fined Facebook $5 billion in 2019 for privacy violations, there were few significant changes to how the company’s products operate. And Facebook continues to grow: More than 3.45 billion people use one or more of its apps — including WhatsApp, Instagram or Messenger — every month.

The decisions were particularly deflating after actions to rein in tech power in Washington had gathered steam. Ms. Khan’s appointment to the F.T.C. this month followed that of Tim Wu, another lawyer who has been critical of the industry, to the National Economic Council. Bruce Reed, the president’s deputy chief of staff, has called for new privacy regulation.

Mr. Biden has yet to name anyone to permanently lead the Justice Department’s antitrust division, which last year filed a lawsuit arguing Google had illegally protected its monopoly over online search.

The White House is also expected to issue an executive order this week targeting corporate consolidation in tech and other areas of the economy. A spokesman for the White House did not respond to requests for comment about the executive order or Judge Boasberg’s rulings.

Activists and lawmakers said this week that Congress should not wait to give regulators more tools, money and legal red lines to use against the tech giants. Mr. Cicilline, along with Representative Jerrold Nadler of New York, the chairman of the House Judiciary Committee, said in a statement that the judge’s decisions on Facebook show “the dire need to modernize our antitrust laws to address anticompetitive mergers and abusive conduct in the digital economy.”

Senator Amy Klobuchar, a Democrat of Minnesota who chairs the Senate Judiciary Committee’s subcommittee on antitrust, echoed their call.

“After decades of binding Supreme Court decisions that have weakened our antitrust policies, we cannot rely on our courts to keep our markets competitive, open and fair,” she said in a statement. “We urgently need to rejuvenate our antitrust laws to meet the challenges of the modern digital economy.”

But the six bills to update monopoly laws have a long way to go. They still need to pass the full House, where they will likely face criticism from moderate Democrats and libertarian Republicans. In the Senate, Republican support is necessary for them to overcome the legislative filibuster.

The bills may also not go as far in altering antitrust laws as some hope. The House Judiciary Committee amended one last week to reinforce the standard around consumer welfare.

Even so, Monday’s rulings have given the proposals a boost. Bill Baer, who led the Justice Department antitrust division during the Obama administration, said it “gives tremendous impetus to those in Congress who believe that the courts are too conservative in addressing monopoly power.”

Facebook and the tech platforms might like the judge’s decisions, he said, “but they might not like what happens in the Congress.”

Mike Isaac contributed reporting.

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Immunity to the Coronavirus May Persist for Years, Scientists Find

Immunity to the coronavirus lasts at least a year, possibly a lifetime, improving over time especially after vaccination, according to two new studies. The findings may help put to rest lingering fears that protection against the virus will be short-lived.

Together, the studies suggest that most people who have recovered from Covid-19 and who were later immunized will not need boosters. Vaccinated people who were never infected most likely will need the shots, however, as will a minority who were infected but did not produce a robust immune response.

Both reports looked at people who had been exposed to the coronavirus about a year earlier. Cells that retain a memory of the virus persist in the bone marrow and may churn out antibodies whenever needed, according to one of the studies, published on Monday in the journal Nature.

The other study, which is also under review for publication in Nature, found that these so-called memory B cells continue to mature and strengthen for at least 12 months after the initial infection.

other studies.

Some scientists have interpreted this decrease as a sign of waning immunity, but it is exactly what’s expected, other experts said. If blood contained high quantities of antibodies to every pathogen the body had ever encountered, it would quickly transform into a thick sludge.

Instead, blood levels of antibodies fall sharply following acute infection, while memory B cells remain quiescent in the bone marrow, ready to take action when needed.

landmark study in 2007 showed that antibodies in theory could survive decades, perhaps even well beyond the average life span, hinting at the long-term presence of memory B cells. But the new study offered a rare proof of their existence, Dr. Gommerman said.

Dr. Nussenzweig’s team looked at how memory B cells mature over time. The researchers analyzed blood from 63 people who had recovered from Covid-19 about a year earlier. The vast majority of the participants had mild symptoms, and 26 had also received at least one dose of either the Moderna or the Pfizer-BioNTech vaccine.

So-called neutralizing antibodies, needed to prevent reinfection with the virus, remained unchanged between six and 12 months, while related but less important antibodies slowly disappeared, the team found.

confirming results from other studies; the shots also ramped up the body’s neutralizing ability by about 50-fold.

Senator Rand Paul, Republican of Kentucky, said on Sunday that he would not get a coronavirus vaccine because he had been infected in March of last year and was therefore immune.

But there is no guarantee that such immunity will be powerful enough to protect him for years, particularly given the emergence of variants of the coronavirus that can partially sidestep the body’s defenses.

The results of Dr. Nussenzweig’s study suggest that people who have recovered from Covid-19 and who have later been vaccinated will continue to have extremely high levels of protection against emerging variants, even without receiving a vaccine booster down the line.

“It kind of looks exactly like what we would hope a good memory B cell response would look like,” said Marion Pepper, an immunologist at the University of Washington in Seattle who was not involved in the new research.

The experts all agreed that immunity is likely to play out very differently in people who have never had Covid-19. Fighting a live virus is different from responding to a single viral protein introduced by a vaccine. And in those who had Covid-19, the initial immune response had time to mature over six to 12 months before being challenged by the vaccine.

