Already grappling with coronavirus, a political crisis stemming from President Jovenel Moïse’s assassination last month and resulting gang violence, Haiti was hit with a two-punch 7.2-magnitude earthquake and tropical depression this week, leaving almost 2,000 dead and thousands more injured or missing.

Thousands are without shelter because some 83,000 homes have been destroyed. International aid has been slow to arrive, delayed by Tropical Storm Grace’s heavy rains, and some Haitians are frustrated that their own government hasn’t done enough to help.

Also of little help has been the United States, one of the contributors to Haiti’s political and economic troubles, which has the ability to aid Haitians attempting to flee the country due to its three most recent crises, but has instead prevented them from accessing the protection to which many of them are entitled.

The Biden administration has sent a search and rescue team to the island and is transporting medical personnel to the most hard-hit areas and carrying out evacuations. It is also distributing much-needed supplies, such as food, hygiene kits, and tents.

But the administration is still turning away Haitians who have chosen to flee in light of recent events. Thousands of Haitians are still stuck in Mexico on account of US policies, which currently allow asylum seekers and other migrants to be turned away on the basis of pandemic-related border restrictions, known as the Title 42 policy.

Many more Haitians may seek entry: Though it’s hard to estimate how many, the Darién Gap, a treacherous stretch of jungle and swamp on the border of Panama and Colombia that has functioned as a migrant corridor, has seen more crossings this year — at least 46,000 — than it has in the previous three years combined, and most of those attempting to navigate it are Haitians and Cubans.

The Biden administration has allowed more than 100,000 Haitians who arrived in the US before July 29, 2021, to apply for Temporary Protected Status (TPS), which is typically offered to citizens of countries suffering from natural disasters or armed conflict. Those people are able to live and work in the US free of fear of deportation.

But that doesn’t help those who might be continuing to leave the country due to the political fallout from Moïse’s July 7 assassination, or now, in the aftermath of Saturday’s earthquake. What’s more, Haitians who have been prohibited from entering the US under Title 42, for which experts say there is no public health justification, appear indefinitely trapped in Mexico. And the US has continued to carry out deportation flights of Haitians despite the turmoil.

At the same time, the Biden administration has discouraged Haitians, as well as Cubans fleeing their communist regime’s recent crackdown on anti-government protesters, from trying to reach the US by boat. Officials have made clear that those who try will be intercepted by the US Coast Guard and will not be permitted to enter the US. Instead, they will either be repatriated back to Haiti or, if they can demonstrate the need for humanitarian protection, resettled in another country.

“The United States has deployed staff and resources to Haiti to help survivors of the earthquake, a vital step,” Wendy Young, the president of the immigrant legal aid group Kids in Need of Defense, said in a statement. “For the administration to then also send Haitians back into harm’s way would not only be senseless and cruel, but it would also deepen the grave humanitarian issues U.S. assistance is trying to address.”

The Biden administration could aid Haiti by rethinking policies that have barred Haitians from seeking refuge in the US. In light of the devastation from the earthquake and other recent crises, advocates are asking the administration to expand TPS for Haitians, indefinitely halt deportations and expulsions to the country, and allow Haitians at the US-Mexico border to temporarily enter the US on humanitarian parole.

These are all policy changes accomplishable through executive action. But the Biden administration has yet to try them, and its reticence may be undermining its Haitian foreign policy goals.

Open up legal pathways for Haitians to seek refuge in the US

The Biden administration could easily expand TPS eligibility for Haitians who have continued to arrive in the US beyond the July 29 cutoff date. It has already done so in recent months, pushing back the original cutoff date of May 21, 2021.

Beyond offering Haitians affected by the earthquake a pathway to protection in the US, allowing those affected by the earthquake entry into the US would bolster the Biden administration’s efforts to help Haiti recover.

Though the administration has already pledged millions in government funds for relief, granting TPS to more Haitians would give them the ability to work in the US and send money to their families back home, hastening the rebuilding process and stimulating a struggling economy. That can be a powerful tool for rebuilding: Haiti received $3.1 billion in remittances in 2020 alone, which represents almost a quarter of its GDP, and by some estimates, the US accounted for more than 80 percent of those remittances.

“An investment in the Haitian diaspora in the United States is an investment in a stable and strong Haiti and will benefit the United States,” Douglas Rivlin, a spokesperson for the immigrant advocacy group America’s Voice, said in a statement.

Without these remittances, Haiti’s economic development and infrastructure will suffer, which could drive more people to migrate to the US.

The Biden administration could also revive a parole program for Haitians arriving on the southern border and elsewhere in the US. Starting in 2014, the Obama administration allowed some 8,000 Haitians to come to the US under what is known as the Haitian Family Reunification Parole Program. Certain eligible US citizens and green card holders could apply for parole on behalf of their family members in Haiti who already had pending visa applications, but would have otherwise had to face years-long wait times.

Parole is granted only in situations where the Department of Homeland Security finds there are pressing humanitarian concerns or determines doing so would significantly benefit the public. The program was designed to help Haiti recover from a devastating 2010 earthquake that displaced hundreds of thousands of people, in part by increasing the remittances that Haitian migrants could send to their family back home.

The Trump administration, however, terminated the program in 2019. Over 130 human rights, humanitarian, immigration, and women’s rights organizations have supported reviving the program, but the groups are also calling for an even broader parole program that would apply to any Haitian arriving at a US border.

End pandemic-related restrictions at the border

The US continues to turn away the majority of migrants arriving at the southern border — including Haitians — under pandemic-related border restrictions, with exceptions for unaccompanied minors, some families from Central America with young children, and people who were sent back to Mexico to wait for their court hearings in the US.

Last March, at the outset of the pandemic, then-President Donald Trump invoked Title 42, a section of the Public Health Service Act that allows the US government to temporarily block noncitizens from entering the US “when doing so is required in the interest of public health.”

The policy has allowed US immigration officials at the southern border to rapidly expel more than a million migrants since the outset of the pandemic. Though scientists at the Centers for Disease Control and Prevention (CDC) opposed the policy initially, arguing there was no legitimate public health rationale behind it, then-Vice President Mike Pence ordered the agency to follow through with it anyway.

