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Biden’s Push to Vaccinate the World Is Not Enough, Experts Say - The New York Times

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Administering Pfizer- BioNTech coronavirus vaccines in Colombo, Sri Lanka, in July.
Chamila Karunarathne/EPA, via Shutterstock

When President Biden announced in June that the United States would buy 500 million Pfizer-BioNTech coronavirus vaccine doses for poorer nations, there was a gaping hole in his plan: To fund it, the administration quietly diverted hundreds of millions of dollars that had already been promised to countries for helping to get shots into people’s arms.

Mr. Biden did not make the same mistake a second time.

His announcement on Wednesday that the United States was donating an additional 500 million Pfizer doses came paired with a promise of an additional $750 million for vaccine distribution, roughly half of it through a nonprofit involved in global vaccinations. That reflected a growing awareness on the part of global leaders that turning vaccines into actual vaccinations represents one of the most significant challenges of this phase of the pandemic.

Even so, the Biden administration’s schedule for shipping the newly announced Pfizer doses frustrated activists: Of the 1.1 billion doses that the United States has committed to donations, only 300 million are expected to be shipped this year. The longer the virus circulates around the world, the more dangerous it can become, even for vaccinated people in wealthy countries, scientists have warned.

“Purchasing doses for donation sometime next year is helpful, but it does not meaningfully expand the global supply, and it is not justice,” said Peter Maybarduk, the director of the Access to Medicines program at Public Citizen, an advocacy organization.

Some experts pleaded for more aggressive action by Mr. Biden to pressure American vaccine makers to share their formulas with nations that desperately need more shots.

“Where is the monthly calendar of what each wealthy country is going to deliver?” said Kate Elder, senior vaccines policy adviser for Doctors Without Borders’ Access Campaign. She added, “Where are the announcements about meeting the calls of regions and middle-income countries that are begging to be self-sufficient?”

It was not immediately clear how the administration was planning to allocate the new money for vaccine distributions. Some countries have been struggling to train and pay vaccinators and to transport doses. Pfizer doses present especially steep challenges: They must be stored at ultralow temperatures, requiring the installation of freezers and, in many cases, backup generators.

Early this year, supply shortages represented the most pressing problem for global vaccinations. Rich nations had raced to secure doses while slow-walking pledges of money and supplies to Covax, the United Nations-backed program to immunize the world.

But as those manufacturing difficulties have eased, different problems emerged. One was blatant inequality: More than 5.9 billion shots have been given globally, but overwhelmingly in wealthier nations. Another was that poorer countries had been left without the money needed to move shots from airport tarmacs into people’s arms.

Although the Biden administration’s pledges have outpaced those of most Western nations, analysts said other wealthy countries were setting an extraordinarily low bar.

And even as countries have promised to donate more doses, they have been slow to follow through, with the World Health Organization saying that only 15 percent of promised donations have been delivered. The W.H.O. has set a target of vaccinating 40 percent of every country’s population this year, requiring wealthy nations to share doses significantly more quickly.

There remains considerable excess supply: Wealthy nations will have 1 billion more vaccines than they need by the end of 2021, even if they administer booster shots, according to Airfinity, a science analytics company.

Global health officials have urged wealthy nations to let go of those supplies before they expire. Some countries have donated vaccines so close to their expiration dates, and in such small quantities, that poorer countries have struggled to use them.

Some 11 billion doses are needed globally, and activists said on Wednesday that the wealthy world’s response remained far too piecemeal. The new Pfizer doses purchased by the U.S. will be shipped through Covax starting in January.

Rolex Dela Pena/EPA, via Shutterstock

As President Biden convenes heads of state for a Covid-19 summit on Wednesday, pressure is growing on American drug companies — particularly Moderna, the upstart biotech firm that developed its coronavirus vaccine with billions of dollars in taxpayer money — to share their formulas with manufacturers in nations that desperately need more shots.

Last year’s successful race to develop vaccines in extraordinarily short order put companies like Moderna and Pfizer in a favorable light. But now, with less than 10 percent of the population in many poor nations fully vaccinated and a dearth of doses contributing to millions of deaths, health officials in the United States and abroad are pressing the companies to do more.

The Biden administration has privately urged both Pfizer and Moderna to enter joint ventures with contract manufacturers with the aim of providing vaccines to low- and middle-income countries, according to a senior administration official.

