LISA DESJARDINS: Tonight on PBS News, how one country is tackling methane emissions with a first of its kind tax on livestock, then concerns about patient safety, after leaked documents show call center staff mismanaged some cases at Amazon's One Medical and another impact of climate change.

Why it's forcing some countries to focus more on preserving their history.

MAN: We have a responsibility to safeguards our collections, our islands history, our cultural history.

It's becoming more important than ever.

(BREAK) LISA DESJARDINS: Good Sunday evening.

I'm Lisa Desjardins.

John Yang is away.

President Biden is looking for a comeback on the campaign trail, as more Democrats voice doubts that he should stay in the race for the presidency.

PBS News has learned that at least four top Democrats in Congress, ranking committee members in the House, told their leadership today that Biden should step aside from the 2024 race that was first reported by Punchbowl News.

Earlier, a member of the Democratic National Committee, a convention delegate, became another one to call on Biden to end his campaign.

The president himself was in Pennsylvania, including stops at a church and a campaign office to rally his base.

But even staunch supporters of the president say he needs to do more to convince voters.

SEN. CHRIS MURPHY (D) Connecticut: I think, that he's got to go out there this week and show the American public that he is still, that Joe Biden, that they have come to know and love.

I take him at his word.

I believe that he can do it.

But I think that this is a really critical week.

I do think the clock is ticking.

LISA DESJARDINS: Congress is back in session starting tomorrow.

Five Democrats in the House of Representatives have already publicly called for President Biden to step aside from the presidential ticket.

In Israel, Prime Minister Benjamin Netanyahu is still a no to a potential ceasefire deal in Gaza, saying today that he wants leeway to keep fighting until Israel decides its goals are met.

That, in contrast with protester calls earlier today, hundreds of people marked nine months since the October 7 attacks with marches and by blocking highways in Tel Aviv.

They called for Netanyahu to agree to a ceasefire deal or resign.

Hamas says it's waiting for Netanyahu to officially respond to its latest position after it reportedly dropped a major demand yesterday and is on board with key parts of a U.S. backed ceasefire.

The prime minister of France, appointed by President Emmanuel Macron a few months ago, says he will resign following the country's second round of elections.

Polls are now closed and ballot counting is underway as a left-wing coalition appears to have held off the far right in Sunday's elections.

Early exit polls show leftist candidates may win the most seats, but the lack of a majority party may cause deadlock in parliament.

Turnout for this round of elections is estimated to be the highest in more than 40.

Some voters say what they want most is unity.

PIERRE LUBIN, French Voter (through translator): We are here and it is important to send a message to France of unity.

France is an indivisible republic.

We are all French.

So this is the important message in this election.

LISA DESJARDINS: Ballot counting is expected to continue late into the night, with final results expected as early as tomorrow.

And a NASA crew is sharing their experience of being on an outer space mission for a year without ever leaving Earth.

The four-person crew exited their simulated Mars mission late Saturday after 378 days locked in a 3D printed space in Houston.

They lived, worked, and conducted experiments as if they were living on the red planet.

The next crew begins their year-long mission in 2025.

Still to come on PBS News Weekend, concerns about how Amazon is handling some patient calls at its price primary care company and why preserving history is getting tougher for some island nations.

(BREAK) LISA DESJARDINS: In the battle against climate change, carbon dioxide is the greenhouse gas often grabbing the most attention.

But methane is actually more harmful in terms of trapping heat, with 80 times more of an effect than CO2 during the first decades after it's released.

Now one country is teeing up a different and controversial approach to reducing these emissions.

Ali Rogin has more.

ALI ROGIN: Landfills, oil and natural gas all contribute methane.

But according to the United Nations, 32 percent of human caused methane emissions come from livestock.

Last week, Denmark's coalition government announced that they would introduce a first of its kind annual tax on livestock greenhouse gas emissions.

It amounts to about $100 per cow in an effort to curb climate change.

Ben Lilliston is the director of Rural Strategies and Climate Change at the Institute for Agriculture and Trade Policy.

Ben, thank you so much for being here.

