Tigrayan fighters had marched into the regional capital, Mekelle, hours after beleaguered Ethiopian soldiers quit the city. The city airport was shut, so the only way out of Tigray was on a slow-moving U.N. convoy that took the same desolate route out as the fleeing Ethiopian soldiers.

We drove down a rocky escarpment on a road scarred by tank tracks. As we descended into the plains of Afar, the temperature quickly rose.

publicized the flight but made no mention of the delays or harassment — an omission that privately angered several U.N. officials and other aid workers who said it followed a pattern of U.N. agencies being unwilling to publicly criticize the Ethiopian authorities.

Further complicating the aid effort: The war is now spilling into Afar.

In the past week Tigrayan forces have pushed into the region. In response Mr. Abiy mobilized ethnic militias from other regions to counter the offensive.

Mr. Abiy has also resorted to increasingly inflammatory language — referring to Tigrayan leaders as “cancer” and “weeds” in need of removal — that foreign officials view as a possible tinder for a new wave of ethnic violence across the country.

Ms. Billene, his spokeswoman, dismissed those fears as “alarmist.” The Ethiopian leader had “clearly been referring to a terrorist organization and not the people of Tigray,” she said.

Inside Tigray, the most pressing priority is to reopen the road to Afar.

“This is a desperate, desperate situation,” said Lorraine Sweeney of Support Africa Foundation, a charity that shelters about 100 pregnant women displaced by fighting in the Tigrayan city of Adigrat.

Ms. Sweeney, who is based in Ireland, said she had fielded calls from panicked staff members appealing for help to feed the women, all of whom are at least eight months pregnant.

“It brings me back to famine times in Ireland,” Ms. Sweeney said. “This is crazy stuff in this day and age.”

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Famine Looms in Ethiopia’s War-Ravaged Tigray Region, U.N. Says

Famine is now knocking on the door of Ethiopia’s Tigray region, where a civil war that erupted last year has drastically cut the food supply and prevented relief workers from helping the hungry, the top U.N. humanitarian official has warned.

In a confidential note to the United Nations Security Council, the official, Mark Lowcock, the under secretary general for humanitarian affairs, said sections of Tigray, a region of more than 5 million people, are now one step from famine — in part because the government has obstructed aid shipments.

The note, seen by The New York Times, was submitted Tuesday under a Security Council resolution requiring such notification when conflicts cause famine and widespread food insecurity.

“These circumstances now arise in the Tigray region of Northern Ethiopia,” Mr. Lowcock said in the note. While below-average rain, locusts and the Covid-19 pandemic have all contributed to food scarcity, he said, “the scale of the food crisis Tigray faces today is a clear result of the conflict and the behavior of the parties.”

since last November. Prime Minister Abiy Ahmed and neighboring Eritrea ordered their military forces into the region to crush Mr. Abiy’s political rivals and strengthen his control.

What Mr. Abiy, a Nobel Peace Prize laureate, predicted would be a short operation has instead become a quagmire that threatens to destabilize the Horn of Africa. Ethiopian and Eritrean troops have been accused of ethnic cleansing, massacres and others atrocities in Tigray that amount to war crimes.

While the United Nations and international relief organizations have achieved some cooperation from the Ethiopian authorities in gaining access to deprived areas of Tigray, Mr. Lowcock said in his note, such cooperation has deteriorated in recent months. “Humanitarian operations are being attacked, obstructed or delayed in delivering lifesaving assistance,” he wrote, and at least eight aid workers have been killed.

“As a result of impediments and the effect of restrictions, not nearly enough support is being provided,” he wrote. He urged Security Council members “to take any steps possible to prevent a famine from occurring.”

His warning was echoed by Samantha Power, the administrator of the United States Agency for International Development, the main U.S. government provider of humanitarian assistance to needy countries. Ms. Power, a former American ambassador to the United Nations, said in a statement that one of the aid workers killed had worked for the agency she now runs.

took the unusual step of penalizing Ethiopia over growing American exasperation with Mr. Abiy’s actions in Tigray. Secretary of State Antony J. Blinken announced visa restrictions on officials linked to the conflict, preventing their travel to the United States.

