AUCKLAND, New Zealand — Rawiri Jansen, a Maori doctor, had an urgent message for the 150 people, mostly patch-wearing members of New Zealand’s plentiful street gangs and their families, who sat before him on a bright Saturday afternoon.
Covid is coming for them, he said. Cases in New Zealand’s hospitals are rising rapidly. Soon, dozens of new infections a day might be hundreds or even a thousand. People will die. And vaccination is the only defense. “When your doctors are scared, you should be scared,” he said.
By the end of the day, after an exhaustive question-and-answer session with other health professionals, roughly a third of those present chose to receive a dose then and there.
Having abandoned its highly successful “Covid-zero” elimination strategy in response to an outbreak of the Delta variant, New Zealand is now undergoing a difficult transition to trying to keep coronavirus cases as low as possible. On Friday, the country set a target of getting at least 90 percent of the eligible population fully vaccinated — a goal, the highest in the developed world, whose success hinges on persuading people like those who gathered to hear Dr. Jansen.
intensely criticized, including by police leaders.
Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines. Pfizer and Moderna recipients who are eligible for a booster include people 65 and older, and younger adults at high risk of severe Covid-19 because of medical conditions or where they work. Eligible Pfizer and Moderna recipients can get a booster at least six months after their second dose. All Johnson & Johnson recipients will be eligible for a second shot at least two months after the first.
Yes. The F.D.A. has updated its authorizations to allow medical providers to boost people with a different vaccine than the one they initially received, a strategy known as “mix and match.” Whether you received Moderna, Johnson & Johnson or Pfizer-BioNTech, you may receive a booster of any other vaccine. Regulators have not recommended any one vaccine over another as a booster. They have also remained silent on whether it is preferable to stick with the same vaccine when possible.
The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.
The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.
Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.
Chris Hipkins, the minister responsible for New Zealand’s Covid-19 response, acknowledged earlier this month that the decision to enlist gang leaders was an unusual one.
“Our No. 1 priority here is to stop Covid-19 in its tracks, and that means doing what we need to do to get in front of the virus,” he said. “Where we have been able to enlist gang leaders to help with that, and where they have been willing to do so, we have done that.”
Some gang leaders have acted independently to help the vaccination effort. They have connected members of their community to health officials, organized events with health professionals like Dr. Jansen, and streamed events on Facebook Live to allow an open forum for questions about rare health risks. In some cases, they have taken vaccines to communities themselves.
“Our community is probably less well informed; they’re probably not as health literate,” said Mr. Tam, the Mongrel Mob member, who is a former civil servant and who received the border exemption. Constant media criticism has turned them off from reading traditional news outlets, he added.
“They then resort to social media, because they have much greater control,” he said. “It’s also a space that perpetuates conspiracy theories and false information and all the rest of it.” Health advice has to come from trusted individuals and leaders in the community, he said.
In the past week, Mr. Tam has traveled almost the length of the country organizing pop-up vaccination events for members and their communities, as well as coordinating with other chapter leaders to get their members vaccinated, he said.
It was difficult work that put him at personal risk, he said, and that invited intense skepticism from people who thought of gangs only as violent or connected to organized crime.
“Why do we bother?” Mr. Tam said. “We bother because we care about those people that others don’t care about, as simple as that. They can talk about my gang affiliation, all the rest of it. But it’s that affiliation that allows me to have that penetration, that foot in the door. I can do the stuff that they can’t do.”
BERLIN — They promised they would “hunt” the elites. They questioned the need for a Holocaust memorial in Berlin and described Muslim immigrants as “head scarf girls” and “knife men.”
Four years ago the Alternative for Germany, or AfD, arrived in the German Parliament like a wrecking ball, the first far-right party to win a place at the heart of Germany’s democracy since World War II. It was a political earthquake in a country that had once seen Hitler’s Nazi party rise from the fringes to win power in free elections.
Founded eight years ago as nationalist free-market protest party against the Greek bailout and the euro, the AfD has sharply shifted to the right.
The party seized on Chancellor Angela Merkel’s decision to welcome over a million migrants to Germany in 2015 and 2016, actively fanning fears of Islamization and migrant crime. Its noisy nationalism and anti-immigrant stance were what first catapulted it into Parliament and instantly turned it into Germany’s main opposition party.
But the party has struggled to expand its early gains during the past 18 months, as the pandemic and, more recently, climate change have shot to the top of the list of voters’ concerns — while its core issue of immigration has barely featured in this year’s election campaign.
The AfD has tried to jump on the chaos in Afghanistan to fan fears of a new migrant crisis. “Cologne, Kassel or Konstanz can’t cope with more Kabul,” one of the party’s campaign posters asserted. “Save the world? Sure. But Germany first!” another read.
At a recent election rally north of Frankfurt, Mr. Chrupalla demanded that lawmakers “abolish” the constitutional right to asylum. He also told the public broadcaster Deutsche Welle that Germany should be prepared to protect its borders, “if need be with armed force.”
None of this rhetoric has shifted the race, particularly because voters seem to have more fundamental concerns about the party’s aura of extremism. Some AfD leaders have marched with extremists in the streets, while among the party’s supporters are an eclectic array of conspiracy theorists and neo-Nazi sympathizers.
shot dead on his front porch by a well-known neo-Nazi. The killer later told the court that he had attended a high-profile AfD protest a year earlier.
Since then, a far-right extremist has attacked a synagogue in the eastern city of Halle during a Yom Kippur service, leaving two dead and only narrowly failing to commit a massacre. Another extremist shot dead 9 mostly young people with immigrant roots in the western city of Hanau.
The AfD’s earlier rise in the polls stalled almost instantly after the Hanau attack.
“After these three attacks, the wider German public and media realized for the first time that the rhetoric of the AfD leads to real violence,” said Hajo Funke of the Free University in Berlin, who has written extensively about the party and tracks its evolution.
“It was a turning point,” he said. “They have come to personify the notion that words lead to deeds.”
Shortly after the Hanau attack, Thomas Haldenwang, the chief of the Office for the Protection of the Constitution, Germany’s domestic intelligence agency, placed elements of the AfD under surveillance for far-right extremism — even as the party’s lawmakers continued to work in Parliament.
“We know from German history that far-right extremism didn’t just destroy human lives, it destroyed democracy,” Mr. Haldenwang warned after announcing his decision in March last year. “Far-right extremism and far-right terrorism are currently the biggest danger for democracy in Germany.”
Today, the agency has classified about a third of all AfD members as extremist, including Mr. Chrupalla and Alice Weidel, the party’s other lead candidate. A court is reviewing whether the entire party can soon be placed under formal observation.
“The AfD is irrelevant in power-political terms,” said Mr. Funke. “But it is dangerous.”
Mr. Chrupalla, a decorator who occasionally takes the stage in his overalls, and Ms. Weidel, a suit-wearing former Goldman Sachs analyst and gay mother of two, have sought to counter that impression. As if to hammer home the point, the party’s main election slogan this year is: “Germany — but normal.”
A look through the party’s 207-page election program shows what “normal” means: The AfD demands Germany’s exit from the European Union. It calls for the abolition of any mandates to fight the coronavirus. It wants to return to the traditional German definition of citizenship based on blood ancestry. And it is the only party in Parliament that denies man-made climate change, while also calling for investment in coal and a departure from the Paris climate accord.
