Why lockdowns aren't the best way forward for the Global South

As we move further into the COVID-19 pandemic it is becoming increasingly clear that many of the tools and measures deployed by high-income countries against the virus are most probably not ideal in a low- and middle-income country (LMIC) context. One size does not fit all.

Yet despite representing half the world’s at-risk population, the LMIC perspective on challenges and potential solutions struggles to attract the media spotlight and enter wider debate. In this blog series, we aim to address healthcare challenges through the lens of LMIC, such as current and potential future consequences for primary healthcare, access to vaccines, sexual and reproductive health as well as mental health. We are a group of individuals working across the healthcare spectrum, local and global, with a joint passion for driving positive change.

In this first post, we challenge the feasibility and relevance of lockdowns, and point to the current and future potential consequences for the provision of healthcare when LMIC economies contract. Finally, we urge leaders to regain focus on health care challenges that risk causing the largest amount of suffering and death, whereof COVID-19 is merely one.

While Europe and the US have now started opening up again, large parts of the Global South remain in lockdown. Images from India and beyond, of workers and their families caught in the lockdown with no other option than to walk hundreds of kilometres in scorching heat, illustrate the difficult choices facing LMICs when dealing with COVID-19. Lockdown, fiercely debated in high-income countries, is even more challenging in LMICs. These include countries with intergenerational family structures, crowded urban regions, and a majority of the workforce in the informal sector with daily wages; in other words, populations with a limited ability to stay in place and self-isolate. Add to that the under-financed healthcare systems that struggled to meet basic health care needs before COVID-19 and it becomes clear that mimicking high-income countries’ responses is not advisable nor likely to provide the best outcomes in LMICs.

Let’s start with this question: can LMICs afford to panic and blindly ape the worst Western solutions? The answer is a definitive no. According to The World Bank, most countries are going to plunge into a recession, including LMICs that are expected to see the largest dip in their economies in the past 60 years. Based on those numbers, the Center for Global Development estimates that the coming downturn could translate into a staggering 100,000-200,000 non-COVID-19-related infant deaths across LMICs by next year. ). Indeed, a recent study from Nepal found that infant mortality rates tripled during lockdown.

Worldwide, close to 120 million children could miss out on essential vaccinations like those against measles, and Oxfam warns that the hunger crisis worsened by the pandemic could potentially kill more people each day than the infection itself. One could argue that many countries in LMICs have efficient health systems, but they tend to forget that these systems are brittle in the face of this pandemic. The lockdowns not only cause disruption to mobility, but also to medical supply chains and access to nutrition. While the stakes were already high in LMICs with limited access to healthcare, the lockdowns seem to have unintended consequences that these countries may not be able to recover from.

“Nobody can go back and start a new beginning, but anyone can start today and make a new ending.” — Maria Robinson

WHO Director-General Tedros Adhanom Ghebreyesus has said that "the best defence against any outbreak is a strong health system". Indeed, the pandemic has laid bare the fragility of healthcare systems across most LMICs. Two countries with more robust healthcare systems are Sri Lanka and Malaysia. Sri Lanka’s system was designed in the 1920’s during the spread of communicable diseases, with long-term equitable primary healthcare as its goal. Though not smooth sailing, this system has allowed Sri Lanka to cope more effectively with the current crisis. In Malaysia, the government was quick to mobilize resources to adequately increase primary healthcare capacity while continuing essential health services. That's not to say Malaysia was not one of the hardest-hit countries, but their strategic preparation and previous investments in their healthcare system allowed them to deal with the pandemic and to get back on their feet faster than many other countries. What can countries like India, Bangladesh, Nepal and Pakistan learn from these examples? The answer is perhaps obvious: move away from band-aids towards strategic, capacity-building solutions. This will allow health systems to better cope with current primary healthcare needs, the pandemic, and future needs.

As far as we know, COVID-19 isn't going away anytime soon. One key differentiator for the overall outcome is going to be how quickly we move away from the initial panic into dealing with COVID-19 as we do with other known diseases. Interestingly, the countries in proximity to China are faring well so far and offer learnings when it comes to handling the current pandemic as well as preparing for future ones. Although there are differences in their approaches, one important common denominator is that they have all incorporated hard-earned experiences from previous outbreaks, such as SARS, into their pandemic response mechanisms. They took the early warning signs from China seriously and implemented social distancing, testing, and active coordination of health authorities to rapidly contain the spread of the virus.

Coming out strong on the other side of COVID-19 is not a choice but a requirement – so LMICs must be smarter and more agile by asking the right questions and course-correcting as the world learns more about the disease as well as the effectiveness of different measures. By doing so, LMICs can manage the pandemic while maintaining pre-pandemic levels of vaccinations, diabetes management, maternal and child health, access to contraception, and other forms of essential healthcare. After all, let us not forget that the goal is not to win COVID-19, but to leave no one behind.