The Pandemic Is Us (But Now Mostly Them)

Yves here. I can no doubt be accused of showing my pessimistic colors, but the assumption that the Covid pandemic is largely a thing of the past in advanced economies is too smug for comfort. Even now, with most Americans who’ve been vaccinated having done so in the last four months (as in the immunity is still strong), outbreaks are occurring in populations with vaccination levels higher than US averages. For instance, from Public Radio Tulsa:

At least 25 staff members at the New Life Ranch Flint Valley camp in Colcord have tested positive, according to camp officials….

New Life Ranch does not require staff be vaccinated against COVID-19, but said 63% of employees had been.

And Moderna is saying that those vaccinated in December will soon need shots to protect against new variants. How many of the vaccinated have gotten the memo?

The article also seems to assume that Magic Vaccines will protect the elect in the global north; too bad about the refusniks and the poor. But as GM warned:

It is actually very dangerous for people to be happy with “transmission but little to no disease”

We are basically redoing the serial passaging experiments in mice that were done for SARS-1 and for this virus too, and which take it from a virus that causes little harm to mice to one that is highly lethal. We know very well that the evolutionary potential is there for at least 10% lethality, probably more (if the ancestor of this virus is indeed the one from the Yunnan mine, it was at more than 10% IFR).

So these few months of “normality” may well be paid for with an absolute slaughter further down the line.

I am following the databases carefully, and I am seeing Q498 mutations showing up here and there, all from areas of the world with high vaccination rates. Of course, those are also the places that are sequencing the most, so it’s a confounded observation, but who knows…

Also, the place in the world with the highest abundance of B.1.617.2 + K417N (which is now called AY.1) is California. K417N is a strongly immune evasive mutation so expect it to be just as virulent as regular B.1.617.2 but to break through a lot more often and probably with more serious symptoms too. But CA and everyone else is sequencing a lot less than before, and nobody is bothering to track what’s happening. And testing is dramatically down pretty much everywhere in the US, free mass testing sites are closing, etc…

I got another argument when I was in New York on why to not worry about Covid: all pandemics have fizzled out. The Russian pandemic of the late 1800s is now believed to have been a coronavirus, confirming that this one is not to be particularly feared. IM Doc felt compelled to clear his throat:

The statement that “all pandemics die out” and therefore we are done with this one is about as imbecile as Ibram X Kendi a few years ago at the Aspen Ideas forum when asked “What is your definition of racism?” – and his answer – “Racism is racist policies, leading to racist outcomes by racist people”. And that was that. The answer is so alarmingly stupid it is hard to know which logical fallacy to apply.

I have news for your MIT professor – ALL PANDEMICS DO DIE OUT – and this one will too. I am not sure there is anyone that disputes that. And when they die out they almost all turn into “routine nuisances” – but let us go back in time to the 1890s….

He is talking about OC43 – the coronavirus that is STILL here today – still infects half the world’s population every year – still causes untold billions of days off work from illness – and still kills upwards of 2000-10000 people every year. I guess that is the routine nuisance part. But let us go back in time to the 1890s.

That virus swept through the world 5-7 times depending on geography. It started in 1889. The second wave of 1890-1891 particulary that winter ( which we appear to be entering now with COVID 19) was the bomb in the UK, Western Europe and North America. It killed untold millions the world over. It destroyed the transportation (rail) and retail industry in the West. It led to the worst economic crisis up until that point in the history of America. Although not alone – there were other events that followed – the economic crisis it engendered eventually led to the development of the Fed. The economic strife led to the greatest Anarchist movement the USA and Western Europe had ever seen – eventually to the assassination of McKinley – and was the initial impetus for the Bolshevik Revolution – after the tensions it unleashed had been left to boil for a few more years. The Anarchist movement in the USA and all the issues it caused – bred an equal and opposite backlash in the rest of the country that led to the rise and almost total domination of multiple states by the KKK over the next several decades. It killed the only heir to the British throne – altering world history by placing a German family on the throne of the most powerful nation on Earth. The events unleashed on the world during that decade were the initial blows to Britain – the pre-eminent world power – and eventually led to the rise of the USA. Elites of all stripes were fleeing New York and putting places like Newport RI on the map. The economic conditions unleashed caused the wealth inequality to explode for a few years that only ended with Roosevelt and the trust-busting. (I see no one of similar stature on either side of the aisle – all we have now is Orange Hair Orangutans on one side and President Pudding Head on the other). There are many historians that are of the opinion that the economic, social and political chaos unleashed by this pandemic were the first dominoes that eventually led to WWI.

Does any of this sound familiar?

Now to the main event.

By Rajan Menon. Originally published at TomDispatch

Fifteen months ago, the SARS-CoV-2 virus unleashed Covid-19. Since then, it’s killed more than 3.8 million people worldwide (and possibly many more). Finally, a return to normalcy seems likely for a distinct minority of the world’s people, those living mainly in the United States, Canada, the United Kingdom, the European Union, and China. That’s not surprising.  The concentration of wealth and power globally has enabled rich countries to all but monopolize available vaccine doses. For the citizens of low-income and poor countries to have long-term pandemic security, especially the 46% of the world’s population who survive on less than $5.50 a day, this inequity must end, rapidly — but don’t hold your breath.

