The Navajo Nation managed to tame Covid-19 earlier this year, mounting a campaign that drove its vaccination rate far above the United States average, after the virus ravaged the Navajo people.
But now the nation — the largest reservation in the United States — is enduring yet another virus surge, and experts and tribal leaders aren’t sure why. Other highly vaccinated tribes are also contending with a resurgent virus.
Over the course of the pandemic, the Navajo went from having one of the country’s worst case rates in the spring of 2020 to being lauded in September by Dr. Anthony Fauci, the nation’s top infectious disease official, as an “example of success” in its fight against Covid-19. The rate of fully vaccinated tribal members — 70 percent, according to tribal data — is substantially higher than the nationwide rate of 58 percent.
Indigenous leaders around the country have pushed hard to vaccinate their communities, knowing that Covid has had a disproportionate effect on Native American people, who now have the highest vaccination rate in the United States, according to the Centers for Disease Control and Prevention.
Despite their successes in overcoming mistrust in the federal government and inoculating hard-to-reach communities, the Navajo and other highly vaccinated tribes find themselves experiencing yet another virus surge.
In addition to the Navajo Nation in Arizona, New Mexico and Utah, the Indian Health Service said on Friday that it is seeing “intermittent” increases in the Billings area, covering Montana and Wyoming, and the Great Plains area, covering the Dakotas, Nebraska and Iowa. It said that tribal communities — though they tend to have high vaccination rates — are affected by the surrounding states and communities, which may have much lower vaccination rates.
Many tribal members also commute to work in urban areas or border towns, where they may be at higher risk of exposure.
The Blackfeet Nation of Montana, which has vaccinated nearly every eligible member, experienced a spike in August after recording few to no cases for weeks. That was after the tribe, confident after its successful vaccination campaign, voted to welcome back tourists by reopening its roads into the eastern section of the popular Glacier National Park. Cases are running relatively high among the Blackfeet as the virus surges throughout Montana, where vaccination rates in counties surrounding the reservation are as low as 38 percent.
In Minnesota, the White Earth Nation, where 60 percent of eligible members are vaccinated, recently recorded its highest-ever surge in daily cases, said Ed Snetsinger, the tribe’s emergency manager.
As for the Navajo, officials said the latest spike has been less severe than the nation’s first two, which came last winter and in the spring of 2020, because 70 percent of eligible members are vaccinated.
The nation has exceeded 100 confirmed cases in a day several times recently, according to tribal data. Confirmed cases peaked at almost 400 a day in the winter, and reached a low point in single digits in June and July.
The Navajo Nation is the largest U.S. tribe, with an official enrollment of nearly 400,000 members as of May.
Jonathan Nez, the president of the Navajo Nation, said that some members brought the virus back to the reservation after visiting neighboring communities in Arizona and New Mexico, which have looser Covid regulations than the tribe does. The Navajo have been required to wear masks in public since April last year, indoors and out, but there is no such outdoor mandate in surrounding areas.
“We do have multigeneration families living under one roof, and when someone brings Covid home, it spreads quickly in the house,” Mr. Nez said in an interview last week.
While tribes have largely been successful in vaccinating their members, pockets of people continue to resist getting the shots, said Dr. Mary Owen, the director of the Center for American Indian and Minority Health at the University of Minnesota medical school and president of the Association of American Indian Physicians.
“These pockets seem to be greater in the 17- to 45-year-old range,” said Dr. Owen, who is Tlingit. “From what I’m hearing and what I’m seeing in our clinic, is that people in this age group have a greater sense of invincibility and also seem to be relying more on social media for their news about the vaccine.”
The Centers for Disease Control and Prevention on Tuesday formally endorsed the Pfizer-BioNTech coronavirus vaccine for children aged 5 through 11, a move that will buttress defenses against a possible surge as winter arrives and ease the worries of tens of millions of pandemic-weary parents.
At a meeting earlier in the day, a panel of scientific advisers had unanimously recommended that the vaccine be given to these children. Inoculations could begin as soon as this week.
