F.D.A. Approves Pfizer-BioNTech Covid Vaccine

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Biden Praises Pfizer-BioNTech Vaccine Approval

President Biden lauded the final approval of the Pfizer-BioNTech vaccine by the Food and Drug Administration and implored unvaccinated Americans not to wait any longer to be inoculated.

After a strict process, the F.D.A. has reaffirmed its findings that the Pfizer Covid-19 vaccine is safe and effective, and the F.D.A. has given its full and final approval. So let me say this loudly and clearly: If you have, if you’re one of the millions of Americans who said that they will not get the shot when it’s — until it has full and final approval of the F.D.A., it has now happened. The moment you’ve been waiting for is here. It’s time for you to go get your vaccination, and get it today — today. It’s an important moment in our fight against the pandemic. Remember when we were trying to get? 70 percent of the people over 18, at least one shot? Well, we’ve not only gotten that done, we’ve gotten 71 percent of everyone aged 12 and older their first shot. And that’s over 200 million Americans. And over 170 million are now fully vaccinated. Third, states that have been lagging are seeing their vaccination rates grow faster. In fact, in Alabama, Arkansas, Louisiana, Mississippi, more people got new vaccinations in the past month than in the prior two months combined. The progress we’re making on vaccinations now is going to produce results in the weeks ahead.

The Food and Drug Administration on Monday granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and older, making it the first to move beyond emergency-use status in the United States.

The decision will set off a cascade of vaccine requirements by hospitals, colleges, corporations and other organizations. Defense Secretary Lloyd J. Austin III will be sending guidelines to the country’s 1.4 million active-duty service members mandating that they be vaccinated, the Pentagon announced on Monday.

United Airlines recently announced that its employees will be required to show proof of vaccination within five weeks of regulatory approval.

Oregon has adopted a similar requirement for all state workers, as have a host of universities in states from Louisiana to Minnesota. In New York, the F.D.A.’s approval also brought into force a requirement announced in May that all students attending in-person classes at State University of New York and City University of New York schools be vaccinated.

The approval comes as the nation’s fight against the pandemic has intensified again, with the highly infectious Delta variant dramatically slowing the progress that the country had made over the first half of the year. In a nine-minute speech Monday afternoon, President Biden he said he hopes the development will motivate many of the roughly 85 million unvaccinated Americans who are eligible for shots to get them. He told corporate, state and local leaders: “Do what I did last month. Require your employees to get vaccinated or face strict requirements” such as frequent testing.

He cast Pfizer’s approval as a sign of the overall progress he said his administration is making against the pandemic. While he acknowledged that the death rate, now averaging about 1,000 new deaths a day, has been climbing, he said the toll is still far lower what it was last winter because the vast majority of elderly people are vaccinated.

Mr. Biden also tried to reassure anxious parents about the growing numbers of children who are getting infected with the Delta variant, saying that severe Covid cases among children are still “very, very rare.” He promised to soon address “how we get our kids back to school safely.”

“While millions of people have already safely received Covid-19 vaccines, we recognize that for some, the F.D.A. approval of a vaccine may now instill additional confidence to get vaccinated,” Dr. Janet Woodcock, the acting F.D.A. commissioner, said in a statement. “Today’s milestone puts us one step closer to altering the course of this pandemic in the U.S.”

Pfizer said it presented the F.D.A. with data from 44,000 clinical trial participants in United States, the European Union, Turkey, South Africa and South America. The agency said the data showed the vaccine was 91 percent effective in preventing Covid disease. That was a slight drop from the 95 percent efficacy rate that the data showed when the F.D.A. decided to authorize the vaccine for emergency use in December. Pfizer said the decrease reflected the fact that researchers had more time to catch people who became infected.

A recent poll by the Kaiser Family Foundation, which has been tracking public attitudes during the pandemic, found that three of every 10 unvaccinated people said that they would be more likely to get vaccinated with a shot that had been fully approved.

But the pollsters and other experts warned that percentage could be exaggerated. “I think that is a vanishingly small number of people in real life,” said Alison Buttenheim, an associate professor of nursing at the University of Pennsylvania and expert on vaccine hesitancy.

More important, Dr. Buttenheim said, would be the effect of requirements. “Mandates simplify things for people,” she said.

The regulatory action gives doctors a measure of leeway to prescribe a third shot of the Pfizer vaccine to patients, but federal officials strongly discouraged people from seeking extra shots until regulators decide they are safe and effective. Pending regulatory clearance, the federal government plans to start offering booster shots for adults next month.

The vaccine will continue to be authorized for emergency use for children ages 12 to 15 while Pfizer collects the necessary data required for full approval. A decision on whether to authorize the vaccine for children younger than 12 could be at least several months away, and Dr. Woodcock said no such children should be given any Covid-19 vaccine at this point because regulators have not collected enough data yet from clinical trials on safety or the proper dosage.

So far, more than 92 million Americans — 54 percent of those fully inoculated — have gotten Pfizer shots. Most of the rest received Moderna’s vaccine.

