Johnson & Johnson Vaccine Access Slowed by Baltimore Plant Problems

Here’s what you need to know: Lining up for the Johnson & Johnson vaccine at a college in Los Angeles on Wednesday.Credit...Richard Vogel/Associated Press Supplies of Johnson & Johnson’s one-dose coronavirus vaccine will be extremely limited until federal regulators approve production at a Baltimore manufacturing plant under scrutiny, the White House’s pandemic response coordinator said Friday. With allocations of the Johnson & Johnson vaccine set to plunge by 86 percent next week, governors across the country warned that the loss of the supplies they were counting on would set back their vaccination drives, which have used the shot in more transient, isolated and rural areas where the one-dose vaccine has appealed to many Americans. The other two vaccines, made by Moderna and Pfizer-BioNTech, continue to flow out to the states at high volume. The distribution of Johnson & Johnson’s single-shot vaccine, has been inconsistent since the company delivered its first batch at the beginning of March, sending 2.8 million doses across the country before dipping below 400,000 in the following weeks. Last week, about 1.9 million doses were sent across the country, and this week, 4.9 million shots went out. Next week, that number will drop to 700,000. At a White House briefing on Friday, Jeffrey D. Zients, who leads the Biden administration’s Covid-19 response, said that Johnson & Johnson ultimately expects to be able to deliver as many as eight million doses weekly, if a Baltimore plant making the bulk of doses for the United States is cleared by the Food and Drug Administration. The New York Times reported last week that a mix-up at the factory had contaminated around 15 million doses of the Johnson & Johnson vaccine, delaying the plant’s authorization. But Mr. Zients said he could not speculate on when the F.D.A. would authorize production lines at the plant, allowing shipments to pick up. Until federal regulators give the green light, he said, Johnson & Johnson will only be able to deliver minimal doses of its one-shot vaccine, once heralded as a game changer in the nation’s rollout. Mr. Zients initially suggested that the firm would be able step up deliveries by the end of this month, then backed off, saying he did not know and could not speculate about what federal regulators might do. Last month, Johnson & Johnson was forced to jettison up to 15 million doses manufactured at the factory because the batch had been contaminated with a virus used in the production of AstraZeneca’s vaccine, which is also manufactured there. Another 62 million doses worth of the Johnson & Johnson vaccine are in jeopardy until it can be determined whether any of them were also contaminated. Even if the plant is authorized, most of those doses would still need to be bottled and labeled, adding more delays. Federal officials have said they still expect enough supply from the two other authorized vaccine manufacturers to be able to fulfill President Biden’s promise of having enough doses for all adults in the country by the end of May. Nonetheless, states were counting on the Johnson & Johnson vaccine to fill important gaps in vaccination campaigns. Easier to store and transport — the vaccine can be kept at normal refrigeration temperatures for three months — states had begun using it in transformative ways, on homeless populations, migrant workers and college students. Federal administrators divide vaccine doses nationwide based on each state’s adult population. That means that California will bear the brunt of the reduction: After receiving 572,700 doses of the Johnson & Johnson vaccine this week, it will get only 67,600 next week, according to Centers for Disease Control and Prevention data. In Texas, the allocation will drop to 46,300 from 392,100. Florida, which received 313,200 shots this week, will get 37,000 next week. Guam, which received 16,900 doses this week, will receive none next week. In Michigan, Gov. Gretchen Whitmer said Friday that she had urged President Biden to surge Covid-19 vaccines into her state, where a worst-in-the-nation outbreak has filled hospitals and forced some schools to close. “At this point that’s not being deployed, but I am not giving up,” Ms. Whitmer said, describing a Thursday evening call with the president. “Today it’s Michigan and the Midwest. Tomorrow it could be another section of our country.” Ms. Whitmer, a Democrat whom the president considered as a potential running mate, took pains to praise aspects of Mr. Biden’s coronavirus response at a Friday news conference. But Ms. Whitmer said a rapid influx of shots, particularly the Johnson & Johnson vaccine, was essential to tamping down case numbers even as she resisted additional restrictions on gatherings and businesses. Jeff Zients, the White House Covid coordinator, said at a news briefing on Friday that the administration does not plan to shift additional vaccine doses to hard-hit states like Michigan, which is slated to get ano

Johnson & Johnson Vaccine Access Slowed by Baltimore Plant Problems
Here’s what you need to know: Lining up for the Johnson & Johnson vaccine at a college in Los Angeles on Wednesday.Credit...Richard Vogel/Associated Press Supplies of Johnson & Johnson’s one-dose coronavirus vaccine will be extremely limited until federal regulators approve production at a Baltimore manufacturing plant under scrutiny, the White House’s pandemic response coordinator said Friday. With allocations of the Johnson & Johnson vaccine set to plunge by 86 percent next week, governors across the country warned that the loss of the supplies they were counting on would set back their vaccination drives, which have used the shot in more transient, isolated and rural areas where the one-dose vaccine has appealed to many Americans. The other two vaccines, made by Moderna and Pfizer-BioNTech, continue to flow out to the states at high volume. The distribution of Johnson & Johnson’s single-shot vaccine, has been inconsistent since the company delivered its first batch at the beginning of March, sending 2.8 million doses across the country before dipping below 400,000 in the following weeks. Last week, about 1.9 million doses were sent across the country, and this week, 4.9 million shots went out. Next week, that number will drop to 700,000. At a White House briefing on Friday, Jeffrey D. Zients, who leads the Biden administration’s Covid-19 response, said that Johnson & Johnson ultimately expects to be able to deliver as many as eight million doses weekly, if a Baltimore plant making the bulk of doses for the United States is cleared by the Food and Drug Administration. The New York Times reported last week that a mix-up at the factory had contaminated around 15 million doses of the Johnson & Johnson vaccine, delaying the plant’s authorization. But Mr. Zients said he could not speculate on when the F.D.A. would authorize production lines at the plant, allowing shipments to pick up. Until federal regulators give the green light, he said, Johnson & Johnson will only be able to deliver minimal doses of its one-shot vaccine, once heralded as a game changer in the nation’s rollout. Mr. Zients initially suggested that the firm would be able step up deliveries by the end of this month, then backed off, saying he did not know and could not speculate about what federal regulators might do. Last month, Johnson & Johnson was forced to jettison up to 15 million doses manufactured at the factory because the batch had been contaminated with a virus used in the production of AstraZeneca’s vaccine, which is also manufactured there. Another 62 million doses worth of the Johnson & Johnson vaccine are in jeopardy until it can be determined whether any of them were also