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In Romania, Hard-Hit by Covid, Doctors Fight Vaccine Refusal

COPACENI, Romania — As a new wave of the coronavirus pandemic crashed over Eastern Europe last month, devastating unvaccinated populations, an Orthodox Church bishop in southern Romania offered solace to his flock: “Don’t be fooled by what you see on TV — don’t be scared of Covid.”

Most important, Bishop Ambrose of Giurgiu told worshipers in this small Romanian town on Oct. 14, “don’t rush to get vaccinated.”

The bishop is now under criminal investigation by the police for spreading dangerous disinformation, but his anti-vaccine clarion call, echoed by prominent politicians, influential voices on the internet and many others, helps explain why Romania has in recent weeks reported the world’s highest per capita death rate from Covid-19.

On Tuesday, nearly 600 Romanians died, the most during the pandemic. The country’s death rate relative to population is almost seven times as high as the United States’, and almost 17 times as high as Germany’s.

Europe’s second-lowest vaccination rate; around 44 percent of adults have had at least one dose, ahead of only Bulgaria, at 29 percent. Overall, the European Union stands at 81 percent, with several countries above 90 percent. Complicating matters, Romania has been without a government since last month, when a centrist coalition unraveled.

some form of a vaccine requirement. Here’s a closer look.

As she spoke, a 66-year-old Covid patient, Nicu Paul, gasped for breath on a bed nearby. His wife, Maria, also suffering severe pulmonary problems from Covid, lay in the next bed. Mr. Paul said he had worked for 40 years as an ambulance driver and never gotten sick — “God saved me,” he said — so he decided against vaccination because “there are so many rumors about the vaccine that I did not know what to believe.”

Romania began vaccinating its citizens last December and put the program under the military, the country’s most respected institution, according to opinion polls. The second most trusted institution, however, is the Orthodox church, which has sent mixed signals on vaccines, with Patriarch Daniel in Bucharest telling people to make up their own minds and listen to doctors, while many local clerics and some influential bishops denounced vaccines as the Devil’s work.

Colonel Ghorghita said he had been shocked and mystified by the reach of anti-vaccination sentiment. “They really believe that vaccines are not the proper way to stop Covid,” he said, adding that this was despite the fact that “more than 90 percent of deaths are unvaccinated people.” Old people, the most vulnerable demographic, have been the hardest to convince, he said, with only 25 percent of people over 80 vaccinated.

In central Bucharest, huge signs display photographs of gravely ill patients in hospitals as part of a campaign to jolt people back to reality. “They are suffocating. They beg. They regret,” reads a caption.

Dr. Streinu-Cercel said she was uneasy with trying to reach people by scaring them. “We should be talking about science, not fear,” she said, but “fear is the only thing that got the attention of the general population.”

Distrust of just about everyone and everything is so deep, she said, that some of her patients “are gasping for breath but tell me that Covid does not exist.”

“It is very difficult when so many people are denying all reality,” she added.

At a vaccination center at her hospital, only a trickle of people pass through most days, though vaccines are free and increasingly necessary following new rules requiring vaccination certificates to enter many public buildings.

One of those getting vaccinated was Norica Gheorghe, 82. She said she had held off for months on getting a shot but decided to go ahead this past week after seeing reports that nearly 600 had died in one day. “My hair stood on end when I saw this number, and I decided that I should get vaccinated,” she said.

At the start of the pandemic in 2020, Covid disinformation in Romania mostly followed themes that found traction in many other countries, according to Alina Bargaoanu, a Bucharest communications professor who tracks disinformation, with people spreading wild conspiracy theories under fake names on Facebook and other social media.

But as the pandemic dragged on, she added, this largely fake virtual phenomenon morphed into a political movement driven by real people like Diana Sosoaca, an elected member of Romania’s upper house of Parliament. Ms. Sosoaca led a protest in the north of the country that blocked the opening of a vaccination center, denouncing the pandemic as “the biggest lie of the century,” and organized anti-mask rallies in Bucharest. Videos of her antics have attracted millions of views.

Ms. Bargaoanu, the disinformation researcher, said she suspected a Russian hand in spreading alarm over vaccines, but conceded that many of the most popular anti-vaccination conspiracy theories originate in the United States, making them particularly hard to debunk because “Romania is a very pro-American country.”

