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A problem at the heart of US democracy

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Almost 150 million people voted in last week’s US elections - a remarkable and historic turnout.  The people elected Senators, Members of Congress, members of state legislatures and a variety of other office holders. They did not elect the next US president or vice president. Both will be elected on 14 December when 538 largely unknown individuals meet in the US Electoral College, an arrangement dreamed up by the US Constitutional Convention in 1787, writes Dick Roche.

The legitimacy of the Electoral College has been questioned for decades. There have been numerous to reform it. Currently fifteen US states are campaigning its abolition.

When the Constitutional Convention met in 1787 it had no template as to how the leadership of the new republic should be decided.

The Convention members were a patrician group with mixed feelings about democracy.  The  Father of Constitution” James Madison referred to “the inconvenience of democracy”. Edmund Randolph from Virginia spoke of the need for “sufficient checks against democracy”. Another representative spoke of “the evils we experience flow from the excess of democracy”.

Convention members were concerned that citizens had no knowledge of national figures and that left to their own devices the people could elect a demagog. They did not want Congress electing the President and worried about the balance between the big and small states. To resolve the conundrum a committee was appointed. It produced the idea of an Electoral College, an elite body that would decide who would be the most suitable leader. Other than setting the number of electors to be appointed by each state and details as to when and where the college should meet the US Constitution is silent on how the electors should be chosen or conduct their deliberations.

Today’s Electoral College consists of 538 Electors.  States are allocated college votes on the basis of their representation in Congress. When the election results are certified the states, with two exceptions,  allocate their votes in the College to the political parties on a winner-take-all basis. Following Joe Biden’s victory in California, the state’s  55 Electoral College votes will go to the Democrats.  Florida’s 29 votes will go to the Republicans on foot of Trump’s win there. Two states, Maine and Nebraska,  allocate two votes to the candidate who wins the popular vote in the state and one to the winner of each electoral district.

The political parties decide on who goes to the College. Electors pledge to vote for their party’s candidates. However Electors can become “faithless electors” and cast a ‘deviant’ vote for any person they wish. Bizarrely, there are no Constitutional or federal provisions dealing with faithless electors. Five states impose a penalty on faithless electors. Fourteen states have legal provisions that allow for the cancellation of a deviant vote and replacement of a faithless elector. Oddly the legislation in nineteen states and Washington DC allows the deviant votes to be counted as cast.  The remaining states have no legislation to deal with faithless voters.

As the 1960s Civil Rights Movement was casting light on America’s flawed political structures Senator Birch Bayh, an Indiana Democrat, launched a campaign to abolish the College.  He argued that Americans could not “proudly beat our chest and proclaim ourselves to be the world’s greatest democracy and yet to tolerate a presidential electoral system in which the people of the country do not vote for the President”.

Bayh’s proposal received overwhelming support in the US House of Representatives was endorsed by President Nixon and had the support of many states but like all earlier reform attempts it failed. The proposals were killed off by a segregationist filibuster in the US Senate.

The 2000 and 2016 US presidential elections pulled the spotlight back on the Electoral College.

In 2000 a controversial recount of votes in Florida went to the US Supreme Court. The recount, which risked delaying certification of the election, was halted by the Court. George W Bush was deemed to have beaten Al Gore. Bush won Florida by 537 votes out of almost 6 million votes cast. As a result he received Florida's 25 Electoral College votes: Gore’s 2.9 million votes counted for nil. When the Electoral College met on 18 December 2000 George W Bush won the US presidency by 5 votes. In the popular vote Gore received half a million votes more than Bushfive

In 2016,  the Electoral College was very much back in focus.  When the College convened on 19 December 2016 Donald Trump received 304 votes to Hillary Clinton’s 227, the fifth time in US history that a presidential candidate won the White House while losing the popular vote.  Winning Michigan, Wisconsin and Pennsylvania three battleground states by the paper-thin margins gave Trump his Electoral College win.

