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A funeral in Indonesia on Monday  for someone who died from the coronavirus.
Credit…Dedi Sinuhaji/EPA, via Shutterstock

Two million dead.

It is more people than call the state of Nebraska home and about equal to the population of Slovenia. It is roughly as many people who are estimated to have died in the partition of India and Pakistan in 1947. And it is more than the total number killed in the decades of Soviet and U.S.-led wars in Afghanistan combined.

The global death toll from the coronavirus soared past the two million mark on Friday, just over a year after the virus was first detected in the Chinese city of Wuhan.

In addition, there have been almost 500,000 unexpected deaths globally over the past year, a review of mortality data in 35 countries shows — providing a clearer, if still incomplete, picture of the toll of the crisis. Far more people died in most of these countries than in previous years, The New York Times found.

And the carnage is spreading faster now than at any other time in the pandemic.

It took more than nine months for the world to pass one million deaths in late September, a moment that the United Nations secretary-general, António Guterres, called “mind-numbing” and “an agonizing milestone.” In just a little over three months, the virus has claimed another one million lives.

And as it spreads, it continues to evolve.

It is the same virus, but several variants now circulating around the world are the subject of urgent scientific study as some have been shown to be even more infectious than the iteration that at one point last spring forced about four billion people to shelter at home.

One variant that stymied efforts to contain outbreaks in Britain in the fall is now responsible for a flood of patients that is stretching the nation’s hospitals to the breaking point, officials say.

The World Health Organization said this week that the variant had been detected in 22 European nations, and governments across the continent continue to tighten restrictions in response to the threat. More than 230 million people across Europe are now under full national lockdowns, according to the W.H.O.

Even before the new variants were discovered, the death toll in the United States already dwarfed that of any other country. The virus has now killed nearly 400,000 Americans, according to a New York Times database. And with the country’s new cases still averaging about 240,000 cases per day, there are few signs of it slowing.

Next week, as president, Joseph R. Biden Jr. will take charge of what has been perhaps the world’s most disjointed response to the pandemic. In the course of the past year, even the decision of whether to wear a mask became politicized.

Mr. Biden — like his counterparts around the world — will have an increasingly available tool at his disposal in the form of vaccines. He has vowed to have 100 million doses in arms during his first 100 days in office, and other governments have likewise made ambitious pledges.

But the initial rollouts in many countries have been met with problems: logistical confusion, shortages of doses, unequal distribution and bureaucratic hurdles that have slowed the process of getting shots into people’s arms.

Israel’s inoculation process has been the fastest, with roughly 25 percent of its population of nine million getting vaccinations in just one month. Britain has sped up its efforts; more than three million people have now been given at least a first dose of a vaccine. And Italy says it has given a million shots.

So far, there is no evidence that any of the variants affect the viability of the vaccines that countries have approved for emergency use. However, scientists have cautioned that this may not always be the case as the virus continues to mutate.

In nations where the virus appears to have been tamed, the authorities are maintaining vigilance to ensure that it doesn’t re-establish its grip.

In China, where the market at the epicenter of the outbreak remains closed but others are again open, a team of experts from the W.H.O. arrived this week to begin hunting for the source of the pathogen and how it made the suspected leap from animals to humans.

The virus’s origin is just one of the many enduring mysteries of a virus that has officially infected nearly 100 million people, and likely many more, around the world. And this week, underscoring just how persistent and pervasive it is, it claimed its first life in China since May.

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transcript

transcript

Biden Unveils Plan to Combat Coronavirus

President-elect Joseph R. Biden Jr. called the current vaccine rollout a “dismal failure” and vowed to move aggressively to increase availability, improve access and accelerate production of needed supplies.

Vaccines offer so much hope. We’re grateful for the scientists and researchers and everyone who participated in the clinical trials. We’re grateful for the integrity of the process, the rigorous review and testing that’s led to millions of people around the world already being vaccinated safely. But the vaccine rollout in the United States has been a dismal failure thus far. And in today’s briefing, we discussed five things, five things we’ll do, in attempt to turn things around. First, we will immediately work with states to open up vaccinations to more priority groups. The process of establishing priority groups is driven by science, but the problem is the implementation has been too rigid and confusing. The second thing we’re going to change, if we’re getting more people vaccinated, then we need more vaccination sites. That’s what we’re going to harness the full resources of the federal government to establish thousands of community vaccination centers. The third change we’re going to make is we’re going to fully activate the pharmacies across the country to get the vaccination. The more arms as quickly as possible The fourth thing we’re going to do is we’re going to use the full strength of the federal government to ramp up supply of the vaccines. As I said before, we’ll use the Defense Production Act to work with private industry to accelerate the making of materials needed to supply and administer the vaccine. Fifth, we will always be honest and transparent about where we stand, both the good news as well as the bad. We’re going to make sure state and local officials know how much supply they’ll be getting. And when they can expect to get it so they can plan. This will be one of the most challenging operational efforts ever undertaken by our country. But you have my word, and we will manage the hell out of this operation. But as I said last night, we need funding from Congress to make this happen, and I’m optimistic. I’m convinced the American people are ready to spare no effort and no expense to get this done.

