Molly Moon Neitzel, who owns an ice cream business in Seattle with just over 100 employees, said she had kept guidelines for isolation conservative.

“I’m on the side of protecting people over getting them back to work right now,” she said, adding that if it were summer and her business were busier, she might consider a shorter isolation period. “It’s the slowest time of the year for an ice cream company, so that is in my favor.”

Some public health experts worry that if the C.D.C. shortens its guidelines on isolating, employers could pressure workers to get back before they’re fully recovered.

“What I don’t want to see happen is for this to be used as an excuse to force people to come back while they are unwell,” Dr. Ranney of Brown said.

And even with clearer guidelines, putting policies in place can be tricky. While some experts suggest different isolation rules for vaccinated and unvaccinated employees, some companies do not yet have a system for tracking which of their workers have gotten a vaccine. The question of whether the C.D.C. will change its definition of fully vaccinated to include booster shots adds another layer of complexity.

It’s not just sick employees who may have to stay home: Companies are also grappling with whether vaccinated workers should quarantine after exposure to someone with Covid-19, which C.D.C. guidelines do not require.

“It becomes a challenge for employers to choose between providing a safer environment and keeping staff intact, or going with the C.D.C. guidance,” said Karen Burke, an adviser at the Society for Human Resource Management.

But almost two years into the pandemic, that’s the position that employers continue to find themselves in, amid an ever-flowing cascade of new data, guidelines and considerations.

“Every moment, you’re making life or death decisions,” Ms. Sibley said. “That’s not what we signed up for.”

Rebecca Robbins contributed reporting.

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Moderna, Racing for Profits, Keeps Covid Vaccine Out of Reach of Poor

Moderna’s market value has nearly tripled this year to more than $120 billion. Two of its founders, as well as an early investor, this month made Forbes magazine’s list of the 400 richest people in the United States.

As the coronavirus spread in early 2020, Moderna raced to design its vaccine — which uses a new technology known as messenger RNA — and to plan a safety study. To manufacture the doses for that trial, the company received $900,000 from the nonprofit Coalition for Epidemic Preparedness Innovations.

The nonprofit group said Moderna had agreed to its “equitable access principles.” That meant, according to the coalition, that the vaccine would be “first available to populations when and where they are needed and at prices that are affordable to the populations at risk, especially low- and middle-income countries or to public sector entities that procure on their behalf.”

Moderna agreed in May to provide up to 34 million vaccine doses this year, plus up to 466 million doses in 2022, to Covax, the struggling United Nations-backed program to vaccinate the world’s poor. The company has not yet shipped any of those doses, according to a Covax spokesman, although Covax has distributed tens of millions of Moderna doses donated by the United States.

Mr. Bancel said that many more doses would have gone to Covax this year had the two parties reached a supply deal in 2020. Aurélia Nguyen, a Covax official, denied that, saying, “It became clear early on that the best we could expect was minimal doses in 2021.”

Late last year, the Tunisian government was hoping to order Moderna doses. Dr. Hechmi Louzir, who led Tunisia’s vaccine procurement efforts, didn’t know how to contact Moderna to begin talks and asked the U.S. Embassy in Tunisia for help, he said. Officials there contacted Moderna, he said, but nothing came of it.

“We were very interested in Moderna,” Dr. Louzir said. “We tried.”

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Covid Vaccines Produced in Africa Are Being Exported to Europe

Johnson & Johnson’s Covid vaccine was supposed to be one of Africa’s most important weapons against the coronavirus.

The New Jersey-based company agreed to sell enough of its inexpensive single-shot vaccine to eventually inoculate a third of the continent’s residents. And the vaccine would be produced in part by a South African manufacturer, raising hopes that those doses would quickly go to Africans.

That has not happened.

South Africa is still waiting to receive the overwhelming majority of the 31 million vaccine doses it ordered from Johnson & Johnson. It has administered only about two million Johnson & Johnson shots. That is a key reason that fewer than 7 percent of South Africans are fully vaccinated — and that the country was devastated by the Delta variant.

