Resistance to vaccine mandates, once a fringe position, has entered the Republican mainstream. But the governors fighting President Biden’s Covid-19 vaccine requirements impose mandates of their own.WASHINGTON — Like other Republican governors around the country, Tate Reeves of Mississippi reacted angrily to the coronavirus vaccine mandates President Biden imposed on private businesses. Declaring the move “terrifying,” he wrote on Twitter: “This is still America, and we still believe in freedom from tyrants.”There is a deep inconsistency in that argument. Mississippi has some of the strictest vaccine mandates in the nation, which have not drawn opposition from most of its elected officials. Not only does it require children to be vaccinated against measles, mumps and seven other diseases to attend school, but it goes a step further than most states by barring parents from claiming “religious, philosophical or conscientious” exemptions.Resistance to vaccine mandates was once a fringe position in both parties, more the realm of misinformed celebrities than mainstream political thought. But the fury over Mr. Biden’s mandates shows how a once-extreme stance has moved to the center of the Republican Party. The governors’ opposition reflects the anger and fear about the vaccine among constituents now central to their base, while ignoring longstanding policy and legal precedent in favor of similar vaccination requirements.“Republicans care about getting beyond this pandemic every bit as much as Democrats do,” said Dr. Ashish Jha, the dean of the Brown University School of Public Health. But, he added, “politicians are certainly happy to exploit this issue for political gain, which is why I think the Republican governors are up in arms.”Mr. Biden also imposed vaccine mandates on federal workers and many health care workers. But Republican outrage is really boiling over his plan to require all private-sector businesses with more than 100 employees to mandate vaccines or weekly testing for their work forces.Gov. Greg Abbott of Texas called the president’s move “a power grab.” Gov. Henry McMaster of South Carolina promised to fight Mr. Biden in court, to “the gates of hell.” Gov. Greg Gianforte of Montana called it “unlawful and un-American.” Gov. Kay Ivey of Alabama called the move “outrageous” and “overreaching.”But each of these states — indeed every state in the country — already mandates certain vaccinations for children, and sometimes for adults, including health care workers and patients in certain facilities.President Biden announcing the vaccine mandate at the White House on Thursday. Experts in public health law agree that he is on solid legal footing.Al Drago for The New York TimesMississippi, which has one of the lowest coronavirus vaccination rates in the nation, has consistently led the United States in childhood vaccinations — a point of pride for its health officials and many of its lawmakers. Alabama, similar to Mississippi, also refuses to acknowledge “philosophical, moral or ethical” exemptions to mandatory childhood vaccinations.Experts in public health law agree that Mr. Biden is on solid legal footing, because his actions are grounded in federal workplace safety laws. They say Republican governors who insist that vaccine mandates are an intrusion on personal liberty need a refresher on their own state policies.“That is pure hypocrisy,” Lawrence O. Gostin, a public health law expert at Georgetown University, said of Mr. Reeves’s remarks. “Even religious exemptions are swept away in the state of Mississippi, so how can he say that an order that a president makes to keep workers safe, with authorization by Congress, is an overreach or in any way unconstitutional?”A spokeswoman for Mr. Reeves, Bailey Martin, rejected Mr. Gostin’s assertion. “The only people being hypocritical are President Biden and his administration, who for months have said they would not mandate the vaccine,” she said in an email, adding that Mr. Reeves would use “every tool at his disposal” to block the mandates.Republican suspicion of vaccines was building before the pandemic; when Donald J. Trump was running for president in 2016, he rejected established science by raising the debunked claims that vaccines cause autism. Now, some of the governors argue that given the country’s outsize divisions, and widespread suspicion of Washington, federal intervention would be counterproductive. It would be best, they say, to let state officials continue making the case that the vaccines are safe and effective, and to allow people to make decisions themselves.“I’m trying to overcome resistance, but the president’s actions in a mandate hardens the resistance,” Gov. Asa Hutchinson, Republican of Arkansas, said Sunday on NBC’s “Meet the Press.” School mandates, he said, “have always come at the state level, never at the national level. And so this is an unprecedented assumption of federal mandate authority that really disrupts and divides the country.”Dr. Jha said Mr. Biden had in fact done Republicans a favor.“What the president does is he creates political cover for Republican leaders, who will scream loudly because it’s politically expedient,” he said. “But I think many of them are actually feeling relieved, because now they don’t have to do the hard work of convincing their constituents.”Indeed, when the highly infectious Delta variant began ripping through their communities and overwhelming their hospitals, many elected Republicans — notably Senator Mitch McConnell of Kentucky, the minority leader — started pleading with people to get vaccinated. Most of the Republican governors criticizing Mr. Biden have said much the same.Even as Mr. Reeves blasted Mr. Biden on Twitter, he took care to declare the vaccine itself “lifesaving.” Mr. McMaster held a news conference last month to encourage South Carolinians to take the shots, saying, “Now is a great time to do it while we’re getting ready for the fall.” In Alabama, Ms. Ivey has adopted the same stance as Mr. Biden: “It’s time to start blaming the unvaccinated folks” for the deadly coronavirus surge, she said recently.Three-quarters of American adults have had at least one Covid-19 shot, which suggests growing acceptance of the vaccine. Mr. Biden’s move is aimed at the roughly 80 million Americans who are eligible but remain unvaccinated. Experts call it an unprecedented exercise of presidential authority to encourage vaccination.“It’s really uncharted waters,” said Claire Hannan, the executive director of the Association of Immunization Managers, which represents state immunization officials.Mr. Biden is pointing to childhood vaccine mandates to make his case.“Parents, get your teenagers vaccinated,” he said on Friday during a visit to a middle school in Washington. “You got them vaccinated for all kinds of other things. Measles, mumps, rubella. To go to school and play sports, they have had those vaccinations.”The Supreme Court has twice upheld vaccine mandates, beginning more than a century ago in the 1905 case of Jacobson v. Massachusetts, in which Justice John Marshall Harlan reasoned that a “community has the right to protect itself against an epidemic of disease” — in that case, smallpox — “which threatens the safety of its members.”Even as Gov. Tate Reeves of Mississippi blasted Mr. Biden on Twitter, he took care to declare the vaccine itself “lifesaving.”Rogelio V. Solis/Associated PressBoth cases upheld state or city mandates, and do not apply to Mr. Biden’s actions, according to Mr. Gostin. Because public health powers are reserved to the states under the Constitution, he said, the Supreme Court would almost certainly strike down a national mandate.But Mr. Biden did not impose a national mandate. He took a series of specific, limited actions that legal experts agree are within his purview as president. The mandates he announced — for the federal work force and federal contractors, for employees of health care facilities and Head Start programs that accept federal funding, and for large businesses — are grounded in powers that Congress has granted to the president, including the authority to ensure a safe workplace under the law that established the Occupational Safety and Health Administration.And Mr. Biden gave businesses an out. Employees who do not want to get vaccinated can undergo weekly testing — a fact that his critics fail to note. Mr. Reeves, for instance, asserted that the president had “no authority to require that Americans inject themselves because of their employment at a private business,” without mentioning testing as an option..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}Vaccine mandates are not new, nor is resistance to vaccination. As far back as 1721 in Boston, a vaccine opponent threw a small bomb through the window of Cotton Mather, who was promoting inoculation against smallpox during a deadly outbreak. By the early 1900s, smallpox vaccination again emerged as a contentious issue in Massachusetts, giving rise to the Jacobson case.By the 1920s, many schools in the United States required vaccination against smallpox, according to the History of Vaccines, a project of the College of Physicians of Philadelphia. When vaccines for diseases like pertussis, polio and measles became widely available in the 1940s and ’50s, the American public, inclined to have faith in science and government, voluntarily accepted them, said David Rosner, a Columbia University historian who specializes in the intersection of politics and public health.The 1960s brought social upheaval and an anti-establishment mood — and with it, the beginnings of the antivaccine movement, which led many states to enact mandates, Mr. Rosner said. Often, there is pushback, especially with newly developed vaccines.When the varicella vaccine was developed to combat chickenpox in 1995, for instance, Idaho refused to mandate it. But it was ultimately added to the state’s list of required vaccinations for children born after Sept. 1, 2005.Administering a Covid-19 vaccine in Moultrie, Ga., in July. Gov. Brian Kemp of Georgia said Mr. Biden’s move “is blatantly unlawful, and Georgia will not stand for it.”Matthew Odom for The New York TimesOne Republican governor, Pete Ricketts of Nebraska, drew a distinction between Covid-19 shots and childhood vaccines, insisting in an appearance on “Fox News Sunday” that childhood vaccine mandates do not violate personal freedoms because parents have had “a long history” with them. Of Covid-19 shots, he said, “This is a process that’s going to take time to bring people along, and that’s why it should be a personal choice.”But public health experts say the safety of the community supersedes personal liberty when everyone is at risk from a communicable disease.“It’s always a little noisy and uncomfortable” when vaccine requirements are first imposed, said Dr. Jha of Brown University. But over time, he said, “people get vaccinated and whatever infectious disease you are trying to deal with fades into the background and people move on, and that’s what I expect to happen here.”Still, never before has a vaccine been so caught up in partisan politics. Dr. Rosner sees something deeper at work.“This is part of a much larger dissolution of American society,” he said. “It is part and parcel of the resistance to all forms of social harmony and sense of social purpose that the country is undergoing right now.”Eleven states, including Arizona, Florida and Texas, have already expressly banned Covid-19 vaccine mandates, either through legislation or a governor’s order, and questions are bound to emerge over whether the president’s mandates will trump those state policies or laws. (The answer is yes, Mr. Gostin said.)Dr. Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials, warned in an interview last month that the backlash against Covid-19 vaccine mandates could prompt state legislatures to “also tinker with the idea that maybe all of these childhood vaccines are an overreach of government.”So far, at least, there is no indication of that. And even in Republican-led states where Mr. Biden’s mandates are inciting outrage, the Delta variant is making the case for him. In Mississippi, one of the hardest-hit states, hospitals were so overwhelmed last month that the University of Mississippi Medical Center put up a field hospital in its parking garage.Today, the state is no longer last in the nation for Covid-19 vaccination, as it was throughout the spring and into early July. More than half of Mississippi adults are fully protected against the coronavirus.

