Goood morning, and happy Tuesday — 36ish hours later, we haven't watched Succession yet, but have successfully avoided spoilers. (We will accept spoilers if they come with tips.)

Today, we explore how Colin Powell fit into a category of immunocompromised people who remain vulnerable to covid-19 and look at a new effort from Senate Democrats to gut the Hyde amendment. But first: 

Boosting Johnson & Johnson means reaching the hard-to-reach…again

Johnson & Johnson’s vaccine had a major benefit: It was only one shot.

In the spring, some state and local health officials — as well as other vaccine providers — used the single-dose shot to quickly inoculate harder-to-reach populations. But soon they’ll be tasked with reaching them again. 

  • “Trying to find those folks, particularly if there are people who are homeless or other people who are in transitory situations, that can be challenging,” said Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials.

That’s one of a host of logistical hurdles state and vaccine partners are working through as they gear up for the latest iteration of the country’s massive vaccination campaign. As soon as this week, federal health officials could greenlight extra doses for Moderna and Johnson & Johnson, setting the stage for tens of millions of more Americans to get booster shots.

  • Last week, the FDA’s outside advisers unanimously recommended an additional Johnson & Johnson shot at least two months after the first dose for everyone 18 and older. It recommended Moderna booster shots for a narrower population.
  • 🚨 But the decision is ultimately up to the federal agencies. The Food and Drug Administration is expected to say Americans can get coronavirus booster shots that are different from their initial doses, The Post’s Laurie McGinley reported last night.

Noah Weiland, The New York Times

On the ground

Roughly 15 million Americans received Johnson & Johnson’s shot — a far cry from the over 174 million people who received a shot from the other two vaccine makers. Production issues, as well as a roughly 10-day pause on administering the vaccine, hampered Johnson & Johnson’s uptake in the United States. 

But it's one-and-done nature made the shot favored for populations difficult to reach for a second dose, such as shift workers or those with transient living situations. 

  • For instance: HealthLinc clinics span five counties in northern Indiana. CEO Beth Wrobel said they usually brought the Johnson & Johnson vaccine to homeless shelters or to vaccinate migrant farmworkers.
  • Back then: “We anticipated to be able to fully vaccinate them if they weren't able or weren't willing to come for a follow-up vaccine,” said Clay Marsh, West Virginia’s covid czar.
  • But from the get-go, many experts believed the Johnson & Johnson vaccine would ultimately require a second dose, since most vaccines require another shot to bolster the immune response. Anthony Fauci, Biden’s chief medical adviser, said Sunday on ABC that it was “very likely this should have been a two-dose vaccine to begin with.”

Either way, vaccine providers are now in the throes of laying new plans — and re-creating old ones — to dole out the booster shots, once authorized.

  • In Oklahoma, state officials received grants to hire community health workers and health equity specialists who will lead the charge in reaching out to those underserved populations, said Mendy Spohn, the state’s assistant deputy commissioner for community health.
  • In Denver, the health department is currently determining what new resources can go to support booster shots for vulnerable populations, such as sending more nurses to places like shelters or driving around a mobile health unit.
  • And in California, the nonprofit group Los Angeles Mission — which serves the homeless population — is considering everything from showing up at tent sites to vaccinate residents to putting fliers with information about the booster shot in food boxes it hands out.

Officials will also have to find the right way to message the need for a second shot. 

Kevin Kidd lives in Los Angeles in a single-room occupancy unit, a type of subsidized housing for those who are at risk of homelessness. He told Alexandra that he received a Johnson & Johnson vaccine about a month ago, and he hadn’t yet heard about booster shots. He was reluctant to get the first one — and wasn't enthused about the idea of another. 


Fully vaccinated but immunocompromised: Powell died of covid-19 complications

The death of Colin L. Powell, former secretary of state and chairman of the Joint Chiefs of Staff, was announced Monday. Quickly, some conservative officials and media personalities wrongly seized upon his death to attempt to undermine the utility of coronavirus vaccinations, The Post’s Annie Linskey reports.

  • “Powell, who was 84 and immunocompromised, fit perfectly into a demographic that remains vulnerable to infections despite vaccination. His age puts him at a higher risk for covid-19, and he was battling a blood cancer that’s known to make vaccines less effective. He also suffered from Parkinson’s disease,” Annie writes.

While most Republican officials oppose vaccine mandates, a segment of the party has taken it a step further and questioned the science and efficacy behind mitigation measures. Instead, public health officials say Powell’s death should be seen as a reason why more people should get vaccinated to curb the chance of breakthrough infections in areas of high community spread.

Of note: Powell was scheduled to receive a booster shot when he became ill and was hospitalized, The Post's Joel Achenbach and Lenny Bernstein report.