That the AfD’s polling numbers have barely budged for the past 18 months suggests that its supporters are not protest voters but Germans who subscribe to its ideas and ideology.
“The AfD has brought out into the open a small but very radical electorate that many thought we don’t have in this country,” said Mr. Quent, the sociologist. “Four years ago people were asking: ‘Where does this come from?’ In reality it was always there. It just needed a trigger.”
Mr. Quent and other experts estimate the nationwide ceiling of support for the party at around 14 percent. But in parts of the former Communist East, where the AfD has become a broad-based political force entrenched at the local level, it is often twice that — enough to make it the region’s second-strongest political force.
Among the under 60-year olds, Mr. Quent said, it has become No. 1.
“It’s only a question of time until AfD is the strongest party in the East,” Mr. Quent said.
That is why Mr. Chrupalla, whose constituency is in the eastern state of Saxony, the one state where the AfD already came first in 2017, predicts it will eventually become too big to bypass.
“In the East we are a people’s party, we are well-established at the local, city, regional and state level,” Mr. Chrupalla said. “In the East the middle class votes for the AfD. In the West, they vote for the Greens.”
Christopher F. Schuetze and Melissa Eddy contributed reporting.
The handwritten doctor’s order was just eight words long, but it solved a problem for Dundee Manor, a nursing home in rural South Carolina struggling to handle a new resident with severe dementia.
David Blakeney, 63, was restless and agitated. The home’s doctor wanted him on an antipsychotic medication called Haldol, a powerful sedative.
“Add Dx of schizophrenia for use of Haldol,” read the doctor’s order, using the medical shorthand for “diagnosis.”
But there was no evidence that Mr. Blakeney actually had schizophrenia.
Antipsychotic drugs — which for decades have faced criticism as “chemical straitjackets” — are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments. But understaffed nursing homes have often used the sedatives so they don’t have to hire more staff to handle residents.
one in 150 people.
Schizophrenia, which often causes delusions, hallucinations and dampened emotions, is almost always diagnosed before the age of 40.
“People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. “It’s used to skirt the rules.”
refuge of last resort for people with the disorder, after large psychiatric hospitals closed decades ago.
But unfounded diagnoses are also driving the increase. In May, a report by a federal oversight agency said nearly one-third of long-term nursing home residents with schizophrenia diagnoses in 2018 had no Medicare record of being treated for the condition.
hide serious problems — like inadequate staffing and haphazard care — from government audits and inspectors.
One result of the inaccurate diagnoses is that the government is understating how many of the country’s 1.1 million nursing home residents are on antipsychotic medications.
According to Medicare’s web page that tracks the effort to reduce the use of antipsychotics, fewer than 15 percent of nursing home residents are on such medications. But that figure excludes patients with schizophrenia diagnoses.
To determine the full number of residents being drugged nationally and at specific homes, The Times obtained unfiltered data that was posted on another, little-known Medicare web page, as well as facility-by-facility data that a patient advocacy group got from Medicare via an open records request and shared with The Times.
The figures showed that at least 21 percent of nursing home residents — about 225,000 people — are on antipsychotics.
The Centers for Medicare and Medicaid Services, which oversees nursing homes, is “concerned about this practice as a way to circumvent the protections these regulations afford,” said Catherine Howden, a spokeswoman for the agency, which is known as C.M.S.
“It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures,” she said. “We will continue to identify facilities which do so and hold them accountable.”
significant drop since 2012 in the share of residents on the drugs.
But when residents with diagnoses like schizophrenia are included, the decline is less than half what the government and industry claim. And when the pandemic hit in 2020, the trend reversed and antipsychotic drug use increased.
A Doubled Risk of Death
For decades, nursing homes have been using drugs to control dementia patients. For nearly as long, there have been calls for reform.
In 1987, President Ronald Reagan signed a law banning the use of drugs that serve the interest of the nursing home or its staff, not the patient.
But the practice persisted. In the early 2000s, studies found that antipsychotic drugs like Seroquel, Zyprexa and Abilify made older people drowsy and more likely to fall. The drugs were also linked to heart problems in people with dementia. More than a dozen clinical trials concluded that the drugs nearly doubled the risk of death for older dementia patients.
11 percent from less than 7 percent, records show.
The diagnoses rose even as nursing homes reported a decline in behaviors associated with the disorder. The number of residents experiencing delusions, for example, fell to 4 percent from 6 percent.
A Substitute for Staff
Caring for dementia patients is time- and labor-intensive. Workers need to be trained to handle challenging behaviors like wandering and aggression. But many nursing homes are chronically understaffed and do not pay enough to retain employees, especially the nursing assistants who provide the bulk of residents’ daily care.
Studies have found that the worse a home’s staffing situation, the greater its use of antipsychotic drugs. That suggests that some homes are using the powerful drugs to subdue patients and avoid having to hire extra staff. (Homes with staffing shortages are also the most likely to understate the number of residents on antipsychotics, according to the Times’s analysis of Medicare data.)
more than 200,000 since early last year and is at its lowest level since 1994.
As staffing dropped, the use of antipsychotics rose.
Even some of the country’s leading experts on elder care have been taken aback by the frequency of false diagnoses and the overuse of antipsychotics.
Barbara Coulter Edwards, a senior Medicaid official in the Obama administration, said she had discovered that her father was given an incorrect diagnosis of psychosis in the nursing home where he lived even though he had dementia.
“I just was shocked,” Ms. Edwards said. “And the first thing that flashed through my head was this covers a lot of ills for this nursing home if they want to give him drugs.”
Homes that violate the rules face few consequences.
In 2019 and 2021, Medicare said it planned to conduct targeted inspections to examine the issue of false schizophrenia diagnoses, but those plans were repeatedly put on hold because of the pandemic.
In an analysis of government inspection reports, The Times found about 5,600 instances of inspectors citing nursing homes for misusing antipsychotic medications. Nursing home officials told inspectors that they were dispensing the powerful drugs to frail patients for reasons that ranged from “health maintenance” to efforts to deal with residents who were “whining” or “asking for help.”
a state inspector cited Hialeah Shores for giving a false schizophrenia diagnosis to a woman. She was so heavily dosed with antipsychotics that the inspector was unable to rouse her on three consecutive days.
There was no evidence that the woman had been experiencing the delusions common in people with schizophrenia, the inspector found. Instead, staff at the nursing home said she had been “resistive and noncooperative with care.”
Dr. Jonathan Evans, a medical director for nursing homes in Virginia who reviewed the inspector’s findings for The Times, described the woman’s fear and resistance as “classic dementia behavior.”
“This wasn’t five-star care,” said Dr. Evans, who previously was president of a group that represents medical staff in nursing homes. He said he was alarmed that the inspector had decided the violation caused only “minimal harm or potential for harm” to the patient, despite her heavy sedation. As a result, he said, “there’s nothing about this that would deter this facility from doing this again.”
Representatives of Hialeah Shores declined to comment.
