Exit Polls Showed the Vote Came Down to Covid-19 Versus the Economy

first_imgPre-election polls throughout this election season had shown that roughly four in five voters held strong opinions on Mr. Trump and his leadership, and strong feelings on both sides continued to define this year’s election. Updated Nov. 3, 2020, 10:16 p.m. ET If you just want results… There will be a results map on The Times’s home page, and yes, the infamous needle will be back — but only for Florida, Georgia and North Carolina, the only states providing granular enough information for our experts to make educated projections of uncounted votes.If you want constant updates… Times reporters are live-blogging all day and night. This will be your one-stop shop for minute-by-minute updates: race calls, on-the-ground reporting from swing states, news about any voting issues or disruptions, and more.If you want to check in every so often… Times journalists are also producing a live briefing from roughly 5 p.m. to 3 a.m. ET, with an overview of what’s happening in the presidential race, the Senate and House races, and the voting process itself. Election 2020 ›How to Follow the Election ResultsHere’s a guide to The Times’s election night coverage, no matter when, how or how often you want to consume it. Reflecting a pervasive pessimism, nearly two-thirds of voters said they believed the country was heading in the wrong direction, according to an Associated Press canvass of those who had cast ballots — and those voters overwhelmingly picked Mr. Biden. And while Mr. Trump had attempted to focus the campaign on anything other than the pandemic, it remained a defining issue: More than four in 10 voters said it was the most important problem facing the country, far more than any other issue. A separate survey — the traditional exit poll, conducted by Edison Research — asked the question differently; it found that, as important as it was to them, only about one in five voters considered the virus the top issue affecting their vote. More said the economy was, and a similar share said racial inequality decided their ballots. Moderate voters also swung heavily for Mr. Biden, in a tacit rejection of the “radical” label that Mr. Trump had sought to pin on him. Throughout his term, Mr. Trump has alienated moderates with his rhetoric, and was never seen favorably by most independent voters.It was these voters at the center whom Mr. Biden had most aggressively targeted, using a message of unity and American tradition to offer voters a respite from the bombast of the current president, and to push back against the Trump campaign’s portrayal of the Democrat as a tool of the left.For the first time, not one but two probability-based, scientifically sound voter surveys were conducted amid the election. The Edison exit polls, conducted on behalf of a consortium of news organizations, were carried out by phone with voters who had cast ballots early, and by in-person interviews at voting places.The Associated Press also conducted its own voter survey, called VoteCast, using a panel of online respondents assembled by NORC, a research group based at the University of Chicago. Among those voters who cast ballots for him four years ago, about nine in 10 supported him again this time. But Mr. Biden held onto an even stronger share of Hillary Clinton’s 2016 supporters. As the country faces a dual national crisis — a monthslong pandemic and economic devastation — voters were deeply divided on what mattered more: containing the coronavirus or hustling to rebuild the economy, according early exit polls and voter surveys released Tuesday.Their opinion of which was more important fell along starkly partisan lines, with those who viewed the pandemic as the most pressing issue favoring Joseph R. Biden Jr. for president, while those who named the economy and jobs broke overwhelmingly toward re-electing President Trump.- Advertisement –center_img Far fewer said they knew someone who had died from the virus, but among those who did, the vast majority chose the former vice president. The overall trends in the results were consistent between the two organizations’ surveys, though the exit polls appeared to show Mr. Trump running strongly in more states than the VoteCast survey did. The two polls also asked different questions of their respondents; results from both are referred to in this article.In contrast to four years ago, a very small share of voters, in the single digits, said they had decided within the past few days, according to the exit polls. Four years ago, 13 percent said they had decided in the final week, according to exit polls. Views of the virus also cleaved to politics: Roughly four in five Trump supporters called it at least somewhat under control, while as many Biden voters said it was “not at all under control.”Those who reported that the pandemic had taken a personal toll tended to back Mr. Biden. More than a third of all voters said they or someone in their household had lost a job or income over the past eight months, and most of those voters favored Mr. Biden.Those who did not vote in 2016, a group that the Trump campaign said would be key to re-election, appeared to show up in significant numbers — but they mostly turned out to oppose him. First-time voters appeared to favor Mr. Biden by wide margins.- Advertisement – The overwhelming majority of Trump supporters called the economy excellent or good while an equal share of Biden supporters said it was doing poorly.- Advertisement – Among white voters, there were stark divides along lines of gender as well as education. While Mr. Trump appeared on pace to come close to repeating his blowout win in 2016 among white voters without college degrees, Mr. Biden held a lead among white voters with a college education.That group was one among many — including suburbanites and political independents — that Mr. Trump had narrowly won when facing Mrs. Clinton, but whose support he had long since lost.In certain key states, Mr. Biden appeared to fall short of Hillary Clinton’s support four years ago among Latino voters, particularly men. In Florida, the exit poll put his lead in the single digits with Hispanic voters, and in Texas he was barely winning three in five.But elsewhere his margin among Hispanic voters was much stronger, and nationwide he ran ahead of the president by more than two to one. – Advertisement –last_img read more

