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Chewy’s push into pet telehealth runs into regulatory hurdles, skeptical veterinarians

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The Chewy.com application is displayed in the on an Apple iPhone.

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Chewy, the e-commerce pet-goods giant best known for its convenient auto-ship services and generous return policies, wants to grow its veterinary telehealth service as part of an overall push into health care. 

While the telehealth service is a small part of the company’s rapidly expanding health offerings, it is important to its strategy. Yet it also faces regulatory obstacles and skepticism from the veterinary community. Longtime veterinarians told CNBC the service can have some benefit for minor situations, or for people who don’t have easy access to vet care. But it could create problems for pets, too, they said.

Chewy’s service, called Connect With a Vet, has experienced significant growth, but it’s been limited by a specific kind of regulation known as the veterinary client patient relationship, or VCPR, according to Chewy CEO Sumit Singh. 

“If you look at our Connect With a Vet, it’s the singular most scaled telehealth platform in the market today, only after two years, and yet, it doesn’t form a meaningful portion of our business. Why? Because when you research pet health, you’ll find that there’s a specific term called VCPR,” Singh said.

He also noted that barrier is “breaking down” in the wake of the Covid pandemic and multiple states “are already doing away with VCPR.”

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Chewy Connect with a Vet service.

Chewy.com

Most states forbid veterinarians from performing their primary duties – diagnosing conditions and prescribing medication – until they establish a VCPR by seeing an animal in-person and performing a physical exam. 

“Trying to make an assessment over video without any prior relationship at all, that’s the part that kind of concerns me,” said Brett Levitzke, the chief medical officer and founder of Veterinary Emergency and Referral Group, an emergency animal hospital in New York City. “There is no substitute for a physical exam. Period.” 

Nonetheless, there is a growing movement to change VCPR regulations. The leader behind that push, the Veterinary Virtual Care Association, or VVCA, is an advocacy group co-founded by longtime lobbyist and political strategist Mark Cushing. It’s funded by Chewy and several other pet businesses expanding into vet telehealth. 

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When asked about the company’s position on VCPR, Chewy said it doesn’t take a stance on the issue and declined to say whether its veterinarians would diagnose and prescribe medication if the laws are changed. Currently, Chewy’s veterinarians do not diagnose conditions or prescribe medications.

The company suggested CNBC speak with Cushing, whom the company described as an industry expert on the matter, to learn more about VCPR. Cushing said he does not represent Chewy “in the telemedicine space,” but the company is a primary sponsor of the VVCA. 

It is not clear how much money Chewy has donated to the VVCA because, as a noncharitable nonprofit, it’s not required to disclose donor information to the public. Cushing is also the CEO of the Animal Policy Group, a lobbying organization, which has advocated on behalf of Banfield Pet Hospital, a network of clinics that offer in-clinic services and veterinary telehealth, according to lobbying reports filed with the U.S. Senate. Banfield Pet Hospital is owned by Mars Veterinary Health, a subsidiary of pet food and candy conglomerate Mars. 

The goal of the VVCA is to make veterinary telemedicine legal across the country so vets can diagnose conditions and prescribe medications virtually at their own discretion – even if they’ve never laid hands on the animal. 

“The hardest thing, though, the most expensive thing in telemedicine in the veterinary space, by far, is customer acquisition,” said Cushing.

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Prescribing medication and diagnosing conditions without ever performing a physical exam on an animal poses “massive risks” that could ultimately be harmful, or even fatal in some rare instances, Dr. Linda Isaacson, who has been a veterinarian since 2003 and runs three clinics in Brooklyn, told CNBC.

Sometimes, for instance, a pet owner may say their animal is constipated, but a physical exam will reveal a urinary blockage, Isaacson said.

“A urinary blockage is life threatening, you know, if they don’t urinate, they’ll die and you wouldn’t be able to tell that from telemedicine,” she said. “So, if you’re going on telemedicine and they’re just prescribing, you know, a laxative, that’s not going to help that pet, right? They’ll be dead.”

Chewy pushes into health

Chewy was co-founded in 2011 by Ryan Cohen, an activist investor and the current chairman of GameStop. He left the company in 2018 and the following year, Chewy went public at a valuation of $8.8 billion. Chewy’s market value currently sits around $18.5 billion.

Under Singh’s leadership as CEO, Chewy’s annual revenue soared from $3.53 billion in fiscal 2018 to $8.9 billion in fiscal 2021, but the company has been stymied by repeated annual net losses and slim margins. 

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During a sitdown interview with CNBC earlier this month, the former Amazon executive said expanding pet health and wellness, which are higher-margin categories than pet food, will be essential to getting the company on a path to profitability. 

