hospitalized for four weeks, and underwent surgery on March 3 for what the palace described only as a pre-existing heart condition. He was also treated for an unspecified infection. He was released on March 16, just 24 days before his death.

Elian Peltier, Stephen Castle, Derrick Bryson Taylor, Geneva Abdul, Alex Marshall and Daniel Victor contributed reporting.

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Netflix’s ‘The Crown’ Changed Prince Philip’s Image

Prince Philip’s death is affecting millions today, many of whom only knew of him from Netflix’s “The Crown.”

Since 2016, the hit show has taken viewers inside the British royal family, showing it in all its glittering — and frequently grubby — glory. And for Prince Philip, it’s fair to say the show transformed his image, at least in Britain.

For most younger people here, Prince Philip has long been known as simply a liability, an old man prone to gaffes, often racist ones.

But in “The Crown,” Matt Smith, the British actor, showed a far more vital and complex man who’d played a key role in modernizing some aspects of royal life even as he snarled at its constraints. In the show’s first seasons, covering the 1940s to 1960s, Smith portrayed Prince Philip as “a castrated alpha male,” Tim Lewis wrote in The Guardian, who frequently came across as a “whining, childish husband,” Mike Hale wrote in The New York Times.

seeing the absurdity of the trappings of royalty, even as he remains committed to the institution and its traditions.

In the most recent season, Prince Philip was also pivotal in convincing Prince Charles, his son, to marry Diana Spencer.

What was it like playing Prince Philip? Smith and Menzies have given hints in interviews. (Jonathan Pryce assumes the role next season.)

“What an example of a roguish, brilliant man,” Smith said in a 2017 interview with The Guardian.

“He’s provoking at times, not scared of an opinion but there’s a real energy to him, a kind of heat,” Menzies last year told The Evening Standard, a British newspaper.

Neither actor today responded to interview requests. But Menzies issued a statement that gives a little insight into Prince Philip’s character — or his pride, at least. “If I know anything about the Duke of Edinburgh I’m fairly sure he wouldn’t want an actor who has portrayed him on television giving their opinion on his life,” Menzies said.

“I’ll leave it to Shakespeare,” Menzies added, then quoted a line from the play “As You Like It.”

“O good old man! How well in thee appears,” it reads, “The constant service of the antique world.”

“Rest in Peace,” Menzies added.

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Prince Philip’s Life in Pictures

Prince Philip, the husband of Queen Elizabeth II and the longest-serving consort in British history, was born into Greek royalty in the 1920s, served on a battleship in World War II, toured the world on royal missions for decades and sought for most of his life to defend the interests of Britain’s monarchy.

His life spanned almost a century of upheaval and change for Britain: As a child, he lived with a granddaughter of Queen Victoria, and he died nearly 100 years old, survived by eight great grandchildren who will grow up in an era of smartphones and the internet.

Philip came to England after his father, Prince Andrew of Greece, was banished by a revolutionary Greek junta. He was educated at the Cheam School, an institution bent on toughening privileged children, and then went to Gordonstoun School in Scotland, which promoted a regimen of grueling work, cold showers and hard beds.

He met Princess Elizabeth when she was about 13 or 14. She was instantly smitten, telling her father, King George VI, that she could love no other man but him. They married on Nov. 20, 1947, when he was 26 and she was 21.

warning about greenhouse gases and lending his time to causes like protecting endangered wildlife.

But he grew to hate the relentless tabloid coverage of palace affairs. The public often perceived him as a remote if occasionally loose-lipped figure who made remarks that were called oblivious, insensitive or worse.

He was pained by the headlines that followed the tumultuous marriage and divorce of his eldest son, Prince Charles, and Lady Diana Spencer. He became known as a stern and even imperious figure in the royal family who belittled Charles, and he and the family were castigated by the public for their response to the death of Diana.

Philip died as Buckingham Palace was embroiled in turmoil over Oprah Winfrey’s televised interview last month with his grandson Prince Harry and Harry’s wife, Meghan.

