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At at Johnson Johnson coronavirus vaccine event at the New Hope Baptist Church in Newark, N.J., in March.Credit...James Estrin/The New York Times


People who received a Johnson Johnson coronavirus vaccine may be better off with a booster shot from Moderna or Pfizer-BioNTech, according to preliminary data from a federal clinical trial published on Wednesday.
That finding, along with a mixed review by the Food and Drug Administration of the case made by Johnson Johnson for an authorization of its booster, could lead to a heated debate about how and when to offer additional shots to the 15 million Americans who have received the single-dose vaccine.
The agency’s panel of vaccine advisers will meet Thursday and Friday to vote on whether to recommend that the agency allow Moderna and Johnson Johnson to offer booster shots.
Despite the questions raised by the new data on the strength of Johnson Johnson’s boosters, some experts anticipated that the agency would clear the shots anyway, since the effectiveness of the one-shot vaccine is lower than that of the two-dose mRNA vaccines made by Moderna and Pfizer-BioNTech. And the broader public may also be expecting the authorizations, given the Biden administration’s push for boosters from all brands.
Once the agency authorized a booster from Pfizer-BioNTech last month, “the die was cast,” said John Moore, a virologist at Weill Cornell Medicine.
The Pfizer and Moderna vaccines are by far the most used in the United States, with more than 170 million people in the United States fully immunized with either one or the other vaccine. When Johnson Johnson’s was authorized in February, public health experts were eager to deploy the “one-and-done” option, particularly in communities with poor access to health care. But the shot’s popularity plummeted when the F.D.A. later paused its use to investigate rare blood clotting cases.
For those who have received the Johnson Johnson vaccine, the timing of a booster authorization — of any brand — is still uncertain. The F.D.A. panel is set to vote Friday only on whether the agency should permit a second dose of the Johnson Johnson vaccine, a scenario the Centers for Disease Control and Prevention’s own vaccine advisory committee will discuss next week. If both agencies believe an additional dose should be offered, people could seek them out as early as next week.
Whether the F.D.A. might authorize the mix-and-match approach, and how, is unclear. The strategy will be discussed at the agency panel’s meeting on Friday, but no vote will be taken. If regulators eventually believe there is enough scientific support for the approach, they would likely need to update the authorization language of the Moderna and Pfizer-BioNTech vaccines to allow for their use in people who initially received Johnson Johnson’s.
In a study conducted by the National Institutes of Health, researchers organized nine groups of roughly 50 people each. Each group received one of the three authorized vaccines, followed by a booster. In three groups, volunteers received the same vaccine for a boost. In the other six, they switched to a different brand.
The researchers found that those who got a Johnson Johnson shot followed by a Moderna booster saw their antibody levels rise 76-fold within 15 days, whereas those who received another dose of Johnson Johnson saw only a fourfold rise in the same period. A Pfizer-BioNTech booster shot raised antibody levels in Johnson Johnson recipients 35-fold.
The authors cautioned about the study’s small size and noted that they did not follow the volunteers long enough to identify rare side effects.
Sharon LaFraniere contributed reporting from Washington.

Dominic Dwyer, a member of a since-disbanded World Health Organization team that investigated the origins of the coronavirus, arriving at the Wuhan Institute of Virology in China, in February. Credit...Thomas Peter/Reuters


The World Health Organization on Wednesday named 26 scientists to a new advisory group charged with studying the origins of the coronavirus, opening another chapter of the fraught search for how the pandemic began.
The group, chosen from more than 700 applicants, includes scientists from 26 countries, a reflection of the W.H.O.’s effort to amass widespread international support for the work.
Among them are an American researcher — Dr. Inger Damon, a veteran of the country’s Ebola response who directs work on highly lethal diseases at the Centers for Disease Control and Prevention — and a Chinese scientist. The Chinese scientist, Dr. Yungui Yang, is the deputy director at the Beijing Institute of Genomics at the Chinese Academy of Sciences, a government institution.
Inger K. Damon of the Centers for Disease Control and Prevention is one of 26 scientists named by the W.H.O. to a new coronavirus advisory group.Credit...CDCWith this new group, the W.H.O. is trying to revive its study of the pandemic’s origins. That work that had become bogged down in a political rivalry between China and the United States, and concerns about scientists’ conflicts of interest, since the W.H.O. sent a previous team to China in early 2021.
The result of that visit was a joint report by the W.H.O.-chosen team and China that said a leak of the coronavirus from a lab, while possible, was “extremely unlikely,” a conclusion that the W.H.O.’s director general, Tedros Adhanom Ghebreyesus, later called premature.
Six members of that since-disbanded W.H.O. team have joined the new advisory group. The committee also includes the head of a Swiss biosafety center, an indication of W.H.O.’s efforts to ensure that a laboratory leak be considered alongside scenarios in which the virus spilled over naturally from animals to humans.
“A lab accident cannot be ruled out until there is sufficient evidence to do so and those results are openly shared,” Dr. Tedros and two top W.H.O. officials wrote in an editorial in Science outlining the advisory group’s mandate.
After a two-week public comment period that is customary before W.H.O. advisory groups are set up, the committee will begin to meet.
Videotranscript
W.H.O. Announces New Team to Study Covid-19 Origins
The World Health Organization hopes that the new advisory group, which includes scientists from 26 countries, can revive its study of the pandemic’s origins, after previous efforts became bogged down in a political rivalry between China and the United States.

