As I pulled into a parking lot, a man in an orange vest told me to stay in the car until my appointment time was announced over a very loud loudspeaker to avoid people congregating. After passing through two screenings by people who remained welcoming, despite having to endlessly ask the same questions, and a registration check in, I received a shot four minutes after my scheduled appointment time. It was injected by someone more than qualified for the task: an orthopedic surgeon.

Canada’s decision to get at least one shot into as many people as possible means that I’m not scheduled for a second dose until August.

As many Canadians look at vaccination rates in Britain and the United States, their frustration has been growing. Right now, just 2 percent of Canadians are fully vaccinated compared with 24 percent of Americans. But the scheduled increases in vaccine shipments — the Moderna slip up aside — should help Canada catch up slightly over the next few weeks.

If so, it will also be a relief to the medical world. After he released the projections compiled by Ontario’s table of science experts on Friday, which indicated cases could hit 30,000 a day if nothing is done, Adalsteinn Brown, the dean of the Dalla Lana School of Public Health at the University of Toronto, said, “More vaccination, more vaccination, more vaccination.”


built 100 tiny shelters for homeless people to get though the winter. He now has an even bigger plan.

  • Geneva Abdul, a Times colleague now based in London and former member of Canada’s national soccer team, wrote about the confidence that playing the sport gave her.

  • An exhaustive review found that anti-gay bias by Toronto police helped allow a serial killer to prey on the city’s gay community.

  • William Amos, a Liberal member of Parliament from Quebec, stripped down after a jog while not realizing that his computer’s camera was on and broadcasting to his fellow lawmakers in a virtual meeting. Now some people are asking who leaked the photo of Mr. Amos standing nude to the public.


  • A native of Windsor, Ontario, Ian Austen was educated in Toronto, lives in Ottawa and has reported about Canada for The New York Times for the past 16 years. Follow him on Twitter at @ianrausten.


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    Vaccine Hesitancy Leaves Doses to Expire in Some African Countries

    With growing community transmission and high average mortality rates from the coronavirus in Malawi, there was widespread concern among the country’s health care advocates this week when the authorities announced that they would throw away 16,000 vaccine doses that had expired.

    They were part of a total of 512,000 AstraZeneca vaccine doses that the landlocked southeast African nation had received from India, the African Union and Covax, the global initiative to procure and distribute vaccines. Health officials didn’t specify why the vaccines had expired, but said the doses went void on Tuesday “due to varying expiry dates of the received vaccine consignments.”

    Health experts and campaigners warned that vaccine hesitancy, along with rumors that out-of-date jabs were being administered, might have contributed to the slow distribution of the vaccine doses and their eventual expiration.

    In many African countries, vaccination campaigns have been hindered by factors like science skepticism, limited or no efforts to educate the public, inefficient distribution systems and concerns over the extremely rare but serious cases of blood clots being investigated among a small number of people who received the AstraZeneca and Johnson & Johnson vaccines. Those two vaccines, which require less stringent refrigeration, are crucial to efforts to immunize populations in poorer countries.

    stopped plans to secure the AstraZeneca vaccine — a decision one official said was made to avoid duplicating the efforts of Covax, which will still supply AstraZeneca to African nations. But even though the decision was not linked to concerns over blood clotting, experts said it could still magnify misinformation about the vaccine. And the African Union is shifting its focus to the Johnson & Johnson vaccine, which could add to the problem. Its use has been paused in the United States.

    In African countries, public confusion over whether to get inoculated, and if so when and where to do so, has contributed to the expiration of doses. Like Malawi, South Sudan saw 59,000 unused doses expire this month.

    The problem is not unique to African countries. Tens of thousands of jabs have also been thrown away in countries like France and the United States. But African countries face far more serious supply shortages. According to a New York Times database, Africa has the slowest vaccination rate of any continent, with many countries yet to start mass vaccination campaigns.

    Countries like Ghana, which was the first African nation to receive doses from Covax, is about to run out of its initial supplies with no sense of when the next batch may come.

    “This inequality negatively affects the entire world,” said Dr. Ngozi Erondu, an infectious disease specialist and a senior health scholar at the O’Neill Institute at Georgetown University. If “entire regions and countries remain insufficiently vaccinated,” she said, “it will continue to ravage populations with persistent morbidity and leave the larger global health community always vulnerable to the virus.”

