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All of this has hurt quality of care not only for Covid-19 patients, but also for others with critical medical needs.

“It’s not just Covid patients who come to the hospital,” Huang said. “The ability of the health care workforce to provide needed care to people who are coming in for other serious conditions, like car accidents, is compromised.”

Despite omicron, it’s business as usual in Texas

Despite the pressure on Texas hospitals, omicron hasn’t shifted state Republican leadership’s pandemic strategy. Since March 2021, Gov. Abbott has been primarily focused on rolling back public health measures that had been used to curb the pandemic and keeping Texas open for business, no matter the risk.

He ended the state’s mask mandate and business capacity limits. He banned local officials from implementing their own mask and vaccine mandates and has taken those who defy him to court.

Texas Attorney General Ken Paxton signed on to a lawsuit challenging the Biden administration’s vaccine-or-test mandates for large businesses and health care workers, which is now before the US Supreme Court. Paxton also successfully fought another federal mandate that requires federal contractors to be vaccinated, which has been blocked in court.

That’s despite the fact that most Texas voters support mask mandates and allowing private businesses to require that their workers be vaccinated. There is, however, a large partisan divide on the topic and significant opposition to such mandates among Abbott’s Republican base. For example, a October University of Texas/Texas Tribune poll found that while 89 percent of Texas Democrats believe employers should require their employees to be vaccinated or to be able to show a recent negative test, 72 percent of Republicans believe employers shouldn’t have those requirements.

Though Abbott says he is pro- vaccine, his public remarks on the topic of vaccination have largely focused on protecting the right to be unvaccinated. He told the Dallas Morning News in July, for instance, that people have “the individual right and responsibility to decide for themselves and their children.” He hasn’t held a press conference on Covid-19 in months. He has never tweeted about booster shots, and it’s not clear whether he has received one himself.

His supporters seem to be taking cues from him, and that’s proving to be dangerous amid the omicron wave. It also means hospitals are unlikely to see any relief until omicron begins to decline naturally. In the near term, in part due to personal choices and in part due to policy choices, health care workers in Texas will continue to face an overwhelming number of Covid-19 patients. And all of their patients will continue to suffer for it.

“The lesson that we learned is that we can’t be complacent,” Huang said. “We can’t just go back to the way things were. We need to still keep our guard up.”

Chart: Share of people vaccinated against Covid-19, by country income level. Our World in Data

Nevertheless, this late 2021 surge in vaccine deliveries could be a hopeful sign that a key vessel for global vaccination efforts is finally righting itself. With improvements in supply and delivery, Covax has the potential to help the world reach greater vaccination coverage. But all of this hinges on Covax getting this right — and that few further storms appear on the horizon for the project.

Covax, explained

Covax is an initiative led by three groups. There’s the WHO; Gavi, a public-private group that works on getting people in developing countries vaccinated; and the Coalition for Epidemic Preparedness Innovations, a project co-founded by the Gates Foundation that seeks to make vaccines available in the event of outbreaks. The United Nations Children’s Fund (UNICEF) is also organizing the delivery of vaccines.

Rich countries were supposed to pool funding through Covax to negotiate deals for and finance multiple vaccine candidates, increasing the chances of effective ones being developed. At the same time, some of that financing was intended to allow Covax itself to purchase vaccines for poorer countries that couldn’t afford them. In addition, Covax was also supposed to gather vaccines via donations from nonprofits, businesses, and countries, in order to further shore up its supply.

But all that didn’t quite pan out. Rich countries not only faltered in their funding commitments to Covax, they also struck their own bilateral deals with pharmaceutical companies, even as Covax was still fundraising. That left the group with little supply to buy once it did raise funds. And even when rich nations amassed more vaccines than they needed, they were slow to donate the extras.

Our World In Data
Covid-19 vaccine doses donated to Covax by country. Data is current as of November 29, 2021, and may not fully reflect the surge of donations late last year.

Pharmaceutical companies similarly underdelivered on the commitments they had made to Covax. A report by the People’s Vaccine Alliance — a coalition of organizations and activists campaigning for the sharing of knowledge and technology related to Covid-19 vaccines, treatments, and tests — found that neither AstraZeneca, Pfizer/BioNTech, Moderna, nor Johnson and Johnson “have sold more than 25 percent of their vaccine supply (agreed through contracts)” to Covax as of October 2021.

Groups like Oxfam International suspect this is because these companies “put their rich customers at the front of the line.” And when vaccine doses finally did make it to poorer countries, too many of them were close to expiration, leaving little time to get shots into arms. A joint investigation in October by the Bureau of Investigative Journalism and Stat News also found that Covax had contributed less than 5 percent of all vaccines administered globally.

“The reality is that Covax purchased a bit later than the high-income countries, and bet on Indian manufacturers given their limited resources,” Glassman says. When those Indian vaccines failed to pan out because of the devastating delta surge in that country, another expected source of doses dried up. “It’s not surprising that they didn’t get the deliveries they hoped for during [2021].”

