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Health

Coronavirus strain in UK picks up mutation that could impact vaccines, experts say

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The mutation, called E484K, was already part of the genetic signature of variants linked to South Africa and Brazil. 

According to the PHE report, the mutation has been newly detected in at least 11 samples of the UK’s B.1.1.7 strain. It also appears some of these samples may have acquired this mutation independently, instead of spreading from a single case.

This could mean a variant already known to be more transmissible also risks becoming somewhat resistant to the immune protection offered by vaccines, or more likely to cause reinfection among people who were previously infected, experts say. 

“This doesn’t appear to be great news for vaccine efficacy,” said Joseph Fauver, associate research scientist in epidemiology at the Yale School of Public Health. 

He added the new finding is also something to keep monitoring in the US, where efforts to look for variants through genetic sequencing have lagged behind the UK. The fact that we’ve only seen this in the UK “may be a result of their robust genomic surveillance program,” Fauver said. 

Evidence of immune escape

Experts say it’s too early to predict whether this development will greatly impact the trajectory of Covid-19 in the UK and around the world. 

However, there is some research suggesting that E484K may be a key culprit behind why certain vaccines appear less effective in South Africa.

Novavax recently announced its vaccine was 89% effective in its Phase 3 UK trial, but only appeared 60% effective in a separate Phase 2b study conducted in South Africa. Similarly, in Johnson & Johnson’s Phase 3 trial, efficacy differed by country: 72% in the US versus 57% in South Africa. In both trials, 90 to 95% of cases in South Africa were linked to the B.1.351 variant, which contains the E484K mutation.

But much of the early evidence on this so-called “escape mutant” comes from research in the lab, showing that antibodies appear less able to bind spike proteins arising from the mutation.

The latest example comes from a new study finding that antibodies from vaccinated people were less effective at neutralizing a synthetic virus resembling those in the PHE report — meaning, they contained pivotal mutations from B.1.1.7, plus E484K.

Adding the E484K mutation appeared to raise the bar for the level of antibodies needed to prevent the lab-made virus from infecting cells, when compared to B.1.1.7 mutations on their own.

The study sampled blood from 23 people who had received a single dose of the Pfizer/BioNTech vaccine three weeks prior, with a median age of 82. The study was not able to demonstrate how this impacted people’s actual likelihood of becoming infected with virus variants.

Citing the genomics database GISAID, the study also tallied a slightly higher total of cases than the PHE report: two unrelated cases in Wales and a cluster of more than a dozen in England, appearing as early as the first half of December 2020.

Vaccines more important than ever

Paul Bieniasz, a virologist at the Rockefeller University, noted that the E484K mutation has “appeared sporadically” in multiple samples for months, but until recently it didn’t appear to offer the virus an advantage in populations with no preexisting immunity. 

But it’s a different story in places like South Africa, where many people had been previously infected. On Monday, Dr. Anthony Fauci noted “a very high rate of reinfection to the point where previous infection does not seem to protect you,” citing the work of colleagues in South Africa.

The B.1.1.7 strain first spotted in the UK has now been found in at least 70 countries worldwide, including about 470 known cases in the US, according to the US Centers for Disease Control and Prevention.

Experts say that aggressive testing, adhering to Covid-19 guidelines and rapidly rolling out vaccines are more important than ever in light of these spreading variants. 

“We need to get as many people vaccinated as quickly as we possibly can,” Fauci previously said. “Even though there is a diminished protection against the variants, there’s enough protection to prevent you from getting serious disease, including hospitalization and deaths.”

CNN’s Nina Avramova contributed to this report.

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Health

Pain relief medications like Tylenol and Advil are ‘perfectly fine’ for COVID-19 vaccine aftereffects, experts say

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Avoid pain relief medications just before getting the COVID-19 vaccine, but they are “perfectly fine” to take after, experts say.

Headache, fever, body aches and chills: While these are completely normal side effects of the COVID-19 vaccine – and a good sign your immune system is working – they can be unpleasant.

To minimize the discomfort, some Americans may turn to pain relievers such as acetaminophen or ibuprofen. Others worry those medications could blunt the effectiveness of the vaccine.

Studies on the subject are sparse and inconsistent, but the Centers for Disease Control and Prevention and the World Health Organization recommend against the preventive use of pain relievers, though they allow them if symptoms develop after.