“Following a public call for experts, W.H.O. today announced the proposed members of the W.H.O. scientific advisory group for the origins of novel pathogens, or SAGO. The 26 experts were selected from over 700 applications, and were chosen for their world-class expertise and experience in a range of disciplines, as well as their geographic and gender diversity.” “That is a human endeavor to understand a virus that has stopped our whole world. And I would ask everyone, countries, journalists and everybody else, to create a little space for that discussion to happen because this is probably, right now, this is our best chance, and it may be our last chance, to understand the origins of this virus in a collegiate, collective and mutually responsible way.” “I anticipate that the SAGO, in its discussions about the urgent next steps for understanding you know, the origins of the current pandemic, will recommend further studies in China and potentially elsewhere. And I very much hope, we very much hope, that there will be further missions to China and other countries. The SAGO itself will make recommendations or give advice to W.H.O. Any future missions will be organized by W.H.O. and that member-state in question. And of course, we need the cooperation of that member-state to carry out any future missions.”










The World Health Organization hopes that the new advisory group, which includes scientists from 26 countries, can revive its study of the pandemic’s origins, after previous efforts became bogged down in a political rivalry between China and the United States.CreditCredit...Pool photo by Denis BalibouseW.H.O. officials said the group would assess recent studies, including those describing bats harboring close relatives of the virus behind Covid-19, and advise the organization on what future studies were needed — potentially including field research in China.
China has reacted angrily to the idea that the virus may have emerged from a lab and, analysts have said, is almost certain to resist outside requests to visit research centers, bat caves or wildlife farms within its borders.
Unlike the last W.H.O. team, which was assembled specifically for the visit to China, the new committee will also have a mandate to weigh in on the emergence of any new pathogens beyond the coronavirus, giving it a permanence that the W.H.O. hopes will help insulate it from political squabbling.
At a news briefing on Wednesday, Dr. Michael Ryan, the executive director of the W.H.O. Health Emergencies Program, said it was impossible to ignore obstacles like “national pride” standing in the way of hunting down the origins of the coronavirus. But he said the new advisory group was an effort to return to the scientific issues at the core of that effort.
“This is our best chance,” he said. “And it may be our last chance to understand the origins of this virus in a collegiate and collective and mutually responsible way.”

Nurses performing Covid-19 tests in July on people displaced by political upheaval in Port-au-Prince, Haiti.Credit...Victor Moriyama for The New York Times


In Guatemala, shortages of syringes have slowed vaccination efforts. In Haiti, logistical and security challenges after the devastating Aug. 14 earthquake have contributed to making it the country with the lowest vaccination coverage in the world.
And across the Caribbean, countries are grappling with unequal distribution of doses and vaccine hesitancy, World Health Organization officials warned today in an online news conference.
An “important challenge that the Caribbean is facing — English-speaking countries and French- speaking countries and territories — is vaccine hesitancy,” said Dr. Sylvain Aldighieri, the Covid-19 incident manager at the Pan American Health Organization, which is part of the W.H.O.
“Even if some territories of the Caribbean are leading the regional effort in terms of vaccination coverage, we can say that the vaccine uptick is suboptimal in most of the Caribbean countries,” he said.
The W.H.O. has set a goal of having every country in the world vaccinate at least 40 percent of its population by the end of the year. Four of the six countries in the Americas that have yet to reach the 20 percent threshold are in the Caribbean: Haiti, Jamaica, St. Vincent and the Grenadines, and St. Lucia. The other two — Nicaragua and Guatemala — are in Central America.
“Across all these countries, vaccine availability due to unequal distribution of doses has been a central challenge,” said Dr. Carissa F. Etienne, the Pan-American agency’s director.
But several of the countries are also “facing their own unique barriers,” she added, like the shortage of syringes in Guatemala.
At the same time, Jamaica has had to cope with supply delays.
Haiti, where the August earthquake killed at least 2,200 people, has fully inoculated less than 1 percent of its population.
“The sociopolitical situation in Haiti is still tense, and that has negatively impacted” vaccination efforts, said Ciro Ugarte, the Pan-American agency’s director of health emergencies.
Countries in Latin America and the Caribbean receive vaccines through bilateral agreements with manufacturers as well as through the United Nations-backed Covax program and donations from countries with excess doses. The Pan-American agency has also sealed deals for countries to buy millions of vaccine doses from China’s Sinopharm and Sinovac, as well as from AstraZeneca.
Although the numbers of Covid cases in much of Latin America and the Caribbean are declining, several islands in the Caribbean are seeing increases.
Barbados, for example, is reporting the highest number of infections and deaths since the pandemic started, said Dr. Etienne, the agency’s director. The Dominican Republic, Haiti, the Cayman Islands, Antigua and Barbuda, and Anguilla are also reporting increases in cases.
“In the eastern Caribbean, health services have been — or are still — overwhelmed by the influx of patients requiring hospitalization,” Dr. Aldighieri said. He also noted that the situation was a sharp contrast to last year, when most of the Caribbean island countries were largely able to avoid widespread transmission of the virus.
Despite vaccine hesitancy, 39 percent of the population across Latin America and the Caribbean have been fully vaccinated against Covid-19, Dr. Etienne said. That is sharply higher than in Africa, where less than 5 percent of the population has been fully vaccinated, according to the Africa Centers for Disease Control and Prevention.
As more vaccines start to flow to the region, though, it’s important for countries “to make the necessary preparations so these doses can be used as quickly as possible,” Dr. Etienne said.

