POST 188. August 15, 20201. CORONAVIRUS. “According to an internal CDC briefing….an estimated 1.1 million people have already gotten unauthorized booster shots…”….”If it is left up to the honor system, I think many Americans will suddenly wake up and find themselves immunocompromised enough to get a 3rd dose,”

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“According to an internal CDC briefing reviewed by ABC News, an estimated 1.1 million people have already gotten unauthorized booster shots. The number is most likely an undercount because it includes Moderna and Pfizer recipients who have re-upped but not those who received the single-dose Johnson & Johnson vaccine and then sought out another shot. The leading states for booster-shot seekers are Florida (a state with many older residents currently facing one of the worst outbreaks in the world), Ohio, California, Illinois, and Tennessee.” (Q)

“With the Delta variant surging, and breakthrough cases in Massachusetts nearing 8,000, people are already deciding they do not have time to wait. Some are crossing state lines in hopes of evading detection. Others are darting into pharmacies where they’ve heard no questions will be asked or falsely declaring that they have not already gotten a jab.

People who got J&J may be particularly eager to get an extra shot (even though a new study, out of South Africa, shows it is effective against Delta), but as cases mount, and COVID closes in again, many who got Moderna or Pfizer are also interested, according to observers, as are those with compromised immune systems.

“People are trying to get that third shot by hook or by crook,” said Peter Grinspoon, an internist at Massachusetts General Hospital who’s been bombarded with “can you help me’s” from patients and friends….” (A)

“While Pfizer has said it plans to seek U.S. Food and Drug Administration approval for booster shots, health authorities say that for now, the fully vaccinated seem well protected.

Yet health care providers in the U.S. have reported more than 900 instances of people getting a third dose of COVID-19 vaccines in a database run by the Centers for Disease Control and Prevention, an Associated Press review of the system’s data found. Because reporting is voluntary, the full extent of people who have received third doses is unknown. It’s also unknown if all of those people were actively trying to get a third dose as a booster.

“I don’t think that anyone really has the tracking” in place to know how widespread it is, said Claire Hannan, executive director for the Association of Immunization Managers.

One entry in the CDC database shows a 52-year-old man got a third dose from a California pharmacy on July 14 by saying he had never received one and by providing his passport, rather than a driver’s license, as identification. But when the pharmacy contacted the patient’s insurance provider, it was told he had received two doses in March.

In Virginia, a 39-year-old man got a third shot from a military provider on April 27 after he showed a vaccine card indicating he had received only one dose. A review of records turned up his previous vaccines. The patient then told the provider that the time between his first and second doses was more than 21 days, “so they spoke to their provider, who ‘authorized’ them to get a third shot,” an entry states.

Colorado Gov. Jared Polis said at a recent news briefing that he knew of residents who had received third dose by using fake names, but neither his office nor the state health department could provide any evidence.

Despite a lack of FDA approval, public health officials in San Francisco said Tuesday that they will provide an extra dose of the Pfizer or Moderna vaccine for people who got the single-shot Johnson & Johnson variety — referring to it as a supplement, rather than a booster.” (B)

“….Should the nearly 60% of adult Americans who have been fully vaccinated seek out a booster or not? Is the protection that has allowed them to see loved ones and go out to dinner fading?

Ultimately, the question of whether a booster is needed is unlikely to determine the FDA’s decision. If recent history is predictive, booster shots will be here before long. That’s because of the outdated, 60-year-old basic standard the FDA uses to authorize medicines for sale: Is a new drug “safe and effective”?

The FDA, using that standard, will very likely have to authorize Pfizer’s booster for emergency use, as it did the company’s prior covid shot. The booster is likely to be safe — hundreds of millions have taken the earlier shots — and Pfizer reported that it dramatically increases a vaccinated person’s antibodies against SARS-CoV-2. From that perspective, it may also be considered very effective.

But does that kind of efficacy matter? Is a higher level of antibodies needed to protect vaccinated Americans? Though antibody levels may wane some over time, the current vaccines deliver perfectly good immunity so far.

What if a booster is safe and effective in one sense but simply not needed — at least for now?

Reliance on the simple “safe and effective” standard — which certainly sounds reasonable — is a relic of a time when there were far fewer and simpler medicines available to treat diseases and before pharmaceutical manufacturing became one of the world’s biggest businesses.” (C)

“Pfizer reported on Wednesday that the power of its two-dose Covid vaccine wanes slightly over time, but nonetheless offers lasting and robust protection against serious disease. The company suggested that a third shot could improve immunity, but whether boosters will be widely needed is far from settled, the subject of heated debate among scientists.

