Partners decided not to keep Kevin Sneader in the top job. Weeks earlier, McKinsey had reached a historic settlement agreement in the U.S. over its advice to drugmakers.
Partners at McKinsey & Company voted out the consulting firm’s top executive, Kevin Sneader, this week as it continues to face blowback over its role in fueling the opioid crisis.
The decision to deny Mr. Sneader a second three-year term as global managing partner came in a vote by more than 600 senior partners, according to a company executive. Earlier this month, McKinsey had agreed to pay 49 states a historic settlement of almost $600 million because of sales advice the company had given to drugmakers.
It is highly unusual for a sitting managing partner at McKinsey to be refused a follow-on term. The last time a firm leader was denied a second term was in 1976, according to the company’s internal history book.
Mr. Sneader, 54, did not even make it to the final round of balloting, according to the company executive, who spoke on the condition of anonymity. The final candidates for Mr. Sneader’s replacement are Bob Sternfels, based in San Francisco, and Sven Smit, based in Amsterdam. The shake-up at the prestigious consulting firm was first reported by The Financial Times.
Mr. Sneader’s term was turbulent from the start, as he tried to deal with controversies stemming from client work that had been undertaken during the nine-year tenure of his predecessor, Dominic Barton, now Canada’s ambassador to China. The issues Mr. Sneader had to reckon with went far beyond the deadly opioid crisis.
Days into his new job in July 2018, Mr. Sneader flew to South Africa to apologize for the firm’s work with a state-owned power provider. McKinsey’s lucrative contract, found to be in violation of South African contracting law, involved the use of a local intermediary tied to a corruption scandal that brought down the country’s president. McKinsey has returned tens of millions of dollars in fees it earned in South Africa.
“We came across as arrogant or unaccountable,” Mr. Sneader said at the time. “To be brutally honest, we were too distant to understand the growing anger in South Africa.”
That month, he had to defend McKinsey after a New York Times report revealed that it was working with the U.S. Immigration and Customs Enforcement agency — even in the midst of widespread fury over the Trump administration’s separation of migrant children from their parents.
At the same time, the fuse was lit for what became the biggest scandal of McKinsey’s 95-year history: its extensive work with Purdue Pharma to “turbocharge” sales of OxyContin in the middle of a national opioid epidemic that has contributed to the deaths of more than 450,000 people over the past two decades.
On July 4 of that year, two McKinsey senior partners on the Purdue account exchanged emails discussing possibly “eliminating all our documents and emails” to head off repercussions the firm might face. That exchange was a key part of the settlement states made with McKinsey this month. McKinsey did not admit wrongdoing in the settlement, but both senior partners — who would have been voting in the election of Mr. Sneader’s successor — were fired.
“We deeply regret that we did not adequately acknowledge the tragic consequences of the epidemic unfolding in our communities,” Mr. Sneader said this month. “With this agreement, we hope to be part of the solution to the opioid crisis in the U.S.”
During his watch, Mr. Sneader oversaw the introduction of measures aimed at preventing controversial projects, including new procedures on reviewing prospective clients. But he could also be a staunch defender of McKinsey in the wake of scandal, including its extensive work in Saudi Arabia, which came under intense scrutiny in late 2018 after The Times disclosed that a McKinsey employee, in a written report, had identified influential critics of the Saudi government and that several of those critics or their family members were later arrested.
Mr. Sternfels — who, like Mr. Barton, was a Rhodes scholar — runs many of the firm’s technology-focused initiatives and is also the senior partner overseeing McKinsey’s bankruptcy restructuring practice. That work has been the focus of lawsuits in recent years. In 2019, the firm agreed to pay $15 million in a settlement with the Justice Department to resolve allegations that it failed to properly disclose potential conflicts of interest stemming from its bankruptcy work.
Mr. Smit is a co-chairman of the McKinsey Global Institute, the firm’s in-house think tank.
A spokesman for McKinsey wouldn’t comment on the specifics of the election, saying in a statement: “The election, which is conducted by an independent third-party firm, is now underway and we will announce the result after the election concludes.”
Walt Bogdanich contributed reporting.
‘Pieces of a Woman’ Has Midwives Talking About That Birth Scene
Vanessa Kirby’s Oscar-nominated performance involves an extended sequence that these experts say gets some things right — and a few wrong.
In the movies, birth is usually an emergency. It begins with the woman’s water breaking, at the worst possible moment. She appears to be barely in labor, and yet she is rushed, through gridlock traffic, to the hospital. There she becomes angry, and the pain is her husband’s fault. She yells at him, perhaps even injures him, and orders him to get a vasectomy. Then she begs for an epidural, but for some reason, she can’t have it. After four minutes of intense screaming, she’s handed something that looks like the Gerber baby.
The recent Netflix film “Pieces of a Woman,” featuring an Oscar-nominated performance by Vanessa Kirby, tries to subvert this narrative, with a naturalistic home birth scene that occupies almost a quarter of the movie. The extended sequence, which ultimately has a tragic outcome, has gotten midwives talking, especially because film and television can deeply influence the expectations of couples who have never had a baby. In a handful of interviews, midwives across the country applauded the naturalistic birth as a new frontier in screen depictions, even as they argued that several details fell short of a fully empowered experience.
As the labor scene begins, Martha (Kirby) is leaning against a stove, her contractions intensifying. Her partner, Sean, played by Shia LaBeouf, rushes around her, asking repeatedly if she wants water. They eventually move to the living room, where he cradles her in his lap. “I think I might throw up,” she says, burping and gagging.
Hannah Epstein, a midwife nurse practitioner in San Francisco, said that what struck her about the scene is what many other movies leave out: “You never see labor, only birth.” She said that some patients worry they might not know when they’re in labor, and others think labor is entirely pushing. “Pieces of a Woman” helped correct those misconceptions. “It was a good early-labor depiction of that uncomfortable, icky” feeling, she said, noting that nausea and vomiting in labor are also extremely common.
