Revolutionary. A game changer. Spine chilling. Those are some of the words experts used to describe fresh data for lenacapavir, a twice-yearly shot developed by Gilead Sciences for the prevention of HIV.

Their enthusiasm stems from a more succinct word: zero. That’s the number of cases of HIV that developed in the women and adolescent girls who received the drug in a huge study conducted across dozens of sites in South Africa and Uganda.

Lenacapavir has the potential to at long last move the needle on the incidence of HIV. The virus caused some 1.3 million infections and 630,000 deaths in 2022. One expert told me this preventive drug, if given to enough at-risk women, could be the way to get close to eliminating pediatric HIV. Another talked about finally bending infection curves in young women and adolescent girls, who account for 77% of new infections among younger people in sub-Saharan Africa.

But none of that will happen without the right pieces in place to get the drug to everyone who needs it as soon as it receives regulatory clearance. That’s an all-hands-on-deck effort that should be underway now.

Lenacapavir’s advantage is its unique mechanism and months-long activity. While other HIV antivirals target enzymes the virus needs to replicate, lenacapavir takes aim at the capsid, an eggplant-shaped shell made up of hundreds of proteins that carefully assemble to protect the virus’s genetic material. And it turns out, disrupting that shell works beautifully as a prophylaxis: In the trial, there were no HIV infections in the more than 2,100 women who received the drug, compared with infection rates of 1.5% and 1.8% in women taking Truvada or Descovy, two types of daily pills to prevent HIV infection (also known as PrEP).

“I’ve been doing this for almost 40 years, I have never, ever seen a result like this before,” says Salim Abdool Karim, an infectious disease epidemiologist and director of the Center for the AIDS Programme of Research in South Africa. “To see a 100% efficacious product? It just blew my mind.” (CAPRISA enrolled several hundred women for the study, though Abdool Karim was not directly involved.)

A separate prevention study of lenacapavir in men who have sex with men and transgender people is underway, after which Gilead plans to ask for regulatory approval. (The drug is already on the market in the U.S. and elsewhere as a treatment for HIV.)

But the data involving young women are already extraordinary. The existing options for PrEP — whether daily pills, the dapivirine vaginal ring, or ViiV’s bimonthly shot cabotegravir — have not moved the needle much on rates of infection among young women. “A daily intervention needs a daily decision: ‘I’m going to protect myself,’” says Linda-Gail Bekker, director of the Desmond Tutu HIV Centre at the University of Cape Town and an investigator in the trial.

A wildly effective, twice-annual shot could make a huge difference in bending infection curves, particularly among women and infants.

Yet this astounding success can only come to fruition if lenacapavir reaches the people who need it. That comes down to access and delivery: Lenacapavir needs to be made at a volume that it can be widely available, at a price that makes it widely accessible, and distributed in a way that makes it easy and appealing for everyone to stick with.

The ball is in Gilead’s court on the issues of price and supply. And Gilead is, so far, saying all the right things. The same day it revealed the astonishing trial results, the biotech company announced a two-pronged approach to ensuring lenacapavir can be widely available in the places being hit hardest by HIV. It will form license agreements that allow generic firms to make and sell the drug in low-resource countries hard hit by the HIV epidemic, a strategy used successfully in the past. And until that generic supply is up and running, the company says it will set aside supply for those regions. That’s elicited cautious optimism.

But Gilead will also need to commit to transparency at every step of the process. While the company has made substantial efforts to ensure people in low- and middle-income countries can access its HIV therapies, it also has been criticized for some of its tactics around the price and development of certain medicines. Global health experts would like to better understand which countries will have access to low-cost generic versions of the drug, and be assured that the company will work to transfer not only patents, but know-how to ensure a speedy increase in manufacturing.

That third piece of the equation, delivery, will require a huge effort by global health agencies and their partners to study the most effective way to get the treatment to at-risk groups — not just once, of course, but every six months during the years they might be vulnerable to infection. The work these groups have already done to provide existing forms of PrEP provides a good foundation for distributing lenacapavir, says Carmen Pérez Casas, senior strategy lead at Unitaid. Meanwhile, studies will need to be quickly designed and funded to understand the best way to ensure broad and consistent use of the biannual shot.

