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

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

The president pushed up his target date by two weeks, matching the timetable already being put in place by many states.WASHINGTON — President Biden on Tuesday moved up by two weeks, to April 19, his deadline for states to make every American adult eligible for coronavirus vaccination, following the lead of states around the country that are already meeting that timetable.Mr. Biden’s announcement came as Americans and their elected officials were grappling with competing and seemingly contradictory forces. The pace of vaccinations is accelerating, but worrisome new variants are spreading. The death rate is declining, but caseloads and hospitalizations are on the rise.California officials announced on Tuesday that they plan to lift all coronavirus restrictions on June 15, provided there are enough Covid-19 vaccines available for anyone age 16 or older and hospitalizations remain low and stable. Other states are already lifting restrictions, but Mr. Biden, in remarks at the White House, warned against throwing off the guardrails too soon.“The virus is spreading because we have too many people who, seeing the end in sight, think we’re at the finish line already,” the president said. “But let me be deadly earnest with you: We aren’t at the finish line. We still have a lot of work to do. We’re still in a life-and-death race against this virus.”The president also reiterated and made explicit his pledge to give surplus vaccine to other countries, once he is certain there is enough for people in the United States.Not quite a month ago, Mr. Biden set a deadline of May 1 for states to open up vaccination to all adults. A week after that, he said that by April 19, 90 percent of adults would be eligible for a shot and would be able to get one within five miles of their home.Since then, nearly every state in the nation has accelerated its vaccination program, and the vast majority are now meeting or coming in ahead of the April 19 target. On Tuesday, Oregon said those 16 or older will be eligible for vaccination on April 19.At least 530 new coronavirus deaths and 76,624 new cases were reported in the United States on Monday, according to a New York Times database. Over the past week, there has been an average of 64,855 new cases per day, an increase of 20 percent from the average two weeks earlier.That has put the country in a tenuous situation, with public health officials, including Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, pleading with governors not to lift restrictions and with citizens to continue to follow social distancing guidelines, wear masks and take other public health precautions. Last week, Dr. Walensky said she felt a sense of “impending doom” from a potential fourth surge of the pandemic.But in California, cases have been declining since hitting a peak early this year, with the state now averaging around 2,700 new cases a day, the lowest figure since June. The C.D.C. said that, as of Tuesday, 35 percent of the state’s total population had received at least one vaccine shot, and 18 percent were fully vaccinated.“With more than 20 million vaccines administered across the state, it is time to turn the page on our tier system and begin looking to fully reopen California’s economy,” Gov. Gavin Newsom, a Democrat, said in a statement. “We can now begin planning for our lives post-pandemic.”Many public health experts say that the nation is in a race between the vaccines and the variants and that, for the moment at least, the vaccines appear to have the upper hand. But public health officials are worried that future iterations of the virus may be more resistant.At the same time, they are watching an uptick in cases among young people, particularly those ages 18 to 24. Dr. Walensky told reporters on Monday that the C.D.C. was working with states to investigate outbreaks in young people that she said may be related to extracurricular activities or sports.Mr. Biden spoke on Tuesday after visiting a vaccination clinic at the Virginia Theological Seminary in Alexandria, Va., which is working with community health centers to offer inoculations. Making the rounds of the makeshift clinic, he showed flashes of his old self — the sunny retail politician who likes to get close to people, with a pat on the arm or a squeeze on the shoulder.“He’s gonna be hard — he’s got so much muscle mass there,” the president joked to a nurse as he squeezed the shoulder of a muscular man who was about to get his shot. “I tell you what, I could have been an All-American if I had those.”But his lightness belied the seriousness of the message he would later deliver at the White House. There, he marked a milestone: Since Mr. Biden has been in office, more than 150 million Covid-19 shots have been administered to Americans, which puts the nation on track to reach his goal of 200 million shots by his 100th day in office, at the end of this month.“We’ve vaccinated more people than any other nation on Earth,” the president said. “The vaccines have proven to be safe and effective. That should give us real hope.”But, he added, “we can’t let it make us complacent.”Jill Cowan