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    Vaccines Won’t Protect Millions of Patients With Weakened Immune Systems

    For more than a year, Dr. Andrew Wollowitz has mostly been cloistered inside his home in Mamaroneck, N.Y.

    As chief of emergency medicine at Montefiore Medical Center in the Bronx, Dr. Wollowitz, 63, was eager to help treat patients when the coronavirus began raging through the city last spring. But a cancer treatment in 2019 had obliterated his immune cells, leaving him defenseless against the virus, so he instead arranged to manage his staff via Zoom.

    A year later, people in Dr. Wollowitz’s life are returning to some semblance of normalcy. His wife, a dancer and choreographer, is preparing to travel for work at Austria’s National Ballet Company. His vaccinated friends are getting together, but he sees them only when the weather is nice enough to sit in his backyard. “I spend very little time in public areas,” he said.

    Like his friends, Dr. Wollowitz was vaccinated in January. But he did not produce any antibodies in response — nor did he expect to. He is one of millions of Americans who are immunocompromised, whose bodies cannot learn to deploy immune fighters against the virus.

    as high as 55 percent.

    Most people who have lived with immune deficiencies for a long time are likely to be aware of their vulnerability. But others have no idea that medications may have put them at risk.

    “They’ll be walking around outside thinking they’re protected — but maybe they’re not,” said Dr. Lee Greenberger, chief scientific officer of the Leukemia and Lymphoma Society, which funds research on blood cancers.

    The only recourse for these patients — apart from sheltering in place until the virus has retreated — may be to receive regular infusions of monoclonal antibodies, which are mass-produced copies of antibodies obtained from people who have recovered from Covid-19. The Food and Drug Administration has authorized several monoclonal antibody treatments for Covid-19, but now some are also being tested to prevent infections.

    Convalescent plasma or gamma globulin — antibodies distilled from the blood of healthy donors — may also help immunocompromised people, although a version of the latter that includes antibodies to the coronavirus is still months from availability.

    compassionate use program. (Regeneron released trial results this week showing that the cocktail reduces symptomatic infections by 81 percent in people with normal immune systems.)

    It’s unclear how many immunocompromised people don’t respond to coronavirus vaccines. But the list seems at least to include survivors of blood cancers, organ transplant recipients, and anyone who takes the widely used drug Rituxan, or the cancer drugs Gazyva or Imbruvica — all of which kill or block B cells, the immune cells that churn out antibodies — or Remicade, a popular drug for treating inflammatory bowel disease. It may also include some people over age 80 whose immune responses have faltered with age.

    “We’re extremely concerned and interested in trying to see how we might be able to help those particular patients,” said Dr. Elad Sharon, an immunotherapy expert at the National Cancer Institute.

    As the pandemic spread, doctors who specialize in treating blood cancers or who care for immunocompromised people expected at least some of their patients to encounter difficulties. Dr. Charlotte Cunningham-Rundles, an immunologist at Icahn School of Medicine at Mount Sinai in New York, has about 600 patients who are almost entirely dependent on getting regular doses of gamma globulin to stay safe from pathogens.

    Even so, 44 of her patients became infected with the coronavirus; four died, and another four or five had long-term illnesses. (Chronic infections may offer opportunities for the virus to evolve into dangerous variants.)

    registry to provide information and antibody tests to people with blood cancers. And several studies are assessing the response to coronavirus vaccines in people with cancer, autoimmune conditions like lupus or rheumatoid arthritis, or who take drugs that mute the immune response.

    In one such study, British researchers followed nearly 7,000 people with Crohn’s disease or ulcerative colitis from 90 hospitals in the country. They found that less than half of patients who took Remicade mounted an immune response following coronavirus infection.

    were protected after a single dose of the Pfizer vaccine and only 27 percent after a single dose of the AstraZeneca vaccine. (In Britain, the current practice is to delay second doses to stretch vaccine availability.)

    Likewise, another study published last month indicated that fewer than 15 percent of patients with cancers of blood or the immune system, and fewer than 40 percent of those with solid tumors, produced antibodies after receiving a single dose of the Pfizer-BioNTech vaccine.

    And a study published last month in the journal JAMA reported that only 17 percent of 436 transplant recipients who got one dose of the Pfizer-BioNTech or Moderna vaccine had detectable antibodies three weeks later.

    Despite the low odds, immunocompromised people should still get the vaccines because they may produce some immune cells that are protective, even antibodies in a subset of patients.

