worldwide surge in energy prices threatens to impose more hardship as it hampers the recovery. This week, oil prices hit a seven-year high in the United States. With winter approaching, Europeans are worried that heating costs will soar when temperatures drop. In other spots, the shortages have cut even deeper, causing blackouts in some places that paralyzed transport, closed factories and threatened food supplies.

China, electricity is being rationed in many provinces and many companies are operating at less than half of their capacity, contributing to an already significant slowdown in growth. India’s coal reserves have dropped to dangerously low levels.

And over the weekend, Lebanon’s six million residents were left without any power for more than 24 hours after fuel shortages shut down the nation’s power plants. The outage is just the latest in a series of disasters there. Its economic and financial crisis has been one of the world’s worst in 150 years.

Oil producers in the Middle East and elsewhere are lately benefiting from the jump in prices. But many nations in the region and North Africa are still trying to resuscitate their pandemic-battered economies. According to newly updated reports from the World Bank, 13 of the 16 countries in that region will have lower standards of living this year than they did before the pandemic, in large part because of “underfinanced, imbalanced and ill-prepared health systems.”

Other countries were so overburdened by debt even before the pandemic that governments were forced to limit spending on health care to repay foreign lenders.

In Latin America and the Caribbean, there are fears of a second lost decade of growth like the one experienced after 2010. In South Africa, over one-third of the population is out of work.

And in East Asia and the Pacific, a World Bank update warned that “Covid-19 threatens to create a combination of slow growth and increasing inequality for the first time this century.” Businesses in Indonesia, Mongolia and the Philippines lost on average 40 percent or more of their typical monthly sales. Thailand and many Pacific island economies are expected to have less output in 2023 than they did before the pandemic.

debt ceiling — can further set back the recovery, the I.M.F. warned.

But the biggest risk is the emergence of a more infectious and deadlier coronavirus variant.

Ms. Gopinath at the I.M.F. urged vaccine manufacturers to support the expansion of vaccine production in developing countries.

Earlier this year, the I.M.F. approved $650 billion worth of emergency currency reserves that have been distributed to countries around the world. In this latest report, it again called on wealthy countries to help ensure that these funds are used to benefit poor countries that have been struggling the most with the fallout of the virus.

“We’re witnessing what I call tragic reversals in development across many dimensions,” said David Malpass, the president of the World Bank. “Progress in reducing extreme poverty has been set back by years — for some, by a decade.”

Ben Casselman contributed reporting.

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How Asia, Once a Vaccination Laggard, Is Revving Up Inoculations

Then came the Delta variant. Despite keeping their countries largely sealed off, the virus found its way in. And when it did, it spread quickly. In the summer, South Korea battled its worst wave of infections; hospitals in Indonesia ran out of oxygen and beds; and in Thailand, health care workers had to turn away patients.

With cases surging, countries quickly shifted their vaccination approach.

Sydney, Australia, announced a lockdown in June after an unvaccinated limousine driver caught the Delta variant from an American aircrew. Then, Prime Minister Scott Morrison, who had previously said vaccination “was not a race,” called in July on Australians to “go for gold” in the country’s inoculation drive.

He moved to overcome a supply shortage, compounded by the slow regulatory approval. In August, Australia bought one million Pfizer doses from Poland; this month, Mr. Morrison announced a purchase of a million Moderna shots from Europe.

When the Delta outbreak emerged, fewer than 25 percent of Australians over the age of 16 had received a single shot. In the state of New South Wales, which includes Sydney, 86 percent of the adult population has now received a first dose, and 62 percent of adults are fully vaccinated. The country expects to fully inoculate 80 percent of its population over the age of 16 by early November.

“There was great community leadership — there were people from across the political divide who came out to support vaccination,” said Greg Dore, an infectious-disease expert at the University of New South Wales. “It really helped us turn around a level of hesitancy that was there.”

Many governments have used incentives to encourage inoculations.

In South Korea, the authorities eased restrictions in August on private gatherings for fully vaccinated people, allowing them to meet in larger groups while maintaining stricter curbs for others. Singapore, which has fully vaccinated 82 percent of its population, previously announced similar measures.

Researchers there have also analyzed the pockets of people who refuse to be inoculated and are trying to persuade them.

