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The Navajo Nation, which once had one of the worst coronavirus case rates in the United States, recently reached an extraordinary milestone: zero cases and zero deaths in a 24-hour period.
The nation, which has over 300,000 enrolled members, is averaging about 11 new cases a day, far below its peak of 250 in late November, according to the latest data from the Navajo Department of Health.
And it has vaccinated more of its population than any state, with more than half of its 170,000 residents living on tribal lands fully vaccinated.
But there are some alarming signs. With infections rising again nationally and dangerous variants circulating, U.S. health officials are warning of another surge. And the first confirmed case of the more contagious and possibly more lethal variant first found in Britain has been confirmed on Navajo territory, which stretches across Arizona, New Mexico and Utah.
The Navajo, the second-largest U.S. tribe, aren’t alone in their struggle against the virus. Indigenous Americans have had Covid-19 death rates nearly twice those of white populations in the United States, amid high rates of comorbidities like diabetes and obesity, according to the Centers for Disease Control and Prevention.
Jonathan Nez, the president of the Navajo Nation, said the tribe was able to tame the virus because members had followed strict lockdown orders and a mask mandate, which was imposed nearly a year ago.
“It wasn’t about restricting people’s freedoms when we told people to wear a mask or to stay home. It was looking at the greater good,” Mr. Nez said on the CBS program “Face the Nation” on Sunday.
Vaccination efforts have also been a big success, Mr. Nez said, with about 218,190 shots administered (nearly 90 percent of the doses allocated) and 88,513 people fully vaccinated.
“I think just because of how hard hit the Navajo Nation was, we’ve seen a big increase in participation in taking the vaccine,” Mr. Nez said, adding that officials have been holding town hall meetings to build trust and answer questions about the virus.
Tribal health officials have also credited the nation’s decision to coordinate closely between the federal Indian Health Service, which oversees care for the more than 500 tribes throughout the country, and Navajo health organizations, a much more streamlined operation than the patchwork approach across the country.
Other tribes have also had successful pandemic responses. Reported cases in the Cherokee Nation, the largest U.S. tribe, dropped sharply in mid-March, when Oklahoma stopped reporting daily virus data. The tribe also quickly administered thousands of vaccine shots but is now facing the problem of getting hesitant people vaccinated.
In the pandemic’s early days, the Navajo Nation struggled to contain the virus. Mr. Nez attributed the difficulties to resource inequities, an underfunded health care system and limited federal help.
The Indian Health Service “has been underfunded since its inception,” he said. A New York Times investigation last year found that the agency struggled to respond to the pandemic because it has long been plagued by shortages of funding, supplies and health care workers.
A more recent NPR analysis, however, found that tribes that decided to receive vaccines through the Indian Health Service — including the White Mountain Apache of Arizona and the Rosebud Sioux of South Dakota — were far ahead of those that went through state systems.
Tribal elders’ deaths have devastated their communities. The lack of local data has further complicated the challenge of controlling outbreaks.
President Biden’s $1.9 trillion pandemic relief package, which he signed last month, provides $31 billion for tribal nations and Indigenous people to address persistent problems like poor health care.
And Mr. Biden appointed former Representative Deb Haaland of New Mexico as secretary of the interior, making her the first Native American to lead a cabinet agency and responsible for the well-being of the nation’s 1.9 million Native people.
“We finally have a seat at the table in getting our information and our advocacy addressed,” Mr. Nez said, referring to collaboration with the White House and the acting director of the Indian Health Service. “With the funds that are coming to the citizens of this country in terms of recovery and rescue, this time around it’s finally helping our nation grow.”
More than a year into the pandemic, India recorded its highest tally of new coronavirus infections on Monday as officials in the hardest-hit state reimposed lockdowns and warned that hospitals even in smaller cities were running out of beds.
The worrisome developments were reminiscent of earlier waves in the pandemic, yet they came even as India continues to vaccinate more than three million people every day, one of the largest efforts in the world.
Officials announced Monday morning that they had recorded 103,558 new cases in 24 hours, making India the second country after the United States to cross the 100,000-case threshold in a single day. After several months of declines, daily infections have surged tenfold since the second week of February.
More than half of the new infections were traced to the western state of Maharashtra, which includes Mumbai, India’s financial capital. The state government ordered all shops, movie theaters, markets and restaurants to close starting Monday evening and imposed a nighttime curfew, exempting only essential services.