    “These patients should probably be prioritized for optimally timed two doses,” said Dr. Tariq Ahmad, a gastroenterologist at the Royal Devon and Exeter NHS Foundation Trust who was involved in the infliximab studies.

    He suggested that clinicians routinely measure antibody responses in immunocompromised people even after two vaccine doses, so as to identify those who also may need monoclonal antibodies to prevent infection or a third dose of the vaccines.

    Wendy Halperin, 54, was diagnosed at age 28 with a condition called common variable immunodeficiency. She was hospitalized with Covid-19 in January and remained there for 15 days. But the coronavirus induced unusual symptoms.

    “I was having trouble walking,” she recalled. “I just lost control of my limbs, like I couldn’t walk down the street.”

    Because she was treated for Covid-19 with convalescent plasma, Ms. Halperin has had to wait three months to be immunized and has made an appointment for April 26. But despite her condition, her body did manage to produce some antibodies to the initial infection.

    “The take home message is that everybody should try and get the vaccine,” said Dr. Amit Verma, an oncologist at Montefiore Medical Center.

    The gamble did not pay off in Dr. Wollowitz’s case. Without antibodies in his system to protect him, he is still working from home — a privilege he is grateful for. He was an avid mountain biker and advanced skier, both of which carry risk of injury, but with the coronavirus, he is playing it safe.

    In anticipation of returning to his normal lifestyle, Dr. Wollowitz is tuning his bicycles. But he said he foresaw himself living this way till enough other people are vaccinated and the number of infections in the city drops.

    “I’m not exactly sure what that date is,” he said. “I’m really waiting to get back out.”

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    Top health officials urge Americans to get vaccinated but barely address the J.&J. dose pause.

    Three top federal health officials appeared on Capitol Hill on Thursday and implored Americans to get vaccinated against the coronavirus, but said little about the investigation into whether the Johnson & Johnson vaccine may be linked to a small number of cases of rare blood clots, or when that vaccine might be put back into use.

    “Hopefully we’ll get a decision quite soon, as to whether or not we can get back on track with this very effective vaccine,” Dr. Anthony S. Fauci, President Biden’s top medical adviser for the coronavirus, told a House panel.

    Dr. Fauci’s comments came as the future of the Johnson & Johnson one-shot vaccine hung in the balance. Earlier this week, the Food and Drug Administration and the Centers for Disease Control and Prevention called for a pause in the use of the vaccine in the wake of reports of a small number of rare blood clots in recipients. Though it is unclear whether the vaccine was responsible for the clots, injections came to a sudden halt across the country.

    On Wednesday, a C.D.C. advisory panel suggested that it would be a week to 10 days before they had enough information to assess the vaccine’s risks and could make a decision about its future. In the meantime, the officials — Dr. Fauci; Dr. Rochelle Walensky, the C.D.C. director; and Dr. David Kessler, who runs the Biden administration’s vaccine effort — urged Americans to continue to get vaccinated.

    an immediate pause in the use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the United States developed a rare disorder involving blood clots within one to three weeks of vaccination.

  • All 50 states, Washington, D.C. and Puerto Rico temporarily halted or recommended providers pause the use of the vaccine. The U.S. military, federally run vaccination sites and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix, also paused the injections.
  • Fewer than one in a million Johnson & Johnson vaccinations are now under investigation. If there is indeed a risk of blood clots from the vaccine — which has yet to be determined — that risk is extremely low. The risk of getting Covid-19 in the United States is far higher.
  • The pause could complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy.
  • Johnson & Johnson has also decided to delay the rollout of its vaccine in Europe amid concerns over rare blood clots, dealing another blow to Europe’s inoculation push. South Africa, devastated by a more contagious virus variant that emerged there, suspended use of the vaccine as well. Australia announced it would not purchase any doses.
  • The reports of blood clots were the second recent blow to the Johnson & Johnson vaccine. Earlier this month, an ingredient mix-up at a Baltimore manufacturing plant owned by Emergent BioSolutions ruined up to 15 million doses of the vaccine. The F.D.A. is now inspecting the plant to see whether any vaccine doses manufactured there can be released to the public.

    About 7.7 million Americans had received the Johnson & Johnson vaccine as of Wednesday, accounting for less than 4 percent of the more than 198 million doses administered across the country. The Pfizer and Moderna vaccines are in much greater supply.

