The Biden administration has declared the monkeypox outbreak a public health emergency — a move that gives officials more flexibility to tackle the virus’ spread.
Details: Department of Health and Human Services secretary Xavier Becerra made the announcement Thursday in a briefing on monkeypox.
Federal health officials can now expedite preventative measures to treat monkeypox without going through a full federal review, the Washington Post reports.
What they’re saying: “We’re prepared to take our response to the next level in addressing this virus,” Becerra said Thursday. “We urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus.”
Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said the declaration will help “exploit the outbreak” and potentially increase access to care for those at risk.
Dr. Demetre Daskalakis, the White House national monkeypox response deputy coordinator, said “today’s actions will allow us to meet the needs of communities impacted by the virus … and aggressively work to stop this outbreak.”
State of play: Dr. Robert Califf, the commissioner of the Food and Drug Administration, said the U.S. is “at a critical inflection point” in the monkeypox outbreak, requiring “additional solutions to address the rise in infection rates.”
There are 6,600 cases of monkeypox in the U.S. as of Thursday, Becerra said.
There were less than 5,000 cases of monkeypox last week, he added.
The big picture: Biden’s decision to declare monkeypox a public emergency allows him to raise awareness of the virus and unlock more flexibility for spending on ways to treat and tackle the virus.
About 20% of Americans are worried they’ll contract monkeypox, Axios previously reported. But there are still some gaps in Americans’ knowledge of the virus and how it impacts our population.
What’s next: U.S. health officials said that 800,000 monkeypox vaccine doses will be made available for distribution. But in hotspot states for the monkeypox outbreak, there’s a drastic disconnect between the number of doses that local health officials say they need versus what they have been allotted.
The U.S. will receive another 150,000 monkeypox vaccine doses in the strategic national stockpile in September, Dawn O’Connell, administrator at HHS’ Administration for Strategic Preparedness & Response, told reporters Thursday. These were previously scheduled to arrive in October.
New York state declared an imminent threat and San Francisco issued a state of emergency over monkeypox July 28 as the virus continues to spread in the U.S., NBC News reported.
The news comes after the World Health Organization declared monkeypox a global emergency July 23 and as the CDC reported 4,907 confirmed cases nationwide as of July 28. California and New York account for more than 40 percent of the reported cases in the U.S., according to The Washington Post.
In a statement, New York State Commissioner of Health Mary Bassett, MD, said the declaration allows local health departments “to access additional state reimbursement, after other federal and state funding sources are maximized, to protect all New Yorkers and ultimately limit the spread of monkeypox in our communities.” It covers monkeypox prevention response and activities from June 1 through the end of the year.
In San Francisco, the monkeypox public health emergency takes effect Aug. 1, city officials said in a news release. The release, from Mayor London Breed and the San Francisco Department of Public Health, said the declaration “will mobilize city resources, accelerate emergency planning, streamline staffing, coordinate agencies across the city, allow for future reimbursement by the state and federal governments and raise awareness throughout San Francisco about [monkeypox].”
Four other updates:
1. HHS announced July 28 that nearly 800,000 additional monkeypox vaccine doses will be available for distribution to states and jurisdictions. The 786,000 additional doses are on top of the more than 300,000 doses already distributed. This means the U.S. has secured a total of about 1.1 million doses “that will be in the hands of those who need them in the next several weeks,” HHS Secretary Xavier Becerra said during a July 28 news conference. The additional doses will be allocated based on the total population of at-risk people and the number of new cases in each jurisdiction. “This strategy ensures that jurisdictions have the doses needed to complete the second dose of this two-dose vaccine regimen for those who have been vaccinated over the past month,” HHS said in a news release.
2. As of the morning of July 29, the U.S. has held off on declaring a national monkeypox emergency. Mr. Becerra said July 28 that HHS “continue[s] to monitor the response throughout the country on monkeypox” and will weigh any decision regarding a public health emergency declaration based on the response.
3. The monkeypox response is straining public health workers. Health experts are concerned over how the monkeypox response will further deplete the nation’s public health workforce, still strained and burnt out from the ongoing COVID-19 pandemic. Barriers to testing, treatment and vaccine access largely mirror the missteps in the early coronavirus response, Megan Ranney, MD, emergency physician and academic dean of Brown University School of Public Health in Providence, R.I, told The Washington Post. “I can’t help but wonder if part of the delay is that our public health workforce is so burned out,” she said. “Everyone who’s available to work on epidemiology or contract tracing is already doing it for COVID-19.”
