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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Covax to Receive 200 Million Johnson & Johnson Covid Doses

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Countries Are Scrambling for Vaccines. Mongolia Has Plenty.

Mongolia, a country of grassy hills, vast deserts and endless skies, has a population not much bigger than Chicago’s. The small democratic nation is used to living in the shadow of its powerful neighbors, Russia and China.

But during a pandemic, being a small nation sandwiched between two vaccine makers with global ambitions can have advantages.

At a time when most countries are scrambling for coronavirus vaccines, Mongolia now has enough to fully vaccinate its entire adult population, in large part thanks to deals with both China and Russia. Officials are so confident about the nation’s vaccine riches that they are promising citizens a “Covid-free summer.”

Mongolia’s success in procuring the vaccines in the span of a few months is a big victory for a low-income, developing nation. Many poor countries have been waiting in line for shots, hoping for the best. But Mongolia, using its status as a small geopolitical player between Russia and China, was able to snap up doses at a clip similar to that of much wealthier countries.

deep skepticism over their homegrown vaccines.

Mongolia is a buffer between eastern Russia, which is resource rich and mostly unpopulated, and China, which is crowded and hungry for resources. While Russia and China are often aligned on the global stage, they have a history of conflict and are wary of each others’ interests in Mongolia. Those suspicions can be seen in their vaccine diplomacy.

arrived this week. Mongolia’s most recent agreement with China’s Sinopharm Group, which is state-owned, was made days before the company received emergency authorization from the World Health Organization.

Mongolia was late to the global clamber for Covid-19 vaccines. For nearly a year officials boasted that there were no local cases. Then came an outbreak in November. Two months later, political crisis precipitated by the mishandling of the virus led to the sudden resignation of the prime minister. The prospect of continued coronavirus restrictions threatened to throw the country into further political turmoil.

The new prime minister, Oyun-Erdene Luvsannamsrai, pledged to restart the economy, which had suffered from lockdowns and border closures, particularly in the south, where Mongolian truck drivers ferry coal across the border to China’s steel mills. But these plans were complicated by surging cases, with the daily count going from hundreds a day to thousands.

“We were quite desperate,” said Bolormaa Enkhbat, an economic and development policy adviser to Mr. Luvsannamsrai.

Vero Cell vaccine. Soon after, China donated 300,000 doses of its Sinopharm vaccine to Mongolia, citing a “profound traditional friendship” as motivation.

Opening up more of the border between China and Mongolia was also a part of the vaccine discussions, Chinese and Mongolian officials said in Chinese state media. Mongolia needs China to buy its coal — exports to the country make up nearly a quarter of Mongolia’s annual economic growth. The revenues helped to pad Mongolia’s budget by a quarter last year.

After a month of back and forth, the Mongolian government struck a deal in March with Russia’s Gamaleya Research Institute, too, for one million doses of the Sputnik vaccine. Days later, Mongolia finalized an agreement to buy 330,000 additional doses of the Sinopharm vaccine.

Ulaanbaatar, Mongolia’s capital, 97 percent of the adult population has received a first dose and more than half are fully vaccinated, according to government statistics. Across the country, more than three quarters of Mongolians have already received one shot.

China has shut its border and stopped purchasing Mongolian coal.

Mongolians have also expressed a preference for Russia’s Sputnik vaccine. To get the population to take the Sinopharm shot, the government has offered each citizen 50,000 tugriks — about $18 — to get fully vaccinated. The average monthly salary in 2020 was $460.

The terms and pricing of the Sinopharm and Sputnik deals were not made public, and Mongolia’s foreign ministry declined to comment on pricing. Representatives for the Gamaleya Research Institute and Sinopharm did not respond to requests for comment.

While some global health experts have questioned whether Sinopharm will be able to continue to deliver on its commitments overseas, it has delivered all of the doses Mongolia ordered. China has said it can make as many as five billion doses by the end of the year, though officials have warned that the country is struggling to make enough shots for its citizens.

a third booster shot sooner than expected.

China, for its part, may be playing a long game, said Julian Dierkes, an associate professor at the University of British Columbia who specializes in Mongolian politics. Though many Mongolians may still not trust China, the Mongolian government will remember how it made its vaccines available at a critical moment.

