PESHAWAR, Pakistan—After decades of work, polio had been wiped out almost everywhere in the world. All that was left were pockets in Afghanistan and Pakistan. Medical experts hoped 2020 would be the last year that the main form of the virus, which can permanently paralyze or cause death, posed a threat.
The coronavirus pandemic put a halt to that progress.
In March, house-to-house vaccination teams working across Pakistan were forced to stop their work because of Covid-19. As a result, polio resurged, including a mutated form of the virus. It has now been detected in samples taken from sewers in 74% of Pakistan in late 2020, up from just 13% in early 2018.
“Now the virus isn’t just in select pockets. The risk is everywhere” in the country, said Rana Safdar, the doctor in charge of Pakistan’s polio campaign.
The decadeslong battle to eradicate polio around the world is one of the most ambitious and expensive public-health campaigns in history. The mass-vaccination drive and its progress toward arresting a malady that has disabled or killed millions of people point to the success possible in the efforts to inoculate people around the world against Covid-19.
LONDON—A Covid-19 vaccine developed by the University of Oxford and
AstraZeneca
PLC is effective against a variant of coronavirus that is spreading rapidly in the U.S. and around the world, according to a new study, a reassuring sign for governments banking on mass vaccination to bring the pandemic to an end.
The preliminary findings, published in a study online Friday that hasn’t yet been formally reviewed by other scientists, follow similarly positive results from other manufacturers.
Preliminary studies from
Pfizer Inc.
and
Moderna Inc.
found their Covid-19 shots continued to offer protection against new virus variants that have contributed to a fresh surge in cases in the U.K., Europe, South Africa and elsewhere.
Vaccine makers are nevertheless readying new shots that zero in on the new variants more precisely, underlining how mutations in the virus risk morphing the year-old pandemic into a long-running cat-and-mouse game between scientists and a shifting enemy. The virus behind Covid-19 has so far been linked to almost 2.3 million deaths worldwide and more than 100 million cases.
The study published Friday looked at the AstraZeneca vaccine’s effectiveness against a new variant of coronavirus first identified in the U.K. last year.
As new coronavirus variants sweep across the world, scientists are racing to understand how dangerous they could be. WSJ explains. Illustration: Alex Kuzoian/WSJ
The variant has now displaced older strains to become the dominant version of the coronavirus in Britain and is spreading in many other countries, including the U.S., where public-health officials have said it could become the dominant version of the virus.
Preliminary estimates suggest the variant from the U.K. is 50%–70% more transmissible than earlier versions of the virus. U.K. scientists said recently that early data suggested it could also be deadlier.
Researchers examined blood samples from around 256 participants in an ongoing clinical trial of the vaccine in the U.K. who tested positive for Covid-19.
Genetic sequencing allowed them to identify which participants were infected with the new variant and which had an older version. A little under a third had the new variant.
By testing antibody levels and other markers of immune system activity against the virus, the researchers found the vaccine triggered an effective immune response against the new variant in 75% of cases that showed symptoms of infection, and in around two-thirds of cases if those that didn’t show symptoms were also included.
The U.K. Coronavirus Variant
The small-scale study showed the vaccine works slightly better against older, more established versions of the virus. For those with the older strain, the vaccine was effective in 84% of symptomatic cases and 81% of all cases.
The researchers reported sharply differing antibody responses among the two groups, saying certain types of antibodies induced by the vaccine were up to nine times less effective at neutralizing the new variant than the old. Overall protection was similar, however, suggesting other parts of the immune system are playing a key role.
Andrew Pollard,
director of the Oxford Vaccine Group at the University of Oxford, said it isn’t entirely clear which biological mechanisms are most important. It might be infection-fighting T-cells or other types of antibodies, he said.
“We don’t know the answer,” he said.
Almost 120 million doses of vaccine have been administered worldwide, according to figures compiled by the University of Oxford’s Our World in Data project. Roll-outs have been patchy, with some countries such as Israel and the U.K. moving rapidly to inoculate their most at-risk citizens and others, including in Europe, lagging behind due to supply and other issues. The U.S. has so far given at least one dose of vaccine to 35 million people, around 10% of its population.
Vaccine makers say the technology behind Covid-19 vaccines should allow them to swiftly retool their production lines to produce shots targeted more precisely at new and emerging variants.
Some studies have suggested a variant first identified in South Africa might be less susceptible to existing vaccines than the U.K. variant. Companies including Moderna, Pfizer and its partner
BioNTech
SE,
Johnson & Johnson
and
Novavax Inc.
are designing new vaccines to specifically target the South African variant.
Babak Javid,
associate professor of infectious diseases at the University of California, San Francisco, said small differences in how vaccines perform against new variants compared with established versions isn’t a major concern provided those vaccinated are protected against severe illness and hospitalization. That will be critical to determining when countries relax lockdowns and other public health restrictions, he said.
As a shortage of Covid-19 shots slows vaccination efforts in the West, groups that haven’t been given high priority are increasingly jostling for the right to get immunized first.
In most countries that are currently deploying vaccines, those most at risk of dying or getting seriously ill from the virus—nursing home residents and those caring for them, medical workers and the elderly—have been at the front of the queue.
For months, few questioned the wisdom of a strategy focused on reducing the number of deaths rather than slowing the spread of the virus. But as the weeks roll on, infections remain high and fears grow about the new variants of the virus, groups ranging from essential workers to teachers and people with chronic diseases are growing louder in demanding to be next.
In the U.S., where the vaccination effort started early and has moved relatively fast, many states are moving to immunize those 65 and older as well as people with certain health conditions. Following pressure from interest groups, a few have now started inoculating teachers or farmworkers.
In Europe, where vaccination is progressing painfully slowly because of a mixture of bureaucracy and vaccine-manufacturing hiccups, calls for less vulnerable groups to be given fast-track access are gathering force.
The emerging fight for what is likely to remain a scarce resource for months is the latest challenge for governments that are increasingly under pressure to bring back a degree of normalcy after a year of recurring lockdowns and assorted restrictions.
It is also politically explosive because it raises hard moral questions, including whether elderly people, some bedridden and others well over 100 years old, should have priority over younger cancer patients; or whether groups who no longer play a big role in the economy should take precedence over teachers, police officers, retail workers, bus drivers and others who are statistically less likely to die but will on occasion contract severe cases of Covid-19.