“Together, with science leading the charge, we have taken another important step forward in our nation’s fight against the virus that causes Covid-19,” Dr. Rochelle Walensky, director of the C.D.C., said in a statement Tuesday night.
The C.D.C.’s endorsement arrives just as Americans prepare for a potentially risky holiday season. Cases in the United States have been falling steadily for weeks, but experts have warned that indoor gatherings may send the rates soaring again. Many Americans seem determined to celebrate; already airlines are bracing for what may be the busiest travel season since the start of the pandemic.
While relatively few of the 29 million children in this age group will be fully immunized a month from now, even partial vaccination will provide some protection against the coronavirus. Every million doses given to children ages 5 to 11 would prevent about 58,000 cases and 226 hospitalizations in that group, according to the C.D.C.
Immunizing these children is expected to prevent about 600,000 new cases from November 2021 to March 2022. And rising immunity may reduce the chances that young children will transmit the virus to vulnerable adults in their families and communities, health officials noted.
Vaccinations of younger children are likely to help keep schools open. Virus outbreaks forced about 2,300 schools to close between early August and October, affecting more than 1.2 million students, according to data presented at the committee meeting.
The pandemic has also stalled routine immunizations, widened education gaps and escalated rates of anxiety and depression among children. “Vaccination of children ages 5 to 11 years will not only help prevent Covid-19 infection and serious consequences of infection in this age group, but will also help children emotionally and socially,” said Dr. Pamela Rockwell, who represents the American Academy of Family Physicians on the C.D.C. panel.
Still, about three in 10 parents say they will definitely not get the vaccine for their 5- to 11-year-old child, according to the most recent poll by the Kaiser Family Foundation. Only about three in 10 parents said they would immunize their child “right away,” a percentage that has barely budged since similar polls in July and September.
Many other parents are eager to see their children vaccinated as quickly as possible. Anticipating the C.D.C.’s decision, the Biden administration has enlisted more than 20,000 pediatricians, family doctors and pharmacies to administer the shots. About 15 million doses are already being shipped to vaccination sites across the country, federal officials said on Monday.
Daniel E. Slotnik contributed reporting.
An expert advisory committee to the Centers for Disease Control and Prevention voted unanimously on Tuesday to recommend Pfizer-BioNTech’s coronavirus vaccine for use in children 5 to 11.
The vote followed a decision last week by the Food and Drug Administration to authorize the vaccine for that age group. Then there are steps at the C.D.C. and at the state level before the 28 million children in the age group could get shots.
Here’s what needs to happen first.
At the C.D.C.
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The C.D.C. contemplates the panel’s suggestions, which the agency usually follows.
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The C.D.C., which is led by Dr. Rochelle P. Walensky, weighs in with final guidance, which influences how entities like states, hospitals and doctors’ offices distribute vaccines. In September, Dr. Walensky ignored the C.D.C. panel’s advice and recommended booster shots of Pfizer’s vaccine for frontline workers, aligning her agency’s guidance with the F.D.A.’s authorization.
In the states
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State health authorities typically adopt the C.D.C.’s guidance, though it is not binding.
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Pediatric doses will begin to become available once the regulatory process is done, but the vaccination program will only reach full strength next week, Jeffrey D. Zients, the White House's pandemic response coordinator, said on Monday.
Coronavirus vaccines were significantly less effective in protecting people with weakened immune systems than they were for other people, the Centers for Disease Control and Prevention reported on Tuesday, buttressing the agency’s call for immunocompromised adults to receive third or fourth doses of vaccines.
Two doses of either the Pfizer-BioNTech or Moderna vaccines were 77 percent effective against Covid-related hospitalization for immunocompromised people. That was a significant degree of protection, the agency said, but far lower than the shots’ benefit to people without immune deficiencies: In those people, the agency said, the vaccines were 90 percent effective against Covid hospitalizations.
The Moderna vaccine also offered more protection to people with weakened immune systems than did the Pfizer shot, mirroring results seen across American adults. And certain people with immune deficiencies — especially organ or stem cell transplant recipients, who often take drugs to suppress their immune systems and prevent rejection of the transplant — showed weaker responses to Covid vaccines than other categories of immunocompromised people did.