Dr. Peter Marks, the F.D.A.’s top vaccine regulator, said that the Pfizer vaccine’s licensure followed a rigorous review of hundreds of thousands of pages of data and included inspections of the factories where the vaccine is produced. The agency, which has been under pressure to work ever faster on vaccine decisions, finished its review 97 days after Pfizer filed the required data — or in about two-fifths the normal time for such an evaluation, he said.

“The public and medical community can be confident that although we approved this vaccine expeditiously, it was fully in keeping with our existing high standards for vaccines in the U.S.,” he said.

Dr. Marks said that federal health agencies would continue to monitor the vaccine’s safety and that the F.D.A. would require Pfizer to continue to study the risks of myocarditis, an inflammation of the heart muscle, and pericarditis, an inflammation of the membrane surrounding the heart, including the long-term outcomes for recipients. The F.D.A. in June attached warnings to the Pfizer-BioNTech and Moderna vaccines noting possible increased risk of those conditions after the second dose.

Although Pfizer is now free to market the drug under the name Comirnaty, the company said only the federal government will distribute doses in the United States.

Health experts and state officials welcomed the development. With the Delta variant driving up caseloads across the country, “full approval could not come at a more important time,” said Dr. Richard Besser, president of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention. He called on schools and businesses to require vaccination before allowing people to congregate indoors.

Less than two months after it appeared to have curbed the spread of the virus, United States is now averaging around 150,000 new cases a day and more than 90,000 hospitalized Covid-19 patients.

Vaccination rates have also rising in recent weeks, likely in part because of rising fears about the virus. Providers were administering about 837,000 shots a day. Mr. Biden said the most recent seven-day total was the highest since early July. He said more people in Alabama, Arkansas, Louisiana and Mississippi — all states that are being ravaged by the Delta variant — got their first shots in the past month than in the previous two months combined.

Some experts have estimated that full approval might convince just five percent of those who are unvaccinated to get shots. Even if that’s so, “that’s still a huge slice of people,” Dr. Thomas Dobbs, the chief health officer for Mississippi. He said licensure will help “shake loose this false assertion that the vaccines are an ‘experimental’ thing.”

Dr. Marks, the vaccine regulator, cited a series of other myths about the vaccines as a major impediment to fighting the pandemic, including false claims that the shots would cause infertility, foster rather than prevent Covid disease or had led to thousands of deaths. “Let me be clear. These claims are simply not true,” he said.

The F.D.A. is in the midst of a decision-making marathon related to coronavirus vaccines. The next major one looming for regulators is whether or not to authorize booster shots. The Biden administration said last week it plans to offer third shots to adults who got the Pfizer and Moderna vaccines eight months after their second injection, starting Sept. 20. Third shots are already authorized for some people with immune deficiencies, but the risk-benefit calculus is different for the general population.

Federal health officials said that both Pfizer-BioNTech and Moderna’s vaccines, which rely on similar technology, wane in potency over time. That trend, they said, is converging with the rise of the particularly dangerous Delta variant, making those who completed their vaccinations at the start of the year increasingly vulnerable to infection.

Some health experts have challenged the decision to recommend booster shots as premature, saying the data shows that the vaccines are holding up well against severe disease and hospitalization, including against the Delta variant. Boosters would only be warranted if the vaccines were failing to prevent hospitalizations with Covid-19, some of those experts have said.

Regulators are still reviewing Moderna’s application for full approval of its vaccine. That decision could take several weeks. Johnson & Johnson is expected to apply soon for full approval.

Helene Cooper contributed reporting.

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Pentagon to Require Vaccinations for Active-Duty Troops

Following the Food and Drug Administration’s final approval of the Pfizer-BioNTech coronavirus vaccine, Pentagon officials said they were working on a timeline for requiring vaccinations for all active-duty service members.

The F.D.A. approved full licensure of the Pfizer vaccine this morning and has also, I’m sure you’re aware, back in August on the 9th, the secretary articulated that it was his intent to mandate Covid-19 vaccines upon F.D.A. licensure or by mid-September to seek a waiver from the president. So now that the Pfizer vaccine has been approved, the department is prepared to issue updated guidance requiring all service members to be vaccinated. A timeline for vaccination completion will be provided in the coming days. The health of the force is, as always, of our military and our civilian employees, families and communities is a top priority, and so it is important to remind everyone that these efforts ensure the safety of our service members and promote the readiness of our force, not to mention the health and safety of the communities around the country in which we live. We’re preparing now actionable guidance to the force we’re going to move forward making that vaccine mandatory. We’re preparing the guidance to the force right now, and that the actual completion date of it, in other words, how fast we want to see it get done, we’re working through that guidance right now.

Full federal approval for the Pfizer-BioNTech coronavirus vaccine for those 16 and older is opening the way for institutions like the military, corporate employers, hospitals and school districts to announce vaccine mandates for their employees.

Within hours of the announcement, the Pentagon, CVS, the State University of New York system and the New York City school system, among others, announced that they would enforce mandates they had prepared to carry out but had made contingent on the F.D.A.’s action.

