Category: Covid-19 Vaccine

Gaurav Gaiha, MD, DPhil, a member of the Ragon Institute of MGH, MIT and Harvard, studies HIV, one of the fastest-mutating viruses known to humankind. But HIVs ability to mutate isnt unique among RNA viruses most viruses develop mutations, or changes in their genetic code, over time. If a virus is disease-causing, the right mutation can allow the virus to escape the immune response by changing the viral pieces the immune system uses to recognize the virus as a threat, pieces scientists call epitopes.

To combat HIVs high rate of mutation, Gaiha and Elizabeth Rossin, MD, PhD, a Retina Fellow at Massachusetts Eye and Ear, a member of Mass General Brigham, developed an approach known as structure-based network analysis. With this, they can identify viral pieces that are constrained, or restricted, from mutation. Changes in mutationally constrained epitopes are rare, as they can cause the virus to lose its ability to infect and replicate, essentially rendering it unable to propagate itself.

When the pandemic began, Gaiha immediately recognized an opportunity to apply the principles of HIV structure-based network analysis to SARS-CoV-2, the virus that causes COVID-19. He and his team reasoned that the virus would likely mutate, potentially in ways that would allow it to escape both natural and vaccine-induced immunity. Using this approach, the team identified mutationally constrained SARS-CoV-2 epitopes that can be recognized by immune cells known as T cells. These epitopes could then be used in a vaccine to train T cells, providing protective immunity. Recently published inCell, this work highlights the possibility of a T cell vaccine which could offer broad protection against new and emerging variants of SARS-CoV-2 and other SARS-like coronaviruses.

From the earliest stages of the COVID-19 pandemic, the team knew it was imperative to prepare against potential future mutations. Other labs already had published the protein structures (blueprints) of roughly 40% of the SARS-CoV-2 virus, and studies indicated that patients with a robust T cell response, specifically a CD8+ T cell response, were more likely to survive COVID-19 infection.

Gaihas team knew these insights could be combined with their unique approach: the network analysis platform to identify mutationally constrained epitopes and an assay they had just developed, a report on which is currently in press atCell Reports, to identify epitopes that were successfully targeted by CD8+ T cells in HIV-infected individuals. Applying these advances to the SARS-CoV-2 virus, they identified 311 highly networked epitopes in SARS-CoV-2 likely to be both mutationally constrained and recognized by CD8+ T cells.

These highly networked viral epitopes are connected to many other viral parts, which likely provides a form of stability to the virus, says Anusha Nathan, a medical student in the Harvard-MIT Health Sciences and Technology program and cofirst author of the study. Therefore, the virus is unlikely to tolerate any structural changes in these highly networked areas, making them resistant to mutations.

You can think of a viruss structure like the design of a house, explains Nathan. The stability of a house depends on a few vital elements, like support beams and a foundation, which connect to and support the rest of the houses structure. It is therefore possible to change the shape or size of features like doors and windows without endangering the house itself. Changes to structural elements, like support beams, however, are far riskier. In biological terms, these support beams would be mutationally constrained any significant changes to size or shape would risk the structural integrity of the house and could easily lead to its collapse.

Highly networked epitopes in a virus function as support beams, connecting to many other parts of the virus. Mutations in such epitopes can risk the viruss ability to infect, replicate, and ultimately survive. These highly networked epitopes, therefore, are often identical, or nearly identical, across different viral variants and even across closely related viruses in the same family, making them an ideal vaccine target.

The team studied the identified 311 epitopes to find which were both present in large amounts and likely to be recognized by the vast majority of human immune systems. They ended up with 53 epitopes, each of which represents a potential target for a broadly protective T cell vaccine. Since patients who have recovered from COVID-19 infection have a T cell response, the team was able to verify their work by seeing if their epitopes were the same as ones that had provoked a T cell response in patients who had recovered from COVID-19. Half of the recovered COVID-19 patients studied had T cell responses to highly networked epitopes identified by the research team. This confirmed that the epitopes identified were capable of inducing an immune reaction, making them promising candidates for use in vaccines.

A T cell vaccine that effectively targets these highly networked epitopes, says Rossin, who is also a cofirst author of the study, would potentially be able to provide long-lasting protection against multiple variants of SARS-CoV-2, including future variants.

By this time, it was February 2021, more than a year into the pandemic, and new variants of concern were showing up across the globe. If the teams predictions about SARS-CoV-2 were correct, these variants of concerns should have had little to no mutations in the highly networked epitopes they had identified.

