As countries jostle to secure enough vaccine doses to help put an end to the pandemic, a new competition is unfolding: for syringes to administer them with.
There is simply not enough of them.
Officials in the United States and the European Union have said they need more. And in January, Brazil restricted exports of syringes and needles when its vaccination efforts fell short.
Further complicating the challenge, not just any syringe will do the trick.
Japan revealed last month that it might have to discard millions of doses of the Pfizer-BioNTech vaccine if it couldn’t secure enough syringes able to draw out a sixth dose from vials. In January, the Food and Drug Administration advised health care providers in the United States that they could extract more doses from the Pfizer vials after hospitals there discovered that some contained enough for a sixth — or even a seventh — shot.
“A lot of countries were caught flat-footed,” said Ingrid Katz, the associate director of the Harvard Global Health Institute.
The world needs between eight billion and 10 billion syringes for Covid-19 vaccinations alone, experts say.
In previous years, only 5 percent to 10 percent of the estimated 16 billion syringes used worldwide were meant for vaccination and immunization, said Prashant Yadav, a senior fellow at the Center for Global Development, a think tank in Washington, and an expert on health care supply chains.
Wealthier nations like the United States, Britain, France and Germany pumped billions into developing the vaccines, but little public investment has gone into expanding manufacturing for syringes, Mr. Yadav said.
The industry has ramped up to meet demand.
Becton, Dickinson and Company, which is the world’s largest manufacturer of syringes and is based in New Jersey, said it was producing 2,000 each minute to meet orders of more than a billion.
The United States is the world’s largest syringe maker by sales, according to Fitch Solutions, a research firm. The United States and China are neck and neck in exports, with combined annual shipments worth $1.7 billion.
While India is a small player globally, Hindustan Syringes & Medical Devices in Ballabgarh, one of the world’s largest syringe makers, sunk millions of dollars into preparing its syringe factories for the vaccination onslaught.
Rajiv Nath, the company’s managing director, added 500 workers to his production lines, which crank out more than 5,900 syringes per minute at factories spread over 11 acres in a dusty industrial district outside New Delhi. With Sundays and public holidays off, the company churns out nearly 2.5 billion a year, and plans to scale up to three billion by July.
Mr. Nath has sold 50 million to the Japanese government, he said, and over 400 million to India for its Covid-19 vaccination drive, one of the largest in the world.
More are waiting in line, including UNICEF. In November, the United Nations agency for children reached out to say that it was desperately seeking syringes. And not just any would do. They had to be smaller than usual, and break if used a second time, to prevent spreading disease through accidental reuse.
Most important: UNICEF needed them in vast quantities. Now.
“I thought, ‘No issues,’” said Mr. Nath. “We could deliver it possibly faster than anybody else.”
The company is set to begin shipping 3.2 million of those syringes soon, UNICEF said, provided they clear another quality check. And Mr. Nath has offered to produce about 240 million more.
The images above tell a story of disparity of the starkest sort.
“People of color are getting vaccinated at rates below their representation of the general population,” Dr. Marcella Nunez-Smith, the chair of President Biden’s coronavirus equity task force, said at a recent forum on the vaccine. “This narrative can be changed. It must be changed.”
In recent days, The New York Times’s graphics team set out to measure how equitably Covid-19 vaccines were being distributed across the United States.
The data is imperfect. As of March 3, only 38 states publicly shared race and ethnicity data for vaccinated people.
Further complicating the task, different jurisdictions define race and ethnicity categories in slightly different ways — and with different levels of completeness. In some states, as much as a third of vaccinations were missing race and ethnicity data.
But a disturbing portrait nevertheless emerged.
Communities of color, which have borne the brunt of the Covid-19 pandemic in the United States, have also received a smaller share of available vaccines. The vaccination rate for Black Americans is half that of white people, and the gap for Hispanic people is even larger, The Times analysis found.
Since Johnson & Johnson revealed data showing that its vaccine, while highly protective, had a slightly lower efficacy rate than the ones produced by Moderna and Pfizer-BioNTech, health officials have feared that the new shot might be viewed by some Americans as the inferior choice.
But the early days of its rollout suggest something different: Some people are eager to get it because they want the convenience of a single shot.
