VACCINE IMPERIALISM
China and Russia want to vaccinate the developing world before the West. It's brought them closer than ever

Analysis by Ben Westcott, CNN

When Russia's Sputnik V vaccine is unloaded in countries around the world, hundreds of millions of doses will come with the label "Made in China."

© Mikhail Svetlov/Getty Images Russian President Vladimir Putin (left) and Chinese President Xi Jinping at a welcoming ceremony on November 14, 2019 in Brasilia, Brazil.

Chinese companies have made agreements over the past month to manufacture more than 260 million doses of Russia's Sputnik V vaccine, which has been approved for use in more than 60 countries, including a large number of developing nations such as Mexico, India and Argentina.

The deals are symbolic of how China and Russia's international vaccine goals are increasingly aligned, as they assist developing countries neglected by their traditional Western partners who have been accused of hoarding shots.

Duke University research shows that while some countries, such as Canada, the UK and New Zealand, have bought enough vaccines to cover their population more than three times over, the vast majority of countries have barely got doses for half their citizens, including some of the nations worst hit by Covid-19.

Bobo Lo, an expert on China-Russia relations and former deputy head of mission at Australia's embassy in Moscow, said both Moscow and Beijing saw an opportunity for geopolitical gains in the pandemic, winning favor and influence for their autocratic systems.

"It's useful to them to point out that the West is being selfish in limiting the distribution of vaccine to developing countries," he said. "This is a really convenient narrative for both Beijing and Moscow."

There is also a darker side to Moscow and Beijing's vaccine cooperation. In recent months, Russian disinformation efforts have tried to undermine confidence in US and UK vaccines, such as those made by Pfizer and AstraZeneca, according to Judyth Twigg, professor of political science at Virginia Commonwealth University.

China has done the same, with state-run media hyping up reports of deaths from US and European-made vaccines.

Former diplomat Lo said both Russia and China had an interest in discrediting the US-led world order, particularly Beijing, which is keen for a chance to burnish its own reputation and promote itself as the leader of the global south.

"(China is saying), 'We understand you, we're not an imperial power like the Western powers ... we're just here to help,'" he said.


In demand

Russia was the first country to announce it had produced a viable Covid-19 vaccine in August 2020, named Sputnik V after the country's history making satellite launch in 1957.

Initial doubts over its effectiveness were tempered by a study published in the Lancet in February, which found in preliminary results that the vaccine had 91.6% effectiveness.

Now, hundreds of millions of doses of Russia's Sputnik V vaccine, along with China's Sinovac and Sinopharm shots, are making their way around the world, despite only Sinopharm being accepted into the World Health Organization's COVAX initiative. Neither Sputnik nor Sinovac has been approved by the WHO.

In Latin America, traditionally an area of US influence, countries such as Argentina and Chile have been buying up large numbers of Russian and Chinese shots to fill the gaps in their vaccine rollouts.

According to Duke University's records of vaccine procurements, Argentina has placed orders for 30 million doses of Russia's Sputnik vaccine and 4 million doses of Sinopharm. To date, Argentina has not been able to strike a deal for the US Pfizer vaccine, although it has ordered 23 million doses of AstraZeneca's shot.

Indonesia, a longtime US ally in southeast Asia, turned to China to order more shipments of Sinovac after its AstraZeneca order was delayed by a year due to the outbreak in India, according state-run Antara News Agency. To date, Indonesia has bought more Sinovac vaccines than any other country, at least 125 million doses, according to Duke University.

The second largest buyer of Sinovac is Turkey, a "critical regional partner" for the US, according to the State Department. Turkey purchased 100 million doses of the Chinese-made shot, and started administering the first doses in January -- it took four more months for US-made Pfizer shots to arrive. Ankara even sent hundreds of thousands of excess Sinovac doses of the drug to Libya.

Russia's RDIF sovereign wealth fund said in February there had been requests for more than 2.5 billion doses of the Sputnik V vaccine. At the same time, Sinopharm said it had received orders for 500 million doses, according to the state-run tabloid Global Times. Meanwhile, Sinovac was being asked to deliver 450 million doses, and was planning to transfer the technology to manufacture the drug to 10 countries to assist in a rapid rollout, Reuters reported.

Most of Russia and China's vaccine deliveries have been sold rather than donated, but an analysis by Think Global Health found that 63 out of the 65 countries Beijing had donated vaccines to so far were part of Xi Jinping's signature Belt and Road Initiative.

China isn't just producing its own vaccines -- it is also helping to produce Russia's. By April 19, three privately-owned Chinese companies had struck major deals with Russia's RDIF to produce 260 million doses of the Sputnik V vaccine -- 60 million by Shenzhen Yuanxing Gene-tech Co, 100 million by TopRidge Pharma and 100 million by Hualan Biological Bacterin Inc, according to the Global Times.

The deal is partially the result of inadequate manufacturing capacity in Russia. In January, the RDIF warned of delays of up to three weeks for countries waiting for their doses.

China's ability to manufacture vaccines for other countries, including Russia, is partially due to having the Covid-19 outbreak almost completely controlled within its borders and rapid upgrades to the country's manufacturing capacity.

In March, Sinopharm announced plans to create up to 3 billion doses per year, making it the biggest coronavirus vaccine producer in the world, according to state-run media. Sinovac said it was aiming to ramp up its annual capacity to 2 billion.

Meanwhile, Russia has been forced to cut deals with international suppliers to reach its delivery goals for Sputnik -- in April, the RDIF announced 20 manufacturers in 10 countries would be making the shots.

An unlikely partnership

China and Russia have had a rocky relationship over the past century, despite both being large Asian nations with a long history of Communist rule. There have been border clashes, political hostages and a famously long-running chilliness between Russian leader Joseph Stalin and China's Mao Zedong.

But in recent years, under Presidents Xi Jinping and Vladimir Putin, the two countries have developed a tight bond built on mutual geopolitical interests. In 2019, amid growing trade tensions between Beijing and Washington, Xi described Putin as his "best and bosom friend," while Putin said relations were at an "unprecedented level."

The Covid-19 pandemic has strengthened those bonds further, with Russian ambassador to China Andrey Denisov saying in April 2020 that the two countries would fight the common enemy "hand-in-hand." "As we did in World War II," he said.

In an opinion piece in China Daily on April 7, China's ambassador to Moscow Zhang Hanhui said: "The more the world changes, the more chaotic it is and the more significant the great friendship between China and Russia is."

The cooperation has caused rising concern for some Western leaders. Speaking on March 25, French President Emmanuel Macron warned Russia and China could use their vaccines to exert influence over the developing world, in "a world war of a new type."

Thomas Bollyky, director of the Global Health Program at the Council for Foreign Relations, said many developing nations were "desperate" for vaccines.

But Bollyky said while there might be some concern from the US government over any political influence China and Russia might be gaining from their rollouts, at the end of the day "the world needs more vaccines."

"My only concern with the China vaccine and Russia's vaccine is they still haven't released the underlying clinical trial data too assess their safety and effectiveness," he said.

Former diplomat Lo said while it was hard to know if the closeness would remain in the long term, for now both Xi and Putin were being brought together by the growing Western opposition to their governments. Under President Joe Biden, the US has increasingly focused on building coalitions of friendly nations to put pressure on Beijing and Moscow.

"For the time being, the US is so evidently, for both Moscow and Beijing, the clear and present danger," he said.

Vaccine diplomacy

China and Russia have denied they are engaged in vaccine diplomacy. Speaking at a meeting with Russian Foreign Minister Sergey Lavrov on March 23, Chinese Foreign Minister Wang Yi said both countries were engaged in "humanitarian work."

