A1 A1
Local
top story
Cheshire Career Center
Cheshire Career Center to close child-care program for infants, toddlers
  • Updated

The Cheshire Career Center’s child-care program for infants and toddlers, which has provided care to the children of students and SAU 29 staff members for many years, will close at the end of the school year, according to the center’s director.

Samantha Belcourt said students enrolled in the center’s careers in education program historically have provided crucial support for the infant and toddler room, which currently has five children who are all under the age of 2. Due to a change in state requirements for the careers-in-education program, though, these students can no longer gain credit toward their diplomas by working with infants and toddlers, Belcourt said.

“For the careers-in-education program, the state standards have shifted from an early childhood focus to a K-12 focus to give students better opportunities for high-wage, high-skilled career pathways in education,” she said.

The N.H. Department of Education reviewed the Cheshire Career Center’s programs in December, Belcourt said, and found that the careers-in-education program was out of compliance with state standards.

“And so we’re doing what’s necessary to be compliant with the state,” Belcourt said of the decision to end the infant and toddler room, which she announced last Friday in a letter to families who have kids in the program.

If the career center does not comply with the state, it could lose federal funds from the Perkins grant, which provides states money for career and technical education, according to a Feb. 11 letter from Eric Frauwirth, administrator of the state education department’s Bureau of Career Development.

“In order for CTE programs to be eligible for Federal Perkins funds, they are required to meet qualifications detailed in the legislation: high wage, high skill, in-demand careers,” Frauwirth wrote in the letter addressed to Belcourt. “Under these requirements, a program focusing on pre-school and early childhood education would not be eligible, primarily due to the current wage level for employees.”

Child-care workers in New Hampshire make an average of $25,910 a year, according to the U.S. Bureau of Labor Statistics. Meanwhile, elementary school teachers in the state make an average of $60,730, a figure that jumps to $62,210 for high school teachers. Experts have cited low wages for early childhood education workers as one of the driving factors behind a lack of affordable, accessible child-care nationwide.

The state education department’s December review of the Cheshire Career Center “identified a compliance concern” with the careers-in-education program since it currently focuses “almost exclusively on preschool and early childhood education,” Frauwirth added. The state required CTE programs focused on early childhood to switch to an emphasis on K-12 education “several years ago,” he wrote.

For the current school year, the career center — which is located at Keene High School and enrolls about 700 students from Keene, Fall Mountain Regional and Monadnock Regional high schools — received about $180,000 in Perkins funds out of a budget of roughly $1.9 million, according to Belcourt, who started in her position last July.

The Cheshire Career Center’s infant and toddler program started around the same time the center opened in the mid-1970s, as a way to help students who became pregnant stay in school, Belcourt said. Only a few students in the past five or six years have used the care provided by the program, she added.

Over the years, the infant and toddler room opened up to N.H. School Administrative Unit 29 staff members, too, who could send their children there from 8 a.m. to 4 p.m. each school day for “very minimal cost,” Belcourt said, though she did not have the specific figure.

Of the five children of staff members currently in the program, two were not planning to return next year, Belcourt added, leaving three children to look for a child-care alternative for the 2021-22 school year.

Along with the 12 students who currently help in the infant and toddler room, the program has two full-time staff members, who will still have jobs with the career center next year, Belcourt said. Funding for two part-time paraprofessionals in the program was not included in the budget for the 2021-22 school year, she added.

The careers-in-education program, one of 17 offered at the career center, consists of two yearlong classes in which students get hands-on experience working with children and study topics such as child-development theory, preparing them for a wide variety of jobs in schools. Other programs at the career center include construction trades, culinary arts, accounting and engineering.

For the roughly 30 students in the career center’s careers-in-education program, Belcourt said SAU 29 has plenty of internal options for them to gain hands-on experience in K-12 schools that will count toward their diplomas.

“We have a lot of opportunities in just our own district,” she said. “We can set our students up to co-teach with a teacher in a grade level that they are interested in. Or, if someone wants to be a special ed case manager, they can work with special ed. We have all sorts of levels in SAU 29 and lots of opportunities to provide.”


“A male and female wood duck pause on a boulder in Pearly Pond while shopping for some waterfront real estate,” Rindge resident Greg Walsh said of this feathered pair he photographed earlier this month. 


