Covid and Vaccine News: Live Updates
WASHINGTON — Federal regulators have told Johnson & Johnson that about 60 million doses of its coronavirus vaccine produced at a troubled Baltimore factory cannot be used because of possible contamination, according to people familiar with the situation.
The Food and Drug Administration plans to allow about 10 million doses to be distributed in the United States or sent to other countries, but with a warning that regulators cannot guarantee that Emergent BioSolutions, the company that operates the plant, followed good manufacturing practices.
The agency has not yet decided whether Emergent can reopen the factory, which has been closed for two months because of regulatory concerns, the people said.
The Johnson & Johnson doses administered in the United States so far were manufactured at the firm’s plant in the Netherlands, not by Emergent. For weeks the F.D.A. has been trying to figure out what to do about at least 170 million doses of vaccine that were left in limbo after the discovery of a major production mishap involving two vaccines manufactured at the Baltimore factory.
More than 100 million doses of Johnson & Johnson and at least 70 million doses of AstraZeneca were put on hold after Emergent discovered in March that its workers had contaminated a batch of Johnson & Johnson’s vaccine with a key ingredient used to produce AstraZeneca’s. Federal officials then ordered the plant to pause production, stripped Emergent of its responsibility to produce AstraZeneca’s vaccine and instructed Johnson & Johnson to assert direct control over the manufacturing of its vaccine there.
Johnson & Johnson’s vaccine was once considered a potential game-changer in the nation’s vaccine stock because it required only one shot and was particularly useful in vulnerable communities. But the federal government now has an ample supply of the vaccines from Pfizer-BioNTech and Moderna, the two other federally authorized vaccine developers, and no longer needs Johnson & Johnson’s supply.
Still, the loss of 60 million Johnson & Johnson doses puts a dent in the Biden administration’s plan to distribute vaccines to other countries that are still in the grip of the pandemic. The administration had been counting on sharing doses of both Johnson & Johnson and AstraZeneca but had to delay its plan while the F.D.A. completed a review of the facility.
After he arrived in Britain for the Group of 7 summit this week, President Biden announced he had found another source for donations. Pfizer-BioNTech has now agreed to sell his administration 500 million doses at cost for donation to low and lower-middle income countries over the next year. The World Health Organization estimates that 11 billion doses are needed globally to stamp out the epidemic.
The F.D.A.’s action is disappointing news for Emergent and Johnson & Johnson, which hired the firm as a subcontractor. Inspectors are still reviewing the plant and are not expected to decide whether the company can reopen it until later this month, according to people familiar with the situation. Regulators are also continuing to cast doubt on whether the company, which has been paid hundreds of millions of dollars by the federal government to manufacture coronavirus vaccines, adhered to manufacturing standards.
The agency’s plan to allow 10 million doses to be used in the United States or abroad with a warning is somewhat unusual for a product under emergency authorization, experts said. Regulators have the discretion to take that action if the drugs are badly needed and in short supply, they said.
In a statement, the F.D.A. said that before making its decision, it “conducted a thorough review of facility records and the results of quality testing performed by the manufacturer.” It also considered the ongoing public health emergency. The agency said it was continuing to “work through issues” at the Baltimore plant with Johnson & Johnson and Emergent.
Dr. Peter Marks, the F.D.A.’s top vaccine regulator, said in the statement that the agency has been conducting an extensive review of batches of vaccine produced at the plant “while Emergent BioSolutions prepares to resume manufacturing operations with corrective actions to ensure compliance with the F.D.A.’s current good manufacturing practice requirements.”
Representatives from Johnson & Johnson and Emergent declined to comment on the agency’s decision.
The leaders of the world’s wealthiest democracies are expected to pledge one billion doses of Covid vaccines to poor and middle-income countries on Friday as part of a campaign to “vaccinate the world” by the end of 2022.
The stakes could hardly be higher.
“This is about our responsibility, our humanitarian obligation, to save as many lives as we can,” President Biden said in a speech in England on Thursday evening, before the meeting of the Group of 7 wealthy democracies. “When we see people hurting and suffering anywhere around the world, we seek to help any way we can.”
It is not just a race to save lives, restart economies and lift restrictions that continue to take an immeasurable toll on people around the globe.
