While most of the provider aid has been distributed, the Biden administration is expected to begin doling out the remaining funds, estimated at $25 billion of the original $178 billion, said Kristen O’Brien, a vice president for McDermott+Consulting in Washington, D.C. Hospitals are asking for more time to spend the money.
How the aid was spent has not been fully documented. While the larger hospital networks aggressively sought the funds from the start, smaller organizations, children’s hospitals and those in rural areas or serving large numbers of low-income patients had more difficulty securing the aid because of the way the funding formula was structured.
In a later round of funding decisions, officials with the Department of Health and Human Services reviewed applications more closely, and in some cases, reduced or denied requests, Ms. O’Brien said.
Grants given after the initial rush were more targeted, to those hospitals in Covid hot spots or rural areas. A few large chains, including HCA Healthcare and the Mayo Clinic, returned at least some of the money, in the wake of disclosures that wealthier hospitals had received far more aid while reporting healthy profits.
Overall, the aid program did prevent hospital closings, said Ken Marlow, a lawyer with K&L Gates in Nashville, who advises hospitals. “We haven’t seen a real avalanche of these distressed hospitals coming on the market.”
But some may no longer be able to resist takeovers or mergers. “Those providers are potentially more distressed as a result of the stress of the pandemic and will have to be thinking hard about the future, their survival,” said Torrey McClary, a lawyer with Ropes & Gray who also counsels hospitals.
People in Africa who become critically ill from Covid-19 are more likely to die than patients in other parts of the world, according to a report published on Thursday in the medical journal The Lancet.
The report, based on data from 64 hospitals in 10 countries, is the first broad look at what happens to critically ill Covid patients in Africa, the authors say.
The increased risk of death applies only to those who become severely ill, not to everyone who catches the disease. Over all, the rates of illness and death from Covid in Africa appear lower than in the rest of the world. But if the virus begins to spread more rapidly in Africa, as it has in other regions, these findings suggest that the death toll could worsen.
Among 3,077 critically ill patients admitted to the African hospitals, 48.2 percent died within 30 days, compared with a global average of 31.5 percent, the Lancet study found.
The study was observational, meaning that the researchers followed the patients’ progress, but did not experiment with treatments. The work was done by a large team called The African Covid-19 Critical Care Outcomes Study Investigators.
For Africa as a whole, the death rate among severely ill Covid patients may be even higher than it was in the study, the researchers said, because much of their information came from relatively well-equipped hospitals, and 36 percent of those facilities were in South Africa and Egypt, which have better resources than many other African countries. In addition, the patients in the study, with an average age of 56, were younger than many other critically ill Covid patients, indicating that death rates outside the study could be higher.
The other eight countries in the study were Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique, Niger and Nigeria. Leaders of 16 other African nations had also agreed to participate, but ultimately did not.
Reasons for the higher death rates include a lack of resources such as surge capacity in intensive care units, equipment to measure patients’ oxygen levels, dialysis machines and so-called ECMO devices to pump oxygen into the bloodstream of patients whose lungs become so impaired that even a ventilator is not enough to keep them alive.
But there was also an apparent failure to use resources that were available, the authors of the study suggested. Proning — turning patients onto their stomachs to help them breathe — was underused, performed for only about a sixth of the patients who needed it.
Almost 16 percent of the hospitals had ECMO, but it was offered to less than 1 percent of patients. Similarly, although 68 percent of the sites had access to dialysis to treat kidney failure, which is common in severe Covid cases, only 10 percent of the critically ill patients received it. Half the patients who died were never given oxygen, but the authors of the study said they had little data to explain why.
A Lancet editorial by experts not involved in the study said, “It is common in Africa to have expensive equipment that is non-functional due to poor maintenance or lack of skilled human resources.” Some 40 percent of the medical equipment in Africa was out of service, according to a 2017 report by the Tropical Health and Education Trust, the editorial said.
