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The US has not yet approved the Astra Zeneca vaccine. Yet the US sits on large supplies of the Astra Zeneca vaccine. Europe badly needs the vaccine with its failure to procure enough vaccine doses. This is one of the paradoxes of the situation today. Italy faces a lockdown by Easter. 70% of cases in France are now variants, says the Health Minister Olivier Veran, and ICU's are 80% full. In Germany there are fears of a third wave. Yet vaccine supplies remain low and vaccination drives in Europe are slow, creating much frustration for the people.

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Pfizer says a third dose of Pfizer vaccine neutralized the Omicron variant in lab tests. The two dose was much less effective at blocking the virus. A third dose increased antibodies 25 fold compared two doses for the omicron variant. Pfizer CEO Albert Bourla says- "Although two doses of the vaccine may still offer protection against severe disease caused by Omicron strain, it's clear from these preliminary data that protection is improved with a third dose of our vaccine."

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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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A chaotic return of school children to school in September 2021 in most of Europe and America, because of a lack of clear statement on the rules to be followed for mask use, social distancing, and testing. Most children are also returning to school without vaccination.  It is also happening at this time in September when the Delta variant is spreading. US president Biden's decision for vaccine mandate for 100 million or two thirds of American workers comes at this time of uncertainty in schools about the future and coronavirus variant. In the US rules are being set school district by school district, at a time when vaccines are not approved for children under 12 years. One leading school administrator in the US says "it's as chaotic as you can get."

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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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With a shortage of nurses and healthcare workers, some hospitals are dropping the vaccine mandate for healthcare workers. Shortages existed before the pandemic. The burnout for healthcare workers led to people dropping out. The lure of high pay has also led to nurses to travel to hot spots further crimping supply of workers. Recently workers who do not want ot get vaccinated have quit the industry or lost their jobs, some have left for facilities that do not follow the vaccine requirement. CDC estimates 30% of healthcare workers at 2000 hospitals in the US are unvaccinated as of September 2021. The Biden vaccine mandate would be effective for second shots by Jan. 4. A federal judge in Louisiana has ruled in Nov. questioning the president's authority for a vaccine mandate. Following that ruling HCA, AdventHealth, Tenet, Cleveland Clinic are among the hospital chains reversing earlier decisions for vaccine mandate. Other hospital chains in California Kaiser Permanante and in New York Northwell Health have kept the vaccine mandate. Kaiser had 98% staff vaccinated, with a similar situation at Northwell. Kaiser has 210,000 employees and Northwell 77,000. Utah Mountain also has 98% vaccinated.  Research on vaccine mandates suggests them to be effective. U Penn psychology research shows people are more likely to get encouraged to get vaccine than discouraged with a vaccine mandate not vaccinated working in healthcare in September will shrink considerably by January. ...

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In Britain, in India and in the EU, the race is between the vaccination drive and the infection case growth, as each country and region takes steps to accelerate and organize production, distribution and administering of the vaccine to all parts of the population.

The latest late stage trial for Astra Zeneca vaccine in US, Chile and Peru, offers new hope. It is shown in that trial that it is 100% effective in prevention of hospitalization and deaths, and 79% effective in prevention of symptomatic illness from the coronavirus. It is also seen as safe by experts as it goes for FDA regulatory approval in the US. It is provided at cost, and storage is in ordinary refrigerators for long periods, with production in India of large quantities of the vaccine, making it a vaccine that could reach large parts of the world's population.

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This video in The Indian Express shows how president Biden invoking US defense act provisions to ensure supplies of vaccine ingredients to US companies prevents exports to countries that badly need it. India has surpassed 300,000 daily cases of coronavirus on April 22, and India's largest vaccine manufacturer Serum Institute of India says vaccine manufacturing in India is restricted because of president Biden invoking that law. 

India's vaccination drive is stalling because of not enough vaccine supplies.

