COVID-19 is a Development Issue
COVID-19 is a global issue, but it’s not impacting everyone equally. In the developing region of the Lower Mekong — made up of Cambodia, Lao PDR, Myanmar, Thailand, and Vietnam (the LMCs) — the virus enters a context of great inequality and a high proportion of vulnerable populations. Two to 22.7% of the populations of the various LMCs live under US$1.90 a day. Fifty-five percent of the urban population in Cambodia to 25% in Thailand live in urban slums and other informal settlements. A conservative count of 1.5 million refugees and internally displaced peoples, including the Rohingya of Myanmar, hail from the region. 35 million indigenous and ethnic minorities from upwards of 320 groups, many of which are not recognized by national governments, live in the region. The hawkers, cross-border vendors and others account as high as 91% of the informal¹ non-agricultural sector in Cambodia, and the lowest hovering just above 50% in Thailand. Intersecting all of these populations is women.
The global COVID-19 response is rooted in a data-driven, epidemiological approach. It focuses on combating the countable aspects of the coronavirus itself — who it impacts, how it is spread, and what the disease does to the body. But this approach, while epidemiologically sound and recommended by the WHO, is based on a disease model using elements most relevant to wealthy countries. In addition, it is limited by the fact that it relies only on known counts of individual people, which we already know doesn’t adequately identify marginalized populations or capture them in the count. In the Mekong, COVID-19 interventions based on the epidemiological model will not work for Rohingya families in overcrowded refugee camps, poor Cambodia migrant workers in Thailand, or highland ethnic minorities living too far from a hospital with testing equipment.
Limitations in data collection in the LMCs have already hampered an understanding of the virus based on the local statistical context. Insufficient test kits globally, combined with regional low statistical capacity, limited ability of the healthcare system to conduct testing, and low transparency in public health decision-making and information-sharing has meant that infection counts reported by national governments in the region have been discounted by observers. Lao and Myanmar (both neighbours of China) did not report their first cases until March 24, 2020 and March 23, 2020 respectively, months after China announced their first cases.
Further, the epidemiological approach will fail the millions of vulnerable people living in the Mekong Region. A growing body of literature² is noting that the implications of responding to COVID-19 without considering the known context of developing countries has already fallen disproportionately on the shoulders of the highly vulnerable. Furthermore, considering existing governance structures, public health infrastructure, and social welfare systems allows us to gauge the longer-term implications on the sustainable development goals of the region. Underscoring all of this is a concern about the impact of COVID-19 on human rights. Will this pandemic be a platform for authoritarian leaders to abuse legitimate emergency measures constraining civil liberties, leading to further impoverishment, preventable illness, arbitrary detention and social disorder? To answer this question, we need to look beyond epidemiology, and into development data.
The necessary context: Governance, health care, and social welfare
Governance
The WHO-recommended response to COVID-19 has required the limitation of freedoms — movement, association and others — and seen an increase of proposals for government surveillance of citizens using novel tech solutions. But, in the Mekong, these actions were normal before the advent of COVID-19. Already known for authoritarian governance structures — Lao PDR and Vietnam have communist governments, Thailand is governed by a military junta, and Cambodia and Myanmar are governed by institutions only ostensibly democratic — the region is marked by low transparency in governance, low access to information, and a poor record of human rights. There is a danger of further human rights abuses in authoritarian settings such as these, during periods of emergency which Human Rights Watch describes as a “convenient pretext to silence critics and consolidate power”. These abuses, under the guise of a response to COVID-19, have already begun in the LMCs.
Currently, one of the key ways this is being done is by using the legal system to limit access to information and freedom of expression. Anti-“fake news” laws (a recent development in the region) and criminal law have been used to silence opposition voices in Cambodia, Vietnam, Thailand, and Myanmar. This is not a new tactic; now the governments claim that misinformation is being spread about the virus, or that social disorder is being spread by not following social distancing measures. For instance, in Lao PDR, an individual was charged with violating a stay-at-home order for livestreaming an event on Facebook. Digital surveillance at the government’s discretion is also sanctioned by law in Cambodia, Vietnam, Thailand; in Myanmar, there is nothing preventing this intrusion. Moreover, overly broad and vague emergency laws are coming into force, which has been flagged by observers as cause for concern. Cambodia’s newly drafted emergency law joins hundreds of coronavirus-related legal instruments being written in Vietnam, and Thailand’s Emergency Decree on Public Administration in an Emergency Situation (all being tracked by the Open Development platforms). Not unexpectedly, very little information is available from public sources on the coronavirus response in Lao PDR and Myanmar, two countries known to be extremely low in government transparency. At the same time, the Myanmar government has limited access to websites and disconnected telecommunications in an arbitrary limitation of access to online information and freedom of expression.