After offering words of encouragement, Martha’s midwife (played by Molly Parker) suggests that they move to the tub. Angelina Ruffin-Alexander, a midwife in Atlanta, was pleased to see water included in the labor, a technique that reduces the stress of labor pain. “You’re trying to create a sense of calm and a sense of peace,” she said.
In the tub, Martha asks Sean for music and explains how she wants the lights dimmed. Stephanie Tillman, a midwife nurse practitioner and clinical medical ethics fellow in Chicago, applauded this exchange. “There’s not always a positive depiction of how parents interact with each other,” she said. “I appreciated seeing how the partner supported her, especially moving around the space with her.”
With ambient music in the background, Martha pushes her forehead against Sean’s, and they speak in hushed voices. According to Epstein, this quiet tone is more accurate than the chaos she’s used to seeing onscreen. She described the labor and birth process as “whispery, soft, breathy, and not a ton of words” as women try to conserve their energy.
After about three minutes in the tub, Martha begins to shake, and a low groan evolves into a deep, animalistic grunt. The midwife asks her, “Are you feeling like you want to push?”
To Tillman, “this was a really good portrayal of the physiology.” She added, “People will go from nauseous to body shaking, legs shaking. That’s the result of a natural change in hormones.”
Martha moves to the bed, but before the pushing phase begins, the midwife does a pelvic exam. “I’m just going to check your cervix and see where you’re at, OK?” she asks, but proceeds without receiving an answer. “Ow!” Martha responds, to which the midwife says “I know, I know, sorry babe,” and continues. Later, the midwife tells her “Just rest, honey,” and while she’s pushing repeatedly encourages her by saying “Attagirl!”
Tillman, who studies consent in intimate health care, said she found this exchange “very disheartening,” as well as a missed opportunity to show a properly conducted pelvic exam. “It’s exactly what I try to unteach physicians,” she said. Consent in pelvic exams should work similarly to consent during sex, Tillman explained: Providers should get a clear yes before beginning an exam. If a patient expresses pain, she said, they should stop and investigate.
Tillman also found the midwife’s terms of endearment “patronizing, belittling and misogynistic,” though common. “It reinforces a power dynamic between patients and providers,” she said. “It implies ‘I have knowledge or social status or power over you,’ rather than ‘You and I are working together.’” To Epstein, this language was “very cringey.”
Several midwives were critical of showing Martha delivering on her back in bed, when in reality women may give birth squatting, on their hands and knees, on their side, in water, or even holding onto a pole. Roberto Caldeyro-Barcia, a pioneering doctor in the field of childbirth, once wrote that “except for being hanged by the feet, the supine position is the worst for delivery.”
Vicki Elson, a childbirth anthropologist and educator who studies depictions of birth in the media, said that she first became interested in the topic when a 1995 episode of “E.R.” about a mother’s death in labor led to a surge in calls to midwives from worried parents. “My job is to undo the fear that people have learned from the culture,” she said in an interview.
“The mass media is quite dangerous,” she added. “It sets up expectant parents to think they’re going to experience something dangerous and harrowing. And that can have a physical effect on you in labor. When you’re afraid, your body tenses up, and doesn’t work as well with natural hormones.”
Such portrayals, as well as scenes that show mothers’ lack of agency, show up onscreen regularly, whether in “Mother!” (2017), in which Jennifer Lawrence labors in the midst of a nightmarish mob, or a 2019 episode of “Grey’s Anatomy” in which a woman arrives at the hospital in a police car and screams at both her partner and the health-care provider during delivery.
So how can filmmakers depict a natural, healthy and focused birth, while also maintaining tension and drama? “It’s dramatic to follow someone flipping their body around in 10 directions,” Tillman said. “It’s dramatic to help a partner or family member catch their own family member.”
Other midwives described a range of birth scenarios they would like to see depicted, like women giving birth surrounded by family members, or laboring alone. Epstein also pointed out that while “Pieces of a Woman” depicts a white woman’s dehumanizing experience, when it comes to births that result in tragedy, “it’s striking how much more common that is for people of color.” Epstein and other midwives called for more depictions of women of color giving birth.
The midwives interviewed were hopeful that future films and television would portray women as having agency, rather than being out of control and dependent on others.
In the end, Sander said, what makes an empowering birth scene is actually quite simple: It’s people in the room “listening to women and what they want.”
Women and the Covid-19 Vaccine: What You Need to Know
Can it affect mammograms or the timing of fertility treatments? What side effects should you look out for? Experts weigh in.
News that six women developed a rare blood clotting disorder after receiving Johnson & Johnson’s Covid-19 vaccine has prompted new questions about whether vaccines affect women differently than men, and whether there are special considerations that women should take into account when getting vaccinated.
We spoke with a few experts to learn what women should know as they become eligible to get their shots.
Federal health agencies on Tuesday recommended that practitioners pause administering the Johnson & Johnson vaccine after a half-dozen women developed a rare blood clotting disorder about two weeks after vaccination. The recipients were between the ages of 18 and 48; one woman died and a second was hospitalized in critical condition.
But it is not clear if the clotting was caused by the vaccines or whether women are necessarily more often affected.
In Europe, it initially appeared that women were at greater risk for blood clots associated with the AstraZeneca-Oxford vaccine, which has not been authorized for use yet in the United States, but it turned out that more women were getting the vaccine overall in some countries. British regulators now say that they don’t have evidence to say whether men or women are more likely to be affected by blood clots.
Anyone who has a severe headache, abdominal pain, shortness of breath or leg pain after receiving the Johnson & Johnson vaccine should call their health care provider.
Coronavirus vaccinations can cause enlarged lymph nodes in the armpit that will show up as white blobs on mammograms. This type of swelling is a normal reaction to the vaccine and will typically occur on the same side as the arm where the shot was given, said Dr. Geeta Swamy, a maternal-fetal medicine specialist and a member of the American College of Obstetricians and Gynecologists’s Covid vaccine group. It usually only lasts for a few weeks.
But the vaccine’s effect on mammograms can be concerning to radiologists, she added, because “if someone had breast cancer we might see enlarged lymph nodes as well.”
