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As Dr. Javaid Perwaiz faces trial, the women he treated question decades of care

CHESAPEAKE, Va. — The last time Brittni DuPuy-German saw her trusted gynecologist, she once again explained that the stabbing, mystery pain in her abdomen had not gone away.

It first appeared two years earlier, after she said her doctor, Javaid Perwaiz, surgically tied her tubes. To fix it, he had proposed more surgery — three additional procedures in nine months that she said included a hysterectomy when she was 29. But the pain persisted.

So on Nov. 8, 2019, at his private-practice office, Perwaiz and DuPuy-German discussed the possibility of yet another surgery, she said. He scheduled an ultrasound for just days later, a sign of the efficiency that DuPuy-German had come to expect from her family’s longtime gynecologist. He was her mother’s doctor, her sister-in-law’s doctor, her best friend’s doctor. Perwaiz had delivered DuPuy-German and delivered her children.

Which is why, when her phone buzzed the day after her appointment, she was shocked by the headline she was reading: “Chesapeake doctor tied women’s tubes, performed hysterectomies without their consent, feds say.”

She absorbed the details of the FBI investigation. Her doctor, the news report said, was accused of lying to patients and persuading them to have life-altering surgeries they didn’t need. DuPuy-German began doubting everything Perwaiz had told her about her own body.

“That’s when all of the things that I didn’t question before started popping up,” she said.

As Perwaiz faces trial this week, a year after his arrest, DuPuy-German has received few answers to those questions — even as the FBI’s investigation expanded and the list of alleged victims grew. There are 29 patients specified in court documents and hundreds of others who contacted authorities after the doctor’s arrest.

DuPuy-German, now 32, is not cited in the criminal case but has filed a lawsuit against Perwaiz.

The U.S. attorney’s office for the Eastern District of Virginia would not say how many women in total were allegedly mistreated by Perwaiz, but in a recent trial memorandum prosecutors wrote that “the identified patients are only ‘examples’ of the scheme to defraud.”

The case, which authorities said was launched in 2018 after a hospital employee’s tip, first hinged on one charge each of health-care fraud and false statements. Federal prosecutors now allege that Perwaiz executed an “extensive scheme” spanning nearly a decade that endangered women’s pregnancies, robbed their ability to conceive and pressured them into unnecessary procedures based on unfounded cancer diagnoses and exams using broken equipment.

The more procedures Perwaiz performed, authorities said, the more money he made off insurance companies. He used the profits, according to prosecutors’ trial memorandum, “to support his lavish lifestyle.”

Perwaiz, who is jailed without bond, pleaded not guilty. He has not spoken publicly about the allegations but defense attorneys said in a court document he is “prepared to defend himself at trial.” His lawyers in the criminal case have not responded to multiple requests for comment, but have argued unsuccessfully in numerous motions to dismiss that, among other things, some charges were duplicative.

Trudeau prepares for possible ‘disruptions’ after U.S. election outcome; Edmonton faces new voluntary restrictions

On Thursday, Oct. 8, Prime Minister Justin Trudeau said that Canada needs to be ready for “all outcomes” of the U.S. presidential election, such as if there are any “disruptions” following the result.

Trudeau shared his thoughts on the controversy in the U.S., after announcing a $295 million investment from the federal government into a Ford Motor Co. assembly complex in Ontario. The investment, which was matched by Premier Doug Ford’s provincial government, will make it a global hub for battery electric vehicle production.

In Alberta, a record-high spike of 364 new daily cases was announced. Dr. Deena Hinshaw said that a worrisome trend may have developed in its epicentre of Edmonton — where new voluntary restrictions have been introduced — because some people will only follow public health recommendations if they’ve been “personally impacted” by COVID-19.

In Prince Edward Island, the province’s top doctor raised concern about the current “Atlantic bubble,” after an outbreak was reported in New Brunswick, where there are now more active cases than the rest of the Atlantic provinces combined. In New Brunswick, officials announced new mandatory mask restrictions on Thursday, while they also suspended non-essential travel between itself and a Quebec border community.

For more on today’s top stories and the spread of the novel coronavirus across the country, please refer to our live updates below, as well as our COVID-19 news hub.

Trudeau’s focus on Canada’s COVID-19 response, not U.S. election debates

Prime Minister Justin Trudeau was asked repeatedly to share his thoughts regarding the U.S. presidential election, especially on Canada’s response if Donald Trump doesn’t accept Nov. 3’s results.