So far, federal health officials have said boosters for the general population are unnecessary. And experts questioned whether vaccinated people should get more doses when so many people have yet to be immunized at all.

“There’s not enough evidence right now to support that that is somehow the best use of resources,” said Natalie Dean, a biostatistician at Emory University in Atlanta.

Still, the findings raise questions about how well the Pfizer vaccine will prevent infection in the months to come. And with coronavirus cases surging again in many states, the data may influence the Biden administration’s deliberations about delivering boosters for older people.

If third shots are cleared for the general population, the boosters would likely represent a multi-billion-dollar business for Pfizer.” (D)

“Moderna said Thursday that its COVID-19 vaccine maintained 93 percent efficacy six months after the second dose but said that a booster shot will likely still be needed before the winter.

The 93 percent efficacy after six months announced by Moderna ahead of an earnings call on Thursday is a positive sign and compares to 84 percent efficacy after that time for the Pfizer vaccine.

Still, Moderna CEO Stephane Bancel said on CNBC on Thursday that the data was collected before the delta variant became prevalent in the United States, meaning the equation could change now that the delta variant is widespread.

“We are pleased that our COVID-19 vaccine is showing durable efficacy of 93% through six months but recognize that the Delta variant is a significant new threat, so we must remain vigilant,” Bancel said in a statement.

While there is strong data for six months, the company said in a presentation that it believes antibody levels will “continue to wane and eventually impact vaccine efficacy.”

It added that the combination of delta, fatigue with wearing masks and people moving indoors as the weather gets colder will cause an “increase of breakthrough infections in vaccinated individuals.”

“Given this intersection, we believe dose 3 booster will likely be necessary prior to the winter season,” the company said.” (E)

“The Johnson & Johnson coronavirus vaccine provides immunity that lasts at least eight months. The immunity appears to provide adequate protection against the worrying delta variant, the company said in a statement Thursday night.

“Current data for the eight months studied so far show that the single-shot Johnson & Johnson COVID-19 vaccine generates a strong neutralizing antibody response that does not wane; rather, we observe an improvement over time,” Dr. Mathai Mammen, head of research and development at J&J’s Janssen vaccine arm, said in a statement.

One dose of the vaccine elicits a lasting antibody response and generates immune cells called T-cells that last eight months, the company said.

A research team tested blood from vaccinated volunteers against different variants of the virus. One of the variants tested was the delta variant.

“We see robust neutralizing antibody coverage of the variant,” said Dr. Dan Barouch, of Beth Israel Deaconess Medical Center and Harvard Medical School.

The immune system utilizes neutralizing antibodies to inactivate a virus before it can replicate.

J&J said a second or booster dose of its vaccine would not be necessary.” (F)

“There are generally two reasons why people might consider vaccine boosters. The first is that immunity naturally wanes over time. Without repeated exposure to certain antigens, the immune system may become less able to prevent infection or disease. Vaccine boosters help the immune system maintain a protective response.

“Another reason we may need booster vaccinations is viral variants,” a spokesperson from the COVID-19 Vaccine Team at the University of Oxford told Medical News Today. They went on to explain:

“Some variants have evolved to avoid some parts of our immune response, which means they can more easily infect those who have an existing immune response to the virus — i.e., those who have been previously infected or vaccinated. However, the virus cannot avoid all parts of our immune response. A booster vaccination is helpful, as it can improve the parts of our immune response the viral variant cannot avoid.”

“Alternatively, we can use a booster vaccine that specifically targets the viral variant. This works by producing a new immune response to the parts of the virus which have changed from the original vaccine whilst also improving the existing immune response against the unchanged parts of the virus, which also should help protect against other variants,” they added.” (G)

“In late June, O’Halloran and her team at the Washington University School of Medicine researchers published their study in the journal Nature showing that germinal centers were still forming in participants for up to 15 weeks after vaccination. Although that might not seem like a long time, O’Halloran says the idea is that those germinal centers “are potentially producing these long-lived memory cells that we need to give long-term immunity.” The study’s lead author Ali Ellebedy told National Institutes of Health director Francis Collins that the germinal center response is so robust that he believes it could last for years.