Another factor is that few doctors in Africa have the training in pulmonary and critical care that is considered essential in treating Covid patients.
As in other studies, chronic conditions like diabetes, high blood pressure, and diseases affecting the heart, kidney or liver increased the risk of death from Covid. This study was the first to include a large proportion of patients with H.I.V., which nearly doubled the risk of death. The report states, “Our data suggests that H.I.V./AIDS is an important risk factor for Covid-19 mortality.” But the authors also said they did not have data on how the severity of the H.I.V. infection might affect the risk.
An unexpected finding of the study was that, unlike Covid patients in the rest of the world, men in Africa were no more likely than women to die. That result suggests that African women are at higher risk than women in other regions.
The authors suggested that women in Africa might face “barriers to accessing care and limitations or biases in care when critically ill.”
The editorial asked whether new variants could be causing the high death rate found in the study, but also said, “This is a question which, in a continent with severe shortage of sequencing, could take a long time to answer.”
At Fort Bragg, soldiers who have gotten their coronavirus vaccines can go to a gym where no masks are required, with no limits on who can work out together. Treadmills are on and zipping, unlike those in 13 other gyms where unvaccinated troops can’t use the machines, everyone must mask up and restrictions remain on how many can bench-press at one time.
Inside Dodgers Stadium in Los Angeles, where lines not long ago snaked for miles with people seeking coronavirus vaccines, a special seating area allows those who are fully inoculated to enjoy games side by side with other fans.
When Bill Duggan reopens Madam’s Organ, his legendary blues bar in Washington, D.C., people will not be allowed in to work, drink or play music unless they can prove they have had their shots. “I have a saxophone player who is among the best in the world. He was in the other day, and I said, ‘Walter, take a good look around because you’re not walking in here again unless you get vaccinated.’”
Evite and Paperless Post are seeing a big increase in hosts requesting that their guests be vaccinated.
actually doughnuts, beers and cheesecake — to prod laggards along. Some have even offered cold hard cash: In Ohio, Gov. Mike DeWine this week went so far as to say that the state would give five vaccinated people $1 million each as part of a weekly lottery program.
On Thursday, federal health officials offered the ultimate incentive for many when they advised that fully vaccinated Americans may stop wearing masks.
Now, private employers, restaurants and entertainment venues are looking for ways to make those who are vaccinated feel like V.I.P.s, both to protect workers and guests, and to possibly entice those not yet on board.
Come summer, the nation may become increasingly bifurcated between those who are permitted to watch sports, take classes, get their hair cut and eat barbecue with others, and those who are left behind the spike protein curtain.
for children ages 12 through 15.
But even without a mandate, a nudge can feel like a shove. The military has been strongly encouraging vaccines among the troops. Acceptance has been low in some branches, like the Marines, with only 40 percent having gotten one or more shots. At Fort Bragg, one of the largest military installations in the country and among the first to offer the vaccine, just under 70 percent have been jabbed.
podcast designed to knock down misinformation — a common misbelief is that the vaccines affect fertility — plays around the base. In addition to their freedom gym, vaccinated soldiers may now eat in groups as they please, while the unvaccinated look on as they grab their grub and go.
With soldiers, experts “talk up to decliners versus talk down,” said Col. Joseph Buccino, a spokesman at Fort Bragg.
promoting inoculations, and stadiums have become a new line of demarcation, where vaccinated sections are highlighted as perks akin to V.I.P. skyboxes.
In Washington, Gov. Jay Inslee recently announced that sporting venues and churches would be able to increase their capacity by adding sections for the vaccinated.
Some businesses — like gyms and restaurants — where the coronavirus was known to spread easily are also embracing a reward system. Even though many gyms have reopened around the country, some still haven’t allowed large classes to resume.