The plan calls for an initial investment of at least $15 billion — half of what President Biden initially proposed.WASHINGTON — The White House, stepping into delicate negotiations on Capitol Hill over funding to prevent future pandemics, unveiled on Friday a $65.3 billion preparedness plan that it likened to the Apollo missions to the moon, and called on Congress to immediately invest at least $15 billion for the effort.But the $15 billion figure is only half of what Mr. Biden initially proposed, and the announcement on Friday drew complaints from health experts who warned lawmakers not to squander an opportunity to use the lessons of the coronavirus pandemic to fully prepare the nation for the next one.The plan, drafted by President Biden’s science adviser, Eric S. Lander, and his National Security Council, would establish a full-time “Mission Control” office to coordinate the work of agencies across the government to spot emerging threats and ready the nation to fight them. It calls for $65.3 billion to be spent over the next seven to 10 years.Roughly a third of the total investment, $24 billion, would be allocated to developing, testing and manufacturing new vaccines for a broad range of viral threats. Nearly $12 billion would be for developing therapeutics, and $5 billion for diagnostic tests; the rest would help develop early warning systems, improve the nation’s pandemic preparedness stockpile and build capacity for manufacturing vital supplies.“We’ve got to seize the unique opportunity to transform our scientific capabilities so we’re prepared for the increasing frequency of biological threats on the horizon,” Dr. Lander said, adding, “And it’s vital that we start with an initial outlay of $15 to $20 billion to jump start these efforts.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}Mr. Biden’s request for $15 billion to be included in a sweeping budget bill Democrats intend to pass in the coming weeks represents a significant compromise. In March, the White House announced that its American Jobs Plan would include $30 billion for pandemic preparedness. But on Capitol Hill, where moderate Democrats are pushing to lower the price tag of the $3.5 trillion package, lawmakers have considered spending $8 billion on pandemic preparedness.“It would be a travesty if, in this time of the worst pandemic in a century, the administration and Congress, both sides of the aisle, didn’t get together and provide substantial funding to greatly reduce the risk of future pandemics,” said Dr. Tom Frieden, who ran the Centers for Disease Control and Prevention in the Obama administration.In July, when it looked like Democrats on Capitol Hill might slash the president’s $30 billion request to $5 billion, Dr. Frieden and Tom Daschle, a former Senate Democratic leader who made health care his signature issue, wrote an opinion essay in The Hill that argued such a cut was unthinkable after the worst public health crisis in a century.Mr. Daschle said Friday that both $15 billion and $65 billion were “a fraction of what is needed now.” The Bipartisan Commission on Biodefense, a private organization of which he is a member, has proposed $100 billion over 10 years, he said.“I am very concerned that if we don’t commit the resources now, it will only get harder, and less likely, in the years ahead,” Mr. Daschle wrote in an email. “Now is the time to apply lessons learned.”Some Democrats have repeatedly called for the initial $30 billion to be included in the budget package. Among them are Senator Patty Murray, Democrat of Washington and the chairwoman of the Senate health committee, and Senator Elizabeth Warren, Democrat of Massachusetts. Ms. Warren and six of her Democratic colleagues recently wrote to the House and Senate leaders of both parties, calling on them to include $30 billion in the budget package “to prevent and prepare for future pandemics.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}“The Covid-19 pandemic has made clear that underinvesting in our public health infrastructure, our biomedical research pipeline and our medical supply chain has disastrous consequences,” the senators wrote.Committees are still negotiating the details of the budget package, and several people familiar with the plan said the White House announcement on Friday might be an effort to press leaders on Capitol Hill — especially Senator Chuck Schumer, Democrat of New York and the majority leader — to get behind the administration’s full $65.3 billion plan and to commit to at least $15 billion in the budget measure.Mr. Schumer has so far been noncommittal. “I’ve been working and I’ll keep working to make the investments needed to ensure we are fully prepared for future pandemics,” he wrote last month on Twitter.Dr. Lander was joined on Friday by Elizabeth Cameron, the senior director for global health security and biodefense on the National Security Council — a job she also held in the Obama White House, where she drafted a preparedness document known as the pandemic playbook. She said the Biden plan “very much draws on those efforts,” as well as “on lessons from this pandemic.”According to documents released by the White House, the plan has five central goals: improving and expanding the nation’s arsenal of vaccines, therapeutics and diagnostics; improving surveillance of infectious disease threats; strengthening the public health system, with a “particular focus on reducing inequities”; building up the supply chain and the stockpile for personal protective gear and other items; and “managing the mission,” by creating a new Mission Control office — a task Dr. Lander likened to the Apollo missions to send astronauts to the moon in the 1960s.“If you’re getting to the moon, and you have a great booster rocket but you haven’t got a capsule capable of landing or computers capable of directing, it’s not going to work,” he said.

President Biden, who has pledged to fight the coronavirus pandemic by making the United States the “arsenal of vaccines” for the world, is under increasing criticism from public health experts, global health advocates and even Democrats in Congress who say he is nowhere near fulfilling his promise.Mr. Biden has either donated or pledged about 600 million vaccine doses to other countries — a small fraction of the 11 billion that experts say are needed to slow the spread of the virus worldwide. His administration has also taken steps to expand Covid-19 vaccine manufacturing in the United States and India, and is supporting production in South Africa and Senegal to expand access to locally produced vaccines in Africa.But with the administration now recommending booster doses for vaccinated Americans starting next month, outraged public health experts and many Democrats on Capitol Hill are calling on the president to move more aggressively to scale up global manufacturing. In an analysis published on Thursday, the AIDS advocacy group PrEP4All found that the administration had spent less than 1 percent of the money that Congress appropriated for ramping up Covid-19 countermeasures on expanding vaccine manufacturing.Tracking Coronavirus Vaccinations Around the WorldMore than 5.08 billion vaccine doses have been administered worldwide, equal to 66 doses for every 100 people.Congress put a total of $16.05 billion in the American Rescue Plan this year, in two separate tranches, that could be used to procure and manufacture treatments, vaccines and tools for ending the pandemic. But PrEP4All found that all told, the administration had spent $145 million — just $12 million of it from the American Rescue Plan — to expand vaccine manufacturing. The United States has donated 115 million surplus doses, and has purchased 500 million more from Pfizer and BioNTech to be distributed through Covax, more than any other country. But that is still a minute fraction of the 12 billion doses Duke University’s Global Health Innovation Center predicts the world needs by the end of 2021. James Krellenstein, a founder of PrEP4All and the author of its report, said “if they don’t change course pretty soon, the Biden administration is going to be remembered in terms that the Reagan administration is remembered today in not dealing with the AIDS crisis.”

