The last person on earth to die of smallpox was Janet Parker, a medical photographer in Birmingham, UK. She was working above a research laboratory in 1978 when the virus escaped through the ventilation system. It infected her, and she died.

The year before, 1977, marked the climax of an 11-year worldwide vaccination campaign, mounted by the World Health Organization, to eradicate smallpox once and for all. It was led by American vaccinologist Donald Henderson, who declared smallpox extinct.

The U.S. and the Soviet Union, which held the now-redundant viral cultures and vaccines, agreed to destroy these stocks at some future date. That commitment has since been postponed indefinitely. Meanwhile, the CIA says that four nations - Russia, Iraq, North Korea and France - possess undeclared samples of the virus. And the Bush administration cited terrorist organizations as having mentioned smallpox among bioweapons they are interested in acquiring.

Biostatistician Ira Longini Jr. at Emory University in Atlanta observed, "Donald Henderson now works in the Office of Homeland Defense. He's really the key person in smallpox policy in the White House."

Longini and Emory biostatistician Elizabeth Halloran are co-senior authors of a paper in the current Science, dated Nov. 15, 2002, titled: "Containing of bioterrorist smallpox." It compares, by computer-aided modeling, two basic and contrasting defensive strategies - targeted vaccination and mass vaccination.

"Targeted vaccination, if done quickly and properly," Longini told BioWorld Today, "could be competitive with mass vaccinations. The more herd immunity to smallpox we have in the population, the better targeted vaccination does. It's after an outbreak starts, you find all the reported cases of smallpox, isolate them, and vaccinate as many of their close contacts as you can find - which in the case of smallpox would be most of them

"In mass vaccination," Longini continued, "you simply vaccinate some proportion of the population, say 80 percent. And you can do mass vaccination before an attack or like targeted vaccination, as quickly as you can after the outbreak. It means you vaccinate everybody you decide needed to be mass vaccinated, regardless of whether they've had contacts with smallpox or not."

All Out For Vaccine-Spread Herd Immunity

"Before the WHO eradication campaign in 1966-77," Longini went on, "virtually all Americans were routinely mass vaccinated. Nowadays we vaccinate for measles and other childhood diseases, and try to mass-vaccinate for influenza. The goal of mass vaccination is to achieve herd immunity. This means that you have enough immune people in the population such that viral transmission is greatly slowed or entirely cut off. Transmission," Longini explained, "is a combination of inhalation or direct contact. Touching some material that an infected person may have handled, being exposed to body fluids of any sort, would all be ways of transmitting smallpox. To spread the disease, you have to have repeated close contact with an infected person. The probability is much higher in transmission in that setting than casual contact, which has a very low probability of transmission.

"Nobody has modeled smallpox as carefully as we," Longini allowed. "There hasn't been a need. But it's an extension of the model we used for influenza; we simply modified it for smallpox. Before we did this in the modern context in the U.S. right now I don't think anybody had any idea how targeted vaccination would perform in comparison to mass vaccination. The other thing is the role of prior residual immunity. We ran two scenarios: In one we assumed people vaccinated before 1972 had no residual protection. When there was residual immunity, we assumed people vaccinated 30 years ago or before were about half as well protected as the same people vaccinated today. We assume that 50 percent are likely to be infected compared to an unvaccinated person. Their death rate, given they're ill, would be reduced from 30 percent to 3 percent. And 80 percent less infectious to others if they did become infected.

"With fresh modern smallpox vaccine," Longini pointed out, "the estimated probability of infection and illness is reduced by a factor of 95 percent. We ran another set with no protection whatsoever on any level if they were vaccinated 30 years ago or before. We found that targeted vaccination works reasonably well with no residual immunity. That leads us to recommend that we probably should go ahead vaccinating first responders now, and also volunteers - people who want to be vaccinated and understand the risk. First responders are hospital workers who would come into contact with smallpox cases if there were an attack, such as vaccinators, ambulance drivers, anybody who potentially might be on the scene when the first cases appear."

Suicide Attackers Supply Low-Tech Terror

Asked how Homeland Defense planners imagine such a terrorist smallpox attack would be launched, Longini replied: "From what I've heard at meetings where some of those people were present, I picture the simplest low-tech attack. There would probably be a handful of dedicated suicide terrorists infecting themselves, then moving contagiously among the population. They'd incur a 30 percent possible death rate. So the suicide assault is the easiest way to do it. You don't need any high-tech technology to inoculate victims.

"You can easily control an attack," Longini noted, adding, "But you'd pay a price because, say, you protectively mass-vaccinated 200 million Americans, you'd have roughly 200 to 400 deaths, and at least 20,000 people with serious side effects from the vaccine. That's the argument against mass vaccination. With targeted vaccination, of course, if there were an attack, more people would probably get smallpox, but you'd certainly be doing less damage with the vaccine, and - according to our work - control the outbreak pretty quickly."

