vox--2020-12-10--The US is about to begin the first big test of Covid-19 vaccine distribution

The first 6.4 million Covid-19 vaccine doses may begin to ship out in the US as early as this weekend , after the Food and Drug Administration approves an emergency use authorization of the Pfizer/BioNTech vaccine .
The EUA is expected to be imminent following the Thursday vote of an advisory committee , which recommended it in a 17-4-1 vote .
Per Centers for Disease Control and Prevention guidance , these doses will be earmarked for front-line health care workers , as well as residents and staff of long-term care facilities .
The government estimates another 13.6 million people in @ @ @ @ @ @ @ be vaccinated by the end of 2020 , with the rest of the US population following in about the next six months .
Many experts , however , are concerned that the US has not adequately prepared for mass Covid-19 vaccination .
“ The logistics of vaccine administration and distribution are complex , ” Stanley Kent , chief pharmacy officer for Michigan Medicine , wrote in an email to Vox .
Especially for vaccines that have such stringent cold storage needs and require two precisely timed doses — during a pandemic that ’ @ @ @ @ @ @ @ day on average .
The first , smaller rollout to health care workers will ultimately be a critical test of vaccine distribution and administration tactics — and a chance to make adjustments before the country tries to have hundreds of millions more people roll up their sleeves .
Health systems have been working quickly and furiously to figure out how to make these first doses go well .
But there are substantial hurdles , from dealing with delicate vaccines to keeping track of the millions of people who get the shot and will @ @ @ @ @ @ @ .
Although most of us will be waiting many more months until we might be able to get vaccinated , here are the important things to watch out for as the first health care workers get the Covid-19 vaccine in the US .
Getting the vaccine out of the freezers and to vaccinators As the first Covid-19 immunization to be submitted to the FDA for emergency use authorization , the Pfizer/BioNTech vaccine is expected to be the first to receive this initial green light , followed by Moderna next week .
But Pfizer/BioNTech @ @ @ @ @ @ @ temperature requirements , needing to be stored at minus 94 degrees Fahrenheit , and only viable for five days in standard refrigeration and six hours at room temperature .
( And although slightly less sensitive , the Moderna vaccine still needs to be kept frozen at minus 4 degrees Fahrenheit until 30 days before it is used , and then needs to be refrigerated , until at most 12 hours before administration . )
Very few facilities have the medical-grade ultra-cold freezers needed to store the Pfizer/BioNTech vaccine , so it will be @ @ @ @ @ @ @ — packed in dry ice — to hospitals , clinics , and other vaccination sites .
This will take finely tuned planning to ensure that just the right number of vaccine doses make it to just the right place at just the right time .
“ The challenges of redistribution are inventory management , getting the right number of doses to each administration site to minimize waste , and cold chain adherence , ” Kent explained .
With these cold requirements , even simply removing the vaccine from the super-cold freezers could be @ @ @ @ @ @ @ gloves .
And to keep freezers at the right temperature , they ’ re not supposed to be opened more than a couple of times a day and for no more than a minute at a time , NPR reported .
Doses are also not ready to give once they are out of the freezer .
The vaccine vials Pfizer is sending out actually contain five doses of the vaccine — and need to be mixed with 1.8 ml of saline solution before being given .
“ Preparing the product for administration is @ @ @ @ @ @ @ , reconstitution , and drawing it up ” into the syringe , Kavish Choudhary , director of inpatient and infusion pharmacy services at the University of Utah Health , explained .
These are yet more logistical steps in the process that needs to be carefully plotted out and well staffed .
Finally , there is the issue of ensuring all the IT systems are in place to record each dose and recipient and report it to the state database within 24 hours .
This will allow any adverse events to be reported and @ @ @ @ @ @ @ — but it is also how we will be able to know if and when someone has received one or both doses .
Some health system administrators are still suggesting those receiving the vaccine keep the paper vaccination card they will receive and even take a picture of it with their phone , in case systems go down .
Ensuring all of these steps hold — and work together — is not only essential for the success of these first doses for the very highest-risk people , but also as we look at @ @ @ @ @ @ @ of people in the first half of 2021 .
Deciding who should get a vaccine — and finding them There will not be nearly enough vaccine in the first shipments to vaccinate every health care worker ( 21 million people ) or nursing home resident or staff ( 3 million people ) in the country .
( Custodial staff , people who deliver meals to patient rooms , and those who transport patients are among the many others in these groups . )
The federal government has decided to allocate doses based on @ @ @ @ @ @ @ number of potential recipients in each of the risk categories .
This means not all states will be able to vaccinate the same proportion of their health care workforce right away ( a pattern that is likely to reappear with other category-based allocations down the road ) .
So although health care workers are among those eligible for the first round of vaccines , states and health care systems will have to decide which ones can get it and when .
( Further information in an emergency use authorization from the FDA could @ @ @ @ @ @ @ first . )
Choudhary says they are “ prioritizing healthcare workers that work in areas that have regular and frequent interactions with Covid-19 positive patients , ” in an email to Vox .
This includes some working in the ER , ICUs , medicine units , urgent care , and testing facilities .
This will hopefully help more people stay healthier and preserve the capacity of these essential staff as pandemic hospitalizations spike — and it is an approach many health systems are taking .
Yale New Haven Health , which provides care @ @ @ @ @ @ @ opening up appointments to their 30,000-plus employees in alphabetical order instead .
There are a few reasons for this .
First , it ensures a level of randomization that will make the process transparent and equitable .
Second , the frontrunning vaccines are known to have occasional minor side effects , such as fever .
So by vaccinating employees based on name rather than unit or office , they can help avoid multiple people from a team being out for a day or two after the vaccine .
“ That is one logistical @ @ @ @ @ @ @ director of population health at Yale Medicine , who is also a co-chair of the health system ’ s Covid-19 vaccine task force .
Down the road , these sorts of more granular prioritization or organization strategies will become essential , as the number of people eligible on the general priority list balloon .
And other organizations , such as food service companies , might need to take similar lessons on strategic and equitable scheduling .
It ’ s tricky , though , to schedule people for appointments — no matter the order @ @ @ @ @ @ @ told how many doses are available to give .
As of earlier this week , some states had not yet informed systems how much of the vaccine they will get in the first weeks .
“ One of the biggest challenges is not knowing how many vaccine doses we will receive , ” Kent said .
Roy agrees : Having prepared other details — from deep freezers to distribution — now , she says , “ our biggest challenge is keeping up with what the allotment will be on a weekly basis ... @ @ @ @ @ @ @ for example , had to retabulate the numbers after the CDC announced that the first doses would be made available to residents and staff of long-term care facilities in addition to the health care workers it was already planning to vaccinate ( meaning there would be fewer doses available for the latter group ) .
These shifts in quantities may continue to be a part of the vaccine administration landscape for months to come , forcing those planning the shots to quickly adjust their operations and scheduling .
Despite all these challenges , @ @ @ @ @ @ @ many ways , much simpler than reaching and scheduling members of the broader population for two doses .
For one , many work for large hospitals or health systems that can use employee records to determine who should be getting the vaccine — and contacting them through the organization ’ s system .
Many vaccine hubs in health care settings , however , are also responsible for vaccinating workers outside of their system .
Yale New Haven Health plans to set up sites to vaccinate health care workers from other hospitals and clinics @ @ @ @ @ @ @ keep their own doses of the vaccine .
This will require not only spinning up additional vaccination locations and distribution ( “ those will be a little delayed , maybe week two or three — we don ’ t have that nailed down exactly yet , ” Roy says ) , but also getting in touch with those additional people .
Connecticut is helping provide some of the information about individuals who fit the priority category , but Yale New Haven Health will also need to establish communication with them and get them @ @ @ @ @ @ @ Health in Virginia , Cindy Williams , vice president and chief pharmacy officer , explained to Vox in an email that their system has four of the state ’ s 25 facilities that can store the Pfizer vaccine , “ giving us the ability to help distribute across physician practices and across the state at large , ” she wrote .
They plan to work with local health departments and other health care groups to reach other workers eligible for the vaccine .
“ I do believe that this experience will assist us @ @ @ @ @ @ @ move through the priority groups for vaccination , ” she said .
Although nearly 6.5 million doses of the Pfizer/BioNTech vaccine might be available to ship the day after an emergency use authorization , there will be no way of getting all of those doses into top-priority arms in the following day or weeks .
Health systems are carefully working out their logistics to maximize the number of workers they can vaccinate in a day , while also making the process as safe as possible .
This is a challenge during a Covid-19 @ @ @ @ @ @ @ much of the country limiting how much can reliably be done outdoors .
Which means streamlining the administration process as much as possible , from getting all of a recipient ’ s information to ensuring each vaccinator has every supply they need on hand .
One simple requirement will be space .
At University of Utah Health , Choudhary and others have been working closely with the facilities team to shuffle services around to clear room for vaccination locations to eventually vaccinate almost 20,000 health staff and students with two doses .
These @ @ @ @ @ @ @ in a clinic setting ; “ that way we have the appropriate equipment and personnel in place if we need to respond to an adverse reaction.
” During trials of the vaccines , participants were observed for 30 minutes after receiving the vaccine to monitor for side effects , a step that would add a big hurdle to the logistics of safely moving people through during a pandemic .
But recent guidance says that administration sites will not necessarily need an observation period , Roy notes — although some might still have a @ @ @ @ @ @ @ able to flow through fairly quickly after receiving their shot .
At Michigan Medicine , they are planning to initially vaccinate several hundred of their employees a day , building up to 1,000 to 1,500 per day , Kent said .
All of this also needs to be carefully planned to minimize any potential waste of precious vaccine doses .
