CoronavirusCovid News: Thanksgiving Air Travel May Rise to Near 2019 Level

Officials expect U.S. travel for Thanksgiving to approach prepandemic levels.

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The T.S.A. security checkpoint at Louis Armstrong New Orleans International Airport during a busy period in August ahead of Hurricane Ida.Credit...Scott Olson/Getty Images

Airline travel this Thanksgiving season is expected to approach prepandemic levels, Transportation Security Administration officials said on Wednesday. The agency is preparing to handle about 20 million air passengers.

“We are staffed and prepared for the holiday travelers,” David Pekoske, the T.S.A. administrator, said in a statement.

The large volume of travelers expected comes as inoculation rates across the United States have risen, allowing many families to gather safely for the first time since 2019, when T.S.A. screened 26 million people. The uptick also signals a willingness by people to resume customary holiday travel.

“I recommend that travelers pay attention to the guidance that the T.S.A. officers are providing at the checkpoint,” Mr. Pekoske said. “They may be directing you to a shorter line or guiding you around someone who is moving slowly, and they may be giving you some advice that will lessen the likelihood that you’ll need a pat-down.”

Coronavirus cases in the United States by region

This chart shows how reported cases per capita have changed in different parts of the country. The state with the highest recent cases per capita is shown.

The busiest days during the Thanksgiving travel period are usually the Tuesday and Wednesday before Thanksgiving and the Sunday afterward, the T.S.A. statement said. While the travel volume this year is not expected to reach 2019 levels, the agency said it could be higher in the time leading up to Thanksgiving.

The increase comes as airlines deal with an uptick in cases of unruly passengers. The Federal Aviation Administration has issued fines, and the president of the Association of Flight Attendants union, Sara Nelson, has attributed the rising tensions to the politically charged atmosphere over health protocols.

In an interview with “CBS Mornings,” Mr. Pekoske said the number of such reports were higher than he can recall ever having seen.

“We’re working very closely with the carriers, the flight attendants, the flight deck crews, the air force and the F.A.A., to do everything that we can to message how dangerous this behavior is,” he said.

The White House estimates nearly 10 percent of younger children have gotten a first shot.

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White House: About 10% of Younger Children Have Received First Shot

White House officials estimated that nearly 10 percent of the nation’s 5- to 11-year olds had received their first coronavirus vaccine dose since the approval of the Pfizer-BioNTech shot for that age group.

Our effective rollout is helping parents and families across the country experience the giant sigh of relief of knowing their kids are on the path to having protection from the virus. We estimate by the end of the day today, 2.6 million kids ages 5 to 11 will have gotten their first shot — 2.6 million, that’s about 10 percent of kids. So just 10 days into our program being at full strength, we’re at 10 percent of kids. For perspective, it took about 50 days for us to reach 10 percent of adults with one shot. And when the polio vaccine was first rolled out for kids in the 1950s, it took about three months to cross two and a half million shots in arms. And in fact, the pace of vaccinations for kids has been accelerating. In the last week, 1.7 million kids got vaccinated, double the prior week. Operationally, we continue to make strong progress with the kids vaccination program. Vaccines for kids are now available at more than 30,000 trusted and convenient locations. That’s up from 20,000 last week. That means just 10 days in, we have one vaccine site for every 900 kids. That compares to one vaccine site for every 3,500 Americans age 12 and older.

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White House officials estimated that nearly 10 percent of the nation’s 5- to 11-year olds had received their first coronavirus vaccine dose since the approval of the Pfizer-BioNTech shot for that age group.CreditCredit...Meridith Kohut for The New York Times

The pace of vaccination against the coronavirus among newly eligible younger children is accelerating, and nearly 10 percent of the nation’s 5- to 11-year olds have already had their first shot, the White House estimated on Wednesday.

Last week alone, 1.7 million young children were vaccinated, about double the previous week, Jeff Zients, President Biden’s coronavirus response coordinator, said at a White House Covid-19 briefing. The administration estimates that by the end of Wednesday, 2.6 million of the 28 million children in that age group will have had their first of two doses of the Pfizer-BioNTech vaccine, the only one currently authorized for them.

“Just 10 days into our program being in full strength, we’re at 10 percent of kids,” Mr. Zients said. “For perspective, it took about 50 days for us to reach 10 percent of adults with one shot. And when the polio vaccine was first rolled out for kids in the 1950s it took about three months to cross two and a half million shots in arms.”

The pediatric figures come as the nation is about to cross another vaccination threshold: Nearly 80 percent of Americans aged 12 and older have had their first shot, according to the Centers for Disease Control and Prevention.

The figure suggests slow but steady acceptance of the vaccine. This past summer, President Biden failed to meet his goal of having 70 percent of U.S. adults receive at least one dose by the July 4 holiday.

Studies and real-world evidence show that coronavirus vaccines are extremely effective at preventing hospitalization and death from Covid-19. During Wednesday’s briefing, Dr. Anthony S. Fauci, Mr. Biden’s top medical adviser for the pandemic, shared a slide deck showing data from states including Texas and Indiana to make that point.

In Texas, Dr. Fauci said, unvaccinated people were 13 times more likely than fully vaccinated people to become infected with the coronavirus during the month of September, and 20 times more likely to die of Covid-19. In Indiana, during the week that began on Sept. 30, 1,447 people were hospitalized with Covid-19; about 10 were fully vaccinated. Of 219 who died, fewer than 15 were fully vaccinated.

Tracking the Coronavirus ›

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The F.D.A. could authorize Moderna boosters for all adults as early as this week.

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Booster shots of Moderna’s coronavirus vaccine were being administered in Los Fresnos, Texas, in October.Credit...Denise Cathey/The Brownsville Herald, via Associated Press

Moderna has asked federal regulators to authorize booster shots of its coronavirus vaccine for all adults, a request that the Food and Drug Administration could grant as early as this week along with a similar request from Pfizer, according to people familiar with the planning.

If the Centers for Disease Control and Prevention also signs off every adult who was fully vaccinated with the Pfizer-BioNTech or Moderna shot at least six months ago would not only be eligible for a booster, but could choose which vaccine. The agency’s committee of independent experts is set to meet Friday to discuss booster shots.

It would also allow President Biden to fulfill his August pledge to offer booster shots to every adult — nearly two months later than the administration originally planned, though, and amid an ongoing debate among experts over whether extra shots are necessary for younger, healthy adults.

New reported doses administered

Source: Centers for Disease Control and Prevention | Note: Line shows a seven-day average. The C.D.C., in collaboration with the states, sometimes revises data or reports a single-day large increase in vaccinations from previous dates, which can cause an irregular pattern.

