Many States with Recent Outbreaks Show Case and Hospitalization Drops

The Emergent BioSolutions plant in Baltimore. Workers for the company accidentally conflated the ingredients of two coronavirus vaccines, one by Johnson & Johnson and the other by AstraZeneca.
Credit…Jim Lo Scalzo/EPA, via Shutterstock

Two top executives of Emergent BioSolutions, a previously obscure Maryland biotech firm whose Baltimore plant ruined millions of doses of coronavirus vaccine, have agreed to testify on Capitol Hill next week as part of a congressional investigation into their company, a politically connected federal contractor.

Fuad El-Hibri, the company’s founder and executive chairman, and Robert Kramer, its chief executive officer, will appear on May 19 before the House Select Subcommittee on the Coronavirus, committee officials said on Wednesday morning. The panel has opened a sprawling inquiry into Emergent’s manufacturing failures, and whether the company used its contacts with the Trump administration to land hundreds of millions of dollars in coronavirus vaccine contracts.

“Emergent’s actions wasted American taxpayer dollars and reduced the number of doses available for global vaccination efforts,” Representative Jim Clyburn, Democrat of South Carolina and the subcommittee’s chairman, said in a statement to The Times. He said that Congress “is looking for answers and they are long overdue.”

An investigation by The New York Times, published in March before the firm’s vaccine manufacturing troubles were known, examined Emergent’s aggressive lobbying tactics and lucrative relationship with the federal government.

The hearing will put an unwelcome spotlight on the company, which kept a low profile over the past two decades as it cornered the market on sales of anthrax vaccines and other bioterror-related products to the Strategic National Stockpile, the nation’s emergency medical reserve.

Emergent’s stock performed so well in 2020 that Mr. El-Hibri cashed in shares and options worth over $42 million, corporate filings show. Mr. Kramer, who has boasted to investors that “extensive relationships across multiple agencies within the federal government” helped build the company, took home a $1.2 million cash bonus and $2 million in stock awards.

Credit…Joe Andrucyk/Office of Governor Larry Hogan

In an interview with CNN on Wednesday morning, Mr. Clyburn indicated that the committee was also scrutinizing the executives’ market moves. “They all made millions in stock transactions while they seem to be hiding stuff from the public,” he said.

The Times reported last month that workers at Emergent’s Baltimore plant had accidentally conflated the ingredients of two coronavirus vaccines, one by Johnson & Johnson and the other by AstraZeneca. The error resulted in the loss of up to 15 million Johnson & Johnson doses, and a recent inspection by the Food and Drug Administration said that more doses may have been exposed to contamination.

In a statement on Wednesday, the company said that it had responded to the F.D.A.’s observations with a “comprehensive quality enhancement plan” and had “already started making improvements.”

On a recent call with investors, Mr. Kramer announced a management shake-up and said that while the company had “implemented multiple layers of disinfection and other protocols to lessen the inherent risk of cross-contamination” when manufacturing two vaccines in the same plant, the precautions “did not function as anticipated.” He took “full responsibility” for the manufacturing problems that ensued, acknowledging that the “loss of a batch for a viral contamination is extremely serious, and we treated it as such.”

In letters to the two Emergent executives last month, Mr. Clyburn and Representative Carolyn Maloney, Democrat of New York and chairwoman of the House Oversight and Reform Committee, demanded a slew of documents, including any correspondence between the company and Dr. Robert Kadlec, President Trump’s assistant secretary for preparedness and response, who previously consulted for the company. In interviews, Dr. Kadlec has said his consulting work, in 2013 and 2014, was limited and did not affect contracting decisions.

“Emergent has been in the news a lot lately, and that’s frankly not something we’re used to,” Mr. Kramer wrote in a commentary posted on the company’s website last month. “Until a year ago we were a little-known company that does our work behind the scenes.”

The company is trying to burnish its image with television and digital advertising, as part of a campaign it is calling “We Go.” The 30-second ads feature images of white-clad lab technicians and spotlight some of the company’s lesser-known work manufacturing cholera vaccines and medicine used to treat opioid overdoses, as well as its Covid-19 work.

Emergent’s plant in Baltimore is one of two federally designated Centers for Innovation in Advanced Development and Manufacturing, funded in part by taxpayers. In June 2020, the federal government awarded Emergent a $628 million contract, largely to reserve space for coronavirus vaccine manufacturing, despite staffing and quality concerns.

The Biden administration responded to the potential contamination last month by putting Johnson & Johnson in charge of the Baltimore facility and moving out AstraZeneca. Doses made at the plant have not been cleared for use in the United States, and millions of shots made in Baltimore and sent overseas have also been put on hold.

