Category: Covid-19 Vaccine

Michael J. Stern, Opinion columnist Published 4:00 a.m. ET April 30, 2021

Enough analysis of these human petri dishes. Everyone who wants a vaccine will soon have one, and proof should be required to work, play and travel.

Has-been rock star Ted Nugent told the world last week that he has COVID-19. Nugents announcement was an oddity because he previously called the viral pandemic a leftist scam to destroy former president Donald Trump.As I watched Nugents Facebook Live post, in which he repeatedly hocked up wads of phlegm and spit them to the ground, I got emotional when he described being so sick he thought he was dying. But when hetrashed the COVID-19 vaccine and warned people against taking it, I realized that the emotion I was feeling was not empathy, it was anger.

For the better part of a year, as the coronavirus racked up hundreds of thousands of American deaths, the flickering light at the end of the tunnel was herd immunity the antibody force-shield that comes when enough people have survived the illness or have been vaccinated against it. "Go get vaccinated, America," President Biden said inhis speech to Congress this week, referring to the shot as"a dose of hope.

Anthony Fauci, the nations top infectious disease doctor, suggested in December that if 75% to 85% of the population got vaccinated, we could reach herd immunity by June. And with herd immunity, wed return to a measure of normalcy, meaning indoor dining, movie theatersand hugs.

But herd immunity is slipping away because a quarter of Americans are refusing to get the COVID-19 vaccine.Dr. Gregory Poland, director of the Mayo Clinic's Vaccine Research Group recently said: There is no eradication at this point, its off the table. We as a society have rejectedherd immunity. Hmm, no! We have not rejected anything. A quarter ofthe country is ruining it for all of us.

Its not just wacky former rockers who have put herd immunity out of reach. It is white evangelicals(45% say they won'tget vaccinated).And it is Republicans (almost 50%are refusing the vaccine). In Texas, 59% of white Republicans have said no to the vaccine.You can slap the euphemism vaccine hesitancy on the problem, but in the end the G.O.P., and the children of G.O.D., are perpetuating a virus that is sickening and killing people in droves.

A big part of the problem stems from the cultish relationship many evangelicals and Republicans have with former President Donald Trump.Theyabsorbed his endless efforts to downplaythe danger of the virus and turn public health precautions into a political freedom movement. But the time for analyzing why these human petri dishes have chosen to ignore the medical science that could save them, and us, is over.We need a different strategy.I propose shunning.

COVID-19 vaccination site on April 27, 2021, in Los Angeles.(Photo: Frederic J. Brown/AFP via Getty Images)

Bidens wildly successful vaccine rollout means that soon everyone who wants a vaccine will have one.When that happens, restaurants, movie theaters, gyms, barbers, airlinesand Ubers should require proof of vaccination before providing their services.

And it shouldnt stop there.Businesses should make vaccination a requirement for employment.A COVIDoutbreak can shut down a business and be financially devastating.And failure to enforce basic health and safety measures is not fair to employees who have to work in offices, factories, and stores where close contact is required.Things should get personal, too:People should require friends to be vaccinated to attend thebarbeques and birthday parties they host.Friends dont let friends spread COVID.

Pro-life party: Where are the Republican COVID-19 heroes willing to risk their careers to save lives?

As Im writing this I can almost see the Twitter rebuttals:If peoplewant to risk being microchipped by the deep state, they can protect themselves by getting a vaccine without making me do the same. Nope.In its real life application, the vaccine is about 90% effective.Sure, thats impressive, but if the roulette wheels makes you one of the unlucky 10%, its little consolation.

There have already been several thousand documented breakthrough cases of COVID-19 infections in people who have been vaccinated.Some have died.And with coronavirus variants popping up across the globe, for which the vaccine is less effective, we should expect to see more infections in vaccinated people.

Unwilling to miss an opportunity to flout common sense, Republican leaders from Florida,Pennsylvania, Wisconsin, Arkansas and other states want toprevent businesses from requiring customers to be vaccinated.Florida Gov.Ron DeSantis has already issued an executive order prohibiting businesses from requiring patrons or customers to show vaccine documentation.

There are decades of state laws that require vaccination before children can attend schools.There are seatbelt and helmet laws, no-texting-while-drivinglaws, and countless other laws that restrict individual freedoms to ensure safety for the public at large.Despite this, vaccine requirements designed to curb a global pandemic that has cost us more than 570,000 American lives is the hill on which Republicans want to die.

Are we about to hit a vaccine wall?If you have doubts about getting the COVIDshot, reconsider.

When states pass these laws, designed to tell private companies how to run their businesses, there should be immediate legal challenges.Surely, if a bakery can refuse to provide its services to a gay couple getting married, they can refuse to bake a cake for people who choose to place themselves, the bakery staffand its customers at risk of contracting a deadly illness.

As a country, America has become too tolerant of half-witted individual autonomy that ignores the existential needs of the vast majority of its citizens.While writing this column I caught a TV promo for a new documentary in which Cher saves an elephant.It made me think of her performance in "Moonstruck." Vaccine hesitancy? We need Cher to slap us in the face and tell us to snap out of it.

