Jumbo jets carrying pallets of coronavirus vaccines touched down last week in Rwanda, Sudan, Kenya, the Gambia, the Philippines and the Democratic Republic of the Congo, where pilots posed for happy, masked photographs with health ministers and United Nations officials.
But the occasions for celebration veil a deeper crisis, one that is leaving low- and middle-income countries even further behind than they were before the pandemic hit. As wealthy nations like the United States race toward herd immunity, the pace of vaccine rollout has been painfully slow in Africa and Southeast Asia at a time when both regions are experiencing worrying increases in case numbers.
The inequality wrought by the coronavirus in the United States, where people of color are suffering both the health and economic impacts of the year-old pandemic at greater rates than their white counterparts, is a microcosm of a global phenomenon. As lower income countries struggle to secure vaccines, they will be left behind as other nations reopen their economies, exacerbating an economic gap that is already the widest it has ever been.
“Eventually, everywhere else people will be able to travel and move about freely, and Africans won’t be able to,” said Gyude Moore, a senior fellow at the Washington-based Center for Global Development and Liberia’s former minister of public works. “We’re going to see inequality play out again in terms of who has access to the world.”
So far, World Health Organization officials and wealthy nations have pledged more than a billion doses of COVID-19 vaccine to African nations. But only 1.5 percent of those doses have been delivered. The African Export-Import Bank has $2 billion to spend on vaccines, just a fraction of the estimated $10 billion to $12 billion it will cost to vaccinate a sufficient number of Africans to reach immunity on the continent.
At the current pace, Africa would not reach herd immunity until the end of 2023 or even into 2024.
“Wealthy countries are going to be able to achieve significant and decisive levels of vaccination coverage by late summer or fall, in 2021. The trajectory that we’re on with respect to poor countries goes out beyond 2022, if we don’t make some changes,” said Gayle Smith, president and chief executive of the ONE Campaign. “We are still in danger of not bringing this to closure as quickly as we might.”
At least 72,000 Africans and 208,000 Southeast Asians have died of the coronavirus pandemic, according to World Health Organization figures. And though the true toll is likely far higher, both regions have fared better than the Americas and Europe.
Experts speculate that a combination of demographics and culture explain some of the positive news in both areas.
The population is generally younger than in countries that have been hit harder — the median African is 20 years old, while the average U.S. resident is 38, and the coronavirus leads to death more often in older people than in younger people. African and Southeast Asian nations do not have substantial populations in settings like nursing homes, prisons and meat-packing plants, all places where the virus spread easily in Europe and the Americas.
More of life in Africa and Southeast Asia also takes place outdoors, where the virus doesn't spread as quickly.
But cases are once again on the rise, after a holiday surge when people in those regions traveled home from big cities to smaller villages, providing the virus with countless new vectors for spread.
“The continent is definitely going through a second wave, and the second wave is much more deadly,” Moore said.
Public health experts warn that rampant spread of the virus anywhere in the world affects everyone else — even in nations where vaccines are widely accepted and administered. The more opportunities the coronavirus has to mutate, the greater the odds that a variant evolves to successfully evade the vaccine.
“We are not safe here in America until everyone around the globe has been vaccinated,” said Rich Besser, a former director of the Centers for Disease Control and Prevention who now runs the Robert Wood Johnson Foundation. “You could see mutations in the virus that make our vaccines ineffective, our treatment ineffective, and put at risk people who have already been infected by COVID once.”
Beyond the epidemiological imperative of curbing the spread of the virus, health experts say wealthier nations have a moral imperative to assist, which has gone unfilled in the race to protect their own citizens.
“As a country, we’ve abdicated our social responsibility to the world’s low- and middle-income countries,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College.
Wealthy nations will have an opportunity to correct that, and to mitigate some of the suffering in low- and middle-income countries because of the success of several different vaccine candidates. The United States and European Union entered into deals to purchase many more vaccine doses than they will ultimately need, an early bet on a variety of candidates made with the assumption that some would fail.
But the success of multiple vaccines now means those wealthier nations will have a surplus they can share with less affluent countries.
“If I were an African government now, I would be in touch with the U.S. government now to see how many extra doses we can get,” Moore said. “They’re going to have way more supplies that they paid for than they can use.”
The Group of Seven leading industrialized nations discussed the pandemic at their meeting last month, where the United States pledged billions more for vaccine funding. The coronavirus relief package making its way through Congress adds $11 billion for the global response, some of which will go to Gavi, the global vaccine alliance.
The United States is in talks with India, Japan and Australia over increasing shipments to Asian countries, in part to counter China’s soft diplomacy of vaccine distribution in a region where the two sides are vying for influence and control. China has shipped doses of its own vaccine to Zimbabwe, Ethiopia and other countries in Africa, Latin America and elsewhere.
“A year in, we still do not have a global plan that ensures that we can bring this pandemic to a close on a timely basis,” Smith said. “What we do have that is different is some of the first signs that world leaders are preparing or starting to take some of the steps that are necessary.”