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Sofia Richie Spotted Kissing Boyfriend Matthew Morton on Date Night

first_imgHot and heavy! Sofia Richie packed on the PDA with her new boyfriend, Matthew Morton, while on a date night with friends.The model, 22, was spotted out to dinner with Morton, 27, at Japanese restaurant Matsuhisa in Beverly Hills on Monday, November 2, in photos posted by the Daily Mail.Sofia Richie Spotted Kissing New Boyfriend Matthew Morton on Date NightSofia Richie attends the Guitar Hotel grand opening at Seminole Hard Rock Hotel and Casino in Hollywood, Florida on October 24, 2019. Larry Marano/Shutterstock- Advertisement – A second source told Us that Richie’s family is supportive of her blossoming romance with Morton.“They both run in the same circle and have known each other. So, it’s easy and fun for both of them,” the insider said. “Sofia’s family approves of him, which is super nice for her.”Morton is also equally invested in his relationship with Lionel Richie‘s youngest daughter. A source told Us on Tuesday, November 3, that the entrepreneur is serious about the fashion designer.- Advertisement – – Advertisement – “Matt grew up with an insane amount of wealth, but always remained grounded. He is a hard worker and wants to prove himself to his dad [Hard Rock Cafe cofounder Peter Morton],” the insider said. “He used to be somewhat of a player and has always surrounded himself with very pretty girls and dated pretty girls. But he’s calmed down a lot and likes Sofia a lot.”Richie previously dated Disick, 37, from 2017 until their split in August. The Keeping Up With the Kardashians star has been spotted out with models Bella Banos, Megan Blake Irwin and Amelia Hamlin in the wake of their split. Disick has also been getting cozy with ex Kourtney Kardashian with whom he shares children Mason, 10, Penelope, 8, and Reign, 5.A source told Us in September that Richie’s family thinks she “is way better off without him” and are “advising her to do her own thing.”Listen to Us Weekly’s Hot Hollywood as each week the editors of Us break down the hottest entertainment news stories! Richie was dressed casually in an orange sweater, black pants and a crossbody purse. The Cha Cha Matcha founder, for his part, also looked low-key in a white shirt, dark pants and a white jacket accessorized with a baseball cap.Richie and Morton sparked dating rumors on October 17, when they were spotted getting dinner at Nobu in Malibu. Two days later, Us Weekly broke the news that the pair were dating following Richie’s split from Scott Disick.“They’re trying not to make a big deal about their relationship or about how serious it is,” an insider said at the time. “But they are definitely seeing each other.”Sofia Richie Spotted Kissing New Boyfriend Matthew Morton on Date NightMatthew Morton YouTube- Advertisement –last_img read more

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Both Georgia Senate races appear headed for runoffs as Senate control hangs in the balance.