At the same time, Johnson & Johnson has been exporting millions of doses that were bottled and packaged in South Africa for distribution in Europe, according to executives at Johnson & Johnson and the South African manufacturer, Aspen Pharmacare, as well as South African government export records reviewed by The New York Times.

donated by the United States. But about four million of the country’s 60 million residents are fully vaccinated.

That left the population vulnerable when a third wave of cases crested over the country. At times in recent months, scores of Covid-19 patients at Helen Joseph Hospital in Johannesburg were waiting in the emergency department for a bed, and the hospital’s infrastructure struggled to sustain the huge volumes of oxygen being piped into patients’ lungs, said Dr. Jeremy Nel, an infectious-disease doctor there.

“The third wave, in terms of the amount of death we saw, was the most heartbreaking, because it was the most avoidable,” Dr. Nel said. “You see people by the dozens dying, all of whom are eligible for a vaccine and would’ve been among the first to get it.”

a United Nations-backed clearinghouse for vaccines that has fallen behind on deliveries. South Africa was slow to enter negotiations with manufacturers for its own doses. In January, a group of vaccine experts warned that the government’s “lack of foresight” could cause “the greatest man-made failure to protect the population since the AIDS pandemic.”

announced in November. Aspen’s facility in Gqeberha, on South Africa’s southern coast, was the first site in Africa to produce Covid vaccines. (Other companies subsequently announced plans to produce vaccines on the continent.)

South African officials hailed Aspen’s involvement as indispensable.

Aspen “belongs to us as South Africans, and it is making lifesaving vaccines,” South Africa’s president, Cyril Ramaphosa, said during a visit to Aspen’s plant in March. He said he had pushed Johnson & Johnson to prioritize the doses made there for Africans.

“I want them now,” Mr. Ramaphosa added. “I’ve come to fetch our vaccines.”

results of a clinical trial suggested that the vaccine from AstraZeneca offered little protection from mild or moderate infections caused by the Beta variant that was circulating in South Africa.

Weeks later, Johnson & Johnson and the government signed a contract for 11 million doses. South Africa ordered another 20 million doses in April. That would be enough to vaccinate about half the country.

South Africa agreed to pay $10 per dose for the 11 million shots, according to the contract. That was the same price that the United Statespaid and slightly more than the $8.50 that the European Commission agreed to pay. The South African contract prohibited the government from banning exports of the vaccine, citing the need for doses to “move freely across national borders.”

introduced export controls this year to conserve scarce supplies. India halted exports produced by the Serum Institute, which was supposed to be a major vaccine supplier to poor countries. In the United States, officials said they didn’t ban exports, but they didn’t need to. The combination of the extensive vaccine production on American soil and the high prices the U.S. government was willing to pay meant that companies made the delivery of shots for Americans a priority.

Other benefits for Johnson & Johnson were embedded in the South African contract.

While such contracts typically protect companies from lawsuits brought by individuals, this one shielded Johnson & Johnson from suits by a wider range of parties, including the government. It also imposed an unusually high burden on potential litigants to show that any injuries caused by the vaccine were the direct result of company representatives engaging in deliberate misconduct or failing to follow manufacturing best practices.

“The upshot is that you have moved almost all of the risk of something being wrong with the vaccine to the government,” said Sam Halabi, a health law expert at Georgetown University who reviewed sections of the South African contract at the request of The Times.

Mr. Halabi said the contract’s terms appeared more favorable to the pharmaceutical company than other Covid vaccine contracts he had seen. South African officials have said Pfizer, too, sought aggressive legal protections.

The contract said Johnson & Johnson would aim to deliver 2.8 million doses to South Africa by the end of June, another 4.1 million doses by the end of September and another 4.1 million doses by the end of December. (The government expects the 20 million additional doses to be delivered by the end of this year, Mr. Maja said.)

