Congressional Support Research Articles

Congressional support for democratic norms on January 6th

Abstract Increasing partisan polarization has characterized American politics for decades. On January 6, 2021, both Republicans and Democrats in Congress expressed their horror at the violent invasion of the US Capitol, leading to the popular perception—emphasized by media accounts—that the attack generated a rare moment of bipartisan unity. We argue that while members of both parties condemned the attack, a marked partisan divide characterized their messaging even as events unfolded. We analyze all 1861 tweets by members of Congress on January 6th and find that Republicans were significantly more likely to characterize the invasion as a protest grown out of hand, while Democrats described it as an attack on democracy. The results strongly indicate that partisan polarization was alive and well on January 6th and may help to account for Republicans’ shift toward normatively positive portrayals of the day in subsequent months.

REFLECTIONS ON CONGRESSIONAL BIPARTISAN SUPPORT FOR UKRAINE NOW AND BEFORE UKRAINE’S INDEPENDENCE

This paper discusses bipartisan US Congressional Ukraine support and advocacy efforts over the course of more than a century. It examines Congress’ extraordinary focus on Russia’s war against Ukraine and the difficult but ultimately successful April 2024 passage of the Ukraine supplemental assistance. The paper then looks back at the history of Congressional activity with respect to Ukraine prior to the re-establishment of Ukraine’s independence in 1991. It examines the peak of Congressional activity in the decade and a half leading up to independence, highlighting the role of the Commission on Security and Cooperation in Europe (a.k.a U.S. Helsinki Commission). This pre-independence Congressional activity, greatly abetted by the Ukrainian American community, took place in an environment in which little was known about Ukraine and the Ukrainian people’s aspirations in U.S. policy circles and public. This period laid the groundwork for greater U.S. political and material support following independence. Senators and Congressmen from both major U.S. political parties supported Ukraine prior to independence. This bipartisan Congressional support continues to this day, notwithstanding the challenges from the isolationist right wing of the Republican party.

A PUBLIC HEALTH APPROACH TO BRAIN HEALTH: THE HBI ROAD MAP SERIES

Abstract In 2005, congressional support led to the creation of the Healthy Brain Initiative (HBI) and the longstanding collaboration between the Alzheimer’s Association and the Centers for Disease Control and Prevention to advance understanding of and support for cognitive decline as a central part of public health practice. Since then, HBI partners have worked together to implement public health strategies that promote brain health, address dementia and help support caregivers. The Healthy Brain Initiative Road Map Series guides this effort. The first HBI Road Map was released by CDC and the Alzheimer’s Association in 2007 and was the first framework for viewing cognitive health and dementia as a public health issue. The second HBI Road Map was released in 2013 and expanded the role of state and local public health departments and partners in improving cognitive health. The third HBI Road Map, published in 2018, continued to chart a course for state and local public health departments and their partners by aligning actions with the essential services of public health. The HBI Road Map for Indian Country, published in 2019, is the first public health guide focused on dementia in American Indian and Alaska Native communities. The release of the fourth HBI Road Map in 2023 continues to advance the field and prepare public health departments to better address health equity and build capacity as new treatments become available. This symposium highlights successes of the Road Map Series and the development of the 4th edition of the HBI Road Map.

Expanding Global Health Engagement through Multilateral Security Organizations.

