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CDC Shifts Pandemic Goals Away From Reaching Herd Immunity

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Since the earliest days of the pandemic, there has been one collective goal for bringing it to an end: achieving herd immunity. That’s when so many people are immune to a virus that it runs out of potential hosts to infect, causing an outbreak to sputter out.

Many Americans embraced the novel farmyard phrase, and with it, the projection that once 70% to 80% or 85% of the population was vaccinated against COVID-19, the virus would go away and the pandemic would be over.

Now the herd is restless. And experts at the Centers for Disease Control and Prevention have set aside herd immunity as a national goal.

The prospects for meeting a clear herd-immunity target are “very complicated,” said Dr. Jefferson Jones, a medical officer on the CDC’s COVID-19 Epidemiology Task Force.

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“Thinking that we’ll be able to achieve some kind of threshold where there’ll be no more transmission of infections may not be possible,” Jones acknowledged last week to members of a panel that advises the CDC on vaccines.

Vaccines have been quite effective at preventing cases of COVID-19 that lead to severe illness and death, but none has proved reliable at blocking transmission of the virus, Jones noted. Recent evidence has also made clear that the immunity provided by vaccines can wane in a matter of months.

The result is that even if vaccination were universal, the coronavirus would probably continue to spread.

“We would discourage” thinking in terms of “a strict goal,” he said.

To Dr. Oliver Brooks, a member of the CDC’s Advisory Committee on Immunization Practices, it was a sobering new message, with potentially worrisome effects.

With just 58.5% of all Americans fully vaccinated, “we do need to increase” the uptake of COVID-19 shots, said Brooks, chief medical officer of Watts Healthcare in Los Angeles. Unfortunately, he said, Jones’ unexpected admission “almost makes you less motivated to get more people vaccinated.”

Dr. Oliver Brooks, center, looks on as Lucy Arias checks a patient’s temperature at a COVID-19 screening station outside the Watts Health Center in Los Angeles.

(Irfan Khan / Los Angeles Times)

Brooks said he worries that as the CDC backs off a specific target for herd immunity, it will take the air out of efforts to run up vaccination levels.

And if public health officials stop talking about the “herd,” people may lose sight of the fact that vaccination is not just an act of personal protection but a way to protect the community.

A public tack away from the promise of herd immunity may also further undermine the CDC’s credibility when it comes to fighting the coronavirus.

On issues ranging from the use of masks to how the virus spreads, the agency has made some dramatic about-faces over the course of the pandemic. Those reversals were prompted by new scientific discoveries about how the novel virus behaves, but they’ve also provided ample fuel for COVID-19 skeptics, especially those in conservative media.

“It’s a science-communications problem,” said Dr. John Brooks, chief medical officer for the CDC’s COVID-19 response.

“We said, based on our experience with other diseases, that when you get up to 70% to 80%, you often get herd immunity,” he said.

Dr. John Brooks, chief medical officer for the CDC’s COVID-19 response, working from his home office with his cat, Cosmo.

(Centers for Disease Control and Prevention)

But the SARS-CoV-2 virus didn’t get the memo.

“It has a lot of tricks up its sleeve, and it’s repeatedly challenged us,” he said. “It’s impossible to predict what herd immunity will be in a new pathogen until you reach herd immunity.”

The CDC’s new approach will reflect this uncertainty. Instead of specifying a vaccination target that promises an end to the pandemic, public health officials hope to redefine success in terms of new infections and deaths — and they’ll surmise that herd immunity has been achieved when both remain low for a sustained period.

“We want clean, easy answers, and sometimes they exist,” John Brooks said. “But on this one, we’re still learning.”

Herd immunity was never as simple as many Americans made it out to be, said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania and an expert on the challenges of communicating science to increasingly skeptical — and often conspiracy-minded — citizens.

It’s an idea that emerged about a century ago from the field of livestock medicine. Epidemiologists now calculate it with a standard equation. But like many tools that model a complex process with math, it makes some simplifying assumptions.

For instance, it assumes an unrealistic uniformity in the behavior of individuals and groups, and in the virus’ ability to spread from person to person.

So it doesn’t reflect the diversity of population density, living arrangements, transportation patterns and social interactions that makes Los Angeles County, for instance, so different from Boise County, Idaho. Nor does it account for the fact that Boise County, where less than 35% of adults are fully vaccinated, gets no protection from L.A. County’s 73% vaccination rate among adults.