The study did not examine recipients of the Johnson & Johnson vaccine.
To help immunocompromised people mount a more aggressive immune response, the C.D.C. suggests that they be given three doses of Pfizer or Moderna vaccines, plus an additional booster shot six months after the third dose. In addition, the agency’s scientists wrote, they should take precautions like wearing masks, and be considered for treatments like monoclonal antibody therapy as early as possible after a Covid diagnosis.
The study released on Tuesday used a circuitous experimental design. The researchers examined roughly 20,000 immunocompromised adults and 70,000 people without immune deficiencies hospitalized this year with Covid-like illness. Of the immunocompromised patients in the study, 43 percent were fully vaccinated. Of the other participants, 53 percent were vaccinated.
The researchers then determined how many of those hospitalized patients were indeed infected with the coronavirus, and compared the odds of a positive test results between fully vaccinated and unvaccinated patients.
The immunocompromised patients included those with cancer, inflammatory disorders, organ or stem cell transplants and other immune deficiencies.
The study’s authors cautioned that there could have been cases in which patients were misclassified as immunocompromised, and that there could have been biases in which patients sought out coronavirus tests.
With its coronavirus vaccine on track this year to generate the biggest single-year sales ever for a medical product, Pfizer on Tuesday disclosed revenue projections indicating that the shot will likely beat that record or come close in 2022.
The company said while reporting its third quarter earnings that it expects its vaccine to bring in $36 billion in revenue this year. Pfizer said it has already reached supply deals worth $29 billion in revenue for its vaccine next year, covering 1.7 billion shots it has already committed to countries around the world. Billions more in sales are likely to come as the company reaches more deals to sell to governments the four billion shots it expects to produce next year.
The company’s chief executive, Dr. Albert Bourla, told analysts on Tuesday that most of the company’s negotiations are with high- and upper-middle-income countries. He said he was concerned that poorer countries and their proxies were not lining up to place orders. “I don’t want to reach a level that again the low- and middle-income countries will be behind in their deliveries because they didn’t place their orders,” he said.
Pfizer says it is selling shots for poorer countries at discounted prices, but many of the world’s poorest countries cannot afford to buy doses directly. They have depended on donations from the United States and other wealthy countries, and on supply from Covax, the United Nations program to vaccinate the globe.
There remain stark differences in vaccine access: Worldwide, about 75 percent of all shots that have gone into arms have been administered in high- and upper-middle-income countries, according to the Our World in Data project at the University of Oxford. Only 0.6 percent of doses have been administered in low-income countries.
The enormous sales figures will translate into billions in profits for Pfizer. The company, which must split its vaccine revenue with development partner BioNTech, said that it expects its profit margins on the vaccine will be in the high 20 percent range next year, the same margin it projected this year.
The doses that will be delivered next year include booster shots, mostly for wealthier countries, and primary immunizations, with an emphasis on second doses, for poorer countries.
A small chunk of the doses will be given to children. The company won authorization last week for its vaccine to be given in the United States to children between the ages of 5 and 11. An advisory panel to the Centers for Disease Control and Prevention voted unanimously on Tuesday to recommend pediatric doses for that age group, and if the director signs off, children could begin receiving it this week.
Pfizer expects to have initial data from its studies evaluating its vaccine in children between the ages of 2 and 4 by the end of December and in children between the ages of six months and 1 by the end of March, the company’s research chief, Dr. Mikael Dolsten, told analysts on Tuesday.
Pfizer could get another revenue boost next year from an antiviral pill it is developing for high-risk Covid patients early in their infections. Results are expected within the next few months from a key clinical trial evaluating whether the drug can cut the risk of hospitalizations and death.
A Pfizer executive, Angela Hwang, said the company sees a market of up to 150 million people for the pill. She called it a “durable opportunity,” saying that governments may be interested in stockpiling the drug.
A rival pill from Merck, known as molnupiravir, has already been shown to halve the risk of hospitalization in similar patients. Merck said last week that it expects molnupiravir to generate between $5 and $7 billion in revenue globally through the end of next year.
