COVID-19 Situation Report
EPI UPDATE The WHO COVID-19 Dashboard reports 204.6 million cumulative cases and 4.32 million deaths worldwide as of 12:15pm EDT on August 12.

Global Vaccination
The WHO reported 4.43 billion doses of SARS-CoV-2 vaccines administered globally as of August 12. The WHO reports that a total of 1.70 billion individuals have received at least 1 dose, and 866 million are fully vaccinated. Analysis from Our World in Data shows that the global daily doses administered has declined steadily from its second-highest peak—43.3 million doses per day—down to 35.9 million*. The global trend continues to closely follow the trend in Asia. Our World in Data estimates that there are 2.40 billion vaccinated individuals worldwide (1+ dose; 30.8% of the global population) and 1.26 billion who are fully vaccinated (16.1% of the global population).
*Average doses administered is exhibiting a sharp decrease for the most recent several days, which indicates effects of reporting delays. In an effort to reflect the longer-term trends, the averages reported here may not correspond to the most recent data.

As national SARS-CoV-2 vaccination campaigns continue, some new countries are emerging as successes, while some that were among the top countries earlier in the year have tapered off. This week, we will compare trends among the top countries in terms of full vaccination over the past several months**.

Top 10 as of August 12
1. Malta- 91%
2. Iceland- 75%
3. UAE- 73%
4. San Marino- 70%
5. Seychelles- 70%
6. Uruguay- 68%
7. Singapore- 68%
8. Chile- 67%
9. Nauru- 67%
10. Belgium- 65%

Among these countries, only 4 have remained in the top 10 since May: Chile, Malta, San Marino, and Seychelles. The UAE was only outside the top 10 in June, but this was likely a result of no updated data between April 20 and July 5. While Malta has remained among the top countries over this period, it climbed steadily through the rankings, up from #9 in May to #1 in August. Iceland also quickly rose through the rankings, from nearly 10 percentage points (pp) outside the top 10 in May to #2 globally in August. Seychelles’ vaccination coverage increased rapidly through the end of April, but progress has slowed considerably since then, causing it to fall from #1 to #5 since May. Interestingly, Qatar was not in the top 10 at any of the dates included in this analysis, but it was consistently close, ranking #12 in May and #11 from June through August.

In May, there was a gap of approximately 20pp between Seychelles and Israel and the rest of the top 10 countries—from #3 UAE at 39% to #2 Israel at 59%—but that gap closed over the past several months. Israel was #1 globally through late April, but after reaching 58% by the end of that month, its coverage increased by fewer than 5pp since then, with most of that occurring since mid-July. By virtue of initiating vaccination earlier than most countries, the US was among the top 3 globally through early March, but as progress slowed, it fell to #7 in May and #10 in June before falling outside the top 10 in July. Similar to the US, slowing progress in the UK following steady progress earlier in the year caused it to fall out of the top 10 between June and July. Bahrain and Hungary have exhibited similar trends.

In July, Singapore was 15pp outside the top 10, but rapid progress resulted in an increase in coverage of nearly 30pp in just a month—from 40% to 68%—propelling Singapore to #7 in August. Similarly, Nauru reported a rapid increase between July and August, climbing from just 17% coverage on June 29 (its earliest available data) to 67% on July 27 (its most recent data), good enough for #9 globally in August. After a relatively slow start, Belgium’s vaccination coverage increased rapidly starting in early May, outpacing the European average and moving the country up to #10 globally. Among the countries currently in the top 10, Uruguay and Mongolia initiated vaccination efforts later than most others, with less than 1% coverage reported on March 30 and April 22, respectively. Both countries exhibited rapid progress, however, and have been among the global top 10 since June.
**Data and rankings correspond to the 12th of each month, unless noted otherwise.

The US CDC reported 36.3 million cumulative COVID-19 cases and 617,096 deaths. The current average of 114,190 new cases per day is the highest since February 6 and nearly 10 times the most recent low—11,606 on June 19. It appears as though the US may be passing an inflection point, but it is difficult to determine whether this is an artifact of reporting frequency or an early indication of a longer-term trend. Daily mortality appears to continue its exponential increase up to 492 deaths per day, the highest average since May 22*.
*Changes in the frequency of state-level reporting may affect the accuracy of recently reported data, particularly over the weekend. In an effort to reflect the longer-term trends, the averages reported here may not correspond to the most recent dates.