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President-elect Joseph R. Biden Jr. called the current vaccine rollout a “dismal failure” and vowed to move aggressively to increase availability, improve access and accelerate production of needed supplies.CreditCredit…Amr Alfiky/The New York Times

WASHINGTON — President-elect Joseph R. Biden Jr., racing against a surge in coronavirus cases and the emergence of a new variant that could significantly worsen the pandemic, is planning a vaccination offensive that calls for greatly expanding access to the vaccine while promising to use a wartime law to expand production.

But his plan is colliding with a sobering reality: With only two federally authorized vaccines, supplies will be scarce for the next several months, frustrating some state and local health officials who had hoped that the release of a federal stockpile of vaccine doses announced this week could alleviate that shortage. Trump administration officials clarified Friday that the existing stockpile would only go toward giving second doses to people who had already received the vaccine, and not to new groups of people.

“The vaccine rollout in the United States has been a dismal failure so far,” Mr. Biden said. “The honest truth is this, things will get worse before they get better. And the policy changes we are going to be making, they’re going to take time to show up in the Covid statistics.”

The president-elect said he would invoke the Defense Production Act, if necessary, to build up vaccine supply. But the team also sought to tamp down expectations. Mr. Biden said his plan “won’t mean that everyone in these groups will get vaccinated immediately, because supply is not where it needs to be.” But, he added, it will mean that as doses become available, “we’ll reach more people who need them.”

The Biden team promised to ramp up vaccination in pharmacies, and build mobile vaccination clinics to get vaccine to hard-to-reach and underserved rural and urban communities, emphasizing equity in distribution.

Mr. Biden spoke of “the tragic reality of the disproportionate impact this virus has had on Black, Latino and Native American people,” adding that “equity is central to our Covid response.”

Like the Trump administration, Mr. Biden called for states to expand the vaccine eligibility groups to people 65 or older.

The administration will also make “programs available for high-risk settings, including homeless shelters, jails and institutions that serve individuals with intellectual and developmental disabilities,” the fact sheet said.

In some respects, Mr. Biden’s proposals echo those of the Trump administration, which also called earlier this week for opening vaccine eligibility to groups to 65 and older, making greater use of pharmacies and moving vaccinations to federally qualified health centers. The Trump administration has also frequently used the Defense Production Act to give vaccine makers priority with suppliers for raw ingredients and other materials.

Mr. Biden unveiled the vaccine distribution plan just one day after he proposed a $1.9 trillion spending package to combat the economic downturn and the Covid-19 crisis, including $20 billion for a “national vaccine program.” The president-elect has said repeatedly that he intends to get “100 million Covid vaccine shots into the arms of the American people” by his 100th day in office.

Time is of the essence. The federal Centers for Disease Control and Prevention on Friday sounded the alarm about a fast spreading, far more contagious variant of the coronavirus that is projected to become the dominant source of infection in the country by March, potentially fueling another wrenching surge of cases and deaths. Some public health experts are worried.

“I think we are going to see, in six to eight weeks, major transmission in this country, like we’re seeing in England,” said Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of Mr. Biden’s coronavirus advisory board. “If we can set up vaccine clinics faster and more efficiently, how many lives do we save?”

Mr. Biden intends for the federal government not only to develop mass vaccination sites, but also to reimburse states for the use of National Guard troops to administer vaccines. To staff the mass clinics, Mr. Biden promised to “mobilize thousands of clinical and nonclinical professionals.”

The plan’s emphasis on ensuring equitable distribution includes mobile vaccination clinics, as well as using data to target vaccinations in hard-hit areas and in communities that have been disproportionately affected by the virus. The fact sheet also says that officials will focus on places where people live in close quarters, such as jails — which some state plans have failed to prioritize, even though some of the country’s largest clusters of infections have been in prisons.

The vaccine distribution plan is part of Mr. Biden’s broader effort to use the current crisis to rebuild the nation’s crumbling public health infrastructure — long a goal of Democrats on Capitol Hill.

To that end, Mr. Biden has promised to increase federal funding for community health centers and has called for a new “public health jobs program” that would fund 100,000 public health workers to engage in vaccine outreach and contact tracing. Such a corps of trained public health workers would presumably be in place for the next pandemic.

“The details still have to be worked out but, this is really a critical recognition that state and local health agencies need to be shored up in a way that they haven’t been in decades,” Dr. Osterholm said.

