August 3: Johns Hopkins COVID 19 Report

COVID-19 Situation Report

The Center also produces US Travel Industry and Retail Supply Chain Updates. You can access them here.

EPI UPDATE The WHO COVID-19 Dashboard reports 198.8 million cumulative cases and 4.2 million deaths worldwide as of 11:30 EDT on August 3. Global weekly incidence increased for the sixth consecutive week, up 5.1% over the previous week, but weekly mortality decreased for the first time since June, down 8% compared to the previous week.

The US is #1 globally in terms of total daily incidence (85,459 new cases per day), accounting for 14% of the global total, and Indonesia is #1 in terms of total daily mortality (1,789 deaths per day), representing 19% of the global total.

Global Vaccination

The WHO reported 3.89 billion doses of SARS-CoV-2 vaccines administered globally as of August 3. The WHO reports a total of 1.51 billion individuals have received at least 1 dose, and 752 million are fully vaccinated. Analysis from Our World in Data shows that the global daily doses administered continued to increase through August 1, peaking at 41 million doses per day before falling to 39 million on August 2. The global trend continues to closely follow the trend in Asia. Our World in Data estimates that there are 2.23 billion vaccinated individuals worldwide (1+ dose; 28.6% of the global population) and 1.15 billion who are fully vaccinated (14.8% of the global population).

UNITED STATES

The US CDC reported 34.97 million cumulative COVID-19 cases and 611,051 deaths. Despite considerable vaccination coverage at the national level, daily incidence continues to accelerate, mirroring the early stages of previous surges. At 72,790 reported cases per day on July 30, the current surge is the United States’ second largest to date, surpassing both the spring 2020 and spring 2021 peaks. The average daily incidence is the highest since February 17*.

We expect the US to surpass 35 million cases in this afternoon’s update. If that is the case:

1 case** to 5 million cases- 196 days

5 million to 10 million- 93 days

10 million to 15 million- 29 days

15 million to 20 million- 25 days

20 million to 25 million- 22 days

25 million to 30 million- 61 days

30 million to 35 million- 132 days

**First reported cases on January 22, 2020.

Daily mortality also continues to increase, up to 302 deaths per day on July 30, which is 76% higher than the most recent low on July 10 (172)*. Daily mortality does not appear to be increasing exponentially like daily incidence; however, this could change over the coming weeks as daily incidence increases.

As the US epidemic continues to surge, several states are reporting daily incidence at or near their highest peak to date. According to CDC data, Louisiana (4,119 new cases per day) has already surpassed its previous record—10% higher than its January 2021 peak—and Hawai’i (298) surpassed its highest peak (August 2020). On July 30, Florida reached its second highest average daily incidence to date (15,817). Florida has not yet reported data from this weekend, and we expect that it will set a new record in its next report. Arkansas (1,869) and Mississippi (1,475) are at 61% and 63% of their respective highest peaks, both in January 2021. And Alabama (2,057) and Missouri (2,642) are both approaching 50% of their highest peaks from January 2021 and November 2020, respectively*.

*Changes in the frequency of state-level reporting may affect the accuracy of recently reported data, particularly over the weekend. In an effort to reflect the longer-term trends, the averages reported here may not correspond to the current date.

US Vaccination

The US has administered 347 million cumulative doses of SARS-CoV-2 vaccines. Daily vaccinations are increasing slowly, now up to 552,647 doses per day*. A total of 191.8 million individuals in the US have received at least 1 dose, equivalent to 57.8% of the entire US population. Among adults, 70.0% have received at least 1 dose—finally reaching the White House’s target—as well as 11.1 million adolescents aged 12-17 years. A total of 164.9 million individuals are fully vaccinated, which corresponds to 49.7% of the total population. Approximately 60.6% of adults are fully vaccinated, as well as 8.4 million adolescents aged 12-17 years.

*Due to delays in reporting, estimates for the average daily doses administered are less accurate for the most recent 5 days. The most current average provided here corresponds to 5 days ago.

VACCINE-RESISTANT VARIANT RISK With the number of new COVID-19 cases rising in much of the world, scientists are warning that continued transmission provides an opportunity for the evolution of new, and potentially more harmful, SARS-CoV-2 variants. The current increase in cases is being fueled by the highly transmissible Delta variant as well as the loosening and inconsistent use of public health prevention measures, increased social mobility, and inequitable vaccine access, WHO Director-General Dr. Tedros Adhanom Gebreyesus said on July 30, warning that health systems in many countries are overwhelmed and that more variants will emerge as long as the virus continues to spread. US CDC Director Dr. Rochelle Walensky cautioned that a new variant could potentially evade vaccines but added the vaccines authorized in the US continue to protect people from severe disease and death.

In a modeling study published in Nature Scientific Reports on July 30, researchers with the Austria Institute of Science and Technology examined the impact of the rate of vaccination and the strength of non-pharmaceutical interventions on the probability of the emergence and establishment of a vaccine-resistant SARS-CoV-2 strain. The researchers' model identified three factors that could lead to the establishment of a vaccine-resistant strain: the high probability of a resistant strain’s initial emergence, a high number of infected individuals, and a low rate of vaccination. The researchers’ analysis showed that the highest risk of vaccine-resistant strain establishment occurs when a large proportion of the population is vaccinated but viral transmission is high, underlining the importance of controlling transmission through public health interventions while continuing vaccination campaigns. Nevertheless, the researchers conclude “the emergence of a partially or fully vaccine-resistant strain and its eventual establishment appears inevitable.” The UK’s Scientific Advisory Group for Emergencies (SAGE) published an updated theoretical and non-peer-reviewed paper on July 30 essentially coming to the same conclusion, that a vaccine-resistant SARS-CoV-2 variant almost certainly will emerge and public health authorities must continue efforts to reduce transmission as much as possible.  

US CDC MASK GUIDANCE ​​The US CDC’s latest masking guidance—calling for all people, even those who are vaccinated, to wear masks in indoor public settings in areas where transmission is categorized as high or substantial—is in direct response to the increased transmissibility of the Delta variant. According to data released last week, data show that individuals fully vaccinated for SARS-CoV-2 who become infected—known as breakthrough cases—carry viral loads similar to those found in infected unvaccinated individuals, suggesting that vaccinated people can transmit the Delta variant of concern just as easily as those who are unvaccinated.