contaminated. Even if the plant is authorized, most of those doses would still need to be bottled and labeled, adding more delays. Federal officials have said they still expect enough supply from the two other authorized vaccine manufacturers to be able to fulfill President Biden’s promise of having enough doses for all adults in the country by the end of May. Nonetheless, states were counting on the Johnson & Johnson vaccine to fill important gaps in vaccination campaigns. Easier to store and transport — the vaccine can be kept at normal refrigeration temperatures for three months — states had begun using it in transformative ways, on homeless populations, migrant workers and college students. Federal administrators divide vaccine doses nationwide based on each state’s adult population. That means that California will bear the brunt of the reduction: After receiving 572,700 doses of the Johnson & Johnson vaccine this week, it will get only 67,600 next week, according to Centers for Disease Control and Prevention data. In Texas, the allocation will drop to 46,300 from 392,100. Florida, which received 313,200 shots this week, will get 37,000 next week. Guam, which received 16,900 doses this week, will receive none next week. In Michigan, Gov. Gretchen Whitmer said Friday that she had urged President Biden to surge Covid-19 vaccines into her state, where a worst-in-the-nation outbreak has filled hospitals and forced some schools to close. “At this point that’s not being deployed, but I am not giving up,” Ms. Whitmer said, describing a Thursday evening call with the president. “Today it’s Michigan and the Midwest. Tomorrow it could be another section of our country.” Ms. Whitmer, a Democrat whom the president considered as a potential running mate, took pains to praise aspects of Mr. Biden’s coronavirus response at a Friday news conference. But Ms. Whitmer said a rapid influx of shots, particularly the Johnson & Johnson vaccine, was essential to tamping down case numbers even as she resisted additional restrictions on gatherings and businesses. Jeff Zients, the White House Covid coordinator, said at a news briefing on Friday that the administration does not plan to shift additional vaccine doses to hard-hit states like Michigan, which is slated to get another 17,500 Johnson & Johnson doses next week, an 88 percent drop compared to the nearly 148,000 doses it was allocated this week, according to C.D.C. data. The mistake that ruined so many doses occurred a plant in southeast Baltimore run by Emergent BioSolutions. Earlier in the spring, federal officials had projected that regulators would certify the plant by early April, and Johnson & Johnson would then be able deliver about four million doses a week beginning in April. Shipments are now limited to about 10 million doses a week from Moderna and more than 13 million a week from Pfizer. Johnson & Johnson fell behind this winter on its production goals for the United States, delivering less than it had promised in February and March. All of the doses of Johnson & Johnson’s vaccine used so far in the United States came from a Dutch plant and were delivered on an uneven schedule. That led the Biden administration to warn state health officials that the supply of the vaccine would be variable. But federal officials expected that with the help of the Emergent factory in Baltimore, there would be a steady stream of doses from the company in April. Now, with that plant still lacking authorization, the anticipated delivery schedule is up in the air. In Maryland, the state health secretary, Dennis R. Schrader, told vaccine providers that the “significant decrease with no advance notice is a surprise and a disappointment, and we share your frustration.” The state will receive 78,300 less shots next week compared with this week. The C.D.C. said on Thursday that about 112 million people in the United States had received at least one dose of a vaccine, including about 66.2 million people who have been fully vaccinated by Johnson & Johnson’s single-dose vaccine or the two-dose series made by Pfizer-BioNTech and Moderna. Mitch Smith and Julie Bosman contributed reporting. Video transcript Back bars 0:00/1:07 -0:00 transcript Michigan’s Governor Urges Caution as Virus Cases Surge Gov. Gretchen Whitmer of Michigan called on residents of the state to exercise caution and practice upholding social distancing measures as coronavirus cases across the state spread. Anyone who looks at a Covid map knows Michigan is unquestionably a national hotspot, right now. My team and I have been in regular conversation with the national Covid response team, and we have asked for more vaccines. But as we take a hard look at the data and observe the spread of the variants, we all need to go above and beyond the rules we already have in place. We all have to step up our game for the next two weeks to bring down rising cases. And that’s why I’m calling on high schools to voluntarily go remote for two weeks past spring break. Calling on youth sports to voluntarily suspend games and practices for two weeks. And I’m strongly encouraging all Michiganders to avoid dining indoors and avoid gathering with friends indoors for two weeks. This is my ask to you, the people of Michigan. Please redouble your efforts on these fronts for the next couple of weeks. I know Michiganders are concerned about the latest rise in cases, and I am too. We’ve come so far, we’ve sacrificed so much. This has changed every aspect of our lives for over a year. We can’t let up now, not when we’re so close. Gov. Gretchen Whitmer of Michigan called on residents of the state to exercise caution and practice upholding social distancing measures as coronavirus cases across the state spread.CreditCredit...Jake May/The Flint Journal, via Associated PressGov. Gretchen Whitmer of Michigan said Friday that she had urged President Biden to surge Covid-19 vaccines into her state, where a worst-in-the-nation outbreak has filled hospitals and forced some schools to close. “I made the case for a surge strategy. At this point that’s not being deployed, but I am not giving up,” Ms. Whitmer said, describing a Thursday evening call with the president. “Today it’s Michigan and the Midwest. Tomorrow it could be another section of our country.” Ms. Whitmer, a Democrat whom the president considered as a potential running mate, took pains to praise aspects of Mr. Biden’s coronavirus response at a Friday news conference. But Ms. Whitmer said a rapid influx of shots, particularly the one-dose Johnson & Johnson vaccine, was essential to tamping down case numbers even as she resisted additional restrictions on gatherings and businesses. Johnson & Johnson will send 86 percent fewer doses across the United States next week than are currently being allocated, according to data provided by the Centers for Disease Control and Prevention, dealing a setback to a national vaccination campaign that has just found its footing. Michigan is slated to get another 17,500 Johnson & Johnson doses next week, an 88 percent drop compared to the nearly 148,000 doses it was allocated this week, according to C.D.C. data. “The Biden administration does have a strategy and by in large it is working,” Ms. Whitmer said. “As should be expected, though, in an undertaking of this magnitude, there are shortcomings and different points of view.” About 75 percent of vaccine doses sent to Michigan have been administered, according to federal data, near the middle of the pack nationally. Jeff Zients, the White House Covid coordinator, said at a news briefing on Friday that the administration does not plan to shift additional vaccine doses to hard-hit states like Michigan. “There are tens of millions of people across the country in each and every state and county who have not