A middle school student waiting to receive a coronavirus vaccine shot on Wednesday in Decatur, Ga.
Credit…Ron Harris/Associated Press

The federal government on Wednesday took a final step toward making the Pfizer-BioNTech coronavirus vaccine available to 12- to 15-year-olds in the United States, removing an obstacle to school reopenings and cheering millions of families weary of pandemic restrictions.

An advisory committee to the Centers for Disease Control and Prevention voted to recommend the vaccine for use in children in that age group. The C.D.C. director, Dr. Rochelle Walensky, is expected to review the recommendations and approve them later on Wednesday.

Many parents are eagerly anticipating the availability of vaccines for children, at least in part to speed their return to schools. Roughly one-third of eighth graders, usually 13 or 14 years old, are still learning fully remotely.

Vaccinations of adolescents have already begun in a few states, like Maine. Others plan to offer the vaccine as early as Thursday. There are nearly 17 million 12- to 15-year-olds in the United States, accounting for 5.3 percent of the population.

Nearly all states now have a glut of vaccine doses that could be quickly redirected to adolescents. The dose used to immunize adults is also safe and effective for these adolescents, clinical trials have shown.

While children’s risk of severe illness is low compared with that of adults, the coronavirus has infected more than 1.5 million children and sent more than 13,000 to hospitals, more than are hospitalized for flu in an average year, according to data collected by the C.D.C.

Young children are thought to spread the virus less often than adults do, but their ability to transmit increases with age. Teenagers, particularly those in high school, may transmit the virus as readily as adults. Children aged 12 to 17 years represent an increasing proportion of Covid cases in the country.

Vaccinating children should increase the level of immunity in the U.S. population, helping to bring down the number of cases.

Pfizer announced in March that the vaccine seemed to be at least as effective in 12- to 15-year-olds as it has been in older teenagers and adults. Apart from a slight increase in the frequency of fevers, the shots also seemed to have comparable, mostly negligible side effects.

The Food and Drug Administration reviewed the clinical data and on Monday authorized the Pfizer vaccine for use in these children, capping weeks of anticipation from parents and children about a swifter return to normalcy.

President Biden promised last week to be “ready to move immediately” after authorization of the vaccine for 12- to 15-year-olds. Pediatricians, family doctors, schools and about 20,000 pharmacies nationwide are expected to offer the vaccine for free to these children.

Medical workers tending to a coronavirus patient in an emergency room in New Delhi last week.
Credit…Adnan Abidi/Reuters

A virus variant that has been spreading rapidly in India and designated a variant of concern by the World Health Organization might be more contagious than most versions of the coronavirus, the agency said in a report it published on Tuesday evening.

The W.H.O. emphasized in its report that it wasn’t yet clear how much the variant, known as B.1.617, had contributed to the devastating surge that has crushed India in recent weeks. It cautioned that India, like many countries, is only sequencing a tiny fraction of positive samples, and that with so little surveillance, it’s difficult to make firm conclusions about B.1.617.

The W.H.O. study comes amid growing condemnation of the Indian government’s response to its ferocious virus wave and calls for nationwide restrictions to try to limit the death toll, as hospitals are overrun and crematories burn nonstop.

India recorded more than 360,000 new cases on Wednesday and more than 4,200 deaths, the country’s highest daily death toll since the pandemic began. India has now reported more than 250,000 deaths from the virus, although experts believe that the true toll is far higher.

Experts also caution that it is not yet clear just how much of a factor B.1.617 has played in the explosion of cases in India. They point to a perfect storm of public health blunders, such as permitting enormous political rallies and religious festivals in recent months. It’s possible that the variant is being lifted up by the surge, rather than the other way around.

The W.H.O. speculated that another variant known as B.1.1.7, first identified in Britain and now dominant in the United States, might also be driving the swell in cases.

It’s not yet clear whether B.1.617 causes more severe Covid-19. Anecdotally, doctors in India are reporting higher numbers of young people and children testing positive for the virus and more patients with severe disease requiring oxygen support. But until more genetic sequencing is done, it’s impossible to know if the variant is to blame.

Stacia Wyman, a genomics scientist at the University of California, Berkeley, said that the W.H.O. had made the right decision. She pointed to the fact that the variant had already spread to at least 49 countries. “This appears to be posing the biggest threat right now in terms of transmissibility, with many countries reporting increasing trajectories of the B.1.617 variant,” she said.

B.1.617 is the fourth variant of concern recognized by the W.H.O. The others include B.1.1.7; B.1.351, which swept through South Africa; and P.1, which has devastated Brazil.

