CoronavirusCovid News: W.H.O. Warns Health Care Workers Are Burning Out

Follow the latest coverage on the coronavirus pandemic, vaccines and boosters.

Burned-out health care workers are nearing a breaking point, the W.H.O. warns.

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A health care worker updating a Covid patient’s information in the intensive care unit of a hospital in São Paulo, Brazil, in May.Credit...Mauricio Lima for The New York Times

The World Health Organization on Thursday urged countries to do more to protect health care workers, saying that they are increasingly plagued by anxiety, burnout, illness and death on the front lines of the fight against the coronavirus pandemic.

The agency estimates that 115,500 health care workers around the world died of Covid-19 between January 2020 and May 2021, the middle scenario of its broader estimate of 80,000 to 180,000 deaths during that period.

Speaking at a W.H.O. briefing on Thursday, Annette Kennedy, the president of the International Council of Nurses, said that the world had entered the pandemic with a shortage of nurses and that the problem was only being worsened by the stresses of the pandemic.

“There is another crisis coming down the tracks,” she said, “and that is a shortage of health care workers.”

To combat the problem, the W.H.O. called on governments to strengthen their collection of data on coronavirus infections and deaths among health care workers and to accelerate the vaccination of those workers.

On average, two in five health care workers had been fully vaccinated by September, according to W.H.O. data from 119 countries, but that included less than one in 10 of health care workers in Africa and the western Pacific region. By contrast, 80 percent of health care workers in 22 mostly high-income countries had been vaccinated.

Ms. Kennedy noted a major problem that women face when working in health care settings: personal protective equipment designed for men. “And yet,” she noted, “90 percent of nurses are women. Seventy percent of all health care workers are women.”

W.H.O. leaders also highlighted inequality in the global distribution of vaccines and called on wealthy nations to lead the charge in addressing the issue.

The agency’s director general, Dr. Tedros Adhanom Ghebreyesus, said it had been more than 10 months since the first vaccines were approved and that the lack of vaccinations for millions of health workers was “an indictment on the countries and companies that control the global supply of vaccines.”

High- and upper-middle-income countries have administered almost half as many booster shots as the total number of doses administered in low-income countries, he said.

To meet global vaccination goals, Dr. Tedros said, “the barrier is not production. The barriers are politics and profit.”

Gordon Brown, the former British prime minister who is now the W.H.O.’s ambassador for global health financing, said the goal of vaccinating 40 percent of adults around the world by December, which was put forward last month at the Global Covid-19 Summit led by President Biden, had “no chance” of being met without action from wealthy countries.

Mr. Brown said 240 million vaccine doses were lying unused in the West, citing figures from Airfinity, a data research agency. He added that the number of unused doses was projected to reach 600 million by the end of December. A shortfall of 500 million doses in the global South could be alleviated by flying vaccine stockpiles to countries in need and by switching delivery contracts. Up to 100 million doses could pass their use-by dates and end up being destroyed, he said.

Ahead of the Group of 20 summit that starts in Rome on Oct. 30, Western leaders should make a plan to transfer vaccines, Mr. Brown said, and other G20 nations could follow suit.

The C.D.C. endorses Moderna and J.&J. boosters for millions of Americans.

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The C.D.C. recommended booster shots for millions of people who received the Moderna and Johnson & Johnson vaccines.Credit...From left: David Zalubowski/Associated Press; Mark Lennihan/Associated Press

In a sweeping victory for the Biden administration, the Centers for Disease Control and Prevention on Thursday endorsed booster shots of the Moderna and the Johnson & Johnson Covid-19 vaccines for tens of millions of Americans.

The decision follows an agency endorsement last month of booster shots of the Pfizer-BioNTech vaccine and opens the door for many Americans to seek out a booster shot as early as Friday.

The coronavirus vaccines “are all highly effective in reducing the risk of severe disease, hospitalization, and death, even in the midst of the widely circulating Delta variant,” Dr. Rochelle Walensky, director of the C.D.C. said in a statement on Thursday night.

Her approval brings the country closer to fulfilling President Biden’s promise in August to offer boosters to all adults. The pandemic is now retreating in most parts of the country, but there are still about 75,000 new cases every day and about 1,500 Covid deaths.

That pledge angered many experts, including some advising the Food and Drug Administration and the C.D.C., who said that scientists had not yet had a chance to determine whether boosters were actually necessary.

Studies showed that the vaccines remained very effective against severe disease and death, although their effectiveness might have waned against milder infections, particularly as the Delta variant spread across the nation this summer.