yet been vaccinated, and the fair and equitable way to distribute the vaccine is based on the adult population by state, tribe and territory,” he said. “That’s how it’s been done, and we will continue to do so. The virus is unpredictable. We don’t know where the next increase in cases could occur.” Ms. Whitmer elevated her national profile last year by taking a tough, unapologetic approach to restrictions despite pushback from the Republicans who control the state’s Legislature. But as cases have risen again this year, she has taken a dramatically different tack. On Friday, she asked for high schools to voluntarily move classes online for two weeks and asked youth sports organizers to pause games and practices during that period. Ms. Whitmer also suggested, but did not require, that residents avoid eating inside restaurants for two weeks. “It is less of a policy problem that we have and more of a compliance and variants issue that we are confronting,” Ms. Whitmer said. “Policy change alone won’t change the tide. We need everyone to step up and to take personal responsibility here.” The outbreak in Michigan is bad and getting worse. Hospitalizations have more than tripled in the last month and cases continue to spike. About 7,200 new cases are being reported each day, a sevenfold increase since late February. And 16 of the 20 metro areas with the country’s highest recent case rates are in Michigan. Debra Furr-Holden, an epidemiologist at Michigan State University, said before the governor’s announcement on Friday that the state should reimpose restrictions that were loosened just before the most recent surge. “What it looks like happened is she tried to be fair and meet us in the middle,” said Dr. Furr-Holden, who was appointed last year by Ms. Whitmer to the state’s Coronavirus Task Force on Racial Disparities. “And what I think we’ve learned — and I hope other states will get the message — is that there really isn’t a lot of middle ground here. We just have to tighten up and hold tight.” But there is also a sense — articulated by Ms. Whitmer, politicians from both parties and even some public health officials — that pandemic fatigue and partisanship have limited the effectiveness that any new state mandates might have. “It’s been a long time,” said Mayor Pauline Repp of Port Huron, where case rates are among the highest in the country. “It’s a long time to be restrictive and you get to the point where you kind of think, ‘Will life ever go back to normal?’” Eileen Sullivan contributed reporting. Administering the AstraZeneca vaccine in Paris.Credit...Christophe Archambault/Agence France-Presse — Getty Images Recipients of a first dose of AstraZeneca’s Covid-19 vaccine who are under 55 should get a second shot with other vaccines, France’s top health regulator said on Friday. Several European countries briefly suspended use of the AstraZeneca vaccine last month because of the risk of rare blood clots. France resumed administering shots of the AstraZeneca vaccine after European health regulators vouched for it, though only to people 55 and older. That left over 500,000 younger people who had received a first dose wondering how they would get their second. (In Britain, the authorities recommended the opposite strategy on Thursday: Health Minister Matt Hancock said that the 1.5 million people age 18 to 29 who had received one AstraZeneca dose should get a second injection of the same vaccine. Others, he said, would be offered an alternative.) France’s top health agency said on Friday that a single shot of the AstraZeneca vaccine was “insufficient” for lasting and efficient protection from the virus. It recommended administering a shot of vaccines like those produced by Pfizer or Moderna 12 weeks after the initial AstraZeneca jab. The new guidelines in France come amid growing skepticism over the use of the AstraZeneca vaccine across Europe. In Spain, the authorities in the Madrid region said that nearly 20,000 people had turned down the vaccine on Thursday after the country’s central government changed the age threshold for its use to 60. A regional health official said that more than 60 percent of the people called up for vaccination in Madrid had not shown up, higher than the no-show rate of two percent before the authorities announced the change. The official, Antonio Zapatero, called on the central government and European officials to authorize the use of Russia’s Sputnik V vaccine to speed up the country’s vaccination campaign. In France, Dominique Le Guludec, who heads the country’s top health agency, said at a news conference that the immune reaction to a second dose was sometimes stronger than the first, which could expose younger people to heightened risks of rare blood clotting if they got a second AstraZeneca shot. Prof. Élisabeth Bouvet, who leads the health authority’s vaccine committee, said at the news conference that clinical data on mixing and matching vaccines was still sparse. But she stressed that available data indicated that the strategy was safe. “There is no reason to fear any particular side effects,” Professor Bouvet said. The health authority said that the mixing of Covid-19 vaccines would be closely monitored to assess people’s immune response and to ensure adequate protection from the virus. The twists and turns over use of the AstraZeneca vaccine in Europe have put a dent in people’s trust in the vaccine over the past months, but Ms. Le Guludec emphasized that it was still efficient and broadly safe to use. “Those older than 55 represent over 95 percent of the 98,000 people who have died of the coronavirus in France,” she said. “This vaccine will therefore save lives, and if we want to win the battle against the virus, we must use all the weapons at our disposal.” Preparing a dose of the Johnson & Johnson vaccine in Hempstead, N.Y., last month.Credit...Chang W. Lee/The New York Times The risk-assessment committee of the European Medicines Agency is investigating whether a handful of blood-clotting events could be linked to Johnson & Johnson’s one-dose vaccine, the agency said on Friday, though it was unclear whether there was any casual link. The agency, which is the European Union drug regulator, said serious cases of “unusual blood clots with low blood platelets” have been reported in four people after they received the Johnson & Johnson shot. It’s unclear if any of them were caused by the vaccine. One of the cases emerged in a clinical trial, though it was not immediately clear where the trial was held. Three other cases were found in people in the United States after vaccinations. One of the four people died, though it was unclear where it happened. According to the Centers for Disease Control and Prevention, about 4.9 million people in the United States, as of Thursday, have been vaccinated with the Johnson & Johnson shot, which was developed by the company’s drug development arm, Janssen Pharmaceuticals. The Food and Drug Administration did not have an immediate statement. The company noted that blood clotting events have been reported with other Covid-19 vaccines. “Our close tracking of side effects has revealed a small number of very rare events following vaccination,” the company said in a statement. “At present, no clear causal relationship has been established between these rare events and the Janssen Covid-19 vaccine.” The vaccine, which is easier to store than vaccines manufactured by other companies and has the benefit of being a one-and-done shot, is being widely used only in the United States. It has been approved for use by European Union states, but has not yet been rolled out, the agency said. Use of the Oxford-AstraZeneca vaccine has been limited in many countries because of blood-clotting issues. Earlier this week, the European Medicines