Pandemics are highly inequitable. They impose a disproportionate burden on those at the lower end of the income distribution. In the case of COVID-19, control efforts through social distancing and population lockdowns have brought additional deprivations on vulnerable populations. In low- and middle- income countries (LMIC) and elsewhere, the slowdown in economic activity has resulted in rapidly rising unemployment, particularly in the informal sector, where the majority of workers are employed and without adequate social safety nets. The effects of COVID-19 and population lockdowns will have short and long-term effects on health, human capital and income of vulnerable populations. To mitigate the deprivation due to COVID-19, government safety net programs must provide long-term support focused on vulnerable populations.
The 1918 Spanish flu left around 500 million people infected and at least 50 to 100 million deaths worldwide. Poor countries bore the brunt of the pandemic. Between 1918 and 1920, India lost an estimated 18 million lives or 6% of the population, the highest anywhere. In contrast, the United States experienced only 675,000 deaths. Similarly, inequities in access to vaccines imply that the poorest countries are likely to see a prolonged outbreak of the disease, compounding these issues further. Deaths and illness due to COVID-19 are both an emotional and economic shock. Deaths, particularly of earning family members, represent a financial loss to vulnerable households, which can take a long time to recover from. Those unable to work due to contracting COVID-19 may experience income losses – particularly challenging for daily-wage earners and poor households. Such productivity losses have been reported to be as large as half the income of the poorest households. Inequities in COVID-19 morbidity and mortality are yet unknown in LMICs; however, social conditions in these contexts are much more conducive to epidemic spread, and will likely disproportionately affect economically vulnerable households.
Studies report that exposure to tropical diseases and poor nutrition in-utero or during early childhood have lasting effects on future cognition, educational achievement, and adult income. A study on the Spanish flu in the United States reported that individuals who were in-utero during the pandemic, as adults displayed reduced educational attainment, increased rates of physical disability, lower income, and greater dependence on social security payments, compared with birth cohorts just before and after the pandemic. For example, this same study reported that children born to infected mothers were 15% less likely to graduate from high school; their annual wages were 5–9% lower compared to birth cohorts not affected by the flu.
Irrespective of the extent to which contracting COVID-19 inflicts financial hardship on vulnerable households, it is certain that COVID-19 control measures such as social distancing and population lockdowns will profoundly affect economic well-being and health as well. The collapse of economic activity has affected employment and livelihoods on a massive scale, particularly in LMICs; the International Labor Organization estimates that around 114 million jobs were lost in 2020 compared to 2019 levels. The workforce in LMICs is largely in the informal sector with limited access to paid or sick leave, or social safety nets. In India, thousands of migrant workers fled cities as the lockdown led to a loss of income; in Bangladesh, 1 million garment workers lost their jobs. For poor households, the loss of livelihood may result in greater emotional stress, lower food, and health care consumption. The closing of schools has deprived many children of their only nutritious meal through school-feeding programs. The health effects on pregnant women and children are particularly important because of their long-term effects.
Governments in LMICs have announced a range of social protection measures aimed at vulnerable households. These interventions have relied on existing safety nets and typically include – providing free or subsidized food, direct cash transfers, extending unemployment insurance for those in the formal sector, providing micro-financing loans or restructuring existing loans. The effectiveness of these safety nets will depend on the adequacy of the relief package, how well they reach the poorest groups and efficiencies in the delivery system. It is important to note that these measures are one-off and intended only for a short period of time. However, the economic and health deprivation caused by COVID-19 will have long-term effects. It will require extending relief measures for a longer duration and expanding the benefit package. To prevent human capital deprivation in the future, relief measures will need to target specific populations like pregnant women and young children. Protecting vulnerable households from the short and long-term consequences of COVID-19 will be expensive and require sustained political commitment.
Pandemics affect the economic well-being of survivors long after they are over. The COVID-19 outbreak will affect economically vulnerable populations in LMICs in multiple ways in the short and long-term. Governments need to take a long-term view of mitigating the many economic and human capital effects of COVID-19 and its control measures.
About the author: Dr. Krishna D. Rao is an Associate Professor in the Department of International Health, Johns Hopkins Bloomberg School of Public Health. Krishna D. Rao’s research work broadly focuses on health systems and primary health care in low and middle-income countries. His work has largely been on three areas – human resources, health services, and health financing. He is interested in finding ways to improve access to health services in resource poor areas and in the application of research methods drawn from the social sciences and economics to seek solutions to these issues. Previously, Dr. Rao has worked in Afghanistan, India, and Latin America. He also serves as an Assistant Editor of the International Journal for Equity in Health
Conflict of interest: None
Handling Editor: Neha Faruqui