Johnson & Johnson Applies for Emergency Vaccine Authorization

A scientist at work at a Johnson & Johnson affiliate in the Netherlands.
Credit…Johnson & Johnson, via Associated Press

Johnson & Johnson on Thursday submitted to the Food and Drug Administration an application for emergency authorization for its one-dose coronavirus vaccine, putting the company on track to potentially begin shipping it by early March.

The agency has scheduled a meeting with its outside advisory panel, which will vote on whether the F.D.A. should authorize the vaccine on Feb. 26, according to people familiar with the planning.

That leaves regulators about three weeks to pore over a large and complex application that includes clinical and manufacturing data. A decision on whether to authorize the vaccine could come within days of that meeting.

A similar timeline was used for the review of two-dose vaccines made by Pfizer-BioNTech and Moderna, which were authorized by the F.D.A. in December.

Dr. Paul Stoffels, the company’s chief scientific officer, said in a statement that the application was a “pivotal step toward reducing the burden of disease for people globally and putting an end to the pandemic.” He said Johnson & Johnson was ready to ship the vaccine as soon as the F.D.A. clears it.

Last week, the company announced promising results from its clinical trial, which showed that the vaccine provided strong protection against Covid-19. The trial found it was 85 percent effective in preventing severe disease in all three regions where the vaccine was studied: the United States, Latin America and South Africa. After 28 days, none of the vaccinated participants who developed Covid-19 had to be hospitalized.

But the results came with an ominous note: The vaccine’s efficacy rate was 72 percent in the United States, but only 57 percent in South Africa, where a highly contagious variant of the coronavirus is driving most cases. Preliminary studies have shown that some coronavirus vaccines are less effective against that variant.

There is also still uncertainty about how many doses Johnson & Johnson will be able to provide in the days and months after getting emergency clearance, when the company may have only about seven million ready, according to federal officials familiar with its production. About 30 million doses, made at facilities in the Netherlands and Baltimore, could be available by early April.

The company said on Thursday that it expected to supply the 100 million doses it has promised the U.S. by the end of June.

Janet Woodcock, the F.D.A.’s acting director, said that the agency is preparing a plan for variants that could evade vaccines.  
Credit…Brendan Mcdermid/Reuters

Confronted with the possibility of coronavirus variants that may evade current vaccines, therapies and tests for the virus, the Food and Drug Administration is readying a plan for action in the next few weeks.

The Pfizer and Moderna vaccines have so far proven to be effective against known variants of the coronavirus, but they are less potent against the variant first identified in South Africa. That variant has only been diagnosed in three people in the United States so far, but the country’s surveillance is thin and may be missing other cases.

“If variants emerge that are not prevented, that the vaccines have poor efficacy against, then we will need to rapidly change,” Janet Woodcock, the agency’s acting director, said in a call with reporters Thursday. New versions of the vaccine would need to be rapidly manufactured, tested and distributed.

Officials at Pfizer and Moderna have said they are prepared to tweak their vaccines as needed and that the process could be complete in as little as six weeks.

Dr. Woodcock declined to reveal any details of how the F.D.A. plans to evaluate the tweaked vaccines, but said that the agency would probably require smaller and shorter trials than in the original trials run by Pfizer and Moderna.

If the current vaccines prove ineffective against a new variant, “we can’t go through more 30,000 patient trials,” she said. “There are things short of doing full-fledged efficacy trials that we can use to shift or perhaps add components to the existing vaccines.”

Dr. Woodcock said the plans will be released for comment from scientists before they are implemented. The agency may also look to an advisory committee to help guide any changes to existing vaccines.

The F.D.A. also plans to release guidance documents for monoclonal antibody treatments and for tests of the virus. The monoclonal antibody made by Eli Lilly and one of the two antibodies in the cocktail made by Regeneron are powerless against the variant circulating in South Africa, according to a recent study.

“We knew from the very beginning that monoclonals were vulnerable to this type of strain shift,” she said.

Laboratory tests for the coronavirus that rely on a technique called P.C.R. seem to detect the new variants accurately, but if that were to change, they could easily be altered, Dr. Woodcock said. But it would be “much more complicated” to determine whether antigen tests that are manufactured en masse are missing variants.

Neppie Martin and Samia Pereira prepare to see another patient at a drive-through testing site at Franciscan Health Indianapolis in December.
Credit…Lee Klafczynski for The New York Times

The official coronavirus death toll in Indiana suddenly shot up by 1,507 this week. Though it was a huge jump for a state that has lately been reporting fewer than 100 deaths a day, it conveyed little about where the pandemic is headed in the state — and a lot about how difficult it can be to track accurately.

The sudden increase was the result of a recent audit of death records and positive coronavirus test results going back many months, according to the state health department. In effect, the state was catching up with coronavirus deaths that ought to have been counted earlier but were overlooked.

The huge addition, raising the state’s overall toll for the pandemic to about 11,200 total deaths, will now be a major asterisk for researchers and health professionals who try to understand whether the country is winning the battle against the virus by watching daily reports of coronavirus deaths.

In a presentation on Wednesday, Dr. Kristina Box, the Indiana state health commissioner, spoke of the challenges of trying to keep precise tabs on an epidemic of this magnitude as it is unfolding. “Please understand that never before have local and state departments of health had to present data in real time, before it was vetted,” Dr. Box said.

State auditors identified the added deaths by matching every death certificate that indicated a Covid-19 infection as a cause of death, or as a contributing cause, to a positive Covid-19 test, Dr. Box said.

Indiana’s addition appears to be one of the largest death-toll adjustments that any state has made so far, but there have been a number of others. One reason is that it can be difficult to rule out other causes of death in some cases.