4. Monkeypox testing demand is low, commercial laboratories told CNN. In recent weeks, five major commercial laboratories have begun monkeypox testing, giving the nation capacity to conduct 80,000 tests per week. While Mayo Clinic Laboratories can process 1,000 samples a week, it’s received just 45 specimens from physicians since it began monkeypox testing July 11, according to the July 28 CNNreport. “Without testing, you’re flying blind,” William Morice, MD, PhD, president of Mayo’s lab and chair of the board of directors at the American Clinical Laboratory Association, told the news outlet. “The biggest concern is that you’re not going to identify cases and [monkeypox] could become an endemic illness in this country. That’s something we really have to worry about.”
The World Health Organization (WHO) has declared the monkeypox outbreak a global health emergency after the virus reached more than 70 countries around the world.
WHO Director General Tedros Adhanom Ghebreyesus said at a press conference on Saturday that he decided the outbreak represents a “public health emergency of international concern.”
“WHO’s assessment is that the risk of monkeypox is moderate globally and in all regions, except in the European region where we assess the risk as high,” he said.
Tedros said the WHO’s International Health Regulations Emergency Committee came to a consensus at a meeting a month ago that monkeypox did not represent an international public health emergency, but the situation has changed.
He said the WHO had received reports of just more than 3,000 cases from 47 countries at the time, but more than 16,000 cases have now been reported from 75 countries and territories. He said there have been five deaths.
Tedros said the committee was unable to reach a consensus on whether the outbreak should be considered a public health emergency of international concern, but he considered five factors in declaring it an emergency.
He said the first factor is information countries have shared with the WHO, and that data from countries around the world shows that the virus has spread rapidly to many countries that have not seen it before.
He added that the second factor is the definition of a public health emergency and that the three criteria for declaring such an emergency have been met.
A public health emergency of international concern is considered a situation that is serious, sudden, unusual or unexpected, carries implications for public health beyond a country’s borders and may require immediate international action, according to the WHO.
Tedros said the third factor is the advice of the committee, which was divided, and the fourth factor is scientific principles and evidence, which is currently “insufficient” and leaves “many unknowns.”
He said the fifth factor is the risk to human health, international spread and the potential for interfering with international traffic.
He said there is a “clear risk” for international spread, but the risk of interfering with international traffic is currently low.
“So in short, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations,” Tedros said.
The Hill has reached out to the WHO for comment.
Monkeypox has spread quickly in the United States since cases were first detected in the country in May. The virus appears to be spreading primarily among men who have sex with men and spreads through extended physical contact.
The virus can cause symptoms like lesions, a rash and swelling of lymph nodes.
Ghebreyesus said he is making recommendations for four categories of countries in managing monkeypox.
For countries that have not seen any cases or not reported a case in 21 days, they should take measures like activating health mechanisms to prepare to respond to monkeypox and raise awareness about transmission, according to a WHO statement.
Countries with recently imported cases of monkeypox and that are experiencing human-to-human transmission — which includes the United States — should implement a coordinated response, work to engage and protect their communities and implement public health measures like isolating cases and using vaccines.
The Biden administration announced earlier this month that it would distribute an additional 144,000 doses of the Jynneos vaccine to address monkeypox after having distributed about 40,000 doses previously.
The third group of countries are those with the “known or suspected” transmission of the virus from animals to humans. They should establish or activate mechanisms for understanding and monitoring the animal-to-human and human-to-animal transmission risk and study transmission patterns.
The fourth group are countries with the manufacturing capacity to create vaccines and other medical countermeasures. The WHO statement calls on these countries to increase production and availability of these measures and work with WHO to ensure necessary supplies are made available based on public health needs at “reasonable cost” to countries that need support the most.
Ghebreyesus said the outbreak is concentrated among men who have sex with men and especially those with multiple sexual partners.
“That means that this is an outbreak that can be stopped with the right strategies in the right groups,” he said.
He added that countries should work with communities of men with male sexual partners to inform them and offer support and to adopt measures that protect the “health, human rights and dignity of affected communities.”
Ghebreyesus said civil society organizations, especially those with experience working with people who are HIV-positive, should work with WHO to fight stigma and discrimination.
The spread of HIV and AIDS in the 1980s led to increased stigma for those who identify as gay as the virus was initially reported to be spreading among gay men.
