So far the UK has managed to stay within the capacity of its ventilator stock, despite early concerns that it would be insufficient. With over 11,000 of the potentially life saving machines, there is one for roughly every 6,000 people in the UK. By contrast, the New York Times estimates that there are over 20 million people for every ventilator in the DR Congo. Somalia, one of the consistently poorest countries in the world, has no ventilators. Clearly, this presents a problem, if not a surprising one. The lack of mechanical ventilators in the developing world has long been acknowledged, but intervention has been slow and often regarded as cost-ineffective, owing to the complex set of requirements for operation. Ventilators require trained staff, regular maintenance and specialised supplies such as compressed oxygen – it is not a simple matter of plugging them in and switching them on. Even if it were, there would still be difficulties in areas without consistent access to electricity. The deficit in these particular machines is emblematic of the wider problem: healthcare systems in the developing countries are, practically by definition, underprepared for a widespread outbreak like that of coronavirus.
This is not to say that the situation is uniform across all countries in the so-called ‘developing’ world. Ghana, for instance, has made extensive use of testing and contact tracing but the government there is already easing lockdown measures for fear that they are disproportionately harming the poorest in society. The South African response has been hailed as exemplary due to the strong lockdown measures taken early on by the government and to their rapidly mobilised health research centers, currently searching for new treatments. Innovation also helps address the lack of resources – for instance the ‘trash bag’ PPE improvised by a Liberian nurse during the Ebola pandemic has now been replicated across the world in response to equipment shortages.
These success stories provide hope, as does the fact that the median age in Sub-Saharan Africa (just over 19) is much younger than in Europe (43) which should translate to more resilience against the disease. However, these causes for optimism must be taken in context. Improvised medical equipment is better than none at all, but its use everywhere (in both the developing and developed world, though more prominently in the former) reflects a dangerous deficiency in the real thing. Furthermore, South Africa’s leadership in health research is largely a necessary consequence of its struggle with HIV – a condition that puts over 25 million Africans at heightened risk from COVID-19. Certainly then, developing countries are not passive in this crisis, and many are in fact in a position to help, both each other and the developed world – as Somalia demonstrated when it sent 20 medics to Italy in March.
The virus has yet to ramp up in the developing world, the way it has in Europe. Any attempts to shore up the supplies of vulnerable healthcare systems should therefore be part of a holistic and coordinated effort. Thus far, however, the international response has been fragmented, as countries struggle to deal with their own cases. Where help has been offered, it has generally been piecemeal. The Trump administration in the US has committed to sending ventilators to several ‘developing’ countries around the world. The Chinese government has sent PPE and medical experts. Individual philanthropists are stepping up, with Alibaba’s Jack Ma sending supplies to over 150 countries and Twitter’s Jack Dorsey pledging $1bn, a quarter of his net wealth, towards relief efforts. Nonetheless, a coordinated international effort has not been forthcoming, as evidenced by the UN’s appeal in March for pledges towards a $2bn support package. A month on, and the package is barely a quarter funded.
The World Bank is in a better position to help, with its explicit mission to fund development, and indeed it probably offers the closest thing to a unified response: their support program would disburse up to $160bn over the next 15 months. Together with the IMF, the Bank has also called on governments to suspend debt payments from vulnerable developing countries.
These are positive steps, although more are needed. Governments in developing countries are going to need all the help they can get as many of their revenue streams diminish. Remittances – money sent back home by migrant workers – are now estimated to be the largest source of external financing for the developing world but the flows will be under strain as developed economies struggle. Governments reliant on natural resource revenue will also struggle, as world commodity prices crash for the same reasons.
As scientists tentatively predict that the UK and Europe are passing the peak of the coronavirus, one thing is certain: the developing world is still facing a dangerous climb. Perhaps it is precisely because many of these countries have been relatively neglected by the globalisation process, that they have managed to stave off widespread infection for so much longer than Europe or the US. A few months head start, however, is not likely to be enough to overcome the institutional shortcomings, particularly in healthcare, from which these countries suffer. Of course developed countries are occupied with their own cases, but they must work together more effectively to help the rest of the world avert disaster.
Further reading and sources
Oxford Professor calls for a global Marshall plan: ‘Coronavirus is the biggest disaster for developing nations in our lifetime’
The case against intervention: ‘Africa does not need saving during this pandemic’
NYT on Healthcare Capabilities: ‘10 African Countries Have No Ventilators. That’s Only Part of the Problem.’
Ventilator intervention study: ‘The need for ventilators in the developing world: An opportunity to improve care and save lives‘
Africa: BBC Africa Live