A new drug quashes all coronavirus variants. But regulatory hurdles and a lack of funding make it unlikely to reach the U.S. market anytime soon.Over the past year, America’s arsenal of Covid treatments has shrunk as new variants of the coronavirus have eroded the potency of drug after drug. Many patients are now left with a single option, Paxlovid. While highly effective, it poses problems for many people who need it because of dangerous interactions with other medications.But a new class of variant-proof treatments could help restock the country’s armory. Scientists on Wednesday reported in The New England Journal of Medicine that a single injection of a so-called interferon drug slashed by half a Covid patient’s odds of being hospitalized.The results, demonstrated in a clinical trial of nearly 2,000 patients, rivaled those achieved by Paxlovid. And the interferon shots hold even bigger promise, scientists said. By fortifying the body’s own mechanisms for quashing an invading virus, they can potentially help defend against not only Covid, but also the flu and other viruses with the potential to kindle future pandemics.“It doesn’t matter if the next pandemic is a coronavirus, an influenza virus, or another respiratory virus,” said Eleanor Fish, an immunologist at the University of Toronto who was not involved in the new study. “For all the viruses we’re seeing that are circulating now, there’s utility to using interferon.”For all of its promise, though, the drug — called pegylated interferon lambda — faces an uncertain road to the commercial market. Regulators at the Food and Drug Administration late last year told the drug’s maker, Eiger Biopharmaceuticals, that they were not prepared to authorize it for emergency use. Eiger executives said part of the problem seemed to be that the clinical trial did not include an American site, but rather only sites in Brazil and Canada, and that it was initiated and run by academic researchers, rather than the company itself.The regulators suggested that only a large clinical trial conducted at least in part in the United States and with more involvement from the company would suffice, Eiger executives said, a scenario that would require several years and considerably more funding. An F.D.A. spokeswoman said disclosure laws prevented the agency from commenting.Those barriers are indicative of problems that some experts worry are threatening the development of a wide range of next-generation Covid treatments and vaccines — products that may help address the ongoing toll from Covid and also give scientists a head start in preparing for the next pandemic.More on the Coronavirus PandemicCovid Vaccine Mandate: New York City will end its aggressive but contentious coronavirus vaccine mandate for municipal workers, Mayor Eric Adams announced, signaling a key moment in the city’s long battle against the pandemic.End of an Era: The Biden administration plans to let the coronavirus public health emergency expire in May, a sign that federal officials believe the pandemic has moved into a new, less dire phase.Canceled Doses: As global demand for Covid-19 vaccines dries up, the program responsible for vaccinating the world’s poor has been negotiating to try to get out of its deals with pharmaceutical companies for shots it no longer needs.Mask Rules: Many countries dropped pandemic mask requirements months ago. But in places like South Korea, which only recently got rid of its rule, masks remain common. This is why.As it stands, Eiger executives said that they might seek authorization for the interferon shot outside of the United States. China, for example, has been looking for new treatment options.Some scientists involved in the research expressed frustration that doctors could not already prescribe the shots. Despite vaccines and previous infections helping to contain the damage from the virus, Covid is still killing roughly 450 Americans daily.“I think it is a crazy situation that we’re still here now, three years into the pandemic, and I have one drug that I can prescribe with confidence to people who are getting infected,” said Dr. Jeffrey Glenn, a virologist and director of a pandemic preparedness initiative at Stanford University, who helped lead the study of the interferon shot. “We need more options.”Dr. Glenn founded Eiger, holds shares in Eiger and sits on its board of directors, but no longer works for the company.A participant in the interferon drug trial took a Covid test in Montes Claros, Brazil.CardResearch, Belo Horizonte, BrazilInterferons are a group of proteins that alert neighboring cells to fortify themselves in the hours after a virus invades. The coronavirus, like other viruses, is good at defusing the body’s natural interferon response. A drug that delivered extra interferons, researchers believed, could potentially help patients outmaneuver the virus.In targeting patients’ immune responses, rather than the virus itself, those treatments potentially offered another advantage over existing treatments, reducing the chance that a variant would evolve that could resist the drug, said Vineet Menachery, an immunologist at the University of Texas Medical Branch.A number of monoclonal antibodies have fallen out of use because they stopped working against new variants. Paxlovid has remained effective because it is much more difficult for the virus to get around, but new variants could one day render it less useful, too.“I don’t know of any virus that can navigate a cell where interferon got there first,” said Benjamin tenOever, a microbiologist at N.Y.U. Grossman School of Medicine.Harnessing those capabilities in a drug, though, is not easy. Interferons can trigger wide-ranging side effects, including inflammation, a risk in Covid cases because some patients have an overactive immune response.“You basically tell your body you’re being highly infected by a virus, and to fight, fight, fight at all costs,” said Juliet Morrison, a microbiologist at the University of California, Riverside.Previous studies had tested interferon treatments only on patients who were already sick and in the hospital. That meant that the drugs were often administered too late, leading to mixed or disappointing results.The scientists behind the Eiger drug envisioned a clever workaround.With hepatitis treatments in mind, they had previously acquired a drug based on lambda interferons, a lesser-known type of interferon whose receptors are largely restricted to specific areas, like the respiratory tract. That happened to be precisely where the coronavirus was replicating. And it meant that the side effects would theoretically be less intense than those from the more commonly used class of interferons, whose receptors are throughout the body.Those hopes were borne out in the latest trial. After administering the shot to about 900 patients and giving another 1,000 patients a placebo, the researchers found no appreciable difference in the incidence of side effects, they said.Vaccination kept the vast majority of patients in both groups safe from hospitalization or a prolonged emergency department visit. But treating patients with interferon within a week after they noticed symptoms halved their chances of being hospitalized: Twenty-five people given the shot were hospitalized, compared with 57 who had not been treated.The effects were even more pronounced when the drug was given within three days of symptoms developing, and when it was given to unvaccinated people. Most of the patients in the study were at relatively high risk from Covid — either because they were 50 or older, or because they had an underlying condition or a weakened immune system.And the drug appeared to work across variants, showing even more potency when Omicron was dominant, the study found.“Despite the pandemic being less of an emergency than it was at its peak, we’re still seeing people coming into the hospital and getting very sick with Covid,” said Dr. Jordan Feld, a specialist in viral hepatitis at the University of Toronto, who is a co-author of the study and has received funding from Eiger. “Having treatment options to try to prevent that from happening would be really helpful.”Some researchers said they envisioned testing interferon drugs in people who were seeking treatment for a range of respiratory viruses, including the flu and R.S.V., or respiratory syncytial virus, which put considerable pressure on hospitals this winter. Doctors could even treat patients before they knew which virus was causing them problems.Some studies have also suggested that the same class of drugs, if used quickly enough, could prevent people exposed to the virus from getting infected in the first place.“I suspect the greatest utility of all these interferons will be in prophylactic treatment,” said Dr. Fish of the University of Toronto, “especially in outbreak settings for high-risk individuals to protect them from infection.”