first_imgRepublicans were ready to try to harness the grievance among Mr. Trump’s most ardent supporters, hoping that the president’s baseless claims of fraud and a backlash to his potential loss could power them to a win in January. Over the last 24 hours, Ms. Loeffler has repeatedly tweeted support for the president, who is falsely claiming that the election is being illegally stolen from him. Facing such extraordinarily high stakes, both parties were quickly preparing themselves for a nine-week year-end sprint that some estimated could ultimately cost at least another $100 million and put Georgia at the center of the nation’s political fray just two weeks before Inauguration Day.Democrats around the country were already mobilizing to use the contests to complete Mr. Biden’s victory and make possible the liberal agenda on health care, the economy and the environment he ran on.“Change has come to Georgia,” Mr. Ossoff said in a rally in Atlanta on Friday. “And Georgia is a part of the change coming to America.”- Advertisement – If Joseph R. Biden Jr. prevails in winning the White House, his vice president could cast tiebreaking votes to give the party de facto control.- Advertisement – Georgia’s special Senate election has been destined for a runoff since Tuesday, when the Rev. Dr. Raphael Warnock, a Democrat, and Senator Kelly Loeffler, a Republican, emerged as the top two vote-getters in a crowded field vying to replace the retired Senator Johnny Isakson.Democrats would need to win both seats on Jan. 5 — a steep task in a state with deep conservative roots — to draw the Senate to a 50-50 tie, but they were riding a wave of liberal enthusiasm and demographic change that appeared poised to deliver victory in Georgia to a Democratic presidential candidate for the first time since 1992. Ms. Loeffler said that she had donated to a fund fighting for the president’s cause.“Praying for four more years of @realDonaldTrump!” she wrote in another message.With Mr. Trump defying the election results, it was hard to predict how involved he might be in the Senate races. But early Friday morning, he insinuated in a tweet that Democrats were still trying to claim power through nefarious means so they could reverse Republican policies.“Would End the Filibuster, ‘Life’, 2A, and would Pack and Rotate the Court. Presidency becomes even more important,” he wrote. “We will win!” – Advertisement – With control of the Senate hanging in the balance, Republicans and Democrats began positioning themselves on Friday for a pair of high-stakes January Senate runoffs in Georgia that could serve as a referendum to cement or upend the results of Tuesday’s election, even as one of the races remained uncalled.Senator David Perdue, a Republican, was narrowly leading his Democratic opponent, Jon Ossoff, in the uncalled race. But as protracted counting dragged on, he fell below the 50 percent threshold needed to win outright. He was not expected to clear that bar with many of the remaining votes coming from Democratic counties.- Advertisement –last_img read more

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Biden’s Team Steps Up Transition Plans, Mapping Out a White House

