Science
Where will the next pandemic begin? The Amazon rainforest offers troubling clues

The ten-year-old took off working down a dust highway within the coronary heart of the Amazon rainforest, turning cartwheels, enjoying tag and selecting fistfuls of untamed bougainvillea.
Small fires flared throughout Darah Girl Assunção Oliveira da Costa and her younger cousins as males burned bushes to make room for extra farmland. On the horizon loomed what was left of still-virgin jungle, dense and impossibly inexperienced. A series noticed roared from inside.
Within the three a long time since Darah Girl’s widowed grandmother first arrived on this distant stretch of northern Brazil, clearing the jungle by hand to construct a home for her 14 kids, the household has pushed deeper and deeper into the Amazon. It has been pushed by the frontier maxim that prosperity comes when nature succumbs to human dominion.
A settler slashes and burns a patch of land close to the sting of the rainforest in Maruaga, Brazil. Massive and small encroachments occur all through the Amazon on any given day. Since 1970, greater than 1 / 4 million sq. miles of Brazilian rainforest have been destroyed.
(Luis Sinco / Los Angeles Occasions)
“To outlive, we have to use what we have now,” stated Darah Girl’s father, 60-year-old Aladino Oliveira da Costa, who toppled old-growth forest to construct houses for every of his 4 older kids.
He and the remainder of the group have been prepping Darah Girl and her 42 cousins for all times on the literal fringe of civilization, educating them which bugs to keep away from, which crops remedy colds and which wild animals might be hunted and eaten.
Darah Girl Assunção Oliveira da Costa, 10, picks flowers close to her house in a jungle settlement referred to as Maruaga. The woman’s grandmother settled within the space about 30 years in the past, clearing the land and constructing a house for her 14 kids. The household has pushed deeper into the Amazon with every passing technology.
(Luis Sinco / Los Angeles Occasions)
But their rising outpost in northeastern Amazonas state — one in every of 1000’s of casual settlements all through the world’s largest rainforest — might imperil not solely their kids’s future but in addition that of your entire planet.
It’s not nearly bushes. It’s about viruses.
Extra world pandemics like COVID-19 are on the way in which, scientists say, and the subsequent one is more likely to emerge from a group like Darah Girl’s, the place individuals are encroaching on the pure world and erasing the buffer between themselves and habitats that existed lengthy earlier than a shovel reduce this earth.
The World They Inherit
That is the sixth in a sequence of occasional tales concerning the challenges younger individuals face in an more and more perilous world. Reporting was supported by a grant from the Pulitzer Middle.
From palm oil cultivation in Malaysia to mining in Africa or cattle ranching in Brazil, as individuals demolish forest, they not solely speed up world warming but in addition dramatically improve their danger of publicity to illness. Lurking in mammals and birds are about 1.6 million viruses, a few of which might be lethal after they leap to people. The stakes flip catastrophic if a virus proves transmissible between individuals.
That’s what occurred with COVID-19, which originated from shut contact between people and wild animals — whether or not it sprung from a pure setting or a laboratory.
The excessive rises of Manaus jut out of the Amazon rainforest alongside the Rio Negro in northwestern Brazil. Based within the nineteenth century as a middle for the rubber commerce, Manaus now could be a free import and export enterprise zone. Commerce and trade listed below are bustling.
(Luis Sinco / Los Angeles Occasions)
Scientists say that illness sizzling zones are multiplying from Africa to South America, and that deforestation has already triggered an increase in infectious illness. Zoologists have traced a couple of third of all identified outbreaks world wide to fast land use change, together with Nipah virus, malaria and Lyme illness. The issue is worsened by hotter temperatures introduced by local weather change that permit disease-carrying bugs to flourish.
Brazil has misplaced 270,000 sq. miles of the rainforest — the scale of two Germanys — since 1970. Darah Girl’s hamlet of Maruaga is rife with dangers for viral spillover, from omnipresent mosquitoes, roaming canines and chickens, and the wild sport her household recurrently eats. Contaminated bushmeat consumption in all probability sparked the 2013 Ebola outbreak within the West African nation of Guinea.
“Oh, it’s scrumptious!” Darah Girl stated of paca, a hunched, striped rodent that lives within the forest, as she and her cousins stopped to say good day to her father, who was smoothing mortar between concrete blocks, including a brand new room to their two-story home.