Here is his life in pictures:

Philip on his ninth birthday, in Greek dress.

Philip, second from left, at the MacJannet American School in St. Cloud, France.

Philip and Elizabeth, then a princess, after their wedding ceremony on Nov. 20, 1947.

The couple in the grounds of Broadlands in Hampshire, where they spent their honeymoon, in 1947.

Elizabeth and Philip with their children, Prince Charles and Princess Anne, at Clarence House, in 1951.

The queen and prince in Boston in 1975.

Philip flying a Blackburn military transport plane a few minutes before a fire extinguisher burst in 1956. He landed the plane 10 minutes later.

Throwing a javelin during a visit to the Outward Bound Sea School, in Wales, in 1949.

Feeding a colony of penguins during a visit to the Antarctic.

Philip, an avid horseman and polo player, taking part in a bicycle polo game at Windsor.

Philip at a group therapy session at the National Addiction and Research Institute in London, in 1969.

A photo of the royal family in July 1969 shows Philip and the queen with their children: Charles, 21; Anne,18; Prince Andrew, 9; and Prince Edward, 5.

Philip in 1980 driving a team of horses through a water obstacle in the World Carriage Driving Championships at Windsor Great Park.

Speaking in 1986 at a banquet held by the Japanese Equestrian Federation in Tokyo, as the chairman of the International Equestrian Federation.

Philip and the queen ride in an open carriage down the course at the Royal Ascot in 1986. He regularly accompanied Elizabeth on royal visits and often stood in for her.

Philip and Elizabeth looking at tributes that had been left outside Buckingham Palace in memory of Princess Diana, who was killed in a car crash on Aug. 31, 1997.

Philip visiting the Richmond Adult Community College in June 2015 in London.

Elizabeth and Philip in Westminster, during the state opening of Parliament in 2012.

Philip, as colonel in chief of the Royal Canadian Regiment, inspecting members of a battalion at Queen’s Park.

Attending a garden party at Buckingham Palace in 2017.

Feeding an elephant named Donna after opening the new Centre for Elephant Care in Whipsnade, north of London, in 2017.

Philip and Elizabeth walking in Romsey, in southern England, in 2007.

Philip at a garden party held at Buckingham Palace in June 2014, when he was 93.

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Vaccine Passports Could Unlock World Travel and Cries of Discrimination

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.

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Prince Philip, Husband of Queen Elizabeth II, Is Dead at 99

Another was instituting efficiencies at Buckingham Palace, originally bought by his and Elizabeth’s ancestor George III. Philip had intercoms installed, for example, to obviate the need for messengers.

At home he showed — by palace standards, at any rate — a common touch. When the telephone rang, he answered it himself, setting a royal precedent. He even announced to the queen one day that he had bought her a washing machine. He reportedly mixed his own drinks, opened doors for himself and carried his own suitcase, telling the footmen: “I have arms. I’m not bloody helpless.”

He sent his children to school instead of having them tutored at home, as had been the royal custom. He set up a kitchen in the family suite, where he fried eggs for breakfast while the queen brewed tea — an attempt, it was said, to provide their children with some semblance of a normal domestic life.

Prince Philip carried British passport No. 1 (the queen did not require one) and fulfilled as many as 300 engagements a year, including greeting President Barack Obama and his wife, Michelle Obama, at Buckingham Palace in April 2009 and again in May 2011. (He was not in attendance when the queen met with President Donald J. Trump in December 2019 in London.) And he was front and center at royal events, like the marriage of Prince William and Kate Middleton in April 2011, watched around the world, and Elizabeth’s visit to the Irish Republic, the first by a British monarch, the next month.Philip was the first member of the royal family to go to the Soviet Union, representing the queen on a trip with the British equestrian team in 1973.