Giving priority to the most vulnerable helps protect the public-health system, but it also means some people who are highly exposed because of their jobs will have to wait, all at a cost to education or the economy, said Alberto Giubilini, a senior researcher on ethical vaccines distribution at the University of Oxford.
“The concept of prioritization means that we have to sacrifice certain values,” he said. “It’s very hard to strike a balance.”
In France, where schools have remained open throughout most of the pandemic and where daily cases have risen steadily since early December, teachers are lobbying the government to be considered a priority for vaccination.
“More and more teachers are scared to go to work,” said Guislaine David, co-secretary general of the SNUipp-FSU teachers union, pointing to data from the education ministry that shows an increase in school shutdowns due to Covid-19 outbreaks since early January. “If we want to keep schools open, getting teachers vaccinated is essential.”
France’s education minister recently said the country would start vaccinating teachers in March. But France’s vaccine rollout has been among the slowest in Europe, raising doubts as to whether any teacher could gain access to shots in the spring, Ms. David said. Unions especially want preschool teachers to get vaccinated urgently as children under the age of 6 don’t wear masks in school in France.
Protesters gathered in Marseille, France, on Jan. 26 to demand more government support for teachers during the pandemic.
Photo:
Daniel Cole/Associated Press
In Italy, teachers unions have also pleaded with the government to vaccinate teachers before other categories, possibly immediately after the elderly and medical personnel, to help reopen schools that have stayed shut longer than in most other European countries.
In the U.K., where vaccinations are progressing much faster than in the European Union, government officials have been looking at whether front-line workers, including teachers and police officers, should be bumped up the priority list. One petition from a teacher in the north of England obtained nearly half a million signatures and triggered a parliamentary debate.
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The government currently says it wants to vaccinate everyone over the age of 50 before considering front-line workers such as teachers. Given the pace of the rollout, this may not happen until the spring.
British Prime Minister
Boris Johnson
said last week that taking away vaccinations from vulnerable groups could result in additional deaths. Mr. Johnson is due to lay out a road map for future vaccination plans and the gradual removal of lockdown measures in the week of Feb. 22.
New research could help explain why thousands of Covid-19 survivors are facing debilitating neurological symptoms months after initially getting sick. WSJ breaks down the science behind how the coronavirus affects the brain, and what this could mean for long-haul patients. Illustration: Nick Collingwood/WSJ
While people with vulnerabilities in principle take high priority for vaccinations in most countries, some complain they have been overlooked.
In Germany, people with disabilities, some with chronic rare illnesses and cancer patients are lobbying—even suing—authorities to obtain priority treatment.
Christian Homburg is campaigning for people with serious conditions to be moved up the priority list for vaccination.
Photo:
Christian Homburg
“Reducing deaths is the main goal of our current vaccination strategy yet somehow people like me were forgotten,” said Christian Homburg, 24, who has Duchenne muscular dystrophy, a severe form of muscle loss that means he currently only has some 20% of his lung capacity.
Mr. Homburg said doctors warned him that catching Covid-19 would likely kill him. But because he is young and doesn’t live in a care facility, where vaccinations are already happening, and because his condition isn’t explicitly mentioned in Germany’s vaccine regulation, Mr. Homburg isn’t entitled for priority treatment.
He has now launched a petition to change that. Advocacy groups defending people with disabilities or diseases made similar appeals, while some patients succeeded in obtaining prioritization by going to court.
Faced with pressure, the Robert Koch Institute for infectious diseases’ standing vaccination committee, which advises the government, last month updated its advice, recommending a case-by-case assessment of people whose disease might put them at a high risk of dying from Covid-19 even in the absence of statistics proving it.
Rainer Schell managed to obtain an exception for his son, who also has Duchenne, can’t breathe without a ventilator and needs 16 caregivers to look after him. But it took him nearly four weeks, the help of a lawyer and hours of pleading with different authorities to get the vaccination appointment.
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The problem, said André Karch, an epidemiologist at the University of Münster, is that because there is little evidence on the level of risk for many rare diseases, such case-by-case decisions will be difficult to make.
Prioritization strategies will change over time as new studies appear on risks for certain populations and new vaccines get approved, health officials say. In Germany, some people in lower-priority groups could get vaccinated faster now after the government decided not to clear
AstraZeneca
PLC’s Covid-19 vaccine for use in people over 65, potentially freeing up supplies for younger adults.
But virologists and epidemiologists say that until there is more hard evidence that vaccines prevent recipients from transmitting the virus—not just from falling ill when infected—or statistics emerge that show an increased risk of illness or death for certain essential workers, governments will have trouble justifying vaccinating younger before older.
“That’s a real dilemma we have here,” said Uwe Liebert, a virologist at Leipzig University. “Of course there are many groups where we can relate why they should be prioritized, but from a pure epidemiological and virological perspective, the current strategy is right.”
—Max Colchester in London and Giovanni Legorano in Rome contributed to this article.
Consulting giant McKinsey & Co. has reached a $573 million settlement with states over its work advising OxyContin maker Purdue Pharma LP and other drug manufacturers to aggressively market opioid painkillers, according to people familiar with the matter.
The deal, reached with 47 states and the District of Columbia and expected to be publicly announced Thursday, would avert civil lawsuits that attorneys general could bring against McKinsey, the people said. The majority of the money will be paid upfront, with the rest dispensed in four yearly payments starting in 2022.
McKinsey said last week it is cooperating with government agencies on matters related to its past work with opioid manufacturers, as state and local governments sue companies up and down the opioid supply chain. At least 400,000 people have died in the U.S. from overdoses of legal and illegal opioids since 1999, according to federal data.
The consulting firm stopped doing opioid-related work in 2019 and said in December its work for Purdue was intended to support the legal use of opioids and help patients with legitimate medical needs.
While some companies have reached deals with individual states to avoid trials, the McKinsey settlement marks the first nationwide opioid pact to come from the flood of litigation that began in 2017. A much larger, $26 billion deal with three drug distributors and Johnson & Johnson has been in the works for more than a year but is still being negotiated.
The Wall Street Journal reported last week that McKinsey was close to a settlement with states and that a deal could be worth hundreds of millions of dollars. The negotiations occurred as hundreds of exhibits describing McKinsey’s work to boost OxyContin sales were made public in recent months during Purdue’s chapter 11 bankruptcy case in White Plains, N.Y.