    Officials note that the blood clots are extremely rare; the handful of cases represent less than one in one million recipients, although that incidence estimate could go up if more cases are reported.

    Biden administration officials say that the absence of the Johnson & Johnson vaccine might not have a major impact on the U.S. vaccination campaign. But if use of the vaccine is severely restricted worldwide, it could prove disastrous for the global vaccination effort.

    Health officials had hoped that the Johnson & Johnson vaccine, along with a similar vaccine developed by AstraZeneca, would help supply the world because they are less expensive and easier to store and handle than the Pfizer and Moderna vaccines.

    Denmark, where two recipients suffered severe blood clots, permanently suspended use of the AstraZeneca vaccine.

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    How Mario Draghi Has Made Italy a Power Player in Europe

    ROME — The European Union was stumbling through a Covid-19 vaccine rollout marred by shortages and logistical bungling in late March when Mario Draghi took matters into his own hands. The new Italian prime minister seized a shipment of vaccines destined for Australia — and along with them, an opportunity to show that a new, aggressive and potent force had arrived in the European bloc.

    The move shook up a Brussels leadership that had seemed to be asleep at the switch. Within weeks, in part from his pressing and engineering behind the scenes, the European Union had authorized even broader and harsher measures to curb exports of Covid-19 vaccines badly needed in Europe. The Australia experiment, as officials in Brussels and Italy call it, was a turning point, both for Europe and Italy.

    It also demonstrated that Mr. Draghi, renowned as the former European Central Bank president who helped save the euro, was prepared to lead Europe from behind, where Italy has found itself for years, lagging behind its European partners in economic dynamism and much-needed reforms.

    In his short time in office — he took power in February after a political crisis — Mr. Draghi has quickly leveraged his European relationships, his skill in navigating E.U. institutions and his nearly messianic reputation to make Italy a player on the continent in a way it has not been in decades.

    denied her a chair, rather than a sofa, during a visit to Turkey last week, saying he was “very sorry for the humiliation.”

    In his debut in a European meeting as Italy’s prime minister in February, Mr. Draghi, 73, made it clear that he was not there to cheerlead. He told an economic summit including heavy hitters like his European Central Bank successor, Christine Lagarde, to “curb your enthusiasm” when it came to talk about a closer fiscal union.

    That sort of union is Mr. Draghi’s long-term ambition. But before he can get anywhere near that, or tackle deep economic problems at home, those around him say Mr. Draghi is keenly aware that his priority needs to be solving Europe’s response to the pandemic.

    Italian officials say his distance from the contract negotiations, which were completed before he took office, gave him a freedom to act. He suggested that AstraZeneca had misled the bloc about its supply of vaccine, selling Europe the same doses two or three times, and he immediately zeroed in on an export ban.

    “He understood straightaway that the issue was vaccinations and the problem was supplies,” said Lia Quartapelle, a member of Parliament in charge of foreign affairs for Italy’s Democratic Party.

    On Feb. 25, he joined a European Council videoconference with Ms. von der Leyen and other European Union leaders. The heads of state warmly welcomed him. “We owe you so much,” Bulgaria’s prime minister told him.

    Then Ms. von der Leyen gave an optimistic slide presentation about Europe’s vaccine rollout. But the new member of the club bluntly told Ms. von der Leyen that he found her vaccine forecast “hardly reassuring” and that he didn’t know whether the numbers promised by AstraZeneca could be trusted, according to an official present at the meeting.

    He implored Brussels to get tougher and go faster.

    Ms. Merkel joined him in scrutinizing Ms. von der Leyen’s numbers, which put the Commission president, a former German defense minister, on the back foot. Mr. Macron, who had championed Ms. von der Leyen’s nomination but quickly formed a strategic alliance with Mr. Draghi, piled on. He urged Brussels, which had negotiated the vaccine contracts on behalf of its members, to “put pressure on corporations not complying.”

    At the time, Ms. von der Leyen was coming under withering criticism in Germany for her perceived weakness on the vaccine issue, even as her own commissioners argued that responding too aggressively with a vaccine export ban could hurt the bloc down the road.

    Mr. Draghi, with his direct talk during the February meeting, tightened the screws. So did Mr. Macron, who has emerged as his partner — the two are dubbed “Dracon” by the Germans — pushing for a more muscular Europe.

