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Logistical hurdles and missteps could drive slower vaccination campaigns. But states may also be falling behind because of high levels of vaccine hesitancy. If that's the case, it will take more than just opening up eligibility to get the country to levels of vaccination that can reach herd immunity — when roughly 70 percent of people are vaccinated, making it too difficult for the virus to spread.

Scientists have already found that vaccines using different technologies can vary in their effectiveness. The strongest vaccines include Moderna and Pfizer-BioNTech, both of which are based on RNA molecules.

Some preliminary studies suggest that these markers — known as correlates of protection — exist for Covid-19 vaccines. Research is underway to find them.

Clinical trials showed that the vaccine had an efficacy of 95 percent against the original version of the coronavirus. But a variant called Alpha, first identified in Britain, lowered the effectiveness to 89.5 percent.

Pfizer has begun a trial to test both options. Some volunteers who have already received two doses of their vaccine will get a third dose of the same shot as a booster. As part of the same trial, researchers will give other volunteers an experimental booster designed to protect against the Beta variant.

Dr. Hensley says it’s wise to prepare for the possibility that boosters will be needed. But he hoped that they didn’t become a distraction from the pressing need to get first doses to billions of people across the world.

"I do believe that the US is obligated to share vaccines with other countries," said Keisha Ray, an assistant professor and bioethicist at UTHealth McGovern Medical School in Houston, "especially those countries we might consider poorer countries or what we call underdeveloped countries."

From an ethical perspective, everyone should have access to protection from Covid-19, Kathy Kinlaw, associate director for Emory University's Center for Ethics, told CNN.

many countries lack vaccine access because of the "diminished purchasing power for healthcare in general, but also for Covid-19 treatments and vaccin

"I think the United States is definitely in a position where we should be sharing, absolutely,"

The US is not simply obligated to share vaccines by virtue of its resources, Ray said. Wealthier countries like the US have historically benefited by hindering other countries, she said, whether through government relations or colonialism.

"Now we are in a position to give back, we are in a position to go there and help these countries," she said, like "paying our debt." All three agreed it was right for the US to control its virus outbreaks before sharing vaccines. The pandemic is still an issue in the US, Ray said, but conditions have improved greatly.

"You need to stabilize your own nation before you assist others," he said. "And I think we're there. I think we're getting there now."

The US needs to continue to address vaccine hesitancy at home and be responsive to peoples' concerns, Kinlaw said. "But certainly there could be a point where there are people who will not take the vaccine and we have extra vaccine in this country, in which case it should be used and shared."

"Once this happens," the report said, "efforts to encourage vaccination will become much harder, presenting a challenge to reaching the levels of herd immunity that are expected to be needed."

One factor in deciding to release extra vaccines is the issue of supply and demand -- specifically, that the former will soon outstrip the latter in the US, Kinlaw said. And that could mean it's time to start shipping spare doses overseas, she said.

Data from the US Centers for Disease Control and Prevention shows that 30% of the US population is fully vaccinated. Experts like Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, have estimated the US needs between 70% and 85% of the country to be immune -- either through vaccination or prior infection -- to reach herd immunity.

"The world's wealthiest nations have locked up much of the near-term supply," wrote Dr. Krishna Udayakumar and Dr. Mark McClellan, health experts at Duke. "At the current rate vaccines are being administered, 92 of the world's poorest countries won't vaccinate 60% of their populations until 2023 or later."

"That is an education, a public outreach and an access issue," she said. "We have other hurdles that are not supply hurdles. So we do have the supply to help other countries."

"Epidemiologically, we should be working to suppress the virus and to decrease transmission and decrease the continue evolution of the virus and the variants," she said. "That is going to be beneficial to every single person."

But vaccinations everywhere could also present economic benefits, Kinlaw said, allowing people to travel more freely and conduct business around the world.

"One of the ethical challenges is, are we going to insist on fair distribution within those countries? Or are we just going to give them vaccine and let them give it to the military and elite?" he said.