Local
State prepares for federal funding to boost broadband access

Kara Toms had never worried about having high-speed Internet in her Meriden home, but when the pandemic hit, her teenage children suddenly depended on the connection to attend their high school classes.

At one point both Toms and her husband were working remotely — she’s a mental health counselor and he’s an engineer — but their DSL connection was not up to the task.

“It just, it didn’t work,” she said.

When her son would get booted out of his online synchronous classes, he would have to hop on his bike and ride to their local library in hopes of catching at least part of the class.

“On days when it was pouring rain we would park at the library, he’d sit in the car all day for his classes,” Toms said. Luckily, she said, her son is a strong student, and he has been able to manage the interruptions without falling behind. But during the pandemic, unequal access to the Internet has meant unequal access to education, highlighting the glaring gaps in broadband service across the state.

“How can there be equity when one kid is having to sit outside the library in the rain when another kid can sit inside their house and still be able to do the same thing?” Toms said.

Like many parts of the state, in Meriden there aren’t options to get faster Internet. A hotspot — the solution the school recommends — won’t work because there’s poor cell service where Toms lives. The only provider in her area is TDL, which charges $110 a month for phone and Internet. She’s done speed tests that show upload speeds of .6 megabits per second; broadband is typically defined as 25 megabits per second download speed, and 3 megabits per second upload speed. Even if Toms wanted to pay a higher premium, TDL doesn’t offer any faster options.

Places like Meriden are sprinkled throughout the state: addresses at the end of dirt roads, entire towns where broadband simply isn’t available. Even cities have pockets without coverage. Five percent of New Hampshire residents live in an area without broadband, and 10 percent of households don’t have an Internet subscription, according to data from the White House. In the northern and western parts of the state, those percentages are even higher.

This problem isn’t new, but it has become acute in the past year. The pandemic has made it clear that high-speed Internet is not a luxury but an essential service for telehealth, education, and remote work.

Now, with an influx of federal money from the American Rescue Plan, state lawmakers are working on a plan to distribute the money to the towns, districts, or companies that are working on building out broadband.

But the last round of relief funding was a rocky road. Of the $50 million allocated to broadband spending in the CARES Act, New Hampshire was able to get only $14 million out of the door by the tight, end-of-year deadline for spending those funds, according to Sen. Jeb Bradley, a Wolfeboro Republican.

“I thought, all right this is kind of ridiculous, we need a more long-term, ongoing initiative in New Hampshire,” said Bradley.

This session Bradley’s been working on legislation — Senate Bill 85 — that would help get stimulus funding out of the door more smoothly in the future. The proposal would allow for 50 percent of a qualifying project to be funded through a matching grant. A town or a company that wanted to do the work would have to come up with the other 50 percent.

If passed, the law would also be a mechanism for distributing broadband money from Biden’s infrastructure plan, the American Jobs Act, that sets aside $100 billion to assure nationwide broadband coverage.

“We have seen that there’s a so-called digital divide in some areas of New Hampshire, not just in rural areas at the end of dirt roads but in the more populated areas there are problems, too,” said Bradley. “That’s what we’re trying to solve.”

The problem exists in part because there are hard-to-reach areas that aren’t profitable for providers. They have passed over these areas, leaving towns and municipalities to figure out how to solve the problems that private industry won’t. The question now is whether cutting the project cost in half will convince providers that the build-out is worth it.

The new funding might also help with efforts to more accurately map where there are holes in service. Right now, the state depends on providers for that data.

‘Some towns are going to be left behind’

In New Hampshire, the state has left the work of solving the broadband problem to individual towns. But with each town fending for itself, some broadband experts worry about who gets left behind.

Sen. Jay Kahn, a Keene Democrat, said there are no measures in SB 85 to ensure that money is allocated equitably, without leaving some towns out.

Carole Monroe, a board member and former CEO of ValleyNet, said: “If the money can be distributed fairly and without prejudice, not just to the incumbent carriers, not just to the large companies, then I think there’s an opportunity for New Hampshire to really be covered.”

But without mandating universal access, Monroe worries that the state will face the same problems in the future. And she warned that the influx of federal funding could drive up prices for broadband construction in the state. There will be a demand for equipment, fiber, and contractor time.

“I don’t think these construction companies can ramp up fast enough or find enough fiber splices to do the work that’s going to be necessary in the next two years when this money is hot,” said Monroe.