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Why Asia, the Pandemic Champion, Remains Miles Away From the Finish Line

SYDNEY, Australia — All across the Asia-Pacific region, the countries that led the world in containing the coronavirus are now languishing in the race to put it behind them.

While the United States, which has suffered far more grievous outbreaks, is now filling stadiums with vaccinated fans and cramming airplanes with summer vacationers, the pandemic champions of the East are still stuck in a cycle of uncertainty, restrictions and isolation.

In southern China, the spread of the Delta variant led to a sudden lockdown in Guangzhou, a major industrial capital. Taiwan, Vietnam, Thailand and Australia have also clamped down after recent outbreaks, while Japan is dealing with its own weariness from a fourth round of infections, spiked with fears of viral disaster from the Olympics.

the new outbreak in southern China will affect busy port terminals there. Across Asia, faltering vaccine rollouts could also open the door to spiraling variant-fueled lockdowns that inflict new damage on economies, push out political leaders and alter power dynamics between nations.

The risks are rooted in decisions made months ago, before the pandemic had inflicted the worst of its carnage.

blocked the export of 250,000 doses of the AstraZeneca vaccine meant for Australia to control its own raging outbreak. Other shipments were delayed because of manufacturing issues.

“The supplies of purchased vaccine actually landing on docks — it’s fair to say they are not anywhere near the purchase commitments,” said Richard Maude, a senior fellow at the Asia Society Policy Institute in Australia.

with the United States and Europe.

In Asia, about 20 percent of people have received at least one dose of a vaccine, with Japan, for example, at just 14 percent. By contrast, the figure is nearly 45 percent in France, more than 50 percent in the United States and more than 60 percent in Britain.

Instagram, where Americans once scolded Hollywood stars for enjoying mask-free life in zero-Covid Australia, is now studded with images of grinning New Yorkers hugging just-vaccinated friends. While snapshots from Paris show smiling diners at cafes that are wooing summer tourists, in Seoul, people are obsessively refreshing apps that locate leftover doses, usually finding nothing.

“Does the leftover vaccine exist?” one Twitter user recently asked. “Or has it disappeared in 0.001 seconds because it is like a ticket for the front-row seat of a K-pop idol concert?”

keep its borders closed for another year. Japan is currently barring almost all nonresidents from entering the country, and intense scrutiny of overseas arrivals in China has left multinational businesses without key workers.

The immediate future for many places in Asia seems likely to be defined by frantic optimization.

China’s response to the outbreak in Guangzhou — testing millions of people in days, shutting down entire neighborhoods — is a rapid-fire reprise of how it has handled previous flare-ups. Few inside the country expect this approach to change anytime soon, especially as the Delta variant, which has devastated India, is now beginning to circulate.

has threatened residents with fines of around $450 for refusing vaccines. Vietnam has responded to its recent spike in infections by asking the public for donations to a Covid-19 vaccine fund. And in Hong Kong, officials and business leaders are offering a range of inducements to ease severe vaccine hesitancy.

Nonetheless, the prognosis for much of Asia this year is billboard obvious: The disease is not defeated, and won’t be anytime soon. Even those lucky enough to get a vaccine often leave with mixed emotions.

“This is the way out of the pandemic,” said Kate Tebbutt, 41, a lawyer who last week had just received her first shot of the Pfizer vaccine at the Royal Exhibition Building near Melbourne’s central business district. “I think we should be further ahead than where we are.”

Reporting was contributed by Raymond Zhong in Taipei, Taiwan, Ben Dooley in Tokyo, Sui-Lee Wee in Singapore, Youmi Kim in Seoul and Yan Zhuang in Melbourne, Australia.

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Global Shortages During Coronavirus Reveal Failings of Just in Time Manufacturing

In the story of how the modern world was constructed, Toyota stands out as the mastermind of a monumental advance in industrial efficiency. The Japanese automaker pioneered so-called Just In Time manufacturing, in which parts are delivered to factories right as they are required, minimizing the need to stockpile them.

Over the last half-century, this approach has captivated global business in industries far beyond autos. From fashion to food processing to pharmaceuticals, companies have embraced Just In Time to stay nimble, allowing them to adapt to changing market demands, while cutting costs.

