COVID-19 and the Law: Law and Policy to Address Basic Needs and Marginalized Populations

As we embark on this new semester amid the unusual challenges posed by COVID-19, Faculty Director of the Food Law and Policy Clinic, Professor Emily Broad Leib, is leading a unique opportunity to explore the particular difficulties and opportunities presented by the COVID-19 pandemic. 

This fall, Professor Emily Broad Leib and Professor Martha Minow are co-hosting a Colloquium series titled, COVID-19 and The Law: Law and Policy to Address Basic Needs and Marginalized Populations. The series will cover issues such as health law and COVID-19 (September 16, featuring Professor Robert Greenwald) and Housing and Food Law (September 23, featuring Professor Emily Broad Leib). Anyone in the Harvard community may register to participate in live sessions. Recordings, blog posts, and other resources developed throughout the series will be available online to the broader public. A full description of the Colloquium series is as follows:

Colloquium: 
Involving more than 40 experts from Harvard Law School’s faculty, clinics, and research programs, the Colloquium will include a weekly virtual discussion series with faculty experts who will share their expertise in topics ranging from public health and drug development to criminal justice, from social safety nets to finance, from issues involving race, gender, and disability to questions involving immigration and international relations, and from regulation of farms and meat-packing plants to election law. These sessions will take place from 12pm – 1pm each Wednesday starting Sept. 9; the live sessions are open only to members of the Harvard community (a Harvard email must be used at registration), however recordings will be posted online and shared with the public. 

The topics and participating speakers are listed on the Colloquium Blog, and registration is available HERE  (early registration is encouraged to secure attendance).  

Blog:
We will post the recordings of our colloquium sessions on the COVID-19 and the Law Blog. The Blog will also feature: readings and resources on each topic; blog posts by students, faculty, and other experts; and opportunities for students to volunteer their time and talents.

Opportunities for Credit:
For Harvard Law School students, there are currently two opportunities to get involved and secure credit(s) through the Colloquium:

  1. Become a contributor to the blog (1 or 2 credits): author, edit, and help curate blog posts that provide deeper analysis of topics covered in the Colloquium, reports of ongoing developments and current events, insights from interviews with the faculty speakers and other experts, or examination of important and relevant topics not included in the Colloquium series. Sign up for this opportunity by contacting Professor Minow (minow@law.harvard.edu).
  2. Write an independent paper with participating faculty members (2 credits): Many faculty members participating in the colloquium have indicated willingness to work with students on papers related to their session; you can contact professors directly and check the “Student Engagement” page on our Blog for the list of participating professors and their availability.

We hope you join for one, some or all of the sessions.

Harvard Center for Health Law and Policy Innovation Calls on Department of Justice to Enforce the Americans with Disabilities Act and Stop Health Insurers from Illegally Restricting Access to Critical Care

New research finds that hepatitis C treatment restrictions based on alcohol or drug use violate the Americans with Disabilities Act and undermine efforts to end the hepatitis C epidemic.

The Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School is urging the U.S. Department of Justice (DOJ) to enforce the Americans with Disabilities Act (ADA) against discriminatory barriers to hepatitis C virus (HCV) treatment in both Medicaid programs and correctional health facilities. New research by CHLPI published in the July/August edition of Public Health Reports concludes that HCV treatment restrictions based on alcohol or drug use violate the ADA, which prohibits discrimination against persons with disabilities in public services, including people with substance use disorders who are seeking health care.

Although there is now a cure for HCV, cases have continued rising since 2010 due to the ongoing opioid use epidemic. Meanwhile 13 states deny treatment to Medicaid patients based on their alcohol or drug use, according to a recent snapshot of states with HCV treatment restrictions by CHLPI and the National Viral Hepatitis Roundtable (NVHR). Such restrictions are in conflict with the medical standard of care and ethical conduct of medicine. While court cases brought by Medicaid beneficiaries and incarcerated persons have been successful in removing other restrictions to care, such as those based on the severity of a patient’s disease, CHLPI concluded that the DOJ should enforce the ADA using its civil enforcement authority to remove sobriety restrictions for HCV treatment in Medicaid programs and correctional health facilities.

“Sobriety restrictions effectively feed this communicable disease, and they are especially damaging in the midst of the COVID-19 pandemic that places people with chronic conditions at greater risk, and in the middle of the opioid epidemic that is strongly linked to an increase in HCV prevalence,” said Robert Greenwald, a Clinical Professor of Law and the Faculty Director of the Center for Health Law and Policy Innovation at Harvard Law School. “Preventing care for patients with HCV who have a history of substance use disorder is illegal. We want to work with the DOJ to remove these harmful restrictions, but we are also committed to pursuing litigation if discrimination persists.”

DOJ enforcement of the ADA would be a faster and more effective avenue for eliminating sobriety-based restrictions than litigation brought by private parties. By expanding access to HCV treatment, this strategy could significantly reduce the spread of HCV infections, and improve public health.

“Sobriety restrictions perpetuate the stigma and discrimination associated with drug and alcohol use and limit efforts to prevent and treat hepatitis C among underserved populations,” said Michael Ninburg, Executive Director of the Hepatitis Education Project and NVHR. “We can eliminate hepatitis C in this country, but we need to ramp up testing and treatment in these same populations, including among people who inject drugs and prisoners.”

