As the Caribbean sees its first Category 5 hurricane of the year, scientists warn that extreme weather is here to stay due to climate change. Aru Pande reports from Washington, where U.S. President Joe Biden on Tuesday announced new climate resilience measures. Kim Lewis contributed to this report.
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WASHINGTON — U.S. officials have approved another Alzheimer’s drug that can modestly slow the disease, providing a new option for patients in the early stages of the incurable, memory-destroying ailment. 

The Food and Drug Administration approved Eli Lilly’s Kisunla on Tuesday for mild or early cases of dementia caused by Alzheimer’s. It’s only the second drug that’s been convincingly shown to delay cognitive decline in patients, following last year’s approval of a similar drug from Japanese drugmaker Eisai. 

The delay seen with both drugs amounts to a matter of months — about seven months, in the case of Lilly’s drug. Patients and their families will have to weigh that benefit against the downsides, including regular IV infusions and potentially dangerous side effects like brain swelling. 

Physicians who treat Alzheimer’s say the approval is an important step after decades of failed experimental treatments. 

“I’m thrilled to have different options to help my patients,” said Dr. Suzanne Schindler, a neurologist at Washington University in St. Louis. “It’s been difficult as a dementia specialist — I diagnose my patients with Alzheimer’s and then every year I see them get worse and they progress until they die.” 

Both Kisunla and the Japanese drug, Leqembi, are laboratory-made antibodies, administered by IV, that target one contributor to Alzheimer’s: sticky amyloid plaque buildup in the brain. Questions remain about which patients should get the drugs and how long they might benefit. 

The new drug’s approval was expected after an outside panel of FDA advisers unanimously voted in favor of its benefits at a public meeting last month. That endorsement came despite several questions from FDA reviewers about how Lilly studied the drug, including allowing patients to discontinue treatment after their plaque reached very low levels. 

Costs will vary by patient, based on how long they take the drug, Lilly said. The company also said a year’s worth of therapy would cost $32,000 — more than the $26,500 price of a year’s worth of Leqembi. 

The FDA’s prescribing information tells doctors they can consider stopping the drug after confirming via brain scans that patients have minimal plaque. 

More than 6 million Americans have Alzheimer’s. Only those with early or mild disease will be eligible for the new drug, and an even smaller subset are likely to undergo the multistep process needed to get a prescription. 

The FDA approved Kisunla, known chemically as donanemab, based on results from an 18-month study in which patients given the treatment declined about 22% more slowly in terms of memory and cognitive ability than those who received a dummy infusion. 

The main safety issue was brain swelling and bleeding, a problem common to all plaque-targeting drugs. The rates reported in Lilly’s study, including 20% of patients with microbleeds, were slightly higher than those reported with competitor Leqembi. However, the two drugs were tested in slightly different types of patients, which experts say makes it difficult to compare the drugs’ safety. 

Kisunla is infused once a month compared to Leqembi’s twice-a-month regimen, which could make things easier for caregivers who bring their loved ones to a hospital or clinic for treatment.
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islamabad — A new study has revealed that recent floods in Pakistan have substantially weakened its societal resilience in coping with and recovering from such disasters as the threat from climate change continues to grow.

The London-headquartered independent global charity Lloyd’s Register Foundation said Tuesday the findings are part of the latest edition of their flagship World Risk Poll Resilience Index.

The study also highlighted that the number of Pakistanis who have experienced a disaster in the past five years has more than doubled since 2021, increasing from 11% to 27%.

“This increase has been driven primarily by the extensive floods that hit the country in 2022, affecting regions containing around 15% of the population,” the study said.

The report noted that community and society resilience scores declined sharply in the regions most affected by the floods, particularly in the southern Sindh province.

“These scores declined because people reported losing confidence in the support of the government, community and infrastructure — at a national level, those who said their government cared ‘not at all’ about them and their well-being rose from 60% in 2021 to almost three-quarters [72%] in 2023.”

Meanwhile, the country’s already low individual and household resilience levels failed to improve, with Pakistan ranking in the bottom 10 globally for both resilience scores, according to the report.

Nancy Hey, the director of evidence and insight at Lloyd’s Register Foundation, urged policymakers in Pakistan to prioritize rebuilding and strengthening the resilience of the most affected communities.

She said this would better prepare them to face natural hazards and other potential causes of disasters in the wake of the growing threat of climate change.

“For residents of Pakistan, catastrophic flooding is largely responsible for the doubling in disaster experience since 2021. This may have led to a ‘reality check’ for residents in terms of how prepared they feel for such events, with community and societal resilience particularly negatively affected,” Hey said.

In 2022, Pakistan’s southern and southwestern regions experienced devastating floods triggered by climate change-induced unusually heavy monsoon rains, killing more than 1,700 people, affecting 33 million others, and submerging approximately one-third of Pakistan.

The South Asian nation of about 245 million contributes less than 1% to global carbon emissions but bears the brunt of climate change.

The country’s weather patterns have changed dramatically in recent years, and it officially “ranks fifth among the countries most affected by global warming.”

April was recorded as the wettest month in Pakistan since 1961, with more than double the usual monthly rainfall, killing scores of people and destroying property as well as farmland.