In a study published in the peer-reviewed Journal of Virology, researchers found nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the production of antibodies and affect other aspects of the immune response to SARS-CoV-2, the virus that causes COVID-19.

Researchers said the study’s results raised the possibility that pain relievers such as ibuprofen could alter the immune response to the COVID-19 vaccine.

Dr. Colleen Kelley, an associate professor of medicine at Emory University School of Medicine, who was not affiliated with the study, speculates that an altered response could be caused by reducing inflammation triggered by the immune system.

“The immune system generates a response through controlled inflammation. (Pain relievers) can reduce the production of inflammatory mediators,” she said. “So, this is the potential mechanism for a reduced immune response to vaccination if you take these medications.”

But Dr. Marian Michaels, a member of the University of Pittsburgh Medical Center’s COVID-19 vaccine advisory committee, says studies have shown the immune system responds differently to the COVID-19 vaccine than it does to natural infection.

“We believe that the (immune) response to the vaccine is actually a better response than the wild-type virus with COVID-19,” said Michaels, who is also a pediatric infectious disease physician at UPMC Children’s Hospital of Pittsburgh. “For that very reason, even for someone who has had the infection in the past … we recommend that people still receive the vaccine.”

‘This is fantastic’: Mass vaccination clinics to play key role in ending COVID-19 pandemic

One 2016 study from Duke University looked at the effectiveness of various vaccines among children and found those who took pain relievers before getting their regularly scheduled shots had fewer antibodies than those who didn’t.

But the few studies that exist on pain relievers and vaccines are not robust enough to draw conclusions, experts say, as the children in the 2016 study who took pain relievers and showed fewer antibodies still had a sufficient immune response to provide protection.

There’s no data that shows a reduced immune response if the medications are taken after getting the vaccine to treat side effects, Kelley added.

‘Actively looking at it’: Will travelers need a negative COVID-19 test to board flights within the US? The CDC says it’s under consideration

“It’s perfectly fine to take NSAIDs or Tylenol if you are feeling unwell after vaccination,” Kelley said. “The symptoms you are experiencing indicate that your immune system is functioning normally and that the immune response is ongoing.”

Michaels notes that study participants were not prohibited to take pain relievers in either the Pfizer-BioNTech and Moderna COVID-19 trials and efficacy rates were still over 95%.

“While I don’t have the exact numbers of people in the research study … I’m sure a number of them took acetaminophen or ibuprofen because 70% had mild (side effects to the vaccine),” she said. “And yet, there was still an immunologic response.”

Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: COVID vaccine: OK to take Tylenol, Advil for side effects after shot

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Sports

On the anniversary of Covid-19 becoming an official public health emergency, experts say it’s time for a change

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“At the time there were fewer than 100 cases of the disease we now call Covid-19 and no deaths outside China,” WHO Director-General Tedros Adhanom Ghebreyesus said Friday. “This week we reached one hundred million reported cases. More cases have been reported in the past two weeks than during the first six months of the pandemic. A year ago, I said the world had a window of opportunity to prevent widespread transmission of this new virus. Some countries heeded that call, some did not.”

The rare emergency declaration, also known as a PHEIC, is the highest level of alarm under international law. Only six have ever been declared in history.

It’s supposed to notify the world that urgent action is needed, but experts say the reason “some countries heeded that call, some did not” is because the declaration has no teeth.

The declaration gives the WHO “few surge powers and no funding,” according to Lawrence Gostin, a professor of public health law at Georgetown University and the director of the World Health Organization Collaborating Center on Public Health Law & Human Rights.

“The only power a declared emergency provides is to make ‘recommendations’ to governments. But most governments, especially in the US and Europe, almost universally failed to adhere to (WHO) recommendations,” Gostin said.

The WHO has been evaluating how it can improve the system, and changes could happen during the World Health Assembly in May.

In this second year of the declaration, Gostin and other legal scholars argue that there needs to be urgent reform to give the WHO much stronger authority and more ample funding, if such a declaration is ever to work more effectively in a global health crisis.

How a public health situation becomes an emergency declaration

Countries are supposed to notify the WHO within a short time frame if they have an event in their country that could trigger an emergency declaration. As spelled out in the International Health Regulations, certain diseases or public health events must pose enough of a significant risk that it requires a coordinated international response.

