Source: BBC News

The worst effects of the coronavirus pandemic have, so far, mostly been confined to richer nations. Countries like China, Italy, Spain, France, the UK, and the United States have struggled immensely in the task of getting the pandemic under control and will continue to do so for the foreseeable future. It appears likely that in some rich countries not everybody who needs urgent medical treatment will receive it and, as a result, avoidable deaths will occur. This has already been witnessed in Italy and Spain, where doctors now make life or death decisions about who receives life-saving treatment and who does not.

The economic fallout has also been immense, with the slowdown of business activity and the implementation of lockdowns seeing unemployment rising to levels not seen since the Great Depression. The full extent of the financial resources of the developed nations are being deployed in a desperate attempt to avoid a complete meltdown of the economy. How successful such measures will be remains to be seen.

If the rich world is under such strain, what lies in store for the world’s poorer nations? The pandemic has not yet fully unleashed its force upon such countries, but many are now experiencing a similar trajectory to that experienced by more developed regions. An outbreak such as we have seen in Europe may not be far off in the developing world and in nations such as India, Pakistan, Venezuela, Brazil, Nigeria, South Africa, amongst many others, there are “hundreds, sometimes thousands, of cases”.

The ability of such countries to avoid a scenario akin to Italy or Spain is highly doubtful especially given that many already suffer with severe problems. Some already face “extra burdens such as battling other endemic diseases, recent natural catastrophes, or coping with large-scale refugee influxes”. Others are afflicted with economic and political crises and are on the verge of becoming failed states. In the Middle East, where in the past week cases of coronavirus have doubled to 60,000, the huge population displacements caused by war mean that it will be extremely difficult to halt the spread of the virus. In war-torn states such as Syria, Iraq, Libya and Yemen widespread testing and contact tracing will not be possible, and healthcare systems in these countries are simply not equipped to deal with an influx of infected patients.

Even in countries not devastated by war, widespread poverty will contribute significantly to the spread of the virus. Overcrowded urban slums are already disease “hotspots” and the infeasibility of social distancing and self-isolation in such locations means that the coronavirus will likely prove to be much more destructive than it has been in prosperous regions. Even the most basic weapon with which to fight the virus will not be available in large parts of the world because, as the United Nations Development Programme notes, “up to 75 per cent of people in least developed countries lack access to soap and water”. Under such conditions, the basic hygiene measures that can help stop the spread of the virus will prove impossible. It is hard to envision how an epidemic of a scale much greater than that currently witnessed in Europe and America can be prevented.

Once such an epidemic does become established, many third world countries will struggle to bring it under control. Implementing a general lockdown, for example, would bring further economic hardships for what are already poverty-stricken nations. Given the current fiscal positions of governments in the developing world, they will struggle to provide the type of income supports that we have seen in the developed world, especially considering that the healthcare response will also require huge resources. Where governments do seek to implement lockdowns, the poorest members of society will be hit hardest, especially those working in the informal economy who will be unable to avail of whatever meagre income supports may exist.

We are beginning to witness what lockdowns in underdeveloped nations look like. In India, where 176 million people earn less than $1.90 a day, the economic effects of the lockdown are proving to be catastrophic. Unemployment has skyrocketed and businesses are closing. As a result, millions of migrant workers are fleeing the cities and undertaking journey’s of hundreds of kilometres on foot, in an attempt to reach the perceived safety of their villages. In South Africa, 23,000 migrant workers fled the country to neighbouring Mozambique, seeking to avoid being trapped in a lockdown with no means to feed themselves. Such population movements are likely to contribute greatly to the spread of the virus, but the people involved have no choice; their position at the margins of global society means that they do not have the luxury of merely stocking up on groceries and waiting the lockdown out, as many in the west are now doing.