Congress appropriated $16 billion to ramp up Covid-19 countermeasures, but a new report found that the Biden administration had spent very little of it on expanding vaccine manufacturing capacity.WASHINGTON — President Biden, who has pledged to fight the coronavirus pandemic by making the United States the “arsenal of vaccines” for the world, is under increasing criticism from public health experts, global health advocates and even Democrats in Congress who say he is nowhere near fulfilling his promise.Mr. Biden has either donated or pledged about 600 million vaccine doses to other countries — a small fraction of the 11 billion that experts say are needed to slow the spread of the virus worldwide. His administration has also taken steps to expand Covid-19 vaccine manufacturing in the United States and India, and is supporting production in South Africa and Senegal to expand access to locally produced vaccines in Africa.But with the administration now recommending booster doses for vaccinated Americans starting next month, outraged public health experts and many Democrats on Capitol Hill are calling on the president to move more aggressively to scale up global manufacturing. In an analysis to be published on Thursday, the AIDS advocacy group PrEP4All found that the administration had spent less than 1 percent of the money that Congress appropriated for ramping up Covid-19 countermeasures on expanding vaccine manufacturing.Congress put a total of $16.05 billion in the American Rescue Plan this year, in two separate tranches, that could be used to procure and manufacture treatments, vaccines and tools for ending the pandemic. But PrEP4All found that all told, the administration had spent $145 million — just $12 million of it from the American Rescue Plan — to expand vaccine manufacturing. The bulk of that went to retrofitting production lines at Merck, the pharmaceutical giant, which is teaming up with Johnson & Johnson to produce one billion vaccine doses starting in early 2022.White House officials dispute the $145 million figure, but did not respond to repeated questions about how the administration planned to use the bulk of the $16 billion. Senator Patty Murray, Democrat of Washington and the chairwoman of the Senate health committee, has also asked for a more detailed accounting, her office said.On Capitol Hill, 116 Democrats, including Senator Elizabeth Warren of Massachusetts, have called for putting $34 billion to increase vaccine manufacturing capacity in the upcoming budget reconciliation act. This month, they wrote to the president asking him to endorse the idea, but have not gotten a response, said Representative Raja Krishnamoorthi, Democrat of Illinois, who is leading the effort in the House.“This lack of attention to executing a robust vaccination strategy abroad is arguably one of their biggest missteps with regard to Covid,” said Mr. Krishnamoorthi, who said he lost three members of his extended family in India to Covid-19..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}James Krellenstein, a founder of PrEP4All and the author of its report, was more pointed. “If they don’t change course pretty soon,” he said, “the Biden administration is going to be remembered in terms that the Reagan administration is remembered today in not dealing with the AIDS crisis.”Addressing the world’s coronavirus vaccine needs is a complicated endeavor, with many layers of challenges. Vaccine makers around the world, including those in Russia, China and India, have predicted a total of 12 billion doses by the end of 2021, according to Duke University’s Global Health Innovation Center, which tracks vaccine manufacturing and publishes the Launch & Scale Speedometer website. Eight months into the year, an estimated five billion have been delivered.Some manufacturers are falling behind. Novavax has had production problems. Johnson & Johnson, which initially planned for one billion doses this year, has made slightly more than 103 million, Mr. Krellenstein said, citing data from the scientific intelligence firm Airfinity. That is in part because its contract manufacturer, Emergent BioSolutions, ruined up to 15 million doses, prompting the Food and Drug Administration to shutter its Baltimore plant for three months.If 12 billion doses were indeed produced and equitably distributed by year’s end, the world’s needs could be met. But, the Duke institute wrote, “those are both big ifs.”Several other countries as well as the United States are already recommending booster shots, which will cut into the supply. And the virus changes shape so rapidly — the highly infectious Delta variant is now dominant around the globe — that the vaccines developed last year may soon be outdated, said Dr. Richard Hatchett, the chief executive of the Coalition for Epidemic Preparedness Innovations, which helps lead the international vaccine effort known as Covax.In the short term, poor nations need doses, and Mr. Biden is correct when he says the United States has donated more than any other country. The United States has already donated 115 million surplus doses from the nation’s own supply, and has purchased 500 million doses from Pfizer and BioNTech to be distributed through Covax. With the United States planning for booster shots, one official said, there is no surplus right now.“Their financial contributions are huge — no other country has pledged as much as the U.S.,” Dr. Hatchett said. But, he added, “it’s not to say that they can’t and shouldn’t do more.”Dr. Hatchett said he would like to see a more nuanced discussion of the logistics of not only making vaccines for poor and middle-income nations, but also administering them. The New York Times recently reported that Covax was having trouble getting those shots into people’s arms. Unused doses are sitting idle on airport tarmacs in poor nations that lack the money and capacity to buy fuel to transport doses to clinics, to train people to give the shots — and to persuade people to take them.Mr. Biden took his first steps to address the vaccine shortage in March, when the White House announced the Merck deal as well as a partnership with Japan, India and Australia aimed at expanding manufacturing capacity. That included a pledge to help Biological E, an Indian manufacturer, produce one billion doses by the end of 2022.A White House official said the United States International Development Finance Corporation, which is making the investment, “expects to begin disbursing funds within the next several weeks.” The official did not offer specifics, or an amount.Mr. Biden promised in June that the United States would begin an “entirely new effort” to increase vaccine supply and vastly expand manufacturing capacity, most of it in the United States. He also put Jeffrey D. Zients, the White House coronavirus response coordinator, in charge of developing a global strategy. Mr. Zients pledged to work with U.S. manufacturers to “vastly increase supply for the rest of the world in a way that also creates jobs here at home.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}But since then, the Delta variant has shifted the focus to the new domestic crisis. Dr. Krishna Udayakumar, the director of the center at Duke, faulted Mr. Biden for pursuing an approach that “continues to be piecemeal” — an assessment echoed by J. Stephen Morrison, a global health expert at the Center for Strategic and International Studies in Washington.“They don’t have a strategy, nor do they have a structure to execute it,” Mr. Morrison said.White House officials say that it is not possible for them to scale up production quickly, in part because of a scarcity of raw materials, and that doing so would take three to five years — an assertion that Dr. Tom Frieden, who directed the Centers for Disease Control and Prevention during the Obama-Biden administration, dismissed as “nonsense.”Dr. Frieden, now the president of Resolve to Save Lives, a health nonprofit, pointed to Lonza, a Swiss biotechnology company, which entered into an agreement with the vaccine maker Moderna in May 2020, retrofitted its facility in Portsmouth, N.H., and was producing vaccine six months later.“People say, ‘Oh, it’s going to take months,’” Dr. Frieden said. “Well, Covid is with us for years. The best time to plant a tree is 20 years ago. The second best time is today.”Dr. Frieden and others also want the Biden administration to lean more heavily on Pfizer and Moderna to transfer their technology to manufacturers around the globe. The Financial Times reported this week that South Korean vaccine makers are poised to expand, but are struggling to secure intellectual property licensing deals with the two companies.Mr. Biden is likely to make some kind of announcement about addressing the pandemic when the United Nations General Assembly convenes in New York for its annual meeting in September. The administration is considering creating a government-owned manufacturing plant that would be run by a private contractor — a plan endorsed by PrEP4All. But a person familiar with the proposal said it was only a possibility at this point.There are challenges with such an approach, particularly if experienced vaccine makers do not participate, as the situation with Emergent BioSolutions demonstrated.Mr. Krishnamoorthi said the Democrats’ plan was modeled on PEPFAR, the President’s Emergency Plan for AIDS Relief, an initiative started by President George W. Bush that has invested $85 billion to address the global AIDS epidemic.Public Citizen, the nonprofit consumer advocacy organization, has a plan calling for the government to invest $25 billion in developing regional manufacturing hubs around the world, which it says would produce enough vaccine for low- and middle-income countries in a year.“He’s said, ‘We’ll be an arsenal for the world’ — that’s a little vague,” said Peter Maybarduk, who directs Public Citizen’s Access to Medicines program. “What we see instead are dribs and drabs, like the excess of the U.S. supply, maybe if we’re not using it for third shots at home.”

