results of a clinical trial suggested that the vaccine from AstraZeneca offered little protection from mild or moderate infections caused by the Beta variant that was circulating in South Africa.

Weeks later, Johnson & Johnson and the government signed a contract for 11 million doses. South Africa ordered another 20 million doses in April. That would be enough to vaccinate about half the country.

South Africa agreed to pay $10 per dose for the 11 million shots, according to the contract. That was the same price that the United Statespaid and slightly more than the $8.50 that the European Commission agreed to pay. The South African contract prohibited the government from banning exports of the vaccine, citing the need for doses to “move freely across national borders.”

introduced export controls this year to conserve scarce supplies. India halted exports produced by the Serum Institute, which was supposed to be a major vaccine supplier to poor countries. In the United States, officials said they didn’t ban exports, but they didn’t need to. The combination of the extensive vaccine production on American soil and the high prices the U.S. government was willing to pay meant that companies made the delivery of shots for Americans a priority.

Other benefits for Johnson & Johnson were embedded in the South African contract.

While such contracts typically protect companies from lawsuits brought by individuals, this one shielded Johnson & Johnson from suits by a wider range of parties, including the government. It also imposed an unusually high burden on potential litigants to show that any injuries caused by the vaccine were the direct result of company representatives engaging in deliberate misconduct or failing to follow manufacturing best practices.

“The upshot is that you have moved almost all of the risk of something being wrong with the vaccine to the government,” said Sam Halabi, a health law expert at Georgetown University who reviewed sections of the South African contract at the request of The Times.

Mr. Halabi said the contract’s terms appeared more favorable to the pharmaceutical company than other Covid vaccine contracts he had seen. South African officials have said Pfizer, too, sought aggressive legal protections.

The contract said Johnson & Johnson would aim to deliver 2.8 million doses to South Africa by the end of June, another 4.1 million doses by the end of September and another 4.1 million doses by the end of December. (The government expects the 20 million additional doses to be delivered by the end of this year, Mr. Maja said.)

The company has so far fallen far short of those goals. As of the end of June, South Africa had received only about 1.5 million of the doses from its order. The small number of doses that have been delivered to the African Union were on schedule.

The difficulties in procuring doses have revealed the limits of fill-and-finish sites, which leave countries dependent on vaccines from places like the European Union or the United States, said Dr. Salim Abdool Karim, who until March was co-chairman of South Africa’s ministerial advisory committee on Covid.

“Ultimately,” he said, “the solution to our problem has to be in making our own vaccines.”

Lynsey Chutel and Choe Sang-Hun contributed reporting.

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Germany Will Offer Vaccine Booster Shots Starting in September

BERLIN — As concerns grow over the highly contagious Delta variant of the coronavirus, Germany on Monday became the biggest Western country yet to announce that it will offer vaccine booster shots to a wide range of people considered potentially vulnerable, adding to growing momentum in rich nations to give additional shots to fully vaccinated people.

The move by Germany came even as a top European Union official criticized the bloc as falling far short of its promises to donate vaccine doses to Africa and Latin America. And with a limited global vaccine supply, health experts say the top priorities should be distributing doses to poor countries that lag far behind in inoculations, and persuading vaccine-resistant people in wealthy countries to get their first shots.

There is also still no consensus among scientists on the need for booster shots, but as fears rise of more pandemic waves and more costly lockdowns, a growing number of countries are preparing to give their people booster doses — or have already started.

Starting in September, Germany, Europe’s largest economy, wants to administer a booster of the Pfizer-BioNTech or Moderna vaccine to older people, residents of care homes, and people with compromised immune systems — and also to anyone who was already fully vaccinated with the two-dose AstraZeneca or single-dose Johnson & Johnson shots, which clinical trials have shown are not as highly protective.

an early leader in vaccination, began administering boosters to people 60 and older last week. A month ago, Russia made additional shots available to anyone six months after inoculation, and on Sunday, Hungary began offering them four months post-vaccination.

France is offering them only to those with weak immune systems, and plans to give them this fall to those who were the first to be vaccinated early this year — mostly people over 75 and those with serious health problems.

government advisers recommended in late June that everyone over 50 should be eligible but said the priority should be getting the shots to people over 70, health workers, nursing home residents, and younger adults with immune problems or other serious vulnerabilities.

increasingly think that vulnerable populations may need additional shots even as research continues into how long the vaccines remain effective. Some people have already obtained boosters simply by not revealing previous vaccination.

