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OSHA vaccine-or-test mandate is smart public policy

The Occupational Safety and Health Administration (OSHA) has proposed an emergency temporary standard (ETS) for employers to cope with the health dangers posed by COVID-19.

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The Occupational Safety and Health Administration (OSHA) has proposed an emergency temporary standard (ETS) for employers to cope with the health dangers posed by COVID-19. The centerpiece of the ETS is a vaccine-or-test mandate for employees working at firms with over 100 employees to be vaccinated against COVID-19. The mandate is good public policy: it will reduce deaths and hospitalizations, and it will also increase economic growth and reduce the main inflationary pressures facing the U.S. economy.

The proposed ETS has spurred a large legal battle and its eventual fate is uncertain, even though exemptions for religious and health reasons are possible, and a version of these standards is already in effect for federal government employees, government contractors, and health care workers. In early November, the U.S. Court of Appeals for the Fifth Circuit stayed the ETS pending judicial review. However, over this past weekend, the stay was removed by the court with current jurisdiction over the case (the U.S. Court of Appeals for the Sixth Circuit).

The lifting of the ETS stay is welcome news. The vaccine-or-test mandate is a key plank in an effective public health response to the continuing havoc wreaked by COVID-19. For example, a recent paper examining the introduction of vaccine mandates at the provincial level in Canada, France, and Germany found “that the announcement of a mandate is associated with a rapid and significant surge in new vaccinations (more than 60% increase in weekly first doses)…” Higher vaccination rates will contribute meaningfully to reducing deaths and hospitalizations from COVID-19.

Despite broad availability, the United States lags far behind dozens of countries in vaccination rates, and a mandate would likely boost the U.S. rate in a significant way. Recent research examining the international experience of vaccine mandates by Karaivanov et al. (2021) finds large increases in vaccination rates (up to 5 percentage points) driven by mandates.

The mandate would have large economic effects as well, even beyond the considerable economic value of deaths and hospitalizations averted. Overall economic growth over the past year has been largely driven by the fall and rise of COVID-19 cases. In the first six months of this year, as case growth fell sharply, gross domestic product (GDP) rose at a 6.5% annualized rate—an extraordinarily fast pace of growth. However, in the third quarter, as the Delta variant surged in the United States in August and September, GDP growth decelerated to just 2.1%.

Further, from February to July—the six months prior to the Delta variant hitting the U.S. economy—job growth averaged 710,000 per month. However, since August and the rise of the Delta variant, job growth has fallen to a monthly average of 405,000—a respectable pace compared with previous recoveries, but a pronounced slowdown.  

Looking more granularly at state-level data in the major sector most affected by social distancing requirements—leisure and hospitality—we also see that employment growth in the first 10 months of 2021 was positively correlated with a state’s vaccination progress over that time. Figure A below shows that states with higher total vaccination rates in October 2021 also saw faster leisure and hospitality job growth between January and October. These links between faster economic growth, greater job creation, and virus control are generally well-understood. Less well-known, however, is that the economic effects of COVID-19 are by far the largest drivers of the acceleration in U.S. inflation in 2021. Inflation rates are higher than usual because the pandemic has reallocated consumer spending away from services and towards goods, exacerbating supply chain problems.

Figure A

As we have noted elsewhere, the inflation acceleration in 2021 is not happening because the U.S. economy’s underlying productive capacity has been overwhelmed by too much spending—whether private or public spending. In fact, measured “output gaps”—the difference between actual GDP and the economy’s underlying productive capacity measured by potential GDP—remain negative, a fact usually associated with mild disinflation. But even as aggregate spending remains below the economy’s underlying capacity, the allocation of this spending has changed radically, shifting away from face-to-face services and towards goods (particularly durable goods). This is clearly an effect of COVID-19; households still feel uncomfortable doing as much face-to-face service consumption as they did before March 2020, yet fiscal relief measures substantially supported incomes (until this fall).

An unanticipatedly large share of this income has been thrown into the goods sector. This, of course, does not simply mean that less aid should’ve been provided overall. In the set of realistic choices facing policymakers in January 2021, providing less aid than was provided by the American Rescue Plan (ARP) would’ve been the wrong choice. Even with the inflation acceleration of 2021, household incomes are higher at the end of the year because of the ARP aid.