Memos McKinsey sent Purdue executives in 2013 that have been made public in bankruptcy court filings included recommendations that the company’s sales team target health care providers it knew wrote the highest volumes of OxyContin prescriptions and shift away from lower-volume prescribers. McKinsey’s work became a Purdue initiative called “Evolve to Excellence,” which the U.S. Justice Department described in papers released last year in connection with a plea agreement with Purdue as an aggressive OxyContin marketing and sales campaign.
According to bankruptcy court records, McKinsey sent recommendations to Purdue in 2013 that consultants said would boost its annual sales by more than $100 million. McKinsey recommended ways Purdue could better target what it described as “higher value” prescribers and take other steps to “Turbocharge Purdue’s Sales Engine.”
Stamford, Conn.-based Purdue pleaded guilty in November to three felonies, including paying illegal kickbacks and deceiving drug-enforcement officials. The drugmaker filed for chapter 11 protection in 2019 to address thousands of opioid-related lawsuits brought against it. Purdue said in a lawsuit filed last week against its insurers that creditors have asserted hundreds of thousands of claims in the bankruptcy case and collectively seek trillions of dollars in damages.
McKinsey also advised other opioid makers on sales initiatives. The firm’s work for
Johnson & Johnson
came up in a 2019 trial in a case brought by Oklahoma against the drug company for contributing to the opioid crisis in the state through aggressive marketing of prescription painkillers. The trial ended with a $572 million verdict against Johnson & Johnson, which was later reduced to $465 million and is still on appeal.
The vast majority of the money McKinsey will pay in the settlement will be divided among the participating states, with $15 million going to the National Association of Attorneys General to reimburse it for costs incurred in the investigation, one of the people familiar with the deal said.
The settlement also includes some nonmonetary provisions, like requiring McKinsey to create a repository of documents related to its work for opioid makers, the person said.
The holdout states include Nevada, which said Wednesday night that its investigation into the consulting giant continues “and we are conversing with McKinsey about our concerns.”
Purdue has been negotiating with creditors, which include states, since filing for bankruptcy, but finalizing a deal has been slowed by demands from some states that the company’s owners, members of the Sackler family, contribute more than the $3 billion they have agreed to.
States have been keenly focused on ensuring any settlement money from the opioid litigation goes toward helping alleviate the impact of the crisis, including through beefing up treatment programs and helping overstretched law enforcement. The states are looking to avoid the outcome of the 1990s tobacco litigation, when a $206 billion settlement was often spent to fill state budget holes. The McKinsey settlement documents say the money is intended for abatement, the person familiar with the deal said, though state laws differ widely on how settlement funds can be earmarked.
Write to Sara Randazzo at sara.randazzo@wsj.com and Jonathan Randles at Jonathan.Randles@wsj.com
BNEI BRAK, Israel—Israel’s attempt to suppress a roiling pandemic has collided with a hard-hit ultraorthodox community that has proven resistant to lockdowns and suspicious of the nation’s mass vaccination campaign.
On Sunday, thousands of ultraorthodox mourners attended two funerals of famous rabbis who died from the coronavirus. The mourners flouted bans on public gatherings of no more than 10 people on the same day that Israel’s cabinet extended a strict lockdown that includes barring all international flights. Thousands of men dressed in black wool hats and suits crowded together, many without masks, images of the event show. Fearing violence, police steered away from arrests while some top Israeli politicians seethed.
“This is how unequal enforcement looks,” said
Benny Gantz,
the defense minister and head of the Blue and White party. “Millions of families and children are locked in their homes and abide by the rules while thousands of haredim crowd the funeral, most of them even without masks,” he said, using the Hebrew word for ultraorthodox.
The funerals followed anti-lockdown protests in Bnei Brak and other ultraorthodox cities the week before, in which ultraorthodox men threw rocks at police, lit dumpsters on fire and knocked down street signs and light poles.
Many of the mourners crowding together for a rabbi’s funeral on Sunday in Jerusalem weren’t wearing face masks.
Photo:
Ariel Schalit/Associated Press
Israel’s health officials have also struggled to coax ultraorthodox to take a Covid-19 vaccine. While much of Israel has lined up for vaccinations, the ultraorthodox population has been slower to get on board, with some doubting the safety of the vaccine and others suggesting the country’s citizens are being used to test its efficacy.
“This isn’t a vaccine. It’s an experiment,” said
Izhar Mahpud,
a 57-year-old resident from Bnei Brak, an ultraorthodox city just east of Tel Aviv that has been one of the hardest hit by Covid-19 in the country. “I’m not ready to be a rat in a laboratory.”
Israel aims to vaccinate much of its population by March and get the economy going again, allowing the tiny nation beside the Mediterranean sea to serve as a global showcase for how to beat back the deadly virus. But the ultraorthodox have undermined those lofty goals, largely by bucking lockdowns and shying from vaccines.
Israel’s ultraorthodox make up about 12% of the population but account for nearly one-third of the country’s coronavirus infections. Israel currently has 68,331 active coronavirus cases with new infections hovering at about 7,000 a day.
Officials are scrambling to get the latest surge under control. A British variant of the virus accounts for about 70% of current coronavirus infections, even as almost one-third of Israelis have received the first dose of a vaccination. Prime Minister
Benjamin Netanyahu
last month banned all international flights and lawmakers passed a bill Sunday doubling fines for lockdown violations.
Ultraorthodox Jews argued with Israeli police officers during a protest over coronavirus lockdown restrictions in Ashdod last month.
Photo:
Oded Balilty/Associated Press
Public health officials say the ultra-Orthodox community is particularly vulnerable to the fast-moving virus. Their large families typically live in crowded apartments and traditionally shun electronic communication that helps get information out about the vaccines.
Data from Israel’s health ministry shows Israel’s ultraorthodox are getting vaccinated at a lower rate than other groups. Among those over 60, to whom the campaign has been open the longest, 85% of all Israelis have taken the vaccine, compared with 78% of Israel’s ultraorthodox.
Ultraorthodox and Arab towns are lagging behind in overall immunity to the virus due to the lower vaccination rates, according to
Eran Segal,
a computational biologist at the Weizmann Institute of Science who presented his findings to Israel’s government on Sunday evening. “It’s going to slow down the decline of the pandemic,” said Mr. Segal.
