The White House, besieged with requests from other nations to share excess doses of coronavirus vaccine, on Thursday announced that it would distribute an initial 25 million doses this month across a “wide range of countries” within Latin America and the Caribbean, South and Southeast Asia, and Africa, as well as the Palestinian territories, war-ravaged Gaza and the West Bank.
The doses represent an initial tranche of a total of 80 million that President Biden has pledged to send overseas by the end of this month. Three-quarters of that first batch will be given to the international vaccine effort known as Covax, officials said at a White House briefing on the pandemic. The rest will be reserved for “immediate needs and to help with surges around the world,” said Jake Sullivan, the president’s national security adviser, including in India and Iraq as well as the West Bank and Gaza.
Thursday’s announcement comes a week before Mr. Biden leaves for Cornwall, England, to meet with the heads of state of the Group of 7 industrialized nations, where the global vaccine supply is certain to be a topic of discussion. Officials said the Biden administration would continue to donate additional doses throughout the summer as they become available.
“This is just the beginning,” said Jeffrey Zients, Mr. Biden’s coronavirus response coordinator. “Expect a regular cadence of shipments around the world, across the next several weeks.”
While China and Russia have used vaccine donations as an instrument of diplomacy in an effort to extract favors from other nations, Mr. Biden has insisted the United States will not do that — a point that Mr. Sullivan emphasized on Thursday.
Nearly two-thirds of U.S. adults have had at least one shot of a coronavirus vaccine, and the rate of new cases and deaths has plummeted, contributing to an overall picture across the country that is “encouraging and uplifting,” Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said.
But the picture around the world, especially in poorer nations in Africa and Central and South America, where vaccination rates are much lower, is bleak. According to data from Johns Hopkins University, Uruguay, Argentina, Colombia and Paraguay are all awash in new cases; in Colombia, nearly 500 people a day have died of the coronavirus over the last several weeks. A sudden, sharp rise in coronavirus cases in many parts of Africa could amount to a continental third wave, the World Health Organization warned on Thursday.
Some African nations have less than 1 percent of their populations partially vaccinated, according to data from the Our World in Data project at the University of Oxford, and the percentages of vaccinated people in Honduras and Guatemala are around 3 percent of the population.
Mr. Sullivan said the administration has decided to give priority to countries he described as neighbors of the United States, including Guatemala and Colombia, Peru and Ecuador, while also working with existing regional networks like the African Union to allow local authorities to allocate the vaccines as they see fit.
Mr. Biden came into office vowing to restore America’s position as a leader in global health, and he has been under increasing pressure from activists, as well as some business leaders, to do more to address the global vaccine shortage. Earlier this year, he said he was reluctant to give away vaccine doses until the United States had enough for its own population, though he did promise in March to send a total of four million doses of AstraZeneca’s vaccine to Mexico and Canada.
Those doses, it turned out, were made at a Baltimore facility owned by Emergent BioSolutions, where production has since been put on hold after an incident of contamination.
Mr. Biden’s pledge to donate 80 million doses involves vaccines made by four manufacturers. Besides AstraZeneca, they are Pfizer-BioNTech, Moderna and Johnson & Johnson, the last three of which have received U.S. emergency authorization for their vaccines. The president announced last month that his administration would send 20 million doses of the authorized vaccines overseas in June — the first time he had pledged to give away doses that could be used in the United States. Officials did not say on Thursday why that number had been increased by five million.
Last month, Mr. Biden announced he would send one million doses of Johnson & Johnson’s vaccine to South Korea; a plane carrying those doses was expected to take off Thursday evening, Mr. Zients said.
Mr. Biden has also pledged to donate up to 60 million doses of AstraZeneca’s vaccine, but those doses, also made at the Emergent plant, are not authorized for domestic use and cannot be released until regulators deem them safe. In March, his administration committed to providing financial support to help Biological E, a major vaccine manufacturer in India, produce at least one billion doses of coronavirus vaccines by the end of 2022.