The purpose of the vaccines is to prevent illness severe enough to require medical attention, not to prevent infection, Dr. Wilbur Chen, an infectious disease physician at the University of Maryland and a member of the C.D.C. panel, the Advisory Committee on Immunization Practices, said during the deliberations on Thursday.

“It might be too much to ask for a vaccine, either a primary series or the booster, to prevent all forms of infections,” Dr. Chen said.

The C.D.C.’s advisers last month tried to narrow the number of Americans who should receive a booster dose of the Pfizer-BioNTech vaccine, saying that research did not support boosters for people whose jobs exposed them to the coronavirus, as the F.D.A. had indicated.

But in a highly unusual move, Dr. Walensky overturned their decision, aligning the agency’s advice with the criteria laid out by the F.D.A.

On Wednesday, the Food and Drug Administration authorized booster shots for millions of people who received the Moderna and the Johnson & Johnson vaccines, just as it did for recipients of Pfizer-BioNTech shots last month. The F.D.A. also gave the green light for people eligible for booster shots to get a dose of a different brand.

But in practice, who will get the shots and when depends greatly on the C.D.C.’s final guidance. Though the agency’s recommendations do not bind state and local officials, they hold great sway in the medical community.

On Thursday, members of the C.D.C.’s panel endorsed the so-called mix-and-match strategy, saying people fully immunized with one company’s vaccine should be allowed to receive a different vaccine for their booster shot.

Limited evidence strongly suggests that booster doses of one of the two mRNA vaccines — Moderna or Pfizer-BioNTech — more effectively raise antibody levels than a booster dose of the Johnson & Johnson vaccine.

The committee advised that recipients of the single-dose Johnson & Johnson Covid vaccine should receive a booster shot at least two months after their first dose.

Among Americans initially immunized with an mRNA vaccine, adults over 65, adults who are 50 to 65 with certain medical conditions, and those who reside in long-term care settings should receive a single booster dose six months or longer after their second dose, the committee decided.

For adults ages 18 to 49 with certain medical conditions and adults whose jobs regularly expose them to the virus, the panel opted for softer language, saying they may choose to get a booster after considering their individual risk.

The experts emphasized that people who have received two mRNA vaccine doses or a single Johnson & Johnson dose should still consider themselves fully vaccinated. Federal health officials said they would continue to study whether those who had weak immune systems and had already received a third dose of a vaccine should go on to get a fourth dose.

Some advisers were concerned that young and healthy Americans who don’t need a booster might choose to get one anyway. Side effects are uncommon, but in younger Americans they may outweigh the potential benefits of booster doses, the scientists said.

“Those that are not at high risk should really be thoughtful about getting that dose,” said Dr. Helen Talbot, an infectious disease expert at Vanderbilt University.

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Pfizer says new data show booster shots of its vaccine are highly protective against Covid.

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A nurse at a mobile vaccine clinic at Fircrest Senior Living in McMinnville, Ore., administered Pfizer-BioNTech vaccinations and booster shots earlier this month. Credit...Alisha Jucevic for The New York Times

Booster shots in adults who received the Pfizer-BioNTech vaccine were highly effective at preventing symptomatic Covid-19 breakthrough infections, Pfizer announced on Thursday.

The company said that out of more than 5,000 Pfizer-BioNTech vaccine recipients enrolled in its study who received a booster shot, only five later developed symptomatic disease, compared with 109 people among a similar group that received a placebo instead of a booster dose.

The news arrived as an advisory committee to the Centers for Disease Control and Prevention debates whether Americans should receive booster shots of the Moderna and Johnson & Johnson vaccines.

The company claimed the findings came from the first randomized efficacy trial of booster shots. But the results, announced in a news release, have not been peer-reviewed or published in a medical journal.

Last month, the Food and Drug Administration authorized Pfizer-BioNTech booster shots for people 65 and over, people who are at high risk of severe Covid-19, and those who are at elevated risk of exposure because of where they work or live. That decision was based on limited effectiveness data.

The new findings appear to bolster proof that booster shots are highly effective, though the trial participants were only followed for a median period of two and a half months after receiving the booster.

“These important data add to the body of evidence suggesting that a booster dose of our vaccine can help protect a broad population of people from this virus and its variants,” said Dr. Ugur Sahin, founder and chief executive of BioNTech.

The results will be shared with the F.D.A. and its European equivalent, the European Medicines Agency, as well as other international regulatory agencies, according to Albert Bourla, Pfizer’s chief executive.