HCV infection rates in the United States tripled from 2010 to 2015 despite the introduction of new and effective treatment during this era. This increase is attributed in part to the ongoing opioid epidemic, as injection drug use is the most common method of new HCV transmission. With high initial prices for direct acting antiviral (DAA) drugs, several Medicaid programs and correctional health facilities created unfair systems to reduce their costs, including by limiting access to DAA therapies based on disease severity (as measured by liver damage), and based on periods of sobriety from drugs and/or alcohol before treatment.

Treating HCV reduces its prevalence, and treatment success with DAAs is extremely high regardless of alcohol use. With the public’s health at stake, especially during the COVID-19 pandemic, there is widespread disapproval of sobriety restrictions, including from the Centers for Medicare & Medicaid Services (CMS), the U.S. Department of Veteran Affairs, and other leading professional associations of Medicaid providers.

“HCV is curable and preventable, and no one deserves to be denied effective treatment. If we are going to stop the spread of HCV infection in the United States, it is critical that we expand access to DAA treatment to all who need it,” added Greenwald.

New FBLE Backgrounder: COVID-19 & Farm Bill Policy

This blog post was originally published by Farm Bill Law Enterprise on August 20th, 2020 on farmbilllaw.org.


The COVID-19 pandemic has presented a number of new and difficult challenges for families, farmers and other small business owners, and food producers across the country. While closures of schools, restaurants, and hotels help slow the rapid spread of infection, they have also resulted in surges in unemployment and food insecurity. Moreover, these closures cut farmers off from key markets and led to supply chain disruptions that pervaded every level of the U.S. food system. In the absence of infrastructure to divert produce intended for these markets to grocery stores or emergency feeding organizations, millions of pounds of food rotted in fields, farmers went uncompensated, and food banks ran out of inventory at a time when demand was at an all-time high. As the U.S. food system weathered this economic stress, Congress passed a series of bills aimed at keeping businesses afloat and families fed.

Since March 2020—and as of August 2020—Congress has passed four emergency response bills. To help elucidate these developments FBLE has published a COVID-19 Response & Farm Bill Policy Backgrounder. This Backgrounder provides an overview of the new legislation and takes a closer look at how it impacts domestic agricultural and nutrition policies included in the 2018 Farm Bill. As Congress prepares to pass the next stimulus package, this Backgrounder maps the current landscape of farm-bill related, federal food and agriculture policy enacted during the pandemic.

Click here to access the PDF.

Health care institutions, nonprofits team up to battle hunger and the pandemic

This article was originally written by Janelle Nanos and published in The Boston Globe on August 14, 2020. 


 

During the pandemic surge in the spring, Dr. Amy Smith, a family medicine physician at Cambridge Health Alliance, received a desperate phone call from one of her colleagues.

The respiratory clinician on the line was about to release a COVID-19 patient to recover at home, but the individual didn’t have enough money to buy food for their family. The clinician was crying on the phone, worried that the patient would expose themselves or others to the virus if they waited in line at a food pantry.

“I looked and said, This is a solvable problem,” Smith said. And then she solved it.

At the end of April, Smith and her team at Cambridge Health Alliance began screening their COVID-19 patients for food insecurity and created a grocery referral program. Over the last several months, they’ve been partnering with community-based organizations like Food For Free, the Malden YMCA, and Maverick Landing Community Services to deliver groceries to over 670 COVID-19 patients in Chelsea, Lynn, East Boston, Everett, and other hard-hit areas.

The food deliveries, which reached as many as 2,400 household members, have meant these vulnerable patients can recover safely at home, Smith said. This in turn can help stop the spread of the disease in high-risk populations, many of whom may be undocumented and therefore unable to access federal benefits such as SNAP, the Supplemental Nutrition Assistance Program.

Smith is now co-leading the hospital’s strategy around food insecurity, and is one of many health care practitioners stepping up their efforts to incorporate emergency food assistance into their care as a result of the pandemic.

Health care workers have long been able to draw a straight line between access to nutritious food and health outcomes: Unhealthy diets, after all, are often the root cause of chronic diseases. But as COVID-19 has wreaked havoc on at-risk populations, its economic fallout has also exacerbated the need for emergency food services throughout the state that serve those populations.

“We recognize that it’s important for us to have partnerships beyond our four walls; hospitals can’t do everything alone,” said Dr. Thea James, vice president of mission and associate chief medical officer at Boston Medical Center. BMC, which was the first hospital in the country to have a food pantry, recently began partnering with the local nonprofit About Fresh to coordinate over 1,000 door-step grocery deliveries to 200 of its patients.

“The partnership has been amazing for us during the pandemic,” James said.

As a result of the crisis, “a variety of nutrition services have suddenly become more accessible as a care system to patients,” said Kristin Sukys, a policy analyst at the Center for Health Law & Policy Innovation at Harvard Law School, and one of the leaders of the Food as Medicine Massachusetts coalition. “When COVID-19 struck, the community-based organizations that had partnerships with health care providers became a main lifeline to address emergency food need.”

