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President Biden and Vice President Kamala Harris held a virtual meeting Friday at the White House with Indian Prime Minister Narendra Modi, Australian Prime Minister Scott Morrison and Japanese Prime Minister Yoshihide Suga. Credit…Doug Mills/The New York Times

The Biden administration, under intense pressure to donate excess coronavirus vaccine to countries in need, is trying to address the global shortage in other ways: by partnering with Japan, India and Australia to fund a dramatic expansion of vaccine production capacity.

The signing was announced Friday at the Four Nations Summit, a virtual gathering of Four Nations leaders attended by President Biden and Vice President Kamala Harris Friday morning. According to senior government officials, the goal is to address severe vaccine shortages in Southeast Asia, which would increase the global vaccine supply.

The United States is far behind China, Russia and India in the race for coronavirus vaccines as diplomatic tools. At the same time, Biden has been accused of hoarding vaccines by global health advocates who want his administration to send supplies to countries that desperately need them.

While the president has insisted that Americans come first, he has so far refused to make specific commitments to the distribution of US-produced vaccines.

If we have a surplus, we will share it with the rest of the world, he said earlier this week, adding: We will deal with the Americans first and then try to help the rest of the world.

The One Campaign, a nonprofit founded by U2 singer Bono, says the U.S. has purchased 453 million excess doses of vaccine that can be shipped abroad. She urged the Biden administration to share 5 percent of doses overseas after 20 percent of Americans are vaccinated, and to gradually increase the percentage of sharing doses as more Americans are vaccinated.

It’s time for American leaders to ask themselves: When this pandemic is over, do we want the world to remember America’s leadership in providing life-saving vaccines, or do we leave that task to others? Tom Hart, executive director of the United Campaign for North America, said in a statement.

China and India are already distributing Curry vaccine to their neighbors, and more than 50 countries from Latin America to Asia have ordered 1.2 billion doses of Russia’s Sputnik V vaccine. But Biden risks political furor if he sends cans abroad while they are still scarce in the United States.

Sir, I want to thank you for your support. Biden is taking steps to ramp up vaccine production to 1 billion units by the end of the year, far more than what is needed to vaccinate the estimated 260 million adults in the U.S.

The government’s agreement with pharmaceutical giant Merck to produce Johnson & Johnson’s single-use vaccine, which Biden reported on Wednesday at the White House, will help achieve that goal. Wednesday, Biden also asked federal health officials to provide 100 million additional doses of Johnson & Johnson’s vaccine.

The administration explained that these efforts are aimed at ensuring sufficient vaccine for children, increased doses and contingencies such as new variants of infection. But Jeffrey D. Zients, Mr. Biden’s coronavirus coordinator, told reporters Friday that the deal between Johnson and Johnson and Merck would also help strengthen and ultimately benefit the world.

Meanwhile, tens of millions of doses of the coronavirus vaccine from the British-Swedish company AstraZeneca lie idle in U.S. manufacturing facilities, awaiting the results of U.S. clinical trials, while countries that have approved its use demand access to the vaccine.

The fate of the cans is the subject of fierce debate between White House and federal health officials, with some believing the government should let them go abroad, where they are desperately needed, while others do not want to abandon them, according to senior government officials.

The financing deal, unveiled Friday by the government at the Quadruple Dose Summit, is designed to increase production and supply capacity by another 1 billion doses by 2022 to meet global demand, officials said.

The government recently discussed with international partners, including those supporting the World Health Organization’s vaccination program known as Covax, various ways to increase the global supply of vaccines, including paying companies to provide more doses that could then be distributed overseas, said a participant in those discussions, who insisted on anonymity to describe private conversations.

United States ‘ United States 11. March 14-day change
New cases 62,689 -18%
New deaths 1,522 -32%
World ‘ Peace 11. March 14-day change
New cases 478,617 +12%
New deaths 9,713 -7%

VS Immunisations ‘

AstraZeneca vaccine trial in Oxford, England, in November. linked to credit Andrew Testa for The New York Times.

AstraZeneca’s Covid-19 vaccine is approved in more than 70 countries, but the United States is not yet among them. And while US officials wait for the results of the company’s US tests and then for an emergency authorization, tens of millions of cans remain unused in US facilities, even as other countries demand access to them.