To escape the court life, Philip liked to drive fast, often relegating his chauffeur to the back seat. Once, when the queen was his passenger, a minor accident led to major headlines. He ultimately surrendered his driver’s license in 2019 at age 97, after his Land Rover collided with another vehicle, injuring its two occupants, and overturned near the royal family’s Sandringham estate in Norfolk.

He liked to pilot his own planes and once had a near miss with a passenger jet. He enjoyed sailing, but was said to have so little patience with horse racing that he had his top hat fitted with a radio so that he could listen to cricket matches when he escorted the queen to her favorite spectator sport.

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Help! I Want to Go to Europe in August. Is This a Pipe Dream?

My husband and I are currently planning a trip to Ireland, Portugal and Italy for August and September. We are only reserving hotels with free cancellation policies and our airline tickets can be changed to a future date. Knowing that much of Europe is closed right now to United States citizens because of the virus, is there much hope that our plans will materialize, or are we wasting our time? What should I watch for? Kathy

Although there are some signs of life — Iceland is newly open to fully vaccinated travelers and Greece will reopen to vaccinated or virus-tested visitors next month — Europe, where case counts are rising in some parts and the vaccine rollout has been disappointingly slow, is still largely closed to Americans. Ireland is open to United States citizens with a combination of testing and quarantine, but Portugal and Italy, like most of the continent, for now remain off limits. Italy, in particular, was hard-hit by the virus in the early months of the pandemic; and in March, the spread of a contagious variant from Britain pushed the country back into another lockdown.

“This environment is so challenging because there is significant pressure for countries that rely on tourism to rebound, which counterbalances much slower vaccination rates in Europe,” said Fallon Lieberman, who runs the leisure-travel division of Skylark, a travel agency affiliated with the Virtuoso travel network. “So unfortunately, those two forces are at odds with one another.”

Your question, like many related to the pandemic, involves various degrees of risk. First, let’s look at the concrete risk: If you book now for late summer, how likely are you to lose money?

flexibility with seats beyond Basic Economy, and now, especially, it’s wise to book tickets that can be easily changed. Delta Air Lines has eliminated change and cancellation fees for all flights originating from North America, and Delta eCredits set to expire this year — including for new tickets purchased this year — can be used for travel through 2022. United Airlines has also permanently eliminated change fees.

Unlike a plane ticket, which can always be changed (either for free or for a fee), a nonrefundable hotel reservation is generally exactly that: a use-it-or-lose-it investment.

The good news: “Hotels in Europe — and around the world, really — are being quite flexible,” said Ms. Lieberman, who has helped hundreds of Skylark clients cancel and rebook last year’s felled Europe trips, many to this summer and beyond. “While this is a very challenging time, many suppliers are providing maximum flexibility.”

Cancellation policies vary by property, but many of the multinational companies have made it easy, and relatively risk-free, to plan ahead. Companies like Hilton and Four Seasons are allowing cancellations up to 24 hours before check-in. Hyatt is allowing fee-free cancellations up to 24 hours in advance for arrivals through July 31 (and it’s always possible that date will be extended). For points nerds, most of the big hotel chains allow most award nights to be canceled scot-free, with the points redeposited, within a day or two of the expected check-in.

More complicated than physical refunds, though, is the larger, metaphysical risk: How likely is it that this trip is actually going to happen? What forces can help predict whether the Europe trips we book today will actually materialize in August and September?

France and Italy have just been locked down again, interest in Europe is rising, aided, no doubt, by signs that President Biden could lift the ban on European visitors to the United States as early as next month, news of the possibility of European health passes, rumors that Spain and Britain could both restart international tourism in mid May, and more.

At Hopper, a travel-booking app that analyzes and predicts flight and hotel prices, bookings for Europe-bound summer 2021 travel surged 68 percent week-over-week between the last week of February and the first week of March. Searches for round-trip flights to Europe departing this summer increased a whopping 86 percent in the 30 days following February 22.