The Brooklyn Nets guard Kyrie Irving in New York in June.Credit...Adam Hunger/Associated Press


Kyrie Irving, the N.B.A. star who has been indefinitely barred from practicing or playing with the Brooklyn Nets because of his refusal to get the Covid-19 vaccine, spoke out publicly on Wednesday night for the first time since the team decided to keep him off the court, saying his refusal was a matter of personal freedom.
“You think I really want to lose money?” Irving, who is set to earn about $40 million in salary this season, said on his Instagram feed in a meandering monologue that included incorrect medical information. More than 90 percent of players in the league are vaccinated, a proportion much higher than in the general population of the United States.
“You think I really want to give up on my dream to go after a championship?” Irving, 29, said. “You think I really just want to give up my job? You think I really want to sit at home?”
On Tuesday, the Nets said they had barred Irving from playing until he becomes “eligible to be a full participant.” New York City requires most teenagers and adults to have at least one vaccination shot to enter facilities such as sports arenas, and Irving has not practiced with the Nets in Brooklyn. Irving joined the Nets in 2019 as they built a team of superstars that includes Kevin Durant and James Harden.
Irving asked that his decision to remain unvaccinated be respected and said that he has no plans to retire. He couched his refusal to get vaccinated in his opposition to mandates, saying nobody should be “forced” to do it.
Irving falsely claimed his decision to remain unvaccinated does not harm other people. The highly contagious Delta variant has quickly spread in areas with low vaccination rates. And hospitals in those areas have been overrun with unvaccinated patients, leaving few beds and staff members to treat other patients.

Ricarlo Flanagan.Credit...Ben Cohen/NBCUniversal, via Getty Images


Ricarlo Flanagan, a comedian, actor and rapper best known for his appearances on TV’s “Last Comic Standing” and “Shameless,” died on Saturday in Los Angeles. He was 41.
He contracted Covid-19 a few weeks ago, said his representative, Stu Golfman, who could not confirm the disease was the cause of Mr. Flanagan’s death.
On Oct. 1, Mr. Flanagan said on Twitter that “this Covid is no joke. I don’t wish this on anybody.”
On “Last Comic Standing,” Norm Macdonald, a comedian and a judge on the show who died recently, said Mr. Flanagan was his favorite comic in the competition.
“I was stunned,” Mr. Flanagan would later say about the exchange.
After his run on “Last Comic Standing,” he appeared on several TV shows, including “Insecure” and “Shameless,” the Showtime series that featured him in a four-episode arc, according to his IMDb page.
He discovered his love of stand-up after he took a comedy class that he saw advertised on a flyer in Ann Arbor, Mich., according to a statement from his representative.
“After the first class, he was hooked and never stopped getting on stage,” the statement said.
He had moved to Michigan after graduating from college in 2007, but his comedic talents soon brought him to Los Angeles, his representative said.
Mr. Flanagan also dabbled in rap, tweeting recently that he had almost finished an album. In a song called “Revolution” that he released last year, he lamented police brutality and said, “We got to mobilize.”
“I’m tired of seeing my brother on the ground with his face pinned down,” he rapped.
Ricarlo Erik Flanagan was born on March 23, 1980, in Cleveland, according to a death announcement. He is survived by his mother, Katrina McLeod, his father, Keith Flanagan, and his grandmother, along with several aunts, uncles and cousins.

Commuters in Canary Wharf, an area of London where many financial firms are clustered. Credit...Victoria Jones/Press Association, via Associated Press


Blackstone, the giant private equity firm, will require employees who want to work in its London office to be vaccinated beginning next week, as the American company takes a more forceful approach to vaccinations than many other businesses in Britain.
Across the United States, vaccine mandates, which require employees to be inoculated to remain in their jobs, are becoming increasingly common ahead of a rule by President Biden that will apply to companies with more than 100 employees.
But in Britain, data protection and employment discrimination laws have prevented companies from mandating their own “no jab, no job” policies and have made it harder to physically separate unvaccinated workers. Instead, companies have been advised to encourage vaccinations rather than enforce them.
Starting Monday, only fully vaccinated employees will be allowed to work at Blackstone’s London office, according to a memo seen by The New York Times. The company is asking employees to voluntarily upload proof of vaccination to an internal system. Though it has been encouraging its staff to return to the office, working in the office is voluntary. Vaccinated employees will still need to have a negative Covid-19 test to go to the office, where more than 400 people work.
“The health and well-being of our people is our number-one priority,” Blackstone said in a statement. “Data shows that vaccines prevent serious illness or hospitalization, and we believe that this is the best way, for now, to help protect our employees and their families.”
This is one of the challenges facing international companies as they bring workers back to their offices, with employees facing different requirements in different countries. In the United States, Blackstone asked vaccinated deal makers to return to the office three months ago. An American law firm, Morrison Foerster, reportedly said in August that its London staff needed to be vaccinated to return to the office in mid-September.
The Blackstone office in Berkeley Square in London.Credit...Will Wintercross/European Pressphoto AgencyRequiring vaccinations to return to a British office is “not entirely unheard-of, but not too many companies that I’m aware of have taken that step yet,” said Holly Cudbill, an employment lawyer at Blake Morgan. “At the moment, the focus very much has been on encouragement rather than mandating that people are vaccinated.” But companies have been asking if this is something they can, or should, do, she added.
The publishing house Bloomsbury, which said Thursday that it would require any employees returning to the office to be vaccinated, is another rare example.
One of the challenges in mandating vaccinations is that it would require proof of a jab, and medical records have special protection under British data privacy laws, which means there needs to be a good legal reason to hold this information.
A related concern is that if workers who aren’t vaccinated for medical or religious reasons are then treated differently from other staff because they are not in the office, the company could be accused of discrimination. But if companies can show they have a justifiable reason for collecting this data and the request is a proportionate measure to achieve a legitimate aim, the legal risks are diminished, said Lucy Lewis, an employment lawyer and partner at Lewis Silkin.
“The challenge for employers is, is it justifiable if you’re taking other Covid-secure measures within the business?” Ms. Lewis said. “For example, if you’re continuing to retain social distancing, if there’s an element of mask wearing, can you satisfy that test that requiring vaccination is reasonable within an organization?”
It’s more common for companies to ask people to be double-vaccinated or show evidence of a negative Covid test, currently freely available in Britain, to go into the office, she said. She doesn’t expect requiring vaccines to work in the office to become the norm in Britain.
“Whether it’s possible comes down to you being able to essentially demonstrate to a court that doing it was necessary within your business,” Ms. Lewis said. “In types of businesses where you’ve got a lot of very vulnerable people, it’s much more likely to be reasonable because the risk to those people is that much greater.”
The furthest Britain has gone in making vaccines compulsory for work is in nursing homes. The government has said anyone working or volunteering in nursing homes, unless medically exempt, must be vaccinated beginning Nov. 11. Even to take this step, Parliament had to pass a new piece of legislation, which is now the subject of legal challenges.
In Britain, vaccine uptake is high, with 78 percent of the population over the age of 12 vaccinated. But there are disparities across age groups, with younger cohorts less likely to be vaccinated. In the United States, there is some evidence that vaccine mandates have increased rates above 90 percent within companies.
Businesses can decide who does and doesn’t enter their premises, especially for health and safety reasons. But in the case of the coronavirus, if other measures like mask-wearing, ventilation and social distancing can reduce the risks, it’s difficult to justify barring people’s entry, Ms. Cudbill said.
“I think that they can justify it, but they just need to think about how and make sure it’s not just a knee-jerk reaction,” she said. “Because it will be challenged. There’s absolutely no doubt.”