Those talks led to an agreement with Pfizer, announced Wednesday morning, to sell the United States an additional 500 million doses of its vaccine at a not-for-profit price — rather than license its technology — to donate overseas.

The discussions with Moderna have not been fruitful, said the official, who expressed deep frustration with the company but requested anonymity to discuss sensitive information.

A coalition of major drug and vaccine manufacturers in developing countries around the world is drafting an appeal to Mr. Biden asking him to press the companies more aggressively.

The World Health Organization has also had trouble getting Moderna to the negotiating table, according to Dr. Martin Friede, a W.H.O. official, and Charles Gore, who runs a United Nations-backed nonprofit organization, Medicines Patent Pool. Both are working with a W.H.O.-backed technology transfer hub in South Africa.

“We would love to get a discussion with Moderna, about a license to their intellectual property — this would make life so much simpler, but for the moment all attempts have resulted in no reply,” Dr. Friede said.

Mike Kai Chen for The New York Times

After weeks of internal strife at the Food and Drug Administration, the agency on Wednesday authorized people over 65 who had received Pfizer-BioNTech’s coronavirus vaccine to get a booster shot at least six months after their second injection.

The F.D.A. also authorized booster shots for adult Pfizer-BioNTech recipients who are at high risk of becoming severely ill with Covid-19 or are at risk of serious complications from the disease due to frequent exposure to the coronavirus at their jobs.

The authorization sets up what is likely to be a staggered campaign to deliver the shots, starting with the most vulnerable Americans. It opens the way for possibly tens of millions of vaccinated people to receive boosters at pharmacies, health clinics, doctors’ offices and elsewhere.

Roughly 22 million Americans are at least six months past their second dose of the Pfizer-BioNTech vaccine, according to the Centers for Disease Control and Prevention. About half of them are 65 and older. Millions of Americans who received the Moderna and Johnson & Johnson vaccines are still waiting to learn whether they, too, can get boosters.

The F.D.A.’s decision will be followed as soon as Thursday by a recommendation from the C.D.C., which issues guidance on vaccine policy for clinicians and public health officials throughout the United States. An advisory committee of the C.D.C. is now in the midst of a two-day meeting on the issue. But even if the C.D.C. takes a different stance, health care providers are now authorized to offer third shots to Pfizer-BioNTech recipients who meet the F.D.A.’s eligibility criteria.

The ruling followed weeks of internal disagreement at the F.D.A., where some vaccine regulators openly challenged the idea of offering booster shots to the general population. Public health experts and state officials have criticized what they said were confusing public messages from the Biden administration about who should be eligible for a booster shot and when.

Ng Han Guan/Associated Press

The United States Olympic & Paralympic Committee announced on Wednesday that all athletes and team staff members who use the organization’s training centers and facilities must be fully vaccinated against Covid-19 by Nov. 1.

The organization, which encouraged but did not require vaccinations ahead of the Tokyo Games this summer, also said that by Dec. 1, any athletes vying to represent the country at the Winter Games, scheduled to begin on Feb. 4 in Beijing with the Olympics followed by the start of the Paralympics on March 4, will need to show proof of vaccination to be able to join the Team U.S.A. delegation.

The International Olympic Committee has not announced a vaccine requirement for the Beijing Games.

The U.S.O.P.C.’s new policy arrived amid swirling speculation about the rules that athletes, officials, team staff members and journalists will face in China, where widespread lockdowns and strict quarantines have been fairly common during the pandemic.

The new policy, first reported by The Associated Press, takes the U.S.O.P.C. a step farther than the major North American professional sports leagues, none of which has required athletes to be vaccinated to compete.

In July, Jonathan Finnoff, the U.S.O.P.C.’s chief medical officer, said that about 83 percent of American Olympians had been vaccinated for the Tokyo Olympics. And the I.O.C. estimated that more than 80 percent of all Olympians staying at the athletes’ village in Tokyo were fully vaccinated.

Twenty-eight athletes tested positive in Tokyo in the lead-up to the Summer Olympics and during the competition, as did 13 athletes in Tokyo for the Paralympics.

Karsten Moran for The New York Times

The fate of unvaccinated employees in New York City’s largest private hospital system was uncertain Wednesday night, as the deadline to get a first shot of a Covid-19 vaccine drew near.

New York State’s vaccination mandate for workers at hospitals and nursing homes doesn’t require a first shot until Monday, Sept. 27. But NewYork-Presbyterian, the city’s largest private hospital network, has ordered its 48,000 employees to get vaccinated on a faster timeline, requiring a first dose no later than Wednesday.

