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COVID-19 Vaccine Distribution Will Be Challenging. States Rush To Plan Ahead : Shots


While coronavirus vaccine trials are ongoing and U.S. vaccine has yet to be approved, state health officials are planning ahead for how to eventually immunized a large swath of the population.

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While coronavirus vaccine trials are ongoing and U.S. vaccine has yet to be approved, state health officials are planning ahead for how to eventually immunized a large swath of the population.

Chandan Khanna/AFP via Getty Images

Even the most effective, safest coronavirus vaccine won’t work to curb the spread of the virus unless a large number of people get immunized. And getting a vaccine from the manufacturers all the way into people’s arms requires complex logistics — and will take many months.

Now, public health officers across the country are rushing to finish up the first draft of plans for how to distribute a coronavirus vaccine if and when it is authorized, and they’re grappling with a host of unknowns as they try to design a system for getting the vaccine out to everyone who wants it.

The Centers for Disease Control and Prevention gave state immunization managers only 30 days to draft a comprehensive COVID-19 vaccine distribution plan — and Friday is the day those plans are due.

The timing of vaccine research and planning is politically fraught, with the presidential election a few weeks away. When CDC announced the October deadline last month, critics worried that political pressure was tainting the process, since President Trump has repeatedly promised a vaccine will be ready soon.

“If you listen to the White House, [vaccine distribution] could be just a matter of weeks away,” New York Governor Andrew Cuomo told reporters on Thursday. He and Arkansas Governor Asa Hutchinson sent a letter to President Trump on behalf of the National Governors Association, asking for a meeting to talk through the many unanswered questions about the process.

“We need to know: What is the plan? What does the federal government do, what do you expect the states to do? When does it start? Who funds it?” Cuomo said. “Let’s figure it out now, because this virus has been ahead of us every step of the way — it’s about time this country catches up.”

Planning fast, with changing expectations

For dozens of public health officials across the country, the process over the past month has been like “herding a lot of cats,” says Claire Hannan, director of the Association of Immunization Managers. “It’s really cramming three to six months worth of strategic discussions […] into 30 days,” she says.

States need to lay the groundwork for distribution now, says James Blumenstock, vice president for pandemic response and recovery for the Association of State and Territorial Health Officials. That means deciding who’s in charge of responsibilities such as ordering supplies, signing up vaccine providers, training staff, running mass vaccination clinics and outreach campaigns, he explains. They’ll also need a data management system to track who received an initial vaccine dose, and to remind them to come back for their second dose.

“We have been working feverishly over the past few weeks,” says Decrecia Limbrick, assistant director of the Department of Health in Houston, which is one of several large cities that receives funding directly from CDC. “I think we’re ready to submit a plan — a ‘Version One’ of a plan.”

Then there are conflicting messages from the Trump administration. “Originally there had been talk about hurrying up and getting your plan done because the vaccine will be ready before the election,” says Kris Ehresmann, director of infectious disease for Minnesota’s Department of Health. When the Food and Drug Administration recently said that vaccine trials must allow two months after the last experimental dose is administered, that guidance “changes the timeline” again.

“It’s pretty much like being in a continuous earthquake,” she adds. “The ground is constantly moving.”

Overcoming logistical hurdles

Nobody knows which vaccine will be authorized first, when that will happen, which populations it will be authorized for, and how many initial doses will be available.

Adding to this uncertainty is the likelihood that the first coronavirus vaccines will be extremely challenging to handle. The CDC playbook notes the vaccines will likely require cold chain storage — possibly “ultra-cold” storage, which is colder than Antarctica — must be given in two doses a certain number of days apart, and could have a minimum order of 1,000 doses.

“For routine vaccines, [providers] will order 10 doses at the time or 20 doses at a time,” explains Michigan Department of Health and Human Services immunization director Bob Swanson. “It makes it more difficult to think about — how are we going to use a thousand doses for at risk populations across a rural county?”

Initially, the focus will be on the priority groups who will be first in line to get immunized. The specifics of who that will be are still getting worked out by a CDC advisory committee, although frontline health workers will almost certainly be at the top of the list. There are also concerns about distributing the vaccine equitably to communities that, for instance, speak different languages or are difficult to reach, especially at first when doses are limited.

