Vaccinating Venezuela’s 28.5 million people against the coronavirus was always going to be a challenge given low levels of trust and the hollowed-out nature of the country’s public institutions. Bringing visibility to Venezuela’s vaccination debacle has been a pitched battle between the country’s democratically elected political opposition, which demands a credible and efficacious vaccination campaign, and the ruling regime, which has suppressed and obfuscated information on the pandemic.
Data on the country’s vaccination campaign, currently in phase two, indicates a nation unprotected against COVID-19 transmission. Prior to the end of May, fewer than 5 percent of Venezuelans had received a single dose and just 0.5 percent had been fully vaccinated. This brought apocalyptic warnings from Venezuela’s independent National Academy of Medicine that, at those rates, it would take the country 10 years to fully vaccinate the entire population. Fortunately, June and July brought an upward inflection in vaccinations; by mid-July, an estimated 4 million vaccine doses had been administered, with 3.9 percent of the population fully vaccinated and another 6.3 percent partially vaccinated. Still, more than 25 million Venezuelans had not yet received a single dose. Despite this upturn in vaccine administration, Nicolás Maduro’s government lacks a credible, coordinated nationwide vaccination plan. Maduro’s earlier claim that Venezuela would vaccinate 70 percent of its population by the end of August seems dubious. To provide realistic context, both Chile and Uruguay, two of Latin America’s wealthiest and most developed countries, have surpassed the 70 percent threshold, but their vaccine rollouts began in early spring and required about five months to reach this benchmark.
Lacking vaccine protection, Venezuelans remain as vulnerable to COVID-19 infection, disease, and mortality as they were in the pre-vaccine era—but with far more dangerous COVID-19 variants currently circulating. Venezuela remains reliant on enforcement of community-level population protection measures. Due to the size of the informal labor sector, the existential need for survival in an economy that has plummeted by nearly 80 percent in the last decade, and a minimum wage that barely eclipses $2 per month, many citizens are unable to comply with any imposed restrictions on mobility or to observe social distancing. Ominously, the coronavirus restrictions that have been enforced have allowed the Maduro regime to more tightly consolidate political power and vitiate street-level pressure for change by prohibiting public gatherings and mass protests, as occurred in 2019 and early 2020.
The Maduro regime has taken a disjointed, circuitous path to procuring foreign-made vaccines, boldly proclaiming agreements to purchase vaccines while wasting precious months waiting for shipments to materialize and vaccination programs to get underway. The secrecy of the Maduro regime’s acquisition plan, moreover, makes it difficult to say exactly how many vaccines it has managed to procure. Venezuela has recently received Russia’s Sputnik V and Chinese-made vaccines, estimated at 3.5 million doses, a small down payment on a program that should be reaching 28.5 million. Furthermore, the Chinese-made vaccines, widely used throughout Latin America, have been found to be less efficacious than the mRNA vaccines developed by Pfizer and Moderna.
To compensate for the egregious shortfall, Maduro has begun importing two experimental Cuban vaccines, Abdala and Soberana 2, currently in late-stage trials. Neither of these three-dose vaccines has been approved by the World Health Organization (WHO), nor have these vaccines been scrutinized in peer-reviewed studies. The only information on efficacy comes from the Cuban government itself. WHO has urged caution—and the release of public data—while the Venezuelan Medical Federation has advised people not to take the Cuban vaccines. Nevertheless, Maduro has forged ahead. The first shipment of 12 million planned doses of the Abdala vaccine (reported efficacy of 92 percent) arrived in Venezuela on July 22, a sufficient supply to fully vaccinate just 4 million people at three doses per person.
The Maduro regime must therefore rely heavily on COVAX—WHO’s mechanism for attempting to achieve worldwide vaccine access—to fill its considerable vaccine gap, but the de facto president’s irascible personality has led to frictions. Initially, Maduro agreed to split the financing for vaccine procurement with funds controlled by the country’s democratic opposition. Fearing a political victory for his opponents, Maduro then backed out of the agreement. Further delays ensued when Maduro blocked the AstraZeneca vaccine—on which COVAX relies heavily—arguing unscientifically that the vaccine is unsafe. Next, Maduro sought to undermine U.S. sanctions by claiming they prevented him from paying the $120 million COVAX fee—despite clear humanitarian exemptions built into U.S. sanctions architecture. Maduro, eager to play the victim, issued an “ultimatum” to COVAX, demanding an immediate shipment of delayed vaccines or a return of the country’s money.