Monroe lives in Dublin, a town that used bonding to pay for broadband. This is one model for financing broadband in the state, where a town authorizes a 20-year bond. Those funds are matched with money from a provider, which in many cases has been Consolidated Communications.

The provider uses the money to build out the infrastructure, running fiber to the home. Subscribers then pay a monthly fee that goes toward paying back the bond. The fee is around $10 a month, said Monroe, who got a fiber connection at her home just last week.

Bonding is sometimes called the Chesterfield model, named after the first town to use the method to expand access to broadband. In 2018, New Hampshire was the first state to authorize municipal bonding for broadband. Since then, 18 towns have opted to use bonding to fund the broadband build-out. Of those, six towns are already providing service, according to Kahn, who has been tracking progress since he introduced the enabling legislation.

“It gave towns the ability to leverage provider investment to achieve universal coverage across their boundaries,” said Kahn. “And it’s worked great.”

But bonding does put the burden on towns to finance costly build-outs. Not all towns have the capacity to undertake the extensive research and planning required.

“The pain points are when you think about the risk and the debt towns are taking on, that rural towns are having to pay a premium over areas where they got service maybe just because they met population densities or things like that,” said Henry Underwood, a GIS specialist and planner at Southwest Region Planning Commission.

The proposed grant funding would be another option that towns could pursue. “It would function as an alternative to a town having to raise their own funds, or having to raise so much,” he said.

The town of Bristol has taken yet another approach to the broadband problem: The community financed and built its own infrastructure through a combination of grants, an appropriation from the town, and CARES Act funding.

Town Administrator Nicholas Coates said the approach has allowed the town to maintain more control over the quality and type of service residents will receive.

“We wanted to build the system the way we wanted it, not the way a telecom business wanted it,” he said. The town had been disappointed with the service it had been getting, and the provider wasn’t interested in providing better service.

“The only way that’s going to happen is if we build it ourselves and find partners to operate and manage it,” Coates said.

The town started working on the project in 2017, and Coates expects that connections will be available as early as June. The goal is to have service in every home and business.

Coates sees building out broadband as a way to revive the region’s economy. He wants to position Bristol as a rural, high-tech hub. Better Internet access would enable people to telework from Bristol.

“I grew up in New Hampshire, and people always talk about how northern New Hampshire hasn’t been able to redefine itself economically,” he said. “I would love to see the northern part of the state redefine itself and become thriving again. I think broadband is a critical piece of the new economy.”

Now, Coates is working with four other rural communities in the county as the chair of the Grafton County Broadband Committee, which includes the towns of Bristol, Campton, Canaan, and Haverhill.

“However we can get broadband deployed we should do it as quickly as we can,” he said. “Broadband is a critical infrastructure. Why should the power not reside with the people? They’re the ones paying for it.”


Local
NH colleges respond to enrollment cliff

Higher ed analysts have long predicted a spate of closures among colleges and universities due to declining demand and escalating tuition fees. That was before a global pandemic struck with blunt force.

To stave off an apocalyptic vision of empty classrooms and lost revenues, colleges slashed budgets and laid off staff. At the same time, they had to invest in technology for remote learning and coronavirus testing to safeguard students from a highly transmissible virus.

Total enrollment across higher education is down 2.5 percent, nearly twice the rate of decline in fall 2019, as reported by the National Student Clearinghouse Research Center. Even more striking is a pandemic-injected 13.1 percent drop among first-time freshmen.

While the number of high school graduates may improve slightly in the next five years, long-term projections for the Northeast from the 10th edition of “Knocking at the College Door” show such growth is not sustainable, and this demographic will shrink by nearly 13 percent by 2037. That leaves institutions in New Hampshire hustling after a slim pool of students.

Ryan Farquhar, a Hollis High School graduate, was accepted into the mechanical engineering program at the University of New Hampshire for the fall of 2020. But when the pandemic canceled the authentic campus experience, Farquhar deferred his admission. He is now researching schools farther south. “Being in New Hampshire is not quite what I need right now,” he says. “I need to explore somewhere else.”

Similar stories are playing out across the country. Many families decided to wait out the pandemic, says Mark Kantrowitz, a student loan expert and author of “How to Appeal for More College Financial Aid.” Their child may have taken a gap year, a leave of absence or decided college is not worth the investment.