“However you may’t go overboard with the pepper,” Darah Girl continued. “There was this one time when he went to arrange the paca” — she caught her tongue out and panted — “and it was so sizzling!”
Her father, long-limbed and quick-witted like his daughter, smiled, placing his arm across the woman’s slender shoulders. “And tapir,” he added, referring to a jungle mammal that resembles a big pig with a trunk. “They’re additionally actually good.”
Birds choose a tree within the central sq. of Manaus, Brazil. Constructed on the banks of the Rio Negro, town of two million individuals stands in the midst of the Amazon jungle. It’s a bustling middle for commerce, trade and commerce.
(Luis Sinco / Los Angles Occasions)
Their household has already battled zoonotic sicknesses — the time period used to explain infectious illnesses transmitted between animals and people. Darah Girl’s father is a survivor of malaria and Leishmaniasis, a illness carried by sand flies that causes flesh-eating pores and skin sores.
When 40% of a land space has been destroyed, in accordance with Tom Gillespie, an Emory researcher targeted on environmental change and illness, the area hits a form of tipping level: Wild animals are pushed nearer to people for meals, and viruses start to unfold.
Even small decreases in forest cowl can drive up publicity to pathogens. In Brazil, Zika, the mosquito-borne virus that causes devastating delivery defects, is a primary instance. Scientists say deforestation has contributed to file warmth and droughts that trigger extra individuals to retailer water in open containers — wonderful breeding grounds for mosquitoes. With world warming, these vectors will in all probability creep north, breeding in components of North America, Europe and East Asia the place it had beforehand been too chilly.
It’s possible Darah Girl will confront one other pandemic in her lifetime. However her household isn’t frightened. When COVID-19 swept by way of the Amazon, her family members say they survived by sipping tea made with the bark of a forest vine. Darah Girl’s grandmother Iracema, 81, went into the jungle to gather the elements.
“It’s one thing that God placed on the face of this Earth,” Darah Girl’s aunt Ivaneide Assunção da Silva stated of the virus. “And God gave us the instruments to remedy ourselves.”
A primate seems to be out from its cage at a wildlife analysis facility in Manaus, Brazil. Veterinarians and researchers continually monitor and catalog pathogens discovered within the Amazon jungle. As individuals proceed to encroach on the rainforest, buffers between people and wildlife are erased, rising the opportunity of pathogen transmission between species.
(Luis Sinco / Los Angeles Occasions)
The group right here revolves across the small neo-Pentecostal church Iracema helped construct. The church’s nationwide leaders have claimed that the coronavirus is attributable to Devil and won’t damage those that are usually not afraid of it. The entire household has declined to take the vaccine.
Iracema believes the household will meet any problem, even a future pandemic, with the assistance of God — and the fruits of the forest.
“It’s vital to know concerning the forest,” she stated. “As a result of, once we reside right here, there’s nobody to assist us. We’ve all the time been right here fending for ourselves.”
::
100 miles south of Maruaga, within the sprawling metropolis of Manaus, a cemetery edges up in opposition to the rainforest, a sea of recent picket crosses giving method to a seemingly countless thicket of bushes.
Through the worst of the COVID-19 pandemic, when hospitals in Manaus ran out of oxygen and medical doctors might do not more than prescribe morphine to sufferers as they slowly asphyxiated, employees razed acres of jungle so backhoes might dig mass graves for 1000’s of lifeless.
1000’s of individuals in Manaus died in two separate surges of the COVID-19 pandemic. Nearly everybody on this metropolis of two million individuals is aware of somebody who died a sluggish and excruciating dying after native hospitals ran out of oxygen. Officers bulldozed components of the jungle for area to bury the lifeless.
(Luis Sinco / Los Angeles Occasions)
If there’s anyplace on the planet that understands simply how devastating a pandemic might be, it’s Manaus, a metropolis of two million that rises out of the forest alongside a tributary of the Amazon River. Scientists are involved Manaus is also the breeding floor for the subsequent world epidemic, and say its poor efficiency responding to COVID-19 suggests it’s nowhere close to prepared for what could come.
“We weren’t ready,” stated nursing assistant Ludernilce Peixoto Costa, 43, who works at one of many metropolis’s important hospitals treating COVID-19 sufferers. Peixoto misplaced each of her dad and mom to COVID-19. Within the ICU the place she works, her father died holding her hand.