Longini explained why the vaccinia virus itself is so virulent: "It's an old vaccine developed decades ago. It gives very good protection but causes a vaccinia infection at the inoculation site. People who are immunosuppressed or have eczema or other skin conditions can suffer very serious complications. Even a perfectly healthy person, on rare occasions, may develop vaccinia infections, which are difficult to deal with.

"For smallpox, the development of a new, safe vaccine," Longini concluded, "is something to start looking for now."

A team of Italian and American researchers, including the University of Florida’s Ira Longini, Ph.D., has received the Aspen Institute Italia Award for scientific research and collaboration between Italy and the United States. The team was honored at a ceremony held Oct. 26 at the institute’s Rome headquarters.

The Aspen Institute Italia Award recognizes significant research contributions in the field of natural, theoretical or applied sciences produced jointly by scientists from Italy and the U.S. The award includes a prize of 40,000 euros to be shared among the researchers’ institutions.

The research team was recognized for creating a computational model of the spread of the Ebola virus during the Liberian epidemic in 2014-15, based on the concentration and movement of individuals, including those not infected with the virus. Their findings, published in January 2015 in The Lancet Infectious Diseases, also highlighted the importance of various interventions employed by health authorities to combat the epidemic, such as the opening of dedicated health centers for patients with Ebola.

The group’s mathematical work improved understanding of the Ebola virus’ spread and how best to focus control efforts, said Longini, a professor in the department of biostatistics in the UF College of Public Health and Health Professions and the College of Medicine.

“The research also helped lay the groundwork for the design, analysis and interpretation of the highly successful Ebola ring vaccination trial conducted in Guinea,” said Longini, the co-director of the Center for Statistics and Quantitative Infectious Diseases at the UF Emerging Pathogens Institute. “We have now confirmed the potential of that vaccination trial design, which will help us in controlling not only Ebola, but other emerging infectious disease threats in the future.”

The team is composed of 10 researchers representing two Italian and three American institutions. In addition to Longini, they include Stefano Merler, M.S., Marco Ajelli, Ph.D., and Laura Fumanelli, Ph.D., of the Bruno Kessler Foundation in Trento, Italy; Luca Rossi, Ph.D., of the Institute for Scientific Interchange in Turin, Italy; Alessandro Vespignani, Ph.D., Marcelo F.C. Gomes, Ph.D., and Ana Pastore y Piontti, Ph.D., of Northeastern University in Boston; and M. Elizabeth Halloran, D.Sc., and Dennis L. Chao, Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle.

The team has worked together for several years as members of the Center for Inference and Dynamics of Infectious Diseases, a center of excellence of the National Institute of General Medical Sciences-funded Models of Infectious Disease Agent Study, or MIDAS Network. The team has collaborated on a number of other studies on Ebola as well as on influenza viruses, cholera, dengue and Zika.

There is a lot of misinformation out there and hype around the Novel Coronavirus, also known as COVID-19. Based on my research of this issue, there are many people over-reacting, and also many people under-reacting to this threat. At this stage, in March of 2020, the virus has effectively spread to such an extent that containment is not possible. For the latest numbers, check the Johns Hopkins GIS tracking system.

As of right now, the total confirmed cases are 116,000, and just over 4000 deaths. If we calculate the death rate from the confirmed cases, we come to roughly 3.5%. That means that based on the confirmed numbers so far, 3.5% of those infected have died. That said, there are probably more cases than this that have not been confirmed or reported, which means that the death rate could be a bit lower on average – perhaps as low as 2.5%, based on some reports. But in some countries, such as Italy, the death rate is as high as 5% as the health care system becomes overwhelmed.

Let’s presume that the average death rate is actually 3%, because the rates seem to be hovering on either side of that number, depending on which data you look at. That said, I expect the death rate in the United States to be on the higher side, due to our poor diet and extensive healthcare system, we have one of the sickest populations in the world. We eat badly and are kept seemingly “healthy” by our extensive treatment options.

That façade of health comes crashing down in the presence of an aggressive infection that heavily taxes your immune system’s resources. The people who are at the most risk for death from COVID-19 seem to be older adults, and especially those with other underlying diseases such as diabetes, cancer, or other ailments which weaken immune response. Sugar, which Americans consume in copious amounts, is one of the most powerful immune suppressants.

In contrast to the COVID-19 death rate of 3%, the seasonal flu only has a death rate of 0.1%, or 30 times lower than COVID-19. The Spanish Flu, which killed tens of millions of people, had a death rate of around 2.5%, for comparison.

People saying that the seasonal flu is more deadly than COVID-19 are either making the assumption that it will be contained, which I believe is extremely unlikely at this point, or they are looking only at the annual flu deaths thus far versus COVID-19.

Obviously, a large percentage of the population has been exposed to the flu, resulting in a larger actual number, whereas only a very small fraction of the population has been exposed to COVID-19 thus far, so that’s not a realistic comparison.

As COVID-19 spreads, it is expected by most scientists, including Ira Logini, an adviser to the World Health Organization (WHO), that it will infect perhaps two thirds of the global population. If we look at herd immunity numbers based on similar viruses, it would need to infect, and thus generate a herd immunity of 75%-86% of the population before it may ‘burn out.’ Thus, in a nutshell that means that somewhere between 217 million and 277 million Americans should expect to become infected, eventually, if those numbers hold.