"Unlike some major countries that are hoarding the vaccines for their own interests, we want to see more people immunized. Our hope is for the world to beat the pandemic as soon as possible," Wang said.

"For China and Russia, our choice is not to benefit only ourselves, but rather to help the whole world."

Virginia Commonwealth University's Twigg said China and Russia knew they had a very limited window in which to offer their vaccines to the developing world before Western nations caught up.

Questions have already been raised by some world leaders over Russia's motivations behind its rapid rollout of the Sputnik vaccine to developing countries.

"We still wonder why Russia is offering, theoretically, millions and millions of doses while not sufficiently progressing in vaccinating its own people," European Commission President Ursula von der Leyen told a news conference in February. "This a question that should be answered."

To date, only 5.9% of Russia's population has been fully vaccinated. China said it had administered over 300 million doses of the vaccine as of May 7, but it isn't clear how many of those are first or second shots.

Even if Russia and China can work quickly to vaccinate the developing world, some experts doubt their efforts will have the desired long-term political payoff.

Twigg said the global rollout is still in its infancy and any number of developments, including Biden's to waive vaccine patent laws, could change the current vaccine landscape. By the end of the pandemic, she said most nations are likely to have inoculated their populations with a variety of vaccines from a number of countries.

"A year or two, or three, from now, the places where Russia or China got there first, I don't think anyone's going to remember," she said.

Unemployment benefits: More GOP states drop pandemic aid early

By Tami Luhby, CNN 

BOURGEOISIE PROMOTE THE TROPE OF THE LAZY WORKER
Five more Republican governors are joining their peers in terminating federal pandemic unemployment benefits early, citing workforce shortages in their states.

© Provided by CNN Tennessee Gov. Bill Lee, Iowa Gov. Kim Reynolds, Missouri Gov. Mike Parson

Jobless residents in Missouri, Iowa, Idaho, Tennessee and Wyoming join those in several other states who will soon lose the $300 weekly federal boost to their state benefits, though Congress has made it available until early September to those in states that continue to participate. The moves will also end the federal expansion of jobless benefits to freelancers, independent contractors, certain people affected by the virus and those who have run out of their regular state benefits.

"While these benefits provided supplementary financial assistance during the height of Covid-19, they were intended to be temporary, and their continuation has instead worsened the workforce issues we are facing," said Gov. Mike Parsons of Missouri, which has an unemployment rate of 4.2%. Benefits there will cease on June 12. "It's time that we end these programs that have ultimately incentivized people to stay out of the workforce."

These states join Montana -- which last week was the first to announce it was pulling out -- along with South Carolina, Arkansas, Alabama, Mississippi and North Dakota. Other red states are likely to follow.

The withdrawals, which are allowed under the terms of the historic expansion of the nation's unemployment benefits system enacted by Congress in March 2020, deepen the divide over safety net programs available in red versus blue states -- much like the ongoing partisan battle over Medicaid expansion under the Affordable Care Act. A dozen red-leaning states have yet to provide expanded Medicaid benefits, and two states have yet to implement voter-approved expansions.

The terminations are also likely to widen the split between Republican officials and business owners on one side and Democrats and workers on the other. The former argue that the more generous payments are keeping Americans from returning to the labor market. They point to the growing shortage of workers as evidence that people would rather stay home than accept job offers.

Tennessee's job board has more than a quarter million postings. The state's unemployment rate is 5%, which is lower than the national rate of 6.1% but higher than some other states. Benefits will end on July 3.

"We will no longer participate in federal pandemic unemployment programs because Tennesseans have access to more than 250,000 jobs in our state," said Gov. Bill Lee. "Families, businesses and our economy thrive when we focus on meaningful employment and move on from short-term, federal fixes."

Job openings nationwide jumped 7.9% in March, on top of strong gains in January and February, with available positions hitting a record high, according to JPMorgan, citing Labor Department data released Tuesday.

"We see signs that demand for labor is strong but that supply could be limited," wrote Daniel Silver, an economist at JPMorgan.

Democrats and workers, however, argue that millions of people remain out of work and cannot return easily because their children are still learning remotely or they remain concerned about the coronavirus.

The economy is still down 8.2 million jobs compared with February 2020, and it added a scant 266,000 positions last month, a major disappointment. Nearly 4.2 million people have been out of work for at least six months -- and it's harder for them to return to the labor market.

President Joe Biden, while warning Monday that people who can work must accept offers or lose their benefits, said most Americans want to be employed if possible.

"We still have 8 million fewer jobs than we did when the pandemic started," he said Monday. "And for many of those folks, unemployment benefits are a lifeline."

The Democrats recently extended the pandemic unemployment programs until early September as part of their $1.9 trillion coronavirus rescue package.

Whether ending benefits early will address the scarcity of workers remains to be seen.

The states' decisions will force some people back into the labor market, but that will not resolve all the workforce shortages, said Gregory Daco, chief US economist at Oxford Economics. Some people cannot return because they are still contending with virus-related child care issues or health concerns.

"It's not because you end unemployment benefits that everybody will find a job," said Daco, noting that the terminations will do more harm than good because some residents can't return to work at this time. "It's simply not the case, because we are not in a pre-pandemic environment."

Unemployed Americans thought they’d receive benefits until September. Now that aid is in jeopardy

Annie Nova@ANNIEREPORTER

CNBC
PUBLISHED TUE, MAY 11 2021

KEY POINTS

Unemployed Americans thought they’d receive benefits until September.

Now that aid is in jeopardy in a growing number of states, with Republicans saying it’s causing a labor shortage.

Others say cutting the benefits prematurely will only make it harder for people to get back on their feet, and that meaningful solutions include higher wages and more affordable child-care options.


Justin Mackey, his wife, Cassie, and their three young children:

 Camdyn, 14, Connor, 7, and Charlie, 3.

While Justin Mackey worked to rebuild his locksmith business, the 38-year-old was relying on getting a $420-a-week unemployment check for another four months.

That money was a fraction of what he brought home before the coronavirus pandemic shut down his business in Arkansas, but at least it kept his mortgage and other bills paid. And it allowed him to buy clothes and school supplies for his three young children: Camdyn, 14, Connor, 7, and Charlie, 3.


“It’s better than losing everything,” Mackey said.

But last week, Arkansas Gov. Asa Hutchinson said the state would be ending the federal unemployment programs early, including the $300 weekly boost. Those benefits will now expire at the end of June, more than two months earlier than Mackey had expected.

“Continuing these programs until the planned expiration date of Sept. 4, 2021, is not necessary and actually interferes with the ability of employers to fill over 40,000 job vacancies in Arkansas,” Hutchinson wrote in a letter. He joins Republican governors in Montana, South Carolina and Mississippi, who have also announced an early end to the aid, saying that it’s stopping people from taking jobs. Other states could follow.

As a result, many jobless people in these states will soon receive only their state benefit. The average weekly check is $248 in Arkansas; in Mississippi, it’s $195.

Rebecca Dixon, executive director of the National Employment Law Project, said leaving people with smaller benefits is shortsighted and dangerous.

“We’re going to see family hardship,” Dixon said. “We’re looking at a tsunami of debt, evictions and food insecurity on the horizon, and it’s mostly women and people of color who will bear the brunt of that.”

What’s more, because the federal programs expanded the pool of workers who are eligible for unemployment benefits, many self-employed, gig workers and freelancers will be entirely cut off from aid come July.

Mackey is one such worker.

His unemployment benefits have allowed him to keep his locksmith business, Jonesboro Lock & Key, running. He’s owned it for more than a decade.