Colonel Ghorghita has taken to social media to rebut the more outlandish falsehoods, and also met with Christian, Jewish and Muslim leaders to ask them not to fan the flames of disinformation. “They don’t have a duty to recommend vaccination but they do have a duty not to recommend against it,” he said.

The Orthodox church is particularly important because of its strong influence in rural areas, where vaccination rates are half those in cities like Bucharest, where more than 80 percent of adults have received at least one shot.

In Copaceni, a rural county south of Bucharest, workers at a small clinic offering vaccines said they were appalled by Bishop Ambrose’s anti-vaccine tirades.

“I am fighting to get people vaccinated every day, and then he comes along and tells them not to bother,” said Balota Hajnalka, a doctor running the clinic.

Boryana Dzhambazova contributed reporting from Sofia, Bulgaria, and Anton Troianovski from Moscow.

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Why China Is the World’s Last ‘Zero Covid’ Holdout

The trip began in Shanghai, where the couple, both former professors, joined a tour group of other retirees. They traveled through Gansu Province and Inner Mongolia, staying at a bed-and-breakfast and eating three times at the same lamb chop restaurant. Flying south to Xi’an, they dropped into a 1,300-year-old temple. Their fellow tour group members checked out an art museum, strolled through parks and visited friends.

Then, on Oct. 16, the day they had planned to visit the Terracotta Warriors, the couple tested positive for the coronavirus.

Since then, China has locked down a city of 4 million, as well as several smaller cities and parts of Beijing, to contain a fresh outbreak that has infected more than 240 people in at least 11 provinces and regions. The authorities have shuttered schools and tourist sites. Government websites have detailed every movement of the unlucky couple and their sprawling web of contacts, including what time they checked into hotels and on which floors of restaurants they sat.

The no-holds-barred response is emblematic of China’s “zero Covid” policy, which has served the country remarkably well: China has reported fewer than 5,000 deaths since the pandemic began. The scale of the new outbreak, while tiny compared to many other countries, is large for China.

Lynette Ong, a political scientist at the University of Toronto. “At a huge cost, though.”

at-times strident nationalism.

Other countries that adopted “zero Covid” policies were hailed as models of competent governance that prioritized saving lives over convenience and economic growth.

As the virus has dragged into its second year, and with the onset of the far more contagious Delta variant, countries are again reconsidering their strategies. Australia, which was home to the world’s longest lockdown, is scrapping quarantine requirements for vaccinated residents returning from overseas. New Zealand formally abandoned its quest for zero this month. Singapore is offering quarantine-free travel to vaccinated tourists from Germany, the United States, France and several other countries.

attacked viciously online as a lackey of foreigners. A former Chinese health minister called such a mindset reckless.

Zhang Jun, an urban studies scholar at the City University of Hong Kong.

In addition, though China has achieved a relatively high full inoculation rate, at 75 percent of its population, questions have emerged about the efficacy of its homegrown vaccines.

And, at least for now, the elimination strategy appears to enjoy public support. While residents in locked-down areas have complained about seemingly arbitrary or overly harsh restrictions on social media, travel is relatively unconstrained in areas without cases. Wealthy consumers have poured money into luxury goods and fancy cars since they’re not spending on trips abroad.

reinstated them in September amid a spike in infections. (Still, the government is moving forward with travel lanes.)

But experts agree that the costs of expecting zero cases will hit eventually. China’s economic growth is slowing, and domestic travel during a weeklong holiday earlier this month fell below last year’s levels, as a cluster of new cases spooked tourists. Retail sales have proven fitful, recovering and ebbing with waves of the virus.

The country may also suffer diplomatically. Mr. Xi has not left China or received foreign visitors since early 2020, even as other world leaders prepare to gather in Rome for a Group of 20 summit and Glasgow for climate talks.

China’s hard-nosed approach is also trickling down to Hong Kong, the semi-autonomous territory and global financial hub. In trying to align their own Covid prevention policies with the mainland’s, Hong Kong’s leaders have introduced the world’s longest quarantine, ignoring escalating warnings from business leaders about an exodus of foreign firms.

said in a recent interview with Chinese media that once the country reached an 85 percent vaccination rate, “why shouldn’t we open up?”