If we do the math, that means that somewhere between 6.5 million and 8.3 million Americans should expect to die from complications of COVID-19.

Based on some early numbers, the median age of death is 81 years of age, and median age of infection is 61 years of age. Those who die from COVID-19 frequently have other underlying health issues which compromise their immune system’s ability to fight the virus.

Interestingly, children seem to be the least affected by COVID-19, with a much lower than average infection rate, and an even lower rate of severe symptoms and death. It is also possible that vaccines and other treatment options could reduce both the infection rate and the death rate, but until those options exist, we should use the numbers and the math that we currently have to guide our preparations.

It appears that up to 80% of people who become infected, mostly healthy people with strong immune systems, will have few symptoms and will not experience great difficulty from this virus. However, between 10-20% of people may have more severe cases, especially if they have weak immune systems, and will require advanced supportive care.

COVID-19 kills people primarily through ARDS, or Acute Respiratory Distress Syndrome, which is what happens when the connection point between the alveoli, which oxygenate the blood in the lungs, become inflamed, and that inflammation, caused by the virus interferes with that oxygenation process.

The inflammation also causes the capillaries to seep fluid into the alveoli which further prevents oxygen from reaching the blood stream. Those who have reached this stage will need treatment from a ventilator utilizing low tidal volume and lying on their stomachs, usually in an intensive care unit, likely under sedation and possibly a paralytic.

While the US has an advanced healthcare system, the demands placed upon it by a large number of citizens requiring this level of care would easily overwhelm the number of beds, ventilators, and healthcare providers available. This is why, while containment at this point is likely not possible, slowing the spread of this virus is absolutely critical and that’s why quarantines, good hygiene practices, and other precautions such as school closures are being put into place. If there is a rapid spread of the virus, the demand for treatment will overwhelm the health care system, and millions of additional people will die that could have been saved, driving the death rate up substantially, as is happening in Italy.

I expect most schools in the US to be closed in the next 2-3 weeks. While children and young adults are actually the least affected by this virus, they are one of the most effective vectors to spread it to their families and other people.

With all of this in mind, what can we do? Well first and foremost, we should all follow basic hygiene procedures – wash your hands thoroughly, use alcohol-based hand sanitizer, avoid touching your face, do not share food or drinks, and avoid putting yourself into situations where you’re exposed to large numbers of people in close proximity.

Do everything you can to stay healthy by getting plenty of sleep and eating healthy, especially avoiding things that suppress the immune system like sugar and refined carbohydrates.

Take regular vitamins and other supplements that are known to improve immune system function such as Vitamin C, Vitamin B6, Vitamin E, Vitamin D, Folic Acid, Zinc, Garlic, Oregano, etc.

Common sense and an abundance of caution will go a long way to help fight this virus. There is certainly no reason to panic but sticking our heads in the sand and ignoring the deadly consequences of this virus and ignoring the basic math is also not helpful.

Officials at the U.S. Centers for Disease Control and Prevention and epidemic experts from universities around the world conferred last month about what might happen if the new coronavirus gained a foothold in the United States. How many people might die? How many would be infected and need hospitalization?

One of the agency’s top disease modelers, Matthew Biggerstaff, presented the group on the phone call with four possible scenarios — A, B, C and D — based on characteristics of the virus, including estimates of how transmissible it is and the severity of the illness it can cause. The assumptions, reviewed by The New York Times, were shared with about 50 expert teams to model how the virus could tear through the population — and what might stop it.

The C.D.C.’s scenarios were depicted in terms of percentages of the population. Translated into absolute numbers by independent experts using simple models of how viruses spread, the worst-case figures would be staggering if no actions were taken to slow transmission.

Between 160 million and 214 million people in the United States could be infected over the course of the epidemic, according to a projection that encompasses the range of the four scenarios. That could last months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities, experts said. As many as 200,000 to 1.7 million people could die.

And, the calculations based on the C.D.C.’s scenarios suggested, 2.4 million to 21 million people in the United States could require hospitalization, potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds. Fewer than a tenth of those are for people who are critically ill.

The assumptions fueling those scenarios are mitigated by the fact that cities, states, businesses and individuals are beginning to take steps to slow transmission, even if some are acting less aggressively than others. The C.D.C.-led effort is developing more sophisticated models showing how interventions might decrease the worst-case numbers, though their projections have not been made public.

“When people change their behavior," said Lauren Gardner, an associate professor at the Johns Hopkins Whiting School of Engineering who models epidemics, “those model parameters are no longer applicable,” so short-term forecasts are likely to be more accurate. “There is a lot of room for improvement if we act appropriately.”

