The end of the COVID-19 pandemic will not be linear, homogeneous or simultaneous, enabling the virus to become endemic. As outbreaks become increasingly localized, companies and individuals around the world will face short-term uncertainty surrounding the resumption of activity and travel as they navigate disjointed policies and requirements. The developing world, meanwhile, will likely face long-term disadvantages of endemic disease and waning international interest. With vaccination campaigns in the United States and Europe now in full swing, the developed world will start to hit the ceiling of vaccine hesitancy and/or political pushback by the end of the year. And in the developing world, bottlenecks holding up vaccine distribution and the resumption of international travel will continue to create pockets for transmission, keeping low levels of COVID-19 in those populations with the potential for localized and possibly seasonal outbreaks. 

• In the Pew Research Center’s most recent survey, 30% of Americans said they definitely or probably would not get a COVID-19 vaccine. This leaves little room for error or logistical issues in order to innoculate the 70-80% of the U.S. population needed to achieve the estimated threshold for so-called “herd immunity.”
• Vaccine hesitancy rates throughout Europe vary greatly, but skepticism in France is particularly high, with polls showing that more than half of the population is unlikely to get a shot.
• A survey conducted by the international science journal Nature shows that most experts expect the virus to become endemic, meaning it will continue to spread at either low levels or in localized pockets. But experts also believe COVID-19 will start to pose an overall smaller global threat as more people are protected from severe illness, whether it be through immunity from vaccines or prior infection. 

Without herd immunity as an achievable vaccination target, the return to activity globally will remain disjointed. Media attention and policy targets in the initial stages of vaccination campaigns focused on achieving herd immunity as the marker for when restrictions could be fully lifted. However, as it becomes more obvious that herd immunity is likely unreachable even in many parts of the developed world, ambitious goals and targets will be set aside as reality sets in and mindsets begin to shift. Political and economic pressure will push for faster, more widespread reopenings. This will happen at different rates around the world depending on government structure, the severity of outbreaks and social pressures. Vaccine distribution and manufacturing will also remain disjointed, especially over the course of the next year. Additionally, we will likely see continued regional variation in willingness to take any necessary booster or seasonal shot. 

• National targets and “successes” will start to focus on ensuring those most at risk of severe illness are vaccinated, shifting the narrative on exactly who needs to get a shot before safely resuming normal activities. Some EU countries like Belgium, for example, have set a 70% vaccination rate among only their elderly population as the threshold for reopening. 
• As case levels continue to drop in the United States, several states have already begun widely reopening up activities and businesses, despite vaccination rates still being below 50%. 
• Meanwhile, many Asian nations remain under more restrictive lockdown measures despite comparatively low COVID-19 numbers.

The inability to standardize a system of global immunity data — along with political and social backlash — will limit the use of COVID-19 health certificates, adding uncertainty to travel and business operations. Continued uncertainty for households, companies and legislators about the future of the pandemic will influence spending and investment decisions, as well as government policy. The initial vaccine rollout already illustrated inequalities in distribution between the developed world and the developing world, as well as between and within developed countries. Vaccine “passports” risk exacerbating these inequities by enabling potential discrimination and limiting mobility for those who either can’t or won’t utilize the applications. The European Union’s shift from “passport” discussions to that of a “certificate” (which does not focus on a person’s vaccination status alone) was in part due to perceived concerns over discrimination against unvaccinated individuals. 

The uneven global economic recovery, as well as unequal access to vaccines and treatment, will ultimately hit the world’s poorest countries hardest, widening the gap between developed and developing nations. As the COVID-19 crisis shifts from global to regional, impoverished countries will become home to the bulk of the epidemics. Slower vaccination campaigns will also increase the severity of outbreaks and symptoms in the global south, prolonging COVID-19’s financial impact on these countries’ already financially fragile economies. 

• Malaria, the mosquito-transmitted disease prevalent across the developing world, is estimated to cost Africa $12 billion in GDP output a year.
• HIV/AIDS is prevalent across countries of all economic levels, but the impact varies widely. In the developed world, being HIV positive is now often synonymous with having a chronic but manageable medical condition, thanks to advancements in treatments and prevention measures. But in the developing world, HIV remains a very costly disease, both in terms of human life and economic output, with the mortality rate highest in Southern African countries including Botswana, Lesotho, Eswatini, Mozambique and South Africa.

The COVID-19 pandemic is deepening the inequality gap between rich and poor nations, while a slower recovery in the developing world is increasing the risk of social unrest and economic crises. Because of global travel, the potential will remain for travel to result in localized outbreaks and the spread of new variants, which would be particularly damaging to the developing world due to limited infrastructure and medical resources. If additional travel restrictions are placed on these countries, their tourism and services sectors would also be negatively affected. Inequality and economic burdens will likely result in increased social unrest and risk of violence. Additional financial fragility will also increase the risk of debt defaults in Latin America and Africa as well. In addition, once the developed world recovers from the health and economic fallout from the COVID-19 crisis and the sense of urgency is gone, its interest in providing financial, logistical and humanitarian assistance to the developing world will likely decrease. 

• The United Nations expects economic growth in the sub-Saharan African region for 2021 to be between 2.3-3.4% after fairing better than the global average in 2020. However, the U.N. forecast also notes that support from the international community, lack of access to vaccines and the potential recurrence of COVID-19 could significantly reduce that growth.  
• The International Monetary Fund expects that Latin America, one of the regions economically hit hardest by the pandemic last year, will continue to struggle in 2021 and doesn’t expect the region to recover to pre-pandemic levels until 2024.