The Centers for Disease Control and Prevention has quietly changed its recommendations for coronavirus immunizations to allow patients to switch the authorized vaccines between the first and second doses in “exceptional situations,” and to extend the interval between doses to six weeks, even though such changes have not been studied in large clinical trials.
The new guidelines were posted on the agency’s website on Thursday with little public notice. With the possibility of vaccine shortages on the horizon and little expectation that supply can be increased before April, the changes may offer a way to vaccinate more people — a high priority for President Biden, who outlined his national Covid-19 strategy on Thursday.
A C.D.C. spokeswoman, Kristen Nordlund, said the agency’s “intention is not to suggest people do anything different, but provide clinicians with flexibility for exceptional circumstances.”
Dr. Anthony S. Fauci, the president’s special adviser for Covid-19, has repeatedly said advised against delaying the second dose or making any other changes in vaccination protocol without the data to support them.
Earlier this month, Britain quietly updated its vaccination playbook to allow for a mix-and-match vaccine regimen if the second dose of the vaccine a patient originally received isn’t available, or if the manufacturer of the first shot isn’t known. Some scientists questioned the move at the time, saying Britain was gambling with its new guidance.
In the United States, two vaccines have emergency federal authorization — one by Pfizer and BioNTech, and the other by Moderna — and both rely on the same mRNA technology and call for two doses. Until now, the C.D.C. has strictly adhered to the recommendations from its Advisory Committee on Immunization Practices, which specifically stated that the vaccines were not to be mixed.
The updated C.D.C. guidance still states that the authorized vaccines are “not interchangeable with each other or with other Covid-19 vaccine products.” The agency put the word “not” in bold on its website, and noted that the safety and efficacy of mixing doses has not been studied.
But “in exceptional situations in which the first-dose vaccine product cannot be determined or is no longer available,” the guidelines added, any available mRNA vaccine can be used for the second dose.
With respect to dosing, the guidance says that the second dose should be administered as close as possible to the recommended interval — three weeks for the Pfizer-BioNTech vaccine and four weeks for Moderna. But if that is “not feasible,” the agency wrote, the interval between doses may be extended to six weeks.
The pace of vaccination is critical not just to curbing disease and death, but also to heading off the impact of more infectious forms of the virus. The C.D.C. has warned that one variant, which is thought to be 50 percent more contagious, might become the dominant source of infection in the United States by March.
Although public health experts are optimistic that the existing vaccines will be effective against that variant, known as B.1.1.7, it may drive up the rate of new cases if enough people remain unvaccinated.
At a White House briefing on Thursday — his first since November — Dr. Fauci said that experts are particularly concerned about new variants of the virus in South Africa and Brazil, which have not yet reached the United States. He said vaccines still appear effective against those variants, but the variants may sidestep the immune system to some degree, making it all the more urgent for people to be vaccinated.
“Replicating viruses don’t mutate unless they replicate,” Dr. Fauci said, “and if you can suppress that by a very good vaccine campaign, then you can actually avoid this deleterious effect that you might get from the mutations.”
Federal health officials and corporate executives agree that it will be impossible to increase the immediate supply of vaccines before April because of lack of manufacturing capacity. And the current vaccination effort, which had little central direction under the Trump administration, has so far sown confusion and frustration. Some localities are complaining they are running out of doses, while others have unused vials sitting on shelves.
According to a senior administration official, Pfizer-BioNTech and Moderna are on track to deliver up to 18 million doses a week. Together, they have pledged to deliver 200 million doses by the end of March.
A third vaccine maker, Johnson & Johnson, is due to report the results of its clinical trial shortly. If approved, that vaccine would also help shore up production. If all of that supply were used, the nation could average well over two million shots a day.
In April and afterward, the outlook brightens. Pfizer and Moderna have each committed to supply another 100 million doses by the end of July; the companies may be able to provide even more. A week ago, Pfizer and BioNTech, its German partner, increased their global production target for the year to two billion doses from 1.3 billion doses.
A year into the worst global health crisis in a century, and much of the world feels frozen in place.
