National

Vaccinating the world will be perhaps the single greatest global challenge of 2021, and that process is now beginning in earnest.

The big picture: If you're reading this in Europe, the U.S. or one of several other wealthy countries, you will probably have access to a vaccine in 2021. But if you're in a lower-income country, particularly in sub-Saharan Africa, you could be waiting until 2023.

The first vaccines to gain regulatory approval in the West — from Pfizer/BioNTech and Moderna — are bound almost exclusively for wealthy countries, at least in the near term.

Many rich countries have hedged their bets by buying enough doses of several different vaccine candidates to cover their populations even if some candidates aren't approved.

At least 7.7 billion vaccine doses have already been purchased, with another 3.9 billion reserved should countries or blocs elect to expand their orders, according to Duke University's tracker.

If you combine both categories, the U.S. has reserved nearly one-quarter of the global supply with 2.6 billion doses.

Not a single country in sub-Saharan Africa has announced a deal to purchase vaccine doses, though Johnson & Johnson is aiming to produce 300 million doses in South Africa next year.

Data: Duke Global Health Innovation Center; Chart: Axios Visuals

It's not just that access to doses varies wildly by income level — richer countries are also buying different vaccines than poorer ones.

 India is home to the world's largest vaccine manufacturer, and has sealed massive deals to begin to cover its population of nearly 1.4 billion.

Those deals are with Novavax, which has yet to release efficacy data, and AstraZeneca, whose vaccine appears to be about 70% effective but is undergoing further evaluation and testing.

The EU has purchased roughly the same number of doses but has a much more diversified portfolio. It includes 300 million doses of the Pfizer vaccine, the first shipments of which will begin on Thursday.

Several developing countries have struck deals for just one vaccine candidate, often from Russia (as with Kazakhstan, Nepal and Venezuela) or China.

Breaking it down: A forecast from The Economist Intelligence Unit projects that the most fortunate countries — including the U.S., U.K., EU and Japan — will spend the first half of 2021 vaccinating priority groups and the second half of the year vaccinating the remainder of their populations.

In other high-income countries — as well as in countries like China, Brazil, India and Russia that are producing or manufacturing vaccines at scale — mass vaccinations will begin next year but likely continue into early 2022.

Other middle-income countries aren’t expected to be able to vaccinate all high-priority groups until late 2021, with mass vaccinations continuing throughout 2022.

Low-income countries that can’t afford to purchase doses in bulk will still be vaccinating high-priority groups into early 2022, with mass vaccinations continuing throughout 2023 and perhaps into 2024.

There are a number of variables that could shift that outlook significantly in either direction.

1. Further announcements on the safety, efficacy and scalability of additional vaccines, including those from Oxford/AstraZeneca, J&J, Novavax and Sanofi, which have together committed more than 2 billion doses to developing countries.

2. More news on Russia's Sputnik V vaccine and on the several vaccines in development in China.

3. The ability to increase manufacturing capacity in the developing world, and to build strong supply chains to ship and distribute doses globally.

4. The efficient distribution of unused doses by rich countries to poorer ones.

5. The engagement of the Biden administration. President-elect Biden has said he'll re-engage with the World Health Organization and restore America's global leadership, but he hasn't spoken about a U.S. role in global vaccine distribution.

The single biggest factor will be the success of the COVAX initiative, from the Gavi vaccine alliance, the Coalition for Epidemic Preparedness Innovations and the WHO.

Driving the news: Those groups told reporters in a briefing on Friday that they're on track to meet their ambitious goal of ensuring at least 20% of the population in virtually every country on earth has access to a vaccine by the end of 2021.

The big picture: COVAX is the only route to a vaccine for dozens of countries, and wealthier participants will effectively subsidize their access.

What to watch: The aim for the first half of 2021 is to provide enough doses to all participant countries to cover frontline health and social care workers.

Then comes the 20% wave, which is intended to reach the most vulnerable people in each country.

Dr. Krishna Udayakumar, director of Duke's Global Health Innovation Center, says the 20% target will be very difficult to hit next year, and 60%-70% vaccination rates — the target for herd immunity — are unlikely before the end of 2022 even in a best-case scenario.

Yes, but: Vaccinating the most vulnerable and combining vaccination with other public health measures to slow the spread will allow "a real reduction in death and disability but also really an uptick in economic activity," he adds.

The challenge of 2021: Vaccinating the world

Americans will have access in 2021. Africans could wait until 2023.

Illustration of a vaccine bottle with a picture of the Earth on its label. 

World

Coronavirus vaccines

Coronavirus

Conflicts, policies and powers are intersecting and shaping the world. Breaking news and analysis of national security, foreign policy and global crises.

