A quarter of the country won’t get the coronavirus vaccine

We’re a year into the coronavirus pandemic, so the math that undergirds its risks should by now be familiar. We all should know, for example, that the ability of the virus to spread depends on it being able to find a host, someone who is not protected against infection. If you have a group of 10 people, one of whom is infected and nine of whom are immune to the virus, it’s not going to be able to spread anywhere.

That calculus is well known, but there is still some uncertainty at play. To achieve herd immunity — the state where the population of immune people is dense enough to stamp out new infections — how many people need to be protected against the virus? And how good is natural immunity, resistance to infection built through exposure to the virus and contracting covid-19, the disease it causes?

The safe way to increase the number of immune people, thereby probably protecting everyone by limiting the ability of the virus to spread, is through vaccination. More vaccinated people means fewer new infections and fewer infections needed to get close to herd immunity. The closer we get to herd immunity, the safer people are who can’t get vaccinated, such as young children (at least for now).

The challenge the world faces is that the rollout of vaccines has been slow, relatively speaking. The coronavirus vaccines were developed at a lightning pace, but many parts of the world are still waiting for supplies sufficient to broadly immunize their populations. In the United States, the challenge is different: About a quarter of adult Americans say they aren’t planning on getting vaccinated against the virus, according to Economist-YouGov polling released last week.

That’s problematic in part because it means we’re less likely to get to herd immunity without millions more Americans becoming infected. Again, it’s not clear how effective natural immunity will be over the long term as new variants of the virus emerge. So we might continue to see tens of thousands of new infections each day, keeping the population at risk broadly by delaying herd immunity and continuing to add to the pandemic’s death toll in this country.

But we also see from the Economist-YouGov poll the same thing we saw in Gallup polling earlier this month: The people who are least interested in being vaccinated are also the people who are least likely to be concerned about the virus and to take other steps aimed at preventing it from spreading.

In the Economist-YouGov poll, nearly three-quarters of those who say they don’t plan on being vaccinated when they’re eligible also say they’re not too or not at all worried about the virus.

That makes some perverse sense: If you don’t see the virus as a risk, you won’t see the need to get vaccinated. Unfortunately, it also means you’re going to be less likely to do things like wear a mask in public.

Or you might be more likely to view as unnecessary precautions such as avoiding close-quarter contact with friends and family or traveling out of state.

About a quarter of adults hold the view that they won’t be vaccinated when eligible. That’s equivalent to about 64 million Americans.

Who are they? As prior polls have shown, they’re disproportionately political conservatives. At the outset of the pandemic, there was concern that vaccine skepticism would heavily be centered in non-White populations. At the moment, though, the rate of skepticism among those who say they voted for Donald Trump in 2020 and among Republicans is substantially higher than skepticism overall.

That shows up in another way in the Economist poll. Respondents were asked whose medical advice they trusted. Among those who say they don’t plan to get the vaccine, half say they trust Trump’s advice a lot or somewhat — far more than the advice of the Centers for Disease Control and Prevention or the country’s top infectious-disease expert Anthony S. Fauci.

If we look only at Republican skeptics, the difference is much larger: Half of Republican skeptics say they have a lot of trust in Trump’s medical advice.

The irony, of course, is that Trump sees the vaccine as his positive legacy on the pandemic. He’s eager to seize credit for vaccine development and has — sporadically — advocated for Americans to get the vaccine. (He got it himself while still president, without advertising that fact.) It’s his supporters, though, who are most hostile to the idea.

Trump bears most of the responsibility for that, too. Over the course of 2020, worried about reelection, he undercut containment efforts and downplayed the danger of the virus. He undermined experts such as Fauci largely out of concern that continuing to limit economic activity would erode his main argument for his reelection. Over and over, he insisted that the virus was going away without the vaccine, that it was not terribly dangerous and that America should just go about its business as usual — and his supporters heard that message.

