Padmashree Gehl Sampath is a Fellow at the Berkman Klein Center for Internet & Society, Harvard University. She is also an Adjunct Professor at the Department of Social Sciences, University of Aalborg, Denmark, and a Professorial Fellow at the United Nations University-MERIT.
Last week, Africa recorded over 75,000 COVID-19 infections. While this count seems low when compared to the total tally of COVID-19 infections in Western Europe or the United States, the pandemic places low-income countries worldwide in a particularly disadvantaged position. Their disadvantages–a joint outcome of long-term poverty and resource-constrained healthcare systems–are only worsened by the unforeseen socio-economic effects of lockdowns and infections. As the pandemic unfolds in low-income countries, its health impacts are often overshadowed by the existential threats it poses to the most impoverished and vulnerable groups of people. Not articulating a timely global response that factors in these fallouts will be a true failure for humanity.
Low income countries have an abundance of crowded, semi- or fully- unregulated urban spaces including slum dwellings that increase the risk of spread exponentially. This is particularly true in megacities like Mumbai, Dhaka, Lagos or Cairo, where a large share of people reside in slums, with low access to water and hygiene facilities and little possibility for social distancing. This poses a particular challenge for disease control. In the Dharavi slum in Mumbai, for example, the COVID-19 outbreak in April exposed 850,000 people living on a little over two square kilometres of land to the possibility of widespread contamination. Second, national health infrastructure, a critical asset in coping with the pandemic, is heavily under-funded and ill-equipped. In most low-income countries, public health systems run on shoestring budgets, often suffering from shortages of regular medical care and supply capacity even in the best of the circumstances, due to a chronic shortage of doctors, nurses, qualified healthcare personnel, and equipment. Third, institutional capacity of the kind needed to test, trace and control–the three pillars of pandemic control in the context of COVID 19–is largely compromised due to weakened instiutional infrastructure.
Systemic deficits such as low public sector budgets, a lack of policy planning, and weakened coordination capacity create a confluence of factors–the lack of trained personnel, little public accountability, low procurement and supply capacity in health care–that critically undermine the collection of accurate data on infection rates, treatments, recoveries and deaths, as called for by a pandemic of this nature. A recent report tracing data coverage capacity in Africa finds, for instance, that only eight African countries have nationwide birth registration systems. Finally, although the demographic median in a large number of countries in Africa and Asia is between 20 to 40 years of age, many of these countries house chronically ill people suffering from heart illnesses, Asthma, HIV/AIDS, Tuberculosis and other infectious and respiratory illnesses. Africa, for instance, is not only home to the most HIV/AIDS infections worldwide, but also encompasses 22 of the 25 most vulnerable countries with infectious diseases, according to the most recent Infectious Disease Vulnerability Index. These pre-existing health conditions in a large segment of the population make lower-income countries particularly vulnerable to the spread of COVID-19.
Economic Upheavals and Longer-Term Consequences
On the economic front, the lockdowns and closure of businesses in Western Europe and the USA have led to the disruptions of supply chains in a number of sectors globally. The economic slowdown will have a large cascading effect on economies of the South, with grim prospects for workers in sectors, ranging from coffee and floriculture to textiles and automobiles. In all these sectors, the poor, who work at the lowest rungs of the supply chain with little or no economic reserves, will be most affected.
Notably, the economic consequences of the COVID-19 lockdowns and infections affect the poorest groups in low-income countries: the informal labor sector, the homeless, child laborers, and refugees. In India, the lockdown left over 415 million informal migrant workers stranded without work and shelter for the past four weeks. In Kenya, the most tangible fear amongst the slum dwellers of Kibera is hunger and not disease. Already exposed to extreme risks and vulnerabilities, refugees in in Syria, Bangladesh, Myanmar, and Pakistan face a similar struggle. For these groups of people, COVID-19 is not just a disease, it is an existential threat. Weighing these effects on employment and wellbeing, a recent study of the United Nations estimates that half a billion people could be pushed below the poverty line by the end of the year, setting back the global fight against poverty by thirty years. Relatedly, the International Labour Organisation has issued a warning that the pandemic will wipe out nearly seven percent of working hours worldwide in the second quarter of this year–the equivalent of 195 million full time workers.
Reiterating the Need for a New Global Compact
This crisis offers a unique opportunity to chart new territory. Its key lesson is that health and economic wellbeing are inter-connected on a global scale. Building on that, leaders, institutions, businesses, and governments need to envisage bold initiatives for international cooperation based on the principle of universality. "Business as usual" efforts, like the G20 initiative to suspend debt service payments for less-developed countries or the World Bank and IMF joint COVID-19 response strategy will only go so far. What is required is a new Global Compact that restructures trade and international relations in a more humane way with health, environment and wellbeing of all at its center. Only by purposefully including those who have been previously systematically excluded will prevent the mistakes of unilateralism manifesting once again.