PUNE, India — India on Saturday began one of the most ambitious and complex initiatives in its history: the nationwide rollout of coronavirus vaccines to 1.3 billion people, an undertaking that will stretch from the perilous reaches of the Himalayas to the dense jungles of the country’s southern tip.
The campaign is unfolding in a country that has reported more than 10.5 million coronavirus infections, the second-largest caseload after the United States, and 152,093 deaths, the world’s third-highest tally.
Prime Minister Narendra Modi kicked off the vaccine drive on Saturday with a live television address as 3,000 centers nationwide were set to inoculate a first round of health care workers.
“Everyone was asking as to when the vaccine will be available,” Mr. Modi said. “It is available now. I congratulate all the countrymen on this occasion.”
The government had hoped to inoculate about 300,000 people on Saturday, but government data showed that 165,000 people received a shot. The plan is to give the vaccine to millions more health care and frontline workers by the spring.
At Kamala Nehru Hospital in Pune, a city of about 3.1 million southeast of Mumbai, 100 long-stemmed red roses were stacked neatly on a table beside a bottle of hand sanitizer. Each person registered to receive the Covishield vaccine, developed by AstraZeneca and Oxford University and manufactured by the Pune-based Serum Institute of India, was to get a rose.
Covishield and another vaccine called Covaxin were authorized for emergency use in India this month.
Neither Covaxin’s manufacturer, Bharat Biotech, nor the Indian Council of Medical Research, which contributed to the vaccine’s development, has published data proving that it works. In a Covaxin consent form at District Hospital Aundh, one of a handful of sites in Pune where the vaccine was being administered, the manufacturer noted that clinical efficacy was “yet to be established.”
Dr. Rajashree Patil, one of the health workers who received the Covishield vaccine at Kamala Nehru Hospital, said she was both excited and nervous. After contracting the coronavirus while working in the government hospital’s emergency room in May, she spent 12 days in a Covid ward at another hospital, having lost her senses of smell and taste and experiencing extreme fatigue.
“I’m a little bit worried. Actually we’re on a trial basis,” Dr. Patil said. “But I am happy we are getting it so we can one day be corona-free.”
Another doctor who received the Covishield vaccine at that hospital, Usha Devi Bharmal, said that she had wanted to get a shot to dispel people’s fears about coronavirus vaccines. “There are rumors on social media,” she said, adding that she hoped to help show that vaccines are a “positive thing.”
Mr. Modi has pledged to inoculate 300 million health care and frontline workers, including police officers and, in some cases, teachers, by July. But so far the Indian government has purchased only 11 million doses of Covishield and 5.5 million doses of Covaxin.
Indian television stations showed Dr. Randeep Guleria, the director of the All India Institute of Medical Sciences in New Delhi and a prominent government adviser on Covid-19, receiving a jab on Saturday. It was unclear whether Mr. Modi was vaccinated.
India’s rollout, among the first in a major developing country, comes as millions of people in the United States, Britain, Israel, Canada and the European Union have received at least one dose.
India’s vaccination effort faces a number of obstacles, including a growing sense of complacency about the coronavirus. After reaching a peak of more than 90,000 new cases per day in mid-September, the country’s official infection rates have dropped sharply. Fatalities have fallen about 30 percent in the last 14 days, according to a New York Times database.
City streets are buzzing. Air and train travel have resumed. Social distancing and mask-wearing standards, already lax in many parts of India, have slipped further. That alarms experts, who say the real infection rate is probably much worse than official numbers suggest.
Even as President-elect Joseph R. Biden Jr. makes public his ambitious plans to tame Covid-19, a far more contagious variant of the virus is causing researchers to fear that another wrenching surge of cases and deaths is looming.
Federal health officials sounded the alarm on Friday about the fast-spreading variant, which was first identified in Britain. They warned that it could become the dominant source of infection in the United States by March.
“I think we are going to see in six to eight weeks major transmission in this country, like we’re seeing in England,” said Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of Mr. Biden’s coronavirus advisory board.
In a study released Friday, the Centers for Disease Control and Prevention called for a doubling down on preventive measures to fight the variant, including more robust distribution of vaccines, which remain far below the benchmarks the government has set.
Tweeting on Friday that his administration “will move Heaven and Earth” to get more people vaccinated as soon as possible, Mr. Biden was still sober about his plans for broadening vaccine distribution even as supplies remain limited. He said he would create mobile vaccine clinics and widely — and equitably — expand access to the shots across the country.
