granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for mandates in both the public and private sectors. Such mandates are legally allowed and have been upheld in court challenges.

  • College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
  • Schools. California became the first state to issue a vaccine mandate for all educators and to announce plans to add the Covid-19 vaccine as a requirement to attend school, which could start as early as next fall. Los Angeles already has a vaccine mandate for public school students 12 and older that begins Nov. 21. New York City’s mandate for teachers and staff, which went into effect Oct. 4 after delays due to legal challenges, appears to have prompted thousands of last-minute shots.
  • Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get vaccinated. Mandates for health care workers in California and New York State appear to have compelled thousands of holdouts to receive shots.
  • Indoor activities. New York City requires workers and customers to show proof of at least one dose of the Covid-19 for indoor dining, gyms, entertainment and performances. Starting Nov. 4, Los Angeles will require most people to provide proof of full vaccination to enter a range of indoor businesses, including restaurants, gyms, museums, movie theaters and salons, in one of the nation’s strictest vaccine rules.
  • At the federal level. On Sept. 9, President Biden announced a vaccine mandate for the vast majority of federal workers. This mandate will apply to employees of the executive branch, including the White House and all federal agencies and members of the armed services.
  • In the private sector. Mr. Biden has mandated that all companies with more than 100 workers require vaccination or weekly testing, helping propel new corporate vaccination policies. Some companies, like United Airlines and Tyson Foods, had mandates in place before Mr. Biden’s announcement.
  • “I think a lot of times we are so focused on wanting to get good results that we just have tunnel vision,” she said.

    Ms. Ng lives across from a testing center. Almost daily, she watched a constant stream of people go in for tests, a strategy that many public health experts say is a waste of resources in such a highly vaccinated country.

    “Freedom Day — as our ministers have said — is not the Singapore style,” said Jeremy Lim, an associate professor at the National University of Singapore and an expert on health policy, referring to England’s reopening in the summer. But moving too cautiously over the potential disadvantages of restrictions is a “bad public health” strategy, he said.

    The government should not wait for perfect conditions to reopen, “because the world will never be perfect. It’s so frustrating that the politicians are almost like waiting for better circumstances,” Dr. Lim said.

    Sarah Chan, a deputy director at Singapore’s Agency for Science, Technology and Research, said she had a fleeting taste of what normal life was like when she arrived in Italy last month to visit her husband’s family.

    No masks were required outdoors, vaccinated people could gather in groups, and Dr. Chan and her son could bop their heads to music in restaurants. In Singapore, music inside restaurants has been banned based on the notion that it could encourage the spread of the virus.

    Dr. Chan said she was so moved by her time in Italy that she cried.

    “It’s almost normal. You forget what that’s like,” she said. “I really miss that.”

    View Source

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    Candy Makers Sue THC Lookalikes

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    At first glance, the Skittles package appears to be just like the one sold in the candy aisle of a supermarket: It has block letters filled in with white, a flowing rainbow and a red candy that replaces the dot above the letter “i.”

    A closer look reveals some small differences: a background pattern of small, stylized marijuana leaves; a warning label; and numbers that reveal the amount of THC, the intoxicating substance in cannabis, in each piece of candy.

    The images are included in a lawsuit that the Wm. Wrigley Jr. Company, owned by the candy behemoth Mars Inc., filed in May against five companies for selling cannabis-infused edibles that look like our old friends Skittles, Starburst and Life Savers. Though the suit focuses on intellectual property rights, the plaintiffs also argue that the copycat products could lead people, particularly children, to mistakenly ingest drugs.

    recreational marijuana consumption roamed by pandemic-stressed adults.

    In recent years, lawsuits similar to the one filed by Wrigley have been brought by the Hershey Company (against TinctureBelle for products resembling Reese’s Peanut Butter Cups, Heath bars, Almond Joy bars and York peppermint patties), Mondelez International (against a company hawking Stoney Patch Kids) and Ferrara Candy Company (against a store selling Medicated Nerds Rope). These lawsuits have all been settled, with the smaller companies agreeing to halt production and sales of the offending products.

