Mark Lowcock has long had reason to be optimistic. For most of the UN’s humanitarian chief’s lifetime, the lot of people across the Global South has been steadily improving. Billions were being lifted out of extreme poverty, deadly diseases such as smallpox were being eradicated, the status of women around the globe was advancing. The 58-year-old has even written a book, Ten Generations, to be published next year, charting that seemingly inexorable march of progress and prosperity though 300 years of his own ancestors’ history.
No longer. In the span of just a few months, the coronavirus pandemic has knocked global development back years, possibly as much as a quarter of a century, according to a report published by the Gates Foundation in September. “For most of the past 50 years, for most people on the planet, life has been getting a tiny bit better. And the really terrible thing about this pandemic is that it’s knocking that back,” Lowcock told the New Statesman in a wide-ranging interview from New York, where the UN humanitarian body he leads is headquartered.
He warned of the terrible toll the pandemic is already taking on the Global South – not primarily because of its direct effects on health, but because of its economic cost – and against rich countries turning inwards as competition for potential vaccine doses intensifies.
Covid-19 seems to directly affect rich countries much more than poor countries, because the populations of rich countries are older. The average Burkinabé is 17 years old; the average Belgian 41 – and the virus kills those aged under 30 at rates dozens of times smaller than those over 60, according to figures compiled by Our World in Data.
Accordingly, in many poor countries, “the biggest effects [of the pandemic] have arisen from the economic contraction”, Lowcock said. Their governments followed the model of richer nations and locked down hard and early. “That has a huge impact on hundreds of millions of people who can only put food on the table on one day if they’ve been out to work the previous.”
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Lowcock, who was a British civil servant in the former Department for International Development for more than 20 years, rising to the highest rank of permanent secretary, regrets that many of the measures taken by rich countries for the benefit of poorer countries during the 2008 global recession have not been repeated during the coronavirus crisis.
Rich countries have spent up to 20 per cent of GDP protecting their citizens, according to Statista. “If they would just spend 1 per cent of that effort on protecting the most vulnerable countries, then we wouldn’t see this big increase in poverty. We’re going to see a reduction in life expectancy and more kids dying in infancy. We are already seeing a reduction in immunisation,” Lowcock warned.
On women’s rights, too, the picture is bleak, Lowcock said: “It’s women and girls who are paying the biggest price. Because we’re seeing increases in gender-based violence, there’s a seven- or eight-fold increase in the number of women calling hotlines for help in the countries where we work.”
There is also a danger, he adds, of international organisations becoming overly preoccupied with Covid-19 and attention shifting away from diseases, such as measles, that are less newsworthy but much deadlier than coronavirus in countries with poor health infrastructure and young populations. “Something like 80 million kids [worldwide] under one year haven’t had their routine immunisations,” he said, stressing the importance of not forgoing these at the expense of a coronavirus vaccine. “Otherwise we will see an increase in the loss of life because coronavirus is very unlikely to take as many lives as measles does among babies in Africa.” In 2018, more than 140,000 people died of measles, mostly children under five in sub-Saharan Africa, according to estimates from the World Health Organisation. The official coronavirus death toll in Africa, by contrast, stands at 40,000.
The great hope of politicians worldwide is a coronavirus vaccine, which will release voters from months of social isolation and economies from devastating restrictions and closures. Russia and China already appear keen to administer their candidates, though much of the world’s scientific community is sceptical about the safety of rushing through vaccines.
But approval of a Covid-19 vaccine by internationally recognised regulators is just the start. Equally as significant a challenge will be manufacturing, distributing and administering it. Vaccinating perhaps eight tenths of the world population – the proportion some scientists estimate is required to ensure herd immunity to coronavirus – as rapidly as possible will almost certainly represent the greatest logistical challenge in the modern history of humanitarianism.
For a start, it is likely that the richest countries will monopolise the first few billion doses produced for their own populations. Global vaccine production capability currently stands at 6.4 billion doses annually, according to one estimate. Some coronavirus vaccine candidates require several separate doses, however, meaning up to 15 billion doses could be required to immunise the world population of around 7.5 billion and to halt the spread of the disease. Producing that number could take as long as 3 years, while conventional vaccines for diseases such as measles would have to continue to be manufactured at the same rates as before the pandemic.
[See also: The geopolitics behind the race for a vaccine]
The effect on the Global South – which largely comprises governments too poor to afford to vaccinate their populations and war-torn nations incapable of it – will be devastating. Economic confidence is expected to lift at the news of a vaccine approval, even before a single dose has been administered, delivering some relief to poor countries presently suffering more from the economic slowdown than from the disease itself, Lowcock said. But as rich countries monopolise the first doses of the vaccine, poor countries will likely be neglected, leaving the disease to spread among their populations for further months or years. The Covax initiative, intended to ensure an equitable distribution of the vaccine, has signed up governments representing some 60 per cent of the world population, but the alliance is unlikely to prevent scrabbling for doses in the early stages of a vaccination programme.
Finally, according to Lowcock, there is the question of distributing and administering the vaccine – a significant challenge in poor and war-torn countries with limited health systems, some parts of which are controlled by groups so hostile to aid workers that international organisations cannot operate in them. In order to remain potent, doses will need to be administered without spending more than 24 hours at room temperature, a difficult task for health workers operating in rural areas without developed infrastructure. “It will be a huge challenge in countries where health services are so eroded that the number of kids getting the measles vaccine is way down.”
It would be a mistake for countries to turn inwards, after their populations are vaccinated, believing that they can eliminate the disease from within their borders without helping poorer countries do so too, Lowcock warned. “There are some problems that you might kid yourself that you can protect against in a globalised world. Some people are trying to do that on immigration and refugee flows, and it actually turns out that’s quite difficult. There are other problems though, for which the classic examples are climate change and the virus.”
“It’s a complete delusion to think that [governments] can protect only themselves.”