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WASHINGTON — When a commercial plane carrying 2.5 million doses of Moderna’s coronavirus vaccine took off on Wednesday from Dallas for Islamabad, Pakistan, federal officials had just finished a dizzying bureaucratic back-and-forth to get them there.
The United States had arranged a donation agreement with Moderna and Covax, the year-old vaccine-sharing initiative. Covax had previously worked out indemnity agreements with Moderna, which shield the company from liability for potential harm from the vaccine. U.S. Embassy officials in Islamabad had worked with regulators there to evaluate the Food and Drug Administration’s review of the vaccine; Pakistani regulators had to pore over reams of materials on the vaccine lots and the factory where they were made before authorizing the vaccine for use.
The result was a so-called tripartite agreement: a type of deal that has increasingly come to consume the Biden administration’s pandemic response efforts.
Amid criticism from some public health experts that President Biden’s vaccine diplomacy efforts have been slow and insufficient, the White House plans to announce on Thursday that it has fulfilled the president’s pledge to share an initial 80 million doses by June 30.
More than 80 million have been formally offered to about 50 countries, the African Union and the 20-nation Caribbean consortium, with around half already shipped and the rest to be scheduled in the coming weeks, said Natalie Quillian, the Biden administration’s deputy Covid-19 response coordinator.
Researchers have estimated that 11 billion doses of Covid vaccines are needed worldwide to try to stamp out the pandemic. To date, more than three billion vaccine doses have been administered worldwide, equal to 40 doses for every 100 people. Some countries have yet to report a single dose, even as the highly contagious Delta variant spreads around the world, further exposing vaccine inequities.
“If this is the pace at which it will continue, then unfortunately, it’s much slower than what is needed,” Dr. Saad B. Omer, the director of the Yale Institute for Global Health, said of the U.S. effort.
Credit…Tatan Syuflana/Associated Press
The nightmare is returning.
In Indonesia, grave diggers are working into the night, as oxygen and vaccines are in short supply. In Europe, countries are slamming their doors shut once again, with quarantines and travel bans. In Bangladesh, urban garment workers fleeing an impending lockdown are almost assuredly seeding another coronavirus surge in their impoverished home villages.
And in countries like South Korea and Israel that seemed to have largely vanquished the virus, new clusters of disease have proliferated. Chinese health officials announced on Monday that they would build a giant quarantine center with up to 5,000 rooms to hold international travelers. Australia has ordered millions to stay at home.
A year and a half since it began racing across the globe with exponential efficiency, the pandemic is on the rise again in vast stretches of the world, driven largely by the new variants, particularly the highly contagious Delta variant first identified in India. From Africa to Asia, countries are suffering from record Covid-19 caseloads and deaths, even as wealthier nations with high vaccination rates have let their guard down, dispensing with mask mandates and reveling in life edging back toward normalcy.
Scientists believe the Delta variant may be twice as transmissible as the original coronavirus, and its potential to infect some partially vaccinated people has alarmed public health officials. Unvaccinated populations, whether in India or Indiana, may serve as incubators of new variants that could evolve in surprising and dangerous ways, with Delta giving rise to what Indian researchers are calling Delta Plus. There are also the Gamma and Lambda variants.
“We’re in a race against the spread of the virus variants,” said Professor Kim Woo-joo, an infectious disease specialist at Korea University Guro Hospital in Seoul.
Credit…Ivan Valencia/Associated Press
BUENOS AIRES — Latin America and the Caribbean continue to be hammered by increasing numbers of Covid-19 infections and deaths, highlighting the stark global inequalities in access to vaccines, officials from the World Health Organization warned on Wednesday.
At a time “when we are seeing some reprieve from the virus in countries in the Northern Hemisphere,” Carissa Etienne, the director of the W.H.O.’s Pan American Health Organization, said at a news conference that for most countries in the Southern Hemisphere, “the end remains a distant future.”
“Despite this worrisome picture, just one in 10 people in Latin America and the Caribbean have been fully vaccinated against Covid-19,” she added, calling it an “unacceptable situation.”
“Access to Covid-19 vaccines shouldn’t be a privilege for a few but a right we all share,” Dr. Etienne said.