"It sounds nice to say we're going to aid others, but its simplistic, because some governments are corrupt," he said. "Some governments have no distribution plan other than to give it first to their own leaders, rather than to those in need."

The first warning sign came when case numbers, after weeks of steep declines, appeared to level off -- with the country still averaging tens of thousands of new cases daily.

But governors cited fewer Covid-19 cases and more vaccinations while lifting measures aimed at curbing the spread of the virus.

Chicago officials earlier this month raised indoor capacity for bars, restaurants and other businesses and Baltimore leaders announced Wednesday they were easing restrictions on places including religious facilities, retail stores and malls, fitness centers and food service establishments -- changes that will go into effect next week.

Delaware, Montana, Alabama and West Virginia have also seen big increases.

The B.1.1.7 variant, she said this week, is projected to become the dominant variant in the US by the end of this month or early April.Despite the warnings, spring break crowds are gathering -- with Florida officials reporting too many people and not enough masks -- and nationwide, air travel numbers are hitting pandemic-era records.

Now, as the country inches closer to 30 million reported infections, cases are rising by more than 10% in 14 states this week compared to last week,

We're in a race to get the population vaccinated. At the same time, we're fighting people's exhaustion with the restrictions that public health has put in place and we're fighting the move by so many governors to remove the restrictions that are keeping us all safe."

Michigan cases are increasing the fastest, with more than a 50% jump this week compared to last,

All that while cases of the worrying variants -- notably the highly contagious B.1.1.7 variant -- climbed. The variants have the potential to wipe out all the progress the US made if Americans get lax with safety measures,

In West Virginia, Gov. Jim Justice said Wednesday that Covid-19 hospitalizations have "jumped up" slightly

Those include the rolling back of restrictions, a prison outbreak, Covid-19 fatigue, a failure to wear masks, and the B.1.1.7 variant fueling the surge, Morse told CNN. Michigan Gov. Gretchen Whitmer eased restrictions earlier this month, upping capacity limits at restaurants as well as in retail stores, gyms and other facilities.

There's a long list of factors contributing to the spike in cases in Michigan,

Justice had eased restrictions earlier this month, increasing capacity at bars, restaurants and other businesses to 100% and upping the social-gathering limit.

During Wednesday's news briefing, he added that the state has had "seven outbreaks in our church community" across five counties.

what could play a key role in helping control the pandemic will be more accessible, inexpensive coronavirus tests, top health officials

"I do believe that once we have teachers vaccinated that we can use testing in the schools -- serial testing, cadence testing -- to identify potential infections, asymptomatic infections, shut down clusters and keep our schools open."

Her remarks came the same day the CDC released updated guidance about testing, saying more and better testing should help catch asymptomatic cases and control the spread.

More than 73.6 million Americans have received at least one dose of a Covid-19 vaccine, according to CDC data. And more than 39.9 million people are fully vaccinated -- roughly 12% of the US population. But challenges -- including vaccine hesitancy, disinformation and inequities -- remain, and it's not entirely clear when the US will hit herd immunity -

On Wednesday, both Fauci and Walensky pushed back against questions about herd immunity, saying a lot depended on how quickly Americans take vaccines.

For now, the US still has a long way to go to overcome vaccine hesitancy,

Vaccination is the country's best hope to get beyond the pandemic, he said, "and yet there's all this overlay, and some of it is politics and some of it's social media conspiracy theories and some of it is just distrust of anything that the government had anything to do with."

Additionally, in the first two and half months of vaccine distribution, counties considered to have high social vulnerability had lower vaccine coverage than counties considered to have low social vulnerability,

The agency's social vulnerability index identifies communities that may need additional support during emergencies based on more than a dozen indicators across four categories: socioeconomic status, household composition, racial/ethnic minority status and housing type.

By March 1, vaccination coverage was about 2 percentage points higher in counties with low social vulnerability than in counties with high social vulnerability -- and the differences were largely driven by socioeconomic disparities, particularly differences in the share of the population with a high school diploma and per capita income.

