Britain expanded the list of vaccination certificates it recognizes from other countries and territories, but certificates from many nations in Africa and South America remain excluded.Credit…Guy Faulconbridge/Reuters
Over the summer, many countries across the world opened to international visitors following the successful rollout of vaccination programs. But fragmented rules about which vaccines will be accepted and what documentation is required, as well as a lack of compatibility between vaccine apps, have left many travelers confused and frustrated over where they can visit without extraordinary headaches and restrictions.
More than 2.7 billion people around the world have been fully vaccinated with a range of vaccines that vary in degrees of efficacy, according to Our World in Data, an Oxford University Covid-19 database. Across Asia, the United Arab Emirates and South America, millions have received Sinopharm, Sinovac and other vaccines manufactured in China, but concern over their efficacy has resulted in many countries not recognizing them for the purpose of travel. Millions more who received domestic vaccines like the Sputnik V in Russia and Covaxin in India, which have not received approval from the World Health Organization, are also limited in where they can go.
Britain eased its travel rules this week, expanding the list of vaccination certificates it recognizes from other countries and territories, including Turkey and India, but certificates from many nations in Africa and South America were excluded. In terms of vaccines, the United Kingdom, the 27-member European Union and the 26-country Schengen Area accept the four vaccines approved by the European Medicines Agency — AstraZeneca, Pfizer-BioNTech, Moderna and Johnson & Johnson — but Britain and many E.U. states do not recognize the Sinopharm and Sinovac vaccines, despite their approval by the World Health Organization.
The United States is still in a “regulatory process” to determine which vaccines it will accept when the country opens to fully vaccinated travelers in November, the Centers for Disease Control and Prevention said in a statement. But vaccines listed for emergency use by the W.H.O. will be recognized, the agency said. Besides the three authorized for use in the United States — those made by Moderna, Pfizer-BioNTech and Johnson & Johnson — they are AstraZeneca, the version of AstraZeneca made in India, and two Chinese vaccines: Sinopharm and Sinovac.
The Sputnik V vaccine, which has been approved in more than 70 countries but not yet by the W.H.O., is unlikely to be accepted by the United States as it initially reopens for international travel.
These confusing rules over approved vaccines are not limited to Britain and the United States. Experts warn that the haphazard and preferential approach to travel regulations is creating a two-tier system where people vaccinated with the most effective vaccines — mainly in the west — are able to cross borders freely, while those in developing countries, who have received vaccines with a lower efficacy, are not.
A dose of Moderna’s Covid vaccine being administered last month in Kajiado, Kenya, a middle-income country where the United States has donated doses.Credit…Patrick Meinhardt / AFP via Getty Images
The Massachusetts-based company Moderna has been supplying its shots almost exclusively to wealthy nations, keeping poorer countries waiting and earning billions in profit.
According to Airfinity, a data firm that tracks vaccine shipments, Moderna has shipped a greater share of its doses to wealthy countries than any other vaccine manufacturer. About one million Moderna doses have gone to countries the World Bank classifies as low income, as compared to 8.4 million doses of the Pfizer shots set aside for those nations.
In addition, middle income countries have had difficulty getting a hold of the Moderna vaccine, with most of those that have reached deals to receive it reporting they have not obtained any doses, and at least three countries reporting they are paying more for the doses than the United States and the European Union.
Moderna executives have said that they are doing all they can to make as many doses as possible as quickly as possible but that their production capacity remains limited.
Moderna developed its breakthrough vaccine — its only commercial product — with the financial and scientific support of the U.S. government. The company’s market value has nearly tripled this year to more than $120 billion. Two of its founders, as well as an early investor, this month made Forbes magazine’s list of the 400 richest people in the United States.
The disparity in the distribution of its doses has earned the company some criticism. “They are behaving as if they have absolutely no responsibility beyond maximizing the return on investment,” said Dr. Tom Frieden, a former head of the Centers for Disease Control and Prevention.
Receiving a flu shot at a community clinic in Chicago last year.Credit…Taylor Glascock for The New York Times
While not as virulent as the coronavirus, the flu has a staggering global impact: three million to five million cases of severe illness every year, and up to 650,000 deaths. Every few decades, a new flu strain spills over from animals and leads to a pandemic.
