sometimes-violent resistance in rural communities. Vaccine hesitancy rates there approach 50 percent among those who have not completed high school. In some parts of the country, more than a third of doses spoil amid the low demand.

Still, many are eager to be vaccinated. When doses first became widely available in South Africa earlier this year, a third of the country’s adults swiftly got inoculated, a pattern that is repeating elsewhere.

allegations of corruption amid last year’s lockdown, have heightened public unease.

“There’s a lack of confidence in the public health system’s ability to provide vaccines,” said Chris Vick, the founder of Covid Comms, a South African nonprofit group.

The group has been holding vaccine information sessions, but overcoming skepticism is not easy. After a session in the Pretoria township of Atteridgeville, one 20-year-old who attended said she had not been persuaded.

briefly pause delivery of the Johnson & Johnson vaccine, leading South Africa to delay its rollout to health care workers. Both countries decided to resume the shots after concluding that they were safe.

The South African government held regular briefings, but these were on television and in English, when radio remains the most powerful medium and most South Africans do not speak English as their mother tongue.

a recent study found. That is in part because of mistrust of the Black-led government, but also because American Covid conspiracists have found wide reach among white South Africans on social media, according to Mr. Vick of Covid Comms.

Covid pill from Merck for high-risk adults, the first in a new class of antiviral drugs that could work against a wide range of variants, including Omicron. The pill could be authorized within days, and available by year’s end.

The first modern, worldwide campaign, begun in 1959 against smallpox, provoked deep skepticism in parts of Africa and Asia, where it was seen as a continuation of colonial-era medical abuses. Some W.H.O. officials used physical force to vaccinate people, deepening distrust. The campaign took 28 years.

The effort to eradicate polio, which finally ramped up in poor countries in the 1980s and is still ongoing, has run into similar resistance. A study in the science journal Nature found that vaccine avoidance was highest among poor or marginalized groups, who believed that the health authorities, and especially Western governments, would never voluntarily help them.

In Nigeria in the early 2000s, amid a spike in religious tensions, unfounded rumors circulated that foreign health workers were using polio vaccines as cover to sterilize the country’s Muslim population. Boycotts and local bans led to a polio resurgence, with cases spreading to 15 other countries, as far as Southeast Asia.

survey by the Africa Center for Disease Control found that 43 percent of those polled believe Africans are used as guinea pigs in vaccine trials — a legacy of Western drug companies’ doing exactly this in the 1990s.

Even within their own borders, Western governments are struggling to overcome vaccine resistance. So it is hard to imagine them doing better in faraway societies where they lack local understanding.

Any appearance of Western powers forcing unwanted vaccines into African or Asian arms risks deepening the backlash.

“If the objective is to keep the U.S. and the rest of the world safe, it should be pretty obvious that the success of the domestic program depends on what happens internationally,” Dr. Omer said.

Declan Walsh contributed reporting from Nairobi.

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Omicron Variant Prompts Travel Bans and Batters World Markets

The world reacted with alarm on Friday to the highly mutated new coronavirus variant discovered in southern Africa, as the United States, the European Union and nations across the globe imposed new travel restrictions, financial markets swooned and visions of finally emerging from the pandemic started to dim.

Just two days after the world learned of the variant, the World Health Organization officially labeled it a “variant of concern,” its most serious category — the first since the Delta variant, which emerged a year ago. The designation means that the variant has mutations that might make it more contagious or more virulent, or make vaccines and other preventive measures less effective — though none of those effects has yet been established.

suffered terribly when Covid first hit Europe early last year.

On Friday, Israel, Singapore, several European nations individually, and then the European Union as a whole, the United States and Canada followed the lead set by Britain on Thursday night, temporarily barring foreign travelers who have recently been in South Africa or any of several neighboring countries. As with past travel bans, countries are allowing their own citizens and permanent residents to return home if they test negative for the virus, with some requiring additional testing and quarantine after arrival.

fights over vaccines and social restrictions have grown increasingly harsh.

world’s highest case rates for their populations are all European — several of them about six times as high as the U.S. rate.

South Africa, whose last coronavirus wave peaked in July, has recently reported case rates far below the worldwide average. But last week the rate more than doubled from the week before.

Reporting was contributed by Sheryl Gay Stolberg, Zolan Kanno-Youngs, Carl Zimmer, Lynsey Chutel and Nick Cumming-Bruce.

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Severe Covid Is More Often Fatal in Africa Than in Other Regions

People in Africa who become critically ill from Covid-19 are more likely to die than patients in other parts of the world, according to a report published on Thursday in the medical journal The Lancet.