Among the most robust efforts have stemmed from MassHealth’s new Flexible Services initiative, which aims to reduce health care costs and improve health outcomes and began rolling out statewide at the start of this year. The nutrition component of the pilot program lets health care providers screen Medicaid patients for food insecurity, and then refer them directly to community-based organizations that can help them apply for SNAP or WIC benefits, or get access to food pantries, meal or grocery deliveries, or even supermarket gift cards.

Jean Terranova, the director of food and health policy at Community Servings, a Jamaica Plain-based nonprofit that delivers medically tailored meals to patients, has been on the front lines of the Food as Medicine movement for years. But the pandemic escalated the need overnight, she said.

“With COVID it was right in your face…. It was an accelerant for this to take off,” she said. Community Servings had just finished a massive $21 million expansion, tripling the size of its kitchen and expanding the program statewide, when the pandemic hit. The organization has received 300 referrals from health care providers since March, and is on track to deliver 800,000 meals this year, a 40 percent increase over 2019. The referrals, Terranova said, have been coming “fast and furious.”

A few years ago, Project Bread ran a successful pilot program with Cambridge Health Alliance, working directly with its clinics to help sign patients up for SNAP and WIC benefits. The organization had planned to expand the program under the new MassHealth initiative to 13 health centers in Eastern Massachusetts and Worcester in July of this year. But at the outset of the pandemic, they leapt into action, and have since received 657 referrals from their partner clinics over the last several months.

“The need is so much greater than any of us ever anticipated,” and is critically important now that the additional $600 weekly unemployment benefits have run out, said Erin McAleer, the organization’s executive director. Project Bread is now offering trainings for health care workers in clinics throughout Boston to help them sign up patients for SNAP and WIC benefits.

“We want to make sure that more health care workers know what SNAP is and are comfortable talking with their patients about it,” McAleer said.

These new partnerships are creating a “transformation of how health care has invested in the social determinants of health,” said Josh Trautwein, chief executive officer of About Fresh, which runs the Fresh Truck mobile grocery store, and has been partnering with Boston Medical Center and other health systems to coordinate over 21,000 grocery deliveries to high-risk patients.

Through the MassHealth initiative, he is also beginning to roll out the Fresh Connect food purchasing program, a prepaid debit card that health systems can give patients to buy healthy food at existing restaurants and retailers. The nonprofit has a $3 million contract with a half-dozen area health care providers to give the cards to at-risk patients.

And Sukys, the policy analyst, said that for every formal state-supported MassHealth partnership, there are dozens more across the state, like Smith’s, that have emerged from the crisis out of sheer need. She and others hope that these emergency partnerships will result in stronger connections among social safety net programs.

The coordination of health providers and community-based food programs creates a “perfect scenario,” said Eric Rimm, an epidemiologist at Harvard University who studies the health effects of diet and lifestyle. Patients get more comprehensive support while bringing down the overall cost of health care, he said.

And for now, these links are providing a lifeline.

“Our patients’ lives are chaotic even when they haven’t lost their jobs and suddenly fallen ill,” said Dr. Leah Zallman, who co-heads the Social Determinants of Health Steering Committee at the Cambridge Health Alliance, and worked with Smith to create the grocery referral program. “You’re taking patients who are disenfranchised in every possible way and you add a COVID layer of burden. There’s no slack in the system.”

The Care and Feeding of a Nation

This article was originally written by Erin O’Donnell and published in the September-October 2020 Edition of the Harvard Magazine


In the United States, “The primary way we define ‘food safety’ is, ‘If I eat this product today, will I be in the hospital in 24 to 72 hours?’” says clinical professor of law Emily Broad Leib. “But this doesn’t account for other ways that the food system produces health risks for members of the public,” including the lifelong risks of, say, developing type 2 diabetes after consuming sugary foods for decades, or the environmental effects of industrial farming, such as fertilizer runoff in waterways, which creates oxygen-free dead zones inhospitable to aquatic life. The single-minded emphasis on microbes like salmonella and E. coli, Broad Leib asserts, “means we’re under-regulating a bunch of other risks that have bigger health impacts.”

As director of Harvard Law School’s Food Law and Policy Clinic, she engages law students in projects that investigate how U.S. law intersects with the broader food system, “from the first seed going into the ground, to someone’s plate or perhaps to a trashcan.” Her purview encompasses environmental impacts, worker safety, and even immigration as factors in food production.

This holistic, systems approach is a relatively new way to consider food law; when Broad Leib first made the case to law-school colleagues about her work, many misunderstood, thinking she was narrowly focused on foodborne illness or the work of the Food and Drug Administration (FDA). But Broad Leib says that in reality, a food-systems approach is “breathtakingly broad” in its scope. She sees this as a necessity. “This is the way we have to look at these issues,” she says, “or we’re going to continue to make really short-sighted, less equitable, less utilitarian policies.”

For that reason, Broad Leib considers issues such as conditions for workers at fruit and vegetable farms and meatpacking plants, which became COVID-19 hotspots during the spring and summer months. “We underpay and undervalue workers in the food system, and then they often become sick themselves,” she says. When workers lack job security and paid sick leave, many continue to work while sick, infecting fellow workers and potentially jeopardizing supply chains.

