Covid News: J.&J. Recipients May Be Better Off With Other Boosters

Date: 2021-10-13T09:01:07.000Z

Location: www.nytimes.com

People who received a Johnson & Johnson coronavirus vaccine may be better off with a booster shot from Moderna or Pfizer-BioNTech, according to preliminary data from a federal clinical trial published on Wednesday.

That finding, along with a mixed review by the Food and Drug Administration of the case made by Johnson & Johnson for an authorization of its booster, could lead to a heated debate about how and when to offer additional shots to the 15 million Americans who have received the single-dose vaccine.

The agency’s panel of vaccine advisers will meet Thursday and Friday to vote on whether to recommend that the agency allow Moderna and Johnson & Johnson to offer booster shots.

Despite the questions raised by the new data on the strength of Johnson & Johnson’s boosters, some experts anticipated that the agency would clear the shots anyway, since the effectiveness of the one-shot vaccine is lower than that of the two-dose mRNA vaccines made by Moderna and Pfizer-BioNTech. And the broader public may also be expecting the authorizations, given the Biden administration’s push for boosters from all brands.

Once the agency authorized a booster from Pfizer-BioNTech last month, “the die was cast,” said John Moore, a virologist at Weill Cornell Medicine.

The Pfizer and Moderna vaccines are by far the most used in the United States, with more than 170 million people in the United States fully immunized with either one or the other vaccine. When Johnson & Johnson’s was authorized in February, public health experts were eager to deploy the “one-and-done” option, particularly in communities with poor access to health care. But the shot’s popularity plummeted when the F.D.A. later paused its use to investigate rare blood clotting cases.

For those who have received the Johnson & Johnson vaccine, the timing of a booster authorization — of any brand — is still uncertain. The F.D.A. panel is set to vote Friday only on whether the agency should permit a second dose of the Johnson & Johnson vaccine, a scenario the Centers for Disease Control and Prevention’s own vaccine advisory committee will discuss next week. If both agencies believe an additional dose should be offered, people could seek them out as early as next week.

Whether the F.D.A. might authorize the mix-and-match approach, and how, is unclear. The strategy will be discussed at the agency panel’s meeting on Friday, but no vote will be taken. If regulators eventually believe there is enough scientific support for the approach, they would likely need to update the authorization language of the Moderna and Pfizer-BioNTech vaccines to allow for their use in people who initially received Johnson & Johnson’s.

In a study conducted by the National Institutes of Health, researchers organized nine groups of roughly 50 people each. Each group received one of the three authorized vaccines, followed by a booster. In three groups, volunteers received the same vaccine for a boost. In the other six, they switched to a different brand.

The researchers found that those who got a Johnson & Johnson shot followed by a Moderna booster saw their antibody levels rise 76-fold within 15 days, whereas those who received another dose of Johnson & Johnson saw only a fourfold rise in the same period. A Pfizer-BioNTech booster shot raised antibody levels in Johnson & Johnson recipients 35-fold.

The authors cautioned about the study’s small size and noted that they did not follow the volunteers long enough to identify rare side effects.

Sharon LaFraniere contributed reporting from Washington.

The World Health Organization on Wednesday named 26 scientists to a new advisory group charged with studying the origins of the coronavirus, opening another chapter of the fraught search for how the pandemic began.

The group, chosen from more than 700 applicants, includes scientists from 26 countries, a reflection of the W.H.O.’s effort to amass widespread international support for the work.

Among them are an American researcher — Dr. Inger Damon, a veteran of the country’s Ebola response who directs work on highly lethal diseases at the Centers for Disease Control and Prevention — and a Chinese scientist. The Chinese scientist, Dr. Yungui Yang, is the deputy director at the Beijing Institute of Genomics at the Chinese Academy of Sciences, a government institution.

With this new group, the W.H.O. is trying to revive its study of the pandemic’s origins. That work that had become bogged down in a political rivalry between China and the United States, and concerns about scientists’ conflicts of interest, since the W.H.O. sent a previous team to China in early 2021.

The result of that visit was a joint report by the W.H.O.-chosen team and China that said a leak of the coronavirus from a lab, while possible, was “extremely unlikely,” a conclusion that the W.H.O.’s director general, Tedros Adhanom Ghebreyesus, later called premature.

Six members of that since-disbanded W.H.O. team have joined the new advisory group. The committee also includes the head of a Swiss biosafety center, an indication of W.H.O.’s efforts to ensure that a laboratory leak be considered alongside scenarios in which the virus spilled over naturally from animals to humans.

“A lab accident cannot be ruled out until there is sufficient evidence to do so and those results are openly shared,” Dr. Tedros and two top W.H.O. officials wrote in an editorial in Science outlining the advisory group’s mandate.

After a two-week public comment period that is customary before W.H.O. advisory groups are set up, the committee will begin to meet.

W.H.O. officials said the group would assess recent studies, including those describing bats harboring close relatives of the virus behind Covid-19, and advise the organization on what future studies were needed — potentially including field research in China.