The randomized controlled trial of the booster included more than 10,000 participants aged 16 and older, half of whom received a booster that contains the same amount of vaccine as each of the two primary doses, and half of whom received a placebo.

The booster was given an average of 11 months after the initial regimen, and participants were monitored for symptoms of Covid that developed between a week and 2.5 months after the booster, on average.

Stratified analyses showed the relative efficacy rate of 95.6 percent for the boosters was consistent regardless of age, sex, race, ethnicity or chronic medical conditions.

Slightly more than half of the participants were between 16 and 55 years old, and just under one quarter were 65 or older. The companies said that they had not identified any new side effects or safety concerns during the trial.

Here’s a closer look at the science behind mixing and matching Covid vaccines.

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A trial at the University of Maryland School of Medicine found that switching boosters raised the level of coronavirus antibodies.Credit...Charles Krupa/Associated Press

An advisory panel to the Centers for Disease Control and Prevention discussed on Thursday whether Americans would be allowed to switch vaccines when choosing a Covid-19 booster shot.

The panel endorsed the so-called mix-and-match strategy — whether people fully immunized with one company’s vaccine should be allowed to switch to a different one for their booster. Limited evidence strongly suggests that booster doses of one of the two mRNA vaccines — Moderna or Pfizer-BioNTech — more effectively raise antibody levels than a booster dose of the Johnson & Johnson vaccine, the committee noted.

Below is a rundown of the science behind mixing and matching, and what the future of the strategy may hold.

Immunizations typically consist of two or more doses of the same vaccine.

The Moderna vaccine, for example, is administered in two identical shots of mRNA, separated by four weeks.

A double dose can create much more protection against a disease than a single shot. The first dose causes the immune system’s B cells to make antibodies against a pathogen. Other immune cells, called T cells, develop the ability to recognize and kill infected cells.

The second shot amplifies that response. The B cells and T cells dedicated to fighting the virus multiply into much bigger numbers. They also develop more potent attackers against the enemy.

In recent years, some vaccine researchers have experimented with a switch from one vaccine to another for the second dose.

This mixed strategy is technically known as a heterologous prime boost. One of the first authorized vaccines of this kind for any disease is the Sputnik V vaccine, developed last year by Russian researchers to prevent Covid-19. It uses two different adenoviruses to deliver coronavirus proteins, which the immune system then attacks. The first dose contains an adenovirus called Ad5, and the second contains another, called Ad26.

Different types of vaccines stimulate the immune system in different ways, and switching between two vaccines might give people the best of both worlds.

Experiments on animals have suggested that two different vaccines can build a stronger defense by strengthening different parts of the immune system. In a study published Thursday, French researchers looked at what happened when people switched from a first dose of AstraZeneca to a second dose of Pfizer-BioNTech. The mixed vaccines were more effective at protecting against Covid-19 than two doses of Pfizer-BioNTech.

The mix-and-match option could also offer lifesaving flexibility in a world where Covid-19 vaccines remain in desperately short supply. If supplies were to run out before people got a second dose, they could switch to another vaccine and still get a strong immunity to the coronavirus.

The Food and Drug Administration has authorized the use of the Pfizer, Moderna and Johnson & Johnson vaccines.

The Moderna and Pfizer-BioNTech vaccines, which are both delivered in two doses, began showing some loss of effectiveness against infection over the summer, although they both remained strong against hospitalization. (A study published last month found that the one-dose Johnson & Johnson vaccine was 71 percent effective against hospitalization, compared with 88 percent for Pfizer-BioNTech and 93 percent for Moderna.)

On Wednesday, the Food and Drug Administration authorized boosters for the Moderna and Johnson & Johnson vaccines and updated the authorizations for all three vaccines to allow mixing and matching of booster doses.

In June, the National Institutes of Health started a study looking at what happens when fully vaccinated people switch to a new vaccine for a booster.

Dr. Kirsten Lyke of the University of Maryland School of Medicine presented the first results of the trial at a F.D.A. meeting last week. The researchers recruited people who had gotten one of the three vaccines authorized in the United States, and then gave them one of the three vaccines as a booster.

Dr. Lyke and her colleagues found that switching boosters raised the level of coronavirus antibodies, no matter which combination people got. And switching to a new booster did not produce any notable side effects.

The results for people who initially received a Johnson & Johnson vaccination were particularly striking.

Those receiving a Johnson & Johnson booster saw antibodies go up just fourfold. Switching to a Pfizer-BioNTech booster raised antibody levels by a factor of 35. A Moderna booster raised them 76-fold.