The paucity of vaccines has engendered some protest activity largely unseen since before the emergence of the coronavirus in Venezuela. Those who have managed to get vaccinated have done so despite significant obstacles—long lines, uncertainty about where to go and when for vaccination, and inexplicably long waits for second doses, coupled with fear and understandable mistrust of the unproven Cuban vaccines. The dearth of readily available vaccines has spawned a burgeoning black market, where Chinese- and Russian-made vaccines can fetch hundreds of U.S. dollars per dose.
The Maduro regime’s abject failure to secure a sufficient supply of efficacious COVID-19 vaccines for its citizens, and to launch an equitable campaign for population-wide vaccine distribution, has been further complicated by politicization of the vaccination campaign that prioritizes regime allies and makes use of the country’s problematic Patria System to dole out the limited doses Venezuela has received. This system has historically served as a tool for the regime to exercise social control and reward political allies in the public distribution of goods, including food—and now, COVID-19 vaccines. In Venezuela’s vaccination program, the system has been used to determine eligibility for a lottery and to summon those selected for vaccination. Given the number of Venezuelans who refuse to get a homeland identification card and submit to the Chinese-built surveillance technology behind it, the health ministry has established an alternative system for vaccine distribution, but the parallel processes have served only to confuse people.
Venezuela’s inability to obtain and distribute sufficient doses of efficacious COVID-19 vaccines in a timely manner has triggered a cascade of consequences for Venezuelan citizens, and the region, when examined through an epidemiological lens.
First, the longer the delay in vaccination, the greater the population exposure to the virus, leading to more illness, “long COVID” aftereffects, and mortality. Second, the longer the delay in achieving a high level of vaccination, the greater the opportunity for variants of concern to enter the population from sources outside the country. The gamma variant is predominant in neighboring Brazil and Colombia. Lambda, which originated in Peru, has reached both Brazil and Colombia—and almost certainly Venezuela, too. The delta variant is rapidly sweeping the planet and will likely be a major player throughout Latin America.
Third, because mutation occurs continuously, Venezuelans who become infected with the coronavirus could be the source of new variants. In the absence of testing, gene sequencing, and surveillance, Venezuela has a much greater likelihood of becoming a source nation for a yet-unidentified variant to gain prominence and proliferate, especially one that may have one or several of the characteristics that distinguish variants of concern: increased transmissibility, increased severity (pathogenicity and/or virulence), and/or the capability to evade vaccine protection. Without a change in policy, Venezuela may become a breeding ground for new variants.
Fourth, Venezuela’s broken health care system and dilapidated health infrastructure are unequipped to provide the levels of care required for severe cases of COVID-19 and are more likely to create care settings where—due to a lack of intensive care beds, vaccinated staff, personal protective equipment, soaps and cleansers, and surface disinfection—transmission among staff and patients may occur.
Lastly, a cross-cutting theme that intersects with these COVID-19 transmission dynamics is the reality that the mass exodus of Venezuelans continues unabated, even during the pandemic. Migration moves COVID-19. The Venezuelan diaspora has swelled to almost 6 million, and 1 in 6 Venezuelans has left the country from the time of Hugo Chávez to the present day. Some are in the United States and have access to the best vaccines, but many have migrated to nearby Latin American countries (e.g., 2 million to Colombia) that are also grappling with recent surging rates of cases and deaths. Venezuelans who migrate are usually unvaccinated. COVID-19-infected migrants may become infectious, including those who are incubating or are asymptomatic, and unwittingly propagate the disease. They may transmit COVID-19 to other migrants they are traveling with and to people they encounter along their trajectory in the communities where they seek shelter. Pendular migrant populations, shuttling back and forth between Venezuela and Colombia on a regular basis, may become mobile vectors, potentially able to transport COVID-19 variants in multiple directions.
Migrants work in the informal sector. Their lifestyles do not allow social distancing, mask-wearing, infection control, or proper hygiene. They may become infected on the job and bring COVID-19 home. They may be infected at home and bring COVID-19 into the work setting. Due to their irregular legal status, migrants tend to lack health care coverage in their host countries, thereby reducing their access to testing, treatment, diagnosis, care, and vaccination. Many have underlying comorbidities that elevate their risks for severe or deadly COVID-19.
Taken together, the consequences of Venezuela’s COVID-19 vaccine fiasco are grave—for Venezuelans and for Latin America and the Caribbean as a whole. Indeed, the public health of the entire region may be contingent on the Maduro regime’s ability to develop a credible vaccination campaign and execute it. Failure to do so could be a potential ticking time bomb for a region already severely buffeted by COVID-19.
