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Economic inequities threaten COVID-19 response

The growing pandemic funding gap The gap between donor commitments and the funding needed to respond to [ ... ]

Last week, the Global Pandemic Monitoring Board published its second annual report calling for multilateral systems to strengthen global pandemic preparedness and response capacity. The independent body, convened by the WHO and the World Bank, noted that the COVID-19 pandemic has been exacerbated by a “failure of governance in global collective action, including coordination and engagement with multilateral systems” as well as financing gaps in global health security, including “chronic underinvestment in preparedness as well as states withdrawing financial support.”

The report calls for a re-centering of governance across multilateral systems, including in the following areas: (a) global and regional mechanisms to track pathogens, (b) strengthen early warning and information sharing, (c) intermediate grading of health emergencies, (d) evidence-based policy formulation on travel and trade restrictions, (e) collaborative mechanisms for research and regulatory harmonization, as well as (f) strengthening IHR compliance assessment and enforcement mechanisms.

Global health security presents distinct challenges in low- and middle-income countries, according to the Centre for Global Development, requiring policy restructuring to ensure development gains. In the article, the President of CGD outlines three key problem areas that require coordinated global action: (1) reversing decades of underinvestment in global health security, (2) ensuring the continuity of developmental programs, and (3) expanding funding for these programs to reflect the disproportionate impact of the looming economic crisis on vulnerable populations.

Countries will meet for the 75th UN General Assembly this coming week where they will adopt two resolutions on the Global Response to COVID-19. Acknowledging the key leadership role of the WHO and the UN system more broadly, the all-encompassing resolutions call for intensified international cooperation and solidarity to contain, mitigate and overcome the pandemic and its consequences through responses that are people-centred and gender-responsive, with full respect for human rights. It also encourages countries to partner with relevant stakeholders in order to increase R&D funding for diagnostics, treatment and vaccines, leverage digital technologies, and strengthen scientific cooperation. The resolution moreover urges climate- and environment-sensitive approaches to drive the recovery, reflecting growing support and recognition within the UN of the importance of combatting the threat of climate change.

Two countries voted against the UN resolution in a break from multilateralism: the U.S. launching renewed attacks against China in rejecting the expressions of support for the WHO, while Israel objected to an amendment that discouraged countries from enacting unilateral sanctions on states that were not in accordance with international law. The last-minute amendment was introduced by Cuba and supported by 84 countries, claiming the original text failed to reflect concerns on national efforts to deal with the COVID-19 crisis.

In a second resolution that was adopted unanimously, the UN General Assembly called for intensified international cooperation and multilateral efforts in addressing current and future disease outbreaks. That includes sharing timely, accurate and transparent information, exchanging epidemiological and clinical data, sharing materials necessary for R&D, and implementing relevant guidance, including the International Health Regulations. The resolution also stressed the importance of expanding global efforts to fight health crises in order to maintain economic stability by supporting economies, protect workers and businesses as well as shielding the vulnerable through adequate social protection.

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The WHO Weekly Epidemiological Update reported that the pandemic has surpassed 30 million confirmed cases, and that the number of confirmed COVID-19-related deaths approach one million globally. Many regions are reporting a resurgence in cases, as countries experiment with different strategies for reopening schools and businesses, as the International Monetary Fund last month estimated the pandemic is costing the global economy US$375 billion a month.

With more than 15 million confirmed cases, the region of the Americas represents over half the global burden of the pandemic. The U.S. and Brazil remain among the top three countries, while Venezuela is approaching a humanitarian catastrophe as outbreaks in the capital have exacerbated existing food shortages and economic crisis. Public health experts are also warning that the virus is spreading from major cities to less populated areas of Latin America where health systems are weaker. A quarter of the countries in the region have suspended routine vaccination, at least 25 countries have suspended primary care programs for diabetes and hypertension – notable risk factors for COVID-19 – while pregnancy-related health services have dropped by nearly 40% in the region. The WHO Director for the Americas region urged countries to sustain essential health services, as well as scaling up alternative approaches such as telemedicine, home visits, and community outreach.

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A new study in Science demonstrates the need for a coordinated approach for countries in Europe to lift lockdown measures in order to prevent subsequent outbreaks of cases. The research team from WorldPop highlight the significant impact of actions by countries that are populous, well-connected and with strong interventionsin place – which include France, Germany, Italy, Poland and the UK. The study produced over 1,200 exit strategy scenarios, using publicly available epidemiological data as well as anonymized mobile phone data to map population movement in 35 European countries. A notable finding of the study is that premature and uncoordinated easing of control measures by some countries could accelerate the resurgence of COVID-19 outbreaks across the entire continent by up to five weeks. The simulations furthermore show that synchronizing intermittent lockdowns across countries would lead to half as many necessary lockdown periods in order to achieve an end to community transmission in six months.