Michael J. Stern, a member of USA TODAY's Board of Contributors,was a federal prosecutor for 25 years in Detroit and Los Angeles. Follow him on Twitter: @MichaelJStern1

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It's time to start shunning the 'vaccine hesitant.' They're blocking COVID herd immunity. - USA TODAY

Two Colorado health experts said severe reactions to COVID-19 vaccines are rare, but here's what people should do if they experience non-emergent symptoms.

COLORADO, USA The Centers for Disease Control and Prevention (CDC) recommends that those who experience a severe or immediate allergic reaction to their first COVID-19 vaccine should not get their second dose.

The CDC considers an allergic reaction to be severe when someone needs to be treated with an EpiPen or if they must go to the hospital. This kind of reaction is also known as anaphylaxis. An immediate allergic reaction happens within four hours of getting vaccinated, according to the CDC.

"Immediate hypersensitivity reactions or anaphylactic reactions are actually quite unlikely with the COVID-19 vaccines," said Dr. Anjeli Kalra, an allergist with UCHealth. "The only contraindication to the Moderna and Pfizer vaccines is a history of anaphylaxis to polyethylene glycol (PEG) and the only contraindication to the Johnson and Johnson vaccine is a history of anaphylaxis to polysorbate 80."

Kalra said it's important to know the symptoms of anaphylaxis before opting out of receiving your second dose.

"Symptoms will include diffused redness of the skin, hives, swellings of the lips or tongue and 90% of people who have anaphylaxis to the vaccine will have skin findings, in addition to wheezing, trouble breathing, diarrhea, nausea, vomiting and/or loss of consciousness," she said.

Professor of immunology with the CU College of Medicine, Dr. Ross Kedl, also said that severe reactions to COVID-19 vaccines are rare. For people who had a reaction to Pfizer or Moderna, Kedl said the Johnson and Johnson vaccine may be a better option, but only after discussing it with your doctor.

"If someone had an allergic reaction to Pfizer then switched to J&J, and then had an allergic reaction to J&J, well theyve had two doses, and so frankly, theyre done so good news, if they dont need to worry too much, that shouldnt negatively affect their immunity," said Kedl.

After having a reaction to either Pfizer or Moderna, patients who are given the green light to get the Johnson & Johnson vaccine after consulting their doctor should wait 28 days after their first COVID vaccine dose, Kalra recommended.

TheColorado Department of Public Health and Environmentsaid vaccine providers are required to report any adverse events following a COVID-19 vaccine to the Vaccine Adverse Event Reporting System (VAERS).

After receiving the vaccine, people should get a v-safe information sheet telling them how to enroll in v-safe, a smartphone-based, after-vaccination health checker.

Those enrolled receive regular text messages directing them to surveys where they can report any problems or adverse reactions they have after receiving a COVID-19 vaccine. V-safe is available in English, Korean, simplified Chinese, Spanish and Vietnamese.

Kedl and Kalra recommend going over symptoms of the first dose reaction with a primary care doctor, allergist, or immunologist before getting a second dose.

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Health experts on how to handle severe, immediate reactions from COVID vaccine - 9News.com KUSA

The action was innocent: While cleaning the Veterans Affairs hospital in Boston this past January, a contractor knocked a loose freezer plug from its socket. This simple mistake resulted in the loss of nearly 2,000 doses of Moderna's COVID-19 vaccine that had been chilling inside the unplugged appliance. While that's a small hit on the grand scale of worldwide vaccination, it's emblematic of a much larger issue for many COVID-19 vaccines; they have to be kept frozen.

Two of the major coronavirus shots authorized for emergency use in the United Statesthe Moderna and the Pfizer/BioNTech vaccinesrely on a costly series of temperature-controlled shipments and storage, known as the cold chain, to get vaccines from manufacturers to muscle injection. Such stringent temperature requirements also pose an obstacle for equitable vaccine distribution, increasing the cost and difficulty of shipments and cutting off access to remote communities without reliable electricity or refrigeration.

The reason for these frigid conditions is that the key vaccine ingredienta molecule called messenger RNA (mRNA)is extremely fragile and storage at cold temperatures slows down the chemical reactions that can tear it apart. But promising efforts to reduce this frosty burden are already in the worksfrom tinkering with the mRNA structure to shipping the vaccine in solid form with a sugary protectant.

Such efforts are not just important for halting the current pandemic. Scientists see promise in mRNA vaccines for treating a wide variety of other diseases, since they can be readily tweaked for different viral variants as well as rapidly developed for new viruses.

"All those steps that are taken now will be really important in the coming years," says Rein Verbeke, a pharmaceutical scientist specializing in mRNA vaccines at Ghent University in Belgium.

The necessity for cold storage lies at the heart of how these vaccines work, which is mRNA. These strands of genetic code in the COVID-19 vaccine carry instructions that the human cell uses to manufacture the characteristic spike protein, which sits on the surface of SARS-CoV-2. This preview of the protein familiarizes the body's immune system with the virus so that it can recognize and fight future coronavirus invaders.

Messenger RNAis similar to a single strand of DNA, but its backbone carries one crucial difference: an additional chemical group made up of oxygen and hydrogen, known as hydroxyl.