The extraordinary move came just days after officials learned the plant had ruined 15 million doses of Johnson & Johnson’s coronavirus vaccine.WASHINGTON — The Biden administration on Saturday put Johnson & Johnson in charge of a troubled Baltimore manufacturing plant that ruined 15 million doses of the Johnson & Johnson coronavirus vaccine and moved to stop the plant from making another vaccine by AstraZeneca, senior federal health officials said.The extraordinary move by the Department of Health and Human Services came just days after officials had learned that Emergent BioSolutions, a contract manufacturer that has been making both the Johnson & Johnson and the AstraZeneca vaccines, mixed up ingredients from the two, which led regulators to delay authorization of the plant’s production lines.By moving the AstraZeneca vaccine out, two senior federal health officials said, the plant can be solely devoted to the Johnson & Johnson single-dose vaccine and avoid future mishaps.The Department of Health and Human Services directed Johnson & Johnson to install a new leadership team to oversee all aspects of production and manufacturing at the Emergent Baltimore plant, the officials said. The company said in a statement that it was “assuming full responsibility” for the vaccine made at the Emergent plant.With President Biden making an aggressive push to have enough doses to cover every adult by the end of May, federal officials are worried that the mix-up will erode public confidence in Covid-19 vaccines. The AstraZeneca vaccine in particular has generated safety concerns; Germany, France and other European nations briefly suspended its use after reports of rare brain blood clots in some vaccine recipients.The ingredient mix-up, and Saturday’s move by the administration, is a significant setback and a public relations debacle for Emergent, a Maryland-based biotech company that has built a profitable business by teaming up with the federal government, primarily by selling its anthrax vaccines to the Strategic National Stockpile.A spokesman for Emergent declined to comment, except to say that the company would continue making AstraZeneca doses until it received a contract modification from the federal government.Unlike Johnson & Johnson, AstraZeneca does not yet have emergency authorization from the Food and Drug Administration for its vaccine. With three federally authorized vaccines (the other two are by Pfizer-BioNTech and Moderna), it is not clear whether the AstraZeneca vaccine, which has had a troubled history with regulators, could even be cleared in time to meet U.S. needs.However, one of the federal officials said the Department of Health and Human Services was discussing working with AstraZeneca to adapt its vaccine to combat new coronavirus variants. AstraZeneca said in a statement that it would work with the Biden administration to find a new site to manufacture its vaccine.So far, none of the Johnson & Johnson doses made by Emergent have been released by the F.D.A. for distribution. Officials have said it may take weeks to sort out whether other batches of vaccine were contaminated and for F.D.A. inspectors to determine whether the Emergent plant can be cleared to release any doses that it has made.The acting F.D.A. commissioner, Dr. Janet Woodcock, said in a statement on Saturday that the agency “takes its responsibility for helping to ensure the quality of manufacturing of vaccines and other medical products for use during this pandemic very seriously.”But she made it clear that the ultimate responsibility would rest with Johnson & Johnson, saying: “It is important to note that even when companies use contract manufacturing organizations, it is ultimately the responsibility of the company that holds the emergency use authorization to ensure that the quality standards of the FDA are met.”In another arrangement brokered by the Biden administration last month, Johnson & Johnson is now working with Merck, one of the world’s biggest vaccine manufacturers. Officials said Merck would help with management of the Baltimore plant.Emergent’s Baltimore plant is one of two that are federally designated as “Centers for Innovation in Advanced Development and Manufacturing” and were built with taxpayer support. Last June, the government paid Emergent $628 million to reserve space there as part of Operation Warp Speed, the Trump administration’s fast-track initiative to develop coronavirus vaccines.Johnson & Johnson and AstraZeneca both contracted with Emergent to use the space. Both vaccines are so-called live viral-vector vaccines, meaning they use a modified, harmless version of a different virus as a vector, or carrier, to deliver instructions to the body’s immune system. The Johnson & Johnson vaccine is administered in one dose, AstraZeneca’s in two doses.Experts in vaccine manufacturing said that in the past, the F.D.A. had a rule to prevent such mishaps by not allowing a plant to make two live viral vector vaccines, because of the potential for mix-ups and contamination.Last month, Mr. Biden canceled a visit to Emergent’s Baltimore plant, and his spokeswoman announced that the administration would conduct an audit of the Strategic National Stockpile, the nation’s emergency medical reserve. Both actions came after a New York Times investigation into how the company had gained outsize influence over the repository.

