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 thatshe 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.
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.”
To federal health officials, asking states on Tuesday to suspend use of the Johnson & Johnson coronavirus vaccine until they could investigate six extremely rare but troubling cases of blood clots was an obvious and perhaps unavoidable move.
But where scientists saw prudence, public health officials saw a delicate trade-off: The blood clotting so far appears to affect just one out of every million people injected with the vaccine, and it is not yet clear if the vaccine is the cause. If highlighting the clotting heightens vaccine hesitancy and helps conspiracy theorists, the “pause” could ultimately sicken — and even kill — more people than it saves.
“It’s a messaging nightmare,” said Rachael Piltch-Loeb, an expert in health risk communications at the N.Y.U. School of Global Public Health. But officials had no other ethical option, she added. “To ignore it would be to seed the growing sentiment that public health officials are lying to the public.”
The one-dose Johnson & Johnson vaccine was just beginning to gain traction among doctors and patients after its reputation took a hit from early clinical trials suggesting its protection against the coronavirus was not as strong as that from the vaccines made by Pfizer-BioNTech and Moderna. Before Tuesday’s pause, some patients were asking for it by name.
But amid the blizzard of news and social media attention around the pause, those gains may well be lost, especially if the rare blood clotting feeds politically driven conspiracy theorists and naysayers, who seemed to be losing ground as the rate of vaccinations rose.
The problem is explaining relative risk, said Rupali J. Limaye, who studies public health messaging at the Johns Hopkins Bloomberg School of Public Health. She noted that the potential rate of blood clotting in reaction to the vaccine is much smaller than the blood clotting rate for cigarette smokers or for women who use hormonal contraception, although the types of clots differ.
And officials are not “pulling” the vaccine. They are simply asking for a timeout, in effect, to figure out how best to use it.
Vaccinators were already fielding questions from worried patients on Tuesday.
Maulik Joshi, the president and chief executive of Meritus Health in Hagerstown, Md., which has given 50,000 doses of all three vaccines without any reported major reactions, said he had a simple message to calm patients’ fears: “It’s a great thing that they have paused it, and this is science at work.”
Jennifer Steinhauer, Madeleine Ngoand Hailey Fuchs contributed reporting.
BRUSSELS — First it was AstraZeneca. Now Johnson & Johnson.
Last week, British regulators and the European Union’s medical agency said they had established a possible link between AstraZeneca’s Covid-19 vaccine and very rare, though sometimes fatal, blood clots.
On Tuesday, Johnson & Johnson said it would pause the rollout of its vaccine in Europe and the United States over similar concerns, further compounding the continent’s one-step-forward-two-steps-back efforts to quickly get people immunized against the coronavirus.
European officials had been confident that they had secured enough alternative vaccine doses to take up the slack of the AstraZeneca problems and achieve their goal of fully inoculating 70 percent of the European Union’s adult population — about 255 million people — by the end of the summer.
On Tuesday, European officials did not immediately say whether they believed the milestone would also survive the Johnson & Johnson suspension. But the European commissioner for health, Stella Kyriakides, wrote on Twitter that “Today’s developments with the J&J vaccine in the US are under close monitoring” by the bloc’s medicines regulator.
months of short supplies and logistical problems.
There is mounting evidence that the concerns are eroding Europeans’ willingness to get the AstraZeneca vaccine in particular, and threatening to elevate already high levels of vaccine hesitancy generally.
YouGov poll published last month, 61 percent of the French, 55 percent of Germans and 52 percent of Spaniards consider the AstraZeneca vaccine “unsafe.” That is in stark contrast to the findings of a similar poll from February, when more people in those countries, with the exception of France, believed that the shot was more safe than unsafe.
Regulators have asked vaccine recipients and doctors to be on the lookout for certain symptoms, including severe and persistent headaches and tiny blood spots under the skin. Doctors’ groups have circulated guidance about how to treat the disorder.
In Poland, where the vaccination campaign relies to a large extent on AstraZeneca and where its use has not been restricted, a recent poll showed that given a choice, fewer than 5 percent of Poles would choose the AstraZeneca shot.
Almost everywhere across the European Union, it seems, many are eager for alternatives, as the new types of vaccines that include the Moderna and Pfizer, which utilize science known as “mRNA,” have not been associated with similar side effects.
Data from the 27 E.U. member states by the European Center for Disease Prevention and Control shows that over all, 80 percent of vaccine doses distributed to the bloc have already been administered. That share drops to 65 percent for AstraZeneca, however, suggesting that many of its doses are sitting unused.
Yet it is hard to predict how serious a blow the latest twist in the AstraZeneca saga — and the new Johnson & Johnson concerns — will be to E.U. vaccination efforts, as officials in Brussels have made big if belated efforts to turbocharge the second-quarter supply of doses.
The European Union is poised to receive at least 300 million doses of various vaccines, three times what it got in the first quarter. Two hundred million are slated to come from Pfizer/BioNTech. Moderna is expected to deliver 35 million doses. Another 55 million doses are due of the Johnson & Johnson jab, and 70 million from AstraZeneca.
In the rosiest scenario, the European Union could get up to 360 million doses by June.
On Thursday, after Spain’s government changed the age threshold for the AstraZeneca shot, two-thirds of people called up for vaccination in Madrid did not show up, Antonio Zapatero, the regional health minister, told a news conference on Friday.
He attributed the no-show by 18,200 people to “confusion” generated by Spain’s central government, which said on Wednesday that the AstraZeneca vaccine should be given only to people over 60. Before this change, Mr. Zapatero said, the rate of abstention was 2 percent.
In Belgium, where the use of the AstraZeneca vaccine has also been limited, the authorities said they did not expect major delays in the overall rollout, but they are still concerned about the confusion that the rare blood clotting issue is causing.
Yves Van Laethem, a top epidemiologist who is the country’s Covid task force spokesman, said he expected a two-week delay that would mostly affect younger age groups in late summer. He said the E.U. regulator guidance had only partly helped in clarifying the situation.
The European Medicines Agency’s opinion “wasn’t very clear, and it is also part of the problem,” Dr. Van Laethem said in an interview. “When you say, ‘We don’t apply limitations, but we just say there are serious side effects,’ there is part science and part diplomacy in that.”
He said the limited effect that the new AstraZeneca issues would have on Belgian’s rollout was in large part because the country had ordered big shares of other vaccines.
Although all E.U. countries have been offered a chunk of each vaccine approved in the bloc so far — AstraZeneca, Johnson & Johnson, Moderna and Pfizer — many opted to forgo parts of their share of more expensive or cumbersome vaccines like Pfizer and Moderna early on, instead favoring the AstraZeneca jab.
“In Britain or Eastern Europe, a big part of the campaigns are based on AstraZeneca,” Dr. Van Laethem said.
Wealthier bloc members like Denmark, France, Germany and the Netherlands can better compensate for the loss of confidence in AstraZeneca, because they acquired extra doses of other vaccines — especially Pfizer — through a secondary market after poorer E.U. nations gave theirs up.
Those countries — including Bulgaria, Croatia, Latvia and Slovakia — are likely to be less able to quickly offer alternatives.
Dr. Van Laethem, the Belgian immunologist, said that the national and European authorities needed to better communicate the costs and benefits of taking the AstraZeneca dose versus and the other authorized vaccines.
Experts worry that even limited concerns over one vaccine’s unlikely side effects can affect people’s overall willingness to be immunized.