In May and June, Pakistan experienced relatively hotter heat waves, with temperatures in some districts rising to more than 52 degrees Celsius for days. The hot weather prompted authorities in May to temporarily shut down education for half of Pakistan’s schoolchildren to protect them from heatstroke and dehydration.

The United Nations has warned that an estimated 200,000 Pakistanis could be affected by the coming monsoon season and flash floods, as national weather forecasters project above-normal rainfall.

Prime Minister Shehbaz Sharif reviewed preparations for the monsoon season at a special meeting Tuesday and formed “a high-level committee” to handle potential emergencies, his office said in a statement.

National Disaster Management Authority officials told the meeting that all relevant institutions and Pakistani troops remain on “high alert” in vulnerable districts. They were quoted as saying that “adequate stocks” of boats, tents, drainage pumps, medicines and other essential items were available for people in areas prone to rain-related disasters.”
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WASHINGTON — The U.S. Supreme Court took up an e-cigarette case Tuesday, weighing whether the Food and Drug Administration wrongly blocked the marketing of sweet, flavored products amid a surge in vaping by young people.

Vaping companies argue the FDA unfairly denied more than a million applications to market fruit or candy flavored versions of nicotine-laced liquid that’s heated by the e-cigarette to create an inhalable aerosol.

The case comes as the FDA undertakes a sweeping review after years of regulatory delays intended to bring scientific scrutiny to the multibillion-dollar vaping market, which includes thousands of flavored vapes that are technically illegal but are widely available in convenience stores, gas stations and vape shops. The FDA recently approved its first menthol-flavored electronic cigarettes for adult smokers.

The agency says the sweet, flavored e-liquids pose a “serious, well-documented risk” of enticing more young people to pick up a nicotine habit. In 2020, nearly 20% of high school students and almost 5% of middle school students used e-cigarettes, and almost all of those kids used flavored products, the agency said in court documents.

The agency says companies were blocked because they couldn’t show the possible benefits for adult smokers outweighed the risk of underage use. The companies say they had prepared detailed plans to avoid appealing to young people.

The companies scored a victory when the U.S. 5th Circuit Court of Appeals sided with vaping companies and tossed out orders denying the marketing of e-liquids with names like “Jimmy The Juice Man in Peachy Strawberry.”

The 5th Circuit found the agency was unfair because it required the companies, without warning, to present studies showing that flavored products would help with smoking cessation.

The FDA appealed that finding to the Supreme Court. The justices are expecting to hear the case in the fall.

Other appeals courts have sided with the FDA, which regulates new tobacco products under a 2009 law aimed at curbing youth tobacco use.

Vaping companies have long claimed their products can help blunt the toll of smoking, which is blamed for 480,000 U.S. deaths annually due to cancer, lung disease and heart disease.

Youth vaping has declined from all-time highs in recent years, but about 10% of high schoolers still reported e-cigarette use last year.
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UCLA molecular bioengineer Mireille Kamariza has developed a new tuberculosis test that tackles shortcomings of existing TB diagnostics. VOA’s Genia Dulot reports for this week’s episode of LogOn.
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Phoenix — Alfred Handley leaned back in his wheelchair alongside a major Phoenix freeway as a street medicine team helped him get rehydrated with an intravenous saline solution dripping from a bag hanging on a pole.

Cars whooshed by under the blazing 96-degree morning sun as the 59-year-old homeless man with a nearly toothless smile got the help he needed through a new program run by the nonprofit Circle the City.  

“It’s a lot better than going to the hospital,” Handley said of the team that provides health care to homeless people. He’s been treated poorly at traditional clinics and hospitals, he said, more than six years after being struck by a car while he sat on a wall, leaving him in a wheelchair.

Circle the City introduced its IV rehydration program as a way to protect homeless people from life-threatening heat illness as temperatures regularly hit the triple-digits in America’s hottest metro. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Maricopa County, which encompasses metro Phoenix.

Dr. Liz Frye, vice chair of the Street Medicine Institute that provides training to hundreds of health care teams worldwide, said she didn’t know of groups other than Circle the City administering IVs on the street.

“But if that’s what needs to happen to keep somebody from dying, I’m all about it,” Frye said.

As summers grow warmer, health providers from San Diego to New York are being challenged to better protect homeless patients.

Even the Boston Health Care for the Homeless Program, featured in last year’s book, “Rough Sleepers,” now sees patients with mild heat exhaustion in the summer after decades of treating people with frostbite and hypothermia during the winter, said Dr. Dave Munson, the street team’s medical director.

“It’s certainly something to worry about,” said Munson, noting that temperatures in Boston hit 100 degrees with 70% humidity during June’s heat wave. Homeless people, he said, are vulnerable to very hot and very cold weather not only because they live outside, but they often can’t regulate body temperature due to medication for mental illness or high blood pressure, or because of street substance use.

The Phoenix team searches for patients in homeless encampments in dry riverbeds, sweltering alleys and along the canals that bring water to the Phoenix area. About 15% are dehydrated enough for a saline drip.  

“We go out every day and find them,” said nurse practitioner Perla Puebla. “We do their wound care, medication refills for diabetes, antibiotics, high blood pressure.”

Puebla’s street team ran across Handley and 36-year-old Phoenix native Phillip Enriquez near an overpass in an area frequented by homeless people because it’s near a facility offering free meals. Across the road was an encampment of tents and lean-tos along a chain-link fence.  