But as governments, terrified of another surge in the virus, increasingly lean toward boosters, the need for them remains unclear.

Studies have indicated that immunity resulting from the Pfizer-BioNTech and Moderna vaccines is long-lasting, and researchers are still working to interpret recent Israeli data suggesting a decline in efficacy of the Pfizer-BioNTech vaccine months after inoculation.

although the vaccine remains powerfully effective against severe disease and death.

Experts were divided on the utility of booster shots so soon after vaccination began. Experience with other diseases indicates that older people and those with weak immune systems might benefit, but there is little hard evidence with the coronavirus.

“The problem here is, we’re just sort of going on immunological priors, rather than really great data to justify things one way or the other,” said Deepta Bhattacharya, an immunologist at the University of Arizona. “I totally understand the decision, but I think we have to acknowledge that there’s a wide range of uncertainty on what it’s going to do.”

Booster doses may help some people with weak immune systems, but others may show little improvement even after a third dose, and still others may not need a booster at all, scientists say.

While dozens of mostly wealthy countries, including the United States and most of Europe, have administered more than 100 doses per 100 people, many other nations remain below five per 100 — primarily in Africa, where cases have soared as the Delta variant spreads.

Doctors Without Borders said recently that it would be “unconscionable” to give booster doses in richer nations before people in poorer ones get their first doses.

“Wealthy governments shouldn’t be prioritizing giving third doses when much of the developing world hasn’t even yet had the chance to get their first Covid-19 shots,” Kate Elder, the senior vaccines policy adviser at Doctors Without Borders’ Access Campaign, said in a statement.

a so-called vector vaccine, like AstraZeneca or Johnson & Johnson.

It is the latest sign that governments are encouraging their citizens to mix and match vaccines in the hope of provoking a more protective immune response against Covid-19. Early results from a British vaccine study showed that volunteers produced high levels of antibodies and immune cells after getting one dose each of the Pfizer-BioNTech and AstraZeneca-Oxford shots.

The new German guidelines announced Monday also went a step further in encouraging parents to vaccinate children between 12 and 17, announcing that doctors and vaccination centers across the country would make the jab available to them before the start of the new school year.

Health ministers stopped short of making a formal recommendation for vaccinating children, but the move made plain their impatience with Germany’s Standing Committee on Vaccinations, which has so far refrained from guiding parents one way or the other, pending more data becoming available.

Vaccinating children “is one building block to allow a safe start into the new school year after the summer vacation,” Mr. Holetschek said.

Apoorva Mandavilli contributed reporting from New York, Benjamin Mueller from London, Aurelien Breeden from Paris, Gaia Pianigiani from Rome, Monika Pronczuk from Brussels, Raphael Minder from Madrid and Thomas Erdbrink from Amsterdam.

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Why Asia, the Pandemic Champion, Remains Miles Away From the Finish Line

SYDNEY, Australia — All across the Asia-Pacific region, the countries that led the world in containing the coronavirus are now languishing in the race to put it behind them.

While the United States, which has suffered far more grievous outbreaks, is now filling stadiums with vaccinated fans and cramming airplanes with summer vacationers, the pandemic champions of the East are still stuck in a cycle of uncertainty, restrictions and isolation.

In southern China, the spread of the Delta variant led to a sudden lockdown in Guangzhou, a major industrial capital. Taiwan, Vietnam, Thailand and Australia have also clamped down after recent outbreaks, while Japan is dealing with its own weariness from a fourth round of infections, spiked with fears of viral disaster from the Olympics.

the new outbreak in southern China will affect busy port terminals there. Across Asia, faltering vaccine rollouts could also open the door to spiraling variant-fueled lockdowns that inflict new damage on economies, push out political leaders and alter power dynamics between nations.

The risks are rooted in decisions made months ago, before the pandemic had inflicted the worst of its carnage.

blocked the export of 250,000 doses of the AstraZeneca vaccine meant for Australia to control its own raging outbreak. Other shipments were delayed because of manufacturing issues.

“The supplies of purchased vaccine actually landing on docks — it’s fair to say they are not anywhere near the purchase commitments,” said Richard Maude, a senior fellow at the Asia Society Policy Institute in Australia.

with the United States and Europe.

In Asia, about 20 percent of people have received at least one dose of a vaccine, with Japan, for example, at just 14 percent. By contrast, the figure is nearly 45 percent in France, more than 50 percent in the United States and more than 60 percent in Britain.