The president has described the vaccine donations as part of an “entirely new effort” to increase vaccine supplies and vastly expand manufacturing capacity, most of it in the United States. To broaden supply further, Mr. Biden recently announced he would support waiving intellectual property protections for coronavirus vaccines. He also put Mr. Zients in charge of developing a global vaccine strategy.
But activists say simply donating excess doses and supporting the waiver is not enough. They argue that Mr. Biden must create the conditions for pharmaceutical companies to transfer their intellectual property to vaccine makers overseas, so that other countries can stand up their own vaccine manufacturing operations.
Mr. Zients also said the United States was lifting the Defense Production Act’s “priority rating” for three vaccine makers — AstraZeneca, Novavax and Sanofi. None of those vaccines are authorized for U.S. use, and the shift means that U.S.-based companies that supply the vaccine makers will be able to “make their own decisions on which orders to fulfill first,” Mr. Zients said.
Abdi Latif Dahir contributed reporting.
An earlier version of this item misspelled the name of a vaccine maker. It is Novavax, not Novovax.
A sudden, sharp rise in coronavirus cases in many parts of Africa could amount to a continental third wave, the World Health Organization warned on Thursday, a portent of deeper trouble for a continent whose immunization drives have been crippled by shortfalls in funding and vaccine doses.
The W.H.O., an arm of the United Nations, said test positivity had risen in 14 African countries over the last seven days, with eight reporting a surge of over 30 percent in new cases. Infections are steadily climbing in South Africa, where four of nine provinces are battling a third wave. There has also been a sharp increase in cases in Uganda, with hospitals overwhelmed with Covid patients and authorities mulling a lockdown.
The W.H.O. attributed the rise to loose compliance with social restrictions, and increasing travel along with the arrival of the winter season in southern Africa.
Experts also believe the spread of new coronavirus variants — like those first identified in South Africa, the United Kingdom and India — is contributing to the surge, and the ensuing rise in deaths. While Africa has reported less than 3 percent of global coronavirus cases, the W.H.O. said the continent accounted for 3.7 percent of total deaths. And that is almost certainly a severe undercount, since in the vast majority of countries on the African continent, most deaths are never formally registered.
“The threat of a third wave in Africa is real and rising,” Dr. Matshidiso Moeti, the W.H.O. regional director for Africa, said in a statement. She added: “It’s crucial that we swiftly get vaccines into the arms of Africans at high risk of falling seriously ill and dying of Covid-19.”
But while many wealthier countries have vigorous vaccination campaigns, and some are on track to fully reopen, many of Africa’s poorer countries face a huge challenge in accessing vaccines.
Out of a continental population of 1.3 billion, only 31 million people have received at least one dose, Dr. Moeti said, and only seven million are fully vaccinated. In Kenya, 1,386 people are fully vaccinated.
Countries like Ghana and Rwanda have run through their first deliveries of vaccines through Covax, the global facility working to ensure the equitable distribution of vaccines.
Vaccine hesitancy has afflicted the rollout in nations like Malawi, while concerns over rare blood clots and limitations in inoculation capacity pushed the Democratic Republic of Congo to donate millions of doses to other African states before they expired.
The rising cases, the W.H.O. warned, could overwhelm already creaky health care systems struggling with limited intensive care beds, oxygen and ventilators.
To forestall a full-blown crisis, Dr. Moeti urged “countries that have reached a significant vaccination coverage to release doses and keep the most vulnerable Africans out of critical care.”
Nearly a year ago, more than 43 percent of coronavirus deaths in the United States were tied to long-term-care facilities. Now, the deaths of people connected to such facilities has dropped to 31 percent, according to a New York Times database, revealing an improving picture for the oldest Americans.
Throughout the pandemic, The Times has tracked Covid-19 cases and deaths in nursing homes, assisted-living centers, memory care units and other long-term facilities for older people, and has identified more than 1.38 million infections among residents and employees of the facilities, as well as more than 184,000 deaths. The virus has spread easily in these facilities, and has been particularly lethal for unvaccinated adults in their 60s or older.
