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 Edward Jenner invented the small pox vaccine in 1796. Before this a method called variolation was used. Pieces of fabric or threads moistened with a sick person's small pox postules were pulled through incisions in a person's arm. This was effective until Edward Jenner invented the vaccine itself for mass vaccination efforts. Tom Parfitt of The Times writes about how Catherine Empress of Russia invited Dr Dimsdale from Britain to give her the inoculation against smallpox. She became the first person to be inoculated in Russia and had the courage to do so after this method had been tried and successfully tested in Britain. Catherine writes in this letter to Count Rumyantsev that she had only mild discomfort. She then championed smallpox inoculation for the Russian people and says "it does not call for huge expenditure." Today the Russian government is making its best efforts to vaccinate the Russian people, yet only 38% are fully vaccinated. The example of a medical revolution 200 years ago and how it was handled in Europe is new inspiration for renewed efforts. ...

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Sabrina Tavernise writes about vaccine skeptics in the US. She sees it as a problem about gut beliefs. It is prevalent among people of different political views, not just conservatives. The misinformation on vaccines has made people who normally would be open to getting vaccinated a bit leery. Because of the flood of information spread in today's hyper sensitive news environment, including misinformation. Tavernise describes how different people in the US tackle the decision to get vaccinated or not and how this leads some to simply postpone getting vaccinated. Britain tackled this problem of spreading misinformation on vaccine effectiveness or risks early. It also helped that in Britain there is a very high regard for the National Health Service, the NHS. In Germany and also in France there was increasing skepticism in the beginning, yet this is reversible as there is growing recognition of the benefit of taking the vaccine in Germany and France. Much can and needs to be done to create public confidence and limit the spread of misinformation that leads to postponement of vaccination at a time when variants are becoming more contagious. ...

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In his farewell speech Boris Johnson, with true British resilient spirit,  says "I will be giving fervent support to Liz Truss and her government every step of the way." Johnson likened his transfer of power to Ms Truss to a relay race. "The baton will be handed over," saying it "unexpectedly turned into a relay race, they changed the rules halfway through." But he expressed no feelings of regret, having come to terms with the arrangement in his own way. More likely Johnson is without saying it still determining the policies and direction of the government, perhaps more so now with Liz Truss and his loyalists the only persons in the cabinet and running the British government. Johnson addressed people's fears about the energy price increases- "the UK would continue to have the strength to give people cash they need to get through this energy crisis that is caused by Putin's vicious war."  He listed his government's achievements- the response to Covid. Some of this is forgotten as the UK not the EU leadership was first to move forward with vaccination plans. Johnson put his government's faith in the vaccine invented at Oxford University and committed early while the EU languished under Merkel and her protege Ursula Von der Leyen. The EU fell behind in providing vaccine leadership as Britain forged ahead early, giving hope to the rest of the world's population including India that adopted the Oxford vaccine. Johnson likened his role to the missions to the planets- "Let me say I am now like one of those booster rockets that has fulfilled its function and I will be re-entering the atmosphere and splashing down invisibly into some remote and obscure corner of the Pacific." Johnson has taken the situation in a truly British way without any rancor and gracefully. With Liz Truss in charge he even gets a break after the difficult period handling the once in a century pandemic, handing over to a younger member of his group, and yet deciding on many of the policies and guiding the government for the term it was elected for to 2024. History will look at him favorably for his handling of the pandemic and vaccination, and for his instincts about the Ukraine war and Britain's unwavering support, and now in guiding Truss to provide Britain with strong support for the cost of living crisis caused by the war. His failings stem partly from his exuberance and optimistic spirit, but nowhere near detract from these achievements. ...

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Vaccine mandates are becoming a favored action as companies and governments see the dangers of rapid spread of highly transmissible delta variant. Following the action by the French government to make vaccinations mandatory for all healthcare workers, and require health pass passe sanitaire showing one is fully vaccinated at restaurants, cafes, and trains, more governments are taking up this action. This is supported by French premier Castex showing that 97% of the 18000 average daily cases in France this week, up 150% from prior week, are from unvaccinated people. Similar situation prevails in the US making it critical that governments take action early, and not miss the right time for such action.

