2023

WASHINGTON — Federal officials are seizing more shipments of unauthorized electronic cigarettes at U.S. ports, but thousands of new flavored products continue pouring into the country from China, according to government and industry data reviewed by The Associated Press.

The figures underscore the chaotic state of the nation’s $7 billion vaping market and raise questions about how the U.S. government can stop the flow of fruit-flavored disposable e-cigarettes used by 1 in 10 American teens and adolescents. 

More than 11,500 unique vaping products are being sold in U.S. stores, up 27% from 9,000 products in June, according to tightly held industry data from analytics firm Circana.

“FDA whacks one product and then the manufacturers get around it and the kids get around it,” said Bonnie Halpern-Felsher, a Stanford University psychologist who develops anti-vaping educational materials. “It’s too easy to change your product a little bit and just relaunch it.”

Halpern-Felsher says she is “constantly” updating her curriculum to keep pace with new vaping brands and trends.

Nearly all the new products are disposable e-cigarettes, according to the sales data gathered from gas stations, convenience stores and other shops. The products generated $3.2 billion in the first 11 months of this year.

The FDA has authorized a handful of e-cigarettes for adult smokers and is still reviewing products from several major companies, including Juul. Regulators consider nearly all other e-cigarettes to be illegal.

“Those committing illegal acts don’t advertise their crimes, and those trying to import illegal tobacco products into the United States are no different,” said FDA’s tobacco director, Brian King, in a written response to AP questions. “The FDA and our federal partners are using tools, like import alerts, to stop these illegal tobacco products at the border and to deter countless others.”

The rise in e-cigarettes sold continues despite a record number of products detained.

An FDA database shows officials “refused” entry to 148 containers or pallets of “tobacco” goods last month, consisting almost entirely of vaping products from China. Refused imports are typically destroyed.

Through the end of November, U.S. officials had refused 374 such shipments this year, more than double the 118 refused in 2022.

This year’s items included $400,000 worth of Esco Bars, a disposable brand placed on a list of banned imports in May. The agency’s posted data is often preliminary because it takes time to finalize refusals.

But recent history shows how easily companies can maneuver around import bans.

In July 2022, the FDA barred dozens of e-cigarettes from Chinese manufacturer Fume, including flavors Pineapple Ice and Blue Razz.

Fume sales dipped after the ban, but the company launched a slew of new products, posting $42 million in U.S. sales in the third quarter of 2023, the data shows. Roughly 98% of sales came from products not on the FDA’s “red list” of products that can be detained.

Industry shipping tactics are also challenging the usefulness of import restrictions.

In July, FDA and customs officials intercepted $18 million worth of illegal vapes, including leading brand Elf Bar. But the shipments were mislabeled as shoes, toys and other items — not e-cigarettes — requiring officials to individually open and verify the contents of more than two dozen containers.

Circana, formerly IRI, restricts access to its data, which it sells to companies and researchers. A person not authorized to share it gave the AP access on the condition of anonymity.

The FDA has no schedule for updating its import lists but said it is “closely monitoring” instances where companies try to avoid detection.

“The FDA has a variety of tools at our disposal to take action against these tactics,” FDA’s King said.

The agency has limited powers to penalize foreign companies. Instead, regulators have sent hundreds of warning letters to U.S. stores selling their products, but those are not legally binding.

Even as the FDA attempts to work with customs officials, it is struggling to complete a yearslong review of applications submitted by manufacturers hoping to market their products to adults.

The few tobacco-flavored products currently authorized by FDA are deeply unpopular. Their combined sales were just $174 million, or 2.4% of the vaping marketplace this year, according to Circana.

“Nobody wants them,” says Marc Silas, owner of 906 Vapor shop in Michigan. “If people wanted them, they’d be on the shelves and they’re not.”

Deeply frustrated with the pace of FDA’s review, public health groups have successfully sued the agency to speed up the process. The agency aimed to complete all major outstanding applications this year, but it recently said the process would stretch into next year.