Epidemiologist Luke Nyakarahuka sprays disinfectant on scientists Jonathan Towner and Brian Amman in Queen Elizabeth National Park, Uganda, in 2018. The scientists were researching how bats transmit the Marburg virus to humans.
After the coronavirus pandemic and the rise of monkeypox cases, news of another virus can trigger nerves globally. The highly infectious Marburg virus has been reported in the West African country of Ghana this week, according to the World Health Organization.
Two unrelated people died after testing positive for Marburg in the southern Ashanti region of the country, the WHO said Sunday, confirming lab results from Ghana’s health service. The highly infectious disease is similar to Ebola and has no vaccine.
Health officials in the country say they are working to isolate close contacts and mitigate the spread of the virus, and the WHO is marshaling resources and sending specialists to the country.
“Health authorities have responded swiftly, getting a head start preparing for a possible outbreak. This is good because without immediate and decisive action, Marburg can easily get out of hand,” said the WHO’s regional director for Africa, Matshidiso Moeti.
Fatality rates from the disease can reach nearly 90 percent, according to the WHO.
Here’s what we know about the virus:
What is the Marburg virus?
Marburg is a rare but highly infectious viral hemorrhagic fever and is in the same family as Ebola, a better-known virus that has plagued West Africa for years.
The Marburg virus is a “genetically unique zoonotic … RNA virus of the filovirus family,” according to the Centers for Disease Control and Prevention. “The six species of Ebola virus are the only other known members of the filovirus family.”
Fatality rates range from 24 percent to 88 percent, according to the WHO, depending on the virus strain and quality of case management.
Marburg has probably been transmitted to people from African fruit bats as a result of prolonged exposure from people working in mines and caves that have Rousettus bat colonies. It is not an airborne disease.
Once someone is infected, the virus can spread easily between humans through direct contact with the bodily fluids of infected people such as blood, saliva or urine, as well as on surfaces and materials. Relatives and health workers remain most vulnerable alongside patients, and bodies can remain contagious at burial.
The first cases of the virus were identified in Europe in 1967. Two large outbreaks in Marburg and Frankfurt in Germany, and in Belgrade, Serbia, led to the initial recognition of the disease. At least seven deaths were reported in that outbreak, with the first people infected having been exposed to Ugandan imported African green monkeys or their tissue while conducting lab research, the CDC said.
Where has Marburg been detected?
The Ghana cases are only the second time Marburg has been detected in West Africa. The first reported case in the region was in Guinea last year. The virus can spread quickly. More than 90 contacts, including health workers and community members, are being monitored in Ghana. The WHO said it has also reached out to neighboring high-risk countries to put them on alert.
Cases of Marburg have previously been reported elsewhere in Africa, including in Uganda, the Democratic Republic of Congo, Kenya, South Africa and Zimbabwe. The largest outbreak killed more than 200 people in Angola in 2005.
The virus is not known to be native to other continents, such as North America, and the CDC says cases outside Africa are “infrequent.” In 2008, however, a Dutch woman died of Marburg disease after visiting Uganda. An American tourist also contracted the disease after a Uganda trip in 2008 but recovered. Both travelers had visited a well-known cave inhabited by fruit bats in a national park.
What are the symptoms?
The illness begins “abruptly,” according to the WHO, with a high fever, severe headache and malaise. Muscle aches and cramping pains are also common features.
In Ghana, the two unrelated individuals who died experienced symptoms such as diarrhea, fever, nausea and vomiting. One case was a 26-year-old man who checked into a hospital on June 26 and died a day later. The second was a 51-year-old man who went to a hospital on June 28 and died the same day, the WHO said.
In fatal cases, death usually occurs between eight and nine days after onset of the disease and is preceded by severe blood loss and hemorrhaging, and multi-organ dysfunction.
The CDC has also noted that around day five, a non-itchy rash on the chest, back or stomach may occur. Clinical diagnosis of Marburg “can be difficult,” it says, with many of the symptoms similar to other infectious diseases such as malaria or typhoid fever.
Can Marburg be treated?
There are no vaccines or antiviral treatments approved to treat the Marburg virus.
However, supportive care can improve survival rates such as rehydration with oral or intravenous fluids, maintaining oxygen levels, using drug therapies and treating specific symptoms as they arise. Some health experts say drugs similar to those used for Ebola could be effective.
Some “experimental treatments” for Marburg have been tested in animals but have never been tried in humans, the CDC said.