The team obtained sequences from the newly circulating B.1.1.7 Alpha, B.1.351 Beta, P1 Gamma, and B.1.617.2 Delta SARS-CoV-2 variants of concern. They compared these sequences with the original SARS-CoV-2 genome, cross-checking the genetic changes against their highly networked epitopes. Remarkably, of all the mutations they identified, only three mutations were found to affect highly networked epitopes sequences, and none of the changes affected the ability of these epitopes to interact with the immune system.

Initially, it was all prediction, says Gaiha, an investigator in the MGH Division of Gastroenterology and senior author of the study. But when we compared our network scores with sequences from the variants of concern and the composite of circulating variants, it was like nature was confirming our predictions.

In the same time period, mRNA vaccines were being deployed and immune responses to those vaccines were being studied. While the vaccines induce a strong and effective antibody response, Gaihas group determined they had a much smaller T cell response against highly networked epitopes compared to patients who had recovered from COVID-19 infections.

While the current vaccines provide strong protection against COVID-19, Gaiha explains, its unclear if they will continue to provide equally strong protection as more and more variants of concern begin to circulate. This study, however, shows that it may be possible to develop a broadly protective T cell vaccine that can protect against the variants of concern, such as the Delta variant, and potentially even extend protection to future SARS-CoV-2 variants and similar coronaviruses that may emerge.

Reference: Structure-guided T cell vaccine design for SARS-CoV-2 variants and sarbecoviruses by Anusha Nathan, Elizabeth J. Rossin, Clarety Kaseke, Ryan J. Park, Ashok Khatri, Dylan Koundakjian, Jonathan M. Urbach, Nishant K. Singh, Arman Bashirova, Rhoda Tano-Menka, Fernando Senjobe, Michael T. Waring, Alicja Piechocka-Trocha,Wilfredo F. Garcia-Beltran, A. John Iafrate, Vivek Naranbhai, Mary Carrington, Bruce D. Walker, Gaurav D. Gaiha, Accepted, Cell.DOI: 10.1016/j.cell.2021.06.029

Gaiha is an assistant professor of Medicine at Harvard Medical School. Additional authors include Clarety Kaseke, Ryan J. Park, Dylan Koundakjian, Jonathan M. Urbach, PhD, Nishant K. Singh, PhD, Rhoda Tano-Menka, Fernando Senjobe, Michael T. Waring, Alicja Piechocka-Trocha, PhD, Wilfredo F. Garcia-Beltran, MD, and Bruce D. Walker, MD, from the Ragon Institute; A. John Iafrate, MD, Vivek Naranbhai and Ashok Khatri from MGH; Mary Carrington, PhD, of NIH; and Arman Bashirova, NCI.

This study was supported by the National Institutes of Health and the Massachusetts Consortium of Pathogen Readiness (MassCPR). Additional support was provided by the Howard Hughes Medical Institute, the Ragon Institute, the Mark and Lisa Schwartz Foundation and Enid Schwartz (B.D.W.), and Sandy and Paul Edgerly. Roider is supported by the Heed Ophthalmic Foundation. Gaiha is supported by the Bill and Melinda Gates Foundation, a Burroughs Wellcome Career Award for Medical Scientists and the Gilead HIV Research Scholars Program. This project has been funded in whole or in part with federal funds from the Frederick National Laboratory for Cancer Research.

Conflicts of interest: Roider and Gaiha have filed patent application PCT/US2021/028245.

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Potential Path Discovered to a Broadly Protective COVID-19 Vaccine Using T Cells - SciTechDaily

Sandra Lindsay immigrated to the U.S. from Jamaica when she was 18 years old. Now, she's going down in history for her role in the fight against COVID-19.

President Biden announced on Friday that Lindsay, who was the first person in the nation to receive an FDA-approved COVID-19 vaccine, will have her hospital scrubs, vaccination card and the badge she wore on the day she received her first dose displayed at the COVID-19 exhibit in the Smithsonian Museum of American History.

She was also awarded the "Outstanding American by Choice" award from U.S. Citizenship and Immigration Services, which recognizes naturalized citizens who have made "significant contributions to our country," Mr. Biden said, adding that she "represented the very best of us all."

"Over the past, and I don't believe this, 30 years she doesn't look 30 years old she's pursued her dream of becoming a nurse to allow her to do what she wanted to do most, give back to her new country," Mr. Biden said on Friday. "If there are any angels in heaven ... having spent a lot of time in the ICU, they're all nurses male and female. Doctors let you live. Nurses make you want to live."

Lindsay was vaccinated on December 14. Shortly after her first dose, she said she felt "hopeful" and "relieved."

"I feel like healing is coming," she said. "I hope this marks the beginning to the end of a very painful time in our history."