US Vaccination
The US has administered 353.9 million cumulative doses of SARS-CoV-2 vaccines. Daily vaccinations continue to increase steadily, up to 640,617 doses per day*. A total of 196.5 million individuals in the US have received at least 1 dose, equivalent to 59.2% of the entire US population. Among adults, 71.5% have received at least 1 dose, as well as 11.9 million adolescents aged 12-17 years. A total of 167.4 million individuals are fully vaccinated, which corresponds to 50.4% of the total population. Approximately 61.3% of adults are fully vaccinated, as well as 8.9 million adolescents aged 12-17 years.
*Due to delays in reporting, estimates for the average daily doses administered are less accurate for the most recent 5 days. The most current average provided here corresponds to 5 days ago.

THIRD DOSE AMONG IMMUNOCOMPROMISED The US FDA on August 12 authorized the administration of an additional dose of SARS-CoV-2 mRNA vaccines for certain people with compromised immune systems, “specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.” The FDA amended the emergency use authorizations (EUAs) for both the Pfizer-BioNTech and Moderna vaccines to allow for a third dose for this population, which is estimated to be about 2.7% of the US adult population. Several studies, including one published this week in the New England Journal of Medicine, show that immunocompromised people experience a significant increase in their immune response after a third dose of vaccine. The agency noted that other fully vaccinated people do not need an additional dose at this time, but several US health officials believe extra doses might be needed in the future. According to the FDA, the EUA for the J&J-Janssen vaccine was not updated because there is not yet sufficient evidence to support additional doses in any population. 

The US CDC’s Advisory Committee on Immunization Practices (ACIP) is meeting today to further discuss and vote on clinical recommendations regarding who will be eligible for extra shots and how they will be administered, with CDC Director Dr. Rochelle Walensky expected to sign off on any decisions later in the day. The ACIP also is expected to discuss what type of evidence is needed to inform a decision about whether additional vaccine doses are needed for a larger portion of the population and, if so, which populations should get them first.

US SURGE The US COVID-19 surge continues, its second largest to date, and concerns are growing regarding the impact on health systems and schools. Analysis from The Washington Post illustrates a close correlation between low vaccination coverage and elevated SARS-CoV-2 transmission, with the vast majority of hotspot areas located in counties with full vaccination coverage less than 40%, including much of the South and Southeast regions, and relatively few in counties with moderate or high coverage. Even as the surge grows, some state lawmakers are continuing efforts to curb the authority of local governments and health officials. In Tennessee, all 73 Republican members of the state House of Representatives called for a special legislative session in order to pass measures that would limit local officials’ ability to implement COVID-19 protective measures such as mask mandates.

In severely affected areas, hospitals are being forced to implement emergency plans to manage the influx of COVID-19 patients. In Florida, which represents 22% of the national daily incidence, state health officials requested 200 ventilators and 100 high-flow nasal cannula kits from the federal Strategic National Stockpile (SNS). The state is not yet experiencing a shortage of this equipment, but statewide hospitalizations continue to set new records. Reportedly, officials in Brevard County, Florida, are emphasizing that the 9-1-1 telephone number should be used only for emergencies and encouraging residents to seek care through other means for less urgent conditions in order to reduce the burden on ambulance services and emergency departments. Despite having the country’s largest surge, Florida Governor Ron DeSantis continues to resist protective measures, including mask mandates, to slow transmission. Rather, he touted a state plan to expand infusion centers for monoclonal antibody treatments to mitigate the impact on hospitals. Notably, these treatments require a prescription and could cost thousands of dollars, whereas mask use is relatively inexpensive and vaccination is provided free of charge.

Daily incidence among children continues to increase, setting new records nationally and in severely affected states. In Mississippi, one school district—notably, with no mask mandate—is transitioning to virtual learning only 1 week into the school year, after 40% of students at one high school were required to quarantine. As of August 12, at least 10 cohorts of students at the high school are under quarantine, but the school elected to resume in-person classes and continue quarantining students following exposures prior to the district order to go virtual beginning August 16.

VACCINE MANDATES FOR PUBLIC SCHOOL STAFF California (US) Governor Gavin Newsom on August 11 announced the state will require all teachers and school staff to show proof of SARS-CoV-2 vaccination or undergo weekly testing. The move—which applies to more than 800,000 employees, including about 320,000 public school teachers and many other support and administrative staff—comes after several large state school districts (San Jose Unified, San Francisco Unified, Sacramento City Unified, and Long Beach Unified) announced similar requirements for their employees. The state’s 2 major teachers unions—the California Teachers Association and the California Federation of Teachers—among other unions, support the plan, citing state and national data showing that nearly 90% of educators have been vaccinated. There is debate over whether California is the first state with such a requirement for public school employees, as Hawai’i Governor David Ige last week announced his intention to require vaccinations for all public sector workers, including school staff. However, several public workers unions, including those representing teachers, pushed back on the announcement, saying they were not consulted and arguing there is no detailed plan on implementation. 

