U.S. to Send 500 Million Pfizer Doses to 100 Nations Over Next Year

President Biden did not provide details. But he is under intense pressure to do more to address the global vaccine shortage. Here’s the latest on Covid-19.,

LiveUpdated June 9, 2021, 4:55 p.m. ETJune 9, 2021, 4:55 p.m. ET

President Biden is under intense pressure to do more to address the global shortage of coronavirus vaccines as he heads to Britain to meet with leaders of the Group of 7 nations.

President Biden and the first lady, Jill Biden, on Wednesday shortly before the president's first trip abroad.
President Biden and the first lady, Jill Biden, on Wednesday shortly before the president’s first trip abroad.Credit…Tom Brenner for The New York Times

The White House has reached an agreement with Pfizer and BioNTech to provide 500 million doses of coronavirus vaccine to about 100 countries over the next year, a pact that President Biden plans to announce as early as Thursday, according to multiple people familiar with the plan.

Under intense pressure to do more to address the global vaccine shortage and the disparities in vaccination between rich and poor nations, the president hinted at the plan Wednesday morning, when he was asked if he had a vaccination strategy for the world.

“I have one, and I’ll be announcing it,” Mr. Biden said, shortly before he boarded Air Force One for his first trip abroad as president. He was headed first to Cornwall, England, to meet with leaders of the Group of 7 nations.

People familiar with the deal said the United States will pay for the doses at a “not-for-profit” price. The first 200 million doses would be distributed this year, and 300 million would be distributed by the middle of next year, they said. Albert Bourla, chief executive of Pfizer, is expected to appear with the president when Mr. Biden makes his announcement.

The United States has already contracted to buy 300 million doses of the Pfizer-BioNTech vaccine, which requires two shots. The new agreement is separate from those contracts, according to one person familiar with it, bringing to 800 million the total number of doses the United States has agreed to purchase from the companies thus far.

The White House coronavirus response coordinator, Jeffrey D. Zients, whom Mr. Biden has put in charge of global vaccination, said in a statement on Wednesday that the president would use the “momentum” of the U.S. inoculation campaign “to rally the world’s democracies around solving this crisis globally, with America leading the way to create the arsenal of vaccines that will be critical in our global fight against Covid-19.”

The 500 million doses, all of which will be produced in the United States, still fall far short of the 11 billion doses the World Health Organization estimates are needed to vaccinate the world, but significantly exceed what the United States has committed to share so far. Other nations have been pleading with the United States to give up some of its abundant vaccine supplies.

Last week, Mr. Biden said that the United States would distribute 25 million doses this month to countries in the Caribbean and Latin America; South and Southeast Asia; Africa; and the Palestinian territories, Gaza and the West Bank.

Those doses are the first of 80 million that Mr. Biden pledged to send abroad by the end of June; three quarters of them will be distributed by the international vaccine effort known as Covax. The rest will go toward addressing pressing and urgent crises in places like India and the West Bank and Gaza, administration officials have said.

But activists have insisted that the effort is not nearly enough. They are calling on the Biden administration and leaders of other developed nations to go beyond sharing surplus doses by laying out a plan to ramp up manufacturing overseas, and pushing for vaccine makers to transfer their technology to other nations.

Mr. Biden has already committed to supporting a waiver of an international intellectual property agreement, which would require vaccine makers to share their technology. But European leaders are still blocking the proposed waiver, and pharmaceutical companies are strongly opposed to it. The World Trade Organization’s Council for Trade-Related Aspects of Intellectual Property Rights is meeting this week to consider the waiver.

“The truth is that world leaders have been kicking the can down the road for months — to the point where they have run out of road,” Edwin Ikhouria, executive director for Africa at the ONE Campaign, a nonprofit aimed at eradicating global poverty, said in a statement on Wednesday.

“This is the moment to do whatever it takes to beat the virus everywhere,” he said, “starting by immediately sharing their surplus doses, fully funding the global initiatives set up to distribute Covid vaccines,” and coming up with an economically viable strategy to distribute them to countries in need.