“The main thing is to make people understand that the problem is the virus,” he said. “We have to vaccinate people — the risk linked to the virus is higher than those rare side effects.”
Raphael Minder contributed reporting from Madrid and Constant Méheut from Paris.
On Tuesday morning, U.S. federal health regulators recommended a pause in the use of Johnson & Johnson’s Covid-19 vaccine while they investigated six reports of blood clots in women ages 18 to 48. One has died, and a second is hospitalized in critical condition.
As of Monday, 6.8 million people in the United States had received the vaccine without any other serious adverse reactions reported.
Experts have yet to determine to what extent, if any, the vaccine is responsible for the clots. But the investigation follows actions by European regulators who concluded that a vaccine made by AstraZeneca may also be the cause of a similar, extremely rare clotting disorder.
U.S. and European public health experts have emphasized that for most people, the benefits of the Covid vaccines far outweigh the risks.
recommends that people who have received the Johnson & Johnson vaccine within the past three weeks should contact their doctors if they experience severe headaches, abdominal pain, leg pain or shortness of breath. People should not be concerned about mild headaches and flu-like symptoms in the first few days after vaccination. Those are common, harmless side effects brought on by the immune system’s production of a defense against the coronavirus.
What is a pause?
During clinical trials and after vaccines go into wide use, experts keep track of any medical problems experienced by people who receive them. If an unusually large cluster of cases turns up, regulators may decide to pause a trial or stop the use of a vaccine to investigate further.
Pauses are common, and typically the investigations reveal that the medical problems were a matter of coincidence. If the investigation reveals that a vaccine does pose a risk, regulators may write new guidance about who should or should not receive it.
regulators have said, roughly one in 1,000 people are affected by a blood clot in a vein every year.
But the clotting disorder of concern in the vaccine recipients is much rarer and different from typical blood clots. In addition to clotting in the brain — called cerebral venous sinus thrombosis, or CVST for short — the patients all had a notably low level of platelets, which left them prone to abnormal bleeding.
said the company was aware of an extremely rare disorder involving people with blood clots in combination with low platelets in a small number of individuals who have received our COVID-19 vaccine. “In addition, we have been reviewing these cases with European health authorities,” the company said in its statement. “We have made the decision to proactively delay the rollout of our vaccine in Europe.”
Is this the same problem linked to the AstraZeneca vaccine in Europe?
At the news conference on Tuesday, Dr. Marks of the F.D.A. said the cases were “very, very similar.”
a number of possible symptoms, including swelling in the leg, persistent abdominal pain, severe and persistent headaches or blurred vision, and tiny blood spots under the skin beyond the area where the injection was given.
But that set of symptoms was so vague that almost immediately, British emergency rooms experienced a surge in patients who were worried that they fit the description.
Nonetheless, German researchers say that such symptoms in vaccine recipients must be followed up. Blood tests can detect the antibodies.
Can the disorder be treated?
Doctors in Germany and Norway have treated patients with blood-thinning drugs to try to stop the growth of the clots, and with intravenous immune globulin, which can help eliminate the misguided antibodies that are causing the problem.
AstraZeneca vaccines. One recipient, a physician in Florida, died from a brain hemorrhage when his platelet levels could not be restored, and others have been hospitalized. U.S. health officials have said that the cases are being investigated, but they have not reported the findings of those reviews and have yet to indicate that there is any link to the vaccines.
Johnson & Johnson’s single-dose coronavirus vaccine after six recipients in the United States developed a rare disorder involving blood clots within about two weeks of vaccination.
All six recipients were women between the ages of 18 and 48. One woman died and a second woman in Nebraska has been hospitalized in critical condition.
Nearly seven million people in the United States have received Johnson & Johnson shots so far, and roughly nine million more doses have been shipped out to the states, according to data from the Centers for Disease Control and Prevention.
“We are recommending a pause in the use of this vaccine out of an abundance of caution,” Dr. Peter Marks, director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, and Dr. Anne Schuchat, principal deputy director of the C.D.C., said in a joint statement. “Right now, these adverse events appear to be extremely rare.”
On a media call later on Tuesday morning, Dr. Marks said that “on an individual basis, a provider and patient can make a determination whether or not to receive the vaccine” manufactured by Johnson & Johnson.
While the move was framed as a recommendation to health practitioners in the states, the federal government is expected to pause administration of the vaccine at all federally run vaccination sites. Federal officials expect that state health officials will take that as a strong signal to do the same. Within two hours of the announcement, Gov. Mike DeWine of Ohio, a Republican, advised all health providers in his state to temporarily stop giving Johnson & Johnson shots. In New York, the health commissioner, Dr. Howard Zucker, said the state would halt the use of the vaccine statewide while federal officials evaluate the safety risks. Appointments for Johnson & Johnson’s shot on Tuesday at state mass sites would be honored with Pfizer doses, Dr. Zucker said.
The authorities in New Jersey, Connecticut, Massachusetts, Maryland, Nebraska, Georgia, Indiana, Texas and Virginia also said that they would follow the call from federal health agencies.
Scientists with the F.D.A. and C.D.C. will jointly examine possible links between the vaccine and the disorder and determine whether the F.D.A. should continue to authorize use of the vaccine for all adults or limit the authorization.
In the media call, federal health officials tried to reassure recipients of Johnson & Johnson’s vaccine while at the same time describing symptoms that they should watch out if they received a shot within the past month.
Dr. Schuchat said that the risk of dangerous blood clots is “very low” for people who received the vaccine more than a month ago.
“For people who recently got the vaccine within the last couple of weeks, they should be aware, to look for any symptoms. If you receive the vaccine and develop severe headaches, abdominal pain, leg pain or shortness of breath, you should contact your health care provider and seek medical treatment,” she said. She emphasized that an emergency meeting of the C.D.C.’s outside advisory committee, which has been scheduled for Wednesday, to discuss how to handle the vaccine in the future is made up of independent experts.
Dr. Janet Woodcock, acting commissioner of the Food and Drug Administration, said she expects the pause in distributing and administrating the vaccine will last for “a matter of days” while officials investigate the cases. Officials also stressed that no serious safety problems have emerged with either of the other two federally authorized vaccines, developed by Pfizer-BioNTech and Moderna.
The move could substantially 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. Regulators in Europe and elsewhere are concerned about a similar issue with another coronavirus vaccine, developed by AstraZeneca and Oxford University researchers. That concern has driven up some resistance to all vaccines, even though the AstraZeneca version has not been authorized for emergency use in the United States.
The vast majority of the nation’s vaccine supply comes from two other manufacturers, Pfizer-BioNTech and Moderna, which together deliver more than 23 million doses a week of their two-shot vaccines. There have been no significant safety concerns about either of those vaccines.
But while shipments of the Johnson & Johnson vaccine have been much more limited, the Biden administration had still been counting on using hundreds of thousands of doses every week. In addition to requiring only a single dose, the vaccine is easier to ship and store than the other two, which must be stored at extremely low temperatures.
Jeffrey D. Zients, the White House Covid-19 response coordinator, said Tuesday the pause “will not have a significant impact” the Biden administration’s plans to deliver enough vaccine to be able to inoculate all 260 million adults in the United States by the end of May. With the Johnson & Johnson setback, federal officials expect there will only be enough to cover fewer than 230 million adults. But a certain percentage of the population is expected to refuse shots, so the supply may cover all the demand.
