Over the last month or so, I’ve been working on my “magic spreadsheets,” seeking to re-build my picture of where we’re at in the COVID epidemic around the world. The last time I looked at the epidemic on a world-wide basis, between February and May of this year, I first looked at each of six geographical areas (Europe, Americas, Middle East/North Africa, Sub-Saharan Africa, Rest of Asia, Australasia and Oceania), then summarized the results world-wide. This time round, though, I plan to “slice and dice” the data rather differently.
I plan to present eight subsets of the data (vaccinations, cases, transmission, lockdowns, hospitalizations and intensive care, deaths, excess mortality, testing) in separate articles. Furthermore, I will seek to keep the presentations “in sync” by using the same data in all of them. The data I used, as before, comes from Our World in Data and from the Blavatnik School of Government, both part of Oxford University. This data runs up to and including Friday 20th August 2021.
Today, I’ll begin with vaccinations. The reason for starting here is that vaccination levels are mainly a function of policy and vaccine affordability in a particular country. While vaccination levels can be expected strongly to affect other measurable statistics such as case growth, hospital and ICU occupancy, and deaths from COVID, there is far less reason to expect an effect in the reverse direction. So, what happens to the COVID statistics must always be considered in the light of the vaccination situation in the country at the time.
People fully vaccinated, people vaccinated and susceptibles
Our World in Data provides daily data on two measures of vaccinations: people fully vaccinated (two jabs) and people vaccinated (one or two jabs). To enable inter-country comparisons, I always look at these measures in terms of percentages of population.
In an earlier article, I defined a measure I call “susceptibles.” This is an estimate of the percentage of the population in a country who are still susceptible to infection at the current level of vaccination. The reason for calculating this figure is that I would expect the actual reproduction rate or R-rate (the number of new infections resulting from each infection) of the virus in a particular country to be approximately the basic reproduction rate of the variant (also known as R-zero), multiplied by the proportion of susceptibles in the country.
In an earlier paper, I calculated the susceptibles measure by, first, subtracting from 100% the percentage of the population who have been reported as cases (on the grounds that only a very small proportion of people who have already had COVID get it again). I then subtracted from that figure the percentage of the population fully vaccinated, times an efficacy factor. Initially, I used an efficacy factor of 95%; however, it seems that the actual efficacy of the vaccines at limiting COVID transmission has proved to be rather lower than this. I have heard figures of around 62% to 68% for this efficacy, so I changed my calculation to use an efficacy factor of 65%. I also subtract from my susceptibles figure half this percentage (32.5%) times the percentage of the population vaccinated but not fully vaccinated. This assumes, not unreasonably I think, that one jab provides half the protection of two. Lastly, assuming the vaccination becomes effective two weeks after it is given, I move the figures forward so that the number of susceptibles is based on the vaccination figures as they were 14 days earlier.
This calculation does not attempt to account for asymptomatic infections which were never reported as cases. Different studies, at different times, have put this as being between 1.4% and 78% of the total infections! It also does not try to account for infections with no or mild symptoms at the very beginning of the outbreak, which were never officially diagnosed as cases because there were no tests available at the time.
I’ll start in the core of Europe, with graphs of people fully vaccinated (two jabs) and people vaccinated (one or two jabs) over time:
You can see that the UK has lost its early lead. It is now in seventh place out of 14 in this group for people fully vaccinated; Denmark, Belgium and Portugal are at the top, and France, Switzerland and Sweden are starting to become a little detached at the bottom. In terms of people vaccinated, the UK has slipped to sixth, with Portugal being in the lead and Switzerland at the bottom.
Here is the corresponding graph of susceptibles:
Of these 14 countries, Belgium now has the lowest proportion of susceptibles, followed by Spain, Portugal, the Netherlands and the UK.
Here are the percentages fully vaccinated and vaccinated in the rest of Europe:
The following countries in these three groups now have 50% or more fully vaccinated: Hungary, Lithuania, Cyprus, Greece, Malta, Iceland, San Marino, Liechtenstein and Andorra. The Maltese lead by miles, having fully vaccinated more than 90% of their population. Czechia and Monaco are right on the 50%, too.
