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

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

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

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

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

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

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

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

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

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

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

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

Lynsey Chutel and Choe Sang-Hun contributed reporting.

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Countries Are Scrambling for Vaccines. Mongolia Has Plenty.

Mongolia, a country of grassy hills, vast deserts and endless skies, has a population not much bigger than Chicago’s. The small democratic nation is used to living in the shadow of its powerful neighbors, Russia and China.

But during a pandemic, being a small nation sandwiched between two vaccine makers with global ambitions can have advantages.

At a time when most countries are scrambling for coronavirus vaccines, Mongolia now has enough to fully vaccinate its entire adult population, in large part thanks to deals with both China and Russia. Officials are so confident about the nation’s vaccine riches that they are promising citizens a “Covid-free summer.”

Mongolia’s success in procuring the vaccines in the span of a few months is a big victory for a low-income, developing nation. Many poor countries have been waiting in line for shots, hoping for the best. But Mongolia, using its status as a small geopolitical player between Russia and China, was able to snap up doses at a clip similar to that of much wealthier countries.

deep skepticism over their homegrown vaccines.

Mongolia is a buffer between eastern Russia, which is resource rich and mostly unpopulated, and China, which is crowded and hungry for resources. While Russia and China are often aligned on the global stage, they have a history of conflict and are wary of each others’ interests in Mongolia. Those suspicions can be seen in their vaccine diplomacy.

arrived this week. Mongolia’s most recent agreement with China’s Sinopharm Group, which is state-owned, was made days before the company received emergency authorization from the World Health Organization.

Mongolia was late to the global clamber for Covid-19 vaccines. For nearly a year officials boasted that there were no local cases. Then came an outbreak in November. Two months later, political crisis precipitated by the mishandling of the virus led to the sudden resignation of the prime minister. The prospect of continued coronavirus restrictions threatened to throw the country into further political turmoil.

The new prime minister, Oyun-Erdene Luvsannamsrai, pledged to restart the economy, which had suffered from lockdowns and border closures, particularly in the south, where Mongolian truck drivers ferry coal across the border to China’s steel mills. But these plans were complicated by surging cases, with the daily count going from hundreds a day to thousands.

“We were quite desperate,” said Bolormaa Enkhbat, an economic and development policy adviser to Mr. Luvsannamsrai.

Vero Cell vaccine. Soon after, China donated 300,000 doses of its Sinopharm vaccine to Mongolia, citing a “profound traditional friendship” as motivation.

Opening up more of the border between China and Mongolia was also a part of the vaccine discussions, Chinese and Mongolian officials said in Chinese state media. Mongolia needs China to buy its coal — exports to the country make up nearly a quarter of Mongolia’s annual economic growth. The revenues helped to pad Mongolia’s budget by a quarter last year.

After a month of back and forth, the Mongolian government struck a deal in March with Russia’s Gamaleya Research Institute, too, for one million doses of the Sputnik vaccine. Days later, Mongolia finalized an agreement to buy 330,000 additional doses of the Sinopharm vaccine.

Ulaanbaatar, Mongolia’s capital, 97 percent of the adult population has received a first dose and more than half are fully vaccinated, according to government statistics. Across the country, more than three quarters of Mongolians have already received one shot.

China has shut its border and stopped purchasing Mongolian coal.

Mongolians have also expressed a preference for Russia’s Sputnik vaccine. To get the population to take the Sinopharm shot, the government has offered each citizen 50,000 tugriks — about $18 — to get fully vaccinated. The average monthly salary in 2020 was $460.

The terms and pricing of the Sinopharm and Sputnik deals were not made public, and Mongolia’s foreign ministry declined to comment on pricing. Representatives for the Gamaleya Research Institute and Sinopharm did not respond to requests for comment.

While some global health experts have questioned whether Sinopharm will be able to continue to deliver on its commitments overseas, it has delivered all of the doses Mongolia ordered. China has said it can make as many as five billion doses by the end of the year, though officials have warned that the country is struggling to make enough shots for its citizens.

a third booster shot sooner than expected.

