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The Gamble: Can Genetically Modified Mosquitoes End Disease?
A female Anopheles mosquito, marked with fluorescent powder, under a microscope in a field laboratory on the island of Príncipe. Only female mosquitoes bite humans, and thus spread disease.
The Gamble: Can Genetically Modified Mosquitoes End Disease?
"Working on a remote island, scientists think they can use genetic engineering to block a malaria-carrying species of mosquito from spreading the disease — and do it in just a few months. But governments are wary.
The global health reporter Stephanie Nolen and the photographer Natalija Gormalova reported this story from the country of São Tomé and Príncipe in the Gulf of Guinea.
On a muggy evening in July on the island of Príncipe, part of a volcanic archipelago 200 miles off the West African mainland, 11,000 mosquitoes dusted in fluorescent green powder flew together into the heavy equatorial air, tiny volunteers in the service of science.
Over the next 10 nights, another group of volunteers, human ones, sat outside their houses in villages nestled in the rainforest, keeping their arms and legs exposed in the damp dark, waiting for the faint tickle of a mosquito in search of blood. Once one alighted, they switched on a headlamp and used a rubber tube attached to a glass vial to suck the insect up and seal it in a cup.
The mosquitoes were raised from larvae, dusted green, then set free, by an international team of scientists who are trying to bring cutting-edge genetic science to an ancient fight — that against malaria, the most deadly mosquito-borne disease.
For each of the 10 mornings after the mosquito release, the scientists fanned out along the northeastern coast of this remote island, collecting cups humming with mosquitoes. They then took the insects to a makeshift lab in their hotel suite in the island’s one town, Santo Antonio, where they slid them under the light of a fluorescent microscope. Twelve of the 253 mosquitoes that had been caught glimmered with tiny particles of the green powder that clung to their scaly bodies.
The recaptured green mosquitoes offered insight into how far they flew and the size of the mosquito population, clues to the dynamics of malaria in this country. And they moved the scientists one step closer to their goal: replacing the mosquitoes that live here now with ones they have genetically modified so that they can no longer transmit the malaria parasite.
Their idea is to release a small colony of genetically modified mosquitoes, just the way they did with the green-dusted ones, to mate with wild ones. The gene engineering technology they are using could, in just a few generations — a matter of months when it comes to mosquitoes — make every member of the species that transmits malaria here, the Anopheles coluzzii, effectively immune to the parasite.
This team, working with a project called the University of California Malaria Initiative, has already successfully engineered the Anopheles coluzzii to block the parasite in a lab. And the scientists believe they can harness gene drive, a process in which an inherited trait spreads swiftly throughout a population, so that all the species’s offspring will carry it, not just half, which is the way inheritance normally works.
Normal genetic modification
Gene drive inheritance
A modified gene is added to only one chromosome.
A modified gene added to one chromone copies itself onto the other chromosome.
Wild mosquito
chromosomes
Wild mosquito
chromosomes
The modified gene has a roughly 50 percent chance of being passed on to the next generation.
The modified gene has a nearly 100 percent chance of being passed on to the next generations.
Modified
mosquito
Modified
mosquito
Even if the modified mosquitoes mate frequently with wild mosquitoes, many of their offspring will not carry the modified gene.
If the modified mosquitoes mate with wild mosquitoes enough, scientists hope the entire mosquito population could change within several generations — possibly within a few months.
The malaria situation in São Tomé and Príncipe, an African island nation with a population of 200,000, epitomizes the current challenge in the global struggle against the disease. The country is among the world’s least developed, and it has depended on foreign aid to fight malaria. Various campaigns over the past 50 years drove cases down, only to have them resurge worse than ever when the benefactor moved on.
Over the past 18 years, with nearly $21 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria, São Tomé has used a package of tools — including insecticide-treated bed nets; new and better drugs; killing larvae in bodies of water; and indoor spraying of homes — to stunning effect. No one has died of malaria here in the past five years.
Ivan Mugeni Mulongo, an insect technician with the University of California Malaria Initiative team, using an aspirator to sample mosquitoes on Príncipe.
Mr. Mulongo with a cage filled with mosquitoes. The insects will be marked with fluorescent powder to track their movements, and then released.
The team, led by Gregory Lanzaro, a molecular geneticist at the University of California, Davis, right, believes it can harness gene drive in the fight against malaria in São Tomé and Príncipe.