Nearly 400,000 people in the United States have died with the virus during the pandemic, and the country has logged more than 23 million infections, according to a New York Times database. Over the past week, there has been an average of more than 240,000 cases per day, an increase of 27 percent from the average two weeks earlier. More than 4,400 deaths were announced on Tuesday, a record.

As of Friday, according to the federal Centers for Disease Control and Prevention, about 10.6 million people had received at least one dose of a Covid-19 vaccine, and about 1.6 million had received the second dose. That is far short of the goal federal officials set to give at least 20 million people their first shots before the end of 2020.

Vials of Moderna’s Covid-19 vaccine in Santa Rosa, Calif., on Wednesday.
Credit…Jim Wilson/The New York Times

When the federal government announced Tuesday that it was releasing a stockpile of vaccine doses, some state health officials expected to get a boost in their weekly shipments to help address soaring demand for the vaccines as the pandemic rages out of control.

But now, the states face a stark reality. That stockpile consisted only of vaccines earmarked for booster shots for people who had already received a first dose. That means the release of this pool will not expand inoculations to a new group of people. Federal officials have said second doses will be prioritized in the weekly shipments to ensure everyone can get a booster shot.

A senior administration official said on Friday that the government expects the two companies producing vaccines, Moderna and Pfizer, to supply between eight and 12 million vaccine doses per week to the American public over the next several weeks — shipments that will then be divided among those getting their first and second shots. The two companies have deals with the federal government to supply a total of 200 million doses to the United States — or enough to fully vaccinate 100 million people — by the end of March.

The confusion stemmed from a call that Alex M. Azar II, the federal health and human services secretary, held on Tuesday with reporters and top Operation Warp Speed officials, in which he chided states for not efficiently using the vaccines they had already been sent and urged them to open up eligibility to people 65 and older. Some states, including New York, quickly followed the federal government’s advice and opened their doors to a wider group of people, prompting a surge of interest — and confusion — as thousands of newly eligible people sought appointments to get vaccinated.

“This next phase reflects the urgency of the situation we face — every vaccine dose that is sitting in a warehouse rather than going into an arm could mean one more life lost or one more hospital bed occupied,” Mr. Azar said.

Later in the call, he said that “We are releasing the entire supply we have for order by the states, rather than holding second doses in physical reserves.” Going forward, he said, no vaccine doses would be held in a stockpile, and each weekly shipment would go toward people needing a first as well as a second dose.

That announcement prompted several states to assume that they would get an influx of new doses that could be used to vaccinate new people, as first reported by the Washington Post.

On Friday, Gov. Kate Brown of Oregon, a Democrat, tweeted that she had received “disturbing news” on Thursday evening: “States will not be receiving increased shipments of vaccines from the national stockpile next week, because there is no federal reserve of doses.” She added, “I am shocked and appalled that they have set an expectation on which they could not deliver, with such grave consequences.”

However, senior administration officials clarified on Friday that all of the reserve doses were already dedicated to people who had gotten the vaccine, and that Mr. Azar was actually just spelling out the logical extension of a distribution policy that had been established by top federal officials in December, when shipments began.

In a statement, a spokesman for the federal health department said that nearly 13 million doses were made available to states so they could order their first and second doses, which is “millions more” than previous weeks. The spokesman, Michael Pratt, also said that many states have not ordered up to the full amount that they have been allocated by the federal government.

“I think states have been doing their best to plan with whatever information they can get from the feds on expected future allocations, and then revising those plans if they get less,” said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials. “What is more concerning is that public expectations have been raised and limited supply may lead to significant disappointment.”

During the first few weeks of distribution, Gen. Gustave F. Perna, the chief operating officer of Operation Warp Speed, the federal effort to develop and distribute a vaccine to the American public, decided to hold back half of the weekly shipments of vaccine to save those doses for the people who had received an initial shot. He said at the time that it was important to be cautious as manufacturing was getting underway, and to hold onto a stockpile of second doses in the case of any manufacturing glitches.

Even then, his decision came under criticism by public health experts who argued that the focus should be on getting as many people as possible their first dose of a vaccine — since clinical trials showed even the first dose offers some protection — given that the country was facing record cases, hospitalizations and deaths.

But federal officials stuck to their plan, and as the weeks passed, that stockpile gradually depleted as those who had received the initial shots from Pfizer needed their second dose, which is given three weeks later. The first people who received the Moderna vaccine are now due for their booster shot, which is given four weeks later.

Senior administration officials said Friday that the remaining second doses drawn from that reserve are being distributed this week and next week to the states, and that they were never intended to be used toward vaccinating additional people.

From now on, officials said Tuesday, each weekly shipment from the manufacturers will include doses for new people as well as second doses for those who are due for their booster shots.