Policymakers with perfect foresight about the sui generis problems that would emerge in 2021 with supply chains and the reallocation of household spending following a once-in-a-century pandemic could perhaps have tweaked the pandemic fiscal relief in ways that would’ve led to less-pronounced inflationary pressure. For example, households could have been provided two sets of vouchers instead of cash relief. One of the vouchers could be used immediately, but only to purchases services. The other set of vouchers could be spent on goods, but could only be used slowly over time, starting small and rising in value each month. Of course, just writing out how pandemic aid could have been structured differently to avoid inflationary pressures highlights how politically unrealistic all of this would have been, and how unreasonable it would be now to judge policymakers for not providing it in this way.

On the supply side, goods production is far more affected by global events than services. Globally, the rise of the Delta variant this summer caused rolling shutdowns of ports and transport facilities around the globe, snarling supply chains. This is threatening to repeat itself with the rise of the Omicron variant.

Despite rhetoric in the United States blaming inflation on fiscal relief efforts following COVID-19, the acceleration of core inflation across countries is unrelated to the size of these relief efforts. Outside of clearly global energy markets, core inflation (inflation excluding the volatile prices of energy and food) has accelerated across a range of countries that undertook widely varying levels of COVID-19 fiscal relief. Figure B below shows the relationship between the increased spending or decreased taxes resulting from discretionary fiscal relief aimed at blunting the economic shock of COVID-19 across countries, and the acceleration in core inflation in September 2021 relative to pre-COVID-19 trends. As can be seen, there is no relationship at all.

Figure B
Figure B

However, there is a slight but significant pattern of core inflation accelerating more in countries with larger COVID-19 shocks, as shown below in Figure C. For the same countries examined in Figure A, there is a positive correlation between cumulative COVID-19 cases and the acceleration in core price inflation.

Figure C
Figure C

Dividing the 37 countries into three groups—the 12 countries with the lowest cumulative COVID-19 case count, the 12 countries with the 12 highest case counts, and the 13 countries in the middle—reveals another striking pattern, as shown below in Figure D. The countries with the lowest case counts (New Zealand, Australia, South Korea, Japan, Finland, Mexico, Norway, Iceland, Canada, Germany, Denmark, and Greece) saw an acceleration of core inflation of just 0.4 percentage points. Countries in the middle of case counts (Italy, Poland, Chile, Ireland, Hungary, Austria, Turkey, Switzerland, Spain, Portugal, France, and Costa Rica) saw an acceleration of 1.0 percentage points, while the countries with the highest case count (Sweden, Belgium, Latvia, Netherlands, Luxembourg, the United Kingdom, and the United States) saw an acceleration of 1.5 percentage points.

In short, the extreme distortions caused by COVID-19 in the United States—a sharp reallocation of spending away from services towards goods and supply chains bottlenecks—are also associated with inflation in other countries as well. One reason why U.S. inflation has been more pronounced than in other countries is because our COVID-19 case counts have been higher. As a result, public health policy is clearly the most effective economic policy we have to tamp inflation back down. Vaccines, in turn, are by far our most powerful public health measure against COVID-19. Maximizing vaccination rates both domestically and globally hence will pay huge economic returns. Domestically, an employer mandate is an invaluable tool for maximizing vaccination rates.

Figure D
Figure D

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Monkeypox cases are rising. Should we be worried?

The World Health Organization has said the current outbreak of monkeypox is the largest ever recorded outside sub-Saharan
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The World Health Organization has said the current outbreak of monkeypox is the largest ever recorded outside sub-Saharan Africa, with cases rising above the 100-mark a few days ago and the UK top of the table with 56 as of yesterday.

Top of the list of concerns is how the virus – which does not spread easily between humans and requires skin-to-skin contact – is spreading so quickly in so many countries in Europe, the Americas and Australia where the disease is not endemic.

There is speculation that monkeypox may be being spread between sexual partners, even though it is not normally considered a sexually-transmitted infection. Thankfully, there have been no deaths reported so far, although the WHO notes monkeypox has a fatality rate of between 3% and 6%.

