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    Trump Claims Credit for Vaccines. Some of His Backers Don’t Want to Take Them.

    #masthead-section-label, #masthead-bar-one { display: none }Covid-19 VaccinesVaccine QuestionsDoses Per StateHow the Moderna Vaccine WorksWhy You’ll Still Need a MaskPost-Vaccine OutlookAdvertisementContinue reading the main storySupported byContinue reading the main storyTrump Claims Credit for Vaccines. Some of His Backers Don’t Want to Take Them.A deep distrust of the government is fueling vaccine hesitancy among Republicans, who are more likely than Democrats to resist being inoculated against Covid-19.A pharmacist preparing a dose of the Pfizer vaccine for the coronavirus on Wednesday. The “anti-vaxxer movement” is not new, and it typically cuts across political parties. But partisanship plays a major role in how people view the coronavirus vaccine.Credit…Michael A. McCoy for The New York TimesDec. 18, 2020Updated 9:43 p.m. ETWASHINGTON — Elizabeth Graves, an ardent supporter of President Trump, is not opposed to vaccines. She said she had taken flu shots and pneumonia shots and, having just turned 50, was interested in being vaccinated against shingles.But Ms. Graves, a legal transcriptionist in Starkville, Miss., said she would not be taking a coronavirus vaccine — and the sight of Vice President Mike Pence rolling up his sleeve to get vaccinated on live television on Friday, she added, would not change her mind.Lawrence Palmer, 51, a field service engineer in Boiling Springs, Pa., and Brandon Lofgren, 25, who works in his family’s trucking and construction business in rural Wisconsin, said they felt the same way. All are fans of Mr. Trump, and echoed Ms. Graves, who said she was “suspicious” of government and that Mr. Pence’s vaccination “doesn’t mean a thing to me.”It is a paradox of the pandemic: Helping speed the development of a coronavirus vaccine may be one of Mr. Trump’s proudest accomplishments, but at least in the early stages of the vaccine rollout, there is evidence that a substantial number of his supporters say they do not want to get it.Until the past week, their objections were largely hypothetical. But with a second vaccine about to become available in the United States — the Food and Drug Administration on Friday authorized emergency use of the vaccine developed by Moderna, a week after the version developed by Pfizer and BioNTech won the same approval — more people will confront the choice of getting inoculated or not. The authorization will clear the way for the shipment of 5.9 million doses over the weekend and tens of millions more in coming months, greatly expanding the reach of the vaccination campaign as the nation grapples with the uncontrolled spread of the disease.For the most part, public opinion has been swinging in favor of vaccination. Seventy-one percent of Americans are willing to be vaccinated, up from 63 percent in September, according to a survey released this week by the Kaiser Family Foundation.Still, the survey found that Republicans were the most likely to be hesitant, with 42 percent saying they would probably not or definitely not be vaccinated, as compared with 12 percent of Democrats.Experts say that vaccine hesitancy may diminish over time if people see friends and relatives getting vaccinated without incident. Sheri Simms, 62, a retired businesswoman in Northeast Texas who describes herself as a “moderate conservative” supporter of the president, said that while she did not intend to get vaccinated now, that could change.“As more information comes out, and things appear to work better, then I will weigh the risks of the vaccine against the risk of the coronavirus and make a judgment,” she said.The “anti-vaxxer movement” is not new, and it typically cuts across political parties. But the coronavirus vaccine, developed against the backdrop of a bitterly fought presidential election and championed by an especially polarizing figure in Mr. Trump, has become especially associated with partisanship.During the campaign, while Mr. Trump was promising a vaccine by Election Day, some Democrats expressed concern about whether safety would be sacrificed in the rush to deliver a vaccine in time to help the president at the polls.Political leaders in both parties worked on Friday to dispel concerns about the vaccine.Mr. Pence, who took the Pfizer vaccine on Friday in a ceremony at the Eisenhower Executive Office Building in Washington, was not the only prominent public official to get vaccinated. On Capitol Hill, congressional leaders including Speaker Nancy Pelosi, a Democrat, and Senator Mitch McConnell, the Republican leader, were also inoculated against Covid-19. President-elect Joseph R. Biden Jr. and his wife, Jill Biden, are to be vaccinated on Monday..css-fk3g7a{font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:0.875rem;line-height:1.125rem;color:#121212 !important;}@media (min-width:740px){.css-fk3g7a{font-size:0.9375rem;line-height:1.25rem;}}.css-1sjr751{-webkit-text-decoration:none;text-decoration:none;}.css-1sjr751 a:hover{border-bottom:1px solid #dcdcdc;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-zs9392{margin:10px auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-zs9392{font-size:1.25rem;line-height:1.4375rem;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.75rem;margin-bottom:20px;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-size:1.5rem;line-height:1.875rem;}}.css-121grtr{margin:0 auto 10px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-qmg6q8{background-color:white;margin:1.5rem auto 1.9rem;max-width:600px;}#NYT_BELOW_MAIN_CONTENT_REGION .css-qmg6q8{padding:0;width:calc(100% – 40px);max-width:600px;margin-right:auto;margin-left:auto;}.css-qmg6q8 strong{font-weight:700;}.css-qmg6q8 em{font-style:italic;}@media (min-width:740px){.css-qmg6q8{margin:40px auto;}}.css-qmg6q8:focus{outline:1px solid #e2e2e2;}.css-qmg6q8 