1-dose shot is off pause, back in use

States move swiftly to enlistvaccine in covid fight again

Pharmacy Technician Synclaire Anderson vaccinates Joe Freed with the Johnson & Johnson COVID-19 on Saturday, April 24, 2021 at The Indianapolis Motor Speedway in Indianapolis. With a green light from federal health officials, several states resumed use of the one-shot Johnson & Johnson coronavirus vaccine on Saturday. Among the venues where it's being deployed is the Indianapolis Motor Speedway, where free vaccinations were available to anyone 18 or older. (Michelle Pemberton/The Indianapolis Star via AP)
Pharmacy Technician Synclaire Anderson vaccinates Joe Freed with the Johnson & Johnson COVID-19 on Saturday, April 24, 2021 at The Indianapolis Motor Speedway in Indianapolis. With a green light from federal health officials, several states resumed use of the one-shot Johnson & Johnson coronavirus vaccine on Saturday. Among the venues where it's being deployed is the Indianapolis Motor Speedway, where free vaccinations were available to anyone 18 or older. (Michelle Pemberton/The Indianapolis Star via AP)

NEW YORK -- With a green light from federal health officials, many states resumed use of the one-shot Johnson & Johnson coronavirus vaccine Saturday. Among the venues where it was being deployed was the Indianapolis Motor Speedway.

Among the states ordering or recommending a resumption were Arizona, Colorado, Connecticut, Louisiana, Maine, Massachusetts, Michigan, Missouri, Nevada, New York, Tennessee, Texas and Virginia.

The moves happened swiftly after U.S. health officials said Friday evening that they were lifting an 11-day pause on the vaccine as scientific advisers decided the vaccine's benefits outweigh a rare risk of blood clot.

"The state of New York will resume administration of this vaccine ... effective immediately," Gov. Andrew Cuomo said in a statement Saturday morning.

"The vaccine is the weapon that will win the war against COVID and allow everyone to resume normalcy, and we have three proven vaccines at our disposal," Cuomo said, urging New Yorkers to take whichever one is available first. "The sooner we all get vaccinated, the sooner we can put the long COVID nightmare behind us once and for all."

Indiana's Department of Health announced resumption of a vaccination clinic Saturday at the speedway, offering Johnson & Johnson shots to anyone 18 or older. It will run at least through Friday, when there will be a family vaccination day at which 16- and 17-year-olds also can get shots.

"I can't think of a better way to welcome the month of May in Indiana than getting your vaccine this week at the Yard of Bricks," said Dr. Chris Weaver, chief clinical officer for Indiana University Health.

Virginia health officials also told providers to immediately resume using the Johnson & Johnson vaccine.

"This extra scrutiny should instill confidence in the system that is in place to guarantee covid-19 vaccine safety," said Dr. Danny Avula, the state's vaccine coordinator. "As with any vaccine, we encourage individuals to educate themselves on any potential side effects and to weigh that against the possibility of hospitalization or death from covid-19."

Avula received the Johnson & Johnson vaccine himself April 1.

Missouri officials also said providers with the vaccine in stock could immediately begin administering it and that shipments from the federal government will resume this week.

Louisiana providers also can immediately resume vaccinating patients with the Johnson & Johnson shot, state health officials said Saturday.

The state Department of Health "encourages all Louisianans to take advantage of the available vaccines, so the state can continue to slow the spread of COVID-19 and put the pandemic in its rearview," it said in a news release.

"Safety is all of our top priority, and we appreciate the thorough review," said Dr. Joseph Kanter, state health officer. "We have the utmost confidence in the safety and monitoring process and commitment to transparency."

In Texas, state health commissioner Dr. John Hellerstedt said Saturday that vaccine providers should resume using the Johnson & Johnson vaccine -- "an important tool in our fight against covid-19, and the scientific review over the last 11 days has affirmed its safety and effectiveness."

