Covid-19 third wave: why cases are on the rise in some highly vaccinated countries

Chile and Bahrain were among the fastest to distribute the vaccine but now face rising case numbers

Nurses check equipment in an intensive care field hospital in Riffa, Bahrain on April 14, 2020. The island nation has seen a spike in cases and an average of 70 people die of Covid-19 each week. Reuters

A Saudi driver shows his vaccination certificate on a smart phone at Bahrain's immigration checkpoint on the King Fahad Causeway on May 17. Hamad Mohammed/ Reuters

A Saudi motorbike rider shows his vaccination certificate as crosses the King Fahad Causeway. The country has seen a spike in cases since the Eid Al Fitr holidays. Hamad Mohammed / Reuters

Bahrain opened leisure spaces after Eid Al Fitr to vaccinated people and people who had the virus and recovered. Getty

People ride their bikes at the sunset in Manama, Bahrain. Hamad Mohammed / Reuters

A US Navy servicewoman receives the vaccine at the Fifth Fleet's naval base in Manama, Bahrain. Brandon Woods / US Navy

Crown Prince of Bahrain Sheikh Salman bin Hamad Al Khalifa receives a Sinopharm vaccine dose in July, 2020. AFP/BNA

A woman attends her appointment for a second dose of a coronavirus vaccine at Bahrain International Exhibition & Convention Centre (BIECC), in Manama, Bahrain. Reuters

Swift vaccine distribution programmes in some countries has led to a return to near-normal life.

In Israel, people no longer have to wear masks outside, while in the UAE, vaccinated football fans can now attend games and nightclubs have reopened.

But elsewhere, countries that had effectively achieved herd immunity are seeing a third wave of cases. From Chile to Bahrain, figures are rising. And the coronavirus continues to kill an average of 10,000 per day worldwide.

So what's gone wrong?

The case of Chile has been of particular interest.

The BMJ medical journal said in April that the South American nation had experienced "one of the most successful vaccine rollouts in the world", and the latest statistics indicate that 93 vaccine doses have been administered per 100 people.

Chile's summer surge

After infections in the country surged in mid-2020, political pressure on President Sebastian Pinera is said to have driven a concerted effort to secure vaccine supplies, with negotiations taking place with multiple western and Chinese vaccine developers.

"The government started dealing with how to buy it very early, maybe from June last year, before even there were vaccines," Dr Claudia Cortes, an infectious diseases specialist and associate professor at the University of Chile, told The National.

“They decided at that moment to have conversations with different companies and get different kinds of vaccine and that’s a big difference from our other countries around.”

In its quest to gain access to foreign-developed vaccines, Chile benefited from having skilled trade negotiators and from involving itself in late-stage clinical trials, according to analysts.

The country’s “solid tradition” and long experience of comprehensive vaccination programmes helped ensure that subsequent drives went well, says Dr Cortes.

But, despite at one point trailing only Israel and the UAE in doses per capita, the country has endured high infection and death rates this year, and has recorded more than 28,000 deaths in its population of about 19 million.

Masks and rules ditched too quickly

Dr Cortes feels “miscommunication” seemed to indicate, with wide vaccine availability, risks were lessening. A sense of complacency may have developed and measures such as mask wearing became less common.

“In February, that was in the middle of our summer, the government eased a lot of the restrictions we had in terms of travel around the country,” she said.

“So, after many months of being in isolation and quarantine, they gave permission to travel inside the country. Around five million people travelled around.

"So, in that way, the virus was spread all around. Every single small village, town.”

The government has been criticised for failing to control the country’s borders, allowing the Brazilian variant to enter.

Even though case rates have been high, and there have been concerns over the 50 per cent efficacy of the Sinovac jab that's widely used in Chile, Dr Cortes says the vaccination programme has brought a reduction in hospital admissions of elderly people.

While limited in its ability to stop transmission, the Sinovac shot seems to prevent severe illness, a hopeful sign even in the midst of high case rates, she said.

Seventy die each week in Bahrain's third wave

Bahrain, another heavily vaccinated nation, with about 96 shots given per 100 people, is currently experiencing its worst surge of infections and deaths since the pandemic began. More than 70 people are dying each week in the island nation of 1.6 million, where the death toll has reached around 900.

Like Chile, Bahrain has experienced a surge that has been blamed on increased mixing among residents.

While Bahrain is advanced in its vaccination programme, only a minority of residents have had two shots.

At 79 per cent, Sinopharm has a much higher efficacy than Sinovac, although a third dose is being offered after four to six months.

Bahrain's government urged the island's residents to stick to coronavirus rules, while shutting malls, cinemas, restaurants and gyms for two weeks to tackle the surge.

The lesson from Chile is, says Dr Cortes, that movement restrictions are still needed until very high rates of vaccination have been achieved.

“When countries are getting vaccines, and more countries daily are getting more vaccines, you cannot relax,” she says.

“You need to keep taking care – wash your hands, wear your mask, avoid crowds – until 80 per cent at least of your population is vaccinated.”

In the EU, vaccination rates have picked up after a slow start that sparked criticism of the 27-member bloc’s leadership.

As an example, the Netherlands has now administered about 50 shots per 100 people and, while case rates were relatively high in April, they fell in May and deaths are at fairly low levels compared to the country’s peaks, although Europe as a whole is a mixed bag.

As Chile, Europe and some Middle Eastern nations look ahead to a time when most of their residents are fully vaccinated, in Asia, developed and developing nations are much further behind. In Japan, for example, only about 8.4 vaccine doses have been administered per 100 people.

Asian nations left behind in vaccine race

The early success of face coverings, social distancing, restrictions on international travel and well-operated test, trace and isolate systems have been credited with keeping case rates in parts of Asia low without vaccinations.

But, not having seen the huge surges in cases early in the pandemic, there was said to have been less political pressure to focus on vaccine development and on securing supplies.

The lack of domestic pharmaceutical companies on a par with the likes of Pfizer or AstraZeneca has also been cited as a factor behind the limited availability of vaccines in many nations in the region.

While Japan’s Covid-19 death total of less than 13,000 remains modest compared to many other developed nations, especially given a population size of around 127 million, the country is currently experiencing its worst surge in deaths, at almost 800 per week, illustrating its vulnerability in the absence of widespread vaccination.

In some developing Asian nations, vaccination programmes are even further behind, with Thailand, for example, having administered only 4.6 shots administered per 100 people.

After keeping total Covid-19 deaths in double figures up until the end of March, according to official statistics, the country has recently seen a surge in infections, and fatalities are now approaching 1,000.

The increase compounds the concern of residents who in some cases are not expecting to be vaccinated until late this year.

In contrast to its neighbours, China has been a vaccine powerhouse, developing and distributing its own vaccines. It has administered more doses than any other country, at over 550 million.

Beijing has even been able to engage in “vaccine diplomacy” by making supplies available to other countries, bolstering its soft power.

As countries vaccinate more of their populations, they will face tough choices over when to lift restrictions and allow life to return to normal. Experts indicate that case rates are likely to increase even within heavily vaccinated populations as the current shots do not completely stop transmission.

“At some point, we’re going to have to say, ‘Most of us are vaccinated, so if you do get an infection, you’re not likely to get as severe illness,’ take the brakes off, let it do its thing,” says Paul Hunter, an infectious diseases specialist at the University of East Anglia in the UK.

“It’s going to circulate amongst us for decades or centuries. In the short term, if we can stop people getting sick or dying, that’s as much as we can do.”