GIGA Focus Lateinamerika
Nummer 5 | 2021 | ISSN: 1862-3573
Da die Infektionsraten in großen Teilen Lateinamerikas zurückgehen, scheint die Region eine Atempause von der COVID-19-Pandemie zu bekommen. Der Zugang zu Impfstoffen ist jedoch sowohl innerhalb der einzelnen Länder als auch zwischen ihnen ungleich verteilt, und die Immunisierungsraten durch Impfungen sind sehr unterschiedlich. In Verbindung mit dem Auftreten der hochansteckenden Delta-Variante sind neue epidemiologische und politische Herausforderungen zu bewältigen.
Mit 45 Millionen registrierten Infektionen und fast einem Drittel aller COVID-19-bedingten Todesfälle weltweit ist Lateinamerika zu einem globalen Hotspot der Pandemie geworden.
Chile und Costa Rica haben höhere Impfraten als Deutschland oder die Vereinigten Staaten, aber die Hälfte der lateinamerikanischen Bevölkerung hat noch immer nicht ihre erste Impfung erhalten. Zu Hilfe kommt dabei nun die große Zahl der Menschen, die durch eine frühere COVID-19-Infektion eine gewisse Immunität erworben hat – und die weit über die in den offiziellen Statistiken erfassten Fälle hinausgeht.
Die Impfdiplomatie hat ihren Charakter geändert. Ursprünglich war Lateinamerika auf Impfstofflieferungen aus China, Indien und Russland angewiesen. Inzwischen sind die USA und die multilaterale COVAX-Initiative zu den größten Gebern avanciert. Die Politik wird sich auf die daraus resultierende Mischung von Impfstoffen mit unterschiedlicher Wirksamkeit und unterschiedlicher internationaler Anerkennung einstellen müssen.
Um die externe Abhängigkeit zu verringern, muss die Region ihre Kapazitäten für die Entwicklung und Massenproduktion von Impfstoffen, Diagnosegeräten und mRNA-Technologie ausbauen. Die in Kuba entwickelten Impfstoffe können Teil des Impfstoffportfolios werden, das der Kontinent in den kommenden Jahren benötigen wird.
Die Pandemie hat die strukturellen Schwächen der Region aufgedeckt. Die Mittel für die öffentliche Gesundheit müssen aufgestockt werden; die während der Pandemie getroffenen sozialpolitischen Ad-hoc-Maßnahmen sollten genutzt werden, um die sozialen Sicherheitsnetze auf Dauer tragfähiger und integrativer zu machen.
Um die Pandemie einzudämmen, ist eine intensive Impfkampagne weiterhin unerlässlich. Da die Immunität – sei es aufgrund einer früheren Infektion oder einer Impfung – mit der Zeit nachlässt, werden Impfungen in die routinemäßige Gesundheitsvorsorge zu integrieren sein. Die verstärkte Zusammenarbeit über ideologische Links-Rechts-Dichotomien hinweg bei der epidemiologischen Diagnose, der Forschung, der Impfung und der Gesundheitsversorgung, sollte sowohl in der Region als auch bei den internationalen Partnern zu einer Priorität werden.
Despite being home to just 8.4 per cent of the world’s population, Latin America and the Caribbean has accounted for almost one-third of COVID-19-related deaths to date. This includes the world’s second-highest death toll on the country level (Brazil) and the world’s highest registered rate of deaths per capita (Peru; see Figure 1). The tragic milestone of a million deaths regionally was passed as early as May 2021.
The horrendous death toll in Latin America and the Caribbean comes despite a population with a median age of 31, and hence much younger than that of the United States (median age 38.5) or Europe (42.5). The case of Peru – which for years had some of the highest economic growth rates on the continent – highlights that the death toll is no mere function of gross domestic product. Instead, the pandemic has brutally exposed the region’s structural weaknesses: strained and underfunded healthcare systems, late and limited access to vaccines, deep-seated social inequalities, extensive informal-labour practices, unhealthy diets leading to widespread obesity, insufficient state capacity, and incoherent policies have all contributed to this painful outcome.
Beyond the epidemiological drama, the economic and social fallout from disrupted global trade and travel as well as from lockdown measures has been enormous, from steep economic decline, to psychological suffering, to lost educational potential. A recent study estimates that 22 million more people fell into poverty in the region in 2020, with a significant impact on children (ECLAC and PAHO 2021: 3). It also stressed that in what is the world’s most unequal region “socioeconomic vulnerability is highly correlated with the severity of COVID-19 infection and mortality” (ECLAC and PAHO 2021: 18).
The COVID-19 pandemic has also shown that early advances are not the same as long-term success. Israel, the United Kingdom, and the US had been frontrunners in the vaccination drive; by late 2021, however, not only have their vaccination rates become stagnant but their COVID-19 infections per capita are higher than those of South America. Certainly, significant undercounting due to insufficient testing or test avoidance must be taken into account here. But still: while in Israel, the UK, and the US infection rates have gone up since summer 2021, in South America reported infection, hospitalisation, and death rates have all been in decline. There are three main factors likely explaining this trend:
The seasonal effect, since the Southern Hemisphere is now past winter season.
The progress of vaccination campaigns. Most Latin American countries have by now attained vaccination coverage rates of around 30 to 60 per cent of their populations, which is far higher than in other tropical regions such as sub-Saharan Africa.