They’re still listening to it, as the Economist poll shows. One result may be that the United States doesn’t reach herd immunity through vaccinations and, instead, some large chunk of those tens of millions of skeptics end up being exposed to the virus. Some of them will die. Some may risk repeat infections from new variants against which a vaccine offers better protection. Some of those unable to get vaccinated may also become sick from the virus because we haven’t achieved herd immunity, suffering long-term complications from covid-19.

Trump wants his legacy to be the rollout of the vaccine. His legacy will also probably include fostering skepticism about the vaccine that limits its utility in containing the pandemic.

3 major health items included in Biden’s budget request

President Joe Biden proposed an ambitious budget for the next federal fiscal year that includes more money for fighting the opioid epidemic, bolstering public health and several other healthcare items.

The budget request to Congress, released Friday, acts as essentially a wish list of priorities for the administration for the next year.

It is doubtful how much would get approved by Congress but sends a message of what the administration prioritizes.

Here are three healthcare priorities outlined in the request:

  • The opioid epidemic: $10.7 billion was requested for fighting the opioid epidemic, $3.9 billion over the 2021 enacted level. The money will help support research, prevention and recovery services. The administration also is calling for targeted investments for “populations with unique needs, including Native Americans, older Americans and rural populations,” according to a release from the Office of Management and Budget on Friday.
     
  • Public health infrastructure: $8.7 billion was requested for the Centers for Disease Control and Prevention to boost public health capacity in states and territories. OMB calls the budget increase the largest in nearly two decades for the agency at the frontlines of combating COVID-19. The Biden administration hopes to use the new money to train new epidemiologists and public health experts and “build international capacity to detect, prepare for and respond to emerging global threats.” A letter sent Friday to congressional leaders from the White House said that CDC funding was 10% lower than the previous decade after adjusting for inflation.
     
  • Research funding boosts: $6.5 billion to launch a new agency called the Advanced Research Projects Agency for Health. The new agency would provide major increases in federal research and development spending on cancer and other diseases such as diabetes and Alzheimer’s. The goal of the investment is to “drive transformational innovation in health research and speed application and implementation of health breakthroughs,” OMB’s letter to Congress said. The funding is rolled into a $51 billion request for funding to the National Institutes of Health.

How basic research leads to future job growth

https://www.axios.com/basic-science-research-fuels-job-growth-fcf7723b-b701-4ed2-8b2b-699d28dd1fbd.html

Illustration of a hand in a medical glove holding a beaker full of liquid

A new report out later today concludes that basic scientific research plays an essential role in creating companies that later produce thousands of jobs and billions in economic value.

Why it mattersThe report uses the pandemic — and especially the rapid development of new mRNA vaccines — to show how basic research funding from the government lays the necessary groundwork for economically valuable companies down the road.

By the numbers: The Science Coalition — a nonprofit group that represents 50 of the nation’s top private and public research universities — identified 53 companies that have spun off from federally funded university research.

  • Those companies — which range from pharmaceutical startups to agriculture firms — have contributed more than $1.3 billion to U.S. GDP between 2015 and 2019, while supporting the creation of more than 100,000 jobs.

What they’re saying: “The COVID-19 pandemic has shown that the need for the federal government to continue investing in fundamental research is far from theoretical,” says John Latini, president of the Science Coalition. “Consistent, sustained, robust federal funding is how science evolves.”

DetailsLatini praised the Biden administration’s first budget proposal to Congress, released last week, which includes what would be a $9 billion funding boost for the National Institutes of Health (NIH) — the country’s single biggest science research funding agency.

  • The National Oceanic and Atmospheric Administration would see its budget rise to a record high of $6.9 billion, including $800 million reserved for climate research.

The catch: The Biden budget proposal is just that, and it will ultimately be up to Congress to decide how much to allocate to research agencies.

Context: Government research funding is vital because private money tends to go to applied research. But without basic research — the lifeblood of science — the U.S. risks missing out on potentially world-changing innovations in the future.

  • The long-term value of that funding can be seen in the story of Katalin Kariko, an obscure biomedical researcher who labored for years on mRNA with little reward — until the pandemic, when her work helped provide the foundation for mRNA COVID-19 vaccines.