Districts are heeding President Biden’s call to host pop-up vaccination clinics. But promoting vaccines is politically difficult, and persuading parents isn’t easy.CHEYENNE, Wyo. — There were no cheery signs urging “Get your Covid-19 vaccine!” at the back-to-school immunization clinic at Carey Junior High School last week. In the sun-drenched cafeteria, Valencia Bautista sat behind a folding table in a corner, delivering a decidedly soft sell.Hundreds of 12- and 13-year-olds streamed through with their parents to pick up their fall schedules and iPads. Ms. Bautista, a county public health nurse, wore a T-shirt that said “Vaccinated. Thanks, Public Health” and offered vaccines against ailments like tetanus and meningitis, while broaching the subject of Covid shots gently — and last.By day’s end, she had 11 takers. “If they’re a no, we won’t push it,” she said.Vaccination rates among middle and high school students need to rise drastically if the United States is going to achieve what are arguably the two most important goals in addressing the pandemic in the country right now: curbing the spread of the highly infectious Delta variant and safely reopening schools. President Biden told school districts to hold vaccination clinics, but that is putting superintendents and principals — many of whom are already at the center of furious local battles over masking — in a delicate position.The Pfizer-BioNTech vaccine is authorized for people 12 and older, but administering it to anyone younger than 18 usually requires parental consent, and getting shots into the arms of teenagers has proved harder than vaccinating adults. Only 33 percent of 12- to 15-year-olds and 43 percent of 16- and 17-year-olds are fully vaccinated, according to federal data, compared with 62 percent of adults. Yet some school districts offering the shots, along with pediatrics practices, appear to be making progress: Over the past month, the average daily number of 12- to 15-year-olds being vaccinated rose 75 percent, according to Biden administration officials.Wyoming won national praise for keeping schools open all last year. Despite the Delta surge and a C.D.C. recommendation for universal masking in schools, Gov. Mark Gordon recently said he would not impose another mandate but would leave it to each district to decide.Rachel Woolf for The New York TimesAs the school year begins, many superintendents do not know how many of their students are vaccinated against Covid-19; because it is not required, they do not ask.It is no surprise that nurses like Ms. Bautista are circumspect in their approach. In Tennessee, the state’s top immunization leader, Dr. Michelle Fiscus, said she was fired last month after she distributed a memo that suggested some teenagers might be eligible for vaccinations without their parents’ consent.In Detroit, where county health officials have been running school-based clinics all summer, nurses discovered “strong hesitancy” when they made more than 10,000 calls to parents of students 12 and older to ask whether their children would get the shots and answer questions about them, said the deputy superintendent, Alycia Meriweather. More than half said no.In Georgia, Savannah-Chatham County Public Schools held their back-to-school clinic at the mall — a “neutral location,” said M. Ann Levett, the superintendent. She is also planning school-based clinics, she said, despite some political pushback and “Facebook chatter” accusing her of “pushing the vaccine on kids.”Ms. Levett said she was deeply concerned about whether she would be able to keep schools open.“This is only the second day of school, and already we have positive cases among children,” she said in a recent interview. Her district has a mask mandate, but with 37,000 students, “I just introduced 37,000 more opportunities for the numbers to rise.”In Laramie County, the center of the Delta surge in Wyoming, the Health Department proposed back-to-school clinics to Janet Farmer, the head nurse in the larger of the county’s two school districts. Ms. Farmer knew she would have to tread carefully. The flier she drafted for parents of students at the county’s three middle schools made little mention of Covid-19.“Vaccines — NOT Mandatory,” it declared.Nationally, more children are hospitalized with Covid-19 — an average of 276 each day — than at any other point in the pandemic. In Laramie County, Dr. Andrew B. Rose, a pediatrician at the Cheyenne Children’s Clinic and the president of Wyoming’s chapter of the American Academy of Pediatrics, said two newborns — one a few days old, the other younger than two weeks — were recently admitted to the hospital with Covid-19 symptoms after their parents tested positive.Dr. Andrew B. Rose, a pediatrician at the Cheyenne Children’s Clinic and the president of Wyoming’s chapter of the American Academy of Pediatrics, said two newborns were recently admitted to the hospital with Covid-19 symptoms after their parents tested positive.Rachel Woolf for The New York TimesMargaret Crespo, the superintendent of Laramie County School District 1 in Wyoming, plans to make an official announcement on masking on Friday, before school starts on MondayRachel Woolf for The New York TimesWyoming, a heavily Republican state where nearly 70 percent of voters cast their ballots for former President Donald J. Trump in 2020, has one of the nation’s lowest vaccination rates, with about a third of its population fully vaccinated. Laramie County has about 100,000 people and Cheyenne, the state capital, which bills itself as “home to all things Western” including “rodeos, ranches, gunslingers” and eight-foot-tall cowboy boots.At Casey Junior High, few children or adults wore masks at the recent clinic, despite a sign on the door saying they were “strongly recommended.” Parents seemed to have visceral reactions; they were either enthusiastic about the Covid shot or adamantly against it. Those who were wavering were few and far between, and not easy to persuade.A nurse in blue scrubs and her husband, a nuclear and missile operations officer at the nearby Air Force base, who declined to give their names, wandered past Ms. Bautista’s table with their 12-year-old son. Their daughter, 13, has cystic fibrosis and is vaccinated. But their son was reluctant. They chatted amiably with Ms. Bautista, but decided to wait.Cheyenne Gower, 28, and her stepson Jaxson Fox, 12, both said they were leaning toward getting the shot after talking with their doctors. Ms. Gower, citing the Delta surge, said she would get vaccinated soon. Jaxson said he was “still thinking about it” after his pediatrician discussed the risk of heart inflammation, a very rare side effect seen in young boys ages 12 to 17.“Put down that I’m more on the getting it side,” he instructed, eyeing a reporter’s notebook.Although the vaccines were tested on tens of thousands of people and have been administered to nearly 200 million in the United States alone, many parents cited a lack of research in refusing. Aubrea Valencia, 29, a hair stylist, listened carefully as Ms. Bautista explained the reasons for the human papilloma virus and meningitis vaccines. Ms. Valencia agreed that her daughter should take both.But when it came to the coronavirus vaccine, she drew the line. “The other two have been around longer,” she said, adding that she might feel “different about it if we had known someone who died” from the coronavirus.Every once in a while, the nurses encountered a surprise, as when Kristen Simmons, 43, a professional dog handler, marched up with her son, Trent.“He turned 12 on Monday, and so we want to get his Covid vaccine,” she declared. Ms. Bautista and the other nurses looked stunned.District 1 offered coronavirus vaccines at mandatory clinics to educate high school student athletes about concussions; 32 students accepted shots, said Janet Farmer, a nurse.Rachel Woolf for The New York Times“We tend to be more liberal,” Ms. Simmons later said — a statement that would have sounded odd in explaining a medical decision before the pandemic.In the spring, when vaccines were limited to older Americans who were clamoring for them, officials including Dr. Anthony S. Fauci, the top U.S. infectious diseases expert, envisioned fall 2021 as the last mile of a campaign that could produce “herd immunity” by year’s end. Vaccinating children was crucial to that plan.Now it is clear that will not happen. Children ages 11 and under are not yet eligible, but if and when the vaccine is authorized for them, experts expect it could be harder to persuade their parents than those of older children. A recent survey by the Kaiser Family Foundation found that parents of younger children were “generally more likely to be hesitant to vaccinating,” said Liz Hamel, who directed the research..