Scientists and pharmaceutical companies developed the two federally authorized Covid-19 vaccines in record time, but their distribution has fallen far short of initial goals. Federal officials had promised that 20 million people would be immunized before the end of 2020, but only about 9.7 million have received their first dose so far.

Federal, state and local officials have traded blame for the faulty rollout, with the federal government accusing states of being overly prescriptive in who can get the vaccine and not having put in place plans to quickly distribute it. But state and local authorities have countered that they were not given enough money to do the job properly, and scaling up distribution has been difficult because they cannot predict how many doses they will have from week to week.

Even as states have complained about federal deliveries, many have struggled to give out all of the vaccine doses they have been sent. Overall, only about 36 percent of the 30.6 million doses that have been distributed have been injected into arms, according to federal data.

But as vaccination drives have picked up, that is changing and some states and local governments have warned they are running out. On Friday, New York City said it expected to exhaust its supply of doses by early next week.

A health care worker in Reims, France, last week, preparing the vaccine developed by Pfizer and BioNTech. The delivery of more doses is being delayed in Europe.
Credit…Andrea Mantovani for The New York Times

BRUSSELS — Pfizer plans to halt production of its coronavirus vaccine for weeks as it undertakes upgrades to its manufacturing plant in Puurs, Belgium, in order to reach its goal of producing two billion doses this year — up from its earlier goal of 1.3 billion.

The move, which will reduce deliveries to European Union member states as well as other countries, triggered outrage among health officials across the bloc and added to already strong concerns over the sluggish pace of immunizations. It comes as the virus continues to rage in the region, many people are supposed to be receiving timely second doses and more transmissible variants of the virus are emerging.

On Friday, health ministers from six E.U. countries asked for urgent help from the European Commission, which has taken the lead in negotiating vaccine contracts with pharmaceutical companies on behalf of its 27 members.

“We are writing to you with severe concern about the sustainability and credibility of the Covid-19 vaccination process, following the oral announcements of BioNTech/Pfizer representatives about their delivery difficulties,” said a letter addressed to the European commissioner for health, Stella Kyriakides, that was signed by senior ministers from Estonia, Latvia, Lithuania, Sweden, Denmark and Finland.

“Officials responsible for vaccination in our countries were informed by BioNTech/Pfizer local representatives that delivery to our countries will be substantially reduced in the coming weeks,” the letter continued, adding that some countries were told deliveries would resume Feb. 8, but others were not given a date at all.

In a statement, Pfizer said that while its planned upgrade “will temporarily impact shipments in late January to early February, it will provide a significant increase in doses available for patients in late February and March.”

The full impact of the disruption is not clear.

Pfizer makes doses for the United States at its plant in Kalamazoo, Mich., and a company spokeswoman confirmed that only markets outside the country would be affected. Britain, which has left the European Union, is supplied by the Puurs plant, so is also likely to see reduced deliveries.

The vaccine is also being produced at BioNTech’s factory in Mainz, Germany. A plant in Marburg that BioNTech purchased last year is expected to start producing vaccine doses soon.

In most of the region, citizens are still in some form of lockdown and the E.U.’s efforts to inoculate 450 million people, which began in the last days of 2020, have been marred by shortages of syringes and trained personnel, among other problems. But the pace is stepping up in much the region.

Italy, one of Europe’s worst-hit nations, announced on Friday that it had made its millionth vaccination. “Let’s continue like this, keeping up our guard,” Prime Minister Giuseppe Conte tweeted.

Germany, the bloc’s largest and most populous country, has vaccinated some 700,000 people have been vaccinated. France, the bloc’s second-largest economy, is facing significant vaccine skepticism among other obstacles, and French authorities said on Friday that 380,000 people had been vaccinated.

The E.U.’s Center for Disease Control reported that Europe has had more than 28 million infections and more than 600,000 deaths, but those figures include a number of countries that are not in the European Union, including Britain and Russia.

A healthcare worker watches carefully as a patient administers a nasal swab Covid-19 test on herself in Sonoma, Calif on Thursday.
Credit…Jim Wilson/The New York Times

Federal health officials sounded the alarm Friday about a fast spreading, far more contagious variant of the coronavirus that is projected to become the dominant source of infection in the country by March, potentially fueling another wrenching surge of cases and deaths.

In a study released on Friday, the Centers for Disease Control and Prevention said that its forecasts indicated outbreaks caused by the new variant, which was first identified in Britain, could lead to a burgeoning pandemic. It called for a doubling down on preventive measures, including more intensive vaccination efforts across the country.

The variant is not known to be more deadly or to cause more severe disease. But the dire warning — hedged by limited data about just how prevalent the variant has become — landed in a week where the nation’s nascent vaccination campaign was hampered by confusion and limited supplies as demand grew among growing numbers of eligible people.

