move on.
Davidovich Fokina celebrates against Djokovic.
`` It's not something that is bothering me on a daily basis so to say, I don't feel like it has left huge scars on me that I 'm unable to train or participate in tournaments or live my life, far from that.
`` But it has definitely been a very challenging few months and something I 've never experienced before. So I 'll try to use that as a fuel for what's coming up. '' | general |
Cramer: Be ready with cash on hand when market uncertainty settles | CNBC's Jim Cramer on Tuesday told investors that they shouldn't rely on optimism as a market strategy, but should still be prepared to act when the market recovers.
`` I think you can do very well right now in a balanced portfolio that also has a lot of cash on the sidelines. You want to be ready for the moment when things actually get better. It's just that there's so much uncertainty, you got to be a little more cautious than we might like at least in a number of key sectors, '' the `` Mad Money '' host said.
The latest U.S. inflation data revealed that consumer prices in March climbed 8.5% compared with a year earlier, their highest levels since 1981. Stocks on Tuesday fell in response, with the Dow Jones Industrial Average dropping 0.26%, while the S & P 500 fell 0.34%. The Nasdaq Composite declined 0.30%.
Cramer said that while he doesn't think investors should lose all hope that the market will recover, he's cautious of spreading `` false positivity. '' He noted Russia's invasion of Ukraine, Covid shutdowns in China and the semiconductor chip shortage as some of the main culprits of the market's poor performance.
`` When there are fewer problems, you're leaving the realm of hope and headed toward the realm of reasonable possibilities. … I love betting on reasonable possibilities. That's why we 've got so much cash ready for the Charitable Trust so we can pounce when we start seeing them, '' Cramer said.
`` But for now, all we 've got is hope, and that's not enough of a game plan, '' he added.
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French elections: Macron and Le Pen to battle over younger voters | While Emmanuel Macron might have breathed a sigh of relief that voting wasn't closer on Sunday night, digging deeper into the election data shows a worrying trend for the French president.
The outcome of the first round of France's presidential election Sunday was a stark awakening for the incumbent leader. Visibly shaken, the center-right former investment banker addressed supporters after coming out ahead of far-right opponent Marine Le Pen by five percentage points.
`` Make no mistake, nothing is decided, '' Macron told the crowd at a rally Sunday night. `` Let's be humble, determined … I want to extend my hand to all those who want to work for France. ''
The result, which saw Macron take 28.3% and Le Pen take 23.3% of the vote and set a runoff election between the two on April 24, means much is at stake not just for France but Europe as a whole, for which the candidates have dramatically different visions.
In third place was far-left socialist candidate Jean-Luc Melenchon with 21% of the vote, followed by far-right newcomer Eric Zemmour with 7.2%, whose anti-immigrant comments have made Le Pen look moderate. Le Pen and Macron must now attempt to win over as many of those voters as they can before the final vote in two weeks ' time.
Facing a war on Europe's eastern flank the scale of which has not been seen on the continent since World War II, and the highest inflation levels in decades, the stakes for France could hardly be higher.
And in a striking contrast from political trends in other parts of the Western world, older French voters, particularly those above 70, are more liberal while younger voters are increasingly attracted to the far left and right.
According to polling data from Ipsos, Macron only came out on top among voters over the age of 60 and Melenchon and Le Pen received a larger share of the vote from the 18-24 age group. While younger people in France tend to vote less, which may in this case bode well for Macron, he will still have to appeal to a more left-leaning audience in order to capture many of those votes for the runoff.
Data from polling group Harris Interactive showed the hard-left Melenchon won the biggest chunk of voters aged 18-24 with 34.8% of their votes, with Macron and Le Pen following with 24.3% and 18% of that vote, respectively. Le Pen took the largest proportion of voters aged 25-49 at 30%.
She also came ahead among 35-49 year olds with 28.8% of that vote. Macron only beat his rivals among the elderly, winning 37.5% of voters over the age of 65 and 28% among 50-64 year olds.
More so than reflecting a shift in social values, some analysts say that much of the younger electorate's lurch to the far right and far left reveals the appeal of economic populism espoused by Le Pen and Melenchon, and a rejection of the globalism of the status quo.
With Macron facing a nationwide cost of living crisis and a widespread belief in the country that he's a `` president of the rich, '' his pitch to younger voters and those further out on the political spectrum is looking far more challenging than he may have previously expected.
The surge in popularity of candidates at the extreme ends of the spectrum `` is a manifestation of anger towards the lost years of their life due to the Covid pandemic and government lockdowns; part of it is an anti-establishment positioning against the French government, '' Brussels-based international political affairs expert Julien Hoez told CNBC. `` On top of this, there's the generational, economic, employment and cultural stressors across French society which have been picked up and weaponized by parties such as the RN and LFI, '' Hoez said, referencing Le Pen's National Rally and Melenchon's La France Insoumise.
Le Pen, who has softened her image and that of her party, National Rally, in recent years, has shifted from a focus on immigration and national identity to bread-and-butter issues like the cost of living. And with inflation in the euro area at its highest ever, her message is resonating.
According to a poll by Ipsos published on April 10, purchasing power and the cost of living is the single most important issue for 58% of voters and a clear majority within every age group except for those 18 to 24, for whom the environment ranks first.
Le Pen has appealed to voters with proposals of tax cuts on energy, prices of which are at historic highs thanks to inflation and Russia's invasion of Ukraine. Macron meanwhile has pledged some tax cuts but is also pushing for an increase in the retirement age and cut to public sector employment – something that won't find much support among the left-wing voters whose support he now needs.
Macron wants to raise the retirement age from 62 to 65 and is the only candidate aiming to abolish the special pensions system in place for some state company employees, which includes major benefits and a lower retirement age. Zemmour wants to raise the retirement age to 64, and Le Pen plans to leave it unchanged, but bring it down to 60 for those who started working at the age of 20 or younger. Melenchon wanted to lower it to 60.
Zemmour, in a speech following Sunday's elections, urged his supporters to give their vote to Le Pen, while Melenchon beseeched his supporters to vote for anyone but her. Still, he did not go so far as to endorse Macron, something the sitting president would have appreciated.
Macron has been pushing for European unity at a crucial time when the EU faces an aggressive Russia. His focus on the war in Ukraine initially gave him a large advantage in polls, but just in the final fortnight before the first vote, the focus has shifted domestically to the cost of living crisis.
Le Pen has been able to exploit this, pushing her economic promises to the forefront as her anti-NATO and anti-EU stance and friendly relationship with Russian President Vladimir Putin have come under scrutiny.
But make no mistake, a shift in topic focus doesn't mean a move away from the issues that made Le Pen a controversial firebrand in the first place, said Mujtaba Rahman, head of the Europe desk at political risk consultancy Eurasia Group.
Le Pen `` is no more moderate or reasonable today than she has been historically, '' he said in a note ahead of the vote. `` She remains an extreme right force in French politics. ''
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