Pfizer launches late-stage trial of virus shots for those under 12

In this file photo taken on March 4, 2021, vials of the Pfizer/BioNTech vaccine against COVID-19 are seen as elderly people are inoculated amid the novel coronavirus pandemic, at the Belisario Porras school San Francisco neighbourhood in Panama City. (LUIS ACOSTA / AFP)

GENEVA / BRASILIA / LISBON / HAVANA / BRUSSELS / COPENHAGEN / ROME / LONDON / KAMPALA / MEXICO CITY / JOHANNESBURG / WASHINGTON / BERLIN / NICOSIA / SANTIAGO / BOGOTA / WINDHOEK / ADDIS ABABA / MOSCOW / PARIS – Pfizer Inc and BioNTech SE’s COVID-19 vaccine will be tested in children under the age of 12 in a late-stage study of as many as 4,500 participants.

The vaccine partners announced plans on Tuesday to kick-start the trial of the shot within weeks. It will be conducted at more than 90 sites, spanning the US, Finland, Poland and Spain.

Based on findings from an early-stage trial that evaluated safety, tolerability and the immune response prompted by the vaccine, the companies selected new doses for children. Those ages 5 to 11 will receive a 10-microgram dose – a third of the size given to those 12 years old and older. Children 6 months to 5 years old will be given 3 micrograms – a tenth of the amount given to adolescents and adults.

On May 11, the two-shot messenger RNA vaccine was cleared for use in those 12 to 15 in the US, paving the way for the mass vaccination of middle- and high-school students. The trial of young teens, which enrolled more than 2,000 participants, found that the vaccine was 100 percent effective against symptomatic disease.

Haiti

Haiti, the poorest nation in the Western hemisphere, has earned another grim distinction: it’s the only one that hasn’t vaccinated a single resident against COVID-19.

One of a handful of nations worldwide still awaiting vaccines, Haiti was among the 92 poor and middle-income countries offered doses under the COVAX Facility. But the government initially declined AstraZeneca PLC shots, citing side effects and widespread fears in the population.

By last month the equation had shifted. Fears about AstraZeneca were subsiding just as Haiti was seeing a surge in cases. When the country finally agreed to receive the doses, production issues in India and a spike in global demand made them unavailable.

The United Nations’ Vaccine Market Dashboard – which processes information provided by COVAX – has no scheduled delivery date for Haiti. And Adrien said it is unclear when the vaccines will arrive.

Uganda

Uganda has suspended mass vaccination against COVID-19 as the country waits to receive more vaccines from different sources, an official said on Tuesday.

Emmanuel Ainebyoona, spokesperson for the Ministry of Healthm told Xinhua by telephone that mass vaccination would resume when the new orders arrive.

Ainebyoona said there were a few remaining doses that would continue to be used for priority groups like health workers, elderly and those with other conditions.

Figures from the ministry showed that as of Monday, 748,676 people had been vaccinated out of the 964,000 doses of the AstraZeneca vaccine that the country received in March.

In another development, Uganda's Chief Justice Alfonse Owiny-Dollo on Monday suspended court sessions for 42 days, as the country sought to ease a surge in COVID-19 cases. Only urgent matters will be heard during that period, he said.

The Chief Justice said all judicial officers with pending judgements and rulings must utilize the 42 days to deliver them online.

As of June 7, Uganda had reported 53,961 COVID-19 cases, according to health ministry figures.

WHO

The World Health Organization (WHO) warned Monday of the danger of buying overpriced vaccines from intermediaries, reminding that countries should buy vaccines certified by the WHO and make sure to identify the origin of the product.

The role of intermediates regarding the purchase of vaccines was recently raised as a middleman, located in the United Arab Emirates, was caught selling the Sputnik vaccines to Ghana and Pakistan at double the original price.

Mariangela Batista Galvao Simao, WHO assistant director-general for access to medicines and health products, said it was important to vaccinate people with products "certified" by the WHO

Mariangela Batista Galvao Simao, WHO assistant director-general for access to medicines and health products, said countries should either buy directly from the manufacturer or "contact the manufacturer to make sure that the intermediate is legal".

Simao also said it was important to vaccinate people with products "certified" by the WHO.

