Covid-19 is about to overload health-care systems in Italy, France, Spain, Britain and the United States. But what if you don’t have a health-care system to overload?
Liberia, in West Africa, has a population equivalent to Louisiana. But according to one expert, there are just three ventilators for the entire country. Beyond the lucky three who get them, all Liberian coronavirus patients who need a ventilator to live will die.
In the coming months, the coronavirus death tolls will be horrific. Yet, astonishing as it may seem to all of us living in lockdown, we are the lucky ones. In rich countries, it is likely that hundreds of thousands, if not millions, will die in the coming months. But if past pandemics are any guide, those numbers are likely to be a small fraction of the body count in the poorest parts of the globe. Every public health problem that we face will be far worse in the developing world.
In the 1918 flu pandemic, somewhere between 25 million and 100 million people died. Roughly 12 million of those deaths came from India alone. The Gold Coast (modern Ghana) had a population of roughly 2 million at the time; 100,000 people — 5 percent of the entire population — perished.
Unfortunately, similar patterns are likely to play out again, particularly in poor, urban slums. The United States has roughly one intensive care bed for every 2,800 people. In Uganda, it’s close to one ICU bed for every million people.
In Dharavi, the largest slum in Mumbai, the population density is roughly 850,000 people per square mile. Take Manhattan and replace every person with 13 people and you’ve got Dharavi. But there’s no world-class hospital ship on the way if a New York City-style outbreak strikes in Mumbai, as now seems inevitable.
As Phil Boyle, the British ambassador to Madagascar, explained to me: “Coronavirus challenges in developed countries are immensely greater in the poorest, such as Madagascar.” The island, he told me, has minimal health infrastructure. There are 10 doctors per 100,000 people. (The number is 295 in the United States.) “Families, schools and even some hospitals do not have access to water,” he said. “Hand sanitizer is the equivalent of a day’s salary for most. If developed countries don’t step up, the humanitarian consequences could be considerable.”
Those consequences will be magnified because developing countries simply don’t have the government capacity to mitigate the downsides of keeping people apart. In many parts of the world, strict enforcement of isolation guidelines could lead to widespread starvation. While the British government is delivering meals and medicine to 1.5 million of its most vulnerable citizens as they self-isolate, a similar program would be unthinkable in Togo. And what do you do where everyone is vulnerable, as in densely packed refugee camps?
Next, there’s the struggle to adapt to public health measures in economies and cultures that simply aren’t built for it. Sure, some developing countries have sectors that can be transferred online. But the street vendors and markets that line the streets of slums and densely packed cities in Africa, India and Southeast Asia can’t replace their business with Zoom or Skype. Factories in Bangladesh that cram workers into poorly ventilated spaces can’t observe social distancing. And they won’t get a $2 trillion emergency relief bill, either.
Culturally, pandemic prevention efforts may prove to be an immense challenge, too. In the United States, a comparatively religious country by Western standards, 1 in 3 people worships weekly. In Nigeria, 9 of 10 do. And when people resist churches being shut down or lockdowns being put in place, the government can’t always keep order. In Senegal, there were mass demonstrations when mosques were closed to slow the outbreak. Thousands congregated in narrow streets, not just creating a public health risk but also contributing to unrest.
And while governments in the West struggle to combat misinformation about the coronavirus — and some presidents spread it themselves — the problem is likely to be far deadlier in poor countries. Madagascar’s president, Andry Rajoelina, announced the discovery of a supposedly new miracle medicine that prevents the coronavirus. It’s reminiscent of when the dictator of Gambia, Yahya Jammeh, claimed to have personally discovered a cure for AIDS that turned out to be a mixture of herbs and bananas. An unknown number of patients died as a result.
There is some good news. Most African countries have confirmed cases, but the numbers are still low. That buys us time. Moreover, the median age in sub-Saharan African countries is roughly 19.5, compared with 38 in the United States. That could prove a small blessing in managing an illness that seems to create more complications in older people.
Of course, governments in rich countries must act to save their own citizens first. But that doesn’t have to conflict with saving huge numbers of lives elsewhere at relatively little cost. Rich countries could establish a rapid innovation fund to encourage social entrepreneurs to develop low-cost, scalable ventilators. We must also prepare famine aid to places that are at highest risk of starvation. And rich countries past their own peaks will need to send staff and supplies to emerging outbreaks in poor countries. There is no time to waste.
Brian Klaas is an assistant professor of global politics at University College London, where he focuses on democracy, authoritarianism, and American politics and foreign policy. He is the co-author of «How to Rig an Election» and the author of «The Despot’s Apprentice» and «The Despot’s Accomplice.»