Enriquez sat on a patch of dirt as Puebla started a drip for him. She also gave him a prescription for antibiotics and a referral to a dentist for his dental infection.

Living outside in Arizona’s broiling sun is hard, especially for people who may be mentally ill or use sedating drugs like fentanyl that make them less aware of surroundings. Stimulants like methamphetamine contribute to dehydration, which can be fatal.

Temperatures this year have reached 115 degrees (45 Celsius) in metro Phoenix, where six heat-related deaths have been confirmed through June 22. Another 111 are under investigation.

“The number of patients with heat illnesses is increasing every year,” said Dr. Aneesh Narang, assistant medical director of emergency medicine at Banner Medical Center-Phoenix, which treats many homeless people with heat stroke.

Narang’s staff works frequently with Circle the City, whose core mission is providing respite care, with 100 beds for homeless people not well enough to return to the streets after a hospital stay.

Extreme heat worldwide requires a dramatic response, said physician assistant Lindsay Fox, who cares for homeless people in Albuquerque, New Mexico, through an initiative run by the University of New Mexico’s School of Medicine.

Three times weekly, Fox treats infections, cleans wounds and manages chronic conditions in consultation with hospital colleagues. She said the prospect of more heat illness worries her.

Highs in Albuquerque can hit the 90s and don’t fall enough for people living outside to cool off overnight, she said.

“If you’re in an urban area that’s primarily concrete, you’re retaining heat,” she said. “We’re seeing heat exposure that very quickly could go to heat stroke.”

Serious heat stroke is far more common in metro Phoenix, where Circle the City is now among scores of health programs for the homeless in cities like New York, San Diego and Spokane, Washington.

Circle the City, founded in 2012 by Sister Adele O’Sullivan, a physician and member of the Sisters of St. Joseph Carondelet, now has 260 employees, including 15 doctors, 13 physician assistants and 11 nurse practitioners. It annually sees 9,000 patients.

Grants, donations and other gifts account for about 20% of the funding. Most of the rest comes from insurance payments for services provided through Medicaid and Medicare.

Circle the City works with medical staff in seven Phoenix hospitals to help homeless patients get after-care when they no longer need hospitalization. It also staffs two outpatient clinics for follow-up.  

“This partnership allows us to offer the best outcomes for our patients,” said Craig Orsini, social work manager at St. Joseph’s Hospital and Medical Center in Phoenix.

Often that’s a few weeks in respite care or, for less acute needs, a stay in one of a handful of medical beds at the downtown shelter for things like dressing changes for wounds. Someone who needs months to heal might go to a skilled nursing facility.

While patients recover, Circle the City works to find longer-term transitional shelter such as those for people 55 and older, or in permanent housing. About 77% of respite patients are sent somewhere other than the street or an emergency shelter.

“We try to find the best fit for people,” said Wendy Adams, Circle the City’s community outreach supervisor.

Circle the City medical staff distributes tens of thousands of water bottles each summer and tries to educate people about hot weather dangers, said Dr. Matt Essary, who works at one of five mobile clinics that stop outside soup kitchens and other services for homeless people. 

Essary said Circle the City is also considering a blood analysis tool to detect electrolyte imbalances caused by dehydration.

“You can see right away how dehydrated they have become because it’s so hard to draw their blood,” he said. Other possible symptoms include headache, extreme thirst, dizziness and dry mouth.

“We also see a lot of people with surface burns,” Essary said of the wounds common in broiling Phoenix, where a medical emergency or intoxication can cause someone to fall on a sizzling sidewalk.

Rachel Belgrade waited outside Circle the City’s retrofitted truck with her black-and-white puppy, Bo, for Essary to write a prescription for the blood pressure medicine she lost when a man stole her bicycle. She accepted two bottles of water to cool off as the morning heat rose. 

“They make all of this easier,” said Belgrade, a Native American from the Gila River tribe. “They don’t give you a hard time.” 
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Beijing — Beijing Tianbing Technology Company said Sunday that the first stage of its Tianlong-3 rocket under development had detached from its launch pad during a test due to structural failure and landed in a hilly area of the city of Gongyi in central China.

There were no reports of casualties after an initial investigation, Beijing Tianbing, also known as Space Pioneer, said in a statement on its official WeChat account.

Parts of the rocket stage were scattered within a “safe area” but caused a local fire, according to a separate statement by the Gongyi emergency management bureau.

The fire has since been extinguished and no one has been hurt, the bureau said.

The two-stage Tianlong-3 (“Sky Dragon 3”) is a partly reusable rocket under development by Space Pioneer, one of a small group of private-sector rocket makers that have grown rapidly over the past five years.

Falling rocket debris in China after launches is not unheard of, but it is very rare for part of a rocket under development to make an unplanned flight out of its test site and crash.

According to Space Pioneer, the first stage of the Tianlong-3 ignited normally during a hot test but later detached from the test bench due to structural failure and landed in hilly areas 1.5 km (0.9 mile) away.

A rocket can consist of several stages, with the first, or lowest, stage igniting and propelling the rocket upward upon its launch.

When the fuel is exhausted, the first stage falls off, and the second stage ignites, keeping the rocket in propulsion. Some rockets have third stages.

Space Pioneer says the performance of Tianlong-3 is comparable to SpaceX’s Falcon 9, which is also a two-stage rocket.

