The best and worst places to be as we learn to live with Delta
Bangladesh edged up five notches as the country recorded its lowest number of daily deaths in nearly four months and schools reopened after being shut for more than 500 days
Delta has redefined how we live with the virus, with places that stayed resilient amid the variant's onslaught providing a new model for how the world emerges from the pandemic.
In September, European nations dominate the top rungs of Bloomberg's Covid Resilience Ranking for a third month, and we have a new No. 1—Ireland has taken pole position from Norway after steadily climbing the ranks from the start of 2021, when it had the worst outbreak in the world.
It pulled off the startling turnaround with a strategy used Europe-wide. Even as the peak summer travel season unfolded alongside delta's spread, Ireland and places like Spain, the Netherlands and Finland held down serious illness and deaths through pioneering moves to largely limit quarantine-free entry to immunized people. Bestowing more domestic freedoms on the inoculated helped boost vaccination levels to some of the highest in the world—over 90% of Ireland's adult population has received two shots—while allowing social activity to resume safely.
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In contrast, delta left the US reeling. The world's biggest economy dropped three spots to No. 28 in September as unfettered normalization, regardless of vaccination status, drove a surge in cases and deaths. Inoculation has hit a wall, with places that started shots later than the US now overtaking it.
The Covid Resilience Ranking is a monthly snapshot of where the virus is being handled the most effectively with the least social and economic upheaval. Compiled using 12 data indicators that span virus containment, the quality of healthcare, vaccination coverage, overall mortality and progress toward restarting travel and easing border curbs, the Ranking captures which of the world's biggest 53 economies are responding best—and worst—to the same once-in-a-generation threat.
Southeast Asian economies continue to populate the Ranking's bottom rungs in September, with Indonesia, Thailand, Malaysia, Vietnam and the Philippines the last five. While the region's outbreak may have peaked, their export-reliant economies are still struggling from the hit.
Once the gold standard for virus containment, the Asia-Pacific is faltering in the era of vaccination. Not only are their strict measures less effective in the face of delta, former top rankers in the region are also grappling with how to reopen after such a long period of isolationist border curbs.
No. 1 at the Ranking's inception last November, New Zealand fell nine spots from August to No. 38. A delta incursion after months virus-free has left the country in varying degrees of lockdown, still seeking to stamp out infections as it strives to boost vaccination levels. Singapore, which is trying to pivot from a Covid Zero approach to a vaccine-led reopening, fell 11 rungs as an unsettling surge in cases saw some restrictions reimposed.
What's increasingly apparent is that the pandemic is far from over—for some more than others.
Called "a shame on all humanity" by World Health Organization chief Tedros Adhanom Ghebreyesus, vaccine inequality persists, confining developing economies to the bottom half of the Ranking. With so many countries barely inoculated, the risk of another destructive variant emerging has never been higher, just as rich nations grapple with waning immunity from the first round of shots.
Will booster campaigns by the richest nations worsen vaccine inequality? Can Europe remain resilient as cold weather, the virus's optimal conditions, descends? Might Asia claw back ground as inoculation progresses?
These questions will be the focus of the Ranking as we move into October.
Notable Movers
Big shifts upward in September:
• Spain jumped eight places to No. 2 as its infection rate fell to the lowest level in more than a year.
• Denmark moved up six spots into the top five as high vaccination coverage enables it to lift restrictions while its outbreak is contained.
• Canada advanced 14 rungs, while the U.K. climbed six places to No. 16 after both nations eased travel curbs for fully vaccinated people.
• Bangladesh edged up five notches as the country recorded its lowest number of daily deaths in nearly four months and schools reopened after being shut for more than 500 days.
• South Africa's waning wave and the easing of restrictions to revive its economy boosted it six spots, to No. 40.
• The United Arab Emirates and Mexico rose nine and seven places respectively, as domestic restrictions became less stringent amid falling cases and deaths.