Ethiopia’s Foreign Ministry reacted angrily, calling the restrictions “extremely regrettable” and suggesting they would “seriously undermine this longstanding and important bilateral relationship.”

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In Israel, Blinken Pushes U.S. Support for Rebuilding Gaza

JERUSALEM — Israel will launch a “very powerful” response to any new attacks by Hamas militants, Prime Minister Benjamin Netanyahu warned on Tuesday, thanking the United States for bolstering his country’s air defenses during a visit by the top American diplomat that sought to promote peace.

Secretary of State Antony J. Blinken, in his first trip to the Middle East during the Biden administration, was met by a country on edge following more than 10 days of war with Hamas that ended with a tenuous cease-fire late last week.

In brief but blunt comments after their private meeting, Mr. Netanyahu said he was grateful that the Biden administration consistently affirmed Israel’s right to defend itself after coming under rocket attack by militants in the Gaza Strip. He said he and Mr. Blinken had discussed how to curb Hamas, which controls Gaza, and how to help rebuild and otherwise improve the lives of the two million Palestinians who live there.

“If Hamas breaks the calm and attacks Israel, our response will be very powerful,” Mr. Netanyahu told reporters after the meeting, standing next to Mr. Blinken.

77,000 people who were forced from their homes during the hostilities and are sheltering in schools maintained by the United Nations.

Hundreds of thousands of people have been cut off from electricity and clean water, and pockets of Gaza have been reduced to piles of rubble after nearly two weeks of Israeli airstrikes.

rebuild our relationship” with the Palestinian people and the Palestinian Authority. He was to meet later Tuesday in Ramallah with President Mahmoud Abbas and Prime Minister Mohammad Shtayyeh of the Palestinian Authority.

In seeking to prop up the authority, the Biden administration aims to sideline Hamas, the militant group that controls Gaza, which the United States considers a terrorist organization. Hamas and the Palestinian Authority are bitter political rivals, and it is far from assured that the militants will cede any of their grip over Gaza.

In a series of discussions with Mr. Blinken throughout the afternoon, Mr. Netanyahu and other Israeli officials also homed in on what they described as another urgent threat to their stability: Iran.

With American and Iranian diplomats separately meeting with world powers in Vienna, officials have in recent days noted progress in negotiations to bring both sides back into compliance with a 2015 nuclear deal.

the Trump administration jettisoned in 2018, in hopes of imposing stricter limits on Iran’s nuclear, missile and military programs.

Mr. Netanyahu said the original deal “paves the way for Iran to have an arsenal of nuclear weapons.”

riots erupted at Al Aqsa Mosque in Jerusalem, one of the holiest sites in Islam.

“We believe that Palestinians and Israelis equally deserve to live safely and securely to enjoy equal measures of freedom opportunity, and democracy, to be treated with dignity,” Mr. Blinken said.

“Healing these wounds will take leadership at every level of society,” he said.

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Blinken Hopes to Solidify Hamas and Israel’s Cease-Fire

As a candidate, Mr. Biden had said there would be “no more blank checks for Trump’s ‘favorite dictator’” — meaning Mr. el-Sisi, whose increasing authoritarianism has drawn widespread criticism. Though the Egyptian president was the first Arab leader to congratulate Mr. Biden after the election, Mr. Biden waited until last week to return the call.

But after that chilly start to their relationship, Egypt has sought to capitalize on the Gaza crisis to shore up its ties with the new administration. Mr. Blinken will meet Mr. el-Sisi in Cairo, providing the Egyptian leader an opportunity not only to reaffirm his nation’s the relationship with the United States but also to promote Egypt’s status as a regional power broker and leader among Arab countries.

Though that status has been fading for years as Egypt fell into domestic turmoil and wealthier Arab states asserted themselves in the region, Cairo enjoyed mostly smooth relations with Washington in recent years until the arrival of the Biden administration, which has put human rights at the center of its foreign policy strategy.

