| | | | | |  | | By Renuka Rayasam | Presented by Brilliant | With help from Myah Ward THE TEXAS VACCINE MESS — President Joe Biden is expected to promise that every American adult will be eligible for a Covid-19 vaccine by May 1 in a primetime speech tonight. The U.S. is not Israel or the Seychelles, which lead the world in distributing shots, but it's ahead of most other nations — including European countries that have been far more successful at tamping down Covid spread. Yet the country's federalist, 50-state approach to vaccine distribution — a system that Biden inherited when he became president — has led to starkly different vaccination rates around the country. Texas has one of the country's slowest moving vaccination campaigns: About 16 percent of Texans have gotten one dose of a Covid vaccine. About half a dozen states — including Alaska, New Mexico, South Dakota, North Dakota, Connecticut and Rhode Island — have vaccinated about a quarter of their populations. Nearly 19 percent of Americans have been vaccinated nationwide. Within those states, wide disparities exist among who has been vaccinated. The people who need it the most might not necessarily be getting a shot, something Biden will promise to fix tonight by shipping more vaccines to community health centers, pharmacies and federally run vaccination sites. But nowhere are the disparities as pronounced as in Texas, a state that as of Wednesday no longer has Covid restrictions or a mask mandate. "Texas is very much an outlier," said Lawrence Gostin, a global health law professor at Georgetown who is tracking the nationwide vaccine rollout. By not prioritizing poor and minority communities, Texas has created a profoundly unequal and chaotic system, he said. "As long as there is vaccine scarcity, Texas's approach will be unfair." Most states are using data from the CDC's vulnerability index to send vaccines to the places with the biggest need, which includes people who are at highest risk of dying from Covid (such as the elderly) or at highest risk of contracting Covid (such as grocery store workers). Rhode Island, for example, set aside vaccines for towns with the highest Covid rates. That approach made low-income Central Falls one of the state's most vaccinated towns. Texas, however, is distributing doses to providers in its 254 counties largely based on their overall population. It's also prioritizing big health care systems. That's led to tech-savvy people with cars and time to travel getting vaccinated before others who are at higher risk. At one point at the end of January, when Texas was six weeks into its Covid vaccine rollout, several rural hospitals had yet to receive a single dose, according to Don McBeath at the Texas Organization of Rural & Community Hospitals. They couldn't vaccinate their health care workers, even though they were in the highest priority tier. The distribution can seem arbitrary: Rural Baylor County, which has less than 4,000 residents and is near the Oklahoma border, had the highest vaccination rate in the country at the time. Even now as the state continues to get more doses, wide disparities exist throughout the state. Bigger cities are getting more doses — there are now three FEMA vaccine distribution sites in Houston and the Dallas area — but they have a lot more people in need. People in smaller towns without a health care provider or pharmacy don't have a local source of supply. There is an acute dearth of vaccines in Black communities, Texas State Senator Borris Miles said. Black Texans, about 13 percent of the state's population, have gotten 6 percent of vaccine doses in the state, when race is tracked. Hispanics, about 40 percent of the state's population, have gotten less than 20 percent of the doses. Chris Van Deusen, a spokesperson for the Texas health department defended the state's approach of distributing doses based on population and providers, arguing it is an efficient way to distribute limited vaccine supply. The state's expert vaccine allocation panel has "discussed the possibility of some weighting by various vulnerability metrics," he added. But next week the imbalance will become even bigger: All Texans older than 50 will be eligible for the Covid vaccine starting Monday, even though not everyone in the initial priority populations have been vaccinated, another departure from federal guidance. In other words, the state is expanding its vaccine pool to still more people who face lower risks — people who work from home, for example — while teachers, the elderly, factory workers and other vulnerable groups are still waiting. Welcome to POLITICO Nightly. I hope more people will join me on my silent campaign for more essential-oil-free skincare. Reach out with news and tips at rrayasam@politico.com, or on Twitter at @renurayasam.