China has reacted angrily to the idea that the virus may have emerged from a lab and, analysts have said, is almost certain to resist outside requests to visit research centers, bat caves or wildlife farms within its borders.

Unlike the last W.H.O. team, which was assembled specifically for the visit to China, the new committee will also have a mandate to weigh in on the emergence of any new pathogens beyond the coronavirus, giving it a permanence that the W.H.O. hopes will help insulate it from political squabbling.

At a news briefing on Wednesday, Dr. Michael Ryan, the executive director of the W.H.O. Health Emergencies Program, said it was impossible to ignore obstacles like “national pride” standing in the way of hunting down the origins of the coronavirus. But he said the new advisory group was an effort to return to the scientific issues at the core of that effort.

“This is our best chance,” he said. “And it may be our last chance to understand the origins of this virus in a collegiate and collective and mutually responsible way.”

In Guatemala, shortages of syringes have slowed vaccination efforts. In Haiti, logistical and security challenges after the devastating Aug. 14 earthquake have contributed to making it the country with the lowest vaccination coverage in the world.

And across the Caribbean, countries are grappling with unequal distribution of doses and vaccine hesitancy, World Health Organization officials warned today in an online news conference.

An “important challenge that the Caribbean is facing — English-speaking countries and French- speaking countries and territories — is vaccine hesitancy,” said Dr. Sylvain Aldighieri, the Covid-19 incident manager at the Pan American Health Organization, which is part of the W.H.O.

“Even if some territories of the Caribbean are leading the regional effort in terms of vaccination coverage, we can say that the vaccine uptick is suboptimal in most of the Caribbean countries,” he said.

The W.H.O. has set a goal of having every country in the world vaccinate at least 40 percent of its population by the end of the year. Four of the six countries in the Americas that have yet to reach the 20 percent threshold are in the Caribbean: Haiti, Jamaica, St. Vincent and the Grenadines, and St. Lucia. The other two — Nicaragua and Guatemala — are in Central America.

“Across all these countries, vaccine availability due to unequal distribution of doses has been a central challenge,” said Dr. Carissa F. Etienne, the Pan-American agency’s director.

But several of the countries are also “facing their own unique barriers,” she added, like the shortage of syringes in Guatemala.

At the same time, Jamaica has had to cope with supply delays.

Haiti, where the August earthquake killed at least 2,200 people, has fully inoculated less than 1 percent of its population.

“The sociopolitical situation in Haiti is still tense, and that has negatively impacted” vaccination efforts, said Ciro Ugarte, the Pan-American agency’s director of health emergencies.

Countries in Latin America and the Caribbean receive vaccines through bilateral agreements with manufacturers as well as through the United Nations-backed Covax program and donations from countries with excess doses. The Pan-American agency has also sealed deals for countries to buy millions of vaccine doses from China’s Sinopharm and Sinovac, as well as from AstraZeneca.

Although the numbers of Covid cases in much of Latin America and the Caribbean are declining, several islands in the Caribbean are seeing increases.

Barbados, for example, is reporting the highest number of infections and deaths since the pandemic started, said Dr. Etienne, the agency’s director. The Dominican Republic, Haiti, the Cayman Islands, Antigua and Barbuda, and Anguilla are also reporting increases in cases.

“In the eastern Caribbean, health services have been — or are still — overwhelmed by the influx of patients requiring hospitalization,” Dr. Aldighieri said. He also noted that the situation was a sharp contrast to last year, when most of the Caribbean island countries were largely able to avoid widespread transmission of the virus.

Despite vaccine hesitancy, 39 percent of the population across Latin America and the Caribbean have been fully vaccinated against Covid-19, Dr. Etienne said. That is sharply higher than in Africa, where less than 5 percent of the population has been fully vaccinated, according to the Africa Centers for Disease Control and Prevention.

As more vaccines start to flow to the region, though, it’s important for countries “to make the necessary preparations so these doses can be used as quickly as possible,” Dr. Etienne said.

Daniel Politi

Kyrie Irving, the N.B.A. star who has been indefinitely barred from practicing or playing with the Brooklyn Nets because of his refusal to get the Covid-19 vaccine, spoke out publicly on Wednesday night for the first time since the team decided to keep him off the court, saying his refusal was a matter of personal freedom.

“You think I really want to lose money?” Irving, who is set to earn about $40 million in salary this season, said on his Instagram feed in a meandering monologue that included incorrect medical information. More than 90 percent of players in the league are vaccinated, a proportion much higher than in the general population of the United States.

“You think I really want to give up on my dream to go after a championship?” Irving, 29, said. “You think I really just want to give up my job? You think I really want to sit at home?”

On Tuesday, the Nets said they had barred Irving from playing until he becomes “eligible to be a full participant.” New York City requires most teenagers and adults to have at least one vaccination shot to enter facilities such as sports arenas, and Irving has not practiced with the Nets in Brooklyn. Irving joined the Nets in 2019 as they built a team of superstars that includes Kevin Durant and James Harden.