The administration, however, has not fundamentally changed the terms of the relationship with Cairo, which centers on the $1.3 billion in military aid Egypt receives each year from the United States, a historical byproduct of its agreement to make peace with Israel in 1979. The State Department approved a $197 million arms sale to Egypt in February, around the same time that Egypt arrested the cousins of an Egyptian-American dissident, Mohamed Soltan, in what Mr. Soltan said was a bid to pressure him to stop criticizing it.

The conflict also could serve to continue repairing the relationship between the United States and Jordan that had been largely shelved during the Trump administration. At least two million Palestinian refugees live in Jordan, and its Hashemite monarchy is the custodian of the Aqsa Mosque in Jerusalem, one of the holiest sites in Islam.

Mr. Blinken’s visit comes at a fraught time in Israeli politics, with Prime Minister Benjamin Netanyahu heading a caretaker government that could be in its last days, after four inconclusive elections in two years, and with no clear picture of what lies ahead.

Experts in the region said Mr. Blinken would have to maneuver carefully between expressing his administration’s unwavering support for Israel and its security while not handing over any gifts that could be perceived as intervening in Mr. Netanyahu’s domestic predicament.

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U.S. Looks to Rebuild Gaza, but Aid Could Hinge on Hamas’s Rocket Arsenal

A Brookings Institution analysis concluded in 2017 that the reconstruction effort largely failed because of intractable political opposition to Hamas — not only from Israel, but also from Egypt, which opposes the militants’ ties to the Muslim Brotherhood.

Restricted access to Gaza — as enforced by Egypt and an Israeli blockade — limited building supplies, humanitarian assistance and other equipment to the area, the analysis concluded. That fueled already-simmering tensions between Hamas and its political rivals in the Palestinian Authority, whom Egypt was pressuring to take over security operations in Gaza as a way to open access.

At the same time, the analysis found, international donors were slow to send money they had committed to the 2014 rebuilding effort in Gaza. The vast majority of donations that were unfulfilled, three years after the cease-fire, had been pledged by Arab states in the Persian Gulf that also opposed Hamas’s ties to the Muslim Brotherhood. The Muslim Brotherhood has renounced violence but has some links to extremist groups. Hamas is considered a terrorist organization by both Israel and the United States.

Taken together, Gaza’s reconstruction fell flat, confining residents to temporary housing amid soaring unemployment and diminished services in electricity, clean water and waste management.

Mr. Ross said that the earlier efforts to rebuild Gaza had largely failed and that any future monitoring system, potentially by the United Nations, would need to be an effective, round-the-clock endeavor that would halt reconstruction if Hamas was found to be storing, building or preparing to launch rockets.

“The issue is massive reconstruction for no rockets,” Mr. Ross said. “There has to be enough oversight of this process to know that it’s working the way it’s intended. And the minute you see irregularities, everything stops.”

He said that would not necessarily mean a complete disarming of Hamas, and that some immediate humanitarian aid should be delivered to Gaza. But, Mr. Ross said, the offer for broader reconstruction assistance should be made publicly to assure donors of consequences if Hamas resumes its rocket program. He predicted Hamas would, at least in the beginning, agree to some sort of arrangement. “Right now, the needs are so profound that they will go along with something,” Mr. Ross said.

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Past Israel-Hamas Cease-Fire Periods Didn’t Always Hold

Under growing international pressure, Israel and Hamas are said to be edging toward a cease-fire that could end their deadliest conflict since a 2014 war. But the history of Israeli-Palestinian hostilities is littered with agreements that have failed to resolve the underlying disputes.

Past cease-fires between Israel and Hamas, the militant group that rules the Gaza Strip, have usually gone in stages, beginning with an agreement that each side will stop attacking the other, a dynamic that Israelis call “quiet for quiet.”

That means Hamas halting rocket attacks into Israel and Israel ceasing bombardment of Gaza.