Instagram, where Americans once scolded Hollywood stars for enjoying mask-free life in zero-Covid Australia, is now studded with images of grinning New Yorkers hugging just-vaccinated friends. While snapshots from Paris show smiling diners at cafes that are wooing summer tourists, in Seoul, people are obsessively refreshing apps that locate leftover doses, usually finding nothing.

“Does the leftover vaccine exist?” one Twitter user recently asked. “Or has it disappeared in 0.001 seconds because it is like a ticket for the front-row seat of a K-pop idol concert?”

keep its borders closed for another year. Japan is currently barring almost all nonresidents from entering the country, and intense scrutiny of overseas arrivals in China has left multinational businesses without key workers.

The immediate future for many places in Asia seems likely to be defined by frantic optimization.

China’s response to the outbreak in Guangzhou — testing millions of people in days, shutting down entire neighborhoods — is a rapid-fire reprise of how it has handled previous flare-ups. Few inside the country expect this approach to change anytime soon, especially as the Delta variant, which has devastated India, is now beginning to circulate.

has threatened residents with fines of around $450 for refusing vaccines. Vietnam has responded to its recent spike in infections by asking the public for donations to a Covid-19 vaccine fund. And in Hong Kong, officials and business leaders are offering a range of inducements to ease severe vaccine hesitancy.

Nonetheless, the prognosis for much of Asia this year is billboard obvious: The disease is not defeated, and won’t be anytime soon. Even those lucky enough to get a vaccine often leave with mixed emotions.

“This is the way out of the pandemic,” said Kate Tebbutt, 41, a lawyer who last week had just received her first shot of the Pfizer vaccine at the Royal Exhibition Building near Melbourne’s central business district. “I think we should be further ahead than where we are.”

Reporting was contributed by Raymond Zhong in Taipei, Taiwan, Ben Dooley in Tokyo, Sui-Lee Wee in Singapore, Youmi Kim in Seoul and Yan Zhuang in Melbourne, Australia.

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The EU Could Seek Billions in Penalties if AstraZeneca Doesn’t Deliver Vaccine Doses

Lawyers representing the European Union said on Wednesday that they would seek potentially billions of euros in penalties from AstraZeneca if the pharmaceutical company failed to deliver tens of millions of doses of its Covid-19 vaccine that it is contractually required to supply.

In the first hearing in a lawsuit that the bloc has brought against AstraZeneca, lawyers representing the European Union told the judges in a Brussels courtroom that the bloc was seeking to apply a penalty of €10 (about $12) per dose per day that it has been delayed.

The bloc is demanding 90 million doses from the company by the end of June. The proposed penalties, if accepted by the judge, would begin on July 1 and could quickly balloon into billions of euros.

The European Union paid a little over €2 per dose for the vaccine, which AstraZeneca sold at cost for the first stretch of the pandemic.

A European Commission spokesman on health issues said that the bloc was not demanding both the money and the doses, and that if the doses were delivered, the demand for the penalties would be dropped. The spokesman, Stefan De Keersmaecker, said that the lawsuit’s prime goal was to get AstraZeneca to deliver the doses.

The lawsuit, which has pitted the pharmaceutical company against one of its biggest clients globally, has inflicted reputational damage on both parties.

The company says that the delays were caused by production problems and do not constitute a breach of contract. But they have been blamed for the European Union’s slow vaccination start, as shortages meant that the inoculation rollout was delayed in many of its member countries.

The bloc has largely caught up in recent weeks and is on track to get at least one dose to 70 percent of its adult population by July. But the political and reputational impact of the sluggish start has been damaging.

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New Variant Posing Threat, as Global Vaccine Drive Falters

LONDON — A new and potentially more contagious variant of the coronavirus has begun to outpace other versions of the virus in Britain, putting pressure on the government to shorten people’s wait for second doses of vaccines and illustrating the risks of a faltering global immunization drive.

The new variant, which has become dominant in India since first being detected there in December, may be responsible in part for a grievous wave of infections across Southeast Asia, including Nepal, where people have been dying in hospital corridors and courtyards. But efforts to understand the variant picked up once it began spreading in Britain, one of at least 49 countries where it is present. Scientists there are sequencing half of all coronavirus cases amid a push to complete the reopening of its economy.

The preliminary results out of Britain, drawn from only a few thousand cases of the variant, contained both good and bad news, scientists said.