Only five states -- Arizona, Montana, Alaska, Minnesota and West Virginia -- had higher coverage in counties with high social vulnerability.

Achieving vaccine equity, the CDC said, is an important goal requiring "preferential access and administration to those who have been most affected"

"The good thing is there would be the opportunity that if it turned out there was some waning of the immune response," Jameson says. "Then, like many other vaccines, maybe ... you get another booster after a year or something."

the available vaccines slash the odds that infected people will spread the virus onward by at least half and likely more. In the rare cases that the virus breaks through, infections are generally milder, shorter, and lower in viral load.

Worryingly, a recent study documented several cases during India’s spring surge in which health-care workers who were fully vaccinated with AstraZeneca’s vaccine were infected by Delta and passed it on.

If other vaccines have similar vulnerabilities, vaccinated people might have to keep wearing masks indoors to avoid slingshotting the virus into unvaccinated communities

2. The variants are pummeling unvaccinated people.

Vaccinated people are safer than ever despite the variants. But unvaccinated people are in more danger than ever because of the variants.

While America worries about the fate of states where around 40 percent of people are fully vaccinated, barely 10 percent of the world’s population has achieved that status, including just 1 percent of Africa’s.

Many nations that excelled at protecting their citizens are now facing a triple threat: They controlled COVID-19 so well that they have little natural immunity; they don’t have access to vaccines; and they’re besieged by Delta.

richer nations would be wrong to think that the variants will spare them, because ...3. The longer Principle No. 2 continues, the less likely No. 1 will hold.

it’s how we might eventually face variants that can truly infect even vaccinated people.

“We have to assume that’s going to happen,” Gupta told me. “The more infections are permitted, the more probable immune escape becomes.”

We’re unlikely to be as vulnerable as we were at the beginning of the pandemic. The vaccines induce a variety of protective antibodies and immune cells, so it’s hard for a variant virus to evade them all. These defenses also vary from person to person, so even if a virus eludes one person’s set, it might be stymied when it jumps into a new host.

“I don’t think there’ll suddenly be a variant that pops up and evades everything, and suddenly our vaccines are useless,” Gupta told me. “It’ll be incremental: With every stepwise change in the virus, a chunk of protection is lost in individuals. And people on the edges—the vulnerable who haven’t mounted a full response—will end up bearing the cost.”

The discussion about vaccine-beating variants echoes the early debates about whether SARS-CoV-2 would go pandemic. “We don’t think too well as a society about low-probability events that have far-reaching consequences,”

even highly vaccinated nations should continue investing in other measures that can control COVID-19 but have been inadequately used—improved ventilation, widespread rapid tests, smarter contact tracing, better masks, places in which sick people can isolate, and policies like paid sick leave.

it will continue to mutate as it reproduces in human cells, especially in areas of more intense admission.

“Fortunately, we have tools to save lives, and these in combination with good public health will permit us to learn to live with Covid-19.”

“The likely scenario is the virus will become another endemic virus that will remain somewhat of a threat, but a very low-level threat in the context of an effective global vaccination program.

“The existence of a vaccine, even at high efficacy, is no guarantee of eliminating or eradicating an infectious disease. That is a very high bar for us to be able to get over.”

That was why the first goal of the vaccine was to save lives and protect the vulnerable, Ryan said. “And then we will deal with the moonshot of potentially being able to eliminate or eradicate this virus.”

Ryan warned that the next pandemic may be more severe. “This pandemic has been very severe … it has affected every corner of this planet. But this is not necessarily the big one,”

“This is a wake-up call. We are learning, now, how to do things better: science, logistics, training and governance, how to communicate better. But the planet is fragile.

“We live in an increasingly complex global society. These threats will continue. If there is one thing we need to take from this pandemic, with all of the tragedy and loss, is we need to get our act together. We need to honour those we’ve lost by getting better at what we do every day.”

being vaccinated against the virus did not mean public health measures such as social distancing would be able to be stopped in future.

The first role of the vaccine would be to prevent symptomatic disease, severe disease and deaths, she said. But whether the vaccines would also reduce the number of infections or prevent people from passing on the virus remains to be seen.

