POST 165. May 31,2001. CORONAVIRUS. “Like all pandemics, this one will end either with millions — maybe billions — being infected or being vaccinated. This time, world leaders have a choice, but little time to make that choice before it is made for them.”

 “In countries with widespread vaccination.. we can expect that Covid cases, hospitalizations and deaths will continue to decline or stay low, especially because lab tests and real world experience show that vaccines appear to defend recipients well against the severe effects of both variants. For much of the rest of the world, though, these even more transmissible new variants could be catastrophic…” 

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“Breakthrough infections — those occurring in people who have been vaccinated against COVID-19 — are happening. So far, though, they are largely occurring without major problems. Most people are asymptomatic, and their cases are discovered only during routine testing.

As variants of the novel coronavirus continue to spread and mutate, researchers are monitoring how the vaccines perform and whether booster shots will be needed to maintain meaningful immunity.

Right now, experts say it’s too early to speculate whether we’ll need booster shots like some routine vaccines.

Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security in Baltimore, says it’s premature to predict whether COVID-19 boosters will be needed and, if so, at what intervals.

“To me, the threshold for boosters would be to see fully vaccinated individuals getting breakthrough infection severe enough to land them in the hospital,” Adalja told Healthline. “We have not crossed that threshold.”…(L)

“Leading infectious disease expert Anthony Fauci on Wednesday said that he believes recipients of the coronavirus vaccine will need a booster shot, but he declined to say when.

“I don’t anticipate that the durability of the vaccine protection is going to be infinite,” Fauci told a Senate subcommittee. “It’s just not. So I would imagine we will need, at some time, a booster.”

He said the interval of protection from the vaccines is unknown but that it lasts at least six months and likely a year.

Fauci said that he is “not exactly sure when” a booster would be needed but that research into vaccine durability is ongoing.” (A)

“The U.S. government is planning for the potential need for Covid-19 vaccine booster shots “just in case,” the head of the Centers for Disease Control and Prevention told CNBC.

CDC Director Dr. Rochelle Walensky didn’t say what those plans were. However, should Americans require booster shots, the U.S. would likely need to make arrangements with drugmakers to supply additional doses and make plans for vaccine distribution.

Walensky told CNBC that U.S. health officials are “thinking ahead” in the event that vaccine-induced immunity against the coronavirus begins to wane. Officials still don’t know if that will happen or if booster shots will be needed, “but we are planning for it just in case,” she said.

“Right now, if you have two doses of the mRNA vaccines, you are protected,” Walensky said in comments that aired Tuesday during CNBC’s Healthy Returns Summit.

“What we’re talking about is thinking ahead,” she said in the interview with CNBC’s Meg Tirrell. “What happens if in a year from now or 18 months from now your immunity wanes? That’s really our job is to hope for the best and plan for what might happen if we need further boosters in the future, the way we get flu vaccine boosters every year.”

Walensky said scientists are currently looking at the immunity of a small population of people who were vaccinated months ago. However, she said, she doesn’t expect scientists will do mass testing looking for reduced immunity against the virus….

Walensky told CNBC scientists still don’t know whether the coronavirus is seasonal with new infections slowing down during warm summer months and speeding up in the winter.

Some scientists predict states will see repeated outbreaks when the U.S. enters its colder months.

“We have other coronaviruses be seasonal viruses and yet this coronavirus has not proven to be seasonal,” she said, adding that the U.S. witnessed a surge in cases last summer.” (B)

“Pfizer announced Monday morning that it had started testing a COVID-19 booster shot — a third dose the company’s CEO said fully vaccinated people will likely need in another 12 months.

The goal of the study is to see whether another vaccine can be taken along with a booster dose of Pfizer’s COVID-19 vaccine. In the study, participants will get both the booster shot and a pneumonia vaccine.

“To see if they’re able to tolerate it, see if that in any way adversely affects their development of antibodies against COVID-19 and see how the immune reaction is, you know, the side effect profile of the combination,” Joshi explained. “And if that looks good, maybe then consider combining it with seasonal flu vaccine as well.” (C)

“A large body of research on the coronavirus now indicates that both natural infection and vaccines stimulate the production of these long-lasting memory cells, which means that boosters should not be needed any time soon to conquer covid-19.

