THIMPHU, Bhutan — The Lunana area of Bhutan is remote even by the standards of an isolated Himalayan kingdom: It covers an area about twice the size of New York City, borders far western China, includes glacial lakes and some of the world’s highest peaks, and is inaccessible by car.
Still, most people living there have already received a coronavirus vaccine.
Vials of the Oxford-AstraZeneca vaccine arrived last month by helicopter and were distributed by health workers, who walked from village to village through snow and ice. Vaccinations proceeded in the area’s 13 settlements even after yaks damaged some of the field tents that volunteers had set up for patients.
“I got vaccinated first to prove to my fellow villagers that the vaccine does not cause death and is safe to take,” Pema, a village leader in Lunana who is in his 50s and goes by one name, said by telephone. “After that, everyone here took the jab.”
emphasized its citizens’ well-being over national prosperity, had administered a first vaccine dose to more than 478,000 people, over 60 percent of its population. The Health Ministry said this month that more than 93 percent of eligible adults had received their first shots.
according to a New York Times database.
That rate was ahead of those of the United Kingdom and the United States, more than seven times that of neighboring India and nearly six times the global average. Bhutan is also ahead of several other geographically isolated countries with small populations, including Iceland and the Maldives.
Dasho Dechen Wangmo, Bhutan’s health minister, attributed its success to “leadership and guidance” from the country’s king, public solidarity, a general absence of vaccine hesitancy, and a primary health care system that “enabled us to take the services even to the most remote parts of the country.”
“Being a small country with a population of just over 750,000, a two-week vaccination campaign was doable,” Ms. Dechen Wangmo said in an email. “Minor logistic issues were faced during the vaccination but were all manageable.”
Serum Institute of India, the world’s largest vaccine producer. Bhutan’s government has said it plans to administer second doses about eight to 12 weeks after the first round, in line with guidelines for the AstraZeneca vaccine.
according to the World Health Organization. Immunization levels in recent years have been above 95 percent.
But Bhutan’s health system is “hardly self-sustainable,” and patients who need expensive or sophisticated treatments are often sent to India or Thailand at the government’s expense, said Dr. Yot Teerawattananon, a Thai health economist at the National University of Singapore.
A government committee in Bhutan meets once a week to make decisions about which patients to send overseas for treatment, Dr. Yot said. He said the committee — which focuses on brain and heart surgery, kidney transplants and cancer treatment — was known informally as the “death panel.”
What You Need to Know About the Johnson & Johnson Vaccine Pause in the U.S.
On April 13, 2021, U.S. health agencies called for an immediate pause in the use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the United States developed a rare disorder involving blood clots within one to three weeks of vaccination.
All 50 states, Washington, D.C. and Puerto Rico temporarily halted or recommended providers pause the use of the vaccine. The U.S. military, federally run vaccination sites and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix, also paused the injections.
Fewer than one in a million Johnson & Johnson vaccinations are now under investigation. If there is indeed a risk of blood clots from the vaccine — which has yet to be determined — that risk is extremely low. The risk of getting Covid-19 in the United States is far higher.
The pause could complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy.
Johnson & Johnson has also decided to delay the rollout of its vaccine in Europe amid concerns over rare blood clots, dealing another blow to Europe’s inoculation push. South Africa, devastated by a more contagious virus variant that emerged there, suspended use of the vaccine as well. Australia announced it would not purchase any doses.
“I don’t think they could cope with the surge of severe Covid cases if that happened, so it is important for them to prioritize Covid vaccination,” he said, referring to Bhutan’s health authorities.
Bhutan has reported fewer than 1,000 coronavirus infections and only one death. Its borders, tight by global standards even before the pandemic, have been closed for a year with few exceptions, and anyone who enters the country must quarantine for 21 days.
received his first vaccine dose last month while in quarantine after a visit to Bangladesh. He has been supporting the vaccination effort in recent weeks on his official Facebook page.
“My days are dotted with virtual meetings on numerous areas that need attention, as I closely follow the vaccination campaign on the ground,” Dr. Tshering, a surgeon, wrote in early April. “So far, with your prayers and blessings, everything is going well.”
The economy in Lunana depends on animal husbandry and harvests of a so-called caterpillar fungus that is prized as an aphrodisiac in China. People speak Dzongkha, the national language, and a local dialect.
Last year, the drama “Lunana: A Yak in the Classroom” became the second film ever selected to represent Bhutan at the Academy Awards. It was filmed using solar batteries, and its cast included local villagers.
Lunana’s headman, Kaka, who goes by one name, said the most important part of the vaccination campaign was not on the ground, but in the sky.
“If there hadn’t been a chopper,” he said, “getting the vaccines would have been an issue, since there’s no access road.”
Chencho Dema reported from Thimphu, Bhutan, and Mike Ives from Hong Kong.
The Treasury Department said on Friday that it was putting Taiwan, Vietnam and Switzerland on notice over their currency practices, but it struck a more conciliatory tone than the Trump administration by stopping short of labeling any of them a currency manipulator.
The announcement came in the Treasury Department’s first foreign exchange report under Treasury Secretary Janet L. Yellen. The report, which Treasury submits to Congress twice a year, aims to hold the United States’ top trading partners accountable if they try to gain an unfair advantage in commerce between nations through practices such as devaluing their currencies.
Being labeled a currency manipulator requires a trading partner to enter into negotiations with the United States and the International Monetary Fund to address the situation. The blemish is somewhat symbolic but can lead to tariffs or other forms of retaliation if talks collapse.
Both Switzerland and Vietnam had been on the list of currency manipulators after the Trump administration added them last year, and their removal on Friday means no country currently faces that designation. Still, Treasury said there were signs that Switzerland, Vietnam and Taiwan were improperly managing their currencies.
Vietnam and Switzerland as manipulators in its final report in 2020, but the Biden administration said there was insufficient evidence to support the designation. To receive the label, Treasury must conclude that a country manipulates the exchange rate between its currency and the dollar for “purposes of preventing effective balance of payments adjustments or gaining unfair competitive advantage in international trade.”
wrote a report concluding that Taiwan was hiding $130 billion in reserves to mask its currency interventions and that the case for naming it a manipulator was stronger than the case for naming China.
“Taiwan really has been intervening on a large scale to maintain an undervalued currency for competitive advantage,” Mr. Setser wrote on Twitter at the time.
The Treasury Department did not label China as a currency manipulator, instead urging it to improve transparency over its foreign exchange practices.
Treasury kept China, Japan, Korea, Germany, Italy, India, Malaysia, Singapore and Thailand on its currency monitoring list, and added Ireland and Mexico.
A panic erupted on the West Coast this week. Over a drink.
It happened when beverage aficionados learned that tapioca, the starch used to make the sweet, round, chewy black bubbles — or pearls — that are the featured topping in the popular boba tea drink, was in short supply.
“I was shocked,” said Leanne Yuen, a longtime boba drinker and student at the University of California, Irvine. “What am I going to do now?”
