Up until today, nearly a quarter of Russians, 18 percent of Americans, and about 10 percent of Germans, Canadians, and French are “unwilling” to get vaccinated, according to a November Morning Consult poll of 15 countries. This doesn’t mean that vaccine availability is the problem as much as vaccine hesitancy. Vaccine access is crucial. But vaccine hesitancy is an urgent problem and a global one.

New variants can emerge wherever populations remain unvaccinated. Some surveys suggest that vaccine hesitancy is actually higher in rich countries than in poor ones, so the virus is just as likely to evolve into some dreadful new form in an unvaccinated American’s body as in a South African or Russian person’s.

“If we had had everybody immunized in the world who is over the age of 18 with at least one dose of COVID vaccine, Omicron might not have happened,” Noni MacDonald, a vaccinologist at Dalhousie University in Nova Scotia, told the Atlantic

In South Africa, for example, the country where the Omicron variant was first reported from, vaccine hesitancy is higher among white South Africans than among Blacks, though whites are more likely to have been vaccinated, possibly because of better access, an August survey found. Some white South Africans mistrust the country’s government, which is led by politicians from the Black majority.

South Africa did receive vaccines far too late, partly because wealthy countries did not donate enough doses and pharmaceutical companies refused to share their technology. At one point, South Africa had to export doses of the Johnson & Johnson vaccine that it had manufactured in-country in order to comply with a contract it had signed with the company. The COVID-19 vaccines must be kept cold, and because not everywhere in South Africa has reliable roads and refrigeration, the country has struggled to store and transport vaccine doses to far-flung areas.

Today, though, South Africa has about 150 days’ worth of vaccine supply. It’s now facing the same problem that’s bedeviling countries the world over: Lots of people don’t want to get their shots. South Africa recently paused deliveries of the J&J and Pfizer vaccines because it has more stock than it can use. “We have plenty [of] vaccine and capacity but hesitancy is a challenge,” Nicholas Crisp, the deputy director-general of the country’s health department, told Bloomberg recently.

The South African experience is an example of how anti-vaccine sentiment has become a global phenomenon at precisely the worst time.  As such, If policymakers want to limit the damage that Omicron and future variants do, they’ll have to better understand why people reject vaccines. Something as complex as vaccine hesitancy is bound to have many causes, but research suggests that one fundamental instinct drives it: A lack of trust. Getting people to overcome their hesitancy will require restoring their trust in science, their leaders, and, quite possibly, one another. The crisis of vaccine hesitancy and the crisis of cratering trust in institutions are one and the same.

Read the full article of The Atlantic here