“I don’t believe we have the evidence on any of the vaccines to be confident that it’s going to prevent people from actually getting the infection and therefore being able to pass it on,”

“So I think we need to assume that people who have been vaccinated also need to take the same precautions.”

He said the year ahead would see new setbacks and new challenges.

“For example, new variants of Covid-19, and helping people who are tired of the pandemic continue to combat it,”

The shortfall in testing isn’t just a problem for individual patients and their doctors. It is also holding back large-scale surveys of seemingly healthy populations, in workplaces and elsewhere, and scientific research into fundamental properties of the virus and the disease it causes.

there is an escalating need to test much larger groups repeatedly—to track the spread of the virus as restrictions ease—and to carry out population-based studies that will reveal more about how this virus behaves.

in determining whether an individual is safe to enter a workplace or school on a given morning. Ideally, for the later purposes, tests would be conducted swiftly and at high volume at the places where samples are taken

One such approach, still in development, would exploit the ability of the well-known bacterial gene-editing system known as CRISPR to recognize coronavirus RNA.

While the need for greatly expanded testing in the next phase of this pandemic is widely acknowledged, the United States has no coordinated plan for how to achieve it. The technical building blocks are in hand, but how to put them together is not yet clear. Moreover, major regulatory hurdles limit the use of the results from novel tests in patient care, especially in certain states such as New York. And the logistics of deploying enough personnel to track samples and deliver results are daunting. Because of the complexity and importance of such testing, a centralized program, run by a strong scientific leader and paid for with federal dollars, may be the only solution.

rmed with efficient and accurate tests to detect the virus (indicating active infection) and reliable tests to measure antibodies against it (implying prior exposure and possible immunity), public-health programs could paint an accurate picture of the current pandemic. Small and large businesses, schools, health-care facilities, and other organizations could track the outcomes of their attempts to restore normal activities, and scientists could answer key questions about viral transmission and host immunity.

decisive answers will come only from studying human beings who are exposed to the virus under real-life conditions. Such studies may be feasible only under circumstances in which natural transmission is occurring at significant rates, as it currently is. Therefore, if we are to get answers to the following questions, we must act now.

tudies to answer these questions require identifying enough people who have recovered, then testing them repeatedly for the appearance of a new infection. Such people are relatively easy to find. They include doctors and nurses in hospitals in hard-hit metropolitan areas such as New York City; staff and residents at nursing homes with high rates of infection; and crews of U.S. Navy ships that have experienced outbreaks of COVID-19.

identify asymptomatic infections. Following up on those cases will shed light on how many asymptomatic people ultimately develop symptoms; how long it takes for them to do so; whether asymptomatic people who ultimately develop symptoms have higher viral loads than those who don’t get sick; whether symptomatic and asymptomatic people have different immune responses; whether other, simpler procedures (such as tests for some chemical abnormality in the blood) might be used to screen for infection; and how large a contribution asymptomatic people make to the ongoing transmission of the virus.

Despite repeated warnings after prior epidemics about the likelihood of new ones caused by novel microbes, the United States and many other countries failed to respond efficiently to this one. Scientists might have detected the new coronavirus much earlier with the better tools for microbial surveillance that already exist; prevented the pathogen’s worldwide spread by more aggressive testing and contact tracing; and supported better and safer health care with larger stockpiles and pipelines for procurement of medical equipment. Humanity should never be this unprepared again.

Scientists are also using different strains of another virus, adenovirus, as a vector or a missile to deliver genes that code for these same spike proteins and that also provoke an immune response. The vector has been engineered in the lab to be replication-defective; that is, the vector is able to deliver the spike gene into humans but once it’s done its job, the vector cannot replicate any further. At least three groups are testing these vectors.

The science is paying off. Novavax, a Maryland-based company working on this type of vaccine, recently reported the results of its Phase 1 trial. The levels of antibodies generated were stunning, about four times higher than those in individuals who are recovering from a COVID-19 infection.

