10 May 2020

The COVID-19 dilemma: Health or the economy?

The world faces the “health - economy” dilemma. In poor countries, it means choosing between saving people from the pandemic or saving them from hunger.

Initial priority to health

Since the start of the COVID-19 pandemic, the inclination has been to give absolute priority to the protection of people’s health. China was first to set an example by end January when it organised the lockdown of initially tens of millions of people in Wuhan and in the Hubei Province, and then hundreds of millions of individuals in various parts of the country, bringing its economy to a near stop. While it seemed yet improbable if not impossible in February to experience such a shutdown in a democratic country, Italy followed China’s approach in March, echoed by France, Spain, the UK and a long series of countries throughout the world.

The economy is back

By April, various voices challenged the lockdown-based strategy. Some believed that to save some tens of thousands of lives from COVID-19, governments were ready to sacrifice the economy and trigger a crisis from which the world would need years to recover. Others were attempting to tabulate the number of casualties that the priority given to health would imply, arguing that they would be in greater numbers than those who would have been caused by the virus in the absence of a lockdown: patients suffering from serious cardiovascular problems or from cancer who are afraid or cannot go for care any more, children who could not be vaccinated, victims of the economic and food crisis following a halt of activities and movement restrictions, victims of domestic violence or civil unrest. And others, finally, were surprised to see the enthusiasm demonstrated by governments to combat COVID-19, when silence was kept on diseases like malaria, HIV/AIDS, respiratory illnesses created by pollution, cancers resulting from alcohol and unhealthy food, the death toll of which exceeds annually several dozen (hundreds?) times the number of casualties caused by COVID-19.

These days, the media are full of references to the forecasts made by the IMF (International Monetary Fund) that anticipates a contraction by 3% of the world economy in 2020 (to be compared with the initial growth projection of 3.3%), with rich countries being hit harder (less 6.1% and up to less 14% for the UK according to the Bank of England), to those of the UNCTAD that expects a strong reduction in foreign direct investment flow, to the ILO that foresees a rise of unemployment (doubling in the UK according to the Bank of England) or to WTO’s projections who envisage a decline of world merchandise trade somewhere between 13 and 32% in 2020, not forgetting to observers who caution against massive debt increase.

All these messages seek to put the economy back into the centre of concerns. To use the opportunity thus generated, some industrialists have been asking for the relaxation of environmental rules and have challenged what they consider to be obsolete objectives of greenhouse gas emissions reduction, with the view to create a faster route to the resumption of growth, while airline companies and aircraft manufacturers request for astronomical amounts to be able to remain in business, threatening to dismiss tens of thousands of their staff or to increase substantially the price of air tickets if strict health guidelines oblige them to operate with half-empty planes.

The money required to boost recovery is staggering: the IMF projects that $2.5 trillion will be needed only for emerging economies (comparable to the GDP of the UK).

Economic and food crisis

Worried by the consequences of a world economic crisis on hunger, the FAO projects a large increase in the number of undernourished people living in the poorest countries. In a note that was just published, the FAO stresses the close link between economic context and food situation in a given territory. It informs that 65 out of the 77 countries that have experienced a degradation of their food situation had simultaneously suffered from an economic slowdown or a recession. It may therefore be expected, write the authors, that the COVID-19 crisis will contribute to a faster deterioration of the food situation in the world, insofar as governments have been imposing strict public health rules like lockdown and physical distancing. The likely continuation of the latter rule over many months would imply a slow economic recovery.

The note adds that the economic stimulus package will have to address the reduction of inequalities if it should allow a sustainable decrease of food insecurity and undernourishment. FAO takes stock of the fact that a large number of countries have already started to act so as to boost economic recovery as well as to assist the more vulnerable people, in particular by distributing money or food to the poorest. It is however concerned that in the more fragile countries, those that have very limited financial resources, these latter measures are generally neglected. This is true, especially in a majority of African states.

Late April, the WFP warned that the number of people facing acute food security could almost double in 2020 to reach 265 million, as a result of COVID-19. One hundred and thirty million individuals could thus sink into undernourishment because of the impossibility for the informal sector to operate normally, because of the decrease of tourism-related income, reduced remittences send to families by migrant workers and because of various restrictions, including travel bans. These frightening figures presage an increase of undernourishment-related mortality. However, the UN has not, for the time being, attempted any macabre accounting of potential victims.