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Warnings to governments and leaders in industry and pharmaceutical research about epidemic preparedness by Bill Gates were ignored. He spent hundreds of millions of dollars to develop new vaccines and create disease tracking systems. But only governments could tackle this problem. He tells the WSJ in an interview that he feels terrible and that he wishes he had done more. His fear that a once in a century pandemic has come true. Governments did respond to the public health preparation needs as reported in France 24 to both SARS and the H1N1, both in Britain and France. It was the disbanding of this effort in the period of the global financial crisis and the eurozone financial crisis that led to the level of unpreparedness that Western Europe finds itself in today. This was caused by irresponsible banking practices. The response was austerity measures in Britain, France, Germany and Spain that led to leaving public health system investment being neglected, without fixing the original source of the problem. Misallocation of capital and lopsided priorities continued through most of the period leading up to the pandemic. There is a lot that Gates and other public spirited leaders could do now do in the new reordering of priorities and shifting the allocation of capital to public services and investments in infrastructure, and supply chain renewal to safeguard national interests. Today he is working with pharmaceutical executives and governments to produce billions of doses of vaccines while they are being tested. His foundation has reserved space in a manufacturing plant so that production can begin quickly once an effective vaccine is found. He says nobody has made 7 billion vaccines so that it will need all the help that it can get and international cooperation.  In an earlier interview with WSJ he told the interviewer in November 2014 that the world as a whole did not have preparedness. France and Britain prepared and then abandoned the effort for epidemic response by 2012 following the global financial and eurozone financial crises. Gates repeated the warning to 2016 presidential candidates in the U.S.  In 2017 at the Munich Security Conference he reminded people- "getting ready for a global pandemic is every bit as important as nuclear deterrence and avoiding a climate catastrophe." One focus of Gates was to come up with faster ways to a vaccine by using ready made components and then customizing it. This is an approach being adopted today by Oxford scientists and by Quidel Corp. in the U.S.   ...

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Moderna, J&J, Pfizer in the U.S., Sanofi in France, AstraZeneca in Britain, have accelerated their efforts to have a vaccine ready by the fall.  Moderna and Pfizer use new technologies. Astra Zeneca is working with Oxford University on a vaccine that builds on existing technologies. Both AstraZeneca and Sanofi are building capacity to make hundreds of millions of doses of the vaccine. 

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France and Britain support president Biden in removing vaccine patent barriers so that vaccine production can be ramped up.

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The vaccine cost varies with the company Astra Zeneca at $4 and Moderna at $25. Government money is taking away much of the risk for manufacturers. The U.S. government has allocated massive investments with different manufacturers to ensure that a vaccine is available. Worldwide demand is about 2 billion doses over 2 years. Seven manufacturers have joined together to reassure the public that a vaccine will be tested carefully for safety and effectiveness. Some manufacturers excluding Pfizer and Moderna have stated that the vaccine will be provided at cost.

To return to some level of normal economy and people able to live normal lives the vaccine has to be available to all people at an affordable and widely available level.

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The new tiered system of tighter restrictions passed in the British parliament 291 to 78 with 51 Tory rebels voting against and 10 Tories abstaining. Labour abstained from the vote getting it to pass. Tory rebels are voting with their constituents in Tory seats in parliament that have lower rate from coronavirus and see the restrictions hurting the lives of people in their areas. The prime minister had to make a special plea to them to get it passed including promising to review in granular detail these areas which needed lifting restrictions because of low infection rates.

Other steps the government is taking are to seek emergency approval of vaccines with the first approval done for Pfizer vaccine. This means Britain will be the first country to start vaccinations in 24-48 hours- December 3 or December 4.

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Vaccine passports play an important role in tackling the pandemic. France and other countries in Europe have increased the percentage of people getting vaccinations by requiring EU vaccine digital certificate for entry into pubic transportation, restaurants and large events. Vaccine digital certificate helps reduce the the need for lockdowns. Us president Biden has also moved in this direction with the new vaccine mandate in the US requiring all federal government employees and employees of companies with more than 100 workers to get vaccinated and show digital proof of vaccination.

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Bharat Biotech that makes India's Covaxin vaccine says its Phase 3 trials show the vaccine 93.4% effective against severe symptomatic coronavirus.

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The Oxford vaccine is to be combined with a dose of Russia's Sputnik vaccine in a study to determine if this will provide improved results. The idea is to test whether two doses combined of Oxford and Sputnik vaccine can provide better protection than two doses of the same vaccine. Trials will begin by the end of 2020. This is being done under the concept of heterologous prime boost which has been adopted in  vaccination programmes against other diseases.

,Both the Russian and the Oxford vaccine use a modified version of adenovirus, a common cold virus. This is stripped of disease causing genes and given genetic instructions that make the coronavirus cause a spike in the protein when it passes it to the human cells. This then triggers an immune response.

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"Its a sign of the decline of the country, and this decline is unacceptable," says a key Macron ally, Francois Bayrou, who heads long term state planning. France lacks a vaccine developed by its scientists. France was a leader in vaccine technology and the world looked up to France for new medical breakthroughs. Something has gone wrong and this is causing soul searching in France and friendly countries. 

The Pasteur Institute was a leader in medical science. It has failed to develop a vaccine. Sanofi says it will be the end of the year 2021 when a vaccine is developed.