Contra expectativas e previsões, mais uma vez o Brasil surpreende. A população brasileira vive nos últimos dois anos um boom de interesse por ciência, ocasionado pela pandemia e seus efeitos. Apesar de sermos uma sociedade desigual e apenas 5% da população ter curso superior concluído, a maioria apoia e quer conhecer mais a ciência. A eleição presidencial de 2018 foi combustível para a indústria de fake news e deu força a discursos que negam ou distorcem a realidade e as evidências científicas e históricas. Naquele momento, parecia que entraríamos fundo em uma fase de obscurantismo.
Mas a história deu sua volta, diante da tragédia imposta pela gestão do governo federal diante do coronavírus, a mobilização foi em sentido contrário. A sociedade brasileira, majoritariamente, reagiu ao negacionismo, impulsionada pela necessidade de lutar contra a pandemia, procurar informação confiável e defender a vida. Com o auxílio de cientistas, mídia e movimentos pela vida, vimos aumentar o interesse sobre ciência, universidades e institutos que produzem conhecimento.
Foi neste contexto que instituímos o SoU_Ciência. Um centro que congrega pesquisadores e cujas atividades estão voltadas para dialogar com a sociedade sobre a política científica e de educação superior, em especial sobre o que fazem as universidades públicas, que no Brasil são responsáveis por mais de 90% da produção de conhecimento e abrigam 8 entre 10 pesquisadores em nosso país. Em curto período de atuação, fizemos levantamentos de opinião pública, em parceria com o instituto Ideia Big Data, além de análises das mídias sociais, grupos focais e notícias. Descobrimos que o Brasil tem 94,5% da população a favor da vacinação contra Covid-19, e que a campanha antivacina liderada pelo próprio Presidente, tem apoio de apenas 5,5%. O que faz o nosso país ser diferente de países da Europa e dos EUA, onde os movimentos anti-vaxsão muito maiores, ainda podemos estudar. Certamente, a tradição em vacinações obtida pelo Plano Nacional de Imunizações (PNI), além do Sistema Único de Saúde (SUS), são fatores determinantes.
Em nossos levantamentos de opinião pública, 72% da população afirmou que seu interesse pela ciência aumentou com a pandemia. Isso fez 69,7% dos entrevistados declarar ter “muito interesse pela ciência” e apenas 2,2%, “nenhum interesse”. Entre evangélicos e os que consideram o governo ótimo/bom, o elevado interesse pela ciência também é expressivo: 63% e 62% respectivamente. Além disso, 32,1% da população declarou ter o hábito de pesquisar em sites, blogse canais das universidades e institutos de pesquisa na procura de informações confiáveis e, surpreendentemente, 40% gostariam de ler artigos científicos. Comparativamente, apenas 8,8% afirmam confiar no que o Bolsonaro fala sobre a pandemia, num claro distanciamento da população em relação ao presidente eleito em 2018.
A procura por informação confiável na pandemia levou a um fortalecimento do ecossistema que envolve universidades, instituições de pesquisa e cientistas na sua capacidade de comunicação e divulgação científica, com um ampliado espaço na mídia. Dois fenômenos merecem destaque. Em primeiro lugar, a competência que cientistas tiveram para se comunicar e alertar sobre o novo coronavírus e seus efeitos, utilizando redes sociais como o Twitter, e canais do YouTube, como monitorou o Science Pulseda Núcleo e IBPAD com apoio da Fundação Serrapilheira. Adicionalmente, muitos cientistas passaram a falar para a grande mídia, que por sua vez ampliou suas sessões de ciência e saúde e deu espaços para novos colunistas na área. Tem havido rápido aprendizado e maior mobilização de cientistas para utilizar os diferentes meios de comunicação.
O segundo fenômeno decorre do grande interesse da mídia e grande parte da população sobre os estudos clínicos das diversas vacinas que estavam sendo desenvolvidas em tempo recorde. Os estudos geraram grande audiência e expectativa. As universidades públicas, como a USP e a Unifesp, atuaram na coordenação dos estudos das duas primeiras vacinas licenciadas no País, ganharam enorme destaque. O Instituto Butantan e a Fiocruz, além das pesquisas, se tornaram mais conhecidos pelas pesquisas e produção dos imunizantes.
Diante de todos estes elementos, nos parece que, 120 anos depois da Revolta da Vacina, a revolta agora ocorre contra um governo que se recusou a comprar vacinas para sua população e propôs falsas alternativas, como apontou a CPI da Pandemia. A revolta em 2021, dado o enorme contingente a favor da vacina e em defesa da ciência, direcionou-se contra o governo federal e faz derreter a popularidade do presidente, passando a aprovação (ótimo/bom) de 37%, em dezembro de 2020, para 22% em dezembro de 2021, segundo o Datafolha; enquanto a rejeição (ruim/péssimo) passou de 32% para 53% no mesmo período. Dentre os fatores dessa virada de popularidade no “ano da vacina” esteve o contínuo embate presidencial contra a ciência, a partir da negação dos benefícios da vacina e da distorção nos dados. Isto vem ocorrendo de maneira renovada agora, na batalha da vacinação infantil e na fraca reação contra a variante Ômicron. Sem dúvida, em 2021 a maior oposição a Bolsonaro veio pela conscientização por meio da ciência e da aproximação dos cientistas junto à sociedade, mídia e redes sociais.
Tentando reagir nesse embate, o governo federal escalou alguns médicos e outros apoiadores para fazer o contraponto e distorcer dados científicos, criando novas interpretações fantasiosas. E atuou e segue atuando para o desmanche acelerado do sistema de ciência e pesquisa no Brasil, com ataques ao CNPq, CAPES e Finep, e cortes brutais de orçamento, cuja dimensão e impacto discutiremos noutros artigos deste blog. Ataques estes que não se reproduziram na opinião pública, já que levantamento do SoU_Ciência mostrou que somente 9% da população apoiam os cortes impostos.
Temos pela frente um grande desafio: consolidar a onda pró-ciência, para além da pandemia, e para tanto é necessária a recuperação do sistema nacional de ciência e pesquisa, com a recomposição efetiva de seu financiamento. Estamos diante da oportunidade de alcançarmos um novo patamar na relação sociedade-ciência com a formulação de políticas públicas baseadas em evidências científicas. Para isso, buscamos um “letramento científico” que colabore no combate às fake news e amplie a capacidade da população em tomar decisões racionais e fundamentadas. Os sinais são de esperança, mas nos pedem atenção e muito trabalho. A criação do Centro SoU_Ciência que terá neste blog uma voz, faz parte desse momento e pretende colaborar para fortalecer as conexões com a sociedade, na defesa da democracia, e na garantia de direitos para um novo momento da história de nosso país.
Soraya Smaili, farmacologista, professora titular da Escola Paulista de Medicina, Reitora da Unifesp (2013-2021). Atualmente é Coordenadora Adjunta do Centro de Saúde Global e Coordenadora Geral do SoU_Ciência;
Maria Angélica Minhoto, pedagoga e economista, professora da EFLCH-Unifesp, Pró- Reitora de Graduação (2013-2017) e Coordenadora Adjunta do SoU_Ciência;
Pedro Arantes, arquiteto e urbanista, professor da EFLCH-Unifesp, Pró-Reitor de Planejamento (2017-2021) e Coordenador Adjunto do SoU_Ciência.
New antibody and antiviral treatments, and better vaccines, are on the way
The Economist – Nov 8th 2021
IN THE WELL-VACCINATED wealthier countries of the world, year three of the pandemic will be better than year two, and covid-19 will have much less impact on health and everyday activities. Vaccines have weakened the link between cases and deaths in countries such as Britain and Israel (see chart). But in countries that are poorer, less well vaccinated or both, the deleterious effects of the virus will linger. A disparity of outcomes between rich and poor countries will emerge. The Gates Foundation, one of the world’s largest charities, predicts that average incomes will return to their pre-pandemic levels in 90% of advanced economies, compared with only a third of low- and middle-income economies.
Although the supply of vaccines surged in the last quarter of 2021, many countries will remain under-vaccinated for much of 2022, as a result of distribution difficulties and vaccine hesitancy. This will lead to higher rates of death and illness and weaker economic recoveries. The “last mile” problem of vaccine delivery will become painfully apparent as health workers carry vaccines into the planet’s poorest and most remote places. But complaints about unequal distribution will start to abate during 2022 as access to patients’ arms becomes a larger limiting factor than access to jabs. Indeed, if manufacturers do not scale back vaccine production there will be a glut by the second half of the year, predicts Airfinity, a provider of life-sciences data.
Booster jabs will be more widely used in 2022 as countries develop an understanding of when they are needed. New variants will also drive uptake, says Stanley Plotkin of the University of Pennsylvania, inventor of the rubella vaccine. Dr Plotkin says current vaccines and tweaked versions will be used as boosters, enhancing protection against variants.