Health officials say that infections in ultraorthodox communities have gone down in recent days, as some leading rabbis have endorsed vaccinations. There are also efforts under way to combat misinformation and get residents to take the vaccine.
In the large ultraorthodox city of Bnei Brak, local officials have set up a war room. In the oval-shaped, wood-paneled room on the top floor of city hall, with portraits of important religious figures lining the walls, young ultraorthodox sit around a large circular table with large jugs of hand sanitizer and work the phones. They stare at spreadsheets with information about everyone who has or hasn’t been vaccinated.
Officials had called nearly 10,000 people who hadn’t been vaccinated—and spoken with nearly 7,000 of them. About 5,000 said they wanted a vaccine but hadn’t been able to get one yet. Another 1,500 or so didn’t want to be vaccinated. The city officials work to overcome any obstacles raised on the calls.
For those who don’t have a ride to a vaccination center, they arrange one. If would-be vaccine recipients can’t get in touch with their health insurance providers, they also help. And if anyone they reach doesn’t want to take the vaccine, they note why.
Avi Blumenthal, who leads the health ministry’s outreach to the ultraorthodox, said he and his staff are combing through lists of Israel’s ultraorthodox towns to find the rabbis who are against vaccination, and seeking answers. In one instance, an ultraorthodox community in Jerusalem had low vaccine rates that many attributed to its rabbi’s alleged antivaccine stance. But when health officials interviewed the rabbi, they learned he was actually pro-vaccine—someone had spread a rumor attributed to him that the vaccine is dangerous.
An ultraorthodox Jewish man received a coronavirus vaccine in Jerusalem last month.
Photo:
abir sultan/epa/Shutterstock
Yehuda Shaish,
63, who runs four ultra-Orthodox schools in Bnei Brak and nearby towns, said he waited until the rabbis blessed the vaccines. “After the rabbis authorized it, I went happily,” he said.
Even with rabbis’ blessings, many ultraorthodox remain skeptical about vaccines. Yedidya Hasson, 28, who manages a network of WhatsApp groups with 30,000 people in which some members have questioned the wisdom of vaccines and coronavirus restrictions, says he won’t take the vaccine at least for now because he fears possible health risks.
“When it comes to vaccines,” he said, “I think that the media in Israel is hiding the truth.”
Some ultraorthodox leaders say that while community mistrust may help to explain resistance to vaccines and recent displays of civil disobedience, that distrust doesn’t justify violating rules that endanger public health. “You expect from religious men to be more moral,” said Rabbi
Dov Halbertal,
a prominent ultraorthodox lawyer and commentator. “But when it comes to the biggest test of saving lives, we are failing.”
Israel says it’s on track to vaccinate everyone over 16 by the end of March. To understand how the small country has vaccinated more of its population than any other so quickly, WSJ visited clinics that are giving shots to young and middle-aged citizens. Photo: Tamir Elterman for The Wall Street Journal
Write to Felicia Schwartz at Felicia.Schwartz@wsj.com
Timetables for vaccinating enough people to effectively curb Covid-19 are slipping in many countries, raising fears that a large portion of the world will still be battling the pandemic and its economic effects well into 2022 or beyond.
While the U.S. and some other mostly small countries are making progress toward vaccinating most of their populations by late summer, health experts and economists are concluding that much of the planet—including parts of Europe, Asia and Latin America—face a longer slog.
Places from Germany to Mexico are running into serious problems sourcing sufficient vaccines. Other countries with low caseloads are less pressed to start vaccination campaigns and aren’t eager to reopen borders anytime soon.
Just 10 countries are on track to vaccinate more than a third of their population this year. People being vaccinated in Salisbury Cathedral in the U.K. in recent days.
Photo:
neil hall/EPA/Shutterstock
At the current rates of vaccination, only about 10% of the world would be inoculated by the end of the year and 21% by the close of 2022,
UBS
says. Just 10 countries are on track to vaccinate more than one-third of their population this year.
The UBS data includes hard-hit middle-income countries such as South Africa where vaccination rates are expected to be painfully slow, though some countries it measured are expected to increase the pace of vaccinations soon.
Economies on target to vaccinate one-third of the population in 2021
Economies on target to vaccinate one-third of the population in 2021
Economies on target to vaccinate one-third of the population in 2021
Economies on target to vaccinate one-third of the population in 2021
But richer regions such as Europe are also facing delays. European officials in recent days watched as their goal of vaccinating 70% of the population by summer looked unachievable after doses ran out in some places, with just 2% of European Union residents covered so far.
The differing pace in vaccine rollouts world-wide raises the prospect of divergent economic fortunes for the world’s main economic blocs, at least in the near term. The U.S. economy could grow by 5.1% this year, according to International Monetary Fund forecasts, but recoveries of the eurozone and developing economies have become more uncertain given vaccination delays.
The U.S. and a few other countries could wind up enjoying many benefits of herd immunity but still be unable to fully mend their economies because they are waiting on other places to catch up. With borders shut globally, some businesses even in vaccinated countries would have to rely on domestic demand.
“So long as the pandemic terrorizes part of the world, normality will not be restored anywhere,” said
Erik Nielsen,
chief economist at UniCredit Bank.
Uneven vaccine distribution also means that Covid-19 could keep circulating for years, especially in nations such as Brazil and South Africa, where new infections are vastly outpacing inoculations. Both have become breeding grounds for more infectious new strains. In time, virologists expect the virus could mutate—in particular, modifying the shape of its outer protein spikes—an outcome they fear might ultimately render our current vaccines less effective.
Many scientists and policy makers predicted immunization programs would take a long time. Still, the unusually rapid development of vaccines raised hopes that 2021 would mark a return to normal for most of the world. Economists began upgrading their forecasts.
Global growth is still expected to be strong this year, and residents of many countries including the U.S. will undoubtedly see restaurants filling up and other signs of progress. The recovery is already so strong in some places that supplies of semiconductors are running short.
Mexico, where gravediggers buried a Covid-19 victim in Panteón Sueños Eternos in November, has immunized just 0.5% of its population.
Photo:
Briana Sanchez/The El Paso Times/Associated Press
The U.S. and U.K. also experienced some early delays rolling out vaccine campaigns, only to see distribution pick up as snags were worked out.
Still, the outlook is growing considerably more uncertain elsewhere.