“Those kinetics are different than someone who got immunized and then gets immunized again three weeks later,” Dr. Pepper said. “That’s not to say that they might not have as broad a response, but it could be very different.”

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A Misleading C.D.C. Number

When the Centers for Disease Control and Prevention released new guidelines last month for mask wearing, it announced that “less than 10 percent” of Covid-19 transmission was occurring outdoors. Media organizations repeated the statistic, and it quickly became a standard description of the frequency of outdoor transmission.

But the number is almost certainly misleading.

It appears to be based partly on a misclassification of some Covid transmission that actually took place in enclosed spaces (as I explain below). An even bigger issue is the extreme caution of C.D.C. officials, who picked a benchmark — 10 percent — so high that nobody could reasonably dispute it.

That benchmark “seems to be a huge exaggeration,” as Dr. Muge Cevik, a virologist at the University of St. Andrews, said. In truth, the share of transmission that has occurred outdoors seems to be below 1 percent and may be below 0.1 percent, multiple epidemiologists told me. The rare outdoor transmission that has happened almost all seems to have involved crowded places or close conversation.

Saying that less than 10 percent of Covid transmission occurs outdoors is akin to saying that sharks attack fewer than 20,000 swimmers a year. (The actual worldwide number is around 150.) It’s both true and deceiving.

struggling to communicate effectively, and leaving many people confused about what’s truly risky. C.D.C. officials have placed such a high priority on caution that many Americans are bewildered by the agency’s long list of recommendations. Zeynep Tufekci of the University of North Carolina, writing in The Atlantic, called those recommendations “simultaneously too timid and too complicated.”

They continue to treat outdoor transmission as a major risk. The C.D.C. says that unvaccinated people should wear masks in most outdoor settings and vaccinated people should wear them at “large public venues”; summer camps should require children to wear masks virtually “at all times.”

These recommendations would be more grounded in science if anywhere close to 10 percent of Covid transmission were occurring outdoors. But it is not. There is not a single documented Covid infection anywhere in the world from casual outdoor interactions, such as walking past someone on a street or eating at a nearby table.

Today’s newsletter will be a bit longer than usual, so I can explain how the C.D.C. ended up promoting a misleading number.

If you read the academic research that the C.D.C. has cited in defense of the 10 percent benchmark, you will notice something strange. A very large share of supposed cases of outdoor transmission have occurred in a single setting: construction sites in Singapore.

one study, 95 of 10,926 worldwide instances of transmission are classified as outdoors; all 95 are from Singapore construction sites. In another study, four of 103 instances are classified as outdoors; again, all four are from Singapore construction sites.

This obviously doesn’t make much sense. It instead appears to be a misunderstanding that resembles the childhood game of telephone, in which a message gets garbled as it passes from one person to the next.

The Singapore data originally comes from a government database there. That database does not categorize the construction-site cases as outdoor transmission, Yap Wei Qiang, a spokesman for the Ministry of Health, told my colleague Shashank Bengali. “We didn’t classify it according to outdoors or indoors,” Yap said. “It could have been workplace transmission where it happens outdoors at the site, or it could also have happened indoors within the construction site.”

As Shashank did further reporting, he discovered reasons to think that many of the infections may have occurred indoors. At some of the individual construction sites where Covid spread — like a complex for the financial firm UBS and a skyscraper project called Project Glory — the concrete shells for the buildings were largely completed before the pandemic began. (This video of Project Glory was shot more than four months before Singapore’s first reported Covid case.)

Because Singapore is hot year-round, the workers would have sought out the shade of enclosed spaces to hold meetings and eat lunch together, Alex Au of Transient Workers Count Too, an advocacy group, told Shashank. Electricians and plumbers would have worked in particularly close contact.

one of the papers analyzing Singapore, told me, “and ultimately decided on a conservative outdoor definition.” Another paper, published in the Journal of Infection and Public Health, counted only two settings as indoors: “mass accommodation and residential facilities.” It defined all of these settings as outdoors: “workplace, health care, education, social events, travel, catering, leisure and shopping.”

I understand why the researchers preferred a broad definition. They wanted to avoid missing instances of outdoor transmission and mistakenly suggesting that the outdoors was safer than it really was. But the approach had a big downside. It meant that the researchers counted many instances of indoors transmission as outdoors.

And yet even with this approach, they found a minuscule share of total transmission to have occurred outdoors. In the paper with 95 supposedly outdoor cases from Singapore, those cases nonetheless made up less than 1 percent of the total. A study from Ireland, which seems to have been more precise about the definition of outdoors, put the share of such transmission at 0.1 percent. A study of 7,324 cases from China found a single instance of outdoor transmission, involving a conversation between two people.

“I’m sure it’s possible for transmission to occur outdoors in the right circumstances,” Dr. Aaron Richterman of the University of Pennsylvania told me, “but if we had to put a number on it, I would say much less than 1 percent.”

ditching their masks, even indoors, while others continue to harass people who walk around outdoors without a mask.

All the while, the scientific evidence points to a conclusion that is much simpler than the C.D.C.’s message: Masks make a huge difference indoors and rarely matter outdoors.

masks remain rare.

It certainly doesn’t seem to be causing problems. Since January, daily Covid deaths in Britain have declined more than 99 percent.

cramped train ride to Manhattan.

Almonds, oats, rice: Are plant milks good for you?