    Many public health officials fret that without proper regulation, accidental ingestion cases will continue to rise among children as the availability of edibles grows. Some poison control centers have already observed this trend in their data.

    For example, there were 122 cases of exposure to THC for children under 5 in Washington State in the first nine months of 2020, compared to 85 for the same time period in 2019. The most common side effects reported included vomiting, lethargy and chest pain.

    the illegal market is still thriving.

    “When companies like these create headlines for doing what we’ve purposely avoided at Wana, I feel anger and frustration,” said Joe Hodas, the chief marketing officer at Wana Brands, a Colorado company that sells cannabis-infused products.

    A recent review of the websites belonging to defendants in the Wrigley suit turned up cannabis-infused offerings like Stoner Patch Dummies, the Worlds Dankest Gushers, Gasheads Xtremes Sourfuls, Trips Ahoy, Buttafingazzz and Caribo Happy Cola.

    “The situation has become more and more egregious,” said Christopher Gindlesperger, a spokesman for the National Confectioners Association, a trade organization in D.C. with 350 members, including Mars Inc., Hershey’s, Ferrara and Mondelez. “The cannabis companies cannot and should not be allowed to tarnish existing brands at will. It creates consumer confusion.”

    joined the list), and 18 of them, including New York, have legalized recreational marijuana as well. Though sales in New York are not expected to begin until 2022 at the earliest, businesses are rushing to grab real estate and prepare for the market’s opening. Some are already selling Delta-8-THC, derived from hemp, in candy form.

    an infamous commercial spot.

    considered 1 to 2 milligrams of THC, but effects vary based on many factors, like body weight and how much food the consumer ate that day.

    Accidental consumption can affect anyone, but, Dr. Schauer said, “it has primarily impacted children because they can confuse cannabis edible products with other edible products, because most edibles look like candy or cookies or cake.” She pointed to reports compiled by poison control centers in Colorado and Washington, the two earliest states to legalize recreational cannabis use, in 2012.

    Between 2014 and 2018, annual calls to the Washington Poison Center about children under 5 being unintentionally exposed to cannabis nearly tripled, rising from 34 to 94. In 2017, Washington State began requiring that all edibles have a logo stating “Not for Kids” (not that this will mean much to a 2-year-old).

    edibles are the leading method by which children under 5 accidentally consume cannabis. In 2019, in Colorado, 108 people under the age of 19 were accidentally exposed to cannabis. In 2011, the year before the state legalized recreational use, that number was 16.

    Like Washington, Colorado now requires packaging of edibles to include a warning symbol. The state also bans the use of the word “candy” on any marijuana packaging, and the sale of edibles that look like people, animals or fruit.

    Dr. Schauer said other ways to reduce the risks of accidental ingestion include mandating childproof packaging, requiring that each edible item in a package is individually wrapped, limiting the potency of each individual edible, and educating consumers who live with children on how to store their cannabis products.

    Making packages that will not catch the eye of a child is important, she said. In Canada, for example, where cannabis is legal, federal law requires packaging to have a uniform color and a smooth texture, and not to have cutout windows, scents, sounds or inserts (among other requirements).

    Despite the stringency of Canada’s laws, as recently as mid-May, a child was hospitalized in the province of New Brunswick after eating Stoneo cookies that were made to look like Oreos, according to the Canadian Broadcasting Corporation.

    In America, state laws are far less strict; for the most part, they prohibit the inclusion of cartoon characters and make general statements about how the packaging should not appeal to a child.

    “The risks can be much more limited than we’ve seen them be so far,” Dr. Schauer said.

    Mr. Hodas has three children, aged 12, 17 and 19. He has been in the cannabis industry for more than seven years. When he has products at home, he keeps them secure in bags made by StashLogix. It may not slow down a motivated 15-year-old, but it will stop a toddler, he said.

