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Despite mounting anticipation for the decision, the percentage of parents who will get their young children vaccinated is likely to be low compared to other age groups. A survey from February found that 31% of parents of children in the age range will get their kid vaccinated right away if a vaccine is authorized.

The decision has to come this month “because of the time required for manufacturing the necessary doses,” three of FDA’s top officials – FDA Commissioner Robert Califf, vaccine expert Peter Marks and principal deputy commissioner Janet Woodcock – wrote in a paper published by the journal JAMA in May.Both Pfizer and Moderna are studying vaccines designed to combat omicron and other strains. However, data on the shots remains scarce.

Clinical data from Moderna’s shot is expected this month, according to the company. Moderna in April released findings to support its booster shot development strategy, but the data comes after research in animals suggested the omicron-specific shot might not provide additional protection. A study from scientists at the National Institutes of Allergy and Infectious Diseases’s Vaccine Research Center found that primates boosted with the original vaccine had similar levels of protection as monkeys who got an omicro

The Biden administration has warned of potential fall and winter surges infecting up to 100 million Americans as it gears up for a fall booster shot campaign, whether that is with an omicron-specific shot or not. The FDA authorized a fourth vaccine dose for people ages 50 and older in March, and expanding the shot to more age groups is under consideration.“Administering additional COVID-19 vaccine doses to appropriate individuals this fall around the time of the usual influenza vaccine campaign has the potential to protect susceptible individuals against hospitalization and death, and therefore will be a topic for FDA consideration,” the officials wrote.In fact, the officials said that coronavirus booster shots could be on their way to becoming a yearly occurrence.

It is time to “accept that the presence of SARS-CoV-2, the virus that causes COVID-19, is the new normal,” according to the officials.“It will likely circulate globally for the foreseeable future, taking its place alongside other common respiratory viruses such as influenza,” they wrote.But paying for the shots remains an issue for the Biden administration as Congress shows little appetite for approving more COVID-19 funding.

Immunizing children will help schools to reopen as well as help to end the pandemic, said Dr. Emily Erbelding, an infectious diseases physician at the National Institutes of Health who oversees testing of Covid-19 vaccines in special populations.

Children under 18 account for about 23 percent of the population in the United States, so even if a vast majority of adults opt for vaccines, “herd immunity might be hard to achieve without children being vaccinated,” Dr. Erbelding said.

Scientists will test three doses of the Pfizer vaccine — 10, 20 and 30 micrograms — in 144 children. Each dose will be assessed first in children 5 through 11 years of age, then in children ages 2 through 4 years, and finally in the youngest group, six months to 2 years.

“It sounds like a good plan, and it’s exciting that another Covid-19 vaccine is moving forward with trials in children,” said Dr. Kristin Oliver, a pediatrician and vaccine expert at Mount Sinai Hospital in New York.

More than 3.3 million children have tested positive for the virus, at least 13,000 have been hospitalized and at least 260 have died, noted Dr. Yvonne Maldonado, who represents the American Academy of Pediatrics on the federal Advisory Committee on Immunization Practices.

Children often react more strongly to vaccines than adults do, and infants and toddlers in particular can experience high fevers.

“But this is a little different, because we’ve already had experience with tens of millions of people with these vaccines,” Dr. Maldonado said. “So there’s a higher degree of confidence now in giving this vaccine to kids.”

Parents will want to know how the companies and the F.D.A. plan to monitor and disclose side effects from the vaccines, and how long they will continue to follow trial participants after the vaccines’ authorization, Dr. Oliver said.

Consider a slice of Florida’s seniors, ages 65 to 74, who have been eligible for vaccination for four months. Almost all seniors in the state’s wealthiest county, St. Johns, have been vaccinated. (The numbers may be inflated because of seasonal residents, or snowbirds, who aren’t necessarily counted as part of the county’s population but are still counted among people getting vaccinated there.) But the first county west of St. Johns is one of the state’s poorest: Putnam, where the median annual income is about $35,000. Only half of the county’s residents ages 65 to 74 have been vaccinated.

The reasons are myriad: The state’s rollout has been deeply reliant on tech savviness and reliable transportation to secure and then get to vaccination appointments, said Dr. Frederick Anderson, who runs a community health clinic at Florida International University’s medical school. Additionally, some of the current vaccines are difficult to store and transport, which makes vaccine rollout easier in population hubs, which tend to be wealthier.