The delays have raised questions about the viability of the current regulatory framework for e-cigarettes.

“FDA is trying to operate with an old model when the whole environment has changed,” said Scott Ballin, a health policy consultant who previously worked for the American Heart Association. “They have this long line of products that have to be reviewed one by one and now they’re in a giant hole.” 
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AMSTERDAM — Climate activists blocked part of the main highway around Amsterdam near the former headquarters of ING bank Saturday to protest its financing of fossil fuels.

Amsterdam Municipality said in a message on X, formerly Twitter, that traffic authorities closed part of the road and diverted traffic “to prevent a life-threatening situation.”

Hundreds of activists walked onto the road in the latest road blockade organized by the Dutch branch of Extinction Rebellion. Earlier this year, the activist organization repeatedly blocked a highway leading into The Hague.

Some of Saturday’s protesters walked along the closed A10 highway carrying a banner emblazoned with the words “Change or die” as two police vans drove slowly behind them.

Another person carried a handwritten banner that said: “ING get out of oil and gas now!” Others glued their hands to the road surface.

Police criticized the protesters for blocking the road close to the VU medical center, one of Amsterdam’s main hospitals.

“The blockade is very undesirable given its impact on the traffic in the city and, for example, employees at the nearby VU medical center and people visiting patients,” Amsterdam police said in a statement.

The protest took place despite ING announcing earlier this month that it is accelerating its moves to phase out loans for fossil fuel exploration.

ING made its announcement a week after nearly 200 countries at the COP28 climate meeting in Dubai agreed to move away from planet-warming fossil fuels in a document that critics said contained significant loopholes.

Extinction Rebellion spokesperson Let de Jong said the phase-out plan was not fast enough.

“We demand that ING immediately stops all fossil fuel financing,” De Jong said in a statement ahead of the protest. “Every day, people are dying around the world because of the climate and ecological crisis. That has to stop.”

At past protests in The Hague, police used a water cannon to force activists off the road and arrested hundreds of people.
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BILLINGS, Mont. — Since passage of the Endangered Species Act 50 years ago, more than 1,700 plants, mammals, fish, insects and other species in the U.S. have been listed as threatened or endangered with extinction. Yet federal government data reveals striking disparities in how much money is allocated to save various biological kingdoms.

Of the roughly $1.2 billion a year spent on endangered and threatened species, about half goes toward recovery of just two types of fish: salmon and steelhead trout along the West Coast. Tens of millions of dollars go to other widely known animals including manatees, right whales, grizzly bears and spotted owls.

But the large sums directed toward a handful of species means others have gone neglected, in some cases for decades, as they teeter on potential extinction.

At the bottom of the spending list is the tiny Virginia fringed mountain snail, which had $100 spent on its behalf in 2020, according to the most recent data available. The underground-dwelling snail has been seen only once in the past 35 years, according to government records, yet it remains a step ahead of more than 200 imperiled plants, animals, fish and other creatures that had nothing spent on their behalf.

With climate change increasing threats to organisms around the planet and adding to the number that qualify for protection under the Endangered Species Act, government officials are struggling in many cases to execute recovery actions required under the law.

Some scientists even argue for spending less on costly efforts that may not work and putting the money toward species with less expensive recovery plans that have languished.

“For a tiny fraction of the budget going to spotted owls, we could save whole species of cacti that are less charismatic but have an order of magnitude smaller budget,” said Leah Gerber, a professor of conservation science at Arizona State University.

An Associated Press analysis of 2020 data found fish got 67% of the spending, the majority for several dozen salmon and steelhead populations in California, Oregon and Washington. Mammals were a distant second with 7% of spending and birds had about 5%. Insects received just 0.5% of the money and plants about 2%. Not included in those percentages is money divided among multiple species.

Species drawing no spending at all included stoneflies threatened by climate change in Montana’s Glacier National Park, the stocky California tiger salamander that has lost ground to development and flowering plants such as the scrub lupine around Orlando, Florida, where native habitat has been converted for theme parks.

