One afternoon a couple months ago, hijackers commandeered a truck just east of Mexico City and hauled off its cargo. It wasn’t cash or jewelry but doses of ordinary flu vaccine so scarce in Mexico this year that there’s a black market for it in what many worry is an omen for Covid-19 vaccination.

In Brazil, the region’s other behemoth, President Jair Bolsonaro, who belittles masks, is vowing not to get a Covid vaccine, causing health officials to worry that his loyal supporters might follow suit. In Bolivia, the government has approved ingesting chlorine dioxide — bleach — against the virus, widely considered useless and dangerous.

Arguably, no region in the world has been hit as hard by the virus as Latin America. At the best of times, its health systems are wobbly. This pandemic year, with Brazil registering the world’s second-highest Covid death toll and Mexico the highest case-fatality ratio, they’re unraveling, aggravating rising inequality, crime, economic decline and public mistrust. With 8% of the globe’s population and 30% of its Covid deaths, Latin America is facing the pandemic’s next phase — mass vaccination — with alarm.

“Vaccine distribution will be complicated in developed countries but in Latin America you have to add a lack of transparency, lack of governance and corruption,” said Sergio Litewka, director of global bioethics at the University of Miami. “Will the same people who were incapable of handling the pandemic be able to handle the vaccine?”

There are problems that will affect all countries. Pfizer Inc. just announced that supply chain snags will halve this month’s distribution from original plans. INTERPOL has issued a global alert saying organized crime networks are targeting Covid-19 vaccines, both physically and online, around the globe.

But Latin America, apart from a couple countries, appears more vulnerable than other regions. The virus has set back decades of gains in democracy and equality, and nearly tripled the number facing food insecurity. Given how poorly the region has fared over the past nine months and the ultra-cold equipment needed to store and transport two of the proven vaccines, many of its health leaders expect it to lag behind, with the risk of more virus waves still ahead.

Of the three vaccine front-runners, Pfizer’s and Moderna Inc.’s have shown 95% effectiveness but their costs and the temperature requirements might prove prohibitive. That leaves AstraZeneca Plc. The shot developed with the University of Oxford accounts for more than 40% of the supplies going to lower- and middle-income nations, based on deals tracked by London-based research firm Airfinity Ltd.

Read More: Tracking the Coronavirus Vaccines That Will End the Pandemic

Health ministries across the region say they are gearing up with equipment, distribution points and plans to mobilize the military. Some have deals with big drug companies, most are part of Covax, a World Health Organization endeavor to help less well-off countries obtain vaccines speedily and at low prices.

But many in the know are worried.

Jorge Martin Rodriguez, professor of public health policy at Javeriana University in Bogota, says it will probably be 2022 or 2023 before Colombia is protected, something many don’t seem to realize.

“That hasn’t been mentioned much and it’s something to which we need to bring awareness,” Rodriguez said in a phone interview. “The risk will fall only when we reach herd immunity, ideally through vaccination.”

He estimates 45% of the population will acquire immunity through vaccine or infection next year, meaning restrictions will need to remain.

Mexico and Argentina signed a deal in August with Astra through billionaire Carlos Slim’s foundation to fund the production of as many as 250 million doses. Brazil is hosting phase 3 trials for Pfizer, AstraZeneca, Sinovac and Janssen.

In theory, Brazil should fare better vaccinating its 210 million people than it did containing the disease. According to a dozen health experts consulted, its five-decade-old immunization program, which operates 35,000 outposts, is in sturdy shape. Even in this difficult year, the government reached 90% of the people it intended to with the annual flu shot.

Vice President Hamilton Mourao said on Monday the country should vaccinate 150 million people by the end of 2021. The government, which is mostly relying on the AstraZeneca shot, is now also in talks to purchase 70 million doses from Pfizer.  

But recent mishaps are causing concern. Last month, it was reported that there were almost 7 million high-quality Covid tests sitting unused in a Sao Paulo airport, with most of them set to expire by January.

“I had no idea that was even there,” said Carlos Lula, health secretary of the northern state of Maranhao and president of Conass, the association of the country’s state secretaries. “We had been pleading with the health ministry for more tests.”

Like the U.S., Brazil is a federal system and the central government may or may not play a major role in health care. Governors implemented measures as they saw fit, asking the country’s supreme court to ensure Bolsonaro would not overrule them in his push to get people back to work. As a result, the virus behaved differently across the nation’s 27 states, a first wave that folded into a second in what some have described as a “tsunami” of infections.

Talks between the health ministry and states remain stalled and there are disagreements over whether to use the Chinese vaccine, CoronaVac, which Sao Paulo state says will begin to be deployed on Jan. 25. The expectation is that Brazil will need more than one vaccine to cover the whole country.

“We’ll have to get creative — applying vaccines at home, in drive-throughs, churches, stadiums,” said Juarez Cunha, the head of the Brazilian Society of Immunization. “We’ve done it before, and we’ll have to do it again.”

In next-door Argentina, Adolfo Rubinstein, a former health minister, said he doesn’t expect mass vaccination across Argentina until the second half of 2021 partly because of the need for the low-temperature freezers.

“There aren’t so many freezers available, particularly in the most distant, rural areas,” he said. Noting that winter, along with its spike in cases, will start in the Southern Hemisphere as vaccine distribution begins, he added, “It’s very likely that, starting in April, you’ll start to see a new outbreak of cases.”

AstraZeneca is among the pharma companies supplying Covax, the WHO effort, which will accelerate the production of Astra or Novavax shots for low- and middle-income nations, priced at a maximum of $3 per dose. Sanofi and partner GlaxoSmithKline have also signed on. As the shots become available, Covax will distribute them at the same rate until all countries have enough doses to cover 20% of their populations.

Read More: Covid Vaccine Rush in China Raises Fears of Booming Black Market

In Mexico, the government says more flu shots will be available in the coming weeks, blaming the slow deployment on one of the largest producers, Sanofi Pasteur Inc. Sanofi says its supply chain was affected by the pandemic.

“It’s been a complete failure, there are no flu vaccines,” said Francisco Moreno, head of internal medicine at ABC Medical Center in Mexico City. “Mexico is gearing up for another disaster because we couldn’t control the Covid pandemic and we didn’t prepare the population against the flu.”

There are a couple bright spots in the region.

Uruguay has the lowest infection and mortality rates in South America thanks to one of the best health-care systems and widespread adoption of voluntary social distancing policies. The country of 3.5 million closed its borders early and plans to keep them closed over the Christmas tourism season. President Luis Lacalle Pou said the government expects to have a vaccine available as soon as April.

And in Chile, which had some tough Covid months, Josefina Bascunan, head of academic, research and strategic alliances at Hospital del Trabajador in Santiago, said the flu vaccine went well this year and she believes the government can put in place a strong coronavirus vaccination strategy.

More typical however, is Peru, which has suffered mightily under Covid despite stringent lockdown efforts and now looks to vaccination with concern.

Victor Zamora, a recent health minister, said congress — which recently impeached a president — hasn’t yet debated legislation to fast-track the approval for new vaccines. He added that 70,000 nurses and a great deal of equipment need to be mobilized.

“You can’t expect this fragmented, bureaucratic, slow, politicized state to guarantee you modern, executive logistics,” he said by telephone. “I’d prefer the private sector do it even if it costs more money. Just in masks and gowns in the public sector, there is enormous loss because of theft, corruption and mismanagement.’’

“If the private sector can get a Coca-Cola to the remotest point on this map of Peru, and I can’t get there with a paracetamol, we’re doing something wrong and they’re doing something right.”



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