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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 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, 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.
| United States › | United StatesOn May 7 | 14-day change | |
|---|---|---|---|
| New cases | 47,608 | –27% | |
| New deaths | 812 | –3% | |
| World › | WorldOn May 7 | 14-day change | |
|---|---|---|---|
| New cases | 431,614 | –11% | |
| New deaths | 9,208 | –3% | |
U.S. vaccinations ›
Credit…Justin Hamel for The New York Times
Federal health officials on Friday updated public guidance about how the coronavirus spreads, emphasizing that transmission occurs by inhaling very fine respiratory droplets and aerosolized particles, as well as through contact with sprayed droplets or touching contaminated hands to one’s mouth, nose or eyes.
The Centers for Disease Control and Prevention now states explicitly — in large, bold lettering — that airborne virus can be inhaled even when one is more than six feet away from an infected individual. The new language, posted online, is a change from the agency’s previous position that most infections were acquired through “close contact, not airborne transmission.”
As the pandemic unfolded last year, infectious disease experts warned for months that both the C.D.C. and the World Health Organization were overlooking research that strongly suggested the coronavirus traveled aloft in small, airborne particles. Several scientists on Friday welcomed the agency’s scrapping of the term “close contact,” which they criticized as vague and said did not necessarily capture the nuances of aerosol transmission.
“C.D.C. has now caught up to the latest scientific evidence, and they’ve gotten rid of some old problematic terms and thinking about how transmission occurs,” said Linsey Marr, an aerosol expert at Virginia Tech.
The new focus underscores the need for the federal Occupational Safety and Health Administration to issue standards for employers to address potential hazards in the workplace, some experts said.
“They hadn’t talked much about aerosols and were more focused on droplets,” said David Michaels, an epidemiologist at George Washington School of Public Health and head of OSHA in the Obama administration.
He and other researchers expressed concern that the C.D.C. has not yet strengthened its recommendations on preventing exposure to aerosolized virus.
The new information has significant implications for indoor environments, and workplaces in particular, Dr. Michaels said. Virus-laden particles “maintain their airborne properties for hours, and they accumulate in a room that doesn’t have good ventilation.”
“There’s more exposure closer up,” Dr. Michaels said. “But when you’re further away, there’s still a risk, and also these particles stay in the air.”
Donald Milton, an aerosol scientist at the University of Maryland, agreed that federal officials should provide better guidelines for keeping workplaces safe.
“We need better focus on good respirators for people who have to be close to other people for long periods of time,” Dr. Milton said. “A surgical mask, even if it’s tucked in on the edges, is still not really going to give you enough protection if you’re in a meatpacking plant elbow to elbow all day long with other people.”
Health care workers, bus drivers and other workers may also require respirators, Dr. Michaels said. Customers in retail stores should continue to maintain distance from one another and to wear masks, he added; good ventilation is paramount in these settings.
Dr. Marr pointed out that one updated page on the C.D.C. website, entitled “How Covid-19 Spreads,” says that inhaling the virus when people are far apart is “uncommon.” The statement is “misleading and potentially harmful,” Dr. Marr said.
“If you’re in a poorly ventilated environment, virus is going to build up in the air, and everyone who’s in that room is going to be exposed.”
Credit…Karsten Moran for The New York Times
New coronavirus cases have fallen dramatically in New Jersey, where at times this spring the virus was spreading faster than anywhere else in the United States.
Over the last two weeks, the state has seen its average number of new daily drop by 61 percent, according to a New York Times database.
New Jersey’s case numbers are dropping along with the rest of the country’s. But the state’s decline is the steepest in the United States and its rate of new daily cases per person is now just above the national average.
“Clearly vaccinations are playing a role in this,” said Dr. Edward Lifshitz, medical director of the New Jersey Department of Health Communicable Disease Service, although he warned that while cases are declining, they are still higher than the number of infections in the state last summer. “It certainly is too early to declare victory,” he said.
Behind New Jersey is neighboring New York, with a 48 percent decline, and Michigan, which despite a similar drop still has the highest rate of new cases in the country. In Puerto Rico, cases are also down 61 percent.
The steady decline in New Jersey comes as the state prepares for a broad reopening on May 19, when it will lift almost all of its remaining virus restrictions, including most capacity limits.