Those actions include testing for the virus, tracing contacts, and reducing human interactions by stopping mass gatherings, working from home and curbing travel. In just the last two days, multiple schools and colleges closed, sports events were halted or delayed, Broadway theaters went dark, companies barred employees from going to the office and more people said they were following hygiene recommendations

The Times obtained screenshots of the C.D.C. presentation, which has not been released publicly, from someone not involved in the meetings. The Times then verified the data with several scientists who did participate. The scenarios were marked valid until Feb. 28, but remain “roughly the same,” according to Ira Longini, co-director of the Center for Statistics and Quantitative Infectious Diseases at the University of Florida. He has joined in meetings of the group.

The C.D.C. declined interview requests about the modeling effort and referred a request for comment to the White House Coronavirus Task Force. Devin O’Malley, a spokesman for the task force, said that senior health officials had not presented the findings to the group, led by Vice President Mike Pence, and that nobody in Mr. Pence’s office “has seen or been briefed on these models.”

The assumptions in the C.D.C.’s four scenarios, and the new numerical projections, fall in the range of others developed by independent experts.

Dr. Longini said the scenarios he helped the C.D.C. refine had not been publicly disclosed because there remained uncertainty about certain key aspects, including how much transmission could occur from people who showed no symptoms or had only mild ones.

“We’re being very, very careful to make sure we have scientifically valid modeling that’s drawing properly on the epidemic and what’s known about the virus,” he said, warning that simple calculations could be misleading or even dangerous. “You can’t win. If you overdo it, you panic everybody. If you underdo it, they get complacent. You have to be careful.”

But without an understanding of how the nation’s top experts believe the virus could ravage the country, and what measures could slow it, it remains unclear how far Americans will go in adopting — or accepting — socially disruptive steps that could also avert deaths. And how quickly they will act.

Studies of previous epidemics have shown that the longer officials waited to encourage people to distance and protect themselves, the less useful those measures were in saving lives and preventing infections.

“A fire on your stove you could put out with a fire extinguisher, but if your kitchen is ablaze, that fire extinguisher probably won’t work,” said Dr. Carter Mecher, a senior medical adviser for public health at the Department of Veterans Affairs and a former director of medical preparedness policy at the White House during the Obama and Bush administrations. “Communities that pull the fire extinguisher early are much more effective.”

From Flu to Coronavirus

Dr. Biggerstaff presented his scenarios in a meeting held weekly to model the pandemic’s effects in the United States, Dr. Longini said. Its participants had been at work for several months before the emergence of the virus, modeling a potential influenza pandemic. “We just kind of retooled, re-shifted,” said Dr. Longini. “The priority’s now coronavirus.”

The four scenarios have different parameters, which is why the projections range so widely. They variously assume that each person with the coronavirus would infect either two or three people; that the hospitalization rate would be either 3 percent or 12; and that either 1 percent or a quarter of a percent of people experiencing symptoms would die. Those assumptions are based on what is known so far about how the virus has behaved in other contexts, including in China.

Other weekly C.D.C. modeling meetings center on how the virus is spreading internationally, the impact of community actions such as closing schools, and estimating the supply of respirators, oxygen and other resources that could be needed by the nation’s health system, participants said.

In the absence of public projections from the C.D.C., outside experts have stepped in to fill the void, especially in health care. Hospital leaders have called for more guidance from the federal government as to what might lie in store in the coming weeks.

Even severe flu seasons stress the nation’s hospitals to the point of setting up tents in parking lots and keeping people for days in emergency rooms. Coronavirus is likely to cause five to 10 times that burden of disease, said Dr. James Lawler, an infectious diseases specialist and public health expert at the University of Nebraska Medical Center. Hospitals “need to start working now,” he said, “to get prepared to take care of a heck of a lot of people.”

Dr. Lawler recently presented his own “best guess” projections to American hospital and health system executives at a private webinar convened by the American Hospital Association. He estimated that some 96 million people in the United States would be infected. Five out of every hundred would need hospitalization, which would mean close to five million hospital admissions, nearly two million of those patients requiring intensive care and about half of those needing the support of ventilators.

Dr. Lawler’s calculations suggested 480,000 deaths, which he said was conservative. By contrast, about 20,000 to 50,000 people have died from flu-related illnesses this season, according to the C.D.C. Unlike with seasonal influenza, the entire population is thought to be susceptible to the new coronavirus.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, speaking at a congressional hearing on Thursday, said predictions based on models should be treated with caution. “All models are as good as the assumptions that you put into the model,” he said, responding to a question from Representative Rashida Tlaib about an estimate from the attending physician of Congress that the United States could have 70 million to 150 million coronavirus cases.

What will determine the ultimate number, he said, “will be how you respond to it with containment and mitigation.”

Clues From 1918

Independent experts said these projections were critically important to act on, and act on quickly. If new infections can be spread out over time rather than peaking all at once, there will be less burden on hospitals and a lower ultimate death count. Slowing the spread will paradoxically make the outbreak last longer, but will cause it to be much milder, the modelers said.

A preliminary study released on Wednesday by the Institute for Disease Modeling projected that in the Seattle area, enhancing social distancing — limiting contact with groups of people — by 75 percent could reduce deaths caused by infections acquired in the next month from 400 to 30 in the region.