The bottom line: Because its ultimate payoff might lay years in the future, it’s easy to see basic research funding as a waste — until the day comes when we need it.

A preview of a longer pandemic

Featured image

All the things that could prolong the COVID-19 pandemic — that could make this virus a part of our lives longer than anyone wants — are playing out right in front of our eyes.

Driving the news: The British variant is driving another surge in cases in Michigan, and Gov. Gretchen Whitmer has resisted reimposing any of the lockdown measures she embraced earlier in the pandemic.

  • Variants are beginning to infect more kids — “a brand new ball game,” as University of Minnesota epidemiologist Michael Osterholm recently put it.
  • New research confirms that our existing vaccines don’t work as well against the South African variant.
  • And some experts fear the pace of vaccinations in the U.S. is about to slow down.

Between the lines: The concern isn’t necessarily that the facts on the ground right now could end up being disastrous, but rather that we’re getting a preview of the longer, darker coronavirus future the U.S. may face without sufficient vaccinations.

  • If we don’t control the virus well enough, then even years into the future, we could be living through more new variants — some of which might be more deadly, some of which might be more resistant to vaccines, some of which might be more dangerous for certain specific populations.
  • That would translate into an ongoing risk of illness or potentially death for unvaccinated people and new races to reformulate vaccines as new variants keep emerging.
  • And it would lead to a world in which today’s vaccine-eager population would have to stay on top of those emerging risks, get booster shots when they’re available, and perhaps revive some of the pandemic’s social-distancing measures, in order to stay safe.

I Missed My Second COVID-19 Vaccine Appointment. What Happens Now?

Today, W.S. in Florida asks:

I got my first Pfizer vaccine in January. Is it too late to get the second injection now, more than two months later? What should I do?

The second dose of Pfizer-BioNTech’s vaccine should ideally be given three weeks after the first. (Moderna’s second dose is meant to be given four weeks after the first, while the Johnson & Johnson/Janssen shot is delivered in a single dose.) But, well, sometimes life gets in the way. So what happens if you don’t make it to that second appointment?

Schedule another one as soon as you can, says Dr. Adam Ratner, a pediatric infectious disease doctor at NYU Langone Health and a vaccine researcher.

While a three- or four-week gap between shots is ideal, the U.S. Centers for Disease Control and Prevention (CDC) says you can get your second shot within 42 days of the first one and still mount a full immune response. “Beyond that, we start to operate in an area where there’s simply less data,” Ratner says.

That doesn’t mean your second shot will be ineffective if it’s given more than six weeks after the first. It only means that studies have not specifically measured how much protection the two-dose vaccines offer when the shots are given more than 42 days apart. Still, the CDC says you don’t have to start over if you can’t get a second vaccine within 42 days. Countries including the U.K. are even purposely delaying second shots so they can get first doses out to more people, and some experts in the U.S. advocate for the same policy.

Ratner says if he were in your shoes, he wouldn’t worry too much. “I would say get the second dose now and consider yourself fully vaccinated,” he says. Just make sure you get a second dose of the same vaccine, since the CDC does not recommend mixing and matching with different shots.

It may be tempting to just stick with the one dose you’ve got—after all, one recent study showed that a single dose of the vaccine was about 80% effective at preventing COVID-19 infections, compared to 90% protection after two doses. But “it is somewhat of a tenuous 80%,” National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci said at a recent press briefing. “When you leave it at one dose, the question is, ‘How long does it last?’”

To get the vaccine’s full benefits, and to make sure they last as long as possible, you’ll need a second shot.

CDC director walks tightrope on pandemic messaging

https://thehill.com/policy/healthcare/546269-cdc-director-walks-tightrope-on-pandemic-messaging

Images: Tightrope walk across the Grand Canyon

Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky finds herself in a delicate position as she seeks to balance the optimism of increasing vaccinations with the reality that the U.S. is still very much in the grip of a deadly pandemic.

