Editor’s note: This is a live account of COVID-19 updates from Tuesday, Aug. 10, as the day unfolded. It is no longer being updated. Click here to see all the most recent news about the pandemic, and click here to find additional resources.
Amid a spike in COVID-19 infections driven by the delta variant and unvaccinated people, the state of Washington, as well as Seattle and King County, issued sweeping orders requiring public employees get vaccinated or lose their jobs.
The push in Washington State comes as the Biden administration has increasingly been urging state and local government, as well as businesses, to consider such mandates. The administration has said it is pondering how to encourage more unvaccinated Americans to get their shots without issuing further vaccine mandates beyond the federal workforce.
Meanwhile, Dr. Anthony Fauci said he hopes the Food and Drug Administration will begin giving full approval to the coronavirus vaccines by month’s end, potentially spurring a wave of vaccine mandates in the private sector as well as in schools and universities.
We’re updating this page with the latest news about the COVID-19 pandemic and its effects on the Seattle area, the U.S. and the world. Click here to see previous days’ live updates and all our other coronavirus coverage, and here to see how we track the daily spread across Washington and the world.
Experts say New Zealand should keep virus elimination plan
WELLINGTON, New Zealand — Only 26 people in New Zealand have died from the coronavirus since the pandemic began, after the nation of 5 million managed to completely stamp it out its spread.
But a big question has arisen. Is it realistic for the country to maintain its zero-tolerance approach, which has included strict lockdowns for even small outbreaks, once it begins to reopen its borders?
The answer from an expert group advising the government is a resounding “Yes.”
Chaired by epidemiologist David Skegg, the group said in a highly anticipated report released Wednesday that it believes it’s possible to maintain an elimination strategy even after more people start arriving.
The group said that many countries such as Britain and the U.S. were already resigned to living with the virus and perhaps enduring seasonal surges.
Vaccine side effects rare and outweighed by benefits, CDC reports
For adults, the benefits of the three coronavirus vaccines authorized in the United States outweigh the risks of serious side effects, which remain rare, according to a new report from the Centers for Disease Control and Prevention.
The Pfizer-BioNTech and Moderna vaccines have been linked to inflammation of the heart muscle, known as myocarditis, and the Johnson & Johnson vaccine may increase the risk of a rare blood-clotting disorder and a neurological condition known as Guillain-Barré syndrome. All of the conditions can be serious but remain uncommon.
These small risks are exceeded by the benefits of the vaccines, which provide powerful protection against disease and death, experts concluded. For instance, every 1 million doses of the Johnson & Johnson vaccine that are administered are likely to prevent roughly 1,800 hospitalizations and 140 deaths, while causing 14 to 17 cases of Guillain-Barré and 1 to 2 cases of the blood-clotting disorder, according to the paper, which was published Tuesday.
The paper is based on data reported to the federal Vaccine Adverse Events Reporting System. The database contains unverified reports, but researchers confirmed many of the cases used in their calculations, which were initially presented at a July meeting of the CDC’s vaccine advisory group.
Some worry the Johnson & Johnson shot isn’t enough. New study offers answers — and questions.
Choosing the Johnson & Johnson vaccine was about convenience for Amy Riley. She was knee-deep in planning a virtual event for her communications job when she became eligible for vaccination and couldn’t chance losing two days to potential side effects from a two-dose mRNA vaccine. Plus, she wanted to be fully immunized before her niece’s graduation.
Riley, 41, said she knew Johnson & Johnson’s shot had lower efficacy numbers than the other approved vaccines, but she remembers health officials assuring the public that the one-dose vaccine was just as good.
Now, she’s not sure she believes them, frustrated by how little information seems to be available about her vaccine brand’s effectiveness against the delta variant.
Riley is among the more than 13 million Americans who have received the Johnson & Johnson jab, some of whom now question how well it will protect them against the delta variant.
Europe reopened to Americans. Why, it asks, hasn’t the U.S. reciprocated?
In June, as the United States made headway in its vaccination campaign, European Union leaders recommended that member countries reopen their borders to Americans, a significant gesture meant to signal what they hoped would be the beginning of the pandemic’s end. They expected to be repaid in kind.
But nearly two months later, even as Europe has overtaken the United States in vaccinations, America’s borders remain closed to most European travelers, even ones with vaccinations. And with fears of the delta variant of the virus raging, there appears to be no end in sight.