Chewy CEO Sumit Singh is interviewed on CNBC during the Chewy IPO at the New York Stock Exchange, June 14, 2019.

Andrew Kelly | Reuters

It’s a strategy that Chewy’s main competitor outside of big-box retailers, Petco, has undertaken as well. It rebranded as a health and wellness company in 2020. Petco has veterinarians on its payroll working inside of full service hospitals and clinics built inside stores. When asked, Petco said telehealth isn’t off the table, but for now, its focus is “hands on pets,” which is what they say pet parents want.

Chewy’s expansion into health – including insurance, prescription food and medication – came as the pandemic-fueled pet boom saw 23 million American households welcome a new animal into their homes, turning the overall pet industry into a $123.6 billion market in 2021, according to data from the ASPCA and the American Pet Products Association.

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Chewy aims to make health care about 30% of its overall business in the coming years, according to Singh. The company wouldn’t say how much pet health care accounts for in its current revenue stream, but less than 5% of Chewy’s customer base buys their health products from the company.

“If you notice, there has been little to no innovation in pet health over the last decade, and yet in the last three years, there’s been more innovation in pet health than in the last decade or 20 years,” Singh said.

The tricky nature of pet telehealth

The sudden surge of new animal owners during the pandemic made it difficult to book vet appointments, and it put a strain on an already understaffed and burnt out veterinary community. The rules around establishing a VCPR virtually without a physical exam were relaxed in some states out of emergency need.

Outside of an emergency like a global pandemic, the American Veterinary Medical Association, the nation’s leading advocacy group for veterinarians, maintains that a VCPR can only be established after an in-person exam. The group’s ethical standards allow vets to diagnose, prescribe medication or treat animals virtually – but only after a VCPR has been established in-person. 

“Without a VCPR, any advice provided through electronic means should be general and not specific to a patient, diagnosis or treatment,” the AVMA advises in its guidelines on telemedicine.

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Despite the AMVA’s stance, at least five states – Michigan, Oklahoma, Indiana, Virginia and New Jersey – have made the lighter rules permanent, according to the VVCA.

Chewy said it considers Connect With a Vet a tele-triage platform, not a replacement for in-clinic care, where customers can be connected with a licensed doctor or technician and ask them about their pet’s health concerns, diet, behavior and products that can increase “lifelong wellbeing.” 

A dog hi-fives it’s owner in front of the New York Stock Exchange (NYSE) during Chewy Inc.’s initial public offering (IPO) in New York, U.S., on Friday, June 14, 2019.

Michael Nagle | Getty Images

Chewy said the program was created to make vet care more affordable and accessible to everyone. The service is designed to help clients access some form of care when they can’t book an immediate appointment, can’t afford one or don’t live close to an in-person clinic, the company said.

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Connect With a Vet is also intended to help pet parents figure out if an issue their pet is having is an emergency that requires immediate care or something they could handle down the line during an in-person veterinarian appointment. The company warns customers to go to the closest veterinary clinic if their animals are experiencing a life-threatening situation. Other companies offer similar services.

Chewy has also started a B2B offering called Practice Hub, which provides existing veterinary clinics a platform to practice telemedicine with existing clients. The service is currently free for veterinarians, and they get a portion of the revenue when their clients place orders on Chewy for products offered by the clinic. In return, Chewy gets access to their clients. This month, the platform will have 1,500 clinics, Chewy said.

Veterinarians weigh in

Isaacson, the Brooklyn vet, used telehealth during the height of the pandemic. She said about 50% of clients needed to bring their pet to the clinic after virtual sessions. 

“It’s very hard to hold the pet still. I can’t really even see anything usually over the video. I think it works better for human medicine, but for animals, you know, it wasn’t ideal,” Isaacson said. “It’s not like a person that can tell you how they’re feeling or sit still or show you something.”

Isaacson no longer offers the virtual service. And she is concerned new pet parents might consider Chewy’s service and others like it a replacement for traditional, industry standard veterinary care.

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“You think if it’s allowed, then it’s safe, right?” said Isaacson. “It’s not, it’s substandard care.”

On the web page for Chewy’s Connect With a Vet service, the company advertises a sample conversation between a Chewy doctor and a client whose animal had started limping. It’s a condition that could be serious and can only be managed after a physical exam if there’s no prior relationship with the pet, according to Levitzke, of Veterinary Emergency and Referral Group. 

“Are they limping because they have an overall sense of weakness? Are they limping because their knee hurts? Are they limping because they can’t feel their leg at all? Those are all three drastically different scenarios that are all possible,” said Levitzke. 