    “If you have it locked up, and you keep in a place where they can’t reach it or see it, that’s the best way to prevent ingestion,” Mr. Hodas said.

    To parents of a certain age, the situation may bring to mind the 1983 public service announcement “We’re Not Candy,” in which a barbershop quartet of singing pills on television advises children “to have a healthy fear of us.”

    That the products now under scrutiny are a form of candy, just enhanced — and that no one is watching the same screen anymore — makes it difficult to imagine a marijuana meme so memorable.

    View Source

    Big Candy Is Angry at Look-Alike THC Treats

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    At first glance, the Skittles package appears to be just like the one sold in the candy aisle of a supermarket: It has block letters filled in with white, a flowing rainbow and a red candy that replaces the dot above the letter “i.”

    A closer look reveals some small differences: a background pattern of small, stylized marijuana leaves; a warning label; and numbers that reveal the amount of THC, the intoxicating substance in cannabis, in each piece of candy.

    The images are included in a lawsuit that the Wm. Wrigley Jr. Company, owned by the candy behemoth Mars Inc., filed in May against five companies for selling cannabis-infused edibles that look like our old friends Skittles, Starburst and Life Savers. Though the suit focuses on intellectual property rights, the plaintiffs also argue that the copycat products could lead people, particularly children, to mistakenly ingest drugs.

    recreational marijuana consumption roamed by pandemic-stressed adults.

    In recent years, lawsuits similar to the one filed by Wrigley have been brought by the Hershey Company (against TinctureBelle for products resembling Reese’s Peanut Butter Cups, Heath bars, Almond Joy bars and York peppermint patties), Mondelez International (against a company hawking Stoney Patch Kids) and Ferrara Candy Company (against a store selling Medicated Nerds Rope). These lawsuits have all been settled, with the smaller companies agreeing to halt production and sales of the offending products.

    Many public health officials fret that without proper regulation, accidental ingestion cases will continue to rise among children as the availability of edibles grows. Some poison control centers have already observed this trend in their data.

    For example, there were 122 cases of exposure to THC for children under 5 in Washington State in the first nine months of 2020, compared to 85 for the same time period in 2019. The most common side effects reported included vomiting, lethargy and chest pain.

    the illegal market is still thriving.

    “When companies like these create headlines for doing what we’ve purposely avoided at Wana, I feel anger and frustration,” said Joe Hodas, the chief marketing officer at Wana Brands, a Colorado company that sells cannabis-infused products.

    A recent review of the websites belonging to defendants in the Wrigley suit turned up cannabis-infused offerings like Stoner Patch Dummies, the Worlds Dankest Gushers, Gasheads Xtremes Sourfuls, Trips Ahoy, Buttafingazzz and Caribo Happy Cola.

    “The situation has become more and more egregious,” said Christopher Gindlesperger, a spokesman for the National Confectioners Association, a trade organization in D.C. with 350 members, including Mars Inc., Hershey’s, Ferrara and Mondelez. “The cannabis companies cannot and should not be allowed to tarnish existing brands at will. It creates consumer confusion.”

    joined the list), and 18 of them, including New York, have legalized recreational marijuana as well. Though sales in New York are not expected to begin until 2022 at the earliest, businesses are rushing to grab real estate and prepare for the market’s opening. Some are already selling Delta-8-THC, derived from hemp, in candy form.

    an infamous commercial spot.

    considered 1 to 2 milligrams of THC, but effects vary based on many factors, like body weight and how much food the consumer ate that day.

    Accidental consumption can affect anyone, but, Dr. Schauer said, “it has primarily impacted children because they can confuse cannabis edible products with other edible products, because most edibles look like candy or cookies or cake.” She pointed to reports compiled by poison control centers in Colorado and Washington, the two earliest states to legalize recreational cannabis use, in 2012.

