In the past few weeks, the pandemic has taken an alarming turn in many countries of South Asia including Bangladesh. To suppress the growth of infection, initially, a week-long lockdown was announced from April 5 in Bangladesh. Then, the government imposed a "strict" lockdown from April 14 which has been later extended by two more weeks. While an apparent slow pace observed through positivity rate may provide some short-time relief, lockdown is not a panacea. Rather an upsurge is extremely likely if the restrictions are lifted. To reap the full benefit of lockdown, a lot of prerequisites are paramount that many developing countries cannot manage. Therefore, lockdown-a much touted tool in developed countries-loses its prowess in developing countries. Hence, developing countries like Bangladesh only opt for 'lockdown' if all other tools are deemed futile.
China, New Zealand, Australia imposed strict measures (or lockdown) as a preventive measure to control the massive spread of coronavirus. However, a handful of countries embraced other measures rather than a complete shutdown of the economy. For instance, Vietnam, South Korea, Taiwan to name a few where community engagement, contract tracing etc. were the main weapons. If lockdown is not followed by other measures, then the success of lockdown will wither away within a very short time. That is exactly what happens in many developing countries. Hence, lockdown does not possess the long-bearing effects in curbing infection in developing countries.
One of the biggest challenges for developing countries is that a significant part of the labour force work in the informal sector, and a great number of them are migrant workers-migrating from rural areas to urban areas temporarily just for earning opportunity. As most of them are daily wage earners, a strict lockdown plays a very adverse effect on their livelihood. This large number of the populace leave the city if they do not have any work in hand. The social capital developed in villages-which is almost missing in the urban areas-motivates them to go back to their origin when a rainy day comes in as they believe that in villages, they will get support from friends and family members. Sadly, the people leaving Dhaka or the other big cities are carrying the virus with them. It is seen that most of the cases in rural areas are asymptotic. At the same time, the rate of infection reduces in the big cities as a big portion of the population leaves the city. The reduced rate of infection in the official statistics may be the result of shifting infection from urban areas to rural areas. Hence, it is commonly observed that the number of tests goes down when such lockdowns are enforced.
The government is often criticised for not being strict with these people. However, the truth is that it is impossible to hold these people back in the city if they do not have any work. Moreover, our safety net programmes are awfully weak in targeting the poor of urban areas. There is no formal list of the urban poor. Even though a great number of poor people live in urban areas, our safety-net system is still very rural focused which incentivises urban poor to migrate back to rural areas when they expect a long-term shut-down of activities in urban areas.
Income shock is not the only blow of lockdown to the poor. Early evidence suggests that there is a distributional impact of the lockdown. If lockdown is imposed, the rate of the infection goes down for the high-income group who can afford to stay at home. But lockdown does not necessarily have the same impact on poor people. Overall, the distributional impact of the lockdown is that the high-income people who are working from home are getting better off at the expense of poor people. This increased inequity is observed in many studies.
It is well know that the economic loss of lockdown is enormous. Even though developing countries rarely estimate the true economic loss of such measures, it is obvious that the economic benefit of lockdown is much less than the benefit of it. A study conducted by the Institute of Health Economics of Dhaka University finds that economic losses are around three thousand crores for each day of shut-down. Many developed countries use a cost-threshold to make decisions on health interventions. For instance, UK uses 30,000 pound threshold for health intervention-i.e., a health intervention will not be taken if per QALY (Quality Adjusted Life Years) gain costs more than 30 thousand pounds. It is 50 thousand Australian dollars for Australia. A recent estimate suggests that the lockdown enforced in Melbourne and some other areas, the cost was 200 thousand Australian dollars for each QALY gain i.e., four times higher than their maximum threshold. Even though for Bangladesh no such threshold exists, it is understandable that the cost per QALY gain for Bangladesh is extremely high since the death rate is relatively lower here. Hence, lockdown is not a good solution an economic perspective.
While lockdown may suppress infection of Covid, it has many unintended consequences even for the health and health sector. There are cases of undiagnosed diseases. It is observed in many countries that diseases other than Covid-19 are being diagnosed less in the lockdown. There is no reason to believe other diseases disappeared. Rather, other diseases are less diagnosed or late-diagnosed due to lockdown. Moreover, wide ranging evidence suggests that people suffer from mental health issues due to strict measures. This indirect loss of other health issues due to one non-pharmaceutical intervention (i.e. lockdown) is often overlooked.
To utilise the short-term strict measure like lockdown, one of the major steps that should be taken by the government is strengthening the health system to its maximum capability promptly. However, in countries like Bangladesh, a new project gets stuck in the bureaucratic process. The government should also put efforts to prepare a list of the urban poor as early as possible. These urban informal workers should be given the confidence to stay in the city. Thus, the spread of the virus all over the country can be avoided. The goverment can collaborate with NGOs and other organisations for effective targeting in both rural and urban areas.
For immediate steps, the government can focus more on the more infected areas. Imposing targeted strict measures alongside community's involvement. For example, involving the Bazar committee while enforcing any strict measures in rural areas could have avoided unfortunate events as happened at Shalla. By involving them, the administration can assign some responsibilities to keep the situation under control. This will also help to manage the crowded places like bazar or banks. Moreover, Bangladesh could not establish the health measures as a community movement. The success story of Vietnam in handling the Covid-19 pandemic shows that strict measures with a set of directives do not work unless it is coupled with community engagement. Community engagement and risk communication are the keys to success.
Another step could be prioritising the sectors for stimulus and level of strictness. If a matrix is formed with the economic benefit and the infection rate, we can come up with four cells for priority setting: a) low infection potential, economically very important, b) high infection potential, economically less important, c) low infection potential, economically less important, and d) high infection potential, economically important. While sectors that have the characteristics of (a) will remain open, and for other sectors, a rational decision needs to be taken. Of course, emergency services will get topmost priority. Economics and health should dominate the decision making, not politics or the pressure of interest groups.
It is not just that practical realities that make the lockdown less effective for developing countries, the true and long-term benefit of lockdown is not evident in the literature. There is no strong evidence that lockdown is very effective in the long-run, especially for developing countries. Rather the counter-evidence is very common. Covid-19 is not the only problem that developing countries are facing. We have hunger, informality, a broken healthcare system, poor living conditions, lack of literacy, economic vulnerability, so on and so forth. While lockdown may help suppress the infection for the short-term, considering all the negative effects, lockdown should be avoided unless it is really a dire situation. Instead of following others, contextual policy adoption and priority setting should be emphasised.
Shafiun N. Shimul is an Associate Professor of Institute of Health Economics, University of Dhaka. [email protected]
Shafa Tasneem is a third year student of the Department of Economics, University of Dhaka. [email protected]