Until then, those stranded by the lockdowns have been trying to make the best of their situations. State news outlets have reported that roughly 10,000 tourists are trapped in Ejin Banner, a region of Inner Mongolia, after the emergence of cases led to a lockdown. As consolation, the local tourism association has promised them free entry to three popular tourist attractions, redeemable within the next three years.

Liu Yi and Joy Dong contributed research.

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New Zealand Wants a 90% Vaccination Rate. Its Street Gangs May Hold the Key.

AUCKLAND, New Zealand — Rawiri Jansen, a Maori doctor, had an urgent message for the 150 people, mostly patch-wearing members of New Zealand’s plentiful street gangs and their families, who sat before him on a bright Saturday afternoon.

Covid is coming for them, he said. Cases in New Zealand’s hospitals are rising rapidly. Soon, dozens of new infections a day might be hundreds or even a thousand. People will die. And vaccination is the only defense. “When your doctors are scared, you should be scared,” he said.

By the end of the day, after an exhaustive question-and-answer session with other health professionals, roughly a third of those present chose to receive a dose then and there.

Having abandoned its highly successful “Covid-zero” elimination strategy in response to an outbreak of the Delta variant, New Zealand is now undergoing a difficult transition to trying to keep coronavirus cases as low as possible. On Friday, the country set a target of getting at least 90 percent of the eligible population fully vaccinated — a goal, the highest in the developed world, whose success hinges on persuading people like those who gathered to hear Dr. Jansen.

intensely criticized, including by police leaders.

Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines. Pfizer and Moderna recipients who are eligible for a booster include people 65 and older, and younger adults at high risk of severe Covid-19 because of medical conditions or where they work. Eligible Pfizer and Moderna recipients can get a booster at least six months after their second dose. All Johnson & Johnson recipients will be eligible for a second shot at least two months after the first.

Yes. The F.D.A. has updated its authorizations to allow medical providers to boost people with a different vaccine than the one they initially received, a strategy known as “mix and match.” Whether you received Moderna, Johnson & Johnson or Pfizer-BioNTech, you may receive a booster of any other vaccine. Regulators have not recommended any one vaccine over another as a booster. They have also remained silent on whether it is preferable to stick with the same vaccine when possible.

The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.

The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.

Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.

Chris Hipkins, the minister responsible for New Zealand’s Covid-19 response, acknowledged earlier this month that the decision to enlist gang leaders was an unusual one.

“Our No. 1 priority here is to stop Covid-19 in its tracks, and that means doing what we need to do to get in front of the virus,” he said. “Where we have been able to enlist gang leaders to help with that, and where they have been willing to do so, we have done that.”

Some gang leaders have acted independently to help the vaccination effort. They have connected members of their community to health officials, organized events with health professionals like Dr. Jansen, and streamed events on Facebook Live to allow an open forum for questions about rare health risks. In some cases, they have taken vaccines to communities themselves.

“Our community is probably less well informed; they’re probably not as health literate,” said Mr. Tam, the Mongrel Mob member, who is a former civil servant and who received the border exemption. Constant media criticism has turned them off from reading traditional news outlets, he added.

“They then resort to social media, because they have much greater control,” he said. “It’s also a space that perpetuates conspiracy theories and false information and all the rest of it.” Health advice has to come from trusted individuals and leaders in the community, he said.

In the past week, Mr. Tam has traveled almost the length of the country organizing pop-up vaccination events for members and their communities, as well as coordinating with other chapter leaders to get their members vaccinated, he said.

It was difficult work that put him at personal risk, he said, and that invited intense skepticism from people who thought of gangs only as violent or connected to organized crime.

“Why do we bother?” Mr. Tam said. “We bother because we care about those people that others don’t care about, as simple as that. They can talk about my gang affiliation, all the rest of it. But it’s that affiliation that allows me to have that penetration, that foot in the door. I can do the stuff that they can’t do.”

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Singapore Struggles to Reopen After Vaccinations

The country’s experience has become a sobering case study for other nations pursuing reopening strategies without first having had to deal with large outbreaks in the pandemic. For the Singapore residents who believed the city-state would reopen once the vaccination rate reached a certain level, there was a feeling of whiplash and nagging questions about what it would take to reopen if vaccines were not enough.

“In a way, we are a victim of our own success, because we’ve achieved as close to zero Covid as we can get and a very, very low death rate,” said Dr. Paul Tambyah, an infectious diseases specialist at National University Hospital. “So we want to keep the position at the top of the class, and it’s very hard to do.”

vaccinated people are already gathering at concerts, festivals and other large events. But unlike Singapore, both of those places had to manage substantial outbreaks early in the pandemic.