The state of Washington announced in December that it was reviewing a number of previously reported coronavirus deaths, and was removing 214 deaths from its state Covid data dashboard, at least temporarily. Officials said at the time that they expected to add about 152 of them back again once they had been more thoroughly investigated.

Last week in New York, Letitia James, the state attorney general, announced that Gov. Andrew M. Cuomo’s administration had substantially undercounted Covid deaths in the state’s nursing homes. The state health department soon added 3,800 people to its tally. (The deaths were already included in the state’s overall total but had not been classified as nursing home-related.)

The New York Times, which has been tracking coronavirus data, maintains a detailed list of known reporting anomalies and methodology changes.

Taking these into account, the data as of Thursday for the United States paint both a bleak picture and a cause for hope: Though more than 450,000 people are reckoned to have died of the virus so far, new reported cases, hospitalizations and deaths have been declining for the last two weeks.

Students at the University of Wisconsin campus in Madison.
Credit…Lauren Justice for The New York Times

The politicization of mask wearing reached fever pitch in Wisconsin on Thursday when the State Legislature repealed Gov. Tony Evers’s statewide mask mandate, only to have the governor issue a new one an hour later.

“Wearing a mask is the most basic thing we can do to keep each other safe,” Mr. Evers said in a recorded video on Twitter. “If the Legislature keeps playing politics and we don’t keep wearing masks, we’re going to see even more preventable deaths and it’s going to take even longer to get our state and our economy back on track.”

The ping-pong pandemic management was just another example of the partisan politics that have plagued the state during the pandemic, with a Republican-controlled legislature and a Democratic governor.

The Legislature has fought Mr. Evers over his response to the coronavirus since it began. Republicans successfully sued the governor in April to block the extension of a stay-at-home order, discussed removing his public health secretary and amplified protesters’ calls last spring to reopen the state.

The Republican-sponsored repeal would have ended a monthslong requirement to wear masks in many settings that came into effect as part of emergency orders issued by Mr. Evers. Republicans in both chambers had argued that the mandate was unconstitutional and that Mr. Evers cannot issue emergency orders indefinitely.

The original mask order went into effect in August, but has been extended multiple times.

The political roundelay seems likely to continue.

After the governor issued his new mask order on Thursday, State Senator Steve Nass, a Republican, said that he was drafting a new resolution to block the emergency order issued by Mr. Evers and that he was considering filing an emergency action in the Wisconsin Supreme Court.

“The rule of law and the Wisconsin Constitution require Evers to recognize the Legislature ended his emergency powers,” Mr. Nass said in a statement. “Instead, Tony Evers now acts no differently than a dictator in control of a banana republic.”

Doctors and health care professionals have widely condemned the resolution, saying that masks are the best way to prevent the spread of the virus until people are vaccinated. They cited evidence from repeated studies.

Without a statewide mask mandate, local officials would be left to choose whether or not to adopt their own, creating a patchwork of policies across towns and counties.

Before Thursday’s vote, lawmakers sent Mr. Evers a letter saying they would support a more limited mask mandate that applies to places “susceptible to transmission of the virus.”

In a statement, Representative Jim Steineke, a Republican, said Mr. Evers had opted “for continued authoritarian rule.”

“I’m disappointed that the governor would rather continue issuing orders that he knows to be illegal as opposed to working with the Legislature to keep Wisconsinites safe,” said Mr. Steineke.

Nine states, including Florida and South Dakota, do not have a statewide mask requirement, according to the National Academy for State Health Policy.

As of Thursday afternoon, there have been at least 595,756 cases and 6,500 deaths in Wisconsin since the beginning of the pandemic, according to a New York Times database. Around 7.9 percent of the state’s population has received at least one dose of the vaccine, according to a New York Times tally.

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Health Experts Encourage Sports Fans to Watch Super Bowl Safely

Despite having two Covid-19 vaccines rolling out, public health experts encouraged sports fans to avoid large crowds when watching Super Bowl LV on Sunday.

Cases and hospital admissions continue to decrease, and we now appear to be in a consistent downward trajectory for both of these important outcomes. While deaths have continued to increase, the pace appears to be slowing with the average number of deaths increasing 1 percent to slightly more than 3,100 deaths per day from Jan. 26 to Feb. 1. And the recent decline in hospitalizations gives us hope that the number of deaths should start to decrease in the coming weeks. Although we have seen declines in cases and admissions, and a recent slowing of deaths, cases remain extraordinarily high. Based on contact tracing of recent variant cases, not wearing masks and participating in in-person social gatherings have contributed to the variants’ spread. And this Sunday, remember, whichever team you’re rooting for and whichever commercial is your favorite, please watch the Super Bowl safely, gathering only virtually or with the people you live with. The C.D.C. recently posted guidance on how to safely enjoy the game.

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Despite having two Covid-19 vaccines rolling out, public health experts encouraged sports fans to avoid large crowds when watching Super Bowl LV on Sunday.CreditCredit…Michelle Gustafson for The New York Times

With twice daily coronavirus tests for players, coaches and staff, a record low number of in-person spectators and a socially distanced halftime show, Super Bowl LV — a matchup between the Tampa Bay Buccaneers and the Kansas City Chiefs to be held in Tampa, Fla. — will look different from years past.

And as Super Bowl Sunday approaches, there are reasons to be hopeful: Two highly effective Covid-19 vaccines are rolling out around the United States and cases and hospitalizations have dropped nationwide.

But cases remain at levels that are nearly twice as high as last summer’s peak and contagious new variants circle the globe, some of which appear to make the vaccines less effective.

