This time, the Americans won’t be coming. The battle for Kunduz has become an intimate fight between Afghan opponents at close range.

“Every night they come to these houses and fire on us,” said the chief of police of Kunduz’s Third Municipal District, Sayed Mansoor Hashimi, looking out at now-vacant dwellings all around his police station. “Slowly, slowly they are tightening the circle.”

The war in Kunduz is intertwined with the fabric of the city. Shopping trips are planned between bursts of war. Residents no longer pay sufficient attention, said Marzia Salam Yaftali, the medical director at Kunduz Regional Hospital. “They are wounded in the streets or in the bazaar,” she said.

At the hospital, Ezzatullah, 14, lay in one of the wards, his legs wrapped in bandages: He lost both his feet when a mortar landed as he was playing outside his house. Three members of his family, including one of his parents, were killed.

“I can’t go to school now,” he said. Asked what he saw as his future, he replied firmly: “I want to be a man, to rebuild my country.”

The war, and the enemy, are inescapable. “We have to live here. Where can we go?” asked Ezamuddin Safi, a telecommunications worker who had to flee his home inside the city in early July. He was passing the day inside a small downtown restaurant.

“My 3-year-old boy, he screams when he hears the firing. He’s tired,” said Mr. Safi, 25. “Taliban are everywhere.”

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Taliban Try to Polish Their Image as They Push for Victory

KABUL, Afghanistan — In June, when the Taliban took the district of Imam Sahib in Afghanistan’s north, the insurgent commander who now ruled the area had a message for his new constituents, including some government employees: Keep working, open your shops and keep the city clean.

The water was turned back on, the power grid was repaired, garbage trucks collected trash and a government vehicle’s flat tire was mended — all under the Taliban’s direction.

Imam Sahib is one of dozens of districts caught up in a Taliban military offensive that has swiftly captured more than a quarter of Afghanistan’s districts, many in the north, since the U.S. withdrawal began in May.

It is all part of the Taliban’s broader strategy of trying to rebrand themselves as capable governors while they press a ruthless, land-grabbing offensive across the country. The combination is a stark signal that the insurgents fully intend to try for all-out dominance of Afghanistan once the American pullout is finished.

have begun to muster militias to defend their home turf, skeptical that the Afghan security forces can hold out in the absence of their American backers, in a painful echo of the country’s devastating civil war breakdown in the 1990s.

report. Some homes there were burned down by the Taliban, residents said.

“The Taliban burned my house while my family was in the house,” said Sirajuddin Jamali, a tribal elder. “In 2015, a military base was under siege and we provided food and water for them, but now the Taliban are taking revenge,” Mr. Jamali sobbed. “Do they do the same in any area the Taliban take?”

Zabihullah Mujahid, a spokesman for the Taliban, said the accusations of burning down homes was under investigation.

The group’s public responses, though rarely sincere, play directly into a strategy meant to portray the insurgents as a comparable option to the Afghan government. And they ignore the fact that local feuds drive large amounts of the war’s violence, outweighing any official orders from the Taliban leadership.

On the battlefield, things are shifting quickly. Thousands of Afghan soldiers and militia members have surrendered in past weeks, forfeiting weapons, ammunition and armored vehicles as the Taliban take district after district. Government forces have counterattacked, recapturing several districts, though not on the scale of the insurgents’ recent victories.

But little reported are Taliban losses, aside from the inflated body counts announced by the Afghan government’s Ministry of Defense. The Taliban, with their base strength long estimated to be between 50,000 and 100,000 fighters, depending on the time of year, have taken serious casualties in recent months, especially in the country’s south.

The casualties are primarily from the Afghan and U.S. air forces, and sometimes from Afghan commando units.

Mullah Basir Akhund, a former commander and member of the Taliban since 1994, said that cemeteries along the Pakistani border, where Taliban fighters have long been buried, are filling up faster than in years past. Pakistani hospitals, part of the country’s unwavering line of support for the insurgents, are running out of bed space. During a recent visit to a hospital in Quetta, a hub for the Taliban in Pakistan, Mr. Akhund said he saw more than 100 people, most of them Taliban fighters, waiting to be treated.

But despite tough battles, the weight of a nearly withdrawn superpower, and the Taliban’s own leadership issues, the insurgents continue to adapt.

Even as they seek to conquer the country, the Taliban are aware of their legacy of harsh rule, and do not want to “become the same pariah and isolated state” that Afghanistan was in the 1990s, said Ibraheem Bahiss, an International Crisis Group consultant and an independent research analyst.

“They’re playing the long game,” Mr. Bahiss said.

Reporting was contributed by Asadullah Timory in Herat, Taimoor Shah in Kandahar, Ruhullah Khapalwak, Farooq Jan Mangal in Khost and Zabihullah Ghazi in Jalalabad.