Flu vaccines have been around for eight decades, but they remain mediocre. A flu shot is good for only one flu season, and its effectiveness typically reaches somewhere between 40 and 60 percent. In some years it’s as low as 10 percent.
But a new generation of highly effective flu vaccines may emerge in the next few years, based on the same mRNA technology that has protected hundreds of millions of people against Covid-19.
While traditional influenza vaccines are grown for months in chicken eggs, mRNA vaccines are manufactured relatively quickly from scratch. In theory, their faster production may make them better matched to each season’s flu strains. And when they’re injected into people, they may provoke a stronger immune response than traditional flu vaccines do.
Two companies — Moderna, the Massachusetts biotech company that produced one of the authorized mRNA vaccines for Covid-19, and Sanofi, a French vaccine maker — began trials for mRNA flu vaccines this summer. Pfizer and BioNTech, the companies that produced the other mRNA Covid-19 vaccine, started their own flu trial last month. And Seqirus, a vaccine producer based in England, is planning to test another mRNA vaccine for the flu early next year.
No one can say for sure how well any of these four seasonal flu vaccines will turn out, but many experts are optimistic. And further down the line, mRNA technology may be tailored to make vaccines that work for years against a wide range of influenza strains.
“I am beyond excited for the future of flu vaccination,” said Jenna Bartley, an immunologist at the University of Connecticut.
Gov. Doug Burgum of North Dakota speaking at the State Capitol last year in Bismarck.Credit…Mike McCleary/The Bismarck Tribune, via Associated Press
While the Delta variant-driven surge is receding in much of the United States, it rages on in less-vaccinated states like North Dakota,to the point where the state’s governor and health professionals have asked people to avoid risky activities that could add to the burden on hospitals.
The pleato maximize capacity for the crush of Covid patient came last week from Gov. Doug Burgum and doctors and administrators from some of North Dakota’s largest hospitals. They asked the public to drive defensively, skip dangerous activities that could lead to injuries, regularly visiting primary care physicians and make sure all their vaccinations were up to date.
About this data
Source: U.S. Department of Health and Human Services. The seven-day average is the average of a day and the previous six days of data. Currently hospitalized is the most recent number of patients with Covid-19 reported by hospitals in the state for the four days prior. Dips and spikes could be due to inconsistent reporting by hospitals. Hospitalization numbers early in the pandemic are undercounts due to incomplete reporting by hospitals to the federal government.
“The pressure on hospitals and clinics in both our urban and rural areas is reaching critical levels, and we all need to do our part to avoid hospitalization and prevent further strain on these facilities and their staff as we work through this incredibly challenging time,” said Mr. Burgum, a Republican.
The problem has been compounded by health care worker shortages and a wave of patients who can no longer delay care for other conditions, said Dr. Joshua C. Ranum, the vice president of the North Dakota Medical Association.
North Dakota’s caseload —81 cases per 100,000 residents — trails only those of Alaska and Montana, according to a New York Times database, a 25 percent increase over the past two weeks. And Covid-related hospitalizations are up more than a fifth in the past two weeks.
Nationally, the United States is averaging below 100,000 new daily cases for the first time since Aug. 4. The average of 97,933 cases is down 20 percent from two weeks ago. New daily deaths are down 14 percent, to an average of 1,770.
Covid caseloads remain high in North Dakota and Western states like Wyoming, Montana and Idaho, where vaccination rates are relatively low. Some areas have had to ration care and send patients to distant hospitals for treatment.
Just 45 percent of the North Dakota’s population is fully inoculated, according to federal data, compared with 56 percent nationally.
Mr. Burgum has asked North Dakotans to get vaccinated, but he has resisted mandating vaccines and threatened legal action after President Biden announced vaccination requirements last month that Mr. Biden said would affect 100 million workers.
About this data
Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of a day and the previous six days of data.
In North Dakota, Dr. Ranum said most hospitals were being forced to get by with the staff members they had, sometimes training them to work in different parts of the hospital to fill gaps. Reinforcements from elsewhere are rare because demand for traveling nurses and other health workers is so high, he said.
Dr. Michael LeBeau, president of Sanford Health Bismarck, North Dakota’s second-largest hospital, said the facility’s staff was depleted and exhausted as it reckoned with overdue care amid the surge.