Despite efforts like this mobile vaccination clinic for farmworkers last May, Minnesota hospitals are experiencing increased Covid-19 caseloads this fall.Credit...Liam James Doyle for The New York Times


Intensive care units are nearing capacity and health care workers are in short supply in Minnesota, as coronavirus cases, hospitalizations and deaths all reach levels not seen since vaccines became widely available.
All of the state’s counties are at high risk for community transmission, according to the Centers for Disease Control and Prevention. New daily cases have risen by 29 percent in the last two weeks and hospitalizations by 17 percent, according to a New York Times database.
























About this data
Source: U.S. Department of Health and Human Services. The seven-day average is the average of a day and the previous six days of data. Currently hospitalized is the most recent number of patients with Covid-19 reported by hospitals in the state for the four days prior. Dips and spikes could be due to inconsistent reporting by hospitals. Hospitalization numbers early in the pandemic are undercounts due to incomplete reporting by hospitals to the federal



The state’s daily case average is at its highest level for 2021 and reached 2,932 on Monday, a dramatic increase since the summer, when it bottomed out at an average of 81 daily cases.
While a monthslong increase driven by the Delta virus variant is waning in much of the country, Minnesota is just one of several Upper Midwestern and Mountain West states where the virus is surging. Cases are up and hospitals have been overwhelmed in North Dakota, Wyoming, Montana and Idaho, all of which have low vaccination rates. Some areas have had to ration care and send patients to distant hospitals for treatment.
The Minnesota Department of Health said the state’s surge is overwhelming hospitals, with rural and metropolitan areas equally stretched.
“Even before Covid cases started to rise in this latest surge, our hospitals were very full with patients needing care for other critical conditions,” Jan Malcolm, the state’s health commissioner, said in a news conference last week.
According to a state health department database, 96 percent of I.C.U. beds in Minnesota are in use along with 93 percent of non-intensive care beds. Although beds are almost at capacity, the state is equipped with respirators to combat the surge, Ms. Malcolm said. The bigger issue now is a shortage of medical personnel, she said.
“What’s important to understand is that this isn’t so much about the physical asset of a hospital bed or a ventilator, and those were big focuses earlier in the pandemic, but now this is really an issue of health care worker capacity,” Ms. Malcolm said. “There are actually fewer health care workers on the job today than there were last year due to the extreme stress and burnout that they have faced for over 18 months now.”
Dr. Kevin Croston, chief executive officer at North Memorial Health, one of Minnesota’s largest medical systems, said “every element of our health system is incredibly stressed.”
Both hospitals run by North Memorial — North Memorial in Robbinsdale and Maple Grove Hospital — are almost running at capacity and are experiencing staffing shortages that have reached a “critical level.”
“Staff vacancies are increasing while our customer patient volumes remain high,” Mr. Croston said. “We have rapidly escalated measures to attract and retain talent in health care and that’s adding more expense to an already stressed financial picture for all these health care systems.”
He also noted that all patients hospitalized with Covid were unvaccinated.
In Minnesota, 59 percent of the state’s population is fully vaccinated compared to 56 percent of the population nationally.
“With the amount of virus that’s out there and the amount of the population that is not protected by the vaccine, there’s unfortunately plenty of room for the virus to still do its harm,” Ms. Malcolm said.

Videotranscript
Biden Announces Plan to Address Supply Chain Shortages
President Biden said the Port of Los Angeles would move toward 24/7 operations, joining its counterpart in Long Beach, in an effort to curb product shortages.