When eligibility is expanded in other states, vaccinations are expected to surge among the wealthiest Americans and lag among the poorest.

“The rural counties are lagging slightly behind what we would expect,” said Dave Jeppesen, the director of Idaho’s health department, in a news conference Wednesday.

Nationally, many conservatives — men in particular — have said in multiple polls that they do not wish to be vaccinated. In some of Idaho’s more conservative counties, senior vaccination rates are below 40 percent.

If that's the case, it will take more than just opening up eligibility to get the country to levels of vaccination that can reach herd immunity — when roughly 70 percent of people are vaccinated, making it too difficult for the virus to spread.

In the Northeast, where case counts are on the rise, adults will be able to register for appointments starting April 1 in Connecticut and April 2 in New Hampshire. On the opposite coast, California announced Thursday that adults ages 50 and older will be eligible for appointments starting April 1, with individuals 16 and older to follow on April 15.Other states are moving to make more groups eligible ahead of schedule, based on age or underlying conditions.

More states will join that list in the coming days. Starting March 29, for example, eligibility will expand to all adults in places like North Dakota, Louisiana, Ohio and Texas. Minnesota and Indiana will similarly expand access before the end of the month.

Alaska became the first state to make vaccinations available to all adults over the age of 16 earlier this month, followed by Mississippi. Several others have since followed suit, including Arizona, Utah, Indiana, Georgia and West Virginia.

New Jersey's governor said on Friday that people ages 55 and older, individuals over the age of 16 with intellectual and developmental disabilities, higher education employees and other essential workers will qualify starting April 5. Floridians ages 40 and older will be eligible beginning March 29, officials announced Thursday.

According to a map released by the White House COVID-19 Response Team on Friday, four states have yet to confirm plans to expand eligibility ahead of the May 1 deadline: New York, Wyoming, Arkansas and South Carolina, where officials have said they are not on track to hit that threshold until May 3.

Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said at the briefing that the country has seen an uptick in case counts and hospital admissions, with the most recent 7-day averages showing about 57,000 cases and 4,700 hospitalizations per day, and hospitalizations hovering around 1,000.

Noting the trajectory with concern, she implored listeners to "take this moment very seriously" and continue following public health guidance.

Friday's announcement comes a day after Biden declared a new goal of getting 200 million shots in arms by his 100th day in office, or the end of April. Federal officials said the country hit his initial target of 100 million doses last Friday, which was his 58th day in office.

The U.S. is administering 2.5 million shots a day at its current pace, Zients said, adding that vaccine makers are "setting and hitting targets." Some 27 million doses went to states, tribes and territories this week.

Johnson & Johnson has accelerated production of its single-shot vaccine and is on track to deliver 11 million doses next week. Zients expressed confidence that it will, and, in doing so, meet its goal of 20 million doses for the month of March.

Alaska has received 288,000 vaccines and has vaccinated 170,993 people, according to state data.

Dunleavy said some regions in the state, including Kodiak Island, the Petersburg Borough and the Kusilvak Census Area, are nearing or exceeding 90% vaccination rates among seniors

As of Tuesday morning, more than 123 million vaccine doses had been distributed to states. More than 93.6 million shots had been administered, according to the Centers for Disease Control and Prevention's COVID-19 vaccine data tracker.

Alaska on Tuesday became the first state in the nation to make COVID-19 vaccinations available to anyone over the age of 16 who lives or works in the state.

Alaska Gov. Mike Dunleavy called the vaccination expansion a "game changer." He said eligibility requirements for the vaccinations are dropped, effective immediately.

As of Tuesday morning, more than 123 million vaccine doses had been distributed to states. More than 93.6 million shots had been administered, according to the Centers for Disease Control and Prevention's COVID-19 vaccine data tracker.

Dunleavy said some regions in the state, including Kodiak Island, the Petersburg Borough and the Kusilvak Census Area, are nearing or exceeding 90% vaccination rates among seniors. The Nome Census Area, with a population slightly over 10,000, has had more than 60% of residents age 16 and over receive at least one shot, he said.

"I do believe that the US is obligated to share vaccines with other countries," said Keisha Ray, an assistant professor and bioethicist at UTHealth McGovern Medical School in Houston, "especially those countries we might consider poorer countries or what we call underdeveloped countries."