| | | | A message from Brilliant: Start learning with Brilliant and develop the problem-solving skills needed for a STEM career. Learn More | | | | | | BIDEN'S COVID WHISPERER — When Biden wanted to know more about his administration's plan to relax safety guidelines for vaccinated Americans, he turned to Anthony Fauci. During a meeting last Friday evening in the Oval Office, Fauci, Biden's chief medical adviser, walked the president through a policy drafted by experts at the Centers for Disease Control and Prevention. It wasn't that Biden didn't trust the CDC or its director, Rochelle Walensky, or value their input. But as with other major policy announcements, the president turned to his old friend Fauci for a rundown. The straight-talking infectious disease expert has developed an increasingly close relationship with the president, who now leans on Fauci more than any other health official to guide his pandemic response, according to three senior officials with knowledge of Biden's thinking. Through dinners and White House conversations, the pair has built on a connection that began early in the Obama administration, during the scramble to respond to the H1N1 swine flu pandemic, Sarah Owermohle, Erin Banco and Adam Cancryn write.
| | | | SUBSCRIBE TO "THE RECAST" TO JOIN AN IMPORTANT CONVERSATION: Power dynamics are changing. "Influence" is changing. More people are demanding a seat at the table, insisting that all politics is personal and not all policy is equitable. "The Recast" is our new twice-weekly newsletter that breaks down how race and identity are recasting politics, policy and power in America. And POLITICO is recasting how we report on this crucial intersection, bringing you fresh insights, scoops, dispatches from across the country and new voices that challenge "business as usual." Don't miss out on this important new newsletter, SUBSCRIBE NOW. Thank you to our sponsor, Intel. | | | | | | | | RELIEF FOR THE LONG HAUL — After months of battling symptoms, some Covid long haulers are finally finding relief. The evidence so far is only anecdotal, but some patients have reported improved symptoms after getting vaccinated. There was concern that long haulers would face worsened symptoms after getting the shot — a fear that's kept some long Covid patients from getting vaccinated at all — but so far Aruna Subramanian, a professor of infectious diseases at Stanford University, hasn't seen any cases like that. And a few of her patients have reported feeling better since inoculation. More than 12,000 members discuss their symptoms and ask questions about vaccinations in a Covid long haulers group on Facebook. Some members shared their experiences with Nightly's Myah Ward.
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| Amanda Finley, of Kansas City, Mo., and the 44-year-old founder of the Facebook group, wondered if she'd made the right choice after getting her first dose of the Moderna vaccine. Her long haul symptoms — chronic fatigue, severe headaches, vomiting, shortness of breath, elevated heart rate (the list goes on) — hit her even harder. She said she didn't leave her bed for three days. But after a week, these symptoms faded. She said she could breathe again and walk up the stairs without feeling depleted. Finley got her second dose Monday and said she is still feeling great. "Not ashamed to admit that I cried," she said. Finley added that she's trying to pace herself and not get too excited, though she plans to take her son to the park next week for the first time in a year. One patient had a lingering headache that finally subsided after her first dose of the Pfizer vaccine. Her brain fog cleared up a few days later, she said, and her eyes are less red. She still has chest tightness, but she said she feels like the shot "jump-started my stalled recovery." Another woman had two strokes after having Covid last March. She got her first shot on Feb. 25. "For the first time in a year, I actually feel good," she said. "I think I might actually survive this. I'm planning to take a trip as soon as I get that second shot." While it's understood that long haulers are facing systemic inflammation due to a hyper-activated immune system, research on the phenomenon is still thin. Akiko Iwasaki, a Yale immunologist, has proposed three potential mechanisms for what might be causing long Covid cases. One possibility is that patients may have a viral reservoir where the virus accumulates and persists. Or it could be a "viral ghost" — fragments of the virus like the spike protein that linger post-infection and continue to stimulate the immune system. The third mechanism could be an ongoing autoimmune response induced by the initial infection, Iwasaki wrote in a blog post last week. Research has supported each of these mechanisms, Iwasaki said, and it's possible patients are battling varying degrees of all three — and that each could benefit from a vaccine. If a long hauler is dealing with a viral reservoir, the vaccine-induced immune cells would attack infected cells to eliminate it. Vaccine-induced immunity may also be able to eliminate the lingering "viral ghosts" associated with the spike protein. For the autoimmune response, the vaccine could potentially divert the cells causing this long-term response in patients — the idea being that the immune cells responsible for attacking a new foriegn body may shift attention to the new antigen introduced by the vaccine. "It is not clear for how long," Iwasaki said As with everything Covid-related, the next step is more research. A trial with long haulers and vaccines could tell researchers not only what is causing long Covid, but which therapies would work best for treatments.