And public health officials are enthusiastic about how much faster they can get the single-shot doses distributed, particularly in vulnerable communities that might not otherwise have access to vaccine.
“This is a potential breakthrough,” said Dr. Joseph Kanter, the top health official in Louisiana.
With its first allotted doses, that state is holding a dozen large Johnson & Johnson vaccination events at civic centers and other public places, modeled after what has worked for flu vaccines.
Only four million doses were shipped this week, and the company’s manufacturing lags mean that it will be at least a month before states start receiving significant supplies. But as Johnson & Johnson ramps up production over the next few months, Dr. Kanter said, the vaccine will allow his state to slash costs for staffing and operations related to second doses.
“The J. & J. vaccine brings a lot to the table,” he said.
Judged by how well it prevents severe disease, hospitalization and death, the Johnson & Johnson shot is comparable to those made by Moderna and Pfizer-BioNTech. And although it has a lower overall efficacy rate in the United States — 72 percent, compared with roughly 95 percent for the others — experts say that comparing those numbers is problematic because the companies’ trials were conducted in different places and at different times.
Besides being a single-dose shot, the Johnson & Johnson vaccine offers another benefit: It can be kept at normal refrigeration temperatures for three months. That makes it ideal for distribution at nonmedical sites such as stadiums and convention centers. The vaccine has caused a surge of excitement at small, independent pharmacies, too.
Many state health officials said they were focused on getting the vaccine to people who might be harder to reach for a second dose, such as those who are homeless or on the verge of release from prison.
Patricia Cooper, a teacher in Washington, D.C., said that President Donald J. Trump’s efforts to claim credit for a vaccine last year and the label “emergency use authorization” had suggested to her that the federal government may have rushed its reviews of vaccines. That left her feeling jittery about their safety.
But Ms. Cooper said she was eager to get a shot, especially the Johnson & Johnson one.
“This one is more appealing to me,” she said. “Who likes to get stuck more than once?”
A small group of scientists and others who believe the novel coronavirus that spawned the pandemic could have originated from a lab leak or accident is calling for an inquiry independent of the World Health Organization’s team of independent experts sent to China last month.
While many scientists involved in researching the origins of the virus continue to assert that the SARS-CoV-2 pandemic almost certainly began with a leap from bats to an intermediate animal and then to humans, other theories persist and have gained new visibility with the W.H.O.-led team of experts’ recent visit to China.
Officials with the W.H.O. have said in recent interviews that it was “extremely unlikely” but not impossible that the spread of the virus was linked to some sort of lab accident.
In an open letter, first reported in The Wall Street Journal and Le Monde, the French newspaper, the signers list what they cast as flaws in the joint W.H.O.-China inquiry, and argue that it could not adequately address the possibility that the virus leaked from a lab.
Many of those who signed the letter were based in France. Richard Ebright, a molecular biologist at Rutgers University and one of the scientists who signed the letter, said it grew out of a series of online discussions among scientists, policy experts and others who came to be known informally as the Paris group.
Dr. Ebright said that no one in the group thought that the virus had been intentionally created as a weapon, but they were all convinced that an origin in a lab through research or by accidental infection was as likely as a spillover occurring in nature from animals to humans.
Asked to respond to the letter, Tarik Jasarevic, a spokesman for the W.H.O., replied in an email that the team of experts that had gone to China “is working on its full report as well as an accompanying summary report, which we understand will be issued simultaneously in a couple of weeks.”
Cyprus has announced a plan to allow vaccinated residents of Britain to visit the island beginning in May, a further signal that countries, particular those dependent on tourism, could resort to inoculation certificates to reopen their borders.
Savvas Perdios, the deputy tourism minister for Cyprus, told the Cyprus News Agency that, as of May 1, British citizens who had received two doses of a vaccine approved by the European Union’s drug regulator would be allowed to travel to the Mediterranean island without having to be tested for the coronavirus or to isolate on arrival.
Some European nations with economies that are heavily reliant on tourism, such as Spain, have advocated for a vaccine certificate program to be created at the European Union level but have also said that they could adopt bilateral systems if no broader agreement is reached. The European Commission, the bloc’s executive arm, this week announced plans to create a “digital green pass” to facilitate safe travel among member nations, though that system is expected to take at least three months.