The College made the news for other reasons. In the run up to its meeting a major campaign was launched to persuade Republican electors to break their pledges and vote against Trump. A petition was launched requesting the College to elect Clinton. Republican electors were offered support to break their pledges. Advertisements were run in newspapers. Hollywood personalities made a video calling on Republican electors to vote against Trump. Anti Trump rallies were mounted. Nancy Pelosi’s daughter, a Democrat elector from California demanded that a briefing on Russian interference be given before the College voted. Time Magazine argued that the Electoral College was created to stop 'Demagogues Like Trump'.

Voting in the College further demonstrated the system's flaws. Four Democrat electors from Washington State, where Hillary Clinton had 52.5% voter support ‘went rogue’. Three voted for Colin Powell and the fourth voted for Faith Spotted Eagle, a Sioux elder and environmental campaigner. The four were subsequently fined $1,000 each. Mrs Clinton also lost an elector from Hawaii who voted for Bernie Sanders. Over 62% of Hawaii’s voters supported Clinton.

Two Republican electors from Texas, where Trump won over 52% of the vote, broke ranks. One of these, Christopher Suprun, explained in the New York Times that he would not vote as pledged because he felt that Donald Trump was “not qualified for the office”.

The US Constitution requires that the Electoral College convene to vote for the President and Vice President on “the first Monday after the second Wednesday in December” – 14 December this year. All vote counting, recounts and court disputes must be completed by 8 December.

The rapid rush to roll out vote-by-mail which played a very significant role in getting the Democrat vote out has produced a series of court actions. Where they will lead remains to be seen.  Given the sheer scale of the Biden majority it is very hard to see any case playing as central a role as in 2000, only time will tell.

One thing that is likely to happen is that Republicans and Democrats will continue to battle over a fundamentally undemocratic electoral system dreamed up between May and September 1787 and US electoral reform will continue to “play second fiddle” to partisan political advantage.

Dick Roche is a former Irish minister for environment, heritage and local government and former minister for European affairs.

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EAPM: Beating cancer inequalities, getting ready for summer hols and transparency

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Good afternoon, health colleagues, and welcome to the European Alliance for Personalised Medicine (EAPM) update – there is much to discuss, on beating inequalities in cancer treatment, clinical data transparency and, importantly, planning for summer holidays writes EAPM Executive Director Dr. Denis Horgan.

Commissioner says EU cancer plan must ‘break the silence’ on women’s cancers

There is a large inequality of access to women’s cancer services and treatments across the EU, according to the bloc’s health chief, who highlighted the role of Europe’s Beating Cancer plan in bridging these disparities. Speaking during a webinar, Health Commissioner Stella Kyriakides said there is a need to “break the silence” and talk openly about gynaecological cancers. 

The EU, she added, has “to assure that all women in all corners of the EU, get the support, have access to the screening and the vaccination, the information and the multidisciplinary care that they should be having”. 

Her hopes are on Europe’s beating cancer plan, which must bring “real change”. “This is what European citizens expect from us. And I also believe that we don’t have a right to fail them. We have an opportunity and we need to seize it,” Kyriakides said. Europe’s Beating Cancer Plan was set in 2020 to tackle the entire disease pathway, from prevention to treatment, with the goal to equalise access to high-quality care, diagnosis and treatment across the bloc. 

About 40% of cancer cases are preventable through effective cancer prevention strategies. The commissioner added that the EU cancer plan “aims to offer breast cancer screening to 90% of people who qualify for it by 2025”.

EMA chief sceptical about waiving patents as answer to vaccine inequity

The head of the European Medicines Agency expressed scepticism that waiving patents on coronavirus vaccines will bring about equitable access, saying that instead the answer was increasing distribution and availability.

In an interview with several national European newspapers, EMA Executive Director Emer Cooke said that she firmly believes in “equitable access to vaccines and that nobody is safe until we are all safe,” when asked about the U.S. proposal for a vaccine patent waiver. 

“For me, however, the way to solve this problem at the moment is to increase the distribution and availability of vaccines,” she said, pointing to a significant number of doses set to be available over the next several months. 

Cooke said that the focus should be on “enabling innovation.” “None of our existing vaccines would have come about if there hadn’t been an environment that made innovation attractive,” she said. 

Despite this, Cooke conceded that in the “long term” the debate on patent protection should be carried out. 

