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    I.M.F. Board Backs $650 Billion Aid Plan to Help Poor Countries

    The expansion of emergency reserves to help fund vaccines and pay down debt is politically contentious in the United States.VENICE — The International Monetary Fund took a step on Friday toward easing widening global inequality and helping poor nations get access to vaccines, saying its executive board approved a plan to issue $650 billion worth of reserve funds that countries can use to buy vaccines, finance health care and pay down debt.The decision comes at a pivotal moment as Covid-19 infections continue to spread among populations that have not been inoculated and as more contagious variants of the coronavirus are posing new health threats. The pandemic has drained the fiscal resources of poor countries over the past year, and the I.M.F. projected this week that faster access to vaccinations for high-risk populations could save 500,000 lives in the next six months.The new allocation of so-called Special Drawing Rights would be the largest such expansion of currency reserves in the I.M.F.’s history. If approved by the group’s board of governors, as is expected, the reserves could become available by the end of next month.“This is a shot in the arm for the world,” Kristalina Georgieva, managing director of the I.M.F., said in a statement. “The S.D.R. allocation will help every I.M.F. member country — particularly vulnerable countries — and strengthen their response to the Covid-19 crisis.”Ms. Georgieva made the announcement as finance ministers and central bank governors of the Group of 20 nations were gathering in Venice to discuss international tax policy, climate change and the global economic response to the pandemic. The I.M.F., established in 1944 to try to broker economic cooperation, has warned of a two-track economic recovery, with poor countries being left behind while advanced economies experience rapid expansions.Ahead of the meetings, Treasury Department officials said expanding access to vaccines would be a central topic of discussion. It is also a potentially contentious one, as some developing countries have suggested that advanced economies are not doing enough to ensure fair distribution of vaccines.“The immediate priority for developing countries is widespread access to vaccines that match their deployment programs,” David Malpass, president of the World Bank, said in a speech in Venice on Friday.Mr. Malpass called on G20 countries to share doses and remove all trade barriers to exporting finished vaccines and their components. He noted that the pandemic had aggravated structural weaknesses that had dogged developing countries for years.“Even as that is accomplished,” Mr. Malpass said of expanded vaccine distribution, “development faces years of setback and struggle.”Narrowing the gap between the fortunes of advanced and developing economies was a central topic on the first day of the G20 meetings in Venice. Bruno Le Maire, France’s finance minister, told reporters on Friday that inequality was a risk to the stability and security of Europe that could lead to an influx of refugees. He argued that it must be urgently addressed.It remains to be seen how far the $650 billion will go to help developing countries as they race to vaccinate people before new variants of the virus take hold, including the Delta variant, which has plunged many countries back into a health crisis.The United Nations Conference on Trade and Development called this year for $1 trillion worth of Special Drawing Rights to be made available by the I.M.F. as a “helicopter money drop for those being left behind.”Jubilee USA Network, a nonprofit organization that advocates debt relief for poor countries, praised the move by the I.M.F. and called on wealthy countries to do more to help.“This is the biggest creation of emergency reserve funds that we’ve ever seen, and developing countries will immediately receive more than $200 billion,” said Eric LeCompte, executive director of Jubilee USA Network. “Wealthy countries who receive emergency reserves they don’t need should transfer those resources to developing countries struggling through the pandemic.”The I.M.F., the World Bank, the World Health Organization and the World Trade Organization have created a new vaccine task force and called for an additional $50 billion investment to broaden access to supplies. The groups have also called on G20 countries to set a goal of having 40 percent of their populations vaccinated by the end of this year and 60 percent by the middle of next year.The United States has thrown its support behind the expansion of the I.M.F. reserves, reversing a Trump administration policy and angering Republican lawmakers in the process.The Trump administration balked at the proposal last year and prevented it from moving forward. It argued at the time that boosting the emergency reserves was an inefficient way to provide aid to poor countries and that doing so would provide more resources to advanced economies that did not need the help, like China and Russia.Republican lawmakers have since accused the Biden administration of bolstering the fortunes of adversaries, while doing little to actually help developing nations. Although Republicans have introduced legislation that would put restrictions on how the I.M.F. reserves were used if they were authorized, such proposals are unlikely to pass with Democrats in control of Congress.Under Treasury Secretary Janet L. Yellen, the United States has taken a different view from the Trump administration, and the United States supports the allocation. Ms. Yellen believes that rich countries will have little use for the S.D.R.s but that developing economies will be able to use them to get enough money to vaccinate their people.Treasury Secretary Janet Yellen, center, arriving for the Group of 20 finance ministers and central bank governors meeting in Venice on Friday.Andrea Merola/EPA, via ShutterstockSpecial Drawing Rights work by allowing member countries of the I.M.F. to cash the asset in for hard currency. Their value is based on a basket of international currencies and is reset every five years.Each of the 190 countries that is a member of the I.M.F. gets an allotment of S.D.R.s based on its shares in the fund, which tracks with the size of a country’s economy. The new reserves would also be distributed under this formula, with the largest economic powers like the United States gaining the biggest tranche.The drawing rights cannot be used to buy things on their own, but they can be traded for currencies that can. If two countries agree, they can trade their Special Drawing Rights for cash, with the I.M.F. acting as a middleman to facilitate the trade.That has prompted some criticism that the program will not work unless rich countries voluntarily transfer their holdings to poorer nations.“It is a legitimate concern that new S.D.R.s will end up mostly in the hands of large and rich countries that have little use for them rather than in the hands of the smaller and poorer countries that really need them,” said Eswar Prasad, the International Monetary Fund’s former China chief. “A reallocation of S.D.R.s toward the latter group, in addition to increasing the overall volume of S.D.R.s, would be helpful in dealing with stresses to the global financial system.”To address some of those concerns, the I.M.F. is working to develop a new trust fund where rich countries can channel their excess S.D.R.s. The goal is to create a $100 billion pot of money that poor countries take loans from so they can expand health care systems or address climate change in conjunction with existing I.M.F. programs.The United States has previously indicated it will make available about one-fifth of its allocation, worth about $20 billion. At the urging of the United States, the I.M.F. is also working to create greater transparency around how the assets are being used so that it is clear that American adversaries are not benefiting from the proceeds.The I.M.F.’s board of governors is expected to hold its vote in early August. More

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    They Relied on Chinese Vaccines. Now They’re Battling Outbreaks.

