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The coronavirus pandemic death toll reaches 700,000 making it the deadliest in history. In 2021 the death toll increased with another wave now in the southern and western states such as Florida, Texas in the south, and California, Idaho in the west, with deaths concentrated among the unvaccinated.

The vaccination drive stalled by August 2021 leaving a large number of people between 18-35 unvaccinated mostly in the south and some in western states. States with large Republican support tended to show higher vaccination resistance though the reasons for not getting vaccinated were complex and some misinformation played apart in fear of vaccines. Vaccine supplies were ample in the US.

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How is it that Britain's regulatory agency approved the Pfizer vaccine before the U.S. FDA agency? This report in the NYT says FDA looks at the raw data. Britain's Medicine and Healthcare Products Regulatory Agency looks at the information provided by the company. It still does the testing batch by batch and has access to the data and looks at thousands of pages of data. What about the European Union? The European Union Medicines Agency meets on December 29. It takes days after it meets to get input of 27 countries so that vaccination cannot start till January. The U.S. president summoned the FDA to the White House to find out how soon the FDA could act. Both Britain and the U.S. are feeling the impact of the second wave of coronavirus.

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The U.S. is moving quickly to gain access to an effective vaccine by September or October 2020. It is doing this by providing the money for companies to conduct trials and ramp up manufacturing in a big way. The U.S. government has agreed to give Astra Zeneca upto $1.2 billion to secure supply of a Oxford University developed vaccine which could be ready by October. Astra Zeneca has agreed to make the vaccine under a licensing deal with Oxford University's Jenner Institute and promised it will not make a profit on this. U.S. has also given $483 million to Moderna in Cambridge, Massachusetts, for making the vaccine. Both Oxford and Moderna are testing the vaccine on humans. Oxford uses a tested older technology, Moderna a new technology. UK has given Astra Zeneca $79 million to secure 100 million doses of the vaccine, with 30 million ready by September. Oxford is also in negotiations with Gavi the international vaccine alliance, and Coalition for Epidemic Preparedness Innovations on further deals to boost production. Oxford began a 1100 person study in April, and is  doing a 5000 person trial in late May.  ...

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The experience of J&J and Novavax in vaccine manufacturing shows the importance of vaccine manufacturing and of Quality Assurance in the production of vaccines for coronavirus. The success of Pfizer and Indian companies in vaccine manufacturing shows how important it is to think early and plan early for vaccine manufacturing technologies, personnel and quality assurance. This is also why the US effort, India's billion vaccine target in 6-12 months of planning, is a great effort in thinking ahead of every aspect of vaccines and vaccinating, planning of all details, hard work, by Pfizer, by Indian pharmaceutical companies, and by the Modi and Biden administrations. 

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How do you setup a vaccine business. Consider Mr. Adar Poonavalla in the city of Pune in India. His company Serum Institute of India, remains family owned. Founded in 1966 by Cyrus Poonavalla, it produces billions of doses of vaccines for measles, polio and other diseases. It is expected to be one of the key sources of vaccines because of its expertise and the stocks of vials and other supplies that it has in stock for the next 2 years of vaccine production. It is working on a separate facility for coronavirus production that could turn out 800 million doses of vaccine at a price of about $13 a dose over 2 years. Serum Institute is working with 3 companies that are doing the research on the vaccine for coronavirus in the U.S. and Europe, and will play a key role in the manufacturing of vaccines. To respond to the question how do you setup a company to produce vaccines for the people of the world. This is what Mr. Poonavalla says- he will only work with ethical long term funds and sovereign funds because he does not want to be in the situation where he has to charge high prices to give them returns. Unlike most countries in the world, India is unique in making certain that most of the basic pharmaceutical drugs are available to over a billion people at a low cost. Serum's goal is low cost quality vaccine production so that over a billion people in Asia can be "protected from the birth onwards." As the U.S. and Europe and large parts of Asia, Africa and Latin America, face the second vaccine phase of the coronavirus response following difficulties in PPE, Ventilators, and Masks in the first phase, they can have confidence because of companies such as Serum and the research centers in U.S. and Europe like the one at Oxford University. ...