Still, there were 2,000 cases of malaria here last year, and the disease can be fatal and create serious economic burdens. The country, much of which is a pristine protected biosphere rich in birds and orchids, depends heavily on tourism from Europe. Being certified as malaria-free would be a huge benefit.
The journey from a few thousand cases to elimination is complicated and costly; some experts say it’s as hard to close that last gap as it is to eliminate the first 90 percent of cases. Here, as in other countries that have dramatically suppressed malaria, mosquitoes have evolved to resist all of the insecticides now in use. They have started to bite outdoors and in the daytime, when people are not under bed nets, instead of indoors and at night, when most malaria transmission used to occur. The parasite itself is evolving to resist the main treatments. And malaria funding has plateaued even as the necessary interventions have grown more costly.
These countries need a way to fight the disease that is permanent and does not require continuous investment.
Greg Lanzaro, a molecular geneticist at the University of California, Davis, who leads the malaria team, believes his group has that solution.
“We’ve been working on this for 30 years, and from the beginning we said, ‘It has to work, but it also has to be inexpensive, and it has to be sustainable,’” he said as he watched the mosquitoes being released in a Santo Antonio park. “And we believe we have it.”
But genetic modification is a controversial endeavor. Governments are hesitant, and few in Africa have laws to regulate the use of the technology. Its risks lie in the unknowns: Could the modified mosquito evolve in some way that has harmful effects on the rest of the ecosystem? Could it prompt a dangerous mutation in the malaria parasite, which will find a new way to spread to survive?
It is, in essence, the Jurassic Park question: Could meddling in genetic code have catastrophic consequences that no one anticipates? (The original Jurassic Park experiments were carried out on a remote tropical island to minimize risk. We know how that turned out.)
Mountain peaks on Príncipe.
Collecting coconuts on Príncipe.
São Tomé City, São Tomé’s capital.
Yata Mota, who works as a guide at a tourist center on a coffee plantation on São Tomé, said she was initially hesitant when she heard about the genetic modification proposal. “We would be the first place in the world with these mosquitoes, and that scares me: When it’s the first time they’re doing it, you don’t know what could happen,” she said.
These fears are why the University of California team chose São Tomé and Príncipe for its experiment: The island nation is isolated and has limited international traffic. The team has also built in a plan to wipe out the population of its modified mosquitoes if there is a need to end the experiment for any reason.
There are a handful of other projects working on ways to use genetic modification against malaria and other mosquito-borne diseases in Africa and beyond. Some have tried spreading a genetic trait by releasing millions of mosquitoes into a wild population — the “inundation” technique. The logistics of that approach have always seemed improbable to the California team, because they require continuous releases of insects and huge investments in infrastructure.
A gene drive, however, is an efficient way to spread a protective modification through a wild mosquito population, fast. “You’re letting the mosquito do the work for you,” Dr. Lanzaro explained.
Gecinildo Dilo, a first-time mosquito collector, sitting out at night with his legs exposed to attract and capture mosquitoes.
Anton Cornel, left, explains the steps for a nighttime mosquito collection to a volunteer collector in the village of São Joaquim.
Dr. Cornel inspecting a puddle for mosquito larvae.
African opponents of genetic modification say it is neither well-enough understood to be safe, nor necessary. “The provision of basic sanitation and better and safer housing would not only eradicate the disease, it would boost the local economy,” said Nnimmo Bassey, a prominent Nigerian environmentalist.
“The problem we have seen here is that the agency and the scientists cannot explain the nature of the genetically modified organisms or the implications of releasing them into the population in ways that people understand,” said Mr. Bassey, who heads the Health of Mother Earth Foundation. “People cannot consent to what they do not understand. They’re just being used as guinea pigs.”
Abdoulaye Diabaté, who runs the most advanced mosquito genetics program in Africa, said he understood these concerns but argued that anxiety was an insufficient reason not to try genetic modification.
“We may not know what may happen but we know what is happening today: 600,000 people dying of malaria, and we need to fix it,” said Dr. Diabaté, the principal investigator in Burkina Faso for Target Malaria, a project backed by the Bill & Melinda Gates Foundation. “We can’t say we are afraid of the future so we will accept 600,000 people dying. We make good progress as a society when we invest in our dreams, rather than our fear.”