It’s a rumour that has gained traction with Trump and U.S. Vice President Mike Pence not providing clear answers as to how they would respond to potential defeat in the 2020 election, such as if there will be a peaceful transfer of power.

The prime minister on Thursday said that he’s watched “clips” from both the U.S. presidential and vice-presidential debates, but “my focus right now needs to be on keeping Canadians safe and working with premiers across this country to engage in everything we need to do to control this second wave.”

“Of course what happens in the United States is going to be impacting Canada after the election. But our job is to be ready for all outcomes.”

Trudeau was then pressured to elaborate on what “all outcomes” could mean. 

“Well I think we’re certainly all hoping for a smooth transition or a clear result from the election, like many people are around the world,” said Trudeau. “If it is less clear, there may be some disruptions and we need to be ready for any outcomes, and I think that’s what Canadians would expect of their government, and we’re certainly reflecting on that.”

The prime minister said that he doesn’t comment or weigh in on American political processes.

Trump has repeatedly questioned the integrity of the upcoming U.S. election due to the significant amount of Americans who will be

PTCE Announces September ‘Faces of Pharmacy’ Winners in Recognition of American Pharmacists Month

Yearlong campaign recognizes pharmacists for their dedication, and often overlooked contributions, to transforming healthcare

In support of American Pharmacists Month in October, PTCE, a leader in continuing education for multispecialty pharmacists and pharmacy professionals, is committed to recognizing pharmacists’ contributions to health care practices and all they do for their communities through its ‘Faces of Pharmacy’ recognition program.

In this transforming health care landscape, The Faces of Pharmacy nomination opportunity celebrates pharmacists, who navigate evolving health care practices and continue to make a difference in the lives of their patients.

Continuing its year-long campaign, PTCE is proud to announce its September winners:

  • Alisa Eibling, Pharm.D., Clinical Director, PFSP Specialty Pharmacy

  • Adam King, MPH, CPhT, PR, Executive Director and founder, CompassionRx

  • Jameika Stuckey, Pharm.D., Clinical Supervisor and medication safety manager, University of Mississippi Medical Center

  • Michael Lorenzo Tinglin, Pharm.D., Clinical Pharmacist, Premier Family Medical

“Congratulations to the four pharmacy professionals who were selected as the winners of our Faces of Pharmacy program,” said Jim Palatine, R.Ph., MBA, president of PTCE. “The number of nominations we have received for the month of September truly exemplifies the need and desire to acknowledge these healthcare professionals who make a difference in the lives of their patients. In honor of American Pharmacists Month, we are devoted to showing our appreciation for the care and commitment of pharmacy professionals in the industry, and we will continue to recognize these professionals every month with our inaugural yearlong campaign.”

Each month, PTCE will select four pharmacy professionals to feature on its website and social media platforms in recognition of their unwavering commitment to delivering exceptional care to patients.

Nominations can be submitted online by colleagues, patients, friends and family members of outstanding pharmacists, pharmacy technicians or anyone else working in the industry. Submissions should detail what the nominee has done to ensure access to treatment and care or describe how they go above and beyond to support their patients or community.

For more information about the September Faces of Pharmacy winners, click here.

About Pharmacy Times Continuing Education™

Pharmacy Times Continuing Education™ (PTCE) is a leader in continuing education for retail, health system, oncology, managed care and specialty pharmacists. PTCE is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education (CPE). PTCE’s print, online and live CPE activities are designed to help improve the knowledge, competence and skills of pharmacists so they are better prepared to provide the highest quality pharmacy care to the patients they serve and to the physicians they assist as part of a multidisciplinary treatment/management team. To learn more about the educational activities sponsored by PTCE, visit https://www.pharmacytimes.org.

View source version on businesswire.com: https://www.businesswire.com/news/home/20201008005978/en/

Contacts

PTCE
Alexandra Ventura, 609-716-7777
[email protected]

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Novak Djokovic enters French Open semi-finals but faces fitness battle

Video: Serena pulls out of French Open with Achilles injury (Reuters)

Serena pulls out of French Open with Achilles injury

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Novak Djokovic is still in the French Open – but only after a drawn-out struggle in four sets on Wednesday night against Pablo Carreño Busta, the Spaniard who cashed in at the US Open when the world No 1 was disqualified for striking a line official with a spare ball. It was not a joyous reunion.