“We could coin a phrase here: ‘The opportunity of smallness,’” he said.

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Indian Vaccine Manufacturer Signals it Won’t Export Doses Before Year’s End

The vaccination woes of some of the world’s poorest nations will continue as the Serum Institute of India, a crucial manufacturing pillar in the plan to supply two billion doses of Covid-19 vaccines to low-income countries, signaled that it would not be able to provide vaccines beyond India before the year’s end.

The revelation, tucked into a statement by the vaccine manufacturing giant that attempted to deflect mounting criticism, was another setback for Covax, the global vaccine partnership for the poor. It is already more than 140 million doses behind schedule, and the Serum Institute’s announcement suggested it was all but impossible to meet the goal of two billion doses by the end of the year.

The announcement once again underscored the glaring contrast of inequality: As some of the richer nations tout levels of vaccinations that allows them to reopen their society, most of the poorer nations have barely gotten a start.

“We continue to scale up manufacturing and prioritize India,” the Serum institute of India said in the statement on Tuesday. “We also hope to start delivering to Covax and other countries by the end of this year.”

Oxford-AstraZeneca vaccine, licensed to it with the commitment that a large share would go to poor nations.

As part of its plan to have two billion doses by the end of the year, Covax has been counting on hundreds of millions of the Oxford-AstraZeneca vaccine produced by Serum Institute, as well hundreds of millions of as a second vaccine called Novavax that the company is developing.

After India’s devastating second wave of coronavirus infections, the institute diverted all its manufacturing powers to domestic needs, falling behind on commitments to the Covax partnership as well as on bilateral commercial deals with many countries. The institute played down each delay as temporary. But Tuesday’s statement makes clear it is unlikely to meet commitments before the end of the year.

So far, the Covax alliance has supplied only 65 million vaccines, spread across 124 countries, according to the World Health Organization. The W.H.O. said the global alliance was already 140 million doses behind and likely to miss another 50 million doses in June.

“Once the devastating outbreak in India recedes, we also need the Serum Institute of India to get back on track and catch up on its delivery commitments to Covax,” said Dr. Tedros Adhanom Ghebreyesus, the chief of W.H.O.

the government’s mismanagement of the crisis.

India has administered about 180 million doses of vaccines. Only about 5 percent of the country’s adult population. The vaccination rate has fallen to about 1.8 million doses a day, which means it would take the country more than three years to vaccinate 80 percent of its population.

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U.S. to Donate 20 Million Doses for Global Vaccination Effort

The United States will send at least 20 million coronavirus vaccine doses in June to countries struggling against the pandemic, answering calls that the Biden administration isn’t doing enough to help countries that face dire shortages of vaccines and other treatments.

President Biden said on Monday that those 20 million doses, of Pfizer-BioNTech, Moderna and Johnson and Johnson vaccines, would be in addition to 60 million doses of AstraZeneca’s vaccine, which the U.S. plans to donate once the vaccine is cleared for use by the Food and Drug Administration. It is not clear exactly how long it will take the F.D.A. to authorize AstraZeneca’s vaccine.

“We know America will never be fully safe until the pandemic that’s raging globally is under control,” Mr. Biden said during a news conference at the White House. “No ocean’s wide enough, no wall is high enough, to keep us safe.”

Mr. Biden’s announcement on Monday afternoon came not long after a World Health Organization news conference at which the director general, Dr. Tedros Adhanom Ghebreyesus, said that countries with high vaccination rates had to do more to help countries that were being hit hard by the coronavirus, or the entire world would be imperiled.

Britain, which have seen a decline in cases and deaths in recent weeks, relaxed restrictions as the virus battered India and other Asian countries.

Variants like B.1.617, first discovered in India and recently designated a variant of concern by the W.H.O., are contributing to the spread of infections and worry many researchers.

Dr. Tedros called for well-supplied nations to send more of their vaccine supplies and allocations to harder-hit countries, and for vaccine developers and manufacturers to hasten delivery of hundreds of millions of doses to Covax, an international initiative dedicated to equitable distribution of the vaccine, noting an appeal by Henrietta Fore, UNICEF’s executive director.

Ms. Fore released a statement on Monday saying that Covax would soon complete delivering 65 million doses, but that it should have delivered at least 170 million and that the effort could be short by as much as 190 million doses by the time Group of 7 leaders gather in England in June.

convincing the remaining unvaccinated people to get the shot.