First of all, how big of a problem is methane and does it get enough attention as it relates to the attention that seems to be put on carbon dioxide?

BEN LILLISTON, Institute for Agriculture and Trade Policy: It's a huge problem.

It's a huge challenge.

It's also an opportunity to help us have a bigger impact on climate change faster.

So methane is only in the atmosphere for around twelve years, and it is about 80 times the potency of carbon dioxide over a 20 year period.

So as a result, if you reduce methane, you can get more near term results and allow us to have a little longer of a window to reduce carbon dioxide emission.

ALI ROGIN: And why do cows and other livestock produce so much methane?

BEN LILLISTON: Well, it's ruminants in particular.

So cows and sheep, and it has to do with their stomachs and how they work.

They have multiple stomachs, and they belch out most of that methane is coming out of their belches.

But they can also produce methane through their manure, depending on how their manure is stored.

But in particular in the United States, but also in Denmark, as we're talking about, the cows themselves are a major source of methane.

ALI ROGIN: And what do you see as the goal behind this tax that Denmark is putting in place is it to get farmers to reduce their herds?

How does this tax lead to reduced methane emissions?

BEN LILLISTON: Yeah, well, they have multiple parts of this policy, so the tax is only one part of it.

But yes, the biggest part of their agriculture sector is dairy and hog production.

And so they are trying to address that head on but they also have components of that policy that help farmers transition towards reforestation on their land to help install wetlands, what they call peatlands in Europe, which are also major sources of greenhouse gas emissions.

When you drain those wetlands, and reforestation, of course, can help pull carbon dioxide out of the air.

It's both helping farmers transition out of so much animal production.

They're still going to produce a lot of animals and still produce meat and dairy, but maybe not as much and maybe scale back and then have some of their land transition towards more climate beneficial land practices.

ALI ROGIN: And how do you see the efficacy of this?

Do you think it's going to be effective?

BEN LILLISTON: You know, we'll have to see.

I think what's really exciting about it is this plan came together when farmers sat down with food system workers and climate and environmental advocates and put this plan together.

They have a phase in period.

So it starts in 2030 and then amps up even more in 2035.

So it's a strategy and a plan, and it's sending signals to farmers.

It's sending signals to the marketplace there.

So we'll have to see how it actually turns out.

But I think I, most importantly, they actually have a plan to reduce some of these big sources of greenhouse gases, including methane.

ALI ROGIN: There's been research into other ways to address livestock methane emissions, including changing up the feed to reduce emissions.

How do those efforts factor into this broader conversation?

BEN LILLISTON: Well, this is a rising source of debate, I think right now.

I think it's still unclear how well those feed additives actually work, how well they work over time.

Do the cow system sort of make adjustments and go back to reduce emitting as much methane as they did before?

And what are the impacts on the animal's health of eating those types of feed additives over time?

The other element is that it really requires a confined system in order for those feed additives to work.

A lot of farmers have animals on pasture, and so the feed additives are not going to be as applicable for them.

Of course, those systems do emit less because of how they manage their manure.

ALI ROGIN: And so far, this tax is the first of its kind.

New Zealand had proposed something similar, but they ended up scrapping it.

But how likely is it that it could be replicated outside of Denmark, especially here in the United States?

BEN LILLISTON: I do think governments around the world are grappling with this question about how to deal with animal related methane.

And they have started down the path that Denmark has.

In the U.S., agriculture is a smaller part of our overall emissions, but we do have a problem with our large scale dairies and our large scale hog operations, which in that case, it has to do with how their manure is being managed in giant manure lagoons where it's liquefied and that creates a lot of methane.

But we haven't really gotten to the point where we're ready to have different parties sit down in the way that they did in Denmark and really hammer out a compromise proposal.

But we do need to start thinking about it.

We have a lot of programs that are public programs that sort of provide the carrot part of the policy.

We have conservation programs that are in huge demand in the U.S. two-thirds of farmers who apply for those programs get closed out.

So that tells you how big the demand is, and that has to do with all types of farming systems, but including animal agriculture.

So we have the carrot part, but the carrot part really hasn't worked very well in terms of reducing greenhouse gas emissions or water pollution or air pollution in agriculture.