B.1.617 first came to light in October 2020. It had a number of mutations, some of which have been proved worrisome in other variants. Preliminary studies on the mutations suggest that some of them might give the coronavirus a tighter grip on cells, increasing their chances of a successful infection.

Other mutations could make it more difficult for antibodies produced by infections with other variants to stick to them. Studies on antibodies produced by vaccinated people also suggest that they work less successfully against B.1.617. Experts expect that most vaccines will remain effective against the variant.

W.H.O. researchers determined that B.1.617 is spreading fast in India, making up over 28 percent of samples from positive tests. The shift suggests that B.1.617 has a higher growth rate than other variants circulating in India, with the possible exception of B.1.1.7. And B.1.617 has been growing rapidly in Britain.

Gagandeep Kang, a pre-eminent Indian virologist, said there was not enough data to conclude whether either variant was contributing to India’s deadlier second wave.

“There is some conflicting data regarding the B.1.1.7 variant, which seems to indicate in some studies that it does cause more severe disease, in other studies not,” said Dr. Kang, the executive director of the Translational Health Science and Technology Institute in India.

Based on reports from hospitals, Dr. Kang said, it appeared that B.1.617 was causing more severe disease but that, again, there was insufficient data to draw conclusions. She said that real-time genetic information would be needed to determine whether B.1.617-infected people needed more oxygen.

Officials in India are trying to track how many fully vaccinated people have fallen ill. If an unusual number of these so-called breakthroughs are caused by a variant such as B.1.617, then that could point to the variant’s ability to evade a vaccine.

Pramod Sawant, chief minister of Goa, India, on the left and wearing personal protective gear, visited Covid-19 patients at a hospital in Panjim, a city in the state, on Tuesday.
Credit…Goa Chief Minister’s Office, via Agence France-Presse — Getty Images

NEW DELHI — Just a few months ago, the southwestern state of Goa was welcoming tourists from across the rest of India who were drawn to its picture-perfect beaches, an ideal source of relief from coronavirus rules in other regions.

Group celebrations, many without masks, were common. Life appeared to have gone back to normal.

But it did not last.

With India in the grip of a devastating coronavirus outbreak, 26 people died at the state-run Goa Medical College and Hospital on Tuesday morning, possibly because of an oxygen shortage, one official said.

“Due to interrupted supply of oxygen, we feel that between 2 a.m. and 6 a.m. many people are dying in G.M.C.,” the health minister for Goa, Vishwajit Rane, told The Times of India. He also called for a High Court inquiry to investigate the cause of the deaths.

Goa reported 75 deaths in total on Tuesday, its highest daily toll of the pandemic, and there were over 32,800 new daily infections in the state, which has a population of about 1.5 million. Officially, India has surpassed 250,000 total reported deaths from Covid.

Contradicting the health minister, Pramod Sawant, Goa’s chief minister, who visited the hospital, said that there was “no scarcity” and that the state had “abundant supplies of oxygen.” Mr. Rane said the chief minister might be “misguided.”

Goa has been reporting one of the highest infection rates in the country for at least a week.

Mr. Rane said in an interview with CNN last week, “Opening up of tourism without any restrictions in December has led to this situation.”

Goa has also created headlines for approving the use of ivermectin, an anti-parasite drug, in the treatment and prevention of Covid-19. The World Health Organization has said that there is not enough evidence to suggest that the drug reduces mortality in coronavirus patients.

On Monday, Mr. Rane announced on Twitter that the state government would make the drug available for everyone over 18 as a prophylactic.

Patients will be treated with ivermectin for a period of five days, Mr. Rane said, adding that the government would make the drug available at hospitals and primary health centers for people to “start the treatment immediately, irrespective of any symptoms.”

The W.H.O. has warned against the use of the drug, except in clinical trials.

“Safety and efficacy are important when using any drug for a new indication,” said Dr. Soumya Swaminathan, the W.H.O. chief scientist, in a post about ivermectin on Tuesday.

“Current institutions, public and private, failed to protect people from a devastating pandemic,” according to new reports delivered to the World Health Organization today. The Minneapolis-St. Paul International Airport in Minneapolis last November.
Credit…Tim Gruber for The New York Times

The next time the world faces an outbreak of a fast-spreading and deadly new pathogen, governments must act swiftly and be ready to restrict travel or mandate masks even before anyone knows the extent of the threat, according to a pair of new reports delivered to the World Health Organization.

The studies are intended to address missteps over the past year that led to more than 3.25 million deaths, some $10 trillion in economic losses and more than 100 million people pushed into extreme poverty.