Agency said that blood clots and low blood platelets should be listed as a very rare side effect of that vaccine. A blood clot is a thickened, gelatinous blob of blood that can block circulation. Clots form in response to injuries and can also be caused by many illnesses, including cancer and genetic disorders, certain drugs and prolonged sitting or bed rest. Clots that form in the legs sometimes break off and travel to the lungs or, rarely to the brain, where they can be deadly. Blood clots are common in the general population. From 300,000 to 600,000 people a year in the United States develop blood clots in their lungs or in veins in the legs or other parts of the body, according to the C.D.C. Carl Zimmer, Monika Pronczuk and Denise Grady contributed reporting. — Kaly Soto Former Trump health adviser Paul Alexander sent messages to Michael Caputo, right, celebrating efforts to alter reports by career scientists.Credit...Sam Hodgson for The New York Times Political appointees in the Trump administration’s health and human services department celebrated their efforts last year to alter reports written by career scientists at the Centers for Disease Control and Prevention, according to new emails released by the House’s select committee investigating the federal government’s pandemic response. Paul Alexander, a science adviser in the department’s communications office who regularly clashed with the C.D.C., wrote to the agency’s acting chief of staff, Nina Witkofsky, in August claiming that attempts to influence the agency’s closely-guarded guidance on disease outbreaks, known as the Morbidity and Mortality Weekly Reports, had been a success. “The last 2 MMWR reports have been more positive than usual and I find encouraging,” Dr. Alexander wrote. “So have you seen this shift? Maybe you are having a huge impact and this is tremendous. Well done!” The emails were the latest evidence of how a small group of Trump loyalists at the Department of Health and Human Services used their roles last year to question career scientists at the C.D.C. and label them antagonists bent on hurting the political fortunes of Mr. Trump. Their messages were released as part of the House investigation into the federal government’s pandemic response. The committee asked for interviews with Dr. Alexander and Dr. Scott Atlas, a White House pandemic adviser with no background in infectious disease responses. Dr. Alexander, who had been a part-time professor at McMaster University in Canada, and Michael Caputo, a longtime Trump loyalist with no health background, repeatedly attempted to edit and halt the agency’s latest research on the spread of the virus. In a separate email with the subject line “Examples of CDC adjusting writing based on my inquiry,” Dr. Alexander claimed success in altering a report on transmission of the virus at an overnight camp. The changes, Dr. Alexander wrote, were a “small victory but a victory nonetheless and yippee!!!” In one exchange last May between Dr. Alexander and Mr. Caputo, the two planned an effort they saw as a boost to Mr. Trump: organizing data on what they viewed as the social and economic costs of shutdown policies. That campaign would be similar to one the president waged as he fought against states with more restrictive responses to the virus. “I know the President wants us to enumerate the economic cost of not reopening. We need solid estimates to be able to say something like: 50,000 more cancer deaths! 40,000 more heart attacks!” wrote Mr. Caputo, who at one point accused C.D.C. scientists of sedition. “You need to take ownership of these numbers. This is singularly important to what you and I want to achieve.” Around the time Dr. Alexander celebrated his efforts to edit the C.D.C. reports, he worked to draft an op-ed column under the name of Dr. Atlas, pushing to keep schools open during the pandemic. It later appeared in the New York Post. In Berlin last month.Credit...Lena Mucha for The New York Times BERLIN — Germany’s government plans to ask lawmakers to grant it stronger powers in order to introduce a nationwide lockdown as the country is gripped by a third wave of the coronavirus. The country’s approach has so far been to have the governors of Germany’s 16 states agree to any nationwide pandemic policies. But as calls from public health officials have grown stronger for a new nationwide lockdown in recent weeks, Chancellor Angela Merkel has had trouble gaining all of the governors’ support. The lawmakers’ new plan seeks overcome regional differences in how to curb the latest surge in cases. It will be put before Ms. Merkel’s cabinet next week, Ulrike Demmer, a spokeswoman for the chancellor, told reporters on Friday. The law would spell out which restrictions would be imposed in areas with over 100 new cases per 100,000 residents over a period of seven days. “Germany is in the middle of a third wave, so the federal government and the states have agreed to add to the national legislation,” Ms. Demmer said. Last month, the chancellor sought to impose a strict lockdown over the Easter holiday weekend, only to retract that move in the face of criticism from opposition lawmakers and industry leaders. She also offered a public apology. Speaking on national television, she then raised the idea of seeking Parliament’s support in consolidating her government’s powers to ensure that all states abide by the same rules. Germany has been wary of consolidating power in the central government since World War II, but several lawmakers have backed the idea for this specific circumstance. “The aim here is to create uniform national rules,” Ms. Demmer said, adding that the law change would be put before cabinet on Tuesday. The German authorities registered 25,464 new infections on Thursday, 3,576 more than a week ago. On Thursday, nearly 300 people died of the virus. “There will be, once again, a couple of difficult weeks,” Health Minister Jens Spahn said on Friday, calling for a unified lockdown. “It is about not overburdening our health care system. It is about protecting human lives.” A planned meeting between the chancellor and state leaders that was planned for Monday was canceled as part of the decision, Ms. Demmer said. Christopher F. Schuetze contributed reporting. Video The coronavirus variant first detected in Britain is now spreading in at least 114 countries, and nowhere are its devastating effects as visible as in Europe, where thousands are dying each day and already-battered economies are being hit by new restrictions on daily life. The variant, known as B.1.1.7, is not only more contagious than the virus’s initial form, but is also deadlier. With the mutation now propelling a surge in cases in Europe — the epicenter of the pandemic last spring — an interactive article by The New York Times’s graphics team outlines the toll that the B.1.1.7 variant is taking on the continent, and lessons that it might offer the world. Having surged in Britain starting in December, the variant also seeded outbreaks across the continent, but many went unnoticed behind an overall drop in cases. Those outbreaks have since ballooned, and B.1.1.7 has crowded out other versions of the virus, becoming dominant in more than a dozen European countries. Despite watching the B.1.1.7 variant wallop Britain, lawmakers in continental Europe were slow to react. In late January, President Emmanuel Macron of France defied calls from his scientific advisers for new restrictions. Now, daily cases have doubled, hospitals are swelling with patients and Mr. Macron has imposed a third national lockdown. “What’s surprising to me is how many countries didn’t anticipate what B.1.1.7 would bring,” said Devi Sridhar, a professor of global public health at the University of Edinburgh in Scotland. “People underestimated