The Global North: Normalcy Returns

In the United States new daily infections, which peaked in early January, had plummeted 96% by June 16th. The daily death toll also dropped — by 92% — and the consequences were apparent. Big-city streets were bustling again, as shops and restaurants became ever busier. Americans were shedding their reluctance to travel by plane or train, as schools and universities prepared to resume “live instruction” in the fall. Zoom catch-ups were yielding to socializing the old-fashioned way.

By that June day, new infections and deaths had fallen substantially below their peaks in other wealthy parts of the world as well. In Canada, cases had dropped by 89% and deaths by 94%; in Europe by 87% and 87%; and in the United Kingdom by 84% and 99%.

Yes, European governments were warier than the U.S. about giving people the green light to resume their pre-pandemic lifestyles and have yet to fully abolish curbs on congregating and traveling. Perhaps recalling Britain’s previous winter surge, thanks to the B.1.1.7 mutation (initially discovered there) and the recent appearance of two other virulent strains of Covid-19, B.1.167 and B.1.617.2 (both first detected in India), Downing Street has retained restrictions on social gatherings. It’s even put off a full reopening on June 21st, as previously planned. And that couldn’t have been more understandable. After all, on June 17th, the new case count had reached 10,809, the highest since late March. Still, new daily infections there are less than a tenth what they were in early January. So, like the U.S., Britain and the rest of Europe are returning to some semblance of normalcy.

The Global South: A Long Road Ahead

Lately, the place that’s been hit the hardest by Covid-19 is the global south where countries are particularly ill-prepared.

Consider social distancing. People with jobs that can be done by “working from home” constitute a far smaller proportion of the labor force than in wealthy nations with far higher levels of education, mechanization, and automation, along with far greater access to computers and the Internet. An estimated 40% of workers in rich countries can work remotely. In lower- and middle-income lands perhaps 10% can do so and the numbers are even worse in the poorest of them.  

During the pandemic, millions of Canadians, Europeans, and Americans lost their jobs and struggled to pay food and housing bills. Still, the economic impact has been far worse in other parts of the world, particularly the poorest African and Asian nations. There, some 100 million people have fallen back into extreme poverty.

Such places lack the basics to prevent infections and care for Covid-19 patients. Running water, soap, and hand sanitizer are often not readily available. In the developing world, 785 million or more people lack “basic water services,” as do a quarter of health clinics and hospitals there, which have also faced crippling shortages of standard protective gear, never mind oxygen and ventilators.

Last year, for instance, South Sudan, with 12 million people, had only four ventilators and 24 ICU beds. Burkina Faso had 11 ventilators for its 20 million people; Sierra Leone 13 for its eight million; and the Central African Republic, a mere three for eight million. The problem wasn’t confined to Africa either. Virtually all of Venezuela’s hospitals have run low on critical supplies and the country had 84 ICU beds for nearly 30 million people.

Yes, wealthy countries like the U.S. faced significant shortages, but they had the cash to buy what they needed (or could ramp up production at home). The global south’s poorest countries were and remain at the back of the queue.

India’s Disaster

India has provided the most chilling illustration of how spiraling infections can overwhelm healthcare systems in the global south. Things looked surprisingly good there until recently. Infection and death rates were far below what experts had anticipated based on the economy, population density, and the highly uneven quality of its healthcare system. The government’s decision to order a phased lifting of a national lockdown seemed vindication indeed. As late as April, India reported fewer new cases per million than Britain, France, Germany, the U.K., or the U.S.

Never one for modesty, its Hindu nationalist prime minister, Narendra Modi, boasted that India had “saved humanity from a great disaster by containing Corona effectively.” He touted its progress in vaccination; bragged that it was now exporting masks, test kits, and safety equipment; and mocked forecasts that Covid-19 would infect 800 million Indians and kill a million of them. Confident that his country had turned the corner, he and his Bharatiya Janata Party held huge, unmasked political rallies, while millions of Indians gathered in vast crowds for the annual Kumbh Mela religious festival.

Then, in early April, the second wave struck with horrific consequences. By May 6th, the daily case count had reached 414,188. On May 19th, it would break the world record for daily Covid-19 deaths, previously a dubious American honor, recording almost 4,500 of them.

Hospitals quickly ran out of beds. The sick were turned away in droves and left to die at home or even in the streets, gasping for breath. Supplies of medical oxygen and ventilators ran out, as did personal protective equipment. Soon, Modi had to appeal for help, which many countries provided.

Indian press reports estimate that fully half of India’s 300,000-plus Covid-19 deaths have occurred in this second wave, the vast majority after March. During the worst of it, the air in India’s big cities was thick with smoke from crematoria, while, because of the shortage of designated cremation and burial sites, corpses regularly washed up on riverbanks.

We may never know how many Indians have actually died since April. Hospital records, even assuming they were kept fastidiously amid the pandemonium, won’t provide the full picture because an unknown number of people died elsewhere.

The Vaccination Divide

Other parts of the global south have also been hit by surging infections, including countries in Asia which had previously contained Covid-19’s spread, among them Malaysia, Nepal, the Philippines, Sri Lanka, Thailand, and Vietnam. Latin America has seen devastating surges of the pandemic, above all in Brazil because of President Jair Bolsonaro’s stunning combination of fecklessness and callousness, but also in Bolivia, Columbia, Chile, Paraguay, Peru, and Uruguay. In Africa, Angola, Namibia, South Africa, and the Democratic Republic of the Congo are among 14 countries in which infections have spiked.  