In Michigan, where health departments have a key role in vaccination decision-making, the state's chief medical executive, Dr. Joneigh Khaldun, recommended resuming use of the Johnson & Johnson vaccine.

In Los Angeles County, the nation's most-populous county, public-health officials told vaccination providers they could resume administering Johnson & Johnson doses Saturday as long as they provided an updated fact sheet to recipients.

The material will "include what we think is really important information about what to look for -- the signs and symptoms if you were to have this, again, very rare reaction," said Dr. Paul Simon, chief science officer for the county's Department of Public Health.

The federal government uncovered 15 vaccine recipients who developed a highly unusual kind of blood clot out of nearly 8 million people given the Johnson & Johnson shot. All were women, most younger than 50. Three women died, and seven remain hospitalized.

But ultimately federal health officials decided that the one-and-done vaccine is critical to fighting the pandemic -- and that the small clot risk could be handled with warnings to help younger women decide if they should seek an alternative shot.

CRIES FOR U.S. HELP

In Honduras, Victor Guevara knows people his age have been vaccinated against covid-19 in many countries. His own relatives in Houston have been inoculated.

But the 72-year-old lawyer, like so many others in his country, is still waiting. And increasingly, he is wondering why the U.S. is not doing more to help, particularly as the American vaccine supply begins to outpace demand and doses that have been approved for use elsewhere in the world, but not in the U.S., sit idle.

"We live in a state of defenselessness on every level," Guevara said.

Honduras has obtained a paltry 59,000 doses for its 10 million people. Similar gaps are found across Africa, where just 36 million doses have been acquired for the continent's 1.3 billion people, as well as in parts of Asia.

In the United States, more than one-fourth of the population -- nearly 90 million people -- has been fully vaccinated, and supplies are so robust that some states are turning down shipments from the federal government.

This stark gap is prompting increased calls across the world for the U.S. to start shipping vaccine supplies to poorer countries. That's creating a test for President Joe Biden, who has pledged to restore American leadership on the world stage and prove to wary nations that the U.S. is a reliable partner after years of retrenchment during the Trump administration.

J. Stephen Morrison, senior vice president and director of the Global Health Policy Center at the Center for Strategic and International Studies in Washington, said that as the U.S. moves from vaccine scarcity to abundance, it has an opportunity to "shape the outcomes dramatically in this next phase because of the assets we have."

Biden has responded cautiously.

He has focused the bulk of his administration's vaccination efforts at home. He kept in place an agreement struck by the Trump administration requiring drugmakers that got U.S. aid in developing or expanding vaccine manufacturing to sell their first doses produced in the country to the U.S. government. The U.S. also has used the Defense Production Act to secure vital supplies for the production of vaccine, a move that has blocked the export of some supplies.

White House aides have argued that Biden's approach was validated in the wake of manufacturing issues with the Johnson & Johnson vaccine and the subsequent safety pause. In addition, officials say they need to maintain reserves in the U.S. to vaccinate teenagers and younger children once safety studies for those age groups are completed and if booster shots should be required later.

The White House is aware that the rest of the world is watching. Last month, the U.S. provided 4 million doses to Canada and Mexico, and last week Biden said those countries would be targets for additional supplies. He also said countries in Central America could receive U.S. vaccination help, though officials have not detailed any specific plans.

The lack of U.S. vaccine assistance around the world has created an opportunity for China and Russia, which have promised millions of doses of domestically produced shots to other countries, though there have been production delays that have hampered delivery. Chinese Foreign Minister Wang Yi said this month that China opposes "vaccine nationalism," and that shots should become a global public good.

Professor Willem Hanekom, director of the Africa Health Research Institute and a vaccinologist, said wealthy countries have a stake in the success of vaccination efforts in other corners of the world.

"Beyond the moral obligation, the problem is that if there is not going to be control of the epidemic globally, this may ultimately backfire for these rich countries, if in areas where vaccines are not available variants emerge against which the vaccines might not work," Hanekom said.