The impending boba shortage is yet another sign of how the pandemic has snarled global supply chains, upended industries and created scarcities of goods from toilet paper to electronics to ketchup. In this case, a surge of pent-up demand for products assembled abroad, coupled with a shortage of workers because of coronavirus cases or quarantine protocols, has caused a monthslong maritime pileup at ports in Los Angeles and San Francisco and left ships delivering goods from Asia — including tapioca — waiting out at sea.
Boba or bubble tea, a drink that can be made with milk or fruit-flavored green or black tea, originated in Taiwan and has steadily grown in popularity and prominence in the United States throughout the 2000s. Boba suppliers based in the San Francisco Bay Area who are running low on tapioca said their shipments of fully formed boba come from Taiwan, while supplies of cassava root, which is used to make tapioca, come from Thailand and islands in the Pacific Ocean.
Instagram post this month that some boba shops had already run out of tapioca balls and others would follow in the next few weeks. The owners of Boba Guys also operate the U.S. Boba Company, which produces and sells tapioca pearls to other stores around the country.
The boba shortage, which was first reported by The San Francisco Chronicle, has boba fans in a panic. A post sharing the news in the Facebook group Subtle Asian Traits, a gathering place for Asian people around the world, attracted 10,000 comments and messages of dismay and sadness.
Boba is “something that translates across a lot of Asian cultures,” said Zoe Imansjah, a student at the University of California, Santa Barbara, and an administrator of the Subtle Asian Traits group. “Something so simple can bring a lot of people together.”
Ms. Yuen, 21, gets boba once or twice a week and sells boba stickers online. She said she grew up visiting a boba shop near her house in South San Francisco with her parents, and now considers getting boba a great way to socialize with friends.
“A lot of my Asian-American friends will bond over boba,” said Ms. Yuen, whose family is from Hong Kong. “Hong Kong has a lot of good milk tea. It brings us back to our roots, in a sense.”
cheese foam, fruit jellies or egg pudding.
“Maybe I’ll try to take a break from the tapioca to relieve that pressure,” Ms. Yuen said.
Vietnam and Switzerland as manipulators in its final report in 2020. The Biden administration’s report undid those designations, citing insufficient evidence.
Instead, the department said it would continue “enhanced engagement” with Vietnam and Switzerland and begin such talks with Taiwan, which includes urging the trading partners to address undervaluation of their currencies.
“Treasury is working tirelessly to address efforts by foreign economies to artificially manipulate their currency values that put American workers at an unfair disadvantage,” Ms. Yellen said in a statement.
Taiwan is the United States’ 10th largest trading partner in 2019, according to the United States trade representative. Vietnam is the 13th largest, and Switzerland is 16th.
The Treasury Department did not label China as a currency manipulator, instead urging it to improve transparency over its foreign exchange practices.
Treasury kept China, Japan, Korea, Germany, Italy, India, Malaysia, Singapore and Thailand on its currency monitoring list, and added Ireland and Mexico.
Millions of workers are wondering what the office will be like when they go back after a long stretch of remote work. Employers are trying to prepare them for it.
IBM has designed a “reorientation” program to help its employees adjust when they return to a familiar setting but face a host of unfamiliar new procedures, the DealBook newsletter writes.
“It’s sort of like the first day of school,” said Joanna Daly, the company’s vice president of talent. “A day early, kids go and get to see the classroom or see how things work.”
This is needed, she said, because it is “not simply returning to the workplace as it existed before or the ways of working as it existed before.”
IBM made a “day in the life” video to show employees what to expect. One version of the 11-minute-long video seen by DealBook starts with “Paul” going back to one of IBM’s offices in Britain. To start the day, he goes through a self-screening checklist to assess potential exposure. He enters the office through designated entrances and picks up his masks for the day (and disinfectant wipes if he needs them). Arrows guide him through the halls and up one-way staircases. Only one person is allowed in the bathroom at a time.
The cafeteria is closed, so Paul must bring his lunch. He can’t use the whiteboards or marker pens in conference rooms (and he shouldn’t linger there longer than necessary). If Paul sees other IBMers not following the safety protocols, “It is OK to politely remind them,” the narrator assures him.
Along with the video, IBM produced an 18-page presentation depicting “Sonia’s’’ return to the workplace, serving as a friendly, cartoon-filled back-to-work manual.
“We’re looking now at how might anxiety manifests itself differently for different employees around being back together and then how do we address that,” Ms. Daly said, “through practical understanding of health and safety and also through having enough flexibility in the environment that everyone can kind of get used to coming back.”
IBM, which has 346,000 employees, hasn’t set a timeline for when its U.S. workers will return to the office. The company’s chief executive, Arvind Krishna, has said he expects 80 percent of them will work in a hybrid fashion when they do.
Mercedes-Benz unveiled an electric counterpart to its top-of-the-line S-Class sedan on Thursday, the latest in a series of moves by German automakers to defend their dominance of the high end of the car market against Tesla.
The EQS, which will be available in the United States in August, is the first of four electric vehicles Mercedes will introduce this year, including two S.U.V.s that will be made at the company’s factory in Alabama and a lower-priced sedan. Mercedes did not announce a price for the EQS, but it is unlikely to be lower than the S-Class, which starts at $94,000 in the United States.
The cars could be decisive for Daimler, the parent company of Mercedes, as it tries to adapt to new technology.
“It is important to us,” Ola Källenius, the chief executive of Daimler, said of the EQS during an interview. “In a way it is kind of day one of a new era.”
The EQS has a range of 770 kilometers or about 480 miles, according to Mercedes. If that figure is confirmed by independent testing, the EQS would dethrone the Tesla Model S Long Range Plus as the production electric car that can travel the farthest between charges. The Tesla currently occupies the No. 1 spot with a range of just over 400 miles, according to rankings by Kelley Blue Book.
The EQS owes its stamina to advances in battery technology and an exceptionally aerodynamic design, Mr. Källenius said. Some analysts question whether Mercedes can sell enough electric vehicles to justify the cost of development, but Mr. Källenius said, “We will make money with the EQS from the word ‘go.’”
The EQS is the latest attempt by German carmakers to show that they can apply their expertise in engineering and production efficiency to battery-powered cars. Vehicles are Germany’s biggest export, so the carmakers’ success or failure will have a significant impact on the country’s prosperity.
On Wednesday, Audi, the luxury unit of Volkswagen, unveiled the Q4 E-Tron, an electric SUV. The Q4 shares many components with the Volkswagen ID.4, an electric SUV that the company began delivering to customers in the United States in March. Though priced to compete with internal combustion models, neither vehicle offers as much range as comparable Tesla cars.
In the S-Class tradition, the EQS offers over-the-top luxury features like software that can recognize when a driver might be feeling fatigued and can offer to turn on the massage function embedded in the seat.
“You’re going to get S-Class level refinement in a very, very high performing electric car,” Mr. Källenius said. “That’s your buying argument.”
China on Friday reported that its economy grew by a remarkable 18.3 percent in the first three months of this year compared with the same period last year.But the spike is as much a reflection of how bad matters were a year ago — when the China’s output shrank by 6.8 percent — as it is an indication of how China is doing now.