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The Centre for Global Development published a study this week providing a comprehensive taxonomy of direct and indirect costs associated with failure to act proactively in containing the spread of the Coronavirus and mitigating its cascading effects. These can include direct and spill-overs health care costs, such as disruptions and resource diversion (with one study estimating two million additional deaths due to HIV, TB and Malaria alone). The human and economic costs associated with increased poverty have also been unprecedented, with the latest biennial World Bank Global Economic Prospects estimating the biggest collapse in per capita GDP in over 150 years. The two billion informal workers are expected to be impacted most severely, with 80% already affected by pandemic containment measures. Protracted school shutdowns will also generate learning losses estimated at $10 trillion globally, while a study by Oxford highlights the risk of outbreaks across 63 fragile countries, with 13 additional states projected to experience new conflicts over the next two years. Based on present and anticipated human and economic costs, the CGD study argues frontloading responses to COVID-19 and its secondary effects would not only cost exponentially less but would also be more dignified for people globally.
The unorthodox approach Sweden initially adopted of virtually ignoring COVID-19 has since become the cautionary tale. Unlike the rest of Europe, the country resisted lockdowns and physical distancing measures for economic reasons, gambling instead on herd immunity. The result three months later has been significantly higher cases as well as 12 times higher mortality rates than neighbouring Norway, while a much slower projected economic recovery. An analysis by Peterson Institute for International Economics affirms Sweden “literally gained nothing” from what they describe as a “self-inflicted wound.”

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During its Monday media briefing, the WHO Director General outlined four types of COVID-19 outbreaks occurring globally, including countries that [1] responded rapidly and avoided large outbreaks, [2] brought large outbreaks under control, [3] overcame their first peak and are struggling with new peaks, and [4] are currently in the intense transmission phase. The last category presents the biggest immediate risk and includes ten countries that account for almost 80% of new infections, with half of these in the U.S. and Brazil alone. The rate of new infections in the U.S. does not appear to be slowing despite an increase in testing, with total cases expected to surpass 4 million this week. With over 2 million confirmed cases, the outbreak in Brazil continues to be a major concern, particularly in light of irregularities in official government figures. This led to a stand-off last month between Brazilian President Bolsonaro– who has been criticized for downplaying the pandemic despite testing positive for the virus last week – and the Supreme Court, which prompted one Justice to demand the government immediately “re-establish the daily dissemination of epidemiological data on the COVID-19 pandemic.”
The Red Cross Red Crescent has warned that South Asia is quickly becoming the next epicentre of the pandemic, with rapidly rising cases across India, Pakistan, Bangladesh and Afghanistan. With the second highest number of daily new cases and over 1.1 million confirmed infections, the outbreak in India is rapidly escalating. This includes the Delhi metropolitan area that is home to 25 million people and accounts for almost half of all cases in the country. The latest projection from MIT, still under peer review, warns that India could have the largest number of cases in the next six months, with modelling scenarios estimating up to 287,000 cases per day in the absence of stronger public health measures.
Across Africa, the number of COVID-19 infections surpassed 750,000 this week, as the over 15,000 mortalities over the past five months have now exceeded the total number of lives lost to the West African Ebola outbreak between 2014 and 2016. At least 22 African countries have seen the number of Coronavirus cases double in the last month, with at least 35 countries experiencing community transmission. With the largest number of cases on the continent, South Africa recently re-imposed a ban on the sale of alcohol to reduce avoidable injuries and the burden on hospitals, while tightening curfews and mask requirements. Fragile health systems in many countries on the continent are increasingly overwhelmed, according to the WHO Director for Africa, who called on governments and the international community to scale up public health measures such as testing, contact tracing and case isolation. There is particular fear of outbreaks among vulnerable populations such as humanitarian response locations, marginalized communities as well as elderly populations, who are on average ten times more at risk of death, although they only account for 20% of COVID-19 infections in Africa.
Countries that previously succeeded in containing the virus are meanwhile reporting resurgence in cases, such as Hong Kong where a third wave of outbreaks prompted renewed lockdowns and physical distancing measures. A paper in the BMJ shows how COVID-19 related mortalities in Mexico have also tripled since the country began to relax lockdowns in early June despite warnings by experts and local health officials questioning official figures by the government. The cost of a subsequent lockdown in OECD countries alone has been estimated at US$1.1 trillion in additional output losses this year, which would increase five-fold if an outbreak were to occur in early 2021.

