The real impact of COVID-19 on emerging markets

Views & Analysis
The real impact of COVID-19 on emerging markets

When COVID-19 began to spread uncontrollably, numbers of confirmed cases initially grew most quickly in developed economies across China, Europe and then the US. It took some time to reach the door of some of the world’s most prominent emerging markets but, now it has, the impact is set to be much longer-lasting.

By now, many developed markets are seeing an easing of new cases within their borders. Deaths due to the virus are dropping and the focus has perceptibly shifted from the healthcare emergency to the reopening of economies and communities. These are the countries that are heading towards the ‘late accumulation’ and, tentatively, ‘recovery’ phases of one of the most contagious pandemics the world has ever seen. They are the ones that feel the eye of the storm has passed; hence, attention is naturally turning to the aftermath.

Meanwhile, most emerging markets lag behind in the earlier ‘acceleration’ phase. Some of the world’s poorest countries are still to reach the centre of their pandemic when the harshest effects will hit. The challenge for them is that the COVID-19 spotlight is moving on, at a moment when they are in most urgent need of attention and support.

Bringing the focus back to health

While the devastating economic effects of COVID-19 on emerging markets have been widely reported, the implications for community health and society have received less attention.

“The pandemic has re-awakened the urgent need to address the health demands of a growing nation. It was described by one front-line professional as ‘a blessing in disguise’.”

Emerging markets should be in line to benefit from the experience and scientific advances of those countries now moving on toward recovery. They should have ready access to the knowledge gained, be armed with best practice and bolstered by shared expertise. Yet in reality, the concentration of experts actively working on the virus are centered around the US, Western Europe and China, creating a significant global imbalance when it comes to accessing specialist knowledge of COVID-19.


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Image: A time-lapse of when institutions (the blue dots) started working on COVID-19 overlaid on outbreak numbers from 23 January 2020 to 10th June 2020. Source, visualising the scientific community's response to coronavirus

We recently conducted a qualitative study to collect first-hand accounts from frontline healthcare professionals in emerging markets, in an effort to return the spotlight onto the healthcare challenges these nations are facing as COVID-19 continues to spread. The experts involved in the study all hold positions of responsibility for public health handling of the COVID-19 virus and are working closely with communities to control its impact and spread.

Our study outlines the real impact of COVID-19 in these countries and how improved access to knowledge and expertise can make a difference.

Pressure to raise healthcare provision, fast

Developed markets spend, on average, 14% of Gross Domestic Product (GDP) on healthcare provision. In emerging markets, expenditure is just 5-6% of GDP. On a per capita basis, emerging market spending is just 5% of that in developed nations.

As such, public healthcare systems in these nations are largely unprepared for escalation of a virus outbreak on such a scale. Poor funding and a lack of facilities means, across many emerging markets, there is pressure to evolve quickly in order to provide essential health services in the face of the pandemic. Yet each country faces its own specific challenges.

Indonesia is the largest archipelago and the fourth most populous country in the world. A hospital doctor in Java, one of Indonesia’s largest islands, explained to us that national healthcare has evolved at a different pace throughout the nation’s islands and regions. The larger conurbations can keep pace with government policies on disease diagnostics and countermeasures, while scarce resources, logistics and transportation make it more difficult in smaller islands and cities. The country is reporting more than 40,000 cases to date, with more than 2,200 deaths and a rising trend.

Still in Indonesia, competition for personal protective equipment (PPE) and essential medications is reportedly driving prices out of reach of public health providers while, in Uganda, a lack of resources has prompted the government to commandeer ministerial vehicles for use as ambulances.

In Nigeria, which also faces a rising trend in confirmed cases, though a relatively low mortality rate based on currently available data, our interview with a consultant Infectious Diseases Physician portrayed a public healthcare system jolted into action. In countries such as this one, the pandemic has re-awakened the urgent need to address the health demands of a growing nation. It was described by this front-line professional as “a blessing in disguise”.