Once a five-dose vaccine vial is opened , it has only a six-hour shelf life before it goes bad .
Yale New Haven Health is working with a modeler to assess how to @ @ @ @ @ @ @ stock precisely the right amount of vaccine doses .
They , along with many systems , are drawing from their experience with flu shot clinics this year , having people sign up ahead of time and staggering appointments for safety .
“ We ’ re going to try to keep it pretty precise , ” Roy says .
“ We want to make sure that as many appointments each day are filled as possible.
” Fine-tuning these logistics and procedures in this first group of recipients will be essential to ensuring the vaccine @ @ @ @ @ @ @ general population .
Choudhary begs patience for the outset of this unprecedented effort .
“ We recognize the need and urgency to get our staff vaccinated so we can turn our attention to the community and our patients .
We are limited by our supply and our lack of familiarity with the product , but have the appropriate time , personnel , and resources , ” he wrote .
Both the Pfizer/BioNTech and Moderna vaccines are designed to be given in two doses , spaced either 21 or 28 days apart ( depending @ @ @ @ @ @ @ high levels of protection against Covid-19 reported in early trial results .
So making sure people get their second shot when they are supposed to , and that it is the correct brand , is crucial .
Even those overseeing vaccination of health care system employees in their own organization have concerns about ensuring people make it back for their second dose .
For that reason , some groups are scheduling the second visit in person when people receive their first dose .
At other places , they ’ ve been so busy @ @ @ @ @ @ @ dose , adherence is second on the list .
“ We have not yet talked a lot about that , ” says Roy .
“ I have not yet heard of a contingency plan of what happens if someone goes beyond two to three days beyond their window , ” she says .
And finally , there is the question of making sure a second dose will be available at just the right time , in the right place .
The federal government has said it will hold second doses back from the @ @ @ @ @ @ @ in part because once it leaves super-cold storage , it can only be kept on dry ice for 15 days and refrigerated for another five , just missing the vaccine ’ s 21-day mark for second shots .
This means the main hubs should receive second doses in time to give them .
But the delicate ballet of coordination , distribution , and administration will need to begin anew before recipients roll up their sleeves again .
There will be a lot that might go off the rails , from IT systems to @ @ @ @ @ @ @ will learn a significant amount during the initial weeks of distribution , ” Kent said .
“ Operationally , this is the first time I can think of that we ’ re trying to disseminate a vaccine all at the same time , ” Roy says .
Even with the annual flu shot push , only about half of the US population typically gets vaccinated .
“ But this is different , ” she says .
“ We need 80 to 90 percent [ of the US population ] .
Logistically , how @ @ @ @ @ @ @ much of that will come down not just to the physical logistics but also to messaging .
Even for health care workers .
At Yale New Haven Health , Roy notes that she has heard “ a fair amount of vaccine hesitancy in places where I wouldn ’ t have expected .
And these are people who get their annual flu vaccine and whose children are up to date on all of their vaccines.
” When it comes to a Covid-19 vaccine , she suspects that many health care workers are mostly wary @ @ @ @ @ @ @ trial participants — to get the shot .
And they are likely aware that getting both doses of the vaccine will still not yet change the precautions they need to keep taking , such as wearing PPE ( in part because we don ’ t yet know if the vaccine keeps people from carrying and spreading the virus — or just from developing the illness ) .
She worries that if these health care workers skip out on their chance to get the vaccine now , doses might not be available to allocate @ @ @ @ @ @ @ , after other risk groups have been covered and when it is more broadly open to the general community .
To encourage more health care workers to get the vaccine right away , Roy says , “ we will be doing some more messaging around the safety profile of the vaccine.
” But she still worries .
“ The amount of hesitancy I heard surprised me.
” Working through it , however , should provide learning opportunities for messaging ahead of wider rollouts among the general population .
This will be essential , @ @ @ @ @ @ @ We ’ re going to need to get to 80 to 90 percent vaccination rate to achieve herd immunity ” in the US .
Every lesson we can learn from these early rollouts will be valuable in reaching a broader population as effectively and quickly as possible as more doses become available .
And health care systems know eyes will be on them in the coming weeks .
This means even the best-laid plans might need to change quickly .
“ It ’ s going to be important to be responsive and be @ @ @ @ @ @ @ make the process better as we go , ” Roy says .

The first 6.4 million Covid-19 vaccine doses may begin to ship out in the US as early as this weekend, after the Food and Drug Administration approves an emergency use authorization of the Pfizer/BioNTech vaccine. The EUA is expected to be imminent following the Thursday vote of an advisory committee, which recommended it in a 17-4-1 vote. Per Centers for Disease Control and Prevention guidance, these doses will be earmarked for front-line health care workers, as well as residents and staff of long-term care facilities.
The government estimates another 13.6 million people in these high-risk groups might be able to be vaccinated by the end of 2020, with the rest of the US population following in about the next six months.
Many experts, however, are concerned that the US has not adequately prepared for mass Covid-19 vaccination. “The logistics of vaccine administration and distribution are complex,” Stanley Kent, chief pharmacy officer for Michigan Medicine, wrote in an email to Vox. Especially for vaccines that have such stringent cold storage needs and require two precisely timed doses — during a pandemic that’s taking more than 2,000 lives a day on average.
The first, smaller rollout to health care workers will ultimately be a critical test of vaccine distribution and administration tactics — and a chance to make adjustments before the country tries to have hundreds of millions more people roll up their sleeves.
Health systems have been working quickly and furiously to figure out how to make these first doses go well. But there are substantial hurdles, from dealing with delicate vaccines to keeping track of the millions of people who get the shot and will need to return for a second one.
Although most of us will be waiting many more months until we might be able to get vaccinated, here are the important things to watch out for as the first health care workers get the Covid-19 vaccine in the US.
Getting the vaccine out of the freezers and to vaccinators
As the first Covid-19 immunization to be submitted to the FDA for emergency use authorization, the Pfizer/BioNTech vaccine is expected to be the first to receive this initial green light, followed by Moderna next week. But Pfizer/BioNTech’s vaccine has the most extreme temperature requirements, needing to be stored at minus 94 degrees Fahrenheit, and only viable for five days in standard refrigeration and six hours at room temperature. (And although slightly less sensitive, the Moderna vaccine still needs to be kept frozen at minus 4 degrees Fahrenheit until 30 days before it is used, and then needs to be refrigerated, until at most 12 hours before administration.)
Very few facilities have the medical-grade ultra-cold freezers needed to store the Pfizer/BioNTech vaccine, so it will be shipped to hub locations to be distributed — packed in dry ice — to hospitals, clinics, and other vaccination sites. This will take finely tuned planning to ensure that just the right number of vaccine doses make it to just the right place at just the right time.
“The challenges of redistribution are inventory management, getting the right number of doses to each administration site to minimize waste, and cold chain adherence,” Kent explained.
With these cold requirements, even simply removing the vaccine from the super-cold freezers could be a bottleneck, since it requires special gloves. And to keep freezers at the right temperature, they’re not supposed to be opened more than a couple of times a day and for no more than a minute at a time, NPR reported.
Doses are also not ready to give once they are out of the freezer. The vaccine vials Pfizer is sending out actually contain five doses of the vaccine — and need to be mixed with 1.8 ml of saline solution before being given. “Preparing the product for administration is a multi-step process, requiring thaw time, reconstitution, and drawing it up” into the syringe, Kavish Choudhary, director of inpatient and infusion pharmacy services at the University of Utah Health, explained. These are yet more logistical steps in the process that needs to be carefully plotted out and well staffed.
Finally, there is the issue of ensuring all the IT systems are in place to record each dose and recipient and report it to the state database within 24 hours. This will allow any adverse events to be reported and linked to a particular run of vaccine — but it is also how we will be able to know if and when someone has received one or both doses. Some health system administrators are still suggesting those receiving the vaccine keep the paper vaccination card they will receive and even take a picture of it with their phone, in case systems go down.
Ensuring all of these steps hold — and work together — is not only essential for the success of these first doses for the very highest-risk people, but also as we look at scaling way up to hundreds of millions of people in the first half of 2021.
Deciding who should get a vaccine — and finding them
There will not be nearly enough vaccine in the first shipments to vaccinate every health care worker (21 million people) or nursing home resident or staff (3 million people) in the country. (Custodial staff, people who deliver meals to patient rooms, and those who transport patients are among the many others in these groups.)
The federal government has decided to allocate doses based on state adult populations, rather than the number of potential recipients in each of the risk categories. This means not all states will be able to vaccinate the same proportion of their health care workforce right away (a pattern that is likely to reappear with other category-based allocations down the road).
There's definitely a big focus on mapping if we have enough vaccine to cover high priority pops, like this planner.
Delivery - How many vaccinations can one heath worker deliver in a day? When are folks available to get vaccinated? - is also complex. https://t.co/1W99JwsmHv — Amanda Makulec MPH (@abmakulec) December 3, 2020
So although health care workers are among those eligible for the first round of vaccines, states and health care systems will have to decide which ones can get it and when. (Further information in an emergency use authorization from the FDA could add additional clarification for whom to vaccinate first.)
Choudhary says they are “prioritizing healthcare workers that work in areas that have regular and frequent interactions with Covid-19 positive patients,” in an email to Vox. This includes some working in the ER, ICUs, medicine units, urgent care, and testing facilities. This will hopefully help more people stay healthier and preserve the capacity of these essential staff as pandemic hospitalizations spike — and it is an approach many health systems are taking.
Yale New Haven Health, which provides care to people across Connecticut, will be opening up appointments to their 30,000-plus employees in alphabetical order instead. There are a few reasons for this. First, it ensures a level of randomization that will make the process transparent and equitable. Second, the frontrunning vaccines are known to have occasional minor side effects, such as fever.