One of the first and largest to move ahead was the Pentagon. Defense Secretary Lloyd J. Austin III had already received authorization from President Biden to mandate vaccines for all active-duty troops once the vaccine was fully approved, and he was moving swiftly to put the plans into action, said John F. Kirby, the Pentagon spokesman. The secretary will soon send specific vaccination guidelines to 1.4 million service members.

“These efforts ensure the safety of our service members,” Mr. Kirby said during a news briefing on Monday. He said the deadline date for getting vaccinated was still being determined.

Last month, Mr. Biden ordered that all federal employees and on-site contractors must be vaccinated against the coronavirus, or else submit to regular testing and other measures. The requirement applied to the 766,372 civilians working for the Defense Department, but not active-duty service members.

The Defense Department’s website said that as of Aug. 18, more than one million service members have been vaccinated, along with more than 300,000 civilian employees.

Vaccine mandates for college students were also gathering pace after the F.D.A.’s decision.

The F.D.A.’s approval brought into force a requirement in New York, announced in May, that all in-person students at State University of New York and City University of New York schools be vaccinated. CUNY’s website said that after federal approval students “have 45 days to get fully vaccinated or will be subject to potential academic withdrawal.”

The University of Minnesota System, with five campuses and 60,000 students, said on Monday that the coronavirus vaccine would be added to the university’s list of mandatory immunizations for students. And the president of Louisiana State University told reporters that his school would also require vaccination. Each institution had previously said it would do so once the F.D.A. gave a coronavirus vaccine final approval.

The drugstore chain CVS said on Monday that its pharmacists would have to be fully vaccinated by Nov. 30 and that all corporate employees and other workers who interact with patients had until Oct. 31 to comply. The requirement affects about 100,000 employees, the company said. Workers may request exemptions for medical or religious reasons.

New York City announced on Monday that every employee of the city’s Department of Education, from principals to janitors, would have to receive at least one dose of a coronavirus vaccine by Sept. 27.

Hours later, New Jersey’s governor, Philip D. Murphy, said that all state employees and employees of public, private and parochial schools in his state must be fully inoculated by Oct. 18 or be tested once or twice a week for the virus. And Chevron became the first major American oil producer to require its field workers to get vaccinated.

Before the F.D.A.’s announcement, the three coronavirus vaccines available in the United States, made by Pfizer-BioNTech, Moderna and Johnson & Johnson, were all being administered in the United States under an emergency use authorization. (The Pfizer vaccine remains available on that basis for youths 12 to 15 and for extra doses for some immunocompromised people.)

U.S. officials hope that full federal approval will quiet some of the vaccine misinformation online and induce more hesitant people to get vaccinated. A recent poll by the Kaiser Family Foundation found that three out of every 10 unvaccinated people said that they would be more likely to get a shot once it was fully approved.

But whether the announcement will help convince the roughly 85 million unvaccinated Americans to get inoculated without the added pressure of new requirements remains to be seen

Stephanie Saul, Eliza Shapiro, Tracey Tully and Coral del Mar Murphy-Marcos contributed reporting.

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N.Y.C. Requires Vaccination for All School Employees

Mayor Bill de Blasio of New York said every employee of the city’s Department of Education must receive at least one dose of a coronavirus vaccine by Sept. 27.

So today, a major announcement to ensure the safety of our schools, of our kids, of all the adults in our schools as well, today the New York City, Department of Health will be issuing an order requiring all staff in the New York City public schools to be vaccinated. This will require that all staff of every kind — principals, teachers, custodians, food service, you name it, needs to have at least one dose by Sept. 27, the entire staff, by Sept. 27, at least one dose. And we know this is going to help ensure that everyone is safe. Now, we’re going to start immediately working with labor unions. I spoke to the leaders of the key unions over the last few days, and we’re going to start bargaining with them immediately on the impact of this decision and how to ensure we can implement it properly and fairly. We’re going to work together. And what a perfect moment for this given the big news today. And we’re so thrilled the F.D.A. has announced today the full approval of the Pfizer vaccine. This is a game-changing moment. We’ve been waiting for this for a long time to have the full approval of the vaccine. We now have it. This helps us move forward and we’re moving forward with our schools with this new vaccine mandate.

All employees of New York City’s Department of Education — including teachers, principals, custodians and workers in the department’s central office — must get at least one dose of a coronavirus vaccine by Sept. 27, without the option of submitting to weekly testing instead, Mayor Bill de Blasio said on Monday.

The announcement was a major step in Mr. de Blasio’s effort to fully reopen the city’s school district, whose one million students make it the largest in the United States, next month, and a significant escalation of his push to vaccinate more New Yorkers.

Mr. de Blasio has put reopening the city’s schools at the center of his plan to help New York recover from the pandemic. He is eager to reassure anxious parents and teachers that schools will be safe this year despite an increase in virus cases in the past two months linked to the Delta variant — especially given the decision not to offer students a remote-learning option.

New York’s vaccine requirement affects about 148,000 education department workers. It is almost surely a harbinger of similar requirements for school districts, municipal employees, private businesses and federal agencies around the country following the Food and Drug Administration’s approval on Monday of the Pfizer-BioNTech vaccine for those 16 and older.