Ahead of the big game, public health experts and elected officials are cautioning fans nationwide against hosting large parties that could turn into superspreader events.

Dr. Anthony S. Fauci, the nation’s top infectious disease expert and President Biden’s chief medical adviser for Covid-19, urged people to keep Super Bowl celebrations to a minimum by watching the game at home. On NBC’s “Today” on Wednesday, he pointed to coronavirus spikes that followed celebrations and holidays like Christmas and New Year’s.

“You don’t want parties with people that you haven’t had much contact with,” Dr. Fauci said on ABC’s “Good Morning America” on Wednesday. “You just don’t know if they’re infected so as difficult as that is, at least this time around, just lay low and cool it.”

The Centers for Disease Control and Prevention recommended hosting a virtual Super Bowl party, or an outdoor gathering where guests can spread six feet apart — but even outdoors it’s still important to wear masks the entire time (except when eating).

The C.D.C. also said to try to avoid shouting, cheering loudly or singing, which can increase the amount of respiratory droplets in the air. Instead, clap, stomp your feet or use noisemakers. If you attend a gathering, the agency recommends bringing your own food, drinks, plates, cups and utensils.

“This Sunday, remember: Whichever team you’re rooting for and whichever commercial is your favorite, please watch the Super Bowl safely,” Dr. Rochelle Walensky, director of the Centers for Disease Control, said during a White House virus team briefing on Wednesday. “Gathering only virtually or with the people you live with.”

Some states have said restrictions will be loosened in time for the big game. Gov. Philip D. Murphy of New Jersey announced that the 10 p.m. curfew for indoor dining will be lifted starting on Friday. He also raised the ceiling on indoor dining to 35 percent of capacity, up from 25 percent.

In New York City, where indoor dining can resume at 25 percent capacity starting Valentine’s Day, Mayor Bill de Blasio encouraged New Yorkers on Thursday to “not let Super Bowl parties be the reason” the virus keeps spreading.

“If you’re going to do a Super Bowl gathering it should really be just the people immediately in your life,” he said. “The last thing you want to do is get together for the big game and someone gets sick as a result.”

In Florida, the N.F.L. will host fewer than 25,000 fans, a record low, but bars and restaurants remain open throughout the state. Last week, Jane Castor, the mayor of Tampa, signed an executive order requiring masks in certain areas of downtown Tampa and near Raymond James Stadium, the site of this year’s Super Bowl.

Daniel E. Slotnik contributed reporting.

New York State’s plan for vaccinating prisoners, including those at Rikers Island, is changing to include inmates 65 and older.
Credit…Dave Sanders for The New York Times

New York corrections officials announced that people in prisons age 65 and older will soon be inoculated against the coronavirus, hours after a coalition of advocacy groups sued Gov. Andrew M. Cuomo and the state’s top health official demanding that all of the roughly 50,000 incarcerated people in the state be immediately offered a vaccine.

The lawsuit argued that leaving inmates out of the state’s vaccination plan, while others living in close quarters like homeless shelters are eligible, violates the equal protection clause of the 14th Amendment and contradicts the advice of health experts.

Several states, including New York, have declined to place incarcerated people among the highest priority groups for vaccination, despite the high risk of infection in prisons, and advocates have responded with litigation. In a similar suit in Oregon, a federal court judge ordered the state prison system on Tuesday to provide doses to every inmate who wants to be inoculated.

“New York’s current vaccination policy discriminates against our clients on a basic level,” said Elizabeth Fischer, a lawyer at the Neighborhood Defender Service of Harlem, one of the groups filing the New York suit on Thursday. “It says that their lives, their families and their neighborhoods matter less than those of other New Yorkers.”

At least 5,700 people incarcerated or employed in New York’s prisons have tested positive in the past two months, and 13 have died, outpacing even the early days of the pandemic, though far less testing was being done then.

The governor’s office did not respond to a request for comment on the lawsuit on Thursday. But Thomas Mailey, a spokesman for the state’s corrections department, said shortly after the lawsuit was filed that officials are “in the process of preparing to vaccinate” the 1,075 incarcerated people in prisons who are 65 or older. It remained unclear when they would begin receiving doses.

Theresa Grady, a community leader with the Release Aging People in Prison Campaign, an advocacy group not part of the suit, called the move a “good first step.” But she added that “more needs to be done” — both to broaden eligibility to the entire incarcerated population and to address mistrust of the vaccine among incarcerated people.

“Knowing that a robust plan will likely take months to go into effect, Governor Cuomo should immediately release those most vulnerable to this virus,” she said.

Prison and jail workers in the state became eligible to receive the vaccine on Jan. 11.

The Centers for Disease Control and Prevention recommends offering doses to everyone at correctional facilities simultaneously, and public health experts broadly agree that all inmates regardless of age should already be eligible because of their particularly unique risk for contracting and spreading the virus.Several states, including Massachusetts, New Jersey and California, have begun to vaccinate inmates, while many others like Florida have not included those behind bars in their plans.

The five advocacy groups that filed the suit against Governor Cuomo and Dr. Howard Zucker, the state health commissioner, include the Legal Aid Society, the Bronx Defenders and the New York Civil Liberties Union. The groups argue that the exclusion of incarcerated people from vaccination plans hinders the goal of ensuring equitable access to vaccines regardless of social status, and the goal of giving priority to Black and Latino New Yorkers, who are overrepresented both among the virus’s victims and among prison populations.

“The past year has been the scariest of my life,” Alberto Frias, who is incarcerated at Rikers Island in New York City and is a petitioner in the suit, said in a news release. “I am simply asking to be treated fairly and with dignity.”