So by vaccinating employees based on name rather than unit or office, they can help avoid multiple people from a team being out for a day or two after the vaccine. “That is one logistical hurdle,” says Brita Roy, director of population health at Yale Medicine, who is also a co-chair of the health system’s Covid-19 vaccine task force.
Down the road, these sorts of more granular prioritization or organization strategies will become essential, as the number of people eligible on the general priority list balloon. And other organizations, such as food service companies, might need to take similar lessons on strategic and equitable scheduling.
It’s tricky, though, to schedule people for appointments — no matter the order — when you haven’t been told how many doses are available to give. As of earlier this week, some states had not yet informed systems how much of the vaccine they will get in the first weeks. “One of the biggest challenges is not knowing how many vaccine doses we will receive,” Kent said.
Roy agrees: Having prepared other details — from deep freezers to distribution — now, she says, “our biggest challenge is keeping up with what the allotment will be on a weekly basis ... and designing around that.” Connecticut, for example, had to retabulate the numbers after the CDC announced that the first doses would be made available to residents and staff of long-term care facilities in addition to the health care workers it was already planning to vaccinate (meaning there would be fewer doses available for the latter group).
These shifts in quantities may continue to be a part of the vaccine administration landscape for months to come, forcing those planning the shots to quickly adjust their operations and scheduling.
Despite all these challenges, vaccinating health care workers is, in many ways, much simpler than reaching and scheduling members of the broader population for two doses. For one, many work for large hospitals or health systems that can use employee records to determine who should be getting the vaccine — and contacting them through the organization’s system.
Many vaccine hubs in health care settings, however, are also responsible for vaccinating workers outside of their system. Yale New Haven Health plans to set up sites to vaccinate health care workers from other hospitals and clinics that do not have ultra-cold storage to keep their own doses of the vaccine. This will require not only spinning up additional vaccination locations and distribution (“those will be a little delayed, maybe week two or three — we don’t have that nailed down exactly yet,” Roy says), but also getting in touch with those additional people.
Connecticut is helping provide some of the information about individuals who fit the priority category, but Yale New Haven Health will also need to establish communication with them and get them into the appointment system.
At Riverside Health in Virginia, Cindy Williams, vice president and chief pharmacy officer, explained to Vox in an email that their system has four of the state’s 25 facilities that can store the Pfizer vaccine, “giving us the ability to help distribute across physician practices and across the state at large,” she wrote. They plan to work with local health departments and other health care groups to reach other workers eligible for the vaccine. “I do believe that this experience will assist us in outreach to other populations as we move through the priority groups for vaccination,” she said.
Maximizing speed — and minimizing waste
Although nearly 6.5 million doses of the Pfizer/BioNTech vaccine might be available to ship the day after an emergency use authorization, there will be no way of getting all of those doses into top-priority arms in the following day or weeks. Health systems are carefully working out their logistics to maximize the number of workers they can vaccinate in a day, while also making the process as safe as possible. This is a challenge during a Covid-19 spike, and with cold temperatures in much of the country limiting how much can reliably be done outdoors.
Which means streamlining the administration process as much as possible, from getting all of a recipient’s information to ensuring each vaccinator has every supply they need on hand.
One simple requirement will be space. At University of Utah Health, Choudhary and others have been working closely with the facilities team to shuffle services around to clear room for vaccination locations to eventually vaccinate almost 20,000 health staff and students with two doses. These spots, he notes, will be in a clinic setting; “that way we have the appropriate equipment and personnel in place if we need to respond to an adverse reaction.”
During trials of the vaccines, participants were observed for 30 minutes after receiving the vaccine to monitor for side effects, a step that would add a big hurdle to the logistics of safely moving people through during a pandemic. But recent guidance says that administration sites will not necessarily need an observation period, Roy notes — although some might still have a brief one — so people should be able to flow through fairly quickly after receiving their shot.
At Michigan Medicine, they are planning to initially vaccinate several hundred of their employees a day, building up to 1,000 to 1,500 per day, Kent said.
All of this also needs to be carefully planned to minimize any potential waste of precious vaccine doses. Once a five-dose vaccine vial is opened, it has only a six-hour shelf life before it goes bad.
Yale New Haven Health is working with a modeler to assess how to maximize “throughput” while ensuring they stock precisely the right amount of vaccine doses. They, along with many systems, are drawing from their experience with flu shot clinics this year, having people sign up ahead of time and staggering appointments for safety. “We’re going to try to keep it pretty precise,” Roy says. “We want to make sure that as many appointments each day are filled as possible.”
Fine-tuning these logistics and procedures in this first group of recipients will be essential to ensuring the vaccine is safely and efficiently given to the general population. Choudhary begs patience for the outset of this unprecedented effort. “We recognize the need and urgency to get our staff vaccinated so we can turn our attention to the community and our patients. We are limited by our supply and our lack of familiarity with the product, but have the appropriate time, personnel, and resources,” he wrote.
Ensuring adherence
Both the Pfizer/BioNTech and Moderna vaccines are designed to be given in two doses, spaced either 21 or 28 days apart (depending on the vaccine) to reach the high levels of protection against Covid-19 reported in early trial results. So making sure people get their second shot when they are supposed to, and that it is the correct brand, is crucial.
Even those overseeing vaccination of health care system employees in their own organization have concerns about ensuring people make it back for their second dose.
For that reason, some groups are scheduling the second visit in person when people receive their first dose. At other places, they’ve been so busy putting together a plan for the first dose, adherence is second on the list. “We have not yet talked a lot about that,” says Roy. “I have not yet heard of a contingency plan of what happens if someone goes beyond two to three days beyond their window,” she says.
And finally, there is the question of making sure a second dose will be available at just the right time, in the right place. The federal government has said it will hold second doses back from the first shipments of the Pfizer/BioNTech vaccine, in part because once it leaves super-cold storage, it can only be kept on dry ice for 15 days and refrigerated for another five, just missing the vaccine’s 21-day mark for second shots.
This means the main hubs should receive second doses in time to give them. But the delicate ballet of coordination, distribution, and administration will need to begin anew before recipients roll up their sleeves again.
There will be a lot that might go off the rails, from IT systems to supply chains. “All health systems will learn a significant amount during the initial weeks of distribution,” Kent said.
“Operationally, this is the first time I can think of that we’re trying to disseminate a vaccine all at the same time,” Roy says. Even with the annual flu shot push, only about half of the US population typically gets vaccinated. “But this is different,” she says. “We need 80 to 90 percent [of the US population]. Logistically, how do we do that?”
And much of that will come down not just to the physical logistics but also to messaging. Even for health care workers.
At Yale New Haven Health, Roy notes that she has heard “a fair amount of vaccine hesitancy in places where I wouldn’t have expected. And these are people who get their annual flu vaccine and whose children are up to date on all of their vaccines.” When it comes to a Covid-19 vaccine, she suspects that many health care workers are mostly wary of being the first ones — after trial participants — to get the shot. And they are likely aware that getting both doses of the vaccine will still not yet change the precautions they need to keep taking, such as wearing PPE (in part because we don’t yet know if the vaccine keeps people from carrying and spreading the virus — or just from developing the illness).
She worries that if these health care workers skip out on their chance to get the vaccine now, doses might not be available to allocate to these higher-risk folks again until summer, after other risk groups have been covered and when it is more broadly open to the general community.
To encourage more health care workers to get the vaccine right away, Roy says, “we will be doing some more messaging around the safety profile of the vaccine.” But she still worries. “The amount of hesitancy I heard surprised me.” Working through it, however, should provide learning opportunities for messaging ahead of wider rollouts among the general population.
This will be essential, because, as Roy notes, “We’re going to need to get to 80 to 90 percent vaccination rate to achieve herd immunity” in the US.
Every lesson we can learn from these early rollouts will be valuable in reaching a broader population as effectively and quickly as possible as more doses become available. And health care systems know eyes will be on them in the coming weeks.
This means even the best-laid plans might need to change quickly. “It’s going to be important to be responsive and be nimble and to continually learn, and make the process better as we go,” Roy says.


vox--2020-12-10--FDA advisers recommend the first Covid-19 vaccine for emergency use in the US

An advisory committee to the Food and Drug Administration has voted 17 to 4 , with 1 abstention , to recommend emergency use authorization to the first vaccine for Covid-19 in the United States .
The highly anticipated vote means health workers facing high exposure to the disease and residents of long-term care facilities could start receiving the first doses of the two-dose vaccine , developed by Pfizer and BioNTech , within days .
The first 6.4 million doses could be ready to ship as soon as Friday .
The Vaccines and Related Biological Products Advisory Committee held the vote @ @ @ @ @ @ @ consider the emergency use authorization request ( EUA ) for Pfizer and BioNTech ’ s Covid-19 vaccine candidate .
The committee specifically voted on whether the benefits of the Pfizer-BioNTech vaccine outweigh the risks in people aged 16 years and older .
That a vaccine for a disease only discovered late last year would be ready so quickly is already an unmatched scientific feat , but the fact that it ’ s also based on a new technology that yielded 95 percent efficacy in preventing disease makes the announcement all the more remarkable @ @ @ @ @ @ @ have heard today into consideration when deciding not only the EUA issuance here but also how to move forward on the end licensure of this product , ” said Marion Gruber , director of the Office of Vaccines Research and Review at the FDA .
The approval of the Pfizer/BioNTech vaccine in the US follows green lights from regulatory agencies in Canada and the United Kingdom .
Next week , the vaccine advisory committee will consider another EUA for the Covid-19 vaccine using a similar approach developed by Moderna .