This new drug, while astounding, does not obviate the need to keep pushing for an effective HIV vaccine. Yes, the new drug will likely meaningfully reduce infections (which also reduces transmission). But a vaccine that ideally can be administered before puberty is the key to eradicating this deadly virus.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

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Marisol Doyle wasn’t bothered by the frozen dough and canned mushrooms common in the pizzas she ate as a kid growing up in Sonora, Mexico. It was comfort food.

“But as an adult,” she said, “I wanted something better.”

Doyle’s first experience with better pizza came in 2006 at Pizzeria Bianco, in Phoenix, and it was probably a lot like yours. Mozzarella that melts into pools. Crust that invites comparisons to fresh bakery bread. These are qualities found in the Neapolitan-style pies served at the wood-fire-oven pizzerias that are now fixtures of urban America.

In recent years, they’ve become fixtures outside cities, too, drawing diners to the types of small communities — from southern Illinois and coastal New England to rural Wisconsin and Oregon — whose restaurant cultures are often dominated by national chains. All those fussed-over pies, with their blistered crusts, basil sprigs and hot honey drizzles, taught Americans they could ask more from a dish routinely eaten from a cardboard box — and consumed by about 1 in 8 people on any given day, according to U.S. Department of Agriculture research.

That broad appeal, coupled with the relatively low cost of opening pizzerias and the ease of acquiring the information to master high-quality pizza-making, has made the dish a uniquely effective vehicle for chefs to find a voice while also making a living. Until recently, chefs looking to make sublime Neapolitan pizzas would have few options beyond traveling to Italy, said Chris Bianco, who opened Pizzeria Bianco in 1988.

“Today you just swipe and study and you can bring great pizza to any town, anyplace,” said Bianco, who is arguably the country’s most influential pizzaiolo.

The ensuing renaissance has done more than make pizza in the United States better than it has ever been. It has also made the country home to the world’s best pizza — or, at least, in Bianco’s estimation, “the most hyper-focused and style-diverse” collection of pizzerias.

The open kitchen at City House, in Nashville, Tenn., May 20, 2024. Since the early 2000s, the variety and quality of pizza made by ambitious chefs all over the country have only gotten better. (William DeShazer/The New York Times)

There is no question that American pizza is better than ever virtually everywhere. That includes Cleveland, Mississippi, where Doyle opened Leña Pizza + Bagels last year.

The pizzeria is part of a rare culinary phenomenon: a restaurant trend born of big-city chef culture that doesn’t peter out at the inner suburbs. Leña resembles any number of smart urban trattorias, except that it’s located in a small-town storefront, on a street called Cotton Row.

Leña’s spiritual kin includes an astonishingly diverse array of restaurants in all corners of the country, including Pizzeria Sei, the Tokyo-influenced, neo-Neapolitan pizzeria in Los Angeles; Short & Main, a pizzeria-oyster bar in Gloucester, Massachusetts; Yellow, a Levantine bakery-pizzeria in Washington, D.C.; and Lincoln Wine Bar in Mount Vernon, Iowa.

While the character and food of these restaurants vary widely, nearly all feature a cross-cultural blend of dishes whose common denominator is a supple, flavorful crust.

At Leña, there are the expected, crowd-pleasing pizzas, like margherita and pepperoni (named pepperrory, after Doyle’s husband and business partner, Rory), but also pies highlighting seasonal produce and Doyle’s Mexican heritage, including the Sonoran, which replaces tomato sauce with refried beans and is topped with housemade roasted jalapeño salsa.

Leña has become a destination in the rural Mississippi Delta. It was a hit even before it opened, as a frequent pop-up restaurant. Doyle recalls posting her plans for Leña after returning home from Naples, Italy, where she studied pizza-making at Scuola di Pizzaioli and the Associazione Verace Pizza Napoletana.

“People would come up to me in Walmart to ask me when the restaurant was going to open,” Doyle said.

Fancy pizzas are nothing new in the United States. They’ve been on the menus at Chez Panisse Café, Spago, Beverly Hills and Al Forno in Providence, Rhode Island, since the early 1980s. In 2003, Bianco became the first pizzaiolo to win a regional chef award from the James Beard Foundation.

But the first glimmer of the current pizza boom didn’t flicker until the 2000s, with the opening of pizzerias that were also well-rounded, erudite neighborhood restaurants, like A16 in San Francisco, 2 Amys in Washington, D.C., and Franny’s in Brooklyn. Tandy Wilson was cooking in California at this time, including at Tra Vigne, a celebrated Napa Valley restaurant with a wood-burning oven that served pizza at lunch and, occasionally, dinner.