The variant, known by evolutionary biologists as B.1.617.2, is “highly likely” to be more transmissible than the variant behind Britain’s devastating wintertime surge, government scientists have said. That earlier variant, known as B.1.1.7, was itself considerably more contagious than the one that first emerged last year in Wuhan, China.

Public Health England report published this weekend provided signs that government scientists said were consistent with a more transmissible virus: The variant first seen in India was roughly 50 percent more likely than B.1.1.7 to be transmitted to the close contacts of an infected person. Government scientists said last week that it could be anywhere from a few percentage points to 50 percent more contagious than B.1.1.7.

Helpfully for Britain and other wealthy nations, the latest worrisome variant has emerged at a less dire moment of the pandemic. More than four out of every five people in England above the age of 65 — among the groups most vulnerable to the virus — have been given both doses of a coronavirus vaccine, driving down hospitalizations and deaths.

And a new study by Public Health England offered reassuring signs that fully vaccinated people were about as well protected from the variant first detected in India as they were from other forms of the coronavirus.

The Pfizer-BioNTech vaccine offered 88 percent protection against the variant first sampled in India, only a slight drop from the 93 percent protection given against the variant from Britain, Public Health England said. The AstraZeneca-Oxford vaccine was 60 percent effective against the variant from India, compared to 66 percent effective against the one first seen in Britain.

Other studies in England have shown little to no difference between the effectiveness of the Pfizer and AstraZeneca vaccines.

wrote on Twitter.

In Britain, part of its rapid growth may have to do with the particular places it was first introduced. Bolton, in northwest England, where the new variant is most advanced, is a highly deprived area with tightly packed housing that could be hastening its spread, scientists said.

“We do not know if the increase in transmissibility is the result of specific mixing patterns, or super-spreading events,” a group of researchers led by Robert Challen of the University of Exeter reported on May 11, in a study that was among those presented to an influential government advisory group.

That government advisory body said several days later that it had “high confidence” that the variant first seen in India was indeed more contagious, warning that a “substantial resurgence of hospitalizations” was possible. It said that the variant was gaining a foothold in diverse parts of Britain where “contact patterns or behaviors” alone could not explain its spread.

It is not clear if the variant from India is any deadlier than B.1.1.7.

With cases of B.1.1.7 falling, the variant first seen in India now accounts for roughly half of the sequenced coronavirus cases being monitored by Public Health England. The agency’s scientists have said it was likely to replace B.1.1.7 as England’s dominant virus within a month, a startling turnabout so soon after B.1.1.7 swept much of the world.

“For countries that are starting to struggle with B.1.1.7, they now know they have an even faster one close by,” said Devi Sridhar, a professor of global public health at the University of Edinburgh in Scotland.

experimenting with ways to encourage sick people to isolate.

Some scientists have urged the government to go further by dramatically closing the gap between doses of the Pfizer or Moderna vaccine, for instance, and rerouting those shots to cities hardest hit by the variant from India. Because the AstraZeneca vaccine appears most protective with a 12-week dosing interval, those scientists said, using it meant leaving people only partially vaccinated for a period of time.

At the very least, Professor Sridhar said, people needed to be reminded to remain cautious until they were fully vaccinated.

Prime Minister Boris Johnson’s plan to scrap almost all remaining lockdown restrictions on June 21 rests in large part, scientists said, on how many second doses Britain can administer in the coming weeks.

For many poorer nations, starved for vaccines, there is little choice but to leave long delays between first and second doses. Some of them are uncertain about when shipments of second doses will arrive. Large portions of those countries remain entirely unprotected.

If the variant from India spreads as quickly in other countries as it has in Britain, the burden on unvaccinated nations may grow.

“It’s a warning,” Professor Sridhar said. “What we’re seeing in India is being repeated in Nepal, it’s being repeated in other countries. You need to get ahead of it.”

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Pakistan’s Private Vaccinations Draw Criticism

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ISLAMABAD, Pakistan — The coronavirus was ripping through Pakistan, and Muhammad Nasir Chaudhry was worried. Long lines and tight supplies plagued the government’s free vaccine campaign. Newspapers were filled with reports of well-connected people jumping the line for a free dose.

Then Mr. Chaudhry, a 35-year-old government consultant, discovered he could pay to leapfrog the long lines himself. He registered to take two doses of the Russian-made Sputnik V vaccine for about $80 from a private hospital. That’s a lot of money in a country where the average worker makes about $110 per month, but Mr. Chaudhry was ready to make the commitment.