With 12.6 million confirmed coronavirus cases, according to a New York Times database, India’s caseload is the world’s third highest after the United States and Brazil. Officials have attributed the recent spike to a relaxed attitude among Indians when it comes to wearing masks and maintaining social distance.
But critics say Prime Minister Narendra Modi’s government has sent mixed signals. Officials have allowed large crowds to gather for a major Hindu religious festival — where hundreds of coronavirus infections have been reported — while Mr. Modi’s party has held crowded rallies in several states where local elections have begun.
In the early days of the pandemic, Mr. Modi enacted one of the world’s severest and most abrupt lockdowns, leaving hundreds of thousands of migrant workers instantly unemployed and forcing many to return to their villages on foot. As India’s already ailing economy contracted even further, Mr. Modi began lifting restrictions last May, and infections started to explode.
The new restrictions in Mumbai have been met with resistance by opposition politicians and business leaders. Representatives of the hotel industry appealed to the Maharashtra state government for financial support and tax waivers, saying the latest lockdown moves would bring economic doom.
India’s vaccination drive has been a rare bright spot domestically, but at a cost to other nations: The government has curtailed exports of vaccines manufactured by its mammoth pharmaceutical industry, dealing a setback to poorer countries that had been relying on India for their doses.
Israel’s vaccination program has been remarkably swift and successful. In recent weeks, new coronavirus infections have dropped significantly, from a peak of 10,000 a day in January to a few hundred by late March. The economy has almost fully reopened.
And just as Israel became a real-world laboratory for the efficacy of the vaccine, it is now becoming a test case for a post-lockdown, post-vaccinated society.
The Green Pass, a document that can be downloaded to a smartphone, is the entry ticket.
Green Pass holders may dine indoors in restaurants, stay in hotels and attend cultural, sports and religious gatherings in the thousands both indoors and out. They can go to gyms, swimming pools and the theater. They can get married in wedding halls.
Local newspapers and television stations are advertising summer getaways for the fully vaccinated in countries prepared to take them, including Greece, Georgia and the Seychelles.
Restaurants ask those booking tables: Do you have a Green Pass? Are you vaccinated?
The system is imperfect, and, beyond the Green Pass, in many ways “system” may be an overstatement. Enforcement has been patchy. There are troubling questions about those who are not vaccinated and noisy debates playing out in real time — some landing in court — about the rules and responsibilities of the return to near normalcy.
Moreover, there’s no guarantee that this really is the start of a post-pandemic future. Any number of factors — delays in vaccine production, the emergence of a new vaccine-resistant variant and the huge numbers of Israelis who remain unvaccinated — could rip the rug out from under it.
The new world has also underscored the inequities and divides between societies with more or less access to the vaccine. Many in the West Bank and Gaza have not been able to get vaccinations yet.
The Palestinian vaccination campaign is just getting started, with doses largely donated by other countries amid a bitter debate over Israel’s legal and moral obligations for the health of people in territory it occupies. Israel has vaccinated about 100,000 Palestinians who work in Israel or in West Bank settlements but has been criticized for not doing more.
More than 5.2 million Israelis have received at least one shot of the Pfizer vaccine. About four million remain unvaccinated, half of them people under 16 who are not yet eligible to receive the vaccine pending regulatory approvals and further testing on children. Hundreds of thousands of citizens who have recovered from Covid-19 were only recently included in Israel’s vaccination program.
And up to a million people have so far chosen not to get vaccinated, despite Israel’s enviable supply of doses.
The Maryland biotech firm at the center of a mix-up that ruined up to 15 million doses of the Johnson & Johnson coronavirus vaccine declared late Sunday that it “continues to own and operate” the Baltimore plant where the problems occurred, even though the Biden administration has put Johnson & Johnson in charge of manufacturing there.
In an apparent bid to reassure its shareholders, Emergent BioSolutions, a contract manufacturer that was making vaccines for both Johnson & Johnson and AstraZeneca, said it was “on track with its manufacturing agreements related to Covid-19 vaccines” and “that there are no changes to its financial guidance for 2021.”
Yet even as the company sought to defend its reputation, it acknowledged that there would be changes in the way its plant, known as Bayview, was managed — and that Johnson & Johnson would in effect run its own vaccine manufacturing operation there.