A recent paper, cited by Dr. Fauci at a news briefing on Tuesday, concludes that the rapid and aggressive quarantine and social distancing measures applied by China in cities outside of the outbreak’s epicenter achieved success. “Most countries only attempt social distancing and hygiene interventions when widespread transmission is apparent. This gives the virus many weeks to spread,” the paper said, with the average number of people each new patient infects higher than if the measures were in place much earlier, even before the virus is detected in the community.

“By the time you have a death in the community, you have a lot of cases already,” said Dr. Mecher. “It’s giving you insight into where the epidemic was, not where it is, when you have something fast moving.” He added: “Think starlight. That light isn’t from now, it’s from however long it took to get here.”

He said a single targeted step — a school closing, or a limit on mass gatherings — cannot stop an outbreak on its own. But as with Swiss cheese, layering them together can be effective.

This conclusion is backed up by history.

The most lethal pandemic to hit the United States was the 1918 Spanish flu, which was responsible for about 675,000 American deaths, according to estimates cited by the C.D.C.

The Institute for Disease Modeling calculated that the new coronavirus is roughly equally transmissible as the 1918 flu, and just slightly less clinically severe, and it is higher in both transmissibility and severity compared with all other flu viruses in the past century.

Dr. Mecher and other researchers studied deaths during that pandemic a century ago, comparing the experiences of various cities, including what were then America’s third- and fourth-largest, Philadelphia and St Louis. In October of that year Dr. Rupert Blue, America’s surgeon general, urged local authorities to “close all public gathering places if their community is threatened with the epidemic,” such as schools, churches, and theaters. “There is no way to put a nationwide closing order into effect,” he wrote, “as this is a matter which is up to the individual communities.”

The mayor of St. Louis quickly took that advice, closing for several weeks “theaters, moving picture shows, schools, pool and billiard halls, Sunday schools, cabarets, lodges, societies, public funerals, open air meetings, dance halls and conventions until further notice.” The death rate rose, but stayed relatively flat over that autumn.

By contrast, Philadelphia took none of those measures; the epidemic there had started before Dr. Blue’s warning. Its death rate skyrocketed.

The speed and deadliness of the pandemic humbled doctors then much as the coronavirus pandemic is doing now. Some commented on the difficulty of getting healthy people to take personal precautions to help protect others at greater risk.

Modern societies have tools that did not exist then: advanced hospitals, the possibility of producing a vaccine in roughly a year, the production of diagnostics. But other signs are more worrying.

The world population is about triple the size it was the year before the 1918 flu, with 10 times as many people over 65 and 30 times as many over 85. These groups have proven especially likely to become critically ill and die in the current coronavirus pandemic. In Italy, hospitals are so overwhelmed that ventilators are being rationed.

“It’s so important that we protect them,” said Dr. Gabriel Leung, a professor in population health at Hong Kong University. In work accepted for publication in the journal Nature Medicine, he estimated that 1.5 percent of symptomatic people with the virus died. He and others who have devoted their careers to modeling said that looking at the experiences of other countries already battling the coronavirus was all it took to know what needed to be done in the United States.

“All U.S. cities and states have the natural experiment of the cities that have preceded us, namely the superb response of Singapore and Hong Kong,” said Dr. Michael Callahan, an infectious disease specialist at Harvard. Those countries implemented school closures, eliminated mass gatherings, required work from home, and rigorously decontaminated their public transportation and infrastructure. They also conducted widespread testing.

They were able to “reduce an explosive epidemic to a steady state one,” Dr. Callahan said.

As in the case of an approaching hurricane, Dr. Mecher said, “You’ve got to take potentially very disruptive actions when the sun is shining and the breeze is mild.”

To boost or not to boost? The question of whether to authorize vaccine boosters is vexing scientists and public health officials as the nation endures the worst phase of the COVID-19 pandemic.

The answer will undoubtedly impact Florida, where 21 percent of the population — more than 4.5 million people — are over 65 and could benefit the most if booster shots are found to be safe and effective.

A panel of experts who advise the Food and Drug Administration voted Friday that current evidence does not support giving Pfizer booster shotsto most Americans. But they did agree that boosting people ages 65 and older and those at high-risk of death if infected was warranted. The panel also included those who risk getting infected on the job, like frontline medical workers.

That is not the final say. The FDA is not bound by the vote. The agency and the Centers for Disease Control and Prevention must both decide the booster question.

The Biden administration still hopes this coming week to offer booster shots. But those who received the Moderna and Johnson & Johnson vaccine face a longer wait to find out if scientists will endorse boosters for them.

The debate grabbed national attention last week after a group of 18 scientists, including two FDA officials, published an article arguing there is insufficient evidence to justify booster shots to the general public — that the best strategy to combat the pandemic is to use those doses to vaccinate the unvaccinated in the U.S. and across the world.

Scientific debate usually plays outs behind closed doors and in specialized journals. But the question of COVID boosters is the latest rift in the scientific community to spill out into the public during the pandemic, and the stakes are as high as ever.

