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Tuesday, August 1, 2023
POLITICO Nightly: The latest indictment drops
Indictment!
A thunderclap hits the headlines. How long does it take for the full impact to sink in? Can we even comprehend all that it implies? While we knew another indictment for Donald Trump was likely, it is impossible to be fully prepared. There will be much to parse and analyze in the days to come. But one central fact we already knew. Because we saw it happen. In real time. Our nation was wronged by a man who had sworn to uphold our Constitution. It was a betrayal of our noblest democratic ideals. In the months and years that have followed, we have learned further details of the treachery. This indictment suggests there might be much more to discover. The latest charges add to a litany of grave malfeasance already alleged in previous charges. Prosecutors have shown some of their hand. The evidence seems strong, even as we recognize the defendant carries a legal presumption of innocence. (Individuals and large swaths of the population can come to their own personal conclusions, of course. But by law, every defendant is presumed innocent until proven otherwise.) Almost immediately comes a cacophony of resonant emotions. They are uncontainable. We have much to consider: The facts. There is no yardstick in our national story by which to measure this moment — a former and potentially future president stands accused of abusing his office and undermining the safety and security of our republic. We have written some form of this sentence countless times before. But the cumulative repetition does not lessen its impact as we consider the depths to which Trump allegedly sank. Yet to focus only on the man is to miss the full contours of this perilous story. Today’s indictment is a legal document. But it is also part of a more sweeping historic and political indictment of our times. For Trump couldn’t have done this alone. Today represents an indictment of all who validated his vile indulgences, whitewashed his wantonness, disguised his depravity, legitimized his lawlessness, and acquiesced to his autocracy. Meanwhile, Trump is not the only one facing trial. We all are. What kind of country will we have? How much are we willing to fight for our ideals? Our future? Today marks a reckoning, but it’s far from a resolution. The danger Trump and his legions of MAGA supporters pose remains very present, very real, and very dire. The polls indicate this con man, divisive charlatan, and wrecking ball to the rule of law is running away with the Republican nomination for the presidency. And he looks, at this point, despite everything, to be competitive with President Biden. He could be reelected. The more scrutiny he receives, the more evidence of his unfitness for office is laid out publicly, the more his stalwarts rally behind him. Trump has no coherent or persuasive rejoinders to the numerous charges he faces. He instinctively relies on his overused playbook of lies, divisiveness, and dystopian rhetoric. It’s all he’s got. Nevertheless, his crowds roar their delight without hesitation. A campaign rally, however, is not a court of law. And Special Counsel Jack Smith seems to have a meticulousness that matches Trump’s recklessness. The former president’s antics may drive the Republican faithful to euphoria. Will that work in court or at the ballot box next November? Some of us will be pondering that question deep into the night and beyond. |
RSN: John Ehrenreich | Sympathy for the Devil: The Making of Robert F. Kennedy Jr.
01 August 23
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Robert F. Kennedy Jr. was not always a crank. He was not always a notorious promoter of pseudoscience and of conspiracy theories. But for years now, he has been the country’s most prominent anti-vaccine activist. In the midst of the COVID pandemic, he campaigned against the new vaccine, opposed masks, and promoted discredited cures such as ivermectin and hydroxychloroquine. More than 300,000 of the 1.1 million American deaths from COVID might have been prevented by the vaccine he relentlessly crusaded against.
A well-known optical illusion shows a drawing that can be seen as a beautiful woman, perhaps a model for an angel, or as an ugly old woman, a caricature of a witch. The drawing is either or both. Robert F. Kennedy Jr., too, is either pro-science or anti-science, an environmental angel or a conspiratorial monster. Or both.
The way Kennedy himself would tell the story, there is no conflict in his beliefs. “Science, at its best, is a search for existential truth,” he has said. The problem only arises when “greedy corporations and captive government regulators,” his go-to villains, “twist, distort, falsify, and corrupt science, hide information, and censor open debate to protect personal power and corporate profits.”
In March 2023, Kennedy announced his candidacy for the Democratic nomination for the presidency, forcing a wider public to grapple with both sides of his character. After a pandemic in which “follow the science” became a battle cry, we have to try to understand how someone can embrace science yet aggressively reject the science that most actual scientists believe in. How can someone be both a steel-witted lawyer and a crackpot? The story of a man with a famous name and startling strength in early polls shows why we ignore that question at our peril.
Kennedy is perhaps best known today for his disdain for vaccines—he’s called the COVID-19 shot “the deadliest vaccine ever made.” Where did his doubts come from? Such “skepticism” can start with reasonable questions, and from the viewpoint of the early 2000s, concern about the safety of regular childhood shots was not an entirely crackpot notion.
In 1998, British physician Andrew Wakefield had published an article in the Lancet reporting on a link between the measles, mumps, and rubella (MMR) vaccine and rapidly rising rates of autism. In 1999, the American Academy of Pediatrics and the Public Health Service had released a statement urging vaccine manufacturers to remove thimerosal—a mercury-containing preservative—as quickly as possible and advising pediatricians to postpone giving most newborns the birth dose of the hepatitis B vaccine. Although the aggregate amount of thimerosal that children received in vaccines had rapidly increased, the Environmental Protection Agency had dragged its feet on enforcing federal regulation of mercury.
Big, bad companies putting stuff in products that harm people while governmental agencies do nothing, all backed by “science” provided by the companies themselves—it was familiar territory for Kennedy. He knew only too well that the fossil-fuel industry had publicized studies to confuse the climate change debate, and that all too often regulatory agencies had been “captured” by the very industries they were supposed to regulate. “I was drawn into the controversy only reluctantly,” Kennedy claimed in 2005 in “Deadly Immunity,” a widely read article published jointly by Rolling Stone and online by Salon, noting that the eradication of early childhood diseases depends on inoculations. But he had come around to the idea that some of the vaccines on the market were dangerous. “If, as the evidence suggests, our public-health authorities knowingly allowed the pharmaceutical industry to poison an entire generation of American children, their actions arguably constitute one of the biggest scandals in the annals of American medicine.”
Even in 2005, Kennedy’s concerns about vaccine safety were overstated, and over the next 10 years most of the remaining concerns about vaccines were laid to rest. Thimerosal was removed from almost all vaccines. Autism rates still continued to soar, though, suggesting that the linkage between thimerosal and autism had been spurious. Wakefield’s articles were retracted, and Wakefield himself was accused of fraud and lost his license to practice medicine. Epidemiological studies consistently found no evidence of a link between the MMR vaccine and autism. An overwhelming body of evidence supporting the safety of vaccines in common use accumulated. By 2011, both Rolling Stone and Salon had retracted Kennedy’s 2005 article.