The British authorities have said that talks on opening up travel are underway with a number of countries, including some in the European Union.
Matt Hancock, the British health secretary, said this week, “If another country wants to say that you need to have been vaccinated with a recognized vaccine to travel there, we want to enable Brits to be able to take that journey.”
More than a million travelers from Britain visited Cyprus in 2019, representing by far the highest number of international tourists to the island, according to official statistics.
Despite the green light from Cyprus, international travel from Britain is forbidden for leisure purposes until at least May 17 under the current lockdown rules, and it is unclear how many British residents will have received two vaccine doses by then. Fewer than a million people in Britain have so far been fully vaccinated.
In other news around the world:
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South Korea’s drug safety agency approved the Pfizer-BioNTech vaccine on Friday and doses for about 23 million people are expected to begin arriving this month, the news agency Yonhap reported. The country, which has a population of about 51 million, began its vaccination program last week as part of a plan to achieve herd immunity by November. South Korea approved the Oxford-AstraZeneca vaccine in February and expects to receive more than two million doses through Covax, an international group that has negotiated for coronavirus shots.
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Prime Minister Jacinda Ardern of New Zealand has said that a snap lockdown imposed last week on the country’s largest city, Auckland, will end on Sunday morning. Social gatherings will be capped at 100 people and other restrictions will remain in place. The lockdown was imposed after the authorities discovered an untraceable case. They have since conducted more than 50,000 tests and tracked more than 6,000 contacts.
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Japan has extended its state of emergency for the greater Tokyo metropolitan area until March 21, the government announced on Friday, according to the national broadcaster NHK. Emergency orders were lifted in six other prefectures. The restrictions, which include an order for restaurants and bars to close by 8 p.m., had been scheduled to end on Sunday.
After a quiet summer, doctors at Rhode Island Hospital began seeing one or two patients with Covid-19 on each shift — and soon three. Then four.
Cases climbed steadily from September until early December, when Rhode Island earned the dubious distinction of having more cases and deaths per 100,000 people than any other state in the country. The case rate still puts it among the top five states.
Where did this tightly knit state go wrong? Former Gov. Gina Raimondo’s “pauses” on economic activity were short-lived and partial, leaving open indoor dining, shopping malls and bowling alleys. But the shutdowns were no patchier than those in many other states.
Until late summer, she was lauded for reining in the virus. Even now, few residents blame her for the bleak numbers.
Experts point instead to myriad other factors, all of which have played out elsewhere in the country but converged into a bigger crisis in Rhode Island.
The fall chill sent people indoors, where risk from the virus is highest, and the holidays brought people together. Rhode Island is tiny — you can traverse it in 45 minutes. But crammed into that smallish area are a million people — a population density second only to that of New Jersey.
Apart from its density, Rhode Island has a high percentage of older residents in nursing homes, accounting for the bulk of deaths. Packed into the state are multiple urban areas — Central Falls, Pawtucket, Providence — where language barriers, mistrust and jobs have left immigrant families in multigenerational homes particularly vulnerable. The state is also home to multiple colleges that set off chains of infection in the early fall.
As in most of the country, the Latino community has borne the brunt of the epidemic. In Rhode Island, Latinos have 6.7 times the risk for hospitalization and 2.5 times the risk of death, compared with white people.
The state’s epidemic has been disastrous for immigrant families in multigenerational households.
Workplace exposures have especially hurt the Latino and Cape Verdean community, many of whom hold jobs that cannot be done from home. But in state surveys, it also became obvious that people were still holding get-togethers of 15 to 20 people even as the virus spread, said Dr. James McDonald, medical director of the Covid-19 unit at the Rhode Island Department of Health.
“People weren’t willing to live differently during the pandemic,” he said.
European authorities will offer a coronavirus vaccine to every adult in an Austrian district battered by a surge in infections to determine how effective the inoculation is against the variant first found in South Africa.
Starting next week, everyone aged 16 and older living in the Schwaz district, near the western Austrian city of Innsbruck, will be eligible for free shots of the vaccine from Pfizer-BioNTech, as part of the unique drive to learn more about fighting the variant.
