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A Return to Normal? Not for Countries With Covid Surges and Few Vaccines.

BOGOTÁ, Colombia — In Colombia, nearly five hundred people a day have died of the coronavirus over the last three weeks, the nation’s most dramatic daily death rates yet. Argentina is going through the “worst moment since the pandemic began,” according to its president. Scores are dying daily in Paraguay and Uruguay, which now have the highest reported fatality rates per person in the world.

“The vaccines are coming too late,” said María Victoria Castillo, whose 33-year-old husband, Juan David, died in May as he waited for the Colombian government to extend shots to his age group.

Deep into the second year of the pandemic, the world is dividing along a powerful, and painful, line: Those who have vaccines, and those who do not.

As rich nations like the United States prepare for a return to normalcy — at least half of the populations there and in Britain and Israel have received at least one dose of a vaccine, sending cases plummeting — some poorer nations, scrambling for shots and heaving under weary health systems and exhausted economies, are seeing their worst outbreaks since the start of the pandemic.

This is the case in Malaysia, Nepal and other nations in Asia. But in few places is the situation as bleak as South America, which has the highest rate of new infections in the world, according to data from Johns Hopkins University. Uruguay, Argentina, Colombia and Paraguay have all ranked in the top 10 in cases per 100,000 residents over the past week.

Social networks in Paraguay have become obituaries in motion: “Rest in peace professor,” reads one. “My mother has died,” reads another, “my heart is broken into a million pieces.” In Argentina, in-person classes in Buenos Aires province, the country’s most populous district, have largely been called off as officials scramble to control cases.

Ms. Castillo said the death of her husband, a father of three, had left her so disillusioned that she has come to believe the globe’s “only solution is God.”

Six weeks ago, Claudia López, the mayor of Colombia’s capital, Bogotá, told residents they should ready themselves for the “worst two weeks” of their lives. But instead of reaching a peak, followed by a fall, new cases and deaths have surged — and then stayed there.

Some governments — Argentina, South Africa, Malaysia, Thailand and others — have responded to the sharpening health crisis by putting new lockdowns in place. Others have given up on that strategy altogether. In late May, Ms. López announced that the city would reopen on June 8, and that she was repealing nearly all movement restrictions related to the pandemic. All students should return to school that day, she added.

“It sounds absolutely contradictory, from an epidemiological point of view, to have 97 percent ICU occupancy and to announce a reopening,” she said, “but from the point of view of the social, economic and political context, with deep institutional mistrust, unacceptable poverty, and unemployment that is especially affecting women and young people, it is necessary to do so.”

In Colombia, rising virus cases and deaths have coincided with the largest explosion of social anger in the country’s recent history, bringing thousands of people to the streets to protest poverty exacerbated by the pandemic, among other issues, and prompting concern that the protest movement will spread throughout the region.

Experts say that the only way to stamp out the virus in these regions — and the world — is to rapidly increase vaccinations, which have raced ahead in the United States and Europe while lagging in many other countries around the world.

In North America, 60 vaccine doses have been administered for every 100 people, compared with 27 in South America and 21 in Asia, according to data from the Our World in Data project at the University of Oxford. In Africa, the rate is two doses per 100 people.

During a two-day trip to Costa Rica for meetings with Central American officials, U.S. Secretary of State Antony J. Blinken was asked repeatedly about American plans for vaccine distribution to the hard-hit region, where vaccination rates remain low.

In March, the Biden administration said it would send 2.5 million vaccine doses to Mexico and 1.5 million to Canada as a loan. By April, Mexico said it had received 2.7 million.

In all, President Biden has committed to distributing 80 million vaccine doses overseas by the end of June.

Appearing on Tuesday with Costa Rica’s president, Mr. Blinken provided no specifics, but said the Biden administration would announce “sometime in the next week to two weeks” its plans for “the process by which we will distribute those vaccines, what the criteria are, how we will do it.” He later said the announcement could come as early as Thursday.

About 11 billion shots are needed to vaccinate 70 percent of the world’s population, the rough threshold needed for herd immunity, according to researchers at Duke University, but only a fraction of that number has been manufactured so far.

The Biden administration has also said it will donate $4 billion to Covax, a World Health Organization program that will supply vaccines to countries in need.

The reasons for the surges vary across countries, but together they reflect “the challenge of maintaining vigilance against a highly transmissible, airborne virus for long periods of time, balanced against economic and social considerations,” said Claire Standley, an assistant research professor at Georgetown University.

Globally, new infections have declined from their peak of more than 800,000 recorded cases a day in late April. Still, half a million people are reported infected with the virus daily, and there were more infections in the first five months of this year than in all of 2020.

As the pandemic drags on, countries that have kept cases low for more than a year, such as Australia and Singapore, are seeing pockets of new infections that have prompted partial lockdowns and further delayed plans to reopen borders.

“Global vaccine access has been woefully inequitable, with a handful of high-income countries dominating procurement agreements and receipt of initial batches,” Dr. Standley said.

Many less-wealthy countries have not received the vaccines they were promised.

Among them is Vietnam, which in 2020 kept infections low through rigorous quarantining and contact tracing. The Vietnamese government has ordered vaccines from multiple providers but received doses only from the Covax global vaccine center and the Russian government.

Barely one million people, or 1 percent of Vietnam’s population, have received even one shot, and the country is now experiencing its worst outbreak yet: 4,000 cases in the past month, more than the total in the previous 16 months.

In South America, countries that imposed lockdown measures found that they did not function as well as in the United States and Europe at stopping the spread of the virus because many low-income day laborers had to continue to work, said Matthew Richmond, a sociologist at the London School of Economics. As new outbreaks emerge, the region’s lack of investment in medical care, especially in rural areas, has put health systems at risk of collapse and delayed the rollout of vaccines, he said.

“The combined effect of social inequality and weak state capacity have meant these countries have not been able to reduce transmission, treat those with severe symptoms or vaccinate populations at the same scale or speed” as in the United States and Europe, Dr. Richmond said.

As the United States and Europe barrel — at least, seemingly — toward a summer in which vaccinated people are once again able to hug, travel and host dinner parties, a sort of vaccine apartheid could emerge in which rich countries shut off travel with nations where the virus remains endemic, Dr. Richmond said. But the newest outbreaks underscore that as long as the virus circulates widely, border closures could mean little. And new variants could emerge that are more resistant to vaccines.

“The ongoing devastation being wreaked by Covid-19 in the global south should be reason enough for the rich countries to want to enable a quick and cheap global vaccine rollout,” Dr. Richmond said. “If it’s not, enlightened self-interest should lead them to the same conclusion.”

Reporting was contributed by Michael Crowley in San José, Costa Rica; Santi Carneri in Asunción, Paraguay; Daniel Politi in Buenos Aires; and Sofía Villamil in Bogotá, Colombia.

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