Unlike other mosquito-control efforts, he said, genetic modification promises to benefit everyone in a community equally, regardless of income level, which is not the case with products like bed nets, insecticides and vaccines. And while people from high-income nations express fears about genetic modification, Dr. Diabaté hears far fewer of these concerns from people in villages whose children get malaria six or eight times a year, he said.
The University of California project has poured resources and energy into public education to advertise the benefits of genetic modification and try to assuage fears; it has teams of community agents educated on the gene drive process who can field questions, and it presents to school groups across São Tomé and Príncipe. In an effort to avoid the perception that foreign scientists are experimenting on the local population, the program has set up a laboratory at the University of São Tomé and Príncipe, where the genetic modification work would take place, and is funding graduate studies for São Tomense students.
Dr. Cornel dusting mosquitoes with fluorescent powder before a sunset release.
The team preparing to release marked mosquitoes.
The mosquitoes dusted in powder glowed green under the microscope in the jury-rigged field lab in Príncipe.
But the program needs government approval to move forward with the genetic portion of the intervention and São Tomé and Príncipe, like many other African countries, does not yet have a legal framework for the use of genetically modified organisms. Legislation to establish one has stalled in the National Assembly. Without a body assessing the risks and safety of using a tool like these mosquitoes, the California team has no one to submit its project proposal to and is effectively stalled.
The country’s health minister, Celsio Junqueira, said in an interview that his government was focused on basic services such as getting water and electricity into primary care facilities, and that genetically modified mosquitoes were a luxury his government couldn’t spare time or energy on now. He did not have a timeline for when the University of California project might be able to proceed with actual, island-bred mosquitoes.
In 2021, the World Health Organization issuednew guidelinesto help countries think through how they can test mosquito-control interventions based on genetic modification, which the organization said could have potential as self-sustaining solutions, particularly when low case numbers create pressure to allocate resources away from malaria.
Ricarda Steinbrecher, a molecular geneticist who sits on the United Nations advisory council on synthetic biology, said that genetic modification projects required international regulation. “Mosquitoes cross boundaries, you cannot make them stop at the national borders,” she said.
A fishing community in Santo Antonio, Príncipe’s capital. The University of California team chose São Tomé and Príncipe for its experiment because of the island nation’s isolation.
Preparing hooks for fishing. São Tomé and Príncipe, much of which is a pristine protected biosphere rich in birds and orchids, depends heavily on tourism from Europe.
An abandoned boat served as a diving board in a bay on the island of São Tomé.
This is one of the challenges for Target Malaria’s project: How can it keep its modified mosquitoes inside the borders of Burkina Faso? Target Malaria is modifying insects not to block the parasite, but essentially to wipe themselves out. The project has a genetically modified line of mosquitoes that produces sterile females, and another in which males are modified to produce predominantly male offspring, gradually distorting the population (only females bite and spread disease). This approach works to fight dengue fever and other kinds of mosquito-borne disease, not just malaria, since it eliminates the vector.
In 2019, Dr. Diabaté oversaw a small release of sterile males, the first field experiment in Africa with genetically modified mosquitoes, which was intended as an initial demonstration of safety. A British biotechnology company called Oxitec has a modified Aedes aegypti mosquito that it has been selling directly to consumers in Brazil since 2021, to fight diseases such as dengue and yellow fever. For the last two years, Oxitec has been releasing its modified mosquitoes in the Florida Keys, after winning approval from the U.S. Environmental Protection Agency. That is a test to fight dengue; cases of the debilitating and sometimes fatal disease are climbing quickly as the warming climate expands the range of the mosquito that carries the illness.
Oxitec recently set up shop in Djibouti, on the Horn of Africa, where it is modifying Anopheles stephensi, a newly invasive species of mosquito that has caused a resurgence of malaria in a country that had almost eliminated it.
The Oxitec and Target Malaria approaches both take the mosquito out of the ecosystem. Proponents say this isn’t a problem — there are 3,500 species of mosquitoes in the world, and no animal that depends solely on one mosquito species for food. But the premise often makes people nervous.
Hugulay Maia, a professor of biology at the University of São Tomé and Príncipe, serves on the project’s scientific advisory board. “We can’t know what will happen with these genetically-modified mosquitoes,” he said. “But anyone who believes in science know there is always risk.”
