Administering Covishield, the Serum Institute version of the AstraZeneca vaccine, in Bengaluru, India.
Credit…Aijaz Rahi/Associated Press

As inoculations help a sense of normalcy return in the lives of many Americans, much of the world remains gripped by the pandemic, with little hope that a significant number of vaccine doses will be made available soon.

The effort to vaccinate enough of the world’s population to get the virus under control — already a huge struggle, experts said — was set back again this week after the Serum Institute of India, the world’s largest vaccine producer, signaled that it would not be able to export doses until the end of the year.

The Serum Institute’s manufacturing capacity is at the heart of Covax, a global effort to vaccinate the populations of low- and middle-income countries. The program is already more than 140 million doses behind schedule, and the Serum Institute announcement suggested that its goal of two billion doses by the end of the year would be all but impossible to meet.

Dr. Arthur Reingold, chief of the epidemiology division at the University of California, Berkeley, said that the delay was “not surprising, given the drastic situation” in India, which has been pummeled by the virus in recent weeks.

Faced with India’s devastating second wave of coronavirus infections, the institute has diverted all its manufacturing powers to domestic needs, falling behind on commitments to the Covax partnership as well as on bilateral commercial deals with many countries.

“It simply means that poor countries of the world, the low- and middle-income countries of the world,” Dr. Reingold said, “are going to have to wait longer to come anywhere close to the kind of vaccination coverage that we’ve achieved in some of the wealthier countries.”

More than 47 percent of people in the United States have received at least one dose of a Covid-19 vaccine, according to the Our World in Data project at Oxford University. In the United Kingdom, the figure is 54 percent, and in Germany, nearly 38 percent.

But only 10 percent of people in India have received a dose of the vaccine. Just over 1 percent of people in Honduras have received a shot, and less than 1 percent have been at least partially vaccinated in Somalia.

Experts have warned that — aside from the humanitarian aspect — the global inequity in vaccinations can affect wealthier countries that have vaccinated significant portions of their populations. If the virus is allowed to run rampant anywhere, it could allow the emergence of a new variant that may evade vaccines.

The United States was hit by its own setback on Wednesday, which could still have global implications, when the chief executive of Emergent BioSolutions, whose Baltimore plant ruined millions of coronavirus vaccine doses, revealed that more than 100 million doses of Johnson & Johnson’s vaccine were now on hold as regulators checked them for possible contamination.

The Johnson & Johnson vaccine has been viewed by public health officials as an important tool to vaccinate populations that are more difficult to reach, because it requires only one dose and does not need the special low-temperature storage required by the Moderna and Pfizer-BioNTech vaccines.

The rate of vaccinations in the United States has slowed considerably in recent weeks, though about 1.8 million doses are being administered to Americans each day on average, according to a New York Times database.

President Biden announced on Monday that the United States would send 20 million doses of the three vaccines abroad. The 100 million Johnson & Johnson doses under inspection could pad the American stockpile, or be sent to help meet the dire need abroad.

Still, Dr. Reingold said that it was “time well spent” to “very carefully look at those doses and ensure that they’re safe and effective.”

United States ›United StatesOn May 1914-day change
New cases28,935–35%
New deaths675–13%

World ›WorldOn May 1914-day change
New cases660,636–20%
New deaths13,647–5%

U.S. vaccinations ›

Where states are reporting vaccines given

The Marigold nursing home in Washington, D.C., in April. Researchers said that the use of vaccinations appeared to protect nursing home residents who did not get immunized.
Credit…Nate Palmer for The New York Times

Nursing home residents, considered among the most vulnerable to Covid-19, appear to receive significant protection from vaccination, according to research published on Wednesday in the New England Journal of Medicine.

In a letter to the editor, the researchers said that the use of vaccinations also appeared to protect nursing home residents who did not themselves get a shot. That finding suggests, researchers said, that unvaccinated residents benefit when others around them are immunized.

“These findings show the real-world effectiveness” of the Pfizer-BioNTech and Moderna vaccines “in a vulnerable nursing home population,” the researchers wrote.

The findings conform to recent guidance from the Centers for Disease Control and Prevention about the protective benefit of vaccination. The federal agency, in hoping to encourage widespread immunizations, has said that those who get inoculated face sharply reduced risk, but considerable risk remains for those who do not.

The nursing home population has been one of the hardest hit during the pandemic, with the virus spreading rapidly in close quarters among people with weakened immune systems. More than 132,000 U.S. nursing home residents have died during the pandemic, about one-third of all the country’s deaths from Covid-19.