The report, based on data from 64 hospitals in 10 countries, is the first broad look at what happens to critically ill Covid patients in Africa, the authors say.

The increased risk of death applies only to those who become severely ill, not to everyone who catches the disease. Over all, the rates of illness and death from Covid in Africa appear lower than in the rest of the world. But if the virus begins to spread more rapidly in Africa, as it has in other regions, these findings suggest that the death toll could worsen.

Among 3,077 critically ill patients admitted to the African hospitals, 48.2 percent died within 30 days, compared with a global average of 31.5 percent, the Lancet study found.

The study was observational, meaning that the researchers followed the patients’ progress, but did not experiment with treatments. The work was done by a large team called The African Covid-19 Critical Care Outcomes Study Investigators.

For Africa as a whole, the death rate among severely ill Covid patients may be even higher than it was in the study, the researchers said, because much of their information came from relatively well-equipped hospitals, and 36 percent of those facilities were in South Africa and Egypt, which have better resources than many other African countries. In addition, the patients in the study, with an average age of 56, were younger than many other critically ill Covid patients, indicating that death rates outside the study could be higher.

The other eight countries in the study were Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique, Niger and Nigeria. Leaders of 16 other African nations had also agreed to participate, but ultimately did not.

Reasons for the higher death rates include a lack of resources such as surge capacity in intensive care units, equipment to measure patients’ oxygen levels, dialysis machines and so-called ECMO devices to pump oxygen into the bloodstream of patients whose lungs become so impaired that even a ventilator is not enough to keep them alive.

But there was also an apparent failure to use resources that were available, the authors of the study suggested. Proning — turning patients onto their stomachs to help them breathe — was underused, performed for only about a sixth of the patients who needed it.

Almost 16 percent of the hospitals had ECMO, but it was offered to less than 1 percent of patients. Similarly, although 68 percent of the sites had access to dialysis to treat kidney failure, which is common in severe Covid cases, only 10 percent of the critically ill patients received it. Half the patients who died were never given oxygen, but the authors of the study said they had little data to explain why.

A Lancet editorial by experts not involved in the study said, “It is common in Africa to have expensive equipment that is non-functional due to poor maintenance or lack of skilled human resources.” Some 40 percent of the medical equipment in Africa was out of service, according to a 2017 report by the Tropical Health and Education Trust, the editorial said.

Another factor is that few doctors in Africa have the training in pulmonary and critical care that is considered essential in treating Covid patients.

As in other studies, chronic conditions like diabetes, high blood pressure, and diseases affecting the heart, kidney or liver increased the risk of death from Covid. This study was the first to include a large proportion of patients with H.I.V., which nearly doubled the risk of death. The report states, “Our data suggests that H.I.V./AIDS is an important risk factor for Covid-19 mortality.” But the authors also said they did not have data on how the severity of the H.I.V. infection might affect the risk.

An unexpected finding of the study was that, unlike Covid patients in the rest of the world, men in Africa were no more likely than women to die. That result suggests that African women are at higher risk than women in other regions.

The authors suggested that women in Africa might face “barriers to accessing care and limitations or biases in care when critically ill.”

The editorial asked whether new variants could be causing the high death rate found in the study, but also said, “This is a question which, in a continent with severe shortage of sequencing, could take a long time to answer.”

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Geoff Crowther, 77, Dies; Guided Travelers Looking to Get Lost

After all, Lonely Planet, which was founded by Tony Wheeler with his wife, Maureen, was itself named by mistake. Mr. Wheeler thought he was adopting the name from the lyrics to “Space Captain,” sung by Joe Cocker and written by Matthew Moore — until his wife corrected him. (The actual line is “Once while traveling across the sky, this lovely planet caught my eye.”)

A 1986 article by Nicholas Kristof in The New York Times anointed Mr. Crowther “the patron saint of travelers in the third world,” although Mr. Kristof acknowledged that even saints aren’t perfect. He mentioned a jungle hike in North Borneo that had been included in “Southeast Asia on a Shoestring” at the suggestion of an earlier reader.

“Then, a couple of years later,” Mr. Kristof wrote, “a man came into Mr. Wheeler’s office and said: ‘You know that hike that you said would take a day and a half? It took me six weeks. Halfway through I was cursing your name, but later I realized it was the greatest adventure I’d ever had.’”

Not every traveler read Lonely Planet’s guides for pleasure. After Ethiopian rebels used the guidebook’s maps of Addis Ababa, the nation’s capital, to seize it from the dictator Mengistu Haile Mariam in 1991, Mr. Wheeler marveled, “As far as I know it’s the only time we’ve directly helped to overthrow a government.”