China, for its part, may be playing a long game, said Julian Dierkes, an associate professor at the University of British Columbia who specializes in Mongolian politics. Though many Mongolians may still not trust China, the Mongolian government will remember how it made its vaccines available at a critical moment.

“We could coin a phrase here: ‘The opportunity of smallness,’” he said.

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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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Seychelles Sees Rise in Coronavirus Cases Despite Vaccinations

Marie Neige, a call center operator in Seychelles, was eager to be vaccinated. Like the majority of the residents in the tiny island nation, she was offered China’s Sinopharm vaccine in March, and was looking forward to the idea of being fully protected in a few weeks.

On Sunday, she tested positive for the coronavirus.

“I was shocked,” said Ms. Neige, 30, who is isolating at home. She said she has lost her sense of smell and taste and has a slightly sore throat. “The vaccine was supposed to protect us — not from the virus, but the symptoms,” she said. “I was taking precaution after precaution.”

China expected its Sinopharm vaccines to be the linchpin of the country’s vaccine diplomacy program — an easily transported dose that would protect not just Chinese citizens but also much of the developing world. In a bid to win good will, China has donated 13.3 million Sinopharm doses to other countries, according to Bridge Beijing, a consultancy that tracks China’s impact on global health.

Instead, the company, which has made two varieties of coronavirus vaccines, is facing mounting questions about the inoculations. First, there was the lack of transparency with its late-stage trial data. Now, Seychelles, the world’s most vaccinated nation, has had a surge in cases despite much of its population being inoculated with Sinopharm.

has managed to beat back the virus. A study has shown that the Pfizer vaccine that Israel used is 94 percent effective at preventing transmission. On Wednesday, the number of daily new confirmed Covid-19 cases per million people in Seychelles stood at 2,613.38, compared to 5.55 in Israel, according to The World In Data project.

Wavel Ramkalawan, the president of Seychelles, defended the country’s vaccination program, saying that the Sinopharm and AstraZeneca vaccines have “served our population very well.” He pointed out that the Sinopharm vaccine was given to people age 18 to 60, and in this age group over all, 80 percent of the patients who needed to be hospitalized were not vaccinated.

according to the Seychelles News Agency. Sinopharm did not respond to a request for comment.

an article from The Wall Street Journal on Seychelles, a spokeswoman for China’s foreign ministry blamed Western media for trying to discredit Chinese vaccines and “harboring the mentality that ‘everything involving China has to be smeared.’”

In a news conference, Kate O’Brien, director of immunizations at the World Health Organization, said the agency is evaluating the surge of infections in Seychelles and called the situation “complicated.” Last week, the global health group approved the Sinopharm vaccine for emergency use, raising hopes of an end to a global supply crunch.

She said that “some of the cases that are being reported are occurring either soon after a single dose or soon after a second dose or between the first and second doses.”

According to Ms. O’Brien, the W.H.O. is looking into the strains that are currently circulating in the country, when the cases occurred relative to when somebody received doses and the severity of each case. “Only by doing that kind of evaluation can we make an assessment of whether or not these are vaccine failures,” she said.

But some scientists say it is increasingly clear that the Sinopharm vaccine does not offer a clear path toward herd immunity, particularly when considering the multiple variants appearing around the world.

Governments using the Sinopharm vaccine “have to assume a significant failure rate and have to plan accordingly,” said John Moore, a vaccine expert at Cornell University. “You have to alert the public that you will still have a decent chance of getting infected.”

Many in Seychelles say the government has not been forthcoming.

“My question is: Why did they push everyone to take it?” said Diana Lucas, a 27-year-old waitress who tested positive on May 10. She said she received her second dose of the Sinopharm vaccine on Feb. 10.

Emmanuelle Hoareau, 22, a government lawyer, tested positive on May 6 after getting the second dose of the Sinopharm vaccine in March. “It doesn’t make sense,” she said. She said the government had failed to give the public enough information about the vaccines.

“They are not explaining to the people about the real situation,” she said. “It’s a big deal — a lot of people are getting infected.”

Ms. Hoareau’s mother, Jacqueline Pillay, is a nurse in a private clinic in Victoria, the capital. She said she believes there is a new variant in Seychelles because of an influx of foreigners who have arrived in recent months. The tourism-dependent country opened its borders on March 25 to most travelers without any quarantine.

