It is very understandable that, in the heart of a pandemic, people’s first concern is for their family and friends. And one of the really heart-warming things about the British response is the way in which the public has embraced the NHS “family” in all its diversity.
Abroad, by contrast, is somewhere to escape from; to look to for illustrations of the horrors to come (Italy); to search for examples of good practice to follow (Germany and South Korea); and to seek reassurance from, that there are countries even less prepared than us (the US). The coronavirus outbreak, more than any other crisis in my lifetime, has brought two contrasting emotions to the surface: a feeling that we are “all in it together, everywhere” – a sense of shared humanity – alongside the protective need to “look after our own”.
Centuries ago, a moral philosopher posed the question: how do we weigh the relative claims on our concerns about an infected little finger in a friend or relative against millions dying in a catastrophe on the other side of the world? His point was that the finger wins, overwhelmingly.
We have, more recently, become sensitised through TV and travel to needs elsewhere. This has manifested itself in generosity channelled through development charities and, by comparative standards, a very creditable official overseas aid budget. But the relative weight (and funding) given to domestic concerns will be clear to see as coronavirus spreads in developing countries.
So far the virus has mainly hit the west, and the once poor but now well-organised and prosperous countries of east Asia. Japan and Singapore are now richer than the UK; Korea is close behind, and China is catching up fast. Yet the impact on the world’s poorest countries and peoples in Africa and south Asia, and on others in Latin America and the Middle East, will be even more devastating.
They are highly vulnerable to the spread of infection. High densities in urban settlements and refugee camps preclude social distancing, and the absence of clean running water makes hand-washing routines meaningless. Health services are already overwhelmed by poverty-related illness, mainly bacteriological, and are skeletal in rural areas. The supply of doctors is depleted, since talented people leave. There are also large groups with weakened immune systems, such as the 10 per cent of the population living with HIV across the nine countries of southern Africa. The chance of public hospitals in poor countries providing properly equipped ICU facilities to cope with the expected flood of critically ill patients is close to zero.
There are some mitigating factors. There are relatively few frail elderly and, though there have been tragic exceptions, we are told that children are largely immune. Some countries faced with even more deadly epidemics such as Ebola have – with help – been impressively resilient. Outbreaks of Cholera and Typhoid are usually contained. Humorists in Africa point to the benefit of having leaders who will no longer be able to fly to Europe or the US for health treatment, so may get first hand experience of squalid hospitals back home.
The poorest countries will need to consider whether a cut-and-paste response based on Europe, the US and China makes sense where they are. The idea that the economy should be shut down for a while to ease pressure on the health services may be a bad trade-off where the economy is already very fragile and health services already overwhelmed by more lethal diseases. Donald Trump’s warning, that the cure may be worse than the disease, may be self-serving nonsense in his own country, but could actually be sensible advice elsewhere.
While many building sites continue working in London, there are scenes from India of millions of migrant construction workers – and others who have no formal employment – left destitute in the absence of a system of welfare payments. As they flee to the villages, they spread the disease. Lagos and Kinshasa will be far worse.
In any event the rural economy can’t be quarantined. It depends on fixed climatic cycles and has to keep going to avert hunger. For some poor countries, paradoxically, it may make more sense to apply the permissive Swedish model, keeping their economies going where possible. So far, however, none have challenged the orthodoxy.
Even on the more optimistic scenarios there will be massive loss of life, dwarfing that of the rich world. We should care both for humanitarian and self-interested reasons. Unless and until the virus is controlled, through near-universal immunity, it could well bounce back. Travel will eventually be restored, even if only partially, with reinfection emerging. We could also be faced with floods of desperate refugees heading for the Mediterranean on a scale which dwarfs 2016.
We should remember too that the extreme financial hardship in poor countries coming down the track will have its origin in unilateral order cancellations from wealthier countries. Hundreds of thousands of horticultural workers in east Africa; similar numbers in the Bangladesh garment industry; millions in tourism in many countries will be jobless and incomeless without a furlough scheme or universal credit to fall back on.
There are five critical points of action the developed world needs to take to support developing countries and their populations:
1. The IMF has raised its game but there is an urgent need for international agreement from its main shareholders to free up more and suspend conditions. With the collapse of exports, remittances drying up; investors taking flight; falling currencies and defaults looming on dollar debt, 80 countries are already looking for emergency financing.
2. Britain has been one of the biggest and best aid donors for the last two decades. The aid programme is needed more than ever because the charitable sector is crippled, so the budget needs boosting temporarily beyond 0.7 per cent of GDP as GDP itself shrinks.
3. Governments should recognise that it is better to channel emergency aid to support public health programmes through multilateral bodies like the World Bank working with the World Health Organisation. A Trump appointee heads the bank, which may help.
4. With many countries now caught in a debt trap with official and commercial debt, full relief is needed now. There is no time to negotiate “rescheduling” of burdens which were unsustainable in the first place
5.If the post-war gains in growth and poverty reduction through trade are not to be reversed, a rescue effort must be mounted to save the trading system from its looming reversion to 1930s trade warfare and protectionism.
Action starts with an acknowledgement that there is no salvation in one country. Shared problems require shared solutions, not the beggar my neighbour uncoordinated chaos we have seen so far between nations and within them.
The sooner the western world gets on top of the virus through the belated and painful, but necessary, measures we are experiencing, the easier it will be to focus attention on those most in need, but currently at the bottom of the political pile.
Sir Vince Cable is a former leader of the Liberal Democrats