Black Americans younger than 45 are far more hesitant to get the vaccine than those 60 and older.
Credit…Kenny Holston for The New York Times

Poll after poll has found that Black adults in the U.S. are more skeptical than white adults about Covid-19 vaccines, and that many are reluctant to get the shots. But a survey released Thursday suggests that the picture is not as simple as that. It found that Black Americans’ views of the vaccines actually vary sharply by age and gender.

Younger Black adults are far more hesitant to get the vaccine than their elders, according to the new survey of 1,340 respondents released by the National Foundation for Infectious Diseases. Only 38 percent of those aged 18 to 44 said they plan to get vaccinated, compared with 68 percent of those 60 and older group, according to the survey, which was conducted for the foundation by NORC at the University of Chicago, a nonpartisan research institute.

The results also found that Black women across all age groups were more uncertain about the vaccines than Black men are, with 33 percent of women having no plans to get a shot and 22 percent unsure, compared with 27 percent of men who say they won’t get one and 17 percent who are unsure.

The gender divide is especially wide among Black people aged 45 to 59: Only 43 percent of women in that group said they would get a Covid-19 shot, compared with 75 percent of men.

Experts say one reason older people may be more amenable to the vaccines is that they are more likely to be hospitalized or to die from Covid-19, while younger people, who are generally healthier, tend to feel less threatened by it.

Dr. Patricia N. Whitley-Williams, a pediatric infectious disease expert and president of the foundation, said that younger Black people are more vocal about their mistrust in part because of the recent string of racist episodes highlighted by the Black Lives Matter movement.

As for the gender divide, she said, “Women are often responsible for health care decisions in their families, so they are generally more worried, and seek out multiple sources of information about vaccines, including from social networks and social media, where there can be a lot of misinformation.”

Survey respondents expressed distrust of both the vaccines themselves and the way they are being distributed: Fewer than one in four said they were very confident that the shots were effective, and only one in six were very confident that the shots would be given out equitably. More than half said the American health care system either always or often treats people unfairly based on race or ethnicity, a sentiment that was most pronounced in Black adults under 30.

The survey found that Black adults were a bit more open to flu vaccines than to Covid-19 vaccines. While 49 percent of Black adults overall said they would get a Covid-19 vaccination, 54 percent said they had gotten a flu shot or planned to get one.

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Capitol Police Will Be Vaccinated for the Coronavirus, Pelosi Says

Speaker Nancy Pelosi said all members of the Capitol Police will be vaccinated for Covid-19 as part of ongoing efforts to increase safety and security at the Capitol.

To do the people’s work, it is essential to keep the people safe, and to keep this House safe for our members, our staff, the custodians — custodial staff who make all of this possible. For those of you who cover it in the press, for our visitors, hopefully soon we’ll have some again after Covid. And I want to salute the General Honoré for his work in reviewing the security here. I have — I was honored that he accepted the charge to study how we keep members safe here as they do their jobs in Washington, in the Capitol, as they do their jobs in their districts and their travel to and fro. One of the proposals that he made that we’ve already had some good news on is that it was clear that many, that the Capitol Police have been severely affected by Covid. Separate and apart from everything else that’s going on, like the rest of the country they have been severely affected by Covid, and he recommended that we vaccinate the Capitol Police. And now with the cooperation of the Biden administration, we were able to do that.

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Speaker Nancy Pelosi said all members of the Capitol Police will be vaccinated for Covid-19 as part of ongoing efforts to increase safety and security at the Capitol.CreditCredit…Pool photo by Drew Angerer/EPA, via Shutterstock

All members of the Capitol Police will be vaccinated against Covid-19, the acting chief of the force announced on Thursday, almost a month after the deadly riot at the Capitol that killed one officer and injured others.

“The department expects delivery of the vaccines to occur shortly, and is already working with the Office of Attending Physician on logistics to administer them to our employees as quickly and safely as possible,” Chief Yogananda Pittman said, adding, “I am tremendously grateful for the dedication of our officers who have worked tirelessly and sacrificed to uphold our mission.”

Chief Pittman took over the top post at the department when her predecessor resigned following the riot at the Capitol on Jan 6. She apologized to Congress last month for the agency’s extensive security failures, and acknowledged that the department had been aware of a “strong potential for violence” on Jan. 6.

Several members of Congress who took shelter in the Capitol during the riot have since tested positive for the coronavirus, and there have been complaints that some members and their staffs have been heedless about mask-wearing and other pandemic safety precautions.

The announcement came after President Biden, Vice President Kamala Harris and other lawmakers paid their respects to Brian D. Sicknick, the Capitol Police officer who died of injuries he received during the riot. On Tuesday, he became the fifth person to lie in honor at the Capitol. At a news conference on Thursday, Speaker Nancy Pelosi called Mr. Sicknick a “martyr for democracy.”

Ms. Pelosi said that Lt. Gen. Russell Honoré, whom she tapped to lead a review of security at the Capitol complex, recommended that the force be vaccinated.

“To do the people’s work, it is essential to keep the people safe and to keep this House safe,” she said. Ms. Pelosi added that “the Capitol Police have been severely affected by Covid, separately and apart from everything else that’s going on.”

A New Delhi market in October. A recent survey in the city of 20 million found that 56 percent of people who provided blood samples had coronavirus antibodies.
Credit…Sajjad Hussain/Agence France-Presse — Getty Images

A new coronavirus antibody survey in the Indian capital, New Delhi, estimates that more than half of the city’s 20 million residents have had Covid-19.

