Covid News: France Orders Health Care Workers to Get Vaccinated


Credit…Ludovic Marin/Agence France-Presse — Getty Images

Hoping to combat a possible new wave of coronavirus infections, President Emmanuel Macron of France on Monday announced new vaccination requirements, including mandatory inoculation for health care workers and proof of immunization or a recent negative test to enter restaurants and cultural venues.

But it was highly uncertain whether the measures would be enough to avoid a fourth wave of the virus powered by the fast-spreading Delta variant, which already accounts for about half of new infections in France.

Mr. Macron’s announcement came just three days after nightclubs reopened for the first time in 16 months, which many believed had symbolically signaled the completion of France’s protracted efforts to emerge from the pandemic. But the new measures dashed hopes of a return to a prepandemic normal and of a smooth summer vacation season.

In a televised address, Mr. Macron spoke of “a strong resurgence of the epidemic” that would require France to redouble use of “a key asset”: vaccines.

He announced that he wanted to pass a law that would require all health workers to get vaccinated by Sept. 15 and that the goal was now to “put restrictions on the unvaccinated rather than on everyone.”

The law is likely to pass this summer as most political parties are in favor of mandatory vaccinations for health care workers.

After Mr. Macron’s address, the French health minister, Olivier Véran, said on French television, “Starting Sept. 15, if you are a health care worker and you’re not vaccinated, you won’t be able to work and you won’t be paid.”

Starting July 21, anyone entering a cultural venue or an amusement park will also need to show proof of vaccination or a recent negative test for the virus, Mr. Macron said. The requirement will be extended in August to restaurants, shopping centers, hospitals, retirement homes and long-distance transportation.

France will also start charging money for some virus tests, which until now were free, “to encourage vaccination rather than increased testing,” Mr. Macron said.

Although none of the new measures compared to the severe restrictions that were imposed from early 2020 through last month — France has experienced three national lockdowns, nighttime curfews and forced shutdowns of all nonessential businesses — they were aimed at reminding the French that the pandemic was not over.

For several days, the authorities had warned that the Delta variant was spreading fast and could hamper the country’s reopening. Some 4,300 new coronavirus infections were reported on Sunday, compared with 2,500 daily cases just a week earlier.

“That could become 6,000 cases in a week, 12,000 cases in 15 days and rise to 20,000 or more in early August if we don’t act,” Mr. Véran told the French broadcaster Radio J on Sunday. Despite the rise in cases, hospitalizations have so far not increased.

In a report released last week, France’s scientific council — a government body that Mr. Macron set up last year to advise him on coronavirus issues — said that, given the fast-spreading Delta variant, “the epidemic cannot be controlled unless 90 to 95 percent of people are vaccinated or infected.”

So far, less than 10 percent of the total population has been infected and about 36 percent have been fully vaccinated. Studies suggest that vaccines remain effective against the Delta variant.

The government aims to get two-thirds of people fully protected by the end of August, but public demand has dwindled in recent weeks because of vaccine hesitancy and a growing sense among many people that the virus is no longer a threat.

On Monday, Mr. Macron stopped short of making vaccinations obligatory but added that such an option may be considered, “depending on the evolution of the situation.”




‘Seriously Disappointing’: W.H.O. Criticizes Booster Vaccines

Dr. Tedros Adhanom Ghebreyesus, the W.H.O. director general, called on wealthy countries not to order Covid booster shots while most countries are still struggling to give their residents initial vaccines.

While many countries haven’t even started vaccinating, and another country has already vaccinated majority of its population, the two doses and now moving to a surplus, which is the booster. It’s really not only disappointing, it’s seriously disappointing. And high-income countries who are vaccinating their population significantly are starting to see Covid-19 pandemic as if it’s not their problem. That is dangerous. You have seen it and everybody is seeing it now. High-income countries are starting to say, we have managed to control it. It’s not our problem. And there will be two problems on this: One, I’m not sure if they are out of the woods, and I don’t think they’re in control. Instead of Moderna and Pfizer prioritizing the supply of vaccines as boosters to countries whose populations have relatively high coverage, we need them to go all out to channel supply to Covax, the Africa Vaccine Acquisition Task Team, and low- and middle-income countries, which have very little vaccine coverage.

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Dr. Tedros Adhanom Ghebreyesus, the W.H.O. director general, called on wealthy countries not to order Covid booster shots while most countries are still struggling to give their residents initial vaccines.CreditCredit…Christopher Black/World Health Organization, via Agence France-Presse — Getty Images

Representatives of Pfizer met privately with senior U.S. scientists and regulators on Monday to press their case for swift authorization of coronavirus booster vaccines, amid growing public confusion about whether they will be needed and pushback from federal health officials who say the extra doses are not necessary now.