Global demand for the computer screens and video consoles that China makes is soaring as people work from home and as a pandemic recovery beckons. That demand has continued as Americans with stimulus checks look to spend money on patio furniture, electronics and other goods made in Chinese factories.
China’s recovery has also been powered by big infrastructure. Cranes dot city skylines. Construction projects for highways and railroads have provided short-term jobs. Property sales have also helped strengthen economic activity.
Exports and property investment can carry China’s growth only so far. Now China is trying to get its consumers to return to their prepandemic ways.
Unlike much of the developed world, China doesn’t subsidize its consumers. Instead of handing out checks to jump-start the economy last year, China ordered state-owned banks to lend to businesses and offered tax rebates.
Travel restrictions over the Lunar New Year holiday dampened consumer appetite and slowed the momentum of Chinese shoppers. But retail data on Friday showed that March sales were better than expected, raising hopes that consumers might be starting to feel confident.
By: Ella Koeze·Data delayed at least 15 minutes·Source: FactSet
Global stocks rose on Friday after a string of strong economic reports and company earnings.
The S&P 500 rose 0.2 percent, set for its fourth straight week of gains and another record. The benchmark had gained 1 percent in the week through Thursday and is up nearly 5 percent so far this month.
The Stoxx Europe 600 rose 0.6 percent on Friday, also climbing to a record, while the FTSE 100 in Britain climbed above 7,000 points for the first time since February 2020. Stock indexes in Japan, Hong Kong and China all closed higher.
China reported on Friday that its economy grew by 18.3 percent in the first three months of the year compared with the same period last year, when swathes of the country had been shut down because of the coronavirus pandemic. On Thursday, data showed U.S. retail sales in March leapt past expectations, increasing by nearly 10 percent, and initial state jobless claims fell last week to their lowest level of the pandemic.
This week, banks including Goldman Sachs and JPMorgan Chase reported better-than-expected earnings, and their chief executives delivered upbeat economic forecasts.
The yield on 10-year Treasury notes slipped to 1.57 percent on Friday. Last month, concerns that government spending would overheat the economy and lead to higher inflation sent bond yields shooting higher, to 1.74 percent on March 31. But those worries appear to have been soothed by central bank officials, who have repeatedly said they expect increases in inflation to be temporary.
Earlier this week, data showed that prices in the United States rose2.6 percent in March from a year earlier, a larger-than-normal increase partly because prices of some items fell in March 2020 as the pandemic took hold.
Another reason yields have drifted lower is a “remarkable” demand for bonds, ING, a Dutch bank, said. Recent Treasury bond auctions have received more bids than normal, and JPMorgan Chase sold $13 billion of bonds on Thursday, the biggest sale ever by a bank, according to Bloomberg.
“Cash has to go somewhere, and it can’t all go into equities,” the ING analysts wrote in a note to clients.
Twitter said on Thursday that it had blocked the account of James O’Keefe, the founder of the conservative group Project Veritas.
Mr. O’Keefe’s account, @JamesOKeefeIII, was “permanently suspended for violating the Twitter Rules on platform manipulation and spam,” specifically that users cannot mislead others with fake accounts or “artificially amplify or disrupt conversations” through the use of multiple accounts, a Twitter spokesman said.
In a statement on his website, Mr. O’Keefe said he will file a defamation lawsuit against Twitter on Monday over its claim that he had operated fake accounts.
“This is false, this is defamatory, and they will pay,” the statement said.
“Section 230 may have protected them before, but it will not protect them from me,” Mr. O’Keefe said, referring to a legal liability shield for social media. That shield, part of the federal Communications Decency Act, has become a favorite target of lawmakers in both parties.
In February, Twitter permanently suspended the Project Veritas account, saying it had posted private information. It also temporarily locked Mr. O’Keefe’s account.
To keep you watching, YouTube serves up videos similar to those you have watched before. But the longer someone watches, the more extreme the videos can become.
Caolan Robertson learned how making clever edits and focusing on confrontation could help draw millions of views on YouTube and other services. He also learned how YouTube’s recommendation algorithm often nudged people toward extreme videos.
Over more than two years, he helped produce and publish videos for right-wing Youtube personalities including Lauren Southern, Cade Metz reports for The New York Times.
Knowing what garnered the most attention on YouTube, Mr. Robertson said, he and Ms. Southern would devise public appearances meant to generate conflict. They attended a women’s march in London and, with Ms. Southern playing the part of a television reporter, approached each woman with the same four-word question: “Women’s rights or Islam?”
They often received a confused, measured or polite response, according to Mr. Robertson. They continued to ask the question and sharpened it. Ms. Southern, for example, said it would be difficult for Muslim women to answer the question because their husbands wouldn’t let them attend the march. That caused anger to build in the crowd.
“It appears in the videos that we are just trying to figure out what is going on, gather information, understand people,” Mr. Robertson said. “But really, we were trying to find the most incendiary way of making them mad.”
Ms. Southern described the situation differently. “We asked the question because we knew it was going to force people to question their own political views and realize the contradiction in being a hard-core feminist but also supporting a religion that, quite frankly, has questionable practices around women,” she said. And, she added, they used video techniques that any media company would use.
A court has awarded attendees of the infamous Fyre Festival approximately $7,220 apiece, nearly four years after they were left scrounging for makeshift shelter on a dark beach. The $2 million class-action settlement, reached Tuesday in U.S. Bankruptcy Court in the Southern District of New York between organizers and 277 ticket holders from the 2017 event, is still subject to final approval, and the amount could ultimately be lower depending on the outcome of Fyre’s bankruptcy case with other creditors.
CBS is turning to a pair of outsiders to restore the fortunes of a news operation that trails its rivals at ABC and NBC. CBS said on Thursday that Neeraj Khemlani, a vice president at the publishing powerhouse Hearst, and Wendy McMahon, a former ABC executive, would succeed Ms. Zirinsky. The two will serve as presidents and co-heads of CBS News, a division that will be expanded to include local stations owned by the network.
Over the course of the book, Ms. Woolever never makes the claim that the guide is comprehensive — and the end result does feel incomplete and unbalanced. The countries of Ghana, Ireland and Lebanon get three pages apiece; the United States gets nearly 100. There is a chapter on Macau, but nothing on Indonesia or Thailand. These are somewhat predictable shortcomings, dependent as the book is on voice-over transcripts spanning decades and the impossible task of stringing them together across time.
Some of the inclusions feel at odds with Mr. Bourdain’s avoid-the-tourists approach to travel, as well. In the Tokyo section, recommendations include the Park Hyatt hotel (made famous by “Lost in Translation,”); Sukiyabashi Jiro, the restaurant at the center of the documentary “Jiro Dreams of Sushi”; the bizarre kitsch-fest that is the Robot Restaurant; and a bar in the tourist-clogged Golden Gai neighborhood. These may be all appealing attractions to a first-timer in Tokyo, but there is nothing in that selection that you wouldn’t find at the top of an algorithm-generated TripAdvisor list.