A Times classic: Here are the climate risks facing your country.

Lives Lived: Critics called the postmodern buildings of the architect Helmut Jahn “dazzling,” “convention-busting” and “unrelated to anything else in the whole of Western civilization.” He died at 81.

play online.

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Companies are torn over whether to require employees to get vaccinated.

As companies make plans to fully reopen their offices across the United States, they face a delicate decision. Many would like all employees to be vaccinated when they return, but in the face of legal and P.R. risks, few employers have gone so far as to require it.

Instead, they are hoping that encouragement and incentives will suffice, Gillian Friedman and Lauren Hirsch report for The New York Times.

Legally, companies seem largely in the clear. The Equal Employment Opportunity Commission issued guidance in December stating that employers are permitted to require employees to be vaccinated. But employers are still worried about litigation, in part because several states have proposed laws that would limit their ability to require vaccines.

“It would seem to me that employers are going to find themselves in a fairly strong position legally,” said Eric Feldman, a law professor at the University of Pennsylvania, “but that doesn’t mean they’re not going to get sued.”

So, companies are resorting to carrots over sticks. Darden offers hourly employees two hours of pay for each dose they receive. Target offers a $5 coupon to all customers and employees who receive their vaccination at a CVS at Target location. And many companies are hosting on-site clinics to make it easier to get vaccinated.

Others are experimenting with return-to-office policies that aren’t all or nothing. Salesforce will allow up to 100 fully vaccinated employees to volunteer to work together on designated floors of certain U.S. offices. Some companies are mandating the shots only for new hires.

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Health Advocate or Big Brother? Companies Weigh Requiring Vaccines.

As American companies prepare to bring large numbers of workers back to the office in the coming months, executives are facing one of their most delicate pandemic-related decisions: Should they require employees to be vaccinated?

Take the case of United Airlines. In January, the chief executive, Scott Kirby, indicated at a company town hall that he wanted to require all of his roughly 96,000 employees to get coronavirus vaccines once they became widely available.

“I think it’s the right thing to do,” Mr. Kirby said, before urging other corporations to follow suit.

It has been four months. No major airlines have made a similar pledge — and United Airlines is waffling.

herd immunity has slipped as the pace of vaccinations has slowed.

But making vaccinations mandatory could risk a backlash, and perhaps even litigation, from those who view it as an invasion of privacy and a Big Brother-like move to control the lives of employees.

survey of 1,339 employers conducted by Arizona State University’s College of Health Solutions and funded by the Rockefeller Foundation, 44 percent of U.S. respondents said they planned to mandate vaccinations for their companies. In a separate poll of 446 employers conducted by Willis Towers Watson, a risk-management firm, 23 percent of respondents said they were “planning or considering requiring employees to get vaccinated for them to return to the worksite.”

two hours of pay for each dose they receive, while emphasizing it would not make doses mandatory. Target is offering a $5 coupon to all customers and employees who receive their vaccination at a CVS at Target location.

Supreme Court ruled about a century ago that states could require vaccinations for children attending public school. And universities like Rutgers have instituted mandatory Covid-19 vaccinations.

But the pandemic brings up a host of complications that companies typically prefer to avoid, involving the private lives, religious preferences and medical histories of employees, such as whether an employee is pregnant, breastfeeding or immuno-compromised, information they may not want to reveal.

Major union groups, like the A.F.L.-C.I.O., have not aggressively pushed the issue either. They are facing dueling forces — standing up for individual worker’s rights on the one hand and protecting one another on the other. Unions have also been arguing for stronger workplace safety measures, efforts that could be complicated by companies’ arguing that mandatory vaccinations reduce the need for such accommodations. The return to work protocols negotiated between the Alliance of Motion Picture & Television Producers and Hollywood’s unions, for instance, will not include mandatory vaccinations.

“There are going to be some people who may have legitimate reasons for not getting the vaccine or for not wanting to talk about it,” said Carrie Altieri, who works in communications for IBM’s People and Culture business. “It’s not an easy issue at this point.” IBM is working with New York State on a digital passport linking a person’s vaccination records to an app to show businesses, like performance venues, that may require vaccination. It is not, though, requiring vaccinations for its employees.

already struggling to hire workers, mandating vaccinations could make hiring even more difficult. And there are questions of logistics and execution. How can companies confirm the veracity of those who say they’ve been vaccinated?

Companies may need to hire additional staff, potentially with medical training, to handle such tasks, which could saddle businesses — particularly small ones — with burdensome costs.

Vivint, a home security company based in Utah with 10,000 employees, began offering vaccines in its on-site clinic this week, after the state approved the company to distribute 100 shots a week to its staff. It paid $3,000 for the necessary medical-grade freezer.

“We’re not requiring employees to get vaccinated, but we’re highly encouraging it,” said Starr Fowler, senior vice president for human resources. “For a lot of our employees, particularly those that are younger, the easier that we make it for them, the more likely they’re going to do it.”

Salesforce is introducing a policy in certain U.S. offices, including Salesforce Tower in San Francisco, where up to 100 fully vaccinated employees can volunteer to work on designated floors. The New York Stock Exchange issued a memo to trading firms saying they would be allowed to increase their staff on the floor, provided all the employees have been vaccinated.