Over the weekend, Randi Weingarten, President of the American Federation of Teachers, announced support for vaccine mandates for educators as the first line of prevention for unvaccinated, younger students as they return to in-person learning, saying mask wearing is the second most important factor for keeping kids in school. Weingarten cited an increasing number of new COVID-19 cases among children over the past few weeks, as compiled by the American Academy of Pediatrics (AAP). Last week, Becky Pringle, President of the National Education Association, the largest teachers union in the US, said vaccine and mask mandates should be decided on local levels. In an interview on August 10, Dr. Anthony Fauci, Chief Medical Adviser to the President, voiced support for vaccination mandates for public school employees, saying vaccination of all eligible adults would help children more safely return to classrooms this fall. In most states, there are laws dictating vaccination requirements for school children but, to our knowledge, none requiring teachers and school staff workers to undergo immunizations. Some states provide public school employees a list of recommended vaccines—such as those for diphtheria, tetanus and pertussis (DTaP); influenza; and measles, mumps and rubella (MMR)—but there is no requirement or follow-up.

Much of the urgency over vaccinating public school employees centers on the fact that children under the age of 12 remain ineligible for vaccination in the US. In a letter sent last week to the US FDA, AAP President Lee Savio Beers urged the agency to fast-track vaccine authorization for this age group, saying the Delta variant “changes the risk-benefit analysis.” In May, the FDA authorized the emergency use of the Pfizer-BioNTech vaccine for young people aged 12 to 15 years, but the companies have not yet applied for authorization among children aged 5 to 11 years. A Pfizer spokesperson said the company plans to submit an emergency use authorization (EUA) application for that age group by the end of September. For now, the timeline for a vaccine EUA for school-aged children is amorphous, but experts remain hopeful that authorization and recommendations could still come before the end of the year.

COVID-19 AMONG CHILDREN Public health experts, state officials, and healthcare providers are warning about a surge in COVID-19-related hospitalizations among children and cautioning that the Delta variant could be more dangerous for younger individuals. As of August 10, US hospitals admitted an average of 246 children with COVID-19 every day over the previous week, representing a 27.3% increase over the week ending August 3, according to CDC data. While children ages 12 and older are eligible to receive the Pfizer-BioNTech SARS-CoV-2 vaccine, rates of vaccination in that age group remain below the national average, around 31% fully vaccinated

States experiencing the largest increases in overall COVID-19 cases, such as Louisiana and Florida, also are seeing the greatest increases in hospitalizations among children. Dr. Mark Kline of Children’s Hospital in New Orleans said children with COVID-19 account for about 20% of the facility’s hospitalized patients, with most of them under age 10 and too young to be vaccinated. In Texas, more children are being treated in hospitals for COVID-19 than ever before, and many also are infected with respiratory syncytial virus (RSV). One physician, warning of dwindling hospital capacity, said the 2 viruses are “spreading like wildfire” among younger children, particularly those under age 2. According to the American Academy of Pediatrics, nearly 94,000 cases among children were recorded in the week ending August 5, continuing a “substantial increase” in the number of new cases since the beginning of July. 

Although children continue to account for a small percentage of total COVID-19 hospitalizations—between 1.5% and 3.5%—the disease impacts kids of different ages differently, and even those who have asymptomatic or mild infections could experience so-called “long COVID,” or post-acute sequelae of COVID-19 (PASC). Experts are still learning about the condition, which is characterized by a variety of symptoms including memory or concentration difficulties (ie, “brain fog”), trouble sleeping, fatigue, dizziness, headaches, gastrointestinal problems, or changes to smell or taste. The impacts of these long-lasting symptoms could be “huge,” according to some pediatric experts, with the symptoms disrupting school and extracurricular activities especially among those in their formative teen years. Concern over the rising number of COVID-19 cases and hospitalizations among younger populations, and the potential for long-term impacts, is amplified by anecdotal evidence the Delta variant might cause more severe disease among children and that many are returning to in-person learning. These factors, and the fact that about 50 million children remain ineligible for vaccination, places even more importance on utilizing other risk reduction methods, including vaccination among those who are eligible, mask wearing, and physical distancing. 