ALSO READ: WHO: Funding, vaccines sought from G20 nations for COVAX

Meanwhile, WHO Director-General Tedros Adhanom Ghebreyesus renewed pleas for shot donations, saying that glaring COVID-19 vaccine inequality has created a "two-track pandemic" with Western countries protected and poorer nations still exposed.

"Six months since the first COVID-19 vaccines were administered, high-income countries have administered almost 44 percent of the world's doses. Low-income countries have administered just 0.4 percent. The most frustrating thing about this statistic is that it hasn't changed in months," Tedros said.

Meanwhile, Tedros said he hoped African COVID-19 vaccine manufacturing sites will be identified and some even close to producing by the end of 2021, in the race to deliver more shots to the continent.

Separately, Mike Ryan, the WHO's top emergencies official, said that he would advise any country undertaking mass gathering be extremely careful to manage risks.

Ryan made the remarks when asked about Brazil hosting the Copa America soccer tournament.

He said a host nation like Brazil should reconsider in the interest of safety and slowing the spread of COVID-19. 

Global tally

The number of coronavirus cases recorded worldwide has exceeded 173.70 million while the global death toll topped 3.73 million, according to data compiled by Johns Hopkins University. 

A nurse injects a man with a dose of the Pfizer COVID-19 vaccine at an inoculation center in Panama City on June 7, 2021. (ARNULFO FRANCO / AP)

Africa

The number of confirmed COVID-19 cases in Africa reached 4,928,685 as of Monday evening, the Africa Centers for Disease Control and Prevention (Africa CDC) said.

The death toll stood at 132,517 while a total of 4,447,383 people across the continent have recovered from the disease, the Africa CDC said.

READ MORE: In boost for Africa, Senegal 'aims to make vaccines next year'

US

Safety concerns about Johnson & Johnson (J&J)'s COVID-19 vaccine along with overall flagging demand for vaccinations have slowed its US rollout to a crawl, leaving close to half of the 21 million doses produced for the United States sitting unused.

Americans have largely eschewed it over the six weeks it has been back in use after a pause to study a rare safety issue, according to data from the US Center for Disease Control and Prevention (CDC) and interviews with health officials and pharmacists in eight states across the country.

In the week ended May 25, fewer than 650,000 Americans received the J&J shot, accounting for about 5 percent of total vaccinations administered and down from nearly 3 million in the week leading up to the pause, CDC data show.

Demand for all the vaccines has slowed since mid-April, but the drop has been significantly steeper for the J&J shot.

The slowdown may mean some J&J doses will expire unused at a time when global demand for any COVID-19 vaccine is high. J&J doses will be among the 25 million donated by the US announced by the White House last Thursday.

At least 13 lots of the vaccine have expiration dates of June 27 or earlier, according to a J&J website. It is not clear how many doses that reflects, but the vaccine has a 3-month shelf life and most doses were sent out by early April, including 11 million in the first week. J&J has another 100 million doses on hand but shipment timing is uncertain.

Restart of US-UK flights sought 

Airlines from Britain and the US issued a joint plea for the resumption of travel between the two countries, saying government curbs on the world’s most lucrative air route are holding back an economic recovery.

Leisure and business trips could restart without undermining efforts to combat COVID-19, the heads of Delta Air Lines Inc., United Airlines Holdings Inc., American Airlines Group Inc. and JetBlue Airways Corp. said Monday. They were joined by counterparts from British Airways and Virgin Atlantic Airways Ltd.

While carriers have been pitching for a resumption of trans-Atlantic travel since last summer, the latest push comes days before President Joe Biden is set to attend the G7 summit in England.

Argentina

Argentina reported 22,195 new COVID-19 cases over the past 24 hours, bringing the national tally to 3,977,634, the Ministry of Health said Monday.

The ministry said 733 more deaths were logged, taking the death toll to 81,946.

A total of 3,560,148 patients have recovered while 335,540 cases remained active, said the ministry.

The country has fully vaccinated more than 3 million people against COVID-19, while 11.4 million have received at least one dose of the vaccine, according to the Public Vaccination Monitor.

Brazil

Brazil has had 37,156 new cases of coronavirus reported in the past 24 hours, and 1,010 deaths from COVID-19, the health ministry said on Monday.

The South American country has now registered 16,984,218 cases since the pandemic began, while the death toll has risen to 474,414, according to ministry data.

