The United States opened more distance between itself and much of the rest of the world Thursday, nearing the 200 millionth vaccination in a monthslong race to protect the population against covid-19 -- even as other countries, rich and poor, struggle with stubbornly high infection rates and deaths.
Nearly half of American adults have gotten at least one dose of vaccine, and about 30% of adults have been fully vaccinated, according to the Centers for Disease Control and Prevention. But the picture is still grim in parts of Europe, Latin America, Africa and Asia as variants fuel an increase in new cases and the worldwide death toll closes in on 3 million.
France on Thursday passed 100,000 virus deaths, becoming only the eighth country to do so.
India's two largest cities, New Delhi and Mumbai, imposed business shutdowns and stringent restrictions on movement as new infections surge. Some hotels and banquet halls were ordered to convert their space into wards for treating virus patients, and the surge forced India -- a major vaccine producer -- to delay exports of doses to other countries.
Japan also saw a rapid resurgence of infections just three months before it's scheduled to host the Olympics. A top ruling-party official suggested the possibility of canceling the games if the infections make them impossible.
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Troubling signs also emerged in the U.S. despite the good news that more than 198 million shots have been administered and the seven-day average of daily shots given hit 2.9 million last week: New daily infections have increased 11% in the past two weeks.
According to Johns Hopkins University, the U.S. has recorded more than 31,491,000 covid-19 cases and more than 565,000 deaths.
Many states have lifted restrictions on businesses and public gatherings. But more people are being admitted to hospitals in some states, including Michigan, which leads the nation with nearly 8,000 new infections per day.
In suburban Detroit, Dr. Nick Gilpin of Beaumont Health likened a rising crush of patients to a "runaway train." Staff members were using tents to handle the flow of people seeking emergency care from Michigan's largest hospital system, which Thursday was treating more than 800 patients. That's up from about 500 two weeks ago.
"Our covid-19 numbers are climbing higher and faster, and it's very troubling and alarming to see this," said John Fox, chief executive of Beaumont Health, which operates eight hospitals.
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Coronavirus patients statewide were near record numbers in Michigan, which had 3,960 people with confirmed infections hospitalized Wednesday.
Even though half of U.S. adults are still completely unvaccinated, dwindling demand for shots was reported by some hospitals in Alabama and Missouri. Both states already lag the nation in vaccinating their populations.
In Alabama, only 37% of adults have received even one dose. Yet Cullman Regional Medical Center north of Birmingham cited declining appointments as it announced that its vaccine clinic was being moved to an urgent care center. East Alabama Medical Center near Auburn University said it was preparing to wind down its vaccination program in a county where fewer than 18% are fully vaccinated.
"The number of vaccine requests has reached a plateau," hospital spokesman John Atkinson said.
Health care officials in Missouri are also worried that not enough people are seeking shots. A large federally operated vaccination site in downtown St. Louis is administering less than half its capacity of 3,000 shots per day. Appointments have also slowed in St. Joseph, Mo., said Dr. David Turner, chief medical officer for Mosaic Life Care.
"As a medical professional, I am concerned," Turner said. "We would like to see more folks getting vaccinated. Even if they had covid, we still recommend vaccination."
In other developments, the U.S. government reported Thursday that some vaccinated people, as expected, have become sick from the coronavirus, though such cases are rare.
The CDC said about 5,800 of such "breakthrough" infections have been confirmed. That's out of about 75 million Americans who have been fully vaccinated, but the agency warned that reporting of such cases is uneven and incomplete.
Serious illness among vaccinated Americans is even more rare, with fewer than 400 who were hospitalized and 74 who died. As with the flu, people who get covid-19 after being vaccinated are more likely to have a milder illness than unvaccinated people, the CDC has said.
AIDING POOR COUNTRIES
Meanwhile, U.S. Secretary of State Antony Blinken on Thursday appealed for other countries to inject another $2 billion into the U.N.-backed program to ship vaccines to the world's poorest countries at a time when rich countries including the U.S. have seized the lion's share.
Blinken's call came as the United States co-hosted a virtual conference that drummed up hundreds of millions of dollars in support from governments and philanthropy groups to help buttress the $6.3 billion that's already been raised for the COVAX program.
The program has begun donating millions of vaccines to 92 low- and middle-income countries in recent months. But the World Health Organization -- insisting that no one is safe until everyone is -- has repeatedly decried a lack of equity.
Donors either chipped in funds or announced plans to share doses.
Prime Minister Stefan Lofven said Sweden was increasing its contribution to COVAX from $20 million to $280 million in the day's biggest pledge. In addition to contributing about $12 million, New Zealand will donate enough vaccines for more than 800,000 people, Prime Minister Jacinda Ardern said.
That contribution marked the start of COVAX efforts to get countries with excess doses to share them.
Gavi, the Vaccine Alliance -- a Geneva-based public-private partnership that helps run COVAX -- said about $400 million was raised Thursday toward the goal of locking in 1.8 billion doses this year.
The Bill and Melinda Gates Foundation, Gates Philanthropy Partners and Google.org were among philanthropists that contributed, committed or mobilized tens of millions of dollars worth of support Thursday, Gavi said.