“Humans are not a herd,” Jamieson said.

Public health leaders would have been better served by framing their vaccination campaigns around the need for “community immunity,” she said. That would have gotten people to think in more local terms — the ones that really matter when it comes to a person’s risk of infection, she added.

Changes in the coronavirus itself have also made herd immunity a moving target.

The calculation that produced a herd immunity estimate of 70% to 85% rests heavily on the innate transmissibility of SARS-CoV-2. But with the emergence of new viral strains like the Alpha and Delta variants, the virus’ ability to jump from person to person has escalated dramatically in the last year.

In addition, herd-immunity calculations presume that when people gain immunity, they remain immune for a known period of time. But it’s become clear that neither vaccination nor natural infection confers lasting protection. Booster shots or a “breakthrough” case might, but for how long is still unknown.

That’s just the way science works, said Raj Bhopal, a retired public health professor at the University of Edinburgh who has written about the maddening complexity of herd immunity.

For any agency engaged in public messaging, “it’s very hard to convey uncertainty and remain authoritative,” Bhopal said. “It’s a pity we can’t take the public along with us on that road of uncertainty.”

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Original Post: latimes.com

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Looking for a Boost, Taiwan’s Oldest Political Party Turns to the Great-grandson of Chiang Kai-shek

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TAIPEI, Taiwan — 

Between internal strife, muddled campaign messages and a stance on China that has become a political liability, Taiwan’s oldest political party is deep in existential crisis.

The Chinese Nationalist Party, better known as the KMT, or Kuomintang, was founded in mainland China but went into exile in Taiwan in 1949. It ruled the island for 50 years before losing its grip on power.

The party has long pushed for closer ties with China, a position that has increasingly put it out of touch with a younger generation that identifies as Taiwanese and has grown wary of the Chinese Communist Party’s designs on the island.

Now the 110-year-old KMT is looking to a rising star to refurbish its image: Chiang Wan-an, who is favored to become the next mayor of Taipei — among thousands of local offices up for grabs in nationwide elections Saturday.

The charismatic 43-year-old former legislator and lawyer has billed himself as a thoroughly modern figure who can lead the party into the future. He supports same-sex marriage and lowering the voting age from 20 to 18. His handsome looks and young children haven’t hurt his appeal either.

At the same time, he claims deep roots in the party’s past as a great-grandson of the revolutionary Chiang Kai-shek.

It was under Chiang Kai-shek that the party fled to Taiwan after losing the Chinese civil war to Mao Zedong’s Communist Party. Waiting to someday take the mainland back, the KMT often using brutal means to suppress any political threats, finally lifting martial law in 1987as Taiwan began to democratize.

Ham radio, a niche hobby among older Taiwanese, has reemerged as a potential wartime tool as China’s military aggression grows.

Now, it’s the Communist Party that wants to retake Taiwan. In the face of growing aggression under President Xi Jinping, who considers the democracy of 23 million a part of China, much of the national political discourse has centered on the best way to defend the island.

President Tsai Ing-wen of the Democratic Progressive Party, or DPP, was reelected by a landslide in 2020, thanks to growing Taiwanese nationalism and anti-China sentiment. But this year, the KMT has enjoyed a boost of support that could help it clean up in local races.

The mayorship of Taipei is often a stepping stone to the presidency. According to recent polls, Chiang is leading independent candidate Huang Shan-shan, the former deputy mayor of Taipei, and the DPP’s Chen Shih-chung, who as minister of health and welfare oversaw Taiwan’s pandemic response.

“He is the young, fresher and slightly updated face that the KMT needs,” said Lev Nachman, a political science professor at National Chengchi University. “But one candidate does not a successful political strategy make.”

In local elections, cross-strait tensions take a backseat to more immediate concerns. The mayoral candidates have talked a lot about urban renewal, the rising cost of housing, subsidies for young parents and ways to make the city friendlier for pets. Chiang wants to improve health insurance for animals and expand programs to let them ride on public transportation.

He has also sought to capitalize on voters’ dissatisfaction with the Tsai administration, in particular pointing to a lack of transparency in its vaccine rollout early in the pandemic.