But if that aid ends early, he might have to grab a job and abandon the shop. He said the wages on offer in his area were often unsustainable.

“I couldn’t afford to work in a fast-food place,” Mackey said. “I was making that money in high school.” (The minimum wage in Arkansas is $11.)






Before the public health crisis, he earned around $2,000 a week. He and his family lived comfortably.

And Mackey’s business is just starting to improve, he said, with more people calling of late.

“One of the reasons this pandemic unemployment is important for now is because it’s helping people with small businesses like myself try and build back,” he said.

The movement to end the federal unemployment programs took off after April job’s report showed that the U.S. economy added 266,000 jobs, compared with the 1 million expected.

The U.S. Chamber of Commerce is among the voices calling on states to end the $300 federal boost, saying that “paying people not to work is dampening what should be a stronger jobs market.”

The lobbying group also estimates that 1 in 4 jobless individuals are earning more with unemployment than they were when working.

Yet cutting the aid will only make it harder for people to get back on their feet, said Megan Dishong, an attorney at the Montana Legal Services Association.

Instead of looking for jobs, people will be worried about getting evicted and forced to spend their time applying for additional government assistance such as food stamps and rental aid, she said.

“People are in such a bind,” she said. “Ending the $300 benefit is only going to tie the knot tighter.”

If the goal is to get people back to work, she said, the focus needs to be on increasing wages and access to child care. (Among President Joe Biden’s proposals is a plan to make child care affordable or free for many families.)

“Until you have a safe, affordable place to send your kid, you just can’t go to work,” Dishong said.

People are in such a bind. Ending the $300 benefit is only going to tie the knot tighter.
Megan Dishong

LEGAL AID ATTORNEY

Meanwhile, some of the barriers to returning to work are unique to the pandemic, she said. Some of her clients, for example, are dealing with the long-term symptoms of Covid.

“They want to go back to work, but they’re still suffering,” she said.

As the number of states announcing an early end to unemployment benefits grows, Julianne O’Brien fears Florida will be next.

She was laid off at the start of the pandemic from her job as an estimator for a manufacturing company and was recently diagnosed with stage 2 breast cancer.

Without the federal aid, she would be left with just $275 a week. She lives around 40 minutes north of Palm Beach with her two children.

Julianne O’Brien   Source: Julianne O’Brien

“People are saying we’re lazy and collecting unemployment,” O’Brien, 46, said. “I’m just trying to survive.”

Taking a job is not an option for her right now.

“My doctors say I should mostly stay home because my immune system is low,” she said. “Covid is still out there.”

Ashley Broshious said the $300 federal unemployment boost has been a lifeline for her during the pandemic, helping her to start a restaurant consulting and career coaching business.

In the past, she’s worked as a wine director and a general manager at different restaurants and earned more than $65,000. Those same positions are now offering $40,000, or less, an income that wouldn’t allow her to pay all her bills.

She’s been receiving jobless benefits since April 2020 when she was laid off from a restaurant in South Carolina, one of the states to announce an early end to the aid. (She recently stopped receiving her unemployment checks, but is working with a nonprofit lawyer to get them resumed.)

“There’s people like me who need that money to start something new, and if we lose it, all those plans end,” Broshious, 33, said.

It’s not just foiled plans that she fears.

“If these benefits get cut and I don’t win this case, I’ll lose my home,” she said. “I’m going to have to pack up my car and move in with my mom in her tiny house in Toledo, Ohio.”

THIRD WORLD USA

Man who spent 22 years in solitary confinement fights to end the practice

"I had no idea that I was about to be tortured for decades," Anthony Gay said.

ByGabriella Abdul-Hakim andAnthony Rivas
11 May 2021


After spending 22 years in solitary confinement, Anthony Gay is trying to make sure no other prisoner in Illinois has to experience the same level of trauma that he went through.

Gay is the face of the state's Anthony Gay Isolated Confinement Act, a bill developed over the last 10 years that would limit solitary confinement to no more than 10 days per six-month period. It's one of several bills currently moving through state legislatures across the country that aim to reform solitary confinement in prisons and reduce the severe mental health toll on prisoners.

"The worst part is being trapped in a cell 24/7, not being able to receive social contact and human contact," said Gay, who was released from prison in 2018 after representing himself in over 80 appeals before he was able to retain the help of a lawyer.

Gay's path to solitary confinement began when he was 20 years old. He'd been involved in a street fight and, as a result, was charged with aggravated battery and robbery for stealing a hat and a dollar bill.

"They were like, 'If you plead guilty to the robbery, they'll dismiss the aggravated battery.' So, I'm thinking, 'I don't want to face 15 years [in prison] for a street fight,'" he said. "So, I plead guilty to the robbery and get four years probation."


ABC
After spending 22 years in solitary confinement, Anthony Gay is trying to make sure no other prisoner in Illinois has to experience the same level of trauma that he went through.

Gay, of Rock Island, Illinois, said he was arrested during his probation for driving without a license. His probation was revoked and he was resentenced to seven years in prison.

"I had no idea that I was about to be tortured for decades," he said.

While serving time, Gay was involved in another fight, which landed him in solitary confinement.

"It's dark and it's cold as a dungeon -- psychologically, anyway," he said. "The light is dim in the room, and [the room is] very small, and it just seemed like the walls are caving in."
MORE: Could solitary confinement on Rikers Island be laid to rest?

Gay said he was in the cell for 24 hours a day and that occasionally he'd be let out for an hour.

"But when I got out," he added, "it was much different because I didn't have to do the extreme in order to have social stimulation in human contact."

There are an estimated 80,000 Americans in solitary confinement on any given day, according to the Prison Policy Initiative. Gay said the experience nearly broke him.

"I would cut on myself. ... I would act out [and] throw urine, liquids, [at] all officers. They would extend my time and things of that sort instead of allowing me to see mental health [professionals] and taking it as a health concern. They took punitive measures."




ABC
Illinois State Rep. Lashawn Ford drafted the Anthony Gay Isolated Confinement Act.

Gay said he doesn't think people understand the importance of human contact. Some people, he said, "don't care and other people are just not aware."

Stephanie Gangemi, Ph.D., a forensic social worker, said solitary confinement is a "devastating and brutal" way to lock people up, and that it can sometimes perpetuate a cycle of heightened anxiety that can cause inmates to act up, leading to extensions in their stay.

"It breaks down the ability for people to do emotional regulation -- to read appropriate social cues," Gangemi said.

The Chicago nonprofit Uptown People's Law Center first introduced Illinois state Rep. Lashawn Ford to the solitary confinement reform bill that now bears Anthony Gay's name. His name was attached to the bill after Ford heard about his story. The bill was passed in the state's House last month and is now being considered by the state Senate.
MORE: Texas' longest serving death row inmate has sentence tossed

"When we learned about Anthony Gay's situation and how it impacted him mentally, and what he had to do to get out of solitary confinement, it was devastating," said Ford. "He immediately touched my heart."

Former prisoner on mission to change solitary confinement
ABC News’ Linsey Davis speaks with Anthony Gay, who spent 22 years in solitary confinement, a...

He went on to say, "What we're learning is if there's going to be some form of solitary confinement, it's our job to make sure that you don't keep people locked away for over 20 years in a solitary state. That's harmful, it's traumatic and it only harms society as a whole because those people come back and they become our neighbors."

Even now, Gay said there are times when he cries at night. He said more people need to be made aware of what he called the "psychological torture" of solitary confinement.

