Remember when N95s were in short supply? American companies stepped in to manufacture them. Now, they can’t compete.Mask mandates have eased, a welcome milestone in the battle against Covid-19. But for the two dozen domestic companies that jumped into the mask-making business last year, the good news comes with a downside: a calamitous drop in sales.Some of the slackening demand is tied to the loosening of masking guidelines by the Centers for Disease Control and Prevention, but industry experts say a bigger factor has been the return of inexpensive protective gear from China that began flooding the American market earlier this year.Industry executives and some members of Congress have accused China of dumping, noting that many imports are priced so low — sometimes a tenth of what American factories charge for comparable products — that there is little chance for domestic companies to survive.In recent weeks, at least three companies have stopped producing masks and medical gowns, and several others have markedly scaled back production, among them Premium-PPE, a year-old surgical mask-maker in Virginia that recently laid off most of its 280 workers.“Our industry is in break-glass mode,” said Brent Dillie, the co-owner of the company. Like other start-ups, the company got into the mask business after China, the world’s largest producer of protective medical gear, halted exports at the start of the pandemic. “Six months from now, many of us won’t be around and that won’t be good for America the next time there’s a national health emergency.”The crisis faced by domestic producers is an urgent test for the Biden administration and embodies two of its most important priorities: shore up American manufacturing and ensure that health care workers will never again scramble to find adequate protective gear. Those shortages, health experts say, most likely contributed to the high rates of infection among frontline workers, more than 3,600 of whom died of Covid-19 during the first year of the pandemic, according to a tally by The Guardian and Kaiser Health News.The White House has announced a few measures aimed at buoying domestic producers of personal protective equipment, but industry executives say they are still awaiting more substantial trade policies and supply-chain reforms that would bolster their companies’ chances of survival.Tim Manning, the White House Covid-19 supply coordinator, said the administration has tried to address some of the industry’s challenges: They have pushed federal agencies to procure domestic supplies and they have introduced start-ups to the distribution giants that supply the nation’s hospital chains. The administration, he said, was also poised in the coming months to allocate billions of dollars in federal relief spending that would replenish the Strategic National Stockpile with American-made medical goods.“The scale and scope of these efforts is something we’re still working through,” Mr. Manning said in an interview.In Congress, a bill with bipartisan support would allocate $500 million in annual spending over the next three years to support domestic manufacturers of vital medical equipment.While industry executives commend these moves, they say that time is running out. The American Mask Manufacturer’s Association, a recently created trade group, said its 27 members had already laid off 50 percent of their work force. Without concerted action from Washington, most of those companies will go belly up within the next two months.An immediate boost, they say, would be to rescind the C.D.C. guidelines, born during the pandemic, that force health workers to repeatedly reuse N95 masks, even though they are designed to be thrown away after contact with each patient. Many hospitals are still following the guidelines, even though 260 million masks are gathering dust in warehouses across the country.“We’re not looking for infinite support from the government,” said Lloyd Armbrust, the association’s president and the founder and chief executive of Armbrust American, a mask-making company in Texas. “We need the government’s support right now because unfair pressure from China is going to kill this new industry before the legislators even get a chance to fix the problem.”The association is planning to file an unfair trade complaint with the World Trade Organization, claiming that much of the protective gear imported from China is selling for less than the cost of production. The price for some Chinese-made surgical masks has recently dropped to as low as 1 cent, compared with about 10 to 15 cents for American masks that use domestically produced raw material.“This is full-on economic warfare,” said Luis Arguello Jr., vice president of DemeTech, a medical-suture company in Florida that earlier this month laid off 1,500 workers who made surgical masks. He said that in the coming weeks, 500 other workers who make N95 masks would also likely be let go.“China is on the mission to make sure no one in the industry survives, and so far they’re winning,” Mr. Arguello said.The Chinese Embassy in Washington did not respond to requests for comment.The International Trade Administration, a division of the Commerce Department, declined to say whether it would support an anticompetitive complaint against China. The agency, a spokesperson said in a statement, “continues to monitor market trends closely and assess options to ensure American manufacturers are competing on a level playing field.”The office of United States Trade Representative, which makes trade policy recommendations to the President, did not respond to interview requests.The flood of inexpensive imports also affects producers of other medical gear. Merrow Manufacturing, a 183-year-old textile company in Fall River, Mass., produces an unlikely array of goods — from lingerie and bulletproof vests to tank covers. It entered the surgical gown business last year, prompted in part by the desperation of hospitals across New England that suddenly could not obtain medical supplies from China.“Our phones were ringing off the hook with people asking if we could help,” said Charlie Merrow, who runs the company with his brother.Hundreds of workers were quickly retrained, dozens more were hired and after a retooling that cost $10 million, Merrow’s sewing machines were churning out 700,000 gowns a week by last summer. The governor of Massachusetts stopped by the factory to lionize their efforts. The governor of Rhode Island described the Merrows as heroes.These days, not many hospitals are calling, and Mr. Merrow recently stopped production after the number of unsold gowns hit a million. The company’s $18 reusable gowns, he said, don’t stand a chance against similar products from China that sell for $6.“It’s really a lost opportunity for the country when you consider that our national security is at stake,” he said.The Merrows are determined to stay in the protective gear business. They are pivoting to making scrubs and other medical garments from recycled material, but other companies have decided to call it quits.National Filters, a surgical mask company in Harbor Beach, Mich., ceased production earlier this month, and Protective Health Gear, a year-old mask start-up in Paterson, N.J., is weeks away from laying off its remaining 40 workers. “We’re hanging on by a thread,” said Brian Wolin, the chief executive.The industry shakeout comes as no surprise to Mike Bowen, the co-owner of Prestige Ameritech, a Texas company that is one of the largest mask manufacturers in the country. Mr. Bowen, who has been in the business since 1986, has long warned political leaders in Washington about the nation’s dependence on foreign suppliers.“I have 14 years of letters to presidents, members of Congress and hospital executives telling them a whole bunch of people are going to die without serious changes, and that’s exactly what happened,” he said.

Ha sido un viaje largo y extraño en las cuatro décadas que han transcurrido desde que Rick Doblin, un investigador pionero de las drogas psicodélicas, probó su primera dosis de ácido en la universidad y decidió dedicar su vida a los poderes curativos de los compuestos que alteran la mente. Aunque las campañas antidrogas provocaron la criminalización del éxtasis, el LSD y los hongos alucinógenos, y ahuyentaron a la mayoría de los investigadores del campo, Doblin continuó su cruzada quijotesca con la ayuda económica de sus padres.La misión de Doblin de lograr que los alucinógenos sean aceptados por el público en general dará un salto significativo este mismo mes, cuando se espera que la revista Nature Medicine publique los resultados de su estudio de laboratorio sobre el MDMA, la droga de clubes nocturnos conocida popularmente como éxtasis y Molly. En el estudio clínico, el primero en Fase 3 con terapia asistida por drogas psicodélicas, reveló que el MDMA ligado a una terapia produce un alivio notable en los pacientes con trastorno por estrés postraumático grave (TEPT).Los resultados fueron divulgados semanas después de un estudio publicado en New England Journal of Medicine que enfatizaba los beneficios de la psilocibina, el ingrediente psicoactivo de los hongos alucinógenos, en el tratamiento de la depresión y han emocionado a científicos, psicoterapeutas y empresarios de la medicina psicodélica, un campo que se ha expandido con rapidez. Estas personas aseguran que es solo cuestión de tiempo para que la Administración de Alimentos y Medicamentos de Estados Unidos (FDA, por su sigla en inglés) apruebe el uso terapéutico de los compuestos psicoactivos: en 2023, el MDMA ya podría recibir la aprobación, y la psilocibina uno o dos años más tarde.Tras décadas de satanización y criminalización, las drogas psicodélicas están a punto de entrar a la psiquiatría tradicional, con profundas consecuencias para un campo que en décadas recientes ha visto pocos avances farmacológicos para el tratamiento de los trastornos mentales y las adicciones. La necesidad de una nueva terapéutica se ha vuelto más urgente en medio de una epidemia de abuso de opioides y suicidios en Estados Unidos.“Algunos días despierto y no puedo creer cuán lejos hemos llegado”, comentó Doblin, de 67 años, quien ahora supervisa la Asociación Multidisciplinaria de Estudios Psicodélicos (MAPS, por su sigla en inglés), un imperio multimillonario de investigación y defensoría que tiene una plantilla de 130 neurocientíficos, farmacólogos y especialistas regulatorios que están preparando el terreno para la próxima revolución psicodélica.Las universidades más importantes del país aceleran el paso para crear centros de investigación psicodélica y los inversionistas destinan millones de dólares a un grupo de empresas emergentes. Hay estados y ciudades de todo Estados Unidos que han comenzado a relajar las restricciones hacia las drogas, y algunas personas esperan que estos sean los primeros pasos hacia la despenalización federal de las drogas psicodélicas para uso terapéutico e incluso recreativo.