Coronavirus Cases Are Rising Globally—and Poor Countries Are Worst Off

Experts have long said extensive testing is the key to mitigating the pandemic. But an analysis of testing data shows low-income countries have few resources.

Mobile hospital staff wearing personal protective equipment perform COVID-19 nasal and throat swab testing  on April 28, 2020 in Bangkok, Thailand.
Mobile hospital staff wearing personal protective equipment perform COVID-19 nasal and throat swab testing on April 28, 2020 in Bangkok, Thailand. Lauren DeCicca/Getty Images

The coronavirus pandemic has brutally exposed existing inequalities in the world’s wealthiest nations. In the United States, black people—whose household wealth is a 10th that of their white counterparts—are dying at more than double the rate of white Americans. In England, the COVID-19 death rate was more than twice as high in the poorest parts of the country than in its wealthiest areas.

But inequality is also playing out on a global scale. As wealthier countries cautiously reopen their economies after having slowed their rates of infection, countries in the developing world are recording progressively higher numbers of new daily cases. In Suriname and Nepal, for example, total cases are doubling every week. And as countries such as Germany and South Korea have shown, a high rate of testing—along with contact tracing and a well-resourced public health system—is the key to a robust coronavirus response. Foreign Policy’s analysis of global testing data shows a strong correlation between a country’s wealth and its ability to test its population for the coronavirus.

Breaking up the world into the four income bands commonly used by the World Bank helps make the gulf in testing clear. Countries classified as “high income,” such as Germany and Japan, have a gross national income (GNI) per capita of $12,376 or higher. Citizens of “upper-middle-income” countries, such as Turkey and China, have average incomes between $3,996 and $12,375; average salaries in “lower-middle-income” countries range between $1,026 and $3,995; and “low-income” countries have a GNI per capita of $1,025 or less.

Poorer countries have conducted far fewer coronavirus tests than rich countries, as the chart below shows.

China is not included in these figures as its decentralized health system does not report national testing numbers. (Publicly reported numbers from provinces show at least 27 million people have been tested in Hubei and Guangdong.) Even if China’s relatively high testing figures were included, it wouldn’t change the stark reality: The world’s richest countries have tested a far higher proportion of their populations, while those at lower average income levels have barely scratched the surface. As the chart below shows, the richest countries have a testing rate 40 times higher than the world’s poorest.

Countries at the very bottom of these charts have real cause to worry. In Yemen, where the country’s health infrastructure was already largely destroyed by an going war, the medical charity Médecins Sans Frontières (MSF) has attempted to draw attention to the high number of coronavirus cases going under the radar. “What we are seeing in our COVID-19 treatment center is just the tip of the iceberg in terms of the number of people infected and dying in Aden,” Caroline Seguin, MSF’s operations manager for Yemen, said in a May 21 press release. “People are coming to us too late to save, and we know that many more people are not coming at all: they are just dying at home. It is a heartbreaking situation.”

One question, then, is why international organizations haven’t been able to bridge these disparities. An investigation by the New York Times in April revealed a shady world of backroom dealing as rich countries attempted to strong-arm their way to the front of the line for testing equipment. Those early moves mean that poorer countries now face order backlogs lasting months.

The Africa Centres for Disease Control and Prevention has attempted to address this gap with a promise of 10 million new tests, but even that would cover less than 1 percent of the continent’s population.

The World Health Organization (WHO) is also working to tackle the imbalance among countries. The Global Humanitarian Response Plan released by WHO calls for $6.7 billion in funding to “stave off the most debilitating effects of the pandemic in 63 low and middle-income countries,” including by providing testing equipment.

Colm Quinn is the newsletter writer at Foreign Policy. Twitter: @colmfquinn

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