Pauses in the fighting are usually followed by other steps: Israel easing its blockade of Gaza to allow humanitarian relief, fuel and other goods to enter; Hamas reining in protesters and allied militant groups that attack Israel; and both sides exchanging prisoners or those killed in action. So far, this time, Israel has not used ground forces in Gaza.

But bigger challenges — such as a more thorough rehabilitation of Gaza and improving relations between Israel, Hamas and Fatah, the Palestinian party that controls the West Bank — have remained elusive over the past several rounds of violence.

the devastating toll on Palestinian civilians and the extensive damage to homes, schools and medical facilities in Gaza, the current conflict has been more limited than the wars Israel and Hamas waged in 2008 and 2014, when Israeli troops entered Gaza. In past conflicts, fierce fighting has erupted in the days before and after cease-fires as both sides sought to strike decisive blows.

In July 2014, six days after the Israeli Army began bombarding Gaza, Egypt proposed a cease-fire that Israel agreed to. But Hamas said that it addressed none of its demands, and the cycle of rocket attacks and Israeli airstrikes resumed after less than 24 hours.

Egypt announced another cease-fire two days later, but Israel then sent in tanks and ground troops and began firing into Gaza from the sea, saying that its aim was to destroy tunnels that Hamas uses to carry out attacks. Over the next several weeks, Israeli forces periodically paused their attacks to allow humanitarian aid, but the fighting continued.

nine truces came and went before the 2014 conflict ended, after 51 days, with more than 2,000 Palestinians and more than 70 Israelis killed.

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Publicly Supportive, Biden Is Said to Sharpen His Tone With Netanyahu in Private

WASHINGTON — President Biden has maintained his public support toward Israel even as he adopted a somewhat sharper private tone with Prime Minister Benjamin Netanyahu, a calculus shaped by Mr. Biden’s longtime relationship with the Israeli leader as well as by growing hopes that Israel’s military operations against Hamas are nearing an end.

In a phone call on Monday, Mr. Biden warned Mr. Netanyahu that he could fend off criticism of the Gaza strikes for only so long, according to two people familiar with the call. That conversation was said to be significantly stronger than an official summary released by the White House. It affirmed Israel’s right to self-defense and did not repeat calls by many congressional Democrats for an immediate cease-fire.

That phone call and others since the fighting started last week reflect Mr. Biden and Mr. Netanyahu’s complicated 40-year relationship. It began when Mr. Netanyahu was the deputy chief of mission at the Israeli Embassy in Washington and Mr. Biden was a young senator with a passion for foreign affairs. Since then, they have rarely seen eye to eye, but have forged an occasionally chummy working relationship through seven American presidencies — Mr. Netanyahu has been prime minister for four of them — and raging political battles over the Iran nuclear deal and Israeli settlement policy.

Today, that relationship is as complicated as ever. Mr. Biden’s juggling act on Israel, always a challenge for an American president, is especially difficult given that Democrats are no longer solidly in Israel’s corner.

Palestinian grievances — and that his approach has less to do with the military situation on the ground than with domestic politics and his broader foreign policy agenda, including nuclear talks with Iran.

For his part, Mr. Netanyahu is fighting for his political life at home while trying to sustain support for his country in Washington. With Mr. Biden now in the Oval Office, the men are again trying to sustain mutual trust amid larger forces driving them apart.

Martin S. Indyk, a former United States ambassador to Israel, said that Mr. Biden had bought himself private space to persuade Mr. Netanyahu to wind down the strikes in Gaza, which were launched in retaliation for Hamas’s indiscriminate rocket attacks on Israeli cities. Mr. Indyk also said that Mr. Biden was trying to get the Israeli leader to agree to a cease-fire “by making clear publicly that he was in Israel’s corner, that Israel has a right to defend itself, and that he has Netanyahu’s back.”

“That was very important for the moment that has now come, in which he has to turn to Netanyahu and say, ‘Time to wrap it up,’” Mr. Indyk said.

Mr. Biden and Mr. Netanyahu have been through countless highs and lows together.