The high-level online meeting, which lasted an hour and involved Pfizer’s chief scientific officer briefing virtually every top doctor in the federal government, came on the same day that Israel started administering third doses of the Pfizer-BioNTech vaccine to heart transplant patients and others with compromised immune systems. Officials said after the meeting that more data — and possibly several more months — would be needed before regulators could determine whether booster shots were necessary.

The twin developments underscored the intensifying debate about whether booster shots were needed in the United States, at what point and for whom. Many American experts, including Dr. Anthony S. Fauci, President Biden’s chief medical adviser for the pandemic, have said that there is insufficient evidence yet that boosters are necessary. Some, though, say Israel’s move may foreshadow a government decision to at least recommend them for the vulnerable.

Pfizer is gathering information on antibody responses in those who receive a third dose, as well as data from Israel, and expects to submit at least some of that to the Food and Drug Administration in the coming weeks in a formal request to broaden the emergency authorization for its coronavirus vaccine.

But the final decision on booster shots, several officials said after the meeting, will also depend on real-world information gathered by the Centers for Disease Control and Prevention about breakthrough infections — those occurring in vaccinated people — that cause serious disease or hospitalization.

And any recommendations about booster shots are likely to be calibrated, even within age groups, officials said. For example, if booster shots are recommended, they might go first to nursing home residents who received their vaccines in late 2020 or early 2021, while older people who received their first shots in the spring might have a longer wait. And then there is the question of what kind of booster: a third dose of the original vaccine, or perhaps a shot tailored to the highly infectious Delta variant, which is surging in the United States.

“It was an interesting meeting. They shared their data. There wasn’t anything resembling a decision,” Dr. Fauci said in a brief interview Monday evening, adding, “This is just one piece of a much bigger puzzle, and it’s one part of the data, so there isn’t a question of a convincing case one way or the other.”

A spokeswoman for Pfizer said in a statement: “We had a productive meeting with U.S. public health officials on the elements of our research program and the preliminary booster data.”

With less than half of the U.S. population fully vaccinated, some experts said that the country needed to remain focused on getting all Americans their first dose. The Food and Drug Administration’s most important task, they said, is to increase public confidence by granting full approval to the coronavirus vaccines in use, which for now are authorized on an emergency basis.

“At this point, the most important booster we need is to get people vaccinated,” said Dr. Carlos del Rio, an infectious disease expert at Emory University in Atlanta.

Within the Biden administration, some fear that if Americans are convinced that coronavirus vaccines provide only short-lived immunity before requiring a booster, they will be less likely to accept a shot. But those concerns could fall by the wayside if data from Israel, expected in the next several weeks, shows conclusively that immunity wanes after six to eight months, significantly raising the risks for older people or other vulnerable populations.

The administration convened Monday’s session in response to last week’s announcement by Pfizer and its German partner, BioNTech, that they were developing a version of their vaccine that targets the Delta variant, and reporting promising results from studies of people who received a third dose of the original vaccine six months after the second.

The new data is not yet published or peer-reviewed, but when the companies announced that they would submit data to the Food and Drug Administration for authorization of booster shots, it caught the Biden White House by surprise.

In an unusual joint statement Thursday evening, hours after the Pfizer-BioNTech announcement, the F.D.A. and the C.D.C. pushed back.

Boxes of the Johnson & Johnson coronavirus vaccine in Shepardsville.
Credit…Pool photo by Timothy D. Easley

The Food and Drug Administration is planning to warn that Johnson & Johnson’s coronavirus vaccine can lead to an increased risk of a rare neurological condition known as Guillain–Barré syndrome, another setback for a vaccine that has largely been sidelined in the United States because of manufacturing problems and a temporary safety pause earlier this year, according to several people familiar with the plans.

Although regulators have found that the chances of developing the condition are low, they appear to be three to five times higher among recipients of the Johnson & Johnson vaccine than among the general population in the United States, according to people familiar with the decision.

Federal officials have identified roughly 100 suspected cases of Guillain-Barré disease among recipients of the Johnson & Johnson shot through a federal monitoring system that relies on patients and health care providers to report adverse effects of vaccines. The reports are considered preliminary. Most people who develop the condition recover.

“It’s not surprising to find these types of adverse events associated with vaccination,” said Dr. Luciana Borio, a former acting chief scientist at the F.D.A. under President Barack Obama. The data collected so far by the F.D.A., she added, suggested that the vaccine’s benefits “continue to vastly outweigh the risks.”

The database reports indicate that symptoms of Guillain-Barré developed within about three weeks of vaccination. One recipient, a 57-year-old man from Delaware who had suffered both a heart attack and a stroke within the last four years, died in early April after he was vaccinated and developed Guillain-Barré syndrome, according to a report filed to the database.

