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The broad leeway for vaccination in the Pacific Northwest of the U.S. is leading to the outbreak of a disease that was seen as wiped out twenty years ago. A measles outbreak has taken place in Washington state. 50 cases are reported from this area according to CDC.

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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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Some local governments in China are making vaccination mandatory. China is setting a goal of getting 64%  of the population fully vaccinated by the end of 2021. In European Union countries mandatory vaccination by country or region is now being put in place to fight new coronavirus variants that spread faster in the population. The reopening of economy, business and tourism is increasing the risk from variants in summer 2021. The mandatory vaccination is a way to increase the percentage of the population that is vaccinated. Getting younger people who lag behind to get vaccinated is important to protect the percentage of the elderly population that is still not vaccinated. There are risks also to the younger population as seen in previous waves of the pandemic. The initial hesitation to make health pass showing a person is vaccinated mandatory was because only a small fraction of the population was vaccinated in Europe. Now that over 50% are vaccinated in most EU countries and UK, that hesitation thinking that it is discriminatory to those people who did not have access to vaccines no longer exists. Ample vaccine supplies and the misinformation spread about vaccines are making action on health pass necessary to protect the overall population. National governments in France, Denmark, Austria, Greece, and local governments in Germany, Portugal and other EU countries such as Ireland, Italy, see the danger from coronavirus variants that spread quickly as too big to take any risks a second time. ...

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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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India recorded 100,000 cases in one day on April 5, 2021. About half of these cases are in one state Maharashtra. Most of the cases are in about 6 states. Super spreader events such as cricket matches, weddings and social gatherings, political rallies with elections in states of Tamilnadu, Kerala, West Bengal, and Holi festival, are increasing the rate of infection. People have become lax in wearing masks and following the safety protocol after cases dropped to less than 15,000 for the whole country in February. This report says variants also are playing apart. Google Mobility Reports have shown that movements around retail areas dropped to about 80% below regular levels in the middle of the national lockdown in spring of 2020, and have come back up to about 20% below normal levels. When the winter surge did not happen, and the vaccination drive started in January in India people became less vigilant, allowing infections to increase. The vaccination drive is accelerating and open to everyone over 45 years. About 80 million doses have been given and the target is still for 300 million doses by August.  ...

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A second survey by the Indian Council of Medical Research shows an increase in the number of people estimated to be affected. The survey sampled people from 70 districts in 21 States in India. Overall prevalence using this method is high at about 21.5%. India has confirmed 10 million cases. Children and young are also affected.

Dr. Balaram Bhargava, Director General of ICMR, says "The message is that large proportion of the population remains vulnerable, Vaccines are necessary, and there can be no complacency with regards masks, social distancing and hand hygiene." India has so far not seen the kind of second wave happening in Europe and the US, yet the risks remain, showing the need for rapid implementation of the vaccine program for 300 million in the first part of the vaccination drive.

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German Heath Minister Karl Lauterbach says vaccine mandates are the only way out of this pandemic. Speaking to German daily Welt he said, gaining immunity through infection was a "dirty vaccination" that made little sense as it would not protect one against a more harmful variant. He saiid that it "would be naive to think that omicron is the end of the pandemic." Omicron would not make one immune to the next viral variant. "No one can guarantee that a variant will not develop soon that is much more dangerous."

Lauterbach says 25 million doses of the Moderna vaccine have been procured that would be enough for 50 million booster shots to be done in the first quarter of 2022.