In recent weeks, the hospital had warned employees that those who remained unvaccinated without a legitimate exemption “will be deemed to have opted to resign,” according to an email sent to some employees.

A hospital spokeswoman, Alexandra Langan, declined to comment on Wednesday afternoon about how many employees faced the loss of their jobs.

More than 90 percent of NewYork-Presbyterian employees had gotten a first dose by early last week, according to a court affidavit by Shaun E. Smith, NewYork-Presbyterian’s chief human resources officer. In recent days, more holdouts have gotten vaccinated, according to interviews. But that still left hundreds, if not thousands, of employees unvaccinated.

About 200 employees have valid medical exemptions, according to Mr. Smith’s affidavit. And at least 1,364 employees had sought religious exemptions, Mr. Smith said. The hospital had granted about 129 of those requests before the state’s Department of Health reversed course in late August and said religious beliefs no longer qualified for an exemption.

A federal judge has since temporarily ordered the state to refrain from enforcing that policy. For now, NewYork-Presbyterian has said it will not take action against unvaccinated employees who had previously received a religious exemption or had a request pending, according to court filings.

One nurse in an intensive care unit, Maureen A. Buckley, said in a lawsuit that NewYork-Presbyterian suspended her without pay last week because she remained unvaccinated against Covid-19. In court papers, she said that the hospital system denied her a medical exemption and ignored her efforts to obtain a religious exemption. Reached by phone Wednesday evening, she declined to comment further, explaining that she was “still in the middle of negotiating with the hospital.”

At more than 90 percent, the vaccination rate within the NewYork-Presbyterian system is higher than at many other hospitals. At St. Barnabas Hospital, an independent safety-net hospital in the Bronx, just under 80 percent of staff are vaccinated against Covid-19, the hospital’s chief medical officer, Eric Appelbaum, said. He expressed hope the rate would climb as Monday — the state-mandated deadline — approached. “Some folks are like that: ‘If the deadline is Friday morning, I’ll do it Friday morning,’” he said.

Holdouts at New York hospitals have cited a range of reasons for not getting vaccinated: some say they distrust the safety of the vaccine, or worry about fertility, while others object to the use of cell lines derived from aborted fetuses in the development or production or testing of Covid-19 vaccines, according to interviews and court records.

Another major New York hospital network, Mount Sinai Health System, had told employees to get vaccinated by Sept. 13, but a spokeswoman said she did not know if anyone had yet been placed on leave or fired for not complying.

Correction: 

Because of an editing error, a caption for a photograph in an earlier version of this article incorrectly stated the number of employees in the NewYork-Presbyterian Hospital network. There are 48,000, not 36,000.

E. Jason Wambsgans/Chicago Tribune, via Associated Press

The Rev. Jesse Jackson was released from a rehabilitation hospital in Chicago on Wednesday morning, a month after he and his wife, Jacqueline, were hospitalized with Covid-19, his representatives said.

A spokesman for Mr. Jackson’s organization, Rainbow PUSH Coalition, said the reverend was released from the Shirley Ryan AbilityLab, where he had been transferred after being treated for about a week in another hospital for Covid-19.

Mr. Jackson’s recovery was complicated by the fact that he has Parkinson’s disease, which caused his muscles to atrophy after he spent several days in a hospital bed, said Frank Watkins, a spokesman for Rainbow PUSH Coalition. Mr. Jackson revealed his Parkinson’s diagnosis in 2017.

“After he was in the hospital, they had to transfer him to a rehab center to restrengthen his muscles,” Mr. Watkins said in an interview on Wednesday.

Mr. Jackson, 79, and his wife, Jacqueline, 77, were hospitalized on Aug. 21 with Covid-19, and Mr. Jackson was transferred to the rehabilitation hospital around Aug. 27, the organization said. Mrs. Jackson went home earlier this month after she received oxygen treatment in an intensive care unit. Both had been treated at Northwestern Memorial Hospital in Chicago.

Mr. Jackson got vaccinated in January, and he had been campaigning to convince more Black Americans to get inoculated.

“It is a miracle that both of our parents are now Covid-19 survivors, and we thank God for their healing,” Jonathan Jackson, the couple’s son, said in a statement on Wednesday.