Today, we have an important announcement that we’ll get things you buy to you, to the shelves faster. After weeks of negotiation and working with my team, and with the major union retailers and freight movers, the Ports of Los Angeles, the Port of Los Angeles announced today that it’s going to begin operating 24 hours a day, seven days a week. This follows the Port of Long Beach’s commitment to 24/7 that it announced just weeks ago. By staying open seven days a week through the night and on the weekends, the Port of Los Angeles will open over 60 extra hours a week, will be open. In total, that will almost double the number of hours that the port is open for business from earlier this year. Walmart, our nation’s largest retailer, is committing to go all in on moving its products 24/7 from the ports to their stores nationwide. Specifically, Walmart is committing as much as a 50 percent increase in the use of off-peak hours over the next several weeks. Additionally, FedEx and UPS, two of our nation’s biggest freight movers, are committing today to significantly increase the amount of goods they’re moving at night. And other companies are stepping up as well. They include Target, Home Depot and Samsung, that have all committed to ramp up their activities that utilize off-peak hours at the ports.










President Biden said the Port of Los Angeles would move toward 24/7 operations, joining its counterpart in Long Beach, in an effort to curb product Zaucha for The New York Times
President Biden said Wednesday afternoon that his administration is taking steps to untangle supply chains and clear disruptions that have threatened the holiday shopping season, including moving a key port and some large retailers toward round-the-clock operations.
Speaking from the White House, Mr. Biden said the country must “take a longer view” and invest in shoring up supply chain vulnerabilities that have been exposed by the Covid-19 pandemic.
The remarks came as the White House sought to spotlight its efforts to address the problems in ports, factories and shipping lanes that have helped produce shortages, long delivery times and rapid price increases for food, televisions, automobiles and much more.

The resulting inflation has chilled consumer confidence and weighed on Mr. Biden’s approval ratings. On Wednesday, the Labor Department announced that the Consumer Price Index, a key reading of monthly inflation, jumped 5.4 percent in September when compared with the prior year, raising the stakes for the White House and the Federal Reserve.
Mr. Biden cheered an announcement that the Port of Los Angeles will begin operating around the clock as his administration struggles to relieve growing backlogs in the global supply chains that deliver critical goods to the United States.
“Today’s announcement has the potential to be a game-changer,” Mr. Biden said, but added that its success would depend on private retailers taking steps to more rapidly move products from ports to stores around the country.
Administration officials say that they have brokered a deal to move the Port of Los Angeles toward 24/7 operations, joining Long Beach, which is already operating around the clock, and that they are encouraging states to accelerate the licensing of more truck drivers. UPS, Walmart and FedEx will also announce they are moving to work more off-peak hours.
Mr. Biden’s team, including a supply chain task force he established earlier this year, is working to make tangible progress toward unblocking the flow of goods and helping the retail industry return to a prepandemic normal.

But it is unclear how much the White House’s efforts can realistically help. The blockages stretch up and down supply chains, from foreign harbors to American rail yards and warehouses. Companies are exacerbating the situation by rushing to obtain products and bidding up their own prices. Analysts say some of these issues may last into late next year or even 2023.
Reporters peppered Jen Psaki, the White House press secretary, with questions Wednesday about lingering effects on holiday shopping, including whether she could guarantee it would not be disrupted by supply chain issues. “We cannot guarantee,” she said. “What we can do is use every lever at the federal level to reduce delays.”

People getting Covid-19 vaccinations in Nanjing, in China’s Jiangsu Province, in August.Credit...Li Bo/Xinhua, via Associated Press


Chinese authorities are rolling out third shots of coronavirus vaccines for high-risk groups in at least 10 regions, according to state media, as the country races to meet its goal of fully vaccinating 80 percent of its population by the end of the year.
After a series of outbreaks of the Delta variant, Wang Huaqing, chief expert for China’s immunization program at the Chinese Center for Disease Control, recommended last month that additional shots be administered to people in frontline professions, including medical workers; people with weaker immune systems; those age 60 or older; and travelers going to countries deemed at high risk.
Chinese health officials have said that further studies were still needed to determine whether the rest of the population would benefit from getting an additional shot.
By Sunday, more than 40,000 people in Hubei, the province encompassing Wuhan where the virus first emerged, had received booster shots, according to state media reports. In the northeastern province of Heilongjiang, which had a flare-up of the Delta variant last month, local health officials said that people who got the booster shot would see their government-issued health codes upgraded to reflect their strengthened immune status.
Last month, China announced that it had fully inoculated 1 billion people, or about 71 percent of its population of 1.4 billion. The country has administered 2.21 billion doses, more than twice that of India, which is ranked second for shots given, according to Our World in Data, which tracks vaccination figures.
Despite its high vaccination rate, China has shown no signs of abandoning its “zero Covid” strategy, and has instead continued to employ a mix of stringent border controls, mass testing and snap lockdowns to tame outbreaks.
On Monday, a panel of experts advising the World Health Organization recommended that an additional dose be administered to people over 60 who were inoculated with vaccines made by the Chinese companies Sinopharm and Sinovac. The panel cited evidence from studies in Latin America that immune protection from the Chinese vaccines wanes significantly over time. While the experts also recommended additional doses of the seven W.H.O.-authorized vaccines for people with weaker immune systems, the Chinese-made shots were the only ones that were singled out for expanded use for older people in the general population.
In a nod to concerns that poorer countries are struggling to offer first doses to their populations while some wealthier countries administer boosters, the W.H.O. panel recommended that health authorities using the Sinovac and Sinopharm vaccines aim to fully inoculate older populations before administering third doses.
Authorities in Turkey have already been allowing people inoculated with Sinovac’s vaccine to get an additional shot of the Pfizer vaccine to help facilitate travel to countries where the Chinese vaccines have not been approved.
More than 1 billion Chinese-made doses have been administered in over 90 countries outside China, though outbreaks in several countries over the summer have raised questions about the efficacy of the shots at preventing the spread of the virus, especially new variants.
The concerns have not slowed China’s efforts to engage in vaccine diplomacy. Last month, the Pan American Health Organization struck a deal with Sinovac to buy millions of Covid-19 vaccines for countries in Latin America and the Caribbean where access to vaccines has been highly uneven.