Such poverty-stricken individuals make up a considerable portion of the world’s population. According to Oxfam nearly half the world’s people live on less than $5.50 a day. The precarity that such a large number of people suffer from means that governments of poorer countries will be reluctant to initiate the type of policies that could halt the spread of the virus. They will perhaps see the cost of shuttering their economy as worse than allowing the virus to spread unchecked and, tragically, they could be right. Lockdown in some nations might lead directly to disruptions in the supply of basic food staples and widespread famine could be the result. In Ethiopia, Prime Minister Abiy Ahmed has warned that “even a short interruption in planting or harvesting could have devastating consequences on his country’s food supply”. Some countries may be forced into making a devastating calculation; a choice between coronavirus mitigation or protecting livelihoods, with both outcomes resulting in the deaths of tens of thousands of people.

Given the difficulties in implementing policies of mitigation, many underdeveloped nations are likely to experience an epidemic that is far deadlier than that in Italy or Spain. When it hits, healthcare systems will become overwhelmed. Even prior to the pandemic, millions of people in underdeveloped nations did not receive adequate healthcare, for example in Africa, where less than half of people have access to adequate healthcare. An appropriate public health response to the coronavirus will thus be all but impossible. Furthermore, several less developed nations already suffer from severe and ongoing health crises; for instance in South Africa which has the world’s highest prevalence of HIV or Nigeria, which is “currently dealing with what is turning out to be the world’s largest epidemic of Lassa fever, a viral disease deadlier than coronavirus”. As these under-strain health systems come under renewed assault as a result of the coronavirus epidemic, it is likely that the mortality rate will far exceed that which has been witnessed thus far in the developed world. What’s more, the overall mortality rates are likely to be impacted further as “overstretched hospitals will not be able to care for people with other potentially treatable medical conditions”.

Mortality rates will be driven even higher still due a lack of medical supplies, especially as rich nations seek to retain and increase their own supplies of such vital assets. Already, countries such as France and Germany are stockpiling masks and hazmat suits, meaning that there will be less availability on the world market of essential supplies. Rich countries are also engaging in shameful bidding wars against each other, with reports that US officials are turning up at Chinese airports in order to purchase masks destined for other countries. It should be clear that in such a competitive procurement environment those with the least ability to pay will find themselves to be the most under-equipped. Brazil has already announced that its attempts to purchase protective gear from China have failed and it is now not expected to receive shipment of such vital materials for another thirty days. As a result, health officials are now urging citizens to make their own masks at home.

We have witnessed countries that possess world class healthcare systems suffer comprehensive failures in their efforts to control the spread of the coronavirus. Italy, the world’s worst affected nation, has one doctor for every 243 people and is one of the world’s richest countries. The contrast with somewhere like Zambia, where 58% of the population earn less than $1.90 per day and where there is one doctor for every 10,000 people, is striking. Yesterday, it was reported that Zambia had recorded its first death from coronavirus. The hope is that Zambia, and other countries like it, can learn from the failures of countries such as Italy and implement policies that can avoid the cataclysm of an unchecked epidemic. To do so successfully, they will need international support from wealthy nations who, even now, can afford to help them. But it is unlikely that such help will be forthcoming, at least not from western nations. Certainly not from an America ruled by Donald Trump, who famously referred to third world nations as being “sh*thole countries”. Nor are Europeans likely to offer much assistance as even solidarity between EU nations has broken down, with each country focusing on its own response to the pandemic. China is the most likely source of aid although there are some indications that they may seek to direct most of their overseas aid to where it will be most relevant to their ongoing struggle with the US for global supremacy. This could mean a focus on Europe and a select few strategically important developing nations.

People in the developing world will thus suffer disproportionately, as they did before the pandemic, and as they will afterwards.

There are multiple charities doing great work in the ongoing fight to help developing nations avoid the worst effects of the pandemic. One such charity, Concern, are currently training healthcare workers in 23 of the world’s poorest nations to prevent and respond to the threat of coronavirus. If you’re lucky enough to be in a position to consider even a small donation, please do so. https://www.concern.net/donate/covid-19-response