first_imgMr. Biden, 77, has told associates that he considers his two terms as vice president and his knowledge of how a White House operates from the inside as crucial advantages in building out a government. And he has made it plain in public and private that a diverse team is central to his mission.“Men, women, gay, straight, center, across the board, Black, white, Asian,” Mr. Biden said this spring when talking about his prospective cabinet. “It really matters that you look like the country, because everyone brings a slightly different perspective.”Though Mr. Biden and Democrats had aggressively pushed to take control of the Senate, the party fell short in hotly contested races this week. Now Senate Republicans are likely to hold veto power over his most senior appointments, a reality that looms large over conversations, even if Democrats could still conceivably control the Senate if they win two runoff elections in Georgia in January. Lael Brainard, who sits on the Federal Reserve’s board of governors and served in the Treasury Department under Mr. Obama, is the most talked-about candidate to run the department, especially if the Senate is controlled by Republicans, which would make it harder to confirm a more progressive choice like Senator Elizabeth Warren of Massachusetts. Mr. Biden’s team quietly began raising money for his transition operation in May and has raised at least $7 million to pay for its efforts. The Biden camp has prepared for multiple scenarios in case Mr. Trump refused to concede and his administration would not participate in a transition.- Advertisement – So far, officials in Mr. Trump’s government have worked in good faith, according to Biden officials, who said they hoped and expected that cooperation to continue.As coronavirus infections hit new highs, Mr. Biden’s aides are planning for the first critical transition decisions to focus on health care and addressing the pandemic, the central theme of his campaign in the final months. They have assembled an internal group of roughly two dozen health policy and technology experts to look at the development and delivery of a vaccine, improving health data and securing supply chains, among other issues.Among those expected to play a key health care role in a Biden administration is Vivek Murthy, a former surgeon general under President Barack Obama, who has privately advised Mr. Biden for months on the pandemic and is expected to play a large public role as a face of the potential Democratic administration’s response to the virus, dispensing advice on mask-wearing and social distancing.- Advertisement – Like Mr. Biden, Mr. Kaufman is seen as an institutionalist, and he in fact wrote the law devoting additional government resources to transition teams. Yohannes Abraham, who worked in the Obama White House as a top aide to Valerie Jarrett and the National Economic Council, is overseeing the day-to-day operation.Given his decades-long career in Washington, Mr. Biden has numerous relationships from his time in the Senate and the White House with people across various policy areas. That history also means that his transition team has faced a crush of outside advice and former Biden associates jockeying for jobs and influence.Parts of the cast that had Mr. Biden’s ear throughout the presidential campaign — Anita Dunn, a senior adviser; Steve Ricchetti, another former vice-presidential chief of staff; and Mr. Klain — are among those guiding the formation of a would-be government. Senator Kamala Harris of California, his running mate, is generating names and speaks regularly to Mr. Biden. In Mr. Biden’s policy orbit on the campaign, Jake Sullivan and Antony J. Blinken are widely seen as the most influential figures, and both are expected to hold senior posts in a potential administration. Even before it was clear that Democrats would not win a clear majority in the Senate, Mr. Biden’s advisers began gearing up for bruising cabinet confirmation battles, bringing in top Obama veterans to run what is informally being called a transition war room. If Mr. Biden wins, he is expected to initially focus on filling top posts at the White House, including chief of staff, the most powerful single staff position. Ron Klain, his former chief of staff as vice president, who served as the White House Ebola response coordinator under Mr. Obama, is seen to have the inside track for that job, though others are still reportedly under serious consideration.At the center of Mr. Biden’s transition planning is Ted Kaufman, his former chief of staff in the Senate, who was appointed to replace Mr. Biden as a senator after he became vice president, as well as Jeff Zients, a former Obama administration official. The behind-the-scenes activity underscored that even as Mr. Biden publicly offered a disciplined message about counting every vote and refrained from claiming victory, he was already mapping out a quick start in office as the nation faces a worsening pandemic and a damaged economy.Mr. Biden, who ran from Day 1 on a message of bringing the country together, is said to be interested in making a bipartisan gesture as he plans a prospective government after a divisive election whose results President Trump has tried to undermine. Mr. Biden is looking to fill out his possible White House staff first, with cabinet posts not expected to be announced until around Thanksgiving, according to more than a half-dozen people familiar with the planning process who spoke on the condition of anonymity to discuss the transition. Some Democratic House members who endorsed Mr. Biden early, such as Representative Filemon B. Vela Jr. of Texas and Representative Brendan Boyle of Pennsylvania, could be in line for administration positions if they wanted them.“We have an expression where I come from: You never forget those who brung you to the dance,” Mr. Biden said at a stop with Mr. Boyle in Philadelphia this week.The Biden operation is preparing for Mr. Trump to potentially put up transition roadblocks. The transition team has already assembled a staff of more than 75 officials, with plans for that number to balloon to roughly 300 transition staff members by Inauguration Day in January. The administrator for the General Services Administration has the legal authority to release about $6.6 million in federal funding to Mr. Biden’s transition, and in past years has done that soon after the race is called.Pamela Pennington, a spokeswoman for the G.S.A., said in a statement that Emily W. Murphy, Mr. Trump’s appointee as the agency’s administrator, would start the official transition when it was clear that the race was over.“The G.S.A. administrator does not pick the winner in the presidential election,” Ms. Pennington said. “The G.S.A. administrator ascertains the apparent successful candidate once a winner is clear based on the process laid out in the Constitution.”Reporting was contributed by Jonathan Martin, Jim Tankersley, David E. Sanger and Katie Glueck. Joseph R. Biden Jr.’s advisers accelerated their transition planning on Friday as election results showed him with an advantage in battleground states that could hand him the presidency, with the first senior officials in a potential Biden White House possibly named as early as next week.In Wilmington and Washington, Mr. Biden’s advisers and allies are ramping up their conversations about who might fill critical posts, both in the West Wing and across the agencies, guided heavily by Mr. Biden’s plan to assemble what would be the most diverse cabinet in history.- Advertisement – Where they land is considered one of the early decisions that would help determine other appointments. Mr. Sullivan, a former adviser to Hillary Clinton, is lined up for one of a number of posts, while Mr. Blinken, who served as national security adviser to the vice president, is considered the leading candidate for national security adviser.Some of the most powerful cabinet positions in a possible Biden administration already have perceived front-runners.The top candidate to lead the Defense Department is Michèle Flournoy, a former under secretary of defense for policy who worked with Biden officials during the campaign. She would be the first woman ever to be appointed to the job. Susan Rice, a former national security adviser during the Obama administration whom Mr. Biden vetted for vice president, has been considered a leading choice for secretary of state, but the threat of Senate Republicans blocking her from becoming the nation’s chief diplomat in 2012 led to her withdrawal, and her nomination now would surely set off a fight.Mr. Blinken, a former deputy secretary of state, has been discussed among Biden allies as a possible choice, along with Senator Chris Coons of Delaware, a top Biden supporter who in October wrote an article in Foreign Affairs magazine on his worldviews.Representative Cedric Richmond of Louisiana, one of Mr. Biden’s campaign co-chairs and an adviser, is widely expected to take some role in the White House if the Democratic nominee wins. Another campaign co-chair, Mayor Eric Garcetti of Los Angeles, who also served on Mr. Biden’s search committee for vice president, could join a prospective administration, though it was not clear what post might lure him to Washington.Leaders of the Biden transition are aware that many civil servants throughout the federal bureaucracy have become demoralized and have felt marginalized during the Trump administration. In a small gesture, they are calling their potential first arrivals at agencies “agency review teams,” as opposed to what the Trump operation called “landing teams” in 2016. Updated Nov. 6, 2020, 10:06 p.m. ET – Advertisement – Transition officials are also looking at what types of economic actions could be taken almost immediately, including rolling back some of Mr. Trump’s executive orders, part of a tradition in which new presidents move quickly to change or reverse regulations across federal agencies. Already hanging over the discussions are the midterm elections, in 2022, which have traditionally been a struggle for whichever party holds the White House and which could be especially complicated for Democrats during an era of increasingly common progressive primary challenges.last_img read more