Science, or any practice that relies on evidence, routinely includes “shifts” in what is seen as “truth.” John Maynard Keynes, questioned about why he had changed his views on an economic question, is famously supposed to have replied, “When the facts change, I change my mind. What do you do, sir?”
Robert F. Kennedy Jr.’s answer was to double down on his beliefs. He continued to insist that vaccines were dangerous. To maintain his position, however, he had to insist that the evidence supporting vaccine effectiveness and safety was not only wrong but outright fraudulent. Perhaps the tendency to go down this path had been there all along.
In his judgment of the conflicting claims on vaccine safety, Kennedy was not a scientist, but a litigator. To be a good scientist is to acknowledge uncertainty. “Truth” is never final, always about likelihoods and not about certainty. Conclusions and theories are always changing, constantly subject to challenge by other scientists. Debate among scientists with knowledge and expertise in the area of dispute takes place, mainly in the form of written articles. The scientific method itself—lab experiments, clinical and epidemiological trials, and comparison of data to theory—provides the mechanism for resolving these conflicts. “Truth” emerges over time (sometimes a long time). “Questioning the science” is what scientists do.
The legal system, meanwhile, does not seek ultimate “truth”—it seeks only a resolution of a dispute. In the civil cases Kennedy specialized in, the standard for decision is not “beyond a reasonable doubt,” but “the preponderance of evidence.” A claim must have more than a 50 percent chance of being true. The decision is made by a judge or a jury, based on evidence presented by lawyers. The job of the lawyers on each side is not to weigh conflicting science objectively: Cherry-picking and spinning evidence, minimizing the opponent’s evidence, making ad hominem attacks on the credibility of those presenting contrary evidence, and using the rhetorical skills of the lawyers are part of how you win a case. The outcome is a binary resolution with a consequence (liable or not liable), not a judgment of the scientific debate.
Kennedy’s views about how to evaluate the validity of conflicting scientific evidence were shaped by long-standing and deeply ingrained suspicions based on his own experience as a lawyer. He was only too familiar with secrecy and bad faith on the part of large corporations, corporate capture of governmental regulatory agencies, and the willingness of some scientists, at least, to willingly serve false masters. He was a master at presenting the strongest version of his client’s case and challenging the “facts” brought by the other side.
This can be an enormous force for good when it comes to life-and-death matters: Science moves slowly, and scientists can be prone to clouding declarations with uncertainty. A steady and firm judgment call in the face of a mishmash of evidence can, at times, improve the well-being of communities. But even when Kennedy was using his legal skills to protect the environment, not everyone was comfortable with how far he took his version of the reality. George Rodenhausen, who had worked with Kennedy as legal counsel for Putnam County during negotiations over the New York City Watershed, told the New York Times in 2000, ”I think he separates himself from good science at times in order to aggressively pursue an issue and win.” Robert Boyle, a former colleague of Kennedy’s at the environmental organization Hudson Riverkeeper, recalled, “I came not to trust him.” He added: “He shoots from the hip. Whatever comes into his mind becomes the truth.”
A degree of paranoia and conspiratorial thinking can be seen as an occupational hazard for lawyers. A lawyer is supposed to be suspicious, supposed to be wary that someone is out to get their client, supposed to be aware that an innocent mistake could come back to haunt them. “It’s not your imagination that someone is out to get you all the time,” said psychologist Amiram Elwork, who has taught a course on the matter at Widener University Delaware School of Law in Wilmington. Lawyers are trained to be pessimists, ever on the lookout for what could go wrong. “Thinking like a lawyer” requires close scrutiny of spoken and written thought to identify any problem that may undermine an adversary’s position or create future problems for one’s client. Conspiratorial thinking is close to the surface.
Still, plenty of litigators are able to separate a view they are arguing in court on behalf of a client from their own views, as well as to update their beliefs on scientific matters over time. Whether Kennedy’s days as a superstar litigator helped entrench a certain mode of thinking, or a tendency toward self-assuredness helped him become a superstar litigator in the first place, that is not the whole story. Something further happened with Kennedy.
It is tempting to call someone who espouses such a wide variety of pseudoscientific beliefs and conspiracy theories “crazy.” But there is nothing unusual, much less “crazy,” about belief in pseudoscientific ideas and conspiracy theories. Conspiracy theories are held by people you know, people whose ideas you trust, and by leaders you follow; they are held by people you regard as intelligent, kind, and caring, by people who you would be surprised to learn believe anything of the sort. One 2019 poll found that nearly 80 percent of Americans believed in at least one unscientific idea; another a few years earlier reported that half of the American public consistently endorsed at least one conspiracy theory. Without putting much faith in the exact numbers, it is clear that such beliefs are widespread.
Belief in pseudoscientific ideas and conspiracies is not merely a matter of lack of education, either. Twenty-four percent of Americans with a college education and 15 percent of those with a postgraduate degree told researchers early in the pandemic that it was “probably” or “definitely” true that powerful people intentionally planned the COVID pandemic. Even being a skilled scientist does not protect one from believing in wild, dangerous ideas. Two-time Nobel laureate Linus Pauling insisted that oral vitamin C could cure 90 percent of cancers. Luc Montagnier, who discovered the virus that causes AIDS, believed that water can retain a “memory” of its history, supposedly explaining how homeopathic “medicines” containing not a single molecule of a pharmacologically active substance can cure disease.
Conspiracy theories thrive in the context of fear, anxiety, mistrust of institutions, uncertainty, and feelings of powerlessness. They appeal to those who mistrust conventional sources of information because they represent the antithesis of the usual accounts. Kennedy himself shared in the widespread social mistrust of American institutions.
Psychologists have identified a variety of psychological characteristics that also tend to make some individuals more vulnerable than others to believing in fringe science and in conspiracy theories. As a result, people who believe in one conspiracy theory tend to believe in others. Whatever personal characteristics Kennedy may have had that made him vulnerable to seeing vaccines through the eyes of a conspiracy theorist may have made him vulnerable to believing in other conspiracies, as well.
In the 2010s, Kennedy increasingly cultivated an anti-vax following. He founded and became chairman and chief litigation counselor for Children’s Health Defense, a leading anti-vax organization which also campaigns against 5G, fluoridation of water, the use of ultrasound in obstetrics, and similar causes. In early 2017, he flirted with heading a possible commission on vaccine safety and integrity being considered by then-President Donald Trump. Beginning in 2017, he broke his ties with most of the environmental groups with which he had previously been associated.