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The Oxford vaccine developed by British scientists could be ready by September. Astra Zeneca has joined with Oxford so that it can produce 100 million vaccine doses by the end of the year. This is because in a sense the vaccine is not new. It uses an existing tech platform where there is a lot of experience. The use of ring vaccination method shortens the process of testing on humans the vaccine to a few months. The core of the virus ChAdox1 already exists in chimpanzees and has a mild effect on humans. This is an adenovirus. It is combined with another virus to produce the covid vaccine for coronavirus. Researchers at Oxford have used ChAdox1 in the past to test vaccines for Ebola and MERS as well as other virus.  Already tests have been conducted on rhesus macaques. The rhesus macaques given the vaccine at a Montana lab did not get coronavirus.The surface protein of coronavirus is simply added to the ChAdox1 so that it is able to attach to host cells and infect them in the human body, and let antibodies develop from this. The purpose is to let the human body develop defense mechanism against this attaching to a human cell.   ...

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The lack of vaccine supplies in Africa and Latin America, parts of Asia, is a major problem in 2021. Of the 66 million doses of vaccine planned to be given to Africa under COVAX plan only 19 million have been delivered. In total about 49 million doses have been delivered. Vaccine shortages are a result of the huge wave of coronavirus in India in April, so that vaccine shipments from India have stalled. Of the countries in Africa a few have made some progress- Egypt, Ghana, Nigeria. Other problems in Africa are lack of trained people to give vaccination. Last week 2.3 billion dollars in additional funds were raised at a donor conference for COVAX, the initiative for poor countries vaccines. That is enough to buy 1.8 billion doses. US and UK have not exported vaccines. India has made a good start in shipping vaccines to many countries in Africa, Asia and Latin America as shown in the Ministry of External Affairs website of the Indian government. For India to do this once it meets its own needs and resume exports, vaccine patent protection needs to be lifted for sometime, which the US is now accepting. ...

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The Jal Jeevan Mission (tap water for all), Swacch Bharat Mission (Clean India), cooking gas for rural women, digital bank accounts for all, and other projects pushed forward by Mr. Modi are changing life for India's 1.3 billion people. Gati Shakti is a master plan for integrated development of infrastructure by bringing in all ministries of federal and local governments together to work together in an overall plan. Because of the new digital capabilities in 2021, and large technical capabilities India is witnessing development in a way that is unprecedented. Uttar Pradesh, India's largest state in the north with a population of 230 million, is the focus of a major development transformation through infrastructure building with determined effort at the state and federal levels. For the first time Mr. Modi is ensuring projects are part of a master plan for transforming the country making certain projects get done on time, efficiently and without leakage of funds. The best evidence of this delivery of services is the vaccination drive with nearly 1.4 billion people vaccinated. And projects to complete new vaccine development including mRNA vaccine that does not require cold storage, and is easier to provide. ...

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US secretary of state Anthony Blinken meets Indian foreign minister Jaishankar, and prime minister Modi in New Delhi. India and the US are working together on how to make vaccine supplies accessible and affordable in Asia, Africa, and Latin America. To promote the vaccination drive in India the US announced an additional $25 million to the $200 million announced earlier, during Anthony Blinken's visit to New Delhi. Post pandemic economic recovery was also a subject of discussions. Blinken thanked Jaishankar for collaborative discussion on many points, including security in the Indo-Pacific region. He went on to say that "the US welcomes India's emergence as a leading global power." Blinken also said that the future in the 21st century will be written in the Indo-Pacific region.  Blinken thanked Jaishankar for the collaborative discussions on many topics, including trade and economy, and how to promote greater bilateral investments to deepen commercial ties. ...

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Bill Gates describes the successful work of 2 million volunteers and millions of children and parents in India's poorest rural areas to get all the children in India vaccinated for polio. This includes the work of the Bill and Melinda Gates foundation. He decribes his visits to India and realizing over time how bringing vaccinations, healthcare, improvement in agricultural development would enable hundreds of millions of India's children to participate and contribute to bringing out India's full potential. Harnessing their full potential is the next big challenge in India's development and modernization.

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Jenny Medina looks at America's Biden 10 months into his presidency. Biden compared his presidency to that of FDR in his first years in office in 1933 with America in the depths of the Great Depression.  This report says FDR was better able to communicate how the New Deal would help families and workers in the face of distrust. Biden needs this today. During the ten months of the presidency Biden has already taken the tough decisions that are needed. For the vaccination drive, for the vaccine mandate on the coronavirus pandemic. On Afghanistan Biden took a similar tough decision to step away after learning the lessons of that conflict. He has quietly moved forward to build the alliance with Europe. On the infrastructure plan he has made the tough decision to make certain the essential components of spending on healthcare, education, childcare, support for mothers and older Americans are put in place, so that one bill for infrastructure is not passed without the bill for healthcare, childcare, mothers, elderly and education. Only this can provide the needed credibility for Republicans in states such as Tennessee who support community college open to all to come behind the overall Biden families and workers plan, and for working families throughout the whole country to support further spending for renewal of America.  ...