Mr. Biden’s announcement comes after the United States has at least partly vaccinated 52 percent of its population. But as the pace of vaccination has dropped sharply since mid-April, the Biden administration has pursued a strategy of greater accessibility and incentives to reach Americans who have not yet gotten shots.

In spite of those efforts, there are unused vaccine doses that could go to waste. Once thawed, doses have a limited shelf life and millions could begin expiring within two weeks, according to federal officials.

Providing equitable access to vaccines has become one of the most intractable challenges to reining in the pandemic. Wealthier nations and private entities have pledged tens of millions of vaccine doses and billions of dollars to shore up global supplies, but the disparity in vaccine allocations so far has been stark.

Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, warned earlier this week that the world was facing a “two-track pandemic,” in which countries where vaccines are scarce will struggle with virus cases even as better-supplied nations return to normal.

Those lower-income countries will be largely dependent on wealthier ones until vaccines can be distributed and produced on a more equitable basis, he said.

Breakthrough coronavirus infections -- meaning those that occur after full vaccination -- remain uncommon. And severe Covid among the vaccinated is even more rare.
Breakthrough coronavirus infections — meaning those that occur after full vaccination — remain uncommon. And severe Covid among the vaccinated is even more rare. Credit…Apu Gomes/Agence France-Presse — Getty Images

Over the last few months, a steady drumbeat of headlines has highlighted the astounding real-world effectiveness of the Covid-19 vaccines, especially the mRNA vaccines made by Pfizer-BioNTech and Moderna. The vaccines, study after study has shown, are more than 90 percent effective at preventing the worst outcomes, including hospitalization and death.

But alongside this good news have been rare reports of severe Covid in people who had been fully vaccinated.

On June 3, for instance, Napa County announced that a fully vaccinated woman, who was more than a month past her second Moderna shot, had died after being hospitalized with Covid. The woman, who was over 65 and had underlying medical conditions, had tested positive for the Alpha variant, which was first identified in Britain.

Although these cases are tragic, they are uncommon — and not unexpected.

“I’m very sad that she had a sufficiently severe illness that it actually led to her death,” said Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases and a vaccine expert at Vanderbilt University. But, he noted, “we expected to have the occasional breakthrough infection.”

Such cases should not dissuade people from getting vaccinated, scientists said. “There is not a vaccine in history that has ever been 100 percent effective,” said Dr. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “This is your best chance of avoiding severe, critical disease. But as is true of everything in medicine, it’s not perfect.”

Severe Covid is rare in people who have been fully vaccinated. In a paper published last month, the Centers for Disease Control and Prevention said that it had received reports of 10,262 breakthrough infections by April 30. That is just a tiny fraction of the 101 million Americans who had been vaccinated by that date, though the agency noted that it likely represented “a substantial undercount” of breakthrough infections.

Of those breakthrough cases, 10 percent of patients were hospitalized and 2 percent died — and in some of those cases, patients were hospitalized or died from something unrelated to Covid-19. The median age of those who died was 82.

Older adults, who are at greater risk for Covid complications, may also be more likely to develop breakthrough infections because they are known to mount weaker immune responses to vaccines. People who are immunocompromised or have other chronic health conditions may also be at increased risk.

Some of the variants — particularly Beta, which was first identified in South Africa — may be more likely to evade the protection induced by vaccines. But Beta is not currently common in the United States, Dr. Schaffner noted.

The Alpha variant that infected the Napa County woman is highly contagious, but vaccines provide good protection against it — as well as against the original strain of the virus.

“Vaccines provide exceptional protection against death and illness from the virus and all residents should continue to get vaccinated to protect themselves and others,” Dr. Karen Relucio, Napa County’s public health officer, said in a statement.

Breakthrough infections are likely to decrease as more people get vaccinated and community transmission rates fall. “The virus will find fewer and fewer people to infect — it will be harder for the virus to work its way through the population,” Dr. Schaffner said. “These are great vaccines. In order for the vaccines to work optimally — on an individual basis and a community basis — as many people as possible have to be vaccinated.”