"I know what it's like to be ... tortured and I know that many people are still being tortured, and I feel guilty because I got out and they didn't," he said. "But I believe that if we can inform more people and more people become aware that strength is in numbers. … This is domestic terrorism. This is psychological torture. This is a crime against humanity, and [we can] compel them to do something about it. It's wrong ... despicable and it's horrible and it needs to stop."

AMERIKA END THE DEATH PENALTY
A man with intellectual disability is on death row — give him his day in court

Tim Shriver, opinion contributor 

The COVID 19 pandemic has brought Americans hard lessons in fear and isolation. But it also has laid bare other long-simmering pandemics - racism, inequities in health care, divisiveness, hidden biases. For people with intellectual disability, fear, isolation and bias are not new; they've experienced these conditions much of their lives. The time has come to awaken our country to what we can and must do to end the inequities they face. We can unite in action now by demanding that the government enforce the law and stop risking the execution of individuals with intellectual disability.

© Getty Images A man with intellectual disability is on death row — give him his day in court

Here's a place to start: Mark Jenkins is a man with intellectual disability soon to face the execution chamber on Alabama's death row. Convicted of the 1989 murder of Tammy Hogeland, he is at risk of being executed despite the Supreme Court's mandate that individuals with intellectual disability are ineligible for the death penalty. He has asked the Supreme Court to grant him a hearing to prove his intellectual disability and is awaiting their response.

Today we read a lot of articles about innocent people trapped on death row, which is a terrifying reality of our nation's capital punishment system. No innocent person should be convicted, let alone executed. Like the execution of an innocent person, the execution of someone with intellectual disability is a grave injustice, even when the crime was horrific. Our country¹s modern understanding of "justice" and "decency" in punishment, in theory, prioritizes more than just innocence or guilt; it also prioritizes the dignity of the individual facing punishment. In Atkins v. Virginia, the Supreme Court relied on this understanding to rule that the execution of individuals with intellectual disability is cruel and unusual punishment.

But no court has allowed Jenkins to prove his intellectual disability. Why? Because, in reality, our legal system continues to fail to enforce the Supreme Court's mandate in Atkins. This is why I have joined many others in urging the high court to hear his case and give Jenkins a hearing that the Constitution demands and that dignity-centric justice necessitates.

Individuals with intellectual disability on death row must be given their day in court. In fact, approximately 136 individuals have been saved from execution after they had the opportunity to prove their intellectual disability. The brief that I joined highlights the stories of five of these individuals - men who found themselves in the same situation as Jenkins, but who were given the chance to prove their intellectual disability. Like Jenkins, they struggled to learn basic tasks in school such as counting coins or telling time, and were placed in special education classes. They functioned as adults with a third-grade reading level; they were limited to menial work tasks, such as bringing tools to others. They relied on others to obtain housing and pay their bills. And at times they were bullied by their peers for being "slow."

Unlike these men, Jenkins repeatedly has been denied the opportunity to prove his intellectual disability for 30 years by courts blinded by misconceptions, stereotypes and incomplete evidence. Indeed, an Alabama court perpetuated offensive stereotypes that individuals with intellectual disability cannot maintain relationships or be employed. For example, the court said it was convinced Jenkins did not have intellectual disability because he had worked at a gas station. This stereotype is harmful and has no basis in science. The Supreme Court should right this wrong.

Our law's 20-year-old prohibition on the execution of individuals with intellectual disability has not saved every person with intellectual disability on death row from execution. To the contrary, at least 25 such individuals have been executed, eight of whom were executed in the past five years. That is 25 too many. Modern-day justice demands that courts do better, and that the execution of an individual with intellectual disability be taken as seriously as the execution of an innocent person. Indeed, at least five men exonerated from death row had intellectual disability - one factor that made them more vulnerable to wrongfully ending up on death row.

As recently as the late-20th century, our government has stigmatized, sterilized, experimented on, and even killed individuals with intellectual disability. In theory, the government has stopped executing individuals with intellectual disability. In reality, though, the government still executes them. Mark Jenkins's life is at serious risk. He is not asking for a second bite of the apple, but rather, a first bite to prove his intellectual disability. In this time when we are all the more conscious of harmful biases and mistreatment towards marginalized groups, we cannot stand on the sideline - and neither should the justices of the Supreme Court.

Give Mark Jenkins his long-overdue day in court, before it's too late.

Tim Shriver, chairman of Special Olympics and founder of UNITE, is a signatory to an amicus brief filed March 1 requesting that the Supreme Court hear Mark Jenkins's cert petition. Follow him on Twitter @TimShriver.

ISRAEL WAR ON GAZA REDUX

Hamas: Gaza City commander killed by Israeli airstrike

24 PALESTINIAN DEATHS PER EVERY ISRAELI'S

GAZA CITY, Gaza Strip (AP) — Militant group Hamas confirms that its Gaza City commander was killed in an Israeli airstrike, the highest-ranking militant killed since the 2014 war in the Palestinian territory

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© Provided by The Canadian Press

Earlier, Israel’s internal security agency said that a series of airstrikes had killed Bassem Issa and several other senior Hamas militants.

THIS IS A BREAKING NEWS UPDATE. AP’s earlier story follows below.

GAZA CITY, Gaza Strip (AP) — Rockets streamed out of Gaza and Israel pounded the territory with airstrikes Wednesday as the most severe outbreak of violence since a 2014 war took on many hallmarks of that devastating 50-day conflict, with dozens killed and no resolution in sight.

Palls of gray smoke rose in Gaza, as Israeli airstrikes levelled two apartment towers and hammered the militant group’s multiple security installations, destroying the central police compound.

In Israel, barrages of hundreds of rockets fired by Gaza’s Hamas rulers and other militants at times overwhelmed missile defenses and brought air raid sirens and explosions echoing across Tel Aviv, Israel’s biggest metropolitan area, and other cities.

The death toll in Gaza rose to 48 Palestinians, including 14 children and three women, according to the Health Ministry. More than 300 people have been wounded, including 86 children and 39 women. Six Israelis, including three women and a child, were killed by rocket fire, and dozens of people were wounded.

While the rapidly escalating conflict has brought images familiar from 2014 Israel-Hamas war, the past day has also seen a startling new factor: A burst of fury from Israel’s Palestinian citizens in support of those living in the territories and against Israel’s recent response to unrest in Jerusalem and its current operations in Gaza.

Amid those protests, communal violence erupted in several mixed Jewish-Arab Israeli cities, including the burning of a Jewish-owned restaurant and a synagogue, the fatal shooting of an Arab man and attacks on Arab-owned cars. In a rare move that highlighted the tensions, Israeli Defense Minister Benny Gantz on Wednesday ordered units of border guards deployed to help police keep order.

There was no sign that either side is willing to back down. Prime Minister Benjamin Netanyahu has vowed to expand the offensive, saying “this will take time.” Hamas has called for a full-scale intifada, or uprising. The last such uprising began in 2000 and lasted more than five years.

The latest eruption of violence began a month ago in Jerusalem, where heavy-handed police tactics during the Muslim holy month of Ramadan and the threatened eviction of dozens of Palestinian families by Jewish settlers ignited protests and clashes with police. A focal point was the Al-Aqsa Mosque compound, a site sacred to Jews and Muslims.

Late Monday, Hamas, claiming to be “defending Jerusalem,” launched a barrage of rockets at the city in a major escalation.

The Israeli military said militants have fired more 1,050 rockets since the conflict began, with 200 of them falling short and landing inside Gaza. Lt. Col. Jonathan Conricus, a military spokesman, said two infantry brigades were sent to the area, indicating preparations for a possible ground invasion.