Once a country notifies the WHO about its health threat, the WHO will then call an expert committee together that meets behind closed doors to review the data and listen to testimony from the country that has reported the threat. The committee then makes a recommendation to the WHO director-general who makes the ultimate decision.

If an emergency is declared, then the WHO creates a list of recommendations for governments to undertake to stop the spread of the disease. The WHO also makes recommendations about how to share information.

If it’s in their own backyard, governments don’t like the declaration

As the policy is written now, there are many downsides and disincentives for governments to provide public health information to the WHO and no real guaranteed upside, according to global health law expert Mara Pillinger.

“Governments tend to prefer that the WHO not call them out and issue this highest alarm, because it may not help them manage the outbreak, but could in fact make it harder for humanitarian supplies and assistance to get into the country,” said Pillinger, an associate in the Global Health Policy & Politics Initiative at the O’Neill Institute of National and Global Health Law at Georgetown. “And it can impose an economic cost.”

In theory, the emergency declaration should raise the alarm and motivate other countries to act, not just to protect themselves, but also to help the country with the outbreak get that problem under control so it doesn’t spread further.

Instead, an emergency declaration often triggers other countries to issue travel and trade restrictions against the country with the outbreak. That country suffers financially, and the travel restrictions are often ineffective since they are applied too late or in a piecemeal fashion, Pillinger said.

The declaration needs more authority

With an emergency declaration nothing mandates other countries to send technical or financial assistance to help that country fight or control the disease. Assistance is instead a “question of political will and political coordination.” China didn’t need the money with the Covid-19 outbreak, but Congo did when an emergency declaration was declared with an outbreak of Ebola in 2018.

While the WHO can make recommendations about how countries should respond to a public health threat, it’s incumbent upon each individual country to decided how to respond; how to work with the WHO; how it will aid the country at the heart of the outbreak; and whether it will even take the WHO’s warning seriously.

“It’s a little bit like declaring a five alarm fire, but imagine that you had a center that is responsible for ringing the alarm bell and then it were up to individual fire houses to decide whether or not they send trucks to the fire,” Pillinger said.

The declaration also gives the WHO no real authority to investigate the outbreak if the country does not want the WHO there.

“Even now, WHO has just sent a team to China, a year late,” Gostin said. “WHO has no authority to independently verify country reports, which is why China was allowed to mislead the world concerning the community spread of (the novel coronavirus). The WHO team also has no legal authority to demand access to full information from the Chinese government and scientists.”

The future of the emergency declaration

One step may be the help the US has promised to give the WHO. The Biden administration reversed the Trump administration’s decision to withdraw from the organization. On January 21, Director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci told the WHO that the US would “work constructively” to strengthen and importantly reform the WHO.

Gostin believes as the world heads into the second year of the emergency declaration the International Health Regulations need to be improved now to better manage the current Covid-19 crisis and to help manage future pandemics.

“WHO should be able to rally the world in response to a pandemic,” Gostin said, noting it hasn’t really even been able to do that. “We have seen little global solidarity and in fact ‘go-it-alone’ nationalism, especially ‘American first and only.’

“The mission of WHO is to lead a globally coordinated response to a pandemic,” Gostin said. “That never happened with Covid-19. And that is why it is urgent to reform the International Health Regulations and to give WHO strong powers and ample funding.”

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Health

Male fertility: Covid-19 may impact sperm, a study finds, but experts urge caution about new evidence

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“This report provides the first direct evidence to date that COVID-19 infection impairs semen quality and male reproductive potential,” the study said.

However, experts not involved in the study were immediately skeptical about the report’s conclusion and urged caution in overgeneralizing the research findings.

“I need to raise a strong note of caution in their interpretation of this data. For example, the authors state that their data demonstrates that ‘COVID-19 infection causes significant impairments of male reproductive function’ yet it only actually shows an association,” said Allan Pacey, a professor of andrology at The University of Sheffield in South Yorkshire, United Kingdom, via email.

“Being ill from any virus such as flu can temporarily drop your sperm count (sometimes to zero) for a few weeks or months. This makes it difficult to work out how much of the reductions observed in this study were specific to COVID-19 rather than just from being ill,” said Dr. Channa Jayasena, a consultant in reproductive endocrinology and andrology at Imperial College London, in an email.