“Emergent’s top priority continues to be the strengthening of the supply chain for Johnson & Johnson’s vitally needed Covid-19 vaccine,” Robert Kramer, the company’s chief executive, said in the statement. “We have been working closely with Johnson & Johnson and welcome the additional oversight and support at our Bayview facility.”
On Saturday, days after the disclosure that workers at the Baltimore facility had mixed up ingredients from the two vaccines it was making, the Department of Health and Human Services stepped in, instructing Johnson & Johnson to take control of the plant. The department also ordered Emergent to stop making the AstraZeneca vaccine to avoid future mistakes.
Emergent said on Sunday that it would work with the government on a “mutually agreed ramp-down” of AstraZeneca manufacturing. The administration has said that it will look for another site to make that vaccine, which unlike the Johnson & Johnson vaccine does not have emergency authorization from the Food and Drug Administration.
The error in Baltimore has delayed future shipments of Johnson & Johnson doses in the United States while the F.D.A. investigates what happened. It has also created a public relations headache for the Biden administration, which is trying to increase production of coronavirus vaccines and assure skeptics that they are safe.
Emergent is well known in Washington; last month The New York Times published an investigation into the company’s aggressive lobbying for federal contracts, particularly for the Strategic National Stockpile, the nation’s emergency medical reserve. After the article appeared, President Biden canceled a visit to the Baltimore facility.
The Baltimore plant is one of two federally designated “Centers for Innovation in Advanced Development and Manufacturing” that work with the government and are supposed to stand ready to help in a public health emergency. In June, the government awarded Emergent a contract valued at up to $628 million to reserve manufacturing space for coronavirus vaccines and upgrade the Baltimore facility.
The government recently increased the contract by $23 million to allow Emergent to purchase manufacturing equipment specific to Johnson & Johnson’s vaccine — an award the company highlighted in its statement on Sunday. The increase was awarded on March 23, two days before the government learned about the mix-up at the Baltimore facility.
Prime Minister Boris Johnson of Britain is expected to give the first detailed glimpse of England’s post-pandemic society on Monday, announcing free twice-weekly coronavirus testing and Covid certificates to allow people into nightclubs and sporting events.
The plans, to be laid out by Mr. Johnson in a news conference on Monday evening, are the next step in the government’s phased reopening of the economy, as new coronavirus cases, hospital admissions and deaths continue to fall. Starting next week, the government is expected to allow outdoor areas in restaurants and pubs as well as nonessential shops in England to reopen. Restrictions vary in Scotland, Northern Ireland and Wales, where some aspects of the lockdown measures are determined by local governments.
Mr. Johnson will also address foreign travel to Britain, which in most cases is banned until May 17, though he is expected to continue to be cautious because of the risk of new virus variants being imported. Details of the government’s plans were widely reported in the British news media over the Easter weekend.
Among the most ambitious elements is a plan to offer free rapid-testing kits to the entire population, so that people can test themselves up to twice a week and be confident they are not carrying the virus. The kits, which are already used by hospital staff and schools, will be available by mail or at pharmacies.
Later in the spring, the government plans to roll out some form of certificate that will verify that a person has been vaccinated, has tested negative for the virus, or has antibodies from having recovered from Covid-19. These certificates will be used to gain admission to places where social distancing is most difficult.
How exactly the certificates will work is not yet clear, as the government is wrestling with thorny issues of civil liberties, social equity and logistics. The opposition Labour Party and a rebellious minority in Mr. Johnson’s Conservative Party have both expressed misgivings about the certificates, raising the possibility that the government could lose a vote on the measure in Parliament.
Across white evangelical America, reasons not to get vaccinated have spread quickly.
The deeply held spiritual convictions or counterfactual arguments may vary, but the opposition is rooted in a mix of religious faith and a longstanding wariness of mainstream science, and it is fueled by broader cultural distrust of institutions and gravitation to online conspiracy theories.
The sheer size of the community poses a major problem for the country’s ability to recover from a pandemic that has resulted in the deaths of half a million Americans.
There are about 41 million white evangelical adults in the United States. About 45 percent said in late February that they would not get vaccinated against Covid-19, making them among the least likely demographic groups to do so, according to the Pew Research Center.