Virus samples collected from patients to study are an “extreme biohazard risk,” the WHO says, and laboratory testing should be conducted under “maximum biological containment conditions.”
Anything else to know?
The WHO said this week it is supporting a “joint national investigative team” in Ghana and deploying its own experts to the country. It is also sending personal protective equipment, bolstering disease surveillance and tracing contacts in response to the handful of cases.
More details are likely to be shared at a WHO Africa online briefing scheduled for Thursday.
“It is a worry that the geographical range of this viral infection appears to have spread. This is a very serious infection with a high mortality rate,” international public health expert and professor Jimmy Whitworth of the London School of Hygiene and Tropical Medicine told The Washington Post on Monday.
“It is important to try to understand how the virus got into the human population to cause this outbreak and to stop any further cases. At present, the risk of spread of the outbreak outside of Ashanti region of Ghana is very low,” he added.
Amid an international string of cases, a Massachusetts man has been infected with the first case of monkeypox in the United States this year. And while the virus isn’t likely to cause a pandemic like Covid-19, experts say the outbreak is still concerning.
What is monkeypox?
Monkeypox—so called because it was first identified in laboratory monkeys—is a rare viral infection that begins with flu-like symptoms and progresses to a distinctive rash on the face and body. Most infections resolve within weeks, but some cases can be fatal, according to the World Health Organization (WHO).
People can catch monkeypox through contact with infected animals or animal products. Human-to-human transmission, meanwhile, can occur via contact with bodily fluid, sores, or items contaminated by bodily fluid, but most often occurs via large respiratory droplets, which rarely travel more than a few feet.
According to WHO, “There is no evidence, to date, that person-to-person transmission alone can sustain monkeypox infections in the human population.”
Symptoms of monkeypox are typically mild, including headaches, muscle pain, chills, and swollen lymph nodes, The Hill reports. Patients can also develop rashes on their face and body that then turn into skin lesions that eventually fall off.
Although there are no specific treatments for monkeypox, at least one vaccine has been approved in the United States to protect against both monkeypox and smallpox.
Monkeypox cases pop up around the world
On Wednesday, the Massachusetts Department of Public Health (MDPH) reported the first confirmed case this year of monkeypox in the United States in a man who had recently traveled to Canada.
According to MDPH, “The case poses no risk to the public, and the individual is hospitalized and in good condition.”
MDPH said it’s “working closely with the CDC, relevant local boards of health, and the patient’s health care providers to identify individuals who may have been in contact with the patient while he was infectious. This contact tracing approach is the most appropriate given the nature and transmission of the virus.”
Generally, monkeypox cases are very rare in the United States, however two cases were reported in the United States last year—one in Texas and one in Maryland.
Monkeypox cases have also been popping up recently around the world. The United Kingdom has reported nine monkeypox cases, Spain has reported 23 suspected cases, Portugal has reported five and is investigating another 15, and Canadian health officials are investigating at least 15 potential cases in Montreal.
British officials noted that four of the nine cases it identified were among men who have sex with men, suggesting that the virus could be spreading through sexual contract.
What experts are saying
According to Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine, the monkeypox virus isn’t likely to follow a similar path to Covid-19.
“This isn’t going to cause a nationwide epidemic like COVID did, but it’s a serious outbreak of a serious disease—and we should take it seriously,” he said.
Still, experts said they are concerned by the monkeypox outbreaks. Typically, monkeypox doesn’t spread easily between humans, but the fact that multiple cases are emerging in different countries at the same time is concerning, said Aris Katzourakis, a professor of evolution and genomics at the University of Oxford.
“It’s either a lot of bad luck or something quite unusual happening here,” he said.
“The fact that it’s in the U.K. in multiple unrelated clusters, plus Spain, plus Portugal, is a surprise,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.
According to Mateo Prochazka, an epidemiologist at the U.K. Health Security Agency, the fact that the virus appears to be spreading through sexual contact is especially strange.
“What is even more bizarre is finding cases that appear to have acquired the infection via sexual contact,” he said. “This is a novel route of transmission that will have implications for outbreak response and control.”
While experts aren’t worried about the virus being a global threat as of now, Jay Hooper, a monkeypox expert from the U.S. Army Medical Research Institute of Infectious Diseases, noted that “[e]very time there’s an outbreak—and the more people get infected—the more chances monkeypox has to adapt to people.”
“With viruses that spill over from animals, you just never know what’s going to happen,” he added.