From an ethical perspective, everyone should have access to protection from Covid-19, Kathy Kinlaw, associate director for Emory University's Center for Ethics, told CNN.

many countries lack vaccine access because of the "diminished purchasing power for healthcare in general, but also for Covid-19 treatments and vaccin

"I think the United States is definitely in a position where we should be sharing, absolutely,"

The US is not simply obligated to share vaccines by virtue of its resources, Ray said. Wealthier countries like the US have historically benefited by hindering other countries, she said, whether through government relations or colonialism.

"Now we are in a position to give back, we are in a position to go there and help these countries," she said, like "paying our debt." All three agreed it was right for the US to control its virus outbreaks before sharing vaccines. The pandemic is still an issue in the US, Ray said, but conditions have improved greatly.

"You need to stabilize your own nation before you assist others," he said. "And I think we're there. I think we're getting there now."

One factor in deciding to release extra vaccines is the issue of supply and demand -- specifically, that the former will soon outstrip the latter in the US, Kinlaw said. And that could mean it's time to start shipping spare doses overseas, she said.

"Once this happens," the report said, "efforts to encourage vaccination will become much harder, presenting a challenge to reaching the levels of herd immunity that are expected to be needed."

The US needs to continue to address vaccine hesitancy at home and be responsive to peoples' concerns, Kinlaw said. "But certainly there could be a point where there are people who will not take the vaccine and we have extra vaccine in this country, in which case it should be used and shared."

Data from the US Centers for Disease Control and Prevention shows that 30% of the US population is fully vaccinated. Experts like Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, have estimated the US needs between 70% and 85% of the country to be immune -- either through vaccination or prior infection -- to reach herd immunity.

"The world's wealthiest nations have locked up much of the near-term supply," wrote Dr. Krishna Udayakumar and Dr. Mark McClellan, health experts at Duke. "At the current rate vaccines are being administered, 92 of the world's poorest countries won't vaccinate 60% of their populations until 2023 or later."

"That is an education, a public outreach and an access issue," she said. "We have other hurdles that are not supply hurdles. So we do have the supply to help other countries."

"Epidemiologically, we should be working to suppress the virus and to decrease transmission and decrease the continue evolution of the virus and the variants," she said. "That is going to be beneficial to every single person."

But vaccinations everywhere could also present economic benefits, Kinlaw said, allowing people to travel more freely and conduct business around the world.

"One of the ethical challenges is, are we going to insist on fair distribution within those countries? Or are we just going to give them vaccine and let them give it to the military and elite?" he said.

"It sounds nice to say we're going to aid others, but its simplistic, because some governments are corrupt," he said. "Some governments have no distribution plan other than to give it first to their own leaders, rather than to those in need."

Yet in many states, there are racial disparities in who has received the shot.

Boyd says there's evidence that Blacks will seek out vaccines when they have access to them.

Blacks are 26% of the population but they've made up only 16% of COVID-19 vaccinations so far

NPR identified disparities in the locations of vaccination sites in major cities across the South — with most sites placed in whiter neighborhoods. NPR found that the health care locations likely to be used to distribute a vaccine tend to be located in the more affluent and whiter parts of town where medical infrastructure already exists.

Boyd, who wrote about the lack of health care access for Blacks in a recent New York Times op-ed, urges expanding the network of health care services and placing primary care clinics "right in Black communities." She also calls for making "going to the doctor in the United States free.

1 out of 5 Black adults are unlikely to have a regular provider. They don't have somebody that they go to who they trust for their clinical care. We also know Black folks have some of the highest rates of uninsured and underinsurance,"

Back in the 1990s, our federal government said let's eliminate cost as a barrier to vaccination for children. And they created the Vaccines for Children program. ... By 2005, there were no gaps between Black children and other racial and ethnic groups for receipt of regularly recommended vaccines like MMR and polio.

Boyd and other Black health care workers and researchers created a campaign, called The Conversation: Between Us, About Us, to educate Blacks about COVID-19 vaccines.

"We knew that there were already baseline information gaps about how vaccines work and particular concerns that folks in the Black community had about this vaccine's development and their safety,"

"So we put together a campaign to actually tackle that misinformation so that when folks make the choice about vaccination, they can make an informed one."

She says the perception that Blacks are hesitant to get a COVID-19 vaccine has its roots in racial inequity.

"We say the reason that you have higher rates of diabetes or higher rates of heart disease is your own individual choices. You know, your cultural choices to choose what to eat shapes your disparity rather than the structural environment around you that might place you in a food desert.

"I think in health care we have had an analysis of what drives racial health inequities that centers on individuals rather than on our systems. And that has led us not to really confront racism as a cause of racial health inequities, including right now during the vaccine distribution."