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Pakistan’s Private Vaccinations Draw Criticism

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ISLAMABAD, Pakistan — The coronavirus was ripping through Pakistan, and Muhammad Nasir Chaudhry was worried. Long lines and tight supplies plagued the government’s free vaccine campaign. Newspapers were filled with reports of well-connected people jumping the line for a free dose.

Then Mr. Chaudhry, a 35-year-old government consultant, discovered he could pay to leapfrog the long lines himself. He registered to take two doses of the Russian-made Sputnik V vaccine for about $80 from a private hospital. That’s a lot of money in a country where the average worker makes about $110 per month, but Mr. Chaudhry was ready to make the commitment.

Critics have assailed such private sales in Pakistan and around the world, saying that they make inoculations available only to the wealthy. But in Pakistan, like elsewhere, tight supplies have stymied those efforts. The private hospitals are out of supplies, and Mr. Chaudhry still hasn’t been vaccinated.

“I am willing to pay double the price for the vaccine, but I don’t want to wait on and on,” Mr. Chaudhry said.

bought up most of the world’s vaccine supplies to protect their own people, leaving millions of doses stockpiled and in some places unused. Less developed countries scramble over what’s left.

To speed up vaccinations, some countries have allowed doses to be sold privately. But those campaigns have been troubled by supply issues and by complaints that they simply reflect the global disparities.

blocked them over fears that counterfeit vaccines would be sold. In the United States, some well-connected companies, like Bloomberg, have secured doses for employees.

can’t find vaccines to buy. Demand has been strong. The government sets a ceiling on prices but has been locked in a dispute with private importers over how much that should be.

In April, in the city of Karachi, long lines formed when two private hospitals began selling the Sputnik V vaccine to walk-ins. Private hospitals in Islamabad, the capital, and Lahore faced a similar rush of people and ran short within days. Hospitals in the major cities have now stopped taking walk-ins, and online registration has also been put on hold.

Sputnik V isn’t the only vaccine that the government allows to be sold privately. A one-dose shot made by CanSino Biologics of China is priced at around $28. Demand has been weaker because of greater public confidence in the Russian vaccine. Still, supplies sold out quickly after the CanSino doses went on sale last month. The government has said another 13.2 million doses will arrive in June.

AGP Limited, a private pharmaceutical company that has imported 50,000 doses of Sputnik, is urging patience.

“Sputnik V received an overwhelming response in Pakistan with thousands of people being vaccinated in just a few days and an even higher number of registrations confirmed in hospitals across Pakistan,” said Umair Mukhtar, a senior official of AGP Limited. He said the company has placed large orders for more.

The government price dispute could delay further expansion. The drug regulatory authority wants Sputnik V to be sold at a lower price. AGP won an interim court order on April 1 to sell the vaccine until a final price is fixed.

For those who can afford the doses, frustration is growing. Junaid Jahangir, an Islamabad-based lawyer, said several of his friends got private inoculations. He registered with a private lab for Sputnik V but got a text message later saying that the vaccination drive was on hold.

“I am being denied a fair chance to fight this virus if I end up getting infected,” Mr. Jahangir said. “The demand is there, and I don’t see what could possibly be the reason behind the inefficiency in supply.”

Some of the people who paid for private doses justified their decision by citing media reports that some well-connected people were jumping the line to get free, public doses. In May, at least 18 low-level health care workers were suspended by the authorities in Lahore for vaccinating people out of turn after taking bribes.

Iffat Omar, an actor and talk show host, apologized publicly in April for jumping ahead of the line to get the vaccine. “I am sorry,” she said on Twitter. “I am ashamed. I apologise from the bottom of my heart. I will repent.”

Fiza Batool Gilani, an entrepreneur and the daughter of Yusuf Raza Gilani, the former prime minister, said she knows of several young people who jumped the queue and got the free government vaccine in recent weeks.

“I was myself offered out of turn, free vaccine, but I declined as I wanted to avail the private vaccine,” said Ms. Gilani. Wealthy people should pay for their doses, she said, adding that her family would pay for CanSino shots for its household staff.

Many people, like Tehmina Sadaf, don’t have that option.

Ms. Sadaf, 35, lives along with her husband and a seven-year old son in a working-class neighborhood on the outskirts of Islamabad. Her husband is a cleric at a mosque. She gives Quran lessons to young children. She said the pandemic had negatively impacted the family’s income of around $128 per month. “After paying the house rent and electricity bill, we are not left with much,” she said.

She had her doubts about the public vaccine, “but the price of the private vaccine is very high,” she said. “It should have been lower so that poor people like us can also afford it.”

Zia ur-Rehman contributed reporting from Karachi, Pakistan. Richard C. Paddock and Muktita Suhartono contributed reporting.

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Australia, ‘Hermit Nation’? Some Warn Against Another Year of Shut Borders.

