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Covid was twice as deadly in poor countries as in rich ones

A man transports a bed on a trolley in South Africa
Reuters/Siphiwe Sibeko
A man transports a bed on a trolley as the coronavirus disease (COVID-19) lockdown regulations ease in Soweto, South Africa, April 7, 2021. REUTERS/Siphiwe Sibeko
  • Annalisa Merelli
By Annalisa Merelli

Senior reporter based in New York City

Published Last updated

In the early months of the pandemic, there was a perception that high-income countries had bore the brunt of covid. In May 2020, the medical journal The Lancet (pdf) wrote that “for the first time in the post-war history of epidemics, there is a reversal of which countries are most heavily affected by a disease pandemic.” Indeed, it seemed that deaths were concentrated in rich countries.

It wasn’t quite so. As the pandemic progressed, more accurate calculations showed that even though rich countries were uncharacteristically hit in a dramatic way, poorer ones still paid a higher toll. Comparing reporting on covid deaths from low- and middle-income countries with data on the same countries’ excess mortalities showed that cases and deaths had been undercounted.

In poor countries, covid killed more young people

An especially relevant difference between covid deaths in poor and rich countries was in relation to age. A study published in the British Medical Journal by researchers in the US, Australia, Uruguay, Ethiopia, Brazil, and Denmark analyzed data on infection and mortality from 25 low- and middle-income countries. It found that on average, covid was twice as deadly in poor countries as in rich ones, but the difference wasn’t shared equally among age groups.

For people aged 60 or more, the so-called “infection fatality” rate, or the rate of death per covid infection, was about 1.7 times higher in low-income countries than it was in high-income ones. But in younger people the difference was much bigger, with 20-year-olds in poor countries experiencing a covid mortality rate 2.7 times higher than their peers in rich countries.

The researchers also found that older people were more likely to have contracted covid in poor countries than in rich ones. In fact, rates of infection in poor countries didn’t vary much across age groups, while in rich ones relatively younger people experienced more cases, as older ones adhered to stricter protection guidelines. This, the authors suggest, is likely linked to living arrangements, with more people in poorer countries sharing multi-generational households. But it also points to the overall difficulties of isolating in more informal economies, where people have fewer opportunities to work from home, and less access to personal protective equipment.

The mortality was already unequal, but it has become even more uneven since immunization started, as vaccine distribution left poor countries behind in immunization rates. In 2022, in the first three months since the emergence of the omicron variant, 3 million people died in low-income countries, according to Oxfam. This further highlights the urgency of vaccine equality. Currently, only about 16% of the population in poor countries has received a dose of vaccine, compared to nearly 80% in rich countries, exposing poor countries population to higher infection and mortality risk, and the whole world to the emergence of new variants.

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