More action on rare diseases

Any disease affecting fewer than five people in 10,000 in the EU is considered rare. Although this might appear small, it translates into approximately 246,000 people. Most patients suffer from even rarer diseases affecting 1 person in 100,000 or more. Approximately 5,000-8,000 distinct rare diseases affect 6-8% of the EU population i.e. between 27 and 36 million people.

Public Health Policy Director Anna Kole has said that the successful launch of Europe’s Beating Cancer plan had provided inspiration for the idea of creating a dedicated action plan for rare diseases. 

Meanwhile, the Commission is moving on several different fronts to improve rare disease treatment in the EU. An impact assessment evaluating proposals to change EU regulations for medicines for rare diseases and for children is expected to run until the first quarter of next year. That will open the door to new legislative changes. And creation of a European health data space will allow pooling data from rare disease patients across different member countries. 

Kole said that an action plan would allow better coordination across the disparate fields that the Commission is acting on, as well as the introduction of new flagship initiatives. 

“If there’s one disease area where EU added value can’t be more clearly demonstrated, it’s rare diseases,” said Kole, who pointed to the benefits of allowing patients to move across borders for specialist treatment, or for facilitating data sharing throughout the bloc, as examples.

The EU supports research into rare diseases through Horizon 2020, the EU Framework Programme for Research and Innovation. Horizon 2020 is the biggest EU Research and Innovation programme ever, with nearly €80 billion of funding available over 7 years (2014 to 2020). Close to €900 million, is available to more than 160 collaborative projects related to rare diseases.

Rich-poor vaccine inequity

The disparity in access to COVID-19 vaccines between rich and low-income countries has become impossible to ignore; according to UNICEF data, 86% of all doses given worldwide up to 30 March were administered to those in high- and upper-middle-income countries, while just 1% of jabs have been given to those in the world’s poorest. 

Low-risk groups in the UK, US and Israel are becoming eligible for jabs, while vulnerable populations elsewhere remain at risk of contracting the virus. The hoarding of vaccines by wealthy countries, as the pandemic ravages economically disadvantaged nations, has brought the issue of vaccine patents to the fore. 

Biotechnology Innovation Organization  wrote in the Economist that the proposal “undermines the very system that produced the life-saving science in the first place”, and “destroys the incentive for companies to take risks to find solutions for the next health emergency”. 

Regulators and WHO call for clinical data transparency

World regulatory authorities are calling for increased transparency from the pharmaceutical industry in how they report and give access to clinical trial data. In a joint statement, the World Health Organization (WHO) and the International Coalition of Medicines Regulatory Authorities (ICMRA) cited need for “wide access to clinical data for all new medicines and vaccines”. 

Data related to a therapy or vaccine “must be published at the time of finalization of the regulatory review,” they said, regardless of whether the decision is positive or negative. “It cannot be justified to keep confidential efficacy and safety data of a medicine available on the market, or which has been refused access to the market.” 

The two bodies cited “overriding public health interest” in their statement, which called for pharmaceutical companies to report clinical trial results without redacting information that would otherwise be confidential because of commercial reasons. Only personally identifying information and individual patient data should be redacted from publicly available clinical trial data, wrote WHO and ICMRA. 

People can ‘start thinking about Europe summer travel’ 

People can start thinking about summer holidays in Europe on condition of being vaccinated, the EU has said, as its planned digital travel 'health pass' is on track for use from mid-June. The plan is that a European-wide health pass will be launched at the same time across the EU, and countries that do not have the resources to put it in place will be supported by the Commission, to avoid delays. Internal Market Commissioner Thierry Breton said: “I seriously believe that we can start thinking about [summer travel], probably like last year in Europe. “It will be important to open the continent gradually, and to be able to go on holiday. Everyone must go to get vaccinated. As soon as you are called, go to get vaccinated.”

Commission publishes open public consultation on the European Health Data Space 

The Commission has published an open public consultation on the European Health Data Space (EHDS) - an important building block of the European Health Union. The EHDS aims to make full use of digital health to provide high-quality healthcare and reduce inequalities. It will promote access to health data for prevention, diagnosis and treatment, research and innovation, as well as for policy-making and legislation. The EHDS will place individuals' rights to control their own personal health data at its core.