The U.S. health system faces critical questions about cost, access and equity. Technological advances and new discoveries about diseases like cancer and Alzheimer’s are transforming patient care and reshaping public health.

Health

Axios AM

Dr. Anthony Fauci has long cited 60% to 70% as the level of COVID infection/vaccination the country would need to achieve herd immunity — for the disease to fade and life to return to normal, writes the New York Times' Donald G. McNeil Jr.

But, but, but: "About a month ago, he began saying '70, 75 percent' in television interviews. And last week, in an interview with CNBC News, he said '75, 80, 85 percent' and '75 to 80-plus percent,'" McNeil writes.

What's new: "In a telephone interview," McNeil continues, "Fauci acknowledged that he had slowly but deliberately been moving the goalposts."

"He is doing so, he said, partly based on new science, and partly on his gut feeling that the country is finally ready to hear what he really thinks."

"When polls said only about half of all Americans would take a vaccine, I was saying herd immunity would take 70 to 75 percent ... Then, when newer surveys said 60 percent or more would take it, I thought, "I can nudge this up a bit," so I went to 80, 85. We need to have some humility here .... We really don’t know what the real number is. I think the real range is somewhere between 70 to 90 percent. But, I'm not going to say 90 percent."

Go deeper: Keep reading McNeil's "How Much Herd Immunity Is Enough?" (subscription.)

NYT: Fauci acknowledges moving goalposts on herd immunity from COVID-19

Fauci previously cited 60% to 70% as the level of infection or vaccination needed.

President Trump passes Dr. Anthony Fauci after a coronavirus task force briefing on March 26. Photo: Jonathan Ernst/Reuters

Health Care

Anthony Fauci

Politics

Starting Monday the U.S. will require all air travelers from the United Kingdom to test negative for coronavirus within 72 hours of their departure, the Centers for Disease Control and Prevention has announced.

The big picture: More than 50 countries have restricted air travel to the U.K., as concerns have continued to grow after the nation and the World Health Organization said they'd identified a new variant of COVID-19 within the country.

How it works: Passengers will have to show proof of a negative result on a genetic swab test, known as PCR, or an antigen test that was administered within three days before their flight.

Airlines will be required to confirm the negative test result of all passengers before they board, and they will have to deny boarding to those who decline to show a test.

"This additional testing requirement will fortify our protection of the American public to improve their health and safety and ensure responsible international travel," the CDC wrote in a news release late Thursday.

United Airlines, Virgin Atlantic and Delta Air Lines already had a similar policy in place for flights between Britain and the U.S., according to the New York Times.

U.S. to require negative coronavirus test from travelers from the U.K.

Miami International Airport on Dec. 24, 2020. Photo: Daniel Slim/AFP via Getty Images

COVID-19

Pope Francis said in his Christmas Day message that coronavirus vaccines should be made available to everyone at no charge, and that nations should work together as they recover from the effects of the pandemic.

The state of play: Because of Italy's restrictions to stem the spread of COVID-19, the Catholic Church leader delivered the traditional Urbi et Orbi (to the city and the world) speech from the Apostolic Palace at the Vatican, instead of from a balcony overlooking St. Peter's Square to a usually large crowd.

“At this moment in history, marked by the ecological crisis and grave economic and social imbalances only worsened by the coronavirus pandemic, it is all the more important for us to acknowledge one another as brothers and sisters,” Francis said, per the AP.

What he's saying: "Today, in this time of darkness and uncertainty during the pandemic, different lights of hope appear, like the discovery of the vaccines ... they must be available to everyone," the pope said, according to CNN. 

"I beg all those in charge of states, of companies, of international bodies ... to promote cooperation and not competition and to seek a solution for everyone, vaccines for all, especially for the most vulnerable and needy in all regions of the globe."

The pope called for generosity and support toward people who are experiencing hardships during the pandemic, including unemployment and domestic violence.

Pope Francis in Christmas message calls for COVID-19 vaccines for everyone

The pope delivered the traditional speech from the Apostolic Palace at the Vatican.

Pope Francis. Photo: Vatican Pool/Getty Images

Pope Francis

Georgia's U.S. Senate Democratic candidates Raphael Warnock and Jon Ossoff each raised more than $100 million in the last quarter of 2020, shattering fundraising records and eclipsing their Republican rivals in the race, new filings show, per the Federal Elections Commission and CNN. 

Why it matters: The figures reflect the largest single-quarter totals by any candidate in U.S. Senate history, beating the $57 million South Carolina Democrat Jaime Harrison raised earlier this year during his failed bid for the Senate.