Israel has struck hundreds of targets in the Gaza Strip, where 2 million Palestinians have lived under a crippling Israeli-Egyptian blockade since Hamas took power in 2007.

The fiercest attack was a set of airstrikes that brought down an entire 12-story building. The building housed important Hamas offices, as well as some businesses. Israel fired a series of warning shots before demolishing the building, allowing people to flee and there were no casualties.

Israeli aircraft heavily damaged another Gaza City building early Wednesday. Israel said the nine-story building housed Hamas intelligence offices and the group’s command responsible for planning attacks in the occupied West Bank; it also had residential apartments, medical companies and a dental clinic. A drone fired five warning rockets before the bombing.

Fighter jets struck the building again after journalists and rescuers had gathered around. There was no immediate word on casualties. The high-rise stood 200 meters (650 feet) away from the AP bureau in Gaza City, and smoke and debris reached the office.

Soon after, Hamas fired 100 rockets at the Israeli desert town of Beersheba in what it said was retaliation.

Samah Haboub, a mother of four in Gaza, said she was thrown across her bedroom in a “moment of horror” by an airstrike on an apartment tower next door. She and her children, aged 3 to 14, ran down the stairway of their apartment block along with other residents, many of them screaming and crying.

“There is almost no safe place in Gaza,” she said.

One strike hit a taxi in Gaza City, killing a man, woman and driver insider, and a second strike killed two men nearby on the street, witnesses who brought the bodies told the AP at the hospital. Several other bystanders, including a woman, were wounded.

In the Israeli city of Lod, a 52-year-old man and his 16-year-old daughter, reportedly Arab citizens of Israel, were killed early Wednesday when a rocket from Gaza hit the courtyard of their home.

The Jerusalem turmoil and the ensuing battle come at a time when the long-stalled Israeli-Palestinian peace process is virtually non-existent.

It has been seven years since the two sides held formal negotiations. Israel’s political scene pays little attention, and the peace process was hardly an issue in the country’s string of recent elections. Arab nations, including several that recently reached normalization deals with Israel, rarely push for any resolution.

The result has left the nearly 5 million Palestinians in the West Bank, Gaza Strip and east Jerusalem living in a limbo — caught among Israeli occupation, accelerated Israeli settlement building in the West Bank, a weak Palestinian Authority that recently canceled elections, and Hamas rule and the blockade that are impoverishing Gaza.

With the protests in Arab communities, the unrest in Jerusalem has also spread across Israel.

“An intifada erupted in Lod, you have to bring in the army,” the central Israeli city’s mayor, Yair Revivo, said. Lod saw heavy clashes after thousands of mourners joined a funeral for an Arab man killed the previous night, the suspect a Jewish gunman.

Israel and Hamas have fought three wars since the Islamic militant group seized power in Gaza from rival Palestinian forces. The conflicts ended after regional and international powers convinced both sides to accept an informal truce.

Once again, diplomats are seeking to intervene, with Qatar, Egypt and the United Nations working to deliver a cease-fire.

The U.N. Security Council also planned to hold its second closed emergency meeting in three days Wednesday on the escalating violence.

Israel faced heavy criticism over the bombing of residential buildings in Gaza during the 2014 war, one of several tactics that are now the subject of an investigation by the International Criminal Court into possible war crimes. Israel is not a member of the court and has rejected the probe.

In a brief statement, ICC prosecutor Fatou Bensouda said she had noted “with great concern” the escalation of violence and “the possible commission of crimes under the Rome Statute” that established the court.

Conricus, the military spokesman, said Israeli forces have strict rules of engagement, follow international laws on armed conflict and are trying to minimize civilian casualties.

But Israel has said it has no choice because Hamas fires rockets from residential areas. Hamas has also come under international criticism over its indiscriminate rocket fire at Israeli population centers.

___

Krauss reported from Jerusalem. Associated Press writer Karin Laub in the West Bank contributed.

NOBEL PEACE PRIZE UGLY WAR
Tigray: Eritrean troops disguised as Ethiopian military are blocking critical aid

By Nima Elbagir, Barbara Arvanitidis and Eliza Mackintosh 

Video by Alex Platt and Mark Baron, CNN 

Axum, Ethiopia — Eritrean troops are operating with total impunity in Ethiopia's war-torn northern Tigray region, killing, raping and blocking humanitarian aid to starving populations more than a month after the country's Nobel Peace Prize winning leader pledged to the international community that they would leave.

© Alex Platt/CNN Eritrean soldiers are captured on a hidden camera at a checkpoint in the hills above Adigrat, as they block access to the road to Axum.

© Alex Platt/CNN USAID distributes supplies in Hawzen, central Tigray, where residents hadn't received aid for two months.

A CNN team traveling through Tigray's central zone witnessed Eritrean soldiers, some disguising themselves in old Ethiopian military uniforms, manning checkpoints, obstructing and occupying critical aid routes, roaming the halls of one of the region's few operating hospitals and threatening medical staff.

© Nima Elbagir/CNN Seven-year-old Latebrahan lies on a gurney at Axum University Teaching and Referral Hospital, where she's being treated for malnourishment.

Despite pressure from the Biden administration, there is no sign that Eritrean forces plan to exit the border region anytime soon.

On April 21, a CNN team reporting in Tigray with the permission of Ethiopian authorities traveled from the regional capital Mekelle to the besieged city of Axum, two weeks after it had been sealed off by Ethiopian and Eritrean soldiers. An aid convoy also made the seven-hour journey.

Ethiopia's government has severely restricted access to the media until recently, and a state-enforced communications blackout concealed events in the region, making it challenging to gauge the extent of the crisis or verify survivors' accounts.

But CNN's interviews with humanitarian workers, doctors, soldiers and displaced people in Axum and across central Tigray -- where up to 800,000 displaced people are sheltering -- indicate the situation is even worse than was feared. Eritrean troops aren't just working hand in glove with the Ethiopian government, assisting in a merciless campaign against the Tigrayan people, in some pockets they're fully in control and waging a reign of terror.

The testimonies, shared at great personal risk, present a horrifying picture of the situation in Tigray, where a clash between Prime Minister Abiy Ahmed and the region's ruling party, the Tigray People's Liberation Front (TPLF), in November has deteriorated into a protracted conflict that, by many accounts, bears the hallmarks of genocide and has the potential to destabilize the wider Horn of Africa region.

Ethiopian security officials working with Tigray's interim administration told CNN that the Ethiopian government has no control over Eritrean soldiers operating in Ethiopia, and that Eritrean forces had blocked roads into central Tigray for over two weeks and in the northwestern part of the region for nearly one month.

As the war and its impact on civilians deepens, world leaders have voiced their concern about the role of Eritrean forces in exacerbating what US Secretary of State Antony Blinken, according to spokesperson Ned Price, has described as a "growing humanitarian disaster." In a phone call with Abiy on April 26, Blinken pressed Ethiopia and Eritrea to make good on commitments to withdraw Eritrean troops "in full, and in a verifiable manner."

© Alex Platt/CNN A sign at Axum University Teaching and Referral Hospital reads: "Blood Campaign, for mothers, for children, for all those that need it."

CNN's efforts to reach Axum were thwarted by both Ethiopian and Eritrean soldiers multiple times over several days.

On one of the first attempts, the CNN team encountered what it later learned was the aftermath of a grenade attack, where a group of local residents were flagging down cars, warning passersby not to go any further. But before we reached the scene, a large army truck drove up and parked sideways, blocking the road. Our cameraman got out of the car and started filming only to be confronted by Ethiopian soldiers, who threatened the team with detention, demanding that we hand over the camera and delete the footage. But we refused and were able to conceal the footage until we were eventually released.