As it stands now, only people who received two doses of the Pfizer-BioNTech or Moderna vaccines and are 65 or older, or adults who are considered to be at special risk because of their medical conditions, jobs or living environments are eligible for boosters. Anyone who received the single-dose Johnson & Johnson shot can already get a booster, two months after the first shot. Eligible people can select from any of three vaccine brands as a booster.

By some estimates, the existing eligibility categories, which are broad but complicated, cover up to 70 percent of adults. More than 30 million Americans, or about 16 percent of those fully vaccinated, have already gotten additional shots. But under the federal rules, tens of millions more are still ineligible.

Even if federal regulators do not act on Moderna’s request this week, the F.D.A. and the C.D.C. are expected to allow all fully vaccinated adults access to Pfizer’s booster. At a White House briefing on Wednesday, Dr. Anthony S. Fauci, the government’s top infectious disease expert, defended the administration’s approach of broad access to boosters, saying vaccines should protect against symptomatic illness, not just hospitalization and death.

“I don’t know of any other vaccine that we only worry about keeping people out of the hospitals,” he said. “I think an important thing is to prevent people from getting symptomatic disease,” noting that it can have long-term consequences, a condition dubbed long Covid.

“There’s a really good reason to optimally protect younger individuals” as well as older and more vulnerable people, he said.

A growing number of state and localities have moved on their own to offer booster shots to all their adult residents, either by generously interpreting or simply ignoring the federal guidelines. As of Wednesday, a number of states had broadened access, including Kansas, Kentucky, Maine and Vermont. New York City health officials on Monday encouraged all adults who want boosters to seek them out.

Moderna announced Wednesday that it had requested the F.D.A. broaden its booster authorization to include all adults, as regulators in Canada and the European Union have recently done.

Moderna’s vaccine is considered more protective than Pfizer-BioNTech’s; its dose for the initial two shots is 100 micrograms, while Pfizer’s is 30. Regulators authorized a half-dose of Moderna as a booster for older people and other vulnerable groups, in part to mitigate concerns about side effects; Moderna is seeking the same half-dose booster for the broader adult population.

State and local health officials have criticized the existing federal eligibility categories for Moderna and Pfizer booster shots as far too complicated for the public to figure out. Besides those who are 65 or older, those eligible include those with medical conditions ranging from heart conditions to obesity to depression.

Also eligible, the C.D.C. has said, are people “at increased risk for Covid-19 exposure and transmission because of occupational or institutional setting” — a category covering health care workers, residents of homeless shelters and prisoners, among others.

Munich’s famed Christmas market is canceled again as another virus wave hammers Germany.

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The Christmas market in Munich in 2013. It has been canceled for a second straight year.Credit...Marc Mueller/European Pressphoto Agency

The Munich Christkindlmarkt, one of Germany’s oldest and biggest Christmas markets, has been canceled for the second consecutive year as another coronavirus wave sweeps through the country.

It is the largest German Christmas market to be canceled as the events struggle to survive the country’s fourth virus surge after being mostly shuttered last year.

“It is bitter news that I have today for all Munich residents, and especially for the stall owners,” said Mayor Dieter Reiter. “However, the extreme situation in our hospitals and exponentially rising infection rates leave me no other choice.”

Germans have gathered at outdoor markets in the weeks before Christmas since the 14th century, when vendors first built their stands in city centers to sell their wares to people coming from church services. They offer an array of foods, artisanal gifts and other provisions for the coming celebrations and the long winter months.

Germany’s roughly 3,000 Christmas markets are an important economic boon to many communities. Local restaurants, breweries, bakeries and artisans depend on the annual holiday fairs for a substantial amount of their income.

The Munich market is famed for its stalls offering traditional gingerbread, grilled sausages, mulled wine and hand-painted trinkets, according to Lonely Planet.

A combination of factors has propelled Germany’s latest virus surge, among them wintry temperatures, a slow rollout of booster vaccines and an even more pronounced spike in neighboring Eastern European nations like the Czech Republic.

Experts say the unvaccinated are driving the wave of cases that are filling up hospitals across Germany.

For the Christmas markets that remain open, only people vaccinated against the coronavirus or fully recovered from a previous infection can fully participate, Reuters reported. Unvaccinated people can partake in some limited activities, such as listening to carols.

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A vaccine developed by Novavax, a Maryland-based company, is approved in the Philippines.

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An inoculation drive in Quezon City, the Philippines, on Wednesday. The country has now approved nine vaccines for emergency use.Credit...Aaron Favila/Associated Press

The Philippines has granted emergency-use authorization for Novavax’s Covid-19 vaccine for people 18 and older, giving a boost to the Maryland-based company and becoming the second country after Indonesia to allow the shots.

Novavax has also submitted applications for emergency use in India and with the World Health Organization. And the European Union’s main drug regulator said on Wednesday that it could decide whether to issue conditional marketing authorization “within weeks” if the drugmaker’s data show the vaccine to be safe and effective.

The Novavax shots proved highly effective in clinical trials, but the company fell behind other manufacturers despite receiving $1.75 billion from the U.S. government. Novavax struggled to ramp up its manufacturing and to demonstrate the purity of its vaccines to regulators, and it said in August that Washington would not pay for further production until it had resolved regulators’ concerns.

New reported cases by day
Feb. 2020
Sept.
Apr. 2021
Nov.
Jun. 2022
Jan. 2023
10,000
20,000
30,000 cases
7-day average
126
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

The vaccine involves two doses, given at least 21 days apart, the company said. It differs from the shots now authorized in the United States in that it involves viral proteins assembled into nanoparticles, mixed with an immune-boosting compound called an adjuvant.

Indonesia approved Novavax’s vaccine for emergency use this month.

Novavax’s chief executive, Stanley C. Erck, said in an announcement on Wednesday that the shots would “contribute substantially to increased vaccination rates” in the Philippines, where only about 37 percent of the population is fully vaccinated, according to the Our World in Data project at the University of Oxford.

The vaccine doses will be manufactured by the Serum Institute in India.

The E.U. drug regulator, the European Medicines Agency, has approved the use of the AstraZeneca, Janssen, Moderna and Pfizer-BioNTech vaccines. The approval of a fifth vaccine could bolster inoculation drives on the continent at a time when it is experiencing the world’s biggest Covid outbreaks.

The Philippines had already approved eight other vaccines for emergency use, according to Dr. Rolando Enrique Domingo, director of the Philippine Food and Drug Administration: AstraZeneca, Bharat Biotech, Gamaleya Sputnik V, Johnson & Johnson, Moderna, Pfizer-BioNTech, Sinopharm, and Sinovac.