Such spending inequities are longstanding and reflect a combination of biological realities and political pressures. Restoring salmon and steelhead populations is expensive because they are widespread and hemmed in by massive hydroelectric dams. They also have a broad political constituency with Native American tribes and commercial fishing interests that want fisheries restored.

Congress over decades has sent massive sums of money to agencies such as the Bonneville Power Administration that operate dams along rivers the fish once traveled up to spawn. The money pays for fish ladders around dams, habitat restoration projects, monitoring by scientists and other needs.

More than half the species protected under the Endangered Species Act are plants, but the entire plant kingdom was almost excluded from the landmark conservation law when it was adopted in 1973, according to the Congressional Record and Faith Campbell, who interviewed people involved in the bill’s passage for a 1988 study published in the Pace Environmental Law Review.

Plants initially were left out when the measure passed the Senate, with opposition led by influential Republican Sen. Ted Stevens of Alaska. They were added back at the 11th hour following a push by botanists from the Smithsonian Institution and Lee Talbot, a senior scientist at the White House Council on Environmental Quality, according to Campbell.

Botanists at the time proposed more than 2,500 plants as threatened with future extinction. However, most failed to get protections because federal officials failed to act prior to a Congressional deadline.

Today more than 900 trees, ferns, flowers and other flora are protected. Combined, they received about $26 million in 2020.

“In terms of numbers they’re catching up, but as far as money and attention they’re still not getting their share,” said Campbell, a longtime environmental advocate who now works at the Center for Invasive Species Prevention. “The threats are serious, they’re the same as the threats to animals. Yet they don’t have the political clout of, say, a couple dozen of the big animal species that attract favorable attention or get in people’s way.”

Most plants receive less money than recommended under their recovery plans, according to Gerber and others. Researchers say that has direct consequences: species tend to decline when allocated less funding than needed, while they have a higher chance of recovery when receiving enough money.

Gerber has suggested redirecting some money from species getting more than their recovery plans seek — the bull trout, the gopher tortoise and the Northern spotted owl among them — to those receiving little or none. Her ideas have stirred pushback from some conservationists.

Former U.S. Fish and Wildlife Service Director Jamie Rappaport Clark said debating how to allocate scarce resources for rescuing endangered species is a distraction.

“The issue is not where the money is spent,” said Clark, now president of Defenders of Wildlife. “The issue is that there isn’t nearly enough of it.”

Gerber said she doesn’t want to let anything go extinct but that a strategic approach is needed with the shortage of resources.

“Unfortunately, the clock is ticking,” she added. “We need to take action.”

Wildlife officials say they are trying to do just that with money for endangered species in the climate law signed last year by President Joe Biden.

It included $62.5 million officials said will allow them to hire biologists to craft recovery plans to guide future conservation work, initially for 32 species and for as many as 300 over coming years.

Among them are a colorful fish known as the candy darter that lives in rivers in the southeastern U.S., a flowering shrub from the Virgin Islands called marron bacora, the Panama City crayfish of Florida and the pocket-sized Stephens’ kangaroo rat in southern California.

The extra money is intended to provide some relief after the agency’s environmental review staff fell 20% over the past two decades, even while new species were listed, according to officials. Increased funding is especially important because more than half the agency’s existing recovery plans are more than two decades old, according to Lindsay Rosa, vice president for conservation research at Defenders of Wildlife.

Also in the law was $5.1 million for recovery projects that could benefit hundreds of species from four groups that officials said have historically been underfunded: Hawaii and Pacific island plants, butterflies and moths, freshwater mussels and desert fish in the southwestern U.S.

“Each of these species are part of this larger web of life,” Fish and Wildlife Service Director Martha Williams said in an interview. “They’re all important.”
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SACRAMENTO, Calif. — More than 700,000 immigrants living illegally in California will gain access to free health care starting Monday under one of the state’s most ambitious coverage expansions in a decade.

It’s an effort that will eventually cost the state about $3.1 billion per year and inches California closer to Democrats’ goal of providing universal health care to its roughly 39 million residents.