The vaccination of children will also expand, in some countries to those as young as six months. Where vaccine hesitancy makes it hard for governments to reach their targets they will be inclined to make life difficult for the unvaccinated—by requiring vaccine passports to attend certain venues, and making vaccination compulsory for groups such as health-care workers.
Immunity and treatments may be widespread enough by mid-2022 to drive down case numbers and reduce the risk of new variants. At this point, the virus will become endemic in many countries. But although existing vaccines may be able to suppress the virus, new ones are needed to cut transmission.
Stephane Bancel, the boss of Moderna, a maker of vaccines based on mRNA technology, says his firm is working on a “multivalent” vaccine that will protect against more than one variant of covid-19. Beyond that he is looking at a “pan-respiratory” vaccine combining protection against multiple coronaviruses, respiratory viruses and strains of influenza.
Other innovations in covid-19 vaccines will include freeze-dried formulations of mRNA jabs, and vaccines that are given via skin patches or inhalation. Freeze-dried mRNA vaccines are easy to transport. As the supply of vaccines grows in 2022, those based on mRNA will be increasingly preferred, because they offer higher levels of protection. That will crimp the global market for less effective vaccines, such as the Chinese ones.
In rich countries there will also be greater focus on antibody treatments for people infected with covid-19. America, Britain and other countries will rely more on cocktails such as those from Regeneron or AstraZeneca.
Most promising of all are new antiviral drugs. Pfizer is already manufacturing “significant quantities” of its protease inhibitor. In America, the government has agreed to buy 1.2bn courses of an antiviral drug being developed by Merck, known as molnupiravir. This has shown its efficacy in trials, and the company has licensed it for widespread, affordable production.
There are many other antivirals in the pipeline. Antiviral drugs that can be taken in pill form, after diagnosis, are likely to become blockbusters in 2022, helping make covid-19 an ever more treatable disease. That will lead, in turn, to new concerns about unequal access and of misuse fostering resistant strains.
The greatest risk to this more optimistic outlook is the emergence of a new variant capable of evading the protection provided by existing vaccines. The coronavirus remains a formidable foe.
Natasha Loder: Health-policy editor, The Economist■
This article appeared in the Science and Technology section of the print edition of The World Ahead 2022 under the headline “From pandemic to endemic”
But the taming of the coronavirus conceals failures in public health
The Economist – Nov 8th 2021
PANDEMICS DO NOT die—they fade away. And that is what covid-19 is likely to do in 2022. True, there will be local and seasonal flare-ups, especially in chronically undervaccinated countries. Epidemiologists will also need to watch out for new variants that might be capable of outflanking the immunity provided by vaccines. Even so, over the coming years, as covid settles into its fate as an endemic disease, like flu or the common cold, life in most of the world is likely to return to normal—at least, the post-pandemic normal.
Behind this prospect lie both a stunning success and a depressing failure. The success is that very large numbers of people have been vaccinated and that, at each stage of infection from mild symptoms to intensive care, new medicines can now greatly reduce the risk of death. It is easy to take for granted, but the rapid creation and licensing of so many vaccines and treatments for a new disease is a scientific triumph.
The polio vaccine took 20 years to go from early trials to its first American licence. By the end of 2021, just two years after SARS-CoV-2 was first identified, the world was turning out roughly 1.5bn doses of covid vaccine each month. Airfinity, a life-sciences data firm, predicts that by the end of June 2022 a total of 25bn doses could have been produced. At a summit in September President Joe Biden called for 70% of the world to be fully vaccinated within a year. Supply need not be a constraint.
Immunity has been acquired at a terrible cost
Vaccines do not offer complete protection, however, especially among the elderly. Yet here, too, medical science has risen to the challenge. For example, early symptoms can be treated with molnupiravir, a twice-daily antiviral pill that in trials cut deaths and admissions to hospital by half. The gravely ill can receive dexamethasone, a cheap corticosteroid, which reduces the risk of death by 20-30%. In between are drugs like remdesivir and an antibody cocktail made by Regeneron.
Think of the combination of vaccination and treatment as a series of walls, each of which blocks a proportion of viral attacks from becoming fatal. The erection of each new wall further reduces the lethality of covid.
However, alongside this success is that failure. One further reason why covid will do less harm in the future is that it has already done so much in the past. Very large numbers of people are protected from current variants of covid only because they have already been infected. And many more, particularly in the developing world, will remain unprotected by vaccines or medicines long into 2022.
This immunity has been acquired at terrible cost. The Economist has tracked excess deaths during the pandemic—the mortality over and above what you would have expected in a normal year. Our central estimate on October 22nd was of a global total of 16.5m deaths (with a range from 10.2m to 19.2m), which was 3.3 times larger than the official count. Working backwards using assumptions about the share of fatal infections, a very rough estimate suggests that these deaths are the result of 1.5bn-3.6bn infections—six to 15 times the recorded number.
The combination of infection and vaccination explains why in, say, Britain in the autumn, you could detect antibodies to covid in 93% of adults. People are liable to re-infection, as Britain shows, but with each exposure to the virus the immune system becomes better trained to repel it. Along with new treatments and the fact that more young people are being infected, that explains why the fatality rate in Britain is now only a tenth of what it was at the start of 2021. Other countries will also follow that trajectory on the road to endemicity.
All this could yet be upended by a dangerous new variant. The virus is constantly mutating and the more of it there is in circulation, the greater the chance that an infectious new strain will emerge. However, even if Omicron and Rho variants strike, they may be no more deadly than Delta is. In addition, existing treatments are likely to remain effective, and vaccines can rapidly be tweaked to take account of the virus’s mutations.
Just another endemic disease
Increasingly, therefore, people will die from covid because they are elderly or infirm, or they are unvaccinated or cannot afford medicines. Sometimes people will remain vulnerable because they refuse to have a jab when offered one—a failure of health education. But vaccine doses are also being hoarded by rich countries, and getting needles into arms in poor and remote places is hard. Livelihoods will be ruined and lives lost all for lack of a safe injection that costs just a few dollars.
Covid is not done yet. But by 2023, it will no longer be a life-threatening disease for most people in the developed world. It will still pose a deadly danger to billions in the poor world. But the same is, sadly, true of many other conditions. Covid will be well on the way to becoming just another disease.
Edward Carr: Deputy editor, The Economist■
This article appeared in the Leaders section of the print edition of The World Ahead 2022 under the headline “Burning out”
João Paulo Charleaux – 13 de out de 2021 (atualizado 13/10/2021 às 00h26)
Laurent-Henri Vignaud, historiador da ciência na Universidade de Bourgogne, fala ao ‘Nexo’ sobre as ideias, à direita e à esquerda, por trás do movimento antivacina nos últimos 300 anos
Manifestante com máscara rasgada em marcha contra a imposição de um passaporte sanitário na Holanda
A resistência à vacinação é um fenômeno antigo e persistente, que encontra adeptos à esquerda e à direita – sempre nas franjas mais extremas desses setores –, e não está ligado à falta de educação, mas ao excesso de informação e à dificuldade de saber em que acreditar, de acordo com o historiador da ciência Laurent-Henri Vignaud, da Universidade de Bourgogne, na França.
O autor do livro “Antivax: Resistência às vacinas, do século 18 aos Nossos Dias” esmiuça, nesta entrevista concedida por escrito ao Nexo nesta quarta-feira (6), os argumentos dos que ainda resistem a se vacinar contra a covid-19 em todo mundo, e faz um retrospecto desse movimento antivacinal ao longo da história.
Vignaud fará uma conferência virtual sobre o tema no dia 14 de outubro, no ciclo de palestras sobre a Covid promovido pelo Consulado da França em São Paulo em parceria com a Unesco, órgão das Nações Unidas para educação e cultura, e com os Blogs de Ciência da Unicamp. A transmissão é ao vivo e os vídeos ficam disponíveis nos canais do Consulado da França na internet.
Quais são os argumentos daqueles que se opõem à vacinação? Como esses argumentos variaram nos últimos 300 anos?
Laurent-Henri Vignaud Esses argumentos são muito diversos, assim como os perfis “antivax”. Muitos têm dúvidas simples sobre a qualidade das vacinas ou sobre os conflitos de interesse de quem as promove. Outros desenvolvem teorias extremas de conspiração, dizendo que as vacinas são feitas para adoecer, para esterilizar, matar ou escravizar. No meio, há aqueles que “hesitam” por tal ou tal motivo.
Aqueles que recusam explicitamente uma ou mais vacinas – quando falamos estritamente dos “antivax” – o fazem por motivos religiosos, políticos ou alternativos e naturalistas. Há certas correntes rigorosas, em todas as religiões, que recusam a vacinação em nome de um princípio fatalista e providencialista, numa afirmação da ideia de que o homem não é senhor de seu próprio destino.
