March 7, 2022
By Elizabeth Mebrahtu
01 Introduction
Coronavirus 2019 (COVID-19) has unveiled the systemic disparities that exist between high-income countries and low-and-middle income countries (LMICs), particularly the disparities addressed in the United Nations’ 17 Sustainable Development Goals (SDGs). More specifically, SDG #3, Promoting Good Health and Well-Being Globally, remains under threat as these health disparities persist and have been perpetuated by the global pandemic. As such, there is a need to identify, analyze, and address these systemic barriers to achieving good health and well-being for all, and to mitigate the risk that COVID-19 poses to exacerbating the inequitable health disparities between the Global North and the Global South. COVID-19 has unveiled and perpetuated a number of systemic issues, such as international relations, inadequate health systems, and structural inequalities, which impede LMICs’ capacity to achieve good health and well-being, a basic human right. This paper identifies the political, economic, social, and technological/infrastructural barriers experienced by LMICs, how these barriers led to global disparities in the COVID-19 response, and how these can be framed as opportunities to better leverage SDG 3: Promoting Good Health and Well-Being Globally.
02 Coronavirus Disease 2019 (COVID-19)
Since 2019, the COVID-19 pandemic has rippled across nations and has had detrimental impacts on the political, social, economic, and health climate (Kelley et al., 2020). Despite the world having experienced a number of global health threats, such as SARS and H1N1, countries had not sufficiently invested into pandemic preparedness efforts, and as such, have suffered great economic, social, and health impacts of the COVID-19 pandemic. While at first the pandemic was immediately addressed through a biomedical lens, there was no addressing the wider political, economic, social, and technological/infrastructural issues, particularly in vulnerable countries which did not have the capacity to effectively respond to a pandemic (Kelley et al., 2020). While many global governance advocates and scholars saw this as an opportunity for a unified approach to swiftly combat this global threat, this idea quickly diminished as resources became scarce and economies began to collapse (Kelley et al., 2020). To this effect, high-income countries led siloed efforts to mitigate the health and economic impacts of the global crisis, while LMICs struggled to carry the disproportionate burden of COVID-19.
03 COVID-19 Response in High-Income Countries
The Global North’s response to COVID-19 served as a stark reminder that though this is an increasingly globalized world, facing a common threat does not mean it is managed through a unified response (Gostin et al., 2020). Despite the clear need for international cooperation, regional networks, and a unified approach that considers both the interests of the Global North and the Global South, high-income nations had focused on addressing the rapidly-unfolding epidemic in their own countries through vaccine, equipment, and treatment procurement (Gostin et al., 2020). Furthermore, these countries opted to invest in domestic resources to support their vulnerable economies, while COVID-19 took advantage of the weaknesses and gaps experienced in the systems of LMICs (Kelley et al., 2020).
04 COVID-19 Response in LMICs
While the world was concerned with the threat of COVID-19, there was another rising global threat at large: nationalism. The lack of international support from high-income nations had directly impeded the response of LMICs and left devastating impacts on millions, despite the fact that many of the system gaps within the Global South primarily exist because of the longstanding systemic oppression of low-income nations.
During the COVID-19 crisis, LMICs faced a number of competing priorities, a major conflict being between economic prosperity and population health. Because of the nature of low-resource contexts, many low-income nations had to choose between lockdown measures to preserve health but severely destabilize the economy and put many into poverty, or remove restrictions and trade-off the health of the population, ultimately overwhelming the health systems. Because of the lack of social assistance that LMICs’ governments were about to provide, these countries found themselves in a unique situation, where no matter the response to the crisis, millions would suffer (Kelley et al., 2020).
Additionally, LMICs did not have the capacity to effectively procure equipment, treatments, or vaccines to nearly the same magnitude as high-income nations, thus, suffered under the collapse of the health care systems (Kelley et al., 2020). As such, resource constraints led to extreme burn out among healthcare workers, many of which went on strike to advocate for decent work environments, impeding the response to the public health crisis.