Many countries around the world employ defense capabilities in support of global health engagement (GHE) through bilateral and multilateral organizations. Despite this, there does not appear to be a strategic approach and implementation plan for U.S. DoD GHE in support of and through multilateral organizations. The purpose of this research is to identify which security multilateral organizations are engaged in GHE, as well as how and why. These findings could inform an interoperable approach for doing so going forward. A systematic review was conducted to develop a list of multilateral security organizations and agreements which engage in GHE, or could potentially play a role in GHE. Of the 3,488 agreements and organizations identified, 15 met the inclusion criteria. Among them, 87% (13/15) of the multilateral organizations are regional and 13% (2/15) are international, all established between 1948 and 2020. The 15 organizations cover all DoD Geographical Combatant Commands. Among them, 20% (3/15) are a legally binding alliance, 73% (11/15) have a treaty, and 7% (1/15) have a diplomatic partnership. Twenty percent (3/15) have an explicit intent to improve health in either their mission statement or as part of their goals, priorities, and/or objectives. Eighty percent (12/15) engage in at least two GHE domains outlined in DoD Policy, 67% in three (10/15), and 47% in all four (7/15). The most common domain is humanitarian assistance and foreign disaster response at 100% (15/15) and least common is Nuclear, Chemical, and Biological Defense Programs at 53% (8/15). Although there is high demand for GHE, resourcing to enable implementation has not been prioritized. Therefore, multilateral organizations continue to support what is funded (e.g., disaster response) versus prioritizing capacity building or modifying authorities and appropriations to match demand. It is also worth noting most organizations included in this review support the European theater aligning to historical defense priorities, versus emerging threats in the Indo-Pacific region. Identifying a forum within these multilateral institutions to convene GHE policy makers and practitioners is a logical next step. The forums could guide and direct priorities, devise solutions, and implement best practices. Near term efforts could include GHE financing, governance, assurance, and technical assistance within and across multilateral institutions. Recent efforts highlight growth in both interest and action to support the variety of GHE activities regionally and internationally. As the United States seeks to reinforce multilateral institutions and uphold the international and rules-based order, employing GHE through multilateral cooperation could buttress efforts. Now is a perfect time given the sustained interest in global health, amplified value of allies and partners, and renewed emphasis placed on multilateral cooperation for the DoD to design a multilateral GHE strategy and seek Congressional support to resource it accordingly.

Back to the Moon ... to stay?

Despite a lack of public enthusiasm, NASA’s Artemis program will endure because human spaceflight has strong congressional support and signals great-power status.

The effects of presidential breakdowns on foreign policy in Latin America

AbstractPresidents and their ideologies have long been thought to be important explanatory variables in Latin American foreign policy, but little is known about how presidential breakdowns, a common form of leader change, affect foreign policy. I use a qualitative structured comparison to analyze the effects of nine presidential ousters on their successors’ foreign policies. I focus on cases in which the legitimacy of the process is in a gray zone, when narrative disputes are more likely to emerge. The findings indicate that incumbents politicize foreign policy when they use it to attain public support but accommodate it to congressional interests when they need support of Congress; meanwhile, international peers respond to presidential breakdowns according to their strategic and ideological rather than normative concerns. Even though Latin America is dominated by weak states, domestic politics, especially during crises, play a major role in explaining their foreign policies. Considering the role played by presidents in foreign policymaking, understanding this kind of presidential succession is essential.

Presidential Control over Administration: A New Historical Analysis of Public Finance Policymaking, 1929-2018 by Patrick O’Brien

Americans hold presidents responsible for economic growth and stability, but because each president must rely on entrenched experts and administrative norms, their ability to shift policy is often curtailed. In this book, author Patrick O’Brien tries to understand that tension by exploring how efforts to imbue the presidency with greater capacity to live up to those expectations have fluctuated over time, too often limiting presidents whose ambitions for economic reform outsized their managerial abilities. The book succeeds in meeting this overarching objective. It is clear that despite similar formal powers, not all presidents have left the same legacy on public finance—namely, none as influential as Franklin D. Roosevelt (FDR) or Ronald Reagan. Yet, presidential success does not boil down to popularity or congressional support. Roosevelt brought about a New Deal finance apparatus; Reagan bequeathed his name on a second one that supplanted it. Both did so because they repudiated an older order whose legitimacy was tarnished. Other presidents, even if fortunate to have the political capital and unified government, were constrained by an administrative apparatus still beholden to a previous era.

