Preparations for the burial of a COVID-19 victim in Abbottabad, Pakistan, March 2020 Sultan Mehmood / Reuters

An Insight to epidemic Outbreaks in Low- and Middle-Income Countries

The pandemics have affected the human race throughout history with emerging and re-emerging diseases like SARScholeraPandemic H1N1MERSyellow feverEbolaZika, and drug-resistant infections. They have caused significant illness and deaths among populations in low- and middle-income countries. 

About one-third of the world population was infected in 1918 by influenza and Spanish flu, and approx 50 million people died. It was estimated later that if an influenza pandemic similar in severity to the 1918 pandemic were to hit today, there could be 62 million deaths, of which 96% would be in low- and middle-income countries. Irrespective of where an outbreak starts, low-and middle-income countries always tend to bear the brunt due to fragile health systems and inadequate capacity to handle surges in cases like the current COVID-19 situation in Pakistan and many other third world countries. (According to a study published in 2019, Pakistan occupies 84th position in the third world.)

The social and economic impact of viral disease outbreaks in low and under developing countries is often more significant than would be estimated from the number of cases of disease and deaths. The impact of an epidemic depends on the direct health magnitudes and the indirect effect of disease control measures. These include social distancing interventions, such as educational sector closures, quarantine, and travel and trade restrictions. Fear-based behavior due to lack of information or reduced confidence in governments and institutions also play a role. In low and middle-income countries, grave economic disruption carries particular risks for poor households, as they may have less access to health care and lower savings to protect against financial adversity.

Epidemic outbreaks can adversely impact the economy’s long-term growth by the destruction of human capital. Human capital, mainly the manpower of a country, is considered an essential determinant of long-term growth. Furthermore, the decline in health capital, as measured in general by life expectancy, negatively affects economic growth. For example, Liberia lost 8% and Sierra Leone 7% of their healthcare workers to Ebola, with longer-term indirect effects on already weaker health systems far beyond the duration of the epidemic. 

The loss of gross domestic product (GDP) is yet another undeniable reality. This was due to already poor investment and lack of prioritization of Health and Research in these countries’ budget and a significant loss in private sector growth and agricultural production, leading to concerns about food security and cross-border trade, fall in tourist numbers, etc. as restrictions on movement, goods, and services increased. The current COVID-19 Pandemic enables us to accept it with a rational approach.

A Clinic prepared for patients during the Cholera Outbreak in 2017, Bangladesh

The social and economic consequences can continue for years after an outbreak has been controlled. 

Thus, ensuring effective epidemic outbreak preparedness at regional, national, and global levels is essential to protect human populations against epidemic threats and its long-lasting impacts on the country’s prosperity.

A pandemic or disease outbreak can overwhelm the health system, limiting the capacity to deliver even routine healthcare, particularly in low-resource settings. Vulnerable populations, especially the underprivileged, are more likely to suffer.

In addition to the direct impact, further social consequences can devastate weaker health systems and affected communities, undoing decades of social development. This can only be minimized when a high level of trust exists between the community and their health facilities. One aspect that is common to all control efforts, in this case, is clear, evidence-based, and specific communication with the public to rapidly and effectively trigger the response.

A lesson well-learned from history is that epidemics occur more frequently and with greater severity in crisis settings than in comparable stable situations. 

When we talk about crises, we refer specifically to instances of substantially low Health Literacy, which is one of the major limiting factors in epidemic control, cause misinformation and tons of myths and lesser adherence of public to the control strategies.

Other crises may include armed conflicts like terrorism, food insecurity, mass displacement, natural disasters like floods, and/or collapse of state functions. 

Another significant aspect of epidemics is they detected and reported late in these countries. Lack of public adherence to accept disease as real is yet another factor worsening it, leaving many cases unreported.

This map shows all recent outbreaks before the COVID-19, strengthening the fact that they occur all over the world

Although the history and the present situation shows that no country is safe from the threat of an outbreak irrespective of its economic, social, or geographical position in the world.

But the risk is not equal. Countries with no sound health systems and those that are fragile or conflict-affected states are at risk of the effects of outbreaks because of a lack of ability to prevent or respond to them. 

To conclude, there is a dire need to keep the world safe from epidemics, serve the vulnerable, and promote health. These include sound surveillance systems so that we can detect clusters of disease and then respond rapidly to prevent spread, effective front-line reporting in communities, mutual trust, investment between the health authorities and the community, well-trained health care workers, the necessary supplies like Personal Protective Equipment (PPE), adequate investment in research and in documenting and learning from previous outbreaks. 

All this development requires national commitment at both individual and government levels and often requires external international support and a strong partnership with international bodies like World Health Organization (WHO) and the Centers for Disease Control (CDC). Only this way we can lessen the impacts of outbreaks in low- and middle-income countries.

Also Read: Low Health budget amid the pandemic: a disaster in the breeding?

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