In April 2023, Space Pioneer launched a kerosene-oxygen rocket, the Tianlong-2, becoming the first private Chinese firm to send a liquid-propellant rocket into space.

Chinese commercial space companies have rushed into the sector since 2014 when private investment in the industry was allowed by the state.

Many started making satellites while others including Space Pioneer, focused on developing reusable rockets that can significantly cut mission costs.

The test sites of such companies can be found along China’s coastal areas, located by the sea due to safety reasons.

But some are also sited deep in the country’s interior such as Space Pioneer’s test center in Gongyi, a city of 800,000 people in the central province of Henan.
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SAN JUAN, Puerto Rico — Hurricane Beryl strengthened into what experts called an “extremely dangerous” Category 4 storm as it approaches the southeast Caribbean, which began shutting down Sunday amid urgent pleas from government officials for people to take shelter.

Hurricane warnings were in effect for Barbados, St. Lucia, Grenada, and St. Vincent and the Grenadines. Beryl’s center is expected to pass about 112 kilometers south of Barbados on Monday morning, said Sabu Best, director of Barbados’ meteorological service.

“This is a very serious situation developing for the Windward Islands,” warned the National Hurricane Center in Miami, which said that Beryl was “forecast to bring life-threatening winds and storm surge.”

Beryl was located about 570 kilometers east-southeast of Barbados. It had maximum sustained winds of 215 kph and was moving west at 33 kph. It is a compact storm, with hurricane-force winds extending 30 kilometers from its center.

Beryl is expected to pass just south of Barbados early Monday and then head into the Caribbean Sea as a major hurricane on a path toward Jamaica. It is expected to weaken by midweek, but still remain a hurricane as it heads toward Mexico.

Historic hurricane

Beryl had strengthened into a Category 3 hurricane on Sunday morning, becoming the first major hurricane east of the Lesser Antilles on record for June, according to Philip Klotzbach, Colorado State University hurricane researcher.

It took Beryl only 42 hours to strengthen from a tropical depression to a major hurricane — a feat accomplished only six other times in Atlantic hurricane history, and with Sept. 1 as the earliest date, according to hurricane expert Sam Lillo.

Beryl is now the earliest Category 4 Atlantic hurricane on record, besting Hurricane Dennis, which became a Category 4 storm on July 8, 2005, hurricane specialist and storm surge expert Michael Lowry said.

“Beryl is an extremely dangerous and rare hurricane for this time of year in this area,” he said in a phone interview. “Unusual is an understatement. Beryl is already a historic hurricane and it hasn’t struck yet.”

Hurricane Ivan in 2004 was the last strongest hurricane to hit the southeast Caribbean, causing catastrophic damage in Grenada as a Category 3 storm.

“So this is a serious threat, a very serious threat,” Lowry said of Beryl.

Reecia Marshall, who lives in Grenada, was working a Sunday shift at a local hotel, preparing guests and urging them to stay away from windows as she stored enough food and water for everyone.

She said she was a child when Hurricane Ivan struck, and that she doesn’t fear Beryl.

“I know it’s part of nature. I’m OK with it,” she said. “We just have to live with it.”

Forecasters warned of a life-threatening storm surge of up to 3 meters in areas where Beryl will make landfall, with up to 15 centimeters of rain for Barbados and nearby islands.

Long lines formed at gas stations and grocery stores in Barbados and other islands as people rushed to prepare for a storm that has broken records and rapidly intensified from a tropical storm with 35 mph (56 kph) winds on Friday to a Category 1 hurricane on Saturday.

Warm waters were fueling Beryl, with ocean heat content in the deep Atlantic the highest on record for this time of year, according to Brian McNoldy, University of Miami tropical meteorology researcher. Lowry said the waters are now warmer than they would be at the peak of the hurricane season in September.

Beryl marks the farthest east that a hurricane has formed in the tropical Atlantic in June, breaking a record set in 1933, according to Klotzbach.

“Please take this very seriously and prepare yourselves,” said Ralph Gonsalves, the prime minister of St. Vincent and the Grenadines. “This is a terrible hurricane.”

Bracing for the storm

Thousands of people were in Barbados for Saturday’s Twenty20 World Cup final, cricket’s biggest event, with Prime Minister Mia Mottley noting that not all fans were able to leave Sunday despite many rushing to change their flights.

“Some of them have never gone through a storm before,” she said. “We have plans to take care of them.”

Mottley said that all businesses should close by Sunday evening and warned the airport would close by nighttime.

Kemar Saffrey, president of a Barbadian group that aims to end homelessness, said in a video posted on social media Saturday night that those without homes tend to think they can ride out storms because they’ve done it before.

“I don’t want that to be the approach that they take,” he said, warning that Beryl is a dangerous storm and urging Barbadians to direct homeless people to a shelter.

Echoing his comments was Wilfred Abrahams, minister of home affairs and information.

“I need Barbadians at this point to be their brother’s keeper,” he said. “Some people are vulnerable.”

Meanwhile, St. Lucia Prime Minister Philip J. Pierre announced a national shutdown for Sunday evening and said that schools and businesses would remain closed on Monday.

“Preservation and protection of life is a priority,” he said.

