HAMBURG, Germany — When a young woman showed up at Hamburg’s giant Covid vaccination site last week, the city officials who check whether people are eligible were skeptical.
She was in her mid 20s; shots are being given mainly to those 60 and older. But she said she qualified for an exemption because she was caring for her infirm mother and produced a form to make her case. Without a signature from her mother, the form was invalid and the officials turned her away. But she returned quickly, a little too quickly, with the document signed.
This time she claimed to have a sister who was vaccinated for the same reason, but a spot check of inoculation records showed that to be false as well.
“She could not get out of here fast enough,” said Martin Helfrich, a spokesman for the city who witnessed the scene.
Ugur Sahin, the 55-year-old chief executive of BioNTech, the German company that designed the Pfizer vaccine, has said he will also wait his turn.
Germany’s vaccine program is gaining steam, and federal lawmakers have granted new freedoms for the fully vaccinated (as of Wednesday, just under 12 percent of the population), including the right to meet with other inoculated people, shop and travel without testing or quarantining. The move was a clear incentive for Germans who are hoping for a more normal summer (in 2019 Germans took 52 million vacations longer than four days abroad; in 2020 it was only 28 million). But officials say it might also have been a prompt for some to try and get around the priority rules.
AstraZenecaGo, because of its similarity to the popular augmented reality geolocation game Pokemon Go.
Xenia Balzereit, 29, a Berlin journalist, wrote about her lack of shame in taking the initiative to get herself vaccinated with AstraZeneca, the government’s handling of which led to widespread confusion.
“Honestly, my guilty conscience was worse when I cut in line at Berghain in prepandemic times,” she wrote, referring to Berlin’s most famous club.
Family doctors, who started vaccinating in April, have also had much more leeway over whom they choose to vaccinate and why. On Monday both Berlin and the western State of Baden-Württemberg officially dropped vaccine prioritization lists for shots administered by doctors.
But at Hamburg’s vaccine center — the biggest in Germany — priority lists are still in place and enforced.
Kai Pawlik, 43, a coordinator at the vaccine center, says cheats are often easily found out.
Mr. Pawlik, who often has to deal with the less clear-cut cases, says he understands that some people are so desperate to get the shot that they might misrepresent or pretend to misunderstand the rules.
“And on the other hand, of course, there are people who quite brazenly try to take advantage of a system and get ahead,” he said. “And then my sympathy is quite limited.”
Björn Eggers, a 43-year old police officer, who like many other frontline workers is already eligible, came for his second shot on Friday. He was not impressed with the idea of line jumpers.
“If everyone tried to do it,” he said, “we’d have absolute chaos.”
Federal health officials have now confirmed 28 cases, including six in men, of a rare blood clotting disorder in adults who have received the Johnson & Johnson Covid-19 vaccine.
Dr. Tom Shimabukuro, the deputy director of the immunization safety office at the Centers for Disease Control and Prevention, presented the new cases on Wednesday at a meeting of a panel of advisers to the C.D.C.
The figure is an increase from the 15 confirmed cases, all of which were in women, that were reported at last month’s meeting.
Although officials have now identified a handful of cases in men, women — especially those between the ages of 30 and 49 — appear to remain at elevated risk. “The trend is that the reporting rates are higher in females compared to males in all age categories,” Dr. Shimabukuro said at the meeting.
lifted the suspension 10 days later and added a warning about the potential risks to the vaccine’s label, which notes that a connection between the vaccine and the condition is “plausible.”
Twenty-two of the confirmed cases so far have been in women, and six have been in men. All were in adults between the ages of 18 and 59 who received the vaccine before the national pause. (There was also one additional case recorded in a 25-year-old man who participated in the clinical trial.)
Three people have died and four remain hospitalized, including one who is in intensive care. No new deaths have been documented since last month’s meeting, Dr. Shimabukuro said.
The overall risk remains exceedingly low. More than 9 million doses of the Johnson & Johnson vaccine have now been administered in the United States.
There have been 12.4 cases per million doses among women between the ages of 30-39 and 9.4 cases per million doses among women between 40 and 49, the two demographic groups that appear to be at highest risk. Among older women and men of all ages, there were fewer than 3 cases per million doses.
