Covid-19 Updates: F.D.A.’s Vaccine Approval Leads Pentagon and Others to Add Requirements

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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.

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.CreditCredit…Carl Court/Getty Images

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.

And Disney World said unions representing more than 30,000 employees had agreed to a mandate, citing the F.D.A.’s full approval, that would require workers to be vaccinated by Oct. 22.

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 Murphy-Marcos contributed reporting.

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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.

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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.CreditCredit…Stefani Reynolds for The New York Times

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 is sure set off a cascade of vaccine requirements by hospitals, colleges, corporations and others. The Pentagon responded immediately, with Lloyd J. Austin III, the defense secretary, poised to send guidelines to the country’s 1.4 million active-duty service members requiring that they be vaccinated, the Biden administration said on Monday.

Oregon has adopted a vaccine requirement for all state workers, as have universities in Louisiana and Minnesota. And in New York City, Mayor Bill de Blasio said on Monday that all education department employees would have to be vaccinated by Sept. 27, without the option of submitting to coronavirus testing instead

The F.D.A. approval comes as the fight against the pandemic has intensified again in the United States, with the highly infectious Delta variant drastically slowing the progress the country had made in the first half of the year. There are now an average of around 150,000 new cases a day in the United States and more than 90,000 hospitalized Covid-19 patients.

In a brief speech on Monday, President Biden said he hoped the approval would prompt many of the roughly 85 million Americans who are unvaccinated and eligible for shots to get them.

Dr. Janet Woodcock, the drug administration’s acting commissioner said in a statement that “we recognize that for some, the F.D.A. approval of a vaccine may now instill additional confidence to get vaccinated.”

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

But pollsters and other experts warned that the 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.

Some experts have estimated that full approval might convince just 5 percent of those who are unvaccinated to get shots. If so, “that’s still a huge slice of people,” said Dr. Thomas Dobbs, the chief health officer for Mississippi.

In his remarks, Mr. Biden acknowledged that the death rate, now averaging about 1,000 new deaths a day, had climbed, but he said the toll was still far lower than what it was last winter because most older people had been vaccinated. He also tried to reassure anxious parents about the growing numbers of children who had been infected with the Delta variant, saying that severe Covid cases among children were still “very, very rare.”

The vaccine will continue to be authorized for emergency use for children 12 to 15 while Pfizer collects the data required for full approval. A decision on whether to authorize the vaccine for children under 12 could be at least several months away, and Dr. Woodcock said such children should not get a Covid-19 vaccine in the meantime.

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

Pfizer said it had presented the F.D.A. with data from 44,000 participants from clinical trials 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, a slight drop from the 95 percent efficacy rate reported when the agency authorized the vaccine for emergency use in December.

Dr. Peter Marks, the F.D.A.’s top vaccine regulator, said the agency had finished its review 97 days after Pfizer filed the required data, or about two-fifths the normal time for such an evaluation.

He said that while the F.D.A. had approved the vaccine “expeditiously,” it had done so “fully in keeping with our existing high standards for vaccines in the U.S.”

Federal health agencies will continue to monitor the vaccine’s safety, Dr. Marks said, and the F.D.A. will require Pfizer to keep studying 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. In June, the F.D.A. attached warnings to the Pfizer-BioNTech and Moderna vaccines noting a potential for increased risk of the conditions after a second dose.

Health experts and state officials welcomed the approval. Dr. Richard Besser, the president of the Robert Wood Johnson Foundation and the former acting director of the Centers for Disease Control and Prevention, said it “could not come at a more important time,”

Vaccination rates have already been rising lately, likely in part because of growing fears about the Delta variant’s spread. Mr. Biden said that more people in Alabama, Arkansas, Louisiana and Mississippi — all states being ravaged by the Delta variant — had gotten first shots in the past month than in the previous two months combined.

The next major vaccine decision looming for the F.D.A. involves whether to authorize booster shots, which federal officials have strongly discouraged people from seeking until regulators decide they are safe and effective.

The Biden administration said last week that starting Sept. 20, pending regulatory approval, it planned to offer third shots to adults who had gotten their second injection of Pfizer and Moderna vaccines eight months earlier. Third shots are already authorized for some people with immune deficiencies.

