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 U.S. health authorities hope by late next month to have some draft guidance on how to ration initial doses, but it’s a vexing decision.“Not everybody’s going to like the answer,” Dr.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

While answering a question about how she would rule in potential Supreme Court cases involving LGBTQ+ people's rights during her confirmation hearing Tuesday, Judge Amy Coney Barrett used the term "sexual preference" — a term classified as "offensive" by GLAAD.Barrett used the term while denouncing discrimination against gay and lesbian people, during questioning by Senate Judiciary Committee Ranking Member Dianne Feinstein, D-California."Senator, I have no agenda, and I do want to be clear: I have never discriminated on the basis of sexual preference and would not ever discriminate on the basis of sexual preference," Barrett said. "Like racism, I think discrimination is abhorrent."Later in the day, Sen. Mazie Hirono, D-Hawaii, followed up with Barrett about the term."Sexual preference is an offensive and outdated term. It is used by anti-LGBTQ activists to suggest that sexual orientation is a choice. It is not. Sexual orientation is a key part of a person's identity," Hirono said.In response, Barrett apologized, saying "I certainly didn't mean and would never mean to use a term that would cause any offense in the LGBTQ community. So if I did, I greatly apologize for that."The term "sexual preference" is generally deemed to be outdated. On its website, GLAAD lists the term on its website as "one to avoid" as it implies that sexuality is a "choice" that can be "cured."Instead, GLAAD says the preferred term to use is "sexual orientation," saying it is the "accurate description" of "an individual's enduring physical, romantic and/or emotional attraction" to another person.Prior to Barrett's initial comment, Feinstein asked how she would rule in potential cases regarding LGBTQ+ rights given the judge's relationship with Justice Antonin Scalia, who dissented in the case that gave gay people the right to marry in 2015.While Barrett gave credit to Scalia, her former mentor, in her opening statements, she stated multiple times during Tuesday's questioning that she would be her own judge."You'll be getting Justice Barrett, not Justice Scalia," if confirmed, Barrett said Tuesday. 2114

What does it look like when galaxies collide? The Hubble Telescope captured a unique sight as two galaxies are in the process of merging.NASA says the galaxy, called NGC 1614, is about 200 million light-years from Earth and is the result of a “galactic merger” which has created a unique appearance. They call it “eccentrically shaped” and “ablaze with activity” in a statement on NASA’s website. It sits in the constellation of Eridanus.The result of the cosmic collision is a flow of interstellar gas from the smaller galaxy into the nucleus of the larger one, “resulting in a burst of star formation that started in the core and has slowly spread outward through the galaxy,” NASA says.Astronomers say NGC 1614 is one of the most luminous objects in the local universe. 780

When Sgt. Brian Maynard pulled over Laura and Jimmy Baker, he was preparing to deliver a ticket. Instead, the state trooper summoned an EMS team, which delivered the couple's baby girl on the side of North Carolina's US 64 highway.It all began Saturday night in suburban Raleigh when Laura Baker got in a minivan with her husband for a visit to the hospital to check on some contractions she'd been having. Then, 10 minutes into their drive, she suddenly went to labor."I said, 'I cannot control this, we're not going to make it there,'" Baker said.So when her husband spotted Maynard's patrol car, he did everything he could to get the officer's attention, speeding and flicking his lights."As soon as we pulled over, my water broke," Baker said. "And my husband jumped out with his arms up, saying, 'My wife's in labor and I really need help.'"All three knew they didn't have time to get to a hospital. Maynard called the EMS team in nearby Wendell but was prepared to do the job himself."I said, 'OK, well, we're going to do this right here, me and you,'" he told CNN affiliate WSOC.So Baker's husband and Maynard held the mother's hands and urged her to wait for the EMS team."My husband and the trooper were nervous, because they certainly weren't prepared," she said. And when the EMS team arrived, everyone realized they couldn't get Baker on a stretcher. So she delivered in the front seat of the van.It was this team -- as well as the trooper's assistance -- that Baker said she's most thankful for."Without them, I don't know how successful it would have been," she said. "It was maybe a five-minute experience, but a vital five-minute experience. [The EMS team] did everything to make sure it was sanitary and healthy."Baker was taking her baby, Halyn, home Monday and was planning on paying a visit to the EMS team that helped keep her infant daughter healthy throughout the delivery. She doesn't know much about the EMS crew, but she'll be looking for Charlie and Danny, who held her hands throughout the birth and walked her through every step."She was born outside in 40-degree weather, but she's a perfect, healthy little girl," she said. "They did everything perfect." 2198

While not final, the status update offers a look at what went wrong at MSU with the findings being what happened at MSU was a failure of people, not policy. The status update and the investigations scope was limited to what was done or not done at MSU specifically related to Larry Nassar. 297