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The WHO published an updated COVID‐19 Strategic Preparedness and Response Plan containing the latest epidemiological findings in order to support countries preparing for a phased transition from widespread transmission to a steady state of low‐level or no transmission. The Strategy Update emphasizes a whole-of-UN approach, and provides practical guidance for whole‐of‐society strategic action that can be adapted to local conditions and capacities. Countries have been asked to identify the lead coordinator of multiagency COVID-19 plans, map existing preparedness and response capacities and gaps, engage key technical and operational partners to identify appropriate coordination mechanisms and mobilize resources and capacities, and to establish monitoring mechanisms and operational reviews to track progress and adjust strategies.

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The decision by President Trump to “terminate” relations with the WHO over accusations of undue influence by China on the agency was widely condemned, within the U.S. and globally. It remains uncertain if and how this would happen, but experts worry it may exacerbate global health challenges. The President’s suggestion to redirect intended resources (about US$450 million last year, accounting for 15% of the WHO budget) through bilateral development channels could lead to greater incoherence and inefficiency, according to Rebecca Katz (Georgetown University). A Nature article outlines a range of other possible repercussions, from the resurgence of polio and malaria to barriers in the flow of information on COVID-19. As Dr Kelly Lee (Simon Frasier University) warns, the damage to scientific partnerships would also extend to waning U.S. influence in global health initiatives, including ongoing drug and vaccine development and distribution.

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An article by the WHO Director General and President of Costa Rica remind us that COVID-19 will remain a global threat everywhere as long as it is present anywhere, demanding a collective and collaborative global response. At the World Health Assembly last month, Costa Rica took leadership in proposing a new COVID-19 Technology Access Pool (C-TAP) that would allow all participating countries, research partnerships and companies to share data, knowledge and intellectual property relating to diagnostics, treatments and vaccines for COVID-19. The mechanism was launched in the first week of June and has attracted at least 30 countries after resolutions by the WHA and UN General Assembly were adopted in support of “universal, timely, and equitable access to health technologies.”

At the Global Vaccine Summit on June 4, countries, philanthropic foundations and private companies pledged US$8.8 billion towards the WHO Access to COVID-19 Tools Accelerator, which places special emphasis on access.

While the IMF reports that countries have committed over $10 trillion USD in global fiscal response to the pandemic (of which 90% is in OECD countries), the monthly funding update by UNOCHA shows that only about $2 billion has been pledged thus far for the COVID-19 Global Humanitarian Response Plan ( that requests 6.7 B USD). This represents less than 18% of requested emergency funding for UN and aid agencies needed for supplies and logistical support to reach those in urgent need of assistance.

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The latest media briefing by the WHO warned that the global outlook has been “worsening” over the past week, with over 100,000 daily case reports in nine of the past ten days, as total confirmed cases surpass 7 million and total reported deaths approach half a million. One challenge has been complacency, as the WHO Technical Lead explains “people grow tired” which makes it difficult for governments to maintain or reintroduce public health and social distancing measures. As some regions like parts of Europe are beginning to see stabilizing or declining rates of new COVID-19 infection, Latin America has quickly become the ‘epicentre of the pandemic’. Of the 136,000 reported cases on Monday June 1, 2020, almost 75% came from just 10 countries, more than half of which were from Central and South American countries. The WHO Director General said he was “especially worried” given the large number of countries reporting rapidly increasing case and mortality rates straining health systems “from Mexico through to Chile.”

With almost 600,000 confirmed cases, Brazil has the second highest case count in the world following the U.S. With 2,600 deaths reported in just two days, the WHO Regional Office for the Americas, PAHO, warns that Brazil could see 88,000 deaths from COVID-19 by August unless the country takes drastic containment measures. Elsewhere in the world, Iran has reported more than 3,000 confirmed cases for a fourth consecutive day, raising concerns that the country may be experiencing a second wave of infections.

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According to the latest report by UNDP, global human development is projected to decline for the first time since the UN defined and began measuring the concept in 1990. Unlike other crises over the past three decades, the “triple hit to health, education and income” as a result of COVID-19 has been reported globally. The UNDP warns that developing countries that are less able to cope with the pandemic’s social and economic fallout remain acutely vulnerable. The report urges countries to focus on equity in order to limit these impacts. Closing the digital divide by providing more equitable internet access, for example, is estimated to cost less than 1% of the fiscal support packages but could result in a two-thirds reduction of the impact of school closures that currently leave 60% of children globally without access to education.