“This gives us insight that the body is doing what it’s supposed to be doing,” O’Halloran says. Wherry, who wasn’t involved with the study, agrees. “Now we know for sure that’s happening really robustly with these vaccines,” he says.

But the study provides a fairly small dataset, particularly when compared to the abundant studies measuring antibody levels. That’s because studies like this one are much harder and take longer—meaning fewer researchers have been able to take them on.

“Sometimes the easy bit to measure is not the thing that gives us the best window into what’s going on in the body,” O’Halloran says.

O’Halloran also points out the study only speaks to the durability of the Pfizer shot. Some observers have extrapolated that Moderna’s vaccine may have similar durability since it relies on the same mRNA technology. But for that and the Johnson & Johnson vaccine, O’Halloran says, you’ll have to look to how they’re performing in the real world.

Another argument Pfizer has made for booster shots has pointed to real-world data out of Israel showing that the efficacy of its vaccine declines six months after full vaccination. On July 5, Israel’s Ministry of Health said that it has observed a “marked decline” in the vaccine’s efficacy to 64 percent in preventing both infection and symptomatic illness.

There’s also some indication that protections are waning among the immunocompromised, leading Israel to begin administering a third jab to transplant patients. (Here’s why COVID-19 vaccines are so complex for immunocompromised people.)

Wherry says that the dramatic decline in efficacy in Israel can be attributed in part to the country’s robust COVID-19 testing program. “They test everybody all the time,” he says. “They’re picking up asymptomatic infections.”

He points out that Israel’s data shows the vaccine remains 93 percent effective in preventing serious illness and hospitalization. This suggests that, while the vaccines may no longer be producing the robust levels of antibodies that shield people entirely from infection, the long-term memory response is still kicking in and preventing the infection from spreading.

Public health data elsewhere would seem to back that up: Earlier this month, CDC director Rochelle Walensky said that more than 99 percent of the U.S. deaths from COVID-19 in June were among unvaccinated people. O’Halloran says that’s really the point of getting vaccinated.

“At no point have the vaccines been said to 100 percent prevent infection,” O’Halloran says. “The most important thing is their impact on severe disease and death.””  (H)

“If there were enough vaccines for every adult in the world, third doses for those in rich countries wouldn’t appall so many researchers. But disparities are growing. A July report from KFF, a health-policy organization based in San Francisco, California, finds that low-income countries won’t achieve substantial levels of protection until at least 2023, at current vaccination rates. Almost all of the roughly 3.2 billion mRNA vaccine doses expected this year from manufacturers Pfizer–BioNTech and Moderna in Cambridge, Massachusetts, have been purchased by the United States and Europe, according to the London-based analytics company Airfinity. Although some of those will be donated to countries in need, the KFF report suggests that they will be insufficient. The pace of vaccination in low-income countries needs to increase 19-fold to inoculate 40% of those nations’ populations by the end of the year, the report says.

This modest vaccination target of 40% is endorsed by the WHO, the World Bank and the IMF as a threshold that would significantly reduce deaths and allow economies to begin recovery. But because it looks increasingly out of reach, the IMF has revised its economic forecasts for 2021, downgrading projections for developing and emerging economies. It warns that highly infectious variants could derail worldwide economic recovery and wipe US$4.5 trillion from the global gross domestic product by 2025.”  (I)

“The World Health Organization on Wednesday called for a halt on booster shots of coronavirus vaccines through at least September, as poorer countries struggle to access doses, even for high-risk populations such as health-care workers and the elderly.

“We cannot and we should not accept countries that have already used most of the global supply of vaccines using even more of it while the world’s most vulnerable people remain unprotected,” WHO Director General Tedros Adhanom Ghebreyesus said at a news conference.

Tedros said the focus for now should be meeting the U.N. health agency’s goal of 10 percent vaccination coverage in every country by the end of September. So far, more than 80 percent of vaccine doses globally have gone to high- and upper-middle-income countries that account for less than half of the world’s population.

The remarks come as the United States and other wealthy nations weigh whether and when booster shots are necessary and consider how to balance domestic calls for additional doses against growing evidence of an alarming vaccine gap around the world.

White House press secretary Jen Psaki on Wednesday said the WHO was presenting a “false choice.”

The United States announced Tuesday “an important milestone” of more than 110 million vaccine doses donated to the world, she said, more than all other countries have shared, combined.