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}For school superintendents and public health officials who are intent on bringing students back to the classroom — and keeping them there — the low vaccination rates, coupled with the Delta surge, are worrisome. Wyoming won national praise for keeping schools open all last year. Gov. Mark Gordon, who contracted Covid-19 last year and has encouraged people to get vaccinated, imposed a statewide mask mandate in December that he kept in place for schools even after he lifted it in March, which helped limit the spread of disease in classrooms. Despite the Delta surge and a recommendation from the C.D.C. for universal masking in schools, Mr. Gordon, a Republican, said this month that he would not impose another mandate and that he would leave it to each district to decide.In Laramie County School District 1, which has about 14,000 students, including about 840 at Carey Junior High, the school board recently cut short its public meeting about masking when a man began ranting about another hot-button issue: critical race theory.The vaccine clinic, top right, shared a room with a back-to-school event at Carey Junior High.Rachel Woolf for The New York Times“Fifty percent of the calls here have been, ‘Please mask our kids,’ and 50 percent of the calls have been, ‘We’re not wearing masks,’” said Margaret Crespo, who left Boulder, Colo., about six weeks ago to become the new District 1 superintendent. “There’s no gray area.”Dr. Crespo plans to make an announcement on masking on Friday, just before the school year starts on Monday. Fights over the masking issue are even more divisive than the vaccination campaign, “and that is playing out in front of our eyes,” said Ray Hart, the executive director of the Council of the Great City Schools, which represents the country’s largest urban school districts. “Everywhere I go this summer, that’s part of the message: Let’s get vaccinated,” said Allen Pratt, the executive director of the National Rural Education Association. But “because it’s government, you’ve got a line in the sand where people don’t trust you, and you’ve got to be understanding.”White House officials have also been encouraging pediatricians to incorporate coronavirus vaccination into back-to-school sports physicals. Many districts are offering the shots during sports practice, with a reminder to athletes that if they are vaccinated, they will not have to quarantine and miss games if they are exposed to the coronavirus.Sarah McFadden waiting with her 12-year-old son, Benjamin, after he received his Covid vaccine at the clinic at Carey Junior High School last week.Rachel Woolf for The New York TimesLaramie County District 1 offered coronavirus vaccines at mandatory clinics to educate high school student athletes about concussions; 32 students accepted shots, said Ms. Farmer, the nurse. The numbers were better at the junior high clinics; over two days at three schools with a total of about 2,400 students, more than 100 took their shots.Ms. Farmer was satisfied.“If it’s 100 people,” she said, “that’s 100 that didn’t have it yesterday.”

With vaccination rates lagging among young people, the administration wants to incorporate vaccination into school sports physicals and is asking schools to host vaccine clinics.WASHINGTON — The White House, worried that coronavirus vaccination rates among young people are lagging as the school year approaches, is enlisting pediatricians to incorporate vaccination into back-to-school sports physicals and encouraging schools to host their own vaccination clinics as part of a new push to get students their shots.The initiative, announced on Thursday by Education Secretary Miguel A. Cardona, is part of a broader “return to school road map” aimed at getting students back to in-person learning this fall. School officials around the country are worried that a surge in coronavirus cases, fueled by the highly infectious Delta variant, will threaten the return.Roughly 90 percent of the country’s educators are vaccinated, Dr. Cardona said during an appearance in the White House briefing room, and the administration sees vaccinating students as essential to keeping schools open. But experts and school superintendents said in interviews that increasing vaccination rates among students may be a slow and uphill battle.“When you look at a map of the United States and you see those states that have low vaccination rates and high infection rates, those are the areas where superintendents are having problems in getting kids vaccinated,” said Dan Domenech, executive director of AASA: The School Superintendents Association, which represents about 13,000 superintendents around the country.Young people ages 12 and older have been eligible for vaccination since May, when the Food and Drug Administration gave emergency authorization to the Pfizer-BioNTech vaccine. Though the nation has met President Biden’s goal of having at least 70 percent of adults at least partially vaccinated, only 40.7 percent of 12- to 15-year-olds and 51 percent of 16- to 17- year olds have received at least one dose, according to data collected by the Centers for Disease Control and Prevention.Last week the C.D.C. said it wanted in-person schooling to resume across the country, and updated its mask guidance to call for universal mask use by students, staff members and visitors in schools, regardless of their vaccination status or the rate of community transmission of the virus.Dr. Cardona issued a pointed message to Republican governors, including Ron DeSantis of Florida and Greg Abbott of Texas, about the steps they have taken to prevent local officials from requiring face coverings.“Don’t be the reason why schools are interrupted,” Dr. Cardona said. “Kids have suffered enough.”A White House official, speaking on condition of anonymity to preview Dr. Cardona’s announcement, said the administration was focusing on school athletics as an important path to vaccination.Millions of students play organized sports, and some school officials are making the case that if student athletes get vaccinated, they will be able to avoid quarantining — and forfeiting their games — if they are exposed to an infected person.To that end, the White House official said, the administration has enlisted groups including the American Academy of Pediatrics and the American Medical Society for Sports Medicine to help put out guidance for doctors and update the forms required for school physicals. Dr. Cardona and Doug Emhoff, the husband of Vice President Kamala Harris, are expected to visit a school vaccination clinic in Kansas next week.“Don’t be the reason why schools are interrupted,” said Miguel A. Cardona, the education secretary. “Kids have suffered enough.”Sarahbeth Maney/The New York TimesThe White House has also declared the week beginning this Saturday as “a week of action,” in which the administration is partnering with community groups to run texting campaigns and phone banks to encourage young people to get their shots.Mr. Biden called last week for every school district to host at least one pop-up vaccination clinic, and many schools and school districts — particularly those in urban areas — are already doing so.The Covid Collaborative, a bipartisan group of politicians and policymakers, has also been working with the White House and educational associations to promote school-based clinics. “Schools as vaccination sites is an issue whose time has come,” said John Bridgeland, a founder of the collaborative..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}Schools have been integral to past vaccination campaigns, especially those aimed at controlling infectious diseases. In 1875, New York City used schools to deliver the smallpox vaccine, and schools were used in the 1950s to deliver the Salk polio vaccine. During the 2012-13 school year, a school vaccination project in rural Kentucky administered the HPV vaccine, significantly improving vaccination rates, according to the National Association of School Nurses.But like everything else in the pandemic, the coronavirus vaccines have become caught up in partisan politics. Some school officials are finding that persuading parents to get their students vaccinated is difficult, and some are encountering resistance to using schools as vaccination clinics.The school district in Anchorage has been a national leader in encouraging vaccination. A clinic it hosted at the district headquarters drew 29,000 people between January and April, many of them older adults eager for their shots, the district superintendent, Deena Bishop, said in an interview.But when Anchorage set up clinics in schools over the summer, the demand was much lower; those clinics vaccinated only about 30 students a day, Dr. Bishop said. She said athletes, in particular, respond to the message that vaccination can help them avoid having to quarantine after an exposure to the coronavirus.“Kids will bug their parents more about playing sports and having a vaccine than they would just to go to science class,” she said, adding, “We’re disappointed in the number of people coming out to get vaccinated, but we’re just trying to think of new ways, new manners to connect.”Dr. Cardona reiterated the president’s call for schools to host pop-up vaccine clinics. But some superintendents said school-based clinics, which typically partner with local pharmacies or county health departments, are an especially hard sell in rural areas where there is already resistance to vaccination.“For people who are for it, it’s an easy one — they support vaccination as a strong strategy to fight Covid, and they don’t see any issue with the use of public space,” said Kristi Wilson, the superintendent of the Buckeye Elementary School District, just outside Phoenix, and the immediate past president of the superintendents association.“But the other side I’m hearing is, ‘Where do you draw the line? Who’s going to administer it? Even if public health does it, is it an appropriate use of space?’” she said. “If you have a community that is very anti-vaccination, how do you manage that?”