MELBOURNE, Australia — When Australian officials announced last week that the country was unlikely to fully reopen its borders until mid-2022 because of the coronavirus, the backlash immediately began building.

Critics warned that Australia risked becoming a “hermit nation.” Members of the Australian diaspora who had been struggling to return home for months saw it as another blow. The announcement drew dire warnings from business, legal and academic leaders.

Polls show that keeping the borders shut is a popular idea. But the opposition sees political opportunism on the part of the government. Others predict that a continued policy of isolationism means young people could “face a lost decade” because of prolonged economic loss and social dislocation.

Australian officials contend that the restrictions on international travel — some of the strictest in the world — are the main reason the country has been so successful in crushing the virus. The government is resisting pressure from many quarters to consider an earlier reopening, with Prime Minister Scott Morrison declaring on Tuesday, “I’m not going to take risks with Australians’ lives.”

report, titled “A Roadmap to Reopening,” of long-lasting damage to the country, and especially its young people.

“There is an illusion that Australia can go at it alone and be this Shangri-La in the South Pacific,” Tim Soutphommasane, a political expert at the University of Sydney and co-sponsor of the report, said in an interview. “But I think that’s a misguided view. Other countries that do have a vaccinated population will be able to attract skilled migrants, have their universities open up to international students.”

recent poll showing that three-quarters of Australians support it.

Many were barred for weeks from flying home from India because of the Covid crisis raging there. Tens of thousands have been separated from their families or have put their lives on hold as the country refused to budge on travel restrictions.

For Madeleine Karipidis, an Australian solicitor living in London, the travel hurdles have driven her to take a drastic step. She moved to London from her native Australia seven years ago. After a year of being unable to get home to see her family, and after the government announced the extended closure last week, she began the process of applying for British citizenship.

Government data released on Monday showed that 1.5 million vaccine doses — a quarter of those distributed — had not been used.

Vaccine complacency is also a growing concern, with some Australians seeing the perceived risks of a shot as outweighing the danger of getting sick from the coronavirus.

Still, the government predicts that most people will be vaccinated by the end of the year. But that in itself will not be enough to trigger the reopening of borders, Mr. Morrison has said, because it excludes “millions” of children and those who choose not to be vaccinated. The vaccines may also not be equipped to deal with new variants and mutations, he added.

For Owais Ahmed, an Australian permanent resident and a cybersecurity consultant, the border closure has put his life in limbo. His family and his fiancée are in Pakistan, and though he has been trying to leave Australia to see them, his requests for an exemption have been denied.

Mr. Ahmed said he had been happy to wait out the border closure last year, but that the extended lockdown now seemed more political than medical. His plans to get married and start a family in Australia have all been put on pause.

“I just want to continue my life,” he said.

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Biden Administration Clears 3 Guantánamo Detainees for Release

The Biden administration has approved three detainees at Guantánamo Bay for release to countries that agree to impose security conditions on them, including the oldest of the remaining wartime prisoners, lawyers and United States government officials said on Monday.

The approvals raised to nine the number of the 40 detainees currently at the wartime prison who have been approved for transfer to other countries. But it is unclear where the three men will go, or when, in part because the State Department has to make diplomatic and security arrangements with countries to take them.

Some of the other detainees who have been cleared for release over the years have been waiting for a decade for another country to agree to take them. In some instances, countries are asked to continue to jail the detainees or put them on trial. In most cases, they are asked to prevent them from traveling outside the country for at least two years.

Among those who have been granted approval is Saifullah Paracha, 73, of Pakistan, who was captured in Thailand in 2003. In addition to being the oldest of the detainees, he has also been described as among the sickest there, with heart disease, diabetes and high blood pressure.

Abdul Rabbani, 54, also a citizen of Pakistan, and Uthman Abdul al-Rahim Uthman, 40, a Yemeni. None have been charged with a crime by the United States in the two decades they have been in custody.

Of the other remaining detainees, 12 have been charged with war crimes, one of them has been convicted, and 19 are considered too dangerous for transfer to the custody of another country.

Word that the men were approved for release initially came from their lawyers, who heard about it from prisoners in attorney-client telephone calls. Two government officials confirmed the three release decisions, but on the condition of anonymity because they were not authorized to discuss it.

The decision to approve the three releases, one official said, was made early last week by the attorney general, the director of national intelligence, the chairman of the Joint Chiefs of Staff and the secretaries of defense, homeland security and state. All of them have representatives who sit on the Periodic Review Board, the organization that assesses the threat posed by the detainees.

Khalid Shaikh Mohammed, and Mr. Mohammed’s nephew, Ammar al-Baluchi, with financial transactions in Pakistan after the attacks. Both men are accused of conspiring in the Sept. 11 attacks, a capital case.

returned to Pakistan last year in a deal with prosecutors to drop the case if he relinquished his status as a permanent resident of the United States.

