Globally, the picture of total exposure is somewhat murkier, thanks to far more patchwork testing regimens. There may still be relatively more immunologically naïve people elsewhere in the world than here in the United States — though not all that many. And while there is good reason to believe that at least three-quarters of the global population has now been infected with a disease that was publicly identified only about 40 months ago, an unconscionably high proportion of the world’s poorest remain unprotected by vaccination.
As of this winter, only 23 percent of people living in low-income countries had been vaccinated, according to the U.N. Development Program. And most of that vaccination came in the past year: When high-income and upper-middle-income countries reached about 70 percent vaccination at the end of 2021, low-income countries were still stuck at 3 percent. This has been called “shot-hoarding” by the world’s wealthiest; a less generous term is “vaccine apartheid.”
Early in the pandemic, it was often said that the poorest countries of the world were faring better than the richest — perhaps to some degree because of resilient public health systems and healthier social structures, but mostly because their populations were so much younger and therefore less vulnerable. But vaccine apartheid reversed those trends. According to an analysis by Philip Schellekens, an economist at the U.N.D.P., though the richest countries fared worst through the first year of the pandemic, by 2023, high-income, upper-middle-income and lower-middle-income countries were all bunched quite closely together in cumulative excess mortality. Low-income countries had roughly two-thirds as much excess mortality in 2022 as in 2021 and have already had as much this year as in all of 2020.
In much of the wealthy world, given lower death rates in an age of mass vaccination, people have mostly moved on from the pandemic emergency already. But it is much harder to see an imminent “end” in sight for the world’s poorest, especially given that the W.H.O. still describes polio — with 800 cases globally last year — as an ongoing emergency.
Overall, globally, the story looks somewhat different — and indeed a bit better. In 2020, there were just under five million excess deaths worldwide, The Economist estimates. In 2021, year two, the figure was just under 10 million. In 2022, year three, a little over six million, and this year, so far, a bit above one million. The line is pointing down, year to year. But it’s still quite far from zero. For now, at least, the endemic phase of Covid remains pretty brutal, however much suffering and disruption and anxiety is in the rearview mirror. And however much of a relief it is to leave the official emergency behind.
David Wallace-Wells (@dwallacewells), a writer for Opinion and a columnist for The New York Times Magazine, is the author of “The Uninhabitable Earth.”