The Equal Employment Opportunity Commission issued guidance in December stating that employers were indeed legally permitted to require employees to be vaccinated before they return to offices. But the threat of litigation still looms.

plans to open its offices on May 17 on a voluntary basis, said it strongly encouraged vaccines for employees — barring any religious or health restrictions — but would not require them. A spokeswoman for Goldman Sachs, which has not guided employees either way, declined to comment.

One potential path for companies seeking a middle ground is to mandate the shots only for new hires. Still, there is a fine line between encouraging and requiring shots — sometimes resulting in conflicting messages to employees.

The investment bank Jefferies sent a memo to employees in early February stating “verification of vaccination will be required to access the office.” On Feb. 24 came a follow-up memo. “We did not intend to make it sound as if we are mandating vaccines,” it said.

Reporting was contributed by Rebecca Robbins, Sapna Maheshwari, Kellen Browning, Niraj Chokshi and Eshe Nelson.

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Biden Seeks $80 Billion to Beef Up I.R.S. Audits of High-Earners

WASHINGTON — President Biden, in an effort to pay for his ambitious economic agenda, is expected to propose giving the Internal Revenue Service an extra $80 billion and more authority over the next 10 years to help crack down on tax evasion by high-earners and large corporations, according to two people familiar with the plan.

The additional money and enforcement power will accompany new disclosure requirements for people who own businesses that are not organized as corporations and for other wealthy people who could be hiding income from the government.

The Biden administration will portray those efforts — coupled with new taxes it is proposing on corporations and the rich — as a way to level the tax playing field between typical American workers and very high-earners who employ sophisticated efforts to minimize or avoid taxation.

Mr. Biden plans to use money raised by the effort to help pay for the cost of his “American Families Plan,” which he will detail before addressing a joint session of Congress on Wednesday.

$2.3 trillion infrastructure package, is expected to cost at least $1.5 trillion and will include universal prekindergarten, a federal paid leave program, efforts to make child care more affordable, free community college for all and tax credits meant to fight poverty.

The administration also aims to pay for the plan by raising the top marginal income tax rate for wealthy Americans to 39.6 percent from 37 percent and raising capital gains tax rates for those who earn more than $1 million a year. Mr. Biden will also seek to raise the tax rate on income that people earning more than $1 million per year receive through stock dividends, according to a person familiar with the proposal.

Administration officials have privately concluded that an aggressive crackdown on tax avoidance by corporations and the rich could raise at least $700 billion on net over 10 years. The $80 billion in proposed funding would be an increase of two-thirds over the agency’s entire funding levels for the past decade.

The administration is expected to portray the $780 billion it expects to collect through enhanced enforcement as conservative. That figure includes only money directly raised by enhanced tax audits and additional reporting requirements, and not any additional revenue from people or companies choosing to pay more taxes after previously avoiding them.

Previous administrations have long talked about trying to close the so-called tax gap — the amount of money that taxpayers owe but that is not collected each year. This month, the head of the I.R.S., Charles Rettig, told a Senate committee that the agency lacked the resources to catch tax cheats, costing the government as much as $1 trillion a year. The agency’s funding has failed to keep pace with inflation in recent years, amid budget tightening efforts, and its audits of rich taxpayers have declined.

whose research with the Harvard University economist Lawrence H. Summers suggests that the United States could raise as much as $1.1 trillion over a decade via increased tax enforcement.

Mr. Summers praised Mr. Biden’s expected plan in an email late Monday. “This is the broadly right approach,” he said. “Deterioration in I.R.S. enforcement effort and information gathering is scandalous. The Biden plan would make the American tax system fairer, more efficient and, I’m confident, raise more revenue than official scorekeepers now forecast — likely a trillion over 10 years.”

Mr. Biden’s efforts would incorporate some of Ms. Sarin and Mr. Summers’s suggestions, including investing heavily in information technology improvements to help the agency better target its audits of high-earners and companies.

They would also provide a dedicated funding stream to the agency, to enable officials to steadily ramp up their enforcement practices without fear of budget cuts, and to signal to potential tax evaders that the agency’s efforts will not be soon diminished. Mr. Biden would also add new requirements for people who own so-called pass-through corporations or hold their wealth in opaque structures, reminiscent of a program established under President Barack Obama that helps the agency better track possible tax evasion by Americans with overseas holdings.

Fred T. Goldberg Jr., an I.R.S. commissioner under President George H.W. Bush, called Mr. Biden’s plan “transformative” for combining those efforts.

“Information reporting, coupled with restoring enforcement efforts, is key to improve in compliance,” Mr. Goldberg said in an email. “Audits alone will never do the trick.”

He added: “None of this happens overnight. A decade of stable funding is necessary to recruit and train talent and build on the necessary technology — not only for compliance purposes but to meet the quality of services that the vast majority complaint taxpayers expect and deserve.”

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Millions Are Skipping Their Second Doses of Covid-19 Vaccines

Millions of Americans are not getting the second doses of their Covid-19 vaccines, and their ranks are growing.

More than five million people, or nearly 8 percent of those who got a first shot of the Pfizer or Moderna vaccines, have missed their second doses, according to the most recent data from the Centers for Disease Control and Prevention. That is more than double the rate among people who got inoculated in the first several weeks of the nationwide vaccine campaign.

Even as the country wrestles with the problem of millions of people who are wary about getting vaccinated at all, local health authorities are confronting an emerging challenge of ensuring that those who do get inoculated are doing so fully.