The variant, though it spreads more rapidly, is not known to be more deadly or to cause more severe disease. But further study is needed, the C.D.C. says, to determine whether existing vaccines and treatments will be effective in treating the variant — as well as others that have been discovered in Brazil and South Africa.
As of Friday, the variant first discovered in Britain had been detected in more than 70 cases from 13 states — most recently in Oregon — but the actual numbers are likely to be much higher, said Dr. Jay Butler, deputy director for infectious diseases at the C.D.C.
“I want to stress that we are deeply concerned that this strain is more transmissible and can accelerate outbreaks in the U.S. in the coming weeks,” Dr. Butler said. “We’re sounding the alarm and urging people to realize the pandemic is not over and in no way is it time to throw in the towel.”
“We know what works, and we know what to do,” he said.
Current spikes in cases threaten to cripple already overwhelmed hospitals and nursing homes in many parts of the country. Some are at or near capacity. Others have faced troubling rates of infection among their staff, causing shortages and increasing patient loads.
Covid-19 cases and deaths have broken record after record across the country, with a peak number of deaths, 4,400, announced on Tuesday. More than 3,740 new deaths and at least 241,000 new cases were reported on Friday, and the nation is nearing a milestone of 400,000 deaths.
And with the possibility that yet another surge from the new variant will overtake the country’s ability to inoculate enough people to stamp out the virus altogether anytime soon, it will be awhile before people can relax their guard.
“The honest truth is this: things will get worse before they get better,” Mr. Biden said. “And the policy changes we are going to be making, they’re going to take time to show up in the Covid statistics.”
All at once, the coronavirus seemed to change.
For months, Dr. Steven Kemp, an infectious disease expert, had been scanning a global library of coronavirus genomes. He was studying how the virus had mutated in the lungs of a patient struggling to shake a raging infection in a nearby Cambridge hospital, and wanted to know if those changes would turn up in other people.
Then in late November, Dr. Kemp made a startling match: Some of the same mutations detected in the patient, along with other changes, were appearing again and again in newly infected people, mostly in Britain.
Worse, the changes were concentrated in the spike protein the virus uses to latch onto human cells, suggesting that a virus already wreaking havoc around the world was evolving in a way that could make it even more contagious.
“There’s a load of mutations that occur together at the same frequency,” he wrote on Dec. 2 to Dr. Ravindra Gupta, a Cambridge virologist. Listing the most troubling changes, he added: “ALL of these sequences have the following spike mutants.”
The two researchers did not yet know it, but they had found a new, highly contagious coronavirus variant that has since stampeded across Britain, shaken scientists’ understanding of the virus and threatened to set back the global recovery from the pandemic.
Word raced through a consortium of British disease scientists, longtime torchbearers in genomics who had helped to track the Ebola and Zika epidemics. They gathered on Slack and on video calls, comparing notes as they chased down clues, among them a tip from scientists in South Africa about yet another new variant there. Still others have since emerged in Brazil.
For nearly a year, scientists had observed only incremental changes in the coronavirus, and expected more of the same. The new variants forced them to change their thinking, portending a new phase in the pandemic in which the virus could evolve enough to undermine vaccines.
President-elect Joseph R. Biden Jr. said on Saturday that he was “always going to lead with science and truth” as he announced top science and technology officials on his White House staff, reaffirming trust in the kind of expert research that the Trump administration often ignored or disdained.
“This is how we are going to, God willing, overcome the pandemic and build our country back better than it was before,” he said on Saturday while announcing the top members of his White House science team.
Extolling what he called “some of the most brilliant minds in the world,” Mr. Biden said his new team’s mission would be to ask: “How can we make the impossible possible?”
The team includes Eric S. Lander, Alondra Nelson, Frances H. Arnold and Maria Zuber. Mr Biden described the scientists as “some of the most brilliant minds in the world.” Mr. Biden will nominate Mr. Lander to be director of the White House Office of Science and Technology Policy, a position that will for the first time hold cabinet rank.
Mr. Biden also said that Dr. Francis S. Collins would remain as the director of the National Institutes of Health.
On Friday, Mr. Biden pledged to increase vaccination availability in pharmacies, build mobile clinics to get vaccines to underserved rural and urban communities, and encourage states to expand vaccine eligibility to people 65 and older. He also vowed to make racial equity a priority in fighting a virus that has disproportionately infected and killed people of color.