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.

Correction: 

An earlier version of this item misstated the name of the organization led by Dr. Richard Besser. It is the Robert Wood Johnson Foundation, not the Robert Wood Foundation. 

Correction: 

An earlier version of this item misstated the name that the Pfizer-BioNTech coronavirus vaccine is now free to be marketed under. It is Comirnaty, not Comiraty.

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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.

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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.CreditCredit…Stephanie Keith for The New York Times

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.

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Hawaii Governor Urges Tourists to Stay Away as Coronavirus Surges

Gov. David Ige of Hawaii asked visitors not to travel to the islands unless it is for essential business purposes, as high numbers of coronavirus cases strain the state’s hospitals.

We are seeing more Covid patients in our hospitals and the I.C.U.s are filling up. We need to take action now in order to reduce the spread of Covid and ensure that our hospitals are not overrun. I did ask everyone, residents and visitors alike, to reduce travel to Hawaii to essential business activities only. We do know that it is not a good time to travel to the islands. Restaurant capacity has been restricted. There is limited access to rental cars and we know that the visitors who choose to come to the islands will not have the typical kind of holiday that they expect to get when they visit Hawaii. Our call to reduce travel to the islands to only essential businesses will have an impact on the numbers who have come here. But I also would like to point out that our hospitals are at capacity, our I.C.U.s are full. We are working on surge plans at every facility to expand capacity. We’re transitioning acute care beds to be able to support those who are sick. And so I do know that that’s a risk. But I believe that as a community, that’s a risk we have to take to discourage travel to the islands until we can get to a better place with our health care facilities.

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Gov. David Ige of Hawaii asked visitors not to travel to the islands unless it is for essential business purposes, as high numbers of coronavirus cases strain the state’s hospitals.CreditCredit…Michelle Mishina Kunz for The New York Times

Facing a surge of Covid-19 cases that is straining hospitals, Gov. David Ige of Hawaii asked tourists to stay away.

“It’s not a good time to travel to the islands,” he said. “The visitors who choose to come to the island will not have the typical kind of holiday that they expect to get when they visit Hawaii.”

The governor’s remarks came at a news conference on Monday after the island of Oahu said it was imposing tighter restrictions on gatherings.

Starting Aug. 25, indoor gatherings of more than 10 people and outdoor gatherings of more than 25 will be prohibited in Oahu, Mayor Rick Blangiardi said. The new rule will apply 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.”

The governor said he fully supported the actions that Oahu had taken.

Since July 1, Hawaii has experienced a sharp rise in new cases. The state’s seven-day average of new case reports peaked at 729 a day on Aug. 19, more than double the state’s previous high last fall, according to a New York Times database. In the past two weeks, new cases increased by 37 percent in Honolulu County, and hospitalizations more than doubled.

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 of capacity, and youth sports can finish their seasons as long as parents spread themselves out as spectators.

Hawaii was the last state to expand vaccine eligibility to all adults. About 55 percent of the state population has been fully vaccinated so far.

At the news conference on Monday, officials said they were concerned about low vaccination rates in Oahu and the large number of young men and women with Covid-19 who were being treated in 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 any more patients and that emergency services were close to “maxed out.”

Although Oahu was acting to curb large gatherings, which appear to be fueling the current spread, officials emphasized that the best way to fight the virus was to get 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.”

Afghans camping outside the gates of the airport in Kabul on Sunday.
Credit…Jim Huylebroek for The New York Times

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.”

People getting the Pfizer vaccine at the University of Texas Rio Grande Valley in Brownsville, Texas, in June.
Credit…Verónica G. Cárdenas for The New York Times

The full federal approval on Monday of a coronavirus vaccine for people 16 and older appeared to clear the way for local officials, private businesses and others who want to impose vaccine requirements to do so in some states that have banned them.

By giving its formal blessing to the Pfizer-BioNTech vaccine, the Food and Drug Administration lifted it out of the emergency-use category and effectively put it on par with other vaccines required by public health authorities, universities, employers and others.

At least three states that banned vaccine requirements by law or executive order — Montana, Texas and Utah — did so specifically because the three vaccines in use in the United States were being administered under emergency-use authorizations, not full approval.