“Ha habido un cambio en las actitudes hacia algo que, hasta hace no mucho tiempo, era considerado una ciencia marginal”, dijo Michael Pollan, cuyo éxito de ventas sobre la psicodelia, Cómo cambiar tu mente, es un libro que ha ayudado a eliminar el estigma en contra de las drogas en los tres años que han pasado desde su publicación. “Debido a la crisis de salud mental en el país, hay una gran curiosidad y esperanza en torno a las drogas psicodélicas y un reconocimiento de que necesitamos nuevas herramientas terapéuticas”.La pregunta que se hacen muchas personas es qué tan lejos —y qué tan rápido— debería balancearse el péndulo. Incluso los investigadores que defienden la terapia asistida por alucinógenos aseguran que el deseo de comercializar las drogas combinado con un creciente movimiento para liberalizar las prohibiciones existentes podrían ser un riesgo, en especial para quienes padecen trastornos psiquiátricos graves, que malograría el regreso metódico y lento de este campo a la aceptación pública.El investigador psicodélico Rick Doblin tomó su primera dosis de ácido en la universidad y decidió dedicar su vida a los poderes curativos de los compuestos que alteran la mente. Su centro de investigación, MAPS, ha recaudado 44 millones de dólares en los últimos dos años.Tony Luong para The New York TimesDoblin sostiene un número de septiembre de 1985 de la revista The Miami Herald en la que aparece un retrato suyo.Gretchen Ertl para The New York TimesLa organización de Doblin, MAPS, se enfoca principalmente en obtener la aprobación para las terapias asistidas por drogas y promoverlas en todo el mundo, pero también está abogando por la legalización de las drogas psicodélicas a nivel federal, aunque con estrictos requisitos de concesión de licencias para el uso recreativo en adultos.Varios estudios han mostrado que los alucinógenos clásicos como el LSD y la psilocibina no son adictivos y no causan ningún daño a los órganos incluso en dosis altas. Además, contrario al conocimiento popular, el éxtasis no deja hoyos en los cerebros de los usuarios, según los estudios, ni tampoco hay daño a nivel cromosómico tras un mal viaje de ácido.Sin embargo, la mayoría de los científicos concuerda en que es necesaria una mayor investigación relacionada con otros posibles efectos secundarios, como la manera en que las drogas podrían afectar a las personas con problemas cardiacos. Además, aunque la acumulación constante de datos alentadores ha suavizado el escepticismo de científicos prominentes, algunos investigadores desaconsejan la aceptación precipitada de las drogas psicodélicas sin una supervisión rigurosa. A pesar de que un “mal viaje” es poco común, un puñado de testimonios anecdóticos sugiere que las drogas psicodélicas pueden inducir psicosis en quienes padecen trastornos mentales subyacentes.Michael P. Bogenschutz, un profesor de psiquiatría que dirige el Centro para la Medicina Psicodélica del Centro Médico Langone de la Universidad de Nueva York desde su inauguración hace cuatro meses, comentó que la mayoría de los estudios clínicos hasta la fecha se habían realizado con cantidades pequeñas de personas que eran examinadas a detalle para descartar a las que tuvieran esquizofrenia y otros problemas mentales graves.Esto dificulta saber si habrá posibles reacciones adversas si millones de personas consumen esas sustancias sin orientación ni supervisión. “Sé que puede sonar como una tontería pero, chicos, no las prueben en casa”, mencionó Bogenschutz. “Simplemente les sugeriría a todos que no se adelanten a los datos”.La prisa por invertirDe pronto, las drogas psicodélicas nadan en dinero.Doblin puede recordar cuando el financiamiento para la investigación era casi imposible de conseguir. No obstante, ahora la MAPS está forrada de dinero, tras haber recaudado 44 millones de dólares durante los últimos dos años.“Ahora paso una gran parte de mi tiempo diciéndoles que no a los inversionistas”, comentó Doblin, cuyo trabajo ha recibido el financiamiento de una colección atípica de filántropos, entre ellos Rebekah Mercer, una donante política del Partido Republicano, y David Bronner, un liberal heredero de la empresa de jabón líquido Dr. Bronners.La Universidad Johns Hopkins, la Universidad de Yale, la Universidad de California, campus Berkeley, y el Hospital Monte Sinaí en Nueva York son algunas de las instituciones que hace poco crearon divisiones para la investigación de las drogas psicodélicas, o están en planes de hacerlo, con financiamiento de donantes privados.Además, hay científicos realizando estudios para determinar si los alucinógenos pueden ser eficaces en el tratamiento de todo tipo de trastornos, desde la depresión, el autismo y la adicción a los opioides hasta la anorexia y las ansiedades que experimentan los enfermos terminales.Una clínica Field Trip Health en ManhattanCalla Kessler para The New York TimesEn la clínica Field Trip de Manhattan se anima a los clientes para que sean creativos.Calla Kessler para The New York TimesSe han involucrado más de una decena de empresas emergentes y en conjunto el puñado de compañías que cotizan en los mercados públicos están valuadas en más de 2000 millones de dólares. Field Trip Health, una empresa canadiense con dos años de existencia que cotiza en la Canadian Securities Exchange y en el OTC Markets Group, ha recaudado 150 millones de dólares para financiar decenas de clínicas de gama alta que ofrecen tratamientos a base de ketamina en Los Ángeles, Chicago, Houston y otras ciudades de Norteamérica. Compass Pathways, una empresa de atención médica que ha recaudado 240 millones de dólares y cotiza en la Nasdaq, está llevando a cabo 22 estudios clínicos de la terapia con psilocibina para la depresión resistente al tratamiento en diez países.El cambio en las políticas ha incentivado a los inversionistas, un giro inspirado en parte en la rapidez con la que la nación aceptó la marihuana recreativa y en el hartazgo del público por la eterna guerra de Estados Unidos contra las drogas. El año pasado, Oregón se convirtió en el primer estado en legalizar el uso terapéutico de la psilocibina. Denver, Oakland, California, y Washington D. C. han despenalizado esa sustancia y varios estados, entre ellos California, están considerando una legislación similar. Aunque las drogas siguen siendo ilegales conforme a la ley federal, hasta la fecha el Departamento de Justicia ha tenido un enfoque no intervencionista en la aplicación de la ley, con una estrategia similar a la que se ha implementado con la marihuana recreativa.Incluso algunos republicanos, un grupo que tradicionalmente se ha opuesto a la liberación de las leyes relacionadas con las drogas, están empezando a convencerse. El mes pasado, tras citar las altas tasas de suicidios entre los veteranos de guerra, el exgobernador de Texas Rick Perry les pidió a los legisladores de su estado que apoyaran un proyecto de ley respaldado por los demócratas para realizar un estudio de la psilocibina en pacientes con TEPT.“Hemos tenido 50 años de propaganda política en torno a estas sustancias y, gracias a la investigación y a un movimiento comunitario, esa narrativa está cambiando”, opinó Kevin Matthews, un defensor de la psilocibina que lideró una exitosa propuesta de votación en Denver.Décadas en el desiertoMucho antes de que Nancy Reagan le advirtiera a la nación que le dijera no a las drogas y que el presidente Richard Nixon supuestamente declarara a Timothy Leary como “el hombre más peligroso de Estados Unidos”, investigadores como William A. Richards estaban usando las drogas psicodélicas para ayudar a los alcohólicos a dejar la bebida y a pacientes con cáncer a hacerle frente a la ansiedad relacionada con la muerte.Las drogas eran legales y Richards, quien en ese entonces era un psicólogo del Centro de Investigación Psiquiátrica de Maryland, era uno de los varios científicos que estudiaban la capacidad terapéutica de los enteógenos, el tipo de sustancias psicoactivas que los humanos han usado durante milenios. Incluso años después, según Richards y otros investigadores, muchos de los primeros voluntarios consideraron las sesiones psicodélicas como las experiencias más importantes y significativas de sus vidas.Sin embargo, en la década de 1960, cuando las drogas salieron de los laboratorios y el movimiento de contracultura las recibió con los brazos abiertos, la élite política tradicional del país reaccionó con alarma. Para cuando la Administración de Control de Drogas emitió su prohibición de emergencia en contra del MDMA en 1985, el financiamiento para la investigación de las drogas psicodélicas en esencia había desaparecido.“Estábamos aprendiendo mucho y luego todo se acabó”, comentó Richards, de 80 años, quien ahora trabaja como investigador de la Escuela de Medicina de la Universidad Johns Hopkins.En estos días, el Centro para la Investigación de Alucinógenos y la Conciencia de la Universidad Johns Hopkins, creado hace dos años con 17 millones de dólares de financiamiento privado, está estudiando, entre otras cosas, la psilocibina para dejar de fumar y el tratamiento de depresión asociada con el alzhéimer, así como exploraciones más espirituales que involucran al clero religioso.“Debemos ser cuidadosos y no prometer de más, pero estos compuestos son fantásticamente interesantes y tienen numerosos usos posibles”, opinó Roland R. Griffiths, el director fundador del centro y psicofarmacólogo, en cuyo estudio de 2006, del cual es coautor Richards, administró psilocibina a voluntarios sanos, el primer estudio con alucinógenos en obtener la aprobación de la FDA después de una generación.Los pioneros: William Richards, a la izquierda, y Roland R. Griffiths.Matt Roth para The New York TimesViaje artístico: una talla de madera y un cuadro de hongos que contienen psilocibina decoran el despacho de Griffiths.Matt Roth para The New York TimesAunque los investigadores todavía tratan de comprender los mecanismos cognitivos y terapéuticos de los psicodélicos, han llegado a la conclusión de que la psilocibina, la DMT y otras sustancias químicas psicoactivas pueden ayudar a las personas a sentir más tolerancia, comprensión y empatía. También inducen la neuroplasticidad, la capacidad del cerebro para cambiar y reorganizar los patrones de pensamiento, lo que permite a las personas con trastornos psicológicos encontrar nuevas formas de procesar la ansiedad, la depresión o los traumas profundamente arraigados.