Walensky started the CDC job with a reputation as a savvy communicator, tasked with salvaging the reputation of an agency that took a beating under the Trump administration.

“When I first started at CDC about two months ago, I made a promise to you: I would tell you the truth, even if it was not the news we wanted to hear,” Walensky told reporters recently.

Walensky’s expertise is in HIV research, like her predecessor Robert Redfield, and before being appointed to lead the CDC, she was head of infectious diseases at Massachusetts General Hospital.

While former colleagues say Walensky is the perfect fit for the CDC post, her skills are now being put to the test as she faces criticism for being both too negative and too hopeful.

“She is quite a compelling and clear communicator, but it’s a challenging set of messages to try and get out there,” said Chris Beyrer, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health.

Public health messaging during a global pandemic is complicated enough, but experts say this particular moment is especially difficult.

After weeks of decline and then stagnation, the rate of coronavirus infections has once again started to climb across much of the country. Cases are up about 12 percent nationally compared with the previous week, averaging around 62,000 cases per day, according to the CDC.

At the same time, nearly 100 million Americans have received at least one dose of a coronavirus vaccine. Many states are expanding vaccine eligibility, in some instances to all adults, and federal health officials say there will be enough supply for everyone to be vaccinated by the end of May.

Walensky tried to emphasize both aspects this week when she issued an emotional appeal to the public.

“We have so much to look forward to, so much promise and potential of where we are, and so much reason for hope. But right now I’m scared,” Walensky said, adding that she had a “sense of impending doom” if people continued to ignore public health precautions.

Yet almost in the next breath, she talked about a “tremendously encouraging” new study showing that vaccinated people were 90 percent protected from infection, meaning they pose an extremely low risk of spreading the virus.

While that may come across as mixed messaging, experts say it accurately reflects not only where things stand right now but also how the country has been reacting to the virus for the past year.

“Whiplash is a true reflection of how we’re all experiencing the epidemic and the response to it. So I’d rather she be honest about that and others be honest about that than give people something that they want … to make them feel better,” said Judith Auerbach, a professor in the University of California San Francisco School of Medicine.

Auerbach, who previously worked with Walensky on HIV research, praised the director’s openness, which she said had been missing from agency leadership during the Trump administration.

“She’s being really honest about her own emotions. That’s hard for a fed to do and get away with,” Auerbach said. “The science that says we all still need to be, in fact, quite scared because we’re in this race between the vaccines … versus the emergence of these variants, and she felt it at a visceral level, and she conveyed that in a way that I thought was quite telling.”

Glen Nowak, director of the Center for Health and Risk Communication at the University of Georgia and a former CDC media relations director, said Walensky’s candor helps establish credibility.

“She has embraced the fact that credibility comes from being transparent and honest and genuine about your fears and your concerns,” Nowak said.

The CDC declined to make Walensky available for an interview, but in a statement to The Hill, an agency spokesman said every communication reflects the latest science and epidemiology.

“At times, moments must balance hope that we will move out of the pandemic with the reality that we are not out of it yet,” the spokesman said.

“We acknowledge the challenge of conveying such hope and promise that vaccines offer with the reality that cases and deaths are rising. While we are sending the critical message that people cannot and should not let up on their prevention measures, we do remain very optimistic about what the future of a fully vaccinated public will offer,” the spokesman added.

On Friday, Walensky again came under criticism for her messaging. In updated guidance, the CDC said it is safe for people who have been fully vaccinated to travel.

But Walensky struck a cautionary tone by saying the CDC still recommends anyone, vaccinated or not, avoid nonessential travel because infection numbers are so high.

“We know that right now we have a surging number of cases,” Walensky said during a White House briefing. “I would advocate against general travel overall. Our guidance is silent on recommending or not recommending fully vaccinated people travel. Our guidance speaks to the safety of doing so.”

Nowak said part of what makes public health messaging so difficult is the fact that science doesn’t always deal in absolutes and that the public overall doesn’t do well with nuance.