“We spent the better part of a year where we had a hard time keeping up with standard health maintenance, yearly physicals, the stuff that prevents hospitalization,” Dr. LeBeau said.
A view of Chicago last winter. Mayor Lori Lightfoot said on Friday that city employees could avoid the vaccine mandate she issued in August by getting tested twice a week through the end of the year.Credit…Shannon Stapleton/Reuters
Just a day after President Biden visited Chicago to plead for vaccine mandates, saying they were the only way to defeat the coronavirus, Mayor Lori Lightfoot on Friday said public workers could opt out of the city’s mandate until the end of the year by getting regularly tested.
The mayor announced the mandate for Chicago workers in August. But the proposal was met with immediate pushback from employees and labor groups, including the Fraternal Order of Police and the Chicago Federation of Labor.
Now, workers who are not fully vaccinated by Oct. 15, including those who have sought medical or religious exemptions, must get tested twice a week, separated by three to four days, at their own time and expense, the mayor’s office said.
Employees who fail to report their vaccination status by the Oct. 15 deadline will be placed on unpaid leave.
The test-out option will remain in place until Dec. 31, after which employees must be fully vaccinated unless they have received a medical or religious exemption. It was unclear what the consequences will be for those who refuse to comply.
Cities and states around the country have introduced vaccine mandates for their workers, and some have been met with legal challenges.
After being delayed by the courts, a vaccine mandate for educators and staff in New York City public schools was cleared to proceed after a ruling by a federal appeals panel last week. Though it faced opposition, the mandate pushed tens of thousands of Department of Education employees to get their shots.
Municipal workers in Seattle and in Los Angeles are required to be fully inoculated against the virus by next week, though unlike Chicago’s policy, there is no test-out option. Both mandates allow for religious or medical accommodations.
Chicago had been negotiating with labor unions since the August announcement.
A mobile billboard truck urging the board of Orange County Public Schools to issue a mask mandate in front of the board’s headquarters in downtown Orlando in August.Credit…Joe Burbank/Orlando Sentinel, via Associated Press
The political battle in Florida over masks in schools escalated this week, as the state Board of Education voted to authorize sanctions on eight local school districts for not following instructions from Gov. Ron DeSantis’s administration that make masks optional.
The eight districts, whose boards all voted to require masks in school buildings, could face cutbacks equal to their school board members’ salaries unless, according to the Tampa Bay Times, they show within 48 hours that they are in compliance with state orders. The districts are in Alachua, Brevard, Broward, Duval, Leon, Miami-Dade, Orange and Palm Beach Counties.
The measure was approved unanimously during a conference call meeting on Thursday by the State Board of Education, all of whose members are appointees by Republican governors. The vote came after superintendents from the eight districts argued their mask policies had been effective at curbing the spread of the virus.
After the vote, one of the superintendents, Alberto M. Carvalho of Miami-Dade County Public Schools, noted on Twitter there had been “no major outbreaks” in his district and that student cases had been declining after a spike in early September.
“We disagree with today’s State Board of Education’s recommendation and wholeheartedly believe that we are in compliance with law, reason, and science,” he said in a Twitter post.
But the state board said that the county school boards had “willingly and knowingly violated the rights of students and parents by denying them the option to make personal and private health care and educational decisions for their children.”
Masks in schools have become the center of a fiercely partisan debate in Florida, Texas, Arizona and other states whose Republican governors oppose mask mandates as an infringement on personal liberties. In late July, Governor DeSantis, a possible Republican presidential candidate, signed an executive order directing state officials to ensure parents have the power to decide whether children wear masks in school.
The Centers for Disease Control and Prevention recommended that all students, teachers and employees wear masks, regardless of their vaccination status. Most masks offer far more protection to others than to the person wearing them, dispersing the exhaled aerosols that carry the coronavirus in an infected person. So individual masking undermines the protection the masks offer.
President Biden, a Democrat, has openly criticized the Republican governors blocking local mask mandates, and the federal Department of Education has started investigating whether such policies in five states violate the civil rights of disabled students.
Lawsuits have also been filed in a number of states, including Florida, challenging bans on mask mandates. In late August, a federal judge said that Florida’s state constitution allowed school districts to impose strict mask mandates on students, handing Mr. DeSantis a defeat. The state asked an appellate court to reverse the ruling, which has been stayed temporarily pending a final decision.