For a while, Kennedy’s pseudoscientific and conspiracy theories remained focused on his opposition to vaccines. But then they metastasized, spreading to a broader range of health– and public health–related issues. He opposed not only vaccines but the fluoridation of water. He attacked mainstream medicine and extolled the virtues of alternative and holistic therapies. He suggested that the cause of AIDS was use of “poppers” (alkyl nitrite inhalants), not the human immunodeficiency virus, and he blamed firearm deaths on psychiatric drugs, teenage depression on aluminum in vaccines, and the rise in the number of those identifying as transgender on drugs released into the water. He claimed that Wi-Fi and cellphones as health threats and described 5G technology as both medically dangerous and part of a plan to control the population.
Once a person believes in a conspiracy theory, two key psychological factors can make it hard for them to disentangle themselves from their beliefs: First, shared beliefs bind people together. We want to believe what others who are important to us believe. To not do so would threaten our relationships with them. The beliefs become part of a person’s identity: I am a person who believes such and such. By the late 2010s, Kennedy was increasingly surrounded by people who thought as he did, and he was increasingly cut off from the environmentalist community oriented toward more conventional science.
Second, we also try to maintain consistency in our beliefs. Information that is not consistent with our other beliefs and values gives rise to an internal sense of discomfort—what psychologist Leon Festinger called ”cognitive dissonance.” Either the old narrative must go, or we must find a way to discredit the new facts so that they can be incorporated into what we already believe. Belief in pseudoscience to belief in conspiracy theories is a short step. Kennedy’s narrative became one of extreme distrust.
When the COVID pandemic came along, he was primed to see masking, shutdowns, and the vaccine as all part of a conspiracy to promote vaccine sales by Big Pharma and to justify attacks on civil liberties. The COVID-19 vaccine didn’t work (it actually caused more disease, in his view). Ivermectin and hydroxychloroquine were more than sufficient to deal with the COVID pandemic. Bill Gates and Anthony Fauci had held meetings in 2019 to plan pandemic mitigation measures as assaults on personal freedom. He had spent years nurturing similar beliefs, and in 2020, he had found their most potent vessel yet.
Although we can see in Kennedy’s history his two sides—the pro-science environmentalist and the pseudoscience-spouting anti-vaxxer—the latter has become dominant. And now, he is running for president.
Kennedy’s campaign for the nation’s highest office can’t simply be dismissed as “quixotic.” And his views may not disqualify him. Kennedy’s doubts about vaccines are common. Even before the pandemic, 45 percent of American adults told a 2019 Harris Poll that they had some cause to doubt vaccine safety, and 1 in 10 Americans believed that vaccines were unsafe and possibly ineffective. And we know all too well that a candidate who initially seems fringe can quickly gain support. As I write this, 15 percent of potential Democratic voters say they support him, and his favorability ratings are higher than President Joe Biden’s.
His two sides emerge in his politics, too. For the most part, Kennedy’s candidacy emphasizes traditionally “liberal”—even progressive—issues of corporate wrongdoing and responsibility, capture of regulatory agencies, and lack of transparency in business and government. We must “revitalize our health care system,” his campaign website says, and “move from a sick care system to a wellness society.” He expresses concern for civil liberties and for the impact of the war on drugs and prisons and policing on minorities and the poor.
But at the same time, he has openly courted the right. As a presidential candidate, he appeared on platforms with Elon Musk and Joe Rogan and Jordan Peterson, used the far-right social media platform Gab to recruit followers, and got callouts from Tucker Carlson and Steve Bannon. Right-wing rhetoric slips into his campaign as well: He denounces “the Covid-era suspension of the right to assembly, trial by jury, and freedom of worship,” pushes to “seal” our border with Mexico, and toys with antisemitism and anti-Asian racism. Although he is concerned about gun violence, he opposes gun control (“I’m not going to take away anybody’s guns. I’m a constitutional absolutist”) and blames firearm deaths on those psychiatric drugs released into the water. He sees the free market rather than governmental intervention as the solution to most social problems. And he promotes “medical freedom”: the right of individual Americans to make their own health care decisions, free of governmental interference, regardless of the impact their individual decisions have on others.
In Robert Louis Stevenson’s 1886 novella The Strange Case of Dr Jekyll and Mr Hyde, the kindly, respected Dr. Jekyll is in conflict with his dark alter ego, the impulsive, violent Mr. Hyde. Is Kennedy Dr. Jekyll, the environmental advocate who uses science to promote human well-being? Or is Kennedy Mr. Hyde, the anti-vaxxer who seeks the darkness of conspiracy theories and promotes false cures and paranoid fantasies? What do we lose when we fail to see Kennedy’s Dr. Jekyll side? Does it matter that we can at least understand the roots of his Mr. Hyde side?
All human beings, including our leaders, are full of contradictions. Thomas Jefferson was simultaneously the author of the Declaration of Independence and a slave owner. FDR liberal and union president Ronald Reagan became the hero of modern conservatism. In Stevenson’s novella, the contradiction must be resolved: Dr. Jekyll and Mr. Hyde cannot coexist. To end the conflict, Dr. Jekyll kills himself and thereby kills his alter ego, Mr. Hyde. But in the real world, a storybook ending, even a macabre one, is hardly a guide.
It is easy to dismiss Kennedy’s darker fantasies as a joke or to try to weigh them against his earlier environmental contributions. But Kennedy’s opposition to vaccines and to measures taken to mitigate the COVID pandemic contributed to the deaths of hundreds of thousands and the illness of millions. His attacks on public health measures have helped handcuff our country’s ability to respond to future public health emergencies. And his promoting of pseudoscientific ideas has furthered the growing mistrust of science, of knowledge, of rationality, of evidence, and of facts themselves.
Each one of us has a choice: We can embrace science, aware of its uncertainties and even of its failure sometimes to meet its own standards. Or we can accept pseudoscience and conspiracy theory. We can’t do both. But we have to understand how easy, how appealing, it is to go the route that Kennedy did.
To understand how Robert F. Kennedy Jr. became the man he is now is to understand the arc of millions of Americans as they weigh the conflicting claims of science and pseudoscience, of truth-tellers and demagogues and conspiracymongers. It is to understand the early but real potency of his campaign and the threat of what he is trying to do now. His run is no sideshow.
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A doctor in Atlanta protests in favor of abortion rights as part of a nationwide wave of demonstrations held last year before the Supreme Court overturned Roe v. Wade. (photo: Alyssa Pointer/Reuters)
Ohio is among at least five states where physicians have mobilized to protect reproductive rights. Here’s what doctors in the state are doing to protect abortion.
The first Monday after the Dobbs v. Jackson Women’s Health Organization ruling was emotional. Beene fielded a call from the mother of a 13-year-old patient. The mother was worried her child might need birth control in case she was the victim of a sexual assault. Beene also talked to a 16-year-old patient unsure about whether to continue her pregnancy. Time wasn’t on her side, Beene told the girl.
“What if it were too late to get her an abortion? What would they do? And I just, I felt sick to my stomach,” Beene said. “Nobody had ever asked me a question like that before.”