Novak Djokovic is swinging a racket at a ball: Photograph: Clive Brunskill/Getty Images


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Photograph: Clive Brunskill/Getty Images

A month after their shared New York drama, Carreño Busta had notions of winning on his own merits after taking the first set of the second quarter-final on day 11, but Djokovic ignored nagging pain in his upper left arm and his neck as he cobbled together a 4-6, 6-2, 6-3, 6-4 win in 3hr 10min under the lights on Court Philippe Chatrier. He has two days to recover before playing Stefanos Tsitsipas on Friday, and he will need every waking hour of them.



Novak Djokovic is swinging a racket at a ball: Novak Djokovic plays a forehand during his French Open quarter-final victory against Pablo Carreño Busta of Spain.


© Photograph: Clive Brunskill/Getty Images
Novak Djokovic plays a forehand during his French Open quarter-final victory against Pablo Carreño Busta of Spain.

Related: Rafael Nadal weathers cold and Jannik Sinner to reach French Open semi-final

If the 2016 champion is to win the title again he has to beat injury, an in-form Tsitsipas and, probably, the 12-time champion, Rafael Nadal, who plays Diego Schwartzman in the other semi-final. It is the sort of mountain Djokovic loves climbing, but the question remains: is he fit and strong enough to reach the summit?

Djokovic was cleared to play in Rome, where he beat Schwartzman in the final, and in Paris after testing positive for coronavirus on his Balkans exhibition tour earlier in the summer – but he looked a physical mess in the first set. Sweating and anxious, he grimaced, tugged at his arm and bandaged neck and tried to bang life into his upper legs with his racket as his opponent waited for his chances.

The tournament physio massaged Djokovic’s arm during the break and the player told him: “It feels better now.” Yet he did not look remotely comfortable, even when he got his serve working and levelled at a set apiece. The trainer returned between the third and fourth games, and it seemed to lift Djokovic’s spirits. Just when he looked as if he was slipping into a confused state again, he bounced back to level at a set apiece.

Related: Petra Kvitova sets up French Open semi-final meeting with Sofia Kenin

He broke early in the third, overcame a blip when Carreño Busta broke back for 2-3, then hit hard again to go a set up. But he looked far from commanding. Carreño Busta dug his heels into the Roland Garros clay in the fourth, and Djokovic had to fight for every point. Carreño Busta chose a woeful option to hand him the break for 3-4, Djokovic saved break point to hold through deuce

Dogs’ brains aren’t hardwired to care about human faces, study shows

Researchers measured brain activity in dogs and humans as they showed them videos of faces and backs of heads, a press release from Eötvös Loránd University, in Hungary, said.

While faces are hugely important for visual communication in humans, the same can’t be said for our canine companions.

Experiments involving functional magnetic resonance imaging on 20 dogs were carried out at Eötvös Loránd University and the National Autonomous University of México, Querétaro, Mexico, two of very few facilities that can scan dogs’ brains when they are awake and unrestrained.

Results revealed large dedicated neural networks in human brains are used to differentiate faces from non-faces. In dogs there are no brain regions that fire to differentiate faces.

Instead, dogs use more information from smell or larger parts of the body, study co-author Attila Andics of Eötvös Loránd University, told CNN.

Germans could legally have to let their dogs out twice a day

“In dogs, for kin recognition and mate selection facial cues are not more important than non-facial bodily cues, acoustic or chemical signals,” Andics said.

The full study, described by researchers as the first one of its kind, was published in the Journal of Neuroscience Monday.

Andics told CNN that dogs do care about human faces, even if their brains aren’t specifically tuned into them.

“I think it is amazing that, despite apparently not having a specialized neural machinery to process faces, dogs nevertheless excel at eye contact, following gaze, reading emotions from our face, and they can even recognize their owner by the face,” Andics said.

“During domestication, dogs adapted to the human social environment, and living with humans they quickly learn that reading facial cues makes sense, just as humans learn to pay attention to little details, of let’s say, a phone, without having specialized phone areas in their brain.”

Researchers will now compare how dog and human brains process other visual categories such as body parts, various species and everyday objects, said Andics.

The team will also investigate whether dog brains have developed different specializations as a result of living with humans, Andics added.

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Trump Makes Calls, Tweets From Hospital But Faces Decisive Days

US President Donald Trump has resumed making calls and tweeting from hospital, but doctors say his progress on Sunday will be crucial to see if he develops a more severe form of Covid-19.