Lastly, many LMICs faced the burden of COVID-19 with a number of other simultaneous endemics, such as malaria, immunizations, HIV, and tuberculosis, and chronic disease management (Kelley et al., 2020). However, COVID-19 threatened much higher economic, social, and health costs; as such, health systems in these regions collapsed under the competing priorities of multiple health threats, and many lost their lives from diseases that likely would have been preventable deaths in the Global North.
05 Disparity in Response
The key disparities in the COVID-19 response between the Global North and the Global South were centered on balancing the trade-offs between the economy and the well-being of populations, limited capacity to procure treatments and vaccines, and the overwhelming of health systems due to competing public health crises (Martinez-Juarez et al., 2020). While this disparity is caused by a number of factors, with the crux of these factors centering on medical nationalism, and how this ideology perpetuates the inequitable access to health, directly impeding progress towards SDG 3. The burden of COVID-19 was disproportionately higher in LMICs, where the health systems are most vulnerable (Nhamo et al., 2020). As such, in a globalized world, medical nationalism poses a serious threat to promoting good health and well-being globally. Universal access to global public goods, such as medical treatments, equipment, and vaccines is not only a basic right, but is necessary in sustainably improving the health of the global population. However, the clear disparity in the COVID-19 responses unveiled a number of systemic political, economic, social, and technological/infrastructural barriers that not only impede LMIC’s capacity to address public health crises, but to advance the global progression towards achieving SDG 3.
06 Political Barriers & Economic Barriers
COVID-19 has demonstrated that there are many gaps in global health governance, highlighting a major political barrier to an adequate response to COVID-19 among LMICs. The current global health governance lacked the sufficient authority or financial resources to push for international cooperation to unify an approach to address the global threat (Javed & Chattu, 2020). COVID-19 has revealed that the general lack of international cooperation is a major systemic barrier in achieving SDG 3, and has been a longstanding barrier in addressing many preventable diseases burdening LMICs. Without high-income nations investing in international development, and the absence of international cooperation in the equitable distribution of global public goods, LMICs are not only unable to sufficiently control the virus, but are unable to sufficiently support good health and well-being across populations in general. The politics of attention and neglect highlights the global asymmetries in resources and power–there is a lack of sustained focus on achieving universal access to healthcare, and the COVID-19 pandemic has unveiled the lack of international cooperation in achieving this goal (Jensen et al., 2021).
Through an economic lens, the Global South has experienced a longstanding disparity in Gross Domestic Product (GDP) with the Global North, a significant driver of the disparity in the COVID-19 response and the overall capacity to procure global health goods and population health. As LMICs faced economic barriers in the procurement of medical treatments, equipment, and vaccines, this echoed a major, unjust determinant of population health in these nations: economic resources (Martínez-Córdoba et al., 2021). Along the same vein, despite the World Health Organization (WHO) proposing an effort to facilitate investment from high-income countries to provide COVID-19 vaccines for LMICs, very capable and powerful nations swiftly rejected the idea, highlighting the intersection of political and economic determinants of health among the world’s most vulnerable populations.
COVID-19’s unveiling of these determinants serve as opportunities for global health governance to prioritize strengthening international buy-in into sustained, unified approaches to global threats, and in achieving the sustainable development goals.
07 Social Barriers
During the COVID-19 pandemic, many individuals in LMICs struggled to attain sufficient access to testing, medical treatments, or protection from COVID-19 because of various social determinants, such as poverty, lack of decent work and/or living environments, and lack of education/health literacy. Furthermore, epidemiological data suggested that, even in high-income countries, socially disadvantaged groups were most likely to be diagnosed with and die from COVID-19, highlighting a dire need to challenge these prominent social determinants of health.
The glaring disparity in the experiences of privileged individuals and socially disadvantaged groups during the COVID-19 pandemic suggests there are multiple opportunities for promoting good health and well-being across all populations. Firstly, there is a greater need for health system strengthening in both high-income countries and LMICs; secondly, it is critical to challenge unjust institutional practices in health care; and lastly, investing in upstream approaches to mitigate the long-term health effects of the aforementioned social factors.