And so we're going to have to think about what is, what other types of regulatory tools can we apply?

I think every country is different.

Every context is different around climate change.

But what would work in the US?

And we need to start that conversation right now.

ALI ROGIN: Ben Lilliston with the Institute for Agriculture and Trade Policy, thank you so much for joining us.

BEN LILLISTON: Oh, thanks for having me.

LISA DESJARDINS: Serious questions are rising over a new player in American health care.

Amazon, the online giant, has been moving more aggressively into hands on medicine, including last year when it bought One Medical, a business providing primary care with scores of clinics across the country.

But recent reporting from the Washington Post is highlighting new concerns about patient safety.

Leaked documents show more than a dozen patients safety was put at risk when their care was handled by call center staffers with little to no medical training.

Caroline O'Donovan is a tech reporter covering Amazon for the Washington Post.

Caroline, I want to start actually with the big picture here.

Can you talk about how significant you think this move is by Amazon in general, and how significant for healthcare in America is it that Amazon is looking to get into this market?

CAROLINE O'DONOVAN, The Washington Post: Absolutely.

So Amazon, of course, is, you know, the second largest employer in the United States.

It's an absolutely massive company.

It has an entire cloud computing inside of it.

It's one of the biggest retail companies in the country.

One Medical, the primary care clinic that they bought, it's sort of a drop in the bucket of the overall American healthcare system.

But recently, Amazon has been sort of completing its plan, if you will.

They opened up a discount for One Medical to all Amazon prime subscribers, which would take the number of people who are currently using one medical and potentially increase that to the millions of people who have Amazon prime.

They're also increasing their telehealth offerings that you can access without insurance.

So it has a potential not only to impact a large number of patients if all prime members were to sign up for it, but also to kind of lead the market.

Right.

You can see other companies following what Amazon's doing here.

LISA DESJARDINS: So let's talk about your reporting about what we know so far, a little bit about One Medical.

Now, that company's promoted itself is very patient centered.

However, your reporting found out that they outsourced a key part of the medical process for their patients.

That initial call that someone might make to express a medical concern, what did that mean for patients exactly?

What did you find out?

CAROLINE O'DONOVAN: So many one medical patients, the primary way that they're accustomed to interacting with their health providers is through an app.

But what a lot of people didn't know, and what I didn't know when I started reporting this story is that before Amazon acquired One Medical.

One Medical had acquired a company called Iora, which is a senior healthcare company.

And that company was all about providing people the most engaged, the most frankly expensive and intensive care that they could upfront in hopes of keeping people on Medicare out of the hospital over the years to come.

Those patients were obviously accustomed to being able to text with physicians' assistance, call their doctor's office, and get someone on the phone right away.

In the year following Amazon's acquisition of One Medical, though, they made the decision to shift those phone calls to a call center in Tempe, Arizona, which they refer to internally as mission control.

When you have these 65 and older patients, many of whom have chronic healthcare issues, who are used to having a very close, intimate relationship with their healthcare provider, and now they're calling that same exact phone number, and the call is being picked up by someone who may not actually have all the details about their charts and their health conditions and stuff like that.

Obviously, some of the patients have been fairly frustrated.

LISA DESJARDINS: Can you help us with some specific examples of what happened to the patients when they called this call center?

CAROLINE O'DONOVAN: Yeah.

So what was happening, what we found through the documents that I was able to obtain and see is that patients were calling in with what are called red flag symptoms internally.

There's 17 of them.

Things that would suggest, okay, maybe something urgent is going on in about a dozen cases.

What we saw, at least, rather than connecting those people to a virtual health provider who could answer their questions right away, someone who is medically trained.

The call center employees, they were scheduling appointments for these people same day or the next day or in some cases, a couple days into the future, rather than connecting them by phone with someone who could help them.

There is a period of time in mid-February when this change was initially happening, when it seemed like just in this Colorado area alone, this was happening almost every day.

Someone dealing with symptoms of a blood clot, someone with sudden rib pain, someone calling in with stomach pain and blood in their stool.