Last week the Centers for Disease Control and Prevention changed its guidance to allow people who have been vaccinated to forgo their masks indoors and outdoors in many situations. The decision caused confusion in states and individuals, some who were eager to return to a semblance of normalcy and others who said they planned to stay masked indefinitely.

Dr. Rochelle Walensky, the director of C.D.C., said on “Meet the Press” on Sunday that the agency’s suggestions were “not permission to shed masks for everybody, everywhere.”

On Monday, Dr. Tedros’s message was more straightforward.

“No one is safe until we are all safe,” he said.

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Sanofi-GlaxoSmithKline Covid Vaccine Shows Promise, Firm Says

Sanofi, the French pharmaceutical company, said on Monday that it would move the experimental Covid-19 vaccine it is developing with GlaxoSmithKline into a late-stage trial after the shot produced strong immune responses in volunteers in a mid-stage study.

The findings are encouraging news for a vaccine that has fallen behind in development and has so far disappointed those expecting that it would be crucial in combating the pandemic. If the vaccine can become available in the last three months of this year, as its developers hope, it could still play a central role as a booster shot as well as an initial inoculation in the developing world, where the pace of vaccination is lagging.

The vaccine hit a major setback in December, when its developers announced that it did not appear to work well in older adults and that they would have to delay plans to test it in a Phase 3 trial, the crucial test that will assess the vaccine’s effectiveness.

But the companies modified the vaccine and in February began testing it in a Phase 2 study that included more than 700 volunteers in the United States and Honduras between 18 and 95 years old. Sanofi said the vaccine did not raise any safety concerns and produced a strong immune response across age groups, a finding suggesting it has been successfully tweaked.

Sanofi announced the findings in a statement and said it plans to soon publish the results in a medical journal.

Sanofi and GSK are much more experienced in vaccine development than a number of their rivals that have already won authorization. The two companies used a more established approach than those deployed in other, more swiftly developed Covid vaccines. Their shot is based on viral proteins produced with engineered viruses that grow inside insect cells. GSK is supplying the Sanofi vaccine with an adjuvant, an ingredient used in many vaccines meant to boost the immune response.

Sanofi and GSK’s vaccine was one of six selected for funding from Operation Warp Speed, the Trump administration’s effort to accelerate vaccine development. Last summer, the federal government agreed to give the companies $2.1 billion to develop and manufacture the vaccine, in exchange for 100 million doses once the shot was ready.

Sanofi also has supply deals with the European Union and Canada. It has also agreed to supply 200 million doses to Covax, the program to deliver vaccines to middle- and lower-income countries that has been struggling with a shortfall in expected doses. Sanofi has also announced plans to help manufacture the authorized vaccines made by Pfizer-BioNTech, Moderna and Johnson & Johnson.

Sanofi said its Phase 3 trial of its vaccine will begin in the coming weeks and enroll more than 35,000 adult volunteers around the world. It will test two formulations of the vaccine, one aimed at preventing the original strain of the virus and the other aimed at the B.1.351 variant first seen in South Africa that some vaccines appear to be less effective against.

Su-Peing Ng, Sanofi’s global head of medical for vaccines, told journalists on Monday that the company expects it to be “operationally quite challenging” to enroll unvaccinated participants in the Phase 3 trial as vaccination coverage increases in many nations. Still, she said, vaccine doses are still scarce in many parts of the world, pointing to Latin America and Asia as places where the company may look to enroll volunteers.

The company said that soon after starting the Phase 3 trial it plans to assess whether its vaccine can boost immune responses in people who had been vaccinated months before with authorized vaccines. Those booster studies are expected to enroll volunteers in well-vaccinated parts of the world, including the United States and Europe.

Sanofi and GSK said last year they were preparing to be able to make 1 billion doses annually. Thomas Triomphe, Sanofi’s global head of vaccines, said on Monday that the company’s production this year, if its vaccine is shown to work, would depend on the world’s needs.

The vaccine, he said, has “potential to be a booster of choice for many nations and many different platforms.”