The president’s medical team was due to give an update of the his condition late Sunday morning.

Trump posted a video Saturday from the business suite in Walter Reed medical center near Washington, saying he was improving and would be “back soon” — but that the crucial coming days would be “the real test.”

On Sunday, his deputy campaign manager Jason Miller told ABC he had spoken to Trump for a half-hour Saturday and that the president was eager for political news with the November 3 election less than a month away.

This White House handout photo released October 4, 2020 shows US President Donald Trump working in his conference room at Walter Reed National Military Medical Center in Bethesda, Maryland a day earlier after testing positive for Covid-19 This White House handout photo released October 4, 2020 shows US President Donald Trump working in his conference room at Walter Reed National Military Medical Center in Bethesda, Maryland a day earlier after testing positive for Covid-19 Photo: The White House / Joyce N. BOGHOSIAN

 

He was even “cracking jokes,” Miller said.

National security advisor Robert O’Brien also said Trump was doing well, telling CBS that any discussion of a potential transfer of power to Vice President Mike Pence — as has happened when other presidents underwent surgery or were sedated — was “not something that’s on the table” for now.

Pence has been close to some of those testing positive but says he has regularly tested negative. As Trump has had to freeze or rework his campaign, the vice president is continuing a busy schedule of appearances.

But serious questions linger over the timing and severity of the president’s illness — and whether he might have exposed dozens of others to Covid-19 even after a close aide tested positive.

US President Donald Trump was said to be doing "well" although there was confusion over mixed messaging from his medical team US President Donald Trump was said to be doing “well” although there was confusion over mixed messaging from his medical team Photo: AFP / SAUL LOEB

 

A confusing timeline provided by Trump’s advisors and doctors suggested that he met with more than 30 donors on Thursday in Bedminster, New Jersey even after learning that close aide Hope Hicks had tested positive — and just hours before he announced his own positive test.

 

 

All this came in a week when one poll — taken in the two days after a bruising presidential debate with Democratic rival Joe Biden but before news emerged of Trump’s illness — showed his approval rating hitting a low point for the year.

The Wall Street Journal/NBC survey gave Biden a significant a 53-39 percent lead among registered voters.

The celebration for Supreme Court nominee Amy Coney Barrett at the White House on September 26 is thought to have been the source of new infections inside the president's inner circle The celebration for Supreme Court nominee Amy Coney Barrett at the White House on September 26 is thought to have been the source of new infections inside the president’s inner circle Photo: GETTY IMAGES NORTH AMERICA / CHIP SOMODEVILLA

 

News of Trump’s hospitalization has drawn widespread sympathy but also fueled a sense among some that he was paying a price for months of consistently downplaying the severity of the pandemic.

He mocked Biden’s

EPA faces decision on chemical linked to brain damage in children

When Claudia Angulo was pregnant with her son, she often felt nauseated and experienced vomiting and headaches. 

She didn’t think much of it, until after she learned her son had Attention Deficit Hyper Disorder and difficulties with language and learning. 

Angulo said she later discovered that a chemical she had been exposed to through her job — which involved taste-testing produce before it was washed — has been associated with health risks including brain damage in children. 

“At the time that I was pregnant, in the company there were like 10 women that were pregnant and of those 10 women, seven of their kids were born with [health] problems,” she told The Hill in an interview conducted in Spanish. 

And they’re not alone. 

Studies have linked prenatal exposure to the chemical, called chlorpyrifos, to neurodevelopmental issues including lower IQ and impaired working memory. 

Chlorpyrifos is used to prevent insects from affecting a variety of crops like berries, citrus fruits, vegetables and nuts. It’s currently banned for most residential uses but is still used in agriculture and there are several ways farmworkers can be exposed to it including through handling and applying it as well as experiencing drift from other nearby farms. 

In 2015, the Obama administration proposed banning its use on food and crops. However, in 2017, then-EPA Administrator Scott PruittEdward (Scott) Scott PruittAnother toxic EPA cookbook Juan Williams: Swamp creature at the White House Science protections must be enforceable MORE reversed course, saying that further study was warranted. 

“We are returning to using sound science in decision-making — rather than predetermined results,” he said at the time.

The EPA now is weighing whether to propose a ban. 