Já os que se opõem às vacinas por razões políticas atacam as leis impositivas em nome da livre disposição de seus corpos e das liberdades individuais, no discurso do “meu corpo me pertence”.
Outros, muito numerosos hoje, contestam a eficácia das vacinas e defendem outras terapias que vão desde regimes de saúde a fitoterápicos e homeopatia – o que aparece em discursos como “a imunidade natural é superior à imunidade a vacinas” e “as doenças nos fortalecem”. A maioria desses argumentos está presente desde o início da polêmica vacinal no final do século 18, mas se atualizam de maneira diferente em cada época.
Historicamente, o movimento antivacinação é de direita ou de esquerda? Isso é algo que mudou ao longo do tempo ou permanece o mesmo?
Laurent-Henri Vignaud Atualmente, as duas tendências existem: há uma postura “ecológica” antivacina que é bastante esquerdista e burguesa – um modelo muito difundido por exemplo na Califórnia entre funcionários de empresas digitais. E há uma postura “libertária” ou “confessional” antivacina, que é de direita, presente sobretudo na América, em círculos religiosos conservadores e partidários de líderes populistas como [o ex-presidente dos EUA Donald] Trump ou [o presidente do Brasil, Jair] Bolsonaro.
Manifestante exibe cartaz contra vacina em protesto na Avenida Paulista
Historicamente, a inoculação, técnica que antecedeu as vacinas no século 18, foi promovida por filósofos como Voltaire [iluminista francês, 1694-1778] e contrariada por homens da Igreja. Portanto, podemos classificar essa oposição como uma oposição à direita. No século 19, a dureza das medidas de vacinação obrigatória levou à revolta de setores mais pobres que não podiam escapar da injeção. O vacinismo aparece aí como higiene social e o antivacinismo, como algo protagonizado por movimentos operários, feministas e de defesa dos animais, mais marcadamente à esquerda, portanto.
A Revolta da Vacina, de 1904, no Brasil, foi desencadeada por uma campanha de vacinação forçada pretendida pela jovem República, que gerou motins na classe trabalhadora. No século 20, o antivacinismo está representado à direita e à esquerda, mas quase sempre nos extremos.
O que explica por que a França, país desenvolvido, rico, cientificamente avançado, onde não faltam fontes confiáveis de informação, tenha hoje uma resistência tão elevada à vacinação, mesmo entre os profissionais de saúde?
Laurent-Henri Vignaud Esse é um fenômeno recente. A França não está isenta da tradição antivacinal. Na verdade, essa era uma tradição até bastante virulenta na época de Pasteur [século 19], a ponto de atrasar o estabelecimento de uma obrigação de vacinar contra a varíola, mas esta não é uma opinião muito difundida até o início do anos 2000.
Por exemplo, nossa primeira liga “antivax” apareceu em 1954 após a entrada em vigor da obrigação do BCG, mas, à época, os ingleses e os americanos já tinha ligas “antivax” há quase um século.
Clientes exibem passe sanitário em seus celulares num café de Paris
Durante a última epidemia de varíola na Bretanha em 1954-1955, na altura em que o prefeito decretou o reforço da vacinação obrigatória, mais de 90% dos habitantes concernidos já tinham sido vacinados voluntariamente.
Essa confiança foi abalada durante o debate sobre a vacina contra a hepatite B em meados da década de 1990, até porque os políticos se contradiziam sobre sua possível periculosidade. E, na crise do do influenza A em 2009, a campanha de vacinação falhou. Os franceses não acreditavam na possibilidade de uma pandemia e não entendiam por que deveriam ter sido vacinados contra uma doença na qual não viam perigo. Talvez o choque da pandemia de covid reverta essa tendência.
Como você explica o fato de que os boatos, o misticismo e a irracionalidade persistam, mesmo em uma época em que a ciência se desenvolveu tanto, mesmo em uma época em que a educação formal alcançou tantos? Essa adesão às teorias da conspiração seria uma característica humana inextinguível?
Laurent-Henri Vignaud A suspeita de riscos tecnológicos – porque a vacina é um produto manufaturado – não se alimenta da falta de informação, mas de seu transbordamento. É por sermos inundados com informações e por não podermos lidar com um décimo delas que nós duvidamos.
Quem de nós pode explicar, ainda que de forma grosseira, como funciona algo tão difundido como um telefone celular? Diante dessa superabundância de quebra-cabeças técnico-científicos e de conhecimentos que não podemos assimilar, os cidadãos 2.0 fazem seu mercado e acreditam no que querem acreditar de acordo com o que consideram ser do seu interesse.
A maioria confia em palavras de autoridade e no pouco que conseguem entender de tudo o que chega a si. Alguns ficam insatisfeitos com as respostas que lhes são dadas e passam a duvidar de tudo, chegando a imaginar universos paralelos e paranóicos. Não é, portanto, na ignorância que estas crenças se baseiam, mas sim num “ônus da prova”, que pesa cada vez mais sobre os ombros dos cidadãos contemporâneos.
Nessa “sociedade de risco”, os cidadãos contemporâneos são cada vez mais instados a assumir a responsabilidade por si próprios e julgar por si próprios o que é verdadeiro e o que é falso. Em alguns, o espírito crítico se empolga e leva a uma forma de ceticismo radical da qual o antivacinismo é um bom exemplo.
Despite warnings, American and European officials gave up leverage that could have guaranteed access for billions of people. That risks prolonging the pandemic.
Credit: Joao Silva/The New York Times
In the coming days, a patent will finally be issued on a five-year-old invention, a feat of molecular engineering that is at the heart of at least five major Covid-19 vaccines. And the United States government will control that patent.
The new patent presents an opportunity — and some argue the last best chance — to exact leverage over the drug companies producing the vaccines and pressure them to expand access to less affluent countries.
The question is whether the government will do anything at all.
The rapid development of Covid-19 vaccines, achieved at record speed and financed by massive public funding in the United States, the European Union and Britain, represents a great triumph of the pandemic. Governments partnered with drugmakers, pouring in billions of dollars to procure raw materials, finance clinical trials and retrofit factories. Billions more were committed to buy the finished product.
But this Western success has created stark inequity. Residents of wealthy and middle-income countries have received about 90 percent of the nearly 400 million vaccines delivered so far. Under current projections, many of the rest will have to wait years.
Growing numbers of health officials and advocacy groups worldwide are calling for Western governments to use aggressive powers — most of them rarely or never used before — to force companies to publish vaccine recipes, share their know-how and ramp up manufacturing. Public health advocates have pleaded for help, including asking the Biden administration to use its patent to push for broader vaccine access.
Governments have resisted. By partnering with drug companies, Western leaders bought their way to the front of the line. But they also ignored years of warnings — and explicit calls from the World Health Organization — to include contract language that would have guaranteed doses for poor countries or encouraged companies to share their knowledge and the patents they control.
“It was like a run on toilet paper. Everybody was like, ‘Get out of my way. I’m gonna get that last package of Charmin,’” said Gregg Gonsalves, a Yale epidemiologist. “We just ran for the doses.”
Credit: Lena Mucha for The New York Times
The prospect of billions of people waiting years to be vaccinated poses a health threat to even the richest countries. One example: In Britain, where the vaccine rollout has been strong, health officials are tracking a virus variant that emerged in South Africa, where vaccine coverage is weak. That variant may be able to blunt the effect of vaccines, meaning even vaccinated people might get sick.
Western health officials said they never intended to exclude others. But with their own countries facing massive death tolls, the focus was at home. Patent sharing, they said, simply never came up.
“It was U.S.-centric. It wasn’t anti-global.” said Moncef Slaoui, who was the chief scientific adviser for Operation Warp Speed, a Trump administration program that funded the search for vaccines in the United States. “Everybody was in agreement that vaccine doses, once the U.S. is served, will go elsewhere.”
President Biden and Ursula von der Leyen, the president of the European Union’s executive branch, are reluctant to change course. Mr. Biden has promised to help an Indian company produce about 1 billion doses by the end of 2022 and his administration has donated doses to Mexico and Canada. But he has made it clear that his focus is at home.
“We’re going to start off making sure Americans are taken care of first,” Mr. Biden said recently. “But we’re then going to try and help the rest of the world.”
Pressuring companies to share patents could be seen as undermining innovation, sabotaging drugmakers or picking drawn-out and expensive fights with the very companies digging a way out of the pandemic.
As rich countries fight to keep things as they are, others like South Africa and India have taken the battle to the World Trade Organization, seeking a waiver on patent restrictions for Covid-19 vaccines.
Russia and China, meanwhile, have promised to fill the void as part of their vaccine diplomacy. The Gamaleya Institute in Moscow, for example, has entered into partnerships with producers from Kazakhstan to South Korea, according to data from Airfinity, a science analytics company, and UNICEF. Chinese vaccine makers have reached similar deals in the United Arab Emirates, Brazil and Indonesia.