© Alex Platt/CNN Hannibal, 7, is treated at Axum Teaching and Referral Hospital for a gunshot wound to the leg, which he received from soldiers' gunfire as he was sitting on his mother's lap.

On another occasion, CNN was turned back by an Ethiopian National Defence Force (ENDF) Command operating out of a former USAID distribution center in the outskirts of the city of Adigrat, where several trucks laden with sacks of desperately needed food sat languishing in the hot sun. The aid, bound for communities in Tigray's starved central zone, had been stopped from going any further despite daily phone calls from humanitarian workers pleading for access.

Even after being granted entry to Axum by the Ethiopian military, CNN's path was obstructed by Eritrean troops controlling a checkpoint on a desolate mountain top overlooking Adigrat. The forces were wearing a mixture of their official light-colored Eritrean Defence Forces (EDF) fatigues and a woodland camouflage with a green beret, which military experts verified as tallying with old Ethiopian army uniforms.

It is one of the first visual confirmations of reports -- relayed in recent weeks by the UN's top humanitarian official Mark Lowcock and US ambassador to the UN Linda Thomas-Greenfield -- that Eritrean soldiers are disguising their identities by re-uniforming as Ethiopian military, in what Thomas-Greenfield described as a move to "remain in Tigray indefinitely."

CNN was informed by aid agencies that they had also been turned back by Eritrean soldiers manning the same checkpoint. Ethiopian military sources in the region confirmed to CNN that Eritrean soldiers were in control of key checkpoints along the route to Axum. The military sources said they had requested multiple times for the Eritreans to allow cars and convoys through, but had been refused.

CNN has reached out to the Ethiopian and Eritrean governments for comment.

After repeated phone calls to Ethiopian central government and senior military officials, CNN was finally allowed into Axum on its fourth try. On the same day, international medical humanitarian organization Medecins Sans Frontieres demanded that the 12-day blockade of the road into Axum be lifted.

Many aid agencies are still being barred from the besieged city, where one of the few hospitals operating for miles is running out of essential supplies, including oxygen and blood, humanitarian workers working in the region told CNN.

On arrival at the Axum University Teaching and Referral Hospital, patients are greeted by a sign asking for blood.

The medical staff we spoke to asked not to be named for fear of reprisals, but requested that CNN identify their hospital -- they say that they want people to know that they are still here.

Inside one of the under-resourced examination rooms, a malnourished 7-year-old was lying on a gurney, wrapped in a blanket to cushion her fragile skin. Latebrahan's emaciated legs could no longer hold her weight and she lay wide-eyed, staring up at the crowd of doctors gathered around her bed.

The medical team were doing their best to keep her alive, but they had run out of a therapeutic feeding agent due to the blockade, the only way to help her gain weight without disturbing her delicate system.

Latebrahan's father, Girmay, who asked to be identified only by his first name, told CNN the journey from their home in Chila, around 60 miles north of Axum, near the border with Eritrea, had been dangerous and costly.

"There is no help, no food, nothing. I didn't have a choice though -- look at her," Girmay said.

Like many other rural border towns, Chila has been blocked off from receiving aid since the conflict began six months ago. Humanitarian workers say famine could have already arrived there and they would have no way of knowing.

"Based on guesswork there is a sense that in these areas that we are not able to access, out in the countryside for instance, places are falling into pockets of famine. But we're not able to verify that and that's part of the problem," Thomas Thompson, the UN World Food Programme's emergency coordinator, told CNN.

The fighting erupted during the autumn harvest season following the worst invasion of desert locusts in Ethiopia in decades. The conflict has plunged Tigray even further into severe food insecurity, and the deliberate blockade of food risks mass starvation, a recent report by the World Peace Foundation warned. The Ethiopian government itself estimates that at least 5.2 million people out of 5.7 million in the region are in need of emergency food assistance.

Eritrean soldiers have been blocking and looting food relief in multiple parts of Tigray, including in Samre and Gijet, southwest of Mekele, according to a leaked document from the Emergency Coordination Centre of Tigray's Abiy-appointed interim government obtained by CNN. In a PowerPoint presentation dated April 23, the center states that Eritrean soldiers have also started showing up at food distribution points in Tigray, looting supplies after "our beneficiaries became frightened and [ran] away."

That report was corroborated by humanitarian workers in Tigray, who said they had "protection" issues around distributing aid in some areas as civilians were later robbed of the aid by Eritrean soldiers. Emily Dakin, who leads the USAID Disaster Assistance Response Team in Tigray, also told CNN that she had received reports of health centers being looted, which was "contributing to some of the dysfunctionality of the hospitals."

Eritrea's Minister of Information Yemane Meskel has rejected these claims.

Eritrea's power in the region feels absolute even in the Axum Teaching Hospital, where Eritrean soldiers are among the gun-toting troops roaming the corridors, dropping off wounded soldiers and threatening medical staff. It is a terrifying scene for patients, many of whom say they were injured either directly or indirectly by soldiers.

One doctor, who asked not to be named, told CNN that the siege had prompted a surge in patients. In addition to cases of malnutrition like Latebrahan, doctors and nurses are treating a grim array of trauma from shrapnel, bullets, stabbings and rapes. In a desperate attempt to keep pace with demand, medical workers have also begun donating blood.

But despite this, there wasn't enough blood on hand to save one young woman, who had been attacked by soldiers who tried to rape her.

The doctor treating the woman told CNN that the hospital had seen a spike in sexual assault cases over recent weeks, but that the rise was just "the tip of the iceberg," as many were too scared to seek medical services.

An alarming number of women are being gang-raped, drugged and held hostage in the conflict, in which sexual violence is being used as a weapon of war and its use linked to genocide. According to one agency's estimate, almost one-third of all attacks on civilians involve sexual violence, the majority committed by men in uniform.

An autopsy photo of the young woman seen by CNN showed her internal organs spilling out from a wound in her lower abdomen.

"She came to our emergency department and she had a sign of life initially. [But] if you find blood for a patient, it's only one or two units and one or two units could not save this woman. She bled [out] and she died," the doctor said haltingly, overcome with emotion.

He took a deep breath, then added, "I see this woman in my dreams."

This reporting would not have been possible without the support of dozens of Tigrayans, who shared their stories at great personal risk. CNN is not naming them to protect their safety. It also builds on a series of investigations into massacres and sexual violence in Tigray by CNN's Bethlehem Feleke, Gianluca Mezzofiore and Katie Polglase. Read CNN's full Tigray coverage here.

VIDEO

Canada's worst outbreak at Alberta oil sands site still getting worse

KENNEY SAYS TARSANDS ESSENTIAL 

WON'T SHUT THEM DOWN

Duration: 02:27 

Calls from labour leaders are growing for Alberta to shut down oilsands operations, as COVID-19 outbreaks within them continue worsen. Heather Yourex-West looks at how the biggest outbreak at CNRL Horizon managed to grow out of control.

 Global News 11/5/2021

Future of AstraZeneca COVID-19 vaccine in question in Canada over blood clots, supply issues

 Evan Mitsui/CBC Ontario and Alberta will no longer give the AstraZeneca-Oxford vaccine as a first dose and future supply would instead be reserved for optional second shots.

The future use of the AstraZeneca-Oxford COVID-19 vaccine in Canada is now in question due to concerns over the increased risk of rare but severe blood clots connected to the shot, an unpredictable future supply and a significant amount of other vaccines.

Alberta was the first province to confirm it would stop administering first doses of the AstraZeneca vaccine, citing a scarcity of supply. The province will instead prioritize mRNA vaccines like Pfizer-BioNTech and Moderna while reserving existing AstraZeneca for second doses.