    Between 2014 and 2018, annual calls to the Washington Poison Center about children under 5 being unintentionally exposed to cannabis nearly tripled, rising from 34 to 94. In 2017, Washington State began requiring that all edibles have a logo stating “Not for Kids” (not that this will mean much to a 2-year-old).

    edibles are the leading method by which children under 5 accidentally consume cannabis. In 2019, in Colorado, 108 people under the age of 19 were accidentally exposed to cannabis. In 2011, the year before the state legalized recreational use, that number was 16.

    Like Washington, Colorado now requires packaging of edibles to include a warning symbol. The state also bans the use of the word “candy” on any marijuana packaging, and the sale of edibles that look like people, animals or fruit.

    Dr. Schauer said other ways to reduce the risks of accidental ingestion include mandating childproof packaging, requiring that each edible item in a package is individually wrapped, limiting the potency of each individual edible, and educating consumers who live with children on how to store their cannabis products.

    Making packages that will not catch the eye of a child is important, she said. In Canada, for example, where cannabis is legal, federal law requires packaging to have a uniform color and a smooth texture, and not to have cutout windows, scents, sounds or inserts (among other requirements).

    Despite the stringency of Canada’s laws, as recently as mid-May, a child was hospitalized in the province of New Brunswick after eating Stoneo cookies that were made to look like Oreos, according to the Canadian Broadcasting Corporation.

    In America, state laws are far less strict; for the most part, they prohibit the inclusion of cartoon characters and make general statements about how the packaging should not appeal to a child.

    “The risks can be much more limited than we’ve seen them be so far,” Dr. Schauer said.

    Mr. Hodas has three children, aged 12, 17 and 19. He has been in the cannabis industry for more than seven years. When he has products at home, he keeps them secure in bags made by StashLogix. It may not slow down a motivated 15-year-old, but it will stop a toddler, he said.

    “If you have it locked up, and you keep in a place where they can’t reach it or see it, that’s the best way to prevent ingestion,” Mr. Hodas said.

    To parents of a certain age, the situation may bring to mind the 1983 public service announcement “We’re Not Candy,” in which a barbershop quartet of singing pills on television advises children “to have a healthy fear of us.”

    That the products now under scrutiny are a form of candy, just enhanced — and that no one is watching the same screen anymore — makes it difficult to imagine a marijuana meme so memorable.

    View Source

    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.

    View Source

    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.

    View Source

    Why the C.D.C. Changed Its Advice on Masks

    Advice from federal health officials that fully vaccinated people could drop their masks in most settings came as a surprise to Americans, from state officials to scientific experts. Even the White House got less than a day’s notice from the Centers for Disease Control and Prevention, the press secretary, Jen Psaki, said at a news briefing on Friday.

    “The C.D.C., the doctors and medical experts there, are the ones who determined what this guidance would be based on their own data, and what the timeline would be,” Ms. Psaki said. “That was not a decision directed by or made by the White House.”

    For months, federal officials have vigorously warned that wearing masks and social distancing were necessary to contain the pandemic. So what changed?

    Introducing the new recommendations on Thursday, Dr. Rochelle P. Walensky, the C.D.C. director, cited two recent scientific findings as significant factors: Few vaccinated people become infected with the virus, and transmission seems rarer still; and the vaccines appear to be effective against all known variants of the coronavirus.

    There is no doubt at this point that the vaccines are powerful. On Friday, the C.D.C. released results from another large study showing that the vaccines made by Pfizer-BioNTech and Moderna are 94 percent effective in preventing symptomatic illness in those who were fully vaccinated, and 82 percent effective even in those only partly vaccinated.

    “The science is quite clear on this,” said Zoë McLaren, a health policy expert at the University of Maryland, Baltimore County. Mounting evidence indicates that people who are vaccinated are highly unlikely to catch or transmit the virus, she noted.

    The risk “is definitely not zero, but it’s clear that it’s very low,” she said.

    One of the lingering concerns among scientists had been that even a vaccinated person might carry the virus — perhaps briefly, without symptoms — and spread it to others. But C.D.C. research, including the new study, has consistently found few infections among those who received the Pfizer-BioNTech and Moderna vaccines.