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| — Military leaders thrash Tucker Carlson after comments about female troops: Senior military officials are condemning the Fox News host for saying this week that Biden is making a "mockery" of the armed forces through efforts to recruit and keep women in the service. — Whitmer suggests double standard for Dem, GOP politicians on misconduct allegations: "Is there a different standard for different sides of the aisle? We just had a president who lasted all four years with numerous allegations against him, so far as rape. No one on his own side of the aisle was making observations about whether or not he should stay in office," Michigan Gov. Gretchen Whitmer said during a POLITICO Live event. "So is there a different standard? I guess one could conclude that." — Novavax vaccine shown highly effective against severe Covid: Novavax's coronavirus vaccine is more than 96 percent effective against the original virus and prevents severe Covid-19 illness entirely, the pharmaceutical company announced today. — Senate advances Becerra nomination for HHS secretary: A divided Senate advanced Xavier Becerra's nomination to lead HHS after Maine Republican Susan Collins joined all of the chamber's Democrats to support a confirmation vote. — House passes bill to expand gun sale background checks: Democrats are making a new push to enact the first major new gun control laws in more than two decades — starting with stricter background checks. — Capitol riot suspects held in D.C. are in "restrictive housing": All suspects detained in Washington, D.C., on charges stemming from the Jan. 6 siege of the Capitol are being treated as "maximum security" prisoners and are held in "restrictive housing," District officials revealed this week.
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| | | ANOTHER OXFORD/ASTRAZENECA STUMBLE — Countries across Europe are suspending — some fully, some partially — the rollout of the Oxford/AstraZeneca jab after reports of blood clotting after vaccination. There have been several deaths from clotting, but health authorities have stressed there's no indication of a link to vaccination. Still, Austria, Denmark, Estonia, Lithuania, Luxembourg, Latvia and Italy, as well as non-EU Norway and Iceland, have suspended the rollout of at least some Oxford/AstraZeneca batches as a precautionary measure. Denmark launched more extreme measures today when it paused the entire rollout of Oxford/AstraZeneca vaccines. Norway and Iceland followed suit and halted all distribution of the jab. MORE ON VAX PASSPORTS — China's doing them. Europe's considering them. But they could amplify global inequities. In the latest POLITICO Dispatch, Carmen Paun breaks down the pros and cons of vaccine passports.
| | | | | | | FIND OUT THE LATEST WHISPERS FROM THE WEST WING: Add Transition Playbook to your daily reads to find out what's really happening inside the West Wing, who really has the president's ear, and get the latest scoop from inside cabinet departments and agencies. Track the people, policies and emerging power centers of the Biden administration. Don't miss out. Subscribe today. | | | | | | | | | | | | | | MEXICO'S MARIJUANA MOMENT — Mexico is on the verge of creating the world's largest legal marijuana market, a move that could pressure Biden to embrace weed, too, Paul Demko and Ximena Bustillo write. Mexico's Chamber of Deputies passed landmark legislation today. The Senate is expected to back the bill in the coming days. "It's historic," said Luis Armendáriz, a cannabis attorney with the Hoban Law Group who works with companies that are looking to enter the Mexican market. "You have the end of prohibition of more than 100 years." President Andrés Manuel López Obrador, whose party strongly backs the proposal, is expected to sign the bill, sandwiching the U.S. between the world's two biggest legal marijuana markets.
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