“Current institutions, public and private, failed to protect people from a devastating pandemic,” concluded one of the reports, released on Wednesday, which called the Covid-19 pandemic “the 21st century’s Chernobyl moment.”

“Without change,” it said, these institutions “will not prevent a future one.”

The reviews, released in advance of this month’s meeting of the W.H.O.’s governing assembly, were written by appointees who donated countless hours in the midst of their own countries’ pandemic fights to interview hundreds of experts, comb through thousands of documents, gather data and seek counsel from public and private institutions around the world.

Pandemics, the authors concluded, are an existential threat on the order of a chemical or nuclear weapon, and preparing for them must be the responsibility of the highest levels of political leadership rather than only health departments, which are often among the least powerful of government agencies.

Mobile vaccination sites are one way public health officials try to improve access to shots. Firefighters administered vaccine doses in the Chinatown neighborhood of Los Angeles in February.
Credit…Philip Cheung for The New York Times

The slowdown in vaccinations across the United States is often attributed to a blend of misinformation and mistrust among Americans known as “vaccine hesitancy.”

But a sizable number of people — some 30 million, by a new U.S. census estimate — remain unvaccinated even though they are not hesitant or skeptical. They just haven’t managed to get a shot, for a host of reasons.

These people outnumber the truly hesitant — the more than 28 million who said they would probably or definitely not get vaccinated — and also the 16 million who said they were unsure. And they became an official new focus of the nation’s mass vaccination campaign this month.

In addition to “the doubters,” President Biden said at a press briefing last week, the mission is to get the vaccine to those who are “just not sure how to get to where they want to go.”

For the most part, they are working-class people with jobs and family obligations that leave them little discretionary time. Many have health issues or disabilities, or face language barriers that can make getting inoculated against Covid seem daunting. Others don’t have a regular doctor, and some are socially isolated.

Technically, they have access to the vaccine. Practically, it’s not that simple.

“Hesitancy makes a better story because you’ve got controversy,” said Tom Frieden, a former director of the Centers for Disease Control and Prevention. “But there’s a bigger problem of access than there is of hesitancy.”

Marisol Gerardo, 9, is held by her mother as she gets a second dose of the Pfizer vaccine during a clinical trial for children at Duke Health in Durham, N.C., in April.
Credit…Shawn Rocco/Duke Health, via Reuters

On May 4, Dr. Hina Talib, who goes by the handle @teenhealthdoc on Instagram, asked the parents among her 33,000 followers if they were hesitant to get the coronavirus vaccine for their 12- to 15-year-olds, and if so, why. Dr. Talib, a physician in the adolescent medicine division at the Children’s Hospital at Montefiore in New York, got 600 messages in response.

More often than not, Dr. Talib said, the parents had already had the Covid-19 vaccine, and would preface their message with: “I’m not an anti-vaxxer or an anti-masker. I’m just worried.”

Although trials have shown no serious safety concerns for children thus far, some recent polls show that only about 30 percent of parents across the United States say they would get their children vaccinated right away. Parents of infants and preschoolers expressed even more anxiety about the vaccine than parents of teenagers.

These parents tend to be concerned about the vaccine affecting puberty and future fertility for their children, and its possible impact on allergies and side effects. Their fears are a key hurdle for U.S. efforts to expand vaccinations to younger teens.

A healthcare worker preparing a dose of the Johnson & Johnson coronavirus vaccine at Grand Central Terminal in Manhattan on Wednesday.
Credit…Carlo Allegri/Reuters

Coronavirus variants will pose a continuing threat to the United States, with the potential to spread quickly and blunt the effectiveness of vaccines, scientists told a House panel on Wednesday.

“We must ensure that the tools we use to detect, treat, and forecast the virus are keeping up with emerging variants,” said Rep. Bill Foster, Democrat of Illinois and the chairman of the House subcommittee that heard the scientists’ testimony.

Last month, the White House announced almost $2 billion in funding for tracking coronavirus variants. The plan calls for large-scale sequencing of virus genomes, as well as research to understand how mutations alter the biology of viruses.

The funding is needed urgently, said Salim S. Abdool Karim, a professor of clinical epidemiology at the Mailman School of Public Health at Columbia University. “Over the coming months, we can reasonably expect new variants to emerge that are able to escape vaccine-induced immunity, because the virus is being put under pressure from wide-scale vaccination,” he said.

The world is not doing enough to track such variants, said Nathan Grubaugh, an epidemiologist at the Yale School of Public Health. “These global and national genomic surveillance gaps severely limit our ability to detect new and emerging SARS-CoV-2 variants, and should be considered as a threat to U.S. public health,” he said.

