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Obama Affordable Care Act ACA and its downfall are covered by two experienced authors over 2 book written over 2 decades. The authors are James Morone and David Blumenthal followed the healthcare issue over 25-30 years through the Clinton, Edward Kennedy and Obama efforts and wrote two books. The first was "The Heart of Power" on the healthcare situation from FDR to 2008. The last titled "Whiplash" in 2026, for which the authors are interviewed in Harvard Medicine magazine. C-SPAN has a book program on this book at a Washington DC bookstore. From the discussion on C-SPAN between Senator Michael Blumenthal, borther of one of the authors, James Morone and David Blumenthal physician, couple of conclusions are seen that may be new to readers. Q. What was the one single factor that doomed the Affordable Care Act? A. The deep antipathy towards the Obama administration influenced the response to the Obama handling of healthcare. The likelihood of Republicans accepting healthcare from a black person was simply not there say the book's authors in the discussion and Q&A on C-SPAN. Yet there were other reasons for the ACA failing. Obama had not gauged the mood of the nation well. UK Labour's Starmer won by a big majority in 2024 yet that does not reflect the mood of the British nation just 2 years later- by election year 2012 Obama's campaign was faltering and had to be rescued with Hispanic votes and a weak candidate in Utah's Mitt Romney. Obama lacked maturity and came in the way Bush came in when the list of candidates were mediocre in the US, similar to the period in the UK with David Cameron and Boris Johnson. To take on the health care issue required someone with the experience and caliber of LBJ, which Obama clearly lacked, coming from the minority community was not going to help in credibility. Obama's presidency was thus premature and to gain experience he would have done better in a key cabinet position such as at Department of State where an intellectual could have influenced world opinion in favor of emerging countries, a doable and necessary. Obama's lack of experience showed when he told Republicans two words in the first months in 2008- "We Won," perceiving arrogance it would set Republicans against him. The years 2008-2016 cost the US dearly in that the US needed a withdrawal from all of the Middle East which would require a strong president  with deep roots of support in all parts of the country including the south, to avoid recriminations. In the end by continuing the wars Obama weakened the US and let China move ahead. Q. Did Obama consider Medicare for All? A. Obama told Congressmen of his party according to Morone- if you can get 60 votes in the Senate for Medicare for All we can try.  Q. Would it take a major upheaval for Medicare for All to be accepted now that the health system is failing all Americans in 2026? A. It will take a world war or a economic depression- some major disaster for Medicare for All to be accepted in the US, say the authors. A pandemic happened in 1918 and again in 2019 the results were not positive, as the authors believe it unleashed the war on science after the vaccination for and against camps, leading to the culture wars in America seen today. Q  Obama's analytical mind thought he learned from the Clinton efforts in healthcare that failed. But he did not see things from the heart. There is good reason to think that the lessons learned of moving fast, letting Congress write the legislation, settling for what can be done not what needs to be done, were exactly the wrong lessons to be learned as opposed to writing off the Clinton experience entirely as Clinton's, and starting from scratch without preconceptions. In the end Obama if he was older, had more experience, and listened to the mood of the country would have realized that healthcare was for another day, and got right down to the most difficult challenge, to end the wars in the Middle East. Even small steps in the right direction would still have earned appreciation him today. Instead Bush and Obama, the most inexperienced of presidents will be remembered for wars they continued that weakened America.       ...

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For the first time the number of people vaccinated in a single state in India reaches 40 million. In Maharashtra state in western India, with state capital Mumbai, the vaccinations crossed 40 million on July 20, 2021, according to the state's Additional Chief Secretary for Health. India has vaccinated 410 million people by July 20, 2021. About 3 million people are getting vaccinations daily.

Maharashtra was one of the top 5 states in the first and second waves of the coronavirus in India. About 2 million healthcare and front line workers have been fully vaccinated in Maharashtra. Maharashtra has a 2021 population of about 125 million according to Aadhar and is the second most populous state in India after UP which has an effective vaccination drive. 