Seven of the 52 homes on the inspector general’s list were owned by a large Texas company, Daybreak Venture. At four of those homes, the official rate of antipsychotic drug use for long-term residents was zero, while the actual rate was much higher, according to the Times analysis comparing official C.M.S. figures with unpublished data obtained by the California advocacy group.
make people drowsy and increases the risk of falls. Peer-reviewed studies have shown that it does not help with dementia, and the government has not approved it for that use.
But prescriptions of Depakote and similar anti-seizure drugs have accelerated since the government started publicly reporting nursing homes’ use of antipsychotics.
Between 2015 and 2018, the most recent data available, the use of anti-seizure drugs rose 15 percent in nursing home residents with dementia, according to an analysis of Medicare insurance claims that researchers at the University of Michigan prepared for The Times.
in a “sprinkle” form that makes it easy to slip into food undetected.
“It’s a drug that’s tailor-made to chemically restrain residents without anybody knowing,” he said.
In the early 2000s, Depakote’s manufacturer, Abbott Laboratories, began falsely pitching the drug to nursing homes as a way to sidestep the 1987 law prohibiting facilities from using drugs as “chemical restraints,” according to a federal whistle-blower lawsuit filed by a former Abbott saleswoman.
According to the lawsuit, Abbott’s representatives told pharmacists and nurses that Depakote would “fly under the radar screen” of federal regulations.
Abbott settled the lawsuit in 2012, agreeing to pay the government $1.5 billion to resolve allegations that it had improperly marketed the drugs, including to nursing homes.
Nursing homes are required to report to federal regulators how many of their patients take a wide variety of psychotropic drugs — not just antipsychotics but also anti-anxiety medications, antidepressants and sleeping pills. But homes do not have to report Depakote or similar drugs to the federal government.
“It is like an arrow pointing to that class of medications, like ‘Use us, use us!’” Dr. Maust said. “No one is keeping track of this.”
published a brochure titled “Nursing Homes: Times have changed.”
“Nursing homes have replaced restraints and antipsychotic medications with robust activity programs, religious services, social workers and resident councils so that residents can be mentally, physically and socially engaged,” the colorful two-page leaflet boasted.
Last year, though, the industry teamed up with drug companies and others to push Congress and federal regulators to broaden the list of conditions under which antipsychotics don’t need to be publicly disclosed.
“There is specific and compelling evidence that psychotropics are underutilized in treating dementia and it is time for C.M.S. to re-evaluate its regulations,” wrote Jim Scott, the chairman of the Alliance for Aging Research, which is coordinating the campaign.
The lobbying was financed by drug companies including Avanir Pharmaceuticals and Acadia Pharmaceuticals. Both have tried — and so far failed — to get their drugs approved for treating patients with dementia. (In 2019, Avanir agreed to pay $108 million to settle charges that it had inappropriately marketed its drug for use in dementia patients in nursing homes.)
‘Hold His Haldol’
Ms. Blakeney said that only after hiring a lawyer to sue Dundee Manor for her husband’s death did she learn he had been on Haldol and other powerful drugs. (Dundee Manor has denied Ms. Blakeney’s claims in court filings.)
During her visits, though, Ms. Blakeney noticed that many residents were sleeping most of the time. A pair of women, in particular, always caught her attention. “There were two of them, laying in the same room, like they were dead,” she said.
In his first few months at Dundee Manor, Mr. Blakeney was in and out of the hospital, for bedsores, pneumonia and dehydration. During one hospital visit in December, a doctor noted that Mr. Blakeney was unable to communicate and could no longer walk.
“Hold the patient’s Ambien, trazodone and Zyprexa because of his mental status changes,” the doctor wrote. “Hold his Haldol.”
Mr. Blakeney continued to be prescribed the drugs after he returned to Dundee Manor. By April 2017, the bedsore on his right heel — a result, in part, of his rarely getting out of bed or his wheelchair — required the foot to be amputated.
In June, after weeks of fruitless searching for another nursing home, Ms. Blakeney found one and transferred him there. Later that month, he died.
“I tried to get him out — I tried and tried and tried,” his wife said. “But when I did get him out, it was too late.”
Building dams that flood land, the beavers have infuriated farmers. Some have obtained permits to kill the animals — setting off outrage among conservationists.
By Stephen Castle
Photographs by Kieran Dodds
EDINBURGH — Wrapped inside a brown hessian sack, the baby beaver wriggled as it was carried to an examination table, but gave up the fight as a veterinarian deftly punched a microchip into its thick pelt and removed clumps of brown fur for samples.
“It’s stressful for the animal,” said Romain Pizzi, a wildlife specialist, as he extracted blood from the scaly flat tail of the male kit captured just a few hours earlier. Nonetheless, he added, this was a lucky young beaver.
“The alternative,” he said, “is that it’s going to be shot.”
But the sanctioned killing of an otherwise protected species has enraged conservationists, prompting a legal challenge and igniting a polarizing debate about farming, biodiversity and the future of Scotland’s countryside.
Although there was an official trial reintroduction of beavers in 2009 in the west of Scotland, the animal’s return is primarily a result of earlier escapes or unauthorized releases of beavers imported privately, mainly from Bavaria or Norway. The growing population is most evident in the streams of Tayside, north of Edinburgh.
The five-month-old kit in the examining room, weighing in around nine pounds, had been caught in a trap in Tayside and rescued from what is called a “conflict area” — where, because of the damage the animals cause, farmers have won licenses to kill them. In 2020, they killed 115 of the animals, about 10 percent of a beaver population that now stands at roughly 1,000 across Scotland.
the new Scottish government’s draft policy program.
In Scotland, beaver territories, which vary in size but typically feature around four animals, have increased steadily — from 39 in 2012 to 251 in 2020-21, according to an official report. In 2019, beavers were given protected status, albeit with farmers able to apply for licenses to cull.
Now, a rewilding charity, Trees for Life, has challenged the Scottish government’s nature agency, NatureScot, in court claiming that it issues licenses too readily.
Bamff estate in Perthshire, where Paul and Louise Ramsay run an eco-tourism operation. The Ramsays brought Scotland’s first recent-era beavers to the site in 2002, when there were fewer restrictions, as part of their own beaver rewilding project.
The idea was to restore natural habitats on their land after centuries of drainage designed to maximize farm yields. A significant transformation can be seen in a wild, scenic stretch of the 1,300-acre estate, which has been in the family since 1232.
Tall trees felled by beavers have crashed into pools of water separated by dams. Along the bank of a small river stood birch trees that were almost gnawed through; a few meters away a beaver could be seen swimming with a large clump of foliage in its mouth.
regulate the water level of their aquatic habitats.
The 20 or so beavers living here have killed many trees, a point of contention for the Ramsays’ critics. But they have attracted otters, allowed water pools to fill with trout, frogs and toads, and given a nesting place in dead trees to woodpeckers, Ms. Ramsay said.
She said the problem was not the beavers, but farmers who think that any land that does not produce a crop is wasted.
“Their motivation is to drain, drain, drain, so a beaver comes along and wants to make a wet bit here or there — which might be a brilliant habitat — that’s against the farmer’s interest,” she said.