“The good news is now becoming almost overwhelming, and that’s a good thing,” Gov. Philip D. Murphy said in public remarks on Thursday.
Mr. Murphy has cited the state’s rising vaccination rates as the cause of the reopening. As of Friday morning, more than 3.4 million New Jersey residents had been vaccinated, according to state health data.
Mr. Murphy has set a goal of fully vaccinating 4.7 million adult residents by the end of June.
As of Friday, 40 percent of the state’s adult population was fully vaccinated and 54 percent had received at least one dose, according to a New York Times database, outpacing the nation as a whole.
But as the demand for vaccines wanes, New Jersey has joined other states and cities in turning to an array of not-so-subtle incentives to get shots into the arms of more residents. Residents who get their first vaccine dose in May are eligible for a “shot and a beer” at participating breweries in the state.
Credit…Amanda Voisard/Reuters
Dr. Nancy Messonnier, who famously warned the nation early last year that the coronavirus would upend their lives, resigned from her position at the Centers for Disease Control and Prevention on Friday.
Dr. Messonnier’s resignation is effective May 14. She is taking on a new role as an executive director at the Skoll Foundation, a philanthropical organization based in Palo Alto, Calif., she told staff in an email on Friday.
Her exit may augur more changes at the agency. Reports have circulated for weeks that the C.D.C.’s new director, Dr. Rochelle Walensky, planned to completely reorganize the division Dr. Messonnier led.
“My family and I have determined that now is the best time for me to transition to a new phase of my career,” Dr. Messonnier wrote in the email to staff.
Dr. Messonnier began her career in public health in 1995 with a stint in the prestigious Epidemic Intelligence Service. She has since held a number of leadership posts in the C.D.C. Since 2016, she has served as director of the National Center for Immunization and Respiratory Diseases, the C.D.C. division responsible for managing influenza and other respiratory threats.
In late 2019, she became the agency’s lead in responding to the coronavirus, and initially shared a stage with President Trump at briefings about the coronavirus.
She fell out of favor with President Trump and sent stocks tumbling after she sounded a dire alarm about the coronavirus, saying it would disrupt the lives of every American.
“It’s not a question of if this will happen but when this will happen and how many people in this country will have severe illnesses,” she said on Feb. 25, just as Mr. Trump was boarding Air Force One in New Delhi for his flight home.
Soon after that, she stopped appearing at briefings of the White House and of the C.D.C.
Credit…Noah Berger/Associated Press
Pfizer and the German company BioNTech have become the first companies to apply to the U.S. Food and Drug Administration for full approval of their Covid-19 vaccine for use in people 16 and older. The vaccine is currently being administered to adults in America under an emergency use authorization granted in December.
The approval process is likely to take months.
The companies said in a statement on Friday that they had submitted their clinical data, which includes six months of information on the vaccine’s safety and efficacy, to the F.D.A. They plan to submit additional material, including information about the manufacturing of the vaccine, in the coming weeks.
“We are proud of the tremendous progress we’ve made since December in delivering vaccines to millions of Americans, in collaboration with the U.S. government,” Dr. Albert Bourla, Pfizer’s chief executive, said in the statement. “We look forward to working with the F.D.A. to complete this rolling submission and support their review, with the goal of securing full regulatory approval of the vaccine in the coming months.”
As of Thursday, more than 134 million doses of the vaccine had been administered in the United States, according to the Centers for Disease Control and Prevention. Full approval would allow Pfizer and BioNTech to market the vaccine directly to customers.
It could also make it easier for companies, government agencies and schools to require vaccinations. The Equal Employment Opportunity Commission said in December that employers could mandate vaccination, and legal experts have generally agreed.
Many companies have been hesitant to require the vaccines, especially while they have only emergency authorization, which is designed to be temporary. Some institutions, like the University of California and California State University systems, have said that they would do so only after a vaccine has full approval.
Full approval could also prompt the U.S. military, which has had low uptake of Covid-19 vaccines, to mandate vaccinations for service members.
If the F.D.A. grants full approval, it could also help raise confidence in the vaccine. The pace of vaccination has slowed in the United States in recent weeks, and a recent national survey indicated that most people in the country who planned to get the shots had already done so.
The agency is also expected to issue an emergency authorization for use of the Pfizer-BioNTech vaccine in 12- to 15-year-olds next week. The companies have said that they plan to file for emergency authorization for 2- to 11-year-olds in September.