What’s more, public health experts have repeatedly said that migrants can be processed and admitted to the US safely. Indeed, this is already occurring on a small scale as some migrants are being tested for Covid-19 with private funds before they are allowed to cross the border.

Biden has not overturned the policy, despite outcry from immigrant advocates and humanitarian groups who say it prevents migrants from exercising their right under US and international law to seek asylum.

Yet the CDC nevertheless issued an updated order recently saying that the policy would remain in effect until the agency’s director determines that migrants no longer pose a “serious danger to the public health” in terms of spreading Covid-19. Officials at the Department of Homeland Security, meanwhile, have continued to insist that they are merely deferring to public health experts at the CDC in opting to continue enforcing the policy.

But keeping the order in place has serious humanitarian consequences for migrants trapped in Mexico.

Haitian Bridge Alliance, an organization that provides services to Black migrants at the border, estimates that 5,000 to 10,000 Haitians are still stuck in Mexico on account of Title 42, and most of them have been waiting between 18 months and five years for a chance to apply for asylum. They have reported facing discrimination in Mexican border towns, where they fear retribution from police or local armed groups.

“The administration should ensure that all Haitians and those seeking protection whose lives and safety are at risk are afforded the opportunity to request protection at our borders and at all ports of entry to the United States,” Young said.

Halt deportations and expulsions to Haiti

Many Central American families have been sent back to Mexico after being expelled at the US border. But many Haitian families have been sent back to their home country directly because the Mexican government has refused to take them back. The Biden administration briefly paused deportation flights to Haiti earlier this year due to escalating political violence. But officials have since chartered dozens of deportation flights to Haiti, despite the fact that many of those being sent back had no communities to return to.

One plane, carrying more than 130 people, including children as young as two, landed two days before the earthquake, said Guerline Jozef, co-founder and executive director of Haitian Bridge Alliance. She said that one recent deportee seeking help from her organization had gone to live with his sister, his only family member left in Haiti, but that sister, along with her husband and two children died in the earthquake.

There are no US deportation flights scheduled this week, but they could resume anytime thereafter. Jozef said that she wants a more long-term commitment — not one that lasts just a few days or weeks, which is not enough time for the conditions on the ground in Haiti to meaningfully improve. The administration has already acknowledged how dire those conditions are when it announced that it was partially expanding its Haitian TPS program last month.

“The Biden Administration should immediately cease deporting and expelling Haitians so as not to cause additional and needless suffering and harm,” Young said.

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Without a vaccine or treatment, the world has been forced to adopt severe tactics to slow the spread of Covid-19: social distancing, shutdowns, closures, and cancellations. As states in the US begin to reopen, it’s clear there is still much hardship to come — for those laid off, for businesses forced to implement costly new health measures, for those still at risk of infection.

But the global race to develop a Covid-19 vaccine to shield people from the infection is now well underway, and gaining ground by the week. There are now more than 150 vaccines under development from governments, nonprofits, and private companies. Several are in stages of human clinical trials. Some of the developers, including a research group in China and the US biotech firm Moderna, have already posted preliminary but promising results from their vaccine trials.

“This is an extraordinary time we’re living in right now,” said Anna Durbin, a vaccine researcher and a professor of international health at the Johns Hopkins School of Public Health. “The pandemic is motivating a lot of [vaccine] efforts around the world.”

Yet as tempting as it is to predict how the vaccine will fit into the great epic of Covid-19, it’s impossible to know exactly how it will play out.

The kinds of vaccines we get and how well they’re distributed could determine whether this virus will fade away or will linger forever. And many of the decisions that could affect those outcomes are being made now.

There are four key elements that will determine how a vaccine will play out — how effective it will be, when it will be ready, how much of it would be available, and what the world does in the meantime to limit Covid-19. Here are some of the possibilities, and how they could change the course of the pandemic.

Efficacy: Will the vaccine grant lifelong immunity, or will immunity weaken in a few years?

A vaccine is a drug that primes the immune system to fight off an infection from a specific pathogen, protecting the recipient from a future infection.

Given the number of trials underway, some researchers are optimistic that not just one, but multiple Covid-19 vaccines will likely come to fruition. But the amount of protection they provide could vary. On the high end of possibilities, the vaccine could provide what’s called “sterilizing immunity,” meaning the recipient would be safe from infection potentially forever. This would be along the long lines of the smallpox vaccine.

Then there are lesser degrees of protection that could allow the virus could take root but the vaccine would coach the host’s immune system to fight it off before it can do too much damage. The inoculated could experience mild symptoms and transmit the disease, but the vaccine would prevent the more dangerous outcomes. This is how some influenza vaccines work.

One variable shaping efficacy is how quickly the virus mutates. A faster rate of mutation would increase the likelihood that the vaccine would not generate an effective immune response to the virus. SARS-CoV-2, the virus behind Covid-19, is a single-stranded RNA virus. Such viruses are notorious for high mutation rates, but those mutations don’t necessarily occur in a way that would weaken protection from a vaccine.

“Measles is also a single-stranded RNA virus. It mutates a little but it doesn’t mutate away from the vaccine,” said Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “I think that you’re not going to need to do what you do with influenza where you have to get a yearly vaccine. Influenza is a moving target. That’s not going to be this virus.”

In fact, evidence seems to show that SARS-CoV-2 may have a relatively slow mutation rate for an RNA virus, increasing the chances that a vaccine would offer long-term protection.

“On the other hand, the vaccines will likely induce immunity that is short-lived and incomplete,” Offit said.

That is, the vaccine will likely offer protection that lasts a few years rather than decades or the near-lifetime immunity granted by some vaccines for other viruses.

And by “incomplete,” Offit explained that the vaccine would likely prevent the most severe manifestations of Covid-19, but it would likely do little to stop asymptomatic infections or milder forms of the illness.

This theory is based on what scientists have learned from how people have responded to other coronaviruses and how long people have retained immunity after an infection or a vaccination. For instance, people can get reinfected by the coronaviruses that cause the common cold within a couple of years of their first infection.

It’s not clear yet that surviving Covid-19 creates immunity to future infection. Even if it does, there’s isn’t a good way to tell how long that immunity will last besides waiting and seeing if survivors are susceptible again. That means it’s hard to gauge how long immunity will last from a vaccine at this point either.

