Covid News: Some Parents Aren’t Ready For Young Children To Get Vaccine – The New York Times

Here’s what you need to know:ImageDamarcus Crimes, 13, receiving a dose of the Pfizer-BioNTech vaccine while his mother, Christina, and brother, Deshaun, 13, look on in San Antonio, Texas, in May.Credit…Tamir Kalifa for The New York TimesWith Pfizer-BioNTech’s announcement on Monday that its coronavirus vaccine had been shown to be safe and effective in low doses in children ages 5 to 11, a question looms: How many parents will have it given to their children?

If authorized by the Food and Drug Administration, the vaccine could be a game changer for millions of American families and could help bolster the U.S. response to the highly contagious Delta variant. There are about 28 million children of ages 5 to 11 in the United States, far more than the 17 million of ages 12 to 15 who became eligible for Pfizer’s vaccine in May.

But it remains to be seen how much of the younger group will be vaccinated. Uptake among older children has lagged, and polling indicates reservations among a significant number of parents.

Lorena Tule-Romain was up early Monday morning, getting ready to ferry her 7-year-old son to school in Dallas, when she turned on the television and heard the news.

“I was like, ‘Oh my gosh, this is exciting,’” said Ms. Tule-Romain, 32, who said she felt a surge of hope and relief. She has spent months in limbo, declining birthday party invitations, holding off registering her son for orchestra in school and even canceling a trip to see her son’s grandparents in Atlanta.

Ms. Tule-Romain will be among those eagerly waiting to learn whether federal officials authorize the vaccine for the younger group, a step that is expected to come first on an emergency-use basis, perhaps as soon as around Halloween.

However the F.D.A. rules, Michelle Goebel, 36, of Carlsbad, Calif., said she was nowhere near ready to vaccinate her children, who are 8, 6 and 3, against Covid-19.

Though Ms. Goebel said she had been vaccinated herself, she expressed worry about the risks for her children, in part because of the relatively small size of children’s trials and the lack of long-term safety data so far. She said the potential risk from a new vaccine seemed to her to outweigh the benefit, because young children have been far less likely than adults to become seriously sick.

Only about 40 percent of children ages 12 to 15 have been fully vaccinated so far, compared with 66 percent of adults, according to federal data. Polling indicates that parental openness to vaccination decreases with a child’s age.

If authorized by the F.D.A., the vaccine could be a game changer for millions of American families with young children.Credit…Allison Zaucha for The New York TimesAbout 20 percent of parents of 12- to 17-year-olds said they definitely did not plan to get their child vaccinated, according to polling by the Kaiser Family Foundation published last month. The “definitely not” group grew to about 25 percent in parents of children ages 5 to 11, and 30 percent among parents of under-5s.

René LaBerge, 53, of Katy, Texas, said she planned to vaccinate her 11-year-old son when he became eligible. “But I’m not impatient. I want them to do the work,” she said.

She said she had heard about some rare, but serious, side effects in children, and she was eager for federal officials to thoroughly review the data.

“I don’t want my son to take something that is unsafe,” she said, but added, “I believe Covid is dangerous. There aren’t any good easy answers here.”

Among the side effects scientists have been studying is myocarditis, an inflammation of the heart. In rare cases, the vaccine has led to myocarditis in young people. But a large Israeli study, based on electronic health records of two million people aged 16 and older, also found that Covid was far more likely to cause these heart problems.

The Pfizer trial results were greeted enthusiastically by many school administrators and teachers’ organizations, but are unlikely to lead to immediate policy changes.

“This is one huge step toward beating Covid and returning to normalcy. I don’t think it changes the conversation around vaccine requirements for kids,” said Randi Weingarten, president of the American Federation of Teachers, a national union.

Ms. Weingarten predicted that there would not be widespread student vaccine mandates until the 2022-2023 school year. She noted that parents and educators were still awaiting full F.D.A. approval of vaccines for children aged 12 to 15, and that mandates for adults did not come until months after the shots first became available.

A significant barrier to child vaccination, she said, were widespread conspiracy theories about the shots affecting fertility.

“When people have these conversations prematurely about requirements, it adds to the distrust,” she said.

A child receiving the Pfizer coronavirus vaccine in San Francisco last month.Credit…Mike Kai Chen for The New York TimesThe Pfizer-BioNTech coronavirus vaccine has been shown to be safe and highly effective in young children ages 5 to 11, the companies announced early on Monday. The news should help ease months of anxiety among parents and teachers about when children, and their close contacts, might be shielded from the coronavirus.

The need is urgent: Children now account for more than one in five new cases, and the highly contagious Delta variant has sent more children into hospitals and intensive care units in the past few weeks than at any other time in the pandemic.

Pfizer and BioNTech plan to apply to the Food and Drug Administration by the end of the month for authorization to use the vaccine for ages 5 to 11. If the regulatory review goes as smoothly as it did for older children and adults, millions of elementary school students could begin to receive shots around Halloween.

Trial results for children younger than 5 are not expected until the fourth quarter of this year at the earliest, according to Dr. Bill Gruber, a senior vice president at Pfizer and a pediatrician.

Pfizer and BioNTech announced the results in a statement that did not include detailed data from the trial. The findings have not yet been peer-reviewed nor published in a scientific journal.

But the new results dovetail with those seen in older children and in adults, experts said.

“There’s going to be a huge number of parents who are going to heave a big sigh of relief when they hear this,” said Dr. Kristin Oliver, a pediatrician and vaccine expert at Mount Sinai Hospital in New York. “We’ve been waiting for these kids to be protected.”

Children have a much lower risk of Covid-19 than adults, even when exposed to the Delta variant. Still, some small number of those infected develop a life-threatening condition called multi-system inflammatory syndrome in children, or MIS-C. Others may have lingering symptoms for months.

Nearly 30,000 children were hospitalized for Covid in August; the least vaccinated states reported the highest rates. At Seattle Children’s hospital, about half of the children who are admitted for Covid are older than 12, according to Dr. Danielle Zerr, a pediatric infectious diseases expert at the hospital.

“I’ve been dismayed at the fact that the sickest children in our hospital with acute Covid-19 or MIS-C are children who could have been vaccinated,” Dr. Zerr said.