“Pueden ayudar a las personas que han perdido la línea argumental de sus vidas”, afirma Doblin.El negocio del viajeYa se le puede echar un vistazo al futuro de la medicina psicodélica en una serie de lujosas “habitaciones para viajar” decoradas de una forma relajante que ocupan el piso más alto de un edificio de oficinas en Midtown Manhattan. La clínica, dirigida por Field Trip Health, es un emprendimiento que inició hace un año en el que los pacientes usan antifaces para dormir y escuchan música electrónica y cantos tibetanos, mientras les administran seis inyecciones de ketamina a lo largo de varias semanas.Los viajes de 90 minutos se intercalan con “sesiones de integración” guiadas por un terapeuta para ayudar a los participantes a procesar sus experiencias y trabajar a fin de lograr sus objetivos de salud mental. Un curso típico de cuatro sesiones está disponible a partir de 4100 dólares, aunque algunas aseguradoras reembolsan parte del costo a los pacientes.La ketamina no es una droga psicodélica clásica; es un anestésico que tal vez es mejor conocido como una droga de clubes nocturnos y un tranquilizador de caballos. No obstante, en dosis altas, puede producir alucinaciones y ha sido prometedora en el tratamiento de depresión grave y TEPT grave, aunque los efectos suelen durar menos que las terapias con psilocibina o MDMA. Sin embargo, la ketamina tiene una ventaja distintiva en comparación con esas drogas: es la única disponible de manera legal en Estados Unidos para pacientes que no participen en estudios clínicos.Emily Hackenburg, la directora clínica de Field Trip, comentó que la droga solo era un componente de un proceso terapéutico demandante. “El fármaco no es una varita mágica”, comentó.Joe, un ejecutivo de mercadeo de unos 40 años que lleva décadas luchando contra la depresión y la ansiedad, dijo que decidió visitar la sede de la empresa en Atlanta tras ver uno de sus anuncios en Facebook. Los antidepresivos, dijo, lo dejaron emocionalmente frágil, y sus años de psicoterapia sirvieron de poco. (Pidió que no se dijera su nombre completo, citando los estigmas que rodean tanto a las enfermedades mentales como a las drogas que alteran la mente).En una entrevista realizada una semana después de su última sesión, describió una nueva conciencia de los factores que podían llevarle a la desesperación: su obsesión de “macho alfa” por el éxito, las frustraciones avivadas por el mal comportamiento de su hija de 9 años y los malos hábitos alimenticios y de consumo de alcohol que, a menudo, hacen que se sienta mal.Dos semanas después, Joe dijo que los efectos de la terapia estaban empezando a desaparecer. Dijo que estaba ansioso por probar la terapia asistida con psilocibina. “Estoy deseando que llegue el día en que sea legal”, dijo.Una silla de meditación en Field Trip, que ofrece terapia asistida con ketamina.Calla Kessler para The New York TimesEmily Hackenburg, directora clínica de Field Trip, dijo que la ketamina era sólo un componente de un exigente proceso terapéutico. “El fármaco no es una varita mágica”, dijo.Calla Kessler para The New York TimesLo mismo ocurre con Field Trip. La empresa, que empezó abriendo dispensarios de cannabis en Canadá, tiene previsto probar la terapia con psilocibina el mes que viene en Ámsterdam, donde las trufas de hongos mágicos son legales. Además, sus científicos están desarrollando un nuevo psicodélico que tiene el mismo efecto terapéutico que la psilocibina, pero que funciona en la mitad de tiempo, entre dos y tres horas. La creación de un psicodélico patentado de corta duración reduciría los costes de personal de las sesiones supervisadas, pero lo más importante es que daría a la empresa una lucrativa exclusividad sobre su nuevo fármaco. Otras empresas de biotecnología también están desarrollando nuevos compuestos psicodélicos.Ronan Levy, el presidente ejecutivo de Field Trip, mencionó que la empresa esperaba tomar una tajada de los 240.000 millones de dólares que los estadounidenses gastan cada año en servicios de salud mental. “Estamos al frente de lo que creo que será una ola cultural y comercial significativa”, opinó.Para los científicos veteranos que vivieron la primera y desafortunada historia de amor de la nación con los alucinógenos, ese tipo de impulso corporativo es tan emocionante como preocupante. Están conscientes de los posibles tropiezos que podrían deshacer el progreso de años recientes y se preguntan si la próxima comercialización podría restringir el acceso de quienes tienen recursos económicos limitados.A Charles S. Grob, profesor de psiquiatría de la escuela de medicina de la Universidad de California en Los Ángeles, quien ha dedicado décadas a la investigación de los alucinógenos, le preocupa que la comercialización y una premura por conseguir el uso recreativo puedan provocar una reacción negativa del público, en especial si una mayor disponibilidad de las drogas produce una ola de reacciones psicóticas problemáticas.Según Grob, es necesario que haya protocolos rigurosos y un sistema para capacitar y acreditar a los profesionales de la medicina psicodélica. “Debemos seguir muy de cerca los parámetros de seguridad porque, si no se mantienen las condiciones de manera adecuada, corremos el riesgo de que algunas personas se descarrilen psicológicamente”, opinó. “Y si la principal motivación es extraer ganancias, creo que el campo será más vulnerable a sufrir percances”.Doblin comparte algunas de esas preocupaciones, aunque su instituto obtenga grandes beneficios. Si bien MAPS es una organización sin fines de lucro, recientemente ha creado una entidad corporativa y contrató a consultores de gestión para ayudar a trazar el futuro de la terapia legalizada con MDMA.Obtener la aprobación de la FDA daría a MAPS al menos seis años de exclusividad para comercializar sus tratamientos con MDMA para el TEPT, con una ganancia potencial de 750 millones de dólares. La mayor parte de ese dinero, dijo, ayudaría a formar a una generación de profesionales de la psicodelia, a financiar los esfuerzos de los grupos de presión para exigir la cobertura de los seguros para esos tratamientos y a promover las nuevas terapias en todo el mundo. “Nuestro objetivo es la salud mental masiva”, dijo, explicando el rechazo de la organización a la inversión privada. “No es amasar un montón de dinero”.A pesar de su optimismo, Doblin no ignora la posibilidad de que la fascinación de la sociedad por los psicodélicos pueda agriarse. “Hemos avanzado mucho y muy rápido, pero hay muchos retos por delante”, dijo. “Soy consciente de que podríamos estropear las cosas en el último momento, así que no pienso celebrarlo pronto”.Andrew Jacobs es reportero de Ciencia y Salud en Nueva York. Anteriormente reportó desde Pekín y Brasil y ha escrito para Metro, Estilos de vida y ha sido corresponsal de Nacional, donde cubría el sur de Estados Unidos. @AndrewJacobsNYT

It’s been a long, strange trip in the four decades since Rick Doblin, a pioneering psychedelics researcher, dropped his first hit of acid in college and decided to dedicate his life to the healing powers of mind-altering compounds. Even as antidrug campaigns led to the criminalization of Ecstasy, LSD and magic mushrooms, and drove most researchers from the field, Dr. Doblin continued his quixotic crusade with financial help from his parents.Dr. Doblin’s quest to win mainstream acceptance of psychedelics will take a significant leap forward later this month when the journal Nature Medicine is expected to publish the results of his lab’s study on MDMA, the club drug popularly known as Ecstasy and Molly. The study, the first Phase 3 clinical trial conducted with psychedelic-assisted therapy, found that MDMA paired with counseling brought marked relief to patients with severe post-traumatic stress disorder.The results, coming weeks after a New England Journal of Medicine study that highlighted the benefits of treating depression with psilocybin, the psychoactive ingredient in magic mushrooms, has excited scientists, psychotherapists and entrepreneurs in the rapidly expanding field of psychedelic medicine. They say it is only a matter of time before the Food and Drug Administration grants approval for psychoactive compounds to be used therapeutically — for MDMA as soon as 2023, followed by psilocybin a year or two later.After decades of demonization and criminalization, psychedelic drugs are on the cusp of entering mainstream psychiatry, with profound implications for a field that in recent decades has seen few pharmacological advancements for the treatment of mental disorders and addiction. The need for new therapeutics has gained greater urgency amid a national epidemic of opioid abuse and suicides.“Some days I wake up and can’t believe how far we’ve come,” said Dr. Doblin, 67, who now oversees the Multidisciplinary Association for Psychedelic Studies, a multimillion dollar research and advocacy empire that employs 130 neuroscientists, pharmacologists and regulatory specialists working to lay the groundwork for the coming psychedelics revolution.The nation’s top universities are racing to set up psychedelic research centers, and investors are pouring millions of dollars into a pack of start-ups. State and cities across the country are beginning to loosen restrictions on the drugs, the first steps in what some hope will lead to the federal decriminalization of psychedelics for therapeutic and even recreational use.“There’s been a sea change in attitudes about what not long ago was considered fringe science,” said Michael Pollan, whose best-selling book on psychedelics, “How to Change Your Mind,” has helped destigmatize the drugs in the three years since it was published. “Given the mental health crisis in this country, there’s great curiosity and hope about psychedelics and a recognition that we need new therapeutic tools.”The question for many is how far — and how fast — the pendulum should swing, and even researchers who champion psychedelic-assisted therapy say the drive to commercialize the drugs combined with a growing movement to liberalize existing prohibitions could prove risky, especially for those with severe psychiatric disorders, and derail the field’s slow, methodical return to mainstream acceptance.The psychedelic researcher Rick Doblin dropped his first hit of acid in college and decided to dedicate his life to the healing powers of mind-altering compounds. Now his research center, MAPS, has raised $44 million over the past two years.Tony Luong for The New York TimesThat’s him on the cover: Dr. Doblin holding a September 1984 issue of The Miami Herald magazine.Gretchen Ertl for The New York TimesDr. Doblin’s organization, MAPS, is largely focused on winning approval for drug-assisted therapies and promoting them around the globe, but it is also pushing for the legalization of psychedelics at the federal level, though with strict licensing requirements for adult recreational use.Numerous studies have shown that classic psychedelics like LSD and psilocybin are not addictive and cause no organ damage in even high doses. And contrary to popular lore, Ecstasy does not leave holes in users’ brains, studies say, nor will a bad acid trip lead to chromosome damage.But most scientists agree that more research is needed on other possible side effects — like how the drugs might affect those with cardiac problems. And while the steady accumulation of encouraging data has softened the skepticism of prominent scientists, some researchers warn against the headlong embrace of psychedelics without stringent oversight. Although “bad trips” are rare, a handful of anecdotal reports suggest that psychedelics can induce psychosis in those with underlying mental disorders.Dr. Michael P. Bogenschutz, a professor of psychiatry who runs the four-month-old Center for Psychedelic Medicine at NYU Langone Health, said most of the clinical studies to date had been conducted with relatively small numbers of people who were carefully vetted to screen out those with schizophrenia and other serious mental problems.That makes it hard to know whether there will be potential adverse reactions if the drugs are taken by millions of people without any guidance or supervision. “I know it sounds silly but, Kids, don’t take these at home,” Dr. Bogenschutz said. “I would just encourage everyone to not get ahead of the data.”The Rush to InvestPsychedelics are suddenly awash in money.Dr. Doblin can remember when research funding was nearly impossible to come by. But MAPS is flush now, having raised $44 million over the past two years.