Among the 28 confirmed cases, 12 people who developed the disorder had obesity, 7 had high blood pressure, 3 had diabetes, and 3 were taking estrogen, though it is not yet clear whether any of those factors might substantially increase the risk of the disorder.
Officials will continue to monitor for cases of the clotting disorder in people who have been vaccinated, Dr. Shimabukuro said.
There have been no confirmed cases of the clotting disorder following the Pfizer-BioNTech or Moderna vaccines, which employ a different technology, Dr. Shimabukuro said.
Novavax, one of the first players in the race to vaccinate the world against Covid, delivered disheartening news on Monday, saying that its highly protective vaccine would not be authorized in the United States or Britain until at least July, and that it would not reach peak production until the end of the year.
The delays, announced during an earnings call with investors, are the latest setback for the little-known Maryland company, which was granted up to $1.6 billion from the U.S. federal government last year and whose product has shown robust results in clinical trials. Despite these wins, the company has struggled to demonstrate that it can deliver on its promise to supply the world with 2 billion doses this year. Novavax has never brought a vaccine to market in its 34-year history.
On the call, the company’s president and chief executive, Stanley C. Erck, said that the regulatory and manufacturing hurdles causing the delay have now been resolved. “Nearly all of the major challenges have been overcome, and we can clearly see the light at the end of the tunnel,” he said.
Investors did not appear to agree: By Tuesday morning, the company’s stock had fallen to $133.86, down nearly 17 percent, although it rebounded somewhat later in the day.
finalized a deal with Gavi, a public-private global vaccine partnership, to supply 1.1 billion doses of its shot to low- and middle-income countries. Novavax has struck other deals with countries like South Korea, Japan and Australia, and has set up agreements with eight production plants around the world.
In January, the company estimated that it would hit its full production capacity of 150 million doses a month by the middle of this year, a prediction it later revised after facing a shortage of supplies like filters and the giant single-use bags that are used in vaccine manufacturing. On Monday, the company delayed its estimate again, saying it expected to reach production of 100 million doses a month by the end of the third quarter, and to make 150 million a month by the fourth quarter.
One of its major manufacturing partners, the Serum Institute in India, has faced its own production and geopolitical challenges. A fire at the facility earlier this year reduced its capacity, and in April, Serum’s chief executive, Adar Poonawalla, called out the United States for restricting access to raw vaccine ingredients. And though Novavax’s deal with Serum is intended to supply the rest of the world through its arrangement with Gavi, the Indian government has banned exports of vaccines from the country as it struggles with a deadly second wave of Covid-19.
which is tracking global vaccine deals. “I think particularly for countries in South and Southeast Asia, as well as countries in Africa, it is hard to overstate the impact that this is having.”
Regulatory hurdles have also set Novavax back. On Monday, company executives said that a now-resolved issue with an “assay” — a test that was needed to confirm that their product can be consistently manufactured at commercial scale across multiple production plants — was delaying regulatory approvals around the world, and that countries like Britain and the United States would not grant authorization until at least July. Company officials once said they hoped to gain authorization for their vaccine in April.
persuaded Novavax to set up a trial there last year in part by promising speed in clinical development and regulatory approval. But time is running out: About two-thirds of British adults have received a first dose of a coronavirus vaccine, most made by AstraZeneca, and every adult is expected to be offered one by the end of July.
The vaccine’s role in Britain depends in part on how quickly Novavax can start distributing its shot. A British factory making the vaccines has said that it would be ready by the summer. The country has recently turned away from the AstraZeneca shot in younger people because of the risk of very rare blood clots, leaving room for Novavax to be an alternative for people under 40.
The country is also studying the effects of administering a second dose of the Novavax vaccine in people who have already received a first dose from either Pfizer or AstraZeneca.
the company was on the verge of closing after a major trial failure for another vaccine, and it was forced to sell off its manufacturing facility to raise money.
