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The Pandemic Has Split in Two

Zero deaths in some cities. Thousands in others. The pandemic’s fault lines continue to widen as vaccines flow toward rich countries.

20%

40%

60% have one vaccine dose

40

80

120

160

200 new cases per 100,000

More vaccinated
More cases

Many wealthy cities are making dramatic progress slowing Covid-19. As they vaccinate more people →, cases have started to drop ↓.

Tel Aviv, one of the most vaccinated cities in the world, counted just two cases on Wednesday. Los Angeles turned a corner this spring, and is now vaccinating those as young as 12.

But outbreaks are devastating India and much of South America, and there aren’t nearly enough vaccines available to stop them.

The pandemic’s disparities have never been this stark.

Much of the world’s vaccine supply continues to be used or stockpiled by countries that have already made steady progress, even as outbreaks in the developing world are raging. With almost half of residents vaccinated, New York City and London are preparing to welcome tourists this summer, while Cape Town waits to administer its first vaccine doses to non-medical workers.

Vaccines are not the only tool to control the spread of infection, and some areas — particularly those across Asia and Oceania — have kept cases low without them. But this year, no factor has determined a nation's path out of the pandemic more than the vaccines it can buy.

It wasn’t always this way. A few months ago, outbreaks were exploding across major European and North American cities, and fledgling inoculation campaigns were no match for the spread of new variants. India’s leaders, meanwhile, boasted that they had triumphed over the virus.

But an analysis of vaccination campaigns and case trajectories across 22 global cities shows how the picture has changed over the last few months. Cases remain an imperfect measure — rates of testing vary widely and many infections are missed. But the broad outlines are unmistakable: The pandemic is splitting into haves and have-nots.

Where vaccines are too slow to tame devastating outbreaks

20%

40%

60% have one vaccine dose

40

80

120

160

200 new cases per 100,000

Goa

Delhi

Bogotá

São Paulo

Buenos Aires

More vaccinated
More cases

Two countries with surging epidemics have played central roles seeding outbreaks across their regions: India and Brazil. Neither is vaccinating fast enough to keep things under control.

In India, infections have skyrocketed across Delhi and Goa, and outbreaks are spreading quickly to more rural areas, in one of the deadliest waves since the start of the pandemic. Testing is spotty, and the case numbers only hint at the true scale of the problem.

“Every event in India is a super-spreader event,” said Dr. S.V. Subramanian, a professor of population health and geography at Harvard University.

India started vaccinating later than many major Western nations, and just 10 percent of its 1.4 billion people have received at least one dose. And the pace of vaccinations has slowed dramatically in recent weeks, even as the country halted vaccine exports to vaccinate more people at home. Donated vaccines from the United States and other countries are too few to stop the current epidemic.

Now India’s outbreak, along with a potentially more contagious variant of the virus first detected there, appears to be spreading to neighboring countries, which are once again imposing strict national lockdowns.

An uncontained outbreak in Brazil has helped to spur a new wave throughout Latin America, which was already one of the hardest-hit regions in the world. Vaccines are limited, health care systems are weak, and the political will to keep people home and economies closed has waned.

Where vaccines have helped make dramatic progress

20%

40%

60% have one vaccine dose

40

80

120

160

200 new cases per 100,000

New York City

London

Los Angeles

Tel Aviv

Santiago

Miami

More vaccinated
More cases

In New York City, London and Tel Aviv, nearly half of residents have received a first dose of a vaccine. Those rates, paired with significant natural immunity acquired from past outbreaks, have helped to push down outbreaks to levels not seen for a long time.

Vaccines did not act alone. Restrictions were critical in bringing case numbers down from their peaks, experts say.

From January through early April, the United Kingdom implemented a strict national lockdown, closing schools and nonessential shops, and ordering everyone to stay at home. Israel tightened restrictions in early January, even as vaccines were being rapidly doled out. And Los Angeles faced stay-at-home orders until late January, by which point cases had fallen by about half since their peak earlier that month.

The rapid vaccination campaigns in these cities and others like them means they are likely to be shielded from dire outbreaks in the future.

The picture looks slightly different in Santiago, Chile, where cases recently saw a slight uptick despite high vaccination rates.