WHO COVID-19 Strategic Preparedness and Response Plan

The WHO published a Strategy Update to the COVID‐19 Strategic Preparedness and Response Plan of the emerging epidemiological situation in order to support countries preparing for a phased transition from widespread transmission to a steady state of low‐level or no transmission. The Strategy Update emphasizes a whole-of-UN approach, and provides practical guidance for whole‐of‐society strategic action that can be adapted to local conditions and capacities. Countries have been asked to identify the lead coordinator of multiagency COVID-19 plans, map existing preparedness and response capacities and gaps, engage key technical and operational partners to identify appropriate coordination mechanisms and mobilize resources and capacities, and to establish monitoring mechanisms and operational reviews to track progress and adjust strategies.

An accompanying COVID‐19 Monitoring & Evaluation Framework was developed to support countries, listing key public health and health systems indicators for countries to monitor their preparedness and response to the pandemic. The M&E Framework is organized across three dimensions: Geographical Scope (global, all countries, priority countries); Planning and Monitoring Needs (informing strategic planning, operational tracking, evidence‐based decision‐making, as well as advocacy and transparency between donors, UN agencies, and partners); and across 9 Pillars (Country‐level coordination/planning/monitoring, Risk communication/community engagement, Surveillance/rapid response teams, Points of entry/travel/transport, National laboratories, Infection prevention & control, Case management, Operational support & logistics, Maintaining essential health services & systems).

World Economic Forum’s COVID-19 Risks Outlook

The World Economic Forum, which publishes the annual Global Risks Report, released two new reports that map the global risks, challenges and opportunities that COVID-19 presents. Adopting a complex systems approach, the reports highlight the interdependencies within and across borders but also health, economic, environmental, social, geopolitical systems. At the same time, the emphasis in both documents tilts towards the Great Transformation that will be needed. These include the need to reframe essential public services, notably health but also education, care and social safety nets. The factors that promote and inhibit solidarity and compassion are also raised, alongside needed behavioural shifts towards more sustainable consumption and mobility habits.

Global fiscal support during the COVID pandemic

The monthly IMF Fiscal Monitor adjusted the estimated fiscal support by countries around the world to US$9 trillion as a result of COVID-19. This was roughly divided between public sector loans (and other equity injections) as well as direct budgetary support. The IMF reports that a second wave of government measures to address the economic impact of the pandemic this past month accounted for the $1 trillion increase in the overall figure.

The G20 account for most of this sum ($8 trillion), reinforcing global inequities in the distribution of resources and fiscal support capacities. Developing countries, meanwhile, are also anticipating a “hidden debt risk” due to the unprecedented synchronization of fiscal stresses. Including currency depreciation, capital outflows and foreign-currency borrowing.

Dynamic intervention to relax lockdowns and school closures

A study in the European Journal of Epidemiology modelled dynamic interventions (i.e. cycles of lockdown to reduce R0 to below 1, and intervals of relaxed social distancing) across 16 distinct countries globally. The authors conclude that a ‘rolling schedule’ of 50 days of lockdown followed by 30 days of relaxation could reduce transmission levels and keep ICU demands below national capacities. The model furthermore suggests that adopting such dynamic suppression measures over 18 months could lead to significant reductions of new infections and deaths, particularly in developing countries. Since each model was only run one time per country, one study limitation is testing underlying factors at one fixed value rather than a range of possible outcomes from multiple runs, introducing uncertainty.

The SAGE group in the U.K. also released a report last week that modelled the impact of eight scenarios of school re-opening on community transmission of COVID-19. Between the two extremes of staying closed and fully opening, the most promising scenario was breaking classes into two cohorts and alternating between ‘two weeks on / two weeks off’ over academic year. The authors acknowledge the uncertainties associated with the model, but nevertheless suggest that the impact of school re-opening is likely to be relatively small compared to maintenance of other social distancing measures in the broader community.

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The growing pandemic funding gap

The gap between donor commitments and the funding needed to respond to the pandemic continues to grow. As the UN Office for the Coordination of Humanitarian Affairs tripled its appeal last week to US$6.7 billion, they admit to only receiving US$1 billion towards its initial request for US$2 billion. That includes a mere $65 million contribution from the U.S. that a senator described as “unconscionable,” while the Washington Post reports the US$3 trillion COVID-19 bill introduced by Democrats this past week contains no funding for international assistance. Germany and France likewise agreed to support a 500 billion Euro aid package to support E.U. countries with recovery from the pandemic.