Last year, the Trump administration placed a major bet on the tiny company as part of its Operation Warp Speed project, signing a $1.6 billion contract for delivery of 110 million doses by early this year. In April, the total amount of the deal was increased to $1.75 billion, according to Novavax’s financial filings. The company’s large trial in the United States and Mexico has still not been completed, although executives said on Monday that they expected results from that study “in a few weeks.”
Novavax officials said they now did not expect to deliver those doses until the end of this year or early 2022. A spokeswoman for Novavax said there was no penalty for later delivery in its contract with the U.S. government.
Novavax’s spotty track record does not offer confidence that it can rise to the challenge of producing billions of doses, said Les Funtleyder, a health care portfolio manager at E Squared Capital Management who invests in domestic and emerging markets. “It seems they were really unprepared for a challenge of this magnitude,” he said.
Recent news of internal turnover — such as the departure last month of Novavax’s chief financial officer, five months after taking the role, for personal reasons — does not help, Mr. Funtleyder said. “It’s a bad look,” he said.
children older than 12, in an effort to catch up to Moderna and Pfizer, which have already tested their products in that age group.
The vaccine can also be stored at normal refrigeration temperatures, without the freezing temperatures required by Pfizer and Moderna’s vaccines.
“By the end of 2021 there will still be a great need for safe and effective vaccines that can travel well,” said Ms. Taylor, of Duke University. “Novavax looks like it can fit that description.”
Dr. Saad B. Omer, the director of the Yale Institute for Global Health, noted that when concerns were raised over the Johnson & Johnson and AstraZeneca vaccines because of links to blood clots, countries with multiple vaccines available were able to switch to other options.
“It’s good to hedge our bets,” he said. “If we want to avoid, for example, body blow after body blow to low-income countries in many parts of the world that has an impact on everyone, we need to vaccinate a huge chunk of the world.”
Benjamin Mueller and Noah Weiland contributed reporting.
Several states are turning away Covid vaccine doses from their federal government allocations, as the daily average of coronavirus vaccine doses administered across the United States has fallen below two million for the first time since early March. Experts say the states’ smaller requests reflect a steep drop in vaccine demand in the United States.
Wisconsin officials have asked for just 8 percent of the 162,680 doses the federal government had set aside for the state next week, according to The Associated Press. In Iowa, officials asked for just 29 percent of the state’s allocated doses. And in Illinois, the state is planning to request just 9 percent of its allotted doses for everywhere, except for Chicago, for next week, The A.P. reported.
North Carolina, South Carolina, Washington State and Connecticut are also scaling back on their vaccine requests.
As demand falls and the spread of the virus slows in the United States, the Biden administration is under increasing pressure to share vaccine doses with countries like India, which has been ravaged by a catastrophic surge. About 83 percent of shots have been administered in high- and upper-middle-income countries, while only 0.3 percent of doses have been given in low-income countries.
normal refrigeration temperatures for at least three months, making its distribution considerably easier. But allocations of that have remained low nationally after a pause over extremely rare cases of blood clots was lifted last month, and that has contributed to the drop in vaccinations being given more broadly.
shifted the administration’s strategy to battle the pandemic. Changes include creating a federal stockpile of vaccine doses to given to states as needed, instead of strictly by population, and investing millions in community outreach to target underserved communities, younger Americans and those hesitant to get shots.
Mass vaccination sites will wind down in favor of smaller settings. Pharmacies will allow people to walk in for shots, and pop-up and mobile clinics will distribute vaccines, especially in rural areas. Federal officials also plan to enlist the help of family doctors and other emissaries who are trusted voices in their communities.
Dr. Adalja suggested that federal health guidance should take care to avoid “underselling the vaccine” as the nation tries to get more people vaccinated. Guidance on issues such as traveling and mask-wearing can be loosened “aggressively” for vaccinated people, Dr. Adalja said. “They seem to be several steps behind what infectious disease doctors like myself are telling people that are fully vaccinated what they can do.”
Experts warn that states where vaccinations are falling behind — particularly in the South — could be especially prone to outbreaks in the weeks ahead as more contagious virus variants spread. Texas and North Carolina are trailing the national average in vaccinations, with about 40 percent of people receiving at least one shot. In Alabama, Mississippi and Louisiana, about a third of residents have gotten their first shot.