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Lindsay, who is the director of nursing for critical care at a hospital on Long Island, has been devoted to her co-workers, patients and family over the past year, Mr. Biden noted, but not without cost.

"During the height of the pandemic, she poured her heart and soul into her work to help patients fight for their lives and to keep her fellow nurses safe," Mr. Biden said. "With a grandson at home prematurely she did what she had to do. She kept her distance and kept him safe. He is safe, but she lost an aunt and an uncle to the virus."

He added that she also became the first person in America to become fully vaccinated outside of clinical trials. "She can now hug her grandson," he said. "She's out there making sure her patients and folks in her community are getting vaccinated so they can get back to their lives and their loved ones."

More than 33.7 million people in the U.S. have been diagnosed with COVID-19 since the pandemic began more than a year ago, and more than 605,000 people have died, according to Johns Hopkins University.

As of Friday, more than 327 million vaccine doses have been administered, according to Johns Hopkins, but just 17 states have fully vaccinated more than half of their population. Many are concerned that the Delta variant, which is known to be more contagious, could devastate vulnerable populations that are not vaccinated.

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Nurse who received first FDA-approved COVID-19 vaccine will have her scrubs and vaccine card displayed in Smithsonian - CBS News

(Precision Vaccinations)

The journal Nature published an article on July 1, 2021, which says 'mixing COVID-19 vaccines is emerging as a good way to get people the protection they need when faced with safety concerns and unpredictable supplies.'

'Most vaccines against SARS-CoV-2 must be given in two doses, but multiple studies now back up the idea that mixing the OxfordAstraZeneca jab and the PfizerBioNTech vaccine triggers an immune response similar to or even stronger than two doses of either vaccine.'

'People can now feel a bit more comfortable with the idea of mix-and-match,' says immunologist Leif Erik Sander at Charit University Hospital in Berlin.

The results also give researchers confidence that combining other COVID-19 vaccines that havent yet been tested together might also work.

At least eighteen COVID-19 vaccines have been approved for use in variouscountries, and mix-and-match studies so far have been limited. This means,more extensive trials and long-term monitoring for side effects are sorely needed.

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Mixing and Matching COVID-19 Vaccines Accelerates - PrecisionVaccinations

Researchers in the United States have conducted a study showing that the humoral (antibody) immunity induced by vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the agent that causes coronavirus disease 2019 (COVID-19) varies significantly among immunocompromised individuals.

The findings come from an interim analysis of an ongoing observational, prospective cohort analysis called the COVID-19 Vaccination in the Immunocompromised Study (CoVICS), which began on April 14th, 2021.

Ghady Haidar and colleagues report that the presence of antibodies (seropositivity) against SARS-CoV-2 was significantly lower among certain groups of immunocompromised individuals compared with among healthy vaccinees.

Seropositivity was significantly lower among immunocompromised individuals who had received solid organ transplants (SOT) and those with hematologic malignancies.

By contrast, among immunocompromised individuals with solid tumors or autoimmune conditions, seropositivity approached that observed among healthy individuals.

The study also found that more than 90% of patients with human immunodeficiency virus (HIV) were seropositive.

The researchers from the University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center in Pennsylvania say the findings demonstrate how the humoral response to COVID-19 vaccines significantly varies, depending on the underlying immunosuppressive condition.

There is an urgent need to optimize and individualize approaches to COVID-19 prevention among these patients, they add.

A pre-print version of the research paper is available on the medRxiv* sever, while the article undergoes peer review.

Immunocompromised patients are at an increased risk for severe and protracted illness following infection with SARS-CoV-2.

While these individuals should therefore be prioritized for COVID-19 vaccination, the presence of confounding comorbidities has meant their exclusion from clinical trials evaluating the immunogenicity and efficacy of vaccines.

Not surprisingly, recent studies have shown that vaccination elicits antibody responses that fall well below the 100% response rates observed among healthy individuals.

Despite these emerging data, several unknowns persist, including the degree of the antibody response in seropositive immunocompromised patients, and whether antibodies from immunocompromised patients are capable of neutralizing SARS-CoV-2, writes Haidar and the team.

The researchers conducted an interim analysis of the ongoing CoVICS study. The analysis involved 107 HCWs and 489 immunocompromised patients who had been fully immunized with the Moderna, Pfizer-BioNTech or Johnson & Johnson vaccine.

Fourteen days following completion of vaccination, serum samples were collected and tested for the presence of immunoglobulin G (IgG) against the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein.