Canada

Prime Minister Justin Trudeau is preparing to ease Canada’s border restrictions for travelers who have been fully vaccinated against COVID-19, according to people familiar with the discussions.

The government is crafting plans to loosen the current 14-day isolation period for border-crossers who’ve had two vaccine doses, said the people, speaking on condition they not be identified. Travelers entering Canada would still be tested for the virus and may be required to quarantine for a shorter period.

The plan is expected be announced within days, though the timing could shift, according to the people. It isn’t clear when the changes would be implemented or whether Canada will open up its borders to non-US travelers at the same time.

Meanwhile, Ontario will loosen COVID-19 restrictions starting June 11, three days ahead of schedule, Premier Doug Ford announced, as infection rates continue to drift lower after a punishing third wave while vaccinations pick up pace.

The province will enter step one of its reopening plan, allowing non-essential retail to operate at 15 percent capacity, outdoor dining with a maximum of four people per table, and outdoor gatherings of up to 10 people to take place.

The province hit key metrics ahead of schedule, hence the earlier reopening date, the statement from the premier's office said, including a vaccination rate of 60 percent.

Chile

Chile's COVID-19 toll topped 30,000 on Monday, as 121 more deaths were reported, bringing the total to 30,058, said the Ministry of Health.

The country also reported 6,958 new cases, taking the cumulative caseload to 1,434,884.

Health Minister Enrique Paris noted that there had been a "major increase in deaths" in the last few days.

Meanwhile, Deputy Health Minister Paula Daza said Chile's border closure will be extended to June 30 in an effort to prevent the spread of the virus and the entry of new variants into the country.

Daza also said that 11 communes, among them two in the Santiago Metropolitan Region, will be placed under lockdown starting on Thursday. 

Colombia

Colombia reported another 535 deaths from COVID-19 in the past 24 hours, bringing the death toll to 92,496, the Ministry of Health and Social Protection said Monday.

The ministry said 21,949 new cases were also posted, taking the cumulative caseload to 3,593,016.

A total of 11,615,265 vaccine doses had been administered in the South American country, with 3,450,521 people having been fully inoculated as of Sunday night.

Cuba

Cuba's COVID-19 tally reached 150,103 on Monday, after the country saw 1,185 new cases in the past 24 hours, the Ministry of Public Health said.

The death toll rose by 13 to 1,025, the ministry said.

"We are facing one of the moments of greatest transmission of COVID-19," the ministry's director of hygiene and epidemiology Francisco Duran said during his daily report.

Havana, the epicenter of the pandemic on the island, registered 399 cases, with an incidence rate of 334.9 per 100,000 inhabitants, the highest in the country.

Cyprus

Cyprus will issue a temporary COVID-19 vaccination certificate to citizens who wish to travel abroad starting from Tuesday, the health ministry said in a statement on Monday.

The certificate will be valid for the month of June as the new European Digital COVID Certificate is scheduled to be introduced on July 1.

The ministry said that those traveling to Greece would not need a vaccination certificate as the Greek authorities accept Cyprus' vaccination card, which is issued at the vaccination centers after people receive the jab.

According to the latest data released by the ministry, 54.9 percent of the population above 18 years old had received at least the first vaccine dose by last Friday.

Denmark

Denmark researchers are using virtual reality to encourage more COVID-19 vaccinations, through a game of maneuvering through a virus-infected crowd in a city square.

In an experiment by the University of Copenhagen, participants wear goggles to play an elderly person crossing the square while avoiding red-clothed bypassers infected with COVID-19. Vaccinated characters dress in blue.

"We know from similar studies that after people went through a virtual reality experience like this, their vaccination intention increases. We have observed this with COVID already," said Robert Bohm, professor of psychology at the University of Copenhagen, citing a prior online study by the researchers.

A total of 1,369,059 Danes, or 23.4 percent of the population, have been fully vaccinated, and a further 2,391,327, or 40.9 percent of the population, have received at least one jab, according to the Statens Serum Institut (SSI) on Monday.

A total of 1,334 Danes were infected with COVID-19 after being fully vaccinated, according to a report by SSI.

Ecuador

Ecuador is planning to close a deal this week for 6 million shots of the single-dose vaccine made by CanSino Biologics Inc., Health Minister Ximena Garzon told Teleamazonas. 

The first batch of 3 million shots is expected to arrive in early July and the rest a month later.