But the tumultuous events of the past year have challenged the merits of paring inventories, while reinvigorating concerns that some industries have gone too far, leaving them vulnerable to disruption. As the pandemic has hampered factory operations and sown chaos in global shipping, many economies around the world have been bedeviled by shortages of a vast range of goods — from electronics to lumber to clothing.

In a time of extraordinary upheaval in the global economy, Just In Time is running late.

“It’s sort of like supply chain run amok,” said Willy C. Shih, an international trade expert at Harvard Business School. “In a race to get to the lowest cost, I have concentrated my risk. We are at the logical conclusion of all that.”

shortage of computer chips — vital car components produced mostly in Asia. Without enough chips on hand, auto factories from India to the United States to Brazil have been forced to halt assembly lines.

But the breadth and persistence of the shortages reveal the extent to which the Just In Time idea has come to dominate commercial life. This helps explain why Nike and other apparel brands struggle to stock retail outlets with their wares. It’s one of the reasons construction companies are having trouble purchasing paints and sealants. It was a principal contributor to the tragic shortages of personal protective equipment early in the pandemic, which left frontline medical workers without adequate gear.

a shortage of lumber that has stymied home building in the United States.

Suez Canal this year, closing the primary channel linking Europe and Asia.

“People adopted that kind of lean mentality, and then they applied it to supply chains with the assumption that they would have low-cost and reliable shipping,” said Mr. Shih, the Harvard Business School trade expert. “Then, you have some shocks to the system.”

presentation for the pharmaceutical industry. It promised savings of up to 50 percent on warehousing if clients embraced its “lean and mean” approach to supply chains.

Such claims have panned out. Still, one of the authors of that presentation, Knut Alicke, a McKinsey partner based in Germany, now says the corporate world exceeded prudence.

“We went way too far,” Mr. Alicke said in an interview. “The way that inventory is evaluated will change after the crisis.”

Many companies acted as if manufacturing and shipping were devoid of mishaps, Mr. Alicke added, while failing to account for trouble in their business plans.

“There’s no kind of disruption risk term in there,” he said.

Experts say that omission represents a logical response from management to the incentives at play. Investors reward companies that produce growth in their return on assets. Limiting goods in warehouses improves that ratio.

study. These savings helped finance another shareholder-enriching trend — the growth of share buybacks.

In the decade leading up to the pandemic, American companies spent more than $6 trillion to buy their own shares, roughly tripling their purchases, according to a study by the Bank for International Settlements. Companies in Japan, Britain, France, Canada and China increased their buybacks fourfold, though their purchases were a fraction of their American counterparts.

Repurchasing stock reduces the number of shares in circulation, lifting their value. But the benefits for investors and executives, whose pay packages include hefty allocations of stock, have come at the expense of whatever the company might have otherwise done with its money — investing to expand capacity, or stockpiling parts.

These costs became conspicuous during the first wave of the pandemic, when major economies including the United States discovered that they lacked capacity to quickly make ventilators.

“When you need a ventilator, you need a ventilator,” Mr. Sodhi said. “You can’t say, ‘Well, my stock price is high.’”

When the pandemic began, car manufacturers slashed orders for chips on the expectation that demand for cars would plunge. By the time they realized that demand was reviving, it was too late: Ramping up production of computer chips requires months.

stock analysts on April 28. The company said the shortages would probably derail half of its production through June.

The automaker least affected by the shortage is Toyota. From the inception of Just In Time, Toyota relied on suppliers clustered close to its base in Japan, making the company less susceptible to events far away.

In Conshohocken, Pa., Mr. Romano is literally waiting for his ship to come in.

He is vice president of sales at Van Horn, Metz & Company, which buys chemicals from suppliers around the world and sells them to factories that make paint, ink and other industrial products.

In normal times, the company is behind in filling perhaps 1 percent of its customers’ orders. On a recent morning, it could not complete a tenth of its orders because it was waiting for supplies to arrive.

The company could not secure enough of a specialized resin that it sells to manufacturers that make construction materials. The American supplier of the resin was itself lacking one element that it purchases from a petrochemical plant in China.

One of Mr. Romano’s regular customers, a paint manufacturer, was holding off on ordering chemicals because it could not locate enough of the metal cans it uses to ship its finished product.

“It all cascades,” Mr. Romano said. “It’s just a mess.”

No pandemic was required to reveal the risks of overreliance on Just In Time combined with global supply chains. Experts have warned about the consequences for decades.