Because this type of swelling could be mistaken as a sign of cancer, the Society of Breast Imaging recommends trying to schedule your routine mammogram before your first Covid-19 vaccine dose or at least one month after your second vaccine dose.
“I am particularly eager to get the word out to all the patients undergoing surveillance after successful prior treatment of cancer,” Dr. Constance D. Lehman, who has written about the problem and is the chief of breast imaging at Massachusetts General Hospital, told The New York Times in March. “I can’t imagine the anxiety of getting the scan and hearing, ‘We found a node that is large. We don’t think it’s cancer but can’t tell.’ Or worse, ‘We think it might be cancer.’”
But say you are getting a diagnostic mammogram because of a suspicious lump or other symptoms of breast cancer disease or you are someone who had been treated for breast cancer and needs to get regular exams; in those cases, “do not delay,” Dr. Swamy said. You should keep your current mammogram appointment as well as your vaccination appointment, and tell your radiologist the date that you received the vaccine.
Fertility patients who are scheduled for procedures like egg retrieval, embryo transfer or intrauterine insemination are advised to avoid getting a Covid vaccine within three days before and three days after the procedure, according to the American Society for Reproductive Medicine.
That’s because patients undergoing surgical procedures could develop vaccine-related side effects like fever or chills that might make it difficult for doctors to know if a post-surgical infection is brewing. In addition, many medical providers may not allow a patient who is experiencing Covid-like symptoms into their facility, even if it’s likely that the symptoms are from a vaccine and their Covid-19 test is negative.
If you manage to get a vaccine appointment and you are scheduled to undergo a fertility procedure, tell your fertility doctor right away so that you can plan any surgical procedures, testing or treatment.
All timing issues aside, getting vaccinated is the right thing to do, experts say. Based on all of the reassuring evidence to date, when it comes to fertility or pregnancy, “there are no known safety concerns with the vaccine,” said Dr. Sigal Klipstein, a reproductive endocrinologist in Chicago who is a member of the American Society for Reproductive Medicine Covid-19 Task Force.
“Women who contract Covid during pregnancy are at increased risk for more severe disease compared to women who get Covid when they’re not pregnant,” she added.
The American College of Obstetricians and Gynecologists said in a statement on Tuesday that for the time being, pregnant and postpartum women who want to be vaccinated should be encouraged to get either the Pfizer-BioNTech or Moderna shots, not the Johnson & Johnson vaccination.
If one of your vaccine shots is scheduled during the “two-week wait” — the period of time between ovulation and your expected period when the embryo would implant in the uterus — don’t worry, even if you develop side effects from the vaccine.
“Fever should not interfere with implantation,” Dr. Klipstein said.
Try not to take any painkillers ahead of time in anticipation of vaccine-related symptoms like fever or headache, because it is believed to dampen your body’s immune response. After the vaccine, it is OK to take acetaminophen, which is considered safe during pregnancy. Women who are pregnant or potentially pregnant should avoid ibuprofen, Dr. Klipstein said.
Some women say they have observed changes in the flow or timing of their period after getting vaccinated.
But so far this is purely anecdotal.
“It’s unlikely that the Covid vaccine would affect menstrual cycles, and there’s no plausible biological mechanism by which this would occur. However, there is little data on this topic,” Dr. Klipstein said.
Kathryn Clancy, an associate professor of anthropology at the University of Illinois, generated hundreds of responses on Twitter after saying that her period was heavier than usual after her first dose of the Moderna vaccine. She is now collaborating with Katharine Lee, a postdoctoral research scholar at Washington University in St. Louis, to survey women on short-term vaccine side effects related to the menstrual cycle. Their online survey has been available for less than a week and has so far drawn more than 19,000 responses, Dr. Lee said on Wednesday.
Periods can be affected by a multitude of factors, including stress, thyroid dysfunction, endometriosis or fibroids. If you have questions about your menstrual cycle, be sure to speak with your doctor.
A study by the Centers for Disease Control and Prevention, published in February, examined the Pfizer-BioNTech and Moderna vaccines and found that 79 percent of the side effects reported to the agency came from women, even though only 61 percent of the vaccines had been administered to women.
It could be that women are more likely to report side effects than men, said Dr. Sabra L. Klein, a professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health. Or, she added, women might be experiencing side effects to a greater degree. “We’re not sure which it is,” she said.
If women are in fact having more side effects than men, there might be a biological explanation: Women and girls can produce up to twice as many antibodies after receiving flu shots and vaccines for measles, mumps and rubella (M.M.R.) and hepatitis A and B, probably because of a mix of factors, including reproductive hormones and genetic differences.
A study found that over nearly three decades, women accounted for 80 percent of all adult allergic reactions to vaccines. Similarly, the C.D.C. reported that most of the anaphylactic reactions to Covid-19 vaccines, while rare, have occurred among women.
And in a letter published in the New England Journal of Medicine describing the experiences of people who had redness, itching and swelling that began four to 11 days after the first shot of the Moderna vaccine, 10 of the 12 patients were women. It is not clear, however, whether women are more prone to the problem.
If you have mild side effects like headache or a low fever, it’s actually a good thing, Dr. Klein said, because it means your immune system is ramping up. A lack of side effects, however, does not mean the vaccine isn’t working.
You can share your symptoms or concerns via the C.D.C.’s V-safe app, which records symptoms and provides health check-ins after vaccinations. Medically significant reports sent using V-safe will be followed up by a call from a representative.
Western Warnings Tarnish Vaccines the World Badly Needs
Amid a deep residue of mistrust, American and European cautions on the AstraZeneca and Johnson & Johnson vaccines risk igniting anti-vaccine fervor in the global south.
Safety worries about the AstraZeneca and Johnson & Johnson vaccines have jeopardized inoculation campaigns far beyond the United States, undercutting faith in two sorely needed shots and threatening to prolong the coronavirus pandemic in countries that can ill afford to be choosy about vaccines.
With new infections surging on nearly every continent, signs that the vaccination drive is in peril are emerging, most disconcertingly in Africa.