What the year-end surge means

But if Covax’s performance to date has been underwhelming, the surge in activity in late 2021 has renewed hopes that it’s turned the corner.

Olly Cann, director of communications at Gavi, believes that the end-of-year surge in shipments is indeed a hopeful sign that the pace of vaccine distribution will pick up for Covax this year. “We do have genuine momentum when it comes to delivering doses into the countries that we serve,” he says. “We’re now in a situation where we can now meet the demand” of the low- and middle-income countries that Covax is prioritizing.

A major reason for that optimism is in seeing positive signs in India, a major vaccine producer and the main supplier of vaccines to Covax. Due to the devastating second wave of Covid-19 that hit India last spring, the country focused its efforts on vaccinating its own citizens and had banned exports of doses, which Cann notes was “a severe blow to us at the time.”

The country finally resumed exports to Covax at the end of November. Along with the WHO’s long-awaited emergency approval of the vaccine developed by US-based Novavax, whose manufacturing partner for Covax is the Serum Institute of India. and which doesn’t require the cold storage needed by mRNA vaccines from Moderna and Pfizer/BioNTech, Covax is “back in business,” Glassman says.

She expects India’s shipments to Covax to continue for the next three months at least, adding that even with Omicron, India may not need to resort to export bans again now that 62 percent of Indians have received at least one dose.

Another problem with Covax is that it was initially developed as a procurement and shipping effort for vaccines, but not a delivery effort — meaning actually getting shots into arms. “Waiting for a delivery is a big deal, obviously, because the longer the wait, the more disease and deaths there will be,” Glassman says.

But Covax deliveries are now ramping up, as shipments from India are finally reaching recipient countries and also because the international community is finally starting to address this problem of delivery. Glassman also notes that last month, Covax’s leadership appointed Ted Chaiban, the regional director for the Middle East and North Africa for Unicef, to serve as the organization’s global coordinator for vaccine readiness and delivery. In her view, this reflects a shift in Covax’s strategy toward actually administering vaccines in recipient countries.

SUDAN-HEALTH-VIRUS-VACCINE Ebrahim Hamid/AFP via Getty Images

Aid workers check a shipment of Covid-19 vaccines sent by Covax to Khartoum, Sudan, on October 6, 2021.

Can Covax help achieve 70 percent global vaccination by the middle of 2022?

Despite the recent good news, it’s highly unlikely that Covax will enable the WHO to reach its goal of 70 percent global vaccination by mid-year. While supply constraints have eased, financing is still a challenge, as high-income countries have remained unwilling to share enough funds or resources for low- and middle-income countries to acquire or make the vaccines themselves.

But there are also questions about how practical that 70 percent vaccination coverage threshold is — both for the rich nations meant to be funding Covax and the poorer countries meant to receive vaccines. Governments in lower- income countries with younger populations (who are less susceptible to hospitalization and death from Covid-19) are overwhelmed by many competing priorities, such as poverty, hunger, and other diseases like HIV/AIDS and malaria. Glassman and Cann both mentioned that the 70 percent vaccination goal may not just be out of reach, but also simply not the best allocation of limited resources.

Cann also notes that Covax was never meant to be the solitary silver bullet to solve the issue of vaccine equity.

“What we were set up to do was to cover the most vulnerable groups as quickly as possible,” Cann says. “That’s why we initially focused on the 20 percent coverage of the [highest priority low- and middle-income recipient] countries. This is roughly 950 million doses. We’re actually quite close to this now, and we’ll have delivered that number in the coming days, if not weeks.”

Meeting its goals will also depend on whether Covax will be pushed down the priority list again in favor of high-income countries, as the latter now aim to shore up supplies of vaccines to administer booster shots for their populations.

“The big problem we’ve had, and still to a degree do, is that it’s been very, very hard to get transparency from manufacturers on when doses are going to be coming to us,” Cann says. “It’s difficult for us to be confident that we’re not being pushed to the back of the queue, or being deprioritized over bilateral deals.”

Ultimately, Glassman believes that the optimistic scenario is that there are “orders in place, there’s manufacturing under way to meet those orders, and then it’s just a matter of time and effort for the shots to get from airports into arms.”

Covax has a long way to go though if it wants to achieve the WHO’s goal, and it’s likely the poorest countries in the world won’t achieve 70 percent vaccination until 2023 at current rates of delivery.

That said, countries in the Global South also may not need to keep waiting on Covax. They are already pursuing other avenues to vaccinate their populations, from pushing for a patent waiver at the World Trade Organization to encourage technology transfer, to shoring up their own domestic manufacturing capabilities (including for mRNA vaccines) to seeking out other vaccine sources.

And there was one more development of note at the very end of 2021: CORBEVAX, a vaccine created by Texas Children’s Hospital Center for Vaccine Development and Baylor College of Medicine in Houston, was licensed for use without patents and had its technology transferred immediately to Biological E. Limited, an Indian pharmaceutical manufacturer. One of the key people behind the project, Dr. Peter Hotez, claimed available CORBEVAX doses will soon surpass in number the vaccine doses donated so far by the US government or any other G7 country.

