And we could be screwing this one up just as badly…

(Originally published Aug. 23 in “What in the World“) It’s starting to sink in just what bad news it is that the vaccines we have aren’t really working against the delta variant of SARS-CoV-2.

According to The New York Times, the latest studies by the U.S. Centers for Disease Control confirm what officials in Israel have been saying for a while, that “vaccines have an effectiveness of roughly 55 percent against all infections, 80 percent against symptomatic infection, and 90 percent or higher against hospitalization.”

So, the good news is that Covid vaccines are almost certain to keep you from getting so sick you have to be hospitalized or die. Whew! Party on, dude. Let’s keep re-opening borders, lifting quarantines, mask mandates and restrictions on crowds. Right?

Wrong. The vaccines are also very likely to keep you from developing symptoms. But they’re only slightly more reliable than a coin toss in determining whether or not you get infected by delta if exposed. Put another way: vaccinated people have only slightly better than even odds of catching delta, but when they do are very likely to carry it around without knowing it, enabling them to infect others, who if they’re unvaccinated are very likely to get sick, possibly very sick. And because delta is so much more infectious than its forbears, this means vaccines will do little towards achieving herd immunity. Vaccines were supposed to limit transmission without the population needing to survive an infection first. That isn’t happening with delta.

You may think that’s just tough luck for people who refuse to get vaccinated, but spare a thought for those still waiting for vaccines. That’s why plans to start offering booster shots for the vaccinated have generated howls of protest about how this will widen global vaccine inequity.

And keep in mind that, just because you don’t die or have to be hospitalized, getting Covid is still no walk in the park, according to those who’ve experienced these “breakthough infection.” The immunity that vaccines proffer fades over time, henc the call for boosters. There’s also the threat of developing so-called “long Covid.” So basically, getting delta after vaccination stands to be a lot like getting the flu: no fun and best avoided.

Worse, there’s a risk that all these infected, vaccinated people provide a vast reservoir for Covid to mutate yet again. As this excellent piece in Science explains, in the game of natural selection, this virus hasn’t even been seriously challenged yet. While one might reasonably hope that its next iteration will move towards evading immunity while becoming less deadly, there are reasons to believe that Covid might be able to have its cake and kill us, too: “In SARS-CoV-2, most transmission happens early on, when the virus is replicating in the upper airways, whereas serious disease, if it develops, comes later, when the virus infects the lower airways. As a result, a variant that makes the host sicker might spread just as fast as before.”

[Gulp.]

The problem is that the world has become divided between countries that did a lousy job of using restrictions on mobility to minimize infections but a good job of speeding vaccinations (the U.S., the U.K. and Europe—let’s call them “the West”) and those that did a great job of using restrictions to prevent infections, but screwed the pooch on vaccinating their populations (Australia, New Zealand and most of Asia—let’s call them “the East”). Both of these groups are now faces defeat by politics rather than epidemiology. Despite the risks posed by delta (and new strains), politicians in the West can’t reasonably impose restrictions or even reverse the reopening against the groundswell of public relief, and so are instead focusing on a “live with the virus” strategy, even though it’s clear that we’re now facing a very different virus than the one we developed vaccines for in 2020. Thousands more people will die, but at a much lower rate. And these nations appear to have reconciled themselves to sacrificing loved ones in exchange for being able to go mask-less to Walmart, get pissed in the pub, or ride their Harleys around the Black Hills—you know, freedom.

In the East, meanwhile, governments are reaping the dividends of their longstanding demographic dilemma. Many imposed effective restrictions, but failed to secure adequate vaccine supplies. And even those with adequate supplies have disovered that the most powerful part of their constituencies—the elderly generation that controls the preponderance of property, wealth and, in democracies, votes—isn’t all that bothered by rules against taking holidays abroad or jamming into crowded clubs. They’re old, they’re stuck at home living with their kids (now also stuck at home) and grandkids (also at home), and so weighed against the risk of a vaccine that might make them feel lousy or even kill them, the restrictions don’t represent much of an inconvenience. On the contrary, lockdown is great if you’ve been neglected at home by your busy progeny. Hence, vaccination rates among Hong Kongers aged 80 and above is below 10%, and only 24% among those aged 70 to 79.

The East’s younger generation—i.e. that minority that will inevitably inherit the property and wealth—is chafing under this gerontocratic tyranny. So are businesses in Hong Kong and Singapore that rely on their position as international hubs for trade and finance. So it seems inevitable that governments will eventually have to sacrifice their elders to the epidemiological odds. Amid public protests over lockdown measures, Australia’s prime minister is now talking about “living with the virus” once his government manages to overcome their abysmally low vaccination rate. One might argue that this is a more difficult sacrifice in “the East” to make given traditional Confucian values than it is for “the West,” and so might take longer where these value are more deeply entrenched. But Singapore has clearly done a better job of selling vaccines to its own elder and has managed to raise its vaccination rate to 74%, one of the world’s highest. It’s now moving to reopen its borders to vaccinated travelers and ease local restrictions as part of a “living with the virus” strategy.

…while one might reasonably hope that its next iteration will move towards evading immunity while becoming less deadly, there are reasons to believe that Covid might be able to have its cake and kill us, too…

This will undoubtedly be good news for Singapore’s economy. But it may prove unwise from the point of view of beating Covid. Indeed, given how little protection vaccines provide against infection by delta, letting in vaccinated travelers without quarantine seems almost certain to boost the rate of transmission to both its small minority of unvaccinated, but also its vaccinated. Most of these new local infections will show no symptoms, but the nominal number of breakthrough cases will nevertheless grow. More worryingly, it will exponentially expand the opportunities for Covid to mutate into something against which vaccines have even less effectiveness. Singapore will then be able to call itself a global hub for something truly innovative.

Perhaps the greatest cause for hope is India, which still seems to have recovered from its own delta surge (the original) and avoided what many publications have worried all too loudly might be a new surge. A month has gone by and still the numbers keep falling.

Even if you accept that the official tallies are off by as much as ten times, the trend is still noteworthy. We have to hope that India has, even with fewer than 10% of its population fully vaccinated, managed to achieve inadvertently and at a tragic cost what Sweden did intentionally: herd immunity through infection.