Borders are closing across much of Europe. New Zealand Prime Minister
Jacinda Ardern
said last week the country would continue to bar international visitors through most of 2021. A senior Australian health official recently made a similar prediction, in part because it isn’t clear whether Covid-19 vaccines prevent transmission of the virus or just stop people from getting severely ill.
Even the world’s fastest-vaccinating country—Israel—remains in a lockdown, with international flights banned indefinitely.
“This assumption that when Jan. 1 came we could just burn the old calendar and everything would be fine is proving to be a wildly optimistic view,” said
Robert Carnell,
an ING Group economist in Singapore.
Brazil, where new infections far outpace inoculations, has become a breeding ground for new strains, with hospitals like this one in Manaus on the front lines.
Photo:
Sandro Pereira/Fotoarena/Zuma Press
The World Bank has forecast that remittances to the developing world—a vital lifeline—will fall 7.5% this year, after a 7% drop in 2020. Concert halls and schools might remain closed longer than expected.
Hotels in places such as Southeast Asia and the Pacific aren’t expecting business to fully rebound until the middle of next year. Many international students could be absent from university campuses until mid-2022.
“I’ve just been on the phone this morning to some lovely American clients,” said Mark Fraenkel, who owns Blue Dive Port Douglas, a scuba-diving business near Australia’s Great Barrier Reef. “I said, ‘Let’s not book you for 2021. We’ll just have to cancel.’ ”
Shippers, including DHL, are expecting air freight to get tighter for the first part of this year, not better, because fewer planes are flying to carry cargo. Discussions at the United Nations to normalize air traffic by creating a vaccine passport or even a common set of rules for tests are snagged in U.N. bureaucracy.
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Intercontinental flight traffic won’t return to 2019 levels until 2023 at the earliest, the International Air Transport Association forecasts.
“We’re talking about years rather than months, and it’s partly related to the two-speed vaccination,” said Senior IATA Vice President Nick Careen. “We need governments to agree on a process; we can’t continue to operate like this.”
A central problem is that it is proving hard to scale up vaccine production quickly. Delayed deliveries can have domino effects on other buyers.
In Europe, where several top vaccines are made, production issues emerged last month with factories saying they couldn’t keep up. Frustrated, the EU introduced new measures on Friday that would let it block exports to wealthier countries, such as Canada, Japan or the U.S.
Slow production at a Belgian plant has meant Canadian officials recently received 70% fewer doses of a
Pfizer
vaccine. The same troubles have left Japan struggling to get doses it needs to vaccinate its population by the end of June, a crunch that may mean few fans for Tokyo’s Summer Olympics in July.
“I can’t tell you which month,” said
Taro Kono,
the minister in charge of Japan’s vaccine rollout, when asked when the general public could get immunized.
China also faces challenges. Although it has started inoculations using homegrown vaccines, without providing a firm timeline for reaching herd immunity, approvals and production arrangements have come more slowly than anticipated, according to Trivium China, a consultancy.
In one sign of the difficulties, the Beijing government’s talent office said that vaccine producer Sinovac is struggling to hire new staff.
“The main issue is production volume,” said
Guo Wei,
deputy secretary general of the health-care logistics association at the government-backed China Federation of Logistics and Purchasing, in an interview. He said that based on production estimates by China’s vaccine makers, the country wouldn’t be able to reach herd immunity this year.
Trivium estimates that a total of 850 million doses is the high end of what is possible for China this year, while administering at least 1.68 billion doses would be considered full inoculation. The Economist Intelligence Unit doesn’t rule out some major Chinese cities reaching herd immunity this year but estimates that the country as a whole likely won’t be able to reach it until late 2022.
Any production delays in China could affect other countries. Morocco planned to vaccinate 80% of its population in the coming months, in part using Chinese vaccines, but officials say they haven’t received all the supplies they need and have blamed manufacturers that can’t keep up.
Analysts doubt other countries can reach their stated targets. In Indonesia, officials want to vaccinate 65% of a population of 270 million in 15 months, which would more likely take three to four years, according to analysts at IMA Asia. The Philippines aims to vaccinate 70 million people this year.
A nurse vaccinated a health-care worker in Liege, Belgium, as European Union officials grow concerned that just 2% of EU residents have been vaccinated.
Photo:
Francisco Seco/Associated Press
“We doubt if half the 2021 goal can be reached,” IMA Asia said in a recent report.
Latin America’s two largest countries, Brazil and Mexico, have so far immunized just 0.8% and 0.5% of their populations, respectively. Argentina planned to receive five million doses of Russia’s Sputnik V vaccine in January, but only 800,000 have been delivered because of production delays in Russia.
Nigeria’s 206 million people have only one delivery scheduled, of 100,000 doses, expected next month.
Meanwhile, more people are putting plans on hold.
Mohammed Waqas,
a 25-year-old in London, initially aimed to start a master’s program in teaching at an Australian university in February. Mr. Waqas decided to defer enrollment until at least July because Australia’s border is closed to most international visitors. If the border isn’t open by July, he could defer until 2022.
“I’m one year behind where I would like to be,” Mr. Waqas said.
—Chao Deng, Peter Landers and Samantha Pearson contributed to this article.
Write to Drew Hinshaw at drew.hinshaw@wsj.com and Mike Cherney at mike.cherney@wsj.com
Officials from Ohio said recently that 60% of nursing-home staff so far haven’t elected to take the vaccine. In New York,
Gov. Andrew Cuomo
said this month that state officials expect 30% of health-care workers offered the vaccine will ultimately turn it down. Two-thirds of the staff at a Florida hospital refused the vaccine this month, leaving so many unused doses that the facility started giving away shots to the general public.
The hesitancy among health-care workers concerns public-health officials who expected America’s front-line workers to serve as a model for others.
“Please get vaccinated,”
Anthony Fauci,
who is serving as President Biden’s chief medical adviser for the Covid-19 pandemic, said in a video message to health-care providers. “It’s important to protect yourselves, to protect your family, but as important, symbolically, as health-care providers, to show confidence in the vaccine so that other people in this country follow suit.”
In a survey of 1,563 respondents conducted in January by researchers at the Kaiser Family Foundation, 79% of U.S. adults who haven’t yet been vaccinated say they would be likely to turn to a doctor, nurse or other health-care provider when deciding whether to get a vaccination.