Credit: Adam Dean for The New York Times
Addressing patents would not, by itself, solve the vaccine imbalance. Retrofitting or constructing factories would take time. More raw materials would need to be manufactured. Regulators would have to approve new assembly lines.
And as with cooking a complicated dish, giving someone a list of ingredients is no substitute to showing them how to make it.
To address these problems, the World Health Organization created a technology pool last year to encourage companies to share know-how with manufacturers in lower-income nations.
Not a single vaccine company has signed up.
“The problem is that the companies don’t want to do it. And the government is just not very tough with the companies,” said James Love, who leads Knowledge Ecology International, a nonprofit.
Drug company executives told European lawmakers recently that they were licensing their vaccines as quickly as possible, but that finding partners with the right technology was challenging.
“They don’t have the equipment,” Moderna’s chief executive, Stéphane Bancel, said. “There is no capacity.”
But manufacturers from Canada to Bangladesh say they can make vaccines — they just lack patent licensing deals. When the price is right, companies have shared secrets with new manufacturers in just months, ramping up production and retrofitting factories.
Credit: Andrew Testa for The New York Times
It helps when the government sweetens the deal. Earlier this month, Mr. Biden announced that the pharmaceutical giant Merck would help make vaccines for its competitor Johnson & Johnson. The government pressured Johnson & Johnson to accept the help and is using wartime procurement powers to secure supplies for the company. It will also pay to retrofit Merck’s production line, with an eye toward making vaccines available to every adult in the United States by May.
Despite the hefty government funding, drug companies control nearly all of the intellectual property and stand to make fortunes off the vaccines. A critical exception is the patent expected to be approved soon — a government-led discovery for manipulating a key coronavirus protein.
This breakthrough, at the center of the 2020 race for a vaccine, actually came years earlier in a National Institutes of Health lab, where an American scientist named Dr. Barney Graham was in pursuit of a medical moonshot.
‘We’d already done everything’
For years, Dr. Graham specialized in the kind of long, expensive research that only governments bankroll. He searched for a key to unlock universal vaccines — genetic blueprints to be used against any of the roughly two dozen viral families that infect humans. When a new virus emerged, scientists could simply tweak the code and quickly make a vaccine.
In 2016, while working on Middle East Respiratory Syndrome, another coronavirus known as MERS, he and his colleagues developed a way to swap a pair of amino acids in the coronavirus spike protein. That bit of molecular engineering, they realized, could be used to develop effective vaccines against any coronavirus. The government, along with its partners at Dartmouth College and the Scripps Research Institute, filed for a patent, which will be issued this month.
When Chinese scientists published the genetic code of the new coronavirus in January 2020, Dr. Graham’s team had their cookbook ready.
“We kind of knew exactly what we had to do,” said Jason McLellan, one of the inventors, who now works at the University of Texas at Austin. “We’d already done everything.”
Dr. Graham was already working with Moderna on a vaccine for another virus when the outbreak in China inspired his team to change focus. “We just flipped it to coronavirus and said, ‘How fast can we go?’” Dr. Graham recalled.
Credit: Pete Marovich for The New York Times
Within a few days, they emailed the vaccine’s genetic blueprint to Moderna to begin manufacturing. By late February, Moderna had produced enough vaccines for government-run clinical trials.
“We did the front end. They did the middle. And we did the back end,” Dr. Graham said.
Exactly who holds patents for which vaccines won’t be sorted out for months or years. But it is clear now that several of today’s vaccines — including those from Moderna, Johnson & Johnson, Novavax, CureVac and Pfizer-BioNTech — rely on the 2016 invention. Of those, only BioNTech has paid the U.S. government to license the technology. The patent is scheduled to be issued March 30.
Patent lawyers and public health advocates say it’s likely that other companies will either have to negotiate a licensing agreement with the government, or face the prospect of a lawsuit worth billions. The government filed such a lawsuit in 2019 against the drugmaker Gilead over H.I.V. medication.
This gives the Biden administration leverage to force companies to share technology and expand worldwide production, said Christopher J. Morten, a New York University law professor specializing in medical patents.
“We can do this the hard way, where we sue you for patent infringement,” he said the government could assert. “Or just play nice with us and license your tech.”
The National Institutes of Health declined to comment on its discussions with the drugmakers but said it did not anticipate a dispute over patent infringement. None of the drug companies responded to repeated questions about the 2016 patent.
Experts said the government has stronger leverage on the Moderna vaccine, which was almost entirely funded by taxpayers. New mRNA vaccines, such as those from Moderna, are relatively easier to manufacture than vaccines that rely on live viruses. Scientists compare it to an old-fashioned cassette player: Try one tape. If it’s not right, just pop in another.
Moderna expects $18.4 billion in vaccine sales this year, but it is the delivery system — the cassette player — that is its most prized secret. Disclosing it could mean giving away the key to the company’s future.
Credit: Mike Kai Chen for The New York Times
“There should be no division in order to win this battle,” President Emmanuel Macron of France said.
Yet European governments had backed their own champions. The European Investment Bank lent nearly $120 million to BioNTech, a German company, and Germany bought a $360 million stake in the biotech firm CureVac after reports that it was being lured to the United States.
“We funded the research, on both sides of the Atlantic,” said Udo Bullmann, a German member of the European Parliament. “You could have agreed on a paragraph that says ‘You are obliged to give it to poor countries in a way that they can afford it.’ Of course you could have.”
A People’s Vaccine
In May, the leaders of Pakistan, Ghana, South Africa and others called for governments to support a “people’s vaccine” that could be quickly manufactured and given for free.
They urged the governing body of the World Health Organization to treat vaccines as “global public goods.”
Though such a declaration would have had no teeth, the Trump administration moved swiftly to block it. Intent on protecting intellectual property, the government said calls for equitable access to vaccines and treatments sent “the wrong message to innovators.”
World leaders ultimately approved a watered-down declaration that recognized extensive immunization — not the vaccines themselves — as a global public good.
That same month, the World Health Organization launched the technology-access pool and called on governments to include clauses in their drug contracts guaranteeing equitable distribution. But the world’s richest nations roundly ignored the call.
In the United States, Operation Warp Speed went on a summertime spending spree, disbursing over $10 billion to handpicked companies and absorbing the financial risks of bringing a vaccine to market.
“Our role was to enable the private sector to be successful,” said Paul Mango, a top adviser to the then health secretary, Alex M. Azar II.
The deals came with few strings attached.
Credit: Philip Cheung for The New York Times
Large chunks of the contracts are redacted and some remain secret. But public records show that the government used unusual contracts that omitted its right to take over intellectual property or influence the price and availability of vaccines. They did not let the government compel companies to share their technology.
British and other European leaders made similar concessions as they ordered enough doses to vaccinate their populations multiple times over.
“You have to write the rules of the game, and the place to do that would have been these funding contracts,” said Ellen ’t Hoen, the director of Medicines Law and Policy, an international research group.
By comparison, one of the world’s largest health financiers, the Bill & Melinda Gates Foundation, includes grant language requiring equitable access to vaccines. As leverage, the organization retains some right to the intellectual property.
Dr. Slaoui, who came to Warp Speed after leading research and development at GlaxoSmithKline, is sympathetic to this idea. But it would have been impractical to demand patent concessions and still deliver on the program’s primary goals of speed and volume, he said.
“I can guarantee you that the agreements with the companies would have been much more complex and taken a much longer time,” he said. The European Union, for example, haggled over price and liability provisions, which delayed the rollout.
In some ways, this was a trip down a trodden path. When the H1N1 “swine flu” pandemic broke out in 2009, the wealthiest countries cornered the global vaccine market and all but locked out the rest of the world.
Experts said at the time that this was a chance to rethink the approach. But the swine flu pandemic fizzled and governments ended up destroying the vaccines they had hoarded. They then forgot to prepare for the future.
The International View
For months, the United States and European Union have blocked a proposal at the World Trade Organization that would waive intellectual property rights for Covid-19 vaccines and treatments. The application, put forward by South Africa and India with support from most developing nations, has been bogged down in procedural hearings.
“Every minute we are deadlocked in the negotiating room, people are dying,” said Mustaqeem De Gama, a South African diplomat who is involved in the talks.
But in Brussels and Washington, leaders are still worried about undermining innovation.
During the presidential campaign, Mr. Biden’s team gathered top intellectual property lawyers to discuss ways to increase vaccine production.
“They were planning on taking the international view on things,” said Ana Santos Rutschman, a Saint Louis University law professor who participated in the sessions.
Most of the options were politically thorny. Among them was the use of a federal law allowing the government to seize a company’s patent and give it to another in order to increase supply. Former campaign advisers say the Biden camp was lukewarm to this proposal and others that called for a broader exercise of its powers.
The administration has instead promised to give $4 billion to Covax, the global vaccine alliance. The European Union has given nearly $1 billion so far. But Covax aims to vaccinate only 20 percent of people in the world’s poorest countries this year, and faces a $2 billion shortfall even to accomplish that.