Mr. Zients said the administration will still “reach every adult who wants to be vaccinated” by the May 31 target.
Federal officials are concerned that doctors may not be trained to look for the rare disorder if recipients of the vaccine develop symptoms of it. The federal health agencies said Tuesday morning that “treatment of this specific type of blood clot is different from the treatment that might typically be administered” for blood clots.
“Usually, an anticoagulant drug called heparin is used to treat blood clots. In this setting, administration of heparin may be dangerous, and alternative treatments need to be given,” the statement said.
In a news release, Johnson & Johnson said: “We are aware that thromboembolic events including those with thrombocytopenia have been reported with Covid-19 vaccines. At present, no clear causal relationship has been established between these rare events and the Janssen Covid-19 vaccine.” Janssen is the name of Johnson & Johnson’s division that developed the vaccine.
In the United States alone, 300,000 to 600,000 people a year develop blood clots, according to C.D.C. data. But the particular blood clotting disorder that the vaccine recipients developed, known as cerebral venous sinus thrombosis, is extremely rare.
All of the women developed the condition within about two weeks of vaccination, and government experts are concerned that an immune system response triggered by the vaccine was the cause. Federal officials said there was broad agreement about the need to pause use of the vaccine while the cases are investigated.
The decision is a fresh blow to Johnson & Johnson. Late last month, the company discovered that workers at a Baltimore plant run by its subcontractor had accidentally contaminated a batch of vaccine, forcing the firm to throw out the equivalent of 13 million to 15 million doses. That plant was supposed to take over supply of the vaccine to the United States from Johnson & Johnson’s Dutch plants, which were certified by federal regulators earlier this year.
The Baltimore plant’s certification by the F.D.A. has now been delayed while inspectors investigate quality control issues, sharply reducing the supply of Johnson & Johnson vaccine. The sudden drop in available doses led to widespread complaints from governors and state health officials who had been expecting much bigger shipments of Johnson & Johnson’s vaccine this week than they got.
The authorities in Ohio, New York, New Jersey, Connecticut, Massachusetts, Maryland, Nebraska, Georgia, Indiana, Texas and Virginia said on Tuesday that they would follow the call from federal health agencies to pause the administration of Johnson & Johnson’s vaccine after six women in the United States developed a rare disorder involving blood clots within about two weeks of vaccination.
CVS, the nation’s largest retail pharmacy chain, also said that it would immediately stop its use of Johnson & Johnson vaccinations and was emailing customers whose appointments would be canceled. A spokesman said that CVS would reschedule appointments “as soon as possible.”
Gov. Mike DeWine of Ohio and the state’s chief health official said they were advising all state vaccine providers to temporarily halt use of the single-dose vaccine. New York’s health commissioner, Dr. Howard Zucker, said the state would stop using the Johnson & Johnson vaccine, while the Food and Drug Administration and the Centers for Disease Control and Prevention evaluate the safety risks.
Connecticut health officials said they told vaccine providers to delay planned appointments and give an alternative option if they had the supply.
The C.D.C.’s outside advisory committee has scheduled an emergency meeting for Wednesday.
Jeff Zients, the White House Covid coordinator, said on Tuesday that the pause will not have a significant impact on the country’s vaccination campaign, which has accelerated in recent weeks as a rise in new virus cases threatens a fourth possible surge. Many states have already opened vaccination eligibility to all adults and others plan to by next week.
“Over the last few weeks, we have made available more than 25 million doses of Pfizer and Moderna each week, and in fact this week we will make available 28 million doses of these vaccines. This is more than enough supply to continue the current pace of vaccinations of 3 million shots per day,” Mr. Zients said in a statement.
Even though the reaction to the Johnson & Johnson shot is rare, any questions about the safety of the shots could bolster vaccine hesitancy.
Nearly seven million people in the United States have received Johnson & Johnson shots so far, and roughly nine million more doses have been shipped out to the states, according to data from the Centers for Disease Control and Prevention. The six women who developed blood clots were between the ages of 18 and 48. One woman died and a second woman in Nebraska has been hospitalized in critical condition.
“Right now, these adverse events appear to be extremely rare,” Dr. Peter Marks, director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, and Dr. Anne Schuchat, principal deputy director of the C.D.C., said in a joint statement on Tuesday. “People who have received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider.”
Like many states, New York had already prepared for a significant drop in its supply of the Johnson & Johnson vaccine after federal officials said that supplies would be limited because of a production issue at a Baltimore manufacturing plant. On Friday, Gov. Andrew M. Cuomo said that New York expected to receive 34,900 Johnson & Johnson shots, a decrease of 88 percent from the previous week.
Dr. Zucker, New York’s health commissioner, said that the state would honor appointments made at state-run mass vaccination sites for the Johnson & Johnson vaccine by giving people the Pfizer-BioNTech vaccine instead. That vaccine requires two doses, and it was not immediately clear how the state would handle the additional strain on its supply.
Mayor Bill de Blasio of New York City said that the city would work to reschedule appointments at city-run vaccine sites, giving those people the Pfizer or Moderna vaccines instead.
“Every site has been told this morning to stop giving the J&J shots,” he said at a news conference.
Mr. Cuomo received the Johnson & Johnson vaccine at a public appearance last month in Harlem, which he framed as an effort to boost confidence in that vaccine’s efficacy rate and to address vaccine hesitancy.
Regulators in Europe and elsewhere are concerned about a similar issue with another coronavirus vaccine, developed by AstraZeneca and Oxford University researchers. That vaccine has not been authorized for emergency use in the United States.
The virus is again surging in parts of the United States, but it’s a picture with dividing lines: ominous figures in the Northeast and Upper Midwest, but largely not in the South.
Experts are unsure what explains the split, which doesn’t correspond to vaccination levels. Some point to warmer weather in the Sun Belt, while others suspect that decreased testing is muddying the virus’s true footprint.
The contours of where the virus is resurgent can be drawn around one figure: states that are averaging about 15 new cases a day for every 100,000 people. The 23 states — including Alabama, Mississippi and Arkansas — that have averaged that or fewer over the past week seem to be keeping cases relatively low, according to a New York Times database. Nationally, the country is averaging 21 new cases per 100,000 people.
In the 27 states above that line, though, things have been trending for the worse. Michigan has the highest surge of all, reporting the most drastic increase in cases and hospitalizations in recent weeks. Illinois, Minnesota and others have also reported worrisome increases.
Nationally, reported cases in the United States are growing again after a steep fall from the post-holiday peak in January. In the past two weeks, new confirmed cases have jumped about 11 percent, even though vaccinations picked up considerably, with an average of 3.2 million doses given daily.
Some Southern states, like Alabama and Mississippi, are lagging in vaccinations. Only about 28 percent of people in each state have received at least one shot, according to a New York Times vaccine tracker. Still, case counts continue to drop in both states.
Health experts say cases are rising in the Northeast and Upper Midwest for several reasons, including pandemic fatigue, the reopening of schools and the resumption of youth sports.
Hospitalizations tend to follow the trend line in cases by a few weeks, and have been rising in some states, most notably in Michigan.
Officials are also concerned about the spread of more contagious virus variants, especially B.1.1.7, first identified in Britain. The variant is now the leading source of new coronavirus infections in the United States, the director of the Centers for Disease Control and Prevention said last week.
Just why those factors might affect some states more than others is hard to pinpoint, experts say.
