What Developing Countries Can Teach Rich Countries About How to Respond to a Pandemic

Jerri-Lynn here. Back in the 1980s when I had a research fellowship in Switzerland, I remember a conversation with another scholar from Trinidad and Tobago about how her country pursed better infection control protocols than did the Swiss. Trinidad and Tobago had no choice, as their generally hotter climate was a breeding ground for infection, and health care officials were anxious to prevent their spread, as prevention was far cheaper than cure. I recalled that conversation when I saw the following post highlighting the relative success of developing countries in managing the pandemic, as compared to rich countries, including the U.S.and much of Europe, which have instead seen failure as they enter their second wave.

(I am aware that Trinidad & Tobago has the third highest GDP per capita in the Americas, behind only to the U.S. and Canada, but I don’t think that country’s relative wealth is to the point here, as the post discusses  how countries with drastically less have been able to do more.)

By Maru Mormina, Senior Researcher and Global Development Ethics Advisor, University of Oxford, University of Oxford, and Ifeanyi M Nsofor, Senior Atlantic Fellow in Health Equity, George Washington University. Originally published at The Conversation.

Nine months into the pandemic, Europe remains one of the regions worst affected by COVID-19. Ten of the 20 countries with the highest death count per million people are European. The other ten are in the Americas. This includes the US, which has the highest number of confirmed cases and deaths in the world.

Most of Africa and Asia, on the contrary, still seems spared. Of the countries with reported COVID-related deaths, the ten with the lowest death count per million are in these parts of the world. But while mistakes and misjudgements have fuelled sustained criticism of the UK’s handling of the pandemic, the success of much of the developing world remains unsung.

Of course, a number of factors may explain lower levels of disease in the developing world: different approaches to recording deaths, Africa’s young demographic profile, greater use of outdoor spaces, or possibly even high levels of potentially protective antibodies gained from other infections.

But statistical uncertainty and favourable biology are not the full story. Some developing countries have clearly fared better by responding earlier and more forcefully against COVID-19. Many have the legacy of Sars, Mers and Ebola in their institutional memory. As industrialised countries have struggled, much of the developing world has quietly shown remarkable levels of preparedness and creativity during the pandemic. Yet the developed world is paying little attention.

When looking at successful strategies, it’s the experiences of other developed nations – like Germany and New Zealand – that are predominantly cited by journalists and politicians. There is an apparent unwillingness to learn from developing countries – a blind spot that fails to recognise that “their” local knowledge can be just as relevant to “our” developed world problems.

With infectious outbreaks likely to become more commonaround the world, this needs to change. There is much to learn from developing countries in terms of leadership, preparedness and innovation. The question is: what’s stopping industrialised nations from heeding the developing world’s lessons?

Good Leadership Goes a Long Way

When it comes to managing infectious diseases, African countries show that experience is the best teacher. The World Health Organization’s weekly bulletin on outbreaks and other emergencies showed that at the end of September, countries in sub-Saharan Africa were dealing with 116 ongoing infectious disease events, 104 outbreaks and 12 humanitarian emergencies.

For African nations, COVID-19 is not a singular problem. It’s being managed alongside Lassa fever, yellow fever, cholera, measles and many others. This expertise makes these countries more alert and willing to deploy scarce resources to stop outbreaks before they become widespread. Their mantra might best be summarised as: act decisively, act together and act now. When resources are limited, containment and prevention are the best strategies.

This is evident in how African countries have responded to COVID-19, from quickly closing borders to showing strong political will to combat the virus. While Britain dithered and allowed itself to sleepwalk into the pandemic, Mauritius (the tenth most densely populated nation in the world) began screening airport arrivals and quarantining visitors from high-risk countries. This was two months before its first case was even detected.

And within ten days of Nigeria’s first case being announced on February 28, President Muhammadu Buhari had set up a taskforce to lead the country’s containment response and keep both him and the country up to date on the disease. Compare this with the UK, whose first case was on January 31. Its COVID-19 action plan wasn’t unveiled until early March. In the intervening period, the prime minister, Boris Johnson, is said to have missed five emergency meetings about the virus.