In Malawi, people are asking doctors how to flush the AstraZeneca vaccine from their bodies. In South Africa, health officials have stopped giving the Johnson & Johnson shot, two months after dropping the AstraZeneca vaccine. And in the Democratic Republic of Congo, 1.7 million AstraZeneca doses have gone unused.
The sense of uncertainty deepened on Wednesday, when an advisory committee to the U.S. Centers for Disease Control and Prevention delayed a decision for seven to 10 days on lifting a pause on the Johnson & Johnson vaccine, saying it wanted more data on a rare blood clotting disorder. Those shots were halted on Tuesday over concerns about the disorder, which emerged in six women, and on Wednesday the panel learned of two more examples.
Also on Wednesday, the European Union said it would not make any more purchases of the AstraZeneca or Johnson & Johnson vaccines, but would pivot to relying solely on those, like Pfizer’s and Moderna’s, that are based on a newer technology and have not raised similar safety concerns.
The actions of American and European officials reverberated around the world, stoking doubts in poorer countries where a history of colonialism and unethical medical practices have left a legacy of mistrust in vaccines. If the perception takes hold that rich countries are dumping second-rate shots on poorer nations, those suspicions could harden, slowing the worldwide rollout of desperately needed doses.
Dr. Sara Oliver of the C.D.C. told the advisory panel that prolonging the pause in using the Johnson & Johnson vaccine “could have global implications.”
Already, doctors say, the recent pauses have vindicated vaccine skeptics and made many others feel duped.
“People, especially those who were vaccinated, felt like they had been tricked in a way — they were asking, ‘How do we get rid of the vaccine in our body?’” said Precious Makiyi, a doctor and behavioral scientist in Malawi, where health workers have been racing to empty their shelves of nearly expired AstraZeneca doses. “We fought so hard with vaccine messaging, but what has happened this past week has brought us back to square zero.”
African health officials have reacted with fury at the breezy reassurances of American and European lawmakers that people denied the AstraZeneca or Johnson & Johnson shots could be given another vaccine. In much of the world, there are no other vaccines.
And even as American health officials stressed that they paused use of the Johnson & Johnson vaccine on Tuesday in “an abundance of caution,” they forced global health officials to begin crafting the difficult case that shots that might not be safe enough for the world’s rich were still suited to its poor.
“It’s sending vaccine confidence into a crater,” Ayoade Alakija, co-chair of the African Union’s Africa Vaccine Delivery Alliance, said of rich countries’ actions. “It’s irresponsible messaging, and it speaks to the selfishness of the moment that there wouldn’t be more consultation and communication.”
What rich countries call caution, poorer nations will experience as a devastating gamble with the survival of their citizens against Covid-19. “Out of an abundance of caution, let us not destroy vaccine confidence in places that only have access to one type of vaccine,” Dr. Alakija said.
The Johnson & Johnson and AstraZeneca shots have been considered especially crucial for less developed and hard-to-reach parts of the world, because they are less expensive and easier to store than Moderna’s or Pfizer’s, and the Johnson & Johnson vaccine requires just one dose.
AstraZeneca’s shot is being used in at least 118 countries. Lately, amid shortages of that vaccine, some regions have pivoted to Johnson & Johnson’s: Two weeks ago, the African Union acquired 400 million doses.
Together, the two vaccines account for a third of the portfolio of Covax, the international effort to procure and distribute vaccines.
But it is becoming more apparent by the day that those shots are becoming afterthoughts in wealthy nations. After canceling Johnson & Johnson appointments, American states offered people the pricier Pfizer or Moderna vaccines instead.
The European Union said on Wednesday that it had acquired another 50 million doses of the Pfizer vaccine, allowing it to curb use of AstraZeneca’s vaccine and phase it out altogether next year. Many European nations have already restricted the use of that shot, after clotting problems emerged in a small number of recipients.
Those decisions, intended for domestic audiences, have nevertheless resounded in countries where variants are spreading, physical distancing is a luxury and there is no choice of shots.
Health officials fear that any setbacks in vaccinations could sow the seeds of the next calamitous outbreak, one that deluges hospitals and exports new mutations around the world. In those places, doctors said, the math is obvious: Many more people will die without the AstraZeneca and Johnson & Johnson vaccines than with them.
Amid the clotting concerns, the World Health Organization and African Union have not wavered in recommending the use of the AstraZeneca and Johnson & Johnson’s vaccines. In Britain, AstraZeneca’s vaccine remains the backbone of the country’s speedy inoculation campaign, despite people under 30 being offered alternatives. Congo, after spurning the AstraZeneca shot in light of unease in Europe, said on Tuesday that it would start the much-delayed inoculations next week.
And in Dakar, the capital of Senegal, people continued to line up on wooden benches on Wednesday for the AstraZeneca shot as they watched their children run through the corridors of a medical center.
“We don’t have a choice,” said Alioune Badara Diagne, 34, who lives in the city’s lively Ouakam neighborhood. Despite talk of vaccination pauses in wealthy nations and rumors of vaccine makers using Africans as “guinea pigs,” he said, Westerners themselves were continuing to be injected. He added, “The vaccine is our only hope.”
But in much of the world, the American regulators who endorsed Tuesday’s pause on Johnson & Johnson vaccinations act as sort of surrogate decision makers on drugs and vaccines, giving their hesitation extra weight in African nations.
“I became even more skeptical when I heard that the United States suspended Johnson & Johnson,” said Lawmond Lawse Nwehla, 32, an engineer in Dakar. “They said it was effective and then they stopped it. So I wonder why.”
In immediately pausing the use of Johnson & Johnson’s shot, American regulators reacted more aggressively than did their British counterparts, who backed the AstraZeneca vaccine even as they investigated clotting cases.
The costs of the American approach were already evident in Europe, where many nations stopped and then restarted AstraZeneca vaccinations, only to find that it had become a pariah. Most people in France, Germany and Spain distrusted the vaccine.
“Once you take the cork out of the bottle, I’m not sure you can get it back in particularly easily,” said Anthony Cox, a vaccines safety expert at the University of Birmingham in England.