When I asked Ms. Woolever about these recommendations, she agreed they were perhaps obvious choices, but said Mr. Bourdain wanted to include them because of how much they meant to him, after so many visits to the city. “He wasn’t always (or, arguably, ever) about cool for cool’s sake, or obscurity as its own reward,” she said in an email.
If it’s a guide they are after though, travelers may be left wanting. In Cambodia, you get recommendations for three hotels, two markets for dining and a suggestion to check out the temples of Angkor Wat, the country’s most famous attraction by a long shot. It isn’t exactly the list of hole-in-the-wall spots with no addresses that fans of Mr. Bourdain may be hoping for. What those fans will find though is Mr. Bourdain’s word-for-word rant against American military involvement in Cambodia (“Once you’ve been to Cambodia, you’ll never stop wanting to beat Henry Kissinger to death with your bare hands.”) Having those passages — the no-holds-barred monologues that were a hallmark of his television shows — in one place might be the book’s greatest strength.
Over the decades that Mr. Bourdain spent traveling the world, there was a lot of talk of the “Bourdain Effect”: how a culinary gem, previously only frequented by those in the know, could be “ruined” by being included in his show. When I asked Ms. Woolever whether she thought this book could amplify that effect, she emphasized that most business owners knew what they were in for when approached by producers. “People call it the ‘Bourdain Effect,’ but Tony didn’t invent it,” she said. “It’s something that business owners have to weigh out for themselves.”
As I read the book, I was thinking of a different Bourdain Effect, one that feels more vital than ever right now, as travel begins to take its first baby steps back after a year of lockdowns. Seeing so much of Anthony Bourdain’s work in one place and being able to compare his impressions country-by-country in a tightly packed medium, makes it easier to see what he stood for. A traveling philosophy emerges: his utter disdain for stereotypes, his undying commitment to challenging his own preconceptions, his humility in the face of generosity.
Because of tragic circumstances following its inception, “World Travel” may feel more like an anthology of greatest hits than a new, original guidebook. But read cover to cover, country by country, it is an enduring embodiment of Anthony Bourdain’s love for the whole world and a reminder of how to stack our priorities the next time we’re able to follow in his footsteps.
clinical trial results announced on Monday. The drug, if authorized, could offer another line of defense against the disease for people who are not protected by vaccination.
The findings are the latest evidence that such lab-made drugs not only prevent the worst outcomes of the disease when given early enough, but also help prevent people from getting sick in the first place.
Using the cumbersome drugs preventively on a large scale won’t be necessary: Vaccines are sufficient for the vast majority of people and are increasingly available.
Still, antibody drugs like Regeneron’s could give doctors a new way to protect high-risk people who haven’t been inoculated or who may not respond well to vaccination, such as those taking drugs that weaken their immune system. That could be an important tool as rising coronavirus cases and dangerous virus variants threaten to outpace vaccinations.
Regeneron said in a news release that it would ask the Food and Drug Administration to expand the drug’s emergency authorization — currently for high-risk people who already have Covid but are not hospitalized — to allow it to be given for preventive purposes in “appropriate populations.”
There’s “a very substantial number of people” in the United States and globally who could be a good fit to receive these drugs for preventive purposes, said Dr. Myron Cohen, a University of North Carolina researcher who leads monoclonal antibody efforts for the Covid Prevention Network, a National Institutes of Health-sponsored initiative that helped to oversee the trial.
“Not everyone’s going to take a vaccine, no matter what we do, and not everyone’s going to respond to a vaccine,” Dr. Cohen said.
Regeneron’s new data come from a clinical trial that enrolled more than 1,500 people who lived in the same household as someone who had tested positive for the virus within four days. Those who got an injection of Regeneron’s drug were 81 percent less likely to get sick with Covid compared to volunteers who got a placebo.
Dr. Rajesh Gandhi, an infectious diseases physician at Massachusetts General Hospital who was not involved in the study, said the data were “promising” for people who have not yet been vaccinated. But he said that the study did not enroll the type of patients that would be needed to assess whether the drug should be used preventively for immunocompromised patients. “I would say we don’t yet know that,” Dr. Gandhi said.
Regeneron’s cocktail, a combination of two drugs designed to mimic the antibodies generated naturally when the immune system fends off the virus, got a publicity boost last fall when it was given to President Donald J. Trump after he got sick with Covid.
The treatment received emergency authorization in November. Doctors are using it, as well as another antibody cocktail from Eli Lilly, for high-risk Covid patients.
But use of the antibody drugs has been slowed not by a shortage of doses, but by other challenges, though access has improved in recent months. Many patients don’t know to ask for the drugs or where to find them.
Many hospitals and clinics have not made the treatments a priority because they have been time-consuming and difficult to administer, in large part because they must be given via intravenous infusion. Regeneron plans to ask the F.D.A. to allow its drug to be given via an injection, as it was administered in the results of the study announced on Monday, which would allow it to be given more quickly and easily.
Britain reopened large parts of its economy on Monday, allowing people in England back in shops, hair salons and outdoor areas of pubs and restaurants, a long-awaited milestone after three months of lockdown, and a day after the country recorded its lowest daily coronavirus death toll since September.
Under the second stage of the government’s gradual reopening, libraries, community centers and some outdoor attractions like zoos will also return, though outdoor gatherings remain limited to six people or two households.
For many in England, the return was a hopeful — if not definitive — sign that the worst of the pandemic was behind them, after a new variant of the virus detected last year in the country’s southeast spun out of control around Christmas, overwhelming hospitals and causing tens of thousands of deaths.
At its winter peak, Britain reported as many as 60,000 daily cases a day and 1,820 daily deaths, according to a New York Times database. But after months of restrictions and an aggressive vaccination program that has offered a dose to about half of Britain’s population, those figures declined to 1,730 daily cases and seven deaths reported on Sunday.
Prime Minister Boris Johnson has so far gone ahead with the gradual easing of measures that he had announced, reopening schools on March 8, reducing restrictions on outdoor gatherings on March 29, and allowing large parts of the economy to reopen on Monday.
Mr. Johnson said on Monday that the reopening was “a major step forward in our road map to freedom.” Still, he urged caution.
“I urge everyone to continue to behave responsibly and remember ‘hands, face, space and fresh air’ to suppress Covid,” he said.
Scotland, Wales and Northern Ireland, where devolved governments are responsible for coronavirus restrictions, have laid out similar plans to reopen their economies.
The apparent success represents a turnaround for Mr. Johnson’s government, which struggled to stem cases earlier in the pandemic and at one point reported the greatest rate of excess deaths in Europe.
But now E.U. countries — hampered by a vaccine rollout slower than Britain’s and a scare over a possible links between the AstraZeneca vaccine and blood clots — are facing a third wave of coronavirus infections. France, Italy and other countries have recently imposed new lockdown measures.
In England, business owners reopened on Monday with hope — and some anxiety that the numbers of infections could go up again. Still, “we’re looking confident we won’t be seeing anything like that again,” said Nicholas Hair, the owner of The Kentish Belle, a London pub that opened its doors to patrons one minute after midnight.