But a vote @ @ @ @ @ @ @ word for getting people immunized against the deadly disease .
The FDA must then accept the recommendation and issue its formal EUA , which could happen as soon as Friday .
Then the vaccine will be shipped to health facilities and administered in two doses .
These steps present their own challenges , ranging from keeping the vaccine at the frigid temperatures it requires to getting patients to come back for a follow-up shot .
Meanwhile , many of the health systems administering shots are struggling to care for a huge surge of @ @ @ @ @ @ @ be part of the largest vaccination effort in history .
But there will not be enough doses for everyone at the outset , even for people placed at the front of the line .
Pfizer and BioNTech expect to produce 50 million doses of their vaccine around the world before the end of the year , enough for 25 million people — half of which has been pledged for the US .
The first doses to roll out will be a crucial test of the vaccine distribution system in the United States , @ @ @ @ @ @ @ acceptance and of the integrity of the clinical trial process .
The Pfizer/BioNTech vaccine is cleared for emergency approval .
Now what ?
One of the first challenges for the Pfizer/BioNTech vaccine is getting it where it needs to go .
That ’ s complicated by the fact that the vaccine requires temperatures of minus 70 degrees Celsius ( minus 94 degrees Fahrenheit ) or lower , some of the coldest temperature constraints of any Covid-19 vaccine under development .
Maintaining the cold chain from factories to distribution hubs to hospitals is crucial @ @ @ @ @ @ @ and become ineffective .
Pfizer has developed its own temperature-controlled shipping containers that use dry ice to maintain the recommended temperatures for their vaccine for up to 10 days .
But longer storage will require ultra-cold freezers , and not many clinics have the requisite hardware , so timing the shipments will be key .
There may also be shortages of dry ice .
The next hurdle is figuring out who gets the vaccine first .
The 6.4 million doses available at the outset are nowhere near enough to quench the raging Covid-19 @ @ @ @ @ @ @ in daily hospitalizations and fatalities .
An advisory committee to the Centers for Disease Control and Prevention voted at the beginning of this month on a set of guidelines that prioritize health care personnel , as well as staff and residents of long-term care facilities .
But these groups alone add up to about 24 million people , so states and local governments and health groups are having to narrow these groups further .
Pfizer and BioNTech ’ s vaccine also has to be administered as two doses spaced 21 days apart .
@ @ @ @ @ @ @ other vaccines show that people are really bad at getting follow-up shots .
As many as half of patients failed to get their second dose of the hepatitis B vaccine , for example .
For the Covid-19 vaccine , side effects from the first dose , scheduling conflicts , or supply shortages may inhibit recipients from getting the second dose .
The good news is that the Pfizer/BioNTech vaccine may offer some protection against Covid-19 from the first dose , although it takes a few days for the shielding to build up .
@ @ @ @ @ @ @ former FDA commissioner Scott Gottlieb , argued that the entire allotment of doses should be given to as many people as possible , as fast as possible , rather than withholding injections to give to people as second shots .
“ We should get as many shots in our arms as possible right away , ” he told USA Today on Monday .
“ The idea that we need to cut ( the doses ) in half and give half of it now and hold onto it , so we have supply in @ @ @ @ @ @ @ I just fundamentally disagree with that.
” But other experts say there isn ’ t yet enough data on a single dose to know whether it will provide enough protection from the virus for the broader population .
Meanwhile , the FDA is likely to authorize another Covid-19 vaccine in the coming weeks , clearing the way for the distribution of 25 million doses of the Moderna vaccine , enough for 12.5 million people on the two-dose regimen .
Moncef Slaoui , the scientific lead for Operation Warp Speed , the program from @ @ @ @ @ @ @ to accelerate and deploy Covid-19 vaccines , said he expects 20 million Americans will be vaccinated in December , 30 million more in January , and 50 million more in February as more vaccines with promising early results are approved .
The clinical trials for Covid-19 vaccines must continue , but they ’ re going to get harder to complete as placebo participants leave to get vaccinated An EUA is a critical step , but it ’ s not full approval , and it signals that the FDA still wants answers to key @ @ @ @ @ @ @ standards for an EUA for a vaccine is that there is an urgent public health need , the proposed vaccine may have a beneficial effect , and that there are no approved alternatives .
The FDA also set a minimum threshold of 50 percent efficacy for a Covid-19 vaccine , a line that several vaccines have completely vaulted .
So far , Pfizer and BioNTech are only reporting two months of observational safety for their phase 3 clinical trial , although the companies have committed to continue monitoring their more than 43,000 trial @ @ @ @ @ @ @ , Covid-19 is spreading rampantly in the United States , and more than 20,000 people in Pfizer and BioNTech ’ s trial have received a placebo rather than the actual vaccine , leaving them vulnerable to the disease .
Of the 178 reported cases of Covid-19 in the trial pool , 169 were in the placebo group .
Of those , 9 in the placebo group and 1 in the vaccine group experienced severe Covid-19 .
As time goes on , more people in the placebo group will likely get sick and some @ @ @ @ @ @ @ .
Without intervention , some of these people in the placebo group may die .
The EUA now presents a huge dilemma for the clinical trial .
People in the placebo group may be at risk of Covid-19 , but if they receive the vaccine , it would diminish the value of the trial and make it harder to answer questions about safety and efficacy , particularly in vulnerable subgroups like older adults .
And since this is a double-blind clinical trial , neither the recipients nor the companies know who received the @ @ @ @ @ @ @ Vaccinating the placebo group would require breaking this blind , and if participants find out which group they ’ re in , they could change their behavior .
People who received the vaccine may engage in riskier behavior while people in the placebo group may end up taking more precautions if they decide not to get vaccinated themselves .
Those changes in behavior will make it harder to isolate the effects of the vaccine .
William C. Gruber , senior vice president for vaccine clinical research and development for Pfizer , told the @ @ @ @ @ @ @ the company has an ethical obligation to inform trial participants that the vaccine has received an EUA , but they are working on coming up with ways to maintain the integrity of the trial as much as possible .
“ Eligible participants in the placebo group will have the option to receive the vaccine , ” Gruber said .
“ We are currently in discussions with the FDA about the best way to vaccinate placebo recipients.
” Gruber added that the study will continue for 24 months regardless , with ongoing monitoring of @ @ @ @ @ @ @ large-scale and long-term follow-up is key because there may be rare complications that emerge that weren ’ t detected over a shorter time frame or were not present in the selected pool of participants in the trial .
Already , the rollout of the Pfizer/BioNTech vaccine in the UK has revealed that people with severe allergies could face complications .
“ [ T ] he expectation would be that subjects with known severe reaction — allergic reaction — should not take the vaccine until we understand exactly what happened here , ” Slaoui @ @ @ @ @ @ @ receiving this inoculation will further clarify any problems and concerns .
But it will take months before the vaccine will start to constrain new Covid-19 cases since tens of millions of people would need to have immunity before the spread starts to slow down .
And while the Pfizer/BioNTech vaccine has demonstrated effectiveness against disease , it ’ s still not clear how well it prevents asymptomatic infection .
Scientists don ’ t yet know if people who are vaccinated could still transmit the virus to other people without getting sick themselves .
@ @ @ @ @ @ @ vaccination , hospitals will still be battling severe Covid-19 as case numbers reach grim new heights .
And handwashing , social distancing , and mark-wearing will remain the orders of the day for months to come , even for people lucky enough to receive a vaccine .

The Food and Drug Administration on Friday evening granted an emergency use authorization (EUA) to the Covid-19 vaccine developed by Pfizer and BioNTech, making it the first Covid-19 vaccine in the United States to begin distribution outside of clinical trials.
The first 6.4 million doses could ship within days.
The announcement came after an advisory committee to the Food and Drug Administration, the Vaccines and Related Biological Products Advisory Committee, voted 17 to 4, with 1 abstention, to recommend and EUA for the Pfizer-BioNTech vaccine. The committee specifically voted on whether the benefits of the Pfizer-BioNTech vaccine outweigh the risks in people aged 16 years and older.
The highly anticipated regulatory green light means health workers facing high exposure to the disease and residents of long-term care facilities can now start receiving the first doses of the two-dose vaccine.
That a vaccine for a disease only discovered late last year would be ready so quickly is already an unmatched scientific feat, but the fact that it’s also based on a new technology that yielded 95 percent efficacy in preventing disease makes the announcement all the more remarkable.
“The tireless work to develop a new vaccine to prevent this novel, serious, and life-threatening disease in an expedited timeframe after its emergence is a true testament to scientific innovation and public-private collaboration worldwide,” said FDA Commissioner Stephen Hahn in a statement.
The approval of the Pfizer/BioNTech vaccine in the US follows green lights from regulatory agencies in Canada and the United Kingdom. Next week, the vaccine advisory committee will consider another EUA for the Covid-19 vaccine using a similar approach developed by Moderna.
But an EUA is only one step forward.
The vaccine must then be shipped to health facilities and administered in two doses. These steps present their own challenges, ranging from keeping the vaccine at the frigid temperatures it requires to getting patients to come back for a follow-up shot. Meanwhile, many of the health systems administering shots are struggling to care for a huge surge of hospitalized Covid-19 patients.
This rollout will be part of the largest vaccination effort in history. But there will not be enough doses for everyone at the outset, even for people placed at the front of the line. Pfizer and BioNTech expect to produce 50 million doses of their vaccine around the world before the end of the year, enough for 25 million people — half of which has been pledged for the US. The first doses to roll out will be a crucial test of the vaccine distribution system in the United States, as well as a test of public acceptance and of the integrity of the clinical trial process.
The Pfizer/BioNTech vaccine is cleared for emergency approval. Now what?