    “This study, added to the many studies that preceded it, was pivotal to C.D.C. changing its recommendations for those who are fully vaccinated against Covid-19,” Dr. Walensky said in a statement on Friday.

    Other recent studies confirm that people who are infected after vaccination carry too little virus to infect others, said Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai.

    “It’s really hard to even sequence the virus sometimes because there’s very little virus, and it’s there for a short period of time,” he said.

    Still, most of the data has been gathered on the Pfizer-BioNTech and Moderna vaccines, Dr. Krammer cautioned. Because Johnson & Johnson’s vaccine was authorized later, there are fewer studies assessing its effectiveness.

    In clinical trials, the Johnson & Johnson vaccine had 72 percent efficacy — lower than the figure for the Pfizer and Moderna vaccines. And effectiveness was measured in terms of moderate and severe disease, rather than mild disease.

    “It’s a very good vaccine, and I’m sure it will save many, many, many lives,” Dr. Krammer said. “But we need more data on how well the J.&J. vaccine prevents infection, and how well it prevents transmission.”

    Variants of the virus have been a particular worry for scientists. While Dr. Walensky cited evidence showing that the mRNA vaccines like those from Pfizer and Moderna are effective against the variants circulating in the United States, there is little data about variants and the Johnson & Johnson vaccine. And new variants are emerging constantly.

    “I’m not at all saying that this is now a big problem,” Dr. Krammer said. But before lifting the masking requirements, “I might have waited a little bit longer to look at the numbers.”

    In a statement on Friday, a C.D.C. spokesman said, “All of the authorized vaccines provide strong protection against serious illness, hospitalization, and death, and we are accumulating data that our authorized vaccines are effective against the variants that are circulating in this country.”

    Fully immunized people are unlikely to get seriously ill, even if they are infected with the coronavirus. The risk of infection is greater for the people around them — unvaccinated children and adults, or vaccinated people who remain unprotected because of a medical condition or treatment.

    C.D.C. officials said they weighed those factors and were confident in their assessment of the science. And the new advice has other salutary effects, rewarding fully immunized people by giving them permission to end their social isolation — and perhaps incentivizing others to opt for vaccination.

    The new advice “signals that we really are on the final stretch here, and I think that’s a very good thing for people,” said Dr. Joshua Sharfstein, the vice dean for public health practice and community engagement at Johns Hopkins University Bloomberg School of Health.

    “It’s unlikely that we’re going to have another huge surge in cases,” he added. “But will the final stretch last for weeks or months is still a question.”

    The difficulty with the new recommendations, he and other experts said, is not so much the science underpinning them as their implementation.

    Leaders at the state, city and county levels still have the authority to require masks even for vaccinated people, as the C.D.C. was quick to acknowledge on Thursday. After the agency’s announcement, some states instantly lifted mask mandates, while others said they would need more time to weigh the evidence.

    But in states without mask mandates, the onus of checking vaccination status will fall on shopkeepers, restaurant workers, school officials and workplace managers.

    “Without a means to verify vaccination, we will have to rely on an honor system,” said Caitlin Rivers, an epidemiologist at Johns Hopkins University.

    The number of cases in the country is the lowest it has been since September, and many experts support lifting mask mandates in much of the country. But doing so will be riskier in places like Michigan, where there are more cases, and for people who are unprotected, including children under 12 and people with a weak immune systems, Dr. Rivers said.

    “People who are unvaccinated should continue to wear masks in public indoors and avoid crowds,” she said.

    In Nacogdoches, Texas, Dr. Ahammed Hashim fretted that only 36 percent of the population was immunized and the pace seemed to have stalled. And yet only one or two people in 10 in the local shops wore masks.

    “I think the C.D.C. might send a wrong message saying that everything’s OK,” said Dr. Hashim, a pulmonologist. “It would feel much better if we had a 60 or 70 percent vaccination.”

    The C.D.C.’s guidance is intended for fully vaccinated individuals, and should only be interpreted as such, Dr. Sharfstein cautioned. Nationwide, only 36 percent of the population is fully vaccinated.