Others are inclined to follow the lead of gyms like solidcore in Washington, D.C., which seeks proof of inoculation to enroll in classes listed as “Vaccine Required: Full Body.” “Our teams are now actively evaluating where else we think there will be client demand and will be potentially introducing it to other markets in the weeks ahead,” said Bryan Myers, chief executive officer of the national fitness studio chain, in an email.
specific invitation designs with the inoculated in mind, vaccinated only please RSVP.
Not everyone endorses this type of exclusion as good public policy. “I worry about the operational feasibility,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Coronavirus Resource Center. “In the U.S., we don’t yet have a standard way to prove vaccination status. I hope we’ll see by fall such low levels of infection in the U.S. that our level of concern about the virus will be very low.”
But few dispute that it is legal. “Having dedicated spaces at events reserved for vaccinated people is both lawful and ethical,” said Lawrence O. Gostin, an expert in health law at Georgetown Law School. “Businesses have a major economic incentive to create safer environments for their customers, who would otherwise be reluctant to attend crowded events. Government recommendations about vaccinated-only sections will encourage businesses and can help us back to more normal.”
so far to impose vaccine mandates for workers, especially in a tight labor market. “Our association came out in favor of masks,” said Emily Williams Knight, president of the Texas Restaurant Association. “We probably will not be taking a position on mandates, which are incredibly divisive.”
But some companies are moving that way. Norwegian Cruise Line is threatening to keep its ships out of Florida ports if the state stands by a law prohibiting businesses from requiring vaccines in exchange for services.
Public health mandates — from smoking bans to seatbelt laws to containing tuberculosis outbreaks by requiring TB patients to take their medicines while observed — have a long history in the United States.
“They fall into a cluster of things in which someone is essentially making the argument that what I do is only my business,” said Dr. Frieden, who is now chief executive of Resolve to Save Lives, a program designed to prevent epidemics and cardiovascular disease. “A lot of times that’s true, unless what you do might kill someone else.”
Dr. Frieden was the main official who pushed for a smoking ban in bars and restaurants in 2003 when he was the New York City health commissioner under former Mayor Michael R. Bloomberg. Other senior aides at the time felt certain the ban would cost Mr. Bloomberg a second term. “When I was fighting for that, a City Council member who was against the ban said of bars, ‘That is my place of entertainment.’ And I said, ‘Well, that’s someone’s place of employment.’ It did have impact.”
Mr. Duggan, the bar owner in Washington, said protecting his workers and patrons are of a piece. “As we hit a plateau with vaccines, I don’t think we can sit and wait for all the nonbelievers,” he said. “If we are going to convince them, it’s going to be through them not being able to do the things that vaccinated people are able to do.”
Clean water in 1842, food safety in 1906, a ban on lead-based paint in 1971. These sweeping public health reforms transformed not just our environment but expectations for what governments can do.
Now it’s time to do the same for indoor air quality, according to a group of 39 scientists. In a manifesto of sorts published on Thursday in the journal Science, the researchers called for a “paradigm shift” in how citizens and government officials think about the quality of the air we breathe indoors.
The timing of the scientists’ call to action coincides with the nation’s large-scale reopening as coronavirus cases steeply decline: Americans are anxiously facing a return to offices, schools, restaurants and theaters — exactly the type of crowded indoor spaces in which the coronavirus is thought to thrive.
There is little doubt now that the coronavirus can linger in the air indoors, floating far beyond the recommended six feet of distance, the experts declared. The accumulating research puts the onus on policymakers and building engineers to provide clean air in public buildings and to minimize the risk of respiratory infections, they said.
new workplace standards for air quality, but the scientists maintained that the remedies do not have to be onerous. Air quality in buildings can be improved with a few simple fixes, they said: adding filters to existing ventilation systems, using portable air cleaners and ultraviolet lights — or even just opening the windows where possible.
Dr. Morawska led a group of 239 scientists who last year called on the World Health Organization to acknowledge that the coronavirus can spread in tiny droplets, or aerosols, that drift through the air. The W.H.O. had insisted that the virus spreads only in larger, heavier droplets and by touching contaminated surfaces, contradicting its own 2014 rule to assume all new viruses are airborne.
