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Who gets to be first in line for a COVID-19 vaccine? U.S. health authorities hope by late next month to have some draft guidance on how to ration initial doses, but it’s a vexing decision.“Not everybody’s going to like the answer,” Dr. Francis Collins, director of the National Institutes of Health, recently told one of the advisory groups the government asked to help decide. “There will be many people who feel that they should have been at the top of the list.”Traditionally, first in line for a scarce vaccine are health workers and the people most vulnerable to the targeted infection.But Collins tossed new ideas into the mix: Consider geography and give priority to people where an outbreak is hitting hardest.And don’t forget volunteers in the final stage of vaccine testing who get dummy shots, the comparison group needed to tell if the real shots truly work.“We owe them ... some special priority,” Collins said.Huge studies this summer aim to prove which of several experimental COVID-19 vaccines are safe and effective. Moderna Inc. and Pfizer Inc. began tests last week that eventually will include 30,000 volunteers each; in the next few months, equally large calls for volunteers will go out to test shots made by AstraZeneca, Johnson & Johnson and Novavax. And some vaccines made in China are in smaller late-stage studies in other countries.For all the promises of the U.S. stockpiling millions of doses, the hard truth: Even if a vaccine is declared safe and effective by year’s end, there won’t be enough for everyone who wants it right away -- especially as most potential vaccines require two doses.It’s a global dilemma. The World Health Organization is grappling with the same who-goes-first question as it tries to ensure vaccines are fairly distributed to poor countries -- decisions made even harder as wealthy nations corner the market for the first doses.In the U.S., the Advisory Committee on Immunization Practices, a group established by the Centers for Disease Control and Prevention, is supposed to recommend who to vaccinate and when -- advice that the government almost always follows.But a COVID-19 vaccine decision is so tricky that this time around, ethicists and vaccine experts from the National Academy of Medicine, chartered by Congress to advise the government, are being asked to weigh in, too.Setting priorities will require “creative, moral common sense,” said Bill Foege, who devised the vaccination strategy that led to global eradication of smallpox. Foege is co-leading the academy’s deliberations, calling it “both this opportunity and this burden.”With vaccine misinformation abounding and fears that politics might intrude, CDC Director Robert Redfield said the public must see vaccine allocation as “equitable, fair and transparent.”How to decide? The CDC’s opening suggestion: First vaccinate 12 million of the most critical health, national security and other essential workers. Next would be 110 million people at high risk from the coronavirus -- those over 65 who live in long-term care facilities, or those of any age who are in poor health -- or who also are deemed essential workers. The general population would come later.CDC’s vaccine advisers wanted to know who’s really essential. “I wouldn’t consider myself a critical health care worker,” admitted Dr. Peter Szilagyi, a pediatrician at the University of California, Los Angeles.Indeed, the risks for health workers today are far different than in the pandemic’s early days. Now, health workers in COVID-19 treatment units often are the best protected; others may be more at risk, committee members noted.Beyond the health and security fields, does “essential” mean poultry plant workers or schoolteachers? And what if the vaccine doesn’t work as well among vulnerable populations as among younger, healthier people? It’s a real worry, given that older people’s immune systems don’t rev up as well to flu vaccine.With Black, Latino and Native American populations disproportionately hit by the coronavirus, failing to address that diversity means “whatever comes out of our group will be looked at very suspiciously,” said ACIP chairman Dr. Jose Romero, Arkansas’ interim health secretary.Consider the urban poor who live in crowded conditions, have less access to health care and can’t work from home like more privileged Americans, added Dr. Sharon Frey of St. Louis University.And it may be worth vaccinating entire families rather than trying to single out just one high-risk person in a household, said Dr. Henry Bernstein of Northwell Health.Whoever gets to go first, a mass vaccination campaign while people are supposed to be keeping their distance is a tall order. During the 2009 swine flu pandemic, families waited in long lines in parking lots and at health departments when their turn came up, crowding that authorities know they must avoid this time around.Operation Warp Speed, the Trump administration’s effort to speed vaccine manufacturing and distribution, is working out how to rapidly transport the right number of doses to wherever vaccinations are set to occur.Drive-through vaccinations, pop-up clinics and other innovative ideas are all on the table, said CDC’s Dr. Nancy Messonnier.As soon as a vaccine is declared effective, “we want to be able the next day, frankly, to start these programs,” Messonnier said. “It’s a long road.”___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. 5581

