What if you can't afford to fight coronavirus?

As the coronavirus has tiptoed closer to global pandemic status, the world's major economies are ramping up their spending on defenses. 

Italy plans to spend $4 billion on emergency economic measures to tackle the outbreak, while US lawmakers rejected a White House request of $2.5 billion as too low. Expectations of additional fiscal and monetary measures to combat the disease helped fuel a rebound in risk assets Monday. 

The science and spending that rich countries are able to marshal in the face of epidemic disease is inadequate to the task at hand, as my colleague Anjani Trivedi has written. It is nonetheless awesome in its size and speed, and reassuring for those of us who expect to be facing spreading infections in the coming weeks and months. That makes the dearth of similar measures in lower-income countries all the more gratuitous.

Mortal threat
The vast majority of infectious disease deaths are in Africa, South Asia and Southeast Asia.

Nearly three-quarters of all deaths from infectious disease in 2016 happened in sub-Saharan Africa, South Asia and Southeast Asia. While just 5 percent of Europeans die from infections, the rate in Africa is more than 40 percent. Conditions such as HIV, diarrhea and malaria have seen precipitous declines south of the Sahara in recent years, but diseases of the nose, throat and lungs like influenza remain far more prevalent. After cardiovascular and neonatal conditions, respiratory infections are now the leading cause of death in Africa.

To date, most lower-income and lower-middle-income countries have been mercifully free of reported coronavirus cases. Sub-Saharan Africa has recorded just two infections, in Nigeria and Senegal. India has had five named cases; Indonesia, two.

Absence of evidence doesn't mean evidence of absence, though. The community surveillance that picks up infections and chains of transmission is far harder in countries where the public health system is less equipped to handle major outbreaks.

Struggling to breathe
Respiratory infections are now the leading cause of death in sub-Saharan Africa, after cardiovascular and neonatal conditions.

Just 168 of the 18,500 deaths reported to the World Health Organization from the 2009 H1N1 influenza pandemic were from Africa, but a 2013 study used disease modeling to estimate that the true burden on the continent was about 21,000 deaths — roughly in line with the continent's 15 percent share of the global population. With a disease like Covid-19 that appears to spread unnoticed, it's possible that the rate of infection in these countries is already higher than has been recorded.

The background level of disease makes responding to new outbreaks even harder. Coronavirus, like influenza, appears to be particularly fatal among those with existing conditions. That's likely to be a problem in Africa, where about two-thirds of the world's HIV-positive people live and where an 18-month Ebola outbreak in the Democratic Republic of Congo is only just slowing down.

Even if you don't catch the coronavirus, you stand a higher chance of dying during a pandemic in a country with a bigger burden of disease and less developed health system. By overwhelming hospitals and clinics, major outbreaks decrease the quality of care and raise the risk of mortality for everyone. Almost all of the countries the World Bank deems to be least-prepared to handle pandemics are in Africa, South Asia and Southeast Asia.

No recovery
Per-capita gross domestic product in Liberia and Sierra Leone is yet to bounce back from the 2014 Ebola pandemic. 

Improving this situation could be remarkably cost-effective. Spending about $3.4 billion a year on improving human and animal emergency medical preparedness would yield $30 billion of annual benefits, according to the WHO.

The advantages could be even greater, since major outbreaks can leave long-lasting scars on an economy. Diseases shrink the labor force by sending people to convalesce at home, reducing their ability to work, or, in the worst case, killing them. A 1 percent increase in life expectancy results in a 5 percent increase in per-capita GDP, according to one analysis. Four years after the 2014 Ebola epidemic, Sierra Leone and Liberia had still not recovered the levels of income per capita they enjoyed on its eve. 

That's reason for the world — and in particular rich countries — to take this opportunity to spend the $1.69 or so per person that would be needed to bring all the world's health systems up to scratch. The burden of poor health in the developing world impoverishes us all.