Talks with Johnson & Johnson and the Gamaleya Research Institute will also go ahead this week, with the government targeting delivery of at least 1 million shots of Gamaleya’s Sputnik V vaccine this month and a similar amount in July.

Ecuador has administered about 2 million doses, enough to cover 5.9 percent of its population, according to the Bloomberg Vaccine Tracker.

The country reported on Monday 386 new cases and four more deaths in the last 24 hours, bringing the tally to 432,739 and the toll to 15,293.

The Ministry of Public Health also reported another 5,521 deaths considered to be COVID-19 related, but not verified.

READ MORE: G7 urged to vaccinate world by end of 2022

Ethiopia

Ethiopia registered 110 new COVID-19 cases in the past 24 hours, taking the nationwide tally to 273,024 as of Monday evening, according to the Ministry of Health.

Four newly reported deaths pushed the death toll to 4,213, the ministry said.

Another 636 more recoveries were posted, raising the total number of recoveries to 246,883, it added.

EU

The European Medicines Agency (EMA) does not expect to make a decision on the approval of German biotech group CureVac's COVID-19 vaccine before August, an official at Germany's health ministry familiar with the matter told Reuters.

The source said German health minister Jens Spahn had provided the update on the EMA's view on the timing of the review on Monday in a call with his regional state counterparts.

In what has so far been CureVac's only major confirmed supply deal, the European Union secured up to 405 million doses of the vaccine in November last year, of which 180 million are optional.

The company said on May 28 that the late-stage trial involving about 40,000 volunteers in Europe and Latin America had reached a first interim analysis at 59 COVID-19 cases, but that more data would be necessary for statistically reliable efficacy numbers.

The European Commission is engaged in negotiations with third countries, such as the United Kingdom and the United States, on the mutual recognition of vaccine certificates, European Commissioner for Justice Didier Reynders said on Monday.

At a press conference following a meeting of the justice ministers of EU member states, Reynders said that since the US does not intend to issue a federal vaccination "passport", "we have to think about other kinds of proof for vaccination or recovery or tests, but it must be possible to solve the issue."

Reynders said the Commission was finalizing its new recommendations on free movement.

Germany

The number of confirmed coronavirus cases in Germany increased by 1,204 to 3,702,688, data from the Robert Koch Institute (RKI) for infectious diseases showed on Tuesday.

The reported death toll rose by 140 to 89,384, the tally showed.

Ireland

Ireland’s deputy prime minister is urging a return to offices in August, a month earlier than currently planned, the Irish Independent newspaper reported, citing Leo Varadkar.

Varadkar is asking the Institute of Public Health to consider a phased return to offices in August, rather than September when schools and colleges will return, the newspaper reported.

Ireland’s hospitality sector resumed outdoor service on Sunday with indoor dining scheduled to be permitted from July 5.

This file photo taken on June 3, 2021 captures tourists taking selfies on the Ponte dell'Accademia bridge over the grand canal in Venice. (ANDREA PATTARO / AFP)

Italy

Venetians breathed a sigh of relief on Monday as the lagoon city finally moved into a low-risk COVID-19 “white zone”, meaning most pandemic restrictions were lifted and a nightly curfew scrapped.

Face masks and social distancing rules remain in place, but bars and restaurants are allowed to stay open without any time limits – something locals hope will entice back visitors.

Venice is among the seven regions that were moved to the “white zone” on Monday. The rest of the country remains in the moderate-risk "yellow" zone.

ALSO READ: First post-COVID-19 cruise ship leaves Venice amid protest

Also on Monday, the nighttime curfew was shortened by an hour to 12 midnight (instead of 11 pm) until 5 am.

Italy reported 65 coronavirus-related deaths and 1,273 new cases on Monday, bringing the totals to 126,588 deaths and 4.23 million cases.

The country has administered over 38 million vaccine doses, with more than 13 million people (24 percent of the population) fully immunized, according to official statistics.

Malta

Malta registered no new COVID-19 cases for the first time in 11 months on Monday, but the Mediterranean island's health minister urged people to remain careful to prevent any resurgence.

"Today is the first day with zero cases since last summer," minister Chris Fearne wrote on Twitter. "It is essential that we maintain discipline and responsibility."

The news came as Malta allowed bars, cinemas and theaters to reopen as part of a government timetable to progressively roll back restrictions that was announced months ago.