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South Africa feels a sense of relief as omicron cases follow a pattern of very steep upward increase, followed by a short period of a month, and then a very steep decrease. Cases in South Africa with a population of 60 million, about the size of Britain, dropped from 27,000 at the peak to about 15,000 on December 21, 2021. The area around Johannesburg was hardest hit. The median age is 27 years in South Africa, 40 in UK and 43 in Italy. With younger populations in India and parts of Asia South African population demographic is closer to India than it is to Europe where populations are much older. Scientists do not want to extrapolate from the South African experience with Omicron for this reason. Immunity from vaccination and prior infection could be contributory causes to the less severity of omicron say NCID scientists. "In South Africa this is the epidemiology. Omicron is behaving in a way that is less severe," says Dr. Cheryl Cohen, of the National Institute for Communicable Diseases (NCID). "Compellingly together our data really suggest a positive story of a reduced severity of omicron compared to other variants," he said at a conference with other scientists on Wednesday, Dec. 22.  ...

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European Union countries reopen for travel this summer. A new travel pass or digital Covid certificate is approved to promote freedom of travel as more people get vaccinated. About a third of people are vaccinated for first shot in France and about 40% in Germany, which means in coming weeks they will have the second shot and enough antibodies to make a return to normal life possible. The EU has negotiated this time with Pfizer for 1.8 billion doses and is building enough vaccine supplies. For the first time governments are stepping up with plans and resources allocated - in India the government now has plans to create supplies of 2 billion doses by the end of the year. This means there is new hope if the vaccination is accompanied by efforts to build booster shot supplies this time planning ahead. Managing the risk of those who are vaccine skeptical remains a problem to be tackled. Masks and other essential precautions also need to be followed in crowded spaces as this was neglected where there was a second or third wave. Public education for this is essential to better manage the pandemic. ...

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India's lower house of parliament passes a Food Security bill which provides subsidized rice, wheat and other grains to the poorer sections of society, covering about 75% of people living in the rural areas and 50% of the people in cities. The legislation increases the cost of food subsidies by $4 billion to $20 billion a year. Because of high levels of malnutrition in rural areas in India, especially among children, the program helps the needy. Brazil's Bolsa Familia program is more far reaching in helping the poor because it also requires vaccinations of children and making sure children attend school.

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In a factory the size of 5 football fields located in Gurnee, Illinois, Abbott Labs makes its BinaxNow Covid-19 home tests. Abbott turned out 1 billion tests in 2021 and at one point had 80% of the market. Along with Pfizer vaccine, BinaxNow Home covid-19 tests are a dominant product during the pandemic. Abbott generated a fifth of its $43 billion in revenue from these home tests. Abbott faced several hurdles along the way. It gained when the US government authorized it to make the test. Yet after vaccination took off by mid 2021 the demand for tests declined and Abbott nearly idled its giant factory in Gurnee. Delta and Omicron variants led to a sudden reversal and surge in demand. Abbott developed its test based on an existing design it used in the US for flu tests, by a company it inherited by acquisition called Binax. To do that test one sends a swab up the nose, add that sample and a liquid mixture to a rectangular paper card, and close the card shut. The liquid then travels up the paper strip, revealing one or two pink lines, one for negative, two for positive. This is done in 15 minutes and the simple design described as a lollipop shape, put Abbott far ahead of competitors. The US FDA authorized Becton Dickinson and Quidel to make the tests before it authorized Abbott, but these rival companies had a poor and complex design. The Trump administration gave Abbott a $760 million contract to buy 150 million tests for distribution to health departments, long termcare facilities, nursing homes, and schools. And by October 2020 Abbott was already making 50 million tests a month. When it comes to distribution Abbott tapped into its pharmacy connections for baby products such as Similac baby formula. This gave it an advantage over Quidel and others who also lacked the manufacturing knowhow for large scale ramp up. The BinaxNow in pharmacies was sold at $24 for a box of two tests, while government paid $5 for one test. Abbott says it makes $ 7 per single consumer test. Yet there was one problem waiting to hit Abbott in 2021- demand dried up as the vaccination campaign took off. In fact the plant manager, Mr. Rodriguez, planned to move to another job inside Abbott as production declined. Then came the Delta variant and he was asked to ramp up production again. With Omicron demand soared. The Biden administration committed $3 billion to help boost test production and asked Kroger and Walmart to sell over the counter tests at cost for 3 months. Abbott had to lure workers from Amazon at $25 an hour for the Gurnee plant expansion. What was learned by the government and Abbott from this experience? The US government now looks for ideas in meeting demand volatility, supply challenges and production needs,. Sustaining production capacity is important for future virus flareups- a new government-industry partnership is required for maintaining test making infrastructure. With government help Abbott plans now to keep the facility at Gurnee operating indefinitely. ...