The data are based on a COVID-19 outbreak that began in Provincetown, MA (US) in early July following multiple summer events and large public gatherings. Of the 496 cases reported in the outbreak at the time of data analysis, 346 (74%) cases were among fully vaccinated people and 90% of 133 cases sequenced were caused by the Delta variant. Almost 80% of the breakthrough cases were symptomatic, with common symptoms including cough, headache, sore throat, myalgia, and fever. Among 5 patients who were hospitalized, 3 had underlying medical conditions and 4 were vaccinated. No deaths were reported. The report, published as an early release in the CDC’s MMWR, said even jurisdictions without high or substantial transmission should consider expanding prevention measures, including masking for all individuals in indoor public spaces. Health officials emphasize that breakthrough cases remain rare and that vaccines provide protection against severe symptoms and hospitalization. Lending further credence to the protective power of the vaccines, data show that counties with low vaccination rates are experiencing rapid rises in COVID-19 cases and increases in deaths.

SARS-COV-2 TRANSMISSIBILITY An internal report from the US CDC suggests that the SARS-CoV-2 Delta variant may be capable of causing more severe disease than previous variants and that it may be as transmissible as chickenpox. Studies from Canada, Scotland, and Singapore indicate that individuals infected with the Delta variant are at a higher risk of hospitalization and requiring oxygen supplementation. Evidence discussed in the report shows that the Delta variant may be capable of skirting the protection offered by the vaccines, and fully vaccinated individuals who become infected may carry high viral loads in their noses and throats, possibly making transmission from the vaccinated more common than previously understood. Despite the concerns raised in the report, vaccination remains the best way to protect against severe disease. The report states that vaccines are capable of preventing severe symptoms in at least 90% of cases, even though they might be less effective at preventing infection. Experts acknowledge that discussions around vaccination may need to shift from preventing transmission to personal protection in light of the new data.

US EVICTION MORATORIUM The federal eviction moratorium, administered by the US CDC, expired on July 31, without extension, after the US Supreme Court on June 29 declared that the agency could no longer extend the program without “clear and specific congressional authorization (via new legislation).” A recent surge in COVID-19 daily incidence, driven by the highly transmissible Delta variant, is lending urgency to efforts to keep people in their homes and out of congregate or dangerous living situations, such as in shelters or on the street. More than 11 million adult renters are behind on payments, according to the Center on Budget and Policy Priorities. But it appears the CDC, US Congress, and the White House were caught off guard by the moratorium’s expiration, leaving officials scrambling for solutions.

Over the weekend, White House officials asked the CDC to extend the moratorium, focusing specifically on areas with high or substantial COVID-19 transmission, but the CDC denied the request, saying it has no legal authority to do so under the Supreme Court’s ruling. Additionally, Congress failed to pass legislation that would have provided a last-minute extension of the federal moratorium until October 18. Afterward, Congressional leaders called on the White House to extend the moratorium, but officials said they also lack legal authority to do so. On August 2, US President Joe Biden called on state and local governments to extend or implement eviction moratoria for at least the next 2 months. Approximately one-third of states currently have eviction moratoria through August. Additionally, President Biden, at the request of Congressional leadership, is asking relevant federal agencies to examine why more of US$46.5 billion in Emergency Rental Assistance provided to state and local governments has not yet been distributed. The White House made other requests of federal, state, and local agencies and jurisdictions and committed to “doing everything in its power” to keep people housed.

US GLOBAL VACCINATION PROGRAM The US government announced today that the country has donated and shipped more than 110 million doses of SARS-CoV-2 vaccines to more than 60 countries, fulfilling a June pledge by President Joe Biden to donate at least 80 million doses. The majority of the vaccines were shipped through the COVAX facility, with other portions provided through regional partners such as the African Union and the Caribbean Community (CARICOM). Reportedly, an “initial tranche” of 25 million vaccines is going to African nations, and the US government is supporting vaccine manufacturing efforts in South Africa and Senegal. A White House fact sheet lists the countries and amount of vaccines the US has donated to date.

According to the fact sheet, the US government has purchased 500 million doses of the Pfizer-BioNTech vaccine and expects to begin shipping them to 100 low-income countries at the end of August. The donated vaccine doses, worth $3.5 billion, will be delivered through COVAX, helping the facility get closer to its goal of delivering 2 billion doses in 2021. However, to offset the costs of purchasing the supply, the US reportedly is diverting hundreds of millions of dollars intended to support vaccination drives in low-income countries. COVAX continues to struggle, delivering only 177 million vaccines so far, some of which are going unused in recipient countries due to a lack of funding, shortage of sufficient transportation, a dearth of trained vaccine administrators, or the absence of public interest to receive the shots.

EMERGENT VACCINE PRODUCTION FACILITY After a more than 3-month shutdown of SARS-CoV-2 vaccine manufacturing at Baltimore, MD (US)-based Emergent BioSolutions, the US FDA last week granted permission for the plant to resume manufacturing based on the regulatory agency’s “observations of the implemented corrective actions.” As we previously reported, the FDA published a report in April stating the facility was unsuitable to produce vaccine doses, and Emergent agreed to pause production until issues identified in the report were resolved, which appears to have happened. At the time, Emergent was manufacturing both the J&J-Janssen and AstraZeneca-Oxford vaccines for the federal government; production for the latter has since moved to another company. J&J, which has been in control of the plant since April, confirmed the FDA is permitting manufacturing to resume and said it will continue to work with the agency to gain clearance to use up to 30 million doses of its vaccine made at the facility prior to its shutdown.

In a call with investors on July 29, Emergent officials disclosed a US$41.5 million loss from having to discard vaccine doses deemed unusable by regulators as well as the expenditure of US$12.4 million to address problems at the facility. The following day, Emergent filed documents with the US Security and Exchange Commission disclosing for the first time it has received “preliminary inquiries and subpoenas to produce documents” stemming from shareholder lawsuits and investigations from the SEC, the US Department of Justice, the Financial Industry Regulatory Authority, the state attorney generals of Maryland and New York, and committees in both houses of the US Congress. Additionally, Reuters reports that AstraZeneca-Oxford vaccine doses sent from the plant to Canada and Mexico in late March were cleared without proper regulatory inspections. These reports underscore ongoing troubles for Emergent, which holds a US$628 million federal contract to be the primary domestic manufacturer of both the J&J-Janssen and AstraZeneca-Oxford vaccines, as well as other federal contracts for various products included in the National Strategic Stockpile, most notably the company’s anthrax vaccine.