Kantrowitz says that only 90 percent of those who leave college return, and when they do, their financial aid is recalculated, often against their favor, making it less likely they will complete college.

These are troubled times for higher education in the region, but Nathan Grawe, an economics professor at Carleton College in Minnesota and author of “Demographics and the Demand for Higher Education” and the forthcoming “The Agile College,” says colleges can break free from these dire projections by accessing student groups they haven’t in the past.

Articulation agreements between community colleges and private four-year colleges reduce barriers to student success while generating enrollment, says Grawe. New England College in Henniker recently broadened its applicant pool by extending its transfer agreement beyond New Hampshire’s borders to include any community college graduate in New England. Grawe says colleges may need to redefine their identities to grow and survive.

Eyeing the plummeting K-12 population, board members at Saint Anselm College in Goffstown decided to attract adult learners with the college’s first graduate offering in criminal justice. “It’s not in our wheelhouse to become a huge university,” says President Joseph Favazza, but he acknowledges that Saint Anselm is looking to expand revenue streams with graduate and certificate programs.

Grawe cautions college leaders to strategize beyond recruitment efforts. The unpleasant math, he says, is that there really are fewer students. “We have to talk about access broadly or we’re just talking about a zero-sum game where I grab a student that you got last year.”

Franklin Pierce University President Kim Mooney knows what her college, with campuses in Rindge and Manchester, is up against: fewer traditional-aged students seeking college degrees and competition with the Boston market. Against these odds, faculty and staff reviewed the school’s academic offerings to more carefully meet market and student demands.

This resulted in the launch of an accelerated master’s program in nursing in 2020 at the satellite Manchester campus. It targets those with bachelor’s degrees or higher in another field. Once completed, graduates are prepared to assume leadership roles in health care organizations.

“We knew there was a shortage,” says Mooney, “especially in our rural regions of health care providers, and now in light of COVID, it is more imperative than ever we continue to create and offer these innovative programs that prepare students for success.”

Linking academic programs to the needs of the health care industry has been a buffer against the pandemic, says Sue Stuebner, president of Colby-Sawyer College in New London. Last year, the college announced an up to $3.2 million investment from Dartmouth-Hitchcock Medical Center in Lebanon, the state’s largest private employer. The agreement, which launched with an initial installment of $750,000 followed by another million in 2021, supplied the college with the faculty and clinical support to implement five new health science programs.

“I’m really grateful we started when we did,” says Stuebner. The college typically enrolls 60 first-year nursing students, but this year, enrollment ballooned to nearly 100. Stuebner expects that to climb another 25 percent by 2022.

Colby-Sawyer added an associate’s program in health sciences and two master’s tracks in nursing. Pending review by the N.H. Board of Nursing, the college plans to launch an accelerated 15-month nurse completion program this fall.

Since the last recession, when enrollments peaked at New Hampshire’s community colleges, the number of traditional degree students has slowed, says Shannon Reid, spokesperson for the Community College System of New Hampshire (CCSNH). The decline hovered around 12 percent for the last four years.

Other niches in enrollment are on the rise: including short-term training programs such as line worker training, LNA, microelectronics and coding bootcamps. CCSNH’s Running Start, a dual college and high school credit-earning program with scholarships available for STEM courses, spiked 40 percent in the last three years to more than 8,000 students annually.

About half of CCSNH students are not in the traditional 18 to 22 age group. “This is the case in so-called normal times,” says Reid, but the pandemic heightens the need to help people re-skill or change careers.

Competing on price

Colleges and universities are working on short-term strategies for attracting and retaining students as well as long-term as COVID-19 turned the admissions process upside down. No more campus tours led by enthusiastic volunteers, personal meetings with professors or strolls around the campus greens.

Institutional visits are not likely to resume before this year’s high school graduates receive their acceptances. For fall 2021, students and their families must choose a college sight unseen. The deciding factor is often the calculated return on investment.

Southern N.H. University in Manchester is making an aggressive case for itself. After the pandemic hit, SNHU leaders accelerated plans to radically slash tuition as much as 50 percent to $15,000 or $10,000 per year with an updated 2021/22 curriculum that focuses on experiential and project-based learning, connecting courses to careers.

Last fall, SNHU offered incoming freshmen a hard-to-refuse bargain: free for the first year with online-only classes. This was a one-time overture to students already tasked with learning remotely because of public health concerns.