Dr. David Rubin, the director of PolicyLab at the Children’s Hospital of Philadelphia, said warmer weather in Southern states and California was probably playing a role, because it allows people to gather outdoors, with less risk of transmission.
New case reports have fallen by about 11 percent in Georgia over the past two weeks. And in Alabama, new cases are down roughly 29 percent, with a 17 percent decline in hospitalizations.
Some experts say, though, that reduced testing in some states could be obscuring the true picture. Testing in Alabama, for instance, has started to dip, but the share of tests that come back positive has remained high, at 11.1 percent, compared with a nationwide average of 5.1 percent, according to data compiled by Johns Hopkins University.
“People who are symptomatic and go to their provider are going to get a test,” said Dr. Michael Saag, the associate dean for global health at the University of Alabama at Birmingham, but “the desire for people to go get tested just because they want to know what their status is has dropped off dramatically.”
Still, Dr. Saag said, there is probably not a hidden spike in cases in Alabama right now, since hospitalizations in the state remain low.
— Madeleine Ngo
Millions of Muslims on Tuesday began celebrating a second Ramadan in the middle of the pandemic, although in many countries the first day of the holy month offered the promise of a Ramadan with fewer restrictions than last year.
Mosques across the Middle East and other parts of the world were closed for prayer last year, and lockdowns prevented festive gatherings with friends and family. In Jerusalem, for instance, the Old City was largely empty and the Aqsa Mosque compound was closed to the public, as coronavirus cases were surging.
But a large degree of normalcy was back on Tuesday: The Old City’s narrow alleys were crowded, sweet shops were preparing Ramadan desserts, clothing stores were open and the Aqsa compound was welcoming worshipers.
“Last year, I felt depressed and I didn’t know how long the pandemic would last,” said Riyad Deis, a co-owner of a spice and dried fruit shop in the Old City, while selling whole pieces of turmeric and Medjool dates to a customer. “Now, I’m relaxed, I have enough money to provide for my family and people are purchasing goods from my shop — it’s a totally different reality.”
The enthusiasm of some didn’t mean the Ramadan would go as normal. Across several countries in the Middle East, the authorities imposed limitations on customs and festivities, requiring that mosques enforce social distancing and telling worshipers to bring their own prayer rugs and to wear face masks.
In Dubai, Saudi Arabia and Egypt, taraweeh, the optional extra prayers that worshipers can observe at night, were capped at half an hour. No one will also be allowed to spend the night in a mosque, as is common during the last 10 days of Ramadan.
Mosques around the region were also prohibited from serving the fast-breaking meal of iftar or the predawn meal of suhoor. Though Muslims could still gather for those meals with friends and family, the authorities asked them to limit those gatherings this year.
In Jerusalem, Omar Kiswani, the director of Al Aqsa Mosque, said he was overjoyed that the compound was open to worshipers, but still urged caution.
“These are times of great happiness — we hope the blessed Aqsa Mosque will return to its pre-pandemic glory — but these are also times of caution because the virus is still out there,” Mr. Kiswani said.
In Egypt, government officials and prominent television hosts linked to the authorities warned Egyptians of a third wave of infections as Ramadan approached, hinting that another curfew or other lockdown restrictions could be imposed if cases rose.
“If you want the houses of God to remain open,” Nouh Elesawy, an official who oversees mosques at the Egyptian Ministry of Endowments, said earlier this month, “adhere to the precautionary procedures and regulations.”
The Ramadan restrictions may hit the hardest in poor neighborhoods, where residents depend on iftar banquets usually sponsored by wealthy individuals or organizations. For those people, feasting and Ramadan gifts are likely to be rarer, with tourism still at a trickle and many small businesses still suffering from the economic effects of the pandemic.
In Lebanon and Syria, the pandemic has worsened economic crisis that will likely squeeze people’s ability to enjoy the holy month, more than the governments’ limited restrictions aimed at curbing the spread of the coronavirus.
In Syria, where experts say the official infection and death numbers for Covid-19 are far below the reality, the government has few restrictions in place. Worshipers will even be allowed to stand in line inside of mosques to pray together after breaking their fast, the Syrian Ministry of Religious Affairs said.
In Lebanon, which emerged recently from a strict lockdown, shops and restaurants can operate regularly during the day but must offer only delivery service during a nighttime curfew from 9:30 p.m. to 5 a.m.
India said on Tuesday that it would fast-track the approval of vaccines in use in other countries, a move aimed at rapidly increasing the country’s vaccine supply as it battles what is currently the world’s biggest coronavirus outbreak.
The Indian government said that it would grant emergency authorization to any foreign-made vaccine that had been approved for use by regulators in the United States, the European Union, Britain or Japan, or by the World Health Organization. The move had been recommended by a panel of Indian scientists and eliminates a requirement for drug companies to conduct local clinical trials.
“The decision will facilitate quicker access to such foreign vaccines” and encourage imports of materials that would boost India’s vaccine manufacturing capacity, the government said in a statement.
Earlier on Tuesday, India’s top drug regulator granted emergency approval to Sputnik V, the Russian-made vaccine, adding a third vaccine to the country’s arsenal on the same day that health officials recorded 161,736 new coronavirus infections in 24 hours.
It was the seventh straight day that India has added more than 100,000 cases, according to a New York Times database. Only the United States has seen a faster rise in infections during the pandemic.
India has administered about 105 million domestically produced vaccine doses for a population of 1.3 billion, but it is widely believed that the country needs to scale up inoculations rapidly because other measures have failed to control the virus. Many states have reimposed partial lockdowns and weekend curfews. In the country’s financial hub, Mumbai, health officials are racing to erect field hospitals as facilities report shortages of oxygen, ventilators and coronavirus testing kits.
And there is the risk of a superspreading event with the gathering of millions of Hindu pilgrims for the annual Kumbh Mela festival on the banks of the Ganges River, where the authorities say they are powerless to enforce social distancing.
India’s outbreak is reverberating worldwide as its pharmaceutical industry — which was supposed to manufacture and export hundreds of millions of doses of the AstraZeneca vaccine — is keeping most supplies at home. The approval of the Sputnik vaccine, whose first doses are expected to be available for use in weeks, offers hope that India could speed up its inoculation drive.
But it is unclear at this stage whether India will be able to procure significant quantities of other vaccines, including the Pfizer, Moderna and Johnson & Johnson shots in use in the United States. Major Western nations have accumulated much of the global supply of those vaccines and manufacturers are struggling to meet the surging demand.
India will import millions of Sputnik doses from Russia and then begin manufacturing the vaccine domestically, officials said. More than 850 million doses will be made, with some intended for export, Kirill Dmitriev, chief executive of the Russian Direct Investment Fund, a sovereign wealth fund that has financed the vaccine’s development, said in an interview with India’s NDTV channel.
“India is a vaccine-manufacturing hub and our strategic partner for production of Sputnik V,” Mr. Dmitriev said.
India has more than 13.6 million confirmed coronavirus cases, the second most after the United States, and 171,058 deaths, the fourth highest toll.
In other news around the world:
Japan has begun vaccinating 36 million people over age 65, the first time shots have been made available to the public during the country’s slow vaccine rollout. Officials said that 1,139 people nationwide had received doses on Monday, and that doses to cover all Japanese above the age threshold would reach municipal health facilities by the end of June. Although Japan has weathered the pandemic better than most countries, the pace of its vaccination effort, which until now had only covered 1.1 million frontline medical workers, has sparked public criticism and raised questions about readiness for the Tokyo Summer Olympics in just over three months.
