Phase 3 trial, recruiting 40,000 volunteers in Europe and Latin America. The company will get its first look at the data when 56 volunteers develop Covid-19. If most of them are in the placebo group, and few in the vaccinated group, it will be proof that the vaccine works.

with a lawsuit.

In April, the European Union finally fixed this shortfall, negotiating with Pfizer and BioNTech to get 1.8 billion doses of their vaccine between now and 2023. That arrangement has left analysts wondering how much demand will be left for CureVac.

“They’re going to miss the boat on the major, advanced-economy markets,” said Dr. Kirkegaard. “The U.S., Europe and Japan are going to be largely vaccinated using these Moderna and Pfizer vaccines.”

Dr. Haas countered that most of the bloc’s doses from Pfizer-BioNTech won’t come until next year. “CureVac sees itself as a major player in ending the Covid-19 pandemic in Europe and elsewhere,” he said.

Ursula von der Leyen, president of the European Commission, said that if the CureVac vaccine worked, it would be in the mix, thanks to two advantages: It is an mRNA vaccine, and it was created in Europe. It is also possible that individual European nations will make side deals with the company.

Billions of other people in low- and middle-income countries have yet to receive a vaccine, and experts say that CureVac may meet some of their demand. “We still need a lot of vaccine globally,” said Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai in New York. “I think a lot of people can benefit from it.”

The vaccines from Moderna and Pfizer-BioNTech are challenging to distribute in the developing world because of the equipment and power supply required to freeze these vaccines. CureVac’s RNA vaccine can stay stable for at least three months at 41 degrees Fahrenheit, and it can sit for 24 hours at room temperature before it is used.

“The stability is a real advantage,” Dr. Jackson said. C.E.P.I. is “in very active discussions” with CureVac, he said, about distributing the company’s vaccine through Covax, an initiative to distribute vaccines to low- and middle-income countries.

But CureVac is also designing a new generation of vaccines with a goal of eventually moving into markets in the United States and other wealthy nations. Because its potent RNA requires only a small dose, the company could potentially create vaccines for different variants and mix them in a single shot.

But such possibilities are meaningless until CureVac can prove that its vaccine works. Mary Warrell, a vaccine researcher at the University of Oxford, is reluctant to speculate about the fate of the vaccine before that milestone.

“Prediction during this pandemic has rarely been profitable,” she warned.

Matina Stevis-Gridneff contributed reporting.

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What Would It Take to Vaccinate the Whole World? Let’s Take a Look.

More than 600 million people worldwide have been at least partially vaccinated against Covid-19 — meaning that more than seven billion still have not. It is a striking achievement in the shadow of a staggering challenge.

Half of all the doses delivered so far have gone into the arms of people in countries with one-seventh of the world’s people, primarily the United States and European nations. Dozens of countries, particularly in Africa, have barely started their inoculation campaigns.

As wealthy countries envision the pandemic retreating within months — while poorer ones face the prospect of years of suffering — frustration has people around the world asking why more vaccine isn’t available.

Nationalism and government actions do much to help explain the stark inequity between the world’s haves and have-nots. So, for that matter, does government inaction. And the power of the pharmaceutical companies, which at times seem to hold all the cards, cannot be ignored.

said Sarah Schiffling, an expert on pharmaceutical supply chains and humanitarian relief at Liverpool John Moores University in Britain. “We’re adding this on top. We’re basically doubling output. Supply chains of this magnitude usually take years to accomplish.”

Covax, the global effort to supply vaccines to the developing world at little or no cost.

But some of the pledges have not been fulfilled as yet. And in any case they amount to a small fraction of what the wealthy nations have spent on themselves, and a small fraction of the global need.

The Covax campaign also lost some ground when concerns emerged that the AstraZeneca shot — which was expected to be the backbone of the effort — might be tied to very rare but serious side effects. That led to some public wariness over using it.

Many public health advocates have called for Western governments to force drug makers to share their own patented processes with the rest of the world. No vaccine producer has done so voluntarily, and no government has indicated that it will move in that direction.

mass production of the Johnson & Johnson shot for people in other parts of the world. And the administration said this week that it would send up to 60 million doses of AstraZeneca’s vaccine — which the United States has bought but isn’t using — to other countries.

But the United States remains well behind China and Russia in such “vaccine diplomacy.”

The United States and other countries have also restricted exports of some vaccine-making materials, drawing intense criticism, especially from India, as Covid ravages that country on a scale not seen anywhere else. India’s own government has barred exports of finished vaccines, hampering immunization efforts in Africa.

This past week, the Biden administration said it would relax export controls for India.

controls a crucial patent on a process used in vaccine making, and its National Institutes of Health helped develop the Moderna vaccine.