Meanwhile, 28% of 128 health-care workers in the Kaiser survey said they want to wait and see how the vaccine is working for other people before getting it themselves. While they weren’t the most resistant group the foundation studied, their outsize influence over whether members of the general public would choose to get the vaccine concerns public-health officials.
Surveys of vaccine skepticism of broader populations have shown that people have become less hesitant as they see others vaccinated.
Some health-care workers say they’ve passed up the shot for altruistic reasons, believing that others should get it first. Several health-care systems said they have struggled to persuade female employees to get vaccinated due to a lack of data about the vaccines’ impact on pregnancy. Other health-care workers say while they want to encourage others to get vaccinated, when it comes to their own health, they are still wary.
“As I was getting my first shot, I asked the two nurses who were administering it to me how they felt when they got the shot. And they were on the side of waiting. That scared me a little bit, but I went through with it,” said
Charles Smith II,
chief financial officer at Vibrant Health in Kansas City, Kan.
At the system of clinics where Mr. Smith works, about 30% of the staff have decided against getting the vaccine to this point, according to Vibrant Health’s chief executive,
Patrick Sallee.
Mr. Smith said he felt uncomfortable with the speed of the process and the lack of long-term data, but news that a more highly transmissible virus variant was spreading made him take the leap. “There is an expectation for the health industry to lead other industries to say this thing is safe and lead by example,” he said. “I feel like I’m shaking the dice, really.”
Mr. Smith, CFO at a health-clinic system, and Dr. Jackson-Smith, a dentist, felt reluctant about a Covid-19 vaccine but decided to lead by example and get the shot.
Photo:
Katie Currid for The Wall Street Journal
Mr. Smith’s wife, Aniika Jackson-Smith, a dentist, said she also hesitated to get a vaccine because she doesn’t feel enough is known about their long-term effects. She said she finally decided to make an appointment to get the first shot in late January because she feels a responsibility as a health-care provider not to discourage others from getting it.
“My mind isn’t really changed,” she said. “But I guess in order for us to get past this, people are just going to have to take the vaccine or we’ll just be here forever.”
Heidi Arthur,
chief campaign development officer at the Ad Council, which has been running a large-scale public-service education effort about the Covid-19 vaccines, said getting health-care workers on board wasn’t originally part of the plan.
“It was surprising, the level of hesitancy,” she said.
Covid-19 Vaccine’s Last Mile
Instead of health-care workers lining up, the Ad Council found themselves pulling together a diverse group of leaders within the industry, including Dr. Fauci, to educate other health-care workers about the vaccines and address their concerns.
For Susan Izzo, an adult nurse practitioner in Connecticut, her initial hesitancy was because she felt her patients deserved the vaccine before her. Ultimately, her patients persuaded her to get the shots, she said, so that she could be healthy to protect them.
“I didn’t feel like it was my turn, even though as a health-care worker it is my turn. I would have gladly given up my vaccine to my 55-year-old patient who just had a lung transplant,” she said.
Deborah Burger,
a president at National Nurses United, the largest nurses’ union in the U.S., said many nurses felt information about vaccines that came out during the Trump administration was politicized and wanted to learn more so they could decide for themselves whether it was safe. Education and more information, she said, is increasing uptake among nurses.
Dawn Allen,
vice president of patient services at Huron Regional Medical Center in South Dakota, said at first less than 50% of their workforce chose to be vaccinated. After sitting down with staff to answer their questions, particularly around concerns of infertility, she said they are up to 76% of staff choosing to be vaccinated over a two-week period.
Still, some nurses say they have no intention of getting vaccinated.
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Cleon Charles,
a traveling nurse who has been working in Covid-19 hot spots throughout the pandemic, said she would never get the vaccine and has discouraged her daughters and parents from getting it, despite having had Covid-19 herself.
She cited a general mistrust of the pharmaceutical industry, among other concerns, and the death of baseball legend Hank Aaron, who publicly received the Covid-19 vaccine in early January. Medical officials say the baseball legend died of natural causes, but his death has been taken up by antivaccination leaders, including
Robert F. Kennedy Jr.
, who called the death “part of a wave of suspicious deaths among elderly closely following administration of #COVID #vaccines,” on Twitter.
“I don’t want it,” Ms. Charles said. “I’ll take my chances and my vitamins.”
Scientists are settling on a road map that can help critical sectors of the economy safely conduct business, from meatpacking plants to financial services, despite the pandemic’s continued spread.
After nearly a year of study, the lessons include: Mask-wearing, worker pods and good air flow are much more important than surface cleaning, temperature checks and plexiglass barriers in places like offices and restaurants. And more public-health experts now advocate wide use of cheap, rapid tests to detect cases quickly, in part because many scientists now think more than 50% of infections are transmitted by people without symptoms.
The playbook comes after months of investigations on how the coronavirus spreads and affects the body. Scientists combined that with knowledge gained from years of experience managing occupational-health hazards in high-risk workplaces, such as factories and chemical plants, where tiny airborne pollutants can build up and cause harm. They say different types of workplaces—taking into account the types of interactions workers have—need slightly different protocols.
The safety measures have taken on new urgency in recent weeks as new infections, hospitalizations and deaths rise across the U.S. and Europe, and potentially more-transmissible variants of the virus spread around the globe. This phase of the pandemic is prompting a new wave of stay-at-home orders, closures and travel restrictions, important first steps to curbing contagion. Infection-prevention specialists say known strategies for stemming spread should continue to work against the new variants, but that increased adherence is even more important.
Vaccines are rolling out, but slowly, and access will be limited mostly to high-priority groups for some time.
“We have to still deal with ‘the right now.’ We’ve zeroed in on this set of controls that we know work,” said
Joseph Allen,
director of the Healthy Buildings Program at the Harvard T.H. Chan School of Public Health.
Over the past year, the lack of consistent and cohesive messaging among scientists and lawmakers has seeded confusion over what makes up risky behavior, what activities should be avoided and why. That is beginning to change as consensus builds and scientists better understand the virus.
In the U.S., scientists at first advised people against wearing masks, in part because of shortages, while the idea of stay-at-home orders received severe pushback from some lawmakers. Early in the pandemic, testing was limited to people with symptoms, also partly due to shortages. That advice has shifted, but a year later, sufficient testing remains a critical issue.
London’s Regent Street was nearly empty last week.