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What is behind the anti-vaccine movement in the US? This NYT report looks at some of its unlikely origins- the anti-vaccine efforts of Robert Kennedy's son, Robert Kennedy Jr.. Mr. Kennedy is planning to run against Mr. Biden for the White House. Kennedy's opposition to vaccine's is traced back to his getting involved in cases as an environmental lawyer. Parents who had intellectually disabled children from other chemicals asked Kennedy to look into vaccines. Around 2010 Thimerosal, a mercury based preservative which been used for many years to prevent bacteria from growing in multiple dose vials of vaccine, was suspected to cause autism.  Already by 1999 the American Academy of Pediatrics, federal health agencies and pharmaceutical manufacturers agreed that thimerosal should be removed from childhood vaccines.  Yet it is still used, says this report.  This led to Mr. Kennedy's getting into vaccines in general by the time of the pandemic. He had a book out that was critical of Dr. Faucci, during the pandemic. Mr. Kennedy cautioned about the unintended effects of vaccines. He has another book out called the Wuhan Coverup that looks into the origins of the coronavirus. It refers to research conducted at the Wuhan Institute of Virology that was funded by the US. Mr. Kennedy believes that more transparency is needed on decisions made in the health care sector, and that critical views need to be aired for the public to be able to decide the right course of action. Vaccination is generally supported by people in America though there is a subsection of people who have concerns about side effects. On issues outside of vaccination there is a sense that America's health sector needs more transparency.     ...

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Bellman and Dayal in WSJ give this amazing report of how vaccine travels from Pune to remote region of Mizoram hills in India's northeast near Burma. This is the story of the largest vaccination drive in the world that aims to have the vaccine supplies by July to vaccinate the entire population of 1.2 billion people by December 2021. It all began with Oxford University and Astra Zeneca with the decision to make the vaccine available to such a vast population and to people in all parts of the world not just Europe and the US. Bharat Biotech and India's pharmaceutical manufacturers have now joined efforts with the help of the Indian government to produce enough vaccine at affordable cost and make vaccine supplies ample and accessible. This will then be extended to all parts of the world.

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EU Commission president Leyen announces Pfizer will supply EU with 1.8 billion doses of Pfizer vaccine to 2023. The increased supplies will include booster shorts to increase immunity. Another change is the new date for 70% of European Union population to be vaccinated, which is now advanced to end of July instead of end of September. With new waves of the coronavirus affecting Europe, and criticism of the EU's earlier effort in securing vaccine supplies, more urgency has gone into the new effort in 2021. Leyen told Pfizer CEO Albert Bouria- "If I may say so, engineer the mRNA in a way that it can adapt to potential escape vaccines," at a joint press conference. Leyen thanked Pfizer for its enormous effort in boosting vaccine manufacture and delivery. This will help accelerate the vaccination effort in Europe after the slow start in March and April of 2021. Bringing much needed optimism and new hope of a lasting recovery both in economic activity, health and in the mood in Europe, which can then spread from the US and Europe to the rest of the world. ...

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The Indian prime minister reviewed progress of the vaccination drive. On July 26, in the last 6 days about 38 million doses of vaccine have been adminstered in India. In a separate affidavit to the Supreme Court the government laid out its plan for making enough vaccine supplies to vaccinate the entire population over 18 by December 31, 2021, over 940 million people requiring over 1880 million doses.  "Out of this requirement for 1880 million doses 516 million doses will be made available by July 31, 2021, in about 34 days. The remaining 1350 million doses for complete vaccination to the eligible population" says the government information provided to the Supreme Court. The breakdown of vaccine supplies manufacturing is also given to SC. Of the total of 1350 million vaccine doses the following is how it will be manufactured in India in the next 6 months. Covishield  vaccine     500 million Covaxin vaccine          400 million Bio E Subunit vaccine  300 million Zydus Cadila DNA vaccine  50 million Sputnik V  vaccine          100 million The government told the Supreme Court that the procurement of Bio E Subunit vaccine and Zydus Cadila DNA vaccine will be subject to approval that is expected in the near future. From this new vaccine supplies picture it is clear that Covaxin and Bio E Unit will play a major part in the second half of 2021 in vaccinating India's entire population with 2 doses. This would be a historic achievement for the federal government after the lessons learned and the action taken with a new vaccine supplies policy for India in June 2021. There is also the challenge to be overcome of maintaining the vaccination drive at 6-8 million doses a day which would be another historic achievement for the federal and state, and local governments in India working with community education and logistical setup, medical staff.  ...