Nine vaccine candidates have now entered Phase 3 human trials, the final step before regulatory approval. The fact that entirely different approaches to vaccine development are all yielding promising early results is highly encouraging.

Equally important is the unprecedented global collaboration among scientists around the world, as well as the high degree of cooperation between scientists and clinicians, biopharmaceutical companies, government, philanthropic funders, and regulators. They are all working together toward the common goal of developing as quickly as possible a safe and effective vaccine against COVID-19.

My optimism doesn’t stop with these early results, although they are key. I’m also encouraged because at least five very different approaches (I’ve walked through only three above) are being explored to make a vaccine. As we say in Canada, if you want to win, you have to take many shots on goal.

the encouraging news is that all of the vaccine candidates that have entered trials in humans so far are safe and have elicited high levels of antibodies against COVID-19. Some have also been shown to activate the cellular arm of our immune system, another crucial component of our defenses against foreign pathogens.

the mandate that the approval process be above any political considerations and solely based on data from the clinical trials. Anything else risks losing the public’s confidence in a vaccine or, in a worst-case scenario, might result in a vaccine that is less effective than those that might be approved later, or the widespread administration of a vaccine that turns out to have serious adverse side effects. That would be a public-health tragedy.

The world will need billions of doses and many billions of dollars to produce and disseminate the vaccine. My main concern in this whole process is that governments will not spend enough on manufacturing the vaccine to administer it to every adult on the planet

Ensuring equitable access to a vaccine is imperative, and not just a generous gesture by wealthy nations. It’s also in their best interests. If the virus is anywhere, it’s everywhere.

The United States, the wealthiest nation in the world and historically the first among nations in its generosity and leadership, has yet to contribute to the various multilateral initiatives established to purchase vaccines for the developing world. To date, 75 industrialized nations have agreed to finance vaccine purchases for 90 lower-income countries. But the U.S. is not yet one of them.

The cost of manufacturing enough doses to vaccinate every adult on the planet will be in the hundreds of billions of dollars. But compared with the trillions of dollars that governments are now spending to assist individuals who have lost their jobs and to prop up their economies, $100–200 billion is a bargain and an insurance policy that developed countries cannot afford not to buy.

If people everywhere—regardless of their gender, citizenship, ethnicity, skin color, or ability to pay—have equal and timely access to a safe and effective vaccine against COVID-19, the world will come out of this pandemic stronger than it went in

Being in close proximity to people I don’t know will always feel less safe than it used to,” said Ellicott Matthay, a postdoctoral scholar at the University of California, San Francisco.

Three-quarters of respondents said they planned to spend Christmas, Hanukkah or other winter holidays only with members of their household, or not celebrate at all, similar to how they spent Thanksgiving.

Most scientists say around 70 percent of the population will need to be immune for the United States to reach herd immunity, when the virus slows down significantly or stops.

Nearly a third of respondents said they would be comfortable returning to more activities of daily life once they were vaccinated.

Since the spring, 79 percent of the epidemiologists said their assessment of various risks had changed, and that they had adjusted their behaviors accordingly. Science is a process, they said, and the virus is new, so even those studying it most closely have learned things along the way.

“It entirely depends upon what we do as a nation to address the pandemic,” said Emeli Anderson, a doctoral student of epidemiology at Emory. “Right now, we are not nearly doing enough.”

Many epidemiologists expressed disappointment and frustration that public health messaging had not been more effective, and that a growing share of Americans seemed to distrust science.

“This virus has humbled me as a professional and a person,” said Michelle Odden, associate professor of epidemiology at Stanford. “I did not think this level of failure in a federal response was possible in the United States. We have a lot of work to do.”

As for the future, some said that parts of life could begin to return to normal sometime in the summer, thanks to vaccines. B

ut assuming a highly effective therapeutic drug isn’t developed, a significant number said it would be at least a year before they felt it would be safe to do many of the things they used to.

Many said they planned to keep working from home at least part of the time. Some said they would always be more hesitant about greeting people with a handshake or a hug, being in crowded places or traveling internationally.