it, instead of saying we should learn from what’s happening in the U.K.” A teenager receives a dose of the Pfizer-BioNTech vaccine in New York on Tuesday. The companies asked to expand their vaccine’s emergency use authorization to include adolescents ages 12 to 15.Credit...Shannon Stapleton/Reuters Pfizer and BioNTech requested on Friday that the Food and Drug Administration expand the emergency use authorization for their coronavirus vaccine to permit its use in children ages 12 to 15. If broadened, young adolescents could start getting vaccinated before going back to school in the fall. The companies plan to request similar authorizations from health agencies around the world in the coming days, they said in a joint statement. “These submissions represent a critical step in Pfizer’s and BioNTech’s ongoing efforts to support governments in broadening global vaccination efforts,” the statement said. Clinical trial results found the vaccine highly effective in that age group, the companies said last month. The Pfizer-BioNTech vaccine is currently approved for use via emergency authorization in people 16 and older. Granting approval for its use in the younger age group would also speed the country’s efforts to reach herd immunity, which will depend on vaccinating children. More than 2,000 young adolescents participated in a Phase 3 trial of the vaccine. Among those who received the vaccine, none developed symptomatic coronavirus infections or exhibited serious side effects, the companies said last month. The vaccinated 12- to 15-year-olds also produced higher levels of antibodies, on average, than older adolescents and young adults did. The trial results have not yet been published in a scientific journal. — Emily Anthes People in Nairobi, Kenya, waited in line on Thursday to receive doses of the AstraZeneca vaccine provided through the Covax initiative. Covax announced it has not reached its distribution goal due to short supply of doses.Credit...Brian Inganga/Associated Press Covax, a global initiative dedicated to distributing coronavirus vaccines to low- and middle-income countries, has delivered just 38 million doses so far, falling short of the 100 million doses it had expected to distribute by now, the World Health Organization said on Friday. “Most countries do not have anywhere near enough vaccines to cover all health workers, or all at-risk groups, never mind the rest of their populations,” said Dr. Tedros Adhanom Ghebreyesus, the director general of the W.H.O. “There remains a shocking imbalance in the global distribution of vaccines.” Although the pace of vaccinations has sped up considerably in the United States, where about a third of the total population has received at least one shot of the vaccine, enormous disparities exist between nations. In other high-income countries, nearly one in four adults have received a vaccine, Dr. Tedros said. In low-income countries, which have received just 0.2 percent of the world’s vaccine supply so far, that figure is one in 500. Covax, which is run by the W.H.O. and relies on donors, was $32 billion short of the funding it needed, Dr. Tedros said in February. China and Russia have been donating vaccine supplies globally, while the United States has focused on vaccinating its entire adult population as quickly as possible. The Biden administration had agreed to donate $4 billion to Covax earlier this year, and it has faced pressure to donate more of its supply after securing more than enough vaccine doses to guarantee American adults can be inoculated. The W.H.O. and other Covax partners are currently investigating ways to boost supply, including accelerating the release of new vaccines and asking for donations from countries that have extra doses, Dr. Tedros added. — Emily Anthes A woman showed her Green Pass before entering a show at an opera house in Tel Aviv. Israel is one of the countries that has already implemented the use of digital vaccine passports.Credit...Dan Balilty for The New York Times Vaccine rollouts in some countries have world travelers dreaming of trips abroad again, as travel destinations eagerly await the return of the tourism lifeline. But a ticket to travel that requires some kind of vaccine documentation has set off a fraught debate about the fairness of a two-tier system for haves and have-nots. Almost everywhere, the pressure to restart international travel is forcing the debate. With tens of millions of people vaccinated, and governments desperate to reopen their economies, businesses and individuals are pushing to regain more freedom of movement. Verifying whether someone is inoculated is the simplest way to do that. At its simplest, this verification is something like the physical card created by the Centers for Disease Control and Prevention, typically given to people in the United States after their first Covid-19 shot. Similarly, the World Health Organization has a “yellow card,” used for decades by travelers to show inoculation against diseases like yellow fever. But paper documents are vulnerable to forgery, which makes vaccine passports (as they are commonly called) appealing as an electronic record of vaccination — possibly in the form of a QR code easily accessible through a smartphone, or possibly stored on the device or printed out. Some versions are taking shape or already in use. Israel’s version, for example, allows people who are fully vaccinated to go to bars, restaurants, concerts and sporting events. (Israel has vaccinated more than half its population, and the vast majority of its older people.) At this point, allowing access only to vaccinated people deprives young people of access to many of the pleasures of their elders. In most cases, consideration of vaccine passports has heavily focused on international travel and not domestic everyday life. In some strictly quarantined countries like China and Singapore, it is not clear that a vaccine passport designed for travel would also be used for citizens at home, setting up another inconsistency between those who can afford to travel freely overseas and those who continue to live under onerous restrictions at home. Any requirement to prove vaccination status would discriminate against those who can’t get the shot or refuse to, and there is lingering uncertainty about how well inoculation prevents virus transmission. For those reasons, the W.H.O. said this week that it does not support requiring proof of vaccination for travel — for now. A man waiting for the results of a mandatory Covid-19 test given to all new arrivals at Hong Kong International Airport in October.Credit...Anthony Wallace/Agence France-Presse — Getty Images The Hong Kong government said last month that it would allow hundreds of residents who have been stranded in Britain by virus-related travel restrictions to return on two special flights. But when those residents went to book seats on flights, the website for Cathay Pacific Airways, Hong Kong’s flag carrier, crashed. The snafu on Thursday was the latest chapter in a bureaucratic saga that has left them feeling angry, confused and exasperated. The Hong Kong government suspended flights from Britain in December as a coronavirus variant spread through that country. It also barred anyone who had spent more than two hours there or in other “extremely high-risk” places in the previous 21 days from boarding a direct flight to the Chinese territory. Those measures, which remain in effect, also apply to inbound travelers who have recently been to Brazil, Ireland or South Africa. But last week Hong Kong said that it would arrange two special return flights from London on Cathay Pacific in late April. It cited Britain’s declining caseload and “satisfactory vaccination progress” as reasons for the policy shift. When the airline’s