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The Labour party's support for not withdrawing from the European Medicines Agency is the subject of an argument after Prime Minister's Questions in the British parliament. Labour leader Keir Starmer confronts prime minister Boris Johnson in parliament after Johnson reminds Labour that it had on repeated occasions called for the UK not to withdraw from the European Medicines Agency.  The UK vaccination drive is far ahead of the vaccination drive in European Union countries including France and Germany, because of British initiative in boldly betting money on vaccine supplies with pharmaceutical companies, and earlier approval by the UK health regulatory authority. Here is the comment in the House of Commons by Boris Johnson- "If we had listened to (Starmer), we would still be at the starting blocks because he wanted to stay in the European Medicines Agency and said so four times from that dispatch box." Starmer disputes the statement. The Times cites Hansard, the official record of the House of Commons. It records that Starmer questioned why Britain would want to withdraw from the Medicines Agency in Jan. 2017. In 2018 Labour party supported an Amendment to the Trade Bill that called for the UK to seek participation in the European Medicines Agency. Germany, Spain and France are hit hard by the second wave of the coronavirus and the lack of adequate vaccine supplies is causing grief in European Union. The EU president Von der Leyen, another European Union style bureaucrat, seen as having bungled the handling of vaccine supply. ...

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An India like surge is feared for Indonesia with the spread of the Delta variant and rising cases. Sudden spikes in Jakarta, central Java, and Bangkalan on the Java coast are straining hospitals. A nation of 270 million Indonesia has only a small vaccination program dependent on Sinovac vaccine from China, and only 5% are vaccinated.

Doctors say whether you are young or old have co-morbidities or not you can catch the coronavirus delta variant. Several members of a household can catch it and the deterioration happens quickly. Doctors in India made similar comments during the surge there in May 2021. Kudus region in central Java is typical. At first cases were declining from a January peak by May. Then cases jumped in June. A third of cases turned up positive for PCR tests.

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Biden's record on taking America through the pandemic, and getting the largest vaccination program in history like that of prime minister Modi has been forgotten to some extent by the Nation and more by the media than the Nation. Decisions on supply chain concentration in China were made long before Biden for decades since Clinton and Bush, Obama and Trump, which caused the spurt of inflation and cost of living to 9% that has so disconcerted Americans on incomes below $100,000. Biden and Fed chairman Powell brought this down to 3% in 2023. Yet the cost of living in housing and transport has lingering effects that lead to people describing Biden's record in a disparaging way as this title suggest, when it has through investments of trillions in aging dilapidated  infrastructure and in renewable energy, chips, science given America a pathway to a bright vision for the future. It is left to Kamal Harris to communicate this vision and what it offers for America's future. ...

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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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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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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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U.S. added 245,000 jobs in November. Unemployment rate drops from 6.9% to 6.7% as some Americans give up looking for work. The concern now is not the rate of job creation which is healthy but the drop outs from the workforce.  Concern arises from the long drawn out effects of the 2009 financial crisis and its effects which were seen over a decade. This report in NYT says the share of prime age Americans who were employed returned to the January 2008 level in 2019. And then the pandemic hits putting everything back again. This time if the lesson is learned about the long term damage to working families it is that this be tackled as a priority for the central bank, the U.S. Federal Reserve, an the Treasury, and Council of Economic Advisors, under the leadership of president Biden. Fortunately both Yellen and the new proposed head of the Council are students of labor markets and have stated this is one of the lessons they have learned and will act on. As this report says the opiate crisis, the risks of addiction increased, and there were links to the long period people were without jobs. The longer a person is without a job the more likely he will become permanently unemployed. The hope now is that the vaccination effort could bring people back to work quickly as business and life resumes in 2021, with workers being hired back. The share of prime age Americans working in November is 76.5% compared to 80.5% in February, which means this has to go up by about 4 percentage points. The people who are not in the labor force today but still want a job are 2.2 million. It is this that needs to be the focus of the new administration, central bank, and Congress. ...

