As I scroll through my twitter feed from the comfort of my home in Canada, there are countless tweets with hashtags: #stayhomeandsavelives and #flattenthecurve full of endless tips on how to deal with social isolation. This is the overarching strategy being adopted globally to address the COVID-19 pandemic.The basis of this strategy is that by implementing social-distancing policies we will prevent COVID-19 related deaths and reduce the unmanageable burden on the most advanced healthcare systems.
As a biologist and a health-tech professional, I understand the need for social distancing to contain viral transmission. What I question is the application of lockdown policies in low-income countries with already fragile economies, where economic hardship may be worse than the disease.
This weekend I got off the phone with a friend in Khyber Pakhtunkhwa (KPK), Pakistan, who is donating food packages of basic grains to the marginalised, as they are on the brink of starvation following a full lockdown in the country. I have been told stories of people having to sell their few possessions for food, starvation being a consequence of the economic mayhem that is caused by the COVID-19 lockdown in Pakistan. This begs the question, are these social-distancing solutions adopted by countries like China (GDP per capita: 9,770.8), UK (GDP per capita 42,943.9), US (GDP per capita: 62,794.6) appropriate for Pakistan (GDP per capita: 1,482.4), and other low-income countries without implementing a corresponding social safety net to prevent starvation and enforced poverty? Are we all in this together or are the world’s poorest being asked to bear the brunt of the crisis?
Social-distancing and lockdown strategies are informed by leading epidemiological models that aim to limit COVID-19 mortality and healthcare demand resulting from the infection. Without further economic analysis, these strategies are adopted indiscriminately by low-income countries, despite the fact that these models clearly state the analysis does not consider the “wider social and economic costs of suppression, which will be high and may be disproportionately so in lower income settings”.
Since we can impact only what we measure or model, we need leading epidemiologists from low-income countries to build appropriate models that incorporate the total human cost of the pandemic, including human lives lost due to economic hardship, in turn informing policies for low-income countries.
Firstly, social-distancing and lockdown measures may be simply implausible in Pakistan, with multiple generations inhabiting a single room with sole breadwinners feeding families of five or more. Alternative transmission prevention strategies, such as compulsory mask and glove should be modelled for situations where the local socio-economic conditions are factored. Recent data published in Nature Medicine indicate that face masks could prevent transmission of human coronaviruses from symptomatic individuals.
Secondly, the majority of the population does not have access to significant savings, and a lockdown risks pushing large sections of society into poverty, leading to a higher mortality from economic hardship, rather than COVID-19 related mortality. It would be prudent to keep in mind that the right policy to control the human impact of this pandemic may not be the same for every country. It isn’t one-size fits all.
In Pakistan 4% of the country is living under approx two dollars a day, with around 75 million people living in poverty. For context, that is greater than the entire population of the UK living under 15 pounds a month, with 70% of the 220 million population working in the informal sector. Compared to service-driven economies like the US, where remote working allows entire organizations to be fully remote and continue to work, the majority of Pakistani organizations do not have that luxury.
Strict economic lockdown measures mean putting millions of lives at risk of starvation as they do not have the financial reserves to “stock up”. Current estimates assume the death rate from COVID-19 is between 1%-3%, modelled on countries with an older population. For Pakistan, that can lead to approximately 4 million deaths without intervention. In comparison, if only 10% of the 75 million living under the poverty line are pushed to the brink of starvation from the lack of food and daily income, is this a reasonable tradeoff? It is depressing that this is the trade-off policy makers have to consider, but I urge governments to consider the total human cost of this pandemic, not just the deaths from the pandemic, as modelled on well functioning and well funded economies. What we need are smart policy interventions that consider the local knowledge of the transmission factors and the local socio-economic factors to avoid creating a series of unintended consequences. One alternative could be a significant aid package coordinated by the UN, to support developing countries, along with significant debt write-offs and free supply of personal protective equipment and testing kits, to protect the small number of healthcare workers.
The horrific economic impact of the pandemic is not restricted to low-income countries, but the UK and the US are injecting large sums of cash, with the US buffering the economy with 1.5 Trillion USD. This is in stark contradiction to the additional 1.4 billion USD bailout needed for Pakistan to deal with the consequences of the shut down, building upon the 6 billion dollar loan. Such loans and the interest on these loans will push an already struggling economy over the edge. According to current estimates, it would cost USD 160 billion to impact half the world’s poorest population, equivalent to just 10% of the US financial stimulus in the face of COVID-19.
This pandemic has brought people together in high-income countries, with frequently updated projections of deaths in Italy, China, UK, US, France, and a plethora of tweets/posts about how to work remotely and stay sane during the crisis, ignoring the costs on the poorest in Pakistan, India and Bangladesh. The leaders of developing countries are being shamed into adopting policies which are in fact detrimental and more harmful to their populations.
In this crisis, we have ignored humanity.
I believe future generations will look back and judge us not by what we did for “our country” but saving those that are most affected, within our borders and outside of them. Globally, we should judge humanity’s success in tackling this pandemic by the impact on total deaths, not COVID-19 deaths, with increased weight being applied to those who cannot sit comfortably and adopt remote working solutions. We should support low-income countries in adopting policies that are suited to their challenges leveraging technology platforms like those built by Singapore and deploying mass testing, to protect the vulnerable.
It is a time for the global community to lead with purpose and humanity – perhaps we can finally come together and treat all human life as equal.
Rabia T. Khan has a PhD in immuno-genetics from McGill University, an MBA and is the Managing Director of the Discovery Sciences Division at Sensyne Health, a clinicalAI company. Prior to joining Sensyne Health, Rabia held senior roles at BenevolentAI and Meta (acquired by Chan Zuckerberg BioHub). She is recognized as a leader in the life-sciences industry, featured as one of the 50 Movers and Shakers in Biobusiness in 2019.