As vaccines become more widely available, and as more contagious virus variants develop, the problem takes on new urgency. Significant numbers of Americans generally are resistant to getting vaccinated, but white evangelicals present unique challenges because of their complex web of moral, medical and political objections. The challenge is further complicated by longstanding distrust between evangelicals and the scientific community.
No clear data is available about vaccine hesitancy among evangelicals of other racial groups. But religious reasoning often spreads beyond white churches.
Many high-profile conservative pastors and institutional leaders have endorsed the vaccines. Franklin Graham told his 9.6 million Facebook followers that Jesus would advocate vaccination.
Pastor Robert Jeffress commended it from an anti-abortion perspective on Fox News. (“We talk about life inside the womb being a gift from God. Well, life outside the womb is a gift from God, too.”)
But other influential voices in the sprawling, trans-denominational movement, especially those who have gained their stature through media fame, have sown fears. Gene Bailey, the host of a prophecy-focused talk show on the Victory Channel, warned his audience in March that the government and “globalist entities” would “use bayonets and prisons to force a needle into your arm.”
Dr. Simone Gold, a prominent Covid-19 skeptic who was charged with violent entry and disorderly conduct in the Jan. 6 Capitol siege, told an evangelical congregation in Florida that they were in danger of being “coerced into taking an experimental biological agent.”
One widespread concern among evangelicals is the vaccines’ ties to abortion. In reality, the connection is remote: Some of the vaccines were developed and tested using cells derived from the fetal tissue of elective abortions that took place decades ago.
The vaccines do not include fetal tissue, and no additional abortions are required to manufacture them. Still, the kernel of a connection has metastasized online into false rumors about human remains or fetal DNA being an ingredient in the vaccines.
Some evangelicals see the vaccine as a redemptive outcome for the original aborted fetus.
Dr. Julie Morita, the executive vice president of the Robert Wood Johnson Foundation and a former Chicago public health commissioner, said the method to reach white evangelicals is similar to building vaccine confidence in other groups: Listen to their concerns and questions, and then provide information that they can understand from people they trust.
But a public education campaign alone may not be enough.
After almost two months of near-zero local coronavirus infections, China is working to contain a small outbreak in a southwestern city near the border with Myanmar.
Ruili, a city of 210,000 people in Yunnan Province, has recorded 48 new cases in the past week, including 15 reported on Monday. It has been on lockdown since last week as officials conduct citywide virus testing. The local authorities also said they would aim to vaccinate every resident by Tuesday in an effort to contain the virus.
The city is the main crossing point on the border between Yunnan and Myanmar, which was difficult to secure even before a Feb. 1 coup by the Myanmar military set off deadly unrest. Nineteen of the 48 infected patients are Myanmar nationals, and officials in Ruili said on Saturday that the outbreak was most likely traceable to people or goods arriving from across the border.
Since largely stamping out the virus last spring, China has responded aggressively to new outbreaks with lockdowns and other measures — including in Ruili last September, after infections were found in two people from Myanmar accused of crossing the border illegally. China’s last major outbreak, which began in January in the northeast, prompted lockdowns in several cities that affected millions of people.
In other news from around the world:
Investigations have begun in France after government officials and others were accused of dining in secret restaurants in violation of coronavirus restrictions. The Paris prosecutor’s office confirmed that it was looking into whether parties were organized in disregard of health restrictions and to determine who organized and participated in the events, a spokesman said.
Greece took cautious steps on Monday toward lifting restrictions in a bid to breathe life into its beleaguered economy and offer relief to residents that have been under some form of lockdown since November. Retail shops opened across much of the country, but bars and cafes remain closed. They are likely to open next month, just before a planned reopening of the country’s crucial tourism sector on May 14.
Kenya has imposed new restrictions on travelers from Britain, days after Kenya was added to a government “red list” barring entry to travelers from certain countries. Beginning April 9, anyone arriving in Kenya from a British airport will be required to quarantine for 14 days at a government-designated facility and will have to take two coronavirus tests, according to the Kenyan Ministry of Foreign Affairs. Kenyan citizens will be exempt from the rules, as will cargo flights between the countries.
Bangladesh began a weeklong national lockdown on Monday after a stark rise in new cases. The government said it would restrict movement, and all nonessential shops and services have been shut. Domestic flights and public transportation services have also been suspended.