The reasons vary for why people are missing their second shots. In interviews, some said they feared the side effects, which can include flulike symptoms. Others said they felt that they were sufficiently protected with a single shot.

Walgreens, one of the biggest vaccine providers, sent some people who got a first shot of the Pfizer or Moderna vaccine to get their second doses at pharmacies that only had the other vaccine on hand.

Several Walgreens customers said in interviews that they scrambled, in some cases with help from pharmacy staff, to find somewhere to get the correct second dose. Others, presumably, simply gave up.

voted to recommend lifting a pause on the Johnson & Johnson Covid vaccine and adding a label about an exceedingly uncommon but potentially dangerous blood clotting disorder.

  • Federal health officials are expected to formally recommend that states lift the pause.
  • Administration of the vaccine ground to a halt recently after reports emerged of a rare blood clotting disorder in six women who had received the vaccine.
  • The overall risk of developing the disorder is extremely low. Women between 30 and 39 appear to be at greatest risk, with 11.8 cases per million doses given. There have been seven cases per million doses among women between 18 and 49.
  • Nearly eight million doses of the vaccine have now been administered. Among men and women who are 50 or over, there has been less than one case per million doses.
  • Johnson & Johnson had also decided to delay the rollout of its vaccine in Europe amid similar concerns, but it later decided to resume its campaign after the European Union’s drug regulator said a warning label should be added. South Africa, devastated by a more contagious virus variant that emerged there, also suspended use of the vaccine but later moved forward with it.
  • In Arkansas and Illinois, health officials have directed teams to call, text or send letters to people to remind them to get their second shots. In Pennsylvania, officials are trying to ensure that college students can get their second shots after they leave campus for the summer. South Carolina has allocated several thousand doses specifically for people who are overdue for their second shot.

    recommended restarting use of the vaccine, but the combination of the safety scare and ongoing production problems is likely to make that vaccine a viable option for fewer people.

    The C.D.C.’s count of missed second doses is through April 9. It covers only people who got a first Moderna dose by March 7 or a first Pfizer dose by March 14.

    Roughly three-quarters of adults come back for their second dose of the vaccine that protects against shingles.

    In some cases, problems with shipments or scheduling may be playing a role in people missing their second doses. Some vaccine providers have had to cancel appointments because they did not receive expected vaccine deliveries. People have also reported having their second-dose appointments canceled or showing up only to find out that there were no doses available of the brand they needed.

    Some people can be flexible about being rebooked. But that’s harder for people who lack access to reliable transportation or who have jobs with strictly scheduled hours, said Elena Cyrus, an infectious disease epidemiologist at the University of Central Florida.

    Walgreens booked some customers for their second appointments at places that didn’t have the same vaccine that they had received for their initial doses. The company said it fixed the problem in late March.

    come under fire for, until recently, scheduling second doses of the Pfizer vaccine four weeks after the first shot, rather than the three-week gap recommended by the C.D.C. Pharmacists have been besieged by customers complaining, including about their inability to book vaccine appointments online.

    In other cases, though, access to vaccines is not the sole barrier; people’s attitudes contribute, too.

    Basith Syed, a 24-year-old consultant in Chicago, nabbed a leftover Moderna vaccine at a Walgreens in mid-February. But when the time came for his second shot, he was busy at work and preparing for his wedding. After the first shot, he had spent two days feeling drained. He didn’t want to risk a repeat, and he felt confident that a single dose would protect him.

    C.D.C. says there is limited data on the vaccine’s effectiveness when shots are separated by more than six weeks, although some countries, including Britain and Canada, are giving shots with a gap of up to three or four months.

    Mr. Syed’s experience is part of a broader shift in Illinois. When vaccines were mostly being given to health care workers, residents of long-term care facilities and people over 65, almost everyone was getting their second shots. In recent weeks, though, the number dipped below 90 percent, though it has since rebounded slightly, according to the Illinois Department of Public Health.

    In Arkansas, about 84,000 people have missed their second shots, representing 11 percent of those eligible for those shots, said Dr. Jennifer Dillaha, the state epidemiologist. Workers recently began calling people who are due or overdue for their second shots.

    College students pose a particular challenge. Many recently became eligible to be vaccinated and are getting their first shots, but they will have left campus by the time they are due for their second doses.

    In Pennsylvania, health officials have instructed vaccine providers to give second doses to college students even if they did not receive their first doses from that location.

    Some vaccine providers have put on special clinics for people who need a second dose. In South Carolina, the health system Tidelands Health started a program specifically for people who received their first Pfizer doses more than 23 days earlier but hadn’t been able to find a second shot. The state health department sent the health system 2,340 doses for the effort.

    Demand has been strong, and Tidelands only has a few hundred doses left. The majority of takers have been people who “were having difficulty navigating all the various scheduling systems and providers,” said Gayle Resetar, the health system’s chief operating officer.

    In many cases, vaccine providers had canceled second-dose appointments because of bad winter weather. “It was up to the individual to reschedule themselves on a web portal or web platform, and that just became difficult for people,” Ms. Resetar said.

    There are rare cases in which people are supposed to forgo the second shot, such as if they had an allergic reaction after their first shot.

    Zvi Ish-Shalom, a religious studies professor from Boulder, Colo., had planned to get fully vaccinated. Then, an hour after his first shot of the Moderna vaccine, he developed a headache that hasn’t gone away more than a month later.