Some beavers did escape from Bamff, Ms. Ramsay acknowledged. She claimed that by the time that happened, though, others had already escaped from a wildlife park some distance away.
The Ramsays took over management of the estate in the 1980s. In the late 1990s, Mr. Ramsay said, he became excited by the idea of introducing beavers at a time when he says the farming and fishing lobby had blocked an official trial project. He denies suggestions from critics that he deliberately let beavers escape to speed things up.
At his farm not far away in Meigle, Adrian Ivory was unconvinced. “Those animals have now escaped for whatever reason,” he said, “and the financial burden is not on the person who caused the problem but on us where the issue now is. They’re now being hailed as heroes for getting beavers back in and there is no thought about what damage it’s doing to our livelihoods.”
Beaver dams in a stream on his land must be removed regularly, Mr. Ivory said, because they threaten the drainage system in a nearby field and caused one year’s crop to rot. Burrowing threatens the stability of banks, making it potentially dangerous to use tractors.
Mr. Ivory said the damage may have cost him £50,000, including wrecked crops and labor costs. “If you rewild everywhere, where’s your next meal coming from?” he asked. “Food becomes a lot more expensive, or you have to import it.”
Mr. Ivory declined to discuss whether he had culled the beaver population on his land, but said he allowed the animals to be trapped for relocation, a task undertaken in Tayside by Roisin Campbell-Palmer, the restoration manager at the Beaver Trust charity.
She works with farmers, rising early in the morning to check traps, then relocating animals to beaver projects in England, where more than 50 have been sent. (Scotland does not allow the animals to be relocated within the country.)
Ms. Campbell-Palmer said she found beavers fascinating and admired their dam-building skills, tenacity and single-mindedness. That said, she understands the complaints of farmers and admits that, having seen some particularly destructive tree-felling, has occasionally said to herself, “‘Of all the trees to cut down, why did you do that one?’”
As she inspected a trap filled with carrots, turnips and apples, Ms. Campbell-Palmer reflected on the ferocious debate and concluded that beavers had undeniably achieved one thing in Scotland.
“I think what they are doing,” she said, “is making us ask wider questions about how we are using the landscape.”
Women at tech start-ups wrote to her thanking her for saying what they had been feeling, Ms. Esponnette said.
Lola Priego, 30, the founder of Base, which offers at-home blood and saliva tests that are processed at traditional labs, hears a Theranos comparison at least once a week, she said. The references come directly or indirectly from potential partners, advisers, investors, customers and reporters, she said.
She said she understood the need for skepticism, since new health care companies should be looked at critically to prevent malpractice. Often the comparisons stopped after people learned that Base works with Quest Diagnostics, a multinational company, for analysis of its tests.
“But the additional bias and skepticism is challenging to overcome,” Ms. Priego said.
The biggest blow came from a scientific adviser whom Ms. Priego said she had tried to recruit in 2019. The adviser took the meeting only to tell her that bringing technology into health care was doing a disservice to the industry, just like Theranos. It caused Ms. Priego to question whether she could hire the caliber of advisers she had hoped for.
“It was quite demoralizing,” she said. She has since recruited six advisers.
In July, Verge Genomics struck a three-year partnership with the pharmaceutical giant Eli Lilly to work on drugs for the treatment of amyotrophic lateral sclerosis, or A.L.S., Ms. Zhang said. The company also published a paper about its methods in a scientific journal last year and recruited a chief science officer this year.
It was a relief to have something to show to those who were doubtful, Ms. Zhang said.
“The most fragile part of the company is the earliest stage, when you have to buy into the people, the vision and the idea,” she said. Reflecting on Ms. Holmes and Theranos, she added, “It’s where these types of associations can be really harmful and curtail potential.”
Norwegian Center for Global Analyses, a group that provides intelligence information to agencies of the global organization. It was shared internally at the United Nations and seen by The New York Times.
Members of the Afghan military and the police, as well as those who worked for investigative units of the toppled government, were particularly at risk, the document said.
It contained a reproduced letter dated Aug. 16 from the Taliban to an unnamed counterterrorism official in Afghanistan who had worked with U.S. and British officials and then gone into hiding before the insurgents came to the official’s apartment.
The letter instructed the official to report to the Military and Intelligence Commission of the Islamic Emirate of Afghanistan in Kabul. If not, it warned, the official’s family members “will be treated based on Shariah law.”
The Taliban have repeatedly issued assurances that they will not use their victory to wreak revenge on those who opposed them. The report adds to the growing doubts about that pledge, and suggests that the Taliban may indeed engage in reprisal killings, as they did when they took over in Afghanistan more than 20 years ago.
On Wednesday, a public display of dissent in the northeastern city of Jalalabad was met by force. Taliban soldiers fired into the crowd and beat protesters and journalists.
The Taliban faced the first street protests on Wednesday against their takeover of Afghanistan, with demonstrations in at least two cities, even as they moved to form a new government.
A public display of dissent in the northeastern city of Jalalabad was met by force. Taliban soldiers fired into the crowd and beat protesters and journalists.
The Taliban had taken control of the city, a commercial hub east of Kabul near the main border crossing with Pakistan, four days earlier without much of a fight after a deal was negotiated with local leaders. This week, the Taliban have been out in large numbers, patrolling the city in pickup trucks seized from the now defunct police force.
Despite the risks, hundreds of protesters marched through the main shopping street, whistling, shouting and bearing large flags of the Afghan Republic. Taliban fighters fired in the air to break up the crowd, but the protesters did not disperse, video aired by local news media outlets showed.
When that failed, the fighters resorted to violence. At least two people were killed and a dozen injured, according to Al Jazeera.
For the new Taliban government, the jarring images of violence at the protest — as well as images of chaos and people being beaten while trying to approach Kabul’s airport in an attempt to flee the country — have undermined their efforts to present themselves as responsible stewards of the government.
In Khost, in the southeastern part of the country, there were also demonstrations, with dramatic photos and video showing hundreds of people taking to the streets.
The outpouring of public anger came as the Taliban prepared to offer details on the shape of their government, naming ministers and filling key positions.
The younger brother of a top Taliban leader met in Kabul on Wednesday with former President Hamid Karzai and Abdullah Abdullah, the chairman of the Afghan delegation to the recent peace talks in Qatar. He was accompanied by the speaker of Afghanistan’s upper house of Parliament.
The meeting was further evidence of the group’s determination to gain international acceptance.
It followed a news conference on Tuesday in which the Taliban offered blanket amnesty, vowing no reprisals against former enemies.
“We don’t want Afghanistan to be a battlefield anymore,” Zabihullah Mujahid, the Taliban’s longtime chief spokesman, said. “From today onward, war is over.”
While many were skeptical of those assurances, in Kabul the rhythms of daily life started to return — but they were in many ways circumscribed.
There were noticeably fewer women on the streets. Some of those who ventured out did not cover up in the traditional burqa, the full-length shroud that covers the face that was required the last time the Taliban ruled. At homes and businesses, a knock on the door could stir fear.
It remains to be seen whether the pragmatic needs of a nation of 38 million will continue to temper the ideological fanaticism that defined the group’s rule from 1996 to 2001. But the country the Taliban now control is vastly changed from two decades ago.
