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How U.K. and Israel raced to global lead in covid vaccinations

InternationalFeb 28. 2021People queue outside a covid-19 mass vaccination center at Rabin Square in this aerial photograph taken in Tel Aviv, Israel, on Jan. 4, 2020. MUST CREDIT: Bloomberg photo by Kobi Wolf.

By Syndication Washington Post, Bloomberg · Eric Pfanner

The U.K. and Israel have raced ahead of most of the rest of the world in covid-19 vaccinations, speeding shots to millions of people.

Although new variants of the coronavirus are raising concern, the crash immunization programs show signs of working. Case numbers, hospitalizations and deaths are falling in both countries, allowing their governments to set out plans for reopening.

Bloomberg News spoke with Kate Bingham, former head of the U.K.’s Vaccine Taskforce, and Ran Balicer, chair of the covid advisory committee at Israel’s Ministry of Health, about how these countries were able to move so quickly and what the world can do to prepare for future pandemic challenges. Their comments have been edited for clarity.

Q: When buying vaccines, you had to lock in supplies without knowing which shots would work. How did you decide what to acquire?

Bingham: Our approach was to build a portfolio of different vaccines. That meant blending the most clinically advanced vaccines, about which we knew the least — which are the mRNA vaccines and the adenoviral-based vaccines — with the more established vaccine formats. That’s the protein adjuvant-based vaccines and the whole inactivated virus vaccines. So our approach was to pick the most promising across the different formats, with the hope that at least one or more of them would be successful.

A: In Israel you’ve done it largely with one vaccine so far. How did that come about?

Balicer: Israel was fortunate to get enough from Pfizer to allow a very wide vaccination campaign. The vast majority of our populations at risk have now been covered. We are beginning to see the benefits of this vaccination program as we see a massive decline in the rates of severe morbidity.

Q: Some people in the European Union are skeptical about the AstraZeneca vaccine, which the U.K. is relying on alongside the Pfizer shot. How well does it work?

Bingham: When you’re running different trials in different places with different mutations, it may not be exactly apples to apples, but the evidence we’re seeing out of Scotland is that the AstraZeneca vaccine is demonstrating a higher level of reduction in hospitalization versus the Pfizer vaccine. But the fact is both are effective, both are safe and if anyone gets offered those vaccines they should take them.

Q: How will the new variants affect strategies, and how well are we prepared to deal with them?

Bingham: Part of our strategy has been to make sure we are able to pivot quickly if there are serious mutations that evade the current vaccines. At the moment that’s not the case. The evidence we have is that the vaccines we’ve got will address the U.K. variant and the South African variant and the Brazil variant. We have doses coming from Novavax, which shows very profound effects against those different variants.

Beyond that we have two different strategies. One is to explore mixing and matching different vaccines so as to provoke different immune responses. And we’ve invested in manufacturing so that we can pivot quickly to update the vaccines to address those potential variants if they evade the current responses.

Balicer: The U.K. variant was the key driver of the surge in new cases we’ve seen in recent months. We’ve been able to get it under control thanks at least in part to the massive vaccination campaign, which our data suggests has been highly effective. All of the data we have about vaccine effectiveness stems from the time when the new variant was the dominant strain of the virus, so this is good news.

At some point we will have strategies mixing and matching different vaccines, and I also believe both Pfizer and Moderna will be able to create new adapted vaccines that will be more appropriate for those new variants as they come along.

Q: Do you think that at some point we’ll get so-called multivalent vaccines that work against whatever new variant comes along?

Balicer: We haven’t been able to do that for flu, but flu is mutating in a different way from coronavirus. While I maintain the hopes, I’m not sure we’ll be able to develop such a vaccine. We might need to update our vaccine campaign on a yearly basis or a seasonal basis depending on the variants that come in. I think the jury is still out on this question.

Q: How much of a responsibility do the U.K. or Israel have to ensure equitable vaccine distribution around the world?

Balicer: As a small country, there’s fairly little that can be done. What we are trying to do is get evidence out about the effectiveness of the vaccine, and in that way help other countries tackle vaccine hesitancy.