— Emily Anthes

A nurse checking on patients who just received a vaccine in Ulaanbaatar, Mongolia, last month.
A nurse checking on patients who just received a vaccine in Ulaanbaatar, Mongolia, last month.Credit…Khasar Sandag for The New York Times

Coronavirus cases are surging in Mongolia, where more than half the population is fully vaccinated, prompting a new focus on the effectiveness of its main vaccine, developed by China’s Sinopharm.

Mongolia reported 1,312 new cases of the coronavirus on Wednesday as the country’s total infections neared 70,000, almost all recorded since January. New daily infections have risen more than 70 percent in the past two weeks, according to a New York Times database.

The landlocked nation has emerged as an outlier in the global scramble for vaccines among developing nations, securing enough doses for its eligible population thanks to its strategic location between Russia and China — two vaccine manufacturing giants with global ambitions. Mongolia has signed deals for 4.3 million doses of the Sinopharm vaccine and one million doses of Russia’s Sputnik V vaccine, although only 60,000 Sputnik doses have arrived so far.

Chinese vaccines, such as the ones made by Sinopharm and another company, Sinovac, use inactivated coronaviruses to trigger an immune response in the body. They have been shown in studies to be less effective than the vaccines developed by the pharmaceutical companies Pfizer and Moderna, which use newer mRNA technology.

Sinopharm’s vaccine initially came under scrutiny because of a lack of transparency in its late-stage trial data. The vaccine faced more questions after the island nation of the Seychelles, which relied heavily on Sinopharm to inoculate its population, also saw a spike in cases, although most people did not become seriously ill.

“Inactivated vaccines like Sinovac and Sinopharm are not as effective against infection but very effective against severe disease,” said Ben Cowling, an epidemiologist and biostatistician at the University of Hong Kong School of Public Health.

“Although Mongolia seems to be having a spike in infections and cases, my expectation is that there won’t be large number of hospitalizations,” he added.

And some virus variants may spread fast enough to cause concern even in countries where much of the population has vaccinations effective against them: Britain is dealing with a rise in cases linked to the Delta variant, despite having more than half of its adult population fully vaccinated, largely with shots from AstraZeneca and Pfizer.

Still, the wave of infections has raised questions in Mongolia over why the government relied on the Sinopharm shots instead of a vaccine proven to be more effective. It came as Mongolians headed to the polls on Wednesday to vote for president, the first election since the constitution was amended to limit the president to one six-year term. The prime minister is the head of government and holds executive power.

A year ago, Mongolia was among the few countries in the world that boasted no local coronavirus cases, but an outbreak in November changed that. A political crisis ensued and protests over perceived mishandling of the outbreak led the prime minister to resign in January.

The new prime minister, Oyun-Erdene Luvsannamsrai, has promised to revive a flagging economy and end social distancing restrictions that have hurt businesses. A fresh wave of cases could threaten this pledge.

Explorer of the Seas (front), a Royal Caribbean cruise ship, along with other cruise ships in Miami, late May. It's unclear if cruise lines will be able to sail out of cities in Florida.
Explorer of the Seas (front), a Royal Caribbean cruise ship, along with other cruise ships in Miami, late May. It’s unclear if cruise lines will be able to sail out of cities in Florida.Credit…Joe Raedle/Getty Images

Cruise lines are starting to make plans to sail this summer out of Florida, which one company called “the cruise capital of the world.” But the state’s ban on vaccine passports complicates how ships can navigate its ports.

Some cruise lines, such as Norwegian Cruise Line, plan to sail with fully vaccinated crews and ensure that guests are also fully vaccinated. But while the federal government says employers can make on-site employees get vaccinated, a Florida state law prohibits businesses from requiring a vaccine passport, or proof of Covid-19 vaccination, in exchange for services.

The law has local officials concerned that their cities lose out if cruise lines decide to skip Florida ports, as Frank Del Rio, chief executive of Norwegian Cruise Line, recently threatened to do as a last resort.

On Monday, the company announced that it planned to set sail this summer from New York, Los Angeles and two Florida cities, Port Canaveral and Miami. The cruise line, however, did not specify how it planned to sail out of Florida.

Mr. Del Rio said the company was in contact with Gov. Ron DeSantis’s staff and legal team to “ensure that we can offer the safest cruise experience for our passengers departing from the cruise capital of the world.”