On Thursday, the Florida school board maintained that a “parents’ bill of rights” enacted by state lawmakers earlier this year gave parents the sole right to decide if their children should wear masks. The board’s statement said that the law requires districts and schools to “protect parents’ right to make health care decisions such as masking of their children in relation to Covid-19.”
“Every school board member and every school superintendent has a duty to comply with the law, whether they agree with it or not,” the chairman of the state board, Tom Grady, said in the statement.
The Rev. John S. Udo-Okon encouraging vaccinations last month at Word of Life International Church in the Bronx, N.Y.Credit…Thalia Juarez for The New York Times
Dozens of people gathered at the Word of Life International Church in the South Bronx in New York City on a recent Saturday for its weekly food bank, but the pastor was also interested in discussing a different subject.
He said he wanted everyone there — mostly Black residents, including seniors and mothers with small children — to know that Covid vaccines were easy to find. More important, the pastor, the Rev. John S. Udo-Okon, wanted them to know that the vaccines would not harm them.
More than 80 percent of adults in New York City have received at least one dose of a Covid vaccine, but there are significant racial disparities in the vaccination rate.
Only 55 percent of Black adults have received at least one vaccine dose, compared with 92 percent of Asian Americans, 75 percent of Hispanic adults and 62 percent of white residents, according to data published by the city government. Community leaders attribute that low vaccination rate among Black New Yorkers to a combination of factors, primarily a history of racism in the medical system and a subsequent distrust of authorities.
To address the gap, health officials and some Black churches have sought to use the power of the pulpit to vouch for the safety of vaccines and to push back against misinformation. They have also hosted vaccination events in church halls or from mobile vans parked outside of churches after Sunday services.
“These cultural institutions are a safe space to have discussions — you go to your faith leader and they’ll answer questions,” said Dr. Torian Easterling, the first deputy commissioner and chief equity officer at the New York City Department of Health and Mental Hygiene.
Singapore’s government has reinstated restrictions as cases double every eight to 10 days, despite an 83 percent vaccination rate.Credit…Ore Huiying for The New York Times
Singapore is adding the United States and seven other countries to its list of places where two-way travel for fully vaccinated people can occur without needing to quarantine, officials announced on Saturday, as the Southeast Asian country begins to cautiously reopen.
“We are charting a course for the new normal, toward living with Covid-19,” S. Iswaran, the transportation minister for Singapore, said in a post on Facebook. “This is how we must move forward to protect both our lives and livelihoods, to learn to live with the virus, and to journey toward a Covid-resilient nation.”
In addition to the United States, the new countries in this arrangement are Canada, Denmark, France, Italy, the Netherlands, Spain and Britain, according to Mr. Iswaran. Singapore already announced similar arrangements with South Korea, Brunei and Germany.
Under the plan, known as Vaccinated Travel Lanes, fully vaccinated people traveling between Singapore and those countries will subject only to PCR tests for the coronavirus instead of quarantining, according to the transportation ministry. Those travelers will also have no restrictions on their purpose of travel and will not be required to have a controlled itinerary or sponsorship, the ministry said.
The expanded travel plan will start on Tuesday, according to the ministry.
Email messages to the ministry seeking comment were not immediately returned.
The Vaccinated Travel Lanes are one of the biggest reopening steps being taken by Singapore, a major economic and transportation hub, after early successes in thwarting the coronavirus and then a sharp setback in controlling its spread.
Singapore was widely considered a success story in its initial handling of the pandemic, closing its borders, testing and tracing aggressively, and ordering vaccines early.
Singapore has now fully inoculated 83 percent of its population, and a top politician told the public in August that an 80 percent vaccination rate was the criterion for a phased reopening.
But in September, with cases doubling every eight to 10 days, the government reinstated restrictions on gatherings. The United States said its citizens should reconsider travel to the country, emergency departments in several Singapore hospitals were crowded, and people were once again told to work from home.
The country’s experience has become a sobering case study for other nations pursuing reopening strategies without having had to deal with large outbreaks in the pandemic. For Singapore residents, there were nagging questions about what it would take to reopen if vaccines were not enough.
For many, the repeated tweaks to the restrictions have taken a toll. The number of suicides in 2020 was the highest since 2012, a trend that some mental health experts have attributed to the pandemic.