Beene felt she had to do something. She drafted a letter to a state lawmaker about the dangers of abortion bans, then another doctor reached out with an idea to get dozens of doctors to sign on. The effort took off. About 1,000 doctors signed that letter, and they later published it as a full-page ad in The Columbus Dispatch.
Beene felt momentum building within the medical community and decided to help use that energy to form the Ohio Physicians for Reproductive Rights coalition. Now, Beene and the coalition are working to pass a citizen-led amendment to enshrine reproductive rights into the state constitution. The state’s six-week ban on abortion was blocked by a judge in October 2022.
The group is a part of an emerging political force: doctors on the front lines of the reproductive rights debate. In many states, the fight to protect reproductive rights is heating up as 14 states have outlawed abortion. Doctors who previously never mixed work with politics are jumping into the abortion debate by lobbying state lawmakers, campaigning, forming political action committees and trying to get reproductive rights protected by state law.
In Texas, at a two-day court hearing earlier this month , women who were denied abortion care testified they were harmed by the state’s abortion ban. Two Texas doctors, who are plaintiffs, took the stand to testify about the chilling effect they say the laws have had on them. Dr. Damla Karsan, a Houston obstetrician, said she had never testified in a court case before but felt compelled to participate in this one to advocate for her patients and colleagues.
“I feel like I’m being handicapped,” Karsan said, referring to the Texas abortion law. “I’m looking for clarity, a promise that I will not be persecuted for providing care with informed consent from patients that someone interprets is not worthy of the medical exception” that would permit a legal abortion.
Although doctors’ groups have formed on both sides of the issue, most of these groups oppose abortion bans, largely because doctors worry that abortion bans could put their patients’ health at risk. Doctors now find themselves risking criminal and civil penalties in some states if they act to help patients who are suffering.
The Ohio coalition, along with its partners, gathered signatures for months in order to put the proposed constitutional amendment on the November ballot. The group filed more than 700,000 signatures on its petition, nearly twice the minimum number needed. The amendment’s language would protect several aspects of reproductive medical care, not just abortion: misscarriage care, contraception and in vitro fertilization.
“We see all those areas being negatively impacted by the Dobbs decision,” Beene said. “So we felt that by establishing that fundamental right to reproductive freedom, we would be able to protect all of those issues.”
In Nebraska, doctors formed the Campaign for a Healthy Nebraska PAC, which raised money to target key races, according to the Flatwater Free Press. The group also worked to get the Nebraska Medical Association to publicly oppose abortion restrictions, the news organization reported.
The Good Trouble Coalition in Indiana also mobilized medical professionals to work with legislators on abortion laws.
States including Michigan and Vermont have also used citizen-led ballot initiatives to get reproductive protections included in their constitutions, efforts that were supported by voters. In Michigan, doctors created a committee to help campaign for the proposal. Beene said the Ohio coalition modeled its strategy on Michigan’s approach.
In at least one state, doctors have rallied for a measure that would have limited abortion access.
In Kansas, a coalition of 200 physicians, nurses and pharmacists publicly supported an amendment to remove the right to an abortion from the state constitution, according to the Kansas Reflector. Voters ultimately rejected the amendment, with 59% voting against the initiative.
Mary Ziegler, an abortion historian and a law professor at the University of California, Davis, said medical associations have been involved in the abortion debate before, but the organizing efforts are broader this time, with several doctors’ groups throwing their support behind ballot initiatives that protect reproductive rights and draw widespread public support.
“It’s not a trivial thing that it’s a ballot initiative, because one of the other things we’ve seen is that voters are with them,” Ziegler said. “Doctors who are afraid of alienating potential patients or colleagues are realizing that bans are not popular with most people. So the risk may be lower than people thought of taking a stand.”
Beene prepared for backlash when she and other Ohio physicians came out against abortion bans. But she didn’t expect that lawmakers would try to change the rules needed to pass a citizen-led amendment just months after the coalition started to collect signatures.
Lawmakers in May passed a controversial resolution to raise the threshold needed for an amendment to pass from a simple majority to 60%. Voters will decide whether to adopt the proposal, known as Issue 1, in an Aug. 8 special election.
The Republican-controlled Ohio legislature passed a law last year banning special elections, citing their low turnout and high costs, but state lawmakers scheduled this August’s election despite the ban. Republicans have signaled that this vote on Issue 1 was aimed at blocking the reproductive rights amendment.
Jen Miller, executive director of the League of Women Voters of Ohio, a nonpartisan voting rights organization, said the group is against Issue 1 because it would overturn more than 100 years of precedent in the state for how citizen-initiated amendments are passed.
“What they’re trying to do is to trick voters into voting our own rights away in a low-turnout August election,” Miller said. “Even voters who never miss an election are unaware that there is an August special election.”
It’s possible that only a single-digit sliver of the population will vote — records from the Ohio secretary of state’s office show the 2022 August primary election had 8% voter turnout.
If Issue 1 is adopted, the reproductive-rights amendment would require approval from 60% of voters to pass in November, which Beene said she believes is what lawmakers want.
“They’ve sunk to tremendous lows and they’re doing everything they can to try to stop us,” Beene said.
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Joe Biden. (photo: Frank Franklin II/AP)
Their concern stems from a 10 percentage-point decline in Black voter turnout in last year’s midterms compared with 2018, a bigger drop than among any other racial or ethnic group, according to a Washington Post analysis of the Census Bureau’s turnout survey. Such warning signals were initially papered over by other Democratic successes in 2022: The party picked up a U.S. Senate seat in Pennsylvania, Sen. Raphael G. Warnock won reelection in Georgia and anticipated losses in the House were minimal.
But in key states like Georgia, the center of Democrats’ plans to mobilize Black voters in large margins for Biden in 2024, turnout in last year’s midterms was much lower among younger and male Black voters, according to internal party analysis.
The drop in Black turnout has become a focus for Democratic leaders as the party reorients to next year’s presidential contest. Biden’s election in 2020 hinged on narrow victories in states like Georgia, Wisconsin, Michigan and Pennsylvania that former president Donald Trump had won in 2016. Democratic activists are cautioning that the party can’t afford to let support from Black voters slip.
W. Mondale Robinson, founder of the Black Male Voter Project, shared a dire assessment of Democrats’ potential turnout problems with Black men. In many of the battleground states, he said many Black men are “sporadic or non-voters,” meaning they are registered, but have voted in one or none of the past three presidential elections. Robinson said Democrats spend too much time focused on converting “conservative-leaning White women” in the suburbs who they see as swing voters. Instead, he said, they should focus more on turning out Black men, viewing them as swing voters who are debating whether to vote or stay home.