Janete Marbel Viegas, a laboratory technician at the university, delivering water to mosquito cages for egg collection.
Ms. Viegas inspecting dead mosquitoes in the lab.
The University of California approach carries less risk, and less of the appearance of meddling with nature, said Arlindo Carvalho, a former health minister of São Tomé and Príncipe who now advises various malaria-control projects including this one.
“Not eradicating, but modifying — this is the most secure and sustainable path.” The modification approach can also work on multiple diseases and species. And it doesn’t require the repeated release of massive numbers of mosquitoes, or the infrastructure to breed and rear them.
The genetic modification that the California team is proposing will be susceptible to the same evolutionary pressures as every other mosquito intervention: That is, nature will find a way around the modification the same way mosquitoes develop resistance to insecticides. The malaria parasite will eventually develop resistance to get around the modification making the mosquito immune.
“That’s the price of doing business,” said Dr. Lanzaro.
But he said the project is prepared for it. First, its modification attacks plasmodium falciparum, the most common and most lethal species of the malaria parasite, in two different ways — which makes it more difficult for it to develop resistance. The project has also developed modifications that focus on mosquito genes that trigger different immune responses to the parasite. “We have those on the shelves, ready to plug in,” he said. If the parasite started to show resistance — if malaria came back — the scientists in São Tomé could raise a colony of mosquitoes with the new modification swapped in, and release those, he said.
But until São Tomé has a governing body to whom the team can submit the reams of data it has amassed while studying the country’s ecology and mosquitoes — like the green ones the project tracked across Príncipe — it has no way of knowing if its method will work in the wild. A lab-bred, lab-tested mosquito is not a wild one. Will the team’s modified ones be appealing to potential wild mates? Will they be as successful in finding food and shelter? The team has no way of knowing.
“We have got to get going,” Dr. Lanzaro said. “We can’t just keep saying 10 more years, 10 more years. Six million people have died while we’ve been fiddling around.”
Where Would a Government Shutdown Immediately Be Most Felt?
"As federal agencies prepare to enact their contingency plans for a shutdown, this is where the public could notice changes in the coming days.
FEMA has said it would be unable to continue its operations in all of the 82 major disaster sites it is currently servicing, including rebuilding from wildfires in Hawaii.Max Whittaker for The New York Times
Washington braced for a government shutdown over the weekend as Congress remained mired in dysfunction on Friday. Federal agencies planned to send home hundreds of thousand workers, who would not be paid until the shutdown ended. Hundreds of thousands of others deemed essential, like air traffic controllers, would be ordered to work. They, too, would not be paid until Congress reached a deal.
The nation’s capital always feels the effects of shutdowns most acutely, but Americans beyond Washington also face consequences. Here is where they would notice them most immediately.
Food and medical help
The Special Supplemental Nutrition Program for Women, Infants and Children would run out of funding within days, jeopardizing food and medical assistance for nearly seven million mothers and children. About 10,000 children would also immediately lose access to Head Start programs.
Some of the most essential benefits, including Social Security, Medicare and Medicaid and a variety of benefits for veterans, would be unaffected. The Supplemental Nutrition Assistance Program, or SNAP, is also expected to continue through October, according to the Agriculture Department.
Business and tax support
Private businesses that depend on the federal government even in tangential ways would have to adjust.
The Small Business Administration would be forced to halt processing new loan applications. Many farmers would be similarly unable to secure loans from the Department of Agriculture around harvest season.
Routine inspections of a variety of workplaces could be limited or paused. The Occupational Safety and Health Administration would have to minimize work site safety inspections. And in the most recent shutdown, the Food and Drug Administration had tocurtail food inspectionsat processing plants that produce fruits, vegetables and seafood.
Businesses and individual taxpayers would also run into problems.
The I.R.S. will see two-thirds of its work force furloughed, which means delayed refunds, closed call centers and no access to the National Taxpayer Advocate, an internal watchdog that helps troubleshoot problems. The revenue service normally receives 46,000 telephone calls per day in October.
National parks and forests
Many national parks and recreational areas wouldclose their gates, hurting the surrounding communities that depend heavily on income from tourism.
Some states including Arizona and Utah have said they plan to draw on state funds to keep flagship national parks open, but a majority will close as many park rangers and forestry workers are furloughed.