In addition to sequencing more genomes, scientists said that they needed ways to share their data quickly. That data should include more than just mutations carried by viruses, according to Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security. Dr. Rivers said that scientists also needed a way to learn about the health of people after they get infected with variants.

“We must be able to observe how the variant behaves in individuals and populations,” Dr. Rivers said.

For example, when New York researchers connected information about B.1.526, a variant common in the city, with medical records, they found that it does not make people unusually sick with Covid-19.

By monitoring variants, Dr. Rivers said, researchers could offer early warnings about threats to the protection afforded by vaccines. Vaccine developers could then respond by creating formulations tailored to the variants.

“We must not again be unprepared,” Dr. Rivers warned.

Unloading an oxygen cylinder as a patient lay outside the emergency ward of a hospital in Kathmandu, Nepal, on Monday.
Credit…Niranjan Shrestha/Associated Press

As hospitals in Nepal strain to cope with one of the world’s fastest-growing coronavirus outbreaks, relief groups in the Himalayan nation are asking mountain climbers to hand over their used oxygen cylinders so that they can be refilled for Covid-19 patients.

The unusual appeal reflects the strange duality in Nepal: While hundreds of foreign climbers are attempting costly expeditions to the summits of Mount Everest and other peaks, the impoverished nation down below is facing urgent shortages of hospital beds, medical oxygen, coronavirus test kits and other supplies.

Expedition operators are preparing to airlift thousands of cylinders from the Himalayas as expeditions are completed this month, the culmination of the climbing season. Kul Bahadur Gurung, general secretary of the Nepal Mountaineering Association, estimated that tour companies would be able to provide at least 4,000 cylinders by the first week of June.

“We are asking them not to leave even a single oxygen cylinder in the mountains,” Mr. Gurung said.

Climbers attempting to reach the top of Everest, the world’s tallest peak, and other mountains carry oxygen to help them breathe in the thin air. Although Nepal prohibits leaving equipment behind in the mountains, canisters are sometimes left buried in the snow by exhausted climbers or stashed by expedition companies for later use.

Cylinders used in mountaineering are smaller to those typically found in intensive-care wards, but Mahabir Pun, a prominent Nepali scientist who is helping to lead the cylinder drive, said that they could be used by patients who cannot find a hospital bed or who are being treated at home.

“I.C.U. beds are already filled with critical Covid patients, so we want to distribute these portable expedition cylinders with regulators for those patients staying in home isolation,” Mr. Pun said.

Nepal’s outbreak has surged in recent weeks, most likely fueled by the virus’s catastrophic surge in India, with which it shares a long, porous border. On May 1, Nepal reported 26 deaths from the virus. On Tuesday, the official death toll was 225.

Doctors say that a shortage of medical oxygen is a factor in many of the deaths. Many hospitals have stopped admitting new Covid-19 patients, citing a lack of oxygen. Wealthy families are airlifting their loved ones by chartered helicopter to cities where they can find intensive-care beds. Other patients are being treated in makeshift emergency facilities set up in parking lots and other open spaces.

With almost half of Nepal’s coronavirus tests coming back positive, health experts warn that the worst is yet to come.

China has pledged to provide Nepal with 20,000 oxygen cylinders and 100 ventilators, the first batch of which arrived on Tuesday.

Expedition companies are stepping in with smaller donations. Mr. Gurung’s group said that he was sending five dozen cylinders, along with a few more from a local mountaineering museum, to hospitals treating coronavirus patients.

Mingma Sherpa, chairman of Seven Summit Treks, Nepal’s largest expeditions operator, said that he planned to ship as many as 500 cylinders used in expeditions to Everest and other peaks soon after climbers descended to base camps.

“My only condition is that those cylinders should be used for poor and helpless people rather than V.I.P.s,” he said, adding: “It’s our responsibility to help the government during these trying times. We will do it happily.”

Taking temperatures at a vaccination site in Bangkok on Tuesday.
Credit…Lillian Suwanrumpha/Agence France-Presse — Getty Images

As a resurgent coronavirus threatens countries across Southeast Asia, the health authorities in Thailand are working to contain an outbreak that is ripping through the tight-knit community of gemstone traders in the southeastern reaches of the country near the border with Cambodia.

The town of Chanthaburi — which has a long history as a center of the country’s business in rubies, sapphires and other stones — is at the heart of the outbreak, which has infected at least 166 in the community of traders from Africa who work in the country. At least 103 Thais in the town have also tested positive as a result of the latest outbreak, officials reported.