“The Democratic Party has been failing epically at reaching this demographic of Black men — and that’s sad to say,” Robinson said. “Black men are your second-most stable base overwhelmingly, and yet you can’t reach them in a way that makes your work easier.”
Biden’s political team says it has received the message and is taking action, especially among younger Black men.
“We have to meet them where they are and we have to show them why the political process matters and what we have accomplished that benefits them,” said Cedric L. Richmond, a former Biden adviser who is now a senior adviser at the Democratic National Committee. He said there will be a clear focus on making Black voters aware of how they have benefited from Biden administration policies, learning from the errors of past Democratic efforts that fell short.
“We will not make the mistake that others made of not drawing all the connections,” he said.
Black voter advocates say the challenge is particularly acute among Black men, many of whom say they feel alienated from the political process and were hurt by policies pushed by both parties that led to increased incarceration and a decline in manufacturing jobs decades ago. Many say their lives haven’t improved regardless of which party was in power, and are dispirited after the country elected Trump, life was upended by a global pandemic and violence worsened in urban areas.
Many Democrats interviewed said they were less worried about Black women, whose voting enthusiasm has historically been more robust than that of Black men. Black women were a huge factor in Biden’s victory in 2020. Advocates expect that trend to continue, particularly with Vice President Harris on the ticket and the appointment of Supreme Court Justice Ketanji Brown Jackson, who both made history as the first Black women in their roles.
Terrance Woodbury, chief executive of HIT Strategies, a polling firm focused on young, non-White voters, has been shopping around a PowerPoint presentation to liberal groups warning of the need to act soon to convince Black voters that they have benefited from Biden’s time in office.
Part of the problem, he argues, is that the party’s focus on Trump and Republican extremism is less likely to motivate younger Black men than arguments focused on policy benefits. The messaging, he has argued, must focus on how Black communities have benefited from specific policies.
His own polling has shown that voters’ belief that their vote doesn’t matter is the greatest barrier to voting among Black Americans.
A Washington Post/Ipsos poll of Black Americans in May found a tepid reaction to Biden’s reelection. Just 17 percent said they would be enthusiastic if he wins another term, 48 percent said they’d be satisfied but not enthusiastic, 25 percent said they’d be dissatisfied but not angry and 8 percent said they’d be angry about another Biden term. The poll also found that nearly 8 in 10 Black Americans say they would not consider voting for Trump over Biden and that 54 percent would be “angry” if Trump were to become president again.
Brittany Smith, the executive director of the Philadelphia-based Black Leadership PAC (BLP), which is working to turn out Black voters, said she has noticed a change in how Black people respond to her get-out-the vote efforts in recent years. In the past, she simply needed to remind people of where and when to vote. Now, she said, many express a cynicism about politics that requires a deeper level of persuasion.
“There’s not a night I don’t go to sleep thinking about what turnout will look like in 2024,” Smith said.
“When you think about election cycle to election cycle, [Black voters] have been telling us for a long time what matters,” Smith added. “They want to put food on the table, a roof over their head, send kids to good schools, live in neighborhoods that are safe. I don’t think the issues are new, it’s the way we talk about them and the way we’re centering the voice of the people who live in these communities.”
Some Republicans say they see an opportunity to siphon off some of those disenchanted Black voters in next year’s presidential election with messaging on some key issues. Jay Williams, a longtime GOP strategist in Georgia and founder of the Stoneridge Group, a Republican firm, said school choice and transgender and LGBTQ+ issues, especially as they relate to children and schools, could harm Democrats among their reliable base.
“My guess is Democrats for the foreseeable future will continue to do well [with Black voters], but I think there’s some cultural issues that don’t typically resonate with the Black community as a whole and frankly a lot of minority communities,” Williams said. “Republicans will be able to peel some folks off based on that, depending on the area. It could be a real wedge issue for us.”
Williams acknowledged any growth in support among Black voters could be harder for the GOP if Trump is the nominee — and there will be many other groups, including suburban White women, that the party will have to worry about in that case. He added that he expects Republicans to have a better return on investment with other minority voting blocs, such as Latinos and Asian Americans, “because I don’t think they’re as in lockstep with the Democrats as the Black voter bloc is.”
Meanwhile, Democrats say they are significantly more worried that Black voters will sit it out rather than defect to the Republicans.
Sharif Street, a Pennsylvania state senator and the chairman of the state Democratic Party, said it’s incumbent on the party to give people not just something to vote against, like Trump, but something to vote for.
“Ultimately, the Democratic Party is in the right place substantively on all of those issues,” he said. “But we’ve got to understand that people don’t just know that. We have to message to people so that they know where we are, and being better than the Republicans is not always enough to get people motivated to vote.”
In Detroit, liberal organizers targeting Black turnout have made education about how politics work a centerpiece of their pitch, along with concrete examples of policies that have benefited people from state and federal legislation.
“There is a slow leaking of Black men from the base because the issues that they care about aren’t being addressed,” said Branden Snyder, executive director of Detroit Action, whose organizers tell people the exercise is more like writing a Yelp review to spur change. “We have politics that were created by both Democrats and Republicans that don’t get to the heart of what our community cares about.”
But Malcolm Kenyatta, a Black Pennsylvania state representative who is an official surrogate for the Biden reelection campaign, said that Black voters will come out for Biden next year if Democrats can articulate Biden’s successes.
“This is like being married. You have to spend just as much time, maybe even more time, on the people who show up for you every time as you do for the people who don’t,” Kenyatta said. “What Black folks care about is what everybody cares about, to be able to take care of their community, to be able to live in a community that is safe … If the president is able to do what he is doing now, which is tout his record, I think we are going to be fine.”
Many advocates say that work needs to start early and be consistent. Cliff Albright, co-founder and executive director of Black Votes Matter, said the resources needed to successfully mobilize Black voters and fight voter suppression in key states were too little and came too late in 2022. He pointed to places like North Carolina and Wisconsin, which had Black Democratic Senate candidates, but said the party didn’t prioritize investments there.
“Everybody knows that there’s no path, whether it’s President Biden or any other Democrat, federal or state, there’s no path to win that does not involve massive turnout from Black voters,” Albright said. “But they can’t just think that it’s just going to happen on its own. They’ve got to invest in making that happen.”
It’s a message also stressed by Mandela Barnes, the first Black lieutenant governor in Wisconsin, who ran for the Senate in 2022 and lost by only 26,000 votes, much of which could be attributed to depressed turnout in the heavily Black city of Milwaukee. Barnes is president of Power to the Polls Wisconsin, a new organization dedicated to working year-round to boost engagement and turnout among Black voters in the state. He’s also trying to support diverse candidates who might be overlooked by the national Democratic establishment.