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U.S. to Require International Travelers Be Fully VaccinatedThe White House press secretary, Jen Psaki, said strict protocols would be put in place to prevent the spread of the coronavirus as the Biden administration prepared to lift travel restrictions for fully vaccinated international travelers in November.Starting in November we will be implementing, I should say, in early November we’ll be putting in place strict protocols to prevent the spread of Covid-19 from passengers flying internationally into the United States by requiring that adult foreign nationals traveling to the United States be fully vaccinated. Obviously, this is the conclusion of a policy process on that particular issue, an important one facing many people around the world. This was an ongoing process, as you all know, that we discussed pretty extensively here. C.D.C. is going to issue a contact-tracing order that will require airlines to collect comprehensive contact information for every passenger coming to the United States and to provide that information promptly to the C.D.C. upon request to follow up with travelers who have been exposed to Covid-19, variants or other pathogens. And these requirements will apply globally.

The White House press secretary, Jen Psaki, said strict protocols would be put in place to prevent the spread of the coronavirus as the Biden administration prepared to lift travel restrictions for fully vaccinated international travelers in November.CreditCredit…Frederic J. Brown/Agence France-Presse — Getty ImagesThe Biden administration will lift travel restrictions starting in November for foreigners who are fully vaccinated against the coronavirus, reopening the country to thousands of people, including those who have been separated from family in the United States during the pandemic, and easing a major source of tension with Europe.

The halt to the 18-month ban on travel from 33 countries, including members of the European Union, China, Iran, South Africa, Brazil and India, will help rejuvenate a U.S. tourism industry that was left crippled by the pandemic. The industry suffered a $500 billion loss in travel expenditures in 2020, including a 79 percent decease in spending from international travel, according to the U.S. Travel Association, a trade group that promotes travel to and within the United States.

Foreign travelers will need to show proof of vaccination before boarding and a negative coronavirus test within three days of coming to the United States, Jeffrey D. Zients, the White House pandemic coordinator, said on Monday. Unvaccinated Americans who want to travel home from overseas will have to clear stricter testing requirements. They will need to test negative for the coronavirus one day before traveling to the United States and show proof that they have bought a test to take after arriving in the United States, Mr. Zients said.

The Centers for Disease Control and Prevention will also soon issue an order directing airlines to collect phone numbers and email addresses of travelers for a new contact-tracing system. Authorities will then follow up with the travelers after arrival to ask whether they are experiencing symptoms of the virus.

“I am trying not to cry because it’s such a beautiful day,” said Giovanni Vincenti, 42, an Italian professor who lives in Baltimore. Mr. Vincenti’s daughter, who was born last May, has never met her grandparents because of the travel ban.

On Monday, Mr. Vincenti’s wife, who is a Polish researcher on vaccines, was already on her computer trying to book a flight for her mother. “We are going to cook something nice tonight,” Mr. Vincenti said, “but for Champagne we are going to wait for the grandparents.”

The changes announced on Monday apply only to air travel and do not affect restrictions along the land border, Mr. Zients said. He referred a question about which vaccines would qualify under the new rules to the C.D.C., which did not directly answer inquiries on the topic.

“International travel is critical to connecting families and friends, to fueling small and large businesses, to promoting the open exchange of ideas and culture,” Mr. Zients said. “That’s why, with science and public health as our guide, we have developed a new international air travel system that both enhances the safety of Americans here at home and enhances the safety of international air travel.”

But along with opening up travel for some, the new rules shut it down for others. Unvaccinated people will soon be broadly banned from visiting the United States even if they are coming from countries such as Japan that have not faced restrictions on travel to America during the pandemic.

The Trump administration began enforcing the bans against foreign travelers in January 2020 in the hopes of preventing the spread of disease. The effort was largely unsuccessful.

Emma Bubola contributed reporting from Rome, and Stephen Castle from London.

The front desk at The Pierre in New York City last year.Credit…Angela Weiss/Agence France-Presse — Getty ImagesThe U.S. travel industry breathed a sigh of relief on Monday after the Biden administration said it would ease longstanding restrictions on international travelers, allowing those who are fully vaccinated against the coronavirus to visit the country beginning in November.

The 18-month travel ban on travelers from Europe, China, Iran, South Africa, Brazil and India has been crippling for the industry, which suffered a $500 billion loss in travel expenditures in 2020, including a 79 percent decease in spending from international travel, according to the U.S. Travel Association, a trade group that promotes travel to and within the country. There were 19.4 million international visitors to the United States in 2020, less than one-quarter of the number who visited in 2019.

Unvaccinated travelers from many countries, including Mexico, Canada and Japan, who have been permitted to travel to the United States before Monday’s announcement will not be allowed in once the new proclamation takes effect.

Roger Dow, the president of the U.S. Travel Association, praised the lifting of the restrictions on vaccinated travelers.

“The U.S. Travel Association applauds the Biden administration’s announcement of a road map to reopen air travel to vaccinated individuals from around the world, which will help revive the American economy and protect public health,” he said in a statement Monday.

“This is a major turning point in the management of the virus and will accelerate the recovery of the millions of travel-related jobs that have been lost due to international travel restrictions.”

Nicholas E. Calio, president of Airlines for America, an industry trade group, also applauded the new policy, which will require airlines to play a role in checking international travelers’ vaccination status. “U.S. airlines have been strong advocates for a stringent, consistent policy and are eager to safely reunite the countless families, friends and colleagues who have not seen each other in nearly two years, if not longer,” Mr. Calio said in a statement.

Willie Walsh, the director general of the International Air Transport Association, a trade group of the world’s airlines, called the new approach to international travel “a step forward” for the U.S. economy, for families separated by previous rules and for managing the spread of coronavirus throughout the world. But there is still much to resolve, he said, given that along with opening up travel for many people to the United States, the new rules also prohibit travel for unvaccinated individuals from across the world.

“The next challenge is finding a system to manage the risks for travelers who do not have access to vaccinations,” he said in a statement. “Data points to testing as a solution. But it is also critical that governments accelerate the global rollout of vaccines and agree on a global framework for travel where testing resources are focused on unvaccinated travelers. We must get back to a situation where the freedom to travel is available to all.”

No city in the United States felt the impact of the travel ban like New York, which had the highest share of overseas travel and drew more than 13.5 million foreign visitors in 2019. International arrivals fell by as much as 93 percent in 2020, according to data from the Port Authority of New York and New Jersey, which runs the area’s airports, among other things.

