The first wave of the Covid-19 pandemic unfolded in China starting in December last year. We watched on with growing alarm, but thought that it wouldn’t happen here.

The second wave has been unfolding from mid-February onwards in the rich countries of the world (as well as Iran). Some have responded better than others. None are out of the woods, and the suffering in some countries has been staggering, but many now seem to be turning the corner.

Tragically, we are also now experiencing the start of the third wave, in which Covid-19 is wreaking havoc in the developing countries of Asia and the Pacific, Africa, Latin America, and the Middle East.

Out of the first 20 countries to reach 1,000 confirmed Covid-19 cases, only three were developing: China is still officially a developing country, Iran was the fourth, and Malaysia the eighteenth. But out of the next 30, 16 have been developing countries. So far, Covid-19 has overwhelmingly been a rich-country burden, with 83% of the deaths to date in wealthy countries. But the next frontier for the pandemic is at the opposite end of the global income spectrum.

One thing that will protect developing countries is that they are third cab off the rank. They have had time to see the damage Covid-19 can do even in rich countries, and they are terrified.

Will Covid-19 rip through the most vulnerable countries on the planet and produce fatalities far in excess of anything we have seen to date? We will have a better idea of its global lethality in a couple of weeks, since by then the virus’ trajectory will, sadly, be clearer in a larger number of poorer countries.

Given the difficulties of social distancing and the weak public health systems in most poor countries, and given the number of developing countries in which Covid-19 has already made an inroad, it is hard to imagine that there won’t be at least some in which it becomes widespread. There are frightening accounts emerging from Brazil, Turkey, Pakistan, and Indonesia, to name a few. It is surely plausible that at least for some poor countries the national health effects could be catastrophic.

Then there is the fact that Covid-19 is hitting at a time when the number of displaced people is at its highest since the end of the Second World War. What if the virus takes hold in a massive refugee camp in Africa, the Middle East, or Asia?

But will Covid-19 be a global public health catastrophe? It certainly has a mountain to climb to compete with the major infectious diseases. So far, more than 74,000 people have died of the virus. Every year, about 2.4 million poor people die of diarrhea, 1.2 million of tuberculosis, 1 million of HIV/AIDS, and 600,000 of malaria.

One thing that will protect developing countries is that they are third cab off the rank. They have had time to see the damage Covid-19 can do even in rich countries, and they are terrified. Many have put in place strict containment measures, if not shutdowns, at a very early stage of spread. Some have even gone into pre-emptive lockdown, before a single case of the virus has been confirmed.

Jobless labourers in Bangalore are employed to fill sacks with potatoes for the distribution of emergency essentials and groceries to be to people in need during India’s nationwide lockdown (Manjunath Kiran/AFP/Getty Images)  

One can hardly blame countries for acting promptly and decisively, especially when they know their health systems are weak. Nevertheless, even if warranted, these measures are now devastating the livelihoods of the people whose health their objective is to protect. Unlike rich ones, many poor countries lack the safety nets and access to capital markets needed to cushion the lockdown blow. And many have weak institutions, raising the probability of unintended lockdown consequences.

Images of labourers walking hundreds of kilometres from India’s capital back to their villages are haunting. In Papua New Guinea, a fresh round of police brutality has been catalysed by the country’s state of emergency. In Solomon Islands, a boat capsized last week in bad weather, leading to the drowning of 28 passengers returning to their home villages at the advice of their government.

Widespread fatalities would obviously make things much worse, but it would be a grave underestimate to evaluate the damage of Covid-19 only in health terms. The economic and social damage being wrought by the response to the pandemic – at home and abroad ­– is itself catastrophic for developing countries around the world. 

As the tragedy unfolds, it is not surprising that there is increasing talk of a humanitarian response, perhaps on an unprecedented scale. Whether that eventuates remains to be seen. Much of the development assistance architecture is itself shut down. Certainly, there will be additional multilateral financing, and individual bilateral efforts. But economic damage will not be enough to induce a major humanitarian response in the current circumstances. There would have to be prolonged periods of mass fatalities.

Whatever the uncertainties, there is one area where global cooperation will be critical, and that is to end the crisis. Even if countries contain Covid-19, they will be scared to relax domestic controls, and petrified to open borders again until they have some confidence that they will not face yet another outbreak. A combination of vaccines and effective treatments will be critical for allowing all countries once again to embrace economic activity both at home and abroad.

Ironically, for an era in which the irrelevance of aid has often been declared, an aid-funded international agency is playing a critical role in mobilising the funds needed for a Covid-19 vaccine: CEPI, the Coalition for Epidemic Preparedness Innovations.

Finding a successful vaccine is only the first step, and for that we shouldn’t actually need to draw on foreign aid. But the next step, and one where aid will be needed, is to distribute that vaccine. Donors will need to provide massive financial and logistical support to ensure that the vaccine, once developed, is distributed not just nationally but worldwide, and quickly. The same goes for treatments, once identified. The motivations for this will be not just humanitarian but commercial. It will be in everyone’s interests to open the world up again for business.