In 1999, an earthquake shook Taiwan, shutting down computer chip manufacturing. The earthquake and tsunami that shattered Japan in 2011 shut down factories and impeded shipping, generating shortages of auto parts and computer chips. Floods in Thailand the same year decimated production of computer hard drives.

Each disaster prompted talk that companies needed to bolster their inventories and diversify their suppliers.

Each time, multinational companies carried on.

The same consultants who promoted the virtues of lean inventories now evangelize about supply chain resilience — the buzzword of the moment.

Simply expanding warehouses may not provide the fix, said Richard Lebovitz, president of LeanDNA, a supply chain consultant based in Austin, Texas. Product lines are increasingly customized.

“The ability to predict what inventory you should keep is harder and harder,” he said.

Ultimately, business is likely to further its embrace of lean for the simple reason that it has yielded profits.

“The real question is, ‘Are we going to stop chasing low cost as the sole criteria for business judgment?’” said Mr. Shih, from Harvard Business School. “I’m skeptical of that. Consumers won’t pay for resilience when they are not in crisis.”

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Irish Hospitals Are Latest to Be Hit by Ransomware Attacks

A cyberattack on Ireland’s health system has paralyzed the country’s health services for a week, cutting off access to patient records, delaying Covid-19 testing, and forcing cancellations of medical appointments.

Using ransomware, which is malware that encrypts a victims’ data until they pay a ransom, the people behind the attack have been holding hostage the data at Ireland’s publicly funded health care system, the Health Service Executive. The attack forced the H.S.E. to shut down its entire information technology system.

In a media briefing on Thursday, Paul Reid, chief executive of the H.S.E., said the attack was “stomach churning.”

Caroline Kohn, a spokeswoman for a group of hospitals in the eastern part of the country, said the hospitals were forced to keep all of their records on paper. “We’re back to the 1970s,” she said.

upended the lives of cancer patients whose chemotherapy treatments had to be delayed or recreated from memory.

The attacks come on top of a similar ransomware attack on Colonial Pipeline, the American pipeline operation that supplies nearly half the gas, diesel and jet fuel to the East Coast. That attack prompted Colonial Pipeline to shut down its pipeline operations, triggering panic buying at the pump and gas and jet fuel shortages along the East Coast. Colonial Pipeline agreed to pay its extortionists, a different cybercriminal gang called DarkSide, nearly $5 million to decrypt its data.

The attack in Ireland has caused backlogs inside emergency rooms from Dublin to Galway, and patients have been urged to stay away from hospitals unless they require urgent care.

In many Irish counties, appointments have been canceled for radiation treatments, MRIs, gynecological visits, endoscopies and other health services. Health authorities said the attack was also causing delays in Covid-19 test results, but a vaccine appointment system was still working.

Irish health officials said Thursday that H.S.E. was working to build a new network, separate from the one that has been affected. Hundreds of experts have been recruited to rebuild 2,000 distinct systems. The effort is likely to cost tens of millions of euros, Mr. Reid said.

The H.S.E. said Thursday that it had been provided with a key that could decrypt the data being held for ransom, but it was unclear if it would work.

a separate legal fight by Microsoft — to take down a major botnet, a network of infected computers, called Trickbot, that served as a major conduit for ransomware.

In the weeks that followed those efforts, cybercriminals said they planned to attack more than 400 hospitals. The threat caused the Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency to warn health care operators to improve their protection from ransomware.

Ransomware groups continue to operate with relative immunity in Russia, where government officials rarely prosecute cybercriminals and refuse to extradite them. In response to the Colonial Pipeline episode last week, President Biden said Russia bore some responsibility for ransomware attacks because cybercriminals operate within its borders.

Adam Meyers, vice president of intelligence at CrowdStrike, the cybersecurity firm, said members of Wizard Spider, the group responsible for the attack on Ireland’s health systems, spoke Russian and researchers “have high confidence that they are Eastern European, likely Russian.”

Last month, the data of a school district in Florida was held hostage by Wizard Spider. Broward County Public Schools, the sixth largest school district in the United States, was hacked by cybercriminals who demanded $40 million in cryptocurrency. The criminals encrypted data and posted thousands of the schools’ information online after officials declined to pay.

Last December, the chip maker Advantech was also hit by Wizard Spider. Its data was posted to the so-called dark web after it refused to pay.