She worries about her youngest brother, 16, who has grow to be more and more withdrawn — one other COVID-19 orphan in a metropolis filled with them. She worries, too, about her 6-year-old daughter, Adrielly, who can’t keep in mind a life earlier than protecting masks and who says she needs to be a physician someday as a result of she has identified so many sick individuals.
Peixoto wonders: What if the virus by no means actually goes away, or one other one seems, and the younger must reside with pandemics endlessly?
“It scares me lots,” Peixoto stated on a current morning after one other exhausting evening shift. “It’s an unsure future.”
Ludernilce Peixoto Costa, 43, and her daughter Adrielly, 6, at their house on the outskirts of Manaus, Brazil. Peixoto works at one of many metropolis’s important hospitals treating COVID-19 sufferers. She misplaced each of her dad and mom to COVID-19.
(Luis Sinco / Los Angeles Occasions)
Others share that fear, together with Nelcicleide Vasconcelos Barbosa Reis, 39, who works for a Catholic charity in a casual settlement about three hours north of Manaus.
The city, with a reputation, Rumo Certo, that interprets to Proper Path, sprung up from the jungle lower than three a long time in the past and is now sandwiched between a sequence of cattle ranches and a lake shaped by a hydroelectric dam.
Vasconcelos was busy ensuring kids didn’t fall behind whereas faculties have been closed when final 12 months she, her husband and their 9-year-old daughter fell sick.
Her husband died in a Manaus hospital in December. Her daughter, Emanuelle, is shattered, spinning with anxiousness when anyone mentions the phrase “COVID.”
“It’s unfair,” Emanuelle tells her mom. “Couldn’t God see {that a} child wants her dad?”
Colleges have been closed for properly over a 12 months and there’s no signal she’s going again.
Throughout a current celebration on the church, the place Emanuelle floated round with a bunch of youngsters, together with a toddler in a T-shirt emblazoned with {a photograph} of his father, who additionally died from COVID-19, Vasconcelos wiped away tears. She questioned if kids’s lives would ever really feel “regular” once more.
“Both they are going to mature shortly or they are going to get misplaced,” she stated.
::
The capuchin monkey was out chilly, sprawled on a steel examination desk as veterinarian Alessandra Nava gently searched its legs for an excellent vein.
The monkey, an unlawful pet turned over to Brazil’s federal environmental safety company, was malnourished and underweight, however Nava lastly discovered a good website for a draw on its thigh. Blood crammed a vial, and because the monkey was carried again to its cage to sleep off the sedatives, Nava dropped the vial right into a tank of liquid nitrogen — one other pattern for her database.
Veterinarian Alessandra Nava attracts blood samples from a primate at a lab in Manaus. Nava is a researcher with the Oswaldo Cruz Basis, Brazil’s most distinguished scientific establishment, and tracks viruses within the Amazon jungle.
(Luis Sinco / Los Angeles Occasions)
Nava is a virus hunter. As a researcher with Oswaldo Cruz Basis, a government-run lab, she spends her days in and round Manaus taking samples from primates, rodents and bats. These specimens are serving to construct up the establishment’s biobank — a library of the viruses which can be circulating amongst animals within the jungle.
Not like conventional biobanks that retailer human samples for genomics and personalised medication, these repositories serve a extra common function: surveilling viral circulation. The scientists know that whereas reservoir hosts just like the monkey can harbor many viruses with out ever falling sick, when these viruses make their approach into people, they’ll set off a disastrous outbreak.
Scientists like Nava stalk and examine the pathogens in hopes of outsmarting them. If a mysterious case of illness have been to look in a human, lab employees might sequence the virus’ genome and attempt to match it to a virus within the biobank, rushing up efforts to include it.
There are related initiatives in Thailand, Singapore and Malaysia — the place scientists fear a couple of Nipah virus spillover — and the Congo basin, the place Ebola and Marburg stay fixed threats.
Internationally, the International Virome Undertaking is probably the most strong instance: an enormous analysis venture that goals to catalog each virus that might threaten people. Dennis Carroll, the researcher who runs it, believes that if such an information set had been obtainable prior to now, the coronavirus that spilled into people some two years in the past would have been recognized a lot quicker.