The effectiveness of the vaccine can also vary for different groups. The shingles vaccine, for instance, is recommended for people over 50 years of age because they face higher risks of severe illness from the virus. The influenza vaccine has a different formula for people over the age of 65.

It may be the case that one type of Covid-19 vaccine is recommended for some age groups or people with preexisting conditions, while another type of vaccine is deployed to the general public. If immunity fades over time, people will need periodic boosters or revaccinations. And some people’s immune systems may not respond to the vaccine at all. “There may be people out there who are fundamentally unvaccinatable,” said Benjamin Neuman, a virologist at Texas A&M University Texarkana.

Timing: How soon until scientists find a vaccine that works?

A lot can change between now and whenever a vaccine for Covid-19 will become available. It may be months, it may be years — it’s not clear how long it will take, and that has huge implications for public health decisions we make in the meantime.

There is a global effort underway to speed up vaccine development. Governments are making efforts to fast-track funding and regulatory approvals, like combining phases of clinical trials. Companies are also putting their own researchers on the task. Nonprofit groups and philanthropists are also chipping in. That’s why some researchers are optimistic that a Covid-19 vaccine could arrive in record time. “This is as accelerated as it gets,” Offit said.

But the history of vaccine development shows that it can be a long, frustrating process. For instance, the mumps vaccine holds the record for fastest development time, which was four years. Most vaccines have taken much longer, often more than a decade.

The timing of when a vaccine comes out is critical because it determines the landscape where a vaccine would be released. Within the next two years, odds are Covid-19 will have spread, but the vast majority of the world’s population would still be unexposed and vulnerable to infection.

“A lot of optimism is swirling around a 12- to 18-month time frame, if everything goes perfectly,” Rick Bright, the former head of the Biomedical Advanced Research and Development Authority, told lawmakers in May. “We’ve never seen everything go perfectly. I think it’s going to take longer than that.”

As time goes on and the virus spreads, more people in a population will have been exposed to the virus, so fewer doses of the vaccine would be needed. The massive trade-off is that allowing the virus to spread further would come with more deaths and strain on the health care system.

A longer wait for a vaccine could mean increasing fatigue from pandemic control measures. Lockdowns and stay-at-home orders have already proven to be immensely costly and controversial. But a sudden relaxation of these measures without a vaccine or viable treatment for Covid-19 would allow the pandemic to continue spreading.

At the same time, the unprecedented resources flowing toward a vaccine doesn’t mean it will arrive any sooner. Even in the best of times, developing a vaccine is an enormous technical challenge that pushes the frontiers of science, demands the focus of swarms of researchers, and requires grueling trial and error. Despite the dozens of candidates under review, there is no guarantee any of them will pan out.

And those candidates that do show promise then need to undergo extensive testing for safety. A Covid-19 vaccine would have to be administered to millions, if not billions, of people. That means the rate of complications from the drug has to be so low that giving it to so many people is still a net positive.

For instance, one concern with vaccines is the risk of a problem known as vaccine enhancement or immune enhancement. That’s where the recipient’s immune system overreacts to the vaccine and may worsen the disease. It’s rare, but the likelihood of it has to be reduced as much as possible and balanced against the efficacy of a vaccine.

Still, a vaccine that offers imperfect protection could still be distributed; a vaccine that hasn’t met minimum safety thresholds could not.

In contrast, a treatment is only administered to people who are already ill, or as a preventive measure to people who face a high likelihood of getting infected. The risks and side effects for a treatment are more tolerable because they are weighed relative to the damage from the virus.

Reaching the point where a vaccine is ready to deploy requires extensive, slow, tedious, and expensive testing in humans. Until a vaccine reaches the necessary safety benchmarks, its use will be delayed. That’s a big reason pharmaceutical companies have been reluctant to invest in vaccine development on their own. But this testing is also why vaccines are some of the safest medical tools ever developed.

Some vaccines could be used before testing is completed under compassionate use guidelines, or for people in high-risk roles. A research team at Oxford University’s Jenner Institute said they may have a vaccine ready for emergency use as soon as September. However, a widespread rollout will take much longer.

Distribution: Will countries compete or collaborate on a global vaccination campaign?

The next obstacle to ending the Covid-19 pandemic with a vaccine is getting to enough people inoculated to achieve herd immunity. That’s where enough members of a population are immune to the virus, making it so that the virus can’t spread easily. The herd immunity threshold in a population can range from 60 percent to more than 90 percent, depending on how readily the pathogen can spread. At those levels, even people who aren’t immune receive protection since the virus is less likely to jump from person to person.

Depending on the prevalence of the virus at the time, that could mean vaccinating the majority of people on Earth. It’s not clear that the world will muster the resources, knowledge, and political will to do this.

“People don’t realize the full extent, that we as a country, we as a global community, have never vaccinated adult populations in the numbers that we need” to end the Covid-19 pandemic, said Saad Omer, a vaccine researcher and director of the Yale Institute for Global Health. “The numbers you would need for normalization — numbers you would need for NFL games to resume with crowds, the numbers you would need for a sense of normalcy, where grandma-can-attend-your-wedding kind of normalcy — would require vaccine-level herd immunity, and that would mean pretty high numbers.”

Billions of doses will be needed, which demands a robust supply chain and manufacturing capacity. Very little of this infrastructure exists now, and building it up would require extensive government and private sector investment.

A related issue is that different types of vaccines — mRNA, viral fragments, inactivated viruses — require entirely different manufacturing techniques, so one assembly line can’t be easily repurposed for another. Each approach requires its own infrastructure.

Vaccinating everyone would also demand legions of workers trained to administer it all over the world. It’s a process that will take years of sustained effort, and planning needs to begin right away. “Just the logistics for it are pretty substantial,” Omer said. “My concern is that we’re not preparing for it now.”

And at the outset, there won’t be enough vaccines for everyone, which means making difficult decisions about whom to prioritize for immunization.

Whether there will be enough vaccines to go around will depend on decisions and investments being made now. Philanthropists like Bill Gates, economists, and some nonprofits are calling to start building vaccine factories for different candidates immediately, even before testing is complete, with the expectation that many of these vaccine candidates will not be selected.