The research was conducted in part when older variants of the coronavirus were spreading. Other factors may have influenced the conclusions.Updated booster shots have bolstered Americans’ defenses against serious Covid, reducing the risk of hospitalization by roughly 50 percent compared with certain groups inoculated with the original vaccines, the Centers for Disease Control and Prevention reported in a pair of studies published on Friday.The research represents the agency’s first look at how the reformulated boosters, tailored to protect against recent Omicron variants, are performing in the prevention of severe consequences of infection with the virus, including emergency department visits and hospitalizations.Federal health officials are urging Americans to get the updated booster shots, hoping to revive a lagging vaccination campaign. So far, though, fewer than a fifth of American adults and only a third of people ages 65 and older have received updated shots, reflecting a retreat in many parts of the country from the more aggressive vaccination drives earlier in the pandemic.New virus variants that are better able to dodge the immune system have gained traction, and Covid cases and hospitalizations have climbed in recent weeks. About 375 Americans are dying each day on average, an increase of 50 percent over the past two weeks. Older people have been hit especially hard.The virus has exacerbated the difficulties facing a health care system already under strain from resurgences of the flu and respiratory syncytial virus after two years of reductions in those infections.Read More on the Coronavirus PandemicFree at-Home Tests: With cases on the rise, the Biden administration restarted a program that has provided hundreds of millions of tests through the Postal Service.Updated Shots: The Food and Drug Administration expanded eligibility for the updated coronavirus boosters to children as young as 6 months old.Contagion: Like a zombie in a horror film, the coronavirus can persist in the bodies of infected patients well after death, even spreading to others, according to two startling studies.Pregnant Women: Even though studies have shown that the Covid vaccine is safe for expectant women, many have avoided getting the shots, unaware of the risks that the virus poses.Even as federal health officials encourage testing and mask use in certain settings, precautions have become far less common in practice. Antiviral medication for Covid remains difficult to find for many who are infected.“We probably won’t see waves of Covid like we have in the past, which is a good thing, but it doesn’t mean people aren’t still dying and that those lives couldn’t still be saved if we got more shots in arms,” said Dr. David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.One C.D.C. study released on Friday examined how the updated shots protected people from Covid-related emergency department visits and hospitalizations in seven health systems.The study, which looked at about 15,000 hospitalizations, stretched from mid-September to mid-November, when Covid cases were largely being caused by the BA.5 Omicron variant — the target, in part, of the reformulated shots.Since then, however, more evasive versions of Omicron known as BQ.1 and BQ.1.1 have become more common, and it’s not clear how relevant the conclusions are to the newer variants.During the BA.5 period, people who had received the updated boosters had a 57 percent lower risk of hospitalization compared with unvaccinated people, a 38 percent lower risk compared with people who had recently received doses of the original vaccine, and a 45 percent lower risk compared with people whose last dose of the original vaccine was at least 11 months earlier.But the C.D.C.’s study did not account for whether patients had previously been infected with the virus, potentially making the updated vaccines appear less effective than they are. And the research did not take into account whether certain groups were more likely to have received treatments like Paxlovid, which might have skewed the results.A second study reported on the benefits of updated boosters for older Americans in 22 hospitals from early September to late November.Among people ages 65 and older, the updated vaccines reduced the risk of Covid hospitalization by 84 percent compared with unvaccinated people, and by 73 percent compared with people who had received at least two doses of the original vaccines.C.D.C. scientists said that the higher estimates of vaccine effectiveness in older age groups might reflect a variety of differences in the particular groups of patients being studied.

It will be the first Nobel Prize awarded this year, with more announcements being made over the coming week.The Nobel Prize in Physiology or Medicine will be awarded by the Nobel Assembly in Sweden on Monday — the first of several prizes to be given over the next week. The Nobel Prizes, among the highest honors in science, recognize groundbreaking contributions in a variety of fields.Who won the Nobel Prize in Physiology or Medicine in 2021?The prize was awarded jointly to David Julius and Ardem Patapoutian for their discoveries about key mechanisms of how people sense heat, cold, touch and body movements.When will the other Nobel Prizes be announced?The Nobel Prize in Physics will be awarded on Tuesday by the Royal Swedish Academy of Sciences in Stockholm. Last year, Syukuro Manabe, Klaus Hasselmann and Giorgio Parisi won for their work detailing humanity’s role in climate change.The Nobel Prize in Chemistry will be awarded on Wednesday by the Swedish Academy in Stockholm. Last year, Benjamin List and David W.C. MacMillan won for their development of a new tool that spurred research into new drugs and reduced the chemistry’s effect on the environment.The Nobel Prize in Literature will be awarded on Thursday by the Swedish Academy in Stockholm. Last year, Abdulrazak Gurnah won for “his uncompromising and compassionate penetration of the effects of colonialism and the fate of the refugee in the gulf between cultures and continents.”The Nobel Peace Prize will be awarded on Friday by the Norwegian Nobel Institute in Oslo. Last year, Maria Ressa and Dmitri A. Muratov, both journalists, won for their efforts in the struggle to protect press freedoms.Next week, the Nobel Memorial Prize in Economic Sciences will be awarded on Oct. 10 by the Swedish Academy in Stockholm. Last year, the prize went to David Card, Joshua D. Angrist and Guido W. Imbens.All of the prize announcements will also be streamed live by the Nobel Prize organization. Prize winners will receive their awards at a ceremony in Stockholm in December.