    More than 90 countries are using Covid shots from China. Experts say recent infections in those places should serve as a cautionary tale in the global effort to fight the disease.Mongolia promised its people a “Covid-free summer.” Bahrain said there would be a “return to normal life.” The tiny island nation of the Seychelles aimed to jump-start its economy.All three put their faith, at least in part, in easily accessible Chinese-made vaccines, which would allow them to roll out ambitious inoculation programs when much of the world was going without.But instead of freedom from the coronavirus, all three countries are now battling a surge in infections.China kicked off its vaccine diplomacy campaign last year by pledging to provide a shot that would be safe and effective at preventing severe cases of Covid-19. Less certain at the time was how successful it and other vaccines would be at curbing transmission.Now, examples from several countries suggest that the Chinese vaccines may not be very effective at preventing the spread of the virus, particularly the new variants. The experiences of those countries lay bare a harsh reality facing a postpandemic world: The degree of recovery may depend on which vaccines governments give to their people.In the Seychelles, Chile, Bahrain and Mongolia, 50 to 68 percent of the populations have been fully inoculated, outpacing the United States, according to Our World in Data, a data tracking project. All four ranked among the top 10 countries with the worst Covid outbreaks as recently as last week, according to data from The New York Times. And all four are mostly using shots made by two Chinese vaccine makers, Sinopharm and Sinovac Biotech.“If the vaccines are sufficiently good, we should not see this pattern,” said Jin Dongyan, a virologist at the University of Hong Kong. “The Chinese have a responsibility to remedy this.” A vaccination on Chiloé Island, Chile. In Chile, the Seychelles, Bahrain and Mongolia, 50 to 68 percent of the populations have been fully vaccinated.Alvaro Vidal/Agence France-Presse — Getty ImagesScientists don’t know for certain why some countries with relatively high inoculation rates are suffering new outbreaks. Variants, social controls that are eased too quickly and careless behavior after only the first of a two-shot regimen are possibilities. But the breakthrough infections could have lasting consequences.In the United States, about 45 percent of the population is fully vaccinated, mostly with doses made by Pfizer-BioNTech and Moderna. Cases have dropped 94 percent over six months.Israel provided shots from Pfizer and has the second-highest vaccination rate in the world, after the Seychelles. The number of new daily confirmed Covid-19 cases per million in Israel is now around 4.95.In the Seychelles, which relied mostly on Sinopharm, that number is more than 716 cases per million.Disparities such as these could create a world in which three types of countries emerge from the pandemic — the wealthy nations that used their resources to secure Pfizer-BioNTech and Moderna shots, the poorer countries that are far away from immunizing a majority of citizens, and then those that are fully inoculated but only partly protected.China, as well as the more than 90 nations that have received the Chinese shots, may end up in the third group, contending with rolling lockdowns, testing and limits on day-to-day life for months or years to come. Economies could remain held back. And as more citizens question the efficacy of Chinese doses, persuading unvaccinated people to line up for shots may also become more difficult.One month after receiving his second dose of Sinopharm, Otgonjargal Baatar fell ill and tested positive for Covid-19. Mr. Otgonjargal, a 31-year-old miner, spent nine days in a hospital in Ulaanbaatar, the capital of Mongolia. He said he was now questioning the usefulness of the shot.“People were convinced that if we were vaccinated, the summer will be free of Covid,” he said. “Now it turns out that it’s not true.”Xi Jinping, China’s leader, pledged to deliver a Chinese vaccine that could be easily stored and transported to millions of people around the world. He called it a “global public good.”Andrea Verdelli/Getty ImagesBeijing saw its vaccine diplomacy as an opportunity to emerge from the pandemic as a more influential global power. China’s top leader, Xi Jinping, pledged to deliver a Chinese shot that could be easily stored and transported to millions of people around the world. He called it a “global public good.”Mongolia was a beneficiary, jumping at the chance to score millions of Sinopharm shots. The small country quickly rolled out an inoculation program and eased restrictions. It has now vaccinated 52 percent of its population. But on Sunday, it recorded 2,400 new infections, a quadrupling from a month before.In a statement, China’s Foreign Ministry said it did not see a link between the recent outbreaks and its vaccines. It cited the World Health Organization as saying that vaccination rates in certain countries had not reached sufficient levels to prevent outbreaks, and that countries needed to continue to maintain controls.“Relevant reports and data also show that many countries that use Chinese-made vaccines have expressed that they are safe and reliable, and have played a good role in their epidemic prevention efforts,” the ministry said. China has also emphasized that its vaccines target severe disease rather than transmission.No vaccine fully prevents transmission, and people can still fall ill after being inoculated, but the relatively low efficacy rates of Chinese shots have been identified as a possible cause of the recent outbreaks.The Pfizer-BioNTech and Moderna vaccines have efficacy rates of more than 90 percent. A variety of other vaccines — including AstraZeneca and Johnson & Johnson — have efficacy rates of around 70 percent. The Sinopharm vaccine developed with the Beijing Institute of Biological Products has an efficacy rate of 78.1 percent; the Sinovac vaccine has an efficacy rate of 51 percent.The Chinese companies have not released much clinical data to show how their vaccines work at preventing transmission. On Monday, Shao Yiming, an epidemiologist with the Chinese Center for Disease Control and Prevention, said China needed to fully vaccinate 80 to 85 percent of its population to achieve herd immunity, revising a previous official estimate of 70 percent.Data on breakthrough infections has not been made available, either, though a Sinovac study out of Chile showed that the vaccine was less effective than those from Pfizer-BioNTech and Moderna at preventing infection among vaccinated individuals.A representative from Sinopharm hung up the phone when reached for comment. Sinovac did not respond to a request for comment.William Schaffner, medical director of the National Foundation for Infectious Diseases at Vanderbilt University, said the efficacy rates of Chinese shots could be low enough “to sustain some transmission, as well as create illness of a substantial amount in the highly vaccinated population, even though it keeps people largely out of the hospital.”Mongolia now ranks among the top countries that have fully vaccinated its population, inoculating about 52 percent of its people. But on Sunday, it recorded 2,400 new infections, quadrupling from a month before.Khasar Sandag for The New York TimesDespite the spike in cases, officials in both the Seychelles and Mongolia have defended Sinopharm, saying it is effective in preventing severe cases of the disease.Batbayar Ochirbat, head researcher of the Scientific Advisory Group for Emergencies at Mongolia’s Ministry of Health, said Mongolia had made the right decision to go with the Chinese-made shot, in part because it had helped keep the mortality rate low in the country. Data from Mongolia showed that the Sinopharm vaccine was actually more protective than the doses developed by AstraZeneca and Sputnik, a Russian vaccine, according to the Health Ministry.The reason for the surge in Mongolia, Mr. Batbayar said, is that the country reopened too quickly, and many people believed they were protected after only one dose.“I think you could say Mongolians celebrated too early,” he said. “My advice is the celebrations should start after the full vaccinations, so this is the lesson learned. There was too much confidence.”Some health officials and scientists are less confident.Nikolai Petrovsky, a professor at the College of Medicine and Public Health at Flinders University in Australia, said that with all of the evidence, it would be reasonable to assume the Sinopharm vaccine had minimal effect on curbing transmission. A major risk with the Chinese inoculation is that vaccinated people may have few or no symptoms and still spread the virus to others, he said.“I think that this complexity has been lost on most decision makers around the world.”In Indonesia, where a new variant is spreading, more than 350 doctors and health care workers recently came down with Covid-19 despite being fully vaccinated with Sinovac, according to the risk mitigation team of the Indonesian Medical Association. Across the country, 61 doctors died between February and June 7. Ten of them had taken the Chinese-made vaccine, the association said.The numbers were enough to make Kenneth Mak, Singapore’s director of medical services, question the use of Sinovac. “It’s not a problem associated with Pfizer,” Mr. Mak said at a news conference on Friday. “This is actually a problem associated with the Sinovac vaccine.”Bahrain and the United Arab Emirates were the first two countries to approve the Sinopharm shot, even before late-stage clinical trial data was released. Since then, there have been extensive reports of vaccinated people falling ill in both countries. In a statement, the Bahraini government’s media office said the kingdom’s vaccine rollout had been “efficient and successful to date.”Still, last month officials from Bahrain and the United Arab Emirates announced that they would offer a third booster shot. The choices: Pfizer or more Sinopharm.Reporting was contributed by Khaliun Bayartsogt, More