Lawrence Wong, Singapore’s finance minister and a chair of the country’s Covid-19 task force, said the lesson for “Covid-naive societies” like Singapore, New Zealand and Australia is to be ready for large waves of infections, “regardless of the vaccine coverage.”

up against the Delta variant, Mr. Wong said.

“In Singapore, we think that you cannot just rely on vaccines alone during this intermediate phase,” he said. “And that’s why we do not plan an approach where we reopen in a big bang manner, and just declare freedom.”

highest since 2012, a trend that some mental health experts have attributed to the pandemic. People have called on the government to consider the mental health concerns caused by the restrictions.

“It’s just economically, sociologically, emotionally and mentally unsustainable,” said Devadas Krishnadas, chief executive at Future-Moves Group, a consultancy in Singapore. Mr. Krishnadas said the decision to reintroduce restrictions after reaching such a high vaccination rate made the country a global outlier.

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.”

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    Inside United Airlines’ Decision to Mandate Coronavirus Vaccines

    Scott Kirby, the chief executive of United Airlines, reached a breaking point while vacationing in Croatia this summer: After receiving word that a 57-year-old United pilot had died after contracting the coronavirus, he felt it was time to require all employees to get vaccinated.

    He paced for about half an hour and then called two of his top executives. “We concluded enough is enough,” Mr. Kirby said in an interview on Thursday. “People are dying, and we can do something to stop that with United Airlines.”

    The company announced its vaccine mandate days later, kicking off a two-month process that ended last Monday. Mr. Kirby’s team had guessed that no more than 70 percent of the airline’s workers were already vaccinated, and the requirement helped convince most of the rest: Nearly all of United’s 67,000 U.S. employees have been vaccinated, in one of the largest and most successful corporate efforts of the kind during the pandemic.

    The key to United’s success, even in states where vaccination rates are at or below the national average, like Texas and Florida, was a gradual effort that started with providing incentives and getting buy-in from employee groups, especially unions, which represent a majority of its workers.

    praise from President Biden, who weeks later announced that regulators would require all businesses with 100 or more workers to require vaccinations or conduct weekly virus testing. And the company drew scorn from conservatives.

    Other mandates are producing results, too. Tyson Foods, which announced its vaccine requirement just days before United but has provided workers more time to comply, said on Thursday that 91 percent of its 120,000 U.S. employees had been vaccinated. Similar policies for health care workers by California and hospitals have also been effective.

    charge its unvaccinated employees an additional $200 per month for health insurance.

    United had been laying the groundwork for a vaccine mandate for at least a year. The airline already had experience requiring vaccines. It has mandated a yellow fever vaccination for flight crews based at Dulles International Airport, near Washington, because of a route to Ghana, whose government requires it.

    In January, at a virtual meeting, Mr. Kirby told employees that he favored a coronavirus vaccine mandate.

    Writing letters to families of the employees who had died from the virus was “the worst thing that I believe I will ever do in my career,” he said at the time, according to a transcript. But while requiring vaccination was “the right thing to do,” United would not be able to act alone, he said.

    The union representing flight attendants pushed the company to focus first on access and incentives. It argued that many flight attendants couldn’t get vaccinated because they were not yet eligible in certain states.

    Mr. Kirby acknowledged that widespread access would be a precondition. The airline and unions worked together to set up clinics for staff in cities where it has hubs like Houston, Chicago and Newark.

    was calling on all employers to do so. A mandate would strike workers as unfair and create unnecessary conflict, the flight attendants’ union argued.

    “The more people you get to take action on their own, the more you can focus on reaching the remaining people before any knock-down, drag-out scenario,” said Sara Nelson, the president of the Association of Flight Attendants, which represents more than 23,000 active workers at United.

    In May, the pilots reached an agreement that would give them extra pay for getting vaccinated and the flight attendants worked toward an agreement that would give them extra vacation days. Both incentives declined in value over time and typically expired by early July.

    vaccinated by Oct. 25 or within five weeks of a vaccine’s formal approval by the Food and Drug Administration, whichever came first. The timing was intended to ensure that the airline had adequate staffing for holiday travel, said Kate Gebo, who heads human resources.

