The writer is a former UK prime minister
Covid-19 is the toughest practical challenge for government I have ever seen. To a greater or lesser degree every country in the world is grappling with the virus.
For developed countries such as the UK, there is an urgent need for a new strategy. We toyed with the idea of herd immunity, but backed off, rightly, when the mortality rate of such a policy became apparent. So, we transitioned to a policy that looked like eradication, with the lockdown a necessary step to get there, until a vaccine arrived.
Now we should know that eradication is not possible. Containment is. But the only route to that is mass testing of the population to pick up the asymptomatic cases, which appear to be nearly half of the total. Otherwise, we risk resurgence or return to lockdown.
The UK was too slow at the onset of this crisis. But, given its nature that was excusable. A similar error at this stage is not excusable. It is clear what must be done. But the UK’s challenge pales into insignificance beside the dilemma facing developing countries. And if the developing world fails, the consequence will reverberate around the world.
Globally, Covid-19 is gathering pace. In Brazil, there are now more than 3m confirmed cases, India is above 2m, and the continent of Africa passed the 1m mark last week. These countries face a daunting choice.
On one hand they cannot simply allow the pandemic to take its course. We are already seeing hospitals in Delhi, São Paulo and Cape Town reach intensive care capacity. Health services that are dramatically less comprehensive than in western countries are coming under intense pressure due to reallocated resources, large numbers of sick healthcare workers and shortages of personal protective equipment. As a result, people are avoiding seeking basic healthcare for fear of being infected.
There is a risk of a huge rise in both Covid-19 and non-Covid-19 deaths, as modelling from the Institute for Global Change has shown, compounding existing economic and food security crises. An increase could mean not just losing gains made in tackling HIV, tuberculosis, malaria and maternal and child health, but seeing those trends reverse.
Leaders know that stringent containment measures such as lockdowns cannot be reimposed on a significant scale because a large part of their economies and food systems are informal, and stimulus packages are expensive. They cannot afford to remain disconnected from the global economy for long. In fact, many developing countries are now reopening for international travel.
Leaders should focus on three priorities and the developed world must help them do so. First, healthcare workers and services must be protected. Without these, deaths from tuberculosis, HIV, malaria and malnutrition will spiral as Covid-19 cases surge. This means prioritising pay, PPE and safety procedures including testing for healthcare workers.
The second priority is public engagement. With no suitable vaccines, limited diagnostics and treatments, and with stringent lockdowns being unfeasible, the only way to reduce the infection and death rate is through community action. This includes measures to shield at least 80 per cent of vulnerable people as well as social distancing measures such as handwashing, mask-wearing and spacing in public places.
Consistent, clear messaging is essential, both through media campaigns and outreach to religious leaders, tribal heads, business people and youth groups. Government should mobilise community action by sharing the cost of handwashing stations and boreholes. Such an effort was critical in turning the tide during west Africa’s Ebola crisis in 2014-2015 and it can play a vital role again now.
The third priority is to build up surge capacity in hospitals to reduce the risk of being overwhelmed. This requires infrastructure, such as adding as many makeshift critical care beds as possible (through the support of development partners if necessary) as well as staff and supplies. The example of Kenya, where the president has asked its health ministry to retain retired anaesthetists and ICU staff temporarily, should be followed.
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In each of these areas, the international community can help. It must offer both resources and fair methods of distribution of future vaccines, not only for reasons of humanity, but also self-interest. If low and middle-income countries cannot deal with the crisis, we cannot control the disease globally.
Developing world governments can show leadership by setting focused aims, providing their international partners with clear and precise requests for support, underpinned by effective command and operational structures with the head of state in the driving seat.
The toughest stage of the Covid-19 pandemic lies ahead for poorer countries. If their leaders focus on these three priorities, they stand a decent chance of minimising the damage.