A large share of the population have acquired some level of immunity from having experienced infection, whether diagnosed or not.
However, the highly contagious Delta variant of SARS-CoV-2 – a so-called variant of concern (VOC) which has swept most of the world already – is only now making its full entry into South America. It arrived earlier this summer in the Caribbean, which in its wake would see soaring infection rates. Barbados currently tops global tables with a seven-day incidence rate of more than 700 infections per 100,000 people.
So how much light is there at the end of the tunnel for Latin America? Is the worst over, really? To tackle this question we look at the uneven vaccination process in the region; at the heterogenous levels of past infections conferring some level of immunity; at the delayed arrival of the Delta variant in parts of the region; and, at the complex mix of vaccines applied and the implications hereof. We then address the need to strengthen pandemic preparedness to overcome external dependence, before finally identifying necessary steps towards rectifying the societal and economic damage the pandemic has wreaked regionally.
The absolute scarcity of vaccines marking the initial phase of the pandemic has since given way to a highly uneven process of vaccination in the region – between countries, within countries, and also with regards to the types of vaccines available. In the last few months, almost all Latin American countries have significantly advanced their vaccination programmes (see Figure 2 below). But it is worth distinguishing between three sub-regions here:
Across South America, almost two-thirds of the population have received at least their first shot; only Venezuela’s vaccination rate is below the global average.
In Central America the picture is mixed: significant progress in Costa Rica, El Salvador, and Panama; low vaccination rates in Guatemala, Honduras, and Nicaragua; in Mexico, a middle ground has been reached, being almost on par with Colombia and Peru but clearly below South America’s leaders Argentina, Brazil, Chile, and Uruguay.
In the Caribbean, initially clever vaccine diplomacy made a number of states vaccination pioneers (Hoffmann 2021). However, these campaigns soon stagnated; by now, vaccination rates largely trail behind those on the Latin American mainland. Cuba is a notable exception: it started vaccination later than others, but almost 90 per cent of the population have received at least a first dose.
In many places, vaccine availability is still a bottleneck. Another issue – also very unevenly distributed – is vaccine hesitancy. In Brazil, for instance, public-health institutions have a long-standing reputation for social progress, and over the decades vaccinations have acquired broad acceptance. This has prevailed over social media disinformation and the negationist attitude of the federal government. The metropoles Rio de Janeiro and São Paulo by now boast higher vaccination rates than Berlin or New York.
Nevertheless in other countries, including many in the Caribbean, health authorities are battling with vaccine scepticism, even as the Delta variant sweeps the region with force. In the small island state of Dominica, for instance, as early as 1 April 2021 some 25 per cent of the population had received their first jab, putting the country at the vanguard. However since then the vaccination campaign has advanced at snail’s pace: standing at less than 35 per cent by 1 October 2021. Dr. Carissa Etienne, Director of the Pan American Health Organization (PAHO) and herself a native of Dominica, recently noted: “Even when vaccines are available, persons are not coming forward” (PAHO 2021).
In Jamaica, the vaccination rate is lower still. Less than 10 per cent of the population have been fully vaccinated. According to one 2020 survey, 72 per cent of Jamaicans reportedly said they would not accept a COVID-19 vaccine (cited in CARPHA 2021: 2). However, surveys fail to provide satisfactory explanations. In the one carried out by the Caribbean Public Health Agency, respondents most often offered the standard answers: that they were concerned about possible side effects; did not know enough about the vaccine; thought the vaccine was developed too quickly (CARPHA 2021: 11). But in none of this – nor in its exposure to social media – does the region differ from the rest of the world. Instead, it seems likely that part of the mistrust is rooted in a history of racialised, colonial public health – including unethical healthcare research among Afro-descendent populations.
Since this summer the Delta VOC’s predominance has been observed globally, however not (yet) in all of South America. In Colombia the Mu variant still dominates, in Bolivia the Gamma variant, while in Peru the Lambda variant maintains a strong presence. Whether these have delayed the rise of the Delta variant or whether its late introduction is simply a matter of reduced international connectivity remains a matter of debate. Nonetheless, there is little doubt that the increased transmissibility of the Delta variant will lead to its dominance in those countries eventually.
In Mexico, where the Delta variant became dominant over the course of this summer, COVID-19 infection rates have gone up – but not dramatically, and not for long. Argentine health minister Carla Vizzotti warned that it will be impossible to prevent the Delta variant from circulating in the country; indeed, it has come to represent 50 per cent of cases in the latest samples. In Brazil, many feared that the Delta variant would produce another wave of devastation in a country which has already mourned 600,000 dead. However, even with the Delta variant fully dominating by now and despite a relaxing of social-distancing measures so far no major increase in infection rates has been seen.
This is all the more remarkable as in the Caribbean the picture is the absolute opposite. The latter had passed impressively lightly through the early waves of the pandemic compared to mainland Latin America. However, this changed when the Delta VOC reached the Caribbean’s islands this summer. The first country hit was Cuba, where spiralling infection rates brought the island’s healthcare system to the brink of collapse. More recently, it has been the island states of the anglophone Caribbean seeing an explosion of cases – battering their healthcare systems and putting them among the countries with the world’s highest per capita incidences of infection (Figure 3).