Having borne the brunt of the coronavirus pandemic, the countries of Latin America and the Caribbean will enter 2021 knowing they face huge challenges before mass vaccinations can help them exit the health emergency.
Though home to just 8 per cent of the world’s population the region accounts for a fifth of global infections and 30 per cent of all deaths from Covid-19 so far. But while other parts of the world start vaccination programmes Latin America is facing insufficient access to doses and must tackle major logistical difficulties before it can distribute those it does get.
Blaming inequality and under-investment in health systems, Pan-American Health Organisation (Paho) director Dr Carissa Etienne warned last week "we must be patient and remain realistic that Covid-19 will be among us for some time".
Meanwhile the social backdrop to any roll-out is a rise in anti-vaccine sentiment, most notably in Brazil, home to a third of the region's population, whose far-right president Jair Bolsonaro has emerged as a leading vaccine sceptic.
The declining influence of once flourishing international organisations designed to drive integration means Latin America has not even attempted to come up with a co-ordinated regional approach towards a vaccination programme. Instead this will be largely on a country-by-country basis, which will leave states competing against each other for doses in a marketplace where demand far outstrips supply.
In an effort to guarantee better access, many governments have signed up to participate in the Covax initiative of health organisations and charities being co-ordinated by the World Health Organisation to ensure poorer nations can vaccinate their populations. Most participants will pay under the scheme but 10 regional nations including Haiti, Nicaragua and Bolivia will receive their consignments as donations.
But the initiative envisages having between just 10 and 20 per cent of the doses needed in each country, with delivery only due to commence after March next year. Paho says an initial 65 million doses would be a "realistic expectation" for a region with 650 million inhabitants.
The Pfizer vaccine which was the first to be used anywhere in a mass campaign is set to be the lead Covax vaccine once approved by the WHO. But the need to transport and store it at ultra-low temperatures presents a particular challenge in many Latin American countries where infrastructure is poor, especially outside of large urban centres.
That means health ministries are anxiously awaiting approval by regulators of less technically demanding vaccines.
Worries about the viability of the Covax initiative mean the region’s governments are also engaged in a scramble to secure as many doses of vaccines as possible directly from manufacturers.
Mexico, which has one of the world's highest death tolls, became the first country in the region to approve a vaccine, when its regulator became the latest to authorise use of Pfizer's. President Andrés Manuel López Obrador says his administration will vaccinate 10 million people a month next year using a variety of solutions. But with a population of 130 million this means herd immunity will only be achieved late next year.
Peru, which has Latin America's highest mortality rate despite enforcing strict lockdown measures, says between Covax and private sources it has secured enough doses to vaccinate three quarters of its 32 million population. The health ministry has targeted immunising people at polling centres in April's presidential election. But almost 10 million of its doses are from Pfizer which will be difficult to deliver across mountainous and jungle regions.
Several administrations in the region have turned to the Russian Sputnik V vaccine as a cheaper and more readily available option.
Argentina's president Alberto Fernández says it will receive enough doses from manufacturer Gamaleya to vaccinate 10 million people during the first two months of next year. With its economy ruined and public health infrastructure collapsed, Venezuela is heavily dependent on its Russian ally to supply it with its vaccine.
Sputnik V is also part of the jumble of vaccine solutions being pursued in Brazil where some state governors have been developing their own plans in response to the chaotic approach of the Bolsonaro administration’s health ministry.
Earlier this month health minister Gen Eduardo Pazuello reversed course for a second time and admitted the Chinese CoronaVac vaccine will now be part of the government's vaccination programme. The first time he announced its inclusion, Bolsonaro ordered him to reverse course amid a bout of anti-Chinese hysteria among his supporters. But even as his government said it would deploy the Chinese vaccine, Bolsonaro once again stirred up anti-vaxxer sentiment by declaring he would never take it. "My life is at risk? The problem is mine," he said.
In the face of the president’s campaign against vaccination, the number of Brazilians who say they will not get one against Covid-19 has jumped from 9 per cent to 22 per cent. Last week Brazil’s supreme court authorised state and local authorities to impose restrictions on people who refuse to be vaccinated.