The spike protein mediates the initial stage of infection when its RBD binds to the host cell receptor angiotensin-converting enzyme 2 (ACE2). The spike RBD is a major target of binding and neutralizing antibodies following natural infection or vaccination.

The researchers also selected a subset of participants who had their blood tested in pseudovirus neutralization assays.

All antibody levels (seropositive and seronegative patients) in healthy healthcare workers and immunocompromised patients. Figure 2B. Comparisons of antibody levels among only patients with positive results. Figure 2C. Comparison of antibody levels among only patients with negative results, demonstrating that near absence of antibodies in many SOT recipients and patients with hematological malignancies. Figure 2D. Comparison of antibody levels CLL vs non-CLL hematological malignancy patients with negative results.

Among the immunocompromised patients, 183 (37.4%) had received a solid organ transplant (SOT), 160 (32.7%) had an autoimmune condition, 75 (15.3%) had a hematologic malignancy, 37 (7.6%) had HIV and 34 (7.0%) had solid tumors.

Compared with HCWs, seropositivity was significantly lower among immunocompromised patients with SOT (37.2%) or hematologic malignancies (54.7%), than among HCWs (98.1%).

Among the SOT recipients, lung transplant recipients had the lowest seropositivity (22.2%), while liver transplant recipients had the highest seropositivity (60.6%).

Seropositivity was also lower among immunocompromised individuals with solid tumors (82.4%) or autoimmune conditions (83.8%), but was closer to the that observed for HCWs.

Importantly, well-controlled patients with HIV mounted antibody responses that were almost identical to those of healthy HCWs.

Although it is extremely encouraging that 94% of participants with HIV responded to the vaccines, this group of patients continues to be a marginalized group with poor access to vaccination, and outreach efforts should focus on increasing awareness of vaccination in these patients, warns Haidar and colleagues.

The study also found that SARS-CoV-2 neutralization titers were generally strongly correlated with anti- RBD IgG levels. However, more extensive studies will be needed to fully evaluate whether subsets of immunocompromised patients fail to neutralize the virus, adds the team.

Taken together, our findings demonstrate the heterogeneity of the humoral immune response to COVID-19 vaccines based on underlying immunosuppressive condition and highlight an urgent need to optimize and individualize COVID-19 prevention in these patients, says Haidar and colleagues.

The researchers say the findings also have important implications for public health guidance, particularly given that revised guidelines from the Centers for Disease Control and Prevention permit vaccinated individuals to abandon masking and social distancing in most settings.

Future studies are warranted to determine assessment of cellular immunity, longitudinal measurement of immune responses, and the safety and efficacy of revaccination, they conclude.

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

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COVID-19 vaccination induces highly variable immunity among the immunocompromised - News-Medical.Net

A U.K. study found the Pfizer vaccine is 33% effective against the Delta variant for people who only receive one dose as opposed to 88% effective after two doses.

HOUSTON Theres a lot to celebrate this Fourth of July as COVID-19 cases and hospitalizations remain at an all-time low.

But it isnt all good news. The number of people skipping the second dose of the COVID-19 vaccine has grown.

We have a large percent 10% of the people in the community here in Houston who got their first shot and didnt get their second shot, said Dr. David Persse with the Houston Health Department.

HHD data shows 147,787 people were overdue for their second dose as of May 28.

The Texas Department of State Health Services says 8.9% of Texans who got the Pfizer or Moderna vaccine skipped their second shot as of June 27, which is more than 1.2 million people.

Thats not good, Dr. Katelyn Jetelina, an epidemiologist with UTHealth School of Public Health, said. It looks like our vaccines, after the first dose, dont work well at all against Delta, so that second dose is critical.

A U.K. study found the Pfizer vaccine is 33% effective against the Delta variant for people who only receive one dose, and 88% effective after two doses.

Jetelina said the Delta variant is the most contagious version of the virus so far and it is in Houston. She urges people to stick to the recommended shot schedule. However, if youre already overdue, getting both doses is key no matter how long you wait in between.

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State says 1.2 million Texans have skipped second dose of the COVID-19 vaccine - KHOU.com

South Korean senior citizens receive their first dose of the Pfizer-BioNTech coronavirus disease (COVID-19) vaccine at a vaccination centre in Seoul, South Korea April 1, 2021. Chung Sung-Jun/Pool via REUTERS

SEOUL, July 5 (Reuters) - South Korea is in talks with mRNA vaccine makers including Pfizer (PFE.N) and Moderna (MRNA.O) to produce COVID-19 shots in the country and is ready to offer the capacity to make up to 1 billion doses immediately, a senior government official said.