Mr. Buck said the president’s approach was not necessarily helpful to him politically because it “didn’t pass the laugh test for a super serious situation that has ruined millions of people’s lives.” But he said it was still concerning because “half the country takes their cues from him.”

the hope was that discussing his own experience would help him manage the pandemic going forward, and could have political benefits.

It is hardly the first time Mr. Trump has undermined the desires of his aides. He has contradicted them on issues ranging from China policy to preparation for the debate last week.

And the president could use that to show from now until the second presidential debate, scheduled for Oct. 15, that the disease is serious but can be combated, and that he was ready to re-enter the campaign.

While that was the hope, it was severely undermined over the last few days by the president’s own behavior — no more so than Monday when he tweeted to the nation “Don’t be afraid of Covid. Don’t let it dominate your life!” without acknowledging that, as president, he gets far better care than the average citizen. His comments signaled a far likelier reality: that the erratic handling of his illness by Mr. Trump and his aides will remind voters of his administration’s failures and efforts to play down the deadly pandemic for six months.

he hadn’t yet reached the critical seven- to 10-day window that doctors watch for with the coronavirus to see whether patients take a turn for the worse.

the president did not mention the hardship the virus had caused to others or that anyone had suffered greatly from it. Nor did he mention the White House staff members who had fallen sick.

almost immediately ripped off his mask for the cameras once there. He then filmed a campaign-style video from the balcony, saying that he was “better” and that “maybe I’m immune, I don’t know” to the ravages of the virus.

“I feel better than I did 20 years ago,” framed the virus as something akin to a weekend at a spa

“You would hope someone who has been in serious health crisis would have a bit of an awakening, find a little religion on this, but he seems incapable of doing that.”

“He has experience now fighting the coronavirus as an individual,” said Erin Perrine, a campaign spokeswoman. “Joe Biden doesn’t have that.”

Mr. Trump’s advisers are also trying to paint the virus as one in a long string of fights he has overcome, in line with the investigation into whether his campaign had ties with Russia or the impeachment inquiry.

researchers found that people with obesity who caught the coronavirus were more than twice as likely to end up in the hospital and nearly 50 percent more likely to die of Covid-19. Another study, which has not yet been peer-reviewed, showed that among nearly 17,000 hospitalized Covid-19 patients in the United States, more than 77 percent had excess weight or obesity.

Similar links were unmasked during the H1N1 flu pandemic of 2009, when researchers began to notice that infected people with obesity were more likely to wind up in the hospital and to die. Flu vaccines administered in subsequent years performed poorly in individuals with extra weight, who fell ill more often than their peers even after getting their shots

Large amounts of fat, for instance, can compress the lower parts of the lungs, making it harder for them to expand when people breathe in.

When obesity enters the picture, Dr. Beck said, some of the immune cells found in 30-year-old people “look like those of an 80-year-old.”

If the immune systems of people with obesity are more prone to pathogen amnesia, then they may need different dosages of a vaccine. Some products might not work at all in people carrying extra weight

Ms. Franklin’s case of Covid-19 was more moderate than her sister’s. But she still deteriorated quickly, to the point where she could no longer reach the bathroom without assistance.

Even with this latest increase, Vermont’s total cases and deaths per capita remain the lowest on the mainland. But the state’s recent backslide carries troubling implications. If Vermont has finally lost control of the pandemic, what chance is there for the rest of the country?

Before the CDC opened up vaccinations to children under 12 earlier this month, about 50,000 Vermonters in a population of more than 600,000 had not received a single shot, Mark Levine, the state’s health commissioner, told me. “That’s still a lot of people who the virus finds. It’s very effective,”

The sheer contagiousness of Delta means that achieving herd immunity is likely impossible even if nearly everyone has been vaccinated or previously infected, and though Vermont has vaccinated a higher percentage of its population than any other state, its protection from the virus is nowhere close to universal.

Whether by choice or because of age restrictions, more than one-quarter of Vermonters are not fully inoculated, and as in other places across the country, that percentage is higher in rural counties.