Scientists say there is still room for the virus to evolve

Coronavirus infections are down, and many are hoping that the worst of the pandemic is over.

  • “But so much depends on the virus itself. It is not static,” our colleagues Joel, Ben Guarino and Aaron Steckelberg report. “The possibility of further significant mutations in the virus looms like a giant asterisk over any discussion of the trajectory of the pandemic.”

The coronavirus surprised experts, many of whom predicted early in the pandemic that it would be slow to mutate. Many scientists now suspect that if a new "variant of concern" emerges it will descend from the delta variant, although they caution viral evolution is unpredictable.

The virus can mutate in two concerning ways, by becoming more transmissible, or by evading immunity produced by vaccines or prior infection. Scientists say the best way to prevent those mutations is to increase vaccinations. The more opportunity the virus has to spread, the more chances it has to mutate.

From our notebook

Today: Another round of negotiations 

Congress is back — and so are Biden’s meeting with key Democratic factions as he looks to chart a path forward on his legislative agenda. 

  • At 2 p.m.: House progressives will meet with Biden. This includes Rep. Pramila Jayapal (D-Wash.), the chair of the Congressional Progressive Caucus, a spokesperson for the congresswoman confirmed. The more liberal members are pushing hard to expand Medicare benefits to include dental, vision and hearing.
  • At 4:30 p.m.: A group of bicameral moderates will be at the White House. This includes the chair of the House’s moderate-leaning New Democrat Coalition, Rep. Suzan DelBene (D-Wash.), a spokesperson confirmed. The group of 95 lawmakers has zeroed in on policies to shore up Obamacare, such as extending Medicaid to 2.2 million poor adults and boosting financial assistance for Obamacare shoppers.

(Check out The Early 202 for a full list)

On the Hill

Senate Democrats release spending bill without the Hyde Amendment

The Senate Appropriations Committee released its package to fund the Labor-HHS-Education departments yesterday — and it noticeably excluded a provision prohibiting the federal government from funding abortion services. 

The Hyde Amendment, which prevents programs like Medicaid from covering the costs of abortions in most circumstances, has been included in federal spending bills since the 1970s. But Democrats have prioritized getting rid of the ban — a position Biden took on the campaign trail. 

Notable: The House passed a spending bill without the provision in July.

But to pass the Senate, the appropriations bill must garner at least 10 votes from Republicans who overwhelmingly back Hyde, arguing it protects taxpayers opposed to abortion. Some Democrats, including Sens. Joe Manchin (D-W.V.) and Tim Kaine (D-Va.), have also expressed support for the amendment.

In other spending news: The bill also includes $2.4 billion for the Advanced Research Projects Agency for Health, a new agency Biden has proposed to turbocharge medical innovation. That’s less than the $3 billion envisioned by the House and far less than the over $6 billion the president called for.

Reproductive wars

The Supreme Court will confront Texas’s abortion law for a second time

The Supreme Court allowed a Texas law banning abortion past six weeks to remain in effect. Other conservative states may adopt similar measures going forward. (Blair Guild/The Washington Post)

The Justice Department is asking the Supreme Court to stop a Texas law that outlaws abortions once a fetal heartbeat has been detected, The Post’s Robert Barnes reports.

The Supreme Court allowed the law to go into effect in a divisive 5-to-4 vote last month. The court’s one paragraph opinion said it was not clear that the abortion providers seeking to stop the law were suing the right defendants. 

  • The Biden administration raises different arguments in its filing, saying that the structure of the law — which is enforced by private citizens rather than the state government — was designed to “thwart judicial review” and make an end-run around the courts and the Constitution.

What they want: The Biden administration and abortion providers are asking the Supreme Court to suspend the law and take up the issue this term before the U.S. Court of Appeals for the Fifth Circuit considers its merits.

In other health news

  • As the delta variant sent hospitals into crisis over the summer, the Biden administration promised to send federal officials to help struggling states. Politico’s Erin Banco reports that help was slow to arrive, and in some cases states were pitted against each other as they vied for medical personnel and federal resources.
  • Fauci is urging police officers to get vaccinated against the coronavirus, as some unions and officers are filing lawsuits to oppose vaccine mandates. The Post reports.
  • Sen. Kyrsten Sinema (D-Ariz.) is cashing in on campaign contributions from the pharmaceutical industry, Politico’s Hailey Fuchs writes. The senator, who has reportedly objected to Democrats’ sweeping drug pricing reforms, received $27,800 from PACs of pharmaceutical companies from July through September, compared with $5,000 in the three months prior, according to campaign finance filings. Her individual donors include Gilead CEO Daniel O’Day and Eli Lilly CEO David Ricks.

Sugar rush

Thanks for reading! See y'all tomorrow.