Economic inequality, the huge informal economy and the difficulty of implementing public health measures in Latin America and the Caribbean have all been major obstacles to containing the coronavirus there, said Ciro Ugarte, the director of health emergencies at Dr. Etienne’s organization.
New cases continue to increase in many countries in Central America, including Panama and Guatemala; the Caribbean, including Cuba and the Dominican Republic; and South America, including Colombia and Brazil.
Brazil recently surpassed 500,000 official Covid-19 deaths, the world’s second-highest known total behind the United States. About 1 in every 400 Brazilians has died from the virus, but many experts believe the true death toll may be higher. Home to just over 2.7 percent of the world’s population, Brazil accounts for roughly 13 percent of recorded fatalities, and the situation there is not easing.
This time of year countries in the region also have to prepare for conditions that could further exacerbate the spike in cases: the hurricane season and the flu season farther south, both of which come as social distancing measures have been relaxed.
Variants of the virus have been detected across the Americas, with 14 countries detecting cases of the more-transmissible Delta variant, a fact that adds to the urgency to vaccinate as many people as quickly as possible, said Dr. Etienne. She said inoculation could be ramped up in part through donations from developed countries.
Although there is not yet solid data on how all of the vaccines hold up against Delta, research suggests that full vaccination with several widely used shots, including those made by Pfizer-BioNTech and AstraZeneca, appear to retain considerable effectiveness against the variant.
Eighty-five percent of shots administered worldwide have been in high- and upper-middle-income countries, according to the Our World in Data project at the University of Oxford. Only 0.3 percent of doses have been administered in low-income countries.
Less wealthy countries are relying on a vaccine-sharing arrangement called Covax, which aims to provide two billion doses by the end of the year.
On Wednesday, Jen Psaki, the White House press secretary, said the United States was sending 2.5 million doses of the Johnson & Johnson vaccine to Colombia as part of President Biden’s pledge to dispatch vaccines to countries desperate for them.
For now, the Delta variant remains largely tied to travelers in Latin America and the Caribbean and “community transmission has been limited,” said Jairo Méndez, a regional adviser for viral diseases at the Pan American Health Organization.
The connection between travelers and the increase in infections from variants led the organization to call on governments with high rates of variants to limit travel from their countries, or even to close their borders entirely.
“Now may not be the ideal time for travel, especially in places with active outbreaks or where hospital capacity may be limited,” Dr. Etienne said.
Dan Levin contributed reporting.
Credit…Saul Martinez for The New York Times
A new poll has found that Americans are sharply divided by household over vaccination status, with 77 percent of vaccinated adults saying everyone in their household is vaccinated and a similar share (75 percent) of unvaccinated adults saying no one they live with is vaccinated.
Sixty-seven percent of Democrats reported living in households where everyone had been vaccinated, compared to 39 percent of Republicans. Ten percent of Democrats said they lived in homes where no one had been vaccinated, compared to 37 percent of Republicans, according to the poll by the Kaiser Family Foundation, which has been tracking the public’s attitudes and experiences with vaccinations.
Overall, half of adults live in a fully vaccinated household and one in four lives in a completely unvaccinated household. The remainder, about one in five adults, lives in a household occupied by both vaccinated and unvaccinated people, including children under 12 who are not currently eligible to receive a vaccine.
The main landline and cellphone survey of 1,888 adults 18 and older living in the United States was conducted from June 8 to June 21 and had a margin of error of plus or minus 3 percentage points.
As virus cases fall across much of the country, the poll found that optimism over the idea that the pandemic may be ending could hamper vaccination efforts, with half of unvaccinated adults polled saying that the number of cases is now so low there is no need for more people to be vaccinated.
If adult vaccinations continue their current seven-day average rate, about 67 percent of adults in this country will have received at least one shot by July 4, just shy of President Biden’s target of having 70 percent of adults at least partly vaccinated by that date, according to a New York Times analysis.
As policymakers continue to experiment with lotteries, free beers and other incentives, the poll found that workers were more likely to get the shot when their employers encouraged them to and provided paid time off to make it easier. Two-thirds of the employed adults surveyed said their employer had encouraged workers to get vaccinated and half said their employer had provided them paid time off to get the vaccine or to recover from side effects.