France is aiming to give 15 million people two vaccine doses by July 1, though it has placed orders for enough doses to vaccinate 27 million by then, officials said.

The French authorities are facing a population that is among the world’s most skeptical of vaccines. In a global Ipsos poll conducted in December, just 40% of French respondents said they wanted the vaccine, the lowest acceptance rate among the poll’s 15 countries, which also included the U.S., Germany and China.

On Wednesday, about 61,000 people were vaccinated, according to government figures. Italy must vaccinate about 300,000 people a day until April 1 to reach the government’s goal of having 13 million of the country’s 60 million residents vaccinated with the second shot at that point.

The European Commission is in talks with Pfizer to buy additional doses, on top of the existing order of 300 million doses that would inoculate a third of the bloc’s 450 million people. The commission has also preordered 160 million doses of Moderna Inc.’s vaccine, which the EU’s main drug regulator cleared for use on Wednesday.

Two important factors seem to be playing a role in Brazil’s resurgence. The first is that, after a COVID-19 infection, the natural immunity that our bodies develop seems to vary in strength and permanence. Protection wanes after infection with most respiratory viruses, including coronaviruses

the variant in Brazil, known as the P.1 (or B.1.1.248) lineage, has a potent combination of mutations. Not only does this variant seem to be more transmissible; its lineage carries mutations that help it escape the antibodies that we develop in response to older lineages of the coronavirus.

it at least has a capacity to infect people who have already recovered from COVID-19, even if their defenses protect them against other versions of the virus.

The mutations that help the virus spread and evade immune responses have arisen independently in multiple places. Combined with waning immunity, these factors underscore the challenge before the world: Populations may still be vulnerable to disaster scenarios just when things seem to be getting better.

the virus’s capacity to cause such a deadly second surge in Brazil suggests a dangerous evolutionary potential.

New, dangerous variants are all but inevitable when there are extremely high levels of transmission of the virus. As more people gain immunity, the selective pressure on the virus will favor the variants that can most effectively evade immune responses

the basic nature of evolutionary biology means that the virus should be expected to evolve in ways that circumvent defense mechanisms. Evidence that it is already doing so has been clear in the latest vaccine trial data.

The solution, then, depends on vaccination. The immune response that the vaccines create is generally more robust than the immune response we get after being infected by a virus, and should buy a population more protected time than would a surge in exposure to the virus

Wealthy countries have time to avoid a fate like Brazil’s through immediate, efficient vaccination.

In most places, however, this is not close to happening. And as of last week, only one of the world’s 29 poorest countries had vaccinated anyone at all. A study in the journal BMJ estimated that vaccines will not be available to more than a fifth of the world’s population until 2022.

The coronavirus’s constantly evolving nature is a stark reminder that the entire world is in this crisis together.

Vaccine distribution is more than just an issue of justice or morality

Ensuring that every human is vaccinated is in everyone’s interest, as global distribution of vaccines is the most effective way to drive down the virus’s capacity to replicate and evolve.

The key will be bringing down the global rates of transmission as quickly as possible—not getting any single country to 100 percent vaccination while dozens of countries roil.

“It is truly confounding that wealthier nations think that hoarding vaccines is the way to protect their citizens from a global pandemic that doesn’t respect borders,”

As the virus currently surges across Africa, some 2.5 million health-care workers are unvaccinated. “Clearly, the failure to address vaccine allocation based on health and epidemiological needs, rather than national interest, is now promising to have a dire impact on the world’s ability to achieve rapid, global control of COVID,”

Certain countries will approach herd immunity by vaccinating almost every citizen. Other countries could see mass casualties and catastrophic waves of reinfection—potentially with variants that evolved in response to the immunity conferred by the very vaccines to which these populations do not have access. In the process, these hot spots themselves will facilitate rapid evolution, giving rise to even more variants that could make the vaccinated populations susceptible to disease once again

The countries that hoard the vaccine without a plan to help others do so at their own peril.

Beaumont Health, which operates several hospitals in the Metro Detroit area, had recently announced plans to offer residents 65 and older vaccinations, and about 25,000 people tried to gain access to the online portal simultaneously

Both of the vaccines being used across the country require patients to receive two doses spaced weeks apart, so the process of administering second shots to Americans has only just begun.

Even in states where online registration seemed to go well, some people were stuck with long waits.