The city’s health department in January found antibodies showing immune response to coronavirus infections in 56 percent of the 28,000 people who provided blood samples. The city’s health minister, Satyendar Jain, told reporters on Tuesday that New Delhi was “moving toward herd immunity.”

But New Delhi’s health director, Dr. Nutan Mundeja, said the results did not mean it was safe for people to stop social distancing or wearing masks.

“This is a new disease, and we should not change our strategy,” Dr. Mundeja said. “Let us wait and see.”

The last citywide survey, conducted in October, found that just over a quarter of the population could have been infected.

Even though the new survey shows a higher percentage of coronavirus antibodies in New Delhi’s population, the number of new cases there and across the country has steadily fallen since a September peak of nearly 100,000 nationwide cases a day. About 18,000 cases were reported across India on Wednesday.

India has registered more than 10 million cases in total, the second-highest tally in the world after that of the United States, according to a New York Times database.

The country of 1.3 billion people has also begun one of the world’s largest coronavirus inoculation campaigns. More than four million health care workers have already received their first dose.

The new antibody data did not surprise Bhramar Mukherjee, an epidemiologist at the University of Michigan. She said that her field research in India last fall had suggested that most cases in New Delhi and other large Indian cities were “silent infections” so mild that they went undetected.

“Big metros in India are close to disease induced herd immunity,” Dr. Mukherjee said. She added that India’s vaccination drive could help bridge the gap by protecting people who did not yet have coronavirus antibodies.

In other news from around the world:

  • North Korea is expected to receive nearly two million doses of the AstraZeneca coronavirus vaccine by the middle of this year, according to a report on Wednesday by Covax, an international group that has negotiated for vaccine doses. The planned shipment to North Korea is part of an estimated 336 million doses that Covax expects to distribute around the world in the first half of this year. Doses sent to North Korea and other countries will be manufactured by the Serum Institute of India, according to the report. North Korea has insisted for months that it has no confirmed Covid-19 cases in its territory, but outside experts are skeptical.

  • China’s National Health Commission said on Thursday that only 17 new cases had been reported nationwide the day before, mostly in northeastern provinces. Three locally transmitted cases were recorded in Shanghai, but all were people who tested positive near the end of two-week, government-supervised quarantines. China has been reporting fewer and fewer coronavirus cases in recent days, as its extensive testing, tracing and isolation measures appear to be working. As many as 1,000 people are put in lengthy quarantines for each positive case.

  • In Myanmar, health workers are among the people who have cautiously raised their voices against a coup on Monday by the country’s military. On Wednesday, doctors at one Yangon hospital raised three fingers, a defiant salute from the “Hunger Games” films that has become a symbol of the pro-democracy demonstrations in neighboring Thailand. Around 20 protesters also rallied outside the Mandalay University of Medicine, and six were detained. The country’s civilian leader, Daw Aung San Suu Kyi, was detained on Monday and now faces an obscure charge that could put her in prison for up to three years. President U Win Myint, one of her political acolytes, was also detained, and issued a detention order for violating emergency coronavirus regulations.

Lin Qiqing contributed research.

A vaccination site at Anquan Boldin Stadium in Pahokee, Fla., on Wednesday.
Credit…Greg Lovett/The Palm Beach Post, via Associated Press

Just three months ago, as infections surged around the country and the prospect of a bleak winter loomed, it was not clear if any of the vaccines in development would pan out.

The picture now is very different.

After a sputtering start, coronavirus vaccination in the United States is speeding up. Two of the vaccines have been found to be highly effective. Three others appear to be slightly less robust, but still offer strong, and in some cases complete, protection against serious illness and death.

“We’ve come a long way,” said Akiko Iwasaki, an immunologist at Yale University. “We’re still living with deadly disease because we haven’t vaccinated enough people, but once we do, it’s going to really change the way we live and deal with this virus.”

More than 27 million Americans have received a first dose, and more than six million have been fully vaccinated.

The pace has accelerated enough that President Biden, facing criticism that his administration’s goal of giving out 100 million shots in his first 100 days in office was too modest, last week raised that goal to 150 million shots.

But even as there are reasons for hope in the spring and summer, many public health experts remain pessimistic about the next couple of months. Several warned that the world was nowhere near clear of a pandemic that has taken nearly 450,000 lives in the United States and 2.2 million in total around the globe.

And what progress there has been is hardly uniform.

Vaccinations may have accelerated in wealthy countries, but poorer countries are being left behind.

“I think in the rich world, we have a lot to feel good about for vaccines, but globally, it’s a different story,” said Marc Lipsitch, professor of epidemiology and director of the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health.

Even within the United States, there are disparities. Wealthier, white residents are gaining access to the vaccine more frequently than Black and Latino people, who have been disproportionately affected by the pandemic.

There are other sources of concern.

Dr. Eric Topol, a clinical trials expert at Scripps Research in San Diego, recalled feeling hopeful as recently as December that the pandemic could be tamed in the United States by June, thanks to the flurry of encouraging vaccine data. But as the picture grew clearer in the past few weeks about the threat posed by new, more contagious variants of the virus, his optimism has faded.

“The variants changed everything,” Dr. Topol said.

Still, there are glimpses of a path out of the pandemic as vaccinations increase.

At Bloom Senior Living, a chain in the Southeast and the Midwest, officials have gradually begun to reopen their doors to indoor visitors.

“It means everything for them to be able to see their adult children and, hopefully, eventually their grandchildren — to feel like they’re living life again,” said Bradley Dubin, principal of the firm that owns the Bloom facilities.