The workers who said their employer had taken either one of those steps were more likely to report having been vaccinated, even after the poll controlled for other demographic variables. The finding suggested that more employers’ encouraging vaccination and offering paid time off could lead to higher vaccination rates among workers.
Lazaro Gamio contributed reporting.
Credit…Allison Zaucha for The New York Times
The director of the Centers for Disease Control and Prevention on Wednesday stood by advice that people fully vaccinated against the coronavirus do not need to wear masks in most situations, but added that there are instances where local authorities might impose more stringent measures to protect the unvaccinated.
The comments came after the World Health Organization recently reiterated longstanding guidance that everyone, vaccinated or not, wear masks and take other precautions, following a global surge in infections of the highly contagious Delta variant. On Monday, Los Angeles County recommended that even fully vaccinated people wear masks indoors.
In May, the C.D.C. advised that fully vaccinated Americans could forgo masks in most settings. The agency’s director, Dr. Rochelle P. Walensky, said during multiple television appearances on Wednesday that local changes to masking and distancing rules were consistent with those guidelines.
“We have always said that this virus is an opportunist, and in areas where we still have rates of low vaccination, that is where the virus is likely to take hold,” she said on “Good Morning America.” “We are still seeing uptick of cases in areas of low vaccination, and in that situation we are suggesting that policies be made at the local level.”
Dr. Walensky added that the W.H.O.’s blanket suggestion that both vaccinated and unvaccinated individuals wear masks was informed by its global purview. “The W.H.O. really does have to make recommendations for an entire world,” and many countries have far less access to vaccines than the United States, she said.
The Delta variant now accounts for about one in every four infections in the United States, according to new estimates this week from the C.D.C. But cases across the country have plummeted in recent months, along with hospitalizations and deaths.
Still, the average rate of U.S. vaccinations a day has decreased by about 75 percent from the peak reported in mid-April. As of Tuesday, about 46 percent of people of all ages and about 57 percent of adults are fully vaccinated, according to federal data.
Vaccines consistently protect people from the variants circulating in the United States, including the Delta variant, Dr. Walensky noted on NBC’s “Today” show on Wednesday. But “local policymakers need to make policies for their local environment,” she said, especially in parts of the country with low rates of vaccination.
“Those masking policies are not to protect the vaccinated — they are to protect the unvaccinated,” she added, noting that “everybody should consider their own situation if they would feel more comfortable wearing a mask.”
In Los Angeles County, where half of the population is fully vaccinated, health officials recommended that everyone wear masks indoors because of an uptick in cases and an increase in infections with the Delta variant. Officials in other large cities, like New York and Chicago, indicated earlier this week that they did not plan to change their guidance on masks.
On Tuesday, Dr. Anthony S. Fauci, the government’s top infectious disease expert, said on CNN that he was particularly concerned about the Delta variant causing outbreaks in states, cities and counties with low vaccination rates.
“It’s almost like it’s going to be two Americas,” he said, noting that areas where relatively fewer people are fully vaccinated — as is the case in many parts of the South — are far more at risk than regions with high inoculation rates.
“If you are vaccinated, you diminish dramatically your risk of getting infected and even more dramatically your risk of getting seriously ill,” Dr. Fauci said. “If you are not vaccinated, you are at considerable risk.”
Dr. Vivek Murthy, the United States surgeon general, said on CNN on Wednesday morning that he saw nothing wrong with local authorities imposing new restrictions if they seemed necessary.
“If I was in a community that had a low vaccination rate, as a number of our communities do around the country, if I was seeing a rise in the Delta variant, I think it’s perfectly reasonable to think about different approaches we could take to limit spread to try to get ahead of it,” Dr. Murthy said.
Credit…Geoffroy Van Der Hasselt/Agence France-Presse — Getty Images
France on Wednesday ended most capacity restrictions in restaurants, movie theaters and other public venues, but authorities warned that the spread of the Delta variant of the coronavirus could jeopardize the country’s progress if vaccination rates slowed.