One of the first challenges for the Pfizer/BioNTech vaccine is getting it where it needs to go. That’s complicated by the fact that the vaccine requires temperatures of minus 70 degrees Celsius (minus 94 degrees Fahrenheit) or lower, some of the coldest temperature constraints of any Covid-19 vaccine under development. Maintaining the cold chain from factories to distribution hubs to hospitals is crucial; otherwise, the vaccine may spoil and become ineffective.
Pfizer has developed its own temperature-controlled shipping containers that use dry ice to maintain the recommended temperatures for their vaccine for up to 10 days. But longer storage will require ultra-cold freezers, and not many clinics have the requisite hardware, so timing the shipments will be key. There may also be shortages of dry ice.
The next hurdle is figuring out who gets the vaccine first. The 6.4 million doses available at the outset are nowhere near enough to quench the raging Covid-19 pandemic that is still reaching new peaks in daily hospitalizations and fatalities.
An advisory committee to the Centers for Disease Control and Prevention voted at the beginning of this month on a set of guidelines that prioritize health care personnel, as well as staff and residents of long-term care facilities. But these groups alone add up to about 24 million people, so states and local governments and health groups are having to narrow these groups further.
Pfizer and BioNTech’s vaccine also has to be administered as two doses spaced 21 days apart. That poses a problem because experiences with other vaccines show that people are really bad at getting follow-up shots. As many as half of patients failed to get their second dose of the hepatitis B vaccine, for example. For the Covid-19 vaccine, side effects from the first dose, scheduling conflicts, or supply shortages may inhibit recipients from getting the second dose.
The good news is that the Pfizer/BioNTech vaccine may offer some protection against Covid-19 from the first dose, although it takes a few days for the shielding to build up. In fact, some experts, including former FDA commissioner Scott Gottlieb, argued that the entire allotment of doses should be given to as many people as possible, as fast as possible, rather than withholding injections to give to people as second shots.
“We should get as many shots in our arms as possible right away,” he told USA Today on Monday. “The idea that we need to cut (the doses) in half and give half of it now and hold onto it, so we have supply in January to get the second dose … I just fundamentally disagree with that.”
But other experts say there isn’t yet enough data on a single dose to know whether it will provide enough protection from the virus for the broader population.
Meanwhile, the FDA is likely to authorize another Covid-19 vaccine in the coming weeks, clearing the way for the distribution of 25 million doses of the Moderna vaccine, enough for 12.5 million people on the two-dose regimen.
Moncef Slaoui, the scientific lead for Operation Warp Speed, the program from the Department of Health and Human Services to accelerate and deploy Covid-19 vaccines, said he expects 20 million Americans will be vaccinated in December, 30 million more in January, and 50 million more in February as more vaccines with promising early results are approved.
The clinical trials for Covid-19 vaccines must continue, but they’re going to get harder to complete as placebo participants leave to get vaccinated
An EUA is a critical step, but it’s not full approval, and it signals that the FDA still wants answers to key questions, like long-term safety. The standards for an EUA for a vaccine is that there is an urgent public health need, the proposed vaccine may have a beneficial effect, and that there are no approved alternatives. The FDA also set a minimum threshold of 50 percent efficacy for a Covid-19 vaccine, a line that several vaccines have completely vaulted.
So far, Pfizer and BioNTech are only reporting two months of observational safety for their phase 3 clinical trial, although the companies have committed to continue monitoring their more than 43,000 trial participants.
But at the same time, Covid-19 is spreading rampantly in the United States, and more than 20,000 people in Pfizer and BioNTech’s trial have received a placebo rather than the actual vaccine, leaving them vulnerable to the disease. Of the 178 reported cases of Covid-19 in the trial pool, 169 were in the placebo group. Of those, 9 in the placebo group and 1 in the vaccine group experienced severe Covid-19. As time goes on, more people in the placebo group will likely get sick and some will fall severely ill, requiring hospitalization. Without intervention, some of these people in the placebo group may die.
The EUA now presents a huge dilemma for the clinical trial. People in the placebo group may be at risk of Covid-19, but if they receive the vaccine, it would diminish the value of the trial and make it harder to answer questions about safety and efficacy, particularly in vulnerable subgroups like older adults.
And since this is a double-blind clinical trial, neither the recipients nor the companies know who received the vaccine and who received the placebo. Vaccinating the placebo group would require breaking this blind, and if participants find out which group they’re in, they could change their behavior. People who received the vaccine may engage in riskier behavior while people in the placebo group may end up taking more precautions if they decide not to get vaccinated themselves. Those changes in behavior will make it harder to isolate the effects of the vaccine.
William C. Gruber, senior vice president for vaccine clinical research and development for Pfizer, told the FDA vaccine advisory committee on Thursday that the company has an ethical obligation to inform trial participants that the vaccine has received an EUA, but they are working on coming up with ways to maintain the integrity of the trial as much as possible.
“Eligible participants in the placebo group will have the option to receive the vaccine,” Gruber said. “We are currently in discussions with the FDA about the best way to vaccinate placebo recipients.”
Gruber added that the study will continue for 24 months regardless, with ongoing monitoring of the trial participants. This sort of large-scale and long-term follow-up is key because there may be rare complications that emerge that weren’t detected over a shorter time frame or were not present in the selected pool of participants in the trial.
Already, the rollout of the Pfizer/BioNTech vaccine in the UK has revealed that people with severe allergies could face complications.
“[T]he expectation would be that subjects with known severe reaction — allergic reaction — should not take the vaccine until we understand exactly what happened here,” Slaoui told reporters on Wednesday.
More people receiving this inoculation will further clarify any problems and concerns. But it will take months before the vaccine will start to constrain new Covid-19 cases since tens of millions of people would need to have immunity before the spread starts to slow down. And while the Pfizer/BioNTech vaccine has demonstrated effectiveness against disease, it’s still not clear how well it prevents asymptomatic infection. Scientists don’t yet know if people who are vaccinated could still transmit the virus to other people without getting sick themselves.
That means that until there is widespread vaccination, hospitals will still be battling severe Covid-19 as case numbers reach grim new heights. And handwashing, social distancing, and mark-wearing will remain the orders of the day for months to come, even for people lucky enough to receive a vaccine.


vox--2020-12-10--An overwhelming majority of Americans want Congress to pass more stimulus — now

While Congress is still struggling to come together on a stimulus package , support for getting one done has only grown : According to a new poll from Vox and Data for Progress , 81 percent of likely voters would like to see lawmakers approve another bill before the end of the year .
That ’ s up from 67 percent of people calling on Congress to approve more stimulus before the election in an October Vox/DFP poll .
Right now , it ’ s unclear whether lawmakers will reach an agreement this month .
Although Republicans and Democrats both @ @ @ @ @ @ @ schools , vaccine distribution , and small-business aid , there are still major hold-ups regarding the inclusion of liability protections and state and local funds .
Meanwhile , Americans are continuing to navigate severe economic fallout from the pandemic .
In the Vox/DFP poll , one in five respondents said they ’ ve applied for unemployment insurance since the pandemic began , about three in 10 have applied for SNAP food aid or gone to a food bank , and one in five have struggled with at least one rent or mortgage payment @ @ @ @ @ @ @ likely voters from December 4 to 6 , and has a margin of error of 3 points .
Broader economic data reflects the dire need for relief as well .
According to the latest numbers from the Labor Department , roughly 19 million people are currently receiving unemployment insurance .
And an analysis from the Aspen Institute indicates that almost 40 million people could be at risk for eviction if lawmakers or federal agencies don ’ t take additional action in the coming weeks .
Both Democratic and Republican lawmakers have said they @ @ @ @ @ @ @ stimulus bill approved before the end of the year .
As both this poll and many other measures indicate , the stakes are too high for them not to follow through .
Many people want to see another stimulus check — and far fewer care about liability protections The top stimulus provision that most likely voters are interested in seeing is another round of stimulus checks : 75 percent of poll respondents said this was what they ’ d want prioritized in another package .
Food aid , expanded unemployment insurance , money @ @ @ @ @ @ @ were other areas respondents highlighted .
At least half of those polled signaled that these provisions were important to them .
Liability protections for businesses — something that ’ s been a top issue for Senate Majority Leader Mitch McConnell and an ongoing sticking point in negotiations — was not seen as vital , however .
Just 23 percent of people listed it as a priority for them .
State and local aid , which has been another point of contention , was also less popular , though it saw slightly more support @ @ @ @ @ @ @ it as a priority .
Lawmakers are still at an impasse on what comes next : The White House has offered a $ 916 billion proposal that Democrats have rejected for its omission of funding for enhanced unemployment insurance , and Republican leaders have shied away from backing a $ 908 billion bipartisan Senate plan .
The question of who exactly is to blame for the impasse is an interesting one .
The Vox/DFP poll finds that both parties are seen as responsible for the stimulus delays , though a slightly higher proportion @ @ @ @ @ @ @ fault .
This might come as a surprise to Democrats , who have been pushing for more aid since the spring .
Since March , House Democrats have passed two versions of the HEROES Act , which have not been considered at all in the upper chamber .
Senate Republicans , meanwhile , have tried to advance their own , narrower bills , which Democrats have opposed .
Pressure on both parties has increased in recent months , however , particularly as talks between House Speaker Nancy Pelosi and White House Treasury Secretary @ @ @ @ @ @ @ Pelosi in October rejected a $ 1.8 trillion offer from Mnuchin over disagreements about the approach to several provisions including state and local support as well as unemployment insurance .
McConnell at the time had signaled that he wasn ’ t interested in putting such a large package on the floor , either .