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    For Many Workers, Change in Mask Policy Is a Nightmare

    After a shift by the C.D.C., employers withdrew mask policies that workers felt were protecting them from unvaccinated customers.The Kroger supermarket in Yorktown, Va., is in a county where mask wearing can be casual at best. Yet for months, the store urged patrons to cover their noses and mouths, and almost everyone complied. More

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    United Airlines will start a ticket lottery for vaccinated loyalty program members.

    United Airlines is encouraging people to get vaccinated by offering them the chance to win free flights.The airline said on Monday that loyalty program members who upload their vaccination records to United’s mobile app or website through June 22 are eligible to win a round-trip flight for two “in any class of service, to anywhere in the world United flies.”The carrier will give away 30 pairs of tickets in June. On July 1, United will give five people a grand prize of travel for a year for themselves and a companion. The Centers for Disease Control and Prevention in April said that Americans who were fully vaccinated against the coronavirus could travel at low risk to themselves.The sweepstakes comes as the Biden administration pushes for 70 percent of adults in the United States to receive at least one dose of the coronavirus vaccine by July 4. Some states and businesses have created incentives of their own: Ohio will give five people $1 million each in return for having been vaccinated as part of a weekly lottery program, and Krispy Kreme is offering one free glazed doughnut every day if those take their vaccination card to any location in the United States. More

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    Seychelles Sees Rise in Coronavirus Cases Despite Vaccinations