The large hauls reflect the intense national attention on Georgia's runoffs, which will determine which party controls the Senate.

By the numbers: Ossoff raised some $106.8 million between October 15 and December 16, while Warnock amassed $103 million. 

Warnock's opponent, incumbent Sen. Kelly Loeffler (R), raised nearly $64 million, while Sen. David Perdue (R), who is running against Warnock, raised just over $68 million.

What to watch: Georgia's early voting starts with heavy turnout



Democrats in Georgia runoff shatter quarterly Senate fundraising record

Raphael Warnock and Jon Ossoff each raised more than $100 million in the last quarter.

Democratic U.S. Senate candidates Jon Ossoff and Raphael Warnock. Photo: Elijah Nouvelage/Getty Images

Senate Democrats

2020 election

2024 will be an election year like no other, as President Biden seeks re-election amid economic uncertainty, two wars and questions about his age. His likely foe, former President Trump, faces felony charges and vows revenge on his political enemies. Meanwhile, Americans generally are dissatisfied with those choices and are divided over immigration, race, education and more.

Politics & Policy

Nine months of the coronavirus pandemic have left millions of Americans and small businesses struggling to survive. On this Christmas Day, they all deserve to be in our thoughts. 

The big picture: Millions of Americans have lost their jobs. People who once volunteered at food banks are turning to them to feed their families. And millions of others could face homelessness when the CDC's moratorium on evictions expires on Dec. 31. 

By the numbers: In a survey this fall, around 13% of all adults in the country — 27 million — said their households didn't have enough food during the last week, according to the Center on Budget and Policy Priorities.

That's nearly four times the number of adults who said they didn't have enough to eat at some point in all of 2019.

Latinas and Black women are especially vulnerable. Another survey found that one in six Latinas and one in five Black, non-Hispanic women said they didn't have enough to eat during the last week, per the National Women's Law Center.

The U.S. poverty rate jumped 2.4 percentage points to 11.7%, throwing nearly 8 million people into poverty, researchers found in a study last week. That's the biggest one-year increase in the 60 years that the government has been tracking poverty, according to the Washington Post. 

Renters are in trouble. By next year, roughly 12 million will owe an average of $5,850 in back rent and utilities, per WaPo.

Between 2.4 million and 5 million U.S. households are at risk of eviction in January alone, per the investment bank and financial-advisory firm Stout Risius Ross.

And at a time when so many Americans are turning to food banks for help, many are short of holiday volunteers because of safety concerns, Reuters reports.

The good news is, Americans rich and not-so-much have stepped up to make the holidays a little less bleak for those in need.

Mackenzie Scott, the ex-wife of Amazon CEO Jeff Bezos, announced on Dec. 15 that she had donated $4 billion over the past four months to 384 nonprofit organizations focused on basic needs.

Bezos himself donated $100 million to Feeding America, a Chicago-based nonprofit with more than 200 food banks across the U.S.

Oprah Winfrey in April donated $10 million to coronavirus relief efforts, with $1 million going to America's Food Fund to help alleviate food insecurity.

The Bill and Melissa Gates Foundation donated $1.75 billion to the global virus response.

And Twitter CEO Jack Dorsey donated 28% of his wealth —$1 billion — to global pandemic relief, putting the money into Start Small, which funds a variety of programs. 

Large sums of money are not the only way to help needy communities: 

People across the country started setting up GoFundMe accounts for specific needs, such as these fundraisers for the families of infected Arlington firefighters and for living supplies for the less fortunate in San Diego, California. (Check out the GoFundMe site to search for others.)

Food businesses are also helping families put food on the table for the holidays. Staten Island residents are buying holiday dinners for needy families through the "Staten Island 4 Staten Island" effort, and restaurants in Lincoln City, Oregon are offering "Merry Meals" to donate toys and food to their community.

What you can do: If you're able, give to those who really need your help. Scott's list of the 384 charities she donated to is a great place to start.

Restaurant Workers’ Community Foundation, which has set up an emergency relief fund for restaurant workers, and Children of Restaurant Employees are among the groups accepting cash donations to help small businesses. 

Other nonprofits are also accepting non-financial donations, such as Toys for Tots, which collects toys and distributes them to children in need, and The Conscious Kid, which accepts anti-racist children's books and now has a rent relief fund that has raised over $500,000 since April.

Helping Hands serves seniors and those who are immunocompromised or have preexisting conditions with grocery and other essential supply deliveries, all done contact-free.

The neediest holiday season

The pandemic has left millions of Americans and small businesses struggling to survive.