People waiting in line to testify on a proposed mask ordinance during an Anchorage Assembly meeting in September. Some are wearing Stars of David, attempting to liken mask requirements to the persecution of Jews in the Holocaust.Credit...Bill Roth/Anchorage Daily News, via Associated Press


The Anchorage Assembly approved a mask mandate on Tuesday after two weeks of heated public discussion amid a Covid outbreak that has forced doctors to ration life-saving care in Alaska’s largest city.
The vote was 9-1, concluding a tense, often chaotic debate that included doctors being heckled by members of the public, an armed man being arrested, and protesters sparking outrage by turning up to meetings wearing Stars of David — an attempt to liken mask requirements to the persecution of Jews in the Holocaust.
“The time to act is now,” Meg Zaletel, an assembly member, said on Tuesday night while pressing for a vote. One person in the crowd shouted objections, leading security officers to intervene.
The order requires everyone to wear a mask or face covering in public indoor spaces, with limited exemptions for younger children and for religious or medical reasons.
Alaska has recorded the highest coronavirus case numbers per person in the United States in recent weeks. Although new infections have fallen from a late September high, the surge has overwhelmed hospitals, especially in Anchorage, where many of the state’s patients come for critical needs.
























About this data
Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of a day and the previous six days of data.




















Heart surgeries have been canceled to preserve space in hospitals. One facility rationed oxygen. And doctors have been forced to implement “crisis standards of care,” prioritizing some critical patients over others because of the lack of resources.
One patient who needed emergency surgery was not attended to; a second was taken off of dialysis because another needed it. In both cases, the patients who received substandard care died.
Gov. Mike Dunleavy has resisted a statewide mask mandate, but assembly members in Anchorage — home to about 40 percent of the state’s population — moved forward. Doctors had gone to the assembly meetings in recent weeks to detail the crisis they have been facing, but they faced blowback from community members. One man followed doctors out of a meeting, calling them liars.
Anchorage Mayor Dave Bronson, who has opposed a mask requirement, vowed to veto the mandate, although it appears the assembly has the votes to override it.
About 51 percent of Alaska’s population is fully vaccinated, according to a New York Times database, lower than the national figure of 57 percent.

Lucenia Williams Dunn found it hard to separate the painful history of the Tuskegee syphilis study from the creation of Covid-19 vaccines, though the specifics are quite different.Credit...Matthew Odom for The New York Times


By the time vaccines for the coronavirus were introduced late last year, the pandemic had taken two of Lucenia Williams Dunn’s close friends. Still, Ms. Dunn, the former mayor of Tuskegee, contemplated for months whether to be inoculated.
It was a complicated consideration, framed by the government’s botched response to the pandemic, its disproportionate toll on Black communities and an infamous 40-year government experiment for which her hometown is often associated.
“I thought about the vaccine most every day,” said Ms. Dunn, 78, who finally walked into a pharmacy this summer and rolled up her sleeve for a shot, convinced after weighing with her family and doctor the possible consequences of remaining unvaccinated.
“What people need to understand is some of the hesitancy is rooted in a horrible history, and for some, it’s truly a process of asking the right questions to get to a place of getting the vaccine.”
In the first months after the vaccine rollout, Black Americans were far less likely than white Americans to be vaccinated. In addition to the difficulty of obtaining shots in their communities, their hesitancy was fueled by a powerful combination of general mistrust of the government and medical institutions, and misinformation over the safety and efficacy of the vaccines.
But a wave of pro-vaccine campaigns and a surge of virus hospitalizations and deaths this summer, mostly among the unvaccinated and caused by the highly contagious Delta variant, have narrowed the gap, experts say. So, too, have the Food and Drug Administration’s full approval of a vaccine and new employer mandates. A steadfast resistance to vaccines in some white communities may also have contributed to the lessening disparity.

Matthew Thomas received his second dose of the Moderna vaccine in April at Leupp Field Clinic in Leupp, Ariz.Credit...Sharon Chischilly for The New York Times