The coronavirus pandemic is just one aspect of science in America that the team has been tasked with working on in the coming years. Others include economic prosperity, how science can help confront the climate crisis, ensuring that the U.S. leads the way in tech and industries critical for future development, and finally, building long term health and trust in science and technology among Americans.
Although neither Mr. Biden nor Vice President-elect Kamala Harris mentioned President Donald J. Trump by name, they drew comparisons to the current administration’s handling of the pandemic and decisions to ignore scientists and research.
Ms. Harris said that her mother taught her the importance of “making decisions, not based on intuition or ideology, but based on evidence.”
The Trump administration repeatedly rejected guidance from government scientists on issues including climate change and the pandemic. President Trump left the position of science adviser unfilled for 18 months.
“The science behind climate change is not a hoax,” Ms. Harris said. “The science behind the virus is not partisan. The same laws apply. The same evidence holds true regardless of whether or not you accept them.”
Alex M. Azar II, the secretary of health and human services, suggested in December that all nursing home residents in the United States could be vaccinated against the coronavirus by Christmas.
A month later, vaccinations of some of the country’s most vulnerable citizens are going more slowly than many state officials, industry executives and families expected. Their hopes had been buoyed when government officials said long-term care facilities would be at the front of the line for vaccines.
“I’ve had facilities call me, and I’ve had people cry,” said Betsy Johnson, who leads a group that represents Kentucky’s nursing homes and assisted living facilities. “I’ve had people curse.”
The pace of vaccination has taken on greater urgency as the virus continues to decimate nursing homes and similar facilities. The virus’s surge since November has killed about 30,000 long-term care staff members and residents, raising the total of virus-related deaths in these facilities to at least 136,000, according to a New York Times tracker. Since the pandemic began, long-term care facilities have accounted for just 5 percent of coronavirus cases but 36 percent of virus-related deaths.
CVS and Walgreens, which are largely responsible for vaccinating residents and workers in long-term care facilities, are on track to make at least initial vaccination visits to nearly all nursing homes they are working with by Jan. 25. The two pharmacy chains have already given out more than 1.7 million vaccine doses at long-term care facilities.
But progress is uneven across the country. Thousands of assisted living facilitiesdo not yet have appointments for their first visit from the pharmacy teams. In some states, teams from CVS or Walgreens are not scheduled to visit some nursing homes or long-term facilities until February.
Although vaccinations by CVS and Walgreens were always expected to take several months because of the need to visit facilities three times, a growing number of governors and state health officials have voiced frustration with the pharmacies’ speed. Some states and cities are exploring ways to hasten inoculations.
“This isn’t a drive-through or stadium vaccination effort,” said T.J. Crawford, a spokesman for CVS. “We’re visiting more than 40,000 facilities with an average of less than 100 residents, in some cases going room to room.”
Representative Lou Correa, Democrat of California, announced on Saturday that he had tested positive for the coronavirus a day earlier, becoming the latest lawmaker to contract the virus in the first two weeks of the 117th Congress.
Mr. Correa, who disclosed his test results on Twitter, gave few details about his symptoms, but he said he would “be responsible & self-quarantine, away from my family, for the recommended time.”
He was at the Capitol during last week’s siege by a pro-Trump mob, but was not among the lawmakers corralled into secure rooms with some of the Republicans who refused to wear masks, an action that has created concerns of a super-spreader event. According to a statement from his office, he stayed outside and tried to help the Capitol Police.
But Mr. Correa was among the lawmakers on the House floor who voted to impeach President Trump for a second time after the siege. The day after, he was accosted by Trump supporters at Dulles International Airport. He later told CNN that he was surprised that security was not tighter.
Mr. Correa received one dose of the Pfizer vaccine on Dec. 19, according to a statement from his office.
At least three Democratic lawmakers tested positive after sheltering in place, and all blamed the unmasked Republicans. Representative Ayanna S. Pressley, Democrat of Massachusetts, also cited Republicans after her husband, who was with her during the riot, tested positive. And Representative Adriano Espaillat, Democrat of New York, announced on Thursday he had also tested positive, but it was unclear whether he took shelter in the secure room.