Other cruise lines, such as Royal Caribbean International, might bow to the state’s vaccine passport ban. Announcing its voyage plans out of Miami this summer, the cruise line said that its crews would be fully vaccinated, while guests were “strongly recommended to set sail fully vaccinated, if they are eligible.”

Royal Caribbean guests who are not vaccinated — or unable to prove that they are — will have to be tested for the virus, and could be subject to other protocols to be announced later, the cruise line said.

Last week, the mayors of Broward County, Fort Lauderdale and Hollywood sent a letter to Governor DeSantis urging him to reconsider the state’s position on vaccine passports. They argued that the cruise lines “are ready to set sail” based on U.S. Centers for Disease Control and Prevention guidelines, but that the ban on vaccine passports prevented them from doing so.

“We are extremely concerned that unless a resolution can be reached, this impasse over the rules will result in the loss of the cruise industry in Broward County and Florida overall,” the mayors wrote.

Receiving the Oxford-AstraZeneca vaccine in Currie, Scotland, in January.
Receiving the Oxford-AstraZeneca vaccine in Currie, Scotland, in January.Credit…Photo photo by Russell Cheyne/Agence France-Presse

People receiving the Covid vaccine made by Oxford-AstraZeneca had a slightly increased risk of a bleeding disorder, and possibly other rare blood problems, researchers reported on Wednesday.

The findings, from a study of 2.53 million adults in Scotland who received their first doses of either the AstraZeneca vaccine or the one made by Pfizer-BioNTech, were published in the journal Nature Medicine.

The study found no increased risk of the blood disorders with the Pfizer-BioNTech vaccine.

The AstraZeneca vaccine is not authorized for use in the United States, but has been authorized by the European Medicines Agency, the European Union’s top drug regulator, as well as by many countries outside the bloc. But reports of rare clotting and bleeding disorders in younger adults, some fatal, led some countries to limit the vaccines’s use to older people, and a few to drop it altogether.

The new study found that the AstraZeneca vaccine was linked to a slight increase in the risk of a disorder called “immune thrombocytopenic purpura,” which can cause bruising in some cases but also serious bleeding in others. The risk was estimated at 1.13 cases per 100,000 people receiving their first dose, up to 27 days after vaccination.

Workers near a wholesale market in Wuhan, China, in March 2020.
Workers near a wholesale market in Wuhan, China, in March 2020.Credit…Hector Retamal/Agence France-Presse — Getty Images

In the two years before the pandemic began, markets in the Chinese city of Wuhan were selling nearly three dozen animal species that can harbor pathogens that jump to humans, researchers have found, shedding new light on the possible role of the wildlife trade in the coronavirus’s origins.

The researchers found sales in Wuhan of mink, palm civets and raccoon dogs, but they did not find sales of pangolins or bats, which have been suspected as possible sources of the coronavirus.

In all, the researchers documented sales of more than 47,000 animals across 38 species in Wuhan markets between May 2017 and November 2019. Thirty-three of the species have previously been infected with diseases or disease-bearing parasites that can affect humans, the researchers said.

China suspended the sale and consumption of wild animals as the coronavirus began spreading rapidly early last year. The country’s wildlife trade played a key role in the SARS outbreak in the early 2000s.

A team of experts who led a World Health Organization mission to Wuhan this year examined vendor records and other evidence from the city’s animal markets. But the team reached no firm conclusions about the markets’ role in the outbreak, or about the specific species through which the coronavirus might have spread to humans.

More than a year into the pandemic, the question of the virus’s origins remains largely unresolved. The Biden administration last month announced a new push to investigate whether it could have accidentally leaked from a laboratory in Wuhan.

President Biden’s action came as top health officials renewed their appeals this week for a more rigorous inquiry. And it followed mounting criticism of a report from a team of international experts convened by the World Health Organization that largely dismissed the possibility that the virus had accidentally escaped from a Chinese laboratory called the Wuhan Institute of Virology.