Irving asked that his decision to remain unvaccinated be respected and said that he has no plans to retire. He couched his refusal to get vaccinated in his opposition to mandates, saying nobody should be “forced” to do it.

Irving falsely claimed his decision to remain unvaccinated does not harm other people. The highly contagious Delta variant has quickly spread in areas with low vaccination rates. And hospitals in those areas have been overrun with unvaccinated patients, leaving few beds and staff members to treat other patients.

Ricarlo Flanagan, a comedian, actor and rapper best known for his appearances on TV’s “Last Comic Standing” and “Shameless,” died on Saturday in Los Angeles. He was 41.

He contracted Covid-19 a few weeks ago, said his representative, Stu Golfman, who could not confirm the disease was the cause of Mr. Flanagan’s death.

On Oct. 1, Mr. Flanagan said on Twitter that “this Covid is no joke. I don’t wish this on anybody.”

On “Last Comic Standing,” Norm Macdonald, a comedian and a judge on the show who died recently, said Mr. Flanagan was his favorite comic in the competition.

“I was stunned,” Mr. Flanagan would later say about the exchange.

After his run on “Last Comic Standing,” he appeared on several TV shows, including “Insecure” and “Shameless,” the Showtime series that featured him in a four-episode arc, according to his IMDb page.

He discovered his love of stand-up after he took a comedy class that he saw advertised on a flyer in Ann Arbor, Mich., according to a statement from his representative.

“After the first class, he was hooked and never stopped getting on stage,” the statement said.

He had moved to Michigan after graduating from college in 2007, but his comedic talents soon brought him to Los Angeles, his representative said.

Mr. Flanagan also dabbled in rap, tweeting recently that he had almost finished an album. In a song called “Revolution” that he released last year, he lamented police brutality and said, “We got to mobilize.”

“I’m tired of seeing my brother on the ground with his face pinned down,” he rapped.

Ricarlo Erik Flanagan was born on March 23, 1980, in Cleveland, according to a death announcement. He is survived by his mother, Katrina McLeod, his father, Keith Flanagan, and his grandmother, along with several aunts, uncles and cousins.

Blackstone, the giant private equity firm, will require employees who want to work in its London office to be vaccinated beginning next week, as the American company takes a more forceful approach to vaccinations than many other businesses in Britain.

Across the United States, vaccine mandates, which require employees to be inoculated to remain in their jobs, are becoming increasingly common ahead of a rule by President Biden that will apply to companies with more than 100 employees.

But in Britain, data protection and employment discrimination laws have prevented companies from mandating their own “no jab, no job” policies and have made it harder to physically separate unvaccinated workers. Instead, companies have been advised to encourage vaccinations rather than enforce them.

Starting Monday, only fully vaccinated employees will be allowed to work at Blackstone’s London office, according to a memo seen by The New York Times. The company is asking employees to voluntarily upload proof of vaccination to an internal system. Though it has been encouraging its staff to return to the office, working in the office is voluntary. Vaccinated employees will still need to have a negative Covid-19 test to go to the office, where more than 400 people work.

“The health and well-being of our people is our number-one priority,” Blackstone said in a statement. “Data shows that vaccines prevent serious illness or hospitalization, and we believe that this is the best way, for now, to help protect our employees and their families.”

This is one of the challenges facing international companies as they bring workers back to their offices, with employees facing different requirements in different countries. In the United States, Blackstone asked vaccinated deal makers to return to the office three months ago. An American law firm, Morrison & Foerster, reportedly said in August that its London staff needed to be vaccinated to return to the office in mid-September.

Requiring vaccinations to return to a British office is “not entirely unheard-of, but not too many companies that I’m aware of have taken that step yet,” said Holly Cudbill, an employment lawyer at Blake Morgan. “At the moment, the focus very much has been on encouragement rather than mandating that people are vaccinated.” But companies have been asking if this is something they can, or should, do, she added.

The publishing house Bloomsbury, which said Thursday that it would require any employees returning to the office to be vaccinated, is another rare example.

One of the challenges in mandating vaccinations is that it would require proof of a jab, and medical records have special protection under British data privacy laws, which means there needs to be a good legal reason to hold this information.

A related concern is that if workers who aren’t vaccinated for medical or religious reasons are then treated differently from other staff because they are not in the office, the company could be accused of discrimination. But if companies can show they have a justifiable reason for collecting this data and the request is a proportionate measure to achieve a legitimate aim, the legal risks are diminished, said Lucy Lewis, an employment lawyer and partner at Lewis Silkin.

“The challenge for employers is, is it justifiable if you’re taking other Covid-secure measures within the business?” Ms. Lewis said. “For example, if you’re continuing to retain social distancing, if there’s an element of mask wearing, can you satisfy that test that requiring vaccination is reasonable within an organization?”

It’s more common for companies to ask people to be double-vaccinated or show evidence of a negative Covid test, currently freely available in Britain, to go into the office, she said. She doesn’t expect requiring vaccines to work in the office to become the norm in Britain.