At least 151,000 people in the United States have been fully vaccinated against Covid-19, according to a New York Times survey of all 50 states.

County officials had said they would have a limited number of slots for people 65 and older. The available slots were filled in 20 minutes,

Some states, including Florida, Louisiana and Texas, have already expanded who is eligible for the vaccine, even though many in the first priority group recommended by the Centers for Disease Control and Prevention — health care workers and residents of nursing homes and other long-term care facilities — have not yet received a shot.

about 6.7 million people had received a first dose of a vaccine. That falls far short of the goal federal officials set to give at least 20 million people their first shots before the end of 2020.

On Friday, the transition team for President-elect Joseph R. Biden Jr. announced a plan to accelerate vaccinations that includes reversing course and releasing nearly all available doses. That would provide more people with first doses but raise the risk that second doses would not be administered on time; however, ramped up vaccine production is expected to keep enough in the pipeline for timely second doses

The tally of fully vaccinated people is an undercount because some states did not provide that information.

Some states’ expansions have led to frantic and often futile efforts by older people to get vaccinated. After Florida opened up vaccinations to anyone 65 and older last month, the demand was so great that new online registration portals quickly overloaded and crashed, people spent hours on the phone trying to secure appointments and others waited overnight at scattered pop-up sites offering shots on a first-come first-served basis.

Vaccines alone will not be enough to get ahead of the virus: It will take years to inoculate enough people to limit its evolution. In the meantime, social distancing, mask-wearing and hand-washing — combined with aggressive testing, tracking and tracing — might buy some time and avert devastating spikes in hospitalizations and deaths along the way.

The rapid spread of the new variants is a reminder of the failings and missteps of major countries to contain the virus earlier.

Dr. Anthony S. Fauci, the top U.S. infectious disease expert, told performing arts professionals at a virtual conference on Saturday that he believed that theaters and other venues could reopen “some time in the fall of 2021,” depending on the vaccination rollout, and suggested that audiences might still be required to wear masks for some time.

A week after the first case of a highly contagious coronavirus variant first identified in Britain was found in New York, Gov. Andrew Cuomo announced Saturday that the state had found three additional cases.

The other case appears to be unrelated to those to Saratoga Springs and was traced back to a man in his 60s living in Massapequa, in Nassau County, Mr. Cuomo added. The man first tested positive for the coronavirus on Dec. 27.The travel history of those who tested positive for the variant in New York was unclear.

Pope Francis said in a soon-to-be-televised interview that he would be vaccinated against the coronavirus as early as next week, calling it a lifesaving, ethical obligation and the refusal to do so suicidal.

On Saturday, 1,035 people died of the coronavirus in Britain, a day after health officials reported the highest daily death toll since the pandemic started, with 1,325 deaths. Britain has been the worst-hit country in Europe, with nearly 80,000 deaths.

In a separate decision put in effect Thursday, face masks, long deemed ineffective by Swedish health officials, are now being recommended for use during rush hour on public transport, although they will not be mandatory.

On Friday, Britain suffered its deadliest daily toll since the beginning of the pandemic, with 1,325 deaths. On Saturday, the toll was 1,035 lives.— Elian Peltier

Vaccinations have risen sharply in children 12 years and older, weeks after the Food and Drug Administration said that cohort is eligible to receive the COVID-19 vaccine made by Pfizer-BioNTech. Nearly 5 million adolescents have received at least one dose of the vaccine, according to the CDC's latest data.

President Biden said this month that his new goal is to administer at least one dose of a COVID-19 vaccine to 70% of U.S. adults by the Fourth of July.

Acknowledging the welcome return to a more normal life taking place around the country, he urged more people to get the vaccine: "Unless you're vaccinated, you're at risk."

An increasing number of states, businesses and organizations are offering incentives for people to get vaccinated, from free doughnuts to free airline flights. One of the best-known programs is in Ohio, where people who get vaccinated are entered into a $1 million lottery called the Ohio Vax-a-Million.

Ohio's vaccination rate went up 55% among young adults in the days after unveiling the program.

The U.S. has reported more than 33 million COVID-19 cases, and more than 590,000 people have died from the disease.

The lowest overall vaccination rates in the U.S. remain in the South, where Mississippi, Alabama, Louisiana and Arkansas have administered the fewest doses per 100,000 adults, according to the CDC. The highest rates are in Vermont, Massachusetts, Hawaii and Connecticut.

“We need vaccinators, people who put the shots in people’s arms.”