Dr. Lyke cautioned against drawing hasty conclusions from the results so far.

The researchers hope that by next month they’ll know how well the different boosters increase T cells, not just antibodies. It’s possible that Johnson & Johnson’s vaccine will shine in those results. “We’ll get a more rounded picture,” she said.

Over 100 Covid-19 vaccines are now in clinical trials, with even more being tested in animals.

Adam Wheatley, an immunologist at the University of Melbourne in Australia, predicted that some of those new vaccines could prove to be superior boosters. Unlike vaccines made from mRNA or adenoviruses, those from companies like Sanofi-Pasteur and Novavax contain large amounts of viral proteins.

Nicolas Kressmann, a spokesman for Sanofi, said the company was far along in trials of its protein-based vaccine as a booster for people who have already received other vaccines. “Our intention is also to develop our vaccine as a universal booster, able to boost immunity regardless of the vaccination first received,” he said.

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Struggling with rising cases and low vaccination rates, Moscow announces a lockdown.

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A patient arriving at a Covid-focused hospital in Moscow last week. On Thursday, the city announced a return to some of the tightest restrictions in a year, including closing shops and restaurants.Credit...Maxim Shemetov/Reuters

MOSCOW — Schools, shops and restaurants in the city of Moscow will close next week, municipal officials said, in one of the tightest lockdowns in the Russian capital since the pandemic began, a measure made necessary by low vaccination rates.

Russia’s coronavirus response, like that of many other countries, has seesawed between strict controls and lax enforcement of mask-wearing and vaccination rules. Russia pivoted again this week toward tighter lockdowns as reports of new cases and Covid-19 deaths climbed.

Reported cases are up 33 percent over the last two weeks, reaching more than 32,400, according to a New York Times database. And on average over the past week, 983 people a day died from the coronavirus; on some days that number exceeded 1,000. Only Russian-made coronavirus vaccines are available in the country, and many people are hesitant to get them. Russia’s vaccination rate of 33 percent of the population is lower than the global average of 37 percent and far behind the rates in most of Europe.

To combat the surge in cases and deaths, President Vladimir V. Putin on Wednesday declared a countrywide “nonworking” week from Oct. 30 to Nov. 7, extending a regular fall holiday by several days. The restrictions the city of Moscow announced on Thursday were even stricter.

Mayor Sergey Sobyanin ordered schools and nonessential businesses to close two days sooner, starting on Oct. 28. He said in a statement posted online that the spread of the virus had gone “by the worst scenario” and that Moscow would soon be setting daily records for new cases.

Early in the pandemic, Moscow locked down more strictly than many Western countries did. Residents were prohibited from leaving their apartments other than to shop at grocery stores or pharmacies, attend medical appointments or walk their dogs.

The city also lifted many restrictions this year before other European countries did on a wide scale, a move that became a point of pride. Mr. Putin contrasted Moscow’s bustling restaurants with the continuing lockdowns abroad.

Over the summer, Moscow imposed, but then dropped, a requirement that patrons be vaccinated to eat in some restaurants or to visit bars. Enforcement of mask-wearing rules in Russia is generally lax.

Canada settles on one standard ‘vaccine passport’ for travel.

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Canada Rolls Out Standard Vaccine Passport

Prime Minister Justin Trudeau of Canada said a national standard for vaccination credentials would be required for domestic and international travel, unifying the country’s patchwork of proof-of-immunization programs.

We made a commitment to ensure that there is a national standard for a proof of vaccination certificate that will be issued by every province and territory so that people can travel domestically, but particularly internationally. And today, I’m happy to confirm that all provinces and territories have confirmed that they will be moving forward with a standardized national proof of vaccination. As of today, so far we have Saskatchewan, Ontario, Quebec, Nova Scotia, Newfoundland and all three provinces — all three territories, Nunavut, Northwest Territories and Yukon, who already have put into use the national standard for proof of vaccination.

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Prime Minister Justin Trudeau of Canada said a national standard for vaccination credentials would be required for domestic and international travel, unifying the country’s patchwork of proof-of-immunization programs.CreditCredit...Blair Gable/Reuters

Canada is rolling out a national standard for vaccination credentials that will be required for domestic and international travel, unifying the country’s patchwork of proof-of-immunization programs, Prime Minister Justin Trudeau said on Thursday.

The national proof of vaccination standard features a QR code and official logos from the federal government and the recipient’s province or territory. It will be available digitally and in hard copy.