As immunization managers look ahead to the coming year, different places around the country face a range of challenges.

Then there are seasonal issues. During a North Dakota winter, freezing temperatures and snowfall make outdoor drive-through clinics untenable, says Molly Howell, North Dakota’s immunization program manager, so they’re considering using warehouses or sporting venues for mass vaccination campaigns, so that people can gather indoors while maintaining physical distance. “Those are some of the ways that we’re trying to be creative about vaccinating people safely during the pandemic,” she says.

In Houston, officials are thinking ahead to the complications of the hot and humid summer. “If we get those hot days, we want to obviously ensure that we maintain the integrity of the vaccine,” says Limbrick of the Houston Department of Health, and they have to think about taking care of the medical staff who have to administer the vaccine in those conditions.

“After [health officials] push that button on Friday afternoon, on Saturday morning, they’re going to continue to work on their planning efforts going forward over the days and weeks and months ahead,” says Blumenstock of ASTHO. And when the first vaccine is authorized, “it’s going to be close to a year-long effort,” he says, to immunize everyone across the country who wants to be vaccinated.

Finding the money to execute plans

CDC director Robert Redfield told Congress last month that states are going to need around $6 billion dollars to distribute vaccines.

“This is going to take substantial resources,” Redfield told lawmakers. “The time is now for us to be able to get those resources out to the state[s].”

On Thursday, ASTHO and the Association of Immunization Managers wrote a letter formally requested $8.4 billion from Congress for these efforts.

The letter notes that so far CDC has distributed $200 million to states, territories, and a few large cities to fund the vaccine planning process — but describes this sum as “merely a down payment.” And with the election looming, the chances of a new COVID-19 relief bill getting through the legislature anytime soon are dim.

“The funding I don’t have control over, but I do have control over how we’re going to get vaccines out when they’re available,” says Swanson. “And I will tell you, public health is strong, and public health works hard, and immunizations are public health’s bread and butter.”

Michigan has received $5.9 million so far, and Swanson says that money has gone to getting the state’s immunization registry up to speed, and to local health departments for staffing.

The lack of clarity about funding troubles Dr. Kelly Moore, associate director of immunization education at the Immunization Action Coalition and the former director of Tennessee’s immunization program.

States need additional funds to be able to carry out the plans they’re submitting to CDC, she says. “They need to be able to invest in manpower, in I.T. systems and in the people to use them,” she explains, adding that those who are brought in to run the vaccination campaigns from other parts of the health department like STD clinics and family planning, will also need to be backfilled.

“A lot of things need to be paid for with these billions of dollars,” she says. “Even the best laid plans can’t be executed if you don’t have the resources to do so.”



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COVID-19: Warning issued as cases in U.S. states rise while tapering off in B.C.


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The provincial health officer, Dr. Bonnie Henry, said there are 183 active cases of the disease, with 16 in hospital of whom four are in intensive care. Those numbers continue to fall.

There have been 2,659 cases reported since COVID-19 appeared in B.C. in late January, and 167 deaths.

The contacts of the people who most recently became ill have all been traced.

Henry said there have been no new outbreaks in health-care settings between noon Friday and noon Monday. There are four active outbreaks in long-term care and assisted living facilities.

She said health authorities are working on plans to allow families to start visiting relatives in long-term care homes and that would likely begin in the “coming weeks.”

The outbreaks at Fraser Valley Specialty Poultry and Superior Poultry have ended.

Henry said summer travellers need to be respectful of any community they visit and to practise social distancing.

Dix said B.C. has received 4.8 million N95 respirators, two million sets of goggles and 30 million sets of gloves since the state of emergency was declared on March 18.

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Trump accuses states of asking for unneeded supplies and media of spreading fake news | World news


Donald Trump attempted to discredit media reports of his administration’s failures in the Covid-19 pandemic as he called some outlets in the White House press corps “fake news” at his daily coronavirus briefing on Saturday.

In a rambling introduction to a lengthy and combative briefing the president cited media reports on shortages of ventilators and personal protective equipment and said some state governors had asked for more supplies than they need.

The White House’s own projections show 100,000 Americans could be killed by the virus. On Saturday, Trump said: “There will be a lot of death”.

“It’s therefore critical certain media outlets stop spreading false information,” he said. “I could name them, but it’s the same ones, always the same ones.”