    Seychelles has seen a surge in coronavirus cases despite much of its population being inoculated with China’s Sinopharm vaccine.Marie Neige, a call center operator in Seychelles, was eager to be vaccinated. Like the majority of the residents in the tiny island nation, she was offered China’s Sinopharm vaccine in March, and was looking forward to the idea of being fully protected in a few weeks.On Sunday, she tested positive for Covid-19.“I was shocked,” said Ms. Neige, 30, who is isolating at home. She said she has lost her sense of smell and taste and has a slightly sore throat. “The vaccine was supposed to protect us — not from the virus, but the symptoms,” she said. “I was taking precaution after precaution.”China expected its Sinopharm vaccines to be the linchpin of the country’s vaccine diplomacy program — an easily transported dose that would protect not just Chinese citizens but also much of the developing world. In a bid to win good will, China has donated 13.3 million Sinopharm doses to other countries, according to Bridge Beijing, a consultancy that tracks China’s impact on global health.Instead, the company, which has made two varieties of Covid-19 vaccines, is facing mounting questions about the inoculations. First, there was the lack of transparency with its late-stage trial data. Now, Seychelles, the world’s most vaccinated nation, has had a surge in cases despite much of its population being inoculated with Sinopharm.For the 56 countries counting on the Sinopharm shot to help them halt the pandemic, the news is a setback.Seychelles has relied heavily on Sinopharm to inoculate more than 60 percent of its population.Rassin Vannier/Agence France-Presse — Getty ImagesFor months, public health experts had focused on trying to close the access gap between rich and poorer nations. Now, scientists are warning that developing nations that choose to use the Chinese vaccines, with their relatively weaker efficacy rates, could end up lagging behind countries that choose vaccines made by Pfizer-BioNTech and Moderna. That gap could allow the pandemic to continue in countries that have fewer resources to fight it.“You really need to use high-efficacy vaccines to get that economic benefit because otherwise they’re going to be living with the disease long-term,” said Raina MacIntyre, who heads the biosecurity program at the Kirby Institute of the University of New South Wales in Sydney, Australia. “The choice of vaccine matters.”Nowhere have the consequences been clearer than in Seychelles, which relied heavily on a Sinopharm vaccine to inoculate more than 60 percent of its population. The tiny island nation in the Indian Ocean, northeast of Madagascar and with a population of just over 100,000, is battling a surge of the virus and has had to reimpose a lockdown.Among the vaccinated population that has had two doses, 57 percent were given Sinopharm, while 43 percent were given AstraZeneca. Thirty-seven percent of new active cases are people who are fully vaccinated, according to the health ministry, which did not say how many people among them had the Sinopharm shot.“On the surface of it, that’s an alarming finding,” said Dr. Kim Mulholland, a pediatrician at the Murdoch Children’s Research Institute in Melbourne, Australia, who has been involved in the oversight of many vaccine trials, including those for a Covid-19 vaccine.Dr. Mulholland said the initial reports from Seychelles correlate to a 50 percent efficacy rate for the vaccine, instead of the 78.1 percent rate that the company has touted. Sinopharm vaccines being unloaded in Budapest in February. China has donated 13.3 million Sinopharm doses to other countries.Kkm, via Reuters“We would expect in a country where the great majority of the adult population has been vaccinated with an effective vaccine to see the disease melt away,” he said.Scientists say breakthrough infections are normal because no vaccine is 100 percent effective. But the experience in Seychelles stands in stark contrast to Israel, which has the second-highest vaccination coverage in the world and has managed to beat back the virus. A study has shown that the Pfizer vaccine that Israel used is 94 percent effective at preventing transmission. On Wednesday, the number of daily new confirmed Covid-19 cases per million people in Seychelles stood at 2,613.38, compared to 5.55 in Israel, according to The World In Data project.Wavel Ramkalawan, the president of Seychelles, defended the country’s vaccination program, saying that the Sinopharm and AstraZeneca vaccines have “served our population very well.” He pointed out that the Sinopharm vaccine was given to people age 18 to 60, and in this age group over all, 80 percent of the patients who needed to be hospitalized were not vaccinated.“People may be infected, but they are not sick. Only a small number are,” he told the Seychelles News Agency. “So what is happening is normal.”Sylvestre Radegonde, the minister for foreign affairs and tourism, said the surge in cases in Seychelles happened in part because people had let their guard down, according to the Seychelles News Agency. Sinopharm did not respond to a request for comment.A wedding in Kiryat Gat, Israel, in March. Israel, which has the second-highest vaccination coverage in the world, has kept its number of cases down after using the Pfizer vaccine.Dan Balilty for The New York TimesIn a response to an article from The Wall Street Journal on Seychelles, a spokeswoman for China’s foreign ministry blamed Western media for trying to discredit Chinese vaccines and “harboring the mentality that ‘everything involving China has to be smeared.’”In a news conference, Kate O’Brien, director of immunizations at the World Health Organization, said the agency is evaluating the surge of infections in Seychelles and called the situation “complicated.” Last week, the global health group approved the Sinopharm vaccine for emergency use, raising hopes of an end to a global supply crunch.She said that “some of the cases that are being reported are occurring either soon after a single dose or soon after a second dose or between the first and second doses.”According to Ms. O’Brien, the W.H.O. is looking into the strains that are currently circulating in the country, when the cases occurred relative to when somebody received doses and the severity of each case. “Only by doing that kind of evaluation can we make an assessment of whether or not these are vaccine failures,” she said.But some scientists say it is increasingly clear that the Sinopharm vaccine does not offer a clear path toward herd immunity, particularly when considering the multiple variants appearing around the world.Governments using the Sinopharm vaccine “have to assume a significant failure rate and have to plan accordingly,” said John Moore, a vaccine expert at Cornell University. “You have to alert the public that you will still have a decent chance of getting infected.”Wavel Ramkalawan, the president of Seychelles, right, filling out paperwork before receiving his first dose of Sinopharm vaccine in January. He has defended the country’s vaccination program.Rassin Vannier/Agence France-Presse — Getty ImagesMany in Seychelles say the government has not been forthcoming.“My question is: Why did they push everyone to take it?” said Diana Lucas, a 27-year-old waitress who tested positive for Covid-19 on May 10. She said she received her second dose of the Sinopharm vaccine on Feb. 10.Emmanuelle Hoareau, 22, a government lawyer, tested positive for Covid-19 on May 6 after getting the second dose of the Sinopharm vaccine in March. “It doesn’t make sense,” she said. She said the government had failed to give the public enough information about the vaccines.“They are not explaining to the people about the real situation,” she said. “It’s a big deal — a lot of people are getting infected.”Ms. Hoareau’s mother, Jacqueline Pillay, is a nurse in a private clinic in Victoria, the capital. She said she believes there is a new variant in Seychelles because of an influx of foreigners who have arrived in recent months. The tourism-dependent country opened its borders on March 25 to most travelers without any quarantine.“People are very scared now,” said Ms. Pillay, 58. “When you give people the right information, then people would not speculate.”Health officials have recently appeared on television to encourage those who have only taken the first dose of the Sinopharm vaccine to return for the second shot. But Ms. Pillay said she is frustrated that the public health commissioner has not addressed why the vaccines don’t appear to be working as well as they should.“I think a lot of people aren’t coming back,” said Ms. Pillay.Marietta Labrosse, More

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    China's Sinopharm Vaccine Approved for Emergency Use By W.H.O.