In Case You Missed It
Maurice Sendak Elementary School in Los Angeles in April. Children under 12 may soon be eligible for the Covid-19 vaccine.Credit…Jae C. Hong/Associated Press
Across the United States, many families with young children have been anxiously awaiting a vaccine for those under 12 years old.
This week, they moved one step closer, as Pfizer and BioNTech asked federal regulators to authorize emergency use of their shot, which has been proven to be safe and highly effective for young children, for those aged 5 to 11.
If approved, the vaccine could help protect some 28 million more people in the United States. Federal regulators received another major request this week from Johnson & Johnson as the company sought authorization for a booster shot for adults. It was the last of the three Covid vaccine manufacturers whose shots are authorized for U.S. use to make such a request.
Pfizer’s announcement came on Thursday, the same day that President Biden made an appeal to private employers to adopt vaccine mandates, underscoring the administration’s efforts to reach the tens of millions of Americans who remain unvaccinated. In his speech, Mr. Biden said that mandates were the only way to defeat the virus.
Here’s what else happened this week:
A study published in the journal JAMA Internal Medicine found that a second dose of the Pfizer-BioNTech and Moderna vaccines can nearly triple the chances of a rare heart condition in young men, though the risk remained extremely low. Experts have thus far said that the benefits of the vaccines far outweigh the risk of getting the condition, called myocarditis.
After months of decline, the number of nursing home deaths rose sharply from July to August as the Delta variant spread across the country, a study by the Kaiser Family Foundation found.
The Covax vaccine program backed by the United Nations will fail to meet its target for delivering doses to Latin America and the Caribbean this year, in part because wealthy countries that pay more for the shots are buying up most of the supply, according to the World Health Organization.
The United States will spend $1 billion to quadruple the availability of at-home rapid coronavirus tests by the end of the year, White House officials said. Two hundred million rapid tests are soon expected to be available to Americans each month.
A firefighter picking up his Covid-19 vaccination card in January in Los Angeles.Credit…Jae C. Hong/Associated Press
Vaccine hesitancy among police officers in the United States has been one of the themes of pandemic news this year, but in some places, firefighters are joining the resistance.
This week, hundreds of firefighters in Los Angeles filed a notice of intent to sue the city over its vaccine mandate, saying an Oct. 20 deadline to get vaccinated is “extreme and outrageous.”
The notice, filed on Thursday, said each of the 871 firefighters would seek $2.5 million each if the lawsuit is filed — for a projected total of over $2.1 billion. A lawyer representing the group said that the city would have 45 days to evaluate the notice and that he expected to file the suit immediately after that period.
Firefighters in Spokane, Wash., joined state workers in a lawsuit over statewide vaccine mandates, according to KXLY-TV. In Orange County, Fla., a group of firefighters upset by a vaccine mandate sued the county, WFTV reported.
The International Association of Fire Fighters’ statement on vaccines offers no support for rejecting vaccine mandates. Instead, it notes the extreme importance of vaccination for “fire fighters and medical emergency personnel who work in confined and uncontrolled environments while treating or transporting patients or interacting with the public.” The statement lists the few options available for exemptions, and lists some of the financial penalties and job losses that defying mandates could incur.
Kevin McBride, the lawyer representing the Los Angeles firefighters, said in an interview that his clients did not trust the available vaccines and could be fired for defying the city’s vaccine mandate.
All three vaccines used in the United States are highly effective at preventing serious illness, hospitalization and death from Covid-19, and serious side effects, like a strong allergic reaction, are extremely rare.
Mr. McBride said the Los Angeles authorities had rejected his offer of a “middle ground” in which weekly testing would substitute for getting the shot. The mandate passed by the Los Angeles City Council in August did not include an option for regular testing.
As of Thursday, about 64 percent of members of the Los Angeles Fire Department were fully vaccinated, according to a spokeswoman, Cheryl Getuiza, and about 1,200 members had not had a single shot. Since the pandemic began, two members have died, and 1,070 have been infected, she said.
Los Angeles is also experiencing vaccine hesitancy among its law-enforcement agents. The firefighters’ notice of intent to sue was filed on the same day that the Los Angeles County sheriff, Alex Villanueva, said he would not enforce the vaccine mandate at his department, which employs some 18,000 people.