Vince Dizon, an adviser to President Rodrigo Duterte, has said that because of unequal vaccine distribution, the Philippines needed to approve as many vaccines as it could.

“There is a really big problem with the global supply of vaccines, because many of these vaccines are in rich countries,” he said. “We need to be vaccinated quickly.”

A correction was made on 
Nov. 18, 2021

An earlier version of this item misidentified the person who said that because of unequal vaccine distribution throughout the world, the Philippines needed to approve as many vaccines as it could. It was Vince Dizon, an adviser to the Philippine president, not Rolando Enrique Domingo, the director of the Philippine Food and Drug Administration. 

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Kansas, Kentucky, Maine and Vermont join other states in broadening access to boosters for all adults.

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A pharmacy technician preparing Pfizer-BioNTech’s coronavirus vaccine in Portland, Maine, in March.Credit...Robert F. Bukaty/Associated Press

Kansas, Kentucky, Maine and Vermont on Wednesday joined several states across the United States in expanding access to coronavirus vaccine boosters for all adults. That comes as federal regulators consider granting requests for Pfizer-BioNTech and Moderna boosters to be authorized for all adults as early as this week, according to people familiar with the planning.

State leaders have used various justifications for choosing not to wait for federal decisions on boosters, ranging from concerns about holiday season gatherings and winter temperatures pushing people indoors to rising cases and confusion among residents about eligibility. Federal regulators say boosters are available for adults who meet their eligibility categories and are at least six months past their second dose of the Pfizer or Moderna vaccines, or are two months past receiving the single-dose Johnson & Johnson vaccination.

Gov. Andy Beshear of Kentucky issued an executive order that allows any adult to get a booster, provided they meet timing rules. In Kansas, Gov. Laura Kelly said that vaccine providers should allow people to determine their level of risk exposure and that the entire state was at high risk, urging all adults to get a booster. And Gov. Phil Scott of Vermont expanded booster access to all adults and said the state would simplify the online registration for state-run vaccination clinics and permit walk-in appointments.

Covid patients in hospitals and I.C.U.s
Early data may be incomplete.
Feb. 2020
Sept.
Apr. 2021
Nov.
Jun. 2022
Jan. 2023
50,000
100,000
150,000 hospitalized
Hospitalized
In I.C.U.s
0
Source: U.S. Department of Health and Human Services. The seven-day average is the average of a day and the previous six days of data. Currently hospitalized is the most recent number of patients with Covid-19 reported by hospitals in the state for the four days prior. Dips and spikes could be due to inconsistent reporting by hospitals. Hospitalization numbers early in the pandemic are undercounts due to incomplete reporting by hospitals to the federal government.

Citing a sustained surge in cases in Maine, Gov. Janet Mills announced that all adult residents would be eligible for a booster shot because of their high risk of exposure across the state.

Currently, federal regulators say people who received two doses of the Pfizer-BioNTech or Moderna vaccines and are 65 or older, or adults who are considered to be at special risk because of their medical conditions, jobs or living environments are eligible for boosters. Anyone who received the single-dose Johnson & Johnson shot can already get a booster. Eligible people can select from any of three vaccine brands as a booster.

The Maine Center for Disease Control & Prevention has notified health care providers of the expanded eligibility for the booster shot, according to a news release from the governor’s office.

The authorities in New York City on Monday encouraged all adults to get the booster. Arkansas, California, Colorado and New Mexico have also moved to expand access.

A growing body of early global research has shown that the vaccines available in the United States have remained highly protective against the disease’s worst outcomes over time, even during the summer surge of the highly transmissible Delta variant. And there has been an ongoing debate among experts over whether extra shots are necessary for younger, healthy adults.

Ms. Mills justified broadening access to boosters by saying that since the entire state of Maine had seen significant spread of the virus, it qualified as the kind of high-risk environment for which federal regulators had cleared boosters.

“With Maine and other New England states confronting a sustained surge, and with cold weather sending people indoors, we want to simplify the federal government’s complicated eligibility guidelines and make getting a booster shot as straightforward and easy as possible,” the governor said in a statement.

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The U.S. aims to lift Covid vaccine manufacturing to create a billion doses a year.

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White House Plans to Bolster Vaccine Manufacturing

Jeffrey D. Zients, President Biden’s coronavirus response coordinator, said the administration would partner with companies to increase U.S. manufacturing capacity in order to expand global access and prepare for potential future pandemics.

From the start, President Biden has been clear that the only way to defeat Covid is to defeat the virus here at home and around the world. That’s why we’ve committed to donating 1.2 billion doses to the world. For every one shot we’ve administered here in the United States, we’re donating about three doses to people around the world. Today, we will hit a major milestone in our effort to deliver on this commitment: 250 million doses delivered to 110 countries. Today, we’re taking another major step to bolster vaccine manufacturing, both for this pandemic and to prepare for any future threats. H.H.S. is soliciting interest from companies that have experienced manufacturing mRNA vaccines to identify opportunities to scale up their production capacity. Importantly, initial production could provide more mRNA Covid vaccines for the world. The goal of this program is to expand existing capacity by an additional billion doses per year, with production starting by the second half of 2022. This program would also help us produce doses within six to nine months of identification of a future pathogen, and ensure enough vaccines for all Americans. It would combine the expertise of the U.S. government in basic scientific research with the robust ability of pharmaceutical companies to manufacture mRNA vaccines. We hope companies step up and act quickly to take us up on this opportunity to expand production of mRNA vaccines for the current pandemic, and set us up to react quickly to any future pandemic threats.

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Jeffrey D. Zients, President Biden’s coronavirus response coordinator, said the administration would partner with companies to increase U.S. manufacturing capacity in order to expand global access and prepare for potential future pandemics.CreditCredit...Stefani Reynolds for The New York Times

The White House, under pressure to increase the supply of coronavirus vaccines to poor nations, plans to invest billions of dollars to expand U.S. manufacturing capacity, with the goal of producing at least one billion doses a year beginning in the second half of 2022, two top advisers to President Biden said in an interview on Tuesday.

The investment is the first step in a new plan, announced on Wednesday, for the government to partner with industry to address immediate vaccine needs overseas and domestically and to prepare for future pandemics, said Dr. David Kessler, who oversees vaccine distribution for the administration, and Jeff Zients, Mr. Biden’s coronavirus response coordinator.

“This is about assuring expanded capacity against Covid variants and also preparing for the next pandemic,” Dr. Kessler said. “The goal, in the case of a future pandemic, a future virus, is to have vaccine capability within six to nine months of identification of that pandemic pathogen, and to have enough vaccines for all Americans.”