Chewy offered to make one of the veterinarians using its Practice Hub service available to CNBC for an interview. The company suggested Audrey Wystrach, who is the co-CEO of Petfolk and a co-founder of the VVCA, the nonprofit Chewy funds.

Wystrach has been a veterinarian for 28 years and practices telehealth. She also practices full-on telemedicine, where she can prescribe and diagnose virtually, but only with clients she has an existing relationship with.

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She believes veterinarians should have more discretion to practice the medicine they’re licensed for and should be able to establish a VCPR virtually, if they determine it’s safe.

“You know, it is not a good idea to work on a pet that can’t breathe in a virtual space, that’s a pretty big no brainer,” said Wystrach. “But is it okay for me to, you know, be able to look at a pet’s mouth and see if they have a fractured tooth or talk to somebody about behavior or nutrition? Or even skin?”

She said the demand for veterinarians outpaces the supply, and veterinary telehealth and medicine is crucial to ensure pet parents can get access to care.

“I’ve always had the mantra that says, virtual care is better than no care,” she said. “I think we got to get to where we’ve got a realistic outlook on how we’re going to manage the sheer volume of pets that are under the care of people in today’s day and age.”



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PepsiCo earnings beat expectations as price hikes boost snack and beverage sales

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Pepsi sodas are displayed on shelves at a Walmart Supercenter on December 06, 2022 in Austin, Texas. PepsiCo, the maker of Pepsi soda, plans to cut hundreds of corporate jobs at its North American division according to a news report from The Wall Street Journal.

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PepsiCo on Thursday reported quarterly earnings and revenue that beat analysts’ expectations, fueled by higher prices for its snacks and drinks.

Shares of the company rose more than 1% in premarket trading.

Here’s what the company reported compared with what Wall Street was expecting, based on a survey of analysts by Refinitiv:

  • Earnings per share: $1.67 adjusted vs. $1.65 expected
  • Revenue: $28 billion vs. $26.84 billion expected

The food and beverage giant reported fourth-quarter net income of $518 million, or 37 cents per share, down from $1.32 billion, or 95 cents per share, a year earlier.

Excluding gains from selling its juice business, write-downs of its Russian assets and other items, Pepsi earned $1.67 per share.

Net sales rose 10.9% to $28 billion. The company’s organic revenue, which strips out the impact of acquisitions and divestitures, climbed 14.6% in the quarter.

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But Pepsi saw volume fall 2% across its food business worldwide as price hikes hurt consumer demand.

Looking to 2023, Pepsi is projecting a 6% increase in organic revenue and 8% growth in its core constant currency earnings per share. Wall Street is anticipating net sales growth of 3.5% and earnings per share growth of 7.3%.

Read the full PepsiCo earnings report here.



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Shell’s board of directors sued over climate strategy in a first-of-its-kind lawsuit

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Shell recently reported its highest-ever annual profit of nearly $40 billion.

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Shell‘s directors are being personally sued for allegedly failing to adequately manage the risks associated with the climate emergency in a first-of-its-kind lawsuit that could have widespread implications for how other companies plan to cut emissions.

Environmental law firm ClientEarth, in its capacity as a shareholder, filed the lawsuit against the British oil major’s board at the high court of England and Wales on Thursday.

It alleges 11 members of Shell’s board are mismanaging climate risk, breaching company law by failing to implement an energy transition strategy that aligns with the landmark 2015 Paris Agreement.

The claim, which has the backing of institutional investors with over 12 million shares in the company, is said to be the first case in the world seeking to hold a board of directors liable for failure to properly prepare for the energy transition.

“Shell may be making record profits now due to the turmoil of the global energy market, but the writing is on the wall for fossil fuels long term,” Paul Benson, senior lawyer at ClientEarth, said in a statement.

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“The shift to a low-carbon economy is not just inevitable, it’s already happening. Yet the Board is persisting with a transition strategy that is fundamentally flawed, leaving the company seriously exposed to the risks that climate change poses to Shell’s future success — despite the Board’s legal duty to manage those risks,” Benson said.

We hope the whole energy industry sits up and take notice.

Mark Fawcett

Chief Investment Officer at Nest

The group of investors supporting the claim include U.K. pension funds Nest and London CIV, Swedish national pension fund AP3, French asset manager Sanso IS and Danske Bank Asset Management, among others. Altogether, the institutional investors hold more than half a trillion U.S. dollars in total assets under management.

“We do not accept ClientEarth’s allegations,” a Shell spokesperson said. “Our directors have complied with their legal duties and have, at all times, acted in the best interests of the company.”