“Coronavirus highlighted some of the needs of both the residents themselves and the facilities,” said Cindy Prins, an epidemiologist at the University of Florida, citing a need for more oversight, greater examination of infection controls and better training for staff members.
She said the pandemic had also forced many people to re-evaluate their views on long-term care.
“I’m sure there are people who are feeling like, ‘Could I have cared for them at home? Could I have a different outcome?’” Dr. Prins said.
Since vaccines have arrived, deaths in nursing homes, in particular, have fallen significantly. According to the federal Centers for Medicare and Medicaid Services, nursing homes across the United States reported more than 5,000 deaths per week from early December through mid-January. Since late March, the homes have reported fewer than 300 deaths a week.
Still, deaths slowly continue to mount. Though health care workers were among the first group to become eligible for inoculation, vaccination hesitancy has remained a challenge at long-term care facilities.
With reports of infections occurring among vaccinated people in long-term-care facilities in Chicago and Kentucky, the Centers for Disease Control and Prevention have stressed that inoculating workers and residents is essential to preventing further spread of the virus.
The federal government is requiring nursing homes to report the vaccination status of their residents and staff members in order to examine the impact of the vaccines. More than 4.9 million residents and employees in long-term-care facilities have received at least one dose of a Covid-19 vaccine through a federal program, according to the C.D.C. Others have been vaccinated through state and local efforts.
“Reporting vaccination rates is critical to facilitating in-person visitations in nursing homes,” said Dr. David Gifford, the chief medical officer for the American Health Care Association and National Center for Assisted Living, a trade group that represents more than 14,000 U.S. nursing homes and long-term care facilities.
He added: “It is important that we not judge facilities with low vaccination rates but instead seek to understand whether additional resources or outreach can be done to encourage more staff and residents to get the vaccine, or help facilities acquire additional vaccines for new patients and hires.”
Brillian Bao and
KABUL, Afghanistan — Afghan and American health officials issued urgent health warnings on Thursday describing alarming spikes in reported cases of coronavirus in Afghanistan, where the health ministry recently declared a third wave of the pandemic since the virus first struck in early 2020.
Hospitals are rapidly filling up with Covid-19 patients, the health ministry reported. Some hospitals said they were running out of oxygen, and the U.S. Embassy said some Americans had reported being denied hospital admittance because of a lack of beds.
“The U.S. Embassy strongly suggests that U.S. citizens make plans to leave Afghanistan as soon as possible,” the American mission said in a statement Thursday.
The embassy noted that Afghanistan remained at Level 4, the highest category, of a Travel Health Notice issued by the U.S. Centers for Disease Control and Prevention. The country is also under a State Department Level 4 Travel Advisory that warns Americans not to travel to Afghanistan because of high security and health risks.
In its daily coronavirus report, the country’s health ministry said the rate of positive tests had risen sharply on Wednesday to 34 percent — one of Afghanistan’s highest daily rates since the pandemic began. Four of the country’s 34 provinces reported positivity rates of 50 percent or higher. The reported figures reflect only a fraction of the country’s total number of actual infections and deaths. Testing is severely limited and Afghanistan’s struggling health system is chronically underfunded and overwhelmed by high rates of disease, poverty and malnutrition.
Still, the numbers offer a sense of scale. The 1,500 positive cases reported nationwide for Wednesday, and the 34 coronavirus deaths reported the same day, were among the highest daily totals since the pandemic began, the health ministry said.
Wahid Majrooh, the acting minister of public health, said this week that rising rates of infection had compelled authorities to open another hospital for Covid-19 patients in Kabul, but he conceded that many more facilities were needed.
“Lack of oxygen is becoming a serious problem,” Mr. Majrooh said on Thursday. “We are quickly approaching a critical phase of the coronavirus.”
The price of oxygen canisters has doubled in recent days, according to family members of Covid-19 patients seeking treatment.
The northeastern province of Panjshir closed its borders to Afghan and foreign visitors, the provincial Coronavirus Control Committee announced, citing the country’s third wave of the virus.