Since Mr. Biden landed in Europe for the start of his first presidential trip abroad on Wednesday, he has made it clear that this is a moment when democracies must prove that they can rise to meet the world’s gravest challenges. And they must do so in a way the world can see, as autocrats and strongmen — particularly in Russia and China — promote their systems of governance as superior.
Yet the notion of “vaccine diplomacy” can easily be intertwined with “vaccine nationalism,” which the World Health Organization has warned could ultimately limit the global availability of vaccines.
When Mr. Biden announced on Thursday that the U.S. would donate 500 million Pfizer-BioNTech doses, the president said they would be provided with “no strings attached.”
“We’re doing this to save lives, to end this pandemic,” he said. “That’s it. Period.”
But even as wealthy democracies move to step up their efforts, the scale of the challenge is enormous.
Covax, the global vaccine-sharing program, still remains underfunded and billions of doses short.
The International Monetary Fund estimates that it will cost about $50 billion to help the developing world bring the pandemic to an end. In addition to the countless lives saved, the I.M.F. says that such an investment could bring a dramatic return: $9 trillion in increased global economic growth.
While the pandemic is at the center of Friday’s G7 agenda, with the leaders of the nations meeting face to face for the first time since the coronavirus essentially put a stop to handshake diplomacy, a host of other issues are also on the table.
Finance leaders from the G7 agreed last week to back a new global minimum tax rate of at least 15 percent that companies would have to pay regardless of where they locate their headquarters.
Beyond the specific issues, the summit will be a test of how institutions created in another era to help guide the world through crises can stand up to the challenges of today.
On Thursday, Mr. Biden and Prime Minister Boris Johnson of Britain turned to a World War II-era document to provide inspiration for a new generation of challenges, renewing the Atlantic Charter eight decades after it was signed to take into account the threats of today: from cyberattacks to nuclear, climate to public health.
The gathering of the G7 is also, in many ways, a relic of another era. It was created in the 1970s to provide economic solutions after a shock in oil supply triggered a financial crisis.
Ursula von der Leyen, the European Commission president, said in a preview of the conference on Thursday that the “return of the United States to the global arena” would help strengthen the “rules-based system” and that the leaders of the G7 were “united and determined to protect and to promote our values.”
Only seven African nations, most of them small, are expected to meet the World Health Organization’s goal that every country worldwide vaccinate 10 percent of its people against the coronavirus by September. It is a dire prospect for a continent where vaccine supplies are being quickly depleted, and governments are battling a resurgence in infections.
The W.H.O. said on Thursday that inoculation coverage remained at about 2 percent continentwide — and about 1 percent in sub-Saharan Africa — even as some rich nations across the world have administered shots to a majority of their people.
To achieve the 10 percent target for every country on the continent, Africa would need an extra 225 million doses, said Dr. Matshidiso Moeti, the W.H.O. regional director for Africa. In total, nine out of 10 African nations will miss out on this global vaccination goal, the agency estimated.
The seven countries likely to meet the goal are Comoros, Equatorial Guinea, Mauritius, Morocco, Sao Tome and Principe, the Seychelles and Zimbabwe. An additional six countries — Eswatini, formerly known as Swaziland, Ghana, Kenya, Lesotho, Rwanda and Tunisia — could reach the target if they receive enough supply to keep up with their current pace of vaccination, the W.H.O. said.
“This will really require a massive effort,” Dr. Moeti acknowledged, saying that “without a significant boost” in the availability of vaccines, “many African lives are at stake.”
The announcement came as Africa is set to surpass five million virus cases, with Covid having claimed 133,000 lives so far, according to official statistics. While testing is often limited, known cases have also increased, with 94,145 new ones reported in the past week — a 26 percent increase from the previous week, according to the Africa Centers for Disease Control and Prevention.
Countries including Egypt, South Africa, Tunisia and Zambia have reported a surge in cases, while some, such as Uganda, have reintroduced lockdowns to stem the spread of the virus. The Africa C.D.C. also said that deaths on the continent increased by 2 percent over the past week, and many more countries have reported detecting the variants first reported in Britain, India and South Africa. As cases and deaths rise, many nations have reported exhausting most of the vaccines they received through Covax, a global vaccine initiative. The W.HO. said that 14 African nations had utilized 80 percent to 100 percent of their doses.