Hours after Mr. de Blasio’s announcement, Gov. Philip D. Murphy of New Jersey said that all workers at public, private and parochial schools in the state would have to be fully inoculated against the virus by Oct. 18 or be subject to testing at least once a week. The rules also apply to all state employees and to substitute teachers, who are already in short supply, he said.

As a result of the F.D.A.’s approval, a requirement that all students who plan to attend in-person classes at the State University of New York and the City University of New York schools be vaccinated took effect.

Education department workers are the first group of municipal employees in New York to face a full vaccine mandate. Mr. de Blasio said on Monday that officials were considering a similarly broad requirement for other city workers. His statement came a month after he issued a mandate that let those who did not get vaccinated be tested for the virus weekly instead.

“We know this is going to help ensure that everyone is safe,” Mr. de Blasio said at a news conference, adding that city schools had extremely low virus transmission last year. The mandate, the mayor said, will help the city “build on that success.”

The new requirement is likely to be unpopular with some school employees, but it is broadly supported by the city’s powerful teachers’ union, the United Federation of Teachers. Negotiations are continuing with it and other unions that represent education department employees over what will happen to those who do not comply. The city said last month that educators who did not get vaccinated or submit to testing would be suspended without pay. Those who do not comply with the new requirement will most likely face similar consequence.

On Monday, Michael Mulgrew, the U.F.T. president, acknowledged that the city had the legal right to impose such a requirement, but he said key details of how it would be put in place were still being worked out.

Mr. de Blasio has been adamant that all students will return to schools in person on Sept. 13. But with just three weeks until the first day of classes, he has not said how the city would handle either testing or the quarantining of those who are infected, a delay that has frustrated parents and educators.

It is unclear precisely what percentage of New York City teachers have been vaccinated. Officials have said that more than 63 percent of the education department’s employees are vaccinated, but they have also said that figure does not include those who got shots outside the city. About 75 percent of the teachers who live in the city have received at least one dose. By contrast, about 43 percent of Police Department employees have been vaccinated.

Facing a surge of Covid-19 cases that is straining its hospitals, the island of Oahu in Hawaii is imposing tighter restrictions on gatherings, Honolulu’s mayor said Monday.

Starting Aug. 25, indoor gatherings of more than 10 people and outdoor gatherings of more than 25 in Oahu are prohibited, said the mayor, Rick Glangiardi. The new rule will stay in place for at least 28 days and will affect all events, including those that are professionally organized, a change from previous restrictions.

“We really thought we saw the light at the end of the tunnel,” Mr. Blangiardi said at a news conference. “But over the last several weeks, cases have surged and the Delta variant has proved to be more than formidable.”

Since July 1, Hawaii has experienced a sharp rise in new cases. The wave peaked at 729 new infections on Aug. 19, more than double the number the state had at its previous high last fall, according to a New York Times database. In the past two weeks, new cases increased 37 percent in Honolulu County and hospitalizations rose more than double.

Mr. Blangiardi said that after extensive conversations with state health officials and health care providers, it was determined that large gatherings were the main cause of the rapid communal spread recently.

The restrictions mean that athletic events at the University of Hawaii will proceed without spectators, and that large concerts at the Waikiki Shell will be canceled. The mayor said that people would still be able to hold weddings, funerals and luaus, as long as they adhered to crowd limits. Restaurants will continue to operate at 50 percent, and youth sports can finish their seasons as long as parents spread themselves out on the fields as spectators.

Hawaii was the last state to expand vaccines to all adults in April, and only 55 percent of the state is fully vaccinated. At the news conference on Monday, officials said they were concerned about the low vaccination rates in Oahu and the large number of young men and women with Covid-19 at the island’s intensive care units.

Dr. James Ireland, the chief of the Honolulu Emergency Medical Services, said that over the past couple of weeks, island hospitals had seen a net increase of 10 to 14 patients a day. He warned that “very, very soon” hospitals would not have the capacity to care for patients and that emergency services were close to “maxed out.”

Although large gatherings appear to be the cause of the current spread, officials emphasized that the best way to fight the virus was by getting vaccinated. According to the Hawaii Department of Health, the highly contagious Delta variant, which is more dangerous for those who are not vaccinated, now accounts for 93 percent of the state’s Covid-19 infections.

“That’s the way out of this,” Dr. Ireland said. “Vaccinations.”

The federal approval on Monday of Pfizer-BioNTech’s coronavirus vaccine for people 16 and older appeared to clear the way for local officials and private businesses to impose vaccine requirements in some states that have banned them by law or executive order.

That seemed possible in at least three states — Montana, Texas and Utah — where the bans specifically object to the fact that the three vaccines in use in the United States were being administered under emergency use authorizations rather than full approval.

In Utah, the Republican-led legislature passed a bill in March barring government entities from requiring a Covid-19 vaccine if it was authorized for emergency use only. On Monday, a spokeswoman for the state’s health department, said that because the Food and Drug Administration had approved the Pfizer-BioNTech vaccine, it should no longer fall under the bill’s restrictions. Legislative leaders in Utah did not respond to a request for comment.