“It’s so bad for our country, so bad for the world.”

Trump then accused state governors of asking for materials which he argued they did not need.

“Many of their cupboards were bare,” he said.

Trump’s administration has sought to redefine the national strategic stockpile as a “back up” for states, and avoid co-ordinating a response to the pandemic.

Earlier, New York Governor Andrew Cuomo announced his state, which has been especially hard-hit, had looked to China for ventilator supplies.

“We’re not yet at the apex,” said Cuomo, who described the crescendo of cases to come as “the number one point of engagement of the enemy”.

Cuomo said he had obtained 1,000 ventilators from the Chinese government with the help of billionaires Joseph and Clara Tsai and Alibaba founder Jack Ma. Oregon had loaned New York another 140, he said.

At the White House, Trump said: “We have given the governor of New York more than anybody has been given in a long time. I think he’s happy… I wouldn’t say gracious.”

He also tried to claim credit for the 1,000 ventilators sent to New York by China and said, “two very good friends of mine brought him those ventilators”.

Cuomo put the New York case load at 113,704 and the death toll at 3,565, most in New York City but with nearly 1,000 deaths in other parts of the state. At lunchtime on Saturday, researchers at Johns Hopkins University in Maryland put the national toll at nearly 279,000 cases and 7,170 deaths.

Current projections put the peak of the pandemic in New York between four and 14 days away. Officials hope physical distancing across the state will slow the spread of the disease and forestall the possibility of running out of ventilators and hospital beds.

Cuomo admitted he hoped to see the apex soon, so the experience would soon end. The pandemic, “stresses this country, this state, in a way nothing else has frankly in my lifetime”, he said.

Cuomo’s briefing from the New York state capital, Albany, offered another contrast in leadership between governor and president. While Cuomo’s briefings convey alarming statistics, his frank descriptions of shortages and personal struggles have been praised.

Cuomo said the state had a signed contract for 17,000 ventilators, which he was later told could not be filled because many had already been purchased by China.

Trump retweeted articles about hydroxychloroquine, a treatment for malaria, and then promoted the unproven drug again at the press briefing. Some researchers believe the drug shows promise as a possible treatment for Covid-19 but so far studies lack control groups and are therefore treated as anecdotal. There is no known therapeutic for Covid-19, and no vaccine.

The US federal government’s response to the outbreak has been defined by bungled testing, poor coordination, low stockpiles and planning failures. Federal failure to intervene in supply chains has led to bidding wars for masks and other personal protective equipment, governors have said.

The White House has repeatedly claimed it has 10,000 ventilators in a strategic national stockpile. However, states have reported some of those ventilators are unusable, after the Trump administration failed to ensure the stockpile was properly maintained.

Trump has repeatedly caused confusion, often following hours-long, rambling press conferences featuring attacks on the media. At one such briefing on Friday, the president said he would not follow the advice of his own health department, and wear a mask in public.

“The [Centers for Disease Control and Prevention] is advising the use of non-medical cloth face covering as an additional voluntary public health measure,” Trump told reporters.

“This is voluntary. I don’t think I’m going to be doing it.”



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To Get An Abortion, Teens In 26 States Must Ask Parent Or Judge : Shots


A Massachusetts woman who had an abortion when she was 15 stands outside the Suffolk County Courthouse in Boston. Right now, girls facing that decision who don’t want to tell their parents must get a judge’s approval.

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A Massachusetts woman who had an abortion when she was 15 stands outside the Suffolk County Courthouse in Boston. Right now, girls facing that decision who don’t want to tell their parents must get a judge’s approval.

Jesse Costa/Jesse Costa/WBUR

The teenager was just 15, and recovering from a rape, when she realized she was pregnant. This young woman, whom NPR has agreed not to name, says she knew right away that she wanted to terminate the pregnancy. But like a lot of states, Massachusetts required — and still requires — minors to get a parent’s consent before obtaining an abortion.

“I knew I couldn’t tell my mom or my immediate family members,” she says, “because my pregnancy was the result of a sexual assault from a family friend.” Her home, she adds, “wasn’t necessarily a safe or healthy one at the time.”

