Over 600 years ago, Ambrogio Lorenzetti painted a series of six frescos in the City of Siena, Italy. The “Allegory of Good and Bad Government” aimed to serve as a warning of the dangers of corruption and misrule. Whereas the ‘good government’ images depict people going about their lives in peace, the ‘bad government’ images depict crime, drought and disease.
Six hundred years later we are confronting coronavirus – perhaps the largest pandemic in generations. In our highly interconnected world, the virus spread rapidly and is now present in 180 countries. To date, infections and fatalities have hit mainly middle and high-income countries – perhaps unsurprising, as these are the locations with the greatest number of international travellers. But with each passing day, more cases are appearing in low-income countries and countries contending with exceptionally high violence levels and ongoing conflict.
As the pandemic continues its global expansion, many are trying to predict the scale of its impact. UNDP has, for example, projected that half of all jobs in Africa could be lost as a result of coronavirus, devastating already weak economies and putting families and individuals in dire economic straits.
One theory is that countries with the highest levels of fragility will be those within which coronavirus takes root and is the hardest to tackle. As defined by the OECD, these are the countries with greatest exposure to risk and the least ability to manage these risks. In fragile contexts, it is easy to assume limitations in sharing necessary communications, including appropriate preventive measures essential to limit spread of the virus, and capacity deficits within healthcare systems. The Ebola outbreak in West Africa lasted for two and a half years, in part due to difficulties setting up infrastructure in resource poor areas, but also due to deep scepticism of government and international assistance. In Somalia, a country that has struggled with decades of conflict and severe governance deficits, only 20 intensive care unit beds are available.
But fragility is likely an insufficient lens. Most lists of fragile states (of which there are many) do not sufficiently reflect factors that reinforce or undermine public health. Nor does fragility sufficiently account for high and middle-income countries with extreme levels of inequality where the virus is likely to root among certain segments of society. And fragility measures pay insufficient attention to systems in which state actors rely on abuse and intimidation to retain power.
Rather than looking categorically at fragile states, we should consider overlaying fragility with indicators of inequality, authoritarianism, what Rachel Kleinfeld has termed “privilege violence” and, crucially, demographic data. Fragility plus abuse of power plus demographics is the equations we need to be looking at.
While COVID-19 has been initially spread by those with the financial wherewithal to travel, it will deepen in communities that represent the most marginalised members of society. Even in very wealthy countries, coronavirus is exposing long-standing structural inequalities. Responses within countries will expose fault lines within society and between society and the state. India, for example, is a middle-income country that doesn’t make the OECD list of fragile states. But the four hour advance warning of a nationwide lockdown has left millions in immediate risk of food insecurity and at high levels of risk. The inequalities are perhaps most stark in informal settlements that are home to over 1 billion people, where people live in densely packed conditions often without basic sanitation, including the essential soap and water needed to stay healthy. These settlements exist in both fragile and non-fragile countries.
Effectively preventing the spread of coronavirus requires effective and compassionate communication strategies embedded in a rights framework. Where communications are delivered ad hoc, inaccurately or without due attention to the rights and needs of communities, there will be push-back that will make the essential co-operation of people – in handwashing, physical distancing and complying with instructions – all the more challenging to obtain. It’s important to heed the lessons of the past to improve the actions being taken now.
The tilt towards authoritarianism will also be a factor, although a perhaps more complicated one than many assume. Hungary has just voted to allow unlimited emergency powers to the President, while Turkmenistan has outlawed uttering the word ‘coronavirus.’ While these states may be able to control the spread of COVID-19, it will most likely be through harsh policing measures, resulting in the locking up of individuals who will then be left to fall ill and potentially die while incarcerated. Emergency measures have a way of getting sticky themselves, remaining in place long after they may be needed and serving to further deepen centralised control. Authoritarian actions are likely to reinforce inequalities and marginalisation as those on society’s margins are neglected.
Not only will coronavirus expose government neglect of their responsibility to govern all within society, it will shine a light on contested power dynamics. In Brazil, for example, as the President continues to deny the seriousness of COVID-19, gangs in Rio de Janeiro are asserting control measures within favelas. Gangs are exposing real power dynamics in a context in which last year police killed five people a day in the state of Rio de Janeiro, including many unarmed civilians.
Last year, when the Democratic Republic of Congo was confronting its own Ebola outbreak, health centres were being attacked, but rather than providing protection, being seen to co-operate with the military placed many health workers at greater risk due to years of abuse suffered by civilians at the hands of the military. State use of force against civilians is on the rise globally, undermining trust in public institutions and creating competition for citizen loyalty when others fill the vacuum of protective mechanisms. Both government and criminal enterprises benefit from the fear such popularity contests create while the average population suffers.
Governments formed around maintaining power care less about upholding safety for the average resident, and far more about their own systems of control. In countries reliant upon some degree of violence as a repressive measure, including the violence of mass incarceration, the damage of coronavirus is likely to be steep and lasting.
All these factors must be overlaid with constant updating on how demographic trends will influence the trajectory of the pandemic. Ensuring accurate mortality rates from COVID-19 suffer from lack of clear data, but the trends to date range from 1% in Germany to 10% in Iran. The age of a country’s population matters, but so does a range of underlying conditions. Many fragile states are home to remarkably youthful populations with an average median age of 20 years, as compared to 33 years in non-fragile contexts. Today, the same youthful demographics may serve as a protective layer. Meanwhile, broader health demographics and underlying conditions may off-balance this protective layer, particularly among the most marginalised, including displaced populations and those living in informal settlements.
None of the above diminishes the urgent requirement to bolster low resource health systems and reinforce the importance of legitimate distribution of accurate information in fragile settings. Rather, it suggests an urgent need to advance new analytic efforts to help guide thinking on the type of architecture required to steer international co-operation through what is going to be a marathon effort. As UNDP’s report on economic consequences in Africa hints at, the economic and political fallout will be globally devastating. The international community must prepare for a long-haul journey that is framed around multi-pronged co-operation strategies.
After completing his frescos, Ambrogio Lorenzetti died in 1348 of the Black Death, himself falling prey to the pandemic of his time.