But a pandemic requires also international coordination. While researchers are sharing data about Covid-19 across borders, it’s not clear that countries agree on how to collaborate on making and distributing the vaccine. The US, for instance, has tried to lure vaccine developers to the country to make vaccines for exclusive US use. But the World Health Organization has called for sharing vaccine intellectual property free among companies and countries. Other world leaders have called for a people’s vaccine to Covid-19 to be made available to all countries free of charge.

The extent of global collaboration can therefore shape how quickly the pandemic phases out. If only a handful of countries have a Covid-19 vaccine and aren’t willing to help distribute it, the virus can continue to spread in other areas of the world. And until there’s herd immunity, the virus could be reimported into countries, even with a vaccine.

Public health responses: Can we keep up pandemic control measures until, and after, a vaccine arrives?

Since a Covid-19 vaccination campaign will likely take a long time, many of the current tactics to slow the pandemic will still be needed to an extent after a vaccine is available.

“Without a vaccine, it’s not as though we can do nothing,” said Meagan Fitzpatrick, an assistant professor at the center for vaccine development and global health at the University of Maryland School of Medicine. “With or without a vaccine, what we really need to be doing in the short term is contact tracing and testing. We need to test, trace, isolate.”

And limiting the spread of the virus can boost the effectiveness of a vaccine across a population, even if the vaccine itself doesn’t grant robust, long-term immunity to an individual. For instance, a vaccine that protects older people, coupled with social distancing and mask-wearing, would do more to slow the pandemic than any of these methods on their own. So a vaccine is ultimately one tactic in a suite of methods to control Covid-19.

“If the [moderately efficacious] vaccine is used outside of these comprehensive public health responses — contact tracing, social distancing — it would only protect the individual person for one to two years,” said Neuman.

Another element that could influence a Covid-19 vaccination campaign is the availability and effectiveness of treatments for the virus. Right now, there is no specific treatment recommended for general use — some experimental drugs like remdesivir have been allowed for emergency and compassionate use. However, if a widely available medicine were developed, it would relieve some of the urgency for developing a vaccine.

Treatments could also help optimize the distribution of vaccines. If a treatment is more effective in some groups but not others, say, the elderly, the more vulnerable group could become the priority for vaccination, putting limited vaccines to more effective use.

However, one of the biggest problems for Covid-19 vaccination may be the small but potent movement opposing vaccines. Already, some groups are whipping up conspiracy theories about purported harms of a vaccine that hasn’t even been developed yet. But if such resistance builds, it could undermine the effort to roll out a vaccine, allowing the virus to infect more people.

In thinking about how a Covid-19 vaccine would play out, it helps to look at lessons from other vaccines

The Covid-19 pandemic is unprecedented in many ways, so whatever scenario emerges will be unlike anything we’ve seen before. That said, there are some historical cases that can illustrate what could happen with a Covid-19 vaccine.

The most ideal outcome would be a vaccine akin to that for smallpox, rendering robust and near-lifelong immunity to the virus. With the smallpox vaccine, smallpox has become only one of two viruses to have been eradicated in the wild. “It’s obvious that we’re all aiming for a vaccine that is more like the smallpox vaccine,” Fitzpatrick said.

However, the world was very lucky with smallpox. The vaccine was unusually effective. The virus also had no known animal hosts and only spread from human to human.

Polio, another virus with an effective vaccine, lingers in some parts of the world despite an aggressive vaccination campaign, which has been thwarted by conflict and distrust of the vaccine. Now the Covid-19 pandemic is undermining some of the fragile progress against the disease.

That said, researchers do expect that a usable Covid-19 vaccine will emerge from the race. “I do have a lot of optimism about our ability to develop a vaccine against the coronavirus,” said Fitzpatrick. “The reason they are being tested now is because they have shown promising results in animal models.”

Even if a vaccine doesn’t prevent the disease entirely, it can still be useful if it reduces the severity of the illness. “You could imagine a scenario where something that is less than efficacious is rolled out because some benefit in the pandemic is better than no benefit,” said Omer. That would make it particularly helpful for people in high-risk groups like the elderly or people with preexisting health conditions.

But the lower levels of protection could also mean that an inoculated patient could still spread the virus, which means other control measures would be needed to protect high-risk groups.

On the other end of the spectrum, the race to develop a Covid-19 vaccine could be as fruitless as the effort to develop a vaccine for HIV, which has gone on for nearly 40 years.

Such an outcome would require weighing the trade-offs that may be necessary to live in a world where SARS-CoV-2 may be lurking for years. “We have to start thinking about prevention where we don’t have the magic bullet or the technological fix,” said Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health.

For HIV, the lack of a vaccine to date has led public health officials to focus on treatments like antiviral drugs and to encourage less risky behavior, like using condoms. These tactics have improved the survival rate for people with the virus and reduced its spread. Similar attention to treatment and behavior could mitigate the harms of Covid-19, but it may require lasting cultural changes like wearing masks and avoiding large gatherings.

Researchers do expect that some versions of vaccines will start being deployed in the next few months in limited cases, but getting a widespread vaccine at a record pace would require a lot of the aforementioned factors to precisely fall into place. A vaccine could still arrive in time to be used to protect the majority of people. But the world will still have to endure the pandemic until then.

Even with assembly lines in place ready to ramp up production, there will likely be a scarcity of vaccines at the outset. That will require officials to ration the vaccine and make difficult decisions about whom to prioritize in their distribution.

“It’s not an easy decision to make, and I don’t envy the people who have to make it,” Durbin said.

The central focus of the vaccination campaign would be the people facing the most exposure to the virus, like health workers, followed by people in essential roles like those in grocery supply chains and first responders. Then older people and those at the highest risk of complications could be vaccinated.

One method to economize vaccines is a ring vaccination strategy. For Covid-19, it would involve vaccinating just people who were exposed to the virus rather than everyone in a population, forming a “ring” around a known carrier. Ring vaccination was used effectively in the Democratic Republic of Congo to contain the Ebola virus outbreak there in 2019. But it requires extensive contact tracing to figure out who might have been exposed. With a virus that spreads as far and as quickly as Covid-19, this tracing effort would be far more laborious than it was for Ebola, especially given that many people infected with SARS-CoV-2 can spread it without showing symptoms.