The progress of women — women in critical roles in civil society and millions of girls in school — is the most visible example. But years of Western investment in the country also helped rebuild a nation that was in a state of ruin when the Taliban first emerged.
The protests offered early signs that many Afghans will not simply accept Taliban rule.
The Afghan government’s failure to meet people’s basic needs helped fuel support for the Taliban. That allowed them to sweep across the country swiftly — often not by military force, but by negotiation with frustrated local leaders.
On Wednesday, at a riverside market in Kabul, Jawed was selling apples. Born the year the Taliban were ousted from power, he was not old enough to remember their brutal reign.
His concern this week was getting supplies of fruit from Pakistan. That was now easier, he said.
“The roads are clear now — they are quiet,” said Jawed, who goes by one name. For now, the Taliban meant more order in the traffic, and wholesale prices had dropped. But business was not better.
“The people are afraid right now — they’re not buying,” he said. “But at least it is better than yesterday. Things will slowly improve. The mullahs have arrived.”
The arrival of the Taliban mullahs — a reference to group’s religious leaders — also set off widespread fear.
Tens of thousands are still trying to escape. People lined up early at the banks, worried that there wouldn’t be money to feed their families. And the deployment of soldiers at checkpoints across Kabul made it clear that Taliban have a monopoly on the use of force and would decide how and when to use it.
Chaos erupted outside Kabul’s international airport on Wednesday as thousands of people tried to make their way there to flee Afghanistan. The sound of heavy gunfire echoed through the streets leading to the facility.
There were conflicting reports about what exactly was happening on the streets outside the airport, which the Taliban now control.
A NATO security official at the airport told Reuters that 17 people had been injured in a stampede at one gate to the airport.
People were still camping out near the airport’s gates. Whole families sat under rows of pine trees lining the main airport road, while others, carrying sparse belongings, were still trying to gain entrance, to little avail. The Taliban still had their men stationed at the entrances. There were volleys of rifle fire, pushing, pulling and beating with wooden sticks, Kalashnikovs and pieces of cut hoses.
At one gate, Taliban members had positioned themselves on concrete road dividers overlooking the crowd. Their commander, Kalashnikov slung around the shoulder and megaphone in hand, told the people: “This gate is closed. Only foreigners and people with documents allowed.”
Although the U.S. military has established control inside the airport and military flights have resumed, the situation outside on Wednesday was volatile.
The Taliban have sought to present a kinder and gentler image of an Islamic Emirate of Afghanistan to the world, but scenes near the airport offered a bloody counterpoint. Taliban members at times beat people with rifle butts and clubs to force back the crowd trying to get in.
Images taken on Tuesday by Marcus Yam, a photographer for the Los Angeles Times, were graphic: a man cradling a child with a bloodied forehead. A woman who appeared to be unconscious lying in the road a few feet away, blood streaming down her cheek.
A group of Afghan leaders are trying to rally a force to resist the Taliban from the same strategic valley that two decades ago held out against the militants — and provided American spies and special forces operators a launchpad for the invasion that drove the Taliban from power in the months after the Sept. 11, 2001, attacks.
Yet the parallels with that earlier fight in a pocket north of Kabul known as the Panjshir Valley, however intriguing, are limited, and even Afghans sympathetic to the effort expressed deep doubts about its prospects.
Unlike 20 years ago, the resistance leaders do not control the territory they would need to open a supply line through Afghanistan’s northern borders, nor do they appear to have any significant international support.
How many men and how well supplied they are material is also an open question. Former Afghan officials put the number of fighters holed up in Panjshir between 2,000 and 2,500, and they are said to have little beyond assault weapons.
And the leaders, while well-established Afghan political and military figures, lack the charisma and military prowess of the man who led the old Northern Alliance that resisted the Taliban in the 1990s, Ahmad Shah Massoud. He was killed by assassins from Al Qaeda two days before the Sept. 11 attacks, and is now a mythic figure among the ethnic Tajiks who populate northern Afghanistan, and who made up the bulk of those who first fought Taliban rule.
For now, though, the leaders of the movement insist that their goal is to negotiate a peace deal with the Taliban on behalf of the now-defunct Afghan government, said Amrullah Saleh, one of the men organizing the resistance.
Mr. Saleh was Afghanistan’s first vice president until Sunday, when President Ashraf Ghani fled Kabul ahead of the Taliban’s advance into the city, and he is now claiming to be the “caretaker president” under Afghanistan’s U.S.-brokered 2004 Constitution.
“We have lost territory but not legitimacy,” he said in an interview conducted over text message. “I, as caretaker president, upholder of the Constitution, don’t see the Taliban emirate either as legitimate or national.”
Mr. Salehhas been joined in Panjshir by Ahmad Massoud, the son of the assassinated resistance leader, and Gen. Yasin Zia, a former Afghan army chief of staff and deputy defense minister.
Afghanistan will have “peace and stability,” said Mohammad Zahir Aghbar, an Afghan ambassador to Tajikistan aligned with the holdouts in the Panjshir Valley, “if the Taliban who are in Doha and Pakistan agree to a settlement accepting what the world is asking for.”
Mr. Saleh said the group believed “in a genuine peace process, which doesn’t exist at the moment.”
“Should the Taliban be ready for meaningful discussions, we will welcome it,” he said. “If they insist on military conquest, than they better read Afghan history.”
The Panjshir Valley features prominently in that history.
The deep and narrow gorge at the valley’s mouth was tailor-made for obstruction and ambush, and the valley held out not only against the Taliban in the 1990s but also the Soviets in the 1980s. The first Americans to enter Afghanistan in September 2001, a small Central Intelligence Agency team, went to Panjshir to secure the Northern Alliance as allies.
Mr. Saleh said he survived “two attacks and one ambush” by Taliban fighters as he drove to Panjshir on Sunday.
Mr. Saleh, who also previously ran Afghanistan’s spy service, the National Directorate of Security, was cagey about what size force was in Panjshir, saying that he did not want “compromise our military secrets or operational security.”
“But we are on the top of the situation and organizing things,” he said, adding that his team was in touch with other Afghan leaders who fought the Taliban 20 years ago, though he would not name them.
Still, it was far from clear what outside help might arrive or whether Mr. Saleh’s claim to continuity of government under the Afghan Constitution would gain traction.
At least one place has bought in: the Afghan Embassy in Tajikistan. In the carpeted meeting rooms of the building, off a dusty, taxi-clogged street in Dushanbe, Mr. Ghani’s photographs have come down, and Mr. Saleh’s have gone up.
Farnaz Fassihi contributed reporting from New York.
World Health Organization officials warned on Wednesday that the Taliban takeover of Afghanistan was impeding efforts to address the coronavirus pandemic and other dire health crises.
Gauging the spread of the coronavirus in Afghanistan has always been difficult because of a lack of testing. The average daily number of reported new cases peaked in late June at more than 2,000 and has since fallen sharply, according to the Our World in Data project at the University of Oxford. But it is likely that the figures do not reflect the actual spread of the virus.
Afghanistan’s vaccination efforts have struggled since they began in the spring, beset by corruption, limited public health resources and widespread public skepticism. According to Our World in Data, less than 2 percent of Afghanistan’s population has been vaccinated.