Welcome to Friday’s Health 202, where today we have a special spotlight on the pandemic two years in.
🚨 The federal government is about to be funded. The Senate sent the long-term spending bill to President Biden’s desk last night after months of intense negotiations.
Two years since the WHO declared a pandemic, what health-care system changes are here to stay?
Nurses screened patients at a drive-through testing site in March 2020. (Win McNamee/Getty Images)
Exactly two years ago, the World Health Organizationdeclared the coronavirus a pandemic and much of American life began grinding to a halt.
That’s when the health-care system, which has never been known for its quickness, sped up. The industry was forced to adapt, delivering virtual care and services outside of hospitals on the fly. Yet, the years-long pandemic has exposed decades-old cracks in the system, and galvanized efforts to fix them.
Today, as coronavirus cases plummet and President Biden says Americans can begin resuming their normal lives, we explore how the pandemic could fundamentally alter the health-care system for good. What changes are here to stay — and what barriers are standing in the way?
A telehealth boom
What happened: Telehealth services skyrocketed as doctors’ offices limited in-person visits amid the pandemic. The official declaration of a public health emergency eased long-standing restrictions on these virtual services, vastly expanding Medicare coverage.
But will it stick? Some of these changes go away whenever the Biden administration decides not to renew the public health emergency (PHE). The government funding bill passed yesterday extends key services roughly five months after the PHE ends, such as letting those on Medicare access telehealth services even if they live outside a rural area.
But some lobbyists and lawmakers are pushing hard to make such changes permanent. Though the issue is bipartisan and popular, it could be challenging to pass unless the measures are attached to a must-pass piece of legislation.
“Even just talking to colleagues, I used to have to spend three or four minutes while they were trying desperately not to stare at their phone and explain to them what telehealth was … remote patient monitoring, originating sites, and all this wonky stuff,”said Sen. Brian Schatz (D-Hawaii), a longtime proponent of telehealth.
“Now I can go up to them and say, ‘So telehealth is great, right?’ And they say, ‘yes, it is.’ ”
A new spotlight on in-home care
What happened: The infectious virus tore through nursing homes, where often fragile residents share rooms and depend on caregivers for daily tasks. Ultimately, nearly 152,000 residents died from covid-19.
The devastation has sparked a rethinking of where older adults live and how they get the services they need — particularly inside their own homes.
“That is clearly what people prefer,” said Gail Wilensky, an economist at Project HOPE who directed the Medicare and Medicaid programs under President George H.W. Bush. “The challenge is whether or not it’s economically feasible to have that happen.”
More money, please: Finding in-home care — and paying for it — is still a struggle for many Americans. Meanwhile, many states have lengthy waitlists for such services under Medicaid.
Experts say an infusion of federal funds is needed to give seniors and those with disabilities more options for care outside of nursing homes and assisted-living facilities.
For instance, Biden’s massive social spending bill included tens of billions of dollars for such services. But the effort has languished on Capitol Hill, making it unclear when and whether additional investments will come.
A reckoning on racial disparities
What happened: Hispanic, Black, and American Indian and Alaska Native people are about twice as likely to die from covid-19 than White people. That’s according to age-adjusted data from a recent Kaiser Family Foundation report.
In short, the coronavirus exposed the glaring inequities in the health-care system.
“The first thing to deal with any problem is awareness,” said Georges Benjamin, the executive director of the American Public Health Association. “Nobody can say that they’re not aware of it anymore, that it doesn’t exist.”
But will change come? Health experts say they hope the country has reached a tipping point in the last two years. And yet, any real systemic change will likely take time. But, Benjamin said, it can start with increasing the number of practitioners from diverse communities, making office practices more welcoming and understanding biases.
We need to, as a matter of course, ask ourselves who’s advantaged and who’s disadvantaged” when crafting new initiatives, like drive-through testing sites, Benjamin said. “And then how do we create systems so that the people that are disadvantaged have the same opportunity.”
Scientists and health officials around the world are tracking the BA.2 subvariant of omicron, which has been referred to as “stealth omicron” because it cannot easily be identified via PCR tests.
What is the omicron BA.2 subvariant?
The BA. 2 omicron subvariant is a descendant of the original BA.1 omicron variant that has caused massive global Covid-19 surges. On Monday, the World Health Organization (WHO) urged researchers to prioritize the investigation of BA.2’s characteristics to determine whether it poses new challenges for areas already overwhelmed by the pandemic.
