The Delta variant of Sars-CoV-2 is causing major problems across the world. Estimated to be at least twice as transmissible as the original virus, it is challenging the measures that governments took in 2020. Thailand and South Korea are seeing accelerating cases and deaths, after having successfully managed their epidemics last year. New Zealand and Australia find themselves in snap lockdowns. Low- and middle-income countries are struggling to keep their hospitals from collapsing. Delta has changed the game radically: it is almost like managing a whole new virus. Though, while much of the world struggles, life seems almost normal in Britain. London nightclubs are full of those partying and enjoying themselves without a care in the world. Festivals are going ahead with tens of thousands of revellers. After incessant daily media coverage, Covid-19 has fallen off the front pages, receding into the background. Observing this, it feels as if the pandemic is over for most people. The game-changer in Britain has been vaccination. When the first vaccine trial results were reported, the efficacy was much higher than anyone expected. And early studies from Scotland indicated that the Pfizer vaccine was even effective at stopping transmission. This gave real hope for using a vaccine to suppress the virus or reach a “herd immunity” threshold at which it would stop circulating. It’s true that Delta changed the picture again. While vaccines are still incredibly effective at stopping severe illness and deaths, those who are double vaccinated can still be infected with Delta and transmit it to others. But the important metric is case-conversion: the number of Covid cases in the community that translate into hospital admissions. When the virus first emerged in China, the estimates were around 20%. Wider testing for asymptomatic cases brought this down to about 13%, and vaccines have managed to bring this down even further to 3-4%. Yet these problems pale in comparison to the devastation in countries such as Indonesia, India, Nepal, Peru and Brazil. Hospitals have collapsed in several regions, with beds only becoming available if someone dies, and oxygen shortages are causing usually preventable deaths even in younger people. In June, 30 patients in an intensive care unit in Uganda were reported to have died on one night, as oxygen supplies ran out. Thousands of people have died at home, with teams of civilian volunteers formed to help take away their bodies and support the families of those who have died. What can be done to help and support these countries? In the short term, getting medical capacity such as skilled staff, oxygen, ventilators and more beds into countries is vital. In addition, institutions such as the World Bank have been supporting countries financially to implement lockdown measures with economic support for those who can’t work. But these are again short-term measures, given that Delta will keep spreading. The larger issue is that these countries need more vaccines to be able to protect their health and social workers first, then their elderly and vulnerable groups, and finally move towards broad-scale protection of their populations. Basically, they need to replicate what the UK has done but in a context of billions of people, not millions. And they need to do this in the face of a fast-moving virus that is causing devastation by the day. The main bottleneck to achieving that right now is in the supply chain. The solution proposed by rich countries and pharmaceutical companies is a donation mechanism: rich countries pledged money and doses to an international initiative, Covax, which then distributed these across the world. Alternatively rich countries could directly donate doses to their country of choice. As is widely recognised, this charity model has failed. Under scarcity, rich countries kept their doses and didn’t share. This is being repeated now with the decision to give booster doses (third doses) in rich countries, while poorer countries are still waiting for first jabs. And it’s not surprising – whether with previous epidemics of Ebola or swine flu, rich countries always take care of themselves first, and then turn to the rest of the world. What does this mean looking forward? It means we need to move away from the charity model towards one where regions can produce enough supply for their own populations, ideally from local manufacturing hubs. This means setting up factories in strategic locations across the world, doing the required tech transfer and human capacity investments, and being prepared to pass emergency intellectual property waivers so that manufacturing can happen without the normal patent protection. The World Bank, and richer countries, should be helping these countries to become self-sustainable, instead of remaining in the 20th-century dependency model. As we look to the rest of 2021, what is emerging is a tale of two pandemics. Rich countries are storming ahead, trying to pretend the pandemic is over. Poor countries are being forgotten, yet again, and are struggling to see how they can emerge from this year without continual loss of life and deeper devastation. Prof Devi Sridhar is chair of global public health at the University of Edinburgh