The White House says options to find vaccines nearby, both online and by phone, will launch by May 1 to make it easier for individuals to make vaccine appointments.

On April 13 the FDA and CDC recommended pausing use of the J&J vaccine "out of an abundance of caution" due to reports of a rare combination of blood clots and low platelet counts in some people who received the vaccine

which use a different vaccine technology.

“I think the real range is somewhere between 70 to 90 percent,

Biden suggested that by July 4,

 New strains of the virus could emerge or become dominant, reducing efficacy of the vaccines

Mr. Biden asked President Andrés Manuel López Obrador of Mexico in a video call this month whether more could be done to help solve the problem, according to Mexican officials and another person briefed on the conversation.

Mexican officials acknowledge that relations between the United States and Mexico, which has suffered one of the world’s deadliest coronavirus epidemics, would be buoyed by a shipment of doses south.

Several European countries suspended use of the AstraZeneca vaccine this week, a precaution because some people who had received the shot later developed blood clots and severe bleeding.

Until Thursday, all of Canada’s vaccine supply had come from Europe or India, and Canada’s roll out has proceeded at a slow pace compared with the United States and many other countries.

A Biden administration official declined to comment further on the negotiations with Mexico, but noted that both countries shared a common goal of reducing migration by addressing its root causes, and said they were working closely to stem the flow of people streaming to the border.

But on Thursday, Europe’s drug regulator declared the vaccine safe. AstraZeneca has also said that a review of 17 million people who received the vaccine found they were less likely than others to develop dangerous clots.

The Biden administration’s appeal to do more against migration has put Mexico in a difficult position. While Mr. Trump strong-armed Mexico into militarizing the border, some Mexican officials argue that his harsh policies may have at times helped lessen their load by deterring migrants from attempting to make the journey north.

Many Canadians have expressed dismay that the United States had not shared any supplies with Canada, where no coronavirus vaccines are manufactured.

Mexico has agreed to increase its presence on its southern border with Guatemala to deter migration from Central America, one of the government officials said,

Beijing is shipping vaccines to dozens of countries, including some in Africa and Latin America. Russia has supplied its vaccine to Hungary and Slovakia.

Local government officials in Ciudad Juárez and shelter operators say Mexico is dialing up operations to capture and deport migrants along the northern border.

Despite the very public tensions with Mexico under Mr. Trump, Mr. López Obrador has been wary of the Biden administration, concerned that it might be more willing to interfere on domestic issues like labor rights or the environment.

The need for vaccines in Mexico is clear. About 200,000 people have died in the country from the virus — the third highest death toll in the world — and it has been relatively slow to vaccinate its population.

“Mexico needs cooperation from the U.S. in getting its economy jump-started and getting vaccines to get out of the health crisis,” said Andrew Selee, president of the Migration Policy Institute in Washington.

A cascade of countries — Italy, France and Spain — soon joined the decision to suspend AstraZeneca, dealing a significant blow to Europe’s already shaky inoculation drive despite a lack of clear evidence that the vaccine had caused any harm.

“There is an emotional situation that is the fallout from this case that started in Germany,” Giorgio Palù, the president of Italy’s Medicines Agency said on Tuesday. He said: “There is no danger. There is no correlation at the epidemiological level.”

The agency’s director was more explicit.

But for now, the suspensions seem certain to have had the opposite effect, further delaying Europe’s stumbling rollout and perhaps putting at risk hundreds or thousands more lives.

goal of vaccinating 70 percent of residents by September, and raise pressure on governments to secure vaccines that have not yet been authorized by the bloc’s regulators.

Suspending use of the vaccine is a “temporary precaution” while countries wait for the European Medicines Agency’s assessment, the statement said.

But Monday’s decisions may have already set back Europe’s vaccination campaign at a perilous moment of the pandemic, as the continent confronts a third wave of infections driven by new variants.

It is not yet known whether those conditions were related to vaccines, either.

European countries have not been weighing a decision about just any vaccine. Their concerns center on AstraZeneca, a company with which they have had poisonous relations since it drastically scaled back projected vaccine deliveries for the early part of 2021.

That decision may come back to haunt European lawmakers: Britain, which has given the vaccine to all adults, has since showed that a first dose substantially reduced the risk of older people becoming ill with Covid-19.

Just as European Union member states broke with the bloc’s centralized drug regulator in initially restricting the vaccine to younger people, they split with regulators a second time in pausing rollouts altogether this week. Analysts said that reflected a growing impatience with the bloc’s bureaucracy in the midst of a disastrously slow vaccine rollout.