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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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India achieves an initial vaccination target of 3 million vaccinations in a single day on March 14, 2021. Much of recent increase is from people over 60 getting vaccinated. For healthcare workers the first priority group about 50% still need to be vaccinated. This sets the stage for taking the vaccination drive to the next level in India. Increasing number of people are now getting their second dose.

Health experts see not vaccinating the vulnerable population fast and wide enough as a missed opportunity. The need has never been greater to vaccinate with better organization, vaccinating staff, and supply of vaccines at locations, so that this beats any second surge.

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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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Lessons can be learned about careful reopening in fighting the coronavirus from other countries. Here the Netherlands experienced a rise of cases by 500% within two weeks of reopening after some poor decisions. The Mark Rutte government decided to open all bars and nightclubs resulting in a twelve fold surge in these locations in one week. Most of the new coronavirus cases were in people 18-29. Data from Dutch public health institute shows 4 out of 10 new cases linked to bars and nightclubs with 262% surge in cases for young people 18-24 years. This goes to show that with the vaccination drive what we see is the cases shifting to younger people, the unvaccinated, and to activities like nightlife. People going to work, or doing hybrid remote work with trips to the office, workers in factories, people doing essential shopping, are not causing the rise in cases. Much can be learned from these examples in working out reopening that does not lead to new crises with surging cases in new waves of coronavirus. Earlier in 2020 summer tourists who ignored mask and social distancing restrictions in Croatia brought on a post summer coronavirus wave to Germany and Austria. This time Greece and Portugal are introducing restrictions. Greece plans to make vaccine health pass required effective July 21 to go into restaurants. Another lesson from Netherlands this week is that a 20,000 person music event of 2 days in Utrecht where QR codes were required showing vaccination or PCR tests failed. About 1000 cases were attributed to the Utrecht event alone. Reasons given are that people faked the QR codes, or that the covid testing system produced too many false results as much as 20%. The same QR code system was followed at nightclubs resulting in big problems. One can never be sure that things work as expected and the risks are great as this adds up. Even vaccines offer limited protection and only if fully vaccinated depending on the type of vaccine. One dose of the vaccine is simply inadequate, and obesity, other morbidities can lead to problems. Withdrawing the mandatory use of face masks in most situations is also a risky decision of the Dutch government. Face masks offer the added protection at a time of variants that spread quckly, and when large parts of the population have only one dose of the vaccine, some elderly are still not vaccinated, and young people have not been vaccinated in large numbers. ...

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This interview with Indian Health Minister, Harsh Vardhan, by Amitabh Bachchan and Anant Goenka of the Indian Express covers a range of questions including India's low fatality rate for coronavirus of 1: 46, its vaccination programs for polio, malaria and other diseases long before the pandemic for a population of 1.3 billion people, respect for healthcare workers, and the distribution of the new vaccines under development in India. Vardhan says there are of the 100 vaccines being developed 30 are in India,and of the ones nearing approval 5 are in India.  India makes 60% of the world's vaccines and its distribution capacity for such a large population has been proven many times. During this coronavirus months of preparation are going into reaching the whole population including remote parts in the mountainous areas. Vardhan says the plan is to vaccinate about 30 crores or 300 million people by June-July 2021 out of a total population of 135 crores or 1.35 billion. The vaccination will start with health care workers, moving on to essential service personnel in the military, police and other occupations, and to vulnerable parts of the population based on age and health conditions. Vardhan who is also the chair of the executive board of the WHO as India's representative, says the prime minister is personally holding two 3 hour long meetings to monitor the preparations for the vaccine and its distribution. Vardhan lists the achievements of the Modi administration and the quality of leadership provided by the prime minister- 2100 testing labs, 97% of the country having a testing facility within 3 kms, testing 1-1.5 million people each day, 1 million testing kits produced daily, 2 million beds in India with oxygen support or in ICU, 13,000 quarantine centers. By personally visiting the vaccine development facilities in Ahmedabad, Pune and Hyderabad, the prime minister also directly supported and encouraged scientists and their efforts. ...

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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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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.  ...