Nutrition is another often overlooked factor in food safety. In a paper published in California Law Review, she and coauthor Margot J. Pollans of Pace University note that in 2016, heart disease caused more than 635,000 deaths in the United States, or 200 times more than foodborne illness did. Heart disease is also responsible for an estimated $200 billion in medical costs, and $130.5 billion in lost productivity. Yet of the FDA’s 2016 budget for regulating the food supply, which came to nearly $1 billion, 98 percent was spent on traditional food-safety measures and just 2 percent on nutrition, a critical tool in addressing heart disease. “This is human nature,” Broad Leib says. “We overemphasize risks such as E. coli outbreaks that we read about in the news, and we undervalue these more pedestrian risks such as heart disease that accrue over time.”

Being clear-eyed about such health risks is important in identifying food-system priorities—and the COVID-19 era, she says, offers an ideal time for Congress, regulatory agencies, and others to reimagine the food system. Shoppers have new awareness of these issues, after seeing empty store shelves, headlines about sick workers, and news footage of farmers throwing away fresh potatoes and milk produced for hotels and cruise ships shut down during the pandemic. The food system is currently so specialized and efficient, Broad Leib asserts, that it cannot pivot when circumstances change. Eggs, for example, are often packaged in liquid form for use in industrial kitchens. But if those liquid eggs suddenly aren’t needed, they can’t be rerouted and sold in grocery stores—a frustrating scenario when data suggest that the number of “food insecure” people, those who lack sufficient affordable, nutritious food, has risen to unprecedented levels since the pandemic began.

A tangle of bureaucracy further complicates food-safety efforts in the United States. Fifteen different federal agencies—including the FDA, EPA, USDA, OSHA, and the Department of Commerce—have some role in the food supply, Broad Leib says: each with a narrow view of food safety, and little knowledge of how their individual missions might interact. She has proposed a reorganization to establish a new unified food-system agency better equipped to address interrelated food-system issues.

She also recommends gathering representatives of these federal agencies, plus consumers and other stakeholders, to establish priorities for the U.S. food system and address its interrelated impacts on safety, health, and the environment. In 2017, Broad Leib and colleagues from Vermont Law School developed a “Blueprint for a National Food Strategy,” outlining the process for creating such a strategy that drew on the food policies in place in six other countries and interviews with leaders in the U.S. food system. Canadian officials have already used that document as a blueprint, allocating “millions of dollars in funding to areas of the food system” where they identified “gaps and weaknesses,” she reports. Part of this effort included support for small, local food producers, and operational changes to reduce food waste at retail stores and within the federal government.

As lawmakers consider pandemic stimulus programs, Broad Leib and law students in the clinic have written to Congress and are drawing up briefs, articles, and blogs related to the food system. “My hope is that we can use the energy of the moment. Many groups are working on this,” she points out, but everyone can play a role by “putting the pressure on food businesses and policymakers, so we can find long-term solutions.” 

Welcome to Clinical Fellow Joseph Beckmann

The Food Law and Policy Clinic is pleased to welcome new clinical fellow Joseph Beckmann.

Joseph Beckman
jbeckmann@law.harvard.edu
617-998-0224

Joseph Beckmann joined the Food Law and Policy Clinic in August 2020 as a Clinical Fellow. He received a B.A. in Political Science from the University of Chicago in 2011, a Certificate in Entrepreneurship from the Wisconsin School of Business in 2020, and a J.D. from the University of Wisconsin Law School in 2020.

Prior to joining the clinic, Joseph provided legal services to start-ups and mid-sized businesses in the food, beverage, and agriculture industries. As a Summer Law Clerk with a leading Food and Beverage-focused law firm in Wisconsin, Joseph helped draft proposed statutory revisions on policies surrounding contract manufacturing of various alcoholic beverages. He also assisted companies in their incorporation as Certified B Corporations and their intellectual property protection.  As a Regulatory Affairs Specialist with a Colorado-based CBD manufacturer, Joseph provided critical legal research on the developing regulatory landscape of the cannabusiness industry. Joseph also served as a Judicial Extern for the Honorable Jesse G. Reyes of the Illinois Court of Appeals.

In law school, Joseph was the President of the Student Bar Association and the Jewish Law Student Association, was the Diversity Committee Chair and a Managing Editor for the Wisconsin Law Review, and was a member of both the Latinx Law Student Association and the Wisconsin Moot Court Team. He also was inducted into the Pro Bono Society with an Award of Distinction. Joseph is a current member of the Wisconsin Hispanic Lawyers Association, the Hispanic Lawyers Association of Illinois, and the Hispanic National Bar Association. He is a licensed member of the State Bar of Wisconsin.

Texas Medicaid Enrollees Sue State For Cure To Hepatitis C Virus

The Texas Health & Human Services Commission (“HHSC”) has been challenged by Medicaid enrollees for instituting a policy that rations coverage of prescription drugs to cure Hepatitis C virus (“HCV”). In a class action lawsuit recently filed in federal district court in Austin, Plaintiffs Dorena Coleman, Curtis Jackson and Federico Perez allege that the HHSC has prioritized financial concerns over their health by restricting coverage of HCV cures to only those Medicaid enrollees with severe liver damage, even though the medications result in cure rates approaching 100% for all individuals infected with HCV. 

The case is captioned as Coleman v. Wilson. The plaintiffs are represented by Edwards Law, the Center for Health Law & Policy Innovation of Harvard Law School, and Latham & Watkins LLP.