a{color:#326891;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ccd9e3;}.css-qmg6q8 a:visited{color:#333;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ddd;}.css-qmg6q8 a:hover{border-bottom:none;}.css-qmg6q8[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-qmg6q8[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-qmg6q8[data-truncated] .css-5gimkt:after{content:’See more’;}.css-qmg6q8[data-truncated] .css-6mllg9{opacity:1;}.css-11uwurf{border:1px solid #e2e2e2;padding:15px;border-radius:0;margin:0 auto;overflow:hidden;}@media (min-width:600px){.css-11uwurf{padding:20px;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-11uwurf{border-top:1px solid #121212;border-bottom:none;}Covid-19 Vaccines ›Answers to Your Vaccine QuestionsWith distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.In any other era, Mr. Pence’s vaccination, administered by a technician from the Walter Reed National Military Medical Center in Bethesda, Md., in images beamed across the country, would have been a moment to bring the nation together. He took the shot in front of a giant blue poster declaring in white block letters: “SAFE and EFFECTIVE.”His wife, Karen Pence, and Surgeon General Jerome Adams were also vaccinated.Vice President Mike Pence received the Pfizer vaccine on Friday in a ceremony at the Eisenhower Executive Office Building in Washington.Credit…Doug Mills/The New York Times“I didn’t feel a thing — well done,” the vice president said afterward, adding that he wanted to “assure the American people that while we cut red tape, we cut no corners.”But Mr. Trump was notably absent. One reason for the partisan divide over vaccination, experts said, is the president himself. His repeated denigration of scientists and insistence that the pandemic is not a threat, they said, have contributed to a sense among his followers that the vaccine is either not safe or not worth taking.“I just don’t feel there’s been enough research on it. I think it was sped up too fast,” said Mark Davis, 42, a disabled worker in Michigan. “You don’t even really know the side effects, what’s in it.”Mr. Lofgren agreed. “The jury’s out on whether it’s going to work,” he said, despite studies showing that the Pfizer and Moderna vaccines were more than 94 percent effective.Experts say that “herd immunity” — the point at which so many people are immune that the spread of a virus is diminished — can be achieved when roughly 75 percent of the population is vaccinated. While the Trump administration is rolling out a public relations campaign to encourage people to get vaccinated, the reluctance among even a minority of Republicans is deeply troubling to public health experts.Mr. Trump has been quick to claim credit for the manufacturing and distribution of the vaccine. “Distribution to start immediately,” he said Friday on Twitter, a day after an F.D.A. expert advisory panel recommended approval of Moderna’s vaccine.Although the president has recovered from Covid-19, he remains vulnerable to reinfection. Dr. Anthony S. Fauci, the government’s top infectious disease scientist, has recommended that Mr. Trump be vaccinated. But he has given no indication that he will actually do so, and he has said little, if anything, to encourage Americans to get vaccinated.“We need him taking a proactive role,” said Matthew Motta, a political scientist at Oklahoma State University who studies politics and vaccine views, adding, “The single best person to convince you to change your mind about something is somebody who agrees with you, somebody who you trust on other issues.”Mr. Trump’s own flirtations with vaccine skepticism are well known. He repeated the debunked theory that vaccines cause autism as far back as 2007, when he said he had slowed his son Barron’s vaccination schedule, and as recently as 2015 while first running for president.“Trump helped re-energize the anti-vaccine movement,” said Dr. Peter Hotez, an expert on vaccines, “and now he wants to pivot and make this his greatest accomplishment.”Helping speed the development of a coronavirus vaccine may be one of President Trump’s proudest accomplishments, but at least in the early stages of the vaccine rollout, there is evidence that a substantial number of his supporters say they do not want to get it.Credit…Samuel Corum for The New York TimesSome conservative news media outlets are reinforcing the skepticism, tapping into suspicion of government by raising questions about whether officials are leveling with the public about the risks of the vaccines.Tucker Carlson, the Fox News commentator, railed on Thursday against the “corporate image campaign” promoting vaccination, suggesting incorrectly that isolated instances of allergic reactions to the vaccine were being censored.In interviews, Trump supporters said they felt the pandemic had been blown out of proportion. Mr. Lofgren said several of his co-workers had recovered from Covid-19, “with really no more than just cold symptoms.” Mr. Palmer said that if he “had an issue with breathing or a heart issue or a lung issue,” he might consider it, but does not want to take a chance.Conspiracy theories — including the notion that the virus was created by the Chinese and Democrats to hurt Mr. Trump politically, or that the vaccine contains a microchip allowing the government to track people — cropped up in several conversations. Ms. Graves, who has diabetes, a risk factor for Covid-19, and has a master’s degree in library science, said such thoughts were creating doubts in the back of her mind.“There’s no, quote, evidence that there’s a microchip or that here’s something nefarious about the whole thing,” she said. “But I have a gut check about all of it, and the government pushing it, and they’re finding all these popular people to take the vaccine. And it’s weird, like why are we pushing it so hard?”AdvertisementContinue reading the main story More

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    After 4 Years of Trump, Medicare and Medicaid Badly Need Attention