Gotta Get Those Ill-Gotten Gains: Improving the FTC's Authority to Seek Disgorgement in Antitrust Cases

Disgorgement is an equitable monetary remedy that requires a defendant to give up all ill-gotten gains from their illegal conduct. Unlike damages, which can be compensatory, deterrent, or even punitive in nature, disgorgement focuses primarily on deterring future illegal conduct. It relies on the simple moral premise that wrongdoers should not be allowed to retain the profits of their wrongdoing. Especially in antitrust litigation involving complex, multilayered supply chains, damages can underestimate the true harm suffered as a result of anticompetitive conduct. Disgorgement, if calculated properly and litigated thoughtfully, has the potential to provide redress for the full amount of harm and therefore act as a more efficient deterrent. Federal and state antitrust enforcers have sought disgorgement for anticompetitive conduct with limited success, and a recent Supreme Court decision casts doubt on the Federal Trade Commission’s authority to seek disgorgement altogether. Still, there is bipartisan support in Congress and the White House to restore the FTC’s disgorgement authority. This Note proposes enacting legislation to that effect, including a provision that would allow state attorneys general or private plaintiffs to seek disgorgement on the FTC’s behalf (called a “qui tam” provision). Further, this Note outlines how leveraging existing litigation tools can alleviate concerns that disgorgement will lead to duplicative recovery. By restoring the FTC’s authority to seek disgorgement and creating a qui tam mechanism for private enforcement, antitrust plaintiffs will benefit from increased leverage, enabling them to both recover the totality of harm caused by anticompetitive conduct and deter such conduct in the future.

FREEZE! The Grassroots Movement to Halt the Arms Race and End the Cold War by Henry Richard Maar III

Henry Richard Maar III gives the reader the most definitive study yet of the nuclear weapons freeze movement and its impact on the arms race in the 1980s. (Full disclosure: As the chief foreign policy adviser to Senator Edward M. Kennedy from 1977 to 1984, I wrote the U.S. Senate resolution favoring a nuclear freeze, which Senator Kennedy introduced jointly with Senator Mark O. Hatfield, a Republican from Oregon.) The book provides broad discussion of the U.S. and European peace movements, covering the policies of the Reagan administration, the role of Congress, debates within the Catholic Church, broader cultural and political trends, and the outcomes in national politics and U.S.-Soviet diplomacy.Maar traces the freeze movement's evolution from a grassroots movement to a national vehicle countering the Reagan administration. He is especially persuasive in his discussion of policy and politics. He convincingly highlights the freeze movement's catalytic role in helping to transform President Ronald Reagan's rhetoric, at least, from nuclear weapons to disarmament advocacy. Maar also tells a compelling story of how congressional leaders, including Senators Kennedy and Hatfield and Representatives Edward Markey (D-MA) and Silvio Conte (R-MA), were able to harness a more diffuse national movement behind a more focused congressional initiative. The book also captures well the irony, even the hypocrisy, of congressional support for the freeze while simultaneously voting in favor of new weapons systems such as the B-1 bomber and the Strategic Defense Initiative.Maar acknowledges the tactical compromises the freeze movement found itself having to make with its political supporters, but he underestimates the contribution of the latter to elite support for the freeze. He gives little attention, for example, to how widely Senators Kennedy and Hatfield were able to garner academic, labor, professional, religious, think tank, and business support, which played a large role in transforming U.S. arms control policies in the 1980s.Maar also overstates his argument that the freeze movement played a major role in ending the Cold War. Although the movement did affect U.S. policies, far more decisive were such factors as the Soviet war in Afghanistan, anti-Communism in Eastern Europe, and the bankruptcy of the Communist system in the Soviet Union itself, not to mention the emergence of Mikhail Gorbachev.In one of the book's best chapters, Maar examines the impact of nuclear weapons fears on political and popular culture in the 1980s. From Jonathan Schell's book The Fate of the Earth (1982) to the seminal made-for-TV film The Day After (1983), with references to comics, cartoon strips, Hollywood films, rock performances, and television shows, Maar vividly re-creates the spirit of the age and the freeze's place in it.The book is most effective, and moving, in its description of the rise and fall of the nuclear freeze movement itself. Maar achieves his goal of “decentering the narrative away from a top-down focus on the personalities of statesmen.” In the great tradition of U.S. popular movements, the freeze was perhaps most impressive as an expression of the grassroots, and Maar tells that story exceedingly well.