website crashed on Thursday, said Anthony Sheik Bux, a district councilor in Hong Kong who has been helping the stranded travelers, “people panicked” and started contacting him. In a statement on Friday, Cathay Pacific apologized for the glitch and said that roughly 600 seats on the two flights — scheduled for April 21 and April 28 — had sold out after the website problem was resolved. The South China Morning Post newspaper reported last week that the travel ban had stranded more than 600 Hong Kong residents in Britain. Mr. Bux said on Friday that some of them had been unable to book seats on the special flights. It was unclear whether additional flights would be offered, or why officials in Hong Kong, where the borders have been closed to nonresidents for more than a year, waited more than three months to schedule the two flights. A spokeswoman for the Immigration Department referred questions on Friday to the Food and Health Bureau, which declined to comment. Mr. Bux said he could sympathize with the stranded travelers because he, too, had been stranded by the December ban while visiting family in Liverpool. He said he was among the 200 to 300 Hong Kong residents who had managed to make it home from Britain after spending a 21-day “wash out” period in a third country like Thailand, Egypt or the United Arab Emirates. In Mr. Bux’s case, he flew to Bangkok on Feb. 7 and arrived home more than three weeks later — only to begin a mandatory three-week hotel quarantine, one of the world’s longest. Some scientists have questioned whether that policy is too strict because the coronavirus is widely considered to have a 14-day incubation period. “After my departure from the U.K., I needed 42 days to resume my normal life in Hong Kong,” he said. “It’s a really long period.” Volunteers assisting people who received the Moderna vaccine at a drive-through site on the campus of Delta State University in Cleveland, Miss., in March.Credit...Rory Doyle for The New York Times When it comes to getting a coronavirus vaccine, Mississippi residents have an abundance of options. On Thursday, there were more than 73,000 slots to be had on the state’s scheduling website, up from 68,000 on Tuesday. In some ways, that growing availability of appointments is something to celebrate: It reflects the mounting supplies that have prompted states across the country to open up eligibility to anyone over 16. But public health experts say it also exposes something more worrisome: the large number of people who are reluctant to be inoculated. “It’s time to do the heavy lifting needed to overcome the hesitancy we’re encountering,” said Dr. Obie McNair, an internal medicine practitioner in Jackson, the state capital. Although access remains a problem in rural Mississippi, experts say that the state — which three weeks ago became one of the first to open eligibility to all adults — may be a harbinger of what much of the country will confront in the coming weeks as increasing supplies enable most Americans who want the vaccine to easily make appointments. Demographics help explain Mississippi’s challenge. The state reliably votes Republican, a group that remains highly skeptical of coronavirus vaccines. And its population is 38 percent Black, a group that in one recent survey indicated a lower willingness to be vaccinated than Hispanic or white people. The hesitancy has national implications. Experts say that 70 to 90 percent of people in the United States must be vaccinated for the country to reach herd immunity, the point at which the virus can no longer spread through the population. In Mississippi, a quarter of all residents have received at least one vaccine dose, compared with the nationwide average of 33 percent, according to state data. Other Southern states, including Alabama, Arkansas, Georgia and Tennessee, have similarly low rates of vaccination. Some other heavily Republican states are also finding themselves with surfeits of doses. Officials in Oklahoma, which has delivered at least one dose to 34 percent of its residents, said on Thursday that they would open up eligibility to out-of-state residents. In recent weeks, Republican governors in Ohio and Georgia voiced concern about lackluster vaccine demand among their residents. Tim Callaghan, an assistant professor at the Texas A&M University School of Public Health and an expert on vaccine skepticism, said that more research was needed to determine the reasons behind Mississippi’s slackening vaccine demand, but that states with large rural populations, Republican voters and African-Americans were likely to be the first to confront the problem. “If you’re looking to see vaccine hesitancy to emerge,” he said, “it’s going to be in red states like Mississippi.” Visiting Yosemite Valley National Park in California in November.Credit...Peter Dasilva/EPA, via Shutterstock Reservations will be required for day visitors to Yosemite National Park beginning next month, the park said on Thursday, a system that officials hope will reduce the risk of Covid-19 exposure as the demand for domestic travel increases around the United States. Yosemite, in central California, has seen more than four million annual visitors in recent years, with people drawn to its giant sequoia groves, wilderness and waterfalls. Last year, that number was cut nearly in half, according to the National Park Service. Day-use reservations will be required for all visitors this year, including annual and lifetime pass holders, the park said in a news release. Reservations will be valid for three days and will be required from May 21 through Sept. 30, or until local public health conditions improve. “The health and safety of park visitors, employees and partners continues to be our number one priority,” the park said. It added that it would continue to work with local public health officials to ensure that visitation would not overwhelm the region’s “limited rural health care system.” Yosemite National Park also instituted a reservation system last summer, and this summer similar programs have been announced by Rocky Mountain National Park in Colorado and Glacier National Park in Montana. Travel across the United States has been on the rise in recent weeks, and travel experts expect domestic travel this summer to grow to within 5 percent of prepandemic levels. On March 12, more than 1.3 million people passed through U.S. airports, the highest number on any day since March 2020. Airlines have also added new flight routes and revived old ones, another sign that demand is picking up as national vaccination rates rise. A healthcare worker prepares doses of a Covid-19 vaccine at a clinic in Derbyshire, England, last month. Britain has been delaying second doses of the vaccine in an effort to vaccinate more people.Credit...Oli Scarff/Agence France-Presse — Getty Images The prospect of a fourth wave of the coronavirus, with new cases climbing sharply in the Upper Midwest, has reignited a debate among vaccine experts over how long to wait between the first and second doses. Extending that period would swiftly increase the number of people with the partial protection of a single shot, but some experts fear it could also give rise to dangerous new variants. In the United States, two-dose vaccines are spaced three to four weeks apart, matching what was tested in clinical trials. But in Britain, health authorities have delayed doses by up to 12 weeks in order to reach more people more quickly. And in Canada, which has precious few vaccines to go around, a government advisory committee recommended on Wednesday that second doses be delayed even longer, up to four months. Some health experts think the United States should follow suit. Dr. Ezekiel J. Emanuel, a co-director of the Healthcare Transformation Institute at