We already knew mRNA vaccines — like the Moderna and Pfizer vaccines being widely administered against the coronavirus — form memory B cells. That finding was bolstered in a big way Monday, when researchers reported finding memory B cells in the bone marrow of people who had experienced even mild cases of covid-19. Another study of recovered covid-19 patients found the development of memory T cells comparable to those generated by yellow fever vaccination, which usually needs just one dose over a person’s lifetime. And a 2020 study showed that T cells generated among patients who survived the SARS pandemic of 2003, which is caused by a similar virus, were still going strong 17 years later, indicating long-lasting immunity…

The talk of boosters is not only distracting from the brighter and brighter light we are seeing at the end of our covid-19 nightmare in the United States and the start of normal life, it also distracts us from the most pressing problem of our day, which is to achieve global vaccine equity. Unfortunately, pharmaceutical company executives have suggested that boosters could be necessary for coronavirus vaccines as soon as this fall. Pouring effort into developing boosters — Pfizer has begun studying a modified third booster shot to follow its initial two-shot regiment — threatens to distract from production of adequate supplies of vaccine for the world. Moreover, such messaging of perpetual boosters could also dissuade some people from getting the vaccine altogether.

The pandemic is not over until it is over for all of us. We also have a moral and ethical obligation based on our interconnectedness to vaccinate the planet. Let’s cease talk that boosters will be needed in the near future and get vaccines out to the world.” (D)

““People who were infected and get vaccinated really have a terrific response, a terrific set of antibodies, because they continue to evolve their antibodies,” Dr. Nussenzweig said. “I expect that they will last for a long time.”

The result may not apply to protection derived from vaccines alone, because immune memory is likely to be organized differently after immunization, compared with that following natural infection.

That means people who have not had Covid-19 and have been immunized may eventually need a booster shot, Dr. Nussenzweig said. “That’s the kind of thing that we will know very, very soon,” he said….

The results of Dr. Nussenzweig’s study suggest that people who have recovered from Covid-19 and who have later been vaccinated will continue to have extremely high levels of protection against emerging variants, even without receiving a vaccine booster down the line.

“It kind of looks exactly like what we would hope a good memory B cell response would look like,” said Marion Pepper, an immunologist at the University of Washington in Seattle who was not involved in the new research.

The experts all agreed that immunity is likely to play out very differently in people who have never had Covid-19. Fighting a live virus is different from responding to a single viral protein introduced by a vaccine. And in those who had Covid-19, the initial immune response had time to mature over six to 12 months before being challenged by the vaccine.

“Those kinetics are different than someone who got immunized and then gets immunized again three weeks later,” Dr. Pepper said. “That’s not to say that they might not have as broad a response, but it could be very different.” (E)

“Ram Singh Karki escaped the first wave of India’s pandemic by boarding a crowded bus and crossing the border home to Nepal. Months later, as the rate of new infections fell, he returned to his job at a printing press in New Delhi, which had sustained his family for two decades and helped pay the school fees of his three children.

Then India was swept by a second wave, and Mr. Karki wasn’t as lucky…

Nepal is now considering declaring a health emergency as the virus rampages virtually unchecked across the impoverished nation of 30 million people. Carried by returning migrant workers and others, a vicious second wave has stretched the country’s medical system beyond its meager limits.

Nepal has recorded half a million Covid cases and 6,000 deaths, numbers that experts believe deeply undercount the toll. Testing remains limited. One figure could indicate the true severity: For weeks now, about 40 percent of the tests conducted have been positive.” (F)

“In countries with widespread vaccination, like the United States and Britain, we can expect that Covid cases, hospitalizations and deaths will continue to decline or stay low, especially because lab tests and real world experience show that vaccines appear to defend recipients well against the severe effects of both variants.

For much of the rest of the world, though, this even more transmissible new variant could be catastrophic…

Increased transmissibility is an exponential threat. If a virus that could previously infect three people on average can now infect four, it looks like a small increase. Yet if you start with just two infected people in both scenarios, just 10 iterations later, the former will have caused about 40,000 cases while the latter will be more than 524,000, a nearly 13-fold difference.

Morally and practically, this emergency demands immediate action: widespread vaccination of those most vulnerable where the threat is greatest…

Vaccine supplies need to be diverted now to where the crisis is the worst, if necessary away from the wealthy countries that have purchased most of the supply. It is, of course, understandable that every nation wants to vaccinate its own first, but a country with high levels of vaccination, especially among its more vulnerable populations, can hold things off, especially if they also had big outbreaks before. In addition, excess stockpiles can go where they are needed without even slowing down existing vaccination programs…

The kind of catastrophic outbreak like the one in India can cause many more needless deaths simply by overwhelming our resources. Already, there are reports that countries ranging from Nepal to the Philippines to South Africa to Nigeria may face supplemental oxygen shortages of the kind seen in India. This pathogen has one fatality rate when oxygen is available as a therapy and one when it is not, and it would be an unspeakable tragedy to suffer the latter in the second year of the pandemic.