If the RNA strand bends in just the right way, this hydroxyl group can interact with another part of the backbone sparking a reaction that severs the genetic chain, explains Hannah Wayment-Steele, a PhD student studying RNA structure at Stanford University.

"It cuts the message off," she says. And these shortened messages cannot build a complete protein. "Only one cut in your mRNA strand can be enough to lose your function," says Verbeke, the pharmaceutical scientist.

To slow degradation, companies keep the vaccines at low temperatures. The lower the temperatures, the slower the molecular movementsand the lower the chance of damaging reactions, Verbeke explains. The Pfizer/BioNtech vaccine must be shipped at temperatures colder than nearly 80 degrees below zero. It can be stored for up to two weeks in a standard freezer, up to five days in a fridge, and only six hours at room temperature. Moderna's vaccine is slightly more forgiving. It is stable for up to six months in a standard freezer, up to 30 days if refrigerated, and 12 hours at room temperature.

Vaccine storage is further complicated by another key component: fat. In both the Pfizer/BioNTech and Moderna vaccines the mRNA is encased in fat bubbles known as lipid nanoparticles. They serve as a delivery vehicle to shuttle the mRNA into cells where the cellular machinery can get to work producing the encoded spike protein.

Lipid nanoparticles also help with mRNA stability by shielding it from RNA-degrading enzymes that are abundant both within our bodies and throughout the environment. Yet over time, the lipid nanoparticles themselves can degrade or aggregate, and for a vaccine to work the structure of both fats and mRNA must be injected intact. "It's a difficult thing to accomplish," Verbeke says.

Some natural forms of RNA can survive within our bodies for more than 12 hours, says Rhiju Das, a computational biochemist at Stanford University. "They're these proofs of concept that the RNA should be able to last longer than it does in those vaccines," he says. And one thing these robust RNA molecules have in common are intricate structures that constrict the strand and prevent it from bending in a way in which it can cut itself in two.

"Industry folks had tried using a lot of other things," Das says. They tried tweaking the lipid formulas. They shifted the acidity of solutions. "They couldn't find a way to solve it," he says. But one avenue that was largely unexplored was these intricate folded RNA structures.

This is a potentially useful strategy for vaccine development because multiple mRNA sequences can code for the same proteinand each crumples up in a different way. So if scientists can identify the sequence that folds into the most stable shape, they can produce a vaccine with less stringent temperature requirements for shipping and storage.

The trick, however, is identifying the best genetic origami. "You have these astronomical numbers of possible sequences," says Wayment-Steele, which leads to whole galaxies of structures that a molecule could take. To narrow the possibilities, Wayment-Steele and her colleagues turned to an online game known as Eterna, which harnesses the power of crowds to assist in RNA design through puzzles.

Das and his colleague Adrien Treuille of Carnegie Mellon developed the game about a decade ago when they kept running into problems that AI couldn't solve. "Almost out of desperation we decided to try this sort of crowdsourcing approach," says Das, who is Wayment-Steele's graduate advisor. "Eternas ended up solving hard problem after hard problem."

Eterna users switch out units of the genetic code, called bases, and the game predicts the folded shape and estimates its stability. "Sometimes it will cause the whole [mRNA] structure to change by changing just that one base," says Amy Barish, a retired chemist and an Eterna player in Cumming, GA. The scientists then work with the players to develop AI, using their structures as examples to train a computer to predict the most stable RNA forms.

Through their work with Eterna players, the team developed a series of mRNA sequences that encode for the spike protein of SARS-CoV-2 variants B.1.351, P.1, and B.1.1.7, first identified in South Africa, Brazil, and the United Kingdom, respectively, that are potentially twice as stable as conventionally designed sequences. They are freely available online for vaccine developers, Das notes.

"Its just great that we can work on this fun, challenging game but yet were potentially helping the world," says Barish, who worked on some of the spike protein puzzles.

Much more work is required, however, before these so-called superfolder mRNAs can be injected into arms. One previous concern is that their structure would hinder cellular machinery, known as ribosomes, from reading and translating the mRNA instructions into proteins, explains Maria Barna, a geneticist at Stanford University. She teamed up with Das' lab to test superfolders translation using mRNA that codes for a set of easily analyzed proteins, including one that fluoresces green. They were surprised and delighted to find that ribosomes could not only unwind the superfolder structures to produce lots of protein, but the superfolders actually generated more protein than the less stable RNA structures.

"These superfolder mRNAs are not just a dream, they can actually work, and they work wellmore than we would have expected," Barna says.

Exactly how this will translate to COVID-19 vaccine stability remains uncertain, but Barna says they hope to produce vaccines that can be stored at room temperature for weeks at a time, if not longer. The team is now collaborating with a pharmaceutical company to test the superfolder spike protein structures in real world applications.

Another possibility for stabilizing the vaccines is drying or freeze drying so they can be stored at room temperature in solid form. But removing the water while keeping the RNA structure intact is no small feat. As the liquid freezes, the crystallizing ice can crush the molecule while whisking away water that can lead to structural collapse.

One way to avoid this damage is through the addition of sugar. Carlos Filipe, chemical engineer at McMaster University, and his colleagues have been testing sugary recipes for drying vaccines, and their current formulation relies on two different types of sugartrehalose and pullulan.