The Biden administration is expected to announce the new warning as early as Tuesday. The F.D.A. has concluded that the benefits of the vaccine in preventing severe disease or death from the coronavirus still strongly outweigh the risk, but it plans to include the proviso in fact sheets about the drug for providers and patients. European regulators may soon follow suit. No link has been found between Guillain-Barré syndrome and the coronavirus vaccines developed by Pfizer-BioNTech or Moderna, the other two federally authorized manufacturers. Those rely on a different technology.

Nearly 13 million people in the United States have received Johnson & Johnson’s shot, but 92 percent of Americans who have been fully vaccinated received shots developed by Pfizer-BioNTech or Moderna. Even though it requires only one dose, Johnson & Johnson’s vaccine has been marginalized by manufacturing delays and a 10-day pause while investigators studied whether it was linked to a rare but serious blood clotting disorder in women. That investigation also resulted in a warning added to the fact sheet.

The new safety concern comes at a precipitous moment in the nation’s fight against Covid-19. The pace of vaccinations has slowed considerably just as a new, more contagious variant called Delta is spreading fast in under-vaccinated areas. Federal health officials are worried that the news could make some people even more hesitant to accept the vaccines developed by Pfizer-BioNTech or Moderna, even though well over 100 million people have received those vaccines, according to the Centers for Disease Control and Prevention.

Almost one-third of the nation’s adults remain unvaccinated. The Biden administration has shifted away from relying on mass vaccination sites and is now enlisting community workers in door-to-door campaigns, supplying doses to primary care doctors and expanding mobile clinics in an attempt to convince the unvaccinated to accept shots.

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Prime Minister Boris Johnson said England will lift coronavirus restrictions starting July 19 as planned. Cases in England continue to rise and the highly contagious delta variant is more widespread.CreditCredit…Jeremie Souteyrat for The New York Times

With coronavirus infections surging yet again, Prime Minister Boris Johnson on Monday urged Britons to keep wearing face masks in crowded, indoor spaces even as he promised to unlock England’s economy next week and lift almost all virus-related restrictions.

Mr. Johnson’s admonition on masks, while not compulsory, represents the latest swerve from a government that delayed the imposition of several lockdowns and then promised the “irreversible” lifting of restrictions, culminating in what British tabloid newspapers called “freedom day.”

Having delayed that moment once, Mr. Johnson on Monday confirmed plans to proceed with the removal of most legal curbs in England on July 19, allowing pubs and restaurants to operate at full capacity and nightclubs to open their doors. Curbs on the number of people who can meet indoors, generally limited to six, will also be lifted.

Despite the spread of the highly transmissible Delta variant, the government believes that Britain’s successful vaccination program has weakened the link between cases and hospital admissions. The government now argues that there is no better time to end lockdown restrictions than in the summer when the virus tends to spread more slowly and schools take a vacation break, eliminating one source of transmission.

Still, the landmark once hailed boldly as “freedom day” by libertarian lawmakers is now being given much more cautious billing by the government as Britain records around 30,000 cases a day, a number that the health secretary, Sajid Javid, on Monday said could climb to 100,000 during the summer.

“Whether we like it or not, coronavirus is not going away,” Mr. Javid said in Parliament.

The government decision to recommend the continued use of face masks in crowded indoor spaces is a shift, in tone at least, from a week ago when Mr. Johnson outlined his thinking at a news conference.

When asked then whether he would wear a mask, he said, “it would depend on the circumstances,” before clarifying later that he would wear one on a crowded train.

On Monday, Mr. Johnson struck a decidedly cautious tone. “I cannot say this powerfully or emphatically enough,” he said at a news conference. “This pandemic is not over. This disease, coronavirus, continues to carry risks for you and your family. We cannot simply revert instantly from Monday, 19 July to life as it was before Covid.”

Mr. Johnson added that the government strongly recommended that people wear a face covering in crowded and enclosed spaces such as on public transportation.

The government plans to work with organizers of large indoor events to encourage the use of certification for those who have been vaccinated or recently tested.

Mr. Johnson said he wanted a gradual return to the workplace rather than a mass move back to offices next week. And Britain’s border restrictions would remain in place, including hotel quarantine for those arriving from countries deemed to be in the highest risk category.

Nonetheless, Mr. Johnson argued that delaying the full reopening of the economy would merely postpone any surge in infections to the fall, when schools return and colder weather gives the virus a natural advantage. So he wants to replace an era of government diktat with one of growing personal responsibility as people learn to live with the virus and use common sense to protect themselves.