DELTA VARIANT IN CHINA Once recognized as implementing the world’s strictest COVID-19 prevention measures, China’s zero tolerance COVID-19 policy is facing challenges amid a recent increase in cases caused by the Delta variant. The policy attempts to keep the country’s number of cases to zero by limiting international travel, requiring regular testing, and enforcing stringent quarantine measures, among other regulations. But over a period of 2 weeks, the country’s average number of new daily COVID-19 cases has more than doubled and nearly half of China’s 32 provinces have reported cases caused by the Delta variant, indicating the variant is moving quickly. This current wave is thought to have originated at the international airport in the eastern city of Nanjing, after a case was first detected on July 20. All 9.3 million residents of Nanjing are undergoing testing, and the city of Wuhan, where the virus was first detected in late 2019, plans to test all 12 million residents. Wuhan recently recorded 3 cases of the Delta variant after having reported no cases since mid-May 2020. The variant’s rapid spread has raised concerns over the level of protection provided by Chinese vaccines. So far, China has administered 1.7 billion doses, enough to fully vaccinate about 60% of its population. Public health officials estimate 80% of the population will be fully vaccinated by the end of the year.

INDONESIA Healthcare workers in Indonesia are overwhelmed, as daily COVID-19 incidence remains high, daily mortality continues to climb, patient capacity surges, and medical supplies dwindle. The country’s average number of new daily cases peaked on July 18, reaching a number 4 times higher than the previous peak in January 2020. Average daily incidence is down as of August 2 but still remains high. Average daily mortality continues to rise as of August 2 and is currently 6 times higher than the previous peak in January 2020. Approximately 1,200 healthcare workers in Indonesia have died during the pandemic; nearly half of those were doctors. Many more healthcare professionals have been infected and returned to work after recovering. Facing long hours, stressful working conditions, and greater exposure to infected patients, Health Minister Budi Gunadi Sadikin said the country is prioritizing providing additional vaccine doses to healthcare workers. Most who have been vaccinated received the Chinese Sinovac vaccine, but the additional doses will be the Moderna vaccine.

AUSTRALIA LOCKDOWNS Military personnel are being brought in to help local police enforce a lockdown in New South Wales, Australia. The lockdown comes in response to an outbreak of the highly transmissible SARS-CoV-2 Delta variant in the region. The lockdown was recently extended to August 28 after an outbreak of 170 cases was traced to an infected individual who failed to self-isolate. The 300 unarmed military personnel will aid in enforcing the lockdown by knocking on residents’ doors to ensure everyone is complying with stay-at-home orders. In parts of Sydney, the state’s largest city, residents will be required to wear masks when outdoors and stay within 5 kilometers (3 miles) of their residence. On August 2, Queensland state extended lockdown orders through August 8 in its largest city, Brisbane, after officials detected 13 new locally acquired cases. Australia is expected to continue cycles of stop-start lockdowns until at least 70% of the population is fully vaccinated. Prime Minister Scott Morrison said he expects to reach that goal by the end of the year; only 15.4% of the population is fully vaccinated as of August 2.

BLOOD CLOTS Two studies recently published by The Lancet provide additional insight into the risk of blood clots associated with the AstraZeneca-Oxford SARS-CoV-2 vaccine. A peer-reviewed study conducted by researchers at AstraZeneca included data from all reported cases of thrombosis with thrombocytopenia syndrome (TTS, a blood clotting disorder) within 14 days of vaccination with either dose of the AstraZeneca-Oxford vaccine reported to AstraZeneca’s global safety database through April 30. The researchers identified 399 cases of TTS among 49.2 million individuals who received the first dose of the vaccine, equating to an estimated risk of 8.1 cases per million doses. The risk decreased following the second dose, however, down to 2.3 per million doses—13 cases of TTS among 5.62 million individuals who received the second dose. The researchers estimated that the average over a 14-day period prior to the pandemic was as high as 7.16 cases of TTS per million people. So while the risk following the first dose of the vaccine was a slight increase over the expected risk, the risk following the second dose was “within preliminary estimates.”

A preprint study, conducted in Spain and funded by the European Medicines Agency, included 1.3 million vaccinated individuals as well as 225,000 COVID-19 patients and 4.5 million control participants. The vaccinated participants included 946,000 who received the first dose of the Pfizer-BioNTech vaccine (including 779,000 who received both doses) and 426,000 who received the first dose of the AstraZeneca-Oxford vaccine. The researchers evaluated the risk of blood clotting disorders—including venous thromboembolism (VTE), thrombocytopenia, and thrombocytopenia syndrome (TTS)—following vaccination. Participants who received the Pfizer-BioNTech vaccine had 29% higher occurrence of VTE following the first dose than expected, but there was no significant difference following the second dose. For the AstraZeneca-Oxford vaccine, the researchers did not observe a significant difference in the occurrence of VTE. Notably, the risk of VTE was 8 times higher than expected among COVID-19 patients. Similarly, there was an elevated risk of thrombocytopenia following both doses of the Pfizer-BioNTech vaccine, but not for the AstraZeneca-Oxford vaccine. Neither vaccine exhibited an elevated risk of TTS. The study also provides further analysis of the associated risks by sex and age group; however, the duration was not sufficient to include data regarding clotting risk after the second dose of the AstraZeneca-Oxford vaccine.

MONOCLONAL ANTIBODY The US FDA on July 30 expanded the emergency use authorization (EUA) for the monoclonal antibody REGEN-COV—a combination of casirivimab and imdevimab—to include post-exposure prophylaxis (PEP) among certain people exposed to or at high risk of exposure to an individual infected with SARS-CoV-2. The EUA now allows monoclonal antibody PEP among people at high risk for progression to severe COVID-19, who are not fully vaccinated, or who are not expected to mount an adequate response to vaccination and who have been exposed to a SARS-CoV-2-infected individual or who are at high risk of exposure to an infected individual in congregate or institutional settings such as nursing homes or prisons. Under the EUA, REGEN-COV now can be administered monthly as a subcutaneous injection or intravenous infusion to qualifying people aged 12 and older. The expanded EUA represents the first time an antibody treatment has been authorized for this purpose.

SARS-COV-2 EXPOSURE IN DEER A study conducted by the US Department of Agriculture (USDA) evaluated exposure to SARS-CoV-2 among white-tailed deer in several US states. The USDA’s Animal and Plant Health Inspection Service (APHIS) conducted serological testing on 481 serum specimens collected from white-tailed deer in Illinois, Michigan, New York, and Pennsylvania, from January 2020 through 2021. Antibodies against SARS-CoV-2 were detected in 33% of specimens, including 67% of specimens collected in Michigan. For comparison, only 1 out of 143 specimens collected prior to January 2020 tested positive for SARS-CoV-2 antibodies, and that specimen “was at the minimum threshold of detection,” which could potentially indicate a false-positive result. The researchers did not identify any animals that exhibited signs of illness.