    The World Health Organization has approved a Chinese vaccine for emergency use. The announcement comes at a time when officials in the country are warning of a domestic shortage.Developing countries racing for coronavirus vaccines now have another dependable option — and China’s reputation as a rising scientific superpower just got a big boost.The World Health Organization on Friday declared a vaccine made by a Chinese company, Sinopharm, as a safe and reliable way to fight the virus. The declaration marks a significant step toward clearing up doubts about the vaccine, after little late-phase clinical trial data was disclosed by the Chinese government and the company.The W.H.O. emergency use approval allows the Sinopharm vaccine to be included in Covax, a global initiative to provide free vaccines to poor countries. The possible inclusion in Covax raises hopes that more people — especially those in developing nations — will get access to shots at a crucial moment.Rich countries are hoarding doses of vaccines. India, a major vaccine maker, has stopped exports to address its worsening coronavirus crisis. Safety concerns led health authorities in some countries to temporarily pause the use of vaccines made by AstraZeneca and Johnson & Johnson.“The addition of this vaccine has the potential to rapidly accelerate Covid-19 vaccine access for countries seeking to protect health workers and populations at risk,” Dr. Mariângela Simão, W.H.O. assistant director general for access to health products, said in a statement.Reliable vaccine access could improve even further next week when the W.H.O. considers another Chinese shot, made by a company called Sinovac. But the fanfare may be short-lived. While China has claimed it can make up to five billion doses by the end of this year, Chinese officials say the country is struggling to manufacture enough doses for its own population and are cautioning a pandemic-weary world to keep expectations in check.“This should be the golden time for China to practice its vaccine diplomacy. The problem is, at the same time, China itself is facing a shortage,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. “So in terms of global access to vaccines, I don’t expect the situation to significantly improve in the coming two to three months.”A Sinopharm shipment headed to Cameroon. The W.H.O. approval allows the Sinopharm vaccine to be included in Covax, the global initiative to provide vaccines to poor countries. Christophe Petit Tesson/EPA, via ShutterstockChina’s vaccination campaign got off to a slow start, in part because the government prioritized exports and residents did not feel rushed to get vaccinated. The country is now speeding up its national vaccination campaign and aims to inoculate 40 percent of its 1.4 billion people by the end of June.Sinopharm and Sinovac are producing about 12 million doses a day, just a little over the 10 million doses that China hopes to administer daily to meet the domestic target. The companies would have to produce roughly 500 million additional doses to meet the demands of other countries, according to a calculation of data provided by Bridge Consulting, a Beijing-based consultancy focused on China’s impact on global health.The vaccine shortage in China underscores the complexity of rolling out a mass vaccination campaign for the world’s most populous nation while also trying to execute an ambitious export program. Companies involved in the vaccine supply chain, such as those making syringes, are working overtime.“The whole world is short of this vaccine,” said a Sinovac spokesman, Pearson Liu. “The demand is just too great.”To mitigate the shortfall, Chinese officials said those getting vaccinated in China could delay getting their second shot by as long as eight weeks, or they could combine the same type of vaccine from different companies. They have said the shortage should ease by June.Andrea Taylor, who analyzes global data on vaccines at the Duke Global Health Institute, called the potential addition of two Chinese vaccines into the Covax program a “game changer.”“The situation right now is just so desperate for low and lower middle income countries that any doses we can get out are worth mobilizing,” Ms. Taylor said. “Having potentially two options coming from China could really change the landscape of what’s possible over the next few months.”China’s vaccines have been rolled out to more than 80 countries, but they have faced significant skepticism, in part because the companies have not released Phase 3 clinical trial data for scientists to independently assess the vaccines’ efficacy rates. An advisory group to the W.H.O. published the data this week.The Sinopharm vaccine developed with the Beijing Institute of Biological Products has an efficacy rate of 78.1 percent, according to the W.H.O. advisory group. The Sinovac vaccine has varying efficacy rates of between 50 percent to 84 percent, depending on the country where Phase 3 trials were conducted. Both vaccines were made using a tried-and-tested technology that involves weakening or killing a virus with chemicals.The advisory group’s data showed that it had a “high level of confidence” that the Sinopharm vaccine worked in preventing Covid-19 in adults, but a “low level” of confidence for people over 60. The group’s findings were similar for the Sinovac vaccine.The W.H.O. said that because Sinopharm enrolled few adults above 60 years old in its trials, the health agency could not estimate the vaccine efficacy for this group. But the W.H.O. said it would not restrict the use of the vaccine in that age group because preliminary data suggests “the vaccine is likely to have a protective effect in older persons.”There is limited data on how well the vaccine will work against the many coronavirus variants cropping up around the world. Chinese vaccines are overall less effective than the inoculations produced by Pfizer-BioNTech and Moderna.But for China’s leaders, the W.H.O. approval can still be seen as a badge of honor. Xi Jinping, China’s top leader, has pledged to make a Covid-19 vaccine a “global public good.”After India announced export restrictions on vaccines last month, Indonesia and the Philippines said they would turn to China for help. Last week, China’s foreign minister offered to help South Asian nations get access to vaccines.Indonesia said it would get additional doses from Sinovac after President Joko Widodo held talks with Mr. Xi. In a speech the same week, President Rodrigo Duterte of the Philippines said he owed “a debt of gratitude” to China for its vaccines.It remains to be seen whether the W.H.O. approval will change Beijing’s approach to doling out vaccines. China has given only 10 million doses to Covax, though it has independently donated 16.5 million doses and sold 691 million doses to 84 countries, according to Bridge Consulting. Many of the donations were made to developing nations in Africa and Asia.“They don’t like to subsume their generosity in their products under some U.N. brand,” said J. Stephen Morrison, director of the global health policy center at the Center for Strategic and International Studies. “They are in a historic phase,” he said. “They want the recipients to know that this is China delivering.”Jason Gutierrez More

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    Health Advocate or Big Brother? Companies Weigh Requiring Vaccines.