SNHU officials say the dramatic tuition cuts result from, in part, transitioning to a more transparent financial aid process, awarding monies based on need rather than merit. The university is hedging its bets that it can boost enrollment from 3,000 to 4,500 students on its Manchester campus by 2025.

Eclipsed only by Utah-based Western Governor’s University in online enrollments, SNHU can afford this risk because of the revenue it receives from its 100,000 or more remote students.

“In the wake of the COVID-19 pandemic, the unstable economy and the great uncertainty facing higher education, college affordability and accessibility have never been more critical,” stated SNHU President and CEO Paul LeBlanc in a press release in December.

The strategy seems to be paying off. After SNHU’s announcement of free tuition, enrollments on campus spiked 45 percent compared to fall 2019. The incoming fall first-year class is now the largest in SNHU’s history, with 350 more freshmen than the previous year, according to spokesperson Lauren Keane.

It’s not just private schools that are addressing the affordability crisis. Gov. Chris Sununu recently released his proposed budget, which recommends the University System of New Hampshire (USNH) merge with the Community College System of New Hampshire to better compete for the shrinking pool of students.

UNH has one of the highest in-state tuition rates in the country at more than $18,000 per year with fees. To minimize tuition costs, the University System, which comprises UNH, Keene State College, Plymouth State University and Granite State College, is holding resident tuition flat for the 2020-2022 academic years and plans, with elected state officials, to extend the tuition freeze through 2023, according to spokesperson Lisa Thorne.

Students whose family income makes them eligible for federal Pell grants can apply for a program that will cover their tuition for up to four years at any of the USNH institutions, essentially providing a free education. The program, called Granite Guarantee, has been in place since 2017. Close to 1,600 students used it in FY 2020, and the campuses expect that number to increase to at least 2,000 by FY 2021. New Hampshire Community College students transferring into USNH to complete their bachelor’s degree are also eligible. Numerous financial aid and scholarship opportunities can significantly reduce the true cost of attendance.

Plymouth State University is enticing students in Northern New England to its campus after launching the North Woods Connection tuition program about a year ago. The program, open to incoming first-year students from Maine and Vermont, has awarded $73,540 to 44 students. Participating students are eligible to receive program funding throughout their four years at Plymouth State, combining federal, state and institutional grants and scholarships to ensure out-of-pocket costs do not exceed the university’s in-state direct-billed costs.

Colleges are also figuring out how to cover basic operating costs in the wake of the coronavirus and an economic downturn.

Federal relief packages certainly helped. The U.S. Department of Education awarded about $14.2 billion to colleges and universities as part of the $2.2 trillion Coronavirus Aid, Relief and Economic Security (CARES) Act.

New Hampshire received around $41 million of those funds, which went a long way in covering institutional costs and helping students finance their education, says Debby Scire, president and CEO of the NH College & University Council. “[The funding] was critical to their vitality,” she says. “Without that, we might be having a really different conversation right at this particular moment.”

Recent legislation provides another $21.2 billion of relief funds to higher education in 2021, of which $90 million lands in the Granite State. These federal bailouts, though, do not make up for the estimated $185 million in losses due to the pandemic, says Scire.

Even before the pandemic, colleges and universities were suffering an ongoing decline in revenues, according to a recent report by Moody’s Investor Services. Moody’s suggests a further drop of 5 percent to 10 percent over the next year as universities absorb the shock of the pandemic.

“Reduced enrollment will lead to tuition revenue declines at a majority of public and private universities, while reductions in auxiliary revenue, such as that earned from housing and dining, will also be significant for some,” stated Moody’s analyst Michael Osborn in a press release in December.

Another barometer of financial stress is Forbes’ “College Financial Health Grades.” As of 2019, 177 colleges earned a D grade, a 61 percent increase from 2013. Only 34 earned an A+. With the exception of Dartmouth College and Southern N.H. University, New Hampshire’s private nonprofit schools earned a grade of C or worse, according to Forbes.

These grim measurements are not necessarily a forecast of doom because they conflict with other estimates. For example, Forbes’ D-graded Franklin Pierce University receives high marks in post-COVID fiscal fitness and resiliency from Edmit, a national educational advising company aimed at consumers. Its co-founder Nick Ducoff says Franklin Pierce sustained a multi-million dollar operating surplus and increased its endowment in recent years.