So the 15-year-old pursued her only legal alternative: obtaining permission for the procedure from a state judge. She remembers staring up at a man who never made eye contact with her during their short conversation about grades and whether she played sports. She says the judge never asked her about the assault or her planned abortion.

“And then, right before I was leaving, he just encouraged me to think harder next time, before I had sex,” she recalls. “That was tough to hear.”

The judge issued an order granting her request. But the additional time it took to get that permission pushed the 15-year-old past the point that would allow her to take pills to induce an abortion. Research shows going to court typically delays an abortion for minors in Massachusetts by six days — delays that are most common among low-income, nonwhite teenagers.

So, instead of a medical abortion, she had to have the more invasive surgical procedure. But that’s not what weighs heavily on the young woman, who is now 23, has a masters degree and works for a nonprofit in Boston.

“The feeling that I had — from seeing the judge and those last words he said to me about being ‘more responsible’ ” — is what has stuck with her.

Required parental consent is one of the main reasons Massachusetts, often viewed as a bastion of liberal laws, only gets a grade of “C” for abortion access from an abortion rights group. Now, there’s an ongoing, vigorous debate in Massachusetts about whether to keep or remove this restriction.

It’s part of a larger process, in which both supporters of abortion rights and groups that oppose abortion are re-examining — and often changing — state-level policies in the wake of Brett Kavanaugh’s ascension to the U.S. Supreme Court in 2018. Both sides believe the appointment of Kavanaugh could lead to Roe v. Wade being overturned, which would mean the power to determine abortion policy would return to states.

Abortion-rights opponents say that when minors seek out abortion, having a parent or judge involved is supposed to help protect vulnerable teenagers, such as the 15-year-old who was raped. (That young woman says she has always assumed her lawyer told the judge how she got pregnant, but she can’t be sure.)

“In our laws, we need to do as much as we can — especially given the kind of epidemic abuse that we’re facing — to interrupt that cycle,” says David Franks, chairman of the board of the anti-abortion group Massachusetts Citizens for Life.

And requiring parental consent works to cut down on the procedures, these opponents of abortion rights say. The restriction has prevented at least 10,000 abortions since it was enacted in Massachusetts, according to calculations by Michael New, a visiting professor at The Catholic University of America. That takes into account the hundreds of Massachusetts teenagers who travel to neighboring states every year where parental consent for minors is not required. New says Massachusetts residents have traditionally backed some abortion limits for teenagers.

“Even in these more ‘liberal’ states, some of the existing pro-life laws still enjoy a lot of support,” New says. “I think most people are uncomfortable with minor girls obtaining abortions without their parent’s knowledge.”

Still, a poll out this past summer found that a plurality of Massachusetts voters favor letting minors decide on their own.

Removing parental consent is one of the key elements in a bill being called the “Roe Act” that’s pending in the Massachusetts legislature. It would also allow abortions in the third trimester — if a doctor diagnoses a fatal fetal condition — and, in anticipation of a post-Roe world, would establish the right to an abortion in state law.

The bill’s sponsor, state Sen. Harriet Chandler, argues that abortion is more widely accepted these days as general medical care. Chandler, who is 82, remembers when it wasn’t.

“I think if people realize what a post-Roe world would be, that would make it even more reasonable to do this bill,” Chandler says.

Her proposed legislation is still in committee, and its ultimate fate is unclear. Massachusetts Gov. Charlie Baker, a Republican, says he generally supports access to abortion, but not Chandler’s proposed expansions to state law.

Massachusetts, a heavily Catholic state, was among the first to pass limits on legal abortions in the 1970s, including required parental consent for minors. Twenty-five other states enforce a similar law for minors. No state has repealed the restriction.

‘It’s really been difficult to repeal barriers across the country,” says Rebecca Hart Holder, executive director at the abortion rights group NARAL Massachusetts. “This is a moment for us to take back that narrative and say those barriers are not acceptable.”

The prospect of eroding or overturning Roe v. Wade is triggering a flurry of legislative actions in states across the country. The Guttmacher Institute, which supports abortion rights, says 17 states have passed abortion restrictions or bans this year, as compared to 9 states that have confirmed or expanded access to abortion.

The recent rush in many states to restrict abortion rights is part of what propels Chandler: “We’re going in a different direction than the rest of the country,” she says.