Some of the country’s 10 provinces and its three territories, which are responsible for delivering health care, now offer digital vaccine cards with scannable QR codes and paper copies; others offer paper cards that can be digitized or displayed in phone photos. Regulations about what residents may be asked to present when they enter places like restaurants and movie theaters vary from province to province.

So far, five provinces — Saskatchewan; Ontario; Quebec; Nova Scotia; and Newfoundland and Labrador — as well as the Yukon, Nunavut and Northwest Territories have implemented what will now be the national standard, Mr. Trudeau said, adding that the remaining five provinces were expected to catch up soon.

“We will be picking up the tab for it at the federal level, to ensure that all provinces are able to do it,” Mr. Trudeau told reporters outside the Children’s Hospital of Eastern Ontario in Ottawa.

On Oct. 30, Canada is scheduled to begin enforcing requirements that anyone aged 12 or over who travels domestically by air, rail or cruise ship must be fully vaccinated. For a month, proof of a recent negative Covid-19 test will also be accepted, but immigration authorities warn the unvaccinated that “they risk not qualifying for travel as of Nov. 30.”

About 72 percent of Canadians are fully vaccinated, according to government figures.

No vaccine is yet authorized in Canada for children under 12, but Mr. Trudeau said on Thursday that Pfizer was seeking regulatory approval to administer the Pfizer-BioNTech vaccine to children aged 5 to 11.

“This is great news,” he said. “I can assure you that Health Canada is going to be examining attentively that submission.”

When the authorization is granted, the Canadian government would be scheduled to receive 2.9 million pediatric doses of the vaccine, Anita Anand, the minister of public services and procurement, said in an emailed statement.

Also Thursday, the government announced it was no longer advising against non-essential travel for fully vaccinated people.

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Global Roundup

India’s vaccine campaign hits a billion doses, and other news from around the world.

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A health worker inoculating a woman with the Covaxin vaccine at a health center in New Delhi, India, on Thursday.Credit...Prakash Singh/Agence France-Presse — Getty Images

India on Thursday celebrated having administered a billion doses of Covid vaccine, drawing on local manufacturing after devastating early stumbles in its pandemic response.

Still, the country has some way to go in fully vaccinating its population: Just 30 percent of the 900 million people eligible for vaccination in India have received two doses.

The billion-dose milestone represented a turnaround in a vaccination drive that got off to a slow start, as India’s governing party prioritized elections and took up a lax attitude in tackling the virus, continuing to hold crowded political rallies and allowing religious festivals to take place even as cases surged.

“Gratitude to our doctors, nurses and all those who worked to achieve this feat,” Prime Minister Narendra Modi said on Twitter. More than 70 percent of adults have received at least one dose of vaccine, according to government figures. India is administering second doses 12 to 16 weeks after the first.

More than 450,000 people have died from Covid in India, according to government data that many experts say greatly downplays the true toll. India’s second wave earlier this year led to a shortage of medical care, oxygen, and hospital beds.

But the worst of the pandemic seems to be over, with India reporting about 15,000 new cases daily, down from a recorded peak of more than 400,000.

While other countries have struggled to secure enough doses to vaccinate their populations, India’s gigantic vaccination drive was made possible by domestic manufacturing capacity. The Serum Institute of India, the world’s largest vaccine maker, has supplied more than 80 percent of the doses administered in the country.

The demand for vaccines in India after the devastating second wave was such that the Serum Institute fell short on its commitments to supply vaccines to poorer nations. But as India’s situation stabilizes, vaccine exports from India — seen as crucial to global efforts — have slowly resumed.

The toll of the pandemic on India’s already slowing economy, however, will take years to reverse.

In other news from around the world:

  • Melbourne, Australia, came out of its 78-day lockdown late on Thursday night, after the state of Victoria passed the milestone of having 70 percent of the eligible population fully inoculated against Covid, though the state’s cases are still spiking. Melbourne has spent more time under heavy virus restrictions than any other in the world, with 262 days in lockdown since March 2020.

  • Bulgaria, which is struggling with record coronavirus cases and rising deaths and has the lowest vaccination rate of any E.U. nation, began requiring residents to show proof of vaccination to eat at restaurants, attend movie theaters and enter shopping malls starting Thursday. “The situation is critical,” the interim health minister, Dr. Stoycho Katsarov, said in a television interview on Wednesday. “The nation is facing tremendous hardship and most people cannot even reckon the scale of the calamity.”