Only 76 cases of the variant have been identified so far in the United States, but the actual number is believed to be higher and is expected to spiral upward in the next few weeks, officials said. They emphasized that current mitigation strategies were effective against the new strain, exhorting Americans to be vigilant in wearing face masks, maintaining six or more feet of distance from other people, washing hands frequently, reducing interactions with people outside their households, limiting contacts and avoiding crowds.

Current spikes in cases threaten to cripple already overwhelmed hospitals and nursing homes in many parts of the country. Some are at or near capacity. Others have faced troubling rates of infection among their staff, causing shortages and increasing patient loads.

“I want to stress that we are deeply concerned that this strain is more transmissible and can accelerate outbreaks in the U.S. in the coming weeks,” said Dr. Jay Butler, deputy director for infectious diseases at the C.D.C. “We’re sounding the alarm and urging people to realize the pandemic is not over and in no way is it time to throw in the towel.”

“We know what works and we know what to do,” he said.

Covid cases and deaths have broken record after record across the country, with a peak number of deaths, 4,400, announced on Tuesday. At least 3,973 new deaths and 238,390 new cases were reported on Thursday, and the nation is nearing a milestone of 400,000 deaths.

One in 860 Americans have died of Covid-19 in the last year, according to new figures released by the C.D.C. But the burden of deaths has not fallen equally across racial, ethnic lines and geographic regions, and there is concern that vaccines will not reach the hardest hit communities, where access to health services is limited and distrust is rampant.

In Georgia, which has one of the country’s slowest vaccine distribution rates, health departments have been inundated with people trying to book appointments.
Credit…Nicole Craine for The New York Times

The evolving distribution system for coronavirus vaccines in the United States has opened up the prospect of inoculations to millions more people this week, but has simultaneously set off a new wave of confusion.

At least 28 states and Washington, D.C., have begun vaccinating older people, a New York Times survey shows, in many cases marking a shift in earlier plans that put medical workers and nursing home residents at the front of the line for the inoculations.

As cases and deaths from the coronavirus reach record levels across the country, much is in flux when it comes to states’ plans for distributing vaccines. At least 32 states have expanded their vaccination programs to include critical workers, such as police officers, teachers, grocery store employees and other people at risk of being exposed to the virus on the job. More than a dozen states have said they expect to expand their vaccination pools significantly before the end of the month.

Health experts and officials have faced difficult choices as they decided which groups would be prioritized in the vaccine rollout. While the elderly have died of the virus at the highest rates, essential workers have borne the greatest risk of infection, and the category includes many poor people and people of color, who have suffered disproportionately high rates of infection and death.


Not yet prioritizing by age

The changing rollout in many states, which matches a new federal appeal this week that all people over 65 — not just those in long-term care facilities — should be prioritized, was embraced by many older people, who have been the most vulnerable to Covid-19 and have been waiting eagerly for vaccinations and a return to normal life. But the sudden availability to so many more people also caused a deluge of problems as people tried to figure out whether their state was now allowing them to get shots, how to sign up and where to go.

“Once we get people in, the experience is wonderful,” said Logan Boss, a spokesman for the Northwest Health District in Georgia, which on Monday expanded access to the vaccine to people over the age of 65.

Until then, the process can be fraught. “It’s the anxiety, the frustration, the difficulty people have in scheduling appointments — which we are making with a very limited supply of vaccine that comes in — in quantities that we don’t know until it arrives,” he said.

In states across the country, demand for the vaccine has far outweighed supply, leading to crashed websites, long lines outside vaccination clinics and overwhelmed public health departments that are facing a torrent of calls and emails.

While the federal government advises states on how best to distribute vaccines, states follow their own plans, and that has created a patchwork of policies. While some offered shots to older people in December or early January, most focused their initial plans on medical workers and those in long-term care facilities.

And the rules are changing by the day: At least 14 states and Washington, D.C., opened up vaccinations to older people this week, and some of those changes came after the new federal call on Tuesday to open up vaccines to a wider group.

In an interview on Friday with NBC’s “Today” show, Dr. Anthony Fauci addressed the evolving guidance and encouraged states to be flexible. “If you have a dose, give it, and don’t be so rigid as to those early designations,” he said.

A health care worker receives a Covid-19 vaccine at Mount Sinai hospital in Manhattan last month.
Credit…Kirsten Luce for The New York Times

After a sluggish first month, the pace of coronavirus vaccinations is accelerating to the point that New York City and other places in the state expect to exhaust their supply of doses as early as next week, officials said on Friday, causing several health facilities to alter their immediate inoculation plans.

On Thursday, Mount Sinai Health System, one of the city’s largest hospital networks, canceled many upcoming vaccination appointments for older patients, saying the doses it had anticipated receiving were no longer likely to arrive.