Saifullah Paracha’s younger son, Mustafa Paracha, said in an interview last year that his father aspired to spend time with family upon his return to Pakistan, and a first concern would be to attend to his health care needs. Early in his detention, U.S. military doctors had airlifted a cardiac catheterization lab and surgical team to Guantánamo, but he refused to consent to the procedure out of concern about the quality of the medical care available to him there.

Typically, the Periodic Review Secretariat, which administers the board, publishes the justifications for making the release decisions on its website. The decisions usually include a recommendation for security assurance as well as the board’s recommendations for rehabilitation, repatriation or resettlement of the detainee who is approved for transfer. But it had not done so by Monday night.

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Lockdown Ends in England, for Now, at Least

LONDON — Pubs opened for drinks indoors, lights went on in theaters and airports buzzed with a steady stream of travelers on Monday, but the latest easing of Covid-19 restrictions in England was accompanied by growing fears that a variant of the virus could delay a full return to normality.

The lifting of a wide range of coronavirus rules Monday coincided with a small but worrying spike in cases of a variant, first identified in India, that threatens a lockdown-lifting road map frequently described by Prime Minister Boris Johnson as “cautious but irreversible.”

Already, the second part of that pledge is sounding less secure than it once seemed. In recent days the authorities have scrambled to ramp up testing and inoculation in parts of the country seeing a sharp rise in cases of the more transmissible variant. More than 6,200 people were vaccinated over the weekend in Bolton, a badly hit town near Manchester in the northwest of England.

The opposition Labour Party has accused Mr. Johnson of bringing on the trouble by delaying a decision to close borders to flights from India last month, while government scientific advisers have expressed their concerns about moving too fast to remove curbs.

Even Mr. Johnson, who is normally only too keen to ridicule pessimists as “doomsters and gloomsters,” urged Britons to be cautious in the face of the threat from the new variant, saying that there was a risk of “significant disruption” to plans for easing rules.

Nor did Mr. Johnson plan to visit a pub or restaurant on Monday to celebrate in front of the TV cameras, his office said.

In recent weeks Mr. Johnson has been able to claim credit for a highly successful vaccine program that, combined with lockdown restrictions, has cut cases and death rates to a fraction of their peak numbers. That has enabled England to start easing the burden on many of the parts of the economy that were worst affected by a lockdown in January.

Under the changes that came into force on Monday, pubs and restaurants can serve indoors as well as outside, people can hug each other and mix inside their homes in limited numbers.

Museums, theaters and movie theaters, sports stadiums, hotels and indoor playgrounds opened their doors again in England, though Scotland, Wales and Northern Ireland all have slightly different timetables and conditions for relaxing rules.

A legal ban on all but essential foreign travel ended too, though travelers to any other than a small number of destinations will have to quarantine on their return.

Altogether, that represents the first real breath of freedom for many in England since the third national lockdown was declared in early January. Though restaurants and pubs have been able to serve food and drink outdoors for several weeks, the weather has been unseasonably cold and often rainy, leaving many diners and drinkers shivering in damp beer gardens.

While the government will fight hard not to have to reverse the changes introduced on Monday, there are growing doubts about whether it can proceed with the next stage of the road map. That change, scheduled to take place on June 21, would scrap almost all remaining restrictions.

But with a surge of cases in some communities, including Bolton, the government is refusing to rule out any measures, possibly including the imposition of new restrictions on specific Covid-19 hot spots.

“We must be humble in the face of this virus,” the health secretary, Matt Hancock, told Parliament on Monday, adding that there were now 86 areas with five or more cases of the variant whose higher transmission rate “poses a real risk.” While the overall case numbers, at 2,323, remain low, they have been multiplying rapidly.

Mr. Johnson continues to hear criticism for failing to clamp down fast enough on travel from India, even sparing it for some weeks after placing restrictions on travel from Pakistan and Bangladesh.

Under Britain’s travel system those arriving from “red list” countries that are deemed high risk are required to quarantine in hotels.

“Our borders have been as secure as a sieve,” said Jonathan Ashworth, who speaks for the opposition Labour Party on health issues. “The delay in adding India to the red list surely now stands as a catastrophic misstep.”

Pakistan and Bangladesh were red listed on April 9 but India was not added until April 23, and Mr. Johnson’s critics have suggested he was reluctant to upset India’s prime minister, Narendra Modi, with whom he is trying to strike a trade deal.

Mr. Hancock rejected that claim and said that significantly more people arriving from Bangladesh and Pakistan tested positive for Covid-19 than those arriving from India. In Parliament on Monday he accused the Labour Party of selective hindsight, saying that last month the Indian variant had not been identified as one of concern.

But some experts believe that the government should have reacted faster to the emergence of the variant. “Many of us in the U.K., we’re appalled at the huge delay in classifying it as a variant of concern,” said Peter English, a retired consultant in communicable disease control.