US CDC VACCINATION GUIDANCE FOR PREGNANT WOMEN The US CDC on August 11 recommended that all people who are pregnant, breastfeeding, trying to get pregnant, or might become pregnant in the future be vaccinated for SARS-CoV-2. The agency cited a growing body of evidence showing vaccination during pregnancy is safe, noting new data that found no increased risk of miscarriage among pregnant people who received a SARS-CoV-2 mRNA vaccine during the first 20 weeks of gestation. Previously, the CDC said the vaccine could be offered during pregnancy, but the new recommendation urges all pregnant people to be vaccinated. According to CDC data, only about 23% of pregnant people have received at least one dose of a vaccine. The new recommendation comes amid a surge of new COVID-19 cases, hospitalizations, and deaths in the US, driven by the highly transmissible Delta variant. The CDC’s updated recommendation came 2 days after the release of a joint statement by the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and 20 other health organizations “strongly” urging pregnant and recently pregnant individuals, as well as those planning to become pregnant, to be vaccinated. The groups noted that pregnant individuals are at an increased risk of severe COVID-19 disease, including death, and the best way to protect themselves is through vaccination.

US GOVERNMENT VACCINE MANDATES The US Department of Health and Human Services (HHS) became the latest federal agency to announce a vaccine mandate for some of its employees, requiring more than 25,000 members of its health care workforce to be vaccinated against SARS-CoV-2. Staff of the Indian Health Services (IHS) and National Institutes of Health (NIH) who work in health and clinical research facilities or who have direct contact with patients and members of the US Public Health Service Commissioned Corps who respond to public health crises nationwide are included in the mandate. The HHS mandate also applies to contractors, trainees, and volunteers who might have patient contact at federal clinical research or medical facilities. IHS, NIH, and Commissioned Corps staff already are required to receive seasonal influenza and other routine vaccinations, with allowances for certain medical and religious exemptions.

The US Department of Veterans Affairs (VA) announced a similar vaccine mandate at the end of July, and on August 12 expanded the requirement to apply to most Veterans Health Administration (VHA) employees, volunteers, and contractors who work in VHA facilities, visit such facilities, or otherwise come into contact with VA patients and healthcare workers as part of their jobs. The US Department of Defense earlier this week announced a plan to require all military members to be vaccinated by mid-September or earlier. All other US government employees are required to show proof of vaccination or be subject to other precautions, including regular testing, mask wearing, and travel restrictions.

VACCINE EFFECTIVENESS & VOCs New information continues to emerge regarding the effectiveness of different SARS-CoV-2 vaccines, particularly with respect to variants of concern (VOCs). This week, several articles were published in academic journals and on preprint servers. In one study, published in The New England Journal of Medicine, UK researchers examined vaccine effectiveness against symptomatic disease for both the Alpha and Delta SARS-CoV-2 variants. They included data on participants who received either the Pfizer-BioNTech or AstraZeneca-Oxford vaccines and stratified the sample for those who had received partial or full doses. The research team found that both vaccines were less effective against the Delta variant than the Alpha variant when the individual only had one dose (30.7% vs 48.7%), and also saw reduced effectiveness against Delta for fully vaccinated individuals when compared to Alpha. The Pfizer-BioNTech vaccine was 93.7% effective in preventing symptomatic disease against Alpha and 88% against Delta among fully vaccinated individuals, while the AstraZeneca-Oxford vaccine was 74.5% and 64% effective, respectively.

Another study, conducted in Utah (US) and posted on the preprint server medRxiv, suggested similar findings. The researchers found a modest reduction in overall vaccine effectiveness for all US FDA-authorized vaccines corresponding to the expansion of the Delta variant in the state, saying the reduction in effectiveness due to the VOC, and not waning immunity, is “highly concerning.” A third study, conducted in Qatar and also posted to medRxiv, examined the effectiveness of the Pfizer-BioNTech and Moderna vaccines against the Delta variant. The research team estimated the effectiveness against symptomatic COVID-19 to be 79.0% for the Pfizer-BioNTech vaccine and 84.8% for the Moderna vaccine. The Pfizer-BioNTech vaccine exhibited 89.7% effectiveness against severe, critical, or fatal COVID-19 disease due to Delta, and the Moderna exhibited 100% effectiveness, although this analysis had a very small sample size.