After Mr. Netanyahu faced his first electoral defeat, in 1999, Mr. Biden sent him a letter, praising him for having shown political courage during talks with the Palestinians that were hosted by the United States in Maryland. Mr. Netanyahu replied, and gratefully noted that Mr. Biden was the only American politician to write to him after his defeat.

approving new housing construction in East Jerusalem, a setback to Obama administration efforts to mediate Israeli-Palestinian peace talks.

Obama White House officials were enraged, and several urged Mr. Biden to skip a planned dinner with Mr. Netanyahu in Tel Aviv and leave the country immediately. Mr. Biden disagreed, and chose to confront the Israeli leader in private while minimizing the public discord, betting that such an approach would be more effective, people familiar with the episode said.

longtime view that foreign policy is driven by personal relationships, he has repeatedly made clear over the years that his sometimes exasperation with Mr. Netanyahu’s right-wing policies in such moments never ruptured the men’s bond.

Mr. Biden has spoken publicly about how he once sent Mr. Netanyahu a photograph with the inscription, “Bibi, I don’t agree with a damn thing you say, but I love you.”

And after tensions between Mr. Netanyahu and the Obama White House over Iran’s nuclear program burst into public view in late 2014, Mr. Biden, during a speech to a Jewish American group, offered assurances that he and the Israeli leader were “still buddies.”

Golda Meir, on the eve of an attack on Israel by a coalition of Arab states in what is known as the Yom Kippur War.

Saying he was shaken by the scale of the threat to Israel, Mr. Biden has called that “one of the most consequential meetings I’ve ever had in my life.”

In the years since, Mr. Biden has repeatedly underscored his devotion to the country. “I am a Zionist,” he told an Israeli television station in 2007. “You don’t have to a Jew to be a Zionist.”

Michael Oren, who served as Israel’s ambassador to Washington from 2009 to 2013, said that in an Obama administration where many senior officials mistrusted Mr. Netanyahu’s Likud government and shut out Mr. Oren, Mr. Biden served as his main interlocutor.

“He exhibited, I thought, great insight into the personality of Benjamin Netanyahu,” Mr. Oren said. He said Mr. Biden saw that tensions between President Barack Obama and Mr. Netanyahu made for “a very flammable environment that he did his best to ease down.”

Israeli-Palestinian conflict with dim prospects of resolution at a time when he has been focused on other foreign policy priorities, including climate change, countering China and restoring the 2015 Iran nuclear deal.

“I think the Biden administration was caught a bit off-guard here,” said Sanam Vakil, the deputy director of the Middle East and North Africa program at the London-based think tank Chatham House. “It has taken them a few days to mobilize and find their footing.”

On Tuesday, the White House press secretary, Jen Psaki, told reporters aboard Air Force One that Mr. Biden “has been doing this long enough to know that the best way to end an international conflict is typically not to debate it in public.”

“Sometimes diplomacy needs to happen behind the scenes — it needs to be quiet, and we don’t read out every component,” she said.

Hady Amr.

expectation and hope” that the conflict was nearing an end. More than 100 innocents have been killed in the fighting since then.

Asked why Mr. Biden has not publicly called for a cease-fire, as have dozens of congressional Democrats, a senior administration official said that doing so could be counterproductive and prolong the violence. Some analysts agree that such calls may inspire defiance among Mr. Netanyahu, his political allies and the Israeli public.

Mr. Oren said that he believed that Mr. Biden’s publicly supportive posture toward Israel, which has drawn an increasing number of complaints from congressional Democrats, is motivated in part by indirect negotiations with Iran this month in Vienna that are aimed at restoring the nuclear deal with Tehran, another of Mr. Biden’s top priorities.

“I wouldn’t be surprised if, in the aftermath of this conflict, the Biden administration would say to the Israeli government: ‘You see how we supported your right to defend yourself against Hamas? Trust us to ensure your defense as we renew the Iran nuclear deal,’” Mr. Oren said.

criminal charges, and he has struggled to form a governing coalition that would prevent him from the likelihood of losing power for the first time since 2009.