    This time, the unions were more resigned.

    “For those 92 percent of pilots who wanted to be vaccinated, we captured $45 million in cash incentives,” said Captain Insler, whose union is challenging the decision to fire employees who don’t comply. “For those who did not want to be vaccinated, we were able to hold off a mandate for several months.”

    The success of the incentives — about 80 percent of United’s flight attendants were also vaccinated by the time the airline announced its mandate in August — inspired the company to expand them to all employees, offering a full day’s pay to anyone who provided proof of vaccination by Sept. 20.

    The company hadn’t surveyed its workers, but estimated that 60 to 70 percent were already vaccinated. Getting the rest there wouldn’t be easy.

    Margaret Applegate, 57, a 29-year United employee who works as a services representative in the United Club at San Francisco International Airport, helps illustrate why.

    Ms. Applegate normally does not hesitate to get vaccines, noting that her late father was a doctor and that her daughter does research in nutritional science.

    Her daughter urged her to get vaccinated, but she remained deeply ambivalent. Friends and co-workers “were feeding me stories about horrible things happening to people with the vaccine,” she said. She worried about the relatively new technology behind the Pfizer and Moderna vaccines, and whether her heart condition could pose complications, though her cardiologist assured her it wouldn’t.

    six employees sued United, arguing that its plans to put exempt employees on temporary leave — unpaid in many circumstances — are discriminatory. United has delayed that plan for at least a few weeks as it fights the suit.

    Still, United’s vaccination rate has continued to improve. There was another rush before the deadline to receive the pay incentive and one more before the final Sept. 27 deadline. Toward the end of September, the company said 593 people had failed to comply. By Friday, the number had dropped below 240.

    “I did not appreciate the intensity of support for a vaccine mandate that existed, because you hear that loud anti-vax voice a lot more than you hear the people that want it,” Mr. Kirby said. “But there are more of them. And they’re just as intense.”

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    Canada Election 2021: Justin Trudeau Projected to Remain Prime Minister

    OTTAWA — Prime Minister Justin Trudeau’s political gamble failed to pay off Monday when Canadian voters returned him to office but denied him the expanded bloc of power he was seeking in Parliament.

    Election returns late on Monday showed that while he would remain prime minister, it will again be as the head of a minority government, Canadian broadcasters projected.

    In August, with his approval ratings high, Mr. Trudeau called a “snap election,” summoning voters to the polls two years before he had to. The goal, he said, was to obtain a strong mandate for his Liberal Party to lead the nation out of the pandemic and into recovery.

    But many Canadians suspected that his true ambitions were mere political opportunism, and that he was trying to regain the parliamentary majority the Liberals had until they lost seats in the 2019 election.

    Mr. O’Toole, seeking to broaden Conservatives’ appeal, produced a 160-page campaign platform that essentially turned the party’s back on many once-central positions, like opposition to carbon taxes.

    Mr. Trudeau broke ethics laws when he and his staff pressured his justice minister, an Indigenous woman, in 2018 to offer a large Canadian engineering firm a deal allowing it to avoid a criminal conviction on corruption charges. Last year a charity with close ties to the Trudeau family was awarded a no-bid contract to administer a Covid-19 financial assistance plan for students. The group withdrew, the program was canceled and Mr. Trudeau was cleared of conflict of interest allegations.

    And while Mr. Trudeau champions diversity and racial justice, it came out during the 2019 vote that he had worn blackface or brownface at least three times in the past.

    “Every Canadian has met a Justin Trudeau in their lives — privileged, entitled and always looking out for No. 1,” Mr. O’Toole said during the campaign. “He’ll say anything to get elected, regardless of the damage it does to our country.”

    Mr. Trudeau returned the criticism, saying Mr. O’Toole’s willingness to ditch Conservative policies and alter his platform mid-campaign showed it was he who would say or promise anything to voters.

    While many voters eagerly bumped elbows and posed for selfies with Mr. Trudeau at campaign stops, his campaign was often disturbed by unruly mobs protesting mandatory vaccines and vaccine passports. One event was canceled out of safety concerns, and Mr. Trudeau was pelted with gravel at another.

    Mr. Trudeau did have a strong political challenger on the left nationally with Jagmeet Singh of the New Democrats. Mr. Singh, a lawyer and former provincial lawmaker from Ontario, consistently had the highest approval ratings of all the leaders before and during the campaign. But personal popularity was not enough: His party gained three seats but won only a total of 27.