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Israel’s Gaza Strikes May Cause Covid Surge, U.N. Warns

Israel’s airstrikes and shelling of Gaza have stopped all Covid-19 vaccinations and testing in the Palestinian enclave and raise the risk of super-spreading as civilians cram into shelters for safety, United Nations officials said.

In an interview over Zoom on Friday as the sound of Israeli explosions shook their headquarters, the leaders of the U.N. Palestinian relief agency’s operations in Gaza and the head of the World Health Organization’s Gaza sub-office said they feared that a severe worsening of Covid-19 infections would be a side-effect of the death and destruction from the latest surge in hostilities.

The number of people in Gaza sickened from Covid-19 had been “just leveling off, and then this hit,” said the U.N. agency official, Matthias Schmale. “It is a grim situation.”

He said that unvaccinated Gazans were crowding into the schools run by his agency, known as the United Nations Relief and Works Agency, because the Israelis do not intentionally target those buildings — in effect making them bomb shelters. Now, Mr. Schmale said, those schools “could turn into mass spreaders.”

hit record highs in Gaza, which health experts attributed to the proliferation of the highly transmissible coronavirus variant first identified in Britain. In early May, Doctors Without Borders reported that the territory’s infections were topping 1,000 a day.

Sacha Bootsma, the W.H.O. official, said that before the vaccinations had stopped, 38,000 people in Gaza had received at least one dose of vaccine. That is less than 2 percent of the population of two million. Russia’s Sputnik vaccine and the Pfizer-BioNTech vaccine were given at three Gaza hospitals, and AstraZeneca’s vaccine was being administered at smaller health centers.

But now, Ms. Bootsma said, “People are not daring to visit health facilities. We are fearing this will have a major negative impact.”

By contrast, more than 60 percent of the Israeli population has received at least one dose of either the Pfizer-BioNTech or Moderna vaccines, and more than 55 percent are fully vaccinated, according to the Our World in Data project at the University of Oxford. However, the pace of vaccinations has slowed tremendously in recent months.

Under Covax, the international collaboration to provide vaccines to poor parts of the world, Gaza is supposed to receive enough vaccine to protect 20 percent of its population, the officials said.

But the deliveries, flown to Israel’s Ben Gurion Airport and then sent by land across the border to Gaza, have been indefinitely suspended because air service into Israel has been curtailed by the hostilities. Assuming they resume soon, it still remains unclear when Gaza’s border crossings might reopen.

“The biggest problem now is the borders are closed,” Mr. Schmale said. “Even if there were a delivery, we would not be able to receive any supplies.”

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Why Vaccinating the World Against Covid-19 Will Be Hard

In delivering vaccines, pharmaceutical companies aided by monumental government investments have given humanity a miraculous shot at liberation from the worst pandemic in a century.

But wealthy countries have captured an overwhelming share of the benefit. Only 0.3 percent of the vaccine doses administered globally have been given in the 29 poorest countries, home to about 9 percent of the world’s population.

Vaccine manufacturers assert that a fix is already at hand as they aggressively expand production lines and contract with counterparts around the world to yield billions of additional doses. Each month, 400 million to 500 million doses of the vaccines from Moderna, Pfizer and Johnson & Johnson are now being produced, according to an American official with knowledge of global supply.

But the world is nowhere close to having enough. About 11 billion shots are needed to vaccinate 70 percent of the world’s population, the rough threshold needed for herd immunity, researchers at Duke University estimate. Yet, so far, only a small fraction of that has been produced. While global production is difficult to measure, the analytics firm Airfinity estimates the total so far at 1.7 billion doses.

dangerous new variants emerge, requiring booster shots and reformulated vaccines, demand could dramatically increase, intensifying the imperative for every country to lock up supply for its own people.

The only way around the zero-sum competition for doses is to greatly expand the global supply of vaccines. On that point, nearly everyone agrees.

But what is the fastest way to make that happen? On that question, divisions remain stark, undermining collective efforts to end the pandemic.

Some health experts argue that the only way to avert catastrophe is to force drug giants to relax their grip on their secrets and enlist many more manufacturers in making vaccines. In place of the existing arrangement — in which drug companies set up partnerships on their terms, while setting the prices of their vaccines — world leaders could compel or persuade the industry to cooperate with more companies to yield additional doses at rates affordable to poor countries.