“More needs to happen, but we believe we can do both,” she said.”  (J)

“Here, Nature looks at what scientists know — and what they wish they knew — about COVID-19 vaccine boosters.

Do boosters actually work?

Can COVID vaccines stop transmission? Scientists race to find answers

Is immunity from vaccines waning?

Are vaccinations given months ago still preventing infections?

What about protection from serious illness with COVID-19?

What else could change the calculation on boosters?

What it will take to vaccinate the world against COVID-19?…

Despite the lack of evidence in favour of offering boosters now, Aran expects policymakers to err on the side of caution and begin offering boosters to at-risk groups in the coming weeks. “The risk is low, the advantage is high,” he says. After initially spurning the idea of third doses for most people, the US government is now considering them, according to news reports…. “(K)

“Israel and other countries are rolling out third doses of COVID-19 vaccines to people fully vaccinated. But more research is needed on the benefits and timing of booster doses.

Germany plans to start offering booster doses in September to older adults and people with weakened immune systems. The United Kingdom will also begin its own booster rollout next month.

The United States has yet to fully embrace COVID-19 boosters.

As Delta variant surges threaten to erode pandemic progress, some highly vaccinated countries are offering booster doses of COVID-19 vaccines to their citizens.

This week, Israel began administering third doses of the Pfizer-BioNTech vaccine to people over age 60 who are already fully vaccinated, reports the Associated Press.

According to Reuters, Germany plans to start offering booster doses in September to older adults and people with weakened immune systems. The United Kingdom will also begin its own booster rollout next month.

The United States has yet to fully embrace COVID-19 boosters, but it’s edging in that direction.

As recently as early July, the Centers for Disease Control and Prevention (CDC), along with the Food and Drug Administration (FDA), said “Americans who have been fully vaccinated do not need a booster shot at this time.”

But the agencies added that they’re continuing to monitor the scientific data in order to decide if and when a booster might be needed.”  (L)

“Sure enough, the United States is again awash in virus, with the incidence of new COVID-19 cases having soared 131 percent in the third week of July. To be clear, the vaccines available work well—especially the Pfizer and Moderna products based on mRNA technology. But it is likely that waning vaccine efficacy, coupled with a stubborn one-fifth of the adult population refusing any immunization, has opened the door for the dangerous mutant delta variant of SARS-CoV-2 to wreak havoc among the vaccinated and unvaccinated alike.

That’s why the United States is going to need a third dose of mRNA vaccines; for the nation’s older population, the triple play is already overdue. “I don’t see the virus just disappearing,” said Stanley Plotkin, considered the godfather of vaccinology. The University of Pennsylvania vaccine inventor and immunologist told me that the U.S. Food and Drug Administration (FDA) should comply with requests from Pfizer, following Israel’s example, and immediately approve third-dose immunization for adults over the age of 60, with general triple dosing for all Americans to follow. I agree…

In Atlanta, CDC scientists are scrambling to comprehend what havoc the variant strains are wreaking, how well the vaccines are working, and what forecast ought to end up on the president’s desk. For several months, the CDC has refereed a sort of artificial intelligence conference of modelers and forecasters from all over the United States, mostly academics. Each epidemic modeling team uses its own methodology to track the U.S. epidemic and forecast where it’s headed. Some of the teams are very cautious and consistently lowball the scale of future trends. Some routinely tend to the opposite extreme. The CDC grinds it all up to reach a sort of projection consensus. And so far, these forecasts have been scary correct.

In its latest modeling mashup, the CDC forecast predicts that the new delta-driven surge won’t peak until October, possibly not until Thanksgiving. By late August, at least 2,500 Americans will die, every week, bringing the nation’s cumulative mortality to some 660,000.

With a forecast so grim, it’s time for a Hail Mary move. And that would be the mass third-dose vaccination of every American over 60 years of age, coupled with a return to mask-wearing and social distancing and a massive escalation in genomic surveillance nationwide. Anything less means ceding the battlefield to the virus.” (M)

“To determine whether and when boosters will be needed, experts say there are three key questions that government health officials will need to answer:

How does the immune response generated by the shots hold up over time?

Are there new virus variants that elude the vaccines?

How are the strong efficacy numbers seen in clinical trials holding up in the real world?..

One reason for the ongoing debate is that the science behind Covid-19 boosters is unsettled. There are no agreed-upon blood measurements that scientists can use to confidently determine when protection has eroded.