“Whether it’s possible comes down to you being able to essentially demonstrate to a court that doing it was necessary within your business,” Ms. Lewis said. “In types of businesses where you’ve got a lot of very vulnerable people, it’s much more likely to be reasonable because the risk to those people is that much greater.”

The furthest Britain has gone in making vaccines compulsory for work is in nursing homes. The government has said anyone working or volunteering in nursing homes, unless medically exempt, must be vaccinated beginning Nov. 11. Even to take this step, Parliament had to pass a new piece of legislation, which is now the subject of legal challenges.

In Britain, vaccine uptake is high, with 78 percent of the population over the age of 12 vaccinated. But there are disparities across age groups, with younger cohorts less likely to be vaccinated. In the United States, there is some evidence that vaccine mandates have increased rates above 90 percent within companies.

Businesses can decide who does and doesn’t enter their premises, especially for health and safety reasons. But in the case of the coronavirus, if other measures like mask-wearing, ventilation and social distancing can reduce the risks, it’s difficult to justify barring people’s entry, Ms. Cudbill said.

“I think that they can justify it, but they just need to think about how and make sure it’s not just a knee-jerk reaction,” she said. “Because it will be challenged. There’s absolutely no doubt.”

Intensive care units are nearing capacity and health care workers are in short supply in Minnesota, as coronavirus cases, hospitalizations and deaths all reach levels not seen since vaccines became widely available.

All of the state’s counties are at high risk for community transmission, according to the Centers for Disease Control and Prevention. New daily cases have risen by 29 percent in the last two weeks and hospitalizations by 17 percent, according to a New York Times database.

About this data Source: U.S. Department of Health and Human Services. The seven-day average is the average of a day and the previous six days of data. Currently hospitalized is the most recent number of patients with Covid-19 reported by hospitals in the state for the four days prior. Dips and spikes could be due to inconsistent reporting by hospitals. Hospitalization numbers early in the pandemic are undercounts due to incomplete reporting by hospitals to the federal government.

The state’s daily case average is at its highest level for 2021 and reached 2,932 on Monday, a dramatic increase since the summer, when it bottomed out at an average of 81 daily cases.

While a monthslong increase driven by the Delta virus variant is waning in much of the country, Minnesota is just one of several Upper Midwestern and Mountain West states where the virus is surging. Cases are up and hospitals have been overwhelmed in North Dakota, Wyoming, Montana and Idaho, all of which have low vaccination rates. Some areas have had to ration care and send patients to distant hospitals for treatment.

The Minnesota Department of Health said the state’s surge is overwhelming hospitals, with rural and metropolitan areas equally stretched.

“Even before Covid cases started to rise in this latest surge, our hospitals were very full with patients needing care for other critical conditions,” Jan Malcolm, the state’s health commissioner, said in a news conference last week.

According to a state health department database, 96 percent of I.C.U. beds in Minnesota are in use along with 93 percent of non-intensive care beds. Although beds are almost at capacity, the state is equipped with respirators to combat the surge, Ms. Malcolm said. The bigger issue now is a shortage of medical personnel, she said.

“What’s important to understand is that this isn’t so much about the physical asset of a hospital bed or a ventilator, and those were big focuses earlier in the pandemic, but now this is really an issue of health care worker capacity,” Ms. Malcolm said. “There are actually fewer health care workers on the job today than there were last year due to the extreme stress and burnout that they have faced for over 18 months now.”

Dr. Kevin Croston, chief executive officer at North Memorial Health, one of Minnesota’s largest medical systems, said “every element of our health system is incredibly stressed.”

Both hospitals run by North Memorial — North Memorial in Robbinsdale and Maple Grove Hospital — are almost running at capacity and are experiencing staffing shortages that have reached a “critical level.”

“Staff vacancies are increasing while our customer patient volumes remain high,” Mr. Croston said. “We have rapidly escalated measures to attract and retain talent in health care and that’s adding more expense to an already stressed financial picture for all these health care systems.”

He also noted that all patients hospitalized with Covid were unvaccinated.

In Minnesota, 59 percent of the state’s population is fully vaccinated compared to 56 percent of the population nationally.

“With the amount of virus that’s out there and the amount of the population that is not protected by the vaccine, there’s unfortunately plenty of room for the virus to still do its harm,” Ms. Malcolm said.

President Biden said Wednesday afternoon that his administration is taking steps to untangle supply chains and clear disruptions that have threatened the holiday shopping season, including moving a key port and some large retailers toward round-the-clock operations.

Speaking from the White House, Mr. Biden said the country must “take a longer view” and invest in shoring up supply chain vulnerabilities that have been exposed by the Covid-19 pandemic.

The remarks came as the White House sought to spotlight its efforts to address the problems in ports, factories and shipping lanes that have helped produce shortages, long delivery times and rapid price increases for food, televisions, automobiles and much more.

The resulting inflation has chilled consumer confidence and weighed on Mr. Biden’s approval ratings. On Wednesday, the Labor Department announced that the Consumer Price Index, a key reading of monthly inflation, jumped 5.4 percent in September when compared with the prior year, raising the stakes for the White House and the Federal Reserve.

