More Vaccines Near Approval, but Global Campaign Remains Stalled

Lining up to receive the Sinopharm vaccine in Lahore, Pakistan, on Wednesday.
Credit…Arif Ali/Agence France-Presse — Getty Images

The World Health Organization approved one Chinese-made Covid-19 vaccine and could soon approve another. The Biden administration has backed waiving intellectual property protections for vaccines, which could make it easier for more countries to make them.

But the campaign to vaccinate the world is floundering, and experts warn it will take more to reverse the trend.

The need is urgent: The virus is spreading more rapidly than ever, driven largely by surges in South America and India. The longer it can spread unchecked, the more time it has to mutate into more contagious variants that could evade the protections of vaccines.

Rich countries have been hoarding doses — the United States has given at least one shot to over 44 percent of its population, while the figure in Africa is 1 percent, according to a University of Oxford database. The global vaccination drive has been further slowed by the enormous need for vaccines within China and India, two major manufacturers that are keeping more doses for domestic use.

“The inequitable distribution of vaccines is not just a moral outrage, it is also economically and epidemiologically self-defeating,” Dr. Tedros Adhanom Ghebreyesus, director general of the W.H.O., told African leaders in a meeting on Saturday. “I have said this many times and the gap is very tragic between the have and have-nots.”

The W.H.O.’s approval on Friday of China’s Sinopharm vaccine was celebrated by scientists because it allows the shot to be included in Covax, the sputtering global initiative to promote equitable vaccine distribution. As of Tuesday, Covax had shipped 54 million doses, less than a quarter of its earlier April target.

Vaccine access could improve even more next week when the W.H.O. considers another Chinese shot, made by Sinovac. But the fanfare may be short-lived. While China has claimed it can make up to 5 billion doses by the end of this year, Chinese officials say the country is struggling to manufacture enough doses for its own population and are cautioning a pandemic-weary world to keep expectations in check.

“This should be the golden time for China to practice its vaccine diplomacy. The problem is, at the same time, China itself is facing a shortage,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. “So in terms of global access to vaccines, I don’t expect the situation to significantly improve in the coming two to three months.”

Severe production problems in India, the world’s largest vaccine manufacturer, have left just 2.3 percent of its population fully vaccinated. In some states, people are being turned away from vaccination centers that have run out of doses. As India has been crushed by a record virus surge, it has halted vaccine exports. That has delayed critical Covax shipments.

India’s government has promised to fast-track approvals of foreign-made vaccines. But a waiver of patent protections for Covid-19 vaccines, which the Biden administration is backing, would need approval from the World Trade Organization. And even then, experts warn that pharmaceutical companies in India and elsewhere would need technological help to make the vaccines and time to ramp up production.

Pledges by rich nations to donate vaccines to poor countries — 60 million AstraZeneca doses from the United States, one million AstraZeneca doses from Sweden — have been described by experts as symbolic, haphazard gestures.

Beyond availability, distributing vaccines in the developing world means overcoming deep-seated logistical obstacles and hesitancy. CARE, a global nonprofit group, has estimated that for every $1 spent on vaccine doses, another $5 was needed to guarantee that they made it from airport runways into people’s arms. In the absence of enough funding for chronically underpaid health workers and vaccination training, many of the doses that have been delivered are sitting in warehouses, with expiration dates rapidly approaching.

Scientists remain hopeful that a second wave of Covid-19 vaccines could ease world demand. Novavax, a company based in Maryland whose vaccine uses coronavirus proteins, is expected to apply for U.S. authorization in the next few weeks. In India, the pharmaceutical company Biological E is testing another protein-based vaccine that was developed by researchers in Texas. In Brazil, Mexico, Thailand and Vietnam, researchers are starting trials for a Covid-19 shot that can be mass-produced in chicken eggs.