President Biden intends to nominate Dr. Rahul Gupta, who led West Virginia’s response to a devastating opioid crisis, to run the National Office of Drug Control Policy — a choice that may generate opposition from advocates for people with substance abuse problems.If confirmed by the Senate, he would become the first medical doctor to serve as the nation’s “drug czar” since the role was created in 1988. Dr. Gupta is currently the chief medical and health officer at March of Dimes.White House officials confirmed Mr. Biden’s choice of Dr. Gupta, which was reported earlier in The Washington Post. The president is expected to make his announcement later on Tuesday.On Wednesday, the Centers for Disease Control and Prevention will publish preliminary statistics on drug overdose deaths in 2020 that, by all indications, will shatter previous records. Overdose deaths rose by nearly 30 percent over the 12-month period that ended in November, from more than 71,000 to more than 90,000, according to preliminary federal data released last month.As West Virginia’s commissioner of public health and state health officer from 2015 to 2018, Dr. Gupta won praise for his aggressive response to the opioid crisis. Mr. Biden’s choice of Dr. Gupta may also be politically strategic: He is an ally of Senator Manchin, the moderate West Virginia Democrat whose vote is crucial to the president’s legislative agenda.But Dr. Gupta also garnered criticism for failing to stop the city of Charleston from closing its needle exchange program — a key component of the strategy known as “harm reduction,” which has been embraced by the Biden administration.Instead of helping drug users achieve abstinence, harm reduction aims to reduce their risk of dying or acquiring infectious diseases like AIDS, including by giving them sterile equipment.While Dr. Gupta was health commissioner, his department issued a report that found fault with the Charleston program and led to its decertification after it had already shut it down. The program had been nationally recognized, but was criticized by the city’s mayor at the time. Public health experts said its closure had a chilling effect on other programs, and kept some from getting off the ground.“The Biden administration has made enhancing evidence-based harm reduction programs a priority, and it’s my sincere hope that Dr. Gupta will embrace that policy and show clear leadership on that issue,” said Robin Pollini, an associate professor of behavioral medicine of psychiatry at West Virginia University, who has in the past been critical of Dr. Gupta.In a 2018 interview with West Virginia public broadcasting, Dr. Gupta spoke out against the closure, saying it was “not in the best interest of the community” when needle exchange programs like Charleston’s are shut down “reactively.”“It plays into that stigma and is more harmful long-term than it is beneficial,” the outlet quoted him as saying.The son of an Indian diplomat, Dr. Gupta was born in India and grew up in Washington, D.C. He completed medical school at the University of Delhi when he was 21, according to a biography supplied by the White House.The drug control policy office was created by Congress as part of the Anti-Drug Abuse Act of 1988, signed into law by President Ronald Reagan.

Less than half the country is fully vaccinated against Covid-19, and the contagious Delta variant is spreading. Still, the White House is putting together an “America’s Back Together” celebration for July 4.WASHINGTON — President Biden’s plan to celebrate “independence from the virus” on the Fourth of July is running into an unpleasant reality: Less than half the country is fully vaccinated against the coronavirus, and the highly contagious Delta variant is threatening new outbreaks.The president and Jill Biden, the first lady, have invited 1,000 military personnel and essential workers to an Independence Day bash on the South Lawn of the White House. Mr. Biden and his advisers, eager to claim credit for the virus’ retreat in the United States, are talking about a “summer of joy and freedom.”Mr. Biden will visit Traverse City, Mich., on Saturday as part of what the White House calls the “America’s Back Together” celebration. Dr. Biden will also take to the road, as will Vice President Kamala Harris, her husband, Doug Emhoff, and various cabinet officials who will attend festivals, parades and cookouts around the nation.But public health experts fear that scenes of cross-country celebrations — including a White House party with a liberation theme — will send the wrong message when wide swaths of the population remain vulnerable and true independence from the worst public health crisis in a century may be a long way off.“We’re still in the middle of this marathon,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University. Despite considerable progress in decreasing the number of coronavirus cases and deaths in the United States over the past few months, he said, it remains too early to “unfurl the ‘mission accomplished’ banner.”Suggesting that the country is moving past the pandemic is a delicate task for Mr. Biden and his fellow Democrats, who must balance caution with bolstering the economy and getting national morale back on track.The Democratic National Committee this week released an upbeat ad entitled “America’s Coming Back.” Its spokeswoman wrote on Twitter that the “America’s Back” mobile — a bus with the president’s image on it — would be traveling the country and offering free Jeni’s Splendid Ice Creams, a gourmet brand favored by Speaker Nancy Pelosi.The blowback was swift. “Need to rename this the ‘USS Tone Deaf McCovid Mobile,’” a Twitter user wrote.In interviews, several family members of Covid-19 victims said it was difficult to hear Mr. Biden suggest that the nation was returning to normal while they were still grieving.“There’s no return to normalcy for us,” said Sabila Khan, 42, of Jersey City, N.J., who created a Facebook support group after her father died of Covid-19. “It’s very nerve-racking when the government is encouraging you to just move beyond it. We lost our loved ones. We are never moving past this.”White House officials said Mr. Biden was hardly declaring victory or “mission accomplished,” but simply wanted to take stock of the gains the United States had made against the virus since he took office.“The Fourth of July is a moment for us to step back and celebrate our progress,” Jeffrey D. Zients, the White House coronavirus response coordinator, told reporters on Thursday. At the same time, he said, “There’s a lot more work to do. So we’re going to double down our efforts to keep pushing more and more people to get vaccinated.”The United States has made significant progress against the pandemic since Mr. Biden took office on Jan. 20 warning of a “dark winter” ahead. Daily reports of new cases are holding steady at about 12,000, the lowest since testing became widely available, according to a New York Times database — down from about 200,000 on Inauguration Day.For the first time since March 2020, the country is averaging fewer than 300 newly reported deaths a day, a decline of about 20 percent over the past two weeks. Hospitalizations are also dropping.But the advances have been uneven, with a large portion of U.S. cases emerging in a handful of hot spots, particularly where vaccination rates are low. Las Vegas, rural Utah, rural Arkansas, Cheyenne, Wyo., and the Missouri Ozarks are among the places with upticks. And because the national trend lines are flat, experts do not know precisely which way they will go.“If you looked a couple of weeks ago, most of those projections were trending downwards; it looked like we were sailing into summer,” said Lauren Ancel Meyers, an epidemiologist at the University of Texas at Austin. “Those projections now have flatlined. We’re not necessarily seeing an indication yet that things are going to surge in parts of the country, but we aren’t sure what’s going to happen.”A number of governors are planning to lift their public health emergency orders in the coming weeks; Maryland and Virginia lifted their orders on Thursday, bringing an end to mask mandates and other restrictions.But the national emergency declared by President Donald J. Trump remains in effect through late July, and the White House has told governors that Mr. Biden plans to extend it, officials said.The vaccination campaign, meanwhile, is plodding along, with about a million shots administered each day. Mr. Biden had hoped to have 70 percent of adults at least partly vaccinated by July 4, but the White House conceded last month that it would not meet that goal.The truer measure of protection, experts say, is whether people are fully vaccinated; only 46 percent of Americans fall into that category. With children under 12 still ineligible for the vaccine, it will be some time before a vast majority of the United States is fully vaccinated. Public health officials are particularly worried about outbreaks once school resumes in the fall.In an era when vaccination has become a subject of fierce political debate, White House officials are not requiring guests at the July 4 party to be vaccinated. But they will be asked to present evidence of a negative Covid-19 test taken within three days of the event, and the White House has advised those who are unvaccinated that they “should wear a mask,” Jen Psaki, the White House press secretary, said this week.Dr. Meyers, of the University of Texas, said the requirements were “very sensible” and a show of responsible behavior. “Testing, face masks, vaccinations: Those are our tickets to freedom from this threat,” she said.But the absence of a vaccination requirement for White House party guests is also evidence of the challenges ahead, said Dr. Thomas Frieden, a former director of the Centers for Disease Control and Prevention.“There is so much toxic politics around Covid that it’s constraining sensible action,” he said. “Obviously it makes sense to require proof of vaccination in various settings, but that has become a political lightning rod.”Dr. Frieden and other experts said they feared that if the Delta variant continues to circulate, it will mutate in a way that leaves even the vaccinated vulnerable. That already seems to be happening elsewhere in the world; even countries like South Korea and Israel, where the virus seemed to be in check, have new clusters of disease.“Compared to many other countries, we are in a much more secure situation,” said Dr. Jennifer Nuzzo, an epidemiologist at Johns Hopkins University. But, she added, “I really do worry that as America enjoys its freedoms, we forget about the rest of the world, and that could come back to bite us.”When Mr. Biden announced his July 4 vaccination goal in early May, he said meeting it would demonstrate that the United States had taken “a serious step toward a return to normal.” For many people, that seems to be the case. The president said then that Americans would be able to gather in backyards for small Independence Day barbecues; his gathering of 1,000 guests is partly aimed at showing the country that his administration has exceeded expectations even if vaccinations have stalled.While Mr. Biden has repeatedly spoken of “independence from the virus,” Dr. Arthur L. Caplan, the director of NYU Langone Medical Center’s medical ethics division, said the president should be careful about the language he uses.“Before I went out and had my fireworks and sipped piña coladas on the White House veranda, I would say, ‘I’ve got to make clear, as president, we have major challenges unresolved,’” Dr. Caplan said. “I would say, ‘We’re doing well at halftime.’”Mitch Smith