Democratic Gov. Gavin Newsom and lawmakers agreed in 2022 to provide health care access to all low-income adults regardless of their immigration status through the state’s Medicaid program, known as Medi-Cal.

California is the most populous state to guarantee such coverage, though Oregon began doing so in July.

Newsom called the expansion “a transformative step towards strengthening the health care system for all Californians” when he proposed the changes two years ago.

Newsom made the commitment when the state had the largest budget surplus in its history. But as the program kicks off next week, California faces a record $68 billion budget deficit, raising questions and concerns about the economic ramifications of the expansion.

“Regardless of what your position is on this, it doesn’t make sense for us to be adding to our deficit,” said Republican Sen. Roger Niello, the vice-chair of the Senate Budget and Fiscal Review Committee.

Immigration and health care advocates, who spent more than a decade fighting for the changes, have said the expanded coverage will close a gap in health care access and save the state money in the long run. Those who live in the state illegally often delay or avoid care because they aren’t eligible for most coverage, making it more expensive to treat them when they end up in emergency rooms.

“It’s a win-win, because it allows us to provide comprehensive care and we believe this will help keep our communities healthier,” said Dr. Efrain Talamantes, chief operating officer at AltaMed in Los Angeles, the largest federally qualified health center in California.

The update will be California’s largest health care expansion since the 2014 implementation of former President Barack Obama’s Affordable Care Act, which allowed states to include adults who fall below 138% of the federal poverty level in their Medicaid programs. California’s uninsured rate dropped from about 17% to 7%.

But a large chunk of the population was left out: adults living in the United States without legal permission. They are not eligible for most public benefit programs, even though many have jobs and pay taxes.

Some states have used their tax dollars to cover a portion of health care expenses for some low-income immigrants. California first extended health care benefits to low-income children without legal status in 2015 and later added the benefits for young adults and people over the age of 50.

Now the last remaining group, adults ages 26-49, will be eligible for the state’s Medicaid program.

The state doesn’t know exactly how many people will enroll through the expansion, but state officials said more than 700,000 people will gain full health coverage allowing them to access preventative care and other treatment. That’s larger than the entire Medicaid population of several states.

“We’ve had this asterisk based on immigration status,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group. “Just from the numbers point of view, this is a big deal.”

Republicans and other conservative groups worry the new expansion will further strain the overloaded health care system and blasted the cost of the expansion.

State officials estimated the expansion will cost $1.2 billion the first six months and $3.1 billion annually thereafter from the budget. Spending for the Medi-Cal program, which is now about $37 billion annually, is the second-largest expense in the California budget, according to an analysis by the nonpartisan Legislative Analyst’s Office.

Earlier this month, the state Department of Finance sent a letter urging state agencies to cut costs in light of the deficit. It has not given specific directions about the Medicaid expansion, state officials told The Associated Press in December.

California’s expansion of Medicaid will face other challenges. The state is chugging through a review of Medicaid enrollees’ eligibility for the first time in more than three years that was prompted by the end of some federal pandemic policies. Many immigrants who had their coverage protected during the COVID-19 pandemic now find themselves ineligible because they no longer financially qualify.

John Baackes, CEO of L.A. Care Health Plan, the state’s largest Medi-Cal plan with nearly 2.6 million members, said roughly 20,000 members have lost their Medicaid coverage during the review process this past year and are looking to secure new insurance plans. His organization is juggling to help people navigate through both processes.

“People are being bombarded with information,” Baackes said. “I can’t imagine if somebody were having to maneuver through all this, why they wouldn’t be terribly confused.”

“The phones are ringing off the walls,” he said.

Fear and distrust are also barriers for the expansion, said Sarah Dar, policy director for the California Immigrant Policy Center. 

Many immigrants avoid accepting any public programs or benefits out of fear it will eventually prevent them from gaining legal status under the “public charge” rule. The federal law requires those seeking to become permanent residents or gain legal status to prove they will not be a burden to the U.S., or a “public charge.” The rule no longer considers Medicaid as a factor under President Joe Biden’s administration, but the fear remains, she said.

