C.D.C. Panel Will Debate Booster Shots and Mix-and-Match Strategy

ImageA health worker inoculating a woman with the Covaxin vaccine at a health centre in New Delhi, India, on Thursday.
Credit…Prakash Singh/Agence France-Presse — Getty Images

India on Thursday celebrated having administered a billion doses of Covid vaccine, drawing on local manufacturing after devastating early stumbles in its pandemic response.

Still, the country has some way to go in fully vaccinating its population: Just 30 percent of the 900 million people eligible for vaccination in India have received two doses.

It was a turnaround in a vaccination drive that got off to a slow start, as India’s governing party prioritized elections and took up a lax attitude in tackling the virus, continuing to hold crowded political rallies and allowing religious festivals to take place even as cases surged.

“Gratitude to our doctors, nurses and all those who worked to achieve this feat,” Prime Minister Narendra Modi said on Twitter. More than 70 percent of adults have received at least one dose of vaccine, according to government figures. India is administering second doses 12 to 16 weeks after the first.

More than 450,000 people have died from Covid in India, according to government data that many experts say greatly downplays the true toll. India’s second wave earlier this year led to a shortage of medical care, oxygen, and hospital beds.

But the worst of the pandemic seems to be over, with India reporting about 15,000 new cases daily, down from a recorded peak of more than 400,000.

While other countries have struggled to secure enough doses to vaccinate their populations, India’s gigantic vaccination drive was made possible by domestic manufacturing capacity. The Serum Institute of India, the world’s largest vaccine maker, has supplied more than 80 percent of the doses administered in the country.

The demand for vaccines in India after the devastating second wave was such that the Serum Institute fell short on its commitments to supply vaccines to poorer nations. But as India’s situation stabilizes, vaccine exports from India — seen as crucial to global efforts — have slowly resumed.

The toll of the pandemic on India’s already slowing economy, however, will take years to reverse. The tourism industry is seeing some reprieve, as India last week began gradually welcoming foreign visitors after nearly two years. In the initial stage, only fully vaccinated tourists on charter flights are allowed in, before the country opens up to other tourists next month.

Dr. K. Srinath Reddy, the president of the Public Health Foundation of India, said the country could now hope to avoid a severe third wave unless a dangerous new variant emerged.

“At the moment it appears that while the vaccination doses are a good landmark, we should continue our caution in making sure that people are observing Covid-appropriate behavior, particularly with masks and not having super-spreading events until we actually reach a much higher level of vaccination,” he said.

Credit…From left: David Zalubowski/Associated Press; Mark Lennihan/Associated Press

As the latest wave of the virus ebbs in most parts of the United States, advisers to the Centers for Disease Control and Prevention will meet on Thursday to evaluate which Americans need extra doses of the coronavirus vaccines made by Moderna and Johnson & Johnson.

They will also discuss the so-called mix-and-match strategy — whether people fully immunized with one company’s vaccine should be allowed to switch to a different one for their booster shot.

On Wednesday, the Food and Drug Administration authorized booster shots for millions of people who received the Moderna and Johnson & Johnson vaccines, just as it did for recipients of Pfizer-BioNTech shots last month. The F.D.A. also gave the green light for people eligible for boosters to get an extra dose of a different brand from the one they first received.

But in practice who will get the shots and when depends greatly on the C.D.C.’s final guidance. Though the agency’s recommendations do not bind state and local officials, they hold great sway in the medical community.

Regardless of the tenor of the discussion, the final recommendations from the C.D.C.’s panel — the Advisory Committee on Immunization Practices — are unlikely to hold surprises. The committee is expected to endorse additional doses of the vaccines for many Americans and to strive to bring the country closer to fulfilling President Biden’s promise to provide boosters to all adults.

It will not happen without some misgivings, however.

Some of the C.D.C.’s advisers last month voiced strong reservations about a booster of the Pfizer-BioNTech vaccine, saying the science did not support additional shots for anyone other than adults over 65. A majority voted to recommend booster shots for people with certain medical conditions that increase the risk of Covid-19.

