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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 U.S. health authorities hope by late next month to have some draft guidance on how to ration initial doses, but it’s a vexing decision.“Not everybody’s going to like the answer,” Dr.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

WILMINGTON, Del. – President-elect Joe Biden is promising that his team is “going to get right to work” and is downplaying concerns that President Donald Trump’s refusal to acknowledge his victory could undermine national security.Trump has blocked his Democratic rival from receiving the intelligence briefings traditionally shared with incoming presidents, according to someone with knowledge of the situation but not authorized to disclose private conversations.Asked about the Republican resistance on Tuesday, Biden said it “does not change the dynamic at all in what we’re able to do.” He said additional intelligence briefings “would be useful,” but he doesn’t see anything slowing them down.“It would be nice to have it, but it’s not critical,” said Biden. “We’re just going to proceed the way we have. We’re going to do exactly what we’d be doing if he would have conceded and said we’ve won, which we have. And so, there’s nothing really changing.”Watch Biden and Sen. Kamala Harris speak below:Biden said he and his team are moving along in a “consistent manor,” putting together their administration and reviewing who they’d like to pick for cabinet positions.“Nothing’s going to stop that,” said Biden. “So, I’m confident that the fact that they’re not willing to acknowledge that we won at this point is not of much consequence in our planning and what we’re about to do between now and Jan. 20.”Biden also responded to comments from Senate Majority Leader Mitch McConnell, who said Monday that he supports Trump’s legal actions, despite there being little evidence of widespread voter fraud. Biden said he hasn’t gotten a chance to speak to McConnell yet, but he expects to relatively soon.“I think that the whole Republican Party has been put in a position, with a few notable exceptions, of being mildly intimidated by the sitting president,” said Biden. “But there’s only one president at a time. He’s president. We’re going to have the Electoral College, they’ll be making their judgment in December and it’ll be announced in early January, but in the meantime, I hope to get a chance to speak to Mitch.”When asked about the Trump administration blocking funding for the White House transition, Biden said he thinks his team can get things done without the money.“We can get through without the funding,” said Biden. “We don’t see anything that’s slowing us down, quite frankly.”So far, Biden said he’s been able to speak with six world leaders since he was projected to win the presidency on Saturday.“I’m letting them know that America is back. We’re going to be back in the game. It’s not America alone,” he said. “I’m confident that we’ll be able to put America back in a place of respect that it had before.”Biden said he believes Trump’s post-election behavior won’t help his legacy.“I know from my discussions with foreign leaders thus far, that they are hopeful that the United States’ democratic institutions are viewed as being strong and enduring,” said Biden. “I think at the end of the day, it’s all going to come to fruition on Jan. 20. And between now and then, my hope and expectation is that the American people do know and do understand that there has been a transition, even among Republicans.”When asked during his briefing what he would say to Trump if he were watching, Biden said “Mr. President, I look forward to speaking with you.” 3383

When cruise lines begin sailing again, the Centers for Disease Control and Prevention has some guidance. The health agency issued their “framework for resuming safe and responsible cruise ship” operations Friday, ahead of the no-sail order expiring Saturday.The no-sail order, which originally began in April, prohibits cruise ships from carrying 250 passengers in waters subject to US jurisdiction.The CDC said it has identified at least 3,689 coronavirus-related illnesses, and 41 associated deaths, connected to cruise ships. Although the CDC cautions these figures are likely an underestimate.The framework urges a phased approach, and applies to ships that have the capacity to carry at least 250 passengers in waters subject to U.S. jurisdiction.“A phased approach is necessary because of the continued spread of the COVID-19 pandemic worldwide, risk of resurgence in countries that have suppressed transmission, ongoing concerns related to restarting of cruising internationally, and need for additional time for the cruise industry to test the effectiveness of measures to control potential COVID-19 transmission on board cruise ships with passengers without burdening public health,” a statement from the CDC reads.During the beginning, cruise line operators will have to demonstrate adherence to testing, quarantine and isolation plans, as well as social distancing requirements for passengers and crew members.The CDC says they will help by “establishing a laboratory team dedicated to cruise ships to provide information and oversight of COVID-19 testing,” updating instructions and creating a system to track ship status and passenger cases.Meanwhile, cruise lines will need to build out the capacity and ability to test crew and passengers on a regular basis.In their framework, the CDC says there may be simulated, or mock, voyages with volunteers to test cruise ship operators’ ability to apply COVID-19 mitigation measures.Although the no-sail order will be lifted, Carnival, Royal Caribbean and other cruise lines have already cancelled sailings until 2021. 2083

WEST PALM BEACH, Fla. — The hurricane season continues to be active with the formation of a new tropical storm and a depression in the last 12 hours.Tropical depression 17 formed Sunday night in the Atlantic and became Tropical Storm Paulette just before 11 a.m. Monday.The storm has 40 mph winds with higher gusts and is moving west, northwest at 3 mph.Paulette is the earliest forming 16th named storm on record, breaking an old record set by Philippe on September 17, 2005, according to hurricane expert Philip Klotzbach.A slow-motion toward the northwest or north-northwest is expected tonight. Paulette is then forecast to move a little faster and generally westward on Tuesday and Wednesday.Early indications are it may curve before it reaches the Bahamas, but we will keep an eye on it just in case. It may interact with tropical depression 18, located behind it, which also formed Monday morning.Paulette's path and/or intensity might change because of its proximity to tropical depression 18. 1009

With America’s student loan crisis reaching .5 trillion, it’s not just college graduates who are paying off the loans. Parents are now getting sucked in to pay.One man says he has a warning for other parents, before they try to help their children.Victor Turner, who is a veteran, took out Parent PLUS loans in order to send his daughter to college.  "Out of all the loans, I think the highest one is about 0 a month, but there are 7 of them."  Now, back in school himself and caring for his new son, Turner is not the only parent risking their financial future for their child’s future.  In 2016, an average parent owed about ,000 on loans to help pay for their child's education.   734