The article, published Sept 13 in the medical journal The Lancet, argues no booster is needed because over 90 international studies have shown that “COVID-19 vaccines continue to be effective against severe disease.”

Even if boosters “were eventually shown to decrease the medium-term risk of serious disease,” the authors wrote, “the current vaccine supply could save more lives if used in previously unvaccinated populations.”

But the science is hardly settled, health experts say. The Lancet article did not include recent studies that suggest booster shots can dramatically reduce infection rates, especially for older populations — a view now endorsed by the FDA panel.

Two studies out of Israel indicate booster shots can greatly decrease the chance of infection or illness, especially for those over 60.

One study published in the New England Journal of Medicine tracked the more than 1.1 million Israeli residents over 60 who received a third shot of the Pfizer vaccine between July 30 and Aug. 22. It found a tenfold reduction in infection and severe illness compared to those who only had two doses.

A second study, still under peer-review, followed 150,000 adults who got an additional shot after Israel authorized boosters to anyone over 30. Those participants saw a 70 to 84 percent reduction in the risk of infection after 14 to 20 days.

The dramatic results may be due to the increased level of antibodies produced by the third shot, said University of Wisconsin epidemiologist David O’Connor. Those who got a booster shot had about three times the number of antibodies as someone who had two doses, according to Pfizer data.

There are reasons to believe a third dose “will actually be durable, and if it is durable, then you’re going to have very likely a three-dose regimen being the routine regimen,” said Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, at a Sept. 1 White House briefing.

First lady Jill Biden listens to White House Chief Medical Adviser Dr. Anthony Fauci as he addresses health care workers at the Osceola Community Health Services drive-thru vaccination site in Kissimmee on June 24. [ JOE BURBANK | Orlando Sentinel ]

The Israeli studies only focused on the Pfizer vaccine. Moderna has also applied for approval of a booster dose of its vaccine after initial study results indicate a 36 percent reduction in protection after 12 months. In August, Johnson & Johnson provided evidence that receiving a second dose of the one-shot vaccine produced a stronger immune effect. U.S. Surgeon General Dr. Vivek Murthy said Aug. 22 that Johnson & Johnson vaccine recipients “likely need a booster.”

Epidemiologists like O’Connor who support booster shots are optimistic that, by reducing infection and illness, a booster strategy could help curb community spread and halt the epidemic.

“Giving more people the boost as soon as possible would interrupt the spread of delta in highly affected communities, and it would likely turn the tide within a few weeks,” he said.

Getting transmission rates down helps protect those who remain vulnerable to the coronavirus, he said. That includes kids under 12 who are ineligible to get vaccinated, the elderly and immunosuppressed, unvaccinated adults, and frontline medical workers exhausted by sustained high hospitalization rates.

If boosting can reduce transmission of the virus, then it can save lives.

“I’m personally uneasy with the idea that we’re just going to roll the dice (and not approve boosters),” O’Connor said.

Health experts who oppose a universal booster rollout say it is a policy choice as much as a scientific question. Policy makers, they say, must decide how to prioritize scarce vaccine supplies in the face of scientific uncertainty.

Despite the positive initial results, the long-term efficacy of booster shots is still unknown, said University of Florida epidemiologist Ira Longini, who co-authored The Lancet article.

Israel moved ahead with boosting elderly residents in July after preliminary studies found a waning efficacy of the two-part Pfizer vaccine. Data have shown remarkable results from the boosters so far, Longini said, but the Israeli studies measured immune response after a short window. Nor is it clear how durable the immune response will be and whether reducing individual infections will lower community spread.

The FDA panel, however, questioned whether Israel’s data is relevant to the U.S. population and expressed concerns whether the extra dose would exacerbate side-effects.

Booster shots would need to reduce the chance of infection by 90 to 95 percent to truly halt community spread, Longini estimates — and those are not the kind of results he’s seeing.

“If we can get large numbers of people vaccinated, we can certainly reduce infection and transmission,” he said, “but we’re not going to eliminate the virus even at extremely high coverage.”

The current vaccine regimens are still effective at protecting against hospitalization and death, Longini said, so the nation’s primary goal should be to get as many people fully vaccinated as possible.

The CDC recently published new evidence reinforcing the importance of primary vaccination. It analyzed data from 600,000 Americans between April 4 and July 17 and found that unvaccinated individuals were 5 times as likely to become infected with the coronavirus. They were also more than 10 times as likely to be hospitalized and die from COVID-related illness.

In Florida, 39 percent of the total population remains unvaccinated. Those people pose the greatest threat of spreading the virus and straining the health care system if they require hospitalization, experts say.

“Boosters are not some magic bullet that (is) going to save us,” Longini said. “We need to be vaccinating the unvaccinated, not vaccinating the already vaccinated.”

That’s why the experts who spoke to the Tampa Bay Times say they support President Joe Biden’s efforts to close the vaccination gap by requiring 100 million Americans — including federal and private employees and health care workers — to get vaccinated.