Meanwhile, the data reveal a gargantuan north-south vaccination gap. By early June, the U.S. had administered doses to nearly half the country’s population, in Britain slightly more than half, in Canada just over a third, and in the European Union approximately a third. (Bear in mind that the proportions would be far higher were only adults counted and that vaccination rates are still increasing far faster in these places than in the global south.)

Now consider examples of vaccination coverage in low-income countries.

  • In the Democratic Republic of the Congo, Ethiopia, Nigeria, South Sudan, Sudan, Vietnam, and Zambia it ranged from 0.1% to 0.9% of the population.
  • In Angola, Ghana, Kenya, Pakistan, Senegal, and South Africa, between 1% and 2.4%.
  • In Botswana and Zimbabwe, which have the highest coverage in sub-Saharan Africa, 3% and 3.6% respectively.
  • In Asia (China and Singapore aside), Cambodia at 9.6% was the leader, followed by India at 8.5%.  Coverage in all other Asian countries was below 5.4.%.

This north-south contrast matters because mutations first detected in the U.K., Brazil, India, and South Africa, which may prove up to 50% more transmissible, are already circulating worldwide. Meanwhile, new ones, perhaps even more virulent, are likely to emerge in largely unvaccinated nations. This, in turn, will endanger anyone who’s unvaccinated and so could prove particularly calamitous for the global south.

Why the vaccination gap? Wealthy countries, none more than the United States, could afford to spend billions of dollars to buy vaccines. They’re home as well to cutting-edge biotechnology companies like AstraZeneca, BioNTech, Johnson and Johnson, Moderna, and Pfizer. Those two advantages enabled them to preorder enormous quantities of vaccine, indeed almost all of what BioNTech and Moderna anticipated making in 2021, and even before their vaccines had completed clinical trials. As a result, by late March, 86% of all vaccinations had been administered in that part of the world, a mere 0.1% in poor regions.

This wasn’t the result of some evil conspiracy. Governments in rich countries weren’t sure which vaccine-makers would succeed, so they spread their bets. Nevertheless, their stockpiling gambit locked up most of the global supply.

Equity vs. Power

Tedros Adhanom Ghebreyesus, who leads the World Health Organization (WHO), was among those decrying the inequity of “vaccine nationalism.” To counter it, he and others proposed that the deep-pocketed countries that had vacuumed up the supplies, vaccinate only their elderly, individuals with pre-existing medical conditions, and healthcare workers, and then donate their remaining doses so that other countries could do the same. As supplies increased, the rest of the world’s population could be vaccinated based on an assessment of the degree to which different categories of people were at risk.

COVAX, the U.N. program involving 190 countries led by the WHO and funded by governments and private philanthropies, would then ensure that getting vaccinated didn’t depend on whether or not a person lived in a wealthy country. It would also leverage its large membership to secure low prices from vaccine manufacturers.

That was the idea anyway. The reality, of course, has been altogether different. Though most wealthy countries, including the U.S. following Biden’s election, did join COVAX, they also decided to use their own massive buying power to cut deals directly with the pharmaceutical giants and vaccinate as many of their own as they could. And in February, the U.S. government took the additional step of invoking the Defense Production Act to restrict exports of 37 raw materials critical for making vaccines.

COVAX has received support, including $4 billion pledged by President Joe Biden for 2021 and 2022, but nowhere near what’s needed to reach its goal of distributing two billion doses by the end of this year. By May, in fact, it had distributed just 3.4% of that amount.

Biden recently announced that the U.S. would donate 500 million doses of vaccines this year and next, chiefly to COVAX; and at their summit this month, the G-7 governments announced plans to provide one billion altogether. That’s a large number and a welcome move, but still modest considering that 11 billion doses are needed to vaccinate 70% of the world.

COVAX’s problems have been aggravated by the decision of India, counted on to provide half of the two billion doses it had ordered for this year, to ban vaccine exports. Aside from vaccine, COVAX’s program is focused on helping low-income countries train vaccinators, create distribution networks, and launch public awareness campaigns, all of which will be many times more expensive for them than vaccine purchases and no less critical.

Another proposal, initiated in late 2020 by India and South Africa and backed by 100 countries, mostly from the global south, calls for the World Trade Organization (WTO) to suspend patents on vaccines so that pharmaceutical companies in the global south can manufacture them without violating intellectual property laws and so launch production near the places that need them the most.

That idea hasn’t taken wing either.

The pharmaceutical companies, always zealous about the sanctity of patents, have trotted out familiar arguments (recall the HIV-AIDS crisis): their counterparts in the global south lack the expertise and technology to make complex vaccines quickly enough; efficacy and safety could prove substandard; lifting patent restrictions on this occasion could set a precedent and stifle innovation; and they had made huge investments with no guarantees of success.

Critics challenged these claims, but the bio-tech and pharmaceutical giants have more clout, and they simply don’t want to share their knowledge. None of them, for instance, has participated in the WHO’s Covid-19 Technology Access Pool (C-TAP), created expressly to promote the voluntary international sharing of intellectual property, technology, and knowhow, through non-restricted licensing.