the University of Pennsylvania, has proposed that for the next few weeks, all U.S. vaccines should go to people receiving their first dose. “That should be enough to quell the fourth surge, especially in places like Michigan, like Minnesota,” he said in an interview. Dr. Emanuel and his colleagues published the proposal in an op-ed on Thursday in USA Today. But opponents, including health advisers to the Biden administration, argue that delaying doses is a bad idea. They warn it will leave the country vulnerable to variants — those already circulating, as well as new ones that could evolve inside the bodies of partially vaccinated people who are not able to swiftly fight off an infection. “It’s a very dangerous proposal to leave the second dose to a later date,” said Dr. Luciana Borio, the former acting chief scientist of the Food and Drug Administration. Dr. Anthony S. Fauci, the nation’s top infectious-diseases expert, agreed. “Let’s go with what we know is the optimal degree of protection,” he said. Britain has been able get first doses into an impressive number of arms. As of Thursday, 48 percent of the British population has received at least one dose. By contrast, the United States has delivered at least one dose to just 33 percent of Americans. In January, some researchers lobbied for the United States to follow Britain’s example. But the government stayed the course, arguing that it would be unwise to veer off into the unknown in the middle of a pandemic. Although the clinical trials did show some early protection from the first dose, no one knew how well that partial protection would last. In recent weeks, however, proponents of delaying doses have been able to point to mounting evidence suggesting that a first dose can provide potent protection that lasts for a number of weeks. The Centers for Disease Control and Prevention reported that two weeks after a single dose of either the Moderna or the Pfizer-BioNTech vaccine, a person’s risk of coronavirus infection dropped by 80 percent. And researchers in Britain have found that first-dose protection is persistent for at least 12 weeks. President Biden visited the Centers for Disease Control and Prevention in Atlanta last month.Credit...Doug Mills/The New York Times President Biden’s spending plan calls for an almost 25 percent increase in discretionary funding — to $131.7 billion — for the Health and Human Services Department, the hub of the federal government’s pandemic response. That increase includes a $1.6 billion increase for the Centers for Disease Control and Prevention, an agency public health experts have viewed as chronically underfunded and neglected until public health emergencies. Data collection would be modernized, and epidemiologists would be trained to support local health departments. Almost a billion dollars would go to the Strategic National Stockpile, the country’s emergency medical reserve, for supplies and efforts to restructure it that began last year. The blueprint also calls for $6.5 billion to launch the Advanced Research Projects Agency for Health — part of a requested $51 billion for the typically well-funded National Institutes of Health. The new agency would fund federal research, with a focus on cancer and diseases such as diabetes and Alzheimer’s. Outside of pandemic response, the White House wants to expand spending in several areas that were also budget priorities for the Trump administration: fighting the opioid epidemic and eradicating H.I.V. and AIDS. But on other matters, it diverges clearly from Trump administration policies. The Biden plan would expand spending on the Title X program that provides family planning services to low-income Americans — under Mr. Trump, that program was retooled to reduce the number of eligible providers. The proposal would also double spending on research into the causes of gun-related death and injury, an area long neglected because of political polarization. But most health spending in the country is not discretionary, meaning the proposals do not tell us what the Biden administration hopes to do in Medicaid, Medicare and the Affordable Care Act marketplaces, among other large programs. The American Rescue Plan included some short-term funding to expand Affordable Care Act subsidies that help Americans buy insurance, and the administration has signaled it hopes to make those changes permanent. So far, Mr. Biden has been quiet about whether he will pursue other health initiatives that were part of his campaign, such as lowering the age of eligibility for Medicare or establishing a government-run alternative for private health insurance, known as a public option, for Obamacare users. Global Roundup Passengers at Heathrow Airport in London this year. Prime Minister Boris Johnson’s government is expected to announce new travel recommendations on May 17.Credit...Matthew Childs/Reuters England’s residents will probably be allowed to travel abroad this summer, a government official said on Friday, as the authorities plan to announce new travel guidelines next month. “For the first time, people can start to think about visiting loved ones abroad, or perhaps a summer holiday, but we’re doing it very, very cautiously,” said Grant Shapps, the transportation minister. For months, the authorities in the country have asked residents not to book summer vacations abroad, and the cautious recommendation on Friday was the first official indication that travel could soon be allowed. Prime Minister Boris Johnson’s government is expected to announce new travel recommendations on May 17 based on a tiered system that would outline whether travelers returning to England from various countries must isolate, and where. On Monday, England is scheduled to reopen outdoor spaces in pubs and restaurants, as well as nonessential shops, gyms and hair salons. In other news from other the world: Hong Kong’s health secretary, Sophia Chan, said on Friday that the Chinese territory would delay a shipment of AstraZeneca vaccines that had been scheduled to arrive in the second half of this year. She said the government had sufficient supplies of the Sinovac and Pfizer-BioNTech vaccines and did not want to waste any doses. Germany recorded its highest number of Covid-19 vaccinations on Thursday, with nearly 720,000 people receiving either a first or second dose. The authorities attributed the sharp rise to increased supplies and the addition of family doctors to the vaccine drive. People who are fully vaccinated will not have to present proof of a negative Covid test to travel or to enter shops, as is now the case in some regions, Health Minister Jens Spahn said on Friday. He said at a news conference, however, that Germany could soon require a new nationwide lockdown and a nighttime curfew as the country’s intensive-care units risk being overwhelmed. In Japan, the authorities issued stricter measures in Tokyo, Kyoto and Okinawa set to begin on Monday. Restaurants and bars will have to close by 8 p.m., and large events will be capped at 5,000 people. The measures are expected to be in place until May 11 in Tokyo and May 5 in Kyoto and Okinawa. In Norway, Prime Minister Erna Solberg was fined for organizing a party that violated social distancing rules. She celebrated her 60th birthday with 13 guests at a mountain resort in late February, even though her government had limited such gatherings to 10 people. Ms. Solberg, who has been leading Norway since 2013, was fined about $2,350. Christopher F. Schuetze, Mike Ives, Makiko Inoue and Thomas Erdbrink contributed reporting. Worshippers attending an Easter Mass at St. Elya Chaldean Church in Baghdad on Sunday.Credit...Khalid Al-Mousily/Reuters Iraq reported a record high number of coronavirus cases this week, a situation that the authorities blamed on “the negligence of most citizens, government institutions and the private sector” in disregarding social distancing guidelines, not wearing masks and continuing to hold large events. The health ministry warned that country’s health care system was becoming overwhelmed by a “very dangerous level” of infection. It also said it was alarmed by the low turnout for Covid-19 inoculations in Iraq, for which it blamed rumors that the vaccines are harmful. The country on Wednesday reported 8,331 new coronavirus cases — the highest figure since the pandemic began. A further 7,817 cases were added on Thursday. Iraq has reported over 14,500 Covid-19 deaths, and public health officials believe that the numbers of infections and deaths have been underreported. Many of those infected do not seek treatment in the country’s dysfunctional public health care system. Despite the pandemic, Iraqis have routinely held wedding celebrations and funeral gatherings. Many Iraqis are now rushing to hold weddings before the start next week of the Muslim holy month of Ramadan, when weddings traditionally do not take place. The semiautonomous Kurdistan region this week barred entry for people from other parts of Iraq. The police in the Kurdish capital, Erbil, have been deployed to enforce the wearing of masks in public. Slightly more than 126,000 Iraqis have been vaccinated, according to the health ministry — a tiny portion of the country’s 40 million inhabitants. A first batch of 336,000 doses from the Covax international vaccine sharing initiative arrived in Iraq in March, according to the aid group Doctors Without Borders. The aid group described Iraq as in the grip of a second wave of the pandemic, with Baghdad as its epicenter. Video transcript Back bars 0:00/1:32 -0:00 transcript Remembering Prince Philip, Husband of Queen Elizabeth II Prince Philip, the Duke of Edinburgh and the husband of Queen Elizabeth II, died on Friday at Windsor Castle in England. He was 99. Announcer: “It’s easy to see the radiant happiness of the princess as she and her very good-looking husband-to-be posed for the cameras in the palace. In the evening, Londoners, who had been waiting outside the palace for hours, made their feelings perfectly clear, when princess and her fiancé came out onto the balcony.” Announcer: “Now the most triumphant of all marches, the princess and prince. Once mere Lieutenant Mountbatten in His Majesty’s Navy, march as man and wife toward the West door.” Announcer: “And his work ashore here is as much a part of his regular service as it was when he was at sea in the destroyer H.M.S. Whelp, for example.” “Main lesson that we’ve learned is that tolerance is the one essential ingredient of any happy marriage. It may not be quite so important when things are going well, but it is absolutely vital when things get difficult.” Prince Philip, the Duke of Edinburgh and the husband of Queen Elizabeth II, died on Friday at Windsor Castle in England. He was 99.CreditCredit...Andrew Milligan/Agence France-Presse — Getty ImagesThe death of Prince Philip, the husband of Queen Elizabeth II, at 99 on Friday came at the end of a year marked by mourning, with 150,000 lives lost to Covid-19 in Britain. Buckingham Palace said that Prince Philip had died peacefully, and he was vaccinated against the coronavirus early this year, along with the queen. Yet his death is likely to take on a new meaning in the middle of a pandemic, and to raise many questions: What will the funeral look like at a time of social distancing measures? And with families across Britain unable to hold typical funerals for loved ones lost to Covid-19, how will the country’s most famous family mourn one of their own? The palace said that a full outline would likely be released on Saturday, but details began to emerge on Friday. The ceremony will not be a state funeral and will not be preceded by a lying-in-state, according to a statement from the College of Arms, which has created and maintained official registers of coats of arms and pedigrees since 1484. “His Royal Highness’s body will lie at rest in Windsor Castle ahead of the funeral in St. George’s Chapel,” the statement said. “The funeral arrangements have been revised in view of the prevailing circumstances arising from the Covid-19 pandemic,” it added, “and it is regretfully requested that members of the public do not attempt to attend or participate in any of the events that make up the funeral.” Philip had been hospitalized in February for a heart problem and was discharged last month. Buckingham Palace said that his hospitalization was not related to the coronavirus. But the privileges of royalty did not grant the family immunity from the virus. Prince Charles — Prince Philip’s and Queen Elizabeth’s elder son and the heir to the throne — tested positive for the virus last year, as did Prince William, their grandson. The queen has encouraged people in the country to be vaccinated. “Once you’ve had the vaccine, you have a feeling of, you know, you’re protected,” she said in a public call with health officials. Britain is slowly emerging from a stringent national lockdown of recent months, with outdoor spaces in pubs and restaurants scheduled to reopen on Monday, as well as nonessential shops, gyms and hair salons. But many bereaved families of those lost to Covid-19 have said that as the country moves to brighter days, the staggering deaths of 150,000 people should not be forgotten. A recent analysis of breast milk from women who had received Covid-19 vaccines found significant numbers of IgG antibodies in all the samples.Credit...James Estrin/The New York Times Is breast milk from a vaccinated person a sort of elixir capable of staving off Covid-19? Or should nursing mothers hold off on getting vaccinated? The answer, six researchers agreed, is that newly vaccinated mothers are right to feel as if they have a new superpower. Multiple studies show that their antibodies generated after vaccination can, indeed, be passed through breast milk — though the protection might be short-lived. As with so much to do with the coronavirus, more research would be beneficial. But there is no concrete reason for new mothers to hold off on getting vaccinated or to dump out their breast milk, they said. But over the past few weeks, online forums focused on relactation — the process of getting breastfeeding milk flowing again in mothers who had stopped nursing — have been swarmed with newly vaccinated mothers. Courtney Lynn Koltes of Orange County, Calif., pulled out a breast pump after she returned home from receiving her first dose of a Covid-19 vaccine. She had quit breastfeeding her 4-month-old daughter about two months earlier because of a medication conflict. But she was off those pills, and had recently stumbled across research suggesting that antibodies from a vaccinated mother could be passed to her baby through milk. Olivia de Soria of Asheville, N.C., who has also been vaccinated against Covid-19, has been breastfeeding her 4-month-old and sneaking a bit of her milk into her 3-year-old’s chocolate milk. She has also been sharing her milk with five other families. “I feel like I have this newfound superpower,” Ms. de Soria said. Researchers are confident that breast milk from Covid-19-vaccinated mothers is safe, based on what they know about how vaccines work. Still, they say, it is premature for vaccinated mothers who are breastfeeding to act as if their babies can’t get infected, said Dr. Kirsi Jarvinen-Seppo, the chief of pediatric allergy and immunology at the University of Rochester Medical Center, who has been conducting studies in this area. “There is no direct evidence that the Covid antibodies in breast milk are protecting the infant — only pieces of evidence suggesting that could be the case,” she said.