Unequal Covid-19 vaccination drive hinders control of pandemic in Latin America

Fighting the Covid-19 pandemic in Latin America has become akin to a game of whack-a-mole. Not a single month has gone by since March 2020 without at least one country in the region suffering its own wave of infections and deaths. The prospect of mass vaccination has greatly improved expectations for the remainder of 2021 and 2022, but uneven progress means that hope is not equally spread across the continent.

Peru has recorded the highest excess deaths per capita in the world compared to pre-pandemic years. Ecuador, also close to the top of that ranking, suffered one of the first waves of infections globally, with thousands of deaths in the province of Guayas that were never confirmed as victims of Covid-19. Brazil and Mexico, where infections have persisted at stubbornly high levels, accumulated more than one million excess deaths between them. Despite this, the virus could still produce new waves of infection in the region, often driven by variants of the original virus that have originated in Latin America itself (the Lambda variant in Peru; the Mu variant in Colombia).

Cases are even creeping up in countries that had withstood the onslaught for a whole year. Uruguay recorded the highest per capita peak of new cases in the region, even though it is one of the countries with the best detection in the world. Costa Rica has suffered a double peak since May of this year. And in Cuba, which had the advantage of being an island relatively isolated from the outside world (in the absence of tourism), July and August have been the hardest months.

Eighteen months after the first lockdown was imposed in Latin America, and nine months after the first vaccine vials arrived, there is little doubt that the latter are the real key to combating the virus in a lasting way. This is especially true in a region with large sectors of the population living hand-to-mouth, and in precarious situations that paltry expansions of state welfare during the pandemic have failed to address. These same structural difficulties are defining who gets vaccinated and when in the region.

Inequality between countries

The biggest gulf can be observed in the difference in vaccination rates between countries. Uruguay, the most vaccinated country in the region, has 20 times the immunization rate of Nicaragua, at the bottom of the regional ranking. As in the rest of the world, each country’s wealth is a key determinant of its vaccination rate. The higher the GDP per capita (meaning a better healthcare system, more human capital and better infrastructure), the higher the vaccination rate throughout the Americas.

However, even within these structural limits there are certain countries that have made the most of their lot. Uruguay and Chile are the clearest cases in point, but Ecuador and El Salvador have a ratio of income to vaccination that is well above what would be expected. The big players in the region (Argentina, Brazil, Colombia, Mexico) are at or slightly below where they should be.

There is one notable exception: the United States has been vaccinating below its potential for weeks, so that now the gap between where it is and where it is supposed to be, based on income level, is proportionally equivalent to that of much poorer countries such as Honduras, Guatemala or Venezuela. In fact, those countries are currently vaccinating at a higher rate than the US. Uruguay, Cuba and Ecuador began from very different starting points, but have all been able to implement strategies for rapid vaccine uptake. Somehow this seems to have been beyond the reach of middle-income countries such as Colombia, Mexico or Peru.

Inequalities within countries

Just as not all countries are created equal, regional differences can also be particularly profound within them. These also correlate with income, but not exclusively. In the case of Colombia, one of the most mountainous countries in Latin America, there is an uneven state presence and poor infrastructure in some areas. As a result, the Andean heartland is more vaccinated than the periphery on the plains or the coasts. Territories with low population densities (Vichada, Guainía, Vaupés) or a weak state presence (Chocó, Cauca, Putumayo) have much lower vaccination rates than the main cities, or territories such as the coffee-growing region or Boyacá.

The differences observed in vaccination rates between rural and urban environments in practically the entire continent confirm the suspicion that the journey of a vaccine from vial into the arm of a recipient is very much linked to one’s geographical location and socioeconomic status.

Lingering skepticism

Although Latin Americans show a remarkably high level of willingness to be vaccinated, skepticism is present: in Argentina, Bolivia, Colombia and Nicaragua more than 20% of adults say they have doubts. Data on willingness to be vaccinated come from the Global COVID-19 Trends and Impact Survey by the University of Maryland. The latest data are from June 2021. In countries with rapid vaccination schemes (such as Chile or Uruguay) it is likely that the percentage has declined because many respondents are now vaccinated.

Side effects were the main reason cited for skepticism through the first half of 2021. Similarly, nearly half of all vaccine skeptics in Argentina, Bolivia, Brazil, Chile and Colombia stated a preference for “waiting to see if [the vaccine] is safe.”

This is despite the fact that the vaccines used in the region, with the exception of Cuba’s homegrown ones, have been used the world over for almost a year.

These opinions have remained relatively stable over time, suggesting the existence of a hard core of doubters who may hinder the full implementation of vaccination plans. Here too there is regional variation. In Argentina, for example, the willingness to be vaccinated varies from 78% in Buenos Aires to 60% in the more remote province of Misiones, to 64% in Rio Negro. A combination of skepticism and lack of access could be lethal for these areas, meaning different parts of the country will leave the pandemic behind at differing speeds.