“I spend a lot of my time saying no to investors,” said Dr. Doblin, whose work has been funded by an unlikely collection of philanthropists, among them Rebekah Mercer, the Republican political donor, and David Bronner, a liberal heir to the liquid soap company Dr. Bronners.Johns Hopkins, Yale, the University of California, Berkeley, and Mount Sinai Hospital in New York are among the institutions that have recently established psychedelic research divisions or are planning to do so, with financing from private donors.And scientists are conducting studies on whether psychedelics can be effective in treating everything from depression, autism and opioid addiction to anorexia and the anxieties experienced by the terminally ill.A Field Trip Health clinic in Manhattan.Calla Kessler for The New York TimesClients are encouraged to be creative at the Field Trip clinic in Manhattan.Calla Kessler for The New York TimesMore than a dozen start-ups have jumped into the fray, and the handful of companies that have gone public are collectively valued at more than $2 billion. Field Trip Health, a two-year-old Canadian company that trades on the New York Stock Exchange, has raised $150 million to finance dozens of high-end ketamine clinics in Los Angeles, Chicago, Houston and other cities across North America. Compass Pathways, a $240-million health care company listed on the Nasdaq, is conducting 22 clinical trials across 10 countries of psilocybin therapy for treatment-resistant depression.Investors have been encouraged by the changing politics, a shift inspired in part by the nation’s accelerating embrace of recreational marijuana and by public weariness over America’s endless war on drugs. Last year, Oregon became the first state to legalize the therapeutic use of psilocybin. Denver, Oakland, Calif., and Washington, D.C., have decriminalized the drug, and several states, including California, are mulling similar legislation. Though the drugs remain illegal under federal law, the Justice Department has so far taken a hands-off approach to enforcement, similar to how it has handled recreational marijuana.Even some Republicans, a group that has traditionally opposed the liberalization of drug laws, are starting to come around. Last month, the former Texas governor Rick Perry, citing the high rates of suicide among war veterans, called on his state’s legislators to support a Democratic-sponsored bill that would establish a psilocybin study for patients with PTSD.“We’ve had 50 years of government propaganda around these substances, and thanks to the research and a grass-roots movement, that narrative is changing,” said Kevin Matthews, a psilocybin advocate who led Denver’s successful ballot measure.Decades in the WildernessLong before Nancy Reagan warned the nation to just say no to drugs and President Richard Nixon pronounced Timothy Leary “the most dangerous man in America,” researchers like William A. Richards were using psychedelics to help alcoholics go dry and cancer patients cope with end-of-life anxiety.The drugs were legal, and Dr. Richards, then a psychologist at the Maryland Psychiatric Research Center, was among scores of scientists studying the therapeutic prowess of entheogens, the class of psychoactive substances that humans have used for millenniums. Even years later, Dr. Richards and other researchers say, many early volunteers called the psychedelic sessions the most important and meaningful experiences of their lives.But as the drugs left the lab in the 1960s and were embraced by the counterculture movement, the country’s political establishment reacted with alarm. By the time the Drug Enforcement Administration issued its emergency ban on MDMA in 1985, funding for psychedelic research had largely disappeared.“We were learning so much, and then it all came to an end,” said Dr. Richards, 80, and now a researcher at Johns Hopkins University School of Medicine.These days, the Center for Psychedelic and Consciousness Research at Johns Hopkins, created two years ago with $17 million in private funding, is studying, among other things, psilocybin for smoking cessation and the treatment of depression associated with Alzheimer’s as well as more spiritual explorations involving religious clergy.“We have to be careful not to overpromise, but these are fantastically interesting compounds with numerous possible uses,” said Roland R. Griffiths, the center’s founding director and a psychopharmacologist whose 2006 study, on which he is a co-author with Dr. Richards, administered psilocybin to healthy volunteers — the first psychedelics study to win F.D.A. approval in a generation.Early pioneers: Dr. William Richards, left, and Dr. Roland R. Griffiths.Matt Roth for The New York TimesArt trip: A wood carving and a painting of mushrooms that contain psilocybin decorate Dr. Richards’s office.Matt Roth for The New York TimesThough researchers are still trying to understand the cognitive and therapeutic mechanics of psychedelics, they have concluded that psilocybin, DMT and other psychoactive chemicals can help people feel more tolerance, understanding and empathy. They also induce neuroplasticity, the brain’s ability to change and reorganize thought patterns, enabling people with psychological disorders to find new ways to process anxiety, depression or deeply embedded trauma.“They can help people who have lost the plotline of their lives,” Dr. Doblin said.The Trip BusinessThe future of psychedelic medicine can already be glimpsed at a suite of plush, soothingly decorated “journey rooms” that occupy the top floor of an office building in Midtown Manhattan. The clinic, run by Field Trip Health, is a year-old venture where patients wear eyeshades and listen to electronic music and Tibetan chanting, as they are administered six ketamine injections over the course of several weeks.The 90-minute trips are interspersed with therapist-guided “integration sessions” to help participants process their experiences and work on achieving their mental health goals. A typical course of four sessions starts at $4,100, though some insurance companies reimburse patients for a portion of the cost.Ketamine is not a classic psychedelic; it is an anesthetic perhaps best known as both a club drug and a horse tranquilizer. But at higher doses, it can produce hallucinations, and it has shown promise treating major depression and severe PTSD, though the effects tend to be less enduring than therapies with psilocybin or MDMA. Ketamine, however, has a distinct advantage over those other drugs: It is the only one in the United States that is legally available to patients outside a clinical study.Emily Hackenburg, Field Trip’s clinical director, said the drug was only one component of a demanding therapeutic process. “The drug is not a magic bullet,” she said.Joe, a marketing executive in his mid-40s who has battled depression and anxiety for decades, said he decided to visit the company’s Atlanta location after seeing one of its ads on Facebook. Antidepressants, he said, left him emotionally brittle, and his years of psychotherapy were of little use. (He asked that his full name be withheld, citing the stigmas surrounding both mental illness and mind-altering drugs.)In an interview one week after his final session, he described a newfound awareness of the factors that could drive him to despair: his “alpha male” obsession with success, the frustrations stoked by his 9-year-old daughter’s misbehavior and the poor eating and drinking habits that often leave him feeling unwell.In a follow-up conversation two weeks later, Joe said the therapy’s effects were beginning to fade. He said that he was eager to try psilocybin-assisted therapy. “I’m really looking forward to the day when that becomes legal,” he said.A meditation chair at Field Trip, which offers ketamine-assisted therapy.Calla Kessler for The New York TimesEmily Hackenburg, Field Trip’s clinical director, said ketamine was only one component of a demanding therapeutic process. “The drug is not a magic bullet,” she said.Calla Kessler for The New York TimesSo, too, is Field Trip. The company, which got its start opening cannabis clinics across Canada, is planning to test psilocybin therapy next month in Amsterdam, where magic mushroom truffles are legal. And its scientists are currently developing a new psychedelic that carries the therapeutic punch of psilocybin but works in about half the time — about two to three hours. Creating a proprietary short-lived psychedelic would reduce the staffing costs of supervised sessions, but more important, it would give the company lucrative exclusivity over its new drug. Other biotech companies are also developing new psychedelic compounds.Ronan Levy, Field Trip’s executive chairman, said the company was hoping to grab a slice of the $240 billion that Americans spend each year on mental health services. “We are riding the forefront of what I think is going to be a significant cultural and business wave,” he said.To veteran scientists who lived through the nation’s earlier star-crossed love affair with psychedelics, such corporate boosterism is both thrilling and troubling. They are mindful about potential missteps that could undo the progress of recent years, and they question whether the coming