Patients waiting to receive a third dose of the Pfizer-BioNTech coronavirus vaccine on Monday at the outpatient clinics of the Cardiovascular Centre at Sheba Medical Center near Tel Aviv, Israel.
Credit…Jack Guez/Agence France-Presse — Getty Images

Israel’s Ministry of Health on Monday issued guidelines for administering a third shot of the two-dose Pfizer-BioNTech coronavirus vaccine to people with compromised immune systems, citing the rising infection rate in recent weeks as well as growing evidence that such people do not develop sufficient antibodies after two doses.

The ministry released a list of those now eligible for a third shot, prioritizing heart, lung and kidney transplant recipients followed by others with weak immune systems including cancer patients.

Sheba Medical Center near Tel Aviv began giving third Pfizer shots to dozens of heart transplant recipients on Monday afternoon, an hour after receiving a green light from the Ministry of Health.

“It’s really urgent to do it now,” Prof. Galia Rahav, the head of the Infectious Disease Unit and Laboratories at the Sheba Medical Center, said in a video statement, citing the rise of the Delta variant. The hospital said it would be testing and tracking the recipients of the third shot for research purposes.

Israel initially led the world with a rapid vaccination campaign and 57 percent of its population is fully vaccinated. But the arrival of the highly contagious Delta variant has brought a rise in daily infections, up from single digits a month ago to an average of 452 cases per day. About 58 percent of the 81 Israeli Covid-19 patients currently hospitalized are vaccinated, according to Israeli Ministry of Health data. Studies suggest that vaccines remain effective against the Delta variant.

Health care providers in France have been giving a third dose of a two-dose vaccine to people with certain immune conditions since April.

The number of organ transplant recipients who had antibodies increased to 68 percent four weeks after the third dose, up from 40 percent after the second dose, one team of French researchers recently reported. In the United States, there has been no concerted effort by federal agencies or vaccine manufacturers to test this approach so far.

ECMO, short for extracorporeal membrane oxygenation, adds oxygen and removes carbon dioxide from a patient’s blood before pumping it back in.
Credit…Victor J. Blue for The New York Times

Throughout the pandemic, wrenching scenes have played out across the United States as doctors found themselves in the unfamiliar position of overtly rationing a treatment. But it was not ventilators, as initially feared: Concerted action largely headed off those shortages. Instead, it was the limited availability of ECMO — which requires expensive equipment similar in concept to a heart-lung machine and specially trained staff who can provide constant monitoring and one-on-one nursing — that forced stark choices among patients.

“Patients died because they could not get ECMO,” said Dr. Lena M. Napolitano, co-director of the Surgical Critical Care Unit at the University of Michigan. This spring, she was overwhelmed with requests to accept patients considered good candidates for ECMO. “We could not accommodate all of them,” she said.

Doctors tried to select individuals most likely to benefit from ECMO, a last-resort treatment that can mechanically substitute for badly damaged lungs. But dozens of interviews with medical staff and patients across the country, and reporting inside five hospitals that provide ECMO, revealed that in the absence of regional sharing systems to ensure fairness and match resources to needs, hospitals and clinicians were left to apply differing criteria, with insurance coverage, geography and even personal appeals having an influence.

“It’s unsettling to have to make those kinds of decisions,” said Dr. Ryan Barbaro, a critical care physician in Michigan and head of an international registry of Covid-19 patients who have received ECMO — short for extracorporeal membrane oxygenation — about half of whom survived hospitalization.

Close to 8,000 patients worldwide have received ECMO to date, including nearly 5,000 in North America. Despite the progress the United States has made against the coronavirus, some doctors are still having to ration ECMO, which is offered in less than 10 percent of hospitals.

“It’s something we’re balancing every day,” said Dr. Erik Eddie Suarez, a cardiovascular surgeon at Houston Methodist. If the hospital accepts too many Covid patients for ECMO, he said, “we can’t do cardiac surgery,” because some of those patients also need the treatment.

A vaccination center in Dhaka, Bangladesh, this month.
Credit…Allison Joyce/Getty Images

The pandemic has been a cruel blow for thousands of migrant workers in South Asia who are out of work or unable to return to their jobs abroad.

Countries like Bangladesh, India and Nepal rely heavily on migrant workers, who send billions of dollars home each year. But over the past year, many have lost their jobs and been forced to return to their native countries. Others still have jobs or have found new ones, but are struggling to make travel arrangements to take up the posts.

The lack of Covid-19 vaccines has compounded the problem, with many countries requiring migrant workers to be inoculated to avoid quarantine or sometimes to enter at all.

Ajay Sodari, a migrant worker in Kathmandu, Nepal, who needs to be vaccinated before he can start his job in South Korea, said, “I spent four years studying the Korean language, to get selected as a qualified worker in language tests and sign a labor agreement with the company.” He said that he had spent thousands of dollars to meet the employment requirements but that the pandemic had “shattered my dream.”