The move comes as the Biden administration also plans to buy enough of Pfizer’s new Covid-19 pill for about 10 million courses of treatment to be delivered in the next 10 months, paying over $5 billion, according to people familiar with the agreement. The government has also pledged $3 billion for rapid over-the-counter tests, which are needed to detect the virus early for the Pfizer drug to work.

Taken together, the investments amount to an aggressive effort to vanquish a pandemic that is heading into its third year. When given promptly to trial groups of high-risk unvaccinated people who developed symptoms of the disease, the Pfizer drug sharply reduced the risk of hospitalization and death. Pfizer applied on Tuesday for federal authorization of the drug on an emergency basis.

The antiviral drugs have helped inspire hope among senior administration officials that the United States will be able to curb the devastating toll from the virus. Their promise depends in part on access to testing, because the pills have proved to work in five days or less after symptoms develop.

But the tests are pricey. While federal regulators have cleared a dozen of them, a test typically costs about $12 and not everyone can easily obtain one. One of the newest rapid tests costs $7, though, and by the end of the year the overall supply is projected to be nearly 10 times what it was in August, federal officials said.

The idea for the new public-private vaccine partnership is still in its early stages, and the price tag is uncertain. Dr. Kessler, who has been working on the proposal for months, estimated it at “several billion.” The money has been set aside as part of the American Rescue Plan, the $1.9 trillion pandemic relief package that Mr. Biden signed into law in March.

The Biomedical Advanced Research and Development Agency intends to issue a “request for information” to solicit ideas from companies that have experience manufacturing vaccines using mRNA technology. Mr. Zients said that officials wanted responses “in a very short period of time, 30 days, to understand how most efficiently, effectively and reliably we can increase manufacturing.”

Activists, many of them veterans of the AIDS epidemic, have been demanding for months that Mr. Biden do more to scale up global vaccine manufacturing capacity. Some, furious with what they regard as the administration’s slow progress, turned up at the home of Ron Klain, Mr. Biden’s chief of staff, in September and deposited a fake mountain of bones on the sidewalk in protest.

At the same time, the administration is offering booster shots to millions of vaccinated Americans, despite criticism from World Health Organization officials and other experts who say the doses should go to low- and lower-middle-income countries first. The Food and Drug Administration is aiming to authorize booster doses of Pfizer-BioNTech’s Covid vaccine for all adults as early as Thursday, according to people familiar with the agency’s plans.

Whether the new Biden plan will satisfy the administration’s critics is unclear. Many activists have demanded that the administration build up manufacturing capacity overseas, particularly in Africa, but the Biden plan is focused on building capacity among domestic vaccine makers. “This effort is specifically aimed at building U.S. domestic capacity,” Dr. Kessler said. “But that capacity is important not only for the U.S. supply, but for global supply.”

James Krellenstein, a founder of Prep4All, an AIDS advocacy group, called the Biden plan “a step in the right direction,” but suggested the government build its own vaccine production facility, so as not to depend on the private sector, and hire a contract manufacturer to run it.

“It’s the only way you can leverage the unique skills of the private sector while protecting the taxpayer investment,” he said.

Ahead of Thanksgiving, the N.F.L. adds mask requirements and increases testing.

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Carson Wentz, an Indianapolis Colts quarterback, wearing a mask on the sidelines of a game last month.Credit...Marc Lebryk/USA Today Sports, via Reuters

The N.F.L. said Wednesday it is strengthening its Covid-19 protocols as the number of positive cases rises across the country and people make plans to gather for Thanksgiving.

Every person, regardless of their vaccination status, must wear a mask inside team facilities between Nov. 25 and Dec. 1, and all players, coaches and support staff must be tested for the coronavirus on Nov. 29 and Dec. 1, after the Thanksgiving weekend.

This season, unvaccinated players and staff in the league’s Tier 1 designation, the most essential personnel, must be tested every day. Those who are vaccinated must be tested at least once per week, and potentially more frequently if they are symptomatic or have a close contact with someone who tests positive.

This update to the protocols means unvaccinated players must wait for their test results before entering a team facility, while vaccinated players and staff can enter but must remain masked while they wait for results.

In a memo sent to all 32 teams on Tuesday night, the league also urged clubs to set up drive-through testing facilities for players, staff and any friends or family who may visit them for the holiday.

Dr. Allen Sills, the league’s chief medical officer, said the N.F.L. was tightening restrictions because in the previous two weeks the league saw its highest number of confirmed positive coronavirus tests this season. “That wasn’t a total surprise to us because our numbers mirror the number of cases in the country,” he said.

Between Oct. 31 and Nov. 13, there were 81 confirmed positive cases in the N.F.L., 34 players and 47 staff, the most in any two-week period this season. The players affected included high-profile starters like Pittsburgh Steelers quarterback Ben Roethlisberger, Los Angeles Chargers defensive end Joey Bosa, and Cleveland Browns running back Nick Chubb.

In the prior two-week period, there were 35 confirmed positive cases, including 11 players.

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The Netherlands is maxing out its coronavirus testing capacity.

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A drive-in screening center in Pijnacker, the Netherlands, on Wednesday. Appointments have become very hard to find.Credit...Ramon Van Flymen/EPA, via Shutterstock

Soaring demand for Covid testing in the Netherlands, combined with a shortage of workers to book them, is pushing the limits of the country’s health services, officials have said.

In a statement on Tuesday, the association of regional health services in the Netherlands called the increase in demand for new testing appointments “explosive,” adding that it was taking the approach of “all hands on deck.”

Officials said that they aimed to reach up to 120,000 tests a day, depending on workers’ availability. On Monday, at least 116,000 new appointments were scheduled and 91,000 people were tested — new daily records — according to Jaap Eikelboom, a Covid program director for the health service association.

“We are reaching the maximum of our capacity on all sides,” he said.

New reported cases by day
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Dec.
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7-day average
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Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

Virus cases have been rising in the Netherlands, with more than 110,000 people testing positive over the past week, an increase of almost 44 percent compared with the week before, according to official figures. Last week, the government announced a national partial lockdown for three weeks, including limited operating hours for restaurants, bars and shops.

It is also now largely impossible to book most Covid testing appointments online because of the high demand, the Dutch newspaper De Volkskrant reported, saying that there was only one place in the Netherlands — in the southern province of Zeeland — where people were able to do so.

Speaking at a news conference this month, Prime Minister Mark Rutte hailed the importance of testing to stop the spread of the virus, even for people who are vaccinated.

“Stay home if you have symptoms, and get tested,” he said.

Here’s a look at the U.S. virus picture heading into Thanksgiving.

Although coronavirus case levels remain far lower than at the peak of the summer surge, we’re seeing a rise in cases in the Northeast and parts of the Midwest.