Mr. Jackson has been a civil rights leader for more than 50 years and sought the Democratic presidential nominations in 1984 and 1988. He was a close associate of the Rev. Dr. Martin Luther King Jr.

Loren Holmes/Anchorage Daily News, via Associated Press

Alaska, once a leader in vaccinating its citizens, is now in the throes of its worst coronavirus surge of the pandemic, as the Delta variant rips through the state, swamping hospitals with patients.

As of Tuesday, the state was averaging 117 new cases a day for every 100,000 people, more than any other in the nation, according to recent data trends collected by The New York Times. That figure has shot up by 42 percent in the last two weeks, and by more than twentyfold since early July.

On Wednesday, the state said it had activated “crisis standards of care,” giving hospitals legal protections for triage decisions that force them to give some patients substandard care. The state also announced an $87 million contract to bring in hundreds of temporary health care workers.

Gov. Mike Dunleavy, a Republican, said that while hospitals were strained, he did not see a need to implement restrictions aimed at curbing transmission. Still, he encouraged people who had not yet received a vaccination to seriously consider it.

“We have the tools available to us for individuals to be able to take care of themselves,” Mr. Dunleavy said. While the state led the nation in vaccinations early in the year, it has been lagging in recent months, with under half of its population fully vaccinated, compared with 55 percent nationally, according to federal data.

Jared Kosin, the head of the Alaska State Hospital and Nursing Home Association, called the surge “crippling” in an interview on Tuesday. He added that hospitals were full, and health care workers were emotionally depleted. Patients are being kept waiting for care in their cars outside overwhelmed emergency rooms.

There is growing anxiety in outlying communities that depend on transferring seriously ill patients to hospitals in Anchorage, Mr. Kosin said. Transfers are getting harder to arrange and are often delayed, he said.

“We are all wondering where this goes, and whether that transfer will be available, even tomorrow,” Mr. Kosin said.

Critically ill people in rural areas, where many Alaska Natives reside, often have to be taken by plane to a hospital that can provide the treatment they need, said Dr. Philippe Amstislavski, an associate professor of public health at the University of Alaska Anchorage.

“Unlike in the lower 48, you don’t have that ability to move people quickly, because of the distances and remoteness,” said Dr. Amstislavski, who was formerly the public health manager for the Interior Region of Alaska, focusing on rural and predominantly Alaska Native communities.

Mr. Kosin said that if hospitalizations rise much further, hospitals and clinics around the state could be forced to apply crisis standards of care and more extreme triage decisions. “That is the worst-case scenario we could be heading to,” he said.

Alaska Natives, who have historically suffered from health disparities in the state, are disproportionately struggling during the latest virus wave, Dr. Amstislavski said.

Dr. Anne Zink, Alaska’s chief medical officer, said several factors may be contributing to the surge, including summer tourists bringing in and spreading the virus.

“We’re hoping that as the snow falls and we have less people visiting, those numbers will settle down,” Dr. Zink said in an interview Tuesday night.

On the other hand, she noted that cooling weather drives residents indoors, where the virus spreads more readily.

The state’s Canadian neighbors to the east, Yukon and British Columbia, have not suffered such severe outbreaks, Dr. Amstislavski said, possibly because of that country’s stricter travel restrictions and less strained health care system.

Alisha Jucevic for The New York Times

Scientific advisers to the Centers for Disease Control and Prevention met on Wednesday to begin to decide which Americans should get booster shots of the Pfizer-BioNTech coronavirus vaccine — and when.

The committee’s discussions followed a dramatic exchange at the Food and Drug Administration on Friday, when advisers overwhelmingly rejected a proposal to offer Pfizer booster shots to all Americans over age 16, but then voted unanimously in favor of third doses for some high-risk people and those older than age 65.

On Thursday, advisers to the C.D.C. will try to be more specific about who qualifies. Depending on the verdict, booster shots could be offered to most Americans, or only to a select few.

The C.D.C. committee’s recommendations are influential but not binding, and state officials sometimes implement their own criteria. In any event, the advice will come too late for the Biden administration, which had planned to begin offering third doses this week to most fully vaccinated adults in the United States.

On Wednesday, the committee zeroed in on unanswered questions in the data available so far.

A third dose undoubtedly amps up antibody levels, the experts said. But it’s unclear how long that increase lasts, whether it translates to a meaningful boost in protection against severe disease, and whether it can significantly decrease transmission of the virus. Scientists on the committee also noted the paucity of safety data, especially among younger people.