In the last step of a reopening that began in May, limits on inside gatherings that prevented establishments like cafés or gyms from filling up were lifted everywhere in the country, except in the southwestern Landes region, where the Delta variant was first detected and where local authorities said the restrictions would last for at least one more week.
France’s Covid hospitalizations have dropped steeply, and the number of daily cases has been steadily decreasing over the past months. Over half of the population has received a first dose of a Covid vaccine.
But the share of new infections attributed to the Delta variant doubled from 10 to 20 percent this week, and Jean-François Delfraissy, the head of the government’s scientific council, warned that a fourth wave of the epidemic over the summer was likely if the pace of vaccinations didn’t pick up.
“I think that we are going to have a fourth wave, but it is going to be a lot more nuanced than the first three, because the vaccination level is not at all the same,” Mr. Delfraissy told France Inter radio.
Olivier Véran, the French health minister, expressed satisfaction on Wednesday that the number of vaccination appointments had started picking up again after a decline, but he urged the French not to let up because of the “threat of the Delta variant.”
“Let’s continue, let’s accelerate,” Mr. Véran said on Twitter. The French government is also considering making it mandatory for health workers to get vaccinated.
In other virus news from around the world:
President Vladimir V. Putin urged Russians to get vaccinated against Covid on Wednesday — his most extensive comments on the matter yet — as his country scrambles to contain a vicious new wave of the illness.
The coronavirus has reversed a steady rise in life expectancy in Brazil, with an estimated decline of 1.3 years in 2020 and an even more accelerated drop during the first months of 2021, according to a report published in the journal Nature Medicine.
North Korea’s leader, Kim Jong-un, said that lapses in his country’s anti-pandemic campaign have caused a “great crisis” that threatened “grave consequences,” state media reported on Wednesday.
Seoul’s mayor, Oh Se-hoon, announced Wednesday that the city would extend current social distancing regulations for the capital and its surrounding areas for a week, reversing an earlier decision to ease restrictions starting Thursday.
A rift has emerged between Australia’s federal government, state leaders and medical groups over vaccination advice, with several officials issuing public objections to Prime Minister Scott Morrison’s decision to make the AstraZeneca vaccine available to those under 40.
Credit…Desiree Rios for The New York Times
The World Health Organization wants everybody to wear masks, but according to the U.S. Centers for Disease Control and Prevention, vaccinated people often don’t need to wear them.
So which do we listen to?
Virus experts and epidemiologists also offer mixed advice, but largely agree on one point: Whether a fully vaccinated person needs to wear a mask really depends on the circumstances and what’s happening in your community.
The reaffirmed push to ask vaccinated people to mask up has sown confusion. Here are some answers.
Why is the W.H.O. telling vaccinated people to wear masks?
Mask mandates are largely intended to protect the unvaccinated — people who are vaccinated are already well protected by vaccines, and breakthrough infections are still very rare. But since you can’t tell who is vaccinated and who is not, advising everyone to wear a mask can help stop the spread of the virus.
Linsey Marr, a professor at Virginia Tech and one of the world’s leading experts on viral transmission, said her advice to a fully vaccinated friend about mask wearing would be to follow local rules and to take extra precautions in certain situations, like a very crowded indoor setting or an airplane.
What’s my risk of getting Covid-19 after I’m fully vaccinated?
Although the Covid vaccines are highly effective, no vaccine offers 100 percent protection. While breakthrough infections happen, they are extremely rare, and in most cases, they cause only mild illness.
But because the risk isn’t zero, some health experts still advise that vaccinated people take reasonable precautions, like wearing a mask in crowded spaces.
And people who live in areas with low vaccination rates may also want to consider wearing masks in public because of the potentially higher number of unvaccinated people they might encounter.
Those suggestions could change with time, Dr. Marr said.
“I know everyone wants this to be over or wants a one-size-fits-all rule, but we need to get used to things changing as the virus changes, vaccines roll out, public health responses in different countries shift, and scientists learn more,” she said. “The 1918 flu pandemic lasted two years.”
Credit…Atul Loke for The New York Times
The Delta variant of the coronavirus now accounts for about one in every four infections in the United States, according to new estimates this week from the Centers for Disease Control and Prevention.