The study in Austria is part of a much broader global effort to answer a crucial question as the virus mutates and new variants emerge: Do vaccinations designed last year work against more recent mutations? If not, scientists will have to keep developing new versions of the inoculations.
Laboratory studies have shown that some vaccines that work well against earlier variants are less effective — though they still offer significant protection — against the variant known as B.1.351, which was first found in South Africa in December and has become the dominant one there.
Real-world tests of those findings are still needed, and some combinations of variants and vaccines have not yet been tested, even in lab settings.
Authorities in the Schwaz district, in the state of Tyrol, appealed on Thursday to residents to sign up for their vaccines by March 8, to allow for enough doses to be ordered and delivered for the study. More than 20,000 residents, roughly a third of all those eligible, registered in the first 24 hours, the authorities said.
Earlier this week, Ursula von der Leyen, president of the European Commission, agreed to allocate 100,000 extra doses of the vaccine to Austria, in exchange for allowing a multinational team of scientists to collect data from the mass vaccination in Tyrol. The region has seen one of the worst outbreaks of the variant in Europe and Austria’s chancellor, Sebastian Kurz, had been lobbying the European Union for extra doses to try to stop its spread.
“Our goal is to be able to massively halt, if not eradicate, the South African variant,” Günther Platter, the governor of Tyrol, said on Wednesday. “We want to protect the people from this variant.”
But the success of the project is dependent on everyone being willing to take part. Officials hope to begin administering shots on March 11.
For much of the winter, Meryl Gordon worried about the people caring for her 95-year-old mother, who was rehabbing in a Manhattan nursing home after surgery for a broken hip.
“Every week they sent out a note to families about how many staff members had positive Covid tests,” said Ms. Gordon, a biographer and professor at New York University. “It was a source of tremendous anxiety.”
Ms. Gordon feels reassured now that her mother is fully vaccinated and has returned to her assisted living facility. But what about the two home care aides who help her 98-year-old father, David, in his Upper West Side apartment?
Neither has agreed to be vaccinated. David Gordon’s doctor has advised him to delay vaccination himself because of his past allergic reactions.
Ms. Gordon has not insisted that the caregivers receive vaccinations. “You’re reluctant to do something that could cause you to lose the people you rely on,” she said. But she remains uneasy.
It’s a question that many long-term care employers, from individual families to big national companies, are confronting as vaccines become more available, although not available enough: In a pandemic, can they require vaccination for those who care for very vulnerable older adults? Should they?
Some employers aren’t waiting. Atria Senior Living, one of the nation’s largest assisted living chains, has announced that by May 1 all staff members must be fully vaccinated.
Silverado, a small chain of dementia care homes, most on the West Coast, mandated vaccination by March 1. Juniper Communities, which operates 22 facilities in four states, has also adopted a mandate.
“We felt it was the best way to protect people, not just our residents but our team members and their families,” said Lynne Katzmann, Juniper’s chief executive. Of the company’s nearly 1,300 employees, “about 30 individuals have self-terminated” because of the vaccination requirement, she reported.
Juniper’s experience supports what public health experts have said for years: Vaccine mandates, like those that many health care organizations have established for the flu vaccine, remain contentious — but they do increase vaccination rates. As of Feb. 25, 97.7 percent of Juniper residents had received two vaccine doses, and so had 96 percent of its staff members.
That stands in stark contrast to staff vaccinations in many facilities. The Centers for Disease Control and Prevention has reported that during the first month of vaccine clinics in nursing homes, only 37.5 percent of staff members received the first shot, along with 77.8 percent of residents.
China is requiring some travelers arriving from overseas to receive an invasive anal swab test as part of its coronavirus containment measures, a move that has outraged and shocked several foreign governments.
Japanese officials said on Monday that they had formally asked China to exempt Japanese citizens from the test, adding that some who had received it complained of “psychological distress.” And the United States State Department last moth said it had registered a protest with the Chinese government after some of its diplomats were forced to undergo anal swabs, though Chinese officials denied that.
It is not clear how many such swabs have been administered or who is subject to them. Chinese state media has acknowledged that some arrivals to cities including Beijing and Shanghai are required to take the tests, though the reports said the requirements might vary depending on whether the travelers were deemed to be high-risk.
