A COVID-weary world is facing a distressing reality check
Just a few weeks ago, much of the world seemed poised to leave COVID behind.
U.S. President Joe Biden declared the U.S. close to independence from the virus. Britons hit the dance floor to celebrate "Freedom Day." Singapore's legendarily strict government signaled it would begin to loosen its zero-cases approach and make life and travel more manageable.
But if those places were ready to be done with COVID, COVID wasn't done with them.
The sputtering U.S. vaccine campaign has run headlong into the highly-contagious delta variant. The U.K.'s reopening has coincided with a new surge in cases and fears of "long COVID" in younger people. In Africa, deaths have spiked as vaccine supplies remain meager. And in Japan, rising infections have forced the already-delayed Summer Olympics to be played in empty stadiums and arenas.
Around the globe, people and governments are finding out that COVID won't be thrashed into extinction, but is more likely to enter a long, endemic tail. With that will come delayed recoveries in the places that have had the least access to vaccines. And vaccine- and resource-rich countries will still face their own health and economic aftershocks, as the U.S. and U.K. are discovering.
"The virus is going to do what it wants to do," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, "and not what we want to do."
Vaccines have made a difference — in the places that have deployed them widely. In recent weeks, U.K. cases had risen dramatically, but there hasn't been an equivalent surge in deaths, and the number of new infections has dropped over the last few days. The shots are literal life savers.
At its current pace of vaccination, 75% of the EU population will be inoculated within two months, a level that may be sufficient to push back the virus. China and the U.K. are running at a similar pace, according to the Bloomberg Vaccine Tracker.
But after racing ahead, the now-stalled U.S. vaccine campaign will take eight or nine months to reach 75% coverage because of entrenched pockets of vaccine resistance in parts of the country. Other places are in more dire straits: Indonesia, with a raging outbreak, is a year and a half away. India will need another year, at its current rate. In Africa, countries like Egypt, Nigeria and South Africa are at least a year away — or far longer, according to Bloomberg's analysis.
Many lower-income countries are reliant on Covax, the program set up last year to equitably distribute vaccines to every corner of the planet. But the initiative has delivered just 140 million doses of the 1.8 billion it aims to ship by early 2022, hurt by delays in supplies from India.
"The world is divided between countries which do have vaccines and countries which don't have vaccines," said Klaus Stöhr, a former World Health Organization official who played a key role in the response to SARS in 2003. In the have-not regions, "the virus is going to end the pandemic, not the vaccine, unfortunately."
The pandemic struck $15 trillion off global output in the worst peacetime recession since the Great Depression, and the vaccination disparity is creating an economic wedge as richer countries recover more quickly than less-wealthy ones.
"It is creating a two-speed recovery process," World Bank President David Malpass told reporters on July 15.
Rich countries may not be able to insulate themselves from that fallout, either. One analysis shows that inequitable allocation of vaccines could also drag on GDP in advanced economies that have protected most of their citizens, depriving the global economy of trillions of dollars.
The burden is likely to be greatest in the world's poorest places, Lawrence Summers, the former U.S. Treasury Secretary and a paid contributor to Bloomberg, told reporters on a call earlier this month.
"COVID will be remembered as one of the grave economic events of this century for the U.S., but potentially the gravest event for parts of the developing world," said Summers.
There's a danger this year's V-shaped rebound mutates into a W shape, where growth lurches lower again before recovering, said Warwick McKibbin, a professor of economics at the Australian National University. Governments are running the biggest deficits since the Second World War and have provided more liquidity in the past year alone than the previous decade combined — limiting their options to prop up economies further, McKibbin said.
The highly contagious delta variant has added to the uncertainty. According to an analysis Monday from Bloomberg Economics the fast-spreading strain could widen the split in how fast more- and less-vaccinated places bounce back.
Warnings of those inequalities have been ringing loudly for some time.
In Africa, only about 1.5% of the population is fully vaccinated, according to the WHO. The continent has been hit by a wave of infections and rising deaths, while health systems are in dire need of oxygen and intensive care beds.
The disparity is stark in the Southeast Asian nation of Indonesia, one of the pandemic's latest hotspots. There, cases surpassed 50,000 a day, similar to the U.K.'s recent peak.
But the lower-middle-income country has only given full vaccinations to 6.9% of its population, compared to 56% in the U.K. That lack of vaccination has contributed to the country's 1,500-a-day death toll. In the U.K., that number is less than 100.
That inequality is repeated around the globe. According to the Bloomberg Vaccine Tracker, the wealthiest 25 countries and regions around the globe have administered 18% of the total doses given, despite having only 9% of the population.
Those conditions are "a toxic cocktail for disaster," said Joanne Liu, professor of global health at Montreal's McGill University and former international president of Doctors Without Borders.