Those advocating such intervention have focused on two primary approaches: waiving patents to allow many more manufacturers to copy existing vaccines, and requiring the pharmaceutical companies to transfer their technology — that is, help other manufacturers learn to replicate their products.

more than 100 countries in asking the W.T.O. to partially set aside vaccine patents.

But the European Union has signaled its intent to oppose waivers and support only voluntary tech transfers, essentially taking the same position as the pharmaceutical industry, whose aggressive lobbying has heavily shaped the rules in its favor.

Some experts warn that revoking intellectual property rules could disrupt the industry, slowing its efforts to deliver vaccines — like reorganizing the fire department amid an inferno.

“We need them to scale up and deliver,” said Simon J. Evenett, an expert on trade and economic development at the University of St. Gallen in Switzerland. “We have this huge production ramp up. Nothing should get in the way to threaten it.”

Others counter that trusting the pharmaceutical industry to provide the world with vaccines helped create the current chasm between vaccine haves and have-nots.

The world should not put poorer countries “in this position of essentially having to go begging, or waiting for donations of small amounts of vaccine,” said Dr. Chris Beyrer, senior scientific liaison to the Covid-19 Prevention Network. “The model of charity is, I think, an unacceptable model.”

halting vaccine exports a month ago. Now, as a wave of death ravages the largely unvaccinated Indian population, the government is drawing fire at home for having let go of doses.

poses universal risks by allowing variants to take hold, forcing the world into an endless cycle of pharmaceutical catch-up.

“It needs to be global leaders functioning as a unit, to say that vaccine is a form of global security,” said Dr. Rebecca Weintraub, a global health expert at Harvard Medical School. She suggested that the G7, the group of leading economies, could lead such a campaign and finance it when the members convene in England next month.

Pfizer expects to sell $26 billion worth of Covid vaccines this year; Moderna forecasts that its sales of Covid vaccines will exceed $19 billion for 2021.

History also challenges industry claims that blanket global patent rights are a requirement for the creation of new medicines. Until the mid-1990s, drug makers could patent their products only in the wealthiest markets, while negotiating licenses that allowed companies in other parts of the world to make generic versions.

Even in that era, drug companies continued to innovate. And they continued to prosper even with the later waivers on H.I.V. drugs.

“At the time, it rattled a lot of people, like ‘How could you do that? It’s going to destroy the pharmaceutical industry,’” recalled Dr. Anthony S. Fauci, President Biden’s chief medical adviser for the pandemic. “It didn’t destroy them at all. They continue to make billions of dollars.”

Leaders in the wealthiest Western nations have endorsed more equitable distribution of vaccines for this latest scourge. But the imperative to ensure ample supplies for their own nations has won out as the virus killed hundreds of thousands of their own people, devastated economies, and sowed despair.

The drug companies have also promised more support for poorer nations. AstraZeneca’s vaccine has been the primary supply for Covax, and the company says it has sold its doses at a nonprofit price.

stumbled, falling short of production targets. And producing the new class of mRNA vaccines, like those from Pfizer-BioNTech and Moderna, is complicated.

Where pharmaceutical companies have struck deals with partners, the pace of production has frequently disappointed.

“Even with voluntary licensing and technology transfer, it’s not easy to make complex vaccines,” said Dr. Krishna Udayakumar, director of the Duke Global Health Innovation Center.

Much of the global capacity for vaccine manufacturing is already being used to produce other lifesaving inoculations, he added.

But other health experts accuse major pharmaceutical companies of exaggerating the manufacturing challenges to protect their monopoly power, and implying that developing countries lack the acumen to master sophisticated techniques is “an offensive and a racist notion,” said Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University.

With no clear path forward, Ms. Okonjo-Iweala, the W.T.O. director-general, expressed hope that the Indian and South African patent-waiver proposal can be a starting point for dialogue.

“I believe we can come to a pragmatic outcome,” she said. “The disparity is just too much.”

Peter S. Goodman reported from London, Apoorva Mandavilli from New York, Rebecca Robbins from Bellingham, Wash., and Matina Stevis-Gridneff from Brussels. Noah Weiland contributed reporting from New York.

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What Would It Take to Vaccinate the World Against Covid?

In delivering vaccines, pharmaceutical companies aided by monumental government investments have given humanity a miraculous shot at liberation from the worst pandemic in a century.