HCV is the deadliest communicable disease in the United States. The virus causes chronic inflammation throughout the body of those infected and can lead to serious liver damage, infections, liver cancer and death. However, individuals with HCV may suffer long before these advanced states of the disease, including from conditions such as diabetes, lymphoma, fatigue, joint pain, depression, myalgias, arthritis and jaundice.

Starting in 2011, the United States Food and Drug Administration (FDA) began approving a combination of drugs called direct-acting antivirals (DAAs) to treat HCV. Treatment guidelines approved by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America confirm that DAAs should be available for “all patients with chronic HCV infection, except those with short life expectancies that cannot be remediated by treating HCV, by transplantation, or by other directed therapy.” This clinical guidance reflects the medical standard of care in Texas and across the country. The only obstructions to treatment for patients like Ms. Coleman, Mr. Jackson and Mr. Perez are discriminatory coverage exclusions and limitations, such as those challenged here. In imposing this policy, Texas Medicaid stands in stark contrast to Medicare, the U.S. Department of Veterans Affairs, most commercial health insurers, and nearly every other state Medicaid program in the United States. 

As Medicaid enrollees, Ms. Coleman, Mr. Jackson, Mr. Perez, and others like them are generally entitled to non-discriminatory health coverage. Nevertheless, because HCV treatment is costly, the HHSC has instituted a rationing policy specifically designed to withhold coverage of the cure from thousands of Medicaid enrollees who suffer from HCV, but do not yet have advanced liver disease or cirrhosis of the liver. Thus, the lawsuit states, HHSC is telling Ms. Coleman, Mr. Jackson and Mr. Perez and thousands like them, that they must wait until their health condition worsens before they are eligible for coverage for the cure. This policy is contrary to AASLD guidelines, and it ignores the overall cost-effectiveness of early treatment for HCV and the public health benefit.  

By withholding coverage for individuals without advanced liver scarring, the Complaint alleges that Texas Medicaid is discriminatory in at least two ways. First, the Texas policy categorically denies coverage from individuals with low fibrosis scores (the level of liver scarring), regardless of their individual circumstances. Under the medical standard of care, Medicaid enrollees blocked from coverage have comparable need to those permitted coverage under the Texas policy. Second, the Complaint alleges that Texas Medicaid singles out HCV patients for rationing on the basis of disease severity in a unique manner that no other chronically ill Texas Medicaid beneficiary in need of treatment coverage is subjected to. Under either view of the Texas policy, it violates federal law. 

“Medicaid is not allowed to discriminate in its coverage of medically necessary prescription medications when someone has an infectious disease like HCV,” said Jeff Edwards of Edwards Law, in Austin. “This lawsuit simply enforces the coverage that federal and state law requires to be provided to Medicaid beneficiaries.”

For its part, the federal Centers for Medicare and Medicaid Services issued guidance in November 2015 warning states that exclusions and limitations on public insurance coverage of DAAs may violate federal law. 

“At the end of the day, Medicaid coverage is supposed to be governed by medical reasons, not fiscal concerns, especially in the circumstances here where there is no other equally effective treatment available,” said Kevin Costello, Director of Litigation for the Center for Health Law and Policy Innovation of Harvard Law School. “We have strong reason to believe that HHSC’s policy is motivated by short-sighted and fundamentally unsound budget fears.” 

“The policy at issue here, which deprives some of Texas’s most vulnerable of vital and curative medical treatment for a chronic illness, is contrary to the federal laws that govern critically important benefits under the Medicaid program,” said David Tolley, partner at Latham & Watkins. “We look forward to vigorously pursuing access to treatment for our clients in the State of Texas.”

“Studies have proven that payors like Medicaid do themselves a favor when they remove HCV treatment restrictions in favor of open access that avoids payment for interim health problems and eliminates the risk for serious complications down the road,” said Jeff Edwards. “And it goes without saying that the real potential of this cure is the eradication of HCV altogether, a goal that is furthered by early treatment of Medicaid beneficiaries that makes further transmission of the virus impossible in their case.”

A PDF version of the press release is available here. 

Fixing the Covid Food Disaster Can Slash Climate Emissions

This article was originally written by Sarah McBride and published in Bloomberg Quint on August 13, 2020. 


By the end of April, Olivier Griss knew he had a problem. Coke Farm, the San Juan Bautista, Calif. business his stepfather started in 1981 where Griss now works as sales manager, was awash in a leafy salad ingredient: chicory. Specifically, treviso and castelfranco varieties that end up on plates in high-end restaurants. But high-end restaurants were largely closed, due to the Covid-19 pandemic sweeping the world.

“We held onto it for as long as we could,” Griss says, trying to find a buyer. When it was no longer fit for market, workers tilled it into the ground, along with tiny artichokes also popular with discerning chefs. “It hurt.”

Those fields of dirt-covered chicory became one more casualty in the battle against food waste, a scourge that contributes anywhere between 6% and 10% of global greenhouse gas emissions. All of the world’s food waste taken together creates about the same climate emissions as India. That’s in part because food waste in landfills releases methane, a much more potent greenhouse gas than carbon dioxide.

