Latin America fully vaccinates 15% of its population as variants advance | Society

About one in six people in the continent where the pandemic fire is still alive already has a full vaccination schedule. The flip side of this data: more than 80% of Latin Americans still do not have full access to the only solution that humanity has found for the moment to covid. The variation between countries is, yes, considerable. While in Chile or Uruguay more than half of the citizens have all the necessary doses, in Honduras, Guatemala or Venezuela this figure does not even reach 1%.

The view of people with at least one dose in their body is more encouraging, but it reproduces the same patterns of inequality. Chile, Uruguay and the Dominican Republic are followed by Argentina, Brazil and (a little further) Costa Rica.

In all of them, but especially in the first two, the gap between people with a certain dose and those with a full directive is greater than their neighbors. Argentina has the biggest difference: 40% with a certain dose, and among them only a quarter (10% of the total) with full immunization.

These differences are due to the different approaches that countries have followed in the face of a reality that few have escaped on the continent: the lack of availability of vials during the first months of vaccination. Peru, Colombia or El Salvador have much more equal values, which denotes a vaccination practice that ensures second doses rather than first. It is perhaps no coincidence that these are countries with low income and lower spending capacity.

Uneven evolution

From the beginning, and still today, the availability of vaccines has been marked by the conditions of departure of the countries. Not only the readiness for investment, but also the ability to activate the necessary processes at all levels to execute a policy of unprecedented complexity: it begins in negotiations that have both a diplomatic and a diplomatic component. public-private collaboration, it continues in logistics and transport. and ends locally, with the capacity of the health system permeating every step.

With this interplay of factors, the different trends within Latin America were settled, grouping the countries together. Chile and Uruguay were in the lead. The two countries are not as densely populated, at the top of the income distribution, with low poverty rates and strong primary health care systems. Both also with a good margin of diplomatic movement which, with the fiscal capital available, allowed them to act to avoid the restriction of the initial offer.

Argentina and Brazil have a larger absolute investment space but much more limited in relative terms, measured per capita, and especially in relation to the logistical and social challenge of vaccination in the two countries, in particular in the second. The space for diplomatic maneuver is, paradoxically, less for both, although they are more important players at the international level. In the search for vaccines, when they were scarce, it seems that the small scale played in favor of agility.

Mexico and Colombia are a little lower, characterized by heavier diplomacy and particularly unequal systems (also in terms of health coverage, especially for Mexico), without significant fiscal capacity. They are followed by Peru, Bolivia and Ecuador, with higher poverty rates, less logistics and health capacity than their neighbors, and little power to move in spending and diplomacy.

But at least all of the above (along with El Salvador, Costa Rica, Panama, Cuba and especially the Dominican Republic) have succeeded in producing a curve of administered doses per capita that increases, seeking a gradual increase. Poorer nations like Venezuela, Guatemala, Honduras, Nicaragua or Paraguay have remained anchored in much slower developments for the moment. None of them have even 3% of their population fully immunized, according to the most recent data provided by each government.

Better and worse vaccines?

Doubts about the differentiated quality of the vaccines have already arisen with the comparisons made on the efficacy proven in the phase three studies at the end of 2020: those which apply doses to thousands of people, and many others a placebo , to check how much it costs reduced the likelihood of contagion, symptomatic covid, severe disease development and even death. The results were expressed as percentages that precisely indicated this reduction: thus, for example, a 95% efficiency for severe covid meant that the probability of developing it was twenty times lower for the vaccinated person compared to the unvaccinated person. . The game of putting one percentage next to another has never had strong empirical support, as each phase three study was carried out in different countries, and therefore in different social and contagion contexts. But he had an easy answer as long as the supply restriction was maintained: the right vaccine was the one that arrived.

However, as the bottleneck has been loosened and variants such as alpha, delta, or lambda have been found to be slightly (not by much, in light of the available data) better at spreading even among vaccinees, the argument against the comparison has weakened and the temptation to maintain it has grown.

The main loser of this game was Coronavac. The Chinese laboratory Sinovac was the first to supply doses to both Chile and Uruguay, which supported their strong growth there. He also solved much of the ballot for Colombia, among other countries in the region. However, relatively low reports of a reduction in the likelihood of contagion in some preliminary studies (50.6%) weighed on its image, as did the lack of transparency from Chinese authorities.

But the data coming from Chile and Uruguay do not justify much of this burden. Conversely: en los meses pasados, Coronavac ha demostrado una alta efectividad (equivalent to the eficacia mencionada, pero con una crucial diferencia: esta vez no son estudios controlados con miles de personas, sino agregaciones de millones en el mundo real, con la vacuna in service). The reduction in the likelihood of cases is approximately 60-64%, comparable to Jannsen or AstraZeneca vials. But, more importantly, the percentage reaches and exceeds 90% in severe illness. This means that between 9 in 10 (Chile) and 19 in 20 (Uruguay) deaths due to covid were avoided. As in both countries the current wave has been particularly intense, many lives are potentially saved.

In sum, the two vaccines are almost identical (and so far extremely effective) in protecting against serious disease, and this trait is shared by all the others used in the region. That is to say: if there is a debate on the “best” and “worst” vaccines, this should be limited to the public health objective of avoiding infections in order to reduce the mutation space of the vaccine. virus. And while there are indications that some versions (especially those based on mRNA) are somewhat better than others in this regard, none seem trivial on this front. To maintain this safety, it certainly helps to continue collecting data and strengthening genomic surveillance systems in the region to “hunt” mutations and variants with the power of immune evasion on the fly. Until a significant loss of protection is proven, and while more than three-quarters of Latin America still do not have a comprehensive guideline, access will continue to be the main driver of immunization strategies. on the continent.