Category: Covid-19

Due to a significant drop in demand for COVID-19 vaccines, the County is phasing out some of its vaccination sites, but the push to vaccinate San Diegans continues.

Some County vaccination sites have closed or will be closing at the end of this month; however, people who have not been vaccinated still have plenty of options to do so.

As expected, demand for COVID-19 vaccines has waned significantly, said Wilma Wooten, M.D., M.P.H., County public health officer. While we have to phase out some vaccination clinics, San Diegans still have plenty of places to get vaccinated to protect themselves and others. Throughout the pandemic, the County has focused on equity and has been reaching out to communities and populations that have vaccine hesitancy.

The County has reached the federal goal to vaccinate70% of San Diego County residents 12 and older, or 1,961807 people, with at least one dose.

Overall, more than 2.16 million San Diegans have received at least one COVID-19 vaccine and more than 1.83 million are fully vaccinated.

San Diegans are encouraged to continue getting vaccinated to prevent getting and passing the COVID-19 virus to others.

Vaccinations continue to be available at more than 400 locations, including doctors offices, retail pharmacies and County clinics throughout the region. Some vaccination sites will continue to offer extended hours to make it easier for San Diegans to get immunized.

The more people who get vaccinated, the better chance we have at ending this pandemic locally, Wooten added.

In addition to existing COVID-19 vaccination clinics, County partners like local municipalities, Champions for Health, UC San Diego Health, San Diego American Indian Health Center and the San Diego Black Nurses Association will be handling requests for mobile vaccination events. Organizations wishing to host a vaccination event can submit a request.

No-cost COVID-19 testing sites remain operational around the County. For a complete list of County testing and vaccination locations and more vaccine information, visit coronavirus-sd.com.

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County COVID-19 Vaccination Transitioning to Public Health Sites - countynewscenter.com

Objective To estimate changes in life expectancy in 2010-18 and during the covid-19 pandemic in 2020 across population groups in the United States and to compare outcomes with peer nations.

Design Simulations of provisional mortality data.

Setting US and 16 other high income countries in 2010-18 and 2020, by sex, including an analysis of US outcomes by race and ethnicity.

Population Data for the US and for 16 other high income countries from the National Center for Health Statistics and the Human Mortality Database, respectively.

Main outcome measures Life expectancy at birth, and at ages 25 and 65, by sex, and, in the US only, by race and ethnicity. Analysis excluded 2019 because life table data were not available for many peer countries. Life expectancy in 2020 was estimated by simulating life tables from estimated age specific mortality rates in 2020 and allowing for 10% random error. Estimates for 2020 are reported as medians with fifth and 95th centiles.

Results Between 2010 and 2018, the gap in life expectancy between the US and the peer country average increased from 1.88 years (78.66 v 80.54 years, respectively) to 3.05 years (78.74 v 81.78 years). Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap to 4.69 years. Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. In Hispanic and non-Hispanic Black populations, reductions in life expectancy were 18 and 15 times the average in peer countries, respectively. Progress since 2010 in reducing the gap in life expectancy in the US between Black and White people was erased in 2018-20; life expectancy in Black men reached its lowest level since 1998 (67.73 years), and the longstanding Hispanic life expectancy advantage almost disappeared.

Conclusions The US had a much larger decrease in life expectancy between 2018 and 2020 than other high income nations, with pronounced losses among the Hispanic and non-Hispanic Black populations. A longstanding and widening US health disadvantage, high death rates in 2020, and continued inequitable effects on racial and ethnic minority groups are likely the products of longstanding policy choices and systemic racism.

In 2020, covid-19 became the third leading cause of death in the United States1 and was thus expected to substantially lower life expectancy for that year (box 1). The US had more deaths from covid-19 than any other country in the world and among the highest per capita mortality rates.5 This surge in deaths prompted speculation that the US would have a larger decrease in life expectancy in 2020 than peer nations, but empirical evidence has not been published. Americans entered the pandemic at a distinct disadvantage relative to other high income peer nations: improvements in overall life expectancy have not kept pace with those in peer countries since the 1980s,6 and in 2011, life expectancy in the US plateaued and then decreased for three consecutive years, further widening the gap in mortality with peer nations.7

Life expectancy is a widely used statistic for summarizing a populations mortality rates at a given time.2 It reflects how long a group of people can expect to live were they to experience at each age the prevailing age specific mortality rates of that year.3 Estimates of life expectancy are sometimes misunderstood. We cannot know the future age specific mortality rates for people born or living today, but we do know the current rates. Computing life expectancy (at birth, or at ages 25 or 65) based on these rates is valuable for understanding and comparing a countrys mortality profile over time or across places at a given point in time. Estimates of life expectancy during the covid-19 pandemic, such as those reported here, can help clarify which people or places were most affected, but they do not predict how long a group of people will live. This study estimated life expectancy for 2020. Life expectancy for 2021 and subsequent years, and how quickly life expectancy will rebound, cannot be calculated until data for these years become available. Although life expectancy is expected to recover in time to levels before the pandemic, past pandemics have shown that survivors can be left with lifelong consequences, depending on their age and other socioeconomic circumstances.4

The effect of the pandemic on life expectancy extends beyond deaths attributed to covid-19.8 Studies have found an even larger number of excess deaths during the pandemic, inflated by undocumented deaths from covid-19 and by deaths from non-covid-19 causes resulting from disruptions by the pandemic (eg, reduced access to healthcare, economic pressures, and mental health crises).9101112 Some racial and ethnic populations and age groups have been disproportionately affected.131415 Research on how the pandemic has affected life expectancy is only just emerging.1617 Few studies have examined reductions in 2020 life expectancy across racial and ethnic groups, and none has compared the decline in the US with other countries.

We estimated life expectancy at birth and at ages 25 and 65, examining the US population (in aggregate and by sex, and by race and ethnicity) and the populations of 16 high income countries (in aggregate and by sex). Estimates of life expectancy for 2010-18 were calculated from official life tables and were modeled for 2020. Estimates for 2019 would have been preferable to determine the effect of the covid-19 pandemic but life table data were unavailable for many peer countries. Life expectancy in the US is estimated to have increased by only 0.1 years between 2018 and 2019,18 however, and therefore the changes seen in life expectancy between 2018 and 2020 are largely attributable to the events of 2020.

Data for peer countries did not include information on race or ethnicity. US data were examined for three racial and ethnic groups that constitute more than 90% of the total population: Hispanic, non-Hispanic Black, and non-Hispanic White populations. Although many US individuals self-identify as Latino or Latina, we used Hispanic to maintain consistency with data sources. White and Black populations in this study refer to people in these racial groups who do not identify as Hispanic or Latinx.19 Estimates for other important racial groups, such as Asian, Pacific Islander, and Native American (American Indians and Alaskan Natives) could not be calculated because the National Center for Health Statistics does not provide official life tables for these populations.