“The lack of vaccination is a cancer on our collective productivity when we have high levels of community transmission,” O’Connor said. “We need to be very aggressive in trying to make sure we remove the cancer of this virus.”

Rolling out universal booster shots has implications beyond the U.S. Vaccine doses used to boost the already-vaccinated could instead help inoculate those in poorer nations that have had limited access, the authors of The Lancet article argued.

The math of vaccine boosters vs. increasing the vaccination rate is simple, said Johnathan Gruber, a Massachusetts Institute of Technology economist who helped design the Affordable Care Act.

“In the U.S., there is no evidence that it would reduce hospitalization by more than about 10 percent, and probably less,” he said. “But if you give that booster shot to someone outside the U.S., you probably lower their chance of hospitalization by about 90 percent.”

If a vial of vaccine does about nine times as much good if you give it as a first shot to someone in India than as a third shot to someone in the U.S., Gruber said the question facing Americans is: “Is a life in the U.S. worth nine times a life in India?”

His answer: “My next move would be to take every unit we’ve got and ship it to India.”

Addressing vaccine equity has as much to do with self-preservation as it does with ethics, Longini said. The delta variant emerged in India before spreading to Britain and the U.S.

To halt the global pandemic, the World Health Organization estimates every country would need to vaccinate 40 percent of its population by the end of 2021, and 70 percent by the first half of 2022. So far, only 61 of the 184 nations tracked by the New York Times have met that first benchmark.

The situation is worse in low-income countries, where less than 1 percent are fully vaccinated, according to an article in the British science journal Nature. Just 10 percent of the population of lower-middle-income countries are vaccinated, the article reported, while on average more than 50 percent are fully vaccinated in high-income countries.

“There’s no reason why these variants won’t keep emerging as long as there is global transmission on the planet,” Longini said. “We are putting America first by slowing the transmission on a global level.”

While scientists debate the issue, there may be a way forward that public health experts can agree on: the most vulnerable should get the booster shot first.

The CDC and FDA agreed in August that immunocompromised people should receive a third dose of the Pfizer or Moderna vaccine. That means patients undergoing cancer treatment who received an organ transplant or have another immunodeficiency should undergo a three-dose regimen instead of two doses.

Immunocompromised patients who received either the Pfizer or Moderna vaccine can now schedule a third shot at local pharmacies. Florida had administered 277,551 of those additional doses as of Friday.

Older Floridians have borne the brunt of the latest wave of COVID infections, making up approximately a third of hospitalizations and 63 percent of deaths since June 18.

Public health experts who spoke to the Tampa Bay Times unanimously agreed that the FDA panel’s take — expanding booster shots to the elderly, frontline workers and those with pre-existing conditions — is an agreeable compromise.

“We could possibly help protect them a bit better,” Longini said. “If they do get limited use of boosters, it certainly makes sense.”

Joseph A. Ladapo, a professor of medicine at the University of Florida and the state’s surgeon general, relied upon a flawed analysis and may have violated university research integrity rules when he issued guidance last fall discouraging young men from receiving common coronavirus vaccines, according to a report from a medical school faculty task force. But the university says it has no plans to investigate the matter.

Ladapo recommended in October that men younger than 40 not take mRNA vaccinations for covid, pointing to an “abnormally high risk of cardiac-related death.” Doctors and public health officials swiftly pounced, dismissing the underlying research for its small sample size, lack of detail and shaky methodology.

In its new report, a task force of the University of Florida College of Medicine’s Faculty Council cites numerous deficiencies in the analysis Ladapo used to justify his vaccine recommendation. A summary said the work was “seriously flawed.” The report’s authors say Ladapo engaged in “careless, irregular, or contentious research practices.”

The report, which was shared on Tuesday night with medical school faculty members and obtained by The Washington Post, is the first formal challenge to Ladapo from his academic colleagues. It was referred to the university’s Office of Research Integrity, Security and Compliance, a UF spokesman confirmed on Tuesday. Under university guidelines, the referral could have compelled the state’s flagship university to consider a formal investigation of Republican Gov. Ron DeSantis’s surgeon general.

But the university’s top research officer said on Wednesday it would close the matter, because Ladapo’s work as a state official was outside the school’s purview.

“As this work was done by the Dr. Joseph Ladapo in his role as the state of Florida Surgeon General and not in his role as a UF faculty member, the UF Office of Research Integrity, Security and Compliance has no standing to consider the allegations or concerns regarding research integrity set forth in the Faculty Council task force report,” David Norton, the university’s vice president for research, said in a statement provided to The Post.

The faculty panel does not suggest Ladapo committed classic research misconduct, such as falsifying data or plagiarism. Instead, its report zeroes in on what it describes as methodological flaws in the analysis, which was presented to the public without any named authors — much less their credentials. The analysis relies on data that is not statistically significant, the task force concluded, and it fails to compare the risks of vaccination with the benefits, such as limiting covid-19 deaths and reducing hospitalizations. Finally, the analysis claims deaths are cardiac-related without sufficient evidence to support that, the task force stated. As a result, it adds, Ladapo’s guidance may have violated a section of UF’s research integrity policy that concerns “questionable research practices.”