Vaccine experts are particularly curious to see late-stage clinical trial results of a small German company called CureVac, expected as early as next week. The vaccine is made with the same RNA method as Moderna and Pfizer-BioNTech, but it has an important advantage. While those two vaccines have to be kept in a deep freezer, CureVac’s vaccine stays stable in a refrigerator — meaning it could more easily deliver the newly discovered power of RNA vaccines to hard-hit parts of the world.

A vaccination clinic before a baseball game in Seattle on Tuesday. Washington is one of many states that is reducing the amount of vaccine doses it requests from the federal government.
Credit…Ted S. Warren/Associated Press

States asked the federal government this week to withhold staggering amounts of Covid-19 vaccine amid plummeting demand for the shots, contributing to a growing stockpile of doses in the United States.

Many states are now requesting the Biden administration send them only a fraction of their allocated doses. The turned-down vaccines amount to hundreds of thousands of doses this week alone, providing a stark illustration of the problem of vaccine hesitancy in the country.

More than 150 million Americans — about 57 percent of the adult population — have received at least one dose of a vaccine, but government leaders from the Biden administration and at the city and county level are actively trying to persuade the rest of the country to get inoculated.

Dr. Vivek Murthy, the surgeon general, said Friday that the government had dedicated $250 million for community organizations to promote vaccinations, make appointments and provide transportation.

Some examples include: holding small group conversations with people in minority communities in St. Louis and asking churches in Rhode Island to contact community members and offer them rides to vaccination sites. A global Hindu American organization has also turned temples into vaccination centers.

Federal officials are also expected to expand smaller and mobile vaccination clinics for hard-to-reach communities and push education campaigns, and Mr. Biden has promoted incentive programs, like discounts for shoppers who get vaccinated at grocery stores. Some states are also offering incentives, including eligibility for savings bonds and paying people who help get others registered and to their appointments.

The federal government allocates vaccines to each state based on its population, and the states decide weekly how many doses to order. Early on, states routinely asked for the full allocation.

The Biden administration announced this week that when states did not order their full allocations, the surplus would be shifted to meet demand in other states.

Officials in Wisconsin asked for just 8 percent of the state’s allocated 162,680 doses for next week; Iowa officials asked for 29 percent; Connecticut requested 26 percent. South Carolina plans to order 21 percent.

Officials in Kansas, holding a stockpile of almost 647,000 doses, asked for less than 9 percent of their 162,000-dose allotment this past week. North Carolina scaled back its request by 40 percent. Washington State cut its order by about 40 percent. And Melaney Arnold, a spokeswoman for the Illinois Department of Public Health, said the state already had five weeks’ worth of doses on hand.

The trend is not universal. Maryland and Colorado are still ordering their full amount. So is New York City.

The Biden administration wants to vaccinate 70 percent of adult Americans by July 4, but has acknowledged the downward trend in vaccinations and the challenge to win over people who doubt the vaccine’s effectiveness or simply don’t want to get shots.

Vaccinations in the Puerto Rican city of Bayamón in April. Puerto Rico’s virus numbers have improved significantly after a tough lockdown. 
Credit…Erika P. Rodriguez for The New York Times

The number of coronavirus cases in Puerto Rico is declining precipitously after soaring to record heights in March and April.

The U.S. territory experienced its worst outbreak of the pandemic this spring, with the seven-day average of new daily reported cases surging to a peak of 1,109 on April 20 from about 200 a day in mid-March.

The spike was driven by a confluence of factors, including the arrival of more contagious variants, a tide of spring break tourists and celebrations tied to Holy Week.

In early April, Gov. Pedro R. Pierluisi shut down in-person instruction at schools, reduced indoor capacity at restaurants and businesses and moved a nightly curfew up to 10 p.m. He also required tourists to present negative coronavirus tests, or face a $300 fine.

Since then, the numbers have improved drastically. Puerto Rico’s seven-day average of daily reported cases has dropped by more than 60 percent in the past 14 days, according to a New York Times database. About 38 percent of people have received one dose of a Covid vaccine, and 26 percent are fully vaccinated.