All of that gives governments tremendous power to compel companies to work across boundaries, corporate as well as national, but they have been reluctant to use it. In the United States, that has started to change since President Biden took office in January.

“The government has huge leverage, the most over Moderna,” said Tinglong Dai, an associate professor at Johns Hopkins University’s business school who specializes in health care management.

AstraZeneca and Johnson & Johnson, two of the world’s largest pharmaceutical companies, have run into serious production problems with their Covid-19 vaccines — object lessons in the challenges of scaling up in a hurry from nothing to hundreds of millions of doses.

that process had never been used in a mass-produced vaccine. It calls for different equipment, materials, techniques and expertise than standard vaccines.

The mRNA vaccines encase the genetic material in “lipid nanoparticles,” microscopic bubbles of fat. Few facilities in the world have any experience mass-producing anything comparable. The vaccines also require ultracold temperatures, which experts say limits their use — at least for now — to wealthier countries.

Many pharmaceutical companies insist that they could take on that production, but experts say they would be likely to need considerable time and investment to prepare, a point that Stéphane Bancel, chief executive of Moderna, made in February at a European Parliament hearing.

Even in contracting with highly advanced firms to do the work, Mr. Bancel said, Moderna had to spend months essentially gutting facilities, rebuilding them to new specifications with new equipment, testing and retesting that gear and teaching people the process.

“You cannot go to a company and have them start right away to make mRNA product,” he said.

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The Covid-19 Plasma Boom Is Over. What Did We Learn From It?

Scott Cohen was on a ventilator struggling for his life with Covid-19 last April when his brothers pleaded with Plainview Hospital on Long Island to infuse him with the blood plasma of a recovered patient.

The experimental treatment was hard to get but was gaining attention at a time when doctors had little else. After an online petition drew 18,000 signatures, the hospital gave Mr. Cohen, a retired Nassau County medic, an infusion of the pale yellow stuff that some called “liquid gold.”

In those terrifying early months of the pandemic, the idea that antibody-rich plasma could save lives took on a life of its own before there was evidence that it worked. The Trump administration, buoyed by proponents at elite medical institutions, seized on plasma as a good-news story at a time when there weren’t many others. It awarded more than $800 million to entities involved in its collection and administration, and put Dr. Anthony S. Fauci’s face on billboards promoting the treatment.

A coalition of companies and nonprofit groups, including the Mayo Clinic, Red Cross and Microsoft, mobilized to urge donations from people who had recovered from Covid-19, enlisting celebrities like Samuel L. Jackson and Dwayne Johnson, the actor known as the Rock. Volunteers, some dressed in superhero capes, showed up to blood banks in droves.

took a long time to measure its effectiveness. Eventually, studies did emerge to suggest that under the right conditions, plasma might help. But enough evidence has now accumulated to show that the country’s broad, costly plasma campaign had little effect, especially in people whose disease was advanced enough to land them in the hospital.

N.I.H. recently halted an outpatient trial of plasma because of a lack of benefit.

Doctors have used the antibodies of recovered patients as treatments for more than a century, for diseases including diphtheria, the 1918 flu and Ebola.

So when patients began falling ill with the new coronavirus last year, doctors around the world turned to the old standby.

In the United States, two hospitals — Mount Sinai in New York City and Houston Methodist in Texas — administered the first plasma units to Covid-19 patients within hours of each other on March 28.

Dr. Nicole M. Bouvier, an infectious-disease doctor who helped set up Mount Sinai’s plasma program, said the hospital had tried the experimental treatment because blood transfusions carry a relatively low risk of harm. With a new virus spreading quickly, and no approved treatments, “nature is a much better manufacturer than we are,” she said.

As Mount Sinai prepared to infuse patients with plasma, Diana Berrent, a photographer, was recovering from Covid-19 at her home in Port Washington, N.Y. Friends began sending her Mount Sinai’s call for donors.

thousands of Orthodox Jewish people were getting tested for coronavirus antibodies and showing up to donate. Coordinating it all was exhausting.

“April,” Mr. Lebovits recalled with a laugh, “was like 20 decades.”

Two developments that month further accelerated plasma’s use. With the help of $66 million in federal funding, the F.D.A. tapped the Mayo Clinic to run an expanded access program for hospitals across the country. And the government agreed to cover the administrative costs of collecting plasma, signing deals with the American Red Cross and America’s Blood Centers.

news releases announcing those deals got none of the flashy media attention that the billion-dollar contracts for Covid-19 vaccines did when they arrived later in the summer. And the government did not disclose how much it would be investing.

American Red Cross and America’s Blood Centers since last April.

“The convalescent plasma program was intended to meet an urgent need for a potential therapy early in the pandemic,” a health department spokeswoman said in a statement. “When these contracts began, treatments weren’t available for hospitalized Covid-19 patients.”

