All U.S. adults shot-eligible

‘It’s your turn now,’ president says as deadline is met

FILE - In this  Jan. 24, 2021, file photo, a vial of the Pfizer vaccine for COVID-19 is shown at a one-day vaccination clinic set up in an Amazon.com facility in Seattle and operated by Virginia Mason Franciscan Health. Pfizer announced Wednesday, March 31, 2021 that its COVID-19 vaccine is safe and strongly protective in kids as young as 12, a step toward possibly beginning shots in this age group before they head back to school in the fall. (AP Photo/Ted S. Warren, File)
FILE - In this Jan. 24, 2021, file photo, a vial of the Pfizer vaccine for COVID-19 is shown at a one-day vaccination clinic set up in an Amazon.com facility in Seattle and operated by Virginia Mason Franciscan Health. Pfizer announced Wednesday, March 31, 2021 that its COVID-19 vaccine is safe and strongly protective in kids as young as 12, a step toward possibly beginning shots in this age group before they head back to school in the fall. (AP Photo/Ted S. Warren, File)

All adults in every U.S. state, the District of Columbia and Puerto Rico are now eligible for a covid-19 vaccine, meeting the Monday deadline that President Joe Biden set two weeks ago.

"For months I've been telling Americans to get vaccinated when it's your turn. Well, it's your turn now," Biden said Sunday on a program called "Roll Up Your Sleeves" on NBC. "It's free. It's convenient, and it's the most important thing you can do to protect yourself from covid-19."

The United States is administering an average of 3.2 million doses a day, up from roughly 2.5 million a month ago. More than 131 million people, or half of all American adults, had received at least one shot as of Sunday, according to the Centers for Disease Control and Prevention, and about 84.3 million people have been fully vaccinated.

Hawaii, Massachusetts, New Jersey, Oregon, Rhode Island and Vermont were the last states to expand eligibility, opening vaccinations to all adults Monday.

"It's truly historic that we have already reached this milestone," said Dr. Nandita Mani, associate medical director of infection prevention and control at the University of Washington Medical Center.

After a slow start, the pace of vaccinations has risen considerably in recent months. Biden, who initially said he wanted states to make all adults eligible for a vaccine by May 1, moved the deadline up as vaccinations accelerated. Biden has also set a goal of administering 200 million doses by his 100th day in office, which the nation is on pace to meet with more than 192 million shots administered.

The expansion of eligibility comes as medical officials investigate whether Johnson & Johnson's one-shot vaccine is linked to a rare blood-clotting disorder. All 50 states suspended administration of the vaccine last week after federal health officials recommended a pause.

Dr. Anthony Fauci, the nation's leading infectious disease expert, said Sunday that federal regulators should come to a decision Friday about whether to resume Johnson & Johnson vaccinations. Although he said he did not want to get ahead of the CDC and the Food and Drug Administration, he said he expected experts to recommend "some sort of either warning or restriction" on use of the vaccine.

Even if there is a link between the vaccine and the clotting disorder, the risk is exceedingly low, experts say.

Still, Mani said the pause was likely to harden some Americans' hesitancy to get vaccinated.

At the same time, with the virus resurgent, public health experts are warning Americans not to let their guard down. The United States is averaging more than 67,000 new cases a day over the past seven days, up from over 54,000 a month ago, according to a New York Times database.

"Seventy thousand cases a day is not acceptable. We have to get that down," said Barry Bloom, a research professor and former dean of the Harvard T.H. Chan School of Public Health.

He said more vaccinations would help, but people must remain vigilant about wearing masks and social distancing.

At its current pace, the United States will vaccinate 70% of its population by mid-June. But vaccine hesitancy could slow progress toward herd immunity, which will also depend on vaccinating children.

"We're making tremendous progress, but we're still in the race against this virus, and we need to vaccinate tens of millions more Americans," Biden said Sunday. "We could have a safe and happy Fourth of July with your family and friends in small groups in your backyard. That's going to take everyone doing their part. Get vaccinated."

Pfizer announced this month that it had applied for an emergency use authorization to make children 12 to 15 eligible for its vaccine. Moderna is expected to release results from its trial in young teenagers soon, and vaccinations in this age group could begin before school starts in the fall.

Trials in younger children are underway. Fauci also said Sunday that he expected children of all ages to be eligible for vaccination in the first quarter of 2022.

VACCINE CARDS BEGET SCAMS

On Monday, White House press secretary Jen Psaki told reporters the Biden administration is tracking reports of fake vaccination card schemes but remains focused on ramping up vaccinations.