That the United States remains largely closed has dismayed Europeans and frustrated their leaders, who are demanding that Europe’s decision to open its borders be reciprocated.
“We insist comparable rules be applied to arrivals in both directions,” Ursula von der Leyen, the president of the European Commission, the bloc’s executive arm, said last week at a news conference. Officials with the bloc have even suggested reimposing travel restrictions against U.S travelers, though a quick change is not expected since many countries are reluctant to risk further ruin to summer tourism.
‘Act now’ on global vaccines to stop more dangerous variants, experts warn Biden
More than 175 public health experts, scientists and activists on Tuesday demanded that President Joe Biden take urgent steps to confront the global spread of the coronavirus, warning that without immediate action to inoculate the rest of the world, newer variants are likely to emerge — including ones that may evade vaccines’ protection.
The experts advised announcing within the next 30 days an ambitious global vaccine manufacturing program to build vaccine infrastructure for the future.
High trust in doctors, nurses in U.S., poll finds
Most Americans have high trust in doctors, nurses and pharmacists, a new poll finds.
Researchers say that trust could become important in the push to increase COVID-19 vaccinations, as long as unvaccinated people have care providers they know and are open to hearing new information about the vaccines.
At least 7 in 10 Americans trust doctors, nurses and pharmacists to do what’s right for them and their families either most or all of the time, according to the poll from the University of Chicago Harris School of Public Policy and The Associated Press-NORC Center for Public Affairs Research.
The poll shows high levels of trust among both Democrats and Republicans; men and women; and white, Black and Hispanic Americans.
Republicans raise money on Facebook by tying migrant influx to COVID surge
Facebook has allowed prominent Republican officials and candidates — including the chairman of the Senate Republican Conference — to use its powerful ad technologies to raise money by associating immigrants with the surge of coronavirus infections in the Southern United States.
The ads, whose central claim has been rejected by doctors and fact-checkers, illustrate the platform’s inconsistent approach to defining coronavirus misinformation, especially when elected officials are involved. Facebook’s handle on misleading content is under intense scrutiny by the Biden administration as case counts climb again in the United States and health authorities grapple with the online origins of anti-vaccine attitudes. President Joe Biden raised alarm about the issue last month when he said of Facebook, “They’re killing people.”
The latest test of the social media giant’s policies joins the inflammatory debate over immigration to the life-or-death matter of the coronavirus.
Biden administration looking to pay Florida educators if DeSantis withholds their salaries over mask mandates
The Biden administration is examining whether it can direct unused stimulus funds to support educators in Florida who may defy the governor’s order against mask mandates in schools.
The announcement Tuesday was a sharp response to Republican Gov. Ron DeSantis, who has threatened to withhold the salaries of superintendents and school board members who defy his executive order banning classroom mask mandates.
On Tuesday, President Joe Biden took aim particularly at GOP leaders like DeSantis who, he said, deride mask mandates as government overreach but have no problem imposing their own will on local school districts. “I find that totally counterintuitive and frankly disingenuous,” Biden said.
Facebook bans firm behind Pfizer, AstraZeneca smear campaign
Facebook said Tuesday that it has removed hundreds of accounts linked to a mysterious advertising agency operating out of Russia that sought to pay social media influencers to smear COVID-19 vaccines made by Pfizer and AstraZeneca.
A network of 65 Facebook accounts and 243 Instagram accounts was traced back to Fazze, an advertising and marketing firm working in Russia on behalf of an unknown client.
The network used fake accounts to spread misleading claims that disparaged the safety of the Pfizer and AstraZeneca vaccines. One claimed AstraZeneca’s shot would turn a person into a chimpanzee. The fake accounts targeted audiences in India, Latin America and, to a lesser extent, the U.S., using several social media platforms including Facebook and Instagram.
The Fazze network also tried to recruit social media influencers to post misleading content but that ploy backfired when influencers in Germany and France exposed the network’s offer.
State health officials confirm 900 new coronavirus cases
The state Department of Health (DOH) reported 900 new coronavirus cases and 10 new deaths on Tuesday.
The update brings the state's totals to 495,357 cases and 6,187 deaths, meaning that 1.2% of people diagnosed in Washington have died, according to the DOH. The data is as of 11:59 p.m. Monday. Tallies may be higher earlier in the week because new state data isn’t reported on Sundays and COVID-related deaths aren’t reported on the weekends.