Statements by APHIS note that the study was not sufficient to draw conclusions regarding population-level exposure among deer, but it does provide evidence that deer have been infected by the virus. It is unclear how the animals were exposed or the extent to which the infection is spreading among deer populations. It is also uncertain whether deer can transmit the infection to humans, but information from APHIS indicates there is no evidence that consuming meat from an infected animal could result in SARS-CoV-2 infection. While many questions remain unanswered, this study does provide additional information regarding potential animal reservoirs for SARS-CoV-2, which could potentially impact longer-term epidemic control efforts.

Russian and Chinese COVID vaccines are “better than nothing”

Why the Chinese and Russian Vaccines Haven't Been the Geopolitical Wins They Were Hoping For

Ian Bremmer

Mon, August 2, 2021, 11:58 AM

COVID-19 Vaccination Drive

A beneficiary poses for a photo after getting vaccinated with a dose of Russia's Sputnik V Covid-19 vaccine at a vaccination centre, on July 13, 2021 in Mumbai, India. Credit - Satish Bate-Hindustan Times

China and Russia both thought the pandemic would give them a chance to show that they are scientifically innovative—and more generous—than Western countries, which were slower to roll out vaccines and which have been accused of hoarding supplies.

It hasn’t worked out.

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China’s president Xi Jinping referred to Chinese vaccines as a “global public good.” China’s Sinovac vaccine also offers developing countries some important advantages that the Moderna and Pfizer-BioNTech vaccines can’t match. Sinovac can be stored in a standard refrigerator. The Moderna vaccine must be stored at -20°C and the Pfizer vaccine at -70°C, an obstacle in countries where health infrastructure is lacking. That’s part of why China’s vaccines have been injected into arms in more than 80 countries across the developing world.

Doubts about Chinese-made vaccines

The trouble is that, when compared with these other vaccines, China’s jabs just aren’t very effective. The Pfizer-BioNTech and Moderna mRNA vaccines have efficacy rates of more than 90%. The World Health Organization noted in June that the Sinovac vaccine “prevented symptomatic disease in 51% of those vaccinated and prevented severe Covid-19 and hospitalization in 100% of the studied population,” though it acknowledged that few adults over age 60 took part in the trials, , potentially skewing the numbers by with a sample population that’s less vulnerable that the public at large. Data for the Chinese-made Sinopharm vaccine demonstrated a “vaccine efficacy [rate] for symptomatic and hospitalized disease” at 79%—though here too patients over 60 were underrepresented.

Crucially, these studies tested vaccines only against the version of COVID-19 virus that emerged in late 2019 from the city of Wuhan. They provided no data on effectiveness against variants, including the Delta variant, which is becoming the dominant strain of SARS-CoV-2 in many countries, including the U.S. In many of the places where Sinopharm and Sinovac are in use, there has been a sharp spike in the number of COVID-19 infections in recent weeks.

Russia’s lousy rollout

Russia’s Sputnik V vaccine, now in use in nearly 70 countries, has recently been found to be “safe and effective” in international studies, but it remains controversial for other reasons. Not only was Sputnik the world’s first vaccine authorized for use in any country—the Russian Health Ministry okayed it in August 2020, more than a month before its Phase 1 and 2 trial results were published, and before its Phase 3 trial had even begun. Questions about the credibility of Russian government assurances immediately became suspect. Indeed, both the WHO and European Medicines Agency have yet to authorize Sputnik V for emergency use, due to a lack of access to raw data from the trials, and concerns over rare side effects. But countries like India, South Korea, Argentina, Hungary, Iran and many others which lack more transparent alternatives have proven willing to take the risk. COVID-ravaged India, for example, plans to eventually manufacture at least 850 million doses of Sputnik V per year.

But beyond questions of efficacy, the Russian rollout of Sputnik has faced a series of embarrassing problems. In April, Brazilian regulators rejected Sputnik as potentially dangerous before reversing the decision in June—when COVID-19 infections were soaring across the country—and allowing a small number of doses at a time into the country. Slovak officials said in April that the Sputnik doses it received from Russia did “not have the same characteristics and properties” as Sputnik doses provided by Russia for evaluation in international studies. Indian officials say delayed supplies from Russia have put big production plans there on hold. The Moscow Times reported earlier this month that “Russia has awarded an Emirati royal the exclusive rights to sell its Sputnik V coronavirus vaccine to a host of countries in at least three continents in a deal that has seen buyers paying huge premiums for supplies.”

Put it all together, and it’s easy to see why Russia’s claim that 800 million people worldwide will be vaccinated with Sputnik by the end of 2021 is farcical. Because of delays that have hampered production of Sputnik in other countries, many of the Sputnik doses administered abroad have come directly from Russia, which sharply limits the number than can be manufactured globally. In May, the Russian edition of Forbes reported that some 16.3 million doses of a two-dose vaccine had been exported. That’s just a bit better than 1% of the target Russia set for global Sputnik vaccinations.

But the best tests of the Russian government’s (lack of) credibility comes directly from the Russian people. A poll conducted in March found that a startling 62% of Russians surveyed didn’t want to be vaccinated. As of June 28, just 15% of Russians had received at least one dose of a vaccine that has been authorized inside Russia for nearly a year. This in a country that is breaking records for daily deaths from COVID-19.

The bottom line

Chinese and Russian vaccines won’t win those countries the geopolitical victories they hoped for. A huge missed opportunity for Moscow and Beijing.

What to watch

A remarkably clear explanation in six minutes from an expert on variants and vaccines. The takeaway: Pfizer-BioNTech and Moderna mRNA vaccines are clearly most effective against the Delta variant, but the Chinese or Russian vaccines are still much better than nothing.

Above is from:  https://www.yahoo.com/news/why-chinese-russian-vaccines-havent-165826952.html

July 30: Johns Hopkins COVID 19 Report

COVID-19 Situation Report

The Center also produces US Travel Industry and Retail Supply Chain Updates. You can access them here.

EPI UPDATE NOTE: The Situation Report’s esteemed epidemiologist is on vacation this week, so we will be back next week with a deeper-dive look at trends. Here are the latest numbers:

The WHO COVID-19 Dashboard reports 196.6 million cumulative cases and 4.2 million deaths worldwide as of 12:30 EDT on July 30.