    There is no way to know for sure whether the vaccine triggered the headache. But after weighing what he saw as the risks and benefits of a second dose, Dr. Ish-Shalom reached a decision about how to proceed.

    “At this point in time, I feel very clear and very comfortable, given all the various elements of this equation, to forgo the second shot,” he said.

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    What Do Women Want? For Men to Get Covid Vaccines.

    Holly Elgison and Len Schillaci are a mixed vaxxed couple, and they are far from alone.

    “I was always going to get the vaccine, 100 percent,” said Ms. Elgison, a medical claims auditor in Valrico, Fla.

    Her husband, a disaster insurance adjuster, said he will pass. “To be honest with you, I think that the worst of Covid is behind us,” Mr. Schillaci said. “I’m good.”

    As the Biden administration seeks to get 80 percent of adult Americans immunized by summer, the continuing reluctance of men to get a shot could impede that goal.

    Women are getting vaccinated at a far higher rate — about 10 percentage points — than men, even though the male-female divide is roughly even in the nation’s overall population. The trend is worrisome to many, especially as vaccination rates have dipped a bit recently.

    higher for men than among women. And the division elucidates the reality of women’s disproportionate role in caring for others in American society.

    “It could matter to localized herd immunity,” said Alison Buttenheim, an associate professor of nursing at the University of Pennsylvania and expert on vaccine hesitancy. “While most experts are fretting about larger gaps by race, political party, religion and occupational group,” she said, many of which overlap with the gender disparities, “I haven’t heard of any specific initiatives to target men.”

    In Los Angeles County, where 44 percent of women over 16 have gotten their first shot — compared with 30 percent of men — officials are scrambling to figure out how to do just that.

    “We are very concerned about it and are planning to embark on some targeted outreach among men,” said Dr. Paul Simon, the chief science officer at the Los Angeles County Department of Public Health, who said that the disparities are of particular concern for Black and Latino men. Only 19 percent of Black males in Los Angeles County and 17 percent of Latino males have received at least one dose of the vaccine, compared with 35 percent of Asian men and 32 percent of white men, according to the most recent data available from early this month.

    larger proportion of that age group. In many states, health care workers and schoolteachers were also given vaccine priority: Women account for three-quarters of full-time health care workers and over 75 percent of public schoolteachers in the United States are female.

    The disparities show both where women do the paid and unpaid labor of life. For instance, women lost the majority of the earliest jobs in food services, retail businesses, health care and government jobs. The mothers among them have done most of the work in the shift to remote schooling and caring for parents and sick relatives.

    The combination may have increased their vaccine motivation in two ways: They are seeking to protect the rest of their family and they are desperate to get back in the work force. Indeed, just as women drove the job losses last year, they are leading the economic recovery now; roughly half a million women joined the labor force in March, in part because in-person schooling has resumed across much of the country.

    “In addition to women being disproportionately represented in several essential jobs,” said Pilar Gonalons-Pons, an assistant professor of sociology at the University of Pennsylvania who specializes in gender issues, “they are also disproportionately represented as unpaid caregivers for older adults in their families and communities, and this can also be an additional motivation for getting the vaccine.”

    In many ways, the pattern with vaccines reflects longstanding gender differences when it comes to preventive health care. Women are on average more likely to get annual physicals than men, even when adjusted for pre-existing health conditions and other factors, and are more likely than men to get preventive care.

    less likely to visit doctors regularly and go to the emergency room in a crisis and to get basic dental care, according to federal data. Vaccines are no exception: Historically, influenza vaccination is much higher among females — about 63 percent compared to 53 percent — though the gap narrows in Americans over 75 years old.

    The coronavirus vaccine “is the latest expression of the tried-and-true gender gap we’ve long witnessed in preventive health care seeking patterns,” said Lindsey Leininger, a health policy researcher and clinical professor at Tuck School of Business at Dartmouth College.

    But experts say that even in the context of general male health care recalcitrance, there may be some factors that are specific to this vaccine that are preventing more male shots in arms. Because the sign up has been cumbersome and confusing, men may have had less patience in navigating the system, which has largely taken place online, a process that women might find easier since they tend to get more of their health care information online.

    “We have to figure out if disparities are about access, if men are having more difficulty navigating the appointment systems,” Mr. Simon of Los Angeles said.

    Further, when it comes to the coronavirus — which has been the subject of rampant misinformation, evolving medical advice and politicization — other dynamics may be at work.

    “Some men have a sense that they are not necessarily susceptible,” Mr. Simon said health care workers have told officials. “They have weathered this for more than a year and have a sense of omnipotence.”

    turned it down.)

    research on this trait.

    “In other words, these cultural ideals lead men to avoid important health care in order to act masculine,” she said. “Now that the vaccine is available to everyone, it will be interesting to watch male-female differences in vaccine uptake, because these will more likely reflect social and cultural ideas about gender and health, such as the cultural idea that ‘real men’ don’t need preventive health care.”

    At this stage, U.S. health authorities have not released data on nonbinary adults and vaccination.

    There may also be political connections. Women are far more likely than men to register as Democrats, and polls demonstrate that Republicans across the country have been far less likely than Democrats to embrace the vaccine.