Mr. Crowther’s uncompromising candor was not always welcome. He and his guidebook (“along with ‘Lady Chatterley’s Lover’ and a select list of other highly subversive titles,” Mr. Wheeler wrote) were banned from Malawi after he gently badmouthed the country’s autocratic president, Dr. Hastings Banda, in passing.

Declaring that Mr. Crowther “had an incalculable impact on a unique generation of travelers,” Richard Everist, a former publisher of Lonely Planet, described him as “a true explorer and adventurer who went beyond boundaries and borders” and “defined Lonely Planet’s ethos and style.”

Geoff Crowther was born on March 15, 1944, in Yorkshire, England, to George and Susie (Halstead) Crowther. His parents were both cotton mill workers.

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While rich countries come back to life, the virus is ravaging poorer nations.

In much of the developed world, vaccine orders are soaring into the billions of doses, coronavirus cases are easing and economies are poised to roar back to life. In many less developed nations, though, the virus is raging on, while vaccinations are far too slow to protect even the most vulnerable.

That split screen — clubs and restaurants reopening in the United States and Europe while people gasp for oxygen in India — was never supposed to be so stark.

New variants could emerge in reservoirs of untamed infections, prolonging the pandemic for rich and poor nations alike. The global economy stands to suffer trillions of dollars in losses.

Western nations have promised vaccines to the developing world. But these “donations” are a drop in the bucket, and have in some cases been haphazardly planned.

And even as richer nations inoculate their own citizens, they might start saving vaccine-making capacity for booster shots to deploy against new variants, another blow to countries bereft of manufacturing bases.

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As the Virus Ravages Poorer Countries, Rich Nations Are Springing Back to Life

Many countries, prepared for the sort of childhood vaccination campaigns they carry out regularly, were startled to find that they could not rely on people simply to show up for a coronavirus vaccine.

“A lot of vaccine hesitancy issues could be addressed, though not all of them overcome, with timely operational funding in place,” said Benjamin Schreiber, the coordinator for Covid-19 vaccines at UNICEF, which is leading Covax delivery efforts.

Amid a race to fund vaccine purchases, though, money for getting them into people’s arms has been overlooked. Of the 92 poorer nations being supplied by Covax, eight have cut their health budgets because of virus-related economic losses, and several others are struggling to fund their health systems in part because they do not qualify for grants or more generous loans, Mr. Schreiber said.

The World Bank has promised $12 billion for vaccine rollouts, but has so far approved $2 billion in projects. In mid-March, the bank found that less than a third of low- and middle-income nations reported having plans to train enough vaccinators or campaigns in place to fight vaccine hesitancy, said Mamta Murthi, the bank’s vice president for human development.

Many countries’ needs are even simpler. Some cannot pay to print immunization cards. Malawi, which is planning to destroy 16,000 doses that arrived only shortly before they expired, has struggled to cover lunch allowances for health workers traveling from one facility to another to give vaccines.

The outlook is uncertain. More doses will breed more vaccine confidence, said Freddy Nkosi, the country director in the Democratic Republic of Congo for VillageReach, a health nonprofit. But if India’s outbreak keeps surging, the chief executive of the Serum Institute of India said recently, “We are going to have to keep supplying to India, and not anywhere else.”

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A vaccine scare ripples around the world: The week in Covid-19 news.

Safety worries about the AstraZeneca and Johnson & Johnson Covid-19 vaccines in the United States and Europe have reverberated around the world, undercutting faith in two sorely needed shots and threatening to prolong the coronavirus pandemic in poorer countries that cannot afford to be choosy about vaccines. With new infections surging on nearly every continent, signs that the vaccination drive is in peril are emerging, most disconcertingly in the continent of Africa.

In many African countries, vaccination campaigns have been hindered by factors like science skepticism, limited or no efforts to educate the public, inefficient distribution systems and concerns over the extremely rare but serious cases of blood clots being investigated among a small number of people who received the AstraZeneca and Johnson & Johnson vaccines. Those two vaccines, which require less stringent refrigeration, are crucial to efforts to immunize populations in poorer countries.

But in Malawi, some people are asking doctors how to flush the AstraZeneca vaccine from their bodies. In South Africa, health officials have stopped giving the Johnson & Johnson shot, two months after dropping the AstraZeneca vaccine because it was less effective against the dominant variant there.

Across the continent, public confusion over whether to get inoculated — and if so when and where to do so — has contributed to the expiration of doses. South Sudan saw 59,000 unused doses expire this month, and in the Democratic Republic of Congo, 1.7 million AstraZeneca doses have gone unused.

Pew Research Center — accounting for a majority of the 54 million who slipped out of the middle class worldwide. A second wave of Covid-19 is threatening the dreams of millions more looking for a better life.