A more precise way to assess the success of the president’s legislative agenda: the success of presidential priority bills in Chile, 1990–2018

ABSTRACT The legislative success of a president is normally measured with respect to president-initiated bills. However, when they control the legislative agenda, presidents can also prioritize legislator-initiated bills and take credit for their passage. We contend that presidential legislative success should be measured with respect to both types of bills. With data on the 10301 bills introduced in Chile (1990–2018), we analyze the determinants of success of the 2640 presidential priority bills (PPB) – president-initiated bills and legislator-initiated bills that received a presidential priority motion to speed up debate. Reforms that strengthened the legislature have induced the executive to prioritize more legislator-initiated bills. PPB introduced in the first year of the term are more likely to pass while those introduced after the 2005 reforms and in the last year of the term are less likely to pass. Presidential approval, majority support in congress and Finance or Constitution Committee referrals are not good predictors of the success of PPB. The determinants better explain the passage of president-initiated bills than the passage of legislator-initiated bills.

The discourses of the anti-apartheid sanctions movement in the United States, 1972–86

The passage of the 1986 Comprehensive Anti-Apartheid Act over the veto of President Ronald Reagan was a stunning victory for US campaigners opposed to apartheid in South Africa. Sanctions against the apartheid regime were first proposed in Congress in 1972 but struggled to build sufficient support beyond veterans of the US civil rights movement. This article argues that the discursive framing around the sanctions issue was important to its construction of a wider coalition of supporters in Congress. Both grassroots organizations and supporters in Congress moved away from a civil rights framing to an anti-communist framing, having briefly experimented with a human rights discourse championed by Jimmy Carter. This article is the first to use a word-scoring method to trace discourse systematically during the fourteen-year period when Congress debated the sanctions issue.

Origins of Oversight: Covert Action Amendments to the National Security Act of 1947

The National Security Act of 1947 enabled the CIA to “to perform such other functions and duties related to intelligence affecting the national security as the National Security Council [NSC] may from time to time direct.” Although intended to establish the Central Intelligence Agency (CIA)’s control over the collection of clandestine foreign intelligence, this language was vague enough to authorize other covert operations (psychological, political, and paramilitary) at the direction of the NSC. Attempts at covert action oversight gained traction only after the exposure of unacknowledged CIA activities. The term “covert action” was not defined in legislation until the 1990s. This article categorizes congressional attempts to establish the parameters and regulate covert action both in terms of prohibiting or enabling such action and of enacting substantive or procedural rules. The success of such attempts has depended heavily on the extent of bipartisan support in Congress. Congress is more likely to choose substantive laws when faced with recent intelligence scandals, and Congress is less likely to create prohibitive laws as bipartisan support increases. These trends are supported by the legislative history of the 1991 Intelligence Authorization Act and the 2004 Intelligence Reform and Terrorism Prevention Act.

Fenno’s Paradox in a Polarized Age: How Polarization Lowers the Mass Public’s Assessments of Congress and Legislators

Fenno (1975) famously posited that the mass public’s assessments of the U.S. Congress are rooted in a paradox, with citizens holding negative evaluations of the collective Congress while holding favorable views of their individual members of Congress. Since the conceptualization of “Fenno’s Paradox,” Congress underwent pronounced changes due to increased ideological polarization between increasingly homogeneous parties comprised of more partisan loyal, ideologically extreme legislators. In this article, we ask whether this partisan polarization shifted the public’s assessments of Congress and their individual representatives over time. Leveraging over 45 years of new data measuring the monthly approval of Congress and legislators with generalized error correction models, we find that greater polarization lowers the approval rating of both over time, suggesting that greater polarization weakens Fenno’s Paradox by considerably lowering legislator approval. We explore the underlying mechanism of this finding at the individual level, finding that co-partisan support for Congress and opposing-partisan support for legislators has collapsed since 1980. Taken together, our results suggest that partisan polarization plays a large role in motivating the historic decline in congressional approval and the ability of legislators to amass a personal incumbency advantage.