    So who will men listen to? Not their wives and female friends or doctors, it seems. For their recent preprint study, Leah Witus and Erik Larson, professors at Macalester College in Saint Paul, Minn., watched videos with men and women that featured identical information about the vaccine. Among the 1,184 Americans who watched them, most were positively influenced by the male narrator while the female narrator got a far more mixed response.

    “The male-narrated version of the video increased vaccination intention in viewers,” said Ms. Witus, “but the female-narrated had mixed associations with vaccine propensity, and in some viewers, those that identified as conservative, actually decreased vaccination intention.”

    This may spell victory for Mr. Schillaci as he and his wife subtly joust for influence over their 20-year-old son’s vaccination decision. Mr. Schillaci has been sharing his views with his son, whom his wife is prodding to take a shot.

    “I would rather he got the shot, and I hope that he’ll consider it,” said Ms. Elgison.

    But Ms. Elgison’s own decision may benefit her son, even if he decides against the vaccine.

    As often happens in life, men may find their gaps covered by women. “To the extent most people live and socialize in a mixed-gender setting, the men will benefit from the higher coverage among women,” Ms. Buttenheim said.

    Ms. Elgison, however, still has a trump card she hopes might work. “I would like my son to get it so we can all travel together,” she said. “I explained to him that it’s possible that we could protect his dad.”

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    The Vaccination Gender Gap: Women Are Getting Shots at a Higher Rate Than Men

    Holly Elgison and Len Schillaci are a mixed vaxxed couple, and they are far from alone.

    “I was always going to get the vaccine, 100 percent,” said Ms. Elgison, a medical claims auditor in Valrico, Fla.

    Her husband, a disaster insurance adjuster, said he will pass. “To be honest with you, I think that the worst of Covid is behind us,” Mr. Schillaci said. “I’m good.”

    As the Biden administration seeks to get 80 percent of adult Americans immunized by summer, the continuing reluctance of men to get a shot could impede that goal.

    Women are getting vaccinated at a far higher rate — about 10 percentage points — than men, even though the male-female divide is roughly even in the nation’s overall population. The trend is worrisome to many, especially as vaccination rates have dipped a bit recently.

    higher for men than among women. And the division elucidates the reality of women’s disproportionate role in caring for others in American society.

    “It could matter to localized herd immunity,” said Alison Buttenheim, an associate professor of nursing at the University of Pennsylvania and expert on vaccine hesitancy. “While most experts are fretting about larger gaps by race, political party, religion and occupational group,” she said, many of which overlap with the gender disparities, “I haven’t heard of any specific initiatives to target men.”

    In Los Angeles County, where 44 percent of women over 16 have gotten their first shot — compared with 30 percent of men — officials are scrambling to figure out how to do just that.

    “We are very concerned about it and are planning to embark on some targeted outreach among men,” said Dr. Paul Simon, the chief science officer at the Los Angeles County Department of Public Health, who said that the disparities are of particular concern for Black and Latino men. Only 19 percent of Black males in Los Angeles County and 17 percent of Latino males have received at least one dose of the vaccine, compared with 35 percent of Asian men and 32 percent of white men, according to the most recent data available from early this month.

    larger proportion of that age group. In many states, health care workers and schoolteachers were also given vaccine priority: Women account for three-quarters of full-time health care workers and over 75 percent of public schoolteachers in the United States are female.

    The disparities show both where women do the paid and unpaid labor of life. For instance, women lost the majority of the earliest jobs in food services, retail businesses, health care and government jobs. The mothers among them have done most of the work in the shift to remote schooling and caring for parents and sick relatives.

    The combination may have increased their vaccine motivation in two ways: They are seeking to protect the rest of their family and they are desperate to get back in the work force. Indeed, just as women drove the job losses last year, they are leading the economic recovery now; roughly half a million women joined the labor force in March, in part because in-person schooling has resumed across much of the country.

    “In addition to women being disproportionately represented in several essential jobs,” said Pilar Gonalons-Pons, an assistant professor of sociology at the University of Pennsylvania who specializes in gender issues, “they are also disproportionately represented as unpaid caregivers for older adults in their families and communities, and this can also be an additional motivation for getting the vaccine.”

    In many ways, the pattern with vaccines reflects longstanding gender differences when it comes to preventive health care. Women are on average more likely to get annual physicals than men, even when adjusted for pre-existing health conditions and other factors, and are more likely than men to get preventive care.

    less likely to visit doctors regularly and go to the emergency room in a crisis and to get basic dental care, according to federal data. Vaccines are no exception: Historically, influenza vaccination is much higher among females — about 63 percent compared to 53 percent — though the gap narrows in Americans over 75 years old.

    The coronavirus vaccine “is the latest expression of the tried-and-true gender gap we’ve long witnessed in preventive health care seeking patterns,” said Lindsey Leininger, a health policy researcher and clinical professor at Tuck School of Business at Dartmouth College.

    But experts say that even in the context of general male health care recalcitrance, there may be some factors that are specific to this vaccine that are preventing more male shots in arms. Because the sign up has been cumbersome and confusing, men may have had less patience in navigating the system, which has largely taken place online, a process that women might find easier since they tend to get more of their health care information online.

    “We have to figure out if disparities are about access, if men are having more difficulty navigating the appointment systems,” Mr. Simon of Los Angeles said.

    Further, when it comes to the coronavirus — which has been the subject of rampant misinformation, evolving medical advice and politicization — other dynamics may be at work.