    It is a delicate decision balancing employee health and personal privacy. Some companies are sidestepping the issue by offering incentives to those who get shots.As American companies prepare to bring large numbers of workers back to the office in the coming months, executives are facing one of their most delicate pandemic-related decisions: Should they require employees to be vaccinated?Take the case of United Airlines. In January, the chief executive, Scott Kirby, indicated at a company town hall that he wanted to require all of his roughly 96,000 employees to get coronavirus vaccines once they became widely available.“I think it’s the right thing to do,” Mr. Kirby said, before urging other corporations to follow suit. It has been four months. No major airlines have made a similar pledge — and United Airlines is waffling.“It’s still something we are considering, but no final decisions have been made,” a spokeswoman, Leslie Scott, said.For the country’s largest companies, mandatory vaccinations would protect service workers and lower the anxiety for returning office employees. That includes those who have been vaccinated but may be reluctant to return without knowing whether their colleagues have as well. And there is a public service element: The goal of herd immunity has slipped as the pace of vaccinations has slowed.But making vaccinations mandatory could risk a backlash, and perhaps even litigation, from those who view it as an invasion of privacy and a Big Brother-like move to control the lives of employees.A United Airlines vaccine clinic at O’Hare Airport in Chicago. Employers are using on-site vaccinations to encourage workers to get shots.Scott Olson/Getty ImagesIn polls, executives show a willingness to require vaccinations. In a survey of 1,339 employers conducted by Arizona State University’s College of Health Solutions and funded by the Rockefeller Foundation, 44 percent of U.S. respondents said they planned to mandate vaccinations for their companies. In a separate poll of 446 employers conducted by Willis Towers Watson, a risk-management firm, 23 percent of respondents said they were “planning or considering requiring employees to get vaccinated for them to return to the worksite.”That discrepancy, said Mara Aspinall, who led the Arizona State poll, may have to do with the timing of the surveys and the pace at which executives are growing comfortable with the vaccines. Arizona State conducted its survey in March, while Willis Towers led its survey between Feb. 23 and March 12.Despite what surveys have found, few executives have taken the step of mandating vaccines. It seems that most are hoping that encouragement, whether forceful or subtle, will be enough.“While legally in the United States, employers can mandate vaccines while providing accommodations for religious and for health reasons, socially, in terms of the social acceptability of these decisions, it’s much more tenuous,” said Laura Boudreau, a professor of public policy at Columbia University. “And so the reputational risks to these companies of getting this wrong are really high.”Douglas Brayley, an employment lawyer at the global law firm Ropes & Gray, warns clients of the implications of following through on a mandate, he said.“What if 10 percent of your work force refuses? Are you prepared to lay off that 10 percent?” he said he asked clients. “Or what if it’s someone high-level or in a key role, would you be prepared to impose consequences? And then they sometimes get more nervous.”He added, “Anytime you would have them putting out a mandate, but then carrying through the consequences unevenly, that would create a risk of potentially unlawful unfair treatment.”Companies that require vaccines may also be concerned about any side effects or medical issues that an employee might claim were caused by the vaccine.“They could be held liable for any sort of adverse effects that might happen a year or two down the road,” said Karl Minges, chair of health administration and policy at the University of New Haven.Some companies are sidestepping the problem and trying incentives instead. Amtrak is paying employees two hours’ worth of regular wages per shot upon proof of vaccination. Darden, which owns Olive Garden and other restaurants, told employees it would offer hourly employees two hours of pay for each dose they receive, while emphasizing it would not make doses mandatory. Target is offering a $5 coupon to all customers and employees who receive their vaccination at a CVS at Target location.For restaurants, making vaccinations mandatory could make hiring workers even more difficult.Philip Cheung for The New York TimesIn the United States, there’s nothing new about vaccines being required for participation in public life. The Supreme Court ruled about a century ago that states could require vaccinations for children attending public school. And universities like Rutgers have instituted mandatory Covid-19 vaccinations.But the pandemic brings up a host of complications that companies typically prefer to avoid, involving the private lives, religious preferences and medical histories of employees, such as whether an employee is pregnant, breastfeeding or immuno-compromised, information they may not want to reveal.Major union groups, like the A.F.L.-C.I.O., have not aggressively pushed the issue either. They are facing dueling forces — standing up for individual worker’s rights on the one hand and protecting one another on the other. Unions have also been arguing for stronger workplace safety measures, efforts that could be complicated by companies’ arguing that mandatory vaccinations reduce the need for such accommodations. The return to work protocols negotiated between the Alliance of Motion Picture & Television Producers and Hollywood’s unions, for instance, will not include mandatory vaccinations.“There are going to be some people who may have legitimate reasons for not getting the vaccine or for not wanting to talk about it,” said Carrie Altieri, who works in communications for IBM’s People and Culture business. “It’s not an easy issue at this point.” IBM is working with New York State on a digital passport linking a person’s vaccination records to an app to show businesses, like performance venues, that may require vaccination. It is not, though, requiring vaccinations for its employees.For some businesses like restaurants, which are already struggling to hire workers, mandating vaccinations could make hiring even more difficult. And there are questions of logistics and execution. How can companies confirm the veracity of those who say they’ve been vaccinated?Companies may need to hire additional staff, potentially with medical training, to handle such tasks, which could saddle businesses — particularly small ones — with burdensome costs.Vivint, a home security company based in Utah with 10,000 employees, began offering vaccines in its on-site clinic this week, after the state approved the company to distribute 100 shots a week to its staff. It paid $3,000 for the necessary medical-grade freezer.“We’re not requiring employees to get vaccinated, but we’re highly encouraging it,” said Starr Fowler, senior vice president for human resources. “For a lot of our employees, particularly those that are younger, the easier that we make it for them, the more likely they’re going to do it.”At Salesforce Tower park in San Francisco, up to 100 fully vaccinated employees can volunteer to work on designated floors.Jason Henry for The New York TimesOthers are experimenting with splitting up their work forces. Salesforce is introducing a policy in certain U.S. offices, including Salesforce Tower in San Francisco, where up to 100 fully vaccinated employees can volunteer to work on designated floors. The New York Stock Exchange issued a memo to trading firms saying they would be allowed to increase their staff on the floor, provided all the employees have been vaccinated.The Equal Employment Opportunity Commission issued guidance in December stating that employers were indeed legally permitted to require employees to be vaccinated before they return to offices. But the threat of litigation still looms.“To be concerned about the possibility of litigation seems to me to be a perfectly legitimate concern,” said Eric Feldman, a law professor at the University of Pennsylvania. He added, “It would seem to me that employers are going to find themselves in a fairly strong position legally — but that doesn’t mean they’re not going to get sued.”Legislation that would limit the ability to require vaccines for students, employees or the public in general has been proposed in at least 25 states, according to the National Conference of State Legislatures. Some of those restrictions pertain only to vaccines that, like those for Covid-19, have yet to be granted full approval by the Food and Drug Administration. (The coronavirus vaccines have been granted conditional approval for emergency use.)Pfizer is expected to file for full approval of its Covid-19 vaccine soon. Others are expected to follow.Speaking at a Wall Street Journal conference this week, Jamie Dimon, the chief executive of JPMorgan Chase, mentioned “legal issues about requiring vaccines” when asked about bringing workers back to the office. A press officer for the bank, which plans to open its offices on May 17 on a voluntary basis, said it strongly encouraged vaccines for employees — barring any religious or health restrictions — but would not require them. A spokeswoman for Goldman Sachs, which has not guided employees either way, declined to comment.One potential path for companies seeking a middle ground is to mandate the shots only for new hires. Still, there is a fine line between encouraging and requiring shots — sometimes resulting in conflicting messages to employees.The investment bank Jefferies sent a memo to employees in early February stating “verification of vaccination will be required to access the office.” On Feb. 24 came a follow-up memo. “We did not intend to make it sound as if we are mandating vaccines,” it said.Reporting was contributed by More