In the recent Vox/DFP survey , 31 percent of likely voters think Republicans are responsible for the lack of stimulus , while 38 percent think Democrats are .
Thirty-two percent of people said they saw Senate Republicans , led @ @ @ @ @ @ @ the delays , while 43 percent said the same of House Democrats , led by Pelosi .
Congress is set to leave for the year in just over a week , but House lawmakers have emphasized that they could keep working after Christmas if they aren ’ t able to reach an agreement by then .
“ It ’ s a deal that must come together .
We don ’ t have a choice now .
It ’ s one of those things that has to be done , ” Sen. Joe Manchin @ @ @ @ @ @ @

While Congress is still struggling to come together on a stimulus package, support for getting one done has only grown: According to a new poll from Vox and Data for Progress, 81 percent of likely voters would like to see lawmakers approve another bill before the end of the year. That’s up from 67 percent of people calling on Congress to approve more stimulus before the election in an October Vox/DFP poll.
Right now, it’s unclear whether lawmakers will reach an agreement this month. Although Republicans and Democrats both support several key measures including funding for schools, vaccine distribution, and small-business aid, there are still major hold-ups regarding the inclusion of liability protections and state and local funds.
Meanwhile, Americans are continuing to navigate severe economic fallout from the pandemic. In the Vox/DFP poll, one in five respondents said they’ve applied for unemployment insurance since the pandemic began, about three in 10 have applied for SNAP food aid or gone to a food bank, and one in five have struggled with at least one rent or mortgage payment. This poll was fielded with 1,080 likely voters from December 4 to 6, and has a margin of error of 3 points.
Broader economic data reflects the dire need for relief as well. According to the latest numbers from the Labor Department, roughly 19 million people are currently receiving unemployment insurance. And an analysis from the Aspen Institute indicates that almost 40 million people could be at risk for eviction if lawmakers or federal agencies don’t take additional action in the coming weeks.
Both Democratic and Republican lawmakers have said they’d like to get a new stimulus bill approved before the end of the year. As both this poll and many other measures indicate, the stakes are too high for them not to follow through.
Many people want to see another stimulus check — and far fewer care about liability protections
The top stimulus provision that most likely voters are interested in seeing is another round of stimulus checks: 75 percent of poll respondents said this was what they’d want prioritized in another package.
Food aid, expanded unemployment insurance, money for coronavirus testing, and small-business support were other areas respondents highlighted. At least half of those polled signaled that these provisions were important to them.
Liability protections for businesses — something that’s been a top issue for Senate Majority Leader Mitch McConnell and an ongoing sticking point in negotiations — was not seen as vital, however. Just 23 percent of people listed it as a priority for them. State and local aid, which has been another point of contention, was also less popular, though it saw slightly more support, with 31 percent of respondents citing it as a priority.
Lawmakers are still at an impasse on what comes next: The White House has offered a $916 billion proposal that Democrats have rejected for its omission of funding for enhanced unemployment insurance, and Republican leaders have shied away from backing a $908 billion bipartisan Senate plan.
Who’s getting the blame?
The question of who exactly is to blame for the impasse is an interesting one.
The Vox/DFP poll finds that both parties are seen as responsible for the stimulus delays, though a slightly higher proportion of people view Democrats as being at fault. This might come as a surprise to Democrats, who have been pushing for more aid since the spring. Since March, House Democrats have passed two versions of the HEROES Act, which have not been considered at all in the upper chamber. Senate Republicans, meanwhile, have tried to advance their own, narrower bills, which Democrats have opposed.
Pressure on both parties has increased in recent months, however, particularly as talks between House Speaker Nancy Pelosi and White House Treasury Secretary Steven Mnuchin fell apart this fall. Pelosi in October rejected a $1.8 trillion offer from Mnuchin over disagreements about the approach to several provisions including state and local support as well as unemployment insurance. McConnell at the time had signaled that he wasn’t interested in putting such a large package on the floor, either.
In the recent Vox/DFP survey, 31 percent of likely voters think Republicans are responsible for the lack of stimulus, while 38 percent think Democrats are. Thirty-two percent of people said they saw Senate Republicans, led by McConnell, as specifically responsible for the delays, while 43 percent said the same of House Democrats, led by Pelosi.
Congress is set to leave for the year in just over a week, but House lawmakers have emphasized that they could keep working after Christmas if they aren’t able to reach an agreement by then. “It’s a deal that must come together. We don’t have a choice now. It’s one of those things that has to be done,” Sen. Joe Manchin (D-WV) previously also said.


vox--2020-12-10--Southern California sheriffs are refusing to enforce stay-at-home orders

Sheriffs of counties that represent nearly 40 percent of California ’ s population are refusing to enforce Gov .
Gavin Newsom ’ s newest stay-at-home order aimed at curbing the spread of Covid-19 .
Sheriffs Alex Villanueva , Don Barnes , and Chad Bianco enforce the laws in Los Angeles , Orange , and Riverside counties , respectively .
In response to Newsom ’ s announcement , Villanueva said he won ’ t “ take part in enforcing stay at home orders at businesses , ” Barnes called compliance “ a matter of personal responsibility and not a matter of @ @ @ @ @ @ @ he wouldn ’ t be “ blackmailed , bullied or used as muscle ” in carrying out the order .
The latest rules require regions where the adult ICU bed capacity falls below 15 percent to comply with a stay-at-home order for a minimum of three weeks .
The order , once triggered , bans “ all gatherings with members of other households ” except in specific cases .
KTTV Fox 11 in Los Angeles Fox reported that the order would also shut down all indoor and outdoor dining , limiting restaurants to @ @ @ @ @ @ @ region , which includes LA , Orange , and Riverside counties , dropped to 7.7 percent ICU capacity as of December 10 .
Newsom ’ s order comes amid a nationwide spike in coronavirus cases .
Almost no states are seeing anything close to meaningful suppression of the virus , and daily death tolls are reaching record highs .
America faces a dark few months until the vaccine arrives The standoff is largely about the terrible trade-offs between public health and economic activity , made all but inevitable by Congress ’ s failure @ @ @ @ @ @ @ providing the necessary financial assistance to individuals , businesses , and state and local governments , the federal government has put states in the unenviable position of mandating public health measures without the ability to compensate businesses and individuals suffering the consequences .
As Vox ’ s Li Zhou has reported , Congress is still arguing over major components of a potential stimulus package , including whether to include unemployment assistance , business liability protections , and aid to state and local governments .
The latest competing proposals , neither of which currently @ @ @ @ @ @ @ carry price tags of more than $ 900 billion .
But , as Vox ’ s Emily Stewart recently noted , a new study has estimated that it will take between $ 3 and $ 4.5 trillion in near-term spending to “ get the economy to reach its full potential.
” Meanwhile , states were already facing budget shortfalls numbering in the hundreds of billions before the Covid-19 crisis hit .
They ’ re in no position to offer their residents and businesses the type of financial assistance that Congress could .
There @ @ @ @ @ @ @ The FDA appears on track to grant emergency approval of two separate vaccines in the coming days , with plans to vaccinate about 20 million people in high-risk groups by the end of 2020 and the rest of the US population over the next six months .
But in the meantime , the country is exhausted , and residents are struggling to comply with public health guidance as the holiday season drives more people to gather with family and friends in person .
Julia Marcus , epidemiologist and professor at Harvard Medical School @ @ @ @ @ @ @ “ abstinence-only recommendations regarding social contact ” are a bad policy choice when it comes to Covid-19 prevention .
Instead , she writes , officials need to offer people “ practical ways to reduce risk that go beyond ‘ Just say no ’ ” — especially if they ’ re going to dine indoors themselves in defiance of their own rules .
Sheriffs have long had a lot of leeway in deciding whether to enforce laws The defiant sheriffs are expressing a very real frustration nearly a year into the Covid-19 pandemic .
@ @ @ @ @ @ @ be nonpartisan , that ’ s often not the case , and it shows in their responses to the stay-at-home orders .
Los Angeles Times columnist Gustavo Arellano opined that Riverside County Sheriff Chad Bianco sounded a lot more like an Infowars conspiracy theorist when he falsely claimed in a December 4 video that “ the medical field is so split about this virus.
” When Arellano pressed Bianco on this assertion , he doubled-down , arguing that “ doctors and other medical professionals have differing opinions on benefits of masks , social @ @ @ @ @ @ @ everyone is going to get the virus , and 99.8 [ % ] of those who do , will get over it , ” Bianco added .
These sheriffs ’ refusal to enforce the stay-at-home orders is part of a long tradition of sheriffs picking and choosing when and how to require their constituents to follow the law .
From defying gun control orders to selective enforcement of traffic violations , our system has granted wide latitude to law enforcement .
California ’ s current crisis is a feature , not a bug @ @ @ @ @ @ @ shootings in Aurora , Colorado , and Newton , Connecticut , in 2012 , some states that passed new laws regarding gun ownership — including Colorado , New York , and Florida — saw similar protestations from law enforcement officers who refused to enforce them .
The nature of policing requires some level of discretion when it comes to enforcement .
Traffic violations are so common that police have to decide which ones are worth ticketing and stopping ( these decisions are rife with racial bias ) .
However , outright refusal to @ @ @ @ @ @ @ discretion as sheriffs appoint themselves lawmakers and law enforcers in the same breath .
At the end of the day , the people who are most at risk — those facing eviction , job loss , the shuttering of their business , and isolation from their friends and families — deserve more from their government than theatrical showdowns and hypocritical scolding .
But right now , it looks like that ’ s all they ’ re going to get .

Sheriffs of counties that represent nearly 40 percent of California’s population are refusing to enforce Gov. Gavin Newsom’s newest stay-at-home order aimed at curbing the spread of Covid-19.