BERLIN — Dr. Peter Weitkamp placed an ad in eBay’s classifieds last week, offering appointments for an AstraZeneca vaccine — “free/to give away” — to anyone over 60. Many of his own patients didn’t want it, since the German government had spent months questioning the vaccine.
But within a day, his practice in Kirchlengern, in the western state of North Rhine-Westphalia, was inundated with calls from people seeking the remaining 80 to 90 doses, including some offering to drive in from out of state. Another family doctor got a similar response after setting up a drive-through vaccination center in a grocery store parking lot to administer AstraZeneca shots her that her own patients had rejected.
To the doctors, the response was proof that plenty of Germans were willing, even eager, for doses of AstraZeneca. Days later, the German government apparently agreed and relaxed previous restrictions that limited the AstraZeneca vaccine to certain age groups over concerns about rare but dangerous blood clots.
vaccine passport to make travel within the European Union easier andGermany’s upper house of Parliament moving to exempt the fully vaccinated from many restrictions — social distancing and wearing a mask will still be required of everyone — many Germans who qualified for an AstraZeneca shot were reluctant to get one. That was partly because the rival two-dose vaccine from BioNTech and Pfizer could be completed in only six weeks, whereas the recommended wait between shots for the AstraZeneca one was 12 weeks.
“We will make a lot more flexibility possible,” Mr. Spahn told the public television station WDR on Wednesday. “Many people want to have their second shot earlier, with an eye on summer, and that is possible with Astra.”
The Lancet in February saidthe vaccine provided protection of more than 80 percent if the second shot was administered after 12 weeks, while after less than six weeks, it provided only 55 percent protection.
“The considerable damage to the image of AstraZeneca’s vaccine, which is still unjustified, is also because of the uncertainty caused by the disastrous communication of its possible side effects by politicians and authorities among the population,”said Ulrich Weigeldt, chairman of the German Association of Family Physicians.
German health authorities initially limited its application to younger adults because there wasn’t enough information on how older adults responded. Then they suspended it for several weeks because of reports of cases of blood clots accompanied by low platelet counts, before reintroducing it but only for individuals older than 60.
began reopening retail shops and outdoor dining, at a time when Germans were still wrangling over the terms of a new lockdown. That included nightly curfews to slow a surging third wave of the virus and a cumbersome vaccine sign-up system riddled with bureaucratic hurdles, and overtaxed hotlines.
“The British of course are all laughing, ‘Oh, the Germans again,’” said Henrike Thalenhorst, who is completing her residency in the office of Dr. Weitkamp, who offered the AstraZeneca appointments on eBay. “They are thinking, ‘While they are filling out six pieces of paper and waiting for an appointment we are all vaccinated with Astra and hitting the pubs.’”
But while AstraZeneca’s links to Britain made it a source of local pride, for Germans, similar sentiments surround the BioNTech-Pfizer vaccine, which was developed by a start-up based in the western city of Mainz and known to some as “the Mercedes-Benz of vaccines.”
In a letter to the Neue Westfälische newspaper, one man described his decision to hold out against an offer of AstraZeneca as a matter of national pride. “As a not-yet-vaccinated 67-year-old German patriot,” wrote Lutz Schaal, from Bielefeld, “I am waiting for my BioNTech inoculation.”
Christopher F. Schuetze contributed reporting from Berlin and Megan Specia from London.
Britain’s vaccines regulator advised on Friday that all adults under 40 in the country should be offered alternatives to AstraZeneca’s Covid-19 vaccine. It factored in concerns over very rare blood clots, the dwindling risk of severe coronavirus infection in younger adults and the availability of alternatives.
The guidance extends earlier advice that people under 30 would be offered alternative doses.
The use of the AstraZeneca vaccine has been marred by uncertainty after reports of a possible link between the doses and very rare blood clots, but public health experts around the world say that the vaccine’s benefits far outweigh the risks for most people.
Britain’s Joint Committee on Vaccination and Immunization stressed that the chances of younger people becoming seriously ill with the coronavirus had grown smaller as infection rates decrease across the country. It said that this new reality paired with the availability of alternative vaccines had factored into the decision.