Still, only 35.9 million Covid vaccine doses have been administered on the continent, according to the Africa C.D.C., with the majority given in a few countries, including Egypt, Ethiopia, Morocco, Nigeria and South Africa, and in the Western Sahara region. Burundi, Eritrea and Tanzania have yet to give a single shot, while Chad and Togo only started administering doses last week.
While some countries have faced shortages, others have not been rolling out campaigns quickly. Twenty nations have used less than half of their doses, the W.H.O. estimated, while 12 nations have more than 10 percent of their doses facing expiration.
But on Thursday, both the W.H.O. and the Africa C.D.C. welcomed President Biden’s decision to donate 500 million Pfizer-BioNTech vaccines to poorer nations, including those in the African Union. Countries like France and organizations like the Mastercard Foundation have also promised to finance, deliver or help produce Covid vaccines in Africa.
“It’s a monumental step forward,” Dr. Moeti said of the U.S. effort, which Mr. Biden announced in Europe on Thursday. “We are now seeing wealthy nations begin to turn promises into action. The hope of a shared future without Covid-19 is starting to shine a little bit more brightly.”
The vaccines are set to start shipping in August, with 200 million doses set for delivery by the end of this year, while the other 300 million will be delivered early next year, according to a White House fact sheet.
Dr. John Nkengasong, the director of the Africa C.D.C., welcomed the decision but said that he did not know when or how many vaccines Africa would receive. He urged member states to prepare storage facilities for the Pfizer vaccine and prioritize big cities once those doses arrive. He gave the example of Rwanda, which he said had received over 102,000 Pfizer doses and rolled them out quickly.
“We have to use a combination of vaccines to win this battle against Covid-19,” Mr. Nkengasong said at a news conference on Thursday. “We are at war and you go to war with what you have, not what you need.”
Just as cruises resume after more than a year on pause, the industry is facing an immediate setback.
Two passengers sharing a stateroom aboard the Celebrity Millennium, operated by Royal Caribbean’s Celebrity Cruises from the Caribbean island of St. Maarten, tested positive for the coronavirus on Thursday. The ship, billed as the first fully-vaccinated cruise in North America, has one more day at sea on Friday before returning to St. Maarten to disembark.
All guests will take an antigen test as part of their disembarkation process, said Susan Lomax, the company’s associate vice president for global public relations.
In a statement, the cruise line said that the passengers tested positive during required testing before leaving the ship. The travelers are asymptomatic and are in isolation under observation by a medical team. Testing and contact tracing is in place for close contacts.
The ship’s 650 crew members and 600 or so passengers (including a New York Times reporter) were required to be vaccinated before boarding, and had to show proof of a negative coronavirus test taken within 72 hours before sailing from St. Maarten last Saturday.
Two passengers on a Mediterranean cruise operated by MSC Cruises also tested positive. Both passengers on the MSC Seaside were asymptomatic when they tested positive during routine testing two days ago, the communications manager Paige Rosenthal said. Immediately after testing positive, the two passengers, who were not traveling together, were isolated along with their parties. They all disembarked in Syracuse, Sicily.
All passengers on the vessel were required to take two coronavirus tests before boarding; vaccines were not required.
The major cruise lines are preparing to restart operations from U.S. ports this summer. Celebrity Edge is poised to be the first, sailing out of Fort Lauderdale, Fla., on June 26, with all crew and at least 95 percent of passengers fully vaccinated, in accordance with guidelines issued by the Centers for Disease Control and Prevention.
At the beginning of the pandemic in 2020, cruise ships were sites of some of the largest concentrations of coronavirus cases. The return of cruises and large gatherings such as conferences is a sign that the pandemic is ending in the United States, as the steady pace of vaccinations — 43 percent of Americans are fully vaccinated, and 52 percent have received at least one dose, according to a New York Times database — gives some event organizers the confidence to resume business.
This month, Bitcoin 2021, a business conference dedicated to the digital currency, sold 12,000 tickets and attracted thousands more to Miami for a week of panels, parties, networking and deal making. It was the first major business conference since the pandemic and the largest Bitcoin conference ever.
In the days after the event, several attendees announced on Twitter that they had tested positive for the coronavirus. Others shared stories of their peers testing positive.