Wilson returned to his native Nashville, Tennessee, believing pizza could be a medium for creativity, and made it a central feature of his restaurant, City House, a regional Italian restaurant with a Southern accent that opened in 2007. He also thought pizza would attract a broader array of diners.

“Pizza was this way of opening the playing field a little bit and bringing more people to the table,” Wilson said.

Sang Woo Joo prepares a pie at Pizzeria Sei, in Los Angeles, March 18, 2022. Since the early 2000s, the variety and quality of pizza made by ambitious chefs all over the country have only gotten better. (Ryan Young/The New York Times)

The chef-driven pizzeria was suddenly a thing. Restaurants like Roberta’s, in Bushwick, Brooklyn, and Gjelina, in Venice, California, attracted the sort of praise historically reserved for restaurants with white tablecloths. In a 2011 New York Times review, Sam Sifton called Roberta’s, which opened in 2008 with no heat or liquor license, “one of the more extraordinary restaurants in the United States.”

John Hall, like many other chefs working in traditional high-end restaurants, watched with interest as acclaim flowed to this new strain of pizzeria. He was attracted to the restaurant style as an affordable means to transition from hospitality employee to owner. The chef, who worked for 10 years in some of New York City’s most heralded restaurants, including Gramercy Tavern and Per Se, wanted to own his own business and home.

Hall finally concluded that those things wouldn’t happen in New York after hearing that one of the city’s best-known chefs had to borrow money from his father-in-law to buy an apartment. He left to open Post Office Pies in his hometown, Birmingham, Alabama, in 2014.

“I didn’t have to have fine glassware and plateware and linen and all of the expenses that go along with opening a high-end restaurant,” Hall said of the wood-fire pizzeria, which he and his partners, Mike Wilson and Brandon Cain, opened without outside investors. “That gave me the opportunity to really be my own boss.”

Since pizza-making, as many home cooks have discovered, can be mastered without going to cooking school or even working in a restaurant kitchen, the dish has provided an alternative pathway for more people to become chefs and restaurant owners.

Ann Kim had never even worked in a restaurant when she opened Pizzeria Lola in Minneapolis with her husband and business partner, Conrad Leifur, in 2010. Kim is now an acclaimed chef, having opened a series of well-regarded restaurants, including the genre-bending Young Joni, a pizzeria that showcases the flavors of her native South Korea.

“I make the kind of pizza I want to eat,” Kim told The New York Times in a 2019 interview. “No one ever told me you can’t do that because you’re Korean.”

The restaurant is part of a growing cohort of pizzerias inspired by the food of countries other than Italy, including the Mexican American San Lucas Pizzeria, in South Philadelphia; the Asian-inspired Hapa Pizza, in Portland, Oregon; and the Argentine mini-chain Boludo, in Minneapolis.

A pizza cooks in the wood-fire oven at City House, in Nashville, Tenn., May 20, 2024. Since the early 2000s, the variety and quality of pizza made by ambitious chefs all over the country have only gotten better. (William DeShazer/The New York Times)

Not all of the compelling, new-generation pizzerias rely on wood-fire ovens. Khurshed Ahmed opened Amar Pizza, in Hamtramck, Michigan, after working mainly in chain restaurants, including Domino’s. Amar features both thin and Detroit-style pies, baked in a gas oven, with ingredients from Bangladesh, where Ahmed was born. The sauce for one of the signature pizzas is a chutney commonly found on Bangladeshi dinner tables, made with dried shrimp, anchovies, roasted garlic and cilantro.

It is far from the only Bengali influence on Amar’s menu. “A lot of pizzerias offer pasta,” Ahmed said. “I figured us being a Bangladeshi pizzeria, we could have biryani.”

Some of the best pizzas found in rural America come from multipurpose businesses. Bakeries like Tinder Hearth in Brooksville, Maine; Flour & Flower in St. Joseph, Minnesota; and White Salmon Baking Co. in White Salmon, Washington, are renowned for pizzas served on select evenings.

