Millions More in Extreme Poverty
For many, the economic impacts of the pandemic continue to be severe and enduring. We know we may seem like unlikely messengers on this topic—we’re two of the most fortunate people on the planet. And the pandemic has made that even more clear. People like us have weathered the pandemic in good shape, while those who are most vulnerable have been hit the hardest and will likely be the slowest to recover. An additional 31 million people around the world have been pushed into extreme poverty as a result of COVID-19. Although men are 70% more likely to die from COVID-19, women continue to be disproportionately affected by the economic and social impacts of the pandemic: This year, women's employment globally is expected to remain 13 million jobs below the 2019 level—while men's employment is largely expected to recover to pre-pandemic rates.
Although variants threaten to undermine the progress we’ve made, some economies are beginning to recover, bringing with them business reopenings and job creation. But recovery is uneven between—and even within—countries. By next year, for example, 90% of advanced economies are expected to regain pre-pandemic per capita income levels, while only a third of low- and middle-income economies are expected to do the same. Poverty reduction efforts are stagnating—and that means nearly 700 million people, the vast majority in low- and middle-income countries, are projected to remain mired in extreme poverty in 2030.
Growing Gaps in Education
We’re seeing a similar story when it comes to education. Before the pandemic, nine out of 10 children in low-income countries were already unable to read and understand a basic text, compared to one in 10 children in high-income countries.
Early evidence suggests that learning losses will be greatest among marginalized groups. Growing educational disparities were found in wealthy countries, too. In the United States, for example, learning loss among Black and Latino third grade students was, on average, double that of white and Asian American students. And learning loss among third graders from high-poverty schools was triple those of their peers in low-poverty schools.
More Children Missing Vaccines
Meanwhile, global routine childhood vaccination rates fell to levels last seen in 2005. Between the start of the pandemic and when health services began to recover in the second half of 2020, more than 30 million children around the world missed their vaccinations—that’s 10 million more because of the pandemic. It’s possible that many of these children will never catch up on doses.
But here, the data surprised us: A year ago, we had reported that the Institute for Health Metrics and Evaluation was estimating that vaccine coverage would drop 14 percentage points globally in 2020, which would have amounted to 25 years of progress down the drain. But based on more recent data, it looks like the actual drop in vaccine coverage—devastating though it was—was only half that.
People Stepping Up
The long-term promise of genomic sequencing
By now, the whole world is keenly aware that SARS-CoV-2, the virus that causes COVID-19, has mutated into increasingly infectious and deadly variants, like delta, as it spreads around the world. Thanks to genomic sequencing—identifying the unique genetic makeup of a virus—scientists have been able to identify and track emerging variants.
Historically, the majority of the genomic sequencing in the world has taken place in the United States and Europe. Countries without sequencing technology would send viral samples to labs in places like New York and London for genetic analysis—and they’d only get results months later.
But for the past four years, organizations have been investing in building a genomic surveillance network in Africa, so countries on the continent could sequence viruses like Ebola and yellow fever. The Africa CDC established the Africa Pathogen Genomics Initiative, and when the pandemic hit, the nascent network turned its attention to SARS-CoV-2. The only reason the world knew that the more infectious and deadly beta variant had emerged in South Africa was because the country had invested heavily in R&D—in this case, pairing genomic sequencing capabilities with clinical trials and immunology studies. South Africa’s own Dr. Penny Moore was one of the first scientists to discover that a coronavirus variant identified in South Africa could circumvent the immune system.
With this information, public health officials around the world could plan accordingly. And South Africa, which has also invested deeply in infrastructure to rapidly and effectively conduct clinical trials, could quickly adjust its vaccine trials. They began working to determine whether COVID-19 vaccines provided sufficient protection against the new variant that would soon spread everywhere.
Investing in Systems
As we write this, more than 80% of all COVID-19 vaccines have been administered in high- and upper-middle-income countries. Some have secured two to three times the number of doses needed to cover their populations, in case boosters are needed for increasingly infectious variants. Meanwhile, less than 1% of doses have been administered in low-income countries. These inequities are a profound moral outrage—and raise the very real risk that high-income countries and communities will begin to treat COVID-19 as another epidemic of poverty: Not our problem.
Women’s “self-help groups” are common across India as well as other parts of South and South-East Asia. For years, the Indian government and global partners have been investing in these small collectives of women who pool money and work to improve health, education, and other services in their villages.
When COVID-19 arrived in Bihar, India, home to more than 100 million people, one local self-help group established trust with their neighbors by delivering meals and home-based health care to those who had fallen ill from COVID-19. When vaccines were ready for distribution in their community, these women became a source of information and guidance for those same neighbors who had concerns about vaccine safety. The Bihar government took notice of the work being done at the community level and declared March 8—International Women’s Day—a day to vaccinate women across the state. Nearly 175,000 women took the first dose of the vaccine that week. Building on that success, the government of Bihar is replicating the program, guided by the women of the self-help group.
We’ve seen that COVID-19 vaccine access is strongly correlated with the locations where there is vaccine R&D and manufacturing capability. Latin America, Asia, and Africa are being hit particularly hard by the delta variant right now because so much of their population remains unvaccinated. Africa, in particular, has had difficulty getting access to the doses they need. The continent—home to 17% of the world’s population—has less than 1% of the world’s vaccine manufacturing capabilities. If African leaders, with donor support, invest in and build a sustainable regional vaccine development and manufacturing ecosystem, the continent would be far less likely to be last in line in a future pandemic.
