Clockwise from left: UAE, Portugal, Uruguay, Denmark, Singapore (photos: Sacha Fernandez CC BY-NC-ND 2.0, Sam Valadi CC BY 2.0, Getty Images, Creative Commons)
Clockwise from left: UAE, Portugal, Uruguay, Denmark, Singapore (photos: Sacha Fernandez CC BY-NC-ND 2.0, Sam Valadi CC BY 2.0, Getty Images, Creative Commons)

SocietySeptember 1, 2021

What is life like now for countries with the highest Covid vaccination rates?

Contributing writer
Clockwise from left: UAE, Portugal, Uruguay, Denmark, Singapore (photos: Sacha Fernandez CC BY-NC-ND 2.0, Sam Valadi CC BY 2.0, Getty Images, Creative Commons)
Clockwise from left: UAE, Portugal, Uruguay, Denmark, Singapore (photos: Sacha Fernandez CC BY-NC-ND 2.0, Sam Valadi CC BY 2.0, Getty Images, Creative Commons)

Scott Morrison has urged New Zealand to ‘come out of the cave’ and open up to the world once our vaccination rates ramp up. So what is happening in the world’s most vaccinated countries? George Driver takes a look.

New Zealanders in lockdown are enviously scrolling through images of European summer, where life in some countries appears to be returning to normal.

Croatia is experiencing a mid-summer tourism boom, with thousands lined towel-to-towel on its beaches. In the UK, hundreds of thousands of people are attending events around the country, with about 300,000 turning up to Wimbledon alone.

Meanwhile, New Zealand – currently in the midst of the democratic world’s strictest lockdown – is being urged to follow suit and give up on elimination.

Last week, Australian prime minister Scott Morrison said we can’t stay in the “cave” of Covid-19 elimination. We need to rejoin the world and reduce restrictions, he argued. A few commentators in New Zealand have said we should follow other countries’ lead. But what does life outside of the cave look like?

A handful of countries have surpassed a 70% vaccination rate, giving a glimpse into what opening up with high levels of vaccination might look like. I have looked at the five countries with the highest vaccination rates in the world (excluding territories and microstates): United Arab Emirates, Singapore, Portugal, Denmark and Uruguay.

Their experiences to date will likely make New Zealanders tentative about opening up until we reach higher vaccination rates. On average, these countries are getting 105 cases each day per million people and a death every two days per million people. At that rate, New Zealand would have 2.8 Covid deaths and 541 cases each day. But cases and deaths can be expected to fall as vaccination rates continue to climb.

Restrictions in these countries are at about level 2.5 in the New Zealand classification. Numbers at events and restaurants are limited and mask-wearing and physical distancing is mostly mandatory in public places. Vaccine passports are widespread, with the vaccinated getting perks like being able to attend larger events, and dining and drinking indoors again.

But most of these countries are also opening up further. Denmark plans to drop all Covid restrictions this month, except at the border, while Singapore and Portugal plan to roll back restrictions when the vaccination rate reaches 80% and 85% respectively.

Pedestrians wait to cross the road in Cais do Sodre, downtown Lisbon, on August 1 2021, the day that Portuguese commerce, restaurants and live shows returned to their usual schedules following the Covid pandemic (Photo: Horacio Villalobos/Corbis via Getty Images)

In the context of what some of these countries have been through recently, with thousands of deaths and tens of thousands cases, it’s a remarkable improvement. They are beginning to remove strict controls that have, in some cases, been in place for more than a year.

But it also looks remarkably worse than what New Zealand has been through over the past year. Last month an expert panel, chaired by Sir David Skegg, recommended we continue with elimination as a long-term strategy, even as the borders open, by stamping out cases with lockdowns and other controls as they arise.

But support for a long-term elimination strategy appears to be weakening in the face of delta. Last week, epidemiologist Michael Baker said we should stay the course in the medium term until vaccination rates are up, then we can “choose our future”. Covid-19 response minister Chris Hipkins has said it’s “too early to tell” if elimination is still viable and that delta raises some “pretty big questions about what the long term future of our plans are”.

But does the experience of other countries show that opening up will mean accepting more deaths and more restrictions than we’ve had during the past year?

University of Otago epidemiologist professor Peter McIntyre says New Zealand will eventually have to join the ranks of the countries opening their borders and reducing restrictions due to delta’s infectiousness. But that doesn’t mean we will see the same number of cases and deaths when we do.

“What we will be seeing when we open up, if we have high vaccination rates, will be quite different to what these other countries are experiencing,” McIntyre says.

That’s because the other countries have been reaching high vaccination rates while battling high case numbers during the height of the pandemic, which is different to introducing the virus to a Covid-free country with a high vaccination rate.

“When the virus does arrive, if we can have appropriate use of public health measures like masking, ventilation, distancing, testing and contact tracing then we can keep numbers down as low as possible,” says McIntyre.