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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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With better control over the coronavirus than U.S. and Europe, South Korea is not rushing to buy the vaccines developed by Pfizer or Moderna. It is waiting to see how the vaccine rollouts work in other countries before buying the vaccine. South Korea is also looking at getting better price from manufacturers after the rollouts in the U.S. and Europe. South Korea is moving cautiously and has said it wants to get 10 million doses through the Covax initiative the main global effort to provide broad access to vaccines. Another 20 million doses would be secured from private companies. This is in contrast to the approach in Japan where the government has signed deals for purchase of 290 million doses for 145 million people for its population of 126 million. The money allocated is $6.5 billion and the goal is to vaccinate everyone by first half of 2021.  If it works this would prepare Japan for the Tokyo Summer Olympics to open in July, after 1 year delay. South Korea has the freedom to do this and wait to see what vaccine works best with least long term effects because their are relatively fewer cases there. A total of 313 new daily cases on November 18, lower than daily cases in a single county in the state of Michigan in the U.S. Moderna and Pfizer vaccines use anew kind of gene based technology that has never been approved to prevent infectious diseases. Other competition is the vaccine from Oxford and Astra Zeneca which uses an existing technology that is used in existing vaccines modified for use in coronavirus. The Oxford vaccine and a vaccine from Johnson and Johnson are expected to have a lower price. Because life is functioning very close to normal South Korea is in the unusual position of saying that its people have no reason to be anxious for vaccine procurement, as indicated by its deputy director of Korea Disease Control and Prevention Agency. Only three fifths of the population is the target for vaccination by fall of 2021. ...

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Mr. Pascal Soriot of Astra Zeneca says his company has signed agreements for production of 2 billion doses of the coronavirus vaccine being developed by Oxford University. He says manufacturing is starting now because "we want it to be as fast as possible." One of the deals is with Serum Institute of India, the other is with Bill Gates of the Bill and Melinda Gates Foundation for $750 million for CEPI and GAVI organizations which he supports. Mr. Soriot says the licensing agreement with Serum Institute is to supply one billion doses for low and middle income countries, with 400 million doses ready by end of 2020. He says Astra Zeneca is building supply chains across the world and so far has secured manufacturing capacity for 2 billion doses of the vaccine. Mr Soriot tells BBC that manufacturing vaccines on this scale is not an easy thing to do. He says that Astra Zeneca will not make a profit in production of these Oxford University developed vaccines. The U.S. has secured 300 million doses of the Oxford vaccine, and the UK 100 million doses.   ...

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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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On the first day of the new vaccine policy on June 21, 2021, India has vaccinated 6.9 million people. India has now vaccinated 287 million people out of a population of 1.2 billion. This is a race against time as new variants caused the second wave of coronavirus in April and May of 2021 with cases peaking at over 300,000 a day.  The shortcoming of the old vaccine policy are being corrected. The entire vaccine supply process and the vaccination drive is now being handled by the federal government. Earlier during the second wave vaccine supply and the vaccination drives were under an arrangement with no clear overall responsibility. States shared responsibility with the federal government and target vaccination goals were missed, vaccine supplies were inadequate.  A similar arrangement in Germany failed and Germany's vaccination supplies were inadequate and vaccination drive stalled. This caused immense frustration in Germany in April-May 2021. Germany's troubled history before World War II led to a reliance on decentralized actions, and state governments imposed different rules in a relatively small country compared to India. This was corrected with the federal government taking on the entire responsibility for the vaccine supply and vaccination drive leading to good results today in vaccines. With India's huge population and political process of different state governments, some lacking experience in administration for a complex process, and others failing to coordinate well with the federal government, the lack of overall responsibility at the federal government posed serious risks of missing targets for vaccines and letting the coronavirus wreck the economy and public confidence. Complex negotiations with other governments in Europe and the US for vaccine manufacture in India could only be handled at the federal level. The resources and planning at the federal level were already in place in India for infrastructure and other projects, experience and setting targets in that area at the federal level could now be transferred to this task in vaccines. Somewhere in the range of 8 million vaccines a day need to be reached and sustained from August to December 2021 for India to reach the goal of vaccinated all 1.2 billion people ahead of any further attack from a third or fourth wave, say experts. This is not a choice for the federal government, it is simply something India has got to accomplish to be a healthy nation that can grow with neighbors in Europe, the US, Australia and Japan and build confidence in its Asia-Pacific region. The entire Asia-Pacific region has a lot resting on how well India achieve this goal and moves on to the next phase of assisting its neighbors in the region.  ...