“You can’t stop diseases from crossing boundaries — they inevitably will,” he said, adding: “But you can slow the spread, and while that’s happening, you can learn more about it.”

Mr. English said that there was not yet enough data available to determine how effective vaccines are in combating the variant, but added that more financial support should be given to those on low incomes who need to self-isolate.

In general, Britons are being offered vaccination based on their age, with those oldest treated first. Appointments are to be extended this week to 37-year-olds, Mr. Hancock said.

However, in areas affected by the Indian variant, health chiefs appear to be offering vaccines to some younger people, using the flexibility in guidelines that, for example, suggest the vaccination of those living in a multigenerational household.

On Monday, Mr. Hancock also said that of 19 cases in Bolton hospitals, most of the patients were eligible for vaccination but had not had one. That prompted a debate in and beyond Mr. Johnson’s Conservative Party about whether the lifting of lockdown restrictions should be reversed to protect people who refuse a vaccine.

Andrew Lloyd Webber, composer and theater impresario, told the BBC that vaccine hesitancy was not only foolish but selfish. He added that he could not reopen his shows without an assurance that all restrictions would be eased as planned from June 21, allowing for full seating without distancing.

“I just feel so strongly at the moment, particularly the people who are not getting vaccinated and everything, just how selfish it is because so many people depend on this June 21 date, they really depend on it,” he said.

Megan Specia contributed reporting from London.

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Why Vaccinating the World Against Covid-19 Will Be Hard

In delivering vaccines, pharmaceutical companies aided by monumental government investments have given humanity a miraculous shot at liberation from the worst pandemic in a century.

But wealthy countries have captured an overwhelming share of the benefit. Only 0.3 percent of the vaccine doses administered globally have been given in the 29 poorest countries, home to about 9 percent of the world’s population.

Vaccine manufacturers assert that a fix is already at hand as they aggressively expand production lines and contract with counterparts around the world to yield billions of additional doses. Each month, 400 million to 500 million doses of the vaccines from Moderna, Pfizer and Johnson & Johnson are now being produced, according to an American official with knowledge of global supply.

But the world is nowhere close to having enough. About 11 billion shots are needed to vaccinate 70 percent of the world’s population, the rough threshold needed for herd immunity, researchers at Duke University estimate. Yet, so far, only a small fraction of that has been produced. While global production is difficult to measure, the analytics firm Airfinity estimates the total so far at 1.7 billion doses.

dangerous new variants emerge, requiring booster shots and reformulated vaccines, demand could dramatically increase, intensifying the imperative for every country to lock up supply for its own people.

The only way around the zero-sum competition for doses is to greatly expand the global supply of vaccines. On that point, nearly everyone agrees.

But what is the fastest way to make that happen? On that question, divisions remain stark, undermining collective efforts to end the pandemic.

Some health experts argue that the only way to avert catastrophe is to force drug giants to relax their grip on their secrets and enlist many more manufacturers in making vaccines. In place of the existing arrangement — in which drug companies set up partnerships on their terms, while setting the prices of their vaccines — world leaders could compel or persuade the industry to cooperate with more companies to yield additional doses at rates affordable to poor countries.

Those advocating such intervention have focused on two primary approaches: waiving patents to allow many more manufacturers to copy existing vaccines, and requiring the pharmaceutical companies to transfer their technology — that is, help other manufacturers learn to replicate their products.

more than 100 countries in asking the W.T.O. to partially set aside vaccine patents.

But the European Union has signaled its intent to oppose waivers and support only voluntary tech transfers, essentially taking the same position as the pharmaceutical industry, whose aggressive lobbying has heavily shaped the rules in its favor.

Some experts warn that revoking intellectual property rules could disrupt the industry, slowing its efforts to deliver vaccines — like reorganizing the fire department amid an inferno.

“We need them to scale up and deliver,” said Simon J. Evenett, an expert on trade and economic development at the University of St. Gallen in Switzerland. “We have this huge production ramp up. Nothing should get in the way to threaten it.”

Others counter that trusting the pharmaceutical industry to provide the world with vaccines helped create the current chasm between vaccine haves and have-nots.

The world should not put poorer countries “in this position of essentially having to go begging, or waiting for donations of small amounts of vaccine,” said Dr. Chris Beyrer, senior scientific liaison to the Covid-19 Prevention Network. “The model of charity is, I think, an unacceptable model.”

halting vaccine exports a month ago. Now, as a wave of death ravages the largely unvaccinated Indian population, the government is drawing fire at home for having let go of doses.

poses universal risks by allowing variants to take hold, forcing the world into an endless cycle of pharmaceutical catch-up.

“It needs to be global leaders functioning as a unit, to say that vaccine is a form of global security,” said Dr. Rebecca Weintraub, a global health expert at Harvard Medical School. She suggested that the G7, the group of leading economies, could lead such a campaign and finance it when the members convene in England next month.