“People are very scared now,” said Ms. Pillay, 58. “When you give people the right information, then people would not speculate.”

Health officials have recently appeared on television to encourage those who have only taken the first dose of the Sinopharm vaccine to return for the second shot. But Ms. Pillay said she is frustrated that the public health commissioner has not addressed why the vaccines don’t appear to be working as well as they should.

“I think a lot of people aren’t coming back,” said Ms. Pillay.

Marietta Labrosse, Elsie Chen and Claire Fu contributed research.

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India’s Serum Institute Struggled to Meet Its Covid-19 Vows

NEW DELHI — Adar Poonawalla made big promises. The 40-year-old chief of the world’s largest vaccine maker pledged to take a leading role in the global effort to inoculate the poor against Covid-19. His India-based empire signed deals worth hundreds of millions of dollars to make and export doses to suffering countries.

Those promises have fallen apart. India, engulfed in a coronavirus second wave, is laying claim to his vaccines. Other countries and aid groups are now racing to find scarce doses elsewhere.

At home, politicians and the public have castigated Mr. Poonawalla and his company, the Serum Institute of India, for raising prices mid-pandemic. Serum has suffered production problems that have kept it from expanding output at a time when India needs every dose. He has come under criticism for departing to London amid the crisis, though he said it was only a quick trip. He told a British newspaper he had received threats from politicians and some of India’s “most powerful men,” demanding that he supply them with vaccines. When he returns to India, he will travel with government-assigned armed guards.

In an interview with The New York Times, Mr. Poonawalla defended his company and its ambitions. He had no choice but to hand over vaccines to the government, he said. He cited a lack of raw materials, which he has partially blamed on the United States. Making vaccines, he said, is a painstaking process that requires investment and major risks. He said he would return to India when he had finished his business in London. He shrugged off his earlier comments about threats, saying they were “nothing we can’t handle.”

backed waiving intellectual property protections for vaccines, which could make it easier for Indian factories to make them. Still, that won’t help India’s current crisis, which as of Friday had claimed more than 230,000 lives — a figure that likely represents a vast undercount.

a horse breeder turned vaccine billionaire. Before the crisis, he was extolled in the Indian media as an example of a new class of young, worldly entrepreneurs. Photos of him and his wife, Natasha, were a staple of fashion spreads.

Serum received a $300 million grant from the Gates Foundation to supply as many as 200 million doses of Covishield and another vaccine in development to the Gavi Alliance, the public-private partnership that is overseeing Covax, the program to donate vaccines to poor countries.

Serum pledged between January and March to sell about 1.1 billion vaccine doses in coming months, according to a review of purchase agreements supplied by UNICEF. By the time India largely stopped vaccine exports, Serum had exported only about 60 million doses, about half to Gavi. India had claimed more than 120 million.

AstraZeneca has served Serum a legal notice over delivery delays. Serum has just “temporarily deferred” its commitments, Mr. Poonawalla said, citing the Indian government’s halt of exports.

“This is something coming from India,” he said. “It’s not the supplier that is defaulting.”

The world is grappling with the ripple effect. A spokesman for Gavi said that India’s decision to prioritize “domestic needs” is having “a knock-on effect in other parts of the world that desperately need vaccines.” Still, in a sign of the lack of options for getting vaccines, Gavi on Thursday signed a purchase deal with an American vaccine company, called Novavax, involving doses to be made by Serum.

people are being turned away from vaccination centers that have run out of doses.

Serum has missed its expansion targets. Mr. Poonawalla said last fall that by early this year, Serum Institute would be pumping out 100 million doses per month, of which about four in 10 would go overseas.

But after a fire at a facility that was supposed to help the company ramp up vaccine production, Serum’s capacity has remained at about 72 million doses per month. A grant of more than $200 million from the Indian government should help the company reach its goal by summer, he said.

Mr. Poonawalla has also cited raw materials supplies. In April, he asked President Biden on Twitter to “lift the embargo” on raw material used to make Covid-19 vaccines. White House officials said Mr. Poonawalla mischaracterized his situation. Still, the United States said it would send raw materials to the Serum Institute to increase its vaccine production, though Mr. Poonawalla said they haven’t yet arrived.