The cluster of cases comes as Thailand battles its worst outbreak since the pandemic began. For nearly three weeks, the country has averaged about 2,000 new cases a day — more than double its worst peak in January. The largest outbreak has been reported in Bangkok, which is under a partial lockdown.

On Wednesday, the government reported 34 deaths, a record, and 1,983 cases. One of those who died was from Finland.

Thailand was among the most effective countries last year in controlling the virus, but it has been slow to contain outbreaks this year and has lagged behind other countries in procuring vaccines.

Now, with the latest surge in cases, it is scrambling to obtain shots and to develop a mass inoculation program.

Some officials have declared that foreigners will not be vaccinated despite earlier outbreaks among migrant workers from Myanmar and now among the African gemstone traders. Other officials have said that Thailand will inoculate foreigners but have not provided specifics.

Thailand, which has a population of about 70 million, is home to more than two million foreigners who live in the country legally. More than two million more are believed to live in the country illegally.

Over the years, the gem business has attracted traders from several predominantly Muslim countries in Africa, including Gambia, Guinea and Mali. Many of them have settled in Thailand, married Thai wives and import gemstones from Africa.

Sankung Kongeh, a trader from Gambia, said members of the African community gathered daily at their offices and at the market, where they work, talk and eat together. During Ramadan, which began April 12, many also have prayed together, he said.

It is precisely that kind of close social contact that has fueled outbreaks around the world, but Mr. Kongeh discounted the group prayers as a significant risk.

“The possibility of the Covid spread has nothing to do with praying together,” said Mr. Kongeh, who recently tested negative. “It’s during the time hanging out at the office where we have the AC on, the door closed, and we chat with each other, drinking hot tea. There could be 10 or 12 of us sitting together. We don’t talk to each other during prayer.”

Aurora Duran, 86, is hugged by her granddaughter during a visit from her family at a long-term-care nursing community in Fort Stockton, Tex., in April.
Credit…Tamir Kalifa for The New York Times

Epidemiologists in the United States are starting to hug again, running errands, gathering outdoors with friends and getting haircuts.

In a new informal survey this month by The New York Times, 723 epidemiologists responded to questions about how they were navigating this in-between phase of the pandemic, when vaccines have become widespread and cases are declining but herd immunity is not assured and Covid-19 remains a threat.

More than at any time in the past year, most are feeling hopeful that Covid-19 will eventually become just another risk in daily life, but not one that paralyzes us.

Nevertheless, their advice was to hold on to most precautions just a bit longer.

“There is a strong likelihood that we will experience unexpected problems due to moving about as if the Covid pandemic was no longer a threat,” said Jana Mossey, an epidemiologist who retired from Drexel University.

“It is not ‘one size fits all,’” said Alicia Riley, a sociologist and epidemiologist at the University of California, San Francisco, expressing a version of the profession’s unofficial motto: It depends. “How safe it is depends on the local levels of community transmission.”

Gov. Henry McMaster of South Carolina in Columbia, S.C., last month.
Credit…Jeffrey Collins/Associated Press

Parents in South Carolina will be able to opt their children out of mask requirements in public schools, effectively ending mask mandates for schools throughout the state, according to an executive order signed by the governor that defies Centers for Disease Control and Protection guidance.

The order signed on Tuesday by Gov. Henry McMaster, a Republican, also prevented South Carolina’s local governments from using previously issued orders or states of emergency to enforce mask mandates and barred the use of “vaccine passports” in the state. South Carolina was one of several states that never had a statewide mask mandate, though several counties and cities imposed their own.

At least one school district said its legal counsel was reviewing the order. Doing away with masks in schools conflicts with C.D.C. guidance, which recommends universal masking combined with at least three feet of social distancing.

“Everybody knows what we need to do to stay safe — including wearing a mask if you’re at risk of exposing others — but we must move past the time of governments dictating when and where South Carolinians are required to wear a mask,” Mr. McMaster said in a statement, noting the availability of vaccines and falling coronavirus cases. “Maintaining the status quo ignores all of the great progress we’ve made.”

Mr. McMaster’s announcement comes as leaders in other states and cities have announced a rollback of restrictions and vaccines have become available to any adult. Mayor Muriel Bowser of Washington said on Monday that most of the city’s restrictions, including capacity limits, time restrictions and limits on types of activities would be lifted on May 21. Capacity limits on bars, nightclubs, and large sports and entertainment venues would be lifted June 11.