Credit…Mark Welsh/Daily Herald, via Associated Press
Vaccination equipment at a center in Dubai, the United Arab Emirates, on Wednesday.
Credit…Karim Sahib/Agence France-Presse — Getty Images

The International Federation of Red Cross and Red Crescent Societies, announcing a $110 million plan to help distribute vaccines, warned on Thursday of the “potentially devastating” consequences if poorer countries lagged behind their richer counterparts in inoculations.

Richer countries have dominated in the race to secure shots, and poorer countries face major problems in vaccinating their citizens, with lack of supply one of the most pressing. While an international program, called Covax, aims to procure Covid-19 vaccines at low or no cost for all countries — and plans to provide more than 300 million doses by the summer — it relies on global cooperation.

The federation of Red Cross and Red Crescent Societies warned that the entire world was vulnerable if large pockets remained unvaccinated and urged richer nations to show solidarity. Under the $110 million plan, the federation aims to support the immunization of 500 million people, providing national vaccination efforts with planning and implementation and working to ensure that the doses “get delivered into the arms that need it,” said Jagan Chapagain, the group’s secretary general.

“There must be no politics and there must be no greed around the vaccine, this is about saving lives,” Mr. Chapagain said. “Let’s not do politics.”

The distribution plan will include efforts to build trust in vaccines and to counter misinformation, and volunteers will seek out isolated communities to ensure that they are vaccinated. In some countries, it will also include the physical delivery of vaccines to at-risk groups.

Vaccinating refugees and migrants will also be crucial, Mr. Chapagain said, noting that such hard-to-reach communities often had difficulty gaining access to health services.

“If we exclude these marginalized groups and communities, the safety we believe we have brought through the vaccines will be false,” he said.

Emanuele Capobianco, the federation’s director of health, said that he was optimistic there would be enough vaccine supply, even though it might take time.

He encouraged world leaders to keep global cooperation at the core of their thinking. “Right now, it’s a very difficult crunch phase, which we need to overcome,” he said.

Where are U.S. teachers approved to get Covid vaccines?

Only in about half the states, The New York Times has found.

This map tells the story.

Credit…Lauren Leatherby/The New York Times

The Times, which has been tracking vaccine eligibility rules in all 50 states, found that at least 24 states and Washington, D.C., are providing shots to some teachers of kindergarten through high school. Some of those states, however, consider teachers eligible for the vaccine only in certain counties.

As with many programs that have emerged since the pandemic began, it is a hodgepodge.

In West Virginia, for example, teachers are eligible for the vaccine only if they are age 50 or older.

In Montana, a limited number of teachers are allowed to get shots if they have specific medical conditions.

And in some states — among them Florida and Texas — officials have ordered schools to reopen for in-person learning, but teachers have not been made eligible for shots. Of the 15 counties with the worst coronavirus outbreaks now, more than half are in Texas.

A parking-lot triage tent set up to handle the overflow of patients at Providence St. Mary Medical Center in Apple Valley, Calif., in December.
Credit…Ariana Drehsler for The New York Times

Dr. Sheetal Khedkar Rao, 42, an internist in suburban Chicago, can’t pinpoint the exact moment when she decided to hang up her stethoscope for the last time. In the spring came chaos and confusion when a nationwide shortage of N95 masks forced her to resort to a surgical mask when examining patients; then there was the fear she might take the coronavirus home to her family and, on top of that, the exasperating public disregard for mask wearing and social distancing that was amplified by the White House.

Among the final blows, though, were a 30 percent pay cut to compensate for a drop in patients seeking primary care, and the realization that she needed to spend more time at home looking after her children, who had switched to remote learning.

Doctors, paramedics and nurses’ aides have been hailed in the United States as frontline Covid-19 warriors, but gone are the days when people applauded workers outside hospitals and on city streets. A year into the pandemic, with emergency rooms packed again, vaccines in short supply and more contagious variants of the virus threatening to unleash a fresh wave of infections, medical workers are feeling burned out and unappreciated.

Some health care experts are calling for a national effort to track the psychological well-being of medical professionals, much like the federal health program that monitors workers who responded to the 9/11 terrorist attacks.

So far, the federal government has shown little interest in addressing what Dr. Victor J. Dzau, president of the National Academy of Medicine described as a “parallel pandemic” of psychological trauma among health care workers.

He and other experts say the government should start by making a concerted effort to accurately count medical worker infections and fatalities.

Dr. Erica Bial, a pain specialist from suburban Boston who barely survived Covid-19 last spring, is still plagued by fatigue and impaired lung function.

“The day before I got sick, I could comfortably run eight to 10 miles,” said Dr. Bial, 45, who started a Facebook group memorializing doctors lost to Covid. “Now I go out for a brisk walk and my heart is pounding. I’m starting to wonder whether these effects could be permanent.”

Thousands of health care workers have already paid the ultimate price for their dedication. Since March, more than 3,300 nurses, doctors, social workers and physical therapists have died from Covid-19, according to a tally by Kaiser Health News and The Guardian.

Dr. Donald Pathman, a researcher at the University of North Carolina at Chapel Hill, said he had been struck by the early results of a study he has conducted on the pandemic’s effect on clinicians who serve in poor communities. Many of the 2,000 medical, dental and mental health professionals who have participated in the survey so far say they are disillusioned.

“There is a lot of personal trauma,” Dr. Pathman said. “Many people have been scarred by their experiences during the pandemic, and they will look to leave their practices.”

Researchers say the pandemic’s toll on the health care work force will play out long after the coronavirus is tamed. The impact, for now, can be measured in part by a surge of early retirements and the desperation of community hospitals struggling to hire enough workers to keep their emergency rooms running.