International visitors generate 50 percent of the city’s tourism spending and 50 percent of hotel room occupancy, NYC & Company, the city’s tourism marketing agency, said. Fred Dixon, the agency’s president and chief executive, welcomed the administration’s decision calling it “a shot in the arm for the industry.”

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New York City Will Institute Weekly Coronavirus Testing in SchoolsMayor Bill de Blasio of New York said the city would start weekly coronavirus testing at all public schools starting next week, and relax quarantine rules for unvaccinated students to bring them in line with C.D.C. guidance.The goal is always two crucial things: first and foremost, the health and safety of our kids and our whole school community. Second, maximizing the number of kids in school every day, making sure there’s continuity, avoiding disruption, giving our kids a chance to make that comeback that we know we’re going to do this year. So we put together those two goals. We analyze the data from the first week. And with our health care team, analyze the overall situation with Covid. And we’re making some changes now on both testing and quarantine protocols, and these will take effect next week, starting on the 27th. First of all, we will now go to weekly testing. We’ll be testing in elementary, middle and high school, each school every week, and then we will change the quarantine approach and will align to the C.D.C. guidance on that. When there is a positive test in a school — excuse me, in a classroom, a positive test in a classroom — the unvaccinated students in the classroom will not have to quarantine if they are masked and three-feet distanced. That will allow more kids to safely remain in the classroom. So we’ve been looking at these two issues over the last few weeks. We looked at it in light of the data from the first week of school. We decided to make both of these changes simultaneously, and they do complement each other.

Mayor Bill de Blasio of New York said the city would start weekly coronavirus testing at all public schools starting next week, and relax quarantine rules for unvaccinated students to bring them in line with C.D.C. guidance.CreditCredit…Anna Watts for The New York TimesMayor Bill de Blasio announced on Monday that New York City would take two new steps to address fears over the full reopening of schools: require weekly coronavirus testing of unvaccinated students and relax quarantine rules to keep more students in classrooms.

But the mayor resisted calls for a vaccine mandate for students, even as Pfizer-BioNTech moved toward offering the vaccine to children from 5 to 11 years old.

The city’s latest policy changes get at the heart of Mr. de Blasio’s strategy for schools as a city that was once the global epicenter of the pandemic confronts the Delta variant of the coronavirus. New York City was the first major school system to reopen last year, and Mr. de Blasio is determined to keep students in classrooms as much as possible this school year.

Mr. de Blasio believes that schools are safe, that officials can isolate virus cases and that families will choose to vaccinate their children voluntarily. In many ways, he is staking his legacy on whether the vast majority of the city’s one million public school students return to classrooms and whether city officials can prevent a large number of those students and teachers from getting sick.

Mr. de Blasio on Monday repeated his concerns that a vaccine mandate for students, like a plan in Los Angeles for students who are 12 and older, could prompt some families to keep their children at home. He has also refused to offer a remote learning option.

The mayor noted that more than 70 percent of students ages 12 to 17 had received at least one dose of the vaccine.

Both the new testing and quarantine rules mirror recommendations by the Centers for Disease Control and Prevention. Unvaccinated students will no longer have to quarantine after having close contact with a student who tested positive, as long as they were masked and kept three feet apart. The city previously required all unvaccinated close contacts of a student who tested positive to quarantine for 10 days, leading to frequent disruption as classrooms shut.

In Times Square in Manhattan last month.Credit…John Taggart for The New York TimesTourism officials in New York City welcomed the news on Monday that restrictions on travel to the United States by those fully vaccinated against the coronavirus would be eased in November. It was a sign of hope for a city whose famed retail corridors and hotel and leisure sectors have been pummeled without international tourists during the pandemic.

International visitors have been a critical driver of growth in New York City’s economy for years, helping to fuel a steady rise in the number of hotels and restaurants in the city and the jobs they support.

Though travelers from abroad account for just one-fifth of the city’s visitors, they generate 50 percent of the city’s tourism spending, because they stay longer and shop more, and 50 percent of hotel room occupancy, according to Fred Dixon, the chief executive of NYC & Company, the city’s tourism promotion agency. Mr. Dixon welcomed the administration’s decision on Monday, calling it “a shot in the arm for the industry.”

The restrictions will be lifted for vaccinated travelers including from European countries, which sent millions of tourists to New York City in the years before the pandemic. More than 1.25 million visitors from Britain traveled to New York City in 2018, the most from any single country, according to an analysis of tourism data by Baruch College. Britain and the rest of the European Union accounted for nearly half of all international visitors that year.

Businesses that cater to tourists have been hit the hardest by the pandemic, with the restaurant, hotel and performing-arts industries sustaining the biggest and most sustained job losses. A new report from the Center for New York City Affairs at the New School showed that employment in the city’s hotel industry was still down 60 percent from prepandemic levels, and the number of jobs in full-service restaurants was still down 40 percent.

“Everyone says New York is back, New York is back, but it’s not really back until tourists are back from all countries,” said Leyla Saleh, 28, a pastry chef whose father’s gift shop in Midtown was forced to shut down last year because he did not have enough business.

“American tourists don’t shop like foreigners, we didn’t stand a chance,” she said. “Now we all work in different jobs to get by.”

Major retail districts that depend on international tourists and their spending, notably the SoHo neighborhood and the luxury mall known as the Shops at Hudson Yards, have struggled without them.

Before the pandemic, visitors to New York City from other countries peaked at 13.5 million a year in 2019, according to data compiled by NYC & Company. The figure plunged last year to 2.4 million, almost all of whom arrived before the pandemic took hold in early March and travel restrictions were imposed.

NYC & Company had predicted that the figure would nearly double this year to 4.6 million, a projection that hinged on a relaxation of travel restrictions by the Biden administration.

The agency has estimated that it will take until 2025 for the city to recover all of the international tourism that it lost because of the pandemic.

Luke Miller, the owner of Real New York Tours, which conducts walking tours, said that for his business, the lifting of the ban on international visitors was the “best news I’ve had since the outbreak of Covid.”

Before the virus, 65 to 70 percent of his business came from international travelers, Mr. Miller estimated, and he had to lay off 15 tour guides soon after the pandemic began.

Jared Goldstein, an independent tour operator in New York City, said that he was thrilled by the news. His business was down more than 90 percent in 2020 from 2019, he estimated.