So in the documents that were leaked to us, there's a doctor who wrote a note saying, I don't think these call center people even realize that they're triaging patients, which is not something that they're qualified to do.

LISA DESJARDINS: What does Amazon say about this?

CAROLINE O'DONOVAN: Amazon obviously says that patient feedback is important to them.

They really emphasize the fact that as far as they know, no patients were harmed.

In a couple of cases, they acknowledged that the process didn't go as it was supposed to, and they retrained the employees involved.

But they said, you know, by and large, everyone is okay.

And moreover, one medical is a separate company and no one's medical care is being cited by Amazon is what they said is, you know, one medical doctors are free to make their own independent decisions.

They also said that the call center, you know, is there to increase patient access, which essentially means, like, you can get your phone call answered faster.

But the patients I spoke to again and again, and some of the one medical employees I spoke to said, there's a difference between getting your phone call answered faster, literally someone picking up the phone and actually getting your problem solved.

LISA DESJARDINS: Is it clear this was motivated out of a hunt for increased profits?

Or do we know?

CAROLINE O'DONOVAN: I don't think we necessarily know about profits.

Amazon famously didn't make profits for a number of years.

It's a very data oriented company.

So things like how many minutes it takes for someone's phone call to get answered or how much work one individual type of worker is doing in an amount of time, that's kind of the way Amazon approaches these things and thinks about them.

And I don't know necessarily if they'll find in the long term that taking care of these patients who are on Medicare, who are 65 and older, who have chronic health conditions, necessarily melds with their approach to doing this.

LISA DESJARDINS: Is it clear Amazon plans to do nothing but expand into this area, into healthcare?

CAROLINE O'DONOVAN: Amazon has very large ambitions in the healthcare space, and I think we know that because we've seen them experiment with different things and shut them down, but then keep going, which is another very Amazon way of doing business.

Their CEO, Andy Jassy mentions healthcare every time he talks about the state of the business.

They recently started offering discounts One Medical to all prime members.

They're trying to get One Medical patients to use the Amazon pharmacy system, which they say that in some places you can get your prescriptions delivered in under 2 hours by drone.

So definitely they see healthcare as fitting into the Amazon way of life.

And if you think about what Amazon did for shopping, right, taking something where you want the stuff, but you don't necessarily want to get off the couch, that's, I think, what you're going to see them trying to do with this healthcare thing.

LISA DESJARDINS: Caroline O'Donovan, thank you so much.

CAROLINE O'DONOVAN: Thank you.

LISA DESJARDINS: The damage from Hurricane Beryl, the earliest storm like it in 100 years, highlights concerns about climate change, especially on vulnerable island nations.

Beryl is currently headed toward Texas after devastating the Grenadines in Jamaica.

A storms like these have grown stronger and more common.

They raise new threats for island nations, not just to infrastructure, but also to artifacts and documents that help define cultures.

Ali Rogan is back with this report on two island nations in the Atlantic and Pacific taking steps to preserve their threatened histories for future generations.

SIMON KOFE, Foreign Affairs Minister, Tuvalu: Talofa and warm Pacific greetings from Tuvalu.

ALI ROGIN (voice-over): In 2022, Tuvalu's foreign affairs minister addressed the COP27 Climate Conference from the sandy beaches of his tiny island nation.

At least that's what it looks like at first.

But then the camera zooms out for an eerie revelation.

SIMON KOFE: Our digital nation will provide an online presence that can replace our physical presence and allow us to continue to function as a state.

ALI ROGIN (voice-over): He was not on the island itself, but rather a copy that only exists in the virtual world, a preview of what he said might soon be the only remaining version of his country.

TAPUGAO FALEFOU, TUVALU AMBASSADOR AND PERMANENT REPRESENTATIVE TO THE UNITED NATIONS: We are here talking about the worst case scenario when Tuvalu is no longer exists.

ALI ROGIN (voice-over): Doctor Tapugao Falefou is the ambassador and permanent representative of Tuvalu to the United Nations.

He says that worst case scenario is an increasing reality for his country and its culture.