"It's like climate change," she said from Tunisia, where she's helping in the COVID response. "We see it coming, we don't know how we're going to stop it. It needs a huge collective effort, meaning solidarity, sharing and equitable distribution of vaccine and goods."
Inequitable distribution of vaccines also could enable the virus to keep circulating and spawn more worrisome variants that could escape the immune protection from vaccines and pose a threat to everyone, including rich countries. That would be especially alarming if those strains advance at the start of winter, when conditions are ripe for respiratory viruses.
"We are letting this virus run wild in most of the world," said Saad Omer, director of the Yale Institute for Global Health.
Although the worst is likely over for the U.S. and its European peers, those fortunate countries can't let their guard down. The U.K dropped virtually all remaining restrictions on July 19, but scientists worry about rising numbers of people suffering from persistent fatigue, shortness of breath, cognitive issues and a range of other troubling problems. About 1 million people in the U.K. already report having those "long COVID" symptoms. The country prioritized older-age groups in its vaccine drive, meaning a lower percentage of young Britons have received their shots.
In the U.S., vaccinations slowed to a crawl just as the delta variant began circulating. While the rate of deaths hasn't yet followed the spike in cases, hospitals in less-vaccinated American regions are filling up with COVID patients again.
"This virus has no incentive to let up," Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, said in a July 22 briefing. A handful of cities and states have considered or are starting to re-implement public-health measures like masking, but most have not.
"What we're seeing is irrational exuberance," said Bruce Aylward, a senior adviser to the WHO. The view instead should be "cautious optimism," he said.
"We're in the heat of the battle with an enemy that we're only starting to understand and come to grips with," he said.
Hotspots could emerge in parts of the U.S. and in other places with patchy coverage. But there are worries that even in well-vaccinated areas, risk will remain. Anthony Fauci, the U.S. government's top infectious disease doctor, said Sunday that booster shots may be necessary to protect some people such as the elderly or those with compromised immune systems.
Outside the U.S. and Europe, it may be a year or more before vaccine production ramps up to the point that the pandemic can start to be under control, said William Moss, executive director of the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health.
Around the globe, there are many places that have taken strict measures to stop infections from arriving, but haven't used the time to vaccinate.
In Australia, less than a third of its population has received a first dose, and the country has imposed new lockdowns on half its people after the delta variant leaked into the country. Even after catching up on vaccines, other nations such as Singapore have returned to lockdown-like conditions in the face of new clusters and growing uncertainty.
China, meanwhile, seems no more able to move past the pandemic than any other country. The country successfully stamped out the virus a year ago and is now just a couple of months away from fully vaccinating three quarters of its vast population, an astounding feat. Life has been normal for the majority of its citizens through the past year, and the economy has boomed.
Yet the border is firmly sealed to outsiders and citizens cannot return without serving a long quarantine. Despite widespread vaccination, it continues to deploy aggressive measures whenever virus flare-ups occur, from locking down housing compounds to mandatory mass testing of entire city populations. The efficacy of its vaccines has also been questioned after other places that have relied on them including Mongolia and the United Arab Emirates have seen new infection surges.
"We're still early in this fight," Moss said. "We are going to continue to see widespread transmission in most countries in the world."
After more than 4 million deaths and almost 200 million cases, the world is weary.
But the bottom line is nations will need to figure out how to live alongside the virus. Many scientists expect the disease to become endemic, circulating for years to come but likely posing less of a threat over time as people develop some immunity to it through natural infection or vaccines.
"It's clear that we have to also balance the social impact of lockdowns with the health impact, the mental health impact and the economic impact," said Sally Davies, England's former chief medical officer. "There's a lot for us to learn, and we don't have the answers to quite a bit of it as yet."
In Japan, the world's third-largest economy, another COVID emergency in Tokyo and a decision to bar spectators from the main athletics events has overshadowed the country's hosting of the Olympic Games, smashing hopes for an economic springboard.
And like a track sprinter easing up too soon before the finish line, leaders and people around the world have been too quick to want to declare an end — or the beginning of the end — to the pandemic. The 1918 influenza pandemic that killed 50 million people before it burned out had three major waves running from March of that year to the summer of 1919, according to the CDC. Meanwhile, vaccination campaigns against other major viral diseases have taken many years to reach the far corners of the world. More than 60 years after the first polio vaccines, rare cases of polio still occur in some countries.
"Wanting the pandemic to be over has really caused many people to just not face the facts," said Osterholm, the University of Minnesota infectious disease expert. "I don't think the final script has been written for this pandemic at all."
Bloomberg's Jason Gale, Rachel Chang, Jinshan Hong and Enda Curran contributed to this report.