Mr. Poonawalla has also come under scrutiny for charging different prices to the central government, to India’s states and to private hospitals. Two weeks ago, Serum said it would charge state governments about $5 per dose, about $3 more than what it charges Mr. Modi’s government.

Last week, following criticism, Mr. Poonawalla lowered the price to $4. Still, the critics point to an interview in which Mr. Poonawalla said that he was making a profit even at the central government’s price.

Mr. Poonawalla said that Serum could sell at a lower price to India’s central government because it was ordering larger volumes.

People don’t understand,” Mr. Poonawalla told The New York Times. “They just take things in isolation and then they vilify you, not realizing that this commodity is sold at $20 a dose in the world and we’re providing it for $5 or $6 in India. There’s no end to the cribbing, the complaining, the criticizing.”

includes four to five armed personnel.

In an interview with The Times of London newspaper published last week, he described receiving constant, aggressive calls demanding vaccines immediately. “‘Threats’ is an understatement,” he told the paper.

He played down the threats in his interview with The New York Times, and his office declined to disclose further specifics. Still, the comments caused an uproar in India. Some politicians demanded that he name names.

tweeted that Mr. Poonawalla’s departure to London was “shameful” and that he should reduce prices.

The Serum Institute is planning a major expansion in Britain, investing nearly $335 million for research and development, to fund clinical trials, to build out its sales office and to possibly construct a manufacturing plant, Mr. Poonawalla’s office said.

“Everyone is depending on us to be able to give this magic silver bullet in an almost infinite capacity,” Mr. Poonawalla said. “There’s this tremendous pressure from state governments, ministers, the public, friends, and they all want the vaccine. And I’m just trying to equitably distribute it as best I can.”

Selam Gebrekidan in London and Bhadra Sharma in Kathmandu, Nepal, contributed reporting.

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Why Are There Oxygen Shortages for Covid Patients?

The latest horror of the pandemic is that large numbers of people around the world are dying for lack of access to medical oxygen, especially in India. Each day, tens of thousands of people are admitted to hospitals with Covid-19, driving the demand for the oxygen far beyond the supply.

Oxygen makes up 21 percent of the atmosphere. A handful of companies capture and purify it in bulk, but they sell most of it to industry. Many poorer parts of the world lack the infrastructure needed to deliver or make use of the medical grade supplies those companies sell, which are designed to be delivered via pipes to hospital rooms.

Some hospitals and clinics have machines that produce purified oxygen at a much smaller scale, but they are in short supply. So many hospitals and patients in poor countries and in remote areas rely on the most expensive option: oxygen tanks that have became scarce in the countries hit hardest by the virus.

The shortages affect patients with every kind of respiratory ailment requiring oxygen, not just those with Covid.

northern Brazil, Mexico and elsewhere, that it became clear that what had been seen as a potential problem was becoming a dire emergency. The World Health Organization created an emergency task force on the oxygen shortage and called for money to address it.

the pandemic surged in India, where it had been relatively contained, pushing oxygen supplies to the center of the world’s attention. India’s official count of new coronavirus infections leapt from an average of about 11,000 a day in mid-February to a daily average of more than 370,000 in the past week — and experts say the true figure is far higher.

In the last two months, the unmet, global need for medical oxygen has more than tripled, from less than 9 million cubic meters a day to more than 28 million, according to a coalition of aid groups that are tracking the crisis.

About half of that unmet need is in India. And health advocates warn that the calamity there could be repeated in other countries.

ramping up their production of medical gas by diverting some from industry, whose gas has somewhat different requirements.

India’s government has ordered the producers there to temporarily direct all of their oxygen output to medical needs.

military transport planes to get oxygen to the sick.

If enough money were available, governments and international groups could have advance-purchase agreements with bulk suppliers, and emergency stores of oxygen could be stationed in various parts of the world and deployed as needed.

If nothing else, the last few months have made clear the difficulty of trying to increase oxygen supplies on short notice, amid a crisis.