U.S. Covid Cases are Increasing Again

Mitch Smith
Mitch SmithReporting on the coronavirus

U.S. Covid Cases are Increasing Again

Mitch Smith
Mitch SmithReporting on the coronavirus
Cinemagraph

As the holidays approach, Covid-19 cases are starting to rise again. Conditions are deteriorating in the Upper Midwest and parts of the West.

Here’s what to know →

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Disney Cruise Line will require all passengers ages 5 and older to be fully vaccinated.

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The Disney Dream, docked in Port Canaveral, Fla., last year.Credit...Joe Burbank/Orlando Sentinel, via Associated Press

Disney Cruise Line updated its immunization policy for guests on Wednesday, requiring all children over the age of 5 to be fully vaccinated against the coronavirus.

The vaccine mandate will go into effect on Jan. 13 and will apply to sailings both in the United States and abroad. Until then, unvaccinated guests between the ages of 5 and 11 must take a pre-departure coronavirus test. Currently, guests age 12 and up and all crew members on Disney ships must be fully vaccinated.

The new requirement comes after federal regulators recently cleared Pfizer-BioNTech’s pediatric vaccine for children ages 5 through 11 earlier.

Like Disney, most other major cruise lines have required passengers 12 and older to be fully vaccinated. While some companies like Carnival Cruise Line, Royal Caribbean Group and MSC Cruises have allowed unvaccinated children on board ships with testing requirements, some sailings have had to limit numbers on board because of policies that require at least 95 percent of passengers to be fully vaccinated.

Last week, the chief executive officer of Royal Caribbean, Richard Fain, said he expects an update on vaccine protocols for children soon, but no changes have been announced yet.

“I think we’re moving in the direction where every cruise will have 100 percent of the crew vaccinated and 95 or more percent of the guests,” he said at a media event on board Odyssey of the Seas, a cruise ship owned by Royal Caribbean.

Norwegian Cruise Line has one of the most stringent immunization policies, requiring all passengers and crew to be fully vaccinated — including eligible children — and recently announced that the rules would be extended “indefinitely” in the near future. It bars ineligible children from sailings.

To encourage family cruise vacations, Holland American Line recently announced a new offer allowing fully vaccinated children ages 5 to 17 to sail for free as third and fourth guests in the same stateroom.

“Now that kids ages 5 and older can receive the Covid-19 vaccine, getting out and seeing the world is on everyone’s mind,” said Gus Antorcha, president of Holland America Line.

Ireland adds new restrictions, including early pub closings.

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Last month in Dublin.Credit...Clodagh Kilcoyne/Reuters

Ireland’s bars and nightclubs will be required to close at midnight starting on Friday as part of measures that the government is imposing to curb the spread of the coronavirus as a surge of cases has left hospitals overwhelmed and officials scrambling for solutions.

The measures, which the country’s leader, Micheal Martin, announced on Tuesday night, also include a request that people work from home when possible and a requirement that they show a vaccine pass before entering theaters.

“The surge that we are now experiencing is a dramatic reminder of what this virus can do and the threat that it continues to represent,” Mr. Martin said. “We need to act now to deal with this surge.”

New reported cases by day
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Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

In the last week, Ireland has experienced its second highest rate of hospital admissions in 2021, Mr. Martin said, a situation that is putting hospitals nationwide under significant pressure.

But even as the measures were announced, Mr. Martin acknowledged that “continued progress in the journey to normal conditions is not inevitable.”

He said that he could not rule out further measures to curb the spread of the virus, but that the country’s successful vaccination program meant that a large-scale lockdown could be avoided at least for now.

Stephen Donnelly, the health minister, said that “stark new modeling” on the number of predicted cases was behind the rationale for the new measures.

Speaking to RTE Radio, the public broadcaster, he said on Tuesday that the models showed that without mitigation measures, Ireland’s intensive care units would see an influx of 200 to 450 patients by Christmas. The country has just over 300 permanent intensive-care beds.

“That would be something we have to avoid, so we are making some changes,” Mr. Donnelly said.

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An injured Olympic athlete was flown home on a cargo plane because of Covid rules in Beijing.

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Mateusz Sochowicz competing in Sochi, Russia, last year.Credit...Vasily Fedosenko/Reuters

A Polish luge athlete who was injured during a Winter Olympics training event near Beijing was flown out of China on a cargo plane this week after coronavirus restrictions prevented him from taking a commercial flight, according to the head of Poland’s luge association.

The incident speaks to the kinds of complications that could arise at next year’s Winter Games, which are scheduled to begin on Feb. 4 in accordance with strict health protocols. For training and other events in the prelude to the Games, athletes and team officials are not allowed to move about freely until they have spent 21 days inside a bubblelike training and competition zone.

The luger, Mateusz Sochowicz, 25, hit a barrier and fractured his leg on Nov. 8 while training on the track that will be used during the Winter Games. He was hospitalized near Beijing, and the International Luge Federation said that it and the local track operator were introducing additional safety measures for the Games after the accident.

New reported cases by day
Feb. 2020
Sept.
Apr. 2021
Nov.
Jun. 2022
Jan. 2023
20,000
40,000
60,000 cases
7-day average
0

These are days with a reporting anomaly.

Source: Data for China comes from the Center for Systems Science and Engineering at Johns Hopkins University. Population data from the National Bureau of Statistics of China. Data does not include Hong Kong, Macau or Taiwan. The daily average is calculated with data that was reported in the last seven days.

But when organizers tried to arrange for Mr. Sochowicz to travel back to Poland on a commercial flight, they were told that Covid regulations prevented him from doing so for another two weeks, according to Janusz Tatera, the head of Poland’s luge federation.

Instead, Mr. Sochowicz traveled on an Air China cargo plane from Beijing to Milan on Monday, before taking another flight to Warsaw, Mr. Tatera said in a telephone interview.

The cargo plane’s interior was just like that of a passenger jet, Mr. Tatera said, adding that Mr. Sochowicz had described his journey from Beijing as “very comfortable.”

Mr. Sochowicz remains optimistic, Mr. Tatera said, that he will compete in Beijing 2022 after recovering from the injury.

A standoff over vaccines has intensified between Oklahoma’s governor and the Pentagon.

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Members of the Oklahoma National Guard in Tulsa last year. The state’s newly appointed adjutant general for the National Guard announced on behalf of the governor that no guardsmen would be required to be vaccinated.Credit...Brendan Smialowski/Agence France-Presse — Getty Images

A standoff between the governor of Oklahoma and the Pentagon over a coronavirus vaccine mandate for troops has turned into a stormy test of federal power, as President Biden moves to require vaccinations for a broad swath of the American work force.