African leaders have also shown a strong desire to work together on fighting the virus – a legacy of the 2013-2016 West African Ebola outbreak. This epidemic underlined that infectious diseases don’t respect borders, and led to the African Union setting up the Africa Centres for Disease Control and Prevention (CDC).

In April, the Africa CDC launched its Partnership to Accelerate COVID-19 Testing (PACT), which is working to increase testing capacity and train and deploy health workers across the continent. It’s already provided laboratory equipment and testing reagents to Nigeria, and has deployed public health workers from the African Health Volunteers Corps across the continent to fight the pandemic, applying knowledge picked up when fighting Ebola.

The Africa Union has also established a continent-wide platform for procuring laboratory and medical supplies: the Africa Medical Supplies Platform (AMSP). It lets member states buy certified medical equipment – such as diagnostic kits and personal protective equipment – with increased cost effectiveness, through bulk purchasing and improved logistics. This also increases transparency and equity between members, lowering competition for crucial supplies. Compare this with the underhand tactics used by some developed nations when competing for shipments of medical equipment.

The AMSP isn’t unique. The European Union has a similar platform – the Joint Procurement Agreement. However, a bumpy start together with slow and overly bureaucratic processes led some countries to set up parallel alliances in an attempt to secure access to future vaccines. The AMSP avoided sharing this fate thanks to the African Union handing over its development to the private sector under the leadership of the Zimbabwean billionaire Strive Masiyiwa. He pulled together the expertise needed to quickly develop a well-functioning platform, drawing on his contacts and businesses across the digital and telecoms sectors.

This contributed to the AMSP’s popularity with vendors and created high demand from member states. There are now plans to expand access to hospitals and local authorities approved by member states, and for additional support to be included from donors (such as the Bill and Melinda Gates Foundation and MasterCard Foundation). Again, a decisive decision, focusing on installing strong leadership, has paid dividends.

Strong leadership on COVID-19 hasn’t been limited to African countries. The Vietnamese government has been widely praised for its clear and engaging public health campaign. This has been credited with bringing the country together and getting a wide amount of buy-in on efforts to control the virus.

Vietnam has also shown that good leadership involves acting on the lessons from the past. The 2003 Sars outbreak led to strong investment in health infrastructure, with an average annual increase of 9% in public health expenditure between 2000 and 2016. This gave Vietnam a head start during the early phases of the pandemic.

Vietnam’s experience with Sars also contributed to the design of effective containment strategies, which included quarantine measures based on exposure risk rather than symptoms. Badly affected countries such as the UK, which received warnings that its pandemic preparedness wasn’t up to scratch years ago, should sit up and take note. Vietnam has one of the lowest COVID-19 death tolls.

Finally, let’s look at Uruguay. The country has the highest percentage of over-65s in South America, a largely urban population (only 5% of Uruguayans do not live in cities) and a hard-to-police land border with Brazil, so it should be a likely infection hotspot. Yet it has managed to curb the outbreak without enforcing lockdown.

Early aggressive testing strategies and having the humility to ask the WHO for information on best practices were among the ingredients of its successful response. Along with Costa Rica, Uruguay also introduced a temporary reduction in salaries for its highest paid government officials to help fund the pandemic response. The measure was passed unanimously in parliament and contributed to high levels of social cohesion.

Of course, strong leadership isn’t limited to the Global South (Germany and New Zealand get top marks), nor do all southern countries have effective leadership (think of Brazil). But the examples above show that good leadership – acting now, acting decisively and acting together – can go a long way to compensating for countries’ relative lack of resources.

Doing More with Less

Necessity is said to be the mother of all invention – where money is in short supply, ingenuity abounds. This has been just as true during COVID-19 as at any other time, and is another lesson the developed world would do well to consider.