The plan, if agreed, would help ease tight global supply of COVID-19 vaccines, particularly in Asia which lags North America and Europe in vaccine rollouts, and put South Korea a step closer to its ambition to become a major vaccine manufacturing centre.

South Korea already has deals to locally produce three coronavirus vaccines developed by AstraZeneca (AZN.L)/Oxford University, Novavax (NVAX.O), and Russia. It also has a vaccine bottling and packaging deal with Moderna.

"We've been holding frequent talks with big pharmaceutical companies to produce mRNA vaccines," Lee Kang-ho, director general for the global vaccine hub committee under South Korea's health ministry, told Reuters in an interview.

"There are only a few mRNA vaccine developers - Pfizer, Moderna, CureVac and BioNTech. Thus there's a limit to how much they can produce to meet global demand... South Korea is keen to help by offering its facilities and skilled human resources," Lee said.

It's not immediately clear how advanced these talks are and whether and when a deal will be agreed.

BioNTech (22UAy.DE) declined to comment, Moderna and CureVac (5CV.DE) did not reply to Reuters' requests for comments.

A Pfizer spokesperson said the company is making efforts to enhance its COVID-19 vaccine supply chain but added "we do not have anything specific to announce at this time."

Lee declined to name local vaccine makers which have the capacity to produce mRNA vaccines immediately, but a government source said they include Hanmi Pharmaceuticals Co Ltd (128940.KS) and Quratis Co Ltd.

Hanmi confirmed that it has a big capacity reserved for Sanofi's (SASY.PA) diabetes drug and it can be used for COVID-19 vaccine production as the Sanofi project has stalled.

Quratis, which makes a tuberculosis vaccine, said its new factory built last year can now be used for mRNA vaccine production.

Reporting by Sangmi Cha in Seoul; Additional reporting by Stephanie Nebehay in Geneva, Michael Erman in New York and Ludwig Burger in Frankfurt; Editing by Miyoung Kim and Raju Gopalakrishnan

Our Standards: The Thomson Reuters Trust Principles.

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EXCLUSIVE S.Korea in talks with mRNA vaccine makers to make up to 1 bln doses -govt official - Reuters

The Australian government's entire vaccine supply agreement with AstraZeneca is being withheld from public release on the grounds it poses a "real and substantial risk" to national security if it were released.

Australia's vaccine rollout has faced one of its most difficult weeks, as many states across the country re-entered lockdown following COVID-19 outbreaksand tensionbetween the states and federal government grows over vaccine supply issues and debates over the AstraZeneca vaccine.

The AstraZeneca vaccine was relied on heavily as part of Australia's initial vaccine plan, with plans for 50 million doses to be manufactured locally under a deal struck with the international pharmaceutical company. The total value of Australia's five vaccine deals is more than $5 billionin taxpayer funds.

But much about the deal with AstraZeneca is unknown.

While the government has published a letter of intent, the contract with the organisation which is likely to amount to more than $1billion of taxpayer funds has never been released.

When 7.30 sought the contract under Freedom of Information laws, it was refused access to the contract in full. One of the grounds for denying access was because it could damage Australia's national security.

An assistant secretary with the COVID-19 Vaccine Taskforce in the Department of Healthwrote that there would be a "real and substantial risk to national security" if the contract were released.

"I consider the particular damage to the security of the Commonwealth to be the fact that disclosure of the information could provide insight into the unique arrangements for the manufacture and supply of the COVID-19 vaccine," theassistant secretary wrote.

"Releasing the information in [the contract] would have the effect of signalling to other countries the terms agreed between the Commonwealth and AstraZeneca.

"The integrity and efficacy of the arrangements to manufacture and supply the vaccine may be compromised and thereby pose a threat to the national security of the Commonwealth if those terms were published."

Gavin Hayman, the executive director of global advocacy group Open Contracting, said Australia's blanket suppression of the deal was striking and at odds with other nations.

"There is no merit in using a national security argument for keeping the vaccine contract hidden from public sight," he said.

"In fact, national security is best served by building public trust in the entire vaccination program. We think publishing the contract with a clear explanation of its key terms can contribute to that."

There is widespread confusion since the government madeAstraZeneca an option for all, but some young Aussies (here and abroad) have jumped at their chance to get the vaccine.

The Department of Health also argued that the information should be withheld because it could damage AstraZeneca's commercially valuable information.

"[AstraZeneca] operates in a global, hyper-competitive market. If the information were to be disclosed in the current environment, it could enable the third party's competitors to obtain a commercial advantage over it by disclosing the commercial and risk positions by which the third party is prepared to be bound," the assistant secretarywrote.