Mayor Jim Kenney of Philadelphia announced on Tuesday that all restrictions except the mask mandate would be lifted on June 11. The announcement came a week after Gov. Tom Wolf of Pennsylvania said that all restrictions related to gatherings, businesses and restaurants would be lifted on May 31 and that the statewide mask mandate would be lifted when 70 percent of adults in the state had been vaccinated. But the announcement came with the caveat that municipalities and school districts could continue or implement stricter mitigation efforts, despite the state’s easing restrictions. (An earlier version of this article misspelled the surname of the governor of Pennsylvania. He is Tom Wolf, not Wolfe.)

The governor directed the Department of Health and Environmental Control and the Department of Education to develop a standardized form for opting out, the statement said.

A nurse administered the Sovereign 2 vaccine, developed in Cuba, to a volunteer in Havana as part of a clinical trial in late March.
Credit…Joaquin Hernandez/Agence France-Presse — Getty Images

HAVANA — Cuba began a mass vaccination campaign on Wednesday in the capital, Havana, where authorities aim to eventually vaccinate 1.7 million people. The campaign is using homegrown vaccines that have not yet been shown to work, an emergency step intended to blunt the rapid spread of the coronavirus.

The country’s decision to deploy unproven vaccines mirrors the early introduction of vaccines in Russia, China and India, where regulators permitted mass vaccination campaigns to begin before the completion of Phase 3 clinical trials, which assess the vaccines’ effectiveness and safety.

In Florida, news reports critical of the Cuban government accused it of jumping the gun and endangering public health. American and European health regulators do not allow vaccines to be introduced, even for emergency use, until Phase 3 clinical trials are completed.

Though Cuba’s daily coronavirus case counts remain low by Latin American standards, they have spiked alarmingly in recent months. The island, which reported 12,225 confirmed cases in all of 2020, saw 31,465 confirmed cases in April 2021 alone.

The rapid spread of a virus variant first detected in South Africa has contributed to a surge in cases in Cuba, and justifies the early large-scale use of the Sovereign 2 and Abdala vaccines, according to the country’s health minister, Dr. José Angel Portal.

“Confirmed cases are forecast to rise,” he said. “Our regulatory agency and health experts consider that this intervention’s benefits outweigh the risks.”

Scientists rely on Phase 3 trials, in which a vaccine is compared with a placebo, to determine whether vaccines work. Cuba intends to finish the trials for the two vaccines by June.

Cuban scientists argue that with more than 145,000 Cubans already vaccinated as part of clinical trials and an “intervention study” with health workers, they already have enough data to know that serious adverse reactions to the vaccines are rare.

Unlike the American and European vaccines, which were developed in novel ways, “the technological platform the Cuban vaccines are based on has been used for 30 years,” said Dr. Gerardo Guillén, who has led the development of the Abdala vaccine. He said Cuba’s vaccines “are known to be very safe,” and that the proven track record of the technology “factored into the decision.”

Cuba hopes to produce enough doses for its whole population by August. But scientists say that U.S. diplomatic and economic sanctions are slowing down production, making it hard for Cuba to do business with foreign suppliers and complicating international humanitarian initiatives to donate syringes to the island, which needs about 20 million more to vaccinate the whole country.

Of the 90 coronavirus vaccines around the world currently in clinical trials, five were developed in Cuba, the smallest country to develop and produce its own vaccines.

“We will probably be the first country to immunize its whole population with its own vaccine,” said Dr. Eduardo Martínez, president of BioCubaFarma, the state conglomerate overseeing vaccine development and production.

Buying protective face masks following a small outbreak of coronavirus disease in Taipei, Taiwan, on Wednesday.
Credit…Ann Wang/Reuters

Growing concerns in Taiwan about a small but worsening coronavirus outbreak drove a sharp intraday plunge in its stock market on Wednesday, as investors worried about new government restrictions on businesses in a place that has largely escaped the pandemic.

On Wednesday morning, Taiwan’s health minister, Chen Shih-chung, said that the island’s new outbreak has reached a “very severe stage” and that restrictions could be upgraded in “the coming days.” He spoke after the government reported 16 new cases of local infection on Wednesday and seven on Tuesday.

The Taiwan Stock Exchange weighted index slumped as much as 8.6 percent intraday following the news, a nearly 13 percent loss from its April peak. The market regained some ground later in the day and finished down 4.1 percent.

Taiwan has been a rare success story in a pandemic-stricken world. The island democracy threw up its borders when the pandemic first began to spread from mainland China and has heavily limited travel. It has recorded only 1,210 total cases, according to a tally by The New York Times.

But the authorities haven’t been able to trace the handful of cases that have popped up in recent days, raising questions about whether the government will limit the number of people who can gather within restaurants or other businesses.