Countries that had loosened up their frontiers after imposing restrictions earlier in the pandemic are now tightening them again, worried about new, more contagious variants of the coronavirus. Some are tightening travel restrictions or imposing new rules on travelers.
In the United States, President Biden signed a series of executive orders aimed at thwarting the pandemic, including a requirement that travelers coming from abroad quarantine after arriving in the United States, though it is not clear how that will be enforced.
He also signed an order requiring masks for many kind of interstate travel. Travelers will have to wear masks in airports, as well as on commercial airplanes, trains and public maritime vessels, including ferries, and on certain other modes of public transportation like intercity buses.
While the United States is merely making traveling less hospitable, countries in Europe are going further, with plans to tighten its borders.
European Union leaders agreed to limit nonessential travel within the bloc and from nonmember countries in a bid to slow the spread of two variants that are already present in multiple countries in the region.
Leaders from the bloc’s 27 nations, meeting via teleconference late Thursday, agreed to take coordinated action in response to the variants, which scientists believe originated in Britain and in South Africa and appear to be significantly more contagious than others.
Some E.U. countries have already limited access for their neighbors, a move that is generally avoided in the principally borderless bloc but has been tolerated because of the extraordinary circumstances.
After the conference call, President Emmanuel Macron’s office announced that France would make PCR tests compulsory for all travelers coming from other European Union countries, starting Sunday at midnight. The tests must be done no later than 72 hours before departure.
In Britain, which completed its exit from the bloc on Jan. 1, flights from Latin America and Portugal were banned over fears of a variant first discovered in Brazil. Flights from South Africa, where another highly contagious variant was discovered last month, are also banned.
In all, Britain itself is isolated from more than a dozen countries.
And in China, where the virus spiraled out of control during the Chinese Lunar New Year in 2020, officials are discouraging travel over the holiday, which begins Feb. 12. The new year is usually the occasion for the largest annual human migration in the world.
Beijing is restricting the number of passengers allowed on public transit and has extended the quarantine period for travelers returning from overseas. Schools have been closed, and the authorities said on Wednesday that people returning to rural areas for the holiday must test negative for the virus and quarantine at home for 14 days.
Ma Xiaowei, the National Health Commission minister, has blamed the recent outbreak on travelers returning from overseas and on workers handling imported food.
Three locally transmitted coronavirus cases were confirmed on Thursday in Shanghai, China’s largest city, the first in the city in about two months.
Dr. Anthony S. Fauci, the longtime government infectious disease expert, has returned to the White House spotlight, offering both reassurances and warnings.
Dr. Fauci, shunned by President Donald J. Trump but embraced by President Biden, appeared in the White House briefing room on Thursday to speak to reporters about the pandemic.
He did not mince words, and appeared to enjoy feeling that he no longer had to.
“Historic, in the very bad sense,” was his take on the pandemic, as total cases in the United States edged near the 25 million milestone.
He warned that the nation was “still in a very serious situation,” even if the number of cases appears to be plateauing, pointing to more infectious variants of the virus that could cause spikes in cases in the coming months.
Dr. Fauci, who is now Mr. Biden’s chief medical adviser for the pandemic, said that the vaccines now in use in the United States appeared effective against the new variants so far.
And even if variants do end up diminishing the vaccines’ effectiveness, the drugs will still provide good protection, he said, citing their considerable “cushion effect.”
If need be, he said, the vaccines can be modified.
“That is not something that is a very onerous thing,” he said. “We can do that given the platforms we have.”
The federal government and the states have stumbled, however, in vaccinating Americans on a large scale. And it is more important than ever to do so, Dr. Fauci said. The more viruses spread, the more opportunities they have to mutate.
“If you can suppress that by a very good vaccine campaign, then you could actually avoid this deleterious effect that you might get from the mutations,” he said.
If the United States can vaccinate 70 percent to 85 percent of the population by the middle or end of the summer, he predicted, “by the time we get to the fall, we will be approaching a degree of normality.”
On Thursday, speaking of the problems ahead without a president glowering over his shoulder, Dr. Fauci appeared to be enjoying his own return to normality. Asked how it felt, he paused a beat or two before delivering his review.
