While selfies of people (many of whom do not belong to risk groups) getting vaccinated have become a common sight in the United Arab Emirates, Israel, the United Kingdom, the United States and the EU, throughout the rest of the world, health workers, care workers, firefighters, at-risk patients and the elderly are still waiting for their turn.

Vaccine distribution has mirrored global economic inequalities, leaving the least to those who have the least. At the same time, the pandemic has hit Latin America, which, with 8 per cent of the world’s population, now accounts for a quarter of global Covid-19 cases.

As early as February, UN Secretary General António Guterres complained that “just 10 countries, all of them developed” had administered 75 per cent of all Covid-19 vaccines, while over 130 countries had not received a single dose. In late May, the director-general of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus warned that the COVAX initiative, aimed at equitable access to vaccines, had “shipped 70 million doses to 124 countries and economies, which equates to less than 0.5 per cent of the combined population of those nations”. If not remedied, this ‘two-speed’ response to the pandemic will result in the persistence and mutation of the virus in the world’s poorest countries.

The land-locked country of Paraguay, located in the geographic heart of South America, has the continent’s lowest Covid vaccination rate and one of its worst health systems. Fed up, Paraguayans have taken to the streets in numbers rarely seen over the last decade.

In March, the country’s political opposition called for the president’s resignation, as did half of his own Colorado Party, which has ruled the country for almost 70 years.

As the virus circulated throughout most of the Western world, Paraguay was initially spared the worst affects of the pandemic. It wasn’t until March 2021, with no vaccines in sight, that the country’s health system began to collapse. As of 4 June, just over 448,000 doses of vaccine had been administered to the country’s seven million inhabitants.

Only those over 70 and health workers are entitled to receive the vaccine. Everyone else is still waiting. But not everyone is waiting as long as they should. At a time when intensive care bed capacity has already been exceeded and patients are sleeping outside hospitals, there have been hundreds of complaints of irregularities regarding vaccinations. The most notorious case was that of Mirta Gusinsky, a senator from the ruling Colorado Party, who used her political influence to jump the queue.

Following an outcry from political opponents and even members of her own party, she resigned from her post. But hundreds of others are under investigation for doing the same thing, while more than 40 doctors and 35 nurses in Paraguay have died from exposure to the coronavirus over the past year. The country has one of the six highest mortality rates in South America.

“I am very angry and a mixture of negative feelings, but we are going to continue as best we can,” said Paraguay’s Health Minister Julio Borba after the scandal came to light. He is the second head of the ministry since the beginning of the pandemic following last March’s protests, which provoked a series of resignations and brought President Mario Abdo Benítez to the brink of parliamentary impeachment. The first day of protests saw one death and dozens of arrests. Protesters would go on to burn down the headquarters of the Colorado Party.

Other privileged Paraguayans have taken advantage of their legal residence or visas in the United States, thanks to business established there, where they have travelled to get vaccinated. The increase in flights from Asunción to Miami over the last three months is telling: some 4,000 people flew the route each month, more than double the number of travellers before the pandemic. Executives, businesspeople, football club directors and even one of President Abdo Benítez’s sons were seen at Asunción’s airport boarding flights to Miami in April and May.

The one million vaccines the government promised would arrive by May never materialised. In the meantime, Paraguay has become one of the countries with the highest mortality rates in the world, along with Uruguay. By early March 2021, some 3,000 people had died in connection with Covid-19; 7,200 more have died over the last three months. Deaths related to Covid-19 are currently equal those linked to heart disease, the country’s leading cause of death.

Seeking help on social media

Meanwhile, Paraguay’s social media networks have become real-time obituaries. Paraguayans send hundreds of messages a day seeking help in finding hospital beds and basic or expensive imported medicines. Already tragically commonplace before the pandemic, milaneseadas or polladas, where the proceeds from food sold among neighbours and friends are used to treat the sick, have become even more common. In addition, ollas populares, where women cook so that no one in their neighbourhood goes without food, have become a last resort in working-class neighbourhoods hard hit by the economic crisis brought on by the pandemic.

Paraguay has yet to receive the vaccines it purchased from Russia and India, nor those promised by the WHO, and has been left to fend for itself in a market where it competes with countries with at least three times its GDP. Its vaccination rate of some 10,000 vaccinations a day is among the lowest in the Americas and is not increasing due to the lack of vaccines and the misinformation that keeps many of the elderly away from hospitals. Many vaccines have simply been lost, including some due to lack of proper refrigeration, as happened in the Chaco region.

While the US government recently announced its support for waiving intellectual property protections for Covid-19 vaccines, there is no guarantee that vaccines will soon be available or that there will be a timely agreement on technology transfer.

Paraguay’s intensive care units are on the verge of collapse. According to the Paraguayan Circle of Doctors, 90 per cent of those who have died of Covid-19 did so while waiting to enter intensive care. There are not enough beds or medicine, and space for patients’ families is lacking. Overwhelmed nurses and doctors were the first to warn that the public health system was in danger of collapse and that medicines were lacking, a situation made worse by increasing infections and hospitalisations. They are now organising another round of protests.

Carlos Gómez, an intensive care doctor, walks the corridors of the Hospital de Clínicas, one of the country’s largest public hospitals. “My worst nightmares are now coming true,” he says. “Rooms intended as medical clinics, for multiple use, are now full of Covid respiratory patients.”

He is exhausted and resigned in the face of lacking resources. The most difficult thing, as he explains, is informing the families when a patient has died.

“The situation has changed. A year ago, Paraguay was among the best countries in terms of infection rates, but now the situation has become chaotic. The vaccines didn’t arrive on time.”

Infections are on the rise, as are complaints about corruption and lacking resources. Hospitals are surrounded by families waiting to see what new medicine they will have to buy.

Miguela Quiñonez, whose father is in intensive care for Covid-19, has been waiting for two weeks. “The government should have prepared earlier. Now the health system has collapsed, as you can see. Many people are dying without medicine.” The lack of public investment in Paraguay has forced the majority of its inhabitants to buy almost everything that patients need, from expensive medicines to gauze. According to the World Bank, this is a long-standing problem resulting from underinvestment in health in a fragmented and unequal health system. “I can assure you that this was already the case four years ago. Now it’s getting worse and the pandemic has laid it bare,” adds Gómez.

Although Paraguay took appropriate measures from the beginning of the pandemic, its proximity to and economic dependence on Brazil keeps it at risk. As Guillermo Sequera, epidemiologist and director of health surveillance for the Paraguayan government, explains: “It’s not like Paraguay is an island. It is the country that is most closely linked to Brazil, specifically to São Paulo, where South America’s Covid bomb exploded.”

The government continues to search for new vaccines while awaiting the arrival of those acquired from Russia and India and through the COVAX initiative. How long it will take Paraguay to vaccinate its population, what the consequences will be for its health system and its economy, and for the health of its population, neighbours, and the rest of the world, remains to be seen.