And down:
• Singapore and New Zealand dropped 11 and nine spots respectively, as Covid resurgences saw both nations grapple with the tough transition from zero tolerance for the virus to vaccinated reopening.
• Norway's marked fall from No. 1 in August to No. 10 this month was due to its travel restrictions, which are stricter than European peers. It only accepts travelers with the EU's vaccine certification—in effect barring entry to most people who live outside of Europe—while other economies in the region allow visitors vaccinated anywhere with a shot recognized by EU regulators. Norway has, however, announced a roadmap to phase out these rules over time.
• Romania plunged 10 spots to No. 27 as positive test rates, infections and deaths surged. The country has the second-lowest vaccination level in the EU.
• Germany and Austria both saw cases reach a peak in September, while Italy reimposed restrictions in Sicily as Covid hospitalizations grew. All three dropped eight rungs.
• Nigeria, which has the worst inoculation rate on the Ranking, fell seven spots as a delta-fueled wave continued to course through one of Africa's most important economies, hindering recovery.
• Vaccination vanguard Israel slipped five spots to No. 41 as an uptick in cases raised questions about the immunity provided by the earliest inoculations. The nation reimposed some curbs and started to dole out booster shots.
Opening Up
To capture which of the 53 economies are nailing reopening—an aspect of pandemic management that's become key—we zero in on their progress on vaccination, the severity of the lockdowns and restrictions in place, plus two metrics tracking travel that were introduced in June. They form a gauge that assesses how far each place is from pre-Covid levels of normalcy.
Despite this focus on reopening, indicators that have always been part of the Resilience Ranking remain, with all 12 data points equally weighted. The Covid Status tab includes two death-related indicators: the case-fatality rate over the past three months and a measure of overall mortality through the whole pandemic. This means the US having the highest recorded death toll globally still contributes to its current score.
New No. 1 Ireland rose three places from August thanks to one of the world's best vaccination rates, projections for a rapid economic rebound and the government's decision this month to loosen both domestic restrictions as well as travel quarantine rules. Meanwhile, weekly Covid fatalities hover in the double digits.
Still, the country has been burnt on reopening before, easing curbs prematurely late last year which triggered a surge in cases. Ireland—and Europe's—continued success will depend on widespread vaccination severing the link between easing curbs and virus spread.
Overall, European economies score the highest on the Vaccinated Travel Routes indicator as they've moved the quickest to allow quarantine-free entry for inoculated visitors.
Economies that have largely kept their borders open throughout the pandemic, like Egypt and Mexico, also score highly, though travelers from these countries may be barred from entry elsewhere given their persistent outbreaks and lower vaccination rates.
Parts of the Asia-Pacific that relied on eliminating Covid and keeping it out—meaning their overall mortality rates are vastly lower—score poorly on reopening. The lower risk of being infected initially damped demand for vaccines in some places, until delta got in through strict border curbs, prompting places like New Zealand and Australia to speed up their rollouts.
Despite fully inoculating more than one billion people, China's international borders remain effectively closed. Small virus flareups have caused localized travel restrictions, but the country still scores well on Flight Capacity because of its large internal market.
The numbers provided by aviation data specialist OAG do reward larger economies where domestic flights have made up for the absence of global travel. Conversely, small, travel-reliant economies like Hong Kong and Singapore, which don't have local aviation markets, score among the worst.
The Two-Track Pandemic
Vaccination is where places like Europe—and until recently, the US—are making up for their missteps in containing Covid. Their positions in the Ranking improved in early summer as investment in research and a focus on fast rollouts proved pivotal, though the US has since lost substantial ground as hesitation stalls inoculation. Operation Warp Speed saw some $18 billion plowed into developing some of the most effective Covid vaccines now being administered around the world.
Economies that moved early to secure and roll out shots have the advantage of being mostly inoculated with mRNA vaccines, which appear to not just prevent a person from developing Covid, but lower their chances of contracting and transmitting it as well. But with most shots proving somewhat less effective against delta and evidence emerging that immunity wanes six months after inoculation, vaccination leaders like Israel are seeing record surges again and are moving the fastest on boosters.