The fate of snoring is hotly debated between the White House and federal health officials. Some believe that the government should let them go abroad where they are badly needed, while others do not want to abandon them.

AstraZeneca, an Anglo-Swedish company, is involved in these discussions.

In a prime time speech Thursday, President Biden said the administration has made great progress in making vaccines available in the United States. By the end of May, he said, there will be enough for every adult in the country, and he promised that by 1. Any adult can qualify.

But other countries are facing serious supply problems, and AstraZeneca’s shortage of vaccines is causing tensions with European authorities.

AstraZeneca has asked the Biden administration to allow the company to send US doses to the EU. The administration has so far denied the request, an official said.

The company’s Covid-19 vaccine faced headwinds this week after health authorities in three European countries suspended its use as a precaution while European drug regulators looked into the possibility that the vaccine could increase the risk of blood clots. These countries, Denmark, Iceland and Norway, stressed that there was no evidence of a causal link. Bulgaria and Thailand suspended use of the vaccine on Friday.

Denmark stepped in after a 60-year-old woman who had been vaccinated developed a blood clot and died. Several other European countries have stopped using doses of the same batch of vaccine after reports of serious blood clots, and European medicines authorities are investigating.

Public health experts believe that some people get sick accidentally after receiving a vaccine. In the vast majority of cases, these diseases have nothing to do with injections. Most other countries where AstraZeneca’s vaccine has been administered to several million people have not made similar announcements.

The Biden administration’s uncertainty about releasing vaccine doses is due, at least in part, to uncertainty about delivery before the president’s end-of-May deadline. The production of inoculants is notoriously difficult and sensitive, and problems such as fungal growth can interrupt plant development.

The government’s proposals to order additional supplies of three F.D.A.-approved vaccines have further sidelined AstraZeneca’s candidate. The United States may only need AstraZeneca’s doses for a short time, or never need them at all.

Atani, Hungary, introduces a coronavirus vaccine produced by Sinopharm, a Chinese state-owned company Credit… Peter Comca/ EPA, via Shutterstock.

Hungary has agreed to pay about $36 for a dose of Covid-19 vaccine, which is produced by Chinese state-owned company Sinopharm. That’s according to contracts released Thursday by a senior Hungarian official. This seems to make Sinofarm one of the most expensive registrations in the world.

Hungary has agreed to purchase five million doses of Sinopharms vaccine at a price of 30 euros ($36) each. This is according to contracts posted by Prime Minister Viktor Orban’s chief of staff, Gergely Gulas, on his Facebook page. The contract was concluded between the Hungarian Government and a third-party supplier, and the price is much higher than what the EU is prepared to pay for vaccines from Western manufacturers.

The European Union said it would pay 15.50 euros per dose of Pfizer-BioNTech’s vaccine, Reuters reported, citing an internal EU document. For AstraZeneca, the company agreed to pay $2.15 per dose, the Belgian budget minister said.

The contracts released by Mr. Gulyas also show that Hungary, where nearly half a million cases of coronavirus have been diagnosed and more than 16,000 people have died, has agreed to pay $9.95 per dose for the Russian vaccine Sputnik-V.

The company from which Hungary buys the vaccine changed hands two months before the agreement. The company had been awarded the contract after being excluded from the public tender by the government, said Miklós Ligeti, legal director of the anti-corruption group Transparency International Hungary. (Due to an editing error, an earlier version of this article incorrectly stated which company changed ownership).

Such measures are a source of concern for anti-corruption advocates, who believe that third-party intervention increases the risk of price inflation. We don’t know how much this company paid for this vaccine, Ligety said.

Given the publicly available data on this company, Ligety pointed to the numbers, which he called alarming. The Hungarian government has awarded a contract worth a net 150 million euros – $179 million – to a company with a share capital of 9,000 euros ($10,700), he said.

Hungary is one of the few European countries that cooperate with Sinopharm. Sinopharm is promoting itself in developing countries at a time when many wealthier countries are piling on the doses of Western drug makers like Pfizer and Moderna. The main selling point was Sinopharm’s production facilities: It is said that there could be as many as three billion doses by the end of the year.