Trehalose helps fill the voids in the molecule as the water dries away, acting like scaffolding to prop up the structure. The sugar pullulan, which is the base of Listerine strips, encapsulates the molecule to keep it from twisting, which prevents the backbone from cutting itself apart.

"Its like Hans Solo when he was in the carbonite," says Filippe, posing frozen like the fictional Star Wars character with his hands held up, mouth agape.

Before the COVID-19 pandemic the team demonstrated the efficacy of this sugar treatment to dry out vaccines for the Herpes Simplex type 2 virus and the Influenza A virus and then tested the reconstituted vaccines in mice. Along with his colleague Robert DeWitte, Filipe co-founded a company Elarex to bring this technology to market. They're now working to test the mixture for drying mRNA encapsulated in lipid nanoparticles.

There are multiple different sugar combinations that might work, notes Daan Crommelin, a pharmaceutical scientist at Utrecht University, Netherlands. Yet even with sugar, drying may still have its challenges. For one, drying vaccines could increase the time and cost of production, Crommelin notes. But such costs could be greatly offset by elimination of the cold chain, says DeWitte, who is CEO of Elerax.

Most importantly, there are many options to investigate, or as Crommelin says, "There are several ways that lead to Rome." But he notes the old adage needs a tweak in this case since it's likely not just one road or another. A combination of efforts will be required to distribute COVID-19 vaccines to people no matter where they are in the world.

Versions of a more stable mRNA vaccine for COVID-19 seem to be on the horizon. Pfizer and BioNTech are currently recruiting participants for a phase 3 trial that will evaluate a freeze-dried version of their SARS-CoV-2 vaccine. They hope for results in the second half of 2021, after which they can submit the results to regulatory agencies for review.

Other companies also have new versions of a liquid mRNA COVID-19 vaccine that may be refrigerator rather than freezer stable. But scant details are available on the reasons behind the stability. Moderna initiated a Phase 1 trial for a version of their next-gen COVID-19 vaccine that they say is refrigerator stable. But after repeated requests the company did not answer questions about reasons behind stability of the new formulation.

The German companyCurevac also claims its vaccine is stable in a refrigerator for up to six months and at room temperature for 24 hours. Similar to other vaccines on the market, Curevacs is encapsulated in lipid nanoparticles (LNPs) and must be protected from cutting itself apart. We think we might have achieved this by having the mRNA tightly packed within the LNP, company spokesperson Thorsten Schller wrote in an emailed statement to National Geographic. Our theory is that the more compactly the mRNA is packaged, the less attack surface there is." When pressed for details the company responded: "it is hard to pin down differences in stability to just one aspect."

Still, the diversity of possibilities is an encouraging sign of potential improvements to mRNA vaccines already on the market. "This feat was tremendous," Verbeke says of the speedy delivery of a safe and effective vaccine against COVID-19. But he adds, "Im quite sure theres still a lot of room for improvement."

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Future COVID-19 vaccines might not have to be kept so cold - National Geographic

The British health minister has said that the UK does not currently have any excess doses to send to India -- currently home to the world's worst coronavirus outbreak -- despite the country's ongoing vaccination rollout that has successfully vaccinated its priority groups and is now targeting younger ages.

In spite of mounting calls for rich nations to equitably distribute their surplus vaccines, Hancock said that they are providing India with the Oxford/AstraZeneca vaccine at cost and are also working closely with the Serum Institute of India (SII).

The SII are making and producing more doses of vaccine than any other single organization. And obviously that means that they can provide vaccine to people in India at cost, Hancock said.

We're leaning in, both on what we can provide and the material goods we can provide now like ventilators that we thankfully don't need any more here, he said.

India is in throes of a deadly second wave of the coronavirus which has seen cases surge above 300,000 for eight consecutive days, and a death toll that has surpassed 200,000 -- after the country reported 3,293 deaths on Wednesday.

Hancock's comments on vaccine exports come as a recent Ipsos MORI survey found that many people in the UK are keen to send vaccines to India.

The survey, which polled 1,016 adults aged 16-75 on Tuesday, found:

Over 33.9 million people in the UK have already received a first dose of a Covid-19 vaccine, with over 13.5 million now fully vaccinated, according to the latest government data.

On Wednesday, the UK Foreign and Commonwealth Office (FCO) announced that said it will be sending three oxygen factories to India, saying in a statement that the three oxygen generation units each the size of a shipping container - would be sent from surplus stock from Northern Ireland and would produce 500 litres of oxygen per minute each, which is enough for 50 people to use at a time.

The UK had already committed to providing India with 495 oxygen concentrators and 200 ventilators sent from surplus stock, the first batch of which arrived in India on Tuesday, the FCO statement said.

International collaboration is more essential than ever, and this additional UK support package will help meet Indias current needs, particularly for more oxygen, Foreign Secretary Dominic Raab said in a statement.

The FCO statement comes as the aid sector has heavily criticized the UK's plan to cut 85% of the aid it has pledged to the United Nations familyplanning program.

A top UN official on Wednesday called the move"devastating for women and girls and their families across the world."