“I’m so happy to welcome them back,” he said. Already Monday morning he’d reached out to a client in England who plans group tours to tell him that he could finally solidify his plans. The client responded promptly that he’d be bringing a group in February, Mr. Goldstein said. He welcomed the fact that only vaccinated international travelers will be permitted to visit the United States.

“I’m a New Yorker and I want locals to be safe,” he said.

All adults and many eligible students will soon need to be vaccinated in Washington, D.C., schools.Credit…Pablo Martinez Monsivais/Associated PressAll adults and eligible student-athletes who are regularly in schools and child care centers in Washington, D.C., must be fully vaccinated against Covid-19 by Nov. 1, the district’s mayor said on Monday.

Mayor Muriel E. Bowser’s announcement eliminates an earlier testing option for school employees but retains exemptions for religious or health reasons.

Cities including New York City, Los Angeles and Chicago have also introduced vaccine requirements for school employees without a testing option. Such mandates became more widespread after the Food and Drug Administration fully approved the Pfizer-BioNTech vaccine in August.

In the Washington requirement, in addition to the school employees, student-athletes who are 12 or older (and therefore eligible for the Pfizer-BioNTech vaccine) also have to be vaccinated to engage in “extracurricular athletics.” Student-athletes who turn 12 between Monday and Nov. 1 must be fully vaccinated before Dec. 13.

No coronavirus vaccines have been federally authorized for children younger than 12, meaning they make up a sizable unvaccinated population. Pfizer and BioNTech announced on Monday that their vaccine was found to be safe and highly effective in children aged 5 to 11. If the F.D.A. authorizes its use in children — an application is expected by the end of the month — millions of students could be inoculated in the weeks afterward.

More children have been sickened by the coronavirus since the extremely transmissible Delta variant became dominant. Children are still far less likely to become severely ill than adults, but many schools and districts across the country have closed temporarily because of outbreaks.

Federal guidance recommends that schools impose measures like masking and social distancing, and that as many people as possible get vaccinated to keep students safe.

At a news conference on Monday, Ms. Bowser said that “we feel very confident that our staff have really adopted and accepted the vaccine, for the most part.”

She continued, “It’s very clear, especially for our young people who are not eligible for the vaccine yet, that the best way to protect them is to have the adults around them vaccinated in addition to all of the other mitigation strategies that we use.”

The vaccine requirement will apply to virtually everyone who regularly spends time in schools, including teachers, coaches, principals, librarians, guidance counselors, bus drivers, security personnel, custodians and volunteers, along with student-athletes.

Public, private, charter and parochial schools are all included in the rule, as are child care facilities regulated by the Office of the State Superintendent of Education.

Ms. Bowser said that parents will not need to be vaccinated to drop off their children, but “schools might want to address their protocols where they don’t have a lot of adults lingering in the buildings.”

Apoorva Mandavilli contributed reporting.

Quality checking during the manufacture of the Covishield vaccine at the Serum Institute in Pune, India, in January.Credit…Atul Loke for The New York TimesIndia’s health minister said on Monday that the country would resume exports of Covid-19 vaccines, five months after halting shipments during its own devastating wave of infections.

The health minister, Mansukh Mandaviya, said that exports would resume starting next month, and that the vaccines would help fulfill India’s commitment to Covax, the United Nations-backed vaccine sharing initiative.

He said that India would produce more than 300 million vaccine doses in October and a total of at least a billion over the final three months of 2021.

“We will help the world and also fulfill our commitment toward Covax,” Mr. Mandaviya said.

The minister did not specify which vaccines India would supply to Covax, or how many doses. Before halting exports in April, the country exported 66.4 million doses, a combination of commercial sales, grants and shipments to Covax, which is designed mainly to help low- and middle- income countries.

India’s decision comes as its domestic vaccination campaign has picked up after a slow start. The government says it expects to finish inoculating all 944 million adults in the country by December.

So far, 61 percent of adults in India have received their first dose, according to government data. The two main vaccines in use are Covishield, the local name for the AstraZeneca vaccine, manufactured in India by the Serum Institute of India, and Covaxin, produced by the Indian company Bharat Biotech.

The decision on exports comes days before India’s Prime Minister Narendra Modi arrives in the United States, where he is scheduled to participate in a summit including President Biden and the leaders of Australia and Japan, and to speak at the annual gathering of the U.N. General Assembly. The global vaccination effort is expected to be a focus of both meetings, and the Biden administration had been trying to persuade Mr. Modi to resume exports.

India was initially expected to be the main vaccine supplier for the Covax initiative, and its export ban came as a heavy blow to the program, which is so far behind schedule that fewer than 10 percent of people in poor countries are vaccinated.

India began to expand vaccine coverage to all adults in the country in May, after a devastating second wave of infections that overburdened its health care infrastructure, leaving thousands dead and many struggling to find hospital beds. The country’s total caseload stood on Monday about 318,000, the lowest in approximately six months, according to official data.

A woman receiving the Pfizer-BioNTech vaccine in San Antonio, Texas, this month. The F.D.A. is expected to decide this week who should get a third Pfizer dose.Credit…Matthew Busch for The New York TimesThe Food and Drug Administration is likely to authorize Pfizer-BioNTech booster shots this week for many Americans at high risk of falling seriously ill from the coronavirus, now that a key advisory committee has voted to recommend the measure.

On Friday, a panel of experts endorsed offering Pfizer booster shots for ages 65 and older, and people 16 and over who are at high risk of getting severe Covid-19 or who work in settings that make them more likely to get infected.

The agency, which often follows the committee’s advice but is not required to, is expected to decide early this week. An advisory committee of the Centers for Disease Control and Prevention is scheduled to meet Wednesday and Thursday to discuss booster shots before that agency — which sets vaccine policy — issues its recommendations.

On Monday, Jen Psaki, the White House press secretary, defended the federal regulatory process for signing off on booster shots and urged patience from those eager for an additional dose.

“That process is in place for a reason so that you can trust what the final recommendation and the final outcome is,” she said, noting that President Biden would receive a booster shot on camera after they are cleared by federal regulators.

The decision on Pfizer booster shots is just one of a series of key questions that the agency is expected to consider in coming weeks. Officials have said they expect to soon have data on whether boosters are needed for people who got the Moderna and Johnson & Johnson vaccines.