American Civil–Military Relations and Presidential Power of Removal

Under what conditions are presidents more likely to remove senior defense officials from office? Using a novel data set of all senior U.S. defense officials, both civilian and uniformed military from 1947 to 2021, this article explores whether anticipated support in Congress, partisan factors, or institutional protections for the military affect observed patterns of removal for defense officials. The results suggest that presidents are more likely to remove their own appointees (or their co-partisans’ appointees), but provide little evidence that presidents premise removal on anticipated partisan support for a replacement nominee in Congress. Moreover, the results suggest that military officials may have some insulation from politicization by strong forms of removal, though that protection may weaken an important aspect of civilian control of the military, the threat of punishment by removal, raising profound questions for how civilian control endures.

Evolution and Electoral Implications of Congressional Gun Control Issue Framing: “From Crime Control to Mass Shootings”

AbstractThis paper traces the political development of Congressional gun control issue framing (with a specific focus from the early 1990s to the present), demonstrating that there have been two primary contexts in which gun control policy has been debated over this time frame: as a component of general crime control and as a specific response to mass shooting events. It identifies the primary historical, political, and electoral forces shaping the gun control debate in a given period while distinguishing the critical changes that drove the evolution from a crime control to a mass shooting focus. It assesses the degree of policy coherence and electoral salience specific to each context, illuminating why “gun control as crime control” had bipartisan Congressional support in the early 1990s and identifying what comparative disadvantages hinder the mass shooting focus of the present while also recognizing that the latter unfolded against a backdrop of heighted partisan polarization. The paper concludes that although one cannot compare the crime control and mass shooting framing contexts in a political vacuum, the electoral implications particular to each are relevant for understanding legislative action or inaction in Congress over the past thirty years, if more so in some periods than others.

The Las Vegas military-civilian partnership: An origin story and call to action.

Military-civilian partnerships (MCPs) in urban American trauma centers have existed for more than 60 years to assist in the development and maintenance of wartime skills of military medical professionals. In the last 5 years, MCPs have gained congressional support, and their number and variety have grown substantially. The historical impact of these flagship trauma MCPs is well documented, with bidirectional benefit in the advancement of trauma care during the wars in Iraq and Afghanistan both deployed and stateside, and the future aim of MCPs lies primarily in mitigating the "peacetime effect." The majority of data regarding MCPs; however, focus on trauma care and are biased toward surgeons specifically. The Las Vegas (LV) MCP began in 2002 with the similar goal of sustaining Air Force (AF) expeditionary medical skills by embedding AF medics from nearby Nellis Air Force Base (AFB) into University Medical Center of Southern Nevada (UMC), the only Level 1 Trauma Center in Nevada. Over nearly 20 years, the LV-MCP has evolved into an innovative market-based collaboration composed of numerous relationships and programs that are designed to develop and sustain critical skills for military medical personnel in all aspects of expeditionary medicine. This includes AF medical personnel providing care to federal beneficiaries as well as civilian patients in a variety of medical settings. The partnership's central coordinating authority, the Office of Military Medicine-Las Vegas (OMM-LV), brings together military and civilian organizations with distinct and intersecting missions to support the greater LV population and the DoD mission of readiness. The LV-MCP is presented here as a model for the future of MCPs within the integrated local and national trauma and medical systems.