But access to vaccines -- which has been constrained by hoarding by some wealthy countries and by limits to production -- is a more pressing need than cash.
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Marie-Ange Saraka-Yao, who heads resource mobilization for Gavi, said commitments of money help COVAX nevertheless build capacity and give "clear visibility to manufacturers that the money is there for them to build the supply -- and for us to buy."
Blinken, speaking in recorded remarks, laid out an ambition to raise COVAX's target of vaccinating 20% of populations in the affected countries, even as he praised the pledges and donations made so far.
"To beat this pandemic, we need to aim much higher. With $2 billion more to COVAX, we can reach approximately 30% of people in target countries rather than 20%," he said. "Just think for a moment of all the people whose lives would be impacted by hitting that higher target."
Blinken added: "That's not all we must do. We need to produce more safe, effective vaccines, and we need to distribute them more rapidly."
He did not propose new U.S. funds but highlighted the Biden administration's contribution of $2 billion to COVAX in March and its plans to add another $2 billion through 2022, reversing a Trump administration decision to opt out of the effort.
"We recognize that as long as covid is spreading and replicating anywhere, it poses a threat to people everywhere," Blinken said.
PRESSURE ON U.S.
However, the U.S. is on track to have gathered an oversupply of hundreds of millions of vaccine doses as soon as July, even while many countries in the developing world will have to wait years to vaccinate a majority of their populations, according to a report by the Duke Global Health Innovation Center.
The new estimates, included in the paper alongside recommendations, come as the Biden administration faces mounting pressure to facilitate equitable vaccine distribution around the world. Despite pledging money, Washington has resisted calls to share vaccine technology or donate surplus doses.
Blinken on Thursday did not address the issue of surplus U.S. doses.
On Wednesday, Oxfam released a letter signed by more than 100 former heads of state and Nobel laureates calling on President Joe Biden to waive intellectual property rules for coronavirus vaccines and "put the collective right to safety for all ahead of the commercial monopolies of the few."
"Leadership from the US on safe, effective, and equitable global access to Covid-19 vaccines is imperative," the Duke paper argues, pushing for Washington to increase funding for vaccine-sharing programs, and to donate excess doses and use its clout to open up vaccine manufacturing.
Another proposal, put forward in a letter backed by the Center for Strategic and International Studies, calls for the United States to donate 10% of its excess doses over the summer, moving to 50% by the end of the year, and argues that Biden should deliver a speech this spring to make the case to the American people.
Under the leadership of Gayle Smith, Blinken's new coordinator for global coronavirus response and health security, the nonprofit ONE Campaign called on wealthy countries to donate 5% of their surplus doses once they've vaccinated 20% of their populations.
The United States will probably have "at least 300 million excess doses or more" by the end of July, the Duke paper estimates, even as vaccination programs are extended to the vast majority of U.S. children.
The estimate is based on the assumption that the vaccine developed by AstraZeneca receives emergency-use authorization and that the currently suspended Johnson & Johnson vaccine is used widely despite rare side effects.
The oversupply in the United States is in stark contrast with the situation in many poorer parts of the world, where vaccination programs have been slow to begin amid problems with supply and distribution, and could ultimately prolong the pandemic and hamper a U.S. recovery.
The Biden administration has pledged to donate doses. "If we have a surplus, we're going to share it with the rest of the world," Biden said last month when pressed on the issue. "We're going to start off making sure Americans are taken care of first, but we're then going to try to help the rest of the world."
The paper's authors include former U.S. officials such as Mark McClellan, who served as commissioner of the Food and Drug Administration under President George W. Bush, as well as Krishna Udayakumar, founding director of the Duke Global Health Innovation Center.
Their recommendations echo the concerns from other public health experts globally, including World Health Organization Director General Tedros Adhanom Ghebreyesus, who called vaccine-distribution plans that focus only on domestic issues a "self-defeating strategy [that] will cost lives and livelihoods."
BLOOD CLOTS
Also Thursday, a new study from the University of Oxford said the risk of blood clots among those who've been diagnosed with covid-19 is higher than among those who've received vaccines.
Covid patients saw a clot risk of 39 in a million. That compared with 4 in a million with mRNA vaccines like those developed by Pfizer-BioNTech and Moderna, and 5 in a million people with AstraZeneca's vaccine.
Though the analyses for the three vaccines are based on different data sets, making comparisons difficult, the study suggests that the risk of a clot among those with the disease is about eight to 10 times higher than after vaccination.
Regulators in the U.K. and the European Union have placed restrictions on the use of the AstraZeneca vaccine, while shots of Johnson & Johnson's vaccine have been placed on hold in much of the world amid concern over an association with the rare clots. The relative benefits of the AstraZeneca shot, compared with the risk of clots, decrease when doses are given to younger adults, according to an analysis by the U.K.'s Medicines and Healthcare Products Regulatory Agency.
Information for this article was contributed by Russ Bynum, Ed White, Jay Reeves, Mike Stobbe, Heather Hollingsworth and Jamey Keaten of The Associated Press; by Adam Taylor and Emily Rauhala of The Washington Post; and by Todd Gillespie of Bloomberg News (WPNS).