Credit: Joao Silva/The New York Times
Dr. Graham, the N.I.H. scientist whose team cracked the coronavirus vaccine code for Moderna, said that pandemic preparedness and vaccine development should be international collaborations, not competitions.
“A lot of this would not have happened unless there was a big infusion of government money,” he said.
But governments cannot afford to sabotage companies that need profit to survive.
Dr. Graham has largely moved on from studying the coronavirus. He is searching for a universal flu vaccine, a silver bullet that could prevent all strains of the disease without an annual tweak.
Though he was vaccinated through work, he spent the early part of the year trying to get his wife and grown children onto waiting lists — an ordeal that even one of the key inventors had to endure. “You can imagine how aggravating that is,” he said.
Matina Stevis-Gridneff and Monika Pronczuk contributed reporting.
Hundreds of COVID-19 vaccine candidates are currently being developed. The way emerging vaccines will be distributed to those who need them is not yet clear. The United States has nowtwice indicated that it would like to secure priority access to doses of COVID-19 vaccine. Other countries, including India and Russia, have taken similar stances. This prioritization of domestic markets has become known as vaccine nationalism.
As a researcher at Saint Louis University’s Center for Health Law Studies, I have been following the COVID-19 vaccine race. Vaccine nationalism is harmful for equitable access to vaccines – and, paradoxically, I’ve concluded it is detrimental even for the U.S. itself.
Vaccine nationalism during COVID-19
Vaccine nationalism occurs when a country manages to secure doses of vaccine for its own citizens or residents before they are made available in other countries. This is done through pre-purchase agreements between a government and a vaccine manufacturer.
On June 15, the German government announced it would be investing 300 million euros (nearly US$340 million) in CureVac for a 23% stake in the company.
In April, the CEO of Sanofi, a French company whose COVID-19 vaccine work has received partial funding from the U.S Biomedical Advanced Research and Development Authority, announced that the U.S. had the “right to the largest pre-order” of vaccine.
At the same time, India, alongside the U.S. and Russia, chose not to join the Access to COVID-19 Tools Accelerator, which was launched by the World Health Organization to promote collaboration among countries in the development and distribution of COVID-19 vaccines and treatments.
Vaccine nationalism is not new
Vaccine nationalism is not new. During the early stages of the 2009 H1N1 flu pandemic, some of the wealthiest countries entered into pre-purchase agreements with several pharmaceutical companies working on H1N1 vaccines. At that time, it was estimated that, in the best-case scenario, the maximum number of vaccine doses that could be produced globally was 2 billion. The U.S. alone negotiated and obtained the right to buy 600,000 doses. All the countries that negotiated pre-purchase orders were developed economies.
Only when the 2009 pandemic began to unwind and demand for a vaccine dropped did developed countries offer to donate vaccine doses to poorer economies.
The problems posed by nationalism
The most immediate effect of vaccine nationalism is that it further disadvantages countries with fewer resources and bargaining power. It deprives populations in the Global South from timely access to vital public health goods. Taken to its extreme, it allocates vaccines to moderately at-risk populations in wealthy countries over populations at higher risk in developing economies.
With modern vaccines, there are very few instances in which a single country can claim to be the sole developer of a vaccine. And even if that were possible, global public health is borderless. As COVID-19 is illustrating, pathogens can travel the globe. Public health responses to outbreaks, which include the deployment of vaccines, have to acknowledge that reality.
How nationalism can backfire in the US
The U.S. in notorious for its high drug prices. Does the U.S. government deserve to obtain exclusive rights for a vaccine that may be priced too high? Such a price may mean that fewer U.S. citizens and residents – especially those who are uninsured or underinsured – would have access to the vaccine. This phenomenon is a form of what economists call deadweight loss, as populations in need of a welfare-enhancing product are priced out. In public health, deadweight loss costs lives.
Secretary Azar has said the U.S. government wants the private sector to invest in vaccine development and manufacturing; if the U.S. sets prices, companies may not make that investment because the vaccines won’t be profitable. This view has been widely criticized. A commentator has called it “bad public health policy,” further pointing out that American taxpayers already fund a substantial amount of vaccine research and development in the U.S. Moreover, as legal scholars have pointed out, there are many regulatory perks and other incentives available exclusively to pharmaceutical companies.
If COVID-19 vaccines are not made available affordably to those who need them, the consequences will likely be disproportionately severe for poorer or otherwise vulnerable and marginalized populations. COVID-19 has already taken a higher toll on black and Latino populations. Without broad access to a vaccine, these populations will likely continue to suffer more than others, leading to unnecessary disease burden, continued economic problems and potential loss of life.
What needs to be done
Nationalism is at odds with global public health principles. Yet, there are no provisions in international laws that prevent pre-purchase agreements like the ones described above. There is nothing inherently wrong with pre-purchase agreements of pharmaceutical products. Vaccines typically do not generate as much in sales as other medical products. If used correctly, pre-purchase agreements can even be an incentive for companies to manufacture vaccines that otherwise would not commercialized. Institutions like Gavi, an international nonprofit based in Geneva, use similar mechanisms to guarantee vaccines for developing countries.
But I see vaccine nationalism as a misuse of these agreements.
Contracts should not trump equitable access to global public health goods. I believe that developed countries should pledge to refrain from reserving vaccines for their populations during public health crises. The WHO’s Access to COVID-19 Tools Accelerator is a starting point for countries to test collaborative approaches during the current pandemic.
But more needs to be done. International institutions – including the WHO – should coordinate negotiations ahead of the next pandemic to produce a framework for equitable access to vaccines during public health crises. Equity entails both affordability of vaccines and access opportunities for populations across the world, irrespective of geography and geopolitics.
Insofar as the U.S. can be considered a leader in the global health arena, I believe it should stop engaging in overly nationalistic behaviors. Failure to do so harms patient populations across the globe. Ultimately, it may harm its own citizens and residents, and perpetuate structural inequalities in our health care system.
Many mass immunization efforts worldwide were halted this spring to prevent spread of the virus at crowded inoculation sites. The consequences have been alarming.
Three-year-old Allay Ngandema, who contracted measles, ate lunch with his mother, Maboa Alpha, in the measles isolation ward in Boso-Manzi hospital in the Democratic Republic of Congo in late February. Credit: Hereward Holland/Reuters.
As poor countries around the world struggle to beat back the coronavirus, they are unintentionally contributing to fresh explosions of illness and death from other diseases — ones that are readily prevented by vaccines.
This spring, after the World Health Organization and UNICEF warned that the pandemic could spread swiftly when children gathered for shots, many countries suspended their inoculation programs. Even in countries that tried to keep them going, cargo flights with vaccine supplies were halted by the pandemic and health workers diverted to fight it.
Now, diphtheria is appearing in Pakistan, Bangladesh and Nepal.
Cholera is in South Sudan, Cameroon, Mozambique, Yemen and Bangladesh.
A mutated strain of poliovirus has been reported in more than 30 countries.
And measles is flaring around the globe, including in Bangladesh, Brazil, Cambodia, Central African Republic, Iraq, Kazakhstan, Nepal, Nigeria and Uzbekistan.
Of 29 countries that have currently suspended measles campaigns because of the pandemic, 18 are reporting outbreaks. An additional 13 countries are considering postponement. According to the Measles and Rubella Initiative, 178 million people are at risk of missing measles shots in 2020.
The risk now is “an epidemic in a few months’ time that will kill more children than Covid,” said Chibuzo Okonta, the president of Doctors Without Borders in West and Central Africa.
As the pandemic lingers, the W.H.O. and other international public health groups are now urging countries to carefully resume vaccination while contending with the coronavirus.
A Doctors Without Borders motorcycle convoy carrying measles vaccine crossed a log bridge in Mongala Province of the Democratic Republic of Congo in February. Credit: Hereward Holland/Reuters.
“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said Dr. Tedros Adhanom Ghebreyesus, director general of the W.H.O., in a statement. “Disruption to immunization programs from the Covid-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.”
But the obstacles to restarting are considerable. Vaccine supplies are still hard to come by. Health care workers are increasingly working full time on Covid-19, the infection caused by the coronavirus. And a new wave of vaccine hesitancy is keeping parents from clinics.
Many countries have yet to be hit with the full force of the pandemic itself, which will further weaken their capabilities to handle outbreaks of other diseases.
“We will have countries trying to recover from Covid and then facing measles. It would stretch their health systems further and have serious economic and humanitarian consequences,” said Dr. Robin Nandy, chief of immunization for UNICEF, which supplies vaccines to 100 countries, reaching 45 percent of children under 5.
The breakdown of vaccine delivery also has stark implications for protecting against the coronavirus itself.
At a global summit earlier this month, Gavi, the Vaccine Alliance, a health partnership founded by the Bill and Melinda Gates Foundation, announced it had received pledges of $8.8 billion for basic vaccines to children in poor and middle-income countries, and was beginning a drive to deliver Covid-19 vaccines, once they’re available.