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British regulators say they have"absolute confidence" in the Pfizer vaccine after analysis of over 1000 pages of data on the vaccine. The vaccine was approved by the Medicine and Health care products Regulatory Agency. The first vaccines to be shipped to Britain are being packed in Belgium. Britain has secured 40 million doses enough for 20 million people. Vaccination will begin as soon as doses reach Britain. The NHS will prioritize, first care home staff and residents, then healthcare workers, followed by people over 80 years age. Clinically vulnerable people will get a jab alongside people ages 70-74. People with severe obesity and underlying conditions will get jab after people over 60 years, followed by people over 50 years. About 34% of the 66 million population of Britain is over 50 years age, which is about 22 million. This means the Pfizer vaccine ( with doses already secured by Britain enough for 20 million people) covers over 90% of these people or 19 million people and the 1.1 million workers in NHS. Rapid progress in vaccinating these people would make Britain the first country in the world to have done this, a remarkable achievement. By the end of the year the Oxford vaccine should also be available making it possible to proceed with vaccinating the rest of the population of 46 million people. ...

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A conflict is developing between Britain and the European Union over vaccine supplies as both sides try to get access to limited supplies. Britain and the US have moved ahead with their vaccination drives, causing alarm in Europe as Germany, France, member states of the EU lag behind. The problem comes from the delay in approving the vaccine by Astra Zeneca and Oxford University by the European Union. European Union prestige is at stake because its slower process of approving vaccine has led to a delay of 1 month in approving the Astra Zeneca vaccine. The Oxford vaccine is only now approved in Europe. Other problems have emerged. Astra Zeneca has announced that its vaccines made in Britain are now running short of supply and it can only provide 39 million doses to the EU instead of the 80 million originally arranged by EU. Soon after this announcement Pfizer said its factory in Puurs, Belgium, near Antwerp, is running into production issues. This would reduce supplies to the EU.  The EU has responded to this situation by saying it was being treated unfairly by Astra Zeneca. In response it has introduced new paperwork that would limit supply of Pfizer vaccines to Britain from the Belgian plant. Other countries are watching this situation with dismay as richer countries are fighting for the vaccine supplies. ...

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India's pharmaceutical industry gets a major boost with the development of a mRNA vaccine by Gennova Pharmaceuticals called HGC019. Gennova is funded partly by the government and is being developed in conjunction with Seattle based HDT Bio Corp.  The new vaccine can be stored between 35 to 46 degrees Fahrenheit making it easier to distribute in middle and low income countries with less storage and logistics facilities. It also uses a process of freeze drying called lyophilization to produce the vacine in powder form. It can then be more stable and easy to ship, easy to store at moderate temperatures. The powder can then be diluted with a diluent before vaccination. Another part of the new technology of this vaccine is its use of self-amplifying mRNA instead of non-replicating mRNA. This helps to administer smaller doses with less side effects. India's drug regulator has already approved Gennova vaccine in August for second and third phase trials after the shot was found to be safe in early stage study. Gennova Pharmaceuticals aims to get HGC019 approved for emergency use by Indian authorites this year and manufacture 60 million doses by December end. ...

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China's exports to all countries surged in November by 21% from a year earlier. Chinese made consumer goods and electronic goods were the main products with increased exports. According to WSJ calculations November exports were up 10% to the U.S. and 46% to Asian nations in ASEAN trade group of countries. Some of the exports to ASEAN including Vietnam and Malaysia find their way to the U.S. New tariffs by U.S. on China lead to some products diverted to Asian destinations and reexported to the U.S. China's imports of goods from the U.S. were up 33% from a year earlier but imports of farm, energy and other products and services were below what was expected under trade deals. Experts say Chinese imports of goods covered in the agreement were 55% of the year to date targets. The Biden administration will leave the tariffs on $370 billion in Chinese goods in place. China is not expected to make up the gap by the end of 2020. Experts also say the exports of Chinese goods has accelerated during the pandemic in 2020 and with the size of the second wave in the U.S. In 2021 U.S. imports from China should slow as the U.S. manufacturing recovers following the vaccination effort.  Also expect increased focus on the trade gap as U.S. trade policy continues to focus on closing the trade gap and continuing policy of the Trump administration. ...