The company has so far fallen far short of those goals. As of the end of June, South Africa had received only about 1.5 million of the doses from its order. The small number of doses that have been delivered to the African Union were on schedule.

The difficulties in procuring doses have revealed the limits of fill-and-finish sites, which leave countries dependent on vaccines from places like the European Union or the United States, said Dr. Salim Abdool Karim, who until March was co-chairman of South Africa’s ministerial advisory committee on Covid.

“Ultimately,” he said, “the solution to our problem has to be in making our own vaccines.”

Lynsey Chutel and Choe Sang-Hun contributed reporting.

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Germany Will Offer Vaccine Booster Shots Starting in September

BERLIN — As concerns grow over the highly contagious Delta variant of the coronavirus, Germany on Monday became the biggest Western country yet to announce that it will offer vaccine booster shots to a wide range of people considered potentially vulnerable, adding to growing momentum in rich nations to give additional shots to fully vaccinated people.

The move by Germany came even as a top European Union official criticized the bloc as falling far short of its promises to donate vaccine doses to Africa and Latin America. And with a limited global vaccine supply, health experts say the top priorities should be distributing doses to poor countries that lag far behind in inoculations, and persuading vaccine-resistant people in wealthy countries to get their first shots.

There is also still no consensus among scientists on the need for booster shots, but as fears rise of more pandemic waves and more costly lockdowns, a growing number of countries are preparing to give their people booster doses — or have already started.

Starting in September, Germany, Europe’s largest economy, wants to administer a booster of the Pfizer-BioNTech or Moderna vaccine to older people, residents of care homes, and people with compromised immune systems — and also to anyone who was already fully vaccinated with the two-dose AstraZeneca or single-dose Johnson & Johnson shots, which clinical trials have shown are not as highly protective.

an early leader in vaccination, began administering boosters to people 60 and older last week. A month ago, Russia made additional shots available to anyone six months after inoculation, and on Sunday, Hungary began offering them four months post-vaccination.

France is offering them only to those with weak immune systems, and plans to give them this fall to those who were the first to be vaccinated early this year — mostly people over 75 and those with serious health problems.

government advisers recommended in late June that everyone over 50 should be eligible but said the priority should be getting the shots to people over 70, health workers, nursing home residents, and younger adults with immune problems or other serious vulnerabilities.

increasingly think that vulnerable populations may need additional shots even as research continues into how long the vaccines remain effective. Some people have already obtained boosters simply by not revealing previous vaccination.

But as governments, terrified of another surge in the virus, increasingly lean toward boosters, the need for them remains unclear.

Studies have indicated that immunity resulting from the Pfizer-BioNTech and Moderna vaccines is long-lasting, and researchers are still working to interpret recent Israeli data suggesting a decline in efficacy of the Pfizer-BioNTech vaccine months after inoculation.

although the vaccine remains powerfully effective against severe disease and death.

Experts were divided on the utility of booster shots so soon after vaccination began. Experience with other diseases indicates that older people and those with weak immune systems might benefit, but there is little hard evidence with the coronavirus.

“The problem here is, we’re just sort of going on immunological priors, rather than really great data to justify things one way or the other,” said Deepta Bhattacharya, an immunologist at the University of Arizona. “I totally understand the decision, but I think we have to acknowledge that there’s a wide range of uncertainty on what it’s going to do.”

Booster doses may help some people with weak immune systems, but others may show little improvement even after a third dose, and still others may not need a booster at all, scientists say.

While dozens of mostly wealthy countries, including the United States and most of Europe, have administered more than 100 doses per 100 people, many other nations remain below five per 100 — primarily in Africa, where cases have soared as the Delta variant spreads.

Doctors Without Borders said recently that it would be “unconscionable” to give booster doses in richer nations before people in poorer ones get their first doses.

“Wealthy governments shouldn’t be prioritizing giving third doses when much of the developing world hasn’t even yet had the chance to get their first Covid-19 shots,” Kate Elder, the senior vaccines policy adviser at Doctors Without Borders’ Access Campaign, said in a statement.

a so-called vector vaccine, like AstraZeneca or Johnson & Johnson.