The study published on Wednesday drew from more than 20,000 residents of 280 nursing homes in 21 states. Of those, almost 4,000 were unvaccinated and the rest received either the Pfizer or Moderna vaccines. About 70 percent had received two doses.

The study looked at residents of nursing homes that had received at least one dose as of Feb. 15 and anyone at the facilities present on the first day of their vaccination clinic who had not yet been vaccinated as of March 31.

After receiving a first dose, 4.5 percent of residents still contracted the virus, although most cases were asymptomatic, researchers wrote. Of those receiving the second dose, only 0.3 percent got the virus after 14 days.

The benefit carried over to those in the same nursing homes who did not get vaccinated. Their rate of infection dropped to 0.3 percent from 4.3 percent. For all groups, most infections were asymptomatic; and the rate of both symptomatic and asymptomatic infections decreased over time.

“Robust vaccine coverage among residents and staff, together with the continued use of face masks and other infection-control measures, is likely to afford protection for a small number of unvaccinated residents,” the researchers wrote.

Global Roundup

A healthcare worker prepared a vaccine dose at a vaccination site in Ulaanbaatar, Mongolia as the dose’s recipient watched, last week.
Credit…Khasar Sandag for The New York Times

At a time when most countries are scrambling for coronavirus vaccines, Mongolia already has enough to fully vaccinate more than half its citizens, in large part thanks to deals with both China and Russia.

Officials are so confident about the nation’s vaccine riches that they are promising citizens a “Covid-free summer.”

Mongolia’s success in procuring so many doses within months is a big victory for a low-income, developing nation. Many poor countries have been waiting in line for shots, hoping for the best. But Mongolia, using its status as a small geopolitical player between Russia and China, was able to snap up doses at a clip similar to that of much wealthier countries.

Mongolia has a population not much bigger than Chicago’s. The small democratic nation is used to living in the shadows of Russia and China, which often treat it as a geopolitical pawn.

But during a pandemic, being a small nation sandwiched between two vaccine makers with global ambitions can have advantages.

“It speaks to the Mongolian ability to play to the two great powers and maximize their benefits even while they are on this tightrope between these two countries,” said Theresa Fallon, director of the Center for Russia Europe Asia Studies in Brussels.

It is also a win for China and Russia, which have extensive resource interests in Mongolia and ambitions to appear to play a role in ending the pandemic, even when much of the world has expressed deep skepticism over their homegrown vaccines.

In other news from around the globe:

  • The Parliament of Ukraine named a new health minister, who promised to speed up vaccinations, including by trying to manufacture vaccine domestically, Reuters reported. Viktor Lyashko, previously a deputy health minister, was promoted on Thursday to replace Maksym Stepanov, who was fired this week after Prime Minister Denys Shmyhal accused him of failing to supply vaccines quickly enough.

  • The U.S. Food and Drug Administration has extended the period of time the Pfizer-BionNTech vaccine can be refrigerated. The agency now says undiluted and thawed vaccines can be stored for up to 30 days, rather than up to five, as before. The European Medicines Agency announced a similar recommendation earlier in the week.

  • Prince William, the second in line to the throne of Britain, said on Thursday that he had received his first dose of a Covid-19 vaccine. He shared a photo on social media of the injection at the Science Museum in London on Tuesday, thanking everyone involved in the country’s vaccination program. The prince is 38, part of an age group that became eligible to book inoculations last week. Queen Elizabeth II, his grandmother, was vaccinated in January and his father, Prince Charles, received a first dose in February.

  • The European Commission, the executive arm of the European Union, signed a contract for an additional 1.8 billion doses of BioNTech-Pfizer vaccine to be delivered between December 2021 and 2023, the commission’s president, Ursula von der Leyen, announced Thursday. The deal will allow member countries to buy 900 million doses, including booster shots to prolong immunity, as well as possible new vaccines targeting emerging variants of the coronavirus, with an option to purchase additional 900 million in coming years.

Anna Schaverien, Monika Pronczuk and Kaly Soto contributed reporting.

Joefred and Ralfred Gregory, 24, often wore matching clothes on big occasions.
Credit…via Gregory Raymond Raphael

NEW DELHI — Joefred and Ralfred Gregory moved through life as one.

They went to the same college. They studied the same thing. They wore matching clothes. They trimmed their beards the exact same way.

Identical twins, they were two handsome young men in northern India who above all else really loved each other. And when they both were struck by Covid-19 last month and hospitalized, it was like they shared one sick body.

Hours after Joefred died, Ralfred’s mother told him that his brother was still alive, to keep his spirits up.

But Ralfred sensed his brother was no more and said, from his hospital bed, “Mummy, you’re lying.”