Over a year ago, Puerto Rico became one of the first parts of the United States to lock down to try to contain the spread of the coronavirus, another blow to an island that suffered the ravages of Hurricane Maria in 2017, including a nearly yearlong loss of electricity; earthquakes in 2020; and a prolonged financial crisis.

On Thursday, Mr. Pierluisi announced that in-person school could resume, the nightly curfew would be pushed back to midnight and stores’ opening hours could stretch to 11 p.m. But he left in place the tighter capacity restrictions on some businesses and the tourist test requirement.

Reopening too soon had contributed to some earlier spikes, said Mónica Feliú-Mójer, a biologist and director of communications for Ciencia Puerto Rico, a nonprofit group that supports Puerto Rican researchers.

Dr. Feliú-Mójer said that even though cases appeared to be declining, they were still considerably higher than they had been before the recent surge. And she said she was concerned that the Mother’s Day holiday on Sunday could cause another spike.

A Norwegian Cruise Lines at the Port of Miami last April.
Credit…Angel Valentin for The New York Times

Norwegian Cruise Line is threatening to keep its ships out of Florida ports after the state enacted legislation that prohibits businesses from requiring proof of vaccination against Covid-19 in exchange for services.

The company, which plans to have its first cruises available to the Caribbean and Europe this summer and fall, will offer trips with limited capacity and require all guests and crew members to be vaccinated on bookings through at least the end of October.

During a quarterly earnings call on Thursday, Frank Del Rio, chief executive of Norwegian Cruise Line, said the issue had been discussed with Florida’s governor, Ron DeSantis, a Republican. Mr. Del Rio said if the cruise line had to skip Florida ports, it could operate out of other states or the Caribbean.

“We certainly hope it doesn’t come to that,” Mr. Del Rio said. “Everyone wants to operate out of Florida. It’s a very lucrative market.”

The clash between Norwegian Cruise Line and Florida is one of the many that are likely to surface about how states and businesses address whether proof of vaccination will be required. While some states have yet to take a position on businesses requiring vaccines, others are already operating with such protocols in place.

Norwegian Cruise Line is headquartered in Florida along with Royal Caribbean Cruises and Carnival Corporation. In 2019, about 60 percent of all U.S. cruise embarkations were from Florida ports, according to an economic analysis prepared last year for the Cruise Lines International Association.

GLOBAL ROUNDUP

Madrid on Friday. The country’s state of emergency is set to expire at midnight on Sunday.
Credit…Jesus Hellin/Europa Press, via Getty Images

With a nationwide state of emergency expiring at midnight on Sunday, Spain is preparing to remove most of its Covid-19 lockdown restrictions, but a patchwork of regional measures is likely to follow.

Only four of Spain’s 17 regions plan to keep the nationwide 11 p.m. curfew that was imposed under the six-month emergency. But some regions are keeping municipalities with higher coronavirus infection rates under stricter lockdown rules until their outbreaks subside.

In Madrid, the leader of the region, Isabel Díaz Ayuso, fresh off a landslide re-election victory, plans to lift a ban on visitors in private homes and to allow restaurants and bars to remain open one hour later, until midnight.

Ms. Ayuso successfully campaigned on a “freedom” slogan even as the virus continued to challenge the Spanish capital, with Covid-19 patients occupying a far higher share of intensive-care beds than the national average.

The debate over whether to prolong restrictions has landed in courtrooms in some parts of Spain. The regional government of the Basque Country wanted to keep tougher rules in place beyond Sunday, including a ban on residents traveling outside the region. But a local court struck down the plan, saying that it could not be enforced once the nationwide state of emergency had ended.

Spain is recording about 6,200 new cases a day, the lowest in a month, and has seen cases decline by 29 percent over the past 14 days, according to a New York Times database. There have been more than 3.5 million confirmed cases of the virus in the country, and more than 78,700 people have died.