As spring turned to summer, the Trump administration seized on plasma — as it had with the unproven drug hydroxychloroquine — as a promising solution. In July, the administration announced an $8 million advertising campaign “imploring Americans to donate their plasma and help save lives.” The blitz included promotional radio spots and billboards featuring Dr. Fauci and Dr. Hahn, the F.D.A. commissioner.

provided access to its advertising agency, which created the look and feel for the Fight Is In Us campaign, which included video testimonials from celebrities.

although he later corrected his remarks following criticism from the scientific community.

the Infectious Diseases Society of America recommended that plasma not be used in hospitalized patients outside of a clinical trial. (On Wednesday, the society restricted its advice further, saying plasma should not be used at all in hospitalized patients.) In January, a highly anticipated trial in Britain was halted early because there was not strong evidence of a benefit in hospitalized patients.

narrowed the authorization for plasma so that it applied only to people who were early in the course of their disease or who couldn’t make their own antibodies.

Dr. Marks, the F.D.A. regulator, said that in retrospect, scientists had been too slow to adapt to those recommendations. They had known from previous disease outbreaks that plasma treatment is likely to work best when given early, and when it contained high levels of antibodies, he said.

“Somehow we didn’t really take that as seriously as perhaps we should have,” he said. “If there was a lesson in this, it’s that history actually can teach you something.”

pandemic exceptionalism” — had drained valuable time and attention from discovering other treatments.

“Pandemic exceptionalism is something we learned from prior emergencies that leads to serious unintended consequences,” she said, referring to the ways countries leaned on inadequate studies during the Ebola outbreak. With plasma, she said, “the agency forgot lessons from past emergencies.”

While scant evidence shows that plasma will help curb the pandemic, a dedicated clutch of researchers at prominent medical institutions continue to focus on the narrow circumstances in which it might work.

Dr. Arturo Casadevall, an immunologist at Johns Hopkins University, said many of the trials had not succeeded because they tested plasma on very sick patients. “If they’re treated early, the results of the trials are all consistent,” he said.

found that giving plasma early to older people reduced the progression of Covid-19. And an analysis of the Mayo Clinic program found that patients who were given plasma with a high concentration of antibodies fared better than those who did not receive the treatment. Still, in March, the N.I.H. halted a trial of plasma in people who were not yet severely ill with Covid-19 because the agency said it was unlikely to help.

With most of the medical community acknowledging plasma’s limited benefit, even the Fight Is In Us has begun to shift its focus. For months, a “clinical research” page about convalescent plasma was dominated by favorable studies and news releases, omitting major articles concluding that plasma showed little benefit.

the website has been redesigned to more broadly promote not only plasma, but also testing, vaccines and other treatments like monoclonal antibodies, which are synthesized in a lab and thought to be a more potent version of plasma. Its clinical research page also includes more negative studies about plasma.

Nevertheless, the Fight Is In Us is still running Facebook ads, paid for by the federal government, telling Covid-19 survivors that “There’s a hero inside you” and “Keep up the fight.” The ads urge them to donate their plasma, even though most blood banks have stopped collecting it.

Two of plasma’s early boosters, Mr. Lebovits and Ms. Berrent, have also turned their attention to monoclonal antibodies. As he had done with plasma last spring, Mr. Lebovits helped increase acceptance of monoclonals in the Orthodox Jewish community, setting up an informational hotline, running ads in Orthodox newspapers, and creating rapid testing sites that doubled as infusion centers. Coordinating with federal officials, Mr. Lebovits has since shared his strategies with leaders in the Hispanic community in El Paso and San Diego.

And Ms. Berrent has been working with a division of the insurer UnitedHealth to match the right patients — people with underlying health conditions or who are over 65 — to that treatment.

“I’m a believer in plasma for a lot of substantive reasons, but if word came back tomorrow that jelly beans worked better, we’d be promoting jelly beans,” she said. “We are here to save lives.”’

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Kati Kariko Helped Shield the World From the Coronavirus

She grew up in Hungary, daughter of a butcher. She decided she wanted to be a scientist, although she had never met one. She moved to the United States in her 20s, but for decades never found a permanent position, instead clinging to the fringes of academia.

Now Katalin Kariko, 66, known to colleagues as Kati, has emerged as one of the heroes of Covid-19 vaccine development. Her work, with her close collaborator, Dr. Drew Weissman of the University of Pennsylvania, laid the foundation for the stunningly successful vaccines made by Pfizer-BioNTech and Moderna.

For her entire career, Dr. Kariko has focused on messenger RNA, or mRNA — the genetic script that carries DNA instructions to each cell’s protein-making machinery. She was convinced mRNA could be used to instruct cells to make their own medicines, including vaccines.