Now one of the vaccines has that approval, undercutting that justification and potentially setting the stage for more of the kind of legal battles that have erupted around the country over the bans, 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 Utah — where the Republican-led legislature passed a bill in March barring government entities from requiring a Covid-19 vaccine that was authorized for emergency use only — a spokeswoman for the state health department said the Pfizer-BioNTech vaccine should no longer be subject to the restrictions because it now had full approval. State legislative leaders did not immediately respond to a request for comment.

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.

The Carnival Vista docked in Galveston, Texas, in May. On a recent sailing, a passenger and crew members tested positive for the coronavirus; the passenger later died. 
Credit…Sipa, via Associated Press

As the highly contagious Delta variant of the coronavirus surges around the world, the health and safety protocols established by a cruise industry struggling to fight its way back from the pandemic are being put to the test.

In a grim example of the challenges facing cruise lines, 27 coronavirus infections were identified over two weeks in late July and early August aboard the Carnival Vista ship that had sailing out of Galveston, Texas.

One of the infected, Marilyn Tackett, a 77-year-old passenger from Oklahoma, later died.

Ms. Tackett’s death came about a week before the Centers for Disease Control and Prevention issued a new advisory, warning people with increased risk for severe illness from Covid-19 to avoid travel on cruise ships, regardless of their vaccination status.

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

The companies have responded to the recent increase in cases by introducing pre-departure testing requirements for all passengers. Carnival also added a mask mandate on Aug. 7 for all vaccinated and unvaccinated guests in indoor areas and banned smoking in the casino.

The cruise line had not tested vaccinated passengers before embarking.

Chris Chiames, a Carnival spokesman said in an interview that the company’s safety protocols were “designed to flex up and adapt.”“We never suggested our ships would be Covid free,” he continued. “But we designed our protocols to meet and exceed the guidelines of the C.D.C.”

Michael Bayley, Royal Caribbean’s chief executive, said the cruise line was typically seeing one or two positive cases out of more than 1,000 guests a week per ship. More than 90 percent of passengers were vaccinated, he said, and two to 10 had been prevented from boarding each week because they were tested beforehand as required and their tests came back positive.

But in a candid Facebook post, Mr. Bayley said: “Testing captures status at a point of time and if the guest is incubating infection, then the test will miss it.”

Some cruise lines say passengers have canceled amid concerns about the risks of the Delta variant, but many sailings are fully booked through the rest of year because of pent-up demand.

Many of those booking trips believe cruise ships are among the safest means of traveling during the pandemic because of how many passengers and crew members are vaccinated, as well as the testing requirements and safety measures that are strictly enforced on board.

“It’s very comforting boarding a cruise ship knowing that most people are vaccinated and everyone is tested,” said Aidan Alexander of Florida, 62. He has eight sailings booked through 2022. “When you get on a plane or stay in a hotel you don’t know anyone’s vaccination or Covid status and that makes it very difficult to relax and unwind.”

John Ioannidis, a Stanford University epidemiology professor a, disputed that. In an airport, on a plane or in a hotel, he said, “you only get exposed for a few hours, whereas on a cruise ship you could get exposed for many days and weeks. It’s a kind of cumulative exposure.”

Still, he added, the health and safety protocols adopted by cruise companies would most likely avert the major disasters and deaths seen in the initial stages of the pandemic last year

In the case of the Carnival Vista ship, the 27 infections were the highest number of cases aboard a ship reported since June, when cruises restarted in the Caribbean and United States, and Ms. Tackett’s was the first death.

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

Ms. Tackett was admitted to a hospital in Belize and put on a ventilator after experiencing respiratory complications. Days later, she was evacuated to a hospital in Tulsa, where she received treatment. On Aug. 14, though, her condition worsened and she died, according to a statement posted by her family online.

A health worker showing a box containing a bottle of Ivermectin, in Cali, Colombia, last year.
Credit…Luis Robayo/Agence France-Presse — Getty Images

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.

Chevron is the second-largest oil and gas producer in the United States.
Credit…Mike Blake/Reuters

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.

