Why the Developing World Cannot Flatten the Curve with Coronavirus (COVID-19) and Beyond

The “developing world” is often left behind in the medical treatment of epidemics and other diseases, whether these are HIV-AIDS, Cholera, Black Fever, or Tuberculosis, and so on. These are the countries, what President Trump once called “sh**hole” countries, those in the southern hemisphere, below the Equator. To this day, they are still exploited by the first world for their natural resources and for their cheap labor through beneficial trade agreements with the first world, namely with the United States, Canada, Europe, Japan, Australia, and New Zealand. As medical anthropologist and physician Paul Farmer stated: “The idea that some lives matter less is the root of all that is wrong with the world.”

In other words, when we speak of epidemics, and even pandemics like the Coronavirus (COVID-19), we must understand that medical care is unequal in our world today. We must understand that “power structures” control who gets medical care and who does not. We must understand that so-called “first world nations” will be treated for the Coronavirus and in all likelihood the “developing world” will be left behind.

All you have to do is travel to Haiti, or rural India, or Uganda, or a favela in Brazil, or a Palestinian refugee camp in Lebanon, and there you will encounter why such inequalities are all too evident. It does not have to be this way. However, what we know is that in our post-colonial world, the same sorts of inequities from the colonial world have remained, and most probably will continue to remain for the foreseeable future.

In his well-regarded book, Pathologies of Power: Health, Human Rights, and the New War on the Poor (2003, p. 6), Paul Farmer argues: “…The most basic right—the right to survive—is trampled in an age of great affluence, and…that the matter should be considered the most pressing one of our times. The drama, the tragedy, of the destitute sick concerns not only physicians and scholars who work among the poor but all who profess even a passing interest in human rights. It’s not much of a stretch to argue that anyone who wishes to be considered humane has ample cause to consider what it means to be sick and poor in the era of globalization and scientific advancement.”

We live in an age of extreme inequity. In the United States alone to reach the income of the top 1% would mean earnings of at least $500,000. When measuring varying regions and countries’ Gini coefficient of income, that is, the measure of income inequality, Latin America and Africa have the highest income inequalities. For example, Latin America and the Caribbean have a Gini of 48.82%, whereas Africa has a Gini of 44.26%, in comparison to the U.S. and Canada with a Gini of 37.07%. The top five countries with the highest Gini coefficients are: “1) Lesotho (0.632); 2) South Africa (0.625); 3) Haiti (0.605); 4) Botswana (0.605); and 5) Namibia (0.597).”

Given this, why are first world nations not responding more to the needs of developing nations and to lessen these disparities? The simple answer is that it is not in the interest of the first world to do so. Allowing for international mining concessions, international oil exploration, and labor exploitation, and many other private corporate interests, has become the norm for multinational corporations. Such economic leverage over developing countries and corporate power over leaders of such so-called third-world nations, provide needed cash flows to these emerging nations. Thereby, such relationships of power, similar to the colonial past, have continued unequal forms of dominance and control.

Hence, when we speak of this “new” pandemic, the health care structures in the developing world simply do not exist for dealing with the Coronavirus (COVID-19). Who will be building new hospitals in rural India, or Gambia, or Zimbabwe, or Haiti? Who will donate respiratory machines for those who succumb to the Coronavirus? Who will be providing test-kits to the most vulnerable in the developing world, and most importantly, who will care?

In 2018 statistics, East and Southern Africa is the region most affected by HIV-AIDS in the world and home to those with the largest population living with HIV-AIDS. This total, equals some 20.6 million people, and in the same year, 800,000 new people contracted the disease. While those dying of AIDS decreased by 40%, the World Health Organization (WHO), stated it was not near where it needed to be to decrease infection and mortality rates as a whole.

Another horrendous disease, is Leishmaniasis, which mostly affects impoverished populations, such as those in the Sudan. The disease in the Sudan is known as “Kala-Azar” or “Black Fever”. In one form of the disease, “Visceral Leishmaniasis”, if left untreated is fatal in 95% of the cases. Symptoms of this illness are high fever, weight loss, enlargement of the spleen and the liver, and anemia. Aside from Sudan (and South Sudan), it occurs in Brazil, elsewhere in East Africa, and India. The parasite is transmitted by a sand fly. And again, treatment for the disease is not equal for those living in Africa, compared to health care in the first world.

Hence, when we hear about “Flattening the Curve” from a popular New York Times article, and how washing hands, and social distancing, and self-isolating, will mitigate the Coronavirus (COVID-19), and thereby limit deaths from the disease as well as lessening contagion, does “not” in my view apply to the “developing world” whatsoever. How will third world epidemiological curves flatten if they cannot and do not receive equitable health care as we have in the first world? What countries will step forward to mitigate the spread of the Coronavirus to the developing world—to Africa, Asia, and South America?

What I am talking about here is “structural violence”, that is those structures which keep in place the inequalities which exist in our world today. Such inequalities are power structures by keeping the developing world, impoverished, and by disallowing equal access to health care, which as Paul Farmer maintains, should be a given right for everyone.

In another well-received book by Paul Farmer (1999, p. 5), Infections and Inequalities: the Modern Plagues, he asserts: “…Disease emergence is a socially produced phenomenon, few have examined the contribution of specific social inequalities. Yet such inequalities have powerfully sculpted not only the distribution of infectious diseases but also the course of health outcomes among the afflicted.”

Will the first world even care about “flattening the curve” for the developing world? And when will the news media ever discuss the morbidity rates of the Global South in regard to Coronavirus (COVID-19), instead of solely focusing on how we in the First World are self-isolating, and self-sacrificing?

J. P. Linstroth is a former Fulbright Scholar to Brazil. His recent book, Epochal Reckonings (2020), is the 2019 Winner of the Proverse Prize. He has a PhD (D.Phil.) from the University of Oxford. He is the author of Marching Against Gender Practice: Political Imaginings in the Basqueland (2015) and, most recently, author of Politics and Racism Beyond Nations: A Multidisciplinary Approach to Crises (2022).