Everyone who I hung out with in Miami got covid. Luckily for me I hung out about one feet above everyone
— Larry Cermak (@lawmaster) June 10, 2021
The event attracted Bitcoin enthusiasts from around the world, including some countries that do not yet have easy access to vaccines. Most events took place inside a large, crowded warehouse, and facial coverings were rare. Vaccines were not required to attend.
John Riggins, head of operations at BTC Media, which ran the conference, said that the company had not heard directly from any attendee who tested positive. The company is monitoring the situation and will follow recommendations from the C.D.C., he said.
“Vaccines have been freely available for months in the U.S., to the extent that anyone who wanted to be vaccinated could have been so by the time of the event,” Mr. Riggins wrote in an email.
“We provided all attendees with the current recommendations of the C.D.C. and state of Florida and expressed to our audience that those who were high risk or hadn’t been vaccinated should consider waiting until next year,” he added.
This week, the first major trade show in the United States since the pandemic started, The World of Concrete, is being held at the Las Vegas Convention Center. The event typically draws more than 60,000 industry professionals from around the world.
Emergency room visits related to suspected suicide attempts by teenage girls spiked in the first months of 2021 compared to rates in 2019 and 2020, the Centers for Disease Control and Prevention reported on Friday.
The new study, which relied on data from the National Syndromic Surveillance Program, showed that adolescent girls aged 12 to 17 visited emergency rooms for suspected suicide attempts 50.6 percent more often in the winter of 2021 than the corresponding period in 2019.
The rate of suspected suicide attempts among adolescent boys and adults of both genders aged 18 to 25 remained stable, compared with the corresponding period in 2019.
“The findings from this study suggest more severe distress among young females than has been identified in previous reports during the pandemic, reinforcing the need for increased attention to, and prevention for, this population,” the report said.
Referring to emergency department visits, the report added, “Importantly, although this report found increases in ED visits for suspected suicide attempts among adolescent females during 2020 and early 2021, this does not mean that suicide deaths have increased.”
The research relied on data from about 71 percent of the nation’s emergency departments in 49 states and follows a number of recent studies that showed rates of mental health problems and suicidal thinking and behavior among teenagers increased during the pandemic.
If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.
In April, rumors began swirling in some New York City neighborhoods with large Orthodox Jewish communities about how the Covid-19 vaccine could pose a threat to women’s fertility.
In WhatsApp groups, recordings of rabbis warning against what they said were the vaccine’s adverse effects proliferated among mothers of teenage girls who don’t want their daughters vaccinated.
There is no current evidence that any vaccines, including Covid-19 vaccines, cause fertility problems. Many prominent mainstream Orthodox leaders in the New York region and in Israel, where the virus has all but disappeared, have advised their communities to get the Covid-19 shots.
But in ultra-Orthodox circles in New York — where women marry at a younger age and birthrates dwarf those of the general population — the spread of unsubstantiated rumors about the coronavirus vaccine’s potential adverse effects on fertility and pregnancy have been particularly effective in dissuading young women from getting the vaccine. These neighborhoods have some of the lowest vaccination rates in New York City.
A concern for New York officials is that vaccine resistance in Orthodox neighborhoods could play a part in endangering the city’s long-term prospects for recovery.
As the leaders of wealthy Western democracies step up their efforts to provide Covid-19 vaccines to the world, they are also racing to catch up with China’s moves to establish itself as a leader in the fight against the coronavirus.
Last summer, China’s top leader, Xi Jinping, heralded the promise of a Chinese-made Covid-19 vaccine as a global public good. So far, he appears to be making good on that pledge.
China now leads the world in exporting Covid-19 vaccines, cementing its bid to be a major player in global public health. The country’s vaccines have been rolled out to 95 countries, which have received more than 260 million doses, according to Bridge Consulting, a Beijing-based consultancy.
The World Health Organization recently approved the vaccines made by the Chinese companies Sinopharm and Sinovac for emergency use, giving Beijing’s reputation a further boost.
So far, China has taken a mainly country-by-country approach in doling out its vaccines. The country has given only 10 million doses to Covax, the global alliance backed by the World Health Organization to ensure that developing countries get access to affordable vaccines. But it has independently donated 22 million doses and sold 742 million doses, according to Bridge Consulting. Many of the donations were made to developing nations in Africa and Asia.
“China is picking countries that could potentially be coming back to China for more things in the future,” said Sara Davies, a professor of international relations specializing in global health diplomacy at Griffith University in Australia. “This is the start of a long-term relationship.”