According to TripAdvisor data of hotel searches from the United States for this summer, five of the 10 most-searched European destinations were in Greece, but Rome — and Paris, for that matter — were also on the list.

To make sense of how traveler zeal will jibe with the realities of the pandemic, analysts and travel industry experts are eyeing several factors, including flight schedules.

According to PlaneStats, the aviation-data portal from Oliver Wyman, an international consulting firm, the number of Europe-bound flights scheduled to depart the United States this month is around 26 percent of the number that departed the United States for Europe in April 2019. Next month compared to May 2019, that figure is looking even higher so far: 35 percent. (April and May 2020, by contrast, both clocked in at 5 percent.) That’s lower than normal, but it’s still a drastic uptick from any other point during the pandemic. Although many will be connecting flights (Americans can still transit through Europe) or culminate in destinations like London (Americans can visit England, though multiple testing and quarantines are required), schedules still remain a key indicator.

Khalid Usman, a partner and aviation expert at Oliver Wyman. “What airlines don’t want to do is put out schedules where people are not going to be traveling.”

Pandemic Navigator, which simulates day-by-day immunity growth. “That’s good news for the domestic market, but in the context of international travel, we do have to realize that it’s not just about one country — it’s a country at the other end as well.”

Factoring in the spotty vaccine rollout across the pond, Mr. Usman said it’s reasonable to assume that Europe’s herd immunity will lag several months behind the United States. Over the next several months, he added, European countries will follow in Iceland’s footsteps and open individually, complete with their own regulations about vaccinations, testing and quarantines. To spur travel across the continent this summer, the European Union is considering adopting a vaccine certificate for its own residents and their families.

“It’s not going to be a binary open-or-shut,” Mr. Usman said. “Countries are going to start getting more selective about who they’re going to start letting in.”

Italy’s numbers — plus new lockdowns and growing Covid variants — seem to be stifling optimism; Hopper flight searches from the United States to Italy have remained relatively flat.

For now, Ms. Lieberman, of Skylark, has adopted a “beyond the boot” mind-set: “Our theory is that if you’re willing to go beyond the boot — meaning, Italy — there will be fabulous, desirable summer destinations for you to take advantage of.”

Portugal surged in January but has recently eased lockdown measures as infection rates have slowed. The country is now aiming for a 70 percent vaccination rate this summer.

American interest in Portugal is spiking in response. In the first week of March, following an announcement that Portugal could welcome tourists from Britain as soon as mid-May, Hopper searches on flights from the United States to Lisbon rose 63 percent. (That’s not far behind Athens, for which travel searches shot up 75 percent in the same time period.)

will next month start nonstop service between Boston and Reykjavik — and resume its Iceland service from New York City and Minneapolis.

“Unless demand spikes rapidly enough to outpace the increase in supply, flash sales can be found as airlines attempt to entice travelers to return amid piecemeal easings of travel restrictions,” said Mr. Damodaran. Icelandair, for example, is running sales on flights and packages through April 13.

And with prices for summer flights to Europe still relatively low in general — down by more than 10 percent from 2019, according to Hopper — experts see little downside in penciling in a trip.

“If you’re willing to take some risk, plan early and lock in your preferred accommodations and ideal itineraries,” Ms. Lieberman said. “But of course we caution you to be prepared to have to move deposits and dates if it comes to that.”

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AstraZeneca Vaccine Faces New Setbacks in U.K. and European Union

LONDON — Britain said on Wednesday that it would curb the use of AstraZeneca’s vaccine in adults under 30 because of the risk of rare blood clots, a blow to the efforts of scores of countries reliant on the vaccine to stamp out the coronavirus pandemic amid a global surge in cases.

Adding to the unease, the European Medicines Agency outlined a “possible link” between the vaccine and rare clots, even as it said that Covid-19 remained the far greater threat, leaving decisions about how to use the vaccine in the hands of the 27 member states of the European Union.