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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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In January 2020 employees met at a local Maryland bar to find out how they might salvage their careers in a 33 year old company that had failed to develop an approved vaccine, says this story in WSJ. Only months later following the coronavirus pandemic everything changed as in a miracle for Novavax. The company had to sell manufacturing assets at one point, and had enough cash for another 6 months just months before. By Feb. 2021 shares which had dropped to $4 were up to $229 and valuation which had declined to $127 million went up to 15 billion. Coronavirus has turned things upside down where newcomers are using previously unproven technologies and making them work in this pandemic. The persistence, perseverance and confidence of Novavax even in the most difficult situations shows how the right attitude can lead to remarkable results. Novavax vaccine can be kept in refrigerators for 3 months, and do not require very low freezing temperatures like Moderna and Pfizer vaccines. This is considered a potent weapon in the fight against coronavirus. Novavax says it can produce a couple of billion doses over the next 12 months beginning in April. Novavax has released data showing its vaccine is effective for protection against coronavirus. Results of late stage US trials are expected in March. ...

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A major British and Indian collaboration and scientific achievement of both countries is not given the recognition it should get because of mismanaged communication of the results of clinical trials. Tom Whipple science editor of The Times says do not make the mistake of thinking oh Pfizer vaccine scores a 9 out of 10 and Oxford's a 7 or 8 out of 10. Pfizer vaccine says it 94% effective. But this is only part of the story. It is the first exam paper in a long number of exam papers and the final score will require scoring them all. "Oxford vaccine is complex, and we are happy with the complexity," says Adrian Hill, Oxford researcher and head of the Jenner Institute. It is not highly unusual in this complex field for a half first dose to work better than a full first dose in a two dose vaccine treatment. This happened with the Oxford vaccine. As a result the study results were harder to communicate. This happened by accident. Much of medical research and much of medicine's biggest breakthroughs in the last 200 years happened by accident, as one researcher looked for something and accidentally discovered something else profoundly useful. Whipple's points are turning out to be true now that Britain's medicine regulator has asked that Pfizer vaccine not be given to people with history of allergic reactions after 2 NHS workers had strong allergic reactions. A lot of questions remain for all vaccines. How long will the protection last? WIll it prevent transmission of coronavirus? Are there any other complications? Which vaccines can work without ultralow refrigeration storage? Ahead lie the prospect of billions of doses. Two are in final stages in India including Bharat Biotech request for emergency authorization. Johnson & Johnson has a competing one to Pfizer's in the U.S. As many as 30 are being developed in India and 100 around the world. Countries like South Korea say they will wait to find out which one works best and where cost overall combined with benefit is attractive. Some of the vaccines are coming out only weeks apart. The early ones could stumble, if something was missed. ...

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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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This podcast in WSJ tells the amazing story of the development of a vaccine for malaria by a British scientist that took forty years. In a world of short run startups this tells the story of medical and indirectly other research include research on renewable energy to tackle climate change that takes years to develop and makes a lasting change in our lives. This is also true of the mRNA vaccine developed by two German scientists of Turkish descent who developed the Pfizer vaccine. The Novavax vaccine in the US also has a story of resilience in the face of many challenges. Mr Scholz of the SDP, currently vice chancellor of Germany and winner of the German election said recently he wanted to expose the myth that was created of the self-made man that has penetrated our culture over the last 2 decades. One cannot even conceive of self made people at a time when the whole world depends on vaccines developed such as mRNA vaccine by these 2 German scientists at university labs that are the first line of defense against the coronavirus. Both scientists took only half a day off when they got married. Both are children of immigrants to Germany from Turkey. They both cycle to work. Mr. Shin says "I don't have a car. I am not going to get a plane. What's life changing is to be able to impact something in the medical field." The electric batteries used in today's electric cars use technology developed by a Japanese scientist and professor who also worked at Toshiba in the face of many challenges. ...

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Moderna has made the initial batches of doses of the vaccine for the variant of coronavirus including South African variant, and shipped these to the National Institutes of Health in the US. If the test results are positive the vaccine for variant could be given authorization by the third quarter of 2021. It is becoming crucial to stay ahead of variants developing from the coronavirus and pharmaceutical companies Pfizer, J&J, Astra Zeneca are working on the technology to tackle this.

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A Phase 1 trial of over a thousand volunteers shows the Oxford vaccine works well with minimum side effects that can be handled with acetaminophen. Phase 2 trial is underway with volunteers in UK, Brazil and South Africa. Participants given the vaccine had significant increase in antibodies to neutralize the disease, and T cells for long term protection. About 70% reported fatigue or headaches which can be handled with acetaminophen. After the Ebola crisis of 2014 in West Africa the British government invested 120 million pounds to form a group to develop vaccines for top 10 likely threats dubbed "Disease X." On this list was the coronavirus. Scientists at the Jenner Institute at Oxford formed a team as part of this effort. Sarah Gilbert and Adrian Hill led the scientists at Jenner and pioneered research for  a new way to do this- to first replace a part of the virus with a component of the new virus. Then to remove the part of the virus that allows it to replicate in humans. This method is called recombinant adenovirus vector. The Oxford scientists used existing technology in new ways to increase the chances of getting a good vaccine early.  The first vaccine could be developed and tested for mass production by September. A 30,000 participant trial begins in U.S. in August. About 1 billion doses could be manufactured by end of 2020. India's Serum Institute has the manufacturing facilities to do this near Pune, India.  ...