A key federal advisory committee began two days of meetings that are expected to strongly influence decisions on whether at least some recipients of the Moderna and Johnson Johnson coronavirus vaccines will soon be eligible for booster shots.
After hearing from Moderna officials, Food and Drug Administration scientists, members of the public and others, the panel of outside experts advising the F.D.A. is scheduled to vote Thursday on whether to recommend emergency authorization of a third shot for recipients of Moderna’s vaccine. (You can watch the meeting here.)
The panel will vote Friday on Johnson Johnson’s request for emergency authorization of a second dose. They will also discuss, but not vote on, whether a booster dose of both the Pfizer-BioNTech or Moderna vaccines should be offered to people who are not elderly or in high-risk categories. That would broaden the eligibility categories that the government set for a Pfizer booster last month.
While regulators are not obligated to follow the panel's recommendations, they typically do.
The panel may be more skeptical of a booster shot for Moderna recipients than for Johnson Johnson. Some vaccine experts have long argued that Johnson Johnson should be a two-dose vaccine since its effectiveness is lower than those of the shots produced by both Moderna and won authorization for a booster shot for many recipients last month after arguing that its vaccine, while highly protective in the early months, lost some potency against severe Covid-19 and hospitalization over time.
But Moderna’s potency against hospitalization has held up better over time than Pfizer’s, according to a recent study by the Centers for Disease Control and Prevention.
In documents released Tuesday, Moderna did not argue that its vaccine requires a booster to prevent severe disease or hospitalization. Instead, it concentrated its arguments on preventing infection and mild to moderate disease.
Moderna said the mean antibody level of participants in its study was 1.8 times higher after the booster than it was after the second shot. In another measurement, the booster raised neutralizing antibodies at least fourfold in 87.9 percent of people compared to after the second dose, narrowly failing to meet the agency’s requirement of 88.4 percent.
Given that Moderna’s vaccine appears to still strongly protect against severe disease, at least some committee members are expected to balk at recommending a third dose. “Maybe it won’t be a slam dunk,” said Dr. Peter J. Hotez, a vaccine expert at the Baylor College of Medicine, of the panel’s vote. “Maybe we should wait a little bit longer on Moderna, let it drop off more first before we boost.”
One of the first presentations Thursday came from Israeli health officials, who said their booster campaign offering a third shot to recipients of Pfizer-BioNTech’s vaccine significantly lowered rates of infection and severe disease.
The Biden administration has been closely watching Israel’s experience because the country has a nationalized health care system that allows it to closely track recipients.
Since Israel’s data deal only with Pfizer’s vaccine, it was not clear how much weight committee members will give it. But it did provide them with more information than they had last month before voting to recommend a booster for a broad swath of Pfizer recipients. Several panel members described the data as compelling.
Israeli scientists analyzed rates of infection and of severe illness among 4.6 million people from July 30, when the country first began offering booster shots, to Oct. 6. They compared rates of both among people who got a third dose to those among people who did not, and said they used the same definition of severe disease as the one used by the National Institutes of Health.
Israeli officials said they found a booster dose improved protection against infection across all age groups about tenfold.
Rates of severe illness were six to 20 fold lower for those 60 years or older and three to 20-fold lower for those aged 40 to 60, the researchers said, although the number of severely ill people in the latter group was very small even before boosters were given. Death rates were three to 10-fold lower among the elderly, they said.
A crucial question that was not clearly answered during the Israelis’ presentation, though, was whether the recent drop in cases there could be at least partly due to the retreat of the highly contagious Delta variant.
The Israeli results have been published by a preprint service but have not been peer-reviewed.

A nurse's cold storage bag with three vaccine options at a vaccination event in July in New York City: Moderna is red, Pfizer-BioNTech is purple and Johnson Johnson is blue.Credit...James Estrin/The New York Times


It can be hard to keep track of developments on coronavirus vaccine boosters without a scorecard.
The Food and Drug Administration’s panel of expert advisers is scheduled to vote this week on whether to recommend booster shots for two of the three vaccines in use in the United States, those from Moderna and Johnson Johnson, for each vaccine’s recipients.
The agency has already authorized booster shots of the third, from Pfizer-BioNTech, for certain groups who got that vaccine initially, including adults 65 and older and residents of long-term care facilities. Third doses of the Pfizer-BioNTech and Moderna vaccines also have been authorized for some people with weaker immune systems, who may not have gotten full protection from the original two doses.
All three vaccines initially provide very strong protection against infection, serious illness and death from Covid-19. The impetus for boosters comes from studies suggesting that while that protection remains strong against serious illness and death, it may decline somewhat over time and could allow more breakthrough infections, especially of the highly contagious Delta variant. The decline tends to be most pronounced in older people and those with certain underlying medical conditions.
Here is a rundown of the booster-shot situation for the three vaccines available in the United States.
Pfizer-BioNTech
What you would get: A third full dose, at least six months after your second.
Where it stands in the U.S.: Available now for many people. The F.D.A. has authorized third shots for people over 65, people with certain medical conditions and some others who are at high risk because of where they work or live. (Some immunocompromised people can get a third shot a month after their second.) The agency has put off a decision on whether to authorize boosters for other people.
Where it stands elsewhere: Israel and some other countries are administering Pfizer-BioNTech booster shots widely.
What the science says: The Pfizer-BioNTech vaccine was the first to win full approval in the United States (for those 16 and older), the first to be authorized for some children (those 12 to 15) and the first to be authorized for boosters; the available data on its safety and effectiveness is especially robust. Some studies suggest that the vaccine may decline in effectiveness over time a bit more than the Moderna vaccine.
Moderna
What you would get: A half-dose, at least six months after your second full dose.
Where it stands in the U.S.: Awaiting authorization as a booster for the same population groups who are now eligible for a Pfizer booster. (Some immunocompromised people can receive a full third dose a month after their second.)
Where it stands elsewhere: Some countries are offering Moderna booster shots or planning to do so soon.
What the science says: Some studies suggest that the Moderna vaccine’s effectiveness declines less than the other two vaccines available in the United States do. That may mean there is less need for Moderna recipients to get boosters. Taking that into account, an F.D.A. staff report took a neutral stance on Moderna’s booster-shot application.
Johnson Johnson
What you would get: A second dose, probably six months after the initial dose.
Where it stands in the U.S.: Awaiting authorization. An F.D.A. staff report found significant shortcomings in the data that the company submitted with its application, but it was not clear whether that would delay a decision.
Where it stands elsewhere: No country has yet recommended administering second doses of the Johnson Johnson vaccine.
What the science says: The Johnson Johnson vaccine gives strong initial protection after one dose, though not as strong as the Pfizer or Moderna two-dose vaccines, so there has long been interest in boosters for Johnson Johnson recipients.

