Global response to Covid-19: Tailoring approaches for the developed world
The Covid-19 pandemic is a global threat which has affected more than 213 countries. Although it emerged in China in December 2019, it took nearly a month for the WHO to send a delegation to understand and examine the disease. Whilst spread to the Western world remained limited, leaders from Europe and the USA downplayed the threat. Trump called it a “Chinese virus” and a ploy to destabilise the market.
In early March an exponential increase in the number of cases in prosperous northern Italy revealed that the virus did not distinguish between rich and poor. It was at this time, when the virus reached the developed world, that the WHO declared it a pandemic. The Western world began funding research to develop a vaccine, and introduced strategies to contain its spread. The subsequent application of these same strategies in the developing world has been disproportionate to the impact of the disease and does not factor in the economic and human cost that it will entail.
In India,270 million people live below the poverty line, many of whom stay in rural areas. Close to 63 million Indians are not able to access basic healthcare. Although India is seen as an economic powerhouse, income inequality is substantial with 10% of the population controlling 63% of the wealth.
On the 24th of March 2020, with less than a thousand confirmed cases of Covid-19, the Indian government implemented a 21-day country-wide lockdown within four hours of announcing it. The hundreds of thousands of migrant daily-wage workers earning Rupees 200 to 400 ($2–$5) a day in the glittering, mall-infested metropolises of India were shell-shocked.
Work and wages disappeared overnight and hunger stared them in the face. Left with no option, and no public transport, they began to walk back to their villages. Carrying their meagre belongings, entire families with small children began the extremely risky treks ranging from 200 to 1200 kilometres, relying on the kindness of strangers. Many were stopped at state borders, and then pushed into cramped public shelters. Of those who evaded border checks, many died of hunger, exhaustion or thirst. The official tally of 22 dead (as on 30th March 2020) is, in all probability, a gross underestimate.
The Indian government’s advice to “social distance” and wash hands regularly makes little sense to those living in overcrowded slums with limited access to clean water and a hand-to-mouth existence. The complete lockdown is expected to “flatten the curve” and bring down the peak of the pandemic to avoid overwhelming the health system. This assumes equal access to healthcare, which is clearly not a reality so the flattening of the curve will allow for the affluent to be able to use the health system but not those who do not have access to healthcare. There are 2 intensive care unit beds per 100,000 individuals in India, a low figure that also assumes an even spread amongst all income classes, which is not a reality.
The ethical implications of the government’s strategy need to be questioned and considered. India aspires to be a global powerhouse, and wants to rapidly grow and build its own identity in the process. It continues to be in the global waiting room aspiring to become more developed and emulate the west in more ways than one. In its response to the pandemic, India unthinkingly adopted the strategy of the western world, disregarding the consequences for the poor and those in the informal sector. This blindness to its hugely unequal society and lack of consideration for the long-term implications is beyond belief. Instead of adapting the strategy to its own context, we adopted a model that was completely unsuited for a developing country.
At the same time, the complacency of the WHO in providing technical assistance which follows a “one size fits all” approach suggests that it has failed to acknowledge the reality of the majority of its member nations. The WHO proposes that uniform policies be adopted by all nations irrespective of their level of development. Whilst these recommendations work well for the financially well-endowed developed world, they are not appropriate for low and middle income countries. Given their paucity of resources and lack of technical skills, ethically the WHO’s primary responsibility should be to provide recommendations applicable for the developing world. However, it is likely that until international organisation funding structures are changed, their priorities will continue to align with western interests.
All disease-related issues are problematised as a resource allocation issue, where limited resources need to be optimised. Lives and deaths are reduced to numbers so that they can be compared and weighed against one another. However, for Covid-19 there is little concern about the economic cost. This is largely because it has affected the rich and the powerful — from Prime Ministers to movie stars and captains of industry, no one is immune. To take a wider perspective, 400,000 people die of TB in India every year. However, since this is predominantly a disease of the poor, a commitment to eradicate it is lacking.
Historically, adopting ethical practices in public health has not been easy. The response to Covid-19 has exposed the stark underbelly of society’s class-divide. Life is not valued equally across class, and the global community worries more about individuals who are affluent. In aspiring to be “developed” one forgets the need to contextualise interventions towards one’s own reality.
Over time the unintended and long-term consequences of the response to Covid-19 will be clear. For now, we need to reflect and consider all potential impacts of current policy, acknowledge that India is not the West and have the courage to tailor our strategy to our context. By doing this, we may still be able to limit the harm to those who are already marginalised in our society.