The prestigious medical prizes also recognized the creator of a global Covid dashboard and discoveries of proteins and cell bindings to fight disease.It was a startling discovery: Tiny pieces of an unborn baby’s DNA were found floating through its mother’s bloodstream — not inside the mother’s cells, where genetic material is usually found, but rather outside them.But when Dr. Yuk Ming Dennis Lo, a researcher in Hong Kong, described the finding in 1997, it was greeted with something of a shrug. Industry experts were so indifferent that after Dr. Lo’s team licensed the fetal DNA detection technology to a British company, he said, the company turned around and gave the license back.Two decades later, the significance of the technique is no longer in doubt. Dr. Lo eventually helped turn his discovery into a noninvasive prenatal test for Down syndrome that has been performed tens of millions of times and adopted in more than 60 countries.His work was recognized on Wednesday with a Lasker Award, which is among the most prestigious prizes in medicine, coming with $250,000 in winnings and a reputation for preceding a Nobel Prize. Dr. Lo won in the clinical medical research category.The Lasker Foundation also awarded prizes in two other categories. Lauren Gardner, who created the Johns Hopkins University Covid-19 Dashboard, was given the public service award. A group of three researchers whose work relates to how cells interact with their surroundings received the basic medical research award, which goes to a fundamental discovery that opens new scientific territory.Dr. Lo, of the Chinese University of Hong Kong, published his signature discovery in 1997, shortly after he moved back to Hong Kong, his birthplace, from Britain, where he had done his graduate studies. It was several months before Hong Kong would be returned to China, and a resulting exodus of professionals from the city had created plum university openings for young scientists like him.For eight years, Dr. Lo had been trying to find reasonably high concentrations of fetal DNA in the mother’s bloodstream. Such a discovery, he hoped, could help to obviate the need for risky prenatal testing methods, which relied on sampling fetal tissue, and could open the door to noninvasive screenings instead.Read More on the Coronavirus PandemicA Persistent Variant: Ten months have passed since Omicron’s debut. Since then it has displayed a remarkable capacity to evolve new tricks.A Blunted Response: Major data gaps, the result of decades of underinvestment in public health, have undercut the U.S. government’s response to Covid — and now to monkeypox.Biden’s Comments: In an interview that aired on CBS’s “60 Minutes,” President Biden said that “the pandemic is over.” But 400 to 500 Americans are still dying every day of Covid-19.Updated Boosters: As masks have fallen away and quarantines have diminished, the new vaccines are one of the last remaining weapons in America’s arsenal against the coronavirus. So far, the rollout is methodical, but muted.Dr. Lo had been looking in the mother’s blood cells for the unborn baby’s genetic material. But he had also come across reports describing how DNA from a tumor had been found circulating not in blood cells, but in the watery portion of cancer patients’ blood, the plasma. If tumor DNA could be found in that portion of the bloodstream, why not fetal DNA, too?“I had the strange thought that the cancer growing in the patients is a little bit like the placenta that has implanted into the uterus,” he said.He started searching for traces of fetal DNA in the plasma. “That was a good guess,” he said. Homing in on fetal DNA in the mother’s plasma remained tricky. Dr. Lo needed a way to detect the extra copy of chromosome 21 that causes Down syndrome. Separating out the mother’s DNA from the baby’s in tests did not work well enough. Instead, in 2008, Dr. Lo alighted on a technique in which he looked at a large sample of randomly chosen DNA fragments from the mother’s plasma and investigated whether those from chromosome 21 were very slightly elevated.Dr. Lo likened the task to trying to figure out whether someone had one or two coins in their wallet. Unable to look inside the wallet, he could study their overall weight instead and, using an extremely finely tuned balance, could look for telltale extra fractions of a pound.“I started to actually build that molecular balance,” he said.Lauren Gardner, a civil and systems engineer at Johns Hopkins University, created a Covid-19 dashboard that she said has remained the most detailed global snapshot of the pandemic.Lasker FoundationThe other Lasker awardees, too, managed improbable technical feats, albeit in different fields.Lauren Gardner, a civil and systems engineering professor at Johns Hopkins University, received the public service award for leading the creation of a Covid-19 dashboard that she has said still offers the most detailed global picture of the pandemic.On Jan. 21, 2020, a doctoral student of hers, Ensheng Dong, approached her about tracking cases of a novel pneumonia in his home country, China. Mr. Dong had the tools: He could mine Chinese websites for early case data, and he knew how to build online maps. Dr. Gardner said that she remembered the costs of not having access to timely data during outbreaks of Zika and Middle Eastern respiratory syndrome, or MERS, and she wanted to ensure that would not be the case again.“I was thinking it would be mostly of interest to the research community,” she said.Within a couple of months, the dashboard was receiving tens of millions of page views and more than 4.5 billion requests for data per day. In the absence of similarly fast or comprehensive case data from public health bodies like the World Health Organization or the Centers for Disease Control and Prevention, the university dashboard became a go-to source for policymakers, scientists and ordinary citizens alike.It became so visible, Dr. Gardner said, that she later received calls from the U.S. State Department voicing concerns about how certain geopolitically sensitive countries were represented on their map.Dr. Gardner said that the dashboard drew some of its power from being run out of a university, rather than the government. That feature stood in good stead during periods in 2020 when the Trump administration was downplaying case counts. But she said they were ultimately filling a void in public data that should have been addressed by the government.“We were doing for the U.S. what the C.D.C. should’ve been doing, and for the world what the W.H.O. should’ve been doing,” she said. “But they didn’t have the resources to do it, and that needs to change.”With governments reducing investments in detecting and reporting Covid cases, the future of the dashboard may be dictated more by the loss of high-quality data than by the direction of the pandemic itself, Dr. Gardner said.However, she said she hoped that public demand for accessible health data would outlive the dashboard, even if there remained major challenges, such as a deficit of funding and an absence of national standards for how to report infectious disease cases.“The best thing we’ve done is create this expectation for access to this type of data among the people that are affected,” Dr. Gardner said. Similar maps and dashboards, she said, could be useful well before the next pandemic: “Influenza data exists, but not in an accessible format that’s easy to digest, where I can see as a Marylander or Texan if there’s flu coming my way.”From left, Richard O. Hynes of the Massachusetts Institute of Technology, Timothy A. Springer of Boston Children’s Hospital and Dr. Erkki Ruoslahti of the Sanford Burham Prebys Medical Discovery Institute.Lasker FoundationThe Lasker Award for basic medical research went to three scientists who described how cells bind to their surrounding networks of proteins and other molecules — findings that pointed the way toward treatments for a number of diseases.Two of the winners — Richard O. Hynes, of the Massachusetts Institute of Technology, and Dr. Erkki Ruoslahti, of the Sanford Burham Prebys Medical Discovery Institute in San Diego — independently identified a protein that helps to fasten cells to that surrounding network.The third, Timothy A. Springer, of Boston Children’s Hospital, found proteins that guided immune cells in the body and helped them recognize foreign antigens. That work, in the 1980s, drew skepticism from some scientists. Dr. Springer recalled a professor once passing a napkin down the bar at a scientific conference that read simply, “It doesn’t work.”But it did. The research later formed the basis for treatments for dry eye disease and multiple sclerosis, as well as ulcerative colitis and Crohn’s disease, two types of inflammatory bowel disease.As the three scientists, each in their own labs, homed in on the structure of the proteins they were studying, which are now known as integrins, it became clear that they were all part of the same molecular family. Dr. Springer recalled Dr. Hynes inviting him to his lab, where they compared the sequences of their respective proteins. He eventually met Dr. Ruoslahti at a conference organized by Dr. Hynes.“It was like different kinds of apples — a Gala apple to a Fuji apple,” Dr. Springer said.Despite their achievements, the Lasker awardees are still honing their findings. For Dr. Lo in Hong Kong, that has meant trying to use his critical insight from the 1990s — that tumors and unborn babies both leave genetic signatures in the bloodstream — to develop tests that screen for cancers. The tests are best at detecting bigger tumors but can find some early-stage cancers, too.“If your method is sensitive enough,” he said, “it can actually save lives.”

