With booster doses of Pfizer’s COVID-19 vaccine now authorized in the U.S., government advisers reconvened on Thursday to tackle the most contentious question yet: Exactly who should roll up their sleeves right away?
Late Wednesday, the Food and Drug Administration signed off on extra shots of the Pfizer formula for a broad swath of Americans: those 65 and older, people at high risk of severe illness, and health care workers and others in danger of becoming infected on the job.
But that was not the last hurdle. The Centers for Disease Control and Prevention sets final U.S. policy on who qualifies for the extra shot. And the CDC’s advisers were set to vote Thursday on how many of the roughly 26 million Americans who had their last Pfizer shot at least six months ago should go ahead and get that third dose.
The widespread dispensing of the boosters would represent an important new phase in the nation’s vaccination drive. Britain and Israel are already rolling out a third round of shots over strong objections from the World Health Organization that poor countries don’t have enough for their initial doses.
Whatever the decision from the CDC, millions more Americans still will face confusion — those who received Moderna or Johnson & Johnson shots early in the vaccine rollout. The government still hasn’t considered boosters for those brands and has no data on whether it’s safe or effective to mix-and-match and give those people a Pfizer shot.
The priority still is to vaccinate the unvaccinated. About 182 million Americans, or 55% of the population, are fully vaccinated.
The COVID-19 vaccines used in the U.S. still offer strong protection against severe illness, hospitalization and death, but immunity against milder infection appears to be waning months after people’s initial vaccination.
The FDA rejected a sweeping Biden administration plan announced a month ago to offer boosters to the general population, instead embracing a more targeted approach for now. Acting FDA Commissioner Dr. Janet Woodcock cautioned that booster decisions could very well change as real-world data come in.
“As we learn more about the safety and effectiveness of COVID-19 vaccines, including the use of a booster dose, we will continue to evaluate the rapidly changing science and keep the public informed,” Woodcock said.
The CDC advisory panel had been considering boosters for senior citizens, nursing home residents and front-line health care workers, rather than all adults. But the committee’s two-day meeting opened on Wednesday with many members warning that the priority of the vaccination campaign should be protection against severe disease, not infection.
They also wrestled with how to tell when a booster is needed. While an extra dose revs up numbers of virus-fighting antibodies, those naturally wane over time and no one knows how long the antibody boost from a third Pfizer dose will last — or how much protection it really adds since the immune system also forms additional defenses after vaccination.
The U.S. has already authorized third doses of the Pfizer and Moderna vaccines for certain people with weakened immune systems, such as cancer patients and transplant recipients. Other Americans, healthy or not, have managed to get boosters, in some cases simply by asking.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
As Portugal closes in on its goal of fully vaccinating 85% of the population against COVID-19 in nine months, other countries in Europe and beyond want to know how it was accomplished.
A lot of the credit is going to Rear Adm. Henrique Gouveia e Melo. With his team from the three branches of the armed forces, the naval officer took charge of the vaccine rollout in February — perhaps the moment of greatest tension in Portugal over the pandemic.
Now, the county could be just days away from hitting its target. As of Wednesday, 84% of the total population was fully vaccinated, the highest globally, according to Our World in Data.
Along with the rising number of shots, the COVID-19 infection rate and hospitalizations from the virus have dropped to their lowest levels in nearly 18 months. Portugal could end many of its remaining pandemic restrictions in October — a coveted development for many countries still in the grip of the highly infectious delta variant and lagging in their own vaccination rollouts.
Previously unheralded outside the military, Gouveia e Melo is now a household name in Portugal, having made a point of going on television regularly to answer public concerns about the vaccination program.
Easily recognizable even behind a face mask due to his blue eyes, close-cropped salt-and-pepper hair and 1.93-meter (6-foot-3-inch) height, he’s often greeted in the street by people wanting to thank him.
“People are very nice,” he says. But the 60-year-old officer also is quick to insist he is just “the tip of the iceberg” in the operation and that many others share the credit.