Legal battles have been brewing around the country since the vaccine-mandate bans took effect, often pitting cities, counties or school districts that want stricter vaccine requirements against governors who say they want to protect individual freedom.

The issue has grown more urgent as the pace of vaccination has slowed and as new cases, hospitalizations and deaths have risen sharply, driven largely by the highly contagious Delta variant. Many states that have banned vaccine requirements also have relatively low vaccination rates and are struggling with the latest surge in infections.

In Texas, Gov. Greg Abbott issued an executive order that took effect in July, stating that “no governmental entity can compel any individual to receive a Covid-19 vaccine administered under an emergency use authorization.”

Last week, after the San Antonio Independent School District sought to impose a vaccine requirement for its employees, the state attorney general, Ken Paxton, announced a lawsuit against the district. Pedro Martinez, the district’s superintendent, responded with a statement on Friday saying he would “not compel any staff member to be vaccinated until the vaccines are fully approved by the F.D.A.”

Mr. Paxton claimed victory in a statement on Monday, saying his office had stopped the district from trying to “play by its own set of rules.” But it was not immediately clear what would happen now that the F.D.A. had granted the approval Mr. Martinez said he was awaiting. Neither the school district nor the offices of Mr. Paxton and Mr. Abbott responded immediately to requests for comment.

Montana’s vaccine-mandate ban stipulates that “an individual may not be required to receive any vaccine whose use is allowed under an emergency use authorization or any vaccine undergoing safety trials.”

Brooke Stroyke, a spokeswoman for Montana’s governor, Greg Gianforte, maintained that vaccine mandates remained illegal in the state. She said the F.D.A. approval of the Pfizer-BioNTech vaccine did not entirely invalidate Montana’s law, which also prohibits discrimination based on whether a person has been inoculated.

Taiwan started administering its first locally developed Covid-19 vaccine on Monday after months of struggles to get sufficient supplies of doses from major foreign vaccine makers.

President Tsai Ing-wen received a shot of the domestically made vaccine at a hospital in the capital, Taipei, giving her personal assurance of its safety.

“It didn’t hurt,” Ms. Tsai wrote in a Facebook post. “Now, I am in good spirits, and I will continue my daily work.”

The vaccine, which was developed by the Taiwan-based company Medigen, received authorization for emergency use in late July. But critics say they worry that the vaccine, which has completed Phase 2 trials, is being used before its effectiveness and safety have been proved.

Two politicians from the island’s main opposition party, Kuomintang, recently filed a complaint to a local court seeking to suspend the emergency authorization, citing the concerns over the vaccine’s safety. The court dismissed their request last week.

Taiwan, where fewer than 10 locally transmitted cases are reported each day, has favored a less heavy-handed approach to the virus than neighboring mainland China. Since an outbreak that began in May, the government has introduced a series of measures to promote vaccination and received donations of doses from countries including the United States and Japan.

In the past few months, the island’s vaccination rate has increased significantly. As of Monday, around 40 percent of residents had received at least one dose. But only about 3 percent are fully vaccinated. Taiwan has recorded 15,926 total cases of the virus and 828 deaths, according to a New York Times database.

Nearly 600,000 of Taiwan’s 23.5 million residents have registered to get Medigen shots, according to the government data.

As the highly contagious Delta variant surges around the world, the health and safety protocols established for cruise ships are being tested.

Over two weeks in late July and early August, 27 coronavirus infections were identified aboard a Carnival Vista cruise ship sailing out of Galveston, Texas. One of the infected, a 77-year-old passenger from Oklahoma, later died.

The 27 cases were the most to be reported aboard a ship since June, when cruises started again in the Caribbean and United States; the death was the first in that time.

The passenger, Marilyn Tackett, and 26 crew members were immediately isolated after testing positive for the virus, Carnival Cruise Line said. Contact tracing and further testing were conducted, with no new cases reported by Aug. 11, when the ship arrived at Belize City, on Central America’s northeastern coast, the company said.

The Centers for Disease Control and Prevention issued a new advisory last week in which it warned those at increased risk for severe illness from Covid-19 against traveling on cruise ships, irrespective of their vaccination status.

Although the Carnival ship sailed out of Texas, which prohibits businesses from requiring vaccinations, more than 96 percent of the passengers were vaccinated and all but one crew member was fully vaccinated, according to Belize’s tourism board.

Most of the infected crew members were either asymptomatic or experiencing mild symptoms, but Ms. Tackett was admitted to a hospital in Belize and put on a ventilator after experiencing respiratory complications.

Days later, Ms. Tackett was evacuated to a hospital in Tulsa for treatment. On Aug. 14, however, her condition worsened, and she died, according to a statement that her family posted on online. Ms. Tackett’s family declined to comment on her death.

Carnival is not the only cruise line to experience an uptick in cases. Royal Caribbean had six guests test positive onboard its Adventure of the Seas ship this month.

At Hamid Karzai International Airport, where thousands of U.S. troops and NATO allies are trying to evacuate citizens and Afghans desperate to flee their country after the Taliban took control of Kabul last week, the coronavirus is an afterthought.