"When funding stops, women and girls suffer, especially the poor, those living in remote, underserved communities and those living through humanitarian crises," Natalia Kanem head of the UNs sexual and reproductive health agency, said Wednesday in a statement.

This means that the UK's expected contribution of 154 million (approximately US $211 million) will be reduced to around 23 million (US$32 million).

Speaking about the cuts, Raab said it was part of the Foreign Offices efforts to ensure maximum strategic coherence, impact and value for taxpayers money.

Last year, the UK also garnered criticism from the humanitarian sector when it reduced its aid spending from 0.7% of the national income to 0.5%.

Originally posted here:

(4) UK says it doesn't have excess Covid-19 vaccine doses to send to India, but is providing them at cost - CNN International

India and poorer countries may wait years for Covid-19 vaccines as rich countries hoard them  Vox.com

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India and poorer countries may wait years for Covid-19 vaccines as rich countries hoard them - Vox.com

In the countrys race to vaccinate people and build herd immunity against COVID-19, local governments and public health leaders have had to come up with innovative ways to provide equitable and easy access to the vaccines.

In some areas, this has meant launching vaccination sites specifically geared toward seniors, a group thats seen the highest rates of hospitalization and death during the pandemic.

Mobile clinics have also popped up in underserved areas, eliminating the need for online pre-registration or travel in communities that have limited access to technology and transportation.

Local health officials have taken cultural approaches, opening 24/7 clinics and meeting vaccine-hesitant people at their homes.

Here are some of the most effective ways local health officials are improving access to the vaccines:

In San Marcos, California, it quickly became obvious that vaccine eligibility didnt mean vaccine access, says Tim Lash, president of the nonprofit Gary and Mary West PACE.

As older adults struggled to navigate online appointment systems or lacked caregiver support, we saw an opportunity to fill these gaps for seniors, Lash said.

The Gary and Mary West Foundation teamed up with the county of San Diego along with various municipal, academic, healthcare, and philanthropic organizations to launch a vaccination site specifically geared toward seniors.

The site helped seniors book appointments by providing them with a phone-based scheduling option. The public-private partnership also educated seniors about the vaccine, provided transportation to and from the site, and accommodated all levels of function and mobility.

The CHA Hollywood Presbyterian Medical Center launched walk-up mobile clinics in Los Angeles in partnership with the Southern California Eye Institute (SCEI) and city councilmember Mark Ridley-Thomas. These mobile clinics aim to reach underserved communities that have limited access to healthcare, transportation, and technology needed to book an appointment.

Dr. Rohit Varma, chief medical officer of CHA Hollywood Presbyterian Medical Center, said that after hosting a drive-through vaccination clinic, the medical center looked for new ways to reach and deliver vaccines to the underserved in the Los Angeles community, to those who may not have ready access to computers or transportation.

The site has walk-up onsite registration, eliminating the need for people to book an appointment online via a phone or computer. SCEI offered to convert their mobile eye clinic bus into a vaccination center on wheels, which brought the mobile clinic to life.

Project HOPE, a global health and humanitarian relief organization, partnered with Indian Health Services (IHS) to distribute vaccines to Navajo Nation.

Vaccine sites were set up at hospitals and clinics along with community gathering spots like chapter houses.

Harley Jones, senior manager of domestic emergency response with Project HOPE, said IHS took a cultural approach when messaging the benefits of vaccination, positioning the fight against the pandemic and getting the vaccine as something that everyone should do to support their friends and neighbors.

The use of personal protective equipment, social distancing, and vaccinations were positioned in a way that gave everyone within the tribe a way to support the group, especially the elders, who faced higher risk for complications from COVID-19.

In Navajo culture, elders are revered as the history, health, and strength of the tribe, said Jones. The tribe mobilized to protect the group as a whole.

Despite being disproportionately impacted, including winter months marked by severe infection rates and community losses, Navajo Nation community has had recent landmark successes resulting from a strong increase in vaccinations, Jones said.

Its difficult for many people to secure vaccine appointments during traditional working hours. Across the country, vaccine clinics with overnight hours have been set up to serve people who work and live during nontraditional hours.

In Philadelphia, a pop-up 24/7 marathon clinic hosted by the Black Doctors COVID-19 Consortium was a huge success, vaccinating about 4,000 people in its first 24 hours. The site aimed to improve vaccine equity and reach communities disproportionally impacted by COVID-19.

Near Detroit, ACCESS, a nonprofit bringing social, health, and educational services to Arab American individuals, set up an overnight vaccine clinic for Muslims fasting during Ramadan. The clinic operated between 8:00 p.m. and 1:00 a.m. during Ramadan, when people fast from sunrise to sunset, and appointments were fully booked.

To further promote ease of access, some health leaders are bringing the vaccine directly to people in their homes.

There are services that bring the vaccine to homebound seniors who are unable to reach a vaccination clinic. There are also programs in which volunteers are going out into underserved communities and areas with low vaccination rates and talking with residents about the vaccines.

Health officials in Detroit announced that crews will be visiting peoples homes, educating them about the benefits of the shots and helping them sign up for appointments.

In Louisiana, religious organizations and civic groups are going door to door as well, simplifying the process of getting vaccinated.

Bringing vaccines to peoples homes can help remove the barriers and gives people easy opportunities to get vaccinated.