Northwell Health, the largest health provider in the state, said it was not scheduling additional appointments for the next several days given its limited supply.

Around New York, officials in at least one county said they had only enough doses to last through the weekend, echoing a similar sentiment by city officials.

Mayor Bill de Blasio said Friday on Brian Lehrer’s radio show that New York City would run out of doses by next week.

“It makes no sense that we’re being starved of the capacity we need,” the mayor said.

State officials warned this week that they were growing increasingly worried about the supply, pleading with federal officials to increase the number of doses they send every week. Gov. Andrew M. Cuomo has said the state receives only about 300,000 doses per week, although he indicated on Friday that the state had been told its weekly supply would be sliced to 250,000. About 100,000 of them go to New York City, Mr. de Blasio said on Friday.

“Seven million people for 250,000 doses per week? Every distributor, everyone is gonna say, ‘I need more,’’ Mr. Cuomo said on Friday in a news conference. As a result, he said New York City should expect to receive fewer doses because “the state gets less.”

This week, federal officials indicated that more doses from a stockpile would be sent to states. But they have since clarified that the batch is actually from a tranche saved for second doses. (People are considered fully vaccinated after receiving two doses.)

Until recently, New York City had been struggling to quickly administer vaccines, leading to a backlog of doses. But in recent days, the pace of vaccinations has picked up drastically because of expanded eligibility and because many new vaccination sites have opened over the last week.

Mr. de Blasio argued that the federal government should prioritize vaccine distribution to areas that are inoculating quickly. “I think until the supply increases much more nationally, go where the ability to vaccinate is strongest,” he said. “As soon as we get it in now, it’s going right back out and into people’s arms, that’s not true everywhere because they just don’t have the infrastructure.”

A health care worker decorates a chair at a vaccine center on Friday in Pune, India, where the country’s first vaccine doses will be distributed.
Credit…Atul Loke for The New York Times

PUNE, India — India is preparing to launch one of the most ambitious and complex nationwide campaigns in its history: the rollout of coronavirus vaccines to 1.3 billion people, an undertaking that will stretch from the perilous reaches of the Himalayas to the dense jungles of the country’s southern tip.

The toughest part might be persuading doubters like Shankar Patil to roll up their sleeves.

Mr. Patil, a 27-year-old applicant to the state police academy, lives in Pune, the city central to India’s vaccine rollout, which is set to begin on Saturday. Prime Minister Narendra Modi is staking his pride on India’s ability to manufacture enough inexpensive shots to inoculate his country as well as much of the developing world. India aims to do nothing less than “protect humanity,” Mr. Modi said recently at an online address to the Indian diaspora.

Mr. Patil has questions. He and two friends, also aspiring police officers, expressed skepticism about the country’s vaccine approval process, which has been criticized by health experts for a lack of disclosure.

“We believe in the government, but nobody should play with our health,” Mr. Patil said. “If the vaccines are truly safe, they should make the data public.”

Little data has been published from the early trials of one of the two vaccines being rolled out, and the manufacturer has not yet completed its final trial, even as it is being distributed.

Doubts about transparency only add to the obstacles. In addition to the logistical challenges, Indian officials must deal with a growing sense of complacency. After reaching a peak in the mid-September of more than 90,000 new cases per day, India’s official infection rates have dropped sharply. Fatalities have fallen by about 30 percent in the last 14 days, according to a New York Times database.

City streets are buzzing. Air and train travel have resumed. Social distancing and mask-wearing standards, already lax in many parts of India, have slipped further. That alarms experts, who say the real infection rate is probably much worse than official numbers suggest.

And doubts about the effectiveness of the vaccines are making the mission harder still.

At least one state, Chhattisgarh, has refused to accept shipments of the vaccine that is still in its final trial. And just days ago, one of India’s top virologists was still weighing whether to receive a jab.

“It’s really not a lack of confidence in the vaccine,” Dr. Gagandeep Kang said. “It’s a lack of confidence in a process that allowed the vaccine to move forward in such a way. If my taking the vaccine would convince other people to take the vaccine, I’d think that’s not right.”

global roundup

A view of the Olympic Stadium in Tokyo this week.
Credit…Carl Court/Getty Images

Plans for the postponed Tokyo Olympic Games are growing more uncertain by the day.

As coronavirus cases rise throughout Japan and in several large countries in Europe and the Americas, officials in Tokyo and with the International Olympic Committee have begun to acknowledge that holding a safe Games might not be possible, endangering dreams that the Olympics could serve as a global celebration of the end of the pandemic.

Instead, the I.O.C. may have to cancel the Olympics for the first time since World War II. That would be a huge financial blow to both the Olympic organization and Japan, which has spent more than $12 billion building stadiums and improving its infrastructure to prepare for the Games, and billions more to delay the event by a year.