“The BA. 2 descendant lineage, which differs from BA. 1 in some of the mutations, including in the spike protein, is increasing in many countries,” WHO said. “Investigations into the characteristics of BA. 2, including immune escape properties and virulence, should be prioritized independently (and comparatively) to BA. 1.”
Currently, there is no evidence that BA. 2 is more transmissible or evades immunity better than BA. 1, the Washington Post reports.
In fact, experts still know very little about the transmissibility of BA.2 compared with BA.1, said Jeremy Luban, a professor of molecular medicine, biochemistry, and molecular pharmacology at UMass Medical School. And according to Luban, it is too early to determine whether vaccines and existing medications will provide adequate protection against BA.2.
Like the original omicron variant, BA.2 has many mutations, including roughly 20 found in the area targeted by most vaccines. BA.2 also has unique mutations that are not found in BA.1, which could limit the effectiveness of monoclonal antibodies, Luban said.
Further, scientists have found that BA.2 is harder to detect with PCR tests than BA.1. Although researchers were able to quickly differentiate BA.1 from the delta variant using a PCR test, the BA.2 subvariant does not possess the same “S gene target failure” seen in BA.1. As a result, BA.2 looks like the delta variant on the test, according to Wesley Long, a pathologist at Houston Methodist Hospital.
“It’s not that the test doesn’t detect it; it’s just that it doesn’t look like omicron,” Long said. “Don’t get the impression that ‘stealth omicron’ means we can’t detect it. All of our PCR tests can still detect it.”
Where is BA.2 circulating?
So far, BA.2 has been identified in 40 countries, including the United States. Although there are few reported cases of BA.2 in the United States, the subvariant is widely circulating in Asia and Europe.
Throughout Europe, BA.2 seems to be the most widespread in Denmark—but experts said that could be because of the country’s robust program of sequencing the virus’s genome, the Post reports. On Jan. 20, health officials said that the BA.2 cases made up more than 50% of the country’s omicron cases.
In the United States, at least three cases have been found at Houston Methodist Hospital in Texas, which is currently studying the genetic makeup of virus samples from its patients, the Post reports.
“The good news is we have only three,” said James Musser, director of the Center for Molecular and Translational Human Infectious Diseases Research at Houston Methodist. “We certainly do not see the 5% and more that is being reported in the U.K. now and certainly not the 40% that is being reported in Denmark.”
In addition, a spokesperson for the Washington Department of Health on Monday told Fox News, “Two cases of BA.2 … were detected earlier this month in Washington.”
BA.2 remains ‘an open question’
Although BA.2 is now on at least four continents, experts say this new subvariant shouldn’t be a cause for panic, as it is expected to be relatively mild,USA Today reports.
“I don’t think it’s going to cause the degree of chaos and disruption, morbidity and mortality that BA.1 did,” said Jacob Lemieux, an infectious disease specialist at Massachusetts General Hospital. “I’m cautiously optimistic that we’re going to continue to move to a better place and, hopefully, one where each new variant on the horizon isn’t news.”
Similarly, Robert Garry, a virologist at Tulane University School of Medicine, said, “Variants have come, variants have gone.” He added, “I don’t think there’s any reason to think this one is a whole lot worse than the current version of omicron.”
Still, Musser argued that BA.2 deserves close attention until scientists can learn more about it.
“We know that omicron … can clearly evade preexisting immunity” from both vaccines and exposure to other variants of the virus, he said. “What we don’t know yet is whether son-of-omicron does that better or worse than omicron. So that’s an open question.”
National Institutes of Health (NIH) director Francis Collins said the emergence of a new variant of the coronavirus presents a “great reason” for people in the United States to seek a booster shot.
“There’s no reason to panic, but it’s a great reason to get boosted,” Collins said Sunday during an appearance on CNN.
The World Health Organization over the weekend held an emergency meeting regarding the new coronavirus strain first identified in South Africa, and classified it as being “of concern,” due to the variant’s large number of mutations and an increased risk of re-infection.
Several nations around the world, including the United States, have limited travel to several south African countries in recent days in an attempt to keep the variant from spreading more rapidly.
During an earlier appearance on Fox News Sunday, Collins said it may take weeks before world health officials can determine how effective vaccines being used in the United States are against the new variant, which has been dubbed “omicron.”
“Given that history, we expect that most likely the current vaccines will be sufficient to provide protection,” he said. “And especially the boosters will give that additional layer of protection because there’s something about the booster that causes your immune system to really expand its capacity against all kinds of different spike proteins, even ones it hasn’t seen before.”