The shift away from high-volume centers is an acknowledgment of the harder road ahead: a highly targeted push, akin to get-out-the-vote efforts, to persuade the reluctant to get shots.NEWARK — There were only six tiny vials of coronavirus vaccine in the refrigerator, one Air Force nurse on duty and a trickle of patients on Saturday morning at a federally run mass vaccination site here. A day before its doors shut for good, this once-frenetic operation was oddly quiet.The post-vaccination waiting room, with 165 socially distanced chairs, was mostly empty. The nurse, Maj. Margaret Dodd, who ordinarily cares for premature babies at Brooke Army Medical Center at Fort Sam Houston in San Antonio, had already booked her flight home. So had the pharmacist, Heather Struempf, who was headed back to nursing school in Wyoming.Across the country, one by one, mass vaccination sites are shutting down. The White House acknowledged for the first time on Tuesday that it would not reach President Biden’s goal of getting 70 percent of American adults at least partly vaccinated by July 4. The setback stems from hesitancy in certain groups, slow takeup by young adults and a swirl of other complex factors.The Newark site, which closed on Sunday, was the last of 39 federally operated mass vaccination centers that administered millions of shots over five months in 27 states. Many state-run sites are also closed or soon will be.The nation’s shift away from high-volume vaccination centers is an acknowledgment of the harder road ahead, as health officials pivot to the “ground game”: a highly targeted push, akin to a get-out-the-vote effort, to persuade the reluctant to get their shots.Mr. Biden will travel to Raleigh, N.C., on Thursday to spotlight this time-consuming work. It will not be easy — as Dr. Anthony S. Fauci, the president’s coronavirus response coordinator, discovered last weekend, when he went door-knocking in Anacostia, a majority-Black neighborhood in Washington, with Mayor Muriel E. Bowser.The Newark site once administered as many as 6,700 shots a day.Bryan Anselm for The New York TimesThe site was operated by the Federal Emergency Management Agency in conjunction with the Defense Department and other federal agencies.Bryan Anselm for The New York TimesIn an interview on Tuesday, Dr. Fauci said he and the mayor spent 90 minutes talking to people on their front porches. But even with a celebrity doctor at the door and the prospect of giveaways at the vaccination center in a high school a few blocks away, many remained hesitant. Dr. Fauci said he persuaded six to 10 people to get their shots, though he did encounter some flat refusals.“We would say, ‘OK, come on, listen: Get out, walk down the street, a couple of blocks away. We have incentives, a $51 gift certificate, you can put yourself in a raffle, you could win a year’s supplies of groceries, you could win a Jeep,’” Dr. Fauci said. “And several of them said, ‘OK, I’m on my way and I’ll go.’”But in Newark, where more than three-quarters of the population is Black or Latino, the numbers tell the story. In Essex County, N.J., which includes Newark, 70.2 percent of adults have been vaccinated. But Essex also includes wealthy suburbs; in Newark, the figure is 56 percent, Judith M. Persichilli, the state’s health commissioner, said in an interview.The Newark vaccination site, in a converted athletic facility at the New Jersey Institute of Technology that is ordinarily home to the school’s tennis teams, was set up and run by the Federal Emergency Management Agency in conjunction with the Defense Department and other federal agencies. It opened on March 31; when it was operating at full tilt, its medical staff administered as many as 6,700 shots a day.Dr. Anthony S. Fauci, right, and Mayor Muriel E. Bowser of Washington, center, went door-knocking in the city’s Anacostia neighborhood on Saturday to encourage residents to get vaccinated.Kenny Holston for The New York TimesBy Saturday, the daily tally was down to about 300. The long, corridorlike tents that had once shielded lines of patients from cold weather were empty. Of 18 registration desks, only four were in use, and most of the vaccination cubicles were unoccupied.Most of the patients, including some teenagers brought by their parents, were there for their second dose of the Pfizer-BioNTech vaccine. Many — like Abdullah Heath, 19, who took a year off after high school and will attend Rutgers University in the fall — said they were hesitant. But Rutgers requires vaccination, so Mr. Heath had little choice.“I wanted to wait to see how other people were when they took the shot,” he said.Alfredo Sahar, 36, a real estate agent originally from Argentina, said he had received his first dose on the spur of the moment, without an appointment, when he tagged along with his wife to the Newark site. The couple showed up for their second doses on Saturday with a young friend, Federico Cuadrado, 19, who was visiting from Argentina and received his first shot.“Relax this arm,” Major Dodd said as Mr. Cuadrado rolled up his sleeve. But she will not be administering his second shot; with the site now closed, he will have to go elsewhere.At the height of its vaccination drive, New Jersey had seven mass sites: six run by the state, plus the FEMA site in Newark. Two of the state sites have closed, another will shut down this week, and the last three are expected to do so in mid-July, said Ms. Persichilli, a nurse and former hospital official. She called the FEMA site, which vaccinated 221,130 people in all, “invaluable.”Maj. Margaret Dodd, right, gave Federico Cuadrado his first dose of the Pfizer-BioNTech vaccine in Newark on Saturday.Bryan Anselm for The New York TimesMr. Biden has said repeatedly that equity — making sure people of all races and incomes have the same access to care and vaccines — is crucial to his coronavirus response. FEMA determined the locations for its mass vaccination sites using the Centers for Disease Control and Prevention’s “social vulnerability index” to identify communities most in need, Deanne Criswell, the FEMA administrator, said in an interview.It was a learning experience for the agency, she said, adding that 58 percent of the roughly six million shots administered at the mass vaccination sites were given to people of color.“We didn’t have a playbook for this type of an operation,” Ms. Criswell said. (The agency now has one that is 44 pages long.)In New Jersey, traffic at the mass vaccination sites started tapering off about six weeks ago, Ms. Persichilli said. At about that time, the state moved to a “hub and spoke” strategy, creating pop-up sites in churches, barbershops and storefronts surrounding existing vaccination centers that could store and supply the vaccines.The state also has 2,000 canvassers — 1,200 paid, partly with federal taxpayer dollars, and 800 volunteers — who have knocked on 134,000 doors in areas with low vaccination rates to direct people to nearby clinics. And the Health Department is planning vaccine clinics at a rock music festival, a balloon festival and a rodeo in Atlantic City.Overall, New Jersey is way ahead of most states: 78 percent of adults have had at least one dose of a vaccine. In four states — Mississippi, Alabama, Louisiana and Wyoming — the figure is lower than 50 percent.“We’re running a marathon, and we’re in the last couple of miles, and we’re exhausted, and they’re going to be the most difficult ones,” Ms. Persichilli said. “But they are also going to be the most satisfying ones.”A photo booth outside the Newark site, which closed on Sunday.Bryan Anselm for The New York TimesThe site was the last of 39 federally operated mass vaccination centers that administered millions of shots over five months in 27 states.Bryan Anselm for The New York TimesPublic health officials know that the last mile of any vaccination campaign is indeed the hardest. The eradication of smallpox, considered the greatest public health triumph of the 20th century, came after a highly targeted global campaign that lasted two decades. Polio has still not been eradicated in some countries, Dr. Fauci said, because of vaccine hesitancy, including among women who express unfounded fears of infertility.“We should have eradicated polio a long time ago,” he said.The federal effort has been enormous, involving more than 9,000 people from across the government, as well as 30,000 National Guard members supporting Covid-19 vaccination in 58 states and territories, according to Sonya Bernstein, a senior policy adviser for the White House.With the large vaccination sites winding down, FEMA is also pivoting. The agency still supports more than 2,200 community vaccination centers and mobile vaccination units. Now FEMA is rolling out a new pilot program to offer shots at or near recovery centers that it sets up after hurricanes and other natural disasters. The first of these opened this week in St. Charles Parish, La., which has a large minority population and was devastated by Hurricane Laura last summer. Only 51 percent of the adult population in St. Charles Parish has had at least one shot, according to data from the C.D.C.Long, corridorlike tents at the Newark vaccination site once shielded lines of patients from cold weather. On Saturday, the daily tally of administered shots was down to about 300. Bryan Anselm for The New York TimesIn Newark, the mood on Saturday was bittersweet. People like Major Dodd and Ms. Struempf, thrown together in a crisis, were exchanging phone numbers with newfound friends and colleagues as they planned to go their separate ways. After living in hotels for more than two months, they were both eager to depart and wistful about the prospect.Michael Moriarty, the FEMA official who supervised the creation of the site, surveyed the scene: the vacant cubicles and chairs, the boxes of unused latex gloves, the brown paper taped to the floor to cover the tennis courts. It would not take long to undo, he said, adding, “They’ll be playing tennis here at the end of the week.”