While digital surveillance (for example, for contact tracing, or quarantine tracking) may be effective for limiting the spread of COVID-19 in some settings, some basic requirements must be met: transparency of government action, citizen trust in government institutions, and widespread access to technological tools and infrastructure. Safeguards must be in place to ensure that tech solutions are deployed responsibly, not used as another way to collect highly sensitive data to surveil citizens. Simply put, tech solutions should not come above human rights. Given the existing governance structures in the Mekong region, there are significant concerns in this regard with increasing digital surveillance.
Health care
A key aspect of the COVID-19 standard response is a dependence on hospital care. Hospital infrastructure, services, and qualified personnel are necessary to conduct the testing required to identify, treat, and count instances of the virus. But, the existing health context in the LMCs is not strong enough for this style of intervention.
The health security capability of Thailand is the best in the region, even though like the other LMCs less than 6% of their GDP is spent on health; for comparison, all but Lao PDR spend more on military. Universal health coverage remains a work in progress. Rural access to hospitals is very different from urban access. For those who can access a hospital, the availability of qualified healthcare providers is limited. The WHO notes that a minimum of 23 physicians, nurses and midwives per 10,000 people are required for basic healthcare coverage; only Thailand meets this basic metric. Furthermore, cost of healthcare is a major barrier: 10–15% of the population in Cambodia, Myanmar, and Vietnam spend an amount on healthcare considered catastrophic when compared to their income. Altogether, this means that marginalised ethnic minority communities, more likely to be living in rural areas, are already much less likely to be able to seek medical care early or access a trusted health professional to obtain the care that they need during this pandemic. When the additional limitations of an insufficient number of COVID-19 tests, hospital beds, and personal protective equipment for medical professionals are considered, it seems clear that a hospital-based approach for COVID-19 care is next to impossible for vulnerable and marginalised Mekong region communities.
Social welfare
The WHO has also focused on behavioural changes to limit the spread of COVID-19: handwashing, social distancing, and staying at home. Schools, workplaces, and other public spaces have been shut down in favour of homeschooling and working from home; people have been recommended to stay in to avoid crowds and maintain a distance of at least 1 metre from the nearest person. However, experts seem genuinely surprised to see that the implementation of these measures are failing — even in highly developed nations like the United States. Is implementing these recommendations even a reality for vulnerable populations in developing regions?
For the most vulnerable in the Mekong Region, these recommendations may be impossible to follow. At least 50% of the population in Lao PDR does not have access to basic handwashing facilities including soap and water; even in Thailand, the most developed of the region, at least 16% of the population lacks these basic facilities. Urban slums and other informal settlements, populated by millions, are by definition highly dense and lack sufficient access to WASH. A wide digital divide and an inaccessibility of internet access for people at the margins limits online engagement for school or work. And, for those millions dependent on informal sector work, working from home is not an option.
These social measures and the economic downturn they have triggered will have long-term ramifications for the development of the Mekong region. The LMCs, the majority of which are considered Least Developed Countries and Lower-Middle Income Countries, are dependent on industries that have been both directly and indirectly impacted by the coronavirus. Breakdowns in food chains are a big concern, while textile production and garment manufacturing is no longer a priority. Tourism has come to a standstill. Food insecurity, due to inflation, is projected. And, with three of the five LMCs sharing a border with China, and a high regional dependence on Chinese investment, China’s early border closures has meant that the region’s economy has been suffering since February.
The long view
The coronavirus pandemic has highlighted the privilege of the mainstream coronavirus response.⁴ Relying on just the epidemiological data means that vulnerable populations in the LMCs will die from far more than just the coronavirus. These effects will reach into the future, much longer than the pandemic will last. What are these effects on indigenous and ethnic minorities? What about the environment? These topics will be discussed in the coming weeks as part of this blog series.
A broader approach, taking into account the development context and remaining data-driven, should be used. But what is appropriate for the Lower Mekong countries? Should technology be used? We talk more about the ways to do this, responsibly and transparently, in our next post. Ultimately, responding to the virus should consider data in an intersectional, contextual way, based on the needs of the most vulnerable.⁵
Footnotes
1. This is counted by the World Bank as “all jobs in unregistered and/or small-scale private unincorporated enterprises that produce goods or services meant for sale or barter. Self-employed street vendors, taxi drivers and home-base workers, regardless of size, are all considered enterprises. However, agricultural and related activities, households producing goods exclusively for their own use (e.g. subsistence farming, domestic housework, care work, and employment of paid domestic workers), and volunteer services rendered to the community are excluded”.
2. Start here: https://www.cgdev.org/; https://coronavirustechhandbook.com/home; https://www.hrw.org/tag/coronavirus; http://politicalviolenceataglance.org/tag/covid-19/.
3. For the World Bank, this means that all people can obtain the health services they need without suffering financial hardship.
4. See, for example, https://www.nytimes.com/2020/04/05/opinion/coronavirus-social-distancing.html. Accessed April 14, 2020.
5. See here for a well articulated article: https://www.lshtm.ac.uk/research/centres/health-humanitarian-crises-centre/news/102976. See here for a well articulated video: https://youtu.be/lGC5sGdz4kg. Accessed April 14, 2020.