  • Several Caribbean countries are reporting significant surges in known coronavirus cases, World Health Organization officials warned on Wednesday. Many Caribbean countries have had difficulty with vaccination efforts, because of both difficulty obtaining doses and widespread public hesitancy. Reports of new cases are up 40 percent over the last week in the Dominican Republic and Barbados, and cases are also rising in Trinidad and Tobago, St. Martin, St. Kitts and Nevis, Anguilla and the Cayman Islands.

  • Sweden has extended its pause of Moderna’s Covid vaccine for people aged 30 and younger beyond Dec. 1, out of concern over rare heart-related side effects, the country’s public health agency said on Thursday, according to Reuters. The agency also said it would remove the recommendation for testing for those who are fully vaccinated, even if they are displaying symptoms, because the vaccine was so effective at preventing severe disease and the spread of infection.

  • Singapore extended social curbs for around a month on Wednesday to contain the spread of the coronavirus, Reuters reported, aiming to ease pressure on the health care system amid a spike in infections that thwarted the country’s nascent reopening. The health ministry recorded 18 new Covid deaths on Wednesday, the highest since the beginning of the pandemic.

  • China reported 28 locally transmitted infections on Thursday, the country’s highest one-day figure in a month. Most of the new cases were in northern-central areas. The authorities there have closed tourist sites, canceled flights and locked down neighborhoods.

As borders reopen, New York clamors for free-spending foreign tourists.

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Times Square was a popular location for foreign tourists before the pandemic.Credit...Zack DeZon for The New York Times

As New York City struggles to revive its economy after the devastation wrought by the pandemic on restaurants, hotels, theaters, tours, souvenir shops and the people who keep them running, one crucial element is still missing: big-spending foreign tourists.

Before the virus, the city was flooded with record numbers of visitors from Europe, Asia and South America. In 2019, they filled hotels, restaurants, Broadway theaters and museums, spending billions and fueling a surge in jobs. While American tourists have returned, the city can’t wait until Nov. 8, when the federal government is opening the country’s borders to vaccinated visitors. New York is preparing its most aggressive campaign in an effort to lure those visitors back in time to salvage, if it can, the end-of-year holiday season.

The city’s tourism agency, NYC & Company, plans to spend $6 million in eight countries on an advertising campaign themed “It’s Time for New York City,” with billboards trumpeting the message: “New York City Is Ready for You.”

Fred Dixon, the chief executive of the agency, said it would take years to regain all the lost tourism, but that the campaign could help. “There is an enormous amount of pent-up demand, and people are anxious to travel again,” he said.

Before the pandemic, tourists spent $47 billion annually and supported more than 280,000 jobs in the city, according to official estimates. About half of that came from international visitors, even though they accounted for just 20 percent of all tourists.

This year, the city’s tourism agency forecasts visitor spending of about $24 billion, half of the 2019 total.

Many New York businesses and workers say their survival depends on the robust return of international tourists.

“We’re hoping the city tries to bring back these international tourists because they’re our lifeline,” said Mohammed Rufai, an immigrant from Ghana who sells tickets in Times Square for a double-decker bus tour of Manhattan. “We need them.”

Mr. Rufai, 45, said he could earn $200 a day before the pandemic, more than 70 percent of it from other parts of the world. He now struggles to make half that.

“You cannot ask people to ride if there are no people here to ask,” he said.

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Travel in Asia has yet to rebound as tourists navigate a patchwork of policies.

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Tourists on a beach in Bali on Tuesday, after Indonesia began allowing tourists from 19 countries.Credit...Made Nagi/EPA, via Shutterstock

While fully vaccinated Americans can fly to hundreds of cities and towns across the country and 27 European capitals, border rules across Asia remain far stricter than in any other region in the world.

Governments in Asia have promised to reopen their borders because of the improved Covid situation and progress on vaccinations. But they are falling behind the rest of the world. Air travel in August across the region was still 10 percent of what it was two years ago, lagging the rebound in the United States. Travelers must navigate an inconsistent patchwork of border restrictions, visa rules and travel corridors — one likely to continue for months.

Vaccinated travelers from a handful of countries, including Britain and Spain, won’t have to quarantine to visit Singapore. But Ireland and Portugal, which have comparable vaccination rates, didn’t make the list. And visitors from only four places in Asia — Hong Kong, Macau, China and Taiwan — may enter by applying for a special pass.

The list of eligible countries from which tourists can visit Indonesia is longer, with travelers from 19 countries cleared to visit Bali and the Riau Islands. People from India, which has vaccinated about a quarter of its population, are good to travel. But those from Malaysia, which has vaccinated 72 percent, or Singapore, 82 percent, aren’t yet welcome.