US life tables for 2010-18 were obtained from the National Center for Health Statistics.202122232425262728 Weekly age specific death counts for all men and women in the US and for Black, White, and Hispanic men and women in the US for the years 2018 and 2020 were obtained from the National Center for Health Statistics AH (ad hoc) Excess Deaths by Sex, Age, and Race file.29 Mid-year population estimates by age, sex, and race and ethnicity for men and women in the US for 2015-19 were obtained from the US Census Bureau.30 Population counts for 2020 were estimated from age specific trends in US population estimates for 2015-19. The National Center for Health Statistics and US Census data were merged at ages 0-14, 15-19, . . . 80-84, 85 to calculate age specific death rates (mx) for 2018 and 2020 for men and women in the US in aggregate and by race and ethnicity.

Peer countries included 16 high income democracies with adequate data for analysis: Austria, Belgium, Denmark, Finland, France, Israel, Netherlands, New Zealand, Norway, South Korea, Portugal, Spain, Sweden, Switzerland, Taiwan, and the United Kingdom. Taiwan was treated as a country for our analysis although many countries do not recognize it as an independent country. Australia, Canada, Germany, Italy, and Japan were not included because of incomplete mortality data. To estimate life expectancy in these countries, five year abridged life tables for male and female populations of the peer countries were obtained for 2010-18 from the Human Mortality Database31 (direct sources3233 were used for Israel and New Zealand because current data were lacking in the Human Mortality Database). Weekly death counts in 2018 and 2020 by country for ages 0-14, 15-64, 65-74, 75-84, and 85 were obtained from the Human Mortality Database Short Term Mortality Fluctuations files.

To calculate life expectancy estimates for 2020, we used data from the National Center for Health Statistics and US Census Bureau to estimate rate ratios between the age specific mortality rates of 2018 (2018 mx) and 2020 (2020 mx) for US populations. For populations in peer countries, values for 2018 mx and 2020 mx, taken from data in the Human Mortality Database Short Term Mortality Fluctuations files, were estimated for ages 0-14, 15-64, 65-74, 75-84, and 85. Age specific mortality rate ratios between 2020 mx and 2018 mx data in the Human Mortality Database Short Term Mortality Fluctuations were estimated for each peer country in aggregate and by sex. Age specific probabilities of death in 2020 (qx), for ages 0-1, 1-4, 5-9, . . . 90-94, 95-99, 100, were estimated separately for men and women in the US and for men and women in specific race and ethnic group populations by multiplying 2018 mx28 by the 2020-18 rate ratio estimates derived from data from the National Center for Health Statistics and US Census Bureau, and calculating qx=(mxn)/(1+mxax), where qx is the age specific probability of death, mx is the age specific mortality rate, n is the width of the age interval, and ax is the age specific person years lived by the deceased.34 Probabilities of death for each peer country in 2020 were estimated by multiplying qx in the Human Mortality Database life tables by the 2020-18 rate ratios in the Human Mortality Database Short Term Mortality Fluctuations data.

We used Python (version 3.9.1) to simulate 50000 five year abridged 2020 life tables for each US subpopulation, with the estimated qx for 2020, ax derived from 2018 official life tables,28 and random 10% error in the qx estimate. For each peer country population, 50000 five year abridged 2020 life tables were simulated with the estimated 2020 qx and 2018 ax values in the Human Mortality Database 2018 life tables, and random 10% error in the qx estimate. We present median estimates of 2020 life expectancy at birth and at ages 25 and 65; fifth and 95th centiles are presented in the tables. The supplementary material provides further details on methods.

Involving patients or the public in the design, conduct, reporting, or dissemination plans of our research was not possible because of the urgency of the analysis and its focus on decedents.

After a small increase of 0.08 years between 2010 and 2018, life expectancy in the US at birth decreased by an estimated 1.87 years (or 2.4%) between 2018 and 2020 (fig 1 and supplementary fig 1). The proportional decrease in life expectancy at ages 25 and 65 was even greater (3.4% and 5.7%, respectively) (table 1). US men had a larger decrease in overall life expectancy than women, in both absolute (2.16 years v 1.50 years) and relative (2.8% v 1.8%) terms.

Life expectancy at birth in the United States, by race and ethnicity, and in peer countries, for years 2010-18 and 2020. Data obtained from the National Center for Health Statistics, US Census Bureau, and Human Mortality Database. Data for 2019 could not be calculated because life table data were unavailable for many peer countries

Life expectancy in the United States at birth, and at ages 25 and 65, by sex, for years 2010, 2018, and 2020

Between 2018 and 2020, life expectancy in the US decreased disproportionately among Black and Hispanic populations (table 2). In the Black population, life expectancy decreased by 3.25 years (4.4%), 2.4 times the decrease in the White population (1.36 years, 1.7%), with larger reductions in men (3.56 years, 5.0%) than women (2.65 years, 3.4%). In 2020, life expectancy in Black men was only 67.73 years. The decrease in life expectancy among Hispanic individuals was even larger (3.88 years, 4.7%), 2.9 times the decrease in White people, with larger reductions in men (4.58 years, 5.8%) than women (2.94 years, 3.5%).

Life expectancy in the United States at birth, and at ages 25 and 65, by sex, race, and ethnicity, for years 2010, 2018, and 2020

The disproportionate decrease in life expectancy in the US Black population during 2018-20 reversed years of progress in reducing the gap in mortality between Black and White populations. Although the gap in life expectancy between Black and White populations decreased from 4.02 years in 2010 to 3.54 years in 2014, the gap increased to 3.92 years in 2018, and to 5.81 years in 2020. Historically, the US Hispanic population has had a longer life expectancy than the White population.3536 Although that advantage widened between 2010 and 2017, from 2.91 years to 3.30 years, the gap decreased to 3.20 years in 2018 and then decreased sharply to 0.68 years in 2020 (table 2); the advantage reversed entirely in Hispanic men (from 2.88 years in 2018 to 0.20 years in 2020).

Figure 1 presents estimates of life expectancy for 2010-18 and 2020 for the US and the average for 16 high income countries. The US began the decade with a 1.88 year deficit in life expectancy relative to peer countries. This gap increased over the decade, reaching 3.05 years in 2018. Between 2018 and 2020, the gap widened substantially to 4.69 years: the 1.87 year decrease in life expectancy in the US was 8.5 times the average decrease in peer countries (0.22 years). Table 3 presents the estimates of life expectancy for peer countries at birth, and at ages 25 and 65 in 2010, 2018, and 2020.

Average life expectancy in peer countries at birth, and at ages 25 and 65, by sex, for years 2010, 2018, and 2020

Changes in life expectancy varied substantially across peer countries. Six countries (Denmark, Finland, New Zealand, Norway, South Korea, and Taiwan) had increases in life expectancy between 2018 and 2020. Among the other 10 peer countries, decreases in life expectancy ranged from 0.12 years in Sweden to 1.09 years in Spain, but none approached the 1.87 year loss seen in the US.