Mr. Biden cheered an announcement that the Port of Los Angeles will begin operating around the clock as his administration struggles to relieve growing backlogs in the global supply chains that deliver critical goods to the United States.

“Today’s announcement has the potential to be a game-changer,” Mr. Biden said, but added that its success would depend on private retailers taking steps to more rapidly move products from ports to stores around the country.

Administration officials say that they have brokered a deal to move the Port of Los Angeles toward 24/7 operations, joining Long Beach, which is already operating around the clock, and that they are encouraging states to accelerate the licensing of more truck drivers. UPS, Walmart and FedEx will also announce they are moving to work more off-peak hours.

Mr. Biden’s team, including a supply chain task force he established earlier this year, is working to make tangible progress toward unblocking the flow of goods and helping the retail industry return to a prepandemic normal.

But it is unclear how much the White House’s efforts can realistically help. The blockages stretch up and down supply chains, from foreign harbors to American rail yards and warehouses. Companies are exacerbating the situation by rushing to obtain products and bidding up their own prices. Analysts say some of these issues may last into late next year or even 2023.

Reporters peppered Jen Psaki, the White House press secretary, with questions Wednesday about lingering effects on holiday shopping, including whether she could guarantee it would not be disrupted by supply chain issues. “We cannot guarantee,” she said. “What we can do is use every lever at the federal level to reduce delays.”

Chinese authorities are rolling out third shots of coronavirus vaccines for high-risk groups in at least 10 regions, according to state media, as the country races to meet its goal of fully vaccinating 80 percent of its population by the end of the year.

After a series of outbreaks of the Delta variant, Wang Huaqing, chief expert for China’s immunization program at the Chinese Center for Disease Control, recommended last month that additional shots be administered to people in frontline professions, including medical workers; people with weaker immune systems; those age 60 or older; and travelers going to countries deemed at high risk.

Chinese health officials have said that further studies were still needed to determine whether the rest of the population would benefit from getting an additional shot.

By Sunday, more than 40,000 people in Hubei, the province encompassing Wuhan where the virus first emerged, had received booster shots, according to state media reports. In the northeastern province of Heilongjiang, which had a flare-up of the Delta variant last month, local health officials said that people who got the booster shot would see their government-issued health codes upgraded to reflect their strengthened immune status.

Last month, China announced that it had fully inoculated 1 billion people, or about 71 percent of its population of 1.4 billion. The country has administered 2.21 billion doses, more than twice that of India, which is ranked second for shots given, according to Our World in Data, which tracks vaccination figures.

Despite its high vaccination rate, China has shown no signs of abandoning its “zero Covid” strategy, and has instead continued to employ a mix of stringent border controls, mass testing and snap lockdowns to tame outbreaks.

On Monday, a panel of experts advising the World Health Organization recommended that an additional dose be administered to people over 60 who were inoculated with vaccines made by the Chinese companies Sinopharm and Sinovac. The panel cited evidence from studies in Latin America that immune protection from the Chinese vaccines wanes significantly over time. While the experts also recommended additional doses of the seven W.H.O.-authorized vaccines for people with weaker immune systems, the Chinese-made shots were the only ones that were singled out for expanded use for older people in the general population.

In a nod to concerns that poorer countries are struggling to offer first doses to their populations while some wealthier countries administer boosters, the W.H.O. panel recommended that health authorities using the Sinovac and Sinopharm vaccines aim to fully inoculate older populations before administering third doses.

Authorities in Turkey have already been allowing people inoculated with Sinovac’s vaccine to get an additional shot of the Pfizer vaccine to help facilitate travel to countries where the Chinese vaccines have not been approved.

More than 1 billion Chinese-made doses have been administered in over 90 countries outside China, though outbreaks in several countries over the summer have raised questions about the efficacy of the shots at preventing the spread of the virus, especially new variants.

The concerns have not slowed China’s efforts to engage in vaccine diplomacy. Last month, the Pan American Health Organization struck a deal with Sinovac to buy millions of Covid-19 vaccines for countries in Latin America and the Caribbean where access to vaccines has been highly uneven.

The Anchorage Assembly approved a mask mandate on Tuesday after two weeks of heated public discussion amid a Covid outbreak that has forced doctors to ration life-saving care in Alaska’s largest city.

The vote was 9-1, concluding a tense, often chaotic debate that included doctors being heckled by members of the public, an armed man being arrested, and protesters sparking outrage by turning up to meetings wearing Stars of David — an attempt to liken mask requirements to the persecution of Jews in the Holocaust.

“The time to act is now,” Meg Zaletel, an assembly member, said on Tuesday night while pressing for a vote. One person in the crowd shouted objections, leading security officers to intervene.

The order requires everyone to wear a mask or face covering in public indoor spaces, with limited exemptions for younger children and for religious or medical reasons.

Alaska has recorded the highest coronavirus case numbers per person in the United States in recent weeks. Although new infections have fallen from a late September high, the surge has overwhelmed hospitals, especially in Anchorage, where many of the state’s patients come for critical needs.