Lara Jakes contributed reporting.

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Europe Calls for Immediate Cease-Fire in Israel-Palestinian Fighting

BRUSSELS — European Union foreign ministers overwhelmingly called for an immediate cease-fire between Israel and the Palestinians in an emergency meeting on Tuesday, according to the bloc’s foreign policy chief, Josep Borrell Fontelles.

All of the member states except Hungary backed a statement that condemned rocket attacks by Hamas and supported Israel’s right to self-defense but also cautioned that it had “to be done in a proportional manner and respecting international humanitarian law,’’ Mr. Borrell said at a news conference.

He said that the number of civilian casualties in Gaza, “including a high number of women and children,’’ was “unacceptable.’’ And he said that the European Union, as part of the quartet with the United States, Russia and the United Nations that seeks peace in the Middle East, would push to restart a serious diplomatic process.

“The priority is the immediate cessation of all violence and the implementation of a cease-fire,” Mr. Borrell said. Foreign policy in the European Union works by unanimity, so Mr. Borrell’s comments, despite Hungary’s opposition, were an effort, he said, “to reflect the overall agreement.”

evictions of Palestinians from East Jerusalem.

“The representatives of the European public, the ministers of foreign affairs in this case, are trying very hard to deal with the situation and find the best possible contribution by the E.U. to de-escalate and stop the violence,” he said. “And I think that’s it. I can only repeat that of course the casualties are unacceptable.”

Isabel Kershner contributed reporting from Jerusalem.

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Israeli-Palestinian Strife Widens as Frantic Calls for Calm Go Unheeded

CAIRO — Violence between Israelis and Palestinians expanded in new directions on Friday, with deadly clashes convulsing the occupied West Bank and anti-Israeli protests erupting along Israel’s borders with two Arab neighbors.

The widening sense of mayhem in Israel and the Palestinian territories came as Israeli airstrikes brought mass evacuations and funerals to Gaza, and as Hamas rockets singed Israeli towns for a fifth consecutive day.

Hamas and Israeli officials signaled they were open to discussing a cease-fire amid global calls for peace and frantic diplomacy aimed at heading off a further fracturing in one of the Middle East’s most intractable struggles.

But the violence, which has metastasized with startling velocity compared with previous Israeli-Palestinian conflicts, was finding new footholds and threatening the veneer of Israeli society in ways not seen before.

Power was down to five hours a day in some places, and water came out of the pipes only once every few days. Efforts to contain what had been a worsening coronavirus infection crisis in Gaza all but collapsed.

ground forces had attacked Gaza, later clarifying that the troops were firing from within Israel, and that none had entered the territory.

a 5-year-old boy killed by shrapnel on Wednesday despite having sheltered in a safe room.

On Thursday, his family was mourning at his funeral when the scream of sirens warned that, once again, Hamas rockets were on the way.

Reporting was contributed by Iyad Abuheweila from Gaza City; Patrick Kingsley, Irit Pazner Garshowitz, Myra Noveck and Jonathan Rosen from Jerusalem; Rami Nazzal from Ramallah, West Bank; Gabby Sobelman from Rehovot, Israel; Adam Rasgon from Los Angeles; Rana F. Sweis from Amman, Jordan; and Hwaida Saad from Beirut, Lebanon.

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Biden Confronts Coronavirus Vaccine Patents

WASHINGTON — President Biden, faced with surging Covid-19 crises in India and South America, is under intensifying pressure from the international community and his party’s left flank to commit to increasing the vaccine supply by loosening patent and intellectual property protections on coronavirus vaccines.

Pharmaceutical and biotech companies, also feeling pressure, sought on Monday to head off such a move, which could cut into future profits and jeopardize their business model. Pfizer and Moderna, two major vaccine makers, each announced steps to increase the supply of vaccine around the world.