Chinese experts have suggested that traces of the virus may survive longer in the anus than in the respiratory tract and that samples of the former may prevent false negatives. China has imposed some of the strictest containment measures in the world, including barring most foreign arrivals, and has largely suppressed the epidemic.
Lu Hongzhou, an infectious disease specialist at Fudan University in Shanghai, told the state-controlled Global Times tabloid that nasal or throat swabs could cause “uncomfortable reactions,” leading to subpar samples. He acknowledged that fecal samples could replace anal swabs, to prevent similar discomfort.
But other experts — including in China — have questioned the need for anal samples. The Global Times quoted another expert, Yang Zhanqiu, as saying that nasal and throat swabs are still the most effective because the virus is contracted through the respiratory tract.
Benjamin Cowling, a public health professor at the University of Hong Kong, said in an interview that even if someone did test positive on an anal swab but not a respiratory one, he or she would likely not be very contagious.
“The value of detecting people with the virus is to stop transmission,” Professor Cowling said. “If someone has got an infection but they’re not contagious to anyone else, we didn’t need to detect that person.”
A spokesman for the Chinese Foreign Ministry said this week that the government would make “science-based adjustments” to its containment policies.
Professor Cowling said he did not know what the scientific rationale was behind the existing policies. “I presume there’s some evidence leading to this decision, but I haven’t seen that evidence,” he said.
The San Diego Zoo has given nine apes an experimental coronavirus vaccine developed by Zoetis, a major veterinary pharmaceuticals company.
In January, a troop of gorillas at the zoo’s Safari Park tested positive for the virus. All are recovering, but even so, the zoo requested help from Zoetis in vaccinating other apes. The company provided an experimental vaccine that was initially developed for pets and is now being tested in mink.
Nadine Lamberski, a conservation and wildlife health officer at San Diego Zoo Global, said the zoo vaccinated four orangutans and five bonobos with the experimental vaccine, which is not designed for use in humans. Among the vaccinated orangutans was an ape named Karen, who made history in 1994 when she became the first orangutan to have open-heart surgery.
Dr. Lamberski said one gorilla at the zoo was also scheduled to be vaccinated, but the gorillas at the wildlife park were a lower priority because they had already tested positive for infection and had recovered. She said she would vaccinate the gorillas at the wildlife park if the zoo received more doses of the vaccine.
Mahesh Kumar, senior vice president of global biologics for Zoetis, said the company is increasing production, primarily for its pursuit of a license for a mink vaccine, and will provide more doses to the San Diego and other zoos when possible. “We have already received a number of requests,” he said.
Infection of apes is a major concern for zoos and conservationists. They easily fall prey to human respiratory infections, and common cold viruses have caused deadly outbreaks in chimpanzees in Africa. Genome research has suggested that chimpanzees, gorillas and other apes will be susceptible to SARS-CoV-2, the virus that has caused the pandemic. Lab researchers are using some monkeys, like macaques, to test drugs and vaccines and develop new treatments for the virus.
Scientists are worrying not just about the danger the virus poses to great apes and other animals, but also about the potential for the virus to gain a foothold in a wild animal population that could become a permanent reservoir and emerge at a later date to reinfect humans.
Infections in farmed mink have produced the biggest scare so far. When Danish mink farms were devastated by the virus, which can kill mink just as it kills people, a mutated form of the virus emerged from the mink and reinfected humans. That variant showed resistance to some antibodies in laboratory studies, raising suspicion that vaccines might be less effective against it.
That virus variant has not been found in humans since November, according to the World Health Organization. But other variants have emerged in people in several countries, proving that the virus can become more contagious and in some cases can diminish the effectiveness of some vaccines.
Denmark ended up killing as many as 17 million mink — effectively wiping out its mink farming industry. In the United States, thousands of mink have died, and one wild mink has tested positive for the virus.
Although many animals, including dogs, domestic cats, and big cats in zoos, have become infected by the virus through natural spread, and others have been infected in laboratory experiments, scientists say that widespread testing has yet to find the virus in any animal in the wild other than the one mink.
National Geographic first reported the vaccination of the apes at the San Diego Zoo.
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