    President-elect Joe Biden has pledged to “marshal the forces of science” in his administration. Undoubtedly he needs to start by bolstering the credibility of the Food and Drug Administration and the Centers for Disease Control and Prevention.But a third health agency, central to the lives of older Americans, low-income families and the disabled, is sorely in need of his attention. Science has also been under assault at the Centers for Medicare & Medicaid Services, which provides federal health insurance to more than 130 million Americans at a cost of more than $1 trillion, nearly twice the Pentagon’s budget.C.M.S. does more than just write checks for medical care. Its scientists and analysts determine which treatments should be offered — I am the chairman of the committee that advises Medicare on those decisions — and how best to care for the patients it serves.Unfortunately, the Trump White House has steadily eviscerated the agency’s dispassionate approaches to making those determinations.Recently, for instance, the Trump administration set in motion a plan to strip C.M.S. of its ability to assess for itself whether new medical devices approved by the F.D.A. are appropriate for the older patients it covers. This is important because the benefits and risks of such devices and procedures, which range from implantable hips and cardiac stents to digital apps and laboratory tests, can vary widely based on patient age and disability.The proposed rule requires Medicare to pay for any new device so long as the F.D.A. labels it a “breakthrough.” And that word does not mean what you think it does.The F.D.A. calls a device a “breakthrough” when it is expected — though not yet proved — to be helpful to patients with serious conditions. The designation has nothing to do with how the device works in older patients, or even if it was studied in that population at all. The proposed rule would also require Medicare to cover any new drug or device if at least one commercial insurer covers it for its members, even if its members are young and healthy.Already, companies seldom generate enough data on their products for C.M.S. to assess their value for its patients. In 2019, for instance, data was insufficient in just under half of new F.D.A. drug approvals to assess benefits or side effects in older patients. The proposed rule would drain the last remaining motivation that companies have to study their treatments in the patients who are likely to ultimately receive them.C.M.S. scientists and analysts do more than evaluate new treatments. They also test alternative ways to organize and pay for patient care. The agency has found, for example, that enrolling people at risk of diabetes in gym sessions reduced how often they were hospitalized. But some seemingly obvious ways to improve health care don’t work: C.M.S. also found it could not reduce hospitalizations for cancer patients by paying their doctors to actively manage their patients’ care.The fact that so many promising ideas don’t work as expected is the reason C.M.S. needs to double down on evaluations of how medical care is delivered to its patients.This administration has gone in the other direction. Just before the election, the White House conjured up a plan to send older people a $200 prescription drug discount card in the mail. Research has already demonstrated that if you give people money to buy prescription drugs, they will buy more of them. The pharmaceutical industry knows this, too. That’s why it hands out coupons worth billions of dollars.These same studies also show that when people are indiscriminately given cash for medicines — instead of only those who need that money the most — it costs much more overall than it saves. No wonder the discount card giveaway would have cost around $8 billion. Fortunately, the president has yet to follow through with it.In another troubling development, the administration announced on Nov. 20 that it would run an experiment in which reimbursements to physicians will be cut for dozens of high-cost drugs they administer in the office, such as chemotherapies and treatments for inflammatory diseases.C.M.S. financial analysts warned that the cuts will lead many Medicare patients to lose access to these important treatments. Scientists should evaluate this prediction by including a comparison group of patients whose doctors would not receive a cut in payment. But the agency administrator made it clear that she didn’t believe the warning. No comparison group is planned. That is no way to evaluate whether our nation’s vulnerable would be helped or hurt by this significant policy change.Another example of a poorly designed experiment involved taking Medicaid coverage away from able-bodied people who are not working or going to school, under an ill-founded theory that doing so would inspire them to seek employment. Such a study is best done narrowly, so that any harms are minimized. Instead, the administration invited multiple states in 2018 to test the outcome.A Harvard study found that a work requirement in Arkansas led to a rise in the number of uninsured people and no significant changes in employment. Thousands of Medicaid beneficiaries in Michigan and New Hampshire were set to lose their coverage before work requirements in those states were ended. Given those results, the overall program should have been canceled. The administration broadened it.Through its reliance on scientific evaluation of what it should pay for, and how, C.M.S. has remained financially viable for more than half a century. As the new president plans to fix the damage done by the current president, this vital agency demands his attention.Peter B. Bach is a physician at Memorial Sloan Kettering Cancer Center. He served as a senior adviser to the administrator of the Centers for Medicare and Medicaid Services in 2005 and 2006.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More