“In a swing state like Wisconsin, we could very well be the tipping point … If we show up, we win,” Barnes said. “This country, and that power, is in the hands of Black voters, and we have to take that power seriously.”
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Extreme weather events like heatwaves have increased in frequency and intensity partly due to climate change. (photo: NOAA)
Globally, 2023 has seen some of the hottest days in modern measurements, but what about farther back, before weather stations and satellites?
Some news outlets have reported that daily temperatures hit a 100,000-year high.
As a paleoclimate scientist who studies temperatures of the past, I see where this claim comes from, but I cringe at the inexact headlines. While this claim may well be correct, there are no detailed temperature records extending back 100,000 years, so we don’t know for sure.
Here’s what we can confidently say about when Earth was last this hot.
This is a new climate state
Scientists concluded a few years ago that Earth had entered a new climate state not seen in more than 100,000 years. As fellow climate scientist Nick McKay and I recently discussed in a scientific journal article, that conclusion was part of a climate assessment report published by the Intergovernmental Panel on Climate Change (IPCC) in 2021.
Earth was already more than 1 degree Celsius (1.8 Fahrenheit) warmer than preindustrial times, and the levels of greenhouse gases in the atmosphere were high enough to assure temperatures would stay elevated for a long time.
Even under the most optimistic scenarios of the future – in which humans stop burning fossil fuels and reduce other greenhouse gas emissions – average global temperature will very likely remain at least 1 C above preindustrial temperatures, and possibly much higher, for multiple centuries.
This new climate state, characterized by a multi-century global warming level of 1 C and higher, can be reliably compared with temperature reconstructions from the very distant past.
How we estimate past temperature
To reconstruct temperatures from times before thermometers, paleoclimate scientists rely on information stored in a variety of natural archives.
The most widespread archive going back many thousands of years is at the bottom of lakes and oceans, where an assortment of biological, chemical and physical evidence offers clues to the past. These materials build up continuously over time and can be analyzed by extracting a sediment core from the lake bed or ocean floor.
These sediment-based records are rich sources of information that have enabled paleoclimate scientists to reconstruct past global temperatures, but they have important limitations.
For one, bottom currents and burrowing organisms can mix the sediment, blurring any short-term temperature spikes. For another, the timeline for each record is not known precisely, so when multiple records are averaged together to estimate past global temperature, fine-scale fluctuations can be canceled out.
Because of this, paleoclimate scientists are reluctant to compare the long-term record of past temperature with short-term extremes.
Looking back tens of thousands of years
Earth’s average global temperature has fluctuated between glacial and interglacial conditions in cycles lasting around 100,000 years, driven largely by slow and predictable changes in Earth’s orbit with attendant changes in greenhouse gas concentrations in the atmosphere. We are currently in an interglacial period that began around 12,000 years ago as ice sheets retreated and greenhouse gases rose.
Looking at that 12,000-year interglacial period, global temperature averaged over multiple centuries might have peaked roughly around 6,000 years ago, but probably did not exceed the 1 C global warming level at that point, according to the IPCC report. Another study found that global average temperatures continued to increase across the interglacial period. This is a topic of active research.
That means we have to look farther back to find a time that might have been as warm as today.
The last glacial episode lasted nearly 100,000 years. There is no evidence that long-term global temperatures reached the preindustrial baseline anytime during that period.
If we look even farther back, to the previous interglacial period, which peaked around 125,000 years ago, we do find evidence of warmer temperatures. The evidence suggests the long-term average temperature was probably no more than 1.5 C (2.7 F) above preindustrial levels – not much more than the current global warming level.
Now what?
Without rapid and sustained reductions in greenhouse gas emissions, the Earth is currently on course to reach temperatures of roughly 3 C (5.4 F) above preindustrial levels by the end of the century, and possibly quite a bit higher.
At that point, we would need to look back millions of years to find a climate state with temperatures as hot. That would take us back to the previous geologic epoch, the Pliocene, when the Earth’s climate was a distant relative of the one that sustained the rise of agriculture and civilization.
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Jan Dvorkin posing for a portrait in an undated photo. (photo: Jan Dvorkin/NYT)
A new law underscores how Vladimir V. Putin is increasingly using the war in Ukraine as justification for greater restrictions on L.G.B.T. life, portraying it as a consequence of deviant Western values.
When Mr. Dvorkin asked the woman why she had reported him, she told him he had brought it on himself, and “that I could have easily avoided it by staying in the closet.”
He managed to find another family to take the boy, who is deaf, so that the child would not be sent to an orphanage.
Mr. Dvorkin’s experience underscores the increasingly repressive treatment gay and transgender people are subjected to across Russia — a hardship that seems certain to grow as the government leverages the war in Ukraine as justification for greater restrictions on L.G.B.T.Q. life.
The latest crackdown came last week when President Vladimir V. Putin signed a law that criminalized all surgery and hormone treatments used for gender transitions.
That law comes on top of a measure enacted last December prohibiting the representation of L.G.B.T.Q. relationships in any media — streaming services, social platforms, books, music, posters, billboards and film.
Critics, including legal and medical professionals and gay rights activists, view the campaign as an effort to distract from Russia’s military failings in Ukraine — by creating a boogeyman it can portray as a threat from a deviant and corrupt West.
“It is a common practice to look for internal enemies when their external enemy turns out to be tougher than expected,” Mr. Dvorkin, 32, said in an interview from Moscow. “With no success on the front line, Putin found an easy enemy, a vulnerable group whom he can defeat in Russia.”
As with many repressive measures, Mr. Putin himself seemed to have inspired the law.
Long before his invasion of Ukraine, Mr. Putin had scorned the idea of gay rights. But as his military stumbled, he began to rewrite the war as a Western attempt to undermine Russian security and “traditional values.”
He took aim at questions of gender identity as well as sexual orientation, regularly denigrated transgender people in his speeches, mocking the idea of “Parent No. 1 and Parent No. 2” instead of “mom and dad,” and suggested that the West sought to make the world adopt “dozens of genders.”
The new law bans all gender transitions as well as changing genders on official documents like passports. It became harsher as it proceeded in Russia’s Parliament; typically a rubber stamp for Mr. Putin’s favored legislation, it overwhelmingly passed the law. The final version annuls marriages when one spouse changes gender and bans adoptions by such couples.
The law essentially removes the ability of transgender people to control their own bodies, rights activists said, and even if people had the means to travel abroad seeking surgery, which many do not, they would not be allowed to update official documents. Having the wrong gender on identification papers would create hurdles in countless aspects of life such as employment and travel.
The new law also bans treatment with either estrogen or testosterone, which are typically taken before undergoing transition surgery. There are limited exceptions for people who had started the process and already changed documents.