It is the latest sign that governments are encouraging their citizens to mix and match vaccines in the hope of provoking a more protective immune response against Covid-19. Early results from a British vaccine study showed that volunteers produced high levels of antibodies and immune cells after getting one dose each of the Pfizer-BioNTech and AstraZeneca-Oxford shots.

The new German guidelines announced Monday also went a step further in encouraging parents to vaccinate children between 12 and 17, announcing that doctors and vaccination centers across the country would make the jab available to them before the start of the new school year.

Health ministers stopped short of making a formal recommendation for vaccinating children, but the move made plain their impatience with Germany’s Standing Committee on Vaccinations, which has so far refrained from guiding parents one way or the other, pending more data becoming available.

Vaccinating children “is one building block to allow a safe start into the new school year after the summer vacation,” Mr. Holetschek said.

Apoorva Mandavilli contributed reporting from New York, Benjamin Mueller from London, Aurelien Breeden from Paris, Gaia Pianigiani from Rome, Monika Pronczuk from Brussels, Raphael Minder from Madrid and Thomas Erdbrink from Amsterdam.

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New Variant Posing Threat, as Global Vaccine Drive Falters

LONDON — A new and potentially more contagious variant of the coronavirus has begun to outpace other versions of the virus in Britain, putting pressure on the government to shorten people’s wait for second doses of vaccines and illustrating the risks of a faltering global immunization drive.

The new variant, which has become dominant in India since first being detected there in December, may be responsible in part for a grievous wave of infections across Southeast Asia, including Nepal, where people have been dying in hospital corridors and courtyards. But efforts to understand the variant picked up once it began spreading in Britain, one of at least 49 countries where it is present. Scientists there are sequencing half of all coronavirus cases amid a push to complete the reopening of its economy.

The preliminary results out of Britain, drawn from only a few thousand cases of the variant, contained both good and bad news, scientists said.

The variant, known by evolutionary biologists as B.1.617.2, is “highly likely” to be more transmissible than the variant behind Britain’s devastating wintertime surge, government scientists have said. That earlier variant, known as B.1.1.7, was itself considerably more contagious than the one that first emerged last year in Wuhan, China.

Public Health England report published this weekend provided signs that government scientists said were consistent with a more transmissible virus: The variant first seen in India was roughly 50 percent more likely than B.1.1.7 to be transmitted to the close contacts of an infected person. Government scientists said last week that it could be anywhere from a few percentage points to 50 percent more contagious than B.1.1.7.

Helpfully for Britain and other wealthy nations, the latest worrisome variant has emerged at a less dire moment of the pandemic. More than four out of every five people in England above the age of 65 — among the groups most vulnerable to the virus — have been given both doses of a coronavirus vaccine, driving down hospitalizations and deaths.

And a new study by Public Health England offered reassuring signs that fully vaccinated people were about as well protected from the variant first detected in India as they were from other forms of the coronavirus.

The Pfizer-BioNTech vaccine offered 88 percent protection against the variant first sampled in India, only a slight drop from the 93 percent protection given against the variant from Britain, Public Health England said. The AstraZeneca-Oxford vaccine was 60 percent effective against the variant from India, compared to 66 percent effective against the one first seen in Britain.

Other studies in England have shown little to no difference between the effectiveness of the Pfizer and AstraZeneca vaccines.

wrote on Twitter.

In Britain, part of its rapid growth may have to do with the particular places it was first introduced. Bolton, in northwest England, where the new variant is most advanced, is a highly deprived area with tightly packed housing that could be hastening its spread, scientists said.

“We do not know if the increase in transmissibility is the result of specific mixing patterns, or super-spreading events,” a group of researchers led by Robert Challen of the University of Exeter reported on May 11, in a study that was among those presented to an influential government advisory group.