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Germany's national broadcaster DW.com looks into the details of the vaccination drive in countries around the world, including Germany, and finds that there is more to the story than meets the eye in headlines about safety in vaccinations. Many headlines do not tell the whole story carefully. DW revewed reports from Italy, Austria, South Korea, Germany, Spain, the USA, Norway, Belgium and Peru, and found that in most cases health authorites have not found causal links between the vaccination and deaths.  As of March 15 it says 360 million people have been vaccinated in 120 countries, or about 9.25 million a day.  DW.com cites the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) which states: 'there is no indication that vaccination has caused these conditions, which are not listed as side effects with this vaccine. Information available so far indicates that the number of thromboembolic events in vaccinated people is no higher than that seen in the general population." As of March 10, 2021 30 cases of blood clots are recorded for 5 million people vaccinated with Astra Zeneca vaccine in the European Economic Area.  The Paul Ehrlich Institute which is in charge of vaccination in Germany has looked into 113 reported deaths in 46 years to 100 years old patients in Germany. Of these 113 deaths PEI finds that 20 died of the Covid 19 infection as it takes 14 days after the second dose for full protection, and 43 died of pre-existing conditions or other infections. For the patient population it says "they were seriously ill patients with many underlying diseases." PEI says "based on the data we have we assume they died of their underlying disease- in a coincidental time with the vaccination." A virologist at the Technical University of Munich, says that the deaths after vaccination are below the expected number of deaths without the vaccination.  ...

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How a deficiency in trust is affecting the US effort to vaccinate its whole population in 2021. The US government took steps early to build vaccine supplies, and was one of the first countries with the UK to begin its vaccination drive. Then after 6 months something went wrong. The deficiency in trust led to about 80 million people many of them young, to avoid getting vaccinated. US president Biden said the country was losing patience with these people. He setup a vaccine mandate and required all employees in private sector in companies with more than 100 employees to get vaccinated. This applied to about two thirds of American workers. All federal government workers were also required to get vaccinated. Yet even after the vaccine mandate the number of vaccinations has not exceeded 900,000 a day. By contrast India was doing 20 million a day. By September 2021 the US had fallen behind all nations in the G-7 in percentage of people vaccinated with one or two doses, behind Italy, France, UK, Germany, Japan, Canada. Trust was also needed, not just vaccine supplies to make a vaccination drive effective. By September the US passed the 675,000 deaths that happened in 1918 pandemic. The deficiency in trust leads one expert to call it breakthrough without followthrough. Other experts see the entrenched social forces that had diminished American health and life expectancy since the 1970's also affecting the vaccination drive. ...

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The Japanese government is trying to work with universities and companies to speed up the vaccination drive. The government provides the Moderna vaccines and the companies and universities provide the facilities and the medical staff.

The Tokyo Olympics open shortly. This makes it critical to get the elderly population vaccinated. Government released data June 8 shows just 3% of elderly over 65 years are fully vaccinated or 1 million people, and only 8.4 million people or 24% have 1 dose. Since then the vaccination drive has stepped up and about 18 million of the elderly have been vaccinated with one dose or 51% of the elderly population, and about 17% have been vaccinated fully by June 26.

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From now on the vaccination program in India will be run nationally by the federal government. This will ensure fair access to vaccines to all parts of the Indian population. Earlier vaccine costs were bid up as states and private hospitals bid up prices. Under the new national program 75% of vaccines will be given out by the federal government and 25%  by private hospitals and other private health institutions. The government in New Delhi under prime minister Modi will offer adults free vaccinations. Modi said "We will increase the speed of procuring vaccines and also increase the pace of the vaccination program." Even in private hospitals the cost of vaccine will be kept at Rupees 150 or $2.06. Experts say this is the right policy and the government has learned from errors in letting states and other private institutions run vaccine policy, which made it too fragmented and subject to too many variables, resulting in inequity, and slowing vaccination drives. The Supreme Court stepped in asking for clarity, leading to the clear policy from the federal government announced today.  Advantage of the new policy is that the responsibility lies in one place, and the federal government also has the clout to make things happen, to negotiate with companies and other parties involved effectively. India has vaccinated 222 million people but because of the population being so large at 1.2 billion this comes out to be a small fraction of the population. This puts the task of getting vaccine supplies and getting the vaccination drives to work in the only place that has the determination and the resources to deliver results by vaccinating 1.2 billion people by December 2021. It has never been done before in history says Mr. Modi, and it is a challenge that India is now taking up for itself and for the global community. It also lays the ground for India to help its neighbors in Asia and in Africa, Latin America in 2022.   ...