The issue is coming to a head as the World Trade Organization’s General Council, one of its highest decision-making bodies, meets Wednesday and Thursday. India and South Africa are pressing for the body to waive an international intellectual property agreement that protects pharmaceutical trade secrets. The United States, Britain and the European Union so far have blocked the plan.

Inside the White House, health advisers to the president admit they are divided. Some say that Mr. Biden has a moral imperative to act, and that it is bad politics for the president to side with pharmaceutical executives. Others say spilling closely guarded but highly complex trade secrets into the open would do nothing to expand the global supply of vaccines.

promised the liberal health activist Ady Barkan, who has amyotrophic lateral sclerosis, or A.L.S., that he would “absolutely positively” commit to sharing technology and access to a coronavirus vaccine if the United States developed one first. Activists plan to remind Mr. Biden of that promise during a rally scheduled for Wednesday on the National Mall.

proposal by India and South Africa would exempt World Trade Organization member countries from enforcing some patents, trade secrets or pharmaceutical monopolies under the body’s agreement on trade-related intellectual property rights, known as TRIPS. The idea would be to allow drug companies in other countries to make or import cheap generic copies.

Proponents say the waiver would free innovators in other countries to pursue their own coronavirus vaccines, without fear of patent infringement lawsuits. They also note that the proposed waiver goes beyond vaccines, and would encompass intellectual property for therapeutics and medical supplies as well.

“Many people are saying, ‘Won’t they need the secret recipe?’ That’s not necessarily the case,” said Tahir Amin, a founder of the Initiative for Medicines, Access & Knowledge, a nonprofit dedicated to eliminating health inequities. “There are companies that feel they can go it alone, provided they don’t have to look over their shoulder and feel like they are going to take someone’s intellectual property.”

The pharmaceutical industry counters that rolling back intellectual property protections would not help ramp up vaccine production. It says that other issues are serving as barriers to getting shots into arms around the world, including access to raw materials and on-the-ground distribution challenges.

And just as important as having the rights to make a vaccine is having the technical know-how, which would have to be supplied by vaccine developers like Pfizer-BioNTech and Moderna — a process known as technology transfer.

on LinkedIn that his company would immediately donate more than $70 million worth of medicines to India and is also trying to fast-track the vaccine approval process in India. The company also posted on Twitter promising “the largest humanitarian relief effort in our company’s history to help the people of India.”

Moderna, which developed its vaccine with funding from American taxpayers, has already said it would not “enforce our Covid-19 related patents against those making vaccines intended to combat the pandemic.” But activists have been calling not just for the waiver, but for companies to share expertise in setting up and running vaccine factories — and for Mr. Biden to lean on them to do it.

issued an open letter calling on Mr. Biden to support the proposed waiver.

On Capitol Hill, 10 senators including Bernie Sanders, independent of Vermont, and Elizabeth Warren, Democrat of Massachusetts, urged Mr. Biden to “prioritize people over pharmaceutical company profits” and reverse the Trump administration’s opposition to the waiver. More than 100 House Democrats have signed a similar letter.

a handful of governments, including those of Brazil and Thailand, bypassed patents held by the developers of antiviral drugs for H.I.V./AIDS in an effort to clear the way for lower-cost versions of the treatments.

H.I.V. drugs, however, involve a much simpler manufacturing process than the coronavirus vaccines, especially those using messenger RNA technology, which has never before been used in an approved product.

In a Twitter thread, Mr. Amin offered another example: In the 1980s, Merck and GlaxoSmithKline had developed recombinant hepatitis B vaccines and held a monopoly with more than 90 patents covering manufacturing processes. The World Health Organization recommended vaccination for children, but it was expensive — $23 a dose — and most Indian families could not afford it.

The founder of Shantha Biotechnics, an Indian manufacturer, was told that “even if you can afford to buy the technology your scientists cannot understand recombinant technology in the least,” Mr. Amin wrote.

But Shantha, he added, went on “to produce India’s first home-grown recombinant product at $1 a dose.” That enabled UNICEF to run a mass vaccination campaign.

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