Last week, Oklahoma’s newly appointed adjutant general for the National Guard, Brig. Gen. Thomas H. Mancino, announced on behalf of the governor, Kevin Stitt, that guardsmen in the state would not be required to get the Covid-19 vaccine, defying a Pentagon directive issued in August that makes vaccinations mandatory for all troops, including the National Guard, by deadlines set by each service branch.

“The order I issued came directly from the governor. That is the lawful order to the men and women of the Oklahoma National Guard,” General Mancino said in an interview, adding that he had been vaccinated.

Pentagon officials said Wednesday that a failure to follow “valid medical readiness requirements” could “jeopardize” the status of troops.

The officials insist that Mr. Stitt has no legal standing to obviate the mandate, though experts on the obscure laws governing the Guard disagree. They note that unless federally deployed, National Guard members are under the jurisdiction of the governor of their state and therefore not subject to federal mandates. “Guard members can only serve one boss at a time,” said John Goheen, a spokesman for the National Guard Association of the United States.

New reported cases by day
Apr. 2020
Oct.
Apr. 2021
Oct.
Apr. 2022
Oct.
5,000
10,000 cases
7-day average
291
Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of the most recent seven days of data.

The Pentagon is not without redress. It could deny funding to state units or impede the promotions of Guard members who refuse to get vaccinated. Officials said Wednesday that Guard members who refused to be vaccinated also could face dismissal, just as with active duty troops.

“Oklahoma may be able to take this step as a legal matter, but there are definitely things the federal government can do in response that might make it a painful Pyrrhic victory,” said Eugene Fidell, an adjunct professor of law at the New York University Law School. “The governor and state adjutant general thus might find themselves commanding some very unhappy personnel.”

The Pentagon is bracing for other states to follow Oklahoma’s lead. So far none have, but many are believed to be closely watching the situation, which could become the subject of lawsuits. “This could be contagious,” Mr. Fidell said.

National Guard troops have been caught in the political cross hairs over the years, including in 2018, when several governors said they would withhold or recall their troops from the border with Mexico as the Trump administration separated adults who illegally crossed into the United States from their children. In 1986, several governors balked at sending Guard troops for maneuvers in Honduras ordered by President Ronald Reagan.

But these rare conflicts in the military have never centered on vaccine mandates, which have existed for decades. Many countries now require full vaccination for those crossing into their borders, and Defense Secretary Lloyd J. Austin III has insisted the vaccine against the coronavirus is vital for troop readiness. “In 2021, many things are political,” Mr. Goheen said

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FedEx, citing quarantine rules, will close its crew base in Hong Kong.

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FedEx said it would continue delivery services as usual in Hong Kong.Credit...Budrul Chukrut/SOPA Images, via Getty Images

FedEx said on Wednesday that it would close its Hong Kong crew base and relocate its pilots, citing an evolving global business environment and the strict pandemic requirements in the Asian financial hub.

FedEx said that it would continue delivery services as usual in Hong Kong, and did not specify where its crew would move. The South China Morning Post, citing a FedEx memo, reported that the routes would be flown by workers based in Oakland, Calif., where 180 Hong Kong-based pilots had relocated early this year.

Hong Kong has been successful at controlling the spread of the coronavirus, with just 213 deaths in a city of 7.5 million. But the tough restrictions on travel have grated on many and spurred criticism from some businesses that rely on the swift movement of goods and people.

New reported cases by day
Feb. 2020
Sept.
Apr. 2021
Nov.
Jun. 2022
Jan. 2023
20,000
40,000
60,000 cases
7-day average
0
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

This week Hong Kong ordered 130 Cathay Pacific cargo pilots to undergo three weeks of quarantine because they had stayed at a hotel near Frankfurt where three crew members who tested positive for the coronavirus had also resided.

Carrie Lam, Hong Kong’s chief executive, acknowledged on Tuesday that the quarantine orders put strains on freight companies and highlighted the city’s dependence on goods brought in from overseas and mainland China.

“If there are one or two more such incidents, our freight planes will have no pilots,” she said.

Also on Wednesday, Tara Joseph, the president of the American Chamber of Commerce in Hong Kong, said that she was stepping down, a decision that she partly attributed to the difficulties created by the city’s coronavirus control measures.

“I think the quarantine rules are a huge red line for many people, including myself,” said Ms. Joseph, who is currently in the United States. She said she planned to stay in her role until the chamber found a replacement.

Earlier this year, Alan Beebe and Ker Gibbs, the presidents of the American chambers of commerce in Beijing and Shanghai, said they were resigning from their roles.

Hong Kong’s quarantine rules have weighed on global companies with a presence in the city. The restrictions were making it hard to retain talent, Jamie Dimon, the chief executive of JPMorgan Chase, said this week during a short visit to the city. He was one of a small number of executives who have been granted a quarantine exemption.

A couple convicted of stealing Covid funds is on the run, the F.B.I. says.

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Richard Ayvazyan, who was convicted in a scheme to steal $20 million in Covid-19 relief funds, at the federal courthouse in Los Angeles in June.Credit...Gary Coronado/Los Angeles Times, via Getty Images

When the Covid-19 pandemic began last year, a Southern California man recruited his brother, his wife and many others to use the identities of older people, foreign exchange students who had left the country and dead relatives to apply for $20 million in federal relief funds, the authorities said.

The man, Richard Ayvazyan, 43, bought a $3.25 million mansion and filled it with gold coins, luxury watches and imported furniture using the stolen Covid-19 disaster-relief funds, federal prosecutors in California said.

In June, Mr. Ayvazyan; his wife, Marietta Terabelian, 37; and Artur Ayvazyan, Mr. Ayvazyan’s brother, were convicted of scheming to fraudulently obtain funding that was meant for people and businesses that had sustained economic losses as a result of the pandemic.

In August, as they awaited sentencing at their home in the San Fernando Valley, Mr. Ayvazyan and Ms. Terabelian removed their bracelet monitors and fled, according to the F.B.I. They left their children behind, according to federal prosecutors.

On Monday, they were both sentenced in absentia. Mr. Ayvazyan received 17 years in prison and his wife received six. Artur Ayvazyan, 41, was sentenced to five years.

During the hearing on Monday, Judge Stephen V. Wilson of the U.S. District Court for the Central District of California said he could not recall a fraud case done in such a “callous, intentional way without any regard for the law” and described Mr. Ayvazyan as “an endemic, coldhearted fraudster.”

Mr. Ayvazyan’s lawyer, Ashwin J. Ram, said that his client’s family believed the couple was kidnapped but that the authorities had made no serious effort to investigate the claim.

“There are dozens of people who potentially have exposure,” Mr. Ram said. “My fear was that someone wanted to silence my client.”