    As before the election, the New Democrats are likely to be Mr. Trudeau’s primary source of support in Parliament.

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    A Million Afghan Children Could Die in ‘Most Perilous Hour,’ U.N. Warns

    Millions of Afghans could run out of food before the arrival of winter and one million children are at risk of starvation and death if their immediate needs are not met, top United Nations officials warned on Monday, putting the country’s plight into stark relief.

    Secretary General António Guterres, speaking at a high-level U.N. conference in Geneva convened to address the crisis, said that since the Taliban takeover in Afghanistan last month, the nation’s poverty rate has soared and basic public services have neared collapse and, in the past year, hundreds of thousands of people have been made homeless after being forced to flee fighting.

    “After decades of war, suffering and insecurity, they face perhaps their most perilous hour,” Mr. Guterres said, adding that one in three Afghans do not know where they will get their next meal.

    The deepening humanitarian crisis tops a dizzying array of challenges confronting the new Taliban regime as it navigates governing a country propped up for decades by aid from international donors.

    face potential collapse. At a local hospital in Chak-e Wardak, administrators have been unable to pay salaries or purchase new medicines with banks still closed, according to Faridullah, the facility’s resident doctor.

    as drought enveloped the nation.

    On Monday, in his first public remarks to Congress, Secretary of State Antony J. Blinken defended the Biden administration’s withdrawal from Afghanistan, saying there was no reason to believe the country would have stabilized had the United States remained.

    “There’s no evidence that staying longer would have made the Afghan security forces or the Afghan government any more resilient or self-sustaining,” Mr. Blinken told the House Foreign Affairs Committee, in a live teleconference call. “If 20 years and hundreds of billions of dollars in support, equipment, and training did not suffice, why would another year, or five, or 10, make a difference?”

    international aid workers having fled the country out of safety concerns. Those who remain are unsure if they will be able to continue their work.

    During the conference on Monday, the U.N. said it needed $606 million in emergency funding to address the immediate crisis, while acknowledging that money alone will not be enough. The organization has pressed the Taliban to provide assurances that aid workers can go about their business safely. By the end of the gathering, international pledges had surpassed the amount requested.

    But even as the Taliban sought to make that pledge, the U.N.’s human rights chief, Michelle Bachelet, also speaking in Geneva, said Afghanistan was in a “new and perilous phase” since the militant Islamist group seized power.

    “In contradiction to assurances that the Taliban would uphold women’s rights, over the past three weeks, women have instead been progressively excluded from the public sphere,” she said, a warning that the Taliban would need to use more than words to demonstrate their commitment to aid workers’ safety.

    Monday’s conference was also intended to drive home the enormousness of the crisis and offer some reassurance to Western governments hesitant to provide assistance that could legitimize the authority of a Taliban government that includes leaders identified by the U.N. as international terrorists with links to Al Qaeda.

    their origin story and their record as rulers.

    On Sunday, Taliban authorities sent assurances that they would facilitate humanitarian aid deliveries by road, he said.

    some $12 billion in assistance to Afghanistan over four years.

    While the Taliban did not have a representative in Geneva for the meeting, Zabihullah Mujahid, the Taliban’s deputy information and culture minister, said the government welcomed all humanitarian efforts by any nation, including the United States.

    He also acknowledged that not even the Taliban expected to be in control of the country so quickly.

    “It was a surprise for us how the former administration abandoned the government,” he said. “We were not fully prepared for that and are still trying to figure things out to manage the crisis and try to help people in any way possible.”

    More than half a million Afghans were driven from their homes by fighting and insecurity this year, bringing the total number of people displaced within the country to 3.5 million, Filippo Grandi, the U.N. refugee chief said.

    The danger of economic collapse raised the possibility of stoking an outflow of refugees to neighboring countries.

    Said, 33, lived in Kunduz before fleeing to Kabul, where he now lives in a tent in a park. He has been there with his wife and three children for a month.

    “It’s cold here, we have no food, no shelter, and we can’t find a job in this city,” he said, adding that he had not received any aid. “We all have children and they need food and shelter, and it’s not easy to live here.”

    Jim Huylebroek contributed reporting from Chak-e Wardak, Afghanistan. Sami Sahak also contributed reporting.

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