Feature

Developing nations facing ‘largest crisis’ in a generation


Doug Hendrie


6/05/2020 4:40:50 PM

Experts are divided on whether coronavirus lockdowns could be worse than the disease itself in developing nations.

Woman selling water in Nigeria
Lockdown means devastation for the two billion people around the world who work in the informal economy. (Image: AAP)

Many developing countries are faced with a truly diabolical coronavirus choice.
 
Do they lock society down, destroy the informal economy and see hunger rise – or let the virus loose?
 
The conundrum has led some public health experts and economists to suggest that, for developing countries with a young population, the cure may be worse than the disease.  
 
Earlier in the pandemic, researchers at Princeton University and other organisations suggested India could be a nation where herd immunity could work, given it has a young population less at risk of hospitalisation and death.
 
But as researchers have learned more about what the virus can do to younger people as well as older – ranging from strokes to neurological issues to damage to the heart – fewer are arguing in favour of herd immunity.

Melbourne University Professor of Medicine John Matthews told newsGP that lockdowns should depend on a society’s context.
 
He said that in developing nations like Indonesia, where many work in the informal economy, a full lockdown might not be appropriate due to the damage to people’s livelihoods, and given the potential protective effects of a young population and warmer climate.
 
ANU Infectious Diseases Professor Peter Collignon told newsGP that a low death rate in younger people would still mean a huge number of deaths if most people were infected in a nation.
 
‘The age structure of your country may have a bigger effect on deaths, as will how willing your population is to abide by rules to reduce droplet transmission,’ he said.
 
Dean of Health at Swinburne University Professor Bruce Thompson said the assumption that younger people would be fine is not accurate.
 
‘There’s morbidity and mortality for young people. Poorer countries are not without comorbidities either,’ he told newsGP.
 
So far, the only effective tools we have against coronavirus are non-medical – lockdown, handwashing and social distancing.
 
But for the two billion people around the world who work in the informal economy, representing 60% of all workers, lockdown means devastation, with no way to make an income. Oxford Globalisation Professor Ian Goldin has described this as the largest crisis to face developing countries in our lifetimes.

‘[C]ountries in Africa and Latin America, together with Pakistan, India and Bangladesh, are expected to suffer their greatest ever economic decline,’ he writes in The Guardian.
 
‘One immediate effect of the lockdown is hunger, as transport and distribution systems are severely disrupted and the food supply in many countries – already depleted after years of drought, extreme weather events and recent locust infestations – becomes scarce.’
 
Even worse, developing nations often do not have the means to radically expand the welfare state, as Australia and other wealthy countries have done, while social distancing and regular handwashing are all but impossible in densely populated urban settlements and slums.
 
‘To state the obvious, it is harder to impose a lockdown in a poor country than in a rich one,’ David Pilling writes in the Financial Times.
 
‘In huge cities such as Lagos, Mumbai or Manila, instructing people to stay at home is to confine millions to cramped housing. In the slums where up to half the population may live, people could be crammed six or eight to a room, with no easy access to water, or even soap.’
 
Director-General of the World Health Organization Tedros Adhanom Ghebreyesus has called on governments to provide food and essentials for the ‘poorest and most vulnerable’ most affected by lockdowns.


In India, day laborers have had to walk hundreds of kilometres back to their home villages, while local governments have had to set up temporary camps and provide food to millions of newly jobless people. In South Africa, police have had to keep the lockdown in effect by force. In Nigeria, at least 18 people have been killed for breaching curfew.
 
Indian day labourer Karmu Bhuiya told Al Jazeera he has not worked since the lockdown, with his family surviving on rice and any edible greens they can forage.
 
Some countries have tried to find a path between total lockdown and economic chaos. Indonesia has locked down the most affected areas, with President Joko Widodo claiming a total lockdown would hurt the poor too much.
 
Professor Matthews has previously told Al Jazeera that Indonesia is in a catch-22 in that it could not afford to enter a total lockdown as Australia has.
 
‘Everything we know about epidemiology says if you are going to stop a disastrous spread, the lockdown has to be complete and you have to start early,’ he said.
 
Oksana Abbouda, the head of street vendor advocacy group StreetNet International, told the BBC that informal workers have had to make a horrible choice – put themselves at risk from infection or security forces and continue working, or risk starvation for themselves and their family.
 
‘This is the reality for billions of people around the world … informal is normal in developing countries,’ she said.
 
Why are some countries seemingly untouched?
One of the most baffling aspects of this pandemic is how unpredictable the virus has been. Many expected Japan – with the world’s oldest population and a relatively low testing regime – to be very badly hit. But, to date, Japan has not seen a catastrophe on par with New York or Italy.
 
While many experts have predicted cases in developing nations may be substantially higher than official numbers due to difficulty in test, the confounding factor is that not every developing country where the virus is circulating is seeing its health system overwhelmed, as happened in Wuhan, northern Italy and New York. 
 
Some researchers have predicted warmer countries would be less affected, with people outside more and because the virus is inhibited by sunlight. But tropical Brazil is emerging as a major new hotspot, with hospitals overwhelmed in some parts of the country.  
 
Still, as the New York Times reports, some countries that ‘should have been inundated’ have not been – and researchers are baffled as to why. For example, Thailand had one of the first confirmed cases outside China in mid-January, and continued to allow Chinese tourists. But this did not trigger sustained community transmission.
 
‘In Indonesia, we have a health minister who believes you can pray away COVID, and we have too little testing,’ University of Indonesia infectious diseases expert Dr Pandu Riono told the New York Times. ‘But we are lucky we have so many islands in our country that limit travel and maybe infection.
 
‘There’s nothing else we’re doing right.’
 
Youth may provide a protective effect, with nations such as Nigeria – where the median age is just 18 – recording low rates of infection and death so far.
 
Professor Matthews told newsGP that youth and warm climate could potentially provide some protective effects against the worst of the virus.
 
‘None of the tropical countries are showing high mortality rates as a proportion of the population [except] Brazil,’ he said.
 
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