Figure 2 (and supplementary fig 2) contrasts changes in life expectancy in the US in 2010-18 and 2018-20 with those of peer countries, based on sex, and on race and ethnicity. Figure 3 (and supplementary fig 3) shows how these changes contributed to the gap between the US and peer countries. For example, figure 2 shows that life expectancy for US women increased by 0.21 years in 2010-18, but because life expectancy in women in the peer countries increased even more (0.98 years), the gap increased by 0.77 years (fig 3). The gap increased by another 1.36 years during 2018-20, largely because of the pandemic. Overall, the gap between the US and peer countries for women increased by 2.14 years (fig 3), from 1.97 years in 2010 (81.04 v 83.01 years) to 4.11 years (79.75 v 83.86 years) in 2020 (table 1 and table 3). The gap between the US and peer countries for men increased even more (3.37 years) (fig 3). In 2020, life expectancy for US men was 5.27 years (74.06 v 79.33 years) shorter than the peer country average for men.

Changes in life expectancy at birth in US populations and peer country average, for years 2010-18 and 2018-20. For example, life expectancy in the US for women increased by 0.21 years in 2010-18 and then decreased by 1.50 years in 2018-20. Data derived from the National Center for Health Statistics, US Census Bureau, and Human Mortality Database

Increasing gap in life expectancy between the United States and peer country average, for years 2010-18 and 2018-20. For example, the gap between life expectancy for men in the US men and the average life expectancy for men in peer countries increased by 1.50 years in 2010-18 and by a further 1.87 years in 2018-20. Data derived from the National Center for Health Statistics, US Census Bureau, and Human Mortality Database. Sums might differ because of rounding

The demographic composition and ethnic inequities of peer countries varied considerably, making it difficult to identify analogous reference populations to compare with the US racial and ethnic groups. But the peer country average provides a useful benchmark for showing the disproportionately large decreases in life expectancy in Black and Hispanic populations in the US (fig 1,fig 2, and fig 3). For example, among Black men and women in the US, the decrease in life expectancy between 2018 and 2020 was 12.3 times and 20.3 times greater, respectively, than the average decrease for men and women in peer countries. The corresponding values were even larger for the Hispanic population in the US, with estimated declines in life expectancy 15.9 times and 22.5 times higher among men and women, respectively, compared with their counterparts in peer countries.

Long before covid-19, the US was at a disadvantage relative to other high income nations in terms of health and survival.63738394041 In 2013, a report by the National Research Council and Institute of Medicine showed that from the 1980s, the US had higher rates of morbidity and mortality for multiple conditions relative to other high income countries.6 A recent report by the National Academies of Sciences, Engineering, and Medicine found that this gap widened further through 2017 and that the greatest relative increase in mortality in the US occurred in young and middle aged adults (aged 25-64). Increased mortality in this age group was largely because of deaths from drug use, suicide, cardiometabolic diseases, and other chronic illnesses and injuries.42 Between 2014 and 2017, whereas life expectancy continued to increase in other countries, life expectancy in the US decreased by 0.3 years,7 a three year decline that generated considerable public concern43 but is now overshadowed by the large 2020 declines reported here. Even countries with much lower per capita incomes outperform the US.44454647 According to data for 36 member countries of the Organization for Economic Cooperation and Development (OECD), the gap in life expectancy between the US and the OECD average increased from 0.9 to 2.2 years between 2010 and 2017.4849

This study shows that the gap in life expectancy in the US increased markedly between 2018 and 2020. The decrease in life expectancy in the US was 8.5 times the average loss seen in 16 high income peer nations and the largest decrease since 1943 during the second world war.50 The conditions that produced a US health disadvantage before the arrival of covid-19 are still in place, but the predominant cause for this large decline was the covid-19 pandemic: in 2020, all cause mortality in the US increased by 23%.12

We found large differences in the reductions in life expectancy during the covid-19 pandemic based on race and ethnicity. Decreases in life expectancy among Black and Hispanic men and women were about two to three times greater than in White people, and far larger than those in peer countries. Decreases in life expectancy of US Black and Hispanic men were 12-16 times greater than those in men from other high income countries. Corresponding decreases in life expectancy among US Black and Hispanic women were 20-23 times greater than those for women in peer countries. Progress made between 2010 and 2018 in reducing the gap in life expectancy between Black and White populations in the US was erased between 2018 and 2020. Life expectancy in Black men fell to 67.73 years, a level not seen since 1998.51 The US Hispanic life expectancy advantage was erased in men and nearly disappeared in women.

Our study estimated the effect of the covid-19 pandemic on life expectancy in the US for 2020, and compared life expectancy in the US with other high income countries. The study used a new method for these calculations, detailed in the supplementary appendix. The study also had several limitations. First, life expectancies for 2020 were simulated with preliminary mortality data, which are subject to errors (eg, undercounting, and mismatching between death and population counts) and often vary across racial and ethnic populations and countries. Second, the 2020 qx values used to generate life tables for peer populations could have been biased by the wide age ranges used in the Human Mortality Database Short Term Mortality Fluctuations files. Third, definitions for peer countries vary; our list differs from the 16 high income countries used in several cross national comparisons.63738 Five large high income democracies (Australia, Canada, Germany, Italy, and Japan) were excluded because of incomplete data. Fourth, we compared life expectancy in 2020 with 2018 values; the effect of the pandemic would be better determined by comparisons with life expectancy in 2019, but data for many peer countries were unavailable for this calculation Fifth, for reasons explained in the supplementary material, data on race and ethnicity for the US population and for 2020 deaths were incomplete,52 likely underestimating racial inequalities. Reports suggest that covid-19 and all cause mortality in 2020 were very high in American Indian and Alaskan Native populations.53 Finally, we used the average for peer countries; values for individual countries varied.

This study aligns closely with previous research. An analysis of deaths between January and June 2020 found that US life expectancy decreased by 1.0 years between 2019 and 2020, including reductions of 0.8 years in White people and reductions of 2.7 years and 1.9 years in Black and Hispanic individuals, respectively.17 Andrasfay and Goldman estimated that life expectancy from January to mid-October 2020 was 1.1 years below expected values, including a reduction of 0.7 years in White populations and reductions of 2.1 and 3.1 years in Black and Hispanic populations, respectively.16 Neither study examined changes in life expectancy in other countries or estimated life expectancy in the US for the whole of 2020.