In the countrys race to vaccinate people and build herd immunity, local governments and public health leaders have had to come up with innovative ways to provide equitable and easy access to the vaccines.

In some areas, this has meant launching vaccination sites specifically geared toward seniors, a group thats seen the highest rates of hospitalization and death during the pandemic.

Mobile clinics have also popped up in underserved areas, eliminating the need for online pre-registration or travel in communities that have limited access to technology and transportation.

Local health officials have taken cultural approaches, theyve opened 24/7 clinics, and have recently started meeting vaccine-hesitant people at their homes.

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Countdown to Herd Immunity: The Fight to Get People the COVID-19 Vax - Healthline

A cancer patient in Louisville, Kentucky, receives a dose of a coronavirus vaccine.

By Jennifer Couzin-FrankelApr. 27, 2021 , 4:25 PM

Sciences COVID-19 reporting is supported by the Heising-Simons Foundation.

For Eva Schrezenmeier, a nephrologist at Charit University Hospital in Berlin, the news was sobering: Among 40 patients with transplanted kidneys at her hospital whod been vaccinated against COVID-19, only one was churning out the antibodies that would likely protect him from the disease. Because transplant patients take powerful drugs to suppress the immune system so it doesnt attack a donated organ, her team expected diminished responses to a vaccine. But Schrezenmeier, who posted a preprint describing her study last week, hadnt anticipated just how badly the vaccine might falter in her patients.

Her finding is at the grim extreme of research on how well COVID-19 vaccines work in the many millions of people whose immune systems are suppressed by drugs or disease. In many, the vaccines do seem to maintain their potency. But in othersparticularly organ transplant recipients and those taking certain immune-dampening medicationseffectiveness is less assured or even absent. To learn more, researchers are launching larger studies, seeking more clarity and ways to help patients whose weakened immune systems make protection against COVID-19 all the more urgent. There is a lot of confusion and fear among patients, says Alfred Kim, a rheumatologist at Washington University in St. Louis who cares for people with the autoimmune disease lupus and strongly urges vaccinationfor them.

One source of complexity: The dozens of different medications taken by people with cancer, autoimmune or other immunologic disease, or an organ transplant. Each can gum up different gears in the immune systems intricate machinery. The ailment makes a difference, too. Solid tumors such as colon cancer dont usually interfere with the immune system (although chemotherapy does). But autoimmune diseases or blood cancers such as leukemia and lymphoma can themselves deplete or disrupt certain types of immune cells.

Past research already suggested vaccines can falter in some immune-suppressed patients. Kim says flu and pneumococcal vaccines dont always work as well in people on some common immune suppressants, like methotrexate, which treats cancer and autoimmune diseases. Anda 2012 studyfound that just 44% of cancer patients in treatment produced antibodies to influenza after one dose of flu vaccine; most were first vaccinated 1 week after chemotherapy. The researchers recommended two doses after finding that a second dose boosted the number to 73%.

When they started to parse blood samples after COVID-19 vaccination, scientists were unsure how people with immune suppression would respond to the vaccines. Gauging protection is also a challenge: The vaccines are designed to propel production of antibodies, but scientists dont know what levels are needed to guard against COVID-19. Antibodies are easier to measure than T cell responses, but those, too, play an important role in protection from disease.

Still, in a research setting, the hunt for antibodies can yield important clues. In December 2020, transplant surgeons DorrySegev and Jacqueline Garonzik Wang at Johns Hopkins University put out a call on social media for organ recipients willing to participate in a COVID-19 vaccine study. We had 1000 enrolled in the first week, Segev says. In March, the research team published details inJAMAof participantsimmune responses to the first doseof the Pfizer-BioNTech and Moderna vaccines. The results foreshadowed Schrezenmeiers: Among 436 people whod had liver, heart, kidney, and other organ transplants, just 17% had detectable antibodies.

Outcomes varied based on which medications the volunteers were taking, however. Only 9% of those on a class of drugs that includes the immunosuppressant mycophenolate had some antibodies, compared with about 40% in those not taking drugs in that category. Mycophenolate inhibits production of both B cells, which generate antibodies, and T cells, which help marshal B cells to do their job.

Segev says he and his colleagues are close to sharing results from his cohorts second vaccine dose, which show some improvement. Still, hes surprised that these organ transplant patients seem to respond even less well to COVID-19 vaccines than to flu vaccines. To learn more, he is studying their T cell, B cell, and other immune responses. Were starting to try to say, What is going on here? Why is it so bad?

Although Segev worries about the roughly 500,000 transplant patients in the United States, he suspects the picture is much brighter for the 11 million people with autoimmune diseases, who tend to take different combinations of immune treatments or get by on lower doses. Last week, a paper inGastroenterologyreported that48 people with either Crohn disease or ulcerative colitis, nearly all on immune-targeting medication, responded well to vaccination. Of the 26 whom the researchers followed through both vaccine doses, all produced antibodies, 22 at high levels.