In other news from around the world, compiled from wire services:

  • Pakistan, battling a third virus wave, entered a partial lockdown ahead of the Eid holiday at the end of the Muslim fasting month of Ramadan. Facing record Covid deaths last week, the country sent troops into the streets to help enforce precautions, and there are fears that the virus could rampage through Pakistan as it is in neighboring India.

  • Italy is planning to lift quarantine restrictions for some travelers as early as mid-May in an effort to revive the tourism industry, said Luigi Di Maio, the foreign minister. The change is expected to apply to European countries including Britain as well as Israel and is based on high levels of vaccination. The United States may also face fewer requirements in June.

  • Bangladesh detected its first cases of a contagious variant first found in India, according to health officials. The country’s border with India had already been closed to people, and a lockdown is also in effect.

Mountaineers’ tents at Mount Everest Base Camp in Nepal on Monday.
Credit…Prakash Mathema/Agence France-Presse — Getty Images

Climbers have begun to make the treacherous, windswept ascent toward the summit of Mount Everest despite concerns over a possible coronavirus outbreak at their camp at the base of the world’s tallest peak.

After a team of 12 Sherpa guides affixed a rope to the summit on Friday evening, climbers set off from the base camp on Nepal’s side of the mountain in the first expedition to try to reach the five-and-a-half-mile-high summit since 2019.

Nepal closed its lucrative Himalayan mountaineering industry in 2020 because of the pandemic. As part of the government’s effort to revive the country’s overall $2 billion tourism industry this year, it issued 408 permits for Everest climbs, the most ever, even as the virus began surging across the country.

Nepal, which shares a long border with India, recorded more than 9,100 cases on Friday, compared to a daily average of fewer than 100 one month ago.

Several climbers at Nepali base camp have fallen ill and been evacuated in recent weeks. Upon returning to Kathmandu, the capital, some have tested positive for the coronavirus and shared their accounts on social media — even as Nepal tourism officials deny there have been any infections on Everest.

Despite the reports of infections, local guides spent weeks affixing a rope to help guide climbers to the peak. The team was led by led by Kami Rita Sherpa, who reached the summit of Everest for a record-breaking 25th time on Friday, said Mingma Sherpa, the chairman of Seven Summit Treks, Nepal’s largest expedition operator.

A team of climbers including a Bahraini prince has departed for the summit, he added, and is expected to reach the peak on Tuesday.

The Grand Canyon, looking north from the South Rim, in July 2020.
Credit…Adriana Zehbrauskas for The New York Times

The organizer of a Grand Canyon hike in October that drew more than 150 people has been charged with five counts in court for leading the excursion, which federal officials said violated Covid-19 restrictions and circumvented rules on charging for tours in national parks.

On Tuesday, the organizer, Joseph Don Mount, was charged in U.S. District Court in Arizona with giving a false report, interfering with a government employee or agent acting in an official duty, soliciting business in a federal park without a permit, and violating restrictions for group sizes for park visits and restrictions related to Covid-19.

A tipster alerted officials at Grand Canyon National Park to Mr. Mount’s Facebook post soliciting ever larger numbers of hikers.

Park officials reached out to Mr. Mount and warned him not to violate the ban on groups larger than 11 people during the pandemic.

Yet he continued to advertise the hike and to organize cabin stays and shuttle rides for dozens of people, according to court documents, which showed that by Oct. 24, the day of the hike, more than 150 people had paid $95 to register.

At least 150 people showed up the North Kaibab Trail that day, according to the documents, astounding rangers and overwhelming other visitors who struggled to steer clear of the hikers, many of whom were not wearing masks or social distancing.

Timothy Hopp, a U.S. park ranger, said in an affidavit that Mr. Mount collected $15,185 from participants for the hiking event and said that he planned to use nearly all of it to pay expenses.

Still, Mr. Mount “knowingly profited from leading this commercially organized” event, Mr. Hopp said. “J. Mount admitted he would be receiving a net profit of $65.11 and it would be enough to buy a new pair of hiking poles.”