commercialization could limit access to those with limited financial means.Dr. Charles S. Grob, a professor of psychiatry at U.C.L.A.’s school of medicine who has spent decades researching hallucinogens, worries that commercialization and a rush toward recreational use could prompt a public backlash, especially if increased availability of the drugs leads to a wave of troubling psychotic reactions.What is needed, he said, are rigorous protocols and a system to train and credential psychedelic medicine professionals. “We have to be very attentive to safety parameters, because if conditions are not properly maintained, there is a risk for some people to go off the rails psychologically,” he said. “And if the primary motivator is extracting profit, I feel the field is more vulnerable to mishaps.”Dr. Doblin shares some of those concerns, even if his institute stands to profit handsomely. Although MAPS is a nonprofit, it has recently created a corporate entity and hired management consultants to help plot the future of legalized MDMA therapy.Winning F.D.A. approval would give MAPS at least six years of exclusivity to market its MDMA-guided treatments for PTSD, with a potential windfall of $750 million. Most of that money, he said, would help train a generation of psychedelic practitioners, fund lobbying efforts to require insurance coverage for such treatments and promote new therapies around the world. “Our goal is mass mental health,” he said, explaining the organization’s rejection of private investment. “It’s not to amass a whole bunch of money.”Despite his optimism, Dr. Doblin is not blind to the possibility that society’s fascination with psychedelics could sour. “We’ve made so much progress so fast but there are so many challenges ahead,” he said. “I realize,” he said, “we could screw things up at the last minute so I’m not planning to celebrate any time soon.”

The good news: There are more shots available. The challenge is getting people to take them.When it comes to getting the coronavirus vaccine, Mississippi residents have an abundance of options. On Thursday, there were more than 73,000 slots to be had on the state’s scheduling website, up from 68,000 on Tuesday.In some ways, the growing glut of appointments in Mississippi is something to celebrate: It reflects the mounting supplies that have prompted states across the country to open up eligibility to anyone over 16.But public health experts say the pileup of unclaimed appointments in Mississippi exposes something more worrisome: the large number of people who are reluctant to get inoculated.“It’s time to do the heavy lifting needed to overcome the hesitancy we’re encountering,” said Dr. Obie McNair, an internal medicine practitioner in Jackson, the state capital, whose office has a plentiful supply of vaccines but not enough takers.Though access remains a problem in rural Mississippi, experts say that the state — one of the first to open eligibility to all adults three weeks ago — may be a harbinger of what much of the country will confront in the coming weeks, as increasing supplies enable most Americans who want the vaccine to easily make appointments.The hesitancy has national implications. Experts say between 70 percent to 90 percent of all Americans must be vaccinated for the country to reach herd immunity, the point at which the virus can no longer spread through the population.When it comes to rates of vaccination, Mississippi still has a way to go, with just a quarter of all residents having received at least one dose compared to the nationwide average of 33 percent, according to state data. Other southern states, among them Tennessee, Arkansas, Alabama and Georgia, have similarly low rates of vaccination.A closer look at Mississippi’s demographics explains why hesitancy may be especially pronounced.The state reliably votes Republican, a group that remains highly skeptical of the coronavirus vaccine. Nearly half of all Republican men and 40 percent of Republicans over all have said they do not plan to get vaccinated, according to several recent surveys. Those figures have barely budged in the months since vaccines first became available. By contrast, just 4 percent of Democrats have said they will not get the vaccine.Another factor in the state’s low vaccination rate may be Mississippi’s large Black community, which comprises 38 percent of the state’s population but accounts for 31 percent of the doses administered, according to state data. Vaccine hesitancy remains somewhat high among African-Americans, though the doubts and distrust — tied largely to past government malfeasance like the notorious Tuskegee syphilis experiments — have markedly declined in recent months.According to a survey by the Kaiser Family Foundation released last week, about 55 percent of Black adults said they had been vaccinated or planned to be soon, up 14 percentage points from February, a rate that approaches those of Hispanics, at 61 percent, and whites, at 64 percent.Gov. Tate Reeves of Mississippi during a Covid briefing in February. “I feel much better waking up every day knowing that I have been vaccinated,” Governor Reeves said on Tuesday.Rogelio V. Solis/Associated PressA number of other heavily Republican states are also finding themselves with surfeits of doses. On Thursday, officials in Oklahoma, which has delivered at least one dose to 34 percent of its residents, announced they would open up eligibility to out-of-state residents, and in recent weeks, Republican governors in Ohio and Georgia voiced concern about the lackluster vaccine demand among their residents.Tim Callaghan, an assistant professor at the Texas A&M University School of Public Health and an expert on vaccine skepticism, said that more research was needed to divine the reasons behind Mississippi’s slackening vaccine demand but that states with large rural populations, Republican voters and African-Americans were likely to be the first to confront the problem. “If you’re looking to see vaccine hesitancy to emerge, it’s going to be in red states like Mississippi,” he said.Mississippi officials are well aware of the challenge. On Tuesday, Gov. Tate Reeves held a news conference with a panel of medical experts who sought to dispel some of the misinformation surrounding the vaccines. They tried to explain the vaccine development process, rebutted claims that the vaccine can cause miscarriages and recounted their own personal experiences after getting the shot.“I had about 18 hours of turbulence,” Governor Reeves said, describing the mild, flulike symptoms he had felt after his second injection. “But I was able to continue and move on and work, and I feel much better waking up every day knowing that I have been vaccinated.”Access is still a challenge in swaths of rural Mississippi, especially among African-Americans who live far from the drive-through vaccination sites in urban areas that account for roughly half the doses administered by the state. The scheduling system has also proved frustrating for the poor and for older people, who often lack internet access to book appointments or the transportation to get them to distant vaccination sites.“We’ve got to take the vaccines to the people, to pop-up locations that don’t require internet or registration in advance,” said Pam Chatman, the founder of Boss Lady Workforce Transportation, a system of minivans that has been ferrying residents in the Mississippi Delta to mass vaccination locations.Demand among African-Americans was still robust, she said, noting long lines that formed this week outside a tent in Indianola, a small city in the Delta, where the single-dose Johnson & Johnson vaccine was being offered. (The tents offering the Pfizer and Moderna vaccines, which require two doses, were nearly empty.)But hesitancy is rife. Dr. Vernon Rayford, an internal medicine doctor in Tupelo, said he had been frustrated by patients who offered up a variety of reasons for rejecting the vaccine. They claim it will give them Covid-19 or render them infertile, and they worry about unknown repercussions that might emerge decades down the road. “I’ve heard some really wacky theories,” he said.A drive-through vaccination site on the campus of Delta State University in Cleveland, Miss., last month.Rory Doyle for The New York TimesDr. Rayford, who sees patients of all races, said he had discerned subtle differences in the skepticism: African-Americans voice mistrust of the health care system, while whites express a more amorphous distrust of government. “It’s like that line from ‘Anna Karenina,’” he said. “‘All happy families are alike; each unhappy family is unhappy in its own way.’”Dr. Brian Castrucci, president of the de Beaumont Foundation, which focuses on public health, has been working on ways to allay such fears. Dr. Castrucci, an epidemiologist, is especially worried about young conservatives, ages 18 to 34; he cited a recent survey that found that 55 percent of college-educated Republican women under age 49 would not get vaccinated.“Its polls like these that keep me awake at night,” he said.The biggest obstacles to greater vaccine acceptance, he said, are the misinformation that flourishes on social media and the mixed messaging from Republican governors that leave people confused.“By relaxing Covid restrictions, elected leaders in states like Florida, Mississippi, Texas and Georgia are pushing narratives about coronavirus that are working against a narrative that promotes the urgency of vaccinations,” he said. “And unfortunately, our vaccine campaigns are being undone late at night by Facebook and Twitter and Instagram.”Until now, Mississippi health officials have been focusing much of their vaccine hesitancy efforts on African-American and Hispanic residents through partnerships with churches and health clinics. Governor Reeves, a Republican, has so far declined to single out skepticism among white conservatives in the state, but health officials said they were planning to address the problem through Facebook and Zoom meetings with local organizations.Public health experts say what’s needed are well-crafted messages delivered by doctors, religious leaders and other figures who are trusted in a particular community. Dr. Thomas Friedan, a former director of the Centers for Disease Control and Prevention who took part in a focus group with vaccine-hesitant Trump voters that was organized last month by the de Beaumont Foundation, said participants wanted their fears acknowledged, and they craved factual information without being lectured or belittled. “There isn’t one right way to communicate about vaccines, but you need multiple messages with multiple messengers,” said Dr. Friedan, who leads the health advocacy group Resolve to Save Lives. “And people don’t want to hear from politicians.”