Global Vaccination

The WHO reported 3.8 billion doses of SARS-CoV-2 vaccines administered globally as of July 29. The WHO reports a total of 1.48 billion individuals have received at least 1 dose, and 735 million are fully vaccinated. Analysis from Our World in Data shows that the global daily doses administered continues to rise, now at 37 million doses per day, driven by increases in Asia. Our World in Data estimates that there are 2.17 billion vaccinated individuals worldwide (1+ dose; 27.68% of the global population) and 1.12 billion who are fully vaccinated (14.4% of the global population).

UNITED STATES

The US CDC reported 34.7 million cumulative COVID-19 cases and 609,853 deaths. Daily incidence continues to increase, now up to 66,606 new cases per day, which is nearly 6 times the most recent low on June 19 (11,469) and is still increasing steadily. Daily mortality also continues to increase, up to 296 deaths per day, which is 78% higher than the most recent low on July 10 (166)*.

*In an effort to provide a more accurate analysis of the current epidemiology, we are largely focusing on longer-term trends, as the most recent data are more likely to be affected by changes in the frequency of state-level reporting, particularly over the weekend.

US Vaccination

The US has administered 344 million cumulative doses of SARS-CoV-2 vaccines. Daily vaccinations are increasing slowly, now up to 513,685 doses per day*. A total of 189.9 million individuals in the US have received at least 1 dose, equivalent to 57.2% of the entire US population. Among adults, 69.4% have received at least 1 dose, as well as 10.5 million adolescents aged 12-17 years. A total of 163.9 million individuals are fully vaccinated, which corresponds to 49.4% of the total population. Approximately 60.3% of adults are fully vaccinated, as well as 8.1 million adolescents aged 12-17 years.

*Due to delays in reporting, estimates for the average daily doses administered are less accurate for the most recent 5 days. The most current value provided here corresponds to 5 days ago.

US CDC MASK GUIDANCE Amid a national surge in COVID-19 cases, hospitalizations, and deaths attributed to the highly transmissible Delta variant, the US CDC this week issued updated guidance recommending indoor mask use in areas with high or substantial transmission rates, regardless of individual vaccination status. The agency also called for universal mask use by teachers, staff, and students returning to K-12 schools this fall, regardless of their vaccination status. According to CDC Director Dr. Rochelle Walensky, the agency reinstated its indoor mask use recommendations based on new research showing that vaccinated people infected with the Delta variant carry viral loads similar to those of people who are unvaccinated. The data comes from a new CDC report released today. Dr. Walensky reiterated that the vaccines remain highly effective at preventing severe disease, that breakthrough infections among vaccinated individuals remain uncommon, and that most of the new COVID-19 cases are among unvaccinated people. US health officials continue to urge those who are not yet vaccinated or partially vaccinated to undergo the shots to help slow the spread.

US FEDERAL WORKER VACCINE RULES US President Joe Biden on July 29 announced sweeping new COVID-19-related requirements for more than 4 million federal employees and hundreds of thousands of contractors who work at federal facilities worldwide, with the goal of increasing vaccination rates among the nation’s workforce and influencing other employers. Though not considered a vaccine mandate, all federal workers will be required to sign forms attesting they are fully vaccinated for SARS-CoV-2 or face inconveniences in their daily work lives. Unvaccinated workers “will be required to wear a mask on the job no matter their geographic location, physically distance from all other employees and visitors, comply with a weekly or twice weekly screening testing requirement, and be subject to restrictions on official travel," according to information released by the White House. In his speech, President Biden also called on states and local governments to use federal funding they have received, including from the American Rescue Plan, to give US$100 to anyone who gets fully vaccinated, and he said the federal government would reimburse small- and medium-sized businesses for providing paid leave so their employees and their families could get vaccinated. He also urged the US Department of Defense to quickly implement a mask mandate for members of the military, many of whom are reluctant to undergo vaccination. The plan received mixed reactions from labor unions and other groups, some of which said giving employees options was a tactic aimed at preventing harsh resistance from some people. Questions about the plan remain, and it will be interesting to see how quickly federal agencies implement the requirements.

ADDITIONAL DOSES/”BOOSTERS” Executives from Pfizer-BioNTech, Moderna, and J&J-Janssen, which manufacture the 3 SARS-CoV-2 vaccines authorized for use in the US, have all said fully vaccinated individuals can expect to eventually need additional doses of the vaccines, or “boosters.” However, there is not enough evidence-based data yet to provide a recommendation, according to a WHO official and the CDC’s Advisory Council on Immunization Practices (ACIP), which met last week to discuss the possibility of additional doses among immunocompromised individuals. Several US government health officials, including National Institute of Allergy and Infectious Diseases (NIAID) Director Dr. Anthony Fauci, have signaled that some Americans who are older or have weakened immune systems might need an additional vaccine dose.

Pharmaceutical companies, officials, and healthcare workers cannot technically recommended additional doses for any of the vaccines in the US, which are being administered under US FDA emergency use authorizations (EUAs) that set specific standards for each regimen: 2 doses given 3 or 4 weeks apart for the Pfizer-BioNTech and Moderna vaccines, respectively, and 1 dose for the J&J-Janssen vaccine. In order to provide additional doses, the FDA would need to change a vaccine’s EUA or fully license the vaccine, which would provide greater leeway for providers to recommend additional doses. But last week, Dr. Amanda Cohn, Chief Medical Officer for the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD), indicated the US government is actively looking into ways to provide access to additional doses prior to regulatory decisions, such as a compassionate use program. Some people are taking it upon themselves to seek out third doses, sometimes traveling to other states or even other countries to obtain shots.

According to media reports, Israel’s Ministry of Health on July 29 became the first country to approve third doses of the Pfizer-BioNTech vaccine for people ages 60 and older who are at least 5 months post-second dose. The country already offers third doses to immunocompromised individuals. In a decision made late on July 28, a health ministry panel concluded offering a third dose to elderly residents might help stem the country’s 6-week surge in COVID-19 cases, driven by the Delta variant. In a televised address, Israel Prime Minister Naftali Bennett, noting the Pfizer-BioNTech vaccine is safe and effective, encouraged those eligible to begin registering for third doses as of August 1. Since the emergence of the Delta variant, the Israel Ministry of Health has twice announced a drop in effectiveness of the Pfizer-BioNTech vaccine in preventing symptomatic infection, although some experts say the data could be skewed because most testing occurred in transmission hotspots and among elderly populations.