“It is somewhat of a liberating feeling,” he said.
An unusual experiment to prevent nursing home staff members and residents from infection with the coronavirus has succeeded, the drug maker Eli Lilly said on Thursday.
A drug containing monoclonal antibodies — laboratory-grown virus fighters — prevented symptomatic infections in residents who were exposed to the virus, even the frail older people who are most vulnerable, according to preliminary results of a study conducted in partnership with the National Institutes of Health.
The researchers found an 80 percent reduction in infections among residents who got the drug compared with those who got a placebo, and a 60 percent reduction among the staff, Eli Lilly said.
The study included 965 participants at nursing homes: 666 staff members and 299 residents. The data have not yet been peer-reviewed or published. The company expects to present the findings at a future medical meeting and to publish them in a peer-reviewed journal, but did give a timeline.
The drug, bamlanivimab, has an emergency-use authorization from the Food and Drug Administration that allows it to be provided to symptomatic patients early in the course of their infection. This study sought to establish whether the drug could stop infections before they started.
It was an unusual experiment: In trucks equipped with mobile labs, medical workers sped to nursing homes the moment a single infection was detected there. Then they set up temporary infusion centers to administer the drug.
Although the study has ended, Dr. Daniel Skovronsky, Eli Lilly’s chief scientific officer, said the company would continue to rush to nursing homes in its study network when an outbreak is detected.
“Everyone will get the drug,” he said.
The Hungarian government has for months lauded the opportunities of Russia’s Sputnik vaccine. In November, the foreign minister made public his talks with Russian counterparts about the possibility of manufacturing the Russian vaccine in Hungary. On Thursday, the country approved the Russian vaccine and one made by AstraZeneca for use.
And on Friday, after a meeting in Moscow with his Russian counterpart, Hungary’s foreign minister said that Hungary would buy two million doses of the Russian vaccine.
The moves make Hungary the first European Union nation to move outside the bloc’s supply chain, which the country’s president, Viktor Orban, said was moving too slowly.
“What I need, and what the Hungarian people need, is not an explanation, but a vaccine,” Mr. Orban said. “And if it is not coming from Brussels, then it must come from elsewhere.”
The European Union has approved two coronavirus vaccines: one made by Moderna and one made by Pfizer and BioNTech. The bloc is expected to decide this month whether to authorize the AstraZeneca vaccine.
Each E.U. member state is allotted vaccine doses based on population size, and the bloc has ordered 2.3 billion doses of several vaccines, some of which are still in development.
But a disruption in Pfizer’s production facility in Puurs, Belgium, has stalled or stopped deliveries in Europe and elsewhere, causing frustration. The company has vowed to resume deliveries by mid-February, and says that production upgrades will enable it to increase its output.
In a radio interview on Friday morning, Mr. Orban called the E.U.’s vaccination rate “simply unacceptable.” He added, “It cannot be that Hungarian people are dying because vaccine procurement in Brussels is slow.”
Some Hungarian experts have expressed concern that the government’s approach might increase vaccine skepticism, which might thwart a national vaccination plan.
“The Hungarian authority suddenly approved these two vaccines under political pressure,” said Dr. Ferenc Falus, Hungary’s former chief medical officer, said in reference to the AstraZeneca and Sputnik vaccines. “It would have been better for them to wait for the approval of the European Union’s medicine agency. This is especially incomprehensible in the case of Astra, which will receive the European Union’s approval within days.”
The European Union drugs regulator, the European Medicines Authority, said that the developer of the Sputnik vaccine had “submitted a request for scientific advice to the agency.” That step comes well before a company is ready to submit data for the regulator’s review of its work, let alone applying for authorization to distribute a vaccine to European Union countries.
The comedian Dave Chappelle has tested positive for the coronavirus and has canceled several upcoming shows at the Stubb’s Waller Creek Amphitheater in Austin, Texas, a spokeswoman told The Associated Press.
The venue’s website showed cancellations for four shows through Tuesday.
Mr. Chappelle, who had been hosting socially distanced shows in Ohio since June, with rapid testing for audience members and himself, moved his shows to Austin during the winter, the spokeswoman said.