Workers with vials of vaccine at a production facility of the Serum Institute of India in January.
Credit…Atul Loke for The New York Times

Adar Poonawalla, the 40-year-old chief of the world’s largest vaccine maker, promised to help lead 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 in the middle of the pandemic. Serum has suffered production problems that have kept it from expanding output. Mr. Poonawalla has come under criticism for departing to London amid the crisis. When he returns to India, because of threats he said he’s received, he will travel with government-assigned armed guards.

In an interview with The New York Times, Mr. Poonawalla defended his company, saying he had no choice but to hand over vaccines to the Indian government, and laid some blame on the United States for a shortage of raw materials that has stymied production. But he acknowledged that the Serum Institute alone lacks the capacity to vaccinate India anytime soon, much less the rest of the world.

Jitender Singh Shunty, right, whose organization runs the Seemapuri  cremation grounds in New Delhi, said that about 100 bodies arrived every day.
Credit…Atul Loke for The New York Times

In a crowd of blue and white protective gowns gathered around the burning pyres of a cremation ground, Jitender Singh Shunty’s bright yellow turban stands out.

For 25 years, the former businessman has run a volunteer organization that helps poor people in New Delhi cremate their loved ones with dignity. Hundreds of families have said their final goodbyes at the Seemapuri crematorium that he runs in the eastern part of India’s capital city. But the last month, amid the devastation of India’s second coronavirus wave, has been the hardest.

“I used to get six to eight bodies each day before the pandemic,” Mr. Shunty said. “Now I get around 100.”

Scenes of crowded crematories have symbolized the anguish in India, and for many stand as a rebuke to a government accused of mismanaging the crisis and undercounting the dead. On Friday, India reported 4,187 new deaths from the virus, the most in a single day since the pandemic began. More than 400,000 new infections are recorded daily.

Beyond the harrowing statistics, there is a painful routine of trauma — one that Mr. Shunty and his band of volunteers help grieving families complete, even as their loved ones’ final rites are stripped of the usual space and dignity.

About half of the bodies Mr. Shunty, receives are people who died in their homes, and he said these deaths often aren’t included in the official tallies. He and his large team of volunteers collect the dead from homes, hospitals and morgues, crisscrossing the city in a fleet of hearses. They disinfect them, wrap them in shrouds and transport them to the pyres.

At night, Mr. Shunty, 58, sleeps in his car to avoid becoming infected. His wife and sons are sick at home with the virus. Three of his drivers are infected. His manager is in intensive care.

Before he founded his organization, the Shaheed Bhagat Singh Sewa Dal, Mr. Shunty was a prosperous businessman. One day more than two decades ago, he noticed a man picking up pieces of half-burnt wood at a cremation ground. When Mr. Shunty confronted him for stealing, the man said he didn’t have the money to cremate his son.

“I couldn’t believe that in this megacity where people spend millions on their homes, weddings, and birthdays, here was someone who could not even afford a funeral,” Mr. Shunty said.

He has since dedicated himself to the final rites of the poor. His organization, which includes a large team of volunteers and a fleet of hearses, runs on donations as much as on a dedication to the concept of sewa, or selfless service, a tenet of his Sikh faith.

He veers between sadness and rage as he describes a collapse of governance during India’s second wave. For families these days, the crematorium he runs is the last stop of an ordeal that could have involved dragging their loved one from hospital to hospital in search of a bed, lining up for hours for a cylinder of oxygen, begging strangers for help.

“Delhi has been abandoned, left to its fate by the government,” Mr. Shunty said. “Even oxygen is not free anymore.”

IN CASE YOU MISSED IT

Along the Strip in Las Vegas last week. There is consensus among scientists and public health experts that the herd immunity threshold is not attainable.
Credit…Bridget Bennett for The New York Times

Herd immunity was a term often used at the start of the pandemic, signifying a possible end. Now, scientists and public health experts believe the herd immunity threshold is not attainable — at least not in the foreseeable future, and perhaps not ever.

Instead, they have come to the conclusion that the virus will most likely become a manageable threat that will circulate in the United States for years to come, still causing hospitalizations and deaths but in much smaller numbers.