More resources and effort are required to reach this population “because of the history of just being completely excluded and not interfacing with the health care system or with government programs at all for so long,” Dar said. 

California has more work to do to see the state’s uninsured rate hit zero, known as “universal coverage,” Dar said.

For one thing, immigrants living in the U.S. without legal permission are still not eligible to purchase insurance from Covered California, the state-run exchange offering steep discounts for people who meet certain income requirements. A bill pending in the state Legislature, supported by the California Immigrant Policy Center, would change that.

“It’s going to be another really big undertaking,” Dar said. “And we know that revenues are down … but it’s our job to make the case that, in times of economic downturn and whatnot, these are the communities that need the support the most.”
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MEXICO CITY — Mexico’s president inaugurated a huge “super pharmacy” Friday in a bid to help patients throughout the country who are told they need a specific medicine, but their hospital doesn’t have it.

President Andrés Manuel López Obrador’s solution was to outfit a big warehouse on the outskirts of Mexico City to centralize a supply and send it to hospitals throughout the country.

“The pharmacy is going to be big, big, big, and it is going to have all the medications that are used in the health system,” López Obrador said Friday.

The pharmacy is intended to complement local health facilities. If a patient can’t get needed medications at a local hospital, the patient, the patient’s doctor or the pharmacist would be able to have it delivered from the 40,000-square-meter Mexico City warehouse.

The armed forces, or the government-run pharmaceutical company Birmex, will ship the drugs by land or air “within 24 to 48 hours,” López Obrador pledged.

The question is whether Mexico can overcome its history of being bad at regulating the pharmaceutical industry, bad at buying medicines, bad at storing them, and bad at distributing them. Extreme centralization also hasn’t helped Mexico much in the past in many areas.

The most visible face of this problem are the parents of children with cancer, who frequently stage protests because they say that in recent years chemotherapy and other drugs have been impossible to obtain.

The problems have killed otherwise healthy people. Because Mexico has had problems in obtaining enough morphine, anesthesiologists in Mexico have had to carry around their own vials of the sedative, drawing multiple doses out of a single vial for routine procedures.

That has led to contamination of the vials, triggering outbreaks of injection-induced meningitis in two Mexican states that have killed dozens of people, including some Americans who sought treatment at clinics in the border city of Matamoros, across from Brownsville, Texas.

In the United States, where there is no shortage of morphine, doctors are advised to draw a single dose from a vial and throw the remainder out.

López Obrador mounted a major effort to obtain COVID-19 vaccines in 2021, using the armed forces to distribute them and volunteers to administer them. By the end of that year just about anybody in Mexico who wanted a vaccine got one, for free.

But trying to replicate that model of centralized government purchasing and army distribution on a national scale for thousands of medications is not the same, according to Mauricio Rodríguez-Dorantes, a professor at the School of Medicine at Mexico’s National Autonomous University.

“This is crazy,” said Rodríguez-Dorantes, noting the government is opening the centralized warehouse without answering how the system will operate, especially for urgently needed medications. He noted that concentrating all the drugs at one site increases risks and could sideline some existing distribution systems.

For decades, there have been scandals involving millions of dollars’ worth of medicines that have expired at warehouses while hospitals couldn’t get them.

The country’s medicine regulatory agency, known by its Spanish acronym as Cofepris, was so riddled with corruption before López Obrador that regulators would hide applications for approval of new medicines for years and demand bribes to approve them.

And with alarming frequency, regulators in Mexico send out alerts about falsified or knock-off medications being sold for treating everything from cancer to heart disease. Boxes, labels, vials and certifications are copied with amazing accuracy, but the bottles often contain little or none of the medication.

The fake medicine trade is so common and so lucrative in Mexico because patients or their relatives are often told by doctors to buy medications at private drug stores when they are unavailable at government hospitals.

The civic group Zero Shortages said there was a 142% increase in the number of alerts about falsified medicines between 2021 and 2022.