But wealthy countries have captured an overwhelming share of the benefit. Only 0.3 percent of the vaccine doses administered globally have been given in the 29 poorest countries, home to about 9 percent of the world’s population.

Vaccine manufacturers assert that a fix is already at hand as they aggressively expand production lines and contract with counterparts around the world to yield billions of additional doses. Each month, 400 million to 500 million doses of the vaccines from Moderna, Pfizer and Johnson & Johnson are now being produced, according to an American official with knowledge of global supply.

But the world is nowhere close to having enough. About 11 billion shots are needed to vaccinate 70 percent of the world’s population, the rough threshold needed for herd immunity, researchers at Duke University estimate. Yet, so far, only a small fraction of that has been produced. While global production is difficult to measure, the analytics firm Airfinity estimates the total so far at 1.7 billion doses.

more than 100 countries in asking the W.T.O. to partially set aside vaccine patents.

But the European Union has signaled its intent to oppose waivers and support only voluntary tech transfers, essentially taking the same position as the pharmaceutical industry, whose aggressive lobbying has heavily shaped the rules in its favor.

Some experts warn that revoking intellectual property rules could disrupt the industry, slowing its efforts to deliver vaccines — like reorganizing the fire department amid an inferno.

“We need them to scale up and deliver,” said Simon J. Evenett, an expert on trade and economic development at the University of St. Gallen in Switzerland. “We have this huge production ramp up. Nothing should get in the way to threaten it.”

Others counter that trusting the pharmaceutical industry to provide the world with vaccines helped create the current chasm between vaccine haves and have-nots.

The world should not put poorer countries “in this position of essentially having to go begging, or waiting for donations of small amounts of vaccine,” said Dr. Chris Beyrer, senior scientific liaison to the Covid-19 Prevention Network. “The model of charity is, I think, an unacceptable model.”

Pfizer expects to sell $26 billion worth of Covid vaccines this year; Moderna forecasts that its sales of Covid vaccines will exceed $19 billion for 2021.

History also challenges industry claims that blanket global patent rights are a requirement for the creation of new medicines. Until the mid-1990s, drug makers could patent their products only in the wealthiest markets, while negotiating licenses that allowed companies in other parts of the world to make generic versions.

Even in that era, drug companies continued to innovate. And they continued to prosper even with the later waivers on H.I.V. drugs.

“At the time, it rattled a lot of people, like ‘How could you do that? It’s going to destroy the pharmaceutical industry,’” recalled Dr. Anthony S. Fauci, President Biden’s chief medical adviser for the pandemic. “It didn’t destroy them at all. They continue to make billions of dollars.”

Leaders in the wealthiest Western nations have endorsed more equitable distribution of vaccines for this latest scourge. But the imperative to ensure ample supplies for their own nations has won out as the virus killed hundreds of thousands of their own people, devastated economies, and sowed despair.

The drug companies have also promised more support for poorer nations. AstraZeneca’s vaccine has been the primary supply for Covax, and the company says it has sold its doses at a nonprofit price.

stumbled, falling short of production targets. And producing the new class of mRNA vaccines, like those from Pfizer-BioNTech and Moderna, is complicated.

Where pharmaceutical companies have struck deals with partners, the pace of production has frequently disappointed.

“Even with voluntary licensing and technology transfer, it’s not easy to make complex vaccines,” said Dr. Krishna Udayakumar, director of the Duke Global Health Innovation Center.

Much of the global capacity for vaccine manufacturing is already being used to produce other lifesaving inoculations, he added.

But other health experts accuse major pharmaceutical companies of exaggerating the manufacturing challenges to protect their monopoly power, and implying that developing countries lack the acumen to master sophisticated techniques is “an offensive and a racist notion,” said Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University.

With no clear path forward, Ms. Okonjo-Iweala, the W.T.O. director-general, expressed hope that the Indian and South African patent-waiver proposal can be a starting point for dialogue.

“I believe we can come to a pragmatic outcome,” she said. “The disparity is just too much.”

Peter S. Goodman reported from London, Apoorva Mandavilli from New York, Rebecca Robbins from Bellingham, Wash., and Matina Stevis-Gridneff from Brussels. Noah Weiland contributed reporting from New York.

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