The lack of vaccines has been most acute in Bangladesh and Nepal, both of which planned to source most of their doses from neighboring India until New Delhi stopped vaccine exports this spring to prioritize its own citizens. In Bangladesh and Nepal, only about 3 percent of the population is fully vaccinated, according to a New York Times database.

In Nepal, where inward remittances account for a quarter of gross domestic product, migrant workers were not among the priority groups in initial phases of the vaccination campaign, which favored older adults, frontline health workers, security personnel and government officials. As many as 35,000 migrant workers are stuck in Nepal despite obtaining final work permit approval from the country’s government, according to the Nepal Association of Foreign Employment Agencies. The group says that most countries have stopped recruiting workers from Nepal because they are not vaccinated.

In Bangladesh, there are at least 90,000 migrant workers waiting to get vaccinated before they can start their jobs abroad, said Shahidul Alam, director general at the Bureau of Manpower Employment and Training, a government agency. Mr. Alam said that Bangladesh was stepping up its vaccination efforts among migrant workers, including with the introduction of an app.

“In the last seven days, at least 45,000 workers registered in the app, and the vaccination for them is already started,” he said on Thursday.

The workers’ situation is complicated by the fact that their destination countries sometimes require certain vaccines. Neither Saudi Arabia nor Kuwait, two of the most common destinations for Bangladeshi migrant workers, recognize the Chinese-made Sinopharm vaccine, which Bangladesh now largely relies upon for mass inoculation.

To help the stranded workers, the government in Bangladesh is giving them the Pfizer vaccine at seven health facilities in Dhaka, the capital, using some of the 106,000 doses received through the Covax global vaccine-sharing program. Mr. Alam said that the workers would also receive some of the 2.5 million doses of the Moderna vaccine received from the United States this month in partnership with Covax.

In India, which has the world’s largest migrant population at nearly 18 million, vaccine shortages are worse in some states than others. The southern state of Kerala is home to the greatest number of migrants in India, with nearly four million Keralites living abroad. Though the state has recently prioritized vaccination for migrants, many said they had been stranded in India for months, unable to return to their jobs and worried their visas would expire.

Hanees Babu, 52, has been waiting in Kerala for nearly nine months to return to Kuwait, where he owns a business selling automotive lubricants. He has received both doses of the AstraZeneca vaccine, but that is not necessarily the end of his problems. His vaccine certificate lists the name of the vaccine as Covishield, as it is known in India, which can cause confusion in other countries. The Delhi High Court recently directed the central government to consider including the AstraZeneca name on vaccination certificates to make it easier for people to travel abroad.

The Kerala state government is already issuing vaccination certificates that say AstraZeneca, but they have to be applied for separately. Several people seeking to travel abroad said that having two different vaccination certificates made the process more difficult and had led some countries to stop processing visa applications from India completely.

Shalini Venugopal Bhagat reported from Goa, India; Bhadra Sharma from Kathmandu, Nepal; and Saif Hasnat from Dhaka, Bangladesh.

Janet L. Yellen, the Treasury secretary, speaking on Sunday in Venice. “What happens in any part of the world affects all other countries,” she said.
Credit…Andrea Merola/EPA, via Shutterstock

Treasury Secretary Janet L. Yellen said on Sunday that she was concerned that coronavirus variants could derail the global economic recovery and called for an urgent push to vaccinate more people around the world.

Her comments, made at the conclusion of a gathering of the finance ministers of the Group of 20 nations, came as the highly contagious Delta variant of the coronavirus was driving outbreaks among unvaccinated populations in countries such as Australia, Indonesia, Malaysia and Portugal.

“We are very concerned about the Delta variant and other variants that could emerge and threaten recovery,” Ms. Yellen said. “We are a connected global economy. What happens in any part of the world affects all other countries.”

Many cities and countries have started to declare victory against the pandemic, easing restrictions and returning to normal life. But Ms. Yellen warned that the public health crisis was not over.

She said that the world’s top economic officials had spent much of the weekend in Venice discussing how they could improve vaccine distribution, with the goal of getting 70 percent of the world inoculated by next year. Ms. Yellen noted that many countries had been successful in financing the purchase of vaccines, but that the logistics of getting them into people’s arms were falling short.

“We need to do something more and to be more effective,” she said.

The spread of variants has started to dampen optimism about the trajectory of the recovery. Analysts at Capital Economics said last week that they planned to lower their economic growth outlook for the year to below 6 percent.

“The divergence across economies is intensifying,” Kristalina Georgieva, the managing director of the I.M.F., said on Saturday. “Essentially, the world is facing a two-track recovery.”