In addition, “it is important to note that there is no evidence of Covid-19 virus in the semen and that there is no evidence that virus can be transmitted via semen,” said Alison Murdoch, who heads Newcastle Fertility Centre at the International Centre for Life, Newcastle University in the UK, via email.

Small study of 84 men

The study age-matched 105 fertile men without Covid-19 to 84 fertile men diagnosed with the coronavirus and analyzed their semen at 10-day intervals for 60 days.

Compared to healthy men without Covid-19, the study found a significant increase in inflammation and oxidative stress in sperm cells belonging to men with Covid-19. Their sperm concentration, mobility and shape were also negatively impacted by the virus.

The differences grew with the severity of the sickness, the study found.

“These effects on sperm cells are associated with lower sperm quality and reduced fertility potential. Although these effects tended to improve over time, they remained significantly and abnormally higher in the COVID-19 patients, and the magnitude of these changes were also related to disease severity,” said lead researcher Behzad Hajizadeh Maleki, a doctoral student at Justus Liebig University Giessen, in Hesse, Germany, in a statement.

There were also much higher levels of ACE2 enzymatic activity in men with Covid, the study found. ACE2, or angiotensin-converting enzyme 2, is the protein that provides the entry point for the novel coronavirus to hook into and infect a wide range of human cells

However, it’s not surprising that Covid-19 might impact the male reproductive system because ACE2 receptors, or the “same receptors which the virus uses to gain access to the tissues of the lung, are also found in the testicles,” said Pacey, who is also editor in chief of the journal Human Fertility.

An ongoing concern

“Since the start of the Covid-19 pandemic, there has been an understandable (but theoretical) concern about whether this coronavirus might have a detrimental impact on the fertility of men who become infected,” Pacey said.

After reviewing some 14 studies published on the topic, Pacey said he concluded that “any measurable effect of coronavirus on male fertility was probably only slight and temporary.”

The findings of this study, he added, could be due to other factors, such as the use of medications to treat the virus, which the authors also acknowledged in the study.

“Therefore, all I see in this dataset are possible differences in the sperm quality between men who are sick with a febrile illness (fever) and those who were well. We already know that a febrile illness can impact on sperm production, regardless of what caused it,” Pacey said.

Sheena Lewis, a professor emeritus at Queen’s University Belfast in Ireland, shared similar thoughts via email: “My concerns are that the men with COVID had substantially higher body weight and were on a number of therapeutic treatments.

“We know that obesity alone reduces sperm quality. The COVID treatments may also have affected these men’s sperm quality, rather that COVID itself,” Lewis said.

“Thus, longer term studies are needed before the testes is considered to be a high-risk organ specific to Covid-19,” Newcastle’s Murdoch said.

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Entertainment

Flaming Lips Use of Plastic Bubbles at Concerts Leave Covid-19 Experts Unsure

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There are Covid-19 bubbles — small clusters of friends or family who agree to socialize exclusively with each other during the pandemic — and then there are the kinds of bubbles the Flaming Lips used at recent concerts.

Band members and concertgoers rocked out and bounced while encased in large individual plastic bubbles amid bright swirling lights in trippy scenes at concerts on Friday and Saturday in Oklahoma City.

The band has taken the elaborate precautions at its live performances to protect against the transmission of the coronavirus, but some health experts were unsure about the effectiveness of those measures.

“I’d need to see how the air exchange was occurring between the outside and the inside of the bubbles to be able to say if it were safe over all or reduced risk of transmission,” said Dr. Eric Cioe-Peña, director of global health at Northwell Health in New Hyde Park, N.Y.

The concerts held on Friday and Saturday were originally scheduled for December, but the band postponed them because of rising Covid-19 cases in the Oklahoma City metro area.

“It’s a very restricted, weird event,” the band’s frontman, Wayne Coyne, told Rolling Stone last month. “But the weirdness is so we can enjoy a concert before putting our families and everybody at risk.”

“I think it’s a bit of a new normal,” he added. “You might go to a show, you might not, but I think we’re going to be able to work it out.”

In March, Mr. Coyne posted a sketch on Instagram showing what the bubble concert might look like.

Nathan Poppe, a videographer and photographer documenting the show for the band, said on Twitter that the floor was set up in a grid of 10 bubbles by 10 bubbles. “Each bubble may contain one person or two or maybe three,” he said.