On the (only faintly) brighter side, Moderna announced last October that it wouldn’t enforce its Covid-19 vaccine patents during the pandemic — but didn’t offer any technical assistance to pharmaceutical firms in the global south. AstraZeneca gave the Serum Institute of India a license to make its vaccine and also declared that it would forgo profits from vaccine sales until the pandemic ends. The catch: it reserved the right to determine that end date, which it may declare as early as this July.

In May, President Biden surprised many people by supporting the waiving of patents on Covid-19 vaccines. That was a big change given the degree to which the U.S. government has been a dogged defender of intellectual property rights. But his gesture, however commendable, may remain just that. Germany dissented immediately. Others in the European Union seem open to discussion, but that, at best, means protracted WTO negotiations about a welter of legal and technical details in the midst of a global emergency.  

And the pharmaceutical companies will hang tough. Never mind that many received billions of dollars from governments in various forms, including equity purchases, subsidies, large preordered vaccine contracts ($18 billion from the Trump administration’s Operation Warp Speed program alone), and research-and-development partnerships with government agencies. Contrary to its narrative, Big Pharma never placed huge, risky bets to create Covid-19 vaccines.

How Does This End?

Various mutations of the virus, several highly infectious, are now traveling the world and new ones are expected to arise. This poses an obvious threat to the inhabitants of low-income countries where vaccination rates are already abysmally poor. Given the skewed distribution of vaccines, people there may not be vaccinated, even partially, until 2022, or later. Covid-19 could therefore claim more millions of lives.

But the suffering won’t be confined to the global south. The more the virus replicates itself, the greater the probability of new, even more dangerous, mutations — ones that could attack the tens of millions of unvaccinated in the wealthy parts of the world, too. Between a fifth and a quarter of adults in the U.S. and the European Union say that they’re unlikely to, or simply won’t, get vaccinated. For various reasons, including worry about the safety of vaccines, anti-vax sentiments rooted in religious and political beliefs, and the growing influence of ever wilder conspiracy theories, U.S. vaccination rates slowed starting in mid-April.

As a result, President Biden’s goal of having 70% of adults receive at least one shot by July 4th won’t be realized. With less than two weeks to go, at least half of the adults in 25 states still remain completely unvaccinated. And what if existing vaccines don’t ensure protection against new mutations, something virologists consider a possibility? Booster shots may provide a fix, but not an easy one given this country’s size, the logistical complexities of mounting another vaccination campaign, and the inevitable political squabbling it will produce.

Amid the unknowns, this much is clear: for all the talk about global governance and collective action against threats that don’t respect borders, the response to this pandemic has been driven by vaccine nationalism. That’s indefensible, both ethically and on the grounds of self-interest.

Print Friendly, PDF & Email


  1. Isotope_C14

    “Meanwhile, new ones, perhaps even more virulent, are likely to emerge in largely unvaccinated nations.”

    I think it should be abundantly clear by now that the vaccines are far from perfect, see here:

    I wouldn’t exactly do a victory lap for a death rate after infection with vaccination that looks like this.

    And of course, we don’t know if this virus is lingering in the unvaccinated animals. Animals as a reservoir for human disease transmission is completely normal and to be expected. The way the animals are treated in the large factory farms is abhorrent and a natural recipe for a new variant. One can only hope that after lingering in the pigs or chickens that it becomes less interested in humans, but only time will tell.

    1. Ignacio

      Yes, vaccination is only a helping hand, particularly less useful for viruses entering via de upper respiratory tract that transmit as easily as SARS CoV does. Furthermore, repeated vaccination will have a diminishing benefit/risk ratio as it has been shown with flu probably with both, reduced benefit and increased risks.

      Regarding virus evolution, who can predict what is to come? Evolution doesn’t necessarily goes in the direction of production of more and more virulent strains and each virus has limits in its evolving possibilities and the evolutionary dynamics change when viruses become endemic. We have not yet reached the point when most humans have ‘seen’ the virus (or its artificially produced spike protein via vaccines) but I would never use the term ‘serial passage experiment’ as I see this as the natural evolution of a new viral entry in humans as many other before. It is confounding and serial passage usually produces less virulent rather than more virulent variants. Serial passaging means not natural transmission so I would try to avoid using that term. I find it confusing.

      1. IM Doc

        I could not agree more.

        We must remember that besides OC43 of the 1890s, we also have the precedent in coronaviruses of SARS and MERS. Neither one is with us today. It is still possible that COVID could weaken quickly as well.

        No one knows. Only time will tell and the introduction of the vaccines is a new twist. I will feel much better if we get through this next fall and winter without major problems. That would be my first relief.

        For now, one day at a time. Be thoughtful. And we should continue to look out for one another.

        I love this forum that we can all share with one another like adults. What a gift!

        1. PlutoniumKun

          I second your last comment – this forum is such a haven for high quality discussion. Your contributions (and Ignacio too) have been excellent and I think have helped all our understandings of what is facing us.

        2. Isotope_C14

          Thanks to you in particular IM Doc, I’ve forwarded on your text to my siblings and friends when necessary.

          I’m really hoping you are right on the Ivermectin wall falling into itty bitty pieces. I’d like to see this thing over asap.

        3. Ignacio

          Be thougthful

          I can only say amen to that. There is a long road ahead with Covid and it will never be pleasant. It is my pleasure to share this space with people like you, Yves, Lambert, JL, PK, Isotope C14, and so many others.