Photo:
May James/SOPA Images /Zuma Press
Countries such as New Zealand and others in Asia adhered to a combination of basic mitigation strategies from the start—particularly masking, large-scale testing and lockdowns that broke transmission chains. They have tended to fare better than those that didn’t.
In one of his first moves, President
Biden
signed executive orders to require masks be worn on federal property and at airports and other transportation hubs. The administration said it is focusing on increasing the availability of vaccines, and also stressed the importance of widely available testing, which still lags in low-income and minority communities.
The current scientific playbook follows from two of the biggest research insights since the start of the pandemic. First, individuals who aren’t showing symptoms can transmit the virus. Infectious-disease experts worry most about this silent spread and say it is the reason the pandemic has been so hard to contain. While visibly sick people can pass on the virus, data cited by the Centers for Disease Control and Prevention estimate that 40% to 45% of those infected never develop symptoms at all. With the new viral variants that can transmit more readily, the potential for silent spread is even higher, infectious-disease experts said.
Secondly, researchers now know that tiny airborne particles known as aerosols play a role in the spread of Covid-19. These can linger in the air and travel beyond 6 feet.
An early hallmark of the pandemic response focused on the risk of transmission through large respiratory droplets that typically travel a few feet and then fall to the ground. Businesses rushed to buy plexiglass barriers, creating shortages.
The barriers can be good at preventing larger virus-containing droplets from landing on and infecting healthy individuals. They may offer some protection in shielding workers who have brief face-to-face interactions with many people throughout the workday, such as cashiers and receptionists, some occupational-health experts said.
Yet in settings like offices, restaurants or gyms, the role of the barriers is murkier, because activities like talking loudly and breathing deeply create aerosols that can waft on air currents and get around shields.
A Los Angeles Apparel employee added plexiglass to sewing stations in July.
Photo:
Sarah Reingewirtz/Orange County Register/Zuma Press
Outdoor diners at Eat At Joe’s restaurant in Redondo Beach, Calif., in December.
Photo:
patrick t. fallon/Agence France-Presse/Getty Images
A gym in Milan in October.
Photo:
DANIEL DAL ZENNARO/EPA-EFE/Shutterstock
Also, installing such barriers could affect airflow throughout the space, environmental-health experts said. It is possible they could limit proper ventilation, making things worse, they said.
“There seems to be an assumption that particles are going to get stopped by the barriers, which is simply not true,” said
Lisa Brosseau,
an industrial hygienist and research consultant for the University of Minnesota’s Center for Infectious Disease Research and Policy. Airborne particles ferrying the virus “really distribute all over the place.”
The emphasis on intense surface cleaning has diminished as scientists have come to understand that indirect transmission through contaminated surfaces doesn’t play as critical a role in the spread of Covid-19 as they thought in the early days of the pandemic. In September, the CDC published sanitation guidelines for offices, workplaces, homes and schools that said that, for most surfaces, normal, routine cleaning should suffice, and that frequently touched objects, such as light switches and doorknobs, should be cleaned and disinfected.
“Sanitation is important in general always,” said
Deborah Roy,
president of the American Society of Safety Professionals. “The idea is we went overboard at the beginning because of the amount of unknowns. Now, we’re in a situation where we have more information.”
Temperature checks have become less popular among some employers because scientists now know that not all Covid-19 patients get fevers. One large study published online in November in the New England Journal of Medicine showed only 13% of Covid-19 patients reported a fever during the course of their illness.
Scientists now understand that brief encounters with an infected person can lead to spread, according to an October case study—an advance from earlier, when the rule of thumb was to avoid close contact for 15 consecutive minutes or longer. The report urged people to consider not just time and proximity in defining close contact with a Covid case, but also ventilation, crowding and a person’s likelihood of generating aerosols. Following the report, the CDC changed its definition of close contact to a total of 15 minutes or more over a 24-hour period.
A flight attendant showed an air filter on LATAM airlines in Bogota in August.
Photo:
juan barreto/Agence France-Presse/Getty Images
Fresh air and effective filters indoors are important because they can remove virus particles before they have time to infect.
Masks offer a similar benefit, by lowering the amount of particles that infected individuals emit. Some scientists say there could be a benefit to doubling up on masks, as a second layer may improve both filtration and fit, so long as the masks are worn correctly.
A study published in October found that in countries where mask wearing was the norm or where governments put in place mask mandates, coronavirus mortality rates grew much more slowly than in countries without such measures. This fall, the CDC said that masks also offer some personal protection by reducing a wearer’s exposure to infected particles.
As the weather gets colder and people head indoors, the risk of catching Covid-19 is rising. WSJ explains why air ventilation and filtration are one of our biggest defenses against the coronavirus this winter. Illustration: Nick Collingwood/WSJ
The combination of airborne particles and personal interactions, even among people who don’t feel ill, can turn wedding receptions, plane rides and choir practices into superspreading, potentially deadly events.
“For Covid, those two factors—asymptomatic spread and aerosolization—is what made mask-wearing so essential,” said
Megan Ranney,
emergency physician and assistant dean at Brown University.
Lessons can be gleaned from an outbreak at a Canadian spin studio last fall. The operators of the SPINCO studio in Hamilton, Ontario, had many public-health measures in place, including limiting the number of bikes in each class and screening staff and attendees with a questionnaire about topics including symptoms and travel. Rooms were sanitized within 30 minutes of a completed class, and towels were laundered, according to a statement provided last fall by
Elizabeth Richardson,
medical officer of health for the city of Hamilton.
Masks were also required before and after workout classes, Dr. Richardson said.
In total, 54 people who attended workouts over a span of several classes became infected. Another 31 cases were tied to the outbreak after spin-class attendees who contracted the virus then passed it on. The spin studio temporarily shut down following the outbreak and later reopened. It is currently not offering classes due to local regulations that mandated the closure of all gyms and fitness centers amid rising Covid-19 cases in the area.
In a November statement following the outbreak,
Michelle August,
founder of SPINCO, said that the company has “always put safety first and [has] exceeded all recommended guidelines from public health throughout” the pandemic. She said SPINCO has also strengthened and heightened its Covid-19 mitigation measures. SPINCO’s website currently says face masks are mandated throughout workouts in the company’s Hamilton location.