“In the midst of a pandemic, we’re extremely concerned by the large displacement of people and increasing cases of diarrhea, malnutrition, high blood pressure, probable cases of Covid-19 and reproductive health complications,” Dr. Tedros Adhanom Ghebreyesus, the director general of the W.H.O., said at a news conference.
He said that W.H.O staff are still in Afghanistan and are “committed to delivering health services to the most vulnerable.”
Many Afghans are vulnerable to diseases like polio, which has been eradicated in most of the world but is still endemic there. Fourteen million Afghans are suffering from hunger, United Nations officials said on Wednesday.
Aid groups are struggling to provide humanitarian assistance inside Afghanistan, as well as to the tens of thousands of refugees a week who are fleeing to neighboring countries.
“The utter desperation for a way out of Afghanistan speaks powerfully to the sense of fear and uncertainty among many Afghans,” said Caroline Van Buren, a representative of the U.N. High Commissioner for Refugees.
Refugee camps, with their crowded and often unsanitary conditions, can become incubators for the virus, though many camps have fared better than experts initially feared they would.
U.N. officials said that their agencies in Afghanistan were in contact with the Taliban in an effort to coordinate aid and immunizations. Ms. Van Buren said the Taliban had so far provided protection for all of the refugee agency’s offices in the country.
At the same time, though, the Taliban have resumed some of the practices common when they held power 20 years ago. Ms. Van Buren said officials had received reports of women being prohibited from going to work, and, in some areas, barred from leaving their homes without being accompanied by a close male relative.
Some U.N. employees are pulling out. Stéphane Dujarric, the spokesman for the United Nations secretary general, said a group was leaving Kabul for Kazakhstan on Wednesday to set up a remote office there for the U.N. Assistance Mission in Afghanistan. Mr. Dujarric declined to specify exactly how many were leaving, though he said the office in Almaty was expected to employ up to 100 people.
The fall of Afghanistan to the Taliban has sent thousands of panicked Afghans scrambling to flee the country, but panic is also being felt in some other quarters: Some European politicians are terrified of another mass movement of Muslim asylum seekers.
An influx of migrants, they fear, may fan the embers of the far-right and populist movements that reshaped European politics after a wave of asylum seekers sought refuge from the wars in Syria and Iraq in 2015.
In Germany, even before the first group of 19 Afghan refugees landed on Wednesday, the line was making the rounds in Chancellor Angela Merkel’s conservative camp: “2015 mustn’t be repeated.”
Armin Laschet, who wants to succeed Ms. Merkel as chancellor after next month’s elections, said it on Monday. A party officialused the same words shortly after. And then a government minister repeated them yet again.
Support for anti-immigrant parties has been falling, along with the number of migrants. But with important elections looming in Germany and France, the line being drawn by European leaders is early and firm.
That means Afghans may be facing a compassion deficit in Europe that may be insurmountable.
It is not just Europe.
Other countries, especially the United States, faces a similar quandary over accepting Afghan asylum seekers.
Almost everywhere, governments have expressed general willingness to accept Afghans who worked alongside American forces or international aid groups. But they are wary of committing to the many thousands more who might seek to leave to avoid life under the Taliban.
For now, the number of migrants over land routes has been relatively low.
“We’re talking about thousands, not hundreds of thousands, who need and deserve our help, people who are on lists because they worked with us,” said Gerald Knaus, the founding chairman of the European Stability Initiative.
Given the overall drop in migration numbers in recent years, he said, it is “a straw man argument” to raise fears of another wave.
Intelligence reports presented to President Biden in the final days before the Taliban takeover of Afghanistan this past week failed to predict the imminence of the Afghan government’s collapse, even after warnings had grown more grim in July, senior intelligence officials acknowledged on Wednesday.
The intelligence agencies had been stepping up their warnings about the deteriorating conditions in Afghanistan throughout the summer. Their reports grew more specific in July, noting how the Taliban had taken control of roads leading to Kabul and how the group had learned lessons from their takeover of the country in the 1990s.
But senior administration officials acknowledged that as the pace of White House meetings on Afghanistan grew more frenzied in August and in the days leading up to the Taliban takeover this weekend, the intelligence agencies did not say the collapse was inevitable.
Over the past year, intelligence agencies shrank their predictions of how quickly the Afghan government would fall, from two years to 18 months to six months to a month, according to current and former officials. But, according to intelligence officials, the warning that its demise was days away never came.
“As the president indicated, this unfolded more quickly than we anticipated, including in the intelligence community,” Avril D. Haines, the director of national intelligence, said in a statement to The New York Times.
Still, senior officials noted, the C.I.A. and other intelligence agencies had throughout the fighting season in Afghanistan identified the risk of a rapid collapse and issued increasingly pessimistic reports about the Afghan government’s survival, particularly as President Ashraf Ghani resisted changing military strategies or creating a more inclusive government.
During the frenzied first 48 hours after the collapse of the Afghan government, the desperate scenes at Kabul’s international airport early this week drew parallels to the fall of Saigon.
Now, even though the airport is under the control of the U.S. military and evacuation flights have been stepped up, tens of thousands of Afghans are still struggling to find a way to escape Taliban rule.
And the American experience in Vietnam is being invoked again — as an illustration of how much more the United States could be doing if it had the political will and international support that followed the American exit from Vietnam.
After the war in Vietnam, a bipartisan consensus and collective sense of moral responsibility helped provide the framework for Operation New Life, which swiftly evacuated 130,000 vulnerable, mainly Vietnamese, people to a makeshift refugee camp on the island of Guam. From there, they were processed and moved to temporary migration centers across the United States.
Over the course of years of sustained efforts, 1.4 million Vietnamese people eventually settled in the country.
Now, the United States is trying to provide safety for a far smaller number, and has struggled in that effort.
Pentagon officials said that the pace of the current flights had quickened after more American troops arrived to secure the Kabul airport, with military planes and a smaller number of commercial flights operating.
“There are important parallels between the aftermath of the Vietnam War and the current situation, with implications for addressing current humanitarian needs,” said Alexander Betts, a professor of forced migration and international affairs at the University of Oxford.
“The parallels should be inspiring,” he said, “and show that with political will and international leadership, large-scale resettlement is possible.”
But he said there was now unlikely to be the same degree of political support for admitting large numbers of refugees.
“The politics of refugee assistance is also very different in the aftermath of Sept. 11, 2001, including public concerns relating to security and refugees from predominantly Muslim countries,” he said.
The United Nations said Wednesday that it was temporarily relocating some of its aid workers from Afghanistan to Kazakhstan to work remotely, but stressed that it intended to maintain a presence in the country.
“The U.N. is committed to stay and deliver in support of the Afghan people in their hour of need,” a spokesman for Secretary General António Guterres said in a statement Wednesday.
The organization said a group of staff members was en route to Almaty, Kazakhstan’s largest city.
“In light of security and other constraints in Kabul and other parts of the country at the moment,” the statement said, “it was decided to move part of the U.N. staff out of the country. Personnel will return to Afghanistan as conditions permit.”
The announcement came as humanitarian groups that also provide badly needed aid to the people of Afghanistan were regrouping. Many indicated that they intended to stay in the country, with the Taliban assuring them that their staff would not be harmed.