The W.H.O. conceded on July 9 that transmission of the virus by aerosols could be responsible for “outbreaks of Covid-19 reported in some closed settings, such as restaurants, nightclubs, places of worship or places of work where people may be shouting, talking or singing,” but only at short range.
detailed 10 lines of evidence that support the importance of airborne transmission indoors.
On April 30, the W.H.O. inched forward and allowed that in poorly ventilated spaces, aerosols “may remain suspended in the air or travel farther than 1 meter (long-range).” The Centers for Disease Control and Prevention, which had also been slow to update its guidelines, recognized last week that the virus can be inhaled indoors, even when a person is more than six feet away from an infected individual.
“They have ended up in a much better, more scientifically defensible place,” said Linsey Marr, an expert in airborne viruses at Virginia Tech, and a signatory to the letter.
“It would be helpful if they were to undertake a public service messaging campaign to publicize this change more broadly,” especially in parts of the world where the virus is surging, she said. For example, in some East Asian countries, stacked toilet systems could transport the virus between floors of a multistory building, she noted.
More research is also needed on how the virus moves indoors. Researchers at the Department of Energy’s Pacific Northwest National Laboratory modeled the flow of aerosol-size particles after a person has had a five-minute coughing bout in one room of a three-room office with a central ventilation system. Clean outdoor air and air filters both cut down the flow of particles in that room, the scientists reported in April.
But rapid air exchanges — more than 12 in an hour — can propel particles into connected rooms, much as secondhand smoke can waft into lower levels or nearby rooms.
guidance for Covid does not require improvements to ventilation, except for health care settings.
“Ventilation is really built into the approach that OSHA takes to all airborne hazards,” said Peg Seminario, who served as director of occupational safety and health for the A.F.L.-C.I.O. from 1990 until her retirement in 2019. “With Covid being recognized as an airborne hazard, those approaches should apply.”
In January, President Biden directed OSHA to issue emergency temporary guidelines for Covid by March 15. But OSHA missed the deadline: Its draft is reportedly being reviewed by the White House’s regulatory office.
only during medical procedures known to produce aerosols, or if they have close contact with an infected patient. Those are the same guidelines the W.H.O. and the C.D.C. offered early in the pandemic. Face masks and plexiglass barriers would protect the rest, the association said in March in a statement to the House Committee on Education and Labor.
“They’re still stuck in the old paradigm, they have not accepted the fact that talking and coughing often generate more aerosols than do these so-called aerosol-generating procedures,” Dr. Marr said of the hospital group.
increase the risk, perhaps because they inhibit proper airflow in a room.
The improvements do not have to be expensive: In-room air filters are reasonably priced at less than 50 cents per square foot, although a shortage of supply has raised prices, said William Bahnfleth, professor of architectural engineering at Penn State University, and head of the Epidemic Task Force at Ashrae (the American Society of Heating, Refrigerating and Air-Conditioning Engineers), which sets standards for such devices. UV lights that are incorporated into a building’s ventilation system can cost up to roughly $1 per square foot; those installed room by room perform better but could be 10 times as expensive, he said.
If OSHA rules do change, demand could inspire innovation and slash prices. There is precedent to believe that may happen, according to David Michaels, a professor at George Washington University who served as OSHA director under President Barack Obama.
When OSHA moved to control exposure to a carcinogen called vinyl chloride, the building block of vinyl, the plastics industry warned it would threaten 2.1 million jobs. In fact, within months, companies “actually saved money and not a single job was lost,” Dr. Michaels recalled.
In any case, absent employees and health care costs can prove to be more costly than updates to ventilation systems, the experts said. Better ventilation will help thwart not just the coronavirus, but other respiratory viruses that cause influenza and common colds, as well as pollutants.