Also expected this fall is a decision on a shot for children ages 5 to 11, an intensely watched issue given that about 48 million children are not yet eligible for a vaccine, but have largely returned to classrooms. On Monday, Pfizer said that a trial showed that its vaccine produced a strong immune response in children ages 5 to 11. Pfizer and BioNTech plan to apply to the F.D.A. by the end of the month for authorization to use the vaccine in these children. If the regulatory review goes as smoothly as it did for older children and adults, millions of elementary school students could begin to receive shots around Halloween. Officials have said they expect results from Moderna’s children’s trial later this fall.

Interviewed on Sunday-morning news shows, Dr. Anthony S. Fauci, the nation’s top infectious disease doctor and an adviser to Mr. Biden, asked Americans to be patient and not to get a booster shot until they were eligible. That includes people 65 and over who received the Moderna and Johnson & Johnson vaccines.

“We’re working on that right now to get the data to the F.D.A., so they can examine it and make a determination about the boosters for those people,” he said on NBC’s “Meet the Press.” “They’re not being left behind by any means.”

Last month, the Biden administration proposed a plan that would have made vaccinated Americans eligible who received the Pfizer and Moderna vaccines for a booster shot eight months after their second shot. Officials had also hoped to get boosters to recipients of the one-shot Johnson & Johnson vaccine as more data came in.

But the expert panel concluded that boosters were not necessary for most younger, healthier Americans, unless their jobs put them at special risk for infection.

Jobs in that category would include health care workers, emergency responders and teachers, according to Dr. Peter Marks, who oversees the F.D.A.’s vaccine division.

Whatever the F.D.A. decides about boosters this week, Dr. Fauci predicted it will likely be revised as more data comes in. “In real time, more and more data are accumulating,” he said on ABC’s “This Week.” “There will be a continual re-examination of that data, and potential modification of recommendations.”

Dr. Francis S. Collins, the director of the National Institutes of Health, echoed those remarks on CBS’s “Face the Nation,” saying that the category of who is eligible for an extra shot was likely to be expanded in the “coming weeks.”

F.D.A. officials will also spend the coming weeks and months evaluating vaccines for children under 12. On Sunday on ABC, Dr. Fauci said a decision on children’s vaccines would certainly come “this fall,” adding, “sometime in the mid- to late fall, we will be seeing enough data from the children from 11 down to 5 to be able to make a decision to vaccinate them.” A decision on vaccines for children under 5 would come after that.

The flurry of decisions comes as public health officials hope to avoid a repeat of last fall and winter, when a surge of infections led to peak levels of hospitalizations and deaths in the United States.

The extremely transmissible Delta variant now accounts for more than 99 percent of cases tracked in the country, according to the C.D.C. While hospitalizations and new cases have started to trend slowly downward, deaths have topped an average of 2,000 a day for the first time since March 1, according to a New York Times database. Vaccinations have been shown to protect against severe illness brought on by the variant.

Dr. Fauci said on Sunday that the key to avoiding a fall and winter surge would be encouraging adults who were eligible but still unvaccinated to change their mind.

“I believe if we get that overwhelming majority of the people vaccinated as we enter into the fall and winter, we can have good control over this and not have a really bad winter at all,” he said on “Meet the Press.”

Dan Levin contributed reporting.

GLOBAL ROUNDUP

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New Zealand Eases Virus Restrictions in AucklandPrime Minister Jacinda Ardern of New Zealand ended nearly five weeks of the highest level of lockdown in Auckland, the country’s most populous city, but reminded residents many restrictions would remain in place.Level 4 has done what we needed it to do. It has helped us contain the outbreak. And now as we continue our zero-tolerance approach to cases, Level 3 still provides the really important and strict rules that help us keep up that important work. Therefore, we have accepted the director-general of health’s advice and confirmed that Auckland will move to Alert Level 3 at 11:59 p.m. tomorrow night, Tuesday, the 21st of September. The director-general was also clear that given the long, hard tail of Delta, we will need time here, and Cabinet has accepted his advice for Auckland to stay at Level 3 for at least two weeks. Level 3 is not a situation where we are broadly opening up. You stay in your bubbles, distances kept. Schools remain, broadly speaking, closed, and we keep doing the job of stamping out Covid.

Prime Minister Jacinda Ardern of New Zealand ended nearly five weeks of the highest level of lockdown in Auckland, the country’s most populous city, but reminded residents many restrictions would remain in place.CreditCredit…Phil Walter/Getty ImagesNew Zealand will ease coronavirus restrictions in Auckland, Prime Minister Jacinda Ardern said on Monday, ending nearly five weeks of the strictest lockdown in the country’s most populous city.

Some businesses, including restaurants and cafes, will be allowed to reopen for takeout and delivery beginning Tuesday night, and as many as 10 people will be permitted to gather in the city for ceremonies including funerals and weddings, Ms. Ardern told reporters. In New Zealand’s four-tier system of Covid rules, Auckland will now be at Level 3, the second most restrictive. The rest of the country has been under Level 2 for the past two weeks.

The measures have frustrated residents and shuttered businesses, as the country remained one of the few committed to completely eliminating the Delta variant of the coronavirus. There were 22 new cases reported on Monday, down from a peak of 83 during this outbreak. New Zealand began slowly relaxing some of the world’s strictest antivirus measures earlier this month, aiming to reopen borders to foreigners some time next year.

“We keep doing the job of stamping out Covid,” Ms. Ardern said. “We are not stepping out of Level 4 because the job is done. Nor are we moving because we don’t think we can achieve the goal of stamping out Covid-19.”

Other nations in the Asia Pacific region have begun to reopen despite rising numbers of new cases, acknowledging that strategies that aim to eliminate the virus may be untenable. Australian authorities have said that country will begin to reopen once 70 percent of the eligible population is vaccinated. Singapore has loosened quarantine rules for some travelers. In Vietnam, businesses are reopening, although cases are still high.

Ms. Ardern insisted that the change in rules for Auckland should be considered a cautious step. Across the rest of New Zealand, restrictions at indoor gatherings, including restaurants and bars, will be further eased, allowing 100 people to gather. The new restrictions will remain in place for at least two weeks, and will be reassessed on Oct. 4.