The coronavirus pandemic has cut greenhouse gases in some key ways, as people are flying and driving less. But food waste accounts for one reason why the drops likely won’t fall as low as hoped during the pandemic. And as the virus ebbs and flows, it will likely lead to more waste. (Evidence is emerging that home cooks are throwing away less food— but it’s too early to tell if it’s enough to compensate for the industrial-scale loss at farms.) Food organizations are working hard to fight that squandering, both at the source (farms) and the end point (consumers). If these organizations can tap into the shock engendered by images of scuttled harvests and dairy products during the early days of the pandemic, they could drive lasting transformation in food waste and climate change.

Griss’s predicament is a fancier version of the situation facing so many farmers across the country  starting earlier this spring. To consumers, it didn’t make sense. Why were farmers scuttling tons of perfectly good crops when empty grocery store shelves stretched aisles long, and when food bank lines ran miles long? But farms generally don’t sell directly to grocery stores, or to food banks, and changing distributors on the fly is tough.

“Certainly, it has made some things that were invisible more visible,” says Emily Broad Leib, faculty director of Harvard University’s Food Law and Policy Clinic, speaking about the pandemic. Among them: the inflexibility of the food chain, the large numbers of Americans on the edge of hunger, the risky roles of workers in food processing, the incentives set up to deliver food in set ways, the damage food waste does to the environment. “My hope is that will lead to changes in how we use our natural resources.”

Full Harvest, a San Francisco-based startup, is on the forefront of these efforts. The company normally focuses on finding buyers for imperfect produce like mushy tomatoes or brown spotted lettuce. It recruits farmers to post products on an online marketplace it operates—and also invites food and beverage companies to use that same marketplace to buy the produce, which ends up in chips, juices and sauces. In March, a farmer in the network reached out to chief executive officer Christine Moseley, asking for urgent help with crops that buyers no longer wanted. At the same time, she heard from people who were seeing reports of exploding food waste along with exploding demand at food banks, and wondered if she could do anything about it. 

Since Full Harvest already had relationships with farms and with big food buyers, Moseley figured she could help farmers find homes for the extra produce.

Full Harvest had something many other well-meaning organizations didn’t: relationships with farmers, plus technology to track the components. She’s started trial programs in Oakland, Calif., in collaboration with Eat Learn Play, the organization founded by basketball star Steph Curry and his wife Ayesha, and World Central Kitchen, founded by celebrity chef José Andrés. The efforts grew when Salesforce Inc., which wanted to support minority-owned farmers, got involved. The organizations have now provided around 50,000  food boxes to food insecure Oakland families and expanded to New York City.

The volume of demand floored her.

“This pandemic has shone a light on the food system and how many improvements are needed,” Moseley says. “You have this system that is mostly offline, that is slow and opaque.”

About 2 million farms operate in the United States. Farm income from vegetables is about $20 billion, according to the U.S. Department of Agriculture. About half of all vegetables get sold to supermarkets, and half to food service—restaurants, cafeterias, schools and big processors.

Normally, this system hums. Farmers work with established buyers who typically contract for their crops months in advance. Depending on the crop and the size of the farms and businesses involved, these intermediaries might pick up produce from a farm in bulk and send it on to a canned goods company, or take it to a sorting facility where it gets packaged or bagged and sent to a buyer like a supermarket or restaurant. Sometimes, it gets packaged right in the field. If farmers unexpectedly have extra of something, they pick up the phone and talk to their distributor, who finds another buyer for it.

“Our food distribution system is very finely calibrated in the U.S., which is a good thing because we get fresh food quickly,” says John Mandyck, co-author of the book “Food Foolish.” “Disruption reveals the calibration.”

Farms also have backup plans, such as techniques to delay harvest for a few days or lining up access to spare trucks. It’s just that none of them applied this spring, when demand cratered at restaurants, schools, and other industrial buyers of food while at the same time spiking in grocery stores.

“For a strawberry farm, contingency was around hurricanes,” says Aaron LaMotte, vice president of produce at Sodexo SA, the food-services giant. “It wasn’t around a pandemic.”

Suddenly, farms that grow lemons destined to garnish restaurant-served cups of tea and glasses of water were scrambling to find new customers. Farms that grow extra-large onions—10 or 12 inches in diameter— that normally find their way into cafeteria onion rings found themselves out of luck with grocery stores, where picky consumers prefer something less supersized. Farms that ship milk in bulk containers to those same schools and other cafeterias lost their regular buyers. Ditto eggs. Parsley, in pre-pandemic times liberally sprinkled across millions of now abandoned buffet tables across the country, piled up unwanted.

Even if the product was the same—restaurant lemons match grocery store lemons—many distributors found they needed new packaging. Grocery stores might require one- pound or three-pound bags of lemons, or eggs in boxes of one dozen, or milk in cartons of a gallon or less—not on hand at those distributors who normally sell to big companies. Or the distributor had the packaging and a substitute buyer, but its sorting machines couldn’t handle the new measurements. 

Like many organizations, Full Harvest wanted to help divert the produce to food banks. But Moseley learned that dropping off a truckload or two of produce at a food bank isn’t always possible. They don’t have the refrigeration to store it. Sometimes, the smaller trucks that service their buildings—as opposed to the giant tractor trailers that take produce to, say, a soup factory—are too small to fit the giant pallets of produce that many industrial distributors work with.