Before people realized the importance of clean water, cholera and other waterborne pathogens claimed millions of lives worldwide every year.
“We live with colds and flus and just accept them as a way of life,” Dr. Marr said. “Maybe we don’t really have to.”
The vaccines produced similar responses in all three groups of women, eliciting both antibody and T-cell responses against the coronavirus, the scientists found. Of particular note, experts said, was the fact that the shots produced high levels of neutralizing antibodies, which can prevent the virus from entering cells, in both pregnant and nonpregnant women.
“Clearly, the vaccines were working in these people,” said Akiko Iwasaki, an immunologist at Yale University who was not involved in the research. “These levels are expected to be quite protective.”
The researchers also found neutralizing antibodies in the breast milk of vaccinated mothers and in umbilical cord blood collected from infants at delivery. “Vaccination of pregnant people and lactating people actually leads to transfer of some immunity to their newborns and lactating infants,” said Dr. Ai-ris Y. Collier, a physician-scientist at Beth Israel who is the first author of the paper.
The results are “really encouraging,” Dr. Iwasaki said. “There is this added benefit of conferring protective antibodies to the newborn and the fetus, which is all the more reason to get vaccinated.”
The scientists also measured the women’s immune responses to two variants of concern: B.1.1.7, which was first identified in Britain, and B.1.351, which was first identified in South Africa. All three groups of women produced antibody and T-cell responses to both variants after vaccination, although their antibody responses were weaker against the variants, especially B.1.351, than against the original strain of the virus, according to the study.
“These women developed immune responses to the variants, although the asterisk is that the antibody responses were reduced several-fold,” said Dr. Dan Barouch, a study author and virologist at Beth Israel.(Dr. Barouch and his colleagues developed the Johnson & Johnson vaccine, which was not included in this study.)
“Overall, it’s good news,” he added. “And it increases the data that suggests that there is a substantial benefit for pregnant women to be vaccinated.”
Some countries were not even aware that the regulations existed, his group reported. Others lacked laws vital to responding to outbreaks, such as those authorizing quarantines.
Changing those regulations would require “negotiations for years,” Dr. Wieler said, noting that the latest set took a decade to finalize. Instead, one of his committee’s major recommendations was to increase countries’ accountability for their obligations, including though a pandemic treaty and a periodic review of their preparedness that would involve other countries.
The independent panel also proposed creating an international council led by heads of state to keep attention on health threats and to oversee a multibillion-dollar financing program that governments would contribute to based on their ability. It would promise quick payouts to countries contending with a new outbreak, giving them an incentive to report.
“There’s only going to be the political will to create those things when something catastrophic happens,” said Dr. Mark Dybul, one of the panel members. These recommendations stemmed in part from his experience leading the President’s Emergency Program for AIDS Relief, known as Pepfar, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, he said.
But Dr. Wieler, who led the other international review, said that in general, creating new institutions rather than focusing on improving existing ones could increase costs, complicate coordination and damage the W.H.O.
The recommendations of panels after global emergencies have sometimes been embraced. The Ebola outbreak of 2014 and 2015 led to the creation of the W.H.O.’s health emergencies program, aimed at boosting the agency’s role in managing health crises as well as providing technical guidance. A report released this month noted that the new program had received “increasingly positive feedback” from countries, donors and partner agencies as it managed dozens of health and humanitarian emergencies.
The W.H.O. before the Ebola outbreak and after it are “two different agencies basically,” said Dr. Joanne Liu, a former international president of Doctors Without Borders and a member of the independent panel. Dr. Liu was one of the W.H.O.’s most trenchant critics during the Ebola response, and she noted a “marked improvement” in how quickly the agency had declared an international emergency this time.
Not all teenagers long for the vaccine. Many hate getting shots. Others say that because young people often get milder cases of Covid, why risk a new vaccine?