Critics said the ban could lead to what is essentially a black market for the drugs. One transgender person in St. Petersburg said that a clandestine lab there was already attempting to make estrogen from over-the-counter drugs. Illicit testosterone was a bigger challenge, said the person, who insisted on anonymity to avoid retribution.
Surveys by the independent pollster Levada show that, over the last decade, the Kremlin’s propaganda campaign against the L.G.B.T.Q. community may have affected Russian attitudes: The percentage of respondents who said they viewed gay people with disgust or fear increased from 26 percent in 2013 to 38 percent in 2021.
In 2013, the first Russian law against disseminating “gay propaganda” was framed as protecting children. This time, with the war as a backdrop, the law banning gender transition was presented as a matter of national security.
“The war is not only on the front line, the war is going on in the minds and souls, and we want to protect our country from being destroyed from within,” Pyotr Tolstoy, a hard-line deputy speaker of Parliament, wrote on Telegram.
The concept of national security has become an increasingly fluid one, said Max Olenichev, a lawyer who defends L.G.B.T. people. “It has become an ephemeral thing that can mean absolutely anything,” he said. “Whenever you do not want to give a reason, just say ‘national security.’”
The law also corresponds with Mr. Putin’s attempt to portray Russia as a bastion of what he calls “traditional family values,” a longstanding effort to appeal to conservative voters at home and abroad.
The hope is that support for his social agenda will extend to endorsing the war, said Alexander Kondakov, a sociologist at University College Dublin. “By targeting a group that is already marginalized, they amass support for the war and any other cause that the government wants,” he said.
For the L.G.B.T. Q. community, the law was yet another blow.
Mr. Dvorkin described the mood among transgender people as “dark and depressing,” with members bracing for more hate crimes. “There was already an increase in vocal hate groups, and since the law passed they have gone off the rails,” he said.
Violence against gay people surged after the 2013 law, said Mr. Kondakov, who studies the intersection of law and security for the L.G.B.T. community. Prosecutions also jumped after the stricter version passed last December, according to a report by Novaya Gazeta Europe, an independent newspaper.
Mr. Dvorkin, who began transitioning at 28, is the founder of Center T, which offers medical and other advice to thousands of transgender people. The government recently designated the organization a “foreign agent,” a label whose onerous requirements carry an automatic stigma, and he fears it will soon have to shutter or go underground.
Mr. Dvorkin began looking for a new home for his son not long after the stricter law passed last December. Repeated warnings from the children’s services office, which supervised the adoption, against discussing his gender identity and sexual orientation online, as well as a court-imposed fine, signaled that his custody was in jeopardy.
His son, now 10, also had a kidney disease. In June, Mr. Dvorkin struggled to locate a family willing to take him. He finally persuaded one to do so, then managed to convince officials not to return him to an orphanage.
Use of hormones and surgery for transgender people was first accepted in the Soviet Union in the 1970s, and by 2017 Russia had developed what many considered a rational approach, leaving the decision up to a panel of doctors and psychiatrists.
Gender transition had not been much of a political issue in Russia until now. Initially, the Ministry of Health questioned the need for any change, but it soon surrendered to browbeating by Vyacheslav Volodin, the chairman of Parliament, who accused officials of pursing an American agenda by seeking to emulate “Sodom.”
Although overall numbers are not readily available, Mr. Volodin said that 2,700 people had currently been approved for gender transitions by the ministry; the source of the number was unclear. Russia’s population is more than 143 million.
In St. Petersburg, the person who described the clandestine lab, who uses the pronoun they, rushed to finish the process of being legally recognized as a woman before the law took effect. Describing it as “anarchistic escapism,” they said they invented a new, unusual first name whose spelling looks like someone smashed a keyboard with a fist. They said they assured the bureaucrat reading the application it was a traditional Siberian name.
“The best thing we can do is to resist this state by simply existing,” they said.
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Elon Musk. (photo: Jae C. Hong/AP)
ALSO SEE: Brightly Flashing 'X' Sign Removed From the San Francisco Building That Was Twitter's Headquarters
In a lawsuit filed Monday in U.S. District Court for the Northern District of California, X alleged that the American and British operations of the Center for Countering Digital Hate (CCDH) “engaged in a series of unlawful acts designed to improperly gain access to protected X Corp. data.”
The lawsuit seeks unspecified damages, with interest, for allegations that include breach of contract, violation of the Computer Fraud and Abuse Act, intentional interference with contractual relations and inducing breach of contract. It also asks that the CCDH and its agents be barred from accessing materials licensed to a tool that X’s attorneys alleged the group used to obtain data.
In a statement Tuesday, CCDH founder and chief executive Imran Ahmed said the legal threat shows that X owner Elon Musk “will stop at nothing to silence anyone who criticizes him for his own decisions and actions.”
The CCDH’s “research shows that hate and disinformation is spreading like wildfire on the platform under Musk’s ownership” and that the billionaire “is trying to ‘shoot the messenger’ who highlights the toxic content on his platform rather than deal with the toxic environment he’s created,” Ahmed said. “The CCDH’s independent research won’t stop — Musk will not bully us into silence.”
Musk’s actions, the CCDH said, “represent a brazen attempt to silence honest criticism and independent research in the desperate hope that he can stem the tide of negative stories and rebuild his relationship with advertisers.” Twitter’s owner has called himself a “free-speech absolutist” and taken aim at “woke” language.
X also alleged, without offering evidence for its claims, that the CCDH operations were “activist organizations masquerading as research agencies, funded and supported by unknown organizations, individuals and potentially even foreign governments with ties to legacy media companies.”
The filing also said that X “currently lacks sufficient information to include the identities [of] these entities, organizations, and persons,” but that “when their true names and capacities are confirmed through discovery,” it would amend the lawsuit to name the CCDH’s alleged backers.
The CCDH’s work was cited in a Bloomberg News article published last month about how advertisers have been unsettled by a rise in “hateful, violent and inaccurate posts” on the platform, according to the CCDH and other organizations.
In research published in June, the CCDH found that Twitter had failed to take action against 99 of the 100 paid accounts it flagged to the platform with user-reporting tools for hateful conduct. Among the content the CCDH said it flagged were an antisemitic post and a transphobic post that falsely linked transgender people to pedophilia.
It also published research in February estimating that the reinstatement of 10 major accounts “renowned for publishing hateful content and dangerous conspiracies will generate up to $19 million a year in advertising revenue for Twitter.”
Musk, who became the world’s richest person through Tesla and PayPal, bought Twitter last year. He then embarked on a dramatic overhaul of the platform, including a renaming of the social network — changing the sign on the company’s San Francisco headquarters has turned into a chaotic ordeal — and a temporary limit on how many tweets nonpaying users can view, to the dismay of advertisers. The billionaire recently said the number of monthly users on X had reached a new high.