Photos showed fans climbing inside the spheres on the concert floor, where the bubbles were then inflated with leaf blowers.

Each bubble came equipped with a high-frequency speaker, water bottle, fan, towel and a sign if someone had to use the restroom or if it was too hot inside. If it got too stuffy inside, the bubble could be refilled with cool air, Mr. Poppe said.

He said concertgoers could take their masks off inside the bubble but had to wear them after leaving the bubble.

“You roll your bubble to the exit and unzip it at the door,” he said.

It was not immediately clear what became of the used bubbles after the 90-minute performances, which were attended by about 200 people each.

Some health experts had concerns about users’ safety inside the bubbles.

“There is no evidence about the efficacy — or lack thereof — of these bubbles from an infectious disease transmission point of view,” said Dr. Sandro Galea, dean of the Boston University School of Public Health.

He said that virus transmission control depends on good air circulation and filtration.

“So, in theory, if air filtration is good, protective barriers can helpfully augment and reduce risk of transmission, but I would be hesitant to attend a concert in a bubble at the moment unless this has been assessed further,” he said.

Dr. Cioe-Peña said the plastic bubbles used at the concerts seemed to be unventilated. But if each of the bubbles “had a bidirectionally filtered air supply,” he said, “this would effectively prevent Covid transmission between bubbles.”

While a plastic bubble could help reduce exposure to “infectious agents” if it is filled with filtered air, it could also lead to raised carbon dioxide levels inside the bubble, said Richard E. Peltier, an associate professor of environmental health sciences at the University of Massachusetts Amherst.

“My recommendation would be to add a small CO2 sensor to the bubble,” he said. “Though they aren’t always the most precise, they should be sufficient to tell a concertgoer that it is time for a break and refresh that stale air. And then get back to enjoying the music safely.”



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World

Covid vaccine: Experts say Biden’s strategy could benefit from good timing

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“They’re going to take advantage of the learning curve,” said Vijay Samant, a former Merck executive who oversaw the production of three successful vaccines during his tenure. Samant said vaccine manufacturers have had months to work out supply bottlenecks and that manufacturing was always projected to speed up in the coming months — a boon for the Biden administration.

“They may get a lot of credit because all of a sudden vaccine doses are going to become available and it’s, ‘Oh, well, we did it,’ ” Samant said. “Let me tell you, that’s how it works. They’re on the right end of the curve.”

Connecticut Gov. Ned Lamont, a Democrat, sounded similarly optimistic Thursday, predicting that vaccine supply will rapidly increase in February and March. The governor was fresh off a call with Pfizer, during which the company “reiterated their plan to significantly ramp up production in February,” said the governor’s spokesman Max Reiss. Much of that ramp-up is taking place even before the Biden administration makes any moves under the Defense Production Act.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, appeared to agree with the assessment Thursday.

In an interview on ABC’s “Good Morning America,” Biden’s chief medical adviser expressed confidence in the President’s once seemingly far-reaching goal to vaccinate 100 million people in his first 100 days.

“I feel fairly confident that that’s going to be not only that but maybe even better,” Fauci said, adding that he had looked at the contractual agreements that had been made. “The amount that will be coming in, we will be able to meet that goal.”

Still, questions remain about where US vaccine supply currently stands. The new administration has touted robust federal plans to launch huge vaccination sites and deploy mobile units to hard-hit communities, at the same time some states are canceling appointments at existing vaccination sites, citing a lack of vaccine supply.

Biden’s team has said it’s flying somewhat blind when it comes to the supply of vaccine and how it has been allocated across the country. A source close to the transition told CNN that the Biden team had been denied access to critical resources it needed to accurately gauge the supply and prepare to take over the rollout before Biden took office.

“The cooperation or lack of cooperation funds from the Trump administration has been an impediment,” White House Covid-19 coordinator Jeff Zients told reporters. “So we don’t have the visibility that we would hope to have into supply and allocations.”

To be sure, there’s still not nearly enough vaccine available — in the US or worldwide — and the US has stumbled at getting shots into arms quickly. But the Biden administration also appears to be trying to manage expectations, playing up the shambles the Trump administration left behind while figuring out what concrete steps it can take to improve vaccine manufacturing and distribution.

The Biden administration has not clearly articulated what it’s doing to immediately improve vaccine supply, except to task agencies with looking for opportunities to use the Defense Production Act.