Vermont’s experience, they concede, might simply be a preview of the virus’s endemic future, when states can realistically hope only to keep COVID-19 contained, not eliminate it entirely.

As it did with vaccinations in the spring, Vermont is moving more rapidly than other states to provide booster shots for its adult population and inoculations for younger children who have recently become eligible. And unlike other states experiencing a spike, Vermont has not seen its hospital system overwhelmed

Vermont has also maintained its most important advantage over other states by limiting the most severe outcomes of COVID-19 infection. Deaths have increased, but Vermont’s fatality rate remains quite low

To the extent that hospitals are strained, Levine said, it’s because of an increase in other illnesses and conditions caused by delayed care over the past two years.

Vermonters, Levine said, are “victims of our own success.” So many people got vaccinated so quickly that their immunity is beginning to wane earlier than people’s in other states,

And because relatively few people contracted COVID-19 at other stages of the pandemic, the state has much less natural immunity than other places

Seroprevalence studies found that just 3 to 4 percent of Vermont’s population had COVID-19 antibodies prior to the arrival of the Delta variant; by comparison, similar studies indicate that more than 25 percent of the populace had antibodies at one time in New York City, which was hard hit by the virus in spring 2020.

Covid deaths, though always concentrated in older people, have in 2022 skewed toward older people more than they did at any point since vaccines became widely available.

That swing in the pandemic has intensified pressure on the Biden administration to protect older Americans, with health officials in recent weeks encouraging everyone 50 and older to get a second booster and introducing new models of distributing antiviral pills.

But the mortality gap between older and younger people has grown: Middle-aged Americans, who suffered a large share of pandemic deaths last summer and fall, are now benefiting from new stores of immune protection in the population as Covid deaths once again cluster around older people.

among people 65 and older, 13 percent are unvaccinated, 3 percent have a single Moderna or Pfizer shot and another 14 percent are vaccinated but not boosted.

“The government wasn’t sure about the booster shot,” he said. “If they weren’t sure about it, and they’re the ones who put it out, why would I take it?” Mr. Thomas said Covid recently killed a former boss of his and hospitalized an older family friend.

But scientists warned that many older Americans remained susceptible. To protect them, geriatricians called on nursing homes to organize in-home vaccinations or mandate additional shots.

That changed last summer and fall, during the Delta surge. Older people were getting vaccinated more quickly than other groups: By November, the vaccination rate in Americans 65 and older was roughly 20 percentage points higher than that of those in their 40s. And critically, those older Americans had received vaccines relatively recently, leaving them with strong levels of residual protection.

As a result, older people suffered from Covid at lower rates than they had been before vaccines became available. Among people 85 and older, the death rate last fall was roughly 75 percent lower than it had been in the winter of 2020, Dr. Stokes’s recent study found.

The rebalancing of Covid deaths was so pronounced that, among Americans 80 and older, overall deaths returned to prepandemic levels in 2021, according to a study posted online in February.

“In 2021, you see the mortality impact of the pandemic shift younger,” said Ridhi Kashyap, a lead author of that study and a demographer at the University of Oxford.

For some people, even three vaccine doses appear to become less protective over time against Omicron-related hospital admissions.

During the Omicron wave, Covid death rates were once again dramatically higher for older Americans than younger ones, Dr. Stokes said. Older people also made up an overwhelming share of the excess deaths — the difference between the number of people who actually died and the number who would have been expected to die if the pandemic had never happened.

Long-ago Covid cases do not prevent future infections, but reinfected people are less likely to become seriously ill.

Eventually, her family had to arrange a trip to a pharmacy on their own for a second booster.“It just seems that now the onus is put completely on the individual,” she said. “It’s not like it’s made easy for you.”

And suppose it takes five days between a person’s getting infected and their infecting others. After 30 days, the more transmissible virus is now causing 26, or 64, times as many new cases as the less transmissible one.

Not every case will be mild, though, and even a small hospitalization rate on top of a huge case number will be a big number.