The approach taken by Australia also stands in stark contrast to other countries, according to Mr Hayman.

The European Union, United Kingdom, United States, Mexico and Brazil have all released substantial parts of their vaccine contracts with AstraZeneca.

ABC News: Matt Roberts

Mr Hayman also said the vast public expenditure on these contracts justified a much clearer understanding of how the deals were struck and their terms.

"These contracts contain important information on 'best effort'manufacturing, march-in rights liability, delivery schedules, licensing arrangements for further manufacture at scale, and more," Mr Hayman said.

"Open information on the contracts, delivery schedules, supply arrangements, and other aspects of the vaccination program allows different parts of government to talk to each other and spot problems before they spiral out of control."

A spokesman for Health Minister Greg Hunt referred 7.30's questions to the Department of Health.

A spokesman for the Department of Health said: "The Department of Health fully considered the Freedom of Information request, within its legal obligations, and provided a clear rationale for the document exemptions."

The federal government has sought to keep secret several critical documents relating to Australia's response to the COVID-19 pandemic.

ABC News: Rhiannon Shine

Australia's analysis of COVID-19 in neighbouring Pacific countries is also a tightly held secret.

7.30 was also denied access to a review commissioned by the Department of Foreign Affairs and Trade conducted by ABT Associates Pty Ltd that examined COVID-19 vaccine delivery capacity in the Pacific.

In a letter, the Ambassador for Regional Health Securitywrote that disclosure "could reasonably be expected to cause damage to Australia's international relations" and would have a "substantial adverse effect on the department's operations to pursue Australia's interests overseas".

Independent senator Rex Patrick has also been seeking to obtain key National Cabinet documents relating to the COVID-19 pandemic response but has been met with heavy resistance.

Senator Patrick said he believed the decision to suppress the AstraZeneca contract was another "highly cavalier" confidentiality claimfrom the Department of Health about the COVID-19 vaccine rollout.

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Australia is paying hundreds of millions to AstraZeneca for COVID-19 vaccines. But the deal is a 'national security' secret - ABC News

All 50 states and Washington, DC, have reported cases of the Delta variant, which is believed to be more transmissible than other strains. And though experts have stressed vaccines are the best defense and provide strong protection against the variant, parts of the country are still lagging in vaccination rates, according to data from the US Centers for Disease Control and Prevention.

"As a nation, as a whole, we are doing very well. We have ... about 50% of the population that is vaccinated," said director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci on NBC's "Meet the Press." "But we have a big country with disparity in the willingness to be vaccinated."

The holiday weekend highlighted the divide as some regions saw increased Covid-19 infections and others celebrated holiday gatherings with the safety of vaccine protection.

"This is really a day of independence -- for folks in the United States who are vaccinated, this is really a holiday that celebrates our independence from the fear and the death and the hardships that so many people in this country have faced," CNN Medical Analyst Dr. Jonathan Reiner told CNN's Brian Stelter.

Meanwhile, the South, Southwest and parts of the Midwest are starting to see surges. Florida, in particular, is being hit hard, Reiner noted, with about 17% of all new US cases being reported in the state.

"People will continue to die until we vaccinate everybody," Reiner said.

The importance of vaccination became especially clear last month, when more than 99% of US Covid-19 deaths were among unvaccinated people, Fauci told NBC's "Meet the Press" Sunday.

White House Covid-19 Response Coordinator Jeffrey Zients told CNN Sunday, "If you're not vaccinated, you are not protected so we're going to double down on our efforts to vaccinate millions of more Americans across July and August."

Renewed debate on masks

In areas with high Covid-19 transmission and low vaccination rates, even vaccinated people may want to wear masks, Fauci said Sunday.

"When I'm in that area where there's a considerable degree of viral circulation, I might want to go the extra mile to be cautious enough to make sure that I get the extra added level of protection -- even though the vaccines themselves are highly effective," Fauci told NBC.

And while some areas, like Vermont, Connecticut, Massachusetts, and Maine have fully vaccinated more than 60% of the their total population against the virus, others are lagging far behind, according to the CDC.

Alabama, Arkansas, Louisiana and Mississippi are the furthest behind, with 35.3% or less of their population fully vaccinated, according to CDC data.

"Currently, approximately 1,000 counties in the United States have vaccination coverage of less than 30%. These communities, primarily in the Southeast and Midwest, are our most vulnerable," CDC Director Dr. Rochelle Walensky said Thursday. "As the Delta variant continues to spread across the country, we expect to see increased transmissions in these communities, unless we can vaccinate more people now."