Bingham: It was a core responsibility and one that we’ve taken very seriously. An important part of what we’ve done in the U.K. is to make sure that the clinical trials we’ve supported and run generate data that can then be used by regulators around the world to make sure those vaccines are approved as quickly as possible.

Q: This won’t be the last pandemic the world faces. What can we do to respond even more quickly next time around?

Bingham: The current vaccines, albeit highly effective, are not particularly suitable for widespread distribution around the world. We have costly cold chains and storage, complicated logistics, we’re using glass. We need to find formats that address all of that — scalable, stable, cheap, ideally no health-care professionals involved, so no needles, no on-site dilutions. That is where we should be investing.

Balicer: We also need to improve our surveillance mechanisms. It’s thanks to the tremendous efforts of the U.K. which has been doing massive, systematic sequencing that we have the information in time for other countries to prepare for whatever the variants will bring in. Our surveillance mechanisms need to be harmonized to allow us to reach conclusions in a quicker way.

We need to improve our ability to create less costly and less fastidious vaccines that we will be able to produce quickly and disseminate in all countries regardless of their ability to have more expensive logistics in place.

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House Democrats pass Biden’s $1.9 trillion relief plan despite setback on minimum wage

InternationalFeb 28. 2021House Speaker Nancy Pelosi

By The Washington Post · Erica Werner, Jeff Stein

WASHINGTON – The House approved President Biden’s $1.9 trillion stimulus plan early Saturday and sent it to the Senate, as Democrats defied united GOP opposition to advance the massive relief package aimed at stabilizing the economy and boosting coronavirus vaccinations and testing.

The legislation, Biden’s first major agenda item, passed 219-212. Republicans unanimously opposed the bill, a strikingly partisan outcome just a month after the new president was inaugurated with calls for bipartisanship and unity. All but two Democrats voted in favor.

The vote closed shortly after 2 a.m. Saturday after a long day of debate, with Republicans repeatedly decrying the legislation as a partisan boondoggle and Democrats defending it as much-needed relief. Even bigger fights await in the Senate, where Democratic unity will face greater tests.

The action in the House came after the Senate parliamentarian ruled that the $15 minimum wage in the legislation is not permitted under Senate rules. House Democrats included it anyway, and it’s not clear how the issue will get resolved.

Ahead of the vote House Speaker Nancy Pelosi, D-Calif., pledged that even if the Senate takes out the minimum-wage increase – the No. 1 priority for many liberals – the House will “absolutely” pass the revised legislation and send it to Biden to sign.

“The sooner we pass the bill and it is signed, the sooner we can make the progress that this legislation is all about – saving the lives and the livelihood of the American people,” Pelosi said at a news conference Friday.

Beyond the minimum-wage increase, the sprawling relief bill would provide $1,400 stimulus payments to tens of millions of American households; extend enhanced federal unemployment benefits through August; provide $350 billion in aid to states, cities, U.S. territories and tribal governments; and boost funding for vaccine distribution and coronavirus testing – among myriad other measures, such as nutritional assistance, housing aid and money for schools.

Democrats hope to push the legislation through both chambers and get it signed into law by March 14, when enhanced unemployment benefits are set to expire. It is uncertain whether disputes over the minimum wage or other issues could complicate that timeline, although Pelosi insisted Friday that the March 14 deadline would be met, adding: “I would like it well before that.”

On Thursday night, the Senate’s parliamentarian ruled the wage hike as written could not proceed under reconciliation, the budgetary maneuver Democrats are using to pass the stimulus bill through the Senate without GOP votes.

Liberals erupted, with some even suggesting the nonpartisan parliamentarian should be fired, but Pelosi and other House leaders indicated Friday they’re ready to move beyond the dispute and save the minimum-wage fight for another day, while insisting they’d get it done one way or another.

As an alternative to the minimum-wage increase, Senate Democrats are exploring a tax hike on large corporations that do not pay a $15-an-hour minimum wage. Senate Majority Leader Chuck Schumer, D-N.Y., is considering a move to include the provision in the relief bill in the Senate, according to two Democratic aides who spoke on the condition of anonymity to discuss internal thinking. It was uncertain whether the proposal would prove viable or command enough support to advance.