Collins said on CNN that the emergence of the new variant is “another reason” for people who have not received a coronavirus booster shot to do so once they are eligible.
“The booster basically enlarges the capacity of your immune system to recognize all kinds of spike proteins its never seen,” Collins explained. “This is a great day to go and get boosted or find out how to do so.”
The World Health Organization said Monday that the coronavirus variant first identified in India last year will be reclassified as a “variant of concern,” indicating that it has become a global health threat.
The B.1.617 variant has been found to spread more easily than the original virus, with some evidence indicating that it may evade some of the protections provided by the vaccines, according to a preliminary study. But the shots are still considered effective. The agency will provide more details on Tuesday.
The highly contagious, triple-mutant variant is also the fourth variant to be designated as a global concern, prompting enhanced tracking and analysis. The other variants are those first detected in Britain, South Africa and Brazil.
“We are classifying this as a variant of concern at a global level,” said Maria Van Kerkhove, WHO technical lead on COVID-19, per Reuters. “There is some available information to suggest increased transmissibility.”
A variant is labeled as “of concern” if it is shown to be more contagious, more deadly or more resistant to current vaccines and treatments, according to the WHO.
The global agency said the predominant lineage of B.1.617 was first identified in India in December, although an earlier version was spotted in October 2020.
The variant has already spread to other countries, and many nations – including the U.S. – have moved to end or restrict travel from India.
“Even though there is increased transmissibility demonstrated by some preliminary studies, we need much more information about this virus variant and this lineage and all of the sub-lineages,” said Maria Van Kerkhove, the WHO’s technical lead for COVID-19.
India reported a record-high of daily coronavirus cases, averaging about 391,000 new daily cases and about 3,879 deaths per day, according to Johns Hopkins University data.
The pandemic won’t end for anyone until it ends for everyone. That sentiment has been repeated so many times, by so many people, it’s easy to forget it’s not just a cliche—particularly if you live in one of the wealthy countries, like the U.S. and Israel, that has made significant moves toward what feels like an end to the COVID-19 era.
Israel, for example, has fully vaccinated more than half of its population and about 90% of its adults 50 and older are now immune to the virus—enough that the country is “busting loose” and “partying like it’s 2019,” as the Washington Post put it last week. The U.S. is a bit further behind, with nearly 30% of its population fully vaccinated, but the possibility of a post-pandemic reality is already coming into focus. While daily case counts remain high, they are far lower than they were even a few months ago—about 32,000 diagnoses were reported on April 25, compared to daily tallies well above 250,000 in January. Deaths have also trended downward for most of 2021. The U.S. Centers for Disease Control and Prevention has relaxed its guidance on travel and indoor gatherings, and some states have repealed mask mandates and other disease precautions.
But while people in certain affluent countries celebrate a return to vacations and parties, COVID-19 remains a dire threat in many nations around the world—nowhere more so than India. For five days in a row, the country has set and reset the global record for new cases in a single day, tallying about 353,000 on April 26.
By official counts, about 2,000 people in India are dying from COVID-19 every day as hospitals grow overtaxed and oxygen supplies run short. Experts say the true toll is likely even higher than that. People are dying as they desperately seek treatment, and crematoriums nationwide are overwhelmed.
It can be difficult to grapple with that devastating reality when people in countries like the U.S. are reuniting with loved ones and cautiously emerging from lockdown. How can both scenarios be happening at once? The answer, as it often has during the pandemic, lies in disparity. As of April 26, 83% of vaccinations worldwide had been given in high- and upper-middle-income countries, according to a New York Times data analysis. In the developing world, many countries are preparing for the reality that it could take until 2022 or even 2023 to reach vaccination levels already achieved by richer countries today. Even in India, one of the world’s leading vaccine manufacturers, fewer than 10% of people have gotten a vaccine—a cruel irony, as people in India die in the streets while those thousands of miles away celebrate receiving their second doses.
To truly defeat COVID-19, we must reckon with that cognitive dissonance, says Dr. Rahel Nardos, who is originally from Ethiopia and now works in the University of Minnesota’s Center for Global Health and Social Responsibility. As an immigrant and global health physician who lives in the U.S., Nardos says she inhabits two worlds: one in which the U.S. may feasibly vaccinate at least 70% of its population this year, and another in which many countries struggle to inoculate even 20% of their residents in the same time frame.