Given the enormous need — both to protect vulnerable people in the poorest nations and prevent the rise of new variants — the world must pursue every possible channel to get shots into arms and truly end the Covid-19 pandemic. Though Covax is showing signs of turning the corner, it may end up playing a smaller role than what the international community had originally envisioned for it in 2020.

It hasn’t helped that Americans are courted by a growing number of apps and technologies that expedite how they shop. Through mobile orders, instant delivery, automated chatbots, and even self- checkout kiosks, people are promised immediacy alongside better and faster service. These tools are designed to give the customer a greater sense of control over how they receive their goods. With it comes the pretense of a life efficiently lived — at the expense of digital privacy, money, and tech companies’ brewing influence over our lives. Have you ever given in to a late-night notification encouraging you to order takeout?

Venture capital firms are bullish on the emerging and crowded market of ultrafast delivery startups, which have yet to be profitable without investor help. In substituting human-to-human interactions with human-to-machine transactions, shoppers are opting out of the mundane nuisances involved with running errands or grabbing coffee. This might seem like an individual consumer choice, but it is informed by a post-pandemic retail and service landscape that can be hostile to ordinary shoppers.

In October, tech writer Drew Austin remarked how his regular trips to convenience stores and pharmacies in New York City have become littered with unexpected inconveniences. There are fewer and fewer employees on shift, which means checkout lines are longer. Meanwhile, more merchandise is locked up to compensate for the potential increase in theft from the installation of self-service kiosks, which shoppers are encouraged to use to avoid waiting in long lines.

This makes for an unpleasant and inexpedient in-person shopping experience at a Walgreens, where one expects to flit in and out without a hitch. “The implicit message of all this, for ordinary customers, is that we should have stayed home and ordered online,” Austin wrote. “These spaces aren’t for us. We’re effectively trespassing in the company’s warehouse.” Manhattan resembles “a post-Covid retail wasteland,” he continued, populated by vacated chain stores that are being converted into instant delivery hubs.

New Yorkers, for example, once might’ve needed convincing to try instant grocery delivery or delivery-only restaurants, dubbed “ghost kitchens” by venture capitalists. The pandemic altered the stakes not just for consumers, who had an incentive to stay home and order, but businesses reexamining the need for traditional retail spaces. Starbucks, according to the New York Times, has permanently closed 44 of its 235 locations in Manhattan since the start of 2020. It has plans, however, to expand its mobile pickup offerings and add more pickup-only locations.

Research from Edge by Ascential, a digital commerce advisory firm, predicts that retailers could dedicate as much as a third of their space, once used for in-person shopping, to fulfilling online orders in coming years. This switch will likely cost businesses more money, compared to having customers enter a store and pick out the items they want. The way things are heading, though, more and more people are choosing to have items shipped to them and delivered in the same week, day, or even in the next 15 minutes.

This preference is not just for everyday necessities like groceries, baby formula, or toilet paper. Direct-to-consumer startups, particularly those in the home goods and food and beverage spaces, are trying to reach urban shoppers through on-demand delivery. “What we’re trying to accomplish with fast commerce is to give people the ability to get as close to instant gratification as we can,” the head of customer experience at Olipop, a low-calorie alternative soda, told Thingtesting. “If consumers are looking for a drink late at night, we want to make sure it’s Olipop.”

Despite the booming landscape of instant delivery apps, most have yet to yield sustainable returns for the investors pumping them with billions of dollars. As much as Amazon and couriers like DoorDash, Uber, and Gopuff are pushing to turn urban centers into fulfillment centers, complete with ghost kitchens and ghost brands, stores — and all the nuisances of in-person shopping — will still be around in some capacity. Shoppers still like sauntering through malls, no matter how tech-adjusted they are.

Amazon might have won customers over with its blindingly fast delivery standards, but its business model is not free of logistical complexities. One-day shipping is expensive and dependent on a vast, underpaid workforce that smaller retailers can’t afford. “​​What solves all of these problems — the high return rates, the cost-prohibitive last-mile freight, the logistics nightmares, the buyer frustration, and the monumental volume of consumer waste it all sends to landfills — on some level? Stores. Going to a store,” wrote the Atlantic’s Amanda Mull.

At the start of the pandemic, Americans avoided in-person shopping out of necessity. Today, with most businesses more or less reopened, more are choosing to steer clear of stores due to depreciating customer service. It’s a result of the many cost-cutting factors retailers have implemented, from introducing new technologies to understaffing workers. Meanwhile, delivery appears to be an antidote to the chaos of the store, when it actually isn’t, from retailers’ standpoint.

Soon, retail employees might be too swamped meeting delivery quotas to be relieved that customers are no longer demanding to speak to a manager. The future of retail wants to offer customers hyperoptimized convenience. But is all of this actually good for us? And is it financially feasible?

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