In a trial participants were given a booster shot at six months, and their antibodies against the coronavirus jumped nine times higher than after the first dose.
Credit…Robyn Beck/Agence France-Presse — Getty Images

A booster shot of the Johnson & Johnson vaccine dramatically raises the levels of antibodies against the coronavirus, the company reported on Wednesday.

Johnson & Johnson will submit the data to the Food and Drug Administration, which is evaluating similar studies from Pfizer and Moderna. If authorized by the agency, the Biden administration wants to provide booster shots eight months after vaccination.

The Johnson & Johnson vaccine was absent from the government’s initial booster plan, announced last week. But with the new data, the company hopes to be part of the initial distribution of additional shots, which could happen as early as September.

“We look forward to discussing with public health officials a potential strategy for our Johnson & Johnson Covid-19 vaccine, boosting eight months or longer after the primary single-dose vaccination,” Dr. Mathai Mammen, the global head of Janssen Research & Development at Johnson & Johnson, said in a statement.

In February, the F.D.A. gave emergency authorization to Johnson & Johnson for its one-shot vaccine. A clinical trial carried out last fall and winter showed that a single shot had a 72 percent efficacy in preventing symptomatic Covid-19 among U.S. participants. In the trial, none of the vaccinated volunteers were hospitalized or died.

Johnson & Johnson carried out its clinical trial before the Delta variant became widespread, leaving open the question of how well the vaccine worked against the highly contagious form of the virus. But in a study released earlier this month, South African researchers found that a single shot of the Johnson & Johnson vaccine was up to 95 percent effective against death from the Delta variant, and reduced the risk of hospitalization by 71 percent.

In its new study, Johnson & Johnson tracked 17 volunteers from last year’s clinical trial. Six months after vaccination, their level of antibodies had changed little.

That’s different than the pattern seen with the Moderna and Pfizer-BioNTech vaccines. Those shots initially produce higher levels of antibodies, but their levels then drop over several months.

When volunteers in the Johnson & Johnson trial were given a booster shot at six months, their antibodies against the coronavirus jumped nine times as high as after the first dose.

Studies on the Moderna and Pfizer-BioNTech vaccines found a comparable jump in antibody levels. Because the three vaccines were not tested in a head-to-head comparison, it’s not possible to determine which one provides the biggest boost.

Johnson & Johnson said that it had submitted a manuscript describing the research to the website Medrxiv. It has not been posted there yet.

Noah Weiland contributed reporting.

Judge Jed Rakoff in 2009.
Credit…Justin Maxon for The New York Times

Orders by New York judges — one in the Bronx and one in Manhattan — that two defendants appearing in their courts get vaccinated raise important questions about the line between civic responsibility and civil liberties, legal observers say, though neither defendant appeared to object.

A number of experts who reviewed the orders disagreed as to whether they were justified, or whether one or both could represent an overstep — a debate that underscores the legal and ethical complications that have emerged around vaccination requirements.

In one case, Judge Jeffrey Zimmerman, 61, of the Bronx County criminal court, explained that the defendant, William Gregory, had been accused of crimes — including drug possession, criminal trespass, shoplifting and criminal contempt — that showed he had placed his own interest above others’. In getting the vaccine, the judge argued, Mr. Gregory would be doing the opposite, and so vaccination would represent a form of rehabilitation.

The second order came from a federal judge in Manhattan, Jed S. Rakoff, who granted the release of a defendant, Elouisa Pimental, who was charged with conspiracy to distribute fentanyl, on the condition that she get vaccinated.

Judge Rakoff argued that it fell to him to determine whether a person seeking release represented a danger to their community. The unvaccinated, he wrote, did pose such a danger, given their “enhanced risk of infecting other, innocent people and even potentially causing their deaths.”

Judges have broad discretion in placing restrictions on people who are accused of crimes. It is not unusual for them to limit whom defendants talk to, where they go, even how frequently they use the internet. And judges do often order defendants to proactively engage in certain behaviors, such as receiving counseling or taking certain prescribed medications.

But the power of judges is not unlimited. Nadine Strossen, a professor at New York Law School who led the American Civil Liberties Union from 1991 to 2008, said that in order to fight a vaccination directive, a lawyer would have to demonstrate that a judge had abused his or her discretion.