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Dipti Deshpande writes in the Economic Times that how India's economy recovers depends a lot on how well the government tackles the problems of vaccine supplies, vaccination staff and incentives for vaccination to the public, vaccination logistics, and vaccination skepticism. Vaccination plays a large role in the reduction of fear and permits resumption of normal activity as seen in the US, UK and France. Government education of the public on vaccine safety should be conducted on an organized basis across the country starting now for the gaol of vaccinating the entire population by December 2021. In the 200 days remaining in 2021 the government would have to administer over 1000 million doses or at the rate of 5 million doses a day just for the single dose population, with the second dose meaning additional supplies and logistical effort, organized health staffing, all to be organized.  The thrust of this article is that the economy and especially laggard sectors such as services would gain a fully powered recovery if the problems of vaccine supplies and vaccination drives are resolved early with preparation, lessons learned, and proactive action all taking place immediately. The period after the decline in cases to below 50,000 a day which is fast approaching for India is one that needs to be used to take deep yogic breaths, and prepare the Indian mind for the next challenge for government and nation.   ...

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About 67 million doses have been given out of 89 million doses distributed in the U.S. vaccination drive according to this report tracking the drive in the US.

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India registers an amazing comeback feat of 75% vaccinated with two doses on January 30, 2022, without the resistance to vaccination seen in US and Europe. For over a billion people this is nothing short of extraordinary. India's experience is similar to that in other parts of Asia and Latin America where people trust health authorites, after years of dealing with many diseases requiring vaccination in the last 50 years.

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The Times of London says that it has turned out the way the chief medical officer of England, Mr. Chris Witty,  has warned and predicted. That limited freedoms was as good as it could get, but there is hope for the future. With vaccinations starting by January the third wave can be prevented and more reopening can be done by then. The very fact that cases are beginning to fall shows that the lockdowns work where tiered restrictions did not work. 

The same situation can be seen in the U.S. where new lockdowns in midwestern states are beginning to cause a fall in daily cases.

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The Hindu data team looks at the Indian vaccination drive with graphs by state and progress by dates. During the first 10 days of June the vaccination drive has been stepped up. It is now over 3 million a day and at this rate should reach 400 million vaccinated by the end of July, 100 million below target. For the remainder of the year vaccine supplies have to be pushed up so that 8 million doses can be given each day. This would get India to where everyone in the country of 1.2 billion has been vaccinated by Dec 31, 2021. This would make it possible for India to then use its technology and large manufacturing capacity to help other nations in Asia, Africa and Latin America in 2022. This is the first time in history that India has taken on a challenge of this size and complexity. The vaccine strategy has changed to where the federal government is taking over the overall responsibility of coordinating the production of vaccines in the country and providing access to vaccines from other countries. Federal government is also taking on overall responsibility for distribution of vaccines and setting up the logistical effort. Vaccine supply is being opened up by opening India to multiple vaccines including Pfizer, Moderna, and other vaccines. Production of Covaxin is being stepped up. This strategy is designed to get India to somewhere closer to the 8 million doses a day needed and to ensure distribution and logistical efforts are in place. More resources are put into the effort. The speed of economic recovery also depends on the vaccination drive. Lessons were learned during the second wave in May 2021 and the government is better prepared for the hard work ahead. ...