“Often people don’t want to listen to the nuance; they want advice and guidance to be stable. They get frustrated with the changes or when it seems to be contradictory. They also get frustrated if it doesn’t match their everyday living experiences,” Nowak said.

With the travel guidance, Walensky attempted to spell out the balance she was trying to strike and asked the public for patience and understanding.

“I want to acknowledge today that providing guidance in the midst of a changing pandemic and its changing science is complex,” Walensky said.

“The science shows us that getting fully vaccinated allows you to do more things safely, and it’s important for us to provide that guidance, even in the context of rising cases. At the same time, we must balance the science with the fact that most Americans are not yet fully vaccinated, which is likely contributing to our rising cases,” she said.

Jen Kates, director for global health and HIV policy at the Kaiser Family Foundation, who has known Walensky for decades, said she thinks the CDC director is aware that she can’t escape criticism, especially when so many people have pandemic fatigue.

If the CDC is too strict and refuses to endorse relatively normal behavior, especially after people get vaccinated, it could risk others refusing to get the shot, Kates said.

But if the agency paints too rosy a picture, more people could act like the pandemic is over and risk further spread of the virus.

“It behooves public officials to always be cognizant that their words are being listened to and can be taken out of context or may be hard for people to grasp,” Kates said. “So I think Dr. Walensky is a great communicator, but that doesn’t mean that this is always easy to do and the balance is always straightforward.”

Cartoon – Open the U.S. Now

A. Christian van Gorder: George Washington meets a viral pandemic | Board  Of Contributors | wacotrib.com

Yogi Berra on the Pandemic

Yogi Berra's wordplay wisdom for writers: "It ain't over till it's over"  and more | Stuff Writers Like

Brazil has become South America’s superspreader event

LIMA, Peru — The doctor watched the patients stream into his intensive care unit with a sense of dread.

For weeks, César Salomé, a physician in Lima’s Hospital Mongrut, had followed the chilling reports. A new coronavirus variant, spawned in the Amazon rainforest, had stormed Brazil and driven its health system to the brink of collapse. Now his patients, too, were arriving far sicker, their lungs saturated with disease, and dying within days. Even the young and healthy didn’t appear protected.

The new variant, he realized, was here.

“We used to have more time,” Salomé said. “Now, we have patients who come in and in a few days they’ve lost the use of their lungs.”

The P.1 variant, which packs a suite of mutations that makes it more transmissible and potentially more dangerous, is no longer just Brazil’s problem. It’s South America’s problem — and the world’s.

In recent weeks, it has been carried across rivers and over borders, evading restrictive measures meant to curb its advance to help fuel a coronavirus surge across the continent. There is mounting anxiety in parts of South America that P.1 could quickly become the dominant variant, transporting Brazil’s humanitarian disaster — patients languishing without care, a skyrocketing death toll — into their countries.

“It’s spreading,” said Julio Castro, a Venezuelan infectious-disease expert. “It’s impossible to stop.”

In Lima, scientists have detected the variant in 40 percent of coronavirus cases. In Uruguay, it’s been found in 30 percent. In Paraguay, officials say half of cases at the border with Brazil are P.1. Other South American countries — Colombia, Argentina, Venezuela, Chile — have discovered it in their territories. Limitations in genomic sequencing have made it difficult to know the variant’s true breadth, but it has been identified in more than two dozen countries, from Japan to the United States.

Hospital systems across South America are being pushed to their limits. Uruguay, one of South America’s wealthiest nations and a success story early in the pandemic, is barreling toward a medical system failure. Health officials say Peru is on the precipice, with only 84 intensive care beds left at the end of March. The intensive care system in Paraguay, roiled by protests last month over medical shortcomings, has run out of hospital beds.

“Paraguay has little chance of stopping the spread of the P.1 variant,” said Elena Candia Florentín, president of the Paraguayan Society of Infectious Diseases.

“With the medical system collapsed, medications and supplies chronically depleted, early detection deficient, contact tracing nonexistent, waiting patients begging for treatment on social media, insufficient vaccinations for health workers, and uncertainty over when general and vulnerable populations will be vaccinated, the outlook in Paraguay is dark,” she said.