Pfizer expects to sell $26 billion worth of Covid vaccines this year; Moderna forecasts that its sales of Covid vaccines will exceed $19 billion for 2021.

History also challenges industry claims that blanket global patent rights are a requirement for the creation of new medicines. Until the mid-1990s, drug makers could patent their products only in the wealthiest markets, while negotiating licenses that allowed companies in other parts of the world to make generic versions.

Even in that era, drug companies continued to innovate. And they continued to prosper even with the later waivers on H.I.V. drugs.

“At the time, it rattled a lot of people, like ‘How could you do that? It’s going to destroy the pharmaceutical industry,’” recalled Dr. Anthony S. Fauci, President Biden’s chief medical adviser for the pandemic. “It didn’t destroy them at all. They continue to make billions of dollars.”

Leaders in the wealthiest Western nations have endorsed more equitable distribution of vaccines for this latest scourge. But the imperative to ensure ample supplies for their own nations has won out as the virus killed hundreds of thousands of their own people, devastated economies, and sowed despair.

The drug companies have also promised more support for poorer nations. AstraZeneca’s vaccine has been the primary supply for Covax, and the company says it has sold its doses at a nonprofit price.

stumbled, falling short of production targets. And producing the new class of mRNA vaccines, like those from Pfizer-BioNTech and Moderna, is complicated.

Where pharmaceutical companies have struck deals with partners, the pace of production has frequently disappointed.

“Even with voluntary licensing and technology transfer, it’s not easy to make complex vaccines,” said Dr. Krishna Udayakumar, director of the Duke Global Health Innovation Center.

Much of the global capacity for vaccine manufacturing is already being used to produce other lifesaving inoculations, he added.

But other health experts accuse major pharmaceutical companies of exaggerating the manufacturing challenges to protect their monopoly power, and implying that developing countries lack the acumen to master sophisticated techniques is “an offensive and a racist notion,” said Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University.

With no clear path forward, Ms. Okonjo-Iweala, the W.T.O. director-general, expressed hope that the Indian and South African patent-waiver proposal can be a starting point for dialogue.

“I believe we can come to a pragmatic outcome,” she said. “The disparity is just too much.”

Peter S. Goodman reported from London, Apoorva Mandavilli from New York, Rebecca Robbins from Bellingham, Wash., and Matina Stevis-Gridneff from Brussels. Noah Weiland contributed reporting from New York.

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What Would It Take to Vaccinate the World Against Covid?

In delivering vaccines, pharmaceutical companies aided by monumental government investments have given humanity a miraculous shot at liberation from the worst pandemic in a century.

But wealthy countries have captured an overwhelming share of the benefit. Only 0.3 percent of the vaccine doses administered globally have been given in the 29 poorest countries, home to about 9 percent of the world’s population.

Vaccine manufacturers assert that a fix is already at hand as they aggressively expand production lines and contract with counterparts around the world to yield billions of additional doses. Each month, 400 million to 500 million doses of the vaccines from Moderna, Pfizer and Johnson & Johnson are now being produced, according to an American official with knowledge of global supply.

But the world is nowhere close to having enough. About 11 billion shots are needed to vaccinate 70 percent of the world’s population, the rough threshold needed for herd immunity, researchers at Duke University estimate. Yet, so far, only a small fraction of that has been produced. While global production is difficult to measure, the analytics firm Airfinity estimates the total so far at 1.7 billion doses.

more than 100 countries in asking the W.T.O. to partially set aside vaccine patents.

But the European Union has signaled its intent to oppose waivers and support only voluntary tech transfers, essentially taking the same position as the pharmaceutical industry, whose aggressive lobbying has heavily shaped the rules in its favor.

Some experts warn that revoking intellectual property rules could disrupt the industry, slowing its efforts to deliver vaccines — like reorganizing the fire department amid an inferno.

“We need them to scale up and deliver,” said Simon J. Evenett, an expert on trade and economic development at the University of St. Gallen in Switzerland. “We have this huge production ramp up. Nothing should get in the way to threaten it.”

Others counter that trusting the pharmaceutical industry to provide the world with vaccines helped create the current chasm between vaccine haves and have-nots.

The world should not put poorer countries “in this position of essentially having to go begging, or waiting for donations of small amounts of vaccine,” said Dr. Chris Beyrer, senior scientific liaison to the Covid-19 Prevention Network. “The model of charity is, I think, an unacceptable model.”

Pfizer expects to sell $26 billion worth of Covid vaccines this year; Moderna forecasts that its sales of Covid vaccines will exceed $19 billion for 2021.

History also challenges industry claims that blanket global patent rights are a requirement for the creation of new medicines. Until the mid-1990s, drug makers could patent their products only in the wealthiest markets, while negotiating licenses that allowed companies in other parts of the world to make generic versions.