Scotland on Tuesday moved forward plans to loosen its coronavirus lockdown, a day after the British government eased many restrictions in England. New rules beginning Friday will permit Scots to meet outdoors in groups of up to six adults from six households. The current rules restrict travel and set the maximum group size at four, from two households. Restrictions on shops and outdoor service in pubs, now relaxed in England, are scheduled to remain in Scotland until April 26.
Austria’s health minister resigned on Tuesday, citing personal health problems that he said have been exacerbated by the grueling job of helping lead the country’s response to the pandemic. “It feels like it has not been 15 months, but 15 years,” the minister, Rudolf Anschober, said in a statement. Mr. Anschober, 60, was appointed in January last year, as a Green party minister in a Conservative-led coalition, and has been one of the main faces of Austria’s coronavirus response. “In the worst health crisis in decades, the republic needs a health minister who is 100 percent fit. That is not currently me,” he said.
France will suspend all flights to and from Brazil, because of growing worries about the virus variant spreading there. “We see that the situation is getting worse” in Brazil, Prime Minister Jean Castex told lawmakers. The country previously permitted essential travel from Brazil, subject to testing and isolation requirements.
The World Health Organization on Monday evening called on governments to suspend the sale of live wild mammals in food markets to help prevent the emergence of new diseases. “Traditional markets, where live animals are held, slaughtered and dressed, pose a particular risk for pathogen transmission to workers and customers alike,” the agency said in a statement. Animals are the source of more than 70 percent of emerging infectious diseases in humans, it said. Early in the pandemic, Chinese officials suggested that the coronavirus outbreak might have started at a market. But W.H.O. experts said in a report last year that the role of animal markets in the story of the pandemic was still unclear.
BERLIN — Chancellor Angela Merkel’s government moved a step closer on Tuesday to securing the right to force restrictions on areas where the coronavirus is spreading rapidly, overriding state leaders reluctant to take action.
Ms. Merkel and her ministers approved a legislative proposal that would make it easier for the national government to enforce lockdowns and other limits on movement in regions where infection levels pass a set threshold. At current levels, it could lock down more than half of the country.
Under Germany’s decentralized leadership structures, the 16 state leaders have been meeting regularly with the chancellor to agree on nationwide coronavirus response policies. But with different regions experiencing different rates of infection, some state leaders have been reluctant to enforce the agreed limitations, leading to confusion and frustration among many Germans.
“I believe this amendment is as important as it is an urgent decision about how to proceed in the coronavirus pandemic,” the chancellor told reporters after meeting with her ministers.
Parliament still has to debate and approve the proposal, which would take the form of an amendment to the Protection Against Infection Act, and that process is expected to begin this week.
“We are in a situation where an emergency mechanism is necessary,” Ralph Brinkhaus, the leader of the Christian Democratic Union in Parliament, told reporters, before a meeting of his party lawmakers to discuss the amendment.
Under the proposed amendment, the federal government could force stores and cultural institutions to close and enforce limits on the number of people allowed to meet up in any region where infections surpass 100 new cases per 100,000 residents over a period of seven days.
More controversially, the law would also allow Ms. Merkel’s government to order that schools and day care centers close if the number of new infections reaches more than 200 per 100,000 inhabitants. Schools fall under the jurisdiction of the states, and local leaders are reluctant to relinquish that control.
Germany has registered more than three million infections and more than 78,700 deaths from Covid-19 since the virus began moving through the country last spring. It recorded 10,810 new cases of infection on Tuesday, bringing the national rate of infection to more than 140 per 100,000.
The number of patients in intensive care is expected to hit a record this month, as the country struggles to vaccinate enough people to get ahead of the spread of the highly contagious B.1.1.7 variant.
Britain has now offered vaccinations to everyone in the country age 50 and older, the government announced late on Monday, and is extending its program to another age group, the latest sign that the national rollout is continuing at pace.
On Tuesday, the authorities opened vaccinations to anyone 45 or older, yet the announcement came with a small hiccup: The website for the country’s National Health Service crashed for a short time after the younger cohort was invited to book appointments online.
The new step in the country’s vaccine rollout comes as the authorities eased several restrictions in England on Monday after months of stringent lockdowns, with pubs and restaurants opened for drinks and dining outside, and nonessential shops once again opening their doors.
Prime Minister Boris Johnson called the moment a “hugely significant milestone” and in a statement thanked those involved with the vaccine rollout. Mr. Johnson said the country was on track to offer all adults a vaccination by the end of July. More than 32 million people across Britain have received their first dose of one of the vaccines, according to government data.
The government said it had also already offered vaccinations to every health or care worker, and to everyone with a high-risk medical condition.
England has also began rolling out the Moderna vaccine, which will be offered as an alternative alongside the Pfizer BioNTech vaccine for those under 30, instead of AstraZeneca’s, which has been the mainstay of Britain’s program so far.
There have been concerns about a possible link between the AstraZeneca vaccine and very rare blood clots, and last week British regulators said an alternative should be provided for younger people. Potential infection still poses much greater risks than any vaccine side effect for all those over 30, they said, and could do so for younger people if cases surged again.
“The Moderna rollout marks another milestone in the vaccination program,” Stephen Powis, the medical director of the National Health Service, said in a statement. “We now have a third jab in our armory.”
The vaccination program, he added, “is our hope at the end of a year like no other” as he encouraged people to book their appointments.
But despite the hopeful vaccine news and the return to public life, the country is still battling new cases of the virus, and a cluster in two London neighborhoods of a worrisome variant first discovered in South Africa has prompted mass testing. Health workers have gone door to door to urge residents to get tested, even if they are not showing symptoms, as dozens of cases have emerged. Similar measures were carried out elsewhere in the city earlier this month.
Studies have shown that the variant contains a mutation that diminishes the vaccines’ effectiveness against it. Dr. Susan Hopkins, the chief medical adviser for the country’s test and trace campaign, said the cluster of cases in parts of South London was “significant.”
“It’s really important people in the local area play their part in stopping any further spread within the local community,” she said in a statement.
More than a year after the coronavirus first swept through New York, the streets of Sunset Park in southern Brooklyn reflect the pandemic’s deep and unhealed wounds intertwined with signs of a neighborhood trying to edge back to life.
The sidewalks are filling with shoppers and vendors. More businesses are welcoming customers. But owners still struggle to pay rent and keep their enterprises afloat, while many workers laid off after the city locked down last year remain without jobs.
And while the rate of vaccination in New York has increased significantly, the coronavirus still percolates through this densely packed neighborhood. The ZIP code that includes Sunset Park had the highest rate of positive cases in Brooklyn in early April, nearly double the citywide rate. Some residents have expressed skepticism about the vaccines, spooked by false information circulated over TikTok and other social media.
Adding to the stress is a spate of hate crimes and violence against people of Asian descent in New York and around the country, fed in some cases by racist claims that Asian-Americans are responsible for spreading the virus.
About a third of the residents in Sunset Park have received at least one dose of the vaccine, roughly the same level as the city overall, according to the city health data. But local leaders say they want to push that number much higher.
Kuan Neng, 49, the Buddhist monk who founded Xi Fang Temple on Eighth Avenue, said that people had come to him in recent weeks to express concerns over vaccines.
“Why do I need to do that?” is a common refrain, according to Mr. Kuan, followed by: “I’m healthy now. The hard times are over, more or less.”