The vote on the massive legislation came as the economy showed some signs of progress. Personal income rose 10 percent in January, the Commerce Department reported Friday, thanks largely to the December stimulus package Congress passed. New claims for unemployment insurance fell sharply last week as coronavirus cases continue to decrease and vaccine distribution becomes more widespread.

Still, only slightly more than half the 20 million jobs lost during the pandemic have returned, and Federal Reserve Chair Jerome Powell has said the real unemployment rate is closer to 10 percent, meaning the economy has a long way to go to recover to its pre-pandemic levels.

Congressional Republicans argued throughout hours of debate Friday and early Saturday that Biden’s stimulus is poorly targeted and too expensive, and that it includes measures unrelated to the pandemic. Congress approved some $4 trillion to fight the pandemic last year, including $900 billion in December, and Republicans said that is more than enough, especially in light of signs the economy is improving.

“This isn’t a relief bill. It takes care of Democrats’ political allies while it fails to deliver for American families,” said House Minority Leader Kevin McCarthy, R-Calif. “We already know what is the best stimulus plan out there: It is to fully reopen our economy. To do that, we need our economy to go back to work, back to school and back to health.”

Democrats, however, argued that more financial assistance is sorely needed for families, and more money should be directed to boost vaccine development and production and help the health-care system days after the country reached the grim milestone of 500,000 covid deaths.

“If you don’t think Congress has more work to do here, then you either don’t get what American families are going through, or you don’t care. I don’t know how else to say it,” said House Budget Committee Chairman John Yarmuth, D-Ky. “Well, we cannot wait, and we aren’t going to wait.”

Democrats and Republicans also sparred over the process, with Republicans complaining that they had been shut out of negotiations. Democrats argued that even if the legislation did not command support among Republicans in Congress, it was broadly supported by the public – and by many GOP mayors and some governors.

Biden made some efforts at bipartisan outreach after unveiling his proposal, including meeting with a group of 10 Senate Republicans who made a $618 billion counteroffer. He ultimately dismissed their ideas as too meager and made the decision to move forward without GOP support, repeatedly defending his proposal in recent days and challenging critics to tell him: “What would they have me cut?”

Republicans fumed over Democrats’ go-it-alone approach, but Democrats countered that Republicans took the same tack when they controlled both chambers of Congress and the White House at the start of the Trump administration and pushed through an unpaid-for $1.5 trillion tax-cut bill.The two Democrats opposing the legislation Saturday were Kurt Schrader of Oregon and Jared Golden of Maine. Golden has argued that the House should have pursued a stand-alone vote on a vaccine-funding bill before turning to larger relief legislation.

While House passage of the legislation had been all but assured, the outlook is trickier in the Senate, where moderate Democrats have raised questions about a number of provisions, including the structure of the state and local aid. The Senate is split 50-50 between Democrats and Republicans, so if Republicans remain opposed, Democrats can pass the legislation only if they stay united and Vice President Kamala Harris breaks the tie.

The budget reconciliation process allows legislation to pass the Senate with a simple majority vote instead of the 60 votes usually required. But it also contains limitations, prohibiting certain measures that do not affect the federal budget in particular ways. The parliamentarian determined that the minimum wage did not pass that test.

If the Senate passes the bill without the minimum-wage increase and sends it back to the House, liberals will have to make peace with supporting it anyway. Raising the minimum wage from its current level of $7.25 an hour was some liberals’ top priority in the bill, and they were irate over the parliamentarian’s decision. Some called on Schumer to try to overturn it or move to eliminate the filibuster, the 60-vote threshold that protects minority rights in the Senate.

“Democrats are just going to have to make a choice about using, really going to the mat and really using every lever of power that we have to govern for the majority of the American people,” said Rep. Pramila Jayapal, D-Wash., chair of the Congressional Progressive Caucus. “In two years, I don’t think we can go back to voters and say, ‘Look, I know Republicans, Democrats, independents support this, we promised it, but because of an unelected parliamentarian who gave us a ruling, we couldn’t do it.’ “

The White House, however, has indicated that Biden intends to respect the parliamentarian’s ruling. And Democrats do not have the votes to overrule the parliamentarian or eliminate the filibuster in the Senate anyway, because of opposition from at least two moderate Senate Democrats: West Virginia’s Joe Manchin and Arizona’s Kyrsten Sinema.