NGOs such as the International Rescue Committee argue that much of the aid is stuck within multilateral channels, as humanitarian funding to front-line NGOs accounts for only 2% of commitments under the UN Global Humanitarian Response Plan.

The global economy is shrinking, and 130 million people may be pushed into extreme poverty

Global economic output is expected to drop by 3.5% in 2020, and by US$8.5 trillion over the next two years as a result of the pandemic. The UN World Economic Situation and Prospects report warns that an additional 34 million people could fall below the extreme poverty line by the end of this year. The UN Department of Economic and Social Affairs did “not anticipate (the global economy) would dive as quickly as it did” amidst the sharpest economic contraction since the Great Depression. The report projects that by 2030, an estimated 130 million will be pushed into extreme poverty. Africa is expected to absorb 56% of the rise in poverty, in part due to limited economic and social protection measures as well as debt burdens.

In the World Economic Forum’s weforum.org, the Dean of the Wharton Business School projects that COVID-19 would also reverse trends in globalization and urbanization. The resulting compression of the global economy, he predicts, will be further impacted by reduction in international cooperation and increased likelihood of international conflict.

250 million Africans could be infected, with up to 190,000 dead by years’ end

Modelling by the WHO predicts that nearly a quarter of a billion people across 47 African countries will be infected with the Coronavirus, with as many as 190,000 projected mortalities by year’s end, according to a study to be published in BMJ Global Health. While African countries may experience fewer severe cases and deaths per capita due to younger populations and lower obesity rates, health system capacity gaps and disruptions in maternal and child health could result in additional deaths.=

ODI calls for increased solidarity to support developing countries

The Overseas Development Institute estimates that the economic impacts of the pandemic to sub-Saharan Africa remain uncertain but will likely exceed $100 billion. While many countries have imposed stringent measures to contain the spread of the virus, there are immediate and long-term concerns about the lag in economic and social protection measures as governments face major liquidity and fiscal constraints. Since much of the global economic dislocation stems from decisions to protect citizens in wealthier countries, the ODI calls for increased international solidarity to support developing countries. That can include special drawing rights to address capital outflows, moratoria on debt service repayments, development finance to provide liquidity to protect employment, as well as non-concessional lending and economic resource packages as aid.

Rising Inequity Gap

The IMF warns that COVID-19 could widen the inequality gap between rich and poor across and within countries, urging policymakers to put in place risk-sharing and social assistance mechanisms to protect the most vulnerable from economic impacts. Using past pandemics as a guide, the analysis shows net increases in Gini coefficient (a measure of inequity within a country) after five years as well as long-term impacts due to job loss and other shocks to income (e.g. lower remittances). To minimize long-term damage (or “scarring”) to the livelihoods of vulnerable communities – and improve resilience to future shocks (including the effects of climate change), the IMF urges countries to consider a range of measures including:

Access to sick leave, unemployment benefits, and health benefits;
A “New Deal,” particularly in countries where the employment sector is largely informal and where social protection systems are limited; and
Expanding social assistance systems, introducing new transfers, boosting public work programs, and progressive tax measures.

“Nothing lays bare inequality and discrimination like a disaster”

In a forceful address on the human rights dimensions of the COVID-19 pandemic, the UN Special Representative for Disaster Risk Reduction highlighted the disproportionate impact on marginalized and vulnerable populations, amplifying social inequities, forced displacement as well as gender- based violence. The central message was that the international community “must do more.” This includes treating persons at risk as people with human rights and not just as beneficiaries of humanitarian actions, who are consulted in decision-making relevant to their lives, and to foster greater resilience by focusing on the drivers of disaster risk, including poverty, lack of international solidarity and pandemic preparedness, and increasing frequency and magnitude of extreme weather events.

‘Donor states can and must do more’

According to a Devex survey of development professionals, two thirds say donors are not doing enough to respond to the Coronavirus. The UN estimates that US$500 billion will be needed to address the pandemic in developing countries, as Oxfam urged 30 donors of the OECD Development Assistance Committee to contribute $300 billion. In addition to more funding, development experts point to three other steps donors should take:

Simplified funding mechanisms for a faster response;
Clarity and transparency on decisions; and
Looking beyond the immediate needs, including longer-term impacts of COVID-19 and what preparation is needed now to respond to those.

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