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The Biden administration announced on Tuesday that it intends to contribute $150 million over the next three years to a global effort aimed at rapidly producing a vaccine in case a new biological threat emerges. Still, activists and health experts urged the United States to do more to fight the current coronavirus pandemic.
The financial commitment, which will require approval from Congress, is only a small fraction of what is needed for the project being undertaken by the Coalition for Epidemic Preparedness Innovations, a global foundation. The coalition’s chief executive, Dr. Richard Hatchett, has announced a $3.5 billion, five-year effort to “face down the next Disease X with a new vaccine in just 100 days.”
Tuesday’s announcement echoes a plan announced by President Biden in his State of the Union address, when he pledged to invest in an effort to produce new vaccines within 100 days of the arrival of future coronavirus variants. The contribution was announced by Samantha Power, the administrator of the U.S. Agency for International Development, during a summit convened by the British government and the coalition, known as CEPI. The coalition also supports Covax, the international effort to deliver Covid-19 vaccines to the world, which has struggled to get doses into people’s arms.
“Our eyes, like yours, are also on the horizon — on the epidemic or pandemic that has yet to come,” Ms. Power said, addressing the summit’s attendees by video. “While we continue our current efforts to end this pandemic, we are not losing sight of our long-term preparedness goals.”
The administration’s commitment comes as Mr. Biden is under pressure to do more to combat Covid, as well as to prepare for the next pandemic. Last week, the administration asked Congress for an additional $22.5 billion to fight the pandemic at home and overseas, and Mr. Biden is expected to host his own global Covid summit in the coming weeks.
The president has repeatedly said that the United States has contributed more money, and donated more coronavirus vaccine doses, to the world than any other nation.
But two recent analyses, one by the Kaiser Family Foundation and the other by Public Citizen, suggest the United States is not living up to his promise that the nation would be the “arsenal of vaccines” for the world.
The Kaiser Family Foundation’s analysis found that, when donations of money and doses are measured against a country’s gross domestic product, the United States does not lead the world. The analysis found that when gross domestic product is considered, the United States ranks 12th in financial donations and sixth in donations of doses.
“It was a surprise,” said Jen Kates, who directs the foundation’s global health and H.I.V. policy efforts and conducted the analysis. “The White House has said the U.S. is doing more than any other donor. We just wanted to interrogate that a little bit and see: Does it hold up if you look at it from this perspective?”
A new analysis by Public Citizen, entitled “An Incomplete Arsenal,” raises questions about whether the administration is falling behind on its timeline to deliver 1.2 billion doses to the world by this fall, as Secretary of State Antony Blinken pledged in December.
When the White House announced its new pandemic preparedness plan last week, much of which will also need congressional funding, it no longer attached a timeline to the 1.2 billion doses pledge. So far, the State Department says, nearly 487 million doses have been shipped. To meet the 1.2 billion dose target, the United States would have to donate more than 70 million doses a month — a figure that, Public Citizen notes, is far higher than the current reported monthly donation of about 55 million doses.
“The modest targets that the administration itself set out are likely not to be achieved this year, and that’s shocking,” said Zain Rizvi, an expert on pharmaceutical innovation and access to medicines and the report’s author.
White House officials declined to comment on the Kaiser analysis. But they pointed to Tuesday’s announcement, as well as their funding request to Congress and a plan to ramp up vaccine manufacturing announced by Mr. Biden last year, as evidence that the president is committed to doing more.
Vaccination rates continue to lag in low-income countries, even as vaccines become more widely available, for a variety of reasons including vaccine hesitancy and a lack of infrastructure and personnel to administer the shots. Only 14 percent of the population of low-income nations has received at least one dose of a vaccine, according to the Our World in Data project at the University of Oxford.
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Hawaii on Tuesday became the 50th and final state to announce that it will drop its universal indoor mask mandate as the United States tries to move on from the once ferocious Omicron wave.
Gov. David Ige, in an abrupt reversal, said at a news briefing on Tuesday afternoon that the mandate would no longer be in effect starting on March 26.
“We have reduced Covid-19 in a way to the point where most of us will be safe without masks indoors,” he said.