South Africa immediately copied the American pause on Johnson & Johnson vaccinations, infuriating doctors who are still clamoring for shots, especially in remote parts of the country. In February, health officials dropped the AstraZeneca vaccine over its limited efficacy against a dangerous variant there.
To date, only half of 1 percent of the population is vaccinated, and a mere 10,000 shots are being given each day. At that rate, it could take weeks, if not longer, for a single rare blood clotting case to emerge, said Jeremy Nel, an infectious disease doctor in Johannesburg. He was dismayed by the decision to pause shots, given the risk to vaccine confidence in a country where two-fifths of the people say they have no intention of being vaccinated.
“The slower you go, that failure is measured in death,” Dr. Nel said. “Even if you delay for a week, there is a non-trivial chance that will cost lives.”
The solution in many European countries — to stop using seemingly riskier vaccines in younger people, who are at lower risk from Covid-19 — would be unworkable in Africa, where the median age in many countries is below 20.
And any further restrictions would compound the hurdles facing Covax, among them a paucity of funding for every part of inoculation programs beyond the touchdown of doses at airports.
Mali, in western Africa, has administered 7 percent of the AstraZeneca doses that Covax has delivered. Sudan, in eastern Africa, has given 8 percent of the doses it has received.
Skittishness over the AstraZeneca and Johnson & Johnson vaccines, analysts fear, could stoke demand for Russian- and Chinese-made shots about which far less is known. As it is, some global health officials have turned their attention to the Novavax vaccine, which is not yet authorized but makes up a third of Covax’s portfolio.
“Even at this stage of the pandemic, we have our fingers crossed that some vaccine will work to help vaccinate developing countries, instead of ramping up production of vaccines we know work,” said Zain Rizvi, an expert on medicines access at Public Citizen, an advocacy group.
In Kenya, where enthusiasm for vaccines is high in cities but perilously low in rural areas, “the story about blood clots from Europe could not have come at a worse time,” said Catherine Kyobutungi, the director of the African Population and Health Research Center there. “Even those who were perhaps on the fence, and leaning toward getting vaccinated, all of a sudden had second thoughts,” she said.
The American pause on Johnson & Johnson shots promised a second media furor.
“When the F.D.A. suspends, it makes headlines for days,” she said. “When it lifts the suspension, it doesn’t make as many headlines.”
Mady Camara contributed reporting from Dakar, Senegal.
Denmark says it’s permanently stopping use of the AstraZeneca vaccine.
Denmark on Wednesday became the first country to plan to permanently stop administering the AstraZeneca vaccine, a month after suspending its use following reports that a small number of recipients had developed a rare but serious blood-clotting disorder.
The director general of the country’s health authority, Soeren Brostroem, said Denmark was able to halt use of the vaccine because it had the pandemic under control and could rely on two other vaccines, from Pfizer and Moderna.
The Danish announcement is another setback for the AstraZeneca shot, which is easy to store and relatively cheap, and was expected to be the foundation of vaccination campaigns around the world.
The country initially suspended the use of the vaccine on March 11, along with Iceland and Norway. Several other European countries, including France, Germany and Italy, followed suit last month.
The European Union’s drug regulator, the European Medicines Agency, later recommended that countries keep using the vaccine, saying its benefits far outweighed any potential risks for most people.
Last week, though, the European regulator listed blood clots as a potential very rare side effect of the vaccine.
Several countries that had paused and restarted use of the vaccine have since said they would stop using it in younger people. Britain, which has administered around 20 million AstraZeneca doses, said it would offer alternative vaccines to people under 30.
“Based on the scientific findings, our overall assessment is there is a real risk of severe side effects associated with using the Covid-19 vaccine from AstraZeneca,” Dr. Brostroem, the Danish health official, said in a statement. “We have, therefore, decided to remove the vaccine from our vaccination program.”
“If Denmark were in a completely different situation and in the midst of a violent third outbreak, for example, and a health care system under pressure,” he added, “then I would not hesitate to use the vaccine, even if there were rare but severe complications associated with using it.”
Danish health officials said that they might reintroduce the AstraZeneca vaccine “if the situation changes.”
Public health officials have warned that pausing administration of vaccines like AstraZeneca’s or Johnson & Johnson’s could do more harm than good. They note that among seven million people vaccinated with the single-dose Johnson & Johnson vaccine in the United States, six women had developed the rare blood clots — fewer than one in one million. It is not yet known whether the vaccine had anything to do with the clots, but even if it did, the risk is smaller than that of getting struck by lightning in a given year (one in 500,000).
Denmark, which has a population of 5.8 million, has managed to contain the pandemic better than its neighbor Sweden or many other European countries. As of Wednesday, Denmark had recorded 2,447 Covid-related deaths.
Almost one million people in the country have received at least a first dose of a vaccine, 77 percent of them the one from Pfizer, according to Denmark’s Serum Institute. Around 15 percent received a first dose of the AstraZeneca vaccine before the authorities suspended its use last month, and the remaining 8 percent received the Moderna vaccine.
The country’s health authorities said that people who received a first dose of the AstraZeneca vaccine would be offered a different vaccine for their second dose.
Jasmina Nielsen contributed reporting.
Empty Middle Seats on Planes Cut Coronavirus Risk in Study
Keeping the middle seats vacant during a flight could reduce passengers’ exposure to airborne coronavirus by 23 to 57 percent, researchers reported in a new study that modeled how aerosolized viral particles spread through a simulated airplane cabin.
“Farther is always better in terms of exposure,” said Byron Jones, a mechanical engineer at Kansas Sate University and co-author of the study. “It’s true in airplanes, it’s true in movie theaters, it’s true in restaurants, it’s true everywhere.”
But the study may have overestimated the benefits of empty middle seats because it did not take into account mask-wearing by passengers.
“It’s important for us to know how aerosols spread in airplanes,” said Joseph Allen, a ventilation expert at Harvard T.H. Chan School of Public Health who was not involved in the study. But he added, “I’m surprised to see this analysis come out now, making a big statement that middle seats should stay open as a risk-reduction approach, when the model didn’t include the impact of masking. We know that masking is the single most effective measure at reducing emissions of respiratory aerosols.”