“At this point, we have not received any specific threat for any of our offices,” Hassan Noor, Asia regional director for Save the Children, said in a briefing on Wednesday. He said Taliban representatives had met with the charity’s staff and told them they would not face consequences for delivering services.
The organization, which offers health, education and nutrition support to Afghan children, said that its staff members — almost 1,800 people working across 10 provinces — would remain in Afghanistan to try to deliver services, depending on how the situation unfolded, and that many humanitarian organizations had also opted to stay.
But as of Saturday, Save the Children programs, which reached about 1.6 million Afghans in 2020, were temporarily suspended, and Mr. Noor said the group had been working on safeguarding workers, some of whom had already been relocated.
“We are extremely concerned about our staff,” he said, “and that is our top priority at the moment.”
Information about the situation on the ground in Afghanistan remains “very murky,” said Mr. Noor, but even before last week, some three million people had already been reported displaced. About 14 million people were having trouble meeting daily food requirements because of an enduring drought in Afghanistan, and some two million children depended on nutrition services to survive.
The previous Taliban rule in Afghanistan, from 1996 to 2001, was a bleak period for Afghan women, who were barred from working outside the home or leaving the house without a male guardian. The Taliban eliminated schooling for girls and publicly flogged people who violated the group’s morality code.
The question now is whether the Taliban’s interpretation of Islamic law will be as draconian as when the group last held power.
Taliban officials are trying to reassure women that things will be different this time. In a news conference in Kabul on Tuesday, a Taliban spokesman said that women would be allowed to work and study. Another Taliban official said that women should participate in government.
“We assure that there will be no violence against women,” the spokesman, Zabihullah Mujahid, said. “No prejudice against women will be allowed, but the Islamic values are our framework.” Pressed for details, he said only that women could participate in society “within the bounds of Islamic law.”
But there are scattered signs that, at least in some areas, the Taliban have begun to reimpose the old order.
Women in some provinces have been told not to leave home without a male relative escorting them. In Herat, in western Afghanistan, Taliban gunmen guarded the university’s gates and prevented female students and instructors from entering the campus on Tuesday, witnesses said.
In the southern city of Kandahar, women’s health care clinics were shut down, a resident said. In some districts, girls’ schools have been closed since the Taliban seized control of them in November.
Women there said they were starting to wear the head-to-toe burqa in the street, partly in fear and partly in anticipation of restrictions ordered by the Taliban.
At Kabul University, in the capital, female students were told they were not allowed to leave their dorm rooms unless accompanied by a male guardian. Two students said they were effectively trapped because they had no male relatives in the city.
In Mazar-i-Sharif, in northern Afghanistan, Aliya Kazimy, a 27-year-old university professor, said that women shopping alone in the city’s bazaar had been turned away and told to return with male guardians.
“I am from the generation that had a lot of opportunities after the fall of the Taliban 20 years ago,” she said in a text message. “I was able to achieve my goals of studying, and for a year I’ve been a university professor, and now my future is dark and uncertain. All these years of working hard and dreaming were for nothing. And the little girls who are just starting out, what future awaits them?”
For China’s leaders, the chaotic scenes unfolding in Afghanistan have served as stinging vindication of their hostility to American might. But any smugness in Beijing could be premature.
China is now left scrambling to judge how the American defeat could reshape the contest between the world’s two great powers. While the Taliban’s rout has weakened American prestige and its influence on China’s western frontier, it could also create new geopolitical dangers and security risks.
Officials in Beijing worry that extremists could use Afghanistan to regroup on China’s flank and sow violence around the region, even as the Taliban look to deep-pocketed countries like China for aid and investment. The American military withdrawal could also allow the United States to direct its planning and matériel toward countering Chinese power across Asia.
“There should be anxiety rather than glee in Beijing,” said John Delury, a professor of Chinese studies at Yonsei University in Seoul. “Ending the military presence in Afghanistan frees up resources and attention to focus on the long-term rivalry with China.”
A centuries-old tradition in which women declared themselves men so they could enjoy male privilege is dying out as young women have more options available to them to live their own lives.
Text by Andrew Higgins
Photographs by Laura Boushnak
LEPUSHE, Albania — As a teenager locked in a patriarchal and tradition-bound mountain village in the far north of Albania, Gjystina Grishaj made a drastic decision: She would live the rest of her life as a man.
She did not want to be married off at a young age, nor did she like cooking, ironing clothes or “doing any of the things that women do,” so she joined a gender-bending Albanian fraternity of what are known as “burrneshat,” or “female-men.” She adopted a male nickname — Duni.
“I took a personal decision and told them: I am a man and don’t want to get married,” Duni recalled telling her family.
Few women today want to become what anthropologists call Albania’s “sworn virgins,” a tradition that goes back centuries. They take an oath of lifelong celibacy and enjoy male privileges, like the right to make family decisions, smoke, drink and go out alone.
Ms. Rakipi snorted with contempt when asked about people who undergo transition surgery. “It is not normal,” she said. “If God made you a woman, you are a woman.”
Duni, from Lepushe village, also has strong views on the subject, saying that altering the body goes “against God’s will,” and that people “should be put in jail” for doing so.
“I have not lived as a burrnesha because I want to be a man in any physical way. I have done this because I want to take on the role played by men and to get the respect of a man,” she said. “I am a man in my spirit, but having male genitals is not what makes you a man.”
Locals in Lepushe, including Manushaqe Shkoza, a server at a cafe in the village, said Duni’s decision to become a man initially came as a surprise, but it was accepted long ago. “Everyone sees it as normal,” Ms. Shkoza said.
Duni said she was sad that the tradition of sworn virgins would soon die out, but noted that her niece in Tirana had shown that there were now less drastic ways for a woman to live a full and respected life.
“Society is changing, but I think I made the right decision for my time,” Duni said. “I can’t resign from the role I have chosen. I took an oath to my family. This is a path you cannot go back on.”
“We’ve taken the stance that we’re not going to ask employees to get vaccinated because of the sheer multiple who don’t want to get vaccinated,” said Mr. Lucanera, who is vaccinated. “If we demand for a lot of them to get vaccinated to come back to work, we are afraid they’re not going to come back.”
But as Covid cases have escalated, some of his unvaccinated workers have gotten sick. To cover their shifts, he has had to pay others overtime, which has been a drain on the company’s bottom line. Recently, he turned down a contract with a school district because he didn’t have enough officers to fulfill the request.
“It almost seems that whoever already doesn’t have it by this time has made up their minds,” Mr. Lucanera said. “If I put my foot down, will it hurt the company in terms of creating a bigger problem than we have?”
Still, for many unvaccinated workers, finding a new job is often not a desirable, or feasible, option.
Benjamin Rose, 28, who works at a global bank in the Chicago area, said his decision not to get the shot was “really just a cost-benefit analysis.” He contracted Covid-19 six months ago, he said, and a recent blood test showed he still had antibodies.
But because he is not vaccinated, his company requires that he work remotely even as it has begun to allow vaccinated employees back in the office. While he said he enjoyed the flexibility of remote work and was not opposed to vaccine mandates, he also did not want to feel like he was being coerced.