But for many years her career at the University of Pennsylvania was fragile. She migrated from lab to lab, relying on one senior scientist after another to take her in. She never made more than $60,000 a year.

was published, in Immunity, it got little attention.

Dr. Weissman and Dr. Kariko then showed they could induce an animal — a monkey — to make a protein they had selected. In this case, they injected monkeys with mRNA for erythropoietin, a protein that stimulates the body to make red blood cells. The animals’ red blood cell counts soared.

25 years of work by multiple scientists, including Pieter Cullis of the University of British Columbia.

Scientists also needed to isolate the virus’s spike protein from the bounty of genetic data provided by Chinese researchers. Dr. Barney Graham, of the National Institutes of Health, and Jason McClellan, of the University of Texas at Austin, solved that problem in short order.

Testing the quickly designed vaccines required a monumental effort by companies and the National Institutes of Health. But Dr. Kariko had no doubts.

On Nov. 8, the first results of the Pfizer-BioNTech study came in, showing that the mRNA vaccine offered powerful immunity to the new virus. Dr. Kariko turned to her husband. “Oh, it works,” she said. “I thought so.”

To celebrate, she ate an entire box of Goobers chocolate-covered peanuts. By herself.

Dr. Weissman celebrated with his family, ordering takeout dinner from an Italian restaurant, “with wine,” he said. Deep down, he was awed.

“My dream was always that we develop something in the lab that helps people,” Dr. Weissman said. “I’ve satisfied my life’s dream.”

Dr. Kariko and Dr. Weissman were vaccinated on Dec. 18 at the University of Pennsylvania. Their inoculations turned into a press event, and as the cameras flashed, she began to feel uncharacteristically overwhelmed.

A senior administrator told the doctors and nurses rolling up their sleeves for shots that the scientists whose research made the vaccine possible were present, and they all clapped. Dr. Kariko wept.

Things could have gone so differently, for the scientists and for the world, Dr. Langer said. “There are probably many people like her who failed,” he said.

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The C.D.C. and N.I.H. launch a rapid, at-home testing initiative in Tennessee and North Carolina.

The Centers for Disease Control and Prevention and the National Institutes of Health announced a new initiative on Wednesday to help determine whether frequent, widespread use of rapid coronavirus tests slows the spread of the virus.

The program will make rapid at-home antigen tests freely available to every resident of two communities, Pitt County, N.C., and Hamilton County, Tenn., enough for a total of 160,000 people to test themselves for the coronavirus three times a week for a month.

“This effort is precisely what I and others have been calling for nearly a year — widespread, accessible rapid tests to help curb transmission,” said Michael Mina, an epidemiologist at Harvard University who has been a vocal proponent of rapid, at-home testing programs.

He added, “Taking 30 seconds out of your day three times a week to perform the test is something any person can do.”

testing remains essential, public health experts say.

“We have all hypothesized that testing at home, at scale could stop the chain of transmission of the virus and allow communities to discover many more cases,” said Bruce Tromberg, who directs the National Institute of Biomedical Imaging and Bioengineering and leads its rapid acceleration of diagnostics program, which is supplying the tests for the initiative. “All the mathematical models predict that. But this is a real world, real life example.”

Residents who decide to participate in the program can have the tests delivered to their homes or pick them up at local distribution sites. An online tool will guide participants through the testing process and help them interpret their results. Residents can also volunteer to complete surveys that will assess whether frequent testing has changed their behavior, knowledge about Covid-19, or opinions on vaccination.

Researchers at the University of North Carolina and Duke University will compare the test positivity, case and hospitalization rates in these two communities to those in other similar communities that are not participating in the program.

A. David Paltiel, a professor of health policy and management at Yale School of Public Health, called the launching of a real-world study of the effectiveness of rapid, at-home screening “just great news.” But he cautioned that the results will need to be interpreted carefully, especially if the residents who choose to participate in the initiative are not representative of the community at large.

“We know that self-selection tends to bring out the worried well and a disproportionate number of people who are already Covid-conscious or Covid-conscientious,” he said.

“It’ll be great to see how it works when in the hands of people who really care,” he added. But, he said, the results may not be widely generally applicable to screening programs in which participation is mandatory, as may be the case with some workplace and school programs.

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U.S. health officials question results from AstraZeneca’s vaccine trial, less than a day after they’re released.

Federal health officials said early Tuesday that results from a U.S. trial of AstraZeneca’s Covid-19 vaccine may have relied on “outdated information” that “may have provided an incomplete view of the efficacy data,” casting doubt on an announcement on Monday that had been seen as good news for the British-Swedish company as well as the global vaccination drive.

In a highly unusual statement released after midnight, the National Institute of Allergy and Infectious Diseases said that the data and safety monitoring board, an independent panel of medical experts under the National Institutes of Health that has been helping to oversee AstraZeneca’s U.S. trial, had notified government agencies and AstraZeneca late Monday that it was “concerned” by information the company had released that morning.