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutNew Variants TrackerAdvertisementContinue reading the main storySupported byContinue reading the main storyPandemic Relief Bill Fulfills Biden’s Promise to Expand Obamacare, for Two YearsWith its expanded subsidies for health plans under the Affordable Care Act, the coronavirus relief bill makes insurance more affordable, and puts health care on the ballot in 2022.President Biden after delivering remarks on the Affordable Care Actin November. The changes to the health law would cover 1.3 million more Americans.Credit…Amr Alfiky/The New York TimesMarch 8, 2021Updated 8:30 p.m. ETWASHINGTON — President Biden’s $1.9 trillion coronavirus relief bill will fulfill one of his central campaign promises, to fill the holes in the Affordable Care Act and make health insurance affordable for more than a million middle-class Americans who could not afford insurance under the original law.The bill, which will most likely go to the House for a final vote on Wednesday, includes a significant, albeit temporary, expansion of subsidies for health insurance purchased under the act. Under the changes, the signature domestic achievement of the Obama administration will reach middle-income families who have been discouraged from buying health plans on the federal marketplace because they come with high premiums and little or no help from the government.The changes will last only for two years. But for some, they will be considerable: The Congressional Budget Office estimated that a 64-year-old earning $58,000 would see monthly payments decline from $1,075 under current law to $412 because the federal government would take up much of the cost. The rescue plan also includes rich new incentives to entice the few holdout states — including Texas, Georgia and Florida — to finally expand Medicaid to those with too much money to qualify for the federal health program for the poor, but too little to afford private coverage.“For people that are eligible but not buying insurance it’s a financial issue, and so upping the subsidies is going to make the price point come down,” said Ezekiel Emanuel, a health policy expert and professor at the University of Pennsylvania who advised Mr. Biden during his transition. The bill, he said, would “make a big dent in the number of the uninsured.”But because those provisions last only two years, the relief bill almost guarantees that health care will be front and center in the 2022 midterm elections, when Republicans will attack the measure as a wasteful expansion of a health law they have long hated. Meantime, some liberal Democrats may complain that the changes only prove that a patchwork approach to health care coverage will never work.“Obviously it’s an improvement, but I think that it is inadequate given the health care crisis that we’re in,” said Representative Ro Khanna, a progressive Democrat from California who favors the single-payer, government-run system called Medicare for All that has been embraced by Senator Bernie Sanders, independent of Vermont, and the Democratic left.“We’re in a national health care crisis,” Mr. Khanna said. “Fifteen million people just lost private health insurance. This would be the time for the government to say, at the very least, for those 15 million that we ought to put them on Medicare.”Mr. Biden made clear when he was running for the White House that he did not favor Medicare for All, but instead wanted to strengthen and expand the Affordable Care Act. The bill that is expected to reach his desk in time for a prime-time Oval Office address on Thursday night would do that. The changes to the health law would cover 1.3 million more Americans and cost about $34 billion, according to the Congressional Budget Office.Representative Frank Pallone Jr. of New Jersey, who helped draft the health law more than a decade ago and leads the House Energy and Commerce Committee, has called it “the biggest expansion that we’ve had since the A.C.A. was passed.”But as a candidate, Mr. Biden promised more, a “public option” — a government-run plan that Americans could choose on the health law’s online marketplaces, which now include only private insurance.“Biden promised voters a public option, and it is a promise he has to keep,” said Waleed Shahid, a spokesman for Justice Democrats, the liberal group that helped elect Representative Alexandria Ocasio-Cortez and other progressive Democrats. Of the stimulus bill, he said, “I don’t think anyone thinks this is Biden’s health care plan.”Just when Mr. Biden or Democrats would put forth such a plan remains unclear, and passage in an evenly divided Senate would be an uphill struggle. White House officials have said Mr. Biden wants to get past the coronavirus relief bill before laying out a more comprehensive domestic policy agenda.Senators Bill Hagerty and Chris Coons at the Capitol on Saturday during a series of votes on amendments to the relief bill.Credit…Anna Moneymaker for The New York TimesThe Affordable Care Act is near and dear to Mr. Biden, who memorably used an expletive to describe it as a big deal when he was vice president and President Barack Obama signed it into law in 2010. It has expanded coverage to more than 20 million Americans, cutting the uninsured rate to 10.9 percent in 2019 from 17.8 percent in 2010.The Coronavirus Outbreak