The decreases in life expectancy that we found and the excess deaths reported in several studies of 2020 death counts9101112 could reflect the combined effects of deaths attributed to covid-19, deaths where SARS Co-V-2 infection was unrecognized or undocumented, and deaths from non-covid-19 health conditions, exacerbated by limited access to healthcare and by widespread social and economic disruptions produced by the pandemic (eg, unemployment, food insecurity, and homelessness).854 These adverse outcomes are products of national, state, and local policy decisions, and actions and inactions that influenced viral transmission and management of the pandemic.555657585960 These policies span healthcare, public health, employment, education, and social protection systems. Many organizations are tracking these decisions internationally for ongoing research and development.61626364

The large number of covid-19 deaths in the US reflects not only the countrys policy choices and mishandling of the pandemic555657585960 but also deeply rooted factors that have put the country at a health disadvantage for decades.676566 For much of the public, it was the pandemic itself that drew attention to these longstanding conditions, including major deficiencies in the US healthcare and public health systems, widening social and economic inequality, and stark inequities and injustices experienced by Black, Hispanic, Asian, and Indigenous populations and other systematically marginalized and excluded groups. Many studies have reported that rates of covid-19 infections, admissions to hospital, and deaths are substantially higher in Black and Hispanic populations compared with White people, because of greater exposure to the virus, a higher prevalence of comorbid conditions (eg, diabetes), and reduced access to healthcare and other protective resources.6768

Evidence of disproportionate reductions in life expectancy among racial and ethnic groups in the US, such as the disparities reported here, draws attention to the root causes of racial inequities in health, wealth, and wellbeing. Foremost among these root causes is systemic racism; extensive research has shown that systems of power in the US structure opportunity and assign value in ways that unfairly disadvantage Black, Hispanic, Asian, and Indigenous populations, and unfairly advantage White people.69707172737475 Many of the same factors placed these populations at greater risk from covid-19.1314157677787980 The higher prevalence of comorbid conditions in many racial or marginalized groups is a reflection of unequal access to the social determinants of health (eg, education, income, and justice) and not their race, ethnicity, or other socially determined constructs. Low income communities and women have also been disproportionately affected by the social, familial, and economic disruptions of the pandemic.8182 Reduced access to covid-19 vaccines, and vaccine hesitancy rooted in a communitys distrust of systems that have mistreated them, might exacerbate these disparities. Structural factors affect not only Black and Hispanic populations but other marginalized people and places. American Indians and Alaskan Natives, for example, have some of the worst health outcomes of any group in the US, but data limitations precluded separate calculations for these important populations.

The mortality outcomes examined in this study, in the research literature, and in the daily news represent only part of the burden of covid-19; for every death, a larger number of infected individuals experience acute illness, and many face long term health and life complications.83 Whether some of these long term complications will affect how quickly life expectancy in the US will rebound in the coming years is unclear. Morbidity and mortality during the pandemic have wider effects on families, neighborhoods, and communities. One study estimated that each death leaves behind an average of nine bereaved family members.84 The pandemic will have short and long term effects on the social determinants of health, changing living conditions in many communities, and altering life course trajectories across age groups. Fully understanding the health consequences of these changes poses a daunting but important challenge for future research.

Because of systemic factors in the United States, the gap between life expectancy in the US and other high income countries has been widening for decades

In 2020, the US had more deaths from the covid-19 pandemic than any other country, but no study has quantified how the years large number of deaths affected life expectancy in the US or the gap with peer countries

Between 2018 and 2020, largely because of the covid-19 pandemic, life expectancy in the US decreased by 1.87 years, 8.5 times the average decrease in peer countries, widening the gap in life expectancy with peer countries to 4.69 years

In the US, decreases in life expectancy in Hispanic and non-Hispanic Black people were about two to three times greater than in the non-Hispanic White population, reversing years of progress in reducing racial and ethnic disparities, and lowering the life expectancy of Black men to 67.73 years, a level not seen since 1998

Ethical approval: Not required.

Data sharing: Requests for additional data and analytic scripts used in this study should be emailed to RKM (Ryan.Masters@colorado.edu).

We thank Steven Martin, Urban Institute, for reviewing our methodology; Cassandra Ellison, art director for the Virginia Commonwealth University Center on Society and Health, for her assistance with graphic design; and Catherine Talbot, University of Colorado Boulder, for her advice with Python simulations. These individuals received no compensation beyond their salaries.

Contributors: SHW led the production of this manuscript and had primary responsibility for the composition. He is guarantor. RKM contributed revisions and had primary responsibility for data acquisition and analysis, the modeling results that form the basis for this study, and production of the supplementary material. LYA contributed revisions and had primary responsibility for dealing with the studys policy implications in the discussion section. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Funding: SHW received partial funding from grant UL1TR002649 from the National Center for Advancing Translational Sciences. RKM received support from the University of Colorado Population Center grant from the Eunice Kennedy Shriver Institute of Child Health and Human Development (CUPC project 2P2CHD066613-06). There was no specific funding for this study.

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

The lead author (SHW) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

Dissemination to participants and related patient and public communities: Print, broadcast, and social medial will be used to disseminate the results of this study to journalists and the public, and summaries will be shared with policy makers, social justice organizations, and other relevant stakeholders.

Provenance and peer review: Not commissioned; externally peer reviewed.

Woolf SH, Aron L, eds. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Panel on Understanding Cross-National Health Differences Among High-Income Countries. National Research Council, Committee on Population, Division of Behavioral and Social Sciences and Education, and Board on Population Health and Public Health Practice, Institute of Medicine. National Academies Press, 2013.

Rossen LM, Branum AM, Ahmad FB, Sutton P, Anderson RN. Excess deaths associated with COVID-19, by age and race and ethnicity. United States, January 26-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1522-27.

Arias E, Tejada-Vera B, Ahmad F. Provisional life expectancy estimates for January through June, 2020. Vital Statistics Rapid Release; no 10. Hyattsville, MD: National Center for Health Statistics. 2021. doi:10.15620/cdc:100392.

Arias E. United States life tables, 2002. National Vital Statistics Reports; vol 53 no 6. National Center for Health Statistics, 2004; volume 53, No 6.

Council on Foreign Relations. Improving Pandemic Preparedness: Lessons From COVID-19. Independent Task Force Report No 78. Council on Foreign Relations, 2020.

Preston S, Vierboom Y. Why do Americans die earlier than Europeans? The Guardian, May 4 2021.

Original post:

Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional...

While COVID-19 restrictions are being eased across the United States, PGA Tour players who travel to The Open in England next month will face protocols and procedures more strict than any they have seen in months.

According to a "Player Information Update'' sent this week and obtained by ESPN, The Open at Royal St. George's in Sandwich, England, will "operate under strict government oversight from the UK government,'' according to Martin Slumbers, CEO of the R&A, which runs The Open.

The tournament begins July 15.

Among other things, players will not be allowed to share accommodations and will be required to undergo COVID-19 testing, regardless of vaccination status. They will not be allowed to visit restaurants, pubs or grocery stores -- all of which have been allowed for months at PGA Tour events in the United States.

And yet, the tournament is being permitted to have up to 32,000 spectators per day at the venue in the southeastern part of the country. Although exact numbers were not reported at last month's PGA Championship at Kiawah Island, South Carolina, the spectator capacity being allowed at The Open is likely the largest of any worldwide golf event since the start of the coronavirus pandemic.

As the word has sunk in with the players, many are learning that housing accommodations they had secured previously will not be suitable for The Open. According to the information update, they will be able to choose from a list of hotels provided by the R&A, or they can book their own private residence, but only for use by the player and team and with a maximum of four people.