While health authorities are on alert, the WHO said it thinks the outbreak can be contained and that the overall risk to the population remains low. It also stressed there is no evidence that a viral mutation is responsible for the unusual pattern of infections.

Monkeypox is considered less likely to mutate quickly because it is a DNA virus rather than an RNA virus like influenza or COVID-19.

Several countries including Belgium and the UK are already advising a three-week quarantine period for anyone who contracts the virus and their close contacts.

The increasing case numbers in the current monkeypox outbreak are certainly concerning,” commented Dr Charlotte Hammer, an expert in emerging infectious diseases based at the University of Cambridge in the UK.

“It is very unusual to see community transmission in Europe – previous monkeypox cases have been in returning travellers with limited ongoing spread. However, based on the number of cases that were already discovered across Europe and the UK in the previous days, it is not unexpected that additional cases are now being and will be found, especially with the contact tracing that is now happening.”

Vaccines and drugs are available

Meanwhile, attention is now being turned to other measures to control the outbreak, including the use of vaccines against smallpox – a related virus – in a ‘ring vaccination’ approach designed to control the spread among contacts.

Vaccines used during the smallpox eradication programme can provide around 85% protection against monkeypox, according to the WHO, which notes that one newer vaccine – Bavarian Nordic’s Jyneos – has been approved by the FDA for prevention against both viruses.

There’s also a licensed antiviral drug for monkeypox. SIGA Technologies’ oral drug Tpoxx (tecovirimat) is approved for smallpox, monkeypox and cowpox in Europe, and in the US and Canada for smallpox, although it can be used off-label for the other disease. The US FDA also approved a new intravenous form of the drug last week.

The WHO says there is no need for widespread vaccination, as other control measures like isolation of patients should be enough to curb the spread and in any case supplies of vaccines are limited.

Monkeypox causes symptoms similar to but milder than smallpox, typically beginning with fever, headache, muscle aches and exhaustion. It is transmitted to people from various wild animals, such as rodents and primates, and is usually a self-limited disease with symptoms lasting from two to four weeks.

In 2003, the US experienced an outbreak of monkeypox, which was the first time human monkeypox was reported outside of Africa. The Centers for Disease Control and Prevention (CDC) is making some Jyneos vaccine reserves available for close contact inoculations, including healthcare workers tending to patients.

The UK Health Security Agency (UKHSA) said yesterday it had identified 36 additional cases of monkeypox in England, and that vaccination of high-risk contacts of cases is already underway.

“A notable proportion of recent cases in the UK and Europe have been found in gay and bisexual men so we are particularly encouraging these men to be alert to the symptoms,” said the agency’s chief medical advisor Dr Susan Hopkins.

“Because the virus spreads through close contact, we are urging everyone to be aware of any unusual rashes or lesions and to contact a sexual health service if they have any symptoms.”

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What does good cybersecurity look like in 2022?

The pharma industry is becoming an increasingly hot commodity for cybercriminals. In recent years, digital adoption has accelerated
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The pharma industry is becoming an increasingly hot commodity for cybercriminals. In recent years, digital adoption has accelerated at a rapid pace, with companies racing to integrate cloud-based platforms and telehealth services to expand the delivery of modern healthcare. Combined with the sudden arrival of COVID-19, this perfect storm of events handed cybercriminals an opportunity to exploit weaknesses in fledging systems and processes.

Pharma companies hold masses of vital data sets, from classified intellectual property to proprietary information about drugs and clinical trial developments. The value of such data is not lost on cybercriminals. This was illustrated in 2021, amid growing awareness of the pharma industries’ efforts to develop and distribute COVID-19 vaccines. According to cybersecurity firm Critical Insights, the number of cybersecurity breaches in healthcare reached an all-time high in 2021, exposing an unprecedented amount of protected health information.

Cyber attacks can be highly damaging, both financially and to a company’s reputation. Therefore, it is essential that necessary steps are taken, both at a company and individual level, to understand and prevent the risk of cyber threats. But what does good cybersecurity actually look like? To help navigate the complex world of digital crime, Adarma’s threat consultant Mike Varley, KnowBe4 lead security awareness advocate Javvad Malik, CEO and founder of CyberSmart Jamie Akhtar, and senior engineer at Trend Micro Simon Walsh offer their insights into key trends and best practises for pharma companies.