Even as India hit a record for daily coronavirus infections, and its total caseload rose to second in the world behind the United States, the images that dominated Indian news media on Monday were of a crowded religious festival along the banks of the Ganges River.
The dissonance was a clear manifestation of the confusing messages sent by the authorities just as India’s coronavirus epidemic is spiraling, with a daily high of 168,000 cases and 900 deaths reported on Monday.
Yet millions of devotees have thronged the holy city of Haridwar for the monthlong Kumbh Mela, or pitcher festival, when Hindu pilgrims seek absolution by bathing in the Ganges. Officials have said that about one million people will participate every day, and as many as five million during the most auspicious days, all crowded into a narrow stretch along the river and searching for the holiest spot to take a dip.
Already, fears are running high that one of the most sacred pilgrimages in Hinduism could turn into a superspreading event.
Dr. S. K. Jha, a local health officer, said that an average of about 250 new cases had been registered each day recently. Experts have warned that many more infections are going unrecorded, and that devotees could unwittingly carry the virus with them as they return to their homes across the country.
India is in the grip of the world’s fastest growing outbreak, with more and more jurisdictions going back into varying stages of lockdown. Infections are spreading particularly fast in Mumbai, the country’s financial hub, and the surrounding state of Maharashtra, where the government has announced a partial weekday lockdown and near-total closure over the weekends.
The situation is also worsening in the capital, New Delhi, which reported more than 10,000 new cases on Sunday, surpassing the previous daily high of nearly 8,500. The state government has imposed a curfew and ordered restaurants and public transport systems to run at half capacity. Arvind Kejriwal, Delhi’s top official, has said more restrictions may follow.
Hospitals in several states are reporting shortages of oxygen, ventilators and coronavirus testing kits, and some are also running low on remdesivir, a drug used in serious Covid-19 cases. India has halted the export of remdesivir until the situation improves.
India is also trying to ramp up its vaccination drive, with about three million people being inoculated daily and 104 million doses administered so far. But with many vaccination centers nationwide expressing concern over possible shortages, India’s large pharmaceutical industry has sharply reduced its exports of the AstraZeneca vaccine in order to keep more doses at home, creating serious challenges for other countries that had been relying on those shipments.
On Monday, Indian experts recommended the use of Russia’s Sputnik-V coronavirus vaccine, which would become the third available in the country if approved by the authorities.
After months of lower-than-expected infections and deaths from the virus, critics say Indian officials have sent dissonant messages about the seriousness of the crisis. Police officers are enforcing curfew and mask rules, sometimes resorting to beatings captured on videos shared across social media. But senior political leaders, including the prime minister, Narendra Modi, have been holding large rallies for local elections.
Mr. Modi’s Hindu nationalist government has also allowed the religious festival to proceed — in contrast to what happened last spring, at the start of the pandemic, when India’s health ministry blamed an Islamic seminary for fanning a far smaller outbreak. Critics say rhetoric from members of Mr. Modi’s party contributed to a spate of attacks against Muslims, a minority of about 200 million people in a Hindu-dominated country of 1.3 billion.
In other news around the world:
Bangladesh has announced a weeklong lockdown, closing offices, factories and transport services starting Wednesday, and banning domestic and international flights. The country is facing its severest coronavirus outbreak so far, averaging nearly 7,000 daily new infections, according to a New York Times database, as the virus sweeps across South Asia.
In France, all people over 55 are eligible to receive the AstraZeneca and Johnson & Johnson vaccines starting Monday, as the authorities try to ramp up their vaccination campaign after a sluggish start. Health Minister Olivier Véran said on Sunday that France would also extend the period between the first and second shots of the Pfizer and Moderna vaccines to six weeks from four, echoing Britain’s strategy. Over 14 million people have received a first injection.
High schools reopened in Greece on Monday after five months closed. The reopening only applies to senior high-school classes, and pupils and teachers will have to take a virus test twice a week before returning to classrooms. Thousands did so at home on Sunday, with just 613 positives out of some 380,000, a rate of 0.16 percent, according to state television. Stores in the country reopened last week.
The world’s wealthy nations should commit $30 billion to a global mass vaccination campaign, Gordon Brown, a former prime minister of Britain, said on Monday. Lower-income countries’ inoculation efforts are trailing far behind richer nations’ and the divide has led to allegations of a “vaccine apartheid,” Mr. Brown warned in an op-ed for The Guardian. “The costs may still be in billions, but the benefit will be in trillions,” he wrote.
Anna Schaverien, Constant Méheut and Niki Kitsantonis contributed reporting.
Australia has given up on the goal of vaccinating its entire population against Covid-19 by the end of the year, following updated advice from health officials that younger people should not receive the AstraZeneca vaccine, as well as delays in the delivery of doses.
The Australian government said last week that it had accepted a recommendation by a panel of health experts that people under 50 receive the Pfizer-BioNTech vaccine instead of the one developed by AstraZeneca, which had been the centerpiece of Australia’s vaccination program. The change in guidance came after European regulators found links between the AstraZeneca vaccine and rare blood clots, prompting several countries to restrict use of the shot.
Prime Minister Scott Morrison said Friday that the government had ordered another 20 million doses of the Pfizer vaccine, doubling what it had already purchased. But they are not expected to be available until the fourth quarter of this year, dealing a blow to the government’s previously stated goal of inoculating all of its 25 million people by then.
Mr. Morrison appeared to acknowledge the change in timeline in a Facebook post on Sunday.
“The government has also not set, nor has any plans to set any new targets for completing first doses,” Mr. Morrison said. “While we would like to see these doses completed before the end of the year, it is not possible to set such targets given the many uncertainties involved.”
Public health experts have criticized Mr. Morrison’s government for relying too heavily on the AstraZeneca vaccine, a relatively cheap and easy-to-use shot but one whose troubles have jeopardized inoculation efforts in multiple countries. They said the setback to Australia’s vaccination program risked undermining the country’s success in containing the spread of the coronavirus since recording its first case in January 2020.
“We’re in a position a year later where that hard-won success is jeopardized by a completely incompetent approach to a vaccine rollout,” said Bill Bowtell, a public health policy expert and adjunct professor at the University of New South Wales in Sydney.
Australia has made four separate agreements for the supply of Covid-19 vaccines that would give it a total of 170 million doses, enough to inoculate its population more than three times over. Plans to manufacture almost all of its 54 million AstraZeneca doses domestically were approved last month.
But the Australian government has been under fire for weeks over the sluggish pace of its vaccination rollout, which began in late February. By the end of March, when the government had aimed to vaccinate four million people, only about 600,000 had actually been inoculated. As of Sunday, Australia had administered fewer than 1.2 million doses.
Australian officials have attributed the slow rollout to delays in the delivery of millions of vaccine doses manufactured in the European Union, which has curbed exports amid its own supply shortages. The export restrictions mainly affect the AstraZeneca vaccine.
After enduring strict lockdowns for much of the past year, Australians are now enjoying relatively normal life in a country that has all but stamped out the virus. But public health experts warn that until more of the population is vaccinated, those freedoms are precarious.