That’s when she started talking to Eat Learn Play, World Central Kitchen, and later, Salesforce. The first program started in May, with more in June. They aim to keep pushing into more cities.

 “My hope is to scale it nationally,” says Ebony Beckwith, chief executive officer of the Salesforce Foundation. The group is working to add Los Angeles to its food-box roster later this year. “What if we can connect all farms like this?”

It was up to Full Harvest to find the farms with available surplus produce for sale. Its grower-relations staff hit the phones, asking existing partner farmers if they could offer any leads, and calling other farmers cold. That is how they tracked down Coke Farm, one of about a half dozen now working on various food-box projects with Full Harvest; Coke packed up ripe fruits and vegetables on its farm for an Oakland food-box program set up with World Central Kitchen. It worked so well that Full Harvest and World Central Kitchen just expanded the initiative to New York City, working with nearby local farms there. The goal is to deliver 48,000 boxes to food insecure families in New York by the first week of September.

Meanwhile, for a separate program, Eat Learn Play worked with the Oakland Unified School District to find families with school-age children in the city who could use the veggies. It hired 35 locals, mostly jobless due to the pandemic, to work in a warehouse sorting truckloads of farm goods into individual boxes.

The first boxes included squash, tomatoes and other vegetables. “Summer corn was a smash hit,” reports Eat, Learn, Play’s CEO Chris Helfrich. Kale, not so much, at least for the kids.

The 15-pound boxes of organic produce cost the funders $25 apiece, including transportation and logistics, compared with around $40 for a typical organic community-farm produce box. The goal is to keep driving the price down to a level where a low-income Oakland family could afford to buy it themselves.

Observers hope this project and others like it will outlast the pandemic.

“There’s really an opportunity to build a different supply chain, or a tributary to the supply web,” says Lauren Scott, chief marketing officer of the Produce Marketing Association. “Something that’s truly sustainable, that the food banks could count on and use.” Key to it, she says, is developing a system where farmers and distributors are paid fairly—and figuring it out now, not during the next wave of a pandemic or other crisis.

Some key steps would help solve the problems of excess food going to waste on farms in crisis rather than finding its way to hungry people. Leib of Harvard advocates for tailoring tax incentives for donated food so it is easier for farmers to claim deductions. She would also like to see a tax benefit, either for farmers or transportation companies, so they can get the food where needed.

“It’s not free to take food that is not going to be sold,” she says. “Someone needs to come get it.” She is talking with members of Congress to get such provisions written into law. A proposed piece of legislation called the Food Donation Improvement Act would help because it limits liability for those who donate safe food. She also welcomes changes that the government made as the pandemic struck hard in the spring, such as temporarily allowing eggs that were packaged for food service to be sold in grocery stores even without the mandated nutritional labels.

Food raised or grown and then wasted takes up a fifth of all cropland, and one-fifth of all fertilizer, a serious contributor to greenhouse gases. Wasted food uses around one-fifth of the space in all landfills. 

With a goal of shifting the agricultural legacy of coronavirus to cutting those grim statistics,  Moseley of Full Harvest calls for more steps akin to the plan the government announced in April. Its  $19 billion coronavirus-relief program for  farmers and ranchers included $3 billion to purchase food from U.S. producers so it could go to charitable organizations like food banks instead of getting dumped or plowed under.

“If there’s anything government money should be going towards, it is this: taking money and subsidizing the cost of food that would have gone to waste and feeding people,” she says.

State health officer, experts discuss health disparities

This article was originally written by Danny McArthur and was published in the Daily Journal on August 12, 2020. 


Coronavirus continues to reveal striking health disparities as a result of systemic healthcare issues, according to State Health Officer Thomas Dobbs and a panel of experts, Wednesday.

The Mississippi Center for Justice, a homegrown public interest law firm that advocates for racial and economic justice, and AARP Mississippi hosted a livestream Wednesday to discuss COVID-19 and the implications of health disparities.

“It can no longer be politics as usual. This is about people. It’s about the lives of people and it’s about improving the opportunities, particularly through healthcare, for people to live well and productive lives,” said MCJ President Vangela M. Wade. “We have got to work across, whether it’s political, socioeconomic lines in order to address these issues that are impacting the people across the state of Mississippi.”

The discussion was moderated by MCJ Director of Health Law Linda Dixon and featured Dobbs, Faculty Director for Harvard Law School Center for Health Law and Policy Innovation Robert Greenwald, AARP State Director Kimberly L. Campbell and MS NAACP Executive Director Corey Wiggins as panelists.

Among topics was the disproportionate impact on Mississippians of Black, Hispanic and Native American descent and the current spread of COVID-19 among younger age groups potentially impacting elderly and vulnerable populations.

The current COVID-19 growth trends are largely tied to social behaviors, with some being linked to events such as Memorial Day or the Fourth of July. The number of deaths has also increased, with 45 new deaths reported Wednesday. While ages 18 to 29 still represent the largest number of COVID-19 cases at 14,511 as of Aug. 11, Dobbs said those under 18 will be the fastest growing group of total cases and that MSDH expects more as school starts. He reported 27 schools reported COVID-19 cases as of Tuesday afternoon, and said that information will be publicized.