That government advisory body said several days later that it had “high confidence” that the variant first seen in India was indeed more contagious, warning that a “substantial resurgence of hospitalizations” was possible. It said that the variant was gaining a foothold in diverse parts of Britain where “contact patterns or behaviors” alone could not explain its spread.

It is not clear if the variant from India is any deadlier than B.1.1.7.

With cases of B.1.1.7 falling, the variant first seen in India now accounts for roughly half of the sequenced coronavirus cases being monitored by Public Health England. The agency’s scientists have said it was likely to replace B.1.1.7 as England’s dominant virus within a month, a startling turnabout so soon after B.1.1.7 swept much of the world.

“For countries that are starting to struggle with B.1.1.7, they now know they have an even faster one close by,” said Devi Sridhar, a professor of global public health at the University of Edinburgh in Scotland.

experimenting with ways to encourage sick people to isolate.

Some scientists have urged the government to go further by dramatically closing the gap between doses of the Pfizer or Moderna vaccine, for instance, and rerouting those shots to cities hardest hit by the variant from India. Because the AstraZeneca vaccine appears most protective with a 12-week dosing interval, those scientists said, using it meant leaving people only partially vaccinated for a period of time.

At the very least, Professor Sridhar said, people needed to be reminded to remain cautious until they were fully vaccinated.

Prime Minister Boris Johnson’s plan to scrap almost all remaining lockdown restrictions on June 21 rests in large part, scientists said, on how many second doses Britain can administer in the coming weeks.

For many poorer nations, starved for vaccines, there is little choice but to leave long delays between first and second doses. Some of them are uncertain about when shipments of second doses will arrive. Large portions of those countries remain entirely unprotected.

If the variant from India spreads as quickly in other countries as it has in Britain, the burden on unvaccinated nations may grow.

“It’s a warning,” Professor Sridhar said. “What we’re seeing in India is being repeated in Nepal, it’s being repeated in other countries. You need to get ahead of it.”

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Covax to Receive 200 Million Johnson & Johnson Covid Doses

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Covax, the program to vaccinate the world’s poorest countries, will receive 200 million doses of Johnson & Johnson’s single-shot coronavirus vaccine through an advance purchase agreement announced on Friday. The deal may eventually boost a vaccination campaign that has fallen significantly behind on its goals.

Gavi, the public-private health partnership co-leading Covax, will purchase the doses at a not-for-profit price from Johnson & Johnson. Gavi said that the goal is to supply the 200 million doses this year.

But it was not clear how quickly those doses will start being delivered or whether they can help turn around the struggling Covax program. Jake Sargent, a spokesman for Johnson & Johnson, said the company is “striving to deliver vaccine doses as quickly as possible.”

Only 71 million doses have been shipped out so far through the Covax program, the vast majority of which have been of AstraZeneca’s Covid vaccine. In March, the World Health Organization, another co-leader of Covax, had said 237 million doses would be allocated to participating countries by the end of May.

the growing gap in vaccination coverage between the world’s rich and poor. 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.

Covax has been underfunded and behind schedule even before it faced its most significant blow last month: India, facing a devastating coronavirus crisis, halted vaccine exports out of the country, meaning that Covax could no longer receive doses from its major supplier, the Serum Institute of India. The Serum Institute signaled this week that it would not be able to provide vaccines beyond India before the end of this year.

The massive shortfall in supply has left low-income countries increasingly dependent on donations from wealthy countries. President Biden has pledged to donate 80 million doses of vaccines, most from AstraZeneca, and some of which are expected to be given through Covax. The president of the European Commission, Ursula von der Leyen, said on Friday that the bloc aims to donate 100 million vaccine doses to low- and middle-income countries this year.

Other vaccine makers have also said they would step up supply to low-income countries as they fight a push, supported by the Biden administration, to increase vaccine supply by waiving intellectual property protections on Covid vaccines. Albert Bourla, chief executive of Pfizer, said on Friday that the company expects to deliver two billion doses of its vaccine to developing countries in the next 18 months. That projection reflects existing deals with governments, anticipated future agreements and Pfizer’s pledge to supply 40 million doses to Covax.