In states where about 35% of the population or less is vaccinated, counties or cities could see outbreaks, Fauci said.

Even with the possibility of outbreaks among undervaccinated populations, Reiner said vaccines provide strong enough protection that those who are inoculated shouldn't need to wear masks, except for those with extenuating circumstances like compromised immune systems.

Vaccination is "the ticket to get your life back," Reiner said.

For his part, Zients wouldn't say Sunday if masks should be mandated for vulnerable regions, but said local governments will make their own decisions and the CDC has been clear about who should and should not wear a mask.

Regardless of mandates, former US Food and Drug Administration Commissioner Dr. Scott Gottlieb said Sunday that masks may become normalized for some people looking to protect themselves against respiratory pathogens -- be they coronavirus or the flu.

"I think people are going to use them on a voluntary basis," Gottlieb told CBS's "Face the Nation" Sunday. "I think going to work with the sniffles is going to be frowned upon. I think businesses are going to have access to routine testing. I think there might be symptom checks within certain settings."

A push to get vaccination rates up over the summer

Zients, the White House coronavirus official, said the administration will be increasing efforts this summer to get more people vaccinated so they can return to enjoying life without fear of Covid-19.

President Joe Biden had set a goal to have at least 70% of US adults at least partially vaccinated by July 4. The nation missed that mark by about eight million on Sunday.

The numbers are still ahead of where most people expected they would be, Zients said in defense of the vaccination progress, but added that federal officials will focus on increasing vaccine accessibility to the public to boost numbers.

"The most trusted messenger is the local doctor, the local healthcare provider, so increasingly we have vaccines in doctor's offices, at healthcare clinics, so that people can get their questions answered and roll up their sleeve and get a shot," Zients said.

If not enough people get that shot, it could spell a surge in the pandemic this winter, experts have said.

Vaccine expert Dr. Paul Offit estimated in May that 80% of the population will need to become immunized through vaccines or prior infections to avoid a winter surge.

CNN's Jacqueline Howard, Lauren Mascarenhas, Jasmine Wright and Maggie Fox contributed to this report.

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These areas in the US have officials concerned as Covid-19 cases increase - CNN

SAN DIEGO (KGTV) -- A new study on members of the U.S. military who received the COVID-19 vaccines adds more evidence to a link between the shots and rare cases of heart inflammation, but the researchers said their findings should not diminish overall confidence in the shots.

From January through the end of April, the military administered 2.8 million doses of the vaccines from Pfizer and Moderna.

The study, published in JAMA Cardiology, describes how 23 service members later developed chest pain and sought medical attention. Testing showed it was myocarditis.

Myocarditis is inflammation of the heart, specifically within the middle layer of heart muscle.

Last week, an advisory committee to the Centers for Disease Control and Prevention said there was a "likely association" between about 1,200 reports of heart inflammation and the mRNA COVID-19 vaccines made by Pfizer and Moderna.

RELATED: Benefits of COVID vaccination still greatly outweigh the risks of myocarditis, CDC experts conclude

The panel concluded the vaccines benefits still greatly outweigh the potential risks, but the Food and Drug Administration added a new warning to the literature that accompanies the shots highlighting that rare and typically mild cases of heart inflammation had been detected.

Most of the cases have been in boys and young men.

In the military study, all 23 cases were men, all happened within four days after vaccination and most happened after the second dose. Most of the men were service members in their 20s.

To examine whether the vaccines were the likely cause, researchers compared the number of cases to the background rate. The background rate is the number of cases of myocarditis that would be expected from other causes.

Myocarditis can be triggered by a number of things, including infection. There are like 15 or 20 common offenders, said Dr. Christian Ramers of Family Health Centers of San Diego. Things like chickenpox can do it. Things like enteroviruses that cause infections in kids can do it.

In the days following the second shot, the researchers said they would expect to find between 0 and 8 cases of myocarditis from other causes. Instead, they found 19, suggesting a possible link to the vaccines.

The majority of people will not only get better, but you'll get better very quickly, said Dr. Peter Chin-Hong, an infectious disease specialist at UC San Francisco.

Myocarditis can involve sharp chest pain or shortness of breath at first, but it usually resolves fast, Dr. Chin-Hong said. Some patients heal without treatment. Others may require simple anti-inflammatory medicine. In rare cases, the inflammation can cause permanent damage to the heart.

In the military study, 16 of the 23 patients recovered within one week. Seven patients continued to have chest discomfort at the time the report was published.

Doctors arent sure why the condition is more common in boys and young men, but the cases in healthy, fit military members are renewing questions about the role of exercise.