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“ClientEarth’s attempt, by means of a derivative claim, to overturn the board’s policy as approved by our shareholders has no merit. We will oppose their application to obtain the court’s permission to pursue this claim,” they added.

Shell, which is aiming to become a net-zero emissions business by 2050, said it believes its climate targets are Paris-aligned.

ClientEarth said leading third-party assessments have suggested this is not the case, however, noting Shell’s strategy excludes short to medium-term targets to cut the emissions from the products it sells, known as Scope 3 emissions, despite this accounting for over 90% of the firm’s overall emissions.

The aspirational goal of the Paris Agreement is to pursue efforts to limit global heating to 1.5 degrees Celsius above pre-industrial levels by slashing greenhouse gas emissions. The fight to keep global heating under 1.5 degrees Celsius is widely regarded as critically important because so-called tipping points become more likely beyond this level. These are thresholds at which small changes can lead to dramatic shifts in the Earth’s entire support system.

To be sure, the burning of fossil fuels, such as oil and gas, is the chief driver of the climate emergency.

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Big Oil profit bonanza

The case comes shortly after Shell reported its highest-ever annual profit of nearly $40 billion.

The energy giant’s 2022 earnings smashed its previous annual profit record of $28.4 billion in 2008 and were more than double the firm’s full-year 2021 profit of $19.3 billion.

Shell CEO Wael Sawan described 2022 as a “huge year” for the company, saying he felt privileged to be stepping into the role he started on Jan. 1.

“As we look ahead, I think we have a unique opportunity to be able to succeed as the winner in the energy transition. We have a portfolio that I think is second to none,” Sawan said.

Shell’s results came as part of a Big Oil profit bonanza last year, bolstered by soaring fossil fuel prices and robust demand since Russia’s full-scale invasion of Ukraine.

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Activists from Greenpeace set up a mock-petrol station price board displaying the Shell’s net profit for 2022 as they demonstrate outside the company’s headquarters in London on Feb. 2, 2023.

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Nest Chief Investment Officer Mark Fawcett said the case against Shell’s board of directors showed investors were prepared to challenge those who aren’t deemed to be doing enough to transition their business.

“We hope the whole energy industry sits up and takes notice,” Fawcett said.

Separately, London CIV’s Head of Responsible Investment Jacqueline Amy Jackson said, “In our view, a Board of Directors of a high-emitting company has a fiduciary duty to manage climate risk, and in so doing, consider the impacts of its decisions on climate change, and to reduce its contribution to it.”

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“We consider that ClientEarth’s claim is in our client funds’ interests as a shareholder of Shell, and we support it,” Jackson added.



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Turkey’s devastating earthquake comes at a critical time for the country’s future

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Civilians look for survivors under the rubble of collapsed buildings in Kahramanmaras, close to the quake’s epicentre, the day after a 7.8-magnitude earthquake struck the country’s southeast, on February 7, 2023.

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Life for millions across Turkey and Syria changed forever on Monday, as two consecutive earthquakes sent shockwaves across hundreds of miles.

Nine hours apart and measuring a magnitude of 7.8 in Turkey and 7.5 in Syria on the Richter scale, the quakes were the region’s strongest in nearly a century.

At the time of writing, the death toll from the quakes is more than 12,000, with many still missing and critically injured. The World Health Organization put the number of people affected by the disaster at 23 million. At least 6,000 buildings collapsed, many with residents still inside them. Rescue efforts continue to be the top priority, with some 25,000 deployed in Turkey and thousands more sent in from overseas — but a bitter winter storm now threatens the lives of the survivors and of those still trapped under rubble.

Syria, ravaged by 12 years of war and terrorism, is the least prepared to deal with such a crisis. Its infrastructure is heavily depleted, and the country remains under Western sanctions. Thousands of those in the affected areas are already refugees or internally displaced people.

With the dust of the catastrophe still settling, regional analysts are zoning in on the longer-term rippling effect that the catastrophe could have on Turkey, a country whose 85 million-strong population was already mired in economic problems — and whose military, economy, and politics have a major impact far beyond its borders.

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A crucial year for Turkey

This year will serve as a critical inflection point for Turkey, as it approaches a presidential election on May 14. The result of that election — whether current President Recep Tayyip Erdogan stays in power or not — has massive consequences for Turkey’s population, economy, currency, and democracy.

Erdogan’s response to the disaster — and potential calls for accountability as to why so many buildings were insufficiently designed to withstand such tremors — will now play a major role in his political future.