Predicting when exactly it will become manageable is difficult, as variants continue to spread. It is also unclear how many people will be vaccinated in the United States and around the world.

Early on, the target herd immunity threshold — the proportion of Americans who need to be protected from the virus so that it can no longer find enough new people to infect — was estimated to be 60 to 70 percent of the population. Most experts expected that the United States would be able to reach that level once vaccines were available.

But the initial calculations were based on the contagiousness of the original version of the virus. The rise of variants, including many that are more transmissible, has changed the herd immunity threshold.

There is also concern — as travel restrictions ease — that the virus could continue to spread from areas where vaccination rates are not as high.

More scientists now say that the goal over the next generation or two is for the new coronavirus to become more like its cousins that cause common colds. That would mean that initial infections occur early in childhood, and subsequent ones are milder because of partial protection, even if immunity wanes.

Here’s what else you might have missed this week:

  • President Biden announced that his administration would create a federal stockpile of coronavirus vaccine doses and invest millions in community outreach to help immunize underserved communities and ensure doses go where they’re most needed. Previously, vaccines were allotted to states strictly on the basis of population, but in some states demand has been falling. Federal officials informed states on Tuesday that if they did not order their full allocation of doses in a given week, that vaccine would be considered part of a federal pool, available to other states that wanted to order more.

  • Gov. Andrew M. Cuomo of New York announced that for the first time in a year, restaurants, stores, museums, offices, health clubs and barbershops would be permitted to operate at full capacity starting on May 19. Gov. Philip D. Murphy of New Jersey and Gov. Ned Lamont of Connecticut also announced that they would end most of their states’ virus restrictions.

  • The International Olympic Committee announced that athletes and officials traveling to the Summer Games in Tokyo would be offered doses of the Pfizer-BioNTech Covid-19 vaccine before arriving in Japan. It is the latest attempt by Olympic officials and Japanese organizers to assuage the concerns of the majority of Japanese who oppose staging the games during the pandemic.

  • The United Nations said that the pandemic has fueled soaring hunger and sharp declines in maternal health globally. Last year, at least 155 million people worldwide needed urgent food aid, a five-year high. A separate report from the U.N. Population Fund said newborn deaths, and the risk of death for mothers in childbirth, had risen because of a shortage of midwives.

A man takes a selfie as he receives a dose of the Moderna vaccine at a vaccination center in Los Angeles last month.
Credit…Jae C. Hong/Associated Press

Most people aren’t particularly fond of needles.

For a significant number of people, though, the fear of needles goes beyond anxiety into a more dangerous area, and prevents them from seeking out needed medical care.

As the world’s hopes of returning to a post-pandemic normal rest largely on people’s willingness to take a Covid-19 vaccine, experts and health care professionals are assuring those people that there are ways to overcome this problem.

“It would be heartbreaking to me if a fear of needles held someone back from getting this vaccine, because there are things we can do to alleviate that,” said Dr. Nipunie S. Rajapakse, an infectious diseases expert at the Mayo Clinic in Minnesota.

A study from the University of Michigan found that 16 percent of adults in several countries avoided annual flu vaccinations because of a fear of needles, and 20 percent avoided tetanus shots.

Whether fear is keeping you from being vaccinated at all or is causing you distress about doing so, there are some steps that the experts suggest:

  • Seek professional help. A therapist can help people with the most severe fear, especially if the fear is interfering with getting appropriate medical care.

  • Tell the nurse about your fear before getting the shot. There may be techniques the nurse can use, or products may be available, to reduce the pain of the injection or to put you at ease.

  • Distract yourself. It could be a YouTube video or your favorite song playing on your phone. You could practice deep-breathing or meditation techniques, or wiggle your toes, or look around and count all of the blue items you can see in the room.

  • Focus on the benefits. Think about the summer barbecues, family gatherings and economic recovery the vaccines will help usher in, and you might be feeling more optimistic and excited than nervous.

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