Critics have assailed such private sales in Pakistan and around the world, saying that they make inoculations available only to the wealthy. But in Pakistan, like elsewhere, tight supplies have stymied those efforts. The private hospitals are out of supplies, and Mr. Chaudhry still hasn’t been vaccinated.

“I am willing to pay double the price for the vaccine, but I don’t want to wait on and on,” Mr. Chaudhry said.

bought up most of the world’s vaccine supplies to protect their own people, leaving millions of doses stockpiled and in some places unused. Less developed countries scramble over what’s left.

To speed up vaccinations, some countries have allowed doses to be sold privately. But those campaigns have been troubled by supply issues and by complaints that they simply reflect the global disparities.

blocked them over fears that counterfeit vaccines would be sold. In the United States, some well-connected companies, like Bloomberg, have secured doses for employees.

can’t find vaccines to buy. Demand has been strong. The government sets a ceiling on prices but has been locked in a dispute with private importers over how much that should be.

In April, in the city of Karachi, long lines formed when two private hospitals began selling the Sputnik V vaccine to walk-ins. Private hospitals in Islamabad, the capital, and Lahore faced a similar rush of people and ran short within days. Hospitals in the major cities have now stopped taking walk-ins, and online registration has also been put on hold.

Sputnik V isn’t the only vaccine that the government allows to be sold privately. A one-dose shot made by CanSino Biologics of China is priced at around $28. Demand has been weaker because of greater public confidence in the Russian vaccine. Still, supplies sold out quickly after the CanSino doses went on sale last month. The government has said another 13.2 million doses will arrive in June.

AGP Limited, a private pharmaceutical company that has imported 50,000 doses of Sputnik, is urging patience.

“Sputnik V received an overwhelming response in Pakistan with thousands of people being vaccinated in just a few days and an even higher number of registrations confirmed in hospitals across Pakistan,” said Umair Mukhtar, a senior official of AGP Limited. He said the company has placed large orders for more.

The government price dispute could delay further expansion. The drug regulatory authority wants Sputnik V to be sold at a lower price. AGP won an interim court order on April 1 to sell the vaccine until a final price is fixed.

For those who can afford the doses, frustration is growing. Junaid Jahangir, an Islamabad-based lawyer, said several of his friends got private inoculations. He registered with a private lab for Sputnik V but got a text message later saying that the vaccination drive was on hold.

“I am being denied a fair chance to fight this virus if I end up getting infected,” Mr. Jahangir said. “The demand is there, and I don’t see what could possibly be the reason behind the inefficiency in supply.”

Some of the people who paid for private doses justified their decision by citing media reports that some well-connected people were jumping the line to get free, public doses. In May, at least 18 low-level health care workers were suspended by the authorities in Lahore for vaccinating people out of turn after taking bribes.

Iffat Omar, an actor and talk show host, apologized publicly in April for jumping ahead of the line to get the vaccine. “I am sorry,” she said on Twitter. “I am ashamed. I apologise from the bottom of my heart. I will repent.”

Fiza Batool Gilani, an entrepreneur and the daughter of Yusuf Raza Gilani, the former prime minister, said she knows of several young people who jumped the queue and got the free government vaccine in recent weeks.

“I was myself offered out of turn, free vaccine, but I declined as I wanted to avail the private vaccine,” said Ms. Gilani. Wealthy people should pay for their doses, she said, adding that her family would pay for CanSino shots for its household staff.

Many people, like Tehmina Sadaf, don’t have that option.

Ms. Sadaf, 35, lives along with her husband and a seven-year old son in a working-class neighborhood on the outskirts of Islamabad. Her husband is a cleric at a mosque. She gives Quran lessons to young children. She said the pandemic had negatively impacted the family’s income of around $128 per month. “After paying the house rent and electricity bill, we are not left with much,” she said.

She had her doubts about the public vaccine, “but the price of the private vaccine is very high,” she said. “It should have been lower so that poor people like us can also afford it.”

Zia ur-Rehman contributed reporting from Karachi, Pakistan. Richard C. Paddock and Muktita Suhartono contributed reporting.

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Covax to Receive 200 Million Johnson & Johnson Covid Doses

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Covax, the program to vaccinate the world’s poorest countries, will receive 200 million doses of Johnson & Johnson’s single-shot coronavirus vaccine through an advance purchase agreement announced on Friday. The deal may eventually boost a vaccination campaign that has fallen significantly behind on its goals.