"We are certainly aware of them. We've seen the reports and we, of course, defer to law enforcement and other authorities who are overseeing and cracking down where this has come up," Psaki said at the daily news briefing, cautioning that she did not have data on whether the fake-card schemes were pervasive.

"The best way to get a vaccine card is to get vaccinated. And that's what our focus will continue to be," Psaki said.

The Washington Post reported Sunday that some Americans are making or buying falsified paper vaccination cards to claim they have gotten shots, particularly as some businesses ask for proof of vaccination. The Department of Health and Human Services' inspector general has said that reports of fake-card scams have surged in recent weeks and that they now account for up to half of coronavirus-related whistleblower tips. The FBI and state attorneys general have warned that the practice is illegal and that they would prosecute people who are found to be making, selling or using fake cards.

Some public health experts have said the rise of fake paper cards has increased the need to adopt digital "vaccine passports" that would better track vaccinations and be harder to counterfeit, though the concept has been criticized by Republicans. The White House has said it will not issue digital passports but work to set guidelines for credentials that are being devised by the private sector.

Law enforcement officials warn that a burgeoning trade in counterfeit vaccination cards could spur the spread of the coronavirus even as the United States looks to open up again.

GLOBAL TRAVEL DISCOURAGED

Additionally, the State Department on Monday urged Americans to reconsider any international travel they may have planned and said it would issue specific warnings not to visit roughly 80% of the world's countries.

The United States hasn't had a global advisory warning against international travel since August, when guidance was revoked by the Trump administration.

The advice issued by the department isn't a formal global advisory. Instead, it says the State Department will start using CDC standards as it prepares health and safety guidelines for individual countries. Because of those standards, about 80% of countries will be classified as Level 4, meaning "do not travel."

Travel is also discouraged for the remaining 20%, though not as emphatically. It says people with plans to visit those countries should reconsider.

The department did not reveal which countries will fall under which category. That will become known as guidance is issued individually for each country in the coming week.

"The covid-19 pandemic continues to pose unprecedented risks to travelers. In light of those risks, the Department of State strongly recommends U.S. citizens reconsider all travel abroad," it said.

The department said the new classifications don't necessarily reflect changes in the countries' health situations, but rather an adjustment in the criteria on which it bases the alerts.

BUDGET FALLOFF FEARED

Meanwhile, public health officials are warning against cutting their budgets to pre-pandemic levels once the coronavirus threat recedes, saying cuts could leave the nation where it was before the coronavirus: unprepared for a health crisis.

"We need funds that we can depend on year after year," said Dr. Mysheika Roberts, health commissioner of Columbus, Ohio.

Congress has poured tens of billions of dollars into state and local public health departments in response to the pandemic, paying for masks, contact tracers and education campaigns to persuade people to get vaccinated.

After the pandemic is over, public health officials across the U.S. fear, they'll be back to scraping together money from a patchwork of sources to provide basic services to their communities -- much like after the Sept. 11, 2001, attacks and the SARS and Ebola outbreaks.

"Something happens, we throw a ton of money at it, and then in a year or two we go back to our shrunken budgets and we can't do the minimum things we have to do day in and day out, let alone be prepared for the next emergency," said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents leaders of more than two dozen public health departments.

Funding for Public Health Emergency Preparedness, which pays for emergency capabilities for state and local health departments, dropped by about half between the 2003 and 2021 fiscal years, accounting for inflation, according to Trust for America's Health, a public health research and advocacy organization.

Even the federal Prevention and Public Health Fund, which was established with the Patient Protection and Affordable Care Act -- Obamacare -- to provide $2 billion a year for public health, was raided for cash over the past decade. If the money hadn't been touched, eventually local and state health departments would have gotten an additional $12.4 billion.

Several lawmakers, led by Sen. Patty Murray, D-Wash., are looking to end the boom-bust cycle with legislation that would eventually provide $4.5 billion annually in core public health funding. Health departments carry out essential government functions -- such as managing water safety, issuing death certificates, tracking sexually transmitted diseases and preparing for infectious outbreaks.

Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health, calls Congress' giant influx of cash in response to the crisis "wallpaper and drapes" because it doesn't restore public health's crumbling foundation.

"I worry at the end of this we're going to hire up a bunch of contact tracers -- and then lay them off soon thereafter," Castrucci said. "We are continuing to kind of go from disaster to disaster without ever talking about the actual infrastructure."

Information for this article was contributed by Emily Anthes, Madeleine Ngo and Eileen Sullivan of The New York Times; by Erin Cunningham, Paulina Firozi and Amy B Wang of The Washington Post; by Michelle R. Smith, Lauren Weber, Hannah Recht and staff members of The Associated Press; and by Anna Maria Barry-Jester and Katheryn Houghton of Kaiser Health News.

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