“In order to prevent catastrophe and the spread of this virus,” the committee said, it asked nonresidents “to refrain from coming to Panjshir until the virus is managed and controlled.” The province is a popular tourist site in the spring and summer because of its relative security and scenic countryside.
The risks posed by the pandemic are routinely disregarded by most Afghans, who live in a country preoccupied with war. Terrorist attacks and almost daily assassinations, especially in Kabul, target government employees, off-duty security force members, civil society activists, journalists, clerics and others.
Last week, the Afghan government ordered schools and wedding halls to close for two weeks as the number of reported cases continued to rise, but the directive for wedding halls has been widely disregarded. Many halls continuing to host elaborate wedding celebrations.
Few Afghans wear masks or practice social distancing. Bazaars, shops, restaurants and buses are crowded with customers jammed shoulder-to-shoulder, with limited public access to soap and clean water for hand-washing.
Afghanistan has received 500,000 shipments of the AstraZeneca vaccine from India and another 468,000 doses from Covax, the global vaccine consortium, said Mirwais Alizai, deputy spokesman for the Ministry of Public Health. About 630,000 Afghans have received at least one dose of the vaccine, he said, out of an estimated population of about 34 million.
Delivering the vaccine throughout the country is challenging because large sections of the countryside are controlled or contested by the Taliban amid heavy fighting.
The United States is roughly on track to meet President Biden’s goal of getting every adult at least one shot of a Covid-19 vaccine by July 4 if the current vaccination pace holds. But much of the country has seen a significant slowdown in recent weeks, and the positive national trend hides deeply uneven progress among the states.
A handful of states are unlikely to reach 70 percent of their adult residents before the end of the year.
“You reach a certain rate nationally, which looks excellent and would really suggest that you are in a place to reduce the likelihood of infectious spread, but that can be misleading,” said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, which represents state health agencies.
“You still have these significant pockets and states where the rates of immunity are much lower,” he added. “So we could have another wave pop up.”
In many states in the Deep South and Mountain West, vaccinations have leveled off because of limited access and shot hesitancy.
Alabama, Louisiana, Mississippi and Wyoming have vaccinated fewer than half of their adult residents, and projections show that they are unlikely to reach much more than half by early July.
Travelers returning to Britain from Portugal or its island territories of Madeira and the Azores will no longer be able to avoid quarantining as of Tuesday, British officials announced on Thursday, complicating the plans of Britons hoping for easy getaways to the country this summer.
In mid-May, Britain had put Portugal and 12 other countries and territories with low coronavirus caseloads on a “green list,” allowing British visitors to avoid a quarantine period on their return home from those locations.
Britons fatigued by a miserable winter and a four-month national lockdown began flocking to Portugal, because most of the other green-listed places were either not accepting tourists or were not already favored destinations for British travelers. The process still involved multiple forms and P.C.R. virus tests, whose costs could total hundreds of dollars.
The decision to move the country off the green list, was a “safety first approach” Grant Shapps, Britain’s transport secretary, told the BBC on Thursday.
Portugal had remained on Britain’s green list even as the rate of positive coronavirus cases there rose 37 percent over the past two weeks, and British fans poured into the city of Porto to see two of England’s top soccer teams, Chelsea and Manchester United, face off in the Champions League final last Saturday. (Chelsea won.)
Portugal has seen the spread of the virus variant first identified in India, now known as Delta, Mr. Shapps said in a public statement released on Thursday. Officials also did not add any new countries to the green list.
Spain was also dealt a blow by the decision, particularly for its two tourism-dependent archipelagos, the Canary Islands and the Balearic Islands, which had seen improvement in their virus numbers. British travelers are the largest international contingent of visitors to Spain, accounting for 18 million of the almost 84 million foreigners who came to Spain in 2019, before the pandemic.
The abrupt announcement caused disappointment for British visitors who had booked trips to the country already or hoped that wider travel in Europe was on the rebound. It also caused further dismay for the travel industry, which has been hard-hit economically by the pandemic.