But the country is also closely monitoring new variants of the coronavirus, and on Friday public health officials in England noted that a variant first detected in India was now considered a “variant of concern” — meaning that it is at least as transmissible as the dominant variant in Britain. The cases identified in the country more than doubled from 202 to 520 in the week, but still account for just a fraction of the cases there.
While there is still not enough evidence to indicate whether any of the variants recently detected in India cause more severe illness or render vaccines any less effective, Britain is proceeding with caution. Most of the identified cases of the variant are in London and in the town of Bolton in the northwestern England.
Regarding the AstraZeneca vaccine, the regulator advised that where available, an alternative should be offered to healthy adults under 40, though it stressed that potentially severe side effects from the doses were “extremely rare.” It noted that “for the vast majority of people, the benefits of preventing serious illness and death far outweigh any risks.”
The vaccination committee advised that anyone who received a first dose of the AstraZeneca vaccine should still receive a second, except those who experienced clotting.
Britain’s medicines regulatory agency had received reports of 242 cases of blood clots accompanied by low platelet counts in people who received the AstraZeneca vaccine through April 28. As of that date, about 22.6 million AstraZeneca doses had been administered in Britain, including about 5.9 million second doses.
Over all, about 35 million people in the country have received at least one dose of a coronavirus vaccine.
The American public’s willingness to get a Covid vaccine is reaching a saturation point, a new national poll suggests, one more indication that achieving widespread immunity in the United States is becoming increasingly challenging.
Only 9 percent of respondents said they hadn’t yet gotten the shot but intended to do so, according to the survey, published in the April edition of the Kaiser Family Foundation’s Vaccine Monitor. And with federal authorization of the Pfizer vaccine for adolescents ages 12 through 15 expected imminently, the eagerness of parents to let their children be vaccinated is also limited, the poll found.
Overall, slightly more than half of those surveyed said they had gotten at least one dose of the vaccine, a finding that matches data from the Centers for Disease Control and Prevention.
“We’re in a new stage of talking about vaccine demand,” said Mollyann Brodie, executive vice president of Kaiser’s Public Opinion and Survey Research Program. “There’s not going to be a single strategy to increase demand across everyone who is left. There will be have to be a lot of individually targeted efforts. The people still on the fence have logistical barriers, information needs, and lots don’t yet know they are eligible. Each strategy might move a small number of people to get vaccinated, but all together, that could matter a lot.”
With a growing number of scientists and public health experts concluding that it is unlikely that the country will reach the threshold of herd immunity, the Biden administration has stepped up efforts to reach those who are still hesitant. On Tuesday, the administration announced steps to encourage more pop-up and mobile vaccine clinics and to distribute shots to primary care doctors and pediatricians as well as local pharmacies.
The survey also showed that confidence in the Johnson & Johnson vaccine had suffered a significant blow after the 10-day pause in dispensing it while the authorities examined rare incidents of life-threatening blood clots in people who had taken it. While 69 percent of people said they had confidence in the safety of the vaccines made by Pfizer and Moderna, only 46 percent felt confident about the safety of the Johnson & Johnson vaccine. Among adults who have not been vaccinated, one in five said that the news about the Johnson & Johnson shot had prompted them to change their minds about getting a Covid-19 vaccine.
The survey did show that there had been some progress among Republicans, who have been among the firmest holdouts. Among that group, 55 percent said they had gotten a shot or intended to do so, up from 46 percent in March. The percentage who will “definitely not” get the vaccine is shrinking as well, down to 20 percent from 29 percent in March.
The results were based on telephone surveys of a nationally representative sample of 2,097 adults from April 15 through April 29.
A consortium of universities that includes Harvard, Northeastern and Rutgers has been conducting online polls during the pandemic and recently focused on parents. The group’s latest survey, conducted throughout April and reaching 21,733 adults across 50 states, found that the divide between mothers and fathers in views about the vaccine for children had widened.