Moderna plans to apply for full approval for its Covid-19 vaccine this month, the company said during its quarterly earnings call on Thursday.
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BERLIN — Germany appears to have entered a new, more hopeful phase of recovery after months of struggling against a tough third wave of the coronavirus.
“We appear to have broken the third wave,” the country’s health minister, Jans Spahn, told reporters on Friday, while warning Germans not to get too excited too quickly, even with the prospect of eased restrictions in sight. “Now it’s a matter of sticking it out together over the next few weeks.”
Daily rates of new infections have been dropping steadily since April 21, and the country’s vaccine numbers have risen quickly over the past months. On April 28 alone, the country administered more than one million shots. Today, more than 30 percent of the population has received an initial injection.
German health officials announced on Thursday that anyone willing to receive the vaccine developed by the University of Oxford and AstraZeneca could get one, even though the country has been limiting the shot’s use over concerns about rare but dangerous blood clots. In announcing the change, Mr. Spahn did not make a scientific argument, though anyone under 60 who takes the shot will have to discuss the risks with a doctor. Instead, he emphasized the need for flexibility and getting more people vaccinated.
The new stance on AstraZeneca came as lawmakers were rushing a bill through Parliament that would lift restrictions aimed at preventing the spread of the coronavirus — from limits on the number of people who could meet up to required proof of a negative rapid tests to shop or enforced quarantines after travel abroad — for anyone who is fully vaccinated.
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As American companies prepare to bring large numbers of workers back to the office in the coming months, executives are weighing whether they should require employees to get vaccinated before returning to work.
For the country’s largest companies, mandatory vaccinations would protect service workers and lower the anxiety for returning office employees. That includes those who have been vaccinated but may be reluctant to return without knowing whether their colleagues have as well. And there is a public service element: The goal of U.S. 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.
In polls, executives show a willingness to require vaccinations. In a 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.”
Credit…Caleb Alvarado for The New York Times
Few states collect sexual orientation or gender identity data, so no one knows how many L.G.B.T.Q. people are getting vaccinated in the United States.
Advocates and health experts are concerned that the nation’s estimated 11.3 million L.G.B.T.Q. adults will be unseen in a vaccine rollout for which data has revealed searing inequities across racial and socio-economic lines. L.G.B.T.Q. people could face similar problems but may be overlooked because they aren’t counted.
The collection of this data would increase the visibility of vaccine disparities, advocates say, and allow policymakers and health care providers to more equitably allocate resources and craft messaging for these communities. Of more than 100 federal surveys in one study, only 11 collect some sexual orientation and gender identity data.
But some have expressed concerns about the collection of such information and question whether it’s necessary.
Many L.G.B.T.Q. Americans face discrimination by health care providers, from being denied care to being verbally harassed. In some states, such as Arkansas, doctors will be able to legally withhold medically necessary treatment from L.G.B.T.Q. patients.
In spite of the paucity of data, the Centers for Disease Control and Prevention notes that L.G.B.T.Q. people may be more likely to suffer severe Covid-19 outcomes than heterosexual people, in part because of a higher prevalence of pre-existing conditions. Not knowing how many of these people have received a Covid-19 vaccine is a problem, advocates say.
A February study showed that L.G.B.T.Q. people with high medical mistrust and concern about experiencing stigma or discrimination were least likely to say they would accept a Covid-19 vaccine.
Transparency in how that data would be used, experts say, would also be important in helping this population to report this information at vaccination sites.
Credit…California Department of Alcoholic Beverage Control, via Associated Press
A California bar owner was arrested this week on charges that he had sold fake Covid-19 vaccination cards at his business, prosecutors said.
The owner, Todd Anderson, 59, of Acampo, Calif., was arrested on Tuesday and charged with identity theft, forging government documents, falsifying medical records and having a loaded unregistered handgun, Tori Verber Salazar, the San Joaquin County district attorney, said in a statement this week.
Agents from the California Department of Alcoholic Beverage Control began their investigation into Mr. Anderson after they received a complaint stating that fake cards were being sold at his business, the Old Corner Saloon in Clements, Calif., which is about 40 miles southeast of Sacramento.
In April, undercover agents were able to buy fraudulent cards four times, the Department of Alcoholic Beverage Control said.
The cards were sold for $20 each, according to the district attorney’s office.