“It’s a huge disparity,” Nardos says. “We need to get out of our silos and start talking to each other and hearing each other.”
That’s imperative, first and foremost because it could save lives. More than 13,000 people around the world died from COVID-19 on April 24. Remaining vigilant about disease prevention and monitoring, and working to distribute vaccines in countries that desperately need them to fight back COVID-19 surges, could help prevent more deaths in the future. That’s especially critical for developing countries, many of which are so overwhelmed by COVID-19 that nearly all other aspects of health care have suffered. “We may be looking at five, 10 years before they can get back to their baseline, which wasn’t that great to begin with,” Nardos says.
There’s also a global health argument for distributing vaccines more equitably.Infectious diseases do not respect borders. If even one country remains vulnerable to COVID-19, that could allow the virus to keep spreading and mutating, potentially evolving to such a point that it could infect people who are vaccinated against original strains of the disease. Already, vaccine makers are exploring the possibility of booster shots to add extra protection against the more transmissible variants currently circulating in various parts of the world.
We aren’t at that point yet; currently authorized vaccines appear to hold up well against these variants. But if the virus keeps spreading for years in some areas, there’s no telling what will happen, says Jonna Mazet, an epidemiologist and emerging infectious disease expert at the University of California, Davis.
“Evolution of those new strains could go into multiple directions. They may evolve to cause more severe or less severe disease. Some of the variants [could be] more concerning for young people,” Mazet says. “The whole dynamics of the disease change.”
And if the virus is mutating somewhere, chances are good it will eventually keep spreading in multiple areas, Mazet says. “Unless or until we have a major shift, we are still going to have large parts of every country that have a susceptible population,” she says. “The virus is going to find a way.”
The only way to stop a virus from mutating is to stop giving it new hosts, and vaccines help provide that protection. COVAX—a joint initiative of the World Health Organization; Gavi, the Vaccine Alliance; the Coalition for Epidemic Preparedness Innovations; and UNICEF—was meant to ensure that people in low-income countries could get vaccinated at the same time as people in wealthier ones. COVAX is providing free vaccines to middle- and low-income countries, using funds gained through purchase agreements and donations from richer countries. But supply and funding shortages have made it difficult for the initiative to distribute vaccines as quickly as it intended to. Many of the doses it planned to disseminate were supposed to have come from the Serum Institute of India, which delayed exporting doses in March and April as India focused on domestic vaccine rollout to combat its COVID-19 surge at home.
In the meanwhile, many poorer countries have been unable to vaccinate anywhere close to as many people as would be required to reach herd immunity. That will almost surely improve as new vaccines are authorized for use by regulators around the world, and as manufacturers scale up production, but those moves may be months away.
COVAX is also developing a mechanism through which developed countries could donate vaccine doses they don’t need. Some wealthy countries, including the U.S. and Canada, have contracts to purchase more than enough doses to vaccinate their entire populations, and have signaled their intent to eventually donate unneeded supplies—but timing is everything. That is, these countries will likely only donate once they are sure their own populations have been vaccinated at a level that ensures herd immunity.
On April 25, the Biden Administration said the U.S. would provide India with raw supplies for making AstraZeneca’s vaccine, as well as COVID-19 tests and treatments, ventilators, personal protective equipment, and funding. That’s a significant shift, since the export of raw vaccine materials was previously banned, but it still doesn’t provide India with ready-to-go vaccines. That step may be next, though. The U.S. will export as many as 60 million doses of AstraZeneca’s vaccine once the shot clears federal safety reviews, the Associated Press reports.
Gian Gandhi, UNICEF’s COVAX coordinator for supply, says he fears many wealthy countries’ vaccine donations may not come until late in 2021, just when global supply is expected to ramp up. That may cause a bottleneck effect: all doses may come in at once, rather than at a slow-but-steady pace that allows countries with smaller health care networks to distribute them. “We need doses now, when we’re not able to access them via other means,” Gandhi says.
The global situation is also critical now. Worldwide, more than 5.2 million cases and 83,000 deaths were reported during the week leading up to April 18. Indian hospitals are so overrun, crowds have formed outside their doors and desperate families are trying to source their own oxygen. Hospitals in Brazil are reportedly running out of sedatives. Iran last week broke daily case count records three days in a row. Countries across Europe remain under various forms of lockdown. Vaccines won’t change those realities immediately—but without them, the global community stands little chance of containing COVID-19 worldwide.
HENRY KOTULA 