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Nokia Power Earbuds Lite are completely waterproof » Gadget Flow

first_imgWith an IPX7 rating, the Nokia Power Earbuds Lite are entirely waterproof. In fact, these impressive gadgets can handle up to 30 minutes in one meter of water. So if you happen to drop them in a puddle or a pool, that’s no problem. What’s more, these waterproof earbuds boast up to 35 hours of playtime. Meaning you can listen for a whole day without having to worry about recharging. But, if that isn’t enough battery life for you, just use the pocket-size charging case that comes with them for some extra juice. Available in Fjord, Charcoal, and Snow color options, these Nokia Earbuds draw their inspiration from nature. Thankfully, the Nokia Power Earbuds Lite also use 100% recyclable paper packaging. With a smooth, ergonomic fit and universal Bluetooth compatibility, these earbuds are ones you won’t want to take out pretty much ever. – Advertisement –last_img read more

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A Trump loyalist is installed at the National Security Agency.

first_imgA Trump loyalist has been appointed as the top lawyer at the National Security Agency, a sign that the administration is trying to help its political appointees land career posts that they can stay in even after a new president is sworn in, American officials said.The appointee, Michael Ellis, had served as a National Security Council lawyer and most recently as its senior director for intelligence. Formerly a lawyer for the Republicans on the House Intelligence Committee, he gained notoriety as one of two White House aides who helped his previous boss, Representative Devin Nunes, gain access to intelligence reports in early 2017 to advance President Trump’s political goals.- Advertisement – – Advertisement – In the summer of 2019, Mr. Ellis was a deputy to John A. Eisenberg, the National Security Council legal adviser. As White House officials raised concerns about the shadow Ukraine policy run by Rudolph W. Giuliani, Mr. Eisenberg regularly consulted Mr. Ellis about what to do. Mr. Ellis was one of three finalists for the National Security Agency job. He was chosen by the general counsel for the Department of Defense, which the National Security Agency is a part of, after White House officials made clear that Mr. Ellis was their preferred candidate, according to a person briefed on the decision.Mr. Ellis’s appointment was reported earlier by The Washington Post.The two other finalists were the current acting National Security Agency general counsel, Teisha M. Anthony, and the acting general counsel of the Office of the Director of National Intelligence, Brad Brooker.center_img The position has been vacant since the previous general counsel, Glenn S. Gerstell, stepped down in February. The post is traditionally apolitical; the National Security Agency fiercely guards its reputation of being outside politics, and it is not clear how well a partisan lawyer will sit with the staff.The general counsel job is a Civil Service post, and it would be difficult for President-Elect Joseph R. Biden Jr.’s administration to remove Mr. Ellis. However, Mr. Ellis could be reassigned to another legal job in the military.The National Security Agency declined to comment, and the National Security Council staff did not return a request for comment.- Advertisement – – Advertisement –last_img read more