Even in that era, drug companies continued to innovate. And they continued to prosper even with the later waivers on H.I.V. drugs.

“At the time, it rattled a lot of people, like ‘How could you do that? It’s going to destroy the pharmaceutical industry,’” recalled Dr. Anthony S. Fauci, President Biden’s chief medical adviser for the pandemic. “It didn’t destroy them at all. They continue to make billions of dollars.”

Leaders in the wealthiest Western nations have endorsed more equitable distribution of vaccines for this latest scourge. But the imperative to ensure ample supplies for their own nations has won out as the virus killed hundreds of thousands of their own people, devastated economies, and sowed despair.

The drug companies have also promised more support for poorer nations. AstraZeneca’s vaccine has been the primary supply for Covax, and the company says it has sold its doses at a nonprofit price.

stumbled, falling short of production targets. And producing the new class of mRNA vaccines, like those from Pfizer-BioNTech and Moderna, is complicated.

Where pharmaceutical companies have struck deals with partners, the pace of production has frequently disappointed.

“Even with voluntary licensing and technology transfer, it’s not easy to make complex vaccines,” said Dr. Krishna Udayakumar, director of the Duke Global Health Innovation Center.

Much of the global capacity for vaccine manufacturing is already being used to produce other lifesaving inoculations, he added.

But other health experts accuse major pharmaceutical companies of exaggerating the manufacturing challenges to protect their monopoly power, and implying that developing countries lack the acumen to master sophisticated techniques is “an offensive and a racist notion,” said Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University.

With no clear path forward, Ms. Okonjo-Iweala, the W.T.O. director-general, expressed hope that the Indian and South African patent-waiver proposal can be a starting point for dialogue.

“I believe we can come to a pragmatic outcome,” she said. “The disparity is just too much.”

Peter S. Goodman reported from London, Apoorva Mandavilli from New York, Rebecca Robbins from Bellingham, Wash., and Matina Stevis-Gridneff from Brussels. Noah Weiland contributed reporting from New York.

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Guantánamo Detainee Agrees to Drop Call for C.I.A. Testimony

WASHINGTON — A detainee at Guantánamo Bay has agreed to a deal intended to lead to his release in the next few years in return for giving up the right to question the C.I.A. in court about its torture program, United States government officials said.

The deal, negotiated by the Pentagon official who oversees the military commissions that serve as a court for some detainees, was reached in recent weeks, and comes as a number of those who have been charged at Guantánamo are seeking to cite their abuse at the hands of the C.I.A. as part of their defense.

Under the deal, the prisoner, Majid Khan, 41, who has pleaded guilty to serving as a courier for Al Qaeda, would complete his prison sentence as early as next year and no later than 2025 and then could be released to another country, assuming one will take him, according to people who have seen the terms or are familiar with its details.

In exchange, Mr. Khan will not use his sentencing proceedings to invoke a landmark war court decision that allowed him to call witnesses from the C.I.A.’s secret prison network to testify about his torture.

2014 Senate investigation. He was also sleep deprived, kept naked and hung by his wrists, and hooded, to the point of hallucinations.

Mr. Khan was transferred to Guantánamo Bay in 2006 and saw a lawyer for the first time in his fourth year of detention. In 2012, he pleaded guilty to terrorism-related charges stemming from his work for Al Qaeda after the Sept. 11 attacks, and agreed to postpone his sentencing while he cooperated with government prosecutors.

On April 16, he and his lawyers reached agreement with the overseer of military commissions for a sentence that would end sometime between early next year and March 1, 2025.

The agreement itself is under seal, at least until a judge questions Mr. Khan on whether he voluntarily entered into it. But several people, speaking on the condition of anonymity to describe details of the deal, said that it has a sentencing range of 11 to 14 years, applied starting with his guilty plea in 2012.

prosecutors failed to disclose certain evidence. Colonel Watkins retires from the Army on Aug. 1 and was replaced on the case Wednesday by an Air Force judge, Col. Mark W. Milam.

The agreement is the first involving a Guantánamo detainee that the Biden administration has reached since taking office. It was made by Jeffrey D. Wood, a National Guard colonel who was appointed by the Trump administration to the civilian role of convening authority for military commissions.

had actually seen Mr. Khan in C.I.A. detention.

The issue had been simmering but had not come to a head because travel restrictions during the coronavirus pandemic brought most military commission hearings to a standstill for the last year.

The question of whether Mr. Khan could receive a reduction in his sentence because of his torture was also a potential model for the defense in the capital conspiracy case against Khalid Shaikh Mohammed and four other men accused of plotting the Sept. 11 attacks. Defense lawyers for all five defendants say there is evidence that each was systematically tortured in the black sites, and they want a judge or jury to hear graphic details about it to avert a death sentence when the long-delayed case eventually proceeds.