A fourth preprint study, posted to medRxiv and based on data collected by the Mayo Clinic, retrospectively examined SARS-CoV-2 PCR test data collected between January and July 2021 from 645,109 individuals vaccinated with either the Pfizer-BioNTech or Moderna vaccines. Both vaccines were highly effective during the study period for preventing infection, with Moderna exhibiting 86% effectiveness and Pfizer-BioNTech 76% effectiveness. Additionally, the vaccines worked well to prevent COVID-19 hospitalizations, with an estimated effectiveness of 91.6% for the Moderna vaccine and 85% for the Pfizer-BioNTech vaccine. However, effectiveness against infection dropped in July with the rise of the Delta variant, with Moderna at 76% and Pfizer-BioNtech at 42%. All of these papers reinforce that current SARS-CoV-2 vaccines are effective at preventing COVID-19 disease—particularly severe disease, hospitalization, and death—even in the face of increasing prevalence of VOCs, including the Delta variant. 

SARS-COV-2 RAPID ANTIGEN TESTS Researchers from Germany published (preprint) findings from a study on the accuracy of 2 commercially available SARS-CoV-2 antigen rapid diagnostic tests (RDTs), comparing them to the "gold standard" real-time reverse transcription-polymerase chain reaction (rRT-PCR)-based tests. The SD Biosensor SARS-CoV-2 Rapid Antigen Test by Roche Diagnostics and Panbio COVID-19 Ag Rapid Test by Abbott Diagnostics were compared in a German diagnostic center between February 1 and March 31, 2021. Of 2,215 tests conducted, 338 (15%) were rRT-PCR positive for SARS-CoV-2. The Roche RDT exhibited 60.4% sensitivity and 99.7% specificity, and the Abbott RDT exhibited 56.8% sensitivity and 99.8% specificity. The sensitivities of the RDTs were higher among individuals referred by physicians and health departments compared to the total study population, where the Roche RDT performed at 79.5% and the Abbott RDT at 78.7%. The RDTs had substantially lower sensitivities in individuals with at least one comorbidity (Roche 38.2%, Abbott 34.4%) compared to those without comorbidities (Roche 74.4%, Abbott 71.0%). Higher unadjusted sensitivities in RDTs were also observed in symptomatic individuals (Roche 75.2%, Abbott 74.3%) compared to asymptomatic individuals (Roche 23.8%, Abbott 31.9%).

To put these results in context, if 10,000 symptomatic individuals were tested, of which 500 were truly positive, these RDTs would yield 38 false-positive and 124 false-negative results. If 10,000 asymptomatic individuals were tested, of which 50 are true positives, the RDTs would yield 18 false-positive and 34 false-negative results. Based on the study, the authors call into question whether the widespread use of RDTs for screening purposes is beneficial. Since screening often is recommended for asymptomatic individuals, the results of the study are of crucial importance in assessing tests best suited for this use. 

CANADA VACCINE MANUFACTURING FACILITY Pharmaceutical company Moderna and the Government of Canada on August 10 announced a memorandum of understanding to build a “state-of-the-art” manufacturing facility in Canada to make the company’s SARS-CoV-2 vaccine and possibly other respiratory virus vaccines that use the mRNA platform. Moderna said the facility will help provide Canada with supplies of its SARS-CoV-2 vaccine, “direct access” to pandemic response capabilities in the future, and access to any vaccines currently in development that might receive approval. About 30% of the SARS-CoV-2 vaccine doses distributed in Canada are from Moderna, and that proportion could go up depending on regulatory approval of additional doses. Though the location of the manufacturing plant has not yet been decided, it will likely be similar to Moderna’s main facility in Norwood, Massachusetts (US), and will employ a couple hundred people. Moderna CEO Stéphane Bancel said the company is in talks to build similar manufacturing facilities in other nations in Europe and Asia, although he did not specify which ones, adding they expect to build 5 to 10 such plants worldwide over the coming years. Earlier this year, Canada announced an agreement with Novavax, which is working on its own SARS-CoV-2 vaccine, to produce its doses at a government-owned facility in Montreal either late this year or early next year. Notably, Novavax has delayed its submission for authorization to the US FDA 3 times, most recently citing efforts to validate production consistency.