Many scientists support investigating all possibilities, including the laboratory origin, even though they think the virus was probably transmitted from animals to humans outside of a laboratory. Angela Rasmussen, a virologist at University of Saskatchewan’s Vaccine and Infectious Disease Organization, said of the new study, “I think this puts a big point in the column of natural origin through intermediate species.” She said that while the paper “doesn’t prove anything” it “provides clear evidence that the wildlife markets really haven’t been investigated enough.”

The study of the animal markets, published this week in the journal Scientific Reports, was written by authors affiliated with China West Normal University, Oxford University and the University of British Columbia.

Between 2017 and 2019, one of the researchers conducted monthly surveys of all 17 shops in Wuhan markets that sold live wild animals for food and pets. Seven of these shops were at the city’s Huanan seafood market. Several early Covid cases in Wuhan were discovered in people with connections to that market.

The researchers originally carried out the surveys to investigate a tick-borne virus. But their results became “serendipitously” relevant to the Covid-19 pandemic, the researchers wrote.

Among the other species on sale in Wuhan, according to the researchers, were badgers, hedgehogs, weasels, porcupines, marmots, red foxes, flying squirrels, crested myna birds, snakes, vipers, cobras and Siamese crocodiles. Almost all of the animals were “sold alive, caged, stacked and in poor condition,” the researchers wrote, and were often butchered on site.

A mass vaccination program for older people at a clinic outside Johannesburg, South Africa, last month.
A mass vaccination program for older people at a clinic outside Johannesburg, South Africa, last month.Credit…Themba Hadebe/Associated Press

Mastercard’s charitable arm has promised to donate $1.3 billion for vaccines in Africa, one of the largest corporate donations of the pandemic, as the continent struggles to contain a surge of infections.

The Mastercard Foundation said on Tuesday that its donation would be deployed over three years “in partnership” with the Africa Centers for Disease Control and Prevention. It said the goals were to strengthen the agency’s capacity, “lay the groundwork” for local vaccine manufacturing, acquire vaccines for at least 50 million people and help deliver shots to millions more.

“Ensuring inclusivity in vaccine access, and building Africa’s capacity to manufacture its own vaccines, is not just good for the continent, it’s the only sustainable path out of the pandemic and into a health-secure future,” John N. Nkengasong, the director of the Africa Centers for Disease Control and Prevention, said in the statement announcing the donation.

Africa is battling a sharp, sudden rise in coronavirus infections and deaths that experts believe is linked to the rise of new variants. The latest hot spots include Botswana, Namibia and Tunisia, according to a New York Times database.

But as of Wednesday only about 38 million, or slightly more than 2 percent, of the continent’s 1.3 billion people had received at least one dose of a coronavirus vaccine, according to the Our World in Data project. That was roughly the number of first doses given so far in Italy, which has a population of about 60 million.

Mastercard’s donation is the latest effort to address the glaring vaccination gap between rich and poor countries.

Last week a group of wealthy countries, foundations and private companies pledged $2.4 billion for global vaccination efforts and announced plans to share a total of 54 million doses from their domestic supplies with countries in need, for example.

The World Health Organization said last week that only 0.4 percent of all Covid-19 vaccine doses had been administered in low-income countries. And pharmaceutical companies have only manufactured a fraction of the 11 billion shots that researchers at Duke University estimate will be needed to vaccinate 70 percent of the world’s population, the rough threshold needed for herd immunity.

In a March survey, roughly 60 percent of people said they struggled with pandemic-related insomnia.
In a March survey, roughly 60 percent of people said they struggled with pandemic-related insomnia.Credit…Flora Hanitijo for The New York Times

In a survey of thousands of adults last summer, the American Academy of Sleep Medicine found that 20 percent of Americans said they had trouble sleeping because of the pandemic.

Not surprising. But when the academy repeated its survey 10 months later, in March, with coronavirus infection rates falling and more people being vaccinated, sleep problems had only gotten worse: Roughly 60 percent of people said they struggled with pandemic-related insomnia, and nearly half reported that the quality of their sleep had diminished.

“A lot of people thought that our sleep should be getting better because we can see the light at the end of the tunnel — but it’s worse now than it was last year,” said Dr. Fariha Abbasi-Feinberg, a sleep medicine specialist and spokeswoman for the American Academy of Sleep Medicine. “People are still really struggling.”

