New in @ScienceMagazine: The next pandemic may be deadlier than COVID-19. We argue that future generations deserve well-calibrated laws that empower health officials to act decisively while mindfully safeguarding constitutional rights & social values science.org/doi/10.1126/sc… 1/7 During the pandemic, over 30 states passed laws curbing health measures. Many state law reforms now allow the legislature to rescind executive health orders, shifting decisions from infectious disease experts to lawmakers ill-equipped to make rapid, science-based judgments. 2/7

Braidwood ruling will cost lives. Tomorrow, you may wake up and not have cost free mammograms. Some 100 services are at risk like screenings for cervical, lung, & colorectal cancers, heart disease, & hepatitis, to tobacco cessation & STD counseling. 1X

medpagetoday.com/opinion/the-he… In Sept, Judge O'Connor ruled the Preventative Services Task Force violated the appointments clause. He also ruled the PrEP mandate violated religious freedom
But he did not issue a remedy. Today, he issues a nationwide injunction against enforcing the ACA's primary care mandates

At #Roe's 50th anniversary, the nation is seeking new legal frontiers to safeguard reproductive freedoms. As the battle over abortion continues to evolve, I join Rebecca Reingold of @oneillinstitute in @JAMA_current to talk through key legal strategies:

jamanetwork.com/journals/jama/… To mark the anniversary, President Biden signed a memorandum to ensure access to medication abortion. Now, new FDA rules allow clinicians to prescribe mifepristone in pharmacies or dispense by mail. DOJ also clarified the lawfulness of sending abortion medications through USPS.

My take on the Pandemic Treaty (CA+) Zero Draft

Let's start w/ credit due to @WHO & INB

It's stunning, w/ equity & hrs front & center

The North/South sticking point is that the rich want scientific sharing & LMICs want leverage of sharing pathogens

CA+ treads the needle

1X CA+ has creative equity mechanisms:

* Global Pandemic Supply Chain & Logistics Network
* Pathogen Access & Benefit-Sharing System
* Facilitate tech transfer & IP Waivers (enhanced PIP Framework model)

The CDC was entirely warranted in requiring a negative test for all international travelers before departure from China, Hong Kong, or Macau. China has experienced explosive spread since abandoning its #ZeroCOVIDpolicy. This fully justifies the US response.

I'm not surprised Biden has COVID-19. The White House has loosened masking and distancing protocols & he's interacting with foreign leaders. Biden is elderly & vulnerable. He has all the advantages of being up to date on his vaccinations & on Paxlovid, we shouldn't be complacent People of Biden's age can be seriously ill, or even die, despite being vaccinated. This is a sure sign the pandemic is far from over. The complacency among the American public simply isn't justified. Many Americans have not been fully vaccinated

White House predicts 1 mil cases in fall/winter, but has no clear plan to guide the nation on updating vaccines. By now we should have bivalent or multivalent vaccines targeting the original strain & omicron (which subvariant?) Companies are acting alone w/o FDA/CDC guidance 1/X It's taking more time to develop COVID vaccines from scratch than targeted vaccines to fight omicron, the dominant strain. The promise of mRNA vaccines was their ability to nimbly change formula, but it isn't happening
We can't keep boosting every 4 months
We need better vaccines

Biden's 6 point vaccine plan will be mostly domestic. What should he do? What is lawful?

1) Order CDC to offer technical guidance & funding for vaccine credentialing systems. That'd boost mandates among businesses, colleges, cities & state. Give the tool & others will mandate 2) Mandate vaccines for interstate & int'l travel. He has clear power to do it. Our allies are doing it. And he already requires masks (& testing for int'l arrivals).

Biden will announce a 6-point plan for vaccinations. It'll mostly be domestic but may include a global vaccine summit at UNGA. Here, I'll say what his global plan should be at UNGA. Next tweet, I'll focus the domestic vaccine coverage

US global plan must be big & bold The US knows how to rise to the occasion. Biden's plan must be as audacious as polio & smallpox eradication or PEPFAR. If we don't stop unchecked #SARSCoV2 circulation, we'll face dangerous new variants. Here's a plan that's realistic & would save millions of preventable deaths

CDC data on waning protection is hard to interpret. It's likely a combination of factors:

* Reduced vaccine protection over time
* Increased exposure as cases rise
* Less masking & distancing
* A far more contagious variant

Is boosting the full pop justified? Probably not 1X The data support boosters for the most vulnerable: health workers, nursing home staff & residents & older adults. Younger, healthier people don't need boosters now. That would save scarce global vaccine supplies

Offering a 3rd dose to the entire US pop will create even more global scarcity, robbing low income countries of lifesaving doses for health workers & the vulnerable. It's a slap in the face to WHO which called for a booster moratorium. We can make this a "win-win." Here's how. 1X Biden should limit 3rd doses only to the most vulnerable, including health workers, nursing home residents & the elderly