Why is the healthcare industry a particular target for cyberattacks?

Javvad Malik (JM): Historically cybercriminals were after money, so they often ignored healthcare providers. However, with increasing sophistication within the criminal economies and the ability to monetise data through ransomware, other means of extortion, or resale, healthcare providers have become an almost ideal target for criminals.

Simon Walsh (SW): Despite statements from would-be attackers to the contrary, the healthcare and pharma industries became prime targets during the COVID pandemic, particularly for ransomware operators, as we saw during the breach of the Irish Healthcare Service Executive in May 2021.

There are several reasons for this: they’re seen as easy targets because of their relative lack of security maturity; the COVID pandemic-induced strain they’re already under makes them more likely to pay the ransom; and the fact that the data they hold – patient records – is extremely valuable and opens additional paths to extortion.

Jamie Akhtar (JA): Many healthcare providers have weak or limited defences. These range from poor staff awareness of threats to creaking, outdated operating systems and tech, but whatever the reason, cybercriminals are aware that many healthcare providers make for easy pickings.

Mike Varley (MV): We can expect to see a rising number of ransomware attacks on the healthcare sector. Healthcare is recognised as national critical infrastructure, which makes it an attractive target to malicious foreign entities looking to create chaos and harm. Similarly, when human life is put at risk by an attack, organisations are more likely to pay up, so attackers often view these structures as a quick pay-day.

Where do you see the most mistakes being made in healthcare when it comes to addressing cyber threats?

JM: Perhaps the biggest mistakes or challenges healthcare faces when addressing cyber threats are having outdated or unpatched software running, being too quick to purchase or adopt internet-connected devices without demanding rigorous security testing, and, finally, the lack of security awareness and training amongst IT staff.

SW: Security maturity and the ability to successfully detect and withstand attacks comes from understanding cyber risk and building and developing a cyber security strategy around that understanding. This of course needs to be adopted and driven by the board and C-level executives and too often this is not the case, with a lack of understanding and investment resulting in a weakened security posture.

Over-reliance on security technology without adequate human oversight further weakens this posture. The Irish hospitals who successfully prevented the attack in May 2021 were those who not just detected stages of the attack but also understood what those detections meant and acted as a result.

Developing a human oversight function – for example a Security Operations Centre – in house is costly, difficult, and takes time. So, for many in the healthcare/pharma industry, the quickest route to success on this front is working with the correct partner who will provide that function.

JA: There are two areas in which most organisations, not just healthcare providers, could be doing better. Many aren’t doing the simple things that can thwart most cyber-attacks. For example, regularly updating software and operating systems, using strong passwords and MFA, developing clear policies for staff to follow, and ensuring security tools are configured properly.

On top of this, employee awareness of cyber threats just isn’t widespread enough. An organisation can have the best cybersecurity software around but, if an employee doesn’t know what a phishing email looks like and clicks a malicious link, it’ll be hacked just the same. The way to counter this is basic cybersecurity training. It doesn’t have to be comprehensive, just enough to help your people make informed choices.

“Perhaps the biggest mistakes or challenges healthcare faces when addressing cyber threats are having outdated or unpatched software running, being too quick to purchase or adopt internet-connected devices without demanding rigorous security testing, and, finally, the lack of security awareness and training amongst IT staff.”

 

What trends are you seeing in cybersecurity at the moment?

JA: The most worrying trend is the rise in supply chain attacks. Cybercriminals have worked out that the best way to target large enterprises with solid defences, is to attack a smaller, less well-defended supplier who can give them a backdoor in. As a result, we’re seeing more major attacks originate in this way.

Alongside this, phishing continues to be the single most common form of attack. Due to the general lack of awareness in the working population, many organisations are still struggling to contain the threat.

MV: Increasingly I think we will see healthcare sector organisations turning to managed security service providers who have the expertise, capability, and technology to deal with an increasingly complex and harmful cyber landscape.

The healthcare sector is expected to provide an elevated level of cyber protection and with a shortage of cyber talent and the prohibitive cost of establishing a Security Operations Centre internally, organisations will need a trusted security partner that can provide that level of proactive protection.