Part of the difference may be due to Chile’s reliance on the Sinovac vaccine, which has a comparatively low efficacy rate after just one dose. Still, data shows the vaccine rollout appears to be working: Cases, deaths and hospitalizations are falling among older Chileans, those most likely to be fully vaccinated.

Where cases are few, and so are vaccines

20%

40%

60% have one vaccine dose

40

80

120

160

200 new cases per 100,000

Auckland

Hong Kong

Bangkok

Seoul

More vaccinated
More cases

Some of the world’s slowest vaccine rollouts are in places that have had the most success in controlling the virus. In much of East Asia and Oceania, control measures have kept community transmission almost completely at bay.

Vaccination rates in the region lag behind other wealthy countries, in part because the comparatively low infection rates make the vaccine rollout less urgent. Countries like South Korea and Japan — where just 7 percent and 3 percent of their populations have received at least one dose — also rely on vaccines developed and manufactured elsewhere.

Governments that have successfully managed the virus this long may have success maintaining low transmission to accommodate slower vaccination campaigns. But even small outbreaks offer a warning sign that slow vaccination efforts leave them vulnerable.

Bangkok is battling its largest outbreak since the pandemic began, recording nearly half of Thailand’s new cases. Officials said new clusters were detected in some of the city’s most crowded communities, and now the outbreak threatens two major prisons. Schools, cinemas, gyms, pubs and bars in the capital remain closed, and if there are two or more people in cars — even family — they must wear masks.

Where outbreaks remain uncertain

20%

40%

60% have one vaccine dose

40

80

120

160

200 new cases per 100,000

Istanbul

Stockholm

Toronto

Prague

Rome

Paris

More vaccinated
More cases

Other major cities are in a holding pattern: Their vaccine rollouts are not among the world’s fastest, but at least 10 percent of their population is fully vaccinated, better than most of the world. Outbreaks continue to simmer, but new case counts are much lower than at the worst points during this winter and spring.

But the progress is tenuous. Cases are comparatively low in Rome, Prague and Paris, but so are vaccination rates, leaving those cities vulnerable to another surge. Toronto has extended lockdowns. Istanbul’s cases have dropped after a national lockdown, but reporting from Turkey has been inconsistent throughout the pandemic, making it unclear how much of its outbreak has receded.

Several countries in Africa have some of the lowest vaccination rates in the world. A global vaccine-sharing effort known as Covax has only been able to deliver limited numbers of vaccines, and in many African nations, only health care and frontline workers have been inoculated.

Globally, 18 vaccine doses have been administered for every 100 people, but that number is just 1.6 doses for every 100 African residents, more than 30 times lower than the North American rate. In Nigeria, Ethiopia, Egypt and the Democratic Republic of Congo, the continent’s most populous countries and together home to half a billion people, just over 4.3 million doses have been distributed.

Case counts are currently low, but experts warn that data is spotty and testing capacity is particularly limited across much of the continent, making it difficult to assess the current trajectory. But the slow pace of vaccinations leaves the continent susceptible to more outbreaks.

Methodology and sources

The cases, vaccination and population data were collected individually for each location. Population figures in each area reflect all age groups, not just those that are vaccine-eligible. Daily totals for cases and deaths are often revised when new data arrives. The data on this page represents the best historical data we were able to collect. One vaccine dose includes the first dose of a multi-dose vaccine or the single-dose Johnson & Johnson vaccine.

Auckland, New Zealand ·

Cases and vaccination: New Zealand Ministry of Health; Population: Stats NZ Tatauranga Aotearoa.

Data covers Auckland District Health Board from April 6 to May 11, 2021.

Bangkok ·

Cases: Open Government Data of Thailand; Vaccination: Department of Disease Control, Thailand; Population: National Statistical Office of Thailand.

Data covers Bangkok Province from March 1 to May 9, 2021.

Bogotá, Colombia ·

Cases and vaccination: Instituto Nacional de Salud; Population: National Administrative Department of Statistics of Colombia (DANE).

Data covers Bogotá Capital District (Distrito Capital) from Feb. 17 to May 2, 2021.

