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Johnson & Johnson Vaccine Access Slowed by Baltimore Plant Problems

Johnson & Johnson vaccines were given at a community 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 with a pattern of quality-control lapses, the White House’s pandemic response coordinator said on Friday.

With allocations of the company’s vaccine set to plunge by 86 percent next week, governors across the country warned that the loss of supplies they had been counting on would set back their vaccination drives.

Federal officials said Moderna and Pfizer-BioNTech, the other two federally authorized vaccine manufacturers, could make up some of the shortfall. They also pointed out that some states were not currently using all the vaccine allocated to them.

But increases from Moderna and Pfizer will not make up for the plunge in Johnson & Johnson supply. California will receive 400,000 fewer overall doses next week than this week, a drop of 15 percent, even with slight increases from Pfizer and Moderna. That will be followed by another 5 percent decrease the next week, state officials said on Friday. Officials in a broad band of states said the sudden drop in Johnson & Johnson supply would significantly slow inoculation efforts.

“The last thing we wanted to hear about was we’re getting less vaccines,” Gov. Larry Hogan of Maryland, a Republican, told reporters Friday. “We were hoping to ramp up as they’ve been promising.”

In a statement, Gov. Andrew M. Cuomo of New York, a Democrat, said, “We will not be able to get as many shots into New Yorkers’ arms as we would like.” He added, “As has been the case since the beginning of our vaccination effort, the X factor is supply, supply, supply.”

Some state health officials had hoped to use Johnson & Johnson’s one-shot, easily stored vaccine to target college students and other transient groups. Others were offering it at mass vaccination sites or directing it to rural areas.

Instead, shipment of doses of Johnson & Johnson next week will drop severely in states: California will fall from 572,700 to 67,600 doses, Texas from 392,100 to 46,300, Florida from 313,200 to 37,000 and Virginia from 253,400 to 27,900.

In Virginia, which will broaden vaccine eligibility to its entire adult population in nine days, the effect will be “huge,” Dr. Danny Avula, the state vaccine coordinator, said. He said that officials would have to warn people that even though they would be eligible to sign up for shots, appointments could be hard to come by.

Johnson & Johnson was a latecomer to winning federal authorization for emergency use, after Pfizer and Moderna. But as recently as late February, federal officials were projecting weekly deliveries of more than four million doses of the company’s vaccine in April, a significant increase to the nation’s vaccine stock. Only a quarter of those doses, at best, are now expected this month — all from the Netherlands — while federal regulators comb through the Baltimore factory that was supposed to take over for the Dutch plants.

The falloff comes as new, more contagious variants of the coronavirus are sending infection rates soaring in some parts of the country. In Michigan, Gov. Gretchen Whitmer, a Democrat, said on Friday that she had urged Mr. Biden to surge vaccines into her state, where an outbreak, the worst in the nation, has filled hospitals and forced some schools to close.

But the White House is reluctant to change the allocation formula for states, which doles out doses equally based on population. Jeff Zients, the White House coronavirus coordinator, said on Friday that the administration did not plan to shift additional vaccine doses to hard-hit states like Michigan.

“At this point that’s not being deployed, but I am not giving up,” Ms. Whitmer said, describing a call Thursday evening with the president. “Today it’s Michigan and the Midwest. Tomorrow it could be another section of our country.”

The drop-off in Johnson & Johnson doses is directly tied to quality-control issues at the 112,000-square foot plant in southeast Baltimore, run by Emergent BioSolutions, a subcontractor to Johnson & Johnson. Johnson & Johnson discovered last month that Emergent workers had contaminated a batch of vaccine and was forced to discard the equivalent of 13 million to 15 million doses.

Mitch Smith and Julie Bosman contributed reporting.