“Everyone wants to talk about vaccines, vaccines, vaccines, but for our members, all they want to talk about is work force, work force, work force,” said Alan Morgan, chief executive of the National Rural Health Association. “Right now, our hospitals and our workers are just getting crushed.”

A border police officer in Frankfurt  checking the documentation of a passenger arriving on a flight from Spain on Jan. 28.
Credit…Thomas Lohnes/Getty Images

Among governments and those in the travel industry, a new term has entered the vocabulary: vaccine passport.

One of President Biden’s executive orders asks government agencies to “assess the feasibility” of linking coronavirus vaccine certificates with other vaccination documents, and producing digital versions of them.

The Danish government said on Wednesday that it would introduce a “digital passport” in the next few months that can be used as proof of vaccination.

In a few weeks, two airlines, Etihad Airways and Emirates, will start using a digital travel pass, developed by the International Air Transport Association, that, among other things, provides airlines and governments with documentation that passengers have been vaccinated or tested for the coronavirus.

The challenge is creating a universal document or app that protects privacy and is accessible regardless of people’s wealth or access to smartphones.

“It’s about trying to digitize a process that happens now and make it into something that allows for more harmony and ease, making it easier for people to travel between countries without having to pull out different papers for different countries,” said Nick Careen, senior vice president for airport, passenger, cargo and security at I.A.T.A., where he has been leading the travel pass initiative.

IBM has been developing its own “digital health pass” to aid in providing proof of vaccination or a negative test for those seeking access to a sports stadium, an airplane, a university or workplace. The pass, built on IBM’s blockchain technology, can use temperature checks, virus exposure notifications, test results and vaccine status. The World Economic Forum and the Commons Project Foundation, a Swiss nonprofit group, have been testing a digital health passport called CommonPass that would generate a QR code to show the authorities.

As more people are inoculated, it’s likely that more aspects of public life will be limited to people who have been vaccinated. At the Super Bowl in Tampa, Fla., on Sunday, a significant portion of attendees will be vaccinated health care workers.

For international travel, government and health authorities will need to know if people have been vaccinated or have tested negative for the virus. Many countries are already requiring proof of a negative test for entry. Such passes could be essential to restarting the tourism industry, said Zurab Pololikashvili, secretary general of the World Tourism Organization, a United Nations agency.

“One key element vital for the restart of tourism is consistency and harmonization of rules and protocols regarding international travel,” he said in an email. “Evidence of vaccination, for example, through the coordinated introduction of what may be called ‘health passports’ can offer this. They can also eliminate the need for quarantine on arrival, a policy which is also standing in the way of the return of international tourism.”

Showing evidence of vaccination is not a new concept. For decades, travelers to some countries have had to prove vaccination against yellow fever, rubella and cholera, for example.

“Parents with kids in public school have had to prove their kids have been vaccinated. This is not something new,” said Brian Behlendorf, executive director of Linux Foundation Public Health, an open-source, technology-focused organization helping public health authorities combat Covid-19 around the world.

“As these things get rolled out, it’s important for citizens to ask governments and airlines: How do we make this easy so I have one vaccination record to book a flight, hotel and so I can use that to do some other things,” Mr. Behlendorf said. “It should work like email. If it doesn’t, agitate for it.”

The Czech tennis player Marketa Vondrousova outside a hotel in Melbourne, Australia, on Thursday.
Credit…William West/Agence France-Presse — Getty Images

Tennis officials on Thursday postponed the Australian Open draw by a day after a worker in one of the hotels where players have been quarantining tested positive for the coronavirus.

The positive test, which came days after some players began to emerge from quarantine, forced 507 players and support staff members into isolation until they receive negative test results. Tennis officials have called off matches planned for Thursday in several preparatory events, but they said that the Australian Open would move forward with its scheduled Monday start.

News of the positive test sent chills through Melbourne, the tournament’s host city, whose citizens endured a lockdown of nearly four months last year.

“We have all been through a tough time,” said Craig Tiley, the chief executive of Tennis Australia, which runs the Australian Open. “At some point we need to continue on.”

Officials still plan to allow as many as 30,000 spectators each day at the tournament, a rarity in international sports with the pandemic still raging.

Melbourne, the capital of the state of Victoria, had not recorded a local transmission in nearly a month. The man who tested positive worked at the Grand Hyatt in the center of the city, where some players are still staying. He has not worked there since Jan. 29.

The man’s closest contacts have been tested, and officials have released details of his travels in recent days. He had been working on the same floor where several of the people who tested positive for the virus when they arrived in Melbourne had been staying.

Victoria’s premier, Daniel Andrews, has been criticized for allowing the tournament to go ahead. On Wednesday night, he reintroduced a series of restrictions, including mandatory mask wearing indoors and a limit of 15 visitors to private homes. He also postponed a planned increase in workplace capacity to 75 percent, from 50 percent.

Those measures were less severe than other recent responses to Covid-19 in Australia. The city of Perth, in Western Australia, snapped into a total lockdown on Sunday after health officials discovered a single local transmission. That lockdown is expected to last at least five days.

The Australian Open’s attempt to quarantine players for 14 days and hold four weeks of tennis events has had no shortage of hiccups. Last month, 72 players were forced into a hard lockdown, preventing them from practicing, after 10 people on three flights that brought people from overseas for the tournament tested positive. A handful of those players were at Grand Hyatt, and they went back into isolation on Thursday.

Some players who continued to test negative through their strict lockdowns were furious that health officials had refused to allow exceptions to the isolation requirement for everyone considered a close contact of a Covid-19 case.