    Behind the scenes, Mr. Draghi complemented his more public hard line with a courting campaign. The Italian, who is known to privately call European leaders and pharmaceutical chief executives on their cellphones, reached out to Ms. von der Leyen.

    Of all the players in Europe, he knew her the least well, according to European Commission and Italian officials, and he wanted to remedy that and make sure she did not feel isolated.

    Then, in early March, as shortages of AstraZeneca’s Covid vaccine continued to disrupt Europe’s rollout and increase public frustration and political pressure, Mr. Draghi found the perfect gift for Ms. von der Leyen: 250,000 doses of seized AstraZeneca vaccine earmarked for Australia.

    “He told me that in the days before he was on the phone a lot with von der Leyen,” said Ms. Quartapelle, who spoke with Mr. Draghi the day after the shipment freeze. “He worked a lot with von der Leyen to convince her.”

    The move was appreciated in Brussels, according to officials in the Commission, because it took the onus off Ms. von der Leyen and gave her political cover while simultaneously allowing her to seem tough for signing off on it.

    The episode has become a clear example of how Mr. Draghi builds relationships with the potential to yield big payoffs not only for himself and Italy, but all of Europe.

    On March 25, when the Commission became suspicious over 29 million AstraZeneca doses in a warehouse outside Rome, Ms. von der Leyen called Mr. Draghi for help, officials with knowledge of the calls said. He obliged, and the police were quickly dispatched.

    In the meantime, Mr. Draghi and Mr. Macron, joined by Spain and others, continued to support a harder line from the Commission on vaccine exports. The Netherlands was against it, and Germany, with a vibrant pharmaceutical market, was queasy.

    When the European leaders met again in a video conference on March 25, Ms. von der Leyen seemed more confident in the political and pragmatic advantages of halting exports of Covid vaccines made in the European Union. She again presented slides, this time authorizing a broader six-week curb on exports from the bloc, and Mr. Draghi stepped back into a supportive role.

    “Let me thank you for all the work that has been done,” he said.

    After the meeting, Mr. Draghi, however modestly, gave Italy — and by extension himself — credit for the steps allowing export bans. “This is more or less the discussion that took place,” he told reporters, “because this was the issue originally raised by us.”

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    Changing Strategy, the E.U. Bets Big on Pfizer to Battle Covid

    BRUSSELS — Bruised by major disruptions in supplies of the AstraZeneca and Johnson & Johnson vaccines, the European Union Wednesday announced it was putting trust and money into the Pfizer-BioNTech shot to salvage its vaccination rollout and secure doses for the future.

    The pivot away from AstraZeneca, once a pillar of the E.U. inoculation program, comes after months of discord over delayed shipments and as the company battles worries over rare potential side effects of its shots.

    In announcing the change in strategy, Ursula von der Leyen, president of the European Commission, said Pfizer had agreed to an early shipment of doses that she said should likely allow the bloc to reach its goal of inoculating 70 percent of adults by the end of the summer.

    That goal was in jeopardy after AstraZeneca failed to deliver on expected doses in the first quarter of the year, then suffered fresh setbacks over potential side effects related to blood clots. The European vaccine campaign was dealt a further blow Tuesday when Johnson & Johnson said it would delay its own rollout in Europe because of similar concerns and after regulators paused its use in the United States.

    supply disruptions from AstraZeneca in late January, and then with the emergence of the potential rare blood disorder that has battered the public’s confidence in vaccines and led to appointment cancellations.

    “As we can see with the announcement by Johnson & Johnson yesterday, there are still many factors that can disrupt the planned delivery schedules of vaccines,” Ms. von der Leyen said Wednesday.

    Ms. von der Leyen said the Pfizer doses under negotiation for the next two years would include potential booster shots to extend the immunity of people who have already been inoculated, as well as possible new shots or boosters targeting emerging variants that might prove resilient against existing vaccines.

    The AstraZeneca and Johnson & Johnson vaccines performed well in clinical trials and the possible dangerous side effects have been rare. But trials of the Pfizer and Moderna shots shows that they were even more effective in preventing infection, and similar side effects have not emerged. Another mRNA vaccine, from CureVac, is in clinical trials.

    On Wednesday, the European Medicines Agency, the bloc’s top drug regulator, said it was expediting its investigation of “very rare cases of unusual blood clots” in recipients of the Johnson & Johnson vaccine, and expected to issue a recommendation next week. While the evaluation is ongoing, the agency reiterated its view that the benefits of the vaccine outweigh the risks.