Looking ahead

Caribbean leaders were preparing not only for Beryl, but for a cluster of thunderstorms trailing the hurricane that have a 70% chance of becoming a tropical depression.

“Do not let your guard down,” Mottley said.

Beryl is the second named storm in what is forecast to be an above-average hurricane season, which runs from June 1 to Nov. 30 in the Atlantic. Earlier this month, Tropical Storm Alberto came ashore in northeastern Mexico with heavy rains that resulted in four deaths.

The National Oceanic and Atmospheric Administration predicts the 2024 hurricane season is likely to be well above average, with between 17 and 25 named storms. The forecast calls for as many as 13 hurricanes and four major hurricanes.

An average Atlantic hurricane season produces 14 named storms, seven of them hurricanes and three major hurricanes.
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BADINGILO and BOMA NATIONAL PARKS, South Sudan — Seen from the air, they ripple across the landscape — a river of antelope racing across the vast grasslands of South Sudan in what conservationists say is the world’s largest land mammal migration.

The country’s first comprehensive aerial wildlife survey, released Tuesday, found about 6 million antelope. The survey over a two-week period last year in two national parks and nearby areas relied on spotters in airplanes, nearly 60,000 photos and tracking more than a hundred collared animals over about 120,000 square kilometers.

The estimate from the nonprofit African Parks, which conducted the work along with the government, far surpasses other large migratory herds such as the estimated 1.36 million wildebeests surveyed last year in the Serengeti straddling Tanzania and Kenya. But they warned that the animals face a rising threat from commercial poaching in a nation rife with weapons and without strong law enforcement.

“Saving the last great migration of wildlife on the planet is an incredibly important thing,” said Mike Fay, a conservation scientist who led the survey. “There’s so much evidence that the world’s ecosystems are collapsing, the world resources are being severely degraded and it’s causing gigantic disruption on the planet.”

The east African nation is still emerging from five years of fighting that erupted in 2013 and killed nearly 400,000 people. Elections scheduled for last year were postponed to this December, but few preparations are in place for those. Violence continues in some areas, with some 2 million people displaced and 9 million — 75% of the population — reliant on humanitarian aid, according to the United Nations.

The migration is already being touted as a point of national pride by a country trying to move beyond its conflict-riddled past. Billboards of the migration recently went up in the capital of Juba, and the government has aspirations that the animals may someday be a magnet for tourists.

South Sudan has six national parks and a dozen game reserves covering more than 13% of the terrain. The migration stretches from east of the Nile in Badingilo and Boma parks into neighboring Ethiopia — an area roughly the size of the U.S. state of Georgia. It includes four main antelope, the white-eared kob — of which there are some 5 million — the tiang, the Mongalla gazelle and bohor reedbuck.

The survey said some animals have increased since a more limited one in 2010. But it described a “catastrophic” decline of most non-migratory species in the last 40 years, such as the hippo, elephant and warthog. Associated Press journalists flying over the stunning migration of thousands of antelope last week saw few giraffes and no elephants, lions or cheetahs.

Trying to protect the animals over such a vast terrain is challenging.

In recent years, new roads have increased people’s access to markets, contributing to poaching. Years of flooding have meant crop failures that have left some people with little choice but to hunt for food. Some 30,000 animals were being killed each month between March and May this year, African Parks estimated.

The government hasn’t made a priority of protecting wildlife. Less than 1% of its budget is allocated to the wildlife ministry, which said it has few cars to move rangers around to protect animals. Those rangers say they haven’t been paid a salary since October and are outgunned by poachers.

South Sudan President H.E. Salva Kiir Mayardit said the country is committed to turning its wealth of wildlife into sustainable tourism. He called on the Ministry of Wildlife to prioritize training and equipping rangers to fight poaching.

Matthew Kauffman, a wildlife biologist for the U.S. Geological Survey and a professor of zoology at the University of Wyoming, said the work fits a growing global effort “to map these migrations.” One benefit is to be smarter when landscapes are developed to make way for these seasonal movements, he said.

Villagers near the parks told AP they mostly hunted to feed their families or to barter for goods.

A newly paved road between Juba and Bor — the epicenter of the illegal commercial bushmeat trade — has made it easier for trucks to carry large quantities of animals. Bor sits along the Nile, about 45 kilometers from Badingilo Park. In the dry season, animals coming closer to the town to drink are vulnerable to killing.

Officials at the wildlife ministry in Bor told AP the killing of animals had doubled in the last two years.

Even when those involved in the industry are caught, the consequences can be minor. A few years ago, when wildlife rangers came to arrest Lina Garang for selling animals, she said they let her go, instead telling her to conduct business more discreetly. Garang, 38, said her competition has only grown, with 15 new shops opening along her strip to buy and sell animals.

Part of the challenge is that there is no national land management plan, so roads and infrastructure are built without initial discussions about where best placed. The government’s also allocated an oil concession to a South African company in the middle of Badingilo that spans nearly 90% of the park.

African Parks is trying to square modernizing the country with preserving the wildlife. The organization has been criticized in the past for not engaging enough with communities and taking an overly militarized approach in some of the nearly two dozen areas it manages in Africa.

The group says its strategy in South Sudan is focused on community relations and aligning the benefits of wildlife and economic development. One plan is to create land conservancies that local communities would manage, with input from national authorities.