        4. GM

          MERS is very much with us, it is a camel virus, and has shown no intention of disappearing in the camel populations

          What saves us there is that it does not transmit well human to human, but that does not stop it from making the jump from camels to humans again and again.

          I am not sure how much it was tracked in 2020 and 2021, but there were more than 200 cases in 2019.

          Also, there is sufficient homology between MERS and SARS-CoV-2 for the two to recombine. Which in the long run may well happen given sufficient SARS-CoV-2 spread on the Arabian peninsula. Then things could get interesting — the highly optimized SARS-CoV-2 spike combined with the highly virulent MERS accessory proteins in “MERS-CoV-2″…

    2. David

      I think we have to be clear that there are places in the world that are never going to be vaccinated, or at least not to any useful level. I’m glad that someone has pointed out that many regions of the world:

      “lack the basics to prevent infections and care for Covid-19 patients. Running water, soap, and hand sanitizer are often not readily available. In the developing world, 785 million or more people lack “basic water services,” as do a quarter of health clinics and hospitals there, which have also faced crippling shortages of standard protective gear, never mind oxygen and ventilators.”

      To which you can add non-existent or intermittent electrical power, few paved roads and a largely illiterate population. And of course there are quite a lot of wars going on at the moment, and there are many places where health workers either don’t go, or go only with an armed escort. Money and the theoretical availability of vaccines can only do so much. I would be unsurprised to find, for example, that countries like Mali, Chad and Libya, significant sources of illegal immigration into Europe , never actually vaccinate any useful percentage of their populations. What do we do then?

      1. PlutoniumKun

        I think there has always been a certain amount of denial going on about the number of people in developed countries who get infectious disease from more tropical areas either from thoughtless travel or from migration. I well remember that before my first trip to Africa many years ago I casually mentioned to a doctor in my family whether the long list of vacinations and precautions were necessary. The next day he handed me a spreadsheet indicating the number of serious illnesses and deaths in Ireland and the UK from a range of diseases that don’t officially exist north of the Med. Almost all were the the result of people taking exotic holidays. It was sobering (and I took the hint and got all the necessary shots and prophylactics).

        20 years ago a close friend nearly died from a very serious infectious disease. It was a very rare disease and she was lucky to have been diagnosed and treated. The NHS doctors who saved her life told her she probably caught it on a trip to Goa the year before. But a very quick bit of research showed that this was an impossibility – it didn’t have that length of latency. She lived in an area in Leicester with a lot of South Asian immigrants and it was pretty clear she caught it from someone close by (the disease is endemic in parts of Pakistan/India), but the doctors unsurprisingly didn’t want to spread the idea that these diseases were being brought in by immigrants, although it didn’t take much work to figure this out. But I did wonder just how many cases there were like this (having spoken to a nurse who works in an infectious disease ward, I think the answer is far more than we think).

        I think the only short term answer to the issue is vaccination at the airport, but this of course won’t help the millions of people in those countries. Its been enough of a struggle to get polio and smallpox vaccines nearly universal, and those are much cheaper and easier to distribute. We will have to wait I think until someone develops a cheap and simple nasel spray or similar.

        1. GM

          Vaccination at the airport does not work for this virus, unfortunately.

          This is not smallpox where even vaccinating the infected can be effective, it takes more than a month to build proper immunity.

          It’s the same problem every time there is a surge in some country and there are cries of “give them vaccines, they are having a surge”. Well, we can certainly try to vaccinate, but that will make little difference to any current surge unless it is a Peru/Colombia/Brazil-style four- to six-month long surge.

      2. upstater

        “I would be unsurprised to find, for example, that countries like Mali, Chad and Libya, significant sources of illegal immigration into Europe , never actually vaccinate any useful percentage of their populations. What do we do then?”

        The best course of action to keep COVID coming from Africa to Europe is a vigorous boots on the ground and drone response from US Africom and French militaries. Supplement this with NATO naval forces saturating the Mediterranean and returning people that exited Libya back to the slave markets there. /s

        Needless to say, whatever France, the US and their yapping NATO poodles have spent (on a fully allocated basis) on their misguided, destabilizing military adventures in Africa would certainly pay for vaccines for the entire continent. And they prove they can move materials very quickly to very remote places.

        But the we don’t do things like that… we’re reaping what we’ve sown.

        1. David

          You’ve unwittingly put your finger on one of the main problems with converting good sentiments about “ending vaccine apartheid” into actual needles in peoples’ arms all over the world. The minimum criterion for a successful vaccination campaign is that the government has enough control of the territory to ensure safe delivery and use of vaccines. In large parts of the world that’s not true. The Western Sahel is a good case in point: large parts of Mali, Niger, Burkina Faso and even the North of Nigeria are now out of central government control, and in the hands of the Islamic State, Boko Haram and similar benevolent organisations who are not, to put it mildly, much interested in international vaccination campaigns.

          Several of these states are hanging together by a thread, because of the presence of European (largely French) forces, though the French have now said they are pulling out. The armies of these countries are ineffective, and the IS and its partners are nibbling away at territory, bit by bit, by intimidating and occupying individual villages. If Bamako falls – as it nearly did in 2013 – there will be hundreds of thousands, perhaps millions, of refugees and IDPs in the region, many going to countries which are themselves incapable of dealing with the epidemic in their own population. As with the analogous case of Syria, the pressure to take such refugees into Europe will be enormous and, whatever the humanitarian arguments, it’s going to pose a massive health problem. (Mali has fewer than 1% of its population vaccinated).