The institute urged AstraZeneca to work with the monitoring board “to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible.”

AstraZeneca did not immediately return a request for comment early Tuesday.

In a news release on Monday announcing the results of the U.S. trial, the company said that the vaccine it developed with the University of Oxford was 79 percent effective against Covid-19, a higher figure than observed in previous trials, and completely prevented the worst outcomes from the disease. The long-anticipated results were seen as encouraging global confidence in the vaccine, which was shaken this month when more than a dozen countries, mostly in Europe, temporarily suspended the shot’s use over concerns about possible rare side effects. After conducting a review, Europe’s top drug regulator said last week that the shot was “safe and effective.”

more than 17 million in Britain and the European Union, almost all without serious side effects. In an effort to increase public confidence, many European political leaders have gotten the injections in recent days. The AstraZeneca vaccine has also been administered in the past week to leaders in South Korea, Taiwan and Thailand.

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U.S. Health Officials Question AstraZeneca Vaccine Trial Results

Federal health officials said early Tuesday that results from a U.S. trial of AstraZeneca’s Covid-19 vaccine may have relied on “outdated information” that “may have provided an incomplete view of the efficacy data,” casting doubt on an announcement on Monday that had been seen as good news for the British-Swedish company as well as the global vaccination drive.

In a highly unusual statement released after midnight, the National Institute of Allergy and Infectious Diseases said that the data and safety monitoring board, an independent panel of medical experts under the National Institutes of Health that has been helping to oversee AstraZeneca’s U.S. trial, had notified government agencies and AstraZeneca late Monday that it was “concerned” by information the company had released that morning.

The institute urged AstraZeneca to work with the monitoring board “to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible.”

AstraZeneca did not immediately return a request for comment early Tuesday.

In a news release on Monday announcing the results of the U.S. trial, the company said that the vaccine it developed with the University of Oxford was 79 percent effective against Covid-19, higher than observed in previous trials, and completely prevented the worst outcomes from the disease. The long-anticipated results were seen as encouraging global confidence in the vaccine, which was shaken this month when more than a dozen countries, mostly in Europe, temporarily suspended the shot’s use over concerns about possible rare side effects.

the design of its clinical trials, its results and safety issues. That skepticism carried over to last week, when senior officials at a number of federal health agencies grew suspicious about why AstraZeneca had not announced data from its U.S. study.

That U.S. trial, which involved more than 32,000 participants, was the largest test of its kind for the shot. The results AstraZeneca released on Monday were from an interim look at the data after 141 Covid-19 cases had turned up among volunteers.

The company did not disclose how up-to-date the data are. If the analysis was conducted on data from a month or two ago, it is possible that a more current look would present a different picture of the vaccine’s effectiveness and safety. The company has said it will provide the Food and Drug Administration with a more comprehensive, recent set of data than what it disclosed on Monday. Although no clinical trial is large enough to rule out extremely rare side effects, AstraZeneca reported that its study turned up no serious safety issues.

The fresh data may have arrived too late to make much difference in the United States, where the vaccine is not yet authorized and is unlikely to become available before May. By then, federal officials predict, there will be enough vaccine doses for all of the nation’s adults from the three vaccines that have already been authorized: Pfizer-BioNTech, Moderna and Johnson & Johnson.

Even so, the better-than-expected results were seen as a heartening turn for AstraZeneca’s shot, whose low cost and simple storage requirements have made it a vital piece of the drive to vaccinate the world.

said last week that the shot was “safe and effective,” having conducted a review after a small number of people who had recently been inoculated developed blood clots and abnormal bleeding. The U.S. trial did not turn up any sign of such problems, although some safety issues can only be detected in the real world, once a drug or vaccine has been widely used.

Many millions of people have received the AstraZeneca shot worldwide, including more than 17 million in Britain and the European Union, almost all without serious side effects. In an effort to increase public confidence, many European political leaders have gotten the injections in recent days. The AstraZeneca vaccine has also been administered in the past week to leaders in South Korea, Taiwan and Thailand.

AstraZeneca said on Monday that it would continue to analyze the new data and prepare to apply in the coming weeks for emergency authorization in the United States. The vaccine has already been approved in more than 70 countries, but clearance from American regulators would bolster its global reputation.

The statement from the infectious disease institute comes after a series of miscues and communication blunders by AstraZeneca dating to last year that have eroded American officials’ trust in the company.

Last summer, at least some top F.D.A. officials learned only from news reports that AstraZeneca had paused its Phase ⅔ vaccine trial in Britain after a participant developed neurological symptoms. Then in September, after another participant in the British study fell ill with similar symptoms, AstraZeneca halted its trials globally but failed to promptly notify the U.S. authorities.