Instead, Mr. Matiru said, the world should invest in preparation, “so that if there’s a surge we can press ‘Go.’”

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Global Vaccine Crisis Sends Ominous Signal for Fighting Climate Change

Brazil’s right-wing populist president, Jair Bolsonaro, scorned public health guidance and insisted that lockdowns and mobility restrictions would be a bigger threat to the country’s weak economy. Brazil now has one of the world’s highest death tolls and its economy is in tatters.

India’s right-wing populist prime minister, Narendra Modi, who earlier this year boasted of conquering the virus, allowed large religious and political gatherings. And instead of securing vaccines for India’s 1.4 billion citizens, India began exporting Indian-made doses to other countries. Today, India has become the worst-hit country in the world, with close to 380,000 new infections daily over the past seven days.

The long running global battle over intellectual property rights to medicines has a parallel to climate action, too, with the Paris climate agreement explicitly calling for the transfer of technology to develop clean energy infrastructure. Developing countries have long said they cannot cope with the effects of climate change if the rich world does not share money and technology, and that problem is only made more acute by the economic collapse brought on by the pandemic and the inequitable access to vaccines.

Not least, the consequences of global warming are unequal, hurting the poorest people in poor countries hardest. “The issue of vaccine solidarity is very connected to some of the lessons we should be learning for climate solidarity,” said Tasneem Essop, a former government official from South Africa who is now executive director of Climate Action Network, an advocacy group. Ms. Essop noted that rich countries are “taking care of their own needs, without any idea of looking outwards.”

Money is at the heart of the distrust.

The Biden administration promised to double grants and loans to developing countries to $5.7 billion a year, a target that is widely seen as both insufficient and lagging behind the pledges of other wealthy industrialized nations, notably in Europe. Many low- and middle-income countries are carrying so much debt, they say it leaves them nothing left to retool their economies for the climate era. In addition, the rich world has yet to fulfill its promise to raise $100 billion a year that could be used for green projects, whether solar farms or mangrove restoration.

“In both cases, it’s about a willingness to redistribute resources,” said Rohini Pande, a Yale University economist.

In the case of coronavirus response, it’s about helping vaccine makers around the world manufacture billions of doses in a matter of months. In the case of climate change, huge sums of money are needed to help developing countries retool their energy systems away from dirty sources like coal.

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Pfizer Reaps Hundreds of Millions in Profits From Covid Vaccine

The pricing for the United States was in line with the cost of seasonal flu vaccines and much less expensive than vaccines for conditions like shingles, which can run into several hundred dollars.

“That price point does not seem offensive, even if you don’t spend a lot of time thinking about prescription drugs,” said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University Medical Center. “Just thinking about any prescription you’d fill, you’d be hard-pressed to find pretty much anything for $20.”

But the fact that Pfizer appears to have earned something like $900 million in pretax profits from its vaccine — coupled with its comparatively small sales to poor countries — suggests that profits have trumped other considerations. That could undercut the company’s embrace of loftier principles.

“At Pfizer, we believe that every person deserves to be seen, heard and cared for,” the chief executive, Albert Bourla, said in January as the company announced it would join Covax. “We share the mission of Covax and are proud to work together so that developing countries have the same access as the rest of the world.”

But the company seems to have prioritized higher-priced sales.

“Despite all the talk about Covax, they have been far more interested in bilateral deals, because that’s where they make their money,” said Richard Kozul-Wright, director of the division on globalization and development strategies at the United Nations Conference on Trade and Development in Geneva. “It’s one of the great public relations triumphs of recent corporate history.”

Multiple factors explain the inequitable nature of Pfizer’s vaccine distribution.

The shot, which must be stored and transported at very low temperatures, is less practical for hard-to-reach parts of the world than other shots, like those from AstraZeneca and Johnson & Johnson, that can simply be refrigerated. Some poor countries were initially not hit hard by the virus, and so their governments had less urgency to place orders for the Pfizer vaccine, to the extent that they could afford to pay for the shots.

“Not everyone was interested in the vaccine or prepared to take steps; thus, conversations continue, including working with Covax beyond their initial order of 40 million doses,” said Ms. Castillo, the Pfizer spokeswoman.

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