Getting Off Track: the Northeast Corridor Improvement Project in an International Context

The Northeast Corridor Improvement Project aimed to upgrade the most important passenger route in the country so that it could support high-speed trains. By the early 1970s, North America's rail network had been in decline for decades. However, the energy crisis and strong congressional support prompted a policy of reinvestment. Execution of the Northeast Corridor Improvement Project was plagued with problems owing to both lack of experience delivering major rail projects and a counter-productive, complex administrative structure resulting from conflicts between Congress and the White House. The project's original scope, which was necessary to achieve high-speed operations, was reduced over time as budgetary limits were exceeded. Compared to the coeval Paris–Lyon high-speed rail project, Northeast Corridor Improvement Project history demonstrates the importance of continuous infrastructure investment to maintain the expertise necessary to effectively deliver major capital projects.

Re-examining the relationship between Latino population size and position taking on Latino interests in the US House of Representatives

ABSTRACT In contrast to strong evidence that increases in district-level African American population size leads to greater support of African American issues in Congress, 40 years of research has been decidedly mixed on whether increases in district-level Latino population size translate to greater support of Latino issues. This paper provides an update to this literature by analyzing members’ of Congress (MCs) support of Latino issues through roll call voting, as collected by the National Hispanic Leadership Agenda (NHLA) in the 113th (2013–2014) through 115th (2017–2018) House of Representatives. First, we find no relationship between NHLA scores and Latino district-level population size among Democratic MCs. The reason is that Democrats’ NHLA baseline support is already very high, regardless of Latino population size. But Republican MCs’ support for NHLA positions in the 113th through 115th Congresses increases as the size of their Latino constituency increases. Interestingly, we find that this relationship is tied to a district’s Latino noncitizen population as well as their Latino voter-eligible population. So, while Democrats on the whole may provide greater substantive representation to Latinos than Republican MCs, Republican MCs are not entirely unresponsive to Latino interests, particularly if they are given sufficient reason to be responsive.

ПРОЦЕСС ПРИНЯТИЯ ВНЕШНЕПОЛИТИЧЕСКИХ РЕШЕНИЙ В США НА ПРИМЕРЕ ТОРГОВОЙ ВОЙНЫ С КИТАЕМ (2018–2020 ГГ.)

The article studies the development and implementation process of the US trade strategy towards the People’s Republic of China in 2018–2020. The author tries not only to describe the state of things but thoroughly analyze the peculiarities of the decision-making procedure in trade during Donald Trump’s tenure. The President was a hardliner and thought that maximum pressure would force Beijing to make concessions. We can discern two aspects which have decreased that strategy’s efficiency. First, Trump’s persona has destabilized the diplomatic process. Inconsistency and ever-changing rhetoric have deepened the crisis in the Sino-American relations. Second, right from the beginning, the president did not understand the way the decision-making process worked. The formation of the team in charge of trade took almost a year. In the end, a special group was set up; it managed to elaborate a plan of coordination with the PRC and also secure the Congress support. However, it was unable to establish a regular communication system with the president, who even during the negotiations was openly contradicting the official position of the US delegation. Thus, despite a relatively efficient decision-making system (from a structural standpoint: advisors, cooperation with the Congressional Committees), Trump turned out to be inept to develop a long-term strategy to regulate the commercial relations between the USA and the PRC.

Splenectomy for Primary Immune Thrombocytopenia Revisited at the Era of Thrombopoietin Receptor Agonists: New Insights for an Old Treatment