TAPUGAO FALEFOU: Tuvalu within this century will be engulfed by the ocean, will be submerged, and so how can we maintain our statehood?

How can we preserve our cultural heritage, our identity?

ALI ROGIN (voice-over): Tuvalu's future now project is intended to not just preserve the past, but to protect the country's future, making sure its nearly 12,000 people can still claim citizenship and have access to government services, even if the physical country no longer exists.

So far, 26 countries have recognized the so called digital statehood.

Tuvalu isn't alone.

Other island nations are taking on similar projects, even if they aren't at immediate risk of disappearance.

PETER SCHOLING, National Library of Aruba: We have a responsibility to safeguards our collections, our island's history, our cultural history.

It's becoming more important than ever on.

ALI ROGIN (voice-over): The island of Aruba, Peter Scholing is digitizing the national library.

ALI ROGIN: How does climate change factor into the decision to take on this project?

PETER SCHOLING: We've started digitizing not specifically because of imminent danger, but yeah, with temperatures also rising, that might be a bigger factor in the future.

ALI ROGIN (voice-over): Aruba is not at risk of imminent disappearance, but past natural disasters underscore the need to protect fragile documents and objects.

The database is filled with maps from Aruba's colonial past, 3D artifacts, television shows, and documents describing its history and culture.

MAN: Tawata e Grupo UTC.

KATE KNIBBS, Senior Writer, Wired: Countries that are vulnerable to climate change are becoming keenly aware that the physical objects that are in their libraries and archives and museums are vulnerable to the effects of extreme weather, extreme heat.

ALI ROGIN (voice-over): Journalist Kate Knibbs has written about Aruba's digitization project for WIRED magazine.

KATE KNIBSS: A book that was printed 500 years ago is not going to be in the same condition 500 years from now.

So I just think this is a moment where a lot of different institutions are realizing that getting a digital backup is a smart thing to do.

ALI ROGIN (voice-over): An ancillary benefit to these digital backups easier access worldwide.

ADI MARTIS, Historian and Author: I wish I was younger.

Ten years youngest, 20 years youngest, because there still is a lot of research to be done.

ALI ROGIN (voice-over): Adi Martis is an Aruban born historian and author who lives in the Netherlands.

He frequently searches Aruba's digital archives while doing research on Aruba's history, the first draft of which was controlled mainly by colonizers.

ADI MARTIS: Recently, the history was written with a European vision Eurocentrism.

I'm interested in how people live and the common people, and what they ate, how the food came to Aruba, how they work, how much they earn.

I'm interested in other things than the European historians who came and wrote about our history.

ALI ROGIN (voice-over): Using Aruba's archive, he's been able to tell the stories of enslaved people and even reunite some of their living relatives.

ADI MARTIS: You can find a lot of information when the slave was born, when they sold them or her to someone else, when they moved in another country or the same country, when maybe died.

You can even generate family trees.

ALI ROGIN (voice-over): Aruba is working with the Internet Archive, a U.S. based nonprofit focused on providing free access to information online and the home of the popular wayback machine.

KATE KNIBBS: The Internet Archives overarching goal is just to digitize the entire world.

I guess it's similar to Wikipedia in how you can end up going down rabbit holes and learning a bunch of information that you never anticipated or never thought you would be interested in learning.

ALI ROGIN (voice-over): These virtual archives serve as a rich trove for curious researchers.

But at their core, they are a response to an existential threat and an international distress signal.

TAPUGAO FALEFOU: The pace through which we are going through the impact of climate change, and especially sea level rise, is something that is very alarming and that we can only ask the international community to please pick up speed on how best we can address this.

ALI ROGIN (voice-over): Bringing more awareness to their countries through the digital world, even as their physical one is disappearing.

For PBS News Weekend, I'm Ali Rogin.

LISA DESJARDINS: We have significant coverage of cultures at risk.

That includes a look at the collaboration between the US army and the Smithsonian Institution to minimize damage to art and historic sites during wartime.

For more, visit our website, pbs.org newsHour.

And that's our program for tonight.

I'm Lisa Desjardins.

For all of my colleagues, thanks for joining us.

Have a good week.