“But we won’t keep cases down to nothing. There are going to be people in hospital with Covid, there are going to be people who die, but we want to keep that down so hospitals can cope and it will hopefully not be so different to what happens with influenza.”

New Zealand also has the chance to learn from other countries who are starting to dive into the unknown as they open up.

At the moment, here’s what’s happening in the world’s most vaccinated places.

United Arab Emirates

Population: 10,031,987

Vaccination rate: 74.2%

Total Covid-19 cases: 717,374 / 71,509 per million

Total Covid-19 related deaths: 2,039 / 203 per million

Daily cases: 1,023 / 102 per million

Daily deaths: 3 / 0.299 per million

Lockdown stringency: 54.63

Beyond the microstates and territories of Gibraltar, Malta, Iceland and Pitcairn Island, the UAE is leading the world in vaccinations, with 74% of the country fully vaccinated.

Cases are declining but are still averaging over 1000 a day with three Covid deaths a day.

According to the stringency index, its level of restrictions is between New Zealand’s level three and level two.

There are different restrictions in each of the seven emirates. According to CNN, Dubai reopened to visitors who could present a negative Covid test in August last year and has now opened up quarantine-free travel to fully vaccinated travellers from select countries.

Mask wearing and physical distancing is still compulsory in most public places, but people can go to concerts, restaurants and cafes. Large events are limited to 70% capacity and only the fully vaccinated can attend them.

In Abu Dhabi, access to a range of public places is restricted to those who are vaccinated, including restaurants, malls and gyms.

An Emirati man gets vaccinated against the Covid-19 in Dubai on December 24, 2020. (Photo: GIUSEPPE CACACE / AFP) (Photo by GIUSEPPE CACACE/AFP via Getty Images)

Singapore

Population: 5,904,437

Vaccination rate: 74.0%

Total Covid-19 cases: 67,459 / 11,425 per million

Total Covid-19 related deaths: 55 / 9.3 per million

Daily cases: 118 / 20 per million

Daily deaths: 1 / 0.169 per million

Lockdown stringency: 44.44

Singapore has been transitioning from an elimination strategy to a “live with the virus” strategy, contingent on high rates of vaccination.

On average, someone dies from the virus each day and 118 people get infected.

Currently its restrictions are a bit higher than New Zealand’s level two, but it’s dependent on vaccination status. According to the government, unvaccinated people can’t drink or dine out, while the vaccinated can be served in groups of up to five. Social gatherings and house visits are also limited to groups of five. Cinemas and events can host up to 1000 vaccinated people, or 50 unvaccinated, while public facilities like museums and libraries are limited to 50% capacity.

But the country plans to open up further once it’s vaccinated 80% of the population, a milestone which the government claims to have reached last week. CNN reports it plans to abolish lockdowns and contact tracing, open the borders to travellers, allow large gatherings and stop counting Covid cases. But the timeline for easing restrictions is unclear.

A senior citizen getting the Pfizer-BioNTech Covid-19 vaccine in Singapore, March 8, 2021 (Photo: Wei Leng Tay/Bloomberg via Getty Images)

Portugal

Population: 10,162,440

Vaccination rate: 73.57%

Total Covid-19 cases: 1,036,019 / 101,945 per million

Total Covid-19 related deaths: 17,730 / 1745 per million

Daily cases: 2,218 / 218 per million

Daily deaths: 12 / 1.18 per million

Lockdown stringency: 52.78

Portugal has just come out of its official “situation of calamity” and started lifting restrictions from August 31, but a range of restrictions are still in place.

On average, 12 people are dying from the virus each day and 2,218 become infected. But that’s down from a peak of 330 deaths and 16,332 cases a day in January.

Restaurants and cafes are limited to eight per group and “cultural shows”, weddings and baptisms are limited to 75% capacity. Nightclubs are open, but for drinking only – no dancing – and people have to be seated in restaurants and cafes.

According to UK government travel advice there are also a range of restrictions for the unvaccinated, who can’t eat inside a restaurant on weekends or public holidays, stay in hotels, use gyms, spas, enter casinos and bingo halls or attend major events.

People have to provide a negative test to enter the country, while those from the UK and other high risk countries have to quarantine for two weeks unless they’re vaccinated.

The country plans to remove restrictions further once 85% of the population is vaccinated, with no restrictions on numbers in restaurants and cafes and events, but people would still need a negative test or a vaccination certificate to enter bars and clubs.