Patsy Stinchfield, a nurse practitioner who oversees vaccination for Children’s Minnesota, has stark evidence that some cases in young people can be serious. Not only have more children with Covid been admitted to the hospital recently, but its intensive care unit also has Covid patients who are 13, 15, 16 and 17 years old.
The F.D.A.’s new authorization means all those patients would be eligible for the shots, she noted. “If you can prevent your child ending up in the I.C.U. with a safe vaccine, why wouldn’t you ?” she said.
Mr. Quesnel, the East Hartford, Conn., superintendent, said the most powerful message for reaching older adolescents would probably appeal just as much to younger ones. Rather than focusing on the fact that the shot will protect them, he said, they seize on the idea that it will keep them from having to quarantine if they are exposed.
“They’re not so afraid of the health care dangers from Covid but the social losses that come along with it,” he said, adding that 60 percent of his district’s seniors, or about 300 students, got their first dose at a mass vaccination site run by Community Health Center on April 26. “Some of our greatest leverage right now is that social component — ‘You won’t be quarantined.’”
Michael Jackson of North Port, Fla., can’t wait for his 14-year-old son, Devin, to get the vaccine. During the past year, he said, his son’s beloved Little League games went on hiatus and the family had to suspend their regular Sunday suppers with grandparents And Devin, an eighth grader, had to quarantine three times after being exposed to Covid.
“We in the laboratory are preparing for another big boom in testing,” said Dr. Baird, whose team has run more than two million coronavirus tests since the beginning of the pandemic. “Even if people are vaccinated, they’re going to wonder, ‘Am I the breakthrough case?’”
In addition to Cepheid, other companies have developed tests that look for influenza and the coronavirus at the same time, including Roche, which has received emergency use authorization for a test that looks for the coronavirus, influenza A and influenza B at once.
In recent years various hospitals have developed in-house versions of these combination tests as well, some of which look for more than a dozen different respiratory pathogens simultaneously using P.C.R. technology. Those “multiplex” tests are especially helpful in diagnosing illnesses in people with weak immune systems because they allow doctors to swiftly discern what pathogen is making a person sick before it is too late to start the right treatments.
A French company, bioMérieux, sells a P.C.R. test that looks for the coronavirus as well as 21 other viruses and bacteria simultaneously. And Roche recently bought a company that sells a machine that can screen for more than 20 pathogens in one go.
Testing for multiple pathogens does not always lead to a simple treatment, however. Co-infections, in which a person is infected with multiple viruses simultaneously, are more common than doctors expected, and sometimes the multiplex tests might detect a viral infection but miss a bacterial one, said Dr. Daniel Griffin, chief of infectious diseases at ProHealth New York. A patient could carry the influenza virus but also test positive for a bacterium such as pneumococcus, for example.
“We initially thought that every time we identified a virus, we would just be able stop all antibiotics and just treat the virus if effective antiviral therapy was available,” Dr. Griffin said. “We now know that we often need to continue antibiotics,” he explained, because sometimes the multiplex tests are not sensitive enough to rule out a bacterial culprit.
Doctors and test developers are still grappling with how many pathogens to test patients for in different settings. “A burning question at every company is what panel is best — is it one, two, four, 20?” said Dr. Mark Miller, chief medical officer at bioMérieux. Relatively young and healthy adults might just need a quad test to know if they should start on Tamiflu for influenza, for example, but patients with underlying chronic diseases who are very sick might benefit from receiving the test for 22 different pathogens so that doctors can decide whether they need to be admitted to a hospital.
Even before the pandemic began 14 months ago, nursing homes had become the source for rampant, antibiotic-resistant infections. The facilities also faced systemic problems like high turnover among nursing home staff and the gaming of the federal government’s rating system, which made it hard for families to judge the quality of homes.
For years, federal health officials and some insurers have tried to encourage more stay-at-home care, and the pandemic has created a sense of urgency.