Gavi, the public-private health partnership co-leading Covax, will purchase the doses at a not-for-profit price from Johnson & Johnson. Gavi said that the goal is to supply the 200 million doses this year.

But it was not clear how quickly those doses will start being delivered or whether they can help turn around the struggling Covax program. Jake Sargent, a spokesman for Johnson & Johnson, said the company is “striving to deliver vaccine doses as quickly as possible.”

Only 71 million doses have been shipped out so far through the Covax program, the vast majority of which have been of AstraZeneca’s Covid vaccine. In March, the World Health Organization, another co-leader of Covax, had said 237 million doses would be allocated to participating countries by the end of May.

the growing gap in vaccination coverage between the world’s rich and poor. Only 0.3 percent of the vaccine doses administered globally have been given in the 29 poorest countries, home to about 9 percent of the world’s population.

Covax has been underfunded and behind schedule even before it faced its most significant blow last month: India, facing a devastating coronavirus crisis, halted vaccine exports out of the country, meaning that Covax could no longer receive doses from its major supplier, the Serum Institute of India. The Serum Institute signaled this week that it would not be able to provide vaccines beyond India before the end of this year.

The massive shortfall in supply has left low-income countries increasingly dependent on donations from wealthy countries. President Biden has pledged to donate 80 million doses of vaccines, most from AstraZeneca, and some of which are expected to be given through Covax. The president of the European Commission, Ursula von der Leyen, said on Friday that the bloc aims to donate 100 million vaccine doses to low- and middle-income countries this year.

Other vaccine makers have also said they would step up supply to low-income countries as they fight a push, supported by the Biden administration, to increase vaccine supply by waiving intellectual property protections on Covid vaccines. Albert Bourla, chief executive of Pfizer, said on Friday that the company expects to deliver two billion doses of its vaccine to developing countries in the next 18 months. That projection reflects existing deals with governments, anticipated future agreements and Pfizer’s pledge to supply 40 million doses to Covax.

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Japan Approves Moderna and AstraZeneca Vaccines

Japan on Friday approved the Moderna and AstraZeneca coronavirus vaccines for use in adults, giving the country much-needed new options as it tries to speed up an inoculation campaign that has been one of the slowest in the developed world.

Previously, only the Pfizer vaccine had been authorized for use in Japan, where just 4.1 percent of the population has received a first shot. Vaccinations have been held up by strict rules that allow only doctors and nurses to administer shots, and by a requirement that vaccines be tested on people in Japan before they are approved for use.

Japan is in the midst of a fourth wave of Covid-19 infections, just two months before the Summer Olympics in Tokyo are set to begin. Tokyo and eight other prefectures are under a state of emergency that will last at least until the end of this month, and Okinawa is expected to be added to that list. Japan has been reporting about 5,500 cases a day, compared to 1,000 in early March.

A health ministry panel recommended on Thursday night that the government approve the Moderna and AstraZeneca vaccines. The health minister, Norihisa Tamura, said the Moderna shots would be used at mass inoculation sites scheduled to open on Monday in Tokyo and Osaka, which will be staffed mainly by military doctors and nurses.

very rare cases of blood clotting.

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The global vaccination effort, already in dire shape, faces more setbacks.

As inoculations help a sense of normalcy return in the lives of many Americans, much of the world remains gripped by the pandemic, with little hope that a significant number of vaccine doses will be made available soon.

The effort to vaccinate enough of the world’s population to get the virus under control — already a huge struggle, experts said — was set back again this week after the Serum Institute of India, the world’s largest vaccine producer, signaled that it would not be able to export doses until the end of the year.

The Serum Institute’s manufacturing capacity is at the heart of Covax, a global effort to vaccinate the populations of low- and middle-income countries. The program is already more than 140 million doses behind schedule, and the Serum Institute announcement suggested that its goal of two billion doses by the end of the year would be all but impossible to meet.

Dr. Arthur Reingold, chief of the epidemiology division at the University of California, Berkeley, said that the delay was “not surprising, given the drastic situation” in India, which has been pummeled by the virus in recent weeks.

devastating second wave of coronavirus infections, the institute has diverted all its manufacturing powers to domestic needs, falling behind on commitments to the Covax partnership as well as on bilateral commercial deals with many countries.

“It simply means that poor countries of the world, the low- and middle-income countries of the world,” Dr. Reingold said, “are going to have to wait longer to come anywhere close to the kind of vaccination coverage that we’ve achieved in some of the wealthier countries.”

