Comparing Western/high income countries to low-income countries provides a “natural experiment” between different healthcare policies and systems and shows a massively higher impact from the virus and related policies in high-income countries, suggesting that Western healthcare systems and policies put in place in response to the virus are causing most of the harm, not the virus itself
A US News & World Report article from November 2021 observed:
There is something “mysterious” going on in Africa that is puzzling scientists, said Wafaa El-Sadr, chair of global health at Columbia University. “Africa doesn’t have the vaccines and the resources to fight COVID-19 that they have in Europe and the U.S., but somehow they seem to be doing better,” she said.
A “natural experiment” is when we compare different situations that have enough in common to allow for meaningful conclusions. Natural experiments are often used when intentional experiments aren’t possible: like comparing different pandemic policies in the same country during the same period of time. Obviously we can’t have a “do-over” of U.S. pandemic policy during 2020. But we can compare different policies across different nations and see how they fared.
The World Health Organization (WHO) conducted a very preliminary natural experiment in a report earlier this year that compared many different nations’ Covid case and death rates.
WHO stated in its May 2021 World Health Statistics report, which is issued each year, (p. 1): “Despite the extensive spread of the virus, COVID-19 cases to date appear to be concentrated predominantly in high-income countries (HICs). As of 1 May 2021, the 20 most impacted HICs account for almost half (45%) of the world’s COVID-19 cases, yet they represent only one eighth (12.4%) of the global population.”
Figure 1 illustrates this very significant difference.
And here’s the comparable chart for Covid deaths, also showing a massively higher impact from Covid in HICs, particularly in the Americas and Europe.
It’s become widely known at this point that Africa has seen a strangely low impact from the virus, at literally a 20x lower impact than in HICs, in terms of both cases and death rates. But it’s not just Africa showing this massive 20x lower case and death rate — as Figures 1 and 2 make clear it’s also much of Asia, where malaria is not as widespread as in Africa and no where near as deadly (here’s a great article from Siddhartha Mukherjee in The New Yorker from earlier this year, and a similar article in the New York Times, on these topics).
It’s also the case that, generally speaking, infectious diseases hit the poorest countries the hardest, not the lightest, as has been the case with Covid, which is also noted in the WHO report as a major anomaly.
This can’t all be explained away as differences in data-collection between HICs and LICs. The NYT article from earlier in 2021, linked above, states: “Some portion of the pattern probably does stem from an underreporting of deaths by less developed medical systems. But much of the pattern is real, many epidemiologists believe.” And a November 2021 USNews & World Report article continues to show this huge disparity between HICs and LICs when it comes Covid cases and deaths, well into our second year of the pandemic.
Combining these facts with the extremely over-inclusive definitions of “case,” “hospitalization,” and “death,” that I’ve highlighted in a number of recent essays, plus inherently flawed Covid-19 tests, and massive asymptomatic Covid testing done in high-income countries (with nowhere near as much testing of asymptomatics in low-income nations for various reasons), plus a far far lower vaccination rate in low-income nations, if one is being objective with all of this data it’s pretty hard to come to any other conclusion than this: our “developed nation” public health system and policy choices in the US, Europe and other HICs, seem to have created much of this pandemic, and are sustaining it far beyond reason.
Single digit vaccination rates in African LICs correlates very well with extremely low Covid impacts. More generally, a recent paper, Subramanian and Kumar 2021, peer-reviewed and published in the European Journal of Epidemiology, showing a positive correlation between vaccination rates and case rates, i.e. the higher the vaccination rate the higher the case rates. (Subramanian is a professor of population health and geography at Harvard).
Subramanian and Kumar also found a very high positive correlation in US counties between the highest vaccination rates and high case rates, and the opposite too.
They conclude: “The sole reliance on vaccination as a primary strategy to mitigate COVID-19 and its adverse consequences needs to be re-examined, especially considering the Delta (B.1.617.2) variant and the likelihood of future variants.”
[Added Jan. 3 2022] New York Times included a graphic juxtaposing vaccination rates — darker shades of green means higher vaccination rates — and Covid-19 “hot spots” around the world — darker shades of red mean higher Covid-19 cases — and unintentionally created a strong graphical indication of this unexpectedly strong correlation, see Figure 4 (thanks Alex Berenson for alerting me to this graphic, further supporting Subramanian and Kumar’s research). Brazil and China seem to currently be outliers for this trend.
So what’s going on?
I’m not using hyperbole when I say that the only reasonable data-based conclusion we can draw from global health picture at this point, plus consideration of the extremely over-inclusive definitions of a “Covid case, “Covid hospitalization,” and “Covid death,” as well as the decision to conduct widespread testing of asymptomatics, is that we should not, at any cost, subject developing nation populations to mass Covid-19 vaccination.
Conversely, we should consider how we can learn from developing nations how to tackle the pandemic. This whole mess will, in any rational world, go down, when the dust has settled, as a monumental case study of what not to do to tackle a pandemic. Unfortunately, it is not at all clear that we live in a rational world.