Like the rest of the country, Omicron cases surged in Hawaii from December to mid-January before plummeting fast. As the surge receded, the authorities on the U.S. mainland rushed to end mask mandates, leaving Hawaii and Puerto Rico as some of the last holdouts. Puerto Rico said on Monday that its mask mandate would be lifted for most places on Thursday.
Mr. Ige, a Democrat, said that Hawaii had held on to its indoor mask mandate longer than any other state because “we are all willing to sacrifice to keep each other healthy and safe,” calling it “the aloha spirit.”
Masks are still required indoors at public schools in Hawaii, the last state with such a mandate, though its education department on Tuesday lifted the outdoor mask mandate on school campuses.
The end of Hawaii’s blanket mandate is a stark pivot from a week ago, when Mr. Ige said that the state’s indoor mask mandate would remain in place even though he was lifting other restrictions. The governor had said that, on March 25, he would end the state’s strict entry requirements for travelers and the mandate that state and county employers provide their vaccination status or show negative test results at work.
However, while the indoor mask mandate is lifting, the state authorities still recommend that people wear masks if they are in a crowded setting or around immunocompromised people. Masks are also recommended at health care facilities and prisons.
The mask mandate could be reinstated if cases spike or if the Centers for Disease Control and Prevention upgrades Hawaii’s coronavirus community risk level, said Dr. Elizabeth Char, the director of the state’s health department. “What we’re worried about is, you know, the next surge related to another variant,” she added.
As of this week, four counties in Hawaii stopped enforcing pandemic rules such as those that set limits on gatherings or require proof of vaccination to enter businesses. Mr. Ige said that the state authorities felt comfortable ending the indoor mask mandate because cases have not spiked since the county policies changed.
While nearly all statewide indoor mask requirements have expired, a few remain in place. The mandates in Oregon and Washington will expire on Saturday, the governors of the states said in a joint statement last month. But some U.S. territories, including Guam and the U.S. Virgin Islands, have not lifted mandates.
In recent weeks, the C.D.C. suggested that most Americans did not need to wear a mask and that schools require masks only in high-risk counties.
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The World Health Organization offered a more full-throated endorsement of booster shots on Tuesday than it previously had, though it continued to emphasize the importance of increasing access to initial doses in parts of the world that have been left behind in vaccination efforts.
The broad endorsement comes as the W.H.O.’s stance on boosters continues to evolve. Last year, it opposed booster shots for the general public, arguing that administering extra doses to already-vaccinated people in wealthy countries was morally indefensible when billions of people in poorer countries had yet to receive their first dose. It had then supported additional doses only for immunocompromised people, for whom the initial vaccine series can be less effective.
The endorsement Tuesday expands on the organization’s previous guidance on booster shots. It was released as part of a larger W.H.O. assessment of vaccination efforts amid the wave caused by the Omicron variant, which can evade some of the protection conferred by vaccines and by previous coronavirus infections.
The agency “strongly supports urgent and broad access to current Covid-19 vaccines for primary series and booster doses, particularly for groups at risk of developing severe disease,” the organization said in a statement.
On Dec. 9, the W.H.O. recommended that people who had received the one-dose Johnson & Johnson vaccine get a second dose if possible, based on growing evidence that the vaccine performed better when given as two shots. On Jan. 11, it said that countries could recommend boosters, but that the more urgent priority was primary immunizations. On Jan. 21, it recommended boosters of Pfizer’s mRNA vaccine, starting with high-risk groups.
In August, it called for a moratorium on booster shots, and in September it urged leaders to extend that moratorium at least through the end of the year.
The geographic and economic disparities in vaccination rates remain glaring: Only 14 percent of people living in low-income nations have received a dose, according to the Our World in Data project at the University of Oxford. Worldwide, that number is about 65 percent, and in some countries it exceeds 90 percent.
But the science around boosters has changed along with the virus, and the W.H.O.’s increasingly pro-booster position reflects that. Initial vaccine regimens are much less effective at preventing infection with the Omicron variant than with previous variants, and while they remain very good at preventing severe illness, their efficacy on that front has also waned to a lesser extent.
As a result, boosters have become an increasingly important tool against the virus.
Rebecca Robbins contributed reporting.
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More and more American school districts have dropped mask mandates in recent weeks as coronavirus cases plunged across the United States. But they remain a subject of debate among some students and their parents, and a study released on Tuesday by the Centers for Disease Control and Prevention suggested that those mandates had helped protect children and teachers from the coronavirus last fall.