Museums
The Smithsonian’s network of 21 museums and the National Zoo will use funds rolled over from the previous year and remain open until at least Oct. 7, when it has said it will re-evaluate its financial picture.
Federal courts
Federal courts have enough funds on hand to stay open for around two weeks, allowing most federal criminal cases to continue.
The Justice Department has said it will scale down its prosecution of civil cases to a bare minimum until funding is restored. Around 85 percent of Justice Department employees will continue to work, including the special counsel’s office, which will continue its prosecution of former President Donald J. Trump.
Environmental standards and disaster relief
With much of the Environmental Protection Agency’s staff set to be furloughed, the majority of the agency’s inspections at hazardous waste sites, drinking water and chemical facilities would be halted.
FEMA has also said it would be unable to continue its operations in all of the 82 major disaster sites it is currently servicing, including rebuilding from wildfires in Hawaii and hurricane recovery projects in Florida. If the shutdown persists for weeks or more, the White House has warned that FEMA’s Disaster Relief Fund could be depleted, setting up an emergency if more disasters were to occur this year.
The permitting and environmental review process for many recently launched infrastructure projects could also be disrupted because of furloughs at the E.P.A. and the Department of the Interior.
Student aid and loans
Even as much of the government is shuttered, federal student loan payments will still come due starting in October. Interest on the majority of federal student loans began to accrue again this month.
Customer service at loan-servicing companies would not halt immediately but could be tapered down should the shutdown stretch past next week.
On Monday, Karine Jean-Pierre, the White House press secretary, said that processing for Federal Student Aid and Pell Grants should continue mostly unaffected for “a couple of weeks.”
Travel
Air traffic controllers and Transportation Security Administration officials will continue to work without pay and attempt to minimize flight disruptions. But trainings for new air traffic control staff workers would be paused as many airports are already experiencing shortages.
During the last shutdown, conditions for workers were so bad that T.S.A. employeesconsidered walking off the job, which helped to hasten an agreement in Congress to end the shutdown.
Passport processing, whichalready takes around 10 to 13 weeks, will continue but could be limited by government building closures in some locations that house passport processing offices.
GENEVA (Reuters) - U.N. human rights experts have called for major reforms of the U.S. criminal justice system to combat systemic racism, saying jailed Black women had been shackled during childbirth while male inmates were forced to work in "plantation-style" conditions.In a report published on Thursday, three U.N.-appointed experts said they had found practices in U.S. prisons that amounted to "an affront to human dignity" in visits in April and May.
The U.S. diplomatic mission in Geneva did not immediately respond to a request for comment.
One such practice is restraining and shackling women prisoners during childbirth, the report said.
The experts "heard, first hand, unbearable direct testimonies of pregnant women shackled during labour, who due to the chaining, lost their babies", it said. Asked to give details, a U.N. rights spokesperson referred to "several" cases and confirmed they all involved Black women.
The experts also collected direct testimonies of conditions at a Louisiana prison where it said thousands of mostly Black male prisoners were "forced to labour in the fields (even picking cotton) under the watch of white 'freemen'on horseback, in conditions very similar to those of 150 years ago".It described the stories from the so-called 'Angola' facility as "shocking" and said they amounted to "contemporary forms of slavery". It also voiced alarm at the widespread use of solitary confinement, which it said appeared to be applied disproportionately to inmates of African descent.
One Black man told the experts he had been kept in isolation for 11 years without interruption, the report said.
"Our findings point to the critical need for comprehensive reform," said one of the experts, Juan Mendez.
The commission was set up by the U.N. Human Rights Council in 2021 after the killing of George Floyd, a Black man who died after his neck was pinned to the ground by a police officer.
The report was based on testimonies from 133 individuals in five U.S. cities as well as testimonies collected from five detention centres. It contained a list of 30 recommendations for U.S. authorities, including a call for a new commission on reparations for people of African descent.
Pharmacists who work for CVS have staged a walkout in the Kansas City metro area, protesting what they say are unreasonable work conditions. In this file photo, a CVS store is seen in Jackson, Miss.
Rogelio V. Solis/AP
"Pharmacists working for CVS stores are walking off the job, resorting to a drastic form of protest to highlight what they say are unsafe and stressful work conditions tied to a widespread lack of proper staffing.
One week after a large walkout forced at least a dozen stores to shut down in the Kansas City area, CVS is promising changes. But another round ofpharmacists' walkouts got widespread attention Wednesday.