"Please be aware that the UK has strict contact tracing laws and our ability to stage the Championship relies on persons not creating contacts other than their own player support team group,'' the update said.

Each player is permitted to bring one caddie plus two support team members. The latter can be a coach, manager, medical support or translator. Players can also choose to allow one family member to attend, but that person must already be in the U.K., have completed any quarantine requirements and must stay in the same accommodation as the player.

At present, anyone traveling to England from the United States must be tested prior to departure and quarantine for 10 days upon arrival. The quarantine is waived after five days with a negative COVID-19 test. The four people including the player are exempt from the quarantine criteria.

"All accredited players, caddies and player support team members including family members will be subject to strict 'inner bubble' restrictions for the duration of their time at the Championship and must not mix with members of the general public in restaurants, supermarkets or other public areas,'' the update said. "No one outside the accommodation buddy group is permitted to visit others in self-catering/private accommodation. This would be seen as a breach of the COVID-19 protocols and could lead to withdrawal from the Championship.''

Players are also subject to removal from the tournament if they are deemed to have been in contact with someone who has tested positive for COVID-19. Unlike the PGA Tour, which requires daily testing of a person who is deemed to be a contact, the R&A can disqualify such a player without a positive test.

One player agent, who asked not to be identified, told ESPN: "No pubs, no restaurants, no grocery stores and no walking to the course. Crazy! Also, a player cannot go to another's houses for dinner. We will essentially eat all our meals at the course or have groceries delivered.''

An anonymous player told Golfweek.com: "I'm going to go because it's the British Open. But I certainly thought about not going. I just can't believe with the numerous examples of successfully run, safely held tournaments and majors here that they can't figure out a better situation.

"If someone on your plane tests positive on the way to the British and is sitting anywhere close to you, you're out, no questions asked, no matter if you're vaccinated. It's aggravating that they deem the tournament safe enough for 32,000 fans a day to attend but won't let a player's wife or children travel and watch the tournament, nor will they even let players visit a restaurant without threat of disqualification."

The European Tour has been operating under similar restrictions since its return to action last July. The PGA Tour has gradually lifted various protocols throughout the pandemic. In April, the tour told its membership that players would no longer need to undergo weekly COVID-19 testing if they were fully vaccinated. Contact protocols would also be waived for such players.

The U.K. government recently extended its mask and distancing restrictions until July 19 out of fear for the spread of the Delta variant of COVID-19 that was first detected in India. The United States is on the country's Amber list for travel, which requires testing and quarantine.

Pete Cowen, a U.K.-based instructor who works with several players, including Rory McIlroy, had planned to share a large RV with several caddies near the driving range, he told the Telegraph newspaper in the U.K. Those plans are now off because of the restrictions.

"It wasn't cheap, but it seemed the wisest option in the current climate,'' Cowen said. "But we've just found out that we are not allowed to stay together because it breaks the government protocols.''

Cowen later added: "There are going to be 32,000 fans allowed in every day and they're saying we can't stay in anything other than the dedicated hotels -- most of which are already sold out -- because we'd be mixing with the public. And we can't stay together, like we have on the PGA Tour for the last year.

"We have all been vaccinated and will have been tested before we are allowed in. This 'bubble' we have created between ourselves has produced no problems at all.

"It makes no sense at all when there will be 60,000 at Wembley [for soccer], 140,000 at Silverstone [racetrack] and all those at Wimbledon on the weekend before -- sitting next to each other. I suppose I should be grateful I am going at all, as initially the wording of the [regulations] made me believe instructors would be banned."

The R&A said in its update that the restrictions are required by the U.K. government.

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Golfers to face strict COVID-19 protocols at The Open - ESPN

How to get a COVID-19 test to return to the US from France The Points Guy

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My experience getting a COVID-19 test in France - The Points Guy

Midway through Americas first mass-immunization campaign against the coronavirus, experts are already girding themselves for the next. The speedy rollout of wildly effective shots in countries such as the United States, where more than half the population has received at least one dose of a COVID-19 vaccine, has shown remarkable progressfinally, slowly, steadily beating the coronavirus back. But as people inch toward something tantalizingly resembling pre-pandemic life, a cloud hangs over our transcendent summer of change: the specter of vaccinefailure. We spent months building up shields against the virus, and we still dont know how long we can expect that protection to last.

To keep our bodies from slipping back toward our immunological square one, where the virus could pummel the population again, researchers are looking to vaccine boostersanother round of shots that will buoy our defenses. Around the world, scientists have already begun to dole out these jabs on an experimental basis, tinkering with their ingredients, packaging, and dosing in the hope that theyll be ready long before theyre needed.

When exactly that will be, however, is well, complicated. Nearly all the experts I spoke with for this story said that the need for boosters is looking more and more likely, but no one knows for sure when theyll arrive, what the best ones will look like, or how often theyll be needed, assuming theyre part of our future at all. What underlies this uncertainty isnt scientific ignorance: We know the signs that will portend an ebb in vaccine protection, and were actively looking for them. But their timing could still surprise us. The immunization process is much less akin to erecting an impenetrable fortress than it is to prepping forgetful students for an exam full of unpredictable questions. We can cram with flash cards for weeks, but to some degree we just have to cross our fingers and hope were still well studied when the pop quiz arrives.

Read: Expect the unexpected from the Delta variant

That same brand of bet-hedging is unfolding on a global scale. Around the world, researchers and vaccine manufacturers have been, for months, preparing for what seems to be an inevitable end to our immunological dtente with the virus. But these experts are also playing a very hard and very necessary waiting game. The only way well really know the best approach to boosters is to allow the vaccines to show their weak points, then patch them as soon as they arise.

There are at least two major ways that COVID-19 vaccines could falter. The first might best be described as a memory lapse, and its a bit of a flub on the human side: Left to its own devices, the immune system slowly loses its intellectual grasp on the pathogen, and is much less prepared the next time it sees it. The second is a mismatch between what immune cells studied and what ended up on the final exam: a mutation in the coronavirus thatalters its appearanceso significantly that it becomes unrecognizable, even if immune memory of the vaccine remains intact. Designing and deploying boosters requires keeping tabs on these two fast-changing variables at once.

Memory lapses can, in theory, be easier to detect and repair: Researchers take blood samples from vaccinated people and track the levels ofdifferent immune actors, such as antibodies and T cells. If those levels start to dip below acrucial protective threshold, its time to offer a booster. This approach works well in certain boosting regimens, such as theHepatitis Bvaccine for health-care workers, But sussing out this so-called correlate of protection typically takes gobs and gobs of data. For many vaccines, even ones that have been in use for decades, such as themumps vaccine, those numbers still arent clear-cut. SARS-CoV-2s correlate remains elusive.