“Having eliminated Covid, they thought a mass vaccination campaign would lock that in,” Mr. Bowtell said of the Australian public. “Now they are being deeply disillusioned.”
Thailand is facing its worst coronavirus outbreak just as millions of people head to their home provinces during the country’s biggest travel holiday.
The latest wave of infections, which has sent at least eight cabinet members into isolation, is centered in a Bangkok nightlife district said to be popular with government officials and wealthy partygoers. The country, which until now has largely kept the virus under control, set a record Monday for new daily cases with 985.
One top health official warned that Thailand could soon face as many as 28,000 new cases a day in the worst-case scenario. The government announced it would set up field hospitals as Covid-19 wards at existing facilities begin to fill up.
Officials ordered the closure of hundreds of bars and nightclubs, but critics say the government has been inconsistent in its efforts to bring the outbreak under control. The prime minister, Prayuth Chan-ocha, stopped short of banning travel between provinces for the Songkran holiday, which begins on Tuesday and marks the beginning of the Thai New Year.
“Whatever will be, will be,” he said last week in explaining his decision. “The reason is it’s a matter that involves a huge number of people. The government will have to try to cope with that later.”
Dozens of provinces have imposed their own restrictions on travelers coming from Bangkok and other affected areas, prompting many Thais to cancel their trips. But many others set off over the weekend.
During earlier outbreaks, the government often acted quickly to require face masks, ban foreign tourists, impose quarantine restrictions and lock down hard-hit areas. It has reported fewer than 34,000 cases — mostly from a January surge traced to a seafood market near Bangkok — and just 97 deaths.
But it has been lax in testing and slow to vaccinate. So far, it has procured about 2.2 million doses and given at least one to about 500,000 people. Thailand’s population is 70 million.
Vaccine production is not expected to begin in earnest until June, when a manufacturer in Thailand is scheduled to begin producing 10 million doses a month of the AstraZeneca vaccine.
Health officials were alarmed by the recent discovery of dozens of cases of the highly infectious coronavirus variant first identified in Britain. The finding highlighted the inadequacy of Thailand’s virus testing and suggested that its quarantine procedures have not been as effective as officials believed.
Tourism operators have been especially angered by the government’s lackadaisical approach to obtaining vaccine supplies. The tourism industry, which normally accounts for about 20 percent of the nation’s economy, is highly dependent on foreign visitors and has been calling for widespread vaccinations to speed its recovery.
The outbreak in Bangkok has also prompted questions about the activities of some top officials and their aides.
The transportation minister, Saksayam Chidchob, who was hospitalized with Covid-19, was criticized for not being forthcoming about his whereabouts during times when he may have been exposed to the virus. He denied visiting the gentlemen’s club at the center of the outbreak and said he believed he had contracted the virus from an aide.
Parents with school-age children have struggled to combine their usual work and family responsibilities this past year with at least some degree of home-schooling.
But mothers and fathers of middle-schoolers — the parenting cohort long known to researchers as the most angst-ridden and unhappy — are connecting now in a specific sort of common misery: the pressing fear that their children, at a vital point in their academic and social lives, have tripped over some key developmental milestones and may never quite find their footing.
Experts say some of their worries are justified — up to a point.The pandemic has taken a major toll on many adolescents’ emotional well-being.
Yet as the nation begins to pivot from trauma to recovery, many mental-health experts and educators are trying to spread the message that parents, too, need a reset. If adults want to guide their children toward resilience, these experts say, then they need to get their own minds out of crisis mode.
Early adolescence is considered a critical period, a time of brain changes so rapid and far-reaching that they rival the plasticity and growth that take place in the newborn to 3-year-old phase.
These changes make children more capable of higher-level thinking and reasoning. They also make them crave social contact, attention and approval.
Remote learning and social distancing are in many ways the opposite of what children in this age group want and need.
“It’s been hardest on middle schoolers,” said Phyllis Fagell, a therapist and school counselor who wrote the 2019 book “Middle School Matters.” “It is their job to pull away from parents, to use these years to really focus on figuring out where they are in the pecking order. And all of that hard work that has to happen in these years was just put on hold.”
Yet Ms. Fagell and many other experts in adolescent development were adamant that parents should not panic — and that the spread of the “lost year” narrative needed to stop.
Getting a full picture of what’s going on with middle schoolers, they agreed, requires holding two seemingly contradictory ideas simultaneously in mind: The past year has been terrible. And most middle schoolers will be fine.
Late last month, foreign officials in army regalia toasted their hosts in Naypyidaw, the bunkered capital built by Myanmar’s military. Ice clinked in frosted glasses. A lavish spread had been laid out for the foreign dignitaries in honor of Myanmar’s Armed Forces Day.
That very day, the military, which had seized power on Feb. 1, gunned down more than 100 of its own citizens. Far from publicly condemning the brutality, the military representatives from neighboring countries — India, China, Thailand and Vietnam among them — posed grinning with the generals, legitimizing their putsch.
The coup in Myanmar feels like a relic of a Southeast Asian past, when men in uniform roamed a vast dictators’ playground. But it also brings home how a region once celebrated for its transformative “people power” revolutions — against Suharto of Indonesia and Ferdinand Marcos of the Philippines — has been sliding back into autocracy.
From Cambodia and the Philippines to Malaysia and Thailand, democracy is languishing. Electoral politics and civil liberties have eroded. Obedient judiciaries have hobbled opposition forces. Entire political classes are in exile or in prison. Independent media are being silenced by leaders who want only one voice heard: their own.
alliance of democracies.” With China and Russia involved, the United Nations Security Council has done nothing to punish Myanmar’s generals.
Covid-19 with them.
A scheduled special meeting on Myanmar by the Association of Southeast Asian Nations offers little hope of action. That consensus-driven group avoids delving into members’ internal affairs. Earlier negotiations among regional foreign ministers didn’t result in a single policy that would deter Myanmar’s coup-makers.
Besides, many of the region’s leaders have no wish to uphold democratic ideals. They have used the courts to silence their critics and met protest movements with force.
But if authoritarians are looking out for one another, so, too, are protesters. In Thailand, students have stood up to a government born of a coup, using a three-fingered salute from the “Hunger Games” films to express defiance. The same gesture was adopted after the putsch in Myanmar, the leitmotif of a protest movement millions strong.
its first commoner president, and Malaysia would shunt aside a governing party bloated by decades of graft and patronage. Thailand’s generals had managed to go years without a coup. Even in Vietnam, the Communist leadership was pushing forward with liberalization.
The most significant transformation seemed to be in Myanmar. The military had led the country since a 1962 coup, driving it into penury. In 2015, the generals struck a power-sharing agreement with a civilian leadership fronted by Daw Aung San Suu Kyi, the Nobel laureate who spent 15 years under house arrest. President Barack Obama went to Myanmar to sanctify the start of a peaceful political transition.
Now Ms. Aung San Suu Kyi is again locked in her villa, facing possible life imprisonment. Her supporters have been arrested and tormented. Soldiers picked up one of Ms. Aung San Suu Kyi’s followers and burned a tattoo of her face off his arm.