But as services collapse under the pandemic, “they are the same ones that will be needed to send out a Covid vaccine,” warned Dr. Katherine O’Brien, the W.H.O.’s director of immunization, vaccines and biologicals, during a recent webinar on immunization challenges.
Battling Measles in Congo
Children waited to be registered for the measles vaccine in Mbata-Siala, in western Democratic Republic of Congo, in March. Credit: Junior Kannah/Agence France-Presse — Getty Images.
Three health care workers with coolers full of vaccines and a support team of town criers and note-takers recently stepped into a motorized wooden canoe to set off down the wide Tshopo River in the Democratic Republic of Congo.
Although measles was breaking out in all of the country’s 26 provinces, the pandemic had shut down many inoculation programs weeks earlier.
The crew in the canoe needed to strike a balance between preventing the transmission of a new virus that is just starting to hit Africa hard and stopping an old, known killer. But when the long, narrow canoe pulled in at riverside communities, the crew’s biggest challenge turned out not to be the mechanics of vaccinating children while observing the pandemic’s new safety strictures. Instead, the crew found themselves working hard just to persuade villagers to allow their children to be immunized at all.
Many parents were convinced that the team was lying about the vaccine — that it was not for measles but, secretly, an experimental coronavirus vaccine, for which they would be unwitting guinea pigs.
In April, French-speaking Africa had been outraged by a French television interview in which two researchers said coronavirus vaccines should be tested in Africa — a remark that reignited memories of a long history of such abuses. And in Congo, the virologist in charge of the coronavirus response said that the country had indeed agreed to take part in clinical vaccine trials this summer. Later, he clarified that any vaccine would not be tested in Congo until it had been tested elsewhere. But pernicious rumors had already spread.
The team cajoled parents as best they could. Although vaccinators throughout Tshopo ultimately immunized 16,000 children, 2,000 others eluded them.
This had been the year that Congo, the second-largest country in Africa, was to launch a national immunization program. The urgency could not have been greater. The measles epidemic in the country, which started in 2018, has run on and on: Since this January alone, there have been more than 60,000 cases and 800 deaths. Now, Ebola has again flared, in addition to tuberculosis and cholera, which regularly strike the country.
Vaccines exist for all these diseases, although they are not always available. In late 2018, the country began an immunization initiative in nine provinces. It was a feat of coordination and initiative, and in 2019, the first full year, the percentage of fully immunized children jumped from 42 to 62 percent in Kinshasa, the capital.
This spring, as the program was being readied for its nationwide rollout, the coronavirus struck. Mass vaccination campaigns, which often mean summoning hundreds of children to sit close together in schoolyards and markets, seemed guaranteed to spread coronavirus. Even routine immunization, which typically occurs in clinics, became untenable in many areas.
The country’s health authorities decided to allow vaccinations to continue in areas with measles but no coronavirus cases. But the pandemic froze international flights that would bring medical supplies, and several provinces began running out of vaccines for polio, measles and tuberculosis.
When immunization supplies finally arrived in Kinshasa, they could not be moved around the country. Domestic flights had been suspended. Ground transport was not viable because of shoddy roads. Eventually, a United Nations peacekeeping mission ferried supplies on its planes.
Still, health workers, who had no masks, gloves or sanitizing gel, worried about getting infected; many stopped working. Others were diverted to be trained for Covid.
The cumulative impact has been particularly dire for polio eradication — around 85,000 Congolese children have not received that vaccine.
But the disease that public health officials are most concerned about erupting is measles.
More contagious than Covid
Health workers immunizing against measles in Manila last month. Credit: Aaron Favila/Associated Press.
Measles virus spreads easily by aerosol — tiny particles or droplets suspended in the air — and is far more contagious than the coronavirus, according to experts at the Centers for Disease Control and Prevention.
“If people walk into a room where a person with measles had been two hours ago and no one has been immunized, 100 percent of those people will get infected,” said Dr. Yvonne Maldonado, a pediatric infectious disease expert at Stanford University.
In poorer countries, the measles mortality rate for children under 5 ranges between 3 and 6 percent; conditions like malnutrition or an overcrowded refugee camp can increase the fatality rate. Children may succumb to complications such as pneumonia, encephalitis and severe diarrhea.
In 2018, the most recent year for which data worldwide has been compiled, there were nearly 10 million estimated cases of measles and 142,300 related deaths. And global immunization programs were more robust then.
Before the coronavirus pandemic in Ethiopia, 91 percent of children in the capital, Addis Ababa, received their first measles vaccination during routine visits, while 29 percent in rural regions got them. (To prevent an outbreak of a highly infectious disease like measles, the optimum coverage is 95 percent or higher, with two doses of vaccine.) When the pandemic struck, the country suspended its April measles campaign. But the government continues to report many new cases.
“Outbreak pathogens don’t recognize borders,” said Dr. O’Brien of the W.H.O. “Especially measles: Measles anywhere is measles everywhere.”
Wealthier countries’ immunization rates have also been plunging during the pandemic. Some American states report drops as steep as 70 percent below the same period a year earlier, for measles and other diseases.
Once people start traveling again, the risk of infection will surge. “It keeps me up at night,” said Dr. Stephen L. Cochi, a senior adviser at the global immunization division at the C.D.C. “These vaccine-preventable diseases are just one plane ride away.”
Starting again
Hawa Hamadou, a health worker at the Gamkalé health center in Niamey, Niger, has seen a drop in visits by mothers, who are afraid to bring their children for immunizations. Credit: Juan Haro/UNICEF.
After the W.H.O. and its vaccine partners released the results of a survey last month showing that 80 million babies under a year old were at risk of missing routine immunizations, some countries, including Ethiopia, the Central African Republic and Nepal, began trying to restart their programs.
Uganda is now supplying health workers with motorbikes. In Brazil, some pharmacies are offering drive-by immunization services. In the Indian state of Bihar, a 50-year-old health care worker learned to ride a bicycle in three days so she could take vaccines to far-flung families. UNICEF chartered a flight to deliver vaccines to seven African countries.
Dr. Cochi of the C.D.C., which provides technical and program support to more than 40 countries, said that whether such campaigns can be conducted during the pandemic is an open question. “It will be fraught with limitations. We’re talking low-income countries where social distancing is not a reality, not possible,” he said, citing Brazilian favelas and migrant caravans.
He hopes that polio campaigns will resume swiftly, fearing that the pandemic could set back a global, decades-long effort to eradicate the disease.
Dr. Cochi is particularly worried about Pakistan and Afghanistan, where 61 cases of wild poliovirus Type 1 have been reported this year, and about Chad, Ghana, Ethiopia and Pakistan, where cases of Type 2 poliovirus, mutated from the oral vaccine,have appeared.
Thabani Maphosa, a managing director at Gavi, which partners with 73 countries to purchase vaccines, said that at least a half dozen of those countries say they cannot afford their usual share of vaccine costs because of the economic toll of the pandemic.
If the pandemic cleared within three months, Mr. Maphosa said, he believed the international community could catch up with immunizations over the next year and a half.
“But our scenarios are not telling us that will happen,” he added.
Jan Hoffman reported from New York, and Ruth Maclean from Dakar, Senegal.
What’s the risk of catching coronavirus from a surface? Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Does asymptomatic transmission of Covid-19 happen? So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
How does blood type influence coronavirus? A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How many people have lost their jobs due to coronavirus in the U.S.? The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Will protests set off a second viral wave of coronavirus? Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
How do we start exercising again without hurting ourselves after months of lockdown? Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
My state is reopening. Is it safe to go out?States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
What are the symptoms of coronavirus? Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How can I protect myself while flying? If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
How do I take my temperature? Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
Should I wear a mask? The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
What should I do if I feel sick?If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Two women hold anti-vaccination signs during a protest against Governor Jay Inslee’s stay-at-home order outside the State Capitol in Olympia, Washington on May 9, 2020. JASON REDMOND/AFP/Getty Images
Misinformation is taking a dangerous hold on Fox News viewers. According to a new poll, half of all Americans who name Fox News as their primary news source believe the debunked conspiracy theory claiming Bill Gates is looking to use a coronavirus vaccine to inject a microchip into people and track the world’s population.
The Yahoo News/YouGov poll, released on Friday, found that 44 percent of Republicans also buy into the unfounded claim, while just 19 percent of Democrats believe the lie about the Microsoft co-founder and philanthropist.
According to Yahoo’s report on the poll, neither Fox News nor President Trump has promoted the false Gates conspiracy. But sowing seeds of distrust of mainstream media and the spread of misinformation is a hallmark of the network and the current president. Last month, Fox primetime host Laura Ingraham shared a tweet where she expressed agreement with a user who wrote about the debunked conspiracy theory.