“It’s really changed the paradigm on how older adults want to live,” said Dr. Sarita Mohanty, the chief executive of the SCAN Foundation, a nonprofit group focused on issues facing older adults. The vast majority of those adults would prefer to stay at home as they age, she said.
“What’s happened is a welcome sort of market correction for nursing homes,” said Tony Chicotel, a staff attorney for California Advocates for Nursing Home Reform in San Francisco. Some families, he said, “ended up agreeing to a nursing home without giving it a lot of deliberation.” But after trying home care during the pandemic, many families found keeping an older relative at home was a viable alternative, he said.
Nursing homes rose from the almshouses in England and America that cared for the poor. In the United States, passage of the Social Security Act in 1935 provided money for states to care for the elderly. Thirty years later, the Medicaid program expanded funding, making long-term care homes central to elder care, said Terry Fulmer, the president of the John A. Hartford Foundation, an advocacy group for older adults. “If you pay the nursing homes, that’s where you go,” Dr. Fulmer said.
It wasn’t until the 1970s that some programs began to pay for home care, and the number of nursing home residents nationwide started to slowly decline, with occupancy levels in recent years flattened to about 80 percent, according to data from the Kaiser Family Foundation.
In early 2020, dozens of scientific teams scrambled to make a vaccine for Covid-19. Some chose tried-and-true techniques, such as making vaccines from killed viruses. But a handful of companies bet on a riskier method, one that had never produced a licensed vaccine: deploying a genetic molecule called RNA.
The bet paid off. The first two vaccines to emerge successfully out of clinical trials, made by Pfizer-BioNTech and by Moderna, were both made of RNA. They both turned out to have efficacy rates about as good as a vaccine could get.
In the months that followed, those two RNA vaccines have provided protection to tens of millions of people in some 90 countries. But many parts of the world, including those with climbing death tolls, have had little access to them, in part because they require being kept in a deep freeze.
Now a third RNA vaccine may help meet that global need. A small German company called CureVac is on the cusp of announcing the results of its late-stage clinical trial. As early as next week, the world may learn whether its vaccine is safe and effective.
Novavax, a company based in Maryland whose vaccine uses coronavirus proteins, is expected to apply for U.S. authorization in the next few weeks. In India, the pharmaceutical company Biological E is testing another protein-based vaccine that was developed by researchers in Texas. In Brazil, Mexico, Thailand and Vietnam, researchers are starting trials for a Covid-19 shot that can be mass-produced in chicken eggs.
Vaccines experts are particularly curious to see CureVac’s results, because its shot has an important advantage over the other RNA vaccines from Moderna and Pfizer-BioNTech. While those two vaccines have to be kept in a deep freezer, CureVac’s vaccine stays stable in a refrigerator — meaning it could more easily deliver the newly discovered power of RNA vaccines to hard-hit parts of the world.
“It’s gone largely under the radar,” said Jacob Kirkegaard, a senior fellow at the Peterson Institute for International Economics in Washington, D.C. But now, he added, “they look pretty well positioned to clean up the global market.”
For CureVac’s co-founder, the biologist Ingmar Hoerr, the company’s Covid-19 vaccine trial is the culmination of a quarter-century’s worth of work with RNA, a molecule that helps turn DNA into the proteins that do the work of our cells. As a graduate student at the University of Tübingen in the 1990s, Dr. Hoerr injected RNA into mice and found that the animals could make the protein encoded by the molecules. He was surprised to find that the mice’s immune systems made antibodies against the new proteins.
only a few scientists in the world considered an RNA vaccine a serious possibility. But proponents thought it might change medicine. You could, in theory, craft an RNA molecule to immunize people against any virus. You might even be able to create an RNA vaccine to cure cancer, if you could make an RNA molecule that encoded a tumor protein.
In 2001, Dr. Hoerr co-founded CureVac to chase the idea, but for the first few years the company struggled to survive. To keep the lights on, it took orders from other labs for custom-built RNA molecules. On the side, CureVac’s scientists tinkered with their own designs for RNA vaccines.