First identified in India, Delta is one of several “variants of concern,” as designated by the C.D.C. and the World Health Organization. It has spread rapidly through India and Britain and poses a particular threat in places where vaccination rates remain low.
Here are answers to some common questions.
Does the Delta variant cause different symptoms?
It’s not clear yet. “We’re hurting for good data,” said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
But some evidence of a potential shift is emerging in Britain, where Delta has become the dominant variant.
“What we’ve noticed is the last month, we’re seeing different sets of symptoms than we were seeing in January,” said Tim Spector, a genetic epidemiologist at King’s College London, who leads the Covid Symptom Study, which asks people with the disease to report their symptoms in an app.
Headaches, a sore throat, and a runny nose are now among those mentioned most frequently, Dr. Spector said, with fever, cough and loss of smell less common.
These findings, however, have not yet been published in a scientific journal, and some scientists remain unconvinced that the symptom profile has truly changed. The severity of Covid, regardless of the variant, can vary wildly from one person to another.
If I’m vaccinated, do I need to worry?
Although there is not yet good data on how all of the vaccines hold up against Delta, several widely used shots, including those made by Pfizer, Moderna and AstraZeneca, appear to retain most of their effectiveness against the Delta variant, research suggests.
“If you’re fully vaccinated, I would largely not worry about it,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health.
Pockets of unvaccinated people, however, may be vulnerable to outbreaks in the coming months, scientists said.
“When you have such a low level of vaccination superimposed upon a variant that has a high degree of efficiency of spread, what you are going to see among under-vaccinated regions, be that states, cities or counties, you’re going to see these individual types of blips,” Dr. Anthony Fauci, the nation’s leading infectious disease expert, said on CNN on Tuesday. “It’s almost like it’s going to be two Americas.”
The German company CureVac announced on Wednesday the final results of its late-stage vaccine trial, confirming earlier data showing that its shot is far less protective than other vaccines.
Overall, the CureVac vaccine had an efficacy of just 48 percent against Covid-19. The Moderna and Pfizer-BioNTech vaccines, which use the same mRNA technology as CureVac’s, delivered efficacy rates around 95 percent in clinical trials.
CureVac’s vaccine proved somewhat better for younger volunteers: For those between the ages of 18 and 60, the efficacy rose to 53 percent. In that group, the researchers also found the vaccine provided 100 percent protection against hospitalization and death.
Forty thousand people participated in the company’s trial in Europe and Latin America. By the end of the study, 288 volunteers had gotten Covid-19.
CureVac had to contend with 15 different variants of the coronavirus. Genetic testing showed that only 3 percent of the cases were caused by the original version of the coronavirus. It’s possible that some of the variants were able to evade the immunity provoked by the CureVac vaccine. (No variants had become widespread in 2020 when Moderna and Pfizer-BioNTech ran their trials.)
But vaccine experts have also questioned whether part of CureVac’s problem was with the design of the vaccine itself. The precise recipe that CureVac used to build its vaccine may have blunted its effectiveness.
The European Medicines Agency opened a rolling review of CureVac’s vaccine in February, and the company said it would continue its submission with these data. The vaccine “will be an important contribution to help manage the Covid-19 pandemic and the dynamic variant spread,” Franz-Werner Haas, the chief executive of CureVac, said in the announcement.
Credit…Brandon Thibodeaux for The New York Times
A grand jury in Texas declined on Wednesday to indict a Houston doctor who was accused earlier this year of stealing 10 doses of Covid-19 vaccine — worth a total of $135 — and inoculating a few faint acquaintances and finally his wife in a late-night race in December to use the medicine before it expired.
The doctor, Hasan Gokal, received support for his actions from, among others, the Texas Medical Association and the Harris County Medical Society. But the Harris County district attorney, Kim Ogg, chose to present the case to a grand jury, even after a criminal court judge had dismissed the matter in January for lack of probable cause.
The allegation upended Dr. Gokal’s life. He was fired from his government job and his name ricocheted around the world. A news release from the district attorney’s office asserted that the doctor “stole the vial,” and, according to Ms. Ogg, had “abused his position to place his friends and family in line in front of people who had gone through the lawful process to be there.”