Although the school declined to review Ladapo’s actions, the task force argues that Ladapo should be held to the standards of a university professor at all times, including in his role as a public servant. “While Dr. Ladapo has the right and responsibility to develop public health policy as the state Surgeon General, he must simultaneously uphold the expectations and responsibilities of a tenured professor,” the task force stated in the summary report of its findings.

Ladapo did not respond on Tuesday to emails requesting comment. But he has publicly defended his guidance before. “Backed by the data, I stand by my recommendation against Covid-19 mRNA vaccination for young men,” Ladapo wrote in a column published in October by the Wall Street Journal. “At this point in the pandemic, it is unlikely that the benefits outweigh these risks.”

The Centers for Disease Control and Prevention continues to recommend that everyone 6 months or older get a coronavirus vaccine.

In response to a summary of the task force’s findings, a spokesperson for the Florida Department of Health questioned why Ladapo’s university colleagues would “vilify” him for his work as surgeon general.

“The ‘research’ conducted has no affiliation with the university and was a surveillance assessment of public health data within the Surgeon General’s authority,” James “Jae” A. Williams III, the department’s assistant press secretary, wrote in an email. “It is interesting that theFaculty Council spent such a significant amount of time to vilify their colleague’s work.”

DeSantis, a possible 2024 presidential candidate, is a prominent vaccine skeptic. In December, he successfully persuaded the state’s Supreme Court to order a grand jury investigation of “crimes and wrongs in Florida related to the COVID-19 vaccines.”

Daniel Salmon, a vaccinologist and professor at Johns Hopkins University, said in a recent interview that Ladapo’s affiliation with UF “increases his credibility” — and, as such, also “increases the likelihood that he’ll do harm.”

‘Gray area’

Ladapo, who was known early in the pandemic for his public skepticism of vaccines and mask mandates, was appointed at UF in 2021, around the time DeSantis named him surgeon general. Before joining UF, Ladapo was an associate professor of medicine at the University of California at Los Angeles. He holds a medical degree and a PhD in health policy, both from Harvard University.

Recent controversies are driving what some at UF say is a hyper-politicized environment. Ladapo joined the university with tenure through a fast-tracked process that drew criticism from a faculty panel. In October, students and professors criticized an opaque presidential search process in which Ben Sasse, the departing U.S. senator from Nebraska, was named the sole finalist for UF’s presidency. (Sasse will assume the position in February.) In 2021, UF came under fire for blocking professors from assisting in litigation against the state on matters including voting rights and mask mandates. The school reversed its position under heavy criticism.

“The climate is not good,” said Ira Longini, a member of the task force and a professor of biostatistics. “People feel worried and threatened. The governor controls or tries to control the universities in the state. The whole system is under siege at the moment.”

In addition to experts on biostatistics, the task force included professors with expertise in infectious diseases, pediatrics, public health, vaccines and epidemiology. Michael Haller, chief of pediatric endocrinology at UF, served as chair of the group.

Haller declined to comment on the task force’s findings or the university’s decision not to investigate Ladapo.

In an email to medical faculty on Tuesday night, Martin Rosenthal, president of the medical school’s Faculty Council, said, “The Task Force found no research misconduct.” But the report points to a provision of university policy on “research integrity violation[s].” Rosenthal told the faculty that “Any further investigation is being handled by the Office of Research Integrity.”

Rosenthal did not respond to numerous inquiries from The Post.

At UF, “any allegations of research misconduct and other violations of research integrity” are investigated in accordance with university policy, according to an online description of the university’s processes. An allegation, however, does not ensure a formal investigation — and the research chief’s statement on Wednesday makes clear that won’t happen as a result of the task force’s work.

The case against Ladapo falls into a “gray area” of research compliance, according to Christopher J. Cramer, a former vice president for research at the University of Minnesota.

“I certainly wouldn’t call it misconduct,” said Cramer, a professor emeritus of chemistry. “The question then arises, ‘But what about integrity?’ The faculty of the University of Florida might be within their rights to suggest that the surgeon general should take a leave of absence or otherwise dissociate from the university because of a failure to live up to academic responsibility.”

The challenge to Ladapo from his UF colleagues is reminiscent of a case at Stanford University where, in 2020, the Faculty Senate passed a resolution condemning Scott Atlas, a senior fellow at the Hoover Institution, a think tank hosted by Stanford. As President Donald Trump’s pandemic adviser, Atlas questioned the science of mask-wearing and once urged Michigan residents to “rise up” against covid restrictions. In a recent interview with the Stanford Review, Atlas said the faculty criticisms of him “had no basis whatsoever.”

Paul Offit, a professor of vaccinology and pediatrics at the Perelman School of Medicine at the University of Pennsylvania, said that Ladapo has put people at risk through his vaccine guidance. The university needs to stand up and say that, Offit said.

“If people are making statements that are incorrect and with the potential to do harm,” Offit said, “then I think it’s incumbent upon the university to bring that person who speaks to task.”