  • Keeping the middle seats vacant during a flight could reduce passengers’ exposure to airborne coronavirus by 23 to 57 percent, researchers reported in a new study. This reduction in risk stemmed from increasing the distance between an infectious passenger and others as well as from reducing the total number of people in the cabin. But the study may have overestimated the benefits of empty middle seats because it did not take into account mask-wearing by passengers.

  • More exercise means less risk of developing severe Covid, according to a compelling new study of physical activity and coronavirus hospitalizations. The study found that those who had been the most active before falling ill were the least likely to be hospitalized or die as a result of their illness.

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    Vaccine Hesitancy Leaves Doses to Expire in Some African Countries

    With growing community transmission and high average mortality rates from the coronavirus in Malawi, there was widespread concern among the country’s health care advocates this week when the authorities announced that they would throw away 16,000 vaccine doses that had expired.

    They were part of a total of 512,000 AstraZeneca vaccine doses that the landlocked southeast African nation had received from India, the African Union and Covax, the global initiative to procure and distribute vaccines. Health officials didn’t specify why the vaccines had expired, but said the doses went void on Tuesday “due to varying expiry dates of the received vaccine consignments.”

    Health experts and campaigners warned that vaccine hesitancy, along with rumors that out-of-date jabs were being administered, might have contributed to the slow distribution of the vaccine doses and their eventual expiration.

    In many African countries, vaccination campaigns have been hindered by factors like science skepticism, limited or no efforts to educate the public, inefficient distribution systems and concerns over the extremely rare but serious cases of blood clots being investigated among a small number of people who received the AstraZeneca and Johnson & Johnson vaccines. Those two vaccines, which require less stringent refrigeration, are crucial to efforts to immunize populations in poorer countries.

    stopped plans to secure the AstraZeneca vaccine — a decision one official said was made to avoid duplicating the efforts of Covax, which will still supply AstraZeneca to African nations. But even though the decision was not linked to concerns over blood clotting, experts said it could still magnify misinformation about the vaccine. And the African Union is shifting its focus to the Johnson & Johnson vaccine, which could add to the problem. Its use has been paused in the United States.

    In African countries, public confusion over whether to get inoculated, and if so when and where to do so, has contributed to the expiration of doses. Like Malawi, South Sudan saw 59,000 unused doses expire this month.

    The problem is not unique to African countries. Tens of thousands of jabs have also been thrown away in countries like France and the United States. But African countries face far more serious supply shortages. According to a New York Times database, Africa has the slowest vaccination rate of any continent, with many countries yet to start mass vaccination campaigns.

    Countries like Ghana, which was the first African nation to receive doses from Covax, is about to run out of its initial supplies with no sense of when the next batch may come.

    “This inequality negatively affects the entire world,” said Dr. Ngozi Erondu, an infectious disease specialist and a senior health scholar at the O’Neill Institute at Georgetown University. If “entire regions and countries remain insufficiently vaccinated,” she said, “it will continue to ravage populations with persistent morbidity and leave the larger global health community always vulnerable to the virus.”

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    My Family’s Global Vaccine Journey

    On Feb. 22, Mom texted that she and Dad had booked a March 11 appointment to get their first shots, followed by second doses in April. A day later, she reported that Dad hadn’t pressed the button to confirm the appointment on the online booking system and had lost the slots.

    The next week, they texted again: They had walked to a private clinic that was dispensing Sinovac shots. After a short wait, they received the vaccine. On April 2, they told us that they had gotten their second dose of Sinovac and were feeling fine. Mom groused that even though they had an appointment, they “still need to wait for half an hour.”

    Our responses were more enthusiastic.

    “Great news,” I wrote.

    “Yay!” Pui-Ying texted, followed by celebratory emojis.

    “Congrats!” Pui Ling said.

    Pui-Ying had moved with her family to Malawi in 2016 to work as a doctor and conduct clinical research on children’s health. Resources at the Queen Elizabeth Central Hospital, where she works, were limited. When Madonna’s charity helped finance the construction of a new children’s wing at the hospital, which opened in 2017, it was big news.

    Staffing was tight even before the coronavirus, Pui-Ying said. When the pandemic came, the hospital decided on a one-week-on, one-week-off routine to reduce staff exposure to Covid-19 while ensuring that enough medical professionals would be working at all times. Masks, gloves and other protective equipment were scarce.

    In pediatrics, Pui-Ying and her colleagues set up a “respiratory zone” for children with Covid-19. It was essentially a two-room ward, with about a dozen beds in the main room. The second room, which was an isolation unit, had space for four children.

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