The total case and new case count today is incomplete due to an interruption in DOH’s data processes, according to DOH.
In addition, 27,925 people have been hospitalized in the state due to the virus — 67 new hospitalizations. In King County, the state's most populous, state health officials have confirmed a total of 122,157 COVID-19 diagnoses and 1,688 deaths.
Since vaccinations began in mid-December, the state and health care providers have administered 8,259,381 doses and 53.2% of Washingtonians have been fully vaccinated against COVID-19, according to vaccination data, which the state updates on Mondays, Wednesdays and Fridays. Providers are currently giving an average of about 10,131 vaccine shots per day.
The DOH says its daily case reports may also include duplicate test results, results assigned to the wrong county, results that are reported for today but are actually from a previous day, occasional false positive tests and other data discrepancies. Because of this, the previous day’s total number of cases plus the number of new daily cases does not add up to the new day’s total number of cases. State health officials recommend reviewing the dashboard's epidemiologic curves tab for the most accurate representation of the state's COVID-19 spread.
Stevie Nicks cancels all 2021 performances over coronavirus
Stevie Nicks canceled appearances at five music festivals, citing coronavirus concerns, she said in a statement Tuesday.
Nicks had been scheduled to headline one day each of BottleRock Napa Valley in California and the Jazz Aspen Festival in Colorado in September. In October, she was to have played two days of the Austin City Limits Music Festival and one day of the New Orleans Jazz and Heritage Festival.
The 73-year-old singer said in the statement. “While I’m vaccinated, at my age, I am still being extremely cautious and for that reason have decided to skip the 5 performances I had planned for 2021.”
US to send 8.5 million doses of COVID-19 vaccine to Mexico
MEXICO CITY — The United States will send Mexico 8.5 million more doses of COVID-19 vaccine as the delta variant drives the country’s third wave of infections, Mexican officials said Tuesday.
Foreign Affairs Secretary Marcelo Ebrard said the U.S. government will send AstraZeneca and Moderna vaccines, though the latter hasn’t yet been approved by Mexican regulators.
U.S. Vice President Kamala Harris informed Mexican President Andrés Manuel López Obrador of the new shipments during a call Monday, Ebrard said.
As Mexico’s third wave started, hospitalizations and deaths lagged significantly. But hospitalizations are starting to rise in parts of the country as infections expand rapidly and the health system grows more stressed.
“The appearance of new cases is much greater than what we saw in the first and second waves,” said public health specialist Miguel Betancourt. The much more contagious delta variant is likely responsible. “With this velocity that we are seeing, the risk of saturation of the hospitals is very high.”
New York Film Festival unveils lineup, plots in-person fest
NEW YORK — A year after depending on drive-in and virtual screenings, the New York Film Festival, one of the premier destinations of the fall festival circuit, will return to in-person premieres at Lincoln Center this September, with vaccination proof required for all attendees.
Film at Lincoln Center, which presents the annual festival, announced the lineup to the 59th NYFF on Tuesday. This fall, festivals are taking varied approaches to the pandemic. The Venice Film Festival, which kicks off the circuit, will be entirely in-person, while the soon-after Toronto International Film Festival will depend more heavily on virtual screenings in addition to gala events in downtown Toronto venues.
The New York Film Festival will include virtual events and some outdoor screenings, but forgo virtual screenings. Organizers said that decision was “in response to distributor and filmmaker partners and in light of festivals returning and theaters reopening across the country.”
Dennis Lim, the festival’s director of programming, called the lineup “a reminder of cinema’s world-making possibilities” that “help us make sense of our moment.”
Marjorie Taylor Greene suspended from Twitter for a week over misleading comments on coronavirus vaccines
Twitter suspended Rep. Marjorie Taylor Greene, R-Ga., again Monday after she falsely tweeted that vaccines are failing. The seven-day suspension is the latest rebuke from the platform over a post about coronavirus misinformation – something that violates the social media company’s policies.
Greene claimed that the vaccines don’t work because some people have still contracted the coronavirus despite being vaccinated, and she said the Food and Drug Administration should not fully authorize them. The vaccines have been approved for emergency use and have been taken by more than 166 million people – more than half of the population.