However many zoologists think about it too bold. Estimates counsel the venture would value about $1.6 billion over a decade to establish 75% of all of the world’s viruses. And even a library of all of them wouldn’t reveal which might be transmitted between people. Some scientists suppose a wiser method is convincing particular teams of individuals to undertake much less dangerous behaviors: wet-market employees, mink farmers, chimpanzee hunters — and maybe households residing on the perimeter of the forest, like Darah Girl’s.
A lot of the analysis into zoonotic spillover has thus far targeted on Asia and Africa, however there’s rising consideration on the Amazon. Brazil misplaced an estimated 5 million acres of its part of the forest in 2020, and scientists warn that part might be decreased by greater than 40% by 2050. Outbreaks of zoonotic illness have elevated globally within the final 30 years, and the virus that can mutate to trigger the subsequent one, although maybe undetected, is already on the market.
A sloth takes refuge within the hair of a researcher with the Oswaldo Cruz Basis, Brazil’s most distinguished scientific establishment. As individuals proceed to encroach on the rainforest, buffers between people and wildlife are erased, rising the opportunity of pathogen transmission between species. Scientific researchers monitor and catalog pathogens present in animals from the Brazilian jungle.
(Luis Sinco / Los Angeles Occasions)
“They reduce down a bit of pristine forest and construct a shopping center, and folks suppose it’s progress,” Nava stated. “However while you do this, you’re leaving a complete group of animals with out a house.”
Nava, who has a younger daughter, has been including photo voltaic panels and cisterns to her home to make her household extra self-sufficient within the face of future disasters. As she commutes round Manaus, with its city sprawl ever encroaching on the forest round it, she thinks about her child: “What sort of planet are we leaving her?”
If individuals actually care about avoiding future pandemics, she stated, they are going to notice that the most effective method just isn’t her personal — attempting to find out about viruses earlier than they take root in people — however to cease their unfold altogether.
“It’s not about trying to find the subsequent virus,” she stated. “Now we have to cease deforestation proper now.”
::
Aladino Oliveira da Costa, 60, and his daughter Darah Girl, 10, speak with a reporter exterior their house within the village of Maruaga. Oliviera cleared old-growth bushes from the jungle to construct houses for every of his 4 older kids. He hopes to sometime do the identical for Darah Girl.
(Luis Sinco / Los Angeles Occasions)
Oliveira bristles at options that households like his are doing one thing fallacious by increasing into the jungle.
He helps Brazilian President Jair Bolsonaro, a far-right firebrand who has allowed a rise of logging, mining and cattle farming within the Amazon — actions that scientists say are linked to the emergence of infectious illness.
Oliveira says if scientists need Brazil to cease slicing down the rainforest, they need to compensate these residing there. “Pay me to protect it and I’ll protect it,” he stated on a current morning, sipping espresso in an open-air gazebo along with his spouse and his spouse’s mom whereas Darah Girl sat in Sunday college on the group’s little church.
“Coming from the surface, you need the forest to stay standing,” he stated. “That’s great. However I reside right here within the forest. And I don’t survive on leaves and lizards.”
Round him have been indicators of how the expansion of his household’s compound has already altered a land that lower than a century in the past was untouched and pristine. A paved highway constructed lately is already lined with small shops and cattle ranches. Close by, building employees are getting ready to clear extra forest to construct a hospital. Even the place the plush inexperienced is comparatively undisturbed, thick electrical traces stretch over the cover, buzzing day and evening.
The youngsters trickled out of the church, Darah Girl clutching a Bible. She accepted kisses from all of the adults — together with her grandmother Iracema, who a long time in the past pushed again the forest to make a house — then sat down along with her cousins for a breakfast of fruitcake.
Greater than her elders, Darah Girl appeared to intuit the nuance of deforestation. Simply days earlier than, she had performed on lots that was being cleared.
It had as soon as been a dense universe of life — towering bushes, cacophonous birds, legions of uncommon bugs and animals. However now it seemed as if it had been flattened by a bomb, cleared of any helpful timber and blackened by a still-smoldering fireplace.
“I get type of unhappy,” Darah Girl stated. “As a result of, like, the forest is one thing I’ve beloved since I used to be little. They usually’re deforesting, proper? It’s destroying nature.”