The consultation will remain open for responses until 26 July 2021. Health and Food Safety Commissioner Stella Kyriakides said: ″The European Health Data Space will be a crucial component of a strong European Health Union. It will enable EU-wide collaboration for better healthcare, better research and better health policy-making. I invite all interested citizens and stakeholders to take part in the consultation and help us leverage the power of data for our health. This will have to rest on a strong foundation of non-negotiable citizens' rights, including privacy and data protection.″ 

And that is everything from EAPM for now – stay safe, stay well, have a terrific weekend, see you next week.

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European Jewish chief asks heads of state to step up security of Jewish institutions due to rising threat

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Rabbi Menachem Margolin (pictured), the chairman of the Brussels-based European Jewish Association, has written to heads of state across Europe asking them to step up security around Jewish Institutions and increase their vigilance and monitoring of known extremist networks in light of the ongoing Israel-Gaza conflict.

Europe wide surveys by agencies such as the Fundamental Rights Agency (FRA) show that whenever there is a conflict between Israel and Palestinians, there is a marked uptick in incidents of an anti-semitic nature.

Rabbi Margolin relayed to the Heads of State that Jewish communities across the continent were concerned that if was not a matter of “if” but “when” reprisals against Jews and Jewish Institutions would take place.

In his letter the EJA head wrote:

I write with a heavy heart for having to do so, but with an urgent request for your consideration.

Figures prove that whenever Israel is engaged in skirmishes with Palestinian terror groups or others that seek to undermine Israel’s sovereignty, there is a sharp and marked uptick in antisemitic attacks across Europe.

In short, Jews are held responsible. Of course, this runs counter to the spirit and letter of the IHRA definition of antisemitism - namely that Jews should not be held responsible for events in Israel, but also that antisemitism and anti-zionism are two sides of the same coin.

Our association are hearing from our communities that they are concerned that it isn’t a case of ‘if’ but ‘when’ there will be reprisals and acts carried out against them because of the ongoing conflict. These concerns are not without foundation as we have already seen a number of angry demonstrations outside synagogues in parts of Europe.

I ask you humbly and respectfully to increase vigilance and security in and around Jewish Institutions by your forces of law and order during this tense and difficult time and to increase your monitoring of social media channels and extremist networks.”

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Airbus and Air France ordered to stand trial over 2009 crash

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Air France (AIRF.PA) and Airbus (AIR.PA) should stand trial for involuntary manslaughter over their role in a 2009 crash in the Atlantic that killed 228 people, the Paris court of appeal ruled on Wednesday. (12 May)

The ruling reverses a 2019 decision not to prosecute either company over the accident, in which the pilots lost control of the Airbus A330 jet after ice blocked its airspeed sensors.

Victims' families welcomed the ruling, but Airbus and Air France said they would seek to overturn it at the Cour de Cassation, France's highest appeal court.

"The court decision that has just been announced does not reflect in any way the conclusions of the investigation," Airbus said in an emailed statement.

Air France logo is pictured at the Air France check-in at Bordeaux-Merignac airport, as Air France pilots, cabin and ground crews unions call for a strike over salaries in Merignac near Bordeaux, France April 7, 2018. REUTERS/Regis Duvignau
The Airbus logo pictured at the company's headquarters in Blagnac near Toulouse, France, March 20, 2019.  REUTERS/Regis Duvignau

Air France "maintains that it committed no criminal fault at the root of this tragic accident", said a spokesman for the carrier, which is part of Air France-KLM.

Air France flight AF447 from Rio de Janeiro to Paris crashed on 1 June, 2009, killing everyone on board.

French investigators found that the crew had mishandled the situation arising from the loss of speed data from sensors blocked with ice and caused an aerodynamic stall by holding the aircraft's nose too high.

The earlier decision not to go to trial drew legal challenges from the families as well as pilot unions and prosecutors who had pursued charges against Air France alone.

Wednesday's ruling upheld new demands for a trial of both companies from senior prosecutors who have accused Air France of pilot training failures and Airbus for underestimating dangers posed by known problems with the speed sensors.

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