The U.S. study was ultimately paused for seven weeks last fall, in part because AstraZeneca was slow to provide the F.D.A. with evidence that the vaccine had not caused the neurological symptoms. Investigators ultimately concluded that the illnesses could not be linked to the vaccine. Still, the delay was a key reason that AstraZeneca fell so far behind the three other manufacturers whose vaccines have been granted emergency authorization in the United States.

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U.S. health officials question results from AstraZeneca’s vaccine trial, less than a day after they came out.

Federal health officials said early Tuesday that results from a U.S. trial of AstraZeneca’s Covid-19 vaccine may have relied on “outdated information” that “may have provided an incomplete view of the efficacy data,” casting doubt on an announcement on Monday that had been seen as good news for the British-Swedish company as well as the global vaccination drive.

In a highly unusual statement released after midnight, the National Institute of Allergy and Infectious Diseases said that the data and safety monitoring board, an independent panel of medical experts under the National Institutes of Health that has been helping to oversee AstraZeneca’s U.S. trial, had notified government agencies and AstraZeneca late Monday that it was “concerned” by information the company had released that morning.

The institute urged AstraZeneca to work with the monitoring board “to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible.”

AstraZeneca did not immediately return a request for comment early Tuesday.

In a news release on Monday announcing the results of the U.S. trial, the company said that the vaccine it developed with the University of Oxford was 79 percent effective against Covid-19, higher than observed in previous trials, and completely prevented the worst outcomes from the disease. The long-anticipated results were seen as encouraging global confidence in the vaccine, which was shaken this month when more than a dozen countries, mostly in Europe, temporarily suspended the shot’s use over concerns about possible rare side effects.

the design of its clinical trials, its results and safety issues. That skepticism carried over to last week, when senior officials at a number of federal health agencies grew suspicious about why AstraZeneca had not announced data from its U.S. study.

That U.S. trial, which involved more than 32,000 participants, was the largest test of its kind for the shot. The results AstraZeneca released on Monday were from an interim look at the data after 141 Covid-19 cases had turned up among volunteers.

The company did not disclose how up-to-date the data are. If the analysis was conducted on data from a month or two ago, it is possible that a more current look would present a different picture of the vaccine’s effectiveness and safety. The company has said it will provide the Food and Drug Administration with a more comprehensive, recent set of data than what it disclosed on Monday. Although no clinical trial is large enough to rule out extremely rare side effects, AstraZeneca reported that its study had turned up no serious safety issues.

The data may have arrived too late to make much difference in the United States, where the vaccine is not yet authorized and is unlikely to become available before May. By then, federal officials predict, there will be enough vaccine doses for all of the nation’s adults from the three vaccines that have already been authorized: Pfizer-BioNTech, Moderna and Johnson & Johnson.

Even so, the better-than-expected results were seen as a heartening turn for AstraZeneca’s shot, whose low cost and simple storage requirements have made it a vital piece of the drive to vaccinate the world.

said last week that the shot was “safe and effective,” having conducted a review after a small number of people who had recently been inoculated developed blood clots and abnormal bleeding. The U.S. trial did not turn up any sign of such problems, although some safety issues can only be detected in the real world, once a drug or vaccine has been widely used.

Many millions of people have received the AstraZeneca shot worldwide, including more than 17 million in Britain and the European Union, almost all without serious side effects. In an effort to increase public confidence, many European political leaders have gotten the injections in recent days. The AstraZeneca vaccine has also been administered in the past week to leaders in South Korea, Taiwan and Thailand.

AstraZeneca said on Monday that it would continue to analyze the new data and prepare to apply in the coming weeks for emergency authorization in the United States. The vaccine has already been approved in more than 70 countries, but clearance from American regulators would bolster its global reputation.

The statement from the infectious disease institute comes after a series of miscues and communication blunders by AstraZeneca dating to last year that have eroded American officials’ trust in the company.

Last summer, at least some top F.D.A. officials learned only from news reports that AstraZeneca had paused its Phase 2/3 vaccine trial in Britain after a participant developed neurological symptoms. Then in September, after another participant in the British study fell ill with similar symptoms, AstraZeneca halted its trials globally but failed to promptly notify the U.S. authorities.

The U.S. study was ultimately paused for seven weeks last fall, in part because AstraZeneca was slow to provide the F.D.A. with evidence that the vaccine had not caused the neurological symptoms. Investigators ultimately concluded that the illnesses could not be linked to the vaccine. Still, the delay was a key reason that AstraZeneca fell so far behind the three other manufacturers whose vaccines have been granted emergency authorization in the United States.

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The U.A.E. offers a third dose of Chinese vaccine to some with low immune response.

The distributor of China’s Sinopharm vaccine in the United Arab Emirates says it has started offering a “very small number” of people a third shot after these recipients reported insufficient levels of antibodies following a two-dose regimen.