“This is a contest of values: democracy against the black box,” he declared at an election rally Saturday night. “Hard work against laziness, integrity against lies, light against darkness.”

In the crowd that night was Mark Chu, a 30-year-old IT worker who found the event to be a moving morale boost for KMT supporters. However, he couldn’t help but notice a distinct lack of people his own age.

“There’s a sense of distance between the KMT and young people,” Chu said. “They’re getting further and further away from mainstream ideas.”

But Chiang has managed to convince Bernie Hou, a 33-year-old public relations worker who has supported politicians from various parties over the years.

His decision to back Chiang is in large part a vote against the DPP for its handling of the pandemic. He also was impressed by Chiang’s performance during the mayoral debate.

“He has all the makings of a capital mayor,” Hou said. “And he looks very good.”

Still, even in local races, the strained relations between Beijing and Taipei are an unavoidable factor.

The ruling DPP leans toward independence for Taiwan and has taken a confrontational stance toward China, an approach that appeals to those who came of age under Taiwan’s democracy and rebuke Beijing’s calls for unification. Those voters are leery of giving too much leeway to an authoritarian regime that has threatened to fulfill its territorial claims by force.

The president, whose term ends in 2024, has recently stepped up efforts to capitalize on those fears. But her calls to resist China have failed to translate into broader support for the DPP this election.

“It’s a tough balancing act,” said Sung Wen-ti, a political scientist with Australia National University’s Taiwan Studies Program. “DPP has been riding on the wave of its Taiwanese nationalism card since 2014 and is inevitably facing a degree of voter fatigue.”

The KMT wants to maintain the status quo of Taiwan’s democratic governance, but favors a friendlier relationship with Beijing. Its support comes largely from older generations, who associate the party with their Chinese identities and mainland roots. A minority within the party still hope to see reunification with China.

As the KMT grapples with how to appease both its traditional base and reach a new one, Chiang could help bridge that gap.

His father Hsiao-yan, a former vice premier and foreign minister, was born with the surname Chang, but he changed it after gathering evidence that he was the illegitimate grandson of Chiang Kai-shek. Though some still doubt that claim, his son changed his last name too.

Older KMT members revere the former generalissimo for his contributions to Taiwan’s industrial development and his experiences fighting Japanese and Communist forces. Younger Taiwanese see him as an emblem of the island’s authoritarian past.

The Chiang Kai-shek legacy has come under greater scrutiny in recent years amid initiatives to compensate the families of victims that suffered under his reign and remove statues glorifying him.

Chiang Wan-an has at times found himself caught in the middle. Earlier this year he advocated for removing Chiang Kai-shek’s name from a famous memorial hall in Taipei. But he dropped the proposal after KMT supporters criticized him for diminishing his own history and Chinese identity.

“Leaning too far into his family background is a risk,” said Brian Hioe, a founding editor of the Taiwan-based media outlet New Bloom. “Now there is much more backlash against these second generations and political dynasties.”

The bigger challenge for the KMT looking ahead to the 2024 presidential election may be persuading voters that it can adeptly navigate cross-strait relations without acceding to pressure from Beijing.

Watching Chiang greet voters in Taipei on Monday, Wendy Chang, a 25-year-old visiting home from studying business in the Netherlands, said he seems more modern than the traditional KMT candidates. Nonetheless, she has a hard time swallowing the party’s friendlier attitude toward China.

“I feel like Taiwan’s elections ultimately are all about cross-strait relations,” she said.

Yang is a Times staff writer and Shen a special correspondent.

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Original Post: latimes.com

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The Times Podcast: Mexico’s Unique, Binational Soccer Fans

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Right now, the eyes of much of the world is on the FIFA World Cup in Qatar as 32 teams fight for national pride. One team is Mexico, whose unique fanbase sets it apart from the world. With loyalties to both Mexico and the United States, it’s a representation of resilience, controversy and so much more.

Today, we examine the phenomenon. Read the full transcript here.

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Original Source: latimes.com

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A New Foreign Policy Headache for Biden As Israel Forms Its Most Right-wing Government Ever

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WASHINGTON — 

The Biden administration is grappling with how to deal with a new Israeli government that will be the most right-wing in that country’s history and may stand in the way of core U.S. goals for the Middle East.

