A Lethal Prescription for the World’s Poor: The Coming Coronavirus Crisis in the Developing World

Elias+Silver+%E2%80%9920+weighs+the+pros+and+cons+of+social+distancing+in+the+developing+world.+%E2%80%9CAll+in+all%2C+it+is+most+reasonable+to+implement+modest+social+distancing+and+other+disease+prevention+measures%2C+but+not+to+enforce+a+strict+and+rapid+quarantine+as+has+been+done+in+places+like+Uganda%2C%E2%80%9D++said+Silver.

Kate Reynolds

Elias Silver ’20 weighs the pros and cons of social distancing in the developing world. “All in all, it is most reasonable to implement modest social distancing and other disease prevention measures, but not to enforce a strict and rapid quarantine as has been done in places like Uganda,” said Silver.

While the impacts of a virus can ravage the entire globe, no population will experience them the same; its consequences will vary from continent to continent, country to country, city to city. Some places, like New York City, became epicenters of a global pandemic. Other communities were almost entirely spared. 

From the vantage point of most American communities, the spread of the coronavirus, may as well now feel like a domestic crisis, not an international one. A commentator at the American Prospect rushed last week to label the virus as “our uniquely American virus.” An article in The Verge in late March was headlined “The coronavirus is now the American virus.” When media coverage and conversation deviates from America’s handling of the coronavirus, it often turns to its other Western epicenters. Italy’s collapsing health care system, for example, was described in apocalyptic terms on front pages, foreshadowing America’s epidemic which is now, by a wide margin, the largest in the world. 

This view of the coronavirus pandemic is not empirically ungrounded: 88 percent of confirmed coronavirus cases this April came from the OECD, a club of wealthy nations that make up just 17 percent of the global population, according to Axios. As a result, countries have taken nationalistic views of their respective health crises, with most countries focused on their own domestic supplies and prepardness rather than donating to others (with the exception of China’s pandemic diplomacy). America has withdrawn funding for the World Health Organization under the Trump administration, and President Trump’s attacks on the organization appear to be working: polling by the Morning Consult shows that the WHO’s net approval rating in the United States dropped 29 points since the start of April 2020 to a mere 25 percent. 

The fixation on coronavirus cases in the western, industrialized world obscures the place where the coronavirus may well do its most lasting damage: the developing world. While Africa currently stands at less than 52,000 cases and 2,000 fatalities, these numbers are unlikely to be a realistic reflection of its case load. An analysis of testing data by Quartz found that African countries had some of the lowest testing capacities in the world: in early April, Zimbabwe, a country of 14 million, had tested just 316 people for the virus; Namibia just 306 people; and Nigeria, the largest nation on the continent, had only tested 152 people by March 22nd, 2020. 

Many health experts point out that there are some reasons to be optimistic about the coming coronavirus crisis in developing nations. Poorer countries are younger, with the median age in Africa under 20 and only 2 percent of the continent older than 65 (compared to more than 15 percent in the U.S.), making the virus statistically less deadly for those that will catch it. The warmer climate in the global south could also slow the spread of the virus, perhaps significantly (although the scientific jury on this question is still out). More than two thirds of those in the world’s least developed countries live in rural areas where lower population densities also provide hope of containment; although, conversely, those that live in cities in developing countries are often stuck in slums where the population density is unimaginable (Nigeria’s largest city, Lagos, for example, is the fourth most dense city in the world while New York — America’s most dense city — doesn’t even crack the top 50 worldwide). 

However, for each reason there is to be optimistic about the spread of the coronavirus in the global south there is another, perhaps more compelling, reason to worry. The primary weapon used to fight against infectious disease is, of course, basic hygiene such as consistent handwashing. This basic service for those in the developed world is often inaccessible to the world’s poor, painting a grim picture for the possibility to stop an outbreak in its tracks. The U.N. estimates that 85 percent of sub-Saharan Africans lack access to water and soap with which to wash their hands and a third of all health centers in developing countries lack facilities for doctors and nurses to wash their hands. And, while their populations are younger, African countries will likely not be spared from the worst of the coronavirus as many of their citizens suffer from weak lungs or immune systems due to higher rates of malnutrition, tuberculosis, and HIV. 

Perhaps most importantly, when coronavirus cases begin to pile up in developing countries (as they already have), the health care systems of such countries may well be simply unable to keep up as they are strained for available doctors, healthcare professionals, hospital beds, and medical supplies. In Italy, where a healthcare system virtually collapsed from the weight of its coronavirus cases, there existed a doctor for every 250 people; in Africa, that rate is one per every 5,000. Even more critically, there is a drastic shortage of physical space in intensive care units to care for all those that will need it; America has around 33 ICU beds per thousand people, while in Africa that number is just 1.7, with some countries having virtually no excess capacity at all. In Uganda, there exists 0.1 ICU beds per 100,000 — 330 times less than the United States. 

Other supplies are even more depleted. In all, 41 African countries combined have just 2,000 working ventilators according to WHO data, which around one to two percent of all coronavirus patients require. In some countries, the situation borders on desperation. South Sudan has just four working ventilators for its population of 11 million; Liberia’s population of five million people has just six, one of which is gated inside the United States Embassy. Ten African countries have no ventilators at all. The United States, on the other hand, which itself has been labeled to have a “ventilator shortage,” has 170,000. New York City alone is projected to need at least 30,000. While nations like South Africa have vowed to produce thousands of ventilators, and President Trump (who has dubbed himself the “king of ventilators”) has reportedly floated plans to donate ventilators to African countries, procuring these devices alone may not be enough. Ventilators require intensive medical training to operate and, in most cases, require an anesthesiologist to be involved which most African countries have less than one per 100,000 people.  