Last week, in assessing risks presented by the chemical, the EPA said that “despite several years of study, the science addressing neurodevelopmental effects remains unresolved.”

Advocates fear that this is a signal that the agency won’t ban the substance.

“It seems to signal that they’re going to not ban it because back in 2016 when they did a different risk assessment and found that there was risk, then they started the process to ban it,” said Iris Figueroa, an attorney with Farmworker Justice, a group currently suing in favor of a ban. 

“It logically follows, although it’s not for certain, the fact that they’re saying the stuff is unresolved means that they’re moving toward a different sort of decision than the one that they took just three years ago,” Figueroa added. 

An EPA spokesperson said in an email on Friday that its forthcoming proposal on what to do about chlorpyrifos “will outline potential risk management options to address any potential risks of concern” that were identified in the risk assessments.

The spokesperson said that the agency “has undertaken considerable efforts to assess the available chlorpyrifos data, providing a detailed discussion of the strengths and uncertainties associated with the epidemiology studies.”

The official particularly pointed to a major study from Columbia University’s Center for Children’s Environmental Health (CCCEH) saying that “although EPA

After concerning early Covid symptoms, Trump faces critical days ahead, sources say

President Donald Trump is “doing very well” after his first night at Walter Reed Medical Center where he is being treated for the coronavirus, White House physician Dr. Sean Conley said Saturday.

But a White House aide, who refused to include their name, told members of the White House press pool that the president’s condition may been more serious than the physicians suggested. The pool is a small group of reporters who travel with the president on behalf of all the news outlets who cover the White House.

“The President’s vitals over last 24 hours were very concerning and the next 48 hours will be critical in terms of his care,” the aide said in a statement to the press pool that but not directly to NBC News. “We are still not on a clear path to a full recovery.”

A source familiar with the President’s condition said some of the same to NBC News on Saturday: “Some the President’s vitals signs Friday morning were early indicators of the potential for progression beyond mild illness.”

The assessment was a stark contrast to Conley’s assessment.

The president has been fever free for 24 hours; is not currently receiving supplemental oxygen and has normal organ function, Conley said, adding he is “cautiously optimistic.”

It was unclear whether the aide or the president’s physician had more update information.

Trump broke an extended silence on Twitter on Saturday, writing to praise medical professionals, adding, “With their help, I am feeling well!”

Conley declined to predict when Trump might discharged. He will be on a five-day course of an experimental drug treatment, the doctors said.

The doctors said Trump had a cough, nasal congestion, and fatigue on Thursday, symptoms that have since begun improving and resolving. They also suggested he received an antibody treatment on Thursday morning.

Trump told his doctors, “I feel like I could walk out of here today,” the doctors said.

The White House also tried to clear up confusion set off from the briefing over when Trump became ill.

Standing outside Walter Reed, the president’s doctors said he was “72 hours into the diagnosis,” even though Trump had only announced his positive coronavirus test late Thursday evening, after attending a fundraiser in New Jersey. Another doctor treating the president, Dr. Brian Garibaldi, said had been treated “48 hours” ago — Thursday morning — with antibodies.

Download the NBC News app for breaking news about the president’s health

But a White House official later disputed the timeline, saying Trump had been diagnosed Thursday night and that the doctors meant Trump was on “day 3” not a full 72 hours in on his diagnosis.

The official also said that the antibody treatment was given later Thursday night, not a full 48 hours ago.

On Saturday afternoon, Conley issued a statement through the White House saying Trump had been diagnosed on Thursday night, and given the antibody treatment on Friday.

“I incorrectly used the term ‘seventy-two hours’ instead of ‘day three’ and

Push to bring coronavirus vaccines to those in poverty faces trouble

LONDON (AP) — An ambitious humanitarian project to deliver coronavirus vaccines to the world’s poorest people is facing potential shortages of money, cargo planes, refrigeration and vaccines themselves — and is running into skepticism even from some of those it’s intended to help most.

In one of the biggest obstacles, rich countries have locked up most of the world’s potential vaccine supply through 2021, and the U.S. and others have refused to join the project, called Covax.

“The supply of vaccines is not going to be there in the near term, and the money also isn’t there,” warned Rohit Malpani, a public health consultant who previously worked for Doctors Without Borders.

Covax was conceived as a way of giving countries access to coronavirus vaccines regardless of their wealth.