And the regulations in the Philippines have led to some confusion. Two tourists were sent back to Singapore after they arrived without the proper visas. They were not aware that the Philippines had only opened travel for business or humanitarian reasons.

Thailand is taking a different approach, requiring visitors not to make any stopovers. Tourists can go to the island of Phuket without quarantining if they arrive on a direct flight, and they can tour other parts of the country after seven days. Quarantine-free arrivals to the rest of Thailand will be open to vaccinated tourists from at least 10 countries starting Nov. 1, the authorities said last week.

South Korea has taken yet another path: Instead of allowing tourists to arrive from particular locations, it has allowed people of certain nationalities to visit without a visa. Tourists of one of 49 nationalities may apply for permission to visit.

But a separate list, based on where travelers arrive from, governs who has to undergo two weeks of quarantine on arrival in South Korea; the authorities are adding five countries to the list of those from which fully vaccinated travelers will not have to quarantine starting next month.

Fully vaccinated people flying in from Malawi, Bangladesh, Indonesia, Zambia and Chile will not be required to isolate for two weeks starting in November. Visitors from 16 nations will still need to quarantine, down from 20 in October.

South Korea also relaxed some social distancing regulations on Monday, after several months in which they have been at the highest level in the capital.

Most other countries in the region, including China and Japan, still require visas for vaccinated foreign travelers. Tourists have yet to get approval to enter.

Israel moves to allow tourists back in — if they are vaccinated.

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People arriving at the Ben Gurion International Airport in Lod, near Tel Aviv, last May, when immediate relatives who were vaccinated were allowed to enter the country.Credit...Ronen Zvulun/Reuters

Prime Minister Naftali Bennett and Israeli health officials announced a plan on Thursday to allow vaccinated tourists to enter the country starting Nov. 1, the first time the country will open its borders to tourism since the start of the coronavirus pandemic.

Since May, Israel has allowed entry only to immediate relatives of Israelis who are vaccinated or have recently recovered from a coronavirus infection, provided they obtain approval from the government. The new plan, which still requires official government approval, comes at a time when infection rates in Israel are steadily declining after a fourth wave.

The country, which had one of the world’s fastest vaccination drives but has now been surpassed by more than 30 countries, is currently leading in booster shot distribution, with some 3.8 million of its 8.8 million people having received a third dose of the Pfizer-BioNTech vaccine. Israelis lifted domestic restrictions and largely returned to normal in May.

According to the office of the prime minister, tourists who have been fully vaccinated with most internationally recognized vaccines, as well as those who have recovered from Covid-19 within the last six months, will be allowed to enter the country, unless they are from “red” countries with severe outbreaks.

Tourists qualified to enter the country can receive a digital Green Pass, allowing them to enter restaurants, cafes, bars and other indoor places in Israel.

The plan will not allow those vaccinated with Russia’s Sputnik V vaccine, which is not approved by the World Health Organization, to enter the country yet. Mr. Bennett is mulling postponing their entry until Dec. 1.

The plan came a day before Mr. Bennett was scheduled to meet with President Vladimir Putin of Russia in the Black Sea resort town of Sochi.

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U.S. pharmacies and states face new challenges as an expanded booster rollout begins.

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Gov. Philip D. Murphy of New Jersey, left, touring a coronavirus vaccination site earlier this month in Newark.Credit...Justin Lane/EPA, via Shutterstock

Now that federal regulators have cleared booster shots of all three coronavirus vaccines in use in the United States, state health authorities and pharmacies have begun rolling out plans to get even more shots in arms.

Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, recommended Moderna and Johnson & Johnson boosters on Thursday for tens of millions of Americans, a move that came nearly a month after many Pfizer-BioNTech recipients were cleared for boosters of that company’s vaccine.

The C.D.C. also gave a green light to a “mix-and-match” strategy so people who are eligible for boosters can decide to get a dose of a different type than the one they first received.

And as states, pharmacies and doctors began on Friday trying to get these shots into arms, they faced a variety of complex issues — they will have to help people understand whether they are eligible and answer questions about which booster to get.

According to the C.D.C., certain groups of people who received their second dose of an mRNA vaccine six or more months ago are now eligible for a booster. Those who qualify are people 65 and older, those 18 and older who live in long-term care, and those who have underlying medical conditions or work or live in settings placing them at high risk of infection.

For those who received the single-shot Johnson & Johnson vaccine, anyone 18 and older who was vaccinated two or more months ago is eligible. The Moderna booster, whether people originally got that company’s vaccine or either of the other two, will be a half-dose shot.