“We would definitely aiming for a [vaccine] supply where we didn’t have to consider ring vaccination as a strategy,” Fitzpatrick said.

Another scenario is that the distribution of the vaccine may take longer than the duration of immunity it provides. If a Covid-19 vaccine provides two years of protection but takes five years to reach most people, then the first round of immunity could fade before herd immunity is reached. That’s why it’s important to get the vaccine delivered quickly to as many people as possible. Otherwise, pockets of infection could remain and cause sporadic outbreaks until people are revaccinated.

Supply chains are critical too. If countries are willing to pool resources to ramp up vaccine production, the demand for a vaccine could be met far more rapidly than with countries working on their own. It would also prevent some of the bottlenecks that have hampered other materials needed for the Covid-19 pandemic, like personal protective equipment and reagents for tests.

Communication is also going to be a critical factor for the deployment of a vaccine to explain why vaccines are safe and why getting vaccinated is so important.

It’s a hard-learned lesson from other disease control efforts. Measles, for instance, surged in recent years as vaccination rates stagnated or declined in some areas, leading to 140,000 deaths worldwide in 2018. Part of this was due to a lack of investment in vaccination campaigns, but the outbreak also arose in insular communities with low vaccination rates, as well as among people deliberately avoiding the vaccine and denying its safety.

Even amid a deadly pandemic, it’s unlikely that people who fear vaccines will suddenly change their minds with Covid-19. “That’s not how it works. People have huge motivated reasoning,” Omer said. “There will be vaccine acceptance issues.”

Resolving this will require campaigns to convince people to get vaccinated aimed not necessarily at the people who are most opposed to vaccines, but at people who are ambivalent. Without this kind of outreach, even the existence of a highly effective vaccine won’t contain the virus.

Taken together, these scenarios highlight just how difficult it is to anticipate the pandemic’s future. But they also show why it’s important to game out what’s possible, to build for the best, and to prepare for the worst. Billions of lives and livelihoods worldwide hang in the balance.

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The Argentina icon was not among the seven Barcelona figures included in the shot-stopper's list

Marc-Andre ter Stegen has named his dream XI of current and former team-mates, and there is no place for Lionel Messi in the side.

The goalkeeper’s time with Borussia Monchengladbach, Barcelona and Germany has seen him play alongside many top stars.

With a wide range of big names to choose from, Ter Stegen has listed a solid XI, but omitted the seven-time Ballon d’Or winner.

What has been said?

Ter Stegen opted to line his team up in a 4-4-2 diamond formation and listed seven former or current Barcelona heroes.

Gerard Pique, Jordi Alba, Sergio Busquets, Xavi, Andres Iniesta and Frenkie de Jong were all given the nod.

But the likes of Messi, Neymar and Luis Suarez were all snubbed by the 29-year-old.

Meanwhile, goalkeeper Janis Blaswich, Chelsea defender Antonio Rudiger and Germany team-mates Marco Reus and Mario Gotze were also named in the team.

The full XI is: Blaswich; Alves, Pique, Rudiger, Alba; Busquets; Xavi, Iniesta; De Jong; Reus, Gotze.

Why did Ter Stegen leave Messi out?

Ter Stegen did not mention his former team-mate when listing his team and did not explain why he did not make the cut.

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But the shot-stopper suggested that the pair did not always get along when he posted a farewell message on Instagram after it was confirmed Messi had left Camp Nou.

He wrote in the caption: “Although from time to time we did not share the same opinion, we always went in the same direction and each of us grew as a person regardless of winning or losing.”

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The 27-year-old vented his frustration online after a narrow defeat to the west London outfit earlier in March

Newcastle midfielder Isaac Hayden has been charged by the FA after comments he made on social media suggesting that Chelsea had the referee on their side in their 1-0 win over the Magpies at Stamford Bridge.

in a fiercely competitive contest in west London on March 13, bringing a nine-match unbeaten run for Newcastle to an end.

Hayden was unavailable for the game as he continues his recovery from knee surgery – while he also wasn’t selected in Newcastle’s 25-man Premier League squad for the latter part of the season – but vented his frustration over the performance of referee David Coote online after the final whistle.

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Hayden wrote on Twitter: “Some performance from the boys against 12 men.”

An FA spokesman has released an official statement confirming that Hayden will now face punishment for his remarks, which reads: “Newcastle United’s Isaac Hayden has been charged with a breach of FA Rule E3.1 following their Premier League game against Chelsea on Sunday 13 March 2022.

“It is alleged that the midfielder’s comments on social media after the game constitute improper integrity of the match official and/or are personally offensive and/or bring the game into disrepute.

“Isaac Hayden has until Wednesday 23 March 2022 to provide a response.”

What happened during the game?

Hayden’s anger stemmed from a number of controversial decisions taken by Coote during the contest, most notably after an incident involving match-winner Havertz in the first half.

The German playmaker escaped a red card for , while Newcastle later had a strong penalty appeal turned down.

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Jacob Murphy was clumsily taken down by Trevoh Chalobah just before the hour mark but Coote waved the Magpies’ penalty appeals away, leaving the away bench and supporters incensed.

Newcastle will be back in Premier League action after the international break, with a trip to Tottenham on the cards on April 3.

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The two nations will be battling for a ticket to represent Africa in Qatar in a two-legged encounter 

Ghana interim coach Otto Addo has named his 27-man squad for the 2022 Fifa World Cup playoff against Nigeria.

The two West Africa heavyweights are scheduled to meet in the first leg at the Baba Yara Sports Stadium on Friday, March 25. The second leg is scheduled in Nigeria on March 29.

Among the players included in the team is defender Daniel Amartey, who plays for Leicester City in England, midfielder Iddrisu Baba of RCD Mallorca, and his Arsenal counterpart Thomas Partey.

Captain Andre Ayew misses out owing to the red card he got in the recently concluded Africa Cup of Nations finals held in Cameroon.

Goalkeeper Joseph Wollacott is expected to start in goal ahead of Orlando Pirates shot-stopper Richard Ofori, while Gideon Mensah might marshal the defence alongside Amartey.