08 Technological Barriers
As mentioned, countries of low resource contexts faced financial constraints, and the COVID-19 pandemic was an added pressure to the already-exhausted health systems. Many LMICs struggled without sufficient healthcare infrastructure and human resourcing capacity to effectively combat COVID-19, as well as technological resources to support the demands of high patient flow, equipment, spacing, testing capacity, and vaccination coverage. This was particularly difficult in low-income nations that were simultaneously facing a number of other epidemics, which led to many dying from diseases unrelated to COVID-19 (Sharma et al., 2021).
As such, there is a clear need for future global investment in health infrastructure and human capital to better support the health demands of the population, and rapid adaptation to public health crises (Jensen et al., 2021). Furthermore, investing in domestic health technologies and infrastructure within LMICs would minimize the reliance on high-income nations for resources such as medical equipment, and storage and transport technologies for various treatments and vaccines.
09 Conclusion
Overall, the disparity in the COVID-19 pandemic responses between the Global North and the Global South spotlighted the unjust systemic inequalities and determinants of health experienced by LMICs. Though the impacts are devastating, these revelations have provided many opportunities to advance global health as a whole. As described, there is a clear need to increase international cooperation in order to support all nations in advancing towards good health and well-being for all, increased investment in challenging global upstream social determinants of health, and investing in health infrastructure and human capital to support global health systems and mitigate for the risk of collapse as a result of public health crises. Aligned with SDG 3, leveraging these opportunities are critical in Promoting Good Health and Well-Being Globally, and in making the world a more equitable and healthier place for all (Martinez-Juarez et al., 2020).
Elizabeth Mebrahtu recently completed her Master's in Global Health Systems at Western University, and currently works as a Global Health Policy and Systems researcher at the Global Strategy Lab. With experience researching health systems both in high-income and low-income contexts, Elizabeth's professional interests exist at the intersection of international relations, global governance and law, health equity, and health policy.
References:
Gostin, L. O., Moon, S., & Meier, B. M. (2020). Reimagining global health governance in the age of COVID-19. American Journal of Public Health, 110(11), 1615-1619.
Javed, S., & Chattu, V. K. (2020). Strengthening the COVID-19 pandemic response, global leadership, and international cooperation through global health diplomacy. Health promotion perspectives, 10(4), 300–305. https://doi.org/10.34172/hpp.2020.48
Jensen, N., Kelly, A. H., & Avendano, M. (2021). The COVID-19 pandemic underscores the need for an equity-focused global health agenda. Humanities and Social Sciences Communications, 8(1), 1-6.
Kelley, M., Ferrand, R. A., Muraya, K., Chigudu, S., Molyneux, S., Pai, M., & Barasa, E. (2020). An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries. The Lancet Global Health, 8(7), e888-e889.
Martinez-Juarez, L. A., Sedas, A. C., Orcutt, M., & Bhopal, R. (2020). Governments and international institutions should urgently attend to the unjust disparities that COVID-19 is exposing and causing. EClinicalMedicine, 23, 100376. https://doi.org/10.1016/j.eclinm.2020.100376
Martínez-Córdoba, P. J., Benito, B., & García-Sánchez, I. M. (2021). Efficiency in the governance of the Covid-19 pandemic: political and territorial factors. Globalization and Health, 17(1), 1-13.
Nhamo, G., Chikodzi, D., Kunene, H. P., & Mashula, N. (2021). COVID-19 vaccines and treatments nationalism: Challenges for low-income countries and the attainment of the SDGs. Global public health, 16(3), 319–339. https://doi.org/10.1080/17441692.2020.1860249
Sharma, A., Borah, S. B., & Moses, A. C. (2021). Responses to COVID-19: The role of governance, healthcare infrastructure, and learning from past pandemics. Journal of business research, 122, 597-607.