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The UK NHS is urgently tracking down parents of 35,000 children in London who are not fully vaccinated against polio, says this report in The Times. Health officials have detected the first outbreak since 1984. They are trying to trace it back to a "single household or street." London has lower rates of polio vaccination than the rest of England, dropping to levels that are seen as risky for the health of children. Vaccination rates are low in north and east London says this report in The Times. In London as a whole the vaccination rate for one year olds in 2021 is at 87%,  5 percentage points lower than that of the UK as a whole of 92%.  

Lack of investment in public health and services has weakened the public health system even as hundreds of billions of dollars were misallocated by capital markets gone astray. The pandemic exacerbated a bad situation in public health lowering vaccination rates even further.

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Most of Kennedy's supporters who were Democrat leaning have gone back to the Democratic party and Harris. Only the ones remaining are likely to support Trump. Some of them are vaccine sceptics, the one issue on which Kennedy initially opposed Biden as he was against the vaccination campaign that Biden implemented to get America back on to recovery and on its feet again. The former president Trump also made light of the vaccination campaign and in doing so weakened the response to the Covid pandemic that destroyed 1 million American families. Only the vaccination campaign with full government support and educational effort on the importance of getting vaccinated made it possible for America to recover by 2021.  Hear this America- more lives could have been lost, million more without an effective vaccination campaign.

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As the coronavirus surges in India with over 300,000 cases a day on April 26, a clear picture on the vaccination drive in the country is critical. The following is the picture of the vaccination progress from Union Health Ministry in India as shown in The Hindustan Times. India has vaccinated 140 million people with at least one dose says this report in The Hindustan Times.  On Saturday 24th April 2.4 million doses were given for that day at 8 pm. This was done over 99 days. This means about 12% of the population of 1.2 billion has been vaccinated.  This compares with the vaccination in Germany for about 21% of people vaccinated with over 18 million getting the first dose in Germany by around April 25. Both Germany and India have suffered from vaccine shortages, some skepticism about vaccinations. Gradually sentiment is shifting in both countries so that once skeptical Germany now has about 75% of people willing to take vaccine on April 25, 2021. In India about 6 million healthcare workers have 2 doses of vaccine, and about 9 million have 1 dose. About 6 million frontline workers have 2 doses and 12 million frontline workers have 1 dose of vaccine.  There is a shortage of vaccine supplies and a bold decision was made by the Indian government on April 25th 2021, after the surge of cases to a world wide maximum of over 300,000 cases a day. The decision was to give immediate regulatory approval for the three major vaccines in the US to be brought and used in India. And delivery will be speeded up - no customs duties and fast processing of supplies access to speedy logistical supply routes. This is a huge step forward for the vaccination drive as this means Pfizer, Moderna and J&J vaccines can now be used in India. The government is also urging the companies to make in India or export to India with prices that provide flexibility in pricing for the private market. The locally produced Covishield Astra Zeneca based vaccine produced by Serum Institute will be allowed to be sold to the private market at 600 rupees or close to about $10. Pfizer and Moderna, J&J can price in a way that would be somewhere around this price range. The access to more vaccines and the ability of the companies to make a reasonable profit in the Indian private market means that vaccine supplies should open up in May and June.  This could give a huge boost to vaccination numbers so that India's vaccination percentage of population vaccinated should keep up with that in countries like Germany and France that were slower to get started in Europe but are now catching up quickly. This is a massive achievement because the population numbers are huge compared to Europe. ...

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Thanks go to Pfizer and CEO Albert Bourla for their latest effort the antiviral pill Paxlovid, says the editorial Board of the WSJ. It reduces viral load ten fold and is a game changer in the pandemic, says the WSJ, when vaccinations are not as effective as they could be with the large number of unvaccinated. Pfizer charges $530 per treatment for the 10 million doses ordered by the Biden Administration and signed a voluntary licensing agreement with UN backed Medicines Patent Pool for worldwide access. This should enable access in all countries.

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The use of cathedrals in Britain as vaccination centres is seen as a glorious way to bring people of all ages, particularly  the elderly in the community into a wonderful setting to preserve health. They came since the Middle Ages for a cure, and they come today for hope and care. The Archbishop of Canterbury thanks the cathedrals and the NHS for serving the community in such a beautiful way.