About this data Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of a day and the previous six days of data.

Heart surgeries have been canceled to preserve space in hospitals. One facility rationed oxygen. And doctors have been forced to implement “crisis standards of care,” prioritizing some critical patients over others because of the lack of resources.

One patient who needed emergency surgery was not attended to; a second was taken off of dialysis because another needed it. In both cases, the patients who received substandard care died.

Gov. Mike Dunleavy has resisted a statewide mask mandate, but assembly members in Anchorage — home to about 40 percent of the state’s population — moved forward. Doctors had gone to the assembly meetings in recent weeks to detail the crisis they have been facing, but they faced blowback from community members. One man followed doctors out of a meeting, calling them liars.

Anchorage Mayor Dave Bronson, who has opposed a mask requirement, vowed to veto the mandate, although it appears the assembly has the votes to override it.

About 51 percent of Alaska’s population is fully vaccinated, according to a New York Times database, lower than the national figure of 57 percent.

By the time vaccines for the coronavirus were introduced late last year, the pandemic had taken two of Lucenia Williams Dunn’s close friends. Still, Ms. Dunn, the former mayor of Tuskegee, contemplated for months whether to be inoculated.

It was a complicated consideration, framed by the government’s botched response to the pandemic, its disproportionate toll on Black communities and an infamous 40-year government experiment for which her hometown is often associated.

“I thought about the vaccine most every day,” said Ms. Dunn, 78, who finally walked into a pharmacy this summer and rolled up her sleeve for a shot, convinced after weighing with her family and doctor the possible consequences of remaining unvaccinated.

“What people need to understand is some of the hesitancy is rooted in a horrible history, and for some, it’s truly a process of asking the right questions to get to a place of getting the vaccine.”

In the first months after the vaccine rollout, Black Americans were far less likely than white Americans to be vaccinated. In addition to the difficulty of obtaining shots in their communities, their hesitancy was fueled by a powerful combination of general mistrust of the government and medical institutions, and misinformation over the safety and efficacy of the vaccines.

But a wave of pro-vaccine campaigns and a surge of virus hospitalizations and deaths this summer, mostly among the unvaccinated and caused by the highly contagious Delta variant, have narrowed the gap, experts say. So, too, have the Food and Drug Administration’s full approval of a vaccine and new employer mandates. A steadfast resistance to vaccines in some white communities may also have contributed to the lessening disparity.

A panel of independent medical experts on Thursday unanimously recommended Moderna booster shots for many of those who had received the company’s coronavirus vaccine, paving the way to sharply expand the number of people eligible for an additional shot in the United States.

The advisory panel to the Food and Drug Administration voted 19 to 0 in favor of emergency authorization of a half-dose booster, at least six months after the second dose. Those eligible for the extra shot would include people over 65 and other adults considered at high risk — the same groups now eligible for a Pfizer-BioNTech booster.

The F.D.A. typically follows the panel’s advice, and should rule within days.

The recommendations come as the nation is seeing a decline in coronavirus cases but still faces nearly 90,000 new infections and roughly 1,800 deaths per day. The Biden administration has cast booster shots as an additional tool in the battle against the pandemic, while acknowledging that controlling the disease’s spread depends upon vaccinating tens of millions of Americans for the first time.

In a speech at the White House on Thursday, President Biden once again sought to rally businesses to support vaccination mandates that he said would help reduce the ranks of the unvaccinated in the United States, calling the number of people who have not gotten even a first shot “unacceptably high.”

More than seven million people in the United States have already obtained booster doses of the Pfizer-BioNTech vaccine, and more than a million have received third doses of Moderna’s, even though only those with immune deficiencies are officially eligible.

On Friday, the same expert committee will meet to discuss and vote on whether the roughly 15 million people who received the single-dose Johnson & Johnson vaccine should also be eligible for booster doses. Its members are also supposed to discuss a new federal study that suggests those Americans might be better off getting a booster dose of the Moderna or Pfizer-BioNTech vaccines.

If the F.D.A. quickly authorizes Moderna booster doses, and if the Centers for Disease Control and Prevention signs off after a meeting of its own committee of vaccine experts next week, people in the eligible groups could begin seeking out the shots soon after. In addition to people over 65, those groups include younger adults at high risk of severe Covid-19 or serious complications because of medical conditions or their jobs.

To date, more than 103 million people in the United States have been fully vaccinated with Pfizer’s product, more than 69 million with Moderna’s and about 15 million with the Johnson & Johnson shot.

Dr. Patrick Moore, a panel member and virologist at the University of Pittsburgh, said he voted to recommend a Moderna booster based on a “gut feeling, rather than based on really, truly serious data.” Others questioned whether half a dose was the right amount, and whether a Moderna booster would work better if it was given at least eight months after the second shot, instead of six months.

It can be hard to keep track of developments on coronavirus vaccine boosters without a scorecard.