Sheriffs Alex Villanueva, Don Barnes, and Chad Bianco enforce the laws in Los Angeles, Orange, and Riverside counties, respectively. In response to Newsom’s announcement, Villanueva said he won’t “take part in enforcing stay at home orders at businesses,” Barnes called compliance “a matter of personal responsibility and not a matter of law enforcement,” and Bianco said he wouldn’t be “blackmailed, bullied or used as muscle” in carrying out the order.
The latest rules require regions where the adult ICU bed capacity falls below 15 percent to comply with a stay-at-home order for a minimum of three weeks. The order, once triggered, bans “all gatherings with members of other households” except in specific cases. KTTV Fox 11 in Los Angeles Fox reported that the order would also shut down all indoor and outdoor dining, limiting restaurants to takeout and delivery.
The Southern California region, which includes LA, Orange, and Riverside counties, dropped to 7.7 percent ICU capacity as of December 10.
Newsom’s order comes amid a nationwide spike in coronavirus cases. Almost no states are seeing anything close to meaningful suppression of the virus, and daily death tolls are reaching record highs.
America faces a dark few months until the vaccine arrives
The standoff is largely about the terrible trade-offs between public health and economic activity, made all but inevitable by Congress’s failure to pass more stimulus. By not providing the necessary financial assistance to individuals, businesses, and state and local governments, the federal government has put states in the unenviable position of mandating public health measures without the ability to compensate businesses and individuals suffering the consequences.
As Vox’s Li Zhou has reported, Congress is still arguing over major components of a potential stimulus package, including whether to include unemployment assistance, business liability protections, and aid to state and local governments. The latest competing proposals, neither of which currently have enough support to move forward, carry price tags of more than $900 billion. But, as Vox’s Emily Stewart recently noted, a new study has estimated that it will take between $3 and $4.5 trillion in near-term spending to “get the economy to reach its full potential.”
Meanwhile, states were already facing budget shortfalls numbering in the hundreds of billions before the Covid-19 crisis hit. They’re in no position to offer their residents and businesses the type of financial assistance that Congress could.
There is good news around the corner: The FDA appears on track to grant emergency approval of two separate vaccines in the coming days, with plans to vaccinate about 20 million people in high-risk groups by the end of 2020 and the rest of the US population over the next six months. But in the meantime, the country is exhausted, and residents are struggling to comply with public health guidance as the holiday season drives more people to gather with family and friends in person.
Julia Marcus, epidemiologist and professor at Harvard Medical School, recently argued in the Atlantic that “abstinence-only recommendations regarding social contact” are a bad policy choice when it comes to Covid-19 prevention. Instead, she writes, officials need to offer people “practical ways to reduce risk that go beyond ‘Just say no’” — especially if they’re going to dine indoors themselves in defiance of their own rules.
Sheriffs have long had a lot of leeway in deciding whether to enforce laws
The defiant sheriffs are expressing a very real frustration nearly a year into the Covid-19 pandemic. Though their elected positions are supposed to be nonpartisan, that’s often not the case, and it shows in their responses to the stay-at-home orders. Los Angeles Times columnist Gustavo Arellano opined that Riverside County Sheriff Chad Bianco sounded a lot more like an Infowars conspiracy theorist when he falsely claimed in a December 4 video that “the medical field is so split about this virus.” When Arellano pressed Bianco on this assertion, he doubled-down, arguing that “doctors and other medical professionals have differing opinions on benefits of masks, social distancing, and lockdowns.”
“Not everyone is going to get the virus, and 99.8[%] of those who do, will get over it,” Bianco added.
These sheriffs’ refusal to enforce the stay-at-home orders is part of a long tradition of sheriffs picking and choosing when and how to require their constituents to follow the law. From defying gun control orders to selective enforcement of traffic violations, our system has granted wide latitude to law enforcement. California’s current crisis is a feature, not a bug, of the system.
Following the shootings in Aurora, Colorado, and Newton, Connecticut, in 2012, some states that passed new laws regarding gun ownership — including Colorado, New York, and Florida — saw similar protestations from law enforcement officers who refused to enforce them.
The nature of policing requires some level of discretion when it comes to enforcement. Traffic violations are so common that police have to decide which ones are worth ticketing and stopping (these decisions are rife with racial bias). However, outright refusal to uphold a law goes beyond that day-to-day discretion as sheriffs appoint themselves lawmakers and law enforcers in the same breath.
At the end of the day, the people who are most at risk — those facing eviction, job loss, the shuttering of their business, and isolation from their friends and families — deserve more from their government than theatrical showdowns and hypocritical scolding. But right now, it looks like that’s all they’re going to get.


vox--2020-12-10--The last-gasp Brexit deal negotiations, explained

The Brexit deal talks will live to see another few days .
Until Sunday , at least .
The European Union and the United Kingdom are trying — and failing — to come up with a deal on their future relationship before the December 31 deadline .
And , on Wednesday , British Prime Minister Boris Johnson and European Commission President Ursula von der Leyen had a marathon dinner in Brussels to try to salvage the Brexit negotiations .
As von der Leyen put it in a statement , she and Johnson had a “ lively and interesting discussion on @ @ @ @ @ @ @ a clear understanding of each other ’ s positions .
They remain far apart.
” A statement from the prime minister ’ s office called the discussion “ frank.
” “ They acknowledged that the situation remained very difficult and there were still major differences between the two sides , ” the statement said .
So the two leaders didn ’ t exactly get a breakthrough .
The only thing they seemed to agree on was that , well , the EU and the UK just don ’ t seem to agree .
@ @ @ @ @ @ @ try , engaging in discussions through the weekend .
After which they ’ ll either make a deal , or likely decide to walk away and prepare for no deal when the Brexit transition period ends on December 31 .
The United Kingdom and the European Union have been trying for the last 11 months to negotiate an agreement that will define their future partnership after the UK formally left the bloc in January .
But both sides remain stuck on major points — fishing rights , guaranteeing a “ level playing field @ @ @ @ @ @ @ and how to enforce any deal — with very , very little time before the year-end deadline .
Getting a deal is in the interests of both sides , but reaching , ratifying , and implementing any deal in three weeks is going to be a challenge — and might not be feasible at this late stage .
But without any framework , the EU and the UK could face major disruptions in January on everything from trade to transport .
It will be painful for both sides , but the UK , @ @ @ @ @ @ @ feel that fallout more acutely , which will pile on to economic hurt brought on by the pandemic .
The United Kingdom formally left the European Union in January 2020 , but it entered into an 11-month transition period in which it continued to follow EU rules .
The point of the transition period was to give the EU and the UK time to figure out their post-breakup relationship .
The two sides need to come up with a trade arrangement , but they also have to deal with a slew of other @ @ @ @ @ @ @ .
Those negotiations have dragged on for months , held up by three main issues : fisheries , governance , and state aid and regulations , or the so-called level playing field .
The fisheries issue is a relatively minor economic question for both the UK and the EU , but it ’ s taken on an outsize role in the debate .
It accounts for a very small percentage of the UK economy — as the New York Times reported , Harrods department store contributes more annually to the UK economy — @ @ @ @ @ @ @ industry , and it ’ s symbolically tied to the Brexit ideal of reclaiming sovereignty , including over UK waters .
But the UK doesn ’ t take all the blame for this .
Fishing is also a politically important and symbolic industry in some EU member states that want to retain access to UK waters .
France wants to keep the current arrangements , and French President Emmanuel Macron has insisted that he will not sacrifice France ’ s fishing industry in any deal .
Governance is also an issue , which @ @ @ @ @ @ @ enforced and what penalties — like additional tariffs on certain goods — will exist if one party breaks the terms of any agreement .
This is a particularly sensitive subject for the European Union , which is afraid the UK won ’ t live up to its commitments .
The Brexit negotiations have soured trust between the two , made worse after the UK introduced a bill that would have violated parts of the Brexit deal Johnson reached with the EU last year .
That legislation , known as the Internal Market Bill @ @ @ @ @ @ @ where members of Parliament re-added some clauses that would have breached the protocol around Northern Ireland .
However , the UK extended something of an olive branch , with the government saying it will take out those provisions if the EU can address the UK ’ s concerns , and the two get a deal .
And then there ’ s the issue of state aid , often framed as the level playing field arrangements .
The EU is insisting that if the UK wants tariff-free access to its single market , it @ @ @ @ @ @ @ EU by subsidizing industries or businesses ; the EU also wants to guard against the UK diverging on environmental standards or labor protections post-Brexit .
But the UK sees this as the EU trying to get it to follow the rules of the club it just left .
Brexit was supposed to give the UK the power to reclaim its sovereignty and reestablish its own trading regime , so the UK has bristled at these demands .
This is basically where the two sides have been for months , entrenched on these same @ @ @ @ @ @ @ other of being inflexible .
“ The problem is that both sides want the other to blink first .
That ’ s the root of the problem , ” Anand Menon , director of the UK in a Changing Europe , told me earlier this week .
What are the prospects for a no-deal ?
Sunday is the latest do-or-die date , but these kinds of self-imposed deadlines have been broken before .
Both the EU and the UK could end up talking until the ultimate last moment .
But that ’ s @ @ @ @ @ @ @ final stage of Brexit .
If a deal is reached , both the European Parliament and the UK Parliament must ratify it , and the terms of the deal need to be implemented — something that is going to be very difficult to do on such a short timeline .
And the relationship is changing , deal or no deal .
For example , goods traveling between the EU and UK will now face customs checks and taxes .
Yet if the UK and EU don ’ t reach a deal , things @ @ @ @ @ @ @ messy .