          I wish policy-makers, and medical experts in general, took these sorts of factors more into account. Medical charities like MSF certainly do, but they are not influential in the debate.

          1. upstater

            Continual Western imperialism is the proximate cause of the dysfunction in the global south. Case in point:

            How To Lose a Country in 10 Years: The Burkina Faso Formula

            If the US Government was trying to destroy Burkina Faso, it could hardly have done it any better. But this already impoverished, landlocked West African country is simply symptomatic of Franco-America’s Sahel-wide exercise in absurdity. It goes like this: in the years following the 9/11 attacks there was no Islamist militant threat to speak of in this region. Nevertheless, on account of its hallucinatory fear, racialized mental-mapping, and neocon-neo-imperial reflexes, the Bush administration imagined and then induced not just a genuine jihadi rebellion, but an inter-communal implosion clear across the Sahel. And because Burkina Faso was long considered one of the most stable countries in West Africa – and its conflict currently runs hottest of all – this tortured nation makes for an instructive case study in incompetence and indecency.

            Niger is another example… one wonders if the the former colonial master, France, had EDF customers pay a penny extra per kilowatt hour for the uranium producing most electricity and provided meaningful development instead of enriching. corrupt locals for decades if the picture wouldn’t be better than today. But France never has done anything like that…

            The western democracies play smash and grab.

        2. Thuto

          While we hover at less than 2,5% of our population having received at least one vaccination shot, starting this week, France and Germany will be flying in vaccines to vaccinate their citizens living in South Africa. To your point about their ability to move materials to very remote places when engaging in military adventurism, i’m told every last French citizen in Africa will be vaccinated, where ever they may be located on the continent. This means that the many French citizens in e.g. Francophone West Africa will receive their jab months or even years before their local citizen counterparts, a very stark reminder of the pecking order if ever one was needed. Indifference and lack of political will are bigger impediments to equitable access to vaccines than any logistical challenges could ever be.

          1. David

            It’s actually a little bit less dramatic than that. Some (but by no means all) French citizens in SA will be vaccinated in Joburg and the Cape with the doses they would otherwise have qualified for had they been in France. Politically, Égalité would have made it impossible to do anything else: (“Macron leaves French citizens to die …”) So far there have been no specific announcements about other countries, but I’d be very surprised if in practice the scheme (which runs to 31 August) extends much outside the capital cities of countries with significant French populations. French government advice is still to get vaccinated locally if possible, or otherwise to come back to France if you can.

            1. Thuto

              I take your point about the politics in France and that the French government has “duty of care” obligations to all its citizens, including those living abroad. However, the fact that my neighbour, who, by virtue of being a French citizen, gets vaccinated months or years before me is as stark a demonstration of the inequality between rich countries and the rest as we are ever going to see. This point still stands.

              1. David

                I don’t disagree with that, I just think it’s an example of the horrible political contortions of this grisly episode, and I expect there are a lot more to come. I don’t have much direct experience of the SA health system, at least not recently, but I’m disappointed the figure is that low. Is it about vaccine availability?

                1. Thuto

                  It most certainly begins and ends with availability, at least in so far as SA is concerned. Our private healthcare system is on par with the rest of the developed world (sadly this includes its propensity to gouge on massively overpriced services US style) but the public system, which has its challenges to be sure, has stepped up to deliver the modicum of vaccine supply we’ve had access to with admirable efficiency and reliability. Were it not for challenges with accessing vaccine supplies, our vaccination program would be far more advanced than the levels we are seeing now, of this i’m certain. At this rate someone like me who’s younger than 45 will be on the queue for a while still but we remain hopeful as I caught a glimpse earlier that Ramaphosa and Macron have just struck an agreement (outside the Trips waiver lobbying efforts which will continue) to enable local manufacturing of vaccines (not sure yet which one as I haven’t yet read the full announcement).

    3. LawnDart

      My money’s on natural selection and evolution. Bet we see a lot of shell-shock come next Spring.

    4. SteveW

      The Guardian/UK numbers show that the Delta variance’s hospitalization rate and death rate are quite high for the 2 doses group (0.7% death/infected). Higher than the 1 dose group (0.1%). Higher than the unvaccinated group (0.1%). Likely because the 2 does group has a higher risk profile — older or with underlying conditions? Or it implies that it you are fully vaccinated and still get infected, it would be really serious. Not sure what else it could be? Any idea?

        1. Yves Smith Post author

          I would bet on that. We see it in the US in spades. And they want to finger-wag at the unvaccinated, when some (many?) can’t afford to miss a day or two of work to the “routine” side effects that many experience.

        2. kareninca

          That would explain why so many vaccinated people are getting infected. But it wouldn’t explain why the vaccinated are dying at a much, much higher rate (once infected) than the unvaccinated.

      1. kareninca

        Ugh, that could be antibody dependent enhancement. That is the monster that could be lurking in the shadows. Probably not, but if it is we are real peril. Well, not me, since I am too perverse to be vaccinated. Well, maybe me too, since you can be at risk of it due to a natural previous infection, not just due to a vaccination.

        ADE is when a prior infection, or vaccination, makes you MORE likely to catch or be harmed by a new variant than you would otherwise be.