The next day, on May 14, Ralfred died too.

The touching story of the twins who lived and died together has spread fast and wide on Indian social media, puncturing this nation’s numbing statistics — the daily Covid-19 case numbers, the death counts, the infection rates.

This is a country that has suffered so much and keeps suffering. Though India’s overall case numbers have dropped this past week, the deaths keep going up.

On Wednesday, India broke a world record for the most reported Covid deaths in a single day: 4,529. However alarming that number is — three Indians dying every minute because of the coronavirus — experts say that it is just a small fraction of the true toll and that the real numbers are far higher.

Downtown Lake Oswego, Ore., in early April. Oregon is lifting its indoor mask mandate for people who have been fully vaccinated against Covid-19.
Credit…Gillian Flaccus/Associated Press

Oregon has lifted its mask mandate for people who have been fully vaccinated against the coronavirus, but is requiring businesses, workplaces and houses of worship to verify the vaccination status of individuals before they enter buildings without a mask.

This statewide mandate, one of the first of its kind in the country, raised concerns that the procedure of verifying vaccinations could be too cumbersome for workers.

Many states have lifted mask requirements without requiring confirmation that individuals have been vaccinated after new federal guidance last week said vaccinated people could choose to go maskless in most cases. New York adopted that guidance on Wednesday, though businesses will be allowed to enforce stricter rules. Some Republican governors, like Gov. Greg Abbott of Texas, have instead not only lifted mask rules but banned local governments from enforcing their own. Gov. Ron DeSantis of Florida, also a Republican, issued an executive order last month prohibiting businesses from requiring vaccine documentation.

The notion of relying on the honor system, which some states and businesses have adopted, has raised its own questions. And business groups in Oregon expressed concerns that a mandate to check vaccination status could become — like mask enforcement — a difficult and potentially dangerous proposition for workers.

“We have serious concerns about the practicality of requiring business owners and workers to be the enforcer,” said Nathaniel Brown, a spokesman for Oregon Business and Industry, which represents companies like Nike, as well as small businesses. “We are hearing from retailers and small businesses who are concerned about putting their frontline workers in a potentially untenable position when dealing with customers.”

The Oregon Health Authority said in new guidance on Tuesday that effective immediately, businesses would be required to continue to enforce mask requirements unless they had established a policy to confirm proof of vaccination using a card or photo of one before individuals can enter the building without a mask.

Gov. Kate Brown, a Democrat, said last week that Oregonians who were fully vaccinated no longer needed to wear masks in most public settings, except in places like schools, public transit and health care settings.

But she quickly noted that businesses would have “the option” of lifting mask requirements only if they instituted verification. “Some businesses may prefer to simply continue operating under the current guidance for now rather than worrying about vaccination status, and that’s fine,” she said.

A spokesman for Fred Meyer, a grocery store chain in the Pacific Northwest owned by Kroger, said that it would continue to require customers and employees to wear masks in its stores.

New York has created the Excelsior Pass, a digital proof of Covid-19 vaccination, which will be used at some sites like Madison Square Garden and Radio City Music Hall. Jen Psaki, President Biden’s press secretary, reiterated on Monday that the federal government would not be issuing “vaccine passports,” the development of which she said should be left up to the private sector.

Charles Boyle, a spokesman for Governor Brown, said that “businesses that do not want to implement vaccine verification can keep current health and safety measures in place, which includes masks and physical distancing for all individuals.”

Asked if businesses would face penalties for allowing customers to go maskless without checking their vaccination status, Mr. Boyle said that “in the past year state agencies have issued fines for businesses that are out of compliance with health and safety guidance.”

Tomas Ramos, the founder of The Bronx Rising Initiative, went door to door in NYCHA's public housing complex’s trying to get residents to sign up for vaccinations, in late April.
Credit…James Estrin/The New York Times

New York City public health officials are now trying to reach out to unvaccinated people to overcome vaccine hesitancy in the Black and Hispanic communities.

The city’s vaccination campaign alrealy looks successful by many measures. A second virus wave is receding fast. Pandemic restrictions are loosening. About 59 percent of the city’s adults have received at least one dose.

But Black and Hispanic New Yorkers are getting vaccinated at significantly lower rates than other groups. Citywide, only about 33 percent of Black adults have gotten a vaccine dose. For Hispanic adults, the rate is 42 percent. And demand for the vaccine is dwindling.

The racial disparities are partly the result of access, with more robust health care and vaccine distribution in some neighborhoods than others. But reluctance about the vaccine, which has been well documented in conservative rural areas, also runs strong in major cities, including New York, the epicenter of the pandemic just a year ago.