In the face of limited transportation, patchy internet service and threadbare medical care, community leaders in Alabama and Mississippi are trying to shrink the racial disparities in vaccine access.PANOLA, Ala. — The dog-eared trailer that serves as the only convenience store within 20 miles of this blink-and-you-miss-it rural hamlet, population 144, is more than a place to stock up on life’s essentials. These days the store — or more precisely its proprietor, Dorothy Oliver — has become an unofficial logistics hub for African-American residents seeking the coronavirus vaccine.Even as vaccine supplies in Alabama have become more plentiful, Ms. Oliver’s neighbors, many of them older and poor, lack the smartphones and internet service needed to book appointments. And if they manage to secure a slot, they may not have a way to get to distant vaccination sites.Ms. Oliver helps her neighbors snag appointments online and matches them with those willing to make the 45-minute drive to Livingston, the seat of Sumter County and the nearest town offering inoculations. Nearly three-quarters of the residents of the county, which includes Panola, are African-American.“We’ve got to fend for ourselves because no one else is going to help us,” said Ms. Oliver, 68, a loquacious retired office administrator who spends many of her waking hours on the phone. “That’s the way it’s always been for poor Black people living in the country.”Across the Southern states, Black doctors, Baptist preachers and respected community figures like Ms. Oliver are trying to combat lingering vaccine skepticism while also helping people overcome logistical hurdles that have led to a troubling disparity in vaccination rates between African-Americans and whites.Though local leaders have made headway combating the hesitancy, they say the bigger obstacles are structural: the large stretches of Alabama and Mississippi without an internet connection or reliable cellphone service, the paucity of medical providers, and a medical establishment that has long overlooked the health care needs of African-Americans.As it is, this region has some of the worst health outcomes in the country, and the coronavirus pandemic has disproportionately hit African-Americans, who have been dying at twice the rate of whites.The General Store, run by Ms. Oliver, a retired bookkeeper. The store serves as a logistics hub for people seeking to get vaccinated but unsure of how to do so.Abdul Aziz for The New York TimesDrucilla Russ-Jackson, left, a Sumter County commissioner, encouraged customers at the M&M Market in Geiger, Ala., to get vaccinated.Abdul Aziz for The New York TimesAlabama is one of the few states that does not require vaccine providers to report data on race, but health officials estimate that just 15 percent of the shots have gone to African-Americans, who make up 27 percent of Alabama’s population and 31 percent of all deaths from Covid-19. Whites, who make up 69 percent of residents, have received 54 percent of the vaccine supply, according to the state data, which is missing details on race for a quarter of vaccine recipients.In Mississippi, 40 percent of Covid-19 deaths have occurred among African-Americans — a figure comparable to their portion of the population — but just 29 percent of the vaccines have gone to Black residents compared with 62 percent for whites, who make up nearly 60 percent of the state’s population.The disparities have prompted a flurry of ad hoc organizing across the South that mirrors the increasingly robust get-out-the-vote efforts, which are aimed at surmounting state voting restrictions that critics say dampen minority turnout.In Cleveland, Miss., Pam Chatman, a retired television journalist has been dispatching rented minibuses to ferry older residents to vaccination sites far from their rural homes. In nearby Greenville, the Rev. Thomas Morris uses his weekly Zoom sermons to assuage the concerns of vaccine skeptics — and then offers up church volunteers who book appointments for the flip phone set. And in central Alabama, Dr. John B. Waits, who oversees a constellation of nonprofit health clinics serving the poor, has been sending out mobile vaccinators to reach the homebound and the homeless.Pam Chatman, a retired television journalist and organizer who started the Vaccine Transportation Initiative, which arranges rides to ferry older people to vaccination sites.Rory Doyle for The New York TimesMedical staff waited for patients to arrive at a drive-through site in Cleveland, Miss.Rory Doyle for The New York Times“It’s all hands on deck because this is a life-and-death situation,” said Dr. Vernon A. Rayford, a pediatrician and internal medicine doctor in Tupelo, Miss. Dr. Rayford said he had been disappointed by the state’s reliance on a web-based appointment system and drive-through vaccination sites that are clustered in urban areas and white neighborhoods. Although those without internet access can call a state-run number for help booking appointments, many of his patients, he said, give up after spending long stretches on hold. Instead, he encourages them to call his wife, Themesha, who in recent weeks has made more than 100 online appointments on her laptop.Since returning home to Tupelo eight years ago after a medical residency in Boston, Dr. Rayford said he had been frustrated by the dearth of health care options and entrenched poverty that saddles African-American residents with some of the highest rates of infant mortality, heart disease and diabetes in the country. Mississippi and Alabama are among the dozen states whose Republican-led governments have rejected Medicaid expansion under the Affordable Care Act.“Until we get a better system, we have to come up with these workarounds, but it gets really tiring,” Dr. Rayford said.Public health experts say the $6 billion for community vaccination sites included in President Biden’s recently passed relief package will go a long way to addressing the problem, and officials in Mississippi and Alabama say they have made considerable progress over the past month in narrowing the racial gap in vaccinations. They say they are expanding vaccine distribution to community clinics and expect access to accelerate alongside increasing supplies of the vaccine made by Johnson & Johnson, which needs only one dose and can be kept at normal refrigeration temperatures, making it easier to distribute in rural areas.Dr. Thomas Dobbs, Mississippi’s top health official, said 38 percent of all vaccines administered in the second week of March had gone to African-Americans, a milestone he said was accomplished with the help of local organizations. “The options are increasing very quickly and pretty soon people are not going to have to go to a drive-through site,” he said during a news conference last week.Dr. Karen Landers, Alabama’s assistant state health officer, noted that last week, the Centers for Disease Control and Prevention ranked Alabama among the top 10 states that have vaccinated vulnerable residents — a category that includes racial and ethnic minorities and the economically disadvantaged. But she added that the overwhelmingly rural composition of the state had made the task daunting given Alabama’s limited resources.“We listen to the criticism, and we are certainly trying to take any elements of truth that are in that criticism so we can better serve our citizens,” Dr. Landers said in an interview.Still, the logistical challenges remain stark in rural areas of the Deep South, where years of spending cutbacks and a lack of jobs have made life more difficult for the shrinking number of people left behind.Frances Ford, a registered nurse, has been organizing vaccine appointments in Perry County, Ala., a largely African-American county of 10,000, just north of Selma, where more than a third of all households live in poverty. Ms. Ford, who runs the nonprofit organization Sowing Seeds of Hope, said many older residents were terrified of medical emergencies, even more so at night, given that there are just two ambulances to serve the county’s 720-square miles. The closest critical care hospital, in Tuscaloosa, is nearly 60 miles away.Those who don’t drive and need routine medical care have to rely on a single van operated by the state to take them to dialysis appointments or to see a cardiologist.“We’ve had car accidents where people waited two hours,” Ms. Ford said. She recalled watching in horror three years ago as a woman who had suffered a heart attack at a funeral died before she could get medical care.Cora Toliver climbed onto a bus to be transported to a coronavirus vaccination site in Shaw, Miss.Rory Doyle for The New York TimesWillie Lewis received a vaccine on a minibus at the Cleveland drive-through site.Rory Doyle for The New York TimesThe paucity of health care resources affects much of Alabama. Over the past decade, state budget cuts have led to a 35 percent reduction in staffing at county health departments: Nearly half of them have either one nurse on staff or none at all, according to Jim Carnes, policy director of the advocacy group Alabama Arise, citing internal state data.“Our approach to rural health care has been shameful,” said Mr. Carnes, policy who has been pushing the state to make low-income homebound residents a top priority for vaccination.Dr. Waits, the chief executive of Cahaba Medical Care, which runs 17 clinics in underserved communities across central Alabama, said the state’s ailing public health infrastructure and a severe shortage of health care professionals had made it harder to distribute vaccines to the rural poor. He added that state officials, chastened by news media accounts that have highlighted the racial disparities in vaccine distribution, had begun funneling more doses his way.Dr. Waits is hiring 34 people to help with the logistics and paperwork needed to expand vaccinations — money Cahaba hopes to partially recoup through federal aid — but he says his clinics are still woefully understaffed. “We’ve got more vaccines then we can push out in a day,” he said. “I need more people, or I need money to hire more people.”The lack of qualified vaccinators is also a problem in Sumter County, where Ms. Oliver, the convenience store owner, lives. The pharmacy nearest to Panola that offers vaccines, Livingston Drug, has a waiting list with 400 names. Unlike the nearby county health department, which dispenses vaccines one day a week, the pharmacy has a prodigious supply of vaccines but its owner, Zach Riley, is the only person on staff who can administer inoculations, which he does two dozen times a day between answering the phone, filling prescriptions, restocking the shelves.