Although scientists have documented several cases of coronavirus transmission on planes, airplane cabins are generally low-risk environments because they tend to have excellent air ventilation and filtration.
Still, concern has swirled around the risk of airplane travel since the pandemic began. Planes are confined environments, and full flights make social distancing impossible. Some airlines began keeping middle seats vacant as a precaution.
The new paper, published Wednesday in the Morbidity and Mortality Weekly Report, is based on data collected at Kansas State University in 2017. In that study, the researchers sprayed a harmless aerosolized virus through two mock airplane cabins. (One was a five-row section of an actual single-aisle plane; the other was a mock-up of a double-aisle wide-bodied plane.) The researchers then monitored how the virus dispersed through each cabin.
For the new study, researchers from Kansas State and the Centers for Disease Control and Prevention used the 2017 data to model how passengers’ exposure to an airborne virus would change if every middle seat remained open in a 20-row single-aisle cabin.
Depending on the specific modeling approach and parameters they used, keeping the middle seats vacant reduced the total exposure passengers experienced in the simulation by 23 to 57 percent, compared with a fully occupied flight.
“Some airline carriers have been operating with a vacant seat policy, and this study supports the effectiveness of that intervention, in the context of other measures that are in place,” a C.D.C. spokesperson said in an emailed statement.
This reduction in risk stemmed from increasing the distance between an infectious passenger and others as well as from reducing the total number of people in the cabin, which lowers the odds that an infectious passenger would be aboard in the first place.
The laboratory experiments on virus dispersal in aircraft cabins were conducted several years before the current pandemic began, and did not account for any protection that wearing masks could provide.
Masking would reduce the amount of virus that infectious passengers emit into the cabin air and would likely lower the relative benefit of keeping middle seats open, Dr. Allen said.
Dr. Jones concurred. “In general, I would think that wearing a mask would make this effect much less pronounced,” he said. He also noted that simply being exposed to the virus does not mean that someone will be infected by it.
“The extent to which exposure reduction might decrease transmission risk is not yet understood,” the C.D.C. spokesperson said.
The cost-benefit analysis is tricky for airlines. But purely from a health perspective, keeping middle seats open would be helpful, providing a buffer between an infectious person and others nearby, according to Alex Huffman, an aerosol scientist at the University of Denver who was not involved in the study. “Distance matters, for both aerosols and droplets,” he said.
A panel of independent experts to the C.D.C. says it needs more time to assess data and risks during the Johnson & Johnson vaccine pause.
An advisory committee for the Centers for Disease Control and Prevention met on Wednesday to discuss the decision made on Tuesday to pause use of the Johnson & Johnson Covid-19 vaccine because of its possible link to extremely rare blood clots. After a robust afternoon discussion, the panel decided they needed more time to assess the data and risks, and would not vote on a recommendation until they meet again in a week or 10 days.
The emergency meeting followed the Food and Drug Administration’s announcement on Tuesday that it was studying six cases of rare and severe blood clots in women aged 18 to 48, one of whom died. All of the women had received the Johnson & Johnson vaccine before developing the clots, though it is unclear whether the vaccine is responsible. As of Tuesday, more than seven million people in the United States have received the shot, and another 10 million doses have been shipped out to the states, according to C.D.C. data.
Following the call from federal health agencies on Tuesday, all 50 states, Washington, D.C., and Puerto Rico on Tuesday quickly paused or recommended that providers pause the administration of the vaccine. The U.S. military, federally run vaccination sites, and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix also paused the injections.
The Advisory Committee on Immunization Practices, or ACIP, is a panel of independent experts who advise the C.D.C. on its vaccine policies. At the meeting, the experts reviewed and debated data from the rare blood clots, including a seventh case, and heard comments from the public, before voting on how to proceed.
The clotting disorder of concern in the vaccine recipients is different — and much rarer — than typical blood clots, which develop in hundreds of thousands of people every year. The seven women had not only clotting in the brain, but a notably low level of platelets, parts of the blood that help form normal clots. Three had large, dangerous clots in other parts of their body as well as in the brain.
Use of the vaccine began on Mar. 2, and the first case of blood clots in the brain was reported on Mar. 19. About 1.4 million women ages 20 to 50 — the age range of those who had the clots — received the vaccine.
The panel experts discussed the known background rates of each condition in the general population, but noted that there is not enough data to precisely estimate how often they occur at the same time.
But based on somewhat rough estimates, the clotting disorder in women ages 20 to 50 who received the Johnson & Johnson vaccine occurred at least three times more often than would be expected, according to Dr. Tom Shimabukuro, a safety expert from the C.D.C.
“Right now, we believe these events to be extremely rare, but we are also not yet certain we have heard about all possible cases, as this syndrome may not be easily recognized as one associated with the vaccine,” Dr. Rochelle P. Walensky, the C.D.C. director, said at a White House news conference on the pandemic on Wednesday.
During the panel discussion, one expert reminded the panel that the “risk window” for the condition among vaccine recipients was still open and new cases might emerge, because nearly 3.8 million people had received the shot within the last two weeks.
Other experts encouraged dissemination of health information on diagnosis and treatment of the condition, so that awareness would be spread among doctors, emergency rooms and people who received the vaccine. They noted that patients with the condition need to be treated as soon as possible because the clots are so serious. Some patients needed invasive procedures to remove large clots from blood vessels in their brains.
The committee’s assessment comes at a crucial time, while the nation is racing to vaccinate as many people as possible to curb the steady accumulation of cases, particularly as worrisome variants gain traction. Some public health experts were disappointed in the F.D.A.’s recommendation to suspend the Johnson & Johnson vaccine, arguing that preventing these extremely rare potential side effects was not worth the trade-off of slowing the vaccination campaign and potentially eroding the public’s trust of vaccines in general.
So far, Johnson & Johnson’s vaccine has amounted to about 5 percent of immunizations in the United States. Several panel members reiterated that two other vaccines — from Moderna and Pfizer-BioNTech — are available, neither associated with the clotting problem, so continuing the pause would not stop most people in the United States from being vaccinated.
