With vaccines spreading through rich countries at gathering speed and lockdown restrictions weakening with the spring sunshine, it’s tempting to believe that the long nightmare of Covid-19 is finally ending. In the UK, 58% of the adult population has received at least one dose of vaccine. In the US, President Joe Biden has doubled an original goal of administering 100 million shots in his first 100 days in office, which would bring the total to 200 million by the end of April. On Google, the search term “after Covid” has been getting more interest than “Covid symptoms” for the past month, suggesting the world is thinking more about what life will be like when things return to normal. That’s a mistake. While we’re increasingly talking about the coronavirus in the past tense, the worst may still be ahead of us. Infections worldwide rose 47% during March from a lull in late February. At about 600,000 new cases a day, the rate today is higher than it was for most of last year. Worse still, while previous waves have broken primarily in Western Europe and the US, many of the areas where Covid is now growing most rapidly are in South America and South Asia, the Middle East and other emerging economies. Mostly lacking the first-class public health infrastructure found in the global north, they’re less equipped to cope with the virus. That’s especially the case if new variants, like those identified in the UK or the Brazilian city of Manaus, cause more problems for younger people. For most of the past year, the coronavirus has looked like what Austrian historian Walter Scheidel has called a “great leveler”: One of the many catastrophes such as war, pandemic, revolution and state failure that paradoxically manage to even out the worst excesses of inequality once in every generation or so. More than 46% of deaths have been in just three rich jurisdictions with unusually large elderly populations: the US, UK and the European Union. That may now be shifting. The US, which has mostly held the unenviable top spot for record daily infections since the start of the pandemic, has slipped behind Brazil, possibly permanently, since the start of March. The UK, similarly, is now running a lower rate than Bangladesh and the Philippines for the first time since Europe’s seasonal lull last summer. Many of the nations where Covid has been spreading fastest recently are ones where current rates of vaccine rollout won’t result in herd immunity for years, or even decades, based on Bloomberg’s vaccine tracker: At current rates, rich countries will hit 75% Covid vaccine penetration this year. Other nations arent so lucky. That’s going to put much more emphasis on the issues of inequality and justice around vaccine delivery that have so far been relatively muted in the public debate. In spite of a $4 billion donation from the US in January, Covax — the UN-sponsored program to deliver coronavirus vaccines to lower-income countries — is still about $2 billion short of the funds it needs to distribute 1.8 billion doses to target nations this year. In addition to that, countries including the UK, US, Switzerland and EU members continue to block waivers to intellectual-property rules that would allow generic drug manufacturers in India and South Africa to produce vaccine doses at vastly reduced costs, ensuring that current production is weighted to the developed world. “The solutions at this stage are political and logistical,” said Stephanie Topp, a professor of public health at James Cook University in Townsville, Australia. Countries that protect only their own populations without setting aside IP rules and providing funding for vaccination elsewhere in the world will find it a false economy, she said. “Where we’re considering global public health, that’s a self-defeating argument, because what happens is the disease wins,” she said. “If the disease is circulating elsewhere in this incredibly globalized interconnected world, the disease will come back again.” We’ve seen this movie before. The general indifference to medical problems once they stop bothering rich countries is such an entrenched issue that there’s an entire branch of modern medicine dedicated to “neglected tropical diseases.” Infections like tuberculosis and cholera — often seen by wealthy nations as 19th century relics, encountered mostly in opera and novels — are almost certainly more prevalent today than they’ve been at any point in human history. While US TV networks run nostalgic reruns of the AIDS-themed musical Rent, two-thirds of people with HIV live in sub-Saharan Africa. In the case of Covid, that’s not just a moral failing, but a shortcoming on even the most callous measure of self-interest. If we want to see borders reopen and minimize the risks that fresh variants will arise to overwhelm the vaccine defenses we’ve worked so hard to erect over the past year, the rich world needs to start treating infection in emerging economies as an emergency on a par with what’s happening in its own backyard. In the fight against coronavirus, we will stand together, or fall apart. Bloomberg