The speed, size and scope of the evacuation operation — which came together rapidly as U.S. officials were caught off guard by the Taliban’s swift offensive — have meant that few measures, if any, are in place to help prevent the spread of the disease and its newer, more aggressive variants.

There is no testing of the thousands of passengers passing through the base, in what has turned into the final operation of the United States’ nearly 20-year-old war in Afghanistan. Social distancing is nonexistent as hundreds of Afghans are ferried in from the airport’s gates, held in crowded parking lots or tents and processed in packed terminals.

The U.S. military cargo aircraft responsible for carrying a large number of Afghan refugees to bases in the Middle East and Europe are packed with 300 to 400 passengers at a time who sit practically knee-to-back on the floor.

Coronavirus testing usually takes place at American bases outside Afghanistan, where passengers are tested and isolated if found to be positive. Before the government of Afghanistan collapsed, its ministry of public health had reported a third wave of coronavirus infections in the country, with a record number of positive cases and deaths.

But coronavirus testing in the country has been unreliable and inconsistent since the start of the pandemic, as testing ability was limited or unavailable in rural areas. The current situation is part of a broader humanitarian and medical issue facing Afghans on top of the security crisis.

Humanitarian and medical aid has been scarce in the past week, with the World Health Organization and other aid agencies unable to fly supplies into the airport while it is overwhelmed by the evacuation effort.

“Conflict, displacement, drought and the Covid-19 pandemic are all contributing to a complex and desperate situation in Afghanistan,” the W.H.O. said in a statement.

According to Dapeng Luo, a W.H.O. representative in Afghanistan, the movement and mixing of the newly displaced in Afghanistan, coupled with many now living in overcrowded and unsanitary conditions, has severely limited infection prevention protocols and increased the risk of transmission of the coronavirus.

Dr. Luo said there were concerns that this, and the nation’s relatively low vaccination rate, could lead to an uptick in the virus.

“This will place an enormous burden on the health system, which is already struggling to cope with escalating trauma and emergency cases and experiencing shortage of supplies due to the current instability, disruptions to governance and shipment of supplies into the country,” Dr. Luo said. “A new wave of Covid-19 could leave some of the most vulnerable without critical health care.”

Rice University, where more than 95 percent of students are vaccinated, announced a move to remote classes last week after testing showed an alarmingly high number of community members with breakthrough coronavirus infections.

Those results, the university now says, were badly distorted by a testing glitch.

Of 4,500 tests administered on the Rice campus, 81 had returned positive results, mostly in vaccinated members of Rice’s community. Even in Houston, where the Delta variant was surging, the results were a surprise. Rice had taken tough efforts to control coronavirus in its community, practically demanding that students, faculty and staff be vaccinated, even as the state of Texas prohibited vaccination mandates. The university also required masks.

Further examination revealed that most of the people who appeared to have tested positive were actually negative for the virus, the university now says.

When Rice began to examine the cases, it found that the results didn’t make sense, according to a note to the university community on Sunday from Kevin E. Kirby, vice president for administration at Rice. Most of the people who tested positive did not have any symptoms. And the cases were scattered, with no clusters.

Rice discovered that the testing provider that reported so many positive results had just switched to using a new test. When 50 of the people who tested positive were retested using different types of tests, all but one of the results came back negative.

All the same, Rice says that it plans to stick with its decision to move to remote learning until Sept. 3. According to a university Covid dashboard, Rice now considers only 27 of the 4,500 tests administered on campus since Aug. 13 to have yielded true positive results, not 81.

Ivermectin, an anti-parasitic drug commonly used for livestock, should not be taken to treat or prevent Covid-19, the Food and Drug Administration said on Saturday.

The warning came a day after the Mississippi State Department of Health issued a similar statement in response to reports that an increasing number of people in Mississippi were using the drug to prevent a Covid infection.

Some studies last year spurred use of the drug against Covid-19, especially in Latin America, and Fox News has promoted some of those studies’ findings on air.

But the National Institutes of Health said in February that most of the studies related to Ivermectin and the coronavirus “had incomplete information and significant methodological limitations,” including small sample sizes and study outcome measures that were often unclear.

In Mississippi, where only 37 percent of the population is fully vaccinated, more than two-thirds of recent calls placed to the state’s poison control center were related to “ingestion of livestock or animal formulations of Ivermectin purchased at livestock supply centers,” the state department of health said in a news release.

Of those who called about ingesting Ivermectin, 85 percent had mild symptoms and one person was told to “seek further evaluation” because of the large amount they were reported to have taken, the state’s health department said.

Ivermectin, which is also formulated for use by people to treat parasitic worms, had been controversially promoted as a potential Covid treatment earlier in the pandemic, but recent studies found that the drug’s efficacy against the coronavirus is thin, and the F.D.A. has not approved the drug for Covid treatment.

On Twitter, the F.D.A. was more declarative in its warning.

“You are not a horse,” the agency said. “You are not a cow. Seriously, y’all. Stop it.”