    “Some men have a sense that they are not necessarily susceptible,” Mr. Simon said health care workers have told officials. “They have weathered this for more than a year and have a sense of omnipotence.”

    turned it down.)

    research on this trait.

    “In other words, these cultural ideals lead men to avoid important health care in order to act masculine,” she said. “Now that the vaccine is available to everyone, it will be interesting to watch male-female differences in vaccine uptake, because these will more likely reflect social and cultural ideas about gender and health, such as the cultural idea that ‘real men’ don’t need preventive health care.”

    At this stage, U.S. health authorities have not released data on nonbinary adults and vaccination.

    There may also be political connections. Women are far more likely than men to register as Democrats, and polls demonstrate that Republicans across the country have been far less likely than Democrats to embrace the vaccine.

    So who will men listen to? Not their wives and female friends or doctors, it seems. For their recent preprint study, Leah Witus and Erik Larson, professors at Macalester College in Saint Paul, Minn., watched videos with men and women that featured identical information about the vaccine. Among the 1,184 Americans who watched them, most were positively influenced by the male narrator while the female narrator got a far more mixed response.

    “The male-narrated version of the video increased vaccination intention in viewers,” said Ms. Witus, “but the female-narrated had mixed associations with vaccine propensity, and in some viewers, those that identified as conservative, actually decreased vaccination intention.”

    This may spell victory for Mr. Schillaci as he and his wife subtly joust for influence over their 20-year-old son’s vaccination decision. Mr. Schillaci has been sharing his views with his son, whom his wife is prodding to take a shot.

    “I would rather he got the shot, and I hope that he’ll consider it,” said Ms. Elgison.

    But Ms. Elgison’s own decision may benefit her son, even if he decides against the vaccine.

    As often happens in life, men may find their gaps covered by women. “To the extent most people live and socialize in a mixed-gender setting, the men will benefit from the higher coverage among women,” Ms. Buttenheim said.

    Ms. Elgison, however, still has a trump card she hopes might work. “I would like my son to get it so we can all travel together,” she said. “I explained to him that it’s possible that we could protect his dad.”

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    No Pregnancy Risk Found From 2 Covid-19 Vaccines, Preliminary Research Shows

    In an early analysis of coronavirus vaccine safety data, researchers at the Centers for Disease Control and Prevention have found no evidence that the Pfizer-BioNTech or Moderna vaccines pose serious risks during pregnancy.

    The findings are preliminary and cover just the first 11 weeks of the U.S. vaccination program. But the study, which included self-reported data on more than 35,000 people who received one of the vaccines during or shortly before pregnancy, is the largest yet on the safety of the coronavirus vaccines in pregnant people.

    During the clinical trials of the vaccines, pregnant women were excluded. That left patients, doctors and experts unsure whether the shots were safe to administer during pregnancy.

    “There’s a lot of anxiety about whether it’s safe and whether it would work and what to expect as far as side effects,” said Dr. Stephanie Gaw, a maternal-fetal medicine specialist at the University of California, San Francisco.

    are more likely to become seriously ill, and more likely to die, than nonpregnant women with symptoms.

    Because of those risks, the C.D.C. has recommended that coronavirus vaccines be made available to pregnant women, though it also suggests that they consult with their doctors when making a decision about vaccination.

    The new study, which was published on Wednesday in The New England Journal of Medicine, is based largely on self-reported data from V-safe, the C.D.C.’s coronavirus vaccine safety monitoring system. Participants in the program use a smartphone app to complete regular surveys about their health, and any side effects they might be experiencing, after receiving a Covid-19 vaccine.

    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 had also decided to delay the rollout of its vaccine in Europe amid concerns over rare blood clots, but it later decided to resume its campaign after the European Union’s drug regulator said a warning label should be added. South Africa, devastated by a more contagious virus variant that emerged there, suspended use of the vaccine, and Australia announced it would not purchase any doses.
  • Women who were pregnant were slightly more likely to report injection site pain than women who were not, but less likely to report the other side effects. They were also slightly more likely to report nausea or vomiting after the second dose.

    Pregnant V-safe participants were also given an opportunity to enroll in a special registry that tracked pregnancy and infant outcomes.

    By the end of February, 827 of those enrolled in the pregnancy registry had completed their pregnancies, 86 percent of which resulted in a live birth. Rates of miscarriage, prematurity, low birth weight and birth defects were consistent with those reported in pregnant women before the pandemic, the researchers report.

    “This study is of critical importance to pregnant individuals,” Dr. Michal Elovitz, a maternal-fetal medicine specialist at the University of Pennsylvania said in an email. “It is very reassuring that there were no reported acute events in pregnant individuals” over the course of the study, she said.

    But the report has several limitations and much more research is needed, experts said. Enrollment in the surveillance programs is voluntary and the data are self-reported.

    In addition, because the study period encompassed just the first few months of the U.S. vaccination campaign, the vast majority of those enrolled in the pregnancy registry were health care workers. And there is not yet any data on pregnancy outcomes from people who were vaccinated during the first trimester of pregnancy.

    “I think we can feel more confident about recommending the vaccine in pregnancy, and especially with pregnant people that are at risk of Covid,” Dr. Gaw said. “But we do need to wait for more data for complete pregnancy outcomes from vaccines early in pregnancy.”

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