The decision not to add any other countries to the green list “is a total disaster for the already fragile travel industry and is likely to lead to further airline failures and many more job losses,” Brian Strutton, acting general secretary of the British Airline Pilots Association, said in a statement. “Our airlines need this summer season if they are to survive.”
In Portugal, vendors had been excited to welcome back tourists, typically a major financial boon for the country. But some people in the country had grumbled about foreign visitors not following local restrictions, which include mask-wearing outdoors and a 10:30 p.m. curfew. The move by British officials comes as cases remain generally low in Britain, though officials have been working to contain surges of the Delta variant.
Raphael Minder contributed reporting.
As India’s Covid-19 vaccination drive falters, the country’s Supreme Court has demanded that Prime Minister Narendra Modi’s government explain how it plans to meet its target of inoculating about 900 million adults by the end of the year.
As India struggles with a second wave of the virus that is killing some 3,000 people a day, according to official statistics, Mr. Modi’s administration is already woefully behind in its goal of administering 400 million to 500 million shots by July.
So far, India has administered about 220 million doses, and just 45 million people — about 4 percent of the population — are fully vaccinated with two doses. Vaccinating all adults would require at least another 1.5 billion doses.
The Supreme Court stepped in this week, signing an order on Monday that demanded that the government explain how it would obtain vaccines given stretched global supplies; what purchase orders it has placed; and how officials planned to resolve a messy dispute between states and the central government over vaccine procurement. The fight ensued after Mr. Modi declared in mid-April that states would need to purchase most doses on their own, which the government said would help speed up vaccination efforts but instead sowed confusion.
States have been forced to compete for limited supplies made by two main domestic vaccine manufacturers, the Serum Institute of India, which produces the vaccine developed by Oxford University and AstraZeneca, and Bharat Biotech, which makes a vaccine called Covaxin. Officials in several states have complained that they have been unable to acquire doses directly from suppliers, which insist on dealing with the central government.
The court criticized Mr. Modi’s policy, arguing that the central government would have enjoyed greater bargaining power as a single, wholesale buyer. It also slammed the government for allowing private health facilities to charge people under 45 for vaccinations, calling the policy “arbitrary and irrational.”
To step up its campaign, Mr. Modi’s government is banking on significant expansions of production by the Serum Institute and Bharat Biotech. While Bharat Biotech’s capacity started out relatively modest, the Serum Institute — a giant in vaccine manufacturing — has fallen short of its ambitions to produce more and faster. Serum’s failures have reverberated beyond India; the company has halted supplies to Covax, a global vaccine facility, derailing vaccination efforts in many poorer countries.
India has been racing to find vaccines from other sources. Russia’s Sputnik V vaccine has begun to be used in some parts of the country, with one supplier expecting at least 36 million doses in the next couple of months. This week, the Indian government signed a deal with a domestic company called Biological E. Limited for 300 million doses of its vaccine, which is undergoing clinical trials and has yet to receive regulatory approval.
India’s daily infections have fallen by more than half from a month ago, when it was recording more than 400,000 cases a day. But experts warn that the official statistics are an undercount, and that as the virus spreads into rural areas with limited health infrastructure, the true extent of its toll is unclear.
Milloni Doshi, a 25-year-old student from India who is supposed to start her master’s degree this fall at Columbia University’s School of International and Public Affairs, has a problem.
Ms. Doshi was vaccinated against Covid with two doses of Covaxin, which is made by an Indian manufacturer and is not currently approved by the World Health Organization, as required by the university.
Columbia has told her she will need to be revaccinated with a different vaccine once she arrives on campus, but no one can say for sure if it is safe to do so.
“I am just concerned about taking two different vaccines,” she wrote via a messaging app. “They said the application process would be the toughest part of the cycle, but it’s really been all of this that has been uncertain and anxiety-inducing.”