Meanwhile, Crystal Palace forward Jordan Ayew would be hopeful of leading the line.

The Black Stars are aiming at performing well in the final round of World Cup qualifiers after a poor outing at Afcon, where they were knocked out in the group stage after failing to win a match. 

Ghana squad:

Goalkeepers: Joseph Wollacott (Swindon Town -England), Abdul Manaf Nurudeen (KAS Eupen -Belgium), Lawrence Ati Zigi (St Gallen -Switzerland), Richard Ofori (Orlando Pirates -South Africa).

Defenders: Denis Odoi (FC Brugge -Belgium), Andy Yiadom (Reading FC -England), Gideon Mensah (Bordeaux -France), Dennis Korsah (Hearts of Oak -Ghana), Montari Kamaheni (Ashdod FC -Israel), Daniel Amartey (Leicester City -England), Joseph Aidoo (Bordeaux -France), Alexander Djiku (Strasbourg -France), Abdul Mumin (Victoria Guimaraes -Portugal).

Midfielders: Iddrisu Baba (RCD Mallorca -Spain), Edmund Addo (FC Sherif -Moldova), Mohammed Kudus (Ajax Amsterdam -Holland), Elisha Owusu (KAA Gent -Belgium), Thomas Partey (Arsenal -England), Daniel Kofi Kyereh (FC St. Pauli -Germany).

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Wingers: Issahaku Abdul Fatawu (Sporting CP -Portugal), Osman Bukari (FC Nantes -France), Joseph Paintsil (KRC Gent -Belgium), Yaw Yeboah (Columbus Crew -USA).

Strikers: Felix Afena Gyan (AS Roma – Italy), Christopher Antwi-Adjei (VFL Bochum), Jordan Ayew (Crystal Palace – England), Kwasi Wriedt (Holstein Kiel -Germany)

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It will be a make-or-break summer at Old Trafford with the contenders for the coaching job representing two current predominant schools of thought

If at the beginning of last week Ralf Rangnick held a flicker of hope he would be Manchester United manager next season, then defeat to Atletico Madrid in the Champions League second round has surely extinguished it.

Man Utd enter the international break on a run of one win in five matches in all competitions and closer to West Ham in seventh than Arsenal in fourth.

They are also on track to win 66 points, which, strangely enough, would be the fourth time they’ve hit that total in the last seven years.

in the post-Sir Alex Ferguson years.

It goes without saying they need to get the next appointment right but, .

By the end of next season, it will be 10 years since the club’s last league title, a significant milestone that will cause more soul-searching at Old Trafford.

By then, they need to have in place a long-term vision; a structure that has a league title in its sights but with an understanding that, realistically, it will take several years to get to the level that Jurgen Klopp’s Liverpool and Pep Guardiola’s Manchester City are at.

As Liverpool supporters can attest to, the first 10 years without a title are rough, but not as rough as the next 10.

It gets tougher with every year that passes, and Man Utd must ready themselves for a long process that demands patience. There is no quick fix and no time to waste.

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Broadly speaking, there are two directions United can go. One route is towards hard pressing and verticality, the other a more patient possession approach: the Klopp way or the Guardiola way. 

GOAL sources say that Mauricio Pochettino and Erik ten Hag are level-pegging in the eyes of the decision-makers at United, with Julen Lopetegui, Thomas Tuchel and Luis Enrique the others being considered.

Luis Enrique is surely out of the question as he is determined to lead Spain into the World Cup this winter. The other four neatly reflect that choice between the two dominant tactical systems in European football.

Pochettino or Tuchel represent Kloppites

The Argentine has been tracked by United for a very long time now and it is believed he would love the job.

Pochettino has struggled to handle the egotism that drives Paris Saint-Germain, finding player power too great for his tactical beliefs to take hold.

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But rather than see Pochettino’s time in Paris as a sign he is not capable of managing a difficult group, we should view him as someone with the lived experience to handle it.

and, right now, United are hovering alarmingly close to the same approach.

From the leaks to broadsheet newspapers about Rangnick’s methods to the whinging we see on the pitch, Man Utd could do with a manager who has seen this kind of behaviour at its worst and will work to stamp it out before things spiral out of control.

From a tactical perspective, he is the ideal fit. Pochettino’s desire to play hard-pressing football that focuses on verticality in the transition is in keeping with the Premier League’s tactical shift towards the Germanic way of playing.

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He is not hugely dissimilar from Thomas Tuchel – another manager GOAL understands United are assessing – although Pochettino teams press higher.

Pochettino’s focus on using overlapping full-backs to provide penetration from out wide means but, elsewhere, there are the foundations for a move towards direct football that makes use of the transitions.

Fred would be an ideal box-to-box midfielder for Pochettino or Tuchel, while Jadon Sancho, Marcus Rashford and Anthony Elanga have the explosive pace that would suit the attacking attitudes of the two managers.

However, neither would be keen on Harry Maguire, requiring a more agile defender to cope with holding a high line, while more press-resistant and creative players are needed in central midfield. 

Then there is the Cristiano Ronaldo problem, as the Portuguese’s presence may inform which path United choose.

His unwillingness to press as part of a collective system and sacrifice himself makes the Kloppite option less appealing than the Guardiola style of suffocation and control, which, in theory, allows for a penalty-box poacher.

Ten Hag or Lopetegui represent Guardiola approach

Man Utd may wish to see themselves more as over-dogs, as football royalty who want to completely dominate matches as Manchester City do.

If that’s the case, then Ten Hag or Julen Lopetegui – the latter lower further down the list – make more sense due to their greater focus on possession.

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Ten Hag has been credited with reviving the classic Ajax teams of the past with his slower style of football, which requires constant circulation of possession; opponents are gradually worn down after being camped in their own third for long periods.

Lopetegui’s Sevilla are less successful – owing to their relative size compared with the superclubs in Spain- but they hold 60.8 per cent possession on average in La Liga. 

Their primary ambition is to keep the ball high up the pitch for long periods and while this works from a defensive standpoint – they have the best record in Spain – it does mean Sevilla struggle to break opponents down. They have drawn 12 times domestically this season.

Perhaps Lopetegui would have greater success with a more powerful team like Man Utd.