SENEGAL The Senegalese health system continues to struggle under a third wave of SARS-CoV-2 infections, where cases have skyrocketed. More than 15,000 cases and 139 deaths were reported in July, according to the Ministry of Health. Prior to July, Senegal reported fewer than 44,000 cases and 1,166 deaths. Ambulance services in Dakar, the current epicenter of the outbreak, also are feeling the strain. Since the beginning of the third wave, more than 90% of calls to the Mobile Emergency Care Service (SAMU) have been for respiratory distress. With the influx of emergency calls, hospitals are low on bed space with supplemental oxygen to care for patients, and delivery workers have been working through the night to keep up with the oxygen demand. Cemetery workers also are among personnel working around the clock to keep up with demand. A cemetery manager close to the Dakar hospital reports an average of 30 burials per day during this wave of infections. During the last surge, the average was 20 burials a day, and prior to the pandemic, 10 each day.

Last month, the government announced construction of a vaccine manufacturing plant in the capital, which is expected to produce 25 million doses per month by the end of 2022. The Institut Pasteur in Dakar will run the plant to reduce outside dependence on vaccine supply. As of August 9, just under 2% of the Senegalese population was fully vaccinated against SARS-CoV-2. 

GLOBAL VACCINE ACCESS The WHO is continuing to press wealthier nations and SARS-CoV-2 vaccine manufacturers to reverse the “disgraceful” inequity in global access to vaccines to help low- and middle-income countries (LMICs) vaccinate at least 10% of their populations by the end of September. Speaking during an online Q&A session with WHO officials, Dr. Bruce Aylward, Senior Adviser to the WHO Director-General and head of the Access to COVID-19 Tools (ACT) Accelerator initiative, criticized wealthier nations, saying they should be “disgusted” by the imbalance in the available tools to address the pandemic and calling for US$.7.7 billion to help the WHO supply vaccines, oxygen, and other medical supplies to LMICs. Dr. Aylward’s comments come a week after WHO Director-General Dr. Tedros Adhanom Ghebreyesus called for a moratorium on providing additional, or booster, doses to most people in order to improve global access. Researchers with the Council on Foreign Relations identified 37 high- and middle-income countries that are considering or already administering booster shots as of August 12. They warn—as does the WHO in a recently released interim statement on booster doses—that offering third doses to large swaths of populations, beyond vulnerable groups such as the immunocompromised or people over the age of 80, threatens to further widen the gap between “vaccine-haves and vaccine-have-nots.”

The Pan American Health Organization (PAHO) this week announced a plan to increase SARS-CoV-2 vaccine availability for its member countries. The new COVID-19 initiative, which will be operated through the organization’s well-established Revolving Fund, will purchase “tens of millions” of vaccine doses, syringes, and related supplies and begin delivering them in October to the more than 20 countries in the region that have expressed interest in joining. In making the announcement, PAHO recognized it is not clear whether the COVAX facility will succeed in providing the necessary vaccine doses to its member nations. 

On August 10, more than 175 public health experts, scientists, and civil society leaders as well as more than 50 organizations sent a letter to officials in the administration of US President Joe Biden, calling on them to immediately ramp up a global vaccine manufacturing program to help vaccinate the rest of the world and reduce the likelihood of newer, possibly more dangerous variants emerging. In a separate letter addressed to President Biden, they urge him to release millions of stockpiled doses each week to countries in need, noting the US has more than 55 million doses of mRNA vaccines stockpiled but is administering fewer than 900,000 per day. While many experts are focused on the threat of emerging new variants, the UN Development Programme (UNDP) warns vaccine inequities will have long-term economic and social impacts in LMICs, including a widening poverty gap, increased divides in health care spending, and swollen public debt.

HERD IMMUNITY IMPOSSIBLE Consensus is forming among public health experts and scientists worldwide: the highly transmissible Delta variant of SARS-CoV-2 changed the COVID-19 pandemic, dashing hopes of widespread vaccination creating herd immunity that could protect people from infection and guaranteeing the novel coronavirus will become endemic. While the vaccines are highly effective at preventing serious illness or death, they do not fully protect the vaccinated from infection. Additionally, people who had previous SARS-CoV-2 infections are not necessarily protected from infection from future variants. And because infected people can in turn infect others, whether vaccinated or not, the concept of herd or population immunity with COVID-19 “is not a possibility,” according to experts who recently spoke to the UK’s All-Party Parliamentary Group. However, the vaccines still work, and work well, protecting those fully vaccinated from death and keeping them out of the hospital, and vaccine doses should be urgently distributed to "where they can have the greatest impact," especially to countries in need, Professor Sir Andrew John Pollard, Director of the Oxford Vaccine Group, urged. In the meantime, “the world needs to stay alert,” Ed Yong writes in The Atlantic, and make use of all available protective measures that could help stave off the emergence of new, potentially more dangerous variants.