But another study, of133 people with various autoimmune diseases, suggested two types of medication can act as a sledgehammer against vaccine response. The work, posted as a preprint this month by Kim, rheumatologist Mary Nakamura at the University of California, San Francisco, and their colleagues, showed that on average, subjects churned out roughly one-third as many antibodies as healthy vaccinated peoplea difference that doesnt strongly concern Kim. But people on therapies that destroy B cells, like rituximab, and the powerful steroid prednisone had far lower levels. Bigger studies of these patients are getting underway, including one announced last week by the National Institute of Allergy and Infectious Diseases.

In cancer patients, vaccine response likely depends at least partly on timing, because cycles of chemotherapy alternately squash immune cells and allow them to rebound, says Giuseppe Curigliano, an oncologist at the European Institute of Oncology in Milan. He reported last year that cancer patients on chemotherapyproduced abundant antibodiesafter a bout of COVID-19, leaving him optimistic that vaccines will work well for them. His center waits a couple of weeks after a chemotherapy cycle to offer a COVID-19 shot. Similarly, a U.K. study showed that, although many patients in treatment for solid tumors had a paltry response to the first vaccine dose compared with healthy volunteers, they appearedwell-protected after the second. The researchers write that the results highlight risks of delaying vaccine doses in cancer patients, contrary to the countrys practice across its population.

Theres nagging concern, though, when it comes to people with blood cancers. Ghady Haidar, a transplant infectious disease specialist at the University of Pittsburgh Medical Center, haspreliminary results from patients with leukemia, lymphoma, and multiple myelomasuggesting a sizable fraction arent producing antibodies after vaccination, particularly those with a form of chronic leukemia. Perhaps, he says, this occurs because patients have defects in circulating white blood cells.

Physicians like Haidar say patients often ask whether to stop taking immune-suppressing medications before getting vaccinated, prompting tough choices. No one should be stealth discontinuing meds so that they can respond to vaccines, he says. For some patients, skipping treatment can be dangerous, but doctors can sometimes delay an infusion of a therapy known to make a vaccines job tougher.

For patients who dont appear protected by standard vaccinations, extra doses may help. Some organ recipients already get extra doses of hepatitis B vaccine, and this month, France recommended that they receive a third dose of the Pfizer-BioNTech COVID-19 vaccine. Christophe Legendre, a nephrologist at Necker Hospital in Paris, is planning antibody tests to see how well the approach works in transplant patients. Other researchers say labmade monoclonal antibodies might bolster protection for patients who still dont respond. (Although clinical trials have shown the monoclonal antibodiescan prevent infection, so far they are only authorized for treating early-stage COVID-19.)

In Berlin, Schrezenmeier is planning to offer the AstraZeneca or Johnson & Johnson vaccines to some patients already vaccinated with another COVID-19 vaccine. Will mixing vaccines enhance their effectiveness? I dont know, she admits. But she imagines that giving the immune system two different jolts might sometimes make a difference. The lone kidney transplant volunteer in her study who produced antibodies after vaccination had already survived COVID-19which may have helped kick-start an immune response against it.

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COVID-19 vaccines may protect many, but not all, people with suppressed immune systems - Science Magazine

MIAMI (CBSMiami)

The owners of an expensive Miami private school dont want their teachers and employees getting the COVID-19 vaccine, citing a debunked anti-vaccination theory.

CBS News obtained a copy of an email sent by the Centner Academy to its parents on Monday that reads, in part:

Until further notice, we ask any employee who has not yet taken the experimental COVID-19 injection, to wait until the end of the school year. We also recommended that all faculty and staff hold off on taking the injection until there is further research available on whether this experimental drug is impacting unvaccinated individuals. It is our policy, to the extent possible, not to employ anyone who has taken the experimental COVID-19 injection until further information is known.

The school, which charges almost $30,000 a year per student, is run by Leila and David Centner. Its a fairly new school, which just opened in September of 2020 and was featured in CBS4 Miami Proud segment in October of 2020.

The email appears to be tying employment to the vaccine, threatening legal action would be taken if staff lied about getting the vaccine.

Which made CBS4s Keith Jones wonder, is this even legal?

This is a private school. Its not a public school. So generally a private employer in Florida can fire someone for any reason or no reason at all, said employment lawyer Carter Sox with Gallup Auerbach.

Sox said firing someone for getting the vaccine is legal in this case. But there appears to be some recourse if fired personnel want to fight it.

If a teacher says they have a medical condition, and it discriminates against their right to get the vaccine, Sox said.

As the email began to make nationwide headlines, the United Teachers of Dade released a statement, which read, in part:

As shamefully seen by the actions of the illegally run and uncertified Centner Academy, these schools not only teach misinformation and peddle propaganda, they punish teachers who try to protect themselves and their families. We are horrified by the unsafe conditions and labor violations that colleagues at schools such as this one have to endure due to lack of union representation and contract rights.

CBS4 News has been told one teacher has already resigned, but its not clear if it was in direct result of this policy.

In the meantime, teachers are concerned and so are medical experts, like FIUs infectious disease specialist Dr. Aileen Marty.

Marty said the Centners are promoting a debunked theory that states people who are vaccinated can spread a different type of disease to individuals standing near them.

It shows me that the author has a very primitive understanding of what a vaccine is and really no understanding of the scientific process, she said.