For all of these reasons, Robert Malley, the President and CEO of the International Crisis Group, and his brother Richard, a professor at Harvard Medical School, wrote in Foreign Affairs that they expect the toll of deaths from the coronavirus in Africa to be in the millions. The WHO has warned that as many as 10 million could become infected in the continent in the next six months. The Spanish flu, for example, killed two percent of Africa’s population in half a year; South Africa alone experienced 300,000 deaths from the virus, more than a twentieth of its population. 

Typically a threat of this magnitude would demand a strong-handed government response, perhaps indicating that countries across the developing world should institute strict social distancing measures that could slow the spread of the virus. Accordingly, a report by McKinsey found that half of all Africans are under a partial or full lockdown. Some countries have taken these lockdowns perhaps too seriously: in Latin America gangs have monopolized streets to enforce these measures and Rwanda has even had police shoot those that violated their lockdown. 

Other countries are in an even worse state: denial. Brazil’s President, Jair Bolsonaro, dismissed the coronavirus as “a sniffle” and Tanzania’s President, John Mangufuli, insisted on keeping churches open because, in his words, the “satanic” disease “cannot survive in the body of Christ.”

There is evidence that leaders in the developing world that are taking this crisis seriously are making a difference; McKinsey found that African countries that went under lockdown saw a reduction in the average daily growth of their known coronavirus cases of more than 60 percent. However, even if locking down developing countries can slow the spread of the virus, it may also put many vulnerable citizens on the brink of destitution, making the strategy of social distancing difficult to sustain in the world’s poorest countries.

Most notably, developing countries largely lack the social safety net to cushion the fall in income that economic lockdowns bring. Sub-Saharan African countries spend just $16 in safety net programs per person, and such spending is often distributed in corrupt and ineffectively targeted ways. Remittances, which often serve as a safety net when developing countries experience economic shocks, may also be significantly reduced as migrants in wealthier countries lose their jobs. 

Increasing government spending in the form of stimulus may be difficult in poorer countries as they are saddled with more debt and cannot find new lenders in a bear market. Indeed, the Institute of International Finance reports that foreign investors have already withdrawn $83 billion from emerging markets from the start of this crisis, constituting the greatest capital outflow ever recorded. As a result, while America and Europe have injected vast sums into the economy (stimulus spending has totalled around 25 percent of GDP), in Africa these sums have been meager (South Africa’s stimulus package was around 10 percent of GDP, but poorer countries like Nigeria have spent only around 0.04 percent of their GDP in stimulus). 

These lockdowns in Africa are also complicated by the size of its informal economy: largely daily employment that is not officially reported to the government and provides no benefits like paid leave or health care. The International Labor Organization reports that around two-thirds of all employment in sub-Saharan Africa is informal, meaning that such already vulnerable workers are likely to get no pay during this crisis if they are unable to work. Unlike in America where many workers can work from home, such remote work is largely impossible in a continent with a smaller service-based economy and inconsistent internet and electricity access. “The majority do not have the choice of staying inside and forgoing income for months on end. Their government does not have the resources to support them if it chose this course of action,” said Elias Silver ’20.

Compounded with low levels of savings, the negative shock in income that citizens in developing countries face may push them to the brink of starvation. The World Food Program predicts that the coronavirus crisis will double the amount of people worldwide experiencing acute hunger. As Imran Khan, Pakistan’s Prime Minister, put it, “if we shut down the cities…we will save [people] from corona at one end, but they will die from hunger.” As a result, critics argue that keeping these economies closed may not be worth it at all. “I think it’s a different kind of cruelty to keep impoverished people from supporting themselves,” said Cassandra Ng ’20. 

The cost of these lockdowns compound. School closures can permanently reduce human capital development and some students, especially female ones whose parents are less invested in their education, may never return to their studies if their families are still short on money. As this crisis rages on, economic concerns have only worsened. Commodity demand has been reduced, bringing in less export revenue for developing countries while other industries like tourism have collapsed entirely. Foreign debt repayments and imports have only become more expensive as developing countries need them most, as their currencies have declined by an average of 25 percent. 

The United Nations has offered to help, contributing a $2 billion emergency medical fund to developing countries, but such a small sum will not even begin to seriously mitigate the negative effects of the virus in vulnerable regions. 

The consequences of this virus will be long-lasting and devastating for the world’s poorest countries and citizens. McKinsey estimates that as many as one third of all jobs in Africa will be lost due to the coronavirus-induced crisis, with Africa’s first recession in 25 years on the horizon. The World Food Program predicts a famine to emerge in around three dozen countries. 

In a continent like Africa, such a crisis will have long-ranging effects of reversing progress against extreme poverty as those that lose their jobs fall into destitution, rarely getting the help needed to find gainful employment and support themselves once the crisis is over. The United Nations predicts that 29 million Africans will be pushed into extreme poverty, with this number possibly doubling or tripling if the situation worsens. Rwanda’s President has warned that it will take “a generation or more” for the continent to recover. 

All the while, development will stall. Polio eradication efforts in Africa have been put on hold, as has the distribution of vitamin A supplements, which is crucial to saving the lives of children and preventing blindness. Programs that feed hungry children in schools have been shuttered with the closure of schools. The poorest countries in the world, after a decade of progress on poverty reduction, vaccinations, and improvements in governance, are backsliding on all fronts with the light at the end of the tunnel still yet to be seen. Hope rests in multilateral institutions to step in and help, the same institutions that industrialized countries have been turning their backs upon. Sometimes it takes a crisis to reorient the world, but in which direction the world will land is still an open question. 

“I think it’s a different kind of cruelty to keep impoverished people from supporting themselves,” said Cassandra Ng ’20. 

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