City officials are urging community groups to start knocking on doors to persuade people to get vaccinated. Those who agree get appointments for vaccine shots in a temporary clinic nearby.

And the city has also hired companies to do door-to-door outreach and talk up the vaccine on street corners, largely in Black and Hispanic neighborhoods.

One contract went to a Virginia firm that worked on Defense Department contracts in war-torn countries before expanding into contact tracing. Some of the companies have little public health experience, including one owned by a recent New York University graduate who usually works on political campaigns.

From May through September, the city anticipates that these firms will send about 700 people a day to knock on doors and do street outreach in the hopes of reducing racial disparities and increasing overall vaccination rates, which are key to reopening efforts.

City officials say they anticipate that much of the outreach campaign’s costs, which could be up to $60 million, will be reimbursed by the federal government.

Skepticism about the vaccines’ safety is a significant factor contributing to hesitancy, especially among Black New Yorkers, interviews with more than 40 Black and Hispanic residents across the city show.

A vaccination in Castrop-Rauxel, Germany, on Wednesday.
Credit…Friedemann Vogel/EPA, via Shutterstock

When a young woman showed up at Hamburg’s giant Covid vaccination site last week, the city officials who check whether people are eligible were skeptical.

She was in her mid 20s; shots are being given mainly to those 60 and older. But she said she qualified for an exemption because she was caring for her infirm mother and produced a form to make her case. Without a signature from her mother, the form was invalid and the officials turned her away. But she returned quickly, a little too quickly, with the document signed.

This time she claimed to have a sister who was vaccinated for the same reason, but a spot check of inoculation records showed that to be false as well.

“She could not get out of here fast enough,” said Martin Helfrich, a spokesman for the city who witnessed the scene.

Officials at the center have become adept at spotting people who are trying the most un-German of activities: cutting in line. At state-run sites like the one in Hamburg, those over 60, those with pre-existing conditions and frontline workers are allowed to get shots. But officials at the Hamburg center recently reported that roughly 2,000 ineligible people had sought shots in just one week, either because they did not understand the rules — or were trying to cheat.

In a country that prides itself on keeping order, the news was shocking enough to make national headlines.

Even Chancellor Angela Merkel waited her turn. She was vaccinated in April and only once people of her age bracket — she is 66 — were eligible. Ugur Sahin, the 55-year-old chief executive of BioNTech, the German company that designed the Pfizer vaccine, has said he will also wait his turn.

From the Bronx to Staten Island, Chinatown to Fifth Avenue, in Michelin-starred restaurants and humble corner diners, hardware stores and funeral homes, New York moved gingerly toward reopening on Wednesday, with scenes of a remembered normalcy played out alongside those of caution.

It was a moment that so many people had hoped for, whether aloud over countless Zoom calls or in the frustrated silence of a line of shoppers outside a store. It was less a grand gala than a soft opening, a finish line at the end of a long race that no one wanted to be the first to cross.

New York shut down 423 days ago, on a Sunday night in March 2020 when it accounted for half the nation’s coronavirus cases, and Gov. Andrew M. Cuomo ordered all nonessential workers to stay home and indoors. The city has partially reopened in recent months, but Wednesday was the first day businesses were allowed to operate with fewer restrictions and at near capacity.

The new rules easing mask mandates and capacity limits were widely superseded by the personal comfort levels of millions of people. The reopening was messy and inconsistent and confusing — in short, it was New York City. Many business owners chose to continue requiring customers to wear masks, making Wednesday look and feel not all that different from Tuesday.

But the reopening was also cause for celebration. Julie Ross, 63, in the garden shade of the Museum of Modern Art, described the day in a word.

“Fabulous,” she said. “The streets feel more alive, a little bit. Right?”

The tentative first day arrived amid lowering restrictions in the region, with Connecticut and New Jersey rolling out similar plans, as case numbers continue to fall around the country and overseas. The European Union, looking ahead to summer’s tourist season, agreed on Wednesday to reopen its borders to visitors who have been fully vaccinated or who are coming from a list of countries considered safe from a Covid-19 perspective. And yet, the virus continued to ravage India, which recorded 4,529 Covid-19 deaths on Tuesday, the pandemic’s highest single known daily death toll in any country so far.

The clashing good-news, bad-news headlines seemed to leave many New Yorkers disinclined to lower their guard — or their masks. Facial coverings were no longer a hard requirement, but many people were still wearing them, whether in the big-box stores and tiny boutiques of Manhattan or the shaded paths of Prospect Park in Brooklyn, and they remained on the signs at the entrance of many stores like Victoria, selling clothing in the Bronx.

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