Several advisers said they believed the goal of the boosters should be to prevent severe illness, hospitalization and death, rather than infection.

“I would just encourage us not to lump infection and hospitalization,” said Dr. Sarah Long, a pediatric infectious disease expert at Drexel University College of Medicine in Philadelphia. “I don’t think there’s any hope that vaccines such as the ones we have will prevent infection after the first, maybe couple weeks that you have those extraordinary immediate responses.”

The advisers also wrestled with the practicalities of endorsing a booster shot of the Pfizer vaccine, but not of the Moderna or Johnson & Johnson vaccines. Such a recommendation might leave people who initially were immunized with the latter two vaccines feeling unprotected.

“That’s a big public health panic that we would like to avoid,” Dr. Long said.

Some experts seemed to suggest that if regulatory rules would not permit them to recommend mixing the different types of vaccines, they might delay recommending booster shots altogether until people who got the Moderna shots could also receive boosters.

Moderna asked the F.D.A. this month to authorize a half dose of its vaccine as a booster shot. Federal regulators are reviewing Moderna’s data to determine whether it supports the authorization.

Earlier in the day, the advisers heard detailed evidence about the different types of immunity induced by the vaccines. Natalie Thornburg, a C.D.C. scientist, presented results from a series of studies suggesting that declining levels of antibodies may have little impact on protection from severe illness. Some subsets of antibodies are needed to prevent infection, but immune cells that prevent the illness from progressing are stable, she said.

“Antibodies decrease over time as we expected, in all age groups, but cellular memory is maintained,” she said. Immunity is known to drop off in adults over 80, however, suggesting that boosters may be needed for that age group. And one C.D.C. study showed a drop in the ability of the vaccines to prevent severe disease in adults over 65.

Boosters can reduce cases among nursing home residents, who are among those at highest risk, according to results from a modeling study described at the meeting. But even with highly effective boosters, cases in nursing homes will persist when community transmission is high, said Rachel Slayton, a C.D.C. scientist who presented the model.

Vaccinating staff at nursing homes, and other prevention strategies to limit transmission, will continue to be important, she said.

Some global health experts have criticized the Biden administration for pushing booster shots when much of the world’s population is yet to receive a first dose. But on Wednesday, Jen Psaki, the White House press secretary, reiterated the administration’s argument that it was possible to offer boosters to Americans while vaccinating the rest of the world at the same time.

On Wednesday morning, President Biden said that the United States would buy and donate 500 million doses of the Pfizer-BioNTech vaccine, adding to the 500 million the administration purchased in July.

“We’re now donating three shots globally for every one shot we put in the arm of an American, and our view continues to be that we can do both and it’s a false choice,” Ms. Psaki said. “Our view also continues to be that frankly the rest of the world needs to step up and do more.”

At the meeting of F.D.A. advisers on Friday, senior scientists at Pfizer and the Israeli Ministry of Health presented data they said indicated waning immunity in people who received the Pfizer vaccine months earlier. Boosting immune defenses with a third shot has made a difference in Israel, they said, and could stem the tide of infections in the United States.

The F.D.A. advisers also evaluated data from the C.D.C. on the trajectory of the virus in the United States, as well as summaries from several studies on the effectiveness of the vaccines.

But after reviewing the evidence, the scientists on the committee concluded that while protection against infection may be waning, especially in older adults, the original two-shot regimen still offers excellent protection against severe illness and hospitalization in most people.

“It’s unclear that everyone needs to be boosted, other than a subset of the population that clearly would be at high risk for serious disease,” said Dr. Michael G. Kurilla, a committee member and official at the National Institutes of Health.

Daniel E. Slotnik contributed reporting.

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Vice President Kamala Harris said that the U.S. would contribute at least $250 million to a new global health security fund aimed at increasing disease surveillance, vaccine development and health care worker support.Al Drago for The New York Times

While President Biden gathered with heads of state for a Covid-19 summit, Vice President Kamala Harris on Wednesday announced that the United States will contribute at least $250 million to a new global health security fund that the administration hopes will raise $10 billion to fight future pandemics.

Declaring the coronavirus pandemic a “stark warning” for an increasingly interconnected world, Ms. Harris called for international unity to address a lack of funding for pandemic preparedness highlighted by the flaws in the global response to Covid-19. The collective goal of $10 billion would be spent on a range of issues, like disease surveillance, vaccine development and health care worker support, in order to counter future biological threats.