At the news conference, Jeffrey D. Zients, the White House’s pandemic coordinator, said that the pause would not generally interrupt the momentum of the country’s vaccination campaign.
“In the very short term, we do expect some impact on daily averages as sites and appointments transition from Johnson & Johnson to Moderna and Pfizer vaccines,” he said. “We have more than enough Pfizer and Moderna vaccine supply to continue or even accelerate the current pace of vaccinations.”
Noah Weiland and Madeleine Ngo contributed reporting.
5 Health Care Jobs on the Rise
Occupations in the industry are increasingly in demand because of an aging population and longer life spans.
This article is part of our new series on the Future of Health Care, which examines changes in the medical field.
Economists at the Labor Department project that from 2019 to 2029 employment in health care in the United States will grow 15 percent, much faster than the average for all occupations, adding about 2.4 million new jobs during that span.
The health care and social assistance sector is expected to add the most new jobs, according to the Bureau of Labor Statistics (B.L.S.), with six of the 10 fastest growing occupations. Spurring the expected growth: care for the aging baby-boom population; longer life spans; and persistent growth in the number of patients with chronic conditions.
A recent report by McKinsey & Company similarly expects the greatest growth in labor demand by 2030 among health aides, technicians, wellness occupations and health professionals.
As the world adjusts to the coronavirus pandemic, this figure could expand even more, as “demand for workers in the health care and STEM occupations may grow more than before the pandemic, reflecting increased attention to health,” according to the report.
Among the fastest-growing health care occupations are physician assistants, nurse practitioners (52 percent job growth rate is predicted from 2019 to 2029; the quickest in the field) and occupational therapy assistants.
Researchers at LinkedIn analyzed in-demand jobs pushed by the pandemic’s shock to develop a list of 15 “jobs on the rise.” LinkedIn’s data scientists looked at over 15,000 job titles to uncover the positions that have grown the most, compared with 2019 levels, Andrew Seaman, senior editor for job search and careers at LinkedIn News, said in an interview. “While there was already demand for some of these health care positions, the pandemic intensified that. Since 2019, hiring for health care positions has increased more than 34 percent.”
Here are five health care jobs on the rise.
Overall employment growth of nurse practitioners is projected to top 50 percent from 2019 to 2029. The increase is mainly because of an increased importance on preventive care and demand for health care services from an aging population, according to the Labor Department’s forecast.
According to the B.L.S., registered nursing — a related but distinct job, involving separate state licenses and, in some cases, degrees — is listed among the top occupations in terms of job growth from 2019 to 2029, though it is an understaffed field. The B.L.S. projects that 11 million additional nurses are needed to avoid a further shortage.
Licensed nurse practitioners, who also must have a registered nursing license, legally are able to prescribe medications and have greater flexibility than registered nurses in diagnosing and treating illnesses. Average salaries also differ: In May 2020, the median annual wage for registered nurses was $75,330, according to the B.L.S.; the median annual wage for nurse practitioners for the same period was $111,680.
Nurse practitioners are licensed in all states and the District of Columbia. Certifications include those offered by the American Academy of Nurse Practitioners Certification Board the American Nurses Credentialing Center and the Pediatric Nursing Certification Board.
Overall employment of home health and personal care aides is expected to jump 34 percent from 2019 to 2029, according to the Labor Department. The aging baby-boom generation and the growing elderly population are the main reasons for the increase.
Home health and personal care aides represent the sixth-fastest growing occupation in the country, according to Labor Department data, but the pay is low at about $12.15 per hour, or $25,280 per year.
President Biden’s American Jobs Plan to expand home- and community-based care is sparse on details for now, but calls for addressing the industry’s low wages and “makes substantial investments in the infrastructure of our care economy, starting by creating new and better jobs for caregiving workers,” according to the White House’s fact sheet.
There’s plenty of need for paid workers at private homes, assisted-living communities, memory-care centers for dementia patients, hospice facilities and nursing homes. While the work, often booked through a home care agency, is rewarding, can be taxing mentally and physically. There are part-time positions in assisted-living facilities or hospices. Short-term training is generally on the job by registered nurses for those working for an agency or in-house facility.
There’s typically formal training and a competency test to work for certified home health or hospice agencies that receive reimbursement from Medicare or Medicaid. Requirements vary from state to state. Some employers may require a certified nursing assistant certification and a criminal-background check is standard. CPR training and a driver’s license are helpful, too.
Job openings are generally posted by local care facilities. There are a few big caregiving networks for job seekers. CareLinx, based outside of San Francisco, operates like an online matchmaking site for families. The network, which began in 2011, operates nationwide with over 500,000 professional caregivers ranging from certified nurse assistants all the way up to registered nurses and nurse practitioners.
Employment of substance abuse, behavioral disorder and mental health counselors is likely to grow 25 percent from 2019 to 2029, according to the Labor Department — further boosting current growth.
“According to our listing data, jobs in the mental health sector have risen 28 percent since 2019,” said Sara Sutton, chief executive and founder of the job board FlexJobs. “Jobs like behavioral health care manager, risk reduction manager, social worker and case manager fall under this category. Regarding therapy jobs specifically, the board saw a whopping 56 percent increase in 2020. Titles include therapist, psychologist, counselor, and mental health clinician.”
LinkedIn data shows nearly 24 percent year-over-year job growth among mental health professionals. Fast-growing positions include behavior therapist, mental health technician and psychotherapist. Most of these roles require an associate degree or higher, and training in areas like play therapy for children, mindfulness and cognitive behavioral therapy.
Educational requirements vary but most positions require at least a bachelor’s degree. All states require mental health counselors to be licensed, after completing a period of post degree clinical work under the supervision of a licensed counselor.
Wages vary, but according to Payscale.com, a mental health counselor salary ranges from $31,000 to $64,000, annually. The median annual wage for substance abuse, behavioral disorder, and mental health counselors was $47,660 in May 2020, according to the B.L.S.
