The Delta coronavirus variant that has rapidly become dominant across much of the world is exacting a grim toll on dozens of developing countries, where vaccination levels are insufficient to prevent a surge in cases from becoming a wave of deaths.
As economies in Europe and the US that have successfully weakened the link between infections and deaths have started to reopen, poorer countries with low vaccination rates are in some cases entering their worst phase of the pandemic.
“The world thinks this epidemic is over,” said Fatima Hassan, founder of South Africa’s Health Justice Initiative. “But we still don’t have enough vaccine supplies in the system despite the global realisation that the Delta variant is so devastating.”
The Delta variant first identified in India accounts for 95 per cent of cases in South Africa where the genetic code has been sequenced. Fewer than 3 per cent of people are fully vaccinated in South Africa, where the rollout of the jab has been hampered by supply failures and, more recently, a wave of political violence.
Ninety-nine per cent of sequenced cases in Indonesia, where just 6 per cent of the population is fully vaccinated, are the Delta variant. Both South Africa and Indonesia have reported record numbers of cases this month. In Indonesia, the total of 54,517 cases recorded on July 14 alone was four times the level in January.
The same pattern is evident across much of Africa, which last week recorded a 43 per cent week-on-week rise in Covid-19 deaths, according to the World Health Organization. Five countries — Namibia, South Africa, Tunisia, Uganda and Zambia — accounted for 83 per cent of the deaths.
Africa has recorded 1m new cases over the past month, the shortest time it has taken to add that number, bringing total infections across the continent above 6m.
“The double barrier of vaccine scarcity and treatment challenges is seriously undermining effective response to the surging pandemic,” said Matshidiso Moeti, the WHO’s regional director.
She blamed the upsurge on the more transmissible Delta variant and public fatigue at measures such as mask-wearing after more than a year of on-off lockdowns. The Alpha and Beta variants, first identified in the UK and South Africa respectfully, had also been widely detected, she said.
In Europe, the UK and Portugal are among those facing mounting Delta variant infections, but high vaccination rates have damped the impact.
In the UK, where more than half the population has been fully vaccinated, the deaths-to-cases ratio has fallen from about one in 50 during the winter wave to one in 750. Despite UK daily case rates of more than 40,000 — a figure that before the vaccines rollout would have led to about 800 deaths a day — the current daily tally is about 50.
In contrast, Namibia, with only 1.2 per cent of the population vaccinated, is recording one death for every 22 cases. Namibia’s daily rate of 28 Covid deaths per 1m people is the highest in the world, and far above peak levels recorded in the UK and Italy.
Tunisia, where a surge in infections is killing people faster than at any time during the pandemic, has the world’s second-highest Covid death rate. In Mexico, an estimated 84 per cent of cases are Delta infections, a possible warning that the variant could take hold in Latin America too.
Trudie Lang, director of the Global Health Network at the University of Oxford’s Nuffield Department of Medicine, said the Delta variant was an important factor in the upsurge, adding that new mutations would continue to gradually drive out old ones.
But it was important not to look at Delta in isolation, she stressed. Declining adherence to social distancing measures in poorer countries, where many people had to work to live, were playing a big role in rising deaths, she said.
“We are tired because everyone wants to go on holiday and our children want to go to music festivals,” Lang said of the impact of lockdowns in wealthier countries. “But if you’re a normal family trying to scrape a living together in a favela in Rio [de Janeiro] or a market stall in Dhaka then fatigue at lockdowns is a whole different story.”
In South Africa, the situation is especially acute in Gauteng province, where not only cases but hospitalisations and deaths have reached record levels. There are more than 8,000 Covid patients in the province’s hospitals, with more than 100 deaths a day.
Hassan, of the Health Justice Initiative, said vaccine suppliers, which had not fulfilled their contracts to South Africa and some other poor countries, bore a huge responsibility for what she described as an engulfing crisis.
In South Africa, months of lockdown had contributed to the anger that recently poured on to the streets in a wave of looting and destruction, she said.
“Had we had enough vaccine supplies a few months ago we would have been in a much better position to mitigate the impact of the Delta variant,” she said. “Vaccine companies get to play God in a pandemic. Where is the world? Why don’t they send us 50m vaccines? We really need it, right now.”