Early on in the pandemic, Senegal started developing a ten-minute COVID-19 test that costs less US$1 to administer and doesn’t need sophisticated laboratory equipment. Likewise, scientists in Rwanda developed a clever algorithm that allowed them to test lots of samples simultaneously by pooling them together. This reduced costs and turnaround times, ultimately leading to more people being tested and building a better picture of the disease in the country.

In Latin America, governments have embraced technology to monitor COVID-19 cases and send public health information. Colombia has developed the CoronApp, which allows citizens to receive daily government messages and see how the virus is spreading in the country without using up data. Chile has created a low-cost, unpatented coronavirus test, allowing other low-resource countries to benefit from the technology.

Examples of entrepreneurship and innovation in the Global South aren’t restricted to the biomedical field. In Ghana, a former pilot whose company specialises in spraying crops repurposed his drones and had them disinfect open-air markets and other public spaces. This quickly and cheaply got a job done that would normally have taken several hours and half a dozen people to do. And in Zimbabwe, online grocery start-ups are offering new opportunities for food sellers to retain customers wary of shopping in person.

While these are handpicked examples, they illustrate the importance of the capacity to innovate in conditions of scarcity – what is known as “frugal innovation”. They prove that simple, inexpensive or improvised solutions can solve complicated problems, and that frugal solutions don’t have to involve “chewing gum and baling wire” types of fixes.

The ability to deal with complex problems under resource constraints is a strength that can be useful for all, particularly given the pandemic’s eye-watering impact on high-income economies. Solutions coming out of developing countries may offer far better value for money than the elaborate and expensive “moonshot” solutions being mooted in countries like the UK.

Why Not Follow These Examples?

This pandemic is another wake-up call. Since Ebola and Zika, governments around the world have known that they need to up the “global preparedness” agenda. It’s often said that when it comes to pandemics, the world is as weak as its weakest point.

Global action, however, requires moving beyond national interests to identify with the needs of others. We call this “global solidarity”. Unlike relationships of solidarity within nation states – which are based on a shared language, history, ethnicity and so on – global relationships need to recognise the interdependence of diverse actors. Global solidarity is so difficult to achieve because it must accommodate difference rather than rely on commonality.

The pandemic has shown why we need global solidarity. Globalisation has made countries interdependent, not just economically but also biologically. And yet in recent months, isolationist stances have prevailed. From the USA pulling funding from the WHO to the UK’s refusal to participate in the EU’s Joint Procurement Agreement, countries are instead pursuing do-it-alone strategies. Within this inward-looking context, it’s little wonder that industrialised nations are failing to capitalise on lessons from Africa, Asia and Latin America.

It’s not a lack of recognition that there’s knowledge and expertise outside the developed world; it’s just that such knowledge is not seen as relevant given the structural differences between developed and developing countries. On this point, consider this final example.

Between the start of April and the end of June, the Rural Development Foundation based in Sindh province in Pakistan on its own decreased the spread of infection in the region by more than 80%. It did this by engaging communities through information campaigns and sanitation measures. Community-level approaches have also been successfully deployed in the DRC and Sierra Leone. During these countries’ Ebola outbreaks, rather than relying on tech and apps, authorities trained local people to do in-person contact tracing instead.

These community-level strategies were advocated by developed world experts, including from the UK. And yet, despite the clear current need, tried-and-tested low-cost approaches like this remain underused in high-income countries. They’ve been disregarded in favour of high-tech solutions, which so far haven’t proved to be any more effective.

The problem, as this example illustrates, is the persistence of a pervasive narrative in global health that portrays industrialised countries as “advanced” in comparison with the “backward” or “poor” developing world, as described by Edward Said in his foundational book Orientalism. Europe’s failure to learn from developing countries is the inevitable consequence of historically ingrained narratives of development and underdevelopment that maintain the idea that the so-called developed world has everything to teach and nothing to learn.