“We need to act so that our world will be ready to respond before and not after the next pandemic emerges,” Ms. Harris said, adding that the Biden administration has asked Congress for an additional $850 million for the new fund.

Perhaps recognizing the political challenges that obtaining such funding would face from U.S. lawmakers, Ms. Harris said the administration supports the creation of a “global health threats council” to ensure transparency and accountability for all nations that commit to financing the fund.

The announcement comes as the Biden administration and U.S. drug companies are under growing pressure to address the global Covid-19 vaccine shortage. As part of the administration’s efforts, Mr. Biden also announced on Wednesday a new partnership with the European Union aimed at expanding access to vaccines.

In a statement detailing a joint strategy with the United States to have 70 percent of the global population vaccinated by next September, the European Union said it would donate 500 million coronavirus vaccine doses and ramp up coordination efforts with its American counterparts to deliver and administer them. The European Union has pledged to donate 200 million doses by the end of 2021, but its member countries had only donated 21 million doses as of early September, according to official figures.

Ursula von der Leyen, president of the European Commission, the E.U.’s executive arm, has named global vaccination the bloc’s most urgent priority for the year ahead: “The scale of injustice and the level of urgency are obvious,” Ms. von der Leyen said in a speech on the state of the union last week.

RBL/Bauer-Griffin/GC Images

All visitors and workers in temples operated by the Church of Jesus Christ of Latter-day Saints should wear face masks “at all times” while in the temple, according to a letter sent by the church’s top leaders to local church leaders around the world on Wednesday.

“We want to do everything possible to allow temples to remain open,” wrote the church’s president, Russell M. Nelson, and his two top counselors, Dallin H. Oaks and Henry B. Eyring. “These safety protocols are temporary, based on Covid-19 conditions, and will be rescinded as soon as circumstances permit.”

Mr. Nelson, 97, is a retired heart surgeon and is revered as a prophet by Latter-day Saints, also known as Mormons. He has repeatedly urged the church’s 16.6 million members around the world to wear masks and get vaccinated. In an August letter, he wrote that the approved vaccines were safe and effective and added: “We can win this war if everyone will follow the wise and thoughtful recommendations of medical experts and government leaders.”

There are 167 temples around the world, according to the church, with dozens more under construction or planned. The church closed them all in March 2020 to help stop the spread of the coronavirus, and began reopening them in phases in May of that year.

Temples are not used by Latter-day Saints for Sunday worship services, and unlike the church’s more common meeting houses, are not open to the general public. They are generally open only to members who have a current “temple recommend,” a card that verifies they believe in the church’s doctrines and obey certain rules such as tithing and abstaining from alcohol. Members visit temples for a variety of rituals, including proxy baptisms for the dead.

“Temples are the most important sacred sites in contemporary Mormonism, so restricting access to temples to people wearing masks sends a big message about how important masks are to the leaders of our church,” said Jana Riess, a senior columnist for Religion News Service who writes about the church.

Although the letter says that the church only “asks” members to wear masks in temples, Ms. Riess said that it is likely to be interpreted as “instruction that’s not to be violated.”

In August, Brigham Young University in Provo, Utah, announced that students and staff members would be required to wear masks on campus. The private school, which is sponsored by the church, also urged students to get vaccinated “so that fall semester can proceed as planned.”

The letter on Wednesday emphasized that there is ample precedent for the church urging members to protect themselves from the spread of the disease. In 1900, church leaders urged members to be vaccinated against smallpox, and in 1957 released a similar message about the polio vaccine.

Victor J. Blue for The New York Times

Nearly one-quarter of the hospitals treating Covid-19 in Afghanistan have closed in recent weeks, and the country’s efforts to respond to the pandemic have declined, World Health Organization officials said Wednesday.

The W.H.O. issued an urgent warning on Wednesday, saying that Afghanistan is on the brink of “an imminent humanitarian catastrophe.”

The notice followed a recent visit to Kabul, the capital of Afghanistan, where W.H.O. leaders met with the leadership of the Taliban, which is now in control of the country. The W.H.O. officials also met with United Nations partners, health care workers and patients.

“Cuts in donor support to the country’s largest health project, Sehatmandi, has left thousands of health facilities without funding for medical supplies and salaries for health staff,” Dr. Tedros Adhanom Ghebreyesus, director-general of the W.H.O., and Dr. Ahmed Al-Mandhari, the organization’s regional director for the Eastern Mediterranean, said in a joint statement on Wednesday.