“We’ve been flooded with calls but there’s only so much I can do I on my own,” he said before excusing himself to tend to Hasty Robinson, 73, who was coming in for her first dose after a monthlong wait. “At the rate we’re going, it might take until the end of August to get everyone vaccinated.”Zach Riley, owner, operator and pharmacist at Livingston Drug in Sumter County, Ala. “We’ve been flooded with calls but there’s only so much I can do I my own,” he said.Abdul Aziz for The New York TimesAfter he heard about a chance to get a vaccine, James Cunningham said, “to be honest, I didn’t even know where to begin.” Abdul Aziz for The New York TimesAfter months of agitation by local elected officials, the state health authorities recently announced that they would use the National Guard to stage a mass vaccination event at a park in Livingston. For Drucilla Russ-Jackson, 72, an African-American district leader in Sumter County, it was a vindication of her efforts to prod the state into action. Armed with a stack of fliers, she spent much of last week navigating the county’s rutted back roads to reach constituents spread across the cotton fields and the pine forests.At the M&M Market, one of the few gas stations in the area, she strong-armed customers like James Cunningham, 71, a retired truck driver who doesn’t own a cellphone or a computer, and who lives with his 87-year-old mother.“To be honest, I didn’t even know where to begin,” he said of his reaction after Ms. Russ-Jackson told him about the one-day vaccination juggernaut, which was scheduled for the following Tuesday, on March 23.The event, it turns out, illustrates the difficulty of the mission. At the end of the day, more than half of the 1,100 doses were left unused. Ms. Russ-Jackson said turnout might have been dampened by the rain. Or perhaps it was the resistance of older residents, scarred by the government-run Tuskegee syphilis experiments in eastern Alabama.Or maybe it was the drive-through vaccination site, given that the state had not arranged transportation for those without cars.“To be honest, we need to bring these vaccines out to the people and I’m going to be asking the state to do that,” Ms. Russ-Jackson said with a sigh. “We’re making progress, but we still have a long way to go.”

In the face of limited transportation, patchy internet service and threadbare medical care, community leaders in Alabama and Mississippi are trying to shrink the racial disparities in vaccine access.PANOLA, Ala. — The dog-eared trailer that serves as the only convenience store within 20 miles of this blink-and-you-miss-it rural hamlet, population 144, is more than a place to stock up on life’s essentials. These days the store — or more precisely its proprietor, Dorothy Oliver — has become an unofficial logistics hub for African-American residents seeking the coronavirus vaccine.Even as vaccine supplies in Alabama have become more plentiful, Ms. Oliver’s neighbors, many of them older and poor, lack the smartphones and internet service needed to book appointments. And if they manage to secure a slot, they may not have a way to get to distant vaccination sites.Ms. Oliver helps her neighbors snag appointments online and matches them with those willing to make the 45-minute drive to Livingston, the seat of Sumter County and the nearest town offering inoculations. Nearly three-quarters of the residents of the county, which includes Panola, are African-American.“We’ve got to fend for ourselves because no one else is going to help us,” said Ms. Oliver, 68, a loquacious retired office administrator who spends many of her waking hours on the phone. “That’s the way it’s always been for poor Black people living in the country.”Across the Southern states, Black doctors, Baptist preachers and respected community figures like Ms. Oliver are trying to combat lingering vaccine skepticism while also helping people overcome logistical hurdles that have led to a troubling disparity in vaccination rates between African-Americans and whites.Though local leaders have made headway combating the hesitancy, they say the bigger obstacles are structural: the large stretches of Alabama and Mississippi without an internet connection or reliable cellphone service, the paucity of medical providers, and a medical establishment that has long overlooked the health care needs of African-Americans.As it is, this region has some of the worst health outcomes in the country, and the coronavirus pandemic has disproportionately hit African-Americans, who have been dying at twice the rate of whites.The General Store, run by Ms. Oliver, a retired bookkeeper. The store serves as a logistics hub for people seeking to get vaccinated but unsure of how to do so.Abdul Aziz for The New York TimesDrucilla Russ-Jackson, left, a Sumter County commissioner, encouraged customers at the M&M Market in Geiger, Ala., to get vaccinated.Abdul Aziz for The New York TimesAlabama is one of the few states that does not require vaccine providers to report data on race, but health officials estimate that just 15 percent of the shots have gone to African-Americans, who make up 27 percent of Alabama’s population and 31 percent of all deaths from Covid-19. Whites, who make up 69 percent of residents, have received 54 percent of the vaccine supply, according to the state data, which is missing details on race for a quarter of vaccine recipients.In Mississippi, 40 percent of Covid-19 deaths have occurred among African-Americans — a figure comparable to their portion of the population — but just 29 percent of the vaccines have gone to Black residents compared with 62 percent for whites, who make up nearly 60 percent of the state’s population.The disparities have prompted a flurry of ad hoc organizing across the South that mirrors the increasingly robust get-out-the-vote efforts, which are aimed at surmounting state voting restrictions that critics say dampen minority turnout.In Cleveland, Miss., Pam Chatman, a retired television journalist has been dispatching rented minibuses to ferry older residents to vaccination sites far from their rural homes. In nearby Greenville, the Rev. Thomas Morris uses his weekly Zoom sermons to assuage the concerns of vaccine skeptics — and then offers up church volunteers who book appointments for the flip phone set. And in central Alabama, Dr. John B. Waits, who oversees a constellation of nonprofit health clinics serving the poor, has been sending out mobile vaccinators to reach the homebound and the homeless.Pam Chatman, a retired television journalist and organizer who started the Vaccine Transportation Initiative, which arranges rides to ferry older people to vaccination sites.Rory Doyle for The New York TimesMedical staff waited for patients to arrive at a drive-through site in Cleveland, Miss.Rory Doyle for The New York Times“It’s all hands on deck because this is a life-and-death situation,” said Dr. Vernon A. Rayford, a pediatrician and internal medicine doctor in Tupelo, Miss. Dr. Rayford said he had been disappointed by the state’s reliance on a web-based appointment system and drive-through vaccination sites that are clustered in urban areas and white neighborhoods. Although those without internet access can call a state-run number for help booking appointments, many of his patients, he said, give up after spending long stretches on hold. Instead, he encourages them to call his wife, Themesha, who in recent weeks has made more than 100 online appointments on her laptop.Since returning home to Tupelo eight years ago after a medical residency in Boston, Dr. Rayford said he had been frustrated by the dearth of health care options and entrenched poverty that saddles African-American residents with some of the highest rates of infant mortality, heart disease and diabetes in the country. Mississippi and Alabama are among the dozen states whose Republican-led governments have rejected Medicaid expansion under the Affordable Care Act.“Until we get a better system, we have to come up with these workarounds, but it gets really tiring,” Dr. Rayford said.Public health experts say the $6 billion for community vaccination sites included in President Biden’s recently passed relief package will go a long way to addressing the problem, and officials in Mississippi and Alabama say they have made considerable progress over the past month in narrowing the racial gap in vaccinations. They say they are expanding vaccine distribution to community clinics and expect access to accelerate alongside increasing supplies of the vaccine made by Johnson & Johnson, which needs only one dose and can be kept at normal refrigeration temperatures, making it easier to distribute in rural areas.Dr. Thomas Dobbs, Mississippi’s top health official, said 38 percent of all vaccines administered in the second week of March had gone to African-Americans, a milestone he said was accomplished with the help of local organizations. “The options are increasing very quickly and pretty soon people are not going to have to go to a drive-through site,” he said during a news conference last week.Dr. Karen Landers, Alabama’s assistant state health officer, noted that last week, the Centers for Disease Control and Prevention ranked Alabama among the top 10 states that have vaccinated vulnerable residents — a category that includes racial and ethnic minorities and the economically disadvantaged. But she added that the overwhelmingly rural composition of the state had made the task daunting given Alabama’s limited resources.