Fake vaccination record cards have become a growing problem during the pandemic, according to the authorities. Vaccination cards provide proof that someone has been inoculated against Covid-19 in the United States.
Credit…Bee Trofort for The New York Times
During a news conference on Friday, Atlanta Mayor Keisha Lance Bottoms fought back tears as she spoke about her decision not to run for a second term. Ms. Bottoms, once considered a potential running mate for President Biden, claimed she wasn’t worried about re-election, expressing that she maintained a level of popularity high enough to avoid a runoff. However, Atlanta has experienced what Ms. Bottoms has described as the “Covid crime wave.”
Atlanta, like many American cities during the pandemic, has experienced a spike in violent crime — homicides are up 58 percent over last year. Researchers attribute the rise in these crimes to the strain on many at-risk populations as well as institutions like police departments and courts.
The dynamic is already rippling through other cities, including San Francisco, St. Louis and Philadelphia.
Credit…Rebecca Conway/Getty Images
India’s worsening coronavirus outbreak has spread far outside its cities to rural areas with poor health care infrastructure and limited testing capacities, doctors and experts say.
One factor behind the surge of cases, they believe, is a series of recent campaign rallies held without social distancing.
The state of West Bengal, where Prime Minister Narendra Modi’s party lost an election last week after more than a month of campaigning to vast crowds, is recording the highest rate of positive coronavirus tests in the country. More than 31 percent of tests in the state are now coming back positive.
“There is a clear pattern here: States that went through elections and where large rallies were held are witnessing a huge rise in cases,” said Dr. Thekkekara Jacob John, a senior virologist in the southern state of Tamil Nadu.
In Uttar Pradesh, India’s most populous state, 1,028 new coronavirus cases and four deaths were recorded on March 26. On April 29, after campaigns for local village council elections were held, there were 35,104 cases and 288 deaths. A teachers’ union in the state said that 577 teachers and support staff members who were on duty as election workers had died of Covid-19.
The country’s cases as a whole have been skyrocketing since late March, from a seven-day average of more than 62,000 on March 31 to more than 385,000, according to the Our World in Data project at the University of Oxford. On Friday, the country reported more than 410,000 new daily infections, a record, and more than 3,900 deaths.
As the outbreak reaches new heights, India’s vaccination campaign has slowed down, marred by supply shortages and competition among states.
The official daily death in the country has stayed over 3,000 over the past 10 days, and experts say the numbers are much higher.
The true scope of the outbreak remains hard to measure. Nationwide, India conducted about 1.9 million coronavirus tests on Thursday, an increase from about 1.2 million daily tests last month, but hardly enough to keep up with a daily caseload that has almost quadrupled in that time.
West Bengal, a state of 90 million people that has poor health care infrastructure and is under a partial lockdown, has carried out fewer than 60,000 coronavirus tests a day. That is one of the lowest rates in the country, according to data compiled by researchers at the University of Michigan.
Dr. Abhijeet Barua, a physician in Kolkata, the state’s capital, said that cases had exploded in every corner of the city and that infections were spreading quickly in the state’s rural areas. At his 10-bed clinic, two people have died every day over the past 15 days, Dr. Barua said.
“What is making things worse in Kolkata is that over 70 percent of the population lives in close contact,” he said, adding that he was receiving dozens of calls a day from patients seeking help. “You can’t isolate yourself, because it is so congested here.”
Mr. Modi has repeatedly refrained from imposing a nationwide lockdown. Instead nearly a dozen of India’s 28 states have imposed restrictions, though they are less stringent than the nationwide lockdown put in place last year.
Credit…Etienne Laurent/EPA, via Shutterstock
A series of vaccine developments and the loosening of restrictions amid an improving virus trajectory may foreshadow a welcome return to normalcy for many young Americans, just as summer vacation nears.
By early next week, the Food and Drug Administration is expected to issue an emergency use authorization allowing the Pfizer-BioNTech coronavirus vaccine to be used in children 12 to 15 years old, a major step ahead in the United States’ efforts to tackle Covid-19. Pfizer also expects to seek federal clearance in September to administer the vaccine to children age 2 to 11, the company said on Tuesday.
Vaccinating children is key to raising the level of immunity in the population, experts say, and to bringing down the numbers of hospitalizations and deaths. It could also put school administrators, teachers and parents at ease if millions of adolescent students become eligible for vaccination before the next academic year begins.
