Biden Urges Global Leaders to ‘Go Big’ on Covid Response

Declaring “we need to go big,” President Biden on Wednesday called on other world leaders, pharmaceutical executives, philanthropists and civil society organizations to band together to forge a global consensus around a plan to fight the coronavirus crisis.

Speaking at the opening of a virtual Covid-19 summit he is convening during the United Nations General Assembly in New York, Mr. Biden cited two urgent challenges: vaccinating the world against Covid-19, and solving a global oxygen crisis, which is leading to unnecessary deaths among Covid-19 patients who might survive if oxygen were available.

“We’re not going to solve this crisis with half measures or middle of the road ambitions — we need to go big,” the president said, adding, “It’s an all hands on deck crisis.”

But it may be hard to turn Mr. Biden’s words into reality. Less than 10 percent of the population of poor nations — and less than 4 percent of the African population — has been fully vaccinated against Covid-19. Seventy-nine percent of shots that have been administered have been in high- and upper-middle-income countries, according to the Our World in Data project at the University of Oxford.

Covax, the W.H.O.-backed international vaccine initiative, is behind schedule in delivering shots to the low- and middle-income nations that need them the most. Around the world, more than 4.5 million people have died of Covid-19 — a “global tragedy,” Mr. Biden said.

On Wednesday, the president announced a new partnership with the European Union aimed at expanding access to vaccines. And Vice President Kamala Harris said that the United States would contribute $250 million to start a new global fund that the administration hopes will raise $10 billion to fight future pandemics.

Still, some activists say that Mr. Biden’s new plan for donating doses is not fast enough to meet the World Health Organization’s vaccination targets in poorer nations. Of the 1.1 billion doses that the United States has committed to donating, only 300 million are expected to be shipped this year.

Mr. Biden’s speech came on the same day the Food and Drug Administration authorized booster shots for people over 65 who received the Pfizer-BioNTech vaccine, as well as for others at high risk of becoming seriously ill with Covid-19. The decision opened the way for possibly tens of millions of vaccinated people to get the extra doses.

Asked about the United States move to provide booster doses to some already inoculated people while much of the world lacks vaccines, Jen Psaki, the White House press secretary, reiterated the administration’s position that “we can do both, and it’s a false choice.”

The summit began with Mr. Biden and other world leaders, including António Guterres, the secretary general of the United Nations, gathering virtually for a small panel discussion entitled “Call the World to Account and Vaccinate the World.”

Participants included other presidents and prime ministers, including President Cyril Ramaphosa of South Africa and Prime Minister Boris Johnson of Britain, according to an agenda obtained by The New York Times. Drug company executives, philanthropists and leaders of nonprofit organizations were also invited.

Earlier Wednesday, Pfizer-BioNTech announced that it had struck a deal with the Biden administration to sell the United States an additional 500 million doses of its coronavirus vaccine, to be donated to nations that need them.

Mr. Biden said in his speech the deal would bring to 1.1 billion the total number of doses his administration has purchased for donation. “Put another way, for every one shot we’ve administered to pay in America, we have now committed to do three shots to the rest of the world,” he said.

Mr. Biden has been under intense pressure from global health experts to do more to address the vaccine shortage — and in particular expand manufacturing around the world. Mr. Biden said the U.S. is doing so, through a partnership with India, Japan and Australia.

The director general of the W.H.O., Dr. Tedros Adhanom Ghebreyesus, pointed out in his remarks at the summit that less than 15 percent of the billion doses high-income countries have pledged to poorer countries have been delivered.

“We need an ironclad global commitment today to support the vaccination of at least 40 percent of the population of every country by the end of this year, and 70 percent by mid-2022,” Dr. Tedros said.

Drug manufacturers have also been under pressure to do more. The Biden administration has urged both Pfizer and Moderna to enter into joint ventures where they would license their technology to contract manufacturers with the aim of providing vaccines to low- and middle-income countries, according to a senior administration official.

Those talks led to the Pfizer donation, but the talks with Moderna have not borne fruit, the official said.

Some critics of the Biden administration had low expectations for the summit. “As important as the summit is to corral further commitments, it will not produce the transformative response needed to end the pandemic,” Peter Maybarduk, access to medicines director for Public Citizen, the consumer advocacy organization, said.

Daniel E. Slotnik contributed reporting.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“We have the tools available to us for individuals to be able to take care of themselves,” Mr. Dunleavy said.

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

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

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

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

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

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

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

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

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

On the other hand, she noted that cooling weather prompts residents to spend more time indoors, where the virus spreads more readily.

Dr. Zink said many health care workers in the state were becoming burned out from the strain of the pandemic.

“When you have a deeply rural state that has limited health care capacity at baseline, it doesn’t take a lot more to be able to overwhelm your system, really quickly,” Dr. Zink said, adding that the average Alaskan travels nearly 150 miles for care.

Dr. Amstislavski said many hospitals have struggled to bring in reinforcements from other states because of the long distances and travel times.

He added that Alaska’s vaccination rate, which led the nation early in the year, has been lagging in recent months. Just under half the state’s population has been fully vaccinated, compared with 55 percent for the nation as a whole, according to federal data.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Daniel E. Slotnik contributed reporting.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

— Lauren Katzenberg

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

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

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

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

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

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

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

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

Day after day, they went to work.

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

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

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

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

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

Global roundup

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

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

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

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

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

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

In other news from around the globe:

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