Read: Show your immune system some love

We do have, at least,hintsabout thelongevity of vaccine protection. Antibodies that recognize SARS-CoV-2 are known to stick around in high numbers forat least six monthsafter the first round of shots is administered. John Wherry, an immunologist at the University of Pennsylvania, told me that, based on the data hes seen, he suspects that antibody levels will hold their own for at least a couple ofyearsafter vaccination, though antibodiesrepresent just a sliverof the complex immune response to the coronavirus. There have also been encouragingly fewbreakthroughs, or infections in people who have beenfully vaccinated. An unexpected uptick in these cases would serve as a canary in the coal mine for public-health experts, an indication that protection was ebbing, Sallie Permar, the chair of pediatrics at Weill Cornell Medicine and NewYork-Presbyterian Komansky Childrens Hospital, told me. (The chickenpox vaccine, originally conceived of as a one-and-done shot, became a two-doser in the U.S. in the 2000s tostamp out breakthroughs, including some potentially linked to waningantibody levels, in the years after kids got their first jab.)

Virus mutations can be even tougher to pin down and predict than immunological memory lapses. No known variants have yet managed to fully flummox ourcurrentrepertoireof vaccines, andnone yet seems to be disproportionately causing breakthroughs. But certain versions of the virusdoseem more resistant to vaccine-driven antibodies in the laba hint that the pathogen is becoming more and more unfamiliar to the immune cells that studied it. Some experts are worried that, if enough alterations occur, we may need another round of mass inoculations as early as this fall, possibly with an updated vaccine recipe that accommodates the viruss shape-shifting forma more labor-intensive approach than simply juicing people up with more of the OG inoculation.

In a way, our vaccines stellar track record is an ironichindranceto the process of improving them. Without more long-term data on their shortcomings, epidemiologists and vaccinologists are effectively trying to predict the weather in a climate theyve only just discovered. No universal litmus test exists for making decisions about boostersno single definition for what would constitute a concerning rise in cases, no flare that goes off when our immune cells are hit with microbial amnesia, no spoilers that warn of the coronaviruss next metamorphosis. Instead, the experts are left to determine their own benchmarks for boosters, by evaluating the available information on antibody levels, breakthroughs, variant surveillance, and how different versions of the virus fare in labs and animal models, all while being mindful of the pandemics progress on scales both local and global.

All of this intel then gets fed into a risk-benefit analysis, to determine whether the need for boosters outweighs any possible costs, which can span the medical to the economic, says Grace Lee, a pediatrician at Stanford University and a member of the CDCs Advisory Committee on Immunization Practices. Thats all before public-health officials have to coordinate the logistics of getting another round of vaccines into peoplea campaign that will inevitably reawaken the issues abouttrust, equity, and access still stymieing our current rollout. And even after boosters debut, agencies like the CDC mighttinker with the playbooksfor years or decades to get the scheduling just right. (The CDC did not answer questions about the nature of future boosting efforts, noting only that the need for and timing of COVID-19 booster doses have not been established.)

Even amid all this uncertainty, the road to boosting wont be a fumble in the dark. In the past year and a half, millions of SARS-CoV-2 genomes have been sequenced, helping researchers monitor the viruss every genetic change; other scientists are monitoring the vaccinated, in the hope of catching or even predicting the inflection point, when our immune protection against the virus might start to drop. By the time our first round of shots starts to lose its oomph, contingency plans will have long ago been set in motion.

Some companies and researchers have already started experimentally doling out additional jabs. Johnson & Johnson representatives told me that their single-dose vaccine is being tested as a two-doser, whileModernaandPfizerhave confirmed that theyre checking whetherthirdshots, some of which have been specially reformulated to fight worrisome variants, can better equip immune systems to tussle with new versions of the virus. The National Institutes of Healthrecently announceda clinical trial that willoffer a Moderna boosterto participants who were vaccinated three to five months prior. And researchers at Johns Hopkins are exploring whether certain immunocompromised peoplea groupat higher risk of not responding to standard-issue vaccinesmightbenefit from a third injection. These individuals and others with less exuberant immune systems, such as older people, might need boosters sooner than the rest of us, says Ali Ellebedy, an immunologist at Washington University in St. Louis.

Read: COVID-19 vaccines are entering uncharted immune territory

Several boosting trials will take amix-and-match approach, offering vaccines thatdiffer in formulationfrom the first COVID-19 shot people tooka Moderna boost for people who initially got Pfizer, for instance. If so-called heterologous boosting issafeand effective, future rounds of shots will be much easier to give: People wont have to scour their neighborhood for a company-specific vaccination clinicor waste time struggling to remember which shot they got months or years ago. Hybrid inoculations could evenimproveon the original plan, potentially by marshaling different branches of the immune system, as they have with vaccines against HIV, Ebola, and tuberculosis. Delivered in succession, different types of COVID-19 shots could, in theory, build a punchier and more cohesive response because of their diverse packagingand perhaps provide more comprehensive protection when it comes to variants, Srilatha Edupuganti, an infectious-disease physician and vaccinologist at the Emory Vaccine Center, one of the sites for the NIH trial, told me.

New vaccine recipes, which havent yet been cleared, could also play a role in future vaccination efforts. Some researchers arelooking outside the spike protein, to see whether they can build shots that contain more instructive bits of SARS-CoV-2 anatomy. A few are experimenting with delivering vaccines as oral drops or nasal sprays that might coax out an airway-specific immune response, to head off the coronavirus at its natural point of entry. This whole rigmarole will get easier if we eventually find SARS-CoV-2s elusive correlate of protection, which will probably involve aspecific kind of antibody: Instead of running long, expensive clinical trials to determine a vaccines efficacy, scientists can just check whether it marshals an immune response strong enough to match or exceed the threshold. Its what we dream about, Permar told me. Vaccines would be so much easier to develop and test. Theres even talk of developinguniversal vaccinesthat could accommodate a wide range of potential variants, perhaps cutting down on the amount of mutant-specific tinkering well need to do in the future, and the number of shots well need to give.

Boosting in perpetuity isnt an ideal option, if we can avoid it. For some shots, theseverity of side effectscan ratchet up with each additional dose. (Some evidenceexists that the mix-and-match approach might come with nastier side effects as well.) Vaccinating too often is also possible: At a certain point, cells will stop learning efficiently from the material vaccines provide, and essentially burn out from information overload, Wherry told me. Perhaps the heaviest immunization schedule well end up with is one thats already familiar: annual shots, like those we develop for the flu, each reformulated to tackle a slightly different set of strains. But many experts think thats not terribly likely. Flu viruses mutate faster than coronaviruses do, and hop between animals and humans much more frequently, giving them more opportunity to mutate.

The world is better served when were judicious with vaccines, after all, and inoculate as needed, no more, no less. A lot would feel wrong about lining people up for a second or third helping of a COVID-19 vaccine while billions around the world have yet to receive their first dose, Krutika Kuppalli, an infectious-disease physician at the Medical University of South Carolina, told me. Every unprotected person represents another potential depot for the virus to establish itself and mutate, and jump ahead of our vaccines once again. Getting more first shots into arms means slowing the viruss spread, and limiting its costume changes. It means, perhaps, delaying our need for boosters a little while longer.