Two contract psychologists who devised the C.I.A.’s interrogation program, James Mitchell and John Bruce Jessen, have been publicly identified. But the identities of the people who interrogated Mr. Khan, and in which countries where they did it, are still classified at the court, which operates under rules that the government says are intended to balance state secrets and fair trial rights.

Prosecutors argued that anonymous, in-person testimony about Mr. Khan’s treatment, whether in a classified session or in public, risked exposing covert U.S. government employees, and said it was not possible to take them to Guantánamo Bay. That left the possibility of the judge ordering their appearances, prosecutors refusing to bring them and as a remedy, the judge reducing Mr. Khan’s sentence.

filing on April 22, Mr. Khan’s lawyers will also ask the judge after sentencing to void the June 2020 ruling that found credit for pretrial punishment is an available remedy at a military commission — undercutting its potential use in the Sept. 11 case.

Mr. Khan has been kept apart from the other former C.I.A. prisoners at Guantánamo since he pleaded guilty. At that time, he became a government informant, and has been debriefed on demand although prosecutors have yet to hold a trial where his testimony would be needed.

In pleading guilty he admitted to delivering $50,000 from Mr. Mohammed to militants in Indonesia that was used to finance the bombing of a Marriott hotel in Jakarta, Indonesia, in 2003, killing 11 people. Three men at Guantánamo have been charged in that plot, but have yet to be arraigned and have no trial date.

During the Trump administration, Mr. Khan was also listed as a government witness in a planned federal prosecution of another Pakistani man, Uzair Paracha. Mr. Paracha was convicted in 2005 in New York of federal terrorism-related offenses, but the conviction was overturned. Rather than retry him last year, federal prosecutors dropped the case in exchange for Mr. Paracha voluntarily giving up his U.S. residency and returning to Pakistan, after 17 years of incarceration.

For Mr. Khan, the path out of Guantánamo may be more complex. Successive U.S. administrations have argued that a convicted war criminal who completes his sentence may still be held at Guantánamo in the quasi-prisoner of war status of a detainee, as long as the United States considers itself to be at war with Al Qaeda and other terrorist groups.

Also, it is unclear where Mr. Khan would go. He was born in Saudi Arabia, lived as a child in Pakistan but went to high school in suburban Baltimore and had asylum in the United States before he returned to Pakistan after the Sept. 11 attacks. By law, he cannot be sent to the United States.

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A variant is suspected of fueling an alarming outbreak in Thai prisons.

A variant of the coronavirus is sweeping through Thailand’s prisons, the country’s chief prison doctor said on Thursday, as the government acknowledged that nearly 3,000 inmates had been found to be infected.

The chief prison doctor, Weerakit Harnpariphan, deputy director general of Thailand’s Department of Corrections, did not identify the variant that had been detected. But protective measures that were effective in the prisons last year, he said, are not working well now.

“The spread this time is something very worrying,” he said. “The transmissibility of this variant, as it is known, is very quick. It spread in a short period of time.”

There are two variants of concern spreading in the region: the first, detected last fall in Britain, is now the main driver of the pandemic in countries around the world.

growing concern about the spread of a variant first reported in India, which the World Health Organization said may be even more contagious.

Scientists still don’t know much about that variant, but they are worried that it might be helping to fuel the rise in India’s coronavirus infections and could now be driving up cases in neighboring countries.

Called B.1.617, the variant has been detected in Thailand only in one family that had been quarantined after arriving from Pakistan, health officials said.

On Thursday, Thailand reported a daily record of 4,887 cases, which reflects the inclusion of 2,835 prison cases that had not been counted previously in the national total. Thailand has averaged about 2,000 new cases a day for the past three weeks.

a leader of Thailand’s pro-democracy movement, Panusaya Sithijirawattanakul, 22, was released on bail and reported in a Facebook post that she had contracted the coronavirus. She said that more than 50 women had also come down with the virus at the prison where she had been held for nearly two months.

Justice Minister Somsak Thepsuthin said that the coronavirus was under control in the prisons but acknowledged that too few prisoners were being tested until this week.

In response to the virus, he said, the prison population has been reduced from 390,000 prisoners to less than 310,000 by granting amnesty to some and releasing others to be monitored with ankle bracelets.

Human Rights Watch called on Thailand to ensure that prisoners had adequate protective measures and health care. Nearly 20 percent of the country’s inmates are being held while they await trial, the group said, including other members of the pro-democracy movement who are accused of insulting the monarchy.

Thailand is facing its biggest surge in cases since the start of the pandemic and has imposed a partial lockdown on the hardest-hit parts of the country, including Bangkok.

The country reported only 6,884 cases and 61 deaths for all of last year. But the numbers have soared this year to a total of 93,794 cases and 518 deaths as of Thursday, with most of them coming in the past three weeks.

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