What advice would you give to companies looking to improve their cybersecurity policies, both on a company-wide scale and individual basis?

JA: Above all, make them clear and easy to follow. Avoid technical jargon, where possible, as this will only disengage people. And, explain why the company has adopted the policies it has; your staff will find it much easier to follow them if they know why. Also, store them somewhere that’s easy to access from anywhere. There’s little use in a policy if it’s buried deep in a shared drive where nobody reads it.

MV: Cybersecurity policies should be informed by a threat-led approach. Regular threat modelling will highlight what threats you are facing and how adversaries are likely to target your organisation. With this information on areas of commonality, your security teams can focus on implementing layered security and monitoring.

Your policy should consider asset awareness. As basic as it sounds, it can be easy for a small handful of assets to fall under the radar within vast enterprises, which leads to out-of-date operating systems and software.

JM: Organisations should look to take a data-driven approach. That means, that in addition to following what is occurring externally in terms of attacks, they should look through a year or two worth of internal security logs to see what was the root cause of the incidents during this time period.

Once the root causes have been identified, they should be prioritised, and then controls be put in place to address those specific root causes. Those should inform the cybersecurity policies and tailor them to the specific risks the organisation is facing.

SW: For companies, start at the top and ensure that the board and C-level executives are capable of understanding and assessing risk. This will drive investment in cyber strategy and improve your chances of mitigating that risk. Human oversight of security-related activity in the organisation is also fundamental.

For individuals, heightened awareness and ongoing education are key. We all have a role to play in cyber-security as 100% reliance on technology is unfortunately never enough.

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CDC Now Recommends COVID Testing For All Domestic Air Travel, Including The Vaccinated

CDC Now Recommends COVID Testing For All Domestic Air Travel, Including The Vaccinated

Authored by Jack Phillips via The Epoch Times,

The…

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CDC Now Recommends COVID Testing For All Domestic Air Travel, Including The Vaccinated

Authored by Jack Phillips via The Epoch Times,

The Centers for Disease Control and Prevention (CDC) is recommending that all domestic travelers undergo COVID-19 testing before and after they travel - regardless of vaccination status.

In an update on the agency’s website, anyone traveling within the United States may want to consider “getting tested as close to the time of departure as possible,” and no more than three days before a flight. It previously only recommended testing for people who have not received COVID-19 vaccines or up-to-date booster shots.

The CDC update is also recommending that people take a test before or after a trip if they went to crowded spaces “while not wearing a well-fitting mask or respirator.”

In April, a Florida federal judge struck down the CDC mandate that required people to wear masks inside airports or on airplanes. Justice Department officials have signaled they will challenge the rule, implemented after President Joe Biden took office in early 2021, in court.

A spokesperson for the agency told AFAR Magazine on May 19 that “COVID-19 vaccines are effective at preventing severe disease and death,” but added, “since vaccines are not 100 percent effective at preventing infection, some people who are up to date can still get COVID-19.”

“People who are up to date with their COVID-19 vaccines may feel well and not have symptoms but still can be infected and spread the virus to others,” the spokesperson said.

In January of this year, the CDC also implemented a change to its international travel rule, requiring plane passengers aged 2 and older to show a negative COVID-19 test from no more than a day before boarding a flight or proof of recovery from COVID-19 within the previous 90 days. Foreign nationals have to show proof of COVID-19 vaccination as well.

Neither the CDC nor the White House has given any public indication of when the mandatory testing rule for international travelers will be relaxed. Travel groups have pushed for that rule to be removed for months now.

In a letter to the White House, a group representing more than 250 organizations called for an end to the rule, saying it’s only caused “slow economic recovery of the business and international travel sectors.”

After the federal judge’s order was handed down last month, the CDC issued a new recommendation that people inside airports and airplanes wear masks, despite nearly all major airliners having scrapped enforcement.

And during a news briefing last week, CDC Director Rochelle Walensky, who has been criticized for her agency’s messaging during the COVID-19 pandemic, said that people living in counties that the agency deems to have high COVID-19 transmission should wear masks in indoor settings.

Tyler Durden Mon, 05/23/2022 - 17:40

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