This story was originally published by The Atlantic. Sign up for their newsletter.

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The Only Way We'll Know When We Need COVID-19 Boosters - Defense One

Houston Health Department hosting COVID-19 vaccine town hall in Sharpstown

June 24, 2021

HOUSTON- The Sharpstown community is invited to bring questions about the COVID-19 vaccine to an upcoming town hall meeting hosted by the Houston Health Department.

Take Your Best Shot: COVID-19 Vaccine Community Conversationtakes place June 29, 2021 from 6:30 to 7:30 p.m. at the Southwest Multi-Service Center, 6400 High Star Drive. Virtual participation is available atbit.ly/vaxsharpstown.

Health experts will be on hand to provide information about the safety and effectiveness of the vaccines, answer questions and concerns, and provide information aboutnearby free vaccination sites.

Participants can win one of five $50 restaurant gift cards.

The town hall is the first in a series the health department is hosting throughout Houston.

Find nearby free Houston Health Department-affiliated COVID-19 vaccination sites atHoustonHealth.orgor by calling 832-393-4220.

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Houston Health Department hosting COVID-19 vaccine town hall in Sharpstown - City of Houston

Inova Health, which operates five hospitals in Northern Virginia, will require its employees to be vaccinated against COVID-19 by Sept. 1.

"We believe this a necessary step in prioritizing team member and patient safety, which align in our core values," the health system said in a statement to NBCWashington. "We are committed to answering questions and educating team members about the safety, efficacy and benefits of the COVID-19 vaccine."

Inova employs about 18,000 team members who serve more than 2 million individuals annually through its network of hospitals, primary and specialty care practices, emergency and urgent care centers, outpatient services and destination institutes.

Read more from the original source:

Inova Health to require employees be vaccinated against COVID-19 - Inside NoVA

San Francisco Will Require Its Employees to Get COVID-19 Vaccine  SHRM

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San Francisco Will Require Its Employees to Get COVID-19 Vaccine - SHRM

People think that COVID is gone, perhaps naturally," said Dr. Janak Patel who supports the status share. "They don't know how much the role of vaccine has been."

GALVESTON COUNTY, Texas The Galveston County Health District is now sharing the vaccination status of people whove died from COVID-19.

The detail is added to a list of information like a persons age range, whether or not they had pre-existing conditions and the persons ethnicity and race.

Based on GCHD press releases and posts shared on their social media pages, it seems the first time the health district included vaccination information was three days ago.

On Facebook, the Galveston County Health District reported the June 9 death of an unvaccinated man between 41 and 51 years old who had preexisting donations conditions.

KHOU 11 was unable to reach anyone within the health district who could answer questions as to why the vaccination status is now listed among identifying information, but Dr. Janak Patel, who is the Director of Infection Control & Healthcare Epidemiology for UTMB, thinks sharing the detail is critical to getting more people vaccinated.

People think that COVID is gone, perhaps naturally. They don't know how much the role of vaccine has been in this entire battle against COVID, Dr. Patel said.

As more time passes, more research can be done to study the impact of each COVID-19 vaccine. The Associated Press reports that its journalists analyzed all publicly available data on COVID-19 for the month of May. The AP is reporting breakthrough COVID-19 infections of fully vaccinated people accounted for .1 percent COVID hospitalizations. Of the 18,000 COVID-19 deaths in May, the AP counted 150 people as fully vaccinated.

I think is a very important message. People should hear that that it is true. And that we can show it in our own community, Dr. Patel said.

According to the U.S. Census, more than 342,000 people live within Galveston County. According to the Texas Department of State Health Services, more than 144,000 Galveston County residents are fully vaccinated as of Thursday.

The Galveston County Health District confirms 86 breakthrough infection cases so far. COVID-19 vaccines are widely available across America for everyone 12 and up.

They are nearly 100 percent effective against severe disease and death, said CDC Director Rochelle Walensky during a press briefing on Tuesday. Meaning nearly every death due to COVID-19 is particularly tragic.

So to those who dont want to get a COVID-19 vaccine because they think there are enough medications and therapies to fight the disease, Dr. Patel said, despite all the advances we have made, it is not pleasant to be in a hospital with the infection. Yes, you might survive, but you may have significant problems while you're in the hospital. You may have complications. You may have lingering health problems for days to come.

Patel hopes to see more young adults get vaccinated. Galveston County Health Districts change in communication just might help.

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The vaccination status of people who die from COVID-19 in Galveston Co. is now being shared publicly - KHOU.com

Even as the COVID-19 pandemic continues to ravage parts of the world, the blame game is already well underway to pinpoint why it wasnt better contained. Throughout 2020 and up to the present day, hardly a single aspect of the pandemic responsewhether mask wearing, lockdowns, vaccine production, or school openingshas been free from politicization. Among the public and experts, debates have swirled around who made the most accurate guesses about the number of COVID-19 casualties or its impact on the stock market.

Meanwhile, scientists at the National Institutes of Health and National Institute of Allergy and Infectious Diseases (NIAID) were mapping viral proteins, Operation Warp Speed was disbursing funds to biotech companies to ramp up vaccine development, and a wide global public-private coalition was launching COVAX to ensure vaccine distribution to poorer nations. Other than NIAID director Anthony Fauci, few of those involved would be recognized by any member of the public or chattering class. But if and when COVID-19 is finally eradicated, well have these technocrats to thank.

Even as the COVID-19 pandemic continues to ravage parts of the world, the blame game is already well underway to pinpoint why it wasnt better contained. Throughout 2020 and up to the present day, hardly a single aspect of the pandemic responsewhether mask wearing, lockdowns, vaccine production, or school openingshas been free from politicization. Among the public and experts, debates have swirled around who made the most accurate guesses about the number of COVID-19 casualties or its impact on the stock market.

Meanwhile, scientists at the National Institutes of Health and National Institute of Allergy and Infectious Diseases (NIAID) were mapping viral proteins, Operation Warp Speed was disbursing funds to biotech companies to ramp up vaccine development, and a wide global public-private coalition was launching COVAX to ensure vaccine distribution to poorer nations. Other than NIAID director Anthony Fauci, few of those involved would be recognized by any member of the public or chattering class. But if and when COVID-19 is finally eradicated, well have these technocrats to thank.

In Asia, they already do. From Taiwan to South Korea to Singapore, doctors, engineers, and other professionals occupy the top rungs of elected office and functional agencies. In these countries, public administration is a vocation, and revolving doors between corporate and political life are minimal. Transparency is high and corruption is low. What differentiates all three Asian statesand others with ultra-low COVID-19 death ratesis they are highly technocratic.