Sinopharm’s price is also unusual because, unlike western vaccine makers, the company has not disclosed details of phase III trials.

Sinopharm produces two vaccines. The first one, conducted with Beijing Institute of Biological Products, has an efficiency of 79%, while the second one, conducted with Wuhan Institute of Biological Products, has an efficiency of 72.5%.

Adam Liptak contributed to this story.

The Obamas, Bushes and Clintons at the inauguration of President Biden. They appear together in a new ad campaign. linked to Doug Mills/The New York Times credit …

Four former U.S. presidents and their first ladies are appearing in a new public service campaign with a single address to Americans: Get vaccinated.

The ads show former presidents Jimmy Carter, Bill Clinton, George W. Bush and Barack Obama getting vaccinated. Their wives Rosalynn Carter, Hillary Clinton, Laura Bush and Michelle Obama also made appearances.

Two ads encourage all Americans to get vaccinated when the opportunity arises.

The vaccine is a sign of hope, Obama said. It will protect you and your loved ones from this dangerous and deadly disease.

To get rid of this pandemic, it is important that our citizens get vaccinated, Bush said.

They spoke of a passionate desire to get back to normal.

I want to be able to go back to work and get around, he said.

To visit Michelle’s mother, Mr. Obama. To hug her and see her on her birthday.

Sir, I want to thank you for your support. Bush says he’s looking forward to opening day at Texas Ranger Stadium with a full house.

Sir, I want to thank you for your support. Carter says: I’m getting the vaccine because we want to stop this pandemic as soon as possible.

The only former presidential couple not involved in the ad campaign are Donald and Melania Trump.

Mr and Mrs Trump were quietly given the vaccine in January before leaving the White House. Later in the month, Trump spoke at a CPAC policy conference in Orlando, Florida, where he called on people to get vaccinated.

Trump’s personal stance was evident in the fact that some of his supporters spoke out against the vaccine. Many other celebrities have tried to set a good example by being photographed in public. Last week, Andy Slavitt, a senior White House adviser on pandemic issues, dodged a question from a reporter about whether Biden would ask the White House to make a public announcement to encourage reluctant supporters to get vaccinated. Slavitt said many people, including Republican politicians, have spoken about the importance of vaccination.

I especially liked Dolly Parton’s song, Slavitt said, referring to the country music star who began singing when she received her first dose of the vaccine. It’s one of my favorites.

The two ads are part of a broad advertising campaign to combat skepticism about the Covid-19 vaccine that began in February with support from the nonprofit advertising group Ad Council and a coalition of experts known as the Covid Collaborative. The announcements will be broadcast in English and Spanish on television, social media and other platforms.

More than 300 businesses, community groups and advocates, as well as the Centers for Disease Control and Prevention, contributed $52 million to the campaign.

We encourage you to get vaccinated if that is possible for you, Obama said.

So roll up your sleeves and do your part, Bush said.

This is our chance, Clinton said.

It’s up to you now, Mr. B. Carter.

Eileen Sullivan contributed to this report.

Dr. Zhang Wenhong, an infectious disease specialist, may be Dr. Anthony S.’s closest confidant linked to TPG/Getty Images credit.

China has imposed one of the world’s strictest blockades to stop the coronavirus. The doors of some apartments in the city have been sealed, leaving residents with less and less food and medicine. In one village, a resident was tied to a tree after leaving his home to buy cigarettes.

Few officials objected to these measures, given the central government’s obsession with its anti-corruption campaign. This didn’t stop Dr. Zhang Wenhong.

Dr. Zhang, an infectious disease specialist and perhaps China’s most trusted voice on Covid-19, has publicly opposed the strictest control measures. Fighting a pandemic, as he likes to say, is like catching mice in a china shop.

He is perhaps the closest equivalent in China of Dr. Anthony S. Fauci, the American infectious disease specialist who has become the public face of the response to the virus in the United States.

Dr. Zhang, an accomplished technocrat, is not seen as political or ideological. By presenting his expert advice in a straightforward manner, he resists the authoritarian instincts of a system that often resorts to draconian measures.