But some of the problems are of López Obrador’s own making. Angry at what he claimed were inflated profits made by drug distributors and importers, the president simply cut the private companies out and decided the government should directly buy all medications.

Because the government did not have much infrastructure, contacts or experience in such a massive effort, López Obrador signed an agreement with the World Health Organization to help Mexico in purchasing. But even with that help, Mexico was unable to obtain some specialized medication.

Zero Shortages said the number of prescriptions that went unfilled in Mexico rose from 1.5 million in 2019 to 22 million in 2021; disruptions because of COVID-19 probably played a role.

But even in 2022, about 12.5 million prescriptions went unfilled. 
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CAPE CANAVERAL, Florida — The U.S. military’s secretive X-37B robot spaceplane blasted off from Florida on Thursday night on its seventh mission, the first launched atop a SpaceX Falcon Heavy rocket capable of delivering it to a higher orbit than previous missions.

The Falcon Heavy, composed of three rocket cores strapped together, roared off its launch pad from NASA’s Kennedy Space Center at Cape Canaveral in a spectacular nighttime liftoff carried live on a SpaceX webcast.

The launch followed more than two weeks of false starts and delays. Three earlier countdowns were aborted due to poor weather and unspecified technical issues, leading ground crews to roll the spacecraft back to its hangar before proceeding with Thursday’s fight.

It came two weeks after China launched its own robot spaceplane, known as the Shenlong, or “Divine Dragon,” on its third mission to orbit since 2020, adding a new twist to the growing U.S.-Sino rivalry in space.

The Pentagon has disclosed few details about the X-37B mission, which is conducted by the U.S. Space Force under the military’s National Security Space Launch program.

The Boeing-built vehicle, roughly the size of a small bus and resembling a miniature space shuttle, is built to deploy various payloads and conduct technology experiments on long-duration orbital flights. At the end of its mission, the craft descends back through the atmosphere to land on a runway much like an airplane.

It has flown six previous missions since 2010, the first five of them carried to orbit by Atlas V rockets from United Launch Alliance, a joint venture of Boeing and Lockheed Martin, and most recently, in May 2020, atop a Falcon 9 booster furnished by Elon Musk’s SpaceX.

Thursday’s mission marked the first launched aboard SpaceX’s more powerful Falcon Heavy rocket, capable of carrying payloads even heavier than the X-37B farther into space, possibly into geosynchronous orbit, more than 35,000 kilometers above the Earth.

The X-37B, also called the Orbital Test Vehicle, has previously been confined to flights in low-Earth orbit, at altitudes below 2,000 kilometers.

New orbital regimes

The Pentagon has not said how high the spaceplane will fly this time out. But in a statement last month, the Air Force Rapid Capabilities Office said mission No. 7 would involve tests of “new orbital regimes, experimenting with future space domain awareness technologies.”

The X-37B also is carrying a NASA experiment to study how plant seeds are affected by prolonged exposure to the harsh environment of radiation in space. The ability to cultivate crops in space has major implications for keeping astronauts nourished during future long-term missions to the moon and Mars.

China’s equally secretive Shenlong was carried to space on December 14 by a Long March 2F rocket, a launch system less powerful than SpaceX’s Falcon Heavy and believed to be limited to delivering payloads to low-Earth orbit.

Still, Space Force General B. Chance Saltzman told reporters at an industry conference earlier this month he expected China to launch Shenlong around the same time as the X-37B flight in what he suggested was a competitive move.

“It’s no surprise that the Chinese are extremely interested in our spaceplane. We’re extremely interested in theirs,” Saltzman said, according to remarks published in Air & Space Forces Magazine, a U.S. aerospace journal.

“These are two of the most watched objects on orbit while they’re on orbit. It’s probably no coincidence that they’re trying to match us in timing and sequence of this,” he said.

The planned duration of the latest X-37B mission has not been made public, but it will presumably run until June 2026 or later, given the prevailing pattern of successively longer flights.

Its last mission remained in orbit for well over two years before a return landing in November 2022.
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