After Nepal was forced to close its mountain trails last year, dealing its economy a devastating blow, the tiny Himalayan country has reopened Mount Everest and its seven other 26,200-foot-plus peaks in the hope of a rebound.
For this year’s climbing season, from March to May, Nepal has granted more than 300 climbers the licenses needed to ascend the world’s tallest peak. Many of those climbers hope to reach the summit, 5.5 miles above sea level.
But as the coronavirus resurges in South Asia, the pandemic has made the already deadly climb even more hazardous. Local officials have instituted testing, mask and social-distancing requirements, stationed medical personnel at the Mount Everest Base Camp, and made plans to swoop in and pick up infected climbers. Climbers are typically greeted in Kathmandu with raucous parties thrown by expedition staffers. But not this year.
“No party. No handshake. No hug. Just ‘Namaste,’” said Lakpa Sherpa, whose agency is taking 19 climbers to Everest this spring, referring to the South Asian greeting.
Nepal, one of the poorest countries in Asia, and one where coronavirus vaccination efforts are faltering, is taking a calculated risk. In 2019, tourism brought in $2 billion in revenue and employed about a million people. For tens of thousands of Nepalis, the three-month climbing season is the only opportunity for paid work.
The damage from last year’s closure was immense. At least 1.5 million people in the country of 30 million lost jobs or substantial income during the pandemic, according to Nepal’s National Planning Commission.
Porters who usually cart supplies and gear up the peaks for well-paying foreign climbers were forced to subsist on government handouts of rice and lentils. Expert expedition guides, many of whom are members of Nepal’s Sherpa tribe, returned to their villages in the remote mountains and grew potatoes to survive.
“We have no other options,” said Rudra Singh Tamang, the head of Nepal’s tourism department. “We need to save the mountaineering economy.”
Still, tourism ministry officials and expedition agencies acknowledge that Nepal has no clear plan to test or isolate climbers if one tests positive for the virus.
At the airport in Kathmandu, the capital, incoming travelers must show negative RT-PCR test results or provide vaccination certificates. Climbers initially had to get additional insurance, adding to the average $50,000 price tag to climb Everest, although the government has loosened that requirement.
Despite the challenges, the climbing season has drawn some high-profile mountaineers, including a Bahraini prince with a large entourage, a Qatari who wants to be the first woman from her nation to make the climb, and a former National Football League wide receiver who is aiming to become the oldest N.F.L. player to summit the world’s seven tallest peaks.
“I wanted to be there,” said the former player, Mark Pattison, 59, “in Nepal, this spring, at any cost.”
The Centers for Disease Control and Prevention issued long-awaited technical guidance for cruise lines on Friday, bringing them one step closer to sailing again in United States waters.
While some cruise lines operating in Europe have been requiring all passengers to be vaccinated, the C.D.C. did not go that far. Vaccination will be critical in the safe resumption of cruising, the agency said, and recommended all eligible port personnel, crew and passengers get a Covid-19 vaccine as soon as one becomes available to them.
By making vaccinations a recommendation instead of a requirement, the C.D.C. has avoided conflict with Florida, one of the cruise industry’s biggest bases of operations, which has banned businesses from requiring customers to show proof of vaccinations.
Cruise ships have been docked in the U.S. for over a year because of the pandemic and can only restart operations by following the C.D.C.’s Framework for Conditional Sailing Order, issued in October to ensure that cruise ships build the onboard infrastructure needed to mitigate the risks of the coronavirus.
The technical instructions will allow cruise lines to prepare their ships for simulation voyages, designed to test health and safety protocols and operational procedures with volunteers before sailing with paying passengers.
The new recommendations include increasing from weekly to daily the reporting of Covid-19 cases, implementing routine testing of all crew based on a ship’s Covid-19 status and making contractual arrangements with medical facilities on shore for passengers who may fall ill during a voyage.
Once cruise lines have prepared their ships, they must give 30 days notice to the C.D.C. before starting test cruises and will have to apply for a conditional sailing certificate 60 days before a planned regular voyage.
Norwegian Cruise Line, one of the industry’s biggest operators, submitted a letter to the C.D.C. on Monday outlining its plan to resume cruises from U.S. ports in July, which included mandatory vaccination of all guests and crew. The company said that its vaccination requirement and multilayered health and safety protocols exceeded the agency’s Conditional Sailing Order requirements.