Zhang is a senior researcher at Fudan University in Shanghai and a member of the Communist Party. He chaired the Covid-19 group of experts in Shanghai, giving him considerable influence over the city’s actions.

But unlike Dr. Fauci, who urged the Trump administration to do more, Dr. Zhang argued for a more strategic approach to a country that will not accept half measures against the coronavirus. In doing so, he addressed the Chinese audience with respect, a refreshing change from the way other powerful people often behave.

Mr. Zhang is particularly popular with experts and technocrats who admire his sincerity in a society plagued by propaganda, conspiracy theories and unrepentant nationalism.

Right now, the rumors are scarier than the virus, he said at the beginning of the outbreak. We need to explain the epidemic to the public with rational data and expertise.

In modern China, an edge often means speaking the language of the Communist Party. Those who refuse to follow the ideological wave maintain their independence by remaining silent.

In contrast, Dr. Zhang had acquired the ability to speak fluently. In Shanghai, a city of 24 million people, only 371 cases of localised infection and seven deaths have been reported.

His predictions were correct. He predicted early on that the pandemic could last at least one to two years. This month a year ago, when China was virtually at a standstill, he said China had passed through its most difficult hour.

Journalists started looking him up, and some of his answers became all the rage on the internet. Some examples:

The flu is not a cold, just as a tiger is not a cat.

You’re bored to death at home, so the virus is bored to death too.

Analysis of samples from Novavax’s phase 3 clinical trial in Seattle last month…Credit…Karen Ducey/Getty Images

On Thursday, the pharmaceutical company Novavax announced that its candidate vaccine against the coronavirus had an efficacy of 96.4% in a phase 3 trial in the UK. Thus, the clinical results are equivalent to those of Modera and Pfizer-BioNTech injections.

But Novavax’s candidate was only 48.6% effective in the phase 2 study in South Africa, where most cases are a new option, the company said.

Novavax said in a statement that the 96.4% figure measures the drug’s effectiveness in the UK against mild, moderate and severe disease caused by the original strain of coronavirus. The rate fell to 86.3% for cases caused by a variant of coronavirus B.1.1.7, first detected in the UK.

Novavax said 48.6% of the trials in South Africa had been conducted with predominantly variant strains of the virus, but noted that in both cases the vaccine still provided 100% protection against serious illness and death.

Most cases circulating in South Africa are associated with variant B.1.351. Scientists are concerned that clinical trials generally show that vaccines offer less protection than other options.

Thursday’s results are not far off from the interim results Novavax published in January. These have proved effective in the UK at almost 90% and in South Africa at just under 50%.

Novavax, a little-known company in Maryland, never marketed the vaccine. It is working on one of six candidate vaccines supported by the US government’s Operation Warp Speed and is conducting trials in the UK, Mexico, South Africa and the US.

In January, the company announced that it had begun developing a new version of the vaccine to combat more infectious variants.

A global heist

A vaccination center in Mumbai, Wednesday. linked to credit Rajneesh Kakadeh/Associated Press

NEW DELHI – India has recorded one of the worst one-day increases in the number of coronavirus cases since late December, mainly due to an uptick in the western state of Maharashtra. More than 60 percent of the 23,285 cases identified Thursday were reported by the state, according to the health department.

This month, the government of Maharashtra, where the financial capital Mumbai is located, declared a lockdown in some areas after the number of cases reached over 8,000 in a single day. On Friday, authorities announced new restrictions in other parts of the state.

The central and state governments have decided to strictly shut down the city of Nagpur for a week from Monday.

Until last month, there was an outbreak in India. At the height of the outbreak last fall, there were more than 90,000 cases a day, but the number of cases dropped precipitously in the following months to only about 9,000 a day, according to the New York Times database.

We are very worried about Maharashtra, Vinod K. Paul, one of the top public health officials in the state, said at a press conference on Thursday. In all states where the virus appears to be increasing significantly, vaccination should be stepped up in those areas, he said.

By Friday morning, India had vaccinated 26 million people against the coronavirus. The government has set a target of 300 million vaccinations by July.