CVS has cut back on staffing, including less time for technicians to assist pharmacists, even as the demand for prescriptions and vaccines grow, the protesters say. CVS announced plans at the start of this year tocut or shift hoursat thousands of its pharmacies.
"It's like running a McDonald's with just one person," a pharmacist toldThe Kansas City Star, adding that they must work alone for the vast majority of the 64 hours a week their store is open.
The pharmacists are not in a union, but they are among many workers across industrieswho are walking off the job to protest what they say are unfair conditions."The number of workers who went on strike was50% higher last year than in 2021," as member station KCUR reports.
"Our ability to serve patients in Kansas City was not impacted [Wednesday] and we are not seeing any abnormal activity in other markets," CVS Pharmacy spokeswoman Amy Thibault told NPR on Thursday. She added that the company has been meeting with workers in the Kansas City market this week.
CVS apologizes for workplace issues
CVS Executive Vice President Prem Shah, the company's chief pharmacy officer, apologized to employees in an internal memo that was shared online byUSA Today.
"I want to apologize to our pharmacy teams that we haven't addressed these concerns in the region more quickly," Shah wrote.
A Facebook page run by a pharmacist who has relayed messages from Kansas City protest organizersposted a fairly positive responsefrom the group, saying the new CVS regional leader has reached out and the company is promising better conditions, including adding more paid work hours to meet demand, hiring more staff, and reducing vaccination goals.
But critics are also faulting Shah for seeming to suggest the problems in Kansas City are limited to one market and are tied to vaccine demand, rather than stemming from what they say are widespread and systemic problems. In online discussions, people in the industry say CVS pharmacists in other states will likely hold their own walkouts if their working conditions don't improve.
And as the Kansas City organizers noted, a Walgreens walkout could be on the way: Apost on Reddithas gotten traction after calling for pharmacists at Walgreens to stage their own protest from Oct. 9-11.
Pharmacists say CVS is understaffing and overworking them
FromNebraskatoIowaandCalifornia, pharmacists' professional associations are voicing their support for the Kansas City walkout, pointing to the national Pharmacy Workplace and Well-Being Report.
The report "underscores the persistent issues of inadequate staffing, unreasonable metrics, and harassment," the Nebraska Pharmacists Association said. And while a number of harassment casesnoted in the reportcite customers as the source of verbal or emotional harassment, the majority of them identified the harassers as managers and/or supervisors.
Many of the problems mirror issues found at CVS a store in Virginia Beach, Va., in 2021. Overwork and other problems were linked to dangerous errors in dispensing drugs — and violations that resulted in a$470,000 fine. In response, CVSreportedly saidit "respectfully disagree[s]" with the investigation's results.
In that case, pharmacists warned that the problems extended far beyond one store, similar to how the current complaints are said to extend beyond Kansas City.
CVS has no one but itself to blame for the problems highlighted in the past week according to the California Pharmacists Association, which says it supports the pharmacists who walked out.
"CVS is mired in massive prescription backlogs of its own making,"the group saidon Wednesday. It accusedCVS Caremark, the corporation's pharmacy benefit manager subsidiary, of "cherry-picking" patients and steering them away from other pharmacies. That, combined with understaffing, has put pharmacists and patients in a terrible situation, the association alleged.
New legislation aims to reform pharmacy benefit managers
In the U.S. health care system, companies known as pharmacy benefit managers, or PBMs, act as a go-between for insurance providers and drug makers. PBMs "were created in the 1960s to help employers and insurers select and purchase medications for their health plans,"as NPR has reported.
Dozens of PBMs operate in the U.S., according to theNational Association of Insurance Commissioners. But, it adds, a handful of those companies, including CVS Caremark, control some 89% of the market.
Two senators took aim at the PBM system on Thursday, introducing a bipartisan bill that looks to reform the way pharmacy benefit managers operate, saying the changes would bring prices down and boost competition.
Sen. Ron Wyden, D-Ore., a sponsor of the bill, called the companies "health care middlemen that are driving up costs for seniors and taxpayers."
Another sponsor, Sen. Mike Crapo, R-Idaho, said their bill, theModernizing and Ensuring PBM Accountability Act, would ensure that "seniors can access the pharmacy of their choice, including in rural communities."