'VACCINE APARTHEID'

As India announced a grim record -- the highest daily infection tallies in a single country -- Americans were enjoying a spring of vaccine abundance.

In India, just 1.4% of the population has been fully vaccinated and overwhelmed hospitals have been running short of oxygen. In the United States -- where 1 in 4 people are fully vaccinated and more than 40% have gotten at least the first dose -- a major Miami hospital, Jackson Memorial, said that it would begin winding down vaccinations because of excess supply and weakening demand.

In Michigan, health workers are rolling out shots to high school students. In North Carolina, doses sat on shelves this month during a pause for spring break.

A long-simmering debate over the glaring gap in vaccine access -- largely between rich and poor countries, but among some developed nations, too -- is now boiling over, with global figures and national leaders decrying the vaccine plenty in a few nations and the relative drought almost everywhere else.

African nations such as Namibia and Kenya are denouncing a "vaccine apartheid," while others are calling for policy changes in Washington and a broader rethink of the intellectual-property and trademark laws that govern vaccine manufacturing in global pandemics.

"It's outrageous ethically, morally, scientifically," said Maria Van Kerkhove, an epidemiologist with the World Health Organization.

"We have all the kindling to start fires everywhere," she said. "We're sitting on a powder keg."

It is happening at a demarcation point in the pandemic. In some countries with high vaccination rates -- including the United States, Britain and Israel -- coronavirus numbers are decreasing or plateauing. But globally, the number of new cases per week has nearly doubled since February, according to the WHO.

"Many countries still have no vaccines whatsoever," said Rob Yates, executive director of the Center for Universal Health at Chatham House, a London think tank. "You're seeing much anger, and I think it's justified."

The numbers are surging as a chain reaction of vaccine nationalism is hindering the flow of doses to poorer nations through Covax, the WHO-backed effort to distribute vaccines around the world.

Critics have blamed the United States for policies that have curbed the export of vaccines as well as the supplies used to make them.

"Respected POTUS, if we are to truly unite in beating this virus, on behalf of the vaccine industry outside the U.S., I humbly request you to lift the embargo of raw material exports out of the U.S. so that vaccine production can ramp up," Adar Poonawalla, head of India's Serum Institute, tweeted to Biden on April 16. "Your administration has the details."

"It is disastrous for low- and middle-income countries," said Lawrence Gostin, a professor of global health law at Georgetown University, "particularly countries like India who could be the engine to vaccinate the world."

Many developing nations argue that the United States and other wealthy Western countries could rapidly boost global vaccine supplies by temporarily suspending pharmaceutical companies' intellectual-property rights. That could allow poorer countries to produce their own versions of trademarked vaccines, such as Pfizer's or Moderna's.

In March, the United States, Britain and members of the European Union blocked a World Trade Organization proposal backed by roughly 80 nations to waive patent protections for coronavirus vaccines. The WTO plans to revisit the issue in May.

A group of U.S. senators led by Bernie Sanders, I-Vt., Elizabeth Warren, D-Mass., and Tammy Baldwin, D-Wis., along with former heads of state and Nobel laureates, have urged Biden to support a temporary waiver.

Nicholas Lusiani, senior adviser at the anti-poverty group Oxfam America, said Biden administration officials indicated a potential about-face to support the proposal during recent talks with the group. He said Washington also was considering backing an ambitious effort to help fund vaccine manufacturing hubs in Latin America and Africa.

"In the last few weeks, we've seen a groundswell of support for what was seen as a place the U.S. would never go -- temporarily suspending patent rights," Lusiani said.

Information for this article was contributed by David Crary, Marlon Gonzalez, Zeke Miller, Christopher Sherman, Cara Anna, Aniruddha Ghosal, Huizhong Wu, David Biller, Gisela Salomon, Sonia Perez D., Andrew Meldrum, Mogomotsi Magome and staff members of The Associated Press; and by Anthony Faiola, Emily Rauhala, Antonia Noori Farzan, Joel Achenbach, Amanda Coletta, Quentin Aries and Ana Vanessa Herrero of The Washington Post.