All the trade and regulatory arrangements the UK was following will cease , and tariffs and quotas will kick in .
Checks and controls could create massive gridlock at ports of entry , which could lead to food and medicine shortages .
Planes could be grounded .
The pandemic drained some of the no-deal stockpiles the British government had built up , which it ’ s trying to replenish .
The British government has warned of possible civil unrest .
And all of this will be piled upon the economic hardships @ @ @ @ @ @ @ this in mind , the European Commission put forward no-deal contingency plans on Thursday — basically a series of short-term , six-month arrangements that would soften the disruptions on January 1 , including on aviation and road travel .
They would also allow for reciprocal access to waters for fishing until the end of 2021 , or until the UK and EU can reach a deal on fisheries .
The EU is making the offer dependent on the UK agreeing to maintain the same standards and regulations — a.k.a .
the so-called level-playing @ @ @ @ @ @ @ opposition in the UK , especially among strong Brexit supporters .
The contingency plans presented by the EU may offer a bit of an off-ramp to the worst-case scenario .
But only if the UK gets on board , which it hasn ’ t yet .
Meanwhile , Johnson said Thursday it was a “ strong possibility ” that the UK would leave without a deal , and he urged the public and businesses to prepare for an “ Australian option , ” which is the current euphemism for a no-deal crash-out on @ @ @ @ @ @ @ UK and the EU are facing now is the one they desperately wanted to avoid .
And whether they can actually avoid it may have a lot to do with the internal politics in the EU , but especially the UK .
Johnson is under pressure at home over his handling of Covid-19 , and he ’ s facing a rebellion within his own Conservative Party , primarily over Covid-19 restrictions .
That right flank of his party is also ardently pro-Brexit — the very same people who don ’ t want to @ @ @ @ @ @ @ and are , at least rhetorically , willing to risk the costs of no deal .
If Johnson is seen as caving to the EU , he may face pressure from these Brexiteers , and so his toughness serves a political purpose .
The question is , will he take the brinkmanship to the last possible moment , only to reach a deal and claim victory — or will he see the politics of being able to blame the EU if negotiations feel more politically palatable , at least in the short term @ @ @ @ @ @ @ politics to consider , and it may now see the best option as pushing forward these short-term contingency plans and regrouping in 2021 .
And if that ’ s the case , well , Brexit won ’ t really be over , again .

The Brexit deal talks will live to see another few days. Until Sunday, at least.
The European Union and the United Kingdom are trying — and failing — to come up with a deal on their future relationship before the December 31 deadline. And, on Wednesday, British Prime Minister Boris Johnson and European Commission President Ursula von der Leyen had a marathon dinner in Brussels to try to salvage the Brexit negotiations.
As von der Leyen put it in a statement, she and Johnson had a “lively and interesting discussion on the state of play. We gained a clear understanding of each other’s positions. They remain far apart.”
A statement from the prime minister’s office called the discussion “frank.” “They acknowledged that the situation remained very difficult and there were still major differences between the two sides,” the statement said.
So the two leaders didn’t exactly get a breakthrough. The only thing they seemed to agree on was that, well, the EU and the UK just don’t seem to agree.
But they’ll give it another try, engaging in discussions through the weekend. After which they’ll either make a deal, or likely decide to walk away and prepare for no deal when the Brexit transition period ends on December 31.
The United Kingdom and the European Union have been trying for the last 11 months to negotiate an agreement that will define their future partnership after the UK formally left the bloc in January. But both sides remain stuck on major points — fishing rights, guaranteeing a “level playing field” on government subsidies and regulations, and how to enforce any deal — with very, very little time before the year-end deadline.
Getting a deal is in the interests of both sides, but reaching, ratifying, and implementing any deal in three weeks is going to be a challenge — and might not be feasible at this late stage.
But without any framework, the EU and the UK could face major disruptions in January on everything from trade to transport. It will be painful for both sides, but the UK, now all alone, is expected to feel that fallout more acutely, which will pile on to economic hurt brought on by the pandemic.
What’s holding up this Brexit deal
The United Kingdom formally left the European Union in January 2020, but it entered into an 11-month transition period in which it continued to follow EU rules.
The point of the transition period was to give the EU and the UK time to figure out their post-breakup relationship. The two sides need to come up with a trade arrangement, but they also have to deal with a slew of other issues, from fishing to security cooperation.
Those negotiations have dragged on for months, held up by three main issues: fisheries, governance, and state aid and regulations, or the so-called level playing field.
The fisheries issue is a relatively minor economic question for both the UK and the EU, but it’s taken on an outsize role in the debate. It accounts for a very small percentage of the UK economy — as the New York Times reported, Harrods department store contributes more annually to the UK economy — but it’s a politically important industry, and it’s symbolically tied to the Brexit ideal of reclaiming sovereignty, including over UK waters.
But the UK doesn’t take all the blame for this. Fishing is also a politically important and symbolic industry in some EU member states that want to retain access to UK waters. France wants to keep the current arrangements, and French President Emmanuel Macron has insisted that he will not sacrifice France’s fishing industry in any deal.
Governance is also an issue, which is basically how any deal will be enforced and what penalties — like additional tariffs on certain goods — will exist if one party breaks the terms of any agreement.
This is a particularly sensitive subject for the European Union, which is afraid the UK won’t live up to its commitments. The Brexit negotiations have soured trust between the two, made worse after the UK introduced a bill that would have violated parts of the Brexit deal Johnson reached with the EU last year.
That legislation, known as the Internal Market Bill, returned to Parliament on Monday, where members of Parliament re-added some clauses that would have breached the protocol around Northern Ireland. However, the UK extended something of an olive branch, with the government saying it will take out those provisions if the EU can address the UK’s concerns, and the two get a deal.
And then there’s the issue of state aid, often framed as the level playing field arrangements. The EU is insisting that if the UK wants tariff-free access to its single market, it can’t try to undercut the EU by subsidizing industries or businesses; the EU also wants to guard against the UK diverging on environmental standards or labor protections post-Brexit.
But the UK sees this as the EU trying to get it to follow the rules of the club it just left. Brexit was supposed to give the UK the power to reclaim its sovereignty and reestablish its own trading regime, so the UK has bristled at these demands.
This is basically where the two sides have been for months, entrenched on these same issues, with each side accusing the other of being inflexible. “The problem is that both sides want the other to blink first. That’s the root of the problem,” Anand Menon, director of the UK in a Changing Europe, told me earlier this week.
What are the prospects for a no-deal?
Sunday is the latest do-or-die date, but these kinds of self-imposed deadlines have been broken before. Both the EU and the UK could end up talking until the ultimate last moment.
But that’s a lot harder to do in this final stage of Brexit. If a deal is reached, both the European Parliament and the UK Parliament must ratify it, and the terms of the deal need to be implemented — something that is going to be very difficult to do on such a short timeline. And the relationship is changing, deal or no deal. For example, goods traveling between the EU and UK will now face customs checks and taxes.
Yet if the UK and EU don’t reach a deal, things are going to get really, really messy. All the trade and regulatory arrangements the UK was following will cease, and tariffs and quotas will kick in.
Checks and controls could create massive gridlock at ports of entry, which could lead to food and medicine shortages. Planes could be grounded. The pandemic drained some of the no-deal stockpiles the British government had built up, which it’s trying to replenish. The British government has warned of possible civil unrest. And all of this will be piled upon the economic hardships that stem from Covid-related lockdowns.
With this in mind, the European Commission put forward no-deal contingency plans on Thursday — basically a series of short-term, six-month arrangements that would soften the disruptions on January 1, including on aviation and road travel.
Negotiations are still ongoing but the end of the transition is near. There is no guarantee that if & when an agreement is found it can enter into force on time. We have to be prepared including for not having a deal in place on 1 January. Today we present contingency measures ⤵ pic.twitter.com/FQ4Urn9YUC — Ursula von der Leyen (@vonderleyen) December 10, 2020
They would also allow for reciprocal access to waters for fishing until the end of 2021, or until the UK and EU can reach a deal on fisheries. The EU is making the offer dependent on the UK agreeing to maintain the same standards and regulations — a.k.a. the so-called level-playing field — which is likely to face opposition in the UK, especially among strong Brexit supporters.
The contingency plans presented by the EU may offer a bit of an off-ramp to the worst-case scenario. But only if the UK gets on board, which it hasn’t yet.
Meanwhile, Johnson said Thursday it was a “strong possibility” that the UK would leave without a deal, and he urged the public and businesses to prepare for an “Australian option,” which is the current euphemism for a no-deal crash-out on January 1.
Now is the time for the public and businesses to get ready for the Australian option on January 1st. pic.twitter.com/lLJfmIy9XI — Boris Johnson (@BorisJohnson) December 10, 2020
The exact scenario the UK and the EU are facing now is the one they desperately wanted to avoid. And whether they can actually avoid it may have a lot to do with the internal politics in the EU, but especially the UK.
Johnson is under pressure at home over his handling of Covid-19, and he’s facing a rebellion within his own Conservative Party, primarily over Covid-19 restrictions. That right flank of his party is also ardently pro-Brexit — the very same people who don’t want to see the UK concede to the EU and are, at least rhetorically, willing to risk the costs of no deal.
If Johnson is seen as caving to the EU, he may face pressure from these Brexiteers, and so his toughness serves a political purpose. The question is, will he take the brinkmanship to the last possible moment, only to reach a deal and claim victory — or will he see the politics of being able to blame the EU if negotiations feel more politically palatable, at least in the short term.
The EU has its own internal politics to consider, and it may now see the best option as pushing forward these short-term contingency plans and regrouping in 2021. And if that’s the case, well, Brexit won’t really be over, again.