Taken together, the decisions represented a considerable setback for the AstraZeneca shot, which has been seen as the principal weapon in the battle to reduce deaths in the vaccine-starved global south.

The world’s most widely administered coronavirus vaccine, it is far less expensive and easier to store than some of the alternatives, spurring its use in at least 111 countries, rich and poor. AstraZeneca, based in Britain, has promised to deliver three billion doses this year, enough to inoculate nearly one in five people worldwide.

Cameroon and the Democratic Republic of Congo have already delayed injections of AstraZeneca’s vaccine amid mounting concerns in Europe. Any further hesitation, scientists said, could cost lives.

“In developing countries, the dynamic is to either use the vaccine you have, or you have nothing,” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London. “In which case, carnage ensues.”

For the vast majority of people, British and European regulators said on Wednesday, the benefits of AstraZeneca’s shot far outweigh the risks. The clotting problems were appearing at a rate of roughly one in 100,000 recipients across Europe. Meanwhile, in Britain, the vaccine has driven down hospitalizations from Covid-19 — which can, itself, cause serious clotting problems — and saved thousands of lives, regulators said.

most people doubted the vaccine’s safety.

Over all, use of the shot has suffered: Across Europe, 64 percent of delivered doses of AstraZeneca’s vaccine have been injected into people’s arms, markedly lower than the rates for other shots.

“One hoped there would have been collaboration, and more discussion, between regulators, instead of lots of different countries going off in all sorts of directions,” Professor Ward said. “That aspect has really been the most unhelpful.”

watch 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.

As of March 22, regulators had carried out detailed review of 86 cases, 18 of which were fatal, they said.

Concerns about the shot became acute enough in Britain this week that the University of Oxford, which developed the vaccine with AstraZeneca, stopped giving doses as part of a two-month-old trial in children.

“Safety has been our priority throughout the development of the vaccine,” Andrew Pollard, the Oxford researcher in charge of the trials, said on Wednesday. The identification of the clots, he added, “shows that the safety system works.”

In the United States, AstraZeneca is preparing to apply for emergency use authorization from the Food and Drug Administration. If and when they take up the application, that agency’s regulators are expected to scrutinize the clotting cases.

The United States, flush with vaccines from three other makers, may not ultimately need AstraZeneca’s shot. But any ruling by the F.D.A. is expected to hold considerable weight in some of the poorer nations that are relying on the shot.

The World Health Organization said a vaccine safety subcommittee had met on Wednesday and noted that “rare adverse events following immunizations should be assessed against the risk of deaths from Covid-19 disease and the potential of the vaccines to prevent infections.” It said that a link with the clotting problems, while “plausible,” had not been confirmed.

For Britain, the AstraZeneca vaccine has become a huge source of national pride, and the backbone of the country’s speedy inoculation program.

Even if younger people are at lower risk from severe Covid-19, scientists have said, inoculating them remains essential to creating enough protection in the population to end the pandemic.

Emma Bubola, Monika Pronczuk and Rebecca Robbins contributed reporting.

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AstraZeneca Vaccine Faces Setbacks in U.K. and European Union

LONDON — Britain said on Wednesday that it would curb the use of AstraZeneca’s vaccine in adults under 30 because of the risk of rare blood clots, a blow to the efforts of scores of countries reliant on the vaccine to stamp out the coronavirus pandemic amid a global surge in cases.

Adding to the unease, the European Medicines Agency outlined a “possible link” between the vaccine and rare clots, even as it said that Covid-19 remained the far greater threat, leaving decisions about how to use the vaccine in the hands of the 27 member states of the European Union.

Taken together, the decisions represented a considerable setback for the AstraZeneca shot, which has been seen as the principal weapon in the battle to reduce deaths in the vaccine-starved global south.

The world’s most widely administered coronavirus vaccine, it is far less expensive and easier to store than some of the alternatives, spurring its use in at least 111 countries, rich and poor. AstraZeneca, based in Britain, has promised to deliver three billion doses this year, enough to inoculate nearly one in five people worldwide.