Mr. Chappelle is asymptomatic and quarantining, she said.
Joe Rogan, a comedian and podcast host who had been scheduled to perform with Mr. Chappelle on Friday and Saturday, apologized for the cancellations. “We’ll reschedule them as soon as we can,” Mr. Rogan said early Friday in an Instagram post.
Mr. Chappelle’s positive test result came about three months after he hosted “Saturday Night Live” and commented on the pandemic in a monologue that also heavily touched on the presidential election.
“Do you guys remember what life was like before Covid?” Mr. Chappelle said. “I do. There was a mass shooting every week. Anyone remember that? Thank God for Covid. Someone had to lock these murderous whites up and keep them in the house.”
For weeks, Britain has reported eye-watering coronavirus death numbers, hospitals have continued to fill up, and fears are high that it will take months to control the spread of a highly transmissible variant first detected in the Kent region of England last year.
Yet vaccination figures have offered a glimmer of hope: Nearly five million people had received a first vaccine dose in Britain as of Friday, according to government data. That amounts to about 8 percent of the population.
Fewer than 500,000 have received a second injection, as the National Health Service is prioritizing first injections and second jabs are given up to 12 weeks after the first.
Since the authorities imposed new lockdown restrictions in England this month, Britain has reported its highest daily death figures and remains one of the worst-hit countries in Europe. Nearly 95,000 people have died of the coronavirus in British hospitals, and the authorities have said that England’s lockdown could remain in place throughout the spring.
The situation is so grim that the authorities are considering offering £500 (about $680) to anyone testing positive for the virus, in a bid to encourage people to respect quarantine rules, according to British news reports.
There are also fears that cuts in vaccine deliveries from Pfizer, as has occurred in other places, may slow down the rollout, and that variations in vaccination rates within the country puts some areas at a disadvantage.
Yet six weeks after becoming the first Western country to approve a vaccine, Britain is among those championing their mass vaccination campaign. By comparison, the United States has vaccinated around 4.5 percent of its population, and most European countries less than 2 percent.
In Britain, a racecourse, rugby fields and religious buildings have been turned into vaccination centers, in addition to 1,200 hospitals and medical offices. More than two million people were vaccinated in the past seven days, twice as many as two weeks ago.
At such a pace, Britain may fall short of its goal to vaccinate 13.9 million people by mid-February, but the authorities have said they can reach the target if they continue to increase the pace.
Elsewhere in Europe, members of the European Union have meanwhile urged the bloc to accelerate the delivery of their vaccine doses, and several leaders expressed frustration on Thursday over the rate of the rollout.
Government officials in Romania and Poland said that Pfizer had halved the amount of vaccine doses being delivered to their countries, and Italian officials have threatened legal action against the U.S. vaccine maker.
“Leaders want vaccination to be accelerated,” said Charles Michel, the president of the European Council, the group of E.U. leaders.
KYIV, Ukraine — After a revolution seven years ago, Ukrainians discovered that their ousted president had used public money to build himself a gigantic palace with a private zoo, a golf course and a garage full of antique cars.
To prevent repeats of such corruption, a raft of reforms were put in place, including a requirement that nearly all government contracts be made public, lest secret kickbacks slip into the pockets of high-ranking officials.
The overhaul, widely seen as a rare success in the country’s otherwise halting anticorruption drive, covered tens of millions of dollars in annual medical procurement deals.
But to secure coronavirus vaccine supplies, Ukraine has been forced to largely abandon the rule — a move that the government says is not its choice but rather a demand of the pharmaceutical giants that control the supply.
In negotiating with national governments, drug companies like Pfizer, Moderna and Johnson & Johnson have insisted that many of the deals’ terms amount to trade secrets and must therefore be kept confidential.
Health advocacy groups have criticized those arrangements, saying that governments far better positioned than Ukraine to spend vast sums on doses have been too willing to accept such secrecy.
The requirement has hamstrung the Ukrainian government and forced one state-owned procurement company that was set up to prevent graft in the medical system to be sidelined because it was legally required to disclose the terms of all contracts.