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Xiaomi Mi TV Stick and Mi Box 4K OTT Discount Offers for Diwali: All You Need to Know

first_imgOriginal Price Rs. 399/ year Rs. 299/ year The list of OTT providers covers all kinds of Indian content, including in regional languages, and have TV shows, movies, and documentaries. The highest discount on a single service is for Docubay, with a benefit of Rs. 750 being offered on a one-year subscription. Offer Price Rs. 340/ year The discounts are applicable only on the Mi TV Stick and the Mi Box 4K, priced at Rs. 2,799 and Rs. 3,499, respectively. The former is an affordable offering with support for streaming at up to full-HD resolution, while the latter supports 4K HDR streaming. Both devices run on Android TV 9 Pie and connect to televisions through HDMI port.Mi TV Stick vs Fire TV Stick Lite vs Mi Box 4K vs Fire TV Stick 4K: Which is the best budget streaming device for TVs in India? We discussed this on Orbital, our weekly technology podcast, which you can subscribe to via Apple Podcasts, Google Podcasts, or RSS, download the episode, or just hit the play button below. Rs. 396 Offer Benefit Value Hungama Play 25 percent off Docubay Rs. 999 for 16 months Rs. 103/ month or Rs. 799/ year Sony Liv Aha Rs. 499/ 3 months or Rs 1,499/ year Free for 1 month – Advertisement – – Advertisement – Rs. 100 Xiaomi Mi TV Stick and Mi Box 4K buyers this Diwali festive season will get multiple offers and discounts on premium streaming services. Up to Rs. 2,400 worth of benefits are on offer across various streaming services. The Mi TV Stick and Mi Box 4K were launched earlier this year and are the company’s first standalone streaming devices in India. Both streaming devices run on the Android TV platform, with access to apps and services through the Google Play Store for Android TV.Streaming services with discounts and offersAs part of the offers, Xiaomi has tied up with nine streaming services in India, to offer discounts and benefits to users who want to sign up for the premium streaming services. These include Zee5, Sony LIV, Eros Now, Hungama Play, Shemaroo Me, Epic On, Docubay, Aha, and Hoichoi. Benefits include either discounts on subscription plans, or in a couple of cases, free subscription months.- Advertisement – 50 percent off Eros Now Rs. 999/ year Rs. 149/ month up to Rs. 750 10 percent off Rs. 899/ yearcenter_img 20 percent off OTT Platform Rs. 349/ year (1 screen) or Rs. 489/ year (2 screens) Rs. 249/ 3 months or Rs. 749/ year Rs. 103/ 3 months, Rs. 194/ 6 months, or Rs. 324/ year Rs. 129/ month or Rs. 999/ year – Advertisement – up to Rs. 175 Rs. 149 Zee5 4 months free Epic On Offer 51 percent off Rs. 159/ month, Rs. 299/ 6 months, or Rs. 499/ year up to Rs. 200 30 percent off Rs. 999/ year Shemaroo Me Rs. 359 Hoichoi up to Rs. 210 Rs. 699/ year 1 month free trial Rs. 499/ year (1 screen) or Rs. 699/ year (2 screens) 35 percent off Rs. 100last_img read more

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Osterholm says world isn’t ready for flu pandemic