Taiwan instituted some Covid-related restrictions on Tuesday, the first in a long time. It suspended large events, limiting outdoor gatherings to 500 people and indoor gatherings to 100 people. On Wednesday morning, the health minister said that the restrictions might be stiffened within days.

Taiwan’s stock market was also hit by a broader global tech selloff, though its losses were greater than those suffered on Tuesday in Wall Street. Shares fell on worries about inflation and over whether the long-running boom in technology stocks would last.

Drops in two of Taiwan’s technological corporate heavyweights — Taiwan Semiconductor Manufacturing Co., a leading chip maker, and Hon Hai Precision Industry Co., known as Foxconn and a contract manufacturer for Apple and other big firms — put the biggest drag on the market.

The chip company, known as T.S.M.C., has reaped benefits from a surge in gadget sales amid the pandemic, but it is also squarely in the middle of tensions between the United States and China over which has greater say in the future of technology. It dropped more than 6 percent at one point on Wednesday and ended nearly 2 percent lower.

Hon Hai on Tuesday said output at a factory in India has slumped because workers infected with Covid-19 have had to leave their posts. Hon Hai dropped nearly 8 percent at one point and ended down more than 3 percent.

A patient receiving a vaccine in  Victoria, Seychelles, in February. More than a third of new active Covid-19 cases are occurring in people who have been fully vaccinated, according to the Health Ministry.
Credit…Salim Ally/Associated Press

Seychelles, whose population has the highest rate of vaccination against Covid-19 in the world, has had a surge in coronavirus cases. Much of its population has been inoculated with a vaccine made by Sinopharm in China.

The country, a cluster of islands in the Indian Ocean northeast of Madagascar, with a population of just over 100,000, has reimposed a lockdown after having more than 60 percent of its population vaccinated.

More than one-third of the country’s new cases are in people who have been fully vaccinated, according to the Health Ministry. It did not break down how many of them had received the Sinopharm shot and how many had received the other vaccine in use in the country, made by AstraZeneca. About 57 percent of fully vaccinated people in Seychelles got the Sinopharm shot.

China expected the Sinopharm vaccine to be the linchpin of its vaccine diplomacy program — an easily transported dose that would protect much of the developing world.

For the 56 countries counting on the Sinopharm shot to help them halt the pandemic, the news of the surge in Seychelles is a setback that suggests that the vaccine may be significantly less effective in widespread use than they hoped.

  • The European Union’s executive branch, the European Commission, recommended on Wednesday that the bloc’s 27 member states limit travel from India to reduce the spread of the B.1.617.2 coronavirus variant that is dominant there, after the World Health Organization described it as a “variant of concern.” The European Commission said member nations should continue to allow very limited travel from India to the bloc for essential reasons, such as family reunification, repatriation of E.U. nationals and their family members, or people seeking humanitarian assistance, but to submit those travelers to strict testing and quarantine protocols. E.U. member states have some leeway on who they allow into their territories, but the commission has played an important role in coordinating these policies throughout the pandemic.

Dr. Patrick Soon-Shiong pledged on Wednesday to donate more than $200 million to help transfer vaccine and therapy technology to South Africa.
Credit…Fred Prouser/Reuters

Dr. Patrick Soon-Shiong, the billionaire biotechnology entrepreneur who owns The Los Angeles Times, announced on Wednesday that his corporation and his philanthropic foundation would commit an initial 3 billion South African rand (about $210 million) to transfer the latest technology for producing vaccines and biological therapies to South Africa, where he was born.

Companies there, he said, could then use them to make a second generation of vaccines to address variants of the coronavirus that might make current vaccines less effective.

Dr. Soon-Shiong spoke at an international meeting on the equitable distribution of coronavirus vaccines, diagnostics and therapeutics that was co-chaired by the director-general of the World Health Organization.

Transferring the technology is as important as waiving intellectual property rights, Dr. Soon-Shiong said. “Our goal and our commitment is to come back to South Africa and transfer this kind of technology,” he said.

He added, “Not only do we have the science, we have the human capital and the capacity and the desire.”

Dr. Soon-Shiong said he hoped that the technology, including therapies and vaccines built on viral vectors, messenger RNA and adjuvants, would be used not only to meet the immediate coronavirus crisis, but also to address neglected diseases including schistosomiasis, a parasitic infection common in sub-Saharan Africa.

South Africa, which has had the most confirmed coronavirus cases on the continent, has two manufacturers, Biovac and Aspen Pharmacare, that are involved in producing coronavirus vaccines.

Correction: May 12, 2021

An earlier version of a picture caption with this article misstated the amount Dr. Patrick Soon-Shiong pledged to donate. It was 3 billion South African rand ($210 million), not $2 billion.

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