The new government will be led by Benjamin Netanyahu, Israel’s longest serving prime minister, who was ousted from the job just a year ago and is on trial for corruption. To regain the position, Netanyahu formed an alliance with controversial political figures known for their extreme anti-Arab views, likely dooming any peace deal with Palestinians.

Dealing with the Netanyahu-led government will pose major challenges for the Biden administration, which desires a resolution to the Israeli-Palestinian conflict and broader acceptance of Israel in the Arab world.

Republicans in the U.S. who are eager to cast themselves as true friends of Israel are sure to question any Biden administration criticism of the new government.

Netanyahu and the GOP have grown closer over the past decade, undermining decades of bipartisan support for Israel.

In 2015, Netanyahu, whom congressional Republicans had invited to address a joint session of Congress, used the speech to criticize President Obama’s nuclear deal with Iran. Former President Trump moved the U.S. Embassy from Tel Aviv to Jerusalem and recognized the Israeli annexation of the Golan Heights, delighting Netanyahu. Just this week, Netanyahu delivered a speech to the Republican Jewish Coalition, a partisan group.

Itamar Ben-Gvir, who has a long record of extreme anti-Arab rhetoric, is promised the post of national security minister in Israel’s new government.

Netanyahu and President Biden have both said that U.S. support for Israel should remain bipartisan.

Netanyahu’s new allies may make that difficult, however. Some U.S. officials have already privately indicated they will not meet with Itamar Ben-Gvir and Bezazel Smotrich, two likelymembers of Netanyahu’s government.

Ben-Gvir and Smotrich advocate recognizing illegal Israeli settlements in the West Bank, where most Palestinians live, and eventually annexing most or all of that territory. They oppose a separate Palestinian state. Netanyahu needs their support to cement a majority in the Israeli Knesset, or parliament. Their support could also help him pass a law that would allow him to dodge his corruption trial.

The two men have also called for a far harsher crackdown on Palestinian militants and their supporters, including strict curfews in Palestinian villages, mass deportations and targeted killings of terrorism suspects. They have advocated making it easier for Israeli security forces to use live ammunition against Palestinian protesters who throw stones.

Ben-Gvir has also expressed affinity for the late ultra-nationalist rabbi Meir Kahane, whose ideology the Anti-Defamation League has described as reflecting “racism, violence and political extremism” and whose organization until recently was listed as a terrorist group by the U.S. government.

For years, Ben-Gvir had a poster of Baruch Goldstein, an Israeli American terrorist and Kahane disciple who murdered 29 Muslim worshippers in Hebron in 1994, hanging in his home, according to Israeli media. In 2007, an Israeli court convicted Ben-Gvir of incitement to racist violence and support for a terrorist organization.

Israel has sworn in its most religious and right-wing parliament after nearly four years of political deadlock and five elections.

Ben-Gvir and Smotrich want to head the ministries of public security and defense, respectively, portfolios that have the closest contact with U.S. officials. On Friday, Netanyahu’s Likud party and Ben-Gvir’s Jewish Power party announced an agreement for Ben-Gvir to become security minister.

“This country is a democracy that elected a leadership and I intend to work with them,” the U.S. ambassador to Israel, Thomas Nides, said in an interview with Israeli media, adding quickly: “That said, we have to stand up for the things that we believe in, that’s what American values are about. We have a very strong ally in the state of Israel, but there will be times when we will articulate where we believe our differences are.”

Nides and other U.S. officials have stated that the two countries’ points of disagreement include expansion of Israeli settlements in the occupied West Bank and the possible annexation of the territory.

“The administration will have to decide what the real red lines are,” said Michael Koplow, a senior analyst with the Israel Policy Forum, a U.S.-based pro-Israel organization that advocates the two-state solution. “This will test U.S. boundaries on all fronts.”

Negotiations to form the government are underway and could take days or even weeks. A fair amount of horse-trading is part of the process, so it remains unclear which politicians will assume which posts. Netanyahu offered Smotrich the Finance Ministry instead of Defense, according to Israeli media, but Smotrich has so far given no indication he will budge from his initial demand.

“We provide nearly $4 billion a year to the Defense Ministry … and do we want to put our money in the hands of these guys?” said Daniel Kurtzer, former U.S. ambassador to Israel who now teaches at Princeton University. “I’d say no.”