Roughly two-thirds of the country’s health facilities are part of Sehatmandi, a three-year, $600 million project administered by the World Bank and financed by the U.S. Agency for International Development, the European Union, the World Bank and other donors.

Because funds for the project were funneled through the Ministry of Public Health, donors withdrew their support after the Taliban seized power. Now, only one-sixth of all Sehatmandi facilities are fully functional, according to the W.H.O.

“Many of these facilities have now reduced operations or shut down, forcing health providers to make hard decisions on who to save and who to let die,” the statement said.

Officials also said that nine of the 37 hospitals treating Covid-19 in Afghanistan have closed, and coronavirus surveillance, testing and vaccination efforts have contracted.

Afghanistan, which emerged from a surge in virus infections at the end of June, is starting to see cases rise again, this time involving the highly contagious Delta variant.

Before last month, the W.H.O. said, about 2.2 million people, or about 6 percent of Afghanistan’s population, had been vaccinated against Covid-19. But in recent weeks, the organization said, vaccination rates have slowed markedly, and some 1.8 million vaccine doses in the country remain unused.

The country’s acting health minister and last remaining holdover from the pre-Taliban Cabinet, Dr. Wahid Majrooh, stepped down on Tuesday.

Martin Griffiths, the U.N.’s under secretary for emergency relief, said on Wednesday that he was releasing $45 million to help prevent Afghanistan’s health care system from collapsing.

“Medicines, medical supplies and fuel are running out in Afghanistan,” Mr. Griffiths said in a statement. “Cold chains are compromised. Essential health care workers are not being paid.”

On top of the threat of a public health crisis, new figures released by the World Food Program suggest that 95 percent of Afghans lack secure access to adequate food, a situation that could worsen in the winter, when many remote communities are likely to be cut off from outside support for several months.

Alexander Drago/Reuters

President Biden is convening a panel of 30 scientific advisers — in fields as diverse as agriculture, biochemistry and computer engineering, ecology, nanotechnology and neuroscience — to advise the White House on addressing future pandemics, addressing climate change and a range of other global challenges.

Mr. Biden announced the new President’s Council of Advisors on Science and Technology — to be known by the acronym PCAST — in a video the White House released Wednesday morning. The White House describes the group as a “direct descendant” of the scientific advisory committee established by President Dwight Eisenhower in 1957 after the Soviet Union launched the first Sputnik satellite, beating the United States in the race to space.

The new council includes two Nobel laureates and five MacArthur “genius” grant recipients, as well as two former Cabinet secretaries and a former astronaut who was the first woman to dive into the deepest part of the Earth’s oceans. Half of its members, including two of its three co-chairs, are women. (The other co-chair is Eric Lander, who heads the White House Office of Science and Technology Policy).

“This PCAST will see new possibilities to create good jobs, and power American workers, and grow the economy for everyone, to change the course of human health and disease, to tackle the climate crisis with American innovation and to lead the world in technologies,” the president says in the video.

The panel has been nine months in the making. Mr. Biden asked Frances Arnold, a Nobel Prize-winning biochemical engineer, and Maria T. Zuber, a geophysicist and planetary scientist who was the first woman to lead a NASA planetary mission, to be co-chairs before he was inaugurated.

Dr. Arnold and Dr. Zuber spent months combing through résumés to submit to the president, and said in a joint interview that scientists were eager to serve, particularly in the wake of the administration of former President Donald J. Trump, who many scientists feel devalued their profession. No one they asked said no, and all are serving as volunteers.

“The almost utter dismissal of science as the basis for decision-making by the previous administration was tremendously dispiriting, and played a large role in the alacrity with which I made that decision to take on this new job,” said Dr. Arnold, a professor of chemical engineering, bioengineering and biochemistry at the California Institute of Technology.

The group has not yet held its first meeting or set an agenda. But Dr. Lander, who served on former President Barack Obama’s PCAST, said he would be surprised if the group “did not have a lot of interest in using the learning from this pandemic to think really fundamentally about public health system and how it could be improved.”

Correction: 

An earlier version of this item misstated the timing of President Biden's video announcing the new advisory council. The White House planned to release it Wednesday morning, not Thursday morning. 

Gretchen Ertl for The New York Times

Day after day, they went to work.

While white-collar America largely worked from the cocoons of their homes, these workers left for jobs elsewhere. Most had no choice.