    In a setback for AstraZeneca, Denmark on Wednesday became the first country to permanently stop the administration of the company’s vaccine, saying the potential side effects were significant enough to do so given that it had the pandemic under control and could rely on the Pfizer and Moderna inoculations.

    With the fresh commitment by Pfizer to bring forward the delivery of 50 million doses originally slated for the end of the year, the company expects to deliver 250 million doses in total to the bloc by the end of June.

    Ms. von der Leyen said more than 100 million people in the European Union had already received at least one vaccine dose, and 27 million had received both. The additional Pfizer vaccines, together with 35 million doses expected from Moderna over the next three months, and a more limited use of AstraZeneca doses already in the pipeline, should likely be enough to get the bloc to the coveted milestone of reaching 255 million people by September, E.U. officials said.

    In stark contrast to the criticism of AstraZeneca’s handling of its E.U. dealings, Ms. von der Leyen praised Pfizer effusively, highlighting how important the company’s ability to respond quickly to help the European Union has been.

    “I want to thank BioNTech/Pfizer; it has proven to be a reliable partner,” Ms. von der Leyen said. “It has delivered on its commitments, and it is responsive to our needs.”

    Addressing another sore point, Ms. von der Leyen said that the future Pfizer doses would be produced in the European Union.

    Ample exports from the factories within the bloc to the rest of the world have enabled countries like Mexico and Canada to launch their vaccination campaigns, but those exports have also been identified as one reason there weren’t enough vaccines to go around in Europe.

    The United States and Britain, by contrast, held tight to the vaccines made in their countries, helping speed along their inoculation efforts.

    Monika Pronczukcontributed reporting.

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    Once again, South Africa finds itself halting use, at least temporarily, of a Covid-19 vaccine it had bet on.

    South Africa has faced blow after blow to its pandemic-control efforts: A worrisome variant swept across the country, driving a devastating second wave of coronavirus cases. Then officials had to scramble for an alternative when the vaccine it had bet on, from AstraZeneca, proved ineffective against the variant, which can partially dodge the body’s immune system response.

    Now the alternative — Johnson & Johnson’s single-dose vaccine, the only one now in use in South Africa — has run into trouble as well, over concerns of rare blood clots that emerged in a handful of people in the United States who had received the shot. It is unclear whether the vaccine is responsible.

    South Africa’s health minister, Dr. Zwelini Mkhize, announced on Tuesday that the country would temporarily halt its vaccine program for medical workers, which has inoculated around 290,000 people so far. Dr. Mkhize said he expected the program — a clinical trial — to resume in a few days, after the authorities have had a chance to look into the blood clot cases in the United States.

    “Science must be respected at all times, although this may mean a disruption in our plans,” Dr. Mkhize said on Tuesday.

    halted use of the AstraZeneca vaccine after evidence emerged that it did not protect clinical-trial participants from becoming mildly or moderately ill from the variant, known as B.1.351, that is now dominant in the country. South African authorities then pivoted to the Johnson & Johnson vaccine, which is manufactured in the country under license and has a 64 percent efficacy rate in South Africa, according to an analysis by the U.S. Food and Drug Administration.

    Health experts say that the decision on Tuesday to pause vaccinating health care workers is the kind of thing that happens often in clinical trials, and that it probably won’t have any major implications for vaccinating the general public.

    “At the moment, there is nothing to indicate that this will delay the national rollout program,” said Dr. Richard Lessells, an infectious diseases specialist at the KwaZulu-Natal Research and Innovation Sequencing Platform.

    Even so, if evidence emerges to implicate the Johnson & Johnson vaccine in blood clotting problem, and health officials begin to question its safety, it could be a devastating blow for South Africa, the African country hardest hit by the coronavirus, as it races to inoculate its population before an even more dangerous variant appears.

    “The U.S. has access to other vaccines to fill a gap, in terms of not using the Johnson & Johnson vaccine,” said Shabir Madhi, a virologist at University of the Witwatersrand who ran the AstraZeneca vaccine trial in South Africa. “That sort of luxury doesn’t exist in other countries, including South Africa.”

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    Western Warnings Tarnish Vaccines the World Badly Needs

    The solution in many European countries — to stop using seemingly riskier vaccines in younger people, who are at lower risk from Covid-19 — would be unworkable in Africa, where the median age in many countries is below 20.

