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Biden faces a familiar foe -- uncertainty

President Joe Biden had hoped to return from the Thanksgiving holiday bearing good news about his moves to get the economy back on track, his administration's effort to fix the supply chain crisis and hopes for a holiday season where Americans could gather safely with families and friends.
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Thich Nhat Hanh’s final mindfulness lesson: how to die peacefully
Thich Nhat Hanh, 92, reads a book in January 2019 at the Tu Hieu temple. “For him to return to Vietnam is to point out that we are a stream,” says his senior disciple Brother Phap Dung. | PVCEB “Letting go is also the practice of letting in, letting your teacher be alive in you,” says a senior disciple of the celebrity Buddhist monk and author. The International Plum Village Community of Engaged Buddhism has announced that Thich Naht Hanh passed away on January 22 in Huế, Vietnam. We are republishing this interview with one of his senior disciples. It first appeared on Vox in March, 2019. Thich Nhat Hanh has done more than perhaps any Buddhist alive today to articulate and disseminate the core Buddhist teachings of mindfulness, kindness, and compassion to a broad global audience. The Vietnamese monk, who has written more than 100 books, is second only to the Dalai Lama in fame and influence. Nhat Hanh made his name doing human rights and reconciliation work during the Vietnam War, which led Martin Luther King Jr. to nominate him for a Nobel Prize. He’s considered the father of “engaged Buddhism,”a movement linking mindfulness practice with social action. He’s also built a network of monasteries and retreat centers in six countries around the world, including the United States. In 2014, Nhat Hanh, who is now 93 years old, had a stroke at Plum Village, the monastery and retreat center in southwest France he founded in 1982 that was also his home base. Though he was unable to speak after the stroke, he continued to lead the community, using his left arm and facial expressions to communicate. In October 2018, Nhat Hanh stunned his disciples by informing them that he would like to return home to Vietnam to pass his final days at the Tu Hieu root temple in Hue, where he became a monk in 1942 at age 16. (The New York Times reports that nine US senators visited him there in April.) As Time’s Liam Fitzpatrick wrote, Nhat Hanh was exiled from Vietnam for his antiwar activism from 1966 until he was finally invited back in 2005. But his return to his homeland is less about political reconciliation than something much deeper. And it contains lessons for all of us about how to die peacefully and how to let go of the people we love. When I heard that Nhat Hanh had returned to Vietnam, I wanted to learn more about the decision. So in February I called up Brother Phap Dung, a senior disciple and monk who is helping to run Plum Village in Nhat Hanh’s absence. (I spoke to Phap Dung in 2016 right after Donald Trump won the presidential election, about how we can use mindfulness in times of conflict.) Our conversation has been edited for length and clarity. Wouter Verhoeven Brother Phap Dung, a senior disciple of Thich Nhat Hanh, leading a meditation on a trip to Uganda in early 2019. Eliza Barclay Tell me about your teacher’s decision to go to Vietnam and how you interpret the meaning of it. Phap Dung He’s definitely coming back to his roots. He has come back to the place where he grew up as a monk. The message is to remember we don’t come from nowhere. We have roots. We have ancestors. We are part of a lineage or stream. It’s a beautiful message, to see ourselves as a stream, as a lineage, and it is the deepest teaching in Buddhism: non-self. We are empty of a separate self, and yet at the same time, we are full of our ancestors. He has emphasized this Vietnamese tradition of ancestral worship as a practice in our community. Worship here means to remember. For him to return to Vietnam is to point out that we are a stream that runs way back to the time of the Buddha in India, beyond even Vietnam and China. Eliza Barclay So he is reconnecting to the stream that came before him. And that suggests the larger community he has built is connected to that stream too. The stream will continue flowing after him. Phap Dung It’s like the circle that he often draws with the calligraphy brush. He’s returned to Vietnam after 50 years of being in the West. When he first left to call for peace during the Vietnam War was the start of the circle; slowly, he traveled to other countries to do the teaching, making the rounds. And then slowly he returned to Asia, to Indonesia, Hong Kong, China. Eventually, Vietnam opened up to allow him to return three other times. This return now is kind of like a closing of the circle. It’s also like the light of the candle being transferred, to the next candle, to many other candles, for us to continue to live and practice and to continue his work. For me, it feels like that, like the light is lit in each one of us. Eliza Barclay And as one of his senior monks, do you feel like you are passing the candle too? Phap Dung Before I met Thay in 1992, I was not aware, I was running busy and doing my architectural, ambitious things in the US. But he taught me to really enjoy living in the present moment, that it is something that we can train in. Now as I practice, I am keeping the candlelight illuminated, and I can also share the practice with others. Now I’m teaching and caring for the monks, nuns, and lay friends who come to our community just as our teacher did. Eliza Barclay So he is 92 and his health is fragile, but he is not bedridden. What is he up to in Vietnam? Phap Dung The first thing he did when he got there was to go to the stupa [shrine], light a candle, and touch the earth. Paying respect like that — it’s like plugging in. You can get so much energy when you can remember your teacher. He’s not sitting around waiting. He is doing his best to enjoy the rest of his life. He is eating regularly. He even can now drink tea and invite his students to enjoy a cup with him. And his actions are very deliberate. Once, the attendants took him out to visit before the lunar new year to enjoy the flower market. On their way back, he directed the entourage to change course and to go to a few particular temples. At first, everyone was confused, until they found out that these temples had an affiliation to our community. He remembered the exact location of these temples and the direction to get there. The attendants realized that he wanted to visit the temple of a monk who had lived a long time in Plum Village, France; and another one where he studied as a young monk. It’s very clear that although he’s physically limited, and in a wheelchair, he is still living his life, doing what his body and health allows. Anytime he’s healthy enough, he shows up for sangha gatherings and community gatherings. Even though he doesn’t have to do anything. For him, there is no such thing as retirement. Eliza Barclay But you are also in this process of letting him go, right? Phap Dung Of course, letting go is one of our main practices. It goes along with recognizing the impermanent nature of things, of the world, and of our loved ones. This transition period is his last and deepest teaching to our community. He is showing us how to make the transition gracefully, even after the stroke and being limited physically. He still enjoys his day every chance he gets. My practice is not to wait for the moment when he takes his last breath. Each day I practice to let him go, by letting him be with me, within me, and with each of my conscious breaths. He is alive in my breath, in my awareness. Breathing in, I breathe with my teacher within me; breathing out, I see him smiling with me. When we make a step with gentleness, we let him walk with us, and we allow him to continue within our steps. Letting go is also the practice of letting in, letting your teacher be alive in you, and to see that he is more than just a physical body now in Vietnam. Eliza Barclay What have you learned about dying from your teacher? Phap Dung There is dying in the sense of letting this body go, letting go of feelings, emotions, these things we call our identity, and practicing to let those go. The trouble is, we don’t let ourselves die day by day. Instead, we carry ideas about each other and ourselves. Sometimes it’s good, but sometimes it’s detrimental to our growth. We brand ourselves and imprison ourselves to an idea. Letting go is a practice not only when you reach 90. It’s one of the highest practices. This can move you toward equanimity, a state of freedom, a form of peace. Waking up each day as a rebirth, now that is a practice. In the historical dimension, we practice to accept that we will get to a point where the body will be limited and we will be sick. There is birth, old age, sickness, and death. How will we deal with it? PVCEB Thich Nhat Hanh leading a walking meditation at the Plum Village practice center in France in 2014. Eliza Barclay What are some of the most important teachings from Buddhism about dying? Phap Dung We are aware that one day we are all going to deteriorate and die — our neurons, our arms, our flesh and bones. But if our practice and our awareness is strong enough, we can see beyond the dying body and pay attention also to the spiritual body. We continue through the spirit of our speech, our thinking, and our actions. These three aspects of body, speech, and mind continues. In Buddhism, we call this the nature of no birth and no death. It is the other dimension of the ultimate. It’s not something idealized, or clean. The body has to do what it does, and the mind as well. But in the ultimate dimension, there is continuation. We can cultivate this awareness of this nature of no birth and no death, this way of living in the ultimate dimension; then slowly our fear of death will lessen. This awareness also helps us be more mindful in our daily life, to cherish every moment and everyone in our life. One of the most powerful teachings that he shared with us before he got sick was about not building a stupa [shrine for his remains]for him and putting his ashes in an urn for us to pray to. He strongly commanded us not to do this. I will paraphrase his message: “Please do not build a stupa for me. Please do not put my ashes in a vase, lock me inside, and limit who I am. I know this will be difficult for some of you. If you must build a stupa though, please make sure that you put a sign on it that says, ‘I am not in here.’ In addition, you can also put another sign that says, ‘I am not out there either,’ and a third sign that says, ‘If I am anywhere, it is in your mindful breathing and in your peaceful steps.’” Further reading: Brother Phap Dung explains mindfulness for times of political conflict Zen teacher Frank Ostaseski on what the living can learn from the dying An interview with Robert Wright, the author of Why Buddhism Is True
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Why a 3-Dose Vaccine for Young Kids Might Actually Work Out