The famous cathedrals of England at Lichfield, Salisbury and Blackburn inviting people in for vaccination is the heart warming story of this month. Salisbury is one of the oldest and has copies of the Magna Carta, the historic document that put forward the rights of the people in a constitutional monarchy.

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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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Israel remains a laboratory for the rest of the world in tackling coronavirus. During the beginning of 2021 Israel was the first country to push ahead with Pfizer vaccines for the over 18 population in a country of 10 million people. As winter approaches Israel has given a third booster shot to 50% of the population and is able to conduct normal life with a green pass system and the use of masks indoors. Each time a major surge has been prevented. The green pass in Israel is now for people who have had a third shot or booster shot. By thinking one step ahead, making decisions rapidly, and coordinating action early between the government and other organizations to vaccinate everyone, Israel provides lessons for the rest of the world. Not that there are no unvaccinated -about 700,000 people do not believe in vaccination and are unvaccinated. They are a vocal group but only about 8% of the population, and the vast majority of Israelis are in favor of vaccination and the green pass system. ...

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Serbia ranks high in the countries with successful vaccination drives. About 29.5 people of every 100 have been vaccinated. About 2.2 million doses of the Pfizer vaccine were bought in August 2020 followed by separate deals for the Russian Sputnik vaccine and the Chinese vaccine. Serbian prime minister Ana Brnabic says the success is a result of their approach to vaccination- "A health issue, not a political issue, negotiating with all, whether East or West."

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OECD forecasts show an acceleration of US economic growth in 2021 with the $1.9 trillion aid package of the Biden administration. OECD forecasts show pre-pandemic levels of output reached by mid 2021, 6 months earlier than expected. Global output is expected to grow by 5.6% in 2021, after declining 3.4% in 2020. Main reason- US economy is seen expanding at 6.5%, twice as fast as previously forecast and fastest since 1984. OECD sees the importance of stimulus coinciding with vaccination of the population. The pace in the US with 18 million vaccinated in March and the goal of vaccinating the whole population by May is part of the reason given for the vigorous growth. Astonishingly the OECD sees the US economy larger in end of year 2022 now than it had forecast before the pandemic. For other countries such as India with slower vaccination progress and large population, OECD forecast is for 8% shortfall in growth from what was expected before the pandemic at end of 2022.  This is an amazing bit of good news amid all the dismay and confusion surrounding the coronavirus lockdowns. ...

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The coronavirus variant surge has led to burnout for frontline medical workers in the US. It has been calamitous for the mental health of public health workers in the US. These are the data analysts, policy advisors and other workers in public health departments. Many have quit their job as reported here in The Guardian. A CDC survey of 26,000 public health workers in the US shows about half have problems of mental health. Public health workers have to face problems with elected officials as well as public resentment on issues such as vaccination.

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The European Commission says that 70% of adults in the European Union have now been vaccinated with 2 doses, about 256 million people in 27 countries. In the US this figure is 63% for persons 18 and over, in UK 77% are fully vaccinated for 16 and over. There is a wide variation between countries in Europe- with Portugal at the high end and Bulgaria at the low end for vaccination.

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As the Israeli election happens on March 24, 2021, prime minister Netanyahu's popularity has increased because of his handling of the vaccination drive and the pandemic. Defense minister Gantz who was the rival for prime minister has seen his popularity drop to new lows.