Fathers are becoming more accepting, with their resistance falling to 11 percent from 14 percent since February. But over a quarter of mothers, researchers said, still say they are “extremely unlikely” to vaccinate their children. Both genders are more resistant to the vaccine for younger children than for teenagers. Other research shows that mothers tend to have more sway over the final decision than fathers.
The responses from parents may well change over time, experts say. Just as adults were far more reluctant last summer when the vaccine was still a concept, parents surveyed several weeks ago, when imminent authorization for children under 16 had not been widely discussed, might also have been reacting to a hypothetical situation rather than a reality.
But pediatricians and others who are seen as trusted sources of information are already aware that they have considerable work to do to instill vaccine confidence in this latest cohort.
Dr. Sean O’Leary, a pediatrician in Denver who is vice chairman of the committee on infectious diseases for the American Academy of Pediatrics, predicted that just as adults had swarmed Covid vaccine providers during the initial weeks of distribution, parents and pent-up young teenagers would rush for it at the start, too.
But Dr. O’Leary, who often gives talks to pediatricians about how to motivate patients to accept vaccinations, worries that a slowdown will inevitably follow. To persuade hesitant parents, he said, “we have to make the vaccine available in as many places as possible.”
He added, “If parents and patients are in the pediatrician’s office and the doctor can say, ‘Hey, I’ve got it,’ that may be enough of a nudge for them to say, ‘Let’s go ahead and do this.’”
Denmark will not use the Johnson & Johnson vaccine, the Danish Health Authority announced on Monday, saying in a statement that the country could make adequate progress using other vaccines and did not need to run the risk of a rare, dangerous blood clotting condition that may be linked to the Johnson & Johnson vaccine.
The country has halted administering the AstraZeneca vaccine for similar reasons, after two people died of blood clots after being given that vaccine.
Denmark had been planning to use the Johnson & Johnson single-dose vaccine before reports emerged about a possible link to the clotting condition, which seems to mainly affect younger women. Dropping the vaccine from its plans will set back the country’s timetable for vaccinating adults under 40 by about a month, Danish officials said.
The United States temporarily suspended using the Johnson & Johnson vaccine, but the Food and Drug Administration announced on Friday that it would be made available again, with a warning about the possible clotting risk added to its label.
endorsed use of the Johnson & Johnson vaccine with an added warning.
The Danish Health Authority, however, said it had independently investigated the vaccine and decided against using it.
“Taking the present situation in Denmark into account, what we are currently losing in our effort to prevent severe illness from Covid-19 cannot outweigh the risk of causing possible side effects in the form of severe blood clots in those we vaccinate,” the authority said in a statement.
“One should also bear in mind that, going forward, we will first and foremost be vaccinating younger and healthy people,” Helene Probst, the deputy director general of the authority, said in the statement.
Canada’s drug and vaccine regulator said on Friday that it was withholding the country’s first shipment of the Johnson & Johnson vaccine to verify its safety and quality.
Health Canada, the regulator, said on Tuesday that none of the Johnson & Johnson vaccine, developed by the company’s Janssen subsidiary, had been made at an Emergent BioSolutions factory in Baltimore which had discarded millions of possibly contaminated doses of AstraZeneca’s coronavirus vaccine.
But in a statement issued on Friday evening, it said that since then it has “learned that a drug substance produced at the Emergent site was used in the manufacturing of the initial Janssen vaccines.”
The regulator said that it is now working with Janssen and the Food and Drug Administration in the United States to make sure that the vaccines meet Canada’s standards for “quality, safety and efficacy.”
were also produced at the Baltimore plant. Health Canada said last week that its review of that vaccine uncovered no problems or contamination.
Vaccine production at the plant has been suspended. Up to 15 million doses of the Johnson & Johnson vaccine made there were thrown away because contamination fears. Inspectors from the F.D.A. later found that Emergent did not fully investigate the contamination and found problems with the factory’s disinfection practices, it size and design, how it handled raw materials and trained its workers.
On Thursday, Emergent announced that it had removed some of its senior managers. Robert Kramer, the chief executive, acknowledged that the “loss of a batch for a viral contamination is extremely serious” but said that he hoped production would start again in Baltimore soon.