In places where the majority are inoculated, the link between infection numbers and deaths is weakening, and policy makers are reframing the way they view Covid cases.
"The vaccines will help us keep the pandemic under control, but we need to continue to live with the virus, just as we live with other infectious diseases," said Bent Høie, Norway's health and care services minister. "It is impossible to fully eradicate the risk."
Still, most of the developing world is yet to even start inoculating in a meaningful way, with countries lacking the purchasing power to forge deals that could push them higher up the queue. Covax, the WHO-backed effort to help poorer nations procure doses, started distributing shots at the end of February but is facing a supply shortfall that's seen many places run out of vaccines entirely.
The WHO has called for a temporary moratorium on booster shots to help shift supplies to developing countries.
In September, President Joe Biden called on other rich countries to help vastly expand the production and availability of Covid vaccines and treatments, promising another 500 million doses to nearly double the US's pledge.
After hoarding supplies in the first half of the year, the US has donated more vaccines than any other country, according to UNICEF data. China, while only donating 69 million doses, has exported some 884 million of its homegrown shots via mostly bilateral deals with places like Brazil, Indonesia and Chile.
Covid Lessons
While merely a snapshot in time amid a fast-moving crisis, Bloomberg's Covid Resilience Ranking has helped crystallize some longer-term lessons from the pandemic.
A constant of the consistently high-ranked economies has been a widespread degree of government trust and societal compliance. New Zealand—a stalwart of the top three before the arrival of delta sent it into one of the world's strictest lockdowns—emphasized communication from the start, with a four-level alert system that gives citizens a clear picture of how and why the authorities will act as an outbreak evolves.
Investment in public health infrastructure also matters. Undervalued in many places before 2020, systems for contact tracing, effective testing and health education bolstered the countries that have performed consistently well in the Ranking, helping socialize hand-washing and the wearing of face masks. This was key to avoiding economically crippling lockdowns in the first year, before vaccines were available.
Though wealthy nations that bet on vaccination are now seeing that strategy pay off, their failure to check the coronavirus leaves a deep scar, with nearly 690,000 people dead from Covid in the US and some survivors grappling with debilitating after-effects. It also meant the world missed out on an opportunity to eliminate the virus.
The arrival of vaccines, including those built on the unprecedented mRNA technology, has been a silver lining, and highlighted the importance of funding healthcare research and development.
Norway is one of the only places of the 53 to have combined success in the initial stage of the pandemic with reopening. It's consistently been in the top 15, first relying on social cohesion for people to comply with social distancing measures, and implementing strict border restrictions. Later, it procured a sizable supply of vaccines early with the EU. And now it's cautiously opening up.
What Next?
Bloomberg's Covid Resilience Ranking provides a snapshot of how the pandemic is playing out in 53 major economies right now. By layering in metrics on reopening and the revival of global travel from mid-2021, we also give a window into how these economies' fortunes may shift in the future as places exit the pandemic at different speeds.
It's not a final verdict—it never could be, given the imperfections in virus and vaccine data and the fast pace of this crisis. Circumstance and pure luck also play a role, but are hard to quantify.
Beyond delta, new variants of concern are also a threat: scientists fear mutations that can overcome existing shots and drive a new phase of the pandemic.
Still, having endured more than a year and half of fighting Covid-19, governments and populations now have a better understanding of the pathogen and how to mitigate the damage it inflicts.
Experts say the next six months will be key, with risks high as the weather cools in the US and Europe and schools resume.
"Winter in the northern hemisphere will be the real next big test to see how effective high levels of vaccination have been," said Peter Collignon, a professor of infectious diseases at the Australian National University Medical School in Canberra.
As the data shifts, the Ranking will change too—we'll continue to update the picture every month, as it evolves.
Disclaimer: This article first appeared on Bloomberg, and is published by special syndication arrangement.