“This is due to extremely strict privacy rules and nondisclosure policies, which the procurement company will not be able to comply with under Ukrainian law,” Svitlana Shatalova, a deputy minister of health, said at a news conference on Thursday.
The nondisclosure agreements allow pharmaceutical companies to negotiate prices, delivery timelines and other conditions for vaccine deals without governments or their citizens comparing the agreements to those struck with other nations.
According to a document that a European official posted on social media in December and quickly deleted, the European Union negotiated a lower price for Pfizer’s vaccine — 12 euros, or about $14.60, per dose — than the U.S. government, which agreed to pay $19.50 per dose. European nations tend to pay substantially lower prices for drugs than the United States does.
Nearly two million residents of Beijing were being tested for the coronavirus on Friday as the city rushed to stem mainland China’s worst outbreak since the virus was first detected.
Health officials set up temporary testing facilities in two major districts of Beijing, China’s capital, after three locally transmitted cases were confirmed there on Thursday.
The authorities in Shanghai, China’s business capital and biggest city, were also testing hospital employees after two health care workers tested positive on Thursday. Shanghai recorded six new locally transmitted cases on Friday.
New infections were also reported on Friday in four northern provinces — Hebei, Heilongjiang, Jilin and Shanxi — and in the eastern province of Shandong. That brings the total number of new cases across China this week to at least 500.
While the active case count is still far lower than that of the United States and other countries, the outbreak threatens to undermine the government’s success in stamping out the virus and bringing life in China back to normal.
More than 28 million people have been placed under some kind of lockdown across China in recent weeks, mostly in northern areas. Officials fear that new infections could lead to another major outbreak during the Lunar New Year holiday, when hundreds of millions of people travel across the country to celebrate with their families.
Last January, the coronavirus was spread far beyond its original epicenter, the central Chinese city of Wuhan, in part by people traveling home for Lunar New Year — weeks before health officials in Beijing acknowledged the risk of human-to-human transmission.
In Beijing this month, the authorities have closed all schools, limited the number of passengers allowed on public transit and extended quarantine requirements for travelers returning from overseas to three weeks, up from two weeks.
The central authorities are also requiring anyone traveling to rural areas for Lunar New Year to first test negative for the virus and then quarantine for 14 days — a move that could discourage many people from returning to their hometowns for the seven-day holiday.
In other developments around the world:
Bangladesh will begin a nationwide coronavirus vaccination campaign starting with a gift from India — two million vaccine doses — by next week. Bangladesh, whose population is about 163 million, will also buy 30 million additional doses from India, said Muhibur Rahman, a health ministry secretary. He said that Gavi, the Vaccine Alliance, had pledged to cover doses for 20 percent of Bangladesh’s population. The rollout plan includes “freedom fighters of Bangladesh’s war of independence in the priority list,” Mr. Rahman said, referring to the 1971 conflict with Pakistan that led to Bangladesh’s creation. The country’s health minister told reporters this week that 42,000 volunteers had been trained to carry out the inoculation drive.
Paraguay’s health minister announced that the country had arranged to buy three million doses of coronavirus vaccines from two pharmaceutical companies and plans to start vaccinations in the second half of February, Reuters reported. The minister, Julio Mazzoleni, said the companies would be named when the contracts are signed. The country plans to purchase another 4.2 million doses through Covax, a World Health Organization program.
Despite early successes in handling the pandemic, Germany’s health authorities have now registered a total of 50,000 Covid deaths since the virus was first detected in the country nearly a year ago. And 30,000 of those deaths have occurred since Dec. 9.
“These are not just numbers. These are people who died in loneliness,” Chancellor Angela Merkel said at a news conference on Thursday. “These are families who mourn them. We have to be aware of that, too, again and again.”
Daily reported new infections in the country are decreasing amid a weekslong lockdown, with the authorities registering 17,862 new cases on Thursday, almost 4,500 fewer than a week earlier. But rising death tolls typically trail behind spikes in infection numbers.
In response to the coronavirus’s first wave, Germany locked down early and effectively. Experts attributed the country’s relatively low early fatality rate to high testing rates, well-equipped hospitals and the young age of many of the first people to become infected there.