To be up to its task, the WFP believes that it will require $10 to $12 billion to fund its programme for the current year, much more than the record $8.3 billion raised last year. The humanitarian agency is already prepositioning food stocks in anticipation of substantially higher needs [read].

The 2020 Global Report on Food Crises published by the United Nations earlier this year shows concern about social tension the COVID-19 crisis could imply. Constrained movement, fear of disease, the impossibility to work and earn daily food could create a reaction of panic, violence against authorities responsible for imposing restrictions and looting. This could further destabilise economies of fragile states where social and political tension may often be high. Authors are concerned by risks of conflict between local population and refugees in countries where the latter are many, by possible disruption of electoral processes and consequences for those vulnerable groups who usually benefit from assistance and might be neglected because of the COVID-19 crisis.

Lifting lockdown and relaxing restricting measures

In rich countries, after two months of lockdown by fear of COVID-19 and the priority given to health rather than the economy, the pendulum is now swinging towards the other side. Everywhere the lockdown is being lifted to ease recovery. The official line says that the state of public finance (deficit, debt) has become unsustainable: it is urgent to go back to a “normal” working life. It must be mentioned here that in the US, for example, the number of unemployed had already increased by 23 million by the end of April, and food banks were stormed by crowds, both circumstances unseen since 1929 [read].

In poor countries, the lockdown will have lasted much less and there are signs of activities resuming everywhere. In Haiti, for example, garment factories started operating again by late April, while in Africa, Nigeria, Ghana and Uganda have lifted certain restrictions under the pressure exerted by people living in a desperate situation. These choices were made despite forecasts by WHO that project up to 10 million COVID-19 cases in the region. The relatively small number of cases (62,000 on 2 May) and dead (2,200), so far - probably underestimated according to some reports - has presumably convinced political decision makers to release the stranglehold of the lockdown.

A growing group of leaders and experts believe that the lockdown is not adapted for combatting the expanding pandemic in poor countries, particularly in Africa [see an example here, in French], for economic reasons or because demography in Africa is quite different from that in China, Europe or North America.

Blind or stupid?

In an article published in “African Arguments”, J. Fairhead and M. Leach emphasise that elderly people, who are supposed to be more vulnerable to the virus, only represent a minor part of Africa’s population. They observe that individuals aged more than 55 years constitute 23% of China’s population (and more for Europe and North America) compared to only 5% in Uganda. They reckon, from what is currently known of the virus, that it is likely that there will be fewer direct victims of COVID-19 in Africa than elsewhere and stress the enormous impact - for them impossible to cushion - a shutdown would have on people’s everyday life, given the fragility of the economy of African countries.

Also in “African Arguments”, A. Du Toit replies to Fairhead and Leach that the risks created by COVID-19 are not limited to elderly people in Africa as there are so many young individuals on the continent who are in disastrous health conditions (Tuberculosis, AIDS, diabetes, hypertension and undernourishment) that weaken them. He thinks that what matters is to take stock from experience. Starting from the cholera epidemic during the 19th century and the recent HIV/AIDS pandemic, he reckons that part of the solution can be found in the creation of a public health movement capable of informing and educating people to make them adopt a behaviour that will reduce the expansion of the pandemic while considering them as responsible citizens [read].

In a message published on the web site of the Got Matar Community Development Group, in Kenya, Andrew MacMillan remembers the year 2001 when he visited Kenya during the AIDS pandemic that killed 300,000 people in the country (out of a population of 32 million in 2000) and now continues to kill around 28,000 people yearly because of the consequences of this terrible disease. He remarks that while COVID-19 victims are mainly elderly people, HIV/AIDS kills breadwinners - more than 30% of them died in the most hit and poorest districts of the country -, creating a multitude of orphans and a lasting economic crisis by wiping out a considerable portion of the workforce of a generation. He bitterly notes that it is only with the contribution of foreign private donors that the community could build its future by investing in education.

