Lockdown is not egalitarian: the costs fall on the global poor

We support Richard Horton's call for a post-COVID-19 health recovery programme,1Horton R Offline: CoHERE—a call for a post-pandemic health strategy.Lancet. 2020; 3951242Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar but his lack of attention to so-called lockdown victims is disappointing. Evidence of avoidable non-COVID-19 deaths (eg, cancer deaths,2Thomson A Cancer treatment will be the next NHS crisis.https://www.thetimes.co.uk/edition/comment/forgotten-illnesses-will-be-the-nhss-next-crisis-lxtqggt8lDate: April 14, 2020Date accessed: April 18, 2020Google Scholar child deaths from measles,3Roberts L Why measles deaths are surging—and coronavirus could make it worse.https://www.nature.com/articles/d41586-020-01011-6Date: April 7, 2020Date accessed: April 18, 2020Google Scholar women dying in labour4Biryabarema B In Uganda, mothers in labour die amidst coronavirus lockdown.https://www.reuters.com/article/us-health-coronavirus-uganda/in-uganda-mothers-in-labour-die-amidst-coronavirus-lockdown-idUSKCN21R2FADate: April 9, 2020Date accessed: April 18, 2020Google Scholar) is mounting. We are disappointed by the false dichotomy implicit in the assertion that there “should be no trade-off between health and wealth”. The wealthy might profit from the economy, but the poor live by it. Like UNICEF5UNICEFProtecting the most vulnerable children from the impact of coronavirus: an agenda for action.https://www.unicef.org/coronavirus/agenda-for-actionDate: April 3, 2020Date accessed: April 20, 2020Google Scholar and others, we believe that lockdowns kill people through disruption of health services and deprivation of livelihoods. At the bottom of the global pile, recession is not just a matter of having less: it is a matter of life and death. When we lockdown, we cause deaths in the developing world to prolong lives in the developed world. Too poor to weather the storm, and lucky to make it to adulthood (according to UNICEF, over 5 million children under age 5 years die annually, and according to UN World Population Prospects 2019 data, the median age in Africa is 19·7 years), those near or below the poverty line stand to benefit little from lockdown, but they bear the lion's share of the cost. Children are especially vulnerable to malnutrition and diseases of poverty—and especially not vulnerable to COVID-19. It is unhelpful to characterise lockdown scepticism as a neoliberal political stance. Lockdown is demonstrably not egalitarian in either its costs or its benefits. We must assess lockdowns and other measures holistically,6Walker D Chi Y-L Glassman A Chalkidou K More harm than good? The net impact of COVID-19 policies is what matters for health.https://www.cgdev.org/blog/more-harm-good-net-impact-covid-19-policies-what-matters-healthDate: May 15, 2020Date accessed: June 17, 2020Google Scholar remembering that the costs will mostly fall, as ever, on the global poor. We declare no competing interests. Offline: CoHERE—a call for a post-pandemic health strategyWill the cure be worse than the disease? This question received sharp attention last week when Fraser Nelson, editor of the conservative-leaning magazine The Spectator and writing in The Daily Telegraph, reported a leaked UK Government document revealing that long-term avoidable deaths from the coronavirus disease 2019 (COVID-19) lockdown could reach 150 000. That figure was, he suggested, far higher than the number of deaths expected from COVID-19. These “lockdown victims”, as he called them, are now a major concern for government. Full-Text PDF