The committee did not support boosters for people whose jobs expose them to the virus — but in a highly unusual move, Dr. Rochelle P. Walensky, the C.D.C.’s director, overturned their decision.

“It is going to be a difficult meeting, because I suspect that the science won’t have changed much,” said Dr. Sarah S. Long, a pediatrician and infectious diseases expert at Drexel University in Philadelphia. “I can see making it clear that we still don’t think this is the right approach, and Dr. Walensky would have to override it.”

A similar dynamic played out on the expert panel advising the F.D.A. at a meeting last week. Several advisers to the F.D.A. criticized the paucity of evidence supporting a Johnson & Johnson booster and expressed discomfort at having to decide on the booster before the F.D.A. had carefully vetted the data.

Still, they unanimously voted in favor of a second Johnson & Johnson shot for adults who had received that vaccine because it was clear that two doses would be more protective than one, according to one member of the panel, Dr. Paul A. Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

“There was a value to having that as a one-dose vaccine when it first came out,” Dr. Offit said. “But I think it was always on the road to being a two-dose vaccine.”

He and others suggested that people who got the Johnson & Johnson vaccine might be better served by getting a second dose of the Pfizer-BioNTech or Moderna vaccines. The F.D.A. on Wednesday updated its authorization of all three vaccines, which will allow the C.D.C.’s advisory committee to recommend this mix-and-match strategy when it meets on Thursday.

At last week’s meeting, the F.D.A. advisers were shown evidence indicating that switching between two vaccine types might produce a richer immune response than boosting with the same vaccine.

San Francisco has offered Pfizer-BioNTech or Moderna shots to Johnson & Johnson recipients since August, and many Americans who initially received the Johnson & Johnson vaccine have sought out booster doses of those vaccines on their own before federal agencies had endorsed them.

But the F.D.A. advisers could not vote to recommend that people who initially got the Johnson & Johnson vaccine follow it up with one of the mRNA vaccines because the F.D.A. did not give them that option.

“The formal vote was on the J.-&-J. booster following the J.-&-J. vaccine,” said Dr. Stanley Perlman, an immunologist and coronavirus expert at the University of Iowa. But “everybody knew that the data would show that the heterologous boost would be better.” (Heterologous refers to a shot of a different vaccine.)

Credit…Zack DeZon for The New York Times

As New York City struggles to revive its economy after the devastation wrought by the pandemic on restaurants, hotels, theaters, tours, souvenir shops and the people who keep them running, one crucial element is still missing: big-spending foreign tourists.

Before the virus, the city was flooded with record numbers of visitors from Europe, Asia and South America. In 2019, they filled hotels, restaurants, Broadway theaters and museums, spending billions and fueling a surge in jobs. While American tourists have returned, the city can’t wait until Nov. 8, when the federal government is opening the country’s borders to vaccinated visitors. New York is preparing its most aggressive campaign in an effort to lure those visitors back in time to salvage, if it can, the end-of-year holiday season.

The city’s tourism agency, NYC & Company, plans to spend $6 million in eight countries on an advertising campaign themed “It’s Time for New York City,” with billboards trumpeting the message: “New York City Is Ready for You.”

Fred Dixon, the chief executive of the agency, said it would take years to regain all the lost tourism, but that the campaign could help. “There is an enormous amount of pent-up demand, and people are anxious to travel again,” he said.

Before the pandemic, tourists spent $47 billion annually and supported more than 280,000 jobs in the city, according to official estimates. About half of that came from international visitors, even though they accounted for just 20 percent of all tourists.

This year, the city’s tourism agency forecasts visitor spending of about $24 billion, half of the 2019 total.

Many New York businesses and workers say their survival depends on the robust return of international tourists.

“We’re hoping the city tries to bring back these international tourists because they’re our lifeline,” said Mohammed Rufai, an immigrant from Ghana who sells tickets in Times Square for a double-decker bus tour of Manhattan. “We need them.”

Mr. Rufai, 45, said he could earn $200 a day before the pandemic, more than 70 percent of it from other parts of the world. He now struggles to make half that.

“You cannot ask people to ride if there are no people here to ask,” he said.