How P.1 spread across the region is a distinctly South American story. Nearly every country on the continent shares a land border with Brazil. People converge on border towns, where crossing into another country can be as simple as crossing the street. Limited surveillance and border security have made the region a paradise for smugglers. But they have also made it nearly impossible to control the variant’s spread.

“We share 1,000 kilometers of dry border with Brazil, the biggest factory of variants in the world and the epicenter of the crisis,” said Gonzalo Moratorio, a Uruguayan molecular virologist tracking the variant’s growth. “And now it’s not just one country.”

The Brazilian city of Tabatinga, deep in the Amazon rainforest, where officials suspect the virus crossed into Colombia and Peru, is emblematic of the struggle to contain the variant. The city of 70,000 was swept by P.1 earlier this year. Many in the area have family ties in several countries and are accustomed to crossing borders with ease — canoeing across the Amazon River to Peru or walking into Colombia.

“People ended up bringing the virus from one side to the other,” said Sinesio Tikuna Trovão, an Indigenous leader. “The crossing was free, with both sides living right on top of one another.”

Now that the variant has infiltrated numerous countries, stopping its spread will be difficult. Most South American countries, with the exception of Brazil, adopted stringent containment measures last year. But they have been undone by poverty, apathy, distrust and exhaustion. With national economies battered and poverty rising sharply, public health experts fear more restrictions will be difficult to maintain. In Brazil, despite record death numbers, many states are lifting restrictions. (SOUND FAMILIAR)

That has left inoculation as the only way out. But coronavirus vaccines are South America’s white whale: often discussed, but rarely seen. The continent hasn’t distributed its own vaccine or negotiated a regional agreement with pharmaceutical companies. It’s one of the world’s hardest-hit regions but has administered only 6 percent of the world’s vaccine doses, according to the site Our World in Data. (The outlier is Chile, which is vaccinating residents more quickly than anywhere in the Americas — but still suffering a surge in cases.)

“We should not only blame the policy response,” said Luis Felipe López-Calva, the United Nations Development Program’s regional director for Latin America and the Caribbean. “We have to understand the vaccine market.”

“And there is a failure in the market,” he said.

The vaccine has become so scarce, López-Calva said, that officials are imposing restrictions on information. It’s nearly impossible to know how much governments are paying for doses. Some regional blocs, such as the African Union and the European Union, have negotiated joint contracts. But in South America, it has been every country for itself — diminishing the bargaining power for each one.

“This has been harmful for these countries, and for the whole world to stop the virus,” López-Calva said. “Because it’s never been more clear that no one is protected until everyone is protected.”

Paulo Buss, a prominent Brazilian scientist, said it didn’t have to be like this. He was Brazil’s health representative to the Union of South American Nations, which negotiated several regional deals with pharmaceutical companies before the coronavirus pandemic. But that union came apart amid political differences just before the arrival of the virus.

“It was the worst possible moment,” Buss said. “We’ve lost capacity and our negotiation attempts have been fragmented. Multi-lateralism was weakened.”

Vaccine scarcity has led to line-jumping scandals all over South America, but particularly in Peru. Hundreds of politically connected people, including cabinet ministers and former president Martín Vizcarra, snagged vaccine doses early. Now people are calling for criminal charges.

As officials bicker and the vaccination campaign is delayed, the variant continues to spread. P.1 accounts for 70 percent of cases in some parts of the Lima region, according to officials. Last week, the country logged the highest daily case count since August — more than 11,000. On Saturday, the country recorded 294 deaths, the most in a day since the start of the pandemic.

Peruvians have been stunned by how quickly the surge overwhelmed the health-care system. Public health analysts and government officials had believed Peru was prepared for a second wave. But it wasn’t ready for the variant.

“We did not expect such a strong second wave,” said Percy Mayta-Tristan, director of research at the Scientific University of the South in Lima. “The first wave was so extensive. The presence of the Brazilian variant helps explain why.”