Inequality and Austerity: Our Weak Links in Countering COVID-19

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How inequality hurts us all in the pandemic response

Ambulance that responds to COVID-19 suspected cases and places them in isolation hospitals and quarantine in Durban, KwaZulu Natal, South Africa. Photo credit: Khethukuthula Mbonambi via Wikimedia Commons.

There are weeks where decades happen. These are those weeks.

COVID-19 has shaken the whole world. Established orthodoxies have disappeared overnight. Weeks ago, who would have thought that staying away from aging parents would convey kindness? That governments would release prisoners with the intention of keeping us safe? That the United States, once the world’s hegemon, would run out of face masks? That the Financial Times would call for wealth redistribution? That a new vaccine would be needed for us to safely leave home, attend school, work, and live freely? Our ways of living have changed overnight, and the rules of our societies and economies are being rewritten.

As the weeks pass and new waves of infections loom, there is no easy route out of this. COVID-19 is the ultimate wicked problem—a term coined by California-based academics Horst Rittel and Melvin Webber in 1973 to describe a problem which defies description and is apparently insurmountable. COVID-19 is complex and global, sparking almost unprecedented disruption.

We are deeply aware of our vulnerability. We stay home, stay physically distanced from each other, and yet, thanks to the internet and social media, the global scale of events is omnipresent. This virus does not respect borders and has crippled global supply chains. Everyone is at its mercy. The myth of mastery of our individual fates gives way to the realization that we live in a world even more interconnected than we had ever imagined.

The pandemic has laid bare that each of us is only as safe as the poorest among us. This has always been true in some way, but now we can see it clearly and unambiguously. While the wealthiest can always take steps to shield themselves, the spread of a deadly virus shows that extreme poverty and inequality is ultimately a threat to all.

The spread of the pandemic has tested even the strongest public health systems in wealthy countries to their limits. The stress put on such systems has dominated headlines in the west, but this focus overlooks that gross inequality has left many developing countries massively under-resourced to address COVID-19 and protect the most vulnerable from its effects. And in such a crisis, the most ill-prepared and underfunded healthcare system globally is our weakest link: if COVID-19 persists anywhere, nobody is safe.

With the unthinkable happening around us, we are thrust into a rare moment where we all have a direct stake in creating a more equitable world. The framework of national interest now seems grossly inadequate. Nothing less than a vision encompassing all of humanity will meet the challenge of this moment.

Times of crisis often lead to transformational change—for better or for worse. Looking at how past policy choices have made COVID-19 a wicked problem can help us envision more equal, sustainable, and resilient societies. Solidarity forged now could catalyze systemic change for the better.

 

COVID-19: The Ultimate Wicked Problem

COVID-19 necessitates urgent collective action. But like all wicked problems, the pandemic raises major dilemmas for governments. In most countries, testing is limited, giving us a partial understanding of COVID-19’s overall prevalence. Because it is a new virus, assumptions behind the scientific models continue to shift as new information emerges. A vaccine offers the only definitive solution. Testing, isolating, and tracing contacts require significant resources—and potentially uncomfortable encroachment on individual autonomy and privacy—while lockdowns can have major socio-economic consequences. Response options are limited by past policy and budget decisions.

The pandemic raises big questions about our human rights too. Worldwide, governments have moved to protect the right to health by putting exceptional restrictions on a range of rights, including the right to movement, association, public assembly, work, and family life through quarantines, travel bans, and school and work closures. International law outlines state obligations, but balancing different rights to ensure restrictions are both necessary and proportionate will vary by context. Analyzing these trade-offs requires interdisciplinary approaches steeped in public health, ethics, human rights law, and economic policy.

These policy responses make it imperative that citizens be vigilant to ensure that their governments do not use the crisis as an excuse and a means to consolidate power. Surveillance technology can help governments track COVID-19’s spread, and several countries have already or may soon develop new tools to this end—even going as far as asking tech companies to loosen privacy protections. Yet as this crisis deepens, considerations of individual privacy are becoming an afterthought. Although human rights standards require that technologies are used in a way that is time-bound and proportionate, they will surely remain with us long after their original purpose has passed, as political leaders rarely like to surrender newly acquired powers. We are at real risk of giving up even the illusion of privacy, a right already denied in many countries, such as China, where internet access is controlled by an authoritarian state.

 

Our Resilience is Limited by Inequality

 This pandemic places all of us at risk regardless of privilege. But though swept along by the same current, we are in very different boats.

Singapore offers a cautionary tale. The city-state was initially praised for its successful control of the pandemic but saw a surge in cases among migrant workers from South Asia living in densely packed accommodations. Suddenly, the statistics did not look so good.