The distributor, G42 Healthcare, has found that some people were “not really responsive” to the Sinopharm vaccine, Walid Zaher, the company’s chief researcher, told Dubai Eye Radio on Sunday.

Dr. Zaher’s disclosure could add to questions about the overall efficacy of the Sinopharm vaccine, which has been rolled out to at least six countries. The state-owned company has not reported detailed Phase 3 clinical data for scientists to independently assess the strength of its vaccines. Sinopharm did not respond to a request for comment.

It is unclear which of Sinopharm’s two vaccines Dr. Zaher was referring to. One was developed in conjunction with the Beijing Institute of Biological Products, and the other with the Wuhan Institute of Biological Products. In December, the Emirates became the first government to approve the vaccine that was made with the Beijing Institute.

test a third booster shot in response to concerns over coronavirus variants. Similarly, Moderna said it had shipped doses of a newly adjusted vaccine to the National Institutes of Health for testing that would address the variant first detected in South Africa, known as B.1.351.

Dr. Farida al-Hosani, a spokeswoman for the Emirates’ health sector, has also said that residents and Emiratis inoculated with the Sinopharm vaccine can get a third dose if they do not develop sufficient antibodies, telling the National newspaper this month that only a small number of people would be affected.

Dr. Zaher said he did not know the exact number of people who would require a third shot “because obviously we did not measure everyone, but it’s a very small number.” He said anyone who was concerned about their antibody levels after receiving the Sinopharm vaccine could approach their doctor about getting a third shot.

Sinopharm has said the vaccine made with the Beijing Institute has an efficacy rate of 79 percent, while the one made with the Wuhan Institute of Biological Products has an efficacy rate of 72.5 percent. Both are above the 50 percent threshold that the World Health Organization has said would make a vaccine effective for general use.

inoculating its population faster than any country except Israel and the Seychelles, is also using the Pfizer-BioNTech, Oxford-AstraZeneca and Sputnik V vaccines. The government is donating some of the Sinopharm doses it purchased to countries where it has strategic or commercial interests, including the Seychelles and Egypt.

But some doctors in Egypt have been reluctant to receive the shots, citing a lack of trust in the data released by Sinopharm and the Emirates, where some of the trials were held. Malaysia, one of the Emirates’ biggest trading partners, also declined an offer of 500,000 doses, saying that regulators would have to independently approve the Sinopharm vaccine.

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Rich Countries Signed Away a Chance to Vaccinate the World

In the coming days, a patent will finally be issued on a five-year-old invention, a feat of molecular engineering that is at the heart of at least five major Covid-19 vaccines. And the United States government will control that patent.

The new patent presents an opportunity — and some argue the last best chance — to exact leverage over the drug companies producing the vaccines and pressure them to expand access to less affluent countries.

The question is whether the government will do anything at all.

The rapid development of Covid-19 vaccines, achieved at record speed and financed by massive public funding in the United States, the European Union and Britain, represents a great triumph of the pandemic. Governments partnered with drugmakers, pouring in billions of dollars to procure raw materials, finance clinical trials and retrofit factories. Billions more were committed to buy the finished product.

But this Western success has created stark inequity. Residents of wealthy and middle-income countries have received about 90 percent of the nearly 400 million vaccines delivered so far. Under current projections, many of the rest will have to wait years.

to help an Indian company produce about 1 billion doses by the end of 2022 and his administration has donated doses to Mexico and Canada. But he has made it clear that his focus is at home.

“We’re going to start off making sure Americans are taken care of first,” Mr. Biden said recently. “But we’re then going to try and help the rest of the world.”

Pressuring companies to share patents could be seen as undermining innovation, sabotaging drugmakers or picking drawn-out and expensive fights with the very companies digging a way out of the pandemic.

As rich countries fight to keep things as they are, others like South Africa and India have taken the battle to the World Trade Organization, seeking a waiver on patent restrictions for Covid-19 vaccines.

as part of their vaccine diplomacy. The Gamaleya Institute in Moscow, for example, has entered into partnerships with producers from Kazakhstan to South Korea, according to data from Airfinity, a science analytics company, and UNICEF. Chinese vaccine makers have reached similar deals in the United Arab Emirates, Brazil and Indonesia.

Canada to Bangladesh say they can make vaccines — they just lack patent licensing deals. When the price is right, companies have shared secrets with new manufacturers in just months, ramping up production and retrofitting factories.

pressured Johnson & Johnson to accept the help and is using wartime procurement powers to secure supplies for the company. It will also pay to retrofit Merck’s production line, with an eye toward making vaccines available to every adult in the United States by May.