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"Climate change doesn't only affect cholera through worsening floods and storms. Hotter temperatures and longer and drier droughts can also have an impact." (image: Amelia Bates/Grist)
The bacteria behind one of history’s deadliest diseases is thriving again due to extreme weather.
“That March, we started to see cholera, which is usually endemic in Malawi, becoming an outbreak,” said Gerrit Maritz, a deputy representative for health programs in Malawi for the United Nations Children’s Fund. Cholera typically affects the country during the rainy season, from December to March, during which time it remains contained around Lake Malawi in the south and results in about 100 deaths each year.
The 2022 outbreak showed a different pattern — cholera spread throughout the dry season and by August had moved into Malawi’s northern and central regions. By early February of this year, cases had peaked at 700 per day with a fatality rate of 3.3 percent, three times higher than the typical rate. When cases finally began to decline in March, cholera had claimed over 1,600 lives in a 12-month period — the biggest outbreak in the country’s history.
As climate change intensifies, storms like Ana and Gombe are becoming more frequent, more powerful, and wetter. The World Health Organization, or WHO, says that while poverty and conflict remain enduring drivers for cholera around the world, climate change is aggravating the acute global upsurge of the disease that began in 2021. According to WHO, 30 countries reported outbreaks in 2022, 50 percent more than previous years’ average; many of those outbreaks were compounded by tropical cyclones and their ensuing displacement.
“It’s difficult to say that [Tropical Storm Ana and Cyclone Gombe] caused the cholera outbreak,” UNICEF public health emergency specialist Raoul Kamadjeu said. “What we can say is they were risk multipliers.”
Cholera is a diarrheal illness that spreads in places without access to clean water and sanitation, when people swallow food or water contaminated with Vibrio cholerae bacteria.
“Malawi’s water-sanitation indicators were already extremely bad,” said Kamadje, “but the storms made a bad situation worse.”
Flash floods spread sewage into lakes and boreholes, washed away pipelines and sanitation infrastructure, and ruined roads integral to the delivery of supplies. By one government estimate, Ana alone destroyed 54,000 latrines and about 340 wells. People displaced from their homes turned to whatever water sources were available, often ones that were highly contaminated, and transmitted the disease as they moved to new areas.
While Malawi’s outbreak was spreading across its borders to Zambia and Mozambique, hundreds of thousands of people in Pakistan reported cholera symptoms amid a massive monsoon season that left a third of the country fully underwater. And in Nigeria, cases spiked after over a million people were displaced by extreme flooding during the 2022 rainy season.
The global cholera surge drove a vaccine shortage right when countries needed it most. Malawi in the past used the cholera vaccine for prevention, but “now if you don’t have an outbreak, you don’t get the vaccine,” said Otim Patrick Ramadan, WHO incident manager for regional cholera response in Africa. In response to the shortage, the international coordinating group for cholera vaccines changed its vaccination protocol in October from two doses to one, reducing protection from two years to about five months.
Climate change doesn’t only affect cholera through worsening floods and storms. Hotter temperatures and longer and drier droughts can also have an impact.
“With a severe shortage of water, the remaining sources become easily contaminated, because everyone is using them for everything,” Ramadan said. “We have seen that in the greater Horn of Africa.” Amid a prolonged and extreme drought, which has been directly attributed to climate change, Ethiopia, Somalia, and Kenya all saw cholera proliferate over the past year. In drought areas that have experienced crop failure, malnourishment has also reduced immunity to diseases.
Johns Hopkins University infectious disease epidemiologist Andrew Azman, who specializes in cholera research, cautions against making sweeping statements about climate change turbocharging cholera globally.
“We know cholera is seasonal in much of the world, but the associations between precipitation, drought, floods, and cholera are not really clear,” Azman said. “In some places, more precipitation increases cholera risk. In some places, it’s less precipitation.” He added that destructive storms in the past have not led to massive cholera outbreaks at the scale of the recent epidemic in Malawi, so it’s important to also consider other factors.
“While the storms may have created good conditions for transmission, the outbreak happened after a few years of relative calm in terms of exposures,” Azman said. “Immunologically, you had a much more naive population.” The strain circulating had also been newly introduced from Asia, and scientists are currently studying whether it was more transmissible.
Research suggesting that cholera is largely contracted from bacteria that lives in the aquatic environment and thrives under increasing temperatures has mostly been discredited, said Azman. “But one of the big mechanisms by which extreme events will impact cholera risk is the destruction of water and sanitation infrastructure,” he said. “That is an important point, because we can block those impacts if we invest in [those things].”
Kamadju agrees. “Cholera is just a mark of inequity and poverty,” he said. “It’s a problem of investment, development, and infrastructure.” Malawi’s outbreak came at a time of economic crisis, with its currency devalued in May 2022. Limited health resources were also stretched thin by COVID-19 and a polio outbreak, the first in 30 years.
This March, a year after the cholera outbreak began and as cases were beginning to go down, Malawi and its neighbors braced for a new storm. Cyclone Freddy turned out to be the longest-lasting cyclone ever on record, causing untold damage and killing more than 800 people across Mozambique, Madagascar, and Malawi, with some counts even higher. But while cholera cases started to spike in Mozambique as predicted, in Malawi they continued their downward trend.
Ramadan says that’s in large part because the ongoing cholera response already occurring in Malawi’s southern region — high vaccination rates, advanced distribution of water tablets and supplies, and messaging around cholera — reduced transmission in spite of the direct impacts to infrastructure.
Maritz of UNICEF worries that a shift in Malawi’s methodology for reporting cholera cases may be giving a false impression of just how successful those mitigation efforts are. On June 1, as cases continued to decline significantly, Malawi shifted to an endemic protocol for measuring cholera, which requires a rapid diagnostic test and a lab sample to confirm an infection. In contrast, during an outbreak, anyone who presents at a clinic with symptoms gets marked as a case.
Kamadjeu said this strategy made sense given the low number of current cases. But Maritz says that capacity challenges and delays in testing with the new protocol have led to underreporting of cases.
“We are still seeing people arriving at clinics with cholera symptoms that are not being reported in the national dashboards,” said Mira Khadka, an emergency health specialist leading cholera response for UNICEF in Malawi’s Blantyre district. It’s hard to mask a big cholera outbreak if people start dying, but the reporting lag is still cause for concern.
“Agencies that were responding to the cholera outbreak are now withdrawing,” said Khadka. “This can create the potential for another big outbreak to start.”
A team of government officials and health experts is assessing reporting methods in the southern districts where cases persist.
“What climate change means for us as a humanitarian agency is that we cannot do business as usual anymore,” Maritz said. “We are already preparing that most likely come January, February, there will be another cyclone with a huge flooding event.”
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