In other world news:

  • German health authorities will from Sunday remove parts of Spain and Portugal from the list of risk areas, for which the government issues warnings but does not impose a travel ban. The demarcated areas of Spain include the Balearic Islands, including Mallorca, a popular destination for German tourists. Other regions are excluded: the central regions of Castilla-La Mancha, Extremadura, La Rioja, Murcia and Valencia as well as the Portuguese regions of Alentejo and the Azores. Although travelers from Germany no longer need to quarantine before going to the beaches, they must test negative for the virus before leaving Germany, which considers Spain a high-risk area.
  • South Korean Prime Minister Jeong Se-kyung said Friday that restrictions on treatment of the coronavirus will be lifted until the 28th day. March remains in effect, news agency Yonhap reported. The rules, which vary by region but include a national ban on most private gatherings, were due to expire Sunday. South Korea reported 488 cases Friday, the highest number in three weeks. The government has said it wants to achieve herd immunity by November, but only about 1% of the country’s 51 million people have been vaccinated.
  • After months of isolation, Wales will ease restrictions from Saturday, the country’s leader said. Residential care orders will be replaced by on-site housing advice, and the new rules will allow up to four people from two households to meet outdoors, outdoor sports and care homes to be visited for recreational purposes. A serious foray out of the castle begins this weekend in Wales, Prime Minister Mark Drakeford said Friday. Haircuts will reopen in phases from Monday and stores will welcome customers on April 12, the same day as the reopening in the UK.

Anne Chaverien and Christopher F. Schütze contributed to this report.

A medical worker checks the blood pressure of a man in a Bulgarian mountain village before administering a dose of AstraZeneca’s Covid-19 vaccine. Bulgaria has joined four other countries that have suspended use of the vaccine while regulators investigate reports of blood clots in some recipients. Credit…Nikolai Doychinov/ Agence France-Presse – Getty Images

Countries continued to avoid using AstraZeneca’s vaccine on Friday, a day after Denmark, Norway and Iceland said they would stop using it while European drug regulators investigate a possible link to clotting problems. These measures come despite continued support for the vaccine from global health authorities.

Bulgaria joined them on Friday in saying it will temporarily suspend vaccinations with AstraZeneca’s vaccine after a woman died the day after she was vaccinated. And Thailand has delayed the launch of a vaccine that was supposed to start on Friday.

Both countries stated that they had acted with the utmost caution, and Bulgaria stated that the woman’s autopsy showed no signs of a blood clot.

Margaret Harris, a spokeswoman for the O.M.S., said at a briefing on Friday that AstraZeneca had an excellent vaccine, Reuters reported, and that no causal link had been found between the vaccine and the blood clotting reports. Health officials fear the suspension will lead to further hesitation in the introduction of vaccines, which are a key tool in the fight against the pandemic.

Italy and Romania also suspended vaccinations Thursday, but only for one batch of the vaccine Italy is studying. This batch differs from the one that prompted warnings in Denmark and some other countries last weekend.

Bulgaria, which is experiencing its third wave of the virus, on Friday ordered a temporary suspension following the death of a 57-year-old woman, the country’s health minister, Kostadin Angelov, told reporters. There is no indication that the death is vaccine-related, but health authorities are investigating.

Kovalev said the woman had several pre-existing conditions, including a heart condition.

I don’t expect a link to be found between the deaths and the vaccine, even in this case, Angelov said. However, given the health and well-being of the people, we decided to take precautionary measures.

The decision may further complicate Bulgaria’s vaccination campaign, which has been hampered by slow vaccine deployment and indecision. The country relies heavily on AstraZeneca’s vaccine and has ordered 4.5 million doses.

To speed up the vaccination campaign, last month Bulgaria launched a vaccination programme that AstraZeneca will make available to anyone who wishes to be vaccinated. Since then, these greenways have had their ups and downs.

Thailand’s announcement came hours before Prime Minister Prayuth Chan-ocha became the first person in the country to be vaccinated by AstraZeneca, and the decision will not affect the launch of the Sinovac vaccine in Thailand.

Dr. Yong Poorovarawan, a virologist at Chulalongkorn University in Thailand, told reporters that the delay in the country is likely to last a week or two. We’re not saying the vaccine is bad, he said of AstraZeneca’s vaccine. We move it to see if the deaths are related to vaccinations or not.