Now, as my colleague Ed Yong reports, Omicron could push a collapsing health-care system further into disaster. Hospitals are already dealing with the flu and other winter viruses. They’re already canceling elective surgeries.

If there are no changes to behavior or policy, this year’s winter wave would peak at about double the hospitalizations of last winter at its worst, and 20 percent more deaths, according to the most pessimistic of projections

The most optimistic projection sees a caseload similar to last winter’s, but hospitalizations and deaths at about half of where they were back then, assuming the vaccines keep up their very high protection against severe illness.

If that holds, it’s a “huge decrease,” Meyers says, and one that matches the assumptions of her team’s grimmer—but not grimmest—projections. When they modeled scenarios where vaccine effectiveness against hospitalization dropped by about that much, they saw a difference of tens of thousands of deaths.

Very preliminary data from South Africa’s largest health insurer suggest that two doses of the Pfizer-BioNTech vaccine were 70 percent effective at preventing hospitalization from Omicron infections, down from 93 percent before.

Vaccine protection against severe illness should be more durable than it is against infection, but may still take a hit

The available evidence on Omicron’s inherent severity is likely to be biased in ways that make it appear more promising. First of all, hospitalizations lag infections.

Second, the first people infected may skew young and are thus more likely to have mild cases regardless of the variant

third, some of the mildness attributed to the virus may result instead from existing immunity. In South Africa, where doctors are reporting relatively low hospitalizations compared with previous waves, many cases are probably reinfections

The South Africa health-insurer data suggest that Omicron might carry a 29 percent lower risk of hospitalization than the original virus, when adjusted for risk factors including age, sex, vaccination status, and documented prior infection—but many prior infections may be undocumented, which would make the reduction in risk seem bigger than it really is. (A recent analysis of early U.K. cases found “at most, limited changes in severity compared with Delta.”)

Either way, in the short run, we will have a massive number of Omicron cases on top of a massive number of Delta cases. Together they will infect huge numbers of people, vaccinated or not

While it’s somewhat reassuring that almost half the US stories (41 percent) tried, to varying degrees, to rebut the vaccine-autism connection, the study raises the problem of “objectivity” in stories for which a preponderance of evidence is on one side of a “debate.” In such cases, “balanced” coverage can be irresponsible, because it suggests a controversy where none really exists. (Think climate change, and how such he-said-she-said coverage helped sustain the illusion of a genuine debate within the science community.)

A follow-up study by Clarke and Graham Dixon, published in November 2012, makes this point. The two scholars assigned 320 undergrads to read either a “balanced” article or one that was one-sided for or against a link between vaccines and autism. Those students who read the “balanced” articles were far more likely to believe that a link existed than those who read articles that said no link exits.

Today, people who worry that childhood inoculations trigger autism prefer to be described as “vaccine-hesitant,” rather than “anti-vaccine,” and think the CDC’s immunization schedule “overwhelms” kids’ immune systems. This rhetorical shift is illustrates how those who claim a link exists keep moving the goalposts.

Saudi Arabia has long denied any role in the 9/11 attacks, but victims' families have repeatedly sought to bring the matter to court, only to be rebuffed after the country has invoked legal immunity allowed under current law.

Formally known as the Justice Against Sponsors of Terrorism Act, the bill would prevent Saudi Arabia and other countries alleged to have terrorist ties from invoking their sovereign immunity in federal court.

The White House and State Department say the bill could have dramatic ramifications for the United States and citizens living abroad to retaliatory lawsuits.

"They're not going to suffer a huge financial loss just to make a point," said Cornyn who also predicted the legislation would not be "disruptive of the relationship we have with the Kingdom of Saudi Arabia."

"We feel that the bill is in very good position to move through the House," she said. "We are very excited finally to get it to the House."

Pence is just the most recent example of how the rubble of ruined reputations will become deeper before Nov. 8. It has been well said that “sooner or later, we all sit down to a banquet of consequences.” The Republican Party’s multicourse banquet has begun.