Neglecting control of other diseases

With scarce government resources channelled into testing and treatment of COVID-19, longstanding challenges such as tackling diarrheal diseases, tuberculosis (TB), malaria and AIDS are at risk of being neglected. Together with respiratory tract infections, these conditions normally account for more than 90% of deaths in emerging nations.

“I need to ensure that health workers’ attention is not solely shifted to COVID-19,” stressed a public health specialist in Uganda. He is the Country Implementing Manager for paediatric TB projects and is deeply concerned that the focus on COVID-19 will impact on screening, testing and treatment of those with TB across the nation.

Furthermore, our expert in Indonesia explained that pharmaceutical companies are compounding this problem by shifting production towards COVID-19 formularies, including hydroxychloroquine and azithromycin, and away from a broader range of regular medical products. With medical appointments cancelled, ongoing treatment plans are being disrupted and control plans for other infectious diseases reportedly slowing down.

Overall, concerns highlighted throughout the study underline the heightened risk of people dying from other diseases because of a shift in focus, supplies and, crucially, funding towards testing and treatment of COVID-19.

Reluctance of a fearful community

Controlling the spread of COVID-19 is hampered in many developing nations by high population density and often crowded living conditions.

While application of lockdown measures, curfews and travel restrictions have been successful in smaller countries such as Uganda, in Indonesia and Nigeria there are reports of challenges in enforcement of more basic measures.

For the majority in these geographies, working from home is not an option and the same infrastructure doesn’t exist as in the developed world for enabling virtual services or delivery provisions.

People are continuing to go out to work through fear of losing their job and worries about the impact loss of income would have on their families, particularly at a time of global economic uncertainty. The same mindset is also preventing people from coming forward to be tested in case they are not allowed to return to work, which hampers efforts to gauge the extent of the virus and reduce its spread. And with livelihoods seriously impacted amongst those that can least afford it, there is an increasing reliance on government measures to deliver food, stretching capacity to the extremes across large populations.

Our medical expert in Nigeria described other community challenges in delivering a response to the pandemic, including a frustration with measures such as quarantine and social distancing. Along with travel bans, these have proven to be the most effective controls elsewhere in the world. However, he candidly observed a community reluctance to adhere, given that “many people still do not believe the pandemic is real”.

The long-lasting legacy of COVID-19

The real impact of COVID-19 on emerging economies is predicted to be severe and long lasting. Under-equipped from the outset, and now facing extreme community and healthcare challenges, these nations face a bleak diagnosis as the virus continues to spread.

Developed economies are poised for a predicted ‘second wave’ but, for emerging nations, it is less likely to be a wave than one large-scale, long-lasting crisis. Lack of proper housing and sanitation – issues that have historically hampered standards of hygiene and public health – now threaten to derail control of COVID-19, particularly across larger populations.

The costs and demands of dealing with a health emergency of this magnitude would typically have been supported by the World Health Organization (WHO) through funding from the international community. But with the rest of the world bruised and introspective in the aftermath of the pandemic, there is less impetus for attention to be focused outwardly right now.

This is the time for the global medical community to support fellow professionals on the front line in emerging economies and assist them in their response. Though they can be hard to find, pinpointing the people at the coal face around the world and connecting professionals and experts that are actively fighting the virus in hospitals and communities can help share best practice and speed control on a global scale, rather than by country according to wealth and resources.

It is time to find more effective ways of sharing knowledge and advances across countries that do not have centres of medical excellence or scientific research hubs within their own territory, but that will benefit enormously from the best insights over the coming months.

COVID-19 spreads fast and does not recognise boundaries. Now, the world’s knowledge, experience and insight must follow suit.

About the author

Graham Mills is co-founder and managing director of

About the study is conducting an ongoing study into the impact of COVID-19 in emerging markets. The study commenced in May 2020 to collect qualitative data through 1:1 interviews with targeted frontline healthcare professionals that have a role in the country’s response to and handling of COVID-19. The aim of the study is to gather primary intelligence into the testing, treatment and control of the virus within emerging market communities. Interview transcripts are available on