That reaction has also occurred in other left-leaning states, according to Guttmacher’s senior state issues manager, Elizabeth Nash. The increased focus on abortion began in late 2018, Nash says, when Kavanaugh’s arrival on the Supreme Court created a five-member conservative majority. Before then, abortion access wasn’t an urgent priority among liberals.

“People felt that they were OK,” Nash explains, “that their state was safe because they weren’t seeing the same kinds of attacks as, perhaps, in states like Texas or Louisiana.”

In Massachusetts, abortion-rights opponents are lobbying to dilute or defeat the Roe Act and then focus on their long-term goal: a state constitutional amendment to limit abortions.

Meanwhile, supporters of abortion rights say passage of the Roe Act would help Massachusetts cement its commitment to abortion access — and become a legislative haven for women who can’t obtain abortions in other states. With that message, they have stepped up fundraising appeals with the plea that even more women are going to need help with abortions in a post-Roe future.

This story is part of a reporting partnership that includes WBUR, NPR and Kaiser Health News.



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EU states fail on sharing refugees – VoxEurop (English)



A mandatory 2015 scheme to dispatch people seeking international protection from Greece and Italy across the European Union did not deliver promised results, say EU auditors.

Although member states took in some 35,000 people from both countries, the EU auditors say at least 445,000 Eritreans, Iraqis and Syrians may have been potentially eligible in Greece alone.

The lead author of the report, Leo Brincat, told reporters in Brussels on Wednesday (13 November) that another 36,000 could have also been possibly relocated from Italy.

“But when it boils down to the total migrants relocated, you will find 21,999 in the case of Greece and 12,706 in the case of Italy,” he said.

The EU auditors say the migrants relocated at the time represented only around four percent of all the asylum seekers in Italy and around 22 percent in Greece.

Despite being repeatedly billed as a success by the European Commission, the two-year scheme had also caused massive rifts with some member states – leading to EU court battles in Luxembourg.

When it was first launched among interior ministers in late 2015, the mandatory nature of the proposal was forced through by a vote, overturning objections from the Czech Republic, Hungary, Romania and Slovakia.

Only last month, the advocate-general at the EU court in Luxembourg had declared the Czech Republic, Hungary and Poland likely broke EU law for refusing to take in refugees from the 2015 scheme. While the Czech Republic took 12 people, both Hungary and Poland refused to host anyone at all.

Similar battles have for years played out behind closed doors as legislators grapple with deadlocked internal EU asylum reforms.

The concepts of sharing out asylum seekers, also known as relocation, are at the core of that deadlock.

Politics aside, Brincat’s report honed in on the so-called “temporary emergency relocation scheme” whereby EU states had agreed to take in some 160,000 people from Greece and Italy over a period spanning from September 2015 to September 2017.

Large numbers of people at the time were coming up through the Western Balkans into Hungary and onto Germany, while others were crossing from Turkey onto the Greek islands.

After the EU cut a deal with Turkey early 2016, the set legal target of 160,000 had been reduced to just over 98,000.

When the scheme finally ended in September 2017, only around 35,000 people had been relocated to member states along with Liechtenstein, Norway and Switzerland.

“In our view, relocation was really a demonstration of European solidarity and with almost a 100 percent of eligible candidates in Greece and in Italy having been successfully relocated,” a European Commission spokeswoman said on Wednesday.

Bottlenecks and other problems

The EU auditors present a different view. They point out Greek and Italian authorities lacked the staff to properly identify people who could have been relocated, resulting in low registrations.

They also say EU states only took in people from Greece who arrived before the deal was cut with Turkey in March 2016.

Another issue was member states had vastly different asylum-recognition rates. For instance, asylum-recognition rates for Afghanis varied from six percent to 98 percent, depending on the member state. Iraqis had similarly variable rates.

Some migrants also simply didn’t trust relocation concept. Others likely baulked at the idea being sent to a country where they had no cultural, language or family ties.

Almost all of the 332 people sent to Lithuania, for example, packed up and left.

EU Commission president Jean-Claude Juncker had even poked fun of it in late 2016. He had said asylum seekers from Greece and Italy were hard pressed to relocate to his home country of Luxembourg.

“We found 53 after explaining to them that it was close to Germany. They are no longer there [Luxembourg],” he said.



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