PFIZER-BIONTECH EFFICACY/THIRD DOSE On July 28, medRxiv published preprint data from Pfizer-BioNTech showing the efficacy of its vaccine to prevent COVID-19 declined about 6% every 2 months over a period of 6 months. The data were collected from more than 40,000 clinical trial participants in Europe and the Americas. From 7 days to <2 months post-dose 2, vaccine efficacy was 96.2% (95% confidence interval [CI] 93.3-98.1); from 2 months to <4 months, efficacy was 90.1% (95% CI 86.6-92.9); and from 4 months to 6 months, efficacy was 83.7% (95% CI 74.7-89.9). Overall, vaccine efficacy was 91.1% (95% CI 88.8-93.0) for preventing symptomatic COVID-19, and 96.7% (95% CI 80.3-99.9) against severe disease. The companies said the data show the vaccine to be safe and highly efficacious in preventing COVID-19 through 6 months post-second dose in diverse populations but further data are needed to know whether efficacy continues to wane or whether “booster” doses will be necessary, and, if so, the timing of such doses.

Many experts said the not-yet-peer-reviewed data are reassuring, showing that people who are fully vaccinated likely are adequately protected. However, if the observed decline in efficacy steadily continues over time, it would fall below the internationally accepted threshold of 50% within 18 months of vaccination. This would bolster Pfizer-BioNTech’s claim that an additional shot of its vaccine will be needed to maintain long-term protection. The data also do not address the vaccine’s efficacy against the now widespread Delta variant. On July 28, Pfizer officials presented unpublished data in a quarterly earnings report to investors showing a third dose of the Pfizer-BioNTech vaccine could boost neutralizing antibody titers against the Delta variant in a small sample of individuals. The data show a more than 5-fold increase in post-second dose titers among vaccinees aged 18 to 55 and a more than 11-fold increase among those ages 65 to 85. The officials said they plan to seek authorization with the US FDA for a third dose by mid-August and indicated clinical studies of an experimental Delta variant vaccine are awaiting regulatory approval but also are expected to begin in August.

BREAKTHROUGH CASES A study published in the New England Journal of Medicine on July 28 examines breakthrough COVID-19 cases among healthcare workers who received 2 doses of the Pfizer-BioNTech vaccine. From January 20 to April 28, 2021, researchers identified breakthrough cases at Sheba Medical Center in Israel by monitoring healthcare workers for COVID-19 symptoms and testing those with known COVID-19 exposures. Following the identification of a breakthrough case, the research team matched the individual with 4 or 5 uninfected controls using generalized estimating equations. Of 39 breakthrough cases among 1,497 fully vaccinated healthcare workers, the researchers found the infected individuals had lower levels of neutralizing antibody titers than their uninfected controls. Additionally, most of the breakthrough cases were asymptomatic or mildly symptomatic, although 19% of the individuals reported symptoms that lasted longer than 6 weeks. The majority of the breakthrough cases (85%) were caused by the Alpha variant (B.1.1.7), and the research team observed no secondary cases stemming from breakthrough cases.

IMF GLOBAL FORECAST In an updated “World Economic Outlook,” the International Monetary Fund (IMF) on July 27 warned that the gap in economic recovery is widening between higher- and lower-income nations due to the COVID-19 pandemic and uneven access to SARS-CoV-2 vaccines. Overall, the global economy is expected to grow 6% in 2021 and 4.9% in 2022. The IMF upgraded its 2022 estimate, with a 0.5 percentage point increase over its projection made earlier this year, driven by growth in the US and UK markets. However, for emerging and developing markets, the IMF downgraded projections for 2021 by 0.4 percentage points from its previous projection, to 6.3%, noting the biggest risks include low vaccination rates and growing numbers of COVID-19 cases. The IMF called on wealthier nations to take urgent action to share vaccine doses with low- and middle-income countries (LMICs), warning that a worsening pandemic could severely hit those markets as well as impact growth projections for richer nations.

The IMF also cautioned that if inequality worsens, nations risk experiencing political instability and discontent, which is happening already in some countries. The pandemic is sowing a “summer of anger,” with political protests documented in Tunisia, Iraq, South Africa, Thailand, Colombia, Brazil, and Haiti, to name a few. Even some wealthier nations—including France and Australia—recently have witnessed large protests against vaccination mandates and lockdown tactics centered on slowing the number of new COVID-19 cases. Experts from the Council on Foreign Relations (CFR) and Columbia University write that “COVID-19 has acted like lighter fluid for countries where embers of discontent were already smoldering.” In a closed briefing this week, Ramesh Rajasingham, UN Acting Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator, warned UN Security Council members that three-quarters of the countries needing humanitarian aid have already recorded more COVID-19 cases and related deaths than in all of 2020. Calling the response so far “inadequate,” Rajasingham urged the international community to not only increase vaccine shipments to fragile and conflict-affected countries but also bolster delivery systems by providing logistical and security support. The need for effective and efficient vaccine delivery to LMICs is an issue that cannot be ignored by the developed nations and the private sector.

US POVERTY REDUCTION The number of poor Americans is expected to decline nearly 45% this year from 2018 levels—a record drop in record time—but pieces of the enormous temporary safety net created amid the COVID-19 pandemic that helped to achieve this reduction have ended or are scheduled to soon revert to their pre-pandemic size. In a report released on July 28, the Urban Institute estimated the American Rescue Plan Act, enacted in March 2021, will reduce the 2021 annual poverty rate to 7.7%, well below the 13.9% rate estimated for 2018. The projected poverty rate is expected to be lowest among children (5.6%), but rise for adults ages 18 to 64 (8.1%) and again for older Americans (9.2%). The rates are higher for Hispanic people (11.8%), Asian American and Pacific Islanders (AAPI; 10.8%), and Black people (9.2%) than for white people (5.8%). The federal stimulus checks have had a larger impact on poverty reduction than any other program, according to the report.

One of these programs, the US CDC’s extended federal eviction moratorium, which has prevented eviction for an estimated 10 million people over the past year, is set to expire on July 31. Some advocates, researchers, and US lawmakers are calling for another extension of the program, citing an analysis showing many of these evictions would occur in communities with low vaccination rates and increasing numbers of COVID-19 cases attributed to the Delta variant. A study published this week in the American Journal of Epidemiology supports calls for extending the moratorium, showing that between March and September 2020, eviction moratorium expirations were associated with increased COVID-19 incidence and deaths and backing up the notion that eviction prevention constitutes an important public health measure to mitigate the pandemic’s impacts.