There was a case of thrombosis detected in Spain last weekend, and some regions had stopped distributing a batch of AstraZeneca vaccines, amid safety concerns.

But the chief motivation was political.

When Mr. Speranza brought the issue to Prime Minister Draghi, he noted the unbearable public pressure Italy would face if it alone used a vaccine considered too dangerous for Europe.

As the damage of the delays became clear on Tuesday, European officials tried to play down the disruption. They said they were only waiting for European regulators to complete a fast review of the problems before they began vaccinating people with the AstraZeneca shot again.

“It’s right regulators investigate safety signals,” said Michael Head, a senior research fellow in global health at the University of Southampton. “But pausing a vaccine rollout during a pandemic, when there’s a lot of Covid-19 around, is quite a dramatic decision to make — and I’m not seeing why you would do it.”

The hesitancy has national implications. Experts say between 70 percent to 90 percent of all Americans must be vaccinated for the country to reach herd immunity, the point at which the virus can no longer spread through the population.

A closer look at Mississippi’s demographics explains why hesitancy may be especially pronounced.The state reliably votes Republican, a group that remains highly skeptical of the coronavirus vaccine. Nearly half of all Republican men and 40 percent of Republicans over all have said they do not plan to get vaccinated, according to several recent surveys. Those figures have barely budged in the months since vaccines first became available. By contrast, just 4 percent of Democrats have said they will not get the vaccine.

A number of other heavily Republican states are also finding themselves with surfeits of doses. On Thursday, officials in Oklahoma, which has delivered at least one dose to 34 percent of its residents, announced they would open up eligibility to out-of-state residents, and in recent weeks, Republican governors in Ohio and Georgia voiced concern about the lackluster vaccine demand among their residents.

“I had about 18 hours of turbulence,” Governor Reeves said, describing the mild, flulike symptoms he had felt after his second injection. “But I was able to continue and move on and work, and I feel much better waking up every day knowing that I have been vaccinated.”

Demand among African-Americans was still robust, she said, noting long lines that formed this week outside a tent in Indianola, a small city in the Delta, where the single-dose Johnson & Johnson vaccine was being offered. (The tents offering the Pfizer and Moderna vaccines, which require two doses, were nearly empty.)

“By relaxing Covid restrictions, elected leaders in states like Florida, Mississippi, Texas and Georgia are pushing narratives about coronavirus that are working against a narrative that promotes the urgency of vaccinations,” he said. “And unfortunately, our vaccine campaigns are being undone late at night by Facebook and Twitter and Instagram.”

Michael Pratt, a spokesman for Operation Warp Speed, also denied the notion the reserve was "exhausted" in a statement to CNN.

"It's just so disappointing," he added. "People are desperate for the vaccine, and we have worked so hard to be able to expand who's eligible, and to not be able to do it is just crushing right now."

Oregon Health Director Patrick Allen, in a letter to Azar in which he recounted a call with Brown and Operation Warp Speed CEO Gen. Gustave Perna on Thursday, demanded that the HHS chief reconcile his statement about "releasing the entire supply" with this revelation.

"I do not believe I misunderstood," Allen said. Allen confirmed that Oregon will have to delay its plan to start vaccinating seniors January 23, since no surge in vaccine is coming.

"I am demanding answers from the Trump Administration. I am shocked and appalled that they have set an expectation on which they could not deliver, with such grave consequences," Oregon Gov. Kate Brown, a Democrat, tweeted Friday. "This is a deception on a national scale. Oregon's seniors, teachers, all of us, were depending on the promise of Oregon's share of the federal reserve of vaccines being released to us."

Vaccine maker Pfizer says it has second doses of coronavirus vaccines ready to ship as needed.

"We are hearing there is not a stockpile of vaccine for second dose but that it was more of a 'paper exercise,' " said Dr. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials. "The stockpile appears to be all on paper; they were tracking anticipated need but not actually holding back product."

"I think the original message got lost in a lot of overpromising," Plescia said. "Until there is a more robust supply we need to be clear with the public that opportunity to get the vaccine is limited."

"It was a complete surprise," Freeman told CNN on Friday, adding, "To hear that this had been done for several weeks was actually shocking to us."

"I don't know if the right hand knows what the left hand is doing here," she said, adding that there's a risk that people will not be inoculated correctly if the federal government isn't providing reliable numbers for its vaccine supply.