“The players have been remarkable,” Mr. Tiley said. “They have come to accept that with travel round the world, anything can happen.”

In a news conference after his match Wednesday night, Nick Kyrgios, a veteran player from Australia, said that other players had no right to complain about coronavirus precautions at the tournament.

“There’s too much risk in all of this,” Mr. Kyrgios said. “I don’t understand what’s so hard for tennis players to understand.”

Administering shots developed by the Chinese company Sinovac Biotech at a school in Santiago, Chile, on Wednesday.
Credit…Esteban Felix/Associated Press

A team of Chinese scientists has reported that a coronavirus vaccine made by the Beijing-based company Sinovac Biotech, which has already been rolled out in China and distributed to many developing countries, was shown in early-stage trials to be safe and to have stimulated an immune response in adults over 60.

The results from the Phase 1 and 2 trials, which included 494 volunteers over 60 years old, were published in the British medical journal The Lancet on Wednesday.

But the vaccine’s late-stage trial results have been marred by confusion. The problems have disappointed several governments that placed orders. Brazilian officials said the vaccine had an efficacy rate of just over 50 percent, although those who still became infected included people who showed only “very mild” symptoms.

The vaccine, called CoronaVac, which has been introduced in countries including Brazil, Chile Indonesia and Turkey, is one of two candidates that are being mass produced in China. The other is a shot made by Sinopharm, a state-owned vaccine maker. CoronaVac was created using a tried-and-tested technology that uses a weakened or killed virus to stimulate the immune system.

CoronaVac has been given to millions of people in China, even before the release of late-stage clinical trial data to show that the vaccine would be effective. Sinovac said on Wednesday that the regulator had accepted its filing for approval.

The trials on adults above 60 years old showed no serious side effects, according to the Lancet article. It said that most adverse reactions were mild and that pain at the injection site was the most reported symptom, followed by fever.

Representative John Yarmuth, Democrat of Kentucky and the chairman of the House Budget Committee, stressed the need for prompt action while talking about the proposed stimulus package.
Credit…Anna Moneymaker for The New York Times

The House voted on Wednesday to approve a budget blueprint that lays the groundwork for passing President Biden’s $1.9 trillion coronavirus relief package without needing any Republican votes, a key procedural step as Democrats push for speedy action to address the health and economic toll of the pandemic.

The 218-to-212 vote on the blueprint, known as a budget resolution, helps pave the way for Democrats to pass the relief package through a process called budget reconciliation. With that approach, the bill would be shielded from a filibuster in the Senate and could pass the chamber with only Democratic votes.

It is the same process that Republicans employed in 2017 in their unsuccessful effort to repeal the Affordable Care Act and in their successful effort to overhaul the tax code.

Laying the groundwork to bypass a filibuster does not preclude passing a relief package with some Republican support. But instead of waiting to see if Republicans can be won over, Democrats are putting themselves in a position to pass the package with only a simple majority in the Senate, meaning no Republican votes would be needed if Democrats were united in support.

“We cannot afford to slow down our response to these urgent crises while Republicans decide if they want to help or not,” Representative John Yarmuth, Democrat of Kentucky and the chairman of the House Budget Committee, said Wednesday.

Representative Jason Smith, Republican of Missouri and the Budget Committee’s ranking member, criticized what he called a “partisan process” at odds with the message of Mr. Biden’s Inaugural Address.

“The power of our example — isn’t that what we were told?” Mr. Smith said. “Well, what’s the example here? That the unification, the bipartisanship, work-together attitude that the president called for was just empty words for the House majority.”

The House vote on Wednesday was mostly along party lines, with two Democrats voting against the measure and no Republicans voting in favor. The Senate voted on Tuesday to begin debate on its budget blueprint.

New York City’s health commissioner, Dr. Dave A. Chokshi, in January. Dr. Chokshi tested positive for the virus and has been quarantining at home.
Credit…Mary Altaffer/Associated Press

Official news conferences during the pandemic are often impersonal affairs, replete with troubling statistics and details of the latest policies to control the virus.

On Thursday, the news conference of Mayor Bill de Blasio of New York City veered into the personal when two top city officials were asked about their experiences with the virus.

The officials were the police commissioner, Dermot F. Shea, who tested positive for the virus in early January, and the health commissioner, Dr. Dave A. Chokshi, who said on Wednesday he had recently tested positive for it. Mr. Shea has since recovered, and Dr. Chokshi, who previously said that he had been experiencing mild symptoms, was quarantining at home.

Dr. Chokshi spoke via video during the briefing, dressed in a dark suit and sitting in what appeared to be a bedroom.

“I am doing OK today,” he said, adding that he hoped “that remains the case.”

Dr. Chokshi said that he had not received the vaccine, even though he was a doctor and had worked shifts at the city’s vaccine hubs, because he “hadn’t felt quite right getting vaccinated while we still had such a limited supply” and while many vulnerable people were still waiting for it. He said that he planned to get vaccinated once he recovered.

The health commissioner said that he had likely caught the virus from a family member. He added that the city’s test and trace program had reached out to him, and the interaction had been professional and compassionate.

“This has just been a personal experience that has underlined all of those things that we try to do for the city as a whole,” Dr. Chokshi said.

Mr. Shea, who wore a mask and sat a good distance to the mayor’s right, said that he thought he had a mild case that was complicated slightly by asthma issues related to the terrorist attacks on Sept. 11, 2001.

The police commissioner said he had returned to exercising, cautiously, in the past week. The experience reminded him “of how fragile life is,” he said, and reinforced how New York, a bustling city of 8.5 million people, “gets really small at times like this too, and how people rally around each other.”