Biden “absolutely remains committed to invoking the Defense Production Act in order to get the supply and the materials needed to get the vaccine out to Americans across the country and remains committed to his goal of getting 100 million shots in the arms of Americans in the first 100 days,” White House press secretary Jen Psaki said Thursday.

The White House did not address how they would be communicating or working with states, but in a statement to CNN spokesman Kevin Munoz reiterated that they would be “listening to the unique needs of states and tailoring the federal government’s resources and guidance accordingly to ensure we are getting vaccines in the arms of Americans as quickly and safely as possible.”

White House officials said they have asked the Department of Health and Human Services to look for all potential sources of a type of syringe that can help extract more doses of the Pfizer vaccine from each vial. On Thursday, Biden said he would sign an executive order to use the Defense Production Act to direct federal agencies and private industries to “accelerate the making of everything that’s needed to protect, test, and vaccinate and the care of our people.”

A former administration official told CNN that the Trump administration had already implemented the Defense Production Act to assist each of the six vaccine manufacturers, as well as on needle and syringe contracts.

“We’ll be working paying close and careful attention to all of the components of the supply chain to ensure manufacturing keeps up with what we need,” Tim Manning, the White House Covid supply coordinator, told reporters. “The Defense Production Act is a powerful tool — powerful set of tools — and there are many ways we can use it to help ensure that there are adequate and growing supplies of vaccine.”

Samant, the vaccine expert, said the administration would be better off focusing on the availability of raw materials like lipids rather than specialized syringes.

“It’s like the most ridiculous thing to chase after,” Samant said of ramping up syringe production, adding that such a move might, at best, improve vaccine supply by 5%.

For the Biden team, it’s critical to understand how much supply is on hand and how much could realistically be available in the coming months. States have said they need clear and consistent guidance on vaccine supply so they can continue to streamline their vaccination programs.

“We will work to provide projections on supply. We hear over and over from governors and local leaders that they just don’t know what supply is coming and can’t plan. We will absolutely across the next few days to get our arms around what’s going on, make sure that we are communicating with states and localities, so they can prepare, effectively,” Zients added.

According to one health official involved in the vaccine distribution process, hospitals receiving the Moderna vaccine complained of being completely in the dark on when they were receiving it and how much they were getting and, in some cases, were sent scrambling when they received surprise shipments. Moderna declined to comment.

All these problems are now landing squarely in the lap of the new administration.

Some state officials said they’re already concerned about what the administration’s plan will be to allocate vaccines and communicate with states.

Under the previous administration, then-Vice President Mike Pence and members of the Covid task force held regular calls with the nation’s governors during most of the pandemic. While some governors found the calls largely useless, they could at least rely on the briefings as an opportunity to hear from high-ranking medical experts and ask questions of the administration.

A day after Biden took office, state officials told CNN there is still a lot of confusion as to how states will be working and communicating with the Biden administration as the pandemic continues to surge and vaccine distribution is woefully behind.

According to one Republican state official, the National Governors Association has reached out to some of its governors about working with the Biden administration on Covid. However, not all governors are members of the organization and it remains unclear how the administration plans to work with those outside the association.

A Democratic state official said they, too, had not had any regular communication with the new administration.

Dr. Bechara Choucair, the White House vaccinations coordinator, has been in touch with some governors but had not laid out how the administration would tackle vaccine allocations.

Biden said Thursday that each state would be assigned a liaison with the Federal Emergency Management Agency.

But in a news briefing Thursday, Psaki couldn’t offer any more specifics on how the Biden administration will improve communications with states.

The new Covid team, she said, “will be engaging with governors, Democrats and Republicans, mayors, local elected officials, to gain a better understanding of what’s happening on the ground.”

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Health

Health experts blame rapid expansion for vaccine shortages

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Public health experts Thursday blamed COVID-19 vaccine shortages around the U.S. in part on the Trump administration’s push to get states to vastly expand their vaccination drives to reach the nation’s estimated 54 million people age 65 and over.

The push that began over a week ago has not been accompanied by enough doses to meet demand, according to state and local officials, leading to frustration and confusion and limiting states’ ability to attack the outbreak that has killed over 400,000 Americans.