The debut of Omicron-specific vaccines raises a thorny question: How long should you wait between shots?An influential scientific panel on Thursday recommended updated coronavirus booster shots to the vast majority of Americans, adding a critical new tool to the country’s arsenal as it tries to blunt an expected wintertime surge of the virus.The decision, made by expert advisers to the Centers for Disease Control and Prevention, cleared the way for health workers to begin giving people the redesigned shots within days. And it marked a milestone in the fight against a rapidly shape-shifting pathogen: For the first time in the pandemic, manufacturers have capitalized on the potential of mRNA technology to begin distributing a Covid vaccine that perfectly matches the circulating strain of the virus, a feat that had long seemed improbable.For all their promise, the arrival of updated boosters also adds another wrinkle to what is the country’s most complicated vaccine. Vaccine recipients have already had to parse shifting eligibility rules and decide between brands. Now they face a weighty new question: how long to wait after their last vaccine dose or infection before seeking an updated booster.In authorizing the new boosters, federal regulators said on Wednesday that people needed to leave at least two months between doses. While several members of the expert panel expressed concern on Thursday that two months was too short, the C.D.C. pushed to endorse the same minimum interval.And yet immunologists said that waiting roughly four to six months after a last vaccine or infection would strengthen people’s response to an updated vaccine, even if those scientists also saw the rationale for giving Americans flexibility in choosing when to seek a new shot.The C.D.C. panel, the Advisory Committee on Immunization Practices, endorsed the updated boosters for all adults. People who have received a primary Covid vaccine series are eligible no matter how many additional doses they have gotten, part of an effort to stop counting doses and simplify guidelines, C.D.C. scientists said.The panel’s advice now goes to Dr. Rochelle Walensky, the C.D.C. director, who is expected to make a formal recommendation soon. Hundreds of thousands of updated vaccine doses were being delivered around the country on Thursday, the C.D.C. said. Providers nationwide are expected to have millions by Labor Day, the agency said, though some doctors have said they were told that initial supply would be small in their areas.The new boosters are designed to generate immune responses to the original version of the coronavirus and to BA.5, the Omicron subvariant that is now dominant. Pfizer and BioNTech’s shot was authorized for people as young as 12, and Moderna’s for those 18 and older.The C.D.C. advisory panel’s advice will now go to Dr. Rochelle Walensky, the C.D.C. director, who is expected to make a formal recommendation soon.Pool photo by Stefani ReynoldsExactly how much benefit the new boosters will offer over the existing shots is not clear. In a bid to catch up with the virus’s evolution, regulators authorized them while relying heavily on human trials of a different updated shot, one that was reformulated to defend against the BA.1 subvariant of Omicron.Moderna and Pfizer scientists on Thursday released their most detailed findings yet from studies of the latest BA.5 vaccines in mice. They found that those vaccines substantially increased immune responses to Omicron subvariants, including BA.5.Moderna also deliberately infected mice with the BA.5 virus, and found that a BA.5 booster offered significantly better protection against infection in the lungs than the original vaccine did. The company’s scientists argued that immune responses in mice had correlated with human immune responses in past studies.Immunologists said they were confident that the new shots were the best available Covid boosters, and that they would put something of a damper on the outbreak this fall and winter.Read More on the Coronavirus PandemicHeavy Toll: The average life expectancy of Americans fell precipitously in 2020 and 2021. The decline, largely driven by the pandemic, was particularly pronounced among Indigenous communities.Boosters: An influential panel of expert advisers to the Centers for Disease Control and Prevention recommended updated coronavirus booster shots to the vast majority of Americans, clearing the way for health workers to begin giving people the redesigned shots within days.Paxlovid Study: The Covid-19 medication Paxlovid reduced hospitalizations and deaths in older patients, but made no difference for patients under 65, new research from Israel found.Moderna’s Lawsuits: The vaccine manufacturer sued Pfizer and BioNTech, claiming that its rivals’ Covid-19 shot copied groundbreaking technology that Moderna had developed before the pandemic.Simply having updated vaccines by next week, rather than in mid-November, could save between roughly 7,500 and 18,000 lives by the spring, leading epidemiologists have estimated.“We’re still seeing just under 500 deaths per day, which is putting us at about four times the level of yearly deaths we’ll tolerate for influenza,” said E. John Wherry, an immunologist at the University of Pennsylvania. “That’s still an unacceptable level of death. I’m hopeful we’ll make a dent in that because of updated boosters.”The reformulated shots will deliver the biggest benefits for older and more vulnerable Americans, scientists said. While the existing shots offer more durable protection against hospital admission and death than they do against infections, their effectiveness does also wane over time against severe outcomes, scientists said. That makes updated boosters a potentially important aid in surviving an infection, they said.But it is often younger, healthier people who spread the virus to more vulnerable Americans, Dr. Wherry said. Even if those younger people are at relatively low risk of severe Covid themselves, scientists said, the updated boosters were likely to reduce their odds of getting infected in the first place and, in turn, spreading the virus to someone more vulnerable.The higher levels of immunity generated by an updated booster could also decrease the likelihood of developing long Covid, said Shane Crotty, a virologist at the La Jolla Institute for Immunology.“If people take these boosters, they’ll be better off, almost no matter what their situation is,” Dr. Crotty said. “If we can get as many people to take these boosters as possible, that will definitely reduce the number of cases this winter.”Success of the shots will depend largely how many Americans get them, as the country’s vaccine machinery has been scaled back since booster shots were last offered to all adults.Shannon Stapleton/ReutersBut other scientists have expressed concerns that not enough evidence had yet been generated showing that updated boosters were an upgrade to the existing offerings. They have also worried that updated vaccines would give recipients a false sense of security.