But if COVID-19 has taught us anything, it’s that these times demand that we recalibrate our perceptions of knowledge and expertise. A “second wave” is already on Europe’s doorstep. Many countries in the southern hemisphere are still in the middle of the first. The much talked-up global preparedness agenda will require responses to be handled very differently from what we’ve seen so far, with global solidarity and cooperation front and centre. A healthy start would be for developed countries to get rid of their “world-beating” mindset, cultivate the humility to engage with countries they don’t normally look towards, and learn from them.

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  1. vlade

    Sigh. No.

    The post itself says that there’s a lot of different variables that Africa (and a number of other poor countries) have, for example demographic.

    There’s only very limited amount of what a country like Italy, with a median age of 47 can learn (on handling of CV pandemic) from someone like Nigeria with a median age < 20 (yes, less than twenty. It's a country of teenagers), except for some very generic stuff (yes. leadership is important. But we knew that before. And if Johnson can't take Arden as a leadership example, he sure won't take Nigeria).

    Looking at Germany, with (broadly) similar infrastructure (even split into richer and poorer part of the country, except the split is East-West, not North-South), and demographic _is_ way better.

    It's like saying "Why can't all those old people who can't get jobs learn from the school leavers?". Because while their goal is the same (get a job), their problems are fundamentally different (to be fair to the young, I could have phrased it the other way, because the experience of 60 year old of how he/she chased the first job is as likely as not out of date and inapplicable to the current world).

    There are relevant examples outside of Europe (and definitely America) to follow, but it's more around the second part of the post – countries that had hands-on pandemic experience, like Vietnam, Taiwan, South Korea.

    But there's no "developed country magic". There's "I have the same, or very similar, problem as you" magic.

    1. Jerri-Lynn Scofield Post author

      I have written about this issue before and I have used Asian rather than African examples, precisely because of these demographic reasons. Yet it’s especially sad that countries that have failed so miserably cannot look towards other possible sources of successful advice.

      1. jsn

        Hypothesis: Covid’s evolution and spread track the stressors on the human genome induced by unregulated markets.

        Markets structure available decisions in the things they touch and the advance of neoliberalism has structured decisions about food, education, housing, a clean environment and medicine so that choices from which no one profits monetarily are eliminated.

        All of these market structures impose material stress on people captured by the system making them more vulnerable in the absence of the non-market coerced alternatives, cooperative alternatives, the expansion of markets into everything has eliminated.

      2. oliverks

        I believe the UK has spent over 12 billion pounds trying to develop contract tracing technology. Honestly this should be a 10 Million pound software project (i.e. 1000x cheaper), combined with good community organizing, we could have first rate contact tracing.

        In particular we need to back trace properly to catch the super spreaders. As one of the countries above demonstrated, we also need to isolate based on exposure risk profile not symptoms.

        I think there is lots to learn from what Trump would call the (family blog) countries.

        1. jrkrideau

          A few local people with telephones and bicycles in each local area probably would do better than some stupid apt.

    2. Thuto

      Yet we in the developing world are told over and over to learn from “advanced” countries, and benchmark our own efforts at development against the “world-class” (which world one may ask, apparently the OECD is the world) standards set by said advanced countries. Don’t mind the structural differences when the lessons flow north-to-south, it’s when they flow in the opposite direction that context matters.

      Pride comes before the fall as the saying goes, and if Italy thinks it has nothing learn from Nigeria because well, Nigeria is merely harvesting a favourable demographic dividend, and the decisions by its leadership hold up no lessons for a country with different demographics, then good luck with that kind of attitude.

      What happened to learning lessons in the abstract (i.e. independent of context), recontextualizing them and then synthesizing them into a plan that incorporates the best of locally derived learnings and the best of localized foreign learnings? As was said the other day, there’s still so much that is unknown about what is driving the differing outcomes in covid that it seems unwise to absolve “first world” leaders for their bungles and be dismissive of the relatively better outcomes of the developing world as somehow expected because well, demographics.

  2. thoughtful person

    In some countries the purpose of health care is keeping people alive. In others, the purpose is to maximize profits. Which has better outcomes for more people at a lower cost to the country?