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Biden Dips Into U.S. Vaccine Supply to Send 20 Million Doses Abroad

WASHINGTON — President Biden, heeding widespread calls to step up his response to the pandemic’s surge abroad, said on Monday that his administration would send 20 million doses of federally authorized coronavirus vaccine overseas in June — the first time he has pledged to give away doses that could be used in the United States.

The donation is another step toward what Mr. Biden promised would be an “entirely new effort” to increase vaccine supplies and vastly expand manufacturing capacity, most of it in the United States. He also put Jeffrey Zients, the White House coronavirus response coordinator, in charge of developing a global strategy.

“We know America will never be fully safe until the pandemic that’s raging globally is under control,” Mr. Biden said in a brief appearance at the White House. “No ocean’s wide enough, no wall’s high enough, to keep us safe.”

With new cases and deaths plummeting as vaccination rates rise in the United States, the epicenter of the crisis has moved to India and other nations. A growing and bipartisan chorus of diplomats, health experts and business leaders has been pushing the president to do more to end what the AIDS activist Asia Russell calls “vaccine apartheid.”

There is a huge disconnect growing where, in some countries with the highest vaccination rates, there appears to be a mind-set that the pandemic is over, while others are experiencing huge waves of infection,” Dr. Tedros said.

Variants like B.1.617, first discovered in India and recently designated a variant of concern by the W.H.O., are contributing to the spread of infections and worry many researchers.

Dr. Tedros called for well-supplied nations to send more of their vaccine allocations to harder-hit countries, and for vaccine developers and manufacturers to hasten delivery of hundreds of millions of doses to Covax, an international initiative dedicated to equitable distribution of the vaccine, noting an appeal by Henrietta Fore, UNICEF’s executive director.

Mr. Biden took office vowing to restore the United States as a leader in global public health, and he has taken certain steps to do so: rejoining the World Health Organization, pledging $4 billion to an international vaccine effort and providing financial support to help Biological E, a vaccine manufacturer in India, produce at least one billion doses of coronavirus vaccines by the end of 2022.

To broaden supply further, Mr. Biden recently announced he would support waiving intellectual property protections for coronavirus vaccines. But activists say simply supporting the waiver is not enough; Mr. Biden must create the conditions for pharmaceutical companies to transfer their intellectual property to vaccine makers overseas, they argue. They view his efforts as piecemeal.

“We’re after 100 days into the administration, and what Biden should be delivering is a global battle plan against vaccine apartheid, and the announcement today is lines on a Post-it note,” Ms. Russell said, adding, “There must be a global strategy led by the U.S. that’s based on technology transfer, on forcing pharma to come to the table to share the recipe.”

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.

An open letter to the president, made public last week by a bipartisan group including business leaders, diplomats and a former defense secretary, argued that such a waiver “would make little difference and could do harm.”

While global health activists are strongly in favor of the waiver, some said they welcomed the views of the business community. They see clear parallels to their work fighting the global AIDS epidemic.

“It shows an unprecedented willingness of pharma and its allies in the private sector to admit what all of us having been saying for months — the private sector alone cannot and will not ensure global vaccine access,” James Krellenstein, a founder of PrEP4All, a nonprofit aimed at ensuring universal access to H.I.V. prevention and treatment, wrote in an email on Sunday. “It really shifts the burden to the Biden administration,” he added.

The organizer of the open letter, Hank Greenberg, the chairman of Starr Companies and former chairman of American International Group, the insurance industry giant, said in an interview on Monday that Mr. Biden’s announcement did not go far enough.

Mr. Greenberg, 96, a veteran of World War II, said he was inspired to write after a former chief executive of an A.I.G. subsidiary who later became the ambassador from the Philippines to the United States told him he was not able to get vaccinated. Like Mr. Biden, he used language that evoked the war effort.

“If we don’t do it,” he asked, “who will?”

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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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