    “What we’re just seeing is a little bit of the distance between advice that is entirely appropriate for people who are vaccinated, and the reality that there are places that still are seeing viral transmission and a lot of people who aren’t vaccinated,” he said.

    Individuals may make choices based on their perception of their own risks, but state and local leaders must decide what’s best for the community based on the rate of infections. “Those are two different things,” Dr. Sharfstein said. “And when they get conflated, that’s when people may make bad judgments about policy.”

    The new guidelines should serve as a reminder to health officials to step up their outreach and investment to ensure that everyone has access to vaccines, Dr. McLaren said. Parents of children under 12 should continue to urge them to wear masks indoors.

    The C.D.C.’s new policy shifts the onus onto the immunocompromised as well, to protect themselves from unmasked and unvaccinated people.

    “When we make policy, we need to balance the needs and desires of everyone,” Dr. McLaren said. “We could keep masking forever, but there are benefits to getting back to a life that looks more normal.”

    Health officials should emphasize that the situation may yet change, and official recommendations with it, she added: “We really need to practice being good at responding to changing situations.”

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    Vaccinations Rise in the E.U. After a Long, Slow Start

    Vaccinations are picking up pace in the European Union, a stunning turnaround after the bloc’s immunization drive stalled for months.

    On average over the last week, nearly three million doses of the Covid-19 vaccine were being administered each day in the European Union, a group of 27 nations, according to Our World in Data, a University of Oxford database. Adjusted for population, the rate is roughly equivalent to the number of shots given each day in the United States, where demand has been falling.

    The E.U. vaccination campaign, marred by disruptions in supplies of the AstraZeneca and Johnson & Johnson Covid-19 vaccines, pivoted last month to rely heavily on the Pfizer-BioNTech vaccine.

    Last month, Ursula von der Leyen, the European Commission president, said that Pfizer had agreed to an early shipment of doses that she said should likely allow the bloc to reach its goal of inoculating 70 percent of adults by the end of the summer. The European Union is also on the verge of announcing a deal with Pfizer and its German partner BioNTech for 2022 and 2023 that will lock in 1.8 billion doses for boosters, variants and children’s vaccines.

    customer than an investor.

    “I think it is overdue that the E.U. has stepped up their vaccination campaign,” said Beate Kampmann, director of the Vaccine Center at the London School of Hygiene and Tropical Medicine.

    “I think in the context of the rate of deaths we’ve seen and new cases we’ve seen in the E.U., it is absolutely vital that we get the vaccine to people there very, very quickly,” she added.

    The E.U.’s increase underscores the global disparities in vaccination efforts.

    About 83 percent of Covid shots have been given in high- and upper-middle-income countries, while only 0.3 percent of doses have been given in low-income countries. In North America, more than 30 percent of people have received at least one dose, according to Our World in Data. In Europe, the figure is nearly 24 percent. In Africa, it’s slightly more than one percent.

    waiving intellectual property protections for Covid vaccines, which would need approval from the World Trade Organization. And even then, experts warn that pharmaceutical companies around the world would need technological help to make the vaccines and time to ramp up production.

    European leaders like Ms. von der Leyen and President Emmanuel Macron have made it clear they think President Biden should take a different approach, and instead lift export restrictions on vaccines, which the United States has employed to keep most doses for use domestically. “We call upon all vaccine-producing countries to allow export and to avoid measures that disrupt the supply chains,” Ms. von der Leyen said in a speech last week.

    But the matter is not so absolute, said Dr. Thomas Tsai, a professor who researches health policy at Harvard University. “What’s really needed is an all-of-the-above approach,” he said. Waiving patents is a big long-term step, he said, but lifting export bans would provide help sooner.

    “There is a need to move toward a more comprehensive strategy” in vaccinating the world, Dr. Tsai said. “We need that same sort of Warp Speed type of commitment. It’s an investment.”