Much of the rest of Southeast Asia is in full-fledged democratic retreat. The leader of Thailand’s last coup, Prayuth Chan-ocha, is still the prime minister. His government has charged dozens of student protesters, some in their teens, with obscure crimes that can carry long sentences. Thai dissidents in exile have turned up dead.
After a brief interlude out of government, Malaysia’s old establishment is back in power, including people associated with one of the largest heists of state funds the world has seen in a generation. Vietnam’s crackdown on dissent is in high gear. In Cambodia, Hun Sen, Asia’s longest-ruling leader, has dismantled all opposition and set in place the makings of a family political dynasty.
President Rodrigo Duterte of the Philippines may enjoy enduring popularity, but he has presided over thousands of extrajudicial killings. He has also cozied up to China, presenting it as a more constant friend than the United States, which once colonized the Philippines.
Protesters in Thailand, who gathered by the hundreds of thousands last year, have resumed their rallies, even though most of their young leaders are now in prison.
As the riot police fired rubber bullets near the Grand Palace in Bangkok last month, Thip Tarranitikul said she wanted to erase the military from politics.
army chief, appears to have underestimated the people’s commitment to democratic change. Millions have marched against him. Millions have also joined nationwide strikes meant to stop his government from functioning.
There is little reason to believe the military will back down, given its decades in power. Over the past two months, it has killed more than 700 civilians, according to a monitoring group. Thousands have been arrested, including medics, reporters, a model, a comedian and a beauty blogger.
But the resistance has demographics on its side.
Southeast Asia may be ruled by old men, but more than half its population is under 30. Myanmar’s reforms over the past decade benefited young people who eagerly connected to the world. In Thailand, this same cohort is confronting the old hierarchies of military and monarchy.
Regional defenders of democracy, including the besieged dissidents of nearby Hong Kong, have formed what they call the Milk Tea Alliance online, referring to a shared affinity for the sweet brew. (Twitter recently gave the movement its own emoji.) On encrypted apps, they trade tips for protecting themselves from tear gas and bullets. They have also bonded over the disproportionate impact the pandemic has had on young workers, in countries where income inequality is growing wider.
“The youth of Southeast Asia, these young digital natives, they inherently despise authoritarianism because it doesn’t jibe with their democratic lifestyle. They aren’t going to give up fighting back,” said Mr. Thitinan of Chulalongkorn University. “That’s why, as bad as things may seem now, authoritarianism in the region is not a permanent condition.”
In Yangon, the largest city in Myanmar, protesters have faced the military’s rifles with a sense of an existential mission.
“I’m not afraid to die,” said Ko Nay Myo Htet, a high school student manning one of the barricades built to defend neighborhoods. “I want a better life for the future generation.”
The Hong Kong government said last month that it would allow hundreds of residents who have been stranded in Britain by virus-related travel restrictions to return on two special flights.
But when those residents went to book seats on flights, the website for Cathay Pacific Airways, Hong Kong’s flag carrier, crashed. The snafu on Thursday was the latest chapter in a bureaucratic saga that has left them feeling angry, confused and exasperated.
The Hong Kong government suspended flights from Britain in December as a coronavirus variant spread through that country. It also barred anyone who had spent more than two hours there or in other “extremely high-risk” places in the previous 21 days from boarding a direct flight to the Chinese territory.
Those measures, which remain in effect, also apply to inbound travelers who have recently been to Brazil, Ireland or South Africa. But last week Hong Kong said that it would arrange two special return flights from London on Cathay Pacific in late April. It cited Britain’s declining caseload and “satisfactory vaccination progress” as reasons for the policy shift.
reported last week that the travel ban had stranded more than 600 Hong Kong residents in Britain. Mr. Bux said on Friday that some of them had been unable to book seats on the special flights.
It was unclear whether additional flights would be offered, or why officials in Hong Kong, where the borders have been closed to nonresidents for more than a year, waited more than three months to schedule the two flights. A spokeswoman for the Immigration Department referred questions on Friday to the Food and Health Bureau, which declined to comment.
Mr. Bux said he could sympathize with the stranded travelers because he, too, had been stranded by the December ban while visiting family in Liverpool. He said he was among the 200 to 300 Hong Kong residents who had managed to make it home from Britain after spending a 21-day “wash out” period in a third country like Thailand, Egypt or the United Arab Emirates.
mandatory three-week hotel quarantine, one of the world’s longest. Some scientists have questioned whether that policy is too strict because the coronavirus is widely considered to have a 14-day incubation period.
“After my departure from the U.K., I needed 42 days to resume my normal life in Hong Kong,” he said. “It’s a really long period.”
Faced with accusations that it was profiting from the forced labor of Uyghur people in the Chinese territory of Xinjiang, the H&M Group — the world’s second-largest clothing retailer — promised last year to stop buying cotton from the region.
But last month, H&M confronted a new outcry, this time from Chinese consumers who seized on the company’s renouncement of the cotton as an attack on China. Social media filled with angry demands for a boycott, urged on by the government. Global brands like H&M risked alienating a country of 1.4 billion people.
The furor underscored how international clothing brands relying on Chinese materials and factories now face the mother of all conundrums — a conflict vastly more complex than their now-familiar reputational crises over exploitative working conditions in poor countries.
ban on imports. Labor activists will charge them with complicity in the grotesque repression of the Uyghurs.
Myanmar and Bangladesh, where cheap costs of production reflect alarming safety conditions.
genocide. As many as a million Uyghurs have been herded into detention camps, and deployed as forced labor.
As China has transformed itself from an impoverished country into the world’s second-largest economy, it has leaned on the textile and apparel industries. China has courted foreign companies with the promise of low-wage workers operating free from the intrusions of unions.
regional government said last year.
statement reported by Reuters.
That assertion flew in the face of a growing body of literature, including a recent statement from the United Nations Human Rights Council expressing “serious concerns” about reports of forced labor.
The Better Cotton Initiative declined a request for an interview to discuss how it had come to its conclusion.
“We are a not-for-profit organization with a small team,” the initiative’s communications manager, Joe Woodruff, said in an email.
The body’s membership includes some of the world’s largest, most profitable clothing manufacturers and retailers — among them Inditex, the Spanish conglomerate that owns Zara, and Nike, whose sales last year exceeded $37 billion.
Trump administration furthered the trend by pressuring American multinational companies to abandon China.
“All of the economic forces that pushed this production to China are really no longer at work,” said Pietra Rivoli, a trade expert at Georgetown University in Washington.
Still, China retains attributes not easily replicated — the world’s largest ports, plus a cluster of related industries, from chemicals to plastics.
Cambodia in response to its government’s harsh crackdown on dissent.
Some global brands are seeking Beijing’s permission to import more cotton into China from the United States and Australia. They could employ that cotton to make products destined for Europe and North America, while using the Xinjiang crop for the Chinese market.
Yet that approach may leave the apparel companies exposed to the same risks they face now.
“If the brand is labeled as ‘They are still using forced labor, but they are just using it for the Chinese market,’ is this going to suffice?” said Ms. Collinson, the industry lobbyist.