    Of course if those who decide what system a country uses are those beneficiaries of the profits the system chosen may not be the better one,

  3. guilliam

    ‘There is an apparent unwillingness to learn from developing countries’
    Aye, and not just with regard to covid. I read Chinua Achebe’s excellent ‘Man of the People’ a few years ago and was struck by the endless similarities between the strongman politics and the uncertainties of post independence Nigeria and Brexit Britain and Trump’s America, it’s certainly the most relevant novel I’ve read about our current world yet I’ve never seen any western literary critic refer to its relevance at all

    1. Abi

      So interesting you point out the similarities between Nigeria and the US, particularly how recent events are just so similar. Chinua Achebe remains book remains a personal favourite, have you read anthills of the savannah? I think it’s a nice follow up.

  4. Oh

    I’ll venture say that there’s a strong correlation between rich countries run by neocons/neoliberals and the inability to cope with spread of the pandemic. I would suggest that the requirement to monetize (by privatization) each step has something to do with it. Profit first, people last for them.

    Eight months into the crisis and still no manufacturer of PPE in this country. So much for the “free market”.

  5. David

    I don’t think many people appreciate just how enormous the consultancy industry in the Third World actually is. Throughout Africa, but also in places like Afghanistan, Iraq, Vietnam or Lebanon, you fall over them everywhere. When I was in South Sudan after the civil war, one of the compounds in Juba had a street known as “NGO Alley” where there were literally dozens of foreign NGOs camped, all with grants to do this and that, often in conflict with each other. There are entire consultancies like this one dedicated just to bidding for and managing EU Framework Contracts in different parts of the world. As well as the EU, the UN, the OECD, the World Bank and bilateral donors are all funding programmes on the ground, without any coordination. In theory, all these organisations and consultants are there at the invitation of governments, but in practice, since the funding comes from outside, governments take what they are given. This applies in the medical area as much as any other.

    In each case, the idea is the same. There are internationally recognised standard ideas and practices: donors know these, locals do not, therefore this expertise needs to be transferred. Locals have no knowledge to contribute, and, in true Liberal fashion, what is true in the West is true everywhere. Ironically, in recent years, some have begun to wonder whether the opposite may be true: for example, African ways of dealing with conflict and its aftermath might actually turn out to be more effective than ours. But don’t tell anybody.

    1. Hayek's Heelbiter

      I noticed this when my late wife was working for a struggling local NGO that was liaising with traditional healers in Kampala. The United Nations agencies had wonderfully modern offices, and the workers drove around in SUVs emblazoned with the UN logo emblazoned on the doors.

      All of a sudden, the goal of local people became not facilitating the efficacy of local efforts, but somehow achieving access to the UN money trough.

      Indeed Google “united nations in uganda” and the very first listing:

      UNDP in Uganda
      Search domain http://www.ug.undp.orghttps://www.ug.undp.org
      The United Nations Development Programme (UNDP) in Uganda has donated three vehicles and 28 motorcycles, together worth USD 204,700 (about Shs 751,100,000)…

      US$204,700 would have funded my late wife’s NGO for at least ten years.

  6. vegeholic

    A few years ago I was traveling in one of the poorest provinces in Mexico and developed some digestive problems. I stopped at a pharmacy to self-medicate, they immediately sent me to a doctor (next door) affiliated with the pharmacy. Complete physical exam, prescription meds, and I was soon in good shape. The exam was free. Only charge was for the meds. I shudder to think of the situation where a Mexican tourist needs medical attention in the U.S. The comparison is shameful and at the same time instructive. We apparently have a lot to learn from “underdeveloped” countries who have developed in ways we cannot imagine.

    1. Crazy Horse

      A couple of years ago i developed a root canal infection in a back molar. My dentist referred me to a specialist in the nearest city. At my insistence he quoted a minimum bill for the procedure of $1550.

      The next morning I was on a plane to Puerto Vallarta at a cost of $900. But that included a week stay at a nice hotel. The Mexican root canal specialist operated from a modern facility that was better equipped than the one at home. His bill? $330.