White House press secretary Sarah Sanders on Tuesday defended President Donald Trump's silence on allegations leveled against him by porn star Stormy Daniels, maintaining that while the President is a "counter-puncher," he doesn't necessarily punch back at every story.Daniels, whose legal name is Stephanie Clifford, has saturated the news in recent days, after Anderson Cooper interviewed her over her alleged affair with Trump on CBS' "60 Minutes." Trump so far declined to respond to her on Twitter or otherwise, a rarity for a President who rarely holds back.Sanders said even though she has previously described Trump as a "counter-puncher," she didn't say he "punches back on every single topic.""If he did he would probably be addressing a lot of the stories that most of you write every single minute of every single day," Sanders told reporters. "He also has a country to run. And he is doing a great job with that. ... Sometimes he chooses to specifically engage and punch back and sometimes he doesn't."Trump's terse Twitter persona has targeted everyone from Rosie O'Donnell and the cast of Hamilton to his political enemies and one-time friends. But the President has been advised that lashing out on the Daniels story will only make it worse, a tact he is also taking with Karen McDougal, a former Playboy model who recently recounted in a CNN interview the details of what she alleges was a lengthy affair with the then-businessman.Trump has denied both women's claims.Daniels, in her interview with 60 Minutes, alleged that shortly after she tried to sell her story about her alleged affair with the now-President, a man approached her in the parking lot of a fitness center."And a guy walked up on me and said to me, 'Leave Trump alone. Forget the story,' " Daniels said. "And then he leaned around and looked at my daughter and said, 'That's a beautiful little girl. It'd be a shame if something happened to her mom.' And then he was gone."Daniels, as part of a hush agreement, was paid 0,000 by Trump's longtime personal lawyer Michael Cohen days before the 2016 election. Daniels said she was risking a million fine for potentially violating her nondisclosure agreement "because it was very important to me to be able to defend myself."Sanders once again denied the allegations leveled by Daniels, but declined to get into the details of the porn star's allegations or the payoff she received."That is a question you would have to ask the President's attorney," Sanders said. "I certainly cannot speak for him. I can only speak on behalf of the White House."Pushed on the matter, Sanders stood her ground and declined to comment."The President has denied the allegations," Sanders said. "Anything beyond that I would refer you to the outside counsel and his attorney." 2823

Willie Nelson's 35th annual benefit concert Farm Aid is going virtual this year.Musicians John Mellencamp, Neil Young, Dave Matthews, and others will come together on Sept. 26 at 8 p.m. ET to help raise money for farmers who face challenges amid the coronavirus pandemic.“This pandemic and so many other challenges have revealed how essential family farmers and ranchers are to the future of our planet,” said Farm Aid President and founder Willie Nelson in a press release. “Farm Aid 2020 is going to give the whole country a chance to learn about the important work of farmers and how they’re contributing to our well-being, beyond bringing us good food.”The three-hour event will be live-streamed on Farm Aid’s YouTube channel, AXS TV, and Fans.com.You can find the full line-up here. 796

While congressional leaders continue to search for viable solutions to address America's gun violence, not even some of the more limited proposals are likely to make it to the Senate floor this week, and other issues are starting to crowd Capitol Hill's agenda.It's been more than two weeks since a gunman killed 17 people at a high school in Parkland, Florida, but mixed messages from the White House and reluctance in Congress to tackle anything more than narrow changes has led to a legislative paralysis in Washington.At the forefront of the uncertainty on guns is President Donald Trump. Congressional leaders, as well as rank-and-file members, had been waiting for Trump to take the lead on the issue or at least clearly spell out his priorities, but after a week's worth of confusing and seemingly conflicted statements, the President's contributions have done little to move legislation forward.  917

When it comes to educating America's children, how much of a difference could million make? Could it send a second grader on a school trip to the museum, or provide updated equipment to a class of budding scientists?It can. In fact, it can do it 35,647 times.Ripple, a cryptocurrency and international payment company, has donated million in cryptocurrency to DonorsChoose.org, a donation platform that connects people to classroom needs across the country. With the money, Donors Choose was able to fulfill every single classroom project request on its site -- 35,647 requests in all, from 28,210 teachers at 16,561 public schools."It's fair to say there's never been a day that this many classroom dreams have come true," Donors Choose founder Charles Best told CNN.The Colbert bumpThe massive donation is the culmination, or grand finale, if you will, of the site's #BestSchoolDay project. Two years ago, Stephen Colbert, who is a member of the Donors Choose board of directors, announced he was going to pay for every school project request in his home state of South Carolina.His act of kindness set off a movement that became known as #BestSchoolDay."More than 50 actors, athletes and philanthropists were inspired to fund classrooms in their states," Best told CNN. "Together, those 50-plus people gave more than million, and to use, that represented the idea of a best school day."Best says the response has been overwhelming -- in a good way."An outpouring of joy would not be an overstatement," he said.The Ripple effectBest says when the organization connected with Ripple, the cryptocurrency management company was "inspired to think of the impact" of such a significant gift."At Ripple, we care about giving back to our community and we collectively value the importance of quality education in developing the next generation of leaders," Ripple's SVP of Marketing Monica Long said in a statement."DonorsChoose.org's track record speaks for itself — they are highly effective at improving the quality of education and the experience of teachers and students across America. We're proud to work with them to support classroom needs across the country."According to Ripple's company site, the donation will affect approximately 1 million public school students.Best says the "classroom projects" requested on the site represent specific missions or activities that teachers have for their students."It's a public schoolteacher requesting a classroom library. A field trip. A set of art supplies. A pair of microscopes. It's about requesting experiences or tools to provide a student learning experience," he said."We believe in the wisdom of the front lines," Best added. "Hardworking, passionate teachers know their students' needs better than anyone else in the school environment. If we can tap into their needs, we can unleash smarter solutions and empower those people on the front lines."  2956