Here, it is Uruguay, Chile, Canada and the USA (just) who have passed the 50% fully vaccinated mark. In the West Indies, only the Dominican Republic has reached 40% yet.
Middle East and North Africa
Here, the focus of vaccination activity is in the southern part of the Middle East. The UAE, Qatar, Bahrain and Israel have all fully vaccinated more than 60% of their populations; though Israel has lost its earlier lead. Elsewhere, the Turks and the Moroccans are making brave efforts.
In this region, I’ll only show the percentages of full vaccinations:
Two island countries, the Seychelles and Mauritius, are way ahead here. In mainland Africa, no country has yet fully vaccinated even 10% of the population.
Rest of Asia
Here again, I’ll show only the full vaccinations graphs:
In most of these Asian countries, full vaccinations are below 20-25%; well lower than in Europe and the Americas. Because of the large populations of some of these countries, such as India and Indonesia, this may not seem too surprising. But there are some exceptions. If we can believe their figures, the Chinese have now fully vaccinated more than 50% of their population! Here’s the detailed graph of Chinese vaccinations:
The reported count of total vaccinations in China as at August 19th 2021 is 1,912,419,000. If true, that’s an amazing effort.
Japan and Hong Kong (which is now reporting separately from China) are also approaching 40%. The Mongolians have gone vaccination crazy, with more than 60% fully vaccinated. In South Asia it is Bhutan and the Maldives – both small countries with populations under a million – who are leading the way. India is bottom of that particular league table, with under 10%. And in South East Asia, Singapore leads with more than 70% of its population vaccinated; with Cambodia a respectable second.
Australasia and Oceania
Vaccination levels in this part of the world are comparable with Asia.
Here’s the graph of total vaccinations world-wide:
World-wide, 32% of the population have been vaccinated, and 24% fully vaccinated.
Top and Bottom 20s
Next, I’ll list the top and bottom 20 countries under the headings: People Fully Vaccinated, People Vaccinated, and Susceptibles. I won’t bother with the bottom 20 for full vaccinations, because there are more than 20 countries which as yet haven’t fully vaccinated anyone at all. Or, at least, haven’t reported any full vaccination figures yet.
The UK has now dropped out of the top 20 entirely!
The susceptibles top 20 gives an idea of how much of the world has yet to start significant vaccination activity. The bottom 20 gives an idea of some of the countries which may be most interesting to look at, in order to seek evidence that the vaccines are (or are not) helping to cut case transmission, hospitalizations or COVID deaths.
I decided to look in more detail at the following countries from the bottom 20 list above:
1. Malta and the Seychelles – where you might expect to see a lowering of the reproduction rate by a factor near 3, compared to earlier periods in the epidemic.
2. The UAE (United Arab Emirates) and Israel, both of which were in my list for further investigation when I last reported back in May.
3. Belgium and the UK, both of which have suffered torrid times during the epidemic, and have also managed relatively high vaccination levels.
I’ll be trying to find a “footprint” that the vaccines are helping to control the transmission of the virus (or not). Fortunately, Israel, Belgium and the UK are among the minority of countries reporting daily data on hospital and Intensive Care Unit occupancy by COVID patients, so they will be good examples when I come later to look at those statistics.
What this shows up is that even the highest level of vaccination in the world doesn’t protect a small country (the population of Malta is around 450,000) against a large increase in cases when a new variant enters. The sudden upsurge in cases at the end of June 2021, and the big increase in the R-rate beginning a couple of weeks before, are the signatures of the (relatively) new variant now called “delta.” This variant is said to have an R-zero somewhere between 5 and 9. With only one-third of the population still being susceptibles, that ought to give an actual R-rate between 1.66 and 3. The peak the Maltese R-rate hit, on July 9th 2021, was actually 3.68. That suggests that even the 65% I assumed for the effectiveness factor of the vaccines may be on the optimistic side for Malta.
Still, the Maltese have managed to reduce their lockdown stringency from that peak of around 75% in March to its value of around 44% today.