Military involvement in rolling out the COVID-19 vaccine is not uncommon elsewhere, but Portugal has given it the leading role.
It turned out to be an inspired choice: Although Gouveia e Melo’s team works hand-in-hand with health authorities, police and town councils, the military’s expertise has proven invaluable.
“People in the military are used to working under stress in uncertain environments,” he said at his office in a NATO building near Lisbon that commands a view of the Atlantic. “They’re organized, have a good logistics set-up … and are usually very focused on the mission.”
Gouveia e Melo set the tone of the rollout with his no-nonsense approach and emphasis on discipline. His straight-talking style endeared him to many who worried they might not get vaccinated in time.
In an interview with The Associated Press, he admitted that replacing a political appointee who quit after only three months was “intimidating.”
At the time, Portugal was in the worst phase of the pandemic, when it was among the hardest-hit countries with public hospitals near collapse. Promised vaccine deliveries weren’t arriving. And jockeying for shots was threatening to undermine public trust in the rollout.
“I felt like I had the eyes of 10 million people on me,” Gouveia e Melo said, referring to Portugal’s population.
His 42-year military career helps explain how he handled the pressure.
He was a submarine commander, and at one point was in charge of two of the vessels at the same time — returning to base with one, eating a meal on shore and then taking another out to sea.
Gouveia e Melo also captained a frigate, led Euromarfor, the European Union’s Maritime Force, and has logged the most hours at sea of any serving Portuguese naval officer.
He is unapologetic about couching the vaccine rollout as a battle and has worn combat fatigues ever since taking over the effort. He said he wanted to send a message that it was a call to arms.
“This uniform … was symbolic for people to comprehend the need to roll up our sleeves and fight this virus,” he says.
Gouveia e Melo did away with Portugal’s initial efforts to piggyback on established vaccination strategies, such as those used annually for flu shots in usually small, public health centers. The demands of scale and speed to address COVID-19 required a very different approach.
Portugal began using large sports facilities around the country to set up what Gouveia e Melo called a “production line”: a reception and processing area; a waiting room; cubicles where injections are given; and a recovery area. He used soldiers as guinea pigs at the Lisbon military hospital to figure out the fastest flow of people through a building.
A major push came with what he described as a “tsunami” of vaccine deliveries in mid-June, which allowed a shift into a higher gear.
Tiago Correia, an associate professor in international public health at Lisbon’s New University Institute of Hygiene and Tropical Medicine, reckons that the public view of Gouveia e Melo as the principal factor in the successful rollout is an “exaggeration” of his role.
A key factor, Correia says, is the traditional consenting attitude in Portugal toward national vaccination programs. Its vaccination rate for measles, mumps and rubella, for example, is 95% — one of the EU’s highest – and there is no significant anti-vaccination movement.
Even so, Gouveia e Melo’s military background meant he was able to “cut through all the politics” and ensure public trust in the rollout, Correia told AP.
These days, Gouveia e Melo is often greeted with spontaneous applause from the public when he visits vaccine centers and poses for selfies. He has been the subject of TikTok videos and poems.
Framed on the wall behind his desk is a drawing given to him by a child who wrote “Obrigado” — “Thank you” — in capital letters.
On a visit Tuesday to a vaccine center at the Lisbon University campus, Gouveia e Melo strode around in his combat fatigues and handed out a cloth crest he designed for the rollout to those waiting for their shots. The emblem, worn by many in the effort, depicts a three-headed hydra lunging at two virus cells, with a green border representing the more than 4,700 people who have worked at Portugal’s vaccine centers.
Claudia Boigues, a 53-year-old waiting in the recovery area with her 15-year-old son who had just been vaccinated, said she marveled at the swift rollout.
“I never thought we’d reach 85%,” she said. “But now we deserve congratulations.”
Other countries, which Gouveia e Melo declined to identify because their requests have not been made public, have asked Portugal about its effort.
Gouveia e Melo will soon be able to say “mission accomplished” for his immediate goal. But with significant vaccination hesitancy in some wealthier countries and many poorer countries without sufficient doses, he’s under no illusion that virus variants could come back to torment Portugal.