“Many people want to delay and see,” Mr. Kuan said, himself included.
ArcLight Cinemas, a beloved chain of movie theaters based in Los Angeles, including the Cinerama Dome in Hollywood, will permanently close all its locations, Pacific Theaters announced on Monday, after the pandemic decimated the cinema business.
ArcLight’s locations in and around Hollywood have played host to many a movie premiere, in addition to being favorite spots for moviegoers seeking out blockbusters and prestige titles. They are operated by Pacific Theaters, which also manages a handful of theaters under the Pacific name, and are owned by Decurion.
“After shutting our doors more than a year ago, today we must share the difficult and sad news that Pacific will not be reopening its ArcLight Cinemas and Pacific Theaters locations,” the company said in a statement.
“This was not the outcome anyone wanted,” it added, “but despite a huge effort that exhausted all potential options, the company does not have a viable way forward.”
Between the Pacific and ArcLight brands, the company owned 16 theaters and more than 300 screens.
The movie theater business has been hit particularly hard by the pandemic. But in recent weeks, the majority of the country’s largest theater chains, including AMC and Regal Cinemas, have reopened in anticipation of the slate of Hollywood films that have been put back on the calendar, many after repeated delays because of pandemic restrictions. A touch of optimism is even in the air as a result of the Warner Bros. movie “Godzilla vs. Kong,” which has generated some $70 million in box office receipts since opening over Easter weekend.
Still, the industry’s trade organization, the National Association of Theater Owners, has long warned that the punishing closures were most likely to affect smaller regional players like ArcLight and Pacific. In March, the Alamo Drafthouse Cinema chain, which operates about 40 locations across the country, announced that it had filed for Chapter 11 bankruptcy protection but would keep most of its locations operational while it restructured.
That does not seem to be the case for Pacific Theaters, which, according to two people with knowledge of the matter, fired its entire staff on Monday.
The reaction to ArcLight’s closing around Hollywood has been emotional, including an outpouring on Twitter.
Devastating. Too many losses to process. It’s just too much… At some point when I’m less upset, I’ll tell you guys a funny story about my first time meeting Quentin Tarantino in the lobby of Hollywood Arclight. https://t.co/cFypJxEk4L
— Lulu Wang (@thumbelulu) April 13, 2021
Three people infected with the coronavirus died at a hospital in Bucharest on Monday evening after the oxygen supply stopped functioning, according to the authorities, the latest incident involving oxygen failure, which in many countries has driven up the virus death toll.
It was also another fatal setback for Romania’s ageing and overwhelmed health care system, which has suffered two fires in Covid-19 wards in recent months, killing at least 15 people.
Ventilators shut down at a mobile intensive care unit set up at the Victor Babes hospital in Bucharest after oxygen pressure reached too high a level, the country’s health authorities said in a statement, depriving patients of a vital supply. In addition to the three patients who died, five others were evacuated and moved to other facilities in the city.
Romania has recorded its highest rate of Covid-19 patients in intensive care units since the pandemic began, and on Sunday Prime Minister Florin Citu said that there were just six intensive care beds available across Romania, out of nearly 1,600.
Intensive care units in Hungary and Poland have also been at risk of being overwhelmed, as much of Eastern Europe has struggled to cope with a third wave of infections across the continent. Some Hungarian hospitals have sought medical students and volunteers to assist in Covid-19 wards, giving training to those without previous medical experience.
The mobile unit struck by the oxygen problem on Monday had only been in operation since Saturday, and it has epitomized long-running concerns over the country’s fragile health care system. In January, five patients died and a further 102 were evacuated from a different hospital in Bucharest after a fire broke out. In November, 10 patients hospitalized with the coronavirus died after a fire broke out in a hospital in the northeastern city of Piatra Neamt.
Romania’s spending on health care is among the lowest in the European Union, with just over five percent of gross domestic product allocated toward it, compared with 10 percent on average among other countries of the bloc.
More than 25,000 people who tested positive for the virus have died in Romania, and the authorities have closed schools and kindergartens throughout April as part of an extended Easter holiday.
The authorities have so far administered more than 3.5 million vaccine doses, in a population of about 19 million.
— Kit Gillet
Studies have found that women in academia have published fewer papers, led fewer clinical trials and received less recognition for their expertise during the pandemic.
Add to that the emotional upheaval of the pandemic, the protests over structural racism, worry about children’s mental health and education, and the lack of time to think or work, and an already unsustainable situation becomes unbearable.
Michelle Cardel, an obesity researcher at the University of Florida, worries that this confluence of factors could push some women to leave the sciences.
“My big fear is that we are going to have a secondary epidemic of loss, particularly of early career women in STEM,” she said.
Female scientists were struggling even before the pandemic. It was not unusual for them to hear that women were not as smart as men, or that a woman who was successful must have received a handout along the way, said Daniela Witten, a biostatistician at the University of Washington in Seattle.
Women in academia often have little recourse when confronted with discrimination. Their institutions sometimes lack the human resources structures common in the business world.
Compounding the frustration are outdated notions about how to help women in science. But social media has allowed women to share some of those concerns and find allies to organize and call out injustice when they see it, said Jessica Hamerman, an immunologist at the Benaroya Research Institute in Seattle.
In November, for example, a study on female scientists was published in the influential journal Nature Communications suggesting that having female mentors would hinder the career of young scientists and recommending that young women seek out male help.
The response was intense and unforgiving: Nearly 7,600 scientists signed a petition calling on the journal to retract the paper — which it did on Dec. 21.
The study arrived at a time when many female scientists were already worried about the pandemic’s effect on their careers, and already on edge and angry with a system that offered them little support.
Alisa Stephens found working from home to be a series of wearying challenges. Dr. Stephens is a biostatistician at the University of Pennsylvania, and carving out the time and mental space for that work with two young children at home was impossible.
Things eased once the family could safely bring in a nanny, but there was still little time for the deep thought Dr. Stephens had relied on each morning for her work.
Over time, she has adjusted her expectations of herself. “Maybe I’m at 80 percent as opposed to 100 percent,” she said, “but I can get things done at 80 percent to some extent.”
The prospect of a fourth wave of the coronavirus, with new cases climbing sharply in the Upper Midwest, has reignited a debate among vaccine experts over how long to wait between the first and second doses. Extending that period would swiftly increase the number of people with the partial protection of a single shot, but some experts fear it could also give rise to dangerous new variants.
In the United States, two-dose vaccines are spaced three to four weeks apart, matching what was tested in clinical trials. But in Britain, health authorities have delayed doses by up to 12 weeks in order to reach more people more quickly. And in Canada, which has precious few vaccines to go around, a government advisory committee recommended on Wednesday that second doses be delayed even longer, up to four months.
Some health experts think the United States should follow suit. Dr. Ezekiel J. Emanuel, a co-director of the Healthcare Transformation Institute at the University of Pennsylvania, has proposed that for the next few weeks, all U.S. vaccines should go to people receiving their first dose.
“That should be enough to quell the fourth surge, especially in places like Michigan, like Minnesota,” he said in an interview. Dr. Emanuel and his colleagues published the proposal in an op-ed on Thursday in USA Today.
10 days after the first dose, researchers could see that the volunteers were getting sick less often than those who got the placebo.
In the same month, Britain experienced a surge of cases caused by a new, highly transmissible variant called B.1.1.7. Once the British government authorized two vaccines — from Pfizer-BioNTech and AstraZeneca — it decided to fight the variant by delaying the second doses of both formulations by 12 weeks.
said on Jan. 31 on NBC’s “Meet the Press.”