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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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As the coronavirus pandemic reaches the 20 month mark in October 2021 and the government reaches a target of 1 billion vaccinations given in India, prime minister Modi talks about his experience handling the vaccination drive in this interview. It covers a wide range of topics from his initial experiences in development in Gujarat, translating this experience to the national setting, the multiple yojanas or projects from Swachh Bharat (Clean India), toilets for all, bank accounts for the whole population, cooking gas for women, decisions taken for Aadhar, digitization, GST. His 35 years spent in poverty as a social worker that gave him a clear idea of the aspirations of the working poor. On the achievement of one billion vaccinations- It was the careful preparation that happened as early as March 2020 that carefully anticipated all possible problems and tackled each one of them that made it possible. "Vaccinating such a large number of people comes with its own share of complexities. Ensuring proper temperature control of complexities, cold chain infrastructure across the length and breadth of the country, timely delivery from the manufacturing plant to the remotest vaccination delivery point, supply of needles and syringes, training of vaccinators and preparing for adverse reactions, from quick registration to certificate generation to reminder for next appointment. We needed to look at the entire logistics, planning, and progress of the vaccination drive." To understand the person completely one has to go back to the origins of his experience, skills learned, and his inspiration for the effort. Modi entered the chief minister's office in the western Indian state of Gujarat facing the Arabian sea in 2001. He entered office at the time of the Bhuj earthquake in Gujarat and describes his taking the chief minister's office as accidental as he had been a social worker for 30 years. "Let alone reluctance to join electoral politics, I had nothing to do with the political domain itself. My surroundings, my inner world, my philosophy- these were very different. Right from my younger days,my bent was spiritual. The philosophy of "Jan Seva Hi Prabhu Seva" Serving the people is akin to serving the Divine, which was propounded by Ramakrishna Paramahamsa and Swami Vivekananda inspired me. It became the driving force in whatever I did." In 2014 it was with the inspiration from Swami Vivekananda and taking up Vivekananda's vision for the Indian people that Modi began his campaign to lead the BJP party. It may be looking back that Vivekananda guided Modi in all his projects for a Clean India, Jal Jeevan, Indian infrastructure that benefits the last man in the queue in the country, commitment to hard work. "Global experience says government should be there for those whom nobody is there. Government's whole focus should be on helping them." To do this, to meet the needs of that last person left out in India, he could see that old notions of opposites had to be set aside. "Outdated theories such as the private sector vs the public sector, government vs. people, rich vs. poor, urban vs. rural, are still on people's minds and they try to fit everything into this." Governments since independence in 1947 followed the same political and economic thought. After Gandhi negotiated with the British government for self rule or Swaraj an experimental form was set up with provincial governments ministries with limited powers formed in the 1930's through elections. Many of these ministries had the same problems that were found after independence in 1947, as one sees in the writings in the Gandhi library. They lasted for a few years before they were dissolved by the British government. These problems were more evident under Nehru and Indira Gandhi right into the 1970's and beyond. This was followed by a period of relative stagnation. Most ministries failed to seriously address India's economic problems, urbanization issues and agricultural issues remained unaddressed, and industry building was done with a limited vision and scaled down goals. In some ways the elections created a political class interested in perpetuating itself and did not build administrations based on learning, hard work and delivering on projects with scaled up targets to match the dire needs of the country. One sees similarities with France before 1960, before De Gaulle. A mosaic of peoples all separate from each other, with agriculture the main occupation, and most agriculture done the way it was in the nineteenth century by hand and using horses and cattle- this is the picture of France shown in Nous Paysouns, We Farmers, a documentary on Le Monde French television in October 2021. It was De Gaulle who supported a shift to presidential form of government for France that helped with the transformation through modernization and infrastructure development. Tractors were introduced in 1960 to mechanize agriculture. Road, bridges, rail transport, logistics were planned in the way Gati Shakti master plan for India is now being executed. There can be no transformation without this. Unstable coalition governments in France and lack of clarity and decision making before 1960 made such development impossible. India entered such a period in the 1970's. "The politics of our country is such that till now, we have seen only one model in which governments are run to build the next government (sarkar banane ke liye chalayi jaati haye). My fundamental thinking is different. I believe we have to run the government to build the nation (desh banane ke liye sarkar chalani haye)."  Chalta haye, Chalne do. What is will not change. Families, farmers and workers in India, for a long time accepted this without questioning.  "I take decisions based on Gandhiji's talisman that sees how my decisions will benefit or harm the poorest or weakest person." "While taking decisions, I stop even if the slightest of vested interests is visible to me. The decision should be pure and authentic, and if the decision passes through all these tests, then I firmly move forward to implement such a decision."           ...