Vigorous exercise can worsen myocarditis. If you increase the blood flow needed during exercise, the heart really can't keep up, said Dr. Chin-Hong.

In rare cases, that can lead to heart failure.

People who develop myocarditis are told to avoid vigorous exercise and sports for three to six months so the heart has time to heal, but some doctors are beginning to wonder if exercise just after vaccination could have an impact.

I think that raises a very important question, said Dr. Abisola Olulade of Sharp-Rees Stealy Family Medicine. Do we recommend that people in this age range not exercise after they get the vaccine? I think its an important question because there is data that if someone is experiencing myocarditis they should not exercise because it can make it worse.

So far, there is no such guidance that people avoid exercise in the days after the shot, Dr. Olulade noted.

Scientists have yet to identify a mechanism for how the vaccines might trigger the inflammation.

People infected with COVID-19 have developed heart complications. Nearly one percent of college and pro athletes infected with COVID showed signs of myocarditis in scans, the military researchers noted.

That means infection poses a much higher risk of heart problems than vaccination, Dr. Chin-Hong said.

The latest estimates suggest about 12 cases of myocarditis after every million doses of vaccine, which is a similar risk to drowning while swimming, he noted.

The authors of the military study said their findings should not discourage people from seeking the life-saving protection the vaccines offer.

Concerns about rare adverse events following immunization should not diminish overall confidence in the value of vaccination, the authors wrote.

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COVID-19 vaccine study reveals myocarditis cases in the U.S. military - 10News

Enlarge / A deserted walk-in COVID-19 mass vaccination site at the Convention Center in downtown Washington, DC, on June 1, 2021. Covid-19 CoverageView more stories

The United States is expected to miss the Biden administration's target of having 70 percent of adults vaccinated with at least one dose of a COVID-19 vaccine by July 4. Instead, the country will fall shy of the goal by just a few percentage points.

Currently, about 66.5 percent of adults have received at least one dose of a COVID-19 vaccine. To reach the target of 70 percent, around 9 million unvaccinated adultsthose ages 18 and overwould need to get a vaccine dose over the next three days. Though the number of daily vaccinations has risen slightly in the past week, only around 1.37 million vaccine doses were administered on June 30, bringing the seven-day average of daily doses administered up to about 945,000. And that number includes second doses and doses given to those between the ages of 12 and 17, who are not included in President Joe Biden's target.

Though we'll only just miss the vaccine goal, new polling data highlights just how hard it is becoming to get those small slivers of the population vaccinated going forward.

While about 65 percent of polled adults say they've already gotten their COVID-19 vaccine, only 3 percent say they still plan to get vaccinated as soon as possible. The rest responded that they would "wait and see" (10 percent), only get vaccinated if required (6 percent), or would "definitely not" get vaccinated (14 percent).

The proportion of the "definitely not" crowd has largely gone unchanged throughout the survey, which began last December and is run monthly by the Kaiser Family Foundation. Throughout the survey, between 13 percent and 15 percent of polled adults have fallen into the "definitely not" category. Likewise, the "only if required" proportion has fluctuated between 6 percent and 7 percent since January.

Meanwhile, the "wait and see" proportion has dwindled considerably, shrinking from 39 percent in December to the current 10 percent in the June data. However, the remaining 10 percent may be harder than ever to sway. Of those remaining wait-and-see adults, 61 percent said they worry that current vaccines won't be effective against variants. (Mounting data continues to show that current vaccines are effective against all of the concerning variants circulating in the US). And 43 percent said the number of cases is so low that there is "no need for more people to get the vaccine."

Overall, the country's current lowered rates of cases, hospitalizations, and deathsmainly attributable to highly effective vaccines and successful vaccination effortsappears to be acting as a deterrent for further vaccinations. Among all unvaccinated people polled, 50 percent said the low case numbers mean there is no more need for people to get vaccinated. And among just the people who said they would "definitely not" get vaccinated, 67 percent said the low case counts make vaccination unnecessary.

In the meantime, experts are raising alarms over the looming risk of COVID-19 outbreaks and surges in areas with low vaccination rates. In a White House press briefing Thursday,Rochelle Walensky, director of the Centers for Disease Control and Prevention, noted that around 1,000 counties, primarily in the Southeast and Midwest, have vaccination coverage of less than 30 percent. "These communities... are our most vulnerable,"Dr. Walensky said. "In some of these areas, we are already seeing increasing rates of disease. As the Delta variant continues to spread across the country, we expect to see increased transmission in these communities unless we can vaccinate more people now."

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Success of COVID-19 vaccines may be convincing people not to get vaccinated - Ars Technica