“We’ve won a battle,” he says. “I don’t know if we’ve won the war against the virus. This is a world war.”
Is the delta variant of the coronavirus worse for kids?
No, experts say there’s no strong evidence yet that it makes children and teens sicker than earlier versions of the virus, although delta has led to a surge in infections among kids because it’s more contagious.
Delta’s ability to spread more easily makes it more of a risk to children and underscores the need for masks in schools and vaccinations for those who are old enough, said Dr. Juan Dumois, a pediatric infectious disease physician at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida.
Weekly infection rates among U.S. children earlier this month topped 250,000, surpassing the wintertime peak, according to data from the American Academy of Pediatrics and Children’s Hospital Association. Since the pandemic began, more than 5 million children in the U.S. have tested positive for COVID-19.
The delta variant has been identified in at least 180 countries, according to the World Health Organization. In many of them, the spike in infections has also meant an increase in hospitalizations in young children and teens.
In the U.S., the hospitalization rate for COVID-19 was less than 2 per 100,000 children in late August and early September — similar to the peak last winter, according to the Centers for Disease Control and Prevention. But the portion of kids hospitalized with severe disease hasn’t changed significantly.
The sheer numbers can make it seem like children are getting sicker with the delta variant, but experts say that does not appear to be the case. Most infected kids have mild infections or no symptoms and do not need to be hospitalized.
COVID-19 vaccines continue to provide protection against delta. Among children 12 and older — who are eligible for COVID-19 vaccinations — the weekly hospitalization rate in July was 10 times higher for the unvaccinated than those who have had the shots, CDC data show.
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One desperate California school district is sending flyers home in students’ lunchboxes, telling parents it’s “now hiring.” Elsewhere, principals are filling in as crossing guards, teachers are being offered signing bonuses and schools are moving back to online learning.
Now that schools have welcomed students back to classrooms, they face a new challenge: a shortage of teachers and staff the likes of which some districts say they have never seen.
Public schools have struggled for years with teacher shortages, particularly in math, science, special education and languages. But the coronavirus pandemic has exacerbated the problem. The stress of teaching in the COVID-19 era has triggered a spike in retirements and resignations. Schools also need to hire staffers like tutors and special aides to make up for learning losses and more teachers to run online school for those not ready to return.
Teacher shortages and difficulties filling openings have been reported in Tennessee, New Jersey and South Dakota, where one district started the school year with 120 teacher vacancies. Across Texas, the main districts in Houston, Waco and elsewhere reported hundreds of teaching vacancies at the start of the year.
Several schools nationwide have had to shut classrooms because of a lack of teachers.
In Michigan, Eastpointe Community Schools abruptly moved its middle school back to remote learning this week because it doesn’t have enough teachers. The small district north of Detroit has 43 positions vacant — a quarter of its teaching staff. When several middle school teachers resigned without notice last week, the district shifted to online classes to avoid sending in unqualified substitutes, spokeswoman Caitlyn Kienitz said.
“You don’t want just an adult who can pass a background check, you want a teacher in front of your kids,” Kienitz said. “This is obviously not ideal, but we’re able to make sure they’re getting each subject area from a teacher certified to teach it.”
According to a June survey of 2,690 members of the National Education Association, 32% said the pandemic drove them to plan to leave the profession earlier than expected. Another survey by the RAND Corp. said the pandemic exacerbated attrition, burnout and stress on teachers, who were almost twice as likely as other employed adults to feel frequent job-related stress and almost three times more likely to experience depression.
The lack of teachers is “really a nationwide issue and definitely a statewide issue,” said Linda Darling-Hammond, president of California’s State Board of Education.
A school district in California’s West Contra Costa County is considering hiring out-of-state math educators to teach online while a substitute monitors students in person.
“This is the most acute shortage of labor we have ever had,” associate superintendent Tony Wold said. “We opened this year with 50 — that’s five-zero — teaching positions open. That means students are going to 50 classrooms that do not have a permanent teacher.”