Certainly, with Ronaldo, Bruno Fernandes, and (possibly) Paul Pogba in the starting XI, the territorial advantages of being managed by Lopetegui or Ten Hag should mean more meaningful possession in creative areas of the pitch for United’s stars.

Aside from the forward areas, there would be few differences in the transfer policies of the respective candidates. Lopetegui and Ten Hag also consider attacking full-backs to be crucial, and would want a right-back.

United are crying out for a defensive midfield destroyer who can play progressive forward passes, so no matter who comes in, Declan Rice ought to be a target.

Pochettino ticks all the non-tactical boxes

In choosing Guardiola or Klopp, possession or verticality, it is initially tempting to assume the slower and more dominant system is a better fit.

It is closer to the club’s self-image of global domination and more accommodating to the individualists in their rank.

But the main reason United are in this mess is their nostalgia, inability to move with the times, and indulgence of superstars. For that reason, and , Pochettino is the answer.

Many United fans are concerned about the lack of silverware in Pochettino’s history but, of all the available candidates, he possesses the best mix of attributes to build a long-term project with the support of the dressing room and supporters. 

That is the most important trait of all, far more so than pre-existing ideas of the candidates’ tactical philosophies.

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Because while crude distinctions can be made between the four names here, in reality, all are very talented coaches capable of some adaptation to the unique demands of the Premier League and the idiosyncrasies of the current squad.

The advantage of Pochettino is a hardened appreciation of what to expect from an egotistical dressing room; a tactical ideology built on self-sacrifice that has been proven to work in the Premier League; and a track record of nurturing young players.

United are forever trapped in a media circus, but with a known and likeable figure like Pochettino in charge, there would at least be space – emotionally as well as tactically – for the project to take baby steps over the first two years.

The Manchester United superstar is away on international duty as his country prepares to take part in the play-offs for Qatar 2022

Cristiano Ronaldo has vowed to “fight” for Portugal’s right to grace the 2022 World Cup, with the Manchester United superstar determined to figure at what could be his last major global showpiece.

The five-time Ballon d’Or winner is now 37 years of age and, despite stating on a regular basis that he into his 40s, is .

He has graced four World Cup tournaments in the past, while savouring European Championship glory in 2016, and intends to reach a fifth as on Thursday.

What has been said?

Victory over Turkey would line up an all-or-nothing final showdown with either Italy or North Macedonia on March 29, with Ronaldo already setting his sights on a place in Qatar.

He posted on Instagram: “Total focus on the 2022 World Cup.

“Proud, as always, to represent Portugal.

“We know that the path will not be easy, we have the utmost respect for the opponents we will face and who share the same goals as us.

“But together, we will fight to put Portugal in its rightful place. Let’s do it!”

Portugal could not wish to have a more talismanic presence at their disposal when taking aim at another World Cup finals, with Ronaldo continuing to send records tumbling.

He is the all-time leading goalscorer in men’s international football with 115 efforts to his name and has won more caps, 184, than any other European player.

Ronaldo is the only player in history to have found the target at nine successive major tournaments – with that run stretching back to Euro 2004 – and is the leading scorer at European Championships with 14 goals on his resume.

Who else are Portugal relying on?

While Ronaldo, as national team captain, will be expected to lead by example for Portugal as they look to book tickets to Qatar, Fernando Santos has plenty of alternative match-winners in his ranks.

One of those also plies his club trade at Old Trafford, with Bruno Fernandes echoing Ronaldo in a pre-match rallying call prior to lining up against Turkey.

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He has said on social media: “Now more than ever, we all need to be united.

“We will do everything to reach the World Cup.”

Portugal last failed to reach the World Cup in 1998 and are currently sat eighth in the FIFA world rankings.

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The striker tells GOAL about her return from an ACL injury, battling with Lea Schuller to start and why the Frauen-Bundesliga champions are so good

Jovana Damnjanovic wasn’t on the pitch when Bayern Munich were last in the knockout rounds of the Women’s Champions League, but she remembers it well.

It was last season’s semi-finals and the German giants travelled to London with a 2-1 advantage over Chelsea from the first leg.

At full-time, that had evaporated. .

Damnjanovic was nine months into her ACL recovery at that point and while her rehab would be setback-free, it was these moments that were difficult for the Bayern striker.

“I think the hardest thing actually, for me, was – especially at the end of the season – seeing the team struggling, especially, for example, against Chelsea or some games at the end and you’re not able to help them,” she tells GOAL.

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“You’re there, you’re screaming, you’re trying to be loud, to motivate them, but you cannot actually do anything on the field.

“I mean, the players said it was amazing, that they heard me the whole time, but still just not being there, not being able to tackle someone, to score the goal, to do whatever, I think that was actually the hardest moment for me.”

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Fast forward almost a year and Bayern are back in UWCL knockout action this week, .

This time, Damnjanovic can play the role she wants. She made her return from injury back in pre-season and says she feels “even better” now. “I feel like I was never injured.”

The Serbia international, Bayern’s main source of goals in the season before being sidelined, has returned to stern competition for her place, though, in the form of Lea Schuller.

Signed from Essen last summer, she took on the goalscoring burden in Damnjanovic’s absence, netting 16 times as the team won its first league title in five years.

The relationship between the pair is not like it is for most players fighting for the same shirt, though.

When Damnjanovic was substituted at half time against Cologne this month, Schuller took her place with the game goalless and went on to score a hat-trick. She ran straight to her fellow striker to celebrate.

“I came to her at half-time and said, ‘Come on, bro, you’re going to score twice today’ – and then she scored three,” Damnjanovic explains. “After the third goal, she ran to me and we celebrated together.

“It’s always great to have somebody who is pushing you to be even better. I think that is also great for her, and that’s also great for me.

“Sometimes, she’s playing; sometimes, I’m playing, but we are always supporting each other, 100 per cent.

“I’m super happy when she scores. She’s super happy when I score. For us, that’s just a normal thing.

“It’s funny that people are always surprised when they see that we understand each other that well.”

Damnjanovic knows where that unity can take a team.

Before she signed for Bayern, she was playing for Sand, a small club in the south of Germany with resources nowhere near what the German champions have. Yet, the team reached the DFB-Pokal final two years in a row.