Latin America, South and Southeast Asia and Africa will be among the recipients of an initial 25 million excess doses that the Biden administration is sharing this month.WASHINGTON — The White House, besieged with requests from other nations to share its supply of coronavirus vaccine, announced Thursday that it would distribute an initial 25 million doses this month across a “wide range of countries” in Latin America and the Caribbean, South and Southeast Asia, and Africa, as well as the Palestinian territories, war-ravaged Gaza and the West Bank.The doses are the first of a total 80 million that President Biden has pledged to send overseas by the end of this month. Three-quarters of the initial batch will be given to the international vaccine effort known as Covax, officials said at a White House briefing on the pandemic, though administration officials are helping decide where to send them.The rest will be reserved for “immediate needs and to help with surges around the world” and regions dealing with “urgent, present crises,” said Jake Sullivan, the president’s national security adviser, including in India, Ukraine and Iraq as well as the West Bank and Gaza.But the donation is nowhere close to enough. About 11 billion doses are needed to vaccinate 70 percent of the world’s population against the coronavirus, according to estimates from researchers at Duke University. As of last month, the analytics firm Airfinity estimated that 1.7 billion doses had been produced.Thursday’s announcement comes a week before Mr. Biden leaves for Cornwall, England, to meet with the heads of state of the Group of 7 industrialized nations, where the global vaccine supply is certain to be a topic of discussion. Officials said the Biden administration would donate additional doses throughout the summer as they become available.“This is just the beginning,” said Jeffrey Zients, Mr. Biden’s coronavirus response coordinator. “Expect a regular cadence of shipments around the world, across the next several weeks.”While China and Russia have used vaccine donations as an instrument of diplomacy in an effort to extract favors from other nations, Mr. Biden has insisted the United States will not do that — a point that Mr. Sullivan emphasized on Thursday in describing the White House strategy.Nearly two-thirds of U.S. adults have had at least one shot of a coronavirus vaccine, and the rate of new cases and deaths has plummeted, contributing to an overall picture across the country that is “encouraging and uplifting,” Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, said on Thursday.But the picture around the world, especially in poorer nations in Africa and Central and South America, where vaccination rates are much lower, is bleak. According to data from Johns Hopkins University, Uruguay, Argentina, Colombia and Paraguay are all awash in new cases; in Colombia, nearly 500 people a day have died of the coronavirus over the past several weeks. A sudden, sharp rise in coronavirus cases in many parts of Africa could amount to a continental third wave, the World Health Organization warned on Thursday.Some African nations have less than 1 percent of their populations partly vaccinated, according to data from the Our World in Data project at the University of Oxford, and the percentages of vaccinated people in Honduras and Guatemala are around 3 percent of the population.Mr. Sullivan said the administration had decided to give priority to “neighbors” of the United States, including countries like Guatemala and Colombia, Peru and Ecuador, while also working with existing regional networks like the African Union to allow local authorities to allocate the vaccines as they see fit.Mr. Biden came into office vowing to restore America’s position as a leader in global health, and he has been under increasing pressure from activists, as well as some business leaders, to do more to address the global vaccine shortage. This year, he said he was reluctant to give away vaccine doses until the United States had enough for its own population, though he promised in March to send a total of four million doses of AstraZeneca’s vaccine to Mexico and Canada.Those doses, it turned out, were made at a Baltimore facility owned by Emergent BioSolutions, where production has since been put on hold after an incident of contamination.Mr. Biden’s pledge to donate 80 million doses this month involves vaccines made by four manufacturers. Besides AstraZeneca, they are Pfizer-BioNTech, Moderna and Johnson & Johnson, the last three of which have received U.S. emergency authorization for their vaccines.The president has made several announcements to help reach his goal. He said last month that his administration would send 20 million doses of the authorized vaccines overseas in June — the first time he had pledged to give away doses that could be used in the United States. Officials said Thursday that the number rose to 25 million because more authorized doses have become available.Mr. Biden also announced last month that he would send one million doses of Johnson & Johnson’s vaccine to South Korea; a plane carrying those doses was expected to take off Thursday evening, Mr. Zients said.And the president has pledged to donate up to 60 million doses of AstraZeneca’s vaccine. But those doses, also made at the Emergent plant, are not authorized for domestic use and cannot be released to other countries until regulators deem them safe. If they are not cleared for release, Mr. Biden would have to agree to donate more of the three vaccines used here to fulfill his 80 million promise.The president has described the vaccine donations as part of an “entirely new effort” to increase vaccine supplies and vastly expand manufacturing capacity, most of it in the United States. To further broaden supply, Mr. Biden recently announced he would support waiving intellectual property protections for coronavirus vaccines. He also put Mr. Zients in charge of developing a global vaccine strategy.But activists say simply donating excess doses and supporting the waiver are not enough. They argue that Mr. Biden must create the conditions for pharmaceutical companies to transfer their intellectual property to vaccine makers overseas, so that other countries can establish their own vaccine manufacturing operations.Peter Maybarduk, the director of Public Citizen’s Access to Medicines program, called Thursday for the administration to invest $25 billion in “urgent public vaccine manufacturing at sites worldwide” to make eight billion doses of vaccine using mRNA technology within a year, and to “share those vaccine recipes with the world.”Asked recently whether the United States was prepared to do that, Andrew Slavitt, a senior health adviser to the president, sidestepped the question, saying only that the United States would “play a leadership role” but still needed “global partners across the world.”On Thursday, Mr. Zients said the United States was lifting the Defense Production Act’s “priority rating” for three vaccine makers — AstraZeneca, Novavax and Sanofi — that do not make coronavirus vaccines authorized for U.S. use. The shift means that companies in the United States that supply the vaccine makers will be able to “make their own decisions on which orders to fulfill first,” Mr. Zients said.That could free up supplies for foreign vaccine makers, allowing other countries to ramp up their own programs.Abdi Latif Dahir