People wait to be inoculated with the Covid-19 vaccine in Cascais, Portugal, on July 16, 2021. (Photo: Pedro Fiúza/NurPhoto via Getty Images)

Uruguay

Population: 3,487,794

Vaccination rate: 71.63%

Total Covid-19 cases: 384,778 / 110,321 per million

Total Covid-19 related deaths: 6,029 / 1728 per million

Daily cases: 86 / 25 per million

Daily deaths: 2 / 0.573 per million

Lockdown stringency: 55.56

Uruguay was one of the world leaders in controlling Covid-19 until a large outbreak took hold earlier this year. It recorded the world’s highest number of deaths per capita on some days, peaking at 7,289 cases and 88 deaths in April.

Now Uruguay is down to 85 cases a day and two deaths and the outbreak looks relatively under control, which is being attributed to the country’s swift vaccine rollout. Nature reports that deaths have plummeted by more than 95% among the vaccinated.

The country’s borders remain closed to visitors, but CNN reports it plans to open to vaccinated visitors in November. It said many bars and restaurants were still closed and masks and distancing are mandatory, with restrictions at about NZ’s level 2.5.

A taxi driver is vaccinated at Carrasco airport in Ciudad de la Costa in Uruguay on April 08, 2021 (Photo: PABLO PORCIUNCULA/AFP via Getty Images)

Denmark

Population: 5,816,000

Vaccination rate: 71.35%

Total Covid-19 cases: 344,088 / 58,162 per million

Total Covid-19 related deaths: 2,580 / 444 per million

Daily cases: 946 / 163 per million

Daily deaths: 3 / 0.516 per million

Lockdown stringency: 38.89

Denmark has achieved the second highest vaccination rate in Europe and its restrictions on daily life are currently about the equivalent of a New Zealand level 2.5.

On average it’s getting 946 cases and three deaths a day, down from a peak of 4,508 cases and 43 deaths a day in January.

Restaurants and bars are open, but people need a “corona passport” proving a negative test or vaccine status to dine and drink inside, and discos and nightclubs are closed. People also need corona passports to go to the gym and for indoor events with more than 500 people and outdoor events with more than 2000 people.

But Denmark has announced a bold plan to remove all Covid-19 restrictions, except border controls, on September 10, Forbes reports.

The country has border restrictions including 10 days quarantine, a negative pre-departure test and testing at the airport for arrivals from high-risk countries.

A customer in a Copenhagen bar shows their Corona Pass, an app that displays the results of recent antigen tests and the user’s vaccination status. (Photo: Tom Little / AFP via Getty Images)

New Zealand

Population: 5,122,600

Vaccination rate: 21.61%

Total Covid-19 cases: 3,519 / 686 per million

Total Covid-19 related deaths: 26 / 5 per million

Daily cases: 64 / 12.49 per million

Daily deaths: 0 / 0 per million

Lockdown stringency: 96.3

More Reading

    New Zealand is in the midst of the world’s hardest lockdown, according to Oxford’s Our World in Data, although daily case numbers and deaths are still lower than in the world’s most vaccinated places as we continue to pursue elimination.

    Will we stay the course with elimination in six months time? As the world’s most vaccinated countries open up further, and vaccinate more, over the next few months options will become clearer. In the meantime, we still have time to vaccinate and then, in the words of Michael Baker, ​“choose our future”.

    The data above has been sourced from Oxford University’s Our World in Data programme’s vaccination rates and stringency index, while case numbers and deaths are from Worldometer. Territories and microstates have been excluded. Daily deaths and case numbers are a seven day average. Vaccination figures are for the percent of the total population fully vaccinated. Figures are as of August 30.

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    Image: Tina Tiller
    Image: Tina Tiller

    BusinessSeptember 1, 2021

    One virus, two countries: The challenges of dividing Aotearoa to defeat delta

    Image: Tina Tiller
    Image: Tina Tiller

    This time the challenges are different, writes Duncan Greive.

    From this morning, we enter a new phase of the pandemic. We have a country from roughly the Bombay Hills south which is on the road back to recovering its freedoms – hardware stores are open to tradies, you can get a flat white this morning and takeaways tonight, and healthcare systems will start to operate more normally. Northland is poised to move to level three on Friday, leaving greater Auckland as another country, likely to be stuck fast in level four for some time yet.

    A large majority of us understand why that is, and polling shows support for lockdowns remains as strong as ever. Yet what we’re entering is a new and different phase of the pandemic from a social and economic perspective, one which brings with it complexities we haven’t had to contemplate until now.

    Put simply, the country is going to cleave in two in a way it hasn’t before, and that gap could grow if (as seems likely) the lockdown and its aftermath drags on longer than current signals suggest. The implications for communities, for business and for students are real and will require thought as to how they are managed, both during the outbreak and beyond. This is fundamentally a different situation to the lockdown of a year ago. Yes, Auckland was in a different setting, but it was able to defeat the virus at alert level three, thus allowing much of its life to go on.

    Now, policy responses will accordingly be far trickier than those which have come before. Here are some of the challenges that face us now, and that will become even more stark when, as seems inevitable, large parts of the country enter level two or 2.5.

