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.


    How are we doing?
    We’re eager to have your thoughts about this newsletter and events in Canada in general. Please send them to nytcanada@nytimes.com.

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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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    Paraguay’s ‘Life and Death’ Covid Crisis Gives China Diplomatic Opening

    RIO DE JANEIRO — Taiwan has built thousands of homes for the poor in Paraguay, upgraded the country’s health care system, awarded hundreds of scholarships and even helped fund the futuristic Congress building in the capital, spending generously over decades to nurture their diplomatic ties.

    But the alliance, which makes Paraguay one of only 15 nations to have full diplomatic relations with Taiwan, and the only one in South America, is facing an existential threat as Paraguay’s quest for vaccines becomes increasingly desperate.

    With its health care system buckling as Covid-19 cases soar, Paraguayan officials across the political spectrum say the time has come to consider dumping Taiwan, which doesn’t export vaccines, in order to establish diplomatic ties with China, which does.

    “This is really a life and death situation,” said Pepe Zhang, an associate director at the Atlantic Council who specializes in relations between Latin America and China. “In this very acute phase of the pandemic, less resourceful countries like Paraguay are asking where they’re going to get the vaccine.”

    to rely predominantly on Chinese vaccines to blunt an epidemic that has left a brutal toll.

    That has given Beijing considerable leverage in a region where it has a broad constellation of investments and projects. Suddenly, wresting Paraguay from Taiwan’s orbit — which would advance Beijing’s goal of politically isolating an island it regards as its territory — appears within reach.

    Euclides Acevedo, Paraguay’s foreign minister, said recently that Beijing has made it clear it is interested in establishing ties with Paraguay. He has dangled that prospect of making the diplomatic switch as he has sought to pressure Taiwan and its ally, the United States, to get vaccines to Paraguay quickly.

    late last month in an interview on the television network Telefuturo. “I think our strategic allies, including the United States and Taiwan, must respond.”

    Beijing’s one-China principle forces countries to choose between having full diplomatic relations with Beijing or Taipei. Three countries in Latin America blindsided and angered the United States government in recent years by abruptly severing ties with Taiwan following secret negotiations with Beijing.

    Panama, the Dominican Republic and El Salvador — came with promises of growing trade with Beijing and has made them early recipients of Chinese vaccines.

    Mr. Acevedo said Paraguay should explore what it would gain by doing the same.

    “President Xi Jinping has keen interest in partnering with us,” he said. “It’s a political debate that should draw input from all segments of the state and all of society.”

    Yet, it’s not clear that Paraguay has taken formal steps toward exploring a flip.

    Charles Andrew Tang, who heads the China-Paraguay Chamber of Commerce, said he advised officials at the health ministry earlier this year on the paperwork they would need to fill out to request purchasing Chinese vaccines.

    Mr. Tang, who is seen in Paraguay as a key interlocutor with the Chinese government, said it is conceivable that Chinese vaccine manufacturers would sell vaccines to Paraguay even without formal diplomatic relations. But he said the onus was on officials in Paraguay to make the first move.

    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 virus can spread across borders, but mankind’s love also transcends borders,” he told reporters.

    This week China’s main Covid-19 vaccine manufacturer, Sinovac, made a gesture that is certain to fuel speculation about Beijing’s plans in Paraguay. The South American soccer federation Conmebol, which is based in Paraguay, announced it was receiving a donation of 50,000 doses of CoronaVac, the Covid-19 vaccine produced by Beijing-based Sinovac.

    “The leaders of this company have understood the enormous social and cultural value of soccer in South American countries,” the federation’s president, Alejandro Domínguez, said in a statement, calling the donation a “noble gesture.”

    Despite all these signals, Taiwan’s position in Paraguay may be safer than it appears, said Lee McClenny, who served as the U.S. ambassador in Paraguay until last September. While cabinet members and businessmen have pressured President Mario Abdo Benítez to forge ties with China, the Chinese government didn’t show much interest in getting Paraguay to flip, he said.

    “On the ground I didn’t see very effective efforts to make this happen,” Mr. McClenny said.

    Besides, Mr. McClenny added, the Paraguayan president takes a special pride in the relationship with Taiwan, which was brokered in the 1950s by his late father, who served as the personal secretary to Alfredo Stroessner, the dictator who ran the country for 35 years. And Taiwanese aid has made a major impact in the landlocked, impoverished nation.

    “It’s effective and benefits people’s lives in real ways,” Mr. McClenny said about Taiwan’s assistance.

    The Biden administration has signaled its unease about the prospect that Paraguay could cut a deal with China. In a phone call with Mr. Abdo Benítez last month, Secretary of State Antony J. Blinken urged the Paraguay government to continue to “work with democratic and global partners, including Taiwan, to overcome this global pandemic,” according to a summary of the call provided by the State Department.