That was lifted a week ago after a warning label about the clotting issue was added.
The European Union has sued AstraZeneca over what the bloc has described as delays in shipping hundreds of millions of doses of coronavirus vaccines, a sharp escalation of a longstanding dispute between the bloc and the maker of one of the world’s most important vaccines.
AstraZeneca has said that it would be able to deliver only a third of the 300 million doses that European officials had been expecting by the end of June. As a result, European officials said on Monday that they believed AstraZeneca had broken its contract, and that they were seeking speedier deliveries than the company said it could muster.
The two sides’ relationship had grown acrimonious in January when AstraZeneca slashed its expected deliveries for the first quarter of the year, setting back the bloc’s vaccination campaign by weeks as cases picked up across the continent and political leaders faced scorching criticism for inadequate planning.
For AstraZeneca, whose cheap and easy-to-store shot is being used by 135 countries, the lawsuit could create further difficulties in a bruising stretch. No company had been as instrumental in the race to vaccinate poorer countries around the world, but AstraZeneca has been buffeted in recent weeks by the discovery of an exceedingly rare, though serious, side effect that has prompted restrictions on its use in parts of Europe.
voted to recommend lifting a pause on the Johnson & Johnson Covid vaccine and adding a label about an exceedingly uncommon but potentially dangerous blood clotting disorder.
Federal health officials are expected to formally recommend that states lift the pause.
Administration of the vaccine ground to a halt recently after reports emerged of a rare blood clotting disorder in six women who had received the vaccine.
The overall risk of developing the disorder is extremely low. Women between 30 and 39 appear to be at greatest risk, with 11.8 cases per million doses given. There have been seven cases per million doses among women between 18 and 49.
Nearly eight million doses of the vaccine have now been administered. Among men and women who are 50 or over, there has been less than one case per million doses.
Johnson & Johnson had also decided to delay the rollout of its vaccine in Europe amid similar concerns, but it later decided to resume its campaign after the European Union’s drug regulator said a warning label should be added. South Africa, devastated by a more contagious virus variant that emerged there, also suspended use of the vaccine but later moved forward with it.
That could make it more difficult for European officials to demand faster shipments. But Belgian courts, like many in continental Europe, consider not only the wording of a contract, but also its genesis, which could work to the advantage of the European Union.
“A European judge looks at the good faith or lack of it that the parties brought into the contract, at the way in which the contract was negotiated, the general atmosphere,” said Professor Van Calster. “I think that the commission probably hopes that the judge will be able to determine that AstraZeneca, in particular, has failed to supply a number of vaccines which they could have reasonably supplied to the European Union.”
He said that the court could rule that AstraZeneca must surrender a certain number of doses, but that the outcome was uncertain.
AstraZeneca said on Monday that it “regrets the European Commission’s decision to take legal action over the supply of Covid-19 vaccines,” describing the lawsuit as “without merit.”
It said that it would deliver almost 50 million doses to the bloc by the end of April, and that it had “fully complied with the advance purchase agreement with the European Commission and will strongly defend itself in court.”
Stefan de Keersmaecker, a spokesman on health issues for the European Commission, said that the bloc had begun legal action because it believed the purchase agreement had been breached.
negotiating a contract with Pfizer for 1.8 billion doses over the next two years.
Ursula von der Leyen, the president of the European Commission, told The New York Times on Sunday that AstraZeneca had squandered the bloc’s trust.
“The noncommunication of AstraZeneca of the problems made it like pulling a chewing gum, because you never knew what was going on,” she said. Ms. von der Leyen added that the delivery shortfalls were too steep to ignore.
“At the moment, the company has a delay in delivering 200 million doses of vaccine by the end of the second quarter,” she said. “The number speaks for itself.”
AstraZeneca’s vaccine is being widely used across Europe, though some countries have curbed its use in younger people because of the risk of very rare blood clots. The European Medicines Agency, the bloc’s drug regulator, said this month that the shot’s benefits still outweighed its risks, but that it should carry a warning.
The vaccine is not yet authorized for use in the United States. American officials have given a few million doses that were manufactured there to Canada and Mexico.