About 48 percent of people in the United States have received at least one dose of a Covid-19 vaccine, according to federal data on Wednesday. In the United Kingdom, the figure is 54 percent, and in Germany, nearly 38 percent, according to the Our World in Data project at Oxford University.

But only 10 percent of people in India have received a dose of the vaccine. Just over 1 percent of people in Honduras have received a shot, and less than 1 percent have been at least partially vaccinated in Somalia.

100 million doses of Johnson & Johnson’s vaccine were now on hold as regulators checked them for possible contamination.

The Johnson & Johnson vaccine has been viewed by public health officials as an important tool to vaccinate populations that are more difficult to reach, because it requires only one dose and does not need the special low-temperature storage required by the Moderna and Pfizer-BioNTech vaccines.

The rate of vaccinations in the United States has slowed considerably in recent weeks, though about 1.8 million doses are being administered to Americans each day on average, according to a New York Times database.

President Biden announced on Monday that the United States would send 20 million doses of the three vaccines abroad. The 100 million Johnson & Johnson doses under inspection could pad the American stockpile, or be sent to help meet the dire need abroad.

Still, Dr. Reingold said that it was “time well spent” to “very carefully look at those doses and ensure that they’re safe and effective.”

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Italy’s Vaccine Drive Runs Up Against a Sacred Institution: Summer Vacation

ROME — As Dr. Mario Sorlini sits patients down in a vaccination center near the badly affected Italian town of Bergamo, he explains a potential complication of the coronavirus vaccine.

The second dose, he tells patients with terror-stricken faces, will fall on a date during the summer holidays.

“‘But I’ll be in Sardinia then,’” he said that some had responded with distress. Others moan about hotel rooms they’ve already booked. Some, he said, get up and leave.

For months, Italians have hungered for the vaccines that would give them safety, freedom from lockdown and a taste of normal life. After initial pitfalls and hurdles, the vaccination campaign is finally speeding up, but it is heading smack into the summer holidays that are sacred for many Italians and prompting fears among officials that a significant number would rather get away than get vaccinated.

recent vacation anthem. That could create a significant danger next autumn, Ms. Tosi wrote in an open letter to the region’s president.

“The Second Shot Blocks Vacation,” read a headline in Messaggero Veneto, a newspaper in northeastern Italy, echoing concerns in papers, websites and social media accounts across the country.

An estimated 20 million Italians — mostly 40- and 50-somethings — face the prospect of getting their second shots in the middle of July or worse, in the riptide that is the Italian August, which pulls people out of cities and into swelling seaside towns.

To avoid a potentially disastrous summer freeze in the vaccination campaign, and more economic pain, Italy’s regions are urging the government to meet vacationers where they are and offer shots on the beach.

led by Prime Minister Mario Draghi, prides itself on pragmatism and is desperate to get the tourism economy moving. Mr. Draghi recently announced that Italy would lift quarantines and restrictions on vaccinated international tourists and told them “it’s time to book your holidays in Italy.”

Island paradises like Capri, favored by many foreigners, have accelerated their vaccination campaigns and are now considered Covid free. But when it comes to Italians, who are themselves still in the process of getting vaccinated during the summer months, the government has sought to strike a balance between openness to innovative ideas and scolding Italians for their spring and summer fever.

“If we do flights of fancy and inventions, I’m not in,” Francesco Paolo Figliuolo, an army general who has been put in charge of Italy’s vaccination effort, said on Tuesday, seeking to throw cold water on plans floated by governors to inoculate vacationing Italians wherever they might go.

told reporters. “And that it is technically impossible.”

He suggested leaving vacations for a day and then heading back.

Bergamo, said that for now, most of his patients were accepting the summer date for follow-up shots but that many asked, “‘Can I do it at the beach?’”

He said he expected at least 10 people a day to give up on their August appointments for second shots, which means he will struggle to keep those doses from going to waste.

Ciro Mautone, 58, a security guard at Camponeschi, a cafe popular with the vacation set in Rome, said that he had selected the Johnson and Johnson vaccine, which does not require a second shot, in part not to interrupt a potential holiday.

But he said that after the brutal year, with his work hit by the closing of businesses, he was focused on making up lost income rather than fretting about cutting short a vacation.

“I wish I had that problem,” he said.

Emma Bubola and Gaia Pianigiani contributed reporting.

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