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    The Dream: International Travel. The Reality: Chaos and Confusion.

    The world beckons, especially for those who have been vaccinated, but would-be travelers face a difficult moment when travel possibilities are at odds with the facts of a still reeling world.In recent days, a steady stream of promising news has painted a rosy picture of the return of international leisure travel.More than 105 million people in the United States are fully vaccinated. Greece, Iceland and Croatia, among a growing list of countries, are now open to American tourists. Airlines are resuming overseas flights. And perhaps the biggest development of all: Come summer, fully vaccinated Americans will once again be welcome across Europe.But the optimism may be premature. At the moment, the broader reality is more chaotic, and more sobering.A set of swirling crosscurrents — including a surge in global coronavirus cases, lagging vaccine rollouts in tourist hot spots and the lack of a reliable system to verify vaccinations — may be setting the stage for a slow and tortured return to high-volume international travel, despite ambitious pronouncements and the pressures of a tourism industry hoping to avoid another period of economic strain.Reopening areas to vaccinated tourists is a calculated risk, said Dr. Sarah Fortune, the chair of the Department of Immunology and Infectious Diseases at the Harvard T.H. Chan School of Public Health. “My doomsday scenario,” she said, “is a mixing of vaccinated and unvaccinated populations in a setting where there is high viral load and high viral transmission.”At the same time, countries dependent on tourism revenue are pressing to admit more visitors. Most Caribbean countries are open to Americans, pending negative coronavirus tests — and some European countries are not far behind. Travel restrictions in Greece, where tourism accounts for around 25 percent of the country’s work force, were eased in mid-April, allowing for fully vaccinated travelers from the United States, Britain, Israel and European Union member states, among other places, to visit without quarantining or providing negative coronavirus tests. (A broader reopening is planned for later this month.)For now, it’s hard to know whether the travel industry is in the throes of a temporary transition or staring at the long-term complexities of a clash involving wishful thinking, the hard truths of a relentless pandemic and the possibility of responsible tourism.Whatever the case, there’s a churning array of forces affecting the prospects for overseas travel.Checkpoint Charlie in Berlin, which is normally crowded with tourists, was empty during a coronavirus lockdown in November. Germany is now in another lockdown. Lena Mucha for The New York TimesA dire global realityWould-be international travelers, particularly vaccinated Americans, are entering an increasingly chaotic moment when dreams of travel — fueled by more than a year of confinement — are at odds with the facts of a largely shuttered and still reeling outside world.Globally, more new coronavirus cases were reported in recent weeks than at any point since the onset of the pandemic. The numbers are being driven by an uncontrolled outbreak in India, but they also account for troubling trends among European destinations popular with Americans, from France and Germany to Italy and Spain, some of which are now undergoing extended lockdowns and curfews.In Germany, for example, a new round of lockdowns, aimed at combating a third wave of infections, is expected to last until June.Such developments might be hard for Americans to fully appreciate from afar, given the promising trends at home. But government agencies have taken note.In April, the U.S. State Department vastly expanded the list of countries in its “Level 4: Do Not Travel” category, adding, among dozens of destinations, Mexico, Canada and Britain, three of the most popular destinations for Americans. Many Caribbean countries, including the Bahamas, the Dominican Republic and Jamaica, are also at Level 4.In India, which is facing a cataclysmic surge, the presence of a potentially more menacing variant — possibly more dangerous to children, and against which vaccines may be less effective — is complicating the crisis. For the prospective traveler, it hints at the threat that emerging variants could play in the months and years to come.Inequality and lagging vaccine rolloutsOutside the United States, vaccination numbers remain comparatively low — in some cases, alarmingly so.In Italy, around 11 percent of the population is fully vaccinated. The number in Mexico, historically the country most visited by American tourists, stands at around 6 percent. In Canada, it’s at 3 percent — though that number is partly explained by the long interval between first and second doses there. By comparison, the United States just passed the 32 percent mark.While many of these percentages have been rising more quickly in recent weeks, there is also reason to believe that progress in some countries may stall.Global vaccine supplies have been disrupted by the surge of coronavirus cases in India, which has curtailed exports in order to meet growing domestic demands. Like most countries, Canada, for example, is entirely dependent on foreign sources for its vaccine supply; as a measure of the share of its population that is fully vaccinated, Canada now lags behind more than 50 other nations.Meanwhile, the push for a return to leisure travel raises questions about the ethics of vaccinated travelers demanding services among largely unvaccinated hosts. Such questions are especially complicated within communities that are economically dependent on tourism revenue.Dr. Mami Taniuchi, an infectious disease researcher at the University of Virginia, said that while the risk of breakthrough infections among vaccinated travelers is low, there is nevertheless an increased risk among unvaccinated workers who would not otherwise be coming together in such large numbers, or in such close quarters, to accommodate tourists.“The risks among vaccinated travelers are significantly reduced, but I worry about the risk of transmission among the people who are working around them,” Dr. Taniuchi said. It would help, she added, if travel workers were part of priority vaccination plans.