“I understand that we need better vaccines,” Dr. Pablo Sánchez, a professor of pediatrics at The Ohio State University and member of the C.D.C. panel, said during Thursday’s meeting. But he said that he was struggling “to make a recommendation for a vaccine that has not been studied in humans,” even if those human studies were ongoing. He was the only one of the 14-member panel to vote against recommending the updated vaccines.Scientists said that serious adverse reactions had been very rare after booster doses, and that changes to the updated shots were so subtle that they would be highly unlikely to present new problems.The success of the shots will depend in large part on how many Americans get them. The country’s vaccine machinery has been scaled back since the United States last offered booster shots to all adults, a result in part of congressional resistance to more pandemic response spending.That has especially hurt efforts to give updated vaccines to marginalized and vulnerable Americans, some of the very people who face the greatest risks of being exposed to the virus and of becoming severely ill from it, epidemiologists said.Many Americans seeking an updated booster shot this fall will have passed the four-to-six-month period that immunologists recommend waiting between doses, C.D.C. data showed. Older adults were only made eligible for their last booster shots this spring, but uptake was highest five months ago, during the early period of the rollout in April. Younger people were made eligible for their most recent boosters almost a year ago, and most of them are more than six months past their last shot, the C.D.C. said.But millions of people have also recently gotten Covid. When it comes to the timing of future vaccine doses, those infections act like earlier vaccinations, scientists said, mitigating the benefits of getting a new booster shot shortly thereafter. Receiving a booster soon after an infection could also potentially raise the small risk, most prevalent in younger men, of post-vaccine heart problems, members of the C.D.C. panel said.Federal guidance indicates that people should wait at least until their Covid symptoms have resolved before getting a booster shot, and that they may want to wait a full three months after an infection.Some scientists said it was reasonable to want to give people flexibility about when to get an updated booster.People may want to strengthen their immune defenses before partaking in an unusually high-risk activity. Others may have weakened immune systems that limited their responses to an earlier shot. An approaching case surge, especially this winter, could raise the risk of waiting. And the C.D.C. has urged health providers to offer people flu and Covid vaccines at the same visit.Deepta Bhattacharya, an immunologist at the University of Arizona, said that C.D.C. recommendations could afford to space out doses of routine childhood vaccines at precisely the right intervals because children are unlikely to be exposed to those pathogens in the interim. That’s not the case for the coronavirus, which is circulating so widely that someone leaving a long gap between doses faces higher odds of getting infected in the meantime.“Honestly, that’s probably the more important factor to consider — what’s happening in the real world — rather than in an ideal world of immunological optimization,” Dr. Bhattacharya said.Still, he and other scientists said that waiting four to six months between doses would strengthen people’s response to the updated boosters. That would help people steer clear of a situation in which their antibody levels were so high when they received an updated shot that their immune systems partly cleared out the vaccine before building strong defenses against new Omicron subvariants.“You can really only boost the responses after you’ve gotten below your ceiling,” said Jenna Guthmiller, an immunologist at the University of Colorado. But, she said, “Without testing ourselves and figuring out what our ceilings are, which is very complex, the best option is honestly just to get the vaccine.”

Updated Covid vaccines, expected soon after Labor Day, were designed to thwart Omicron variants. But money to distribute them has dried up.Long past the point when pollsters said there were no more Americans willing to be vaccinated against the coronavirus, Coral Garner kept finding them.An organizer of mobile clinics for the Minnesota Department of Health, she arranged to provide vaccines and booster shots to people who had resisted them, setting up in a retrofitted city bus outside a Nigerian church, a Hmong senior center, a Somali mall and dozens of other sites.But even as the United States now prepares for a critical campaign to deliver Omicron-specific booster shots, Ms. Garner’s job no longer exists. In June, her contract position was canceled because the state said funding had dried up.At the very moment a better coronavirus vaccine is expected to finally become available, America’s vaccination program is feeling the effects of a long period of retreat.Local programs to bring shots to the places where Americans gather and the institutions they trust have folded, a consequence in some cases of congressional resistance to more pandemic response spending.The same local health department workers responsible for Covid and flu shots this fall have also, without new staffing, been juggling a monkeypox outbreak and childhood immunization deficits that have left some places susceptible to polio.And some state health officials, citing weak demand for vaccines and increased survival rates of late, said in interviews that they had stopped aggressively pushing coronavirus shots.With the virus killing far fewer people than it once did and many Americans reverting to their prepandemic ways, the country’s no-expenses-spared attitude to saving lives has evolved into a response that has put a greater onus on individuals to protect themselves. In keeping with that approach, many health officials believe the vaccine machinery is in place to meet what they expect, lamentably, to be tepid demand this fall.Tess Holman, held her daughter, Margot Holman, 1, as she received the Covid vaccine at the Mall of America in Bloomington, Minn., in June.Jenn Ackerman for The New York TimesBut others are worried that the country is surrendering a decisive opportunity to stoke that demand and restore the more robust vaccination efforts that lifted last year’s initial rollout.“We are watching the dismantling of the hyperlocal infrastructure that actually brought needles to arms in the most vulnerable communities in the country,” said Stephen Thomas, the director of the Center for Health Equity at the University of Maryland. “To this day, vaccine uptake in the United States is embarrassing.”The Biden administration said some 70,000 sites were prepared to vaccinate people this fall. While 60 percent of those are pharmacies, they also include doctor’s offices, community health centers and rural health clinics.States can also seek money from the Federal Emergency Management Agency for certain vaccination-related expenses, like setting up sites, buying equipment and offering translation or transportation services.Read More on the Coronavirus PandemicHeavy Toll: The average life expectancy of Americans fell precipitously in 2020 and 2021. The decline, largely driven by the pandemic, was particularly pronounced among Indigenous communities.Boosters: An influential panel of expert advisers to the Centers for Disease Control and Prevention recommended updated coronavirus booster shots to the vast majority of Americans, clearing the way for health workers to begin giving people the redesigned shots within days.Paxlovid Study: The Covid-19 medication Paxlovid reduced hospitalizations and deaths in older patients, but made no difference for patients under 65, new research from Israel found.Moderna’s Lawsuits: The vaccine manufacturer sued Pfizer and BioNTech, claiming that its rivals’ Covid-19 shot copied groundbreaking technology that Moderna had developed before the pandemic.Having shifted much of the rollout to private sites, though, states have been promised FEMA reimbursements on a relatively modest $550 million in vaccination spending so far this year. Last year, that figure was $8.5 billion.And while providers are supposed to vaccinate everyone for free, with or without insurance, the federal government ran out of money this spring to offer reimbursements for shots for uninsured people, making it more difficult for them to receive boosters.Sonya Bernstein, a senior policy adviser for the White House Covid response team, said federal spending to support vaccination efforts was being held back by a stalemate in Congress over the administration’s request for billions of dollars in additional pandemic aid. Republicans have said that additional coronavirus spending could be covered with funding already approved by Congress, an assertion that some state health officials say is false.