For many months now, Pfizer’s COVID-19 vaccine has been slowly making its way into smaller arms in smaller doses—from teens to adolescents to elementary-school-age kids in the fall. Now it’s just the under-5 crowd left, and the word on the lips of parents raring to protect their children is still, simply, when. Somehow, no one yet seems to know.Back in September, the party line was that under-5 trial data would arrive “before the end of the year,” as Pfizer CEO Albert Bourla declared at The Atlantic Festival. Those data never appeared. Instead, the week before Christmas, Pfizer announced in a maddeningly cryptic press release that two little-kid-size doses of vaccine had failed to elicit a hefty-enough immune response in 2-, 3-, and 4-year olds in late-stage trials. (Doubly dosed kids in the six-month-to-2-year-old range, though, did produce enough antibodies to satisfy the company’s criteria.) But the company had a plan—researchers would test a third injection eight weeks after the second—and a new timeline, with data arriving in the “first half of 2022,” maybe April-ish. Add to that the few weeks the FDA typically takes to review the data submitted for emergency-use authorization, and the earliest shots for this group are still probably two or three months away.Then, this week, the White House’s chief medical adviser, Anthony Fauci, seemed to drop a mysterious bombshell: Surprise! Perhaps a trio of mini shots will be greenlit for use in kids under 5 “within the next month or so”—weeks ahead of the updated schedule. But he quickly backpedaled—that was just a hope, and absolutely not a guarantee. The predictions on when we’ll get the data, much less the shots, have ricocheted all the way back to idk I guess spring?[Read: COVID parenting has passed the point of absurdity]Amid all this chaos, Pfizer still hasn’t publicized any data from this youngest age group; if federal officials have that information, they, too, are staying mum. (I reached out to the CDC, which pointed me to the FDA, which pointed me to Pfizer, which said: “Unfortunately we are not offering any interviews on this right now.” Unfortunately indeed.) Parents who just want to know what’s happening are now, understandably, feeling pretty jerked around by all this talk of later? sooner? who knows! “The wait has been excruciating,” Risa Hoshino, a public-health pediatrician in New York City, told me. “They feel the world has moved on without them.” Families have been asking “every single day,” she said, when infant-and-toddler vaccines will finally make their public debut.Hoshino can’t give a definitive answer; outside of Pfizer and BioNTech, and perhaps the FDA, few people can even try. (Remember, no public data.) Still, several experts I spoke with this week remain optimistic that kids under 5 will get shots within the next few months. After seeing disappointing results in the original iteration of its trial, Pfizer took something of a gamble by adding one more small dose to the series for under-5s. But there may be good reason to believe that this bet, the company’s first official departure from the standard two-shot primary series, will pay off spectacularly. The company’s new kid-dosing strategy, experts told me, was likely designed to marry logistics to science—something that would fast-track the vaccine’s rollout while keeping the shots’ risk-benefit ratio ultrahigh.In some ways, vaccines are vaccines are vaccines. But tailoring them to individual populations—which each harbor different needs, risks, and vulnerabilities—is essential to doling them out right. Dosing is a balancing act: The more vaccine in each shot, the likelier that shot is to rile up the immune system—and the likelier it is to make the experience of getting the injection pretty uncomfortable. That means “we’re after the smallest dose possible that will still be as effective as possible,” says Buddy Creech, a pediatric-infectious-disease specialist at Vanderbilt University Medical Center, who’s leading a study of Moderna’s pediatric COVID vaccine. Pfizer already intentionally shrank the dose: Adults have been getting 30 micrograms of mRNA in each injection; in the under-5s, the company is trying three micrograms apiece. But the hope is still to, roughly, get “the response to the childhood vaccine to match what we see in adults,” typically measured by antibody counts, Creech told me. So if a pair of injections weren’t quite enough to get 2-to-4-year-olds there, a bonus third shot could be expected to push them over the top. “I’m hopeful,” Sallie Permar, a pediatrician, immunologist, and vaccinologist at Weill Cornell Medical Center, told me. “The only way to go, really, is up.”It helps to first consider what Pfizer’s other choices might have been. Subpar antibody levels in the blood might suggest that the vaccines couldn’t quite convince little bodies to take them seriously. One option could have involved sticking with two doses, but spacing them further apart—essentially giving the immune system more time to mull what it means to fight SARS-CoV-2. That strategy has been shown, at least in adults, to buoy the quantity, quality, and longevity of immune responses, and parts of Canada have been pursuing it for months in 5-to-11-year-old kids. Another alternative could have been to simply increase the dose, while keeping all else the same; each would deliver a sharper, and perhaps more memorable, scolding to defensive cells. Kids could then stay on the speediest possible track to sufficient protection: three weeks between doses, then another two of immunological cook time. “In a pandemic, you want to do that as fast as humanly possible,” Hoshino said. If Pfizer’s three-dose strategy pans out, the five-week timeline balloons to three months.