“These vaccines are failing and do not reduce the spread of the virus and neither do masks,” she tweeted Tuesday. “There are too many reports of infection and spread of COVID-19 among vaccinated people.”
On Monday, she tweeted that the vaccines should not be fully approved or mandated.
“Many people’s personal testimonies are saying they are still getting sick with COVID and vaccinated people are spreading it,” she tweeted. “It should NOT be approved or mandated.”
Explainer: Will we need vaccine passports to do fun things?
NEWPORT, R.I. — Ready to go out on the town before summer ends? In parts of the U.S., you might have to carry your COVID-19 vaccine card or a digital copy to get into restaurants, bars, nightclubs and outdoor music festivals.
After resisting the divisive concept of vaccine passports through most of the pandemic, a fast-growing number of private venues and some local officials are now requiring proof of immunization in public settings to reduce the spread of the highly transmissible delta variant of the coronavirus — and to assuage wary customers.
It’s unlikely the U.S. will adopt a national mandate like the one in France, which on Monday began requiring people to show a QR code proving they have a special virus pass before they can enjoy restaurants and cafes or travel across the country.
But enough venues are starting to ask for digital passes to worry some privacy advocates, who fear the trend could habituate consumers to constant tracking.
In-person gamblers lifting US casino market to its best year
ATLANTIC CITY, N.J. — Gamblers anxious to hit the slot machines and table games in person after a year of coronavirus restrictions are lifting the U.S. casino industry to its best year ever.
But the great unknown is whether a new, more contagious variant of COVID-19 will slow an industry that is now winning money at a record pace.
Data released Tuesday by the American Gaming Association, the casino industry’s national trade group, show that America’s casinos had their best second quarter in history, taking in $13.6 billion.
The report also shows the industry has nearly equaled all the revenue U.S. casinos took in during 2020, amid widespread casino shutdowns and restrictions that lingered even after they reopened.
It is clear that 2021 could be the best year in history for U.S. casinos. The gambling halls are on track to surpass 2019 ($43.6 billion) as the highest-grossing year ever. Nearly $25 billion has been won during the first six months of this year.
Snohomish County issues indoor masking mandate for all residents older than 5
Snohomish County's health officer on Tuesday morning announced a new indoor masking mandate for all residents over 5 years old.
Dr. Chris Spitters said during a news conference that the mandate comes after the county's COVID-19 cases doubled in the past three weeks. The directive includes retail, grocery and government buildings, in addition to any other public, indoor spaces.
"Our situation continues to be alarming in Snohomish County," Spitters said.
The announcement made the county one of the first in Washington to bring back the widespread directive since Gov. Jay Inslee lifted most COVID-19 restrictions in June.
Last week, the county counted more than 600 close contacts in child-care facilities. At least 15 long-term care facilities in the county have at least one confirmed case, and hospitals are looking after at least 62 hospitalized COVID-19 patients, including four on "mechanical ventilation," he said.
"We really need to be thinking vaccination and masking in public, versus vaccination or masking," he added.
The new rule applies to both vaccinated and unvaccinated residents, and does not apply to outdoor spaces, though Spitters encouraged people to continue masking outside. The directive will go into effect on Thursday.
Nonprofit gives Americans 100,000 free lasagnas
On a recent summer morning, Lynn Hirsch was determined as she packed the back of her gray SUV with 20 aluminum pans of lasagna.
The retiree was on a mission: Drive nearly 70 miles from her suburb of Atlanta to two rural Georgia towns and get the hearty dishes into the hands of people who needed them.
It’s an increasingly typical mission for volunteers of Lasagna Love — a grassroots nonprofit organization of 33,000 people across the country who are sharing free lasagnas with Americans struggling with financial and other challenges brought on by the COVID-19 pandemic. The group is one of many charitable initiatives launched during the pandemic to help families counter hunger, and pay for housing costs and other expenses.
Although more Americans are getting vaccinated and heading back to work, the nonprofit isn’t letting up on its mission of offering a comforting plate of lasagna. It’s transitioning from being COVID-minded to kindness-minded, the organization’s leaders say, and aiming to get additional volunteers so more families can get home-cooked meals.
Thai police fire rubber bullets, tear gas at virus protest
BANGKOK — Thai police clashed for the second time in four days on Tuesday with protesters angry over the government’s handling of a coronavirus surge and a lack of progress in political reform.