The Food and Drug Administration’s panel of expert advisers voted on Thursday to recommend booster shots for many recipients of the Moderna coronavirus vaccine, and on Friday to recommend boosters for recipients of Johnson & Johnson’s vaccine who are ages 18 and older, at least two months after receiving the first dose.

The agency has already authorized booster shots of the other vaccine in use in the United States, from Pfizer-BioNTech, for certain groups who got that vaccine initially. Third doses of the Pfizer-BioNTech and Moderna vaccines also have been authorized for some people with weaker immune systems, who may not have gotten full protection from the original two doses.

All three vaccines initially provide very strong protection against infection, serious illness and death from Covid-19. The impetus for boosters comes from studies suggesting that while that protection remains strong against serious illness and death, it may decline somewhat over time and could allow more breakthrough infections, especially of the highly contagious Delta variant. The decline tends to be most pronounced in older people and those with certain underlying medical conditions.

Here is a rundown of the booster-shot situation for the three vaccines available in the United States.

What you would get: A third full dose, at least six months after your second.

Where it stands in the U.S.: Available now for many people. The F.D.A. has authorized third shots for people over 65, people with certain medical conditions and some others who are at high risk because of where they work or live. (Some immunocompromised people can get a third shot a month after their second.) The agency has put off a decision on whether to authorize boosters for other people.

Where it stands elsewhere: Israel and some other countries are administering Pfizer-BioNTech booster shots widely.

What the science says: The Pfizer-BioNTech vaccine was the first to win full approval in the United States (for those 16 and older), the first to be authorized for some children (those 12 to 15) and the first to be authorized for boosters; the available data on its safety and effectiveness is especially robust. Some studies suggest that the vaccine may decline in effectiveness over time a bit more than the Moderna vaccine.

What you would get: A half-dose, at least six months after your second full dose.

Where it stands in the U.S.: An F.D.A. advisory panel voted on Thursday to recommend Moderna boosters for the same population groups who are now eligible for a Pfizer booster. The panel’s vote is nonbinding, but its recommendations are generally followed by the F.D.A. (Some immunocompromised people can receive a full third dose a month after their second.)

Where it stands elsewhere: Some countries are already offering Moderna booster shots or planning to do so soon.

What the science says: Some studies suggest that the Moderna vaccine’s effectiveness declines less than the other two vaccines available in the United States do. That may mean there is less need for Moderna recipients to get boosters. Taking that into account, an F.D.A. staff report took a neutral stance on Moderna’s booster-shot application.

What you would get: A second dose, at least two months after the initial dose.

Where it stands in the U.S.: The F.D.A. advisory panel unanimously voted on Friday to recommend boosters, even though an F.D.A. staff report found significant shortcomings in the data that the company submitted with its application. The F.D.A. is not required to follow the panel’s suggestions, but it usually does.

Where it stands elsewhere: No country has yet authorized administering second doses of the Johnson & Johnson vaccine.

What the science says: The Johnson & Johnson vaccine gives strong initial protection after one dose, though not as strong as the Pfizer or Moderna two-dose vaccines, so there has long been interest in boosters for Johnson & Johnson recipients.

An independent panel of experts advising the Food and Drug Administration voted on Thursday to recommend a booster shot for many recipients of the Moderna coronavirus vaccine, and on Friday to recommend authorizing booster shots of Johnson & Johnson’s one-dose coronavirus vaccine for people 18 years or older, at least two months after the first dose.

So what happens now? There are further steps at the F.D.A., then steps at the Centers for Disease Control and Prevention, and the process ends with the states. Here’s how it breaks down.

  • The F.D.A., a federal agency of the Department of Health and Human Services that controls and supervises medications and other elements related to public health, takes up the advisory panel’s recommendation, which includes the question of who should be eligible. The advisory panel’s votes are not binding, but the F.D.A. typically follows them.

  • The F.D.A.’s top official — its acting commissioner, Dr. Janet Woodcock — issues the agency’s final determination on whether to authorize the boosters and for whom. Such decisions are typically issued within a few days of advisory committee meetings.

  • An advisory panel to the Centers for Disease Control and Prevention, the United States’ public health agency, reviews the F.D.A.’s decision. On Thursday and Friday of next week, that panel is scheduled to meet and vote on its recommendations regarding boosters.

  • The C.D.C. takes up that panel’s recommendations, and the agency’s director, Dr. Rochelle P. Walensky, issues the agency’s guidance on whether boosters should be used and who should be eligible. That guidance is deeply influential for states, doctors, pharmacies and other health care institutions and the general public. As with the process at the F.D.A., the panel’s recommendations are not binding, but the C.D.C. usually follows them.

    However, there was a rare exception last month: When a C.D.C. advisory panel rejected the F.D.A.’s recommendation that frontline workers be included among those eligible for the Pfizer-BioNTech booster, Dr. Walensky overrode her own agency’s advisers and sided with the F.D.A.

State health departments generally follow the recommendations of the C.D.C. In the case of the Pfizer-BioNTech booster, the shots began being administered widely immediately after Dr. Walensky announced the C.D.C.’s guidance to allow them for people over 65, patients in nursing homes and other institutional settings, those with underlying medical conditions, and frontline workers.