“I find it a little irksome how big corporations, the media and the government are all sort of this united front in pushing the vaccine so hard,” Mr. Rose said.
At the same time, he said, if his company instituted a vaccine mandate, he would likely comply.
“It’s not the hill I’m going to die on,” he said. “If it really became something that was going to strongly affect my career, I would probably just get it.”
TRIPOLI, Lebanon — Rania Mustafa’s living room recalls a not-so-distant past, when the modest salary of a security guard in Lebanon could buy an air-conditioner, plush furniture and a flat-screen TV.
But as the country’s economic crisis worsened, she lost her job and watched her savings evaporate. Now, she plans to sell her furniture to pay the rent and struggles to afford food, much less electricity or a dentist to fix her 10-year-old daughter’s broken molar.
For dinner on a recent night, lit by a single cellphone, the family shared thin potato sandwiches donated by a neighbor. The girl chewed gingerly on one side of her mouth to avoid her damaged tooth.
“I have no idea how we’ll continue,” said Ms. Mustafa, 40, at home in Tripoli, Lebanon’s second-largest city, after Beirut.
The huge explosion one year ago in the port of Beirut, which killed more than 200 people and left a large swath of the capital in shambles, only added to the desperation.
and the central bank unable to keep propping up the currency, as it had for decades, because of a drop in foreign cash flows into the country. Now, the bottom has fallen out of the economy, leaving shortages of food, fuel and medicine.
All but the wealthiest Lebanese have cut meat from their diets and wait in long lines to fuel their cars, sweating through sweltering summer nights because of extended power cuts.
long lines at gas stations, where drivers wait for hours to buy only a few gallons, or none at all if the station runs out.
hampered the investigation into the port explosion, and a billionaire telecoms tycoon, Najib Mikati, is currently the third politician to try to form a government since the last cabinet resigned after the blast.
Mustafa Allouch, the deputy head of the Future Movement, a prominent political party, said, like many other Lebanese, that he feared that the political system, intended to share power between a range of sects, was incapable of addressing the country’s problems.
“I don’t think it will work anymore,” he said. “We have to look for another system, but I don’t know what it is.”
His greatest fear was “blind violence” born out of desperation and rage.
“Looting, shooting, assaults on homes and small shops,” he said. “Why it hasn’t happened by now, I don’t know.”
The crisis has hit the poor hardest.
Five days a week, scores of people line up for free meals from a charity kitchen in Tripoli, some equipped with cut off shampoo bottles to carry their food because they can’t afford regular containers.
Robert Ayoub, the project’s head, said demand is going up, donations from inside Lebanon are going down, and the newcomers represent a new kind of poor: soldiers, bank employees and civil servants whose salaries have lost the bulk of their value.
In line on a recent day were a laborer who had walked an hour from home because he couldn’t afford transportation; a brick layer whose work had dried up; and Dunia Shehadeh, an unemployed housekeeper who picked up a tub of pasta and lentil soup for her husband and three children.
“This will hardly be enough for them,” she said.
The country’s downward spiral has set off a new wave of migration, as Lebanese with foreign passports and marketable skills seek better fortune abroad.
“I can’t live in this place, and I don’t want to live in this place,” said Layal Azzam, 39, before catching a flight to Saudi Arabia from Beirut’s international airport.
She and her husband had returned to Lebanon from abroad a few years ago and invested $50,000 in a business. But she said that it had failed and that she worried they would struggle to find care if their children got sick.
“There’s no electricity. They could cut the water. Prices are high. Even if someone sends you money from abroad, it doesn’t last,” she said. “There are too many crises.”
Drone footage by David Enders and Bryan Denton. Hwaida Saad contributed reporting.
KABUL, Afghanistan — Haji Sakhi decided to flee Afghanistan the night he saw two Taliban members drag a young woman from her home and lash her on the sidewalk. Terrified for his three daughters,he crammed his family into a car the next morning and barreled down winding dirt roads into Pakistan.
That was more than 20 years ago. They returned to Kabul, the capital, nearly a decade later after the U.S.-led invasion toppled the Taliban regime. But now, with the Taliban sweeping across parts of the country as American forces withdraw, Mr. Sakhi, 68, fears a return of the violence he witnessed that night. This time, he says, his family is not waiting so long to leave.
“I’m not scared of leaving belongings behind, I’m not scared of starting everything from scratch,” said Mr. Sakhi, who recently applied for Turkish visas for himself, his wife, their three daughters and one son. “What I’m scared of is the Taliban.”
earlier this month. “A failure to reach a peace agreement in Afghanistan and stem the current violence will lead to further displacement.”
The sudden exodus harks back to earlier periods of heightened unrest:Millions poured out of Afghanistan in the years after the Soviets invaded in 1979. A decade later, more fled as the Soviets withdrew and the country fell into civil war. The exodus continued when the Taliban came to power in 1996.
Afghans currently account for one of the world’s largest populations of refugees and asylum seekers — around 3 million people — and represent the second highest number of asylum claims in Europe, after Syria.
Now the country is at the precipice of another bloody chapter, but the new outpouring of Afghans comes as attitudes toward migrants have hardened around the world.
After forging a repatriation deal in 2016 to stem migration from war-afflicted countries, Europe has deported tens of thousands of Afghan migrants. Hundreds of thousands more are being forced back by Turkey as well as by neighboring Pakistan and Iran, which together host around 90 percent of displaced Afghans worldwide and have deported a record number of Afghans in recent years.
Coronavirus restrictions have also made legal and illegal migration more difficult, as countries closed their borders and scaled back refugee programs, pushing thousands of migrants to travel to Europe along more dangerous routes.
civilian casualties reach record highs, many Afghans remain determined to leave.
One recent morning in Kabul, people gathered outside the passport office. Within hours, a line snaked around three city blocks and past a mural of migrants with an ominous warning: “Don’t jeopardize you and your family’s lives. Migration is not the solution.”
Central Europe have called to increase their border security as well, fearing the current exodus could swell into a crisis similar to that in 2015 when nearly a million, mostly Syrian migrants entered Europe.
But in Afghanistan, about half of the country’s population is already in need of humanitarian assistance this year — twice as many people as last year and six times as many as four years ago, according to the United Nations.
Mohammad Nabi Mohammadi, 40, borrowed $1,000 to bring 36 relatives to Kabul after the Taliban attacked his village in Malistan district. Today his three-room apartment, situated on the edge of the city, feels more like a crowded shelter than a home.
The men sleep in one large living room, women stay in the other and the children cram into the apartment’s one small bedroom alongside bags of clothes and cleaning supplies. Mr. Mohammadi borrows more money from neighbors to buy enough bread and chicken — which have nearly doubled in price as food prices surge — to feed everyone.
Now, sinking further into debt with no relief in sight, he is at a loss for what to do.
“These families are sick, they are traumatized, they have lost everything,” he said, standing near his kitchen’s one countertop — out of earshot from his family. “Unless the situation improves, I don’t know what we will do.”
Asad Timory contributed reporting from Herat; Zabihullah Ghazi from Laghman; Fahim Abed and Jim Huylebroek from Kabul.