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Natural disasters trigger complex chains of events within human societies 1 . Immediate deaths and damage are directly observed after a disaster and are widely studied, but delayed downstream outcomes, indirectly caused by the disaster, are difficult to trace back to the initial event 1,2 . Tropical cyclones (TCs)-that is, hurricanes and tropical storms-are widespread globally and have lasting economic impacts 3-5 , but their full health impact remains unknown. Here we conduct a large-scale evaluation of long-term effects of TCs on human mortality in the contiguous United States (CONUS) for all TCs between 1930 and 2015. We observe a robust increase in excess mortality that persists for 15 years after each geophysical event. We estimate that the average TC generates 7,000-11,000 excess deaths, exceeding the average of 24 immediate deaths reported in government statistics 6,7 . Tracking the effects of 501 historical storms, we compute that the TC climate of CONUS imposes an undocumented mortality burden that explains a substantial fraction of the higher mortality rates along the Atlantic coast and is equal to roughly 3.2-5.1% of all deaths. These findings suggest that the TC climate, previously thought to be unimportant for broader public health outcomes, is a meaningful underlying driver for the distribution of mortality risk in CONUS, especially among infants (less than 1 year of age), people 1-44 years of age, and the Black population. Understanding why TCs induce this excess mortality is likely to yield substantial health benefits., (© 2024. The Author(s).)

Twenty genetic therapies have been approved by the US Food and Drug Administration to date, a number that now includes the first CRISPR genome-editing therapy for sickle cell disease-CASGEVY (exagamglogene autotemcel, Vertex Pharmaceuticals). This extraordinary milestone is widely celebrated owing to the promise for future genome-editing treatments of previously intractable genetic disorders and cancers. At the same time, such genetic therapies are the most expensive drugs on the market, with list prices exceeding US$4 million per patient. Although all approved cell and gene therapies trace their origins to academic or government research institutions, reliance on for-profit pharmaceutical companies for subsequent development and commercialization results in prices that prioritize recouping investments, paying for candidate product failures and meeting investor and shareholder expectations. To increase affordability and access, sustainable discovery-to-market alternatives are needed that address system-wide deficiencies. Here we present recommendations of a multidisciplinary task force assembled to chart such a path. We describe a pricing structure that, once implemented, could reduce per-patient cost tenfold and propose a business model that distributes responsibilities while leveraging diverse funding sources. We also outline how academic licensing provisions, manufacturing innovation and supportive regulations can reduce cost and enable broader patient treatment., (© 2024. Springer Nature Limited.)

The sea level along the US coastlines is projected to rise by 0.25-0.3 m by 2050, increasing the probability of more destructive flooding and inundation in major cities 1-3 . However, these impacts may be exacerbated by coastal subsidence-the sinking of coastal land areas 4 -a factor that is often underrepresented in coastal-management policies and long-term urban planning 2,5 . In this study, we combine high-resolution vertical land motion (that is, raising or lowering of land) and elevation datasets with projections of sea-level rise to quantify the potential inundated areas in 32 major US coastal cities. Here we show that, even when considering the current coastal-defence structures, further land area of between 1,006 and 1,389 km 2 is threatened by relative sea-level rise by 2050, posing a threat to a population of 55,000-273,000 people and 31,000-171,000 properties. Our analysis shows that not accounting for spatially variable land subsidence within the cities may lead to inaccurate projections of expected exposure. These potential consequences show the scale of the adaptation challenge, which is not appreciated in most US coastal cities., (© 2024. The Author(s).)