      A week of sunshine on the beach and a trip up into the mountains certainly helped my recovery process!

  7. Grayce

    Imagine that intelligence, native intelligence, is distributed similarly across all demographics. Then imagine that it does not depend on content/learning/memorized stuff. Yet, during each person’s 24 hours a day something is experienced and is processed. What a bad habit “western,” “first world” and “developed” countries have, that they imagine the others cannot teach them anything.

  8. Alex Cox

    The author’s references to Latin America include Uruguay, Colombia and Costa Rica.

    There is no mention of Nicaragua, Cuba, or Venezuela.

    Yet if the NC reader turns to the Water Cooler’s reliable COVID counter at http://91-divoc.com/pages/covid-visualization/
    and compares, say, Colombia and Venezuela, they will see which country is doing better: 7,500 new daily cases in the bastion of democracy and NATO member, 400 new daily cases in the nation Forbes says we must invade.

    Venezuela, Nicaragua and Cuba are doing far better in fighting the virus than most other Latin American countries, and infinitely better than the United States. Why? All three concentrate on local health centres and preventive care, but perhaps the fact that they suffer severe US and European sanctions has encouraged their self-sufficiency, as well.

  9. cek

    God, I love this site. Thank you, Jerri-Lynn and commenters. There’s never a day I come away without having my head readjusted and learning something new. It’s chiropractic for the brain!

  10. Crazy Horse

    It appears that the single most accurate profile predicting success in the fight against Covid for a country in Latin America is membership on the USA’s enemies list. If a country was lucky enough to be subject to sanctions, coup attempts and economic warfare, and not overrun with NGO’s sent from the US to “help” them they might be fortunate enough to have only 39 fatalities from the entire pandemic like Cuba. LOL

    Cuba’s response to the pandemic reminds one of a low tech version of China’s policy in Wuhan Province— authoritarian, incisive, and ultimately successful. In China the authorities may have resorted to welding the doors of apartment blocks shut, huge temporary tent hospitals and mass cremations (or more likely those stories are just the product of the Western Disinformation Machine.) Cuba relied upon mass mobilization of paraprofessionals to visit and test everyone with possible symptoms on a daily basis and treat everyone who progressed toward Corvid infection with an array of well tested antivirals. In short, universal contact tracing using actual human observers rather than a hodgepodge of inaccurate and contradictory tests. Having a free medical system so nobody need fear asking for treatment didn’t hurt. And having trained 2.8X as many doctors as any other country didn’t hurt either.

    If most USAians were to stumble across the preceding information it would roll off their backs like water off a duck. After all they have had 40 years to learn that Cuba=EVERYTHING BAD. I’d be the last to argue that Cuba is paradise on earth— too many waves of migrants seeking a new car and new life in Miami attest to that. That is no reason to ignore the stark contrast between 39 deaths (or even ten times that to account for the universal tendency for governments to massage statistics) with the 70,000+++ deaths in the smaller population of New York City.

    * An article in today’s inbox argues that anyone can obtain the same treatments that cured President Trump overnight. (except for the “highly experimental monoclonal antibodies” that were likely the key to his success.) So apart from those, you too can get your own personal Trump weekend cure. Your personal cost—- +- $100,000.

  11. "The Rev Kev

    Maybe what it comes down to is that the rich countries are suffering from the “not-invented-here syndrome. Unless they think of it themselves, they won’t consider it. The same happens with organizations like corporations too.

    1. Crazy Horse

      “Exceptionalism” is but one minor aspect of the relationship between the USA (AKA The Empire) and the rest of the world. Follow the money.

  12. Sound of the Suburbs

    At last I found an account of how a country has successfully dealt with the coronavirus, and life has returned pretty much back to normal.
    Steve Keen is one of those “anywhere” types, and is free to move around the world as he chooses. He looked for a country that had dealt successfully with the coronavirus and moved there. The country was Thailand.
    Let’s find out how to deal with the coronavirus successfully.
    Starts at 12.30 mins.

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