The study, examining public school districts in Arkansas from August to October as the Delta variant spread, found that districts with full mask requirements had 23 percent lower rates of the coronavirus among students and staff members than districts without the mandates.
It was not clear whether the same would have been true once the Delta variant was overtaken by Omicron, which is more contagious and spread rapidly among children and adults alike.
The C.D.C. has faced criticism from scientists in the past for overstating the benefits of school masking based on what some researchers have described as a flawed study out of Arizona. Some studies from abroad have also found that mask mandates were not associated with lower rates of the coronavirus in children.
But some scientists said that the latest C.D.C. study had steered clear of the most serious methodological problems and had strengthened the evidence for masks protecting some children from the coronavirus.
“It passes the smell test,” Louise-Anne McNutt, a former C.D.C. Epidemic Intelligence Service officer and an epidemiologist at the State University of New York at Albany, said of the study. “The estimates of the impact of masks are consistent with other studies that show masks have a modest, but important, reduction of SARS-CoV-2 transmission.”
The study compared coronavirus case rates among 233 Arkansas districts. About a third of the districts had full mask mandates, a fifth required masks only in certain settings or situations, and half had no mask policies.
It took into account staff and student vaccination rates and socioeconomic status. It also adjusted for coronavirus rates in the surrounding community — an attempt, the study’s authors said, to partly control for how much testing was happening in a given part of the state. Dr. McNutt, though, said that the study would have benefited from more details on statewide testing levels.
Districts with full mask mandates had lower coronavirus rates relative to the case rates in the surrounding community than districts without the mandates, the study found. And among roughly two dozen districts that put in place mask mandates in the middle of the study period, case rates afterward dropped more than would have been expected from changes in community case rates at the same time, the study said.
Partial masking policies did not show as strong an effect as full mask mandates.
The study did not account for schools’ prevention efforts beyond masking, like ventilating classrooms. Jonathan Ketcham, an economist specializing in health care at Arizona State University, said that could be an “important flaw in the study itself.”
Jason Abaluck, an economics professor at Yale University’s School of Management who helped lead a large trial on masking in Bangladesh, also cautioned that the schools with mask mandates could have differed from those without them in other ways, like adherence to distancing measures. He said that the study could have more closely matched nearby schools with different masking policies to study their effects.
But Dr. Abaluck said the C.D.C. study was an improvement on previous research.
“This study and the broader literature on masking suggests that in places where hospitalization and deaths are very high, the benefits of mask wearing in schools may be considerable,” he said.
Still, he noted that masks can cause discomfort and make it harder for children to communicate. “Figuring out how severe an outbreak has to be to warrant mask mandates in schools,” he said, “requires making best guesses about the costs, which remain highly uncertain given existing evidence.”
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Moderna said this week that it had chosen Kenya to host the company’s first messenger RNA vaccine production facility in Africa. Yet while such a plant would be a major boost for the East African nation and overall efforts to increase vaccine manufacturing capacity in the world’s least-vaccinated continent, it will not assuage Africa’s immediate need for coronavirus vaccines.
The establishment of the Moderna facility also does not answer continuous calls from African leaders and activists to waive vaccine patents in a bid to hasten development, production and distribution of vaccines. And Moderna is not supporting a World Health Organization-led mRNA technology transfer hub in South Africa that was set up to help low- and middle-income countries produce their own vaccines.
After the pharmaceutical company announced on Monday that it would invest up to $500 million in a new facility with the aim of producing up to 500 million vaccine doses annually for Africa, President Uhuru Kenyatta of Kenya said in a statement that his country was “celebrating one of the greatest things that has possibly happened since the onset of Covid-19” in Africa.
The facility will manufacture drug substances and could be extended to become a fill-finish and packaging plant, according to the deal, which was announced in partnership with the United States government and the African Union, and which came five months after Moderna vowed to build a vaccine factory in Africa.
Moderna said it planned to have the facility fill Covid-19 doses as early as next year, over three years after the pandemic began. As of March 6, just over 195 million people — over 14 percent of the continent’s one billion people — had been fully vaccinated against the virus, according to the W.H.O.’s regional office for Africa.