He also should pledge a major global vaccination campaign including billions of donated doses & ramping up global vaccine supplies

Explaining SCOTUS decision upholding CDC #EvictionMoratorium

CDC has power only to prevent the spread of infectious diseases across state or int'l borders

It has never before sought to regulate beyond traditional ph powers like testing, masking, quarantine 1X The Public Health Service Act does not specifically grant CDC the power to regulate in areas like housing

But CDC argued that people evicted during #COVID19 would travel to other states, spreading the virus

CDC used strong evidence for its assessment of interstate spread

Did @WHO wait too late to declare a PHEIC as so many have claimed? Clearly not. In this thread, I provide a timeline that shows @DrTedros acted promptly. It's impossible to conclude that an earlier declaration would have changed the pandemic's trajectory in any way. When @Tedros convened the Emergency Committee on 20 Jan, 282 cases were confirmed, of which 278 were in China. Many called for a PHEIC, but the delay of a few days was immaterial.

jamanetwork.com/journals/jama/…

With #COVID19vaccine roll out, there is intense interest in high coverage, even w/ public distrust. Would vaccine mandates be lawful and ethical, and could they boost vaccine uptake?

Daniel Salmon, @ProfHeidiLarson, and I answer in

@JAMA_current:

jamanetwork.com/journals/jama/… For starters, mandating vaccines under Emergency Use Authorization (EUA) is legally and ethically problematic. Less safety and efficacy data mean that people are more likely to distrust such mandates.

This Thread explains the controversy around delayed 2nd doses of #Covid19vaccines or lowering the amount in each dose. The debate really boils down to what science tells us about maximum protection for INDIVIDUALS versus maximum protection for POPULATIONS. US is individualistic Individual perspective: The clinical trials were designed to give a specified vaccine dose to "prime" the immune system, followed by a second dose 2-3 weeks later. Using this 2-dose, set interval, strategy conferred near 95% efficacy for @pfizer & @moderna_tx vaccines.

94% efficacy of @moderna_tx vaccine at interim analysis of 95 events is stunning. Offers realistic prospect of the beginning of the end of #COVID19 pandemic. Efficacy high enough to eliminate (not eradicate) #SARSCoV2. Comparable to measles vaccine. Don't pop the champagne yet 1X Having 2 vaccines will boost supplies, but adds layer of complexity. Having 2 Ebola vaccines in DRC actually caused huge public fights & public confusion. We don't know which #covid vaccine is better & on which pops. We need studies comparing efficacy & risk profiles of vaccines.

Trump's hint he will fire #fauci is unlawful, unethical, & politically self-destructive. What's more, it would be a nightmare for the nation's public health agencies & for science itself. Here's why. 1X The president has vast powers over executive agencies. But Tony Fauci is not a political appointee. In fact, he has been offered the head of @NIH & turned it down. He is a dedicated & decorated career government scientist. Trump is not his boss. @NIHDirector oversees NIH staff.

Having worked w/ @CDCgov & ph law for 30 years, I'm deeply concerned that @CDCgov & @DistrictofC ph are being pushed aside in investigating major #COVID19 clusters at the @WhiteHouse. The @WhiteHouse is a public health & ethics free zone. It is lawless. Why? See this thread 1/X Let's start w/ an analogy that seems over the top. Suppose the president assaulted a staffer in the @WhiteHouse. DC law enforcement doesn't have jurisdiction. What if @POTUS directed @FBI to stand down? Lawlessness, right? But that's not the same as #COVID transmission. Wrong!

Trump physicians are citing HIPAA Privacy Rule for w/holding key med info. Wrong on many levels. Yes, HIPAA could legally apply. But here's 3 major reasons why HIPAA cannot justify utter failure to be honest & transparent on the presiden'ts health. 1) The president is the chief executive w/ const'l duties. His health impacts our national security. The public has the right to know his condition honestly & in full. Right now we are being kept in the dark about key facts concerning his health & ability to govern.

Should Trump return to @WhiteHouse? Yes, but only if he is fully cleared by Walter Reed treating physicians to return home. He should not leave against medical advice even if his own personal physician approves it. Why? See my thread. 1/X The president should follow the advice treating physicians at Walter Reed because they are independent & experienced. The president's physicians, as we have seen, feel under pressure to present an "upbeat" picture even if unwarranted by clinical facts. It wouldn't be safe.

Thread explains why US w/drawal from @WHO is unlawful & unethical, among most ruinous presidential decisions in history. It will weaken US health & security in midst of a historic #COVID19 pandemic. That's why we sent a letter to Congress urging action:

oneill.law.georgetown.edu/letter-to-cong… Let's start w/ fact that @SecPompeo sent letter to @UN w/o first notifying @WHO or Congress. They weren't informed until a day later. No press briefing or media scrutiny. This lack of transparency & accountability is exactly the unfounded charge @POTUS made against @tedros.