Ontario's Chief Medical Officer Dr. David Williams announced in an impromptu news conference late Tuesday afternoon the vaccine would also no longer be offered to Ontarians as a first dose and future supply would instead be reserved for optional second shots.

But unlike Alberta, Ontario's decision was made largely due to the rising rate of the rare but serious blood-clotting condition connected to the shot known as vaccine-induced immune thrombotic thrombocytopenia (VITT).

Williams said that in the past several days there have been a growing number of reports of VITT in Ontario. Out of more than 850,000 AstraZeneca doses given, there are now eight cases in the province as of Saturday at a rate of about one in 60,000 shots administered.

Other provinces have yet to follow suit, but there are growing signs the vaccine will not be prioritized in provincial and territorial rollouts across the country.

Quebec's Ministry of Health and Social Services said in a statement to CBC News that while the AstraZeneca vaccine is still technically available to people over 45, the remaining doses have almost all expired and mRNA vaccines will be offered if a second dose is unavailable.

Manitoba's Chief Provincial Public Health Officer Dr. Brent Roussin said Sunday that the possibility of stopping the use of the AstraZeneca vaccine was being discussed "at many levels."

British Columbia Provincial Health Officer Dr. Bonnie Henry said Tuesday that while second doses of the AstraZeneca vaccine will be available to those who already had a shot in the province, mRNA vaccines will also be an option.

New international research is expected in the coming days and weeks on the safety and efficacy of mixing and matching COVID-19 vaccines and Canadians who have received an initial dose of AstraZeneca will likely have the option of combining it with an mRNA shot.

"I cannot emphasize enough how important AstraZeneca has been, in particularly March and April when we had limited amounts of the mRNA vaccine and we had high case rates and it's a very good vaccine and very protective," she told CBC's The Early Edition.

"But as we have case rates coming down thankfully and hopefully staying down, and we have a lot more other vaccines available, we'll be looking at using the Pfizer and Moderna that's coming in."

VITT data 'evolving' in real time

The abrupt change in vaccine rollout strategy comes after growing concerns from health experts over the risk of VITT, which they say calls its continued use in Canada into question.

Dr. Andrew Morris, an infectious diseases specialist at the University of Toronto, says the use of the AstraZeneca vaccine in Canada is no longer justifiable, particularly in younger people.

"For the people who are in their 30s and 40s, it just doesn't make sense," he said. "They're at really low risk of dying from COVID and they're assuming a risk of dying from this."

Video: B.C. records first case of rare blood clot related to vaccine (The Canadian Press)

Health Canada approved the AstraZeneca vaccine for all Canadians over 18 in February, but provinces and territories have largely restricted its use in those over 40 due to the increased risk of VITT in younger age groups compared with the risk of death from COVID-19.

Though extremely rare, VITT is much more severe than a typical blood clot because it can cause cerebral venous sinus thrombosis (CVST), where veins that drain blood from the brain are obstructed and can potentially cause fatal bleeding.

© Evan Mitsui/CBC Pharmacist Kyro Maseh administers a dose of the AstraZeneca COVID-19 vaccine to Matthew Stone, 46, at a pharmacy in Toronto on Apr. 20, 2021. Ontario announced Tuesday the vaccine will no longer be offered to Ontarians as a first dose.

Dr. Menaka Pai, a clinical hematologist at McMaster University and a member of Ontario's COVID-19 Science Advisory Table, says that the risk of VITT is changing almost daily and that different guidelines are to be expected.

"The reality is this is what evolving science looks like," she said. "We're asking people to make decisions in real time with the info that we have and then the info evolves a week later and we can be regretful about the decision from a week ago but hindsight is 20/20."

Pai says each region of the country needs to look at its specific epidemiological situation in the pandemic and determine whether the risk of VITT outweighs the risk of severe outcomes from COVID-19.

"What works in a hotspot where you don't have enough mRNA vaccines to quickly cover everyone [may not work] in parts of the Maritimes where you actually have a lot of places with low prevalence," she said.

"If you don't have the privilege of choice because your pandemic is out of control, I think that changes the math a lot and it changes the decision-making."
VITT risk 'increasing' as cases identified

Canada has reported 12 confirmed cases of VITT as of Monday out of more than 2.3 million AstraZeneca doses administered, according to the Public Health Agency of Canada. Quebec, Alberta and New Brunswick have each reported one death; New Brunswick has only 40 COVID-19 deaths overall.

"In a province with low COVID-19 risk like New Brunswick, the risk of death from VITT outweighs the risk of death from COVID-19 at any age," said Dr. David Fisman, an epidemiologist at the University of Toronto's Dalla Lana School of Public Health.

The Ontario Science Table now estimates the frequency of VITT in Canadians who have received the AstraZeneca vaccine at 1 in 55,000, but that number is a moving target with new data being released from countries around the world daily.

"Risk estimates have been increasing as people have started looking for the complication," said Fisman. "It doesn't make sense to use a vaccine where short term harms outweigh short term benefits, when people can stay safe until they get mRNA vaccine."

The National Advisory Committee on Immunization (NACI) came under fire last week for its messaging around its recommendations to provinces and territories that mRNA vaccines such as Pfizer-BioNTech and Moderna, which don't have a risk of VITT, were "preferred."

PHAC said in a statement to CBC News that as the supply of mRNA vaccines like Pfizer and Moderna increase this month, it is "expected" that provinces and territories will "continue to review and adjust their vaccination programs."

Morris says he believes more cases and deaths from VITT will occur in Canada in the future if we continue to use the AstraZeneca vaccine as a significant part of our vaccine rollout.

"You have to be pretty certain that the people who you're giving it to have a really, really, really high risk of death from COVID," he said. "So that the risk of death that you're exposing them to is exceeded by the risk of death that you're preventing."
AstraZeneca use in other countries

Denmark has completely halted the use of the AstraZeneca vaccine due to the risk of VITT, in addition to the Johnson & Johnson vaccine, which uses a similar adenoviral vector method. The move that is expected to set the country back weeks in its vaccine rollout.

The United Kingdom has used the AstraZeneca vaccine as a significant part of its vaccination campaign to successfully control its pandemic and is now able to relax public health restrictions due in large part to the use of the shot.

But VITT was not yet identified when that rollout was in full swing at the beginning of the year and the U.K. restricted the vaccine to those over 40 last week and retroactively reported 242 cases of VITT and 49 deaths out of 28.5 million doses given up to April 28.

The Ontario Science Table says that VITT can present anywhere from four to 28 days after vaccination and Canadians should seek medical attention if they have any of the symptoms listed on its website.

Pai says Canadians who are concerned about having taken an initial dose of the AstraZeneca vaccine despite not having VITT symptoms should rest assured that they made a smart choice at a critical point in the pandemic.

"You guys made an amazing, amazing decision based on the information in front of you," she said. "And now doctors, like me are trying to educate you if there is a very rare risk."

'Very little excuse' to continue to use AstraZeneca in Canada: infectious diseases specialist

It’s time to halt AstraZeneca shots in Canada, except for people 40 or older in hotspots, says Andrew Morris, a doctor on Ontario’s COVID-19 science advisory table

Author of the article:Sharon Kirkey

Publishing date:May 11, 2021 • 

  

Empty vials of Oxford/AstraZeneca's COVID-19 vaccine are pictured amid a vaccination campaign in Bierset, Belgium, on March 17, 2021. PHOTO BY YVES HERMAN /Reuters

The peculiar blood clotting disorder linked with Oxford-AstraZeneca’s COVID-19 vaccine, a vaccine now temporarily paused in Ontario and Alberta, doesn’t cause the regular kind of blood clots. These clots require more extensive care, they can’t be predicted and, most importantly, are “really kinda bad,” says a Toronto infectious diseases specialist. The case fatality rate ranges between 20 and 40 per cent.