FILE - In this April 8, 2021 file photo, the Johnson & Johnson COVID-19 vaccine is seen at a pop up vaccination site in the Staten Island borough of New York.  With a green light from federal health officials, several states resumed use of the one-shot Johnson & Johnson coronavirus vaccine on Saturday, April 24. Among the venues where it's being deployed is the Indianapolis Motor Speedway, where free vaccinations were available to anyone 18 or older. (AP Photo/Mary Altaffer, File)
FILE - In this April 8, 2021 file photo, the Johnson & Johnson COVID-19 vaccine is seen at a pop up vaccination site in the Staten Island borough of New York. With a green light from federal health officials, several states resumed use of the one-shot Johnson & Johnson coronavirus vaccine on Saturday, April 24. Among the venues where it's being deployed is the Indianapolis Motor Speedway, where free vaccinations were available to anyone 18 or older. (AP Photo/Mary Altaffer, File)
A sign is on display at the The Indianapolis Motor Speedway for people to receive the COVID-19 vaccination on Saturday, April 24, 2021 in Indianapolis.  With a green light from federal health officials, several states resumed use of the one-shot Johnson & Johnson coronavirus vaccine on Saturday. Among the venues where it's being deployed is the Indianapolis Motor Speedway, where free vaccinations were available to anyone 18 or older. (Michelle Pemberton/The Indianapolis Star via AP)
A sign is on display at the The Indianapolis Motor Speedway for people to receive the COVID-19 vaccination on Saturday, April 24, 2021 in Indianapolis. With a green light from federal health officials, several states resumed use of the one-shot Johnson & Johnson coronavirus vaccine on Saturday. Among the venues where it's being deployed is the Indianapolis Motor Speedway, where free vaccinations were available to anyone 18 or older. (Michelle Pemberton/The Indianapolis Star via AP)
People drive up for the Johnson & Johnson COVID-19 vaccination on Saturday, April 24, 2021, at The Indianapolis Motor Speedway  in Indianapolis.  With a green light from federal health officials, several states resumed use of the one-shot Johnson & Johnson coronavirus vaccine on Saturday. Among the venues where it's being deployed is the Indianapolis Motor Speedway, where free vaccinations were available to anyone 18 or older. (Michelle Pemberton/The Indianapolis Star via AP)
People drive up for the Johnson & Johnson COVID-19 vaccination on Saturday, April 24, 2021, at The Indianapolis Motor Speedway in Indianapolis. With a green light from federal health officials, several states resumed use of the one-shot Johnson & Johnson coronavirus vaccine on Saturday. Among the venues where it's being deployed is the Indianapolis Motor Speedway, where free vaccinations were available to anyone 18 or older. (Michelle Pemberton/The Indianapolis Star via AP)
People drive up for the Johnson & Johnson COVID-19 vaccination on Saturday, April 24, 2021, at The Indianapolis Motor Speedway  in Indianapolis. With a green light from federal health officials, several states resumed use of the one-shot Johnson & Johnson coronavirus vaccine on Saturday. Among the venues where it's being deployed is the Indianapolis Motor Speedway, where free vaccinations were available to anyone 18 or older. (Michelle Pemberton/The Indianapolis Star via AP)
People drive up for the Johnson & Johnson COVID-19 vaccination on Saturday, April 24, 2021, at The Indianapolis Motor Speedway in Indianapolis. With a green light from federal health officials, several states resumed use of the one-shot Johnson & Johnson coronavirus vaccine on Saturday. Among the venues where it's being deployed is the Indianapolis Motor Speedway, where free vaccinations were available to anyone 18 or older. (Michelle Pemberton/The Indianapolis Star via AP)

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