Lines of police, backed by trucks spraying jets from water cannons, fired tear gas and rubber bullets at scores of demonstrators in Bangkok. Protesters threw rocks and fireworks and set fire to a traffic police booth, sending flames and smoke billowing into the sky.
The clashes continued into the evening in the same area -– Din Daeng -– where similar scenes played out last Saturday.
Tuesday’s protest began as a “car mob,” with demonstrators driving to different points in the capital to get around restrictions on public gatherings and minimize the potential for the spread of the coronavirus. Some later broke away, leading to the confrontation with police.
The protesters blame the government for its perceived bungling of the coronavirus pandemic in which Thailand has struggled to suppress a dramatic spike in cases, partly because of the low rate of vaccinations among the population.
US turns to social media influencers to boost vaccine rates
DENVER — As a police sergeant in a rural town, Carlos Cornejo isn’t the prototypical social media influencer. But his Spanish-language Facebook page with 650,000 followers was exactly what Colorado leaders were looking for as they recruited residents to try to persuade the most vaccine-hesitant.
Cornejo, 32, is one of dozens of influencers, ranging from busy moms and fashion bloggers to African refugee advocates and religious leaders, getting paid by the state to post vaccine information on a local level in hopes of stunting a troubling summer surge of COVID-19.
Colorado’s #PowertheComeback target audience is especially tailored to Latino, Black, Native American, Asian and other communities of color that historically have been underserved when it comes to health care and are the focus of agencies trying to raise vaccination rates.
It’s part of a growing U.S. state- and city-based movement using local social media influencers to reach the most vaccine-hesitant at a neighborhood level. Health authorities in Chicago, Oklahoma City, San Jose, California, New Jersey and elsewhere are running similar campaigns.
King County to give free masks, wipes to restaurant workers
If you work in the restaurant industry in King County, you're invited to stop by a drive-through pop-up in Renton that's distributing masks and sanitizing wipes Tuesday.
County officials are planning to give away free PPE to restaurant workers from 9 a.m. to 1 p.m. at 919 Southwest Grady Way. Each worker can receive up to 10 KN90 masks, 10 cloth masks and one packet of wipes, according to the county.
Register here if you're planning to stop by.
How Seattle’s Scarecrow Video plans to share its vast library nationwide
When Scarecrow Video began its pilot rent-by-mail program back in fall 2019, things were decidedly low-tech. Executive director Kate Barr, describing the system as held together by “bubble gum and duct tape."
But a few things have changed since that early testing-the-waters program, which involved only a few dozen people. A global pandemic occurred, making many of us more reliant on stay-at-home entertainment. Reckless Video closed down, leaving Scarecrow — Seattle’s last video store, though a nonprofit since 2014 — to examine its place as a rare surviving outlet for physical media.
And streaming services multiplied, offering more and more options but at increasing cost to consumers, particularly those who subscribe to more than one service — and a limited and ever-shifting inventory.
“A number of the people who signed up for rental by mail during lockdown were people who said, ‘We’ve watched everything we want to watch on Netflix and Amazon, and now I don’t know what to do,’” Barr said. “We were onboarding people who had never rented from Scarecrow before, turning to us during COVID because they were burned out on the limitations.”
So the time seemed right for Scarecrow, founded in 1986 and located in the University District since 1993, to take a big step: working to create a national rent-by-mail service.
Dallas schools to require masks against COVID, defying governor
DALLAS – Dallas city school leaders defied their governor Monday, announcing that students and staff will be required to wear masks in school buildings as coronavirus cases spike across the region and state.
The announcement from the Dallas Independent School District, delivered hours after some schools began for the year, came despite a statewide ban in Texas on such mandates. Last month, Texas Republican Gov. Greg Abbott issued an executive order barring government entities – including public schools – from mandating masks or vaccines. As virus caseloads have skyrocketed, the governor has declined to modify the policy.
“With numbers getting significantly worse this decision is urgent, and an important one when it comes to protecting our students, teachers, staff and their families,” Superintendent Michael Hinojosa said.
The mandate takes effect on Tuesday.
COVID’s delta variant derailing plans for normalcy as schools reopen
With a mix of optimism and trepidation, teachers and students began returning to classrooms in large numbers Monday, as the nation opens a third-straight school year upended by the pandemic.