    And any further restrictions would compound the hurdles facing Covax, among them a paucity of funding for every part of inoculation programs beyond the touchdown of doses at airports.

    Mali, in western Africa, has administered 7 percent of the AstraZeneca doses that Covax has delivered. Sudan, in eastern Africa, has given 8 percent of the doses it has received.

    Skittishness over the AstraZeneca and Johnson & Johnson vaccines, analysts fear, could stoke demand for Russian- and Chinese-made shots about which far less is known. As it is, some global health officials have turned their attention to the Novavax vaccine, which is not yet authorized but makes up a third of Covax’s portfolio.

    “Even at this stage of the pandemic, we have our fingers crossed that some vaccine will work to help vaccinate developing countries, instead of ramping up production of vaccines we know work,” said Zain Rizvi, an expert on medicines access at Public Citizen, an advocacy group.

    In Kenya, where enthusiasm for vaccines is high in cities but perilously low in rural areas, “the story about blood clots from Europe could not have come at a worse time,” said Catherine Kyobutungi, the director of the African Population and Health Research Center there. “Even those who were perhaps on the fence, and leaning toward getting vaccinated, all of a sudden had second thoughts,” she said.

    The American pause on Johnson & Johnson shots promised a second media furor.

    “When the F.D.A. suspends, it makes headlines for days,” she said. “When it lifts the suspension, it doesn’t make as many headlines.”

    Mady Camara contributed reporting from Dakar, Senegal.

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    Denmark says it’s permanently stopping use of the AstraZeneca vaccine.

    Denmark on Wednesday became the first country to plan to permanently stop administering the AstraZeneca vaccine, a month after suspending its use following reports that a small number of recipients had developed a rare but serious blood-clotting disorder.

    The director general of the country’s health authority, Soeren Brostroem, said Denmark was able to halt use of the vaccine because it had the pandemic under control and could rely on two other vaccines, from Pfizer and Moderna.

    The Danish announcement is another setback for the AstraZeneca shot, which is easy to store and relatively cheap, and was expected to be the foundation of vaccination campaigns around the world.

    The country initially suspended the use of the vaccine on March 11, along with Iceland and Norway. Several other European countries, including France, Germany and Italy, followed suit last month.

    later recommended that countries keep using the vaccine, saying its benefits far outweighed any potential risks for most people.

    Last week, though, the European regulator listed blood clots as a potential very rare side effect of the vaccine.

    Several countries that had paused and restarted use of the vaccine have since said they would stop using it in younger people. Britain, which has administered around 20 million AstraZeneca doses, said it would offer alternative vaccines to people under 30.

    “Based on the scientific findings, our overall assessment is there is a real risk of severe side effects associated with using the Covid-19 vaccine from AstraZeneca,” Dr. Brostroem, the Danish health official, said in a statement. “We have, therefore, decided to remove the vaccine from our vaccination program.”

    “If Denmark were in a completely different situation and in the midst of a violent third outbreak, for example, and a health care system under pressure,” he added, “then I would not hesitate to use the vaccine, even if there were rare but severe complications associated with using it.”

    Danish health officials said that they might reintroduce the AstraZeneca vaccine “if the situation changes.”

    Public health officials have warned that pausing administration of vaccines like AstraZeneca’s or Johnson & Johnson’s could do more harm than good. They note that among seven million people vaccinated with the single-dose Johnson & Johnson vaccine in the United States, six women had developed the rare blood clots — fewer than one in one million. It is not yet known whether the vaccine had anything to do with the clots, but even if it did, the risk is smaller than that of getting struck by lightning in a given year (one in 500,000).

    Denmark, which has a population of 5.8 million, has managed to contain the pandemic better than its neighbor Sweden or many other European countries. As of Wednesday, Denmark had recorded 2,447 Covid-related deaths.

    Almost one million people in the country have received at least a first dose of a vaccine, 77 percent of them the one from Pfizer, according to Denmark’s Serum Institute. Around 15 percent received a first dose of the AstraZeneca vaccine before the authorities suspended its use last month, and the remaining 8 percent received the Moderna vaccine.

    The country’s health authorities said that people who received a first dose of the AstraZeneca vaccine would be offered a different vaccine for their second dose.

    Jasmina Nielsen contributed reporting.

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