Dr. Janet Woodcock, the acting commissioner of the Food and Drug Administration, who will issue the agency’s decision on boosters.Credit...Stefani Reynolds for The New York Times


An independent panel of experts advising the Food and Drug Administration is meeting regarding Moderna’s coronavirus vaccine booster shot on Thursday, and on Johnson Johnson’s on Friday. Each day will culminate in a vote by the panel on whether to recommend emergency authorization for that booster for recipients of that vaccine.
So what happens after the panel votes? There are further steps at the F.D.A., then steps at the Centers for Disease Control and Prevention, and the process ends with the states. Here’s how it breaks down:
The F.D.A.
The F.D.A., a federal agency of the Department of Health and Human Services that controls and supervises medications and other elements related to public health, takes up the advisory panel’s recommendation, which includes the question of who should be eligible. The advisory panel’s votes are not binding, but the F.D.A. typically follows them.

The F.D.A.’s top official — its acting commissioner, Dr. Janet Woodcock — issues the agency’s final determination on whether to authorize the boosters and for whom. Such decisions are typically issued within a few days of advisory committee meetings.


The C.D.C.
An advisory panel to the Centers for Disease Control and Prevention, the United States’ public health agency, reviews the F.D.A.’s decision. On Thursday and Friday of next week, that panel is scheduled to meet and vote on its recommendations regarding boosters.

The C.D.C. takes up that panel’s recommendations, and the agency’s director, Dr. Rochelle P. Walensky, issues the agency’s guidance on whether boosters should be used and who should be eligible. That guidance is deeply influential for states, doctors, pharmacies and other health care institutions and the general public. As with the process at the F.D.A., the panel’s recommendations are not binding, but the C.D.C. usually follows them.
However, there was a rare exception last month: When a C.D.C. advisory panel rejected the F.D.A.’s recommendation that frontline workers be included among those eligible for the Pfizer-BioNTech booster, Dr. Walensky overrode her own agency’s advisers and sided with the F.D.A.


Dr. Rochelle P. Walensky, the C.D.C. director, issues guidance for states and the general public. Credit...Stefani Reynolds for The New York TimesThe states
State health departments generally follow the recommendations of the C.D.C. In the case of the Pfizer-BioNTech booster, the shots began being administered widely immediately after Dr. Walensky announced the C.D.C.’s guidance to allow them for people over 65, patients in nursing homes and other institutional settings, those with underlying medical conditions, and frontline workers.

The Food and Drug Administration typically issues decisions about vaccine matters soon after its scientific advisory panel offers Reynolds for The New York Times


A committee of scientific advisers to the Food and Drug Administration is meeting on Thursday and Friday to examine the available data on using additional doses of the Moderna and Johnson Johnson vaccines to boost immunity. Votes are scheduled on whether to recommend emergency authorization of booster shots for recipients of those vaccines.
While the panel’s recommendations are not binding, they are very likely to influence the F.D.A.’s decision — typically issued within a few days after the advisory committee weighs in. If the agency says yes to the boosters, the process moves to the Centers for Disease Control and Prevention.
Who are the experts on the F.D.A.’s Vaccines and Related Biological Products Advisory Committee?
The committee now has 19 voting members who are scientific authorities from a range of fields, including immunology, vaccine safety and virology. Many are medical practitioners.
Dr. Arnold Monto, the acting chair of the committee, is a professor of epidemiology at the University of Michigan School of Public Health.
Here are the other voting members:
Dr. Archana Chatterjee, a pediatric infectious diseases specialist, is the dean of the Chicago Medical School and vice president for medical affairs at Rosalind Franklin University of Medicine and Science.

Capt. Amanda Cohn is a doctor and senior official overseeing vaccine policy at the C.D.C.’s National Center for Immunization and Respiratory Diseases.

Dr. Oveta Fuller is a trained pathologist and an associate professor of microbiology and immunology at University of Michigan Medical School.

Dr. Hayley Gans is a professor of pediatrics infectious diseases at Stanford University Medical Center.

Dr. James Hildreth is a professor of medicine and the president and chief executive officer of Meharry Medical College.

Dr. Randy Hawkins is a practicing physician who specializes in internal medicine and sits on the committee as a consumer representative.

Dr. Michael Kurilla is a senior official with expertise in infectious diseases and vaccine development at the National Institutes of Health.

Dr. Jeanette Lee is a professor of biostatistics at the University of Arkansas For Medical Sciences in Little Rock, Ark., and an expert on clinical trials.

Dr. Ofer Levy is the director of the Precision Vaccines Program at Boston Children’s Hospital, and a professor of pediatrics at Harvard Medical School.

Dr. H. Cody Meissner is professor of pediatric infectious disease at the Tufts University School of Medicine and Tufts Children’s Hospital in Boston.

Dr. Patrick Moore is a professor of microbiology and molecular genetics at the University of Pittsburgh.

Dr. Michael Nelson is a professor of medicine at the University of Virginia in Charlottesville. He is also president of the American Board of Allergy and Immunology.

Dr. Paul Offit is a professor of pediatrics at Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine.

Dr. Steven Pergam is an expert on infectious diseases at the Fred Hutchinson Cancer Research Center in Seattle and an associate professor at the University of Washington.

Dr. Stanley Perlman is professor of microbiology and immunology at the University of Iowa, and a pediatric infectious diseases specialist with expertise in coronaviruses.

Dr. Eric Rubin is the editor in chief of the New England Journal of Medicine and an expert on infectious diseases at the Harvard T.H. Chan School of Public Health.

Dr. Mark Sawyer is a professor of pediatrics and a pediatric infectious disease specialist at the University of California, San Diego, and Rady Children’s Hospital in San Diego.

Dr. Melinda Wharton is the associate director for vaccine policy at the C.D.C.’s National Center for Immunization and Respiratory Diseases.

Source: New York Times

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