      2. PlutoniumKun

        They are still crunching the numbers. I think the ‘official’ reason for the high rates of vaccinated getting delta is not behavioural, but that those who are already very vulnerable (such as in care homes) are proportionately more likely to be vaccinated).

        In terms of anecdote, people I know here who are vaccinated are still being careful and pretty sensible, just loosening up in a fairly sensible matter. My family are having small get togethers now that nearly everyone has had their second dose, and I’ve been doing likewise meeting up with friends, generally outdoors, but we are less cautious than before.

  2. MrBrokenRecord

    I posted similar in another thread, and I’ll try to be kinder here (I regret using the word ‘fools’). But I was out with my family quite a bit over the weekend. My wife and I are fully vaccinated. The vaccination rate for our state is about 40%. We were saddened, concerned, and yes, a bit angry that almost no one was wearing a mask indoors. It’s not hard to see how outbreaks might be happening.

    1. lordkoos

      While WA state is doing pretty well, here in our eastern WA county the vax rate is only 40%. With restaurants & bars reopening and many mask refuse-niks here, it looks like there could be trouble this fall.

  3. bassmule

    Does the billionaire class care whether the poor live or die? Especially the non-white poor? I get the impression they’re just fine with “thinning the herd.”

    1. Thistlebreath

      Here’s one quote that crops up with three keystrokes: “At least 4 billion useless eaters shall be eliminated by the year 2050 by means of limited wars and organized epidemics of fatal rapid acting diseases…’” Dr. John Coleman, CIA officer.

      There’s an Edgar A. Poe film in the works, “Pale Blue Eye” that looks to be pretty good. Highly recommend re reading his “Masque of the Red Death” when it comes to feeling smug that the minimum wage folks in guard shacks at gated community entries will prove to be a safe protection against things like Covid.

      And has taken down its grim 2025 prediction of population levels. Bad for business.

    2. drumlin woodchuckles

      Poor and poor-ish white people shouldn’t take any comfort that the Global Overclass is “more willing” to see non-white poor die off than to see white poor die off.

      Case in point. Most of the death toll of the Sackler-initiated opiate epidemic are just as white as the Sacklers. But not as rich. And the Sacklers are okay with hundreds of thousands of non-rich white-as-the-Sacklers white addicts dying off from their Sackler-initiated opiate addictions.

  4. MonkeyBusiness

    ICUs in Jakarta, Indonesia and surrounding cities are running out of beds. Will Indonesia become the next India?

  5. Tom Stone

    Humans have known how to deal with Pandemics for a good long while.
    We aren’t doing that for a variety of reasons and the Virus will become endemic in human and a number of Animal populations.
    Whales and Dolphins?
    Dogs and cats certainly and confined populations on factory farms of whatever is being raised and susceptible.
    I gambled on incomplete information and took the vaccine and can’t know how that bet will pan out over the next few years.
    Life, never enough good information when you most need it.
    It would be nice if I could depend on the veracity and competence of the CDC and WHO (Me?), their corruption and loss of legitimacy are coming at a high price.

    Plumes are interesting, I live in a redwood canyon with a few twists and turns and a few months ago I was sitting on my deck and got a whiff of cigarette smoke.
    Like it was right there.
    The closest that smoker could have been was around the next corner, 75 yards away.
    The farthest is 150 yards, there are only three houses past that corner before the road dead ends.

    1. lordkoos

      I also felt the vaccine was a gamble, especially so when after a couple of weeks after my second dose of the Pfizer I began having some very odd symptoms that were far outside my normal (mostly minor) health issues. Those symptoms have subsided now but it was not a pleasant experience.

  6. GeoCrackr

    Minor quibble with the intro: the 1890s pandemic did not kill “the only heir to the British throne – altering world history by placing a German family on the throne of the most powerful nation on Earth.” It’s hard to know where to begin with this statement, but suffice to say that there was a direct line of succession from Victoria to Edward VII to George V (even if George’s elder brother was killed by the pandemic), and that family was German all along (Victoria’s family name Hanover should’ve been a dead giveaway). Sad to say getting these commonly-known and easily verifiable facts wrong throws all of the other assertions about what that pandemic into a suspicious light.

    1. IM Doc

      The fault is all mine.

      A much more appropriate way to have phrased that is that the virus killed the heir apparent to the throne leading to the placement on the throne of family members who maybe were not brought up thinking they would be the “one”.

      Not unlike Elizabeth II’s father after the abdication of her uncle.

      I am an American – and not completely versed in the ins and outs of the British Monarchy. I have however been working with a very elderly gentleman in London who has been sending me all kinds of reports and articles from the time. I can assure you that there was all kinds of concern, chaos and confusion upon the untimely death of Victoria’s heir. It was not a stablizing event, that is for sure.

      This mistake should not reflect on the rest of the article. The plague in the 1890s, just like all pandemics was the catalyst for unleashing all kinds of forces that were already at play at the time but maybe not on the front burner. Absolutely similar to what COVID has done to our world. For example, COVID did not cause wealth inequality – but it sure helped to detonate some of the consequences for all to see.

      Pandemics tend to do that in history.