Over time, they found subtle tweaks to RNA vaccine molecules that caused cells to make more proteins. The more potent the RNA, the lower the dose they needed in vaccines.
CureVac’s researchers also figured out how to put the RNA molecules in fatty bubbles to protect them from destruction on their journey to cells. And perhaps most important, they used a form of RNA that could stay stable at relatively warm temperatures. Instead of requiring a deep freezer, CureVac’s vaccine could be refrigerated.
In time, other companies entered the RNA vaccine business as well: BioNTech in Germany in 2008, then Moderna in Boston in 2011. Their experiments began showing that these vaccines could protect animals against an assortment of viruses. In 2013, CureVac injected human volunteers with a rabies RNA vaccine, in the first clinical trial of the technology against an infectious disease.
For years, CureVac and other RNA vaccine companies toiled on perfecting their vaccines. CureVac’s first attempt at a rabies vaccine demonstrated it was safe, but it yielded a weak response from the immune system. The company has since retooled that vaccine, and the updated version has shown promise in early clinical studies. But other efforts ended in failure. In 2017, CureVac announced that its RNA vaccine against prostate cancer offered no benefits to patients.
$1 billion to move its operations to the United States. CureVac denied the reports, but the chief executive suddenly left, to be replaced by Dr. Haas.
CureVac’s researchers moved ahead with their limited resources, designing an RNA molecule encoding a protein found on the surface of the coronavirus, called spike. Experiments on hamsters showed that it could protect the animals from the virus.
Phase 3 trial, recruiting 40,000 volunteers in Europe and Latin America. The company will get its first look at the data when 56 volunteers develop Covid-19. If most of them are in the placebo group, and few in the vaccinated group, it will be proof that the vaccine works.
with a lawsuit.
In April, the European Union finally fixed this shortfall, negotiating with Pfizer and BioNTech to get 1.8 billion doses of their vaccine between now and 2023. That arrangement has left analysts wondering how much demand will be left for CureVac.
“They’re going to miss the boat on the major, advanced-economy markets,” said Dr. Kirkegaard. “The U.S., Europe and Japan are going to be largely vaccinated using these Moderna and Pfizer vaccines.”
Dr. Haas countered that most of the bloc’s doses from Pfizer-BioNTech won’t come until next year. “CureVac sees itself as a major player in ending the Covid-19 pandemic in Europe and elsewhere,” he said.
Ursula von der Leyen, president of the European Commission, said that if the CureVac vaccine worked, it would be in the mix, thanks to two advantages: It is an mRNA vaccine, and it was created in Europe. It is also possible that individual European nations will make side deals with the company.
Billions of other people in low- and middle-income countries have yet to receive a vaccine, and experts say that CureVac may meet some of their demand. “We still need a lot of vaccine globally,” said Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai in New York. “I think a lot of people can benefit from it.”
The vaccines from Moderna and Pfizer-BioNTech are challenging to distribute in the developing world because of the equipment and power supply required to freeze these vaccines. CureVac’s RNA vaccine can stay stable for at least three months at 41 degrees Fahrenheit, and it can sit for 24 hours at room temperature before it is used.
“The stability is a real advantage,” Dr. Jackson said. C.E.P.I. is “in very active discussions” with CureVac, he said, about distributing the company’s vaccine through Covax, an initiative to distribute vaccines to low- and middle-income countries.
But CureVac is also designing a new generation of vaccines with a goal of eventually moving into markets in the United States and other wealthy nations. Because its potent RNA requires only a small dose, the company could potentially create vaccines for different variants and mix them in a single shot.
But such possibilities are meaningless until CureVac can prove that its vaccine works. Mary Warrell, a vaccine researcher at the University of Oxford, is reluctant to speculate about the fate of the vaccine before that milestone.
“Prediction during this pandemic has rarely been profitable,” she warned.