    That message rankles opposition lawmakers, including the leftist Senator Esperanza Martínez, who served as health minister from 2008 to 2012. Ms. Martínez has long favored establishing relations with China, arguing that Paraguay stands to benefit in the long run by expanding trade. She said Washington’s exhortation was immoral.

    “We’re being loyal to people who impose rules on us while we die,” she said. “Our allies are vaccinating people morning, afternoon and night while they block us from getting vaccines, saying we’ll turn into communists.”

    Ernesto Londoño reported from Rio de Janeiro. Santi Carneri contributed reporting from Asunción, Amy Qin contributed reporting from Taipei, Taiwan and Sui-Lee Wee contributed reporting from Singapore.

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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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    C.D.C. Panel Keeps Pause on Use of J&J Vaccine, Weighing Risks

    “Right now, we believe these events to be extremely rare, but we are also not yet certain we have heard about all possible cases, as this syndrome may not be easily recognized as one associated with the vaccine,” Dr. Rochelle P. Walensky, the C.D.C. director, said at a White House news conference on the pandemic on Wednesday.

    During the panel discussion, experts noted that the “risk window” for the condition among vaccine recipients was still open and that new cases might emerge, because nearly 3.8 million people had received the shot within the last two weeks. In the six women, the severe clotting developed within about two weeks of the shot.

    Other experts encouraged dissemination of health information on diagnosis and treatment of the condition so that awareness would spread among doctors, emergency rooms and people who had received the vaccine. A key point is that the blood-thinner heparin, a common treatment for clots, can harm these patients and should not be used.

    Officials also noted that people with the condition needed to be treated as soon as possible because the clots were so serious. Some patients needed invasive procedures to remove large clots from blood vessels in their brains.

    Several panel members reiterated that two other vaccines — from Moderna and Pfizer-BioNTech — are available, neither associated with the clotting problem, so continuing the pause would not stop most people in the United States from being vaccinated.

    At the news conference, Jeffrey D. Zients, the White House’s pandemic coordinator, said that the pause would not generally interrupt the momentum of the country’s vaccination campaign.

    “In the very short term, we do expect some impact on daily averages as sites and appointments transition from Johnson & Johnson to Moderna and Pfizer vaccines,” he said. “We have more than enough Pfizer and Moderna vaccine supply to continue or even accelerate the current pace of vaccinations.”

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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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    Expert Panel to C.D.C. to Vote on Johnson & Johnson Vaccine Pause

    An advisory committee for the Centers for Disease Control and Prevention is discussing the Johnson & Johnson Covid-19 vaccine pause during a meeting on Wednesday afternoon while a possible link to a small number of rare blood clots is investigated.

    The emergency meeting follows the Food and Drug Administration’s announcement on Tuesday that it was studying six cases of rare and severe blood clots in women aged 18 to 48, one of whom died. All of the women had received the Johnson & Johnson vaccine before developing the clots, though it is unclear whether the vaccine is responsible. As of Tuesday, more than seven million people in the United States have received the shot, and another 10 million doses have been shipped out to the states, according to C.D.C. data.

    Following the call from federal health agencies, all 50 states, Washington, D.C., and Puerto Rico on Tuesday quickly paused or recommended that providers pause the administration 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.

    The Advisory Committee on Immunization Practices, or ACIP, is a panel of independent experts who advise the C.D.C. on its vaccine policies. At the meeting, the experts are reviewing and debating data from the rare cases, and will later hear comments from the public, before a possible vote on how to proceed. They could vote to recommend that the pause continues, for example, or to specify that it should apply only to a certain age or sex.

    reiterated on Wednesday that the pause in Johnson & Johnson vaccinations gives public health officials a chance to investigate the cases and discuss them with health care professionals. He added that pauses are common when new vaccines and drugs are rolled out.

    “We’re just doing the due diligence we need to do to make sure everything is safe so we can continue with our vaccination efforts,” Dr. Murthy said on “CBS This Morning.”

    was not worth the trade-off of slowing the vaccination campaign and potentially eroding the public’s trust of vaccines in general.

    At the news conference, Jeffrey D. Zients, the White House’s pandemic coordinator, said that the pause would not generally interrupt the momentum of the country’s vaccination campaign.

    “In the very short term, we do expect some impact on daily averages as sites and appointments transition from Johnson & Johnson to Moderna and Pfizer vaccines,” he said. “We have more than enough Pfizer and Moderna vaccine supply to continue or even accelerate the current pace of vaccinations.”

    Noah Weiland and Madeleine Ngo contributed 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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