Last week, H&M issued a new communication, beseeching Chinese consumers to return. “We are working together with our colleagues in China to do everything we can to manage the current challenges,” said the statement, which did not mention Xinjiang. “China is a very important market to us.”
Those words appear to have satisfied no one — not the human rights organizations skeptical of claims that apparel companies have severed links to Xinjiang; not Chinese consumers angry over a perceived national indignity.
On Chinese social media, criticism of H&M remained fierce.
“For you, China is still an important market,” one post declared. “But for China, you are just an unnecessary brand.”
A new vaccine for Covid-19 that is entering clinical trials in Brazil, Mexico, Thailand and Vietnam could change how the world fights the pandemic. The vaccine, called NVD-HXP-S, is the first in clinical trials to use a new molecular design that is widely expected to create more potent antibodies than the current generation of vaccines. And the new vaccine could be far easier to make.
Existing vaccines from companies like Pfizer and Johnson & Johnson must be produced in specialized factories using hard-to-acquire ingredients. In contrast, the new vaccine can be mass-produced in chicken eggs — the same eggs that produce billions of influenza vaccines every year in factories around the world.
If NVD-HXP-S proves safe and effective, flu vaccine manufacturers could potentially produce well over a billion doses of it a year. Low- and middle-income countries currently struggling to obtain vaccines from wealthier countries may be able to make NVD-HXP-S for themselves or acquire it at low cost from neighbors.
“That’s staggering — it would be a game-changer,” said Andrea Taylor, assistant director of the Duke Global Health Innovation Center.
Vaccines work by acquainting the immune system with a virus well enough to prompt a defense against it. Some vaccines contain entire viruses that have been killed; others contain just a single protein from the virus. Still others contain genetic instructions that our cells can use to make the viral protein.
Once exposed to a virus, or part of it, the immune system can learn to make antibodies that attack it. Immune cells can also learn to recognize infected cells and destroy them.
spike, latches onto cells and then allows the virus to fuse to them.
But simply injecting coronavirus spike proteins into people is not the best way to vaccinate them. That’s because spike proteins sometimes assume the wrong shape, and prompt the immune system to make the wrong antibodies.
The researchers injected the 2P spikes into mice and found that the animals could easily fight off infections of the MERS coronavirus.
The team filed a patent for its modified spike, but the world took little notice of the invention. MERS, although deadly, is not very contagious and proved to be a relatively minor threat; fewer than 1,000 people have died of MERS since it first emerged in humans.
But in late 2019 a new coronavirus, SARS-CoV-2, emerged and began ravaging the world. Dr. McLellan and his colleagues swung into action, designing a 2P spike unique to SARS-CoV-2. In a matter of days, Moderna used that information to design a vaccine for Covid-19; it contained a genetic molecule called RNA with the instructions for making the 2P spike.
Other companies soon followed suit, adopting 2P spikes for their own vaccine designs and starting clinical trials. All three of the vaccines that have been authorized so far in the United States — from Johnson & Johnson, Moderna and Pfizer-BioNTech — use the 2P spike.
Other vaccine makers are using it as well. Novavax has had strong results with the 2P spike in clinical trials and is expected to apply to the Food and Drug Administration for emergency use authorization in the next few weeks. Sanofi is also testing a 2P spike vaccine and expects to finish clinical trials later this year.
Two prolines are good; six are better
Dr. McLellan’s ability to find lifesaving clues in the structure of proteins has earned him deep admiration in the vaccine world. “This guy is a genius,” said Harry Kleanthous, a senior program officer at the Bill & Melinda Gates Foundation. “He should be proud of this huge thing he’s done for humanity.”
But once Dr. McLellan and his colleagues handed off the 2P spike to vaccine makers, he turned back to the protein for a closer look. If swapping just two prolines improved a vaccine, surely additional tweaks could improve it even more.
HexaPro, in honor of its total of six prolines.
The structure of HexaPro was even more stable than 2P, the team found. It was also resilient, better able to withstand heat and damaging chemicals. Dr. McLellan hoped that its rugged design would make it potent in a vaccine.
Dr. McLellan also hoped that HexaPro-based vaccines would reach more of the world — especially low- and middle-income countries, which so far have received only a fraction of the total distribution of first-wave vaccines.
“The share of the vaccines they’ve received so far is terrible,” Dr. McLellan said.
To that end, the University of Texas set up a licensing arrangement for HexaPro that allows companies and labs in 80 low- and middle-income countries to use the protein in their vaccines without paying royalties.
Meanwhile, Dr. Innes and his colleagues at PATH were looking for a way to increase the production of Covid-19 vaccines. They wanted a vaccine that less wealthy nations could make on their own.
experimenting with Newcastle disease virus to create vaccines for a range of diseases. To develop an Ebola vaccine, for example, researchers added an Ebola gene to the Newcastle disease virus’s own set of genes.
The scientists then inserted the engineered virus into chicken eggs. Because it is a bird virus, it multiplied quickly in the eggs. The researchers ended up with Newcastle disease viruses coated with Ebola proteins.
At Mount Sinai, the researchers set out to do the same thing, using coronavirus spike proteins instead of Ebola proteins. When they learned about Dr. McLellan’s new HexaPro version, they added that to the Newcastle disease viruses. The viruses bristled with spike proteins, many of which had the desired prefusion shape. In a nod to both the Newcastle disease virus and the HexaPro spike, they called it NDV-HXP-S.
announced the start of a clinical trial of NDV-HXP-S. A week later, Thailand’s Government Pharmaceutical Organization followed suit. On March 26, Brazil’s Butantan Institute said it would ask for authorization to begin its own clinical trials of NDV-HXP-S.
Meanwhile, the Mount Sinai team has also licensed the vaccine to the Mexican vaccine maker Avi-Mex as an intranasal spray. The company will start clinical trials to see if the vaccine is even more potent in that form.
To the nations involved, the prospect of making the vaccines entirely on their own was appealing. “This vaccine production is produced by Thai people for Thai people,” Thailand’s health minister, Anutin Charnvirakul, said at the announcement in Bangkok.
In Brazil, the Butantan Institute trumpeted its version of NDV-HXP-S as “the Brazilian vaccine,” one that would be “produced entirely in Brazil, without depending on imports.”
Ms. Taylor, of the Duke Global Health Innovation Center, was sympathetic. “I could understand why that would really be such an attractive prospect,” she said. “They’ve been at the mercy of global supply chains.”
Madhavi Sunder, an expert on intellectual property at Georgetown Law School, cautioned that NDV-HXP-S would not immediately help countries like Brazil as they grappled with the current wave of Covid-19 infections. “We’re not talking 16 billion doses in 2020,” she said.
Instead, the strategy will be important for long-term vaccine production — not just for Covid-19 but for other pandemics that may come in the future. “It sounds super promising,” she said.
In the meantime, Dr. McLellan has returned to the molecular drawing board to try to make a third version of their spike that is even better than HexaPro.
“There’s really no end to this process,” he said. “The number of permutations is almost infinite. At some point, you’d have to say, ‘This is the next generation.’”