First doses for Bogotá, where only total dose numbers are available, have been approximated based on the current ratio of first doses to second doses nationwide.

Buenos Aires ·

Cases and vaccination: Buenos Aires City Ministry of Health; Population: The City of Buenos Aires.

Data covers Buenos Aires City from Dec. 29, 2020, to May 11, 2021.

Delhi, India ·

Cases: The Center for Systems Science and Engineering at Johns Hopkins University; Vaccination: Geographic Insights Lab, Harvard University; Population: ESRI.

Data covers NCT of Delhi from Jan. 22 to May 7, 2021.

Goa, India ·

Cases: The Center for Systems Science and Engineering at Johns Hopkins University; Vaccination: Geographic Insights Lab, Harvard University; Population: ESRI.

Data covers Goa State from Jan. 22 to May 7, 2021.

Hong Kong ·

Cases: The Center for Systems Science and Engineering at Johns Hopkins University; Vaccination: Hong Kong Special Administrative Region Government; Population: National Bureau of Statistics of China.

Data covers Hong Kong Special Administrative Region from Feb. 22 to May 11, 2021.

Istanbul ·

Cases and vaccination: Turkish Ministry of Health; Population: Istanbul Health Ministry.

Data covers the city of Istanbul from Feb. 12 to May 7, 2021.

London ·

Cases: Public Health England ; Vaccination: NHS England; Population: Office for National Statistics.

Data covers London from Jan. 17 to May 11, 2021.

Los Angeles ·

Cases: New York Times database; Vaccination: Los Angeles County Department of Public Health; Population: U.S. Census Bureau.

Data covers Los Angeles County from Dec. 14, 2020, to May 7, 2021.

Miami ·

Cases: New York Times database; Vaccination: Florida Department of Health; Population: U.S. Census Bureau.

Data covers Miami-Dade County from Dec. 14, 2020, to May 11, 2021.

New York City ·

Cases: New York Times database; Vaccination: New York City Department of Health and Mental Hygiene; Population: U.S. Census Bureau.

Data covers five boroughs of New York City from Dec. 14, 2020, to May 11, 2021.

Paris ·

Cases, vaccination and population: France’s Public Health Agency.

Data covers the department of Paris from Dec. 27, 2020, to May 9, 2021.

Prague ·

Cases and vaccination: Ministry of Health of the Czech Republic; Population: Czech Statistical Office.

Data covers Hlavní město Praha region from Dec. 27, 2020, to May 11, 2021.

Rome ·

Cases: New York Times database; Vaccination: Italy’s Special Covid-19 Commission; Population: Italian National Institute of Statistics.

Data covers Lazio state from Dec. 27, 2020, to May 11, 2021.

Santiago, Chile ·

Cases: Ministry of Science, Technology, Knowledge and Innovation, Chile; Vaccination: Ministry of Science, Technology, Knowledge and Innovation; Population: The National Statistics Institute of Chile (INE).

Data covers Santiago Metropolitan Region from Dec. 24, 2020, to May 11, 2021.

São Paulo, Brazil ·

Cases: The Center for Systems Science and Engineering at Johns Hopkins University; Vaccination: São Paulo state government; Population: Brazilian Institute of Geography and Statistics.

Data covers São Paulo state from Jan. 17 to May 11, 2021.

Seoul ·

Cases, vaccination and population: Seoul Metropolitan Government.

Data covers the city of Seoul from Feb. 26 to May 8, 2021.

Stockholm ·

Cases and vaccination: Public Health Agency of Sweden; Population: Statistics Sweden.

Data covers Stockholm County (län) from Dec. 27, 2020, to May 9, 2021.

Tel Aviv ·

Cases and vaccination: Ministry of Health and Tel Aviv-Yafo Municipality; Population: Tel Aviv-Yafo Municipality.

Data covers the city of Tel Aviv from Dec. 19, 2020, to May 10, 2021.

Toronto ·

Cases, vaccination and population: City of Toronto.

Data covers the city of Toronto from Dec. 14, 2020, to May 8, 2021.

Western Cape, South Africa ·

Cases, vaccination and population: Western Cape Government.

Data covers Western Cape province from Feb. 17 to May 8, 2021.