After a monthlong investigation by prosecutors and two days of testimony, a grand jury in Harris County disagreed.
Dr. Gokal expressed relief in a telephone call Wednesday afternoon. “For the first time in six months I’m going to be able to go to bed tonight and not wake up in the middle thinking about this,” he said.
His lawyer, Paul Doyle, said, “What a colossal waste of time.”
In late December, Dr. Gokal, 48, a veteran emergency room doctor then working for the Harris County Public Health Department, set up a vaccination event in the Houston suburb of Humble. Just as the event was about to close for the night, an eligible person showed up. A nurse punctured a new vial to administer the vaccine, which activated the six-hour time limit for its 10 remaining doses.
Dr. Gokal later said that he was determined to abide by his understanding that not a dose of the precious vaccine should be wasted. Colleagues at the event either declined or already had been vaccinated. So, as he drove home to a neighboring county, he called acquaintances to ask whether they knew of older people needing to be immunized.
Within a few frantic hours, he had vaccinated various people in need, most of them older or in fragile health, and unknown to him. As midnight approached, he had one last dose and no one to vaccinate, so he presented the situation to his wife, whose pulmonary sarcoidosis made her eligible — but she was hesitant.
“It makes perfect sense,” he later said he told her. “We don’t want any doses wasted, period.”
The next morning, Dr. Gokal submitted the documentation for the 10 people he had vaccinated with that last vial. Several days later, he was fired from his county job; he said he was told that he should have returned the doses to the office, which by then was closed, or thrown them away.
Soon after, the district attorney’s office issued its news release, with the headline “Fired Harris County Health Doctor Charged with Stealing Vial of Covid-19 Vaccine.”
On Wednesday afternoon, Dr. Gokal — who, since his firing, has been volunteering at a nonprofit health clinic for the uninsured — was busy answering congratulatory text messages and telephone calls. He said he was looking forward to a return to normality for his wife and three children.
Meanwhile, the district attorney’s office issued a statement that read in part: “We respect the decision of the grand jury in this and every case. Evidence, not public opinion, is the guiding principle of our work.”
Credit…Anna Watts for The New York Times
Helped along by an enormous infusion of federal pandemic aid, New York City officials agreed on Wednesday to adopt the city’s largest budget ever, a $98.7 billion spending plan that restores many of the service cuts prompted by the sudden economic downturn caused by the coronavirus.
The budget, which includes $14 billion in federal aid, represents a sharp reversal from last year when the city locked down its economy to control the outbreak, creating a major financial strain and forcing the city to reduce its spending.
But with the pandemic receding amid rising vaccination rates and the lifting of public health restrictions, the outlook for New York has grown brighter. Restaurants and bars are filling with patrons, and popular gathering spots like Times Square are showing glimmers of their prepandemic bustle.
Mayor Bill de Blasio has called his last spending plan a “recovery budget” that builds on the $8 billion the city has already spent to fight the pandemic. The city will spend $30 million to promote the return of tourism and hire 10,000 residents to form a cleaning corps across the city.
To address racial and economic disparities exposed by the pandemic and national protests over the killing of George Floyd, the city will deposit $100 into the accounts of all kindergartners as part of a “Baby Bonds” effort that could expand to $15 million in the next fiscal year.
The city will also invest $4 million to fund full scholarships for Black and low-income residents to the City University of New York and $6.5 million to quickly train 1,000 New Yorkers for jobs in high-demand fields.
To address a rise in shootings and homicides that have plagued the city since the pandemic, the city will spend $24 million to hire 1,000 people who are most at risk of participating in or being a victim of violence in various neighborhoods, including Brownsville, Brooklyn, South Jamaica, Queens, and Mott Haven in the Bronx.
The city also set aside $1 billion in a rainy-day fund to respond to any unexpected challenges, including another pandemic.
But some critics said the budget does not focus enough on creating jobs and instead invests money on starting programs that will require tax increases to maintain once the federal aid dries up.
Correction: June 30, 2021
Because of an editing error, an earlier headline on this article incorrectly described the status of the budget agreement. New York officials agreed on a budget deal, but they have not yet voted to pass it.