Scratch Brewing Company, in Ava, Illinois, becomes a pizzeria on weekends. One of its more memorable pies is spread with pesto made from wild garlic, basil and other herbs, foraged in a nearby forest by the owners, Marika Josephson and Aaron Kleidon. The pizza is finished with chevre from Baetje Farms, melted in Scratch’s handmade brick oven.

When Jesse Sauerbrei first started as a waiter at Lincoln Wine Bar, outside Cedar Rapids, Iowa, his main job was to demystify wine for the customers. “The wine, even today, can be scary for folks,” he said. Pizza made in Lincoln’s wood-fire oven helps put people at ease, he said.

Sauerbrei has continued to focus on local ingredients since buying the business in 2014. Spring is particularly busy, when local morel mushrooms are abundant. They’re followed by local asparagus, which he serves on a white pizza with guanciale and Calabrian chiles.

It’s one of a number of pies centered on local produce favored by customers who, when they first started coming to the restaurant, ordered only sausage or pepperoni.

“Pizza is a really great way to get people to try new things,” Sauerbrei said. “There’s nothing intimidating about pizza.”

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A giant tipping potato bucket called Tippin’ Tater that contains 750 gallons of water. A grumpy ram lifeguard keeping an eye on everyone. Two baby bears sliding down a log. Blue birds on a diving board.

Camp IdaH2O, the latest expansion of Roaring Springs Waterpark, is a celebration of life in the Pacific Northwest, says Tiffany Quilici, the water park’s chief marketing officer.

Meridian is the home of the Northwest’s largest water park. And it just turned 25 years old.

Here are six things to know about the park:

1. It employs hundreds of teens.

The Treasure Valley’s largest employer of young adults, Roaring Springs has 700 employees. About 200 of those are lifeguards, who rotate from one attraction to the next every 20 to 30 minutes. ‘‘That really helps to keep them alert and vigilant,’’ Quilici said.

Lifeguards show up around 9:30 a.m. and ride test every attraction to make sure they are all safe for visitors to go on.

Only 10 employees work full time year round.

Quilici said it’s a privilege for the park to be the first workplace for many teens in the Valley. ‘‘We get to teach them and mentor them in all the qualities they need to launch their future dreams,’’ Quilici said.

The water park is open mid May through mid September and has welcomed 6 million visitors in the past 25 years of operation.

Roaring Springs Waterpark in Meridian, Idaho, is the Northwest’s biggest water park. It requires 700 employees to operate. (Sarah A. Miller/Idaho Statesman/TNS)

2. It uses a lot of water that it must keep clean.

On a typical day, the park’s operations team starts working at 6 a.m. and includes a crew of pressure washers cleaning the concrete.

Roaring Springs uses 1.5 million gallons of Meridian city water that circulates through the water park all season long. That’s enough to cover a football field 3½ feet deep. Like all Meridian city water, it comes from the water-bearing soil and rock of the Snake River Plain aquifer that underlies Ada County.

A certain amount of water gets lost to evaporation and when people walk out of pools and rides, so additional water is used every day. Aaron Forsythe, the water park’s operations manager, said the park takes in 10,000 to 15,000 gallons of water every day but ‘‘it’s hard to measure’’ exactly how much gets lost.

Quilici said the staff is ‘‘extremely vigilant about any leaks from pools and from slides.’’

The water goes through massive sand filter tanks and a chemistry process to keep it clean. Quilici said that the park also has ultraviolet lights that ‘‘kill every bug’’ in the water.

When asked about the park’s efforts to promote sustainability, Quilici said that they ‘‘certainly have some advanced energy efficiency devices in place to operate the pumps and motors at their optimal rate.’’ Deck drains at the end of the slides collect and recirculate water too, Forsythe said.

3. It uses a network of security cameras.

Roaring Springs was the first outdoor water park nationwide to install the Ellis Aquatic Vigilance System, which is supported by artificial intelligence and video analytics, a technology that uses a special algorithm to analyze digital videos and provide security-related services.

Cameras are installed throughout the park. They can see under water. Roaring Springs has two command centers with operators who are alerted through radios when a danger is perceived by one of the cameras.

Forsythe said Roaring Springs uses the cameras as an ‘‘extra layer of security’’ on top of the lifeguards.

4. Those teen employees get free passes and parties.

Employees get a free season pass, numerous half-off tickets for friends and family, and get to attend work-related parties ‘‘to make it a really fun social experience,’’ Quilici said.