The I.M.F. executive board approved a plan last week to issue $650 billion worth of reserve funds that countries could use to buy vaccines and to finance health care initiatives.

Processing residents for vaccination in Dautai, a village in India’s most populous state, Uttar Pradesh.
Credit…Saumya Khandelwal for The New York Times

GARH MUKTESHWAR, India — When a devastating second wave of Covid-19 infections reached India’s countryside this spring, the village of Khilwai took immediate action. Two testing centers were set up, and 30 positive cases were isolated. The outbreak was contained with just three deaths.

It was a different story in the two villages on either side of Khilwai. Testing remained limited. The local health center in one village had been closed, its staff sent away to a larger hospital. The coronavirus spread, and at least 30 people in each village died with Covid-19 symptoms.

But even as the three villages in India’s most populous state, Uttar Pradesh, diverged in their handling of the coronavirus, they have been united in another way: a vaccine hesitancy that is prevalent throughout India and threatens to prolong the country’s crisis.

The combination of an uneven virus response — a reflection of huge inequality in resources and the vagaries of local attitudes — and a struggling vaccination campaign has left officials warning of a third wave of infections when the second has at best only leveled off. Any sense of rapid relief like the one now prevailing in the United States is unlikely anytime soon.

Just 5 percent of India’s 1.4 billion people are fully vaccinated, while about 20 percent have had a first dose. That gives the country insufficient protection against the highly contagious Delta variant of the virus, which first surfaced in India.

At the same time, the country continues to report tens of thousands of new infections and close to 1,000 deaths each day, numbers that are almost certainly an undercounting. Resigned talk of a third wave is indicative of how virus fatigue, and the catastrophic toll of hundreds of thousands of people in the last wave, have resulted in a new definition of acceptable loss.

Workers unloaded boxes containing the Janssen vaccine in Kathmandu, Nepal, on Monday.
Credit…Narendra Shrestha/EPA, via Shutterstock

The Gavi Alliance announced Monday that it had signed its first agreements to buy coronavirus vaccine from two Chinese companies, Sinopharm and Sinovac, providing for deliveries of 110 million doses within three months, with options for bigger deliveries later this year and in the first half of 2022.

Gavi, the public-private partnership that is overseeing Covax, the program to donate vaccines to poor countries, said that Sinopharm would contribute 60 million doses between July and October, with an option to provide 60 million more in the last quarter of 2021 and 50 million more doses in the first half of 2022.

Sinovac would deliver 50 million doses, Gavi said, by the end of September, with an option for Covax to receive 150 million more doses in the last quarter of the year and 180 million doses in the first half of 2022.

The agreements, combined with donations pledged by the United States and other Group of 7 countries, will give a boost to Covax. It was set up to help the poorest countries gain access to vaccines, but it has struggled to gain a footing, as world leaders and vaccine manufacturers have prioritized sending doses to populations in wealthy nations.

China kicked off its vaccine diplomacy campaign last year by pledging to provide a shot that would be safe and effective at preventing severe cases of Covid-19, and dozens of countries are using Covid vaccines from China. Some of the countries that have experienced fresh virus outbreaks despite high inoculation rates, though, relied on Chinese-made vaccines. During a news conference Monday, World Health Organization officials supported the addition of the Sinovac and Sinopharm vaccines to the Covax portfolio, and expressed confidence in the efficacy of the vaccines.

But as concerns grow about more transmissible variants as well as about the waning immunity provided by the Sinovac vaccine, Thailand said on Monday that health care workers who had received the vaccine made by Sinovac would also be inoculated with the Oxford-AstraZeneca or Pfizer-BioNTech shots to give them greater protection.

About 3.4 billion Covid-19 vaccine doses have been administered globally but the vast majority have gone to wealthy countries. Covax, since its launch in February, has shipped 107 million vaccine doses to 135 countries. About 70 percent of these doses have gone to poorer countries; the other 30 percent have gone to wealthier nations paying their own way.

Gavi said that it is now on track to deliver nearly 1.9 billion doses in 2021. It said that it will reach its target of two billion doses distributed in early 2022, instead of by the end of this year.

Covax supplies only W.H.O.-approved vaccines, and Gavi noted that it had approved an emergency-use listing for Sinopharm in May and for Sinovac in June, clearing the way for rapid delivery of the vaccines.

Covax signed an agreement with a third Chinese vaccine manufacturer, Clover, at the end of June, for a total of 414 million doses. Covax said that 64 million doses would be available in the last quarter of the year. Clover, however, is still awaiting W.H.O. emergency-use listing, creating uncertainty over when Covax will be able to start delivering the vaccine.

Lauren McCarthy contributed reporting.