“We are working with less because Congress has not provided us with that funding,” Ms. Bernstein said. “But that has not gotten in the way of our preparations. We’re working day in and day out to make sure states and our partners have the resources and support they need.”The United States is leaning ever more heavily on vaccines to defend against the virus at a time when health officials are pulling back on other preventive measures, like masking, distancing and quarantining.The fall vaccination campaign, which is expected to begin soon after Labor Day, could be crucial. Many Americans have gone months since their last Covid vaccine or infection, allowing immune defenses to wane. More indoor gatherings are on the horizon, and epidemiologists are predicting roughly 100,000 to 165,000 additional Covid deaths by the spring.And, for the first time, the government has bought vaccines that were reformulated in response to the virus’s evolution. Manufacturers may finally have gained on the pathogen: The Omicron subvariant that the updated shots were designed to protect against remains dominant in the United States.But, at the same time, the vaccination campaign is lagging. While two-thirds of Americans have completed the primary vaccine series, only about one-third have received boosters. The country’s per capita booster coverage trails that of some 70 other nations, according to Our World in Data.Some are worried that the country is surrendering a decisive opportunity to stoke demand for and restore the more robust vaccination efforts that lifted last year’s initial rollout.Hannah Beier for The New York TimesPartly as a result, scientists said, Americans this year have died from Covid at a rate 80 percent higher than Canadians and 30 percent higher than residents of the European Union.“We have criticisms of the way the initial vaccine rollout happened, but there was really a very significant effort to get everyone vaccinated,” said Elizabeth Wrigley-Field, a University of Minnesota sociologist, who mentioned mandates, financial rewards and large events. “None of that really exists with boosters.”With Covid deaths having plateaued around 480 a day, policymakers are grappling with whether renewed investments are needed. Some states believe they are not.In Alabama, where one-fifth of residents are boosted, Dr. Burnestine Taylor, the state’s medical officer for disease control and prevention, said officials had pared back health department clinics and become more reliant on pharmacies as demand dropped. The decision to receive additional shots, she said, now fell to individuals.“At this point, we’re not doing a hard push,” Dr. Taylor said. “It’s a personal decision.”Even some more proactive efforts have run into a wall of complacency. In Camden County, N.J., health workers have visited community events and knocked on doors, but they have not encountered as many takers as they had hoped, said Paschal Nwako, the health officer there.But other health workers said that they were still winning converts, if fewer than last year, including those who had been confused about boosters or unable to find clinics with evening availability.In Madison, Wis., Aaron Perry, a former police officer, said that $100 stipends provided by the state have helped draw a dozen or so booster recipients to his health clinic every Friday, many from Black barbershops where he also runs health screening centers.In San Bernardino, Calif., Jacinda Abdul-Mutakabbir, a pharmacist at Loma Linda University, said clinics late this spring could still attract as many as 30 first dose recipients.And in Bismarck, N.D., Renae Moch, the public health director, said organizations like food pantries and homeless shelters still wanted to host regular clinics. But with surge staffing over, workers exhausted and positions harder to fill, she said she could only hold monthly pop-up clinics at a limited number of sites — and none in September, when back-to-school immunizations would consume the staff.Of the hundreds of barbershops nationally that once hosted vaccination events, nine out of 10 are struggling to keep offering shots, said Dr. Thomas, of the University of Maryland, who has helped organize them. In some cases, he said, hospitals or pharmacies that eagerly used to send doses or staff have reported not having the money to partner with barbershops again or being concerned that small turnouts will not make it worth their while.Mike Brown cuts the hair of Michael Venable at the The Shop Spa, a barbershop outside of Washington, D.C. Michael A. McCoy for The New York Times“The health care providers lost interest in us,” said Mike Brown, a barber outside Washington, D.C. “But I don’t think now is the time to give up the fight. People are still dying.”For poorer Americans, the decrease in public vaccination sites could reduce the number who receive shots this fall, experts said.In New York, Emily Gerteis, who arranges shots for people living on the street or in shelters at the Center for Urban Community Services, recalled convincing a patient this summer to be vaccinated. But when she suggested a pharmacy, the patient refused, preferring to hold out for city clinics and their $100 incentives, Ms. Gerteis said.The problem was that those offerings no longer existed. The patient was not vaccinated.“A year ago, there was all this money for advertising, and they were throwing money at vaccines,” said Dr. Zeke McKinney, a physician in Minneapolis who had helped to organize vaccinations at his local barbershop until funding dried up. “Now, it’s like nobody cares.”The White House is still seeking more funding from Congress, which it says is also needed to produce tests and develop next-generation Covid vaccines.For now, some health officials said they were prepared to rev back up shuttered sites in the event demand surged, even if their workers were increasingly depleted. On some days recently, Dr. Mysheika Roberts, the health commissioner in Columbus, Ohio, said she needed to divert two-thirds of her Covid vaccination specialists to monkeypox clinics.“It’s a bit overwhelming for some of our staff members,” she said.Experts said that restoring health workforces and maintaining vaccine outreach could help break a boom-and-bust cycle in public health spending that has especially hurt marginalized Americans. Early investments, for example, helped narrow racial gaps in primary series vaccination rates. But in the booster rollout, considerable racial disparities have re-emerged.The relaxation of federal Covid guidance and the reluctance to incentivize booster shots has not made it any easier to persuade people of the benefits of additional doses, some health officials said.