Innovating for Vaccines: Strive Masiyiwa
Fast-forward to COVID-19. Just 28 days after his appointment, Strive assembled a technical team to develop and launch the African Medical Supplies Platform (AMSP), a user-friendly online marketplace for Africa’s 55 governments to access COVID-related medical supplies, streamline logistics, and consolidate buying power for things like LumiraDx test kits and treatments like dexamethasone. Strive and his team also created a pipeline for high-tech ventilators to be manufactured in South Africa, reducing the cost tenfold. And later, when COVAX vaccine deliveries to the continent were delayed, Strive not only worked to secure contracts independently through the African Vaccine Acquisition Task Team (AVATT), but also helped ensure that vaccine manufacturing would take place in Africa. The World Bank and African Union estimate that by January 2022, African manufacturers will have participated in the production of up to 400 million doses for local distribution.
A fierce critic of highly resourced nations “pushing their way to the front of the queue to secure production assets,” Strive rejects vaccine nationalism, a stance that has—in many ways—defined his work. “We didn’t ask anyone to give us anything for free,” he insists. “Equitable access meant buying vaccines the same day and time they became available.”
Largely pausing his day job during the pandemic, Strive has spent the last year negotiating to help reduce vaccine inequities between rich nations and African ones and has become part of the brain, engine, and heart of Africa’s massive homegrown COVID-19 response. “When we talk about philanthropy, we often talk about money. But this is a once-in-a-lifetime crisis, and the scale of it, both in terms of human cost and human life, as well as economic cost, is pretty profound. You just have to drop what you are doing and tackle it,” he says.
Innovating for Birth: Efe Osaren
Efe had just arrived at the hospital when everything changed. Minutes before, when New York City announced its COVID-19 lockdown, she was barreling underground in the subway, mentally reviewing her client’s case: older woman, bed rest, likely preterm C-section, baby that would be delivered straight to the NICU. For first-time mothers, especially those in high-risk pregnancies, birth can be a traumatic experience. For Efe, her job as a doula meant holding their hand through the unchartered journey, ensuring that stress didn’t harm mom and baby alike. Except that on this most anticipated of March dates, an invisible virus barricaded her from the delivery room.
Efe Osaren was 15 when she became enthralled by a unique ritual in which her newborn niece was stretched and massaged with palm oil and hot rags. It was a traditional Yoruba bath, and her mom told Efe she’d been bathed that way too, so she’d grow up with strong bones. The bath didn’t make Efe unbreakable, but it did mold her. The Nigerian American student living in Texas knew then she wanted to use tradition and science to help babies come into the world in health. Especially babies born to women of color.
In the United States, new Black moms die at higher rates than white ones—irrespective of age, education, rural or urban residence, or socioeconomic status. Black mothers are three times more likely to die in childbirth than white ones. “It makes me feel rageful for my clients,” says Efe. It’s why she also works as a reproductive birth justice advocate. “Pregnancy requires you to feel safe. When you don’t have comfort, you have fear…that can lead to medical emergencies.”
Back in a NYC hospital, she encountered her own worst fear—she would not be able to be there with her client. With no time to lose, she summoned her client’s partner and gave him a crash course in the lobby: how to help mom breathe, how to keep her calm with eye contact, how to press on her hips and back, how to instill confidence in her, how to ensure that if she’s wheeled into the OR, she will be safe.
The flash training became the blueprint for Efe’s pivot during COVID. She began teaching virtual birthing classes, empowering her clients through knowledge, and even helping them get tripods and Bluetooth speakers for their phones so they could video chat during labor.
An advocate for women of color her whole career, Efe now equips them to do the job themselves. It is not an easy task, because she has become bodyguard, concierge, therapist, and mediator. But she knows her work is important.
Innovating for PPE: Kuldeep Aryal
“At first, it was slow. We could only make 40 to 50 per day. The university didn’t allow us to come and go from the lab, so while some spent the night there, others went out looking for raw materials,” he said, describing how there was no down time. While printers slowly churned out face shields, he and his fellow makers formulated hand sanitizer using chemicals they spotted around. “Anything. We had an environment of crisis, with resource constraints,” he said. “We had to figure out how to use what we had, to make whatever we could. And then make it faster.”
Months into the pandemic, Kuldeep was making goggles, handwashing stations, and oxygen concentrators, sophisticated machines that are saving lives in hospitals today. His formula is simple: Use open source to design; localize for your market; and then scale. “The hardest thing is not the inventing. It’s figuring out the challenge of production and where the supply chain lives,” he said, matter-of-fact and without fanfare. Invention comes first. Adaptation to local markets next. And adoption—or taking things mainstream—is the ultimate prize. “That initial spark of innovation, we try to build on it and expand, so we can make our innovations common,” he said. “So everyone can benefit.”
Kuldeep disavows the notion that catastrophe freezes anyone into a state of victimhood. Instead, he insists, the most challenged people on earth are usually the most resilient. “People with inequities have suffered a lot. But we’ve always suffered. It’s not a new thing. COVID has just been another challenge,” he said, and continued his march forward.