Capitol Hill has long struggled to curtail the spread of the virus, with haphazard guidance and a failure to enforce and adhere to a uniform set of health protocols across both chambers and the complex. After the riot, the House enacted a fine system for those who refuse to wear masks in the House chamber.
Nepal has granted emergency approval for a vaccine. Now comes the hard part: rolling out an inoculation drive in a Himalayan country dotted with remote mountain villages.
Nepal’s Drug Administration Authority on Friday approved the Covishield vaccine, which was developed by AstraZeneca and Oxford University and manufactured by the Serum Institute of India. Hridayesh Tripathi, the health minister, said on Saturday that vaccines for 20 percent of the country’s 30 million people would arrive by early March.
Two other manufacturers — Sinopharm of China and Bharat Biotech of India — have also applied for regulatory approval of their vaccines in Nepal. China and India, Nepal’s two powerful neighbors, have long jockeyed for influence in the country.
Nepal has said that it will inoculate 40 percent of its population for free, starting with health care workers and people over 55. Mr. Tripathi said on Saturday that officials were considering whether to later allow private hospitals to vaccinate people who can afford to pay a fee.
Health officials in Nepal say they have established 16,000 vaccination centers, with equipment to store vaccines at cold temperatures. But bringing those vaccines to remote areas — tucked into iceboxes — may prove challenging.
Heavy snowfall in the depths of the Himalayas often blocks traffic, and some villages are not connected to a national road network. Even in good weather, it can take days to reach people who live in the farthest-flung areas.
“Although we use refrigerated vans to transport vaccines to provinces and districts, there might be some difficulties in ferrying vaccines to remote villages from district cold centers,” said Dr. Shyam Raj Upreti, a member of the government’s vaccine advisory committee.
Further complicating the situation, Nepal is currently in political turmoil, weeks after Prime Minister K.P. Sharma Oli dissolved the lower house of Parliament, and its tourism-dependent economy is suffering from an acute crisis.
In other developments around the world:
China’s National Health Commission said on Saturday that it had recorded 130 new coronavirus cases, all but 15 of them locally transmitted, a day after it said that more than 1,000 people nationwide were being treated for Covid-19. The authorities in Nangong, a city in the hard-hit northern province of Hebei, also said on Saturday that they had finished the building the first of six coronavirus hospitals.
Hospitals across England are stretched to the brink with Covid-19 patients, medical workers are at their breaking point, and the death toll is soaring. The number of hospitalized Covid-19 patients in England has risen sharply since Christmas and now dwarfs the spring peak by 70 percent, with almost 14,000 more patients in hospitals than on April 12. Prime Minister Boris Johnson warned this week that there was a “very substantial” risk that many hospitals will soon run out of beds in intensive-care units.
South Korea said on Saturday that it would extend social distancing restrictions in and around Seoul, the capital, for another two weeks. The rules ban private gatherings of five people or more and restrict business operations after 9 p.m.
AstraZeneca’s Covid-19 vaccine became the first to be approved for emergency use by Pakistan, Reuters reported on Saturday, citing the country’s health minister.
Claire Fu contributed research.
Faced with soaring rates of coronavirus infections and more doses of vaccine in freezers than in arms, New Jersey officials made a calculated choice.
They opened the floodgates of vaccine eligibility on Thursday to about 4.5 million additional residents: those 65 and older and younger people with underlying health problems, including cancer, heart conditions and diabetes — diseases that can lead to severe complications from Covid-19.
As part of the expansion, New Jersey also became the second state in the country to open vaccinations to another high-risk group: smokers. As is true for all Covid-19 vaccinations in New Jersey, no documentation of an underlying health condition is required.
The announcement came a day after the Trump administration told states to expand eligibility and to quickly use existing vaccine or risk losing future allocations.
New Jersey’s decision to immediately adopt all of the recommendations by the Centers for Disease Control and Prevention for priority vaccination puts these groups ahead of some essential workers — including teachers. The move has contributed to a sense of confusion and anger among those who now find themselves further back in the line for inoculation.
It has also expanded competition for shots at a time when many people in the first priority groups continue to have trouble making appointments and navigating the overburdened scheduling systems of vaccine clinics.
In a new study, researchers used computer simulations to map how virus-laden airborne particles might flow through the inside of a car. Their results, published this month in Science Advances, suggest that opening certain windows can create air currents that could help keep drivers and passengers safe from infectious diseases like Covid-19.