American officials on Tuesday warned that the reopening of international land borders next week could lead to longer wait times at ports of entry and asked that travelers have their travel and vaccine documents readily available for border officials.
On Monday, U.S. land borders will reopen to authorized adults who can show proof that they are fully vaccinated against the coronavirus. Unvaccinated children under 18 will be allowed in if they are traveling with a fully vaccinated adult, officials said on Tuesday.
This applies to travelers crossing at official ports of entry, as well as those arriving by passenger train. Officials said it did not matter if the proof of vaccination was in a language other than English.
The long-awaited reopening on Nov. 8 comes just ahead of the holiday season, clearing the way for tourists and other nonessential travelers after about 19 months of border closures during the pandemic. It follows a recent decision by the Biden administration to reopen the country to vaccinated foreigners traveling by air. While a negative coronavirus test is required to enter the country by air, that will not be the case for crossing land borders. The border has been open to essential travel for legal trade, emergency response and medical reasons.
The United States saw a record number of illegal border crossings in the past 12 months, which officials blame, in part, on misinformation spread by smuggling networks to vulnerable migrants, telling them incorrectly that American borders were open.
Border officials reiterated on Tuesday that authorities continue to expel migrants who cross the border illegally, authorized under the public health rule that was put in place at the beginning of the pandemic.
“Any foreign national attempting to enter the United States other than at a lawful port of entry or without proper documents will be subject to border restrictions, including expulsions,” said Matthew Davies, the executive director of admissibility and passenger programs at Customs and Border Protection.
The proof of vaccination can be electronic or on paper, officials said, but the vaccine has to be one cleared by U.S. regulators or for emergency use by the World Health Organization.
A fair number of Mexican people have been vaccinated with drugs that do not have W.H.O. authorization, like Sputnik V, developed in Russia, or the CanSino vaccine from China.
Reopening the country to vaccinated air and land travelers has been a welcome development for businesses, many of which have suffered because of the pandemic-driven closures.
In 2019, more than half of the 20.7 million people who visited the United States from Canada traveled across land borders, according to the U.S. Travel Association, a trade group. And more than 15 million people traveled to the United States across the land border with Mexico.
Canada reopened its land borders in August, and Mexico’s never closed.
The official daily death toll from the coronavirus in Russia hit a record of 1,178 on Tuesday as the authorities urged the public to get vaccinated and signaled that a partial lockdown could be extended in some regions.
Russia is in the middle of a vicious fourth wave of the coronavirus, which is wreaking havoc in a population that is largely unvaccinated and distrustful of government interventions to slow the spread. The police have opened 503 criminal investigations into the distribution of fake vaccine certificates since July and have shut down more than 2,000 websites peddling them, the Interior Ministry said on Tuesday.
President Vladimir V. Putin has declared this week to be a “nonworking” period, with nonessential workers encouraged to stay home and employers encouraged to pay them at least the minimum wage to do so. In some regions, including Moscow, restaurants, bars and other businesses are closed. There were signals that the restrictions might extend beyond seven days, but the Kremlin said on Tuesday that no official decisions had been confirmed.
Nonetheless, Anna Popova, a senior health official, said on Monday, “The effect from the measures being taken, and the ones that have been taken, will not come immediately.”
“It is likely that more time will be needed,” she added.
Russia’s coronavirus task force has been reporting more than 1,000 daily deaths since mid-October, for a total of 240,871 since the pandemic’s beginning, though those numbers undercount the true toll. The government’s statistics agency, which provides its own monthly figures, said last week that it had recorded at least 44,265 coronavirus deaths in September, and some 462,000 in total.
Less than half of Russian adults are vaccinated, according to the official statistics, a figure that may be difficult to lift, considering that 45 percent have no plans to get a shot, according to the independent polling center Levada. Analysts say that mixed government messaging and public distrust are to blame — the Russian vaccine Sputnik V has been widely available for months.
A mass text message sent out by the Moscow city government on Tuesday said, “You can protect your close ones by signing them up for a vaccine.” It noted that one out of every nine people older than 60 who contracted Covid was dying and that vaccinated people were eligible to receive a cash prize of 10,000 rubles, or about $140.