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For the first time in three decades US economic growth will be much faster than China's. Second quarter 2021 growth in the US was 12.2% compared to 7.9% in China, and will continue to be much higher for five consecutive quarters. This report in the WSJ says it is the result of the US response to the Covid pandemic. The US vaccination drive, massive fiscal stimulus and near zero interest rates have helped, including the confidence generated by the $1 trillion infrastructure investments planned for this decade. Over the longer term Capital Economic estimates China's GDP around 2030 will drop to 2% growth with demographic decline, just as the demographic factors favor Indian growth to levels that China has seen in the last two decades. This was the plan and vision set out by the Indian prime minister for 2047, on the 100th anniversary of independence. For the future government help has helped US households accumulate $2.6 trillion in excess household savings, which Moody's estimates is 7 times that in China.  In the longer term gaps will have narrowed between Asia and Europe, the US, which is a good thing. More will need to be done in Africa and Latin America. Much of the talk about who leads ignores the local needs in cities and towns across all parts of the world for a better quality of life, better education, better nutrition, better healthcare, meeting aspirations of young people, and supporting hope for a better future. ...

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The P1 coronavirus variant from Brazil is seen in 200 of 877 cases in ski resort in Whistler, British Columbia. Helath officials have little knowledge of how this variant entered Canada's western province. This report says the housing shortage for hospitality workers is worsening the pandemic with 6-8 hospitality workers living together and no chance to limit the spread.   The decision by the state health officials not to screen with testing for which variant is responsible for an infection of covid is coming under criticism, as reported in The Guardian. This allows the variant to spread with no knowledge about where it is happening so that countermeasures can be taken. In the absence of this type of screening and testing one is flying blind, says this report. Recent steps to contain the spread in India advocated by prime minister Modi in India give micro-containment a big role, with screening and testing and detection of incidence of mutation becoming critical. To do this the health system has to be well prepared and have full support and direction from a unified authority bringing together every arm of government at the federal, state and local levels. Response has to be very quick and resource allocation proper from testing labs, people on the ground, vaccine supplies, and vaccination drive effective. ...

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Moscow's mayor says the city has the lowest rate of vaccinated people in European capitals. DW.com looks at vaccination rates and the vaccination drive in the Russian capital, Moscow.

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The perception comes from seeing decisions made but not the process of decisions which is lengthy and even seen by participants as long, in which Mr. Modi act as a patient listener to all voices. Could'nt it be shorter is felt by some participants, yet Mr. Modi would have 2-3 meetings listening to all participants with humility before arriving at a decision. Tough decisions were made on vaccines to get to 1 billion vaccinations goal, on demonetisation and GST, and on digital India, housing schemes, bank accounts, and Jal Jeevan.  Mr. Shah points out that where earlier governments had brought bank accounts, electricity water, and cooking gas to some people, the approach of Mr. Modi was to get electricity, water, cooking gas to all homes for 1.4 billion people in India. He says Mr Modi is hard for even his colleagues to understand in terms of his passion and endless capacity for hard work for bringing essential services to every Indian, and the last Indian is a concept that not the BJP or any party had, it was entirely Mr. Modi's idea for New India. Mr. Modi he says is not the BJP or himself even, he is always thinking how could the lives of ordinary Indian be better in every way, and every rupee going to that last man in line in a nation of 1.4 billion. It can best be understood through Vivekananda's writings some 125 years ago. The passion for India and the Indian people of Vivekananda in his writings is a huge reservoir of energy for someone like Modi, that Modi has tapped into from his beginnings in Gujarat government and more so when he left Gujarat for Delhi. Vivekananda's foresight, energy, and passion for the Indian people is reflected in the efforts for New India. ...