African leaders have accused wealthy nations of hoarding doses and making a “mockery” of vaccine equity by providing booster shots even as Africa struggled with low vaccine coverage.
“We all know the challenges that Kenya and the entire continent of Africa went through in the earlier stages of this pandemic that resulted in Africa being left behind,” Mr. Kenyatta said. “Not because of want, but because of lack, and Moderna has come to fill that space.”
The plant in Kenya will nonetheless complement growing efforts across Africa to bolster local vaccine development. And Mr. Kenyatta expressed hope that the Moderna facility could help Africa fend off the next pandemic.
In October, Rwanda and Senegal signed a memorandum of understanding with BioNTech to build factories that will produce messenger RNA vaccines. And last month, the W.H.O. director general, Tedros Adhanom Ghebreyesus, announced that Kenya and five other African countries — Egypt, Nigeria, Senegal, South Africa and Tunisia — would be the first to get access to the technology needed to produce mRNA vaccines on the continent.
To replicate the Moderna vaccines, the W.H.O. has hired a South African company, Afrigen Biologics and Vaccines, which said last month that it had succeeded in duplicating Moderna’s doses using publicly available data. The South African company will need to carry out clinical trials for its vaccines before the authorities can approve it for mass dissemination.
Besides production, Africa has faced numerous challenges when it comes to administering available vaccine doses.
Data reported to the W.H.O. from 40 African countries indicated a $1.29 billion funding gap for operational costs. And other factors contributing to the low vaccine uptake have included vaccine hesitancy and misinformation, political crises and humanitarian emergencies, and late preparedness to administer vaccines.
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Ukraine’s health care system is still grappling with the coronavirus pandemic, even as it tries to cope with the severe effects of an invasion that has sown destruction and dislocation in the country, the World Health Organization’s regional director for Europe said on Tuesday.
“It is my deepest sorrow to see my region, emerging from two terrible pandemic years, being now confronted with the devastating impact of military hostilities on dozens of millions of its people in Ukraine and beyond,” the regional director, Dr. Hans Kluge, said at a news briefing.
Ukraine reported 731 Covid deaths to the organization last week, a figure that probably underestimates the virus’s true toll because of the disruption caused by Russia’s invasion of the country, which began on Feb. 24. Millions of people have fled or been evacuated from besieged cities and combat zones, and health care systems have not been spared from damage and supply shortages.
Even so, Dr. Kluge said that Ukraine had “remarkably” maintained its surveillance and response to the coronavirus. He said of the virus’s death toll, “Sadly, this number will increase as oxygen shortages continue.”
The W.H.O. has sent 500 oxygen concentrators to Ukraine, among other supplies, to help stem oxygen shortages, Dr. Kluge said. He added that older people were likely to be disproportionately affected by the virus, given disruptions to the health care system.
7–day average
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.
The W.H.O. expressed concern early this year that the highly contagious Omicron variant would sweep through Eastern Europe, which has significantly lower coronavirus vaccination rates than most of Western Europe. Only one-third of people over 60 in Ukraine are fully vaccinated, according to the W.H.O.
Ukraine was reporting more than 30,000 new cases a day in mid-February, and the rate declined to about 25,000 a day just before the invasion, according to agency data. By some estimates, the virus was causing about 300 deaths a day in Ukraine before the invasion.
Catherine Smallwood, a W.H.O. senior emergencies officer, said at the news briefing that Covid hospitalizations in Ukraine had decreased in the past couple of weeks, possibly because of patients being discharged early or unable to seek care because of the war.
Across the organization’s 53-nation Europe region, which also includes Israel and the former Soviet republics in Asia, new cases and Covid deaths have been falling since Feb. 10, Dr. Kluge said.
“While this is good news, I would call on countries to balance optimism with maintaining vaccination and strong vigilance,” he said, adding that as countries lift public health measures, they should be prepared to reintroduce them quickly if needed.
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The Biden administration on Tuesday formally began allowing Americans who had ordered free coronavirus tests this winter to request a second round of four tests per household, through the same U.S. Postal Service program that President Biden unveiled in January.
The move, which Mr. Biden had promised last week during his State of the Union address, followed a crush of interest in the program when it debuted in January. At the time, case rates had skyrocketed because of the Omicron variant and tens of millions of households scrambled to obtain the free tests.