Cameroon and the Democratic Republic of Congo have already delayed injections of AstraZeneca’s vaccine amid mounting concerns in Europe. Any further hesitation, scientists said, could cost lives.

“In developing countries, the dynamic is to either use the vaccine you have, or you have nothing,” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London. “In which case, carnage ensues.”

For the vast majority of people, British and European regulators said on Wednesday, the benefits of AstraZeneca’s shot far outweigh the risks. The clotting problems were appearing at a rate of roughly one in 100,000 recipients across Europe. Meanwhile, in Britain, the vaccine has driven down hospitalizations from Covid-19 — which can, itself, cause serious clotting problems — and saved thousands of lives, regulators said.

most people doubted the vaccine’s safety.

Over all, use of the shot has suffered: Across Europe, 64 percent of delivered doses of AstraZeneca’s vaccine have been injected into people’s arms, markedly lower than the rates for other shots.

“One hoped there would have been collaboration, and more discussion, between regulators, instead of lots of different countries going off in all sorts of directions,” Professor Ward said. “That aspect has really been the most unhelpful.”

watch 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.

As of March 22, regulators had carried out detailed review of 86 cases, 18 of which were fatal, they said.

Concerns about the shot became acute enough in Britain this week that the University of Oxford, which developed the vaccine with AstraZeneca, stopped giving doses as part of a two-month-old trial in children.

“Safety has been our priority throughout the development of the vaccine,” Andrew Pollard, the Oxford researcher in charge of the trials, said on Wednesday. The identification of the clots, he added, “shows that the safety system works.”

In the United States, AstraZeneca is preparing to apply for emergency use authorization from the Food and Drug Administration. If and when they take up the application, that agency’s regulators are expected to scrutinize the clotting cases.

The United States, flush with vaccines from three other makers, may not ultimately need AstraZeneca’s shot. But any ruling by the F.D.A. is expected to hold considerable weight in some of the poorer nations that are relying on the shot.

The World Health Organization said a vaccine safety subcommittee had met on Wednesday and noted that “rare adverse events following immunizations should be assessed against the risk of deaths from Covid-19 disease and the potential of the vaccines to prevent infections.” It said that a link with the clotting problems, while “plausible,” had not been confirmed.

For Britain, the AstraZeneca vaccine has become a huge source of national pride, and the backbone of the country’s speedy inoculation program.

Even if younger people are at lower risk from severe Covid-19, scientists have said, inoculating them remains essential to creating enough protection in the population to end the pandemic.

Emma Bubola, Monika Pronczuk and Rebecca Robbins contributed reporting.

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Possible Side Effects of AstraZeneca Vaccine Come Into Sharper Focus

LONDON — For months, European countries have seesawed between craving and rebuffing AstraZeneca’s vaccine, with the shot’s fortunes rising and falling on spats over supply and on questions over the efficacy of the vaccine itself.

But few concerns have proved as disruptive to the rollout of the world’s workhorse vaccine in Europe as reports of very rare blood clots in some recipients. Many countries responded by halting the shot’s use, only to start giving it again after an all-clear from regulators at the European Medicines Agency, and then stopped inoculations a second time in certain age groups after doctors became more concerned about the clots.

On Tuesday, those concerns were reinforced yet again when a top vaccines official at the European Medicines Agency said that the vaccine was linked to extremely rare, though sometimes fatal, blood clots in a small number of recipients. It was the first indication from an international regulatory body that the clots may be a real, if very unusual, side effect of the shot.

Regulators now appear to be considering issuing their first formal warnings about the potential side effects — not only in continental Europe, which has long been wary of the shot for political and scientific reasons, but also in Britain, the birthplace of the AstraZeneca vaccine and long its biggest champion, where new data have sown concerns as well.

speedy inoculation program, have also insisted that the vaccine’s benefits far outweighed the risks. They and the company cited a lack of evidence in Britain that the clotting events were any more common than would be expected among people who had never been given AstraZeneca’s vaccine.