“MEDICAL FREEDOM” LAW New Hampshire (US) Governor Chris Sununu last week signed into law a so-called “medical freedom” bill that prohibits “any public facility, any public benefit, or any public service” from requiring state residents be vaccinated against SARS-CoV-2 to receive or access such services or facilities. The law states that “every person has the natural, essential, and inherent right to bodily integrity, free from any threat or compulsion by government to accept an immunization.” Notably, the law sets out several exceptions, including vaccination requirements for schools, childcare, county nursing homes, and the state’s mental health system. Additionally, the New Hampshire Department of Corrections may mandate certain medical treatments or immunizations “when a direct threat exists.” The law does not address private businesses. Governor Sununu continues to voice support for SARS-CoV-2 vaccines. According to state data, nearly 54% of the state’s residents are fully vaccinated, above the national average.

TENNESSEE VACCINE OUTREACH The Tennessee (US) state government last week resumed its adolescent vaccine education and outreach activities after earlier this month halting most advocacy in the face of pressure from conservative state lawmakers who accused the department of pressuring teenagers to receive a SARS-CoV-2 vaccine. Tennessee Health Commissioner Dr. Lisa Piercey on July 23 said the state’s health department will restart outreach efforts recommending vaccines for children, except for social media posts specifically targeting teenagers. The department once again will include its logo on public-facing vaccine material and hold vaccination events on school property, including for COVID-19. Dr. Piercey stressed the department never ceased vaccinations among children but only paused its communications and marketing efforts surrounding vaccines. Now that those efforts are restarting, messaging will be targeted toward parents, she noted. Dr. Piercey declared the state will provide vaccines to minors without parental permission in “fringed and nuanced” circumstances. Tennessee is in the bottom 10 states in terms of vaccination coverage, with 39% of its population fully vaccinated.

TANZANIA Tanzania President Samia Suluhu Hassan on July 28 kicked off the country’s SARS-CoV-2 vaccination campaign, publicly receiving the J&J-Janssen vaccine in an effort to bolster confidence in the shots and quell fear stemming from disinformation spread under her predecessor’s administration. Former President John Magufuli, who died in March of heart complications, downplayed the COVID-19 pandemic, endorsed home remedies and prayer as treatments, and called vaccinations “dangerous.” After Magufuli’s death, President Hassan established a COVID-19 expert committee to evaluate the safety and effectiveness of vaccines, as well as make public health recommendations including physical distancing and mask wearing. Tanzania joined COVAX in June, despite having been eligible since the facility’s establishment. The country received more than 1 million doses of the J&J-Janssen vaccine over the weekend from a US donation delivered through COVAX, and President Hassan on July 27 placed an order with the African Union's African Vaccine Acquisition Task Team (AVATT) for an undisclosed number of additional vaccines. The Tanzania government faces challenges to reversing skepticism about vaccines, but President Hassan assured residents the country will obtain enough supplies to reach its goal of vaccinating 60% of the population. Only 2 other African nations—Burundi and Eritrea—have yet to begin national vaccination campaigns.

TOKYO OLYMPICS The Olympics have entered the start of their second week as the COVID-19 situation in Tokyo and Japan continues to worsen. Both the city and the nation on July 29 reported record numbers of new COVID-19 cases, with the nation averaging 6,518 daily new cases. Tokyo, which remains under a state of emergency, recorded 3,865 new cases on July 29, after only the day before passing 3,000 new cases for the first time. The city’s health officials have asked for hospitals to prepare extra beds as the spread of the SARS-CoV-2 Delta variant continues, with more than 75% of new cases caused by the variant. So far, COVID-19 precautions appear to have minimized the spread of SARS-CoV-2 outside of the Olympic “bubble,” although the number of new daily cases reported among Olympic accreditation holders appears to have risen on July 29 and July 30.

COGNITIVE IMPACTS Scientists have long known that areas of the brain involved with smell and taste also are involved in memory, thinking, planning, and mood, and public health officials are increasingly concerned about the long-term impacts of COVID-19 on brain function, memory, and cognition, a phenomenon known as “brain fog.” Scientific evidence is emerging that the virus’s neurological impacts are multi-pronged and not necessarily related to “long COVID,” or post-acute sequelae of COVID-19 (PASC). In a study published in The Lancet journal EClinicalMedicine, researchers from Imperial College London and colleagues examined data from 81,337 people who took exams as part of the Great British Intelligence Test and completed questionnaires regarding self-reports of suspected or confirmed COVID-19. The team found that the 12,689 individuals who had recovered from COVID-19 exhibited significantly more cognitive deficits than their matched counterparts, even among people who said they were no longer experiencing symptoms. Cognitive deficits were found to be especially substantial among those who were hospitalized, those who were hospitalized and on a ventilator, and those who had more severe symptoms but recovered at home.

Researchers with the University of Texas Health Science Center at San Antonio, who recently presented data at the Alzheimer's Association International Conference, found that neurological changes seen after COVID-19 mirror those found in people with Alzheimer’s disease. Genetic studies are showing that the genes responsible for increasing the risk of more severe COVID-19 also increase the risk of Alzheimer’s. Additionally, anecdotal reports suggest Alzheimer’s diagnoses appear to be more common among people in their 60s and 70s who have had severe COVID-19. Further research is ongoing to determine COVID-19’s longer-term impacts on neurological function, including cognition, intelligence, and risk of Alzheimer’s disease.

MUCORMYCOSIS Following India’s most severe COVID-19 surge in the spring, the country has seen an increase in cases of mucormycosis, also called “black fungus,” and related deaths. Since late March, the nation has recorded more than 45,000 cases of the disease, a serious but rare fungal infection caused by the mucormycetes group of molds, and more than 4,300 people have died, with most having contracted COVID-19 prior to their fungal infection. Clinicians have noted that symptoms usually manifest 12-18 days after COVID-19 recovery. In a letter published July 29 in Drug Development Research, researchers warn that because uncontrolled diabetes and other immunosuppressive diseases, as well as corticosteroid treatment, are seen as risk factors for the fungal infection, they suggest avoiding steroids to treat COVID-19, as they might be a contributing factor to the disease. As the number of mucormycosis cases continue to rise, there are questions about unreliable supplies of the drug used to treat the infection, adding an additional challenge to India’s already complicated COVID-19 recovery.