“They’re the people who often are working around the public, often working in jobs that are requiring them to be at particular risk from the virus,” said Eliza Forsythe, an economist at the University of Illinois. “All of these types of jobs where you’re not sitting at a computer — that’s what’s really been the backbone for allowing the rest of the economy to go remote.”

More than a year and a half after the pandemic disrupted nearly all aspects of everyday life, one of the starkest economic divides to emerge has been between workers who can work from home and those who cannot.

Those who could not work from home were employed in a wide array of industries, including health care, agriculture, leisure and hospitality, retail, transportation, construction and manufacturing. Many were considered part of the army of frontline and essential workers, with jobs that were considered so critical that they could not be put on hold even during a public health crisis. They were typically lower-wage, less educated and disproportionately people of color.

The New York Times talked with six never-remote workers about their experiences: an airport wheelchair attendant, a college custodian, a homeless shelter case manager, a commuter rail custodian, a pet store worker and an airport security guard.

Global roundup

Joel Carrett/EPA, via Shutterstock

Australia, which had planned to retain heavy international travel restrictions until mid-2022, now plans to open up months ahead of schedule.

In a speech on Tuesday, Dan Tehan, the minister for trade, tourism and investment, encouraged Australians to keep getting vaccinated and “to stick to the national plan that will see our international border open up, at this rate, by Christmas, at the latest.”

Mr. Tehan’s remarks at the National Press Club of Australia were a departure from the country’s earlier plans to keep its severe lockdown and travel restrictions in place.

Australia’s borders “are closed,” according to the Department of Health’s website. “There is a ban on all overseas travel,” it says, unless an exemption from the government is granted.

The only people allowed inside the country, according to the site, are Australian citizens, permanent residents and their immediate family members. Quarantine-free travel from New Zealand was temporarily suspended in August.

In his speech on Tuesday, Mr. Tehan also said that “hopefully, at the latest by Christmas,” Australians would be able to travel “with a QR code linked to their passport which will be able to show a proof of vaccination.”

In other news from around the globe:

  • New Zealand, which has pursued a zero-Covid strategy, may not get back to eliminating all coronavirus cases in the community, a senior health official there said, according to Reuters. “The important thing is we are going to keep finding any infections and basically continue to contact trace, test and isolate people so that we stop the virus circulating in the community,” Ashley Bloomfield, the director general of health, told Radio New Zealand.

Correction: 

An earlier version of this item misstated when quarantine-free travel from New Zealand was temporarily suspended. It was in August, not on Tuesday.

Daniel Pockett/EPA, via Shutterstock

Australia’s second most populous state announced that some residents stranded in surrounding regions because of the pandemic would be able to travel back home starting Sept. 30.

On Thursday, the state premier, Daniel Andrews, said that people who had been stuck in New South Wales for “a lengthy period of time” could return to Victoria, if they were fully vaccinated and tested negative for the coronavirus. They must quarantine for 14 days.

“We have on numerous occasions sent our apologies to them and made it clear we understand just how challenging it is and we wish things were different,” he said.

Australia has imposed some of the harshest restrictions in the world to help contain the spread of the virus, with individual states employing lockdowns that have prevented people from returning to their cities.

The daily average of new cases has dropped 13 percent in the past two weeks in Australia, which has lived through several lockdowns since the start of the pandemic. While its vaccination kickoff had a slow start, the nation has to date fully vaccinated 39 percent of its population. Recently the country began vaccinating children as young as 12.

While travel restrictions have eased for many Australians, and the tourism ministry has even announced a possible reopening of its borders by Christmas, the country is still facing setbacks with new infections breaking out.

A makeup artist working on an Australian reality television program tested positive for the coronavirus earlier this week, sending over 130,000 Australians into yet another lockdown, according to Chris Cherry, the mayor of Tweed Shire, part of the area in northern New South Wales that has been placed under restrictions for seven days.

According to ABC News, the 31-year-old woman visited various businesses like restaurants and cafes without checking in via QR code. The police have charged her with breaching several public health regulations, including her work travel exemption guidelines.

Michael Lyon, the mayor of neighboring Byron Shire, shared his frustration over going back into lockdown in a Facebook post on Wednesday.

“It is so devastating to be in lockdown again and it is clear the ‘honour’ system relied on by the state government is deeply flawed,” he wrote. “Perhaps our calls for a tightening of restrictions will now finally be heeded.”

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