A beach in Comino, Malta, on Sunday. The country’s government said that most of the people who tested positive for the coronavirus recently were foreign nationals who had not been inoculated.
Credit…Joanna Demarco/Getty Images

Malta will ban visitors over the age of 12 from entering the country starting Wednesday unless they are fully vaccinated against the coronavirus, the first country in the European Union to impose such restrictions.

The small archipelago between Sicily and Libya, with a population of half a million, has the world’s highest proportion of fully vaccinated residents, about 70 percent, and about 74 percent have received one dose, according to data compiled by The New York Times.

But as the highly contagious Delta variant spreads rapidly across Europe, coronavirus infections are increasing in Malta, with an average of 58 new cases a day, according to the Times data.

Chris Fearne, the Maltese health minister, announced the latest measures at a news conference on Friday after new virus cases had doubled every day since the previous Monday, according to Reuters.

“We will be the first E.U. country to do so, but we need to protect our society,” he said of the introduction of the restrictions.

Starting Wednesday, the Maltese authorities will require vaccination certificates issued 14 days after the final dose. Documents issued by Malta, the European Union or Britain will be recognized.

Children ages 5 to 12 must have a negative PCR test for Covid-19, while children under 5 are exempt. All children must be accompanied by a fully vaccinated adult with an authorized vaccine certificate.

The government said on Friday that the rise in coronavirus infections showed very clearly that the country’s vaccination efforts were working, as most of the people who tested positive were foreign nationals who had not been inoculated.

The restrictions were implemented to err on the side of caution to protect the country’s unvaccinated population, the government said.

Here’s what’s happening around the world:

  • On Monday, two regions of Spain moved to reintroduce restrictions amid a surge in virus cases. Catalonia, the northeastern region which includes Barcelona, announced that bars would close early and private gatherings limited to 10 people as it grapples with the highest infection rate in the country. The number of patients hospitalized for Covid-19 in Spain has more than doubled in the past two weeks to nearly 1,100 people. In eastern Valencia, a court permitted the reintroduction of a nighttime curfew in the 32 municipalities that have the highest infection rates.

  • At least 39 people were killed and more than 20 injured in a fire at a coronavirus hospital in Nasiriya in southern Iraq, health officials told the Reuters news agency on Monday. “Health crews carried charred bodies out of the burning hospital while many patients were coughing from the rising smoke,” a Reuters reporter at the site of the fire site said. The state-run Iraq News Agency cited health ministry officials as saying that search operations at the al-Hussain coronavirus hospital were continuing after the fire was brought under control.

  • Greece has mandated Covid vaccinations for some health care workers and announced restrictions as a rise in cases threatens its vital summer tourism season, Reuters reported. Nursing home staff will need to get vaccinated immediately, while health care workers will have to be vaccinated starting Sept. 1, Prime Minister Kyriakos Mitsotakis said. Only vaccinated customers will be allowed indoors in bars, cinemas, theaters and other enclosed spaces, he said.

  • BioNTech on Monday announced a deal to provide 10 million doses of its vaccine to Taiwan, easing a serious shortage there and ending months of deadlock with China, which considers Taiwan part of its territory. The vaccines will be purchased, then donated to Taiwan’s government, by two of the island’s most prominent corporations — Foxconn, a major assembler of iPhones; and TSMC, which makes the cutting-edge chips in Apple’s latest devices — in conjunction with the YongLin Foundation, a charity.

  • Thailand said on Monday that health care workers who had received the vaccine made by Sinovac of China would also be inoculated with the Oxford-AstraZeneca or Pfizer-BioNTech shots to give them greater protection. Thailand is the latest foreign government to indicate doubts about the Sinovac vaccine. On Friday, Indonesia said it would offer the Moderna vaccine as a booster to health care workers who had received the Sinovac vaccine.

  • Officials in Sydney, Australia, warned on Monday that the city’s lockdown could be extended as an outbreak of the highly contagious Delta variant of the coronavirus showed no signs of slowing down. Sydney entered lockdown more than two weeks ago after an airport limousine driver contracted the virus, which then spread rapidly. On Monday, officials reported 112 new cases, the highest one-day total yet in an outbreak that has grown to 678 cases since it began in mid-June.

A ferry dock in Sydney, Australia, on Monday. The city entered lockdown more than two weeks ago after an airport limousine driver contracted the virus, which then spread rapidly.
Credit…Loren Elliott/Reuters

Officials in Sydney, Australia, warned on Monday that the city’s lockdown could be extended as an outbreak of the highly contagious Delta variant of the coronavirus showed no signs of slowing down.