[Read: Why are we microdosing vaccines for kids?]But revamping the two-dose strategy would have also restarted the clock on trials and meant recruiting and enrolling a new cohort of participants. A series of injections, potential side effects, and weeks of blood draws and other follow-ups are a cumbersome commitment for a person of any age, and “the hardest trials to get done are these young ones,” Permar said. “It’s never easy to ask a parent to consider more procedures, especially for toddlers, who are going to cry.” Even vaccine trials for older kids struggled to reach capacity. Tacking on a third dose, then, ends up being the most time-efficient option—not necessarily to get each individual child to the end of a vaccine series, but to obtain regulatory authorization, and to roll out first shots to the public.A two-big-dose option could also be unsavory for another reason—an increased chance of side effects, including fever, fatigue, and headaches, or perhaps something much rarer but more severe. In teenage boys and young men, mRNA vaccines like Pfizer’s and Moderna’s have been linked to cases of heart inflammation, though new results from the 5-to-11-year-old crowd suggest that younger kids may be spared. In any case, dose definitely matters: When it comes to vaccinating super-young kids, whose risk of contracting serious cases of COVID-19 remains relatively low, the shots “have to be supersafe, remarkably safe,” Permar said. “These are healthy, young children who might not be able to say, ‘I feel crummy.’” Perhaps the three-microgram dose was already producing some discomfort. (Do we know? No—again, there’s no data.)It might have been unwise, then, to go up to the next dose in size, the one for 5-to-11-year-olds—which, at 10 micrograms, is a more-than-threefold increase. Creech agrees: Any worries about shot tolerability could end up subjecting study participants to a bevy of irksome tests, and causing distress for the entire family. These concerns and more were part of the logic that motivated Pfizer to choose the three-microgram dose for the under-5s in the first place: In an early-phase study, that was the tiniest dose tested that still coaxed out decent numbers of antibodies in children as young as six months. It’s not clear why those results didn’t carry over perfectly into the company’s more recent trials. But Creech told me that if he’s going to hear deflating news from a kids’ vaccine trial, he’d rather it be about lackluster antibody levels than troubling side effects. With kids this young, “we’re going to put a little more weight on our safety foot than our effectiveness foot.”And three smaller doses could even be more effective than two slightly larger ones. Raising defenses to a threat is a costly endeavor for the body; sometimes, the immune system just needs another nudge before it decides to commit. Some vaccines in the pediatric-medicine roster are already doled out in two, three, or even five doses for that reason. Without Pfizer’s data, it’s impossible to know just how far below the desired threshold kids’ antibody levels fell after two three-microgram doses, but “I have to imagine they already weren’t too far off,” Permar told me. And because each shot should build on the last, three doses could succeed where two have failed.Waiting two months to give the third dose should “refine and mature” toddlers’ immune responses, Creech said. Their bodies will spend that limbo period studying and restudying the doses they’ve already gotten, and sharpening their SARS-CoV-2-sniping skills. Third shots can also goad the immune system into broadening its range of coronavirus-fighting tools, so that kids end up ready to duel even antibody-dodging variants such as Omicron. (And third doses, when injected after a delay, don’t seem to produce any more side effects than seconds, probably because the body gets the chance to cool down in the interim, based on studies in adults.) “Keeping the dose low and adding on a third just makes a ton of sense,” Permar said. Toddlers could even help pave the path to an initial trio of COVID shots being standard fodder for all.[Read: COVID parenting is reaching a breaking point]One smidgen of weirdness remains: why kids under 2 beat out their slightly older peers, as Pfizer reported in December. The magnitude of the difference isn’t yet known. (Imagine, if you will, what might be helpful here: data.) But sussing out this discrepancy could reveal some peculiarities about how immune systems transition from infancy to toddlerhood. Permar pointed out that kids’ immune systems are much more quick-witted than adults’: They can learn a lot from very little vaccine. (That’s why pediatric vaccines are dosed by immunological age, not weight.) Even newborn babies, whose immune systems don’t come out fully fledged, “are actually pretty ready to respond robustly to certain types of vaccines,” Permar said. The results are intriguing enough that some experts may want to explore the option of keeping infants on a two-dose Pfizer track. But Pfizer is still testing the effects of a third dose for this group, which may end up being practical in the long run, especially if it simplifies the number of injection regimens that doctors have to juggle all at once. (The company has not broken out the infant group to seek its own authorization first.)Creech told me he feels great about what he’s observing so far in Moderna’s pediatric trials, and he’s confident things on the kids’-vaccine front will take a turn for the better by early summer—if not for Pfizer’s shot, then for its similar-looking competitor. Moderna’s vaccine also comes in a two-dose series, but the injections are four weeks apart, and bigger: The company is testing 50 micrograms of mRNA in 6-to-11-year-olds, and 25 micrograms in kids 5 and younger (compared with 100 micrograms for adults). If Pfizer’s three-doser doesn’t work, Moderna could be toddlers’ vaccine dark horse. “I have wondered if this is the time Moderna will finally beat Pfizer” to the finish line, Permar told me. It may truly be neck and neck: Moderna’s expecting to report the first of its 5-and-under data in March, not far off from Pfizer’s own early-spring goal. Either way, it’ll be the data—of course—that dictate what happens next.
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