Educators are anxious to begin academic and emotional recovery for students knocked about by more than a year of online and hybrid learning. But as a resurgent virus inflicts fresh damage, many were forced to confront a new round of pandemic politics, with debates over vaccines and masks consuming districts and communities.
The big fear lingering: a repeat of last year, when many students were forced to learn from home all or part of the time and students were regularly shuttled into quarantine after exposures to the virus.
“Things are increasingly chaotic,” said Sasha Pudelski, advocacy director for AASA, the School Superintendents Association. “A month ago there was a lot more calm and assurity.”
COVID outbreak at Tacoma facility for immigrant detainees worsens, with 150 cases since June
An outbreak of COVID-19 cases that began in early June at the Northwest ICE Processing Center in Tacoma, a facility for detained immigrants, has continued to worsen. Since then, 150 people, including seven guards and a federal health care worker, have tested positive, according to a lawyer monitoring court-ordered government notices of coronavirus cases at the facility.
The virus surge came as the federal government, in an attempt to relieve overcrowding at holding facilities at the southern border, transferred nearly 1,100 immigrants to the Tacoma detention center, according to a document submitted to federal court by the U.S. Attorney’s Office for Western Washington.
While the government released about 570 detainees it deemed at high risk of contracting COVID-19, “the harm is done,” said the attorney watching case notices, Aaron Korthuis of Northwest Immigrant Rights Project.
Virtually all of those who contracted the virus tested positive shortly after arriving at the Tacoma facility, leading Korthuis and his legal rights organization to contend the government is not taking adequate precautions when transferring people.
Texas Gov. Abbott seeks out-of-state help against COVID-19
Gov. Greg Abbott appealed for out-of-state help to fight the third wave of COVID-19 in Texas while two more of the state’s largest school districts announced mask mandates in defiance of the governor.
Abbott’s request Monday came as a county-owned hospital in Houston raised tents to accommodate their COVID-19 overflow. Private hospitals in the county already were requiring their staff to be vaccinated against the coronavirus.
Meantime, the Dallas and Austin school districts announced Monday that they would require students and staff to wear face masks. The Houston school district already announced a mask mandate for its students and staff later this week if its board approves.
The highly contagious delta variant is fueling the wave.
Merkel, state governors meet to decide on pandemic rules
BERLIN — Germany Chancellor Angela Merkel and the country’s 16 state governors are set to meet Tuesday to decide on how to handle measures against the coronavirus pandemic amidst a discussion about whether people who have been fully vaccinated or recovered from COVID-19 should have greater freedoms than those who aren’t vaccinated.
While Germany has relatively low numbers of virus cases compared to other European countries, cases are rising again and authorities are fearing that especially young people who are not vaccinated yet may contract and spread the virus in the coming weeks and months.
On Monday, the country’s disease control agency registered 2,480 new cases, about 700 more than a week ago. Some 45.6 million people, or almost 55% of the population, are fully vaccinated.
After a sluggish start of the vaccination campaign that only really gained traction from March onward, the rate of vaccination has dropped again in recent weeks, and officials worry they may not reach the target set by the country’s disease control agency, of immunizing at least 85% of people between ages 12 and 59 and 90% of those over 60.
Catch up on the past 24 hours
What you should know about Washington's new vaccine mandate: Get fully vaccinated or lose your job, Gov. Jay Inslee yesterday ordered most state employees and hundreds of thousands of health care workers. Seattle and King County announced similar mandates for their employees as some politicians quickly blasted the new orders. Our Q&A tackles exactly who's affected, when they'd need to get the first shot and more.
A COVID-19 outbreak has swelled to 150 cases since June at the ICE center for detained immigrants in Tacoma. One detained man is describing the close quarters and lack of precautions as the feds transferred nearly 1,100 immigrants into the center.
The Delta variant is sending far more children to hospitals as researchers try to figure out whether it's making them sicker than the original strain. Delta is also derailing plans for normalcy as schools reopen and pandemic politics surge, too. For an example, look to Dallas, where schools are defying the governor.
The entire state of Arkansas has only eight ICU beds available, after the state yesterday set a record for hospitalizations. You can track the pandemic's resurgence nationally and in Washington state on these maps.
Members of the U.S. military will be required to get a vaccine starting next month — or possibly sooner. Right now, the services vary widely in their vaccination rates.