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United States › United StatesOn April 8 14-day change
New cases 81,320 +13%
New deaths 995 –28%

World › WorldOn April 8 14-day change
New cases 840,558 +18%
New deaths 14,636 +16%

U.S. vaccinations ›

Where states are reporting vaccines given

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Pipeline: 2020-03-16-coronavirus-maps | April 9, 2021, 05:35PM | fb3ed312577f14a1843d690a5c2d1b0042043440

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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.

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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 Press

Gov. 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.

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. The company 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.”

Ms. Whitmer’s decision not to lock down again brought some measure of agreement on Friday from Republicans, who control the Legislature and have for months criticized her use of executive power and warned that residents were losing patience with restrictions.

“I think what’s happening now is she is realizing that she has lost the goodwill of the people,” said State Representative Jack O’Malley, a Republican.

Still, 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.

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 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 the vaccine trial’s third phase. Among those who received it, 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.

The Covid-19 vaccine trials for children got off to a slow start, in part because it took time to find participants. Vaccine makers initially focused on adults, partially because children were proving far less likely to die from Covid-19. A child’s biology differs from that of an adult, which can affect the way vaccines work.

Moderna is also testing its vaccine in children. Results from its study of 12- to 17-year olds, which began in December, are expected soon. A separate trial consisting of children under 12 began last month.

In March, Pfizer began testing its vaccine in children under 12, with results expected during the second half of the year.

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 causal 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 F.D.A. said it had shared information about the cases with the E.M.A., prompting that body’s investigation. “At this time, we have not found a causal relationship with vaccination and we are continuing our investigation and assessment of these cases,” an F.D.A. spokeswoman said in a 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.

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.

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.

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.

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 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.

Migrant workers getting ready to leave Mumbai on Wednesday.
Credit…Divyakant Solanki/EPA, via Shutterstock

Fearing new lockdowns and rising infections in major cities, thousands of migrant laborers in India are beginning to travel home to their villages in crowded scenes reminiscent of the start of the pandemic last year.

India recorded 131,968 infections and 780 deaths on Friday — the fourth day this week that it had announced more than 100,000 new cases. And many states are imposing restrictions, including night curfews and weekend lockdowns.

At least 45 million Indians come from the countryside to work in cities every year, according to government estimates, with many taking jobs at construction sites, working as housekeepers or selling juice at roadside stalls. Last March, Prime Minister Narendra Modi enacted one of the world’s severest and most abrupt lockdowns, leaving laborers instantly unemployed and forcing millions to return to their villages on foot.

The chaotic exodus was widely blamed for helping the virus spread through the countryside, threatening rural India’s patchy health system. When India began reopening its economy, many migrants returned to cities because there was no work at home.

Now, some are fleeing to the villages again.

On Thursday, Mohammad Naseem was among dozens of migrant workers who boarded a train leaving the western city of Mumbai. The 42-year-old sugar cane juice seller said he was returning to his home in the northern state of Uttar Pradesh and probably would not return to Mumbai.

“The city can survive another lockdown and be prosperous again,” he said. “But we don’t want to die here because of hunger.”

Mr. Naseem, who returned to his juice stand after previous lockdown measures were lifted, said that business hadn’t been the same. Two co-workers never returned from their villages. Mr. Naseem, who supports a family of six, said he would try to find work in Uttar Pradesh.

“We will suffer the most, like the previous lockdown,” he said. “I am not going to come back again.”

Even as coronavirus cases have surged in India and elsewhere in South Asia, political leaders, including Mr. Modi, have continued to hold crowded rallies in several states where elections are taking place. Reports in the Indian news media have shown senior officials participating in rallies even after coming into contact with infected people.

“For the political rallies of big leaders, there is no coronavirus,” said Mahesh Kumar, an ice cream seller in New Delhi, the capital, who returned to his home in Jharkhand State on Friday. “But when it comes to our business, officers threaten us with jail if they see three people around our stalls.”

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.

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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.”

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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 Images

The 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.

Source: Johnson & Johnson Vaccine Access Slowed by Baltimore Plant Problems

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