The team simulated a car loosely based on a Toyota Prius driving at 50 miles per hour, with two occupants: a driver in the front left seat and a single passenger in the back right, a seating arrangement that is common in taxis and ride shares and that maximizes social distancing.
Unsurprisingly, they found that the ventilation rate was lowest when all four windows were closed. In this scenario, roughly 8 to 10 percent of aerosols exhaled by one of the car’s occupants could reach the other person, the simulation suggested.
When all of the windows were completely open, on the other hand, ventilation rates soared, and the influx of fresh air flushed many of the airborne particles out of the car; just 0.2 to 2 percent of the simulated aerosols traveled between driver and passenger.
They also found that while the most intuitive-seeming solution — having the driver and passenger each roll down their own respective windows — is better than keeping all of the windows closed, an even better strategy is to open the windows opposite each occupant. This configuration allows fresh air to flow in through the back left window and out through the front right window and helps create a barrier between driver and passenger.
“It’s like an air curtain,” said Varghese Mathai, a physicist at the University of Massachusetts, Amherst, and one of the study’s authors. “It flushes out all the air that’s released by the passenger, and it also creates a strong wind region in between the driver and the passenger.”
Since the turn of the century, the number of international migrants has intensified, driven by desires to avoid armed conflicts and humanitarian disasters, escape political repression and seek economic opportunities elsewhere. But the coronavirus pandemic blunted that trajectory in 2020, according to data compiled by the United Nations.
In a report released on Friday, the Population Division of the U.N.’s Department of Economic and Social Affairs estimated that through the middle of last year, the number of new international migrants was about five million — about two million fewer than expected.
“Around the globe, the closing of national borders and severe disruptions to international travel obliged hundreds of thousands of people to cancel or delay plans of moving abroad,” the department said in the report. “Hundreds of thousands of migrants were stranded, unable to return to their countries, while others were forced to return to their home countries earlier than planned, when job opportunities dried up and schools closed.”
Before the Covid-19 disruptions, the report said, the number of international migrants “had grown robustly over the past two decades,” reaching a total of 281 million in 2020, roughly equal to the population of Indonesia.
In another barometer of the collapse in travel caused by the pandemic, the civil aviation agency of the United Nations said in a report on Friday that the number of airline passengers fell by 60 percent in 2020 — 1.8 billion passengers compared with 4.5 billion in 2019. The report, by the International Civil Aviation Organization, said the reduction had taken air travel totals back to 2003 levels.
Nearly a year into the pandemic, parents are watching their children slide down an increasingly slippery path into an all-consuming digital life.
At first, many relaxed restrictions on screens as a stopgap way to keep frustrated, restless children entertained and engaged. But, often, remaining limits have vaporized as computers, tablets and phones became the centerpiece of school and social life, and weeks of stay-at-home rules bled into almost a year.
The situation is alarming parents, and scientists, too.
“There will be a period of epic withdrawal,” said Keith Humphreys, a professor of psychology at Stanford University, an addiction expert and a former senior adviser to President Barack Obama on drug policy. It will, he said, require young people to “sustain attention in normal interactions without getting a reward hit every few seconds.”
Scientists say that children’s brains, well through adolescence, are considered “plastic,” meaning they can adapt and shift to changing circumstances. That could help younger people again find satisfaction in an offline world, but it becomes harder the longer they immerse in rapid-fire digital stimulation.
Earlier in the pandemic, Dr. Jenny Radesky, a pediatrician who studies children’s use of mobile technology at the University of Michigan, said she told parents not to feel guilty about allowing more screen time. Now, she said, she’d have given different advice if she had known how long children would end up stuck at home.
“The longer they’ve been doing a habituated behavior, the harder it’s going to be to break the habit,” she said.
Over all, children’s screen time had doubled by May compared with the same period in the year prior, according to Qustodio, a company that tracks usage on tens of thousands of devices used by children, ages 4 to 15, worldwide. The data showed that usage increased as time passed: In the United States, for instance, children spent, on average, 97 minutes a day on YouTube in March and April, up from 57 minutes in February, and nearly double the use a year prior — with similar trends found in Britain and Spain.
Yet parents express a kind of hopelessness with their options. Keeping to pre-pandemic rules seems not just impractical, it can feel downright mean to keep children from a major source of socializing.
“These are the tools of their lives,” one parent said.