As with most public health issues, poor people are vastly more exposed to this virus than the wealthy. For example, regular hand washing can help prevent transmission, but in informal settlements many simply cannot afford this. In a city such as Nairobi, Kenya’s capital, only 50 percent of people have piped water. Those without it pay ten to twenty-five times more for water, up to a third of their income. Physical distancing can also reduce COVID-19’s spread and the strain on healthcare systems. But this is impossible in situations where large, most often poor, families live in crowded conditions. Staying home hits the poorest hardest, widening inequality. Informal workers, people on zero hours contracts (under which employers are not required to provide minimum hours), or those who are laid off, lose hours or cannot work because of public transport bans, lockdowns, or curfews are rarely compensated for lost income.

Unless governments mitigate the economic impact on the most marginalized, there is a real likelihood of increasing social unrest among desperate people. People who feel they must fight for their families’ survival may take to the streets, which in turn creates new infection risks.

COVID-19 epitomizes human insecurity. The impact of inequality on poor people’s rights is now visible to those shielded by social segregation. Countries with less poverty, a stronger welfare state, and more resources to mitigate the virus’s economic impact simply have far more options. Several wealthier countries, including the U.K., have launched huge economic stimulus programs to protect jobs and businesses—although millions of the most marginalized are still missing out.

But national-level resilience will only go so far in meeting global challenges. We can only be resilient and stable in the face of our era’s wicked problems if we rebuild all our societies and economies in more equal and sustainable ways.

 

Our Survival Is Compromised by Lack of Healthcare Investment

Countries with a severe shortage of intensive care beds can barely manage any COVID-19 curve and must control the virus or risk mass deaths. Many African countries, drawing on their extensive experience managing infectious diseases, have taken proactive measures to prevent COVID-19’s spread. But if prevention fails, countries with fragile healthcare systems will suffer disproportionately. South Sudan, for example, has four ventilators for around 11 million people. In some developing countries, senior government officials have until now routinely traveled abroad for medical treatment, insulating them from dire public facilities. With borders and airports closed and healthcare systems overseas stretched to the limit, that is no longer possible. If the virus escalates, there will probably not be enough resources even for senior officials and their families.

Inequality between countries impacts developing countries’ ability to deliver the right to health. As Ethiopia’s Prime Minister Abiy Ahmed wrote in the Financial Times, for many African countries, debt repayments are often greater than their annual health budgets. This is not the only factor. Many developing states suffer from a range of structural problems, including a large informal sector and limited tax base, prioritization of other spending, including defense, and theft of state resources, which impede their adequate investment in accessible and affordable healthcare. In this pandemic, healthcare in one country directly impacts health in another.

Governments must awaken to the idea that health is wealth. They must invest more resources into public health and ensure equal access to medical care for people everywhere, underwriting stable, inclusive societies and robust economies. This requires addressing structural inequity between countries, so that developing countries can service their publics, not their debts.

 

Solidarity Will Save Us

Faced with this pandemic, nothing less than a humanity-wide vision is sufficient.

Though physically apart, we are more connected than ever before, our fates inextricably linked. “Social distancing” is being reimagined as “spacious solidarity,” a generous gesture to protect others. As the virus grows exponentially, mutual aid has snowballed too. People are supporting each other in different ways to ease loneliness. Though borne out of catastrophe, such solidarity inspires hope, showing what we can do when we come together.

As the world seemingly spins out of control, people are reimagining societies and economies. Empathy and connections fostered during this crisis can be a catalyst for change. Indeed, change is already happening, from Spain announcing plans for a universal basic income scheme to Amsterdam embracing Doughnut Economics—a vision of holistic, citizen-led environmentally friendly city planning. Time will tell how successful these changes prove to be, but we must call on political leaders to bring people on the margins to the center of their responses. We must repudiate the hollowness of leaders floundering with empty gestures in the face of this wicked problem, and those who see our suffering as a chance to extend their personal power.

To lift us from this crisis, solidarity must extend beyond borders. Empty nationalist rhetoric offers nothing—no country can save itself in isolation. We need to support the weakest healthcare systems in the world. We need to pool resources to maximize our chances of developing a vaccine, and to ensure that pharmaceutical companies pledge not to exploit the crisis through valuable patents, so it can be made available to all at no cost.

Above all, this is a time to recognize that in a world of gross inequality, nobody is safe. The pandemic should be a wake-up call for us all. The illusion of security in splendid isolation is just that: an illusion. While there will be no return to yesterday’s “normality,” habits of the past will return to us like muscle memory after a time of convalescence. Now is the time to be specific and propositional about the changes we need to see. That means putting away self-interested short-termism and starting to think about the good of humanity as a whole.

COVID-19 leaves us grieving. But out of that grief we can choose to make something different. The greatest gift we could give ourselves is to build a more equal world, future-proofed against the wicked problems of tomorrow.


—Sarah Jackson and David Griffiths

David Griffiths is Director of the Office of the Secretary General and Sarah Jackson is Deputy Regional Director for East Africa, the Horn and the Great Lakes at Amnesty International and a Carnegie New Leader.

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