For those reasons and more, Dr. Andrew Morris believes it’s time to halt AstraZeneca’s shots across the country, except where COVID-19 is burning and people at very high risk of COVID cannot wait for a Pfizer-BioNTech or Moderna shot — mRNA vaccines that haven’t been associated with the same blood clot “safety signal.”

There is “essentially no scenario” outside of the hardest-hit regions where it is beneficial to give AstraZeneca rather than wait for an alternative, Morris, a member of Ontario’s COVID-19 science advisory table, said in an interview. While stressing that he wasn’t speaking on behalf of the table, “there is very little excuse for us to be continuing to give AstraZeneca to Canadians” because the estimated risk of the unusual clotting disorder is higher than earlier, overly optimistic estimates, Morris said.

At a hastily called news conference Tuesday, Ontario health officials announced the province is pausing first doses of the AstraZeneca vaccine out of an “abundance of caution” because of the risk of thrombosis and an abundance of mRNA vaccine supply. Alberta is also moving to stop using AstraZeneca for first doses.

There is very little excuse for us to be continuing to give AstraZeneca to Canadians

The risk of VITT — vaccine-induced thrombotic thrombocytopenia — now sits at one in 60,000 doses, based on Ontario data. “That’s a significant safety signal that we don’t want to ignore,” said Dr. Jessica Hopkins of Public Health Ontario. The province has about 50,000 remaining doses of AstraZeneca. “Given that we are seeing the overall case numbers of COVID going down and an increase in the safety signal, at a population level, it makes sense to pause AstraZeneca because the risk of severe outcomes with VITT shouldn’t be underestimated.”

Other provincial medical officers of health across the country are reviewing their use of the controversy-plagued vaccine. The European Union, meanwhile, has opted not to renew its AstraZeneca contracts, which expire in June. In Norway, an expert panel is urging both AstraZeneca and Johnson & Johnson vaccines be ditched over the blood clot scare.

According to Health Canada, the current estimated rate of VITT in Canada is approximately one case per 100,000 persons vaccinated with the AstraZeneca vaccine.

Ontario’s COVID science table, in a brief published Friday, said the risk, based on published estimates, could be as much as one in 26,000.

Morris’ best estimate is that one in 40,000 doses will lead to VITT, a condition that frequently results in complications, with about one in five leading to death and many more cases of severe illness. Given the risk, AstraZeneca only makes sense for those at very high risk of COVID, he said. “But why give them AZ, when we can give them an mRNA vax?”

MORE ON THIS TOPIC

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Ontario likely to give mixed COVID vaccine doses due to shortage of AstraZeneca: minister

Twelve cases of VITT have been reported in Canada, including three deaths. “To me, the most important issue is, we were aware of this a month ago — we probably didn’t appreciate the frequency as much a month ago, although we suspected it,” Morris said.

With two million combined doses of Pfizer and Moderna arriving weekly through May, and 2.4 million combined doses per week scheduled for June, Canada will soon be “swimming in vaccine,” Morris said. “I think that the regulators should say very clearly that, if there are no options for an mRNA vaccine and the incidence of cases is X number, then only in that situation should AstraZeneca be used.”

Some worry this messaging will only make people more confused and concerned. But others agree with Morris. “I’ve done the numbers, too,” University of Toronto epidemiologist David Fisman said on Twitter. “AZ was a useful tool, but our knowledge and understanding, and our supply of other vaccines, has changed. VITT is devastating. We need to move on.”

Just over two million of the 2.3 million doses of AstraZeneca doses delivered to the provinces had been administered as of Monday. The remaining vials won’t “make or break the pandemic” and the shots are likely going to people who are at relatively low risk of COVID, Morris said, meaning “we’re introducing unnecessary risk into people who have relatively low COVID risk.” The 20 million doses on order from an American plant should be donated to India and other countries, he said.

“If we could get a billion doses of AstraZeneca to India, I would do it in a heartbeat, because so many people are dying. And yes, some of those people will die (from vaccine-induced blood clotting) but you’re going to be saving millions and millions of lives,” said Morris, a professor of medicine at the University of Toronto and infectious diseases doctor at Sinai Health and University Health Network.

This shouldn’t be construed as buyer’s remorse, he said. People should not feel as if they were somehow “hoodwinked” into getting AstraZeneca. Every authorized COVID vaccine in Canada has been “absolutely life-saving.” A new analysis just out from Public Health England suggests a single dose of either the AstraZeneca or Pfizer-BioNTech vaccine is 80 per cent effective at preventing death from COVID. That rises to 97 per cent after two doses of Pfizer.

If we could get a billion doses of AstraZeneca to India, I would do it in a heartbeat

When COVID is raging, “it’s a total no-brainer (to use AstraZeneca) because, even if you are adding that small risk of harm, it’s outweighed by the benefit,” Morris said.

But outside of hard-hit Calgary, Edmonton, Winnipeg, Peel, Halifax and other pockets, the third wave is cresting or receding in most parts of the country.

Ontario is offering AstraZeneca to 40 and older. Of the 24,655 COVID-related deaths reported in Canada as of Monday, only 1.6 per cent, or 390, are in people under age 50, and three per cent (749) in people in their 50s.

The blood-clotting syndrome linked to the AstraZeneca vaccine happens four to 28 days after being vaccinated. The mechanism isn’t entirely clear, but it’s thought the body produces antibodies that attack platelets, tiny blood cells that form clots to stop or prevent bleeding. Serious clots have been reported in the brain and other critical organs. The clots can cause strokes, heart attacks and loss of blood supply to a limb.

Canada’s panel of independent vaccination advisors last week reiterated that Pfizer and Moderna remain the “preferred” recommended jabs for all Canadians, and that people at low risk of COVID should consider holding out for an mRNA vaccine, unless they choose to get vaccinated sooner.

However, the second dose question remains — what happens to those who received a single dose of AstraZeneca? Should they get AZ for dose two? According to U.K. data, the risk of VITT after a second dose of the vaccine is one in a million.

Officials are now awaiting the results of a large study in the U.K. that’s tested alternating doses of AstraZeneca and Pfizer in hundreds of volunteers.

The chances that there will be an issue with mixing vaccines are slim to none

“The chances that there will be an issue with mixing vaccines are slim to none,” said Dr. Allison McGeer, a medical microbiologist and infectious diseases specialist at Toronto’s Sinai Health System. “There are a lot of things keeping me awake at night. This is not one of them.”

“The rules have always been that we don’t ask people to be vaccinated if the vaccine is not a direct benefit to them,” McGeer said. “And the calculus of direct benefit to a person for the AstraZeneca vaccine at the moment is really difficult. It depends on community rates around the person, the individual involved, how well they can protect themselves, how sick they’re going to get if they happen to get COVID, what the probability of VITT is and how long people are going to have to wait for Pfizer or Moderna if they don’t choose to get AstraZeneca.”

With COVID rates dropping in most parts of the country, “that changes the calculations of risk in a non-trivial way,” McGeer said.

“If you got your AstraZeneca vaccine more than a month ago, that’s a good decision with a good outcome,” she said. “I know all sorts of people — my husband, my sister, lots of people — who got the AstraZeneca vaccine and it was a good decision at the time.

“This is the thing about pandemics. New diseases. Things change. The right thing to do changes over time.”

National Post