      1. GeoCrackr

        That makes more sense – thank you for the reply. I’m in the same boat as you, only without a London source, so I will defer to his experience as to its characterization (although from this distance and an anti-royalist perspective the succession seemed straightforward, leaving me to wonder how much of all that drama was just newspapers playing to sensationalism). But I can certainly see how the potential for destabilization was there.
        Also agree that plagues/pandemics are catalysts (we have yet to see all of the effects our current one will have on everything I’m sure). My own biases came out in reading your description as similar to many “this singular historical factor/event is the root cause of XYZ” diatribes I’ve seen – the “racism/slavery was the root cause of the American revolution” theme that recently had its moment in the sun springs to mind. In light of your clarification I see that was an unfair reading of it.

      2. Tom Bradford

        I would agree that the 1880 pandemic was likely just one of a number of factors that came together to re-shape the world as IMDoc inferred. Darwin’s “On the Origins of Species” had been published only twenty years earlier, Marx’s “Das Kapital” only ten. The railways and steamships were remaking the world, and likely made the pandemic possible. Electricity and the telegraph were transforming ideas of what was possible – what mankind could do. Even without the pandemic the world, science, industry and society were undergoing a transformation perhaps unique in the history of the world and the upheavals to come were, I’d argue, baked in with the pandemic just another relatively small wrench on the steering-wheel of history – just as today’s pandemic will in due course be seen to have been.

    2. JEHR

      GeoCrackr: Thank you for the clarification as I, too, looked up the names of those in line for the English throne at that time and could not see how George was any more German than his brother or the rest of the family. It would be nice if people who made certain claims would give references or links.

  7. kareninca

    I attend a church whose branch here in northern CA is ultra ultra ultra liberal. As far as they re concerned, the pandemic is over. They met this past Sunday in person; there were 27 people in a what I suppose you would describe as a big room. They were all vaccinated; they did not wear masks. During the worship period they did sit as far apart as possible. Then at the very end they all stood up and squished together for a group photo!!!!!! That could be useful for contact tracing later on, I suppose.

    I have told the people making decisions that vaccinated people can still catch and transmit the virus, and that the vaccines likely put evolutionary pressure on the virus to become more transmissible. I told them that indoor masks would be a good thing. But they are convinced that the vaccines are a panacea.

    I joined them on zoom; so did others who are not so convinced this is going to work out well.

    I mention the political bent of the congregation because it becomes tiresome to be told that this is a Democrat-Republican thing; I am sure there is not a single Republican in the place. I also have an ultra liberal friend who is about to go on a road trip to stay for a couple of weeks with a household full of young relatives in Oregon; she is 78 and her husband is 80. They are real vaccine believers too; they don’t plan to wear masks or distance.

    1. Darius

      If churches had ventilation rates of 5x air exchange per hour, they could gather safely as long as they didn’t pack them in. People should continue to wear masks.

      1. kareninca

        I do think they worked hard on ventilation; there are scientists in the congregation. But omitting masks is just stupid. “Thou shalt not tempt the Lord thy God.”

        1. drumlin woodchuckles

          Didn’t the government tell all these people that the vaccine would confer total and permanent protection? Perhaps the government spokes-clones were too clever to say it in so many legally actionable words. But it is clearly what the government spokes-holes mean to imply.

          If the people you describe are doing anything stupid, trusting the government is the stupid thing they are doing. After all, their “no-mask” behavior is because they trust the government about the super power of the vaccine.

  8. Nikkikat

    Thank you NC and IM DOC for all of the valuable information here. Particularly an understanding of airborne transmission. Masking and proper protection. Persons I know that have been reliant on the CDC and and main media have little to no understanding. I have noticed that no one here in calif at any places I need to go have been maskless. So I guess some realize that taking off the mask will likely get them killed. I am fully vaccinated but will keep to masking, googles, on line ordering etc. I am still as careful and frightened as I was in the beginning.

        1. kareninca

          Yes, it is Xlear. I have never before in my life used a nasal spray, but it does seem harmless. That is, as long as my dog doesn’t consume it; it xylitol is toxic to dogs.

  9. JEHR

    There are just too many unknowns from this new virus and until we have further information it would be wise to use masks and distancing wherever they are needed for the foreseeable future.

  10. Glossolalia

    At least 25 staff members at the New Life Ranch Flint Valley camp in Colcord have tested positive, according to camp officials….

    I’d need to know if there were any hospitalizations or deaths among the vaccinated who tested positive before I decide how worried to be about this.

    1. Yves Smith Post author

      You are missing that there is substantial evidence that asymptomatic cases can transmit Covid, and we have some proof of that also being true among the vaccinated. Vaccinated family groups being tested to go overseas are too often showing most or all having Covid now. It’s highly unlikely that they all in parallel contracted a case from someone outside their bubble. More likely is one or at most two outside infections and then transmission within the family group.

      Moreover, as GM keeps stressing, immune responses are strongest the first two months after full vaccination kicks in (as in starting with 2 weeks after the second mRNA jab). I’ve also gotten reports from real MDs of symptomatic cases among the fully vaccinated. We’re likely to see more of this, and more severe cases, as officials are not preparing people to get a new round of shots 6-8 months after their second shot.

      1. Skip Intro

        I think the logistical complexity required for the mRNA vaccine handling probably means that many of the shots administered were of vaccine which may have (partially) ‘spoiled’. Presumably that would decrease the apparent effectiveness of the vaccine, while confounding immunology studies.

  11. rjs

    almost amused by the “mostly them” drift in this piece; after all, we’ve still had 5 times more cases per million pop than India has…

Comments are closed.