Limited evidence strongly suggests that booster doses of one of the two mRNA vaccines — Moderna or Pfizer-BioNTech — more effectively raise antibody levels than a booster dose of the Johnson & Johnson vaccine.

“Now with 10 months of vaccine experience, some may have an express preference for one booster type over another,” Dr. Walensky said on Friday, referring to the mix-and-match option, adding that it was “perfectly fine” for people to choose a booster of the same vaccine that they received initially.

Other challenges medical providers will contend with include reaching marginalized groups, including homeless people and migrant workers, who may have received the Johnson & Johnson vaccine when it was only meant as a single-dose option, and making sure that people receive the correct dose of a Moderna booster.

More than 120 million Americans will become eligible for a booster in the coming months, Jeffrey D. Zients, the White House coronavirus response coordinator, said at a news conference on Friday, adding that boosters were available at more than 80,000 locations across the country, including at least 40,000 local pharmacies. CVS and Walgreens said they expanded their booster offerings on Friday, and were able to provide “mix-and-match” doses.

State health departments generally follow the recommendations of the C.D.C., and many were prepared to begin moving ahead with boosters.

On Friday, Gov. Jared Polis of Colorado got a Moderna booster, after receiving his second Moderna shot six months earlier. Mr. Polis, 46, said he was eligible because his job puts him at high risk of exposure.

“Like most Coloradans and Americans, I am ready to put this pandemic behind us,” Mr. Polis said from behind a medical mask, adding. “I am excited to get this level of protection.”

In Maryland, Gov. Larry Hogan welcomed the C.D.C.’s guidance on Friday, saying in a statement that “Eligible Marylanders may now choose which vaccine they want for a booster, even if it is different from what they received initially.” Officials said that the state had been preparing for the decision for months, with more than 300 sites available since last month, including large and small pharmacies, hospitals, urgent care centers and mobile vaccination operations.

In Vermont, Gov. Phil Scott announced that eligible residents could receive the new boosters beginning on Friday.

In Oregon, the state health department has enrolled hundreds of providers to administer boosters, and will train them on giving different amounts of doses, according to Kristen Dillon, a senior adviser to the state’s Covid response and recovery unit.

Officials in New Jersey said they would open several state mass vaccination sites to handle the expected demand, in addition to offering shots at schools, pharmacies and large county sites.

Coral Murphy Marcos and Giulia Heyward contributed reporting.

A bat research group failed to submit virus studies promptly, the N.I.H. says.

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Dr. Francis Collins, the director of the N.I.H., in Washington in March 2020.Credit...Anna Moneymaker/The New York Times

The National Institutes of Health said on Wednesday that a nonprofit group under fire from some congressional Republicans for its research collaborations in China had failed to promptly report findings from studies on how well bat coronaviruses grow in mice.

In a letter to Representative James Comer, Republican of Kentucky, the N.I.H. said that the group, EcoHealth Alliance, had five days to submit all unpublished data from work conducted under a multiyear grant it was given in 2014 for the research. The organization’s grant was canceled in 2020 under President Trump’s administration during his feud with China over the origins of the coronavirus.

In recent months, N.I.H. officials have rejected claims — sometimes in heated exchanges with congressional Republicans — that coronaviruses studied with federal funding might have unleashed the pandemic. Dr. Francis Collins, the director of the N.I.H., released a statement Wednesday night reiterating that rebuttal.

“Naturally occurring bat coronaviruses studied under the N.I.H. grant are genetically far distant from SARS-CoV-2 and could not possibly have caused the Covid-19 pandemic,” he said in the statement. “Any claims to the contrary are demonstrably false.”

EcoHealth Alliance has come under scrutiny because of its collaboration on coronavirus research with researchers at the Wuhan Institute of Virology, which is situated in the city where the pandemic began.

Robert Kessler, a spokesman for the group, said on Thursday that EcoHealth Alliance was trying to resolve what it described as a “misconception” about its findings with the N.I.H. He said that the group had reported data from its studies “as soon as we were made aware” in April 2018, and that the agency had reviewed the data and never indicated that further reviews were needed.

Some scientists have argued that it’s possible SARS-CoV-2 was the result of genetic engineering experiments or simply escaped from a lab in an accident. But direct evidence for those theories has yet to emerge. Others have deemed those scenarios unlikely, pointing instead to many lines of evidence suggesting that people acquired the coronavirus in a natural spillover from bats or an intermediate mammal host.

The controversy has drawn scrutiny to the experiments that EcoHealth Alliance and the Wuhan Institute of Virology carried out with funding from the N.I.H.

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