So deciding when a third jab is needed will be a judgment call by public health officials, one that may differ from country to country. U.S. authorities emphasize they won’t rely only on drug company data in making their decision….

“Everyone wants an answer before we have data,” Andrew Pavia, chief of the University of Utah School of Medicine’s pediatric infectious diseases division, said at an event Tuesday. Recommending boosters prematurely would use up valuable shots that could go to billions of people around the world who aren’t vaccinated at all, he said.” (N)

“U.S regulators authorized a third dose of COVID-19 vaccines by Pfizer Inc (PFE.N)-BioNTech and Moderna Inc (MRNA.O) on Friday for people with compromised immune systems who are likely to have weaker protection from the two-dose regimens.

The U.S. Food and Drug Administration amended its emergency use authorization for both vaccines on Thursday, paving the way for people who have had an organ transplant, or those with a similar level of weakened immune system, to get an extra dose of the same shot they have initially received.

An advisory panel to the U.S. Centers for Disease Control and Prevention (CDC) voted to recommend the additional shots, and the agency’s director signed off on that recommendation on Friday. Immunocompromised individuals can begin receving the shots immediately, according to an agency spokesperson.

Mixing of mRNA vaccines is permitted for the third shot if their original vaccine is not available.

Patients will not need a prescription or the signoff of a healthcare provider in order to prove they are immunocompromised and receive the additional dose, according to officials.

“It will be a patient’s attestation, and there will be no requirement for proof or prescription or a recommendation from an individual’s healthcare provider,” CDC official Dr. Amanda Cohn said, speaking before the advisory panel.

There is growing concern about breakthrough infections in vulnerable populations in the United Stats as the country sees a huge spike in new infections from the contagious Delta variant of the coronavirus…

Dr. David Boulware, an infectious disease doctor at the University of Minnesota, backed the FDA decision, noting that most of the fully vaccinated patients he has seen in the hospital are immunocompromised.

Boulware said that the plan to let patients attest to their own status may lead to more people receiving the shots than intended.

“If it is left up to the honor system, I think many Americans will suddenly wake up and find themselves immunocompromised enough to get a 3rd dose,” he said in an email.” (O)

“Clinical experts on the CDC panel spent a good deal of time trying to suss out exactly what conditions might fall under the FDA’s umbrella for a third dose.

In a presentation to the committee, Neela Goswami, MD, an assistant professor of infectious disease and epidemiology at Emory University’s Rollins School of Public Health, stressed that the shots are intended for patients who are moderately or severely immunocompromised in close consultation with their doctors, but that people who should qualify would include:

Those receiving treatments for solid tumors or blood cancers.

Those taking immunosuppressing medications after a solid organ transplant.

People who were within 2 years of receiving CAR-T therapy or a stem cell transplant.

People who have primary immunodeficiencies — rare genetic disorders that prevent the immune system from working properly.

People with advanced or untreated HIV.

Those taking high-dose corticosteroids (more than 20 milligrams of prednisone or its equivalent daily), alkylating agents, antimetabolites, chemotherapy, TNF blockers or other immunomodulating or immunosuppressing biologics.

Certain chronic medical conditions may also qualify, such as chronic renal disease or asplenia — living without a spleen.

People receiving dialysis may also need a third dose

In discussion, CDC experts clarified that these third doses were not intended for people whose immune function had waned with age, such as elderly residents of long-term care facilities, or people with chronic diseases like diabetes.” (P)

“White House chief medical advisor Dr. Anthony Fauci said Thursday everybody will someday “likely” need a booster shot of the Covid-19 vaccines.

“We’re already starting to see indications of some diminution” in the durability of the vaccines, Fauci told “CBS This Morning.”

However, he said it’s not likely that they will be widely administered any time soon. The priority, Fauci said, is to give boosters to people who have compromised immune systems, including those with cancer and transplanted organs.

“We don’t feel at this particular point that, apart from the immune-compromised, we don’t feel we need to give boosters right now,” he said…

The CDC does not currently recommend booster doses of the vaccines for otherwise healthy people at this time. But Fauci, speaking Thursday on NBC’s “TODAY,” said “inevitably there will be a time when we’ll have to get boosts.”

“No vaccine, at least not within this category, is going to have an indefinite amount of protection,” he said.” (R)

“With a stockpile of at least 100 million doses at the ready, Biden administration officials are developing a plan to start offering coronavirus booster shots to some Americans as early as this fall even as researchers continue to hotly debate whether extra shots are needed, according to people familiar with the effort.