Now, with supply outpacing demand and virus cases on a steep decline, White House officials and public health experts say it will require significant effort to sustain interest in testing — and ensure that manufacturers keep producing tests.
“People were able to sell tests like hot cakes over Omicron,” said Gigi Gronvall, a testing expert at Johns Hopkins University. “They were able to gouge prices. It’s now, when the libraries can’t give them away, that the government needs to make sure that the manufacturers don’t pull out, like what happened before Delta.”
The supply of rapid at-home tests has ballooned in recent weeks. Federally authorized manufacturers had the ability to make an estimated 535 million tests last month and 462 million this month, said Mara Aspinall, an expert in biomedical diagnostics at Arizona State University who is also on the board of OraSure, which makes rapid Covid tests.
Tests are now easier to find in pharmacies and at many community sites. And the majority of American households ordered free tests from the Postal Service website over the last seven weeks, said Dr. Tom Inglesby, the White House’s testing coordinator. More than 275 million tests have been delivered to nearly 70 million households, with more than 5,000 Postal Service employees in fulfillment centers packing and shipping them.
But federal funding for at-home tests is now lapsing, Dr. Inglesby said, meaning that lawmakers would have to commit more to prepare for possible outbreaks. As part of its new coronavirus response strategy, the administration requested $22.5 billion from Congress, including funds for testing.
“Testing does not just happen on its own. We’ve seen that a couple of times now, that when testing demand goes down, industry also reduces its output,” Dr. Inglesby said. “We saw with Omicron that we have very little time to react to a surge. We had a matter of weeks to scale manufacturing again. And that is not possible without industry being prepared.”
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New York City officials on Monday eliminated the mask mandate for public school students that had been in place since fall 2020, an aggressive step toward normalcy two years after the coronavirus began battering the city.
Some expressed joy at the chance to remove their masks, but not all the students and parents The New York Times interviewed this week were comfortable with the change.
Oscar Jaffe, 14, a freshman at Stuyvesant High School in Manhattan, said wearing a mask had made it harder for him to participate in class and form friendships. He was one of the few students at his school who chose not to wear a mask on Monday.
“It was hard for people to hear me sometimes,” Oscar said. “Remembering faces was also much more difficult, and remembering names — putting a name to a face — I kind of forgot a lot of names fairly quickly.”
The majority of students passing through the red gates to attend Nelson Mandela High School and Boys and Girls High School, both in Bedford-Stuyvesant, Brooklyn, were still masked on Monday.
Jordan Pickett, 16, a 10th grader at Nelson Mandela High School, where about 40 percent of students are fully vaccinated, said he hadn’t gotten the shot yet because he was waiting for his mother to take him, and she’d been busy with work.
“I just feel unsafe without the mandate,” he said.
Citywide, 52 percent of K-12 public school students are fully vaccinated, according to city data, and 59 percent of students have received at least one dose. But there is wide variation in vaccination rates among neighborhoods.
— Lola Fadulu, Nate Schweber, Julianne McShane and Sadef Ali Kully
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Federal authorities are investigating at least 15 nonprofit groups in the Minneapolis area that received a total of more than $65 million from government food programs during the coronavirus pandemic, according to affidavits filed in federal court.
Raids carried out by the F.B.I. in January revealed a sprawling investigation into a network of groups that had tapped into the huge new sums of money available for programs to feed needy children during the pandemic — and into a much larger nonprofit organization, Feeding Our Future, that was responsible for ensuring that the smaller groups spent the money properly.
In court filings, the F.B.I. said it had discovered a “massive fraud scheme” among groups that Feeding Our Future was supposed to oversee, and that the groups had siphoned off tens of millions of dollars by charging taxpayers for nonexistent meals.
“Almost none of this money was used to feed children,” the government wrote in one filing. “Instead, conspirators misappropriated the money and used it to purchase real estate, cars and other items.”
No one has yet been charged in the case. The leaders of Feeding Our Future and other nonprofit groups have denied wrongdoing.
The case highlights how the federal government’s reliance on nonprofit groups to help carry out an array of programs can make the programs vulnerable to fraud — a problem that has grown as Washington has pumped trillions of dollars into pandemic aid packages.
— David A. Fahrenthold