A person burning jungle in a settlement named Maruaga in Brazil.
(Luis Sinco / Los Angeles Occasions)
“However it’s additionally going to assist,” she stated, exhibiting a baby’s grasp of slash-and-burn agriculture. “This land they’re burning, these bushes, the vitamins from what they burn will go into the soil. And it’ll assist to plant new issues — like orange bushes, guava bushes — and folks can construct homes.”
On this Sunday morning, as she and her household completed up and retired to their house, smoke from farmers clearing extra land once more crammed the sky, an indication of each progress and peril. Darah Girl was so used to it, she barely observed.
Extra from ‘The World They Inherit’
Occasions workers author Linthicum and particular correspondent Ionova reported from Maruaga. Workers author Baumgaertner reported from Los Angeles.
(That is the sixth in a sequence of occasional tales concerning the challenges younger individuals face in an more and more perilous world. Reporting was supported by a grant from the Pulitzer Middle.)

Science
Racing to Save California’s Elephant Seals From Bird Flu

For the last few years, the Marine Mammal Center has been testing any patients with bird-flu-like symptoms, which include respiratory and neurological problems, for the virus.
Science
Lawmakers ask Newsom and waste agency to follow the law on plastic legislation

California lawmakers are taking aim at proposed rules to implement a state law aimed at curbing plastic waste, saying the draft regulations proposed by CalRecycle undermine the letter and intent of the legislation.
In a letter to Gov. Gavin Newsom and two of his top administrators, the lawmakers said CalRecycle exceeded its authority by drafting regulations that don’t abide by the terms set out by the law, Senate Bill 54.
“While we support many changes in the current draft regulations, we have identified several provisions that are inconsistent with the governing statute … and where CalRecycle has exceeded its authority under the law,” the lawmakers wrote in the letter to Newsom, California Environmental Protection agency chief Yana Garcia, and Zoe Heller, director of the state’s Department of Resources Recycling and Recovery, or CalRecycle.
The letter, which was written by Sen. Catherine Blakespear (D-Encinitas) and Sen. Benjamin Allen (D-Santa Monica), was signed by 21 other lawmakers, including Sen. John Laird (D-Santa Cruz) and Assemblymembers Al Muratsuchi (D-Rolling Hills Estates) and Monique Limón (D-Goleta).
CalRecycle submitted informal draft regulations two weeks ago that are designed to implement the law, which was authored by Allen, and signed into law by Newsom in 2022.
The lawmakers’ concerns are directed at the draft regulations’ potential approval of polluting recycling technologies — which the language of the law expressly prohibits — as well as the document’s expansive exemption for products and packaging that fall under the purview of the U.S. Department of Agriculture and the Food and Drug Administration.
The inclusion of such blanket exemptions is “not only contrary to the statute but also risks significantly increasing the program’s costs,” the lawmakers wrote. They said the new regulations allow “producers to unilaterally determine which products are subject to the law, without a requirement or process to back up such a claim.”
Daniel Villaseñor, a spokesman for the governor, said in an email that Newsom “was clear when he asked CalRecycle to restart these regulations that they should work to minimize costs for small businesses and families, and these rules are a step in the right direction …”
At a workshop held at the agency’s headquarters in Sacramento this week, CalRecycle staff responded to similar criticisms, and underscored that these are informal draft regulations, which means they can be changed.
“I know from comments we’ve already been receiving that some of the provisions, as we have written them … don’t quite come across in the way that we intended,” said Karen Kayfetz, chief of CalRecycle’s Product Stewardship branch, adding that she was hopeful “a robust conversation” could help highlight areas where interpretations of the regulations’ language differs from the agency’s intent.
“It was not our intent, of course, to ever go outside of the statute, and so to the extent that it may be interpreted in the language that we’ve provided, that there are provisions that extend beyond … it’s our wish to narrow that back down,” she said.
These new draft regulations are the expedited result of the agency’s attempt to satisfy Newsom’s concerns about the law, which he said could increase costs to California households if not properly implemented.
Newsom rejected the agency’s first attempt at drafting regulations — the result of nearly three years of negotiations by scores of stakeholders, including plastic producers, package developers, agricultural interests, environmental groups, municipalities, recycling companies and waste haulers — and ordered the waste agency to start the process over.