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    China’s Sinopharm Vaccine Approved for Emergency Use By W.H.O.

    Developing countries racing for coronavirus vaccines now have another dependable option — and China’s reputation as a rising scientific superpower just got a big boost.

    The World Health Organization on Friday declared a vaccine made by a Chinese company, Sinopharm, as a safe and reliable way to fight the virus. The declaration marks a significant step toward clearing up doubts about the vaccine, after little late-phase clinical trial data was disclosed by the Chinese government and the company.

    The W.H.O. emergency use approval allows the Sinopharm vaccine to be included in Covax, a global initiative to provide free vaccines to poor countries. The possible inclusion in Covax raises hopes that more people — especially those in developing nations — will get access to shots at a crucial moment.

    Rich countries are hoarding doses of vaccines. India, a major vaccine maker, has stopped exports to address its worsening coronavirus crisis. Safety concerns led health authorities in some countries to temporarily pause the use of vaccines made by AstraZeneca and Johnson & Johnson.

    vaccination campaign got off to a slow start, in part because the government prioritized exports and residents did not feel rushed to get vaccinated. The country is now speeding up its national vaccination campaign and aims to inoculate 40 percent of its 1.4 billion people by the end of June.

    published the data this week.

    78.1 percent, according to the W.H.O. advisory group. The Sinovac vaccine has varying efficacy rates of between 50 percent to 84 percent, depending on the country where Phase 3 trials were conducted. Both vaccines were made using a tried-and-tested technology that involves weakening or killing a virus with chemicals.

    The advisory group’s data showed that it had a “high level of confidence” that the Sinopharm vaccine worked in preventing Covid-19 in adults, but a “low level” of confidence for people over 60. The group’s findings were similar for the Sinovac vaccine.

    The W.H.O. said that because Sinopharm enrolled few adults above 60 years old in its trials, the health agency could not estimate the vaccine efficacy for this group. But the W.H.O. said it would not restrict the use of the vaccine in that age group because preliminary data suggests “the vaccine is likely to have a protective effect in older persons.”

    There is limited data on how well the vaccine will work against the many coronavirus variants cropping up around the world. Chinese vaccines are overall less effective than the inoculations produced by Pfizer-BioNTech and Moderna.

    But for China’s leaders, the W.H.O. approval can still be seen as a badge of honor. Xi Jinping, China’s top leader, has pledged to make a Covid-19 vaccine a “global public good.”

    After India announced export restrictions on vaccines last month, Indonesia and the Philippines said they would turn to China for help. Last week, China’s foreign minister offered to help South Asian nations get access to vaccines.

    Indonesia said it would get additional doses from Sinovac after President Joko Widodo held talks with Mr. Xi. In a speech the same week, President Rodrigo Duterte of the Philippines said he owed “a debt of gratitude” to China for its vaccines.

    It remains to be seen whether the W.H.O. approval will change Beijing’s approach to doling out vaccines. China has given only 10 million doses to Covax, though it has independently donated 16.5 million doses and sold 691 million doses to 84 countries, according to Bridge Consulting. Many of the donations were made to developing nations in Africa and Asia.

    “They don’t like to subsume their generosity in their products under some U.N. brand,” said J. Stephen Morrison, director of the global health policy center at the Center for Strategic and International Studies. “They are in a historic phase,” he said. “They want the recipients to know that this is China delivering.”

    Jason Gutierrez contributed reporting. Elsie Chen contributed reporting and research.

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    Pfizer Reaps Hundreds of Millions in Profits From Covid Vaccine

    The pricing for the United States was in line with the cost of seasonal flu vaccines and much less expensive than vaccines for conditions like shingles, which can run into several hundred dollars.

    “That price point does not seem offensive, even if you don’t spend a lot of time thinking about prescription drugs,” said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University Medical Center. “Just thinking about any prescription you’d fill, you’d be hard-pressed to find pretty much anything for $20.”