“There’s a lot of messaging from federal sources that things are good and we’re back to normal,” said Dr. Clay Marsh, West Virginia’s Covid czar. “It’s mixed messaging.”Dr. Mysheika Roberts has had to divert two-thirds of her Covid vaccination specialists to monkeypox clinics recently.Maddie McGarvey for The New York TimesHealth experts encouraged making Covid shots a routine part of people’s medical care, including by enlisting more primary care doctors in the rollout. More creative marketing could also help generate demand, said Dr. Kevin Schulman, a Stanford University professor.One example, he said, would be a campaign framed around protecting older relatives at fall or winter holiday gatherings. Despite the scientific uncertainties, he also said the time had to come to promise Americans that they would not be asked back for further Covid vaccines for at least a year — and that, when they were, it would be for an “annual Covid vaccine,” rather than a “booster.”“Marketers spend huge amounts of time trying to figure these things out,” Dr. Schulman said. “Unfortunately, we just haven’t seen effort devoted in that direction.”Ms. Bernstein, the White House adviser, said the administration was regularly surveying people about booster shots and using the results to inform messages it suggested to on-the-ground partners.Ben Weston, Milwaukee County’s chief health policy adviser, said the nation’s underfunded booster campaign had hurt the same vulnerable and often nonwhite residents who have long struggled to gain access to good medical care.“It’s putting up barriers,” he said, “particularly for populations that are more susceptible to those barriers.”

At the peak of the Omicron wave, Covid killed Black Americans in rural areas at a rate roughly 34 percent higher than it did white people.The coronavirus pandemic walloped rural America last year, precipitating a surge of deaths among white residents as the virus inflamed longstanding health deficits there.But across the small towns and farmlands, new research has found, Covid killed Black and Hispanic people at considerably higher rates than it did their white neighbors. Even at the end of the pandemic’s second year, in February 2022, overstretched health systems, poverty, chronic illnesses and lower vaccination rates were forcing nonwhite people to bear the burden of the virus.Black and Hispanic people in rural areas suffered an exceptionally high toll, dying at far higher rates than in cities during that second year of the pandemic.In towns and cities of every size, racial gaps in Covid deaths have narrowed. That has been especially true recently, when major gains in populationwide immunity have tempered the kind of pressure on health systems that appears to hurt nonwhite Americans the most.With coronavirus deaths climbing, though, and health officials bracing for an even deadlier winter, scientists warned that efforts so far to close the racial gap in vaccination rates had not been enough to insulate nonwhite people from the ravages of major Covid waves.Nowhere were those difficulties more pronounced than in rural areas. Black, Hispanic and Native American people in those places recorded the deadliest second year of the pandemic of any large racial or ethnic groups anywhere in the United States, according to the new research, which was led by Andrew Stokes, an assistant professor of global health at Boston University.In those communities, the Biden administration’s reassurances that every Covid death is now preventable jar with the difficulties of obtaining medical care.Rural pharmacies are often few and far between, making it difficult for poorer and less mobile residents to receive critical antiviral pills.Doctors said that some Black patients, especially those who are uninsured or far from hospitals, wait too long before seeking help to benefit from new treatments.And Black and Hispanic people have received booster shots at lower rates, a consequence of what some physicians describe as a lack of awareness stemming from cutbacks to public messaging, especially in conservative states.Read More on the Coronavirus PandemicYoung Children: In a new survey, a majority of American parents said they would refuse the coronavirus vaccine for their children, citing concern with the shot’s side effects.Periods: Nearly half of the participants in a recent study reported a heavier flow while menstruating after receiving the Covid vaccine. But experts said there was no cause for alarm.Boosters: The U.S. government has greenlit new vaccines to defend against the latest Omicron variants. But will the shots arrive too late?The Rise of BA.5: As the Omicron subvariant leads to a surge of new infections across the country, New Yorkers seem less inclined to get themselves into high alert mode again.“The national vibe is that everyone should now be in a position to do what they need to protect themselves from the virus,” said Bobby Jenkins, the mayor of Cuthbert, Ga., a mostly Black town whose only hospital closed six months into the pandemic. “But not everyone’s in a position to do that yet.”Racial disparities in Covid deaths have narrowed for several reasons, scientists said. The early vaccine rollout prioritized older Americans, who are disproportionately white. But over the last year, primary vaccinations for Black and Hispanic people climbed at roughly double the pace of white rates.The rate for Hispanic people, 54 percent, now exceeds that for white people, which is 50 percent. The Black vaccination rate, 43 percent, still lags, but the gap has diminished.Patients waited for Covid testing at the North Sunflower Medical Center in Ruleville, Miss.Rory Doyle for The New York TimesThe virus also infected and killed Black and Hispanic people at such greater rates in the pandemic’s first year — at one point in 2020, Black rural dwellers were dying at roughly six times the rate of white dwellers — that it may have had fewer targets by Year 2.Those changes have been so profound that among the oldest Americans, white Covid death rates have recently exceeded those of Black people, according to Centers for Disease Control and Prevention data.But the shrinking of the racial gap is partly because of a worsening of the pandemic for white people rather than serious advances for Black or Hispanic Americans. White Covid death rates climbed by 35 percent from the first to second year of the pandemic, the C.D.C. found. Over that period, death rates fell by only 1 percent in Hispanic people and 6 percent in Black people.“It’s not a movement toward equity,” said Alicia Riley, a sociologist at the University of California, Santa Cruz. “It’s that white people started getting and dying of Covid more.”The national picture has also disguised a shift that has as much to do with geography as with race, Dr. Stokes said. As the brunt of the pandemic shifted in late 2020 from big cities to rural areas, which have a bigger share of white residents, the national tally of Covid deaths naturally came to include more white people.But within rural areas, Covid deaths were apportioned at greater rates to nonwhite people, just as they were in big cities and in small or medium ones, Dr. Stokes’s team found. He used C.D.C. counts of Covid death certificates up until February, avoiding more recent and potentially incomplete data, and took into account the older age of the white population.At the worst of the Omicron wave this winter, Black and Hispanic death rates exceeded those of white people in towns and cities of every size, just as they had at the peak of every previous virus outbreak.Black death rates at this winter’s peak were greater than those of white people by 34 percent in rural areas, 40 percent in small or medium cities and 57 percent in big cities and their suburbs. The racial gap was so large in cities because white urbanites have died from Covid at vastly lower rates than white people in rural areas for most of the pandemic.