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China faces risk of a surge inthe coronavirus in June 2021. The area in and around Guangzhou appears to be seriously affected. The city tested almost its entire population of 18.7 million between June 6 Sunday and June 8 Tuesday. This report shows pictures of a deserted Beijing airport, strict restrictions on foreign travel. The SinoPharm vaccine effectiveness against the Delta variant in India and UK is unknown. The government is locking down entire neighborhoods rather than entire cities or provinces.  As the risks of the Delta variant and other new variants increases most of the population even in the US and Europe have either no dose or one dose. Researchers at the University of New South Wales in Australia show the Astra Zeneca vaccine effectiveness with one dose at only 30%, only after two weeks following the second dose does the vaccine effectiveness reach about 70%. The population of China and India are so large that much larger parts of the population remain unvaccinated. In China with 1.3 billion people and even if the figure of 800 million doses stated by the government is accepted- it could be an overestimate as the US has only managed 300 million doses with many vaccines- most of the population is unprotected. Vaccine skepticism is high in China making vaccination an uphill task. SinoPharmvaccine is not as effective as Pfizer, Moderna, Astra Zeneca, or Covaxin vaccines, making the task even more of an uphill kind. ...

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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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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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The death toll from coronavirus reaches 200,000 in Mexico, the third highest after the US and Brazil. Vaccine supplies are low in Europe affecting the vaccination drive. 

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In some countries such as Tanzania and Chad the vaccination drives have not even begun says this report in the DW.com. A new surge now underway in Africa as cases increase by 30% in June comes at abad time with African vaccination drives stalled. Only 31 million doses adminstered in Africa for a population of 1 billion people. Less than 1% of world vaccine supplies are going to poor countries in Africa and Latin America.

Vaccine companies chose to sell their vaccines to the highest bidders, putting Covax  behind. Aims of Covax are also coming down and watered down to vaccinating 20% or 30% of the population in poor countries, says this report in DW.com.

This means new variants could develop and move back to Asia and Europe, the US in 2022. It means the coronavirus could affect African economies in 2022 and beyond.

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International aid arrives from the UK, France, US, and the European Union, as India faces a surge of the coronavirus in April 2021. A flight with oxygen and ventilators arrives from the UK. The EU is pooling resources, France is preparing flights with equipment. The United States Biden administration says it will release some of the 60 million doses of Astra Zeneca vaccine to India that remain unused in the US to address vaccine shortages.

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The story of the Pfizer BioNTech vaccine is the story of 2 chikdren of Turkish immigrants to Germany. Sahin the son of a engineer working at a Ford factory in Cologne, and Tureci the daughter of a surgeon working at a hospital in Mainz Germany. Sahin was born in 1965 on the Mediterranean coast in Iskerundun, Turkey and he went to Germany when he was 4 years old, his father being recruited in a new effort to rebuild Germany with foreign labour. Both are motivated by scientific research and the drive to come up with some method to tackle cancer for patients with new research and cures.  Both did their doctoral dissertation on experimental therapies at the Johannes-Gutenberg University of Mainz in Germany, and both joined the faculty there. Sahin spent years studying the mRNA , genetic instructions that can be delivered to the body to help it defend itself against viruses and other threats. Much of this mRNA research was already at an advanced stage in January 2020 when Sahin heard about the coronavirus in China. At that point he saw the potential of retargeting the mRNA research to tackling the coronavirus. By this time he already had his own company with over 200 million euros invested in it  by investors including Helmut Jeggle, now supervisory board chairman of BioNTech. This report says he sat down one Saturday, January 25, 2020 and working on his computer designed the template for 10 possible coronavirus vaccines, one of which would become BNT162b2, the vaccine now approved in Britain. On the same day he told a surprised Jettle that he would refocus the company on the new virus that had not yet hit Europe. Shain he says cited the Hong Kong flu that claimed 4 million lives. Why Pfizer. Pfizer had already been working with BioNTech on a new flu vaccine based on mRNA technology. A cooperation deal was signed with Pfizer in March for organizing clinical trials, manufacture globally, and distribute the vaccine. BioNTech then acquired a U.S. company and a German pharmaceutical factory in Germany. ...