“Digitally tracking Americans’ every move has been a dream of the globalists for years. This health crisis is the perfect vehicle for them to push this,” Ingraham wrote.
The poll also found that just 15 percent of MSNBC viewers believe the untrue conspiracy theory which, according to the fact-checking publication Snopes, began with the anti-vaccine movement. They chose to target Gates specifically because of his decade-long advocacy for vaccines.
According to an April report in the New York Times that looked into the right-wing targeting of Gates, media analysis company Zignal Labs found that “misinformation about Gates is now the most widespread of all coronavirus falsehoods” that the company has tracked.
This debunked conspiracy theory could be especially menacing if it deters any portion of the population from getting vaccinated, if and when one becomes available, which would then make it much tougher to rid the world of the virus.
In another poll released on Friday by Reuters/Ipsos showed increasing mistrust in the president due to his consistent habit of sharing misinformation. Thirty-six percent of those surveyed said they would be less willing to take a vaccine if it were endorsed by the president.
The picture these polls paint is both sad and obviously dangerous for all of us, especially with the current pandemic. Unfortunately, our country’s lack of trustworthy leadership means that more and more people are susceptible to bad and untrue advice that is rampant on random Reddit forums, Facebook posts and, yes, even TikTok — where conspiracy theories are paired with viral dances.
David D. Kirkpatrick, The New York Times – 28 de abril de 2020
Na corrida mundial por uma vacina contra o novo coronavírus, o laboratório que está na frente fica na Universidade de Oxford.
A maioria das outras equipes teve de começar com pequenos testes clínicos em umas centenas de participantes para demonstrar que se trata de uma vacina segura. Ocorre que os cientistas do Jenner Institute da universidade começaram mais rapidamente os trabalhos em uma vacina porque já haviam provado em testes anteriores que tais inoculações – inclusive uma no ano passado contra um coronavírus inicial – não eram prejudiciais para o ser humano.
Isto lhes permitiu sair na dianteira e marcar os testes com a sua nova vacina contra o coronavírus com mais de 6 mil pessoas até o final do próximo mês, na esperança de demonstrar que não só é segura, como também funciona.
Os cientistas de Oxford agora afirmam que se as autoridades reguladoras concederem uma aprovação de emergência, os primeiros milhões de doses poderão estar disponíveis até setembro – pelo menos vários meses antes de qualquer outro esforço anunciado – desde que se revele eficaz.
Agora, eles receberam a promissora notícia de que isto será possível.
Os cientista dos National Institutes of Health’s Rocky Mountain Laboratory de Montana, inocularam, no mês passado, seis macacos rhesus com doses únicas da vacina de Oxford. Os animais então foram expostos a grandes quantidades do vírus que está causando a pandemia – exposição que fez com que outros macacos no laboratório ficassem bastante doentes. Mas mais de 28 dias mais tarde, todos os seis estavam saudáveis, disse Vincent Munster, o pesquisador que conduziu o teste.
“O macaco rhesus é o ser mais próximo do humano que nós temos”, disse Munster, observando que os cientistas ainda estavam analisando o resultado. Ele agora espera compartilhá-lo com outros cientistas na próxima semana e depois submetê-lo a uma publicação para a revisão de pares.
A imunidade em macacos não garante que uma vacina proporcione o mesmo grau de proteção aos seres humanos. Uma companhia chinesa que começou recentemente um teste clínico com 144 participantes, a Sino Vac, também afirmou que a sua vacina se mostrou eficaz em macacos rheseus. Mas com dezenas de experimentos atualmente em curso para encontrar uma vacina, os resultados apresentados pelos macacos são a mais recente indicação de que o esforço acelerado de Oxford está se destacando como o primeiro indicador de sucesso.
“Trata-se de um programa clínico extremamente rápido”, afirmou Emilio Emini, um diretor do programa de vacinas da Fundação Bill e Melinda Gates, que está dando o suporte financeiro a muitos experimentos concorrentes neste sentido no atual momento.
Saber qual será a vacina potencial que sairá destes esforços todos como a mais bem-sucedida será impossível enquanto não estiverem disponíveis os dados dos testes clínicos.
Em todo caso, será necessária mais de uma vacina, segundo Emini. Algumas poderão funcionar melhor do que outras em grupos como crianças e idosos, ou por custos e dosagens diferentes. Dispor de mais de uma variedade de vacinas em produção ajudará também a evitar gargalos na fabricação, ele afirmou.
Mas sendo a primeira a atingir uma escala relativamente tão ampla, a que será testada em Oxford, mesmo que fracasse, fornecerá lições tais sobre a natureza do coronavírus e sobre as respostas do sistema imunológico que poderão informar governos, doadores, laboratórios farmacêuticos e ouros cientistas na busca de uma vacina.
“Este amplo estudo britânico”, disse Emini, “se traduzirá na realidade também em um profundo aprendizado sobre algumas das outras”.
Todas as outras enfrentarão os mesmos desafios, inclusive para a obtenção de milhões de dólares em financiamentos, convencendo as autoridades reguladoras a aprovarem testes em humanos, demonstrando a sua segurança e – depois disso – provando a sua eficiência na proteção das pessoas contra o coronavírus.
Paradoxalmente, o crescente sucesso dos esforços para conter o avanço da covid-19, a doença causada pelo vírus, poderá apresentar mais um obstáculo.
“Somos as únicas pessoas do país que querem que o número de novas infecções continue por mais algumas semanas, a fim de podermos testar a nossa vacina,” o professor Adrian Hill, diretor do Jenner Institute, um dos cinco pesquisadores envolvidos na iniciativa, afirmou em uma entrevista em um edifício do laboratório esvaziado pelo fechamento imposto na Grã-Bretanha há um mês.
As normas éticas, como princípio geral, proíbem a tentativa de infectar participantes de testes humanos com uma doença grave. Isto significa que a única maneira de provar que uma vacina é eficaz é inoculando pessoas em um lugar em que o vírus se espalha naturalmente ao seu redor.
Se as medidas de distanciamento social ou outros fatores continuarem reduzindo a taxa de novas infecções no Reino Unido, ele disse, o teste talvez não possa mostrar que a vacina faz uma diferença: os participantes que receberam um placebo poderão não ser infectados mais frequentemente do que os que receberam a vacina. Os cientistas teriam de tentar novamente em outro lugar, um dilema que todos os outros experimentos para a obtenção de uma vacina também terão de enfrentar.
A iniciativa do Jenner Institute contra o coronavírus usa uma tecnologia que se concentra na alteração do código genético de um vírus conhecido. Uma vacina clássica usa uma versão mais fraca de um vírus para desencadear a resposta imunológica. Mas na tecnologia que o instituto está utilizando, um vírus diferente é modificado anteriormente a fim de neutralizar os seus efeitos e então torná-lo uma imitação de um vírus determinado – neste caso, o vírus que causa a covid-19. Injetado na corrente sanguínea, o impostor inócuo pode induzir o sistema imunológico a combater e matar a doença, proporcionando uma proteção.
Hill trabalhou com esta tecnologia por dezenas de anos para tentar agarrar um vírus de uma doença respiratória encontrado em chimpanzés a fim de provocar uma resposta imunológica humana contra a malária e outras moléstias. Nos últimos 20 anos, o instituto realizou mais de 70 testes clínicos de vacinas em potencial contra o parasita que causa a malária. Nenhum ainda levou a uma inoculação bem-sucedida.
No entanto, em 2014, uma vacina baseada no vírus do chimpanzé que Hill havia testado foi fabricada em uma escala suficientemente ampla para fornecer 1 milhão de doses. Isto criou um modelo para a produção em massa da vacina contra o coronavírus, no caso de ela se revelar eficiente.
A professora Sarah Gilbert, sua colega de longa data, modificou o mesmo vírus do chimpanzé para fazer uma vacina contra um primeiro coronavírus, na síndrome respiratória do Oriente Médio (MERS). Depois que um teste clínico, no Reino Unido, mostrou que era segura. Outro teste começou em dezembro na Arábia Saudita, onde surtos da doença letal ainda são comuns.
Quando em janeiro ela ouvia falar que cientistas chineses haviam identificado o código genético de um misterioso vírus em Wuhan, ela pensou que poderia ter a chance de pôr à prova a celeridade e a versatilidade da sua abordagem.
“Nós pensamos: ‘Bom, será que vamos poder tentar?’, ela lembra. “‘Será um pequeno projeto de laboratório, e depois publicaremos um paper’”.
Mas não permaneceu um “pequeno projeto de laboratório” por muito tempo.
Com a explosão da pandemia, eles passaram a receber muitas subvenções. Todas as outras vacinas foram postas em um freezer para o laboratório do instituto concentrar-se totalmente na covid-19. Entretanto, o fechamento do prédio obrigou todo mundo a não trabalhar na covid-19 e a ficar em casa.