It also says that SPINCO is installing air purifiers in all of its studios that filter air in the rooms every 17 to 21 minutes. Airborne transmission experts recommend that building managers pump in clean, fresh air between three to six times an hour and that they install filters that are proven to effectively trap and remove a substantial number of virus-carrying particles.
To film a stage play of “A Christmas Carol” in November, the Guthrie Theater in Minneapolis upgraded its air filters and increased the rate at which the ventilation system pumps in outside air, said
Brooke Hajinian,
the Guthrie’s general manager. Management staggered arrival times, and a compliance officer made sure everyone socially distanced, wore their masks properly and washed their hands.
The theater divided staff into pods depending on how close they must get to the lone actor on stage, who portrayed Charles Dickens and didn’t wear a mask while performing, according to Ms. Hajinian. Those working nearest the stage underwent testing three times a week and wore N95 masks at all times, she said, while cleaning and security crews, who didn’t interact with the stage crews, wore cloth masks and didn’t undergo testing.
Actor Nathaniel Fuller performed in ‘A Christmas Carol’ at the Guthrie Theater in Minneapolis.
Photo:
Kaitlin Schlick
Ms. Hajinian said she monitored the staff’s testing results and symptoms. “Any symptom is not a failure of this plan,” she said. Catching a case “and isolating it—that’s what success looks like for us,” she said. There were no cases, she said.
Scientists say multilayered safety efforts are needed because no single prevention method is 100% effective.
One of the largest studies of asymptomatic transmission to date showed that frequent testing was essential in identifying infections among a group of nearly 2,000 Marine recruits required to socially distance and wear masks except while eating and sleeping.
The study looked at cases identified with lab-based tests that search out and amplify the genetic material of the virus, but those tests aren’t as easily scaled as so-called rapid antigen tests, which search for viral proteins.
Results from lab-based tests can sometimes take days, while results from rapid tests are usually available in less than an hour. As a result, some epidemiologists have been advocating for widespread use of antigen tests to prevent outbreaks, because they are cheaper and don’t require high-tech laboratory equipment to run, meaning they can be deployed in a broader range of settings.
The shift toward using frequent, inexpensive and rapid tests on the same people multiple times a week to screen entire populations—instead of one-time tests on individuals who have symptoms—will be important to efficiently break transmission chains, epidemiologists said.
“Unless we’re doing really broad, frequent screening of the people at large, we’re completely missing the vast majority” of infections, said
Michael Mina,
an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health. “We have to change how we’re doing this.”
A Covid-19 testing site at the Alemany Farmers Market in San Francisco in November.
Photo:
David Paul Morris/Bloomberg News
While rapid tests tend to be less sensitive than lab-based tests, Dr. Mina said the data suggest they have high sensitivity when people are most likely to be infectious.
Other infectious-disease experts have touted contact tracing to identify and bust clusters of infection. But they say the strategy works best when cases aren’t surging, as they are now. When transmission rates are too high, limiting gatherings, travel and crowding are more effective at denting spread, said
Abraar Karan,
a global-health physician at Brigham and Women’s Hospital and Harvard Medical School.
In places without big surges, a high-tech approach is becoming increasingly useful: genetic epidemiology, or tracking tiny changes in viral genomes to map out transmission chains. As the coronavirus replicates and moves from person to person, its genes change slightly. Sometimes, those tiny changes are unusual, and they can be particularly useful in mapping transmission events, according to
Justin O’Grady,
an infectious disease expert at the Quadram Institute in the U.K.
By sifting through the differences among more than 1,000 viral genomes, Dr. O’Grady and his collaborators found that a particular viral variant was moving through multiple nursing homes in the U.K., among patients and staff, but not among the wider community. The unpublished data suggested that transmission was facilitated by the movement of staff from one facility to another, Dr. O’Grady said. The team relayed the findings to government authorities and advised them to restrict staff moving among facilities during the pandemic.
“Sometimes genomic epidemiology is able to find hidden transmission links that traditional epidemiology would struggle to find,” Dr. O’Grady said. “We can’t stop transmission, but when we find a superspreader event…we can bring in the right prevention methods to stop it from spreading further.”
A London ad urged safety measures last week.
Photo:
Dinendra Haria/London News Pictures /Zuma Press
—Betsy McKay contributed to this article.
Write to Daniela Hernandez at daniela.hernandez@wsj.com, Sarah Toy at sarah.toy@wsj.com and Caitlin McCabe at caitlin.mccabe@wsj.com
China overtook the U.S. as the world’s top destination for new foreign direct investment last year, as the Covid-19 pandemic amplifies an eastward shift in the center of gravity of the global economy.
New investments by overseas businesses into the U.S., which for decades held the No. 1 spot, fell 49% in 2020, according to U.N. figures released Sunday, as the country struggled to curb the spread of the new coronavirus and economic output slumped.
China, long ranked No. 2, saw direct investments by foreign companies climb 4%, the United Nations Conference on Trade and Development said. Beijing used strict lockdowns to largely contain Covid-19 after the disease first emerged in a central Chinese city, and China’s gross domestic product grew even as most other major economies contracted last year.
The 2020 investment numbers underline China’s move toward the center of a global economy long dominated by the U.S.—a shift accelerated during the pandemic as China has cemented its position as the world’s factory floor and expanded its share of global trade.
While China attracted more new inflows last year, the total stock of foreign investment in the U.S. remains much larger, reflecting the decades it has spent as the most attractive location for foreign businesses looking to expand outside their home markets.
JOHANNESBURG—Three new laboratory studies are raising concerns that the immune response triggered by a Covid-19 infection or vaccination may be less effective at protecting against the new strain of the coronavirus that first emerged in South Africa.
The findings come from experiments done in the laboratory and only look at certain elements of a body’s immune response. Still, they reinforce the possibility that vaccine makers and regulators will need to update Covid-19 vaccines as the virus evolves.
A fourth study, conducted by scientists at BioNTech SE and Pfizer Inc. and published by the companies, showed that their vaccine successfully neutralized a variant that was initially detected in the U.K. That study didn’t include the South African strain.
The U.K. variant has already spread to many other countries, including the U.S.
More than a year into the pandemic, the discovery of new variants that appear to have made the virus more contagious is forcing researchers to adapt their understanding of the coronavirus that causes Covid-19. One concern, researchers said, is that the new strains are emerging in countries where a significant percentage of people have already built up an immune response to earlier variants after getting Covid-19.