Since mid-December, however, the daily tolls have regularly surpassed 1,000, in a country of about 83 million people.
Early this month, pictures taken inside a mortuary in Meissen, in the east of the country, showed coffins stacked three-high. And on Thursday of last week — the country’s worst pandemic day so far — 1,244 people died from Covid in 24 hours.
Mongolia’s prime minister has resigned after protests in the country’s capital, Ulaanbaatar, over the government’s pandemic response.
The country’s Parliament on Friday approved the resignation of Prime Minister Khurelsukh Ukhnaa, who will be replaced by the chief cabinet minister, the state news media reported. The deputy prime minister and health minister also submitted their resignations.
Protesters took the streets on Wednesday after a widely circulated video showed a Covid-19 patient and her newborn baby being hastily escorted from a hospital to a quarantine facility. Demonstrators were protesting the treatment of the patient, who was still wearing a nightgown and slippers when she was escorted out of the hospital. Some protesters wore nightgowns and slippers in a show of support for the woman.
The World Health Organization praised Mongolia early on in the pandemic for its quick response, with the country shutting down its borders and ceasing much of its coal mining activity. Mining makes up nearly half of its export revenue and provides some of the best-paying jobs in the country.
And although Mr. Khurelsukh won landslide elections last year, the government has faced dissatisfaction over a flailing economy and unemployment. He said in a resignation letter that he would “accept the demand of the public.”
Laura M. Holson, a Times reporter and editor, caught Covid during the New York City outbreak last April, but the acute phase of the illness was just the beginning. Here, she tells her story.
I remember the second time I thought I would die.
The first time was April 17, 2020, when, after finding out I had Covid-19 nine days earlier with aches and a cough, my fever shot up to 101.8, I could barely breathe, and my family doctor told me I had bacterial pneumonia.
The second time I thought I would die was different, yet eerily the same. It was June 22, nearly three months after the initial diagnosis. By then the cough had softened, and I was well past the acute phase of Covid-19, having tested negative twice. The chest tightness had passed, supplanted by a nagging ache. I had lost eight pounds as nausea tamped my appetite, and my heart seemed to race without reason. I was so tired I sometimes fell asleep upright in my chair. And my fever persisted, too.
On that cloudless day in June, the temperature outside hovered at a pleasant 85. I was seated on the couch, working on my laptop when, at about 4 p.m., the crushing chest pain I experienced during Covid’s earliest days suddenly returned. My pulse began to quicken, and a shawl of heat gathered around my shoulders, crept up my neck and swallowed my head. I began to sweat. It felt as if the air was being squeezed out of my lungs. Breathe, I told myself. BREATHE. I stood up, gasping, and walked to the window to look outside.
Could this really be happening again?
About 1,500 people from Pacific Island nations are due to be flown into the Australian state of Victoria to pick fruit on farms. And although the move will help alleviate a shortage of farm hands that has plagued the industry for months because of the coronavirus, it also underscores the greater health risks and economic effects that poorer and non-white populations have faced in the pandemic.
Victoria is one of the last states in Australia to allow Pacific Islanders in to help on farms. Nearly 200 workers from Vanuatu flew into the Northern Territory to harvest mangos in August, and other states have since followed.
Over the summer, the country has been flooded with news reports of fruit and vegetables being left to rot in fields amid a shortage of workers to pick them.
Farmers say they have had difficulty attracting locals to do the work, while some Australians counter that farmers have been unwilling to employ locals because they are “not as exploitable as a foreigner.” The sector has also been the subject of recent reports of underpaying and exploiting workers.
The supply of backpackers and foreign seasonal workers who typically make up the majority of the industry has been cut off since the country shut its borders last March in an effort to stop the spread of the virus.
Before arriving in Victoria, the Pacific Islander workers will be required to quarantine for two weeks on the Australian island state of Tasmania, Victoria’s government said on Friday. In exchange, 330 Tasmanians who have been stuck overseas will be able to return to the country and quarantine in Melbourne hotels.
Victoria has eased its pandemic restrictions after 16 consecutive days with no cases of community infection.