Like all pandemics, this one will end either with millions — maybe billions — being infected or being vaccinated. This time, world leaders have a choice, but little time to make that choice before it is made for them.” (G)

“…Most low-income and middle-income countries (LMICs) face difficulties in accessing and delivering vaccines and therapeutics for COVID-19 to their populations.5 COVAX will require decisive action by Gavi, the Vaccine Alliance, WHO, and the Coalition for Epidemic Preparedness Innovations (CEPI), supported by the countries they serve and with financing for vaccine purchasing, to ensure people worldwide have equitable access to COVID-19 vaccines…8

Many LMICs do not have an established platform for vaccinating their adult populations.10 Although it is feasible to deliver COVID-19 vaccines to health-care and other front-line essential workers, in some LMICs it will be difficult to effectively reach and vaccinate with two doses all elderly populations and individuals with co-morbidities, given insufficient mechanisms to identify such groups. Governments and technical leaders will need to use transparent, accountable, and unbiased processes when they make and explain evidence-based vaccine prioritisation decisions, while also building confidence in COVID-19 vaccines and engaging with all the stakeholders.

The ultracold chain requirements of mRNA COVID-19 vaccines are likely to be an insurmountable hurdle in LMICs, outside of major cities. COVID-19 vaccine delivery will require considerable investment of resources, health-care staff, and careful planning to avoid opportunity costs, including a disruption of routine health services and a decline in essential childhood vaccination coverage, which could result in outbreaks of measles and other vaccine-preventable diseases…

There are further challenges. Governments in LMICs with strong private health sectors, as those in high-income countries, will need to manage the inherent potential for inequity, whereby the rich could access COVID-19 vaccines before individuals with less access to private care who may be at increased risk of severe disease and death, such as older people and those with comorbidities. LMICs affected by war, civil conflict, economic crises, or natural disasters, or with large refugee populations or populations with special needs or vulnerabilities need additional support for vaccines and vaccination under extremely difficult operational conditions.” (H)

“In January, the director-general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, issued a blunt warning. The world was “on the brink of a catastrophic moral failure,” he said. Wealthy countries were buying up available COVID-19 vaccines, leaving tiny amounts for others—a replay of what happened during the 2009 influenza pandemic. “The price of this failure will be paid with lives and livelihoods in the world’s poorest countries,” Tedros said.

He was right. Today, some rich countries are vaccinating children as young as 12 years old, who are at extremely low risk of developing severe COVID-19, while poorer countries don’t even have enough shots for health care workers. Nearly 85% of the COVID-19 vaccine doses administered to date have gone to people in high-income and upper middle–income countries. The countries with the lowest gross domestic product per capita only have 0.3%.

Tedros lambasted the “scandalous inequity” again in his opening speech at the World Health Assembly on 24 May. By September, at least 10% of the population in every country should be vaccinated, he said.

Disparities in global health are nothing new. Lifesaving therapies such as monoclonal antibodies are unavailable in large parts of the world. Even vaccines and drugs that cost pennies to make don’t reach millions of people who need them. But the COVID-19 crisis has exposed the inequities in a distinct, acute way. As normality is returning to vaccine front-runners such as Israel, the United Kingdom, and the United States, India’s health system is buckling under soaring case numbers—and the world is still recording almost 5 million cases and more than 80,000 deaths every week.

The moral argument aside, there’s a very practical reason to try to distribute vaccines more equitably: No part of the world can feel safe if the pandemic rages on elsewhere, posing the risk of reintroduction and spawning potentially more dangerous viral mutants.” (I)

“In 2021, the globe has been split into coronavirus vaccine “haves” and “have-nots,” creating a gap that may define the next phase of the pandemic.

Using publicly available figures from Our World in Data, The Washington Post found that 45 percent of all vaccine doses administered so far have gone to just 16 percent of the world’s population in what the World Bank considers high-income countries.

Through the summer and fall of last year, wealthy nations cut deals directly with vaccine-makers, buying up a disproportionate share of early doses — and undermining a World Health Organization-backed effort, called Covax, to equitably distribute shots.

So now, in a small number of relatively wealthy nations, including the United States, doses are relatively plentiful and mass immunization campaigns are progressing apace. But much of the world is still struggling to secure enough supply. For many, herd immunity is many months — if not years — away, which could extend the crisis.

A team at Duke University’s Global Health Innovation Center recently found that high-income countries locked up 53 percent of near-term vaccine supply. They estimate that the world’s poorest 92 countries will not be able to reach a vaccination rate of 60 percent of their populations until 2023 or later.” (J)

“Until the whole world is vaccinated, the whole world will be at risk. The longer the world lets the virus run free to infect and mutate, the more likely the world will face a prolonged pandemic or another outbreak altogether, pervasive economic decline, and other crises. One year after the pandemic began, the question is not how the world can vaccinate itself, but whether the global commitment exists to do so. Now is the time to decide—ending this pandemic depends on it.” (K)

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