Critics say the new draft regulations cater to industry and could result in even higher costs to both California households, which have seen large increases in their residential waste hauling fees, as well as to the state’s various jurisdictions, which are taxed with cleaning up plastic waste and debris clogging the state’s rivers, highways, beaches and parks.
The law is molded on a series of legislative efforts described as Extended Producer Responsibility laws, which are designed to shift the cost of waste removal and disposal from the state’s jurisdictions and taxpayers to the industries that produce the waste — theoretically incentivizing a circular economy, in which product and packaging producers develop materials that can be reused, recycled or composted.
Science
U.S. just radically changed its COVID vaccine recommendations: How will it affect you?
As promised, federal health officials have dropped longstanding recommendations that healthy children and healthy pregnant women should get the COVID-19 vaccines.
“The COVID-19 vaccine schedule is very clear. The vaccine is not recommended for pregnant women. The vaccine is not recommended for healthy children,” the U.S. Department of Health and Human Services said in a post on X on Friday.
In formal documents, health officials offer “no guidance” on whether pregnant women should get the vaccine, and ask that parents talk with a healthcare provider before getting the vaccine for their children.
The decision was done in a way that is still expected to require insurers to pay for COVID-19 vaccines for children should their parents still want the shots for them.
The new vaccine guidelines were posted to the website of the U.S. Centers for Disease Control and Prevention late Thursday.
The insurance question
It wasn’t immediately clear whether insurers will still be required under federal law to pay for vaccinations for pregnant women.
The Trump administration’s decision came amid criticism from officials at the nation’s leading organizations for pediatricians and obstetricians. Some doctors said there is no new evidence to support removing the recommendation that healthy pregnant women and healthy children should get the COVID vaccine.
“This situation continues to make things unclear and creates confusion for patients, providers and payers,” the American College of Obstetricians and Gynecologists said in a statement Friday.
Earlier in the week, the group’s president, Dr. Steven Fleischman, said the science hasn’t changed, and that the COVID-19 vaccine is safe during pregnancy, and protects both the mom-to-be and their infants after birth.
“It is very clear that COVID-19 infection during pregnancy can be catastrophic,” Fleischman said in a statement.
Dr. Susan Kressly, president of the American Academy of Pediatrics, criticized the recommendation change as being rolled out in a “conflicting, confusing” manner, with “no explanation of the evidence used to reach their conclusions.”
“For many families, the COVID vaccine will remain an important way they protect their child and family from this disease and its complications, including long COVID,” Kressly said in a statement.
Some experts said the Trump administration should have waited to hear recommendations from a committee of doctors and scientists that typically advises the U.S. Centers for Disease Control and Prevention on immunization recommendations, which is set to meet in late June.
California’s view
The California Department of Public Health on Thursday said it supported the longstanding recommendation that “COVID-19 vaccines be available for all persons aged 6 months and older who wish to be vaccinated.”
The changes come as the CDC has faced an exodus of senior leaders and has lacked an acting director. Typically, as was the case during the first Trump administration and in the Biden administration, it is the CDC director who makes final decisions on vaccine recommendations. The CDC director has traditionally accepted the consensus viewpoint of the CDC’s panel of doctors and scientists serving on the Advisory Committee on Immunization Practices.
Even with the longstanding recommendations, vaccination rates were relatively low for children and pregnant women. As of late April, 13% of children, and 14.4% of pregnant women, had received the latest updated COVID-19 vaccine, according to the CDC. About 23% of adults overall received the updated vaccine, as did 27.8% of seniors age 65 and over.
The CDC estimates that since October, there have been 31,000 to 50,000 COVID deaths and between 270,000 and 430,000 COVID hospitalizations.
Here are some key points about the CDC’s decision:
New vaccination guidance for healthy children
Previously, the CDC’s guidance was simple: everyone ages 6 months and up should get an updated COVID vaccination. The most recent version was unveiled in September, and is officially known as the 2024-25 COVID-19 vaccine.
As of Thursday, the CDC, on its pediatric immunization schedule page, says that for healthy children — those age 6 months to 17 years — decisions about COVID vaccination should come from “shared clinical decision-making,” which is “informed by a decision process between the healthcare provider and the patient or parent/guardian.”