Malta last registered zero cases on July 25, but cases then gradually rose, to spike at 510 in March before dropping again. They have been in single figures for weeks.

Mexico

Mexico reported 881 newly confirmed cases of COVID-19 in the country and 34 more fatalities on Monday, bringing total infections to 2,434,562 and the death toll to 228,838, according to health ministry data.

Namibia

Namibia's mortuary capacity is under strain as COVID-19-related deaths surge, Health Minister Kalumbi Shangula said on Monday.

"It is not a crisis yet, but it is a cause for concern. The situation has not only been made worse by the rise in the number of COVID-19 related deaths but also that we have unclaimed bodies that date back to five years ago," Shangula told Xinhua.

Namibia is currently battling a third wave of COVID-19 infections. Last week, the country registered 88 deaths in a week.

The COVID-19 situation in the country is grave, Shangula said, urging people to follow health regulations in order to curb the spread of the disease.

Namibia has so far registered 59,092 confirmed cases and 920 deaths.

Norway

Norway will shorten the interval between COVID-19 vaccine doses to nine weeks from the current 12 weeks, thus speeding up the inoculation process, the health ministry said on Monday.

"We'll have ample supply of vaccines in the time ahead," Health Minister Bent Hoeie said in a statement.

Norway uses vaccines made by Moderna Inc as well as the Pfizer-BioNTech ones, each requiring two injections.

"Reducing the dose interval is part of the Institute of Public Health's strategy to ensure that the population is fully vaccinated as quickly as possible," the ministry said.

As of Monday the country had fully or partly vaccinated 41.8 percent of all adults, according to the Institute of Public Health. In total, 27.6 percent of those aged 18 or older have received two doses, while an additional 14.2 percent got a single injection.

Poland

Poland registered 85,000 youths after opening vaccinations for 12 to 15 years old on Monday, out of 2.5 million that qualify. 

The government is planning to start jabs in schools from September, the head of the prime minister’s office said. 

The country is seeing faltering demand for vaccines after 8.2 million people were fully vaccinated. Authorities are considering fresh incentives, and will give details of a national lottery for those fully inoculated in mid-June.

Portugal

Portugal's foreign minister said Spain's decision to require a negative COVID-19 test for people crossing the border must have been an error, Lusa news agency reported on Monday.

Portugal had asked Spanish authorities for clarification on "what could only have been a mistake", Portugese Foreign Minister Augusto Santos Silva said.

The land border between the two Iberian nations reopened on May 1 after three months of restrictions and checks, providing relief to local tourist hotspots.

A Spanish health ministry spokesperson said people crossing the border would be obliged to carry health documentation in the same way that a driver is expected to have their vehicle's papers in case of sporadic checks.

The protocol is exactly the same as that applied at Spain's other border with northern neighbor France, the spokesperson said, adding that cross-border workers and transport sector employees would be exempt.

Russia

Some Russian drugmakers say they will only manufacture the single-dose Sputnik Light COVID-19 vaccine for the time being because it is easier to make than Sputnik V, which combines two separately-produced shots.

This highlights the complexity of producing the second shot of Russia's Sputnik V vaccination, which is made up of two different products which requires different manufacturing facilities and twice as many people to make.

That makes Sputnik Light, which is identical to the first Sputnik V shot and was approved for use by Russia in May, an attractive short-term solution.

Vikram Punia, president of Pharmasyntez, told Reuters that his firm was waiting for registration to officially launch a new manufacturing facility once its first batches of Sputnik Light had passed quality control tests overseen by the developer.

Pharmasyntez also produced the second component of the Sputnik V vaccine, but had decided not to expand production because manufacturing requires significant resources, he said.

Russia reported 9,977 new COVID-19 cases on Tuesday, including 3,817 in Moscow, taking the official infection tally to 5,145,843.

The government coronavirus task force also said that 379 people had died of coronavirus-related causes in the last 24 hours, pushing the death toll to 124,496.

A man receives the Sputnik V COVID-19 vaccine in Zilina, Slovakia, June 7, 2021. (ERIKA DURCOVA / TASR VIA AP)

Slovakia

Slovakia became the European Union's second country to start inoculating people with the Russian-made Sputnik V coronavirus vaccine on Monday, after months of rows over the shot that has yet to be approved by European regulators.