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The experience of Pintung county in Taiwan with a coronvirus outbreak is shown in The Guardian. Home quarantining of a couple from Peru leads to an outbreak. Community cooperation, a speedy response from local health authorities, testing and quarantining help to limit and control the outbreak. When it started this county on the coast, one of the poorest in the country, had limited health resources and no one was vaccinated. Most of the control response was through testing and quarantine, with vaccination assistance from the Taiwan government. Local people say strict quarantine is essential as the source of infections was from a couple who visited Peru and were allowed to home isolate. Taiwan government is now enforcing quarantine at hotels for all persons returning from overseas. WHO Emergencies program head, Dr Michael Ryan, says it is important to act quickly. He says "Be fast, have no regrets. You must be the first mover. The virus will always get you if you don't move quickly."  This happened in this Taiwan county as the local health authorites setup a soft lockdown of the two affected villages within 3 days of detecting the first case of Delta variant. This was announced over loudspeaker and food plus daily necessities were delivered to each household. A command centre was setup to take and coordinate the action daily. Taiwan authorites have enforced repeat testing and extended testing. ...

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Healthcare, climate change, pensions and social benefits, are three issues uppermost in the minds of German voters. Three million new young voters most of them only about 2 years old when Merkel started 16 years in office, look for change. They are well informed and for these young voters climate change is the most important issue. DW.com shows three voters and how they plan to vote. One voter has cast a mail in ballot for The Greens party. The second voter will vote for the Greens. Both because of climate change concerns. The third voter Thurid says her mother is a geriatric nurse and is not vaccinated. She is vaccinated but had talks with her mother and understands her worries about vaccination. She will vote for the Free Democrats because they oppose compulsory vaccination. The three leading parties for young voters are the Greens party, the Free Democrats, followed by the Social Democrats all in the range of 16-18% of support. The Greens have sent out 2 million brochures to voters. Out of 60 million voters in a German population of 80  million, 3 million is only 5% of the vote. What makes a difference is that it is consistent with the general direction of voters young and old, all looking for change in Germany as the CDU party attracts only about 20% or one fifth of German voters. Social Democrats Scholz is way ahead of Christian Democrats Laschet in how voters view each candidate. Will German voters be well informed enough to make a decision based on their desire for change after 16 years of Merkel or will the CDU bringing back in the last days of the campaign the old fears that the communist Left party would somehow find its way into the government using the Greens as a way in- this is a question for German voters. In1994 during the Cold War with Soviets Kohl used this to keep the Social Democrats out and Greens out and formed a coalition with the FDP. Yet today Merkel has grown close to both Russia and China and away from the Western alliance in a way that was unimaginable under Adenauer who helped build the new Federal Republic of Germany after the war. Merkel refuses to even immediately accept a call from a new US president Biden, American president who is closest in style and temperament to Harry Truman who faced off the Soviets in Berlin in 1948.  The FDP opposes a wealth tax or any form of taxes in which the wealthier pay a fair share of what is needed to build crumbling infrastructure in Germany neglected in the Merkel years. In Germany social and economic disparities have grown during the pandemic with poverty increasing during the pandemic as has happened throughout Europe and the world. The US is already committing to increase taxes for the upper incomes. This is where voters have a choice- do nothing with infrastructure, health or climate change or do something by increasing taxes. The choice is now before the German people.  With this question comes a choice for western civilization, with the recent election in the US, and two elections in Germany and then France. Will it look with optimism to the future or will it huddle up in a deeply cautious and slightly pessimistic view of the world that is embedded in Angela Merkel's cautious vision that ended up only responding to crises- some self inflicted as in migration policy, and even self inflicted in tackling euro problems created in the euro currency's faulty design. In fiscal policy as in migration policy Merkel has reversed her position- by supporting European solidarity. Will Germans vote for optimism or never ending caution? Are lessons learned?     ...

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This report in NYT suggests that coronavirus in New York is becoming endemic. Endemic means chronic instead of the acute crisis situation in 2020. This is because hospitalizations are not filling up ICU's the way they did in 2020. The burden of the coronavirus pandemic is now on people who are unvaccinated and people under 45 years.  New York has a higher rate of vaccination than the rest of the country. About 76% of people ages 12 and over in New York are vaccinated. Yet the 24% of younger people who remain unvaccinated is a part of the population that has fears about getting vaccinated which are harder to overcome. As many of these younger people also spend more time outdoors, and are part of the community, more likely to be in contact with families, relatives and friends indoors in winter, and less likely to wear masks and follow social distancing the pandemic, one could see another surge in the winter of 2021.  Another problem could be that some portion of the population of vaccinated has not taken booster shots by the middle of winter which would create a population of a third of the people even in cities such as New York that remain unprotected. The emergence of another difficult variant could also be a complicating factor. In this way chronic or endemic may still be elusive where masking, social distancing and other preventive actions are not taken. For the community as a whole there will be the risk to upward mobility from the people who risk losing jobs because of fears of the vaccine.     ...