first_img But to really be well prepared for a pandemic, the world needs 10 years of lead time and “a worldwide influenza Manhattan Project aimed at producing and delivering a pandemic vaccine for everyone in the world” soon after the start of a pandemic. “In this scenario, we just might make a real difference,” he states. Osterholm said the United States is ahead of other countries in preparing for a pandemic, but nations can’t deal with the problem singly. A pandemic emerging today would find the world severely short of vaccine production capacity and medical supplies and could bring the global economy to a standstill, writes Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of the Web site. He reported he has already received a lot of supportive feedback on his article. “A lot of people are really wondering where we go next. We need a G-8 [“Group of Eight” countries] initiative for vaccine, and every level of government needs to think about what they’ll do.” The H5N1 virus has killed at least 52 people in Asia in the past 17 months but has shown very limited ability to spread from person to person. If it gained the ability right now to spread quickly among humans while remaining highly virulent, the world would face a grim situation, Osterholm writes. “We need bold and timely leadership at the highest level of the governments in the developed world; these governments must recognize the economic, security, and health threats posed by the next influenza pandemic and invest accordingly,” Osterholm asserts. Osterholm submits that the current system for producing flu vaccine (growing it in chicken eggs) is unlikely ever to be adequate for meeting the challenge of a pandemic. He calls for development of a new cell-culture-based vaccine that would target proteins present in all flu viruses, rather than the surface proteins (hemagglutinin and neuraminidase), which constantly change and necessitate adjustments in the vaccine each year. It would take at least 6 months to produce a vaccine, and with current production capacity, the best that could be expected would be to have fewer than 1 billion doses of vaccine initially, he writes. Since two doses per person might be necessary, that might cover only 500 million people, or about 14% of the world population. Further, the world would face severe shortages of other products and services, including mechanical ventilators, antiviral drugs, and even food. May 5, 2005 (CIDRAP News) – A bleak picture of the world’s ability to cope with an influenza pandemic is painted in an essay by infectious-disease and bioterrorism expert Michael T. Osterholm, PhD, MPH, in this week’s New England Journal of Medicine. “There would be a scramble to stop the virus from entering other countries by greatly reducing or even prohibiting foreign travel and trade. The global economy would come to a halt, and since we could not expect appropriate vaccines to be available for many months and we have very limited stockpiles of antiviral drugs, we would be facing a 1918-like scenario.”center_img In a brief interview, Osterholm told CIDRAP News there is good agreement among public health and infectious disease experts that a pandemic will occur, though no one knows whether it will be the H5N1 virus or some other one. He added that there is “no debate” about such preparedness gaps as the shortage of vaccine production capacity and ventilators, but said he couldn’t assess the level of agreement on other preparedness issues. Such planning should be “on the agenda of every public health agency, school board, manufacturing plant, investment firm, mortuary, state legislature, and food distributor,” Osterholm asserts. “I think our government is leading the way, but we have a lot of holes in medical and nonmedical preparedness,” he said. And nations need to cooperate on preparedness. “Even if countries are able to cover much of their own populations, the impact will still be dramatic. We’re in this together. . . . It could take down the economy.” He says that if the H5N1 avian flu virus now circulating in Asia sparks the next pandemic, it is more likely to mimic the disastrous pandemic of 1918 than the milder events of 1957 and 1968. Such a plague could kill 1.7 million people in the United States and from 180 million to 360 million worldwide, he estimates. Having a year of lead time before the next pandemic would make for a somewhat better scenario, Osterholm says. That might permit health agencies to find ways to extend the vaccine supply, improve supplies of medical equipment, and increase the healthcare workforce. “Beyond research and development, we need a public health approach that includes far more than drafting of general plans, as several countries and states have done,” the articles says. “We need a detailed operational blueprint of the best way to get through 12 to 24 months of a pandemic.” If the world fails to prepare adequately, he concludes, “The loss of human life even in a mild pandemic will be devastating, and the cost of a world economy in shambles for several years can only be imagined.” Osterholm MT. Preparing for the next pandemic. N Engl J Med 2005 May 5;352(18):1839-42 [Full text]last_img read more

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H5N1 vaccine trial shows limited benefit