    But the fact that Pfizer appears to have earned something like $900 million in pretax profits from its vaccine — coupled with its comparatively small sales to poor countries — suggests that profits have trumped other considerations. That could undercut the company’s embrace of loftier principles.

    “At Pfizer, we believe that every person deserves to be seen, heard and cared for,” the chief executive, Albert Bourla, said in January as the company announced it would join Covax. “We share the mission of Covax and are proud to work together so that developing countries have the same access as the rest of the world.”

    But the company seems to have prioritized higher-priced sales.

    “Despite all the talk about Covax, they have been far more interested in bilateral deals, because that’s where they make their money,” said Richard Kozul-Wright, director of the division on globalization and development strategies at the United Nations Conference on Trade and Development in Geneva. “It’s one of the great public relations triumphs of recent corporate history.”

    Multiple factors explain the inequitable nature of Pfizer’s vaccine distribution.

    The shot, which must be stored and transported at very low temperatures, is less practical for hard-to-reach parts of the world than other shots, like those from AstraZeneca and Johnson & Johnson, that can simply be refrigerated. Some poor countries were initially not hit hard by the virus, and so their governments had less urgency to place orders for the Pfizer vaccine, to the extent that they could afford to pay for the shots.

    “Not everyone was interested in the vaccine or prepared to take steps; thus, conversations continue, including working with Covax beyond their initial order of 40 million doses,” said Ms. Castillo, the Pfizer spokeswoman.

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    Vaccinated Tourists Could Soon Be Allowed to Visit Again, E.U. Says

    BRUSSELS — The European Union took a crucial step on Monday toward reopening its borders to vaccinated travelers after the bloc’s executive released a plan for allowing journeys to resume after more than a year of stringent coronavirus restrictions.

    The European Commission, the executive branch of the European Union, proposed that the 27 member countries reopen their borders to all travelers who have been fully vaccinated with shots approved by the bloc’s medicine regulator or by the World Health Organization. The commission also outlined other, looser, pandemic-related conditions that should permit people to travel.

    The proposal would see more regular travel to the bloc gradually restart in time for the summer tourism season, which provides economic lifeblood for several member states. The plans are an important moment in Europe’s efforts to return to a semblance of normalcy after more than a year of strict limitations.

    Travel from outside the bloc was halted almost entirely last spring and only restored tentatively for a handful of exceptions last summer. The measures separated families, hobbled the tourism and aviation sectors and brought business travel to an almost total halt.

    interview with The New York Times last month, during which she said that vaccinated Americans should be able to visit Europe this summer. The detailed proposal laid out on Monday also confirmed Ms. von der Leyen’s earlier statements about the important role that the mutual recognition of vaccination certificates will play in resuming international travel.

    To pass, the proposal released on Monday will require the backing of a reinforced majority of member states, which it is likely to receive late this month or in early June. Still, individual member countries retain a good deal of sovereignty around health policy, so each state will probably use that leeway to tailor the travel measures further.

    For example, some countries that greatly depend on visitors for income and jobs, such as Greece and Spain, have already moved to reopen borders even before the European Union adopts any new, bloc-wide policy. Others, especially in the continent’s north, could maintain more stringent regulations because they don’t stand to gain as much from loosened travel rules for the summer.

    Given those likely differences, the commission’s proposal comes in part to prevent a totally uncoordinated approach to travelers from outside the bloc.

    “digital green pass” for inoculated citizens (and has contracted companies including the logistics giant SAP to digitize vaccine cards), the United States and other countries are further behind and as yet do not offer uniform, verifiable vaccine certificates. The European Union and the United States have been involved in technical discussions on how to ensure American certificates are verifiable and acceptable in the bloc, officials said.

    Addressing some major questions that aspiring visitors have raised in recent weeks, the commission said that children would not need to be vaccinated to travel to the bloc but that they could be required to show a negative test.

    British visitors to the European Union, a big pool of tourists, could be counted among those able to travel more freely given the fast advancement of vaccination there. But the European Union is not yet in touch with British officials over the question of mutually recognizable vaccine certification, officials said.

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