Netanyahu is reported to be considering Ron Dermer as his foreign minister. Dermer served as Israel’s ambassador to the United States starting in 2013 and through the Trump administration, with which he was especially friendly. He arranged Netanyahu’s 2015 speech to Congress. Dermer’s appointment would be a “poke in the eye” for Biden, Kurtzer said.

Former Israeli Prime Minister Ehud Olmert defamed his successor, Benjamin Netanyahu, and must pay damages to Netanyahu and his family, a court rules.

Republicans remain eager to criticize anything short of unquestioning support for Israel from the Biden administration. After the Israeli government revealed that the U.S. Justice Department had launched an inquiry into the May killing of Palestinian American journalist Shireen Abu-Akleh near the West Bank city of Jenin, Sen. Ted Cruz (R-Texas) demanded Atty. Gen. Merrick Garland and “everyone involved in this debacle” be “fired or impeached.”

Multiple investigations by independent human rights and journalism organizations have concluded that an Israeli soldier probably fired the shot that killed the veteran journalist. Israel eventually acknowledged one of its soldiers was likely responsible. No one has been disciplined.

If the new Israeli government decides to try to annex the West Bank, it would jeopardize the Abraham Accords, a deal brokered under the Trump administration that opened business and some diplomatic ties between Israel and several Persian Gulf states, such as the United Arab Emirates, that had previously refused to recognize Israel’s existence.

The UAE’s entry into the agreement was predicated on Netanyahu, in his previous stint as prime minister, backing away from plans to annex West Bank territory.

“If they push too far, it will foreclose any movement forward” in regional relations, said Aaron David Miller, a former U.S. envoy for the Middle East now at the Carnegie Endowment for International Peace.

Miller thinks Biden and Netanyahu will attempt to avoid overt conflict to safeguard their own domestic and global positions: “Biden wants to avoid a public wrestling match with Netanyahu,” Miller said, while Netanyahu “craves the international stage and is intending to strut on it.”

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Publicly, U.S. officials remain cautious, saying they want to see what kind of government Netanyahu ultimately forms, reiterating their “ironclad” commitment to Israel while emphasizing American “values” that include freedom and prosperity “in equal measure” for Israelis and Palestinians.

“The administration is right to be concerned … and to telegraph those concerns,” Sen. Chris Van Hollen (D-Md.), a member of the Senate Foreign Relations Committee, said in an interview. He is one of several Democratic lawmakers who are firm supporters of Israel but have raised alarms over potential members of the new government. These include Sen. Bob Melendez of New Jersey, who chairs the committee, and California Rep. Brad Sherman (D-Northridge).

But Ben-Gvir further alienated Biden administration officials by taking an electoral victory lap at a memorial service for Kahane, who was assassinated more than 30 years ago.

“Celebrating the legacy of a terrorist organization is abhorrent — there is no other word for it,” State Department spokesman Ned Price said in unusually strongly worded comments. “We remain concerned by the legacy of Kahane and the continued use of rhetoric among violent right-wing extremists,” he said.

Ben-Gvir has reached an agreement with Netanyahu that would allow him to vastly expand police powers and remove officers from oversight by other legal authorities.

Naming a person who has been convicted of terrorism-related charges to head Israel’s national police force has alarmed numerous Israelis.

“It means that the police will become politicized to favor the extreme right,” the liberal Israeli newspaper Haaretz said in an editorial this week. “Those who are supposed to be safeguarding democracy have turned into soldiers at the service of politicians. That’s what happens when those accused and convicted of crimes take control of the institutions charged with maintaining law and order.”

The prospect of a Ben-Gvir-run police force has also alarmed American supporters of Israel. Ben-Gvir “has promised a no-holds-barred crackdown on terrorism and increased police and border security presence,” Yulia Shalomov, a fellow at the U.S.-based Atlantic Council think tank, said in a recent web appearance. His party “has consistently stoked domestic ethnic and societal tensions,” she said.

Netanyahu’s right-wing partners will also push for other legislation that would not only have an impact on Palestinians and Arabs. They have threatened to criminalize homosexuality and to ban non-Orthodox Jews from Israeli citizenship. Many U.S.-born Jews are members of more progressive branches of the faith, such as Reform or Conservative Judaism, and might not be able to obtain Israeli citizenship under the proposed laws.

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Original Article: latimes.com

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