Elsewhere in the world:

Vatican City will require residents, workers and visitors to show that they have immunity against Covid-19 starting Oct. 1, officials announced on Monday. The measure matches the requirement introduced last week in Italy, which surrounds the small state. The Vatican police force will check what are called Green Passes, which show whether the holder has received at least one dose of vaccine, recovered from a coronavirus infection or tested negative recently. The only exception will be for people attending Mass.

Boxes of Moderna vaccines distributed through Covax, the United Nations-backed vaccine program, arriving in Nairobi, Kenya, this month.Credit…Brian Inganga/Associated PressAt a virtual summit on Wednesday, while the annual United Nations General Assembly meeting is underway, President Biden will urge other vaccine-producing countries to balance their domestic needs with a renewed focus on manufacturing and distributing doses to poor nations in desperate need of them.

The push, which White House officials say seeks to inject urgency into vaccine diplomacy, will test Mr. Biden’s doctrine of furthering American interests by building global coalitions. Covax, the United Nations-backed vaccine program, is so far behind schedule that not even 10 percent of the population in poor nations is fully vaccinated, experts said. And the landscape is even more challenging now than when Covax was created in April 2020.

Some nations in Asia have imposed tariffs and other trade restrictions on Covid-19 vaccines, slowing their delivery. India, home to the world’s largest vaccine maker, banned coronavirus vaccine exports in April, but announced on Monday that it would resume shipments next month. And an F.D.A. panel on Friday recommended Pfizer booster shots for those over 65 or at high risk of severe Covid, meaning that vaccine doses that could have gone to low and lower-middle income countries would remain in the United States.

Officials said Wednesday’s summit would be the largest gathering of heads of state to address the coronavirus crisis. It aims to encourage pharmaceutical makers, philanthropists and nongovernmental organizations to work together toward vaccinating 70 percent of the world’s population by the time the U.N. General Assembly meets in September 2022, according to a draft document the White House sent to the summit participants.

Experts estimate that 11 billion doses are necessary to achieve widespread global immunity. The United States has pledged to donate more than 600 million — more than any other nation — and the Biden administration has taken steps to expand vaccine manufacturing in the United States, India and South Africa. The 27-nation European Union aims to export 700 million doses by the end of the year.

But on the heels of the United States’ calamitous withdrawal from Afghanistan last month that drew condemnation from allies and adversaries alike, the effort to rally world leaders will be closely watched by public health experts and advocates who say Mr. Biden is not living up to his pledges to make the United States the “arsenal of vaccines” for the world.

Joanne Haynes, a nurse practitioner at the University of Mississippi Medical Center, meeting virtually with a patient. The center will receive more than $3.5 million to improve health care in rural areas of the state.Credit…Imani Khayyam for The New York TimesThe roughly 15 percent of the population living in rural America includes some of the oldest and sickest patients in the country — a disparity that has grown starker during the coronavirus pandemic. The Biden administration is investing more in telemedicine, the use of which has grown sharply during the pandemic, to improve their access to care.

Last month, the Department of Health and Human Services announced that it was distributing nearly $20 million to strengthen telehealth services — usually medical appointments by video or phone — in rural and underserved communities. While the amount is relatively modest, it is part of a broader push to address the long-neglected health care infrastructure in those areas.

The spending includes about $4 million to help bring primary, acute and behavioral health care to patients via telehealth in 11 states, including Arkansas, Arizona and Maine. The money will update technology in rural clinics, train doctors and nurses on telehealth and teach patients how to take advantage of virtual appointments.

An additional $4.3 million will help specialists at academic medical centers train and support primary care providers in rural and other underserved areas via “tele-mentoring,” so that they can treat patients with complex conditions such as long Covid or substance-use disorders.

“Telehealth expands access to care and is a vital tool for improving health equity,” said Diana Espinosa, the acting administrator of the Health Resources and Services Administration, an agency within the department that is distributing the money. “This funding will help drive the innovation necessary to build clinical networks, educational opportunities and trusted resources to further advance telehealth.”

Rural Americans are at greater risk of dying from heart disease, cancer, accidental injury, chronic respiratory illnesses and strokes than their urban counterparts, according to the Centers for Disease Control and Prevention. The pandemic, too, has hit them disproportionately: I.C.U. beds have been sparse in rural Idaho during virus surges. The Navajo Nation in rural Arizona once had a higher virus death rate than New York City.

Before Juhi Singh, 46, who owns a high-end wellness center on Manhattan’s Upper East Side, jetted off to the Amalfi Coast last month, her personal driver took her to Sollis Healthcare, a concierge medical service in Manhattan, to measure her antibodies for the coronavirus.

“I wouldn’t go on a trip without my antibodies,” Ms. Singh said. “It’s nerve-racking, but my numbers have been good.”

Ms. Singh received the Johnson & Johnson vaccine in February, and wanted to see if her immunity was still robust before joining friends at a five-star resort overlooking the Tyrrhenian Sea.

Although medical experts warn that an antibody count cannot tell if somebody is protected against the virus, patients have been reading into the numbers anyway.

Antibody testing on a monthly or regular basis has become a common practice among certain members of the nervous affluent class. “It’s the Upper East Side, the Hamptons circles,” Ms. Singh said. “It’s like dinner conversation at this point. It almost feels like counting calories.”

Current tests only look for antibodies for SARS-CoV-2, the virus that causes Covid-19, and not for T cells, which plays an important role in the body’s immune response.

It is also not clear what the antibody count means.

Two shots of Johnson & Johnson’s Janssen vaccine delivered 94 percent efficacy against mild to severe Covid-19, the company said.Credit…Tobias Schwarz/Agence France-Presse — Getty ImagesA second dose of Johnson & Johnson’s vaccine substantially increased its protection against Covid-19, the company announced Tuesday morning.

In a clinical trial, researchers found that two doses of the vaccine delivered 94 percent efficacy against mild to severe Covid-19 in the United States, up from 74 percent conferred with a single shot, the company reported. And two shots showed 100 percent efficacy against severe disease, although that estimate had a wide range of uncertainty.

The data, presented in a news release, has been submitted to the Food and Drug Administration, Johnson & Johnson said. Since the company received emergency authorization in February, 14.6 million people in the United States have received its one-shot vaccine.