Os doadores já gastam dezenas de milhões de dólares para dar início ao processo de produção em instalações no Reino Unido e na Holanda, antes mesmo que a vacina comprove que funciona, disse Sandy Douglas, um cientista de Oxford que supervisiona a produção de vacinas.
“Não há outra alternativa”, afirmou.
Mas a equipe ainda não chegou a um acordo com um fabricante da América do Norte, em parte porque os principais laboratórios farmacêuticos exigem, como sempre, direitos mundiais exclusivos antes de investir em um medicamento em potencial.
“Pessoalmente, não acredito que em uma época de pandemia deva haver licenças exclusivas”, disse Hill. “Por isso estamos conversando com vários laboratórios. Ninguém vai ganhar um monte de dinheiro com isto”.
Enquanto isso, com os dados sobre a segurança dos testes em humanos de vacinas semelhantes contra o Ebola, a MERS e a malária, os cientistas do instituto de Oxford convenceram as autoridades reguladoras britânicas a permitirem testes inusitadamente acelerados para aproveitar que a pandemia ainda está ao seu redor.
Na semana passada, o instituto começou a Fase I de um teste clínico que envolve 1.100 pessoas. No próximo mês, começará o teste crucial da Fase II e da Fase III que envolverá outras 5 mil. Ao contrário de qualquer outro projeto de vacina atualmente em andamento, esse deverá provar sua eficiência e segurança.
Os cientistas declararão vitória se uma dezenas de participantes que receberem um placebo adoecerem com a covid-19, em comparação com apenas um ou dois que forem vacinados. “Então faremos uma festa e contaremos para o mundo,” disse Hill. Todos os que receberem somente o placebo também serão vacinados imediatamente.
Se poucos participantes forem infectados no Reino Unido, o instituto planeja a realização de outros testes onde o coronavírus estiver se espalhando, provavelmente na África e na Índia.
“Precisamos caçar a epidemia”, disse Hill. “Se ainda estiver devastando alguns países, talvez possamos realizar testes nos Estados Unidos em novembro”. / TRADUÇÃO DE ANNA CAPOVILLA
Scientists and science communicators are engaged in a constant battle with ignorance. But that’s an approach doomed to failure
Be quiet. It’s good for you. Photograph: Gareth Fuller/PA
Tuesday 23 August 2016 08.00 BST. Last modified on Tuesday 23 August 2016 11.33 BST
A video did the rounds a couple of years ago, of some self-styled “skeptic” disagreeing – robustly, shall we say – with an anti-vaxxer. The speaker was roundly cheered by everyone sharing the video – he sure put that idiot in their place!
Scientists love to argue. Cutting through bullshit and getting to the truth of the matter is pretty much the job description. So it’s not really surprising scientists and science supporters frequently take on those who dabble in homeopathy, or deny anthropogenic climate change, or who oppose vaccinations or genetically modified food.
It makes sense. You’ve got a population that is – on the whole – not scientifically literate, and you want to persuade them that they should be doing a and b (but not c) so that they/you/their children can have a better life.
Brian Cox was at it last week, performing a “smackdown” on a climate change denier on the ABC’s Q&A discussion program. He brought graphs! Knockout blow.
And yet … it leaves me cold. Is this really what science communication is about? Is this informing, changing minds, winning people over to a better, brighter future?
I doubt it somehow.
There are a couple of things here. And I don’t think it’s as simple as people rejecting science.
First, people don’t like being told what to do. This is part of what Michael Gove was driving at when he said people had had enough of experts. We rely on doctors and nurses to make us better, and on financial planners to help us invest. We expect scientists to research new cures for disease, or simply to find out how things work. We expect the government to try to do the best for most of the people most of the time, and weather forecasters to at least tell us what today was like even if they struggle with tomorrow.
But when these experts tell us how to live our lives – or even worse, what to think – something rebels. Especially when there is even the merest whiff of controversy or uncertainty. Back in your box, we say, and stick to what you’re good at.
We saw it in the recent referendum, we saw it when Dame Sally Davies said wine makes her think of breast cancer, and we saw it back in the late 1990s when the government of the time told people – who honestly, really wanted to do the best for their children – to shut up, stop asking questions and take the damn triple vaccine.
Which brings us to the second thing.
On the whole, I don’t think people who object to vaccines or GMOs are at heart anti-science. Some are, for sure, and these are the dangerous ones. But most people simply want to know that someone is listening, that someone is taking their worries seriously; that someone cares for them.
It’s more about who we are and our relationships than about what is right or true.
This is why, when you bring data to a TV show, you run the risk of appearing supercilious and judgemental. Even – especially – if you’re actually right.
People want to feel wanted and loved. That there is someone who will listen to them. To feel part of a family.
The physicist Sabine Hossenfelder gets this. Between contracts one time, she set up a “talk to a physicist” service. Fifty dollars gets you 20 minutes with a quantum physicist … who will listen to whatever crazy idea you have, and help you understand a little more about the world.
How many science communicators do you know who will take the time to listen to their audience? Who are willing to step outside their cosy little bubble and make an effort to reach people where they are, where they are confused and hurting; where they need?
Atul Gawande says scientists should assert “the true facts of good science” and expose the “bad science tactics that are being used to mislead people”. But that’s only part of the story, and is closing the barn door too late.
Because the charlatans have already recognised the need, and have built the communities that people crave. Tellingly, Gawande refers to the ‘scientific community’; and he’s absolutely right, there. Most science communication isn’t about persuading people; it’s self-affirmation for those already on the inside. Look at us, it says, aren’t we clever? We are exclusive, we are a gang, we are family.
That’s not communication. It’s not changing minds and it’s certainly not winning hearts and minds.
Uma (in)certa antropologia 
Be quiet. It’s good for you. Photograph: Gareth Fuller/PA
Tuesday 23 August 2016 08.00 BST. Last modified on Tuesday 23 August 2016 11.33 BST
A video did the rounds a couple of years ago, of some self-styled “skeptic” disagreeing – robustly, shall we say – with an anti-vaxxer. The speaker was roundly cheered by everyone sharing the video – he sure put that idiot in their place!
Scientists love to argue. Cutting through bullshit and getting to the truth of the matter is pretty much the job description. So it’s not really surprising scientists and science supporters frequently take on those who dabble in homeopathy, or deny anthropogenic climate change, or who oppose vaccinations or genetically modified food.
It makes sense. You’ve got a population that is – on the whole – not scientifically literate, and you want to persuade them that they should be doing a and b (but not c) so that they/you/their children can have a better life.
Brian Cox was at it last week, performing a “smackdown” on a climate change denier on the ABC’s Q&A discussion program. He brought graphs! Knockout blow.
And yet … it leaves me cold. Is this really what science communication is about? Is this informing, changing minds, winning people over to a better, brighter future?
I doubt it somehow.
There are a couple of things here. And I don’t think it’s as simple as people rejecting science.
First, people don’t like being told what to do. This is part of what Michael Gove was driving at when he said people had had enough of experts. We rely on doctors and nurses to make us better, and on financial planners to help us invest. We expect scientists to research new cures for disease, or simply to find out how things work. We expect the government to try to do the best for most of the people most of the time, and weather forecasters to at least tell us what today was like even if they struggle with tomorrow.
We saw it in the recent referendum, we saw it when Dame Sally Davies said wine makes her think of breast cancer, and we saw it back in the late 1990s when the government of the time told people – who honestly, really wanted to do the best for their children – to shut up, stop asking questions and take the damn triple vaccine.
Which brings us to the second thing.
On the whole, I don’t think people who object to vaccines or GMOs are at heart anti-science. Some are, for sure, and these are the dangerous ones. But most people simply want to know that someone is listening, that someone is taking their worries seriously; that someone cares for them.
It’s more about who we are and our relationships than about what is right or true.
This is why, when you bring data to a TV show, you run the risk of appearing supercilious and judgemental. Even – especially – if you’re actually right.
People want to feel wanted and loved. That there is someone who will listen to them. To feel part of a family.
The physicist Sabine Hossenfelder gets this. Between contracts one time, she set up a “talk to a physicist” service. Fifty dollars gets you 20 minutes with a quantum physicist … who will listen to whatever crazy idea you have, and help you understand a little more about the world.
How many science communicators do you know who will take the time to listen to their audience? Who are willing to step outside their cosy little bubble and make an effort to reach people where they are, where they are confused and hurting; where they need?
Atul Gawande says scientists should assert “the true facts of good science” and expose the “bad science tactics that are being used to mislead people”. But that’s only part of the story, and is closing the barn door too late.
Because the charlatans have already recognised the need, and have built the communities that people crave. Tellingly, Gawande refers to the ‘scientific community’; and he’s absolutely right, there. Most science communication isn’t about persuading people; it’s self-affirmation for those already on the inside. Look at us, it says, aren’t we clever? We are exclusive, we are a gang, we are family.
That’s not communication. It’s not changing minds and it’s certainly not winning hearts and minds.
It’s tribalism.