The above tracker shows the evolving distribution of the global death toll of the pandemic across country income groups.

Four phases can be distinguished in the chart:

  • The first phase was when the pandemic was still an epidemic. Virtually all deaths during that first phase could be attributed to one upper-middle-income country: China.
  • The second phase reflected the spread of the virus beyond China’s borders and the first round of impact that centered on the high-income countries. This happened around March and April with fatalities rising rapidly.
  • The third phase saw a geographical broadening of the spread with mortality rising rapidly in upper-middle-income countries and, to a lesser extent, lower-middle-income countries.
  • The fourth phase started around early October when mortality in high-income countries registered again a sharp rise.
 
The above results are naturally conditioned on the quality of the reported data. High-income countries have been struggling with timely and accurate identification of fatalities with COVID-19 as the underlying cause of death. Such challenges are expected to be compounded in settings with fewer resources and particularly where even the collection of basic vital statistics was problematic prior to the pandemic. As a result, the actual share of the developing world is likely much higher than the reported data indicate.

 

What will be the next phase in the evolution of the mortality share?
 
  • The structural trend has been a shift to the developing world, where differences in demography (population size an age structure) act as a beacon that pandemic outcomes gravitate towards. This trend is expected to continue.
  • Vaccine inequity will amplify the structural trend as higher-income countries are expected to inoculate their populations at a faster pace. This is expected to produce significant upward pressure on  the developing country mortality share, especially in those parts of the world where vaccines have been lacking the most relative to the vulnerable priority group population.