Studies show that in the pandemic, people tended to keep irregular sleep schedules, going to bed far later and sleeping in longer than usual, which can disrupt our circadian rhythms. We slashed our physical activity levels and spent longer indoors; gained weight and drank more alcohol; and erased the lines that separate work and school from our homes and our bedrooms — all of which are damaging to sleep.

Mandy Lin, 43, left, and her 9-year-old son returning to their apartment in Philadelphia last week. Ms. Lin stays close to home because she is fearful of anti-Asian attacks.
Mandy Lin, 43, left, and her 9-year-old son returning to their apartment in Philadelphia last week. Ms. Lin stays close to home because she is fearful of anti-Asian attacks.Credit…Hannah Yoon for The New York Times

Millions of Americans may be leaping into a summer of newly unmasked normalcy, but a surge in anti-Asian attacks during the pandemic is now holding back many Asian American families from joining them.

As schools phase out remote learning, companies summon employees back to work and masks fly off people’s faces, Asian Americans say that America’s race to reopen is creating a new wave of worries — not about getting sick, but about whether they will be attacked if they venture back onto a bus or accosted if they return to a favorite cafe or bookstore.

In more than a dozen interviews across the country, Asian Americans detailed fears about their safety and a litany of precautions that have endured even as the country has reopened.

Stop AAPI Hate, a coalition of community and academic organizations, tracked more than 6,600 attacks and other incidents targeting Asian Americans and Pacific Islanders from March 2020 to March 2021. A survey this spring found that one in three Asian Americans worried about becoming victims of hate crimes.

Asian Americans said they hoped the threats would ebb as more people got vaccinated and the pandemic faded. But person after person echoed the same worry: There is no vaccine against bigotry.

A mobile vaccination clinic in Foley, Minn. last month.
A mobile vaccination clinic in Foley, Minn. last month.Credit…Liam James Doyle for The New York Times

As many Americans prepare to head back to the office, companies are hammering out policies on the extent to which they will require, or strongly encourage, employees there to be vaccinated against the coronavirus.

The bottom line is that companies are legally permitted to make employees get vaccinated, according to recent guidance from the federal agency that enforces workplace discrimination laws, the U.S. Equal Employment Opportunity Commission.

The agency said that employees who will not get vaccinated because of a disability or sincerely held religious belief may be entitled to an accommodation. Many companies are still reluctant to require inoculations for their employees, for a variety of reasons.

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Fauci Says Virus Variants Underscore Importance of Vaccinations

Despite the receding number of coronavirus cases in much of the United States, hospitalizations continue to rise in communities with low vaccination rates as highly contagious variants spread around the country.

What I’m going to do right now is spend the next couple of minutes talking to you about a subject that has gained a lot more attention over the last few days, and that has to do with the variants in general, but particularly in the variant which we now refer to as Delta or the B.1.617.2, which in fact, as you know, originally was noticed in India and dominated in certain states in India, but now has spread throughout other elements and other areas of the world. However, fortunately, two doses of the Pfizer vaccine and AstraZeneca appear to be effective against the Delta variant. The Delta variant currently accounts for more than 6 percent of the sequenced cases in the United States. This is a situation, the way it was in England, where they had a B.1.17 dominant and then the 617 took over. We cannot let that happen in the United States, which is such a powerful argument to underscore what Dr. Walensky said: to get vaccinated, particularly if you had your first dose, make sure you get that second dose. And for those who have been not vaccinated yet, please get vaccinated.

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Despite the receding number of coronavirus cases in much of the United States, hospitalizations continue to rise in communities with low vaccination rates as highly contagious variants spread around the country.CreditCredit…Brett Carlsen for The New York Times

The coronavirus might be receding in much of the United States, but health officials worry that the low immunization rates in parts of the country and the spread of highly contagious virus variants may pose a threat to the nation’s remarkable progress since vaccines were introduced.