On Friday, an F.D.A. advisory committee recommended that the agency authorize Pfizer-BioNTech booster shots for recipients of the vaccine who are at least 65 or at high risk of Covid. That vaccine, like Moderna’s, offers high levels of initial protection after two doses, which then seem to diminish slightly over several months.

By contrast, Johnson & Johnson’s vaccine has shown little sign of waning. Researchers released a study last week comparing 390,517 vaccinated people to 1,524,153 unvaccinated ones. Up to five months after vaccination, the effectiveness of the Johnson & Johnson vaccine against hospitalization remained steady at around 81 percent.

As the pandemic has unfolded, people who received the Johnson & Johnson vaccine have waited for guidance about whether they’ll need a booster. The new clinical trial, which recruited 32,000 volunteers around the world, compared people who received one dose of Johnson & Johnson to those who received two doses eight weeks apart.

The researchers found that the second shot lifted the level of antibodies in the blood of volunteers four times as high as the level produced by the first shot. That improvement translated into stronger protection.

Many people got their Johnson & Johnson shot far more than eight weeks ago. Other research suggests that the extra time between doses could mean even better protection.

In a separate study announced last month, Johnson & Johnson gave boosters to clinical trial volunteers six months after their first dose, and then measured their antibody levels.

Initially, the researchers reported that the antibodies rose nine times as high as after the first dose. But in Tuesday’s news release, the company announced the level had continued to rise, reaching 12 times as high as the initial levels.

Some preliminary studies suggest that higher levels of antibodies against the coronavirus produce higher levels of protection against Covid. If that’s true, then a second Johnson & Johnson shot given after a wait of several months may prove even more effective than after just eight weeks.

Eric Adams, likely to be New York’s next mayor, was cheered on by Shams Da Baron, an advocate for homeless people, as he announced his plan to convert shuttered hotels into permanent housing.Credit…James Estrin/The New York TimesHotels in New York City that have been left empty by the pandemic would be converted into “supportive housing” that provides assistance to people struggling with mental illness or substance abuse and to people leaving the prison system, under a plan proposed on Monday by Eric Adams, who is likely to be the city’s next mayor.

More than 20 percent of the city’s hotels are now closed, a trade association says. At the same time, the city faces a homelessness crisis, growing sentiment against warehousing homeless people in barrackslike shelters and a lot of severely mentally ill people living in the streets.

“The combination of Covid-19, the economic downturn and the problems we’re having with housing is presenting us with a once-in-a-lifetime opportunity,” Mr. Adams, who won the June Democratic primary for mayor, said as he stood outside a boarded-up hotel in Brooklyn’s Sunset Park. “Use these hotels not to be an eyesore, but a place where people can lay their eyes on good, affordable, quality housing.”

Details of the plan were thin. Mr. Adams mentioned the possibility of 25,000 converted hotel rooms, but he said that he would focus on boroughs outside Manhattan, where the number of rooms in closed hotels is much smaller than that.

He was not clear about whether there was any overlap between his plan and those that the current mayor, Bill de Blasio, and the former governor of New York, Andrew M. Cuomo, have already begun to build 25,000 supportive housing units in the city by about 2030. A spokesman for Mr. Adams’s campaign said that Mr. Adams was also considering converting rooms in former hotels that have already become homeless shelters into permanent supportive-housing apartments, something that Mr. de Blasio has also discussed.

Mr. Adams said that creating studio apartments in existing hotels would be far cheaper and faster than building affordable housing from scratch.

During the mayoral primary, he was one of several candidates who called for creating housing in updated versions of single room occupancy hotels, or S.R.O.s, a form of housing once synonymous with seediness and crime that were torn down en masse in the late 20th century, but that has been making a comeback in other cities.

“I’m a big ‘modernized S.R.O.’ person,” Mr. Adams said. “We can create safe spaces particularly for single adults, which is an increased population.”

The nexus of hotels and homelessness has been a contested one during the pandemic. Early in the lockdown imposed to stem the spread of the coronavirus, thousands of people who had been living in dorm-style shelters were moved to hotel rooms, mostly in Manhattan where their presence led to complaints from some residents about harassment and sometimes violence. The city has since moved most of those people back to group shelters.

Several advocates for homeless people and for supportive housing endorsed Mr. Adams’s plan and stood with him at the news conference. “Adams can be the mayor who uses this inflection moment to change the trajectory on homelessness,” Laura Mascuch, executive director of the Supportive Housing Network of New York, said in an interview. “We look forward to working with Adams to implement the strongest supportive housing program in the nation.”

Another advocate who Mr. Adams invited to speak was the formerly homeless man who goes by the name Shams Da Baron and who came to prominence last year as a de facto spokesman for the homeless people who were being put up in a Manhattan hotel. In New York’s primary, Mr. Da Baron had favored more progressive candidates over Mr. Adams, a former police captain. But on Monday he offered the candidate a warm hug and exhorted him to follow through on his plan.

“We are in crisis,” Mr. Da Baron said. “Do what is necessary to get people housed.”

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Brazilian President Says He Is Not VaccinatedDuring a meeting with Prime Minister Boris Johnson of Britain, who hailed the AstraZeneca vaccine, Brazil’s president, Jair Bolsonaro, said he had not been inoculated against Covid-19.“Boris.” “Mr. President, how are you? Very nice to see you. Well, welcome, welcome, welcome. [unclear] Here we go. Here we go. Here we go. How’s that? How are you doing?” “OK.” “Very good.” “Thank you.” “Come here.” “AstraZeneca —” it’s a great vaccine. I had AstraZeneca. Thanks, everybody. Get AstraZeneca vaccine. I had it twice.” “Not yet.” [laughter]

During a meeting with Prime Minister Boris Johnson of Britain, who hailed the AstraZeneca vaccine, Brazil’s president, Jair Bolsonaro, said he had not been inoculated against Covid-19.CreditCredit…Stefan Jeremiah/ReutersPresident Jair Bolsonaro of Brazil kicked off the United Nations General Assembly on Tuesday by defending the use of ineffective drugs to treat the coronavirus and by pushing back on criticism of his government’s environmental record.

Brazil’s far-right president said doctors should have had more leeway in administering untested medications for Covid-19, adding that he had been among those who recovered after “off label” treatment with an anti-malaria pill that studies have found ineffective to treat the disease.