But there are questions about the Chinese vaccines’ effectiveness, in particular those made by Sinopharm, a state-owned company. Countries that have vaccinated their populations widely with the Sinopharm vaccine, such as the Seychelles and Mongolia, have had new surges of the coronavirus.
The global rollout has also been dogged by delayed deliveries. China is struggling to manufacture enough doses of its two-shot vaccines to meet the needs of its 1.4 billion people and its customers abroad.
In April, Turkey’s health minister said that one reason for the country’s slow vaccination campaign was that Sinovac did not comply with a promised delivery schedule.
“This is not because of lack of production, but it is because Chinese government is using the vaccines for its own country,” the minister, Fahrettin Koca, was quoted in the Turkish press as saying.
In a regular news briefing on Thursday, a Chinese Foreign Ministry spokesman called on countries undertaking vaccine research and development to “assume their responsibility” and support Covax.
“As we all know, until recently, the U.S. has been stressing that its top priority with vaccines is its domestic rollout,” said the spokesman, Wang Wenbin. “Now that it has announced donation to Covax, we hope it will honor its commitment as soon as possible.”
Alexandra Stevenson contributed reporting, and Elsie Chen contributed research.
Hawaii has had the strictest entry rules of any American state since the onset of the pandemic. In recent days, Gov. David Ige has issued a series of guidelines on reopening, including an end to testing and quarantining for vaccinated travelers once 60 percent of the state’s residents are fully vaccinated (it’s currently at 53 percent).
His words were welcomed by travelers eagerly planning trips to the islands. But for many who have recently been to the state — and locals who have traveled between the islands — the governor’s plans come a little too late and after causing a great deal of confusion, frustration and what they say is wasted money.
At the moment, to visit the islands or move between them, travelers have to show a negative coronavirus test taken within 72 hours — whether they have been vaccinated or not. These tests range in price, with some paying $200 or $300.
Vaccinated travelers complain that the tests are expensive and unnecessary and that getting the correct information about what is required is too difficult.
“Today’s Hawaii travel is much tougher than you might think,” said Cheryl Temple, a former mayor of the town of Orting in Washington State who is currently on Kauai, one of the islands.
In the past few days, after the listing for a coming book by Dr. Anthony S. Fauci, the Biden administration’s top adviser on Covid-19, was taken down from Amazon’s and Barnes & Noble’s websites, right-wing outlets and social media commentators spread the rumor that the it had been removed because of public backlash to the idea of Dr. Fauci’s “profiteering” from the pandemic.
In truth, Dr. Fauci is not making any money from the book, which is about lessons he has learned during his decades in public service, and the listing was pulled for a simple reason: the publisher had posted it too early.
Dr. Fauci “will not earn any royalties from its publication and was not paid” for the book, “Expect the Unexpected,” said Ann Day, a spokeswoman for National Geographic Books, its publisher. She said Dr. Fauci also would not earn anything for a related documentary. (Dr. Fauci did not respond to a request for comment.)
The book, which compiles interviews and speeches given by Dr. Fauci during his 37 years as the director of the National Institute of Allergy and Infectious Diseases, was taken off the websites because “it was prematurely posted for presale,” Ms. Day said. She added that proceeds would “go back to the National Geographic Society to fund work in the areas of science, exploration, conservation and education and to reinvest in content.”
In a statement, the national institute noted that the book had not been written by Dr. Fauci himself. The institute also confirmed that he would not earn any royalties from its publication.
The falsehood about the book and Dr. Fauci spread widely online. On May 31, the right-wing outlet The Daily Caller published an article about the book’s appearing for presale online. Some conservative Republicans, including Representatives Andy Biggs of Arizona and Dan Bishop of North Carolina, seized on the article and claimed without evidence that Dr. Fauci would be profiting from the book.
“His lockdown mandates destroyed livelihoods and threatened our children’s futures,” Mr. Bishop posted on Twitter on June 1. “Now he’ll be profiting nicely off it.” The post was liked and shared more than 2,700 times.
That same day, Newsweek and Fox News published articles highlighting the “backlash” that Dr. Fauci faced from right-wing commentators “for profiting from pandemic” after the announcement of his book. The articles did not mention that he would not make money from the book. They reached as many as 20.1 million people on Facebook, according to data from CrowdTangle, a social media analytics tool owned by the social network.