But the evidence changed last week when Britain reported 30 cases of the rare blood clots, 25 more than previously. This week, a prominent scientific adviser to the British government said there was “increasing evidence” of the clots being associated with the vaccine.

regulators reported 30 cases of the rare blood clots combined with low platelets among 18 million people given the AstraZeneca vaccine. That translated to roughly one case in 600,000 recipients of the vaccine.

European countries’ divergent approaches to the vaccine stem from a number of factors, including the supply of vaccines and severity of the pandemic. Marco Cavaleri, the official at the European Medicines Agency who spoke about the link between the vaccine and blood clots, said on Tuesday that those factors would likely continue to dictate how countries used the shot.

Beyond those factors, countries also took very different approaches to managing risk, scientists said. Countries that have continued using the shot were more focused on securing the overall health of their citizens. Others were more preoccupied with minimizing the risk to any single person.

“The attitude here is more, ‘Get me out of the pandemic,’” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London, referring to the British approach. In continental Europe, she said, “There seems to be a much higher emphasis on individual safety in the population.”

Adriano Mannino, a philosopher at the University of Munich and director of the Solon Center for Policy Innovation in Germany, said that the collective benefits of the vaccine dominated thinking in Britain, while Germans were more concerned with the risk of an injection going wrong in individual cases. That reflected, partly, Germany’s history with the Nazis, who conducted lethal experiments on people.

“In many areas where law has to regulate ethically delicate and potentially dangerous things,” he said, “the German state has tended to go for tough restrictions.”

Nevertheless, Germans over 60 — the age group still being given AstraZeneca’s vaccine — flooded hotlines to book appointments and stood in line for hours in recent days as eligibility restrictions for their age group were relaxed.

In the northeastern city of Wismar, several hundred people waited for up to five hours on Tuesday in a driving wind and mix of rain and snow to receive the shot.

“I wish there had been better weather,” Kerstin Weiss, the head of the district authority in the northeastern region, told public broadcaster NDR. “But honestly, this is a sign that people are willing to be vaccinated with AstraZeneca.”

Benjamin Mueller reported from London and Melissa Eddy from Berlin. Monika Pronczuk and Emma Bubola contributed reporting.

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U.K. Community Leaders Aid In Vaccine Outreach in Ethnically Diverse Areas

LONDON — Minority communities in Britain have long felt estranged from the government and medical establishment, but their sense of alienation is suddenly proving more costly than ever amid a coronavirus vaccination campaign that depends heavily on trust.

With Britons enjoying one of the fastest vaccination rollouts in the world, skepticism about jabs remains high in many of the very communities where Covid-19 has taken the heaviest toll.

“The government’s response to the Black, Asian and minority ethnic communities has been rather limited,” said Dr. Raja Amjid Riaz, 52, a surgeon who is also a leader at the Central Mosque of Brent, an ethnically diverse borough of North London. “Those people have not been catered for.”

As a result, communities like Brent offer fertile ground for the most outlandish of vaccine rumors, from unfounded claims that they affect fertility to the outright fabrication that the shots are being used to inject microchips.

hit disproportionately hard both by the pandemic itself and by the lockdowns that followed, many local leaders like Dr. Riaz have taken it upon themselves to act.

Some are well-known and trusted figures like religious leaders. Others are local health care workers. And still others are ordinary community members like Umit Jani, a 46-year-old Brent resident.

Mr. Jani’s face is one of many featured on 150 lamppost posters across the borough encouraging residents to get tested for the virus and vaccinated, part of a local government initiative.

The goal is to reframe the community’s relationship with the power structure, and perhaps establish some trust.

second-highest rate of Covid-19 deaths in Britain.

One recent Saturday morning, Mr. Jani set out with another man to survey local residents, setting up a table by a convenience store as nearly a thousand people lined up outside a food bank nearby. The survey was about mental health services, but Mr. Jani took the opportunity to ask about the pandemic.

