A global humanitarian Marshall Plan

For those of us who live in the richest countries in the world, disasters on the scale of the Covid-19 pandemic have always happened to ‘other people’. Now, for the first time in a generation, we know what such a crisis feels like at home. Ben Ramalingam FRSA argues that, as wealthier nation states commit to doing whatever it takes to respond to this crisis, this must include anticipating and responding to the acute needs of poorer countries.

The US, Europe and Asia have taken extraordinary – if unsteady – steps to combat Covid-19, throwing economic and political orthodoxy out the window in favour of massive state support for businesses and households. Yet these attempts miss a fundamental truth. If we are, as some leaders are so fond of saying, ‘at war’ with the virus now, what we are fighting is not a series of national or regional battles, each contained within its own borders but a global struggle. What the current efforts have not yet fully reflected is that winning this will require a strategy that unites and transcends local and national efforts.

In my work to help guide humanitarian efforts on Covid-19, I speak daily with government officials, hospital directors, NGO leaders, community health workers and experts in health, economics, and development. Their message is stark. The impact the coronavirus has had on some of the strongest, most well-funded health systems in the world is a warning: for those living where such systems are weak or fragmented, the disease has the potential to reach levels of destruction never seen before.

Sierra Leone has 13 ventilators for a population of 7.6 million people. In Malawi, which has only 25 intensive care beds for 18 million people and where half of the population lives in poverty, Covid-19 may be the worst catastrophe in the country’s history. Africa as a whole has one intensive treatment unit bed per million people. Elsewhere, Nepal has diagnostic testing in one hospital for a population of 28 million. And we already know that urban slums, conflict zones, refugee camps and prisons are, in effect, giant petri dishes for this most aggressive disease. In Syria, the decade-long war has decimated one-third of hospitals, one-half of clinics, and led 70% of health workers to flee the country. Colleagues in Idlib, where fighting in December displaced a million people, tell me that the number of cases of Covid-19 infection need only reach 6,500 before the health system completely collapses.

Economically, the pandemic threatens to reverse the worldwide gains achieved by developing countries in the past few decades. According to recent research, it will turn the clock back 10 to 30 years for the world’s poorest people; in other words, an additional a half-billion people will be added to the 3.4 billion already living on less than $5 a day.

The ripple effects will be global. Covid-19 running rampant will lead to anywhere from one to 40 million preventable deaths in poorer countries, by current modelling estimates. The International Rescue Committee estimates that without swift action, there will be between 1.5 million and 3.2 million deaths in countries affected by conflict and fragility. Silent killers such as diabetes, malnutrition and infant mortality will follow. As economies crash further, global systems will become more unstable and rebound more slowly. The resulting impact on politics will expose the international community to spiraling insecurity and violence. All of this will only increase the likelihood of second, third, and fourth waves of infection reaching wealthier countries.

There will be exit strategies from lockdown, however partial and gradual. But there is no getting away from the fact that we are all on this small planet together. As Dr Martin Luther King once said, we are all “caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.”

How do we avoid this scenario? A decisive act of global solidarity, fusing political will with grass-roots innovation, could save millions of lives and livelihoods. The rebuilding of Western Europe after World War II and in the Green Revolution of the 1950s and 1960s that led a billion people out of starvation are examples of such global cooperation. In essence, we need a Marshall Plan for the 21st century.

We do not need to look back a generation to see this principle in action. At the height of the global financial crisis in 2008, the world’s wealthiest nations met in a series of summits and established the basis for coordinated action: what we now see as the G20. Within a few short months, this group had become the ‘premier forum for international economic co-operation’, a platform for global action on banking bailouts, economic stimuli, and a collective rescue package of over $1.4 trillion.

The G20’s response to this pandemic has been, thus far, one virtual leaders’ summit. Now we need the same kind of urgent interventions made in 2008. By their next scheduled meeting, in November, it will be far too late. Our leaders must rise to this moment and this includes working around those who will not. In what may seem like ancient history, the Paris Climate Accords saw all of the G20 sign up, bar one. The same flexibility will be needed here as ‘Fortress America’ looks to be pulling up the drawbridge.

There are a number of measures that responsible leaders of the world could and should be working on. First, they need to support preparedness action plans in the poorest countries. One-third of the world’s countries currently have no plan in place to deal with the coronavirus; places where the most vulnerable people are already living with health emergencies. We must aid these governments to develop, test, implement and reinforce measures that will secure the health and dignity of their people.

Second, we need to ensure that the poorest countries are not at the back of the line for essential products and goods. This means creating humanitarian supply chains and providing investment in local innovation to produce urgently needed medical equipment and PPE. It also means providing supplies to offset secondary crises, such as treatments for diabetes, hypertension and malaria, while laying the groundwork for fair and equitable distribution of future vaccines and treatments. Hearteningly, work is already underway on vaccines, but the more immediate needs must also be met.

Third, our international leaders take to take bold, collective and humane decisions to protect the health of the millions of people living in urban slums and refugee camps, migrants and internally displaced people, those incarcerated in prisons (where social distancing is an impossibility), including evacuating and re-housing people to safer and more secure spaces.

Fourth, they should implement redistributive programs to create a global and universal basic income to soften the blow to the livelihoods of billions of workers in the poorest countries, as well as policies to ensure they are not left mired in long-term poverty. And finally, they need to relieve or cancel debt owed by the world’s poorest countries to the richest, advocating for the funds to be used to deal with the direct and indirect consequences of coronavirus on the most vulnerable.

Such measures will not prove universally popular, but neither were the 2008 bank bailouts, or indeed the current raft of anti-pandemic measures in developed countries. But the lessons of history are clear: global problems demand collective approaches that can accelerate large-scale change.

Wealthy countries are mobilising humanitarian aid, including public health and medical and food assistance; such measures are welcome and necessary. But, as I have witnessed in nearly two decades of working in global crisis response, aid is not a substitute for political and diplomatic action. More than ever before, the welfare of the world’s poorest must be the responsibility of all nations, for the benefit of all nations.

History will judge us based on how well we look after the most vulnerable among us. The coronavirus crisis has brought to light the cracks in our global system. If we do not see the same kind of ‘whatever it takes’ mentality used in developed countries applied more widely, then our war against this pandemic could last decades, not months, and lay waste not just to lives and livelihoods, but also to our collective future.

Ben Ramalingam is a Senior Research Associate for the Overseas Development Institute and advises international organisations including the Red Cross and United Nations on strategy, innovation and learning. He is working on COVID-19 responses nationally and globally.