The email goes on to list many unknown variables for their decision and states:

Tens of thousands of women all over the world have recently been reporting adverse reproductive issues from being in close proximity with those who have received any one of the COVID-19 injections.

They also claim, No one knows exactly what may be causing these irregularities, but it appears that those who have received the injections may be transmitting something from their bodies to those with whom they come in contact.

Their email cites no scientific evidence or authority for this.

Marty told CBS4 that this is heartbreaking, and she is devastated because she says there is no basis in science for any of the misinformation that the school is putting out. She also noted that its particularly egregious, that you have a school designed to educate kids promoting this sort of false and misleading information about the vaccine.

CBS4 News reached out requesting an interview with someone from the school, but they simply sent an email reiterating what was in the email sent to the parents, which stated:

Were doing what we think is in the best interest of the children because children shouldnt be around teachers who are vaccinated.

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Miami school won't employ COVID-19 vaccinated employees, citing debunked theory - Wink News

Shoshannah Buxbaum, 30, said she felt pain in every single one of her joints the day after she got her second dose of the Pfizer COVID-19 vaccine.

"I'm sitting at the kitchen table with my mom and I just can't keep my head up," she told Insider about 22 hours after her shot.

Buxbaum also felt nauseous and tired the day after her second dose, and a lifetime of chronic hip pain may have exacerbated her joint pain post-vaccine. She told Insider she took to her bed for the rest of the day. By the next morning, she had fully recovered.

Young adults have gotten a reputation for being relatively symptom-less throughout the pandemic. They're more likely to have asymptomatic infections, which can drive case rates up for the rest of the population.

But when it comes to vaccine reactions, young people are just as likely if not more so to experience side effects compared to older adults. Insider spoke with people in their teens, 20s and 30s about how they felt post-vaccine.

People in their 20s and 30s may have more intenseside effects compared to older folks. That's because our immune systems gradually deteriorate with age, experts previously told Insider.

"Younger individuals have a much more vigorous immune response, so it should make sense that they would also have more side effects," Dr. Vivek Cherian, an internal-medicine physician in Baltimore, told Insider's Aria Bendix.

However, that's not to say the severity of your side effects correlates with the strength of your immune system. Elderly people have reported flu-like reactions similar to those experienced by young adults, and many young people only have mild arm pain after their shots.

Kelly Carton, 27, experienced a couple days of arm tenderness after her first Pfizer shot. Carton's reaction is typical of what many people experience after their first dose of the Pfizer and Moderna COVID-19 vaccines.

Rachel Flannery, also 27, experienced a similar reaction: two days of a sore arm after her first Pfizer shot.

Rachel Greenspan, a 24-year-old digital culture reporter at Insider, got Moderna's COVID-19 vaccine. After her first shot, Greenspan said, she had a bit of nausea and fatigue along with arm pain.

Mia de Graaf, 29, senior health editor at Insider, barely experienced any side effects until a week after her first Moderna shot, when she got so-called "Moderna arm" a slightly hot, red patch at the injection site, which faded within two days.

Most people will experience a more severe reaction after the second shot in Pfizer trials, about twice as many participants developed chills and joint pain after their second dose than after their first. In Moderna's trial, roughly five times as many participants developed chills after their second dose as did after their first.

The day after Flannery's second Pfizer shot, she had aches and pains. She told Insider she had "terrible joint and bone pain, dizziness, headache, and arm pain" that came on about 16 hours after the injection.

Greenspan felt like "every muscle in my body was sore" about three hours after getting her second Moderna shot. Twelve hours after the injection, she woke up with a fever, chills, nausea, and a pounding headache none of which surprised her after hearing about reactions her friends had.

But she was caught off guard when she vomited the next morning.

"That's when I knew I needed the day off," she said.

Some people who got the single-dose Johnson & Johnson vaccine reported reactions after the sole shot.

Christian Mendonca, 34, previously told Insiderhe felt tired, cold, and ran a fever for 12 hours after getting his J&J vaccine.

Manny Fidel, 29, a columnist and editor at Insider, also felt feverish the night of his J&J shot, although he didn't check his temperature. He said he started feeling ill around 7pm and was bedridden for 18 hours with aches, chills, nausea, and a racing heart rate.

Chloe Kathuria, 18, told Insider she had a particularly unpleasant reaction to the J&J shot. She was up all night feeling freezing cold, and her shivers made her muscle aches even worse. She ran a fever for two days, but the soreness in her arm and body lasted a week,

Kathuria, like many others who experience side effects, took a day off from class after getting her shot. Her reaction was on the more severe end of the spectrum but getting vaccinated was still worth it.

"Two days of a fever is better than having the coronavirus and being hospitalized," she told Insider.

While Kathuria didn't expect to feel so ill after her shot, others braced themselves for side effects. Jes Adams, 35, previously told Insider she has some preexisting medical conditions and a history of reacting strongly to vaccinations.

Adams said she spent much of the day after her second Moderna shot bedridden with dizziness and vomiting. Luckily, she had planned ahead to take the day off and recovered quickly.

See the rest here:

The COVID-19 vaccine side effects to expect if you're in your 20s or 30s - Business Insider

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Nearly 13% of Nevadans have missed their second COVID-19 vaccine dose - FOX5 Las Vegas