For weeks, Japanese and Olympic officials have insisted that the Games will go forward and that a further delay is not possible. Organizers have been trying to come up with plans to hold the Games in a manner acceptable to the Japanese public, announcing an array of safety measures.

But polls show an increasing wariness. In a survey conducted this month, the Japanese broadcaster NHK found that nearly 80 percent of respondents believed the Games should be postponed or canceled. In October, less than half of respondents said that. The figure rose to 71 percent in December.

On Friday, Taro Kono, a member of Japan’s cabinet, broke with his government’s official line, saying the Games “could go either way,” according to a report by Reuters.

His remarks followed similar comments this week by the Canadian Dick Pound, the longest-serving I.O.C. member, who told the BBC that there was “no guarantee” that the Games would take place.

Organizers in Tokyo and at the I.O.C. agreed in March to postpone the Games for one year. The sports festival, the world’s largest, was supposed to take place last July and August. The opening ceremony for the Summer Games is now scheduled for July 23.

In other developments around the world:

  • China’s National Health Commission said on Friday that more than 1,000 people nationwide were being treated for Covid-19, a day after the country reported its first coronavirus death on the mainland since May. The virus appears to be spreading widely once again despite the measures China has taken, including electronic monitoring and new lockdowns. The country’s Foreign Ministry said it would allow a British scientist from the World Health Organization who had been stuck in Singapore to enter the country, after the scientist tested negative for coronavirus antibodies. The scientist is part of a team of experts from the health agency who arrived in the central city of Wuhan on Thursday to begin hunting for the source of the virus.

  • France strengthened border controls and extended a curfew to the entire country to keep the coronavirus in check, and the authorities warned that new restrictions are possible in the coming days if the epidemic worsens. For at least 15 days starting Saturday, everyone will have to be home and shops will have to close by 6 p.m., barring certain exceptions.

  • Britain on Friday started barring arrivals from Latin American countries and Portugal over fears of a coronavirus variant first detected in Brazil.

  • Greece’s conservative government said it would establish a dedicated police force for public transport in Athens following a series of violent altercations regarding masks. The most serious was captured on a security video and shows two young men who had refused to wear masks repeatedly kicking a 53-year-old station master in the head and the back, breaking his nose, jaw and ribs.

  • Thailand’s national tourism authority has named six resorts that are offering “golf quarantine” packages under a December law that allows foreigners who meet certain requirements to spend their mandatory two-week quarantine on the links. The agency said this week that Thailand “remains a golfer’s paradise even during the Covid-19 pandemic.”

  • A shortage of oxygen tanks in the Brazil’s northern state of Amazonas pushed the health care system to the brink of collapse this week as officials scrambled to transport critically ill coronavirus patients to other states. “We are in a state of war,” said Wilson Lima, the governor of Amazonas, on Thursday. “Our main difficulty has been in acquiring oxygen.”

  • Hospitals across England are stretched to the brink with Covid-19 patients, medical workers are at their breaking point, and the death toll is soaring. The number of hospitalized Covid-19 patients in England has risen sharply since Christmas and now dwarfs the spring peak by 70 percent, with almost 14,000 more patients in hospitals than on April 12. Prime Minister Boris Johnson warned this week that there was a “very substantial” risk that many hospitals will soon run out of beds in intensive care units.

  • As India prepares to begin an ambitious coronavirus vaccination program this weekend, more than 700,000 Hindu pilgrims gathered to take a dip in the Ganges River on Thursday, the start of the Kumbh Mela, one of the largest religious gatherings in the world. The authorities said that about 1,000 people had been fined for not wearing masks or maintaining social distance. India has recorded at least 10.5 million coronavirus cases — the world’s second-highest total after that of the United States.

The new announcement effectively suspends a so-called “travel corridor” system under which people could come unrestricted to Britain from a limited number of nations considered low risk.
Credit…Neil Hall/EPA, via Shutterstock

Battling a new variant of the coronavirus within its borders, Britain on Friday toughened measures to guard against importing infections from abroad, announcing that anyone arriving in the country must take a Covid-19 test before traveling and quarantine themselves upon arrival.

The new announcement effectively suspends a so-called “travel corridor” system under which people could come to Britain from a limited and dwindling number of nations judged to be low risk without restrictions.

From Monday, anyone who has come from or traveled through any country outside the United Kingdom and Ireland in the previous 10 days will be required to take a pre-departure Covid-19 test and show a negative result. He or she will have to go into self-quarantine for 10 days on arrival, though that period can be shortened to five days by taking a second Covid-19 test after spending several days in Britain.

The government also promised to toughen enforcement by increasing the number of spot checks on passengers entering the country.

“We are operating in a completely new environment in our fight against Covid-19, with several worrying new strains of the virus emerging across the globe,” said Grant Shapps, the transport secretary, in a statement, explaining that the new measures apply to British and Irish citizens as well as other nationalities.