The Seychelles has only about 100,000 people. Despite all the vaccinations, the R-rate has been continuously above 1 since January. In fact, as at August 18th the Seychelles R-rate, although only 1.29, was the highest it had been in the whole epidemic. Moreover, lockdown stringency has been going up since April, and is now at 84%. It’s said that the Seychelles has suffered the “South African” (beta) variant, so maybe the vaccines (Chinese and AstraZeneca in this case) are less effective at controlling the transmission of this variant than they were expected to be?
The population of the UAE is around 10 million, so it is a reasonably large country. Cases and R-rate have been gradually coming down since the new year, and particularly since June. Some of this may be due to the vaccinations; but the movement is slow. The lockdown stringency is currently 65%.
The population of Israel is around 9 million, comparable with the UAE. The rises in cases and R-rate, which began in June, look to have the signature of the delta variant, as in Malta. And the new cases are still rising fast! The lockdown stringency was significantly increased when the cases started to rise, and now stands at 53%. The R-rate is coming down, but it is still well above 1.
Belgium’s population is about 11.6 million. That sudden increase in the R-rate and weekly case growth in the second half of June is the characteristic signature (and timing) of the delta variant. Yet the Belgians have kept their nerve, and haven’t locked down again – they have maintained pretty much the same lockdown stringency since May (it now stands at 47%). New cases are slowly rising, but don’t look concerning when compared to the horrors of last October. Is this due to the vaccinations, or to approaching herd immunity? It’s hard to tell from the data for Belgium alone.
The UK has by far the largest population of the countries I survey here – 68 million and some. The UK was, in a sense, “lucky” to get the delta variant early, perhaps in May or even April 2021. So, the climb in cases wasn’t as steep as in, say, Israel or Malta. That sudden drop in R-rate and cases in the last week before the big unlock on July 19th is interesting; I haven’t seen such a fall anywhere else, that did not shortly follow a new lockdown. As in Belgium, it isn’t clear how much this fall was helped by high vaccination levels.
The official UK lockdown stringency of 44% is a bit misleading, being representative more of Scotland, Wales and Northern Ireland than it is of England, which has 84% of the UK population and is currently locked down only at 23%. (And a good thing, too! For much of the epidemic, England has been locked down harder than the other countries that make up the UK). After that fall, cases have been rising fairly gently, not dissimilar to Belgium, but of course from a far higher base. It looks as if the powers that be have decided that now is a good time of year to push as hard as possible towards herd immunity – certainly better than leaving it until the ’flu season! My expectation is that it is the hospital and ICU occupancy which will (or, at least, should) determine the UK’s COVID strategy over the next couple of months.
To sum up
European countries are by far the biggest takers-up of the vaccines. Of the top 20 countries in percentage of the population fully vaccinated, nine are in Europe; twelve of the top 20 countries in percentage of people vaccinated once or twice are in Europe. The top 20 have all fully vaccinated more than 60% of their populations, whereas the bottom 20 have not vaccinated more than 1.2% of their populations even once. Take-up is generally lower in the Americas and the Middle East than in Europe, and lower still in most of Asia and in Australasia/Oceania. With the exception of two small island countries (the Seychelles and Mauritius), Africa has the lowest vaccination take-up of all. In mainland sub-Saharan Africa, no country has yet fully vaccinated even 10% of its population.
As to the six countries I looked at in more detail:
· Malta seems to have taken the delta variant reasonably well in its stride. But it is questionable how much the vaccines have actually done to limit transmission of the virus.
· What has happened in the Seychelles, one of the highest vaccinating countries per population in the world, is very disappointing. What went wrong?
· The UAE is moving in the right direction, but the movement is very slow, and they are still quite substantially locked down.
· Israel, having been an early leader in vaccinating, got “caught with its pants down” by the delta variant. Cases are still on the up, and it’s not clear where they’re headed.
· Belgium seems to have taken the delta variant in its stride, and looks to be the best placed of the six for a return to some kind of normality.
· The UK has recently taken an aggressive strategy on both vaccinations and unlocking. It looks, perhaps, to be going for the “final push” towards herd immunity? But we’re not out of the woods yet, and there are a lot more cases to come.
And then, there’s China. But that’s a subject for another day.