Despite the hefty government funding, drug companies control nearly all of the intellectual property and stand to make fortunes off the vaccines. A critical exception is the patent expected to be approved soon — a government-led discovery for manipulating a key coronavirus protein.

This breakthrough, at the center of the 2020 race for a vaccine, actually came years earlier in a National Institutes of Health lab, where an American scientist named Dr. Barney Graham was in pursuit of a medical moonshot.

For years, Dr. Graham specialized in the kind of long, expensive research that only governments bankroll. He searched for a key to unlock universal vaccines — genetic blueprints to be used against any of the roughly two dozen viral families that infect humans. When a new virus emerged, scientists could simply tweak the code and quickly make a vaccine.

In 2016, while working on Middle East Respiratory Syndrome, another coronavirus known as MERS, he and his colleagues developed a way to swap a pair of amino acids in the coronavirus spike protein. That bit of molecular engineering, they realized, could be used to develop effective vaccines against any coronavirus. The government, along with its partners at Dartmouth College and the Scripps Research Institute, filed for a patent, which will be issued this month.

another virus when the outbreak in China inspired his team to change focus. “We just flipped it to coronavirus and said, ‘How fast can we go?’” Dr. Graham recalled.

filed such a lawsuit in 2019 against the drugmaker Gilead over H.I.V. medication.

being lured to the United States.

“We funded the research, on both sides of the Atlantic,” said Udo Bullmann, a German member of the European Parliament. “You could have agreed on a paragraph that says ‘You are obliged to give it to poor countries in a way that they can afford it.’ Of course you could have.”

In May, the leaders of Pakistan, Ghana, South Africa and others called for governments to support a “people’s vaccine” that could be quickly manufactured and given for free.

They urged the governing body of the World Health Organization to treat vaccines as “global public goods.”

Though such a declaration would have had no teeth, the Trump administration moved swiftly to block it. Intent on protecting intellectual property, the government said calls for equitable access to vaccines and treatments sent “the wrong message to innovators.”

World leaders ultimately approved a watered-down declaration that recognized extensive immunization — not the vaccines themselves — as a global public good.

grant language requiring equitable access to vaccines. As leverage, the organization retains some right to the intellectual property.

Dr. Slaoui, who came to Warp Speed after leading research and development at GlaxoSmithKline, is sympathetic to this idea. But it would have been impractical to demand patent concessions and still deliver on the program’s primary goals of speed and volume, he said.

“I can guarantee you that the agreements with the companies would have been much more complex and taken a much longer time,” he said. The European Union, for example, haggled over price and liability provisions, which delayed the rollout.

In some ways, this was a trip down a trodden path. When the H1N1 “swine flu” pandemic broke out in 2009, the wealthiest countries cornered the global vaccine market and all but locked out the rest of the world.

Experts said at the time that this was a chance to rethink the approach. But the swine flu pandemic fizzled and governments ended up destroying the vaccines they had hoarded. They then forgot to prepare for the future.

For months, the United States and European Union have blocked a proposal at the World Trade Organization that would waive intellectual property rights for Covid-19 vaccines and treatments. The application, put forward by South Africa and India with support from most developing nations, has been bogged down in procedural hearings.

“Every minute we are deadlocked in the negotiating room, people are dying,” said Mustaqeem De Gama, a South African diplomat who is involved in the talks.

But in Brussels and Washington, leaders are still worried about undermining innovation.

During the presidential campaign, Mr. Biden’s team gathered top intellectual property lawyers to discuss ways to increase vaccine production.

“They were planning on taking the international view on things,” said Ana Santos Rutschman, a Saint Louis University law professor who participated in the sessions.

Most of the options were politically thorny. Among them was the use of a federal law allowing the government to seize a company’s patent and give it to another in order to increase supply. Former campaign advisers say the Biden camp was lukewarm to this proposal and others that called for a broader exercise of its powers.

The administration has instead promised to give $4 billion to Covax, the global vaccine alliance. The European Union has given nearly $1 billion so far. But Covax aims to vaccinate only 20 percent of people in the world’s poorest countries this year, and faces a $2 billion shortfall even to accomplish that.

Dr. Graham, the N.I.H. scientist whose team cracked the coronavirus vaccine code for Moderna, said that pandemic preparedness and vaccine development should be international collaborations, not competitions.

“A lot of this would not have happened unless there was a big infusion of government money,” he said.

But governments cannot afford to sabotage companies that need profit to survive.

Dr. Graham has largely moved on from studying the coronavirus. He is searching for a universal flu vaccine, a silver bullet that could prevent all strains of the disease without an annual tweak.

Though he was vaccinated through work, he spent the early part of the year trying to get his wife and grown children onto waiting lists — an ordeal that even one of the key inventors had to endure. “You can imagine how aggravating that is,” he said.

Matina Stevis-Gridneff and Monika Pronczuk contributed reporting.

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