The move would be a major leap forward, experts say, and comes as the director of the Centers for Disease Control and Prevention, Dr. Rochelle Walensky, said that vaccinated adolescents would be able to remove their masks outdoors at summer camps.
Yet the eagerness of parents to let their children be vaccinated is limited, according to a new national poll, which found that three in 10 parents surveyed said they would get their children vaccinated right away and 26 percent said they wanted to wait to see how the vaccine was working. About 23 percent said they would definitely not get their children vaccinated, and 18 percent said they would do so only if a child’s school required it. The survey also noted that only 9 percent of respondents said they had not yet gotten a shot but still intended to do so, one more indication that achieving widespread immunity in the United States is becoming increasingly challenging.
As health experts focus on the future of vaccinating children, a growing number of students have returned to in-person learning this school year. In March, 54 percent of K-8 schools were open for full-time in-person learning, and 88 percent were open for either full-time in-person and/or hybrid learning, according to data from a federal government survey released on Thursday. But Black, Hispanic and Asian students are enrolled in full-time in-person learning at much lower rates than white students.
The Biden administration has made an aggressive push for reopening schools in recent months, including an effort to prioritize vaccinations for teachers and employees.
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U.K. Says Under-40s Should be Offered Alternative to AstraZeneca Vaccine
Britain’s vaccine regulator advised that all adults under 40 should be offered an alternative Covid-19 vaccine, due to concerns over very rare blood clots that were possibly linked to the usage of AstraZeneca’s vaccine. There is also an availability of alternatives.
Building on our previous advice related to those age 30 years and under, we now advise that unvaccinated adults age 30 to 39 years, who do not have an underlying health condition that puts them at higher risk of severe Covid-19, should be preferentially offered an alternative to the AstraZeneca vaccine where this is possible. And only when no substantial delay in access to vaccination. This updated advice is specific to the current U.K. context. It is conditional on the following factors remaining favorable. That is to say, there continues to be good control of Covid-19 infection in the U.K. There is good availability of alternatives to the AstraZeneca vaccine, and there is strong vaccine rollout.
Britain’s vaccine regulator advised that all adults under 40 should be offered an alternative Covid-19 vaccine, due to concerns over very rare blood clots that were possibly linked to the usage of AstraZeneca’s vaccine. There is also an availability of alternatives.CreditCredit…Oli Scarff/Agence France-Presse — Getty Images
Britain’s vaccines regulator advised on Friday that all adults under 40 in the country should be offered alternatives to AstraZeneca’s Covid-19 vaccine. It factored in concerns over very rare blood clots, the dwindling risk of severe coronavirus infection in younger adults and the availability of alternatives.
The guidance extends earlier advice that people under 30 would be offered alternative doses.
The use of the AstraZeneca vaccine has been marred by uncertainty after reports of a possible link between the doses and very rare blood clots, but public health experts around the world say that the vaccine’s benefits far outweigh the risks for most people.
Britain’s Joint Committee on Vaccination and Immunization stressed that the chances of younger people becoming seriously ill with the coronavirus had grown smaller as infection rates decrease across the country. It said that this new reality paired with the availability of alternative vaccines had factored into the decision.
The government on Friday announced that travelers from 12 countries and territories will have restrictions eased starting on May 17. Travelers visiting these countries, including Portugal, Israel and Australia, will not need to isolate once they arrive in Britain, but they will need to take a Covid test before and after their trip.
In other news from around the world:
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Japan on Friday extended a state of emergency in Tokyo and other regions until the end of May to contain a surge of coronavirus cases, casting further doubt on the country’s ability to safely host the Summer Olympics, which are scheduled to begin in 11 weeks. The government said that the measures were necessary because infections remain at a “high level, mainly in large cities.”
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Australia will resume repatriation flights for Australian nationals in India after May 15, Prime Minister Scott Morrison said on Friday. The resumption will end a travel ban that made it a criminal offense for citizens and residents of Australia to enter the country from India. No other democratic nation has issued a similar ban on all arrivals.
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Tunisia will enter a weeklong nationwide lockdown starting on Sunday, Prime Minister Hichem Mechichi said on Friday. The country of nearly 12 million people has reported 11,122 deaths and 315,000 cases, according a New York Times database.