But the government stayed the course, arguing that it would be unwise to veer off into the unknown in the middle of a pandemic. Although the clinical trials did show some early protection from the first dose, no one knew how well that partial protection would last.
“When you’re talking about doing something that may have real harm, you need empirical data to back that,” said Dr. Céline R. Gounder, an infectious-disease specialist at Bellevue Hospital Center and a member of Mr. Biden’s coronavirus advisory board. “I don’t think you can logic your way out of this.”
But in recent weeks, proponents of delaying doses have been able to point to mounting evidence suggesting that a first dose can provide potent protection that lasts for a number of weeks.
The Centers for Disease Control and Prevention reported that two weeks after a single dose of either the Moderna or the Pfizer-BioNTech vaccine, a person’s risk of coronavirus infection dropped by 80 percent. And researchers in Britain have found that first-dose protection is persistent for at least 12 weeks.
Dr. Emanuel argued that Britain’s campaign to get first doses into more people had played a role in the 95 percent drop in cases since their peak in January. “It’s been pretty stunning,” Dr. Emanuel said.
studies that show that a single dose of Moderna or Pfizer-BioNTech does not work as well against certain variants, such as B.1.351, which was first found in South Africa.
“Relying on one dose of Moderna or Pfizer to stop variants like B.1.351 is like using a BB gun to stop a charging rhino,” said John P. Moore, a virologist at Weill Cornell Medicine.
Dr. Moore said he also worried that delaying doses could promote the spread of new variants that can better resist vaccines. As coronaviruses replicate inside the bodies of some vaccinated people, they may acquire mutations that allow them to evade the antibodies generated by the vaccine.
But Dr. Cobey, who studies the evolution of viruses, said she wasn’t worried about delayed doses breeding more variants. “I would put my money on it having the opposite effect,” she said.
Last week, she and her colleagues published a commentary in Nature Reviews Immunology in defense of delaying doses. Getting more people vaccinated — even with moderately less protection — could translate into a bigger brake on the spread of the virus in a community than if fewer people had stronger protection, they said. And that decline wouldn’t just mean more lives were saved. Variants would also have a lower chance of emerging and spreading.
“There are fewer infected people in which variants can arise,” she said.
Dr. Adam S. Lauring, a virologist at the University of Michigan who was not involved in the commentary, said he felt that Dr. Cobey and her colleagues had made a compelling case. “The arguments in that piece really resonate with me,” he said.
Although it seems unlikely that the United States will shift course, its neighbor to the north has embraced a delayed strategy to cope with a booming pandemic and a short supply of vaccines.
Dr. Catherine Hankins, a public health specialist at McGill University in Montreal and a member of Canada’s Covid-19 Immunity Task Force, endorsed that decision, based on the emerging evidence about single doses. And she said she thought that other countries facing even worse shortfalls should consider it as well.
“I will be advocating at the global level that countries take a close look at Canada’s strategy and think seriously about it,” Dr. Haskins said.
LONDON — For Aruba, a Caribbean idyll that has languished since the pandemic drove away its tourists, the concept of a “vaccine passport” is not just intriguing. It is a “lifeline,” said the prime minister, Evelyn Wever-Croes.
Aruba is already experimenting with a digital certificate that allows visitors from the United States who tested negative for the coronavirus to breeze through the airport and hit the beach without delay. Soon, it may be able to fast-track those who arrive with digital confirmation that they have been vaccinated.
“People don’t want to stand in line, especially with social distancing,” Ms. Wever-Croes said in an interview this week. “We need to be ready in order to make it hassle-free and seamless for the travelers.”
Vaccine passports are increasingly viewed as the key to unlocking the world after a year of pandemic-induced lockdowns — a few bytes of personal health data, encoded on a chip, that could put an end to suffocating restrictions and restore the freewheeling travel that is a hallmark of the age of globalization. From Britain to Israel, these passports are taking shape or already in use.
But they are also stirring complicated political and ethical debates about discrimination, inequality, privacy and fraud. And at a practical level, making them work seamlessly around the globe will be a formidable technical challenge.
The debate may play out differently in tourism- or trade-dependent outposts like Aruba and Singapore, which view passports primarily as a tool to reopen borders, than it will in vast economies like the United States or China, which have starkly divergent views on civil liberties and privacy.
The Biden administration said this week that it would not push for a mandatory vaccination credential or a federal vaccine database, attesting to the sensitive political and legal issues involved. In the European Union and Britain, which have taken tentative steps toward vaccine passports, leaders are running into thorny questions over their legality and technical feasibility.
And in Japan, which has lagged the United States and Britain in vaccinating its population, the debate has scarcely begun. There are grave misgivings there about whether passports would discriminate against people who cannot get a shot for medical reasons or choose not to be vaccinated.
Japan, like other Asian countries, has curbed the virus mainly through strict border controls.
“Whether or not to get vaccinated is up to the individual,” said Japan’s health minister, Norihisa Tamura. “The government should respond so that people won’t be disadvantaged by their decision.”
Still, almost everywhere, the pressure to restart international travel is forcing the debate. With tens of millions of people vaccinated, and governments desperate to reopen their economies, businesses and individuals are pushing to regain more freedom of movement. Verifying whether someone is inoculated is the simplest way to do that.
“There’s a very important distinction between international travel and domestic uses,” said Paul Meyer, the founder of the Commons Project, a nonprofit trust that is developing CommonPass, a scannable code that contains Covid testing and vaccination data for travelers. Aruba was the first government to sign up for it.
“There doesn’t seem to be any pushback on showing certification if I want to travel to Greece or Cyprus,” he said, pointing out that schools require students to be vaccinated against measles and many countries demand proof of yellow fever vaccinations. “From a public health perspective, it’s not fair to say, ‘You have no right to check whether I’m going to infect you.’”
CommonPass is one of multiple efforts by technology companies and others to develop reliable, efficient systems to verify the medical status of passengers — a challenge that will deepen as more people resume traveling.
At Heathrow Airport in London, which is operating at a fraction of its normal capacity, arriving passengers have had to line up for hours while immigration officials check whether they have proof of a negative test result and have purchased a mandatory kit to test themselves twice more after they enter the country.
Saudi Arabia announced this week that pilgrims visiting the mosques in Mecca and Medina during the Muslim holy month of Ramadan would have to show proof on a mobile app of being “immunized,” which officials defined as having been fully vaccinated, having gotten a single dose of a vaccine at least 14 days before arrival, or having recovered from Covid.
In neighboring United Arab Emirates, residents can show their vaccination status on a certificate through a government-developed app. So far, the certificate is not yet widely required for anything beyond entering the capital, Abu Dhabi, from abroad.
Few countries have gone farther in experimenting with vaccine passports than Israel. It is issuing a “Green Pass” that allows people who are fully vaccinated to go to bars, restaurants, concerts and sporting events. Israel has vaccinated more than half its population and the vast majority of its older people, which makes such a system useful but raises a different set of questions.
With people under 16 not yet eligible for the vaccine, the system could create a generational divide, depriving young people of access to many of the pleasures of their elders. So far, enforcement of the Green Pass has been patchy, and in any event, Israel has kept its borders closed.