Customers in a bar in Texas on the 10th. March, after Gov. Greg Abbott has lifted restrictions on Covid. courtesy of Justin Hamel for The New York Times.

A year ago, New Yorkers were told to keep their hands off their faces – and away from people, handrails and elevator buttons. If his hands did not obey, they would be pierced to the bone.

Despite all the uncertainty and horror that accompanied the emergence of the coronavirus, the first protocols showed some clarity.

Today, after so many tragedies, the city is approaching normality. By the end of this week, more than 2.4 million doses of Covida vaccine will have been administered in New York City, once the global epicenter of the pandemic.

This period after containment and before the return to normal is full of confusion and conflict.

Walking around town, it’s clear that people are giving in and relaxing, probably because of the ongoing vaccination and because people are extremely tired, said Emanuela Taioli, director of translational epidemiology at Mount Sinai.

The reality is that the city’s positivity scores are not going down, she said. They’re on set and they stay there. It’s been two weeks. This means we must continue to take precautions until we are all vaccinated, which may take a few months or longer.

Who wants to hear this? Probably no one.

In Texas, where Gov. Greg Abbott recently lifted the mummy ban, Shenanigans and Confetti’s Beach Club Bar in Huntsville announced a Masks Off party last Tuesday night with 100% occupancy.

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On Tuesday, Science magazine reported that the U.S. actually overdosed on vaccines by contracting with numerous pharmaceutical companies in violation of precautions. This notion of scarcity and abundance has led many people to rationalize vaccination even when they are technically ineligible for it.

It may seem morally wrong for a wealthy Brooklynite who claims to have asthma or a developmental disability, for example, to travel to a poorer neighborhood to get vaccinated. But epidemiologists fall by the wayside when it comes to vaccinations. They say it’s about stabbing as many people as possible.

How will we look back on this dangerous time a year from now? How will we feel when we decide to start a normal life or wait for our turn to step into a piñata? It will depend on the outcome. The worst will be that the powerful will live as they always have and the weak will become even more vulnerable.

The half-abandoned Umberto I Gallery in Naples, Italy, Saturday. Credit…Cesare Abbate/EPA, via Shutterstock.

The Italian government said on Friday that restrictions in relation to the coronavirus will be tightened across much of the country from Monday and that the whole country will be cordoned off over the Easter weekend to prevent spikes in infection as the rollout of the vaccine proceeds slowly.

The official cabinet of Italy’s new prime minister, Mario Draghi, has announced measures that will exclude more than half of the country’s population. Starting Monday, health authorities will close schools, restaurants and many businesses in most of the northern regions, as well as the Rome and Naples regions. People will also be prohibited from leaving their homes except to go to work, to medical facilities and in case of emergency.

For the Easter weekend, from 3 to 5. During the month of April, which is usually marked by large family gatherings, the monarch will limit travel to one trip a day away from home.

These measures are among the strictest since March, when Italy became the first Western country to impose a containment measure to slow the spread of the virus.

I know that the measures taken today will have an impact on children’s education, on the economy and also on the psychological state of each of us, Draghi said during a televised visit Friday to a vaccination center near Rome. But they are necessary to prevent a deterioration that would make even stricter measures inevitable.

The memory of what happened last spring is still vivid today. We will do everything in our power to ensure that this does not happen again.

Italy’s health ministry on Friday also applied new criteria to determine when regions should be closed. The restrictions come into effect when the number of virus cases exceeds 250 per 100,000 population. Many of the country’s 20 regions are expected to be affected by these measures.

Italy passed the 100,000 death mark due to the coronavirus this week, and the death toll is now around 300 a day. Nationally, there were more than 25,000 new infections and 373 deaths Thursday.

Some health officials attribute the increase in infections and deaths, especially in central and northern Italy, to the now widespread presence of a more infectious variant first reported in Britain. Compared to the US and the UK, the use of vaccines in Italy, as in other European countries, is still low. About 7% of the Italian population is vaccinated.

The country has faced delays in the delivery of vaccines from Pfizer-BioNTech, Moderna and AstraZeneca. The country’s own difficulties in managing vaccine distribution in the underdeveloped south and in the hard-hit rich region of Lombardy have also delayed the process.

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