In Newton County, Mo., for example, where just 15 percent of the population is fully vaccinated, area hospitals reported they were treating 46 people for Covid-19 as of June 3, a 47 percent rise over the previous two weeks, according to data from the Department of Health and Human Services. Comanche County, Okla., saw a 63 percent jump in Covid hospitalizations, with 10 people being treated; just 32 percent of county residents are fully vaccinated.

Many of the places with the notable recent jumps in hospitalization rates are smaller communities, where new virus cases and hospitalizations may be in the single digits. Nationally, hospitalizations for Covid-19 continue to decline, though eight states have seen upticks. That includes Louisiana, Utah and Oklahoma, which have lagging vaccination rates.

On the other hand, some states with low vaccination rates, including Mississippi and Alabama, have seen fewer people in the hospital in recent weeks, though in Alabama, cases are rising. Hospitalization figures typically lag case counts, because it may take some time for someone who is infected to become severely ill.

Still, experts are concerned that upticks in hospitalization and case numbers could bloom into a surge this summer, as people head indoors to escape the heat, especially across the South in communities where vaccination rates are low.

The recent increase in some communities is not a coincidence, said Dr. Ted Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems. People who become ill with Covid-19 now are, “in most age groups, twice as likely to end up hospitalized as people who got the virus earlier in the course of the pandemic,” Dr. Delbridge said.

In Maryland, of those between the ages of 50 and 59 who contracted Covid-19 over the winter, about 8 percent were hospitalized, he said. From the end of April through the beginning of June, the hospitalization rate in that group was 19 percent.

Worrisome virus variants could be playing a role, Dr. Delbridge said. The variant first found in Britain, now known as Alpha, is more contagious and may be deadlier than most others and is now dominant in the United States. Last month, Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, said the variant, also known as B.1.1.7, made up 72 percent of U.S. cases at the time.

But vaccines have proven to be effective against the Alpha variant. A spring surge that scientists had warned of was smaller than had been feared in the United States.

“I think we got lucky, to be honest,” Nathan Grubaugh, an epidemiologist at Yale University, told The New York Times last month. “We’re being rescued by the vaccine.”

Through Tuesday, about 172 million Americans had received at least one dose of a Covid-19 vaccine, according to a Times database. But vaccine distribution across the country has slowed in recent weeks. About 1 million shots are being administered nationwide each day, down from an April peak of 3 million.

In Michigan, one of the few states that saw a surge in cases this spring, Alpha struck younger people who were returning to schools and playing contact sports.

“Because it’s more transmissible, the virus finds cracks in behavior that normally wouldn’t have been as much of a problem,” said Emily Martin, an epidemiologist at the University of Michigan.

At a White House news briefing on Tuesday, Dr. Anthony S. Fauci, President Biden’s chief Covid adviser, said the Delta variant, which was originally identified in India, was emerging as the dominant variant in Britain.

“We cannot let that happen in the United States,” Dr. Fauci said, adding that the Delta variant now accounted for 6 percent of sequenced cases in the United States.

Dr. Fauci urged young people to get immunized, citing a study that found that the vaccines appeared to be effective against the Delta variant.

One way of limiting the spread is for those who are vaccinated to wear masks around those who are not, doctors say. Although the Centers for Disease Control and Prevention has said that vaccinated people do not need to wear masks in most indoor settings, at least one state is modifying that a rule in some places: When California reopens next week, fully vaccinated colleagues working in a room together will be allowed to work maskless. But if one person is unvaccinated, everyone in the room will need to wear a mask.

“If I’m in close proximity to other people, and I don’t know their vaccination status, I put a mask on,” Dr. Delbridge said. “It’s just too easy.”

Correction: An earlier version of this article overstated the connection between low vaccination rates and hospitalizations. While the number of patients hospitalized for Covid-19 is rising in some counties with low vaccination rates, it is not the case in all such counties. The error was repeated in the headline. The earlier version also misstated the increase in hospitalizations in Smith County, Tenn., and Trousdale County, Tenn., in recent weeks. The 700 percent increase in reported hospitalizations in those two counties is because of an irregularity in how hospitals in the area reported data to the Department of Health and Human Services, not an increase in people actually hospitalized.

Albert Sun contributed reporting.

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