COVID 19 Variants

JULY 29, 2021

Variants and Vaccines

BY SEIJI YAMADA

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Photograph Source: Travis Wise – CC BY 2.0

In late 2020 the British noticed that coronavirus cases were spiraling upward in the region of Kent. The culprit turned out to be a variant of the COVID-19 virus identified in September, Mutations in the genetic make-up, the RNA, lead to variants. They are still COVID-19 viruses, but they can behave differently. The variant first identified in Kent, UK (scientific name B.1.1.7, WHO name Alpha) is more infectious than the original strain which emerged from Wuhan, China.

The number of other people that each infected person infects is called the basic reproduction number, or R0 (“R naught”), in epidemiological parlance. It’s a measure of the biological characteristics of an infectious agent, but it can be affected by social and environmental conditions and human behavior (e.g. crowding vs. social distancing, ventilation, facemasks). The R0 of seasonal influenza is 1.3. The R0 of measles is around 15. As it emerged in Wuhan, the R0 of the original COVID-19 strain was 2.4—2.6. The R0 of the Alpha variant is 4 to 5.

The Beta variant (scientific name B.1.351) arose in South Africa in October 2020. It was found that the AstraZeneca vaccine was ineffective against the Beta strain – leading to a pause in its use there in February 2021. (The AstraZeneca vaccine may make a comeback in South Africa, since it is effective against the Delta strain, which is poised to become dominant there.)

The Gamma variant (scientific name P.1) arose in Brazil in December 2020. Manaus, in the Amazon, had had a severe epidemic of COVID-19 during 2020, such that it was estimated that 50% of its residents had been infected by October 2020. In December, Manaus experienced a second wave, more severe than the first, during which the Gamma strain was detected. Of note, Gamma caused infections in individuals who had been previously infected – demonstrating that an infection with one strain of COVID-19 might not lead to immunity against a different strain.

The Delta variant (scientific name B.1.617.2) was responsible for the April-June 2021 second wave in India. At its peak, India was recording nearly 400,000 cases and over 4000 deaths per day, believed to be a severe undercount. The true cases may have been over a million per day, and true deaths may have been 10 to 15,000 per day. Between January and June 2021, 3 to 4.7 million excess deaths occurred in India. The Delta variant has a R0 of 5 to 8. Each case of Delta leads to 5 to 8 more cases. An infected individual is likely to infect everybody else in the household. This gives it an evolutionary advantage over even the Alpha variant. The WHO declared Delta a “variant of concern” on May 10. By mid-July Delta was the dominant variant in the U.S.

A study involving 4272 cases of Delta from Public Health England (published July 21 in the New England Journal of Medicine) concluded that two doses of the Pfizer-BioNTech vaccine was 88% effective and  that two doses of the AstraZeneca vaccine was 67% effective in preventing symptomatic COVID-19. (One dose of Pfizer was only 35.6% effective against Delta.) In contrast, according to Israeli data from mid-June to mid-July 2021, the Pfizer vaccine was only 39% effective in preventing COVID-19 infection, but this data has not been published in the peer-reviewed literature. Of note, however, vaccination was 91.4% effective in preventing severe COVID-19. On July 22, Los Angeles County Public Health Director Barbara Ferrer announced that 20% of the COVID-19 cases in LA County over the past month were breakthrough infections in individuals who had been fully vaccinated.

Parts of the world that have vaccinated their populations with the Sinopharm and Sinovac vaccines from China are experiencing outbreaks. Indonesia, which is currently experiencing a major Delta wave, has relied on vaccines from China.

While the currently available mRNA vaccines (Pfizer and Moderna) are not quite as effective against Delta as it was against the original COVID-19 virus, they nevertheless prevent hospitalization and death. Currently, in the U.S., 97% of those hospitalized with coronavirus and 99.5% of those dying from coronavirus are unvaccinated. Clearly, we must continue to promote vaccination.

Delta has put “herd immunity” nearly out of reach, however. The percentage of the population that needs to be immune [whether from vaccine immunity or from infection with the original virus (I hesitate to say “wild type”) or a prior variant] to achieve herd immunity is derived from R0. From the estimate that the original COVID-19 strain had an R0=2.5, the

% needed to achieve herd immunity = 1 – 1/R0 = 1 – 0.4 = 60%

which is close to (though a little less than) 70%. This is the basis for government officials telling us that we need to vaccinate 70% of the population. Since the R0 of Delta is estimated to be from 5 to 8, using R0=6,

% needed to achieve herd immunity = 1 – 1/R0 = 1 – 0.17 = 83%

The next variant of concern (or the one after, or the one after that . . . twenty letters left to go in the Greek alphabet) may not only be as contagious as Delta. It may also more easily escape vaccine immunity (like Beta with AstraZeneca) or natural immunity (like Gamma). It is entirely plausible that vaccines will need to be reformulated to match future variants.

As difficult as it may be to achieve, we must continue to try to achieve herd immunity. In the U.S., FDA approval will allow employers and schools to mandate vaccines. During the current Delta wave, because of breakthrough infections, even the vaccinated should maintain social distancing and wear masks indoors. With businesses pressuring government officials not to impose lockdowns, it will be up to the informed to take measures on their own.

The current Delta wave will also pass. Many will die, but because many of the elderly and infirm have been vaccinated, not as many as in the dark days of January. Since the beginning of COVID-19, the epidemic curves of the U.S. and the U.K. have been shaped similarly. Of course, the U.S. has five times the population of the U.K. (331.4 million vs 68.2 million), so its absolute numbers of cases has generally been approximately five times that of the U.K. – except since late June, when Delta, which hit the U.K. earlier, gave the U.K. an absolute number of daily cases higher than that of the U.S. During the Delta wave, the daily cases in the U.K. approached those of its worst days in early January. The U.K.’s Delta wave appears to have peaked, however. The U.S.’s Delta wave is still in its exponential climb.

Regardless of what the future may bring, the task at hand is to deliver life-saving vaccines to the world. To stave off more India-like disasters around the world, we must support an accelerating, global Covid immunization campaign. The Biden Administration’s decision to support the suspension of intellectual property rights for vaccine manufacturing was a step in the right direction. On June 9, the US announced that it will purchase and donate 500 million doses of the Pfizer vaccine. This is clearly inadequate when fewer than 5 doses per 100 people have been administered in Africa (total population 1.34 billion). U.S. taxpayers subsidized the development of the mRNA vaccines. It is a travesty that Pharma profits so handsomely from public investment. Life-saving vaccines are public goods that belong to the people.

Seiji Yamada, a native of Hiroshima, is a family physician practicing and teaching in Hawaii.

Above is from:  https://www.counterpunch.org/2021/07/29/variants-and-vaccines/