The reality of this pandemic is that there’s no end to the cycle of surges without vaccinations

China has now delivered more than 1 billion vaccine doses, hiting that COVID-19 milestone the same weekend that Brazil passed one of its own: more than 500,000 deaths. Daily case numbers remain worryingly high, and those hospitalised and dying include larger numbers of young people. India, meanwhile, is at risk of a third wave of infections sooner than predicted, ater a devastating second.

The end of the pandemic is almost here. But the tail is long and — thanks to short-sighted global and national policies — this phase is no more of a “great equaliser” than the start was. Blame uneven access to immunisation made worse by vaccine nationalism as rich governments focus on domestic needs. Insufficient state capacity, poor logistics, and distrust and misinformation, oten fueled by populist leaders, have let millions behind and widened existing gaps in the global economy. Then there are insular policies in places like Australia or Hong Kong that focus on zero cases, making them reluctant to open up, discouraging vaccination and prolonging the endgame.

We know from past pandemics that the finale was never going to be swit or clear-cut. It’s easy to track the start of the Spanish Flu pandemic in 1918, but far less simple to pinpoint the end, probably ater the winter of 1920. Other mass vaccination efforts to combat infectious diseases, say polio, have also taken years — and aren’t yet over. But we don’t have to repeat all the same mistakes.

Granted, the world has come far. Vanquishing COVID-19 is no longer a vague possibility; it’s visible in the distance. Researchers cracked the vaccine puzzle earlier than expected and shots have been distributed in record time, proving effective against even troublesome variants.

Yet 18 months on, COVID-19 continues to devastate. The developing world doesn’t have enough shots, too many existing inequities have grown worse, and there’s excess bureaucracy. It’s not just a problem for the poorest: Japan has underperformed in large part because of conservative regulation around new medicines that slowed the vaccine rollout, while restrictions on who can give injections led to a chronic staff shortage. With an aging population and the Olympics now weeks away, the country has fully vaccinated only 7% of residents.

For some nations, vaccines created an opportunity to earn back some much-needed political capital ater botching earlier stages of the pandemic. Britain managed, as did the United States thanks to Operation Warp Speed, and most remarkably Israel, helped by a data-rich health system that encouraged Pfizer Inc. and Biontech SE to assure supplies — plus deep pockets that allowed the country to pay a premium. That didn’t keep Benjamin Netanyahu in the prime minister’s seat, but it has resulted in geting 57% of the population fully vaccinated.

Others, ater handling the pandemic well with effective controls, hung back in the inoculation race but are now sprinting to catch up as new variants threaten. Singapore has become the first Southeast Asian nation to distribute at least one shot to more than half its population. China has fully vaccinated 80% of adults in Beijing and distributed more than 1 billion doses, more than a third of the global total, leaning on a triedand-tested top-down approach with the July 1 centenary of the Communist Party on the horizon.

The trouble is that state capacity, urgency and ready cash aren’t the norm. That ability to efficiently deliver policies, correct course, and hold the population’s trust has been a big predictor of pandemic-management success, far more than democracy, autocracy or other measures, as David Skilling of the economic advisory firm Landfall Strategy Group points out. It’s a rare commodity.

The reality of the late stage of this pandemic is, first, that there’s no end to the cycle of surges and lockdowns without vaccinations. There must be a concerted push to get vaccines to the developing world soon — and not by backloading donations, as the Group of Seven nations appeared to do earlier this month. At-risk, jab-hesitant weak spots in the West will need to be tackled. And investment is critically needed in logistics and health care structures that can, in everyone’s interest, continue monitoring once the pandemic fades from headlines.