“Are you afraid to take the vaccine?” he asked one local man.

The man, speaking in Gujarati, a language native to India, said he wanted to take the vaccine, but first wanted to consult with his doctor because he feared an adverse reaction.

Despite this man’s concerns, Mr. Jani said he believed their efforts were making headway.

“It’s become less of a challenge to persuade people,” said Mr. Jani, who himself recently had his first shot.

The numbers appear to back that up: A survey led by Imperial College London and YouGov found that in February, almost 77 percent of people in Britain said they would take a vaccine if offered, up from 55 percent in November.

But other numbers make clear how far the country still has to go.

A government report found that vaccination rates in people 70 and older from early December to mid-March were lowest among the country’s Black African, Black Caribbean and Bangladeshi communities. It also noted that those living in deprived areas like Brent, where the poverty rate of 33 percent is slightly above London’s, were less likely to receive a shot.

colorblind approach” toward distributing vaccines during a pandemic that has not hit all communities equally.

“I think often they’ve overlooked the benefits of local leadership,” said Dr. Azeem Majeed, a professor and department head in primary care and public health at Imperial College London.

In January, the British government said it would give local governments and other groups 23 million pounds, about $31 million, toward encouraging vaccinations among people most at risk from the coronavirus, including minority groups.

Long before the government took that initiative, some local community leaders were already on the job, trying to dispel conspiracy theories and increase vaccinations. They have waged their campaign both online and door-to-door, and have run workshops aimed at countering misinformation.

At Dr. Riaz’s mosque, leaders have been working for months to tackle vaccine hesitancy through a help line, WhatsApp chats, weekly sermons and webinars. And as Ramadan approaches, they are hoping they will be able to vaccinate people who attend mosque after daily fasting.

While the government’s pandemic guidance has been issued in English, community leaders have offered multilingual messages on videos and local radio stations. That approach has particular resonance in a place like Brent, where 149 languages are spoken.

open letter this past week from well-known names, among them the comedian and actor Lenny Henry, urged Black Britons to get vaccinated.

The reasons for vaccine hesitancy vary.

It is not just baseless claims, like those in social media videos and messages circulated on outlets like WhatsApp that maintain — incorrectly — that the vaccines contain animal products forbidden under some religious practices.

Some are simply worried the drugs were developed too quickly. And, research suggests, that much of the hesitation grows out of Britain’s long history of racism and discrimination, as well as a general mistrust of the government and the medical establishment.

Shree Swaminarayan Mandir Kingsbury, a Hindu temple that has inoculated nearly 20,000 people.

“There are fewer doctors who are coming out to tell us exactly what is going on and how this is affecting us,” said Ms. Muyisa, 54.

She considers herself lucky: “I educated myself. I managed to go and find information that helped me understand things.”

Zarvesha Rasool, a 19-year-old student at King’s College London, was inspired to get vaccinated by her faith, and went for her jab at the East London Newham Minhaj-ul-Quran mosque and community center, where she helps teach Quranic studies. Ms. Rasool pointed out that a central tenet of Islam is the importance of looking out not just for oneself but also for the greater good.

“If the government isn’t doing that, you kind of have to tell them, ‘Oh, we exist,’” she said. “Because that’s the only way out.”

In the northern English city of Leeds, Qari Asim, a senior imam, was spurred to action after seeing misinformation spread on WhatsApp in January.

Mr. Asim, the chairman of Britain’s Mosques and Imams National Advisory Board, delivered a sermon that was shared across more than 100 mosques in which he reassured listeners that the vaccines are allowed under Islamic law.

Since then, over 300 mosques have addressed vaccine hesitancy and misinformation. Mr. Asim has also urged mosques to open their doors to the vaccine campaign.

“In this pandemic,” Mr. Asim said, “the messenger is as important as the message.”

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