first_imgMar 30, 2006 (CIDRAP News) – The first experimental US vaccine for H5N1 avian influenza yielded only modest results in its first clinical trial, generating an adequate immune response in slightly more than half of participants who received a heavy dose, scientists report.Fifty-four percent of volunteers who received two doses totaling a dozen times the standard dose of seasonal flu vaccine had an immune response that was considered protective, according to the report in today’s New England Journal of Medicine. Those who received smaller doses were less likely to show an adequate immune response.On the positive side, the vaccine triggered almost no serious side effects, even at the highest doses. The results are in line with some preliminary findings reported last summer.But the findings underscore the huge gap between existing vaccine production capacity and the likely need for vaccine in a pandemic. In an editorial accompanying the report, vaccine expert Dr. Gregory Poland of the Mayo Clinic writes that all the world’s vaccine producers could make only enough of the vaccine for about 75 million people if the high dose that yielded best results in the study were used.”We have a long way to go,” commented Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), as quoted by the Associated Press. The NIAID funded the vaccine trial.The trial was conducted last year at NIAID-supported centers at the University of Rochester in New York state, the University of Maryland School of Medicine in Baltimore, and Harbor–University of California–Los Angeles Medical Center in Los Angeles. John J. Treanor, MD, of the University of Rochester was the first author.The vaccine is based on an H5N1 virus isolated from a Vietnamese patient in 2004. The hemagglutinin and neuraminidase genes from that virus were spliced together with genes from another flu virus strain commonly used in vaccines, the report says. In addition, the hemagglutinin gene was modified to make it harmless to birds so the virus could be grown in eggs. The vaccine was made by Sanofi Pasteur, but the company was not involved in the study.The researchers recruited a total of 451 healthy adult volunteers. They were randomly assigned to receive a placebo or one of four doses of the vaccine: 7.5, 15, 45, or 90 micrograms (mcg). Each volunteer received two doses, the second one 28 days after the first.The study was done in two stages, the first one involving 118 volunteers. After they received their two doses and monitoring showed no safety concerns, the other 333 volunteers were vaccinated in the second stage.The researchers used a neutralizing antibody titer of 1:40 (signaling a fourfold or greater increase in antibody titer) as the criterion for an adequate immune response. Of the 99 volunteers who received the 90-mcg dose, 54% reached this level (95% confidence level, 43% to 64%). Smaller percentages of volunteers in the lower dose-groups had this level of immune response: 43% in the 45-mcg group, 22% in the 15-mcg group, and 9% in the 7.5-mcg group.The volunteers reported few significant side effects, according to the report. They described 84% of symptoms as mild, and there were no serious allergic reactions. Systemic symptoms such as fever and headache were not significantly more common in the vaccine groups than the placebo group. One volunteer suffered a rash, which faded after a few weeks.The results indicate that two 90-mcg doses of the vaccine “would probably have an acceptable tolerability profile and could be effective in preventing H5 influenza in healthy adult recipients,” the authors write. “Elderly people, persons with impaired immunity, or children may have a different response, and trials of the vaccine in these populations are in progress.”Production of the vaccine and this clinical trial are important steps toward control of a pandemic, and the current vaccine would probably be acceptable for licensure, if needed. However, the need for a vaccine with a total dose of 180 micrograms would pose a considerable barrier to rapid production of a supply that would be adequate to meet the world’s requirements should a pandemic occur. Therefore, dose-sparing approaches should be pursued aggressively.”In the editorial, Poland says the results show that the immunogenicity of the vaccine is “poor to moderate at best.” He adds that current annual global production capacity for flu vaccine is estimated at 900 million 15-mcg doses. This means that, at a dose level of 180 mcg, only 75 million people, or 1.25% of the world population, could be fully immunized with the H5N1 vaccine, and only about half of them would actually have protection.In addition, Poland comments that the vaccine might not be effective against more recent strains of H5N1 virus. Researchers have identified an Indonesian clade, or subgroup, of H5N1 viruses that differs antigenically from the Vietnamese clade on which the vaccine is based. The US government recently announced plans to develop a vaccine based on the Indonesian strain of H5N1 virus, called clade 2.Infectious disease expert Michael T. Osterholm, PhD, MPH, said the study was well-designed and yielded important information. “Unfortunately, that information supports our earlier concerns that both the antigen requirements and the immunogenicity of an H5N1 vaccine mean that if H5N1 becomes the next pandemic strain in the next several years, vaccine will play a limited or almost nonexistent role in such a pandemic worldwide,” Osterholm told CIDRAP News.As he has before, Osterholm called for a “Manhattan Project–like investment” to develop a flu vaccine that could be produced before the emergence of a pandemic train. He is director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of the CIDRAP Web site.Poland comments in his editorial that the government has funded studies of more than 30 candidate vaccines for potential pandemic flu strains. These include vaccines with adjuvants (immune-boosting chemicals) to increase potency and live, attenuated vaccines, which could provide cross-protection against different viral subtypes.The study authors write that other possible dose-sparing approaches under consideration include injecting vaccine just under the skin (intradermally) instead of into muscle and “prepriming” the immune system by including an H5 component in the annual flu vaccine.Despite the limitations revealed by the study, flu vaccine expert Dr. William Schaffner of Vanderbilt University said the vaccine represents progress. “My impression is we are better off having stockpiled this vaccine than none,” he told the Associated Press. He added that the vaccine should be viewed as “the first strong step in a long journey.”Treanor JJ, Campbell JD, Zangwill KM. Safety and immunogenicity of an inactivated subvirion influenza A (H5N1) vaccine. N Engl J Med 2006 Mar 30;354(13):1343-51 [Full text]Poland GA. Vaccines against avian influenza—a race against time (editorial). N Engl J Med 2006 Mar 30;354(13):1411-13 [Full text]last_img read more

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