The F.D.A. said it has received multiple reports, including some in Louisiana, of people who have “required medical support and been hospitalized after self-medicating with ivermectin intended for horses.”

“Taking large doses of this drug is dangerous and can cause serious harm,” the F.D.A. said.

The Mississippi State Department of Health alerted its residents that “animal drugs are highly concentrated for large animals and can be highly toxic in humans.”

Some of the symptoms associated with Ivermectin toxicity include rash, nausea, vomiting, abdominal pain, neurological disorders and potentially severe hepatitis that could require hospitalization, Mississippi health officials said.

Mississippi, which has seen a surge in cases recently, reported 5,048 cases on Friday. Hospitalization and death rates have also been rising.

Outside Staten Island University Hospital this week, as passing cars and fire trucks honked supportively, some employees chanted, “I am not a lab rat!” They were among the nurses, medical technicians, infection control officers and other staff at the hospital who are denouncing efforts to push them to get vaccinated.

Staten Island has the highest rate of Covid-19 infection of any borough in New York City.

The aggressive opposition to the vaccines, and even to regular testing, at a hospital in New York City — the epidemic’s onetime epicenter — shows the challenges of reaching the unvaccinated when some of the very people who could serve as role models refuse vaccination.

Some medical workers at the Staten Island hospital are so fiercely opposed that they call themselves “The Resistance,” after the rebel faction in “Star Wars.” They are defending what they view as their inherent rights, and their leader is gathering hospital workers from other states in an attempt to create a nationwide movement.

Scientists and medical professionals say that those who refuse vaccines are potentially endangering the lives of patients.

As the Delta variant, a highly transmissible version of the coronavirus, drives a surge in cases across the country, public health officials are struggling to boost vaccination rates in frontline medical workers.

Among the nation’s 50 largest hospitals, one in three workers who had direct contact with patients had not received a single dose of a vaccine as of late May, according to an analysis of data collected by the U.S. Department of Health.

The Staten Island protests started last Monday when Northwell Health began requiring unvaccinated staff to get weekly coronavirus tests by nasal swab or risk losing their jobs. On the same day, Gov. Andrew M. Cuomo announced that all health care workers across the state would be required to have at least one dose of the vaccine by Sept. 27, with limited exceptions.

Northwell says that it issued its mandate to protect patients. Before the pandemic, the hospital system encouraged flu vaccinations and required employees who were not vaccinated for flu to wear masks when among patients.

Some protesters, dismissive of scientific data and wary of mandates they say infringe on their civil rights, say they are willing to lose their jobs. Other workers said that they were considering moving out of state, perhaps to Florida, where hospital requirements are looser and the number of deaths and hospitalizations has steadily risen since June.

Global Roundup

China’s zero-tolerance approach to Covid is starting to wear thin in the eastern city of Yangzhou, much of which has been in a lockdown since the beginning of the month.

Over the weekend, one man got into a brawl with a group of volunteers at a roadblock. After video of the altercation was widely shared online, some residents complained that they could not go out to buy their own food and had to rely on volunteers to deliver produce that some people claimed was rotten.

Beijing initially scrambled to stamp out an outbreak that began on July 21 and quickly spread to half of China’s provinces and autonomous regions, exposing some limitations of its approach to pandemic control.

The outbreak, which spread fast and often through asymptomatic cases, posed the biggest challenge yet for Chinese officials since the coronavirus first emerged in Wuhan early last year. At one point some domestic health experts even called for a different Covid approach.

Despite the criticism, China’s National Health Commission on Monday reported zero new cases for the first time since this latest outbreak began.

But the approach has elicited frustration and anger from those who have had to scrap plans as officials turned to the same playbook they used last year — limiting travel, testing and tracing infections, and confining people to their homes. Millions of residents in Zhengzhou were forced to stand in line for virus testing. In Nanjing, where Delta cases first emerged, residents were required to submit to four successive tests.

In Yangzhou, a partial lockdown restricted the movement of millions of residents. Later, officials doubled down, preventing families from leaving their homes.

“After our joint efforts in the previous stage, it is now the time when we most need to grit our teeth to try hardest and fight all in one go,” Xu Lincan, a senior Yangzhou official, was quoted in state media as saying last week.

It was this tough approach that appeared to cause one man to lash out over the weekend after he was stopped at a roadblock near his compound. After volunteers checked his identification and documentation, the man hit one of them on the head, according to a police report.

In the video of the brawl posted online, a group of volunteers in red vests appeared to gang up on the man. One volunteer kicked the man in the head, face and chest. He was later fined and put in detention for 10 days. The other volunteers were also fined, the police said.

In other developments around the world:

• New Zealand has extended its national lockdown until the end of Friday, with an additional four days’ lockdown for the city of Auckland. The country on Monday announced 35 new cases in the community, bringing the total reported in the current outbreak to 107, mostly in Auckland. All are believed to be the more contagious Delta variant.

Natasha Frost contributed reporting.

New York has lagged behind the rest of the country in its economic recovery, with a 10.5 percent unemployment rate that is nearly twice the national average. Now, rather than seeing the fuller rebound it was counting on, the city is facing fresh challenges.