President Biden is 79, and Americans his age and older have made up larger and larger shares of those dying from Covid in recent months. The virus has taken advantage of falling immunity caused by long delays since older people’s last vaccinations, and the Omicron variant has evolved a growing ability to skirt the body’s defenses.Covid has been killing substantially fewer Americans of all ages this summer than it did during the peak of the wintertime Omicron wave. Still, older people remain at significantly higher risk.As of early June, four times as many Americans aged 75 to 84 were dying each week from the virus, compared with people two decades younger, according to data from the Centers for Disease Control and Prevention. (Those death counts are provisional, the C.D.C. cautioned, because they were based on death certificates and did not account for all deaths in those age groups.)That is an even bigger age gap than existed at the peak of the Omicron wave this winter. Then, the number of people aged 75 to 84 killed by Covid each week was twice as high as the number aged 55 to 64.The president received a second booster shot in late March, significantly reducing his risk of severe illness. This spring, people aged 50 and older who had received a single booster were dying from Covid at four times the rate of those with two booster doses, the C.D.C. has reported.In 2022, Covid deaths, though always concentrated in older people, have skewed toward older people more than they did at any point since vaccines became widely available. Many older people were vaccinated early in 2021, and among those who have not yet received a booster shot, immune defenses generated by the shots have significantly waned.In contrast, middle-aged Americans, who suffered a large share of pandemic deaths last summer and fall, are benefiting from greater stores of immune protection from both vaccination and prior infections.While Covid deaths remain far lower than in the winter, they are climbing again among older people as the immune-evasive Omicron subvariant known as BA.5 causes more infections, according to the latest C.D.C. data. From early May to early June, the number of Americans aged 75 to 84 dying from Covid each week increased by nearly 50 percent.

The emergence of highly contagious Omicron subvariants this spring in the United States appeared to reduce the protection offered by vaccines against Covid hospitalizations, scientists from the Centers for Disease Control and Prevention reported on Friday.But first and second booster shots helped to shore up people’s defenses, the agency found. The additional shots raised people’s levels of protection against those Omicron subvariants and restored some of the protection that was lost as time passed since their last shots.“Booster doses should be obtained immediately when persons become eligible,” the C.D.C. scientists wrote.The findings, however, came with a notable caveat: Measurements of vaccine effectiveness have been complicated by the number of unvaccinated people who have been infected by the virus, especially during the wintertime surge of Omicron cases.Those prior infections give people some protection against Covid. As a result, in studies like the C.D.C.’s that compare outcomes from the virus in vaccinated and unvaccinated people, the vaccines appear less protective than they really are.The C.D.C. scientists used what little information they had about patients’ infection histories to try to account for those difficulties. Using data from hospitals across 10 states, the agency’s scientists studied some 58,000 hospitalizations with a diagnosis of Covid-like illness from mid-December through mid-June. The study focused on adults with healthy immune systems.By late April, subvariants of Omicron known as BA.2 and BA.2.12.1 had outcompeted the version of Omicron that spread across the country over the winter.After those subvariants became dominant, the Pfizer-BioNTech and Moderna vaccines were less effective in keeping people from being admitted to the hospital with Covid than they had been during the wintertime Omicron wave, the study found.Two doses of the vaccines were 24 percent effective against hospitalizations after the variants took over, compared with 61 percent during the period when the original version of Omicron dominated. (Those figures held for people who had been given their second dose at least five months earlier.)That decline probably partly resulted from the ability of the subvariants to evade people’s immune defenses from the vaccine, and partly from unvaccinated people drawing some protection from earlier infections.A booster dose helped considerably, even though the benefits of those additional doses appeared to wane over time. Once the subvariants became the main sources of infection, a third dose of Pfizer or Moderna raised the vaccines’ effectiveness against hospitalization to 69 percent initially, and 52 percent after four months or more.The third doses had been even more protective during the wintertime surge of the original version of Omicron.Second boosters were authorized in late March for people 50 and older with healthy immune systems, and those additional boosters appeared to help people weather the subvariant surge, the C.D.C. found.At least a week after a fourth dose, the vaccines were 80 percent effective against hospitalizations with Covid, the agency said. That was a considerable lift from the 55 percent effectiveness offered by three doses after four months in that age group.It was not clear how quickly the protection offered by that fourth dose would diminish. The study also did not measure the vaccines’ performance against BA.5, the latest Omicron subvariant, which appears to be driving a fresh surge of cases and hospitalizations. That subvariant has become dominant among new U.S. cases and appears to be the most evasive form of Omicron to spread in the country.With hospital admissions rising, federal health officials have urged eligible people to get booster doses as soon as possible, saying that those shots would not prevent people from getting an additional dose of an updated, variant-specific vaccine in the fall or winter. The latest results reinforced the need for booster shots, the agency said.“Given recent increases in deaths and hospitalizations associated with the BA.5 variant,” the C.D.C. said on Friday, “everyone should stay up to date with recommended Covid-19 vaccinations, including additional booster doses for those who are moderately to severely immunocompromised and adults over 50.”