Roaring Springs also has a scholarship program for employees in college. Quilici said that about $30,000 in scholarships was awarded last year.

A seagull perches on top of a cameras from Ellis Aquatic Vigilance System at Roaring Springs Waterpark in Meridian, Idaho. The system uses artificial intelligence to help identify dangers in the park. The camera can see under water. (Sarah A. Miller/Idaho Statesman/TNS)

5. Missing your dentures or wedding ring?

The park employees find lost items daily. Some of the more unique findings include a hammer, dentures, and a wedding ring. To get their belongings back, guests fill out a form and have one week to collect them. The park donates unclaimed items, Quilici said.

6. New attractions are planned.

Roaring Springs recently opened Class 5 Canyon, the Northwest’s first wave action river, which simulates a whitewater experience.

Quilici and the CEO Pat Morandi travel around the country, and sometimes the world, to try out new rides, get inspired by other water parks and bring back new attractions’ ideas for Idaho.

Camp IdaH2O is just the first of seven phases of Roaring Springs’ plan to expand. A major new water attraction will be added every two to three years for the next 10 years, Quilici said.

________

Today is Thursday, July 4, the 186th day of 2024. There are 180 days left in the year. This is Independence Day.

Today’s Highlight in History:

On July 4, 1776, the Declaration of Independence was adopted by delegates to the Second Continental Congress in Philadelphia.

Also on this date:

In 1802, the United States Military Academy officially opened at West Point, New York.

In 1817, construction of the Erie Canal began in Rome, New York.

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In 1826, 50 years to the day after the Declaration of Independence was adopted, former presidents John Adams and Thomas Jefferson both died.

In 1831, the fifth president of the United States, James Monroe, died in New York City at age 73.

In 1855, the first edition of Walt Whitman’s “Leaves of Grass” was published.

In 1863, the Civil War Siege of Vicksburg, Mississippi, ended as a Confederate garrison surrendered to Union forces.

In 1910, in what was billed as “The Fight of the Century,” Black world heavyweight boxing champion Jack Johnson defeated white former champ “Gentleman” Jim Jeffries in Reno, Nevada; race riots across the country following the fight killed more than 20 people.

In 1912, the 48-star American flag, recognizing New Mexico and Arizona statehood, was adopted.

In 1939, Lou Gehrig of the New York Yankees delivered his famous farewell speech in which he called himself “the luckiest man on the face of the earth.”

In 1946, the United States and the Philippines signed the Treaty of Manila, recognizing Philippine independence from the US.

In 1960, the current 50-star version of the US flag was adopted.

In 1976, America celebrated its bicentennial with daylong festivities; President Gerald R. Ford made stops in Valley Forge, Pennsylvania, Independence Hall in Philadelphia and New York, where more than 200 ships paraded up the Hudson River in Operation Sail.

In 1987, Klaus Barbie, the former Gestapo chief known as the “Butcher of Lyon,” was convicted by a French court of crimes against humanity and sentenced to life in prison (he died in September 1991).

In 1995, the space shuttle Atlantis and the Russian space station Mir parted after spending five days in orbit docked together.

In 2012, scientists at the European Organization for Nuclear Research (CERN) in Geneva cheered the apparent end of a decades-long quest for a new subatomic particle called the Higgs boson, or “God particle.”

In 2013, the Statue of Liberty reopened on the Fourth of July, eight months after Superstorm Sandy shuttered the national symbol of freedom.

Today’s Birthdays:

Actor Eva Marie Saint is 100.
Tuskegee Airman Harry Stewart Jr. is 100.
Queen Sonja of Norway is 87.
Actor Karolyn Grimes (“It’s a Wonderful Life”) is 83.
Broadcast journalist Geraldo Rivera is 81.
Funk/jazz trombonist Fred Wesley is 81.
Vietnam War veteran and peace activist Ron Kovic is 78.
Singer John Waite is 72.
International Tennis Hall of Famer Pam Shriver is 62.
Christian rock singer Michael Sweet (Stryper) is 60.
Actor-playwright-screenwriter Tracy Letts is 59.
Actor Becki Newton is 46.
TV personality Mike “The Situation” Sorrentino is 42.
R&B singer Melanie Fiona is 41.
Singer and rapper Post Malone is 29.
Malia Obama is 26.