“In a situation where there’s a mixing of people who are vaccinated and unvaccinated, most of the transmission events are going to be among those who are not vaccinated,” she said.The trouble with ‘vaccine passports’Health certificates that prove one’s immunization status — commonly referred to as “vaccine passports” — have been touted as keys to unlocking international travel. But so far the prospect of developing an easy-to-use and widely accepted digital certificate has been tripped up by a web of bureaucratic, logistical and technical snags.The Biden administration has ruled out the possibility of a centralized federal vaccination database. Instead, individual states (and some cities and territories) have been maintaining a patchwork of records. Any company or organization hoping to develop a digital vaccine certificate in the United States would therefore need to track down immunization data from a range of registries.At present, the most viable option for Americans to prove their immunization status while traveling internationally is to present the Covid-19 vaccination record cards they received when they got their shots. But the cards are easily forged. Several states have offered downloadable PDFs of the cards freely on their websites; fakes have even been offered for sale on TikTok, eBay and Craigslist.The development of digital health certificates is a multidimensional challenge, involving public policy, public health, customer experience and international cooperation, said Eric Piscini, who has overseen the development of IBM’s health passport app, Digital Health Pass.“I’m very optimistic about the long term,” Mr. Piscini said, “but the road is not easy.” He estimated that the European Commission’s Digital Green Certificate won’t be fully operational until late June or July. Integration with platforms beyond Europe will take time.Until then, he said, countries like Greece — which, for now, is verifying visitors’ immunization statuses with easily forged paper certificates — may face both a lack of trust from travelers and pushback from locals who fear that the policies are putting them at risk.Chairs were piled up in front of a restaurant that was closed because of lockdowns in Paris in March.Bertrand Guay/Agence France-Presse — Getty ImagesAltered destinationsEven if international tourists could travel safely and securely, and without risking the well-being of their hosts, visitors may face yet another impediment: Their destinations may lack many of their usual draws.Throughout the world, the pandemic has shuttered museums, forced restaurants to close and curtailed countless other cultural offerings. Many regions in Europe are subject to local curfews that come and go as case numbers fluctuate. Last month in Spain, confusion reigned over whether socially distanced beachgoers and sunbathers were required to wear masks, though the rule was eventually clarified. (They aren’t.)All of which suggests that, in the near future, there may be a gap between tourists’ expectations and their destinations’ restricted realities.In Paris, for example, bars and restaurants have been closed since the end of October. So, too, are museums — including the Louvre, normally one of the most visited museums in the world. Nighttime curfews, from 7 p.m. to 6 a.m., have emptied the city’s streets.In late April, President Emmanuel Macron of France announced plans to relax certain restrictions beginning on May 19, but he left open the possibility of regional delays. The country, he said, will be able to pull an “emergency brake” in certain places, if need be.“I really don’t know what’s going to be attractive to tourists in Paris, now or in the near future,” said Yumi Kayayan, a travel writer who lives near the Louvre, citing a dearth of cultural offerings. The rules governing curfews and regional restrictions, she added, would be difficult for foreigners to make sense of. “To be honest, the rules are very confusing right now even for Parisians,” she said.The big picture, and the costsIn 2019, the number of international tourist arrivals reached 1.5 billion globally — a staggering figure. But grasping the scale of international travel, and the industries that have grown to support and encourage it, is central to understanding the forces pressing now for its return.Governments, tourism boards, airlines, hotel companies, travel agencies and cruise operators, along with tour bus drivers, housekeepers, local guides, pilots, restaurateurs, museum operators, bed-and-breakfast hosts, entertainers, caterers, fishermen, shopkeepers and bar owners — in short, all the people standing to profit from tourism dollars — are facing extreme economic pressure not to lose out on another tourism season. The past year without travel, when international arrivals dropped from 1.5 billion to 381 million, was devastating. For many, another similar year would be unthinkable.And so an already stressed system has been forced to confront an existential quandary: Do countries opt for continuing international lockdowns, or do they increase the risk of disease and court much-needed tourism revenue? New Zealand, which, through a combination of stringent lockdowns, border closures and strict quarantines, has all but eliminated the coronavirus from its shores, has staked its claim at one end of the spectrum. Greece appears to be claiming the other.There are no easy answers, no universal solutions. In many cases, the onus will fall on individual tourists — the fortunate and vaccinated few, plied with incentives and feverish for travel — to thoughtfully navigate the ethical considerations.Of all the variables, only one thing seems inevitable: The choices we make, whether to venture out or huddle close to home, are unlikely to bode well for the individual workers — the unfortunate and unvaccinated many — who, by dint of circumstance, are vulnerable to both the virus and the teetering fortunes of a hard-hit industry.“I do think we’ve learned important lessons over the course of the year about how to engage more safely in public spaces,” said Dr. Fortune, who emphasized that it’s important for vaccinated travelers to continue testing, wearing masks and practicing social distancing.“I think the real danger,” she added, “is that the most vulnerable people are the ones who have the least ability to mitigate risk.”Follow New York Times Travel on Instagram, Twitter and Facebook. 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