Mr. Ram said a one-sided picture of Mr. Ayvazyan was presented at sentencing.

“The entire point of sentencing is not whether a crime occurred,” he said. “The point of sentencing is what is just punishment in this case.”

Mr. Ayvazyan’s background as a churchgoer, a father and a prominent member of the Armenian community in Southern California who invested in small start-ups did not come up at the hearing.

“That story didn’t get told at sentencing because he wasn’t there,” the lawyer said. According to Mr. Ram, the couple has three children, ages 13, 15 and 16, who are living with their grandparents.

Prosecutors said in court filings that Mr. Ayvazyan left a typed letter for their children explaining they had to flee because he has brought “danger and fear” to their lives.

“We will be together again,” he wrote, according to a copy of the letter. “I will find a way, that’s a promise.”

Mr. Ayvazyan had a history of loan fraud, according to a sentencing memorandum filed by prosecutors.

He pleaded guilty to conspiring with Ms. Terabelian to fraudulently obtaining a line of credit and was charged with conspiring to use stolen identities to secure mortgage loans and green loans for environmentally friendly home projects, the memo stated.

Ms. Terabelian used to work at a children’s hair salon, according to the F.B.I.

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Marietta Terabelian, right, in Los Angeles in June. On Monday she was sentenced in absentia to six years in prison.Credit...Gary Coronado/Los Angeles Times, via Getty Images

Ryan Fraser, a lawyer for Ms. Terabelian, described her as a “loving mother and devoted wife who has tirelessly supported not only her three children, but also her parents, mother-in-law and sister­.”

Mr. Fraser noted that Judge Wilson sentenced Ms. Terabelian to “less than one-third the time” that prosecutors had sought. They asked for 21 years in prison.

Mr. Ayvazyan began stealing disaster-relief funds as soon as they became available in March 2020, according to the prosecutors’ memo.

In messages to his co-conspirators, he joked that the federal government would run out of money and told them to move quickly to get the funds.

“This program is over by end of the month so get as much as you can,” he wrote, according to the memo.

Mr. Ram said the court sentenced Mr. Ayvazyan on guidelines based on the theft of about $1.5 million from the government. He added that he did not believe that prosecutors proved that Mr. Ayvazyan himself stole anyone’s identity.

The government “was handing out money with no checks and a lot of people took advantage of that,” Mr. Ram said.

“It’s a honey trap,” he added. “Richard Ayvazyan fell into that trap.”

The F.B.I. said it was offering a $20,000 reward for anyone with information that could lead to the couple’s arrest.

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Egypt prepares to expand leaders’ powers in epidemics, adding prosecutions for disinformation.

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People waiting to receive a Covid-19 vaccine at the Sadat Metro Station in Cairo on Sunday.Credit...Mohamed Abd El Ghany/Reuters

Egypt is on the verge of passing a law that would allow people to be prosecuted if they publish something deemed to be fake news during an epidemic, an ostensible attempt to control disinformation in the coronavirus era. But critics fear the law could instead be used to repress those who challenge government policies during public health crises.

The legislation awaits ratification by President Abdel Fattah el-Sisi, a mere formality given that he has overwhelming support in the Parliament, which approved the bill on Tuesday. It grants the prime minister extraordinary powers to manage epidemics and pandemics, and it allows the prosecution of people who violate any regulation or mandate imposed by the government to manage such a crisis.

It would set prison sentences of up to one year and a fine of around $635 as punishment for “anyone who deliberately publishes or spreads false news or tendentious rumors related to the situation of an epidemic, with the purpose of disturbing public safety or spreading panic among people.” Only journalists would be exempt from prosecution under the bill.

New reported cases by day
Mar. 2020
Oct.
May 2021
Dec.
Jul. 2022
Feb. 2023
1,000
2,000 cases
7-day average
9
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

That would leave everyone else — including health care workers, researchers and millions of social media users — subject to imprisonment in what critics said would be a breach of the Constitution, which prohibits imprisonment for the act of publication.

Proponents of the bill said the pandemic had shown the need for a firm response to the spread of disinformation in critical times.

“Some women have refused vaccination because of a post on Facebook that warned that it is dangerous for women who are planning on getting pregnant within a year,” the lawmaker Ayman Abol Ela said in a televised interview. “That is an immediate threat to national security.”

But critics said the prison sentences would be primarily used to control the expression of dissent on social media in a country where security services keep a tight grip on traditional media and public spaces and where the authorities often see any opposition as a threat. Doctors, journalists and social media users have been prosecuted on charges of spreading false news after they criticized the government’s handling of the pandemic or questioned the stated number of infections on social media.

“The reality is that hundreds have been thrown behind bars for social media posts, and fake news did not stop,” said Khaled Elbalshy, an Egyptian journalist. “Rumors thrive in an environment where the truth is withheld. Fake news and rumors are fought with upholding freedom of information, not with prison.”

The movement of the legislation comes weeks after prosecutors launched a mysterious, high-profile investigation within the health ministry. Prosecutors announced last month that some health officials had been questioned over allegations that have yet to be detailed. The health minister, Hala Zayed, went on sick leave around the time of the announcement after reportedly having been hospitalized for a heart attack. Reports from local news media outlets saying that the inquiry involved corruption allegations were taken down.

Under the new legislation, the prime minister would also have the power to enforce lockdowns, impose vaccine mandates, ban demonstrations, suspend court sessions, close off places of worship and set limits on the prices of commodities and private health care services.

The bill would grant the country’s top officials many powers that had previously been available to them only under a state of emergency. Egypt lifted a four-year state of emergency last month but quickly passed laws transferring similar powers to the government and the military, raising doubts over the country’s seriousness about easing a ruthless crackdown on dissent that has put its human rights record under international scrutiny.

Egypt is facing a fourth wave of Covid that is adding to the 345,848 cases and 19,636 deaths that the government has reported since the start of the pandemic, though the actual figures are believed to be much higher.

Kenya will be first to benefit from a new U.S. effort to speed Africa’s Covid vaccinations, Blinken says.

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A Maasai woman ​​receiving a dose of the AstraZeneca coronavirus vaccine, in Kimana​, Kenya, in August.Credit...Brian Inganga/Associated Press

Kenya will be the pilot country for a new U.S. effort to accelerate Covid vaccinations in Africa, a program that enlists private company expertise to overcome “last mile” delivery delays, America’s top diplomat said Wednesday.

Secretary of State Antony J. Blinken announced the decision in Kenya, on the first full day of his three-day, three-country trip to East and West Africa.