Over the past few days, authorities in California, Ohio, West Virginia, Florida and Hawaii warned that their supplies were running out. New York City began canceling or postponing shots or stopped making new appointments because of the shortages, which President Joe Biden has vowed to turn around. Florida’s top health official said the state would deal with the scarcity by restricting vaccines to state residents.

The vaccine rollout so far has been “a major disappointment,” said Dr. Eric Topol, head of the Scripps Research Translational Institute.

Problems started with the Trump administration’s “fatal mistake” of not ordering enough vaccine, which was then snapped up by other countries, Topol said. Then, opening the line to senior citizens set people up for disappointment because there wasn’t enough vaccine, he said. The Trump administration also left crucial planning to the states and didn’t provide the necessary funding.

“It doesn’t happen by fairy dust,” Topol said. “You need to put funds into that.”

Last week, before Biden took over as president, the U.S. Health and Human Services Department suggested that the frustration was the result of unrealistic expectations among the states as to how much vaccine was on the way.

But some public health experts said that the states have not been getting reliable information on vaccine deliveries and that the amounts they have been sent have been unpredictable. That, in turn, has made it difficult for them to plan how to inoculate people.

“It’s a bit of having to build it as we go,” said Dr. George Rutherford, an epidemiologist at the University of California, San Francisco. “It’s a front-end supply issue, and unless we know how much vaccine is flowing down the pipe, it’s hard to get these things sized right, staffed, get people there, get them vaccinated and get them gone.”

State health secretaries have asked the Biden administration for earlier and more reliable predictions on vaccine deliveries, said Washington state Health Secretary Dr. Umair Shah.

Dr. Marcus Plescia of the Association of State and Territorial Health Officials was also among those who said opening vaccinations to senior citizens was done too soon, before supply could catch up.

“We needed steady federal leadership on this early in the launch,” Plescia said. “That did not happen, and now that we are not prioritizing groups, there is going to be some lag for supply to catch up with demand.”

Supply will pick up over the next few weeks, he said. Deliveries go out to the states every week, and the government and drugmakers have given assurances large quantities are in the pipeline.

The rollout has proceeded at a disappointing pace. The U.S. government has delivered nearly 38 million doses of vaccine to the states, and about 17.5 million of those have been administered, according to the Centers for Disease Control and Prevention.

About 2.4 million people have received the necessary two doses, by the CDC’s count — well short of the hundreds of millions who will have to be inoculated to vanquish the outbreak.

Biden, in one of his first orders of business, signed 10 executive orders to combat the coronavirus pandemic on Thursday, including one broadening the use of the Defense Production Act to expand vaccine production. The 1950 Korean War-era law enables the government to direct the manufacture of critical goods.

He also mandated masks for travel, including in airports and on planes, ships, trains, buses and public transportation, and ordered the Federal Emergency Management Agency to set up vaccination centers and the CDC to make vaccines available through pharmacies starting next month.

Biden has vowed to dispense 100 million shots in his first 100 days.

“We’ll move heaven and earth to get more people vaccinated for free,” he said.

Florida was one of the first states to open vaccine eligibility to members of the general public over 65. Now uncertainty over the vaccine supply has prompted the state surgeon general, Scott Rivkees, to advise counties to prioritize available doses for state residents, including so-called snowbirds who live there part-time. People seeking vaccination will have to provide a driver’s license or other document, such as rental leases and utility bills.

In New York, Mayor Bill de Blasio and Gov. Andrew Cuomo have been pleading for more doses. Appointments through Sunday for the first dose of the vaccine at 15 community vaccination hubs set up by the city health department were postponed to next week.

Vaccinations in New York haven’t stopped, but demand for the shots now far exceeds the number of doses available, the mayor said.

“It’s just tremendously sad that we have so many people who want the vaccine and so much ability to give the vaccine, what’s happening?” de Blasio said. “For lack of supply, we’re actually having to cancel appointments.”

Rosa Schneider had jumped at the chance to make a vaccination appointment once she heard that educators like her were eligible in New York. A high school English teacher who lives in New York City but works in New Jersey, she said that a day before she was to be vaccinated on Wednesday at a city-run hospital, she got a call saying the supply had run out and the appointment was canceled.

“I was concerned, and I was upset,” said Schneider, 32, but she is trying daily to book another appointment. She is hopeful availability will improve in the coming weeks.

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Associated Press writer Jennifer Peltz contributed to this report from New York.

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