“We listen to the criticism, and we are certainly trying to take any elements of truth that are in that criticism so we can better serve our citizens,” Dr. Landers said in an interview.Still, the logistical challenges remain stark in rural areas of the Deep South, where years of spending cutbacks and a lack of jobs have made life more difficult for the shrinking number of people left behind.Frances Ford, a registered nurse, has been organizing vaccine appointments in Perry County, Ala., a largely African-American county of 10,000, just north of Selma, where more than a third of all households live in poverty. Ms. Ford, who runs the nonprofit organization Sowing Seeds of Hope, said many older residents were terrified of medical emergencies, even more so at night, given that there are just two ambulances to serve the county’s 720-square miles. The closest critical care hospital, in Tuscaloosa, is nearly 60 miles away.Those who don’t drive and need routine medical care have to rely on a single van operated by the state to take them to dialysis appointments or to see a cardiologist.“We’ve had car accidents where people waited two hours,” Ms. Ford said. She recalled watching in horror three years ago as a woman who had suffered a heart attack at a funeral died before she could get medical care.Cora Toliver climbed onto a bus to be transported to a coronavirus vaccination site in Shaw, Miss.Rory Doyle for The New York TimesWillie Lewis received a vaccine on a minibus at the Cleveland drive-through site.Rory Doyle for The New York TimesThe paucity of health care resources affects much of Alabama. Over the past decade, state budget cuts have led to a 35 percent reduction in staffing at county health departments: Nearly half of them have either one nurse on staff or none at all, according to Jim Carnes, policy director of the advocacy group Alabama Arise, citing internal state data.“Our approach to rural health care has been shameful,” said Mr. Carnes, policy who has been pushing the state to make low-income homebound residents a top priority for vaccination.Dr. Waits, the chief executive of Cahaba Medical Care, which runs 17 clinics in underserved communities across central Alabama, said the state’s ailing public health infrastructure and a severe shortage of health care professionals had made it harder to distribute vaccines to the rural poor. He added that state officials, chastened by news media accounts that have highlighted the racial disparities in vaccine distribution, had begun funneling more doses his way.Dr. Waits is hiring 34 people to help with the logistics and paperwork needed to expand vaccinations — money Cahaba hopes to partially recoup through federal aid — but he says his clinics are still woefully understaffed. “We’ve got more vaccines then we can push out in a day,” he said. “I need more people, or I need money to hire more people.”The lack of qualified vaccinators is also a problem in Sumter County, where Ms. Oliver, the convenience store owner, lives. The pharmacy nearest to Panola that offers vaccines, Livingston Drug, has a waiting list with 400 names. Unlike the nearby county health department, which dispenses vaccines one day a week, the pharmacy has a prodigious supply of vaccines but its owner, Zach Riley, is the only person on staff who can administer inoculations, which he does two dozen times a day between answering the phone, filling prescriptions, restocking the shelves.“We’ve been flooded with calls but there’s only so much I can do I on my own,” he said before excusing himself to tend to Hasty Robinson, 73, who was coming in for her first dose after a monthlong wait. “At the rate we’re going, it might take until the end of August to get everyone vaccinated.”Zach Riley, owner, operator and pharmacist at Livingston Drug in Sumter County, Ala. “We’ve been flooded with calls but there’s only so much I can do I my own,” he said.Abdul Aziz for The New York TimesAfter he heard about a chance to get a vaccine, James Cunningham said, “to be honest, I didn’t even know where to begin.” Abdul Aziz for The New York TimesAfter months of agitation by local elected officials, the state health authorities recently announced that they would use the National Guard to stage a mass vaccination event at a park in Livingston. For Drucilla Russ-Jackson, 72, an African-American district leader in Sumter County, it was a vindication of her efforts to prod the state into action. Armed with a stack of fliers, she spent much of last week navigating the county’s rutted back roads to reach constituents spread across the cotton fields and the pine forests.At the M&M Market, one of the few gas stations in the area, she strong-armed customers like James Cunningham, 71, a retired truck driver who doesn’t own a cellphone or a computer, and who lives with his 87-year-old mother.“To be honest, I didn’t even know where to begin,” he said of his reaction after Ms. Russ-Jackson told him about the one-day vaccination juggernaut, which was scheduled for the following Tuesday, on March 23.The event, it turns out, illustrates the difficulty of the mission. At the end of the day, more than half of the 1,100 doses were left unused. Ms. Russ-Jackson said turnout might have been dampened by the rain. Or perhaps it was the resistance of older residents, scarred by the government-run Tuskegee syphilis experiments in eastern Alabama.Or maybe it was the drive-through vaccination site, given that the state had not arranged transportation for those without cars.“To be honest, we need to bring these vaccines out to the people and I’m going to be asking the state to do that,” Ms. Russ-Jackson said with a sigh. “We’re making progress, but we still have a long way to go.”

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutNew Variants TrackerAdvertisementContinue reading the main storySupported byContinue reading the main story‘At Your Age, It’s the Vaccine or the Grave’A nurse in Baton Rouge has been on a crusade to overcome resistance among older African-Americans unwilling to take the coronavirus vaccine.Flossie West, 73, at the East Baton Rouge Council on Aging after receiving a shot of the coronavirus vaccine. “I’m just not interested because everyone tells me the virus is a hoax,” she had said earlier.Credit…Abdul Aziz for The New York TimesMarch 6, 2021, 1:52 p.m. ETBATON ROUGE, La — Flossie West was not at all interested in taking the coronavirus vaccine.Carla Brown, the nurse overseeing her care, was determined to change her mind.Ms. West, 73, has ovarian cancer, congestive heart failure and breathing difficulties — conditions that place her at grave risk should she contract the virus. As it is, Covid-19 has killed far too many of her neighbors in Mid-City, a low-rise, predominantly Black community that sprawls to the east of the Louisiana state capital.But Ms. West’s skepticism about the new vaccines overshadowed her fears of Covid-19. “I’m just not interested because everyone tells me the virus is a hoax,” Ms. West said. “And besides, that shot is going to make me more sick than I already am.”On Thursday morning, Ms. Brown, 62, breezed into Ms. West’s apartment and delivered a stern lecture: The virus is real, the vaccines are harmless and Ms. West should get out of bed, grab her oxygen tank and get into her car.“I’ll be darned if I’m going to let this coronavirus take you,” she said.In recent weeks, Ms. Brown has been frenetically working to persuade her patients to get inoculated, and her one-woman campaign provides a glimpse into the obstacles that have contributed to the troublingly low rates of vaccination in the Black community.Even as vaccine supplies become more plentiful, African-Americans are being inoculated at half the rate of whites, according to an analysis by The New York Times. The disparities are especially alarming given the disproportionate impact of the pandemic on communities of color, who have been dying at twice the rate of whites.Success! Flossie West received her first dose of the Moderna vaccine.Credit…Abdul Aziz for The New York TimesMs. Brown’s mission is fueled by personal loss. “My husband survived being shot in the head, and cancer twice, only to die from Covid-19,” she said. Credit…Abdul Aziz for The New York TimesThe racial gap in vaccination rates is no less stark in Louisiana, where African-Americans make up 32 percent of the population but just 23 percent of those who have been vaccinated.Part of the problem is access. In Baton Rouge, the majority of mass vaccination sites are in white areas of the city, creating logistical challenges for older and poorer residents in Black neighborhoods like Mid-City who often lack access to transportation. Older residents have also been thwarted by online appointment systems that can be daunting for those without computers, smartphones or speedy internet connections.But much of the racial disparity in vaccination rates, experts say, can be tied to a longstanding mistrust of medical institutions among African-Americans. Many Baton Rouge residents can readily cite the history of abuse: starting with the eugenics campaigns that forcibly sterilized Black women for nearly half of the 20th century, and the notorious government-run Tuskegee experiments in Alabama that withheld penicillin from hundreds of Black men with syphilis, some of whom later died of the disease.“The distrust among Black Americans comes from a real place and to pretend it doesn’t exist or to question whether it’s rational is a recipe for failure,” said Thomas A. LaVeist, an expert on health equity and dean of the School of Public Health and Tropical Medicine at Tulane University. Dr. LaVeist has been advising Louisiana officials on ways to increase vaccination rates.Seniors arrived at the East Baton Rouge Council on Aging to receive the vaccine.Credit…Abdul Aziz for The New York TimesRobbie Christian, a pharmacist, prepared to administer a dose of the Moderna vaccine at the Council on Aging. Credit…Abdul Aziz for The New York TimesMs. Brown, 62, the hospice nurse, has a good idea about how to change the minds of vaccine skeptics: encouraging one-on-one conversations with respected figures in the Black community who can address the misgivings and provide reliable information while acknowledging what she describes as the scars of inherited trauma. “If you look back at our history, we have been lied to and there has been a lot racial pain so it’s all about building trust,” she said.The Coronavirus Outbreak