“Where the parent presents with a desire for their child to be vaccinated, children 6 months and older may receive COVID-19 vaccination, informed by the clinical judgment of a healthcare provider and personal preference and circumstances,” the CDC says.
The vaccine-skeptic secretary of Health and Human Services, Robert F. Kennedy Jr., contended in a video posted on Tuesday there was a “lack of any clinical data to support the repeat booster strategy in children.”
However, an earlier presentation by CDC staff said that, in general, getting an updated vaccine provides both children and adults additional protection from COVID-related emergency room and urgent care visits.
Dr. Peter Chin-Hong, a UC San Francisco infectious diseases expert, said he would have preferred the CDC retain its broader recommendation that everyone age 6 months and up get the updated vaccine.
“It’s simpler,” Chin-Hong said. He added there’s no new data out there that to him suggests children shouldn’t be getting the updated COVID vaccine.
A guideline that involves “shared decision-making,” Chin-Hong said, “is a very nebulous recommendation, and it doesn’t result in a lot of people getting vaccines.”
Kressly, of the American Academy of Pediatrics, said the shared clinical decision-making model is challenging to implement “because it lacks clear guidance for the conversations between a doctor and a family. Doctors and families need straightforward, evidence-based guidance, not vague, impractical frameworks.”
Some experts had been worried that the CDC would make a decision that would’ve ended the federal requirement that insurers cover the cost of COVID-19 vaccines for children. The out-of-pocket cost for a COVID-19 vaccine can reach around $200.
New vaccine guidance for pregnant women
In its adult immunization schedule for people who have medical conditions, the CDC now says it has “no guidance” on whether pregnant women should get the COVID-19 vaccine.
In his 58-second video on Tuesday, Kennedy did not explain why he thought pregnant women should not be recommended to get vaccinated against COVID-19.
Chin-Hong, of UCSF, called the decision to drop the vaccination recommendation for pregnant women “100%” wrong.
Pregnancy brings with it a relatively compromised immune system. Pregnant women have “a high chance of getting infections, and they get more serious disease — including COVID,” Chin-Hong said.
A pregnant woman getting vaccinated also protects the newborn. “You really need the antibodies in the pregnant person to go across the placenta to protect the newborn,” Chin-Hong said.
It’s especially important, Chin-Hong and others say, because infants under 6 months of age can’t be vaccinated against COVID-19, and they have as high a risk of severe complications as do seniors age 65 and over.
Not the worst-case scenario for vaccine proponents
Earlier in the week, some experts worried the new rules would allow insurers to stop covering the cost of the COVID vaccine for healthy children.
Their worries were sparked by the video message on Tuesday, in which Kennedy said that “the COVID vaccine for healthy children and healthy pregnant women has been removed from the CDC recommended immunization schedule.”
By late Thursday, the CDC came out with its formal decision — the agency dropped the recommendation for healthy children, but still left the shot on the pediatric immunization schedule.
Leaving the COVID-19 vaccine on the immunization schedule “means the vaccine will be covered by insurance” for healthy children, the American Academy of Pediatrics said in a statement.
How pharmacies and insurers are responding
There are some questions that don’t have immediate answers. Will some vaccine providers start requiring doctor’s notes in order for healthy children and healthy pregnant women to get vaccinated? Will it be harder for children and pregnant women to get vaccinated at a pharmacy?
In a statement, CVS Pharmacy said it “follows federal guidance and state law regarding vaccine administration and are monitoring any changes that the government may make regarding vaccine eligibility.” The insurer Aetna, which is owned by CVS, is also monitoring any changes federal officials make to COVID-19 vaccine eligibility “and will evaluate whether coverage adjustments are needed.”
Blue Shield of California said it will not change its practices on covering COVID-19 vaccines.
“Despite the recent federal policy change on COVID-19 vaccinations for healthy children and pregnant women, Blue Shield of California will continue to cover COVID-19 vaccines for all eligible members,” the insurer said in a statement. “The decision on whether to receive a COVID-19 vaccine is between our member and their provider. Blue Shield does not require prior authorization for COVID-19 vaccines.”
Under California law, health plans regulated by the state Department of Managed Health Care must cover COVID-19 vaccines without requiring prior authorization, the agency said Friday. “If consumers access these services from a provider in their health plan’s network, they will not need to pay anything for these services,” the statement said.
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