So has China, which remains one of the most sealed-off countries in the world. In early March, the Chinese government announced it would begin issuing an “international travel health certificate,” which would record a user’s vaccination status, as well as the results of antibody tests. But it did not say whether the certificate would spare the user from China’s draconian quarantines.
Nor is it clear how eager other countries would be to recognize China’s certificate, given that Chinese companies have been slow in disclosing data from clinical trials of their homegrown vaccines.
Singapore has also maintained strict quarantines, even as it searches for way to restart foreign travel. Last week, it said it would begin rolling out a digital health passport, allowing passengers to use a mobile app to share their coronavirus test results before flying into the island nation.
Free movement across borders is the goal of the European Union’s “Digital Green Certificate.” The European Commission last month set out a plan for verifying vaccination status, which would allow a person to travel freely within the bloc. It left it up to its 27 member states to decide how to collect the health data.
That could avoid the pitfalls of the European Union’s vaccine rollout, which was heavily managed by Brussels and has been far slower than that in the United States or Britain. Yet analysts noted that in data collection, there is a trade-off between decentralized and centralized systems: the former tends to be better at protecting privacy but less efficient; the latter, more intrusive but potentially more effective.
“Given the very unequal access to vaccines we are witnessing in continental Europe, there is also an issue of equal opportunity and potential discrimination,” said Andrea Renda, a senior research fellow at the Center for European Policy Studies in Brussels.
For some countries, the legal and ethical implications have been a major stumbling block to domestic use of a passport. As Prime Minister Justin Trudeau of Canada put it last month, “There are questions of fairness and justice.”
And yet in Britain, which has a deeply rooted aversion to national ID cards, the government is moving gingerly in that direction. Prime Minister Boris Johnson last week outlined broad guidelines for a Covid certificate, which would record vaccination status, test results, and whether the holder had recovered from Covid, which confers a degree of natural immunity for an unknown duration.
Mr. Johnson insisted that shops, pubs and restaurants would not be required to demand the certificate, though they could opt to do so on their own. That did not stop dozens of lawmakers, from his Conservative Party and the opposition Labour Party, from opposing the plan on grounds that were legal, ethical and plainly commercial — that it could keep people out of the country’s beloved pubs.
Government officials now suggest that the plan is targeted less at pubs and restaurants and more at higher-risk settings, like nightclubs and sporting events.
“Would we rather have a system where no one can go to a sports ground or theater?” said Jonathan Sumption, a former justice on Britain’s Supreme Court, who has been an outspoken critic of the government’s strict lockdowns. “It’s better to have a vaccine passport than a blanket rule which excludes these pleasures from everybody.”
Reporting was contributed by Stephen Castle in London, Motoko Rich in Tokyo, Shashank Bengali in Singapore, Vivian Wang in Hong Kong, Vivian Yee in Cairo, Asmaa al-Omar in Beirut, and Ian Austen in Ottawa.
The European Union’s regulator, the European Medicines Agency, has so far declined to approve the Russian vaccine for use and only two members of the bloc, Hungary and Slovakia, have placed orders for Sputnik V. Serbia, which is not a member of the bloc, has also ordered Sputnik V and begun using it in a mass inoculation program that has been far more successful than the stumbling efforts of most European Union states.
Even Germany, a stickler for procedure, has expressed growing interest in Sputnik V. Health Minister Jens Spahn told the public broadcaster WDR on Thursday that he would like to start bilateral talks with Russia over a potential purchase of the vaccine, which would go through only if it is approved by the European Medicines Agency.
The previous day, Markus Söder, the governor of Bavaria, said his government had signed a preliminary agreement to buy 2.5 million doses of the vaccine, which are to be produced at a Russian-owned plant in the southern state. That deal, too, is contingent on E.M.A. approval.
Sputnik V is manufactured at seven locations in Russia, and also at plants in India and South Korea. A number of other countries have signed manufacturing contracts, including Brazil, Turkey and Serbia. Russia has consistently delivered fewer doses of the vaccine than initially promised, suggesting glitches in manufacturing. Producing vaccines at scale is a difficult process and ramping up production has presented problems for Western vaccines, too.
Noting that about 40 countries are using or scheduled to use the Russian vaccine, the Slovak regulatory agency asserted that “these vaccines are only associated by the name.” That raised questions about deviations from the formula reviewed in The Lancet.
“The comparability and consistency of different batches produced at different locations has not been demonstrated,” the Slovak regulator said. “In several cases, they appear to be vaccines with different properties (lyophilisate versus solution, single-dose ampoules versus multi-dose vials, different storage conditions, composition and method of manufacture).”
The Slovak statement could damage Russia’s efforts to establish Sputnik V as a reliable brand. It could also exacerbate lingering doubts left by the vaccine’s highly politicized rollout in Russia, where President Vladimir V. Putin announced that the drug was ready for use in August, before clinical trials had finished.
She grew up in Hungary, daughter of a butcher. She decided she wanted to be a scientist, although she had never met one. She moved to the United States in her 20s, but for decades never found a permanent position, instead clinging to the fringes of academia.
Now Katalin Kariko, 66, known to colleagues as Kati, has emerged as one of the heroes of Covid-19 vaccine development. Her work, with her close collaborator, Dr. Drew Weissman of the University of Pennsylvania, laid the foundation for the stunningly successful vaccines made by Pfizer-BioNTech and Moderna.
For her entire career, Dr. Kariko has focused on messenger RNA, or mRNA — the genetic script that carries DNA instructions to each cell’s protein-making machinery. She was convinced mRNA could be used to instruct cells to make their own medicines, including vaccines.
But for many years her career at the University of Pennsylvania was fragile. She migrated from lab to lab, relying on one senior scientist after another to take her in. She never made more than $60,000 a year.
was published, in Immunity, it got little attention.
Dr. Weissman and Dr. Kariko then showed they could induce an animal — a monkey — to make a protein they had selected. In this case, they injected monkeys with mRNA for erythropoietin, a protein that stimulates the body to make red blood cells. The animals’ red blood cell counts soared.
25 years of work by multiple scientists, including Pieter Cullis of the University of British Columbia.
Scientists also needed to isolate the virus’s spike protein from the bounty of genetic data provided by Chinese researchers. Dr. Barney Graham, of the National Institutes of Health, and Jason McClellan, of the University of Texas at Austin, solved that problem in short order.
Testing the quickly designed vaccines required a monumental effort by companies and the National Institutes of Health. But Dr. Kariko had no doubts.
On Nov. 8, the first results of the Pfizer-BioNTech study came in, showing that the mRNA vaccine offered powerful immunity to the new virus. Dr. Kariko turned to her husband. “Oh, it works,” she said. “I thought so.”
To celebrate, she ate an entire box of Goobers chocolate-covered peanuts. By herself.
Dr. Weissman celebrated with his family, ordering takeout dinner from an Italian restaurant, “with wine,” he said. Deep down, he was awed.
“My dream was always that we develop something in the lab that helps people,” Dr. Weissman said. “I’ve satisfied my life’s dream.”
Dr. Kariko and Dr. Weissman were vaccinated on Dec. 18 at the University of Pennsylvania. Their inoculations turned into a press event, and as the cameras flashed, she began to feel uncharacteristically overwhelmed.
A senior administrator told the doctors and nurses rolling up their sleeves for shots that the scientists whose research made the vaccine possible were present, and they all clapped. Dr. Kariko wept.
Things could have gone so differently, for the scientists and for the world, Dr. Langer said. “There are probably many people like her who failed,” he said.