There are an additional 100 openings for non-credentialed but critical staff like instructional aides — who help English learners and special needs students — custodians, cafeteria workers and others, Wold said.
California’s largest district, Los Angeles Unified with 600,000 students, has more than 500 teacher vacancies, a fivefold increase from previous years, spokeswoman Shannon Haber said.
Schools try to fill in with substitutes, but they’re in short supply, too. Only about a quarter of the pool of 1,000 qualified substitutes is willing to work in Fresno Unified, said Nikki Henry, a spokeswoman for the central California district with 70,000 students and 12,000 staffers.
At Berkeley High School, a shortage of substitutes means teachers are asked to fill in during their prep periods, leading to exhaustion and burnout typically not felt at the start of a school year.
“We are absolutely strained. This has been an incredibly stressful start to the year,” said Hasmig Minassian, a ninth-grade teacher who describes physical and mental exhaustion as she tries to juggle staffing needs and the emotional needs of students who are showing signs of more mental fragility and learning loss.
“It doesn’t feel like there are enough adults on these campuses to keep kids really safe. We feel short-staffed in a way we’ve never felt before,” she said. “You know the early videos of nurses crying in their cars? I kind of expect those to come out about teachers.”
The California shortages range from dire to less severe in places that planned ahead and beat the competition, but those are the minority, said Darling-Hammond of the board of education.
Money is not the problem. School districts have the funds to hire staff, thanks to billions in federal and state pandemic relief funding.
“We’re all competing for a shrinking piece of the pie,” said Mike Ghelber, assistant superintendent at the Morongo Unified School District in the Mojave Desert, which has more than 200 openings for special education aides, custodians, cafeteria workers and others. “I don’t know if everybody is getting snatched up, or if they don’t want to teach in the COVID era, but it’s like the well has dried up.”
The district of 8,000 students has ads in newspapers, radio and social media. Teachers are packing “now hiring” flyers into kids’ lunchboxes, with a long list of openings so families can spread the word. In the meantime, everyone is pitching in.
“Principals and administrators are out being crossing guards. Secretaries are directing traffic because we’re short on supervisors,” Ghelber said.
The shortages raise concerns that schools will hire underqualified teachers, particularly in low-income communities where it’s already harder to fill positions, Darling-Hammond said.
Class sizes also are expanding.
Mount Diablo Unified School District, which serves 28,000 students east of San Francisco, has had to fill several elementary school classrooms at the maximum capacity of 32 students. It’s not ideal for social distancing but frees up teachers for online school.
About 150 kids initially signed up for distance learning, but with spiking infections blamed on the highly contagious delta variant, the number ballooned to 600 when school reopened. The same happened in Fresno, where enrollment in remote learning exploded to 3,800 from 450.
Superintendent Adam Clark said the Mount Diablo district is offering $5,000 signing bonuses for speech pathologists and $1,500 for paraeducators who help students with learning needs.
San Francisco Unified is offering a similar starting bonus for 100 paraeducator jobs. Nearby West Contra Costa County Unified has set $6,000 signing bonuses for teachers, with a third paid out after the first month and rest when the teacher enters year three.
Districts in Oklahoma, North Carolina, New Jersey and elsewhere are offering a range of cash incentives for new teachers, particularly in low-income and low-performing schools.
Of a dozen officials interviewed in California districts, only one said it was facing no shortages.
Long Beach Unified, the state’s fourth-largest district with over 70,000 students, anticipated the need last spring for a hiring spree of about 400 jobs.
“We went full aggressive,” assistant superintendent David Zaid said, including beefing up human resources for a 24-hour turnaround on contract offers.
A virtual interview team worked through the summer. Recruitment events drew hundreds of applicants, and as HR employees met hiring benchmarks, they got rewards like catered breakfasts and an ice cream truck.
“We probably would have experienced the same shortages as others,” Zaid said. “But we became much more assertive, and as a result, we are not in the same position.”