In the northern city of Zilina, one of eight vaccination points chosen to give Sputnik V shots opened on Monday and had more than 600 applications. The center has an initial capacity of about 100 shots per day, which can be increased if needed.

Slovak media reported that more than 5,000 people across the country have so far registered to receive Sputnik V. A total of 77,000 people were waiting for a first dose of all vaccines, according to data from news website www.sme.cz.

South Africa

With more than 61,000 active coronavirus cases in the country, South African Medical Doctors Association Chairperson Angelique Coetzee called for tighter restrictions to curb rising infections.

Coetzee said the government should reduce the sizes of gatherings as they were behind increasing new cases.

"We would like to see tougher restrictions tightened on weekends because that's when most people gather in drinking places and restaurants which is scary," she told Xinhua on Monday.

She expressed concerns over huge gatherings where people chose not to wear masks and socially distance themselves.

UK

Britons should "holiday at home" this year and not travel abroad unless absolutely necessary due to risks of the COVID-19 pandemic, British Environment Secretary George Eustice said Tuesday.

People must be aware of the "risks" in travelling outside of Britain at present, Eustice told Sky News.

His remarks came after holiday hotspot Portugal was removed from the British government's "green list" last week.

On Tuesday, early results from one of Britain's biggest trials studying the commonly used painkiller and blood thinner showed that aspirin does not improve the chances of survival in severely ill COVID-19 patients

Since the drug helps reduce blood clots in other diseases, it was tested in COVID-19 patients who are at a higher risk of clotting issues.

The trial, run by the University of Oxford, is also looking at the effectiveness of several other treatments, and was the first to show that the widely available steroid dexamethasone, could save lives of people severely ill with COVID-19.

The aspirin study did not show any significant change to the risk of patients progressing to invasive mechanical ventilation. For every 1,000 patients treated with the medicine, about six more patients experienced a major bleeding event and about six fewer experienced a clotting event, Oxford said.

The UK reported Monday 5,683 new cases and one additional death, bringing the cumulative caseload to 4,522,476 and the toll to 127,841, according to the latest official figures.

More than 40.4 million people, or more than three-quarters of adults in Britain, have received one shot of the coronavirus vaccine while more than 27.9 million people have been fully vaccinated, according to the latest figures.

The latest data came as Hancock announced that people aged 25 to 29 in England will be able to book their vaccination from Tuesday morning.

Senegal 

The International Monetary Fund (IMF) has approved US$650 million in aid to Senegal to support the West African country's COVID-19 recovery, it said in a statement late on Monday.

The announcement follows an earlier payment of US$442 million to Senegal in April 2020, also to mitigate the economic effects of the coronavirus pandemic, the IMF said.

The pandemic has hit the Senegalese economy hard and caused growth to contract to an estimated 1.5 percent in 2020 from 5.3 percent in 2019, the IMF said. The Fund expects a modest recovery in 2021 with growth reaching 3.7 percent and forecast to reach 5.5 percent in 2022.

Senegal, one of Africa's most stable democracies, was rocked by its worst unrest in a decade in March after the arrest of a popular opposition politician triggered an explosion of pent-up anger over economic hardship.

Senegal has brought COVID-19 cases under control in the last few months, ramping up its vaccination drive, but there is a risk of a third wave, the IMF said. The health ministry has recorded 41,725 cases and 1,150 deaths from coronavirus to date.

France

France is likely to see a resurgence of coronavirus in the autumn mainly due to the potential spread of the Delta variant, which was first detected in India, Jean-Francois Delfraissy, head of the scientific council that advises the government on COVID-19, said Tuesday.

"After a summer that should overall go well … we should see a resurgence of the epidemic in September or October," Delfraissy told RTL radio.

The immunologist warned that the Delta virus strain, which drove a devastating epidemic wave in India, would be dominant at home by the autumn.

Zimbabwe 

Zimbabwe asked the African Export-Import Bank to delay the arrival of Johnson & Johnson vaccines because of concerns about possible blood clots and its inability to keep the doses at the right temperature.

“Zimbabwe is not yet ready to participate in the August allocation as measures are still being put in place to establish the cold chain management framework for the vaccines, as well as on management of the anticipated adverse effects of the vaccines,” George Guvamatanga, secretary for finance, said in a letter to Afreximbank’s chief regional officer.