▪IntroductionAlthough splenectomy is still considered as the most effective curative treatment for primary immune thrombocytopenia (ITP), its use has significantly declined in the last decade, especially since the emergence of thrombopoietin receptor agonist (TPO-RAs) and anti-CD20 monoclonal antibodies 1-3. The main objective of our study was to evaluate if splenectomy was still as effective in the modern era, particularly for patients who failed to respond to TPO-RAs and rituximab. One of the secondary objectives was to assess, among patients who did not respond to or relapse after splenectomy, the pattern of response to subsequent intervention with treatments used before splenectomy and particularly TPO-RAs.MethodsThis multicentre retrospective observational study involved adults who underwent surgical splenectomy for primary ITP in France from 2011 (authorization of TPO-RAs in France) to 2020. To be included in the study, patients had to fulfil the following criteria : age ³18 years, primary ITP diagnosis defined according to the usual international criteria 2. Patients with abnormal spleen histology (other than reactional lymphoid hyperplasia, white-pulp hypoplasia or red pulp hyperplasia) or yet definite secondary ITP were excluded. Response was defined according to international criteria 4. Sustained response was defined as the absence of ITP relapse at last visit. We performed univariable and multivariable logistic regression procedures to calculates the odds ratio associated with a sustained response.ResultsIn total,185 patients, 98 (53 %) women, with median age at splenectomy of 43.3 [interquartile range 27.6-64.3] years, were included in 18 French university and general hospitals from the French reference center network. Most of the patients were splenectomised at the chronic phase of ITP (n=150, 81.1%) and only two patients had undergone surgery within 3 months after ITP onset. Of note, 100 (54.1%) and 135 (73.0%) patients received TPO-RAs and/or rituximab prior to the splenectomy, respectively. The median time of follow-up after splenectomy was 39.2 months [16.5-63.0]. Overall, 144 (77.8%) of patients had an initial response and 23 patients (12.4%) relapsed during follow-up leading to an overall rate of sustained response of 65.4%, similar to the one observed in the pre-TPO-RA's era 1. Characteristics of patients according to the period during which occurred the splenectomy is available in Table 1.Among the 14 patients who failed to respond to both eltrombopag and romiplostim prior to splenectomy a sustained response after splenectomy was observed in 7 (50%). Among the 13 patients who had failed after both TPO-RAs and rituximab, we observed a sustained response in 6 (46%).In the multivariate analysis, an older age (60-75 years: OR 0,39 [0,17-0,86], p=0.02; >75 years: OR 0,28 [0,10-0,75], p=0.013) and a history of more than 4 treatment lines for ITP before splenectomy (OR 0.25 [0.08-0.66], p=0.010) were significantly associated with a lack of sustained response after splenectomy.TPO-RAs were used for 57/64 (89.1%) patients who failed to respond to splenectomy. Among them, 21 were treated with one TPO-RA (i.e. eltrombopag or romiplostim) which was previously used before splenectomy without any efficacy and a response was observed in 13 (62%) of them.ConclusionsIn conclusion, splenectomy seems to be still a relevant option for treating adult primary ITP not responding to TPO-RAs and rituximab. Patients who fail to respond or relapse after splenectomy should be re-challenged with TPO-RAs.1. Kojouri, K., Vesely, S. K., Terrell, D. R. & George, J. N. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term2. Provan, D. et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv.3.Neunert, C. et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 3, 3829-3866 (2019).4. Rodeghiero, F. et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 113, 2386-2393 (2009). [Display omitted] DisclosuresTerriou: Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Ebbo: Grifols: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Octapharma: Other: Attendance Grant; Sobi: Other: Attendance Grant. Viallard: Novartis: Consultancy; Amgen: Consultancy; Grifols: Consultancy; LFB: Consultancy. Jeandel: Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Support for congress; Sobi: Membership on an entity's Board of Directors or advisory committees; Amgen: Other: Support for congress; GSK: Other: Support for congress; Pharming: Other: support for congress. Michel: Amgen: Consultancy; Novartis: Consultancy; Rigel: Honoraria; UCB: Honoraria; Alexion: Honoraria; Argenx: Honoraria. Godeau: Grifols: Consultancy; Sobi: Consultancy; Amgen: Consultancy; Novartis: Consultancy. Comont: Takeda: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Bristol Myers Squibb: Honoraria, Research Funding; AstraZeneca: Honoraria, Research Funding; Abbvie: Honoraria, Research Funding.