The city, Australia’s most populous, entered lockdown more than two weeks ago after an airport limousine driver contracted the virus, which then spread rapidly. On Monday, officials reported 112 new cases, the highest one-day total yet in an outbreak that has grown to 678 cases since it began in mid-June.

“We are at an absolutely critical phase of this disease,” said Gladys Berejiklian, premier of the state of New South Wales, which includes Sydney.

Although Ms. Berejiklian did not say whether the lockdown would be lifted on Friday as scheduled, she stressed that it was contingent on minimizing the number of people who were moving about while infectious.

“All of us want to get out of this lockdown,” Ms. Berejiklian said. “It’s up to all of us to see that number of exposures in the community go down.”

Though Australia has been relatively successful in managing the virus through strict border closures and contact tracing, only about 9 percent of the country’s population is fully vaccinated, and the rapid spread of the Delta variant is a major concern. Studies suggest that vaccines remain effective against the Delta variant.

On Monday, citing the outbreak, Sydney officials said that the AstraZeneca vaccine would be made available to people as young as 40. That is a break from national health guidance, which recommends the AstraZeneca shots only for those over 60 because of blood clotting concerns. For younger people, the guidance is to use the Pfizer vaccine.

Health workers were monitored after receiving a Sinovac vaccine at a hospital in Bangkok in March. Thailand is the latest government to indicate doubts about the immunity provided by the Chinese company’s shots.
Credit…Adam Dean for The New York Times

Thailand said on Monday that health care workers who had received the coronavirus vaccine made by Sinovac of China would also be inoculated with the Oxford-AstraZeneca or Pfizer-BioNTech shots to give them greater protection as concerns grow about more transmissible variants as well as about the waning immunity provided by Sinovac.

Anutin Charnvirakul, Thailand’s health minister, said that people vaccinated with one dose of Sinovac should be given the AstraZeneca shot as the second dose three to four weeks later. Those who have already received both shots of the Sinovac vaccine, he said, should receive a booster shot “right away.”

“This will build immunity against the virus to a high level more quickly,” Mr. Anutin said at a news conference.

Thailand is the latest foreign government to indicate doubts about the immunity provided by the Sinovac vaccine. On Friday, Indonesia said it would offer the Moderna vaccine as a booster to health care workers who had received two doses of the Sinovac shot.

Both countries are facing their most serious coronavirus outbreaks of the pandemic, driven by the highly contagious Delta variant that was first detected in India. On Sunday, Thailand reported a record 9,418 new coronavirus infections, a day after it reported a record 91 coronavirus-related deaths. For at least two weeks starting Monday, the capital, Bangkok, and surrounding provinces will be under tight restrictions aimed at curbing the spread of the virus, including a curfew and a five-person limit on gatherings.

Most medical workers in Thailand were inoculated with the Sinovac vaccine after it was approved in February, with the AstraZeneca vaccine becoming available only recently. Trial results have shown that the Sinovac shot is at least 51 percent effective at preventing symptomatic disease, above the threshold set by the World Health Organization, and even more effective at preventing hospitalization and death.

But several countries that were among the earliest recipients of the Sinovac vaccine have reported that their health care workers have fallen ill with Covid-19 despite being fully vaccinated. On Sunday, the Thai Health Ministry said that out of the 677,348 medical personnel who had received two doses of Sinovac, 618 had become infected, citing data from April to July. One nurse has died and another medical worker is in critical condition.

“Breakthrough infections” — infections that happen even in individuals who are fully vaccinated — can happen with any vaccine. But governments are especially concerned when it happens to health care workers, especially at a time when their hospitals are already under strain.

On Sunday, Prof. Thiravat Hemachudha, a specialist in clinical, virological, and immunological studies at Chulalongkorn University in Bangkok, said that a study of people who had received two doses of the Sinovac vaccine showed that their level of antibodies, at 70 percent, was “barely efficacious” against the Alpha variant first detected in Britain or against the Delta variant.

Professor Thiravat said it was imperative that the Thai government gave frontline medical workers booster shots because they faced higher risks of infection. Thailand is producing the AstraZeneca shots locally, the only country in Southeast Asia to do so. It does not have any Pfizer vaccines on hand but expects to receive a donation of 1.5 million doses from the United States this month.

While studies suggest that most Covid-19 vaccines are effective against the Delta variant, which the W.H.O. says is likely to become the dominant form of the virus worldwide in coming months, less is known about the Sinovac vaccine. One of China’s top epidemiologists, Zhong Nanshan, has said that a study of 160 people infected with the Delta variant in the southern city of Guangzhou showed that China’s vaccines, developed by Sinovac and another company, called Sinopharm, were 69 percent effective in preventing infection among close contacts, according to Xinhua, the state-run news agency. Sinovac has not provided any data.

Elsie Chen contributed research.

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