The move comes on the heels of a decision to suspend flights to Britain from South America and Portugal amid fears over the spread of variants of coronavirus, such as those first identified in Brazil.

Britain has been hit hard by a surge in cases caused by the spread of a new and highly transmissible variant of its own. For the week ending Jan. 14, the country reported an average of 52,977 new cases daily and 1,072 deaths. On the positive side, more than 3.2 million Britons have received a first vaccination against the virus.

Speaking to press on Friday, Prime Minister Boris Johnson said it was vital to take extra measures now, “when, day by day, we are making such strides in protecting the population.”

Keir Starmer, the leader of the opposition Labour Party, welcomed the new restrictions but criticized ministers for being “slow again.”

“Many people will say, ‘Why on earth didn’t this happen before?’” he told news outlets.

A health care worker carries a swab test to a patient at a testing center in Murray, Utah, on Thursday.
Credit…Kim Raff for The New York Times

An organization that represents U.S. state and local public health labs on Friday called for a more unified and consistent testing strategy to better combat the Covid-19 pandemic. In a report, the leaders of the Association for Public Health Laboratories criticized the nation’s testing response as inconsistent and uncoordinated.

“We are nearly a year into our response to Covid-19 and while we have made progress, we still face chronic challenges,” Scott Becker, A.P.H.L.’s chief executive, said in a statement. “The lack of a coordinated national approach is the most vexing.”

Since the pandemic’s early days, fast and reliable tests have been in short supply, seeding long wait times and hampering the ability of public health officials to track and contain the spread of disease. The majority of the tests run in the U.S. have been routed through laboratories — a mainstay strategy in infectious disease diagnostics. But the production of materials and chemicals needed to collect and process test samples has lagged disastrously behind demand, while testing laboratories have struggled to fill employee vacancies, according to the report.

The rise of rapid, non-laboratory tests has been billed as a potential solution. But concerns about the accuracy of some rapid tests, which tend to more often miss active coronavirus infections, especially in people without symptoms, have sown confusion about the role these tests can and can’t play.

The report called for the convening of a panel at the federal level to develop recommendations for a consistent national testing strategy, which would delegate specific roles to public and private testing laboratories, and identify priority populations for testing. It also advocated a federal stockpile for testing supplies to buffer laboratories against future shortages, as well as adequate funding for testing.

Better testing efforts, the report noted, could also help track how well vaccines block the ability of the coronavirus to spread from person to person. Well-designed tests could also monitor the globe for new variants of the coronavirus.

Citing the bungled efforts to set public expectations about the role of testing in the pandemic, the report also underscored the importance of clear communication. People taking tests, it noted, would need to know how to interpret their results in different settings, such as when patients are looking for a diagnosis, or when vulnerable populations without symptoms are checking themselves for silent infections.

Alex M. Azar II, the health and human services secretary, condemned President Trump’s embrace of election conspiracies.
Credit…Oliver Contreras for The New York Times

Alex M. Azar II, the health and human services secretary and one of the most prominent members of the Cabinet, took a parting shot at President Trump in a letter he wrote to him confirming his departure on Inauguration Day, suggesting that he considered quitting after a violent mob stormed the Capitol building last week.

In a not-so-subtle condemnation of Mr. Trump’s embrace of election conspiracies, Mr. Azar wrote that “the actions and rhetoric following the election, especially during the past week, threaten to tarnish” the administration’s legacy, effectively telling Mr. Trump that his attempts to overturn the election results undermined his term.

The letter, dated Jan. 12 and obtained by The New York Times, came days after two Cabinet officials, Betsy DeVos, the former education secretary, and Elaine Chao, the former transportation secretary, resigned after citing the Capitol invasion.

The letter was also a notable break for Mr. Azar. He has repeatedly lavished attention and praise on Mr. Trump in his three-year tenure, ingratiating himself with West Wing officials. Still, the White House came close to firing him in the spring after a series of unflattering stories came out about Mr. Trump’s handling of the pandemic, articles White House advisers believed Mr. Azar had a role in.

Mr. Azar also called on Mr. Trump to “demand that no one attempt to disrupt the inaugural activities in Washington or elsewhere” and to support a peaceful transition of power.

Mr. Azar’s letter includes just a single acknowledgment of Mr. Trump’s influence on health policy, thanking the president for taking on “entrenched special interests in health care.” He added that with the pandemic “raging” and the obligations of a transition, he decided to stay on as health secretary until the end of the term.

In an interview with ABC’s “Good Morning America” this week, Mr. Azar said he had “wrestled” with the idea of staying on in the job after the riot, and declined to discuss whether he had talked with other Cabinet officials about the 25th Amendment.



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