African Parks has set up small hubs in several remote villages and is spreading messages of sustainable practices, such as not killing female or baby animals.

Peter Alberto, undersecretary for the ministry of wildlife, conservation and tourism, said the government hopes the migration can become a point of pride, and reshape how the world thinks of South Sudan.

As for tourism, that may take a while. There aren’t hotels or roads to host people near the parks, and the only option is high-end trips for what one tour company official called a “high-risk” audience. There’s fighting between tribes and attacks by gunmen in the area, and pilots told AP they’ve been shot at while flying.

Will Jones, chief exploration officer for Journeys by Design, a U.K.-based tour company, charges roughly $150,000 per person for a weeklong tour in South Sudan. He said there isn’t strong demand.

Locals trying to protect the wildlife say it’s hard to shift people’s mentality.

In the remote village of Otallo on the border with Ethiopia, young men have started buying motorbikes. What had been an all-day trip on foot to cross the border to sell animals now takes just five hours, allowing them to double the number of animals they take and make multiple trips.

One of them, Charo Ochogi, said he’d rather be doing something else but there are few options, and he’s not worried about the animals disappearing.

“The kob isn’t going to finish. They’ll reproduce,” he said.
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SAN JUAN, Puerto Rico — Beryl strengthened into a hurricane Saturday as it churned toward the southeast Caribbean, with forecasters warning it was expected to strengthen into a dangerous major hurricane before reaching Barbados late Sunday or early Monday. 

A major hurricane is considered a Category 3 or higher, with winds of at least 178 kph. Beryl is now a Category 1 hurricane. 

A hurricane warning was issued for Barbados, and a hurricane watch was in effect for St. Lucia, Grenada, and St. Vincent and the Grenadines, while a tropical storm watch was issued for Martinique, Dominica and Tobago.  

“It’s astonishing to see a forecast for a major (Category 3+) hurricane in June anywhere in the Atlantic, let alone this far east in the deep tropics. #Beryl organizing in a hurry over the warmest waters ever recorded for late June,” Florida-based hurricane expert Michael Lowry posted on X. 

Beryl’s center is forecast to pass about 45 kilometers (about 28 mi) south of Barbados, said Sabu Best, director of the island’s meteorological services. 

On Saturday, Beryl was about 1,160 kilometers (about 721 mi) east-southeast of Barbados, with maximum sustained winds of 120 kph. It was moving west at 35 kph. 

“Rapid strengthening is now forecast,” the Miami-based National Hurricane Center said. 

Warm waters are fueling Beryl, with ocean heat content in the deep Atlantic the highest on record for this time of year, according to Brian McNoldy, University of Miami tropical meteorology researcher. 

Beryl is the strongest June tropical storm on record that far east in the tropical Atlantic, noted Philip Klotzbach, Colorado State University hurricane researcher. 

“We need to be ready,” Barbadian Prime Minister Mia Mottley said in a public address late Friday. “You and I know when these things happen, it is better to plan for the worst and pray for the best.” 

She noted that thousands of people were in Barbados for the Twenty20 World Cup cricket final in the capital, Bridgetown, on Saturday.  

Some fans, such as Shashank Musku, a 33-year-old physician who lives in Pittsburgh, Pennsylvania, were rushing to change their flights to leave before the storm. 

Musku has never experienced a hurricane: “I don’t plan on being in one, either.” 

Meanwhile, St. Vincent and the Grenadines Prime Minister Ralph Gonsalves said in a public address Saturday that shelters will open Sunday evening as he urged people to prepare. He ordered officials to refuel government vehicles and asked grocery stores and gas stations to stay open later before the storm. 

Beryl is the second named storm in what is predicted to be a busy hurricane season, which runs from June 1 to November 30 in the Atlantic. Earlier this month, Tropical Storm Alberto came ashore in northeast Mexico with heavy rains that resulted in four deaths. 

Mark Spence, manager of a hostel in Barbados, said in a phone interview that he was calm about the approaching storm. 

“It’s the season. You can get a storm any time,” he said. “I’m always prepared. I always have enough food in my house.” 

The National Oceanic and Atmospheric Administration predicts the 2024 hurricane season is likely to be well above average, with between 17 and 25 named storms. The forecast calls for as many as 13 hurricanes and four major hurricanes. 

Beryl is expected to drop up to 15 centimeters (about 6 inches) of rain in Barbados and nearby islands, and a high surf warning of waves up to 4 meters (13 feet) was in effect. A storm surge of up to 2 meters (6.6 feet) is also forecast. 
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ABUJA, Nigeria — Yunusa Bawa spends a lot of time talking about the vaccine for the human papillomavirus that is responsible for nearly all cases of cervical cancer. But on most days, only two or three people allow their daughters to be vaccinated in the rural part of Nigeria where he works.

The challenge in Sabo community, on the outskirts of the capital of Abuja, is the unfounded rumor that the HPV vaccine will later keep young girls from giving birth.

“The rumor is too much,” said Bawa, 42.

As more African countries strive to administer more HPV vaccines, Bawa and other health workers tackle challenges that slow progress, particularly misinformation about the vaccine. The World Health Organization’s Africa office estimates that about 25% of the population still has doubts about it — reflecting concerns seen in some other parts of the world in early campaigns for the vaccine.