In technocracies, competence, public spirit, and key performance indicators are more important than cults of personality or popularity contests. Populist dilettantes such as British Prime Minister Boris Johnson and former U.S. President Donald Trump mocked the experts on everything from Brexit to China tariffs to COVID-19, sacrificing public welfare for political gain. Their megalomaniacal hijacking of the state in times of crisis serves as a stark reminder that when its a matter of life and death, wed better trust the technocrats.

COVID-19 isnt the only hazard demonstrating that complex global challenges easily overwhelm most domestic political systems and international diplomatic mechanisms. Rising geopolitical tensions, the governance of frontier technologies like artificial intelligence, and climate change are other existential issues where global cooperation at the moment can best be described as kicking the can down the road. But crisis management is not the same as problem-solving. That requires a strong global application of the precautionary principle as well as the proactive steering of large-scale resources to solutions. If you want a better world for your children, dont hold your breath for global democratic deliberation.

There are numerous examples of 20th century interventions designed to prevent worst-case scenarios. In the latter years of World War II, then-U.S. President Franklin Roosevelt conceived of the Four Policemen to restrain military rearmament, a coalition that became embedded in the United Nations Security Council. Although the U.N. became a theater for Cold War grandstanding, it also served as a conduit for great-power dialogue. The establishment of the supranational European Union is another example of building institutions that overcompensate to prevent history from repeating itself.

Similar approaches have characterized the U.S. and U.N. response to major demographic risks. In the 1970s, fearing the security implications of a rapidly growing world population, the Ford administration began significant support for population planning policies, such as the mass distribution of contraception across the developing world. That represented a turning point in global fertility, contributing to the present plateau of the world population at almost 8 billion people rather than the 15 billion people feared at the time.

In recent decades, the precautionary principle has entered the formal and legal vernacular. In Germany, the Vorsorgeprinzip has been used to enforce strong environmental protections against pollutants. In the aftermath of the financial crisis, a slew of so-called macroprudential measures required banks to maintain higher capital adequacy ratios to guard against liquidity crises, signaling the rise of a new regulatory capitalism. And with the onset of COVID-19, smart countries moved rapidly to close borders and deploy mass testing and contact tracing. All such measures have been designed by experienced professionals, whether lawyers, engineers, doctors, or scientists.

Precautionary principle thinking gained prominence through the work of scholars like Arend Lijphart, the Dutch political scientist who sought to explain how fragile multiethnic and multilingual societies maintain stability, arguing leaders who foresaw undesirable outcomes would preemptively overcompensate through inclusive policymaking and power-sharing agreements. In the 1980s, political scientist Robert Axelrod coined the phrase shadow of the future in his seminal work The Evolution of Cooperation, using game theory tools to find alternative policies to repetitive confrontation. His contemporary, political scientist Robert Jervis, wrote the Lijphart Effect can help transform a dangerous situation into a safer one. Todays world is full of dangerous situations where shadow-of-the-future thinking should inspire preemptive overcompensation.

COVID-19 is a fine example. Risk philosopher Nassim Nicholas Taleb and his collaborators, complexity theorists Yaneer Bar-Yam and Joseph Norman, issued prescient early warnings in January 2020 arguing in favor of the precautionary principle owing to the interconnectedness of global epidemiological, social, and economic systems. Swedens Anders Tegnell, the countrys equivalent to Fauci, took the opposite approach, betting on a herd immunity that never arrived. Tegnell is, of course, an expert but also acted like a maverick rather than acting with the greatest protection of life in mind.

Global leaders have only begun to face the cascading spillover effects of COVID-19 in ways that massively compound existing crises. The International Monetary Fund (IMF) and World Bank have issued more than $2 trillion in emergency lending to cash-strapped governments. The United States, EU, China, and private creditors must consider major debt forgiveness and write-downs to prevent economic collapse in dozens of developing countries. Vaccine shortages and acute hunger have to be confronted through coalitions involving multilateral agencies like the World Food Program and philanthropic donors like the Bill and Melinda Gates Foundation. Business-as-usual, Band-Aid diplomacy wont cut it. Its time for big decisions and strong management, whether a sovereign debt resolution framework or a new Green Revolution.

The global monetary system is another arena ripe for preemptive action. The U.S. dollars hegemony is gradually eroding, but unlike previous great-power transitions, the Chinese renminbi wont replace it. Bodies like the IMF and Bank for International Settlements can engineer an orderly transition toward a multicurrency global system with predictable exchange rates and greater transparency, liquidity, and efficiency among central bank digital currencies. Or the world could just wait for geopolitically motivated currency shocks, such as the 1956 Suez Crisis (during which the United States threatened to dump the pound unless the British withdrew forces from the canal zone) or when former U.S. President Richard Nixon pulled Washington from the gold standard in 1971. China dumping its $1 trillion of U.S. dollar reserves is hardly a cudgel Washington should want held over its head.

Although the United States and China are geopolitical rivals, they do not have direct territorial disputes with each other. China and its neighbors, however, have many. Needless to say, the much-discussed democratic peace theory has no relevance in Asia. Whereas U.S. deterrence has helped maintain stability, actual conflict resolution will require a technocratic peace. Rehabilitating or reunifying North Korea with South Korea will happen through a carefully scripted multistage process, not a continuation of decades of nuclear saber-rattling and preconditions.

In the South China Sea and other maritime domains, disputed islands that have already been fortified will have to be ceded to countries that have claimed themwhether China, Vietnam, or the Philippinesrather than risk uncontrolled warfare to gain them back. Designated negotiators will have to meet in secret to find outcomes where each side gives and takesand all save face. Democratic (and especially nationalist) electorates may howl at compromise, which is why only a technocratic process involving authorized envoys can slow the regions slide toward major escalation.

And then, of course, theres climate change. According to a new report from the International Energy Agency, all fossil fuel investments would have to stop this year to have any chance of keeping pace with intended greenhouse gas reduction targets. Former NASA Goddard Institute director James Hansen has called for the establishment of a planetary regime both to regulate emissions generating industrial activity as well as to undertake global scale ecological conservation projects.

Technologists, philanthropists, and far-sighted governments are also beginning to devote more research to atmospheric and oceanic geoengineering projects that could reduce solar radiation or absorb more carbon dioxide. A wide array of political leaders, civil society activists, and institutional investors have rallied around climate-focused causes, from carbon taxes to coal divestment, but the worse climate scenarios get, the more decision-makers will be forced into radical, top-down measures overseen by technocrats, not activists.

The list of humanitys great challenges is only getting longer, but leaders are still building the global governance plane while flying it. At the same time, the solutions are now widely known, and public and private stakeholders are forming partnerships to implement them, with COVAX being the most recent example. But shifting from reactive to proactivefrom knowing the worst-case scenario to overcompensating to ensure a successful responsewill require new kinds of authority that fit uncomfortably with todays sensitivities around sovereignty and the indecisiveness of democracy.

As the shadow of the future grows nearer, overcoming todays complexity will require less virtue-signaling on Twitter and more technocratic execution. Tomorrows world will be better for it.

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After COVID-19, Only Technocrats Can Save the World - Foreign Policy