While vaccines were developed in record time, the process of getting them into Americans' arms has moved far more slowly than officials promised. That's largely because the Trump administration left it up to each state to figure out the herculean task of vaccinating its population. But the administration's constantly fluctuating estimates about how much vaccine will be available have also made it difficult for states to craft vaccination plans, state officials have said.

as the federal government has left it to states to determine what to do with the vaccines it ships to them, and with some states pushing decision-making to local health departments and hospitals, the process has gone far from smoothly.

“There may have been an expectation from Operation Warp Speed or others that we’d give everyone the vaccine overnight.…It was a logistics equation for them. If you’ve been in vaccines for a long time, you know that’s the easy part. Getting it into actual arms is the hard part.”

Sen. Mitt Romney (R., Utah) criticized the vaccine rollout, saying in a statement that the lack of a comprehensive federal plan to be shared with states “is as incomprehensible as it is inexcusable.”

Public health officials and states say uptake is lagging for several reasons, beginning with holiday seasons that have kept staff of hospitals and nursing homes away from work. They also note they are facing high percentages of people, including some health-care workers, who are skeptical of taking the shots.

Hospitals and other sites are staggering appointments to avoid pulling too many workers from caring for patients amid a nationwide surge in Covid-19 cases, officials say. Administration of the vaccines also takes more time than a typical flu shot, particularly since they are being done in a socially distant way and may be preceded by a Covid-19 test.

Different state policies have led to confusion and shipment delays for hospitals, said Michael Wascovich, vice president of field pharmacy services for Premier Inc., a group purchasing organization whose members include 4,100 hospitals, 80% of which received doses.

“Every state is doing what they want to do,” he said. “You could be in Philadelphia and it’s completely different across the river if you’re in Trenton or Camden.”

Many states are following CDC guidelines to start with front-line medical workers and people in long-term care facilities, but not all. Florida Gov. Ron DeSantis on Dec. 23 extended eligibility to people aged 65 and older. Because each county and hospital in the state implemented its own approach, many people didn’t know whether to call, log on or show up in person to secure a spot.

CVS has begun administering doses at nursing homes and facilities in 48 states and Washington, D.C., with most eligible residents agreeing to be vaccinated, said Chris Cox, a CVS executive who is overseeing the vaccination rollout for the pharmacy chain.

In some cases, residents haven’t been vaccinated because of active outbreaks at facilities, while other facilities have taken longer than others to schedule their vaccination clinics, a challenge exacerbated by the holiday season, Mr. Cox said.

We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health.Coronavirus Briefing: An informed guide to the global outbreak, with the latest developments and expert advice.Sign UpFederal and state officials have denied they are to blame for the slow rollout. Officials behind Operation Warp Speed, the federal effort to fast-track vaccines, have said that their job was to ensure that vaccines are made available and get shipped out to the states. President Trump said in a tweet on Tuesday that it was “up to the States to distribute the vaccines once brought to the designated areas by the Federal Government.”“Ultimately, the buck seems to stop with no one,” Dr. Jha said.These problems are especially worrisome now that a new, more contagious variant, first spotted in Britain and overwhelming hospitals there, has arrived in the United States. Officials in two states, Colorado and California, say they have discovered cases of the new variant, and none of the patients had recently traveled, suggesting the variant is already spreading in American communities.The $900 billion relief package that Mr. Trump signed into law on Sunday will bring some relief to struggling state and local health departments. The bill sets aside more than $8 billion for vaccine distribution, on top of the $340 million that the C.D.C. sent out to the states in installments in September and earlier in December.

Over all, Maryland has given nearly 17 percent of its vaccine doses. In a Wednesday appearance on CBS, Gov. Larry Hogan attributed the slow process to challenges across the board — from the federal government not sending as many doses as initially predicted, to the lack of logistical and financial support for local health departments.

In a news conference on Wednesday, Operation Warp Speed officials said they expected the pace of the rollout to accelerate significantly once pharmacies begin offering vaccines in their stores. The federal government has reached agreements with a number of pharmacy chains — including Costco, Walmart and CVS — to administer vaccines once they become more widely available. So far, 40,000 pharmacy locations have enrolled in that program.

But public health officials warned that reaching these initial groups, who are largely being vaccinated where they live or work, is a relatively easy task. “This is the part where we’re supposed to know where people are,” said Dr. Saad B. Omer, the director of the Yale Institute for Global Health.