On June 2, a conservative outlet, Just the News, posted an article asserting that Dr. Fauci’s book had been “scrubbed” from Amazon and Barnes & Noble because of the backlash. The founder of the site, John Solomon — a Washington media personality who was instrumental in pushing falsehoods about the Bidens and Ukraine — tweeted the misleading article. So did the pro-Trump activist Jack Posobiec, who once promoted the false Pizzagate conspiracy.
“Books are removed from bn.com from time to time if the details are loaded incorrectly,” a Barnes & Noble spokeswoman said in a statement to The Times. “This book was not removed proactively by Barnes & Noble. We expect it will be available again shortly for purchase as soon as the publisher decides to list it.” Amazon did not comment.
Some articles on June 2, including on Fox News and The Daily Mail, included similar comments from National Geographic Books. But many outlets on the far right continued to push the version of events that the book had been “scrubbed” from online listings because of the backlash, without the updated information. The articles collected more than 32,000 likes and shares on Facebook and reached as many as six million people on Facebook, according to CrowdTangle data.
Days later, people like the Fox News host Sean Hannity and Representative Ronny Jackson, a Republican from Texas and former President Donald J. Trump’s onetime doctor, continued to push the false idea on Twitter.
“Anthony Fauci is set to make a fortune on his upcoming book; meanwhile our country continues to SUFFER from his ENDLESS non-scientific policies,” Mr. Jackson said on Twitter. His post collected nearly 4,000 likes, comments and shares.
Jacob Silver contributed research.
Several McDonald’s outlets in Indonesia were forced to close this week after a special “BTS Meal,” named for the wildly popular Korean boy band, drew crowds of delivery drivers that violated safe distancing measures, the police said.
On Wednesday, the first day that the limited edition meal was available, a rush of orders was placed — but because of Covid-19, most were made online. That resulted in flocks of motorcycle delivery drivers showing up at outlets across Indonesia, with most of the restaurants unprepared to manage the turnout.
In Jakarta, the capital, the police said on Wednesday that they had temporarily closed 32 McDonald’s outlets “because they were found to have violated health protocols,” including limiting capacity to 50 percent and avoiding crowds.
The BTS Meal consists of nine chicken nuggets, two sauces, medium fries and a drink, and comes in a box with a purple logo. Introduced in nearly 50 other countries, it is available in Indonesia until next month.
But because nearly anything related to BTS provokes a frenzy, there have been concerns that the introduction of the meal could draw crowds in some Asian countries where coronavirus cases have risen recently and where vaccination levels remain relatively low. The meal’s rollout in Singapore was delayed last month after the government tightened distancing rules, including a ban on dining in restaurants.
Indonesia, which has one of the highest coronavirus caseloads in Asia, has seen a surge of infections in recent weeks as more people gathered and traveled during Eid al-Fitr, which marks the end of the Muslim holy month of Ramadan. New daily cases have risen 26 percent over the last two weeks, and only 4 percent of the population is fully vaccinated, according to a New York Times database.
Indonesian fans of the Korean band have acknowledged that delivery drivers faced long lines and possible exposure to the coronavirus to bring them their BTS Meal. Online message groups have called on customers to reward drivers with handsome tips. On Kitabisa, a crowdfunding site, several initiatives are raising money for drivers and their families.
One user named Vanessa Egas asked for donations to reach a target of 25 million rupiah, about $1,750, to “repay the kindness of our brother drivers who stood in line for hours to deliver the BTS Meal.” By Friday, she had surpassed that goal and begun to disburse the funds, according to the website.
In other developments from around the globe:
The Philippines has begun loosening restrictions on movements across the capital, Manila, and nearby provinces, allowing a range of activities to restart, the government said on Friday. Harry Roque, spokesman for President Rodrigo Duterte, announced that indoor noncontact sports venues, such as gyms, fitness studios, skating rinks and racket sport facilities, would be allowed to reopen at about 30 percent of their capacity. Historical sites and museums would also be allowed to resume operations at limited capacity, he said, but guided tours would remain prohibited. He added that older adults who had been fully vaccinated would be allowed to move more freely, with proof of inoculation.
Jason Gutierrez contributed reporting.