A common sexually transmitted virus, HPV can cause cervical cancer, certain other cancers and genital warts. In most cases, the virus doesn’t cause any problems, but some infections persist and eventually lead to cancer.

Across Africa, an average of 190 women died daily from cervical cancer in 2020, accounting for 23% of the deaths globally and making it the leading cancer killer among women in the WHO Africa region of 47 countries. Eighteen of the 20 countries with the highest rate of cervical cancer cases in the world are in Africa. Yet the region’s HPV vaccination rate has been low.

More than half of Africa’s 54 nations – 28 – have introduced the vaccine in their immunization programs, but only five have reached the 90% coverage that the continent hopes to achieve by 2030. Across the region, 33% of young girls have been vaccinated with HPV.

It’s a stark contrast to most European countries, where both girls and boys have been receiving HPV shots.

Part of why Africa has a high burden of cervical cancer is because of limited access to screening for women, said Emily Kobayashi, head of the HPV Program at the vaccines alliance Gavi.

“The elimination strategy is a long game … but we know that vaccination is the strongest pillar and one of the easiest to implement,” Kobayashi said.

But “it is one thing to introduce the vaccine, but if the vaccine remains in the fridge, it doesn’t prevent cervical cancer,” said Charles Shey Wiysonge, head of the vaccine-preventable diseases program in the WHO’s Africa region. He said information must be provided by people “who are trusted, people who are close to the communities.”

There is a long history of vaccine hesitancy in many African countries that is sometimes linked to a lack of trust in government, as one study published in the Nature science journal in May found, giving room for conspiracy theories and misinformation from social media influencers and religious leaders.

In Zimbabwe, where cervical cancer is the most frequent cancer among women, a group of mostly women known as Village Health Workers have been trained to raise awareness about cervical cancer and the HPV vaccine in rural areas. But they fight a high level of hesitancy among religious sects that discourage followers from modern medicines, asking them to rely instead on prayers and “anointed” water and stones.

The women who eventually agree to be screened for cervical cancer do so in secret, said Zanele Ndlovu, one of the health workers on the outskirts of Bulawayo city.

For a deeply religious country like Zimbabwe, “the spiritual leaders have so much influence that a lot of our time is taken trying to educate people about the safety of vaccines, or that they are not ungodly,” Ndlovu said.

There are also success stories in Africa where authorities have achieved up to a 90% vaccination rate. One example is Ethiopia, which relies heavily on religious leaders, teachers and hotline workers.

In Rwanda, the first African country to implement a national HPV vaccination program in 2011, the coverage rate has reached 90%. Hesitancy is less of an issue due to vigorous awareness work that has relied on school-based campaigns and community outreach programs, said Dr. Theoneste Maniragaba, director of the cancer program at Rwanda Biomedical Center.

Mozambique has deployed school-based programs, a door-to-door approach and mobile outreach for girls in hard-to-reach areas that has helped it reach 80% coverage rate with the first of two doses. In Tanzania, where the HPV vaccine has been in use since at least 2018, authorities in April launched a campaign to target over 5 million girls and further raise coverage, which has reached 79% of girls with the first dose.

One of Africa’s largest HPV vaccination drives targeting girls recently kicked off in Nigeria, which has procured nearly 15 million doses with the help of the U.N. children’s agency. It will target girls ages 9–14 with single doses that the WHO’s African immunization advisory group has said is as effective as the regular two doses.

One challenge is explaining the HPV vaccination to girls ahead of the onset of sexual activity, especially in conservative societies, said Dr. Aisha Mustapha, a gynecologist in northern Kaduna state.

Mustapha has been successfully treated for cervical cancer. She said the experience helps in her meetings with religious leaders and in community outreach programs in Kaduna, where she leads the Medical Women Association of Nigeria.

They try to make the girls feel comfortable and understand why the vaccine is important, she said. That sometimes requires comic books and lots of singing.

“The (cervical) cancer … is no respecter of any identity,” she said. “The vaccine is available, it is free, it is safe and effective.”
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DEIR AL-BALAH, Gaza — Children in sandals trudge through water contaminated with sewage and scale growing mounds of garbage in Gaza’s crowded tent camps for displaced families. People relieve themselves in burlap-covered pits, with nowhere nearby to wash their hands.

In the stifling summer heat, Palestinians say the odor and filth surrounding them is just another inescapable reality of war — like pangs of hunger or sounds of bombing.

The territory’s ability to dispose of garbage, treat sewage and deliver clean water has been virtually decimated by eight brutal months of war between Israel and Hamas. This has made grim living conditions worse and raised health risks for hundreds of thousands of people deprived of adequate shelter, food and medicine, aid groups say.

Hepatitis A cases are on the rise, and doctors fear that as warmer weather arrives, an outbreak of cholera is increasingly likely without dramatic changes to living conditions. The U.N., aid groups and local officials are scrambling to build latrines, repair water lines and bring desalination plants back online.

COGAT, the Israeli military body coordinating humanitarian aid efforts, said it’s engaging in efforts to improve the “hygiene situation.” But relief can’t come soon enough.

“Flies are in our food,” said Adel Dalloul, a 21-year-old whose family settled in a beach tent camp near the central Gaza city of Nuseirat. They wound up there after fleeing the southern city of Rafah, where they landed after leaving their northern Gaza home. “If you try to sleep, flies, insects and cockroaches are all over you.”