• Overall employment remains more than half a million jobs below where it was before the pandemic, with steep losses persisting in the leisure and hospitality industries and in other blue-collar fields.

• Many companies have scrapped plans to bring employees back to the office shortly. Boston Properties, which owns nearly 12 million square feet of space in the New York region, said about 40 percent of prepandemic occupants had returned to its buildings earlier in the summer, based on lobby badge swipes. In August, that figure had dipped to around 30 percent.

• It is less clear whether some suburban workers will ever return to the city and to their sometimes-arduous commutes. Greenberg Traurig, a global law firm, reduced its planned Manhattan footprint and now plans to open two new offices on Long Island, where many of its lawyers and investor clients relocated to during the pandemic.

• More than any other American city, New York counts on international tourists. But visitors from Europe continue to be barred. Domestic travelers have returned to New York in rising numbers, but they do not stay as long or spend as much as overseas tourists.

There are signs of hope. But even as the city sponsored an official Homecoming Week, cancellations of trade shows and other big events have mounted. READ THE ARTICLE →

Australia, which is battling its worst coronavirus outbreak, must cease lockdowns that attempt to stamp out the virus once the country reaches its initial vaccination target of 70 percent of the eligible population, Prime Minister Scott Morrison said on Monday.

“We have to deal with it; otherwise we stay in the cave forever,” Mr. Morrison told reporters in Canberra, the capital. He pushed back on some state leaders who had suggested that they might continue to enforce lockdowns even after the targets were met. He added, “That’s not a sustainable solution.”

Australia, which last year was held up as a blueprint for tackling the pandemic, has for the past several weeks been battling a growing outbreak of the faster-spreading Delta variant. The outbreak, which began in Sydney, has led to lockdowns across the nation.

Last month, state leaders agreed to limit restrictions once 70 percent of eligible Australians were vaccinated. Mr. Morrison has said the goal is to begin to reopen international borders once that number reaches 80 percent. (A trial of a program that would allow vaccinated travelers to quarantine at home, rather than in designated hotels, is beginning this week. The country’s largest airline, Qantas, has also introduced incentives for vaccinated travelers.)

On Monday, New South Wales, of which Sydney is the capital, recorded 818 new cases of the virus, with three additional deaths. In the state of Victoria, 71 new cases were reported on Monday. Melbourne, that state’s capital city, has now been under lockdown for more than 200 days over the course of the pandemic. The latest restrictions there spurred protests over the weekend that turned violent.

“You can’t live with lockdowns forever,” Mr. Morrison said, adding that 30 percent of the eligible population was now fully vaccinated, and that more than half had received one dose. “We must adjust our mind-set.”

CVS Health and the oil and gas giant Chevron said on Monday that they would mandate coronavirus vaccines for some employees, joining other large corporations that are making similar demands on office workers.

CVS pharmacists will have until Nov. 30 to be fully vaccinated, while other employees who interact with patients and all corporate staff have until Oct. 31 to comply. The mandate will affect about 100,000 employees, CVS said.

Chevron said its mandate applied to employees who travel internationally and expatriates, as well as the offshore work force in the Gulf of Mexico and some onshore support personnel, the company said on Monday. Chevron is the second-largest oil and gas producer in the United States after Exxon Mobil. It said employees in the Gulf of Mexico would need to be vaccinated by Nov. 1, but it did not share a timeline for other workers.

On Monday, the Food and Drug Administration gave full approval for Pfizer-BioNTech’s coronavirus vaccine for people 16 and older, a move that is expected to clear the way for many more mandates. New York City said on Monday it would require every employee of the city’s Department of Education — 148,000 people — to be vaccinated, and the Pentagon will demand that 1.3 million active-duty troops receive the shot “no later” than the middle of next month.

President Biden urged corporate leaders on Monday to consider vaccine mandates. “Require your employees to get vaccinated or face strict requirements” such as frequent testing, he said.

United Airlines recently announced that its employees would be required to show proof of vaccination within five weeks of regulatory approval.

Chevron was the first major U.S. oil producer to announce a requirement. “As part of our fitness for duty safety standard, workers in certain jobs are required to be vaccinated against Covid-19,” a Chevron spokeswoman said in an email. “We will continue to carefully monitor the medical data and follow the guidance of health authorities in order to protect our work force.”

Exxon Mobil does not have a formal mandate on vaccines, but the company is strongly encouraging workers to get vaccinated. A company spokesman, Casey Norton, said in a statement that Exxon was monitoring public health guidance.

“Given the spread of the Delta variant and its impact on unvaccinated individuals, all unvaccinated individuals are expected to wear a face covering in all indoor locations when six feet of social distance cannot be maintained,” he said. That policy went into effect on Aug. 18.

Like Exxon, Royal Dutch Shell encourages vaccination among employees, but it is not mandatory. Employees must comply with local laws requiring vaccination for entering public places or to enter countries.

The news of Chevron’s mandate was reported earlier by The Wall Street Journal.

Stanley Reed contributed reporting.