Since March, more than 400 colleges and universities in the United States have announced vaccine mandates, requiring students to be immunized against Covid. But the rules have been designed primarily with domestic students in mind, and they have access to the Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines, three of the eight authorized by the health agency, according to a W.H.O. spokesman.
The disparity could hinder colleges that have made it a major priority to retain international students, who brought in close to $39 billion in tuition dollars in the year before the pandemic, according to one analysis.
Facing vaccine shortages, Canada’s immunization advisory body is recommending that some Canadians follow up their AstraZeneca shots with a different vaccine on the second dose.
The National Advisory Committee on Immunization said on Tuesday that people who had received a first dose of the AstraZeneca vaccine could be given either the Pfizer-BioNTech or Moderna vaccines as their second dose. It also said that the Pfizer and Moderna vaccines could be used interchangeably, although it recommended sticking with a single brand when possible.
While Canada’s health care system has generally been efficient in dispensing shots, no vaccines are manufactured in the country and larger shipments did not begin arriving until the past several weeks. To ensure that the maximum number of Canadians have some protection, Canada focused on getting at least one dose to as many people as possible. While 62 percent of Canadian adults have been given at least one shot, only 5.7 percent are fully vaccinated.
The advisory panel’s recommendation came as many provinces are starting to ramp up second doses, and it may resolve a potential headache.
Most of the increased shipments of vaccine have come from Pfizer, while supplies of the Moderna and AstraZeneca vaccines have been in much shorter supply. To date, 19.3 million doses of Pfizer’s vaccine have come to Canada, compared with 5.7 million doses of Moderna and 2.8 million Astra Zeneca shots.
The ability to substitute Pfizer’s vaccine for second doses eliminates concerns about limited supplies.
The advisory panel said that its recommendation followed similar advice from Denmark, Finland, France, Germany, Norway, Spain and Sweden. Several studies have shown that mixing vaccines is safe and effective, the committee said.
Seven of Canada’s 10 provinces, whose health care systems perform the vaccinations, have said they will allow people to change course between doses.
One of New York City’s hottest tickets is about to get even harder to get: Shakespeare in the Park plans to sharply curtail capacity when it returns to the Delacorte Theater this summer after losing a year to the pandemic, officials announced on Thursday.
The 1,800-seat theater currently plans to allow only 428 attendees for each performance of “Merry Wives,” the adaptation of Shakespeare’s “The Merry Wives of Windsor” being put on by the Public Theater.
In a news release, officials said the capacity limit was put in place because of the need for social distancing. They said all theatergoers over age 2 would be required to wear a mask and either provide proof of full vaccination or a recent negative coronavirus test to attend.
The decision to significantly limit the size of the audience stands in contrast to some other New York venues, most of them indoors, that have elected to reopen to bigger crowds.
It is possible that the limits could be eased before opening night. A spokeswoman for the Public said Thursday that the theater would await updated health and safety guidance from the state and would adapt its policies as needed.
Tickets to Shakespeare in the Park, as usual, will be free and limited to two per person. But this summer, officials said there will be no winding in-person lines to wake up early for; instead, tickets will be distributed entirely through what they called “an advanced digital lottery” hosted on a platform called Goldstar.
While the Italian government has said that people have a right to get vaccinated no matter their legal status, in practice, many undocumented migrants and homeless people have been overlooked — a risk not only for them, doctors say, but for the whole country.
The official explanation in many cases is bureaucracy. Most Italian regions require a social security number to book an appointment on their online platforms, but only three of 20 regions in the country accept the temporary numbers given to hundreds of thousands of migrants.
And in a nation where immigration is a hot-button issue, some have also been asking whether Italians should remain the priority, at least until more shots are available.
“The system forgot about these people,” said Marco Mazzetti, a doctor and the president of the Italian Society of Migration Medicine, “but they are the most fragile.”
Dr. Mazzetti also points out that migrants are often domestic workers.
“If we don’t control the virus circulation among these people who come inside our homes to help us,” Dr. Mazzetti said, “we don’t control the virus circulation in the country.”
Constant Méheut and Christopher F. Schuetze contributed reporting.