The short article (in French) published in “Le Monde” by the Argentine writer and film director Santiago Amigorena echoes MacMillan’s message. Amigorena wonders: “How is it that the lives that we try to save today, by staging a ‘war’ against COVID-19, are more important to us than those we usually don’t save?” and why are we ready to do anything to save them? Why them, rather than those who die from obesity, hunger and poverty who could be saved with incomparably less resources than the trillions of dollars that combatting COVID-19 will cost? And what about the victims of wars that we supply with “weapons that we are so proud, in France or in the US, to manufacture and sell?”

For the Argentine author, the answer to these questions is sadly obvious and devastating. It is the “stupidity” of our leaders, he bluntly says: “COVID-19 is a war here and now, it may create loss - or bring gain in the very short term.” But as a disease, COVID-19 “will only be another disease … [that] will kill more or fewer people than our usual flu, and certainly much fewer than hunger, malnutrition, climate change or war or a combination of all of these”. Because of a lack of preparedness that will have helped to save a little money, “All the rest suddenly ceases to have importance in the eyes of those for whom this rest always justified letting millions of people die.” This absurdity, ultimately, according to Amigorena, will only affect the usual victims of crises, namely the poorest and most vulnerable. For sure a thought-provoking article!

The blind and nonsensical presentism of our societies and of the political leaders who rule them, the weight that vicinity gives to victims in the respect and the assistance we are ready to provide to them are issues that have already been raised on hungerexplained.org [read here and here].

Complexity and diversity of situations, simpleness of solutions

The debate of which some elements were presented here shows the complexity of the issue and the wholly political dimension it has been taking of recent. This is also true in rich countries - see the example of France - where the growing importance in the debate of economic considerations relatively to the health aspects stimulates political - and even philosophical - contradiction. This occurs in a situation of emergency that does not help in making well thought-through decisions.

While pondering over the complexity of the issue, its multiple facets (health-related, demographic, economic, social and also environmental) and the diversity of situations (level of health infrastructure, financial and budgetary resources, institutions, social fabric…), we should not be surprised that the strategies should be equally diversified to adapt to specific field conditions. The error then would be to make choices on the basis of only one criterion (health or the economy, to take the two most obvious ones in this case) or, tossed about by events, to thoughtlessly decide to change criteria during the process because of an immediate emergency felt or public opinion. What is needed here is to consider the multiple outcomes at stake without being tempted to reduce them artificially to only the economic side, as we have tended to do it over the last decades, but accepting to manage our action in a multicriteria framework [read] by analysing and weighing carefully the advantages and disadvantages of each option in their complexity, so as to define the requirements for achieving the best possible final outcome given the conditions and characteristics of each country and its regions. Finally, we should try and use this opportunity to broaden our thinking and action to build a society that will be in a position to avoid repeating a similar crisis and that will be more just and more sustainable.

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To know more:

1. •A. Jaloh, Severe hunger threatens Africa during COVID-19 lockdowns, Deutsche Welle, 2020.
   

2. •Sánchez, M.V. et al., COVID-19 global economic recession: Avoiding hunger must be at the centre of the economic stimulus, FAO, 2020.
   

3. •COVID-19: 50 million people threatened by hunger in West Africa, Save the Children’s global COVID-19 emergency appeal, 2020.
   

4. •Fairhead, F, and M. Leach, One size fits all? Why lockdowns might not be Africa’s best bet, African Arguments, 2020.
   

5. •FSIN, 2020 Global report on food crises - Joint analysis for better decisions, Global Network Against Food Crises & Food Security Information Network (FSIN), 2020.
   

Selection of past articles on hungerexplained.org related to the topic:

1. •COVID-19 and food: the economic and food crisis hits the more vulnerable - some insights, 2020.
   

2. •The selfish, the blind and the invisible: what COVID-19 tells us about our societies, 2020.
   

3. •COVID-19 and food  - The pandemic is likely to cause a major food crisis, 2020.
   

4. •Opinion : Back to reality - Reflections around the COVID-19 crisis, 2020.
   

5. •The dangers of a “partial” impact analysis: the example of a study on the impact of a 100% conversion to organic farming in England and Wales, 2019.

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