“We are going to mandate that the schools submit to us on a weekly basis the number of cases that they have, the number of classes affected, quarantine, the number of quarantined individuals,” Dobbs said. “We do plan on posting that data by school, so we’re still working out the reporting issue process because they’re just starting to send it in to us.”

African Americans make up the majority of COVID-19 cases at approximately 53% of total cases and 50% of total deaths, despite only being approximately 38% of the total population. The Mississippi State Department of Health recognized “pretty quickly, although not quickly enough” the massive impact on the Black community and said 53% represents a decrease from earlier in the pandemic, when African Americans represented over 60% of total COVID-19 cases.

“That reflected a whole host of failures, including not only the failure to recognize that it was already impacting the Black community so severely, but our communications had not really been focused in that direction, and there [was] a lot of actually misunderstanding about the transmission and the risk factors [that] allowed it to really sort of advance more aggressively in the Black community,” Dobbs said.

These disparities are also present in the Hispanic population, which represents a little over 3% of the total population but 5% of COVID-19 cases, and the Native Americans, which 1% of total cases despite there only being approximately 11,000 registered members of the Mississippi Band of Choctaw Indians, the only Federally-recognized American Indian tribe living in Mississippi.

Among challenges to addressing disparities were women, especially Black women, represented more COVID-19 cases than men. Dobbs said one likely reason was many Black women work in the service industry and therefore are more exposed to COVID-19. Other challenges include multigenerational households, such as those found within Hispanic communities, making social distancing more difficult and a lack of access to healthcare.

Greenwald and Wiggins discussed the need for systemic change to address existing disparities. Greenwald shared solution-based approaches, which included expanding healthcare access through the Affordable Care Act and Medicaid, as well as continuing improving telehealth. He also shared successful state and local health initiatives in Baltimore, Kentucky, Dallas, Georgia and Louisiana that were informed by current health disparities to expand access to testing, invest in minorities economically, provide expanded access and use a health equity task force to inform policy making.

“These inequities have long existed a long time before this moment…we have to call it out to understand even as we respond to this crisis in the short term,” Wiggins said. “[We] still have a lot of work to do to respond to the structural issues that have created this [situation] that we’re sitting in right now.”

Disparities in Access to HCV Positive-Donor/HCV Negative-Recipient Transplant

This article was originally written by Victoria Socha and published in Nephrology Times on August 11, 2020. 


Following successful pilot trials of transplanting organs from hepatitis C virus (HCV) viremic donors into HCV-negative recipients, there has been an expansion of the practice. Direct-acting antiviral (DAA) therapies are costly, creating barriers to insurance coverage approvals, particularly in transplantation from HCV positive donors to HCV-negative recipients, due in part to off-label treatment of acute HCV following intentional HCV transmission.

There are few data available on whether there are socio-demographic disparities with respect to access to HCV positive donor organs among HCV-negative patients. T. Nguyen and colleagues conducted an analysis using data from the Organ Procurement and Transplantation Network and the United Network for Organ Sharing from January 1, 2017, to June 30, 2019. Results were reported during the virtual American Transplant Congress 2020 in a presentation titled Socio-Demographic Disparities in Access to Organs from HCV-Viremic Donors among HCV-Negative Patients.

The analysis included kidney, liver, heart, and/or lung transplant recipients at centers that performed ten or more HCV positive donor/HCV negative recipient transplants of the organ type. States’ Medicaid policies were categorized as grades A to F, according to ratings from the Center for Health Law and Policy Innovation of Harvard Law School and the National Viral Hepatitis Roundtable. Under-represented minorities were defined as Hispanic and Black patients.

Evaluation of factors associated with receiving an HCV donor-negative/HCV recipient-positive transplant utilized multivariable mixed effects logistic regression models (center as random effect). Marginal standardization was used to predict the standardized proportion of HCV donor-positive/HCV recipient-negative transplants within insurance and state subgroups standardized with respect to the distribution of all other covariates.

During the study period, 29 transplant centers performed 10 or more HCV donor-positive/HCV donor-negative transplants of one organ type. In multivariable mixed effects models, women (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.61-0.80; P<.001) and under-represented minorities (OR, 0.80; 95% CI, 0.69-0.92; P=.003) were significantly less likely to receive an HCV donor-positive/HCV recipient-negative transplant. Patients with an education level of grade school or less were also significantly less likely to receive an HCV donor-positive/HCV recipient-negative transplant (OR, 0.55; 95% CI, 0.39-0.79; P=.001), compared with college-educated transplant recipients.

There was significant interaction with Medicaid insurance and state HCV Medicaid grade (P=.01): Medicaid insurance was only associated with a lower probability of receiving an HCV donor-positive/HCV donor/negative transplant in HCV Medicaid-restricted states.

In conclusion, the researchers said, “Women, under-represented minorities, patients with the least educational attainment, and Medicaid-insured patients living in HCV Medicaid-restricted states have less access to transplantation from HCV-viremic donors. Understanding the individual factors and public policies that contribute to the disparities in the transplant waitlist can aid in optimizing fair distribution of these limited resources.”

Source: Nguyen T, William W, Sise M, Reese P, Goldberg D. Socio-demographic disparities in access to organs from HCV-viremic donors among HCV-negative patients. Abstract of a presentation at the virtual American Transplant Congress 2020 (Abstract 485), May 30, 2020.