While Mr. Blinken’s visit is aimed largely at efforts to solve crises threatening Ethiopia and Sudan, the Covid-19 pandemic’s ravaging of Africa, and what wealthy countries like the United States are doing about it, is a powerful sub-theme.

New reported cases by day
Apr. 2020
Oct.
Apr. 2021
Oct.
Apr. 2022
Oct.
1,000
2,000 cases
7-day average
3
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

Speaking in Nairobi, Mr. Blinken reiterated American support for Africa’s struggle to curb the spread of the coronavirus. The continent lags global vaccination efforts, with just 6 percent of its population vaccinated, according to the Africa Centers for Disease Control and Prevention.

In Kenya, only 3 percent of the eligible population is vaccinated.

During a joint news conference with his Kenyan counterpart, Raychelle Omamo, Mr. Blinken announced that Kenya would become the first country to benefit from the new White House initiative aimed at overcoming the logistical hurdles that hinder Covid-19 vaccine delivery around the world.

Under the initiative, called the Global Covid Corps, private sector companies work pro bono to help countries streamline their vaccine distribution, such as managing supply chains and storage of the doses. Mr. Blinken first announced the initiative last week, during a virtual meeting of foreign ministers.

“What we found is the so-called last-mile challenges, including delivery and logistical hurdles, can make it difficult to turn vaccines into vaccinations, in other words actually getting shots into arms,” Mr. Blinken said.

Global coronavirus cases by region

This chart shows how reported cases per capita have changed in different parts of the world.

  • Africa
  • Asia-Pacific
  • Europe
  • Latin America
  • Middle East
  • U.S. and Canada
Feb. 2020
Sept.
Apr. 2021
Nov.
Jun. 2022
Jan. 2023
100 cases
200 cases per 100,000
Sources: Center for Systems Science and Engineering at Johns Hopkins University and state and local health agencies (cases); World Bank and U.S. Census Bureau (population data).

Slow vaccination rates increase the risk of vaccine-resistant variants of the virus, experts say. Poor infrastructure to deliver doses of vaccines is a major challenge, further complicated by problems such as a shortage of syringes.

Mr. Blinken’s announcement was the latest in the White House’s vaccine diplomacy, in which the United States has tried to persuade other wealthy nations to balance domestic requirements with a global need. The Biden administration also has encouraged Moderna, one of the leading vaccine makers, to prioritize delivering 15 million doses to Africa ahead of its commitments to the United States.

These steps have followed criticism from activists around the world who accuse wealthy nations of hoarding vaccines, to the detriment of poorer nations. Many critics remain upset over what they call inadequate help for initiatives like Covax, the United Nations-backed vaccine program, and the African Union’s African Vaccine Acquisition Trust. Both are meant to deliver doses to countries that cannot afford to strike large-scale deals with vaccine manufacturers.

Emphasizing what the United States has done, Mr. Blinken pointed to the more than 50 million doses it donated to 43 African countries, as well as $1.9 billion in funding distributed to Africa for Covid-19 relief.

In a thinly veiled allusion to the Covid-19 vaccine aid offered by China, which has enormous economic interests in Africa, Mr. Blinken said the American generosity had been delivered “with no political strings attached.”

Mr. Blinken has previously criticized what he called the ties between China’s vaccine distribution and its geopolitical interests, a criticism that Chinese leaders have rejected.

Among the delegation accompanying Mr. Blinken is Gayle E. Smith, who was appointed as the State Department’s Global Covid Response and Health Security Coordinator. Ms. Smith, a former head of United States Agency for International Development and security aide to former President Barack Obama, was appointed in April.

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As India limits syringe exports, a supply crunch has buyers looking elsewhere.

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Workers checking syringes at Hindustan Syringes and Medical Devices, one of the world’s largest syringe makers.Credit...Rebecca Conway for The New York Times

NEW DELHI — Rajiv Nath’s factories were cranking out more than 7,600 syringes a minute when India decided to limit their export last month to shore up its own vaccination campaign.

The products were meant for clients around the world as nations scramble to inoculate their people and bring the pandemic to an end, but instead Mr. Nath’s warehouses were left with stocks of more than 45 million syringes that he had largely promised to UNICEF and the Pan American Health Organization.

And with India’s export restrictions on syringes in place through the end of this year, experts say the world could experience a shortfall of two billion to four billion needles through the end of next year. The shortages are expected to hit African countries the hardest.

“That will be truly disappointing,” said Prashant Yadav — a senior fellow at the Center for Global Development, a Washington research organization, and an expert on health care supply chains — “that after having waited for over a year to get a reasonable quantity of vaccines, when they do obtain the vaccines, they don’t have syringes to administer them.”

Although India is a small player in overall global exports, it is a major producer of the type of syringe that is being used globally for coronavirus vaccinations. The syringes break on second use to prevent the spreading of disease through reuse.

Covax, the vaccine-sharing initiative, is seeking the syringes from manufacturers around the world, and India was expected to meet at least 15 percent of the global demand for use with Covid vaccines and other inoculations.

The situation became so acute last month that the World Health Organization and PAHO asked India to allow Mr. Nath’s company, Hindustan Syringes and Medical Devices, one of the world’s largest syringe makers, to ship the orders it had agreed to before the restrictions were announced. Prime Minister Narendra Modi’s government subsequently increased the export quota for the health organizations but did not allow a blanket exemption.

The World Health Organization and UNICEF have warned that the syringe shortage could have “dire consequences” for the global vaccination effort.

In India, more than half of the 1.4 billion-strong population has received at least one shot of a Covid vaccine, but only 28 percent of people are fully vaccinated, according to a New York Times database. And new inoculations have slowed recently.

Unlike vaccine doses, syringes are bulky and are typically transported by sea. The shortage comes amid large disruptions in the global supply chain of shipped goods, and experts say that a Covax-like initiative is needed, with nations coming together to better supply syringes to poorer countries.

UNICEF, a major buyer of syringes for Covax, said in a statement on Wednesday that “syringe nationalism” could be addressed if big producers and wealthy countries “influence global markets in a way that unlocks access for other countries in the global south.”

The agency also said it was considering expanding use of another type of syringe approved by the W.H.O. that also prevents reuse.

Dozens of Indian syringe makers spent millions of dollars to scale up manufacturing last year, but buyers are increasingly relying on manufacturers in China.

ProcureNet, a Hong Kong-based supplier of pharmaceutical products, said this week that it would invest $20 million in Anhui Tiankang Medical, a Chinese manufacturer, to produce 750 million syringes for PAHO and other buyers.

“We continue to spend billions on the vaccine,” said Gurbaksh Chahal, ProcureNet’s chief executive, “but what good is the vaccine if we don’t have the tools to deliver the vaccine to the people?”

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