The first boosters are likely to go to nursing home residents and health care workers, followed by other older people who were near the front of the line when vaccinations began late last year. Officials envision giving people the same vaccine they originally received. They have discussed starting the effort in October but have not settled on a timetable.

While many outside experts argue there is no proof yet that the vaccines’ protection against severe disease and hospitalization is waning in the United States, administration officials say they cannot afford to put off figuring out the logistics of providing boosters to millions of people until that tipping point is reached. The spotty nature of the nation’s disease-reporting network makes the question of timing even trickier…

Any booster policy decision is fraught, officials said, because the administration does not want to undermine public confidence in what have proved to be powerfully effective vaccines. Nor does it want to overvaccinate Americans when many other countries have yet to even begin vaccination campaigns in earnest, increasing the threat of dangerous new variants that could spread to the United States and evade the vaccines…

Administration officials continued to insist that boosters remained unnecessary for the general population for now. Determining at what point that changes is difficult because administration experts lack up-to-date data on so-called breakthrough infections in vaccinated people, including their prevalence, when such people were vaccinated and which vaccine they received…

Some federal officials cast the booster discussions as contingency planning; others suggested boosters for the general population were extremely likely and the questions were how to give it to them and when.

Jeff Zients, the White House coronavirus coordinator, said that if and when extra shots were needed, they would be rolled out “in a fast and efficient way.”” (S)

“The director of the National Institutes of Health says the U.S. could decide in the next couple weeks whether to offer coronavirus booster shots to Americans this fall.

“Dr. Francis Collins tells “Fox News Sunday” that federal health officials are looking at the U.S. numbers “almost daily” but no decision has been made because cases so far still indicate that vaccinated people remain highly protected from COVID-19, including the delta variant…

Collins says because the delta variant only started hitting hard in July, the “next couple of weeks” of case data will help the U.S. make a decision.” (T)

“Across the United States, the number of coronavirus cases has skyrocketed, leading to calls from public health officials to mask up regardless of vaccination status. Many vaccinated people are asking whether it’s time to get a booster dose. But the math behind the spread of infectious diseases like covid-19 can help us see that it’s not.

The change in coronavirus guidance from the Centers for Disease Control and Prevention and from some local authorities came about because of the delta variant, which epidemiologists estimate has a basic reproductive number between 6 and 9. The basic reproductive number, or R0 (pronounced arr-naught), is a measure of the average number of people directly infected by a single infectious person in a scenario where no one in the population has any immunity to the disease. The original virus that caused covid-19 had an R0 of about 3, meaning that someone infected in April 2020 would, on average, infect three others. The delta variant is two to three times more infectious; on average, one infected person may infect between six and nine people if none of them are vaccinated or had a prior infection.

But the basic reproductive number alone doesn’t tell the whole story. To really understand what we can expect from the delta variant, we need to consider vaccinations, natural immunity and any precautions people are taking to lower their chances of being exposed, such as wearing masks and social distancing. To do that, epidemiologists calculate another measure, called the effective reproduction number, or Re (pronounced arr-eee). The Re helps us estimate how much a disease may spread when a population has at least some immunity. Technically speaking, the Re measures how many new people a single person infects, accounting for whatever precautions people are taking and overall immunity levels. Whether we’re talking about the Re or the R0, any value larger than 1 means trouble, because if each person can infect more than one other person, any disease outbreak will continue to spread exponentially unless we take action….

The math of outbreaks helps us to understand that we cannot control the delta variant by maximizing the immunity of only a segment of the population. If you’ve already been vaccinated, your best next step for lowering your risk of a breakthrough infection is to help your friends, family and neighbors decide to get vaccinated themselves. Seeking out a booster won’t help as much, unless you are immunocompromised — in which case, do talk to your doctor.

Vaccinating everyone eligible is a lofty goal, but it’s worth aiming for. Vaccines have been a key tool of public health since the first smallpox vaccine was developed in 1796. Widespread vaccination campaigns have stopped outbreaks of polio, measles, chickenpox and many other infectious diseases. We can make sure covid-19 is next by working to vaccinate everybody, not just in the United States but around the world. As of Aug. 10, just under 16 percent of the world’s population was fully vaccinated. Our global Re is still very high, and it will take global cooperation to bring it below 1, but we have the tools and knowledge to do so. All that’s left is to act.” (U)

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