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Illustration: Aïda Amer/Axios

As coronavirus cases rise across the country, some experts are again calling to delay the second doses of vaccines — and to target vaccines to the hardest-hit areas.

Why it matters: America's vaccination strategy should adapt to a changing pandemic, these experts argue.

What they're saying: "It's time for the Biden admin to delay 2nd vax doses to 12 weeks. Getting as many people as possible a vax dose is now urgent," tweeted Atul Gawande, who was a member of President Biden's coronavirus transition team. "I was on the fence on this. I'm not anymore."

  • Part of what got him off the fence, Gawande said, is the fact that more dangerous variants are an increasing share of U.S. cases. He also pointed to a recent CDC study that found the mRNA vaccines reduced the risk of coronavirus infection by 80% after the first dose.
  • A paper published yesterday in Nature argues that delaying or halving doses could slow the development of new, vaccine-resistant variants.

The other side: Opponents of delaying second doses — including the U.S. government, at least for now — note that we don't know how long immunity from just one dose lasts.

  • “We don’t think it’s worth taking the chance," NIAID Director Anthony Fauci said. “We know that the level you get with a single dose, no question, is substantially lower than the level of antibody you get with a double dose. And we know that when we’re dealing with variants, you need a cushion.”

What's next: There's a separate debate brewing over whether more vaccine doses should be sent to hotspots.

  • Michigan Gov. Gretchen Whitmer and New York City Councilmember Mark Levine — representatives of the two biggest hotspots in the country — have recently advocated for that approach.
  • But the White House isn't inclined to change its population-based distribution formula.
  • “I think we shouldn’t do that at the central level…I don’t think it’s necessary," Fauci said. "I think it can be accomplished at the local level.”

Go deeper

The race between COVID vaccines and emerging variants

America is in a race to vaccinate people before the country is overwhelmed by variants that are spurring a fourth wave of COVID-19.

Why it matters: Spring is here, and when cases were dropping, hope was rising for a more normal summer. But experts warn this will only happen if people keep social distancing, wearing masks and getting vaccinated as soon as they can.

Apr 1, 2021 - Health

Canada's 3 biggest provinces impose fresh COVID restrictions as cases surge

Canadian Prime Minister Justin Trudeau elbowing bumps with a patient at a community Covid-19 vaccination clinic in Ontario. Photo: Sean Kilpatrick/The Canadian Press/Bloomberg via Getty Images

Canada's three biggest provinces this week announced new coronavirus restrictions amid a surge in cases largely driven by COVID-19 variants, the Wall Street Journal reports.

Details: Ontario will enter a four-week limited lockdown — its third lockdown since the beginning of the pandemic — starting Saturday, which will ban all indoor activities. Earlier this week, Quebec closed schools and non-essential businesses, and British Columbia banned indoor activities, including places of worship.

The fourth wave is here

Expand chart
Data: CSSE Johns Hopkins University; Map: Andrew Witherspoon/Axios

Coronavirus infections are on the rise yet again, all across the U.S.

The big picture: America may be at the beginning of a fourth wave in the pandemic. It will almost certainly be far less deadly than the previous three, but this persistent failure to contain the virus has real consequences, and will only make it harder to put COVID-19 behind us.