It is being led by the World Health Organization, a U.N. agency; Gavi, a public-private alliance, funded in part by the Bill & Melinda Gates Foundation, that buys immunizations for 60% of the world’s children; and the Coalition for Epidemic Preparedness Innovations, or CEPI, another Gates-supported public-private collaboration.

Covax’s aim is to buy 2 billion doses by the end of 2021, though it isn’t yet clear whether the successful vaccine will require one dose or two for the world’s 7.8 billion people.

Countries taking part in the project can either buy vaccines from Covax or get them for free, if needed.

One early problem that has emerged: Some of the world’s wealthiest nations have negotiated their own deals directly with drug companies, meaning they don’t need to participate in the endeavor at all. China, Russia and the U.S. have said they do not intend to join. Other countries, including France and Germany, will technically join Covax but won’t procure vaccines for their citizens via the initiative.

READ MORE: More than 150 countries sign up for global vaccine distribution plan

Not only that, but firm agreements with Covax came in too late to prevent more than half of all potential doses being snapped up by countries representing 13% of the world’s population, according to an Oxfam study.

“As a continent of 1.2 billion people, we still have concerns,” Africa Centers for Disease Control and Prevention director John Nkengasong said Thursday.

He praised Covax for the solidarity it represents but said there are serious questions about allocation, saying African nations’ envoys are meeting directly with vaccine manufacturers to ask “if we came to the table with money, how would we get enough vaccines to cover the gap?”

The European Union has contributed 400 million euros ($469 million) to support Covax, but the 27-country bloc won’t use Covax to buy vaccines. Instead, the EU has signed its own deals to buy more than 1 billion doses, after some member states raised concerns about what was described as Gavi’s “dictatorship” approach to running Covax.

Gavi, WHO and CEPI announced in September that countries representing two-thirds of the world’s population had joined Covax, but they acknowledged they still need about $300 million more from governments or other

Push to bring coronavirus vaccines to the poor faces trouble

LONDON (AP) — An ambitious humanitarian project to deliver coronavirus vaccines to the world’s poorest people is facing potential shortages of money, cargo planes, refrigeration and vaccines themselves — and running into skepticism even from some of those it’s intended to help most.

In one of the biggest obstacles, rich countries have locked up most of the world’s potential vaccine supply through 2021, and the U.S. and others have refused to join the project, called Covax.

“The supply of vaccines is not going to be there in the near term, and the money also isn’t there,” warned Rohit Malpani, a public health consultant who previously worked for Doctors Without Borders.


Covax was conceived as a way of giving countries access to coronavirus vaccines regardless of their wealth.

It is being led by the World Health Organization, a U.N. agency; Gavi, a public-private alliance, funded in part by the Bill & Melinda Gates Foundation, which buys immunizations for 60% of the world’s children; and the Coalition for Epidemic Preparedness Innovations, or CEPI, another Gates-supported public-private collaboration.

Covax’s aim is to buy 2 billion doses by the end of 2021, though it isn’t yet clear whether the successful vaccine will require one dose or two for the world’s 7.8 billion people. Countries taking part in the project can either buy vaccines from Covax or get them for free, if needed.

One early problem that emerged: Some of the world’s wealthiest nations negotiated their own deals directly with drug companies, meaning they don’t need to participate in the endeavor at all. China, France, Germany, Russia and the U.S. don’t intend to join.

And so many rich countries bought vaccines from manufacturers — before the shots have even been approved — that they have already snapped up the majority of the vaccine supply for 2021.

The European Union has contributed 400 million euros ($469 million) to support Covax, but the 27-country bloc won’t use Covax to buy vaccines, in what some see as a vote of no-confidence in the project’s ability to deliver. Instead, the EU has signed its own deals to buy more than 1 billion doses, depriving Covax of the bulk negotiating power of buying shots for the continent.

Gavi, WHO and CEPI announced in September that countries representing two-thirds of the world’s population had joined Covax, but they acknowledged they still need about $400 million more from governments or elsewhere. Without it, according to internal documents seen by The Associated Press before the organization’s board meeting this week, Gavi can’t sign agreements to buy vaccines.

Covax did reach a major agreement this week for 200 million doses from the Indian vaccine maker Serum Institute, though the company made clear that a large portion of those will go to people in India.

By the end of next year, Gavi estimates, the project will need $5 billion more.

Covax said negotiations to secure vaccines are moving forward despite the lack of funds.

“We are working with the governments who have expressed interest earlier