“If the rescue effort is mishandled and people get frustrated, there’s backlash,” Mike Harris, founder of Cribstone Strategic Macro, told CNBC on Tuesday. “And the other issue of course, is the buildings and which ones have gone down. To the extent these were built under the new codes and the authorities didn’t impose regulations, there could be some serious blowback for Erdogan. So Erdogan’s lost control of the narrative.”

Erdogan has lost control of the narrative, analyst says

Erdogan called for the early May election amid a national cost of living crisis, with local inflation above 57% — down from more than 80% between August and November. Several analysts say that the move reveals Erdogan’s urgency to secure another term in power before his controversial economic policies backfire.

Harris described the president created “this weird situation where inflation is running at 80%, but he needs to keep the currency stable between now and the election.”

Through very unorthodox policies, Erdogan has “found a very creative way, a very costly way, to de-dollarize the economy, basically,” he said, giving examples like allowing Turks to keep their bank deposits at a 13% interest rate, then promising to cover their losses, if the currency drops further.

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Two massive earthquakes rock Turkey and Syria as death toll exceeds 2,000

Harris boldly predicted: “Actually, the currency has to collapse if he wins, because there will be no confidence and he’s created this artificial scenario that can’t be sustained for a prolonged period of time.”

Additionally, Erdogan’s earlier fiscal pre-election promises — populist moves like increasing salaries and lowering the pension age — may be impossible now, as more public funds will need to be directed toward rebuilding entire cities and towns.

Economic anxiety

Turkey’s economic decline has been fueled by a combination of high global energy prices, the Covid-19 pandemic and war in Ukraine, and, predominantly, by economic policies directed by Erdogan that have suppressed interest rates despite soaring inflation, sending the Turkish lira to a record low against the dollar. Turkey’s FX reserves have dropped sharply in recent years, and Ankara’s current account deficit has ballooned.

The Turkish lira lost nearly 30% of its value against the dollar in the last year, severely damaging Turks’ purchasing power and hurting Erdogan’s popularity.

Turkey’s opposition parties have not yet put forth their candidate. The strongest potential challenger, Istanbul Mayor Ekrem Imamoglu, was arrested and slapped with a political ban in December over charges his allies say are politically motivated and used solely to prevent him from running for president.

We still think Turkey is a 'viable' place to invest, Mark Mobius says

Investors in recent years have been pulling their money out of Turkey in droves. One major emerging markets guru, Mark Mobius of Mobius Capital Partners LLP, remains bullish despite the earthquake disaster and economic problems.

“When it comes to investing in Turkey, we still believe it’s a viable place to invest,” Mobius said. “In fact, we do have investments there. The reason is the Turks are so flexible, so able to adjust to all these disasters and problems … even with high inflation that with a very weak Turkish Lira … So it doesn’t scare us at all to invest in Turkey.”

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Mobius did note the glaring issue of Turkey’s earthquake preparation, which may soon come to haunt Erdogan’s election chances.

“This is one of the big problems, the building codes in some of these areas are not up to par,” he said.

NATO and Turkey’s powerful role on the global stage

Internationally, Turkey’s future affects the war in Ukraine, given Erdogan’s role as a mediator between Ukraine and Russia. Turkey is the main NATO member still standing in the way of Sweden and Finland’s accession to the powerful defense alliance.

Ankara is also brokering the Black Sea Grain Initiative between Ukraine and Russia, which allows vital supplies of grain to be exported from Ukraine to the rest of the world despite a Russian naval blockade on Ukraine’s Black Sea ports.

Erdogan’s response to the earthquakes — and subsequent election performance — will have an impact on all of these.

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Russian President Vladimir Putin is expected to meet Turkey’s President Recep Tayyip Erdogan on Thursday.

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Turkey will get some relief from Western pressure on its NATO stance in the wake of the earthquakes, but not for long, says Sinan Ulgen, chairman of the Istanbul-based Center for Economics and Foreign Policy.

“It’s going to be temporary,” Ulgen said. “Turkey will look at a few weeks of reprieve, but after that it will be more back to business on the foreign policy side.”

For now, Western allies and countries from around the world are sending aid and rescue teams to help with Turkey’s disaster relief efforts. Ankara will need to roll out massive public spending to support those in need and rebuild all the areas affected by the quakes.

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“The positive side is that Turkey has fiscal space,” Ulgen said. Turkey has a public debt-to-GDP ratio of around 34%, which is very low compared to the U.S. and Europe. According to him, this “means that Turkey has room for fiscal spending, even if that means a sizeable increase in the public debt ratio.”

As a large country, Turkey has significant capacity to handle natural emergencies. Still, Ulgen added, “no matter what the capacity at hand, it was going to be insufficient to respond to this type of disaster unfortunately.”



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