“We didn’t have such a strong team in Sand, like other teams, or amazing players. But I realised when you have a good group of people and when everybody is investing 105 per cent, you are going to be able to reach amazing things,” she remembers.

“In those two years, we beat Bayern, we beat Wolfsburg, we beat everybody, literally.

“When people are believing in you and you believe in your team, I think everything is possible.”

There are a lot of exciting possibilities for Bayern in these coming weeks.

They are locked in an intense title race with Wolfsburg, the team they took the league crown from last year and also the team they will face in the semi-finals of the cup.

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It was with Wolfsburg that Damnjanovic got her first taste of German football and her first experience outside of Serbia, joining the club as a teenager.

She would leave to play regular football with Sand after two seasons, but what she learned from training alongside such great players was huge. The spell also brought her a Champions League winners’ medal, in 2014.

“I didn’t realise how big that was, at that time.” she admits. “I thought, ‘Okay, cool. I’m 19. It’s my first season in the Champions League. I won it’, you know? Then, you get a reality check and just realise, ‘Oh, it’s not that easy at all’.”

To get the chance to win it again with Bayern then, what would that mean?

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“I couldn’t even compare it with anything,” she says, after pausing to imagine it.

“With this team, with this group of girls and people, it sounds stupid but we are not just team-mates. We are way more than that.

“I couldn’t be happier than to win the Champions League with this group. Every single one of them is amazing in their special way. Not just like two of them – all of them.”

The former Chelsea and Juventus midfielder also stressed the importance of winning both their upcoming friendly games

France head coach Didier Deschamps has insisted that their upcoming friendly matches against South Africa and Ivory Coast have value.

The world champions are set to take on Ivory Coast’s Elephants at Stade Orange Velodrome in Marseille on Friday, before facing Bafana Bafana at Stade Pierre-Mauroy in Lille next week Tuesday.

Nicknamed Le Bleus, France have included high profile players such as Hugo Lloris, Raphael Varane, N’Golo Kante, Olivier Giroud and Kylian Mbappe in their squad for the two games.

There have been critics who have slammed the two matches against the African sides, suggesting that they have little value for Les Bleus, but Deschamps has dismissed this suggestion.

“Some of you will say that these matches have no value but it is better to win them otherwise they will increase in value,” Deschamps said during a press conference according to .

“I prefer to be in my place, qualified for the World Cup with two friendly matches on the programme than that of my Italian or Portuguese counterparts who will face each other in the play-off.”

Les Bleus have already qualified for the World Cup finals which will be hosted by Qatar later this year after they dominated their qualifying group – recording five wins and three draws from eight matches.

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“Do not trivialise an international gathering. The pleasure of meeting up is there because the players have chained matches with disappointments and moments of happiness,” the retired defensive midfielder continued.

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“We haven’t been together for four months: it’s the return of the French team. Next, I am realistic. Many players are there, had very important matches before and will have very important ones after.”

“We are going to play in Lille, the stadium is full and in Marseille, the stadium will be.”

France will be looking to avenge their 2-1 defeat to Bafana at the 2010 Fifa World Cup finals in Bloemfontein.

The Bafana Bafana striker is set to miss forthcoming international friendlies owing to an injury sustained in recent club engagement

South Africa head coach Hugo Broos believes a six-month break would help Percy Tau fully recover from his consistent injury problems.

His latest setback was in Al Ahly’s recent Caf Champions League assignment away to Al Merrikh, where his team won 3-1 with the 27-year-old scoring the first goal. Taher Mohamed replaced Tau in the second half.

The forward has been experiencing muscle injuries while representing club and country, and Broos has suggested a solution for him.

“It is a problem, what I said, Percy is already eight months injured, maybe I am exaggerating but it’s not a surprise. In June with the transfer to Ahly he didn’t train so much, he didn’t play so much,” the 69-year-old said as quoted by .

“Then he played two games, Zimbabwe and Ghana, injury, then he started with Ahly, injury. So I think for Percy it will be good that he trains for six months and not play because his physical basics are not good.

“Every time he plays he’s overloaded and gets injuries, what we see with the players of [Mamelodi] Sundowns and [Orlando] Pirates because the program is so overloaded, they get injuries, this is something normal and this is what happened with Percy.

“His basics are not good, he’s playing too many games and doesn’t have the physical opportunities to do that and he’s falling from injury to injury.”

Tau will not be involved as Bafana Bafana play Guinea’s National Elephants in Belgium on Friday and world champions France in Lille on Tuesday in international friendlies.

He has since been replaced by Royal AM star Victor Letsoalo in the Broos’ squad.

The upcoming friendlies would be the first time Bafana return to action since their 2022 Fifa World Cup hopes were upset by Ghana in November 2021.

South Africa squad

Goalkeepers: Ronwen Williams (SuperSport), Brandon Petersen (Kaizer Chiefs), Bruce Bvuma (Kaizer Chiefs), and Veli Mothwa (AmaZulu).

Defenders: Nyiko Mobbie (Sekhukhune United), Terrence Mashego (Cape Town City), Siyanda Xulu (unattached), Nkosinathi Sibisi (Golden Arrows), Veluyeke Zulu (Chippa), Rushine De Reuck (Mamelodi Sundowns), Lyle Lakay (Mamelodi Sundowns), Khuliso Mudau (Mamelodi Sundowns), Rivaldo Coetzee (Mamelodi Sundowns), Bandile Shandu (Orlando Pirates), and Athenkosi Mcaba (Stellenbosch).

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Midfielders: Sbonelo Cele (Golden Arrows), Pule Mmodi (Golden Arrows), Ethan Brooks (TS Galaxy), Keagan Dolly (Kaizer Chiefs), Teboho Mokoena (Mamelodi Sundowns), Goodman Mosele (Orlando Pirates), and Thabang Monare (Orlando Pirates).

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Strikers: Evidence Makgopa (Baroka), Victor Letsoalo (Royal AM), Mduduzi Mdantsane (Cape Town City), Fagrie Lakay (Pyramids), Victor Letsoalo (Royal AM), Lyle Foster (Westerlo), and Bongokuhle Hlongwane (Minnesota).