More than a million Palestinians had been living in hastily assembled tent camps in Rafah before Israel invaded in May. Since fleeing Rafah, many have taken shelter in even more crowded and unsanitary areas across southern and central Gaza that doctors describe as breeding grounds for disease — especially as temperatures regularly reach 32 degrees Celsius.

“The stench in Gaza is enough to make you kind of immediately nauseous,” said Sam Rose, a director at the U.N. agency for Palestinian refugees.

Conditions are exacting an emotional toll, too.

Anwar al-Hurkali, who lives with his family in a tent camp in the central Gazan city of Deir al-Balah, said he can’t sleep for fear of scorpions and rodents. He doesn’t let his children leave their tent, he said, worrying they’ll get sick from pollution and mosquitoes.

“We cannot stand the smell of sewage,” he said. “It is killing us.”

Basic services breakdown

The U.N. estimates nearly 70% of Gaza’s water and sanitation plants have been destroyed or damaged by Israel’s heavy bombardment. That includes all five of the territory’s wastewater treatment facilities, plus water desalination plants, sewage pumping stations, wells and reservoirs.

The employees who once managed municipal water and waste systems have been displaced, and some killed, officials say. This month, an Israeli strike in Gaza City killed five government employees repairing water wells, the city said.

Despite staffing shortages and damaged equipment, some desalination plants and sewage pumps are working, but they’re hampered by lack of fuel, aid workers say.

A U.N. assessment of two Deir al-Balah tent camps found in early June that people’s daily water consumption — including drinking, washing and cooking — averaged under 2 liters, far lower than the recommended 15 liters a day.

COGAT said it’s coordinating with the UN to repair sewage facilities and Gaza’s water system. Israel has opened three water lines “pumping millions of liters daily” into Gaza, it said.

But people often wait hours in line to collect potable water from delivery trucks, hauling back to their families whatever they can carry. The scarcity means families often wash with dirty water.

This week, Dalloul said, he lined up for water from a vendor. “We discovered that it was salty, polluted, and full of germs. We found worms in the water. I had been drinking from it,” he said. “I had gastrointestinal problems and diarrhea, and my stomach hurts until this moment.”

The World Health Organization declared an outbreak of hepatitis A that, as of early June, had led to 81,700 reported cases of jaundice — a common symptom. The disease spreads primarily when uninfected people consume water or food contaminated with fecal matter.

Because wastewater treatment plants have shut down, untreated sewage is seeping into the ground or being pumped into the Mediterranean Sea, where tides move north toward Israel.

“If there are bad water conditions and polluted groundwater in Gaza, then this is an issue for Israel,” said Rose, of the U.N. agency for Palestinian refugees. “It has in the past prompted actions by Israel to try and ameliorate the situation.”

COGAT said it’s working on “improving waste management processes” and examining proposals to establish new dumps and allow more garbage trucks into Gaza.

Where can garbage go?

Standing barefoot on a street in the Nuseirat refugee camp, 62-year-old Abu Shadi Afana compared the pile of garbage next to him to a “waterfall.” He said trucks continue to dump rubbish even though families live in tents nearby.

“There is no one to provide us with a tent, food, or drink, and on top of all of this, we live in garbage?” Afana said. Trash attracts bugs he’s never seen before in Gaza — small insects that stick to his skin. When he lies down, he said, he feels like they’re “eating his face.”

There are few other places for the garbage to go. When Israel’s military took control of a 1-kilometer buffer zone along its border with Gaza, two main landfills east of the cities of Khan Younis and Gaza City became off-limits.

In their absence, informal landfills have developed. Displaced Palestinians running out of areas to shelter say they’ve had little choice but to pitch tents near trash piles.

Satellite images from Planet Labs analyzed by The Associated Press show that an informal landfill in Khan Younis that sprung up after October 7 appears to have doubled in length since January. Since the Rafah evacuation, a tent city has sprung up around the landfill, with Palestinians living between piles of garbage.

Cholera fears

Doctors in Gaza fear cholera may be on the horizon.

“The crowded conditions, the lack of water, the heat, the poor sanitation — these are the preconditions of cholera,” said Joanne Perry, a doctor working in southern Gaza with Doctors Without Borders.

Most patients have illnesses or infections caused by poor sanitation, she said. Scabies, gastrointestinal illnesses and rashes are common. More than 485,000 diarrhea cases have been reported since the war’s start, WHO says.

“When we go to the hospital to ask for medicine for diarrhea, they tell us it is not available, and I go to buy it outside the hospital,” al-Hurkali said. “But where do I get the money?”

COGAT says it’s coordinating delivery of vaccines and medical supplies and is in daily contact with Gaza health officials. COGAT is “unaware of any authentic, verified report of unusual illnesses other than viral illnesses,” it said.

With efforts stalled to broker a cease-fire between Israel and Hamas, Dalloul says he’s lost hope that help is on the way.

“I am 21 years old. I am supposed to start my life,” he said. “Now I just live in front of the garbage.” 
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Nigeria is one of the world’s leading producers of ginger, but a massive outbreak of fungal disease last year caused millions of dollars of damage. The Nigerian government has launched an emergency recovery intervention to help ginger farmers. Timothy Obiezu reports from Kaduna.
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