Credit…Joedson Alves/EPA, via Shutterstock

Hours before a congressional panel was to announce on national television its recommendation that President Jair Bolsonaro be charged with homicide and genocide for his mishandling of the pandemic, a few senators had second thoughts.

Even though they believed Mr. Bolsonaro was effectively responsible for hundreds of thousands of the 600,000 Covid deaths in Brazil, these senators feared that position might not hold up legally, four panel members said.

Suddenly the highly anticipated report — which still recommended other serious criminal charges against Mr. Bolsonaro — had lost the support of the majority of the panel’s 11 voting members.

The panel, which had riveted the country with its six-month investigation, had a late-night meeting at one senator’s apartment, where, over duck and rice, they debated whether pursuing the more severe charges could jeopardize the prospects of Mr. Bolsonaro’s facing legal consequences.

The report’s author, Senator Renan Calheiros, eventually realized that he would have to walk back the charges to ensure the report would pass the committee and get to the attorney general, who could prosecute of the president. In the end, the main charge against Mr. Bolsonaro was “crimes against humanity.”

The last-minute shift reflects the polarized and complicated political landscape under Mr. Bolsonaro, whose popularity has plummeted since he took office in 2019 but who still retains enormous power.

Credit…Abedin Taherkenareh/EPA, via Shutterstock

Iran plans to abandon production of its Fakhravac Covid-19 vaccine for lack of demand, its defense ministry said on Tuesday. Iran’s five other domestic Covid vaccines could also be in jeopardy, as Iranians have shown they prefer imported vaccines.

The Iranian vaccines have been undermined by the health ministry’s decision to back away from initial promises to purchase large quantities of doses from domestic manufacturers.

“We are in the process of planning to end production, because who will we sell it to?” Ahmad Karimi, the director of the Fakhravac vaccine program, told Iranian news outlets on Tuesday. He said about a million doses had been stockpiled.

A day after the defense ministry announced its plans, the head of the country’s Food and Drug Agency promised to purchase three million doses of Fakhravac and another domestic vaccine. It was not clear whether that would affect the defense ministry’s decision about ending production.

The Fakhravac vaccine had received emergency use authorization in Iran but was still undergoing clinical trials to obtain full approval, and the defense ministry, which developed it, was having trouble finding enough participants for those trials.

Iran has been among the countries hardest hit by the pandemic. The official death toll so far is about 125,000, but health officials and independent experts say the true figure is several times higher. Chaotic planning, lack of transparency and official refusal to lock down cities and impose quarantines early in the pandemic led to major surges in infections, hospitalizations and deaths.

When vaccines became available, Iranian officials said they would give priority to domestically made shots, and health officials boasted that they would have the whole population inoculated by the end of the summer and be able to export surplus doses.

The country’s supreme leader, Ayatollah Ali Khamenei, banned American- and British-made coronavirus vaccines, claiming that they had been designed to harm Iranians — a decision that many critics say caused Iran to fall behind on vaccination and led to more illness and death from the virus. Iran has sped up imports in recent months, and the health minister said that about 120 million doses had been obtained from abroad.

About 59 percent of Iran’s 85 million people have received at least one dose of vaccine, and about 30 percent are fully vaccinated, according to official statistics; Iran is not yet giving booster shots on a wide scale.

The Fakhravac vaccine is named for Mohsen Fakhrizadeh, Iran’s top nuclear scientist, who was assassinated by Israel in November 2020. It was developed by the research branch of the defense ministry and given emergency use authorization in September, when a major surge in cases in Iran was beginning to ease.

Mr. Karimi boasted at the time that the defense ministry would soon produce 5 million doses of Fakhravac a day, but production has never come close to that level.

Mr. Karimi said on Tuesday that the health ministry had not delivered on promises to purchase large quantities of domestic vaccines, a complaint that other manufacturers have also raised.

“Unfortunately, due to the flood of imported vaccines, our policymakers are not paying attention to domestic vaccines,” said Abbas Ashtari, the head of biological products at the Razi Research Institute, which produces a vaccine called CovPars.

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