Employment of massage therapists is projected to grow 21 percent in the next decade, according to the Labor Department. Demand will likely increase as more health care providers understand the benefits of massage and these services become part of treatment plans.
This is a job well suited to a home-based business where clients come to a therapist’s in-house studio. A growing specialty is geriatric massage therapy, which is gentle massage for older adults focusing on circulation and relaxation. The core work consists of assessing the client’s medical past and delivering a treatments based on the clients needs.
Most states and the District of Columbia regulate massage therapy and require a license or certification after graduating from an accredited training program of 500 or more hours of study and experience, although standards and requirements vary greatly by state or other jurisdiction. A high school diploma or equivalent is usually required for admission to a massage therapy program. The median annual wage for massage therapists was $43,620 in May 2020, according to the B.L.S.
Respiratory therapists treat patients with heart and lung problems such as asthma, chronic bronchitis, emphysema, pneumonia, chronic obstructive pulmonary disease and sleep apnea. They perform diagnostic tests for lung capacity, administer breathing treatments, document patient progress, and confer with physicians and surgeons.
Employment of respiratory therapists is forecast to grow 19 percent from 2019 to 2029, according to the B.L.S.
Respiratory therapists typically need an associate degree, but some have bachelor’s degrees in respiratory therapy. Respiratory therapists are licensed in all states except Alaska; requirements vary by state. The American Association for Respiratory Care has a job board.
Educational courses are offered by colleges and universities, vocational technical institutes and the U.S. military. Completion of a program that’s accredited by the Commission on Accreditation for Respiratory Care may be required to gain a license.
Licensure requirements vary by state; for most states they include passing a state or professional certification exam. For specific state requirements, contact the state’s health board. The National Board for Respiratory Care is the main certifying body and the board offers two levels of certification: certified respiratory therapist and registered respiratory therapist. The median annual wage for respiratory therapists was $62,810 in May 2020, according to the B.L.S.
How Exercise May Help Protect Against Severe Covid-19
People who tended to be sedentary were far more likely to be hospitalized, and to die, from Covid than those who exercised regularly.
More exercise means less risk of developing severe Covid, according to a compelling new study of physical activity and coronavirus hospitalizations. The study, which involved almost 50,000 Californians who developed Covid, found that those who had been the most active before falling ill were the least likely to be hospitalized or die as a result of their illness.
The data were gathered before Covid vaccines became available and do not suggest that exercise can substitute in any way for immunization. But they do intimate that regular exercise — whether it’s going for a swim, walk, run or bike ride — can substantially lower our chances of becoming seriously ill if we do become infected.
Scientists have known for some time that aerobically fit people are less likely to catch colds and other viral infections and recover more quickly than people who are out of shape, in part because exercise can amplify immune responses. Better fitness also heightens antibody responses to vaccines against influenza and other illnesses.
But infections with the novel coronavirus are so new that little has been known about whether, and how, physical activity and fitness might affect risks for becoming ill with Covid. A few recent studies, however, have seemed encouraging. In one, which was published in February in The International Journal of Obesity, people who could walk quickly, an accepted gauge of aerobic fitness, developed severe Covid at much lower rates than sluggish walkers, even if the quick striders had obesity, a known risk factor for severe disease. In another study of older adults in Europe, greater grip strength, an indicator of general muscle health, signaled lowered risks for Covid hospitalizations.
But those studies looked at indirect measures of people’s aerobic or muscular fitness and not their actual, everyday exercise habits, so they cannot tell us if getting up and moving — or staying still — changes the calculus of Covid risks.
So, for the new study, which was published Tuesday in the British Journal of Sports Medicine, researchers and physicians at Kaiser Permanente Southern California, the University of California, San Diego, and other institutions decided to compare information about how often people exercised with whether they wound up hospitalized this past year because of Covid.
The Kaiser Permanente health care system was well suited for this investigation, because, since 2009, it has included exercise as a “vital sign” during patient visits. In practice, this means doctors and nurses ask patients how many days each week they exercise, such as by walking briskly, and for how many minutes each time, then add that data to the patient’s medical record.
Now, the researchers drew anonymized records for 48,440 adult men and women who used the Kaiser health care system, had their exercise habits checked at least three times in recent years and, in 2020, had been diagnosed with Covid-19. The researchers grouped the men and women by workout routines, with the least active group exercising for 10 minutes or less most weeks; the most active for at least 150 minutes a week; and the somewhat-active group occupying the territory in between.
The researchers gathered data, too, about each person’s known risk factors for severe Covid, including their age, smoking habits, weight, and any history of cancer, diabetes, organ transplants, kidney problems and other serious, underlying conditions.
Then the researchers crosschecked numbers, with arresting results. People in the least-active group, who almost never exercised, wound up hospitalized because of Covid at twice the rate of people in the most-active group, and were subsequently about two-and-a-half times more likely to die. Even compared to people in the somewhat-active group, they were hospitalized about 20 percent more often and were about 30 percent more likely to die.
Of the other common risk factors for severe disease, only advanced age and organ transplants increased the likelihood of hospitalization and mortality from Covid more than being inactive, the scientists found.
“Being sedentary was the greatest risk factor” for severe illness, “unless someone was elderly or an organ recipient,” says Dr. Robert Sallis, a family and sports medicine doctor at the Kaiser Permanente Fontana Medical Center, who led the new study. And while “you can’t do anything about those other risks,” he says, “you can exercise.”
Of course, this study, because it was observational, does not prove that exercise causes severe Covid risks to drop, but only that people who often exercise also are people with low risks of falling gravely ill. The study also did not delve into whether exercise reduces the risk of becoming infected with coronavirus in the first place.
But Dr. Sallis points out that the associations in the study were strong. “I think, based on this data,” he says, “we can tell people that walking briskly for half an hour five times a week should help protect them against severe Covid-19.”
A walk — or five — might be especially beneficial for people awaiting their first vaccine, he adds. “I would never suggest that someone who does regular exercise should consider not getting the vaccine. But until they can get it, I think regular exercise is the most important thing they can do to lessen their risk. And doing regular exercise will likely be protective against any new variants, or the next new virus out there.”
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