China has called on families and local governments to stock up on daily necessities as the country enforces stringent restrictions intended to curb a number of Covid outbreaks.
The Chinese Ministry of Commerce issued the guidance in a statement on Monday. The Economic Daily, a Communist Party-backed newspaper, said that the directives were an effort by the government to prepare the public for Covid lockdowns in the prelude to winter.
China has enforced a “zero Covid” policy that includes widespread testing and lockdowns to stamp out any small resurgence of the coronavirus. The country is battling several Covid-19 outbreaks.
Pan Chenjun, an agriculture analyst at the Dutch lender Rabobank, said, “The directive to stock up on necessities is mainly about warning residents to prepare for any quarantine if Covid cases occur in their community.”
Extreme weather events in recent months, including flooding, have ruined crops and disrupted food chain supplies in parts of the country, Ms. Pan added.
As a consequence, the cost of certain foods, such as vegetables, has soared. Some vegetables, like spinach, have doubled in price, in some cases costing as much as meat does, according to one local report.
Some residents have taken to social media in recent days to complain about the skyrocketing prices.
One commenter on the Chinese platform Weibo described the shock of being told the price of tomatoes during a recent trip to the market. “I thought I had a hearing problem,” the person wrote.
When the Biden administration announced that vaccinated foreign travelers would be allowed to enter the United States starting Nov. 8, it was as though a starting gun had been fired.
Skyscanner, a travel booking site, saw an 800 percent spike in bookings the day after the announcement. The week after the administration confirmed the date travelers could arrive, Expedia, the online booking site, saw a 28 percent increase in searches for U.S. hotels from Britain and a 24 percent increase from France.
And even domestic tourism seems poised for a lift. Experts said that the U.S. reopening to those coming from overseas signaled to American travelers that they could leave their homes this coming holiday season, too. Searches for outbound international travel on the booking application Hopper, for instance, increased by 24 percent since the announcement, the highest uptick since the spring.
Though the travel industry continues to face staffing and regulatory challenges, the process of traveling is becoming smoother. Coronavirus tests needed before foreign flights are easier to book, and the process for checking documents at airports has been streamlined. But most important, travelers are becoming accustomed to the uncertainties of pandemic travel, planning for it rather than dreading it.
In addition to the big, juicy turkey on the table, there’s also an elephant lurking in the room this Thanksgiving: the vaccination status of your guests.
It’s a tricky thing to talk about. Do you ask your aunt if she received the Covid vaccine after she R.S.V.P.s? What if she says no? Do you endure another scaled-back celebration, like last year? Or should you serve up a bunch of precautions?
According to a Marist Poll published in September, most Americans (nearly 80 percent) say they have gotten or will get a Covid vaccine, but nearly 20 percent still say they do not intend to be vaccinated.
That doesn’t sit well with some of the people who have already rolled up their sleeves. A recent Harris Poll found that half of the more than 1,400 vaccinated respondents were either “extremely” or “considerably” hesitant to spend the holidays with unvaccinated family members or friends.
For some, the risk of celebrating with unvaccinated friends and relatives just isn’t worth it. But if you’re open to gathering with a mixed vaccination status group, there are ways to do it cautiously, experts say.
“Be not afraid, but be reasonable,” said Dr. Juan C. Salazar, a pediatric infectious diseases specialist and physician-in-chief of Connecticut Children’s in Hartford, Conn. You can still get together, he said, but each family will need to ask one crucial question: “What is the likelihood that we will get very sick from Covid-19?”
If you’re uncertain of how to proceed (or whether you ought to gather at all) we asked several experts for ideas on how to make Thanksgiving safer for everyone.
Start by calling your unvaccinated family members and soliciting their ideas on how to gather safely, said Daniel L. Shapiro, an associate professor of psychology at Harvard Medical School and the author of “Negotiating the Nonnegotiable: How to Resolve Your Most Emotionally Charged Conflicts.”
Ask: “What’s your advice on how we can make sure everyone feels safe and comfortable when we get together?” he suggested. Then come up with some ideas. Perhaps you suggest that there should be mandatory testing right before dinner, or that you should gather outside, near a patio heater.
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