“History and science will hold everyone accountable,” said Mr. Bolsonaro, whose handling of the pandemic in South America’s largest country has been widely criticized.

Mr. Bolsonaro’s decision to not get vaccinated against the coronavirus has loomed large over his first couple of days in New York. It made for an awkward moment during a meeting on Monday with Prime Minister Boris Johnson of Britain, who hailed the AstraZeneca vaccine, which was developed at Oxford University.

“Get AstraZeneca vaccines,” Mr. Johnson said during his meeting with the Brazilian president. “I’ve had it twice.”

Mr. Bolsonaro pointed to himself and said: “Not yet.”

Brazil’s president has led one of the world’s most criticized responses to the pandemic. Mr. Bolsonaro repeatedly downplayed the threat the virus posed, railed against quarantine measures and was fined for refusing to wear a mask in the capital.

His government was slow to secure access to coronavirus vaccines even as the virus overwhelmed hospitals across the country. Covid-19 has killed more than 590,000 people in Brazil.

Mr. Bolsonaro, who had a mild case of Covid-19 in July of last year, has said he is in no hurry to get a shot. Earlier this year, the president said he was undecided about getting a vaccine.

“After the last Brazilian gets vaccinated, if there’s a spare shot, I will decide whether or not I get vaccinated,” he said in a televised video, adding, “that’s the example the boss must provide.”

His unvaccinated status has caused logistical problems when it comes to finding a place to eat in New York, where restaurants require that patrons show proof of inoculation for indoor seating. Mr. Bolsonaro and his traveling party have been taking the rule in stride. On Sunday, one of his ministers posted a photo on Twitter of the president and several top aides eating pizza standing up on the street.

“A luxurious dinner in NYC,” joked the minister, Luiz Ramos.

On Tuesday, Mr. Bolsonaro started his speech by telling the assembly that his nation was unfairly portrayed in the press.

“I came here to show a Brazil that is different from what is shown in the newspapers and on television,” he said. “Brazil has changed, and a lot, since we assumed office in January 2019.”

Mr. Bolsonaro’s government has weakened enforcement of environmental laws and hollowed out the agencies responsible for enforcing them. Yet on Tuesday he argued that Brazil should be applauded for how much of its forests remain intact and said the country could sustainably develop land in environmentally critical regions like the Amazon.

“The future of green jobs is in Brazil,” he said.

Gov. Bill Lee spoke at McConnell Elementary School in Hixson, Tenn., in August.Credit…Troy Stolt/Chattanooga Times Free Press, via Associated PressTennessee has recently been a livid purple bruise on a map charting coronavirus hot spots in the United States, and political considerations appear to be contributing to the problem, state officials, hospital administrators and political scientists said.

Tennessee has recently been reporting more new coronavirus cases, relative to its population, than any other state — as of Sunday, an average of 109 for every 100,000 people — and the state’s hospitalizations and deaths have also been very high, according to a New York Times database.

Only 44 percent of the state’s population has been fully vaccinated, and its hospitals are being inundated with Covid-19 patients.

In interviews, officials said that Gov. Bill Lee, a Republican, was politically constrained by a deeply conservative legislature and a political base that became more uncompromising during the pandemic.

He isn’t alone. Many other Republican governors across the country are navigating both the pandemic and their political futures. In the case of Mr. Lee, angering those who oppose mask and vaccination mandates would probably be the only thing that might jeopardize his re-election, said John G. Geer, a political scientist at Vanderbilt University.

Mr. Lee’s office did not respond to requests for comment. Publicly, he has asked Tennesseans to get vaccinated, but has argued for local control of mitigation measures and against any kind of mandate.

Mr. Lee’s response on Twitter to President Biden’s sweeping vaccine requirement is one example. At the end of a thread of messages, Mr. Lee said: “To be clear: the vaccine is the best tool we have to combat the pandemic but heavy-handed mandates are the wrong approach.”

Some Republican politicians in Tennessee say Mr. Lee’s approach amounts to choosing political expedience over the well-being of the state.

“The governor understands completely the seriousness of the problem, and I think that hard decisions are being tempered by political realities, which is that he has an election next year,” said Dr. Richard Briggs, a surgeon and Republican state senator representing Knoxville. Dr. Briggs described the surge of cases in Tennessee as a “completely self-inflicted crisis.”

Mr. Lee retains his party’s public support. The speaker of the house in Tennessee, Cameron Sexton, mirrored the governor’s objection of Mr. Biden’s vaccine mandates. And Kelly Keisling, a Republican state representative, has similarly said the mandates are “an overreach.”

Dr. Briggs said the governor is trying to cater to rural voters who have become increasingly hostile to health measures like masks and vaccines as a result of “the misinformation and disinformation” that they hear in conservative media.

“He’s trying to walk this tightrope between doing what he knows would mitigate the effects of the disease, versus the political reality that it may be hard to win an election because of this radical group,” Dr. Briggs said.

Any hint of a mandate could alienate the governor’s political base, prompt the legislature to defy him and perhaps draw a strong primary challenge, which Mr. Geer said was “the only way he would not be re-elected.”

Mr. Lee signed an executive order last month that gutted local officials’ efforts to require masks in schools, a precaution that the Centers for Disease Control and Prevention recommends. Opponents fought the order in court, and a federal judge ruled in their favor on Friday, blocking the governor’s order from taking effect in Shelby County, which includes Memphis.

Bill Christian, a spokesman for the state’s department of health, said in an email that a study in the spring of 2021 had identified specific populations in Tennessee that were plagued by vaccine hesitancy, and that the department was running ads to try to reach unvaccinated people.

“We continue to see vaccination rate increases in each age group,” Mr. Christian said.

Tennessee has been here before. Last December, before vaccines were widely available, the state had the nation’s highest rate of new cases per capita and a high number of deaths. Then, too, Mr. Lee argued against statewide mask requirements.

“This is the byproduct of a long and frustrating battle with politics instead of professional health care,” ​​said Larsen Jay, a Knox County Commissioner, who in March was the sole Republican to vote against stripping the local health board of regulatory authority. Its powers were transferred largely to the county mayor, who has refused to issue any new pandemic restrictions.

“We have really competent and capable medical professionals that have given us the tools and a road map to end this pandemic,” Mr. Jay said. “But somehow we’ve given rise to people who research things on the internet and weigh that against people with 40 years of medical credentials.”