    Police stop cars at a checkpoint during the Auckland Covid-19 outbreak in 2020 (Photo: Brendon O’Hagan/Bloomberg)

    People will start to have different health outcomes according to where they live as the majority of the country starts to open back up to elective surgeries and other non-acute care, while Tāmaki Makaurau remains under level four restrictions. If you’re waiting on surgery, which may well have already been delayed under prior lockdowns, another postponement of indeterminate length will be hard to take.

    Of course, divergent health outcomes according to geography and ethnicity have long been a feature of our health system. But a prolonged level four lockdown in a high-needs area further exacerbates those issues. There are ways of addressing this in future, such as by bringing in medical staff from around the country to work through a backlog. But this would be poorly received by the area loaning the resource, particularly during a period characterised by unmet shortages of doctors. As it goes for physical health, so it goes for mental health: consults done online or over the phone, and fewer acute beds available, during a time of high stress within the community.

    A large group of Aotearoa’s students could have in-person learning, while another large group will be online-only. The difference to education between levels three and four is largely immaterial for those in school. The big change comes a level down, when around 470,000 of our rangatahi will have the ability to return to in-person learning, while the 290,000 in Auckland will remain at home.

    Already we have seen cancellations of preparatory exams. If this outbreak drags on for weeks, as experts predict, we will see a significant reduction in classroom time during the crucial lead-in to exams. For many Tāmaki Makaurau students in the final years of high school, it marks a second consecutive year with at least a month lost at this time of year. It’s not just the time lost either – the scars of lengthy lockdowns linger in lower decile schools, where chronic absenteeism increased markedly among deciles 1-4, while being flat in deciles 7-10.

    This has been attributed to factors like multi-generational living, which amplifies the risks associated with contracting Covid-19 for whānau; and economic hardship changing working conditions, forcing older children to stay home to care for younger siblings. But irrespective of what drives it, what is undeniable is that a hard and very necessary lockdown will have a disproportionate impact on one city, and on particular communities within that city. These are potentially scarring events which could impact qualification for tertiary study, and future employment outcomes for years to come.

    For many Auckland students, 2021 is the second consecutive year with at least a month lost at this time of year (Photo: Getty Images/additional design: Tina Tiller)

    Competing businesses will have very different abilities to trade depending on where they are headquartered. The most obvious benefit is to large national businesses, which can sell into our biggest city from stores and distribution hubs located elsewhere. MBIE confirmed to The Spinoff that consumers in level four can buy products from level three retailers, “so long as the alert level three business or individual is following the alert level three rules”. Couriers and freight company employees can cross alert level boundaries.

    What it means is that small businesses already strained from multiple lockdowns face the prospect of ceding customers to competitors from outside the region, particularly national chains able to leverage their scale and locations to sell into the city from beyond its boundaries. This plugs into accelerated, long-term shifts to online shopping, and increased use of customer databases in highly sophisticated ways.

    For example, if you sell homeware from a single shop and related online operation based in an Auckland suburb, from today your customers cannot shop with you, but remain stuck at home. If they transfer that business to a national retailer, or even a similar independent business outside of the city, they are also likely to register an account and join an email database. In this way a single transaction can predict a customer lost for good.

    This impacts multiple industries, from screen production to manufacturing. Even construction is almost entirely paused, meaning developers based in Auckland will lose ground and momentum in addressing the big overarching crisis of our time in housing. Many of these transactions and relationships are harder to shift than an online shopper, but the fundamental barriers to commerce being unequally distributed between regions is a reality we now face, with the potential for that to extend and compound.

    Remember these things about Auckland: demographically it is younger, more diverse (Tāmaki Makaurau has higher Pacific, Asian and MELAA populations than Aotearoa as a whole) and has the highest housing costs of the country. Therefore these issues will be disproportionately visited upon some communities which start disadvantaged – and are often our essential workers, too. Where jobs are transferred from Auckland to other centres, they inevitably hit those communities hard.

    This was masked during the first lockdown by its national nature, and during that of August 2020 by being staged at level three, and its relative brevity. This one is already shaping as very different, yet to date the policy response is the same – the wage subsidy and various other levers, largely created and refined a year or more ago.

    They worked for a triage, though the great wage subsidy rort remains an aching and unaddressed sore. This next phase we’re staring down brings with it far more complexities to solve.

    Level four is manifestly the appropriate response to the extraordinary challenge of delta in our community. And it is equally appropriate that the whole country should not suffer unduly when the virus can likely be contained and confronted within a single region. But it’s clear that from this day on, the national interest in defeating the virus weighs disproportionately on one region alone, and particularly on some communities within it.

    It demands that this government rise to meet that with some appropriate and targeted response for the extra burden borne by the city – and particularly some of its most vulnerable populations – in suppressing this outbreak.

    Society