Some cyber insurance companies have covered the costs of ransom payments, calculating that the ransom payments are still cheaper than the cost of rebuilding systems and data from scratch. Regulators have started to pressure insurance companies out of paying ransom demands, arguing that they are only fueling more ransomware attacks and emboldening cybercriminals to make more lucrative demands.

AXA, the French insurance giant, said last week that it would no longer cover ransom payments. Within days of its announcement, AXA was hit with a ransomware attack that paralyzed information technology operations in Thailand, Malaysia, Hong Kong and the Philippines.

“This is just business as usual,” John Dickson, a cybersecurity expert at the San Antonio-based Denim Group, said in an interview Thursday. “These attacks should come as no surprise to anyone who has been paying attention.”

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Traveling to Europe? A Country-by-Country Reopening Guide

Infections and deaths in Turkey from the coronavirus have been declining steadily following a strict three-week national lockdown, which is expected to be lifted gradually through May.

Turkey so far has fully vaccinated about 13 percent of its population of 83 million people; about three million more have received their first dose, according to Our World in Data, an online compendium of data from global sources.

While the country is currently facing a vaccine shortage, forcing it to delay the administration of second doses, the health minister, Fahrettin Koca, said 30 million more doses of the Pfizer-BioNtech vaccine would arrive in June and 50 million doses of the Sputnik V vaccine are expected to arrive from Russia within six months.

Turkey has remained open to tourists, including Americans, throughout the pandemic. Most international arrivals are required to show proof of a negative PCR test taken within 72 hours of their arrival into the country.

Coronavirus tests are not required for passengers arriving from places that Turkey considers epidemiologically safe, which include Hong Kong, China, Taiwan, Vietnam, Australia, New Zealand, Singapore, Thailand, South Korea, Israel, Japan, Latvia, Luxembourg, Ukraine and Estonia.

Passengers arriving from Brazil, South Africa and India will be required to quarantine for 14 days in government-assigned accommodations and will be released if they test negative for the virus after day 10.

Turkey offers health insurance packages starting at as little as $15 that cover foreign visitors for Covid-19 treatment and hospitalization for up to 30 days. The country treats coronavirus patients in both public and private hospitals and opened 17 new hospitals last year to provide more intensive-care capacity for Covid treatment.

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Wall Street tumbles, with tech leading the way. Bitcoin’s drop takes crypto stocks with it.

Tesla was one of the worst-performing stocks in the market on Wednesday, tumbling more than 4 percent. The company had once positioned itself as a prominent supporter of cryptocurrencies, and in March, it announced that it would accept Bitcoin in exchange for cars, helping to set off a surge in the asset.

Last week, Elon Musk, the company’s chief executive, reversed that decision, citing concerns about the energy consumption needed to produce cryptocurrencies. That process, known as mining, involves a using computers to create new Bitcoin by having them solve complex computational problems.

The hard drive maker Seagate Technology — which has a stake in cryptocurrency company Ripple, the creator of the XRP currency — tumbled more than 2 percent. Shares of Seagate and Western Digital, another maker of hard drives, had been on a tear in recent days, as analysts spotlighted surging demand for its computer products, in part, from cryptocurrency miners. Western Digital was down nearly 3 percent.

Bitcoin wasn’t the only element moving the markets. Crude oil tumbled roughly 4 percent, on lingering concerns that the still-spreading coronavirus in India, as well as Thailand, Vietnam and Taiwan, could prompt new restrictions that could curtail economic activity.

The Stoxx Europe 600 index was 1.5 percent lower, while the FTSE 100 in Britain was down 1.3 percent. Stock markets in Asia ended the day mainly lower, with the Nikkei in Japan down by 1.3 percent.

Volatility in the stock markets lately has been driven by sentiment about inflation. Investors are nervous that a jump in prices —  coming as global economies reopen and as the government continues to pump stimulus funds to spur growth — could push the Federal Reserve and other central banks to raise interest rates or take other measures to cool growth. That would be bad news for riskier investments like stocks.

The Fed and other central banks have said they see the recent increases as transitory caused partly by supply chain issues as economies revive from lockdowns, and that they have no plans to remove emergency support for the economy.

Federal Reserve policymakers will release the minutes from their April meeting on Wednesday.

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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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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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