The Food and Drug Administration’s panel of expert advisers voted on Friday to recommend authorizing booster shots of Johnson & Johnson’s one-dose vaccine for people 18 and older, at least two months after the first dose. The committee also voted on Thursday to recommend booster shots for many recipients of the Moderna coronavirus vaccine.

While the panel’s recommendations are not binding, they are very likely to influence the F.D.A.’s decision — typically issued within a few days after the advisory committee weighs in. If the agency says yes to the boosters, the process moves to the Centers for Disease Control and Prevention.

Who are the experts on the F.D.A.’s Vaccines and Related Biological Products Advisory Committee?

The committee now has 19 voting members who are scientific authorities from a range of fields, including immunology, vaccine safety and virology. Many are medical practitioners.

Dr. Arnold Monto, the acting chair of the committee, is a professor of epidemiology at the University of Michigan School of Public Health.

Here are the other voting members:

  • Dr. Archana Chatterjee, a pediatric infectious diseases specialist, is the dean of the Chicago Medical School and vice president for medical affairs at Rosalind Franklin University of Medicine and Science.

  • Capt. Amanda Cohn is a doctor and senior official overseeing vaccine policy at the C.D.C.’s National Center for Immunization and Respiratory Diseases.

  • Dr. Oveta Fuller is a trained pathologist and an associate professor of microbiology and immunology at University of Michigan Medical School.

  • Dr. Hayley Gans is a professor of pediatrics infectious diseases at Stanford University Medical Center.

  • Dr. James Hildreth is a professor of medicine and the president and chief executive officer of Meharry Medical College.

  • Dr. Randy Hawkins is a practicing physician who specializes in internal medicine and sits on the committee as a consumer representative.

  • Dr. Michael Kurilla is a senior official with expertise in infectious diseases and vaccine development at the National Institutes of Health.

  • Dr. Jeanette Lee is a professor of biostatistics at the University of Arkansas For Medical Sciences in Little Rock, Ark., and an expert on clinical trials.

  • Dr. Ofer Levy is the director of the Precision Vaccines Program at Boston Children’s Hospital, and a professor of pediatrics at Harvard Medical School.

  • Dr. H. Cody Meissner is professor of pediatric infectious disease at the Tufts University School of Medicine and Tufts Children’s Hospital in Boston.

  • Dr. Patrick Moore is a professor of microbiology and molecular genetics at the University of Pittsburgh.

  • Dr. Michael Nelson is a professor of medicine at the University of Virginia in Charlottesville. He is also president of the American Board of Allergy and Immunology.

  • Dr. Paul Offit is a professor of pediatrics at Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine.

  • Dr. Steven Pergam is an expert on infectious diseases at the Fred Hutchinson Cancer Research Center in Seattle and an associate professor at the University of Washington.

  • Dr. Stanley Perlman is professor of microbiology and immunology at the University of Iowa, and a pediatric infectious diseases specialist with expertise in coronaviruses.

  • Dr. Eric Rubin is the editor in chief of the New England Journal of Medicine and an expert on infectious diseases at the Harvard T.H. Chan School of Public Health.

  • Dr. Mark Sawyer is a professor of pediatrics and a pediatric infectious disease specialist at the University of California, San Diego, and Rady Children’s Hospital in San Diego.

  • Dr. Melinda Wharton is the associate director for vaccine policy at the C.D.C.’s National Center for Immunization and Respiratory Diseases.

While the number of daily Covid cases in Utah has begun to fall, the state’s hospitals are still overwhelmed and public health leaders are asking residents not to let their guards down.

There were 570 people hospitalized with Covid-19 on Wednesday, nearing the state’s peak in January, when vaccines weren’t yet widely available, according to a New York Times database. Although new coronavirus cases are trending down, the number of Covid patients remains high and is overstretching hospitals in Utah.

That is why public health leaders in a news briefing on Wednesday warned people to remain vigilant and get vaccinated.

“Now is not the time to let your guard down. Covid is not over,” Dr. Russell Vinik, the chief medical officer at the University of Utah Health, said at the news briefing.

The difference between this latest surge and last winter’s is that Utah doesn’t have as many health care workers to treat Covid patients, Dr. Vinik said. Patients who can no longer delay routine care are streaming back into medical facilities. Health care workers across the country are quitting from burnout, while some in Utah have been lured to other states, such as Nebraska and New York, with the promise of extra pay.

Nationally, Covid hospitalizations are trending downward, according to a New York Times database, but cases and hospitalizations have plateaued at high levels in several states in the Mountain West and Upper Midwest.

Hospitalizations in Idaho set a pandemic record on Oct. 2, but are trending slightly downward again. In Wyoming and Montana, hospitalizations have nearly reached peak levels in recent weeks.

The rate of fully vaccinated people in Utah — 52 percent — is lower than the national figure of 57 percent, according to a New York Times database. But the state’s vaccination rate is still far ahead of most of its neighbors, including Idaho and Wyoming.