Edmit gives high marks to St. Anselm and New England College.

Colleges will suffer the battle scars of COVID-19 for years to come. But Scire points out the pandemic also spurs academics to experiment with programs and technology to keep students engaged and ultimately improve retention and graduation rates.


Local
top story
In Keene area, J&J shot is being reserved for harder-to-reach groups
  • Updated

Despite Johnson & Johnson’s COVID-19 vaccine once again being cleared for use, Keene’s vaccination site has no plans to carry it. Instead, the region’s doses will be used for harder-to-reach populations, according to an area public health official.

The pause on the one-shot vaccine was recommended by the Centers for Disease Control and Prevention and the Food and Drug Administration on April 13, after an extremely rare blood-clotting disorder was found in 15 women between the ages of 18 and 59 who had gotten the shot. Of those, three died, according to news reports.

The 15 cases represent 0.0002 percent of the more than 6.8 million Johnson & Johnson vaccines that had been administered nationally.

The pause was lifted April 23, after federal agencies reviewed the data and determined the benefits of having another COVID-19 vaccine available outweigh this rare risk.

“I don’t think there’s anyone who shouldn’t be getting it,” said Dr. Aalok Khole, an infectious disease physician at Cheshire Medical Center in Keene. “There was definitely a concern when these cases came to light ... and having gone through all the pros and cons, we know that this [vaccine] could be associated with a rare side effect of blood clots, but at the same time, the risks of COVID are just as much or even more.”

As of Thursday, 1,301 New Hampshire residents and 574,000 people nationally had died due to COVID-19, according to the latest state and federal data.

New Hampshire is deciding which of its 10 fixed vaccination sites will receive Johnson & Johnson doses, based on availability, according to Tricia Zahn, director of the Greater Monadnock Public Health Network, which is running Keene’s site on Krif Road.

On Sunday, three sites — in Concord, Nashua and Newington — will be offering the one-dose vaccine.

But at Keene’s Krif Road site, there are no plans to offer it, according to Zahn, who said the site has offered only the Pfizer-BioNTech and Moderna vaccines to date.

Instead, the local public health network will use its Johnson & Johnson allotment for home visits, senior-living communities and people experiencing homelessness.

Because the Johnson & Johnson vaccine needs just one dose, Zahn said it’s a much better option for these populations than the other two vaccines, which require two doses. “The [rationale] for this is to remove any unnecessary barriers for folks to be fully vaccinated which happens two weeks after one J&J vaccine,” Zahn said in an email.

She added that the state’s supply of Johnson & Johnson vaccines is limited, so it doesn’t make sense for Keene to carry it at the fixed site.

“Instead of having ~50 J&J vaccines provided arbitrarily to folks with appointments there during a weeklong period,” she said by email, “we save the J&J doses for those who have other barriers.”

The public health network — which covers all of Cheshire County and the 10 westernmost communities in Hillsborough County — had 300 doses left of its current Johnson & Johnson allocation as of Wednesday, Zahn said, when it resumed distributing it to people who are homebound.

The public health network’s mobile teams, which are vaccinating these hard-to-reach groups, have been giving Johnson & Johnson vaccines to them since mid-March, she added.

Those who are unable to leave their home to be vaccinated can call 2-1-1 to request a home visit, according to Zahn.

Vaccine outreach for people experiencing homelessness will be done through area agencies that work with that population, she said, such as the Hundred Nights shelter and Southwestern Community Services, both in Keene.

Separately, the Cheshire County jail is considering whether to switch to Johnson & Johnson, after starting to vaccinate inmates with the Moderna vaccine on April 15. The jail had originally planned to use the one-shot vaccine, but had to pivot at the last minute because of its pause, according to Superintendent Doug Iosue.

While people cannot choose which vaccine they receive, those who do not want the Johnson & Johnson vaccine — or any other vaccine — can decline and see if any other options are available that day.

The Greater Monadnock Public Health Network’s mobile teams will have mostly Johnson & Johnson doses, according to Zahn, but Pfizer will usually also be an option.

She added that those who’ve been given the Johnson & Johnson shot so far have been agreeable to receiving it.

“We haven’t had the pushback that some folks were expecting,” she said, “and so we are continuing on with saying ‘The best vaccine is the available vaccine.’ ”


Back